dagblog - Comments for "With Affordable Care Act, Canceled Policies for New York Professionals"

I love the discussion here,

Tfb — Wed, 18 Dec 2013 14:30:25 +0000

I love the discussion here, which is more informed and in depth than any local journalism I've found. In case it's useful to anybody, I was hoping to get more info and posted some musings on Ask Metafilter.

I think a handful of the NY Exchange plans are HSA compatible, only the Empire BCBS plans as far as I can tell, and they aren't otherwise competitive I think. I agree that they all should, at least unsubsidized bronze and silver plans, but also that that HSA yearly limits are well below the out of pocket costs for those same bronze and silver plans. It just doesn't seem like a good fit.

Right now I'm trying to figure out how much it's worth to me to be able to to see a specialist directly, and basically deciding between Health Republic and MetroPlus (which does offer unsubsidized exchange plans, contrary to something mentioned above). Your mention here that medicaid may pay more for doctors visits than other HMOs is the first thing I've seen to make me think that MetroPlus' network may actually be more competitive than Health Republic's Magnacare network.

Anyway thank you for the discussion, and glad to discover this site!

They don't go about this

artappraiser — Sat, 14 Dec 2013 22:40:02 +0000

In reply to I'm also not clear on why

They don't go about this trying to limit the number of providers! It's the other way around! The providers they have are the only ones interested in doing business with them at the terms and reimbursements they're offering. They say to providers: we're willing to pay this,. take it or leave it. (Example cited above by Kaiser: $60 or $70 per office visit compared to Medicare's $90.

They sell their policy holders as a group to providers, basically. This is why negotiations are ongoing in some cases, and why the sign up problems are so important, as not knowing how many and the age and health of those who will be signing up. They have more bargaining power with providers the more policy holders they have.

And not paying anything at all outside of their own fixed network of providers (unlike PPO's who do reimburse some for outside of network) ready to accept low rates of reimbursement means: fixed costs, more manageable costs, less risk. You can "manage" things like telling your providers that they can't even mention that new more expensive replacement heart valve as an option. That they shouldn't prescribe anything but generics in such and such a class, and don't bother trying to mask that name brand drugt by coding it off label because we have it tagged and simply will not cover it (which probably means they failed at trying to talk that particular drug company down, and the drug company knows they got something hot that fee-for-service insurers are willing to pay full freight for.)

If they are the only game in town, like in New Hampshire, they just really roll over some providers like hospitals and can destroy them-see related links above. Or there is also the example in the links I posted of a children's hospital which caters to really sick children where they are being offered reimbursement rates equal to those for mostly healthy children and feel they just cannot go that low.

Health savings accounts CLEARLY would make much sense for most with exchange policies because all but the gold plans have significant out-of-pocket costs, especially high deductibles that make not having a HSA dumb. The silver plans all have yearly deductibles about equal to the limit you can put in a HSA, and bronze have much higher! If you're someone who has a chronic condition, or plan something like having a baby or surgery, you're going to have to pay that anyway up to and beyond the HSA limit per year, you might as well be paying it from an account that gives you some of it back via your tax return.

You can contribute right before you pay the bill. (You even can tell the provider or insurer-whichever the case may be- that they are just going to have to wait for you to pay until you can get the money into your HSA!) Depending upon tax situation and how long it would take them to pay the payment off, it might even benefit some who would have to pay deductible with a credit card to put a credit card advance in a HSA rather than pay directly with the credit card. I don't know anybody who has a HSA that didn't use all the money in it every year to pay for uncovered required expense; they don't do it for an investment, they do it for the tax benefit of money they have had to spend on deductibles and co-pays and the like, via a couple hundred dollars put in at a time. Only the lucky healthy rich can afford one as an investment! Rather, it's used like a checking account specifically targeted for medical expenses.

But as I said, none of the exchange plans in NY are made to be HSA compatible. Even though they have $2,500 or more yearly deductibles.

I'm also not clear on why

A Guy Called LULU — Sat, 14 Dec 2013 19:34:48 +0000

In reply to This is interesting, AA. I

I'm also not clear on why limiting the scope of providers saves the insurance company money.

