Opinion

Put Families Ahead of Health Insurers

Opinion

By Paul Caron

If you Google ‘health insurance profits,’ it’s clear the industry is doing very well in the U.S. According to one article, the five largest insurers — Anthem, Cigna, CVS Health, Humana, and UnitedHealth Group — cumulatively expect to collect almost $787 billion in 2019.

A share of Anthem’s stock is more than double what it was just five years ago. Cigna’s stock price has not quite doubled in the last five years, but it is close. Humana stock has also doubled in five years, and UnitedHealth Group’s is worth about three times as much in that same time frame. Only poor CVS is down — but you get the picture: it’s good to be in the health-insurance industry.

The primary reason health insurers are doing so well is due to Obamacare, which mandated people in this country get health insurance. In some ways, the health insurers are no different than the gas or electric companies — they are monopolies, and you have to pay them. The federal government has been very good to that industry, and it’s about to happen again.

Legislation in Congress to end surprise billing, is going to put billions in the pockets of health insurers. Now, surprise billing is a terrible problem. In case you don’t know, you get a surprise bill when you go to a hospital that is in your network, but the doctors you see are not. This typically happens in emergency situations, because many hospital emergency rooms are separate entities from the hospital and are not covered by the same insurance plans. Surprise bills in the six figures aren’t uncommon.

In some ways, the health insurers are no different than the gas or electric companies — they are monopolies, and you have to pay them.

This legislation, sponsored by Republican U.S. Sen. Lamar Alexander and essentially replicated in the Democrat-chaired House Energy and Commerce and Education committees, is problematic regardless of its good intentions. These bills purport to end the practice by putting the onus on ER doctors and other emergency services to either cut their prices or allow insurance companies to reimburse them at the local median cost. These bills require a negotiation between insurers and emergency-services providers, but it’s not a negotiation if one side knows a federal law will allow them to pay less if they can’t reach agreement.

Another wonderful gift for the health insurers from Uncle Sam.

The problem for the American people, and workers, is that many emergency services are going to suffer or be pared back, in order to ensure that health-insurance companies remain grossly profitable. If this legislation becomes law, services like air ambulances will be crushed. If you live in a rural area, it’s hard to see how emergency helicopters will continue to service remote areas if this legislation becomes law.

According to the Kaiser Family Foundation, one in six emergency-room visits in 2017 was out of network, which substantially increases the cost of care. This situation cannot persist.

But it just doesn’t seem fair that health insurers, again, get to walk away unscathed, while hospitals, emergency-services providers, patients, and the American taxpayer will be left paying more to ensure that healthcare is accessible.

Paul Caron served as a Massachusetts state representative from 1983 to 2003.

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