Opinion: Repealing the 80th percentile rule is not at all the change Alaska needs

There’s nothing more frightening than the phrase, “I’m from the government and I’m here to help.” Aside from the newer versions you’ve probably heard lately, it’s something like this: “I’m an out-of-state insurance salesman and I’m here to help you too.” ”

Premera Blue Cross Blue Shield, the Seattle-based insurer that has a near monopoly on Alaska’s health insurance market, boasts more lobbyists (three) than employees in its Anchorage office, but still They haven’t stopped working hard to get rid of the rules. It has been protecting Alaskans for nearly 20 years. The 80th percentile rule, a long-standing consumer protection provision that requires insurers to pay local medical costs rather than arbitrarily low amounts that the rest are forced to pay, was recently expanded after extensive lobbying and marketing by Premera. Abolished.

In a recent opinion piece full of misleading statements and omitted details, Jim Glazko, Premera’s Seattle-based market manager, argues that Premera is providing this “assistance.” said it wasn’t to increase profits, but rather to protect Alaskans from overpaid nurses and expensive mammograms. As an example, Premera claimed that health care costs in Anchorage are the same as in San Francisco. Even if that applies to medical care, it does not apply to health insurance. According to KFF, an independent health policy organization, a silver plan for his family of four costs 41% more in Alaska than in San Francisco. This translates into an increase of $9,360 per year in premiums to cover the same amount of medical expenses.

The 80th percentile rule is important to all Alaskans, even those covered by Medicare or Medicaid. The 80th percentile rule, adopted in 2004, ensures that insurers pay their fair share of health care costs and helps balance Premera’s monopoly power in Alaska’s health insurance market. Without it, Premera will decide winners and losers in the health care system, reducing the number of “in-network” providers and facilities and increasing the number of “out-of-network” copays, deductibles, and balances through higher “out-of-network” copayments, deductibles, and balances. That cost will be passed on to us, the consumers. invoice.

Meanwhile, health care providers are increasingly losing out in this game of new rules, being forced to retire or leave the state. reducing the number of health care providers caring for Alaskans; Premera claims that eliminating the 80th percentile rule will reduce billings for health care providers and hospitals. That’s simply not true. It means that patients have to pay even larger bills, just like in the “good old days” before 2004, when rules were put in place to stop this kind of predatory behavior by insurance companies. It just means.

Competition drives down prices, and this applies not only to pencils but also to health insurance. Premera gaslights the medical community that the 80th percentile rule is the cause of Alaska’s rising insurance prices, even though no recent and authoritative studies have found the 80th percentile rule to be the cause of rising insurance prices. Don’t miss the opportunity to.

The April 2022 Insurance Pricing Study by the Urban Institute and the Robert Wood Johnson Foundation found that “the number of competing insurers matters; the number of insurers matters.” Interestingly, the presence of a single carrier means that premiums are, on average, $189.50 higher per month compared to markets with five or more carriers. The presence of Cross Blue Shield insurers…was associated with higher-than-average benchmark premiums.” ”

There are only two insurance companies in Alaska’s individual market: Moda and Premera. To make matters worse, Blue Cross Blue Shield insurance company Premera controls much of the Alaska market.

Moda is trying to compete in Alaska’s insurance market by offering lower premiums and other means. Unfortunately for Alaskans, these lower prices have been rejected by the Alaska Department of Insurance every year for the past two years, forcing Moda to charge higher premiums than Alaskans would like.

In recent testimony before the Alaska State Senate, Insurance Department Director Lori Wing Hyer said, “The most important thing we do at the Insurance Department is to make sure that insurance companies are solvent.” ” he said. Not to make insurance more affordable or convenient, not to increase competition and stability by recruiting more companies into a very narrow market, but to protect insurance company profits. Let’s understand that.

Perhaps this explains why the Department of Health has been artificially increasing the price of health insurance for Alaskans for the past two years. They wondered if Moda, a major company with more than $1.3 billion in annual business in multiple states, would go bankrupt if it sold insurance to Alaskans at prices that Moda’s actuaries could calculate. Are concerned.

Premera and its predecessors have been selling insurance in Alaska since 1952. The term “regulatory capture” was coined to describe the possibility that, over time, government regulators become so familiar with the companies they regulate that they accept their statements as fact without audit or investigation and make regulatory decisions. there is. Face an arbitrary and irrational situation.

We would like to invite Mr. Glasco to visit Alaska, possibly with the Health Department, to publicly discuss the 80th percentile rule and Premera’s misleading claims, and see if we can work together in some way. I would like to consider it. Making life better and healthier for Alaskans. For example, reforming the 80th percentile rule to further reduce costs, incentivizing providers to accept Medicare, Medicaid, and VA benefits, and ensuring seniors and veterans receive the health care provider of their choice here in Alaska. I can arrange to meet you. In the meantime, Mr. Premera, please help me a little more.

john morris from the University of Anchorage is a board-certified pediatric anesthesiologist and president of the Coalition for Trusted Healthcare Access. rick david The Anchorage native is the founder and chairman of the Alaska Roundtable. david morgan of Anchorage is a Fellow of the Healthcare Financial Management Association. Dr. Stephen Compton of Anchorage serves as president of the Alaska State Medical Association.

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