Health Care For America Now

Today, the U.S. House of Representatives will vote on H.R. 358, a dangerous anti-women's health bill that undermines access to care.  It is no surprise that House Republicans would rather play politics with women's health than focus on jobs and the economy.

Call your Member of Congress today toll free - (877) 264-HCAN (4226) and tell them to vote NO on H.R. 358.

Here is the letter HCAN signed along with over 50 other organizations vehemently opposing this bill.

Below are some important facts from National Women's Law Center on this issue. You can download the full fact sheet here.

H.R. 358, authored by Representative Joe Pitts (R-PA), threatens women's ability to purchase health insurance that includes abortion coverage and creates dangerous new rules that will harm women's health-and even risk women's lives.

• H.R. 358 would virtually prohibit health plans in the new health insurance exchanges from covering abortion services, even though most health insurance covers it today.
• The bill exempts hospitals from treating women in need of emergency abortion care, even if they will die without it.
• H.R. 358 allows states to exempt health insurance plans from complying with any obligation under the new health law if it offends the insurer's "conscience." For example, an insurer could refuse to cover contraception, the HPV vaccine or any other service.

Here are some messages and talking points from Planned Parenthood on H.R. 358:

• This legislation represents yet another attempt by some Republican leaders to force consideration of policies that would drastically erode women's health and reduce access to basic health care services and information.
• This bill would take comprehensive health coverage away from women, eliminate existing legal protections for women who need an abortion to save their lives, expand current refusal laws that undermine women's health, and create loopholes that states and insurance companies could exploit to undermine the requirement that insurance companies provide birth control with no co-pays.
• Most devastating, the bill eliminates protections for patients seeking care in emergency circumstances and would allow a hospital to deny lifesaving abortion care to a woman, even if a doctor deems it necessary.
• Any politician who votes for this bill is literally putting politics before women's health.
• This is the latest example that Republican leaders prioritize putting politics before women's health, and just can't keep their eyes on the ball when it comes to jobs and the economy.

Check out today's article from Kaiser Health News - "Federal Officials Try Again to Bolster Plans For People With Medical Conditions".  Thousands of consumers with pre-existing conditions are seeing dramatically lower health care costs thanks to the Affordable Care Act.

Federal Officials Try Again to Bolster Plans For People With Medical Conditions

By Michelle Andrews

Jul 05, 2011

How low can they go? Experts agreed that pricey premiums for the new “pre-existing condition insurance plans” created under the health care overhaul were partly to blame for anemic enrollment in the plans, which reached just 21,454 after several months, compared with potentially hundreds of thousands that had been projected.

Starting July 1, the Obama administration reduced premiums by up to 40 percent in 17 states and the District of Columbia where it runs the new high-risk programs and encouraged other states to follow suit. The reductions were possible because federal officials now have state-specific data that allowed them to more accurately peg the premiums to the rates for individual plans in the state, as the law requires, says Steven Larsen, director of the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services.

Another provision of the health reform law could help make the plans—which are aimed at people with medical conditions who can’t get coverage on the private individual market—even more affordable.

Under the law, starting in 2012 insurers must spend at least 80 percent of the premiums they collect on medical claims, as opposed to administration or profit, or pay rebates to consumers for the excess amount collected.

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

If insurers lower premiums in the individual market to meet the law’s new MLR requirements, that could be good news for the PCIP programs, whose rates are supposed to be no higher than standard rates in a state’s individual market.

Talk about further reductions can wait for another day. “It’s possible,” that the medical loss ratio requirements might further depress premiums in the PCIPs, says Larsen. However, “I wouldn’t care to speculate about that.”

Read more about high-risk insurance plans.

By Ethan Rome - Executive Director, Health Care for America Now

The health insurance industry's mouthpiece doesn't want the rest of us to know what Wall Street knows well — the record-breaking profits of the health insurance companies are, in fact, excessive.

