Consolidations threaten to drive up costs

One of the mantras behind passage of the Affordable Care Act was that it would somehow increase competition, lowering health care prices.

This hasn’t happened. Instead, a wave of anti-competitive consolidation has been encouraged. Hospitals have been buying other hospitals or entering into controlling “strategic affiliations” — as was true when Swedish Health Services joined forces with Providence in 2012.

Much concern about hospital consolidation in Washington has centered upon Catholic-based systems limiting reproductive rights, but there are broader implications. Research shows consolidation drives costs upward. Hospitals now own most physician practices, and that, too, increases costs.

Now even Colorado-based DaVita — previously in the kidney dialysis business — is buying the Everett Clinic. The scale of entities created under the ACA is so large a company like DaVita can easily, as it did last year, pay out $495 million in a Medicare fraud settlement and still afford to purchase our state’s largest independent medical practice group, serving more than 318,000 patients with over 2,000 employees. Why merge? We’re told it facilitates “massive expansion” — a concept better-suited to a medical arms race than patient accountability.

Many of these maneuvers should implicate federal antitrust laws, but the federal government has not intervened — perhaps for fear of acknowledging the inexorable empire-building and profiteering unleashed by the ACA is not entirely benevolent.

Insurers are getting in on the act, too. Wanting to compete with giant UnitedHealth Group, which paid its CEO $66.1 million last year, Anthem is gobbling up Cigna for $54 billion, while Aetna is devouring Humana for $37 billion. Insurers are protected by state-based regulation from federal antitrust enforcement. If the ACA-era marketplace is dominated by fewer carriers, however, the “more competition” claim used to kill a public option will be exposed as a lie.

ACA defenders crow that the state’s Healthplanfinder exchange will have 12 different carriers. But there is less to this than meets the eye:

Four of the 12 are owned by two companies;

Only three of the 12 offer coverage in all 39 counties; and

Only five (one owned by another) of the 12 offer coverage in as many as 22 counties.

ACA defenders also effused that 2016 individual market rate increases will be lower than other states. That’s faint praise. Some huge increases are coming — as high deductibles, narrow networks, and denying care to the autistic (until private litigation stopped that) evidently were not profitable enough. Moda got a 16.5 percent increase (naming rights for the Portland Trailblazers’ arena cost $40 million, after all). RegenceBlueshield received a 10 percent increase, and its subsidiary, BridgeSpan, got a 14.1 percent increase. Premera’s increase was 8.8 percent. These increases far outpace personal income growth, as is also true on the employer-supplied side, where bankrupting high-deductible plans are becoming normal.

To be troubled by these trends is not to oppose health care access for all, but, rather, to note that much more must be done to make health care truly accessible and affordable in our state.

Brendan Williams, an Olympia attorney, is a former state representative (2005-10) and national health care writer.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Opinion

RGB version
Editorial cartoons for Monday, March 18

A sketchy look at the news of the day.… Continue reading

Carson gets a chance to sound the horn in an Everett Fire Department engine with the help of captain Jason Brock during a surprise Make-A-Wish sendoff Saturday, Oct. 21, 2023, at Thornton A. Sullivan Park in Everett, Washington. (Ryan Berry / The Herald)
Editorial: Everett voters will set course for city finances

This fall and in coming years, they will be asked how to fund and support the services they use.

Devotees of TikTok, Mona Swain, center, and her sister, Rachel Swain, right, both of Atlanta, monitor voting at the Capitol in Washington, as the House passed a bill that would lead to a nationwide ban of the popular video app if its China-based owner doesn't sell, Wednesday, March 13, 2024. Lawmakers contend the app's owner, ByteDance, is beholden to the Chinese government, which could demand access to the data of TikTok's consumers in the U.S. (AP Photo/J. Scott Applewhite)
Editorial: Forced sale of TikTok ignores network of problems

The removal of a Chinese company would still leave concerns for data privacy and the content on apps.

Rep. Strom Peterson, D-Edmonds, watches the State of the State speech by Gov. Jay Inslee on the second day of the legislative session at the Washington state Capitol, Tuesday, Jan. 9, 2024, in Olympia, Wash. (AP Photo/Lindsey Wasson)
Editorial: Legislature has its own production of ‘The Holdovers’

What state lawmakers left behind in good ideas that should get more attention and passage next year.

Comment: Measles outbreaks show importance of MMR vaccinations

The highly contagious disease requires a 95 percent vaccination rate to limit the spread of outbreaks.

Harrop: Should ‘affordable’ come at cost of quality of living?

As states push their cities to ignore zoning rules, the YIMBYs are covering for developers.

Saunders: Classified document cases show degrees of guilt

President Biden’s age might protect him, but the special prosecutor didn’t exonerate him either.

Comment: Clearing the internet of misinformation, deep fakes

With social networks’ spotty moderation record, users need to identify and call out problems they see.

Eco-Nomics: Price of gas, fossil fuels higher than you think

Greenhouse gas emissions from fossil fuels force unseen costs in climate disasters, illness and more.

Vote against I-2117 to keep best tool to protect climate

We voters will be offered the opportunity to repeal Washington state’s Climate… Continue reading

Lack of maternal health care raises risks of deadly sepsis

In today’s contentious climate, we often hear political debates about maternal health… Continue reading

Trump’s stance on abortion isn’t moderate; it’s dangerous

Voters deserve to know the facts and the truth about what will… Continue reading

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.