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Prices On Health Exchanges Vary By State


The widely varied success of the rollout of the health care exchanges, as part of the Affordable Care Act, highlighted the fact that even though the health care law is a national one, you're likely to experience it differently state to state.

Larry Levitt is a senior vice president at the Kaiser Family Foundation. He's with us to help us sort through a few different scenarios. Welcome to the program, Larry.

LARRY LEVITT: Oh, thanks. It's a pleasure to be here.

MARTIN: So, state by state, there really is a different price. Where, in general are people paying the most?

LEVITT: Well, insurance now cost very different amounts depending on where you live. But I think, as people are focusing on these new options under Obamacare, it's coming to clearer focus about much different insurance costs in different areas of the country. I mean, there are some states like Minnesota, like Oregon where health care is very cheap and the premiums are much less expensive, as a result. Other areas of the country, they're quite high.

So where you live, what state you live in and, frankly, even where you live in a state could make a huge difference in how much you pay.

MARTIN: OK. Well, let's talk through a few different scenarios. So let's take a scenario of someone who's really going to benefit from the new health care exchanges, say, a lower-middle income working family.

LEVITT: If you are working family but your job doesn't provide health benefits, so you're forced to buy it on your own today, you should see a significant benefit from the law. So if you go to one of these exchanges - whether it's the federal exchange or a state exchange in your state - you'll be able to apply for a tax credit and find yourself paying a lot less for insurance.

MARTIN: OK. What about a poor, unmarried adult with no kids?

LEVITT: Yeah, so if you're poor adult it's going to depend a whole lot on where you live. You know, right now, the Medicaid program, which has existed for decades, is there for low-income people. But it doesn't cover adults without children. And the Affordable Care Act, as it was originally passed, envisions a seamless system where all poor people poor or near poor people would be covered in Medicaid, no matter where they lived. And then, low and middle-income people would be covered through these exchanges with the help of tax credits.

But the Supreme Court decision last summer on the Affordable Care Act, which allowed the law to go into place, kind of through curveball here; where it said that states could choose whether to expand Medicaid or not. And about half the states have and about half the states haven't. So if you're poor adult without children, it's going to depend a lot on whether you live in a state that's expanded Medicaid or a state that's not. In which case, honestly, you're left with pretty much the same options, which aren't great.

MARTIN: OK, there's another category that varies a lot. A person who doesn't have regular full-time job, someone who's always bought their insurance themselves. They're not poor, but maybe they don't make enough for the subsidies. Is a person like this likely to do better or worse on the exchanges?

LEVITT: This is someone, let's say, who was a small-business owner or someone who's self-employed. Because of the changes in the insurance market it will depend a lot on this person's circumstances. So, for example, if you're young and healthy, you may be getting a very cheap premium today. But because the law prevents insurance companies from charging sick people more, if you're young and healthy you may end up actually pay more under the law than you are today.

On the other hand, if you're older - maybe you have a pre-existing condition but were able to get insurance, but just a lot more for it - you might actually find yourself saving money. So it's really going to depend on your personal circumstances.

MARTIN: OK, so what about these people who don't benefit now? Is the system designed to improve or are these populations just out of luck?

LEVITT: What the law does is while some people might pay more today, insurance premiums should be much more stable over time. So, for example, if you're young and healthy today you are able to get insurance and get it pretty inexpensively. If you found yourself getting sick or having an accident, your premiums might end up going up a lot - and that won't happen anymore.

MARTIN: Larry Levitt, he is a senior vice president at the Kaiser Family Foundation. Thanks so much for helping us sort all this out, Larry.

LEVITT: Oh, my pleasure. Transcript provided by NPR, Copyright NPR.