Health Care For America Now

Why is it that virtually every time the Lewin Group has come out with a study this year, the conclusion argues against health care reform?

The right has made an entire campaign out of using Lewin studies that distort the public health insurance option. By using assumptions that will get the results the group paying for the research wants - even if those assumptions have nothing to do with reality - Lewin delivers what it's being paid for. The big example this year was the Lewin report that claimed more than 100 million people would enroll in a public option, a result parrotted most recently by Republican senators during the Senate Finance Committee debate. Lewin got those result by modeling health care proposals that didn't have an insurance exchange and allowed all businesses to enroll in the public option, assumptions that were not reflected in any of the actual health care reform proposals.

Lewin's latest study claims that health care reform (specifically the Senate Finance Bill, but broadly applicable) would increase health care spending overall in this country. The conclusion of this study eerily echoes the conclusions of the fatally flawed insurance industry study which threatened to raise rates if health reform was passed. The industry has been on a campaign to blame health reform for driving premiums up, while at the same time driving premiums through the roof themselves.

Why do all of Lewin's studies seem to come to the same conclusion? Because the Lewin Group is a wholly owned subsidiary of UnitedHealth, and insurance company.

As the Washington Post points out, this salient fact isn't often noted in the media or by the conservatives who use Lewin's flawed numbers to fight against health care reform:

To Rep. Eric Cantor (Va.), the House Republican whip, it is "the nonpartisan Lewin Group." To Republicans on the House Ways and Means Committee, it is an "independent research firm." To Sen. Orrin G. Hatch (Utah), the second-ranking Republican on the pivotal Finance Committee, it is "well known as one of the most nonpartisan groups in the country."

Generally left unsaid amid all the citations is that the Lewin Group is wholly owned by UnitedHealth Group, one of the nation's largest insurers.

More specifically, the Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied UnitedHealth and other insurers with data that allegedly understated the "reasonable and customary" doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care.

Lewin is not independent. As a wholly owned subsidiary of UnitedHealth and a corporate hit man-for-hire, the companies that commission Lewin studies have the option of burying reports that don't give them their desired outcome. This isn't speculation, either. John Sheils, Lewin's chief spokesman and Vice President, admitted this directly.

And Lewin is not non-partisan. UnitedHealth, it's parent company, has a history of giving to Republicans, including $1.5 million to help host 2008's Republican National Committee Convention in Minneapolis.

The Lewin Group always reaches the same conclusion - that health care reform is bad - because it's own by the same insurance companies spending millions to fight reform. No wonder their latest report looks like the insurance industry's - it is.

The House health care bill does numerous things that would strengthen the employer-based health care system, through which most Americans get their insurance. Most significantly, the bill contains strong provisions to ensure employers are responsible and offer good insurance to their employees [pdf].

Currently, many employers offer health care benefits, but some freeloaders don't. The House bill makes it fair to all employers, and to employees. It's only fair to ask employers - who benefit handsomely from healthy workers - to contribute to their employees' health care [pdf], and the House bill does just that.

If you work at a large business (those with payrolls over $750,000 per year), your health care coverage will get better and cheaper:

• Employers will have to contribute at least 72.5% of premiums for individuals and 65% for families.
• Employer health benefits will have to conform to the essential benefits package [pdf]. This means that the coverage would provide for essential services (hospital, physician, prevention, maternity, prescription drugs, baby, mental health), eliminate out-of-pocket costs for preventative care, cap annual out-of-pocket spending, and prohibit annual or lifetime caps on coverage.

If your employer chooses not to offer you insurance, they will have to contribute to the Exchange based on the size of their payroll to help subsidize their employees, who will be able to purchase insurance through the Exchange. In this way, employers would have to either "pay or play," and share responsibility with the government and individuals for keeping everyone in America healthy.

