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Is Obamacare Really Responsible for the Recent Slowdown in Health Care Costs?

"Is Obamacare even partly responsible for the slowdown in health care costs? That is silly. First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different. Does the law have some limited cost containment features in it? Yes. But these are either pilot projects or are years from being fully implemented."

Profitability in the Health Care Market Has Never Been Better

"Continued consolidation by health insurers and hospitals systems combined with coverage expansion has improved profits for both. Profits for Florida HMOs increased by 12% in 2018, and South Florida hospitals reported average profit margins of 8%, their highest in recent years.... The health insurance market has grown significantly more concentrated in the last three years as companies like Anthem and Blue Cross Blue Shield have acquired a number of HMOs. In 2018, the four largest HMO companies -- the five Blue Cross Blue Shield HMOs, Humana, UnitedHealthcare's HMOs and WellCare -- had 64.2% of the market, compared to 51.5% two years earlier."

Does Achieving Lower Health Care Premiums Necessarily Mean Lowering Insurance Coverage?

"What would happen if the plans were more attractive -- if people saw value in them? And, if we had 75% of the eligible group signing up as a result, what impact would that have on current premiums? ... [P]rices could come down at least 30% to 40% from 2018 prices. Said another way, the anti-selection load the current Obamacare exchange plans are carrying is worth at least 30% to 40%."

Obamacare: Observations from the Marketplace

"About half of the enrollments are coming from people who were previously insured and half are not.... About 15% to 20% of new enrollees are not completing their first month's enrollment by not paying their premium... The back-end of HealthCare.gov, that reconciles enrollment between the feds and the health plans, is still not fully built and won't be for months to come.... There is a lot of dissatisfaction being communicated from consumers to insurance company call centers and their agents about the new health insurance plans, particularly compared to the plans people are used to.... What will the 2015 rate increases be? 9.9%... Will any health plans exit the Obamacare exchange markets in 2015? No."

Extending the Obamacare Cancelled Policy Moratorium: One More Contortion in the Pretzel

"As a person whose policy is scheduled to be cancelled at year-end, I am happy to be able to keep my policy with a better network, lower deductibles, and at a rate 66% less than the best Obamacare compliant policy I could get. But for the sake of Obamacare's long-term sustainability, this is not a good decision. The fundamental problem here is that the administration is just not signing up enough people to make anyone confident this program is sustainable."

Is Obamacare Unraveling? More Rumors of Further Extension for Noncompliant Health Policies

"Rumors have been circulating ... that the administration was thinking of extending the individual health insurance policies that Obamacare was supposed to have cancelled for as much as three more years.... The health insurance plans hate the idea of another three-year reprieve.... With enrollment of the previously uninsured running so badly thus far, getting this relatively healthier block in the new risk pool is all the more important. The administration's now doing this wouldn't just be changing the rules; it would be changing the whole game."

Is the Drug Industry an Existential Threat to the Private Health Insurance Business?

"Because of the impact health insurance costs are having on take home income, we are at risk that the historical attractiveness employees and their families have had for employer-based health insurance will be lost. If the health insurance industry loses the support of employer-plan participants it will have lost the firewall that has made voters reluctant to support government-run health care.... [T]he primary villain in the multi-year erosion of the value of the employer-provided health benefit, and private insurance generally, has been drug costs."

Small Group Health Insurance 'Cancellations' -- The Next Shoe to Drop But a More Complicated One

"Many employers are facing significant changes in order to comply with Obamacare and therefore price increases. One Maryland broker ... has 90 small group accounts ... his smallest increase was 15%, his largest was 69%, and most are in the 30%-40% range. (By comparison, Mercer just announced the average large employer health care cost increase for 2014 will be 5.2%, meaning small groups could have reasonably expected an increase under 10% without Obamacare.) ... [T]he simplistic, 'Small employers are better off dropping coverage and sending them to the exchange,' is just too simplistic. It's a lot more complicated than that."

Despite All of Its Efforts to Insure Everyone and Control Health Costs, Things Are Getting Worse in Massachusetts

"Despite significant initiatives, the state reports slippage in many metrics, including burdensome cost increases for employers and their employees. The report points to issues that now vex healthcare policy makers in every state, including medical debt burden, unaffordable premiums and cost shift to employees through plan design and premium share."

Senate Republicans' Obamacare Repeal and Replace Bill Will Not Reduce the Cost of Health Insurance

"Here's the key question: Given that only 40% of the subsidy eligible signed up under Obamacare, will the proposed Senate actions make that 40% take-up rate better or worse? For the life of me, I can't see how it can't be a lot worse. And, if we have an even worse sign-up rate than 40% we can only have relatively fewer healthy people in the pool to pay the claims of the sick. That means costs would be even higher under the proposed Senate bill than what we now have in Obamacare."