Nurse practitioners and physician assistants, oh my!
Despite partisan conflict and mandates, healthcare insurance is a lifeline
We choose our homes and our cars, but not one of us chooses cancer or heart disease. Yet, health insurance is the only product in America for which an entire marketplace of sellers refuses to offer to a consumer who wants to buy, has the means to buy, and is legally eligible to buy.
In no place is this more apparent than Illinois. In Illinois, individuals are denied coverage for any reason other than “race, color, religion or national origin” or, as those in pre-Medicare years have learned, on grounds that are opaque if not mythic. The need for healthcare often forces some of our most capable professionals to forgo talent, ambition and self-employment in pursuit of health insurance for an ill dependent needing the guaranty of group coverage.
The entirely for-profit health insurance industry in Illinois, including a mutual and stock companies, is often belied by the dulcet tones and slick themes of massive adver- tising campaigns. Health insurers annually pay tens of millions for marketing on television and radio, and for sponsorships of Chicago’s professional and college sports teams. All the while, fewer families receive coverage offers.
Illinois health insurers have amassed capital at unprecedented levels. The largest health insurer in our state reported a 2010 surplus of $7.8 billion. The top six health insurers in Illinois reported national totals of at least $28 billion in surplus. Solvency and financial strength have been dwarfed by capital accumulation.
For at least 10 years, small-and mid-size insurers have been leaving the Illinois market, or have been purchased by the larger insurers. A moderately competitive market 10 years ago is now “highly concentrated,” leaving families and employers stranded in an inefficient market that offers less choice and higher cost.
Consumers pay more for less coverage. Reimbursements by payers to doctors and hospitals are less than ever. Commissions and fees paid by insurers to agents and brokers are less than ever.
Insurers often argue that healthcare benefit “mandates” drive the cost of premiums. More important, the irrefutable premise is that a benefit “mandate” equals healthcare. It is beyond true that healthcare costs money. Patients pay premiums and need healthcare.
Therefore, the essential question is whether the cost of the mandated healthcare should be borne by the insurer or by the patient.