If you work for a small business, which are exempt from the "pay-or-play" requirement, you may get health insurance for the first time (if your employer currently doesn't offer it), or your insurance will become better and cheaper:

• Your employer can choose to purchase insurance for all its employees through the Exchange, or you can purchase insurance through the Exchange yourself, giving you the benefits package described above, as well as subsidies to help you afford it if you qualify.
• New rules will prevent insurers from charging more to small businesses if they have sick employees.
• Tax credits will be offered for two years to small businesses to help them afford good coverage.

Over time, bigger businesses will be able to buy into the Exchange, with automatic options opening in the years after the Exchange is set up, and the Secretary of HHS given discretion on whether to allow the largest of businesses thereafter.

The net effect is significant. Not only will you have access to coverage you could afford at work, but your coverage will be better. The House bill significantly strengthens the employer-based health care system, ensuring business and families can afford coverage, and good coverage at that. It expands the choices available to business, and it lets small business employees and potentially large business employees buy into the Exchange, where they can utilize the public health insurance option if they choose.

For those of us who get coverage through work - already the most stable and least costly of the insurance markets, especially the large group markets used by large businesses - this is welcome news.

NEWS

Buoyant Democrats Unveil Health Care Legislation - New York Times

House Democrats on Thursday unveiled their bill to remake the health care system and said they had the votes to pass it. But Republicans said gimmicks had been used to hide the measure’s long-term costs.

Protesters pose grim outlook on health care - Sparks Tribune

Despite another low turnout, a familiar core of local activists stubbornly rallied for government health insurance reform at Thursday's "Have a Heart, Save Lives" event. Some protesters wore scary Halloween costumes, accessories or makeup to illustrate what they believe could be the grim consequences of inaction on health care.

Reid Calls On Americans: "Contact Your Representatives Back Here In Washington And Push Hard" - Huffington Post

Harry Reid, in a new Web video posted Thursday, makes the case for a public health insurance option and appeals to voters across the country to contact Washington to "push hard" for its inclusion in the final bill.

House bill greatly expands health care coverage - San Francisco Chronicle

There was rock music instead of trumpets as Speaker Nancy Pelosi and fellow House Democrats used every flourish Thursday to frame their new $894 billion health care measure as historic legislation on par with the creation of Social Security in 1935 and Medicare in 1965.

Conrad: I Will Vote To Bring Health Care Bill To Debate, And My Colleagues Should Do Same - Greg Sargent

In another step forward for health care reform, a key moderate Dem Senator says he will vote to bring the bill with a public option and an opt-out to the floor — getting the bill past a key procedural vote — and suggested his colleagues should do the same.

Drug Makers Face Tougher Measures - Wall Street Journal

The House health-care bill presents more problems for drug makers than legislation in the Senate, but it gives the medical-device industry better breaks.

U.S. Chamber Of Commerce Recycles Old Ad For New Attack On Health Care Reform - Media Matters

The U.S. Chamber of Commerce has revamped an old ad from the summer to continue its fight against progressive health care reform.  However, just like before, the ad falls flat on facts.

Opt-out divides Schumer and Emanuel - Politico

Chuck Schumer and Rahm Emanuel, the architects of the Democrats’ historic take-back of Congress in 2006, talk to each other nearly every day in abrupt, Morse code bursts stripped of hellos, goodbyes and thank-yous.

Over the next few days, I'll be taking a closer look at the provisions on the House health care bill - H.R. 3962, the Affordable Health Care for America Act. As was the case when the original tri-committee bill was released, the House committees have a ton of fact sheets on the bill that are required reading for folks looking to learn more.

Overall, the House bill is a bill that takes on the insurance industry. Here's how:

A Public Health Insurance Option

First and foremost, the House bill creates a public health insurance option, available in the new health care marketplace called the "Exchange," that would compete directly with private insurance. The public option won't have to worry about profits or stockholders, and because it is run by HHS, it will have huge bargaining clout to get good rates from providers. Overall, while the public option in the House bill won't save taxpayers as much money as a public option based on Medicare rates, it will still save money according to the CBO.

Because of all that savings, and because the public option will have a mandate to provide health care to people, not maximize profit, it will be a strong competitor to private insurance, keeping prices down and attracting customers. Private insurance will be forced to compete or face losing their most profitable customer base - the individuals and small group customers who are in the Exchange from the start.

