Last week I found it odd that Austin Frakt chose to highlight the non-group(individual) insurance rates on the Incidental Economist. As he said in a comment he expects “the individual market will undergo more change than the group market in about a year.” That got me to thinking what if the individual insurance market does not go up as fast as he expects? The Affordable Care Act has been a cornucopia of unintended consequences.

In the health care debate individual health insurance occupies the same position as coal does in the global warming debate. The proponents of the Affordable Care Act have not gone as far as to say they are going to crucify the individual health insurance market but the intent is obvious. I have been unable to confirm their allegations that the individual insurance market policies are substandard and should be eliminated. The spearhead of the attack on the individual insurance market was the the Individual Mandate and the Essential Benefits regulations. The Affordable Care Act proponents were trying to make it easier for people with chronic, high cost health problems to get health insurance. The uncomfortable fact is that no insurance company in their right mind would want this group of people in their plans.  These people need grace and insurance is a dumb substitute. The grand idea of the Affordable Care Act was to force this group of high cost people into the insurance market with least number of people to spread the costs over, the individual insurance market. It is a dumb idea filled with malicious pitfalls. A Milliman report prepared for Ohio expects that the rates will increase 55% to 85% above the normal health insurance inflation rate. The conventional wisdom is that the healthy customers will choose to be self insured rather than pay the much higher premiums and the individual insurance market will lose its best customers. The only customers left will be those who have high medical costs. In this scenario the best case is that the individual insurance market gets smaller and in the worst case the market ceases to exist.

What if the Individual Insurance market expands?

Although I understand the rationale behind the declining individual insurance market scenario, the individual insurance customer is looking at a different health insurance picture. Here are some of the facts that may cause the individual insurance market to go against conventional wisdom and expand. The most important issue that the individual insurance market has going for it is lower cost.

1. As a purchaser of individual health insurance I have been notified of the 2013 rate increase. Although the premium for my family plan will increase by 12% to $391 per month, the annual amount is only $4,692.  As a family who was self insured for a decade this is a competitive amount. The employer sponsored average of $15,022 is ridiculous.
2. As a healthy family covered by a HRA who is living in a state with low individual health insurance rates, we have not paid any health insurance premiums or out of pocket health care costs in several years. When you compare this with the employer sponsored plans, the HRA is a big winner for the healthy families. The 2011 average employee contribution in the employer sponsored plans is $3,962.
3. My insurance plan is “grandfathered”. I am not sure what this means in my specific case but a Kaiser article implies it may be exempt from the “Essential Benefits” regulation and its much higher costs.
4. Ohio has passed a law forbidding the Individual Mandate. Since the Affordable Care Act proponents have said that the Individual Mandate is essential for the system to work, I would not be surprised if our politicians came up with an alternative plan for paying for high cost customers. Anything that spreads the cost of these customers over a much wider base is good for the individual insurance market.
5. If you are a small or medium sized business that partially subsidizes the employee health insurance cost, the individual insurance market is very attractive. The employer sponsored contribution according to the NIHCM brief was $11,060. When you compare this price with a $6,000 HRA, a HRA is pretty attractive option that caps your health care subsidy for the future.
6. If the states choose to implement a market based exchange using companies like www.ehealthinsurance.com rather than a state or federal exchange based on the ideas in the Affordable Care Act, it will be attractive to small or medium sized businesses to dump their employer sponsored plans. The state and federal exchanges have too much government baggage to be successful in a market place. The Affordable Care Act proponents subverted a good idea and are surprised by the lack of interest in their version of the exchange concept by the states. The government sites, http://www.healthcare.gov/ and https://www.mahealthconnector.org/, that try to provide a similar service in www.ehealthinsurance.com are pretty useless for people shopping for insurance.