It’s inevitable that Sarah Palin will declare that the Missouri referendum “refudiated” the new health care law enacted by Congress. We will hear the same from Missouri Representative Roy Blunt, who sides with Wall Street and the insurance companies instead of his constituents and thinks that qualifies him for a promotion to the U.S. Senate. They are both wrong.
The Missouri vote was nothing more than a Republican straw poll. It lacks any legal force, and it certainly wasn’t about health care. If supporters of reform thought this referendum was about the new law, we would have run a campaign against it. But it wasn’t, so we didn’t.
This referendum was really about local Missouri politics in an election dominated by Republican primaries for state auditor, U.S. Senate, U.S. House of Representatives in the 7th and 8th districts, and many state legislative races. The truth is that this was a confusing, partisan ballot measure that included two unrelated questions—one that had nothing to do with the new law and the other that focused on only a single provision of it.
The Missouri referendum wasn’t a vote about ending unfair insurance company practices or making health care affordable. It wasn’t about stopping insurance companies from dumping you when you’re sick or ending the outrageous denial of coverage to children just because they have an illness requiring care. It wasn’t a vote on free preventive care for everyone or saving money for struggling seniors who rely on expensive prescription drugs. And it certainly wasn’t a vote on keeping millions of American families from being driven into bankruptcy by massive medical bills.
The Missouri referendum was a cynical partisan ploy to undermine the law before it even takes effect, just like the frivolous lawsuit filed by the state attorney general in Virginia. The Missouri vote was political theater for Republicans and an attempt to undermine a law that cuts health care costs for families and businesses and ends the worst of insurance company abuses.
People are just as tired of Republicans playing politics as they are of insurance companies denying care while making record profits.
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.
Health reform is now law. So what will health reform do for you?
Today, Health Care for America Now launched a feature on the homepage of its website dedicated to answering that question. It lays out the benefits of health reform for people depending on their insurance status - and when those benefits go into effect.
In keeping with our tradition, we will also highlight ways you can get involved with the continuing health reform fight. Because it will continue. Even though health reform is law the reform fight is far from over. The battle must continue on numerous fronts.
First, reform is being attacked by the radical right-wing, who are calling for its repeal.
While the effort to challenge health reform in court is unlikely to be successful, repeal efforts present an opportunity. Anyone who advocates repeal should be asked how far they're willing to go. Are they willing to say insurance companies should be allowed to deny care based on pre-existing conditions? For children? Or small businesses should give back their tax cuts for employee health care?
When asked, reform opponents like, for example, Missouri Senate candidate Roy Blunt tend to tell us exactly which side they're on - siding with the insurance companies and saying denials of care are completely acceptable. Opponents like this need to be called out and exposed.
Second, reform could be gutted from the inside by insurance companies and their lobbyists.
Health reform leaves a large amount of the crucial details up to national and state regulators. Whether regulators can effectively control premium increases, enforce Medical Loss Ratio provisions, and police pre-existing condition regulations will depend on how regulatory rules get written and enforced. Already, HHS is taking public comment on rules relating to premium oversight and MLR. You can bet insurance company lobbyists will be submitting as many comments as they can to make the rules HHS and the states write as favorable to profits as they can. It's crucial the people stand up and make their voice heard in this process.
And lastly, real efforts must be made to improve the law in Congress.
Giving the government stronger authority over rate increases, as proposed by Senator Feinstein and endorsed by President Obama, is still a good idea. A national public health insurance option is still a good idea. There are still champions in Congress willing to push issues like this. There are people running for Congress who are pushing for more and who deserve support. And the American people are still with us. We should keep fighting for more.
Health Care for America Now was formed in July of 2008 with the express purpose of turning health reform into law. Now that this has happened, Health Care for America Now is sticking around to expose the right wing for the insurance industry cronies they are, make sure the law is implemented in a way that lives up to the promise of reform, and help make further legislation a reality. The organization will be led by Ethan Rome, up to now our Deputy National Campaign Director, with our National Campaign Director, Richard Kirsch, transitioning into a role of Senior Adviser.
