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Illustration: Sarah Grillo/Axios

Premiums for Affordable Care Act coverage are going down in some places, and barely rising in others.

The big picture: Health insurers raised ACA rates dramatically over the past few years, largely due to political chaos. But their plans have still proven to be extremely profitable. Now many companies are lowering premiums as they expect to send money back to their customers.

Driving the news: Blue Cross Blue Shield of North Carolina is reducing the average premium for ACA plans by 5.5% in 2020.

  • Nationally, average ACA premiums are basically flat for next year and are going down in a handful of states, according to an analysis by ACA tracker Charles Gaba.

Between the lines: Insurers jacked up ACA premiums after the Trump administration cut off cost-sharing subsidies and nullified the individual mandate, and as Republicans threatened to eradicate the entire law, among other things. Now, they're correcting for that overpricing.

  • BCBS of North Carolina CEO Patrick Conway said in an interview premiums are falling because the plan cut some providers from its already narrow network and changed the way it pays some hospitals. But he also said the company has "more expertise in the market than when we started."
  • BCBS of North Carolina's ACA plans have been extremely lucrative — in fact, too lucrative. The ACA requires insurers to spend at least 80% of their premiums on medical care, or rebate the difference back to their customers.
  • In the first quarter of this year, BCBS of North Carolina spent just 67 cents of every premium dollar on care for most of its ACA plans, according to financial documents.
  • Many other insurers are in the same boat.

The bottom line: ACA plans for many middle-class people remain prohibitively expensive — often around $600 a month for individuals who get no subsidies. But for those who get financial help, "this is a stable, functional, mature market," said David Anderson, a health policy researcher at Duke University.

Go deeper

USAID chief tests positive for coronavirus

An Air Force cargo jet delivers USAID supplies to Russia earlier this year. Photo: Mikhail Metzel/TASS via Getty Images

The acting administrator of the United States Agency for International Development informed senior staff Wednesday he has tested positive for coronavirus, two sources familiar with the call tell Axios.

Why it matters: John Barsa, who staffers say rarely wears a mask in their office, is the latest in a series of senior administration officials to contract the virus. His positive diagnosis comes amid broader turmoil at the agency following the election.

Bryan Walsh, author of Future
6 hours ago - Health

COVID-19 shows a bright future for vaccines

Illustration: Annelise Capossela/Axios

Promising results from COVID-19 vaccine trials offer hope not just that the pandemic could be ended sooner than expected, but that medicine itself may have a powerful new weapon.

Why it matters: Vaccines are, in the words of one expert, "the single most life-saving innovation ever," but progress had slowed in recent years. New gene-based technology that sped the arrival of the COVID vaccine will boost the overall field, and could even extend to mass killers like cancer.

7 hours ago - Health

Beware a Thanksgiving mirage

Illustration: Sarah Grillo/Axios

Don't be surprised if COVID metrics plunge over the next few days, only to spike next week.

Why it matters: The COVID Tracking Project warns of a "double-weekend pattern" on Thanksgiving — where the usual weekend backlog of data is tacked on to a holiday.

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