ConnectiCare is the latest insurer to rejected by the Connecticut Insurance Department. If this continues, soon the exchanges will be either empty or inaccessible for the people who need them. The system badly needs reform.
Connecticut is certainly not the only state where insurance premiums are skyrocketing; many states are faced with requests for double-digit rate increases. This is not how the system was supposed to work. Rates were supposed to be stable by now instead of spiking sharply upward, and the exchanges were supposed to have plenty of choices for all levels of consumers. Instead, insurers are threatening that unless they get double-digit rate increases, they will take their toys and go home.
What’s the deal? Insurance companies complain that they are taking in less money in premiums than they are paying out. They also complain that the federal risk adjustment program, which was supposed to stabilize rates by forcing companies with a healthier population to financially support those with sicker populations in the same market, is actually making things worse.
Meanwhile, advocates are worried that the rate increases will turn people off from actually seeking insurance in the first place, which was the entire point of Obamacare and the insurance exchanges.
Who’s to blame for this rotten outcome? It seems there’s plenty of blame to go around. We as a nation need a lot more health care than anyone thought, and some members of the public are abusing the system. But health care costs are also rising, which is the fault of insurers, drug companies, big for-profit health care networks, public ignorance, and inertia.
Plenty of people also point the finger at the insurance companies, which often seem a lot more worried about their bottom lines and shareholders than what’s best for their customers.
As for me, I blame Joe Lieberman.
No, really. The Affordable Care Act, in its earlier forms, included the so-called “public option,” which was a government-run insurance plan that would be available to everyone, and would likely have been heavily subsidized. The public option plan would have made it a lot harder for insurance companies to do what they’re doing now — namely, to hold the exchanges hostage for higher rates. Consumers would simply have fled the private insurers for public plans. That’s why insurance companies lobbied hard against it in 2009.
Lieberman, who had close ties to the insurance industry, vowed to join a Republican filibuster against the ACA should the public option be included. In the Senate of 2009, which had just enough Democrats to shut down GOP obstruction, that would have killed the bill entirely.
A public option wouldn’t have been a cure-all. But it would have given government more of a role than either fretting uselessly or, once in a while, denying rate increases. It also would have helped contain health care costs, because, like Medicare, a government-run public health care option would have massive leverage against providers. But it didn’t happen.
What do we do now? There’s no sign that the problem with spiraling rates and insurers threatening to leave the exchanges will get better any time soon. Fortunately, most of the neediest people on the exchanges do get some kind of government subsidy, so hopefully we won’t see a sharp drop-off in people getting insurance, but that still leaves us with huge headaches.
I’d love to suggest that Congress needs to take up the public option again and really rethink and reform the ACA to make it stronger. Insurers need to stay on the exchanges — perhaps penalties for those who aren’t part of the exchanges should be investigated. I’d especially like to see Medicare, which is public health care that already works, expanded to cover everyone. In a perfect world, that would be the solution. However, given how completely broken Congress has been since the 2010 elections, that’ll never happen.
There are some less drastic fixes Congress could make that would help, such as increasing subsidies for the middle class. That still may be politically impossible, sadly.
It’s up to the states, then, to fix the ACA. I’d love to see Connecticut find a way to offer a robust public option. Budget realities, though, mean this is impossible for now. And an ambitious plan by Vermont to implement single payer health care seems to be scuttled.
We must do something, though. We need public health care. The current for-profit model doesn’t work well enough to keep it. Otherwise our country, and our politics, will just keep getting sicker and sicker.
Susan Bigelow is an award-winning columnist and the founder of CTLocalPolitics. She lives in Enfield with her wife and their cats.
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