Insurers announce health reform proposals
By Lisa Wangsness
Globe staff
WASHINGTON -- The nation's largest health insurance industry lobbying group announced a series of proposals for health reform this morning that they said would help achieve universal coverage, control costs and improve the quality of care.
America's Health Insurance Plans, which represents insurance companies that cover some 200 million Americans, have been working with other groups on and off Capitol Hill for months on health reform. Though there are are major differences that remain unresolved, the lobby's leaders said yesterday they believe now is the time for major health reform, and they decided they must contribute to a solution.
"The heart of our proposal is a public-private partnership that builds on the employer-based coverage that 170 million Americans rely on today,"said James Roosevelt, Jr., the president and CEO of Tufts Health Plans, in a press conference held at the National Press Club. "We have laid out a workable, realistic path to universal coverage.... We want to make sure no one falls thorugh the cracks of our health care system because of age, health status or income."
The insurers also released a study they commissioned by PricewaterhouseCoopers on health costs; it found that last year, half of the 6.1 percent increase in health insurance premiums was due to regular inflation, about a quarter was due to increased use of medical services and about a quarter to higher costs for care above and beyond inflation.
The plan -- really a series of proposals, stated so generally that AHIP president Karen Ignagni said they would be impossible to price -- included recommendations for insuring everyone, containing costs, improving quality and reducing administrative hassles for doctors.
Insurers oppose the creation of a Medicare-style public insurance option, which both President-elect Barack Obama and Senate Finance Committee Chairman Max Baucus have proposed, which they believe will force private companies to compete with government on an uneven playing field. The insurers also do not support an employer mandate.
The ideas hinge on a proposal AHIP put forward last month: Insurers would agree to stop denying coverage to people because of pre-existing conditions as long as all individuals were required by law to buy insurance. That would prevent people from only buying insurance when they need it and force younger and healthier people to share the cost of care for older and sicker people.
The insurers also proposed that insurance regulations be revised so that basic, high-deductible health insurance plans with a streamlined set of benefits be available in all 50 states. The "essential benefits" plan would include coverage for wellness and disease management as well as chronic and acute care.
To help make coverage affordable to middle class people, particularly the self-employed and those who work for small businesses, the government would give refundable tax credits on a sliding scale, according to income. Medicaid should cover everybody under the poverty level, the insurers said, and the State Children's Health Insurance Program should cover all kids up to 300 percent of the poverty level.
To help control health costs, the insurers said, Congress should set a goal of reducing the growth of health care costs by as much as 30 percent over five years, for a savings of $500 billion. To reduce wasteful spending on unnecessary tests and treatments, providers need guidelines, based on scientific evidence, of the best course of treatment for diseases, and care for long-term diseases should be managed better, they said. The payment structure for Medicare and Medicaid should also be revised so that doctors are compensated for better care, not more care. And insurers pledged they would make the administrative process simpler for doctors and hospitals.
The insurers' plan also calls for improving the quality of care by devoting more expertise and money to preventive and wellness care; investing in more research to determine the best treatment protocols and providing this information to doctors; and standardizing technology that is used to record and transmit patient information.
The Health Care for America Now, a coalition of mostly left-leaning organizations, including the liberal group MoveOn, immediately issued a statement criticizing the insurers, saying their plan would still allow insurance companies to charge older and sicker people huge premiums and would do nothing to cap CEO salaries.
"We call on Congress to join with President-elect Obama to enact health care reform in 2009 which puts the health of our families before the profits of the insurance industry," the coalition's director, Richard Kirsch, said in a statement.
But aides to US Senator Edward M. Kennedy, whose staff has been meeting with the insurers along with a broad array of health care advocates, employers and providers to develop a major health reform initiative for Congress to consider next year, was encouraged by the insurers' presentation.
"There's a spirit of optimism about our work to ensure quality, affordable health care for all americans -- and today's announcement adds to that optimism," said Kennedy spokesman Anthony Coley. "The insurance industry has advanced serious proposals that deserve serious analysis and consideration."
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After putting up with the crooks at the health insurance companies for years, I really don't care what their proposals are. I'm sure that they will spend millions lobbying so that they can continue to rip off the American public and pay obscene salaries and bonuses to their CEO's ( United Healthcare's CEO was paid a salary of well over one hundred million dollars and back dated stock option bonuses worth over a BILLION dollars) while denying care to thier covered lives. I am so tired of arguing with these managed care fools about what is right for my patients that I am actually in favor of a socialized medical system just to put them all out of business!
One line should be shown in bold "as long as all individuals were required by law to buy insurance". Whats next we throw people in jail because they can't pay for health care?
"as long as all individuals were required by law to buy insurance":
What a windfall for them-- now we can all be faced with paying a huge amount for coverage that doesn't actually cover much at all (large deductibles, paying a fraction of what's promised because the charges are supposedly "above prevailing costs," or because the preferred provider doesn't actually give the "discount," denying coverage for "pre-existing conditions" (even when they're not), refusing to cover mental health or reproductive costs or TMJ or new treatments or brand-name medicines that aren't on their preferred list, making constant "mistakes" in reimbursement (always in their favor), limiting choice of doctors and requiring approval for specialist visits or courses of treatment that are not approved even when medically justified.... the list goes on and on....)
