Archive for the ‘#AffordableCareAct’ Tag

Not A Solution   Leave a comment

So, the United States has a problem with a dysfunctional medical insurance system and a broken government-medical care system. So what is the solution. Well, it’s not becoming Canada.

The Frasier Institute recently undertook a research project to see how Canada’s medical care system stacks up to the rest of the world. When compared to 11 similar countries, including the United States, a recent study shows that whether it’s emergency room visits, same- or next-day appointments, seeing a specialist or getting elective surgery, Canada’s wait times are the worst.

In fact, in 2016, Canadians waited an average of five months for medically necessary specialist treatments. As a specialist working in a field where delay of treatment turns a manageable condition into a death sentence, that concerns me. Apparently it concerns Canadians as well because almost 60,000 of them visit the US and other countries for medical care each year.

Speaking of other countries, over in the United Kingdom, where they’ve had 70 years to figure out how to run a government-controlled health care system, over 80 percent of doctors say their workplaces are understaffed and the NHS reports a 45 percent higher hospital death rate than the US, which might explain why over 50,000 “non-urgent” surgeries were canceled in 2018 when their system was overwhelmed by flu season.

In Canada, apologists for the universal medical care system there (where private doctors are outlawed) claim the wait times remain a small price to pay for universal medicare care, but then why don’t we see similar issues in other countries with universal health care systems? Frasier’s research examined eleven other countries. While you could argue that the US doesn’t have a universal system (I wouldn’t argue that at this point), the other countries. Generally, they allow the private sector to provide core health-care insurance and services in which patients share in the cost of treatment and they fund hospitals based on activity. Canada funds most hospitals from a global budget.

You can look at the Netherlands, which was the top performer in the ability to see a doctor on the same or next day. Individuals are required a standard insurance package from private insurers in a regulated, but competitive market. A for-profit company is the market leader.

France has universally accessible hospital care delivered by public, not-for-profit and for-profit hospitals. In fact, about one-third of all French hospitals are operated on a for-profit basis.

Switzerland ensures universality in an environment of managed competition among insurance companies and medical-care providers. Cost sharing is a central feature. Individuals are expected to pay a deductible before insurance kicks in, and then there is a 10-20 percent insurance copayment, up to a annual maximum.

Germans use social/statutory or private insurance to a access public or private hospital care. Forty-two percent of hospitals are operated on a for-profit basis, but almost all hospitals are accessible by patients with the social/statutory coverage.

So, I believe there is a solution to the medical-care crisis in America, but I think other countries don’t have that solution.

The Problem   Leave a comment

Less than half of the 24 million proponents of Obamacare who said they would sign up during the legislative process in 2010 actually did so in the last eight years.

Why?

Well, they ran up against the cost of socialized healthcare.
Premiums doubled in the first four years of Obamacare. Last year, the average monthly premium for individual insurance was $476 per person per month in the 39 states participating in HealthCare.gov.

Here is Alaska, premiums in the individual and small-group markets doubled in those first four years and have tripled in the three years since. Alaskans in the small-group markets pay an average premium in excess of $1000 a month.

It gets worse than that, however. As premiums have gone up, choices have gone down. In more than 80 percent of counties across the US, there are only one or two health care plans available on the Obamacare exchange. That means millions of Americans now have far fewer choices when it comes to their doctor and health care network.

For the 11 million who did sign up for Obamacare, over 86 percent of them were enrolled in Medicaid. That didn’t ensure they have access to medical care because increasing numbers of doctors and other medical providers are no longer accepting Medicaid because they are reimbursed at an unsustainable level for the amount of staff required to handle all the related paperwork.

Medicaid is notorious for long wait times and poor health outcomes. It is a costly and unsustainable welfare entitlement program that delivers low-quality medical care to many of its enrollees. Because most doctors don’t accept Medicaid, recipients have little choice but to seek non-urgent care in expensive and overcrowded hospital emergency rooms where they often receive inferior medical treatment. When they do need to seek urgent care, they are routinely assigned to less-skilled surgeons, receive poorer post-op instructions, and often suffer worse outcomes for identical procedures than similar patients both with and without medical insurance.

Medicaid has become too large to provide good services to people who genuinely need public assistance. Eligibility expansions have crowded out those who need care and can’t afford it because taxpayer funds are being spent on individuals who could afford private insurance coverage. This diverts resources from the genuinely needy populations of the program.

