What Changed?

It is entirely fair and reasonable to ask, “What changed?”  What is the difference between purchasing a health policy now in July 2021 vs. twelve years ago in 2009?  And yes, there are significant differences.  Here are a few:

  • Insurance Companies in our market
  • Insurance Products
  • Who can purchase insurance
  • When you can buy a policy
  • Insurance premiums

We once had lots of insurers.  Now there are only a few in each area.  My market is the State of Ohio, but my friends from around the country report the same thing.  Some states only have one or two insurers offering comprehensive major medical coverage.  Major insurers with well-known names abandoned entire states.  Some, like Anthem Blue Cross, have started to reenter the individual health insurance business in selected counties.  They carefully pick their spots and severely limit the doctors and hospitals in their networks as they search for a way to make this segment of the industry profitable.

This leads us to the next big change.  Most of our policies in 2009 were PPO’s, Preferred Provider Organizations that provided access to doctors and hospitals around the country.  All of our current policies are HMO’s.  Our clients are limited, except in the case of an emergency, from accessing care outside of a very narrow network.  This is done to control costs.

Our 2021 products are more comprehensive.  The Patient Protection and Affordable Care Act (Obamacare) requires all policies to include the ten Essential Health Benefits (EHB):

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance use disorder services
  6. Prescription Drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services
  10. Pediatric services

It may seem sound odd now, but in 2009 women had a difficult time finding a policy that covered maternity.  Mental health treatments, doctors’ visits or medications, were excluded or severely limited in many of our policies in 2009.

The Who and When are the reasons for today’s post.

Arnold (name changed) has finally decided to devote himself full-time to his business.  He had been operating it for several years as a “side-hustle” while working in a totally unrelated field.  His job gave him security and health insurance.  His business allowed him to explore both his creativity and his full potential.  COVID made the job less and less secure.  And now is the time to jump.  He was in my office today to get health insurance.  If this had been 2009, I would have welcomed him into my office and started the process.  There wasn’t an Open Enrollment Period in 2009.  He could apply at any time.  I would have asked him a lot of questions about his health, occupation, hobbies, and driving record.  And then I would have apologized after explaining that we were not going to be able to secure coverage for him through normal channels.  The problem is that Arnold has a few interesting medical conditions and he weighs 300 pounds.  Health insurance was one of the main reasons that the Arnolds chose to work jobs with benefits and weren’t able to create new businesses in 2009.

Today is July 29, 2021.  Arnold’s previous employer has yet to provide him with the needed documentation proving that his group policy has ended.  That isn’t a problem because this administration created a special enrollment period from March 15, 2021 to August 15, 2021.  For Arnold the big question was whether he wanted the Medical Mutual of Ohio policy that gives him access to the University Hospital System or the Cleveland Clinic + Oscar policy.  The policies are guaranteed issue and preexisting conditions are covered.  The entire process took only a few minutes.

The last change is the cost.  Obamacare created Tax Credit Subsidies to help individuals and families earning less than 400% of the Federal Poverty Level pay for their premiums.  President Biden has expanded that benefit.  Are premiums higher in 2021?  Of course.  Wouldn’t it be odd if you could improve the benefits, insure anyone, and cover preexisting conditions without increasing the price?

Are we better now than we were in 2009?  As always, it depends on who you ask.  If you were a very healthy, young, single male in 2009 your coverage would have been a whole lot cheaper than your 2021 counterpart.  If you are Arnold or one of the 50 million Americans with preexisting conditions, health insurance, the way most Americans access and pay for health care, is a lot better today.

My opinion?  I want Arnold, every Arnold, to fully explore his/her creativity.  Access to insurance should never stand in their way.



Picture – I Was So Much Older Then – David L Cunix

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