CullmanTimes.com - Cullman, Alabama

National News

March 26, 2013

Study: Health overhaul to raise claims cost 32 pct

WASHINGTON — Insurance companies will have to pay out an average of 32 percent more for medical claims on individual health policies under President Barack Obama’s overhaul, the nation’s leading group of financial risk analysts has estimated.

That’s likely to increase premiums for at least some Americans buying individual plans.

The report by the Society of Actuaries could turn into a big headache for the Obama administration at a time when many parts of the country remain skeptical about the Affordable Care Act.

While some states will see medical claims costs per person decline, the report concluded the overwhelming majority will see double-digit increases in their individual health insurance markets, where people purchase coverage directly from insurers.

The disparities are striking. By 2017, the estimated increase would be 62 percent for California, about 80 percent for Ohio, more than 20 percent for Florida and 67 percent for Maryland. Much of the reason for the higher claims costs is that sicker people are expected to join the pool, the report said.

The report did not make similar estimates for employer plans, the mainstay for workers and their families. That’s because the primary impact of Obama’s law is on people who don’t have coverage through their jobs.

The administration questions the design of the study, saying it focused only on one piece of the puzzle and ignored cost relief strategies in the law such as tax credits to help people afford premiums and special payments to insurers who attract an outsize share of the sick. The study also doesn’t take into account the potential price-cutting effect of competition in new state insurance markets that will go live on Oct. 1, administration officials said.

At a White House briefing on Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can’t be compared to the comprehensive coverage available under the law. “Some of these folks have very high catastrophic plans that don’t pay for anything unless you get hit by a bus,” she said. “They’re really mortgage protection, not health insurance.”

A prominent national expert, recently retired Medicare chief actuary Rick Foster, said the report does “a credible job” of estimating potential enrollment and costs under the law, “without trying to tilt the answers in any particular direction.”

“Having said that,” Foster added, “actuaries tend to be financially conservative, so the various assumptions might be more inclined to consider what might go wrong than to anticipate that everything will work beautifully.” Actuaries use statistics and economic theory to make long-range cost projections for insurance and pension programs sponsored by businesses and government. The society is headquartered near Chicago.

Kristi Bohn, an actuary who worked on the study, acknowledged it did not attempt to estimate the effect of subsidies, insurer competition and other factors that could mitigate cost increases. She said the goal was to look at the underlying cost of medical care.

“Claims cost is the most important driver of health care premiums,” she said.

“We don’t see ourselves as a political organization,” Bohn added. “We are trying to figure out what the situation at hand is.”

On the plus side, the report found the law will cover more than 32 million currently uninsured Americans when fully phased in. And some states — including New York and Massachusetts — will see double-digit declines in costs for claims in the individual market.

Uncertainty over costs has been a major issue since the law passed three years ago, and remains so just months before a big push to cover the uninsured gets rolling Oct. 1. Middle-class households will be able to purchase subsidized private insurance in new marketplaces, while low-income people will be steered to Medicaid and other safety net programs. States are free to accept or reject a Medicaid expansion also offered under the law.

Obama has promised that the new law will bring costs down. That seems a stretch now. While the nation has been enjoying a lull in health care inflation the past few years, even some former administration advisers say a new round of cost-curbing legislation will be needed.

Bohn said the study overall presents a mixed picture.

Millions of now-uninsured people will be covered as the market for directly purchased insurance more than doubles with the help of government subsidies. The study found that market will grow to more than 25 million people. But costs will rise because spending on sicker people and other high-cost groups will overwhelm an influx of younger, healthier people into the program.

Some of the higher-cost cases will come from existing state high-risk insurance pools. Those people will now be able to get coverage in the individual insurance market, since insurance companies will no longer be able to turn them down. Other people will end up buying their own plans because their employers cancel coverage. While some of these individuals might save money for themselves, they will end up raising costs for others.

Part the reason for the wide disparities in the study is that states have different populations and insurance rules. In the relatively small number of states where insurers were already restricted from charging higher rates to older, sicker people, the cost impact is less.

“States are starting from different starting points, and they are all getting closer to one another,” said Bohn.

