Sticker Shock' Ahead on Health Insurance

[mikesimon]

'Sticker Shock' Ahead on Health Insurance
By David Pittman, Washington Correspondent, MedPage Today
Published: February 05, 2013

WASHINGTON -- Separate surveys released this week give dramatically different outlooks for two groups of people under the Affordable Care Act (ACA): the young, healthy worker and the part-time worker.

Premiums for a healthy, nonsmoking, 27-year-old in a "bronze" -- or relatively inexpensive -- small-group or individual policy would increase on average by 169% in five markets in 2014, a survey of major health insurers by the conservative American Action Forum (AAF) found.

Meanwhile, premiums for an unhealthy, 55-year-old smoker in a more generous gold-rated policy would decrease by 22%, on average, in those same five markets in 2014.

"The results surveyed above indicate that there will be massive sticker shock to the relatively young and healthy in both the small group and individual markets," the AAF report said. Those increases essentially subsidize the ACA mandated coverage of sicker individuals and limits on variations in premiums between groups of insured such as men and women, the report noted.

ACA mandates coming in 2014 include the mandate for individuals to purchase insurance; minimal coverage requirements for insurers; coverage of pre-existing conditions for adults; limits on premium variation based on age, gender, health status, or group size; new fees and taxes; and other new rules.

The AAF sought to understand how these changes would play out in different markets. It sent a survey to an unspecified number of major insurers and asked them to forecast the ACA's impact on small-group and individual plans in six cities.

Results showed premiums would increase for young, healthy individuals by an average of 190% in Milwaukee and 157% in Phoenix -- the city with the lowest increase for the group.

To put a dollar amount on that, the average current monthly premium in Chicago, Phoenix, Atlanta, Austin, and Milwaukee is $2,047 for young, healthy workers in a small-group plan. The AAF survey found it will jump to around $5,124 in 2014 with the ACA changes.

However, premiums would drop 32% for older, less healthy individuals in Austin, Texas, the largest drop for the surveyed cities, and by 15% in Milwaukee, the smallest drop for a city.

Premiums for older, less healthy workers in a small-group plan in those same five cities would drop from $14,534 today to $10,706 next year, the AAF survey found.

Both groups of enrollees would be helped economically in some cases by federal tax credits available for those making between 100% and 400% of the federal poverty level, if they purchased insurance through a health insurance exchange.

"By eliminating or constraining these 'rating factors' that result in the variation in today's market, the ACA in 2014 increases the premium for the young and healthier and lowers the premium for the older and sicker," the AAF survey said. "The same would be true if there were a law reforming automobile insurance."

The AAF survey didn't specify which health insurers participated in its survey but did say it wouldn't have published results without at least four respondents for each city. Albany, N.Y., was the only city it asked about whose results weren't published.

A separate survey from the ADP Research Institute, also released this week, says the ACA's penalties for employers to offer coverage to employees could result in more of today's part-time workers receiving coverage.

"The shared responsibility provision of the ACA may result in employees who are currently classified as part-time being reclassified as full-time, meaning the employer must offer coverage to those employees or face a potential penalty," ADP's 2012 Study of Large Employer Health Benefits said.

In 2012, 23% of all employee positions were classified as part-time and only 15% of those were eligible for benefits, the survey found. The survey was based on roughly 300 companies with at least 1,000 employees.

The ACA mandates that any employee working at least 30 hours per week, or 130 hours per month, must be offered employer-sponsored health coverage that meets certain requirements if the business employs 50 or more full-time workers.

"The ACA will require employers to extend health coverage to more part-time employees, and employers need to carefully consider the best approach for their organization," the report stated.

On Monday -- the same morning the AAF released its survey -- Health and Human Services Secretary Kathleen Sebelius said the government must reach out to young people currently uninsured who may not know they can gain federal assistance to buy coverage through a health insurance exchange or marketplace. Young people are particularly tough to reach, she noted.

"If we're going to fulfill the full promise of the Affordable Care Act and insure millions of Americans, we need to reach these people," Sebelius said Monday.

http://www.medpagetoday.com/Washington-Watch/Reform/37205

[el_em_en_oh]

Didn't mean anything offensive, in anything I wrote, and I hope you weren't offended by my words.

I stand corrected, on my original comment to you about the "lapse in coverage" pre-existing conditions, thing.

I didn't say that lapse in coverage was the only way... I said it's "ONE of the only ways".

