Latest / Becker’s Healthcare Podcast / Community Over Coverage: Why More Americans Are Opting Out of Health Insurance

Transcript

Community Over Coverage: Why More Americans Are Opting Out of Health Insurance · Becker’s Healthcare Podcast

• 0:00
  - Hi, everyone. This is Brian Zimmerman with Becker's
• 0:02
  - Healthcare. Thank you so much for tuning into
• 0:04
  - the Becker's Healthcare podcast.
• 0:06
  - I'm excited to welcome Dorsey Morrow. He's the
• 0:08
  - CEO of Liberty Health Share, one of the
• 0:11
  - country's leading medical cost sharing ministries.
• 0:13
  - Dorsey brings a unique blend of leadership experience
• 0:16
  - across health care, technology,
• 0:18
  - cybersecurity, and law. Before joining Liberty Healthshare, he
• 0:22
  - held senior leadership roles with international organizations
• 0:25
  - in geophysics and information security, and he has
• 0:28
  - practiced law for more than three decades, including
• 0:30
  - arguing before the US Supreme Court. With degrees
• 0:33
  - in computer science, business, and law, Dorsey offers
• 0:36
  - a distinctive perspective on leadership, innovation, and the
• 0:39
  - evolving health care landscape. Dorsey, welcome to the
• 0:42
  - podcast.
• 0:43
  - Hey, Brian. Thanks for having me.
• 0:45
  - Well, so let's dive in here, and we're
• 0:47
  - we're gonna we're gonna talk about
• 0:49
  - why more Americans are opting out of health
• 0:51
  - insurance and and what can be done about
• 0:53
  - that. So health care affordability has been a
• 0:54
  - growing challenge for Americans for years, even before
• 0:58
  - the recent changes to ACA subsidies.
• 1:01
  - From your perspective, what are the biggest pressures
• 1:03
  - consumers face today when it comes to accessing
• 1:05
  - and paying for care?
• 1:07
  - You know, it it's it's certainly more pronounced
• 1:10
  - these days, but I think it really comes
• 1:13
  - down to two things, and that's being cost
• 1:16
  - and uncertainty.
• 1:18
  - People are are clearly paying high premiums now.
• 1:21
  - As a matter of fact, I I spoke
• 1:23
  - to,
• 1:24
  - a friend that their premiums
• 1:26
  - right now are going up $3,000.
• 1:30
  - Up to $3,000
• 1:31
  - a month is what they're going to be
• 1:32
  - paying for their health their health insurance.
• 1:35
  - And that's before you even talk about deductibles
• 1:39
  - and the out of pocket cost before the
• 1:41
  - coverage kicks in. It's crazy what people are
• 1:44
  - having to
• 1:45
  - pay for,
• 1:46
  - before you even see a doctor.
• 1:48
  - So I think that's part of the equation
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  - there,
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  - the cost,
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  - and then the uncertainty.
• 1:55
  - They don't know
• 1:56
  - after paying all that money whether
• 1:59
  - something's going to actually be covered. You know,
• 2:01
  - is my doctor in this network?
• 2:04
  - You know, when you consider that roughly,
• 2:06
  - one out of five claims are denied
• 2:10
  - according to, KFF,
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  - poll
• 2:13
  - recent poll,
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  - that it it's understandable that people lose confidence
• 2:18
  - in the system.
• 2:20
  - Completely. I mean, that's that's very challenging when
• 2:22
  - you're paying that much money, and then you
• 2:24
  - still are have questions about whether or not
• 2:26
  - you're you're gonna be covered or how much
• 2:28
  - you're gonna you're gonna have to pay.
• 2:30
  - I can it's very easy to imagine losing
• 2:33
  - confidence in such a way. It's it's quite
• 2:36
  - understandable that, you know, the the average consumer
• 2:38
  - these days is so concerned about health care.
• 2:42
  - Yep. And and especially the average consumer isn't
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  - as
• 2:45
  - well versed in the ins and outs of
• 2:47
  - health care, like the the business of this.
