Back in May, the UPMC Health Plan in Pennsylvania said it would need to increase its health insurance premiums on the Affordable Care Act's marketplace by 8 percent, on average, in 2018.
It was an entirely unremarkable number that would allow the plan to cover the expected increase in health care costs and account for the return of the ACA's health insurance tax. "For us, our population is starting to stabilize," Kim Cepullio, president of UPMC commercial products, told me this week.
Then on Monday, UPMC issued a substantial revision. Premiums weren't going up 8 percent next year after all. Instead, the increase would be 41 percent, on average.
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What changed? Obamacare hadn't been overhauled. The customers were still the same. But President Donald Trump had inherited an individual health insurance market that was starting to stabilize and decided to break it.
After months of threats, Trump announced late last week that he would halt federal payments to health insurers, known as cost-sharing reductions. His administration also slashed budgets for Obamacare outreach and suggested it would not enforce the law's individual mandate, which requires every American to have insurance or pay a penalty.
Insurers like UPMC have responded by hiking their rates by upward of 40 percent. "The elimination of the CSRs has a big impact on our rates next year," Cepullio told me.
Trump is not willing to take any blame: "When the premiums go up, that has nothing to do with anything other than the fact that we had poor health care — delivered poorly, written poorly, approved by the Democrats," the president said on Monday. "It was called Obamacare."
Over the past two weeks, though, as I spoke with a nearly dozen health insurers, actuaries, and policy experts, there was near-unanimous consensus: Trump was directly responsible for driving premiums higher. If the White House had made a good-faith effort to implement Obamacare, they said, premiums on the marketplaces likely would have increased by single digits on average.
An emerging Senate deal could belatedly try to undo the damage — but 2018 rates have already been set and the plan has no guarantee of passing Congress.
Instead, premium hikes of 40 percent will be commonplace. Some states and health plans are taking steps to mitigate the actual rate hikes customers will feel. Many Americans buying coverage will be protected from these increases, because they receive financial assistance from the federal government. But the US taxpayer will be on the hook to cover those costs.
People who don't qualify for aid, meanwhile, could bear the full brunt of those hikes — putting a deeper dent in their wallet or making insurance altogether unaffordable.
"The notion that this is a market-driven phenomenon is ridiculous," said Mario Molina, the former CEO of Molina Healthcare, a big player in the market. "This is Donald Trump monkeying around with health insurance, which is something he doesn't understand."