Major insurers surveyed about potential premium increases in six major markets expect premiums to increase by an average of 169 percent in 2014 for younger and healthier individuals.

American Action Forum asked insurers about the impact of the Affordable Care Act (ACA) in the Chicago, Phoenix, Atlanta, Austin, Milwaukee and Albany markets. Despite variation by geography,

the overall trend showed that younger and healthier male individual policyholders are expected to see the highest premium insurance, 189 percent, in 2014.

The survey (PDF) does note that since individual premiums can be as low as $50 a month for young and healthy individuals, an increase can appear very large when measured on a percentage basis. The trends for young and healthier individuals also applied f

or small employers with a predominantly younger and healthier work force.

For older and less healthy individuals, premiums are predicted to decline by an average of 22 percent while small group premiums for employers with older less healthy workers will decline an average of 26 percent. The decline is attributed to the spread of risk across a larger base broadened by

expanded coverage for younger individuals and workers under ACA reforms.

(The American Action Forum is a forward-looking policy institute dedicated to keeping America strong, free and prosperous. It seeks to promote common-sense, innovative, and solutions-based policies that will reform government, challenge out-dated assumptions, and create a smaller, smarter government that will serve its citizens better.)

Wall Street Journal March 22, 2013 By ANNA WILDE MATHEWS and LOUISE RADNOFSKY Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation's biggest firm projecting that rates could more than double for some consumers buying their own plans. The projections, made in sessions with brokers and agents, provide some of the most concrete evidence yet of how much insurance companies might increase prices when major provisions of the law kick in next year—a subject of rigorous debate. Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law. The projected increases are at odds with what the Obama Administration says consumers should be expecting overall in terms of cost. The Department of Health and Human

Services says that the law will “make health-care coverage more affordable and accessible,” pointing to a 2009 analysis by the Congressional Budget Office that says average individual premiums, on an apples-to-apples basis, would be lower. The gulf between the pricing talk from some insurers and the government projections suggests how complicated the law's effects will be. Carriers will be filing proposed prices with regulators over the next few months. Part of the murkiness stems from the role of government subsidies. Federal subsidies under the health law will help lower-income consumers defray costs, but they are generally not included in insurers' premium projections. Many consumers will be getting more generous plans because of new requirements in the law. The effects of the law will vary widely, and insurers and other analysts agree that some consumers and small businesses will likely see premiums go down. Starting next year, the law will block insurers from refusing to sell coverage or setting premiums based on people's health histories, and will reduce their ability to set rates based on age. That can raise coverage prices for younger, healthier consumers, while reining them in for older, sicker ones. The rules can also affect small businesses, which sometimes pay premiums tied to employees' health status and claims history. UnitedHealth Group, the nation's largest carrier, and other health insurers said premiums for some individuals and small businesses could rise. The law's 2014 effect on larger companies is likely to be more limited. Many of the big changes coming next year won't touch them as directly as individual consumers and small businesses, though some will have to grapple with the cost of covering more workers or paying a penalty. The possibility of higher premiums has become the latest focal point of the political tussle over the health law, which marks its third anniversary Saturday. Republican lawmakers have held hearings on the issue, and six

GOP members of the House Energy and Commerce committee wrote last week to more than a dozen insurers asking them to turn over internal analyses on the law's impact on premiums and costs. The insurance industry has also been talking publicly about big potential premium increases in lobbying for tweaks to the law. The individual market includes about 15 million people, and around 18% of the roughly 149 million with employer coverage were at small companies, according to 2011 figures from the Kaiser Family Foundation. The individual market is expected to grow to around 35 million people by 2016 as a result of the law. In a private presentation to brokers late last month, UnitedHealth Group Inc., UNH -1.25% the nation's largest carrier, said premiums for some consumers buying their own plans could go up as much as 116%, and small-business rates as much as 25% to 50%. The company said the estimates were driven i

