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A Voice for Private Physicians Since 1943

More and More Unaffordable

This week’s health policy news roundup curated by Jane Orient, M.D.

Health insurers throughout the U.S. are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected, writes Robert Pear. The rate requests are the first to reflect a full year of experience with the new insurance exchanges and federal guaranteed issue/community rating. In Oregon, claims exceeded revenue by more than $100 million.

Jesse Ellis O’Brien of the Oregon State Public Interest Research Group said: “Rate increases will be bigger in 2016 than they have been for years and years and will have a profound effect on consumers here. Some may start wondering if insurance is affordable or if it’s worth the money.”

President Obama said consumers should complain to state insurance regulators. http://www.nytimes.com/2015/07/04/us/health-insurance-companies-seek-big-rate-increases-for-2016.html

Only the billions of dollars in subsidies keep premiums remotely affordable for some. And just as predicted, low-risk individuals are shunning the Exchanges. Just 250,000 people took advantage of a special enrollment period earlier this year to purchase coverage. The law’s boosters envisioned that five times as many might do so, writes Sally Pipes. http://www.forbes.com/sites/sallypipes/2015/06/29/obamacares-true-costs-are-finally-coming-to-light/

More than 6 million taxpayers paid the fine for not having qualifying insurance. http://www.bloomberg.com/news/articles/2015-07-15/obamacare-fines-paid-by-6-6-million-taxpayers-more-than-planned?mc_cid=0dc478f127&mc_eid=cfafdebde6

Enrollment figures show why ObamaCare in its current form isn’t “here to stay.” It is fiscally unsustainable, writes Robert Laszewski. “The proportion of the population that is signing up for Obamacare is concentrated in the very lowest income categories while Obamacare is obviously unattractive to everyone else.” http://www.forbes.com/sites/robertlaszewski2/2015/06/29/why-the-affordable-care-act-isnt-here-to-stay/print/

The real question for Americans is whether their hospital and their doctor are here to stay as health plan mega-mergers shift power and profits to cash-rich plans, which are no longer risk-bearing entities. “The whole model of healthcare has changed in the past twenty years to have the provider taking the risk,” states Robert Fuller, J.D. former chief operating officer of Downey Regional Medical Center in Los Angeles. http://www.healthleadersmedia.com/print/HEP-317643/MegaMergers-Among-Health-Insurers-Bode-Ill-for-Hospitals

“Seventeen states have a single health insurer with a commercial market share of 50% or more,” states AMA president Steven Stack, M.D. “The dominant market power of big health insurers increases the risk of anti-competitive behavior that harms patients as health insurers substitute corporate policy over good clinical decisions.” http://www.healthleadersmedia.com/content/HEP-318236/Aetnas-37B-Humana-Acquisition-Has-Providers-Wary

One innovation that is making care affordable is the spread of direct-pay practices, writes Paul Hsieh. M.D., and laws in 13 states that have now declared that direct pay practices will not be subject to inappropriate insurance regulations. http://www.forbes.com/sites/paulhsieh/2015/06/29/three-good-things-in-health-care-innovation/3/

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