The Pulse
4:11 pm
Fri March 29, 2013

Will Health Insurance Costs Rise for Rhode Islanders Under the ACA?

You may have seen some headlines about a new report from the Society of Actuaries (the super-smart, nerdy folks who figure out how much risk, say, an insurance company can afford to take on), decrying the near-certain rise in the cost of health insurance for newly insured folks under the Affordable Care Act.

But I'm here to tell you: don't panic. First, read this excellent FAQ from Kaiser Health News on that study. Simple headlines don't convey the nuances, such as the answer to this question from KHN's Jay Hancock:

Q: Does the study predict health insurance premiums will go up 32 percent by 2017?

No. First, it’s only forecasting the individual insurance market. That’s where millions of Americans newly covered under the ACA are expected to find policies. The report says nothing about costs for employer-based health insurance.

Equally important, the 32 percent forecast is for medical expenses paid by insurers, not what insurers will charge in premiums, and not what consumers will pay.

Most Americans get their health insurance through their employers or government programs, so the study is only talking about a small percentage of Americans who will be able to gain coverage through health insurance exchanges that go online this fall.

But...we could see some initial increases in the cost of coverage in Rhode Island once the health insurance exchange comes online, for example. I spoke earlier with Blue Cross Blue Shield VP Monica Neronha about how the cost of creating new plans and building new infrastructure to join the health insurance exchange - and comply with the Affordable Care Act -could add some cost.

However, lots of efforts are underway in Rhode Island to bring costs down in the long term:

  • new insurer-provider agreements that move away from pricier fee-for-service payments to doctors to more holistic payments for overall health outcomes and quality
  • proposed legislation to make health care (and in particular hospital) pricing more transparent for consumers, which some hope may force costs lower
  • a push to get more Rhode Islanders cared for by teams led by primary care doctors, which has been shown to reduce hospitalizations (and, therefore, costs)

Still, lots remains to be seen about what you'll pay for health insurance come this fall and the first of next year. That's when the next major pieces of the Affordable Care Act take effect and could affect you. We'll be covering it!