美国国家公共电台 NPR Many Who Buy ACA Health Plans For 2019 Find Lower Prices And More Choice（在线收听）

STEVE INSKEEP, HOST:

We are in the middle of open enrollment for the Affordable Care Act. It goes until December 15. People can sign up for health insurance plans under Obamacare. And holiday health insurance shoppers are finding something new this year - lower prices. Let's talk this through with Kaiser Health News correspondent Jordan Rau, who has looked at all the prices of all the plans in all the counties in the 39 states which rely on the federal government's healthcare.gov for their marketplaces. And he's here with results. Hey there.

JORDAN RAU: Hey.

INSKEEP: So what did you find?

RAU: Well, big surprise - prices are dropping in a lot of counties - over half of the counties - and sometimes, by large amounts.

INSKEEP: We're not talking about every single plan in every single place going down, right? But what's the average thing happening?

RAU: Well, it goes from place to place. Some places, like D.C., are actually going up. But a lot of places that have had very high premium hikes over the last couple of years, like in Tennessee and in Arizona, are decreasing. And we looked at a couple of different types of plans. We looked at the lowest price plan. That's a bronze plan, a high deductible plan. And then we also looked at the silver plans, which are the plans that about two-thirds of the people get.

INSKEEP: And those are both going down by - what? - a few percentage points.

RAU: It really varies from county to county. I mean, it can change a lot. But in some places, they're going down 17 percent, 20 percent.

INSKEEP: Wow. So why would that be happening?

RAU: Well, a lot of it is that the market is correcting. The insurers went way, way high over the last couple of years because of all the political instability. You know, at the time, they were looking at the possibility that the whole thing would be repealed and replaced. And then also, there have been some changes that the Republicans and President Trump have made that have destabilized the market somewhat. They've let in some plans that people can sign up. There are short-term plans that don't offer all the benefits. And those the insurers fear would siphon away some of their healthier people. And they made some other changes as well. So the insurers just baked all that into their rates. And so for the last couple of years, people have really seen some sticker shock.

INSKEEP: You had mentioned that prices had gone up the last couple of years because of the Republican Congress and the Trump administration. Hadn't prices actually been going up for several years, even before the Trump administration?

RAU: Right. Well, they took a big jump when these markets were created in 2014 because suddenly, people could get insurance, even if they had expensive conditions. And insurers had to cover all sorts of things, whereas before, they could pick and choose.

INSKEEP: Oh, when the plans got better, they also got more expensive.

RAU: That's right. You want more, you pay more. And then they continued to increase because in a lot of places, insurers decided that they didn't want to participate, that they were worried that they wouldn't make a lot of money or lose it. In some areas of the country, there would only be one insurer that was offering plans. And that insurer could set its prices wherever they wanted. People had no choice.

INSKEEP: How will people feel that difference? - because a lot of these plans are subsidized anyway, right?

RAU: Yeah, that's a great question. There's two groups of people. So the people that are subsidized - and that is you get a subsidy if you're, you know, a family of four with income under $100,000. Those people may not see a big difference because they're already capped. And in some cases, one of the weird things that's happening is that because all the prices are dropping, the subsidies are dropping as well. So it's possible some people may even see a small increase. But the big difference is going to be for the people that don't get a subsidy at all. And they have the potential of seeing much lower prices.

INSKEEP: So let me ask you about the prospects for the next couple of years because you mentioned that political instability - efforts to repeal and replace Obamacare - affected the prices and helped to drive them up. Now we have a period where Democrats are about to take control of the House of Representatives. We can presume that although Republicans still have a lot of power, they're not going to repeal Obamacare now for at least the next couple of years. Does that create a stable situation where prices might come down further?

RAU: Yeah, I don't think so at all because the fundamental, underlying problems of the healthcare system are still in existence. You still have no price transparency that allows a functioning market where people can shop around and also, the ability of some providers, some hospitals, some doctors to dictate their own prices. So really, most of the fundamental elements that have led to increases for everybody are still in place.

INSKEEP: So the good news is prices are going down. The bad news is they're still very high, and there's a big risk of further increases over time.

RAU: That's right.

INSKEEP: Jordan, thanks so much.

RAU: Thanks for having me.

INSKEEP: That's Jordan Rau of Kaiser Health News.