health insurance

America’s problems with private health insurance are on full display in Oklahoma. The Affordable Care Act’s rules preventing private health insurance plans from denying care coverage based on pre-existing conditions, life-time policy maximums and other technicalities have caused insurance plans to be more effective for individual holders but also less affordable.

In Oklahoma, only Blue Cross Blue Shield offers plans on the ACA’s exchange, and those plans’ premiums increased about 50 percent from 2016 to 2017. Last week, the Oklahoma Insurance Department sent out a release noting BCBS had submitted its 2018 application for new rates to the Centers for Medicare and Medicaid Services, and the OID noted that the company is likely to be the only carrier on the marketplace again next year.

Oklahoma Insurance Commissioner John Doak took the opportunity to posture politically:

There is an incredible amount of uncertainty in the market right now. Insurers participating in Obamacare have experienced major losses. While we expect a full repeal of this disastrous experiment, insurers have to go by the regulations in place right now. That’s why we’ve seen so many insurers dropping out of exchanges across the country or resorting to double digit premium increases.

While Doak is correct that the health insurance market is uncertain, his broad bashing of “regulations” fails to recognize how many Americans have benefited from the requirements placed upon private health insurers under the ACA. Left to their own devices for decades, private health insurers made billions of dollars in an America where they could find creative ways to deny treatment of costly illnesses.

Although the ACA has altered that business model, Blue Cross Blue Shield of North Carolina saw its profits jump from $500,000 in 2015 to $185 million in 2016.

In Oklahoma, however, hospitals and insurers alike are still reeling from the state’s decision not to expand Medicaid coverage for low-income adults who — believe it or not — get sick and rack up medical bills regardless of their insurance status. To that end, hospitals and insurers essentially have competing interests in how they make their money, and it requires them to negotiate complex contracts that may vary gravely between entities.

Burning insurance cards in Muskogee?

The complicated nature of this health care landscape is fully evident in Muskogee, which has seen its two hospitals change ownership and a temporary contract between new owner Saint Francis Health System and Blue Cross Blue Shield of Oklahoma expire last week.

According to a BCBS statement quoted in the Muskogee Phoenix article above, Saint Francis wanted higher reimbursement rates from BCBS than the facilities’ previous management had agreed to.

The situation will still leave dozens of Muskogee physicians as “in network” with the insurer, but hospital care at the two facilities will now be “out of network,” meaning BCBS will not have to cover as much of the patient’s bills as they might otherwise have had to.

In all, this is the sort of complicated change that will leave many people unhappy, confused and resigned to the notion that neither their hospital nor their insurance company is looking out for patients’ best interests.

Meanwhile, many Oklahoma families have been priced out of the health insurance market altogether, and many more are fretting over a proposed repeal of the ACA’s consumer protections.

As a result, Doak’s claim of “uncertainty” may be an understatement similar to President Donald Trump’s infamous realization that health care is complicated.

Unfortunately, much of the situation is over the head and beyond the control of average Americans.

What’s the old adage about things having to get worse before they get better?