There’s nothing scarier than the phrase, “I’m from the government and I’m here to help.” Apart from the newer version that you’ve probably started hearing lately, it’s something like this: “I’m an out-of-state insurance salesman, and I’m here to help, too.”
Premera Blue Cross Blue Shield, the Seattle-based insurer that has a near monopoly on Alaska’s health insurance market, boasts more lobbyists (three) than employees in its Anchorage office, but still They haven’t stopped working hard: repeal the rules that have protected Alaskans for nearly 20 years. The 80th percentile rule, a long-standing consumer protection provision that requires insurers to pay local medical costs rather than arbitrarily low amounts that the rest are forced to pay, was recently expanded after extensive lobbying and marketing by Premera. Abolished.
Jim Glazko, Premera’s Seattle-based market manager, said in a recent opinion piece full of misleading statements and omitted details that Premera is providing this “assistance.” He said the move is not to increase profits, but rather to protect Alaskans from overpaid nurses. And expensive mammograms. As an example, Premera claimed that health care costs in Anchorage are the same as in San Francisco. Even if that applies to medical care, it does not apply to health insurance. According to KFF, an independent health policy organization, A Silver plan for a family of four costs 41% more in Alaska than in San Francisco.. You’ll pay $9,360 more per year in premiums to cover the same amount of medical expenses.
The 80th percentile rule is important to all Alaskans, even those covered by Medicare or Medicaid. The 80th percentile rule, adopted in 2004, requires insurers to share health care costs fairly and helps balance Premera’s monopoly power in Alaska’s health insurance market. Without it, Premera will decide winners and losers for the health care system, reducing the number of “in-network” providers and facilities and privateizing its costs through higher “out-of-network” copayments. This will be passed on to consumers. , deductions and balance bills.
Meanwhile, health care providers are increasingly losing out in this game of new rules, being forced to retire or leave the state. reducing the number of health care providers caring for Alaskans; Premera claims that eliminating the 80th percentile rule will reduce billings for health care providers and hospitals. That’s simply not true. It’s just like in the “good old days” before 2004, when rules were put in place to stop exactly this type of predatory behavior by insurance companies, when patients still have to pay the balance on their bill. It only means that.
Competition drives down prices, and this applies not only to pencils but also to health insurance. Although no recent and authoritative studies have pinpointed the 80th percentile rule as the cause of rising insurance prices, Premera is seizing the opportunity to gaslight the medical community as the cause of Alaska’s rising insurance prices. yeah.
Ann April 2022 Insurance Price Survey A study by the Urban Institute and the Robert Wood Johnson Foundation found that “the number of competing insurance companies mattered.” Interestingly, the presence of a single carrier means that premiums are, on average, $189.50 higher per month compared to markets with five or more carriers. “Presence of a Cross Blue Shield insurance company” was associated with a higher than average presence. Benchmark insurance premiums. ”
There are only two insurance companies in Alaska’s individual market: Moda and Premera. To make matters worse, Blue Cross Blue Shield insurance company Premera controls much of the Alaska market.
Moda is trying to compete in Alaska’s insurance market by offering lower premiums and other means. Unfortunately for Alaskans, these lower prices have been rejected by the Alaska Department of Insurance every year for the past two years, forcing Moda to charge higher premiums than Alaskans would like.
In recent testimony before the Alaska State Senate, Insurance Department Director Rory Wingheier said, “The most important thing we do at the Insurance Department is make sure that insurance companies are solvent.” said. This is not to increase competition or stability by recruiting more insurers into a very narrow market, but to protect insurers’ profits. Let’s understand that.
Perhaps this explains why the Department of Health has been artificially increasing the price of health insurance for Alaskans for the past two years. They are concerned about Moda. Large company with annual operations of $1.3 billion or more in multiple statesSelling insurance to Alaskans at prices Moda’s actuaries can calculate could bankrupt them.
Premera and its predecessors have been selling insurance in Alaska since 1952. The term “regulatory capture” has been coined, but over time, government regulators can become familiar with the companies they regulate, accept their statements as fact without auditing or investigating them, and potentially make unwarranted decisions. there is. Their faces have an arbitrary and irrational look to them.
We would like to have Mr. Glasco visit Alaska, and perhaps involve the Department of Health, to talk publicly about the 80th percentile rule and Premera’s misleading claims and see if there is a way to do so. . Help us make life better and healthier for Alaskans. For example, reforming the 80th percentile rule to further reduce costs, incentivizing providers to accept Medicare, Medicaid, and VA benefits, and ensuring seniors and veterans receive the health care provider of their choice here in Alaska. I can arrange to meet you. In the meantime, Mr. Premera, please help me a little more.
john morris from the University of Anchorage is a board-certified pediatric anesthesiologist and president of the Coalition for Trusted Healthcare Access. rick david The Anchorage native is the founder and chairman of the Alaska Roundtable. david morgan of Anchorage is a Fellow of the Healthcare Financial Management Association. Dr. Stephen Compton of Anchorage serves as president of the Alaska State Medical Association.
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