So why are health insurance premiums skyrocketing?

Matt Chapman has been a committed citizen lobbyist on many issues this year, including health care reform. -promoted by desmoinesdem

I have always been laser-focused on Medicaid and health care access for the poor. And when Iowa Dems twisted Terry Branstad’s arm until he cried “Medicaid Expansion!” I was elated. So in my bubble, the worst thing going on seemed to be the privatization of Medicaid or “Branstad’s Revenge.”

With the private insurance companies all pulling out of Iowa, now that I am aware of the astronomical raises in premiums, I feel a little shame at my blissful ignorance. All I can tell you is at 51 years old the Affordable Care Act gave me dental insurance for the first time in my life. And I’ve had the same doctor for five years. Before the ACA, the folks around the poverty line would have to drive sometimes 200 miles just to see a doctor. And rarely the same one twice. For dental they line up at Broadlawns (the Polk County public hospital) at six in the morning and hope they’re in bad enough shape to get in.

But what really made me aware was after the Drake forum with Senator Joni Ernst in March.

I had stood around talking and we were outside after the event when she came out to leave. She was kind enough to stop and talk to us. This was before the American Health Care Act had been hammered out, but the initial framework was there. What had me concerned was the $880 that funded the Medicaid expansion. It was a “sharing” tax that was levied on the wealthiest folks among us. I can’t even imagine the amount of wealth these people have.

So when I got my turn, I actually pleaded with Senator Ernst not to give that money to the super wealthy. Two hundred thousand Iowans are getting care and it is saving lives. Please don’t take that away. Her response was, “And we have to look at the premiums that are rising for folks above that poverty line.”

She is a very pleasant person, but that bothered me. My first thought was that I wasn’t considering other folks’ issues, and to an extent I think that applies to everyone. The more I thought about it, it started to dawn on me that Ernst just drove a wedge between those on Medicaid and those just above it. She also dodged the question I asked. That conversation led to some pre-emptive cocktails as I knew I was way too angry to sleep without them.

Then a month or two later, I was at a meeting with Representative David Young (IA-03). I was with many others, way out of my depth, so I just kept asking the same question: Will you vote to remove funding for the Medicaid expansion? I tried that five times in different ways, finally getting him to say, “I don’t want to pull the rug out from under anyone.” What a commitment.

So I’m reading this because you said something about premiums, right? Yes I did. The cagey responses, dodges and doublespeak are the reason for premiums rising.

When the Affordable Care Act was being drafted, the authors knew that twenty or so million people would come onto the rolls. A lot of those people were the ones that had fallen through the cracks and some would have chronic health issues. The health insurance providers were jumping at the chance to have all that business, but they would only sign on if the risk of a catastrophic increase in payouts to providers were hedged by the government. Those hedges were named risk corridors. So if a insurance provider loses money at the end of the year, there is a provision to reimburse them. Starting in 2011 when the house was overrun with Republicans, they attacked the ACA and voted more than fifty times to repeal it. While they knew that bill would be vetoed by President Barack Obama, they did have control of the purse strings.

This is where the GOP really threw a wrench into the ACA. As upset as folks are about our current president and what he will do, the GOP has set a pretty high bar. Let’s hope our president doesn’t hurt as many of us as they did and continue to do.

The strategy was pretty simple. Don’t fund the risk corridors. Here is an excerpt from a Salon article on this very issue. It gives all the credit to Senator Marco Rubio (R- Fla.) but others had just as much if not more to do with it.

Rubio’s “plan limiting how much the government can spend to protect insurance companies against financial losses has shown the effectiveness of quiet legislative sabotage.”

How anyone could be proud of sabotaging our access to health insurance and literally bragging about it amazes me. With Young’s recent amendment and vote for the health care bill, he’s giving the GOP a run for their money on cruelty. And Joni Ernst may have to step up her game. A little wedge issue distraction ain’t gonna work with us on this one.

From the LA Times: “One remarkable feature of this attack is that, even though it helped destroy some low-income insurers and harmed their customers, Republicans in Congress jostled with each other to take credit for it.”

Rubio made his championing of the provision a linchpin of his presidential campaign, claiming that his role in the measure saved billions for the American taxpayer. His bragging ticked off the GOP politicos who actually had sneaked the measure into law. Among them was a certain Senator Jeff Sessions (R-Ala.), then the ranking Republican on the Senate Budget Committee. When Sessions issued a statement listing the measure’s supporters, the Washington Post reported, he “pointedly” left Rubio out.

More from Salon:

“Meanwhile, federal Judge Thomas Wheeler of the US Court of Federal Claims, ruled recently (as reported last month by Forbes) that the feds actually have to pay back – to the tune of about $8 billion – the moneys lost by health insurance companies operating in good faith.”

But it’s way too late. Dozens of non-profits created to provide health insurance through the exchanges, like Iowa’s CoOportunity, have already gone bankrupt, and the health insurance giants are absorbing their smaller competitors and merging like there’s no tomorrow. Additionally, Judge Wheeler’s ruling is in limbo for the moment, with President Donald Trump’s newly-minted Attorney General Sessions expected to appeal to a higher court.

So for six years, the GOP-controlled U.S. House not only sabotaged the healthcare of 20 million new subscribers, they also pushed already-skyrocketing health care premiums to the point where some middle class Americans are paying fifty percent of their income to cover health insurance. When they pulled the “risk corridor” funding, the health insurers ratcheted up premiums to make up for it.

And the chronic conditions of those 20 million new subscribers were underestimated, indicating that we are a much sicker nation than we thought. When we have leadership that jostles to take credit for who made America sicker, it’s not surprising.

Let me finish with this. I was at a meeting in Des Moines on May 22, where the future of Iowa’s health care was being discussed. One gentleman spoke of the risk corridors and Marco Rubio’s sabotage of the ACA. I owe him some gratitude for putting me on this thread, so I could follow where it went. That being said, I also heard a lot of applause at the mentions of single-payer and Medicare for all. This was a pretty diverse group of folks, and skyrocketing premiums will be a uniting force in the next election. We just have to educate those we can about how we got here. I’m in.

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  • thank you for writing

    I would add that it wasn’t only Republicans who tried to sabotage the functioning of the insurance exchanges. Trudy Lieberman wrote a good piece on the failure of Iowa’s non-profit cooperative, CoOportunity:

    Meanwhile, there’s an argument that Wellmark Blue Cross Blue Shield, the dominant insurer in Iowa, has itself gamed the rules. As CoOportunity officials have noted, Wellmark took advantage of adjustments in the law to extend the old plans of its existing customers, who were healthy enough to get insurance before the ACA was passed and insurers were required to take all customers. The company also has also chosen so far not to sell its policies on the public exchange—the only place shoppers can use federal subsidies. That would tend to keep healthier patients at Wellmark and push relatively poorer, sicker patients to the exchange, where CoOportunity was one of only two companies selling policies—and it also likely led CoOportunity to grow more quickly, and require more capital, than it expected. This dynamic has gotten some press attention, and it deserves more. (Before being taken over by the state, CoOportunity also complained about other alleged hardball tactics from Wellmark, as the Register reported.)

    • Thanks!

      That is a great share and I thank you for it. It’s not surprising that Wellmark would be gaming the system as their business model seems to be profiting off of denying health care and causing unnecessary suffering. In trying to expand healthcare to all uninsured while placating the insurers the opportunistic nature of these companies and lack of self control to restrain it is a testament to Medicare for all. As long as shareholders and obscene management compensation is the priority citizens will not get the care that should be their human right in the richest country in the world. They should be banished like work houses and debtors prisons of the past.