The study also did not model the likely patchwork results from some states accepting the law’s Medicaid expansion while others reject it. It presented estimates for two hypothetical scenarios in which all states either accept or reject the expansion.

Larry Levitt, an insurance expert with the nonpartisan Kaiser Family Foundation, reviewed the report and said the actuaries need to answer more questions.

“I’d generally characterize it as providing useful background information, but I don’t think it’s complete enough to be treated as a projection,” Levitt said. The conclusion that employers with sicker workers would drop coverage is “speculative,” he said.

Another caveat: The Society of Actuaries contracted Optum, a subsidiary of UnitedHealth Group, to do the number-crunching that drives the report. United also owns the nation’s largest health insurance company. Bohn said the study reflects the professional conclusions of the society, not Optum or its parent company.

AP White House Correspondent Julie Pace contributed to this report.

Online:

Society of Actuaries

1
Text Only
National News
  • Fort Hood (UPDATED) Officials: 4 dead, including gunman, at Fort Hood

    A gunman opened fire Wednesday at Fort Hood in an attack that left four dead, including the shooter, law enforcement officials said.
    One of the officials, citing official internal U.S. Justice Department updates, said 14 others were hurt. The officials spoke on condition of anonymity because they were not authorized to release information by name.

    April 2, 2014 1 Photo

  • Smartphone kill switches are coming

    Smartphones need kill switches. It's a relatively easy solution to the pricey (and irritating) problem of smartphone theft. But who would have thought that the big carriers would team up with Apple, Google, Microsoft, Nokia, Samsung and lots of other manufacturers to voluntarily begin adding the technology by July 2015? The cooperative spirit! It makes so much sense!

    April 18, 2014

  • Consumer spending on health care jumps as Affordable Care Act takes hold

    Nancy Beigel has known since September that she would need hernia surgery. She couldn't afford it on her $11,000 yearly income until she became eligible for Medicaid in January through President Barack Obama's signature health care law.

    April 17, 2014

  • mfp file Hoffner Fired coach unjustly accused of visiting porn sites

    The president of Minnesota State University-Mankato accused a football coach of looking at Internet porn on a work computer before firing him, an arbitrator has revealed. The official said the claim could not be supported, and the coach shouldn't have been fired.

    April 11, 2014 1 Photo

  • High School Stabbings 4 students seriously hurt in Pa. school stabbings

    A student armed with a knife went on a stabbing and slashing spree at a high school near Pittsburgh on Wednesday morning, leaving as many as 20 people injured, including four students who suffered serious wounds, authorities said.

    April 9, 2014 2 Photos

  • Obit Ultimate Warrior Former pro wrestler Ultimate Warrior dies at 54

    James Hellwig, better known as former pro wrestler The Ultimate Warrior, has died, the WWE said. He was 54.

    April 9, 2014 1 Photo

  • news_amazonfiretv.jpg Amazon introduces Fire TV to challenge Apple in living rooms

    Amazon.com Chief Executive Officer Jeff Bezos is stepping up efforts to win over customers in their living rooms with a $99 TV box for watching digitally delivered shows and movies, challenging Apple's TV device.

    April 3, 2014 1 Photo

  • Washington Mudslide Death toll in Washington mudslide rises to 30

    As medical examiners painstakingly piece together the identities and lives of the 30 people known killed when a mudslide wiped out a small Washington community, one mystery troubles them.

    April 3, 2014 1 Photo

  • APTOPIX Fort Hood Fort Hood gunman sought mental health treatment

    An Iraq War veteran being treated for mental illness was the gunman who opened fire at Fort Hood, killing three people and wounding 16 others before committing suicide, in an attack on the same Texas military base where more than a dozen people were slain in 2009, authorities said.

    April 3, 2014 1 Photo

  • Supreme Court Campaign Big donors may give even more under court’s ruling

    The Supreme Court ruling Wednesday erasing a long-standing limit on campaign donations will allow a small number of very wealthy donors to give even more than is currently the case, according to students of the complex campaign finance system, and could strengthen the establishment in both parties.

    April 2, 2014 1 Photo