Study says most insurance sold to individuals doesn't meet health law standards

May 25 2012

A new report in Health Affairs finds that more than half of individual policies could not be sold on state health exchanges because they fail to meet the law's criteria for coverage.

The New York Times: Individual Health Policies Fall Short, A Study Finds
More than half of all medical insurance policies sold to individuals now fail to meet the standards of coverage set by the federal health care law under review by the Supreme Court, a new study says. Even if the law is upheld, employer-provided insurance plans are likely to continue to be more generous, but the law would significantly improve the quality of coverage for individuals in several ways, the researchers concluded (Abelson, 5/23).

National Journal: Report: Most Individual Health Plans Cover Less Than Health Care Law Requires
Most individual policies currently on the market could not be sold on state exchanges in 2014, a new report concludes. The report, published Wednesday in Health Affairs and funded by the Commonwealth Fund, analyzed individual plans from several states and concluded that 51 percent of the plans would fail to meet the minimum requirements established under the 2010 health care reform law (Sanger-Katz, 5/23).

The Hill: Study: Most Individual Insurance Plans Fall Short Of Health Law's Standards
According to the Health Affairs study, even the most basic plan under the ACA's new standards would be significantly more generous than what most people get today on the individual market. The ACA establishes new insurance marketplaces, called exchanges in every state and it sets minimum standards for plans sold through the exchanges. For the most basic policies, insurers have to cover 60 percent of a plans's total cost, leaving customers to pay no more than the other 40 percent (Baker, 5/23).

Bloomberg: Insurers Must Improve Benefits For New Health Exchanges
Half the people who buy their own health insurance, rather than depend on an employer, are in plans that have fewer benefits than what the U.S. health-care law will require beginning in 2014, a study found.  UnitedHealth Group Inc. (UNH), WellPoint Inc. (WLP) and other companies that participate in the insurance exchanges mandated by the law will have to improve benefits in some plans to meet requirements that they cover at least 60 percent of the cost of a person's care, according to a study published today in Health Affairs (Wayne, 5/23).

Modern Healthcare: Individual Plans Miss Reform-Law Targets: Study
The majority of individual health plans in a representative sample for the year 2010 did not meet the standards and benefits required by the Patient Protection and Affordable Care Act, according to the findings of a new Health Affairs study. Researchers used the Kaiser Family Foundation/Health Research and Educational Trust 2010 Employer Health Benefit Survey to examine group plans and sampled enrollment data in five states through interviews with marketing managers at insurance carriers for the individual plans (Zigmond, 5/23).

Meanwhile, Politico finds that even with the better coverage promised under the health law, many people in the country face a tough time getting insurance and may have fewer options for subsidized care.

Politico: Millions Still Uncovered With Health Law Expansion
The health law, if upheld by the Supreme Court, will help up to 33 million Americans get coverage over the next decade. Around 26 million to 27 million will remain uncovered. And roughly one in four of the uninsured will be illegal immigrants, the Urban Institute has estimated. And as more tax dollars go toward subsidizing low- and middle-income Americans so they can get health coverage, advocates for immigrants say it may be increasingly difficult to care for the undocumented, who are excluded from the law's coverage expansion and the new insurance exchanges. A few communities are testing solutions (Cheney, 5/23).

In other insurance industry news -

Modern Healthcare: Insurers May Face Credit Threat If Reform Stands: Moody's
Insurers could face credit stress if the Supreme Court upholds some or all of the healthcare reform law, according to Moody's Investors Service. The ratings agency, in a new report, called a decision from the court to uphold the Patient Protection and Affordable Care Act "a negative credit event" for insurers. The law restricts insurer revenue and introduces new regulations for the sector, the rating agency said (Evans, 5/23).

Kaiser Health News: Can I Continue My Health Insurance After Quitting My Job? (Video)
Kaiser Health News Insuring Your Health columnist Michelle Andrews responds to a question from a reader contemplating quitting his job to stay home with his wife who has breast cancer and wondering how to keep health insurance (Andrews, 5/23). Watch the video.