Many voices in health Care, including The Sovereign Patient have been warning about this phenomenon where circumstances lead to a high concentration of high risk enrollees, higher costs and smaller networks with limited choices and lack of competition. This mini “death spiral” is a direct and indirect result of three things: 1) Mandating certain minimum coverage regardless if it is really needed – 2) Related to #1 is mandating purchase of this same product by individuals not covered by their employer’s plan – and 3) Not permitting individual risk underwriting combined with mandated low deductibles and artificial cost sharing ratios which makes it impossible to set realistic prices and even harder to predict claims expense.
This same kind of situation will play out in pockets all over the country. It won’t accomplish the goal of more benefits for more people at a lower price without disrupting choice or increasing waiting times. That would be like squeezing a water balloon at one end and expecting not to bulge and eventually break at the other!