Why Are Health Insurance Premiums Still Rising After the PPACA?

Since no one seems willing to discuss the real reasons that health insurance premiums are increasing dramatically since the passage of the PPACA (Patient Protection and Affordable Care Act). Let me break down the 3 primary reasons. They are as follows:

1.) My Blue Cross Group clients are receiving 35.63% renewal rate increases this year for the first time in 15 years. Their prior premium increases were no where near this amount. This is not isolated to Blue Cross either. These premium increases are happening in many markets across the United States in both the Individual and Group health insurance markets. I'm simply using Blue Cross as an example since the name is most widely recognized.

These increases are due in large part to the fact that multiple new "Preventative Care" mandates were imposed upon all "non-grandfathered" health insurance plans as of 9/23/2010 under the PPACA. A "Non-grandfathered" health insurance plan is a plan that was purchased after the PPACA (a.k.a "Obamacare") was signed in to law on March 23, 2010. Keep in mind, these were all mandated to be covered no later than 1/1/2011 without a co pay or a deductible required. The entire list is as follows:

Covered Preventive Services for Adults

• Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked  
• Alcohol Misuse screening and counseling  
• Aspirin use for men and women of certain ages  
• Blood Pressure screening for all adults  
• Cholesterol screening for adults of certain ages or at higher risk  
• Colorectal Cancer screening for adults over 50  
• Depression screening for adults  
• Type 2 Diabetes screening for adults with high blood pressure  
• Diet counseling for adults at higher risk for chronic disease  
• HIV screening for all adults at higher risk  
• Immunization vaccines for adults-doses, recommended ages, and recommended populations vary:
  • Hepatitis A  
  • Hepatitis B  
  • Herpes Zoster  
  • Human Papillomavirus  
  • Influenza  
  • Measles, Mumps, Rubella  
  • Meningococcal  
  • Pneumococcal  
  • Tetanus, Diphtheria, Pertussis  
  • Varicella      

• Obesity screening and counseling for all adults

• Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

• Tobacco Use screening for all adults and cessation interventions for tobacco users

• Syphilis screening for all adults at higher risk

Covered Preventive Services for Women, Including Pregnant Women

• Anemia screening on a routine basis for pregnant women  
• Bacteriuria urinary tract or other infection screening for pregnant women  
• BRCA counseling about genetic testing for women at higher risk  
• Breast Cancer Mammography screenings every 1 to 2 years for women over 40  
• Breast Cancer Chemoprevention counseling for women at higher risk  
• Breast Feeding interventions to support and promote breast feeding  
• Cervical Cancer screening for sexually active women  
• Chlamydia Infection screening for younger women and other women at higher risk  
• Folic Acid supplements for women who may become pregnant  
• Gonorrhea screening for all women at higher risk  
• Hepatitis B screening for pregnant women at their first prenatal visit  
• Osteoporosis screening for women over age 60 depending on risk factors  
• Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk  
• Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users  
• Syphilis screening for all pregnant women or other women at increased risk  

Covered Preventive Services for Children

• Alcohol and Drug Use assessments for adolescents  
• Autism screening for children at 18 and 24 months  
• Behavioral assessments for children of all ages  
• Cervical Dysplasia screening for sexually active females  
• Congenital Hypothyroidism screening for newborns  
• Developmental screening for children under age 3, and surveillance throughout childhood  
• Dyslipidemia screening for children at higher risk of lipid disorders  
• Fluoride Chemoprevention supplements for children without fluoride in their water source  
• Gonorrhea preventive medication for the eyes of all newborns  
• Hearing screening for all newborns  
• Height, Weight and Body Mass Index measurements for children  
• Hematocrit or Hemoglobin screening for children  
• Hemoglobinopathies or sickle cell screening for newborns  
• HIV screening for adolescents at higher risk  
• Immunization vaccines for children from birth to age 18 -doses, recommended ages, and recommended populations vary:
  • Diphtheria, Tetanus, Pertussis  
  • Haemophilus influenzae type b  
  • Hepatitis A  
  • Hepatitis B  
  • Human Papillomavirus  
  • Inactivated Poliovirus  
  • Influenza  
  • Measles, Mumps, Rubella  
  • Meningococcal  
  • Pneumococcal  
  • Rotavirus  
  • Varicella      

• Iron supplements for children ages 6 to 12 months at risk for anemia

• Lead screening for children at risk of exposure

• Medical History for all children throughout development

• Obesity screening and counseling

• Oral Health risk assessment for young children

• Phenylketonuria (PKU) screening for this genetic disorder in newborns

• Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk

• Tuberculin testing for children at higher risk of tuberculosis

• Vision screening for all children

  Source: http://www.healthcare.gov/law/about/provisions/services/lists.html

2.) Multiple new policy design changes have also been mandated. Blue Cross outlines those: http://www.resourcebrokerage.com/BCBSupdates22510B/PPACAILInsuredNotification.pdf

3.) Now we come to reason number three. The new PPACA mandated Medical Loss Ratios or "MLR's". This is why health insurance premiums are increasing on Non-Grand-Fathered plans as well. For more about the new MLR's visit: http://www.heritage.org/Research/Reports/2010/01/Squeezing-out-Private-Health-Plans

Who in their right mind thinks forcing all the following new mandates on to every health insurance policy in the country would actually "bend the cost curve down"? In fact, mandates are a major reason why health insurance premiums have been increasing exponentially over the last few decades. In 1979 there were 252 mandates in force in health care, by 2007 there were nearly 1900. With the implementation of the PPACA we have tipped the scales at nearly 2000 mandates. Keep piling them on and costs will continue to rise.