(Bloomberg) -- To reduce turbulence in thefledgling insurance markets created by the Patient Protection and Affordable CareAct, the Obama administration’s top health official ispushing to get more information to consumers about what they’llactually pay for health care, which can include out-of-pocket costsas well as premiums.

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The changes are meant to help people choose coverage that fitstheir needs when up-front premiums and out-of-pocket costs areadded together, Health and Human Services Secretary SylviaMathews Burwell said during an interview at Bloomberg News’sWashington bureau.

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Cases of patients signing up, paying for a time, and thendropping out of PPACA have plagued insurerslike UnitedHealth Group Inc., which isdebating whether to exit the government-run market to avoid morefinancial losses.

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“Many people came into the system very focused on premium only,and then learned about total cost,” Burwell said Monday. “We thinktotal cost is important, and we’ve been driving the consumer tounderstand that.”

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The Affordable Care Act has helped coverabout 9.9 million people through subsidized markets for privatehealth insurance. Yet the new markets have in some cases provenchallenging for insurers and hospitals.

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Patients may stop paying after a medical event, or can show upin hospital emergency departments with coverage that offers lowpremiums in return for more risk later, leaving them unable to paytheir bills.

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More information

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Sign-ups for 2016 coverage started on Nov. 1. For the firsttime, the U.S.’s healthcare.gov website will show customers thecost of insurance premiums and also estimate what their actualhealth expenses will be.

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That will help people pick appropriate coverage, Burwell said,and could keep them from dropping policies midyear, a problemknown as churn that’s plagued insurers like UnitedHealth and AetnaInc.

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“The insurers are absolutely right that this has to be trulyviable, it has to be a market where people intend to buy insurancefor the long haul,” said Joseph Antos, a health-care policy expertat the American Enterprise Institute, a conservative think tank inWashington.

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“Even with great information, ultimately the big wild card is,are you going to be sick this year or not?” Antos said. “It’s goingto take a few years for people to become minimally able to navigateall this stuff.”

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Burwell’s interview came after UnitedHealth said last weekthat it was considering whether to pull out of PPACA insurancemarkets because it’s losing hundreds of millions of dollars.

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Until recently, PPACA has been viewed as a boon to health-carefirms, sending them millions of new customers and creating payingpatients for drugmakers and hospitals.

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The Standard & Poor’s 500 Health Care Index has more thandoubled from the day President Barack Obama signed the AffordableCare Act into law through Monday, beating the broader S&P 500gauge.

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UnitedHealth, with fewer than 550,000 members on the PPACAexchanges, isn’t among the biggest health insurers in the program.But its experience could be a harbinger of things to come fromother for-profit firms like Anthem Inc. and Aetna.

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“We cannot sustain these losses,” UnitedHealth Chief ExecutiveOfficer Stephen Hemsley told analysts on a Nov. 19 conference call.“We can’t really subsidize a marketplace that doesn’t appear at themoment to be sustaining itself.”

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Aetna has cited similar issues. Aetna Chief Financial OfficerShawn Guertin said earlier this month that people are buyingcoverage “and then staying for only a few months and then droppingagain, and obviously getting service along the way.”

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And Anthem has said that while it was willing to wait, it maytake several years for the new insurance markets to stabilize.

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Burwell declined to talk about UnitedHealth specifically.

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But she pointed to Anthem’s statement last week saying it wascommitted to PPACA, and similar remarks from insurers such asKaiser Permanente and Molina Healthcare Inc., as a sign that thereare plenty of firms willing to participate in the law.

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Hospitals

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Hospitals have faced their own issues, as for-profit chains HCAHoldings Inc. and Tenet Healthcare Corp. have said they’re seeingan increase in uninsured patients.

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HCA said the number of uninsured people admitted to itshospitals climbed 13.6 percent in the third quarter, compared witha year earlier, while Tenet said its uninsured and charityadmissions rose 3.7 percent. Those reports sparked investorsworriesthat the law’s gains in covering the uninsured areslowing.

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Burwell said that while the U.S. had predicted only a modestincrease in PPACA sign-ups for next year, much of that wasbecause people were keeping coverage they had through their jobs,helped by an improving economy.

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“What we want to focus on is the reduction of the number ofuninsured,” Burwell said in an interview on Bloomberg TelevisionMonday. “Whether that happens because people enroll in themarketplace or because we have lower unemployment in the nation,those are both positive ways to impact and affect that uninsurednumber.”

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The U.S. is rolling out other tools as well for thehealth law’s third enrollment season.Insurers are increasingly narrowing the networks of doctors andhospitals that they’re offering on the exchanges, which can helplower the cost of a plan.

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To help individuals figure out what’s included in the coveragethey’re buying, the U.S. is developing a feature that shows whethera particular doctor or hospital is covered, Burwell said.

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While that may mean fewer choices for care, that may not be abad thing if consumers know what they’re getting up front, Burwellsaid. “Narrow isn’t bad if it’s what you want and need.”

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--With assistance from Melissa Mittelman.

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Copyright 2018 Bloomberg. All rightsreserved. This material may not be published, broadcast, rewritten,or redistributed.

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