Obamacare Has Doubled the Price of Particular person Well being Insurance coverage

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The Inexpensive Care Act (ACA), referred to as Obamacare, produced main dislocations within the particular person (non-group) medical health insurance market by imposing a raft of latest mandates and laws, coupled with new income-related protection subsidies. The outcomes have been not solely decreased insurer selection and competitors, but in addition a lot greater medical health insurance premiums for hundreds of thousands of Individuals.REF

Measuring the Price of Well being Insurance coverage

Premiums charged for medical health insurance protection range on account of variations amongst plans of their scope of coated advantages, their ranges of affected person price sharing, and their panels of collaborating suppliers, in addition to variations in enrollee demographics (corresponding to age and placement). Moreover, buyer buying selections mirror private preferences among the many accessible choices providing totally different mixtures of value and profit.

Thus, the easiest way to research modifications in premiums is to make use of information on how a lot prospects truly paid for protection. That strategy captures all the various results of plan designs and client buying selections.

As well as, that strategy additionally displays any modifications to the danger profile of the general insurance coverage pool (which is a key think about insurer pricing calculations) that may consequence from a big share of earlier prospects exiting the market, or a big variety of new prospects getting into the market. Within the case of the person medical health insurance market, each of these modifications occurred in response to Obamacare’s simultaneous software of latest laws and new subsidies to that market.REF

Results of the ACA on the Particular person Market

Beginning in 2014, the ACA imposed quite a few pricey new mandates and laws on individual-market medical health insurance protection and displaced personal markets by creating new government-run medical health insurance “exchanges” to promote insurance coverage. Partly to offset the elevated prices of its mandates, the ACA additionally offered income-related subsidies for plans bought by means of these exchanges.

The legislation’s new mandates and laws (however not its subsidies) additionally utilized to protection bought outdoors the exchanges, although it did permit insurers to resume older insurance policies (with out all the brand new necessities) for a time period. Nonetheless, the design and implementation of the legislation had the impact of lowering the supply of these so-called grandfathered plans in subsequent years, as insurers discontinued them—both voluntarily or in response to directives from state insurance coverage regulators.

For this evaluation, we used information from the annual Medical Loss Ratio (MLR) studies—which insurers are required to file with the Facilities for Medicare and Medicaid Providers (CMS)—to measure the results of Obamacare on the price of particular person market protection.REF

We calculated per-member per-month (PMPM) figures for the common price of protection on the state and nationwide ranges by dividing complete premiums earned by the whole variety of member months. The ensuing numbers, seen in Desk 1, present the common month-to-month premiums that enrollees truly paid for protection.

As 2013 was the final yr of the pre-ACA market, we used that as the bottom yr, adopted by every subsequent yr for which MLR studies can be found (by means of 2019).REF

Obamacare Doubled the Price of Particular person Market Well being Insurance coverage

As Desk 1 exhibits, the nationwide common month-to-month premium paid within the particular person market in 2013 was $244, whereas by 2019 it was $558—greater than doubling (a 129 % improve) from 2013 to 2019. In distinction, over the identical interval, the common month-to-month premium paid within the large-group employer market elevated by solely 29 %—from $363 in 2013 to $468 in 2019. (For comparability functions, we utilized the identical evaluation to the MLR information for the large-group employer market).


IB6068 Table 1 1


IB6068 Table 1 2


The big-group employer market isn’t topic to most of Obamacare’s new insurance coverage laws. It’s also extra secure than the person market, with much less buyer turnover and fewer change over time to the danger pool. By definition, any buyer exits and entrances in that market contain teams of fifty or extra enrollees, and the variety of well being standing among the many members of every group signifies that teams leaving or getting into that market have little impact on the composition of the general danger pool. Thus, modifications over time in common month-to-month premiums paid for large-group employer insurance coverage primarily mirror system-wide modifications within the underlying price of medical care (corresponding to medical value inflation and the introduction of latest therapies).

Consequently, if the 29 % improve in the price of large-group employer protection over this era displays the system-wide improve in the price of medical care, then discounting the 129 % improve within the post-ACA price of particular person market insurance coverage by 29 share factors signifies that Obamacare has principally doubled the price of particular person market insurance coverage relative to what it could have been in any other case.

