Posts Tagged ‘pre-existing conditions’

Handicapping the ACA’s Fate

Wednesday, June 13th, 2012

As the nation anticipates the Supreme Court decision on the future of the Patient Protection and Affordable Care Act (ACA),  pointed questioning by justices has supporters and opponents facing the possibility that the law could be declared unconstitutional.  That would eliminate — along with the contentious mandate that people purchase health insurance — popular provisions such as letting young adults stay on their parents’ plans until age 26, making prescription drugs more affordable for seniors, and requiring insurers to cover those with pre-existing medical conditions.

Even if the court keeps most of the law intact and strikes down the individual mandate, many healthcare advocates, insurers, and legislators believe that these consumer protections will be meaningless.  “There are a series of provisions of the law which have already been enacted which have proven to be fairly popular,’’ said Andrew Dreyfus, president and CEO of Blue Cross Blue Shield of Massachusetts.  “The question nationally is will there be bipartisan consensus to maintain those provisions even if the Supreme Court overturns some aspects of the law or the whole law?’’

Congress has been disinclined to talk about contingency plans, or the possibility of compromise.  There is agreement  that nothing will be done before November’s presidential election.  “Repeal and replace is a good slogan, but what kind of replacement are we talking about?’’ asked Gail Wilensky, a healthcare economist who administered Medicare and Medicaid under George H.W. Bush.  “Is it a replacement that will substantially extend coverage for people who have been uninsured?  At the moment it’s a little hard to see that happening.’’

“It’s a standard rule of politics that people value losses more than hypothetical gains,’’ said John McDonough, director of Harvard University’s Center for Public Health Leadership and who helped the Senate write the ACA.  “If the court were to strike down significant parts of the law that are already in place, there could quite possibly be a potent public reaction against what is being taken away from people.’’

In an interview with Kaiser Health News, Jon Kingsdale, Executive Director of the Commonwealth Health Insurance Connector Authority, who is working to implement the ACA said “We’re working with about a dozen states, and they fall, I’d say, into three camps: One, working very, very hard with a real strong vision of what they want to set up, to implement by October 1, 2013 – which is less than 18 months away.  Others that are planning – they’re preparing.  They’re waiting to see, in fact, if it’s implemented after the Supreme Court decision, which is expected to be announced in June – and/or the election in November.  And then there are states, frankly, we are not working with that are pretty much waiting to see this go away.”

Kingsdale believes that the entire law will not be thrown out by the Supreme Court.  “I think their striking down the entire law is much less probable than striking down the mandate,” he said.  “I’ve begun to talk to people in insurance companies and states and vendor organizations about what happens if the entire law is struck down, and I am struck by the lack of anticipation of what that would mean.  People are aware that there are huge problems. There are many things that have been implemented already, in terms of insurance coverage and Medicare payment policies and accountable care organizations, the authorization of which would be undercut.”

David Axelrod, chief campaign strategist to President Barack Obama, is denying reports that the White House may revisit healthcare in his second term.  “Our hope and our expectation is that the Supreme Court will affirm the healthcare law,” Axelrod said.  “Now is not the time to speculate on that.  We believe that the law is constitutional.  The Affordable Care Act is also really important to the health and well-being of the American people,” Axelrod said. “It is already helping people all over this country, and has improved the position of people relative to their insurance companies, and the kind of policies they are getting and the return they are getting for the premiums they are paying.”

Current Individual Healthcare Coverage Doesn’t Meet ACA Standards

Monday, June 4th, 2012

The majority of individual policies currently on the market could not be sold on state exchanges in 2014, according to a new report.  The report, published in Health Affairs and funded by the Commonwealth Fund, examined individual plans from several states and found that 51 percent of the plans fail to meet the minimum requirements established by the Patient Protection and Affordable Care Act (ACA).

