Time for another brief review of the “progress” of the federal health “reform” law, as the initial period of implementation has supposedly passed.
The exchanges set up by the health reform law have rebounded, largely thanks to the efforts of UnitedHealth Group’s Optum Insights unit, which has made using the federal exchange websites much easier. A number of state exchanges are still struggling. (WSJ Article) Enrollment, the Administration claims, is over 4 million, but the reality is many of those people have not actually paid for coverage yet. The actual number is probably 3.5 million at most. This is far below the Administration’s and the Congressional Budget Office’s projections. Another reality is that younger, healthier people are not enrolling in the numbers needed to create a sound actuarial pool for participating insurers. UnitedHealth, the savior of the federal exchange functionality, also looks pretty smart for not participating as a plan on those exchanges. And it has become apparent that the administration has eviscerated its own individual mandate through a broad and ambiguous “hardship” definition and other loopholes. Young people are smart and word gets around quickly in the age of social media, so don’t expect them to feel pressured to sign up. Many of the people who did sign up will get subsidies and Medicaid enrollment has boomed, so the federal and ultimately the states’ deficits will also be growing more rapidly. It is not an exaggeration to describe reform, as many predicted, as a disaster, a very expensive disaster which has upended many lives. And the worst may be yet to come when the plans offered on the exchanges have to set premiums for the second year of coverage. And of course, we still don’t have the employer mandate in place.
A report from eHealth finds that health insurance on the exchange is costing people substantially more than it did before the implementation of reform.
More good news for fans of big-government mandated health benefit rules---the Office of the Actuary at CMS estimates that 65% of small businesses will pay higher health insurance premiums because of the reform law.
http://online.wsj.com/news/articles/SB10001424052702304834704579403581288810194?KEYWORDS=medicaid&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=12038977&_hsenc=p2ANqtz-9IDXlhCMs_qEQBd9Xnz6U5YFSSSFLLzJj9mIBpkiwprivZcFlI27vGxrxg5ge7LZi1I3OZ3HdUAuYtQqLsEVJWFoNYPA&_hsmi=12038977A Brookings Institution paper examines the effect of the health reform law on various income groups, with the surprising finding that middle income people get a pretty good whack from the law.
The Administration has once again delayed part of the employer mandate in the health reform law, this time for smaller employers, and changed the rules on how larger employers will have to comply.
http://www.nytimes.com/2014/02/11/us/politics/health-insurance-enforcement-delayed-again-for-some-employers.html?emc=edit_tnt_20140210&tntemail0=y&_r=1&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=11905994&_hsenc=p2ANqtz-9frtRekkKkfFQISIbUfX1EPYp_YKTDbCPuUYJwWmAQdJbpgFdNHMVcBmFquXaShlzwR75PjyOo7P8EjUu-H_BQkwbI2A&_hsmi=11905994Aetna reported results for 2013 slightly under analysts expectations, but also revealed that it expects a small loss on its exchange enrollees, due to a worse risk pool than expected.
http://online.wsj.com/news/articles/SB10001424052702303496804579366420589219070?KEYWORDS=health+law&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=11876118&_hsenc=p2ANqtz-8y_gh5sAFMuiAPnxMR7ERFX8xkQPEDuc4Sot_KIFTCIftRgIS9VspnWcDUxjvTVH2Ds8kxZxFla9hvHFWWjehTluJiuA&_hsmi=11876118A brief analysis from PriceWaterhouseCoopers’ Health Research Institute suggests that premiums on the public health insurance exchanges are lower than those for comparable employer-based coverage.
The latest wound to the reform law is the CBOs recalculation that the law will result in greater job losses, as many as 2-3 million, than it previously estimated. It also now believes fewer people will get coverage as a result of the law. The bad news about the job losses is that fewer people working means less economic activity and growth and fewer tax revenues.
http://cbo.gov/publication/45010According to a Kaiser Foundation analysis the most expensive markets for "silver" plans sold on the public exchanges are the Colorado ski regions, at $483 a month for an individual plan, southwest Georgia at $461, rural Nevada at $456 and far west Wisconsin, adjacent to the Twin Cities in Minnesota, at $445.
http://medcitynews.com/2014/02/10-expensive-insurance-markets-u-s/?utm_source=MedCity+News+Subscribers&utm_campaign=790ccb7567-RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_c05cce483a-790ccb7567-67648197The Massachusetts Health Policy Commission issues its annual report on cost trends, finding that almost a decade after reform was initiated in the state, costs are still high, not well-controlled and much spending is wasted.