Josh Earnest’s lips say yes yes yes, but the balance sheets and the consumers say … er, what? Earlier today, the White House press secretary insisted that the individual health-insurance market is better today because of ObamaCare. “That’s just a fact,” Earnest says.
Fact check on aisle 1600?
— Jennifer Wishon (@JenniferWishon) May 16, 2016
Are the insurance markets better? A new study of those markets by McKinsey & Company show that despite rapidly rising premiums, insurers’ losses accelerated as a percentage of their business in 2015. The Hill reports that it’s just a fact that loss-margins more than doubled:
The study from McKinsey & Company finds that in 2014, insurers had a margin of minus-4.8 percent, translating to an overall loss of $2.7 billion on the individual health insurance market, which includes ObamaCare’s marketplaces.
The study finds those losses roughly doubled in 2015 to between minus-9 and -11 percent margins, based on preliminary data.
Many insurers have been complaining about their losses on the ObamaCare marketplaces and are pushing for policy changes. Premium increases are expected to be higher for next year than in previous years, which is likely to become an election issue.
Even the good news from the McKinsey study shows little hint of healthy markets. The authors see little risk of a “death spiral,” but that doesn’t reflect the health of the market itself. It’s just a fact that the risk is entirely dependent on federal subsidies, and that “traditional factors” such as a sustainable economic model are not relevant. In order to survive, McKinsey makes it clear that the federal government will have to ramp up spending to “stabilize” the markets:
The individual market has little risk of entering a classic insurance “death spiral” as long as the federal government continues to offer subsidies to those with incomes below 400% of the federal poverty level. Given the unique regulatory conditions of this market, the key determinants of its stability are not the traditional factors (risk and cost of care for this segment), but rather the ongoing subsidy payments.
The majority of enrollees currently in the individual market—an estimated 69% of those in the market, both on and off the exchanges9—qualify for subsidies, which cap their premium contributions to a percentage of income10 (Exhibit 7). Our modeling work suggests this mechanism acts as a powerful market stabilizer, making coverage affordable for a broad segment of the individual market regardless of premium increases (albeit at a higher rate of government spending). Similarly, the cost-sharing subsidies offered to many enrollees help stabilize the market but increase government spending. In addition, our modeling suggests that the percentage of enrollees eligible for both types of subsidy will likely rise. Thus, under the current design of subsidized and mandated coverage, there will likely continue to be a large, viable individual market.
And what about the delivery of actual health care, as the White House likes to frame it? That’s not so healthy either, as the New York Times pointed out yesterday:
AMY MOSES and her circle of self-employed small-business owners were supporters of President Obama and the Affordable Care Act. They bought policies on the newly created New York State exchange. But when they called doctors and hospitals in Manhattan to schedule appointments, they were dismayed to be turned away again and again with a common refrain: “We don’t take Obamacare,” the umbrella epithet for the hundreds of plans offered through the president’s signature health legislation. …
The goal of the Affordable Care Act, which took effect in 2013, was to provide insurance to tens of millions of uninsured or under-insured Americans, through online state and federal marketplaces offering an array of policies. By many measures, the law has been a success: The number of uninsured Americans has dropped by about half, with 20 million more people gaining coverage. It has also created a host of new policies for self-employed people like Ms. Moses, who previously had insurance but whose old plans were no longer offered.
Yet even as many beneficiaries acknowledge that they might not have insurance today without the law, there remains a strong undercurrent of discontent. Though their insurance cards look the same as everyone else’s — with names like Liberty and Freedom from insurers like Anthem or United Health — the plans are often very different from those provided to most Americans by their employers. Many say they feel as if they have become second-class patients.
Amazingly, the NYT article doesn’t even discuss the biggest factor in making benefits for ObamaCare consumers out of reach — the skyrocketing level of deductibles that insurers have set to curtail the rise in premiums. Most healthy adults paying for mandated comprehensive care will have to spend thousands more out of pocket before their benefits become available. That, plus the lack of providers willing to work within the mandates on their own services within these plans, make ObamaCare insurance all but worthless outside of a catastrophic health event.
Even the issues which the NYT article does discuss fail to note the context of time. As the fourth year of the enforced mandate approaches, and six years have passed since Congress approved ObamaCare, the article offers a look at some of the problems that its critics insisted would be significant issues all along:
A study in the policy journal Health Affairs found that out-of-pocket prescription costs were twice as high in a typical silver plan — the most popular choice — as they were in the average employer offering. In research conducted with the Robert Wood Johnson Foundation, Dr. Polsky found that 41 percent of silver plans offered a “narrow or very narrow” selection of doctors, meaning at best 25 percent of physicians in an area were included. The consulting firm Avalere Health found that exchange plans had 42 percent fewer cancer and cardiac specialists, compared with employer-provided coverage.
Some of the problems may have been predictable. When designing the new plans, for-profit insurers naturally tended to exclude high-cost, high-end hospitals with whom they had little clout to negotiate discounts. That means, for example, that as of late last year none of the plans available in New York had Memorial Sloan Kettering Cancer Center in their network — an absence that would be unacceptable to many New York-based employers buying policies for their employees. Another issue is out-of-state coverage, which many A.C.A. plans don’t offer aside from emergencies, and which is routinely offered in policies from companies — especially large ones — with workers in more than one state.
As a result, many parents who were excited that they would be able to keep their children on their policies until age 26 have discovered that this promise has gone unfulfilled. When Sara Hamilton of New York was shopping on the exchange for a plan to cover her and her two young-adult children — who live in distant states — she discovered that none of the plans covered doctor visits in those places.
Healthy, eh? Even with those price and coverage differences, insurers are losing money faster than ever and patients can’t find providers for health care. Those are just the facts … the inconvenient facts that still has 51% of Americans favoring repeal of the whole mess.
Just the facts, man. Just the facts. Here’s a fun video from six years ago, with some highly ironic predictions from The Man himself …