There’s a wide gap in access and coverage between private and public plans.

Swedish and Molina misled customers and patients.

For a state that claims to encourage entrepreneurism, Washington state’s health insurance marketplace is toxic to the self-employed. There’s a wide gap in access, coverage and transparency between private employer-based insurance and the state’s marketplace.

After signing up with Molina, I learned that its customers facing surgery at Swedish are in for a painful surprise. We have to pay extra for anesthesiology except in emergencies. Swedish promoted itself as in network with Molina but failed to disclose that its anesthesiology provider is out of network.

Molina trained insurance agents that Swedish was in network but also did not disclose the gap. I discovered it only by noticing that the company made no mention of Swedish in its list of anesthesiology providers. It disclosed by omission.

See also: Swedish and Molina Misled Patients on Anesthesiology Coverage

Molina says this is what’s known in the industry as “balance billing”. But balance billing isn’t supposed to occur with in network providers.

Since Swedish anesthesiology is out of network, Molina’s patients must pay additional fees or possibly the entire cost. The company refused to speak with me, and was unwilling to define its compensatory coverage in email.

Health Insurers Run the Legislature

Our marketplace’s expensive, heavily restricted, misleading plans would make even the most ambitious entrepreneur reconsider full time employment and discourage still more from leaving their jobs to launch startups.

This is what happens when health insurance lobbyists run the state legislature. The large insurers employ more than fifty lobbyists in Olympia.

Foresight like this doesn’t come cheap. Molina paid its top two executives $36.7 million combined last year, responsibilities it paid only $10 million for in 2016. Its stock chart is nearly indistinguishable from Amazon’s.

Molina’s stock growth nearly indistinguishable from Amazon’s

Our Cars Have Better Insurance Than We Do

Frankly, Washington state regulates car insurance better than health insurance. Insurers can’t tell you where to take your car for repairs, but they can restrict which doctors you visit.

Our health insurance marketplace provides further evidence of the laissez faire, corporate friendly, lobbyist-led Washington state democratic party.

For the first time in nine years, none of the marketplace plans cover my primary care doctor though she is widely covered by employer-based plans.

State law also requires auto repair shops to provide written estimates up front but not hospitals and emergency rooms.

While auto insurers cover us in Canada, none of the marketplace health plans do. If you travel internationally, even for a weekend trip, you’ll need to spend more for travel insurance.

Mental Health Parody

Washington State’s mental health parity law requires that Molina provide equal coverage for my therapist. So, as it does for my doctor, it provides no coverage.

This month, I’ll have to begin searching for my fifth “in network” therapist in five years.

For people with trauma in their background as I have, counseling provides a consistent relationship with a professional that knows your story. For many, the continuity itself is healing. The ACA’s corrupted networks have severely disrupted my care.

Imagine trying to establish trust and retell the experience of years of child abuse annually to strangers?

Only expletives can concisely articulate the damage from losing coverage for professionals who’ve treated me through my brain surgery, radiation, multiple hospitalizations and trauma. The experience and knowledge lost is incalculable.

Don’t let Governor Inslee and the legislature fool you into believing that the ACA limits them.

I spent last year in Portland with Oregon health insurance. It provided nationwide coverage through a network partner, allowing me to visit with all of my Washington state doctors.

Washington’s marketplace plans provide no out of state coverage.

Complainants to the states Insurance Commissioner are essentially told, “we’re only allowed to act as the legislature allows,” which provides a rubber stamp to the unbounded bureaucracy and profiteering of health insurers and their executives.

For example, through most of the last two marketplace enrollment periods, the commission permitted insurers to use the term “100% coinsurance,” which is doublespeak for patient pays everything.

“100% Coinsurance” is doublespeak for patient pays everything.

While the state licenses tens of thousands of qualified doctors and healthcare professionals, it allows insurers to restrict coverage for care from most of them. The marketplace makes a mockery of these certifications and the state’s investment in the system.

The ACA has always had problems, but this is the first year where I feel scammed as a consumer and as a patient. I’m forced to pay more in healthcare than property taxes and to give up access to doctors and specialists who know my medical history. And, I can’t travel safely without additional insurance.

The Legislature Needs to Act

Through stronger regulation, the democrat’s expanded legislative majority could require reasonable continuity of care and broader networks within the ACA framework.

It could require that to sell private health insurance to Washington employers, insurers such as Regence and Aetna must also offer reasonably commensurate public plans. For two years now, the state’s four company oligopoly preys on residents without alternatives while private insurers offer vastly better plans through private employers.

The legislature could also require that insurers honor an agreed to rate schedule for out of network and out of state care and eliminate the manipulative duplication of in network and out of network deductibles.

Or, Governor Inslee could work with California governor-elect Gavin Newsom and Oregon governor Kate Brown on a three state universal healthcare program. That would be presidential.

For the first time in nine years, none of the marketplace plans cover my primary care doctor though she is widely covered by employer-based plans.

Today’s announcement by Inslee is a step in the right direction but I do not believe it addresses network access, coverage levels, participation by private insurers in the marketplace, transparency or Canada coverage.

So for 2019, it’s business as usual. Our health insurance marketplace provides further evidence of the laissez faire, corporate friendly, lobbyist-led Washington state democratic party.

Soon you’ll hear about the legislature’s reconsideration of a “Surprise Billing” rule from 2017, which would prevent insurers from bizarre out of network exclusions, such as Molina’s  anesthesiology loophole with Swedish. But it doesn’t address the vast gap between employer plans and marketplace plans. Legislation like this is a dumbed down regulatory patch for a system health insurers don’t want us to restructure.

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Posted by Jeff Reifman

Jeff is a technology consultant based in the Pacific Northwest. Check out Portland Wild, a visual map-driven guide to Portland's public art, its Heritage Trees and its Little Free Libraries.

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