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progree

(13,129 posts)

7. As premiums rise, healthier people tend to drop their coverage, leaving the insurance pool sicker on average

Wed Jul 8, 2026, 08:41 AM

Jul 8

From the OP's link, repeated for convenience of reference
https://kffhealthnews.org/insurance/priced-out-obamacare-affordable-care-act-aca-premium-increases-peterson-kff/?utm_source=firefox-newtab-en-us

Insurers expect that with young and healthy people leaving the program rather than paying higher premiums, their remaining customers will be older, sicker, and therefore costlier on average.

“It’s likely that the people who dropped their coverage were also the healthier people, because sicker people were probably going to try to make it work however they could, to stretch their budget to keep their health insurance,” said Cox, of KFF, a health information nonprofit that includes KFF Health News.

Just so people are aware of this death spiral dynamic. This has been much discussed as part of the reason for the large 2026 increases.

Another driver of higher premiums cited by several insurers is that claims submitted on behalf of patients have tended to be for more intense — and costly — levels of care than in the past. Such increased severity may be because patients are actually sicker, or it may reflect that hospitals or doctors are using artificial intelligence to find billing codes that can maximize their payments, the report noted.

With or without AI, this has long concerned me -- doctors upping the diagnosis and billing code to get a larger reimbursement. Doesn't that result in a person's medical record looking a lot worse than their true medical condition? I've seen a lot of discussion about the upcoding, but I haven't seen any of how it might result in a false impression of the person's condition that can mislead future providers into prescribing wrong treatments.

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flamingdem wolfie001 RedArkGuy Ilikepurple

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Highlight:

Affordable Care Act Insurers Want More Premium Increases as Enrollment Sags [View all] riversedge Jul 8 OP

Of course they do,not a surprise. Keep gutting the ACA slowly and it will DIE Bengus81 Jul 8 #1

rs have been gutting things slowly for years and hope they die AllaN01Bear Jul 8 #18

Yes, well that makes sense. Biophilic Jul 8 #2

Why do they even call it insurance? It is just robbery without a mask. twodogsbarking Jul 8 #3

Look, it costs a lot of money to plaster their names on stadiums and flvegan Jul 8 #4

Gee no one saw this coming. mdbl Jul 8 #5

The expiration date of the temporary additional covid era subsidies was written into it when it was passed in 2021. MichMan Jul 8 #13

True but . . . RedArkGuy Jul 8 #25

Um... lonely bird Jul 8 #6

As premiums rise, healthier people tend to drop their coverage, leaving the insurance pool sicker on average progree Jul 8 #7

And then the "healthy people" make that one trip to the ER wolfie001 Jul 8 #24

In its current form, the ACA is a very expensive program that mainlines money to insurance companies. Intractable Jul 8 #8

"I pay about $180 for the premium. The ACA pays more than $1300" MichMan Jul 8 #19

Should I feel guilty? Intractable Jul 8 #20

Hell no!!! wolfie001 Jul 8 #23

But, it is called the "Affordable" Care Act MichMan Jul 8 #9

We are the ONLY country with private health insurance RainCaster Jul 8 #10

We are not the only country with private health insurance. ihaveaquestion Jul 8 #11

My retirement job (age 65 to 73) was at a call center rhiannon55 Jul 8 #12

Cut out the bookies. Universal Medicare for all. Max out the risk pool. Marcuse Jul 8 #14

Thereby defeating the entire point of the AFFORDABLE Care Act. It never should have thrown a lifeline to private Karasu Jul 8 #15

It's already dead in Montana. MontanaMama Jul 8 #16

In Victorian Britain, at least there were homes for the poor wolfie001 Jul 8 #22

Think of the shareholders and nothing else, except top management compensation. Meeting adjourned. twodogsbarking Jul 8 #17

Healthcare Execs need more yachts and 4th and 5th homes wolfie001 Jul 8 #21

Are they so blind that they did not know how much revenue they were going to lose? phxjurist Thursday #26