My guess is that keeping a relatively short list of providers allows the insurer to be the shopper for the best value doctor rather than the insured who would have different priorities. The relatively short list of covered doctors could presumably be adjusted by replacing any doctor that was seen to be hurting the dollar bottom line beyond some arbitrary parameters.

This is useful... I guess,

Peter Schwartz — Sat, 14 Dec 2013 18:28:33 +0000

In reply to Some backgrounders related to

This is useful...

I guess, they are excluding providers whose (high) prices they feel will force them to raise their premiums and copays, etc., and fall short of the goal of keeping the plans "affordable."

I imagine the federal government will be offering more "detailed guidance" on some of these things. They can't simply exclude the best-known and most respected providers in a given area for very long. People will rebel and should.

That said, how are people going to pay these most respected providers (read: more expensive) if they don't have insurance? And if non-exchange policies also have to meet the requirements of ACA, then they aren't likely to include those providers either. Is it possible that employer policies have poorer coverage but greater access to better providers? Does that make sense?

So who will these "most respected providers" have as customers? The five millionaires in town who self-insure? Only folks who get their insurance through work, an option that's also been under severe cost pressures of late as employers cut back, ask for higher contributions, change plans, even exclude people etc.?

Ezra put it well a while back: If you look at the countries where medical costs are under control, they are under control because government controls them. ACA is trying to go with a free market approach, but if the participants don't play nice and we end up with a two-tier system, then there will be trouble.

To be honest, I thought this was all part of the deal. We were going to feed the insurers lots more customers and they, in exchange, were going to do things like not exclude people from their plans. Perhaps the deal didn't cover excluding certain providers, but it should have.

Emma made a good point a while back: Instead of cherry picking, we've expanded the pool to even out the costs. A plan's customers should be underwritten as if they were one big pool. If you have 100,000 policyholders in a plan, then it should be like insuring a company with 100,000 employees.

This is interesting, AA. I

Peter Schwartz — Sat, 14 Dec 2013 18:02:01 +0000

In reply to No that's not exactly what's

This is interesting, AA.

I just went on healthcare.gov and found 11 PPOs at the Silver level for me. Not sure what this means relative to your experience in NYC. I believe I've also seen HSAs available, but they are pointless, IMO, unless you're at a higher income level. Otherwise, who has money to put aside for a rainy day or the need for the tax break? I never had enough to put aside for very long, but I did "launder" my medical expenses through the HSA to get the tax break.

As far as the geographic restriction goes, I haven't dug that deeply into it, but never in my life have I had to go out of town for treatment. Perhaps that's because I've been relatively healthy. When I get cancer and need to go to the Mayo clinic, this may change. Since everyone is now so concerned about whether they can keep their own doctor, I don't see why they'll be eager to fly to Kansas City for treatment, unless they need special treatment.

As I say, NONE, ZERO of my doctors have ever been in the two policies available to me over the years in D.C. Just two providers. I did get some out of network benefit, but not a whole lot. So basically, for the past 40 years, I've paid for almost everything out of pocket. Never met the deductible. My insurance was there in case I got cancer or had a heart attack.

So when my wife got a teaching job, we finally got "good" insurance. It pays for a lot more. So here's an ironic story: I've always wanted to go in for a sleep study. For a long time, I was waking up tired, etc. So finally, I have insurance that pays for sleep studies. So I go in, and it turns out, I have sleep apnea, a very dangerous condition. And lo and behold, the insurance also pays for a pretty expensive CPAP machine and regular supplies.

Did "my doctor" whom I love so well discover this very dangerous condition? Did he ask me about my sleep, whether I was waking up tired? No, he did not. And I could see the chagrin on his face when we discussed this. I didn't point fingers at him because I DO think he's a good doctor, and I believe that everyone makes mistakes, but he likes to be "the source" of medical wisdom between us.

Anyway, based on pure money considerations, I decided to leave "my doctor" and find one in network. What's the big deal?

I've been unclear about whether someone could buy a policy outside of the exchange. I guess, based on what you say, they can.

One thing that is supposed to kick in, but may take some time, is competition. Right now, people are still just trying to navigate the thing (though I personally haven't found it that hard), but once they start shopping on the exchange, then presumably, insurers will reduce prices to compete. And once more people go to the exchanges to shop, then more insurers will want into that game.

