Some Americans could see their insurance bills double next year as the health care overhaul law expands coverage to millions of people.
The nation’s big health insurers say they expect premiums to rise from 20 to 100 percent for millions of people due to changes that will occur when key provisions of the Affordable Care Act roll out in January 2014.
Mark Bertolini, CEO of Aetna Inc., one of the nation’s largest insurers, calls the price hikes “premium rate shock.”
“We’ve done all the math, we’ve shared it with all the regulators, we’ve shared it with all the people in Washington that need to see it, and I think it’s a big concern,” Bertolini said during the company’s annual meeting with investors in December.
To be sure, there will be no across-the-board rate hikes for everyone, and there’s no reliable national data on how many people could see increases. But the biggest price hikes are expected to hit a group that represents a relatively small slice of the insured population. That includes some of the roughly 14 million people who buy their own insurance as opposed to being covered under employer-sponsored plans, and to a lesser extent, some employees of smaller companies.
The price increases are a downside of the Patient Protection and Affordable Care Act (PPACA), which is expected to expand coverage to nearly 30 million uninsured people. The massive law calls for a number of changes that could cause premiums for people who don’t have coverage through a big employer to rise next year — at a time when health care costs already are expected to grow by 5 percent or more:
— Changes to how insurers set premiums according to age and gender could cause some premiums to rise as much as 50 percent, according to America’s Health Insurance Plans, or AHIP, an industry trade group that’s funded by insurers.
— A new tax on premiums could raise prices as much as 2.3 percent in 2014 and more in subsequent years, according to a study commissioned by AHIP. Policyholders with plans that end in 2014 probably have already seen an impact from this.
— Requirements that insurance plans in many cases cover more health care or pay a greater share of a patient’s bill than they do now also could add to premiums, depending on the extent of a person’s current coverage, according AHIP.
The Obama administration says the law balances added costs in several ways, including tax credits that will bring down what many consumers will pay for insurance.
“The health care law will bring down costs and save money for young people and families,” said Erin Shields Britt, a spokeswoman for the Department of Health and Human Services. “It’s misleading to look at one provision of the law alone. Taken together, the law will reduce costs.”
Where ‘rate shock’ may strike
The impact of some cost hikes will be wide ranging. The new premium tax, for instance, will affect individual insurance, some employer-sponsored coverage and Medicare Advantage policies, which are privately-run versions of the government’s Medicare program for the elderly and disabled.
Other price hikes will vary due to factors like a person’s current coverage and age. Young people who currently have low-cost coverage may see some of the biggest hikes.
In many states, insurers charge a 60-year-old customer $5 in premiums for every $1 they collect from a 24-year-old. The logic behind that is that older people use health care more and generate more expensive claims than younger customers, so insurers need to collect more to help pay their bills.
But the overhaul will narrow that ratio to 3-to-1. That alone could cause the premium for a 24-year-old who pays $1,200 annually to jump to $1,800, according to AHIP. Meanwhile, the 60-year-old who currently pays $6,000 will see a 10 percent drop in price.
Gender also can be a factor in whether premiums go up or down. The law will prohibit insurers from setting different rates based on gender — something they currently do because women generally use more health care. That means premiums for some men could rise, while they fall for women.
Prices also may change depending on a person’s current coverage. Many policies on the individual market (coverage not sold through employers) exclude maternity coverage, but that will be considered an essential health benefit under the overhaul. That could mean higher prices for some.
Vikki Swanson, 49, of Newport Beach, Calif., resents that the added benefit may lead to higher costs for her. “I had a hysterectomy, I have no need for maternity coverage, but I have to now pay for it,” she said.