The U.S. Department of Health & Human Services finalized on Feb. 22 the five key consumer protections which the Affordable Care Actwas designed to address. As I have stated throughout this series, I expect there to be continued revisions to the ACA before it goes into effect on Jan. 1. Now that almost all the states have selected either to offer a State Insurance Exchange or a Federal Health Exchange, it is time to focus on the actual rates that will be offered to residents. Since North Carolina has elected to go with a Federal Health Exchange, rates should begin to be available by late August or early September. I have seen some early reports on what some insurance companies would like to offer residents. As of this moment, I am classifying these as a wish list for the insurance companies. HHS has directed all insurance companies participating in any insurance exchange to report on every rate increase requests. Once there is solid information on what is happening in North Carolina, I will share those facts. Once again, even though coverage begins Jan 1., North Carolina residents will be able to select the coverage of their choice on Oct. 1.
As of this week’s article, the HHS final rule on the five key consumer protections of ACA is officially in effect. The five provisions are: Guaranteed Availability; Fair Health Insurance Premiums; Guaranteed Renewability; Single Risk Pool; and Catastrophic Plans. We will focus on two areas that I have been asked the most about — Single Risk Pool and Guaranteed Availability.
First, the Single Risk Pool addresses the practice of insurance companies creating separate pools for various covered people. It is common for states to have several different risk pools for high risk, or pre-existing conditions. A risk pool could be structured to treat all illnesses except a specific condition such as diabetes or cancer. In this separate pool, these types of conditions were just gathered together and charged extremely high rates — in some cases, triple what a healthy person paid. Under the ACA, that practice stops and all individuals within a state will be in one large pool, which will help make the rating process easier and in theory make rates more affordable. I do have some reservations about the theory.
The second, Guaranteed Availability, means no one can be declined. Currently, any health insurance company can decline a person for coverage. If a person has or had cancer, diabetes, or a heart attack in the last two years, most likely they were declined health insurance coverage. Under the ACA, this practice will disappear as well. When you factor in the Single Risk Pool with Guaranteed Availability, a person who does have health problems has a very strong advocate. For example, a person with cancer applies for family coverage, this is the type of scenario they would be facing. A family of four with one member who had cancer two years ago would be facing a premium of $2,400 a month with a very high deductible. Under ACA, the premium will be less and there would be no additional premium increase because you were high risk. Under thhe other scenario, there is a high probability this person would have been declined coverage because the cancer was recent.
Darek Hunt, a Lumberton resident, has his master’s degree in Public Policy and Administration and is a doctoral student in Health Sciences. He specializes in health care administration and health policy.