(Or, we'll find out that competition isn't a driving factor in the purchase of health care or insurance. My contention.)

Offhand, I'm not sure why one would want to buy a policy outside an exchange (technical difficulties aside). That's the old way. Comparisons are even more difficult. You have to contact each insurer separately. You have to figure out how to convert oranges into apples. I suppose IF you have very specific and expensive health care needs, there may be some point in doing so because you'll need highly customized coverage. But other than that...why?

I'm also not clear on why limiting the scope of providers saves the insurance company money. Less paperwork? Less need to rationalize many different ways of charging? I would think that broadening the network would bring more people in. I could see why a Mayo might not want its reimbursements cut, but surely Aetna would not want to exclude a Mayo or a Dr. Kildare.

At bottom, I believe that much of this hoopla is being driven by two big changes which apply across the board: no pre-existing condition exclusions and no caps. I think these are the big cost drivers and are certainly why some people's costs are going up.

I do think that a calculator that allows someone to enter ALL the cost factors that determine the FINAL cost of a policy would be a great idea. At a minimum, you should have access to a policy's formulary or be able to enter your prescriptions into the Web site and see if a plan covers them and how much of their cost. People don't really get all the trade-offs that affect the final cost of a policy.

Klein's article points out the difference between looking at the health care problem from a macro point of view v an individual point of view. An individual's costs may go up while the overall costs we ALL pay may go down. So, you may end up paying more in premiums, but you'll be covered when the "big one" comes no matter how high the bills go. And you'll never go without insurance. And the money other people are saving on premiums will go into the economy and, ultimately, put more money in your pocket from increased economic activity, lower taxes, and lower medical bills. Not trickle, but trickle around.

If we're going to bring down the cost of health care OVERALL--the ultimate driver in all this--then we're going to have to find efficiencies, find cuts, and, in some cases, pay more. But up until now, some people's "good time" has been financed by other people's "awful time." Now, some people will have a somewhat less good time, and other people won't have such an awful time. Equality-ish.

Anyway, good digging, AA.

Some backgrounders related to

artappraiser — Sat, 14 Dec 2013 09:24:41 +0000

In reply to No that's not exactly what's

Some backgrounders related to things in the above comment:

Insurers restricting choice of doctors and hospitals to keep costs down
By Sandhya Somashekhar and Ariana Eunjung Cha, Washington Post, Nov. 20, 2013

As Americans have begun shopping for health plans on the insurance exchanges, they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.

The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to.

The decisions have provoked a backlash. In one closely watched case, Seattle Children’s Hospital has filed suit against Washington’s insurance commissioner after a number of insurers kept it out of their provider networks. “It is unprecedented in our market to have major insurance plans exclude Seattle Children’s,” said Sandy Melzer, senior vice president.

The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange [....]

[...] as a result, families like Jeffrey Blank’s, which has relied on Seattle Children’s since his daughter, Zoe, received a diagnosis of a rare bone disorder, face difficult decisions. Under some of the new law’s health plans, the family would no longer be able to take Zoe to Children’s for her routine checkups, or it could count as an “out-of-network” visit, saddling the family with huge bills.

“It just stresses me,” said Blank, 53, a self-employed massage therapist who is sorting through his options but readily admits that his family has benefited from other parts of the health law. “I hope things continue wonderfully for my daughter and that she doesn’t need the level of care she got after her diagnosis, but there’s this unknown.”

In New Hampshire, Frisbie Memorial Hospital took legal action against an insurer that excluded it from its marketplace plans, and in Missouri, consumer advocates successfully lobbied an insurer to add a children’s hospital after it unveiled a plan that lacked one [....]

Insurers “looked at the people expected to go on the exchanges and thought: ‘These are people coming out of the ranks of the uninsured. They don’t care about the Mayo Clinic or the Cleveland Clinic. They will go to community providers,” explained Robert Laszewski, a consultant to the health-care industry.

Insurers will typically cover out-of-network costs in an emergency. And most hospitals are included in at least one plan.

“I can’t find you a plan with all the major facilities, but if you give me a hospital I can find a plan participating in it,” said Elisabeth Benjamin, vice president of health initiatives for the Community Service Society of New York, one of the agencies helping consumers navigate their new health insurance options.

