Insurance agencies ‘gaming the system’

Published 11:19 pm Wednesday, September 2, 2015

Critics of the Affordable Care Act, popularly known as Obamacare, are often loud in their disdain for the federal regulation of health insurance companies. Their criticism should be dampened by new evidence that insurers are up to their old tricks.
Health insurer profits increased 250 percent from 2000 to 2010, according to the U.S. Department of Health and Human Services. Toward the end of the decade, when tens of thousands of people lost their employer-provided coverage in the wake of the Great Recession, profits really went up because older workers, who tend to have more health issues, were dropped from the rolls.
The most popular element of the Affordable Care Act is the prohibition against insurance companies turning away people with health issues or charging higher premiums. The idea is to provide care to all, often through state insurance pools, and keep people out of costly emergency rooms for primary care.
Now, consumer advocates say, insurance companies are gaming the system to discourage the sick from seeking insurance. They cite three tactics: Forming narrow networks with limited numbers of doctors and hospitals, causing prescription sticker shock with high co-pays, and by delaying entering public insurance exchanges.
The overhaul in health coverage created by the ACA establishes a pool of money the insurance providers pay into to help offset higher costs to companies that have a higher number of people with serious health problems. Still, some of the companies are slow to shoulder their responsibilities.
Many of the cost-saving elements of the Affordable Care Act were stripped away in Congress, and should be revisited. The cost of health cannot continue to rise at current levels and still be accessible to all.

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