- Joined
- Aug 10, 2013
- Messages
- 20,201
- Reaction score
- 21,576
- Location
- Cambridge, MA
- Gender
- Male
- Political Leaning
- Slightly Liberal
In the spring, I sounded the alarm on a troubling trend in the marketplaces:ACA marketplaces getting a bit too lucrative for insurers
Well, the solution to that problem--new market entrants--is materializing in many markets.
Covered California draws more insurers after state moves to bolster Obamacare
No matter how many times, how many ways they try to kill the marketplaces, they just keep coming back.
That's good but more needs to be done. The biggest problem remains that even though premiums have stabilized the price level in the marketplaces has been artificially re-set upwards by the Trump administration's malicious decision to break the system that helps low-and-middle income enrollees afford their deductibles; that decision bumped premium levels up ~34% immediately.
That prices out people who don't qualify for financial assistance for their premiums. (And their coverage levels have fallen: for some reason the Trump administration recently celebrated those people falling out of the market. ) A growing number of states have implemented reinsurance programs to bring their premium levels back down to earth. Every state should be doing this and enabling that should be a federal priority.
And, as always, we should celebrate the fact that the ACA cost far less than promised and put that money back into the program: fix the family glitch, eliminate the income cap on premium assistance, and lower the financial exposure of those receiving assistance. Make premiums and deductibles alike more affordable for consumers. Then we'll see enrollment rise and even more market entrants, reinforcing the competitive downward pressure on premiums we saw in the early days of the marketplaces when there were numerous competitors virtually everywhere.
(And if we really want to get nuts, tie Medicare Advantage and/or Medicaid managed care participation to marketplace participation. And consider ways to make it more attractive for employers to release their employees into the marketplaces--with their employer subsidy--under an employee choice model. Or at least bring back something like the long-repealed employee free choice vouchers to give people control over their own decisions. Recapture the spirit of '14!)
Well, the solution to that problem--new market entrants--is materializing in many markets.
Covered California draws more insurers after state moves to bolster Obamacare
Those new policies [California's restoration of an individual mandate and creation of state-level premium subsidies] appeal to insurers. They’ve responded by expanding operations in the state, enhancing competition and offering consumers more choices.
California’s ACA exchange is not the only one benefiting from the renewed interest of insurance companies. Other states are expected to see more insurers enter or reenter their marketplaces next year. That’s a critical signal, experts said, that the state-based marketplaces, which cover about 11 million people nationally, are becoming more robust and less risky for insurers — despite ongoing political and legal battles over the ACA.
Centene, which has 12 million enrollees nationwide, plans to expand into new ACA markets next year [10 new markets!--GB], a company representative said. It operates in 20 states, three of which it entered for the first time this year.
Two startup insurers, launched in recent years in part to serve the ACA marketplaces, also plan expansions in 2020. Bright Health, based in Minneapolis, announced in late July that it will offer ACA plans in six more states, on top of the four it now serves. And New York-based insurer Oscar, which this year offered ACA plans in nine states, including California, plans to enter Colorado, Pennsylvania and Virginia, as well as new areas of New York and Texas.
The number of insurance companies offering plans in ACA marketplaces has fluctuated. From 2014 to 2016, the average number was between five and six, according to the Kaiser Family Foundation. That number declined to 3.5 last year, following Republican threats to gut or replace the ACA and Trump administration changes to the marketplaces. (Kaiser Health News is an independent program of the foundation.) Premiums in some areas rose 20% to 30%.
This year, the average number of plans ticked up to four.
No matter how many times, how many ways they try to kill the marketplaces, they just keep coming back.
That's good but more needs to be done. The biggest problem remains that even though premiums have stabilized the price level in the marketplaces has been artificially re-set upwards by the Trump administration's malicious decision to break the system that helps low-and-middle income enrollees afford their deductibles; that decision bumped premium levels up ~34% immediately.
That prices out people who don't qualify for financial assistance for their premiums. (And their coverage levels have fallen: for some reason the Trump administration recently celebrated those people falling out of the market. ) A growing number of states have implemented reinsurance programs to bring their premium levels back down to earth. Every state should be doing this and enabling that should be a federal priority.
And, as always, we should celebrate the fact that the ACA cost far less than promised and put that money back into the program: fix the family glitch, eliminate the income cap on premium assistance, and lower the financial exposure of those receiving assistance. Make premiums and deductibles alike more affordable for consumers. Then we'll see enrollment rise and even more market entrants, reinforcing the competitive downward pressure on premiums we saw in the early days of the marketplaces when there were numerous competitors virtually everywhere.
(And if we really want to get nuts, tie Medicare Advantage and/or Medicaid managed care participation to marketplace participation. And consider ways to make it more attractive for employers to release their employees into the marketplaces--with their employer subsidy--under an employee choice model. Or at least bring back something like the long-repealed employee free choice vouchers to give people control over their own decisions. Recapture the spirit of '14!)