Tag Archives: Sherrod Brown

2018 Rate Review

New for 2018, Marketplace rates for children will rise 20% to 53%, on top of the additional average 20%-30% rate increase insurers in Ohio demand in 2018.

Child rates in the past they have always been 63.5% of the adult base rate until the age of 21. Next year, 0-14 will be 76.5% of the adult base rate, with ages 15 to 20 being 83.3% to 97% of the adult base rate.

The preferred prescription to fix what ails the U.S. healthcare situation is Expanded and Improved Medicare for All, or single-payer, if you prefer the generic.

2018. We all know how it’s going. We are supposed to feel lucky that we can at least still buy health insurance. And after what we witnessed in Congress this year, and how it could have gone, but for one vote, we know we’re damn lucky.

We were warned that rates would go through the roof this year. That’s due to the uncertainty of the government reimbursing insurers for CSRs, the uncertainty over the insurance requirement mandate, the uncertainty of a repeal, as well as the totally understandable (not), predictable, ever-rising, unsustainable, runaway medical and non-negotiable pharmaceutical cost factors, that alone amount to a 7% rate increase in 2018, along with the resumption of the ACA tax on premiums that was halted last year, and some increases in administration costs. We are braced for rates to going up 20 to 40% or more. Hands above our heads, they got us, we’ll pay!

But at least the ACA, warts and all, has survived the Congressional guillotine, and most of the 6% of the U.S. population that comprises the individual insurance market is certainly grateful for another year of being able to buy health insurance.

But what a sneaky thing the child age rating hike is, which raises the rates for all children under the age of 21 by 20% to 53%. CMS snuck that in on December 16, 2016, just after Trump was elected. That, on top of all the “uncertainty,” the rising medical costs blah blah blah, 2018 is going to be a real doozy.

Which is why a typical family may see a rate hike of 29% for themselves, and 71% for their children.

Family in 2000 has been through it all

Take your typical Ohio family – say, John and Pam, who are 55. They have two kids who are 17 and 20. John is an independent contractor and earns $78,000. Pam is an adjunct university professor and earns $21,000. Together they make $99,000 before taxes, just over the 400% Federal Poverty Level that would qualify them for a health insurance subsidy. Their net income after taxes is $78,000.

Having to buy individual insurance, they chose Molina, because that was the only plan in which they could find doctors who would accept them as patients.

Toledo, Ohio is a closed town when it comes to doctors accepting new patients. When it became too costly in 2016, John and Pam had to give up their Medical Mutual PPO insurance and hence their ProMedica doctors that they had been going to for 20 years. Molina was one of the cheapest insurance plans they could buy. But they had to find new doctors, because their long-time doctors didn’t accept Molina insurance.

Mercy doctors were in the Molina network, and they were not as closed as ProMedica doctors.  That’s why they chose Molina over CareSource, another cheap plan, but one with a 90% inaccurate provider network, a network that supposedly included ProMedica doctors, but not really. (ProMedica, when last checked, had only one primary care family practice doctor accepting new patients, but you’d have to call back in a month to schedule an appointment, which supposedly would be scheduled for three months after that.*)

If they had made just two thousand dollars less (see Kaiser subsidy calculator here), John and Pam would have qualified for a $3,334 subsidy this year (undoubtably it would be more than $6,000 in 2018 because the SLCSP which is tied to the subsidy may be 20-30% more, in tandem with the rest of the plans; see rate increases below.) The subsidy would have reduced their health insurance premiums to 10% of their gross income for a silver plan, but alas, they make too much money to qualify.

John and Pam chose a gold plan with a lower deductible because they couldn’t afford the risk, just in case, of having to come up with $7,500+ to meet the deductible before the insurance would kick in.

With an increase of over $6,000 in 2018 for health insurance, their tightest budget, cutting down on food, recreation, transportation and clothing, exceeds their net income. Forget about helping with their kids’ education or even saving for their own retirement, which is coming in 10 short years – in 2018, they are going into credit card debt on their necessary expenses just to be able pay for health insurance.

As it was, in 2016 John and Pam paid 22% of their net income on health insurance, $17,448, at $1,454/month. It was a lot more than they were paying just a few years before. An affordable and reasonable percentage, in keeping with the spirit of the ACA, would be 13% of their take-home, or 10% of their gross. John and Pam make more money than most families in Toledo, but to have 22% of their net income going to pay for health insurance really hurts.

In 2016, John and Pam’s rates were $554.50 each per month, and the kids’ rates were $172.62 each.

