To: Kenneth E. Phillipps who wrote (191223 ) 5/7/2016 4:01:33 AM From: FJB Read Replies (1) | Respond to of 224704 The Affordable Care Act’s Elephant in the Room Investor's Business Daily by TERRY JONES The debate over the Affordable Care Act has focused almost exclusively on the roughly 12.7 million health insurance policies obtained through the law’s online exchanges. But what about the elephant in the room: how it’s also affecting employer-sponsored plans — and the 151 million Americans who are covered by them? I just completed a new study that answers this question. Here’s the short version: Premiums for millions of employer-sponsored health insurance plans will nearly double over the next decade. Unable to afford added costs, many employers will be forced to stop offering health care coverage at all. Employees will then be left with two options: Purchase even more expensive coverage on the law’s exchanges, or pay thousands of dollars in tax penalties. In other words, the Affordable Care Act’s harms extend far beyond federal and state exchanges. It’s important to understand how big this problem is. According to my analysis — which relies on the federal Medical Expenditure Panel Survey, among other government data sources — the employer-sponsored health insurance market covers nearly 12 times as many people as are enrolled in the Affordable Care Act’s exchanges, as of the Jan. 31 cutoff for 2016 plans. Premiums for employer-sponsored plans are shared by employers and employees. Employers generally pay around 80% of the total costs, while employees pay the remaining 20%. Both will see their costs escalate dramatically over the next decade. Start with the share paid by employees. Of the eight plan types available in 2016, the most common is a midlevel PPO, covering roughly 90 million people today. Over the next 10 years, I estimate individual employee premiums for these plans will increase by 78%, from $900 annually in 2016 to $1,600 by 2025. Family premiums will grow by a slightly lower 71%, and will cost $4,800 per year by 2025 — roughly $2,000 more than today. The second most popular plan — a high-option PPO plan, which covers around 26 million people today — will increase even more. Individual employee premiums will jump by 83%, from $1,200 per year in 2016 to $2,200 in 2025. Meanwhile, family premiums will nearly double, from $3,700 this year to $7,000 a decade from now. But it doesn’t stop there. Of the six remaining plan types — covering 36 million Americans — every single one will increase by a minimum of 23%. Combined with the two most common options, 95% of today’s employer-sponsored plans will increase by at least 50% through 2025. That amounts to thousands of dollars in additional out-of-pocket costs. And that’s just the cost to employees. The 80% share paid by employers is far worse. That 78% increase for midlevel PPO plans will cost employers an additional $2,800 per individual plan, and $8,000 more per family by 2025. The high-option PPO will cost employers an extra $4,000 per individual by 2025, while family plans will cost an additional $13,200 apiece. Even for small businesses, this could amount to hundreds of thousands of dollars in higher health care costs every year. Those are costs many employers cannot afford. They’ll be forced to choose between offering plans with fewer choices, or not offering health plans at all. Using a projection model funded in part by the U.S. Department of Health and Human Services, I estimate both will occur. While more than 22 million employees have high-option PPO plans today, that number will fall to less than 6 million by 2025. Many of those will be replaced by low-option PPO plans and Health Savings Accounts, which typically have fewer choices available to patients. Meanwhile, 11 million fewer Americans will receive health insurance through their employers by 2025. These families and individuals will then have to choose between purchasing insurance on state or federal exchanges — where premiums for comparable plans may be three to four times more expensive, according to a similar study I conducted — or pay a penalty equal to 2.5% of their taxable income. These higher costs and penalties will crush low- and middle-income families already living paycheck to paycheck. All of this is the inevitable result of the Affordable Care Act’s design. It was never intended to manage costs for employer-sponsored plans. Rather, it merely applied more mandates to an already labyrinthine bureaucracy, dictating what type of coverage patients are allowed to have. Higher costs are the natural consequence of a law that prioritizes government mandates over individual choice. Which gets to the heart of rising costs under the Affordable Care Act: When the government imposes more mandates and takes choices away from patients, costs will rise. It’s really that simple. The law’s supporters may try to avoid this reality all they like, but there’s an elephant in the room they can’t ignore for much longer.Parente , a professor of health finance, is an associate dean at the Carlson School of Management at the University of Minnesota.