Did Ohio anticipate an increase like this? Why did they let it happen?
That’s me in the middle, in the pale blue, in 2016, the last year of Medical Mutual’s individual market PPO. My 2010 personal rate, coincidentally, was about 10% above that average 2010 individual rate for Medical Mutual, shown in the dark blue in that chart. In six short years, my personal rate went up to $775, tripling what it was in 2010. Meanwhile, the group rates went up about 30% during those six years, according to the Kaiser HRET Survey of Employer-sponsored health benefits for group plans in the Midwest. So imagine the chart with 30% added to the group plans, which brings them up to just half the price of the present-day individual plans, and you can see how skewed the balance is for the individual rates compared to the employer group rates.
The individual rates used to be less than the employer group rates due to medical underwriting. In group plans, they had to cover everyone, including those with pre-existing conditions, along with family members with pre-existing conditions. But now, people with pre-existing conditions can buy individual health insurance, and look how much more they are charging us, than they charge the employer group plans!
Here is a chart showing the percentage of people with pre-existing conditions covered in the two insurance markets before and after the ACA. Whereas before, the individual market had 8% less, now it is more or less equal, having 2% more than are in the ESI plans with pre-existing conditions. So why are the rates so crazy?
The individual market is only 6% of the population. Who’s going to notice that the prices when way up, is that what they figure? Or is it that they have way too many insurers, playing way too many games with us? Did they figure, we’re only 6% of the population, so what are we going to do about it?
Medical Mutual dumped their PPOs out of the individual market in 2016, and the only other plan slightly similar (however, it pales entirely when you compare the very limited and inferior provider network) is the Anthem plan (since United Healthcare also skipped out of the individual marketplace in 2016). And look at that Anthem plan, taking advantage by raising their rate by $180, an increase in one year that was close to what I paid for my entire premium in 2010.
Since Medical Mutual was the only PPO in Ohio with a national network that an individual could buy, and now you can only have that kind of insurance if you work for the state or a corporation (or if you are a U.S. Congressman), now individuals are stuck with Medicaid-type plans at Cadillac prices, way above the cost of group plans, with half the quality.
Medical Mutual’s explanation of their 99.3% rate increase in 2014:
- 75% increase for morbidity adjustment
- 1.2% increase for age/gender differences
- 2% increase for EHB mandates
- 4.7% increase for cost sharing differences
- 16.2% increase for 2 years of annual medical and drug increases at 7.8% per year.
And just for good measure, in 2014, they charged an additional 40% to me personally. I have no reason why, since my plan was already compliant with the ACA, and had the same deductible too.
Medical Mutual’s rate increases before and after 2014:
- 2011 – 7.5%
- 2012 – 13.7%
- 2013 – 15.4%
- 2014 – 99.3%
- 2015 – 15.7%
- 2016 – 17%
Maybe about 28,000 people switched to the Medical Mutual Exchange plans in 2014 for the subsidy.
By 2016, there were 52,657 people covered by the Medical Mutual PPO Exchange plans. Maybe there were another 40,000 people covered on Medical Mutual’s brokered PPO plans — same plans for the same price before the subsidy — but in 2017, they eliminated all their PPOs, the last PPO in Ohio that individuals could buy with a national provider network. A huge percentage of the Ohio individual market of about half a million lost their quality healthcare without even a whimper in the news about it. Nobody had a chance.
And that’s how Medical Mutual, ProMedica, and Mary Taylor’s Ohio insurance department dumbed down the individual health insurance market for Ohioans in just three short years.
While it is true, that there was more uitilization in the ACA plans due to the elimination of medical underwriting, with perhaps a larger percentage of use than is in the group plans, the fact is that the percentage of sick people to healthy people was quite skewed by perhaps double, because about one third of the individual market chose to stay in a grandfathered plan.
Not only has “pent-up demand” caused utilization to be greater, but consider this — how those costs of the new “sick people” were artificially accelerated and exaggerated by the illegal price increases of pharmaceuticals — the generic drug companies colluding to price-fix, increasing prices by 8,000%, along with the other issue of mainstream, popular drugs just out of exclusive patent rights given orphan status, which actually raised their prices, when the prices should have gone down. While rising drug costs average about 6% in the overall scheme of things, for people who need the drugs, the cost went up several hundreds, even thousands of percent. So for the beginnings of the ACA, which was skewed to begin with, what a party it was for the health insurance and healthcare industry.
Even the people in the grandfathered-plans are feeling the enormous weight of premium increases, as more people move into Medicare, risk pools get smaller and plans get eliminated. Maybe 10% of the grandfathered plans remain, as they increasingly fold into the overly-inflated ACA plans. The Medical Mutual Supermed Classic had only 117 covered lives in it in 2016. But for the industry, the grandfathered plans served an important capitalistic purpose.
Pharmaceutical companies behave as if it’s the wild wild west. Health insurance companies get to make 20% on our healthcare dollar. And we get the wool pulled over our eyes.
It’s a nasty trick to play on the middle class and the taxpayer; on the self-employed, on the individual; on everyone.
We can’t find doctors. Yet they are advertised in our plans. And we pay through the nose. But we are only 6% of the population. We have to do the nation’s dirty work for being the fall guy for higher rates, yet they get away with lying to us, because we, the individual, and I mean that plurally, are helpless, when we are so ironically the American Dream.