For Profit Insurance
Senate Finance Committee Weakens Insurance Exchanges
Published October 06, 2009 @ 06:00AM PT
Goings-on in Maine are taking a deserved media hammering this week. First Brave New Films puts out a hard-hitting clip about Wellpoint suing the state to increase its profits. Then it leaks out that last Thursday, Maine Senator Olympia Snowe was the main reason Massachusetts Senator John Kerry's amendment to strengthen insurance exchange consumer protections in the Senate Finance Committee (SFC) bill didn't pass. I'd hate to find out those two things are related.
First, a little background. Maine is a guaranteed issue state, meaning insurers may not deny you coverage based on health status. They must also offer policies with standard benefits, co-payments, and co-insurance, and may only exclude pre-existing conditions for 6 months (this is sounding pretty good, no?) Anthem, a Wellpoint subsidiary, in return asked the state of Maine to guarantee it at least a 3% profit margin off its just 12,000 members. Maine said no. So Anthem is suing the state.
Now, about Kerry's proposed SFC bill amendment. Called "Empowering State Exchanges to be Prudent Purchasers," it sought to protect consumers with stronger state standards for insurance exchanges. HR 3200 and the Senate HELP bill have these protections built in; the SFC bill creates more of a Wild West of insurance exchanges. Just what we need.
Insurance Companies Are Cutting Their OWN Benefits: The Best of the Weekend
Published October 04, 2009 @ 10:10PM PT
Every weekend, I present the three articles or videos that best enhanced my own understanding of the myriad issues wrapped up in our national health care debate. All three selections this weekend made the list for one simple reason: much like the Spanish Inquisition, I don’t think anyone ever expected stories like these!
1.) Bloomberg, “WellPoint Cuts its Own Health Benefits as Recession Trims Sales”
In Will Ferrell’s celebrity-studded and satirical public service announcement, “Protect Insurance Companies,” actor Jon Hamme pointed out that health insurance companies needed to make millions and billions in profits... to pay for health insurance for their employees. Well, it turns out that’s not a joke. Given that WellPoint has also been at the forefront of creating “astroturf” consumer-friendly Web sites, ad campaigns and push polls to activate its customer base against health care reform, one could be forgiven for thinking this is but poetic justice.
The company will also raise deductibles and premiums for some of its employee health benefits, the Indianapolis-based insurer told workers in a memo today obtained by Bloomberg.
WellPoint, like its competitors, has seen health plan enrollment shrink this year as employers cut jobs and benefits amid the recession… In the memo from Randy Brown, WellPoint’s chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. “Your cost per paycheck will probably increase,” the memo said. WellPoint has 42,000 employees.
(By the way, in case you’re wondering what the heck the picture on this post is, it’s a “Medical Data Loss Dress,” designed to incorporate private medical data that WellPoint carelessly left unsecured on its Web site for 13 months. Good times.)
Read the full article on Bloomberg’s Web site.
2.) Swampland, “Bill Frist on Health Bill: I'd Vote For It”
So let me get this straight. Former Senate Majority Leaders for the G.O.P. Bob Dole and Howard Baker not only have spoken in favor of health care reform (and endorsed a plan through the Bipartisan Policy Center that closely tracks the proposals in Congress), but now Bill Frist has, too? This would be the same Bill Frist who was not only one of the Republican Congressional leaders for years, but also was a heart and lung transplant surgeon? The one whose conservative credentials are so rock-solid he nearly ran for president last year? That Bill Frist?
And yet we’re thinking the chances of a Republican not from Maine voting for this same reform bill is between slim and none?
OK, just checking.
However, he strongly supports other aspects of the bill--most notably, its requirement that individuals be required to purchase coverage, if they do not receive health insurance through their employers or under government programs. And he also lauds the provisions that would eliminate practices that allow insurance companies to discriminate against people based on their health history, including pre-existing conditions.
Frist also faults some in his own party for injecting alarmism into the debate. "Clearly, the death panels and public plan arguments have been overblown," he says. Frist noted that Republicans themselves voted for a Medicare prescription drug bill that would have established a version of a public plan--with the government negotiating directly with drug companies--if private-sector competition had failed to materialize.
Read the whole blog post on Swampland.
