June 07, 2018
That would have been an appropriate headline for an NYT article in which Alex Azar, the head of the Department of Health and Human Sevices, claimed that the Trump Administration’s policies are not responsible for double-digit price increases for insurance policies in the exchange. If Azar really believes what he claims, he doesn’t understand the basics of insurance.
The Trump Administration has adopted policies that allow more healthy people to opt out of the exchanges’ insurance pool. It created an expanded set of short-term bare-bones policies that would be attractive to people in good health as an alternative to the policies available in the exchanges. Congress also passed legislation that ends enforcement of the individual mandate, which means that healthy have more incentive not to sign up for insurance at all.
Since per person health care costs are rising at less than a 5.0 percent annual rate, the only explanation for the double-digit premium rate increases in the exchanges is a change in the mix of people getting insurance, with the pools becoming less healthy. (The Affordable Care Act was explicitly designed to create a single insurance pool so that the premiums paid by relatively healthy people subsidize the less healthy.) If we accept Mr. Azar’s assertions at face value, that the Trump Administration’s policies are not responsible for the rapid rise in premiums, it indicates he does not understand how insurance markets work.
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