Too many consumers of health insurance are accustomed to an unpleasant annual ritual: When autumn rolls around, letters arrive carrying significant increases in monthly premiums, and health care coverage that was already unaffordable for many becomes even more so.
For Marylanders buying their own health insurance, the news is better this year. For the first time in decades, individual insurance rates have decreased year over year. Premiums are lower across the board, and consumers should closely examine their options for 2019. In some cases, switching from a PPO (preferred provider option) plan to an HMO (health maintenance organization) plan could save consumers over 40 percent while providing comparable access and coverage.
A collaboration between the governor and the General Assembly led to a new law providing premium relief to Maryland residents, and the reductions are significant. But they will be temporary unless the health care community and the state take decisive steps to ensure long-term affordability. We have a window of opportunity to stabilize the individual insurance market, and it is our shared responsibility to seize this moment. As legislators, regulators, health policy experts, insurers and consumers examine next steps, we should work to make coverage affordable and truly accessible to all. Health insurance should not be so expensive that Marylanders opt to go without coverage or are forced to decide between health care and paying daily living expenses. The path forward requires investment to improve community health while reducing the actual cost to deliver care.
Meaningful change requires innovative thinking and new technologies that challenge how care is experienced and engages consumers as part of the solution. Health care providers and insurers must collaborate on behalf of the consumers we serve to promote individual and community well-being, identify those at risk to prevent or halt advancing illness, and best manage the care of those with existing illnesses.
As we grapple with long-term affordability, there are incremental measures we can take to help reduce overall costs. Continued funding for the program that made this year’s premium decrease in the individual market possible will be an important first step.
While advances in pharmaceuticals have improved the lives of many, prescription drug costs are rising at an alarming rate and now represent the single largest component of health care expense. Rising drug costs must be reined in while allowing for continued research and development. This will require the combined efforts of all public and private participants in the health care system.
Health care supply must be tuned to best serve the needs of the community. Choices must be responsive to people’s reasonable expectations of access, quality, convenience and affordability. With these principles in focus, health care networks and payment arrangements should be based on higher quality and improved outcomes. This approach has been embraced by many health and public policymakers and is increasingly common across the country. Such arrangements foster much-needed communication and collaboration among physicians, health systems and insurers, while improving care, reducing inefficiency and helping consumers access appropriate care in cost-effective settings.
As the challenge of affordability is addressed, we must return to a thoughtful discussion on participation. While the Affordable Care Act (ACA) mandated that individuals buy health insurance, the federal penalty for not doing so has been eliminated. The purchase of health insurance is an investment in well-being and having coverage before the onset of acute or chronic illness can improve health outcomes. Spreading risk across everyone who is insured makes affordability possible for the oldest and sickest in our communities. Several states and the District of Columbia have opted to address the mandate at the state level to encourage people to enter the market. We should consider similar action in Maryland.
Broad participation from the health insurance community will be necessary as well. Insurers who selectively choose to participate in some, but not all, insurance markets must be called upon to expand their participation and contribute to a broader more stable set of offerings for individuals and groups. This can be accomplished by the state requiring insurers to serve the needs of both the individual and group markets in Maryland, forming a larger and more stable pool of insured Marylanders.
The bottom line is that premium relief in the individual market for 2019 represents only a temporary reprieve. The same spirit of compromise that made rate reductions possible is necessary to identify long-term solutions to help ensure that all Marylanders can afford the health care they deserve.
Brian D. Pieninck is the president and CEO of CareFirst BlueCross BlueShield; his email is Brian.Pieninck@carefirst.com.