Healthcare Reform Thread II

[Drake Tungsten]

I thought this bill was dead, since there was no workable compromise.

Nope. The White House and Congress are going to make a big push to finish healthcare reform starting on Thursday and are keeping the reconciliation option on the table.

[DanS]

So they're writing this one in the conference?

[Drake Tungsten]

No, they're going to have the House pass the Senate bill after they've been assured that the Senate is going to pass certain fixes via reconciliation.

edit: Of course, I'm not sure everything Obama is proposing can be tacked onto the Senate bill via reconciliation. The path he's hoping to take to a final healthcare reform bill isn't so clear at the moment.

[DanS]

OK, but does Pelosi have the votes? What about the abortion language in the Senate bill? As I recall, the House Right-to-Lifers were unhappy with it.

[Drake Tungsten]

Whether or not Stupak-like abortion language is included in the final bill is one of the big open questions at the moment. Obama's proposal doesn't include it.

[Kidlicious]

Anthem Blue Cross plans 39% increase in premium rates.

http://articles.latimes.com/2010/feb...ama9-2010feb09

Obama official 'very disturbed' by Anthem Blue Cross rate hikes
The insurer should give a 'detailed justification' for its plan to raise premiums on individual policies by as much as 39%, Health and Human Services Secretary Kathleen Sebelius says.
HEALTHCAREFebruary 09, 2010|By Duke Helfand
California insurance regulators asked Anthem Blue Cross to delay controversial rate increases of as much as 39% for individual policies, hikes that have triggered widespread criticism from subscribers and brokers -- and now from the federal government.

In a rare step, the Obama administration called on California's largest for-profit insurer to justify its rate hikes, saying the increases were alarming at a time when subscribers face skyrocketing healthcare costs.

In a letter to Anthem's president, Health and Human Services Secretary Kathleen Sebelius voiced serious concern over the higher premiums, which go into effect March 1 for many of the insurer's estimated 800,000 individual policyholders.

"With so many families already affected by rising costs, I was very disturbed to learn through media accounts that Anthem Blue Cross plans to raise premiums for its California customers by as much as 39%," Sebelius wrote to company President Leslie Margolin.

"These extraordinary increases are up to 15 times faster than inflation and threaten to make healthcare unaffordable for hundreds of thousands of Californians, many of whom are already struggling to make ends meet in a difficult economy."

Woodland Hills-based Anthem said it would respond to Sebelius' request as soon as possible.

California Insurance Commissioner Steve Poizner asked Anthem's parent company, Indianapolis-based WellPoint Inc., to delay its rate increases until May 1 while an independent actuary, appointed by the state, could review them.

Poizner said in his letter to WellPoint's chief executive and chairman that he would stop Anthem's rate increases if the actuary determines that the insurer spends less than 70% of its premiums on benefits, as required by state law.

"The premium increases Anthem proposes for critically needed individual health insurance could have a devastating financial impact on hundreds of thousands of its policyholders in California," Poizner wrote. "The Department [of Insurance] has received numerous complaints from irate Californians describing how Anthem's proposed rate increases would cripple them financially."

A WellPoint spokeswoman said she couldn't immediately respond to questions about the company's reaction to Poizner's request.

An Anthem spokeswoman said the company was reviewing Poizner's letter and did not have a reply Monday.

Anthem said its costs have been driven up in part because the weak economy has led many people in good health to forgo coverage, leaving those with greater medical needs in its pool of customers.

"We regret the impact this has on our members," it said of its rate hikes. "It highlights why we need sustainable healthcare reform to manage the steadily rising costs of hospitals, drugs and doctors. As such, it is important to go back to the beginning and get healthcare reform done right."

Anthem has declined to say how high it would raise rates or how many people would be affected. But brokers who sell these policies said the increases were many and large. They said they were fielding numerous calls from customers angry over premium increases of 30% to 39%, after similar ones just last year.