n part by growing medical costs not directly tied to the law. It also cited the law's requirements that health status not affect rates and that plans include certain minimum benefits and limits to out-of-pocket charges, among other things. Jeff Alter, who leads UnitedHealth's employer and individual insurance business, said the numbers represented a “high-end scenario,” not an average. “There are some scenarios in which a member could see as much as a 116% increase or over,” he said, though others, such as some older consumers, could see decreases. He said the company dwelled on the possible increases because it was trying to prepare brokers to speak with clients facing big jumps. Other carriers have also projected steep rate increases during private meetings and conversations with brokers. Brokers say they are being told to prepare the marketplace for small-business and individual rate increases as carriers get ready to file specific rate proposals and plan designs with regulators. Insurers are “not being shy that premiums are going to increase in 2014,” and are urging brokers to “brace our clients,” said John Lacy, vice president of group benefits at Bouchard Insurance, a brokerage in Clearwater, Fla. His firm has been hearing from carrier representatives that individual premiums in Florida could go up 35% to 50%, on average, and small-business rates around 30%, though it hopes to find strategies to blunt the impact. Aetna Inc., AET -0.82% in a presentation last fall to its national broker advisory council, suggested rates on individual plans not being grandfathered under the law could go up 55%, on average, and gave a figure of 29% for small business rates. Both numbers included 10 percentage points tied to medical-cost inflation, not the law. An Aetna spokesman said the numbers are “still generally in line with what we've been estimating,” and represented the average impact in a typical state. An official with Blue Cross & Blue Shield of North Carolina told a gathering of brokers last week that individual premiums could go up by as much as 40% to 50%, according to brokers who were present. A spokeswoman for the insurer said “we don't have final numbers” yet on premiums. There has long been debate, even among insurance experts, over how the law will affect premiums. Because the effect is likely to vary, different measurements can arrive at different conclusions. The CBO analysis cited by the administration determined that average premiums for consumers who buy their own coverage would be 14% to 20% lower because of the law—if the law didn't change the types of plans they purchased. But the CBO also suggested the law would lead to consumers buying more expensive plans, largely because it requires coverage to include certain benefits and limit charges such as deductibles. When this effect was taken into account, the average premiums would go up 10% to 13%, the agency said, though subsidies would ease the bite for most people. The agency also said small-business policies were likely to cost within a few percentage points of the amount they would have without the law. Health and Human Services officials say competition among insurers, as well as provisions to limit their financial risk from attracting high-cost consumers, will exert downward pressure on premiums, and point to the tax subsidies that will limit many consumers' costs. Subsidies will be available on a sliding scale for people with incomes of up to four times the federal poverty level—currently $45,960 for

a single person and $94,200 a year for a family of four. More than half of the 35 million people expected to be in the individual market by 2016 are likely to qualify for credits. People whose incomes are around the poverty level could see almost all of the cost of their insurance subsidized, while people at the upper end will get only a small discount toward their premiums.

Some Americans could see their insurance bills double next year as the health care overhaul law expands coverage to millions of people.

The nation's big health insurers say they expect premiums — or the cost for insurance coverage — to rise from 20 to 100 percent for millions of people due to changes that will occur when key provisions of the Affordable Care Act roll out in January 2014.

Mark Bertolini, CEO of Aetna Inc., one of the nation's largest insurers, calls the price hikes “premium rate shock.”

“We've done all the math, we've shared it with all the regulators, we've shared it with all the people in Washington that need to see it, and I think it's a big concern,” Bertolini said during the company's annual meeting with investors in December.

To be sure, there will be no across-the-board rate hikes for everyone, and there's no reliable national data on how many people could see increases. But the biggest price hikes are expected to hit a group that represents a relatively small slice of the insured population. That includes some of the roughly 14 million people who buy their own insurance as opposed to being covered under employer-sponsored plans, and to a lesser extent, some employees of smaller companies.

