Jon Walker writes about the decision of private health insurers in Massachusetts to withhold offers for new plans in the state’s Health insurance "Connector." That follows the Boston Globe report of a decision by Massachusett’s insurance regulator to deny most of the requests by insurers to raise their insurance premiums.
Jon traces the problem to the absence of a public option, which could guarantee consumers an alternative/safety net if the private insurers withhold their products. He also faults the ability of private insurers to sell insurance outside the exchange/Connector. I think he’s right, but there’s an even more fundamental problem at work here, and it reminds me of what happened in California’s electricity market.
The short version is that Massachusetts appears to be inadvertently fostering an artificial shortage in health insurance. And they’re doing it for the same reasons that California authorities inadvertently created or exacerbated artificial shortages in electricity that repeatedly caused blackouts during the 2000-2001 crisis.
We’ve seen this before, and unless Massachusett’s Governor and regulators are smarter than California’s Governor and Public Utility Commission, this is not going to turn out well. So what’s going on?
One way to think about this is to ask how the Massachusetts Connector, its health insurance exchange and the model for the exchanges in the national health bill, is supposed to work. The academics who sold this concept to Republican Governor Romney and the Democratic Legislature convinced officials that private health insurers would charge reasonable prices if they were forced to compete in a transparent "market" by offering more or less uniform products whose quality and features were ensured by regulatory oversight. In other words, the competition itself would lead to efficient prices.
On top of this, state insurance regulators would retain some limited authority to review premiums charged by the insurers. But that implies that the scheme’s creators weren’t convinced the market would produce fair prices. They’d have to be limited by regulation.
When the State’s regulators disallowed almost all of the insurers’ proposed premium increases for the Connector/insurance exchange, the State was effectively saying, "the exchange market doesn’t work, and we can’t rely on the consumers shopping on the exchange market to drive prices down to reasonable/fair/efficient levels." In short, the entire premise of the "market structure" just collapsed.
But if the flawed insurance market can’t produce efficient prices, then by definition we’re in a regulatory cost-of-service paradigm. There is a whole body of literature and a hundred years or experience explaining how you regulate utility rates.
The essential principle is a "regulatory bargain," in which the service provider — the utility — is obligated to serve (think guaranteed issue in the insurance sector), but the regulator has an equally important obligation to set rates at levels that will allow the utility/service provider to recover all of its prudently incurred costs plus a reasonable opportunity to earn a reasonable rate of return of/on capital. The profits from these rates have to be sufficient to allow a reasonably managed firm to attract sufficient capital to continue meeting the provider’s obligation to serve.
In this regulatory framework, when Massachusetts authorities rejected the insurers’ proposed premium increases, the insurers translated that to mean the State had broken the regulatory bargain. In their view, the regulators were not allowing them to pass on rapidly rising health care costs and were thus forcing the firms to do business while losing money. In essence, they’re saying, "we cannot stay in business by operating at a loss, so we will withdraw from the market."
Of course, regulators disagree; they claim that lower premiums would be sufficient to recover costs, and costs don’t appear to be rising as fast as proposed premium increases. In a large state, such regulatory decisions usually take months to consider and document, after combing the utility’s books and extensive contested hearings. It’s not clear that happened here.
But of course, the designers of the health insurance market never assumed that all suppliers might react to a negative decision by withholding supply and creating a shortage. They expected the market to drive prices down to marginal costs, but it didn’t. Now what?
In California, when the Governor and PUC failed to understand this problem, that convinced lots of electricity suppliers to withhold power from the market, causing artificial shortages. The State dug in its heels, the market collapsed, and the lights went out because many suppliers refused to operate without being paid. [Different generators were withholding for different reasons, some legitimate, some not.]
Eventually, two of the largest utilities in the world were driven into insolvency/bankruptcy, along with several independent power companies. The state took over power contracting for the bankrupt utilities, and it spent almost 10 years trying to get out of the terrible contracts they negotiated. But ratepayers still had to pick up the tab when the smoke cleared.
And what happened to Governor Gray Davis? He got Terminated.
So good luck to Massachusetts officials. If your market doesn’t work to set reasonable prices, then you need to acknowledge that and start thinking like serious regulators; you’re going to have to get a lot deeper into cost-of-service regulation than you ever imagined.
And setting rates is more than making consumers happy; you also have to allow premiums that keep the insurers from withholding service or withdrawing completely. Welcome to cost-of-service regulation of essential public services.



48 Comments




Does Sebelius have anything to say about this? *G*
If I were Sebelius, I would make sure I wasn’t in her position in 2014.
I think the health care debate is about to come home to roost.