Many policyholders say the rate hikes are the largest they can remember. Some speculated that the company was moving to raise rates ahead of possible national healthcare reform, pending in Congress. Reform could require insurers to take all comers in the individual market, not only those they choose -- a step the industry has said would drive up costs.

Anthem members applauded state and federal officials for reviewing the matter.

"I think all this is driven by money," said Los Angeles graphic designer Keith Knueven, whose rates will jump 37%, to $393 a month from $287. "It's hard for to me to understand how anyone can raise rates now when so many people don't have jobs."

Sebelius said Anthem's "strong financial position" made the increases "even more difficult to understand." She cited recent profit reported by its parent, WellPoint. Last month Wellpoint announced an eightfold increase in profit for the last three months of 2009, a surge attributed largely to the sale of subsidiaries.

"I believe Anthem Blue Cross has a responsibility to provide a detailed justification for these rate increases to the public," Sebelius wrote. "Additionally, you should make public information on the percent of your individual market premiums that is used for medical care versus the percent that is used for administrative costs."

She continued: "Policyholders in the individual market deserve to know if their premium increases would be invested in better medical care or insurance company overhead costs like salaries, profits, and advertising. I am aware that the state of California is investigating this matter, and urge Anthem Blue Cross to cooperate fully. In the meantime, I will be closely monitoring the situation.

"At a time when healthcare costs are a critical threat to families as well as the nation's economy, I hope you appreciate the urgent nature of this request. I look forward to your prompt reply."

[Kuciwalker]

I don't know if Stupak language can be reconciled, but the other big thing they need to do to fix the Senate bill - the union excise tax fix - can definitely be passed through reconciliation.

[rah]

It is starting to look like that the goal is to pass something, anything, regardless of it's merit.

That's why I hate the government.

[Drake Tungsten]

I don't know if Stupak language can be reconciled, but the other big thing they need to do to fix the Senate bill - the union excise tax fix - can definitely be passed through reconciliation.

Obama's excise tax plan...

Labor agreement for everyone. Changes effective date of the Senate policy from 2013 to 2018. Raises the amount of premiums that are exempt from the assessment from $8,500 for singles to $10,200 and from $23,000 for families to $27,500 and indexes these amounts for subsequent years at general inflation plus 1 percent.

http://yglesias.thinkprogress.org/archives/2010/02/how-the-white-house-health-plan-compares.php

[Kuciwalker]

The excise tax was my favorite part of the plan.

Also at indexing it to inflation. Stealth elimination of the deduction altogether

[DanS]

Wages tend to rise faster than inflation, so there will be a stealth elimination nonetheless.

[Drake Tungsten]

More info on Dan's question about votes in the House...

Obamacare Faces Tough Road in the House

... regardless of what happens at this week's superfluous summit, it’s difficult to see how Democrats cobble together enough votes to pass a final health care bill in the House.

Back in November, in a much better political environment for Democrats, Speaker Nancy Pelosi was able to muster only a narrow 220 to 215 majority in the House to pass its version of health care legislation. Since then, Rep. Joseph Cao, the one Republican who voted for the bill initially, has indicated he wouldn’t do so again because of objections to the abortion language. In addition, Florida’s Robert Wexler unexpectedly resigned, Rep. Neil Abercrombie announced plans to retire at the end of this month to run for governor of Hawaii and Rep. John Murtha passed away. Taken together, that brings Pelosi down to 216 votes -- which would be insufficient to pass a health care bill. ...

Of the 39 Democrats who voted against the House health care bill, 31 of them were elected in districts that went for John McCain in 2008, according to a TAS analysis. One of the Democratic “no” votes, Rep. Parker Griffith of Alabama, has subsequently switched parties. Given that a Republican who campaigned on being a vote against the health care bill was just elected to fill the Senate seat once held by Ted Kennedy in a state that went for Obama by 26 points, it’s hard to see why anybody in a McCain district who already voted "no" would decide switch their vote to “yes.”