I joined the campaign in July of 2008 vowing to see it through until health reform either passed or died. Come tomorrow, I will be leaving Health Care for America Now. However, I plan to continue writing on the health reform fight as it moves forward. You can find my future work at my blog, The Seminal.
Health Care for America Now will continue to rally the grassroots, pressure Congress, and above all, make it clear that if the insurance companies win, we lose. And I'm confident it will be as successful in future endeavors as it was in its mission to make history and pass health reform.
Congress voted to overhaul the health care system on a Sunday. On Monday, Patti Lawson e-mailed her employer's human resources office to ask how soon she could get her 22-year-old daughter back on her health insurance.
In about six months, the new law will allow at least 2 million young adults to be covered by their parents' policies. These are the "millennials," those who came of age in the new century and now are struggling to get on their feet during the worst slump since the Depression.
Many can't find jobs, and many who are employed don't have health coverage from their employers.
The law will allow young adults to stay on or return to their parents' insurance until age 26. To qualify, young people must be "dependents" of their parents. They don't necessarily have to live under the same roof.
Current federal law has no minimum age for allowing people to stay on plans as dependents, and most policies allow children to stay on until they are 18, or until they graduate college. Some states force insurance companies to cover dependents until they are much older - into their 30s in some places - and these higher standards will supersede federal law. Still, this is the first time there has been a federal standard in place, and it will affect 2 million young adults - a demographic particularly struggling to find work, not to mention work that offers health benefits.
According to Kaiser Health News, which notes that some families will have very problematic coverage gaps until September when the new laws go into effect, the population this law serves is really in need:
Young adults make up one of the biggest groups of the uninsured. Forty-five percent of those between the ages of 19 and 29 were uninsured for at least part of 2009, according to a Commonwealth Fund survey last summer of 2,002 young adults. This figure is significantly higher than the 30 percent rate reported for 2008 by the Kaiser Family
Foundation’s Commission on Medicaid and the Uninsured, and may be a result of the continuing economic downturn. (Kaiser Health News is part of the foundation.)
Since many health plans require adult children to be full-time students in order to stay on their parents’ plans, young adults are at particularly high risk for losing coverage when they leave high school or college. The Commonwealth Fund survey found that although more than three-quarters of college students had health insurance while they were in school, 28 percent lost their coverage when they graduated or left school. Nearly half of those who were able to get new insurance experienced a gap in coverage; in many cases they were uninsured for a year or more.
It also should be noted that this policy will take a chunk out of insurance company profits.
The most profitable plans insurance companies sell are high-deductible junk insurance with medical loss ratios in the 70% range or even much lower and premium prices aimed at the out-of-work "young invincible" market. Allowing these people to stay on their parent's plan - usually a group health plan, the "blue chip" of the insurance market, with lower profit margins, higher medical loss ratios, and more stable and better benefits - takes away a big chunk of this customer pool, as people are more likely to have good jobs with good benefits the older they get.
Come September, young adults are winning, and the insurance companies are losing.
I've been getting a lot of questions from a lot of places on how insurance regulations and enforcement work in health reform. I reached out to a couple of folks who are experts on the subject to piece together how things work.
After the bill is passed, there are two phases to think about - before exchanges are set up and after they're running in 2014.
Before exchanges are established, the Department of Health and Human Services and other related federal authorities will work with states to implement the law. First, the states will have to bring their state health insurance laws in line with the federal regulations. States are free to go farther than federal regulations if they want, but their laws must be at least as strong as the federal ones.
Every year from 2010 on, insurers will have to make public data on their business practices. The summary of the provision in the bill explains:
…plans seeking certification by Exchanges [must] publicly disclose, in plain language, information on claims payment policies, enrollment, denials, rating practices, out-of-network cost-sharing, and enrollee rights. [They must also] provide information to enrollees on the amount of cost-sharing for a specific item or service.
