Rate hikes just keep coming.
The latest we’ve heard about come from Blue Cross Blue Shield in North Carolina, which just warned 125,000 customers who bought individual policies to brace themselves for unusually large increases. CareFirst Blue Cross Blue Shield of Maryland announced hikes averaging 25 percent for its individual policies and about 15 percent for small businesses. Medico, based in Minnesota, said it would increase rates an average of 13 percent for some 5,000 people covered through small employers who renew their policies this summer. Ditto in other states, where carriers already raised rates for individuals and small employers. Insurance insiders say more will come.
With these increases come lots of questions from the public, questions that journalists will be asked to address. In Rhode Island, Robert Cagnetta, a small business owner and a member of the Health Insurance Advisory Council for the state’s health insurance commissioner, wrote an op ed for the Providence Journal challenging recent rate increases—15 percent for small groups; 18 percent for individuals—announced by Blue Cross & Blue Shield of Rhode Island. “We’re asked to pay blindly, and more and more every year,” he wrote. “We need transparency now.”
Most Americans get their insurance from their employer, or the military, or Medicare. President Obama’s Affordable Care Act primarily affects those who buy their insurance on their own—currently about 15 million people. In that group, some premiums will indeed be pushed higher, while others will be pushed lower. Some people will get subsidies to help them pay their premiums, while others will not.
Will insurance be affordable? It’s a question reporters will be asked to address, and one that can only be fully answered family by family, budget by budget. But journalists can help. The best thing they can do now is work to understand how health insurance is priced.
But insurance pricing is tricky. What follows is a brief primer on some of the nuts and bolts of rates and premiums, which, not so incidently are key to the success or failure of Obamacare.
What’s pushing up premiums
The insurance industry’s standard line is that the reason premiums are rising is because the underlying cost of care continues to rise. Companies maintain they are simply passing along those continuing increases in medical costs, plus a slice for profits and expenses (which include high salaries for CEOs). At least that’s what they’re telling customers.
But how does that rationale square with the news that medical costs have moderated, as the White House points out? A few weeks ago the White House deputy press secretary, quoting the chairman of he Council of Economic Advisers, said that health expenditure data shows the lowest rate of growth since reporting began in 1960. What gives?
Part of the answer: Even though healthcare inflation has slowed a bit, that doesn’t mean it has stopped, or that insurers don’t factor medical price increases into their premiums. They do. While healthcare inflation—called “medical trend” in insurance jargon—has moderated relative to what it has been in the past, that doesn’t mean the price of care has not gone up. It’s running between 4 and 7 percent a year, and insurers account for it in the premiums they charge. (Sometimes, though, carriers now add on slightly more than the current medical trend, particularly for high-deductible plans. The reason: while high deductibles remain fixed, the price of care is not. In 2014 all plans will be subject to these add-ons.)
Higher medical costs don’t explain all the premium hikes, though. And yes, Obamacare is part of the puzzle. The law may indeed cause companies to boost the price of coverage—and “fairly substantially in most states, before a premium subsidy is applied,” says Jim O’Connor, an actuary with the Milliman firm.
But if the main provisions of Obamacare have yet to take effect, how can it be the reason for this year’s increases?

Question: when somebody applies for a policy for the first time, does the first insurer he/she asks have to give him/her one, or is there a 'last-resort' insurer for that?
I read that many small companies will be reducing their staff or the working hours to avoid having to provide health care insurance. Concerning restaurants, this is disconcerting. Does anybody consider a sick person (coughing, sneezing, with high fever) handling FOOD? In the kitchen, handling salads? Waiting on tables? Shouldn't health coverage for all those working in the food-and-beverage business be mandatory, no matter how small?
#1 Posted by Michael S. Cullen, CJR on Mon 13 May 2013 at 03:54 PM
When the health reform law goes into effect Jan. 1, insurers will have to cover all people even those who re sick.Now they can refuse coverage to those with serious and sometimes not so serious illnesses. Currently some states have high risk pools as an insurer of last resort. Those won't be necessary under Obamacare.
#2 Posted by Trudy Lieberman, CJR on Tue 14 May 2013 at 07:27 AM
Under the health reform law insurers have to cover all people even if they are sick.Now they can and do refuse to issue policies to people who have serious and sometimes not so serious health conditions. And in some states there are high-risk pools for people who are turned down. Under the new law, people will no longer be turned down for coverage based on their health status.
#3 Posted by Trudy Lieberman, CJR on Tue 14 May 2013 at 07:29 AM
I thought "silver" plans were 70/30 instead of 80/20 as you mention. I had read that only the 70/30 plans were eligible for subsidies. I had also read that the 60/40 "bronze" plans were not eligible for subsidies. Can you list the plans that are eligible for subsidies?
#4 Posted by Splashoil, CJR on Wed 15 May 2013 at 09:30 AM
http://www.nakedcapitalism.com/2013/05/why-are-people-with-health-insurance-going-bankrupt.html
ZEESE: [T]here’s several levels of insurance coverage [available under ObamaCare:] 90/10, where the insurance company pays 90 percent, consumer pays 10 percent; 80/20; 70/30; 60/40. The subsidy provided by Obamacare to people who can’t afford insurance will only cover 70/30 plans. So when you get a serious illness, you’re paying 30 percent of the cost of that health care.
Now, what’s really bad about this is that prior to Obamacare, some of the state insurance regulators were pushing insurance coverers to a higher level, where they would provide more coverage rather than less. Obamacare has now put it into law that 60/40 is okay and 70/30 is what the government will pay for. And so the 80/20 and 90/10′s become less common. So you’re going to see more and more people with under-insurance and not going to see lack of insurance completely go away.
Having to pay 30% for a really serious illness is “Lose your house” territory. Yikes! And maybe I’m old-fashioned, but when the Feds step in to set a standard, I tend to expect them to improve on what the states are doing, and not degrade the situation.
This is what I read. If you have different information let us know!
#5 Posted by Splashoil, CJR on Wed 15 May 2013 at 12:28 PM
"What insurers fear most is that swarms of sick people will buy their policies."
Sick people are just like locusts eating up insurance companies' profits and executives' bonuses.
#6 Posted by JL, CJR on Wed 15 May 2013 at 06:01 PM