• 2:48
  - So it's gotta be very
• 2:50
  - confusing for them to to to see these
• 2:52
  - kind of prices and and then go through
• 2:54
  - this kind of these challenges when you're actually
• 2:56
  - looking for care. It it really is. You
• 2:59
  - know? And especially,
• 3:00
  - you know, when you consider it, it used
• 3:02
  - to be and and I I, you know,
• 3:05
  - when health insurance started, it this it really
• 3:08
  - started to take off back during the World
• 3:10
  - War two as far as employer offered insurance,
• 3:14
  - because there was a wage freeze.
• 3:16
  - And so employers
• 3:17
  - were looking for anything that would bring in
• 3:21
  - workers. And since then, since that time, it
• 3:23
  - has been sort of a the employer's covering
• 3:26
  - it. And so
• 3:28
  - consumers have just sort of thrown the medical
• 3:31
  - bill over the the proverbial fence and said,
• 3:33
  - let somebody else worry about it.
• 3:36
  - And we're now dealing with the consequences of
• 3:38
  - that.
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  - Huge increases
• 3:40
  - in premiums and deductibles
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  - and costs just keep going through the roof.
• 3:45
  - People are looking for alternatives.
• 3:48
  - Yeah. Certainly. And and wanna let's zero in
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  - on the the ACA subsidies for a moment.
• 3:53
  - How has the the elimination of those subsidies
• 3:55
  - impacted the work you're you're doing at at
• 3:57
  - Liberty Health Share? Can you share a bit
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  - about that? Oh, absolutely.
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  - You know, it's there's no doubt that it
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  - has led to more people
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  - exploring options.
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  - And, of course, health sharing are one of
• 4:09
  - those options. It's an alternative way to pay
• 4:11
  - for health care.
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  - We've seen
• 4:14
  - twenty consecutive
• 4:16
  - months
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  - year over year enrollment growth. And in fact,
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  - during the most recent enrollment period,
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  - that ended in mid January,
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  - our enrollment was more than doubled prior year.
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  - And, you know, we have found that people
• 4:31
  - who are attracted to health sharing,
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  - usually fall into one of three groups. And
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  - that's people who are looking to save cost,
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  - people who want something that aligns with their
• 4:42
  - Christian faith, that sense of community.
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  - And then lastly,
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  - people who don't like the government telling them
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  - or being involved in their health care, and
• 4:52
  - they want that sense of control back.
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  - So it's it has certainly,
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  - had a big impact on
• 5:00
  - Liberty Health Care.
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  - Yes. Certainly. I don't wanna get to sort
• 5:04
  - of another
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  - component here, which is how consumer expectations more
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  - broadly have changed. I mean, you think about
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  - how,
• 5:12
  - I guess, convenient
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  - a lot of the consumer and just other
• 5:16
  - consumers facing industries are for folks these days.
• 5:19
  - And then when it comes to health care,
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  - it's very complicated and difficult
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  - where the stakes are high. Where the stakes
• 5:25
  - are low, like, I can get something to
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  - deliver to my house right now
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  - whenever I want. Pretty low stakes, though, situation.
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  - So but my expectations have shifted. Right? But
• 5:33
  - when when it comes to health care,
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  - the stakes are high, and we're kind of
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  - you know, it's way more confusing and challenging.
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  - Right? So It really is. Yeah. So can
• 5:43
  - you talk a little bit about
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  - as we're seeing cost continue to rise and
• 5:47
  - consumer expectations shift,
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  - how is that I I guess, how are
• 5:51
  - you seeing that from from from your seat?
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  - And what does that tell us sort of
• 5:54
  - about the gaps in the current system in
• 5:56
  - terms of how
• 5:58
  - this what this experience is like for folks?
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  - Well, I don't think there's any doubt
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  - in most,
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  - consumers'
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  - mind that we had a very different system
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  - altogether,
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  - you know, ten, twenty years ago.
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  - At during that time frame,
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  - the the two biggest questions were, you know,
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  - what's my premium going to be, and is
• 6:19
  - my doctor in network? You know? And,
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  - I can remember when my my daughters were
• 6:25
  - born, and we got a hospital bill that
• 6:28
  - was I I you know, I wanna say
• 6:30
  - our
• 6:30
  - our component of that was, like,
• 6:33
  - $1,500.
