The Affordable Care Act was a step in the right direction toward ensuring that all Americans have access to quality healthcare. However, for-profit insurance companies are trying to use the ACA as an excuse to merge into mega-for-profit monopolies, consolidating corporate power to maximize profits instead of focusing on providing the best possible care at the lowest cost to consumers. This power grab by insurers is moving us farther from our ultimate goal as healthcare activists — a single payer public healthcare system that guarantees quality healthcare to all, regardless of income or ability to pay.
Private monopoly over a public good
Four out of the five biggest health insurers recently announced mergers that would dramatically reshape the healthcare industry. Anti-trust government regulators filed lawsuits to block the two mergers between Aetna and Humana and Anthem and Cigna. U.S. Attorney General Loretta Lynch pointed out that these mergers would put a multi-trillion-dollar health insurance industry into the hands just three mammoth insurance companies.
“If these mergers were to take place, the competition among insurers that has pushed them to provide lower premiums, higher-quality care and better benefits would be eliminated,” Attorney General Lynch told The New York Times.
The ACA was intended to increase competition among health insurers so that they would be pushed to offer better coverage at lower rates to consumers. However, the insurers have used their additional leverage through the law to jack up rates and maximize profits.
In the past regulators have stepped in to block mergers among large hospital systems and pharmaceutical companies when evidence showed that these consolidations could hurt the public. Likewise, anti-trust watchdogs are rightly stepping in to stop these two mega health insurer mergers because they could lead to decreased access to care and higher insurance premiums.
Squeezing profits out of patient care
Private insurers aren’t the only bad actors in the system. For-profit providers are also finding ways to funnel more money into their coffers instead of expanding access to quality affordable care. The healthcare industry is rife with corruption because of a flawed and loosely regulated reimbursement system.
NYSNA nurses know that for-profit dialysis companies usually have worse outcomes for patients. That’s why we fought and won a campaign to stop New York City’s public hospitals from outsourcing dialysis to a for-profit company with a history of providing subpar care. And that’s why we spoke out against another for-profit, Fresenius, that shut down clinics in high-need communities and refused to negotiate with caregivers.
One for-profit dialysis company found a way to multiply profits by subsidizing insurance premiums for patients who signed up for private payer insurance instead of relying on government programs. American Renal received less than $300 per dialysis session from government programs but around $4,000 from UnitedHealthcare. UnitedHealthcare sued American Renal Associates for referring patients to get help paying for private insurance.
In this case, two for-profit healthcare entities were fighting over how to make the most money — the insurance company by avoiding coverage for high need patients, and the provider by trying to multiply profits. The needs of the patients were never part of the equation for either corporation.
Meanwhile, insurance companies continue to bemoan the ACA because they haven’t been making the profits they were counting on, largely due to the fact that patients, who for many years were unable to access the healthcare they desperately needed, are now heading to the doctor’s office in unprecedented numbers. But years of lack of access to care has led to a population that seeks treatment for diseases in more acute stages, costing insurance companies much more than preventative care.
Further, pharmaceutical companies have few restrictions on how high their prices can go. Take the former Hedge Fund Manager Martin Shkreli, who increased the price of a key drug for treating a life-threatening parasitic infections by 4000 percent overnight. Another example is the new Hepatitis C drugs that cure the disease — something that all hepatitis C patient should have access to. But the pharmaceutical companies are charging sky high rates and insurers are going out of their way to avoid it, along with other specialty medications for chronic illnesses like Multiple Sclerosis. In fact, most of the insurance companies on New York State healthcare exchange flat out refuse coverage for specialty medications.
Increasing rates for consumers
Health insurance rates on the individual ACA market-place in New York State will go up by 16.6 percent starting in January, the biggest increase since the exchange began. Some patients will see their insurance rates go up by as much as 80 percent in 2017. Others will be shielded partially by government subsidies — which means that taxpayer dollars are being spent to boost profits of private insurers.
MetroPlus, New York City’s public option, is actually being forced to increase rates despite attempting to keep them low to preserve access to care. With another of the most popular plans on the exchange, Health Republic, going belly up and out-of-pocket expenses skyrocketing across the board, New Yorkers are running out of options for affordable care.
Mergers and consolidations by for-profit insurers is a step in the wrong direction. For-profit corporations have no place in healthcare. NYSNA nurses continue to fight for a single payer healthcare system that focuses on maximizing care instead of maximizing profits.