And this is some legitimately tough news for the Exchanges
First United, then Humana, now Aetna. This does not sound sustainable at all. @larry_levitt https://t.co/Q5qdlLHLTs
— Charles Ornstein (@charlesornstein) August 3, 2016
In my region, this is no big deal, the national players never got too much of a foothold here. But if the national players are backing out of most regions then the competition model that underlies the Exchanges with the hope of creating a market dynamic that is closer to national instead of regional is in trouble.
Humana dumped about 85% of their covered lives. UHC is dumped most of their covered lives. Aetna was planning on expanding but it has put off its expansion plans. If it pulls back significantly, the number of counties that have one or two insurers only will increase significantly. If those remaining insurers price to a Silver Gap strategy this could be a net short term win for subsidized buyers but this is a problem over the medium to long term.
Finally if one wants to be a cynical bastard, these moves could be seen as a counter-move to the Department of Justice and the FTC filing suits against the mega-insurer mergers… but who wants to by cynical tonight?
redshirt
One step closer to Single Payer.
Major Major Major Major
Ugh. We REALLY need to take congress.
Baud
Need to take back Congress.
Trentrunner
@redshirt: One step closer to public option.
Brendancalling
@Trentrunner: maybe. Or not
jl
Hopefully one step closer to moving towards more comprehensive health care reform. HRC started campaigning on dubious proposition that PPACA would be fine with minor tinkering, Sanders had a grand vision but no way to get there (certainly politically, and the economics was not persuasive to many). Maybe HRC/Sanders platform compromise with public option, Medicare expansion and public clinics will be persuasive to many voters.
Need national consensus. I remember that conservatives tried to push a bogus Swiss ‘free market’ model that was not at all the real Swiss model. Maybe can shove a real version down their throats. They said they liked it. Go Swiss!
Adam L Silverman
@redshirt: One step closer to no one has a payer.
Prescott Cactus
One step closer to pitchforks and torches. ..
Mark k
I’ll purchase cynical
Mnemosyne
For-profit insurers acting like whiny assholes when they don’t get their way? Who’d’a thunk it?
Yutsano
@jl:
This inches us closer to the Australian system, which suits me just fine.
Major Major Major Major
@jl: isn’t PPACA a lot like the Swiss model? Pre-John Roberts, that is b
redshirt
@Adam L Silverman: Yay! Free healthcare as a right!
Miss Bianca
Hmmm…well, this is what Colorado is looking at – Amendment 69, Colorado Care, which would essentially create single-payer for the whole state of CO. News like this may give the publicity efforts a boost.
Full disclosure: Im supposed to be helping get the word/vote out on this issue. Next week I’m going to a debate featuring Dr. Irene Aguilar, who’s a physician and a state legislator, who has been the Amendment’s biggest champion.
Mnemosyne
@Major Major Major Major:
Sort of, except that all of the Swiss insurance companies are nonprofit and heavily regulated, by law.
I'mNotSureWhoIWantToBeYet
Cui bono?
If the big insurers have found some flaw in the PPACA that lets them game the rules so that they can somehow gain market power by exiting some markets, is there a mechanism in the law to adjust what’s permitted and what’s required? Or would the FTC or DOJ have to bring a lawsuit? Or would Congress and the President have to agree to changes to the law?
While the Constitution is not a suicide pact, is there enough flexibility in the PPACA to keep it from entering a death spiral if the insurance companies want to kill it?
Thanks for explaining these things to us, Richard. It’s a great service.
Cheers,
Scott.
jamesjhare
@Miss Bianca: Vermont tried to figure out a way to do that and the tax increases were unworkable even with a friendly electorate. The problem isn’t just payment side. We have a huge problem with providers that expect to be wealthy.
Miss Bianca
@jamesjhare: I need to do a lot more research on how the plan is structured – I keep hearing that we’ve got a way to deal with that, but you can bet that the “Taxed Enough Already” crowd is going to hammer that point.
Richard Mayhew
@I’mNotSureWhoIWantToBeYet: a single insurer in a market with a year to prep should not be able to lose money… Quirky risk adjustment and the clearinghouse exchange race to the bottom silver spamming strategies leads to problems
redshirt
@jamesjhare: That’s the ultimate problem now – all those expectations of not just profit, but big profit.
If health care is to be a human right, it can’t operate on a profit margin.
rikyrah
I will be cynical, Mayhew.
scott (the other one)
@jamesjhare: One of the problems, if I’m recalling correctly, is one of scale: Vermont was simply too small for the numbers to work. Colorado’s 9 times the size—maybe that’s still not big enough, but I assume that makes it far more likely to work out?
Adam L Silverman
@Major Major Major Major: Yes, but without the heavy and effectively functional regulations that make the Swiss system work really well.
Miss Bianca
@scott (the other one): from the Colorado Care website:
I’ll have to drill down a little deeper for any information on how this rate was determined.
joel hanes
@rikyrah:
cynical
I too.
I remember Harry and Louise.
BruceJ
They don’t need Congress to kill Obamacare; the insurance vampires will do it themselves. This won’t lead to ‘Single payer’ ‘nationalized healthcare’ or any such rot…all it will do is roll back any gains we’ve made. If they refuse to play, the system collapses, and then it’s right back to “Sorry, we won’t cover your cancer treatment, you didn’t inform us you had acne as a teenager” all over again.
Omnes Omnibus
@BruceJ: Problems with the exchanges will not invalidate other aspects of the law. The sky is not falling.
Yutsano
@scott (the other one): It could happen. The real issue is getting it past the religious nuts in Colorado Springs as well as the ranchers and other frontier types out there. still it sounds exciting.
Vhh
@Mnemosyne: as are Aussie health funds
Cthulhu
Richard, is this situation more of an argument for a public option or single payer? I assume the latter but would the former help as a stop gap?
Richard Mayhew
@Cthulhu: either, both
tobie
@Richard Mayhew: wouldn’t the combo of private insurance plus a public option give us the equivalent of the German health insurance system? My understanding is that there too the employer picks up a hefty portion of the monthly bill. It’s not the most efficient system in Europe but that seems to be the direction we decided to go in since it was an easier fit with our pre-ACA system.
Chris
@redshirt:
My uncle, conservative mouthpiece extraordinaire, had it all worked out years ago that Obamacare had been intentionally set up to fail and destroy the health care market in the United States, so that the terrorized masses would have nowhere to turn to by the U.S. government, which would then use the emergency situation to justify the complete nationalization of the health care industry, after which we’d have single payer socialism for all time.
All I could think at the time was “lordy, if only it were true.”
dr. bloor
This has been episode 742,204 in “Health care: not a free-market commodity.”