You could perhaps make an argument for this if states that have expanded Medicaid had experienced better health outcomes for their poorer populations, but there’s no evidence that has happened. While most of those enrolled in Medicaid are relatively healthy children and their mothers, a small subset of enrollees have serious diseases like diabetes, HIV, anemia, or psychosis. These Medicaid patients are typically in worse condition at the time of their diagnosis than either the insured or the uninsured. They also typically have worse average health outcomes after treatment than either of those two demographics.

Compared to the privately insured, Medicaid patients have a 22 percent great chance of complications and a 57 percent greater change of dying following colon cancer surgery. They are more likely to die in the hospital than the uninsured. That’s right – the uninsured. That statistic comes courtesy of the University of Virginia, by the way.

Medicaid patients typically spend longer in the hospital (10.5 days) than both the insured (7.4 days) and the uninsured (7 days). This is because they are more likely to experience complications and that might explain why Medicaid patients have a 21% higher cost for hospitalization than the uninsured and and a 26% higher cost for hospitalization than the privately insured.

These sad statistics are not limited to adults with cancer, but also show up in stroke recovery and in pediatrics. The vast majority of children in and out of Medicaid enrollment are healthy, but of course that’s not always the case. Researchers have found that a child with asthma is five times more likely to see an asthma specialist if she has private coverage rather than Medicaid. Children with Medicaid are 50% more likely to be seen by an emergency room doctor, in large part because of the dearth of private doctors who will accept Medicaid patients. Those same doctors will accept someone paying case, so uninsured patients actually have more access to medical treatment than those insured under the Medicaid system.

The worst part of all of this is that Obamacare’s shifting of lower-income coverage to Medicaid has resulted in a crowd-out of private insurance and patients it used to cover. Yes, some few uninsured who were not previously covered by Medicaid may now have insurance (with no assurance of actual medical treatment), but even for the previously-insured, getting into see a doctor is now much more difficult, resulting in higher prices and longer wait times. Obamacare’s paperwork requirements on doctors have reduced the amount of time they can spend with patients, increasing diagnosis and treatment errors.

And, none of it was necessary. There are better solutions.

Cousin Rick is a world-renown research doctor who works for a major medical center and    would like not to identify himself, as that would likely ruin his career under the current tyrannical environment of the medical community. He is a frequent guest on my blog whenever the current  medical insurance stupidity becomes so great that he feels it necessary to vent.

Come on, GOP! Go Free Market!   3 comments

Lela’s preferred free-market plan for medical care policy would be no plan whatsoever. I’m offended that anyone thinks they need to tell me how to take care of myself. I’m able to make those decisions for myself. Government, get out of the way and let the market work. Free individuals can negotiate among themselves for lower and better coverage and care.

Rick’s preferred free-market plan for medical care policy would include sliding-fee medical clinics that would operate under charitable auspices. We forget that fraternal organizations used to contract with doctors to provide their members with medical care for a low monthly fee and that churches used to operate hospitals. Contrary to revisionist history, these systems and institutions were well-run and responsible for a rapid increase in the overall health and lift expectancy of Americans. That was all before the American Medical Association got involved in deciding who could become a doctor or open a clinic, using the force of government to create a virtual monopoly.

Image result for image of the american health care billRick was stunned when he wrote that. We believe he just became a libertarian … except he supports government-funding for those sliding-fee clinics, so he’s not quite there yet.

The fact is that it’s really scary that so much of the country believes we must have a federal top-down strategy to manage a huge chunk of the American economy. That’s the main problem. We don’t need a federal plan for health care now any more than we needed in the 1990s or the 1950s. Yet Republicans have allowed liberals to frame the entire debate in anti-market terms.

The Freedom Caucus stood up and said these things and Pesident Trump, who is a progressive who in the past said he favored liberty-and-choice-destroying universal health care, pulled the bill. He hinted that they would keep the Amercian Health Care Act on the shelf until Obamacare implodes (likely toward the end of this year) and then dust it off then. That’s the wrong approach!

The AHCA falls far short of a free-market solution. It’s certainly not a repeal of Obamacare. It’s a half measure that tries to fix the unfixable with tiny doses of deregulation that essentially do very little to impact the core of the ACA. The AHCA’s the “tweak” on the rudder of the Titanic headed toward the iceberg that did nothing to keep the behemoth from hitting it and eventually sinking.

