11/30/2015    Brian Kashan, DPM

UnitedHealth May Withdraw From ACA Exchanges in 2017

I may have a distorted view on this topic, but I
find it interesting that the pretense of the ACA
was that ALL individuals were supposed to
participate or be “fined”. The theory that
healthy individuals would not utilize care, but
would pay into the system, is a basic premise of
all insurances. Spread the risk, and have as
many people not use the system as possible. In
order to make people join up, they would be faced
with a penalty for not doing so. However, when
the penalty for not signing up is less than what
signing up would cost, the incentive is reduced.

Insurance companies scrambled to be a part of the
ACA. No one knew if it would be a boom or bust.
To protect themselves, and try and capture as
much business as they could, the players lined
up to get their piece of pie. I can see how they
would think the gamble would be worth it, as the
risk-benefit seemed worth taking a chance. After
a year or 2,they would have a better picture on
what was working and if the system could be
profitable. The government depended on them in
order to sustain the ACA. The foundation of what
the ACA needed to work was patients and insurance
companies.

So why did the government decide to only penalize
patients for not participating? They allow the
insurance companies to leave with no penalty. UHC
stood to make billions of dollars and would not
have had to pay the government for its profits at
all. But if it feels it isn’t worth
participating, it is allowed to walk away free
and clear with no penalty.

As other carriers evaluate the ACA, there will
surely be an exodus of players, leaving those
remaining to increase pricing significantly or
leave ACA as well. So what happens next? Maybe
another government bailout whereby we actually
have a one payor system, the good ole USA, now
stuck with insuring everyone and creating a huge
entitlement program with massive underfunding and
poor service.

My point is that if an insurance company agreed
to participate in the ACA, they should be
mandated to remain in for a minimum amount of
time, say 5 years, or pay a penalty to get out.
Penalties are always levied against the public
and rarely against the insurance world. Patients
and providers are constantly being penalized, a
la PQRS, MU, etc., while the insurers continue
their increased premiums, reduced benefits,
increasing deductibles, and ridiculous denials
for services in order to maintain their billion
dollar profits.

Brian Kashan, DPM, Baltimore, MD

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