Lot of missing info here. The devil is in the details. "Of the states studied, all experienced health insurance rate increases..." doesn't break it to individual companies. If only one company in one state experienced an increase, it would still fit into this category. "Pre-ACA premiums average $62.00 monthly, while post-ACA premiums average $187.08 per month..." is too imprecise to bother with. "The average percent change between 2013 and 2014 minimum level plan monthly premiums is 260 percent, reflecting a nearly 3 to 1 ratio between the two sets of premiums...." doesn't give enough information to judge whether this is true or false.
So you say.
You want the details?
[1] Julie Pace and Jim Kuhnhenn, Obama declared health care law ‘is here to stay’, Associated Press (May 10, 2013), available at
http://www.boston.com/news/politics...w-here-stay/aH3Iy2nHcV7l3859kzd62N/story.html.
[2] See e.g. Katherine Baicker, William J. Congdon, and Sendhil Mullainathan, Health Insurance Coverage and Take- Up: Lessons from Behavioral Economics, 90 The Milbank Quarterly 107, 117 (March 2012); Kirsten Bibbins-Domingo, PhD, MD and Melissa Burroughs Pena, MD, Caring for the “Young Invincibles”, 25 J. Gen. Intern. Med. 642 (2010); Peter Diamond, Organizing the Health Insurance Market, 60 Econometrica 1233, 1236 (1992); Neil D. Weinstein, Unrealistic Optimism About Future Life Events, 39 J. Personality & Soc. Psych. 806, 806 (1980).
[3] See e.g. S. R. Collins, R. Robertson, T. Garber, and M. M. Doty, Young, Uninsured, and in Debt: Why Young Adults Lack Health Insurance and How the Affordable Care Act Is Helping, The Commonwealth Fund, June 2012.
[4] Letter from Nat’l Ass’n of Ins. Comm’rs, to John J. O’Brien, Dir., Healthcare and Ins., U.S. Office of Pers. Mgmt. (Oct. 24, 2012), available at
http://www.naic.org/documents/index_health_reform_section_commentletter.pdf.
[5] See e.g. Thomas Buchmueller and John DiNardo, Did Community Rating Induce an Adverse Selection Death Spiral? Evidence from New York, Pennsylvania, and Connecticut, 92 Am. Econ. Rev. 280 (2002); David Cutler and Richard Zeckhauser, Adverse Selection in Health Insurance, Frontiers in Health Policy Research 1, 8 (January 1998).
[6] 2014 premium rate data was derived from the Kaiser Health News compilation State Premium Watch: Pricing in the New Insurance Marketplaces, which contains website links and PDFs of the rates for the state-run exchanges, state-federal partnership exchanges, and federally-run exchanges. All rates used in this paper were released prior to the October 1, 2013 launch of the exchange system (available at
http://www.kaiserhealthnews.org/stories/2013/august/04/state-premium-watch-exchanges- marketplaces.aspx).
[7] Adjusted rate price (APR) = Base rate (BR) x Premium ratio (PR).
[8] U.S. Government Accountability Office, Private Health Insurance: The Range of Base Premiums in the Individual Market by State in January 2013, GAO-13-712R (Jul 23, 2013).
[9] It should also be noted that as Massachusetts’ premiums increased, the public received less for its money. A 2013 study commissioned by the Commonwealth of Massachusetts Center for Health Information and Analysis found that from 2009-2011, as premiums increased by 9.7 percent, the value of benefits decreased 5.1 percent.
[10] See e.g. Karen Mills, Apples and Oranges, The White House Blog (July 21, 2010), available at
http://www.whitehouse.gov/blog/2010/07/21/apples-and-oranges; Ezra Klein, The shocking truth about Obamacare’s rate shock, Washington Post Online (June 1, 2013), available at
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/01/the-shocking-truth-about-obamacares- rate-shock/.
[11] 42 U.S.C. § 9010.
[12] Congressional Budget Office, An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act (November 30, 2009), available at
http://www.cbo.gov/publication/41792.
[13] Thomas A. Barthold, Letter to Senator Jon Kyl, Joint Committee on Taxation (June 30, 2011), available at
http://www.ahipcoverage.com/wp-content/uploads/2011/11/Premium-Tax-JCT-Letter-to-Kyl-060311-
2.pdf.
