The House Ways and Means Committee 2008 timeline for Obamacare rollout pre-ordained a complete failure of the health insurance industry in 2017 and 2018. The mechanism of the economic failure known as the “Death Spiral” can be best described by adverse selection. Expensive sick patients are staying in and healthy customers are bailing out.
In December, Highmark offered my wife and me a plan in which our premiums for the year would be $19,000 with a combined deductible of $15,000. We bailed out to Medi-share for a vastly reduced amount of money. Highmark BCBS is now in full-fledged collapse mode, greatly exacerbated by eliminating their HMO option and forcing people into high deductible PPO plans. Their biggest block of patients, Delaware state workers, is at risk. Their biggest problem is Aetna which is making a move to consolidate complete control of the Delaware health insurance market, (they just displaced Geisinger as the health insurer for the state’s second largest employer, Christiana Care Health Systems). Aetna may actually survive the death spiral by sheer size and being the last man standing, thereby dictating rates.
The most recent instruction from President Trump to the IRS to not require tax filers to tell whether or not they purchased health insurance in 2016 accelerates the pace of the collapse by eliminating the risk of a penalty for healthy people not participating in the insurance pool. The pool of covered lives is therefore populated with sicker people. Mandated insurance coverage which eliminates denial for pre-existing conditions causes a situation where an uninsured person can develop an expensive disease and then immediately gain insurance coverage, of course at a substantial loss to the insurer.
All of this was obviously predictable, as I wrote in 2009, by simply looking at the timeline. 2017 and 2018 were baked in 8 years ago. Looking forward, the most optimistic chance for stabilization of the chaotic and insolvent market can only begin in 2019. By that time, the temporary federal Medicaid subsidy to Delaware will be gone and Delaware’s budget will not be able to be balanced. Between the loss of free market health insurance competition, the burgeoning cost of Medicaid, and the cost of providing health insurance to Delaware state workers and pensioners, the budget will be busted.
C.D Casscells, MD
Caesar Rodney Institute
Read Full Post »
Posted in Affordable Care Act, tagged Aetna, Affordable Care Act, awareness, Blue Cross Blue Shield, Coventry, Delaware, healthcare, Highmark, Home Depot, Insurance Commissioner, single-payer, Target, Walgreens, Walmart on November 14, 2014|
Leave a Comment »
The open period was supposed to start in October and go to Dec 31. That would allow the ins companies to get set for the 2015 year. The previous March deadline was set because they knew few people would sign up right away.
The rates for this year are going to be very high and a lot of employers will drop out. I am expecting a 25-50% rate hike and many people are going to lose their subsidies as the data gets cross checked with the IRS.
Overall the destruction of the health insurance industry is working quite well and there should soon be no other choice but what is offered by the government as in Medicare. Already the exodus of good doctors has started and health related businesses, like the Scooter Store, are going bankrupt and closing. This is going to be a big downturn of 16% of the economy.
Coventry is essentially already out, Aetna remains in a diminished capacity. Blue Cross Blue Shield of Delaware is gone, absorbed by Highmark. The Delaware Health Commission released its plan this week and it disingenuously presumes a constant insurance market which the State can control. The truth is everyone wants a single payer system, everyone also wants to BE that single payer.
And yes, doctors are quickly moving to drop Medicare and Medicaid and some insurance altogether. Many are simply retiring. Some of my close colleagues are retiring by this year’s end and all are younger than me, mostly family practice. Everyone assumes that when control is established that doctors will just work for less, but to the contrary, they just won’t work. This is the consummate flaw in Ezekiel Emanuel’s thinking. He says that they will have to work as told, but the truth is doctors will not be forced to practice bad medicine and, by and large, they can afford to quit, so they are and will in droves.
On a national and local level, Walmart, Home Depot, Walgreens, and Target have all cut back health insurance for those working less than 30 hours/week. On a local level, Highmark just had its premium increases cut dramatically by Insurance Commissioner Karen Weldin Stewart, which means that they will not offer some products. They cannot calculate the rates now because the sign up period has been delayed onset until after the election cycle. On good background I believe that Highmark will withdraw risky insurance products in the Delaware market.
On a very anecdotal level, one of my patients who employs 47 people has directed his human resource person to fire 5 people so as to be well beneath the 50 person threshold for ACA. This is just as a precaution, in case they 50 employee mark is hit inadvertently.
The White House Administration has declared a moratorium on data release from CMS and the Federal Exchange Website. I do not find any reason to be optimistic about the landscape.
Dr. Casscells, Director
Center for Healthcare Policy
Read Full Post »