But that may not be the case for everyone. In an email to Washburn, a 58-year-old woman said she had to buy her own coverage when her company stopped insuring its workers. Now she pays $447 per month for a Horizon policy. Her new monthly premium will be $695, which is not affordable, she said. Neither were the premiums of Horizon’s two competitors. Horizon’s bronze plan, she explained, had a $2,500 deductible and 50 percent coinsurance. “Who in their right mind would want to waste almost $700/month on this?”
This reminded me of another piece Washburn wrote that received a CJR laurel. She told what happened to a 58-year-old woman named Frances Giordano, whose life descended into chaos when her medical expenses for treating lung cancer were more than she could afford even with a good job and insurance that came with modest copayments. Even with limits on out-of-pocket spending—-a provision delayed until 2015—I wrote that there will be others like Giordano. Washburn’s update shows why.
Steve Koff takes a microscope to premiums for small employers. Small employers were supposed to get a break under the Affordable Care Act. Let’s face it, they have had a tough time paying for worker coverage, because their small employee pool was insufficient to spread the risk of insuring those who got sick. The result: employers in this pickle paid hefty premiums.
Koff, Washington bureau chief for the Cleveland Plain Dealer, looked at the new reality in Ohio and found that “until things stabilize, [the Affordable Care Act] is going to mean a lot of price hikes for small businesses.”
Or to be more precise: the minority of small businesses whose employees are at high risk of substantial medical expenses will pay quite a bit less, and other companies will pay more. That’s because many of the traditional factors that have been used to calculate premiums are outlawed come January 1. They include making women (or their employers) pay more and easing the disparities between what older and younger people pay. Welcome to the world of redistribution that’s in the ACA—something that, as I have pointed out, is not well understood and was almost never discussed in the sales job for Obamacare.
Koff illustrated how this redistribution is happening in the small employer market. “Medical risk is gone,” Mike Troyan, the owner of a benefits brokerage agency, tells him Well, yes, it is—or at least sharply reduced.. A broad sharing of the risk is one of the aims of Obamacare, and it is the key ingredient that makes health systems work for the benefit of everyone in other countries. This risk pooling is also what makes it possible to insure large numbers of old, sick people in Medicare for a reasonable cost. Koff tried to explain some of that in this reporting, ending with this question: “If it all comes together—if the ACA’s current technical glitches are overcome and the pricing works out for at least some—-will next year’s pain for others be worth it, or at least fairer?”
In a note to me, Koff said that his piece actually ended up “a bit more he-said, she said than I would prefer.” It wasn’t even the story he set out to do: He had started to compare actual premiums and that other stuff you need to really know if one plan is better than another, like deductibles and coinsurance. But the new SHOP exchanges that many small businesses are eligible to buy in are not yet operational. “The federal site was cumbersome and didn’t have as much information as you need to compare,” he told me, adding it was “impossible” to do so on insurance company websites because of how time-consuming the process is.
Still, he delivered a thoughtful and nuanced look that largely got past the spin and examined the trade-offs the law makes. Wanted: more reports from the field like these.
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