Democrats and Republicans agree: Obama Health plan needs overhaul

October 03, 2016

As we head into the 4th Open Enrollment period for individuals to buy health insurance, let's take a look at the State of healthcare since the start of Obamacare.

Land of Lincoln Health, the Co Op for Illinois, which officially closed their doors (or should I say were forced by the state to stop operations), had the final days of coverage for all insureds on September 30, 2016. They have now gone the way of about 17 other Co Ops nationwide. (Remember the idea of a Co Op was to bring in competition to offer another choice to consumers and compete with the big bad insurance companies that have been around for years. They got millions from the gov't to start up (Land of Lincoln received $160 million dollars in the form of a loan that had to be paid back). It has not been reported if all the loans have been repaid from all the Co Ops that went belly up across the country.

Unitedhealthcare, one of the largest if not the largest provider of healthcare in the country, has announced they are leaving the individual marketplace nearly entirely. Currently offering an option in most states, they announced they will only remain in 2 states.

Aetna and Coventry (Coventry was acquired by Aetna but operates under its own brand name) have announced they will no longer offer any plans on the exchange for IL, but will have some type of offering off exchange, for those who buy a policy and do not need a subsidy. Those who qualify for the TAX CREDIT (often referred to as a government subsidy), must shop on the exchange to receive the tax credit and will not have an option to buy Aetna or Coventry. Aetna communicated with current insureds saying their current plan will no longer be available, causing some to think their coverage is ending with no option. Aetna failed to mention they will have a policy, and most likely many of these customers will have an option to migrate to the new plans without re-applying.

Harken Health was the brainchild of UHC Execs, and what sounded like a great idea in theory (having an experience of healthcare different than others, based on centers that gave free PCP - primary care physician - visits, and offered wellness coaches, yoga classes and other amenities), is having the same issues as other carriers with ever increasing costs. Next year they will not be paying any commissions to agents, so individuals will have to go direct or find them on the government site. (Harken is currently and will remain only available to residents in Cook County.) The 'model' that allowed access to the healthcare facilities, but still gave access to a very large network of Dr.'s and hospitals outside the centers, will now give little or no access outside the centers without a referral most likely. We don't have the exact details, but the plan will be more like an HMO model. Many people who jumped on board so they could have access to large Providers like Northwestern and Rush, will likely find themselves shopping once again.

Blue Cross and Blue Shield of IL is committed to staying in the market. Last year was a big change when they pulled their large PPO network from any individual policy offering. They will continue to offer the smaller Blue Choice Preferred PPO and two HMO networks - the Precision and the Blue Care Direct, an Advocate Only HMO. Currently Northwestern and Rush are in NONE of their individual networks. Last year the carrier passed along 35-50% increases for people on the PPO, and this year they have filed for rate increases from 10-25%, 40-60% and higher, depending on your county, and the 'metal' plan ie Gold, Silver, Bronze. Many people are looking at double-digit increases for yet another year. (I personally have seen my premiums more than double since having a pre-ACA , nongrandfathered plan. I was forced to change to an Obamacare plan 2 years ago and got a 40% bump in premiums. Last year, we got another lovely 47% increase from Blue Cross, with the lowest cost, cheapest plan we can buy; there is no place for us to go to save money, and now we are looking at 20%? 30%? 40%? 50%? increase - insanity!)

As we watch a mass exodus of carriers leave the individual market, one carrier has decided to enter for the first time. Cigna health insurance, which currently offers health insurance to large Employer groups, will be coming to IL and offering an Individual Health plan. What we don't know is what the plan will look like - will it be a PPO or HMO? And what providers will be in their network - will Northwestern and Rush be available? And last but not least, what will the price be? If they are substantially more money than Blue Cross (currently the lowest cost PPO in many counties), will people pay more if the network is bigger? I guess will we have to wait and see... 1) if their network is in fact bigger, and 2) how much more will the price be to have that freedom to see more providers.

Costs for healthcare are skyrocketing, especially on the pharmaceutical side. The law has managed to do exactly the opposite of what it promised: We were supposed to have more choices, the freedom to choose our Dr.'s and providers, the freedom to go across state lines, and an affordable premium. In some counties north of Chicago, there will be only one insurance carrier offering plans on the exchange. In the past, I have sold Blue Cross policies to people who have relocated in other states (a concern as more and more Illinoisians leave for lower taxes, and green pastures), and they were allowed to take their policies with them. With the networks so narrow and providers ONLY in the state you live, people leaving are forced to go shopping when then move out of state and cannot take their policies. Many carriers are even giving Emergency Only coverage to college kids that are out of state; this is a major problem for parents who are forced to pay out of pocket for less urgent care not covered by their plans.

So as we approach an election in November, one thing is clear: Nothing will happen until after the election. However, Democrats and Republicans will agree, this healthcare law needs a major overhaul. The Democrats want a government option, one step closer to a single-payor system. Republicans want to start over and rewrite the law. Read more:

One thing that no one seems to realize is that the government IS in healthcare right now: it is called Medicare and Medicaid, and guess what. They are having the same problems as private health insurance, with ever escalating costs of care and increased premiums for recipients that pay. So when are we going to address the COST ISSUE? Maybe when more companies leave the market, people drop their coverage because of another 50% rate increase, and we have less people insured than when we started... that might not be too far away!