November 1, 2018


The big secret about the Affordable Care Act: It's working just fine  (Ezekiel Emanuel October 31, 2018, Washington Post)

First, enrollment is strong. During last year's enrollment period, nearly 12 million Americans bought insurance on the exchanges, and more than 25 percent of them were first-time customers. [...]

Second, premiums are lower. For Americans shopping on the exchanges, many are getting a great deal. Across the market, premiums are down in 2019. Yes, you read that right: down. A few weeks ago, the Centers for Medicare and Medicaid Services (CMS) announced that average premiums for the benchmark silver plan are down 1.5 percent. As supporters of the ACA have consistently argued, the 2017 premium spikes were a one-time adjustment. After a few rocky years, insurers are figuring out how to price the market, and premiums are leveling out.

For example, Blue Cross Blue Shield of North Carolina recently announced that it was able to cut premiums for coverage offered in the individual market, including the health-insurance exchange, by 4.1 percent. This is the first rate decline in the North Carolina individual market ever, and it might have been larger had federal and state policy not worked at cross-purposes.

And North Carolina is not alone. According to CMS, of the 39 states on, five had double-digit declines, led by Tennessee with a drop of more than 25 percent. Other populous states, including Pennsylvania and New Jersey, had declines exceeding 14 percent. Only three states had double-digit increases, and all the states were small: Hawaii, North Dakota and Delaware. More important, the subsidized premiums across all states rose a mere 2 percent. This increase was lower than for private, employer-sponsored insurance, where premiums rose by an average of 5 percent for families and 3 percent for individuals.

These declines in premiums reflect the broader success of the ACA in controlling health-care costs. For eight years since the ACA passed, health-care costs have moderated, growing much less than during the George W. Bush administration. Indeed, per-person costs in Medicare and Medicaid have declined, and per-person costs in private insurance have increased on average less than 4 percent annually since 2010.

Finally, in 2019, many health-insurance companies are joining or expanding their presence on the ACA exchanges. 

Who could have predicted that companies would be scrambling to get back in on the action and costs would deflate....

Posted by at November 1, 2018 4:14 AM