Some free-market health care proponents think that universal health care supporters want free, unlimited health care no matter what the price. They are wrong. After reading about $600 EpiPens, $1,000 Hepatitis-C pills and $1 million cancer treatment bills, most people are willing to settle for less.

There are, however, some people that want unlimited health care, including former Democratic candidate for president, Bernie Sanders. Sanders advocates for comprehensive universal health care. According to his website, his (Medicare For All) "plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs."

But things have changed since Sanders first shared his vision of comprehensive universal health care. One, he lost in the presidential primaries and his platform for comprehensive universal health care disappeared. Two, large, private insurer, Aetna, made a showy announcement of leaving the public exchanges causing some to question the future of health care reform. Three, reality started to sink in as the threat of large premium increases became fact. Cries of Medicare For All have changed to Medicaid For All.

Medicaid For All has all the advantages of Medicare For All. It is an established program often administered by private insurance companies and has lower reimbursement rates than exchange or private insurance plans. And, some think we have already moved in the direction of Medicaid like health plans on the public exchanges. Margot Sanger-Katz of the New York Times recently characterized public exchange plans as Medicaid plans but with a high deductible. She may be right. The exchanges are chock full of HMO and narrow network plans. These plans are popular with exchange plan purchasers because they are often the only affordable option. But that doesn’t mean people like or want them (especially those of us paying full cost for these plans).

So, if Medicaid For All is the route to comprehensive universal health care, the price for all individual health plans will need to come down for everyone. And for comprehensive universal health care to happen employer health insurance needs to go away. Continue Reading...

Tags: Medicaid For All

If the presidential candidacy of Donald Trump has taught us anything it is that the federal government is a good punching bag and scapegoat. Yesterday, Aetna Chief Executive Officer, Mark Bertolini, took some time on the bag. Bertolini announced that the company “decided to reduce our individual public exchange presence in 2017.” Aetna will pull out of 11 states on the public exchanges but continue to sell individual policies off of the exchanges. The reasons provided for the pull out, in insurance-speak, were an unbalanced risk pool and “inadequate risk adjustment mechanism.”

What Aetna means by “an unbalanced risk pool.” Put plainly, Aetna did not sell enough policies to healthy people with low to no health care expenses to cover the cost of care for the unhealthy people it sold policies to.

What Aetna means by “inadequate risk adjustment mechanism.” The Affordable Care Act risk adjustment programs are technical. There is a state-based risk adjustment and reinsurance program and a federal risk corridor program. Basically, these programs give money to, take it away from or share it among insurance companies to balance out their losses and gains.

Is It Really The Governments Fault…?

Aetna stated that, it might return to the exchanges in the future, “should there be meaningful exchange-related policy improvements.” This shameless blaming of a federal program to increase access to health insurance is a disguise to hide Aetna’s incompetence at predicting and managing risks. Aetna has a history of not anticipating changes in the health care market and of dropping unprofitable policyholders. Continue Reading...

Tags: obamacare, public exchanges, Aetna

Health insurance companies have a reputation for being bullies. Policyholders feel bullied when their medical claims are denied or processed incorrectly. Hospitals and doctors feel bullied when the bills they submit are refused or amended, or when procedures are not covered. Employers feel bullied when their rates go up automatically. In fact, no one is exempt from the bullying tactics of the big bad health insurance company. Their latest victim(s)—all of us!

My Way Or The Highway

Four large health insurers (Aetna and Humana and Anthem and Cigna) are trying to merge into two and the federal government has filed lawsuits to prevent that from happening. Now, the two companies that will surface if the mergers go through (Aetna and Anthem) are threatening to withdraw their plans from the public health care exchanges. It’s hard to know if Aetna and Anthem are threatening to leave the health care exchanges because they are losing money or because of the government lawsuits. But does it really matter.

Aetna and Anthem are both making moves to increase their profits and shareholder wealth. Any savings they receive by increasing their size and bargaining power with hospitals and doctors will stay with them. There will be no premium savings for policyholders, just more money for shareholders. But if these mergers do not happen, their next target is likely to be the exchanges. Because if they can’t realize increased profits by extracting bigger discounts from health care providers and hospitals, they will do it by minimizing losses on the exchanges.

Profits Without Risks

Through the individual mandate we require healthier people who need little or no health care to purchase insurance to offset the costs of care needed by the sick. Healthier people lose money by subsidizing the sick. However, health insurance companies are not willing to subsidize losses they incur on the exchanges with profits they earn from their other lines of business, like Medicare Advantage and Medicaid. Continue Reading...

Tags: obamacare, health insurance mergers, Aetna, Anthem

I don't have a problem with the Affordable Care Act's (aka Obamacare) individual mandate. I am willing to pool my limited resources with others so that we all have health insurance coverage. But I have to admit that I am starting to feel the squeeze of my non-subsidized, high premium, high deductible health plan. So much so that I think I want out of Obamacare. Honestly, I'm not quite there yet but it may not take much more to get me there.

I already pay nearly $4,000 per year in premiums for a plan with a $6,500 deductible and 60% coinsurance and no out-of-network, non-emergency coverage. And yes, it is a Bronze level plan. I did the research and I used the latest decision support tools and based on my age and excellent health status, which includes never taking a prescription drug, this is the best plan for me. But the plan sucks in both terms of coverage and costs. My only other option—pay a penalty and pay any medical expenses I incur out-of-pocket—is an even worse option. I deserve better choices than this.

And to make my situation even more difficult, there is speculation that insurers will drop many of their Bronze-level plans in 2017, forcing me into a higher premium tier. But who cares about me? A $4,000/$6,500 Bronze plan is equivalent to a $5,500/$5,000 Silver plan, right? No. I don't have an additional $1,500 to pay in premiums that I will never get back. My spirit for the greater good has monetary limits and it ends at the Bronze level. Continue Reading...

Tags: obamacare