‘Obamacare may hurt CNMI in long run’

According to Joeten Kiyu Public Library executive director John Gonzales and CNMI Consumer Assistance Program advocacy officer Kaitylyn Neises-Mocanu, the Affordable Healthcare Act, or Obamacare, will hurt the CNMI in the long run.

Gonzales told Saipan Tribune and those who also viewed his show “John Gonzales Live,” that ACA will also be implemented to the territories but only in pieces.

Three legs are applied under the ACA, which is market reforms, individual mandate, and employer mandate, but only the market reforms is applied to the CNMI.

Under the ACA, the major goal of it is for “every American” to have affordable, comprehensive health insurance.

“It doesn’t create a new public health insurance, rather it reformed and regulates private insurance coverage the goal of which mean to improve the quality in lowering the cost of healthcare to extend health insurance to all of U.S citizens,” Gonzales said.

“Obviously up north in Canada is universal healthcare and many other countries, so the U.S wanted to reform in order to provide universal healthcare provided where it is feasible to all U.S citizens,” Gonzales said.

Mocanu also clarified to Saipan Tribune that federal law mandates only “market reforms” for the CNMI.

Which means, that if an insurer wants to sell an insurance policy in 2014, the insurer must sell coverage to anyone applying in that market.

According to Mocanu, insurance companies run the risk of only insuring the sick which increase claim experience and raises premiums.

Since 2010, insurance companies cannot deny coverage to young adults on their parent’s plan until they are 26, raise premiums without justification such as grants awarded for CNMI rate review, deny coverage of children because of a pre-existing condition, rescind coverage for no good reason, prohibit a consumer from filing an appeal on a coverage denial, and charge any cost sharing or deductibles for certain in-network preventive care services.

“Insurance companies can’t spend less than 80 percent of premiums collected on medical claims, otherwise they must reimburse the difference to their enrollees. This keeps insurers accountable for how they spend your money,” Mocanu said.

According to Mocanu in 2011 and 2012 over $380,000 worth of rebates were given to CNMI residents because of the “medical loss ratio” rule.

The medical loss ratio rule is when the insurance rebates are being provided under a provision in the ACA that requires insurance companies to provide a rebate related to insurance premiums in certain situations.

Mocanu also said that in 2013 health insurance marketplaces, or “exchanges” opened in the U.S. mainland.

These exchanges are used to compare coverage and enroll in health insurance. This is due to the tax credits and subsidies offered in these exchanges, the CNMI could not afford this.

“All U.S territories chose to use the one-time lump funding to expand Medicaid, rather than establish and exchange,” Mocanu said.