Outlook Described As Grim For State's Small Group Insurance Market In 'Death Spiral'
The event, titled "The State of the Fully Insured Small Group Market in
Earlier this year, both
According to Wieske, these problems play a significant role in the decline of small group insurance options in the state.
"The small group market has a unique set of problems," he said. "All the rules of the individual market with no subsidies apply, and this creates significant issues in this market. From the standpoint of
Wieske noted that not all of the news about insurance in
On the insurer's side, representatives of insurance companies that have both decided to stay in the small group market and chose to leave it spoke about the challenges of keeping the market viable.
"It is a shrinking market, as we talked about, and that creates a few problems from the aspect of trying to re-establish the needs of our clients in the small group space, as well as how we re-evaluate our risk on a year over year basis as we have a shrinking number of potential small group members," Gianquinto said. "Affordability is another problem. How can we bring an affordable product to our clients in the small group space?"
Gianquinto continued, suggesting that new treatments – such as gene therapies that the FDA is in the process of evaluating and approving – would drive up costs as they offer real benefits to consumers but are very expensive. He also said that government mandates drive up costs as well, and whether those mandates are necessary or not, their impact on cost is a "reality."
"We've been proud to serve
Moon explained that while the cost of care fell during the pandemic, as people began to feel a sense of normalcy return in 2021 and 2022, their utilization of services led to a cost increase that was challenging to keep down. He also referenced the costs of gene therapies and new drugs that have driven up costs, such as Ozempic, which has seen a large increase in usage.
Sen.
"There's been a lot of talk this morning about the ACA, which is national legislation that applies in all 50 states, but the current death spiral in
Lesser offered several potential approaches to help sustain the small group market, including combining the small group and individual markets, offering more state based subsidies and improving consumer protections for companies who buy into the small group market.
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