The
UnitedHealth Group,
one of the largest commercial insurers, told analysts that so far this
year, insured hospital stays actually decreased in some instances. In
reporting its earnings last week,
Cigna, another insurer, talked about the “low level” of medical use.
Yet the companies continue to press for higher premiums, even though
their reserve coffers are flush with profits and shareholders have been
rewarded with new dividends. Many defend proposed double-digit increases
in the rates they charge, citing a need for protection against any
sudden uptick in demand once people have more money to spend on their
health, as well as the rising price of care.
Even with a halting economic recovery, doctors and others say many
people are still extremely budget-conscious, signaling the possibility
of a fundamental change in Americans’ appetite for health care.
“I am noticing my patients with insurance are more interested in costs,”
said Dr. Jim King, a family practice physician in rural Tennessee. “Gas
prices are going up,
food prices
are going up. They are deciding to put some of their health care off.” A
patient might decide not to drive the 50 miles necessary to see a
specialist because of the cost of gas, he said.
But Dr. King said patients were also being more thoughtful about their needs. Fewer are asking for an
MRI as soon as they have a bad
headache. “People are realizing that this is my money, even if I’m not writing a check,” he said.
For someone like Shannon Hardin of California, whose hours at a grocery
store have been erratic, there is simply no spare cash to see the doctor
when she isn’t feeling well or to get the $350 dental crowns she has
been putting off since last year. Even with insurance, she said, “I
can’t afford to use it.” Delaying care could keep utilization rates for
insurers low through the rest of the year, according to Charles Boorady,
an analyst for Credit Suisse. “The big question is whether it is going
to stay weak or bounce back,” he said. “Nobody knows.”
Significant increases in how much people have to pay for their medical
care may prevent a solid rebound. In recent years, many employers have
sharply reduced benefits, while raising deductibles and co-payments so
people have to reach deeper into their pockets.
In 2010, about 10 percent of people covered by their employer had a
deductible of at least $2,000, according to the Kaiser Family
Foundation, a nonprofit research group, compared with just 5 percent of
covered workers in 2008.
Doctors, for one, say patients’ attitudes are changing. “Because it’s
from Dollar 1 to Dollar 2,000, they are being really conscious of how
they spend their money,” said Dr. James Applegate, a family physician in
Grand Rapids, Mich. For example, patients question the need for annual
blood work.
High deductibles also can be daunting. David Welch, a nurse in
California whose policy has a $4,000 deductible, said he was surprised
to realize he had delayed going to the dermatologist, even though he had
a history of
skin cancer.
Mr. Welch, who has been a supporter of the need to overhaul insurance
industry practices for the California Nurses Association union, said he
hoped his medical training would help him determine when to go to the
doctor. “I underestimated how much that cost would affect my behavior,”
he said.
Dr. Rebecca Jaffe, a family practice doctor in Wilmington, Del., said
more patients were asking for the generic alternatives to brand-name
medicines, because of hefty co-payments. “Now, all of a sudden, they
want the generic, when for years, they said they couldn’t take it,” she
said.
The insurers, which base what they charge in premiums largely on what
they expect to pay out in future claims, say they still expect higher
demand for care later this year. “I think there’s a real concern about a
bounce-back, a rebound, in utilization,” said Dr. Lonny Reisman, the
chief medical officer for Aetna.
Because they say they expect costs to rebound, insurers have not been
shy about asking for higher rates. In Oregon, for example, Regence
BlueCross BlueShield, a nonprofit insurer that is the state’s largest,
is asking for a 22 percent increase for policies sold to individuals. In
California, regulators have been resisting requests from insurers to
raise rates by double digits.
Some observers wonder if the insurers are simply raising premiums in
advance of the full force of the health care law in 2014. The insurers’
recent prosperity — big insurance companies have reported first-quarter
earnings that beat analysts expectations by an average of 30 percent —
may make it difficult for anyone, politicians and industry executives
alike, to argue that the industry has been hurt by the federal health
care law. Insurers were able to raise premiums to cover the cost of the
law’s early provisions, like insuring adult children up to age 26, and
federal and state regulators have largely proved to be accommodating.
But 2014 and 2015 are likely to be far more challenging, as insurers are
forced to adjust to the law’s greatest changes, like providing coverage
to everyone regardless of whether they have an expensive pre-existing
condition. “I think they’re going to go through a winter,” said Paul H.
Keckley, executive director of the Deloitte Center for Health Solutions,
a research unit of the consulting firm Deloitte.
And while the slowing down of demand is good for insurers, at least in
the short term, the concern is that patients may be tempted to skip
important tests like
colonoscopies or
mammograms.
The new health care law will eventually prevent most policies from
charging patients for certain kinds of preventive care, but some plans
still require someone to pay $500 toward a colonoscopy.
In recent times, insurers have prospered by pricing policies above costs, said Robert Laszewski, a former
health insurance
executive who is now a consultant in Alexandria, Va. The industry goes
through underwriting cycles where the companies are better able to
predict costs and make room for profits. “They’re benefiting from a very
positive underwriting cycle,” he said.
“Maybe managed care is finally working,” he said. “Maybe this is the new normal.”
Still, he emphasized, health care costs, even if they are rising at 6
percent or 7 percent a year, are increasing at a much faster pace than
overall inflation. “We haven’t solved the problem,” Mr. Laszewski said.
By 
In
a perfect example of a big media company looking to capitalize on
current events, The Walt Disney Company has trademarked “Seal Team 6,”
which also happens to be the name of the elite special forces team that
killed Osama Bin Laden.
