Following up a February study, which showed that people needing drugs on the highest formulary tier will pay much higher out-of-pocket costs than other ObamaCare enrollees, consultants at Avalere have released another study, which shows that the low-income ObamaCare enrollees will suffer this effect even more than middle-class ones.
A formulary is a list of drugs that a health plan covers. It can be divided into up to four tiers. Drugs on the lowest tier (usually generic medicines) cost the least out of pocket, while those on the highest tier cost the most. However, those on the highest tier are the most expensive, and often indicated for those suffering the worst diseases.
A new study by Professor Steve Parente and Professor Michael Ramlet estimates that the number of uninsured will increase under ObamaCare, from 36.5 million in 2015 to 40.5 million in 2025. It further estimates that the average cost of an ObamaCare Silver plan will increase by over $4,000 in five years.
Nationally, we estimate an initial decrease in the uninsured with greater use of the private health insurance subsidies, but over time health plan prices are likely to increase faster than the value of the insurance subsidy. As a result of the declining purchasing power of the insurance subsidy, the implementation of the qualified health plan requirements and the end of the reinsurance and risk corridor programs we estimate a significant reduction in the private insurance market in 2017 with steady declines continuing for the rest of the decade. The Medicaid population is estimated to grow substantially in 2015 as more individuals are enrolled in states who have chosen to expand the program. Medicaid enrollment is estimated to slow down to between 2% to 3% each year from 2016 to 2024.
I guess they had not heard the President’s declaration that the debate over ObamaCare is over.
A patient with HIV/AIDS can expect to pay over $1,000 out of pocket for medicines, if he buys a policy on the ObamaCare health insurance exchange in Florida.
“Affordable”? Surely not. This perceived injustice has caused legal activists to file a lawsuit against four insurers, which offer plans in the Florida exchange, alleging discrimination.
Readers of this blog know that we have long warned against this consequence of ObamaCare. Insurers are not allowed to charge premiums appropriate to applicants’ expected medical claims. This is somewhat mitigated by a limited open-enrolment period. However, if applicants have chronic diseases, that provision gives little protection to insurers. While there are three methods within ObamaCare that transfer money to insurers which over-enroll sick patients, they do not eliminate the incentives for insurers to design plans that are not attractive to very sick patients. This results in a death spiral of antiselection.
AFLAC has just published its fourth annual survey of employees and business leaders about health benefits. Overall, the responses show how poorly our system of prepaid healthcare (inaccurately labelled “health insurance”) protects workers from the costs of catastrophic illness. Highlights include:
- 53 percent of workers would have to borrow from their 401(k)s and/or use a credit card to cover costs associated with an unexpected serious illness or accident;
- 49 percent have less than $1,000 to pay for out of pocket expenses associated with a serious illness or accident, and 27 percent have less than $500;
- 42 percent say they are not at all or not very prepared to pay out-of-pocket expenses associated with a serious illness or injury.
Although health insurers’ profit margins shrank a little in 2013, enrollment amongst the largest for-profit insurers jumped by eight million over 2012, according to a new analysis by Mark Farrah Associates. The report concludes that “leaders in the health insurance sector have good reason to remain optimistic”.
Although all major insurers succeeded in enrolling members in the new ObamaCare health insurance exchanges, this is still a small fraction of their business.
Many of ObamaCare’s advocates believe that the proportion of a household’s income spent on health care is an appropriate measure of how effective health insurance is at doing its job. If a household spends ten percent or more of income on health care, it is said to be “underinsured” by the Commonwealth Fund or the Kaiser Family Foundation. Five percent is the cut-off for low-income households.
According to that standard, ObamaCare fails miserably at insuring low-income households:
In Washington, one in four individuals in households earning less than 250% of the poverty level signed up for a bronze plan with a deductible of $5,000-$6,350 per person and $10,000-$12,700 per family. Even after premiums, these households could face medical costs ranging from 17% to 40% of income before ObamaCare’s non-preventative-care benefits kick in.
Beyond the premium subsidies that the law provides, households earning up to 250% of the poverty level qualify for cost-sharing assistance. It can greatly reduce the deductible that must be exhausted before benefits kick in and, after that, the co-payments required for medical services and prescription drugs. But those cost-sharing subsidies are available only for those who buy silver-level coverage…
Source:Investor’s Business Daily.
Latest IRS Rule Outlaws Decades-Old Benefits, But Will Not Stop Employers Dumping Workers into ObamaCare’s Broken Exchanges
The New York Times‘ Robert Pear has covered an IRS rule that he interprets as barring employers from dumping workers into ObamaCare health insurance exchanges. Although this is the goal of the IRS rule, it is unlikely to have a significant effect on employers’ executing such changes.
Pear’s article covers a Q&A just released by the IRS that summarizes a decision it made back in September (Notice 2013-54). That notice laid down rules for Health Reimbursement Accounts (HRAs), Flexible Spending Accounts (FSAs), and Employer Payment Plans (EPPs). Employers have made pre-tax contributions to these plans for many years.
The notice clarifies that HRAs and FSAs must be “integrated” with employers’ group health plans to count towards ObamaCare’s minimum essential coverage. EPPs are a little known method for employers to contribute non-taxable dollars to workers’ premiums for individual insurance, and were defined by the IRS way back in 1961. Unfortunately, I can find no estimate of how many workers have such arrangements, although one expert source suggests they are “not as common” as HRAs and FSAs. My contacts confirm that benefits advisors have also proposed to employers that they fund HRAs and FSAs for workers, as long as those workers have individual policies. The contributions don’t necessarily fund premiums directly, but the money is considered fungible by workers who pay premiums out of their wages.