April 10, 2020
by Ceci Connolly
Recently, Sean Nicholson and David A. Asch penned a piece for Harvard Business Review asserting health insurers should begin injecting cash into hospitals to make up for revenue shortfalls. Nicholson and Asch are right that hospitals are in dire need of help. But their assessment of the role health plans can and should take in alleviating this crisis misses the mark—and shows some common misconception about health coverage in the United States.
When it comes to health insurance, not all health plans are created equal. While it’s true that for-profit health plans enroll almost 52 percent of insured individuals in America, the other 48 percent rely on nonprofit, community health plans such as those that comprise the Alliance of Community Health Plans (ACHP).
Our community health plans work in collaboration with providers every day, so they have no need to change their business model in a public health crisis to “transfer … premium dollars and taxes to providers on the front lines,” as the authors suggest. Operating on razor thin margins, these nonprofit organizations are required by law to remain financially healthy. At no time is this more vital than during a health care crisis such as the coronavirus pandemic, as they serve their communities, manage patient care and continue paying claims.
The desire to shine a spotlight on record profits of publicly traded companies is understandable. But efforts to deplete the hard-earned reserves of community health plans would wreak havoc with the nation’s health care safety net.
In this health crisis, as they do every day, community health plans quickly assess their local needs, nimbly adapt coverage and care and innovate to protect public health. The ACHP Board of Directors voted early in the crisis to include COVID-19 testing as a covered benefit, and member companies have gone far beyond that, waiving cost-sharing for testing, expanding telehealth services, creating community funds and flexing their workforces to telecommuting to flatten the curve.
As vested members of the communities they serve, our nonprofit health plans are built on a collaborative model that brings together carriers, clinical teams and the community to advance the best interests of individuals, not Wall Street.
Would the American health care system be better if more health insurers were driven by mission, and not profit? We think so.
Ceci Connolly is president and CEO of the nonprofit Alliance of Community Health Plans (ACHP), which represents the nation’s top-performing non-profit health plans to improve affordability and outcomes in the health care system. She is a former national health correspondent for The Washington Post.