In response to astonishingly high first-quarter profit reports from health insurance companies, the industry trade group America's Health Insurance Plans (AHIP), claims it is among the least profitable health care industries. AHIP says the health insurance industry profit margin is only 4.4%, and that this "low margin" represents less than one penny out of every dollar spent on all health care in the U.S. These are simplistic and misleading statistics.

Last week the New York Times reported that the health insurance industry is enjoying record earnings while millions of Americans get less medical care. Wall Street investors are delighted with the industry's profits, and to health insurance executives, that's all that counts. Insurance CEOs want investors to buy their stock and keep share prices marching higher, and that's exactly what has happened. To achieve excessive profits, insurers are happy to gouge consumers and small businesses, do little to rein in medical costs and spend billions of our premium dollars on lobbying, secret political activities, bloated executive pay and stock buybacks.

AHIP's focus on profit margins is misleading and designed to protect their massive income by shifting attention away from their return on equity — a key measure of profits as a percentage of the amount invested. That return is a phenomenal 16.1% as of today. By that measure, health insurers are ranked fourth highest of the 16 industries in the health care sector. They also deliver a higher return for investors than cellphone companies, beer companies, mortgage companies, life insurance companies, TV broadcasters, drug store companies or grocery stores.

AHIP likes to talk about how insurance profits are a small share of national health spending — less then one penny of every dollar spent on health care in the U.S. — but that is an absurd, deceptive and self-serving statistic. Yet even their own chart of this data shows that the share of the health care economy sucked up by health insurance profits has more than tripled over the past decade.

One penny of the health care dollar is worth $347 billion over 10 years ending in 2019. That one penny would pay for more than one-third of the entire cost of the health reform program.

In response to a memo that Health Care for America Now (HCAN) sent to news outlets yesterday, AHIP attacked HCAN for pointing out the insurance industry's misleading use of statistics. Yet AHIP did not challenge the validity of HCAN's critique. That makes sense, because they are wrong on this issue.

The health insurance industry is also wrong to oppose the Affordable Care Act (ACA) by bankrolling the Republican repeal effort. The ACA expands coverage, ends the worst insurance company abuses, reduces health care costs, and reduces the federal deficit while building on the private insurance system.

The Republicans' relentless opposition to the law is a naked appeal to their extreme right-wing base and an attack on people already benefiting from it — millions of seniors, children, young adults, families and small businesses. It's time for AHIP to turn away from Republican politics and vigorously support implementation of the law.

By, Ethan Rome - Executive Director, Health Care for America Now

If the Republicans have their way and privatize Medicare, it will put millions of seniors at the mercy of health insurance companies and force them to pay $39 trillion more for Medicare coverage than they would under existing law, according to the Center for Economic and Policy Research (CEPR). That's why this is a massive windfall for insurers. The GOP budget plan will also shift trillions of dollars in costs onto America's seniors and families. When the program begins, new Medicare enrollees would have to pay at least $6,400 more each year out-of-pocket for private coverage equivalent to current Medicare benefits. And the average Medicare beneficiary's contribution to the cost of Medicare benefits would skyrocket from 25 percent under the existing system to an astonishing 68 percent in 2030, according to CEPR and the Congressional Budget Office.

The Republican plan will enrich insurance companies at the expense of consumers and actually increase the overall net cost of health care by $34 trillion over the next 75 years, the planning period Medicare trustees are required to use. The increased costs are because of the private health insurance industry's excessive profits, obscene CEO salaries and the costs of the bureaucracy it creates to deny care to consumers. These private plan administrative costs often eat up 20 or even 30 cents of every insurance premium dollar compared to Medicare's roughly 3 cents. And in the past few weeks it's become clear that the industry's profits keep going up as consumers are being crushed by ever-rising co-payments and deductibles.

The sheer waste of Medicare privatization is truly staggering. According to an eye-opening report by CEPR's David Rosnick and Dean Baker, the Republican plan will ultimately force seniors to pay $39 trillion more for health care through 2084 than if Medicare were left alone. That's equal to a tax of about $110,000 for every man, woman and child in the country.

