From the Horse’s Mouth: I Am The Guy Getting Screwed By The Affordable Care Act

I promise that this will be my final post this week about healthcare.

Yesterday I attended a public hearing by the New Hampshire Insurance Department regarding premium rates in the health insurance market.   I expected this hearing to be full of annoyed consumers like me, but I walked into a room full of suits, actuaries, and healthcare executives.

Cigna, MVP Health, Harvard/Pilgrim, and Anthem each had their representatives participating in the only panel I was able to stay for:  each rep reviewed his/her answers to a 4 question survey the NH Insurance Department had asked regarding rate and utilization expectations for 2012/13, and expected impacts of the Affordable Care Act on 2014 rates.

I was surprised as one by one the speakers from MVP (non-profit), Harvard/Pilgrim (non-profit) and Cigna explained that they expected low to mid single-digit percentage premium increases as a result of the Affordable Care Act.   This is probably where I should note that none of these companies serve the Individual insurance market in New Hampshire.    Oh – quick tangent – I learned that New Hampshire has the second highest health insurance premiums in the nation (1: Massachusetts) and the 3rd highest deductibles.    I was somewhat miffed at how all of these firms were talking about how there would be little change in rates, and then Anthem NH President Lisa Guertin spoke.

Guertin said that their 2013 *group* rates were up 1-3%, and that they expected the ACA impact on 2014 group rates to be on the order of 3-5%.  Then she said that the impact on individual plans would be “more noticeable,” in the range of “30 to 40 to 50% increases.”

Interested readers should definitely check out this report from the NH Insurance Department which illustrates why the individual rates are skyrocketing:  it’s actually NOT due mostly to coverage of newly insured under the Affordable Care Act – it’s due to the merging of the current individual purchasers with the extremely unhealthy High Risk Pool and PCIP.  Here’s a few graphics:

first, the “risk” of the different segments:


I get completely crushed because I get lumped in with the actuarial-inferior population.

Next, the breakdown of where the cost increases come from – again, it’s not newly insured, which is surprising to me, and important – it’s about the screwed up risk-pooling.    These numbers are the AGGREGATE premium increase.


Finally, yet more confirmation that my rates will be up even more than the average individual, because I’m younger and healthier.


It seems worthwhile to look at one more table: the breakdown of insurance coverage in NH:

nh_breakdownIt’s pretty amazing that the impact of those 4,000 High risk pool/ PCIP members being lumped in with the 42,000 individual market purchasers (read: ME) is a 40% increase in rates.

So there you have it.  Confirmed: I’m The Guy getting screwed.

Look, if the ACA helps the people it’s supposed to help, and I’m the collateral damage in the form of higher premiums, higher out of pocket maximums, and lower access to doctors and hospitals, well, so be it.   Unfortunately, as detailed in my prior posts linked below,  I’m not optimistic that the ACA is any sort of solution to our healthcare woes.

There were a few more tidbits from the meeting worth mentioning:  the 4 insurers mentioned above were asked about efforts to increase transparency in pricing, with the questioner from the NHID Board mentioning that colonoscopy prices ranged from $1500 to $5000.  Cigna’s speaker answered with a lengthy list of the tools that Cigna provides their members to shop for the best prices, including a website and even a mobile phone app.   The questioner turned to Anthem’s Lisa Guertin and asked her if she wanted to comment on Anthem’s efforts in this regard.  She declined to comment.

Additionally, there was a presentation about how concentrated the NH market is in terms of carrier and provider concentration.   Not surprisingly, the highest concentration (least competition) was in the non-group carrier market – the very group I am a consumer in.  Additionally, the provider market in the mid-state region (read: Concord: my region) was the most concentrated.   A NHID questioner asked the next logical question:  if we’re in a market which is highly concentrated in terms of providers, and highly concentrated in terms of carriers, then does the Narrow Network really adequately satisfy the needs of the members?   The answer, given by academics who had provided the numbers in the study, amounted to little more than hemming and hawing…

and so it goes…

NH Insurance Dept Market Study

Daniel Kahneman Can Solve Our Healthcare Problem

“Affordable” Health Care

I Have Solved National Healthcare

The President Lied To Me – ACA Edition

Health Insurance Needs Reform

My Health Insurance Bill Just Increased By 48%



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