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Health care in jeopardy

ACA-New Customers

The HealthCare.gov website, where people can buy health insurance is displayed on a laptop screen in Washington. The Blue Cross Blue Shield Association said in a report released in 2016 that health insurers gained a sicker, more expensive patient population through the Affordable Care Act's coverage expansion. Its report offers an early glimpse at customers who have gained coverage in the past couple years. (AP File Photo/Andrew Harnik)

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Monday, July 17, 2017

We have faith that Mission Health and Blue Cross Blue Shield of North Carolina can work out their differences before a divorce that would disrupt health care for thousands in Western North Carolina.

We also have faith that the problem will recur, however, as long as this nation has millions of people without health insurance.

The number of uninsured, which had been dropping since adoption of the Affordable Care Act, has stabilized at nearly 29 million, or 8 percent of the population. If Republican plans to gut the ACA come to fruition, another 24 million could lose coverage.

In order to treat those without insurance, hospitals shift costs to those who do have insurance. At the most basic level, the dispute between Mission and the Blues is over the amount of cost-shifting the Blues are willing to accept.

Mission is the largest health-care provider in Western North Carolina. It operates six hospitals plus outpatient and surgery centers, and other health care providers. The Blues are the state’s largest private insurer, and for most of the state the only one participating in the health-insurance exchange under the ACA.

Mission says the Blues want to keep reimbursements essentially at the same level for the next three years.

“Even if we earn every dollar of pay for performance incentives offered by BCBSNC, we could at best get back to zero for three straight years,” said Charles Ayscue, senior vice president and chief financial officer at Mission.

The Blues suggest Mission is asking more than other providers.

“More than 43 other hospitals across the state have agreed to work with us to slow down unsustainable cost increases,” said Mark Werner, vice president of provider network for the Blues.

The Blues also say that Mission “is among the most expensive facilities for common inpatient procedures.”

Dr. Ron Paulus, Mission CEO, says only about 25 percent of its patients are on private insurance, a lower rate than many other health systems.

The deadline is Oct. 5, which gives the two sides time to reach an agreement. We cannot believe they would allow the contract to lapse. The Blues have about 72 percent of the state’s private insurance market, which means a lapse would leave a lot of people scrambling to find alternative providers. There must be an acceptable solution.

The real solution, however, cannot be worked out in Asheville. It must come from Washington and Raleigh. But, instead of working to improve the situation, governments in both capitals are making it worse.

The state refuses to expand Medicaid eligibility under the ACA. That alone added more than 300,000 people to the rolls of uninsured. The state also refused to set up its own exchange, which might have lured more insurers into the market.

Meanwhile, Congress seems determined to destroy the ACA in spite of the good it has done for the 20 million people who have gained coverage. The plans on the table would actually result in more people uninsured than before ACA.

The ACA is convoluted. That’s because it is built upon a system that already was convoluted. We have every conceivable setup ranging from socialized medicine (the military and VA) to catch-as-catch-can (the 29 million uninsured). In between are those covered, by Medicare, Medicaid and private insurance.

What Congress should be doing is working on ways to make the system simpler and more efficient. Instead, lawmakers are exacerbating a system that sets providers and insurers against each other.

Mission and the Blues can reach an accord. It would be easier, however, if they had help from those with the power to reform the system.

 

The Asheville Citizen-Times

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