health insurance

Resolutions, Political Resolutions and Damned Lies

Leo Gerard — Tue, 03 Jan 2012 10:35:07 -0500

‘Tis the season of resolutions. With the new year comes pledges to quit smoking, get out of debt and spend more time with family. Gym memberships jump. Weight Watchers’ profits fatten.

This also happens to be the season of political resolutions. It’s that every-fourth-year event featuring presidential candidates in a contest of campaign promise one-upmanship. Ron Paul pledges to legalize marijuana. Michele Bachmann swears she’ll cut gasoline prices to $2 a gallon. Newt Gingrich guarantees he’ll create millions of jobs “right now.” Mitt Romney assures every college graduate a job.

Unfortunately, this also has been, for some time, a season of damned lies. These are deliberate deceptions involving a higher level of scheming. The Contract with America and the more recent Pledge to America are examples. Republicans knew they couldn’t fulfill what they led the public to perceive as promises. But the GOP designed these “pledges” specifically so that Republicans couldn’t be labeled as failures when what they pseudo-promised never materialized. That’s the stuff of damned lies.

Unfulfilled New Year’s resolutions are legendary. Low calorie salad fixings fill fridges Jan. 2, and remain there, rotting, on Feb. 2. The victim of this broken promise is also the perpetrator and therefore unlikely to protest the infraction.

These days, political resolutions strewn along the presidential campaign trail are picked up and carefully cataloged on the Internet by reporters and bloggers who hold candidates accountable for every syllable. That’s a good exercise, but the public generally recognizes political promise hyperbole and realizes that unexpected events may prevent a president from keeping his word. Franklin Delano Roosevelt, for example, pledged not to involve the country in the European war, but then the Japanese bombed Pearl Harbor. Mostly, the public shrugs off presidential contenders’ inflated political resolutions.

Damned lies, however, are dangerous because they subvert trust in the political system, which needs the faith of the electorate to function. Damned lies may, in fact, be an integral part of Republican strategy since the GOP hates government of the people by the people and hopes to shrink it small enough to drown in a bathtub.

In their 1994 Contract with America, Republicans vowed:

“in this era of official evasion and posturing, we offer instead a detailed agenda for national renewal, a written commitment with no fine print.”

That, and calling it a contract, led Americans to believe it was a step above a pledge. It was inviolable, sacrosanct. It was a bond with no double-crossing footnotes.

Except it wasn’t.

With the help of the “contract,” Republicans took control of the U.S. House of Representatives. And they passed the easy, less controversial parts of the pledge. But they never enacted the most popular, more contentious promises, including a balanced budget amendment and term limits.

They had, however, set up the “contract” so they could never be blamed for those failures. The most insidious aspect of the Contract with America was the fine print escape hatch it provided the GOP.

Republicans never promised to enact their “contract” provisions into law. They only said they’d vote on them:

“within the first 100 days of the 104th Congress, we shall bring to the House Floor the following bills, each to be given full and open debate, each to be given a clear and fair vote and each to be immediately available this day for public inspection and scrutiny.”

No wonder former President Bill Clinton called it the Contract ON America.

In the fall of 2010, when Republicans were trying to regain control of the U.S. House, they came up with a “contract” clone that they called “A Pledge to America.”

It said:

“Our plan puts forth a new governing agenda that reflects the priorities of the American people . . .and can be implemented today.”

Republicans won the majority in the House a year ago and have had nearly 365 “todays” to implement their pledges. Just like with the 1994 “contract,” Republicans have failed to fulfill the big promises, the important resolutions that people remember.

For example, the pledge said:

“A plan to create jobs, end economic uncertainty, and make America more competitive must be the first and most urgent domestic priority of our government.”

Republicans then proceeded to make deficit reduction their priority. When President Obama proposed a jobs plan in September, Republicans blocked it.

Also in the “Pledge,” the GOP swore to permanently stop “job-killing tax hikes” so that families would be able “to keep more of their hard-earned money.” Then in September when President Obama proposed to extend and enlarge the payroll tax cut for 160 million middle class families, the GOP opposed it.

And there was this pledge:

“We offer a plan to repeal and replace the government takeover of health care.”

As in the “Contract on America,” this is a sleight of hand. It doesn’t say Republicans will repeal health care reform. And, in fact, they didn’t. But they can’t be called failures because they only pledged to “offer a plan to repeal.” They didn’t promise to actually accomplish it, even though that’s what they led voters to believe.

What they can be labeled as failures for, however, is neglecting to produce their promised plan to replace health care reform.

Democrats called the latest formal list of Republican promises the “Pledge to Destroy America.” The destruction was done by the damned lies that denigrated trust in political institutions. It was deliberately done to diminish America’s democratic government.

Republican-Hood: Steal from the Workers; Pander to the Rich

Leo Gerard — Wed, 05 Jan 2011 10:06:55 -0500

Robin Hood, the guy who robbed the rich and gave to the poor, wore a short frock and tights. From the get-go, the guy serving the disadvantaged while sporting gay attire would fail the entrance exam required to become a card-carrying Republican.

The GOP is, after all, the anti-gay marriage, anti-repeal Don’t Ask Don’t Tell crew. More than that, Republicans are anti-working class. Their recent policies and activities show them clobbering the middle class while kissing the wealthy’s, well, you know.

