Dr. Kevin Most: Cigarette advertising and Open Enrollment

Steve Cochran

Dr. Kevin Most (photo taken prior to the pandemic)

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Television and radio advertising for cigarettes stopped by law in 1971. In 2006 the federal government decided that cigarette companies needed to publish corrective statements about the risks of cigarette smoking, as they had been lying and misrepresented the facts about cigarette smoking for decades. They were told to put information on packs of cigarettes, in store displays and to place ads in newspapers and on TV that explained the risks of smoking.

This decision has been in the legal system for the past decade and finally this weekend the ads started. You may have seen the ad in yesterday’s Tribune, a full page ad, with block print Or you did you see a new TV ad? The decision forces tobacco company Altria to run these TV ads for 52 weeks and the print ads for several months in 50 large newspapers. The TV ads must be run during primetime, 5 times a week on ABC, CBS or NBC. The ads on TV are also block letter ads being narrated by a female with a very bland voice. Both the print and TV ads clearly begin by saying that they have been ordered to run these. They are boring and bland commercials. These are not the ads you have seen in the past made by the CDC, showing the impact on your lungs or on a fetus, often by an individual who is suffering from the effects of tobacco.

Many are upset as Altria kept the fight in the courts for 11 years, allowing many more individuals to get hooked on cigarettes. The hope was that these ads would stop young adults or children from even trying a cigarette. 9 out of 10 new smokers start smoking before the age of 18. Well, think about it, how many young adults read a newspaper? Very few if any. Couple that with 5 % of today’s network TV watchers are under the age of 25. So during that 11 year legal battle we saw a change in media habits that the decision did not cover. So the individuals that this decision was focused on will not see many if any of these ads.

This is very disappointing and parents should try to educate their children about the effects of tobacco.

The ACA , also known as Obamacare is not dead, this must be very clear for all of us. Sounds like the opening of Dicken’s a Christmas Carol, when they explain that Marley is dead and in order to enjoy the story that must be clearly understood. Well it also must be clearly understood that the ACA is not dead, that the individual mandate is not dead. Is it clearly understood? I don’t think so.

What a mess, or is it a designed mess? Open enrollment for the ACA health plans has been going on for the past month. You were not aware? Don’t worry you are not alone. This confusion and lack of awareness and understanding should be quite concerning for all involved. Couple this with a much shorter enrollment period, new plans, less options, increased premiums and just to make it more confusing, Medicare open enrollment is going on as well.

First we need to understand that the ACA open enrollment is different from Medicare Open enrollment. One of the important things is that Medicare open enrollment ends on December 7, not December 15. So seniors need to understand that when they hear open enrollment is going until December 15, this is not for them. The Medicare open enrollment ends on December 7. This is the time that Medicare beneficiaries can change their plans and prescription drug coverage. Medicare beneficiaries should review their plans, but if they are happy with their plans they don’t need to do anything.

Now let’s discuss the ACA aka Obamacare. Is this a confusing year, is it a concerning year, Many think the answer is yes to both questions

If you are a conspiracy person, you may be asking “ Is the confusion designed to speed up the pending implosion of the Affordable care Act?” What will the impact be on the number of uninsured? Many feel the numbers may plummet, all feel the numbers will decrease. Let’s understand why they are thinking this, as we have only seen increases in the previous 4 enrollment periods.

Have you noticed any ads on TV informing and encouraging individuals to enroll? Marketing and outreach for the ACA in past years had a budget of $100 million this year that was slashed to $10 million. Some may argue that we should not need as much marketing as people are used to and expecting the open enrollment period. In fact most of the ads you are seeing now are from the individual insurance companies not from the federal government. Some may think that we have done all of the education we need to do, but in fact when we look at enrollment we are seeing 25% of those early enrolled are new to the ACA, so education is still needed.

HHS also slashed the navigators by 40%, these are the individuals that help people in the sign up process. It certainly would appear that this year we would need more awareness and more individuals who understand the products help those signing up. Most areas of the country have seen major changes in the plans being offered in their state or county. This is a year we need more marketing as the message coming out of Washington is very confusing. We have the president saying that “Obamacare is gone” We have votes in Congress to repeal the ACA, we have a senate budget bill that has buried in it the repeal of the individual mandate, this is just leading to confusion and lack of clear awareness for all of us. Couple this with a much shorter enrollment period and we are destined to see enrollment drop and the uninsured rise. This year enrollment for some states has shrunk from 3 months to 45 days. In Illinois the enrollment period is November 1st thru December 15th, this time frame is set for 42 of the 50 states. Other states have extended the enrollment time to various dates in December and January, this is just adding to the confusion. Oh yeah, also the HealthCare.gov website will be taken down each Sunday for 12 hours to maintain, each of the weeks during enrollment. These are a few of the reasons we expect enrollment to drop.