The system is broken, and what they want is simply to force more people to buy into it without being forced to really fix it. No deal.
The proposal says it "builds on the employer-based coverage that 170 million Americans rely on today".
I am on Medicare plus insurance from my former employer that primarily covers prescriptions. It now costs me $6000/year plus co-pays that can run as high as $70 for a 90 days supply of a prescription. Expensive.
Not that a new president is in town they want reform?! Insurance companies are full of crooks. I dispute claims and they come back less-how does that happen!
Could it be because I pay my bills in full they add alittle for those who dont! I hope reform is coming that actually works for the people not these compaines who are out of control!
How dumb can these animals be? They have been stealing the American public blind for years.
The have been the biggest crooks of all time, next to the Pharmaceutical companies.
Their ideas should be rejected without any considerations. But let us remember, our politicians love their money. So they will always win the day. And you, dear citizen are the victim aof it all.
How about throwing in a ban on consumer (TV, magazine and newspaper) advertising of prescription drugs? That would definitely bring down the cost of prescription drugs, and eventually all healthcare. While we're at it, ban advertising by hospitals and doctors. We did just fine finding doctors and hospitals before all these ads.
The for profit health insurance industry smells the end of themselves coming and it can't come any to soon for me. This is why they are deploying their agents (Lobby types). Hillary Clinton made a valiant but unsuccessful effort years ago to go to the only answer for this mess which is single payor (government). Mr. Kennedy is heading the charge in congress now to reform health care and I advise him to beware of this for profit health insurance industry. Now is the moment to strike. Most company leaders, physicians, labor unions etc know that this system can't go on like it is. You must be able to control costs from the front and the back and single payor is the only way, A medicare type system.
When are they going to cover preventive medicine that will keep us well. I will no longer see an MD for treatment since being misdiagnosed twice. I would prefer an ND but there are no insurance policies that cover them, I have joined an HMO for emergencies and will pay out of pocket for an ND if I need to see a doctor at all which I don't plan on. I am 81 and taking no prescription medication at all and the only reason I need insurance is if I'm dumb enough to fall down again and have torn muscles as I did once this past year which kept me from going home for six weeks.
The Fox is trying to convince Congress to let them guard the hen house.
The sad thing is Congress will probably allow them.
I still cannot believe this Congress passed a bill saying the Government cannot negotiate a better price on prescriptions...............
This isn't much of a concession from the insurers. Rather it's a desparate attempt to grab a captive market of unwitting customers. Insurance is complicated and cost goes down with volume, so requiring people to buy individual insurance is the least efficient way to cover everyone.
The real story is our health care crisis isn't an insurance problem. There is an Access problem (everyone needs access to affordable care) and a cost problem. Insurers need to show where they have value. Visit the Archimedes Movement web site at www.wecandobetter.org for ideas a group of citizens put together that would create a real solution.
I am becoming ill just reading this article. Its obvious that big business, big insurance companies and lobbyists are calling the tune for our office calls and surgery. Every one of them have a plan that includes their self preservation. The free market (greedy business) tanked the financial industry, energy markets, autos, housing and stock market.
Health care is a very captive audience and will continue to be manipulated by greed just as all of the industries above have seen. We need more than change here. First step, dump the lobbyists, then the TV ads,put insurance on a short leash.m
These vultures need to be hung out to dry-another words except heavy regulation or be eliminated.
I knew I couldn't trust what they had to say, and when I saw "Required by law to buy health insurance", my first reaction was Yeah right...and it will be the first thing ppl will drop when they hit financial hard times. I don't think they have a snowball's chance in a warm oven in passing this stuff, and honestly I hope it fails. Miserably.
What self serving proposals. As usual, insurance companies propose ways to increase their profits forcing all people to purchase insurance. High deductible insurance policies will not help the noninsured as they will have to pay the premium and the high deductible which they can not afford. Insurance companies and health care providers simply charge to much. Its time both reduced their fees. There is way to much profit made by insurance companies and health care providers. A simple solution is to do away with insurance companies which will vastly decrease the cost of health care.
I have been a physician for fifty years. Paper work demands more attention than everl It is impossible to do the paper work demanded and do what is needed for the patients. When needed test or medication is denied by insurance carriers, I think that they need to walk in the shoes of the patient.
I am a health care provider and I am sick and tired of being caught between a rock and a hard place when it comes to commercial insurance. It is very difficult to get reimbursed by insurers which has kept my income artifically low for years. Then when I have to purchace health care for my self and my wife I pay through the nose for very little "care." It cost me $12,000 a year for coverage with a $1000 deductable and I am then hearded into the insurance companies restricted list of "preferred providers." Commercial insurance is nothing but a racket. We need real reform not more of the same in a new package.
Wow! I guess that I shouldn't be shocked that poeple who lack education in the matter have an opinion that opposes those who make it there business to be educated (and educate others) in the matter.
