Market-Based Health Care Is Screwing Rural America

Single payer would be a huge boon for small-town residents.

By: Megan Stanley. Jacobin Magazine. Jan 9, 2018.

Excerpts only. Read complete article here. 

The goal of universal coverage has long eluded the Affordable Care Act — especially in rural areas. Because insurers have less financial incentive to offer plans in less densely populated places, residents have an especially hard time finding health coverage through the ACA exchanges.

The dire state of rural health access was driven home for me recently when I went looking for health coverage. After returning from several months out of the country, my husband and I signed up on healthcare.gov and put in his family’s address in Caroline County, a rural area outside Richmond, Virginia. While we expected to find few options, especially compared to our previous address in Northern Virginia, we were both shocked by the results. Our search turned up just two insurers and eight plans. All of them included a deductible and charged exorbitant rates for two people in their thirties.

As a point of comparison, we decided to look up the rates for a similar silver-level plan in Pittsburgh (Allegheny County), where we’re moving later this year. The premiums were almost half of those in the rural Virginia exchange, and we could easily select a zero-deductible plan, instead of the hefty $3,600 deductible we were saddled with in the other plans.

So what was the big difference in the Pittsburgh marketplace? There were four times as many plans available, with a greater number of enrollees ensuring a diverse mix of health levels (i.e. not just older, sicker populations).

. . .

The situation is even worse in single-insurer counties, which now make up more than half of the counties in the US.

. . .

The recently passed tax reform bill nixed the individual mandate beginning in 2019, which could have catastrophic consequences for exchanges across the country, particularly in rural areas.

While the mandate was unpopular with Republicans, it also ensured a mix of different ages and health levels in the pool of covered persons. Without it, insurers are likely to raise prices or exit markets, fearing healthy people will drop out if there is no longer a penalty for not having coverage.

. . .

Instead of watching insurers ditch the marketplace or drive up prices for people who can no longer afford health care, we need to scrap the market-based approach and look toward a single-payer system that would offer basic universal coverage and shift the focus from profit to quality care.