The law says that plans sold on public exchanges must cover at least 60 percent of the costs of treating a typical patient, a figure known as “actuarial value.”  Most of the policies the researchers analyzed covered less than that, meaning the possibility of high out-of-pocket costs for patients.  To meet the actuarial value targets for “bronze plans, “the lowest category, current plans would have to pay for more care. That likely means they would be more expensive to consumers.

“The individual market of the future will sharply contrast with the market of the past decades,” said John Gabel of the University of Chicago.  They do not say whether changes to the market will be good or bad for consumers, but they are likely to be a mixed bag.  Supporters of the ACA say that new regulation of insurance products provide key consumer protections.  Opponents believe that they will drive up the cost of insurance. “Deductibles will have to be lowered,” Gabel said. “The out-of-pocket limits may have to be lower.  They will have to offer maternity benefits” as well as coverage for mental-health and substance-abuse.

People who buy individual health insurance policies typically pay higher premiums and higher out-of-pocket costs than people who have employer-provided.  Individual policies usually offer less coverage and, until the ACA fully becomes effective in 2014, can exclude coverage for pre-existing conditions.  The ACA sets minimum standards for plans sold through the state-run exchanges.  Slightly more than 50 percent of people on the individual market have policies that cover less than 60 percent of plan costs.  One-third of individual policies pay 60 to 69 percent, enough to meet the lowest thresholds under the healthcare law.

Many consumers will get more generous coverage if they purchase insurance through an exchange.  But, according to the Congressional Budget Office (CBO), the boost in benefits could also increase premiums.  “Premiums for health insurance in the individual market will be somewhat higher on average under (the healthcare law) than under prior law, mostly because the average insurance policy in that market will cover a larger share of enrollees’ costs for healthcare and provide a slightly wider range of benefits,” the CBO said.  The increases would be partially offset by other policies that would cut premiums, but still come out slightly higher.  Consumers won’t have to pay the extra costs, though, because the federal government will provide subsidies to help cover the cost of insurance.

Approximately 62 percent of people who now try to buy insurance for themselves in the so-called individual market report that they can’t find an affordable policy, said Sara Collins, vice president for affordable health insurance at the Commonwealth Fund.  People who do “often end up with coverage that’s really not adequate.”  Enhancing current plans to meet the ACA’s requirements will probably raise consumer’s up-front premiums, Gabel said.  “Other things held constant, the cost of the plan will go up,” he said.  The ACA does not allow insurers to cherry- pick only healthy customers; adding sick people to insurance pools will also raise costs, he said.

People whose policies currently don’t meet the health law’s requirements will have to “buy up” in 2014, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.  “Any time new benefits are added to a policy that adds to the cost of coverage.”  Premium increases can be alleviated by other changes, according to Gabel.  The exchanges should reduce administrative costs for insurers and “make for more price competition” among plans.  The ACA also limits, to 20 percent of premium revenue, the amount insurers can keep for administrative costs and profit, and creates subsidies to cut the cost of insurance for low- and middle-income people.  “Presumably a lot of people on these really crummy plans in the study could potentially be eligible for premium subsidies,” Collins said.  “It’s really going to be important that other provisions of the law address the premium growth issue.”

As Many As 112 Million May Have Pre-existing Conditions

Wednesday, May 16th, 2012

Between 36 million and 112 million Americans have pre-existing conditions, according to the Government Accountability Office (GAO).  Previously insurers have been able to deny coverage to sick people or offer policies that don’t cover their pre-existing conditions.  The Patient Protection and Affordable Care Act (ACA) prohibits insurers from charging higher prices to people with pre-existing conditions.

Americans with pre-existing conditions represent between 20 and 66 percent of the adult population, with a midpoint estimate of 32 percent.  The differences among the estimates can be attributed to the number and type of conditions included in the different lists of pre-existing conditions.