3.) Nicholas Kristof, “Dad’s Life or Yours? You Choose”
There are so many basic injustices and indignities with the way our insurance industry operates, it’s hard to know where to begin. But clearly at the top of the list is the injustice of rejecting coverage for those with pre-existing conditions -- discriminating against the very population most likely to need health care, because they’re most likely to need care. Kristof today supplies a dramatic example where pre-existing conditions actually impeded two generations from getting the care they need and the preventative care they still might need.
Mr. Waddington has polycystic kidney disease, or PKD, a genetic disorder that leads to kidney failure. First he lost one kidney, and then the other. A year ago, he was on dialysis and desperately needed a new kidney. Doctors explained that the best match -- the one least likely to be rejected -- would perhaps come from Travis or Michael, his two sons, then ages 29 and 27.
Travis and Michael each had a 50 percent chance of inheriting PKD. And if pre-donation testing revealed that one of them had the disorder, that brother might never be able to get health insurance. As a result, their doctors had advised not getting tested. After all, new research suggests that lack of insurance increases a working-age person’s risk of dying in any given year by 40 percent.
“At the time David needed a transplant, the people closest to him couldn’t even offer a lifesaving donation -- for insurance reasons,” said Mr. Waddington’s wife, Susan.
Read the full column at NYTimes.com
[Programming note: This is my last blog post as the primary editor of this cause for Change.org. Thanks for reading! However, I’m leaving you in the more than capable hands of Gillian Hubble. I’ll be guest blogging in this space in the weeks and months to come, though not at my usual frequency. Whether you’re a health care reform skeptic or activist, we are truly in unprecedented times. There simply has never been as good a chance of having a comprehensive health care reform bill passed by Congress and signed by a president. But stay vigilant and stay active -- we still have a long way to go, and much work to do to ensure it’s a bill we can all be proud of.]
(Photo credit: http://www.flickr.com/photos/plurimus/ / CC BY 2.0)
Making the Opposition to Reform a Punchline
Published October 04, 2009 @ 07:33AM PT
The disruptive town halls made for good theater on the nightly news, but scarcely seem to have made a dent in the momentum for health care reform. Once the hot August was over, the president made his address to Congress, Sen. Max Baucus got off the dime and released his bill, and we were back in business. A march on Washington by some million 100,000 50,000 people with a somewhat incoherent message that didn’t do anything to impede progress, or even slow it down. And now that the Senate Finance Committee has all but completed its work, we’re moving to unprecedented floor debates in the House and the Senate.
So what did they accomplish, other than ratings? Well, they seem to really have challenged progressives to open up their vast reservoir of sarcasm.
The rock video “We’re Number 37” was of course a direct reaction to the town halls. This new video, “Don’t Ruin American Healthcare” is more of a direct-to-camera PSA, in the style of Will Ferrell’s “Protect Insurance Companies.” But it doesn’t take much to take some of the actual talking points you hear from regular people whipped into a furor over the prospects of reform, and make them laugh-out-loud funny.
We Must Protect Insurance Companies from Reform
Published September 22, 2009 @ 07:25AM PT
Yes, I’ve been a fool. Will Ferrell once again has touched me with enlightenment. He’s like a modern Buddha, but covered with frizzy, ‘fro-like hair. Here I thought keeping costs down so the nation doesn’t go bankrupt, covering more of our citizens so they don’t go broke when they get sick, regulating insurers so they curb their most abusive practices, and improving quality were the chief aims of health reform. But I was wrong. Oh, how I was wrong. Clearly, health insurance companies are the real victims of our broken health care system. After all, my favorite TV actors tell me so.
It’s no secret that 2008 was the year of the celebrity political YouTube video. They ranged from the inspirational (Will.i.am’s “Yes We Can”) to the funny (Paris Hilton challenging John McCain and Barack Obama to a debate, or Sarah Silverman’s “The Great Schlepp”) to the annoyingly preachy (the Leonardo DiCaprio “Don’t vote” video springs to mind). Heck, Obama girl launched an entire Web site. Sure, they were beyond superficial, but they kept people engaged. There haven’t been great celebrity videos since the election. We’ve made do with homegrown videos like “Boyfriend with Health Benefits” and “We’re Number 37.”
Into the breach steps Will Ferrell.
