New for 2018, Marketplace rates for children will rise 20% to 53%, on top of the additional average 20%-30% rate increase insurers in Ohio demand in 2018.
Child rates in the past they have always been 63.5% of the adult base rate until the age of 21. Next year, 0-14 will be 76.5% of the adult base rate, with ages 15 to 20 being 83.3% to 97% of the adult base rate.
2018. We all know how it’s going. We are supposed to feel lucky that we can at least still buy health insurance. And after what we witnessed in Congress this year, and how it could have gone, but for one vote, we know we’re damn lucky.
We were warned that rates would go through the roof this year. That’s due to the uncertainty of the government reimbursing insurers for CSRs, the uncertainty over the insurance requirement mandate, the uncertainty of a repeal, as well as the totally understandable (not), predictable, ever-rising, unsustainable, runaway medical and non-negotiable pharmaceutical cost factors, that alone amount to a 7% rate increase in 2018, along with the resumption of the ACA tax on premiums that was halted last year, and some increases in administration costs. We are braced for rates to going up 20 to 40% or more. Hands above our heads, they got us, we’ll pay!
But at least the ACA, warts and all, has survived the Congressional guillotine, and most of the 6% of the U.S. population that comprises the individual insurance market is certainly grateful for another year of being able to buy health insurance.
But what a sneaky thing the child age rating hike is, which raises the rates for all children under the age of 21 by 20% to 53%. CMS snuck that in on December 16, 2016, just after Trump was elected. That, on top of all the “uncertainty,” the rising medical costs blah blah blah, 2018 is going to be a real doozy.
Which is why a typical family may see a rate hike of 29% for themselves, and 71% for their children.
Take your typical Ohio family – say, John and Pam, who are 55. They have two kids who are 17 and 20. John is an independent contractor and earns $78,000. Pam is an adjunct university professor and earns $21,000. Together they make $99,000 before taxes, just over the 400% Federal Poverty Level that would qualify them for a health insurance subsidy. Their net income after taxes is $78,000.
Having to buy individual insurance, they chose Molina, because that was the only plan in which they could find doctors who would accept them as patients.
Toledo, Ohio is a closed town when it comes to doctors accepting new patients. When it became too costly in 2016, John and Pam had to give up their Medical Mutual PPO insurance and hence their ProMedica doctors that they had been going to for 20 years. Molina was one of the cheapest insurance plans they could buy. But they had to find new doctors, because their long-time doctors didn’t accept Molina insurance.
Mercy doctors were in the Molina network, and they were not as closed as ProMedica doctors. That’s why they chose Molina over CareSource, another cheap plan, but one with a 90% inaccurate provider network, a network that supposedly included ProMedica doctors, but not really. (ProMedica, when last checked, had only one primary care family practice doctor accepting new patients, but you’d have to call back in a month to schedule an appointment, which supposedly would be scheduled for three months after that.*)
If they had made just two thousand dollars less (see Kaiser subsidy calculator here), John and Pam would have qualified for a $3,334 subsidy this year (undoubtably it would be more than $6,000 in 2018 because the SLCSP which is tied to the subsidy may be 20-30% more, in tandem with the rest of the plans; see rate increases below.) The subsidy would have reduced their health insurance premiums to 10% of their gross income for a silver plan, but alas, they make too much money to qualify.
John and Pam chose a gold plan with a lower deductible because they couldn’t afford the risk, just in case, of having to come up with $7,500+ to meet the deductible before the insurance would kick in.
As it was, in 2016 John and Pam paid 22% of their net income on health insurance, $17,448, at $1,454/month. It was a lot more than they were paying just a few years before. An affordable and reasonable percentage, in keeping with the spirit of the ACA, would be 13% of their take-home, or 10% of their gross. John and Pam make more money than most families in Toledo, but to have 22% of their net income going to pay for health insurance really hurts.
In 2016, John and Pam’s rates were $554.50 each per month, and the kids’ rates were $172.62 each.
But next year, in 2018, John and Pam’s health insurance will go up 39%! It will surpass housing as biggest chunk of their budget, becoming a whopping 31% of their take-home income, $24,240 for the year; $2,040/month. The astronomical but necessary expense squeezes out any money that could ever have been saved for retirement, which they need to fund, and eliminates any possible budget they may have hoped for to help their kids with higher education expenses.
While John and Pam’s health insurance is going up 29%, health insurance for their kids goes up 71%. The family’s health insurance premiums next year will cost $6,792 more than last year!
In the midst of uncertainty and rising medical and unnegotiable pharmaceutical cost factors, what a sneaky rate hike this children’s age rating hike is, and what a scary thing it is for families like John and Pam’s. Thanks, elected officials, for looking out for our best interests. Maybe it’s time to stop the killing and let everyone in on Medicare, expanded and improved.
Medical Mutual PPO, United Healthcare, Anthem and Aetna have flown the coup. Also gone is HealthSpan and InHealth, the failed co-op.
Anthem is actually continuing in one tiny, rural county in southern Ohio, with just a few people, just so Anthem can stay in the game, if you call those fair rules, just in case it wants to jump back in, in the next five years. Aren’t they clever at the expense of the public good. But since healthcare is not considered a public good, they can make profit over people all day long, and into the next decade, until they’ve squeezed it dry.
Since all five insurers’ prices are going up about the same, people who receive a subsidy may come out somewhat unscathed. Ironically, the government that caused the uncertainty that led to the increases will be funding the increases via the subsidies. If only the government would take that money that they throw at a multitude of greedy, demanding insurance companies, and allocate it to an expanded and improved Medicare for All, we’d have a pretty nice single-payer system in the U.S., which would go a long way to stimulate our economy. The structure is already in place, and so is the money.
Too bad for the 30% like John and Pam who don’t get a subsidy; their health insurance expense is simply unsustainable. They may have to keep working into their seventies, because there’s no way they can save money for retirement when the insurer gets every red cent.
Four of the five babies in the photo are crying, because they just can’t get enough money. They realize that only one with a certain je ne sais quoi will win in the end.
We have a miserable rotten, broken healthcare system, and our leaders really dug in this year to make it even worse than that. If we want to survive as a nation, we will eventually have single-payer, as it has been proven to work well in the rest of the civilized world. But apparently not before a lot of greedy pockets are lined and the corporate for-profit ravens pick every last bit of flesh there can be, all the way down to the bone.
See also, June 11, 2017 Rate Review Observations