Insurance Industry Regulations

The House bill puts new regulations on the insurance industry to curb their bad practices.

The practice of rescission - terminating someone's insurance plan because they get sick - would be outlawed immediately. Similarly, as soon as this bill is signed, lifetime caps on insurance coverage would be outlawed.

After the Exchange is set up in 2013, all insurers, not just the ones in the Exchange, will be barred from denying care for pre-existing conditions, charging more if your are a woman or sick, or employing annual benefits caps. They will have to cap out-of-pocket expenses at a standard level, keep administrative costs down to below 15%, and publicly disclose and justify their rate increases.

Medicare beneficiaries and the unemployed will benefit as well, with overpayment to private companies through Medicare eliminated and COBRA coverage extended until the Exchange is set up.

Finally, the House bill will eliminate the anti-trust exemption on health insurance companies, making it possible to finally prosecute them for their monopolistic practices.

Immediate Relief

The House bill also provides immediate relief for people at the mercy of the insurance industry by setting up an interim high risk pool open to people who have been uninsured for at least a few months or who have been denied insurance because of pre-existing conditions.

Though clearly not a long term solution, the high-risk pool, combined with the COBRA extensions mentioned above, would get people out from the trap the insurance industry has put them in until full reforms kick in.

Taking on Drug Companies

The House bill also gives us significant savings from drug companies, which according to the Washington Post would amount to between $125 and $150 billion in cuts to their profits.

It does this by eliminating the donut hole which forces seniors to pay unaffordable prices for prescription drugs, starting immediately and completely closing the hole by 2019. It also requires the Secretary of HHS to negotiate for better drug prices for Medicare and Medicaid, and makes it easier for Medicare Part D to offer free generic prescription drugs to enrollees.

Of course, some issues, like biologics (new drugs exempted from generic competition), are still unresolved.

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There's a lot to talk about in the House bill - employer responsibility, fair financing, a whole host of other reforms that take effect immediately. Over the next few days I'll talk about those. However, the overall thrust of the bill is clear - it takes on the insurance industry for consumers, strengthening care for folks without insurance, on the individual market, in small and large businesses, and on Medicare and Medicaid.

On the steps of the Capitol today, Speaker Nancy Pelosi and the Democratic caucus unveiled the "Affordable Health Care for America Act." [pdf]

This bill makes health care more affordable to people, it regulates insurance company bad practices, it is fairly financed and asks employers to pitch in their fair share, and it gives us the choice of a public health insurance option to keep insurance companies honest.

There will be a lot more to say on this bill in the coming hours and days as it is passed through the House of Representatives, but the historical significance of today shouldn't be understated.

I attended the bill unveiling at the Capitol building this morning, and the Members of Congress who spoke often referred to FDR and LBJ, who stood up for health care for all decades ago. One man embodies those passed fights, and it is fitting that he is the first co-sponsor of this new bill that will finally deliver on the promise of quality, affordable health care for all in America.

Representative John Dingell from Michigan has been in Congress since 1955. His father was one of the first to take up the fight for health reform in Congress, and ever since, Representative Dingell has carried on his father's torch, introducing the universal health care bill his father wrote into Congress every year.

Today, Representative Dingell's name appears first in the list of co-sponsors for the Affordable Health Care for America Act, and today on the Capitol steps, Representative Dingell spoke out for reform. He brought with him the gavel he used to help pass Medicare, and said he would lend it to whoever presided over the House vote on this health care bill. As he said, "A good piece of wood does not wear out with one great event."

A comprehensive health care bill has never made it to the floor of the House, or with the kind of support this one has, in our nation's history. We are closer today than we've ever been to passing health reform for the people of this country. And sometimes, it's worth stepping back and thinking about that.

Update

Richard Kirsch, our National Campaign Manager, ads:

“The House of Representatives took an historic step today by introducing a bill that will guarantee good, affordable health care and real choice in the health insurance marketplace.

