What’s happening with health insurance enrollment

The open period was supposed to start in October and go to Dec 31. That would allow the ins companies to get set for the 2015 year. The previous March deadline was set because they knew few people would sign up right away.
The rates for this year are going to be very high and a lot of employers will drop out. I am expecting a 25-50% rate hike and many people are going to lose their subsidies as the data gets cross checked with the IRS.
Overall the destruction of the health insurance industry is working quite well and there should soon be no other choice but what is offered by the government as in Medicare. Already the exodus of good doctors has started and health related businesses, like the Scooter Store, are going bankrupt and closing. This is going to be a big downturn of 16% of the economy.
Coventry is essentially already out, Aetna remains in a diminished capacity. Blue Cross Blue Shield of Delaware is gone, absorbed by Highmark. The Delaware Health Commission released its plan this week and it disingenuously presumes a constant insurance market which the State can control. The truth is everyone wants a single payer system, everyone also wants to BE that single payer.
And yes, doctors are quickly moving to drop Medicare and Medicaid and some insurance altogether. Many are simply retiring. Some of my close colleagues are retiring by this year’s end and all are younger than me, mostly family practice. Everyone assumes that when control is established  that doctors will just work for less, but to the contrary, they just won’t work. This is the consummate flaw in Ezekiel Emanuel’s thinking. He says that they will have to work as told, but the truth is doctors will not be forced to practice bad medicine and, by and large, they can afford to quit, so they are and will in droves.
On a national and local level, Walmart, Home Depot, Walgreens, and Target have all cut back health insurance for those working less than 30 hours/week. On a local level,  Highmark just had its premium increases cut dramatically by Insurance Commissioner Karen Weldin Stewart, which means that they will not offer some products. They cannot calculate the rates now because the sign up period has been delayed onset until after the election cycle. On good background I believe that Highmark will withdraw risky insurance products in the Delaware market.
On a very anecdotal level, one of my patients who employs 47 people has directed his human resource person to fire 5 people so as to be well beneath the 50 person threshold for ACA. This is just as a precaution, in case they 50 employee mark is hit inadvertently.
The White House Administration has declared a moratorium on data release from CMS and the Federal Exchange Website.  I do not find any reason to be optimistic about the landscape.

Dr. Casscells, Director

Center for Healthcare Policy

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