It is important to remember that rising insurance costs are not a phenomenon limited to the Obamacare exchange plans. Health care costs continue to rise overall, and insurance companies have to charge higher premiums and copays to keep up. Employment-based health insurance plans will be costing 5.5% more, and employee out-of-pocket costs continue to increase even faster and have now nearly doubled since 2009.
A recent study in JAMA Oncology highlighted an important point regarding the “financial toxicity” of cancer care – having Medicare coverage is often not enough to protect from catastrophic costs. 10% of Medicare patients with a new diagnosis of cancer will spend two-thirds of their annual income on health care bills.
“Beyond highlighting the need for innovative initiatives for delivery of care, the high level of hospital-associated OOP costs may also demonstrate potential adverse consequences of Medicare’s current design of benefits…Assigning beneficiaries such a high responsibility of cost sharing for inpatient care may not be an effective use of cost sharing, as hospitalizations are usually not at the discretion of beneficiaries.”
A conversation on the potential for Obamacare repeal, from The Incidental Economist bloggers Aaron Carroll and Austin Frakt.
“They’re actually in a tough policy spot. They’ll get the blame if they don’t fix or repeal the A.C.A., and they’ll get the blame if they don’t replace it with something people like better. Health policy is a very difficult and thankless task. I think they’ll opt for something they can call repeal and replace, but they could also just let Obamacare struggle and die. Neither looks good.”
In order to convince health insurance companies to engage in the ACA/Obamacare exchanges, the law included a provision known as the “risk corridors.” In sort, if insurance companies ended up losing money because they insured sicker-than-average patients who incurred higher-than-average health care costs, the risk corridor system would give them money to recoup the losses. So, insurance companies joined the ACA exchanges. And they dutifully lost money. However, Congress did not appropriate money for the risk corridors, so these insurers are still short billions of dollars that was promised to them, and are suing the government to get it.
Nicholas Bagley reports on the debacle at the NEJM.
“For now, the Justice Department is fighting the lawsuits. But the insurers’ legal arguments have considerable force. Indeed, HHS has openly acknowledged that risk-corridor payments are ‘obligation[s] of the United States for which full payment is required.'”
Surgeon General Murthy on ending the opioid epidemic.