Individual market appears stable despite lack of mandate penalty

By | January 9, 2020

Dive Brief:

  • Even without the Affordable Care Act’s individual mandate penalty, the individual market last year was stable and profitable for payers, according to a new analysis from the Kaiser Family Foundation.
  • Overall enrollment in the individual market fell by a modest 5% and premiums were mostly steady. Medical loss ratios for the third quarter of 2019 were at an average of about 75%, up from 71% the year prior, according to the report.
  • Claims costs in the first nine months of 2019 grew modestly and average hospital time was slightly lower than in previous years for individual market enrollees, indicating the market did not have disproportionately sicker patients, KFF said.

Dive Insight:

The individual mandate, which became unenforceable when a Republican-controlled Congress zeroed out its penalty in a late 2017 tax overhaul, is at the heart of the current challenge to the ACA.

The case, which could be headed to expedited review from the U.S. Supreme Court, claims the rule is unconstitutional without the mandate penalty and the rest of the ACA is not severable from the mandate.

KFF’s report finds that removal of the penalty so far hasn’t had the effect some policy analysts feared — a skewed risk pool as the healthiest people drop coverage without fear of a fine.

“Taken together, these data suggest that the individual market risk pool is relatively stable, though sicker on average than the pre-ACA market, which is to be expected since people with pre-existing conditions have guaranteed access to coverage under the ACA,” KFF said.

Read More:  Vicky Phelan gets go-ahead by doctor to book trip home to Ireland

The report found that while premiums were on the rise going into 2019, they stabilized, partly because 2018 premiums were overpriced. That jibes with other KFF research showing a record amount of ACA rebates were sent to customers last year — $ 1.3 billion, or an average of $ 270 per person.

HHS said in October that 175 issuers had plans available on the ACA exchanges for 2020, an increase of 20 from the year before. Meanwhile, benchmark premiums decreased. Enrollment for 2020 dipped slightly but was mostly stable.

Some payers have found particular success in the individual market. Centene, which saw good outcomes early on in ACA business, expanded its footprint to 10 new states for 2020.

Healthcare Dive – Latest News