Huge Variations Amongst States

The modifications in month-to-month premiums for particular person protection underneath Obamacare diversified from state to state, as Desk 1 exhibits.

In just one state, Massachusetts, was the common month-to-month premium paid in 2019 decrease than it was in 2013. That’s as a result of nearly all the ACA’s new mandates and laws, together with an identical set of income-related subsidies, have been already in place within the Massachusetts particular person market earlier than the legislation took impact. In reality, as Desk 1 exhibits, Massachusetts was the state with the best common month-to-month premium pre-ACA ($422 in 2013).

Equally, New Jersey, New York, and Vermont had additionally imposed pricey laws on their particular person markets earlier than the ACA; like Massachusetts, all of them had excessive common premiums in 2013. These states have skilled solely modest will increase in common premiums because the ACA’s implementation.

In distinction, states that had beforehand imposed fewer mandates and expensive laws on their markets have had a lot worse experiences underneath Obamacare. In 40 states, the common month-to-month premium for particular person market protection greater than doubled by 2019—and it greater than tripled in 5 of them (Alabama, Nebraska, Missouri, West Virginia, and Wyoming).

The Common Premium Declined in 20 States in 2019

Between 2018 and 2019, the common particular person market premium in 20 states truly declined. In half of these states, the drop was fairly small (between 0.6 % and three.7 %), whereas the remaining 10 states noticed reductions of between 5 % and 15 %.

A part of the reason is that, confronted with massive losses from Obamacare protection, many insurers sharply elevated their charges in 2017 and 2018. A few of these insurers subsequently decreased their charges in 2019 as soon as they decided that their earlier fee hikes had overshot the mark.

Results of Part 1332 Waivers

Extra noteworthy are the declines in common premiums that occurred in all however one of many seven states that carried out “Part 1332 waivers” in 2018 and 2019. The waivers, approved underneath Part 1332 of the ACA, gave these states regulatory aid from a few of Obamacare’s mandates to be able to allow them to raised align federal subsidy {dollars} with enrollee want utilizing state-based “reinsurance” packages that focus on funding to the sick with excessive well being care prices.REF

The waivers granted to Alaska, Minnesota, and Oregon all took impact in 2018. Comparable waivers for Maine, Maryland, New Jersey, and Wisconsin took impact in 2019.

As Desk 1 exhibits, common premiums paid in Alaska declined by 23 % (from $956 PMPM in 2017 to $737 PMPM in 2019), whereas common premiums paid in Minnesota declined by 18 % (from $525 PMPM in 2017 to $433 PMPM in 2019). Oregon, which carried out a much less aggressive reinsurance design underneath its waiver, didn’t expertise a web decline in common premiums paid, however did see a considerably slower fee of development.

All 4 states that carried out their waiver packages in 2019 additionally skilled web declines that yr in common premiums paid—with reductions of three % in Wisconsin, 6 % in Maine, 8 % in Maryland, and 10 % in New Jersey.

5 extra states carried out Part 1332 waiver packages in 2020, two extra did so in 2021, and yet one more has obtained approval to implement its program in 2022.REF If these packages have comparable premium-reducing results the outcomes must be mirrored within the MLR information for 2020 and subsequent years.


Information on how a lot Individuals truly paid for his or her medical health insurance affirm that the ACA’s mandates and laws dramatically elevated the price of particular person market medical health insurance in nearly all states.

The excellent news is that prices can fall if policymakers present regulatory aid to permit states to redirect subsidies in line with the distinctive wants of the residents of their states. The preliminary information from states that carried out Part 1332 waiver packages present that allowing states to use different approaches enabled them to cut back premiums, develop protection choices, and do a greater job of focusing accessible sources on serving to sick sufferers with excessive well being care prices.

As a result of waiver packages are time-limited and momentary, the following step must be for Congress to construct on the success by increasing the state flexibility granted through the previous Administration, and making this flexibility everlasting.REF

Edmund F. Haislmaier is Preston A. Wells, Jr. Senior Analysis Fellow in Home Coverage Research, of the Institute for Household, Neighborhood, and Alternative, at The Heritage Basis. Abigail Slagle is Analysis Assistant in Home Coverage Research.

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