Posted by: Allison Rice | March 28, 2013

Lions and tigers and premium increases…

Come October 1 of this year, people who don’t have private or public health insurance will be able to enroll in coverage through the new health insurance marketplace. There are a few things we know about what will be on offer. For starters, there will probably be quite a few plans to choose from.  But we also know that the actual benefits offered in the plans will be quite similar. Under the Affordable Care Act, plans offered in the marketplace must offer 10 categories of “essential health benefits.” In North Carolina, those benefits are pegged to the Blue Cross Blue Shield “Blue Options” plan.

There are two key things we don’t know. One is how extensive the provider networks will be. How hard will it be to find a plan that includes your regular doctor, a local hospital, and other needed services within a reasonable distance from your home? The other big question is how much this will cost. We won’t know for sure until the marketplace goes live in the Fall.

But that hasn’t stopped predictions, projections, and pure speculation. A few weeks ago, Brad Wilson, the CEO of Blue Cross Blue Shield of North Carolina told a group of insurance agents and brokers that he expected insurance premiums in North Carolina to rise. As reported in the Triad Business Journal,

Wilson predicted that the short-term impact of the Affordable Care Act, which expands insurance coverage to millions beginning in 2014, will be to drive premiums up for individuals and small groups as the health insurance industry takes on new taxes and fees and health care spending increases. . . .When asked by a broker Tuesday if estimates that say some small groups could see premiums rise by as much as 50 percent, Wilson said he expects increases would vary, but such a large increase wouldn’t surprise him.

The latest addition to the premium discussion comes from the Society of Actuaries. In a report issued this week, “Cost of the Future Newly Insured under the Affordable Care Act (ACA)” the Society concluded that insurance claims costs would increase by 32 percent nationally by 2017.  This would vary by state, with North Carolina projected to have quite a modest increase. The report ran two models – one in which all states expanded Medicaid, and another in which none did.  In the no-states-expand model, North Carolina’s claims are predicted to increase by 8.5%. In the all-states-expand, the increase would be 13.5%. Neither model reflects the reality, which is that some will expand and others not. And, as discussed below, claims costs are not the same as premiums.

As would be expected, the media has run with the Society of Actuaries study.  Some reports have done a more thoughtful job of assessing what the study really means. A good discussion is posted over at Kaiser Health News.  The report first clarifies that insurance claims aren’t the same as premiums, and the SOA did not make any claims about premiums.  As claims costs go up, there are other factors that will affect how those costs influence premiums.

Q: But if medical claims go up, shouldn’t insurance prices also go up? How much difference could there be?

A: In the individual market designed under the health law, quite a bit, say supporters. The ACA limits insurer profits and also gives government regulators oversight of rate increases, both of which could hold premiums down.

Even if sticker prices rise, an important feature of the health law is subsidies for people to buy insurance, through tax credits for those with lower incomes. So what many newly-insured people actually end up paying themselves won’t be the same as what the insurance company bills.

Thanks partly to subsidies, “many people buying individual coverage today will see decreases in costs,” said Larry Levitt, senior vice president at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Insurers who end up signing lots of sicker members will also be partly reimbursed for several years by a reinsurance pool designed to lower their risk. That will lower their expenses, and it wasn’t accounted for by the SOA study.

Another important point made in the Kaiser piece is that the products on the market starting in 2014 are very different animals from the ones on the market currently. Many currently offered insurance plans provide very little coverage. Adding the essential health benefits will cost more. Subsidies will help keep costs down for many, though they may not cover all increases. Also, competition should have an effect on prices. As reported by Kaiser, many insurers are looking at creating lower-cost networks that could bring prices down. (That could create problems with access and provider reimbursements.)

For now, this is all speculation. We’ll have to wait and see what comes down the road in October.


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