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Comment by alphabettsy | Hacker News Reader

What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere...

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There is no evidence because government did not raise the price - the insurance companies did, all while raking in record profits.

Premiums in states which refused federal money to expand Medicaid generally rose much, much more than states (like CA) which did not[1].

Cynically, this was likely a designed play by Republicans to kneecap the effectiveness of the ACA by skewing the risk pool towards the elderly (who require more medical care, in general).

[1] https://www.consumeraffairs.com/news/health-insurance-indust...

A couple additional pieces to keep in mind. Insurance companies are essentially capped at how much profit they can make on average per subscriber. For large groups 85% of every dollar collected has to be spent on medical expenses, and for small group / individual 80% has to be spent on medical expenses. If they don't meet those standards, the companies need to refund the premium to make up the difference.

In the linked article most of their profit would be coming from the large group market. The individual exchange is a separate segment and where they would be suffering those loses. So the desire to not remain in an unprofitable segment is not really negated by being profitable in a completely different segment.

If you're looking for something directly in the law, you're not going to find the government saying that prices should be raised.

It's a second-order effect; there was minimal cost control in the ACA, and plenty of room for companies to raise their prices. In a lot of ways, it was a sweetheart deal to insurance companies: they had essentially a mandate for people to buy their insurance, demand was through the roof, so they could charge more.

> What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere.

My evidence is that the premiums for my insurance went up even before ACA passed just in anticipation. That is exactly what the health insurance representative told us.

It was pretty clear why it happened. After ACA passed it kept going up a higher rate for us than in previous years (I have data for 3 years before).

> What evidence is there that the government itself doubled the price of the plan? The government doesn't collect the money, and it certainly goes somewhere...

Isn't it a bit disingenuous to suggest that the increase in health insurance is unrelated to legislation regulating health insurance. Or to put it another way is there evidence that government regulation didn't affect the prices and something else did?

If you look at the numbers, the rate increases didn't change significantly when the ACA was put into practice. The only exception is the first year, when companies weren't sure what the appropriate pricing should be.

http://blogs-images.forbes.com/mikepatton/files/2015/06/Heal...

It did for our company, we had an HMO as the insurance provider for us. Company of about 40 people or so.

The government does not, so far as I am aware, set the prices of the plans. Therefore it is nonsensical to claim that "the government itself doubled the price".

Now, if one were to claim that the government failed to do anything that had the effect of reducing the cost of health care or health insurance, then I would completely agree.

For example, there is nothing to prevent someone from signing up for insurance, having some expensive medical procedures performed, and subsequently dropping the insurance. I have personally heard reports from insurance agencies that some people do in fact do this. And I can't say I'm surprised, either; even after factoring in the tax penalties, it's probably a completely economically rational thing to do in a lot of cases.

There is basically no real cost control in the bill, with the logical consequence being that insurance companies will do what they can get away with to raise premiums so that the new premium rate minus subsidies equals the old premium rate. The extra requirements of the ACA, and the lack of universal roll-out basically ensures that there are plenty of excuses for doing so.

False. The ACA imposed a minimum 80-85% medical loss ratio on insurance companies. This is a cost control.

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-In...

But there aren't any real cost controls on providers, drug companies, medical device companies, and other suppliers.

> But there aren't any real cost controls on providers, drug companies, medical device companies, and other suppliers.

That's what I said.

> False. The ACA imposed a minimum 80-85% medical loss ratio on insurance companies. This is a cost control.

That's not a cost control. That's a price inflater!

If the only way for them to make more money is to have the price of things go up, what do you expect they're going to be in favor of? In a perfect world (from the perspective of the insurance company), everything from premiums to procedures goes up X% so that their profits go up X%.

That's a seriously messed up system and may be the most egregious part of the entire ACA.

But total medical spending growth slowed, which seems to indicate that this price inflation didn't happen.

Did it? As an industry, hospital and lab management companies outperformed the general stock market (which itself was doing very, very well) for 2010-2015. Compare VHT vs VTI, for example.

Insurers have to compete against other insurers on price. Otherwise they lose market share. All of them negotiate hard with providers to drive down prices.

The creation of exchanges was so that insurance companies would have to compete in a market where customers had an apples to apples comparison tool. Theoretically, that should drive down rates in places where there are enough insurance companies for market forces to take over.

It's at least correlated. Within 1 month's time, the plan cost doubled. The ACA required insurance to cover things like mental health care. As a result, the plans had to be more expensive since they needed to cover more.

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