It’s a pretty safe bet that health care and health insurance will be among the hottest business stories of 2013, with new provisions of the Affordable Care Act kicking in, as well as some of its limitations getting more scrutiny now that the Supreme Court has upheld the law.
For example, check out the Sunday New York Times piece about rising insurance premiums; some medical insurers are posting double-digit increases, with small businesses and individual policy purchases being hit the hardest.
The story attracted hundreds of online comments, many from people saying they couldn’t afford insurance, which has always seemed to me one of the big holes in the Affordable Care Act; even if insurers must now (or rather, starting in 2014) accept people with pre-existing conditions, what’s to prevent them from charging exorbitant premiums?
There are some price protections in the ACA — for example, the one that requires insurers to spend 80 percent of premiums on medical care, or issue rebates, which they did this year to the tune of $1 billion. Also in 2014, subsidies will kick in (tax credits and out of pocket help) for those who make up to 400 percent of the federal poverty level; this U.S. News money blog offers a concise explanation of how it will work. Here’s a University of California-Berkeley Labor Center calculator that also offers some interesting insight.
The subsidies will help many people but not necessarily families making over median household incomes. It’s probably worth talking with your state’s insurance regulator and with executives at major health care plans (those used by your area’s largest employers, for example) about how rate increases are approved and calculated; as Healthcare.gov, the official ACA site, admits there are many plans grandfathered exempted from the “rate review” aspect of the ACA that requires plans justify annual increases of 10 percent or more.
Ask about your state’s rate review policies and what curbs there are, if any, on premium increases. Here’s a rcent Kaiser Family Foundation report that will help you understand the process; it appears to indicate that double-digit rate increase requests, at least initially, fell since the passage of the act. Do regulators and insurance companies in your area expect that trend to continue?
Meanwhile, on a different note but still related to health care costs, I was intrigued by a recent Detroit Free Press article “Hospitals react as Medicare reimbursements influenced by patient satisfaction surveys.” The article, which subsequently ran in other Gannett publications, is rich in detail about efforts by hospitals to improve the patient experience, from abating noise to keeping pre-op patients warm. Because Medicare reimbursement rates to these providers will hinge in part on patient satisfaction, institutions are increasingly responsive to patient concerns.
It’s a very reader-friendly and timely article, with the results of the Centers for Medicare and Medicaid Services patient satisfaction survey now up on the Medicare.gov website. You can report the results for the medical centers in your area, and talk with hospital administrators about how they are working to improve their scores. To find scores for your area, visit the Hospital Compare website, do a ZIP code search and then for each institution, click on the Patient Survey Results tab for scores and how they compare to state and national averages.