But next year, in 2018, John and Pam’s health insurance will go up 39%! It will surpass housing as biggest chunk of their budget, becoming a whopping 31% of their take-home income, $24,240 for the year; $2,040/month. The astronomical but necessary expense squeezes out any money that could ever have been saved for retirement, which they need to fund, and eliminates any possible budget they may have hoped for to help their kids with higher education expenses.

While John and Pam’s health insurance is going up 29%, health insurance for their kids goes up 71%. The family’s health insurance premiums next year will cost $6,792 more than last year!

In the midst of uncertainty and rising medical and unnegotiable pharmaceutical cost factors, what a sneaky rate hike this children’s age rating hike is, and what a scary thing it is for families like John and Pam’s. Thanks, elected officials, for looking out for our best interests. Maybe it’s time to stop the killing and let everyone in on Medicare, expanded and improved.

OTHER OBSERVATIONS

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Toledo is down to five insurers for 2018, listed on the left -- Ambetter, CareSource, Molina, Medical Mutual HMO, and Paramount.

Medical Mutual PPO, United Healthcare, Anthem and Aetna have flown the coup. Also gone is HealthSpan and InHealth, the failed co-op.

Anthem is actually continuing in one tiny, rural county in southern Ohio, with just a few people, just so Anthem can stay in the game, if you call those fair rules, just in case it wants to jump back in, in the next five years. Aren’t they clever at the expense of the public good. But since healthcare is not considered a public good, they can make profit over people all day long, and into the next decade, until they’ve squeezed it dry.

Since all five insurers’ prices are going up about the same, people who receive a subsidy may come out somewhat unscathed. Ironically, the government that caused the uncertainty that led to the increases will be funding the increases via the subsidies. If only the government would take that money that they throw at a multitude of greedy, demanding insurance companies, and allocate it to an expanded and improved Medicare for All, we’d have a pretty nice single-payer system in the U.S., which would go a long way to stimulate our economy. The structure is already in place, and so is the money.

Too bad for the 30% like John and Pam who don’t get a subsidy; their health insurance expense is simply unsustainable. They may have to keep working into their seventies, because there’s no way they can save money for retirement when the insurer gets every red cent.

“You will take the rate hike and be happy, you weak, helpless, but ever so lucky little suckers!” they seem to be saying to us.

Four of the five babies in the photo are crying, because they just can’t get enough money. They realize that only one with a certain je ne sais quoi will win in the end.

We have a miserable rotten, broken healthcare system, and our leaders really dug in this year to make it even worse than that. If we want to survive as a nation, we will eventually have single-payer, as it has been proven to work well in the rest of the civilized world. But apparently not before a lot of greedy pockets are lined and the corporate for-profit ravens pick every last bit of flesh there can be, all the way down to the bone.

See also, June 11, 2017 Rate Review Observations

The preferred prescription to fix what ails our country is  Medicare for All, also available in a generic single-payer form. Money and lives will be saved.

UHCAN’T Find a Doctor

An Open Letter to the Board Members and Partners of Ohio’s UHCAN (Universal Health Care Action Network):

All of Ohio can thank UHCAN (http://uhcanohio.org) for sabotaging our healthcare in the individual market. UHCAN is our watchdog, they get grants to advocate for us, and shame on them for not doing their job.

We have an opioid epidemic in this country and Ohio ranks first. Could Ohio’s 90% inaccurate health insurance provider networks have anything to do with it?

It was recently reported that 715,000 Ohioans gained coverage through the ACA expanded Medicaid, and that 215,000 of them are seeking treatment for opioid addiction. Wow. One third.

We can assume that a good percentage of the Marketplace consumers are also in need of treatment. But when they are faced with a brick wall finding a doctor, after they have signed up for a plan, they are unable to get treatment, so they continue to use, and some of them die.

One year ago, last July, I went to a lot of trouble, all on my own time, to call every PCP doctor listed on every plan sold in my city, Toledo, doctors listed by the insurers as accepting new patients. 308 doctors in total. I discovered that the plans being sold are grossly inadequate, and average of 80% inaccuracies, two in fact had 90% inaccuracies! I made complaints to the insurers, to my elected representatives, to UHCAN, to the Ohio Department of Insurance.

It was a story big enough for the New York Times to report, on December 3, 2016.

Kathleen Gmeiner, a lawyer at UHCAN, was all set to send my complaints to an important contact she had at CMS. Even though she was aware of my complaint for several months, she waited the entire Fall, and then, ready to send the info in December, she was told by the director, Steve Wagner not to bother after all.

