Without a public option, the signature achievement of health care reform is supposed to be new consumer protections that would force the insurance industry to actually pay claims.
But if the final reform bill winds up looking more like the Senate bill than the House bill, those protections will be easy for insurers to work around in the new insurance exchanges, Rep. John Garamendi (D-Calif.), health policy experts and former industry insiders told reporters on a conference call Tuesday.
“Under health reform, 30 million people will buy their insurance through the exchanges. I spent years as insurance commissioner in California, chasing after the insurance company scoundrels. You’re going to toss 30 million Americans to these sharks unless there is a real strong regulatory environment and public option,” Garamendi said.
Though the public option isn’t going to happen, consumer-protection advocates point to four other major problems with the health care bill passed by the Senate on Christmas Eve. In contrast to the House bill, it leaves the states in charge of setting up individual exchanges. It provides little in the way of federal money for enforcement. It includes a loophole that would allow insurers to penalize people who don’t take advantage of available wellness programs or meet related goals, like weight loss. And it completely exempts businesses with more than 100 employees from the new consumer protections, meaning that roughly half of the 160 million Americans with employer-based insurance will still be vulnerable to preexisting conditions and all other kinds of predatory practices.
The rest of the country will be just as vulnerable if reform lacks clear, strong federal enforcement, said Michael McGarvey, a retired chief medical officer for Horizon BlueCross BlueShield of New Jersey and a former New York state regulator. “As a former regulator, I can just tell you that simpler and unified is better than diverse and complex,” McGarvey said. “I think the simpler we keep this, the more straightforward we keep it, the less the opportunity for the insurance industry to game it to death.”
To keep things simple, a House-style national exchange is the way to go, said Karen Pollitz, a director of Georgetown University’s Health Policy Institute. Under the House language, insurers would have to bid their prices lower to join a more selective marketplace, in which the terms of their coverage are laid out in clear language and have been certified by the federal government.
Plus, all the federal money allocated for subsidies and tax credits to low-income Americans being forced to buy health insurance is going to flow through the exchange — or, under the Senate bill, the 50 state exchanges — so either way, the exchange system would be a ripe target for industry abuse if not closely monitored.
“All of this needs to work well for reform to achieve the goals that we want,” said Pollitz. “And so I think for that reason the House approach to establishing a federal exchange where we can build it right the first time and get it done is very important, as opposed to just kind of throwing up a jump ball and letting 50 different states figure out all different ways how to make it work.”
The House language allows states with strong regulatory and enforcement frameworks to take over responsibility for their exchanges, but those states that have a ways to go aren’t likely to get there in the near future. Part of the problem with leaving things to the states, McGarvey and Pollitz said, is that the states are broke, and the Senate bill does little to help them fund enforcement.
Another problem, said former CIGNA communications chief Wendell Potter, is that the insurance companies have their hooks just as deep in state governments as the U.S. Congress, if not deeper.
“The insurance companies have long decried what they refer to as a ‘patchwork’ of state regulatory systems, but they have benefited from that patchwork. In many states they have developed very cozy relationships with insurance commissioners and staff. They’ve been able to get permission to market plans that continue to shift more and more of the economic cost, or the cost of health care, from them and employers to consumers,” said Potter, now a fellow at the Center for Media and Democracy. “So it’s vitally important that the federal government play a significant role in this legislation, that the exchange be a federal exchange, and that the federal government play a very strong role in regulation, and that the federal government provide resources to — you’ve got to make sure the regulations are enforced.”
Even robust enforcement couldn’t touch insurers who exploit the huge loopholes in the Senate bill, however. The Senate language allows insurers and employers to penalize customers and employers who refuse optional health screenings or exercise programs, as well as those who attend but fail to meet targets for weight loss, blood pressure or cholesterol reduction or other benchmarks.
” So now instead of being able to charge people more because they’re sick, insurers will charge them more because they’re not well. And now, instead of calling those people victims of discrimination, we’ll say it’s their fault. And I think that is a very dangerous loophole in a reform scenario where people have to get insurance and continue to be victimized by discrimination,” said Pollitz. “It’s really just medical underwriting by a different name,” McGarvey said.