• 6:35
  - And nowadays, you know, it's not surprising for
• 6:37
  - somebody to get a get a bill with
• 6:39
  - insurance to have a 15,000,
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  - $20,000
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  - bill
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  - from their,
• 6:45
  - dealing with their pregnancy.
• 6:47
  - So today, they're asking,
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  - I think,
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  - rightfully so,
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  - some bigger questions.
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  - They wanna know whether their health care is
• 6:56
  - affordable. You know? Do they really understand it?
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  - Is it predictable?
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  - You know? People are demanding, I think, a
• 7:02
  - little bit more transparency
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  - into costs.
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  - They wanna have confidence
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  - in how their health care dollars are being
• 7:10
  - used and just, quite frankly, fewer surprises.
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  - That's, I think, one of the reasons that
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  - alternative models like health sharing are seeing higher
• 7:20
  - interest.
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  - You know, traditionally, we have
• 7:24
  - invested more time in researching that toaster oven
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  - we're looking at buying off Amazon than we
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  - did looking at our health care and how
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  - we were going to afford it.
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  - And I think the recent,
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  - string of events had has sort of shifted
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  - that model a little, and I'm hopefully hoping
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  - it it'll be a lot greater,
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  - in the months and years to come. You
• 7:46
  - know, at Liberty,
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  - we're very much focused on transparency.
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  - We post our sharing guidelines on our website
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  - so that you can go and easily look
• 7:56
  - and see what's eligible for sharing, what's not
• 7:58
  - eligible.
• 7:59
  - We have a live call center that, you
• 8:02
  - can call in and we'll walk you through
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  - it. We post our financials. We post our
• 8:07
  - tax returns.
• 8:09
  - We, post our our audit reports.
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  - Transparency
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  - is critical, and I think we all need
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  - to expect that from whatever model we are
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  - utilizing.
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  - Yeah. And I I'm sure people are craving
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  - that transparency too. Just when you think about
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  - getting those big bills and you do have
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  - insurance, it's gotta be kind of a head
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  - scratching experience for a lot of people. Absolutely.
• 8:31
  - Yeah. Yeah.
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  - And I did read recently that Liberty Health
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  - Share returned more than 2,000,000,
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  - $2,000,000 to its members. How are you able
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  - to do that when most health care organizations
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  - are are increasing costs?
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  - I think that's the beauty of the the
• 8:46
  - health sharing model is that our members
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  - have a vested interest in how they consume
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  - health care.
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  - They are very
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  - conscientious
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  - about how they utilize and who they're going
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  - to see.
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  - We work with them on the front side.
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  - You know,
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  - not always, you know, that you're gonna go
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  - see the doctor.
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  - But usually, you know, probably 80% of the
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  - time, you know, I'm going in for my
• 9:11
  - wellness visit or I need to go get
• 9:13
  - this done or I'm not feeling good on
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  - this. I need to go see the doctor.
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  - You you have a little time to do
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  - a little research, and our members have been
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  - very good with that.
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  - And on the other side of that same
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  - coin,
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  - Liberty has been a very careful steward of
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  - the contributions from our members.
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  - And all in all, I think that has
• 9:34
  - helped us keep costs down, and it allowed
• 9:37
  - us to return more than $2,000,000
• 9:39
  - to our members
• 9:40
  - while also reducing the monthly shares that our
• 9:44
  - members contribute by about 16%
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  - for families.
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  - You know, quite frankly, it's their money, and
• 9:50
  - we're just thrilled to be able to return
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  - it.
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  - That's wonderful. And and I think that's that
• 9:56
  - transparency probably goes a long way,
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  - for folks these days. And as as we've
• 10:01
  - sort of established here, the the health care
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  - landscape in The US has traditionally been dominated
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  - by employer sponsored insurance and government programs.
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  - But, of course, as we've also established, something's
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  - not working,
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  - for for for the consumer here.
