Health Insurance: Big Spikes and Little Things

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Health Insurance: Big Spikes and Little Things

My local Sun­day paper had an above-​the-​fold head­line the other day: “Oba­macare rate could see big spike in NH next year.” This refers only to my state, where an uniden­ti­fied gov­ern­ment offi­cial leaked to the press a doc­u­ment pro­ject­ing an aver­age Obamacare-​exchange pre­mium rate increase of 44%.

The head­line could eas­ily have said “another spike.” Obamacare-​linked price hikes are old news. Still, I’m glad this wound up on the front page. That indi­cates that at least one assign­ment edi­tor doesn’t take big increases for granted.

The story said that the doc­u­ment was stamped Con­fi­den­tial and Draft Only and Not for Dis­tri­b­u­tion. I wish I knew who leaked it so I could deliver my per­sonal thanks. I don’t like being sur­prised dur­ing enroll­ment sea­son. The prin­ci­pal fac­tor in the pro­jected increase, accord­ing to the news report (I haven’t read the actual doc­u­ment), is Med­ic­aid expan­sion. With­out that, the pro­jected increase is closer to 17%.

I don’t want my neigh­bors cov­ered by Med­ic­aid expan­sion to get sicker or forgo men­tal health care or sub­stance abuse treat­ment. What irks me is that any­one in gov­ern­ment or media could be sur­prised or dis­tressed that expan­sion actu­ally leads to cost increases and dis­tor­tions in how health care is provided.

I hope no one’s sur­prised when the result­ing pre­mium increases for my non-​Medicaid neigh­bors leads to changes in their behav­ior, such as drop­ping insur­ance altogether.

Last year’s price spike finally pushed me over the edge and out of the mar­ket. In the government’s view, I am unin­sured, hav­ing opted for a healthshare pro­gram that Oba­macare benignly tol­er­ates. My hus­band has retained a con­ven­tional pol­icy, and we’re keep­ing records to see how our costs com­pare over time.

Ideal? No. My costs are pretty much under my con­trol, right up to the time I’m badly injured or develop a seri­ous med­ical con­di­tion. I would then be at the mercy of my fel­low shar­ers and of the bean-​counters in my health­care providers’ offices. Fur­ther, I am wait­ing uneasily for the Oba­macare fans to amend the law so that healthshare pro­grams are no longer penalty-​free. Frankly, I think that kind of amend­ment is likely to come much sooner than any Repub­li­can health-​insurance reform.

Med­ic­aid is per­ma­nently expanded. I believe that. So will there be any health insur­ance “fixes” this year that would head off a 44% aver­age increase in pre­mi­ums on my state’s exchange next year? I don’t see how, no mat­ter who’s in the White House. I’m pes­simistic about the finan­cial aspect of gov­ern­ment health insur­ance because I’ve seen over the past five years that elected offi­cials can’t even get the lit­tle things right.

By “lit­tle,” I don’t mean unim­por­tant. I’m think­ing of Obamacare’s con­tra­cep­tive man­date. That’s the gov­ern­ment pol­icy that treats being a woman as a pre-​existing con­di­tion by call­ing women’s con­tra­cep­tives “pre­ven­tive” care. Busi­ness own­ers who offer health insur­ance to employ­ees, and who have moral objec­tions to coerced involve­ment in their employ­ees’ birth con­trol deci­sions, have had to go to court to escape the mandate.

Pres­i­dent Trump’s recent religious-​liberty order was tightly lim­ited and it did not undo the man­date. The Lit­tle Sis­ters of the Poor will ben­e­fit from his order, because he’s taken a per­sonal inter­est in their case. Dozens of other man­date chal­lengers are still mak­ing their way through the courts, with only these words from the President’s order to com­fort them along the way: [cab­i­net depart­ments] “shall con­sider issu­ing amended reg­u­la­tions, con­sis­tent with applic­a­ble law, to address conscience-​based objec­tions to the preventive-​care mandate.”

