As published in the Wall Street Journal, regarding “The Aetna Mugging” (Review & Outlook, Aug. 18):
I believe we are confusing insurance with the moral obligation to get health care to people who need it. Both are vital to the long-term health of our society. But they are not the same.
In the last quarter, Humana and UnitedHealth have announced plans to pull back from markets where they participated in the federal health exchange. Last week Aetna announced its plans to withdraw two-thirds of its ObamaCare coverage as well.
While it appears that the current structure in the exchanges is not sustainable, there are options to stabilize the exchanges and get insurers back in. Centers for Medicare & Medicaid Services has made adjustments, but people are still able to access health insurance when they need it to pay for health-care services, and to cancel it when they don’t.
The basic premise of insurance is the pooling of funds from many to cover the costs of some. For insurance to work well, people need to be in and stay in the insurance pool. When too many people can opt in or out when they need to cover the cost of health-care services, there is no money left in the pool for those who have contributed all along. Premiums invariably go up.
We could place consumers enrolling during the Special Enrollment Period (SEP) into special risk pools separate from the federal health exchanges. These risk pools could be made available for this specific purpose, and be monitored and managed by insurers. Risk pools existed in many states prior to the Affordable Care Act and some states are considering reinstating them. Another option would be refundable tax credits, which are similar to paying for health insurance through taxes.
If we keep the SEPs, the federal government should find ways to better validate requests for them, or require that people prove their eligibility before insurance coverage begins.
We have a moral obligation to get health care to people who need it. But wreaking havoc on the exchanges’ members by charging them for these expenses is not the answer.