The GAO compared several recent studies that tried to determine how many adults have pre-existing conditions,  based on the prevalence of certain common conditions.  Hypertension, mental health disorders and diabetes are the most common ailments that lead insurers to deny coverage, GAO said.  The report doesn’t say how many of those people are presently uninsured, but the insurance industry said that number could be relatively low.  Most people have insurance through an employer that is available irrespective of pre-existing conditions, according to America’s Health Insurance Plans (AHIP).  The trade association stressed that requiring plans to cover everyone is closely linked to the individual mandate, which the Supreme Court could strike down this summer.  There is widespread agreement that the two policies must go hand-in-hand — the Obama administration told the Supreme Court that if it strikes down the mandate, it should also toss out the politically popular requirement to cover people with pre-existing conditions.

Adults with pre-existing conditions spend $1,504 to $4,844 more annually on healthcare, and the majority — 88 to 89 percent — live in parts of the country “without insurance protections similar to the Affordable Care Act provisions, which will become effective in 2014.”

GAO’s analysis found that nearly 33.2 million adults age 19-64 years old, or about 18 percent, reported hypertension in 2009.  People with hypertension reported average annual expenditures of $650, but expenditures reached $61,540.  Mental health disorders and diabetes were the second and third most commonly reported conditions.  Cancer was the condition with the highest average annual treatment expenditures — approximately $9,000.

Sebelius Asks Civil Right Activists to Defend the ACA

Monday, April 23rd, 2012

Secretary of Health and Human Services Kathleen Sebelius has asked civil rights activists to help defend the Patient Protection and Affordable Care Act (ACA), noting that the healthcare law faces an “enemy” whose goal is to set American health policy back half a century.  The remarks come two months before the Supreme Court is expected to issue a ruling that could strike down the law.

Sebelius described the ACA as an crucial weapon against racial disparities that have long meant higher infant mortality rates, shorter life spans and limited access to medical services for minorities.  “The enemy is at the door and we know that they would like to dismantle these initiatives,” Sebelius told the annual convention of the National Action Network, a civil rights group led by the Reverend Al Sharpton“Healthcare inequalities have been one of the most persistent forms of injustice,” she said. “Now is not the time to turn back.”

Civil rights advocates and the minorities they often represent form a key segment of the Democratic base, especially if the Supreme Court strikes down Obama’s signature domestic policy achievement.  Research shows that low-income Americans, including many minorities, have significantly less access to medical care and suffer higher rates of childhood illnesses, hypertension, heart disease, AIDS and other diseases.

Designed to bring healthcare coverage to more than 30 million uninsured Americans, the ACA has become a pet target for Republicans mainly because of an `individual mandate that requires most Americans to have healthcare insurance by 2014.  “We’ve got folks who are committed to undoing…the important initiatives that we’ve made in the last few years,” Sebelius said.  “Frankly, they want to go back and undo Medicare and Medicaid from the mid-1960s.  They want to roll us back years and years.”

The House of Representatives voted recently to partially privatize Medicare and convert Medicaid to a block-grant program for states, although the legislation is likely to be stalled in the Senate.  “I’m here to ask you to help,” Sebelius said.  “If we can begin to close the disparities in health, we begin to close disparities in other areas, too.”

Sebelius asked religious leaders, health advocates and other minority leaders to help the Obama administration educate the public about the healthcare law’s many benefits. The law, which becomes fully effective on January 1, 2014, has already benefited minorities by extending private insurance coverage to young adults, providing free preventive services for those with insurance and prohibiting coverage denials for children with pre-existing conditions.

Small Businesses Can Rely on Pooled Exchanges to Cover Employees’ Healthcare Needs

Monday, February 27th, 2012

The Patient Protection and Affordable Care Act (ACA) lets some small businesses avoid buying employee health insurance.  Despite that, a new study from the RAND Corp., said few will qualify.  Starting in 2014, the ACA mandates that the majority of companies provide health insurance for employees or pay to participate in health insurance exchanges.  Companies with fewer than 100 employees can retain their previous policies under a grandfather clause or they have the option to self insure.  The goal, RAND notes, is to spread the financial risk of covering sick or high-cost enrollees across a wider pool of employers.

