Did you know that Highmark, the largest Blue Cross Blue Shield plan in Pennsylvania, filed a $223 million lawsuit against the Federal Government in May 2016? The suit results from the government’s refusal to pay amounts promised to insurers as part of the Affordable Care Act. Highmark received just $27 million to cover $250 million in risk corridor losses from 2014 pre-existing condition claims on newly insured individuals in the MarketPlace. Rates had to rise as insurers are forced to accept a greater cost than anticipated. As the Affordable Care Act is increasingly considered a failure, this is further exemplified by Pennsylvanians being shocked by 30% to 60% health insurance premium increases this year. And five county Philadelphia stands out as the largest population center in the country with only one MarketPlace health insurer. No competition confirms Obamacare problems are real and local.
A friend who is generous and philanthropic runs a successful legal practice in the Lehigh Valley. When he learned his 2017 family plan premium will increase by more than 50% he exclaimed, “Something needs to be done about this craziness!” He is right and yet I admit my consolation included a retort that health insurance is now too expensive unless you need it, just like a good lawyer.
Our employer system for health insurance grew in popularity during the 1940’s when businesses wanted to increase compensation during World War II at a time of wage and price controls over workers to battle inflation resulting from a scarcity of products and services. It was inexpensive then and remained so for the next 30 years into the 1970s. Since then, the Federal Government has passed law after law designed to protect an increasing number of Americans with health care needs. An example is COBRA added in the 1980s which increased premium rates by 15%.
At the same time medical businesses, pharmaceutical firms, hospitals and physicians have rolled out amazing innovations extending how long we all live. Health care has become a right in the minds of many and the most highly valued form of financial protection offered by employers and the government. Good coverage is crazy expensive and unaffordable unless an employer or the government pay a majority of the premium cost. Adding to the problem is the current MarketPlace for individual health insurance. It has failed healthy working Americans, as not enough of them are voluntarily purchasing and maintaining coverage even when premiums are government subsidized.
High cost premium payment responsibility with no perceived immediate return of value is a functional problem all insurers face. Car owners maintain rarely used auto insurance knowing the lack of coverage results in losing the legal right to drive one’s car. And since driving is necessary for most of us to get to and from work or go to the movies, we accept we must pay for auto insurance. Not only can health insurance be more expensive than auto insurance, the penalty for not maintaining health insurance under Obamacare results in a comparatively nominal reduction to a tax refund. Plus if not invincible and in need of getting patched up, hospitals and doctors are required to provide basic care.
So where do we go from here with the MarketPlace? Ongoing adverse selection should be expected as too often just the chronically ill patients will purchase coverage, knowing they will get more back in care than the cost of their premium. The idea to offer tax credits to pay part of the premium is a good one, but it will not change an individual’s motivation to pay for insurance they are unlikely to use. And yet there is a proven way to increase healthy Americans buying health insurance. Replicate what Medicare retirees signing up for Part D prescription Rx coverage face, which includes a 1% per month penalty tacked on to premiums if a sign up is delayed into the future.
Boosting federal government grants to states for Medicaid plans is a logical approach to help pay for insuring the least economically fortunate. Funding included in Obamacare already exists that can be fine-tuned. Consider that one-half of all Americans already have government insurance plans, and:
70 million Americans under age 65 with Medicaid and CHIP coverage may grow to 90 million by 2020
47 million Americans age 65 and older currently with Medicare coverage is projected to grow to 80 million by 2025
Women who live to age 65 will pass away on average at age 89
Men who live to age 65 will pass away on average at age 84
This growing cost burden may translate to rationing of care, or taxpayers will have to pony up more to pay for Americans on government plans. One way to do so is to increase the current 1.45% Medicare tax on incomes to 3%. Aspects of the Obamacare law designed to temper growth in spending include ACOs (Accountable Care Organizations) made up of hospitals, physicians and health insurers. Designed to reduce health care waste and control growing demand, the question is whether ACO’s can effectively dampen health care demand without being accused of hurtful rationing and litigation by those denied care. Time will tell.
Look forward to 2047 as the time when health care demand declines, as that is when most Baby Boomers will have aged out. Heck, it’s only 30 years from now and plenty of time to spend the sizeable nest egg we have all built up in our HSA (Health Savings Account).
With no guaranteed Silver Bullet to slow premium escalation, funding HSAs coupled with purchasing catastrophic health insurance coverage offers an effective way to help healthy working Americans weather the storm of increasing health care costs. Why:
- Only 11% of our population is hospitalized annually, confirming that most of us infrequently need expensive health care.
- Employers paying the majority of costs will increasingly offer high deductible plan options, while passing to employees the cost to keep richer coverage.
- Future health care laws will continue to include an annual personal responsibility cap per patient of around $7,000, adjusted for inflation.
- While healthy, taking savings from lower premium costs and depositing that money into HSAs allows workers to build a reserve they can draw upon when expensive health care is needed.
- Building a health care reserve offers peace of mind to afford paying high deductibles, copays and coinsurance.
- Unspent money in HSAs rolls over year after year and can be invested in mutual funds earning returns that are not taxed as income.
- Deposits to HSAs enjoy the same pre-tax treatment as 401(k) and 403(b) retirement plan deposits, and are more flexible.
- Flexibility includes being able to draw money without penalty out of HSAs to pay medical, prescription, dental and vision care during working years.
- Certain retiree health care premiums and out of pocket retiree health expenses may be paid from HSAs without being taxed.
- Unspent funds in HSAs upon death roll over to a spouse.
More and more healthy workers will plan for their future and accept that lower premium, catastrophic health insurance coverage is good enough. This naturally inures to self-imposed rationing, reduced health care demand and possibly stabilizing premium rates. I started depositing into my own HSA 10 years ago. The balance had grown to $20,000 the year my spouse and I each spent multiple nights in the hospital. Thankfully we had plenty of pre-tax HSA money to pay our high deductible.
Now $50,000 is in the HSA due to improved health in the past five years, in part because it has earned $6,650 in investment returns. In total I have pulled out $16,500 to pay family qualified medical, dental and vision expenses. Long term goal is a strong HSA balance to cover future deductible needs, plus help pay retiree health care costs. Call it planned peace of mind with no option but to accept that America’s health care system, while amazing, is crazy expensive.