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Risk Corridor, Healthcare Premiums, Companies Leaving the Exchanges, and Republicans

The Washington Post story “Rubio’s inaccurate claim that he ‘inserted’ a provision restricting Obamacare ‘bailout’ funds” is about a year old. Its relevance to the PPACA is in depicting how the Republicans undermined the PPACA causing many Co-ops to go bankrupt, insurance companies to leave PPACA exchanges, saddled insurance companies with $millions in debt, and is a reason for much of the premium increases. I am not pro-insurance; but, this effort to get even with Obama has set the stage for what will negatively affect millions of the insured.

I had written earlier about Rubio playing a part in cutting the funding for the Rick Corridor funding. He did play a not-so-critical part and while researching some additional information I ran across a better explanation.

The Risk Corridor program in the PPACA protects insurance companies from losses during the first three years if they did not estimate premiums properly which can happen in new markets with different characteristics. With the mandate to insure all with pre-existing conditions, keeping children on parents plans, the exchanges, etc.; the Risk Corridor program was put in place (besides two other safe guards) giving insurance companies and Co-ops a three year window to get it right. Besides looking at losses, the Risk Corridor also looked at the profits of companies who had estimated accurately, had excess profits as a result, and required them to pay a ratio of excess profits into the Risk Corridor fund to help underwrite the losses of other companies. Outside of a plus or minus 3% was the basis for whether you gave up a ratio of profits or received a ratio of funding from the Risk Corridor program. The Risk Corridor program is nothing new and was used successfully with Medicare Part D forcing the evil insurance companies to share profits with the government. It still is in place for Part D and “still” generates additional revenue for the government. I do not recall any Republicans complaining about funding for insurance companies then; but then too, Part D was Bush’s legislature while the PPACA legislation was Obama’s. Strictly politics and constituents will pay the price of it.

Depicting the Risk Corridor particulars rather than attempting to explain it in writing will give a better explanation. Click on the image to better read the chart. Please note the plus or minus 3% and then the different ratios of revenue sharing or funding from and to healthcare companies and Co-ops.

invisible hand So what happened? The Risk Corridor program works well for Part D, brings in revenue for the government, and is still in place. February 2014 found Rubio testifying to the House Committee on Oversight and Government Reform on behalf of his bill. At the same time the CBO released their evaluation of the Risk Corridor program. Instead of being detrimental and a fiscal drag, the CBO projected the federal government would collect $16 billion from health insurers. Premiums would outpace claims, $8 billion would be distributed to the plans losing money, and $8 billion in additional revenue would be left for the federal government. Another House probe suggested initially there would be a shortfall with claims exceeding premiums.

The Republicans were not sitting idle and were investigating ways to derail the PPACA. As the ranking member of the Budget Committee, Senator Jeff Sessions and the chairman of the House Energy and Commerce Committee, Rep. Fred Upton came up with a plan to attack the legality of the Risk Corridor payments. They joined forces with the Appropriations Panel Chairman Rep. Jack Kingston whose panel funds the Department of Health and Human Services and the Labor Department. Kind of get the picture so far?

Questioning whether the Risk Corridor payments were being appropriated correctly, the Appropriations Panel forced the HHS to make changes in how they appropriated funds allowing Congress to stop all appropriations. The PPACA could no longer appropriate the funds as they were subject to the discretion of Congress. The GAO issue an opinion on the legality of what the HHS was doing with funds.

GAO Letter to Senator Jeff Sessions. September 30, 2014: Discussion; “At issue here is whether appropriations are available to the Secretary of HHS to make the payments specified in section 1342(b)(1). Agencies may incur obligations and make expenditures only as permitted by an appropriation. U.S. Const., art. I, § 9, cl. 7; 31 U.S.C. § 1341(a)(1); B-300192, Nov. 13, 2002, at 5. Appropriations may be provided through annual appropriations acts as well as through permanent legislation. See, e.g., 63 Comp. Gen. 331 (1984). The making of an appropriation must be expressly stated in law. 31 U.S.C. § 1301(d). It is not enough for a statute to simply require an agency to make a payment. B-114808, Aug. 7, 1979. Section 1342, by its terms, did not enact an appropriation to make the payments specified in section 1342(b)(1). In such cases, we next determine whether there are other appropriations available to an agency for this purpose.”

