WASHINGTON -- Health insurance premium requests are beginning to trickle in from states with early filing deadlines, but the potential effects from the coronavirus pandemic are still largely speculative.
Some health insurers in early deadline states such as Vermont, Oregon and the District of Columbia are attributing portions of their proposed rate hikes for individual and small group plans to the pandemic, according to health department submissions, while most are opting to wait. But all of the companies caution that data on the pandemic's effects have yet to materialize, indicating that final premiums could be higher.
"The short answer is that nobody knows," said Margaret Murray, CEO of the Association for Community Affiliated Plans, adding that "countervailing winds" of things like a decline in routine care and the increase in COVID-19 treatment are clouding the crystal ball.
Proposed rate requests for 2021 will begin to pour in over the next couple weeks, with final rates approved in September. Early signs indicate that more plans will be offered on the exchanges created by the 2010 healthcare law than last year, in spite of the pandemic.
Other unknown factors include the costs of tests and a vaccine, and how the dramatic spike in unemployment will shuffle people out of the small employer market and into the individual market and Medicaid. It's also unclear how quickly routine medical visits will resume, and what the long-term effects of the national shutdown will be -- particularly for patients with chronic disease.
Nearly half of people with chronic kidney disease who aren't already on dialysis are unaware they have the condition, according to the Centers for Disease Control and Prevention. More than 21% of diabetes patients, meanwhile, are also undiagnosed.
The statistics are why many public health experts fear the shutdown will have long-term effects for at-risk individuals who missed routine check-ups and screenings, including for other diseases like cancer. Signs already point to an increase in mental health and substance abuse deaths.
David Hoffman, a bioethicist who chairs the policy committee of the National Association of Chronic Disease Directors, said the effects likely won't begin to surface for another year as the medical community catches up on months of missed appointments.
"All of those things will take time," he said. "We don't have the capacity to screen everyone at once when things reopen."
Hoffman said he will be watching for evidence of increased heart disease, diabetes and other conditions through an annual CDC phone survey, known as the Behavioral Risk Factor Surveillance System. A projected spike in chronic disease diagnoses would likely trigger a correlating jump in healthcare spending, since conditions become more severe and expensive the longer a patient forgoes care.