Of course it is in the nature of satire that I hear similar arguments being made by people who are quite serious. That insurance companies don’t make that much profit (UnitedHealth made $3 billion last year). That state regulations are what’s keeping really keeping insurance down -- an argument so preposterous, that even AHIP is in favor of new national regulations. We even hear Sen. Orrin Hatch say, with a straight face, that families making over $50,000 should be considered uninsured. It’s their choice not to spend 24% of their pre-tax income on insurance!
So listen to #1 on Maxim’s List of Hot Women, actress Olivia Wilde. When it comes to health insurance, “Believe me, that stuff’s not cheap!”
Michelle Obama Enters the Health Reform Debate: The Best of the Weekend
Published September 20, 2009 @ 11:33PM PT
Every weekend, I showcase the three videos or articles that best enhanced my own understanding of the health care reform debate. After all, when you’re talking about a topic that touches each of our lives and intersects policy, politics, medicine, taxes, the legal system, our economy and budgets ranging from a blue-collar family in Pennsylvania to the federal government of the United States -- well, a fellah sometimes need a little help understanding it all!
Although I don’t normally lead off with a political story, this one is well worth it:
1.) Health Reform Watch: “Because She Said So: Michelle Obama Wants Women to Stand Up for Health Care Reform”
Fellow Change.org blogger Jen Nedau posted the First Lady’s speech on the Women’s Rights blog. During the campaign, the president had often referred to Michelle as “the closer” -- the one whose impassioned “from the heart” speeches could close the deal. The White House has determined the only way to escalate the cause of health reform over and above an address to both houses of Congress is to have the First Lady also make the issue her own. It’s not a moment too soon, writes blogger and law professor Pooja Awatramani:
One of the biggest issues Michelle Obama seemed to have with the current system was gender rating; it continues to force women to pay much higher premiums than men in private insurance plans. The actuarial argument, that women’s health care needs require regular preventive care (which in reality, women and men alike should be getting) is significantly undermined by the research which shows the ultimate cost benefits of preventive care–for both women and men. It seems both ironic and counter-productive that this justification is used to punish with higher premiums those who embark upon the proactive health maintenance which so many agree is both the key to ultimate health care cost control and one of the primary goals of health care reform. Hopefully, Obama’s optimism that such gender rating will be removed through the current reform process will prove true.
With so many challenges aligned against women, it is apparent that, as stated by the Congressional Joint Economic Committee, “The status-quo health insurance system is serving women poorly.” Perhaps this is why the Obama administration, in its drive to convince Americans that the issue of health care can no longer be pushed aside, is turning to women. A smart choice, whichever way you look at it, since women as a whole are one of the groups most strongly supporting health care reform.
Read the full analysis on the Health Reform Watch blog.
2.) Washington Post, “You Have No Idea What Health Costs”
Blogger Ezra Klein has an article in this Sunday’s paper spotlighting why it’s so hard to make those of us with employer-based benefits sit up and take notice of escalating costs. Since our employer picks up the lion’s share and the rest is usually deducted from our payroll, it’s difficult for us to realize just how unsustainably premiums are rising each year. If we did, Ezra writes, we’d be more forcefully supporting reform.
The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.
Three years of slightly above-average health insurance will cost a solid six figures.
Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.
Read the full article on WashingtonPost.com
3.) Movin’ Meat, “Feeling Wonkish”
When I'm not quite sure of how proposed policy changes look to someone “in the trenches” of our medical system, I often turn to this blog written by Shadowfax, an Emergency Medicine Doctor who writes eminently readable snap-analyses of health care reform. And for Shadowfax, a lazy weekend at home apparently turned into analyzing the proposed amendments for the Senate Finance Committee from the perspective of an ER doctor.
The other thing that I gained from reading this is a real appreciation of how tricky lawmaking really is. This bill, after modification to some greater or lesser degree in committee, will need to be merged with the HELP committee bill and then (one hopes) with the House bill. That's a real challenge! Sure, there will be the big partisan battles, but all the little line items are the hard parts, I think. When you come to a provision like, say the Stabenow amendments, which have no clear partisan bias and a marginal effect on cost -- and bear in mind that there may be hundreds and hundreds of these in each bill -- how do you decide which are worthy of keeping, and which get tossed? Presumably you can't keep them all, and many are probably in direct conflict. Unless the advocate for a particular bill is at the conference table, it's gotta become a little arbitrary.
