The Reality of the Affordable Care Act


doctor-medical-medicine-health-42273-largeWith this year’s open enrollment getting closer, one thing has become very clear, the individual health insurance market is near complete collapse.

For Indiana, we have seen Humana, Assurant, UnitedHealthcare, & now Physicians Health Plans all exit the individual market. Every carrier has had different situations for leaving, but one thing in common between all is financial loss.

The medical claims from the individual market, have been higher than anyone could have ever projected. After 3 years of claims data, carriers are now seeing just how difficult it is to break even in this market. Then we add government programs that make it advantageous to manage risk by forcing those companies to pay; when they do a better job than expected. This all leads to an individual market that is very different than what the authors of the ACA thought it would be.

For 2017, there will only be one individual carrier operating in all Indiana counties, Anthem. They will have plans both on and off the exchange. If you are eligible for a tax credit, that may be the plan that will give you network access. The other companies patriating on the exchange, are Medicaid carriers that have developed extremely narrow networks. Those carriers are an extension of Medicaid.

With Anthem taking on the entire states individual risk, who knows where the rates will go. This year they filed for a average of a 28% rate increase. That was prior to the exiting of PHP & now IU from the exchange plans.

The current individual market is not sustainable for anyone that is not eligible for a tax credit. Premiums have skyrocketed and will continue to rise. The out of pocket maximum are beyond affordability for most Americans.

The ACA has given coverage to Hoosiers that were denied policies prior to the ACA. The marketplaces have also made it’s more “premium” affordable for Hoosiers to get access to health policies.

At what price?

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