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Three Ways to Make Insurance More Affordable for Ohioans

A recent survey shows that a majority of Americans believe the ACA is here to stay and value what the ACA has accomplished, as we discussed in a recent newsletter. But a strong majority also support proposals to improve the ACA by making health care more affordable. This echoes what we hear from people shopping for coverage on the Marketplace or struggling with increased cost-sharing in private insurance.

A variety of remedies exist to the problem of unaffordable health care. Each require action – by insurance companies, the Ohio Department of Insurance, and/or legislators. Here are several ways to make insurance more affordable for Ohioans.

Value Based Insurance Design: Insurance companies could stop charging high copayments for effective medications and treatments for people with serious illnesses or chronic health conditions. This is known as “Value-Based Insurance Design,” or VBID. Instead of charging the same cost-sharing (deductibles and co-pays) to every patient and every service or medication, VBID reduces financial barriers to obtaining “high value” treatments. “High value” treatments can be defined as those treatments that prevent a patient from needing more expensive care. Think about an asthma inhaler or insulin for diabetes.

VBID should apply to basic diagnostic tests and medication to promote early detection and treatment, as long as they are based on strong clinical evidence of effectiveness. For patients with such chronic conditions as diabetes, hypertension, asthma, cancer, HIV, and multiple sclerosis, reducing barriers to medications that maintain health save money on more expensive care for unmanaged disease.

Surprise medical bills: These most often occur when people obtain care from a hospital and provider in their insurance network, but then get (surprise) bills from other providers who are not in their network, such as radiologists, anesthesiologists, and laboratories they had no idea would be involved in their care. Consumers can’t avoid using out-of-network providers if they either didn’t know they would be involved or had no choice when they went with their in-network hospital and doctor. Legislation, such as a law recently passed in New York, can protect consumers from surprise bills from out-of-network providers.

Insurance rate review: The rates insurers are allowed to charge are regulated by the state department of insurance. Several regulators in other states are more aggressive than the Ohio Department of Insurance in reviewing and approving proposed rate increases. ODI could exert more pressure on hospitals and specialists around the prices they charge for services and quality of care. ODI could consider affordability of higher premiums in relation to the profits and surpluses of the insurance industry. In short, ODI could hold insurance companies more accountable.

These are just three policies organized consumers and their allies could achieve in order to bend the health care cost curve. It won’t happen overnight – few things worth winning are.