December 10, 2023

Health Insurance

Follow Your Health Insurance

Health insurance costs are about to go up. Maybe way up.

Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

For those of you who have private health insurance — insurance provided by your employer, for example — prices are going to rise about 10% on average, based on initial data from states.

But if Congress does not act fairly soon, insurance rates will rise a lot more for the 13 million Americans who get insurance through the Affordable Care Act marketplace, and 1 million Americans will face health insurance costs that are double what they pay today.

This is a little complex but so important, so I will take a detailed dive.

First, let’s talk about private health care costs. For the last several years, private health insurance rates have remained about flat. In part, that is because people did not use their health insurance as much during the pandemic because they could not get elective surgery and they didn’t visit their doctors as often. But as restrictions eased, people started using their health insurance more.

Now, the Kaiser Family Foundation says, based on a review of data from 13 states, it appears health insurance costs will rise around 10% this year.  Rates will vary by location, but also by how much employers pay or pass along. Bigger employers can sometimes cut better deals with insurers.

The Peterson-Kaiser Family Foundation Health System Tracker says:

At the time of this brief, we have compiled data from 72 insurers across 13 states and the District of Columbia. (The 13 states reviewed include: Georgia, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, New York, Oregon, Rhode Island, Texas, Vermont, and Washington.) These filings are preliminary and may change during the review process. Rates will be finalized in late summer.

So far, we find that across 72 insurers in 13 states and the District of Columbia, the median proposed premium increase is about 10%. Most premium changes insurers are requesting for 2023 fall between about 5% and 14% (the 25th and 75th percentile, respectively). Compared to recent years, relatively few insurers are requesting to lower their premiums, with only 4 out of 72 insurers filing negative premium changes, and the remaining 68 insurers requesting premium increases.

Insurers say about half of the increase is because people are using their health care benefits more now and about half is from inflation. The Associated Press has an easy-to-read story about the estimates. Here is Peterson-KFF Health’s Systems Tracker with a much more detailed summary of what is driving private insurance costs through 2023.

Now let’s turn to marketplace insurance premiums for the ACA — commonly known as Obamacare. Congress is likely to extend the program that keeps these costs from going up. But, as you know, nothing is certain in Congress these days. If Congress fails to act, ACA customers will get notices that their rates are rising by a lot sometime around the first of October.

My friend Larry Levitt, KFF’s executive vice president for health policy, has been telling classes that I am leading around the country that journalists should pay attention to whether Congress extends health care coverage under the American Rescue Plan Act.

Before the pandemic-linked ARPA, people who earned more than four times the federal poverty level were not eligible for subsidies under the ACA. People whose income goes over the level even by a little bit would have to pay full price for coverage, which would make it unaffordable for many.

When Congress passed ARPA, it changed the calculation for who could get subsidized health care in the ACA marketplace. The new calculation was based on a percentage of income going to health care, so people with higher incomes would pay not more than 8.5% of their income for Silver Plan coverage, the most basic marketplace plan.

But now Congress has to decide if it will make the new ARPA rule permanent, or if we will go back to income four times the poverty level as the cutoff for subsidies to cover health insurance. The cost of the subsidy is about $22 billion a year.

The current subsidies expire at the end of the year. There’s no doubt this will become an election issue.

Journalists should be asking candidates whether they support extending ARPA health care subsidies. Sen. Joe Manchin, the Senate’s swing vote, indicated that he will support extending ARPA, but (for now) wants a bill that does not include other spending, including climate change measures or tax hikes on the wealthiest Americans.

If Congress does not extend ARPA, millions of Americans will get notices in the mail telling them that their insurance rates are about to skyrocket just weeks before the midterm elections. It will ignite new attacks on Democrats for failing to control health care costs.

Levitt told our seminar participants that if Congress does not extend the ARPA subsidies, some people will pay upwards of $100 a month more for basic coverage. But since coverage costs more or less depending on where you live, some people could end up paying twice as much for coverage.

Kaiser Family Foundation estimates:

A 40-year-old with an income of just over four times the poverty level living in West Virginia or Wyoming would have to pay an average of 18% of his or her income for a silver plan without the ARPA’s subsidies. That’s an increase of over 100% in their premium payments. Meanwhile, the same person living in one of six low-premium states (Colorado, Maryland, Michigan, Minnesota, New Hampshire, and Rhode Island) already pays less than 8.5% of their income for an unsubsidized silver premium.

A 64-year-old Marketplace enrollee making just over four times the poverty level in West Virginia or Wyoming would have to pay more than 40% of their income for a silver plan if they lost access to the ARPA subsidies.

Kaiser provides this calculation as an illustration of how one person would be affected:

On average across the U.S., a 40-year-old with an income just over four times the poverty level ($51,520 per year for individuals buying coverage in 2022), will see their premium payments increase from 8.5% of their income to about 10% of their income if ARPA subsidies expire. The typical 40-year-old would go from having subsidized monthly payments of $365 to an unsubsidized $438, or an increase in their premium payment of about 20% simply due to the loss of subsidies. That’s before accounting for any increase in the unsubsidized premium from 2022 to 2023.

