Friday, January 15, 2016

Health Insurance Providers Face Scrutiny Due to Upcoming Mergers

Competition is a major key for keeping product prices low. When that competition is removed, whether by government interference or as a natural effect of the free market, a single company or small group of companies can effectively gain a monopoly on the supplies of a specific type of good or service, which would give them the ability to charge as high a price as they want. It is that situation that many individuals fear may occur in the health care industry. Chad Terhune, of the Los Angeles Times, describes in his article the various mergers currently in the works between health care providers, and the effects that these mergers, if successful, could have on the average American.

For employers and employees alike, these mergers could have huge effects. If all of the pending mergers are approved, then three companies will have control of the majority of the healthcare market, which could lead to a forcing-out of smaller, competing businesses, which could grant them more control. Currently, the companies have the following goals: Anthem Blue Cross Inc. aims to buy out Cigna Corp. for $54.2 billion, Aetna Inc. wants to take over Humana for $37 billion, and the smaller company Centene is looking to acquire Health Net Inc. for $6.8 billion. In the end, Anthem, Aetna, and United Health Group could be at the top of the industry, in California at least.

Many opponents to these mergers fear that the benefits that these health care providers receive by expanding will not be passed on to consumers. In fact, they fear that the new power earned by the companies might lead them to increase rates, forcing customers to pay more or try to find an alternative provider, which would be quite difficult to accomplish in a short time period. They also want to make sure that these large companies have restrictions and extra rules making them focus on improving patient care. Partly in response to the issues raised by opponents, the Department of Justice is having anti-trust officials investigating each of these deals, but in general, state approval determines the end result.

States tend to put the most regulations on the health insurance market. So, in the end, it is usually up to your specific state to decide what conditions the merging companies will have to meet, including holds on premium increases and general network standards. There are, however, existing issues in the system, involving a patient's ability to get insurance at all, as well as the affordability of the patient's final choice. Often, health insurance providers will set a limit on the amount of coverage they will provide to specific patients, depending on the patients' health and medical history. In some instances, this can actually help the common customer. For example, Anthem at one point declared that it would provide a maximum of $30,000 in coverage for knee and hip replacements. Because of this limit, customers were forced to shop around to find a medical practice that would do the procedure for a lower price, which forced about 20% of hospitals to lower prices so as to not lose the business.

Proponents of the mergers hope that similar situations will occur in the future of the health insurance industry. They hope that, as the companies gain more control, they will be able to force medical providers to lower prices to keep the demand constant. They expect that consumers will see a lowering of overall costs, both to hospitals and to the insurance providers as well. For now, there is no real way to determine definitively whether the mergers will be positive or negative for the common American. In all likelihood, the mergers will be approved by the Department of Justice. So, these three companies will almost definitely become the leaders in the industry. The only question might be the level of restriction placed on these companies by each state.

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