Trump suggested a three-phase rollout, but there were no details for the other two phases, so they might as well not exist because the Republicans will lose the Senate and possibly the House in 2018 if things continue the way that they are headed. Obamacare has too many flaws to ever be fixed and pretending otherwise is not going to get us anywhere.

We’ve seen what the Democratic Party plans for health care (and not insurance, but actual care). They would channel us all into Bureau of Indian Affairs-like services that see our mortality rate drop to British levels (dead people are much lower drain on government than living ones). The Democrats oppose opening up insurance markets across state lines because …. Who knows why because it doesn’t make any sense. Opening up auto insurance across statelines did wonders for improving competition and controlling premiums. Thirty years later, my monthly premiums are just now about what they were before the market was opened up. And Alaska has different coverage than, say, New Hampshire, so no, that’s not a problem either … except maybe in the minds of people who think government-run medical care is the answer to the medical insurance crisis in this country. If that’s the only choice you’re willing to accept, all other alternatives look wrong.

The Democrats don’t want to look at access to actual medical care, insurance costs or the continued growth of the welfare state. They seek to constrain markets to create monopolies that can be controlled by a federal regulatory regime. When that fails, because it ignores economic reality, they will insist upon passing single-payer.

“When I was working in France, I had opportunity to do some visitation in England and Germany and look behind the scenes of their medical care systems. When I developed appendicitis, I dosed myself with pain killers and antibiotics and caught a jet to the United States rather than go under the knife of any of my colleagues in Europe. They’re nice people; some of them were very well trained by European standards and they mean well, but I do not recommend any single-payer or universal medical system in the world. All of the ones I’ve seen are inadequate for anyone I love who has any illness requiring high-skilled treatment.” Rick (speaking as a doctor)

Potential Victories:

  • Halting federal funding of unPlanned Parenthood, the nation’s largest abortion mill
  • Offering states more flexibility in the operation of their Medicaid programs.
  • Expanding health savings accounts
  • Getting rid of the individual mandate
  • Opening insurance across state lines
  • Repealing Obamacare’s taxes

Pressure from conservative groups made the American Health Care Act, as presently conceived, a non-starter. That’s a good thing. The Affordable Care Act would have been a lot worse if it hadn’t been for the moderate Democrats who just couldn’t stomach its more socialist aspects. Democrats did not, despite prevailing mythology, compromise with the GOP in 2009. The GOP managed to pass some amendments, but they were all technical in nature – commas and spelling repair. The Democrats were forced to compromise with their own moderates.It only takes a few senators to hold an entire party’s golden goose hostage.

This time around, the GOP was confronted by the conservative Republicans of the Freedom Caucus, who rightly pointed out that the people did not sweep the GOP into office in order to “tweak” Obamacare. They voted for the GOP because the GOP promised to REPEAL Obamacare.

No federal entitlement has been repealed, replaced or even significantly modified after its passage, but this is the fight that caused Republicans to win majority control in 32 states, hundreds of seats in the House and Senate, and that nicely shaped office in the White House. So Republicans need to take a good hard look at where they stand right now. If they don’t have the strength of character to back of full repeal of Obamacare, then they were elected on a lie. Surely someone among them has a better idea than either the AHCA or the ACA.

Republicans, please recognize that you were put into the position that you’re in right now by people who want to get rid of Obamacare. You shouldn’t allow yourselves to be intimidated by Democratic rhetoric that you’re going to kill Grandma and expose “the children” to the winter winds. We know they’re full of gas. They tried to convince the American people that Obamacare would be a political and economic success story even as the American voters argued that it wouldn’t be. Reality has shown the Democrats were phenomenally wrong and that the American people understand economics better than the elites. The voters who put you in office are not going to fall for a lecture about how unpopular a repeal bill will be. Feel free to pass a bill that incorporates the principles many GOP voters say they believe in.

 

REALLY! They’re behind you and even libertarians like Lela and doctors like Rick will cheer you on.

How Could They Make It Worse   Leave a comment

So when Rick and I started our series, we didn’t yet know what Congress was going to propose for certain, but they came out with the House plan now (March 8), so we decided to write up our impressions.

The draft House health insurance bill fails to correct the features of Obamacare that drove up health insurance and medical care costs and mainly just tweaks Obamacare’s financing and subsidy structure.

The bill focuses on protecting those who gained subsidized coverage through the law’s exchange subsidies and Medicaid expansion, while failing to correct Obamacare’s misguided insurance regulations that drove up premiums for Americans buying coverage without government subsidies.

