Barbara Morales Burke: No holes in coverage

December 23, 2013 

Ron Pollack’s Dec. 21 Point of View, “How the ACA will affect North Carolinians,” explained some of the benefits of the Affordable Care Act, such as new benefits and subsidies to make coverage affordable for certain consumers. But his criticism of cancellations and claims of “Swiss cheese insurance” leave out several critical facts.

Implementing the ACA’s provisions is – as expected – creating change and disruption, especially for those who purchase individual coverage. The problematic rollout of the federal website has exacerbated this disruption and shone a light on the cancellation of individual policies across the country. But what Pollack failed to point out is that those cancellations were a direct result of the ACA.

Purchasers of individual policies in effect before the ACA became law March 23, 2010, are entitled to “grandfathered” status, which means that if they like their plans, they indeed can keep them. But “nongrandfathered” consumers – those who purchased or changed policies since that date – were required by the law to switch to ACA-compliant plans, which include new taxes and fees, additional benefits (such as requiring maternity coverage whether wanted or not) and in some cases higher benefit levels. Those extra benefits and taxes lead to more expensive premiums for many.

Several weeks ago, President Obama announced that insurers could extend the policies of nongrandfathered customers for one year, and BCBSNC quickly exercised this new option in order to help our customers through this transition. However, this is just a one-year solution that delays the policy goals of the ACA while extending the period of disruption along the way.

BCBSNC has offered North Carolinians financial protection from medical costs for 80 years through a wide range of health insurance options. The fact that many of those plans offered coverage for pediatric dental and vision or maternity services (all of which are required by the ACA) as separate products or add-ons does not make those plans “Swiss cheese” as Pollack claimed. Rather, it made those plans more affordable and attractive to consumers who did not need or want that type of coverage.

Barbara Morales Burke

Vice president, Health Policy and Chief Compliance Officer, Blue Cross Blue Shield of North Carolina

Raleigh

The length limit was waived to provide a fuller response to the Point of View.

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