On the morning of September 16, 2013, 34-year-old Aaron Alexis, a former Navy reservist working for a military subcontractor, entered the Washington Naval Yard, a secure military facility, as if he was showing up for work. Since he had clearance to enter the facility, no one asked to look inside his backpack, which contained a sawed-off shotgun and an automatic pistol.
Shortly after entering the Naval Sea Systems Center building, Alexis headed to an atrium overlooking an employee cafeteria, and opened fire, starting an hours-long rampage that forced a portion of central D.C. into temporary lockdown. By the time it was all over, Alexis killed a dozen civilian workers and wounded three more people, including a police officer. Ultimately, Alexis was cornered in a third-floor cubicle and died in a shootout with the police.
After the shooting, Alexis was revealed to have a history of violent altercations with others, including one he explained as a rage-fueled blackout. Prior to the Naval Yard shooting, Alexis had a history of work performance issues, the most recent of which had been addressed just a few days before the shooting, although it appeared that Alexis did not specifically target any of his co-workers. The FBI released notes left behind by Alexis that suggested that he was delusional. He explained that a barrage of ultra-low-frequency waves had driven him to his attack. (UF waves also figure prominently in conspiracy theories regarding government mind control operations.) On his shotgun, he scrawled, “end the torment,” “better off this way” and “my ELF weapon.” Before the attack, he complained of hearing voices, and had reportedly sought help twice from VA hospitals.
Cases of mentally ill mass shooters such as Alexis raise the question that if these individuals had access to the care they needed to treat their mental health issues, perhaps tragedies such as the Naval Yard shooting could have been prevented. That is speculative at best, however, as it assumes that someone as sick as Alexis would seek out and participate in the level of care he would need to prevent his violent actions. But what if that were true? What then? After all, Alexis himself sought help at the VA; one wonders what treatment funded by private insurance could have done.
To find out, National Underwriter conducted an extensive survey of health insurance plans across the country by pulling data from theHealthInsurance.gov Insurance Finder, an online tool that is at the heart of the insurance exchanges mandated by the Patient Protection and Affordable Care Act (PPACA). Those seeking low-cost and subsidized coverage can use the Insurance Finder to locate health plan options open to them in their state of residence. The Insurance Finder then displays all available options with details on each plan, including:
- the carrier
- estimated monthly premiums
- percentage of policies that deviate from the average premium (termed a “surcharge”)
- percentage of applications that are turned down
- individual and family deductibles
- out-of-pocket limits
- annual maximums
The plan also details information on specific components of the coverage, such as mental health care benefits and addiction and rehabilitation benefits. National Underwriter went through every state and the District of Columbia to see how much variety there was between these offerings. We used a sample template that fit the profile of many spree killers and mass murderers: a single male between the ages of 26 and 64. To seek as broad a selection of health plans as possible, we did not select any special conditions and when asked if we found health insurance difficult to afford (who doesn’t, really?), we answered yes.
We sought health plans for individuals and families, rather than health plans through work. The idea was to find coverage for someone on their own. Searching the Insurance Finder will prompt the user for both a state and a ZIP code. Again, to get the broadest selection possible, we entered in the ZIP code with the highest population in any given state, as determined by the U.S. Census Bureau. Usually, these centered on a particular section of the largest city in the state. We indicated that coverage was to start on 11/01/13. We indicated that the coverage was for one person who did not use tobacco. Then we hit ENTER and waited as the site churned back our results.
The results were, to say the least, interesting.
The number of possible health plans that came back for each state varied wildly. Some states (e.g., California and Illinois) returned several hundred records while others (e.g., Arkansas and Montana) returned only a handful. Some states should have had huge selections, but did not (Michigan and Florida) while others were sparsely populated states with a surprising variety in health plans on the market (Idaho and Montana).
We arranged the returns by estimated monthly premium, from high to low. We then took the five most expensive policies, the five least expensive policies, and a block of policies in the center of the cost range. We compared all fifteen to each other to get a sense of how much they varied from each other, and to see what kind of care the policies offered. In some states, such as Alabama and Alaska, the number of available options was less than 15, so the entire selection was sampled.
While looking through all 50 states, it quickly becomes clear that each state’s market has its differences from the rest, with markets of richer states having more expensive plans on average than poorer ones, with some markets tending to offer very little mental health coverage compared to others, and with some markets showing very wide differences among their own plans according to cost. That said, when comparing the states all together, the three brackets of health plans – most expensive, moderately expensive and least expensive – exhibited some telling similarities.
The most expensive policies, on average, tended to offer the most generous benefits, typically offering both in-patient and out-patient coverage, and with small to non-existent deductibles, out-of-pocket limits, co-insurance and co-pays. However, the more generous the policies themselves were, the more costly they became, to the point that when looking at the most expensive policies in states such as California ($1,039/mo) and New Jersey ($3,607/mo) the policies themselves offer seriously diminishing returns, as the ability to afford insurance at that cost suggests a separate ability to pay for the provided mental health coverage benefits entirely out of pocket. At that point, why not self-insure?
The middle bracket of policies tended to charge much more affordable premiums, typically in the $300-$500 range, but with that came higher levels of surcharges, higher deductibles, higher out-of-pocket limits and either no mental health benefits, or those hitched with substantial premiums and/or co-insurance.
The lower bracket showed the same dynamics of the middle bracket, only much more so. The premiums were very low, but the policies tended to provide no meaningful coverage of any kind, requiring such high deductibles, co-pays and/or co-insurance as to provide no coverage for all. True, the policies would eventually cover the costs of very expensive treatment, but they would drive the policyholder into financial ruin well before then. Moreover, the lower-end policies very commonly did not cover mental or behavioral health treatment at all.