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UnitedHealth Group (NYSE: UNH) , the nation's largest health insurer, announced that it would be reducing its individual ACA plan offerings from 34 states in 2016 to just three this year. Humana (NYSE: HUM) and Aetna (NYSE: AET) followed with county-based coverage cuts of nearly 90% and 70%, respectively, after federal regulators moved to block their merger. And Anthem (NYSE: ANTM) , which has been viewed as a major beneficiary of Obamacare, says that it could reduce its coverage in 2018 (assuming Obamacare were to survive till then) if its margins didn't improve. With unsustainable losses, three big insurers have already pulled back on their coverage, and in doing so, they reduced the number of plan options many consumers had to choose from.
Further hurting consumer choice was the failure of the risk corridor, a type of risk-pooling fund that was designed to be capitalized by overly profitable insurers, and would distribute funds to ACA insurers that were losing excessive amounts of money because they priced their premiums too low. Nearly $2.9 billion was requested by money-losing insurers, but only $362 million wound up being paid out. As a result, three-quarters of Obamacare's approved healthcare cooperatives had to shut their doors in 2016.
Healthy adults stayed on the sidelines
Digging even deeper, the real issue with Obamacare and why the program wasn't sustainable for insurers was the lack of healthier young adult enrollment.
When the ACA was signed into law, one of the biggest changes was the mandate requiring insurers to accept all applicants, regardless of whether or not they had preexisting conditions. Prior to Obamacare, insurers could turn away people that they believed would be too costly to insure. Under Obamacare this is no longer the case, meaning insurers were hit by what's known as "adverse selection." In layman's terms, it means insurers saw a large influx of sicker enrollees when Obamacare began enrolling consumers in Oct. 2013.
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The grim reality of Obamacare is that healthy adults, many of whom didn't qualify for any premium subsidies, were never properly incentivized to buy health insurance, which made remaining uninsured more palatable.
It made sense to remain uninsured
To begin with, the Shared Responsibility Payment, or SRP, failed to adequately represent the cost of annual insurance premiums. The SRP is the penalty consumers were required to pay if they chose not purchase health insurance, as required by the individual mandate.
In 2014, the SRP averaged about $150 per uninsured person, according to H&R Block . In 2016, where the SRP increased to the greater of $695 or 2.5% of your modified adjusted gross income, the Kaiser Family Foundation estimated an impact of $969 per uninsured household. However, a $969 penalty is no match for the average annual cost of a bronze-tier plan, which has the lowest premium on the ACA exchange. According to HealthPocket, the average bronze plan premium was $257.68 in 2016 for a 30-year-old, or about $3,092 a year. The average healthy adult could have saved more than $2,100 by remaining uninsured on a static basis, and probably well over $1,000 even if they qualified for a health premium deduction when filing their taxes.
Image source: Getty Images.
But it wasn't just the lack of correlation between the SRP and premium costs that kept healthier adults on the sidelines. Should you actually need to head to the doctor, rising deductible costs meant sizable out-of-pocket expenses before your health coverage really kicked in. The average deductible for an individual bronze plan in 2016 was $5,731. Think about this for a moment: If you're a healthy adult who purchased a bronze plan, you could have to shell out $3,092 in premiums and $5,731 in deductibles before your insurer would step in and begin covering your medical expenses.
What's more, because hospitals and medical offices dislike writing off uncollected revenue, they'll often give discounts to uninsured consumers that'll pay in full or up front for services. There simply wasn't a strong enough incentive to coerce healthy young people to enroll, which ultimately doomed Obamacare.
The biggest challenge that lies ahead for President Trump and the Republican Congress is going to be finding a way to encourage healthy adults to enroll in health insurance without using a penalty for "encouragement." If Trump is interested in keeping the clause requiring insurers to accept all applicants, then not having a dangling carrot to coerce enrollment could lead to failure once again.
Suffice it to say, the future of healthcare in America is once again up in the air.
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Sean Williams has no material interest in any companies mentioned in this article. You can follow him on CAPS under the screen nameTMFUltraLong, and check him out on Twitter, where he goes by the handle@TMFUltraLong. The Motley Fool recommends Anthem and UnitedHealth Group. The Motley Fool has a disclosure policy .
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