The wife of a friend of mine has multiple sclerosis (MS). She is now covered by his employer-supplied health insurance, but he is concerned that might not be the case in the future. He was happy that the ACA emerged intact yesterday.
Yesterday, he read an opinion piece by Michael F. Cannon on the CNN website that said that the ACA makes insurers take a loss on every MS patient, so they have to restrict benefits to discourage enrollment.
My friend is now worried that the ACA, should they need it, might not adequately cover his wife’ MS. “I suspect it’s BS, but you never know,” he said.
I spent some time researching the question. Here is what I found.
The first thing to note is that Michael F. Cannon is from the right-wing libertarian
Cato Institute. When you see the Cato Institute, think the Koch brothers.
Cannon said that "Obamacare forces insurers to take a $14,000 loss for every MS patient they enroll."
Of course, insurers also "lose" a lot money covering enrollees with cancer, heart failure, liver transplant, etc. They balance that out by "making" a lot of money enrolling the young and healthy. That is how insurance works.
Cannon continues that "Those penalties mean insurers must try to avoid those patients by slashing MS coverage, or risk going out of business."
What he means is that if insurance companies want to make mega-profits, they must finesse the ObamaCare rules to discourage MS patients from utilizing benefits. More on that later.
Cannon goes on to complain that "(b)ecause many Obamacare enrollees were sicker (and costlier) than anticipated, premiums skyrocketed and insurers backed out of state exchanges."
So how do the insurers slash coverage for MS?
In summary, there was a lot of BS in Cannon’s article. Unfortunately, the part about insurers restricting coverage in MS is somewhat true. I suspect that insurers play similar games with other expensive to treat conditions.