Dive Brief:
-
A new Physicians for Fair Coverage report conducted by Avalere showed that Affordable Care Act plan members are paying more for health insurance as payers have increased premiums, deductibles and out-of-pocket costs in recent years.
-
Nearly 90% of ACA plan enrollees are in high-deductible plans, according to the report.
-
Avalere found that 68% of health plans in the exchanges offered narrow networks in 2017. That percentage is compared to 48% only three years previously.
Dive Insight:
Health plans have narrowed networks as a way to cut costs and push providers to accept value-based contracts in the exchanges. There are between 34% and 66% fewer providers in ACA plans compared to other markets, Avalere said.
One downside to this cost-saving trend is that narrower networks are leading to more out-of-network care and surprise billing. An example of physician network tightening is in the most popular type of plan in the marketplace: silver. The report found that 41% of silver plan physician networks in 2015 were defined as “small” or “extra small.”
There are also issues with specialists. Avalere said nearly 15% of insurance plans in the exchanges are “specialist deficit,” meaning they lack an in-network provider for at least one specialist, such as radiologists and anesthesiologists.
Avalere said the ACA’s provision for network adequacy isn't enough. A 2017 Commonwealth Fund study found that most states don’t have laws that protect consumers from balance billing for out-of-network care delivered in emergency departments or in-network hospitals. In fact, only six states (California, Connecticut, Florida, Illinois, Maryland and New York) provide a “comprehensive approach to protect consumers in these situations.” Even those laws have loopholes. Another 15 states offer some protection against these surprise medical bills, but there are gaps.
Narrow networks aren't the only issue for ACA plans. Premiums are also increasing faster than in the employer-sponsored market. The average ACA exchange premium increased by 28% between 2014 and 2017. The average silver plan premium rose from $434 in 2014 to $554 in 2017. That’s minor compared to what platinum plan members are seeing. Platinum average plan premiums skyrocketed from $555 in 2014 to $892 in 2017.
Members are also faced with high deductibles. Avalere said nearly 90% of ACA plan enrollees had deductibles above $1,300, which is the IRS definition of a high-deductible plan.
All of these rising costs are resulting in an increasing number of Americans not being able to afford care. The report said nearly one-third of insured Americans say they’re having trouble paying premiums and copays. Avalere warned this could lead to patients delaying or avoiding care.
Premiums are expected to rise again in 2019. Many payers in the ACA marketplace have proposed double-digit premium increases in the exchanges for next year. There are multiple reasons for the increase that go beyond normal healthcare costs: Congress ending the individual mandate penalty that required nearly all Americans have health insurance, President Donald Trump’s proposal to expand short-term plans and association health plans along with other efforts to weaken the ACA.
These efforts will likely cause people to leave the ACA marketplace, leaving ACA plans with a sicker risk pool. Payers, in turn, will increase premiums to offset the imbalance.