We commend Speaker Pelosi and the rest of the House leadership team, Chairmen Waxman, Miller, and Rangel, and Congressman Dingell for all working together to deliver legislation that puts people's health care needs before insurance company profits.  Today, House leadership proved it is on our side with a bill that makes health care much more affordable, ends egregious insurance industry abuse, and injects real choice and competition with the inclusion of a national public health insurance option. We are also pleased to see the bill includes shared responsibility between individuals, employers, and government and draws revenue from fair financing as opposed to taxation of higher-cost health care plans.

Today we took one historic step closer to achieving comprehensive health care reform that works for America’s families and businesses and guarantees people will no longer be left at the mercy of private health insurance companies - companies beholden to Wall Street and corporate shareholders instead of committed to making sure people have good, affordable health care when they need it most.”

NEWS

House health-care reform bill to include public option - Washington Post

House Speaker Nancy Pelosi will unveil a health-care reform bill on Thursday that includes a government insurance option and a historic expansion of Medicaid, although sticking points in the legislation involving abortion and immigration remain unresolved.

Finance Bill’s Fine Print May Cause Sticker Shock For Some Consumers - Kaiser Health News

Proponents of the Senate Finance Committee’s health care bill say the legislation will limit the amount that lower- and middle-income people must pay for health insurance to a maximum of 12 percent of their incomes.

Reid's Math: Liberal Fans Exceed Public-Plan Foes - Wall Street Journal

Some of Senate Majority Leader Harry Reid's colleagues were surprised by his decision this week to include a government-run health-care plan in the Democrats' bill.

Sen. Lieberman's Friendly Relationship With The Health Care Industry - Media Matters

In light of the Independent Senator from Connecticut's revelation that he will try to block Democratic health care reform, Media Matters Action Network highlights Sen. Lieberman's past relationship with the private health care industry.

Business Groups Push Hard Against the Senate Bill - Wall Street Journal

Employers are blasting the Senate's plan to create a new public health-insurance program — a sign of how businesses are becoming increasingly uneasy about Democrats' proposals to overhaul the health system.

Health insurance companies are exempt from federal antitrust laws — laws that protect commerce from monopolies and unfair business practices in most other types of markets. As a result, health insurers have become highly concentrated and premiums have soared. There is movement on Capitol Hill to remove this exemption, but the best way to quickly infuse competition into health insurance markets across the country is with a strong, national public health insurance plan option.

Read more…

It's hard to make the case that private insurers are simply out to protect their profits any better than this:

Maybe it was just lousy timing, but many customers of Blue Cross and Blue Shield of North Carolina are ticked off at the mail they've received recently from the state's largest insurer.

First, they learned their rates will rise by an average of 11 percent next year.

Next, they opened a slick flier from the insurer urging them to send an enclosed pre-printed, postage-paid note to Sen. Kay Hagan denouncing what the company says is unfair competition that would be imposed by a government-backed insurance plan. The so-called public option is likely to be considered by Congress in the health-care overhaul debate.

For those who need a reminder, a public health insurance option would compete directly with private insurers like Blue Cross, and a public health insurance option wouldn't have to turn a profit, forcing Blue Cross's rates down.

Blue Cross extorts more money from their customers with one hand with an 11% rate increase - they do control a whopping 53% of the market in North Carolina after all [pdf], and 98% of the individual market and billions in reserve dollars, so they can get away with that kind of thing - and with the other, tries to enlist these same customers to fight against something that would Blue Cross's rates and profits.

Fortunately, the good people of North Carolina are having none of it:

Indignant Blue Cross customers, complaining that their premium dollars are funding the campaign, have called Hagan's office to voice support for a public option. They've marked through the Blue Cross message on their postcards and changed it to show they support the public option, then mailed the cards.

"I hope it backfires," said Mark Barroso, a documentary film maker in Chatham County who is a Blue Cross customer and recipient of the mailings. "I'm doing everything I can to make sure it does."

Beth Silberman of Durham said she "went sort of bonkers" about the mailing. "You're hostage to them, and then they pull this," she said. "My new premiums are funding lobbying against competition. It's pretty disgusting."