[14] Chris Carlson, Estimated Premium Impacts of Annual Fees Assessed on Health Insurance Plans, Oliver Wyman 3 (October 31, 2011).
[15] Chris Carlson, Annual Tax on Insurers Allocated by State, Oliver Wyman 7 (November 2012).
[16] 31 U.S.C. § 9701(a); 45 C.F.R. § 156.50(b).
[17] Trustmark Companies, Patient Protection and Affordable Care Act In Focus: Overview of Four New Fees, 2 (July 18, 2013), available at
http://www.starmarkinc.com/email/starmark/T500-170.pdf.
[18] 42 U.S.C. § 1311(d)(5)(A).
[19] West Virginia Offices of the Insurance Commissioner, West Virginia Health Benefit Exchange: Financial Sustainability Overview, slide 17 (June 11, 2012), available at
http://bewv.wvinsurance.gov/LinkClick.aspx?fileticket=hJnhICt7GxA=&tabid=112&mid=481 (discussing a maximum projected per member per month user fee of $45.02, or $540.24 annually).
[20] 42 U.S.C. § 300gg(6)(a) (“A health insurance issuer…shall ensure that such coverage includes the essential health benefits package required under section 18022(a) of this title.”).
[21] Id. at § 18022(a)-(b).
[22] Center for Consumer Information and Insurance Oversight, Additional Information on Proposed State Essential Health Benefits Benchmark Plans, Centers for Medicare and Medicaid Services, available at
http://www.cms.gov/CCIIO/Resources/Data-Resources/ehb.html.
[23] See generally American’s Health Insurance Plans, Research Findings: Independent Studies Estimate the Cost and Coverage Impact of the Affordable Care Act in Selected States (2012), available at
http://www.ahip.org/Issues/Documents/2012/Research-Findings--Independent-Studies-Estimate-the-Cost- and-Coverage-Impact-of-the-Affordable-Care-Act-in-Selected-States.aspx.
[24] See Jennifer Smagula and Jonathan Gruber, The Impact of the ACA on Maine’s Health Insurance Markets, Maine Bureau of Insurance, 22 (2011), available at
http://www.maine.gov/pfr/insurance/reports/pdf/Impact_ACA.pdf; see also Wakely Consulting Group, Impact of the ACA on Small Group and Non-Group Market Premiums, State of Rhode Island, 15 (2011), available at
http://www.naic.org/documents/committees_b_hcra_wg_120503_Wakely_RI_12-13-11.pdf.
[25] Tom Baker, Health Insurance, Risk, and Responsibility after the Patient Protection and Affordable Care Act, 159 U. Pa. L. Rev. 1577, 1587 (June 2011).
[26] 42 U.S.C. § 18022(d)(2)(A).
[27] Id. at § 18022(d)(1)(A)-(D).
[28] Jon R. Gabel, Ryan Lore, Roland D. McDevitt, Jeremy D. Pickreign, Heidi Whitmore, Michael Slover and Ethan Levy-Forsythe, More Than Half Of Individual Health Plans Offer Coverage That Falls Short Of What Can Be Sold Through Exchanges As Of 2014, 31 Health Affairs 1339, 1342-43 (May 21, 2012).
[29] Paul Skowronek, Health Industry Perspective on the Affordable Care Act, America’s Health Insurance Plans, slide 9 (July 30, 2012), available at
http://www.slcatlanta.org/WV2012/presentations/skowronek.pdf.
[30] 42 U.S.C. § 300gg(a)(1)(A)(iii).
[31] Kurt Giesa and Chris Carlson, Impact of Changing Age Rating Bands in America’s Healthy Future Act of 2009, Oliver Wyman, 3 (September 28, 2009), available at
http://www.ahip.org/Issues/Document...n-“America’s-Healthy-Future-Act-of-2009”.aspx.
[32] 42 U.S.C. § 300gg(a)(1)(A)(i)-(iv); See e.g. Roger L. Pupp, Community Rating and Cross Subsidies in Health Insurance, 48 J. Risk & Ins. 610, 610–11 (December 1981).
[33] Id.
[34] Janet L. Kaminski Leduc, Community Versus Experience Rating Health Insurance, OLR Research Report – State of Connecticut General Assembly (July 3, 2008), available at
http://cga.ct.gov/2008/rpt/2008-R-0377.htm.