She didn’t send it, she tells me now in an email, because:

Once Donald Trump took office it became clear that the new administration was giving states a lot of flexibility and it would be unlikely anyone in the new CMS would aggressively require Ohio to take more steps around network adequacy.

Depression over the newly elected president?

Or was it depression because UHCAN’s grants were about to dry up?

UHCAN couldn’t even do that one thing that I presented to them on a silver platter.

No administration would allow insurance companies to have 90% provider network inaccuracies. To take our healthcare money and squander it away, especially when we have an opioid crisis in Ohio, is not anything the CMS would condone.

How presumptive of UHCAN to decide on their own that our nation’s overseers of medical spending and the administration of Medicaid and Medicare would not care that Americans are getting ripped off by inadequate and misleading, highly inaccurate provider networks. For UHCAN to withhold my information from the CMS is outrageous, unacceptable, and disgusting. And what a waste of grant money!

No wonder Ohio has the worst statistics for drug addiction. Our entire state, including UHCAN is sick. What drugs are they on at UHCAN, that makes them so heartless, that they can’t advocate for the people of Ohio, the sole reason for their existence?  90% inaccurate provider networks; people dying in the streets.

Yet another example of mis-used grant money.  Grants SHOULD be cut going to UHCAN Ohio. Because after all, UHCAN’T even do this one little thing to help Ohioans get healthcare after they buy health insurance!

UHCAN’T find a doctor on provider networks, and here we have an opioid epidemic!

You CAN, and you MUST, do better than this!

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Steve Wagner, director of UHCAN Ohio, on the UHCAN Ohio Facebook page, June 29, 2017, and my comment.

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UHCAN'T be serious, your mission is to achieve high quality, accessible, affordable health care for all Ohioans? Really?

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UHCAN's partners

Look who is UHCAN’s partner — CareSource, with their 90% inaccurate provider networks! Conflict of interest, to say the least.

2018 Rate Review Observations

Anthem is the only insurer right now in 19 Ohio counties, and in 2018 they will be exiting the Ohio individual market, except for one teeny tiny county, Pike, for a non-exchange plan that probably has 5 members, just so they can keep their foot in the door and not be banned for five years in case they want to come back. Awe.

Isn’t a market-driven health care system great.

Anthem has about 18% of the individual market in Ohio, and they insure millions of Ohio corporate and state workers. 40,000 individuals are presently covered by Anthem, and 10,000 people may not be offered any individual plan next year as a result.

In Toledo, Anthem has the worst, smallest provider network, and it was 66% inaccurate. It is highly expensive, and went up quite a bit last year.

Anthem more than tripled their premiums in seven years, just like Medical Mutual did, who removed themselves just this year from insuring an estimated 100,000 covered lives with their PPO plans, thus eliminating the only national network plan sold to individuals in Ohio. Last year two insurers covered nearly 50% of the Ohio individual market, and now they are gone.

Also gone this year is United Healthcare and Aetna, so just like that, our four largest insurers of the individual market are gone from the individual market, and Ohio let them, even rewarding the insurers with our state employee insurance business. Ohio either has no business sense, or our state really doesn’t care whether or not 300,000 Ohioans can buy insurance in the individual market.

Four things that Ohio can do to mitigate this healthcare crisis:

1.

Ohio should do what New York is doing this year, and ban insurers who leave the exchange from any future participation in public programs such as Medicaid.

Governor Cuomo announces aggressive actions to protect access to quality affordable health care for all New Yorkers  New York State website
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2.

Ohio should propose a Medicaid buy-in for anyone in the state, like the plan that Nevada’s legislature just passed for it’s citizens. After all, our commercial insurers in the individual market (Anthem, Medical Mutual, United Healthcare, Aetna) have been replaced by Medicaid insurers (Buckeye Ambetter, CareSource, Molina), and since all of Ohio is covered for Medicaid, it makes sense that these insurers can also cover all of Ohio for the individual market, and with great ease.

Nevada’s legislature just passed a radical plan to let anybody sign up for Medicaid  VOX
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3.

Ohio should pass an emergency “any willing provider” law so that citizens can take their insurance dollars to any provider willing to accept them and the payment. At an average of 80% inaccuracies in our provider networks, have the worst that have been reported in the entire country! It’s only civilized that Ohio gives us an”any willing provider” law.

4.

Oscar Insurance Corporation of Ohio, a new insurer for Ohio this year, should cover all the counties that Anthem has left hanging.

But they won’t be covering even one of them. It comes to Ohio to set up shop with Cleveland Clinic in the five counties around Cleveland.

It’s a perfect example to show why market-driven health insurance does not jive with societal needs, and it never will.

