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(51,907 posts)
Sun Mar 10, 2013, 05:47 AM Mar 2013

Almost No Existing Individual Health Plans Meet New ACA Essential Health Benefit


Given that health insurance plans will have to meet new minimum coverage standards starting in 2014, HealthPocket examined the current marketplace of individual health plans to measure the market disruption that will occur as these plans are replaced by plans compliant with the new standards.

Our research took the Affordable Care Act's Essential Health Benefits as our starting point. The Essential Health Benefits are the minimum categories of health insurance coverage that every qualified health plan must have starting January 1, 2014. HealthPocket then examined 11,100 individual health plans across the United States to see how many plans had coverage in each of the Essential Health Benefit categories.

The data shows that there will be a near complete transformation of the individual and family health insurance market starting in 2014. Less than 2% of the existing health plans in the individual market today provide all the Essential Health Benefits required under the Affordable Care Act (ACA).

Implications for Health Insurance Premiums?

One of the questions raised by the results of this study is whether the coverage expansion required by the ACA will cause premiums to rise in 2014. Although the answer to that question is beyond the scope of this study, premiums could rise due to a combination of factors, including:

* The closing of the coverage gap as described in this study
* Guarantee issue provisions that will allow people with pre-existing
medical conditions to enroll in health plans
* ACA actuarial value requirements on the maximum out-of-pocket costs that
can be charged to beneficiaries

Comment by Don McCanne of PNHP: One of the problems that needed to be addressed by the Affordable Care Act (ACA) was the fact that health plans in the individual market have very skimpy benefits - benefit packages that were designed by private insurers who were attempting to keep their premiums competitive. This study confirms the extent of the inadequacies of these plans.

In response, ACA included a mechanism to require a minimum basic level of essential health benefits (EHB). The expansion of the benefits to be covered, along with guaranteed issue to those with preexisting disorders, and placing a maximum on out-of-pocket costs, will all result in significantly higher premiums for plans offered in the individual market. That is in spite of the fact that many will still find the benefits to be deficient, and will still face large out-of-pocket costs because of the low actuarial values of the plans that most people will select.

Even with subsidies, these plans will be expensive. And for those who do not qualify for subsidies? Maybe those potential purchasers would finally see the wisdom of establishing an equitable public system of financing health care through progressive taxes - a single payer national health program. They certainly aren't going to like what they are going to get under ACA.
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Almost No Existing Individual Health Plans Meet New ACA Essential Health Benefit (Original Post) eridani Mar 2013 OP
It seems to me that the major gap fasttense Mar 2013 #1
ACA: neither affordable, nor care. KG Mar 2013 #2
I fear premiums will skyrocket in January Ruby the Liberal Mar 2013 #3
Yes, and Democrats will be facing a huge political backlash from this eridani Mar 2013 #4
Sadly, it may take the backlash Ruby the Liberal Mar 2013 #5


(17,301 posts)
1. It seems to me that the major gap
Sun Mar 10, 2013, 07:23 AM
Mar 2013

in health care coverage is childhood dental check ups and eye exams.

I notice there is NO Adult Dental coverage.

In a few years the US will resemble the British stereotype of the 60s and 70s where most people have really bad teeth. Already I'm noticing how bad most people's teeth are in TN. At first I thought it was due to my location in Appalachia, but groups of organic farm interns from around the state have been attending some classes at UT that I have been going to. Almost every last one of these 20 somethings have awful teeth.

Ruby the Liberal

(26,220 posts)
3. I fear premiums will skyrocket in January
Sun Mar 10, 2013, 10:23 AM
Mar 2013

Large employers are already moving to HRA/HSA accounts instead of insurance. Its going to be a bumpy ride...


(51,907 posts)
4. Yes, and Democrats will be facing a huge political backlash from this
Mon Mar 11, 2013, 05:48 AM
Mar 2013

--UNLESS they can pivot to single payer.

Ruby the Liberal

(26,220 posts)
5. Sadly, it may take the backlash
Mon Mar 11, 2013, 07:06 PM
Mar 2013

Right now, it still isn't politically 'expedient' and the RW doesn't give a rip about the cost savings. Its all a power play. Destroy the village to save it and see who blinks first, bla bla bla.

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