About 13 million
people purchase their own health insurance through the individual marketplaces.
About 5 million of them don’t quality for any financial assistance, such as tax
credits or subsidies, to help cover the cost of that health insurance.
Those 5 million
Americans earn more than 400 percent of federal poverty level, and they fall
into a gap, said America’s Health Insurance Plans, earning too much to qualify
for financial support, but still struggling to pay their monthly premiums.
AHIP released a white paper with 12
recommendations that that federal or state leaders can implement to drive down
premiums, increase participation in the marketplace, and offer savings to
consumers.
“Families making
over 400 percent of the federal poverty level are hit the hardest without any
financial cushion,” said Jeanette Thornton, senior vice president of employer
and commercial plans for AHIP. “The goal of this new paper is to close this
gap, ensuring every single American can afford their health coverage regardless
of income, health status or pre-existing conditions.”
The white paper
noted three issues that drive up health care premiums. They are
1.
The cost of health care services and prescription drugs.
2. Families making
more than 400 percent of the federal poverty level are the only segment of the
American population that doesn’t receive some help with their insurance
premiums.
3. Too few healthy
people participate in the individual market to balance out the risk.
Although the white
paper focuses on improving premium affordability for those who don’t qualify
for federal support, AHIP said many of the recommendations will drive down
premiums for everyone, reducing the total cost of subsidies and the financial
burden they place on taxpayers.
Individual market
premiums are becoming more stable, AHIP said. Nonetheless, in some regions,
premiums are too high for many Americans. When families can’t afford premiums
for comprehensive coverage, some decide to purchase leaner coverage– or even go
without coverage at all. That can put their health and financial security at
risk.
AHIP’s
recommendations address three basic goals.
1.
Address rising health care services costs and drug prices.
AHIP recommended
reducing surprise billing, curbing inappropriate third-party premium payments,
increasing drug competition, expanding the use of telehealth, and increasing
flexibility for reference pricing.
2. Offer premium
savings to families making over 400 percent of the federal poverty level.
AHIP made
recommendations aimed at bringing financial parity to the individual market.
The organization advocated for amending the Internal Revenue Code to allow
individual market health insurance premium costs to be deductible for federal
income tax purposes for those who do not qualify for premium tax credits.
In addition, AHIP
recommended expanding health savings account options, creating reinsurance
programs, creating state premium discount programs and repealing the health
insurance tax.
3. Increase the
number of consumers buying coverage, which will balance the individual market
risk pool to bring costs down for everyone.
AHIP recommended
reducing surprise billing, curbing inappropriate third-party premium payments,
increasing drug competition, expanding the use of telehealth, and increasing
flexibility for reference pricing.
Susan Rupe is managing editor for InsuranceNewsNet. She formerly
served as communications director for an insurance agents' association and was
an award-winning newspaper reporter and editor. Contact her atSusan.Rupe@innfeedback.com. Follow her
on Twitter @INNsusan.
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