The price increases are a downside of President Barack Obama's health care law, which is expected to expand coverage to nearly 30 million uninsured people. The massive law calls for a number of changes that could cause premiums for people who don't have coverage through a big employer to rise next year — at a time when health care costs already are expected to grow by 5 percent or more:

— Changes to how insurers set premiums according to age and gender could cause some premiums to rise as much as 50 percent, according to America's Health Insurance Plans, or AHIP, an industry trade group that's funded by insurers.

— A new tax on premiums could raise prices as much as 2.3 percent in 2014 and more in subsequent years, according to a study commissioned by AHIP. Policyholders with plans that end in 2014 probably have already seen an impact from this.

— Requirements that insurance plans in many cases cover more health care or pay a greater share of a patient's bill than they do now also could add to premiums, depending on the extent of a person's current coverage, according AHIP.

The Obama administration says the law balances added costs in several ways, including tax credits that will bring down what many consumers will pay for insurance.

“The health care law will bring down costs and save money for young people and families,” said Erin Shields Britt, a spokeswoman for the Department of Health and Human Services. “It's misleading to look at one provision of the law alone. Taken together, the law will reduce costs.”

WHERE 'RATE SHOCK' MAY STRIKE

The impact of some cost hikes will be wide ranging. The new premium tax, for instance, will affect individual insurance, some employer-sponsored coverage and Medicare Advantage policies, which are privately-run versions of the government's Medicare program for the elderly and disabled.

Other price hikes will vary due to factors like a person's current coverage and age. Young people who currently have low-cost coverage may see some of the biggest hikes.

In many states, insurers charge a 60-year-old customer $5 in premiums for every $1 they collect from a 24-year-old. The logic behind that is that older people use health care more and generate more expensive claims than younger customers, so insurers need to collect more to help pay their bills.

But the overhaul will narrow that ratio to 3-to-1. That alone could cause the premium for a 24-year-old who pays $1,200 annually to jump to $1,800, according to AHIP. Meanwhile, the 60-year-old who currently pays $6,000 will see a 10 percent drop in price.

Gender also can be a factor in whether premiums go up or down. The law will prohibit insurers from setting different rates based on gender — something they currently do

because women generally use more health care. That means premiums for some men could rise, while they fall for women.

Prices also may change depending on a person's current coverage. Many policies on the individual market (coverage not sold through employers) exclude maternity coverage, but that will be considered an essential health benefit under the overhaul. That could mean higher prices for some.

Vikki Swanson, 49, of Newport Beach, Calif., resents that the added benefit may lead to higher costs for her. “I had a hysterectomy, I have no need for maternity coverage, but I have to now pay for it,” she said.

As a self-employed accountant and financial analyst, Swanson has paid for her insurance coverage on the individual market for about 13 years. She watched her monthly premium climb from around $136 in 2001 to more than $600 before she could find cheaper coverage. She's frustrated that the overhaul may add to her bill.

“I have to pay not only my own premium but I have to subsidize everybody else,” she said.

CUSHIONING THE BLOW

While insurers forecast instant premiums hikes starting next January, the overhaul also is expected to tame health care costs for many.

Starting next year, the law will require insurers to cover everyone who applies. That means health care costs could fall dramatically for people who have been unable to find coverage due to a chronic condition like diabetes or high blood pressure.

There also will be tax credits, or subsidies, given to people with incomes that fall within 400 percent of the federal poverty level. For 2013, 400 percent of the poverty level for all states except Alaska and Hawaii would be $94,200. These credits won't lower premiums, but they can ease the insurance bill depending on a person's income.

The credits should help the 20-something customers that insurers warn will see big premium hikes, said Linda Blumberg, an economist with the Health Policy Center of the Urban Institute, a nonpartisan policy research organization. She noted that people in that age range are more likely to be either working for an employer that doesn't offer coverage or earning low wages that would entitle them to a sizeable credit.

“While these folks are potentially facing some premium increases due to all these reforms, they also are the ones most likely to get the financial help from the exchanges,” she said.