• 10:16
  - So I guess thinking about that context, and
• 10:18
  - you mentioned this too, you you have more
• 10:20
  - optimism about, the role of alternative coverage models
• 10:23
  - like health sharing.
• 10:25
  - What look into the future. What do you
• 10:27
  - see the future here in terms of these
• 10:30
  - alternative coverage models playing a role in in,
• 10:33
  - you know,
• 10:34
  - helping consumers, more consumers coming to these to
• 10:37
  - help solve some of these affordability challenges.
• 10:40
  - Yeah. You know, it's I I don't think
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  - that our health care how we finance our
• 10:45
  - health care is going to be defined by
• 10:47
  - a single model. I certainly hope it it
• 10:49
  - isn't because, like, you know, the single payer
• 10:51
  - system,
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  - I really,
• 10:54
  - am scared of the government getting involved. I
• 10:57
  - can't think of a single federal government program
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  - that is under budget,
• 11:01
  - on time, or done without a ton of
• 11:04
  - bureaucratic red tape. So I I just don't
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  - see that working.
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  - I think this is going to be
• 11:12
  - a solution that requires a multitude of options
• 11:15
  - for people
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  - that they can then align their health care
• 11:19
  - with what their needs are, what their family
• 11:22
  - values are, what their budgets are.
• 11:25
  - You know, health sharing, I think, isn't a
• 11:27
  - a a very attractive
• 11:29
  - option because it does
• 11:31
  - offer that affordability,
• 11:33
  - that transparency,
• 11:34
  - you know, community based approach
• 11:37
  - that encourages
• 11:38
  - responsible health care decisions.
• 11:41
  - Those are qualities I think a lot of
• 11:43
  - consumers
• 11:44
  - feel is just quite simply missing from today's
• 11:48
  - health care experience.
• 11:50
  - So it it's going to be about options.
• 11:53
  - Right. And and
• 11:55
  - one one factor factor to consider there, though,
• 11:58
  - with different options, you've gotta
• 12:00
  - have pretty savvy consumers. Right? You've gotta you
• 12:02
  - gotta have consumers who can who can know
• 12:04
  - how to do their homework.
• 12:05
  - So what do they need to understand when
• 12:07
  - evaluating different payment models? I and and also,
• 12:10
  - I guess, what questions should they be asking
• 12:12
  - regardless of which option they they choose? How
• 12:14
  - did how are how can folks find the
• 12:16
  - right option for them?
• 12:18
  - You know, it's I think it's boils down
• 12:21
  - to trust, quite frankly.
• 12:23
  - They've got to have trust that they
• 12:26
  - have with the financing model, whether it's insurance,
• 12:29
  - whether it's a government program, whether it's health
• 12:31
  - sharing,
• 12:32
  - and that they understand that they all operate
• 12:35
  - differently.
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  - They need to have trust that they have
• 12:38
  - the tools
• 12:39
  - available to them from that particular program, whatever
• 12:43
  - model it is that they they decide to
• 12:45
  - go with.
• 12:47
  - Not only about the the monthly cost, but
• 12:49
  - the tools that say, alright. You know, this
• 12:52
  - is,
• 12:53
  - an option for you for that particular you're
• 12:56
  - you got a a heart condition
• 12:58
  - that you need to have addressed.
• 13:00
  - You know, who handles that? Are they available?
• 13:03
  - You know, what is their rating? How how
• 13:06
  - do they work with the patient?
• 13:08
  - It's all about having that trust and information.
• 13:11
  - And I think people should be asking quite
• 13:13
  - frankly three questions. And that's, one, what is
• 13:17
  - my total financial responsibility
• 13:19
  - with this particular program? What's it going to
• 13:21
  - be?
• 13:22
  - You know? Two, are my health care expenses
• 13:26
  - paid? How are they paid?
• 13:28
  - And then three, does this model really align
• 13:31
  - with my family's needs and values?
• 13:34
  - You know, beyond that, they should be evaluating
• 13:36
  - transparency,
• 13:37
  - that financial stewardship,
• 13:39
  - and the quality of support that they're going
• 13:42
  - to receive. Because let's be honest,
• 13:44
  - customer experience matters.