Further down in the GAO letter, the GAO leaves the HHS an out of using other already available appropriations for the Risk Corridor payments to insurance companies. Classifying the payments as “user fees” was another way to retain the authority to spend other appropriations already made by Congress. Otherwise if revenue from the Risk Corridor program fell short, the administration would need approval for addition appropriations from Congress. As it was, the HHS could no longer appropriate funds to make Risk Corridor payments unless the funds were already appropriated by Congress or Congress approved new funds which was not going to happen with a Republican controlled House.

Appropriations Panel Chairman Rep. Jack Kingston put the final nail in the coffin by inserting one sentence in Section 227 of the 2015 Appropriations Act (dated December 16, 2014) which escaped notice. In the 2015 Appropriations Act, the sentence inserted said no “other” funds in this bill could be used for Risk Corridor payments.

Sec. 227. None of the funds made available by this Act from the Federal Hospital Insurance Trust Fund or the Federal Supplemental Medical Insurance Trust Fund, or transferred from other accounts funded by this Act to the “Centers for Medicare and Medicaid Services–Program Management” account, may be used for payments under section 1342(b)(1) of Public Law 111-148 (relating to risk corridors).

This action blocked the HHS from obtaining any of the necessary Risk Corridor funds from any other Congressional appropriated program funds.

Nothing was said by Sessions, Upton, or Kingston before passage on what they had managed to do. It was Rubio who issued a news release saying the provision was appropriate even though he had little to do with it. In the end, Rep. Jack Kingston’s one sentence purposely created a $2.5 billion shortfall in the Risk-Corridor program in 2015 as the HHS had collected $362 million in fees. Insurers who had misjudged the market sought nearly $2.9 billion in payments, many nonprofit insurance Co-ops failed, healthcare insurance companies began to raise premiums to compensate, and some healthcare insurance companies recognizing an untenable environment created by Republicans took their losses and left the market.

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Why Healthcare Premiums are increasing Faster than Healthcare Costs

invisible hand In the first three years of the PPACA, a Risk Corridor Program was established to help insurers get past the initial loss phases. This is typical of startups and was used with Republican President George Bush’s Part D Drug insurance program. The PPACA had built-in protections for insurers who enrolled many abnormally sick people, provided backup payments for very high-cost cases, and protected against big losses and gains during the first three years. Due to eliminating all “pre-existing conditions” with the implementation of the PPACA, this was the protection for companies and the incentive to take on the people with health issues. Not only did it help Insurers cover their losses; but, it was an incentive for insurers not to increase premiums. Much of the funding for the program comes from the Federal Government and profitable Insurance companies paying into the Risk Corridor fund which unprofitable companies use to recoup losses. However in the first three years losses exceeded funding from profitable companies due to a Republican Congress passing laws forcing the Risk Corridor Program to be budget neutral leaving 12.6% of the necessary funds available to make insurance companies whole. As many probably know, the shortfall of funding already forced many CO-OPs to go bankrupt and resulted in Healthcare Insurance companies pulling out of the Exchanges.

Those Healthcare Companies still a part of the PPACA have gone to Federal Court to sue the administration for sustained losses. Moda Health sued the administration for $191 million due to losses in implementing the PPACA supposedly covered by the Risk Corridor Program. Moda has dropped its program in Alaska as a result of its losses and has only received ~$14 million. The Risk Corridor Program ended in 2016 and companies now face the issue of never recouping losses beyond just this.

Interesting how the Republicans have been the proverbial slugs in the process and took advantage of the crisis they created by forcing the PPACA to be budget neutral when the Part D Drug Program had no restrictions. They limited how the PPACA can fund the same Risk Corridor Program used for George Bush’s Part D Program. In September of this year, “ five Republican Senators sent HHS Secretary Burwell a letter demanding how HHS is handling a much-maligned insurance provision within the Affordable Care Act. Earlier this month, the CMS had sent a memo to health insurance companies that said the agency would not be making risk-corridor payments for 2015 because any collections would be used to cover the $2.5 billion shortfall from 2014.”

Under the PPACA Budget Neutral Act passed by the Republicans, the administration (DOJ) must now defend the law claiming they were not guaranteed the massive payouts in the first place. In November Republicans introduced the “HHS Slush Fund Elimination Act,” which restricts the Administration from using any Federal funds for the Risk Corridor Program to settle with the healthcare companies owed money.

“We are going to repeal and replace Obamacare but, in the meantime, the last thing Americans need is for the Obama Administration to sneak in one last bailout on its way out the door,” Sen. Ben Sasse (R-Neb.)”

You can see;

- Why United Healthcare pulled out of the PPACA Exchange early as it did when a Republican controlled Congress reneged on the funding for the Risk Corridor Program to cover losses in the startup of the PPACA.