 

The draft bill leaves Obamacare’s costly insurance regulations in place and attempts to offset those costs with the same basic approach.

Approximately 22 million individuals currently receive subsidized health insurance coverage through the exchanges (8 million) and the Medicaid expansion (14 million). For them, Obamacare’s higher insurance costs are offset by the law’s subsidies.

About 25 million Americans with unsubsidized individual-market coverage (10 million people) or small-employer plans (15+ million people) are the ones who most need relief from Obamacare that can only be supplied by repeal, and they probably don’t care about or for replacement. Their experience of Obamacare has basically been “all pain, no gain,” as they have been subjected to significant premium increases and coverage dislocations with no offsetting subsidies.

Unfortunately, the draft House bill provides no meaningful relief for that group of middle-class Americans who are most adversely affected by Obamacare and are most supportive of repeal.

The draft bill leaves Obamacare’s costly insurance regulations in place and attempts to offset those costs with even more subsidies.

The draft bill’s new Patient and State Stability Fund is particularly problematic. It would provide grants to states of up to a total of $100 billion over the nine years, 2018-2026. What are the significant problems with this new program? They’re substantial.

  • It substitutes new funding for old Obamacare funding without adequately addressing the misguided Obamacare insurance market rules and subsidy design that made the exchanges a magnet for high-cost patients. Those Obamacare mistakes created an insupportable burden on the individual insurance market by concentrating expensive patients in only that small portion of the total market.
  • Like Obamacare, it doesn’t actually reduce premiums, but rather uses subsidies to mask the effects of Obamacare provisions that drove up premiums in the first place.
  • It creates a new entitlement for states.

Furthermore, without a resulting reduction in unsubsidized premium levels, future Congresses will likely face pressure from states and constituents to extend and expand the program. It will become a creeping Medicaid-like drain on resources that will destroy medical care access in this country. Under the Medicaid expansion, the federal government reimbursed states 100 percent of the cost of expanding Medicaid to able-bodied adults, with federal support eventually declining to 90 percent. These are able-bodied people who earn a living (in Alaska, up to $52,000 a year for a family of four) and their medical care is paid for by the taxpayers.

Yet, states continue to receive significantly less federal assistance (50 percent to 75 percent, depending on the state) for covering the more vulnerable populations (such as poor children and the disabled) that the program was intended for. That policy was both inequitable and unaffordable.

The draft bill does not correct that inequity, but rather reduces the enhanced match rate from 95 percent to 80 percent. The better approach would be to allow states to immediately cap expansion population enrollment, while also setting federal reimbursement for any new expansion enrollees at normal state match rates.

Such changes would likely limit the addition of new individuals to the program, and also substantially reduce the size of the federal revenue loss that expansion states will incur when the program terminates. That is because a significant share of current enrollees can be expected to leave the program for other coverage during the transition period.

Yet another policy mistake is the failure to take the first step toward providing more equitable tax treatment of health insurance.

The House version drops a proposed cap on the unlimited tax exclusion on employment-based health insurance contained in an earlier version, while retaining the so-called “Cadillac tax”—the 40 percent excise tax on so-called “high-cost plans”—and delaying its implementation until 2025.

Congress should kill this punitive excise tax and replace it with a cap on pre-tax funding so as to encourage employers & workers to evaluate the trade-off between higher health care spending and higher cash wages, to rethink how much of total employee compensation should be devoted to health benefits.

While the Cadillac tax would force employers to alter the health benefit plans that they provide their workers, no such effect would result from the cap on the exclusion. It would instead limit the amount of employer health benefits that constitute pre-tax income to workers, which would make the tax treatment of employer-sponsored health benefits consistent with the tax treatment of other benefits (such as retirement savings plans, group life insurance, and dependent care) offered by employers.

Workers would still be able to use after-tax income to purchase additional coverage, just as they can with other employer benefits, and the employer would still be able to offer a plan whose value exceeds the level of the cap on pre-tax funding.

This bill misses the mark primarily because it fails to correct the features of Obamacare that drove up health care costs. Congress should continue to focus on first repealing the failed policy of Obamacare and then act to offer patient-centered, market-based replacement reforms. Stop making patients into a group where things are done to them and put them back in control of their own health care.