Using that information, HHS and the states will be required to conduct annual reviews of insurance companies looking for business in the future exchanges. Rate increases must be taken into account during this process under the law and, to gain entry into the exchanges, plans will have to meet minimum standard benefits levels set by the Secretary. Those standards will be developed in a process that the bill says has to be public and accountable to Congress. The benefit package must, by law, be equivalent to coverage you'd get in the large-group market, creating parity in benefits between the individual and large group markets that doesn't exist now.
When it comes time to set up the exchanges, the states must use their annual reviews to determine which insurers get access to the new customers. If a state fails to make progress or follow the law in setting up an Exchange, HHS can step in and set up an exchange under federal authority.
After 2014 when the exchanges are running, HHS continues to play a role in state exchanges.
The states either run the exchanges or contract with a non-profit agency to run them. The Exchange administrators must evaluate insurance companies yearly on quality and price metrics and whether or not the insurers in the exchanges are conforming to the new regulations - no benefit caps, limits on out-of-pocket expenses, no denials for pre-existing conditions, no charging more if you're sick, etc…
The Exchange administrators have the power to deny certification for insurance plans with unreasonable premium increases - in other words, kick them out of the state exchange - and will require a whole new level of transparency from plans, so consumers can understand their rights in plain language. And HHS oversees the operations, making sure state exchanges follow the new law.
At his keynote address back in 2009 at Netroots Nation in Pittsburgh, President Bill Clinton made a prediction:
I don't care how low [the insurance companies] drive support for [health reform] with misinformation, the minute the President signs a health reform bill approval will go up because Americans are inherently optimistic.
Yesterday, President Obama signed the health reform bill into law. Today, President Clinton is rapidly being proved right.
As the days pass, I expect those numbers will continue to climb. Bill Clinton does, too, as he continued in his keynote:
Within a year, when all those bad things they say are going to happen don't happen and the good things do begin to happen, approval will explode.
Within the next six months, a large number of American people will already see the effects of health reform:
Insurance companies will be barred from dropping coverage if you're sick, and lifetime and annual benefit caps will be restricted (to be banned fully in 2014)
Young people will be able to stay on their parents' insurance coverage until they are 26, whereas most insurance companies drop dependent coverage now at the age of 19 or after completion of college.
Seniors will get $250 towards the donut hole coverage gap
Small businesses will be able to deduct 35% of the cost of health care for their employees
And those with pre-existing conditions will be able to finally get insurance through a temporary high-risk pool run by the government
With politically important groups like young people, small business, and seniors seeing real benefits from health reform before the November elections, Bill Clinton will be proven prescient once again.
As President Clinton said, America is going to like health reform, and once they get their hands on the benefits, they're going to fight to keep it and make it better in the future.
The President signed the Senate health care bill into law at noon today.
This year, over 4 million small businesses will get tax credits worth up to 35% of their health care costs. This year, seniors will get $250 towards closing their coverage donut hole. This year, young Americans will be able to stay on their parent's insurance plan until they are 26. This year, lifetime caps on benefits will be a thing of the past. And this year, the people with pre-existing conditions who can't get health care now at any price will be able to buy into high-risk pools until the exchanges are set up in 2014.
But we are not done. Right after the House passed the health care bill on Sunday, they passed a package of improvements that now head to the Senate for an up-or-down vote.
The fixes heading to the Senate are mostly focused on making health care affordable to middle class families.
First, the package vastly improves the excise tax on "Cadillac" insurance plans, raising the threshold at which a plan will be affected to $10,200 for individual plans and $27,500 for family coverage. It also delays the implementation of the tax until 2018. As a result, the burden on middle tax families will be dramatically reduced.
To make up for the loss in revenue, the fixes broaden the Medicare payroll tax on on rich investors, taxing net investment income for those who make more than $250,000 per year.
