One More Time with Feeling

It’s pre-rating filing season again. That means it’s time for the annual ritual of insurers trying to soften up the public and regulators for rate increases. This year, HHS is pushing back on the insurers’ narrative, releasing a report this week that showed that premium increases in the past year were much lower than you might assume if you just read the stories about the initial proposed filings. Key takeaways from the HHS report: there’s a difference between a proposed rate and a final rate (which is almost always lower); consumers can offset a rate increase by shopping for a new plan on the Marketplace; for most consumers in the Marketplace, the effect of any increase is largely blunted by the tax credits that about 85 percent of Marketplace enrollees receive to make health insurance more affordable.

Still, as they say in the mutual fund ads, past performance does not guarantee future results. A number of factors (not all of them bad, such as the stronger than expected enrollment in Employer Sponsored Insurance) are coming together in a way that could lead to larger price hikes this year. 

Complicating the story this year is that premium rates will be released in the middle of a national election. While health care has not featured very prominently in the campaign so far, the stark differences on health care between the parties are likely to result in a higher profile for the issue this fall. In that context we can expect a heated battle over the significance of the premium filings as well as the appropriate response. Hillary Clinton is proposing to build on the ACA and take steps to make coverage more affordable for more Americans. Bernie Sanders is proposing to replace the ACA with a single payer plan, and both of the leading Republican candidates are proposing ACA repeal.

Of course, the repeal argument is weakened by the persistent lack of any coherent proposal of what would be put in its place. House Speaker Paul Ryan, who has taken himself out of contention for the presidential nomination has indicated the House GOP will produce a plan. He has also committed to not yanking away the football when Charlie Brown goes to kick it.

The problem for Republicans working on a replacement is when they made a decision to wage a scorched-earth campaign against the ACA, it was a decision based on politics, not on policy. As result, as John McDonough points out in a recent blog, they were forced to repudiate much of their own health policy agenda and now essentially have nothing left to say.  

Persistent Health Disparities: Our National Disgrace

April is minority health month, and we’ve been featuring blogs about health equity. This week the biggest story was about a new study documenting the widening life expectancy gap between the rich and the poor. But there are some other important stories as well:

While the contaminated drinking water crisis in Flint continues, the problem of lead contamination is actually widespread, causing at least some members of Congress to propose more expansive testing standards, especially in schools and daycare centers. The EPA is also working to strengthen the rules that would protect drinking water, but say that a final rule is at least a year (and a new administration) away.

And, ICYMI, a new study University of Massachusetts’ study appearing in the American Journal of Public Health shows that older African Americans are more likely to have medical debt than are older whites. The study underscores how the issues of racial, economic and health care justice are intertwined.