Insurance for a Few 

Watchdogs: Insurance companies cherry-pick customers

Health care watchdogs recently asked the state's largest health insurance companies to show them the money but what they found were baskets full of cherries and very little transparency in the health insurance market.

The Idaho Community Action Network (ICAN) summarized the results of their investigation of Idaho's private insurance market in the report, Dollars Well Spent?: The Need for Transparency in the Health Insurance Market. The conclusions from their health insurance scavenger hunt led the group to call for greater accountability in health insurance spending and propose an Idaho Health Insurance TRUTH Act.

Dollars Well Spent? notes that current state laws allow Idaho private insurers to shield risk segmentation practices, or what's sometimes called consumer "cherry-picking," behind a veil of secrecy. When ICAN asked Blue Cross, Regence BlueShield and the Idaho Department of Insurance to furnish figures on rates, percentage increases, administrative cost breakdowns and medical loss ratios, the group was told the information was "proprietary" and withheld as "trade secrets."

"Blue Cross and BlueShield couldn't--or wouldn't--give us answers to practically any of our questions," said Ron Matthews of Caldwell. "It makes you wonder, what have they got to hide?"

State and federal Freedom of Information Acts require government agencies to keeping the books of programs such as Medicaid and Medicare accessible and subject to public scrutiny. But private companies are exempt from Sunshine Laws. Blue Cross and BlueShield did not respond to BW's requests for information about their spending practices or for comment regarding the ICAN study.

Dollars Well Spent? notes that current rate regulation laws do little or nothing to prevent health insurers from selectively choosing which individuals and companies to offer quality insurance to while avoiding older or less-healthy populations. The study says the practice may benefit some insurers, but undermines health insurance's role in spreading the risks and sends vulnerable folks into the ranks of the uninsured and under-insured.

"Idaho is facing an acute crisis," said Bill Whitaker, social work professor at Boise State University. That crisis stems from cherry-picking and puts Idaho at the edge of a perfect storm, he said. "Insurance companies, we believe, are increasing profits by cherry-picking."

Whitaker said increasing transparency through sunshine and reporting mandates is the first step in reducing insuring practices that penalize people with disabilities and chronic health problems. "Only then will we be able to see why people are paying more and getting less."

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