Back in the day, Congressional Democrats were saying that Health Insurance Reform was on the verge of passing, while Republicans were saying in effect, over our dead bodies. But there was no need to worry if the Health Care juggernaut steamrolled Congressional Republicans and flattened them like blue scary pancakes. These politicians all had high quality, Federally financed, socialized health insurance. They were fine. It was the rest of us that had a problem.
As a self employed person in Georgia who was only able to afford or obtain high deductible Individual health insurance, I found that it was impossible to obtain honest health insurance from a for profit insurer.
This was true because for profit health insurance companies were not and are not part of the health care industry, but the finance industry. For profit health insurance companies actually have a conflict of interest with their policy holders, because for profit companies have a primary fiduciary obligation to their stockholders Health insurance companies only make money when they collect premiums, not when they pay claims. Thus health insurance companies have no incentive to render good customer service to their policy holders, in fact, just the opposite.
The huge premium increases that insurance companies historically imposed in many states were actually not meant to gouge their policy holders, as some health care advocates proposed, but to induce the policy holder to drop their policies and buy insurance from another company. This is called churning, and it is an integral part of the for profit insurance companies business plan.
While these companies only signed up healthy people, denying insurance to anyone with a pre-existing condition, they have learned from experience that after two years, the number of claims are the same as if they had signed up a random collection of people. Thus, all policy holders have to go.
Conservatives like to quote the aphorism, “no one washes a leased car.” That actually has application to the health insurance industry as well. Since for profit companies only “lease” their policy holders, they have no incentive to pay for preventive care. That’s why the American health care system has been called a “sick care” system and why American health care outcomes compare so poorly with the rest of the civilized world.
High deductible policies for Individuals and small business owners are sometimes called “Catastrophic” insurance. That is an appropriate name. A person with such a policy faces potentially catastrophic financial and health outcomes if he or she falls ill. When premiums go up 40% as they routinely do with these policies, the chronically ill patient either dies or goes bankrupt sooner or later.
Nor is it true that people get medical care even if they don’t have insurance as some Republicans say. Studies have proven that uninsured people get less health care and the care they receive is not up to standard. Patients can’t get surgery or chemo-therapy in emergency rooms, and if the patient doesn’t have insurance or ready money, the hospital and doctors routinely sue the patients to collect their bills.
One of the “reforms” advocated by Republicans is to allow consumers to purchase health insurance “across state lines.” The companies that are pushing this policy change are some of the worst companies in the industry. The idea is to by-pass the barely adequate state regulations that ostensibly protect consumers. If a Georgia citizen’s legitimate claims are denied by an out of state company, he or she will have little recourse, which is the point of those Republican policies.
Another “reform” advocated by Republicans is to allow citizens to band together in Associated Health Plans (AHP) such as the Blue Eyed Left Handed Retail Clerks of America. Supposedly the purpose is to allow consumers to purchase lower cost group insurance. But in practice, rather than being citizen centered, non-profit health insurance groups, these organizations will be front groups for ethically challenged for-profit insurance companies.
This is not a new idea. Back in the 1970’s, Congress allowed Multi Employer Worker Associations, MEWAs. The resulting fraud amounted to hundreds of millions of dollars.
The true purpose of this idea is to allow for profit insurance companies to defraud more citizens more quickly and at less cost. In fact, the AHPs would not offer real Group Insurance, but Individual policies. Group insurance is not more affordable because a bunch of like minded citizens band together to save money, but because the human resources department of a large corporation subsidizes some of the costs, handles most of the paperwork and absorbs the cost of signing up their employees.
Since for profit health insurance companies have a conflict of interest with their policyholders, and because they have no incentive to give good customer service to their policyholders, thus, for-profit companies engaged in business practices that resulted in millions of uninsured American citizens and poor health outcomes.
So how will the Affordable Care Act (ACA) deal with the possibility that the for profit health insurance companies who are offering health insurance on the Health Care Exchanges will engage in these dubious business practices?
I fear that the authors of the ACA, most all of whom enjoyed either government sponsored health care or taxpayer subsidized health care at liberal foundations, don’t appreciate just how dishonest, shameless and corrupt the for profit health insurance businesses truly are.
Did they anticipate that these companies would almost certainly continue to engage in their corrupt and fraudulent business practices?
Based on past and painful experience, I can predict that these for-profit companies will do exactly what they did in the past.
Here is what government officials and health care advocates need to look out for going forward.
Since the goal of the for profit health insurance companies is to collect at least two years of premiums, I predict that the first round of premium increases will be a modest 5 to 10%. However, the third and fourth year will see increases go up exponentially.
If these for profit companies uses the same business practices that they did before the ACA, and that is the only way they know how to conduct their businesses, policy holders will be given the option to raise the already too high deductibles, or switch to another plan. Most policy holders will switch to another health insurance company, thus, mission accomplished.
Premium increases will be blamed on, in no particular order, an aging population, increasingly complicated and expensive medical technology, and Obamacare.
Another technique these companies will almost certainly use will be to “take the money and run.” While the ACA will prohibit for profit insurance companies from canceling individual policies if the policy holder gets sick, unfortunately there won’t be any way for even the strictest government oversight to prohibit one or more of these companies from claiming lack of profits and canceling all the policies in a state. In Republican states, this will be business as usual.
In Georgia, insurance commissioner Ralph Hudgins has already promised, or threatened, that he will not use any state resources to enforce any of the mandates of the ACA, which means it will be business as usual for the predatory for profit health insurance companies that have preyed on the citizens of Georgia for years.
Of course, all of this will be moot if Republicans ever regain control of the Senate and the Presidency. They will almost certainly gut the ACA consumer protections and allow the companies to re-institute the ban on pre-existing conditions, the reinstitution of insurance policy monetary caps and the elimination of the improvement in access to more affordable and comprehensive health care for women.
I support the efforts of Democratic legislators and elected officials to provide affordable and reliable health insurance to the citizens of this country who need it. But the shameful actions of most Republican legislators and governors to deny affordable and reliable health insurance to the citizens of their states should be a serious warning shot to progressively minded people that Republicans will never reconcile themselves to the reality of the need for Americans to have the opportunity to enjoy affordable health care.
These Republican ideologues are still fighting to eliminate Food Stamps, Social Security, Medicare, Medicaid and other “entitlement” programs, and they will never stop trying to sabotage the Affordable Care Act.
Eternal vigilance is the price of freedom, and the guarantee of affordable health care.
Danielsville, GA 30633