- Why Healthcare Insurance companies losing money would resort to increased premiums to compensate for the lack of Risk Corridor Program funds to cover the startup and losses.

- Why the Part D Drug companies have become successful and competitive amongst each other due to their successful startup with the availability of Risk Corridor Program funds.

All of this was an effort to deny the PPACA an opportunity to be successful by a Republican Congress who would deny its constituents healthcare just to get even with a President they did not like and deny him a legacy. Risk Corridors and associated programs still exist and will continue to exist for Medicare Part D; but then, this was pre-Obama and occurred under Republican President George Bush. No one called it a bailout then.

Furthermore, do you think any healthcare insurance company would ever want to be a part of a Government Healthcare plan for the public as implemented by Republicans after they have been repeatedly screwed by Congressional Republicans?

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Tom Price for Healthcare and Human Services

For those of you who may have missed it, Rep. Tom Price (R-Georgia) is Pres. Trump’s pick to be the head of the Department of Health and Human Services. Price is an Orthopedic Surgeon (former?) and has been in the House for 12 years now and a member of the Congressional Healthcare Caucus. It appears he has all of the required qualifications to be the head of the Department of Health and Human Services. The minority representative American Medical Association for doctors has endorsed Tom Price as an excellent choice.

AMA “strongly supports the nomination of Dr. Tom Price to become the next secretary of Health and Human Services (HHS). His service as a physician, state legislator and member of the U.S. Congress provides a depth of experience to lead HHS. Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs,” said AMA Board of Trustees Chair Dr. Patrice A. Harris.”

The choice of Tom Price is a no brainer for Pres. Trump as he is also in line with Republicans wanting to repeal the PPACA and put in its place vouchers for healthcare, Medicare, and Medicaid. Paul Ryan and Mitch McConnell’s jobs suddenly became easier. Mr. Price’s 2009 bill “would allow refundable, age-adjusted tax credits with amounts tied to average insurance for people who buy insurance on the individual market and don’t have access to a government or employer plan.” One can see the widow-peaked Paul Ryan smiling all the way to the House floor.

The AMA in 2012 represented ~17% of all practicing doctors and students. Overall numbers have been in a downward slide over the years. Does the AMA represent the majority view of doctors and how they view the PPACA? “Only 26 percent of all primary care physicians viewed the law ‘very unfavorably’. So it might be said that just one out of four primary care physicians “hate” Obamacare.” Indeed, all the scare tactics of decreased care put forth by the opposition about the PPACA have failed to materialize (Kaiser). It does not matter to Republicans what the finding are and to some on our side of the table can only speak of “crapification” due to the PPACA as it is a bill signed by Pres. Obama

A growing number of doctors have come out in opposition to the AMA as led by Doctor Manik Chhabra, Navin Vij and Jane Zhu on their new blog Clinician Action. At the time (December 1, 2016) of Neil Versel’s article “Pushback begins against controversial HHS pick Tom Price”, 2500 doctors had signed their petition. As of December 4, 2016; >4600 doctors have signed the petition in opposition.

“We are practicing physicians who deliver healthcare in hospitals and clinics, in cities and rural towns; we are specialists and generalists, and we care for the poor and the rich, the young and the elderly. We see firsthand the difficulties that Americans face daily in accessing affordable, quality healthcare. We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken ?—? to protect and advance care for our patients.

We support patient choice. But Dr. Price’s proposed policies threaten to harm our most vulnerable patients and limit their access to healthcare. We cannot support the dismantling of Medicaid, which has helped 15 million Americans gain health coverage since 2014. We oppose Dr. Price’s proposals to reduce funding for the Children’s Health Insurance Program, a critical mechanism by which poor children access preventative care. We wish to protect essential health benefits like treatment for opioid use disorder, prenatal care, and access to contraception.”

The rest of their stetment can be found on their blog; Clinician Action.

Whether Tom Price carries some of his views beyond an agenda to reform healthcare and repeal the PPACA, we will not know until he is appointed and has spent some time in the position. It is worthwhile to point out;

“Tom Price is a member of the Association of American Physicians and Surgeons, a conservative group that publishes a journal that has promoted discredited views — including the supposed link between ‘vaccines and autism.’”

The Association of American Physicians and Surgeons also came out with a statement on Living Wills:

“Living wills are not needed to prevent overtreatment in days when hospital procedures have ‘produced the imperative to ‘move things along.’” Death is usually “orchestrated by professionals in hospitals, … a transition that has markedly shortened the ‘waiting time’ for dying.”

