A Health Insurance Plan Change That Will Hurt Many

Photo by wistech colleges

{ublished in ChicagoNow, October 13, 2015

Let’s put some real faces on the decision by Blue Cross Blue Shield of Illinois (BCBSIL) to eliminate its most popular PPO plans in favor of something BCBSIL is calling Blue Choice. As of January 2016, they are eliminating the plan that covers a mother who is a breast cancer survivor. She has already incurred $250,000 in medical bills to fight her aggressive cancer. None of her medical providers are in Blue Choice, the alternative the company is offering for people who have to buy their insurance from the exchange. So, her “choice” is to get all new providers or go bankrupt trying to keep her current doctors. She worries that choosing a less skilled provider for her cancer treatment could result in her death.

How about the face of a young girl who almost died from anorexia last year? Her BCBS PPO plan was the only one her therapist and the hospital accepted. Now where does she go if she needs to be hospitalized? Will she have to give up the therapist who saved her life and just see a random person covered by her new insurance plan to treat her illness?

Now picture a boy with autism. It’s not hard to do, as one in 68 children are diagnosed with Autism Spectrum Disorders. Yes, his therapy is costly, but his parents would gladly stop making insurance claims if their child did not need treatment so badly. They know that early and intensive intervention makes life-changing differences for their son. In a typical week, he sees several therapists: speech, occupational therapy, augmentative communication, and ABA home sessions. That’s over ten hours of therapy in addition to school. The help he needs is so specialized, and the special education staff at his school is often untrained in the type of educational support he requires. So those ten hours of therapy are his only hope for becoming a productive member of society. His parents would have been willing to pay higher premiums, but were not given the choice. Instead, BCBSIL will offer them Blue Choice. Blue indeed. Choice? Not so much.

According to the Chicago Tribune, the Blue PPO plans are being eliminated because they cost BCBSIL too much money (translation – they don’t make enough profit). For now, employer groups may still offer the plans, but who knows how long that will last? What this means is that the 173,000 folks who have paid their premiums in good faith will have to find a new plan. And these people will likely be forced to find new doctors and go to different hospitals if they stay with Blue Cross. While the old PPO plans included every hospital in Illinois, the substitute Blue Choice plan currently includes only 73 hospitals in the state. Not included: Northwestern Memorial, University of Chicago Medicine, Rush University Medical Center, the Advocate Health Care system and the North Shore University HealthSystem.

Many families will have to choose between being able to use the therapists and providers they currently have or the doctors and hospitals in their community. For people who are sick, folks with those pre-existing conditions that by law must be covered, changing doctors is often a matter of life or death. For children in treatment, changing therapists would be a disaster. These patients currently have providers who are highly skilled and specialized in treating them. They will be forced to make impossible choices. Even if they are able to afford some out-of-pocket costs for the care they need, paying all of the bills will be impossible for most people.

Blue Cross spokeswoman Mary Ann Schultz tells us, “The amount of rate increase that would have been needed to cover the costs of the broad PPO would have been too high to justify offering it to the market.” So even if customers were willing to pay a higher premium, they are not being given that choice. Instead, they get Blue Choice.

Illinois Congresswoman Jan Schakowsky shared the concern of her constituents who purchased health insurance through the Marketplace that this proposed change by BCBSIL will deny people access to their doctors and hospitals. In a letter addressed to Anne Melissa Dowling, Acting Director Illinois Department of Insurance, Schkowsky states in part,

“I am very concerned about this because the current Blue Choice PPO has an extremely limited network of providers and hospitals in the area. As you know, the Patient Protection and Affordable Care Act established a network adequacy standard requirement that there be sufficient numbers and types of providers so that covered services are accessible without unreasonable delay. My understanding is that Northshore, Advocate, Northwestern, Lurie Children’s hospitals, and most of the doctors affiliated with those hospitals, do not accept the Blue Choice plan. That would mean that none of the major hospitals in my district – or their affiliated doctors -would be included in the BCBSIL network and I do not believe that meets the PPACA standard.”

She goes on to state that consumers will be automatically enrolled in Blue Choice if they do not choose another plan, resulting in enormous out of network costs to them if they continue to see their doctors. She also points out that the Get Covered Illinois budget that funds counselors who help people choose insurance plans has been cut by 75 percent. So, in less than a month, people will have to navigate the Marketplace on their own to find new plans that may only partially meet their needs.

I’m sure this is not what was intended when the Affordable Care Act (AKA Obamacare) became the law of the land. But I’m not surprised it happened. Insurance companies like Blue Cross can afford to hire very smart people to figure out how to make the greatest profit off of sick and helpless people and children with special needs. As long as we continue requiring companies to provide healthcare to employees, we will relegate people who are self-employed, independent contractors, or employees of very small businesses to having much inferior coverage.

Equal access to healthcare should be a right in this country. To make health insurance work, everyone has to get in the same pool. Why are insurance companies allowed to get away with this?