[35] William J. Congdon, Amanda Kowalski, and Mark H. Showalter, State Health Insurance Regulations and the Price of High-Deductible Policies, Council of Economic Advisers (January 13, 2005), available at
http://jonmckane.com/Health Insurance/Showalter Study.pdf.
[36] Id. at 6.
[37] 42 U.S.C. §§ 300gg-1(a), 300gg-3, 300gg-4(a).
[38] Id. at § 300gg-1(a) (“[E]ach health insurance issuer that offers health insurance coverage in the individual or group market in a State must accept every employer and individual in the State that applies for such coverage.”); see also Alec MacGillis, The Insured: It’s Status Quo, for Now, in Landmark: The Inside Story of America’s New Healthcare Law and What it Means for Us All, 99, 101 (2010) (discussing the denial of coverage for preexisting conditions as discriminatory).
[39] State Health Insurance Regulations and the Price of High-Deductible Policies, supra note 34, at 6.
[40] Leigh Wachenheim and Hans Leida, The Impact of Guaranteed Issue and Community Rating Reforms on States’ Individual Insurance Markets, Milliman, Inc. (March 2012).
[41] Id. Each of the eight states experienced at least one significant negative consequence as a result of the implementation of community rating and guaranteed issue market reforms. Premium increases were seen in Maine, Massachusetts, New Jersey, and New York. Five states – Kentucky, Maine, Massachusetts, New Jersey, and Washington – experienced a “flight” of insurers from their markets. Decreased enrollment, likely as a result of increased premiums or decreased plan options, occurred in New Hampshire and Vermont.
[42] 42 U.S.C. § 18091(a)(2)(I); see Peter J. Smith, Federalism, Lochner, and the Individual Mandate, 91 B. U. L. Rev. 1723, 1727 (2011) (discussing the damage these provisions would do to the insurance market in the absence of the individual mandate).
[43] Uwe Reinhardt, Ph.D., Health Reform in the 21st Century: Insurance Market Reforms, Hearing before the House Comm. On Ways and Means, 111th Cong., 13 (2009).
[44] 26 U.S.C. § 5000A.
[45] 42 U.S.C. § 18071(c)(1)-(2).
[46] See 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII) (expanding Medicaid eligibility to individuals with family incomes at or below 133% of the federal poverty level).
[47] Id.
[48] 42 U.S.C. § 18082(c)(2)(A) (“The Secretary of the Treasury shall make the advance payment under this section of any premium tax credit allowed under section 36B of [the Internal Revenue Code] to the issuer of a qualified health plan on a monthly basis”).
[49] 26 U.S.C. § 36B(b)(2)(B)(i)-(ii).
[50] Id. at § 36B(b)(3)(A)(i).
[51] 26 U.S.C. § 5000A(c)(3)(B).
[52] Id. at § 5000A(c)(1)(B).
[53] Sherry A. Glied, Jacob Hartz, and Genessa Giorgi, Consider It Done? The Likely Efficacy of Mandates for Health Insurance, 26 Health Affairs 1612, 1618 (November/December 2007).
[54] Design and methodology derived from “Analysis of Exchange Subsidies and Enrollee Payments in 2016” in An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act, supra note 11, at 29.
[55] It should be noted that subsidies are technically available for individuals and families with incomes up to 400% FPL. Although the cut-off for the availability of subsidies for our subject is 314 percent FPL, this level will vary based upon an individual’s unique circumstances.
[56] Amy B. Monahan, On Subsidies and Mandates: A Regulatory Critique of the ACA, 36 J. Corp. L. 781, 794 (July 2011) (discussing the concept of “delta,” the result of a comparison of the benefit of coverage to the difference between premium costs and any penalties).
[57] Emily Carrier, Tracy Yee, and Rachel L. Garfield, The Uninsured and Their Health Care Needs: How Have They Changed Since the Recession?, Kaiser Commission on Medicaid and the Uninsured 3 (October 2011) (data derived from the Center for Studying Health System Change’s 2003, 2007, and 2010 Health Tracking Household Surveys).
http://americanactionforum.org/research/premium-increases-for-young-invincibles-under-the-aca-and-the-impending