In 2014, insurance companies will be allowed to set premiums based on enrollees’ age, family size, where they live or tobacco use.  They won’t be allowed to consider enrollees’ gender, overall health or pre-existing conditions.  “Concerns have arisen that such cost sharing could be undermined if small employers with relatively healthy workers and dependents avoid the new regulations by self-insuring or by maintaining grandfathered health insurance plans,” according to RAND.  “Should such a trend develop…premiums offered to all businesses that remain in the exchanges could become unaffordable.”  RAND’s study came to the conclusion that most small employers will opt not to self-insure because of the potential liability and financial risk in case medical expenses rise unexpectedly.  “The self-insure option will reduce enrollment in the small-business insurance exchanges somewhat but it will not have a substantial impact on exchange premiums,” the RAND study said.

“We found that keeping the rules as they are written, particularly the limitations on maintaining a grandfathered plan, will be essential to keeping premiums affordable in small business insurance exchanges,” said Christine Eibner, RAND senior economist and the study’s lead author.  Under the terms of the ACA’s Small Business Health Options Program, or SHOP, the exchanges for individuals have targeted their opening date for January 1, 2014.

The need for SHOP exchanges is very real.  Small businesses tend to struggle to pay for health insurance for their employees, and they have much less bargaining power with insurers than big business.  According to Timothy Jost of the Washington and Lee University law school, to succeed, the SHOP exchanges will have to provide small employers with an attractive alternative to the options currently available; keep costs affordable; regulate the insurance burden; administer the program; manage enrollment periods; and protect against poor selection, which would lead to a top-heavy number of sicker individuals in the exchanges.

It is estimated that the ACA’s state health insurance exchanges for small businesses will cover nearly 10 million employees, in addition to the 15.3 million individuals who gain coverage through the individual exchanges when the law is fully implemented.  According to Fredric Blavin and colleagues at The Urban Institute and The Commonwealth Fund, SHOP has the potential to provide affordable insurance for small employers who face high premiums and administrative costs.

The reform law grants states considerable flexibility in designing their exchanges, such as allowing them to combine their small business and individual exchanges, limiting enrollment to companies with 50 or fewer employees or opening to firms of up to 100 employees through 2015, or reducing the ability of insurers in the exchange to charge premiums on the basis of age beyond what the law allows.  When they examined all options, the researchers found that merging the small business and individual market exchanges would bring two million additional people into the exchanges, for a total of nearly 27 million.  This would reduce premiums by an average of $600 per person every year, and would cut federal spending on premium subsidies by $4 billion.  Few of the other options significantly impacted coverage or costs.  The authors conclude that “these results suggest that states can make these design choices based on local support and preferences without fear of dramatic repercussions for overall coverage and cost outcomes.

“SHOP exchanges have the potential to transform the experience of small businesses and their employees when shopping for and administering health insurance,” said Sara Collins, vice president for Affordable Health Insurance at The Commonwealth Fund.

AMA: Lack of Competition Among Healthcare Insurers

Monday, October 31st, 2011

More than four out of five metropolitan areas do not have a competitive commercial health insurance market because mergers and acquisitions have allowed some insurers to increase their market share, according to a report issued by the American Medical Association.

The report studied 368 metropolitan markets and 48 states, and determined that 83 percent had minimal competition among health insurers.  In approximately 50 percent of markets, at least one insurer maintained a majority market share of 50 percent or more.  In half of the states studied, the two largest health insurers had a combined market share of 70 percent or more.  The data shows “the degree of anti-competitive market clout” that some insurers have accrued through mergers and acquisitions, which decreases competition for patients, physicians and employers, said AMA President Peter W. Carmel.  Alabama occupied the last place, followed by Alaska, Delaware and Michigan.

According to Carmel, “Our new report is intended to help regulators, lawmakers, researchers and policymakers identify markets where mergers among health insurers may cause competitive harm to patients, physicians and employers.”