And second, the package increases the subsidies available in the exchanges for middle class families and lowers their cost sharing. With the package, a lower percentage of a family's income will be spent on health care costs - both premiums and out of pocket.
And there are more provisions in the package that would help broad swaths of the American public:
The package fully closes the donut hole for seniors over time
It freezes Medicare Advantage overpayments to private insurers and requires private insurers to pay 85% of money in to benefits in Medicare Advantage, to match the levels for all insurance plans in the health care bill
It strikes the deals Senators like Ben Nelson received and replaces them with increased Medicaid funding to all states
And it funds student loans for millions of young Americans
The Senate, after a string of favorable parliamentary rulings, is expected to take up the improvements under budget reconciliation rules today, with the goal of a final vote at the end of this week before the Easter recess.
Health reform passed last night with a vote in the House of Representatives of 219-212. I'll have a lot to say about what's in the bill and what the reconciliation package going to the Senate does to make it better, but for now, some perspective is in order.
Two quotes by Dr. Martin Luther King Jr. sum up this rapidly closing episode of American history. First, Dr. King succinctly illustrates why health reform was and still is a moral imperative:
"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
Health care is an issue taken up by advocates of the public interest everywhere because of this simple and powerful fact. Injustice in health care is an injustice that flies directly in the face of the ideals this country was founded on. As Speaker Pelosi remarked last night, Life, Liberty and the Pursuit of Happiness is what pushes us all to work for health reform. Making America live up to its ideals is what reform is all about.
A second quote by Dr. King sums up for me what the vote last night did to fix this inequality:
"The arc of the moral universe is long, but it bends toward justice."
The health care bill passed last night bends that moral arc towards justice in this country.
There is more work to do - indeed, there may always be more work to do - to rub out the inequality that exists in health care in America. But there is no question today that America has made determined progress towards a more just society, and a more perfect Union.
Tomorrow, we resume the fight to pass the final health reform provisions through the Senate on an up or down vote. But today, I'm thinking about the progress we've made and the progress we have yet to accomplish.
Facing a sharp rise in costs, Pennsylvania has almost doubled the monthly bill for a state health insurance program for poor people who do not qualify for Medicaid and are on a waiting list for a less costly option.
On March 1, the cost of the plan rose to about $600 a month, up from $313 a month, for the roughly 2,400 state residents on the waiting list.
…
Established in 2002, Pennsylvania’s state insurance program, called AdultBasic, covers adults ages 19 to 65 with incomes lower than twice the federal poverty level, or about $21,672 for a single person, at a cost to participants of about $36 per month. About 39,000 people are enrolled in AdultBasic.
About 390,000 other people are on a waiting list to join the AdultBasic program. While they wait, the state gives them the option to pay for the same insurance at a higher rate. It is the cost for members of the waiting list that rose on March 1 to about $600 a month.
Health reform solves this problem.
For families who make 133% of the Federal Poverty Level or less - about $24,000 per year - health reform would allow them to get on Medicaid. Those families who make more than that - up to 400% of the FPL or about $73,000 per year - will be able to purchase heavily subsidized insurance in the Exchanges.
For families making between 133% FPL and 200% FPL ($24,000 - $36,000 per year) - the people affected by Pennsylvania's rate increase above - their average cost for insurance, both premiums and out of pocket, will be [pdf] around $63 per month for families at 133% up to $244 per month for families at 200%.
Seniors who hit the coverage gap in their Medicare prescription drug plans and must use their own money to buy drugs are facing price increases that are far outpacing inflation, a new study finds.
According to the Kaiser Family Foundation, prices paid by enrollees in standalone Part D plans who enter the coverage gap increased 5 percent or more since January 2009 for half of 10 brand-name drugs most commonly used by seniors. That's almost twice the rate of inflation over the same period.
