The writing was on the wall long before the largest US insurer, UnitedHealth, decided to pull the plug on Obamacare in mid April. Then, just a week later, Aetna’s CEO said Thursday that his company expects to break even, but legislative fixes are needed to make the marketplace sustainable.
"I think a lot of insurance carriers expected red ink, but they didn’t expect this much red ink,” said Greg Scott, who oversees Deloitte’s health plans practice. "... A number of carriers need double-digit increases."
It gets better.
One week ago Marilyn Tavenner, who until January 2015 ran the federal Centers for Medicare and Medicaid Services, aka the massive Federal agency that oversaw the rollout of Obamacare and the disastrous implementation of HealthCare.gov and who is now as an insurance lobbyist, said she sees big jumps in Obamacare insurance premiums.
Translation: insurers are not making money, and they need to make money or Obamacare is doomed. Which means even more dramatic rate hikes are about to be unveiled. However, it's not the what but rather the when that is the shock. And, as Politico reports, the timing could not possibly come at a worse time for Democrats.
"Proposed rate hikes are just starting to dribble out, setting up a battle over health insurance costs in a tumultuous presidential election year that will decide the fate of Obamacare."
The headlines are likely to keep coming right up to Election Day since many consumers won’t see actual rates until the insurance marketplaces open Nov. 1 — a week before they go to the polls.
That's right: just one week before the election date, Americans will be served with what now appears will be double (if not more) digit increases in their insurance premiums. Politico is spot on in saying that "the last thing Democrats want to contend with just a week before the 2016 presidential election is an outcry over double-digit insurance hikes as millions of Americans begin signing up for Obamacare."
They will have no choice: following years of actual delays to avoid a major public backlash on the critical mandate, this time the hammer is set to fall and it will do so at the worst possible time for Hillary Clinton.
"Any reports of premium increases will immediately become talking points on the campaign trail,” said Larry Levitt, senior vice president for special initiatives at the nonprofit Kaiser Family Foundation. “We’re in an election where the very future of the law will be debated." Democrats say they will mount a vigorous defense of a law that has provided 20 million people with coverage — and point to Republicans' failure to propose any coherent alternative to Obamacare.
Which is another way to say Democrats are near panic.
"The Republicans will try to make Clinton own the higher prices, but the problem is that Republicans have no alternative or answer," said Anna Greenberg, a Democratic pollster. "They are in the position of taking away insurance if they repeal Obamacare.”
Somehow we doubt that would be such terrible news for all those millions of Americans whose mandatory "tax" (thank you Supreme Court) subsidies keep the program alive. We also doubt that anyone among America's middle class will shed a tear if Obamacare is gone.
Which brings us to the key question: just how much of a shocker will be unveiled days before the election? According to Politico, and here we disagree as we have seen price increases in the high double digit ragne, "average rate hikes have been modest in the past despite apocalyptic predictions: premiums increased by an average of 8 percent this year, according to an administration analysis. That report "debunks the myth" that Obamacare customers experienced double-digit rate hikes, said Department of Health and Human Services spokesman Ben Wakana."
Where we do agree with Politico is that "there are reasons to think the next round may be different." Blue Cross and Blue Shield plans, which dominate many state exchanges, saw profits plummet by 75 percent between 2013 and 2015, according to an analysis by A.M. Best Co. A chief reason for the financial woes: “the intensity of losses in the exchange segment.”
"I have to raise prices because I have to assume the worst,” said Martin Hickey, CEO of New Mexico Health Connections, one of the surviving co-ops, which expects to increase prices by roughly a third for 2017. “Whether it stabilizes or not, we can’t take the risk.”
Even New York-based Oscar, the much ballyhooed, tech-savvy startup bankrolled with billions in venture capital dollar, is sputtering. Medical costs for Oscar’s individual customers in New York, where it has the most customers, outstripped premiums by nearly 50 percent last year, according to financial filings.
"In some cases the hole is getting deeper rather than getting better,” said Deloitte’s Scott.
In short: expect majour double-digit percent increases in premium prices, and not just because Obamacare is fatally flawed, but for two key reasons we warned about years ago when Obamacare was being rolled out: i) not enough participants to make it economically scalable and ii) those who did sign up are so sick that they promptly soaked up all the externalities.
One big reason is lower-than-expected enrollment of younger, often healthier people who balance the costs of those who require more costly care. Roughly 12.7 million Americans signed up for Obamacare plans during the most recent open enrollment period. That’s far below the 22 million projected by the Congressional Budget Office, and it’s certain to decline as some drop out.
“The pool is far less healthy than we forecast,” said Brad Wilson, CEO of Blue Cross Blue Shield of North Carolina, which says it lost $400 million on its exchange business during the first two years and is weighing whether to compete for Obamacare customers in 2017. “That’s an issue not just here in North Carolina, but all over. … We need more healthy people in the pool.”
Then again, the healthy people have no incentive to sign up and would rather pay the penalty charge instead of spending far more to subsidize those who are not healthy. Sure enough, as with all epically flawed government projects, the cracks in Obamacare became apparent with time.
There’s a growing realization the financial penalty for failing to obtain coverage is an insufficient cudgel to convince younger Americans to enroll. The fee for 2016 is $695, or 2.5 percent of income, whichever is higher. Just 28 percent of HealthCare.gov customers for 2016 were between the ages of 18 and 34, significantly below the 35 percent threshold typically considered necessary for a balanced marketplace.
“It wasn’t enough of a hammer,” said Kevin Fitzgerald, an insurance lawyer with Foley & Lardner. “You need a lot of healthy people to sign up to make the numbers work. Obviously that didn’t happen.”
Ah, we get it now: only Obamacare had "enough of a hammer" it would work like a charm.
And then there was the timing arbitrage. Health plans have complained that Obamacare’s enrollment rules are too loose, allowing people to wait until they need medical care to sign up for coverage, and then to halt payments once they’ve received treatment.
This may work for Netflix, but it is an absolute disaster when it affects a mandatory tax program that is supposed to benefit everyone.
The Obama administration is addressing some of these concerns: It has eliminated some reasons Obamacare customers can use to sign up outside the standard enrollment season. And it plans to require proof from exchange customers that they’re eligible to sign up outside the normal window because, say, they've moved or had a kid, which are among the most common reasons.
Alas, such "real time fixes" also never work and end up being gamed by the consumers every step of the way. Which is why health plan officials say more needs to be done to stabilize the markets, for instance, by giving them greater flexibility to sell different kinds of policies. "We have real concerns about the next year or two based on the experience so far,” said Ceci Connolly, CEO of the Alliance of Community Health Plans, which represents 22 plans. “Even for our members that are getting close to breaking even on this, they say that it’s a really challenging and unpredictable environment.”
Most health plans remain optimistic the markets will eventually stabilize. Security Health Plan, which does business in 41 Wisconsin counties, attracted three times as many exchange customers as anticipated during its first year of Obamacare business.
“Was it a financial winner? No,” said John Kelly, the health plan’s chief marketing and operations officer. “We expected to take losses and we did.”
But no more, which is why literally in the days heading up to the general election, the US population will be served a very unpleasant reminder of what happens when big state goes out of control, and that there is no such thing as "free healthcare."
Just how much of a hit to Hillary's election chances the "Obamacare shock" will be, we will find out on November 8.