The Affordable Care Act requires insurers to provide enough doctors and hospitals to ensure quality care. But there is no detailed guidance from the federal government on what this means.

“It’s been mostly up to the plans to attest to it, and for now everyone’s taking their word for it,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation who focuses on health reform and insurance.

In New Hampshire, consumers who purchase insurance through the exchange have only one choice of carrier — Anthem BlueCross BlueShield— because no other insurer applied to join the exchange. The company’s network includes access to only 16 of the state’s 26 acute-care hospitals [....]

Doctors Complain They Will Be Paid Less By Exchange Plans
By Roni Caryn Rabin, Kaiser Health News, Nov 19, 2013

[....] The benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.

Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions [....]

Some NYC hospitals not taking new health plans
By David B. Caruso, Associated Press, Nov. 20, 2013

[....] Those narrower networks are a result of insurers trying to control costs and hospitals being cautious about agreeing to take new, untested insurance products.

A spokeswoman for NYU Langone, Lisa Greiner, said the hospital was taking a "semi-conservative" approach to participation and working only with insurers with "strong records in resolving enrollment and payment issues."

The hospital also chose not to work with insurers that wanted to include the hospital, but not its doctors, in its treatment networks.

Negotiations at several hospitals were ongoing, and it is possible some insurer networks will grow by the time policies take effect on Jan. 1 [.....]

State Marketplace Profiles: New York

Kaiser FamilyFoundation, Sept. 30, 2013

[....]

Contracting with Plans: Insurers may participate in the individual Marketplace, the SHOP, or both and must offer one standard product at every metal level, in every county of their service area. Insurers must offer a standard catastrophic product, but if there is more than one catastrophic plan offered in a county, QHPs may be allowed to opt out of offering the product. An insurer that offers an out-of-network product in a county’s commercial market must offer an out-of-network product through NY State of Health at the silver and platinum levels in that county (an out-of-network product offers coverage for services provided by health care providers that are not in the insurer’s network). QHPs may choose to offer up to three non-standard plans per metal level and can offer non-standard products in a portion of their service area. Child-only plans, catastrophic products, and required out-of-network products will not count towards the non-standard maximum. Standard products must cover the Essential Health Benefits; however, insurers may substitute benefits in the Preventive/Wellness/Chronic Disease Management and Rehabilitation/Habilitation categories in non-standard product offerings. [....]

Limited health networks undo the good of Obamacare
Health insurance companies, like Anthem, are empowered to pick winners and losers among hospitals like ours
By Al Felgar, New Hampshire Business Review, Oct. 18, 2013

On the insurers on the NYC

artappraiser — Sat, 14 Dec 2013 08:29:19 +0000

In reply to No that's not exactly what's

On the insurers on the NYC part of the NY exchange I can provide some factuals and links for anyone interested.

It took some doing to find this out.

And, BTW, I was told incorrectly by an unhelpful woman on the individual marketplace hot line that I could not find this information out on the website. I called the small business exchange hotline first, and a very helpful young man there told me, among other things, that this was possible, that there was a way to do it, but he wasn't sure how and that I would have to ask them at individual hotline, and he transferred me. I let the transfer ring more than 50 times; no one answered. I called the line directly and the woman who answered after a short wait said that I could register and fill out all the information and apply and then find out what would be offered to me, but that I could not see all the insurers offered in my area because I might not qualify for them all and the prices would differ depending upon whether I got a subsidy. Of course, I knew that already, that they want to "protect" people from seeing what other people might be paying. And I told her. And she said that's the way it has to be. Hope my experience does not mean that the small business hotline is trained to treat people like they're smart and the individual hotline is trained to treat people like they're dumb.

So I searched and found it, like the Small Business line said was possible.

Her are the links to the NYState PDF's showing insurers being offered on the exchange in both Manhattan and the Bronx (I did not check for the other 3 boroughs.) They are identical lists. It is 8 insurers in the Individual Marketplace and there are only 3 insurers in the Small Business Marketplace. Of the 8 in the Individual, 3 have operated in the past as Medicaid managed care and other low income and charity care (Fidelis-which is Catholic, Healthfirst and Metroplus) so I suspect (which may be wrong) that anyone who does not qualify for Medicaid is not shown those. That leaves Affinity, Emblem, Empire, Oscar and United. I talked to Emblem directly. They told me they are only offering an HMO now, and how to look at their providers on their website.

