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On Topic: Healthier, maybe, but affordable?

Affordable Care Act is insuring more Iowans the future is less clear

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It happened again just a couple weeks ago. I was talking with someone about the ongoing mishegoss that’s resulted from Gov. Terry Branstad’s rush to transition Medicaid to out-of-state insurers — it’s delivered unsolicited difficulties to the doorsteps of Iowa Medicaid beneficiaries and their families as well as large and small health care providers, and generated a lot of chatter from state lawmakers.

It’s also resulted in an abundance of news stories and commentary in newspapers and on TV stations statewide. So much so, the Des Moines Register more than once has cited or linked to stories written by The Gazette’s Chelsea Keenan, and as recently as last month I referred to the Register’s coverage.

But then that person — and this has happened a few times — said something along the lines of, Well, they never should have passed that Obamacare, they knew it wouldn’t work .

The confusion is understandable, to some degree. Both are massive health care programs and both have become political hacky sacks.

As the Economist magazine recollected in an article on the Patient Protection and Affordable Care Act earlier this month, it was then-Speaker of the House Nancy Pelosi who said back in 2010, “We have to pass the bill so that you can find out what is in it, away from the fog of controversy.” Bizarre advice, but surely an early indicator of what has become only messier.

So much so that today it’s hard to get a clear reading on whether the ACA should go in the plus or minus column as a success. I don’t mean politically — we’re all adult enough to know how something is viewed in the popular or political rearview mirror often has little relationship to its effects in the real world.

But how has it worked out, as a business model, for Iowans and other Americans and for health care providers — which, remember, are businesses that have to turn some kind of profit to continue serving their customer-patients?

So here to shed some light on that question comes Nick Gerhart, Iowa’s insurance commissioner. He and three other states’ top insurance chiefs — from Ohio, Washington and Wisconsin — testified Sept. 15 before a U.S. Senate committee to present what at best can be called a mixed report card.

He noted that the 13 health systems that take part in accountable care organizations established by Iowa’s biggest insurer, Wellmark Blue Cross and Blue Shield, reported savings “by reducing hospital readmissions by more than 22 percent, inpatient admissions by almost 8 percent and emergency department visits by nearly 4 percent.”

In addition, the commissioner said Iowa’s version of the ACA Medicaid Expansion plan offered up coverage for more than 150,000 low-income childless adults — many of whom, he said, were without insurance before

Good news, right?

Gerhart then went on to explain how, in the beginning, lots of policies were underpriced. The insurance carriers simply didn’t have a good enough sense of what issues they might face with their new patients. That is, they didn’t know what sorts of expensive medicine and treatments these previously uninsured would require.

So when the bills started rolling in, the carriers got some sticker shock.

According to Aetna, “the top five percent of spenders drive nearly 60 percent of the cost,” Gerhart testified.

The ACA didn’t have the built-in flexibility to adapt, Gerhart reckoned, and add to that UnitedHealthcare pulling out and CoOportunity’s collapse well, Iowans are going to face “limited options on the Marketplace” in 2017. (You can watch Gerhart’s full testimony at http://smgs.us/3k9o.)

There also is the matter of rate increases. Wellmark received the OK for a rate increase of 26.5 percent for 2016 and 42.6 percent for 2017 for its ACA-compliant, off-the-marketplace plans. Aetna received rate boosts of 19.8 percent and 22.58 percent.

This sunrise/sunset scenario can be witnessed nationwide. Yes, costs are climbing because there are not enough “healthy” people in exchanges to balance out numbers for the carriers who must absorb the costs of the “unhealthy.”

The insurance companies need a reasonable profit margin to stay in operation. (Remember CoOportunity?)

But there is this, too: Something like only nine percent of Americans in 2015 were without health insurance, contrasted with 16 percent five years before.

And that, my friends, surely is a good thing.

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