The wellness exceptions are “extremely important” to the insurance companies and their lobbyists, Potter said, as is the provision that allows insurers to charge older customers more than younger ones. The House bill allows them to charge older people twice as much; the Senate bill, three times as much. “They’re quite willing to live in a world in which they can no longer use preexisting conditions to deny people coverage, but they want to make sure that on the other hand, under this legislation they’ll be able to charge certain people a lot more than others, based on their age, based on their current health or their past health, and where they live,” Potter said.
And while some of the reforms apply across the board in both bills — an end to lifetime caps, for example, and discrimination based explicitly on preexisting conditions — the lack of regulation for companies with more than 100 employees leaves plenty of avenues for insurers and employers to deny coverage. “It would still be possible for a large employer, whether or not they self-fund, to sponsor a plan that doesn’t cover the drugs that you need for your preexisting condition,” Pollitz said. The ban on caps, after all, applies only to covered benefits. “So I think it’s very important in health reform and for pooling for consumer protection, for all the rules to work together and be tight,” she said. Otherwise, “there would still be ways to design policies that would make it very difficult for people to get their claims paid when they get very sick.”
The House bill would do a much better job in each of these areas. However, it’s not clear how many of them the Senate will give ground on. Garamendi said House Democrats will keep pushing, but a single conservative Democratic senator has the power to tell them when to stop.
“I think we’re going to win this day,” Garamendi said. “The role of the federal government is to provide a national market, to provide assurance that the policies that are sold on that exchange are valuable, that the benefits will be paid when they are due, and that the companies obey the rules.”
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A LINE IN THE SAND – From jacksmith – WorkingClass
My Fellow Americans and People Of The World
A strong Government-run MEDICARE like Public Option is STILL! CRITICAL!
We have had a long hard struggle to find out what would be the BEST! that this congress and the Whitehouse could do to fix our highly dangerous, poor quality, most costly, and MOST! disgraceful healthcare delivery system in the world. It is clear that congress can do much more for the American people than what is proposed so far.
It is clear that congress can pass a strong GOVERNMENT-run public option CHOICE. Available to everyone on day one. Expand Medicare and not levy any new taxes on workers healthcare benefits and plans. LET THIS BE YOUR LINE IN THE SAND!
Lastly, there can be NO! INDIVIDUAL MANDATES without a strong Government-run MEDICARE like Public Option CHOICE. Or the American people WILL! and SHOULD! revolt with an all out CIVIL WAR against congress and this Government.
House and Senate progressives and the tri-caucuses should aggressively push for the inclusion of a strong Public Option, Medicare expansion, and no new taxes on workers healthcare benefits and plans. If the obstructionist kill meaningful healthcare reform, then you should kill this bill. Because it will be far worse than the healthcare disaster we have now. It’s failure will be on the obstructionist heads. And they will be punished and replaced.
WITHOUT A PUBLIC OPTION CHOICE, THIS BILL WILL KILL FAR MORE AMERICANS THAN IT WILL SAVE.
What is proposed in the Senate bill is the worst case scenario for health-care reform. It would shift trillions of taxpayer, public and private dollars into the hands of the private insurance industry (The single most costly, deadly and dangerous product sold in America). And it would compel by law millions of Americans to financially support this oxymoronic criminal enterprise. You cant have a individual MANDATE WITHOUT A STRONG PUBLIC OPTION CHOICE!
You will have NO! realistic way of controlling cost and quality. Cost will continue soaring through the roof bleeding the American people dry, and KILLing our economy. And our quality of healthcare will continue to decline below our current ranking of “WORST! quality of healthcare delivery in the developed World”.
From the very start, the American people have been crystal clear about what they wanted. They wanted a humane single payer system like the rest of the developed world has (HR676). Or at least a humane strong GOVERNMENT-run public option CHOICE!! This is what the American people gave the democrats control of the house, control of the senate, and control of the Whitehouse to do.
