People Are More Than Actuarial Math Inputs: Ignore The Humanity Of Healthcare At Our Peril
Mandi Bishop
Gartner CIO Analyst | Healthcare Strategist | Equity Advocate | Data and AI Enthusiast | Keynote Speaker | Author
Like the smiling women blithely ignoring the homeless man on the steps in the image above, many of us may be blind, or at least desensitized, to the human experience of others less fortunate. It isn't an indictment; it's an observation. We are all guilty. Events this week have brought this behavior into sharp focus.
This week, the healthcare industry headlines are dominated by Aetna insurance company's decision to withdraw from 11 of the 15 states in which it offers Affordable Care Act (ACA, Obamacare) individual health plan options on the state Health Insurance Exchanges (HIX). They are not alone: UnitedHealth Group is reducing its ACA plans from 34 states to 6, and Humana is reducing its ACA plans from 15 to 11.
Given that these insurers represent a significant portion of the health plans that were available on the state HIX marketplaces (in some counties, these exits leave local individuals with NO available ACA option), the number of impacted families totals millions of lives - many of them children.
The US Department of Health and Human Services (HHS) reported that 85% of ACA plan members receive tax credit subsidies in order to participate. Subsidies are only available to those whose income qualifies as at or below 400% of the federal poverty level (FPL). Math on FPL's relationship to subsidies below, using California as an example of the interplay between federal and state programs.
400% of FPL means an individual with an annual income of $47,080 qualifies for subsidies. But many, if not most, ACA plan members have income levels far below that maximum threshold.
The Kaiser Family Foundation indicated that the median household income of the newly insured on ACA plans would be 166% of FPL. These individuals earn $20,000 per year. And they tend to be slightly older than the currently-insured; they are making these wages at age 33, an age by which many who might be reading this have/have already had well-established, and comparatively lucrative, full-time careers.
Who will these ACA plan exits affect?
Women and children, disproportionately.
1 in 6 Americans live at or below 100% of the FPL.
1 in 5 children in America live in poverty.
For families already struggling to stretch meager income between food, housing, and school supplies, let alone set aside hundreds of dollars per month in health insurance premiums - and the completely unpredictable healthcare service bills, the increasing lack of choice (affordable or not) in the ACA marketplace is devastating. Especially if they fall off the "subsidy cliff" into the Medicaid Gap and inhabit one of the 19 states that opted not to expand Medicaid.
Beyond the dwindling ACA choices is the concern that members of the 7 remaining non-profit co-operatives will not receive credit for their deductible and out-of-pocket maximum payments if the co-op shutters before year end, as happened this week to 49,000 Illinois members with Land of Lincoln coverage. Imagine telling a working mother in Chicago making $15,000 a year that she has to come up with an extra $1500 if her son breaks his arm falling off the monkey bars the first week of school.
What will happen to the people who are the basis of our actuarial math?
Although we must make pertinent business decisions that will sustain viability, we do not have to lose sight of the humanity of healthcare.
Don't ignore the person who became the statistic. It could easily be you.
Gartner CIO Analyst | Healthcare Strategist | Equity Advocate | Data and AI Enthusiast | Keynote Speaker | Author
8 年It's interesting that much of the commentary is taking a political bent. I wrote this because, regardless of politics and personal or organizational belief in whether the math adds up or not, there are human stories behind each one of the numbers that go into the business decisions made - from government to insurers to providers. The piece is about people. The comments only underscore the point: a single person's story gets lost.
Litigation and in-house counsel experience in complex business matters, contractual disputes, construction defect defense, and healthcare.
8 年If the government would stop going after providers and organizations to fund their "fraud units" where there isn't real fraud, this wouldn't be happening. It isn't the organizations failing the people. It's your own government. Has your journalistic gut asked WHY ACA plans are being dropped by these big guns??... If you really want to be a journalist, go search how AHCA is seeking repayment (all of it - five years prior) of what they pay providers and organizations AND denying millions of claims as medically necessary so they don't have to pay those providing the services. This is leaving providers and organizations NO CHOICE but to drop them. The government is doing bad business -Empty promises and propaganda. The implications are jail sentences and running providers out of business. Some have died from heart attacks under such stress. Don't just take my word for it.. and don't just take the government's. Journalism is what you do, go do it.
NextGen Product Owner
8 年wow.... welcome to America!!! pitiful. Shame on big business. I lived in MS last year and was definitely in that poverty group.
quantitative storyteller and coach, fractional geospatial data scientist, strategist creating narrative around physical-cultural-ecological facilities required for sustainable operation of infrastructure.
8 年The administration was really left with two choices. Get the policy rejected out of hand or create "foot in the door" legislation intended to evolve by the will of the people in a democracy. The foundation was dysfunctional--nobody disputes that--we put a little lipstick on a pig hoping to nudge the policies toward the radical reform necessary. Only a public option will put private insurers on notice and provide relief to those of us getting slammed with premium increases and fewer and fewer options. The research has been out for quite a bit of time but I believe we are all starting to look a little more closely about what a "free market" and capitalistic rendering of healthcare has become.
Advisor - Data Science based Healthcare Transformation at Ingine Inc
8 年We need a movement...To hope that deliverance will be from corporates or from govt who have been execessively lobbied and so in most response is more obfuscation than real actionable policies bringing any much needed succor to those deprived at grass root.