I had a lively conversation this week about premiums in the individual market and Marketplace (healthcare.gov). Misconception is that the Affordable Care Act (ACA/ “Obamacare”) has caused these increases but it is state and federal policy changes.
In 2014, there was a premium increase because of the ACA which implemented consumer protections such as comprehensive essential health benefits, removed pre-existing conditions, eliminated lifetime maximums, created annual max-out-of-pockets, and allowed children to stay on parents’ family plans until they are 26. All benefits justifying a premium increase.
In contrast, the premium driver in 2018 was health reform and cost-sharing reductions uncertainty not improved coverage like in 2014. According to the CBO (Congressional Budget Office) gross premiums will be 25 percent higher by 2020 because of uncertainty not improved coverage.
In 2019, premiums are expected to further increase because of the individual mandate being removed (“Obamacare Repeal”) and healthy premium-paying folks leaving the health insurance market. According to the CBO premiums will increase 10% because of this reason along.
Higher premiums lead to an increase in the uninsured because healthy people will not purchase insurance which causes premiums to go up and so fewer people can afford insurance. More people then go to the emergency room for treatment which causes medical costs to go up resulting again in higher premiums. It’s a vicious cycle.
It is important to recognize that a major cause of 2018 and 2019 Wisconsin premium increases is uncertainty and policies implemented after 2016 at the state and federal level.
District 32 Assembly Candidate Dr. Katherine Gaulke explains, "When I get to Madison I will propose consumer protections to bring stability to the health insurance market as a whole, not just the Marketplace. We can put state-level policies in place to bring premiums down for everyone. We must remove the polarized rhetoric and partisan policies."
Dr. Katherine has extensive for-profit and non-profit health care experience. She began her healthcare career in 1999 with Cogdell Spencer Erdman as a medical property manager in South Carolina. She left this position when the Navy transferred her husband to Kings Bay, GA. She then began working for HCA Patient Account Services in Jacksonville, FL. HCA owns 200+ hospitals in the United States, and was publicly traded when she worked for them. She began as an Accountant, was then promoted to Financial Analyst, and left HCA as Payment Resolution Manager working to resolve insurance company payment discrepancies and contract issues for 25 hospitals. For the last decade she has been adjunct teaching health care at Upper Iowa University in Milwaukee. Dr. Katherine founded the Wisconsin Association of Free and Charitable Clinics (WAFCC) in 2014.
CBO - https://www.cbo.gov/publication/53300, https://www.cbo.gov/publication/53826, and https://www.cbo.gov/publication/53009