Clinical social workers provide the lion’s share of behavioral health services in the rural parts of America, largely because they are willing to work in areas that are traditionally under-served and for which professional services are usually under-paid. Rural clinicians and their clients will soon be facing the difficulties of working for monopolies—private health insurance companies without any competition.
Private health-insurance companies are retreating from rural areas all over the U. S., largely because they did not make the profits that they anticipated under the Affordable Care Act (ACA). In 650 U. S. counties, 70% of them rural, there will be no competition in the ACA online marketplace next year—in each, just one company will provide services, at prices that can be set by the provider. This is already true for the whole state of Wyoming, and will be true for all of Alaska and Alabama and parts of the Kentucky, Tennessee, Mississippi, Arizona, and Oklahoma, per the Kaiser Family Foundation, which is tracking the withdrawals.
A major goal of the ACA was to entice private health insurance companies to participate in markets and among populations they had not served in the past. These results show the limits of a system built on private entities whose main purpose is to make profits rather than provide healthcare. The full extent of the retreat of the health insurers is not yet known, since filing deadlines in some states are not yet closed.
Many consumers in rural settings receive federal subsidies toward payment of premiums; but there is no guarantee that they will be able to pay for care from private health insurers that are monopolizing services and are not limited in the fees they can charge.
Are you a rural clinical social worker who is dealing with the withdrawal of competing health insurers? How have you and your colleagues responded?
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