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  #1  
Old 07-23-2019, 01:10 PM
Pamela Wells Pamela Wells is offline
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Default Coverage Impact of ACA since 2013

Mark Farrah & Associates came out with some information recently, looking at broad trends in the health insurance market, specifically focused around ACA-impacted markets.

One of the items they discussed was the change in coverage levels since 2013. Highlights are:

Individual Market increase net 3% from 10.6 million in 2013 to 10.9 million in 2018.
Small Group Market has decreased 31.7% from 7.6 million in 2013 to 5.2 million in 2018.
Large Group Market has decreased 14.2% from 59.8 million in 2013 to 51.3 million in 2018.
Medicaid Market has increased 32.7% from 55 million in 2013 to 73 million in 2018.

Overall, the Commercial Market decreases 13.6% from 78 million in 2013 to 67.4% in 2018 - a net loss of 10.6 million covered lives.
The net impact, including Medicaid, is an increase of 5.6% (7.4 million).

In effect, overall coverage levels increased due to ACA... but that is almost entirely an increase in Medicaid, which means a substantial increase in public funding for coverage. The Individual Market is running around 80% subsidization level currently, with on average about 77% of the premium cost being federally subsidized. I don't know what that rate is in Small Group, it's not my specialty.

The increased public burden of ACA is very large, and the reduction in private coverage has dropped substantially.

Does anyone think this current program is sustainable for the long term? What can be changed within the current structure of ACA to offset the increased financial burden? Is there a reasonable way to increase private coverage... and is that desirable?
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Old 07-23-2019, 03:43 PM
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mathmajor mathmajor is offline
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Yeah, a lot of people formerly on skimpy individual plans now have ACA through APTCs and M'aid expansion. A lot is funded by a tax levied on all plans, including employer.

Nothing we can do. Healthcare costs money. We're a pretty sick bunch. An insurer may spend $450 PMPM on care for members paying $10/mo. The alternative is to make them go without...?

Many states are looking into 1332 waivers to try to defray premiums on their ivl markets by infusing them with cash from whatever source, so premiums on average decrease to a level reasonable for a less or un-subsidized person.
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Old 07-23-2019, 04:00 PM
Chaos Theory Chaos Theory is offline
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I'm curious to see the corresponding statistics on groups enrollment level in level funding product for small group and ASO/level funding for large group. I wonder if part of the decrease is due groups becoming more sophisticated and more familiar with niche products like level funding.

I assume that when they talk about SG and LG they meant the fully insured market only right?
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Old 07-23-2019, 07:11 PM
Pamela Wells Pamela Wells is offline
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Originally Posted by Chaos Theory View Post
I'm curious to see the corresponding statistics on groups enrollment level in level funding product for small group and ASO/level funding for large group. I wonder if part of the decrease is due groups becoming more sophisticated and more familiar with niche products like level funding.

I assume that when they talk about SG and LG they meant the fully insured market only right?
I am assuming this is correct. My last bout of serious research on this indicates approximately 104 million non-ACA employer covered... which includes alternative funding arrangement like level funding and self funding. But that number is low, because I was only looking at the 39 states using the federal marketplace for ACA.
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Old 07-23-2019, 11:42 PM
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ASO is a massive market. That's where all the really large employers are. Are you saying the study did not account for those members?
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Old 07-24-2019, 08:33 AM
act2106 act2106 is offline
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ASO is a massive market. That's where all the really large employers are. Are you saying the study did not account for those members?
It definitely includes a lot of lives, but I wonder how much of an impact including it would really have in that study, since the point seems to have been to determine the impact the ACA had on covered lives. I wouldn't expect the ACA to have had much impact on groups large enough to self-insure.

But I could be wrong. I wouldn't have expected the large group market to decrease by 14% over those 5 years.
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Old 07-24-2019, 04:08 PM
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Some LGs might have gone level funding or super stop loss or something. Gets around a lot of the taxes and inflexibility of LG FI plans.
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Old 07-24-2019, 04:21 PM
Locrian Locrian is offline
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ASO is a massive market. That's where all the really large employers are. Are you saying the study did not account for those members?
Yea I'm super confused. Those insured groups that declined could have gone - one way or another - self-funded. If that happened and this didn't account for it, it doesn't mean anything.

And if memory serves me (it may not), the ACA put pressure on groups to self-insure.
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Old 07-24-2019, 06:27 PM
cincinnatikid cincinnatikid is offline
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I agree with the general consensus that the vast majority of Commercial losses went to self-funded, while the vast majority of Medicaid and heavily subsidized Individual enrollment gains have come from the previously uninsured.

The increases in government spending on healthcare (Medicare, Medicaid, ACA subsidies) definitely cause one to wonder whether the ultimate state is some form of single-payer or two-tiered system. Given the current trend of massive deficits and raising the debt ceiling to kick the can down the road, I don't see it happening in the very near future, but it certainly feels like it can't be forever away.
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Old 07-25-2019, 08:39 AM
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Add another check mark for growth in self-funded reflecting the commercial losses.

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The increases in government spending on healthcare (Medicare, Medicaid, ACA subsidies) definitely cause one to wonder whether the ultimate state is some form of single-payer or two-tiered system. Given the current trend of massive deficits and raising the debt ceiling to kick the can down the road, I don't see it happening in the very near future, but it certainly feels like it can't be forever away.
Single payer advocates have to get the provider systems on board, which I don't think will happen without a long, drawn out fight. The ticking time bomb of the Medicare trust fund being depleted will only add more pressure to financials for the government, payers, and providers.
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