Monday, October 26, 2015

The Unaffordable Insurance Act Rolls On

I received this email this morning from a physician in private practice in NYC -

The truth about being ‘insured.’

For the past three years, my small business group (less than 50 employees as per insurance status) has received a health insurance policy cancellation notice. Each one points a finger at the PPACA as a reason for the cancellation. At first, continued underwriting modifications as a result of PPACA seemed odd since the law has not been modified, to the best of my knowledge. However, the cancellations of policies developed after 1/1/14, seem to be to limit the insurance industry to components of the law that are sequentially adding into effect since its implementation. Clearly, individuals, small groups, and now medium groups are not being protected, as was the intent.

Take this coming year, for example. The PPACA, as of 1/1/16, now makes businesses with less than 100 employees lose status and forces them to enter my world of less than 50 employees. We now lose the plan at the premium we paid last year ($459/month) because, to the insurance mind-set, we are now a more significant risk as medium size groups add into the community rating. What do you do with risk? You increase the guaranteed premium, of course! To get this to fly past the NYS insurance regulators, you cancel an existing policy, that has a known risk exposure with claims made, and you create a similar, but new policy with no history only prior experience, thus masking an enormous premium increase to the eyes of the NYS regulators. Brilliant from an insurance business move. Morally unethical, however, and certainly, not in the spirit of those that created the PPACA.

Comparing my 2015 policy to the proposed 2016 policy, the only major difference is a 37.6% premium increase. NYS regulators don’t see this, of course, because the 2015 policy is cancelled. What they see is a new policy with a deductible $400.00 lower and a co-insurance 10% higher. However, most middle class workers are going to find it difficult to pay $632.00/month in premiums with a $2600.00 annual deductible applying to everything except the annual well visit and screening tests, followed by co-insurance after the deductible is met.

This hurts both the patients and the physicians caring for them. Patients are delaying care. Physician’s business volume is down and, in many cases, the account receivables are increasing due to the inability of the average middle class patient to pay such high deductibles.

We need to take to the streets with this problem. We should not be silent. The health of patients is at risk.

The Patient Protection and Affordable Care Act neither protects patients nor makes care affordable - rather, for many patients, it's actually the Unaffordable Insurance Act.

If you like your plan, you can keep your plan If you can afford your plan, you can't keep your plan.

Come senators, congressmen
Please heed the call
Don't stand in the doorway
Don't block up the hall
For he that gets hurt
Will be he who has stalled
There's a battle outside
And it is ragin'.
It'll soon shake your windows
And rattle your walls
For the times they are a-changin'.

Bob Dylan