With the open enrollment deadline for Obamacare looming next month, one of the chief architects of the president's health law said Friday the plans offered on government-run exchanges need to be more affordable in order to boost participation rates.
High-deductible plans are part of the problem, Dr. Ezekiel Emanuel added.
His comments came one day after UnitedHealth Group, the nation's largest health insurer, said it's considering whether to opt out of participating in Obamacare in 2017, citing "tempered" growth expectations for Americans signing up for the plans. The company Thursday also cut its 2015 earnings forecast due to projected losses of $425 million on individual exchange plans for the 2015 and 2016 policy years.
Emanuel, a former special advisor to President Barack Obama on health policy, said some of those issues are specific to UnitedHealth. "United was very late in getting into the insurance exchange business. They sat out the first year. They came in the second year, and they might have gotten an adverse pool."
On Friday, Aetna reaffirmed its full-year guidance, saying its individual commercial business, including exchange coverage, was performing as expected.
"Even though I am a liberal, I think we really have to focus on cost control. Affordability is absolutely critical across the board, because if we don't have affordable plans we are not going to get universal coverage. They are intimately linked," said Emanuel, brother of former Obama chief of staff Rahm Emanuel, who's mayor of Chicago.
He did acknowledge: "We've overplayed the high-deductible plans. People are feeling this is less and less insurance. And just more and more, 'I'm paying out of my pocket.'"
Soaring costs for specialty drugs, including those to treat hepatitis C and certain types of cancer, are a big part of the problem, Emanuel contended. "Those are every expensive drugs. They're affecting everyone. It's like 1 percent or 2 percent of the drug sales, but accounts for about 30, 40 or 50 percent of drug costs."
Reigning in drug costs, cutting unnecessary treatments and enforcing the penalties for not having health coverage are ways to bend the cost curve, he said.
According to the government, the penalties for not getting health insurance are going up substantially in 2016.
Unless qualifying for an exemption, the penalty is calculated two different ways, as a percentage of taxable household income or per person, whichever is higher.
Next year, the percentage threshold goes up to 2.5 percent from 2 percent in 2015, with a maximum the average cost of a bronze plan sold through the exchanges. Meanwhile, the per-adult and per-child penalties more than double next year to $695 and $347.50, respectively, with the family maximums going from $975 to $2,085 in 2016.
Open enrollment for locking down 2016 Obamacare coverage ends Dec. 15.