What we ought to do is increase our efforts to eliminate waste, fraud and abuse instead of impoverishing seniors, wasting massive amounts of taxpayer funds and giving the insurance companies control of seniors' health care. That's what the Affordable Care Act does, along with other Medicare reforms within President Obama's deficit reduction proposal.

The Republican plan, drawn by Budget Chairman Paul Ryan of Wisconsin, picks winners and losers in a big way. The winners are big corporations, like the insurance companies and their Washington lobbyists who spend millions to maintain a stranglehold on health care and the Republicans in Congress. The losers are America's working and middle-class families.

The Republicans also give massive tax breaks to millionaires and billionaires like the Koch brothers. To pay for this, they make savage cuts to Medicaid that will destroy the economic security of 60 million people - seniors, people with disabilities, poor families and children. They eliminate Medicare as we know it, and make deep cuts to dozens of programs of services that support America's families, from Head Start to Pell grants that help kids go to college.

Eliminating Medicare, giving seniors vouchers designed to lag far behind actual health care costs, and handing seniors' health care to the insurance companies is just plain wrong. Significantly increasing overall health care costs, as the Republican plan will do, is also wrong.

The Medicare privatization plan is part of the GOP's larger attack on our country's shrinking middle class and the promise of the American Dream: that if you work hard you can expect to have a good job with good wages and benefits, to provide a better life for your children, and to retire with dignity.

The HMO and insurance industries have spent a breathtaking $768,864,642 since 2007 on federal lobbying to influence public policy and elected officials, according to data collected by the Center for Responsive Politics and reviewed by Health Care for America Now. In 2010 they have not let up, despite passage of the new health reform law. They’re now trying to undermine the law with intense pressure on state officials to water down the federal provisions and interfere with their implementation.

As we all know, the insurance industry mounted a massive campaign to defeat health care reform and maintain their stranglehold on our health care. But after they lost, they turned their attention to undermining the new law so they can continue their obscene profiteering, their unconscionable denials of care and their shameless practice of giving CEOs jaw-dropping pay packages.

The top five companies reported a record $12.2 billion in net earnings last year. That’s huge. And the top executives at 10 for-profit companies have pocketed nearly $1 billion in compensation in the last 10 years. That’s staggeringly huge. As a group they received a 167 percent pay raise in 2009 while average American workers saw wages grow about 2 percent. That’s offensively indefensible.

Led by the Washington-based trade group America’s Health Insurance Plans, the $892 billion-a-year health insurance industry laundered $20 million through the U.S. Chamber of Commerce this year to blanket the airwaves with anti-reform TV ads. The Chamber has since announced a $75 million campaign against pro-reform members of Congress running for re-election in November. Insurance companies also are considering spending another $20 million to create their own front group to attack reform supporters and elect pro-industry lawmakers.

The insurance companies are now coordinating a lobbying assault on regulators. Activists are fighting back and we can all help.

This weekend, more than 1,000 insurance lobbyists and executives are expected to converge in Seattle to pressure the National Association of Insurance Commissioners (NAIC) to undercut important new rules intended to control costs and make health insurance more affordable for families and businesses. The new health reform law includes a provision (medical-loss ratio) that requires insurance companies to spend on patient care at least 80 percent of health plan premiums collected from individuals and small employers and 85 percent of premiums paid by large employers. The insurance companies are trying to protect their profits and divert premium dollars away from patient care by having non-medical costs, such as lobbying, profits, executive pay and administration, defined as “medical” under this new regulation.

The insurance lobbyists will be met by scores of activists, because the stakes in this fight are high. Simply put, the battle over the medical-loss ratio is the new health care reform fight, and if the health insurance companies win, we lose. If they win, they’ll be able to deny people needed care and call the administrative costs of that denial “medical care” under the new law.

In a powerful letter to the NAIC president in July, Senator Jay Rockefeller of West Virginia, chairman of the Senate Commerce Committee, urged the insurance commissioners not to succumb to the pressure applied by the industry.

