Taking Care of People

This week’s headlines announced that an insurance carrier was leaving the Marketplace for 2016 and that two health insurance companies were giving significant rate increases – one over 40 percent, another over 60 percent.

This wasn’t “new” news to those of us watching in the health insurance business. Each year, insurance carriers have to file their requests for premium rate increases with the state. The state reviews those filings and if the carrier is requesting a rate increase of more than 10 percent on any Affordable Care Act (ACA) or transitional policy, the federal government has to publish those rate increases to a federal website.  It’s part of the overall transparency agenda of the Affordable Care Act. You can find it yourself by Googling “rate review healthcare.gov.”

It was on this site in mid-July where I found out about the significant rate increases South Dakotans were going to experience in 2016. The discovery that literally took my breath away was one carrier’s average rate increase of 63.2 percent for ACA plans. Alone, in front of my computer screen, I said “wow.”

When I wrote my first blog here in September 2013, I put two disclaimers out there:

  1. I work for a health insurance company.
  2. I have a chronic condition that would have classified me as “uninsurable” under the pre-2014, pre-ACA individual underwriting rules.

I know, on a very personal level, how important health insurance is. I also know from my youth, the absolute feeling of helplessness when you can’t pay your doctor’s bill, pick up your prescription drugs or afford your monthly premium. That afternoon in July those feelings came rushing back. How many people are going to be impacted by this news? How many are getting needed care right now? How can we help?

Avera Health Plans premiums for 2016 were filed and approved by the state over the summer too. We will be offering individual policies both on and off the Marketplace in South Dakota. Our approved rate increase for 2016 is an average 13.69 percent. Offering ACA-compliant plans and becoming a trusted resource on the ACA is not for the faint of heart. It requires that the delivery of health care and the financing of health care come together and face a very real truth – health care is expensive and it is only going to get more expensive – unless we work together.

I haven’t had much to say over the last 24 months buried deep inside the mechanics of operations and navigating the waters of changing government rules. I am breaking the silence now only to bring you current on the how’s and why’s behind the headlines. And on a more personal note, to assure you that Avera and Avera Health Plans is there, standing with our friends and our neighbors –  thousands of dedicated souls standing together to take care of you and be the best possible stewards of your premium dollar.

It is personal. It is about people, not just policyholders.

By Deb Muller

Chief Administrative Officer at Avera Health Plans