Tag Archives: Health Insurance Reform

First Looks at the Delaware Health Insurance Exchange

Under the ACA, each state is supposed to create and manage a medical insurance marketplace where people who aren’t covered by insurance can buy plans. Delaware’s Health Insurance Marketplace website went live this AM — although the details of the exchange and the insurance options on offer are not yet available. I’m mildly surprised that California and NY got theirs up earlier — I had thought at one time that Delaware was pretty far ahead of the planning curve for planning and implementing this. Which is probably a misconception on my part.

The DHSS has selected 4 organizations throughout the state to help with outreach and to help with enrollment in an effort to reach as many people as possible and to make the process easier:

The guides, she said, will exist to help people navigate the marketplace, learn what health reform is all about and define what the marketplace can do.

“It is critically important we have boots on the ground,” she said.

Delaware anticipates serving up to 35,000 people through the marketplace. There are 90,000 uninsured Delawareans currently. As many as 30,000 additional Delawareans will gain access to health care through the state’s expansion of Medicaid, which begins on January 1 2014.

Plans under review include:

Medical plans through Highmark Blue Cross Blue Shield, Coventry Health Care and Coventry Health and Life are all under review by the state. Stand-alone dental plans will also be available on the marketplace and all must include pediatric dental coverage. These include: Delta, Dentegra, Dominion and Guardian.

No word yet as to pricing on these plans, which will include Bronze, Silver and Gold plans. I wouldn’t expect to see the kind of dramatic cost reductions as we’ve sen in the news from places like NY and CA, if anything because our customer base is smaller and perhaps not eligible for the kind of volume reductions seen elsewhere. But I hope I’m wrong about that.

Will any of you be getting health insurance from this exchange? What do you think of this, if so?

The End of For Profit Insurance Companies

So claims the CEO, Chairman and President of Aetna Insurance, Mark Bertolini. He was speaking at a health-related conference in Las Vegas, and told his audience:

“The system doesn’t work, it’s broke today” Bertolini told attendees. “The end of insurance companies, the way we’ve run the business in the past, is here.”

Yes, even insurance companies get that their current lifespans are brief (from the article above):

Bertolini said an amalgamation of regulatory, demographic and economic factors were driving this change. The Affordable Care Act in particular, with its ban on medical underwriting, had made the traditional health insurance business model untenable in the long term, he said. Nonetheless, he offered measured praise for the law, even citing the controversial medical loss ratio rules as having a smoothing effect on premium swings. “We got pulled through the crucible against our will and have been reshaped because of it,” he said. “For most of what has already been implemented, it has been a pretty good thing.”

Moreover, he discounted the prospects that the results of the 2012 presidential election or a Supreme Court decision striking down aspects of the ACA would deter the change. “Reform is not going to stop. It won’t go away.”

As those of you who have read my arguments here will know, I absolutely agree with this. The costs are out of control, the outcomes are not nearly as good as they should be and the astonishing inefficiency of the entire system contributes to the very high cost and the less than stellar outcomes. Once thing that Bertolini doesn’t talk about is the fact that large, established employers are quietly and actively looking for ways to get out of providing insurance so they can get off of the cost roller coaster.

Mark Unger over at Forbes talks about this admission from Bertolini as a sign that some form of single payer is on its way. Not soon, of course, and it will be a horrible fight to get there, but once the big insurers get that their business model is likely done for, it is time for the single payer policy types to swing into action. Because it won’t do to just create a new system that is as costly, inefficient and ineffective as the one we have. Reducing overall costs and making overall health outcomes clearly better has to be at the heart of any new single payer scheme.

If single-payer is in our future, whether on a state-by-state basis or a system operated by the federal government, it would be best to set it up before we are forced into it by failed private insurance companies. That means that devising a workable program with political support from all sides is far preferable to waking up one day to find that this is the only option available to us.

To do this, supporters of the single-payer model are going to have to offer up something more than their good intentions to both politicians and citizens who oppose this approach. Supporters are going to have to offer the solutions designed to control what are now out-of-control health care costs without putting patients in jeopardy of death due to rationing or causing folks undue waiting times to deal with a medical problem.

This is the long-term opportunity that I often argued for with the ACA. The ACA is not a long-term fix, but it can be the turning point towards getting closer to some form of single payer. And we’re close to a point where all of the stakeholders involved in this will be more than ready to do something different. It will be up to single payer advocates to put forth options that achieve cost control and better health outcomes because I have no doubt that insurance companies won’t just leave the field quietly.