“It is clear that health insurance companies are sparing no expense to weaken this new law and the protection it promises to America’s consumers,” Rockefeller said. “Health insurance companies and their allies have been furiously lobbying the NAIC to write the medical-loss ratio definitions in a way that will allow them to continue doing business as they did before the passage of health reform. The resources health insurance companies are throwing into their effort to weaken the medical-loss ratio appear almost limitless.”

Unlike federal lobbying disclosure rules, health insurance companies aren’t required to reveal what they are spending to influence state insurance commissioners, but the numbers are high. In New York alone, the health insurance industry has spent $10,602,387 on lobbying since 2007, according to an HCAN review of data maintained by the New York State Commission on Public Integrity. No figures are readily available on how much money health insurers spend on lobbying in 49 other state capitals.

This gap in reporting is troubling because this lobbying assault on the NAIC is new. This category of state officials—insurance commissioners—has never been subjected to a nationally coordinated pressure campaign to use their state authority to block implementation of consumer protections enacted by Congress. The NAIC is due to make its recommendations soon—perhaps even this weekend—to the U.S. Health and Human Services Department.

That’s why these massive lobbying expenditures must be disclosed. The public has a right to know how much the insurance companies are spending to protect their excessive profits and outrageous CEO pay by changing the intent of the medical-loss ratio established by Congress.

The health insurance industry wants to expand the definition of allowable medical expenses to include costs that are not directly related to the delivery of care and have not historically been classified as medical. Instead of reducing costs and improving the efficiency of their operations, they simply want to change how certain expenses are classified so they don’t really have to alter business practices. Already, WellPoint, the nation’s largest private health insurance company by enrollment and operator of Blue Cross plans in 14 states, has reclassified $500 million in administrative costs as medical expenses. The amount of money riding on the outcome of this battle is huge. 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.

The medical-loss ratio standards in the Affordable Care Act are critical to curbing the worst of the health insurance industry’s consumer abuses, controlling rising premium costs, increasing the value of premiums paid by private and public customers, and reining in the profiteering of health insurance companies. If the lobbyists are thwarted and rules governing medical-loss ratios, rate review and other consumer protections are implemented as intended, the health reform law will hold accountable an industry that abuses millions of customers when they need health benefits the most.

We can all join the fight to hold the insurance industry accountable by demanding that they disclose how much they spend to lobby the NAIC and other state officials. Their unbridled efforts to protect the status quo must be stopped.

As President Obama speaks to Congress and the nation this week in his State of the Union address, I hope he will make clear three important points about health care reform:
1. When it comes to the need to make good health care affordable, nothing is different today than it was yesterday.
2. It is imperative that we put a down payment on the promise of health care reform today by passing a health reform bill.
3. Passing a health reform bill now is just the beginning of health care reform, not the end.

Read more…

The unpopular truth is that most medical interventions have both positive and negative effects. That is the reality that has led to the new mammography screening recommendations from the U.S. Preventive Services Task Force. And, politics aside, isn't having a team of medical experts reviewing the data and making evidence-based recommendations that doctors can use when giving us, their patients, advice exactly what we want?

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Senator Harry Reid, the Majority Leader, has introduced the Senate's health reform bill. The Patient Protection and Affordable Care Act (H.R. 3590), is projected to reduce the federal budget deficit by $130 billion in the first 10 years. So how does the final Senate bill stack up against the House bill in the categories I discussed in my previous post ("House Health Bill Should Be A Model For The Senate")? Pretty much as expected.

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The House's health reform bill (H.R. 3962) should be a model for the final Senate bill in many ways, including that the Health Insurance Exchange is federally created and overseen, states cannot opt out of the public health insurance plan option, there are better consumer protections to promote transparency and accountability from health insurance companies, affordability protections are broader, there are more requirements for employer involvement, and financing is more progressive. One exception: the House bill's regressive language on abortion coverage.

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The GOP health reform bill does very little to expand health coverage to more Americans, very little to lower overall health care costs, and very little to ensure people will be able to afford the health care they need when they need. So where's the reform?

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