What’s often lost in the conflicting information about what the Affordable Care Act (ACA) is and how it’s functioning is this: more than anything, the ACA is a health insurance reform bill.
This is important context to keep in mind when you see headlines about rising insurance rates on the health care exchanges.
Of course, these trends should trouble us all. As should actions by Trump and Republicans in Congress to undermine the ACA by sabotaging insurance company participation in the program.
Two years ago, (Ed Gillespie’s pal) Marco Rubio led a successful charge in the U.S. Senate to gut so-called “risk corridor” funding. This funding was built into the ACA in order to protect insurers from initial financial losses associated with covering (in many cases) sicker, older people who previously were uninsured.
These people gained health insurance because the ACA told insurers that they could no longer reject them due to pre-existing conditions, or excessively overcharge them to the point of making health insurance unaffordable.
Much of what we’ve seen since then on the marketplace exchanges – rising insurance premiums, insurers pulling out – is a result of Rubio’s 2015 meddling.
That sickening trend is perpetuated by Trump’s recent decisions to stop reimbursing insurers for discounts provided to low-income customers as a condition of the ACA, and to end government involvement in promoting annual open enrollment for health insurance through the ACA.
This bit of history is an important lens on something a big insurer that operates in Virginia, and many other states, is doing now to protect its own self-interest at the expense of patients.
Anthem Blue Cross Blue Shield has announced a policy shift in several states that would in many cases largely disregard patient preference when a medical scan like an MRI or CAT scan is needed (see coverage in the Virginian-Pilot and the Daily Press ).
Anthem, the insurer with the largest health insurance market presence in the nation and the highest market share in 82 major cities, claims this is a way to save costs. Actually, it’s about a big company deciding that its financial interests should take precedent over personal health care decisions between you, your doctor, and your family. When it comes to health care, you and the doctor who knows you are best positioned to decide on necessary treatment. And no insurance bean counter should be able to interfere with that to save the company a few dollars.
But Anthem’s position seems to be that cost considerations trump – no pun intended – your voice in health care choices.
Naturally, you might wonder, “Why is it a bad thing for an insurance company to steer me to a provider who offers a procedure I need at a lower price?” It’s a good question, and the answer is that not all medical procedures are created equally.
Let’s say you have an acute illness or injury that can only be detected by an advanced medical imaging scan that’s only available at your local hospital. Your doctor orders up that scan for you. Then the insurance company intervenes and says it won’t authorize that scan. Instead, it will cover another scan performed by less sophisticated imaging technology.
So you get the scan that is performed on lesser equipment and approved by the insurer. Unfortunately, the resolution of the scan image isn’t sufficient for your doctor to diagnose your problem. That means you’re in pain longer as your condition remains untreated, and maybe worsens. Eventually, your doctor orders up another scan on the same high-strength equipment he or she initially suggested. Then you have to fight with your insurance company to get them to authorize the procedure. Now you and the insurer have paid for two scans at a combined cost that far exceeds the initial cost for the advanced scan your doctor wanted from the beginning.
Let’s imagine another scenario, shall we? You live in a rural community and the insurance company again insists that you get a lesser medical imaging scan. Only this time, that means instead of receiving a scan at your nearby community hospital, you have to drive 30 minutes to the nearest imaging center approved by the insurer. In addition to being inconvenient, this means your doctor now has to wait for the imaging center to send your films so he or she can review them to diagnose your condition. And that’s assuming everything goes right – the film is sent to your doctor and the quality of the image is good enough that your doctor can reach a proper medical conclusion.
By seeking to impose this policy in Virginia, Anthem is telling patients their voice doesn’t matter when it comes to personal health care choices. If this plan is implemented, Anthem seems perfectly willing to make patients travel farther, potentially suffer longer, and face hurdles to receiving proper care in the name of Anthem’s own financial interests.
This from a company that just reported a 21 percent net income growth during the third quarter of 2017. Based on those numbers, Anthem’s not exactly hurting.
In Virginia, we outlawed this behavior by auto insurance companies in the 1990s, when the General Assembly said insurers couldn’t force claimants to use the insurance company’s preferred repair shop.
What Anthem is trying to do now is the equivalent of telling you that you can’t take your car to the dealership for service; you can only go to Jiffy Lube. The difference in this case is we’re talking about people and their health, not cars. We don’t accept that for auto insurance in Virginia, so why should we accept it for health insurance? The answer is we shouldn’t.
To bring this full circle: Remember when Republicans falsely claimed Obamacare would result in care rationing? It turns out that big insurance companies like Anthem who were supposed to benefit from ACA, then rolled over when the GOP used underhanded gimmicks to weaken the program, are the ones who are actually trying to ration your access to health care. Ironic, isn’t it?