Digging Deeper: Sick of the Cost - KWWL - Eastern Iowa Breaking News, Weather, Closings

Digging Deeper: Sick of the Cost

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WATERLOO (KWWL) -

Making a decision about health care is not like shopping for a snow blower.

If you're lying in a hospital bed, it's tough to be a rational thinker about cost. You just want to get better.

Many Iowans feel powerless about the cost. They don't know what to do and are falling behind as the bills add up.

According to the Kaiser Family Foundation, insurance premiums for family coverage are up 213% since 1999. That far exceeds what wages have done during the same time.

President Obama tried to address that, but most believe, the Affordable Care Act hasn't worked because costs keep going up.

KWWL has spent time digging into what happened and where we could go from here.

Iowa Insurance Commissioner Nick Gerhart says a small group drives the price.

Commissioner Gerhart, a UNI graduate, was appointed by Governor Branstad.

Gerhart's office signs off on rate increases from insurance companies. This year, they approved rate hikes for 4 companies ranging from 19% to 43%.

"If you would've said to me 3 or 4 years ago, that we'd have a 43% increase and the state would've approved it, I would've said 'No way,' but we did because it's justified unfortunately," said Gerhart.

The insurance companies argue they need you to pay more to cover the high costs of those Iowans who were not insured before.

"In Iowa, low enrollment in the marketplace has resulted in a few members with high cost claims driving up the premiums for the entire group," said Gerhart.

The biggest increase of 43% affects thousands of Wellmark Blue Cross & Blue Shield customers.

One Iowa family has filed $27.3 million in claims over a period of 10 months. Nothing is known publicly about that family's situation because of patient privacy laws, but we do know the impact it's having on a wider scale. 22,000 Wellmark customers are paying more than $800 each to cover it.

"That one claim is 10% of the 43% increase," said Gerhart.

KWWL asked Commissioner Gerhart if Obamacare is primarily to blame for the problems we're seeing today with cost.

"Obamacare has 2,700 pages and about 40-50,000 pages of regulations. I think there are a lot of things to blame. Prescription drugs are out of control, especially specialty drugs. In addition, the high cost of hospital stays, higher levels of hospital utilization, and increasing advances in technology are putting upward pressure on costs. It's really hard for me to sit here and say, '(Obamacare) succeeded or failed,' but I'll tell you for the individual health insurance market, it's certainly been a challenge. The rates have gone up considerably in Iowa and other states and I don't see it getting any better unfortunately," said Gerhart.

Gerhart was recently called before Congress to testify about the problem of cost.

"We are essentially placing consumers in situations where they must choose between health care coverage and paying their mortgage or rent," Gerhart told lawmakers.

"There is little a state can do in isolation to reform their health insurance market. Without changes from the federal level, in collaboration with the states, individual states will be in the difficult position of watching a potential collapse of the individual health insurance market," said Gerhart.

That's where President-elect Donald Trump comes in. He has vowed to repeal Obamacare after he takes office in January. However, there are some parts that could survive.

Here's a look at what could stay:

- Letting young adults stay on parental health plans until they turn 26.

- Some kind of system to protect people with health problems from being denied coverage.

Here's a look at what could go:

-Mandates on individuals to get coverage or risk fines from the IRS.

-Mandates on employers to cover workers.

-All or most of the Affordable Care Act's tax increases on upper-income individuals and the health care industry.

"Iowa had a state high-risk pool that is still in effect today. Looking at using that as a mechanism to cover the most needy and chronically ill people may be worth exploring. High-risk pools effectively spread the cost across society by covering high cost claims, rather than costs being incurred by the individual insurance carrier, and spread to the members of the pool," said Gerhart before Congress.

You can read his testimony here.

No matter what happens, Commissioner Gerhart says transparency has to improve, so you know what you're buying and how much you're spending.

"You can sit here and say, 'My insurance company is paying for it,' but at the end of the day, we're all paying for it. Until we look at the entire system of health care, we are going to be having this dialogue for a long time," said Gerhart.

Time will tell if a new law drives down the cost.

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