Yesterday, the Kaiser Family Foundation issued its preveiw of “how premiums will vary across the country, and how much consumers in different circumstances will actually pay" under Obamacare. The report includes actual premium prices on Obamacare exchanges (also called marketplaces) in 17 states plus the District of Columbia. These include seven states that, due to expense or technology concerns, will allow the federal government to set up their marketplaces, and 11 states that will operate their own marketplaces.

It is important to remember that individuals purchasing insurance on an Obamacare exchange will select from ‘tiers’ of coverage that increase in both services covered as well as premium costs. From the bottom up, these tiers are catastrophic, bronze, silver, gold, and platinum. Participating insurers typically offer more than one plan option within a given tier and a number of plans at different tiers (again — catastrophic, bronze, silver, gold, or platinum). As a result, the number of plans available to consumers will be greater than the number of participating insurers — at least two insurers participating in each state (plus D.C.), and three or more insurers participating in most states listed within the report.

In its report, Kaiser calculated unsubsidized premiums as well as subsidized premiums for enrollees in one bronze and one silver plan at various ages (25, 40, and 60 years old) in the largest city in each of these 17 states and Washington D.C. Most of the people enrolling in plans through an exchange are expected to qualify for tax credits that will lower the amount they pay. For instance, a single 40-year-old earning $28,725 per year will pay for the second lowest cost Silver Plan $255 per month in Los Angeles, $295 in Indianapolis, $258 in Billings, and $249 in Cleveland. After subsidies, the same person will pay $193 in monthly premiums in all of these same cities.

This detailed report, which includes an appendix that breaks down the numbers for each state plus D.C., concludes that the cost of coverage for consumers may be lower than anticipated by the Congressional Budget Office.

Diagnosis: Help!

In 1752, Benjamin Franklin (and his fellow firefighters) helped found the insurance industry in the U.S. with the establishment of the Philadelphia Contributionship for the Insurance of Houses from Loss by Fire. Accident insurance came next; such policies were first offered by the Franklin Health Assurance Company of Massachusetts around the Civil War. Sickness coverage arrived after that, though some claims have been made that Massachusetts Health Insurance of Boston offered early group policies as early as 1847.

Within the past two or three decades, science has advanced swiftly — can you spell genome? — while the rapid growth in technology may best be compared to the spread of cancer cells. The effects of these teeming changes have reached into all areas of our lives, including and most especially health care. Meanwhile, doctors have had to keep pace with science and technology, all while paying bigger malpractice insurance premiums. This combined with the fact that many new procedures and medicines are now deemed 'necessary' for each of us, and costs have spiraled beyond reach for many people.

Those covered by employer-sponsored insurance are generally considered the ‘lucky’ ones; such plans cover about 149 million non-elderly people. Yet, annual premiums for employer-sponsored family health coverage reached $16,351 in 2013, up four percent from 2012, with workers on average paying $4,565 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust 2013 Employer Health Benefits Survey. Consider the last decade: since 2003, premiums within employer plans have increased 80 percent, nearly three times as fast as wages (31 percent) and inflation (27 percent).  

These are the lucky ones?

Do Large Employers Want Their Own Exchange?

We can collectively direct our anger toward insurance companies, but considering all the new science, technology, and procedures, they have done an admirable job for many people. For some people, though, the system fell far short of their needs, despite the fact that each state has had an insurance commission charged with regulating the industry. Whether or not you believe the Affordable Care Act is the correct answer to mushrooming healthcare expenses, the new marketplace — regulated in new ways by the government — has now arrived.

In its 2013 survey of employer insurance, Kaiser Family Foundation discusses the fact that several consulting firms have announced that they will be creating private exchanges for employers.

Nine percent of large firms (200 or more employees), including 29 percent of firms with 5,000 or more employees, reported that they are considering offering health benefits through a private exchange in the future. “This interest may signal a significant change in the way that employers approach health benefits and the way employees get coverage, with employers playing a less active role in plan design and management,” wrote the authors of the survey.

No matter how you currently obtain health insurance, it seems change is on the horizon.