When it comes to health care in Alaska, it's safe to say we've come a long way in the past 15 years. Doctors and patients in Alaska want the same thing — greater access to care across the state, and a strong network of providers ready to provide emergency, primary and specialty care right here at home, without wasting hours and funds on medevac to another state. While we have further to go, maintaining the gains we've made in expanding access to care and emergency services is critical.
As a physician who has been practicing in Alaska and treating patients for more than 20 years, and as president of the Alaska State Medical Association, I have seen these improvements firsthand. Yet right now, the progress we've made is under attack.
The number of physicians throughout the state has increased by almost 30 percent, from 205 to 264 per 100,000 Alaskans. Access to specialty care in particular has grown, from a time when there was only one cardiologist and one neurosurgeon serving the entire state, to today, when patients can receive care they need in five locations throughout the state. There are now 17 trauma centers that can provide care to injured patients, compared to only two prior to 2004.
What does this mean for your family? Sometimes, the difference between life and death. A child who needs a pediatric surgeon no longer has to be flown to Washington, because the procedure can be done in Alaska — saving time, money, and in many cases lives. At the same time, the number of independent physician practices has grown in Alaska, bringing investment, jobs and needed resources to local communities.
The specialty care system in Alaska used to be so fragile that the only neurosurgeon in the state would drive around with a helmet on his head to ensure that in the event of an accident, he could continue to treat patients. Otherwise, Alaska families had no other options available.
So what's behind these gains? In 2004, Alaska's Department of Insurance issued the 80th-percentile rule, which sets a market-driven reimbursement rate to compensate doctors for out-of-network care. So, if you are in a car accident and rushed to the nearest hospital, and an out-of-network anesthesiologist see you — instead of getting stuck with a bill on top of your regular insurance premiums and deductibles, with this rule, your insurance company will pay that anesthesiologist. On top of protecting patients like you from bearing the full cost of care, the rule ensures that emergency services are paid for reliably, which has directly led to the improvements we've seen in Alaska's emergency, primary and specialist care system.
Even though there are more doctors in-network now than before the rule was issued, and even though insurance premiums are going down this year for many people, insurers want to undo this rule — threatening your access to care and protection from additional out-of-pocket costs.
Alaska's largest insurer, Premera, is claiming that the 80th-percentile rule increases costs — yet Premera has been making millions in revenue and has been asked to return money to the state for its excessive profits, and lower monthly patient premiums. Why are insurance companies trying to make patients pay more out of pocket for medical care that should be covered under plans they already pay thousands of dollars for each year?
Across the country, insurance companies are working to narrow their networks — kicking doctors out and limiting choices for patients. These narrower networks create better profit margins for insurance companies, but leave patients without access to care and more exposed to surprise medical bills. In fact, this year, 73 percent of exchange plans offer these restrictive, narrow networks. At the same time, insurance companies are shifting more and more costs directly to patients through increasing premiums, deductibles and out-of-pocket costs. More than 90 percent of patients with exchange plans have high-deductible plans and have to pay at least $1,300 before any coverage kicks in.
Patients are paying more and getting less care, while insurance companies make record profits. This year alone, top insurers have made some of their highest profits in a decade. Recent Q2 earnings show that this trend is continuing, and profit margins are in the billions.
Make no mistake, these are the forces driving insurers to undermine Alaska's 80th percentile rule — they want to lessen their obligations to pay for patient care, narrow their networks reducing your access and choice, and ultimately keep more of the sky-high premiums and deductibles they are charging.
Our state has made tremendous strides in medical care since 2004, and we truly do need to work together to address real problems in the health care system and bring down costs for patients. Doctors and the Alaska State Medical Association are committed to doing just that. But eroding access to care for patients is not in anyone's best interest. Alaska doctors and patients can't afford to cross this line.
Dr. Joseph Roth, M.D., is a family physician in Juneau, Alaska and has been treating patients for more than 20 years.