Dan - "One line should be shown in bold "as long as all individuals were required by law to buy insurance". Whats next we throw people in jail because they can't pay for health care? " It's a simple business proposition - if you get to join with no regard to pre-existing conditions than what is to stop those who wait until they have a condition to join a health insurance plan? It would cause adverse utilization - incenting people to get insurance only when they need it and thus punishing those who pay into the system for years and years (as insurance businesses are based) in favor of those who avoid taking responsibility for their own health until they absolutely need to. (Just bad business - insurance would fail....and so would the government if they were in charge of covering health care costs under such circumstances - all around bad business.)
Stanley - I bet my entire salary that the cost of your Medicare Plus is less than it would be if you paid the costs out of pocket - you're paying less than I am as an employee of a company who pays the bulk of my coverage. Not so bad for you, and yet I'm not complaining.
Of the 49 Million uninsured, about HALF have the option to buy coverage through their employer but opt out! Maybe they have better things to spend their money on?
There are some things missing from the plan. Insurers may not discriminate on the basis of age or previous illnesses. No one should be forced to buy insurance but will be subject to the prior condition non coverage for one or two years.
Also, there should be uniformity in coverage for all insurance companies so that comparison between companies is possible. There should be caps placed on administrative costs of companies. Transferring from one company to another should not force patients to change doctors. If a customer transfers to another insurance company because the cost of insurance has been raised by more than a certain amount, they need to refund to the customer a certain percentage of last years premiums.
No one trusts the insurance companies least of all me. But as a principle government should only compete with private industry when it is unable to provide what the customer needs. I seriously doubt that insurance companies wish to give up on all of the potential sources of profit that I have delineated. If others can think of more protection from insurance company gauging please add them.
We are familiar with education as a right and a responsibility. When everyone is educated, everyone benefits. Everyone is required to be educated and everyone is required to pay taxes for the costs of education. Those who want more education than public education provides to all, may pay for it.
Health care is also a right and responsibility. When everyone is healthy, everyone benefits. The amount and the detail of education is limited by the amount of money tax payers are willing to pay. Accordingly the amount and detail of health care is and will be limited by the amount of money tax payers are willing to pay.
TED KENNEDY has SOLD OUT to the INSURERS, so as to get something passed before he dies. I expected better of him.
Kennedy spokesman Anthony Coley must realize that what the insurers, who have pushed health payments for health care service to 16% plus of our total Gross National Product, are not offerring to restructure - like we are demanding of the autos. There is no pain to the insurers, they get the same profits and overhead and CEO salaries under the plan - and indeed just get a new sales force at no cost to them - via the government. Even the pricing - massive premiums for the sick and older, and the basic flaw in the incentive under the current system - denying coverage payment makes money for the insurrer, are not changed. So this is what Kennedy told his staff - Kennedy spokesman Anthony Coley can not really believe that "The insurance industry has advanced serious proposals that deserve serious analysis and consideration." "(Insurers would) Stop denying coverage to people because of pre-existing conditions as long as all individuals were required by law to buy insurance" and "The insurers also do not support an employer mandate" did not shout out to your writer that the insurrers are running yet another con-job? Give me a break.
We know their proposal will have a very "Flowery title" but what follows
in the fine print is always the tricky part since it will be their lawyers/lobbyists who
draft the legislation.
If morality is ever going to trump greed it will be here or never!
Legislators....our eyes are on you this time!!!
I don't trust insurance companies and their lobbyists as far as I can spit---which is less than an inch. If they're rushing to try to present this after their guy lost and before Obama takes office, it's because they'll make more money with their plan than with Obama's. I think I'll wait and see what our new President has in store for us. He has our interests much more at heart than the insurance companies do. You notice that they didn't even make an effort until the Republicans lost? So much for doing it because they care about Americans! They've been bleeding us dry forever. I think it's time they had some real competition. If that has to be the government in order to make it possible for me to insure my kids, so be it!!!!!
I am not the least bit surprised at how uneducated in how healthcare is financed most of the respondents listed here. I am not an expert on how oil and gasoline is marketed and distributed, but I am not calling those people crooks and evil wrong-doers.
Two items missing from their proposals are liability insurance reform (defensive medicine drives up medical costs) and some way to make sure the money insurance providers take in as premiums is directed more towards actually providing medical care to the insured and less to the padding their own pockets at the expense the insureds' care. How much care could be paid for with the billions of dollars that go to the insurance provider CEOs? Perhaps the physicians could set the compensation levels of these executives, as the insurance providers currently tell physicians how much they may be paid!
Massachusetts already requires citizens to purchase private health insurance or face stiff tax penalties (currently about $1,000 annually). The mandated policies provide lousy coverage and feature high copays and deductibles. Many folks are spending a large chunk of their gross income on these worthless products and still can't see a doctor. Insurance is the problem in U.S. healthcare, it can not be the solution. A single payer system financed by a fair and equitable payroll tax is the fix we need, unfortunately, our politicians are too beholden to the monied interests to actually act on our behalf.
I am amazed with it. It is a good thing for my research. Thanks
As rolls swell in the recession, workers find firms are contesting claims by alleging wrongdoing or quitting in a bid to not pay benefits.