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September 21, 2016
Total Costs of Care
Christopher F. Koller, President
Back to President’s Blog: The View from Here
What does it take to have stable, competitive health insurance markets? I was recently asked this question by the Senate Homeland Security and Governmental Affairs Committee for a hearing on state and federal insurance marketplaces, 2017 insurance premiums, and insurer competition. As the nation’s first health insurance commissioner, serving in Rhode Island (RI) for eight years during the implementation of the Affordable Care Act (ACA), and as head of a Medicaid health plan before that, I have a bit of experience with this issue.
With so much attention on health plan decisions to exit health insurance exchanges and concerns about premium increases, the topic is particularly timely. Here is a summary of the testimony I submitted to the Committee.
The goal of health insurance markets should be to offer a range of reliable, affordable options for consumers. This goal will not be met by accident or by a magic hand of the market. It requires specific conditions which public policies can help bring about:
We did all of this work during my tenure as health insurance commissioner in RI. As a result, by one accounting, the state has had the lowest rate of increase in commercial premiums in New England in recent years. There has been no rate shock in RI’s exchange market—one carrier is reducing its premiums. Often state insurance regulators do not have comprehensive rate review authority, and frequently they do not use the tools they have. If states will not act, CMS’s Center for Consumer Information and Insurance Oversight could address this, in part, by raising its standard of what constitutes adequate state-level rate review.
Markets that are seeing robust insurer competition and lower rates of premium increase—markets as diverse as California and RI—possess most of these characteristics. Policymakers at the state and federal level need to promote greater adoption of these characteristics and discourage policies that are not supported by evidence, including:
Creating markets with these characteristics requires action at the state and federal level. To the extent states have not taken all the steps available to them, they continue to suffer the consequences. Eight of nine states where consumer choices on the exchange will be most limited in 2017 have rejected Medicaid expansion.
Finally, we should not mistake what is driving the problem of health insurance affordability—it is rising health care costs; the same issue that troubles CMS actuaries and Medicaid directors. The most robust commercial insurance competition cannot hide the fact that, in the US, we spend almost two and half times the international average on health care, as a percent of GDP, and get poorer health outcomes as a result. This is a fundamental challenge for our country—robbing us of more productive investments in education, our infrastructure, and the environment—and policymakers must rise to it.
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