
I recently posted a graph showing the relationship between premiums and the insured’s out of pocket costs (OOP) in regards to Obamacare (posted here). It was taken partially from the Washington Post’s article that was trying to show how premiums have leveled a bit since Affordable Health Care Act became the law of land. While it’s true that premium increases have eased compared to historical averages, people are paying more than ever for their health care, as can be seen in the top orange line. When you factor in deductible and changes to policies in the last three years, the black line represents where we would be if Obamacare had not been instituted, and percentages of OOP were still paid by premiums/deductibles.
That’s the problem when government involves itself in the free market, we become focused on the price of things instead of the real cost of things.
What the article fails to mention is that deductibles have risen dramatically in the last three years. Deductibles continue to grow because companies are trying to hold down premiums, according to a Kaiser brief prepared for the American Medical Association. The average deductible for individual coverage went up from $991 in 2011 to $1,097 in 2012, a total that has nearly doubled since 2006. The chart projections reflect that change, and as companies try to hold down premium costs, their employees continue to pay higher deductibles to make up the difference. The net result is that the OOP for most employees has gone from $473 a year to over $733 (the orange line), with high deductible and HSA plans increasing from 10% of the marketplace to over 34% of the market- an astonishing jump.
The real pain is that employers are absorbing high premiums too. Those HSA plans are becoming commonplace as employers struggle to make the bottom line shifting increasing costs of health care while employees don’t feel that pain as their health care begins to enact all those ‘free’ services.
Bottom line, we are all paying more for less health care , even though it isn’t immediately obvious. As a result the Department of Health and Human Services will make the ultimate ruling on HSAs when it decides how to calculate the actuarial value of the high-deductible health insurance policies that must accompany HSAs. That actuarial value will be based on employees claims on all those new ‘free’ services that are provided under Obamacare, minus employee costs.
The health law requires that all insurance policies provide a minimum actuarial value of at least 60% for the benefits covered. If the HHS allows contributions by individuals and employers to health savings accounts to "count" as part of the actuarial value, then HSAs and other account-based plans would likely meet the test. But if contributions are not included, the plans likely would not qualify, removing an important tool to hold health costs down—and with the increased contributions to health insurance that seems likely.
What this means is that HSA plans will no doubt be ruled that they are not true health insurance. At that point, everyone will have to switch to more expensive HMO’s and PPO’s and that hidden cost will suddenly be shifted to the premium.
It’s a bombshell waiting to explode in 2014.
That’s why it’s important what this chart is showing—that we are all paying more for our health care, and have dramatically increased the COST of health care, being focused on PRICE instead.
One of two things will happen in 2014. HSA’s will be found to be not health insurance and rolled back, or the deductibles will have to be dramatically decreased, thus raising premiums. Most employers in either case will drop these plans forcing many on them into government pools, suckered into it by lower premiums and hidden costs.
That is what may have been intended all along.









