Last week, Obamacare supporters rejoiced over new estimates that California’s insurance premiums would be lower than expected under the ACA. But this week they’re being more cautious in their predictions.
On Wonkblog, a pro-ACA outlet that cheered loudly when the California numbers came out, Sarah Kliff argues that success in the Golden State might not be replicable elsewhere. According to Kliff, California is one a few states to take an “active purchaser” approach to the ACA. This means that a state board has the power to select which plans will be available in the exchange, and can reject any plan whose rates are too high. Most other states, however, do it differently:
The vast majority of states…operate under a “clearinghouse model.” In that scenario, any health plan that meets a set of criteria gets approval to sell on the health insurance exchange. All 33 state exchanges that the federal government will run operate under this clearinghouse model. So do 10 of the 18 state-run health exchanges (this includes the District of Columbia). Two states, Kentucky and New Mexico have not, according to Kaiser Family Foundation, addressed the issue yet.
In the final count, only six states are currently “active purchaser” states, so nationwide might not be as low as California’s projections suggest.
If that’s not enough to temper any lingering optimism, consider that the state had to make some significant tradeoffs to keep rates so low, as an LA Times piece reveals. Under the plans offered on the exchange, consumers will have access to far fewer doctors and hospitals. Blue Shield of California, for example, will give its exchange customers access to only 36 percent of its regular physician network:
“If we want to keep costs down, something has to give,” said Betsy Imholz, special projects director for Consumers Union. “At first blush, it seems like Covered California has negotiated some good deals, but in any given community we will see how this network issue plays out.”
Given the limitations in access, California’s cost savings may not benefit as many patients as promised. With Obamacare, even the good news is often bad.