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Premiums Aren't Going Down Under Obamacare
"When it becomes law, families will save on their premiums," President Obama declared in his weekly radio address before Christmas, pitching his health care reform.
If only that were so. Nobody who tracks health insurance sees any sign of softening premium prices for people who already have insurance, Obamacare or not. Premiums for 2010 were up 10% and are predicted to keep growing at the same rate in coming years.Health insurance is beginning to resemble air travel--where deep-pocketed business passengers subsidize penny-pinching vacationers. Insurance companies, under the measures in Congress, would be forced to take all comers, young and old, healthy and sick. Over ten years they would confront $871 billion in spending on uninsured and newly subsidized customers, costs that would be passed along to the young and healthy. The federal government isn't going to pick up all of that tab. So those now insured through a private plan at work or one bought individually will have to chip in.
If you're thinking the legislation will tamp down overall health care spending, reconsider. Policy analysts ranging from the neutral Congressional Budget Office to the HMO lobby see no abatement in the growth rate of health care spending. That sector of the economy is growing at a 7.4% annual rate, says actuarial firm Milliman. Medicare's chief actuary, Richard Foster, thinks that the Senate bill would expand health spending by $234 billion above current projections.
The premium hikes will result from cost shifting, better known as passing the buck. The House and Senate insurance bills aim to cover their costs in part by cutting annual Medicare reimbursements to hospitals, doctors and drug companies by $45 billion. Those providers will likely try to offset the cuts by negotiating higher rates with private HMOs--which then get passed along through higher premiums. That's exactly what occurred after past Medicare and Medicaid cuts, according to the CBO analysis. Families USA, a nonprofit group advocating expanded federal involvement in health care, says insured families are already absorbing $1,000 a year in costs shifted away from uninsured patients.
Also, the legislation requires HMOs to pay $7 billion annually in new fees. That will get passed on to individuals and employers who buy the policies. So-called Cadillac health plans will be taxed at 40%, for anything spent on premiums above $23,000 for a family or $8,500 for an individual, according to the latest Senate bill. The $149 billion this is expected to raise over ten years will also be passed on directly to employers (and their workers) in the form of premium increases.The biggest losers, or rather spenders, will be those who currently pay for their own insurance (individually or for a small business) but make more than four times the federal poverty level, a multiple that comes to $88,200 for a family of four. They will not be eligible for subsidies. The CBO calculated that premiums for that group will go up 10% to 13%, compared with increases absent new laws.
That forecast may be at the low range. It assumes that everyone now without insurance buys a policy on one of the bill's newly created government exchanges, spreading the risk over a broader pool. There's a $750 penalty if you can afford coverage and don't buy it. But, in fact, young people might opt to pay the fine and stay uninsured, while the new entrants into the market are more likely to be older, sicker and thus costlier. "It's adverse selection," says Jason Grau of the Oliver Wyman consulting firm. Using industry statistics the firm predicts in a report for the Blue Cross & Blue Shield Association that rates for those who buy their own coverage will jump 53%, from $3,000 to $4,550 for individuals and $6,300 to $9,650 for families.
WellPoint ( WLP - news - people ), the second-biggest health insurer, predicts a family that now pays for its own coverage in Los Angeles--with the parents age 40, in average health, two kids--would see its premium go from $6,430 a year to $9,160. Breaking that down, it calculates that the "take all comers" rule will cause most of the increase. WellPoint calculates that a small employer in California with workers of average age and health will have to pay 18% more to keep everyone covered. WellPoint claims nobody has refuted its numbers. "They just criticize the messenger," says chief strategy officer Bradley Fluegel.
Defenders of the legislation have pointed out that for small businesses and people who are self-employed and buy their own insurance, the premium increases will be offset by generous government subsidies. If the above family made $65,000 they would get half their premium subsidized. Coverage will, in some ways, be better: The law will forbid lifetime ceilings on claims. But, of course, that generosity will have to be paid for somehow.
If you get coverage at a very large company, your premiums will likely go up but at a slower rate than at a small business or if you buy your own insurance. The reason is that large companies already have to take everybody. But rest assured premium increases will occur as costs trickle down from doctors, hospitals and HMOs looking to cover their costs.
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