Those of you that can, should prepare now to remove every member of congress that fails to support YOUR healthcare reform with a strong Public Option, Medicare expansion, and no new taxes on workers healthcare benefits and plans. Run against them in teams if you have to. But take them out. And replace them with a strong single payer or PRO PUBLIC OPTION CHOICE candidate.
Now! is the time to bring maximum pressure on your members of congress. Contact your representatives and spread the word.
The Public Option http://tinyurl.com/yfftf76
H1N1 IS A WEAPON OF MASS DESTRUCTION!
I have to tell you now that the H1N1 virus is a man-made WEAPON OF MASS DESTRUCTION! and TERROR! It is a WEAPONIZED version of a flu virus. It has swept the planet infecting millions. And causing a global pandemic that has killed tens of thousands, and injured millions.
The H1N1 virus is the product of the DISGRACEFUL, GREED DRIVEN PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! It was released in the U.S. in Texas in early January of this year, but not recognized until around April in California. The reason I know this is because when it came to America, it came to see me FIRST! How sweet…
This was around the time the MEDICAL INDUSTRIAL COMPLEX! assaulted the Whitehouse with all their devils deals to cripple and weaken YOUR! healthcare reform. Especially your right to have a single payer system like HR676 (Medicare For All) which most of you wanted.
They don’t even want you to have your HUGE!!! compromise position of a strong government-run MEDICARE like Public Option CHOICE. To compete with their DISGRACEFUL, GREED DRIVEN, MURDEROUS, PRIVATE FOR PROFIT PRODUCT (The single most costly, deadly and dangerous product sold in America).
They also wanted to take away your rights to have your government meet it’s responsibility to use it’s full power to regulate, negotiate, and control drug cost, healthcare cost and quality. Something every other civilized country in the developed World has done for it’s people. Their Greed! moral degeneracy and lack of patriotism knows no bounds.
Many of you will remember that before we knew about H1N1. I posted a open message to the President and Congress warning them to be vigilant about their health, and cautious about any medical advice they received. As I said then “they will not hesitate to try and hurt you”.
The U.S. and the World have been under a BIOLOGICAL TERROR ATTACK! for over a year now. It is CRITICAL that We The People Of The United States take away control of our healthcare system from the GREED DRIVEN MEDICAL INDUSTRIAL COMPLEX!
For our own National security, and the security of the world.
A Strong, government-run, MEDICARE like Public Option CHOICE. Available to everyone on day one, with the full unfettered power of the federal government to regulate, negotiate, and control cost and quality. Would be the most workable way to deal with this global crisis at this time. Including patent suspensions as needed for national security or the greater good.
As an American I invite the peoples of the World to help us fix our healthcare crisis. And bring pressure on our government to meet it’s responsibility to protect global security by controlling, and removing the corrupting influence of GREED and the PRIVATE FOR PROFIT motivations from healthcare in the U.S. and around the World.
I call on the governments of the World and the global intelligence community to track down these MASS MURDERERS, and bring them to justice. CONNECT THE DOTS! And be vigilant that they don’t slip in another viral strain on you under the cloak of H1N1 sequestration.
Further, the proposed patent protection on biologic’s must be stripped from the US bill. And greatly shorten/restricted, or abolished completely. This is a grave danger to humanity and global security.
I think President Obama is doing the best he can at playing the disastrous deck of cards he inherited from the previous administration. And I think he is doing an excellent job. But the wolves and devils of the medical industrial complex! are trying to exploit, and take advantage of his good heart, and desperate desire to help suffering Americans. But we must be strong and insist that healthcare reform be done right for the American people. Or everyone loose’s.
This is all I can say in a message post. I’ll try to find a way to tell you more later.
God Bless You My Fellow Human Beings
jacksmith – Working Class
p.s. The so-called nominal H1N1 virus is designed in such a way as to make it more lethal to children and young adults. The medical community must be more vigilant of secondary bacterial infections in the young caused by H1N1. And remember, a viral infection is also a transfer of genetic code to you. Think about it, and be vigilant.