We’ve been making year-end health insurance forecasts in roughly the same format since 2014.
For 2014 and 2015, our predictions worked reasonably well.
For 2016, our crystal ball got stuck. Information about the performance of some parts of the Affordable Care Act system is so slow in coming, and so incomplete and hard to interpret, that it’s hard for us to know whether the predictions really failed, have to be answered with information that will arrive later, or are about situations that are still in flux.
One thing that’s clear about the predictions, and the new predictions we made last week for 2017: The Affordable Care Act is an attention magnet.
For consumers, what really matters is keeping themselves healthy, with access to good, affordable care when they do get sick, to maximize their well-being today, and minimize their risk of facing disability or needing long-term care tomorrow.
For employers, the goals are keeping their employees healthy and productive, and maximizing the value of what they’re spending on benefits.
For brokers and insurers, the main goals are making a good living by meeting consumer, employer and health care providers’ needs.
But in the ACA world, the critical, eye-catching priority seems to be knowing what the federal government is up to today. And, to a lesser extent, what state agencies and nonprofit groups that look a bit like government agencies (the National Association of Insurance Commissioners, the National Conference of Insurance Legislators, and the like) are doing.
The regulatory blender is whirring so rapidly in the individual commercial health insurance market that it somehow makes the Medicare Advantage market and the Medicare supplement insurance market, two very highly regulated markets, look like blessed islands of stability.
Here’s a look at our own evaluation of how we did at reading the health insurance system crystal balls for 2014 and 2015.
Maybe you can use your own evaluation of our past forecasts to rate how accurate our 2016 forecast might be.
Some CO-OPs succeeded at attracting many young invincibles who knew how to use Twitter and Facebook. But the collapse of the CO-OPs did not become much of a campaign issue. (Photo: Thinkstock)
1. Letting large numbers of CO-OPs fail will come back to haunt candidates in both parties: WRONG
Drafters of the Affordable Care Act provided funding for a new breed of member-owned, nonprofit health insurers, that would help increase the level of competition in the private health insurance market, then promptly got out of Congress and left the infant CO-OPs in the hands of Republicans who hated them and Democrats who weren’t all that enthusiastic, as the winds of ACA health system change began to howl.
The wave of CO-OP failures that started in 2015 accelerated in 2016. Some of the CO-OPs that are still in business have enrollment growth caps in place for 2017.
But the CO-OPs do not seem to have attracted enough voter love, or voter hate, for the CO-OP failures to have become much of an issue during the 2016 election campaigns. They seemed to be part of the ACA repeal background noise.
No CO-OP has become a gorilla, but some are still here and may have a chance to do so. (Image: Thinkstock)
2. At least one CO-OP will grow up to be a gorilla: INCOMPLETE
Most of the CO-OPs seem awfully quiet right now. But Evergreen Health Inc., Maryland’s Baltimore-based CO-OP, says it has investors who will help it convert to for-profit status and shake off the problems created by the CO-OP program framework. Maybe Evergreen Health and some of other surviving CO-OPs will still find ways to grow up to be health insurance chest thumpers.
Some non-CO-OP health insurers looked as if they had a bit of a fever. (Photo: Thinkstock)
3. At least one traditional health insurer will come down with a serious case of the same flu that’s killing the CO-OPs: UNCLEAR
Some traditional insurers seem to be on track to lose huge sums of cash due to problems with three big Affordable Care Act buffer programs for insurers. So far, none has publicly entered receivership because of those problems. But it’s interesting to see that the committees at the Kansas City, Missouri-based National Association of Insurance Commissioners that deal with insolvencies have not talked much in public about ACA-related insolvencies. No public bad news might mean that there is no bad news, or that whatever news there is happens to be too depressing to discuss in public.
Donald Trump and other Republicans have talked frequently about changing Medicaid, but not much about canceling Medicaid expansion. (Photo: Trump’s campaign)
4. Medicaid expansion will last as long as federal money is there to pay for it, and pretend to exist for years after that: INCOMPLETE
For now, at least, Republicans seem to be avoiding talking about specific attacks on the Medicaid expansion program. Even some advocates of the most aggressive efforts to repeal and replace the ACA have talked about replacing Medicaid expansion by giving state large blocks of cash to spend on Medicaid as they want, not by directly cutting Medicaid expansion funding.