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State must be responsible for helping regulate insurance

February 20, 2014
Cape Coral Daily Breeze

To the editor:

Our governor nor legislature should not be allowed to absolve themselves of the damages done to the people of Florida when they refused to act for us in getting the Health Care Exchange set up. In addition the state agencies are not allowed to aide in any way the working of the law or exchanges in Florida for two years. This was inappropriate and was one cause for poor selection and poor pricing on the Marketplace. There could have been better competition in the market. This would translate into better selection and lower cost. If this attitude does not change we will have the same problems when the SHOP Market Exchange is rolled out. The State must select a Benchmark Health Care option. If the State neglects to choose or set a benchmark then we get one by default. This will also set the limit of small group participation in SHOP Exchange.

Many remain uninsured because they cannot get Medicaid (unqualified) or they fall in the Medicaid gap. Most of these problems can be resolved if our state officials take appropriate action and accept the Medicaid expansion up to 138 percent of the federal poverty level which is funded.

Some in our State refused to take advantage of the opportunity to receive help from the ACA, purchased private plans which were of lower quality, and assumed more risk just to get a lower premium. Some of this could have been avoided had our state taken a different approach and educated our citizens about shopping for insurance and giving the navigators the help they needed. Citizens of Florida will only realize their problems when they have to depend on insurance and find they are not properly covered.

In addition, all citizens should be wary because eventually the risk of under insured and uninsured becomes our risk. Providers of care cannot change their rates and must find some way to make up for loss. For example, hospitals give up $250 billion because they would get an insured patient instead of having to give free care. Now they also risk not receiving the pay they once received for delivering indigent care.

So far, what we have been working through is the insurance part of the ACA. Unfortunately insurance is a major part of our system. Please remember insurance is not health care. Insurers deal in health care by spreading risk. They are in business to make a profit. To be sure we are treated fairly requires both state and federal government working together to protect us and regulate the insurance industry.

People must understand the individual mandate and community rating systems were meant to spread risk and moderate cost for all. They also make insurers operating in the market accept all and not shift risk to those with pre-existing conditions or different sex. Therefor those who did not shop on the exchange in fact made our system weaker.

To be sure state and federal regulations will never make insurance tolerable, they can only help. The public needs to learn how insurance operates. Still most of us do not understand the basic terms used in the industry. Remember the informed public is more powerful than government regulators.

Knowledge and patience are valuable prerequisites when purchasing health care. I relate the experience of a 58-year-old female who has been in good health. She relates her experience on the Marketplace. She started with her physician, listed the plans he was included in, then she eliminated the type of plans she did not want. She then assessed her risk level and decided her deductible, coinsurance and co-pay benefits. So she decided on a plan premium of $129 a month, $1500 deductible, co-pay of $10, and co-insurance 10 percent. She feels happy with what she got.

Lewis Robinson, M.D.

Fort Myers

 
 
 

 

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