As GOP Looks To Drag Health Care Backwards, Health Insurers Look Forward

Recently, Congressman Steve Chabot of Cincinnati, Ohio wrote on his blog, "I haven’t seen so much misinformation and hysterics about a piece of legislation in a long, long time—maybe ever" about the passage by the House of the American Health Care Act (AHCA). I guess he was asleep during the passage of the Affordable Care Act (aka Obamacare). But all kidding aside, I strongly suspect that the Senate will continue the House's work to make American health care look more like it did pre-Obamacare. They never thought health care reform was necessary in the first place.

Republicans have the numbers to pass the health care bill they want; still, I can't help but think that a return to the status quo is not in the country's future, at least not long-term. You see, Republicans may think that they are about to accomplish something that's never happened before, taking away a huge federal entitlement program, but not even health insurers are prepared to return to the bad old days. Insurers know they passed the big-changes-are-coming-moment and are in the redefining-and-refining-our-purpose-moment, and if the GOP had consulted them during the health care reform debate, they would know this also.

What Health Insurers See As Their Future

Optimizing value by providing doctors with data analysis services.
Last week Humana's CEO, Roy Beveridge, described the country's third largest health insurer as
an IT company focused on data analytics to improve health care value. According to Beveridge, the future of health care may be using data to understand risk better and sharing this data with doctors to improve patient outcomes. Doctors can use this data to determine which patient populations need what care and how often to engage with them.

Focusing in on getting a bigger piece of the (new) pie.
Also, last week, health insurer Aetna, Inc.,
announced it would pull out of the Obamacare exchanges for next year. In addition, Aetna CEO, Mark Bertolini, reportedly said, the country needs to have a conversation about single-payer health care. However, instead of health insurers competing with the government to offer health insurance, Bertolini envisions health insurers managing the single-payer program for the government, as it does with Medicare and Medicaid.

Enhancing patient access to health care services.
The Blue Cross Blue Shield Association is looking to help the very population the AHCA would possibly harm, the poor and isolated. Recognizing that not everyone has access to reliable transportation to get to non-emergency medical appoints BCBSA is
piloting a program to partner with Lyft to provide free rides to its members.

What Vision Of The Health Care Future Will Win Out

As the Republican Party respond to a near decade-long promise to make health insurance access what it used to be, health insurers are redefining and refining their role. Insurers like the BCBSA are still stuck in the middleman role mindset, addressing patient behavior, and improving health care outcomes. Other insurers like Aetna acknowledge that the government may have to step in and offer insurance coverage to individuals his company won't touch. And Aetna being Aetna, a company less-focused on risk management and almost totally on business acquisition, just wants a piece of whatever government offers. Meanwhile, health insurers like Humana see their future in risks analysis—exactly what an insurer should be and exactly what Aetna is not.


We are already experiencing the future of health insurance in America. Helping patients with care adherence by addressing socioeconomic concerns is something many insurers are working to achieve. The problems with these programs are that they are only available to the insurers' members, which means they don't reach the millions of other people in need of assistance and are not likely to lower health care costs in general.

Expanding the use of government-private health insurer partnerships also has little chance of lowering health insurance or health care costs. These partnerships greatly benefit private insurers and make up a big chunk of their business and profits. In
Aetna's case, government programs like Medicaid and Medicare are now its most profitable line of business. Aetna has shown time and again that it wants all the reward and none of the risks, the opposite of insurance. Aetna has also shown it will say and do anything to keep its large piece of the government pie, even threatening to pull out of the exchanges if the government disallows its merger with another insurer.

The Humana data analysis model, on the other hand, has the potential to lower health care costs. Of course, technology alone will not lower health care costs as long as people struggle to overcome socioeconomic issues that impact their health. Still, Humana's health insurer of the future shows more promise than anything we hear from other insurers. For one, Humana has found a way for health insurance companies to transition to a different industry—going from insuring patients to analyzing and managing risks through data analysis.

The only questions left are how long will it take us to move to single-payer health care and the end of health insurance companies as payment middlemen when Republicans are trying to undo the health care reform progress we've made so far.

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