Click the photo to visit Oscar’s News page

(Dream on, hoping for a private, for-profit insurance industry to voluntarily go into 19 counties for the business of a mere 10,000 people who won’t otherwise have insurance, when the company can get the same business by simply marketing to the east side of Cleveland. But for some reason, the for-profit, so called “free market” health insurance model persists. And it has nothing to do with what is best for our country.)

5.

Here’s something the federal government can do: Open up the D.C. Exchange to people without an option, as per U.S. Senator Claire McCaskill’s proposal.

McCaskill proposes expansion of DC exchange Columbia Daily Tribune, May 18, 2017
Check out this video clip on McCaskill’s Facebook page from June 9, where she asks the Senate for a hearing on the secret health insurance plan that the Republicans are going to impose on Americans without any discussion with Democrats or the public!

The D.C. Exchange sells insurance for everyone in the country, that is, everyone who is a member of Congress or their staff. I have researched the plans and found that they are really inexpensive compared to what is sold in Ohio. Moreover, it’s quality PPO insurance with national provider networks.

At one time, the ACA was going to have just one exchange for the entire country, like this exchange in D.C. But then the insurers got their mitts on the shaping of the ACA. They sliced it up into hundreds of different state and county plans. Four short years later, insurers are leaving, and hundreds of counties will have no insurance option. It seems logical to open up the D.C. exchange, for everyone. What would be wrong with doing that?

Click on the photo to visit the DC Health Link

On a final note, the chart below shows the three largest insurers in Ohio, from a report made to the state of Ohio by the actuarial company, Milliman, in 2011. I added to the original chart in light blue, to show the individual rate increases since 2010. (The dark blue along with the red and green show the 2010 rates.)

With the withdrawal of Anthem, none will be in the individual market next year! Our three biggest insurers in the individual market in 2010, gone!

It’s no wonder, because our regulators let their rates go up over 300% in 7 years, while the rates for the group plans went up only a total of 30%. Wow. You’d think that all the new members of these plans had leprosy. I hope they are cured, at least.

Divide, divide, divide. Divide and subtract some more! The huge free market health insurance system is so close to knocking off those 23 million people who just don’t fit in their money-making calculations.

Click on the chart for an analysis of seven-year rate hikes

See this page for directions on how to research Ohio insurance rate filings and submit comments.  http://ohiocitizenratereview.info/rate-reviews/how-to-make-comments/

Noblesse Oblige

My Northwest Ohio federal and state senators and representatives, governor, with the lieutenant governor who is also the director of the insurance department, and the state Medicaid director.

We elected these people but King Moola rules.

Please can they throw us some crumbs.

Click on the crowns to read about my representatives. I’m deeply disappointed that they won’t fix the problems that are completely in their control to fix right now, like the highly inaccurate provider networks, and the transparency that the ACA provided for that they won’t abide by, and that they won’t pass an emergency “any willing provider” law so I can take my insurance dollars to my own doctor, and I’m shocked that when they say they are going to give us something better than the ACA, that they only think of the insurance industry, still putting profits over people. King Moola rules. Please, mini Moolas, please please throw us some crumbs!

If you are going to let yourself be crowned by the lobbyists, at least understand the concept of noblesse oblige. It’s like this: the masters must be responsible for those they tame.

Letter to U.S. Senator Sherrod Brown

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Dear Senator Sherrod Brown,

Thank you for June 10th letter, confirming that Ohio is a state that is required to publicly post rate increase justifications, to provide more transparency to the public. You said that I should share my concerns with the Ohio Department of Insurance.  I did in fact contact the Ohio Department of Insurance before I wrote to you last month. The Ohio Department of Insurance told me that they do not release the rate justifications until they are finalized.

We have a problem in Ohio with the Ohio Department of Insurance interfering in the public’s right to obtain public records.

The Ohio Department of Insurance has also withheld my April request for public records of health insurance complaints, specifically, complaints about provider networks. And I recently found out that the department shreds complaints they receive after they image them, then erase them after only two years from the date the complaint was decided on.  So already they have destroyed two months worth of complaints while they are stalling out the inevitable release of the public records, public records that I am and have been completely entitled to.

I wonder what records the Ohio Department of Insurance has destroyed in those two months during the time I had a right to see them. Why is it they are is such a big hurry to destroy public records of health insurance complaints, with a short, two-year retention schedule? Two years is hardly any time at all, to show trends, to help Ohioans understand the problems and help them solve those problems.

Continue reading Letter to U.S. Senator Sherrod Brown