Obamacare Exchanges Collapsing as Insurers Exit

Washington Post story

Health-care exchange sign-ups fall far short of forecasts

Enrollment in the insurance exchanges for President Obama’s signature health-care law is at less than half the initial forecast, pushing several major insurance companies to stop offering health plans in certain markets because of significant financial losses.

As a result, the administration’s promise of a menu of health-plan choices has been replaced by a grim, though preliminary, forecast: Next year, more than 1 in 4 counties are at risk of having a single insurer on its exchange, said Cynthia Cox, who studies health reform for the Kaiser Family Foundation.

Debate over how perilous the predicament is for the Affordable Care Act, commonly called Obamacare, is nearly as partisan as the divide over the law itself. But at the root of the problem is this: The success of the law depends fundamentally on the exchanges being profitable for insurers — and that requires more people to sign up.

In February 2013, the Congressional Budget Office predicted that 24 million people would buy health coverage through the federally and state-operated online exchanges by this year. Just 11.1 million people were signed up as of late March.​

The Republicans said the numbers can't possibly work out, and they didn't.

And this is classic:

A big reason the CBO projections were so far off is that the agency overestimated how many people would lose insurance through their employers, which would force them into the exchanges. But there have been challenges getting the uninsured to sign up, too.

The law requires every American to get health coverage or pay a penalty, but the penalty hasn’t been high enough to persuade many Americans to buy into the health plans. Even those who qualify for subsidized premiums sometimes balk at the high deductibles on some plans.​

The plan failed because not enough people lost their private insurance, and the government didn't do enough to destroy poor people's finances.

They're power-mad socialist assholes all the way down.

Yep, your health care does suck.

How long before garamet tells us how great it's working?

It was never designed to work only to fail.

Bingo.

Of course they will try to MAKE IT WORK! The state of Tennessee, for example, just approved a 62% hike in premiums.

As someone without any skin in the game and who thinks that the whole healthcare situation in the US was and continues to be a clusterfuck, I would actually be interested in someone reasonable (i.e. not gturner) updating me on how Obamacare is performing overall.

A quick google search reveals that it has had a dramatic effect in reducing the number of uninsured but that absurdly high overall costs (by world standards) have not been reduced. Is this broadly accurate?

Yep.

When I went to get an ultrasound (and no I'm NOT pregnant, fuck you guys: ) a few months ago, the tech lamented that this hasn't helped very many people, other than those willing to pay any price just to be allowed to buy insurance.

All I can say is...it's better than nothing. Girlfriend of mine makes $30,000 a year but her job is technically temporary so no employer-sponsored healthcare. With the subsidy she pays $221 a month for insurance through Obamacare. It has a high deductible, but it's been paying a decent portion of her surgery bills. She would have been completely fucked without it.

Goddammit, 220 a month at 30k a year? That's almost one-tenth of her monthly income.

That's insane.

Hey, keep votin' for democrats, tho.

But you get to keep your doctor.

Oh wait. That was a lie, too.

Basically, but "dramatic" might be overstating it - the uninsured rate went from 15% in 2008 to 12% in 2015 (it was up to 18% in 2013). Both overall cost of care and insurance premiums (and deductible sizes) have increased quite a bit, as was expected by pretty much everyone who wasn't living in a fantasy world in 2009 (well, I don't think too many people saw the deductible size increases coming). Now that effectively everyone has to use a 3rd-party payer and insurers must spend 90% of their revenue on care, it's in both providers' and insurers' interests to make medical care as expensive as possible, to generate as much profit as possible for both, as insurance companies that join exchanges often take a loss on customers signed up through them.

I didn't understand the last point -- why is it in the insurers' interest to make care more expensive? Can you walk me through that?

I think the short of it would be that 10% of $5000 is ten times bigger than 10% of $500, and they get to go back and hit the insured or the feds forfor the total costs of the care by raising rates year after year.

And you keep voting Republican, "Mr Independent".

You're not pregnant? Hope you don't end up like this guy.

Considering that Republicans did NOTHING to address the many problems in our health care system? Yes, I'll keep voting for the people who at least try to come up with solutions, rather than the people whose strategy is to first angrily deny that problems exist, then do their best to sabotage any attempt at fixing them, then gripe when the other guy's solution isn't perfect.

Btw, it seems to me that this issue could be easily fixed by allowing people to buy in to Medicare. But Republicans will never go for that, because they're afraid people will actually start to choose that option.

Which would both reduce insurance company profits and go against their borderline-religious fervor that All Government Programs are Bad and the Private Sector is Always Better.

As a young, healthy male, I was able to get a decent plan back in 2009 (pre-Obamacare) for $115/mo. No deductible, $30 copays, etc. That was shopping as an individual without employment.

Nowadays, the cheapest options on the Obamacare exchange for me is about twice the premium with a high deductible. I was able to go back on my parents' insurance for a couple years until age 26, but now I'm fucked. The last time I was home, I was making too little money to afford that kind of plan, but too much to apply for Medicaid.

More progress is needed. I am in favor of "Medicare for All" or some other public option.

In China, I have an international, high-deductible plan for serious things, but for ordinary doctor's visits, I just pay out-of-pocket, because it's cheap.

As a young, healthy male, it used to be legal for insurance companies to discriminate against other people (specifically, women and people with pre-existing conditions) in your favor.

That's not discrimination, that's estimating the likely costs of each customer and charging them accordingly.

Yes, and I appreciated it.

This is an area where my personal interests conflict with greater social interests. So what am I supposed to vote?

Depends on whether you are sure that you will always be safe from old age, serious health issues, and social inequality and conflict.

Most places, you can't even pay for an appointment. Not because the prices were too high (which they are), but most big hospitals won't let you because their insurance company(ies) prevents them from taking it.

That ultrasound I mentioned was to check why I'd been having irregular cycles/crazy long cycles, which has happened off and on since I was 20. I got a bill for the initial consultation with the OB/GYN that with my insurance helping came up to $275. I also owe nearly 600 for the ultrasounds as they charged individually for both kinds despite being hooked up to the same fucking monitor.

I feel sorry for anyone trying to raise kids in this country, I truly do.

You realize that insurance companies, like all companies, are a business, and their goal is to make money, right? The idea of insurance is that you aren't actually supposed to need it. So when faced with people who more than likely, or who would definitely need payouts, yes, insurance companies would try to avoid insuring those people in order to keep the amount they need to charge to keep making a profit lower in order to remain competitive. Now that they can't, their prices have increased. Gee, what a surprise. And for all the defending people like yourself do, you seem to keep purposely missing the point, which is that the ACA didn't actually do anything to address the problem of absurd medical costs that only continue to rise. All it's done is to further financially burden people who were already having a hard time getting by.

The one big company to partially pull out is doing it for political reasons to protest that its accusition of a competitor was blocked on anti-trust grounds. They will be back.

As I float in and out of the US periodically, I change healthcare plans frequently. The ability to enroll without worrying about pre-existing conditions is important to me.

But there's no denying the conflict of pricing. And it's not just people like me.

Obamacare has been a mixed blessing in that sense.

That medical care is considered a commodity at all is the thing that confuses every other country in the world.

How can the same IV saline drip cost $5 in Canada and $800 here?

Of course insurance companies were acting in their best interest. The problem is that we have a for-profit healthcare system in the US. We need to get on board with the rest of the developed world and create a socialized system. No more half measures.