If taxpayers must keep subsidizing health care, they deserve to see the prices

https://thehill.com/opinion/healthcare/5579769-aca-subsidies-premium-rise/

The government shutdown has continued for weeks with no end in sight. 
Although Affordable Care Act subsidies have been at the center of the 
debate, one of the most basic questions remains unanswered: Where is the 
money actually going?

And we cannot answer that, because the U.S. still lacks real price 
transparency in health care.  

In 2024, the federal government spent roughly $125 billion on Affordable 
Care Act subsidies. According to the Congressional Budget Office, federal 
spending on these subsidies will exceed $1 trillion over the next decade. 
These numbers are far higher than initial cost estimates, and increases in 
premiums are at least part of the story. Benchmark plans’ premium rose 
between 70 and 90 percent in the last decade, defying early budget 
expectations that competition among health care exchanges would restrain 
increases. But neither the government nor businesses nor patients can 
benefit from competition if we don’t have markets. And we can’t have 
markets if we don’t have actual prices we can see in advance. 

The Affordable Care Act was sold as a way to help families afford 
coverage, but it’s become a guaranteed revenue stream for insurers. Most 
markets remain dominated by just a few insurers. Subsidies were paid 
directly to insurance companies — not as flat fee vouchers but as a 
percentage of the annual premium. The Affordable Care Act expansion led to 
millions more covered lives — new customers for insurers — and these 
companies returned the favor by hiking their rates, knowing that taxpayers 
would make up the difference. 

What’s the reason for the increase in premiums since Obamacare began? We 
could cynically assume greed, but there are multiple plausible 
explanations, none of which we can quantify with great confidence. Some 
argue that because the subsidies rise with premiums, insurers face less 
pressure to keep prices down. Insurers point to rising hospital and 
pharmaceutical prices, consolidation among health systems, and the 
increasing number of high-cost enrollees.

All of these may be true to a degree, but the real problem is we can’t say 
for sure. 

Federal law requires insurers and hospitals to disclose negotiated prices, 
under the Hospital Price Transparency Rule (2021) and the Transparency in 
Coverage Rule (2022). But unfortunately, compliance has been largely 
performative. Insurers post massive “machine-readable” files that are 
nearly impossible to download, let alone interpret. The information exists 
in theory, but in practice it is unusable for patients, employers and 
policymakers trying to answer the most basic question: What does care 
actually cost? 

The prospect of premiums going up by hundreds of dollars each month 
frightens families. But we need to balance compassion for those individual 
circumstances with the reality that we are spending billions of dollars 
each year to prop up a fundamentally broken system. The largest 
beneficiaries of taxpayer subsidies are not hospitals, doctors or even 
patients — they are insurers.

If Congress extends the Affordable Care Act subsidies that families have 
come to depend on, it should demand something in return: real price-
transparency. Reporting should be mandatory, not voluntary. Readable, 
easy-to-understand disclosures should be made public of what insurers pay 
for care and what patients are expected to pay. Ordinary people should be 
able to tell exactly how much of every subsidy dollar is going to patient 
premiums and patient care, and how much is funding administrative costs, 
executive bonuses and shareholder revenue. Taxpayers deserve to see where 
their money is going. 

Empathy for families facing rate hikes and a demand for fiscal 
responsibility are not mutually exclusive. But in a debate about health 
care costs, we are focusing on the smaller expense (what households pay) 
rather than the larger one: what the federal government pays insurers on 
their behalf, without transparency or accountability in return.  

Congress can continue funding the system as it is — expensive, opaque, and 
insulated from scrutiny. Or it can seize the opportunity to make a basic 
correction that should have happened years ago. If insurers want the 
check, taxpayers should get to see the bill.

Monique Yohanan, M.D., MPH, is a senior fellow at Independent Women, a 
physician executive and health care innovation leader, and chief medical 
officer at Adia Health. 


-- 
November 5, 2024 - Congratulations President Donald Trump.  We look 
forward to America being great again.

We live in a time where intelligent people are being silenced so that 
stupid people won't be offended.

Every day is an IQ test. Some pass, some, not so much.

Thank you for cleaning up the disasters of the 2008-2017, 2020-2024 Obama 
/ Biden / Harris fiascos, President Trump.

Under Barack Obama's leadership, the United States of America became the 
The World According To Garp.  Obama sold out heterosexuals for Hollywood 
queer liberal democrat donors.