No way to know how ACA is working

Blue Cross Blue Shield of North Carolina announced last week it will seek a large premium rate increase for its private health insurance plans sold on healthcare.gov. So what does that mean for the roughly 500,000 North Carolinians now enrolled in ACA exchange plans or for those who might sign up this fall? The short answer is that next year’s plans will cost more than this year’s, but nobody knows how many people will be affected or by how much.

BCBSNC’s announcement was vague. It said individuals could see increases within a large range: from 5 percent to 42 percent. The projected average increase, 34.6 percent, isn’t that helpful, either, because we do not know what plans consumers will choose or what options they will have where they live.

If popular plans – mostly bronze and silver plans with many subscribers, or plans in counties where there are no other insurance companies offering policies – have large premium increases then it could have a big effect on the uptake and affordability of health insurance in North Carolina. However, if rates are rising steeply for plans that few North Carolinians choose anyway, or if other insurers offer more affordable plans that entice consumers to switch from BCBSNC, then that is hardly the apocalyptic outcome the news seemed to foretell but instead the functioning of a market beginning to work.

We do not have a reliable way of understanding what plans are chosen in different parts of the state, who picks them or why. Similarly, when people drop a plan they got via healthcare.gov, we don’t know why. The reasons run the gamut from bad to good news. Coverage could have been unaffordable. It was no longer seen as a priority. They could have aged into Medicare or gotten employer-sponsored health insurance via their job or that of a spouse. Someone else might have quit a job and started a new business because she now could purchase a policy on healthcare.gov. Is this good or bad news? You tell us, but we have no way of identifying how common this might be.

Lack of information about who is picking what plans, what premium individuals paid after subsidies, what coverage they might have had before and what coverage they will have, if any, when they leave an ACA plan makes it difficult to assess how well the ACA is working in North Carolina. Only with better individual-level information will it be possible to understand what BCBSNC’s announced rate hikes mean for consumers.

What can be done?

A few states are tackling this problem on their own. California, Oregon and Minnesota have begun private projects to shed light on ACA exchange enrollment in their states. After the Kaiser Family Foundation, one of the most respected health policy institutions in the U.S., began surveying enrollees in California, the California Legislature approved funding for Kaiser to continue collecting data for subsequent years. These states use this valuable information to inform policies and practices that benefit their residents.

Developing an information resource like that of California or Oregon in North Carolina is crucial to understanding the functioning of the ACA in our state. Whether you love or hate the ACA or fall somewhere in between, you should want the best information possible to be available.

Callie Gable is a senior public policy major at Duke University. Donald H. Taylor Jr. is professor of Public Policy at Duke University and blogs at www.donaldhtaylorjr.com.