Piling on the Affordable Care Act while giving private insurers a free pass

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Gary Schwitzer is publisher of HealthNewsReview.org.  He tweets as @garyschwitzer or with the project Twitter handle of @HealthNewsRevu.

Affordable Care Act searchRight off the top, let me be clear that I’m no apologist for the Affordable Care Act.  Its imperfections are quite clear to me.  However, when I see a news story or newspaper column pile on out of bounds, I’m going to throw a flag for unnecessary roughness.

And so, the flag is thrown for a (Minneapolis) Star Tribune column under the headline:  “Looking death (and ACA) in the face.

That’s the kind of headline that will draw me in any time.  And, if that’s what headlines are supposed to do, it worked in my case.  I wonder how many other readers were drawn in by it.

I know that at least one other reader — bioethicist Steve Miles, MD — had much the same reaction to the piece that followed as I did.

“This has zero to do with the ACA,” Miles told me.

star-tribune-aca-headlineWhy was ACA – the Affordable Care Act – in the headline?

The heart of the story seemed to be that a woman with stage four cancer who was being treated at the Mayo Clinic recently learned that:

“Mayo will soon be considered outside the network of their provider, Blue Cross Blue Shield. To continue to get the care at Mayo that they believe is keeping Anne alive, the Bartas would have to re-enroll in a plan that has no cap on out-of-pocket expenses. The coinsurance would be 50 percent after the deductible is met. John has estimated his wife’s care could be $300,000 next year, meaning he would have to come up with $150,000 a year.

The Bartas seem to have done everything right. They always bought the best health care plan while working, and did so again when John lost his job. The industry has changed on him, and now the Bartas may have to decide whether to continue treatment at the risk of quickly depleting the family retirement savings.”

The only mention of the ACA in the entire piece was this:

“Eileen Smith, director of communications for the Minnesota Council of Health Plans, said that before passage of the ACA, the Bartas would have been able to buy a policy through the Minnesota Comprehensive Health Association. The state’s high-risk pool, where people with preexisting conditions who were turned down by insurance companies could buy a policy, allowed patients to go to the hospital of their choice.”

Steve Miles

Dr. Miles told me there were options that the column didn’t explore:

“If Mayo’s price is too high for insurance, they should ask for a concierge option in the ACA where elite or highly sought high-charge providers can be covered out of network.  This could be done two ways: 1) an out of network fee within Blue Cross Blue Shield or 2) Having Blue pay Mayo the same rate it pays other providers and then having Mayo bill the patient the rest.  A third option would be government price controls on Mayo.”

Instead of the ACA in the Star Tribune’s headline, why not Blue Cross Blue Shield? Or Mayo?

Lynn blewettLynn Blewett, PhD, Mayo Professor of Health Policy and Management at the University of Minnesota School of Public Health also responded to my request for analysis:

“The ACA has made it possible for this family to get coverage without being turned down by private insurance – there are no longer pre-existing conditions and no under-writing–that is doing assessments to figure out who is sick and then sending them to the Minnesota Comprehensive Health Association.  But most plans now are no longer offering Mayo because of its higher costs.”

Blewett also wrote that this sentence in the column was inaccurate unless you add the bold italics she added – “To continue to get the care at Mayo that they believe is keeping Anne alive, the Bartas would have to re-enroll in a plan that has no cap on out-of-pocket expenses for non-network providers.”  She wrote: “All individual market plans are required to have caps on out-of-pocket spending – they do not have to have caps on the spending for “out-of-network.”

Why not more headlines and stories like this one by Salon.com?

Making a killing under Obamacare: The ACA gets blamed for rising premiums, while insurance companies are reaping massive profits

Excerpts:

“While Americans continue to be hammered by rising health care costs, and while congressional lawmakers (with their taxpayer-subsidized health care) do nothing to lower cost of pharmaceuticals and medical care, one group is reaping a windfall in profit: health insurance companies and their investors.

A Salon analysis of regulatory filings found that the top five health insurers — UnitedHealth, Anthem, Aetna, Humana and Cigna — have doled out nearly $30 billion in stock buybacks and dividends from 2013 to 2015. (The Supreme Court ruled in factor of the Affordable Care Act in 2012.)

Meanwhile, the increase in customers that these health insurers received under ACA has helped raise the stock prices of the top five insurers — some 80 percent for Anthem and 165 percent for Aetna since the high court ruled on June 28, 2012 that Obamacare was constitutional.

…Aetna’s earnings report ($734 million in profit on $15.8 billion in revenue for the three months that ended Sept. 30) came a week after UnitedHealth reported a 12 percent jump in revenue to $46.3 billion for the three months that ended Sept. 30 compared with the same period the previous year. (AnthemCigna and Humana will report their latest quarterly earnings next week.)”

Somebody needs to be the referee on some of the cheap shots flying around on an uneven playing field.  Single anecdote “let’s blame the ACA for something else” stories fail to reflect the big picture of people helped by the legislation.  It’s ironic that the next day, the same Star Tribune published a story, “Uncompensated care costs at Minnesota hospitals plunge since health law.” Money quotes:

“…with the health law apparently helping more Minnesotans cover their medical bills. …. A reduction in uncompensated care is important… because ‘it’s likely that fewer people are rationing their own health care or experiencing fragmentation in care.’ “

Not quite the picture we got in a headline that framed one person’s story as “Looking death (and the ACA) in the face.”