The “Tucson, Arizona-based AAPS is also listed on Quackwatch (“Your Guide to Quackery, Health Fraud and Intelligent Decisions”).”

There is more to be said here and I hope you take a moment to read Neil Versel’s article, some of the other references, and visit Clinician Action.

“Pushback begins against controversial HHS pick Tom Price” MedCity News, Neil Versel, December 1, 2016

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Alan Greenspan Forecasts Extremely Low Economic Growth for Germany, Finland, Norway, Denmark, Sweden, Holland and Canada

Alan Greenspan, the former chairman of the Federal Reserve, weighed in last week on one of the pressing issues facing the incoming Trump administration and the country — slow economic growth. Greenspan’s explanation is novel and bound to be controversial. To preview: He blames the welfare state and overall uncertainty for the slowdown. …

By scouring economic statistics, Greenspan thinks he’s discovered heretofore hidden relationships that explain weak productivity growth.

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Redefining Political Correctness to Include Criticism of Appointments of Wall Street, Banking and Fossil Fuel Insiders to Regulatory Bodies

And Extreme Pro-Corporate Lawyers and Judges to the Supreme Court and the Lower Federal Courts. Seriously.

So far, the Trump transition team does not seem particularly concerned, for instance, about a transition team staffed heavily with lobbyists from energy, agriculture, transportation, and banking.

“Frankly, one of the refreshing parts of it about the whole Trump style is that he does not care about political correctness. From a practical standpoint, I have heard lots of people say, ‘Why would we box ourselves out of the most knowledgeable policy people in the country?’” said one source close to the transition team.

Donald McGahn II, a partner at the firm Jones Day and Trump’s lawyer, is expected to play a central role in vetting nominees. So is Arthur Culvahouse, Jr., a partner at the firm O’Melveny & Myers, who helped vet vice presidential candidates and, according to a source, has been helping the campaign organize its White House picks.

Culvahouse declined a request for an interview. None of the lawyers in the political law practice at Jones Day returned POLITICO’S calls. Culvahouse has faced backlash from colleagues at his firm for working with Trump, according to people familiar with the situation, with one person saying the decision was “amazingly controversial” within the firm. Many top partners at O’Melveny, including Tom Donilon, were vocal Clinton backers.

Trump advisers steamroll Christie’s transition: The new, top-down approach is likened to how Dick Cheney ran the Bush transition., Andrew Restuccia and Nancy Cook, Politico, today

Just so you know, Culvahouse played a large role in turning the Supreme Court and lower federal courts into a proxy arm of the far-right Chamber of Commerce, including in Citizens United but also in ways most people have no idea about but would really care about.  These are not pro-union justices and judges, nor are they pro-employee, pro-consumer, pro small-business, anti-financial-industry-fraud, or ant-securities-fraud.  Nor anti-fossil-fuel-industry.  For starters.

So.  From a practical standpoint, who do you think are all those people who are saying to this source close to the transition team, “Why would we box ourselves out of the most knowledgeable policy people in the country?”  And might that source close to the transition team be Mike Pence, who is so close to the transition team that he heads it?

And how likely do you think it is that among the many people who are saying this to the source is, say, a blue-collar voter from Toledo or Youngstown?  Or any region of Michigan?  Or Erie, Pennsylvania?

Or anywhere?

We’re extremely close to down-the-rabbit-hole language of the Arbeit macht frei variety, folks—something I saw last Saturday and mentioned in the update to this post.

George Orwell and Lewis Carroll are laughing.  Really hard.

Good god.  This is the most successful Trojan Horse since the original one. And every bit as sinister.  But also funny, in that this is what’s now called a top-down approach. Always great to see a new euphemism for insider corruption.

They’re not gonna box themselves in, folks.  But massive, intensive publicity might.

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Relatively not bad news about Health Care Reform

Via (one of) the brillian Waldmans

I find a very interesting and actually somewhat reassuring article by Caitlin Owens

“Obamacare repeal? More like Obamacare reform”.

I strongly recommend reading the article which considerably reduced my fear and loathing.

An excerpt

To be clear: Republicans will likely call whatever they end up doing Obamacare repeal, especially publicly. And when you end up with something vastly different, what’s the difference?