While Obama won the districts of the remaining eight “no” votes, in six cases, he won by only single digits, making them potentially competitive races this time around. And a closer look at several members who represent these areas are not very encouraging to proponents of Obamacare. ...

There are two Democrats who voted “no” the first time around that come from solidly Democratic districts, but neither of them is likely to change his vote. Rep. Dennis Kucinich is a committed single-payer advocate who viewed the first bill (which included a public option) as too favorable to private insurance, and he’s attacked the Senate version as a handout to insurance companies. Rep. Artur Davis is now running statewide to be governor of Alabama, and not only has he maintained his opposition to the health care bill, but he has attacked his Democratic rival in the primary for supporting it.

This analysis, keep in mind, is under the best-case scenario in which Pelosi hangs onto every vote she originally had. In reality, Pelosi could have a tough time convincing nervous Democrats in moderate districts who voted against the bill the first time around to vote for it a second time.

The biggest problem she faces is that President Obama’s proposal maintains the abortion provision in the Senate bill, rejecting Rep. Bart Stupak’s more restrictive language. When the bill passed the House the first time around, 41 Democrats voted for the health care bill only after voting for the Stupak amendment. Any of them could explain switching to a “no” vote on a final bill by citing abortion funding. Stupak himself has said there are at least 10 to 12 Democrats who voted for the bill the first time who would vote against it if it didn't include his amendment (he reiterated Tuesday morning that the Senate abortion language adopted by Obama was still "unacceptable"). ...

Pelosi will have to make up for any votes she loses by picking off members among the 39 Democrats who already voted “no.”

None of this is to say that it’s literally impossible for Pelosi to find the votes necessary to pass a health care bill. There are several retiring members who may be willing to vote for it because they don’t have to stand for reelection, some may be won over by provisions in the latest version of the bill, and a few may be willing to take suicide votes for the team. But this week’s political theater shouldn’t obscure how difficult it will be for Obama to get a comprehensive health care bill across the finish line.

http://spectator.org/archives/2010/02/23/obamacare-faces-tough-road-in

[Kidlicious]

http://www.latimes.com/business/la-f...tory?track=rss

Anthem Blue Cross broke law more than 700 times, official says
California Insurance Commissioner Steve Poizner says the insurer failed to pay medical claims on time and misrepresented policies from 2006 to 2009. The firm faces up to $7 million in fines.
February 23, 2010

California's largest for-profit health insurer violated state law more than 700 times over a three-year period by failing to pay medical claims on time and misrepresenting policy provisions to customers, the state's insurance commissioner said Monday.

Anthem Blue Cross of Woodland Hills could face fines of up to $7 million stemming from the alleged violations from 2006 to 2009. Commissioner Steve Poizner said the insurer repeatedly failed to respond to state regulators in a "reasonable time" as they investigated complaints over the last year.

"We believe there is evidence to suggest there are serious issues with how Anthem Blue Cross pays claims," Poizner said at a Sacramento news conference. "Most disturbing to us is that they don't even respond" to the Department of Insurance "in a timely way."

Anthem's parent company, WellPoint Inc., said it hadn't seen the enforcement action but would cooperate fully with Poizner to resolve the matter "in the best interests" of its policyholders.

"We take the issues raised by Commissioner Poizner very seriously," the Indianapolis company said in a statement. "As the largest insurer in California, our responsibility is to pay the many millions of claims on behalf of our members each year fairly, fully and promptly.

"While this review represents a small fraction of those claims, it is nonetheless very important to us to make sure we take any corrective action that may be necessary."

WellPoint and Anthem have faced intense criticism from consumers, regulators, members of Congress and the Obama administration over rate hike proposals of as much as 39% for customers with individual policies in California.

Lawmakers in Sacramento and Washington are holding hearings this week on the increases, which have been postponed until May 1 amid the outcry.

