Insurance Is Personal

The ACA Is Here To Stay – So Let’s Get It Right

Insurance is often perceived to be all about numbers – premium calculations, assessing risk, analyzing claim trends, assigning monetary value to items, etc.

Insurance, however, is incredibly personal.

When an illness or injury takes over your life, it’s personal. When you or someone you love needs ongoing care for a chronic condition, it’s personal.

I understand it’s personal, because I’ve been there. My mother-in-law, Joyce, battled Parkinson’s until the end of her life. At the time, her pre-existing condition made private insurance market options inaccessible. So what option did we have? Luckily, at the time in the State of Wisconsin, HIRSP (Health Insurance Risk Sharing Pool) was an option. Implemented in 1979, HIRSP was funded, in large part, by the health insurance companies who did business in Wisconsin. Insurance companies contributed to the fund in proportion to the percentage of health insurance they sold in the State. And it was a viable solution for the uninsurable. We were able to secure a robust, affordable health plan to carry Joyce through extensive healthcare needs. As a first-hand consumer of HIRSP (on behalf of my mother-in-law), I have to say – it was a system that worked. HIRSP disbanded in March of 2014, overtaken by the Affordable Care Act (ACA).

My thoughts are now on the subject of the ACA and its public healthcare exchanges because insurance companies are required to submit their 2017 public exchange rates by June 1, 2016. The ACA eliminated the need for high-risk pools such as HIRSP by removing the factor of pre-existing conditions being a basis for denying coverage. The net result was combining high-risk individuals and low-risk individuals within the same risk pool for insurance companies.

The portion of the ACA that regulates the buying, selling, pricing, and benefit levels of health insurance – which came in with a bang and so much fanfare – is anything but settled. United HealthCare, the nation’s largest insurance company, has announced they will not be participating in the federal exchange in most states in 2017 because of cost and unpredictability of risk. What can we expect? Premiums are going up. Competition is going down as fewer insurance companies participate. The uninsured population is still too high. The federal government is not/cannot continue its subsidy to insurance companies for insuring high-risk individuals at low-risk prices. We have work to do…

Without going too deeply into where the issue of healthcare falls in the model of federalism, perhaps something so personal should not be too far removed from the people. While the federal government needs to be involved in making it work, so do the states; so do insurance companies and people on the ground in the insurance industry. Making it work may mean reinvigorating older models (like HIRSP). HOW we are going to accomplish something is always tough – and the ACA will be bumpy in years to come. We haven’t solved the issues and we’re going to hear about it. Let’s all work to make the goal of the ACA (affordable access to health insurance for everyone) viable and solvent in the long run.

I urge you to stay involved in the conversation. Step up, and help do the work.
Insurance is personal and this affects you – take it personally.

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