Undercurrents: Unprotected Residents Await Health Insurance Coverage

A regular Source column, Undercurrents explores issues, ideas and events developing beneath the surface in the Virgin Islands community.

There’s no room under the Affordable Care Act umbrella for U.S. residents living in the U.S. Virgin Islands, and thousands of them are getting soaked.

Lt. Gov. Osbert Potter, who is also commissioner of Banking and Insurance, said providing access to individual health care is at the top of his agenda but it is also proving to be one of his most difficult tasks.

In an interview last week, Potter estimated the number of residents needing an individual health care plan as “between 30,000 and 35,000.” That’s approximately one-third of the total population. The rest are covered under group plans, typically through an employer or by Medicare or Medicaid.

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Not everyone may want to purchase health insurance, but it’s dangerous for all to be unprotected in case of a serious and costly medial issue.

“One ailment can you send you bankrupt,” Potter said.

The lieutenant governor said his office is working on a plan, a sort of ACA for the Virgin Islands, which it will send to the Legislature in about a month; he declined to give details. Meanwhile, Potter has been trying to lure companies to the territory to provide coverage, but those attempts are currently in stalemate.

“It’s a very serious problem,” said John Harper, president of the V.I. Insurance Association, in a separate interview.

It used to be that V.I. residents could purchase individual coverage through British United Provident Association (BUPA), a company doing business internationally. But after the ACA became law, BUPA stopped doing business in the territory, Harper said.

He added that he knows of people in the islands who have changed their residency so they could obtain individual health care coverage.

The need is great from the territory’s standpoint, but the numbers of potential subscribers are small from an insurer’s view. To make insurance coverage viable, there needs to be a larger pool.

“There is no individual mandate in the Virgin Islands,” Harper noted. That is a key component of the federal health care reform and would be one way to increase the numbers.

Another might be for the Virgin Islands to combine its individual customers with those from other territories or another state, but both Harper and Potter said so far that has not been feasible.

“We have inquired about joining the other states to just link up with their group, but it’s not easily doable,” Potter said.

There also have been suggestions that the government could require insurers to offer individual coverage as a condition of their ability to do business in the territory, but Harper said that idea is “not healthy.” There are only three or four companies offering group health insurance in the Virgin Islands currently and they may decide it is better for them to leave than to take on the riskier business of individual coverage.

“I don’t see a solution currently,” Harper said, adding he knows the Banking and Insurance office has been trying hard to attract insurers.

Negotiations with one potential insurer have stalled because the company and V.I. medical providers – represented by the local Preferred Provider Organization known as VI Equicare – can’t reach agreement on fees to be paid for specific health care services.

Potter said his office has reached out to a number of insurers and has been part of talks with one in particular.

Potter declined to name the company, but according to Dr. George Rosenberg, chairman of Equicare, “Blue Cross/Blue Shield (as run by Triple S-Salud, Inc. of Puerto Rico) is the only one to come to the table.”

Potter said, “I have been refereeing. It has been a continuing struggle by this office to keep the lines of communication open.”

There are literally thousands of insurance codes for specific services and procedures, Potter noted. The two sides have been able to agree on payment for many of them, but some of those still outstanding are critical.

He did not have specific differences, but by way of example of how wide the gap can be, he said a particular surgery might be judged worth $4,000 by Equicare and just $2,500 by the insurer.

Dynel Soto, director of Equicare, said she could not discuss figures or anything about the talks since “it’s contract negotiations” and confidential.

Soto did say Blue Cross/Blue Shield already has a contact for providing group insurance in the territory and that talks about individual coverage have been ongoing for about a year.

“We know that an individual policy is needed in the Virgin Islands,” she said. Not only would it be good for residents, it would be good for health care providers. She estimated that at the very minimum, it could mean an additional 5,000 patients seeking medical attention in the islands. “We want to see this happen as much as anybody else does.”

“I know it’s a business on both ends,” Potter said, adding he’s still hopeful that there can be a compromise. So far, however, “It has been a miserable failure on those two groups getting together.”

Still he thinks individual coverage will be made available.

“I am confident that it’s going to happen. It’s just moving too slow for my liking,” he said.

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