Affordable Care Act continues death spiral as insurance companies leave

The Affordable Care Act’s projected death spiral may have taken a significant spin in North Carolina recently. Only a few months ago Aetna’s CEO made hopeful comments about the success of the ACA, but in August the company announced it will withdraw from 11 of 15 states in 2017, including North Carolina and South Carolina.

You may recall from my column last month that the state government of Alaska intervened with extra funding just prior to the possibility of no health insurance providers in Alaska. Aetna’s announcement completes the death spiral for at least one county — Pinal County, Arizona, which as of now, has no health insurance provider for 2017.

Aetna’s departure is a particular blow for North Carolina customers, all of whom will need to choose different policies for next year, likely resulting in changing doctors and hospitals, because Aetna typically offered the least expensive policy options in many markets, often $300 to $400 below BCBS. Here in Robeson County, we had three choices for this year — UnitedHealthcare, Aetna, and BCBS. The first two have dropped out for 2017.

Only six Triangle counties will have the choice of Cigna in addition to BCBS. This year, for a family of three in Robeson County, UnitedHealthcare’s cheapest policy with 60 percent reimbursement, before subsidy, was $1,129.65 per month for a $10,400 deductible. Aetna’s cheapest was $1301.59 per month with a $12,900 deductible. BCBS’s cheapest was $1,626.62 with a $13,700 deductible. BCBS has requested an 18.8 percent average increase for 2017, so the cheapest possible policy in Robeson County in 2017 might be $1,932 per month.

I am very curious about the sudden change of heart on the part of Aetna’s and other corporations’ CEOs. I don’t want to be paranoid, but I am concerned about the coercive influence of government officials. When the government bailed out banks recently, they didn’t want to look as though they had bailed out some banks and not others, so they “required” all large banks to accept the bailout money.

John Allison, CEO of BB&T, which is headquartered in North Carolina, was the only courageous executive to speak out about this requirement. However, even BB&T accepted the money because they were lawbreakers and could have been prosecuted.

How were they lawbreakers? Every major bank is. The provisions of the Patriot Act and the Privacy Act conflict with each other. It is impossible to comply with both. So, government can threaten to bring charges against a bank at any time for violating federal law. I do some work with senior executives, some in the health care industry. They can tell you each minute exactly how many customers they have in the ACA. Yet, the government coerces them into not making that information public.

We are at risk individually too. Liberal civil-liberties lawyer Harvey Silvergate wrote a book “Three Felonies a Day” about how the average professional unwittingly commits at least three felonies per day and his book is full of examples of how individuals have been threatened with prosecution to do what a government official wanted.

A Robeson County family of three who does not qualify for a subsidy next year will spend over $35,000 on health care before they get reimbursed a single dollar. The health insurance companies have been afraid to speak out about needed changes to the system. Instead, they are now just dropping out. Is this really a system that we want?

Eric Dent is Endowed Chair Professor of Ethics at Florida Gulf Coast University.


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