America’s Patients Are Losing Patience

With the news that the U.S.’s largest health insurer, UnitedHealthcare, is pulling out of the Affordable Care Act’s pool of providers in all but a few states, many consumers wonder where they will find health insurance in the coming year.

“There’s going to be an impact,” Mark Wilson, chief economist at the American Health Policy Institute in Washington, D.C., told LifeZette. “Prices will rise. The premium prices will increase for individuals and taxpayers.”

UnitedHealth currently serves about 6 percent of all Obamacare enrollees and is available in 34 states. Its departure in 2017 will mean that in 536 counties next year alone, there will only be one insurance carrier available.

“Now that United is pulling out, it’s kind of hard for them [other insurers] to jump into every place United pulled out of,” Wilson said. “Unless other carriers step in — and that remains to be seen — this is another step in the direction of the eventual failure of the exchanges.”

Loannie Reyes, vice president of Authentic Elevator Services in New York City, knows what it’s like to be abandoned by a marketplace carrier. Her company’s provider dropped out of the New York exchange last year, leaving her staff without coverage. 

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“Obamacare is hurting the health insurance industry and they are transferring the damage to us — small businesses. Every year we get higher premiums and lower coverage,” Reyes told LifeZette. “This has to stop.”

Liz Coker, who has coverage from UnitedHealth in Colorado (where the insurer has confirmed it is dropping coverage), said the move doesn’t affect her day-to-day health care right now. If she can access a doctor for basic care, that’s all she needs. But should any major illness or injury strike, things will be different.

“I want the choice of going to the ‘best,’ even if it costs me more,” she said. “Losing access to ‘the best’ unless I’m willing to pay 100 percent out-of-pocket is my biggest concern.”

Coker also fears two of the other currently available carriers, Aetna and Cigna, will drop out soon as well.

“I’m concerned that the one or two remaining carriers in my state will be so overwhelmed with new patients, they won’t have enough doctors — and all the best ones will not be taking new patients,” Coker said, adding that she has already seen that happen to friends.

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Annette Frey, who used to be under UnitedHealth’s coverage via the New York marketplace, said the company is doing people a favor by pulling out. They dropped all of her doctors and the entire New York University hospital network from her plan without giving notice.

“Their pulling out might be doing many people a huge favor,” Frey added. “They are horrendous, and the most expensive of all the choices.”

Managing the Remaining Options
James Capretta, a visiting fellow at the American Enterprise Institute and a senior fellow at the Ethics and Public Policy Center, said patients enrolled in UnitedHealth plans will likely be forced to choose another carrier.

“That could mean disruption of their relationship with their doctor,” he said — and higher prices for whatever care patients are seeking.

Dr. Ramin Oskoui, a cardiologist and CEO of Foxhall Cardiology in Washington, D.C., told LifeZette that Blue Cross Blue Shield is the only choice offered by his practice broker. It shows the marketplace isn’t attracting competition, he said, and it’s forcing enrollees to reconsider what they should do as costs continue to rise.

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“Do they pay the premiums, or go bare and risk a catastrophic event that may bankrupt them?” said Dr. Oskoui. “I suspect an increasing number will risk going without coverage and apply for a hardship waiver in case they have a refund coming.”

He noted that health care costs were exceeding inflation before the ACA.

“The ACA is unsustainable. Health care now consumes nearly 20 percent of our gross domestic product. We should be first in quality, but we aren’t. Americans need to not only repeal the ACA but vigorously deconstruct the monopolistic practices of drug pricing and other practices that have allowed health care costs to become ‘decoupled from economic reality,'” he said.

Straight from the Exchanges
Andrew Ratner, director of marketing for the Maryland Health Benefit Exchange, said people losing their UnitedHealth coverage, wherever they may be, shouldn’t panic. They can shop for a new plan next year, or may be offered the opportunity to default to another carrier’s plan.

Ratner said UnitedHealth had the third-highest amount of enrollees in the state — about 11,5000. In its absence, all areas will have more than one choice of an insurer, as there are about five or six in each area.

Mary Danielson, a spokesperson for Blue Cross Blue Shield of Tennessee, advised making calls to see what might be available. Danielson expects other carriers may try to go into markets where there will only be one insurer after United’s departure.

The pool of insurers in her state will be set by June 11, as it is a federally facilitated marketplace. Other state-run marketplaces may have different deadlines.

Ratner wasn’t sure if Maryland, a state-run exchange, was still accepting insurers for the 2017 year.