This year has been a rough one for health insurance companies of all sizes. With the recent news of Aetna withdrawing from most of its Obamacare exchanges, many Americans are beginning to worry about their shrinking options, skyrocketing premiums, and where they’ll even find services.
Scarily enough, Aetna is not alone in its decision, and joins two other insurers in withdrawing from the program. What does this mean for Americans and their healthcare, and what does it mean for the marketplace?
No matter which side of the political spectrum you favor, healthcare has been a tinder pile of a topic over the last few years. With the implementation of the Affordable Care Act (ACA) – better known as Obamacare – in 2014, the United States became the last remaining developed country to institute universal healthcare. Previously, we were the lone wolf: 32 out of 33 developed nations had already adopted such programs.
Of course, as we have come to understand, “universal healthcare” does not mean free healthcare for many. The United States opted to implement an insurance mandate system, meaning that its citizens are required to either obtain private coverage, qualify for an exemption, obtain State Health coverage, or pay a tax (penalty) for not carrying health insurance. Depending on your income level and the marketplace options available to your area, this could potentially turn into an expensive venture for your family.
One of the selling points of the more comprehensive version of Obamacare that passed, at least in the eyes of the insurance companies, was that the mandate would force more healthy Americans to buy policies. The idea being that the average American would want (and need) to avoid paying the high penalty taxes for their family. This is especially true since the tax is increasing every single year.
In turn, this padding of healthy customers’ premiums (and their policies that would, ideally, go largely unused) would help the insurance companies offset costs… costs involved with providing care for the older and sickly customers that flocked to them for new coverage.
Unfortunately for the insurance giants, this doesn’t seem to be happening.
Why Isn’t It Working?
For many Americans, the reality is disturbingly ironic: paying the government fine for forgoing coverage is actually cheaper than, well, paying for coverage. The only caveat to their practice (and it’s a scary one)? It’s imperative that they stay healthy.
This is, of course, the exact opposite of the intent behind the penalty, and has brought the insurance companies’ fears to the table. They are now losing money in a system that should have guaranteed success. And many of them are pulling out in response.
Their scales are being tipped by the influx of “sickness care.” With decreased memberships from healthy families, insurance companies like Aetna, UnitedHealthcare, and Humana are now scrambling to find balance.
In fact, Aetna lost $430 million just in the first half of 2016 alone. This prompted them to announce last week that they will drop almost 70 percent of the counties in which they have previously offered coverage, beginning in 2017. Whereas they sold policies in 778 counties (within 15 states) this year, they will offer coverage in a mere 242 counties (in only four states) next year.
Of Course, They’re Not Alone…
Aetna is in good company following their pullout. They join giants Humana and UnitedHealthcare Group – the nation’s largest health insurer – who have both already withdrawn from the ACA in some capacity. More are likely to follow, too. In 2014, only 30% of insurers turned a profit in their individual divisions, which dropped to around 25% for 2015.
In April, UnitedHealthcare announced that it will drastically downsize participation for 2017. They are decreasing coverage from 34 states and nearly 800,000 people, to a measly three states. (Seeing as they lost almost $1 billion on Obamacare in 2015 and 2016, the move isn’t too surprising.) Humana has also decided to withdraw from nearly 1,200 counties throughout eight different states.
All three of these companies have cited a financial hemorrhage as their reason for pulling out. Too many young and healthy Americans are choosing the penalty tax over paying premiums. This means that insurers just don’t have enough padding to continue on the same path.
Add to it that many Americans who were previously uninsured – due to preexisting conditions, inability to afford plans, or lack of motivation to navigate coverage – are elderly, sick, or just taking full advantage of having healthcare for the first time in a while. They have flocked to their new in-network providers, requiring care for coughs and cancers alike. This sudden cost has shocked the system, it seems.
Even Blue Cross Blue Shield is thinking about jumping ship. The company has already said that it would consider withdrawing from Obamacare, dependent on future marketplace trends. One of its plans, Highmark, lost more than $773 million in its first two years with the exchange system. Their CEO deemed kind of loss “unsustainable.” And BCBS of Minnesota has already dropped individual plans.
In fact, a Blue Cross Blue Shield Association report studied new Obamacare enrollees – the first investigation of its kind – and the results were alarming. It found that new ACA members have considerably higher rates of serious illnesses like hypertention, HIV, diabetes, and Hepatitis. Most of these are lifelong illnesses, with medical care and costs following them over many decades.
This study also found that Obamacare members’ costs of care were 22% higher than those Americans in employer-based health plans. They had more ER visits, more prescriptions, and more inpatient hospital care.
Regardless of the ‘why’ involved, the fact remains: the insurance giants just can’t plug holes fast enough to keep their fiscal ship from sinking.
How Does This Affect Americans?
You might be saying, “Well, I already have coverage. How does this affect me?” Maybe you’re not yet covered, but plan to just go with whichever remaining company offers service in your area. Okay, great.
Except, you’ll likely suffer the aftershocks, too.
For the counties retaining coverage from these three companies, your premiums are likely to increase in response. Sure, Humana, UnitedHealthcare, and Aetna have chosen to pull out of their least lucrative counties. That doesn’t mean that they aren’t still losing more money than they’d like on the bottom line.
If your coverage has been eliminated by one of these withdrawals, you’re guaranteed to feel the effects. You will, of course, need to find a new plan. This may or may not cost more than you have already been paying. You might be forced to change doctors, hospitals, and treatment facilities, too. Your new plan may not cover the providers with whom you’ve already established care.
For counties losing insurers, you’ve just been robbed of one more bargaining chip. Less providers in your area means less competition, and less incentive to decrease premiums. If you’re one of the unlucky areas that will be reduced to just one or two providers, you’ll likely see a noticeable jump in premiums. In fact, more than 650 counties across the country will experience this. Or, like Pinal County in Arizona, you could be left with NO providers. A state-mandated monopoly is rarely beneficial for the consumer: “Take it or leave it.”
In fact, many insurers were already planning to raise their rates by double-digit percentages in 2017. This is sure to put a pinch on everyone’s wallet. Even Anthem Inc., the second largest insurer in the country (behind UnitedHealthcare, of course), announced that it plans to implement “substantial premium increases” next year in order to offset its ACA losses – as high as 30 percent!
What the Future Holds
It will be interesting to see how Obamacare plays out over the coming years. A lot will depend on whether the government can work with the insurers to fix a system that is limping along. An influx of sick enrollees combined with less-than-desirable participation from healthy families has created a sinkhole for insurance companies.
The only companies happily in the black are those with very strict guidelines, higher premiums, and limited care provisions. The rest are bleeding out, it would seem. If something isn’t done quickly to help the system, it is sure to crack under the pressure.
Premiums will surely rise in 2017, and possibly beyond, as will the penalty tax. Whether or not healthy Americans will choose to enroll and balance the system, or opt out of its chaotic current state, is yet to be determined.
As for me, I’m going to go ahead and book some checkups now. Who knows what 2017 will bring…
Updated December 4, 2016 and originally published August 23, 2016.