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I want you to brace yourself for 2018: all estimates tell us that health insurance premiums are going up.
Theories on why the costs continue to increase are all over the board. Progressives point to efforts by conservative lawmakers over the past few years to defund the ACA. Conservatives blame the ACA for requiring insurance companies not to discriminate against people with pre-existing conditions and thus increasing the costs of care. I have some of my own theories based on my experience and research that I explored in a previous article (check it out my original post, Chicago Tribune, and Madison Cap Times). Healthcare costs have been exponentially increasing for decades. In large part, the ACA was a first big attempt to try to lower costs and create a level playing field for all consumers. Before ACA, people with even minor pre-existing conditions were denied care (check out my story about a resolved ankle injury for which I was denied insurance at the age of 27 that is one of my big motivators to be an advocate). Where are we now? Congressional and executive leaders have resigned to obstructing the ACA because their attempts to repeal it were not successful. This has caused great instability in the market. The current president is still deciding whether or not to leave cost-sharing subsidies in place that make insurance affordable for millions of Americans. Molina cited this uncertainty as one of the main reasons they are pulling out of the Marketplace in 2018. We expect premium costs to increase significantly because of this uncertainty. What can you do? Call your representatives today. Call the Whitehouse. Tweet the president. Let them know that you are paying attention.
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The effort to repeal the Affordable Care Act has currently stalled in the Senate. I have no doubt leaders in Congress will take up the effort again soon, but while we have some resting time we need to discuss what would make health insurance better for Americans. I wrote in previous posts and articles that the current bills being proposed are nearly guaranteed to raise consumer costs and leave millions of Americans unable to get insurance, because the real root causes are not being address and many of the consumer protections would be repealed.
It's time to start talking about solutions. I have some solutions of my own, but I want to hear your ideas, too. And most importantly, your representatives need to hear your ideas. As a very smart person once said, the price of complaining is coming up with solutions. Here are a few of mine: Idea 1: Expand tax credits rather than cutting back. The paused repeal bill in both the House and Senate would make huge cuts to tax credits for almost everyone on the exchange. The Senate bill specifically would make deep cuts in the credits for middle-class Americans. Tax credits in the Affordable Care Act are based on age, location, income, and the actual cost of insurance. Both proposed new bills would simply give credits based only on age, and would have no relationship to the actual cost of insurance. In simple terms, this means that if the repeal were to go forward, Americans could expect less help and higher premiums every year. My solution is to expand the tax credits to middle class Americans. Right now, the credits only go up to 400% of the Federal Poverty Level (FPL). If we expanded the credits, many more middle-class families would find insurance more affordable, rather than more unaffordable. Idea 2: Negotiate provider reimbursements. When the Affordable Care Act was being drafted, a certain faction of representatives wanted the federal government to set fees that doctors, hospitals, clinics, and drug companies could charge. This isn’t a radical idea: it’s exactly what Medicare does. This idea was quickly shot down, though, and didn’t make it into the law. Providers are making billions of dollars of profits on Americans seeking healthcare. In the Affordable Care Act, insurance companies have to follow the 80/20 rule—they must spend at least 80% of premium dollars on healthcare delivery. This leaves them with a 20% margin for wages, administrative costs, and profits (don’t fret, they are still making plenty of money). In my opinion, the 80/20 rule is awesome, but it has a fatal flaw: insurance companies and providers have figured out that if they just raise the 80%, their 20% gets bigger too! Providers should be paid well. But do we need two multimillion dollar hospital complexes with fancy fountains and atriums unmatched by even the Ritz-Carlton on every corner? (Or right across the street from another one?). No, in my opinion. I want great healthcare, I want everyone to have access to doctors/hospitals close to their home, and I want providers to be paid very well. I love money, and everyone should be paid what they are worth. But all your premium dollars largely aren’t going toward paying your doctor more, a good portion of your money is being used to build fancier buildings and to provide more hospital beds in communities where there are already plenty. I want our healthcare dollars spent wisely. Here’s a great example. Last summer, I needed an MRI on my ankle after a running injury. My doctor, who works at the biggest hospital system in Wisconsin, ordered the MRI at the hospital with whom she is affiliated. Being in health insurance advocacy, I called the hospital to ask for a price estimate. Ready? $12,000 before the radiologist reading. I cancelled that appointment immediately. I found a stand-alone MRI clinic covered