I’d love to find the funding that would allow us to scrutinize health care reform and health policy news in a systematic, criteria-driven way as we have with more than 2,200 news stories about health care treatments, tests, products and procedures. Flags would fly, I can assure you.

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Comments (8)

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Alan Cassels

November 2, 2016 at 3:45 pm

Excellent commentary Gary. As a citizen of a country where everyone, like US lawmakers, gets “taxpayer subsidized healthcare” and where the sky always continues to be falling due to alleged wait lists, it is good to hear someone bring some scrutiny to your health reform coverage. In Canada much of the health reform coverage contains real whoppers, blaming all sorts of death, disease and dismemberment on our public health system and implying (and often saying) we’d all be better off with US-style healthcare. I, too, would vote for more funding to HealthNewsReview to critically examine the quality of health reform reporting which is often laden with myths, misreadings and mistruths.
The interesting thing about the US election cycle is that the only time we Canadians get mentioned is when one or another of your presidential candidates praises or condemns Canada’s public health system (like we see here: http://www.huffingtonpost.ca/2016/10/09/donald-trump-canada_n_12423178.html ) It’s true that single-payer healthcare is not without its problems, but it is considered, by most developed nations, akin to democracy, which Winston Churchill most famously said was “the worst form of government, except for all the others.”

Susan Molchan, MD

November 3, 2016 at 10:46 am

Great piece Gary and wish we would see more of this perspective – Health insurance execs make an outrageous amount of money and this comes out of folks’ ever-rising premiums and co-pays and adds zero to care. The amounts the insurance companies give to members of congress has a lot to do with maintaining our sick system.

Karen Steffens

November 6, 2016 at 11:37 am

You missed a HUGE point. Before the stupid ACA Mn had a high risk pool ins that was affordable and worked very well for our state. It was abolished when the ACA was enacted. So yes the ACA should take some heat! Prior to ACA we bought the high risk pool ins for my husband who has some health issues. The kids and I had our own plan. Now because we don’t qualify for subsidies I’m afraid we will be priced out all together. We totally liked our plans prior to ACA. Now we’ll have nothing. The ACA did this. It wasn’t the right solution.

Jack Fowler

November 7, 2016 at 7:48 am

Gary–

That was a terrific commentary. I like to think I am fairly informed, and I learned a lot from your analysis. I certainly hope you can find a way to get the information about how well insurance companies are doing as they raise prices and drop coverage to an even wider set of readers.

Gary Schwitzer

November 7, 2016 at 8:03 am

Karen,

Thanks for your note.

What you may have missed was that our point was there was no balance in the newspaper column. And there were inaccuracies and vital missing pieces, as pointed out by two University of Minnesota experts quoted in the piece.

“Love, hate and the Affordable Care Act” was a much more balanced look published by Minnesota Business Magazine (http://minnesotabusiness.com/love-hate-and-affordable-care-act). The article led with the analogy of the 6 blind men feeling an elephant: “In the legend, each person touches only one part of the beast and then offers wildly varying descriptions of it based on each individual encounter.”

That’s the point I was making: the column reflected on one single anecdote and did not convey a bigger picture – a picture, which the Minnesota Business Magazine article reported:

“Today, depending on who you ask, the mandatory health insurance law is both too little and too much, an unwelcome burden and an overdue source of liberation.

The Bright Side

“One fact that no one disagrees with is that the ACA has led to about 200,000 more Minnesotans being insured.

“Minnesota’s uninsured rate has been cut in half and is the lowest in state history,” says Shane Delaney, communications director for MNsure. The state’s health insurance exchange came online in 2013.”

And you may have also missed my other point: that all blame seemed to be put on the ACA whereas private insurers, whose bottom lines are doing quite well, were left off the hook.

Simple, sweeping, single anecdote reflections on health care reform don’t do anyone any good.

Bill Adams

November 7, 2016 at 9:30 am

Thanks, Gary. Almost daily I get to explain to someone the issues you presented so well. It is so easy to blame nearly everything bad about health care on the Affordable Care Act, usually with little correlation to it. The ACA has enough faults of its own without all the false attributions. Keep up the great work, Gary and colleagues.

David K. Cundiff

November 7, 2016 at 11:21 am

“I’d love to find the funding that would allow us to scrutinize health care reform ….”
I hope you find the funding, Gary.
In the mean time, you could begin scrutinizing healthcare reform by critiquing my book, Grand Bargains–Fixing Healthcare and the Economy. It was intentionally written to appeal to libertarians, conservatives, centrists, liberals, and progressives at the same time. I was delighted that Obamacare passed Supreme Court challenges. And yes, Obamacare is as bad as the conservatives say it is. So we need comprehensive healthcare reform, right? It can’t be the status quo for even another year or two. However, there is no serious reform healthcare proposal in the public discourse. But you can’t fix healthcare without fixing the economy simultaneously. Why? If healthcare reform got us better health outcomes than Japan, Europe, Canada and the rest while costing 40% less than now (i.e., about $1.5 trillion less), we would be immediately plunged into the mother of all economic depressions with 5+ million healthcare workers displaced. My 29 interconnected grand bargains begin with decentralizing the regulation of healthcare and creating 3000-5000 autonomous, privatized, competing health and human services providers who also regulate healthcare services for their own patients. Read it online for free: http://www.grandbargainsbook.com/

Dollis Scheele

November 7, 2016 at 5:40 pm

I think if the drug and insurance companies keep overcharging they will find themselves out of work and single payer becoming a state by state reality.