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Implementing health reform, random report 1

Today brings another in our random reports on progress and stumbles in implementing reform, starting and running Exchanges, and sussing out the reality from the BS.

It looks like there will be more competition for individual insurance come 2014 than there is in today’s market – “the number of carriers offering non-group insurance plans [in the 10 states where data is available] will increase substantially, from 52 to 70–an increase of 35 percent. Six of the 10 states will see more insurers operating on the non-group exchange compared to the number of significant competitors pre-reform.” Four will see no change.

One example is Colorado, where there are 243 individual and group plans available come October.  Rates are in, and while they aren’t lower than current rates, the additional benefits and (in some cases MUCH) lower out-of-pocket maximums make for much better coverage.  Individual rates for lower-end plans range from around $200 for young’uns to $250 or so for 40 year olds, and that’s BEFORE any subsidy, which about 466 thousand Coloradans qualify for.  The folks who know waaaaay more than I do about Colorado health plans are Louise and Jay; they’ve done quite a bit of research into costs, benefits, and the balance between the two.

Louise notes that the demise of medical underwriting makes it impossible for insurers to keep individual insurance rates much below small group premiums; on the other hand, many more individuals will be able to get coverage who can’t today.  And, those unfortunates who are stuck in one job because they need the insurance will be able to move, start a new job, or a new business after 1/1/14.

Gotta love that free market!

Moving a thousand miles plus to the east, data on insurance premiums from the D.C. Exchange are in; rates for the four insurers filing to date are “in line with current rates”; a bronze plan for youngsters can be had for $124, the older folks can get one for $296 on the individual market, with group rates somewhat higher.

Finally, there is growing evidence that the ACOs working in Medicare are beginning to have a measurable impact on outcomes; readmissions fell by one percentage point last year, the first drop in five years. Anecdotally, some hospitals participating in ACOs are reporting decreases in ER visits for Medicare recipients enrolled in ACOs.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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