Alexander-Murray ACA agreement still falls short for rural America
The Affordable Care Act insurance markets are broken in rural America. Forty-one percent of rural marketplace enrollees have only a single option of insurer. Seventy percent of the counties where big insurers have pulled out of have been rural counties. This lack of competition in the marketplace means higher premiums. Rural residents average per month cost exceeds urban ($569.34 for small town rural vs. $415.85 for metropolitan). Despite these troubling numbers, the recent bipartisan proposal by Senator Alexander of Tennessee and Senator Murray of Washington does not do enough to improve health insurance accessibility and affordability in rural America.
Yes, allowing the recent Executive Order signed by President Trump (which would remove insurance subsidies) to remain would likely mean insurance companies will pull out of rural markets entirely, clearly harming rural patients. Additionally, removing the subsidies would likely further exacerbate the rural hospital closure crisis. (Uninsured individuals still get sick and seek care in the emergency room, causing care to be subsidized by small, financially vulnerable hospitals. Bad debt is already up 50 percent since ACA has gone into law, forcing rural hospitals to close across the nation.) However, Alexander-Murray agreement misses an opportunity to truly address the great faults in the ACA rural marketplace.
NRHA as long advanced reform that would prevent insurance providers from withdrawing from rural markets. Despite record profit levels, insurance companies are permitted to cherry pick profitable markets for participation and are currently not obliged to provide service to markets with less advantageous risk pools. True, rural America may not reap huge profits for the insurance companies. (The demographic realities of the rural population make the market less profitable, and thus less desirable for an insurance company with no incentive to take on populations that are per capita older, poorer and sicker.) However, many insurers still report record profits - - and much of those profits come at the taxpayers’ expense. Many for-profit insurance companies are finding tax-payer subsidized Medicare Advantage and Medicaid-Managed Care contracts extremely beneficial to their profit margins. According to a June 2017 article in CNN Money, Medicare Advantage underwriting profitability “soared by 279 percent.”
It's time Congress do more to help rural Americans access affordable health insurance. Two simple additions to the Alexander-Murray proposal would go far. First, Congress could strongly encourage insurance companies to do outreach to underserved communities. (Such encouragement could be similar to what Congress, on a bipartisan basis, required the lending industry to do in the Community Reinvestment Act to encourage big banks to lend to underserved communities.). Second, because much of the profits of private insurers come from the taxpayer, Congress could incentivize states to require insurance companies to have an affordable plan on an exchange if they also operate a Medicare Advantage or Medicaid Managed Care plan in a state.
Each of these proposals would vastly improve affordability and accessibility to insurance for rural Americans - - where such coverage is so critical. Rural Americans are more likely to suffer from diabetes, cancer, and traumatic injury; rural Americans are more likely to be uninsured or underinsured and less likely to receive employer sponsored health insurance. It’s time to stop big insurance companies from discriminating against rural America. We implore the Administration and Congress to make health insurance affordable and accessible for all rural Americans.