Oct. 23--This state's largest health insurer, Blue Cross and Blue Shield of Illinois, recently announced that it is scrapping its most popular health plan sold to individual consumers. Reason: The plan, which provided access to a broad network of doctors and hospitals, proved too costly for the company, which would have to hike already high premiums.
Rather than do that, the company will switch individual customers of its Blue PPO plan to a plan with a much narrower network of hospitals. Those customers likely will find three regional powerhouse hospitals missing from the network: Northwestern Memorial Hospital, University of Chicago Medicine and Rush University Medical Center. (This change does not affect Blue Cross policies sold through employer-based group plans.)
That's a dramatic change for many people. And there are other dramatic changes happening in health care markets around the country.
Health co-ops, designed to inject competition into health care markets, are collapsing, stranding thousands of customers. Many of those co-ops relied on a government promise in the Affordable Care Act of a cash infusion to cover losses. But after Congress cut those funds, co-ops have tanked. Illinois' sole co-op, Land of Lincoln Health, says it is limiting the sales of new policies to small employers for the last two months of the year to help ensure its survival.
In the 5 1/2 years since President Barack Obama signed the Affordable Care Act, we've gained experience about the fulfilled and unfulfilled promises of the law. We've learned more about the market consequences of the law. And we've learned about how the target market -- millions of uninsured people -- has reacted.
Health and Human Services Secretary Sylvia Burwell recently predicted that only 10 million people would be enrolled in Obamacare by the end of next year. That's about the same as the 9.9 million who were covered as of June, and just about half the number of people that the Congressional Budget Office had estimated would be covered by the end of 2016. Burwell concedes that millions of Americans who haven't signed up won't easily be persuaded to do so. "The remaining uninsured have a lot of concerns about whether they can afford coverage," even with federal subsidies, she said.
Burwell's announcement spurred health care consultant Robert Laszewski to wonder, "Has the Obama administration given up on Obamacare?"
Obamacare has provided vital coverage to many people who had been virtually shut out of insurance. Many people are getting health care through the expansion of Medicaid eligibility.
The future of the law, however, depends on whether a stable health care market delivers affordable coverage. Obamacare provided welcome access to insurance, but that's of little benefit if the law distorts the market and consumers find they're priced out of coverage or their doctors and preferred medical centers are out-of-network. If fewer people take coverage, the risk pool becomes too small to protect insurers from losses.
The next open enrollment period starts Nov. 1. The experience from that may finally provide impetus for Republican leaders of Congress and the White House to do what they have been unwilling to do for 5 1/2 years: revisit the Affordable Care Act.
Republican antipathy to the law has receded somewhat: You don't hear the GOP presidential candidates or congressional leaders talking as loudly about repealing Obamacare. But the need to change the law, particularly to provide more flexibility for health care markets, is still urgent.
Lawmakers have floated several innovative ideas to expand lower-cost coverage, allow sales across state lines, sell catastrophic coverage that would come with low premiums. All ideas to tailor insurance to fit the varying needs of people in the market, not to comply with strict dictates of government.
Meanwhile, if you're buying health insurance, check the fine print: Is your doctor in or out?