Penalized for Offering High-Quality Coverage   4 comments

“Would you want to be a patron of a restaurant that didn’t want you as a customer?”  John C. Goodman, Health Economist

Obamcare set up incentives for health insurers to avoid the sickest people because they would not be able to charge for pre-existing conditions.

What? You didn’t know that?

Under the individual insurance that existed prior to Obamacare, beneficiaries could buy guaranteed-renewable health insurance. If they developed a condition while insured, they could still buy health insurance at a premium that applied to the whole pool they were a member of when they originally bought insurance. Insurers were required by contract to take them even if they developed a serious condition and they also had an incentive to treat everyone on the pool well because it was bad publicity that might cost them customers if they were seen to be discriminating against people in the pool.

The political rhetoric around the (un)Affordable Care Act made it seem like insurers could toss people off policies for developing serious diseases or charge them ridiculous prices, but this was not actually true. What Obamacare did do was say that insurers could no longer charge for pre-existing conditions. Only, they figured out a way to game the system, according to a study by Michael Geruso of the University of Texas, Timothy J. Layton of Harvard Medical School, and Daniel Prinz of Harvard University. Goodman describes this as “being the restaurant that turns away customers they don’t want.” ,

Here’s a portion of their abstract:

We first show that despite large regulatory transfers that neutralize selection incentives for most consumer types, some consumers are unprofitable in a way that is predictable by their prescription drug demand. Then, using a difference-in-differences strategy that compares Exchange formularies where these selection incentives exist to employer plan formularies where they do not, we show that Exchange insurers design formularies as screening devices that are differentially unattractive to unprofitable consumer types. This results in inefficiently low levels of coverage for the corresponding drugs in equilibrium.“Screening in Contract Design: Evidence from the ACA Health Insurance Exchanges,” NBER Working Paper #22832, November 2016.

Cato Institute health economist Michael Cannon lays out some of the implications in a recent op/ed titled “How ObamaCare Punishes the Sick,” Wall Street Journal, February 28, 2017 (March 1 for print edition.)

A long excerpt:

Predictably, that triggers a race to the bottom. Each year, whichever insurer offers the best MS coverage attracts the most MS patients and racks up the most losses. Insurers that offer high-quality coverage either leave the market, as many have, or slash their coverage. Let’s call those losses what they are: penalties for offering high-quality coverage.

The result is lower-quality coverage–for MS, rheumatoid arthritis, infertility and other expensive conditions. The researchers find these patients face higher cost-sharing (even for inexpensive drugs), more prior-authorization requirements, more mandatory substitutions, and often no coverage for the drugs they need, so that consumers “cannot be adequately insured.”

The study also corroborates reports that these rules are subjecting patients to higher deductibles and cost-sharing across the board, narrow networks that exclude leading cancer centers, inaccurate provider directories, and opaque cost-sharing. A coalition of 150 patient groups complains this government-fostered race to the bottom “completely undermines the goal of the ACA.”

It doesn’t have to be like this. Employer plans offer drug coverage more comprehensive and sustainable than ObamaCare. The pre-2014 individual market made comprehensive coverage even more secure: High-cost patients were less likely to lose coverage than similar enrollees in employer plans. The individual market created innovative products like “pre-existing conditions insurance” that–for one-fifth the cost of health insurance–gave the uninsured the right to enroll in coverage at healthy-person premiums if they developed expensive conditions.

I would follow the link, because Cannon backs up his analysis with a lot of links. He also warns policy makers who are hesitant about repealing the pre-existing condition rules:

If anything, Republicans should fear not repealing ObamaCare’s pre-existing-conditions rules. The Congressional Budget Office predicts a partial repeal would wipe out the individual market and cause nine million to lose coverage unnecessarily. And contrary to conventional wisdom, the consequences of those rules are wildly unpopular. In a new Cato Institute/YouGov poll, 63% of respondents initially supported ObamaCare’s pre-existing-condition rules. That dropped to 31%–with 60% opposition–when they were told of the impact on quality.

Really, follow the links. Learn what’s really happening. Don’t accept the Wikipedia version of this debate.

Stories from Obamacare’s Path of Destruction | Melissa Quinn   Leave a comment

For the past 15 years, Warren Jones has had the same health insurance plan with Blue Cross and Blue Shield of Kansas City.

Image result for image of aca failureBut over the years, Jones, of Kansas City, Missouri, has watched the coverage offered in his policy “erode” over time.

First, the company got rid of the dental and vision coverage he had.

Then, Jones’ deductible increased – to $2,500 – for his plan alone.

