BOILING POINT
Frustration runs deep for constant marketplace health care changes
Andrea Schankman’s three- year relationship with her insurer, Coventry Health Care of Missouri, has been contentious, with disputes over what treatments it would pay for. Nonetheless, like other Missourians, Schankman was unnerved to receive a notice from Coventry last month informing her that her policy was not being offered in 2017.
With her specialists spread across different health systems in St. Louis, Schankman, a 64- yearold art consultant and interior designer, said she fears she may not be able to keep them all, given the shrinking offerings on Missouri’s health insurance marketplace. In addition to Aetna, which owns Coventry, paring back its policies, UnitedHealthcare is abandoning the market. The 2017 doctor and hospital networks were revealed via the enrollment period for people buying individual insurance on Nov. 1.
“A lot of [ insurance] companies are just gone. It’s such a rush- rushrush no one can possibly know they’re getting the right policy for themselves,” said Schankman.
Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. The instability, which preceded the health law, is intensifying in the fourth year of the Affordable Care Act’s marketplaces for people buying insurance directly instead of through an employer.
“In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.”
Forty- three percent of returning consumers to the federal government’s online exchange, healthcare. gov, switched policies last year. Some were forced to when insurers stopped offering their plans while others sought out cheaper policies. In doing so, consumers saved an average of $ 42 a month on premiums, according to the government’s analysis. But avoiding higher premiums has cost many patients their choice of doctors.
Jim Berry, who runs an internet directory of accountants with his wife, switched last year from Blue Cross Blue Shield of Georgia to Humana after Blue Cross proposed a 16 percent premium hike.
But last month, Humana, which is withdrawing from 88 percent of the counties it sold plans in this year, told Berry his policy was not continuing.
“It’s not like if I don’t want to buy Humana or Blue Cross, I have five other people competing for my business,” Berry said. “It just seems like it’s a lot of money every year for what is just basic insurance, basic health care. I understand what you’re paying for is the unknown— that heart attack or stroke— but I don’t know where the break point is.”
To be sure, the same economic forces— cancelled policies, higher premiums and restrictive networks — have been agitating the markets for employer- provided insurance for years. But there ismore scrutiny on the individual market, born of the turmoil of the Affordable Care Act.
Dr. Patrick Romano, a professor of medicine at the UC Davis Health System in Sacramento, Calif., said the topic has been coming up in focus groups he has been convening about the state insurance marketplace, Covered California. Switching doctors, he said, “is a disruption and can lead to interruptions in medications.”
“Some of it is unintentional because people can have delays getting in” to see their new doctor, he said. “Some of it may be because the new physician isn’t comfortable with the medication the previous physician prescribed.”
Dr. John Meigs, an Alabama physician and president of the American Academy of Family Physicians, said that whatever the source of insurance, changing doctors disrupts the trust a patient has built with a physician and the knowledge a doctor has about how each patient responds to illnesses. “Not everything is captured in a health record” that can be passed to the next doctor, Meigs said.
There is little research about whether switching doctors leads to worse outcomes, said Dr. Thomas Yackel, a professor of medicine at Oregon Health & Science University in Portland.
Brad Morrison, a retired warehouse manager in Quincy, Illinois, said he stuck with Coventry the past few years despite premium increases— he now pays $ 709 a month, up from $ 474— because the policy was the cheapest that would let him keep his doctor. “That’s the one thing I insisted on,” he said. “I love the guy.”
With Coventry leaving the Illinois exchanges, Morrison is unsure whether his alternatives will include his physician. His bright spot is that he turns 65 next spring. “I’m trying to hold out until I get to Medicare,” he said.