By Trudy Lieberman

As Obamacare approaches its fifth sign-up season, policyholders in many parts of the country are facing a marketplace with fewer choices and higher premiums.

Many carriers leaving the market, however, are blaming the Trump administration for causing market uncertainty. A press release from Blue Cross Blue Shield announcing a 21 percent rate increase in the parts of Tennessee where it will continue to sell noted “two significant uncertainties.”

How will the risk pool change if the requirement to buy insurance is no longer enforced? (The Trump administration has loosened enforcement.)

Will the government continue providing cost-sharing subsidies to people with low incomes?  This year individuals with incomes below $30,000 and a family of four with about $62,000 get extra help paying deductibles and coinsurance. 

I have no clue how politicians will solve this.  I do know one thing: The cost of medical care continues to rise and that will be factored into everyone’s premiums each year.

Unless there’s some serious cost control built into whatever comes out of Washington, premium increases could become very steep in the coming years taking health insurance out of reach for many Americans.

Cost containment has barely been discussed. It’s the elephant in the room. For one thing, insurers’ operating costs, which eat up about 18 cents of every premium dollar, are about twice as high as those costs in other countries.

They include:  determining eligibility, processing claims, enforcing controls on care like preauthorizing procedures – and negotiating fees with thousands of hospitals, doctors, and other sellers of care.

Then there’s the matter of new healthcare technology and more use of older technology, which may account for as much as 50 percent of the increase in annual healthcare costs.

At the end of June, for example, the New York Legislature passed a law mandating insurers pay for 3-D mammography without requiring women to pay deductibles or coinsurance and without the blessing of the U.S. Preventive Services Task Force which has made clear that evidence for its use is lacking and “many important questions remain.”

The cost of a mammogram could rise by a third.

This is just the tip of the proverbial iceberg. I will explore technology and its costs in a future column.

How do you think medical costs should be controlled? Write to Trudy at trudy.lieberman@gmail.com.