This latest edition of Competition in Health Insurance: A Comprehensive Study of U.S. Markets is the most comprehensive analysis to date, reporting commercial health insurance market shares and federal concentration measures for all 48 states.  The scope of the analysis provides a comprehensive snapshot of fully-insured and self-insured enrollments for both health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

One conclusion is “A significant absence of health insurer competition exists in 83 percent of metropolitan markets studied by the AMA.  These markets rated ‘highly concentrated’, based on the newly revised Horizontal Merger Guidelines issued last year by the U.S. Department of Justice and Federal Trade Commission.

“The market power of health insurers places physicians and patients at a significant disadvantage,” Carmel said.  “When insurers dominate a market, people pay higher health insurance premiums than they should, and physicians are pressured to accept unfair contract terms and corporate policies, which undermines the physician role as patient advocate.”

Physicians are the least concentrated segment of the healthcare sector with 78 percent of office-based doctors working in practices with nine physicians or less.  The majority of those are in either solo practices or offices with between two and four physicians.

“The market power of health insurers continues to prompt anti-competitive concerns among physicians,” Carmel said.  “To help restore a competitive balance to health insurance markets, the AMA urges the federal and state agencies to prohibit harmful insurance company mergers and adopt policies that would level the playing field between small physician practices and large insurers.”

Writing in the Washington Post,  Ezra Klein points out that one of the major goals of the Patient Protection and Affordable Care Act (ACA) is to create a competitive insurance market.  “This is the bill’s first, and most important, step.  Right now, the insurance market’s version of competition is pretty brutal.  Companies compete to avoid the sickest people and sign up the healthiest people.  Offering the best coverage for the lowest cost isn’t much of a priority, because most consumers don’t know whose coverage is best, and the ones who really do know are probably sick customers who spend their days researching this stuff.

“Outlawing the bad kind of competition while enabling the good kind, which the bill does, is more than just a humanitarian measure.  It’s a cost control.  The insurance ‘exchanges’ imitate the market in which federal employees (including congressmen) purchase their health insurance. In the exchanges, insurance products have to be above a minimum level of comprehensiveness (no more insurance that doesn’t cover anything) and their benefits have to be presented in a standard, comprehensible way.  The insurers themselves can’t discriminate based on pre-existing conditions, will have to answer to regulators if they attempt to jack up premiums, and will be rated by their customers — a rating that everyone else will see when shopping for their insurance,” according to Klein.

“If all goes well, consumers will be able to log onto the exchange’s website, compare insurance plans and choose their favorite.  That means insurers will have to compete for customers in a more transparent market, where shoppers have more information, and where the relationship between price and quality is more obvious.  As any free-market conservative will tell you, that should drive prices down and quality up.  If it doesn’t, insurers will have some annoyed legislators to answer to: The bill says congressmen and their staff members need to buy their insurance from these exchanges, too.”

No More Surcharges on Pre-existing Conditions

Tuesday, September 20th, 2011

There’s good news for Americans who lack healthcare insurance and have pre-existing medical conditions.  As of July 1, 2011, the Obama administration reduced the premiums  these people pay to purchase high-risk insurance plans that the federal government operates in 17 states and the District of Columbia.  Called pre-existing condition insurance plans (PCIPs), this coverage for people with medical conditions that often make then unable to buy insurance on the individual market was created by the Patient Protection and Affordable Care Act (ACA). 

Virginia and six other states will slash their premiums by 40 percent; other states and the District of Columbia will see cuts of between 15 and 25 percent; Mississippi will cut its rates by just two percent.  The revised rates give greater consideration to state-specific data and closely track the standard rates for individual policies in each state.  “Now, the program has been up and running for six to nine months, we’ve had an opportunity to redefine the methodology,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services. 

Advocates for consumers and federal officials hope that the reduced premiums will encourage additional people to opt into the plans.  Although approximately 375,000 people were expected to sign up for the PCIPs, just 21,454 had enrolled as of April 30, 2011.  The biggest roadblocks are seen as high premiums and a legal requirement that enrollees lack healthcare insurance for six months prior to joining the program.