I’d love to hear Jason’s take on this and how it bodes for HIR.
Won’t matter. the Feds. will just say their Bill creates a different set up and why worry anyway the collapse in more then 4 yrs. in the future , plenty of time and distance for most of us ( idiots that passed this POS) to be in nice cozy jobs with the health Ind. or some other BIG Corp. client we have or better yet retired on a nice big fat public pension complete with a Golden health policy for life. In other words don’t bother me kid with the facts in Mass. doesn’t mean anything. Oh, and didn’t you know health reform was a HUGE success?
Nothing about the MA mess is unexpected. Stay healthy, folks, the ride is about to leave the boarding area.
I feel bad for Bay Staters but maybe this is wakeup call our national officeholders need in order to realize that there simply must be a competitive public option insurance policy available on Day One.
Hubris strikes again! Be careful what you wish for, you might get it.
Thank you Scarecrow. I think.
The answer is simple for Massachusetts…self-insure. That move will save at least a third of previous costs.
i think this is wrong.
first, because we don’t have the regulatory infrastructure (risk adjustment, etc).
and second, what are you talking about private insurers not being able to sell insurance outside the exchange? of course they do — and i know this for a fact because i buy my individual policy from bcbs which sells policies both on and off the exchange (i’ve never used the exchange, although i check every year, so far i’ve always gotten a better deal off exchange than on exchange). so, i think the whole premise didn’t just collapse now, the premise collapsed more than a year ago.
Let’s get this straight: Gray Davis was terminated by Enron — Enron turned off the power to piss off Californians, handpicked Ahnold, and bankrolled Ahnold’s campaign. It was a right-wing corporate coup, meant to kill all regulation of the electricity market. The coup wasn’t the result of the market problems; it was the cause of the market problems.
Darrell Issa helped.
Look at California Bill SB810 passed three times and vetoed by the Terminator.
http://dist03.casen.govoffice.com/index.asp?Type=B_BASIC&SEC={5938D509-03E9-4845-9605-F46F87A1758B}
Do you think a model like this one will work under the new federal laws?
our experience in MA should and could have been a wake up call — we were trying to sound the warning more than a year ago: that market competition is NOT the answer — po or no po (which has NEVER worked in the health insurance market when it’s been tried).
can we PLEASE reconsider advocacy for NEOLIBERAL market based solutions that will fail to bring us either universal healthcare or adequately control costs?
Adding to the complexity is we have a one step removed problem with insurance. Basically the connector is telling insures they need to tell the drug makers and hospitals to charge less. Of course in all other system with “private” insurance this function is handled by a single negotiator “all-payer” either government or a regulate insurance cabal.
“Neoliberal” seems to mean “retreaded neocon ideas.”
Not sure what you’re disagreeing with. Perhaps I’ve misunderstood Jon’s points? As I interpret it there are two main points there:
1. If some suppliers are withholding supply through either physical or economic withholding, then it’s better to have at least one supplier that isn’t withholding.
2. If you want to regulate a quasi market, you need to have everyone in the regulatory fold; you can’t have suppliers functioning outside the regulatory framework.
These seem like truisms to me.
About the only difference I’ve seen is the neolibs aren’t quite so quick to start wars. They don’t mind continuing them, however. Good for business.
sorry for not explaining myself very well….
if those are the only two options, not just for the moment, but forever, then i agree. but, i just don’t think we can’t find other options, and not having a public option to dump people on to (especially those with more expensive medical needs — which would probably not be sustainable either), means the private insurance companies don’t have an out cost-wise. the whole state has to deal with this issue now.
completely agree — but insurance policies that are not in the connector are still subject to regulation (such as it is). the connector is a faux market that, as far as i can see, adds unnecessary costs. is there something i’m missing (i’m only going off of my own experience, maybe it’s not representative?)
The US won’t use any ideas from Canada, France, England, Scandinavia or any of the other industrialized countries with healthcare because they’re too “socialist” and might piss off conservatives. But the cobbled together POS modeled after Romneycare we ended up with is hailed by politicians and the corporate media as the most significant piece of domestic legislation in 50 years. Romneycare is a failure and this windfall for Big Pharma and Big Insurance will be too. People were left out of the equation.
Maybe this is all for the good Jon. If this system, which just about everyone agrees the Nat’l bill is modeled after collapses, it’s very possible that this collapse might spur reforms of the Nat’l bill before it’s fully implemented in 2014. Certainly it will at the least high lite the weaknesses in the Bill at a min.
Definitely!
romneycare is, as far as i can tell, MUCH MUCH better than obamacare.
we are so fucked.
