For Dentists Picking Health Benefits, Uncertainty Looms

Insurance premium hikes could hurt both dentists and their employees.

When Craig Start thinks back to the 2010 debates over health care reform, the outcome of the overhaul has been pretty much what he expected. But that doesn’t mean he has any clear answers as to where things go from here.

Start is the longtime president of MDA Insurance, a wholly owned subsidiary of the Michigan Dental Association. The company provides a suite of insurance products to the state’s dental community, including group health insurance. MDA Insurance also provides advice and counsel to dentists who don’t offer health insurance, but instead have their employees buy their own coverage on the individual market.

Start isn’t surprised that health insurance premiums have shot up on the Affordable Care Act’s insurance marketplace.

“Four years ago, I would have definitely said, ‘Don’t do it — here’s what’s going to happen,’” he said. “And I predicted these high premium increases, and they’re absolutely coming true.”

But now that the ACA is law, Start is watching the will-they-won’t-they repeal debate with mixed feelings. He would have preferred if the law had never been enacted, but he’s also aware that millions of Americans now rely on it to be able to access health insurance. As lawmakers in Washington have learned, the healthcare overhaul is difficult to undo.

“Now it’s kind of like the cat is out of the bag,” he said.

Start will do his best to help MDA members navigate their next health insurance steps during a seminar next month at Northern Michigan University.

A lot has changed in Michigan in the years since the ACA was first passed in 2010. Initially, a significant number of members decided it was a good opportunity to get out of the health insurance business and let their employees buy their own coverage.

Those who did ended up subjecting employees to double-digit premium increases. In Michigan, the main ACA marketplace insurer is proposing a rate increase of about 27 percent next year, a number that could be slightly higher if the federal government decides not to fund insurance subsidies.

President Donald Trump has yet to say whether he will continue the subsidies.

Start said that kind of cost hike could hurt dentists who don’t offer their employees insurance, since it might make them less attractive to potential employees.

Meanwhile, dentists who stayed with MDA Insurance and its group plan saw much smaller increases in the low single-digits the past two years.

Altogether, about 4,000 people are on the MDA Insurance plan. At the beginning of the ACA era, Start said about 2,000 people in the MDA community chose to go to the individual market, but he said that number has dropped by a few hundred as people have fled rising premiums.

Start noted, however, that some of those people don’t have the option of group insurance — they either don’t work enough hours to qualify, or they don’t qualify because they are contract workers and not staff members.

As 2018 open enrollment rolls around, what’s a dentist to do?

Start said those in the MDA group plan already know what to expect for 2018 — an increase in the range of 3 to 5 percent on premiums. That number shouldn’t change, regardless of what Washington does regarding health reform.

“[Current MDA Insurance customers] can safely elect their renewal and make that decision early in our open enrollment process. They don’t have to wait til the end,” he said.

Those in the individual market might do well to wait, he said.

“For those folks still stuck in individual market, I think it’s at least worth waiting until word comes out on the subsidies,” he said.

It’s unclear when that decision will come. Even after the subsidy decision is made, it’s unlikely that employers will be able to enjoy long-term clarity when it comes to federal health policy anytime soon.

“The million-dollar question is, ‘What’s going to happen?’” he said. “Of course, I thought I knew about four months ago, but I sure don’t think I know now. We’re all caught in this crossfire of uncertainty going into 2018.”