"...In fact I pay more out of pocket for taxes than you do..."
Is that a FACT? It's curious that you know exactly how much $$$ I pay in taxes. I'll have to talk to my accountant. I guess her security isn't tight enough, and my information is leaking out onto the interwebs! You must be a pretty good hacker!!!

"...And even if we did get a job that carried insurance it used to be any pre existing didn't get covered for the first year..."
If you walk into a new job, not having had healthcare coverage, yes... there's a 1-year waiting period for pre-existing conditions. If you walk into a new job, having NO lapse-in-coverage (you were carrying private insurance, or had COBRA, right up to the point of new employment), there's a 30-day waiting period, for ALL coverage, pre-existing or not (then you're covered 100%). I'm not sure what the Obamacare rules will be, but if pre-existing conditions are covered immediately (with NO 1-year waiting period), then that's a good thing.

Obamacare isn't 100% bad. There's some good stuff in there. SOME. It's all the extra stuff that bothers me, and puts my back up. Requiring employers to offer part-time employees healthcare, is just one thing that should be removed. It'll cost jobs, which in case no ones noticed, are kind of in short supply right now!

My condolences for your lack of health insurance coverage, teko. I don't wish that on anyone, especially someone that I know. The downturn in 2007-2008 hit some harder than others, and it looks like your healthcare coverage was one of the casualties. I'm not sure that "condolences" was the right word, but I both sympathize AND empathize with your situation. Been there, done that, and with MY condition, it was hell, going to a "free" hospital (Ben Taub Hospital, here in Houston, is our local ghetto-hospital... not a fun place to be, especially when you have a kidney-stone).

[teko]

Again, you show your lack of knowledge. We lost our employer sponsered insurance when the recession hit, and we tried to continue it on our own. Again we were told no, we were high risk. I am self employed which makes it even harder. The only way for us to get insurance is to take a job of somekind that offers employer paid insurance where we are once again in a pool. And I may eventually have to quit my own self employment and go to work for Costco or someone that carries it and take the hit on income. Some of us do not survive off your taxpayer ***. In fact I pay more out of pocket for taxes than you do, so? Of course if I quit my self employed position and my husband does too, we still would not be eligible to live off the teet because we have no children. Again, the lack of knowledge is astounding. And even if we did get a job that carried insurance it used to be any pre existing didnt get covered for the first year, altho under obamacare I do think that has changed.  So you see, your not paying for anything for someone like me. Im not on welfare, medicaid or any other government program and pay more out in taxes than you do.

[el_em_en_oh]

One of the only ways to not have health insurance due to a pre-existing condition, is if one has a "lapse in coverage".

I hate to say this, but if one has a medical condition, it's ONES personal responsibility to make sure one has continuous-coverage, so that there are no "gaps". If one has no "gaps" (ie: lapses in coverage), there's no 'pre-existing medical condition' issues.

Even when I've been in between jobs, I've MADE SURE that I cover my healthcare with COBRA (continuation from my previous employment healthcare). Yes, it's expensive as hell, and I was broke while paying for COBRA, but it was MY responsibility to cover my healthcare.

And when my COBRA ran out (due to not being able to find a job within 13 months), I got myself covered by an EXTREMELY expensive private insurance, JUST so that I'd have minimal healthcare coverage, so that there'd be no "gap" (lapse in coverage).

Health insurance is ones own personal responsibility.

And for the homeless people that have no money and have a severe medical condition... No job. No money. Pay no taxes. Do not contribute to society in any way shape or form. My apologies. I don't want to, nor should I be forced, to cover YOUR healthcare needs.

Call me heartless...

[mikesimon]

Well said teko.

[teko]

And I will only add that altho you may pay premiums, lets remember you get that cost because you belong to a pool of people making it possible for you to get that rate, and when you go to the doctor there is an agreement between your insurance company and the provider of that cost of service. That deduction if you will. When you are private pay and go for that same treatment, you dont get discounts, you get the full amount billed to you. So there are always two sides of the same coin.

[teko]

brice that is downright offensive. I dont have health insurance and due to pre existing cannot get it for any amount of money. I would gladly pay premiums instead of everytime I get sick, realizing I cannot go to a doctor because most will not see someone without insurance coverage. Even the hospitals now altho they must see and treat someone, just stablize you and unless you are on your deathbed, the doctor on call has the right to refuse to treat you. In my case money has nothing to do with not getting coverage. That narrow view of things from a limited perspective is what is wrong with this country.