Excellent start, but it's not done yet.
Has Obamacare put health insurance in reach of millions of more Americans? No doubt. Has it made life that much easier for those millions? No question. But is healthcare reform finished in this country?
Not by a long shot.
Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest—and costliest—patients from enrolling.
Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul.
Advocates and industry insiders say these practices may dissuade the neediest from signing up and make it likelier that the customers these insurers do serve will be healthier—and less expensive.
The insurers counter that what they are doing is "prudent business practices, not discrimination against the sick." It's just pure coincidence that their profits continue to hurt sick people. There are some things in the law intended to discourage insurers from these practices, including preventing them from creating or marketing plans specifically for healthy people, and requires insurers to chip in to the "risk corridor," the pool of funds that compensates companies who end up taking on more of the expensive, sick customers. The existence of that risk fund creates less incentive for them to avoid taking on the sick.
But some insurers are still working to keep their networks so narrow as to discourage sick people from buying in. "For instance, MD Anderson Cancer Center said it is included in the networks of less than half of the plans sold on the Houston area’s public insurance exchange." Additionally, there are plans that require patients getting HIV or multiple sclerosis drugs, for example, pay as much as 30 percent in copay for them with the initial prescription. While out-of-pocket costs are limited over the year, that really high initial payment could discourage patients who require expensive medications from signing up. Finally, plenty of large insurers are just staying out of the Obamacare marketplaces, where the people who were previously uninsured for pre-existing conditions are getting their insurance.
The track record and the ability for insurance companies to figure out how to game the system has always been the primary argument for single-payer advocates, and for all the activists who called for a public option—that would have forced competition on private insurers and discouraged these kinds of tactics—to be included in this overhaul. Insurance companies are going to continue to push every boundary and exploit every loophole possible. It's going to take stringent oversight and the threat of real healthcare reform to keep them even reasonably in line.