[coryrc]

Wrong; insurers' profit is limited to a percentage of expenditure in the ACA. Increasing expenditure is the only way to increase profit.

[bduerst]

Which is why ACA also instituted marketplaces and insurance standards, so that competition across substitute services keeps premiums competitive.

E.g. Anthem is more than free to double the premium on their bronze plan to increase net profits, but then customers are free to swap in bronze plans from Cigna, Kaiser, or any number of competitors that didn't.

[ddingus]

Not really. Networks complicate all of that severely.

This massive price escalation was called out as a definite outcome by progressives seeking a public option at the time.

The percent cap was touted as the fix.

Insurers bought facilities and raising dollar amounts kept revenue near expectations.

[bduerst]

How exactly does networks complicate that?

Insurers had to scale (i.e. increase costs) after ACA was implemented because number of uninsured Americans went from 18 to 11%.

[hakfoo]

Networks complicate things by reducing demand elasticity.

For example, look at Maricopa County, Arizona. It's like 100km across and includes both a major capital city (Phoenix) and several suburbs with 6-figure populations (Mesa, Chandler, Glendale).

Many of the marketplace health plans* would have networks which focused around central Phoenix. If you wanted to see an in-network doctor or urgent care and lived at the fringes of the county, it was a 30-minute drive or more.

This meant people in the fringes had to pick the few plans that covered nearby facilities, even if there was a significant price difference.

* This was during the first few years of the marketplace. By 2017 or so they were basically down to a single insurer, so even that degree of consumer leverage was gone.

[ddingus]

Have you ever tried a policy change?

[bduerst]

Yes. I have actually bought my own insurance through one of the state-run exchanges in the past.

[ddingus]

For anyone with complications, medical history that is non trivial, networks become very important, and do costs.

Networks take people in and out of the chain of care providers, and costs swing dramatically.

The whole affair adds zero value when compared to simpler Medicare For All type plans.

People in my life got sick, and the financial carnage has gone on for decades.

This pretty much rules out any favorable view on markets and private insurers I may have. And I am by no means a unique, or even uncommon case.

If it were not for family, I would have picked up and left this cruel system a decade ago.

[refurb]

It’s not that simple.

Insurers compete on the employer market for premiums. If you keep jacking up your premiums, you may find an employer dumps you.

And the pool of money is finite. Getting a better deal on a drug means you have more money to spend on other care that might get you more members.

That said, I agree the 80/20 ACA law is a stupid way to try and control costs.