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JUDY WOODRUFF: Let’s turn to the latest on expanding health insurance coverage and the real costs for people.
The law is called the Affordable Care Act. And while there’s been much attention on enrollment, there’s been
less discussion about a key question, affordability. The first month of the new enrollment season through has gone a lot more
smoothly than last year. More than 2.5 million people have selected a plan through the federal exchange so far.
But what about premiums and out-of-pocket costs?
Mary Agnes Carey covers this for Kaiser Health News. I sat down with her the other day to discuss the latest.
Mary Agnes Carey, welcome back.
MARY AGNES CAREY, Kaiser Health News: Thanks for having me.
JUDY WOODRUFF: So let’s talk first about enrollment. We understand there has been a surge in interest just
in the first month. What are you seeing?
MARY AGNES CAREY: From November 15 to until December 10, which was the last set of reported figures, 2.5 million
people have signed up for a health plan on healthcare.gov.
And, by comparison, this is what happened in the first three months of last year, when you had all those Web site problems.
We’re not seeing those this year. But there seems to be real interest.
JUDY WOODRUFF: Can you — so is it just the fact that the Web site is up and working? Is there something else
going on here?
MARY AGNES CAREY: Well, it’s certainly more appealing to go to a Web site that actually works and sign in.
But we have had a year of information about the Affordable Care Act. Perhaps people that didn’t get in a year ago
are seeing people that are in the Affordable Care Act and getting insurance and decided to sign up.
JUDY WOODRUFF: So what — and, just quickly, what is going — what is it that is smoother about the process?
Is it the response? Is it — what is it? Is it the delay time?
MARY AGNES CAREY: If you had already been in the exchanges, a lot of your information on your application was pre-filled
in for you. That made it faster.
The whole experience of getting on, comparison shopping, signing in and getting a plan, for the most part, has been phenomenally
smoother. So, I think it’s just a smoother consumer experience. That has been their focus this year. They have talked
about that quite a bit.
JUDY WOODRUFF: And people have now heard that message?
MARY AGNES CAREY: They have heard that message. And they are going to continue to hear it because open enrollment
doesn’t end until February 15.
JUDY WOODRUFF: All right, let’s talk now about cost. This is a big piece of this puzzle.
What are you finding out? Because in some places we’re hearing premiums have gone up. In other places, they have
gone down. What is Kaiser seeing there?
MARY AGNES CAREY: Well, what’s really interesting is health insurance, like politics, is local. You have variance
between states. You have variance within counties internally.
There are some places where premiums are going up by 10 percent or higher. There are other counties where they are dropping
by 10 percent or lower, and so you really have to get on there and examine to see what you can find.
JUDY WOODRUFF: And what — and so how do you explain that? I mean, why — in the places where it’s
going up, where are they?
MARY AGNES CAREY: Well, for example, if you look at my colleagues Jordan Rau and Julie Appleby did a story looking
at the effect of competition and what’s happening around the country with these premiums.
They looked at some counties in Southern Indiana where the number of insurers went from one to four. It’s an increase
in competition. And so the premiums dropped by 25 percent. But then they also took a look at Chattanooga, which is already
one of the least expensive areas in the country to get insurance. While the number of insurance companies doubled there, the
premiums still went up by 16 percent.
So even competition sometimes doesn’t guarantee you’re going to get a lower price.
JUDY WOODRUFF: Is there something in common, though, about the places where prices have gone up or have gone down?
Can you find anything in common with these places?
MARY AGNES CAREY: It could be — if prices are dropping, it could be more insurers got in. Some insurers held
back in 2014 and they decided to wait to see what the marketplace was.
For a place where premiums are increased, it could be you have a monopoly insurer that has got a big piece of the market
or an insurer that got in on 2014, looked at the claims experience, and think — they may have thought, I didn’t
price this right. I need to raise my premiums.
JUDY WOODRUFF: What about — Mary Agnes, what about rural vs. urban? Is that making a difference?
MARY AGNES CAREY: It absolutely does.
In an urban area, you tend to have more competition. That tends to keep prices down. But in the rural areas, you tend to
have fewer provide — fewer insurers, rather, and that can make prices go up.
JUDY WOODRUFF: So is this — was there a way to predict that this was going to happen? Or is it just the vagaries
of the marketplace?
MARY AGNES CAREY: I think it’s the vagaries of the marketplace.
And you have to remember before the Affordable Care Act became law, you had all sorts of price variation in the individual
market. You might have had premiums that went up 8 or 10 percent a year. So now you’re looking at — for example,
the Kaiser Family Foundation did a study where they looked at all the counties across the country.
And for the benchmark silver plan, that’s the second cheapest Silver plan, they have an average increase of 2 percent.
So, again, that’s a national number. But when you get down and look at counties, you could see a lot of variance.
JUDY WOODRUFF: And HHS, Department of Health and Human Services, put out a report saying the premiums are rising
about 5 percent, but that has evened out, average across the country.
MARY AGNES CAREY: Right.
And that’s where these averages, they are interesting and they are important, but they don’t tell the whole
story. That is where people really have to shop around. This is a message you have heard from HHS officials. You will continue
to hear it. If you are currently have coverage on the exchanges, you have got to get back in there and look, because, if there
is more competition in your area, your prices may change.
JUDY WOODRUFF: And just a reminder, we’re not just talking about premiums here, because there are other —
it’s deductibles, it’s co-pays.
MARY AGNES CAREY: You have got to look at all the money that is going to come out of your pocket to get health care.
It’s not just the premiums. And that’s a really important message, because people sort of look at that premium
— and it’s understandable and they focus on it — but there are, as you say, a lot of things, your co-pays,
your deductibles, your cost-sharing. It’s the total package that you have got to think about.
JUDY WOODRUFF: Mary Agnes Carey, Kaiser Health News, we thank you.
MARY AGNES CAREY: Thank you.
The post Why
changes in health care costs vary widely around the U.S. appeared first on PBS