Another provision of the law could have the potential to make the plans even more affordable.  Some insurers are already cutting premiums to meet the new “medical loss ratio” requirements.  (Medical claims paid are considered losses in insurance jargon.)  If difficult economic times continue and people cut back on medical care, other insurers may follow suit.  “Plans are getting nervous about how big the rebates they’re going to have to pay are,” said Timothy Jost, a law professor at Washington and Lee University who’s a consumer representative to the National Association of Insurance Commissioners.

Compared to the legal requirement that people be uninsured for six months before signing up for the new plans, high premiums are probably a bigger stumbling block to enrollment, experts say. They can’t really do anything about the six months, because that’s in the law,” says Kansas Insurance Commissioner Sandy Praeger, who heads the health insurance and managed care committee for the National Association of Insurance Commissioners.  “But they can bring down the cost, which will help.”

The trend to ever-increasing healthcare premiums has led some organizations to ask for an extreme solution. Recently, the Greater Boston Interfaith Organization (GBIO) and Health Care for All issued a plea to freeze healthcare premiums for one year to sort out a better solution for healthcare companies and individuals alike.  The freeze’s supporters argue that the price hikes of health insurance have not evened out, despite the fact that more people are facing economic difficulties.  During the year-long freeze, the hope is that consumers will be better educated to find the best deals for their insurance and that companies could find ways to better meet their customers’ needs.

The cost reduction has made a major difference to Kathleen Watson of Lake City, FL, who had been uninsured since 2004 when COBRA coverage under her husband’s previous policy expired.  Because she has leukocytosis — a constantly elevated white blood cell count — locating affordable coverage was impossible.  Watson found herself in an even more difficult position in 2009 when she was diagnosed with non-Hodgkin lymphoma and developed an antibiotic-resistant bacterial infection while hospitalized with pneumonia.

When the ACA created the new plans for people with pre-existing medical conditions, Watson looked into coverage.  Unfortunately, the $605 monthly premium was more than she could afford on what she earns running a medical transport business.  When she learned that rates in the three plans were being reduced by 40 percent, Watson checked out the plans again.  This time, she signed up for an affordable $363 a month that started July 1.  “I’m just happy to have insurance now,” Watson said, noting that she immediately needs a CT scan and a lung biopsy to check out enlarged lymph nodes in her right lung, bladder and colon.  “Hopefully it does what it says.”

Discussions about further reductions could be in the works.  “It’s possible,” that the medical loss ratio requirements might further depress PCIP premiums, Larsen said.  “I wouldn’t care to speculate about that.”

AMA Reaffirms its Support for the Individual Mandate

Wednesday, July 6th, 2011

Despite strong opposition from some member doctors, the American Medical Association (AMA) supports a key element of the Patient Protection and Affordable Care Act (ACA) that requires Americans to buy health insurance.  By a 2 — 1 margin, the AMA’s policy-making House of Delegates voted to continue its support of the individual mandate, saying such responsibility for Americans who can afford to buy coverage was the best option to expand benefits to people who are currently uninsured.  The results of the vote were 326 in favor and 165 opposed.  Without an individual mandate, people will not purchase health insurance until they are sick; that would lead to a spike in premiums for all.

“The AMA’s policy supporting individual responsibility has bipartisan roots, helps Americans get the care they need when they need it and ends cost shifting from those who are uninsured to those who are insured,” said AMA president Dr. Cecil Wilson, a Winter Park, FL. internist.  “Important insurance market reforms, such as an end to denials based on pre-existing conditions, are only possible by having broad participation in the health insurance market.  The AMA reviewed alternatives and concluded that any approach to covering the uninsured that is in line with AMA policy cannot be fully successful in covering the uninsured without individual responsibility for health insurance,” Wilson noted.