In five years, regard­less of the party in power, Con­gress has failed to repeal the man­date. A Repub­li­can pres­i­dent has man­aged only to tell his peo­ple to “con­sider issu­ing amended reg­u­la­tions.” The Supreme Court has had the chance to throw out the man­date as a reli­gious lib­erty vio­la­tion, and it has not done so.

I can’t trust them to fix even one small but crit­i­cal aspect of health care pol­icy. I sure can’t trust them to fix the whole thing. Bring on the spikes.

Ellen Kolb blogs about New Hamp­shire life-​issue pol­icy at Leaven for the Loaf and looks far­ther afield in ellenkolb​.com.

My local Sunday paper had an above-the-fold headline the other day: “Obamacare rate could see big spike in NH next year.” This refers only to my state, where an unidentified government official leaked to the press a document projecting an average Obamacare-exchange premium rate increase of 44%.

The headline could easily have said “another spike.” Obamacare-linked price hikes are old news. Still, I’m glad this wound up on the front page. That indicates that at least one assignment editor doesn’t take big increases for granted.

The story said that the document was stamped Confidential and Draft Only and Not for Distribution. I wish I knew who leaked it so I could deliver my personal thanks. I don’t like being surprised during enrollment season. The principal factor in the projected increase, according to the news report (I haven’t read the actual document), is Medicaid expansion. Without that, the projected increase is closer to 17%.

I don’t want my neighbors covered by Medicaid expansion to get sicker or forgo mental health care or substance abuse treatment. What irks me is that anyone in government or media could be surprised or distressed that expansion actually leads to cost increases and distortions in how health care is provided.

I hope no one’s surprised when the resulting premium increases for my non-Medicaid neighbors leads to changes in their behavior, such as dropping insurance altogether.

Last year’s price spike finally pushed me over the edge and out of the market. In the government’s view, I am uninsured, having opted for a healthshare program that Obamacare benignly tolerates. My husband has retained a conventional policy, and we’re keeping records to see how our costs compare over time.

Ideal? No. My costs are pretty much under my control, right up to the time I’m badly injured or develop a serious medical condition. I would then be at the mercy of my fellow sharers and of the bean-counters in my healthcare providers’ offices. Further, I am waiting uneasily for the Obamacare fans to amend the law so that healthshare programs are no longer penalty-free. Frankly, I think that kind of amendment is likely to come much sooner than any Republican health-insurance reform.

Medicaid is permanently expanded. I believe that. So will there be any health insurance “fixes” this year that would head off a 44% average increase in premiums on my state’s exchange next year? I don’t see how, no matter who’s in the White House. I’m pessimistic about the financial aspect of government health insurance because I’ve seen over the past five years that elected officials can’t even get the little things right.

By “little,” I don’t mean unimportant. I’m thinking of Obamacare’s contraceptive mandate. That’s the government policy that treats being a woman as a pre-existing condition by calling women’s contraceptives “preventive” care. Business owners who offer health insurance to employees, and who have moral objections to coerced involvement in their employees’ birth control decisions, have had to go to court to escape the mandate.

President Trump’s recent religious-liberty order was tightly limited and it did not undo the mandate. The Little Sisters of the Poor will benefit from his order, because he’s taken a personal interest in their case. Dozens of other mandate challengers are still making their way through the courts, with only these words from the President’s order to comfort them along the way: [cabinet departments] “shall consider issuing amended regulations, consistent with applicable law, to address conscience-based objections to the preventive-care mandate.”

In five years, regardless of the party in power, Congress has failed to repeal the mandate. A Republican president has managed only to tell his people to “consider issuing amended regulations.” The Supreme Court has had the chance to throw out the mandate as a religious liberty violation, and it has not done so.

I can’t trust them to fix even one small but critical aspect of health care policy. I sure can’t trust them to fix the whole thing. Bring on the spikes.

Ellen Kolb blogs about New Hampshire life-issue policy at Leaven for the Loaf and looks farther afield in ellenkolb.com