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Did Obamacare Destroy Competition in the Private Insurance Market?

One of the biggest criticisms of the Affordable Care Act was that it would be the death of the private insurance marketplace. Opponents of healthcare reform cautioned that the law change would crowd out private innovation in the market and make insurance carriers less interested in competing.

If we take a closer look back at the progression of insurance company involvement in Illinois, I think we’ll find that not only was this not the case – but in reality, the reverse was true.

Prior to the 2014 open enrollment period, the small business market in Illinois was extremely limited. If you had fewer than 50 employees, the options for group coverage were four to five carrier choices (depending on your county). These companies continued to churn business, and employers would change carriers every two to three years as their premium rate increases continued to increase. There were significant barriers to entry - and every time we saw a new carrier attempt to provide competitive options, the larger more traditional players quickly chased them out of the state.

For sole proprietors and the self-employed, the outlook was even bleaker. There were two or three competitive options, and the underwriting guidelines were so rigid that even those plans were unrealistic for many individuals hoping to gain private insurance coverage.

Reviewing the change to the market, we see that sole proprietors and the self-employed saw the biggest gain in options. The opening of the ACA Marketplaces in 2014 offered up to seven carrier choices for individuals in some regions of Illinois. Although many of the players were familiar faces, one – Land of Lincoln - was brand-new to Illinois consumers. Land of Lincoln is a co-op (oonsumer oriented and operated), a new type of insurance organization made allowable by the ACA.

The federal government has now awarded nearly $2 billion in loans to help create 24 new CO-OPs in 24 states. The CO-OP sponsors - consumer-run groups, membership associations, and other nonprofit organizations - are now moving forward to offer health coverage in competition with established commercial and nonprofit insurance companies. (Health Affairs Policy Briefs)

What about small employers? While the SHOP Marketplace faced many more struggles in Illinois, there were some indications of future hope in improving competitive choices for our state. First, Land of Lincoln did offer and enroll small employer options. This added a new type of plan for employers to consider – and because it was offered on the SHOP, employers that qualified and enrolled in their SHOP plans could take advantage of the Small Business Tax Credit.

Second, we began to see the creation and evolution of private marketplaces and partially self-funded programs being marketed to small employers. In the past, third party administrators had reserved these innovative solutions for larger clients. The need for financial solutions and minimum essential coverage has spurred creative thinking and new progressive options for forward-thinking small employers to test out. Although these solutions are in their early stages of development, they do reflect a market expansion - not contraction.

Finally, and perhaps most importantly, the existing small business market remained intact. All of the same original carriers that offered plans historically continued to do so in 2014. We didn’t see one single insurance company leave the state of Illinois - instead many of them continued to market aggressively to small businesses and create new plan offerings that would be both compliant with ACA rules and competitive.

As we begin to look forward to the 2015 open enrollment cycle, the question remains of whether this trend will continue or reverse. Early indications point to a growing market. Last month, the Department of Insurance in Illinois released a statement noting that 10 carriers have submitted applications to offer plans in the second year of the Marketplace. This representing a significant growth in choices in the insurance carriers and the numbers of plans they will offer from Year 1. (Get Covered Illinois). Here are the exact numbers:

Illinois Healthcare Marketplace Plan Options – Year 1 and 2
Year 1
Options		Year 2
Submitted Options
Individual Plans120306
Small Group Plans 45198
The Illinois Department of Insurance is not expected to announce which plans it has approved until early August. However, given the significant increase in possible options, we can expect that both the individual market and small group market will see growth for 2015. Although this is positive movement, my hope is that the department will focus its expansion of plan approvals on the small group marketplace, which was significantly under-represented in choices in 2014.

In any case, the numbers show promising evidence of expanded insurance plan competition under Obamacare – something that small employers and the self-employed desperately needed prior to its enactment. We can and should consider this component of the legislation a true economic win for Illinois business.


Michele Thornton, MBA
Insurance and Benefits Consultant

Dyscrazia: A Diagnostic Conundrum Solved.

NEAR CRAZY WOMAN CREEK, WY -  Hospitalists in Wyoming have discovered a remarkable illness that has eluded physicians for decades.   Dyscrazia, first reported in the Journal Of Throw Away Journals, was coined by Park Ranger and Father of Native American Hospitalist Mountain Medicine, Dr Run Fast Like Bear PR, MD, MPH, FHM, PHD, PQRI, ABIM, CPOE.

After years of being terrorized by nonsensical middle-of-the-night patient requests, Dr Bear hypothesized, "We always thought dyscrazia was the only rational medical diagnosis to explain why healthy women with 62 complaints but no actual medical problems would demand an order for Colace, Visine, and ChapStick at 3 o'clock in the morning." 

