An extra $100 deductible does not buy much

In Mayhew On Insurance by David Anderson

I was curious. What does $100 more in deductible buy in terms of actuarial value? It depends but the short answer is not much. The graph below shows how much a $100 increase in deductible buys in terms of actuarial value. I used the 2019 CMS AV calculator with the Bronze tables. Deductible is combined and embedded with no other cost sharing. This is a bare bones plan. This is because health care costs are so skewed to the right. Half of the population barely touches the system so the …

Whose costs: My costs

In Mayhew On Insurance by David Anderson

The Kaiser Family Foundation does frequent polling on a wide array of issues. They have a recent poll on politics and they probed a bit on what people actually mean when they say that they are concerned about health care. The key thing was personal costs and not systemic costs: When asked to say in their own words what specific health care issues they most want to hear the 2018 candidates discuss, health care costs are the top issue mentioned by both Democratic-leaning health care voters (31 percent) and Republican-leaning …

What’s going on in Iowa’s rates?

In Mayhew On Insurance by David Anderson

Rate filing season is in full swing. Medica was Iowa’s only ACA insurer for 2018. They asked for a mega rate increase to cover the state and received it. Now they are asking for a much smaller rate increase for 2019. Last year, Medica said it needed a 57% premium increase – the largest in Iowa history – to remain as the state's sole individual health-insurance carrier. This year, the company is proposing an increase less than one-tenth as big. https://t.co/Q6vcmQH47F — Tony Leys (@tonyleys) June 20, 2018 What’s going …

Back to the phones

In Mayhew On Insurance by David Anderson

And here is the repackaged Graham-Cassidy proposal from the Heritage Foundation and Rick Santorum. TLDR: Don’t get sick A coalition of conservative groups releases an outline of their Obamacare repeal plan. Presser comes tomorrow. It tracks with Graham-Cassidy as a grant program. Ends essential health benefits, age ratio and minimum loss ratio. pic.twitter.com/zOqLB3amTd — Alex Ruoff (@Alexruoff) June 19, 2018 The full plan has not been released yet, but the way that the program is set up is that insurance companies are allowed to underwrite and age rate at whatever …

Silver mirrors Bronze plans

In Mayhew On Insurance by David Anderson

In the spring of 2017, the Center for Medicare and Medicaid Services (CMS) announced new rules that broadened the allowable de-minimis variation in actuarial value. Silver, Gold and Platinum plans were allowed to be up to four points under the nominal target instead of the previous two point cushion. They were still restricted to being two points above the target. Bronze plans were allowed to bounce from two points underneath the nominal target of 60% actuarial value. Bronze plans were allowed to go over the nominal target by five points. …

Deductibles and Actuarial Value

In Mayhew On Insurance by David Anderson

Late last week, I saw the following tweet: This is an alarming trend https://t.co/1rU2CwvCkn — Mya Roberson, MSPH (@MyaLRoberson) June 16, 2018 I don’t think the deductible per se is the problem. It is the overall level of cost-sharing that is the problem with a secondary distributional challenge. Let’s think this through a bit with a two period model. In period 1, there there is a 1,000 person pool with an average annual claims expense of $10,000 per person. This means that there is $10,000,000 in total claims. Let us …

Medicaid expansion also helps the middle class

In Mayhew On Insurance by David Anderson

In Morning Consult, I argue that Virginia’s Medicaid expansion will obviously help the folks who directly qualify for Medicaid. It will also help the folks who earn too much money to qualify for ACA subsidies in two ways: There are two ways that Medicaid expansion in Virginia will drive down individual market rates that non-subsidized, middle-class families pay…. Evidence shows that individuals who earn between 100 percent and 138 percent of the federal poverty level (single individuals earning between $25,100 and $34,638) and currently buy ACA insurance have more chronic …

Value does not always mean lower prices

In Mayhew On Insurance by David Anderson

Value based pricing means we should be willing to pay for things that work and not pay (much) for things that don’t work. It does not necessarily mean that all prices nor net expenditures will decrease. Rectal NSAIDs for preventing post-ERCP pancreatitis: <$10/dose at end of trial (https://t.co/scaPU4CoYz), now >$150. How can we fix this @IrokoUSA & G&W laboratories? #drugpricing pic.twitter.com/0998a2SPEy — Joe Elmunzer (@JElmunzer) June 9, 2018 The linked study establishing the new standard of care is from a 2012 article in the New England Journal of Medicine** and …

Go comment

In Mayhew On Insurance by David Anderson

A friend and collaborator makes a very good point in this tweet: Have time between now and Friday? Let the government know that exempting white counties from Medicaid work requirements while requiring them from primarily black counties is wrong: https://t.co/bwewfeovr6 — Emma Sandoe (@emma_sandoe) June 12, 2018 When you see something that you think is wrong in federal rule-making, go comment. Comments must be read and at a broad level, they must be responded to by the regulating agency. The response might not be the on one that you want, …

Half a loaf with Indiana’s HIP 2.0

In Mayhew On Insurance by David Anderson

Health Affairs has a recent evaluation of Indiana’s HIP 2.0 Medicaid Expansion program **. It is a middling result. More people are covered in Indiana than in states where there is no Medicaid expansion and fewer people are covered compared to states where there is a full fledged, no strings attached Medicaid expansions: We estimated the impact of this expansion on coverage rates and compared the effects to results from other states that expanded Medicaid after 2014. We found that Indiana’s coverage gains (relative to pre-ACA uninsurance rates) were smaller …

Farm Bureau plans and yet another out

In Mayhew On Insurance by David Anderson

The North Carolina Farm Bureau wants to sell underwritten health benefit plans next year. The Republican supermajority in the North Carolina state legislature is considering the idea of authorizing “non-profit health benefit plans” that aren’t insurance despite quacking and walking like insurance. My analysis of the similar plan in Iowa stands: And if an individual can pass underwriting and does not qualify for significant ACA subsidies, these plans are a good deal as that group of people are mainly looking for hit by a meteor protection. Well subsidized individuals will …

What’s going on in Texas

In All we want is life beyond the thunderdome, Election 2018, Election 2020, Fuck The Middle-Class, Fuck The Poor, Mayhew On Insurance by David Anderson

I am not a lawyer, so please don’t take any of the following as informed legal analysis. The Trump Administration has decided to argue that the $0 penalty individual mandate is unconstitutional and therefore community rated guaranteed issue requirements are unconstitutional as they are non-severable from the mandate. That would destroy the individual market reforms of the ACA. Take Care has the legal argument and demolition: In the government’s brief, the Trump DOJ makes two arguments. (A) The individual mandate, which the Supreme Court upheld in NFIB v. Sebelius, is …