In Which We Find Karen Weldin Stewart Abandoning Delaware Consumers Again

Back in June, we discussed the actions of KWS to apply for waivers from the medical cost ratio rule for two insurance companies so that they can continue to pay commissions to brokers and sales agents. Since then, HHS has finalized its rule that requires that the costs to pay premiums or other support to brokers and sales agents be categorized as Administrative Costs and therefore included to the maximum 20% overhead allowed by the ACA. Delaware’s own Insurance Commissioner voted in a recent NAIC action to vote on a resolution that recommends that Congress exempt the fees insurance agents and brokers from medical loss ratio calculations (pdf) and that HHS revive their rulemaking to exclude brokers and agents from the the administrative costs of insurance companies.

This is still a remarkable position. Especially since one of the major points of the ACA is to rein in some of the excesses of insurance companies and get them to spend more of your premium dollar on your health care. The ACA is trying to protect consumers with its medical cost ratio provision and KWS is voting to weaken it. Weaken it such that brokers get paid and you get less health care or pay higher premiums. In casting her vote for this, she is reported to have made this argument:

Karen Stewart, Commissioner from Delaware, added her support of the resolution:
• Delaware has to protect their consumers. Since the majority of Delaware residents have private insurance, the medical loss ratio doesn’t really relate to most Delaware consumers.
• Delaware does have a small insurance company that has been at 80 – 88% MLR for years. They are being merged with a larger company because they can’t carry that high an MLR and stay in business.

Did you see that? I think that this is te BCBSD merging with Highmark deal (were there other mergers we missed hearings about this year?) and I thought that the IC supported that because BCBSD needed a new computer system. This is the first time I saw that they needed the merger because they couldn’t live with the MLR, besides, I thought I saw someplace that BCBSD was comfortably living within the 80% already. I could be wrong on that.

But what I’m not wrong on is the fact that KWS is completely abandoning the people who pay premiums for the people who get paid to collect them. The vote on the NAIC resolution was close — 26 yes votes, 20 no votes, and 5 abstentions. I’m not sure about how much weight this resolution has with either Congress of the HHS, but the Insurance Commissioners who voted to support this thing should resign their offices immediately — since they clearly don’t know what Consumer Protection is meant to be. It isn’t the job of Insurance Commissioners to help support the slow dismantling of key bits of the ACA, either — and this is one small bite at the apple. Add up enough exclusions and waivers and you’ve changed how this law is supposed to work. These exclusions are not meant to make this law successful, you know. Insurance companies who can’t meet the 80% threshold have to refund the difference to their customers. But the commissions just aren’t that much money — 1-3% of a premium, I understand. This is just about insurance companies trying to get state ICs to help them weaken what they can of the ACA so they can keep as much money for themselves and not spend it on medical services.

I’d ask everyone to call and tell KWS that she needs to stop representing brokers and start representing us, except I’m thinking that she just might write letters supporting MLR waivers to HHS for each of us who called.

Tom Carper Trying to Help Kill Public Option Effort in the Senate

According to this article in The Hill, Dick Durbin is thinking that the entire caucus needs to come to grips with the idea of voting down any amendments to the HCR reconciliation fix, even the Public Option. And here is Tom Carper — working on his centrist cred, no doubt — egging this on:

Sen. Tom Carper (D-Del.), a leading centrist, suggested Democrats should be able to avoid blowing up a reconciliation package if there is ample negotiation on it before it hits the floor. But Carper appeared to warn his Democratic colleagues that any move to amend the reconciliation bill, however noble the policy aims, would only lead to chaos.

“If we have an agreement with the administration and the leadership of Senate Democrats and House Democrats on what should be in the reconciliation package, I’m sure I could think of plenty of ways to change it, and I’m sure every one of my colleagues could as well,” Carper said. “But that’s a slippery slope I don’t think we want to get on.”

Carper said this week he would likely vote against the public option if it was offered to a reconciliation bill.

“For those who somehow suggest this is going to happen now, they’re just deluding people,” Carper said.

It is a pity that Durbin would get to this point — within 9 or so votes and then announce a strategy to oppose all amendments. Even more of a pity for Tom Carper to trot out his effort to make some Guinness world record of representing more special interests than the number of people who actually voted for him.

What is especially galling here is that repubs will be offering plenty of amendments to try to further weaken and to kill the legislation, and you know that Carper will find at least ONE of these repub-sponsored amendments to vote for. Just so he can keep polishing up his centrist cred at the expense of Delawareans who voted for him.

(h/t to the GOS for the article)

Jacob Hacker Endorses Medicare Buy-in

Even though apparently Joe Lieberman and Ben Nelson are now bad-mouthing a deal that at least Nelson was in the room to help make, Jacob Hacker was in the news last week endorsing the Medicare Buy-In. Hacker being pretty much the Godfather of the Public Option. The complete interview on this (including others) is here on the PBS website, but this piece from Hacker is important:

Well it certainly is a broad compromise, but I think it’s a complex one. It has a lot of moving parts and a lot of details we don’t know yet.

