ObamaCare… the Great Rate Hike … and Collections

By Laura J. Lowenstein, Esq.                                   

Come 2016 every individual enrolled in an ObamaCare exchange plan will be suffering from a wave of sticker shock. Insurers have been quietly putting in their rate requests for 2016 and, by the looks ofObamaCare it, they range from modestly high increases to “why don’t you just punch me in the stomach” kind of increases. Some rate hike requests fall upwards of 50%.

The Obama administration has tried to assuage fears by assuring those enrolled – and those
considering enrollment – that state insurance commissioners will never approve rate hikes anywhere near those requested figures. Yet, hard evidence is proving the administration’s theory wrong as the rate hikes are recognized to be necessary given the older and sicker patient pool that currently comprises ObamaCare. In fact, a recent analysis found that almost one-third of all plans sold through the Federal exchange, which covers 36 states, have approved rate hikes in the double digits. To make matters worse, the resulting premium increases will not correlate to widening networks or diminishing patient-pay responsibilities. Deductibles, co-insurance and co-pays will remain elevated and networks will continue to trend tighter as more physicians turn away from accepting these plans.

So where will these rate hikes take us? A safe prediction is away from ObamaCare. In fact, the latest report from the Centers for Medicare and Medicaid Services finds that 2 million fewer people were enrolled in ObamaCare exchange plans then the Obama administration had touted this past Spring. If that downward enrollment trend continues, the diminished enrollment figures will likely take an even steeper dive as the new premium figures roll out in 2016.

Unfortunately, for those 9.9 million Americans already enrolled, their costs are going to climb, their networks are going to stay narrow and the cost-shifting trend to patients will likely remain. And, as ObamaCare loses steam, the vacuum will likely be filled with new insurance products and plans that will hit new cost highs even though their networks and coverage may be more palatable than an exchange plan. It, thus, appears, that the days of the $20 co-pay are a relic of the past and the new reality post-ObamaCare (or even post post-ObamaCare) is one where medical decision-making and cost-analysis will be inextricably linked from primary care to emergency care to elective surgical decisions.

Physicians and medical facilities recognize this new reality and many have already implemented tighter financial policies and controls. Some States have intervened in the name of “consumer protection” by trying to legislate cost-shifting away from patients in certain circumstances. An example of this being New York State’s Emergency and Surprise Bills Law, which came into effect in April of this year. Yet, no legislative mandate will stop the trend towards higher medical costs and, in the end, patients will need to understand their plans, shop around and recognize that having insurance does not equate to having minimal out-of-pocket expenses.

As a collection agency that specializes in medical debt, we hear every reason as to why someone thinks they should not owe $X amount to their doctor or hospital because “they have insurance” but, as we point out, claims are papered, Explanations of Benefit and subscriber contracts are clear, invoices are registered before sent and in-take financial policies are tighter than they have ever been so if you choose not to pay your medical bills, you may just find yourself in collections. Even though medical debt is one you may not have chosen or expected, it is usually one you owe and are best advised to work out and plan for in this new ObamaCare world.

For more information on Capital Resource Management, Inc. and how we help physicians and facilities generate revenue through better financial practices and HIPAA-compliant collections, please contact us at 1-844-277-3277 (ARREARS).

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