There are other changes that will benefit young and poor people. Some may qualify for coverage under the state-federal Medicaid program for the poor and disabled, which will expand in many states next year.

Additionally, people under age 30 who face big premium hikes will be able to buy plans that charge low premiums and just provide coverage for big or catastrophic costs. Those plans also will be available to people required to pay more than 8 percent of their income for coverage.

Associated Press By TOM MURPHY— Mar. 13 12:50 PM EDT

Plus, people who are age 26 and under are eligible to receive coverage under a parent's plan, thanks to another overhaul provision that already started.

In addition to those changes, insurers will have to compete for business on the exchanges, which could restrain price hikes, said Larry Levitt, a private health insurance expert with the Kaiser Family Foundation, which analyzes health policy issues. He noted, for instance, that some are already creating narrow networks of low-cost providers to help keep costs in check.

“Plans are very focused on trying to get these premiums down,” he said.

But Robert Laszewski, an industry consultant and former insurance executive, said that theory assumes there is no competition in the marketplace now. He noted that a small company may get quotes from as many as 10 insurers competing for business when it tries to find coverage through a broker.

“I haven't had one person in the industry remark to me, 'Gosh, I wonder what the other guy's charging,'” he said. “They're worried that all this stuff is so expensive, they're not going to get the pricing right.”

Blue Shield, Aetna To Proceed With Rate Hikes In California. March 7, 2013 The Los Angeles Times reports, “Despite objections from regulators, health insurers Blue Shield of California and Aetna Inc. are proceeding with double-digit rate increases that state officials said were unreasonable.” The rate increases, averaging eleven percent for about 47,000 policyholders, were called unreasonable by California Department of Managed Health Care officials, although they lack authority

to deny them. “I am disappointed that after le

ngthy negotiations, Blue Shield and Aetna were unwilling to bring their proposed health plan increases

down to a reasonable level,” said Brent Barnhart, director of the angelscamp.org Department of Managed Health Care. According to Barnhart, both insurers did offer some concessions and lowered rate increases for some of the affected policies but some Blue Shield members will still see 20% rate increases. California Insurance Commissioner Dave Jones “is expected to criticize another rate increase from Blue Shield at a news conference Thursday.”

OPINION January 31, 2013,

6:52 p.m. ET
ObamaCare's Broken Promises
Every one of the main claims made for the law is turning out to be false. .
By DANIEL P. KESSLER

As the federal government moves forward to implement President Obama's Affordable Care Act, the Department of Health and Human Services is slated to spend millions of dollars promoting the unpopular legislation. In the face of this publicity blitz, it is worth remembering that the law was originally sold largely on four grounds—all of which have become increasingly implausible.

• Lower health-care costs. One key talking point for ObamaCare was that it would reduce the cost of insurance, especially for non-group insurance. The president, citing the work of several health-policy experts, claimed that improved care coordination, investments in information technology, and more efficient marketing through exchanges would save the typical family $2,500 per year.

That was then. Now, even advocates for the law acknowledge that premiums are going up. In analyses conducted for the states of Wisconsin, Minnesota and Colorado, Jonathan Gruber of MIT forecasts that premiums in the non-group market will rise by 19% to 30% due to the law. Other estimates are even higher. The actuarial firm Milliman predicts that non-group premiums in Ohio will rise by 55%-85%. Maine, Oregon and Nevada have sponsored their own studies, all of which reach essentially the same conclusion.

Some champions of the law argue that this misses the point, because once the law's new subsidies are taken into account, the net price of insurance will be lower. This argument is misleading. It fails to consider that the money for the subsidies has to come from somewhere. Although debt-financed transfer payments may make insurance look cheaper, they do not change its true social cost.

