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David Cane: Patients don’t have to drive to another city for care.
David Cane: Patients don’t have to drive to another city for care.

Health insurance choices wobbly

Posted online
Health insurance discussions won’t be leaving the table anytime soon. The transition of power in the White House will make certain of that.

But as conversation is bubbling across the nation as to what will happen to the Affordable Care Act, southwest Missouri is holding a conversation of its own.

Announced on Dec. 6, individuals enrolled in most UnitedHealthcare plans in southwest Missouri will gain access to over 675 Mercy doctors and facilities in the region for their in-network health care services. The change in policy began Jan. 1 and an additional 30,000-40,000 people insured by UnitedHealthcare will have access to Mercy care that didn’t before. But though Mercy and UnitedHealthcare have expanded their network relationship, other local options for health insurance are few and far between.  

Access to more
David Cane, regional vice president of Mercy, said Mercy previously was only able to see 10 percent of those enrolled in UnitedHealthcare through the parties’ preferred provider organization established in 2014. Now it’s bumped up to 50 percent in the new agreement.

These patients now have access to Mercy children’s and orthopedic hospitals in Springfield, MyMercy and burn treatment.

“As a Springfield native, I understand how important it is that local residents have a choice in where to go for their medical care,” said Patrick Quinn, UnitedHealthcare’s Heartland sales CEO, via email.

Previously, Cane said patients seeking specialized care, like children diagnosed with cancer, had to drive about three hours to St. Louis for treatment. “It gives a lot more people more choice,” Cane said.

Sources were unable to provide the current number of Mercy patients covered in the area. United also works with CoxHealth and had exclusively in the market until January 2014 when it started with Mercy.

But as far as choice goes in health care as a whole, pickings are slim.

Prior to the so-called Obamacare, there were over a dozen health insurance carriers across the nation – which gave consumers more options and allowed niche players in the marketplace to compete, said Richard Ollis, CEO of Ollis/Akers/Arney.

“Insurance companies could go after niche markets like Springfield and provide better customer service, as well as compete in certain marketplaces more effectively than the big ones,” Ollis said.

Cane said Mercy was in talks with UnitedHealthcare for years to expand its network, but it wasn’t until last summer that the carrier decided to move forward.

“We, and a lot of other employers in the market, have been talking for years about having more open access for people,” Cane said. “It’s better for patients.”

Access to less
Currently, there are only a handful of carriers in the nation, Anthem Blue Cross and Blue Shield, UnitedHealthcare and Aetna being among the largest. The downsizing of carriers came with the regulations in ACA, which caused carriers to consolidate.

One of those regulations required carriers to meet a certain loss ratio, meaning the ratio of the claims paid by an insurer to the premiums earned. So, if a carrier makes too much money, they have to refund that money to the consumer.

“If I’m a small insurance company, I may have a year, because I don’t have a lot of clients, that I lose a lot of money,” Ollis said. “The law of large numbers helps these big companies to allow them to have a little bit more predictable underwriting results. They’re able to achieve a more predictable loss ratio. Therefore they’re not at risk as much of losing money.”

Additionally, Ollis said the regulations of reporting, preventive health care and unlimited policy have left insurance carriers thinking they’re better off to be acquired or merged.  

With talks of repealing or replacing “Obamacare” underway, much change in the health insurance system is imminent. More options, like that of the Mercy and UnitedHealthcare expansion, may be coming.

“We don’t know at this point exactly what will happen,” Ollis said.

Possibilities include reduced regulations, ACA being suspended or not enforced, and insurance companies selling insurance products across state lines.

“I believe fewer choices is not necessarily good for the consumer,” Ollis said.

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