Health Care For America Now

The nation’s biggest insurers — not happy with provisions of the four-month-old health care reform law that would force many of them to spend more of the money they collect in premiums for their policyholders’ medical care — are pressuring regulators to disregard what members of Congress intended when they wrote the law, so that they can keep raking in huge profits for their Wall Street owners. If they are successful, many policyholders will soon be shelling out even more than they do today to enrich insurance company shareholders and CEOs. Billions of dollars are at stake, which is why the insurers and their symbiotic allies are pulling out all the stops to gut a key part of the law that would require them to spend at least 80 cents of every premium dollar they take in for medical care.

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There's a new fight around health insurance reform and if the insurance companies win, we lose. If the $892-billion health insurance industry wins this battle, they'll be able to deny people needed care and call the administrative costs of that denial "medical care" under the new health care law.

I'm talking about the fight over the so-called "medical-loss ratio." The insurance companies are pressuring state insurance regulators to undermine a key provision of the law to protect their excessive profits. They want to gut the federal requirement that insurers spend at least 80 percent of premiums on medical care in the individual and small-group markets and 85 percent in the large-group market, or rebate the difference to consumers. The industry is determined to undercut the new law and hold onto its ability to rip off families and employers. They want to continue their long-time practice of spending low percentages of premium revenue on actual medical care in certain states and for certain customers.

If the new law had been on the books in 2009, the six largest for-profit health insurance companies would have been required to refund $1.9 billion for that year alone, according to a Wall Street analyst. Despite the industry's whining, this rebate would have represented only a fraction of their massive profits. The top five for-profit health insurers alone recorded $12.2 billion in profits in 2009.

The definition of "medical care" is at the core of this fight. The law sets a minimum for how much of each premium dollar insurance companies must spend on actual health care. So they want to change the definition of "medical care" to include things that aren't medical care and that have never been considered as such. And the insurance companies are shameless in just how far they will go. They really are trying to have "underwriting," the process by which sick people are weeded out of eligibility for coverage, defined as a medical expense! Along with claims processing, call centers and other expenses that aren't about the actual delivery of care.

This is why we must implement and enforce the new law as it was intended - to hold the insurance industry accountable, stop the worst of their abuses and rein in skyrocketing costs.

Naturally, the insurance companies are doing everything they can to undercut the law by attempting to change the very definition of "medical care" so they can feed their insatiable greed. As Senator John D. Rockefeller IV of West Virginia said in a hard-hitting, fact-filled letter to the President of the National Association of Insurance Commissioners (NAIC), the insurance industry is "sparing no expense to weaken this new law and the protection it promises to America's consumers." The Senator described the insurance industry's effort to influence the NAIC, the organization charged with making detailed recommendations to the Department of Health and Human Services (HHS) on the definitions of medical-loss ratios and other key regulations.

Today HCAN released a comprehensive report on this issue with Senator Al Franken of Minnesota and Representative Bill Pascrell Jr. of New Jersey, along with members of the Main Street Alliance, a network of state-based small businesses. The report shines a light on the accounting tricks the insurance companies want to play to game the medical-loss ratio system, and it exposes their lobbying offensive to protect the status quo and undermine this part of the law before it even takes effect.

Thankfully, HHS Secretary Kathleen Sebelius and the Obama Administration are aggressively implementing the insurance accountability provisions in the new law.

It all comes down to this: Insurers want to use this regulatory fight to take back control of our health care, and we can't let them succeed. We think things like going to the doctor should be considered medical care, and marketing and denying care should not. We don't think that insurance companies should count the cost of stacking and counting their profits as part of your "medical care." That's why a seemingly arcane debate over the definition of the medical-loss ratio is so important.

We all need to fight back. You can go to the HCAN website and take action today.

John Boehner has a lot of bad ideas (like opposing health care, privatizing Social Security and supporting Palin for VP). But today's idea may top them all. His latest federal policy "proposal" is that there shouldn't be any. No rules. No nothing. Schools out!

The timing of his call for a moratorium on new federal regulations is impeccable.

