Jul 19, 2017

Health experts puzzled by HHS analysis of Cruz amendment

AP Photo/Eric Gay

Sen. Ted Cruz got some good news to take into today's White House lunch with President Trump and the other Republican senators: a Department of Health and Human Services analysis that says his insurance deregulation provision in the Senate health care bill would lower premiums, both for people in traditional Affordable Care Act plans and in less regulated plans that wouldn't meet its standards.

But that's almost the exact opposite of what most experts, as well as actuaries and the main health insurance trade groups, say would happen. Health care analysts and economists are criticizing the HHS report for being secretive about its assumptions, which are usually disclosed so outside experts can see how they arrived at their conclusions. They also note that HHS assumes huge premium increases under the current ACA, without explaining why.

The HHS analysis, first reported by the Washington Examiner, says Cruz's plan would reduce premiums substantially, even for people who buy policies that still meet the ACA's benefit requirements. It also says more people would sign up for coverage under Cruz's proposal.

By contrast, almost every independent analysis of the proposal has said it would lead to higher premiums and maybe even the dreaded insurance "death spiral." The insurance industry's leading trade group predicted "widespread adverse selection and unstable health insurance markets." The American Academy of Actuaries said premiums for ACA-compliant plans would soar.

Many health care economists say the HHS report is too incomplete to carry much weight.

One issue is that HHS said its assumptions about elasticity — how people react when the price of health insurance changes — are "proprietary." That's one reason the Kaiser Family Foundation's Larry Levitt says there's "nowhere near enough detail about the assumptions and methodology to evaluate this."

Health economists have been brutal about the methodological secrecy on Twitter:

In addition, Levitt notes that the HHS analysts "seem to be assuming that premiums under the ACA would skyrocket under current law, but it's not clear why."

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