This month, midterm voters identified healthcare as the “most important issue facing the country.” This should come as no surprise, as consumers continue to pay higher prices for their health insurance. One recommendation for the new Congress and administration is to bring more accountability to the healthcare system after years of government overreach and broken promises. The place to start is health insurance companies.
Insurers are some of the largest and most powerful private companies in the U.S. economy. They leverage their size to increase profits for themselves by forcing more costs onto consumers. Insurers typically do this by increasing premiums or deductibles for patients, saddling consumers with higher out-of-pocket costs for routine care.
A recent Bloomberg expose highlighted the effects that these increases have on the average family, profiling families whose monthly costs for mother and daughter increased to “$1,060 from $750 — an additional $3,720 per year” for their family plans, forcing the family to take out loans and lines of credit to pay off their bills.
It’s no surprise that consumers consistently rank insurance companies as among the “least satisfying” companies to deal with.
In fact, insurers’ work to reduce care and increase costs to patients extends beyond plans all the way to hospitalizations. In a widely condemned policy, Anthem has begun to deny emergency room fees for patients whose conditions were later deemed “non-emergent.” The policy saddles patients with exorbitant fees and, if rolled out nationwide, could affect as many as one in six emergency room claims. Worse, studies found the policy to be “unreliable,” as patients were unable to authoritatively determine if their condition could be “non-emergent” and would force them to “weigh[ing] the risk of delayed treatment for severe disease vs an uncovered medical bill.”
And, unfortunately, these trends are only expected to get worse due to consolidation in the industry.
Multiple “mega mergers” between insurers and pharmacy benefit managers promise to completely alter the healthcare landscape. Some of the largest insurers, Aetna and Cigna, are in the end stages of merging with some of the largest PBMs, CVS Health and Express Scripts, respectively.
Multiple studies have found that consolidation in healthcare markets, including in the health insurance market, drives up consumer prices. In fact, a study by the Brookings Institute found that this consolidation directly contributes to price increases, stating, “Consolidation in the health-care industry, for instance, has meant that for some patients, the cost of routine health services have increased by as much as several hundred percent.”
It’s important to note that this isn’t academic bluster. The American Medical Association strongly rebuked the approved Aetna-CVS merger, stating that “The AMA worked tirelessly to oppose this merger and presented a wealth of expert empirical evidence to convince regulators that the merger would harm patients…Patients are better served by promoting competitive health care markets.”
The new Congress has an opportunity to transform our healthcare system by introducing market forces and transparency to bring down wasteful spending and increasing costs.
Congress has an easy target in the bloated and consolidated health insurance industry and should respond to voters’ mandates. It’s an opportunity they will not get again and, if they learned anything from the previous Congress, one that they should seize.