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特朗普要失望了 奧巴馬醫(yī)改法不會“迅速滅亡”

特朗普要失望了 奧巴馬醫(yī)改法不會“迅速滅亡”

Sy Mukherjee 2017-04-16
標準普爾還認為,ACA市場里不少保險公司可能今年會止住虧損勢頭,有些企業(yè)甚至明年有可能扭虧為盈。

新任美國總統(tǒng)唐納德·特朗普喜歡說,他會讓前任奧巴馬打造的醫(yī)改法案“爆炸”(或者先內爆,然后外爆)。但根據國際評級機構標準普爾新近公布的一份報告,奧巴馬醫(yī)改的市場實際上日趨穩(wěn)定,一些投保人享受的投保受益能持續(xù)到2018年。

特朗普堅稱奧巴馬執(zhí)政時通過的《患者保護與平價醫(yī)療法案》(ACA)會迅速滅亡,根據是該法案傳出的一些壞消息。去年醫(yī)療保險公司宣布,大幅上調ACA醫(yī)保市場的個人醫(yī)保計劃保費(但其中不少增加的費用都可以通過聯(lián)邦政府補貼抵消),Humana等保險公司宣布退出ACA市場,稱醫(yī)保計劃導致虧損,而且法案存在不確定性。批評人士預計,種種事件將造成奧巴馬醫(yī)改的保費越來越昂貴,無法持續(xù),從而陷入“死亡循環(huán)”最終崩盤。

標準普爾上述報告深入分析了美國個人保險市場支柱、奧巴馬醫(yī)改法的市場骨干——醫(yī)療保險公司Blue Cross Blue Shield(BCBS)旗下醫(yī)保計劃,發(fā)現(xiàn)“BCBS大多數投保人2016年的投保收益較往年明顯提升?!睒藴势諣柕姆治鰩煂懙溃骸拔覀兎治?016年的業(yè)績和2017年迄今為止的保險申請數據,顯示ACA個人醫(yī)保市場并沒有陷入‘死亡循環(huán)’?!?/p>

標準普爾還認為,ACA市場里不少保險公司可能今年會止住虧損勢頭,有些企業(yè)甚至明年有可能扭虧為盈。

“展望未來,我們預計,保險公司今年(ACA醫(yī)保)基本能接近盈虧平衡,”報告的作者寫道,“如果市場不受影響,(ACA)只做少數修正而非全面整改,我們預計2018年,即ACA個人醫(yī)保市場在運作第五年會逐步好轉,更多保險公司財報會略有盈余(雖然盈利只是低個位數)?!?/p>

考慮到個人醫(yī)保市場諸多復雜因素,呈現(xiàn)逐步好轉意義重大。奧巴馬醫(yī)改出現(xiàn)以前,該市場儼然蠻荒之地,不過是醫(yī)療保險領域的一小塊。和企業(yè)投保的醫(yī)療保險不同,個人醫(yī)保市場鮮有規(guī)范管理收益、醫(yī)療核保和避免歧視病患的法規(guī),也幾乎沒有機構跟進市場動向,了解最新盈虧狀況。

因此,當保險公司遵循奧巴馬醫(yī)改的新監(jiān)管規(guī)定首次設定保費時,實質上是在玩一場龐大的猜謎游戲,投保人健康狀況如何?多少人會投保?最終要賠付多少?客戶會不會年復一年留在市場里?

要回答這些問題并相應調整還需要相當一段時間,以及諸多修正,比如2017年就出現(xiàn)保費大增。標準普爾認為進展相對穩(wěn)定,隨著進一步了解市場,多項早年奧巴馬醫(yī)改計劃到期,保險公司正逐漸調整以穩(wěn)定市場。

但樂觀預期并不意味著市場會形勢大好。對參與奧巴馬醫(yī)改法的保險企業(yè)來說,不確定性是最大的威脅,因為特朗普和國會正在設法推翻奧巴馬醫(yī)改,一旦得手仍然可能嚴重影響ACA。

標準普爾也承認這是當前首要風險。其分析師寫道:“假如個人保險市場出現(xiàn)重大變化,或者(政府為幫助客戶減少投入而給予保險公司的補貼)徹底失效,市場只能按照新規(guī)定從頭再來?!保ㄘ敻恢形木W)

譯者:Pessy

審稿:夏林

President Donald Trump is fond of saying that he will simply let Obamacare "explode" (or implode, then explode). But the health law's marketplaces are actually becoming more stable and may even churn out profits for some participating health insurers by 2018, according to a new Standard & Poor's report.

Trump's insistence that Affordable Care Act (ACA) markets are exploding is based on some legitimately bad news for Obamacare. Health insurers announced substantial premium increases for individual plans sold through the law's exchanges last year (although many of these increases are counteracted by federal subsidies), and insurance companies like Humana have been announcing their departure from the marketplaces, citing losses and general uncertainty surrounding the law. Critics have predicted that this combination of events will lead to a so-called "death spiral" in which Obamacare becomes increasingly expensive and unsustainable, eventually causing a market collapse.

But S&P's dive into the operating performance of Blue Cross Blue Shield plans—which make up the backbone of the individual insurance market and the bulk of the Obamacare exchanges—finds that "2016 was a marked improvement" over previous years for most BCBS insurers. "Our analysis of 2016 results and the market enrollment so far in 2017 shows that the ACA individual market is not in a 'death spiral,'" wrote the S&P analysts.

S&P also believes that many insurers in the marketplaces are likely to stop bleeding money this year—and may even start making some in the next.

"Looking forward, we expect insurers, on average, to get close to break-even margins in this segment in 2017," wrote the report authors. "If the market continues unaffected, with a few fixes rather than an overhaul, we expect 2018, or Year 5 of the ACA individual market, to be one of gradual improvement with more insurers reporting positive (albeit low single-digit) margins."

The gradual improvement makes sense considering the multiple complexities of the individual market. Before Obamacare's enactment, this market, which is just a sliver of the overall health insurance sector, was essentially the wild west. There were very few rules governing benefits, medical underwriting, or discrimination against the sick; unlike in employer-sponsored health insurance, there were few entities keeping track of the market and its finances.

So when insurers set their premiums for the first time under Obamacare's new regulations, they were essentially playing a huge guessing game. How sick would enrollees be? How many would sign up? How much would it cost to cover them? And would customers remain in the market year after year?

It takes a fair bit of time—and plenty of corrections, such as the steep 2017 premium increases—to both answer these questions and then makes changed to fit the market reality. That's finally beginning to happen, according to S&P, as insurers gain a more nuanced understanding of the exchanges and adjust to the expiration of several early-year Obamacare programs meant to stabilize the markets.

But none of that means that the markets will be fine and dandy going forward. Uncertainty is the single biggest threat to insurance company participation in Obamacare, meaning President Trump and Congress' ongoing efforts to dismantle the law could still wreak havoc on the ACA if ultimately successful.

That's a fact that S&P acknowledges right up top. "[I]f there are significant changes to the individual market, or if [subsidies to insurers that help reduce customers' out-of-pocket costs] are made null and void, the market essentially has to restart with a new set of rules," the analysts wrote.

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