But perhaps the most significant change for Jones, a veterinarian, has been the rising cost of his monthly premiums.

Jones’s premium will increase by 45.8 percent between 2016 and 2017.In 2014, the year Obamacare took effect, Jones paid $318 in monthly premiums. In 2015, the price went up to $394 per month, then to $491 for 2016.

For 2017, Blue Cross and Blue Shield of Kansas estimates that Jones will pay $716 each month for his premiums – a 45.8 percent increase – according to a letter the insurer sent him.

“You can’t keep doing this because people’s wages don’t increase by that amount,” Jones told The Daily Signal. “Nobody’s wages are increasing, so it’s taking a bigger chunk of the budget.”

“That’s the scariest part,” he continued. “It takes a bigger chunk of the budget, and there’s no relief in sight.”

Image result for image of aca failureLike millions of other Americans nationwide, Jones, 55, doesn’t buy his insurance on Obamacare’s state and federal exchanges.

And even if he did, he wouldn’t qualify for the subsidies that lessened the cost of health insurance for 7.3 million Americans who received the tax credits last year, according to regulatory filings.

Instead, the veterinarian falls into an overlooked subset of consumers who pay full price for their health insurance in a time of skyrocketing premiums and deductibles.

They don’t qualify for the tax credits offered under the health care law, and they don’t receive their coverage from employers, since many are self-employed.

“I have seen so many people, self-employed people, many started their own little business and make whatever they do, they have a small business, and they buy their individual policy or buy for their family, and what are their options?” said Beverly Gossage, a broker who has worked in the Kansas City area for 14 years.

“Do they no longer be self-employed? Maneuver taxes to make less than the income threshold to get subsidies?” Gossage continued. “They don’t want to do that, but they’re being pushed to do that. I get this question every day – ‘What am I supposed to do?’”

Gossage ran as a Republican for Kansas insurance commissioner in 2014.

Hooked

Image result for image of aca failureOver the past few months, insurers have been submitting rates to state regulators for the 2017 benefit year.

In most states, companies are requesting double-digit rate hikes for those selecting plans sold in the individual market both on and off the Obamacare exchanges.

Experts say insurers are playing catch-up after setting rates too low in the early years of the health care law and enrolling a sicker – and costlier – population than anticipated.

“A lot of insurers didn’t understand that the market was going to be skewed in terms of income and health status as severely as it was,” Ed Haislmaier, a senior research fellow in health policy studies at The Heritage Foundation, told The Daily Signal. “Generally, the pool was much worse than anybody expected because of things the administration did that made it worse.”

Insurers are playing catch-up after setting rates too low in the early years of the health care law.In response to questions about the growing cost of health insurance for consumers who buy plans sold in the individual market, the Obama administration has said that many Americans are shielded from premium hikes since they buy coverage on the exchanges and receive a subsidy from the government.

Many of the exchange enrollees who qualify for a subsidy may end up paying as little as $75 per month in premiums, Health and Human Services Secretary Sylvia Mathews Burwell said earlier this month.

But that’s not the case for people like Jones and the 10 million others paying full price for their coverage.

“The traditional individual market, which consisted largely of middle-class people who are self-employed, those people are hooked onto this,” Haislmaier said. “It’s kind of a situation where you have an anchor that’s too big, and it’s pulling the boat under.”

Jones is considering selecting a new health insurance plan altogether, but because Missouri hasn’t yet approved rates for 2017, he’s unsure if he’ll even be able to find a cheaper alternative.

“The big thing is the unknown still,” Jones said. “But we know we’re getting inundated with increases in premiums.”

The Missouri man said he is familiar with Blue Cross and Blue Shield of Kansas City, and switching to another carrier may leave him with even less coverage.

“You get a comfort level, and at least you know what you’re getting,” Jones said. “If I had to change insurance, you miss the changes that occur. You don’t know what you’re signing up for.”

‘50-50’

While Missouri residents like Jones are confronting a spike in rates, consumers across the state’s western border also are facing fewer insurers to choose from.

Among the insurers that will continue to sell coverage in Kansas, the number of plans they’re offering both on and off the Obamacare exchange is decreasing.

Many insurers, large and small, have decided to leave the exchanges after losing millions of dollars last year; they either withdrew from states altogether or decreased the number of policies offered.

According to an August study from the Kaiser Family Foundation, six in 10 counties may have a maximum of two insurers on the exchanges next year. Additionally, five states will have one insurer selling coverage on an exchange.

