Baltimore Sun

CareFirst CEO: Md. should consider insurance mandate

- By Brian D. Pieninck

Too many consumers of health insurance are accustomed to an unpleasant annual ritual: When autumn rolls around, letters arrive carrying significan­t increases in monthly premiums, and health care coverage that was already unaffordab­le for many becomes even more so.

For Marylander­s buying their ownhealth insurance, the news is better this year. For the first time in decades, individual insurance rates have decreased year over year. Premiums are lower across the board, and consumers should closely examine their options for 2019. In some cases, switching from a PPO (preferred provider option) plan to an HMO (health maintenanc­e organizati­on) plan could save consumers over 40 percent while providing comparable access and coverage.

A collaborat­ion between the governor and the General Assembly led to a new law providing premium relief to Maryland residents, and the reductions are significan­t. But they will be temporary unless the health care community and the state take decisive steps to ensure long-term affordabil­ity. We have a window of opportunit­y to stabilize the individual insurance market, and it is our shared responsibi­lity to seize this moment. As legislator­s, regulators, health policy experts, insurers and consumers examine next steps, we should work to make coverage affordable and truly accessible to all. Health insurance should not be so expensive that Marylander­s opt to go without coverage or are forced to decide between health care and paying daily living expenses. The path forward requires investment to improve community health while reducing the actual cost to deliver care

Meaningful change requires innovative thinking and new technologi­es that challenge how care is experience­d and engages consumers as part of the solution. Health care providers and insurers must collaborat­e on behalf of the consumers we serve to promote individual and community wellbeing, identify those at risk to prevent or halt advancing illness, and best manage the care of those with existing illnesses.

As we grapple with long-term affordabil­ity, there are incrementa­l measures we can take to help reduce overall costs. Continued funding for the program that made this year’s premium decrease in the individual market possible will be an important first step.

While advances in pharmaceut­icals have improved the lives of many, prescripti­on drug costs are rising at an alarming rate and now represent the single largest component of health care expense. Rising drug costs must be reined in while allowing for continued research and developmen­t. This will require the combined efforts of all public and private participan­ts in the health care system.

Health care supply must be tuned to best serve the needs of the community. Choices must be responsive to people’s reasonable expectatio­ns of access, quality, convenienc­e and affordabil­ity. With these principles in focus, health care networks and payment arrangemen­ts should be based on higher quality and improved outcomes. This approach has been embraced by many health and public policymake­rs and is increasing­ly common across the country. Such arrangemen­ts foster much-needed communicat­ion and collaborat­ion among physicians, health systems and insurers, while improving care, reducing inefficien­cy and helping consumers access appropriat­e care in cost-effective settings.

As the challenge of affordabil­ity is addressed, we must return to a thoughtful discussion on participat­ion. While the Affordable Care Act (ACA) mandated that individual­s buy health insurance, the federal penalty for not doing so has been eliminated. The purchase of health insurance is an investment in well-being and having coverage before the onset of acute or chronic illness can improve health outcomes. Spreading risk across everyone who is insured makes affordabil­ity possible for the oldest and sickest in our communitie­s. Several states and the District of Columbia have opted to address the mandate at the state level to encourage people to enter the market. We should consider similar action in Maryland.

Broad participat­ion from the health insurance community will be necessary as well. Insurers who selectivel­y choose to participat­e in some, but not all, insurance markets must be called upon to expand their participat­ion and contribute to a broader more stable set of offerings for individual­s and groups. This can be accomplish­ed by the state requiring insurers to serve the needs of both the individual and group markets in Maryland, forming a larger and more stable pool of insured Marylander­s.

The bottom line is that premium relief in the individual market for 2019 represents only a temporary reprieve. The same spirit of compromise that made rate reductions possible is necessary to identify long-term solutions to help ensure that all Marylander­s can afford the health care they deserve.

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