Austin Frakt on increased ACA competition; Jeffrey Young on what percent of potential QHP enrollees have actually done so

Several great ACA-related stories were written over the holiday weekend. First up is the NY Times' Austin Frakt, who looks into what sort of impact the addition of more companies onto the ACA exchanges is having on insurance premiums. Spoiler: More competition = lower prices (or at least less of an increase):

As a candidate in 2008, President Obama promised that health reform would reduce family premiums by up to $2,500, equivalent today to about a 15 percent reduction from the 2013 level. Though Mr. Obama might have been including the effects of premium subsidies in his calculation, a key premise of the Affordable Care Act is that competition among health insurers will drive premiums downward. So it’s worth asking: How much savings can additional competition produce?

...recent analysis by the Urban Institute found higher premiums in less competitive markets.

The good news is that markets will be more competitive in many exchangesin 2015, as more insurers offer plans. UnitedHealthcare has announced it will enter as many as 24 markets, for example.

Next up is Jeffrey Young of the Huffington Post, who has done an excellent analysis of what percentage of people who can enroll in private insurance via one of the ACA exchanges has done so. The basis for his analysis is an updated study by the Kaiser Family Foundation.

At first I was somewhat confused, because my own "% of eligible" spreadsheet also uses data from the KFF, and the total number eligible for exchange QHPs comes in at 22.4 million instead of the 28.6 million in their new study. Heck, Alabama alone comes in 60% higher (464K vs. 290K).

However, I think I understand the difference now. The prior KFF numbers only include people who were uninsured who qualified for a subsidy on one of the exchanges. The new one includes anyone who qualifies...even if they're already insured on the individual market directly (such as my own family until last winter):

The foundation's analysis includes people who remain uninsured and people who buy their insurance directly from an insurance company without accessing the exchange or applying for financial aid. The estimate excludes people who qualify for Medicaid, and those who aren't allowed to use an exchange, such as undocumented immigrants and workers who turn down their employers' health plans. It also excludes people who live in states that didn't expand Medicaid and who earn too little to qualify for subsidized private insurance.

In other words, there's about 6.2 million people who are already insured directly via Blue Cross, Aetna or whomever, but who could move over to a similar (or possibly the same) plan via an ACA exchange...and receive a tax subsidy in doing so.

Anyway, read his whole piece. This is the sort of thing that I specialize in, but a) he's already done so, and b) I'm a bit swamped with my day job at the moment, so I'm glad to see someone else run these numbers :)

I should also note, however, that the KFF study (and therefore Young's analysis) are a bit outdated, since they only have the 8.02 million QHP tallies from the most-recent HHS report...which only runs through April 19th. As I've been stressing all summer, the actual total is now up to roughly 9.2 million...except that only around 8 million of those have actually paid their first premium anyway, so the KFF numbers are, ironically, probably still pretty accurate regardless.