Mega Mergers & Anti-Trust Issues Aren’t Limited to Cable, Tech, & Drug Companies

Everyone remembers hearing about the the giant hullabaloo that was the Comcast-Time Warner merger.  Some may even remember the 2000 case US Versus Microsoft.  Well, now we come full circle, but I’m not sure as many people know about this potential monopoly, though they should care…

Aetna & Anthem Blue Cross are set to follow in the footsteps of their predecessors in pharmaceuticals by gobbling their competition.   Aetna merged with Humana in July.  They had already acquired Coventry in 2013.   For insurance geeks, here’s an article that weighs out the pros & cons.

Anthem acquired Cigna in July as well.

To keep things basic, the entire problem lies in the Cigna article headline.   This leaves only 3 big insurance companies.  This is as close to a monopoly short of one acquiring everyone as they come.  While this means expanded membership, it does not spell choice or better offerings for the Affordable Care Act exchanges or for the healthcare marketplace as a whole.

It’s extremely concerning.  Keep in mind Aetna & Cigna have third party affiliates & contract with other smaller group insurances on borrowing their networks (as do others I’m sure).

But I wonder if this will in effect not only squeeze those third parties out or eliminate them completely? If the answer is yes, then that is leaving even less choice in the employer sector that remains for those of us who don’t access the marketplace.

It it yet another sector that is already suffering from increased premiums & deductibles in relation to wage.  This was happening before health reform, but it just wasn’t noticed as much.  Now it’s almost pervasive because of the trend & underwriting processes on this particular form of insurance (especially group policies).

But I understand that some many not care until they are personally affected.  The problem is with the increasing deductibles as well as high deductible plans we already don’t know what our insurance discounts or pricing between insurers and hospitals are on an MRI of the brain (for example) ahead of time. We only know what we pay relative to our deductible, or if we’ve met it any percentage we pay after (co-insurance). There’s a grassroots undercurrent swelling up & fighting for transparency now; but winnowing down competition & gobbling it up won’t move that change forward. It might even keep it underground because it gives insurances even more leverage over hospitals or other healthcare providers. It’s concerning because pricing negotiation between these two parties is already a dicey dance.

While I’m not sure what the outcome will be, I can only hope that Congress & federal regulators take this seriously & don’t steamroll the public interest. I say this regardless of my political leanings because this just puts too much power in the hands of too few people if this goes through.

I’m not as concerned imminently since my transplant has already been priced & negotiated. I was informed of this by my insurance company case manager. However, if I should lose coverage due to too large an increase in premium or my  deductible doubles (like it did last year), it still makes me nervous.

Especially since the current marketplace offerings in Pennsylvania even after the expansion will not be equivalent to what I have without just as large or a higher premium.  Even with long-term disability with my company, I do have to pay COBRA separately (to the tune of roughly $600 a month just to maintain coverage) but I’m not eligible for any type of Medicaid or Medicare services for at least 2 years. It would even be that way if I didn’t have company long-term disability & solely relying on Social Security Disability.

This also does not make the lone holdouts who don’t have any insurance yet eager to embrace looking at options.

Savings are not going to be shared or even come.  Costs are not going to go down as a result of these mergers. It’s not even good for the health system as a whole in economic terms.

People are already concerned about drug costs. Because prescription drug copays do factor into the overall out-of-pocket on most insurances, this is not going to help matters.   On high deductible plans, co-pays don’t even apply until the deductible is met. The patient pays the market cost for the drug until that point. Then pays co-pays after. For example,  Lantus solostar, a diabetes insulin pen, a few years ago was close to $300 for 3 pens & that was even with competitive pricing (one sees what it is now at the link).

High cost chronic conditions like hepatitis, multiple sclerosis, & cancer will also be affected.

I take 8 drugs now.  I may trade in some of those after transplant (mostly my inhaled long acting and short acting steroids and inhalers) , but then I will still have to take at least 10-15 if not more at the start. (I have the list, I should scan it in sometime. Maybe in another post I will.) I will take more drugs if I develop post-transplant diabetes (which can occur because of side effects of transplant drugs).

People are going to be hurting.  Pharmacy networks like CVS contract with insurance companies & groups too. Less options for carriers is not going to do them or us any favors in keeping drug prices competitive; which is the other half of why people obtain & use health insurance in the first place.

Some people have told me I care too much about this. To a degree that’s true, mostly because I’ve been on the professional end & have seen people struggle with an ugly insurance plan. I am concerned but mainly for those people who would have a harder time than I would staying on top of issues. Also for those who don’t know enough about their policy in the first place until something of concern happens.

I point this out in context for transplant because this is a major (albeit indirect)  financial barrier to listing. One’s insurance & benefits often dictate how much additional assistance is needed either through crowdfunding or starting a nonprofit medical fund or other methods.  If a person needs $50,000 & they can’t raise at least part of it prior to listing, they might not be able to list at all.

But that serious example aside, this is an issue that speaks to everyone, because it could just as easily take an ER visit for a slip on the ice, a heart attack, or any number of issues before someone suddenly comes face-to-face with the implications in otherwise healthy people.

Mergers like these make it harder to make insurance work for us. Instead they make it easier for it to work against us.


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