November 2, 2013
Insurance Policies Not Worth Keeping
By THE EDITORIAL BOARD
Congressional Republicans have stoked consumer fears and confusion with charges that the health care reform law is causing insurers to cancel existing policies and will force many people to pay substantially higher premiums next year for coverage they don’t want. That, they say, violates President Obama’s pledge that if you like the insurance you have, you can keep it.
Mr. Obama clearly misspoke when he said that. By law, insurers cannot continue to sell policies that don’t provide the minimum benefits and consumer protections required as of next year. So they’ve sent cancellation notices to hundreds of thousands of people who hold these substandard policies. (At issue here are not the 149 million people covered by employer plans, but the 10 million to 12 million people who buy policies directly on the individual market.)
But insurers are not allowed to abandon enrollees. They must offer consumers options that do comply with the law, and they are scrambling to retain as many of their customers as possible with new policies that are almost certain to be more comprehensive than their old ones.
Indeed, in all the furor, people forget how terrible many of the soon-to-be-abandoned policies were. Some had deductibles as high as $10,000 or $25,000 and required large co-pays after that, and some didn’t cover hospital care.
This overblown controversy has also obscured the crux of what health care reform is trying to do, which is to guarantee that everyone can buy insurance without being turned away or charged exorbitant rates for pre-existing conditions and that everyone can receive benefits that really protect them against financial or medical disaster, not illusory benefits that prove inadequate when a crisis strikes.
Starting next year, all plans sold in this country will be required to provide 10 essential benefits, including some, like mental health and substance abuse treatment and maternity and newborn care, that are not now part of many policies. And premiums may well rise, in part because insurance companies must accept all applicants, not just the healthy.
Premiums are apt to come down for older patients and sicker patients with chronic illnesses. Premiums will likely go up for younger, healthier patients. Even so, analysts at the Kaiser Family Foundation believe that most people will actually pay less next year, because those with modest incomes will qualify for federal subsidies and many poor, uninsured people will be eligible for Medicaid.
Many higher-income people who won’t qualify for subsidies, however, will have to buy policies providing more benefits than they want. Maternity care for those who will not have children is one sore point. But that is one price of moving toward universal coverage with comprehensive benefits. And some of these higher-income people could suffer a catastrophic accident or illness that would previously have bankrupted them, but will now be paid for by insurance.
People under 30, who might balk at higher premiums, have another option. They can buy a catastrophic plan that provides all the essential benefits but keeps premiums low by making the beneficiaries bear a greater share of the cost. The hitch is that people who buy such plans are not eligible for federal subsidies, so many would probably be better off buying the cheapest plan available on the exchanges. Federal analysts estimated last week that, after subsidies, two-thirds of the uninsured young adults in 34 exchanges around the country could get coverage for less than $100 a month, and almost half could get it for less than $50 a month. That sounds like a bargain for comprehensive coverage.
Some conservative groups, eager to cripple the individual market by deterring enrollment, are urging consumers not to take out insurance and to instead pay the fine, which is cheaper than the cost of insurance but hardly negligible. For individuals, it starts at $95 or 1 percent of applicable yearly income in 2014, whichever is higher, and rises to $695 or 2.5 percent of applicable income in 2016. But why pay the penalty and get nothing when you can pay a reasonable fee and get a good policy?