From 2009-2013, Dr Bear and his team paid 42 night nurses an extra 25 cents per shift  to examine 60,000 consecutive hospital charts instead of doing optional, but management encouraged 3 A.M. chart checks.   This was their biggest raise in three years.  This nonrandomized cost control study confirmed Dr Bear's suspicion.  He said, "A meticulous review of the data failed to detect any pattern of organic disease, except for excess allergies and vitamin use".

Most patients with  dyscrazia were found to be addicted to over-the-counter vitamins.  "We were shocked to discover this population was abusing an average of 11 vitamins a day, seven of which were ordered from Dr Oz's website.  We never realized how many patients were abusing cinnamin, garlic, and vitamin water.  It was an eye opening study."

In addition, researchers discovered most patients with dyscrazia suffered from allergic reactions to an average of 17 different  medications, abstract thoughts and inanimate objects. "We could never understand how someone could be allergic to the color red.  Now we know", explained Dr Bear. 

Some findings did catch the Bear and his team by surprise.  Dr Bear explained: "We couldn't believe the amount of  documentation embellishment we discovered to get insurance to pay for their stays.  We saw doctors documenting life threatening fever of 97.5 degrees Fahrenheit because their patient said anything over 95.7 means something bad is going on.  We saw bilateral leg fat get intravenous Vancomycin for a week because the redness 'has to be infection'.  I even saw a patient admitted six days for a nondiagnostic scaly rash that responded to routine showering."

Since their discovery, Dr Bear's nocturnists have  notified nursing staff they will no longer be accepting any calls  after 7 pm from any patient with dyscrazia.  All calls are now being  deferred to the ER where they deal with dyscrazia.

All.  Day.  Long.



Learn. Connect. Share. PTSD Treatment can help.


June was PTSD Awareness Month. And although spotlighting it throughout the month of June brings a lot of great information to the public, it is important to remember that PTSD is something that many individuals struggle with throughout the year.

Take the Fourth of July as an example: This great American holiday is only four days past the end of PTSD Awareness Month, but many people are not aware of the impact this holiday has on combat veterans with PTSD. For many of them, these exuberant displays of sound and light trigger combat flashbacks that last long after the last sparkler has fizzed out for the night.

This year, there has been more publicity around the effect that fireworks can have on returned vets. And there has been a growing campaign to increase PTSD awareness by placing signs in front lawns that read: "Combat Veteran Lives Here, Please Be Courteous with Your Fireworks." The experience of combat veterans on the Fourth of July is a prime example of the type of awareness that needs to continue beyond the month of June, and that is an awareness that centers on respect for those who suffered trauma in the past, and who continue to feel the effects to this day.

That being said, it’s hard to know how to be courteous of those with PSTD when you don’t have a very firm grasp on what PTSD is. Although it is most commonly associated with combat veterans – and vets as a population experience PTSD at a much higher rate – it also occurs in those who have lived through other violent experiences. The National Center for PTSD defines it as "a mental health problem that can occur after someone goes through a traumatic event like war, assault, an accident or disaster."

Understanding that PTSD is not limited only to combat veterans is an important step in learning how to be mindful of things that may trigger flashbacks or any other cognitive or bodily symptoms. Things that might seem part of the norm – like fireworks on the Fourth of July – can actually cause a painful reliving of a traumatic moment.

The way each person experiences their PTSD is different, and the only way to be able to really get a grasp on what these individuals experience is through talking with them. However, it is understandably difficult for many to recount their stories, so it is important to be patient and supportive. Reach out if you see that your friend or family member with PTSD wants to talk and be sure to listen to their story.

If you or a loved one struggles with PTSD, or if you just want to learn more about how you can help support someone with PTSD, the Department of Veterans Affairs' websie has a comprehensive section devoted to the condition, the National Center for PTSD (ptsd.va.gov). The section has resources for everything from treatment options like exposure therapy to a section specifically geared toward friends and family members.

Also, let people know that treatment is covered! The Affordable Care Act requires qualified health plans to include mental health services as an essential health benefit. The ACA also outlaws discrimination based on pre-existing conditions, so individuals with PTSD or other mental health symptoms need not be worried that they will be denied coverage or that their coverage will be cancelled.

This year’s PTSD Awareness Month motto was aptly put and is something to keep in mind throughout the year: "Learn. Connect. Share. PTSD treatment can help." Connect by reaching out to someone around you. And finally, share your experiences and knowledge with others.


Julia Ortner
Intern
Health & Disability Advocates

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