Much Ado about Rates – Part II
A steady stream of news headlines about states’ new health insurance rates for plans under the Affordable Care Act (ACA) have generated buzz and also caused some confusion. It seems every state has a different headline, from “Georgia insurance chief’s claim: health care law will inflate rates” to“Health Plan Cost for New Yorkers Set to Fall 50%”. What is the real story for consumers?
At first blush, it seems strange that states are experiencing such different outcomes from the ACA’s changes. To understand what is going on here, it’s helpful to understand a few things:
1. The ACA has created a more level playing field. States have traditionally regulated insurance, and rules have varied greatly across state lines. So New York has allowed all people to buy insurance, regardless of pre-existing conditions, for many years. But Georgia (and most other states) has kept sicker people out of the insurance market by both excluding people with health conditions from insurance and having them pay much more for coverage. In addition, many states have allowed bare-bones coverage with high deductibles and extreme benefit limits to count as insurance. The ACA changes that: Now not only can you get insurance when you have a chronic condition, but there also will be adequate benefits to cover your illness. This is a big change in some states – and less so in others. Therefore, insurance rates will differ.
2. The messenger matters. As you may have noticed, the ACA is politically charged, with some state leaders in overt opposition to law. And state insurance departments are typically run by elected commissioners or those appointed by the governor. Thus, there are different ways to “spin” information. A common tactic is to compare the ACA plans with those currently sold in the individual market – a market that routinely sells high-deductible plans without basic benefits such as maternity care. Comparing these plans to those that will be offered under the ACA really is comparing apples to oranges. That’s why California chose to compare the new plans for individuals with their existing small group plans, which historically cover a wider range of benefits. Bottom line: the data is as important as the source.
3. The rates don’t reflect actual premiums. Rates are something that insurance companies develop to determine average health care costs for a group of people across plans. They do not reflect differences like age or geography or health plan design. In addition, the ‘base rate’ of a plan typically includes all of an average person’s health care costs, including what the insurer pays and what the person pays out-of-pocket in copays and deductibles. It is not correct to look at a rate and translate it to a premium. Furthermore, the Marketplaces offer different levels of coverage – Bronze, Silver, Gold, Platinum, and catastrophic for young people – that have very different levels of cost sharing. Premiums will nearly always be lower than rates, even before the financial assistance the ACA provides to help pay for coverage.
What does this mean for consumers? The ACA provides better benefits and easier access to health insurance than before. And most people will have to wait to determine their premiums and costs until October 1, when it comes time to enroll in health plans. So, for now, the noise about rates is just…noise.