Did UnitedHealthcare’s risk adjustment department actually “turn on the gas,” as one executive put it, in an illegal effort to increase revenue? That’s the claim at the heart of two cases the federal Department of Justice brought this spring against the nation’s largest health insurer. The industry is watching closely.
Medicaid expansion and Covered California’s $100 million marketing plan makes the individual insurance market viable. This, even though premiums have gone up in the past few years (4.2% in 2015, 4% in 2016, 13.3% in 2017), and a movement to install a single-payer system would blow up the private insurance market.
The Lone Star State continues to lead the country in the percentage of its residents without health insurance, although a dent has been made. As of 2015, 17% of Texans were uninsured, compared with 22% two years before, according to the most recent census bureau data.
The ACA drove down the uninsured rate despite the lack of Medicare expansion, but major insurers have left the market. In some rural areas, Florida Blue is the only health plan in the game. Also in the mix: Consumers here usually pick the lowest-cost plan available.
Those who say the ACA is collapsing often point to Tennessee as evidence. And Gov. Bill Haslam has called it “ground zero” for plans pulling out of the ACA marketplaces. To give just one example, UnitedHealthcare left the individual market in the state at the end of 2016.
After premiums for 2017 increased, on average, by 32.5% over premiums for coverage in 2016, rate filings by insurers for 2018 show rates going up by only 8.8% over 2017 rates. But it could take at least five years for the ACA exchanges to shake all the bugs out.
The lowest rate of uninsured, but costs are a concern. That’s due, in part, to the clout of the state’s large prestigious health care systems, especially Partners Healthcare in Boston, which includes Harvard-affiliated Massachusetts General Hospital, and Brigham and Women’s hospitals.
Maine presents some daunting challenges when it comes to insurance coverage and health care costs because it’s both the most rural state in the country and the one with the highest median age, two factors that drive up health spending.
The Democratic governor and the Republican legislature have moved to shore up the individual market, but Minnesotans are leaving it in droves. About 167,000 residents bought individual coverage this year, compared with 270,000 in 2016. Premium hikes have been caused, in part, by the consolidation of providers.