By the way, my electrical company in Washington State has,just in the last couple of months, gotten out from under the over-priced long-term energy contracts forced upon all of them and, by extension, us by the energy fiasco in California and the ever-consumer oriented (snark) Bush Administration.
In the most recent Air Force Times newspaper, they express concern about Tricare Health Care services, because there probably will be a shortage in Primary Care Physicans and those that are around may not choose to accept Tricare, because reimbursement will most likely be too low.
Nice to know, we are getting all the quality support our wonderful members of Congress can provide. Just wish they would quit kicking us in the butt.
I think we’re agreeing? I’ve never argued that the PO proposals were the only alternatives, or even the best. I did argue that if you have an exchange framework, it’s better to have a PO as a choice than not, and if you have a PO, you probably need the strong Medicare-tied version to deal with the market power issues.
Code words = “Uniquely American” = re-design the wheel (round to square)
While the CBO said they think the risk adjuster will be not strong enough there will be one.
probably, at least pretty much – i would and did support the po in stark’s bill (hr 193), part of the reason why is that it used the medicare infrastructure, but not any of the po’s congress came up with in committee last year.
but i didn’t agree with what jon wrote (mostly a comment was influencing my understanding), and maybe i just misunderstood him, and therefore you also.
right, but that’s the prediction of a national risk adjuster. do you know the state data on MA?
I find this germane:
and this:
Mirrored Delusion: Conservatives’ Nightmare/Progressives’ Dream
http://dissidentvoice.org/2010/04/mirrored-delusion-conservatives-nightmareprogressives-dream/
And this:
Kyrgyzstan Protests: Opposition Claims Control, At Least 40 People Killed
http://www.huffingtonpost.com/2010/04/07/police-open-fire-on-oppos_n_528172.html
“so far i’ve always gotten a better deal off exchange than on exchange)”; and if that doesn’t tell the whole story, I don’t know what does.
As Jon said the other day, it will be very interesting to se what, if any, reconciliation language is in the upcoming budget language.
Obama had/has a choice; guns or butter and he seems to have chosen guns.
If selise gets “a better deal” off exchange than on exchange, that suggests to me the “deals” are not comparable. If the deals were the same — same company, same benefits, same service, then there would be no reason to have a price differential — or in other words, the insurer sh/could just offer the same deal on the exchange.
So is there a difference in plans? or difference in regulatory oversight? Does selise’ “better” deal cover exactly the same terms/benefits as the plans on the exchange? I thought one of the reasons for off-exchange plans is that they don’t have to conform to the standarized plans on the exchange.
Great post. This is going to be a fiasco. We on the far left who opposed this bill were accused of being “purists” who would deprive sick children of insurance. Well, this is why.
same company, i think the same service (which has actually been very good – but not inexpensive, although much less than my standard monthly healthcare costs to bcbs which makes me one of the people they’d probably like to get rid of), slightly different plans as well as costs. i’m pretty sure i kept all the bcbs info (but probably not for other insurers) from last summer when i compared the plans (iirc there were 16 from bcbs, so that will give a lot of info even with just one company). will see if i can find it tomorrow….. if i can, then i will be able to give more detailed info, and not just from memory.
And it could be a matter of ‘packaging’ by the insurance companies off exchange versus on exchange. More mandatories on exchange?
NEOLIBERAL: its got a nice sound and I think we can dance to it. Medicare for all and all in for Medicare!
Great post, thanks Scarecrow.
None of the neoliberal healthcare idea’s ever made sense to me.
Market based solutions in a world of consolidated healthcare cartels is a recipe for looting. I’d expect prices to be set based not on cost, but rather, on maximum extraction. In otherwords, the more money that people have, the more the product will cost. Justifications for cost increases can be induced by flipping hospital corporations(private equity/leveraged buyouts), that process increases thier debt load.
Under present conditions, they can cut hospital staff, tighten compensation for doctors and nurses AND still increase the percieved cost of healthcare. They just need to load more debt onto the hospital corporations. Healthcare costs will go up simply to feed an ever growing number of bond holders.
I’m not saying there aren’t legitimate reasons for hospital corporations to take on debt. But these private equity companies will be debt loading these hospitals without corresponding investment in personel or services.
What Yves Smith has to say on Private Equity Companies:
“If these firms destroy or hobble companies by loading them up with debt, sometimes to pay themselves massive dividends that recover all their equity with no earnings, where’s the legislative scrutiny. How many jobs have been lost because of the excess debt loaded onto otherwise healthy companies? It can’t be insignificant.”
well not exactly. States can’t run deficits. Federal government can.
But wait, wasn’t this going to IMPROVE the deficit? Did that talk end already?
maybe people should have listened to those of us that called for more cost controls.
