[…] Guaranteed-issue health insurance is expensive. When it’s enacted without a mandate requiring people to buy it, the premiums can become out of reach very quickly. In Colorado, group health insurance (all eligible employees are guaranteed enrollment, regardless of medical history) is significantly more expensive than individual health insurance (medical underwriting applies until 2014 when the guaranteed issue provisions of the ACA kick in). But since employers usually pay at least a chunk of the premiums, people aren’t generally aware of the full cost of group health insurance. In the individual market, that cost will be more transparent (subsidies – also created by the ACA – will be a significant help for a lot of families).
Any way you look at it, the claims expenses will be high once all health insurance is guaranteed issue. I would assume that individual health insurance premiums will start to look more like group premiums as the years go by. The goal of increasing premiums for late enrollees should be three-fold: To make the practice of waiting to purchase health insurance until one is sick seem less attractive; to make sure that there are enough total premium dollars collected to pay for the total claims submitted; and to make things as fair as possible for people who opt to have health insurance all the time, even when they’re perfectly healthy. Those people should not be paying the lion’s share of the total premiums.
I agree with Jason that if this model were used, it should be up to the carriers – with regulatory oversight – to set the premium adjustments rather than having the government set the prices. But I think that if we use this model to try to accomplish all three of those goals I outlined, the premium adjustments for late enrollees would have to be pretty significant.