Code Red: Two Economists Examine the U.S. Healthcare System

July 19, 2013

The News from New York

Filed under: Uncategorized — David Dranove and Craig Garthwaite (from Oct 11, 2013) @ 10:28 am

While sitting in the crowded waiting room of a medical specialist’s office I was forced to listen to the television set directly over my head. Cranked up so that everyone could listen above the din of conversation, Wolf Blitzer introduced a video clip of the President hailing the latest news from New York about health insurance exchanges. Speaking as if he was still on the campaign trail, the President’s words came through loud and clear over the television: thanks to his health reform, premiums in the New York exchange would be half that of premiums in the individual market. This was a model the entire nation should embrace. No one heard me mutter under my breath that this was a model for New York and a small handful of other states that previously regulated their individual insurance markets effectively out of existence.

What the President undoubtedly knows, but dared not say, is that New York’s individual insurance market is unlike any other state. In New York, insurers cannot charge higher premiums to high risk enrollees. As a result of this aggressive community rating, high risk individuals are disproportionately represented in New York’s individual policy risk pools. This drives up premiums, which drives away low risks, driving premiums even higher. Insurers in New York are counting on the purchase mandate, combined with purchase subsidies, to lure low risks into the pool. This is why they have lowered premiums.

That may be how things play out in New York, but will they play out that way in Peoria, or anywhere else? Elsewhere in the U.S., insurers can experience rate to varying degrees. The result is that low risks are able to purchase insurance at rates far below the rates in New York. The Affordable Care Act places limits on experience rating, forcing the pooling of low risks and high risks. For many, perhaps most individuals, the result will be higher rates. What happens in New York stays in New York.

I am not saying that such pooling is either good or bad. In an economist’s dream, we would have one market for short term health insurance and one market for insurance against premium reclassification risk. Under this system, if you get sick, the premiums on your short term health insurance will go up, but you receive a payout from your reclassification risk insurance to cover the higher premiums. John Cochrane has long argued for such a system, which protects against reclassification risk without introducing distortions into the short term health insurance market. But this system has some practical complications – I’d pity anyone who gets sick and now has to argue with two insurance companies! Barring the emergence of such a market, I favor some forced pooling to protect against some reclassification risk. New research by Igal Handel, Ben Hendel and Mike Whinston even suggests that within health insurance exchanges such pooling will be vastly welfare enhancing. (In effect, I like a system where my older self is subsidized by my younger self. But I wonder if I would feel the same way if I was not 57 years old sitting in a specialist’s office?)

What I am saying is that the President was grandstanding about something of no substance and that he surely knew it. I am not surprised that that the President was working this nonstory for all the political benefit he could. But I don’t have to like it.

1 Comment

  1. When a sizable minority of people see how the ACA affects them personally in the way of large premium increases, the political grandstanding will be less believable.

    Of course, this administration has already trotted out the excuse of why premiums will escalate: the greedy insurance companies are using the opportunity to gouge purchasers, and the greedy corporations are also opportunistically shifting a larger share of the overall premium to employees. It’s easy to predict who will dispute this argument and who will embrace it. They will need another explanation, however, when in 5-10 years time the private insurance industry is in ruins, though I’m sure the speechwriters have a first draft on that topic too.

    Comment by Herm Stonitsch — July 20, 2013 @ 6:57 am

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