Outrageous Rate increases

©Penny Gentieu

MAY 2016

Ohioans pay the highest premium after tax credit than in any other state, with the least amount of premium reduction after subsidy. It’s not because we lack competition, because Ohio has an inordinate number of insurers — 17 — participating, in relation to the size of the population. In fact, it’s second in number only to Texas, which has 19 issuers, but Texas has five times more individuals than Ohio buying on the Marketplace.

And the issuers with the lowest prices seem to have the fewest members, and the issuers with the most members seem to have the highest prices.

All of this is counter-intuitive to what we have been told would happen in a free-market with competition that is supposed to bring down health insurance prices.

It seems as if the only difference between issuers is the condition of the single risk pool, and that it’s a crap shoot, the condition of the pool you fall into. Everything else is basically the same, even though premiums between Marketplace plans can vary in price as much as 200% for a silver plan. All insurers have to spend at least 80% on medical and patient improvements while offering basically the same coverage as the next insurer, more or less.

It’s a gamble. But certainly advertising and marketing psychology has the power to attract older, richer, more at risk people to the more expensive plans, just as it can attract younger, poorer, healthier people to the cheaper plans. Could that be it?

It could be that the cheaper plans don’t pay much to the providers. It could be that the cheaper plans don’t have any providers.

Of course, provider networks are the essence of the plans, but in Ohio they are not regulated, not really, and issuers can publish false information on their networks, blaming inaccuracies on the providers, who sometimes find themselves on the network unbeknownst to them through a future clause on an out-of-date contract with the issuer.

Who wants to buy an affordable plan only to find out that the published provider network is phony?

Take for example, the CareSource Just4me provider network that is linked to their plans on healthcare.gov. For a provider network defined by a 15 mile radius of Toledo zip code 43615, there are 2,347 doctors accepting new patients.  Seriously? The doctors outnumber the area membership by 2-1. The CareSource 2016 rate review lists 1,265 covered lives for the entire state rating Area 1, which includes six counties in Northwest Ohio, including the city of Toledo. The results of calling 50 of the doctors netted in only two doctors who were really accepting new patients. How can they get away with that?

Inaccurate provider network directories are a trending problem.

Maybe the reason why Ohio is so awful is because we have insurance regulators in this state who will not concern themselves with the people of Ohio. They do not post any information about health insurance complaints. They have taken millions of grant dollars from the HHS in the name of “Effective Rate Review” under the assumption that the money was for the creation of a transparent system where rate reviews are made public and the public can comment on them, and yet they have done nothing remotely like that. They approve almost unilaterally every double-digit rate increase requested by every issuer. And year after year, Ohioans let them.

So our premiums after tax credit are the highest in the country. We are suckers for the system. No wonder there are so many issuers in this state compared to anywhere else in the country.

Other states have actual “Effective Rate Review” with public participation. Because of public participation and good insurance regulators, rate review saved Coloradans $32 million in one year, according to the Colorado Consumer Health Initiative. In Oregon, the rate review cut at least $69 million from 2014 premiums, OSPIRG estimates. In California, rate review between 2011 and 2016 has saved $417 million.  And that’s just to name a few.

We need Effective Rate Review in Ohio and we need facts published pertinent to our health insurance choices. We need the truth about provider networks, and we need data about health insurance complaints. We need to know what we are buying. More than anything we need our state to be working for us, not for the insurance companies, and we need it to happen now.