Sometimes when you’re looking all around for news, you miss the story happening right under your nose. Times/Review staff members were shocked last week to learn that our health insurance coverage is changing as of Oct. 1 and our initial choice was between two policies — one that would require an employee to spend $2,850 out of pocket and the other, $3,000 before any benefits were paid by the insurer.
A third option has now been added to the mix and it’s a more traditional health insurance policy, although premiums for most people and co-pays are higher.
The original options offered would provide no payment for anything except an annual physical examination and a few “wellness” procedures such as mammograms. No doctor’s office coverage, no prescription drug coverage — essentially, nothing until an employee satisfied that $2,850 or $3,000 deductible.
What’s happening to us is typical of what’s happening throughout our community and, indeed, throughout the nation.
Is this what the hard-fought debate over health care reform gave us?
Our agent blamed Obamacare and said insurers are saddled with high costs to pay claims, so they have dramatically raised their premiums. That’s his political view.
Before you shed any tears for the insurers, take a look at their profits. WellPoint, Empire’s parent company, turned a profit of $2.5 billion in 2008, and that was considered a bad year. UnitedHealth Group, Oxford’s parent, anticipates revenues of $93 billion by the end of the current fiscal year. And Emblem, the company offering that $3,000 deductible policy, is still reporting profits, although smaller than the giants, since it’s a relatively new entrant into the for-profit marketplace.
Emblem is a for-profit entity that took over two nonprofits, GHI and HIP, in 2007, and is gradually increasing profits. WellPoint and UnitedHealth continue to gobble up smaller companies and see their profits grow.
No, friends, the insurers aren’t going broke paying our claims. And when health care reform is fully effective in 2014, the companies will gain an estimated 36 million to 50 million new customers paying their premiums.
If you didn’t closely follow the debates over the health care package, you might conclude that higher premiums and co-pays and fewer covered services were President Obama’s gift to insurers.
But what the president and others who favored health care reform sought was to stop the escalating costs of premiums while extending coverage to more people. But among the compromises necessary to get any reform package passed was to agree to delay caps on premiums until 2014.
You can bet the for-profit insurers, concerned about that 2014 reality, weren’t going to sit still in the interim. What they’re doing this year and will continue to do unless stopped is to escalate premiums and cut services every year until 2014.
The one bright spot on the horizon for New Yorkers is a move in the New York State Legislature to begin capping those premium increases next year. It’s too early to say how that will fare with our state legislators, but if you care about what this means to your pocketbook, it’s time to wake up and watch what’s happening in Albany.
Yes, some of the reforms will cost insurers more money, but the Department of Health and Human Services estimates that the average premium increase to cover those costs should be between 1 percent and 2 percent. That’s hardly the big increase most of us are facing this year.
New York State Insurance Department data shows that since 2000, premiums for New Yorkers have averaged a 97 percent increase. I’m guessing that your income from 2000 to today hasn’t increased by 97 percent.
Is Obamacare perfect? Hardly. As one of my colleagues said the day we were told about our insurance options, this wouldn’t be happening if we had a single-payer system. And before you start screaming about government-controlled health care, just ask your friends who are on Medicare how they like the program and their benefits. Those I’ve spoken with are quite happy, thank you.
The president and Congress were able to take only baby steps this year because the fear-mongers won the verbal battle that forced so many compromises to dilute the final package.
It’s time to put political philosophy aside and look at real consequences of what’s happening to make top company executives and shareholders richer and the rest of us a lot poorer.