Let us be clear on one thing: the Affordable Care Act, for all its shortcomings, has successfully allowed more Americans to access medical care services than ever before in U.S. history. That said, it was a compromise, and is no substitute for the same guaranteed right to health care enjoyed by citizens in virtually every other industrialized nation on earth.
One shortcoming of the ACA is that while the law has made health insurance more affordable for most people, it has not prevented predatory behavior by insurers and other corporate entities that have nothing to do with the actual delivery of health care but are continuing to find loopholes in the law in order to bleed consumers dry.
In Clark County, Washington, just north of the Columbia River from Portland, Oregon, a local newspaper recently published a story highlighting the problem. Last year, in Vancouver a 60-year-old woman experiencing serious symptoms went to an emergency room at her usual hospital, only to be told that there would be a five-hour wait. She and her husband then decided to go to a different facility that was in her network and offered faster emergency care.
What the woman and her husband did not realize is that when they updated their insurance plan during the renewal period their new plan did not include the second hospital in their provider network – until they received a surprise bill for over $22,000. She was not the only one. Another woman from the small community of LaCenter was hit with a $100,000 “balance bill” after having her son treated at an “out of network” hospital. She wound up having to refinance her home in order to pay it. A third woman from the town of Washougal received a $227,000 bill after she was transferred from her “in-network” hospital to the Oregon Health & Science University for heart surgery.
All three of these people said the same thing: they all had health coverage but had not been informed that the facilities at which they received treatment were “out of network.”
Legislators in Olympia are attempting to pass a bill that would protect consumers from this kind of “surprise medical bills.” If signed into law, as seems likely, the bill would require insurers to cover emergency treatments and surgeries, regardless of whether or not the facility or the attending physicians are “in-network.” Unfortunately, the problem is not limited to the state of Washington.
In an article appearing in the Vancouver Columbian, Washington State Insurance Commissioner Mike Kreidler was quoted as saying that while the network issue “had the effect of really punishing some people unfairly,” he believed it was a “systemic problem in health care,” not “greed and malice and forethought on the part of the hospitals.” While this is probably an honest assessment of the actual facilities (though perhaps naive in light of all the outsourcing in emergency rooms that has contributed to the problem), it certainly does not apply to the parasitic insurance companies.
While subsidies and maximum out-of-pocket (MOOP) limits under the ACA have certainly helped consumers, the law has not addressed the problem that is at the root of the dysfunction of the privatized, for-profit U.S. health care system. Research commissioned by the non-profit research firm Physicians for Fair Coverage (PFC) has found that since 2014 insurance companies, prevented by law from denying coverage for pre-existing conditions, have been protecting their exorbitant profits by limiting patient access to specialists, raising deductibles and MOOP limits, and increasing their premiums far more and much faster than similar markets such as Medicare and employee-sponsored health care plans.
Another part of the problem is the practice of outsourcing. A growing number of hospitals have staffed their emergency rooms with out-of-network physicians through companies such as EmCare. This company has one unstated objective: to squeeze as much profit out of patients while delivering as little as possible. In 2017, the New York Times reported prior to outsourcing through EmCare approximately 6 percent of emergency room patients were billed for the most expensive services. Since EmCare began staffing emergency rooms, that figure has gone up to almost 28 percent – and since those physicians are “out of network,” insurers will not cover their fees.
Currently, PFP, which is a coalition of tens of thousands of physicians and medical specialists, are working at the state level by pressuring lawmakers to pass laws like the current bill under consideration in Olympia. That may indeed help ease the worst of the symptoms but will not cure the disease that is private corporate, predatory, profit-driven control of the U.S. health care system.
The woman who wound up going to OHSU for her heart surgery and wound up with a surprise bill for $227,000 told a Columbian reporter that her attending physician had said that she had “one foot in the grave,” and that he had literally saved her life. But then, in light of her surprise bill, she added, “If I would have been given the option, I would have said ‘Pull the plug now.’ No ifs, ands or buts.”
This is what we have come to in this nation – a society and a culture in which people are ready to sacrifice their own lives rather than face the economic consequences of being saved. It is a disease from which the nation is suffering, and the only real cure is to remove control of our health care system from the private sector and institute Medicare for All.