For example, the price of Actonel, a treatment for osteoporosis, increased 8 percent, from $91 per month in 2009 to $98 per month in 2010. Meanwhile, the prices for both Aricept, an Alzheimer’s medication, and Plavix, a drug used to prevent blood clots, both increased by 7 percent during the same period. Aricept's prices rose from $184 to $198 while Plavix's rose from $142 to $152. Lipitor, a cholesterol medication, was the only drug surveyed that decreased in price, from slightly more than $86 to just under $86 per month.
The rising prices are part of a longer is sufficient longer-term trend. Between January 2006 and January 2010, the analysis showed, prices of drugs bought by seniors who hit the coverage gap increased 20 to 25 percent for Lipitor, Plavix, Nexium, a drug for acid-reflux, and Lexapro, a medication for depression and anxiety; 39 percent for Actonel, and 41 percent for Aricept. Over the same period, inflation has increased 9.2 percent while prices for medical care have surged 16.1 percent.
Health reform solves this problem, too. Immediately after passage of the bill, seniors will get immediate relief that starts closing that coverage gap. The gap will be completely closed as health reform is implemented.
Prohibit pre-existing condition exclusions for children in all new plans;
Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool; (this will help with the Pennsylvania situation as well)
Prohibit dropping people from coverage when they get sick in all individual plans;
Offer tax credits to small businesses to purchase coverage;
Eliminate lifetime limits and restrictive annual limits on benefits in all plans;
Require plans to cover an enrollee’s dependent children until age 26;
Require new plans to cover preventive services and immunizations without cost-sharing;
Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions;
Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.
Reform will also help people like 11-year-old Marcelas Owens, who's mother died because she didn't have insurance:
And Matt Masterson's son, who's pre-existing condition makes him virtually uninsurable, a near death sentence as soon as he's kicked of his father's insurance plan in a few years:
Finally, today, the House Energy and Commerce Committee came out with numbers on how reform will help people in every Congressional district.
The vote is coming in the House. It's likely to take place this weekend. Without reform, none of these problems get solved, and the insurance companies will get to continue their business practices of denying care and carving out coverage while making record profits.
The polling on health reform has long been scattered and misunderstood. The issue is so complex that it's very hard to boil down into a few yes or no questions. And because the issue is so hot, every pollster and their mother wants to grab a headline with new poll results.
There are a few things that can be teased out, however. First, for the most part, people like what's in the health care bills.
Poll after poll finds support for banning denial of care based on pre-existing conditions, creating the Exchanges as a marketplace for health care, requiring business to pitch in for health care costs with tax credits to small business, closing the Medicare donut hole, and helping people afford insurance.
Newsweek's latest poll, taken in mid-February, backs up the assertion that people like the main components of the health care bill. Of course, some things aren't as popular - an individual mandate without a public option or the excise tax, for example - but Newsweek's poll has another finding that is noteworthy.
Second, when people find out what's in the bill, support for it rises. Newsweek's latest poll in mid-February found that while initial support for "Obama's health reform plan" were 40% favor to 49% opposed, once people learn what's in the bill - both the good and the bad - 48% support and 43% oppose. Kaiser tracking polls, among others, have had similar findings.
Third, people want to see reform passed more than they want Congress to fail or "start over."
And finally, the public is closely divided on the question of whether they support or oppose the current health care plan, and support is rising. Via Pollster's average of health care polls:
It's also worth noting that a significant portion of the opposition, anywhere from 10% to 30% depending on which poll you cite, is because health reform "doesn't go far enough," not that it goes "too far."
There's no question that Congress and the President can and should do things to make these bills more popular. The fixes coming to an up-or-down vote in the Senate that will fully close the donut hole and scale back the excise tax is a start. But there are a lot of myths about health reform's popularity, especially right now, that are worth putting to rest.
Our coalition stands by a strong set of principles for health care reform. Our principles provide a guarantee of quality, affordable health care for all.