After the civil, one-hour individual mandate debate,  Wilson said an “overwhelming” majority of physicians voted to continue the position the association has maintained 2006.  Some delegates raised the issue because the constitutionality of that portion of healthcare reform legislation is being challenged.  “Our concern is that if we are not able to have a requirement that people have an individual responsibility to purchase insurance, we’re not aware of another solution, except something that would say that the government would make a requirement and tax the individuals for that,” Wilson said.  “From our perspective, the concern would be raised that would take us down a path toward a government run system.”

Wilson criticized people who can afford health insurance but refuse to purchase it, “who then arrive in the emergency room having fallen off of their motorcycle – and they did not wear a helmet – and they end up with major life-threatening injuries, the treatment for which very few people could afford.  And the result of that is that all of pay for that, private as well as taxpayers.”  Those are the people who cause those who have health coverage to pay premiums that are “$1,000 a year more than they otherwise would be.”  The reaffirmation vote stipulates that for individuals and families who cannot afford health coverage, there would be government tax subsidies or credits inversely proportional to income.  When asked if the AMA might file an amicus brief to support the Obama administration’s fight to block challenges, Wilson said that is unlikely.

According to Wilson, the delegates’ vote emphasized that “We cannot walk away from the fact that some 32 million more Americans would be able to have insurance and who do not have it now, and that as a result of not having insurance, would live sicker and die sooner.”

Several physicians strongly opposed the mandate,  referring to constitutionality challenges, freedom issues, and the opposition of physicians and numerous medical organizations.  The AMA admits to having lost 12,000 members since 2009, many because of their endorsement of ACA.  “The AMA has turned 180 degrees since the 1950s, when it held that ‘the voluntary way is the American way,'” said Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS).  “Now it has adopted the ‘progressive’ left-wing stance of calling for compulsory purchase of government-prescribed insurance.”  People will no longer be able to choose how to pay their medical bills.  Many might opt for the most affordable way: self-payment of most bills, with low-cost, high-deductible insurance for the rare catastrophe.  “But that choice would deprive the government’s favored plans of some fat premiums,” Dr. Orient said.

With 250,000 of the nation’s physicians comprising its membership,  the influential AMA has historically been opposed to a bigger government role in healthcare.  Physicians who oppose the ACA attempted to convince colleagues that the AMA should change its position.  Some delegates have blamed the Association’s support of the individual mandate for a loss of membership in the AMA in their states.  “I believe that each state, working with the population it has and the specific problems it has, can craft a solution that works better for that state than perhaps the one next door,” said Michael Greene, M.D., a delegate with the Medical Association of Georgia.  Dr. Greene, a family physician, supported the amendment.

Ben Cutler: An Insurance Industry CEO Responds to Healthcare Reform

Tuesday, April 26th, 2011

Is the healthcare insurance industry the scapegoat for rising premiums?  In the inaugural episode of the Chuck Lauer Show,  presented by Alter+Care, the former publisher of Modern Healthcare Magazine talked about the insurance industry’s take on healthcare reform with Ben Cutler, Chairman and CEO of USHEALTH Group, Inc., who previously led Fortis Healthcare.  Cutler currently serves on AHIP’s Executive Committee, serves on AHIP’s Board and is also the Chairman of AHIP’s Membership Committee.  The Chuck Lauer Show is an ongoing conversation about the future of healthcare with the leaders and thinkers who are shaping a new direction for healthcare in the United States. 

Cutler, who has spent more than 30 years in the healthcare insurance industry, recalled the ongoing national debate that began nearly 20 years over HillaryCare with the objective of how to provide universal coverage for the more than 50 million uninsured Americans.  Cutler believes that the Obama administration has chosen to focus on access and doesn’t sufficiently address affordability issues.  Healthcare industry groups recognized that the day would come when reform would be a top-line issue and that we would not be well served by just saying “no”.  Cutler says “We’ve worked hard on positioning the industry to accommodate reforms and tried to be very accommodating because getting more people covered is a laudable objective.”

