Are Affordable Care Act Requirements Driving Away Healthy Customers?

As ironic as it may seem, the comprehensive health plan requirements of the Affordable Care Act may actually be driving healthy people away from the ACA marketplaces.

That was the theme of several witnesses who testified at a House Ways and Means Committee hearing that focused on the double-digit premium increases expected for ACA marketplace plans in 2017.

“Overreach by the ACA has contributed to high and growing health insurance premiums,” Joel White of the Council for Affordable Health Coverage told the committee. That has resulted in “an unbalanced and expensive market that is driving away many of the healthy consumers the exchanges need to attract in order to hold coverage costs down over the long term,” he said.

The median premium request filed by insurers for ACA plans for 2017 is 19.2 percent higher than 2016 rates, White said. For millions of people, “Health coverage is less affordable and more out-of-reach than when the ACA was enacted six years ago,” he said.

Under the ACA, moderate- and low-income people can get subsidies for plans bought through the marketplaces, and White called for providing the subsidies for people who buy coverage in private exchanges as well.

He  also suggested allowing plans to be sold under the ACA that cover only 50 percent of medical claims on average. The lowest actuarial value allowed under the ACA is 60 percent.

Peter Lee, director of California’s state-run ACA marketplace, noted that a number of plans have struggled in the ACA marketplaces, but new guidelines issued by federal regulators will help keep premiums lower by tightening rules for people who sign up for coverage outside of the normal open enrollment period. Claims for people enrolling during so-called special enrollment periods have been higher than claims for people who enroll during the normal open enrollment periods.

Competition in the ACA marketplaces is keeping costs down, Lee said. He pushed for making marketplace benefits more uniform, as Covered California has done, so consumers have an easier time comparing network providers and premiums.

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