And you thought last year was bad.
That statement could refer to a number of things, but today I'm talking about health-insurance premiums. Georgians shopping on the Obamacare exchange last fall saw double-digit increases for the second straight year. But the rates for 2018, which the state insurance commissioner approved this week , make previous price hikes pale in comparison:
- Alliant, up by an average of 21 percent in rates for 2017, was approved for a 31 percent jump for 2018.
- Ambetter: 13.7 percent then, 23.8 percent now.
- Blue Cross Blue Shield: 21.4 percent, 40.6 percent.
- Kaiser Permanente: 17.6 percent, 30.6 percent.
As for the other insurers that announced big premium increases last fall, Harken Health and Humana, I have good news and bad news. The good news is their premiums aren’t going up. The bad news: That’s because they’re not selling plans in Georgia anymore.
Those percentages for 2018 could rise further. The state approved even steeper increases in the event Washington doesn’t fund “cost sharing reduction” subsidies, which supplement Obamacare’s other subsidies for lower-income Americans. The increases range from another 17 percentage points on top of Blue Cross’ price spike to 27 points for Ambetter’s.
The debate over CSR, and the potential ramifications for insurance premiums, has garnered the headlines. But it's important to remember this problem pre-existed the CSR controversy and would be getting worse even without it. (Not to mention the U.S. House sued in federal court, and won , to stop the Obama administration from paying CSR subsidies even though Congress hadn't appropriated money for them.)
Restoring the CSR subsidies was on the table for the bipartisan talks Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., held over the summer. The talks were put on ice in September, with the short-lived emergence of the Graham-Cassidy bill widely cited as the reason. That’s only partially true.
The Alexander-Murray talks were never going anywhere. The supposed “give” from the Democrats was a vague paean to more state control over health care — even though that control would have remained in the regulatory framework set out by Obamacare. Which is to say, it would have been “control” in the same way there is “competition” on the exchanges amid those regulations: in name only.
The crisis on the exchanges, where people shop if they don't get insurance through the government or their employer, is a byproduct of those regulations. They drive up premiums as well as deductibles, with little flexibility for insurers to differentiate their plans in a meaningful way. Consumers who are healthy enough to forgo insurance pay a tax penalty and roll the dice (or try to find a way to buy insurance when they become sick). The ones who do buy plans are the ones in poorest health, who naturally are heavy users of health care.
That drives up prices again, and ’round and ’round we go.
That is why, although the Senate looks like it will miss the Sept. 30 deadline for repealing and replacing Obamacare via reconciliation for the 2018 budget year, Republicans can't be finished with health care. Folks in Georgia and elsewhere face the problem of an individual-market death spiral, financial gaps at safety-net hospitals, imperiled rural hospitals, prices for health care (not just insurance) that continue to rise, and more.
The ills wrought by Obamacare aren’t going away on their own.
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