Insurance Company Disgusted That ACA Customers Need Doctors – Raise Rates To Keep Bloated Profit Margin

It turns out that people who didn’t have health insurance their entire life, and were finally able to get it thanks to the Affordable Care Act, are more sick than people that have had regular health insurance. To normal, well-adjusted people, that sentence would be followed by, “well, duh…”

But sadly, this study brought to you by Blue Cross Blue Shield (BCBS) is already being used by conservatives as undeniable proof of the failure of the Affordable Care Act, and has been used by BCBS and other insurance companies to raise premium rates.

A summary of findings from BCBS has conservatives up in arms, which makes sense based on the well-planned summary that doesn’t specifically lie, but also doesn’t tell the whole truth. So let’s break it down:

Members who newly enrolled in BCBS individual health plans in 2014 and 2015 have higher rates of certain diseases such as hypertension, diabetes, depression, coronary artery disease, human immunodeficiency virus (HIV) and Hepatitis C than individuals who had BCBS individual coverage prior to health care reform.

Again…duh. We’re talking about insuring a group of people who haven’t been insured for years, perhaps decades, because they either couldn’t afford it, or no insurance would take them on due to a preexisting condition. Conveniently not mentioned on this point is the long-term savings of both the individual and the insurance company because the new enrollees are now getting treated for these diseases. Over time, this will lead to significant cost savings for a variety of reasons, not the least of which is a reduction in unpaid emergency room visits.

Consumers who newly enrolled in BCBS individual health plans in 2014 and 2015 received significantly more medical care, on average, than those with BCBS individual plans prior to 2014 who maintained BCBS individual health coverage into 2015, as well as those with BCBS employer-based group health insurance.

Let’s think about this logically. Say you haven’t had insurance for years, or longer, and now you suddenly have access to much-needed care. What’s the first thing you do? Find a doctor and set up the initial visit, which costs the insurance company money. Next step would be a physical exam, possibly blood work, x-rays, and on and on.

These services are critical in order to make sure further direct services based on a specific diagnosis are treating the correct diagnosis. But in the first few years of full Affordable Care Act implementation, this was an obvious consequence of which anyone paying attention was already aware.

“The new enrollees used more medical services across all sites of care—including inpatient admissions, outpatient visits, medical professional services, prescriptions filled and emergency room visits.”

I’ll forgive the missing Oxford comma, but not the missing mention that for the first time, hospitals are getting paid for those emergency room visits. This will, over time, lead to slower growth in hospital service costs, which will lead to insurance companies ultimately not having to pay hospitals as much.

This study is already being used as justification for premium increases, which is fairly disgusting. Especially when you consider compensation for CEOs and other executives at insurance companies like BCBS are skyrocketing, even as our premiums increase in order to make up for their “losses.” In other words, they get a few more million dollars for directing studies that are then used as justification for charging more money to us.

Many of these effects were predicted long ago, which was the entire reason for the Republican-turned-Democrat-turned-Satanic idea called the “individual mandate.” In other words, everyone has to have health care, or they will pay a fine. If they can’t afford premiums, the government subsidizes a certain amount to make it more affordable. The individual mandate was the only way to address the gorilla in the waiting room known as “adverse selection,” which predicts the consequences of people not getting insurance because they think they don’t need insurance.

The Affordable Care Act was never meant to be a quick fix. This was a massive effort to fix the sickening dysfunction of the healthcare system, and the results cannot be measured until it has time to undo the immoral consequences of the broken system of the past.

Featured image from Flickr by Vic, available under a Creative Commons Attribution 2.0 license.

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