I am stating my concerns about overpromoting Blue Cross and Blue Shield of North Carolina’s health plans — especially as the “go-to” health plan — in the article “Coverage Connection: Residents May See Lower Rates, Plan Changes for 2020 Health Insurance” [Nov. 20, Xpress]. I am reaching out to those who get their plans through the Affordable Care Act via healthcare.gov. New competitors to Western North Carolina should not be totally discounted. We need more articles to further explain “off-market health plans” and what they do and do not mean. This article discounts the plans across the board with evaluation.
Only three U.S. states — California, Florida and Texas — have ACA exchange enrollment numbers higher than North Carolina. In 2018, the average number of participating insurers per state was 3.5, while North Carolina had one choice. Blue Cross and Blue Shield of North Carolina had at least 10 executives who were paid more than $1 million dollars, topped by the chief executive officer, who was paid $3.6 million dollars — and is essentially a monopoly in Western North Carolina.
Blue Cross financials are in plain English. In 2018, the leadership at Blue Cross chose to raise premiums 14.1%, resulting in their final report that “the Affordable Care Act line of business … performed better than forecasted” and was “a key driver of Blue Cross NC’s 2018 performance” (March 1, 2019, financial announcement). In fact, the 2018 profit was “too good” by federal law that it exceeded capped federal profits set by the U.S. government.
Since the federal government requires a correction, “$75 per person on average” was sent back via check to [about 700,000] customers for a total of [about $52.4 million] in “excessive premiums.” What’s most important, Blue Cross originally asked for a 22.9% rate increase and got the 14.1%, so that rebate check would have been bigger (8.8% more greed than the approved 14.1%).
Blue Cross could try to blatantly say — in plain English — “We saved you money,” but that’s not true. In this monopoly, Blue Cross collected too much of your dollars in the first place, and that’s the problem. We could have used that money for other bills. For 2019, the plans offered a 4.1% decrease in premiums. For 2020, an additional 3% decrease in premiums for individual plans (WNC). The pain point to one’s bank account: a 7% net increase in total premiums and severe restrictions to what is and is not covered (preapproval, denials, procedure limitations, out of network, in network, etc.).
Think about how much you spent in premiums, copays and deductibles. And, think about relating your dollars to Blue Cross “plain English” statement that the “average claims per person climbed to an average of $5,326 per fully insured person.” Blue Cross also grew its reserves from 3.7 to 4.81 months, which is higher than the three-[month] state minimum. That is your money being “saved” for future people instead of being used to provide you and your family health care that year.
If you feel the medical system is breaking your bank, here is the evidence. Blue Cross does everything in plain sight and in plain English. I find what’s happening is unbearable to people of Western North Carolina, and we need to talk about what’s happening. We need to continue to be educated. We need to let people know when there is choice and why it works for them and why there are risks. I do not think it’s fair to discount “off-market health plans” from a full discussion.
— Joel C. Harder
Editor’s note: Xpress always appreciates hearing feedback from our readers. In this case, though the article in question devoted more space to discussing BCBS’s plans, we don’t think we’ve given short shrift to covering off-market plans, which were explored extensively in last fall’s article, “To Your Health: Local Experts Explain Insurance Market Changes, Urge Enrollment Before Dec. 15 Deadline.” At this time, we don’t have plans for another article on the topic.