What they say they won’t get rid of:

Pre-existing condition coverage
Letting children stay on their parents’ plan until age 26
Lifetime caps on coverage
Medicaid expansion (but it will look different)

What they say they will go after:

Essential health benefits (insurers won’t have to cover as many things)

Age rating bands (bigger range of premiums will be allowed)

There’s no step-by-step plan yet — because they had never planned for a President Trump. “We’re in rapid detox of holy crap, we have to actually do this,” the first aide told me.

I love the “holy crap” quote. Now this is only somewhat reassuring for reasons. First, Owens talked to aids. They are people who actually know what is in the ACA, but they have no power. There is no reason to be confident that actual senators will listen to their aids. Second, people talk to reporters for a reason. The apparently very frank statements might be a trial balloon soon to be shot down by enraged conservatives. Third the list of what to keep doesn’t include exchanges, subsidies or a mandate. Even if the claims of the anonymous aids correspond to the decision of a majority of senators, they leave $ 60 billion questions open.

Partly, I love the article, because the anonymous aids confirm that Republicans have been post policy for years. I also liked this quote

Congress tested its repeal strategy last year using “reconciliation,” a procedural tool that prevents legislation from being filibustered in the Senate. Even this repeal bill didn’t get rid of the whole law. But one of the aides said this version of the bill was mostly about “messaging,” and that this time, “We’re not going to use that package. We’re not dumb.”

I am shocked shocked that congress passed a bill which they knew was “dumb” just for messaging.

Repeat of warning: these are anonymous quotes from sources who may have influence but don’t have power and who are motivated by motives.

update: Waldman[n]s think alike.

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James Comey’s Appalling Abuse of Office

“I got a lot of respect for Jim Comey, but I don’t understand this idea of dropping this bombshell which could be a big dud,” said former federal prosector Peter Zeidenberg, a veteran of politically sensitive investigations. “Doing it in the last week or ten days of a presidential election without more information, I don’t that he should because how does it inform a voter? It just invites speculation … I would question the timing of it. It’s not going to get done in a week.”

Nick Akerman, a former assistant U.S. Attorney in the Southern District of New York, was more critical: “Director Comey acted totally inappropriately. He had no business writing to Congress about supposed new emails that neither he nor anyone in the FBI has ever reviewed.”

“It is not the function of the FBI Director to be making public pronouncements about an investigation, never mind about an investigation based on evidence that he acknowledges may not be significant,” Akerman added. “The job of the FBI is simply to investigate and to provide the results of its investigation to the prosecutorial arm of the US Department of Justice. His job is not to give a running commentary about any investigation or his opinion about any investigation. This is particularly egregious since Secretary Clinton has no way to respond to what amounts to nebulous and speculative innuendo.”

Comey’s disclosure shocks former prosecutors, Josh Gerstein, Darren Samuelsohn and Isaac Arnsdorf, Politico, 6:59 p.m. today

Former prosecutors aren’t the only ones shocked by Comey’s disclosure.  I have firsthand knowledge of this and can attest to that fact.

This strikes me as an outright abuse of office by Comey.  As FBI director he learned that the FBI had found new information potentially relevant to a closed investigation but had not reviewed it yet and so its significance is uncertain.  What legal authority does he have to disclose this?  Any? At all?

I have no expertise whatsoever on the breadth of latitude that law enforcement investigative agencies have to disclose raw investigative information, but it sure as hell seems to me unlikely that it extends to willy-nilly disclosure of that information.

This guy apparently thinks that his first obligation is to protect his own reputation from certain types of criticism.*  But actually it is not.

He chose to serve his own interest when faced with what amounted to a conflict of interest.  He doesn’t belong in that job.

 

____

*I added that link at 11:22 p.m. after reading the Washington Post article that the link is to, in which dismayed former prosecutors and former Department of Justice officials make statements similar to mine.  What also is clear from that article, which reports on a letter Comey emailed to FBI employees this afternoon explaining his decision to notify Congress, is that Comey seems not to understand the role of the FBI in a matter of this sort, and misunderstands the meaning of the term “cover-up” as including ongoing investigations that have not been publicly disclosed, rather than just killing investigations.

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“Why would you want to be associated with a party that’s so awful?”

This morning I overheard a part of a conversation between two 30-ish old high school friends, both from career-military families; their high school was on a military base.  One is a disabled Marine veteran, having lost his right leg below the knee, significant muscle in his left leg, a good part of the movement in his right hand (he’s right-handed), and enough of his colon to wear a colostomy bag, when he stepped on an explosive during deployment in Afghanistan, ending his plan to be career Marine.  During an earlier deployment in Iraq he watched as a friend of his was blown up by a suicide bomb in a car.