Oscar is a start up by a venture capitalist; as one might expect if one is into stereotypes, they have an aggressively hipster website promoting how one can get free teleconferences (on your Google glasses?) with a primary care doctor anytime you want. And discounts on birth control, acne and asthma care, pain meds, and physical therapy. I wonder what demographic they are targeting; NOT. But then if you look at their "your network," one does start to get concerned should one need that neuropthalmalgist or pancreatitis specialist.

The Small Business Marketplace is easier to use, more public and I was able to get a simple comparison chart for the Bronze plans of all 3 companies. Health Republic, MetroPlus and United, without having to apply (al then possibly not see all the plans anway.)

I printed it out. The annual deductible for an individual for all three is $3,000 and annual out-of-pocket max is the ACA max, $6,350. Until you hit those limits, you pay 50% of doctors' visits in all 3, including primary care doctor and 50% of all outpatient surgery. Actually, all entries on the comparison chart are identical for all 3. So if you're not into further research, what is the info. you can get here before you make your purchase? Apparently that these are 100% identical plans except for the price!

All 3 are limited network HMO's. I have investigated United's network a bit and so far it seems to me that it might be the one in the Manhattan exchanges with the best provider network both in breadth and in quality. And it's also far more expensive than the other two.(The exchange website does not give a hint at the reason for the difference in price.)

These were the quoted unsubsidized prices for Manhattan per month via the Small Business Exchange: $334.11 for Health Republic, $357.11 per month for MetroPlus and $473.25 for United. For bronze plans probably giving lesser coverage than what people in that NYT article were used to.

As far as exchange website info. on provider networks being offered across the whole state in both exchanges, what you can get at the website is this PDF list in tiny print of 19 insurers, their phone numbers and a "provider network url." Some of the urls are easily useful, some are not. To be clear: only a few of the insurers on this list are offering insurance in all parts of the state.

No that's not exactly what's

artappraiser — Sat, 14 Dec 2013 05:54:26 +0000

In reply to http://www.washingtonpost.com

No that's not exactly what's going on with what is in the NYT article. Which is the same as my spouse's problem whose policy was canceled as of Dec. 31. I've had more time to investigate now and I understand better what is going on.

He had a PPO, Preferred Provider Network, as I glean many of the people in the article did. He also had it through a group formed like explained in the article. A PPO is where you get full payment by the insurer on their Preferred providers, but if you want to go out of network to see the world's specialist in your rare disease who practices in NJ and not NYC,* or if your optic nerve is screwed up and want to see the only neuropthalmalgist in Manhattan that has an opening sooner than a month before you go blind, you could do so, with their good wishes--and without their approval--and they would reimburse a specified portion of his fee.

Plus their preferred provider network was nationwide and was pretty damn impressive. As a New Yorker, you were covered to see some pretty good specialists in L.A. (This is clearlhy and definitely not the case with exchange policies.They are very localized.)

But all of the NYState exchange plans being offered so far, both in the individual exchange and the business exchange, are HMO's or EPO's, Exclusive Provider Networks, and they are plans with pretty small networks. No PPO's. So far the ones I have looked at it's no going outside of network, just no, not at all. (And if you do so out of pocket, better hide if from them, because they are "managing" all your care and it could cause some trouble with them.) PLUS, with more than one I have seen you must have their approval before seeing a specialist in network. Yes, it's back to ye olde HMO's of pre-Clinton era.

Which will mean when you call for an appointment, the wait might be months, just like in the 80's. Because they are providers who have agreed to accept payments from these plans hoping they get enough volume from it to make ends meet. I'll leave it to people to judge for themselves why some doctors who practice in NYC might want volume so badly that they would enter into these agreements. So far, suffice it to say the plans I have been able to access do not seem to be Castle Connolly top docs.

