By Richard Ollis
Health insurance and health care as we know are both changing. A June Supreme Court decision regarding the Affordable Care Act and subsidies for health insurance, along with the 2012 decision regarding constitutionality, basically ensures that the ACA will survive in some form.
Anthem health insurance company has announced that it intends to buy rival Cigna. This news came just weeks after Aetna and Humana announced their potential merger. If approved, these mergers will create three big companies that will dominate the U.S. market, with United Health Group being the third.
What does all this mean for businesses and consumers as we deal with this massive shift?
1. There will be fewer options for insurance. Both businesses and consumers will see their choices dwindle. Three large companies will dominate the market place (Anthem, Aetna and UHC). A recent Wall Street Journal article found that after the mergers, a number of U.S. counties of Medicare Advantage customers will only have one option for insurance. The mergers will also remove competitors from ACA exchanges.
2. Plan quality and customer service could deteriorate. Many plans are already limiting their network of doctors and providers to reduce costs. Telemedicine, online appointments and 1-800 lines are replacing the traditional doctor/patient relationship. Sarah O’Leary, founder of Exhale Healthcare Advocates, says, “when consumers have less choice and the insurers realize it, cost of coverage, plan quality and customer service may be affected.”
3. Out-of-pocket payments could increase. Many plans are already changing plan designs into a more consumer-driven model. Doctor co-pays, deductibles, urgent care deductibles and emergency room deductibles are rising to both contain cost and make plans more “consumer driven.” ACA compliant plans typically offer higher deductibles and co-pays.
4. We will see unique health insurance options and boutique healthcare offerings. Businesses are already considering plans that are self-funded, partially self-funded or are banding together in associations or captive arrangements. These types of plans avoid some of the fees and provisions of the ACA. Direct primary care, where patients either access care at work or pay a membership fee to have access to a doctor, lab and some prescriptions, is becoming more popular. The marketplace will always react to a changing landscape.
5. Regulations are becoming complicated and burdensome. Pay-or-play, exemptions, calculating part-time employees and the individual mandate are just a few. The timeline for implementation of the ACA also continues to change. Becoming educated on all the mine fields is virtually a full-time job.
As this world of health insurance and health care evolves, one thing remains constant – the real objective is improved health. Wellness programs are evolving to include programming for stress, sleep, finances and life balance. The Wellness Council of America is changing its focus to include much more of a holistic approach to the health and well-being of America’s workforce.
The marketplace is beginning to offer more natural and homeopathic forms of healthcare, many not standardly covered by insurance. Massage, yoga, acupuncture and supplements are just a few examples.
Given the complexity of regulations, the changing marketplace and the new offerings available, it’s important to become educated and engage an expert for advice. With change comes opportunity, but only for those who understand the evolving landscape.
This article appeared in the September 20 edition of the Springfield News-Leader and can be accessed online here.
Richard Ollis is CEO of Ollis/Akers/Arney, a regional insurance and business advisory firm. He is a current member of the Missouri State University College of Business Executive Advisory Council. He also serves on the board of the Wellness Council of America.