As next round of ACA enrollment starts, understanding rate hikes, revolving doors

When many North Carolinians opened their mail this week, there were probably gasps, groans and shock as the state’s health carriers delivered the 2016 Affordable Care Act renewal rates just in time for open enrollment that begins Sunday.

ACA rate increases are expected to be about 30 percent, but many families and older individuals could see their renewals increase as much as 50 percent. These rates weren’t low to begin with, so the increases will be alarming. I will have to explain to families that, without federal subsidies, their premiums could be more than $1,500 a month.

The blame game for high health care costs is being played everywhere you turn – it’s because of the federal government for enacting this law, doctors who are compensated for their life-saving skills, hospitals that buy multimillion-dollar medical devices to improve surgical outcomes and the 10,000 baby boomers who turn 65 every day. What else can be fueling this increase?

An ACA bronze high-deductible health care plan costs 55-year-old Mike about $500 a month. Mike signed up for health coverage during 2015 open enrollment and, because there are no pre-existing limitations, immediately had coronary artery bypass surgery. The estimated cost of the surgery is $39,888, and Mike pays his deductible, out of pocket maximum and premiums for six months, adding up to $9,350.

While Mike is recovering, his medication from just one name-brand drug costs upward of $500 a month while insured. Doing the math, it would seem that the insurance companies are not making as much as one assumes.

Mike now feels better and cancels his plan mid-year. He pays a third of the annual shared responsibility tax penalty for not having health coverage for more than three months.

This year, 60,000 people in North Carolina filed $34 million in claims and canceled their coverage mid-year, just like Mike. Part of the large rate increase is because of the lost premium dollars this represents. Under the current ACA eligibility rules, we’ve created a revolving door that more will spin through in 2016.

There are no simple solutions, but one thing that you can do is voice your concern with your elected officials in Washington. Here are some questions to consider asking them:

▪  How do we safeguard the ACA open enrollment process so we share equally in the sustainability of the law?

▪ Why isn’t our government using its collective buying power to negotiate the price of name-brand drugs?

▪  Other countries place caps on the cost a hospital can charge for a particular surgery, why aren’t we doing the same?

Even if you have great health coverage now, this issue affects you because the business owners who pay these higher rates will have to increase the price of their goods and services. There will be less eating out and more staycations. Our elective officials need to hear about the sacrifices you’ll have to make to keep your family insured.

Unless we vocalize our concerns, our congressional representatives will not focus on this issue. It’s going to take collaboration and sacrifice from everyone. Perhaps real change can come as we face these health care challenges together.

This story was originally published October 29, 2015 at 5:28 PM with the headline "As next round of ACA enrollment starts, understanding rate hikes, revolving doors."