He waited until the disaster in the Gulf of Mexico reached such catastrophic proportions that even people who hate regulations now crave them. He waited until the day after the Senate passed the hugely popular sweeping reform to regulate the fat cats on Wall Street. In fact, he even waited until regulations got popular with the public. He even waited until health care started becoming popular again - with a clear majority against repeal.

It may be that the Minority Leader is tired of being one-upped by Mitch McConnell and is jealous he doesn't have a filibuster of his own. The Republicans in the Senate have elevated saying "no" to an art form.

The Republicans in the Senate said no to unemployment benefits, no to aid to the states, no to creating jobs, no to standing up to Wall Street. They have been talking a lot recently about extending the Bush tax cuts for the rich - no matter how much that increases the deficit - but they won't extend unemployment benefits because that will increase the deficit.

Today Boehner said "having a moratorium is a good idea" because it will give the "private sector some breathing room." Sure. Just like unemployment gives people free time. And oil spills give enviros something to do.

Joking aside, a moratorium on regulations is not going to create jobs and jump-start the economy and that's what we need. A real recovery package will. All the Republicans want to do is return to the policies of George W. Bush and let the greedy corporations run the show.

Boehner's big idea today is so silly it's almost comical. So let's chuckle for a moment and stay focused on November.

To hear Sarah Palin and other members of the extreme right tell it, the Socialist Party is a huge political institution on the rise and a necessary stepping-stone for getting into liberal electoral politics, along with being born in Hawaii and other places outside the United States. They practically claim that everyone in the Obama Administration is a socialist. This rap is classic - another one of their big lies and scare tactics. And apparently they don't like people who have traveled abroad either.

Now they're going after Donald Berwick, the Harvard Medical School professor who President Obama appointed to run the Center for Medicare and Medicaid Service (CMS). Sure, Berwick may have traveled to London once (or even twice), but for eight years we had a President who had barely set foot outside of the U.S. before he was elected and then he dragged us into two endless wars that continue to suck the life out of our economy and exponentially increase our deficit.

Which leads me to Dr. Berwick. He's eminently qualified. Everyone who's not trying to score partisan, political points says so. Mark McClellan, who had the job under the last President Bush, said:

"What happens at CMS in the next few years will determine whether the new legislation actually improves quality and lowers costs. Don [Berwick] has a unique background in both improving care on the ground and thinking about how our nation's health care policies need to be reformed to help make that happen."

But none of this matters to the Republican leadership in Congress. Berwick's merits are irrelevant to them. They just blather on and on without regard for the truth. And the truth is that we need this recess appointment because we need to fill this position and move this health reform implementation along.

Consider a few facts:

• CMS has been with out a permanent head since 2006.
• George W. Bush made 171 recess appointments.
• President Obama has now made a total of 18 recess appointments.
• There are currently 180 nominees still pending before the Senate.

One might assume that Senate Republican Leaders might care about these issues. But they don't. They no longer seem to care about anything but crass partisan politics. And they're happy to hold up the process no matter what the consequences. They don't care if people lose their health care benefits. Or if their unemployment benefits run out. Or if state governments have to cut services and lay people off. People don't matter to them. And neither does the truth.

Which is why Sarah Palin really is a whack job. Her "tweet" this Tuesday on the topic says it all:

@sarahpalinusa: Press Corps-pls do your job as Obama sneaks in Berwick appt;pls cover his mission:socialized healthcare&rationing based on"quality of life.

And the Republican leaders in the Senate are no longer holding themselves to a higher standard than people like Palin who are free to "go rogue". They feel no obligation to govern and use the Senate for good of the American people. They have become nothing but populist demagogues, political parasites of the worst kind (though I don't mean to leave out Representatives Boehner or Canter, but fortunately their grotesque political games can't hijack the entire Congressional agenda the way their Senate counterparts can).

So kudos to the White House for doing the right thing and addressing the needs of our country, our economy and the more than 100 million Americans who depend on the life-saving and life-enhancing care provided by Medicaid and Medicare.