• 13:47
  - Health care is often accessed during, you know,
• 13:51
  - times of your life that are quite frankly
• 13:54
  - probably the most stressful you will ever experience.
• 13:57
  - You're you're panicked. You're you're worried about what's
• 14:00
  - about to happen.
• 14:01
  - You need to know that that kind of
• 14:03
  - support
• 14:04
  - is available, that it's easy to get assistance,
• 14:07
  - and whether you're going to be informed and
• 14:09
  - supported
• 14:10
  - throughout that process.
• 14:13
  - Yeah. I mean, the the I sort of
• 14:15
  - mentioned this earlier, but the stakes are incredibly
• 14:17
  - high in health care. Right? And you want
• 14:20
  - somebody who's gonna help you and walk you
• 14:21
  - through that one less thing to worry about,
• 14:23
  - and you can focus on your health. Correct?
• 14:25
  - Exactly.
• 14:26
  - Exactly.
• 14:27
  - Yep.
• 14:28
  - And looking ahead here, we'll we'll we'll close
• 14:31
  - with a forward looking question.
• 14:33
  - What changes do you believe Dorsey could have
• 14:34
  - the greatest impact on improving health care affordability
• 14:37
  - and access for Americans over the next, let's
• 14:40
  - put it, a time horizon. I think things
• 14:41
  - feel like they move very fast these days.
• 14:44
  - But but let's just say several years. What
• 14:46
  - do you think could could have the most
• 14:48
  - meaningful impact on improving health care affordability?
• 14:51
  - Well, I think with our current system in
• 14:54
  - mind,
• 14:55
  - there is no doubt that transparency
• 14:58
  - is probably
• 14:59
  - numero uno, in my opinion,
• 15:01
  - from every component, whether it's the medical provider,
• 15:05
  - whether it's the the payer that's involved.
• 15:08
  - Everybody needs to have a level of transparency
• 15:11
  - so that
• 15:13
  - informed
• 15:14
  - decisions can be made. There's got to have,
• 15:17
  - I think, engagement
• 15:19
  - and and also prevention.
• 15:21
  - You know, there is no doubt that we
• 15:24
  - have
• 15:25
  - a wonderful
• 15:26
  - world class level
• 15:28
  - of, medical care here in The US.
• 15:31
  - But quite frankly, there are very few incentives
• 15:34
  - for prevention,
• 15:36
  - you know, getting ahead of the curve on
• 15:38
  - this. Most people are just, you know, I'm
• 15:40
  - starting to not feel good,
• 15:42
  - and they let it go, let it go.
• 15:44
  - I'm not going to the hospital. I don't
• 15:45
  - wanna have to deal with it. I don't
• 15:47
  - know what to expect
• 15:49
  - until it becomes a full blown
• 15:51
  - real medical problem.
• 15:53
  - So I think we need to have those
• 15:54
  - sort of tools that
• 15:57
  - engage people and make them active participants in
• 16:00
  - their health care decisions.
• 16:02
  - Because quite frankly, the most affordable health care
• 16:06
  - event is the one that never happens.
• 16:09
  - Preventing a heart attack is just way better
• 16:11
  - for everybody
• 16:13
  - and less expensive
• 16:14
  - than treating one. So I, you know, I
• 16:16
  - think those are our our key elements that
• 16:19
  - we need to be looking for,
• 16:21
  - over the next several years. Transparency,
• 16:24
  - engagement, and prevention.
• 16:26
  - Yep. Transparency, that that that trust
• 16:28
  - and prevention is huge.
• 16:30
  - That's probably a space that where American health
• 16:32
  - care consent to improve quite a bit. But,
• 16:35
  - Dorsey, thank you so much for for coming
• 16:37
  - on the podcast today. Brian, thank you so
• 16:39
  - much for having me. Always good to talk
• 16:40
  - to you. Yep. We also wanna thank our
• 16:43
  - podcast sponsor, Liberty Health Share. You can tune
• 16:46
  - in to more podcasts from Becker's Healthcare by
• 16:48
  - visiting our podcast page at beckershospitalreview.com.