The rate hikes would affect many of the 800,000 individual policyholders in California.

Anthem is not the only company facing scrutiny over the way it pays claims.

Poizner's office filed a similar complaint against Cypress-based PacifiCare in January 2008.

Officials said at the time that they had uncovered 133,000 violations of state laws and regulations over payments for medical care. That case is pending, Poizner said Monday.

Nearly 40% of the violations in the Anthem case, 277, stem from allegations that the company failed to pay patient claims within 30 days as required by state law, officials said.

Poizner's office filed the enforcement action against Anthem on Monday with the Office of Administrative Hearings.

An administrative law judge will hear the matter. Each violation carries a maximum penalty of $10,000.

"Over the next several months, we hope to bring this case to fruition," Poizner said.

Copyright © 2010, The Los Angeles Times

[Kidlicious]

Insurance Companies Prosper, Families Suffer: Our Broken Health Insurance System

http://www.healthreform.gov/reports/...ers/index.html

Introduction
Recently, Anthem Blue Cross of California, an insurance company owned by the for-profit company WellPoint, Incorporated, announced that its individual market premiums would rise by as much as 39 percent in the coming months. This shocking increase isn’t unique. Across the country, families have seen their premiums skyrocket in recent years, and experts predict these increases will continue. Sandy Praeger, a leader of the National Association of Insurance Commissioners, predicts that we will “see rate increases of 20, 25, 30 percent.”

These massive increases are disturbing examples of the problems that make reforming our health insurance system more important than ever.

Premiums Rise, Insurance Industry Profits Increase, Health Care Costs Cripple Working Families
Anthem Blue Cross of California announced that its individual market premiums would rise by as much as 39 percent in the coming months. After Secretary Sebelius and state officials asked for a public justification for these increases, Anthem Blue Cross delayed raising its rates for two months.

Anthem Blue Cross isn’t alone in insisting on premium hikes. Anthem of Connecticut requested an increase of 24 percent last year, which was rejected by the state. Anthem in Maine had an 18.5-percent premium increase rejected by the state last year as being “excessive and unfairly discriminatory” – but is now requesting a 23-percent increase this year.

In 2009, Blue Cross/Blue Shield of Michigan requested approval for premium increases of 56 percent for plans sold on the individual market. Regency Blue Cross Blue Shield of Oregon requested a 20-percent premium increase. UnitedHealth, Tufts, and Blue Cross requested 13- to 16-percent rate increases in Rhode Island. And rates for some individual health plans in Washington increased by up to 40 percent until Washington State imposed stiffer premium regulations.

Leading experts have predicted that, without reform, these increases will continue, and the federal government and most states don’t have the legal authority to block or reduce health insurance rate increases.

WellPoint and others claim that the premium increases are necessary given the rise in health care costs. While rising health care costs is a known problem with our broken health care system, [b]some of the premium increases requested by insurance companies are 5 to 10 times larger than the growth rate in national health expenditures.[/b All the while, insurance companies and their CEOs continue to thrive.

Recent economic data show that profits for the ten largest insurance companies increased 250 percent between 2000 and 2009, ten times faster than inflation. Last year, as working families struggled with rising health care costs and a recession, the five largest health insurance companies – WellPoint, UnitedHealth Group, Cigna, Aetna, and Humana – took in combined profits of $12.2 billion, up 56 percent over 2008. These health insurance companies’ profits grew even as nominal GDP decreased by 1 percent over this same time period. WellPoint accumulated more than $2.7 billion in profits in the most recent quarter alone.

And recent data show that the CEOs of America’s five largest insurers were each compensated up to $24 million in 2008.

Now, while insurance companies enjoy increasing profits and CEOs take in millions, American families struggle to find and maintain affordable, quality insurance coverage. A recent study found that almost 75 percent of individuals looking for coverage on the individual market never bought a plan, with 61 percent of those who did not purchase insurance citing premium costs as the primary reason.

