As health insurance companies set rates for 2019, the country is about to be reminded of one of President Trump’s biggest failures, the failure to repeal or reform Obamacare. Republicans made several attempts in 2017 to reform the Affordable Care Act, but failed to garner even the simple majority required to pass the measure under budget reconciliation rules. Now their inability to fix the law is coming home to roost in the form of higher insurance premiums for many Americans.
If you listened to President Trump last December, you might think that Obamacare was repealed. In reality, Republicans repealed the law’s individual mandate, but left most of the ACA intact. Repeal of the mandate without fixing the rest of the law might actually worsen the problem of rising premiums as young, healthy insureds flee from the expensive policies still mandated by Obamacare.
In March, the Wall Street Journal forecast that health insurance premiums would be an election issue after Congress failed to agree on a stabilization (i.e. subsidy) bill to shore up the individual health insurance markets. Now that forecast is starting to come to fruition as the first announcements of premium increases are being heard. Maryland, one of the first states for which information about the new insurance rates has become available, has insurers proposing an average increase of 32 percent. The proposed increases range from 18 to 91 percent.
Announcements of rate hikes, along with news of insurers withdrawing from Obamacare marketplaces, have become an annual tradition in the years since Obamacare was implemented, but rising health insurance costs don’t just affect those Americans on individual plans. Marketwatch recently reported on a study that showed that rising health insurance costs contribute to slower wage growth among the nation’s workers, many of whom are covered by group plans purchased by their employer. Group health insurance premiums were forecast to increase by about four percent for 2018.
Americans are getting less coverage despite paying higher premiums. Spending on deductibles and coinsurance, the patient’s share of medical bills, has increased in recent years as copayments have covered less. Whether you have an Obamacare plan or an employer-based plan, you are probably paying more out of your own pocket for health care than you were just a few years ago.
There are also hidden limitations that you only find out about when you have a claim. As an example, my wife had to go to the hospital in an ambulance last year. Six months after her hospital stay, we received a bill from the ambulance service asking us to pay more than $4,000 for a 30-minute ride. When I followed up with Blue Cross Blue Shield of Texas, our insurance company, I was told that the ambulance service was out-of-network. When I pressed further, I found that Blue Cross did not have any ambulance providers in their network in the entire state of Texas. As a result, Blue Cross paid less than $1,000 on a total claim of more than $5,000.
In the United States, the way that we buy health care is totally disconnected from markets and economic reality. If you have any idea what you will owe a doctor for something as simple as an office visit, you are in a minority of consumers. The problem is even worse if you go to the hospital for tests or surgery where several billing entities from the doctor to the anesthesiologist to pharmacies and labs and the hospital itself are involved. Prices are not known until after the service is provided. In many cases, the patient doesn’t even know what services are being provided or by whom.
In another personal experience, I went for a colonoscopy a few years ago. I discussed the cost of the procedure with the doctor and the hospital before I was admitted, but when the bills came later, it was more than three times what I had been told to expect. After months of running between the hospital, the doctor and the insurance company, I traced the problem to an error in the diagnostic code. It took many more hours on the phone to get this code corrected. Many patients probably simply pay incorrect medical bills without questioning whether they are correct or taking the time to investigate.
An accounts receivable representative for the ambulance service that we used told me that, because Blue Cross is hesitant to pay ambulance bills, they often send shockingly large bills to the patient. Part of the goal is to get the patient to put pressure on the insurance company to pay up. The provider doesn’t necessarily care where the money comes from as long as they get paid and the insurance company is happy if patients pay the bills and let them off the hook.
Because of the lack of competition in the healthcare system, Americans are left without options when health insurance companies misbehave. The majority of Americans who get their health insurance through an employer have no input into the choice of a health insurance provider. You can only decide whether to participate in or drop an employer health plan during open enrollment. If you decide to buy insurance from a company other than your group health provider, you lose the employer contribution to the premium. This means that you end up paying far more to buy your own health insurance that you would if you participated in the group plan.
The problem is similar for workers who like their company’s group health plan, but who leave their job. Coverage may not start at a new company for several weeks. In the meantime, health insurance premiums for your old plan may from a few hundred dollars to more than thousand.
Frustration with the existing health insurance system is probably a major reason why a majority of Americans now favor a single-payer system (i.e. government-run universal healthcare). Several recent polls have shown growing support for more government involvement in health care. In April, a Washington Post — Kaiser poll found that 51 percent of Americans favored single-payer. Gallup and Pew found similar results last year. The increasing costs and decreasing value of private health insurance is undoubtedly leading many Americans to embrace this radical idea.
Republicans have damaged themselves on the issue. The Republican health bills of 2017 were so unpopular that they turned public opinion around on Obamacare. After years of favoring repeal of the ACA, more Americans now oppose repeal than support it. CNN polling from March shows Democrats with a 20-point lead over Republicans when voters are asked which party would do a better job on health care, the largest gap of any issue.
At this point, there are no signs that Republicans are interested in fixing the health insurance problem. President Trump is basking in recent foreign policy successes, but Republicans may be hurt in the midterms if attention shifts to domestic issues like healthcare. Korean dÃ©tente may mean that voters focus more on pocketbook issues instead of national security. If health insurance prices spike in October and November as Obamacare exchanges and employers hold open enrollment for 2019 health plans, it could provide Democrats with a much-needed issue with which to hammer Republicans.
Do you have a health insurance horror story?