The way I would describe it is, in sort of Dickensian terms, is it’s a tale of two public options. Public option one, the public option that was going to be within the exchange and available to Americans on day one to create competition for private insurance plans to give people a choice, that public option has been replaced, in my mind, with an inadequate substitute, a national system of private plans.

But public option two, which was never on the agenda before, a buy-in to the actual Medicare program for 55- to 64-year-olds, is an enormous positive development. It’s actually the original idea, if you will, for the public option, simply letting people get into the Medicare program that provides broad, secure coverage at an affordable price.

The ability to buy in to Medicare is not a new idea and people like Howard Dean had picked it up as recently as the 2004 election to campaign on. And Hacker is clear that he doesn’t think that the nationwide nonprofit does any good, either. But the details of Medicare Buy In aren’t all available yet, either, and without knowing how this works exactly it is hard to tell how good of an opportunity this might be.

Tom Carper Never Lets Go the Rightwing Talking Points

Call this post reason #578,091 why Senator Tom Carper is not a progressive. As if a proud member of the DLC could be. Senator Carper tells WHYY:

Delaware’s senior Senator Tom Carper (D) says Lieberman’s main concern making sure “we don’t balloon or swell the deficit, the nation’s debt further by what we do with respect to a public option.” Carper calls that a reasonable concern.

How is this a reasonable concern in light of the fact that this bill is completely paid for? And both Houses worked pretty hard to make sure it is paid for? And I’ll point out that neither Carper or Lieberman objected to the costs of the BushCo tax cuts, the costs of the Afghanistan or Iraq Wars or even the “War on Terror”, or Medicare Part D — NOT ONE OF THEM WAS PAID FOR. And the combination of these make up the biggest portion of the structural deficit.

Carper is no dummy here and it suits him to feed to untrue wingnut talking point that there is something here that increases the deficit. Because he too is hellbent on eliminating the Public Option and if that takes embracing the lies, apparently this works for him.

Tom Carper’s Chief of Staff Now Lobbies for Wellpoint

You read that right — the nation’s largest insurer has hired Tom Carper’s ex-Chief of Staff as a lobbyist to campaign for their interests on the health care bill:

Then, on September 25, insurer WellPoint hired Jones’ firm to lobby in the issue areas of health care, insurance, and Medicare/Medicaid, according to the lobbying registration filed last week, which lists the anticipated “specific lobbying issues” as “Healthcare reform legislation, specifically proposals affecting health insurance providers.”

Jones’ other health-sector clients include drugmakers Astra-Zeneca and Amgen, the trade groups Pharmaceutical Researchers and Manufacturers of America and the Biotechnology Industry Organization, as well as the American Insurance Association.

In his brief 22 months as a lobbyist, Jones has given $46,800 to Democrats, including White House chief of staff Rahm Emanuel. Jones has also given to Majority Leader Harry Reid, Finance Committee Chairman Max Baucus, health-care waffler Evan Bayh, as well as the Democratic Senatorial Campaign Committee.

You aren’t surprised at this, right? But the narrative does click into place as Senator Carper continues to work at doing everything he can to try to rid the bill of any possibility of real competition for insurance companies. It isn’t enough that the public option as it exists has been pretty well watered down, Senator Carper is working and getting rid of it and letting the Congress walk away with the fig leaf of triggers — for local co-ops, for national co-ops, for some option that will simply never be invoked. Like his trigger for the Medicare Part D drug costs.

Some months back, David Shuster of MSNBC asked Carper directly if the amount of money he gets from insurance companies, drug companies and other medical businesses influences his vote. Time for someone in the media to ask this question again — especially since his ex CoS and friend is now the face of WellPoint in Congressional offices.

(h/t Allan Loudell’s news program this afternoon)

New Commercial Targets Castle on Health Care Vote

This excellent commercial is from the SEIU in conjunction with the Foundation for Patients’ Rights, and started broadcasting in Delaware markets last night:

[youtube]http://www.youtube.com/watch?v=OH4Ja9lAdqs[/youtube]

Nice reminder that Castle is not voting for the interests of people who live here. Hope that one targeting Carper encouraging him to Do The Right Thing for the Senate bill is on the drawing board.

The Castle Amendment – Bend Over!

Here is the amendment Mike Castle added to the GOP “Die Quickly” Health Insurance Bill.

‘‘In applying subparagraph (B), a group health plan
(or a health insurance issuer with respect to health
insurance coverage) may vary premiums and cost
sharing by up to 50 percent of the value of the benefits under the plan (or coverage) based on participation (or lack of participation) in a standards-based
wellness program.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to plan years beginning
more than 1 year after the date of the enactment of
this Act.