In Kansas, 17 carriers sold policies in the state before Obamacare’s implementation, Gossage said.

Before Obamacare, 17 carriers sold policies in Kansas. Now there are two.This year, the majority of consumers in Kansas will have only two insurers to choose from on the exchange, according to the Kansas Department of Insurance.

Those buying plans sold in the individual market off the exchange have five insurers, according to the state.

It’s a similar landscape in Missouri, where four insurance companies are selling coverage on the exchange, according to regulatory filings.

Off the exchange, consumers can choose from at least seven different companies.

Gossage said that over the last few years, she has seen insurers significantly lessen the number of policies they’re offering.

“What we did is we went from a very vibrant, competitive marketplace with extremely low rates and lots of different plans to pick from to over-overregulation with the type of plan you have and to mandates placed on insurance companies which led to high premiums and fewer carriers in the marketplace,” Gossage said.

While much of the focus has been on the declining number of choices for consumers selecting coverage on Obamacare’s exchanges, those with plans sold in the individual market off the exchanges are hurting, too.

Rochelle Bird, who is self-employed and lives in Overland Park, Kansas, has had a policy through Coventry, a subsidiary of Aetna, for two years.

In that time, her monthly premiums have risen from $335 to $487, and her deductible went from $1,200 to $6,200.

Late last month, Bird received a letter from Coventry notifying her that her policy will cease to exist at the end of the year.

“We may still offer coverage in your area, but most of the options available today will not be available for 2017,” the letter stated.

Bird said she wasn’t surprised to learn her policy was being canceled. Rather, she expected it.

“I know that this act has created chaos,” she said of Obamacare, formally the Affordable Care Act. “When I get a thing [in the mail] saying that my rate has changed, I know it’s 50-50 when I open it. It’s either a letter saying this is what you’re going to pay starting Jan. 1, or we’re no longer offering that plan anymore. It wasn’t a total shock to me.”

Bird said she has started researching other policies with different insurance companies, but because officials in Kansas only recently finalized rates, she hasn’t yet made a final decision on her coverage for next year.

She has, however, set expectations for the terms of her next plan.

“I am now faced with the fact that unless something changes, there will be one health care provider presumably with two different health plans that I will have a choice of [while] living in the state of Kansas,” Bird said. “That’s absurd. How is that helpful?”

“I’m expecting (a) I’ll pay more, (b) I’ll have less, and (c) I may or may not have the same doctors,” she said. “Those are always the moving parts.”

Backward

Bird herself didn’t purchase her plan on the Obamacare exchange, and she wouldn’t qualify for a subsidy if she did.

While going without insurance and paying the fine – $695 per adult or 2.5 percent of household income for 2016 – isn’t an option for her, it is for other Kansas and Missouri residents.

Jessica Huayaban of Olathe, Kansas, and her husband, Joel, each purchased plans in the individual market off the exchange in 2014.

Jessica, 36, bought a plan through Humana, and her husband, 35, through Coventry.

Some residents are choosing to forgo insurance and pay the fine rather than spend money buying insurance.The couple, who own a painting and remodeling company, previously were uninsured and saving money each month to pay for a costly knee surgery Joel needed.

Jessica and Joel had insurance before, but when the recession hit in 2009, coverage was too expensive so they decided to go without.

“It was way cheaper to cash pay,” she said of the years they needed medical services but didn’t have insurance.

In 2014, when Obamacare was implemented, the couple purchased their own coverage, but only because the law required it.

“I wasn’t getting [insurance] for even the coverage part,” Jessica told The Daily Signal. “I was getting it for the compliance.”

Over the past two years, the monthly premiums Jessica pays for her Humana plan have gone up minimally, but her plan has a high deductible.

Then, last month, the 36-year-old mother received a letter from her insurer notifying her they’re canceling her policy.

“This is just something that continues to happen, and I don’t have a choice in it,” Jessica said.

She said she isn’t sure whether she and her husband will purchase plans on Obamacare’s exchange when the open enrollment period opens in November.

And although she may qualify for a subsidy, the young mother fears she’ll be stuck with an expensive tax bill when she files with the IRS for 2017, since her income – she is self-employed – fluctuates drastically from month to month.

“All of it is so backward,” she said of the health insurance system.

Source: Stories from Obamacare’s Path of Destruction | Melissa Quinn

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