A Broken Health Insurance System Works for Insurance Companies – Not Families
Our broken health insurance system has allowed these premium increases to occur. More than 94 percent of insurance markets in the United States are now highly concentrated. Without competition, insurers have no reason to drive costs down, and without additional choices in the marketplace, consumers have no choice but to continue to pay, or lose coverage. As premiums go up in the current economic climate, more and more families are priced out of the market altogether, making a bad situation worse.

The “value gap” in the health insurance market is evident not just in overall premium hikes, but also in the use of those premium dollars. Over the past decade, the amount private insurance companies spent on administrative costs grew faster than the amount spent on prescription drugs, a trend that is projected to continue through the next decade. Three of the top five insurers cut the proportion of premiums they spent on customers’ medical care last year, committing more to salaries, administrative expenses, and profits.

Finally, while insurance company profits rise, these companies provide less and less security for American families. The six largest publicly held insurers insured 2.2 million fewer people in the first three quarters of 2009. If the rest of the insurance industry exhibited the same trend, 4.2 million people – or around 15,000 people per day – would have lost private insurance over this period.

Health Insurance Reform Will Fix Our Broken Health Insurance System
Health insurance reform seeks to drive down costs, put consumer power and choice in the hands of the American people, and ensure all Americans receive the health care services they need and deserve. These efforts won’t just help our health care system – they will also help our economy. Lowering health care costs through reform could generate 250,000 to 400,000 jobs a year. And reform will drive down premiums and limit out-of-pocket costs that eat into the family budget.

Reform will:
Place additional oversight on health insurance companies to ensure that people get value for the premiums they pay. Insurance companies will have to report how they spend the premium dollars they collect from their customers. If they spend too much on administrative costs and profits, they will have to give some of that money back to their customers. Insurance companies will also have to provide public justification for premium increases. Consumers can use this information to help decide whether they want to purchase a particular plan. And if insurance companies are not able to justify their premium increases, they could be barred from participating in the health insurance exchanges.

End Arbitrary Limits Placed on Coverage by Insurance Companies. Under health insurance reform, families will no longer face lifetime limits to their benefits, nor will coverage be denied or watered down based on medical history. As a result, health insurance will provide real protection from high health care costs.

End Insurance Company Discrimination. Health insurance reform will prevent any insurance company from denying coverage based on underlying health status. It will end insurance discrimination that charges families more if a family member has or had any illness, and limit differences in premiums based on age.

Create Competition Among Insurers with a Health Insurance Exchange. Health insurance reform creates a marketplace – or “exchange” – for insurance competition that will drive down premium prices for Americans. The health insurance exchange will bring families and plans together into one organized marketplace so families can compare prices and health plans in order to decide which quality, affordable option is right for them. Health insurance reform will guarantee every American a choice of health coverage, even if someone loses a job, switches jobs, moves, or gets sick.

Ensure Value in Our Health Care System. By rewarding high-quality and efficient care, encouraging care coordination, and reducing medical errors, health reform will slow the growth in health care costs and ensure value for every health care dollar spent.

Lower Premiums. The Congressional Budget Office estimates that reform will streamline administrative costs of insurance companies and bring more people into the insurance market, lowering premiums of a comparable plan in the individual market by 14 to 20 percent.25 That means more money in the pockets of American families and the security of having high-quality coverage.

[rah]

Yes it's true that insurance companies are making a profit. (the goal of every profit company) But while overall Anthem Blue Cross of California made a profit they lost money on its individual market. Can you legislate that a company operate at a lose. I have worked at a major insurance company and personally witnessed how books can be cooked but if you make business not profitable, they'll just take their ball and go home. (see florida coastal home insurance availability) When everyone loses.

So increase competition by allowing sales across state lines. Get more power to inspect their books to debunk their tales of woe. But DON"T legislate price control. You'll just end up with expensive government pools that don't service anyone well.