Go to this interactive map to see state-by-state estimates of what this increase could cost if Congress does not extend ARPA:

(Kaiser Family Foundation)

By the way, our Poynter Midterm Essentials workshops head to Columbus, Ohio, and then Philadelphia next week. The classes are full. We end in St. Petersburg in August. We will record that last session and make it available for free soon so you can get the above information right from Larry Levitt himself. I will let you know when we post the videos.

In this 30 second exposure, a meteor streaks across the sky during the annual Perseid meteor shower, Tuesday, Aug. 10, 2021, in Spruce Knob, West Virginia. (NASA/Bill Ingalls)

This weekend essay in The New York Times by Andrea Stanley caught my attention and made me think about my own contributions to the problem.

The essay looks at how light pollution is making it difficult to enjoy the nighttime sky in so much of the country, even in what used to be dark sky country.

Some of it is light from streetlights. Some is from others like me who send light into the night with landscape lighting. The essay caught my attention with this line, “What is the point of an illuminated shrub at 2 a.m.?”

The essay includes this passage:

According to a 2016 study published in the journal Science Advances, 83 percent of the world’s population lives under light-polluted skies, with one-third of humans unable to see the Milky Way at all. Later findings, in the same journal, noted that the amount of light-touched land increases by roughly two percent every year.

“Light pollution is absolutely growing,” Ashley Wilson, director of conservation for the International Dark-Sky Association (IDA), an organization working to combat light pollution, told me. “Not even just our use of light, but the excessive use of it. There was a report published earlier this year by the Department of Energy which stated that 99 percent of the light that we emit has no clear purpose. It boggles my mind. My analogy is with water. You would never want to leave your sprinklers on all night in the hope it is going to water a specific plant in a pot. Why are we doing the same with our light?”

A National Geographic article reported that light pollution has other effects:

Artificial light can wreak havoc on natural body rhythms in both humans and animals. Nocturnal light interrupts sleep and confuses the circadian rhythm—the internal, twenty-four-hour clock that guides day and night activities and affects physiological processes in nearly all living organisms. One of these processes is the production of the hormone melatonin, which is released when it is dark and is inhibited when there is light present. An increased amount of light at night lowers melatonin production, which results in sleep deprivation, fatigue, headaches, stress, anxiety, and other health problems.

And artificial light causes big problems for animals, too, especially for sea turtles and migratory birds:

Studies show that light pollution is also impacting animal behaviors, such as migration patterns, wake-sleep habits, and habitat formation. Because of light pollution, sea turtles and birds guided by moonlight during migration get confused, lose their way, and often die. Large numbers of insects, a primary food source for birds and other animals, are drawn to artificial lights and are instantly killed upon contact with light sources. Birds are also affected by this, and many cities have adopted a “Lights Out” program to turn off building lights during bird migration.

There is even a group called the International Dark Sky Association that “works to protect night skies.” The group maps locations that are part of the Dark Sky Places Program.

(Dark Sky)

The locations are broken down into several categories, all of which could make terrific news stories, especially given the interest in the recent space telescope photos:

The International Dark Sky Places Program offers five types of designations:

  • International Dark Sky Communities: Communities are legally organized cities and towns that adopt quality outdoor lighting ordinances and undertake efforts to educate residents about the importance of dark skies.
  • International Dark Sky Parks: Parks are publicly- or privately-owned spaces protected for natural conservation that implement good outdoor lighting and provide dark sky programs for visitors.
  • International Dark Sky Reserves: Reserves consist of a dark “core” zone surrounded by a populated periphery where policy controls are enacted to protect the darkness of the core.
  • International Dark Sky Sanctuaries: Sanctuaries are the most remote (and often darkest) places in the world whose conservation state is most fragile.
  • Urban Night Sky Places: UNSPs are sites near or surrounded by large urban environs whose planning and design actively promote an authentic nighttime experience in the midst of significant artificial light at night, and that otherwise do not qualify for designation within any other International Dark Sky Places category.

Axios brings us a nice reframe on boredom with studies that show boredom is good for us. Most of us are fiddling with our devices and doomscrolling all day and that leaves no time for our brains to relax, wander and create.  But, Axios points out:

In one study, published in the Academy of Management Discoveries, researchers lulled a group into boredom by instructing them to sort beans by color. Another group was given a far more interesting craft to do.

After that, each group was directed to come up with good excuses for tardiness. The bored group bested their counterparts on both number and creativity of ideas, as judged by an objective outside group.

Another study concluded that boredom motivates people to seek out novelty. Our minds wander when we’re bored, and we think of new things to try.

Yet another researcher found that boredom can be especially useful for kids who, the study says, need unstructured time to create their own thoughts and activities.

All of this explains why almost two-thirds of people surveyed say some of their best thinking happens in the shower. It is not the shower that helps you; it is being disconnected from everything, for even a few minutes, that frees you to think creatively.

Maybe we should not ask, “What are you doing this weekend?” Instead, we might ask, “What are you NOT doing this weekend?” Dare to be bored.

We’ll be back next week with a new edition of Covering COVID-19. Are you subscribed? Sign up here to get it delivered right to your inbox.


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