Major provisions of the Affordable Care Act that go into effect next year could increase health insurance claims costs by an average of 32 percent by 2017, according to a new report published by the Society of Actuaries.
The health care reform law requires almost all Americans to have health insurance starting in 2014. It also prohibits insurers from denying coverage or charging higher premiums for people with illnesses or health conditions.
Health insurance coverage is expected to expand to 32 million new enrollees, decreasing the percentage of uninsured Americans to 6.6 percent from 16.6 percent. That will more than double enrollment in the individual insurance market by 2017.
The influx of relatively healthy people will bring down average claim costs. But those lower costs will be more than offset when a significant number of people with health conditions, some of whom are now insured through high-risk insurance pools, enter the individual market, according to the report. The study also predicts that some people now insured by employer-sponsored plans will move to the individual market, either because their employers will stop offering coverage or because they think they will get a better deal in the individual market. The society's research showed high-cost members were more likely to move into the individual market than people with low health care costs.
Average claims costs will vary by state, with 43 states seeing a double-digit increase and some states seeing double-digit decreases by 2017. The states with the largest projected increases in claims costs are:
- Ohio: 80.9 percent.
- Wisconsin: 80.0 percent.
- Indiana: 67.6 percent.
- Maryland: 66.6 percent.
- Idaho: 62.2 percent.
- New York: 13.9 percent.
- Massachusetts: 12.8 percent.
- Vermont: 12.5 percent.
- Rhode Island: 6.6 percent.
- New Jersey: 1.4 percent.
How these changes will affect premiums consumers pay has yet to be seen. Actuaries will set premium rates based on many considerations, the society said, so the increases in costs do not provide a true indication of what premiums might be.