I sure hope Eshoo got a nice tidy donation from her biologics amendment. I wonder how many billions that’s going to cost us 10 years from now.
“But of course, the designers of the health insurance market never assumed that all suppliers might react to a negative decision by withholding supply and creating a shortage.”
I think the designers of the market were the suppliers and particularly so with Obamacare – in fact that is Obama’s whole MO is to the suppliers in a market write their own regulations. Such things like this happening at a national level shouldn’t be surprising considering how Obamacare was written by a former VP of Wellpoint.
agree with everything you wrote…
but my comparison (romneycare is better than obamacare) was based on the difference between subsidizing health insurance (commonwealth care – a separate exchange for subsidized health insurance) instead of dumping more people into medicaid (called masshealth here). no restrictions that i know of on women’s reproductive healthcare…. stuff like that.
holy cow! is that a progressive policy i see? yep, it is! let’s just add the “improved” to medicare….
i’m not 100% familiar honestly with Romneycare because i’m in NJ. how is it funded? Any additional taxes or did they expect by getting everyone into the pool they’d reduce rates that way?
and it has nothing to do btw with “packaging” as some have said. You may not realize it but the connector I expect has a set standard of benefits required (just like the state based exchanges will require in 2014). Plans outside don’t have to have all those benefits so they will cost less but will have less benefits. What I expect is you’ll NEVER see a large employer on the exchange when it opens to it due to ERISA and you’ll see healthy groups opt for less benefits or more specifically those not needed. That will make the exchanges more expensive, not less.
Wyden-Bennett would have been SO MUCH BETTER.
Sebelius is no Frances Perkins. O is no FDR. The Democrats are still trotting out the sick and beleagered and saying ‘Send us money. Vote for us.’ So we do it. And then they throw their human props to the dogs.
It’s time to get off the bus. (Please pardon my cognitive error.)
I am not part -and haven’t been since 2000- of “So we do it.” And a lot of folks here ‘got off the bus’ when the progressive caucus caved on HIR.
You’re right about “Sebelius is no Frances Perkins”; not even close, not even in the same ballpark much less game. And O isn’t even Truman.
And Republicans who criticize them for that are heartless corporate serfs who gloat at the misery of others.
So the elephant in the drawing room is that our reform addressed 1/3 of the health care cost equation ( the other elephant is that it doesn’t reform even that sector ) while leaving 2/3 either untouched or further emboldened (pHARMa).
We aren’t addressing the fact that for 200 USD you can be weighed, have your temp taken, blood pressure and have your breathing listened to. Usually when shelling out that kind of hourly rate it comes with a happy ending. We’re not addressing the exorbitant costs of simple medicines. We certainly didn’t address either of those factors while ‘reforming’ the insurance sector. And on top of that, we’ve been unconcerned with where the money is going apparently ( all indications are it’s not going to primary care physicians ).
I’d be interested to see where the hole in the health care bucket is regarding provider costs.
One final thing: Anyone recall the line “This is the first step in a process”? All indications are that there is no political will to revisit this. How’s that for pushing a nogressive agenda…
One final thing: Anyone recall the line “This is the first step in a process”? All indications are that there is no political will to revisit this. How’s that for pushing a nogressive agenda…
a journey of 1000 miles begins with a single step. of course, if you’re the democratic party, you have stop and rest for 40 or 50 years before taking the second step…
You have made a major assumption without any apparent evidence and preemptively decided the rate argument in favor of the insurers.
For your thesis to work, you have to grant that the insurer’s rate requests are reasonable and that the regulators are being arbitrary or capricious. Unless you have gone through the rate requests with the necesary expertise, how can you reach that conclusion?
There are equally plausible possibilities that the insurers are using this opportunity to create a crisis in the Mass plan in order to discredit the concept with an eye to derailing the impending national plan.
There is also the possibility that the insurers are conspiring to fix rates by all raising their rates in unison. As I recal, they are immune from anti-trust. This sort of behavior is not unheard of.
Anoter explanation could be that as the game is played in all regulated industries: the providers submit inflated requests to the regulator, then negotiate them back down.
So, there are plenty of reasonable explanations that do not presume the goodwill of the insurers.
As stated above: the exchange model requires true competition to work, meaning enough players and enforcement of antitrust regulations to ensure true competition. The presence of a regulatory board indeed presumes that true and full competition is not happening and the insurers cannot be trusted to offer fair pricing without oversight. That is why a public option is advisable, it ensures an “honest player” in the game.
As also stated above: the california crisis happened because of deregulation (plus the way it was deregulted) and the placing of the energy service in the hands of Enron, which was a criminal enteprise and which promtpy set out to artificially fix energy prices.