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Study: Medical claims costs to spike under Obama's health care law

| Tuesday, March 26, 2013, 9:06 p.m.

WASHINGTON — Insurance companies will have to pay an average of 32 percent more for medical claims on individual health policies under President Obama's overhaul, the nation's leading group of financial risk analysts has estimated.

That's likely to increase premiums for at least some Americans buying individual plans.

The report by the Society of Actuaries could turn into a big headache for the Obama administration at a time when many parts of the country remain skeptical about the Affordable Care Act.

While medical claims costs per person will decline in some states, the report concluded the overwhelming majority of states will experience double-digit increases in their individual health insurance markets, where people purchase coverage directly from insurers.

The disparities are striking. By 2017, the estimated increase would be 62 percent for California, about 80 percent for Ohio, more than 20 percent for Florida and 67 percent for Maryland. Pennsylvania's increase was listed at 28 percent.

Much of the reason for the higher claims costs is that sicker people are expected to join the pool, the report said.

The report did not make similar estimates for employer plans, the mainstay for workers and their families. That's because the primary impact of Obama's law is on people who don't have coverage through their jobs.

The administration questions the design of the study, saying it focused only on one piece of the puzzle and ignored cost relief strategies in the law such as tax credits to help people afford premiums and special payments to insurers who attract a larger share of the sick. The study doesn't take into account the potential price-cutting effect of competition in new state insurance markets that will go live on Oct. 1, administration officials said.

At a White House briefing on Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance is so skimpy it can't be compared with the comprehensive coverage available under the law.

“Some of these folks have very high catastrophic plans that don't pay for anything unless you get hit by a bus,” she said. “They're really mortgage protection, not health insurance.”

A prominent national expert, recently retired Medicare chief actuary Rick Foster, said the report does “a credible job” of estimating potential enrollment and costs under the law, “without trying to tilt the answers in any particular direction.”

“Having said that,” Foster added, “actuaries tend to be financially conservative, so the various assumptions might be more inclined to consider what might go wrong than to anticipate that everything will work beautifully.”

Actuaries use statistics and economic theory to make long-range cost projections for insurance and pension programs sponsored by businesses and government. Kristi Bohn, an actuary who worked on the study, acknowledged it did not attempt to estimate the effect of subsidies, insurer competition and other factors that could mitigate cost increases. She said the goal was to look at the underlying cost of medical care.

“Claims cost is the most important driver of health care premiums,” she said. “We don't see ourselves as a political organization. We are trying to figure out what the situation at hand is.”

On the plus side, the report found the law will cover more than 32 million uninsured Americans when fully phased in. And some states — including New York and Massachusetts — will have double-digit declines in costs for claims in the individual market.

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