by my insurance where the total bill would be $650 including the radiologist reading. The actual MRI would have been the same at either provider, but the place didn’t have a fancy lobby or 40-foot ceilings. Research shows us that hospitals charge more because they have more overhead but also because they are not always competing in the open market (i.e. most people getting an MRI at a hospital are admitted for an emergency and have no choice, or trust their doctor’s referral and blindly go in without asking for price beforehand). We need to have a serious discussion about what prices are fair and smart for consumers and providers. This is about financial waste, not cutting doctor’s wages. There’s no doubt in my mind that leaving the 80/20 rule intact and negotiating provider reimbursements will bring consumer premiums down—and we need both. Idea 3: Negotiate drug prices. Much like Idea #2, the federal government refuses to negotiate drug prices. However, unlike #2, they won’t even do it for Medicare (and in Medicare we see unbelievable drug costs for seniors). The federal government could regulate prices, and in my opinion, we should. Just like providers, drug companies have no regulations on what they can charge for life saving drugs. Caps based on actual production cost and fair administrative costs is my recommendation. I want to hear your ideas! Comment below or connect on Facebook or Twitter. This information is protected intellectual property. Do not reproduce or distribute without citation and credit to the original source. If you have any questions, please contact me here. For people who use the marketplace (healthcare.gov) for their insurance coverage, the new administration changed the rules for Special Enrollment Periods on June 19th. This article applies to anyone who loses coverage mid-year, such as the loss of a job, retirement, move from another state or county, and loss of Badgercare.
The new rules are even more stringent and require people to act even more quickly when they find out they are going to lose coverage. People will also need to be prepared to have at least one month of no coverage while the new Special Enrollment Period Verification processes. What you need to know When you lose other coverage, such as from an employer or BadgerCare, you have 60 days to enroll in a marketplace plan or risk going uninsured for the rest of the year. This is known as a Special Enrollment Period (SEP). If you miss your SEP, you will have to wait until Open Enrollment (November 1st - December 15th) to enroll into a plan for the next year. It is important to act fast, and I highly recommend getting help or using an online enrollment tool like this one to make the process as easy as can be. Acting before you lose coverage is still important, but it has gotten trickier. What you need to do now that’s different The new rules make it so you must prove you lost other coverage before your new coverage can start. This means that at the time you apply, you should have your termination letter in hand so you can submit it right away. Realistically, however, most COBRA notices don’t go out until 10 days after coverage has ended. This means you are likely to face at least a month gap in insurance coverage. What to do if you’re waiting for a COBRA notice Contact your former employer and ask them to write a letter saying what day your insurance ended/ends. If you’re losing BadgerCare, you will get a notice 10 days before your loss. How to prove loss of other insurance You’ll have to upload the document to your account on healthcare.gov and check back in a few days to see if you’ve been approved so you can pay your first month’s premium (you will have already selected a plan that is “pending”). I help people in Wisconsin with the enrollment process and I always help my clients submit verifications. Contact me before you apply on your own if you would like help, at no cost to you. Under Obamacare/ACA, all consumers (whether buying insurance on their own or through an employer) are protected by out of pocket maximums. ACA also gives us a protection against insurance companies imposing lifetime limits. AHCA, if it becomes law, will reverse this policy and allow insurance companies to charge you any deductible, out of pocket maximum, and lifetime limits. #ACA #AHCA #OOP #Healthcare #lifetimelimits Congress passed a bill in May to radically go back to pre-ACA rules for healthcare. We used to have a High Risk Pool (HIRSP) in Wisconsin are would be likely to go back to it. HIRSP was the only option for many people, and was extremely expensive and had wait periods. #ACA #AHCA #HIRSP #riskpool #ACA #AHCA #BigCorp #ConsumerProtections If AHCA becomes law, Medicaid will change perhaps most of all. We are at risk of going back to pre-ACA rules in Wisconsin. Governor Walker has already requested a waiver to kick people off of BadgerCare. #ACA #T19 #AHCA #Badgercare Congress passed a bill in May that would drastically change health insurance if it becomes law. The bill now goes to the Senate. #ACA #AHCA #10essentialhealthbenefits Up next on my series on proposed changes in AHCA: legal rate hikes for older Americans. Follow on Facebook to get all the updates! #ACA #Obamacare#AHCA #olderAmericans #AARP For the next week, I will be sharing a daily video about particular proposed changes to healthcare and what they mean for you and our fellow Americans. Up first: What is the AHCA, and what is all this talk about preexisting conditions? Like us on Facebook and share the video! #ACA#Obamacare #AHCA #prexisting |
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