Check out one of the "corrected" postcards:

It's a true grassroots effort, and one that's already getting the attention of Senator Hagan's office.

Thank you, Blue Cross, for making the point for us so well. Whatever the insurance companies want, you should want the opposite. If they win, you lose.

NEWS

Reid doesn’t have health votes — yet - The Hill

Senate Majority Leader Harry Reid (D-Nev.) is short of enough votes to pass a Senate healthcare bill with a government-run health insurance option with only Democratic support.

Hoyer: House Dems on the verge of bringing healthcare bill to the floor - The Hill

House Democrats are days, if not hours, away from introducing the healthcare bill that will make it to the floor, House Majority Leader Steny Hoyer (D-Md.) said Tuesday.

Lamont: Lieberman "Dithering" On Health Care - Huffington Post

One of Senator Joseph Lieberman (I-Conn.) most strident critics accused him of "dithering" on health care reform after the Independent stated that he would consider sustaining a filibuster of the legislation.

A Delicate Dance for 2 Health Lobbyists - New York Times

One is a smooth-talking former congressman from Louisiana — “the Swamp Fox,” constituents called him — who relishes his image as a rascal, a charmer and a Cajun raconteur. The other is a fireman’s daughter from working-class Rhode Island, strait-laced and studious, who mastered the arcane world of health policy as an analyst for the A.F.L.-C.I.O.

Public likes public option for healthcare. Joe Lieberman doesn’t. - Christian Science Monitor

Poll results tend to show that voters approve of the public option for healthcare. But senators like Joe Lieberman could vote the other way.

You remember Ian Pearl, right? He's the guy who's insurer called him a dog and then threatened to cancel his policy in the entire state to avoid giving him and people like him the benefits they paid for.

As Ian himself explains:

After decades of medical emergencies, we still weren't prepared for the latest crisis — this one created by the same insurance company that once saved my life. Guardian abruptly withdrew our health plan from all policyholders in New York where my father's business is based. Guardian offered a 'replacement' plan with low benefits and no home nursing benefits. They knew that I would never survive with such a plan, but they didn't care.

Suspecting that this action was related to the high cost of my care, we filed a lawsuit and have asked the U.S. Department of Health and Human Services to enforce existing federal laws and require Guardian to continue my health plan. Without federal intervention, I will lose this insurance, and that would be a death sentence.

Our lawsuit uncovered insurance company documents that confirmed my suspicion that I'm a target of discrimination. The documents revealed Guardian had compiled a "hit list" of its costliest members, including patients with muscular dystrophy, multiple sclerosis, brain injury, and paralysis. Guardian executives referred to us all as "dogs" and "trainwrecks," and they debated how and when to dump us from the rolls. Laws prohibited the cancellation of the individual members with serious chronic health problems, so Guardian opted to cancel the plan for all members of this specific health plan in New York, an action that violates federal law.

Ian's mother Susan came to Washington, DC to confront lobbyists Karen Ignagni and the rest of the insurance industry last week. And after an extremely well-attended press conference and a march involving 600+ people, Ian's insurer, Guardian, relented:

The Guardian Life Insurance Company of America today notified the family of Ian Pearl that the company intends to ensure that Mr. Pearl will continue to have the same benefits that Guardian currently provides including 24/7 in-home nursing care. While details are not yet final, our commitment to continuing uninterrupted care to Ian Pearl is absolute.

Needless to say, the Pearl family is ecstatic.

It's unfortunate, however, that a media frenzy and a huge protest were needed to get Ian the care he paid for, deserved, and needed to live. Ian's case serves as an example of the lengths the insurance industry will go to deny care and make a profit.

The case serves as a testament to why we need health reform with a public health insurance option. Without it, there will be no way to hold the insurance industry accountable for their customers who can't travel to DC to confront the industry and who don't have 600+ people backing them up on the street outside. Everyone in America deserves quality, affordable health care, and everyone deserves a choice of public or private insurance.