Jeb Bladine: Local health insurance fight just the beginning

Health insurance in America is unstable and becoming more so.

Insurance companies are cancelling unprofitable policies, creating narrower service networks and tightening benefits. There are nationwide hospital-insurer contract fights, changes in Affordable Care Act subsidies, private-equity pressures for consolidation of hospitals and provider groups, and major changes in Medicare Advantage coverages.

Bottom line for insured Americans: Costs are going up.

For one local perspective — before continuing here — read today’s News-Register story about the contract dispute between United Health Care (UHC) and Willamette Valley Medical Center hospital, clinics and providers (MVMC).

As those contract negotiations continue, panic is setting in among UHC policy holders who, after July 1, may either lose insured access to or pay much higher costs for WVMC services.

This may be the tip of a sprawling iceberg threatening health insurance beneficiaries nationwide.

Providence has announced it will discontinue individual/family plans in 2027, affecting hundreds of thousands of policy holders. One source says Providence may sell its entire Medicare business to Aetna; another says is unlikely, given the negative financial condition of that Providence business.

PacificSource, smaller but with tens of thousands of policy holders, is leaving the Affordable Care Act individual marketplace after 2026 and exiting Montana entirely.

These and other insurance disruptions will exert major pressure on companies such as Regence that are continuing their Oregon insurance plans … and Regence also is experiencing major network fights with large hospital systems.

Speaking of large hospital systems, WVMC is owned by Tennessee-based Lifepoint Health, which in turn is owned by a group of Apollo-affiliated private-equity funds. Lifepoint reportedly owns about 60 community hospitals, about 70 rehab and behavioral-health hospitals, and more than 300 additional sites of care.

It is possible — but not confirmed — that the United Health Care contract battle with WVMC is a precursor to similar high-stakes negotiations with providers throughout the Lifepoint and other health care networks.

More and more — with about 20 percent of the local population age 65 and older — it’s important to understand the pros and con among Original Medicare, Medigap and Medicare Advantage; it’s vital to know the basics and variations of HMO and PPO plans; it’s crucial to get good advice from professionals who can help you navigate the quagmire that is health insurance in America.

For starters, local UHC policy holders wanting services from WVMC should seek appointments elsewhere in the UHC network for planned, voluntary, out-patient medical services. More on that in today’s news story.

In the long run, however, we can only hope that major, ongoing disruptions in the American health insurance system will lead us — with many fighting and screaming — toward inevitable universal health care decisions that most of the world’s advanced nations have already adopted.

That movement, mostly focused on the uninsured, has long stalled because middle-class and seniors have had both coverage and access for health care. As those people experience instability, coverage denial and surprise loss of access, the case for single-payer health care may gain in stature, acceptability and necessity.

Jeb Bladine can be reached at jbladine@newsregister.com or 503-687-1223.