President Donald Trump has moved aggressively to clean up the health care mess his predecessor left even without congressional backing to tear up Obamacare, “root and branch,” as the Republicans once promised to do. His recent expansion of health reimbursement arrangements to increase health care coverage options for employers and workers is a move toward permanently improving a broken system.
Galen Institute President Grace-Marie Arnett is among those bullish on their impact.
“The HRA option is expected to eventually increase by 50 percent the size of the individual market,” Arnett, a recognized health care policy expert said. “It will put insurers back into the market to compete for millions of potential new customers. And the consumer price transparency” — another Trump initiative — “is expected to put downward pressure on the costs of coverage.”
Things are marginally better. The dreaded individual mandate was essential repealed by the 2018 tax cut bill. Yet premiums and deductibles remain too high for most working Americans to manage alongside their other expenses. Additional reforms are needed as the Obama-era law, which was intended to increase the public’s access to insurance impeded it instead. The paradox is vexing.
There are no simple solutions. We can, however, identify the problems and affix responsibility for them, especially on the insurance companies that played an important role in drafting the Obamacare rules and are a major barrier to patient access to care. They were the ones who were supposed to keep costs down.
Instead, they force patients to jump through so many hoops it’s amazing no one breaks a limb. Insurance is key to affordable care, but some companies don’t want to pay.
Some insurance companies act as though anytime a patient gets care it causes them a loss. That puts the company bottom line in direct conflict with the interests of patients and health care professionals who are trying to treat them.
This kind of thinking needs to change.
Since 2010, the country’s largest insurers have experienced exponential growth and held a firm grip on the insurance marketplace. Premiums have skyrocketed, costs for providers have gone up and hospitals have struggled to keep their doors open — all factors that limit directly patients’ access to care. Among smaller facilities, this has produced mergers keeping them open and communities served.
Insurers find it more cost effective to spend millions of dollars on maintaining the status quo instead of taking a financial hit that makes care more affordable and easier to obtain. They oppose mergers. To further their objectives, they’re spreading money around to groups with positive sounding names like the Physicians Advocacy Institute which, when it comes to mergers, is a leading opponent no matter the circumstances.
The non-profit PAI was started and is sustained by a $23.5 million infusion of legal settlement funds. The board members run their own state medical associations (which financially rely on donations from the very insurers who initially funded PAI through settlements) and are tied to anti-consolidation interests. PAI Board President Robert Seligson is CEO of the North Carolina Medical Society, to which the Blue Cross Blue Shield Foundation of North Carolina has contributed at least $8 million.
At the same time, Blue Cross & Blue Shield of North Carolina has come out strongly against a proposed health care partnership that would make North Carolina home to one of the largest hospital networks in the country.
Another PAI board seat — occupied by California Medical Association CEO Dustin Corcoran — has ties to anti-consolidation advocates and major health care players. Aside from the Physicians Foundation, which provided at least $300,000, CMA’s funders include a nonprofit created and funded by Blue Cross of California which contributed nearly half a million dollars to CMA.
None of that is illegal but it is questionable concerning how health care policy is made. The groups like PAI who claim to advocate for patients while being dependent on private insurers driving up health care costs for funding need to be called out.
Providers are fighting to survive rising costs, mandates and uncertainty. Reasonable people can differ on specifics like mergers, but some smaller facilities have found them the best way to keep doors open without compromising the quality of care. A closed hospital provides access to no one.
Peter Roff is a former U.S. News and World Report contributing editor who appears regularly as a commentator on the One America News network. He can be reached by email at RoffColumns@GMAIL.com. Follow him on Twitter @PeterRoff.
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