Furthermore, the selection of insurers in the exchanges, besides each having small networks, is pretty puny in itself. Especially once you subtract the ones that are really Medicaid providers. The way the website works is that once registered, you are only shown the insurers that you qualify for via income.So lots of people who have cancelled policies who don't make low enough to qualify

Furthermore, the unsubsidized prices for these HMO's and EPO's seem to be like 10% to 20% higher than comparable past PPO's, though as you say, it's not always easy to tell, because prices were always being raised every year.

Still, it's very clear with everything Bronze and Silver what the co-pays and deductibles are because that is basically all that the metal colors mean, the percent of the co-pays and deductibles! (And Gold plans are very low deductible or co-pay.) Quality or network is not indicated by the metal colors, just percent cost out of pocket, that's all these color indicators mean, nothing more.

Furthermore, the exchanges opened before insurers could convince more providers to sign up with them. I suspect they were hoping that a mad rush of patients would help them convince more providers to sign up. I don't know about elsewhere, but right now in NYC, this is not happening. It appears that some of the best doctors already have plenty enough to handle with employer-provided health insurance plans, and are even kind of fed up with what they have to do to manage getting paid from those, and are taking a wait-and-see approach to the exchange plans, not signing up.

What many of the people referred to in the NYT article probably don't realize, though, is something that It just learned. If you do not qualify for a subsidy, there is zero reason to bother with the exchanges. That is the only reason to go through the exchange, of which main raison d'etre is to pay the subsidy directly to the insurer (rather than the old fashioned way of having the insured deduct something off their taxes or get a credit on their taxes.) You can buy any of the exchange policies directly from the insurers themselves, same price, same policy, and you can buy any other policy any insurer is offering because they all have to follow ACA rules now. But you must buy before March 31. The open/closed enrollment periods applies to all health insurance policies now, not just exchange policies!

The question is: are insurers still offering lots of other policies too? I already know one company decided to throw all their bets in with the exchange policies and to drop everything else not-employer provided that they were offering, including their PPO policy, but then there are insurers that chose not to be in the exchange. That's the tricky part I haven't gotten into yet. HSA's are still allowed but there are no HSA qualified plans on the individual exchange in NY, and with the small business exchange it's hard to tell because it's sort of a work in progress. It was difficult a few years back for an individual or small business to buy an HSA-qualified plan in NY State because no one wanted to offer them, but that got better when the demand was there.

Insurers no doubt still want to push more people to the exchange policies to see some success, pool-wise, from what they have invested in. I do not have the expertise to figure this out and don't have the time to become an expert. My prediction that brokers who really know all of what is being offered at any moment are going to be worth their weight in gold to anyone over the subsidy income limits.

*I am seeing a lot of complaints in my reading about the geographic limitation being a problem nationwide for many looking at exchange policies. The offerings are limited by county! I haven't a clue why this is. In truth, from looking at NY, I have seen the insurers are offering the same plan and same network in more than one county, so it's not that the pools or networks are limited to 1 county, I suepsect that people are just shocked at the small and exclusionary nature of the networks and therefore think that it's limited that way when it's not necessarily.

http://www.washingtonpost.com

Peter Schwartz — Sat, 14 Dec 2013 00:47:44 +0000

In reply to For years and years, I had

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/29/the-health-care-trilemma-how-obamacare-is-changing-insurance-premiums/

A pretty good discussion of the trade-offs between then and now...

For years and years, I had

Peter Schwartz — Fri, 13 Dec 2013 23:16:50 +0000

In reply to With Affordable Care Act, Canceled Policies for New York Professionals

For years and years, I had insurance through a writer's group. Premiums went up by a lot every year or every other other year. I never had mental health coverage to speak of. None of my doctors ever participated in the plan.

I wonder how these people chose "their" doctors in the first place? By looking on the list of doctors who participated in their plan and picking one. If they picked their doctor before getting their insurance, then likely as not, that doctor was not participating.

So now, I have good insurance for the first time in 40 years through my wife's place of employment. Once again, the doctor I'd been seeing for 12 years was not a participant. So, I looked at the list and picked a different doctor.

Overall, what these people don't get (at least based on the article) is that their "good time" was based on a pricing structure that assumed other people had an "awful time." An awful time as being barred from having any insurance at all at any price.

Individuals should be grouped into virtual groups for underwriting purposes. Who cares whether they work at the same place or in the same profession?