So Mike Castle’s contribution to the bill is to allow your health insurance company to raise your premiums 50% because you didn’t adhere to their strict-as-hell wellness program (which probably requires you to report to them your diet and exercise habits).

I’m serious, that’s Mike Castle’s plan – letting your insurance company raise your rates for not exercising enough. The goal is to generate profits for the health insurance monopolies that contribute huge sums of money to his campaign (an industry generating record profits at the expense of bankrupting consumers). This isn’t your typical “weak-tea” Castle spinelessness, this is the real Mike Castle finally showing it’s evil, crooked face and telling you to “bend over” in the name of profit.

The next time you hear someone suggest they might vote for Castle, or that he’s some kind of “moderate”, remind them that Castle wanted to raise our health insurance premiums 50%.

What a sick fucking crook.

Here It Is! The Republican Heath Care Plan!

Well, at first it was an outline. Then John Boehner got really mad after it was released and people made fun of him again with the outlines.  So now they’ve finished their homework (pdf), now take a good look at Boehnercare:

  • No national exchange
  • No mandates for employers or for individuals
  • Insurance companies still get to exclude people with pre-existing conditions
  • No tax credits to help middle class and lower income people to buy insurance
  • High-risk pools for states to cover people excluded from insurance coverage are included and some funds are provided.  Except lots of states have these and they are expensive.
  • Small businesses band together to get lower rates (don’t get me started)
  • Limit medical malpractice (but nothing about limiting the damage that medical mistakes can cause to people!)
  • Let people buy insurance across state lines — specifically knocking down state laws for consumer protection.

So basically if you don’t have insurance, are afraid you may lose your insurance due to high premium costs, existing conditions or your employer yanks your insurance — Boehnercare does not care about you, or your need for health care insurance.  This doesn’t do anything to rein in premium or actual costs.  This doesn’t even have the GOP endorsed elimination of the employer tax deduction for employee insurance.   But here is an interesting thing to consider about this bill — for all of the whining and wailing these Republicans did about needing a bipartsan bill, one that was done out in the open where everyone was included, a bill that took the best of everyone’s ideas and they did none of that.  And as this blog post from Tim Fernholz asks,  since the traditional media has latched on to bipartisanship as a measure of the health insurance bill’s success, I wonder when the same traditional media will start holding this repub plan up to their own criteria.

Attempted Murder Or Just Business As Usual?

Love, love, love the fact that people against the public option worry so much about rationing, but not so much about stories like these:

Via HuffPo:  Rather than continue to pay for Ian Pearl’s million dollar medical treatments, one insurance company has decided to end certain lines of coverage altogether, reports William Ehart of the Washington Times. Pearl, 37, suffers from Type II spinal muscular dystrophy, and has been using a wheel chair and connected to a breathing tube for most of his life. Patients with his type of muscular dystrophy rarely live past infancy, but Peal credits his vitality to the care he has received all his life.

On December 1 his insurer, Guardian, is discontinuing a portion of its coverage, which will effectively kill him. Without his extensive coverage Pearl will be admitted to a state hospital under Medicaid, with less treatment. Pearl’s mother said that in a state hospital her son would be lucky to live more than a few weeks. Pearl’s plan, as of now, covers 24-hour home nursing, which Medicaid, and the vast majority of plans, do not.

“This is attempted murder” said his father, Warren, “the insurance companies are cheating in order to have obscene profits.”

Seriously, why isn’t this against the law?  Isn’t the insurance business based on risk?  Apparently not.  The deck is rigged in their favor at all times, and their tactics are amoral and disgusting.  Ooh, we lost the bet on Pearl, guess we just take his cards and kick him out of the game rather than pay our losses. Hell, insurance companies don’t even play the odds.  They’re like a seven year old who calls “time out” right before getting tagged.  And, not only is Guardian screwing over Pearl, they’re screwing over everyone else in the state who relies on this service.

And, then there’s this big fella.

By the numbers, Alex is in the 99th percentile for height and weight for babies his age. Insurers don’t take babies above the 95th percentile, no matter how healthy they are otherwise.

“I could understand if we could control what he’s eating. But he’s 4 months old. He’s breast-feeding. We can’t put him on the Atkins diet or on a treadmill,” joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. “There is just something absurd about denying an infant.”

Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.

” ‘Your baby is too fat,’ she told me,” Bernie said.

Simply amazing.  And Republicans claim that the public option will come between you and your doctor.  Hello?  So already happening… on a daily basis.  Funny, how a three card monte tables get shut down while insurance companies run the same scam.

Update: Score one for baby Alex!  He’s covered! (Thanks, MJ)