So much wool over our eyes

PG838604At last count, over 10,000 Toledoans bought health insurance this year on the Marketplace. It could be 20 or 30 million dollars of taxpayer money coming this way to help Toledoans pay for health insurance. That money is for health services, but it’s getting squandered away, because most of the Toledo medical community snub their noses at Marketplace insurance.

ProMedica and Toledo Clinic say they don’t accept the affordable Marketplace insurances. Meanwhile, CareSource, one of the two affordable insurances, has listed on its network 50 ProMedica primary care doctors who are accepting new patients, but when I called each one of them, only two of the 50 doctors were actually accepting new patients.

Yet there they are, 48 ProMedica doctors listed as accepting new patients on the CareSource network, on an insurance that the ProMedica business office told me they don’t accept. How could that be?

And why would ProMedica snub affordable health insurance and the poor people who have to buy it? The poor people in every sense.

What a squandering.

The premiums for any plan other than a very few that are issued by Ambetter and a plan by CareSource have gone up sky high. On a Marketplace that is based on affordability, to have 93 plans offered in our zip code but only a very few that are affordable goes against the purpose of the Affordable Care Act.

How is it possible that plans sold by United Healthcare, InHealth, CareSource, Medical Mutual, Aetna, HealthSpan, Molina, Anthem, and Paramount could be sold after tax credit that are 7, 10, even 15 times more expensive than what the ACA law determined to be affordable for a particular income?

How could InHealth and United Healthcare plans be sold on healthcare.gov that are even more than 1500% of what the government has specifically set by law to be affordable?

Rate reviews by insurance issuers have been redacted so that the citizen reviewer cannot make any sense out of them. Ambetter, which offered 30 plans in 2015 and 11 plans in 2016, submitted a rate review this year that has literally every detail crossed out!

CareSource’s rate review is also highly redacted, and these two companies issue the affordable plans that the Marketplace is based upon.

These are the affordable insurances that control the tax credits, and the public needs to know the details of their pricing because that is one of the purposes of the annual rate reviews. It would be great to know how many policy owners and the demographics of the policy owners, the paid to allowed claims and ratios, the incurred but not paid claims and ratios, data from their Experience Period, the credibility of Experience, the State Average Premium, the projected memberships, the medical costs increases, the age and rating area distributions, the condition of the single risk pools, etc., including all the data on all the adjustments made in determining the pricing and the changes made to the expected population. For starters.

We must try to decipher the complicated, convoluted, and confusing rationale for the pricing, because the prices are completely out of control and we just can’t take it anymore.

Below are excerpts from Ambetter’s rate review submission. I didn’t do the cross-outs, they did. Ambetter is offered through Centene Corporation, an insurance provider that has the second-highest compensated CEO, (second only to United Health), 28.1 Million in 2015.

Ambetter was the second-lowest cost silver plan in Toledo both this year and last year. And this is the kind of rate review they submit? At the top of every page is, “This document is a trade secret and needs to be kept confidential from the public realm,” and everything is crossed out. I think we have a right to know.

Pages from Centene Corporation's highly redacted rate filing for Ambetter. What an insult to the public's intelligence.
Pages from Centene Corporation’s highly redacted rate filing for Ambetter. What an insult to the public’s intelligence.
More from Centene Corporation's Ohio rate review for Ambetter, Toledo's benchmark Marketplace insurance. Centene is one of the largest Medicaid insurance providers in the country, and this is how they regard Americans -- that we are stupid and don't have the right to know.
More from Centene Corporation’s Ohio rate review for Ambetter, Toledo’s benchmark Marketplace insurance. Centene is one of the largest Medicaid insurance providers in the country, and this is how they regard Americans — that we are stupid and don’t have the right to know.

The healthcare.gov Marketplace sent emails for us to change our plan because their records showed that our plan would rise 30-50% next year. It’s as if the Marketplace wants all the other insurances to go sky high, so that everyone will have to sign up for Ambetter or CareSource.

I wanted to switch, but not after I researched them. There’s no value there. These plans have slim to nothing networks, no ProMedica which is by far the largest provider in Toledo; furthermore, they make it difficult to get care, and these insurances don’t pay as much, so I’m told. But these plans costs twice as much as our pre-Marketplace Medical Mutual PPO policy, which was far superior to Ambetter and CareSource’s extremely narrow-networked HMOs.

A notification from Healthcare.gov that our insurance is going up 30-50%! WHAT!!?? And that is ACA business as usual? What's next?
A notification from Healthcare.gov that our insurance is going up 30-50%! WHAT!!?? And that is ACA business as usual? What’s next?

When 90% of the insurance providers can sell plans after tax credit that are seven to fifteen times the cost of an affordable plan, never mind how incongruous that is — how did the prices get up so high, so fast?

This is how: a 224% hike in 2014, and double-digit hikes every single year, before and after, for several years. Our Medical Mutual plan, which is basically the same as it was in 2009, went up 373% in seven years.

That’s outrageous. And the government, the taxpayers, the enrollees, and we the people, are getting taken for a ride.