Wednesday, January 15, 2014

President Obama's sex problem

President Obama's policies have given me a wealth of examples that illustrate adverse selection, moral hazard, and the unintended effects of various policies like price control.  And while this makes it easier to teach these ideas in class, I do fear for the country.

Just as more disabled and old people are signing up for Obamacare, so too are more women (who have higher expected medical costs than men) signing up.  What this means is that premiums will have to go up to finance the higher expected costs, which makes it even less likely that younger, healthier, and men will sign up.

What it means, in Grady’s words, is that “the new health care law forbids sex discrimination in health insurance.” Just as no one can be denied insurance or charged more because of a pre-existing condition, a woman and a man of the same age must be charged the same premium, and their policies must cover the same conditions–including maternity care for unmarried men (and women past childbearing age).
What it also means, however, is that women, like persons with pre-existing conditions, are more expensive to insure. The ban on what is called “gender rating” drives men’s premiums up as well as women’s down. (That doesn’t mean, by the way, that women pay less under ObamaCare than before. It may be that premiums rise for both sexes but the increase is steeper for men.) It means, further, that if ObamaCare enrollees are disproportionately female–just as if they are disproportionately older–premiums will tend to go up for everybody. And lo and behold, they are: The Department of Health and Human Services reports that of the 2.2 million people who have “selected a Marketplace plan,” 54% are female.

HT:  Kevin

96 comments:

  1. Do note that there are no employer plans that use gender rating. (Correct me if I'm wrong.) There are good for this we could debate.

    But that of course when an employer goes out shops its employee pool for insurance the insurer looks at the characteristics of the pool.

    The ACA indeed does have the problem that the insurers cannot gender rate individuals, and since the individuals bear the cost of insurance directly (as opposed to an employer plan), the pool is going to be more predominantly female for self selection reasons as you explain. The insurers would have built that selection into their premium.

    The ACA problem is the mandates it includes that disproportionately adds to the costs of coverage for women that involve choice rather than true insurance. This exacerbates the selection problem.

    ACA evolved from a Heritage Foundation idea, http://www.forbes.com/sites/theapothecary/2012/02/07/the-tortuous-conservative-history-of-the-individual-mandate/

    I suspect that if the idea had ever become law gender-rating at that individual level would have been untenable. Your gender afterall is a pre-existing condition. What the Heritage version would have lacked is all the coverage mandates.

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    "Obamacare’s byzantine complexity reflects the contortions required to simultaneously expand coverage and appease private insurers. And private insurers will exact a steep ongoing toll. Medicare’s overhead is just 2 percent, vs. an average of 13 percent for private plans (on top of the Exchanges’ costs, roughly 3 percent of premiums). A single payer plan that excluded private insurers could save hundreds of billions in transaction costs."

    http://healthaffairs.org/blog/2014/01/02/medicares-rollout-vs-obamacares-glitches-brew/

    Single payer here we come!

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