As the healthcare reform bill was drafted, it soon became clear that the insurance industry would have a problem with some of the issues.  Unfortunately, according to Cutler, the politicians decided they needed an enemy and “that turned out to be us.  We continue to be vilified as an industry”, a situation that could – and should — have been avoided.  The Patient Protection and Affordable Care Act will have some unintended consequences in terms of how the legislation will affect the behavior of various stakeholders who comprise the healthcare economy – consumers, providers, insurers, regulators, etc.  It is inevitable that the insurance industry will have to raise rates if they are to comply with the healthcare law, which essentially constitutes a new tax on the American people.

Cutler cites the example of the $5 billion set aside to subsidize people in high-risk pools.  The government estimated that by this time, upwards of 500,000 individuals would be enrolled in these pools.  So far, just 8,000 people have signed up, an example of where government expectations were totally unrealistic.  Additionally, there is the issue of pre-existing conditions, which the government has characterized as an industry-abusive position, and one which relates to affordability of coverage.  According to Cutler, if people buy homeowners’ insurance only after their house catches fire, the premium obviously would be higher.

Nearly 50 Percent of Americans Think the Healthcare Law Has Been Repealed – They’re Wrong!

Wednesday, March 9th, 2011

Defying the odds – and facing President Barack Obama’s veto pen – the Republican-controlled House of Representatives voted to repeal the Patient Protection and Affordable Care Act (ACA); a move that was DOA in the Senate.

Despite considerable evidence to the contrary, approximately 50 percent of Americans are convinced that the healthcare law has been successfully repealed.  A poll by the Kaiser Family Foundation found widespread public confusion about the law, with 22 percent of Americans incorrectly believing it has been repealed and another 26 percent unsure or unwilling to say. Even after extensive media coverage of the repeal effort, only 52 percent of Americans accurately responded that the healthcare law remained intact.  According to the Kaiser Family Foundation, “There remains no consensus about whether to keep, expand, replace or repeal the law.  Forty-eight percent are opposed to the law, while 43 percent favor it.  Sixty-one percent of those polled oppose Congress cutting off funding of the law in order to block it, as many Republican lawmakers are considering.”

The Republican-sponsored repeal bill, curiously named the “Repealing the Job-Killing Health Care Law Act,” passed 245 – 189 with assistance from three Democrats.  Majority Leader Harry Reid (D-NV) has refused to bring repeal to the Senate floor for a vote.  President Obama has vowed to veto any repeal effort.  Republicans have not introduced an alternative bill, although Speaker of the House John Boehner (R-OH) said Republicans will ask congressional committees to make “common-sense reforms” to expand coverage and cut costs, but told reporters no “artificial deadlines” were needed.

“As has been true since early in the debate, individual provisions of the new law are more popular than the law itself, complicating the debate over repeal,” the study notes. “So while the public in general is divided over whether to keep or repeal the legislation, if they could pick and choose, the large majority (roughly eight in 10 Americans) would keep the provisions providing tax credits to small businesses, and upward of seven in 10 would keep the provisions that close the Medicare doughnut hole, provide coverage subsidies to those of low and moderate income, institute the new voluntary long-term care insurance program known as the CLASS Act, and prohibit insurance companies from denying coverage based on pre-existing conditions.”

According to a USA TODAY/Gallup Poll, 32 percent of Americans would like to see the law repealed; 13 percent want to see the bill left as it stands. The poll found that 29 percent of Americans want to see minor changes and that 24 percent want major changes.  Representative Ben Chandler, (D-KY), who voted against the law last year, said he voted against repeal because he thinks the law’s “bad” parts should be repealed piece by piece.  “I will not vote to repeal parts of the law that protect central Kentuckians by preventing insurance companies from dropping people if they get sick, ending lifetime caps on coverage and eliminating pre-existing condition exclusions,” Chandler said.

Implementation of the law is continuing as planned, according to Health and Human Services Secretary Kathleen Sebelius.  “I want the people who are benefiting from the Affordable Care Act — including families, seniors and small business owners — to know that this vote does not change the law and that this department will continue to work every day to implement this vital law.”