Fighting for Her Life -- Against Her Insurance Company
Published September 19, 2009 @ 02:59PM PT
Most people are happy with their private insurance, especially if it’s provided by their employer and the 9% average increase in premiums each year is largely invisible to them. But most people haven’t had to spend as much time talking to her insurance company as Anne has. Very few of us have been in the position of literally begging for a life-saving brain surgery. But those who have are already too, too many.
Anne’s story is featured on a Web site called Stories of Health, the brainstorm of two former Obama volunteers who had heard too many stories like these in the Bay Area. (Many thanks to @eadvocate for referring me to the site.) They realized if they just recorded these stories straight up and posted them in a way that was easy to find, you couldn’t help but be moved to make sure we don’t fail our efforts at health reform. They’re right. You don’t need a lot of bells and whistles. The people they feature could be any of us -- unfortunate enough to be struck with a disease or injury, and even less fortunate to come head to head with a health insurance industry whose incentives are to create complicated rules to avoid paying for the most expensive care.
Here’s what’s striking to me about Anne’s story: the insurance company had already paid for the consultation, the pre-surgery meetings, the MRIs, all of the little stuff it could have denied with this out-of-network doctor along the way. What it denied was the surgery itself. Of all medical procedures that could be considered unnecessary, neurosurgery is not one of them. You don’t do that for fun. You do that because it’s literally the difference between life and death. And if any of our insurance companies are prepared to literally bar us from receiving life-saving medical care just because it's expensive and less profitable for them, how much security do any of us really have?
Rescissions of Health Insurance Need to Be Illegal
Published September 18, 2009 @ 09:56PM PT
Most people know what “pre-existing conditions” are, and can easily understand why Republicans and Democrats alike want to prevent people being rejected by insurance companies precisely because they need care. But the flip-side is the practice of rescissions -- canceling an existing insurance policy because of perceived or real pre-existing conditions undisclosed on an application. You might say, “If you commit fraud, they should cancel your policy” and I’d be willing to agree with you -- except there’s just no way to do so without canceling the insurance of a sick person precisely at the moment they need care. It’s more tragedy than fraud-fighting. And it should be illegal.
The latest textbook case came from The Chicago Tribune: the Rices, an Illinois family, lose their coverage with the husband’s job and can’t afford COBRA. They purchase a plan on the individual market. At the time, their 17 year-old daughter had a clean bill of health from her most recent physical. But a few months later, she develops celiac disease, a digestive disorder where even small amounts of gluten can trigger a toxic shock reaction. Three months later, the insurance company cancelled the policy. Why? They combed through the daughter’s medical records and found instances of dizziness, fatigue, a persistent cough, and a high cholesterol count. They claimed this meant the celiac disease was a pre-existing condition, and the family had lied on the application. Honestly, I would like to see a teenager who has not experienced dizziness, fatigue or a persistent cough at some point in their life. Now, while fighting for their policy to be reinstated, the family is already $20,000 in the red with medical bills.
But it’s not an uncommon case. There was Robin Beaton, the Texas nurse who developed breast cancer, only to have her insurance cancelled because she once had acne. She sued to be reinstated, but in the months that it took for her to win, her tumor grew substantially. There’s Sally Marrari, whose insurance company said her hyroid disorder, fluid in the heart, lupus, and pancreatic cancer that she developed while a customer were all pre-existing conditions that would have been detectable if she had revealed past back pain on her application. These are all people who thought they were completely covered. All people who paid their premiums. All socked by a heartbreaking illness, and then double socked by losing their coverage at the moment they needed it most.
But surely, you think, this can’t happen that often? For one thing, it can only happen on the individual insurance market, as most states don’t allow rescissions for employer-based group insurance. And that’s true -- but the numbers are still significant. A Congressional investigation found that 20,000 people had their insurance rescinded by just three companies over a five year-period, and those same companies saved $300 million as a direct result. In cast the word "saved" was ambiguous, that's $300 million in medical bills that should have been covered by insurance -- but weren't.
The House, Senate HELP and Senate Finance bills would all eliminate the practice of rescissions. I’d say, “It’s about time,” but for families across America, it’s already too late.
(Photo credit: http://www.flickr.com/photos/ari/ / CC BY-NC-SA 2.0)
