Insurance Exec: Access To Care Is Up, But So Are Costs

Feb. 09--In the six years since the Affordable Care Act was signed into law, there have been gains in access to medical help and millions of dollars lost by insurers, the president of Regence BlueCross BlueShield of Oregon said Monday.

Continued discussion, implementation and reforms have created fatigue, Angela Dowling told a Chamber of Medford/Jackson County Forum at Rogue Valley Country Club.

Oregon has reduced the number of uninsured people to 8.8 percent, compared with 11.7 percent nationally, while market dynamics have created financial losses for health care firms, setting off a ripple of consolidation, Dowling said.

Not long ago 17 percent of Oregonians were uninsured, she said. Now that figure is less than one in 10. At the same time she noted a huge transition in her industry of mergers and acquisitions, including Portland-based Legacy obtaining Springfield-based Pacific Source, Indianapolis-based Anthem purchasing Bloomfield, Conn.-based Cigna, and Oregon Health Sciences University propping up MODA with a $50 million loan and acquiring a stake in the company.

"There's been a huge transition, a lot of consolidation, merger and acquisition," Dowling said.

ACA has created turmoil, creating $720 million in reported losses over a two-year period at United Healthcare. Even her own company struggled after posting a 4 percent gain last year, Dowling said, thanks to a strong third quarter and first- and second-quarter setbacks of $4 million and $13 million.

Even with large premium increases, carriers are losing money, she said. Part of the reason rates have skyrocketed, she said, is that new users have delayed treatment far too long.

"Unfortunately, you have a multiplying effect because they have multiple disease states that need to be managed," Dowling said.

She said all health care reforms proposed to kick in for the past 18 months have been postponed. The Cadillac tax slated to kick in during 2018, for example, has been delayed to 2020. Mid-market employers won't be grouped with smaller companies for another year or two, instead of this year.

"A lot of the things have been pushed out," Dowling said. "Unfortunately, it's from what I call exhaustion, and from that comes inertia. About 90 percent of employers made no moves over the last 18 months. They didn't want to change carriers, they just had enough and wanted to stay where they were at."

She said consumers need to educate themselves and collect information before spending money.

"Just because there's a new medication out doesn't mean it's necessarily a better medication," Dowling said. "There are about 4,000 medications that will be released in the next couple of years from the (Food and Drug Administration), and really about 20 percent of them are significantly better in performance than the drugs that are already on the market. But when you're watching TV and seeing those ads, they look great."

She said designer drugs often take a similar, existing generic medication at a lower level and make slight changes, then charge significantly more for it.

Presently, Dowling said, pharmacy prices are rising about 9 percent, but in two years that figure leaped to 20 percent.

She said patients need to be willing to push back when medication is prescribed, changing dietary and fitness habits and informing themselves of medication side effects.

Ultimately, she said the Affordable Care Act might be a misnomer.

"It should be called the Access Act, because there is really very little in health care reform that makes if affordable," Dowling said. "The thought was if we got enough people in and lowered the uninsured rate, it would take the pressure off some of the cost-shifting the the commercial market space. Unfortunately, we got a lot of people in, which is great. The challenge is, though, that population utilizes health care about three times more than everyone else because they waited so long to see a provider. Eventually, that will level out, and people will start to get healthier in that population."

Reach reporter Greg Stiles at 541-776-4463 or [email protected]. Follow him on Twitter at www.twitter.com/GregMTBusiness, on Facebook at https://www.facebook.com/greg.stiles.31

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