Here 7 of the many, many strange things about the individual major medical market....

1. It could all be a dream.

Having sophisticated, well-researched conversations about what is or isn't working, or could be improved, seems a little beside the point, because the 5th U.S. Circuit Court of Appeals is considering Texas v. USA — a case that's challenging the constitutionality of the heart of the Affordable Care Act.

If the Supreme Court upholds a 5th Circuit ruling killing the ACA, the current U.S. health insurance framework could simply vanish.

(Photo: Tim Roller/ALM)

2. The Republicans won't let the ACA individual public exchange system be like the Medicare Advantage program.

Like the Medicare Advantage program, the ACA public exchange program lets insurers use government subsidies to sell private plans on a guaranteed-issue basis, without consideration of the enrollee's health status. Republicans have backed risk-control subsidy programs for health insurers' Medicare Advantage plans, but not for the same issuers' ACA public exchange plans.

(Credit: Centers for Medicare and Medicaid Services)

3. Democratic supporters of Medicare 4 All won't let Medicare 4 All be like Medicare.

About half of Americans say they approve of a 'Medicare 4 All plan" — but Medicare uses deductibles and co-payments to hold costs down, and it offers ways for enrollees to use private insurers. The major Medicare 4 All proposals don't do that.

(Credit: Sen. Bernie Sanders' YouTube channel)

4. Few seem to respect the power of antiselection and providers' ability to go fishing.

Most of the life and health insurance programs ever created have collapsed, but most of today's would-be reformers assume that creating stable programs is easy.

Advocates of giving states, consumers or other players choices between multiple health finance systems tend to ignore the risk that the sickest patients will end up in one system and kill it. Advocates of programs based on limiting health care provider revenue tend to ignore the risk that providers will walk away — and kill the new programs.

(Credit: Shutterstock)


5. Few in Congress talk about their personal experiences with the ACA public exchange system.

The ACA requires members of Congress to get their congressional health benefits through the ACA public exchange system, to give them real-world ideas about how the system actually works. But few members of Congress other than Rep. Michael Burgess, R-Texas, say much about their own experiences with their public exchange plan coverage.

(Credit: House Energy)

6. Who buys what, at what price, is so complicated.

Actuarial analysts from Wakely show managers of Colorado's state-run ACA public exchange, Connect for Health Colorado, how complicated the picture is every year, with charts that reveal that purchasing patterns for bronze, silver and gold plans are completely different.

(Credit: Wakely, for Connect for Health Colorado)

7. Managers of President Donald Trump's program are working hard to get people into ACA public exchange plan coverage. marketing spending may be down, but Randy Pate, the head of the office that oversees, has improved call center performance, expanded efforts to reach out to agents and brokers, and kept the number of users almost steady — as most Republicans in Congress work to kill the ACA system, and as most Democrats in Congress refuse to say anything nice about how the Trump administration is running ACA programs.

(Photo: Allison Bell/ALM)

The individual major medical insurance open enrollment period for 2020 coverage is set to start Nov. 1 in most of the country, and “What will the individual major medical market be like over the next year?” still looks like a trick question.

Most of the health insurers that are brave enough to still be in the individual market say they are happy with how their individual major medical units have done this year, and that they’re optimistic about 2020.

(Related: Individual Health Volume May Be Doing This Shocking Thing)

Executives at Centene Corp., for example, said the company will be offering individual major medical coverage in more counties in the states that are already in its individual major medical market footprint.

Insurance regulators in many states have said that, in part because of new, state-run reinsurance programs, the full cost of individual major medical coverage has stabilized.

Officials at the Centers for Medicare and Medicare Services (CMS) say a key premium benchmark — the average premium for the second lowest cost silver plan available to a 27-year-old  who buys coverage through — will be 4% lower in 2020 than in 2019.

The total number of issuers selling coverage through will increase to 175, up from 155 for 2019, and up from 132 for 2018.

The number of agents and brokers who have signed up to help people enroll in the coverage offered through the federal government’s Affordable Care Act (ACA) public exchange system has increased to more than 42,000, up 7.7% from the total who had registered by Oct. 28, 2018, to handle 2019 open enrollment period signups.

Right now, agents and brokers seem to be happier with than with the CMS Medicare Plan Finder tool for private Medicare plans. Senior Market Sales Inc. has attracted attention by offering a system that can help Medicare plan agents cope with the problems with the official plan directory system.

Then there’s Congress, the White House, and the federal courts.

For a look at seven reasons why financial professionals might gape at anyone who makes confident statements about what the individual major medical market is really like now, let alone what it might be like a few days from now, see the idea cards in the slideshow above. (To make the control arrows show up, wiggle your mouse over the first slide.)

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