7 milllion enrollees doesn't guarantee reform success

Even though 7 million people have enrolled for coverage under the Affordable Care Act, big challenges loom for the next enrollment period, which opens on Nov. 15, reports the Associated Press. One notable challenge is how to keep premium prices low despite expected increases for 2015.

Republican opponents of the reform law continue to propose alternative solutions to the ACA. For example, The Patient Choice, Affordability, Responsibility, and Empowerment Act (CARE) would revoke the ACA's individual and employer mandates, cancel Medicaid expansion, lower tax credits for buying insurance, and eliminate ACA-related taxes and fees.

''Just talking about repeal is not going to make it with 7 million people getting insurance on the exchange. And it has to be something reasonably credible ... it can't just be repeal. We are beyond that," economist Gail Wilensky, who ran Medicare under President George H.W. Bush, told the AP.

Affordability remains a major issue leading into next year. Insurers must determine the characteristics of new members to set 2015 rates, FierceHealthPayer previously reported. The economic risk insurers made when the law was created remains unknown. If insurers were conservative right from the start, that would take some pressure off next year's premiums, notes the AP.

So far, the average premium increase is 11 percent in the small group market and 12 percent in the individual market, according to a survey of brokers who sell coverage in the individual and small group market, reports Forbes.

Four main factors are driving the rate increases, including commercial underwriting restrictions; the age bands that don't allow insurers to vary premiums between young and old beneficiaries based on the actual costs of providing the coverage; new taxes on insurance plans; and new benefit designs, notes Forbes.

Another affordability concern deals with the cost of deductibles and copayments consumers must pay when they use their insurance benefits. Insurers should be allowed to sell high-deductible plans on all health insurance exchanges, says America's Health Insurance Plans President and CEO Karen Ignagni. To keep premiums low, many plans have high out-of-pocket costs.

To learn more:
- here's the AP article
- check out the Forbes piece