Navigating Health Insurance Change

Wellmark PhotoLAKE MACBRIDE— As a self-employed writer and farm hand, having health insurance means buying an individual policy in the marketplace. The implementation of the Affordable Care Act’s (ACA) health insurance exchanges and initial open enrollment beginning Oct. 1 was a precipitating event for me and for others. There will be changes and some of them have little to do with the ACA.

There is a pent up demand in business to shed the cost of providing health insurance for employees, or to make it a fixed financial benefit. Already after Oct. 1, there is anecdotal evidence that small businesses are pulling the plug on group policies, and large businesses, like Mercy Medical Center in Cedar Rapids, are changing the rules for insurance benefits to exclude part time employees who are currently covered. If there is a way to stabilize or reduce the cost of having employees, businesses will find it, and the ACA appears to be providing the whipping post for moving forward to meet this long-standing want. Corporations and small businesses appreciate the opportunity this major cultural event represents. The days of employers providing health care to employees as a basic benefit are ending, if not over.

Wellmark Blue Cross and Blue Shield, Iowa’s largest health insurance provider, decided not to join the Iowa health insurance exchange during the first year. The expectation is the company will apply to be part of the exchange beginning Jan.1, 2015. In an interview with the Cedar Rapids Gazette last July, Wellmark CEO John Forsyth said, “the company was concerned about the lack of information available and the roll out of the exchange in Iowa.” Forsyth was skeptical of the federal government’s ability to implement the ACA smoothly. In addition to some website glitches in early October, some of the rule-making is incomplete. Wellmark’s decision is understandable from a business perspective, and the impact is that the network of health care providers available in the exchange during 2014 may be significantly reduced without Wellmark’s participation.

What’s a person with an individual health insurance policy to do? Wait. First, wait until December to look at joining the exchange on Jan. 1, 2014. Perhaps some of the details like provider coverage will be better identified to make the consequences of changing more understandable. Second, someone who has a grandfathered plan (no changes in policy since President Obama signed the ACA), may not want to change until there is more certainty about the outcome. The open enrollment period goes through March 2014 during the first year. Take advantage of that extra time. Third, resist the efforts of Wellmark and other providers to rush a decision to remain the same, or lock in rates. Whether or not the Iowa insurance exchange will offer lower rates for equal coverage is uncertain. No reason to make a decision until one gets enough facts about the rates and coverage, and compares apples to apples.

There were five insurance company sales representatives in a health care reform seminar last week, compared to yours truly as the only member present. Organizations who sell health insurance have a lot to lose with implementation of the ACA, and the move to a marketplace. These insurance agents answered all of my questions, and the information provided will help in making a decision about health insurance. Getting facts and working through them, as I did, is essential in navigating change in health insurance, and there is no hurry to make a bad decision.

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