During the first seven years of the Affordable Care Act, the Obama administration’s Office of the Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) put out a series of reports (twenty in 2016 and eight in the first few weeks of 2017) evaluating the effects of the ACA. The reports largely described the ACA as a success.
In April, Dr. Stephen Parente, a health economist from the University of Minnesota, was nominated by the Trump administration to head up ASPE. Dr. Parente has a history of criticizing the ACA and of working on conservative replacement proposals. He provided analysis supporting HHS Secretary Tom Price’s ACA replacement plan in conjunction with the conservative American Action Forum as well as analysis of Paul Ryan’s Better Way proposal. Parente was also an advisor to John McCain’s 2008 presidential campaign. As early as 2014, Parente published opinion pieces predicting that the premiums for ACA plans would explode in 2017.
On May 23, 2017, ASPE published the first Trump administration ACA report, “Individual Market Premium Changes, 2013 – 2017.” The report compares premiums in the individual market in 2013, before the ACA’s market reforms and affordability programs went into effect, as gleaned from medical loss ratio reports filed by insurers, with average premiums in HealthCare.gov states as shown by CMS data. The report finds that premiums more than doubled in the 39 HealthCare.gov states between 2013 and 2017, from an average of $232 to $476. In three states the premiums tripled or more.
The press release accompanying the report, quoting an HHS spokesperson (not from ASPE), states:
With data that shows average premiums doubling nationwide and Americans paying nearly $3,000 more for health insurance per year, this report is a sobering reminder of why reforming our healthcare system remains a top priority of the Trump Administration. The status quo is unsustainable.
Unlike Obama era ASPE reports, the report focuses only on premiums, not on the actual cost of health insurance to the majority of marketplace enrollees who qualify for premium tax credits that dramatically reduce the amount they must pay for coverage. An ASPE report released late in 2017 analyzing premiums for 2017, for example, highlighted the fact that 8 in 10 marketplace enrollees could get coverage for $100 a month or less, less than half the cost of 2013 plans.
The new ASPE report acknowledges that the 2013 MLR and 2017 CMS data are not strictly comparable. But more importantly, individual market coverage before 2014 often failed to cover many of the benefits that insurers must currently cover under the essential health benefits, such as maternity or mental health and substance use disorder services, or even prescription drugs. Although lifetime limits had been outlawed by 2013, many plans still had annual limits on coverage. More than half of individual market enrollees were in plans with actuarial values below the minimum allowed by the ACA. Older enrollees were charged more than three times the rates charged younger enrollees.
Most importantly, people with preexisting conditions could be denied coverage, either for themselves or for their medical conditions. In New Jersey, which had community rating before the ACA, premiums have only increased 12 percent since 2013. The report acknowledges, “The changing mix of enrollees and adverse selection pressure has likely been a significant cause of the large average premium increases in the individual market over this four-year period”
Of course, the Trump administration believes in the principle of providing more choice. It believes that the country would be better off if coverage were available that was less comprehensive, had higher cost sharing, charged higher rates to older people and lower rates to younger people, and used high risk pools to cover some people with preexisting conditions. ASPE is responsible for policy development as well as for program evaluation, and the first Trump-era ASPE ACA report conveys precisely this policy message.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2rQTJK3
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