Tuesday, April 15, 2014

Tell me your ACA-shopping story

Always fair-minded, Jonathan Cohn pauses in his celebration of lower-than-forecast ACA premiums (as highlighted by the latest CBO update) to acknowledge:

In the transition from the old system, in which insurers could charge higher prices to the sick or avoid them altogether, to a new system, in which everybody pays the same price regardless of pre-existing condition, some young and healthy people must now pay more for their individual policies
The "and" in "young and healthy" is interesting, because, as the conjunction suggests if you look twice, it's not just the young who are paying more under ACA rules. Some if not most healthy older buyers who were in the individual market in 2013 are now paying more -- that is, if no one sharing the insurance has a preexisting condition.*

If you're in the individual market and you're paying more for your insurance in 2014 than you did in 2013, I'd like to speak to you (or, for that matter, if you're unsubsidized and paying less or about the same).  I'd like some detail about what your prior policy covered vs. what your current one does -- what were the tradeoffs. (I wrote up two such stories last month, and I'd like to do more.)

I'd also like to speak to buyers on the individual market about another ACA tradeoff highlighted by the CBO report: the prevalence on ACA exchanges of so-called "narrow network" policies that limit the pool of doctors and hospitals below current norms. Economists love narrow networks, because they provide a check on providers' pricing power, which is outsized in the U.S.. My impression, however, is that most people who can afford to will pay more to have access to a broader network.  If you bought an ACA policy and consciously weighed network size vs. price -- again, I'd like to speak to you.

If you'd like to share your experience, please contact me via the "about me" tab on the right margin of this blog. And pass the word if you know others who have tales to tell. Thanks!

*While the ACA reduced the permissible degree to which insurers could charge the oldest buyers more than the youngest, from a pre-ACA norm of 5-to-1 to a maximum of 3-to-1, that relative break for older buyers is offset by community rating, which forbids charging sicker or higher-risk buyers more based on their medical history, and also by mandated Essential Health Benefits, many of which were excluded from many policies pre-ACA. Those exclusions were in some cases fine with the buyers: most fifty-somethings are okay with foregoing childbirth coverage.

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