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Insurers find wiggle room in requirement to cover all

 A healthcare reform specialist helps people select insurance plans at the free Affordable Care Act Enrollment Fair at Pasadena City College, 2013.

It’s September, which means the enrollment period to get health insurance under the Affordable Care Act is practically around the corner.

If you're signing up later this fall, you should consider this: despite provisions under the health law to guarantee coverage for all, some insurance policies are still designed to keep the sick away.

We all know thanks to the ACA, the days when insurers denied coverage because of pre-existing conditions are over. Cherry picking the healthiest among us is one of the ways many insurers used to make their money. Even though the law has changed, former state insurance commissioner Joel Ario says some companies haven’t.

“We have not eliminated discrimination from insurer DNA yet. So you are still going to see remnants of insurers using strategies that are trying to drive away risk than manage risk,” he says.

One of those strategies is to make drugs for high cost conditions like HIV or multiple sclerosis more expensive through hefty deductibles. Another is to limit the network of doctors and hospitals. If consumers want somebody out of that network, they pay through the nose.

The University of Pennsylvania’s Tom Baker says to thrive in today’s insurance climate companies must accept that sick people are part of the mix. “The health insurance companies that are trying to have fewer of those people, just want to have fewer,” he says.

Baker says the insurers who find the sweet spot between healthy and less healthy will be the ones at the top of the industry.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

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