Many were encouraged by the opening weeks numbers, were we saw over 600,000 individuals sign up in week one and 875,000 in week two. The thought is that many of these individuals are individuals with medical conditions where healthcare is important on a day to day basis, as well as the well-organized patient who is looking for insurance. Also we need to understand that about 25% of those who signed up in the first 2 weeks are new to the ACA marketplace and were probably waiting for the open enrollment to open.

Many individuals who are set to continue in the Marketplace are confused. They are not sure if the Marketplace exists anymore, they have heard President Trump state “Obamacare is finished” They are concerned will they be able to afford the premiums as they have heard of large increases in premiums and cuts that Trump has made. Will their state even have insurers are still providing coverage, as they hear of companies dropping out. Does the individual mandate still exist? Forget about the fact that their physician may not be in their plan, we are talking just the basic questions of a plan being available. Thousands of counties across the US will have a single plan available. One half of the people in 39 states are projected to have one single option. In some cases it is even worse, For example in Iowa, they only have one insurer offering plans for the entire state. Oh and by the way their Silver Plan premium is going up 69%. Moststates saw increases of close to 30% for their Silver Plan This should be a year of over communication not decreased communication, even those entrenched in this process have some unanswered questions.

In 2017 we had 10.3 million individuals get insurance thru the exchanges. The administration had set a goal of 10 million and achieved that goal. This goal was set by HHS and although it was only an increase of 1 million from the previous year, it was still a goal and still an increase. This year the federal government has not set any number goals, only that they will have “”a seamless open enrollment for consumers”

Ground setting for those who are not clear.

Marketplace insurance is for those individuals who do not get benefits from their employer and do not qualify for Medicare or Medicaid. These are often low to moderate income individuals. Many of these individuals receive some tax incentives to help offset the premiums that are charged. If you recall recently President Trump removed the Cost Sharing Reduction (CSR) payment that insurance companies were receiving, that change has impacted premiums dramatically. Many of you may be thinking, Wait, I thought that the Senate and Congress had reversed this. Well there is proposed legislation on this but the question is will it be signed? In the meantime what do insurance companies do with premiums? We are seeing large increases in the premiums, with a recent study showing the average increase for a silver plan will increase 34%. Insurance companies anticipated that this may be removed and built into their premiums an increase to cover that loss at the expense of the individual.

Now we do have to remember that 84% of individuals who are buying on the marketplace, fall into an income bracket where the tax credits will protect them from the insurance premiums. However the other 16% will feel substantial impact. For this group the fine for not carrying insurance may come back in play as individuals may not be able to afford the premiums and will take the risk of no coverage and pay the fine. Remember as we ramped up the ACA the fine started very low, and individuals chose to pay the fine, as the fine increased it got to a point where the fine was close to the premiums and individuals then chose the insurance. This was that group of younger healthy individuals that is needed to help balance the financial aspect of any insurance product. These are the same patients that are being counted in the estimated 13 million patients who won’t be insured. They are the patients that are young and health and don’t think they need insurance, as well as those who may not be able to afford the premium increase and have no identified medial issues or concerns. The lack of marketing information and navigators will impact this younger healthy group and again place a large risk on the insurers which will force a raise in premiums, getting dizzy yet?

Who will feel this impact? Certainly the individuals who decide to go without insurance and then need medical care. Insurance companies will also feel the impact, which unfortunately will be handed to the patient in the form of higher premiums next year or less choices in future years as insurers will drop plans in some parts of the country. Hospitals will also feel the impact as the number of uninsured seeking care will rise. Many of the patients who don’t sign up, will unfortunately not participate in health screenings. The ability to identify disease early is key to lowering costs. Remember we discussed last week the new high blood pressure guidelines and the impact treating high blood pressure has on one’s health? Many of these uninsured will fall into that category and not even know the damage BP is doing on their body and the increased risk they have. This impact will be felt by all of us, as hospitals have less funds for staff, less funds for upkeep and less funds for the upgraded equipment needed to care for all patients in the hospital. Many individuals don’t understand that the care delivered in a hospital is blind to the insurance an individual has. So when a hospital has less to invest it impacts the care of all patients.

Many hospitals are closing or are in risk of closing in this country, they run on very thin margins yet need money to stay up to date, allowing the patients to get the best care possible.

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