• Smaller deficits. Increases in the estimated impact of the law on private insurance premiums, along with increases in the estimated cost of health care more generally, have led the Congressional Budget Office to increase its estimate of the budget cost of the law's coverage expansion. In 2010, CBO estimated the cost per year of expanding coverage at $154 billion; by 2012, the estimated cost grew to $186 billion. Yet CBO still scores the law as reducing the deficit.

How can this be? The positive budget score turns on the fact that the estimated revenues to pay for the law have risen along with its costs. The single largest source of these revenues? Money taken from Medicare in the form of lower Medicare payment rates, mostly in the law's out-years. Since the law's passage, however, Congress and the president have undone various scheduled Medicare cuts—including some prescribed by the law itself.

Put aside the absurdity that savings from Medicare—the country's largest unfunded liability—can be used to finance a new entitlement. The argument that health reform decreases the deficit is even worse. It depends on Congress and the president not only imposing Medicare cuts that they have proven unwilling to make but also imposing cuts that they have already specifically undone, most notably to Medicare Advantage, a program that helps millions of seniors pay for private health plans.

• Preservation of existing insurance. After the Supreme Court upheld the constitutionality of health reform in June 2012, President Obama said, “If you're one of the more than 250 million Americans who already have health insurance, you will keep your insurance.” This theme ran throughout the selling of ObamaCare: People

who have insurance would not have their current arrangements disrupted.

This claim is obviously false. Indeed, disruption of people's existing insurance is one of the law's stated goals. On one hand, the law seeks to increase the generosity of policies that it deems too stingy, by limiting deductibles and mandating coverage that the secretary of Health and Human Services thinks

is “essential,” whether or not the policyholder can afford it. On the other hand, the law seeks to reduce the generosity of policies that it deems too extravagant, by imposing the “Cadillac tax” on costly insurance plans.

Employer-sponsored insurance has already begun to change. According to the annual Kaiser/HRET Employer Health Benefits Survey, the share of workers in high-deductible plans rose to 19% in 2012 from 13% in 2010.

That's just the intended consequences. One of the law's unintended consequences is that some employers will drop coverage in response to new regulations and the availability of subsidized insurance in the new exchanges. How many is anybody's guess. In 2010, CBO estimated that employer-sponsored coverage would decline by three million people in 2019; by 2012, CBO's estimate had doubled to six million.

• Increased productivity. In 2009, the president's Council of Economic Advisers concluded that health reform would reduce unemployment, raise labor supply, and improve the functioning of labor markets. According to its reasoning, expanding insurance coverage would reduce absenteeism, disability and mortality, thereby encouraging and enabling work.

This reasoning is flawed. The evidence that a broad coverage expansion would improve health is questionable. Some studies have shown that targeted coverage can improve the health of certain groups. But according to the Robert Wood Johnson Foundation's Economic Research Initiative on the Uninsured, “evidence is lacking that health insurance improves the health of non-elderly adults.” More recent work by Richard Kronick, a health-policy adviser to former President Bill Clinton, concludes “there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the U.S.”

The White House economic analysis also fails to consider the adverse consequences of income-based subsidies on incentives. The support provided by both the Medicaid expansion and the new exchanges phases out as a family's income rises. But, as I and others have pointed out in these pages, income phaseouts create work disincentives like taxes do, because they reduce the net rewards to work. Further, the law imposes taxes on employers who fail to provide sufficiently generous insurance, with exceptions for part-time workers and small firms. On net, it is hard to see how health

reform will make labor markets function better.

Some believe that expanding insurance coverage is a moral imperative regardless of its cost. Most supporters of the law, however, use more nuanced arguments that depend on assumptions that are increasingly impossible to defend. If we are ever to have an honest debate about entitlement spending, we will need to distinguish these positions from one another—and see them for what they really are, rather than what we wish they would be.

Mr. Kessler is a professor of business and law at Stanford University and a senior fellow at the Hoover Institution.

A version of this article appeared February 1, 2013, on page A13 in the U.S. edition of The Wall Street Journal, with the headline: ObamaCare's Broken Promises.