His friend was in the Navy for two years and then in a National Guard unit for several more.

Neither is a college graduate, although both of their wives are.  At least one, the Navy vet, is a comedy-talk-radio devotee, which I think means right-leaning.  Both of their families are decades-long Republicans.

Their conversation was about junk mail.  The Navy vet, one of my neighbors (I live in a college town, but one that has a good number of military vets and a major veterans’ hospital, which makes for a nice mix, in my opinion), made some off-hand comment about it, which I didn’t hear.  The disabled Marine vet responded, “Oh, yeah.  It’s all that campaign stuff.  I said to [I think he said, his mother, but I’m not sure], ‘Why would you want to be associated with a party that’s so awful?”  His friend said, “Yeah.”

What struck me was the indictment of the party, not merely of Trump.

I was so glad to read this morning about Obama’s speech last night in Ohio, in which he indicted the Republican Party itself for Trumpism—a change from the tack he took in his convention speech in July.  The purpose is to–finally–force Clinton to make a serious effort to swing control of the Senate and the House.

I also was struck by Paul Krugman’s column this morning, the purpose of which–notwithstanding its title, “The Clinton Agenda”—is to try to shift the discussion from the Clinton-Trump contest, whose outcome no longer is in doubt, but to which party controls Congress.  Because which party controls Congress will determine whether or not federal policy shifts to what a large majority of Americans want—especially on climate-change-related law, but also on so much else on which there is broad public consensus.

The WikiLeaks-released emails from John Podesta seem to be largely-irrelevant history.  They show the dismaying extent to which Clinton and her aides, other than Podesta, failed so completely, for so very long, to grasp the nature of this election cycle.  But they continue to matter unless Clinton finally does recognize that most of the policies that progressives so care about—foremost, I believe, the policies (a.k.a., law) that the Supreme Court and the lower federal courts and federal agency heads will determine—are supported by the moderates she so fears reminding that she’s a Democrat, and who may decide to vote Democratic for Senate and House precisely on that basis.

Obama talked yesterday only about the Trumpian awfulness of the Republican Party itself—a subject that certainly deserved a speech all its own.  But Clinton should pick up the fiscal and regulatory mantle from her biggest cheerleader pundit and campaign for a Democratic-controlled Congress.  He says she’s done enough on that, but then belies that in the rest of his column.

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PPACA Premiums are Lower than You Think

Or so The Brookings Institute would like us to believe. What would cause Brookings to take such a stance especially since parts of the PPACA increased costs dramatically and premiums have increased dramatically? Coverage such as:

mandated guaranteed issue regardless of health status;

restrictions on the ability to charge different premiums based on anything besides age and smoking habits;

requirements for plans to offer certain benefits deemed “essential;”

limits on out-of-pocket costs an enrollee can pay for covered services in a given year; and

the elimination of any lifetime limits on coverage

have had a significant impact on costs.

Countering elements of the PPACA push the cost dynamics in the opposite direct keeping the impact of costs lower. The individual mandate and federal subsidies increased the pool of people seeking coverage increasing the size of the market and resulting in decreased costs and subsequent premiums. While Healthcare.Gov has its issues; however, it did increase transparency of the market place where consumers can compare the costs of the various plans and what is offered as measured against an actuarial standard.

A larger market or pool of people shopping for healthcare pushed against a historical trend of higher premium increases. Couple this with states reviewing policy pricing and the MLR limiting the percentage of premium being applied to administration. The trend has been lower then pre-PPACA.

As a comparison Brooking used a second tier Silver plan to point out the differences pre-2014 and after implementation of the PPACA.

average premiums for the second-lowest cost silver-level (SLS) marketplace plan in 2014, which serves as a benchmark for ACA subsidies, were between 10 and 21 percent lower than average individual market premiums in 2013 (page 4 graph), before the ACA, even while providing enrollees with significantly richer coverage and a broader set of benefits. Silver-level ACA plans cover roughly 17 percent more of an enrollee’s health expenses than pre-ACA plans did, on average. In essence, then, consumers received more coverage at a lower price.”

Without the PPACA, Loren Adler and Paul Ginsburg of Brooking’s Center for Health Policy analysis shows a 2nd tier Silver Plan insurance policy premiums would have been 30% to 50% higher in 2017 (page 9 graph) even if premiums grew 10% by 2017 in comparison under the PPACA.

Is it free, no. Is it cheaper, yes. Could it be better, it will be in time.

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