Consider health insurance reform and tax cuts for the rich.

The GOP spent the entire fall election cycle yammering about the federal deficit. The world as we know it was coming to an end because of the deficit, they contended loudly and repeatedly.

Then, immediately after Election Day, Republicans insisted on extending tax cuts for the rich. They added more than $36 billion to that supposedly-cataclysmic federal deficit in 2011 so that they could pad the pockets of the nation’s millionaires.

To secure that bonus for millionaires, Republicans held hostage extension of unemployment compensation, which during this grave recession, sustains the nation’s workers who are out of jobs and, all too often, also out of foreclosed-on homes. The deal comes down to this: The average millionaire will be $100,000 richer as a result in 2011. The average worker will get $15,236 in unemployment benefits if jobless the entire year of 2011.

Republicans insisted on giving the rich $84,764 a year more than the poor.

Repealing health insurance reform, as the GOP has said it hopes to do before month’s end, would have the same result – increasing that supposedly-cataclysmic federal deficit while slamming the poor and middle class.

The non-partisan Congressional Budget Office has calculated that the Affordable Care Act will decrease the federal deficit by $140 billion over 10 years. That’s what the GOP wants to repeal – a deficit reduction measure. Republicans want to add $140 billion to the debt.

Most injured by repeal would be the nation’s poor and middle class. That’s because rescinding the law would once again allow insurers to deny health care to children with pre-existing conditions. It would mean the elderly would once again pay more for preventative care and prescriptions. It would permit insurers to once again withdraw coverage from people when they get sick. It would mean insurers could kick out young adults who are now covered under their parents’ plans until age 26. It would permit insurers to re-impose “lifetime maximums,” so that they could cancel the coverage of people with costly illnesses. It would permit insurers to once again pocket for profit and “administrative expenses” an unlimited percentage of premiums paid by workers and employers. It would mean small businesses would lose tax breaks that will help them pay for health insurance for workers.

The GOP intends to deny tens of millions of uninsured Americans the hope that soon they’ll be able to afford coverage.

Republicans want to, as they put it, “undo” the health insurance benefits that the Affordable Care Act provides to Americans. And they’re offering nothing in return, nothing to help the uninsured, nothing to help the untold millions cheated by insurance corporations, nothing to require premiums to be spent on health care.

That’s the way Republican-hood rolls, protecting the wealthy, pummeling the poor. The rich, in the case of health insurance, are CEOs earning millions while increasing rates in double digits during a recession. The Los Angeles Times reported in August, for example, that the top executives of the nation’s five largest for-profit health insurers pulled down $200 million in compensation in 2009. The poor, in this case, are policy holders who the insurers charged rate increases as high as 39 percent.

House Republicans would exempt their cancelling of health insurance reform from their own rule that new legislation be paid for. So they wouldn’t have to find an additional $14 billion when they attempt to fulfill their campaign pledge to slash $100 billion from domestic programs – that would be from the programs most needed by the nation’s workers – those that help pay for education and transportation, for example. Because these domestic programs are such a small part of the budget, securing $100 billion from them would cost each department approximately 20 percent of its funds this year. That means painful reductions to areas like law enforcement and medical research. This is accompanied by Republican demands for cuts to many workers’ only retirement plan – Social Security.

In the meantime, the main concern of most Americans, as it was in the grueling days of Robin Hood, is jobs. Not the deficit. The GOP offers no plan to increase jobs for formerly working people, to end the suffering of tens of millions of Americans. Republican-hood is, instead, focused on pampering those who don’t need it.

"Reform Now" Radio Ad Denounces Obstruction Of Health Care Bill

Isaiah J. Poole — Tue, 02 Mar 2010 17:43:43 -0500

The Campaign for America's Future worked with group of private citizens frustrated with the slow pace of health care reform to produce this radio ad, the centerpiece of a media campaign in key congressional districts urging Democratic members of Congress to support health care reform.

“The advertisements are meant to inform and energize independents and rank-and-file Democrats to push forward and encourage their representatives to pass meaningful legislation during this congressional session,” said Roger Hickey, co-director of Campaign for America’s Future. “President Obama has laid down an agenda for passage and engaged our country’s leaders. It is up to the Congress to move forward now!”

The campaign begins with a radio advertisement entitled "Reform Now" that will air on stations in New York, Philadelphia, Detroit, Columbus, Ohio and Charlottesville, Va.

» Right-click this link to download the ad.

What's In The President's Health Care Plan?

Jason Rosenbaum — Tue, 23 Feb 2010 11:17:20 -0500

Over the past few weeks, House and Senate Democratic leaders have been working to craft a compromise between their two health care bills that were passed over the last few months. Today, President Obama has released what Dan Pfeiffer, Communications Director at the White House, is calling the administration's "best shot" at bridging the differences between the House and Senate.

The proposal comes in advance of the planned February 25 health care summit, where Republicans and Democrats will meet and talk about the health care proposals on the table. The White House thought it would be most productive to "come to the table with one proposal," as Pfeiffer put it.

Over the last few months, we've been fighting to finish health reform right under the rubric of two main goals. By making health care affordable we mean making sure insurance is affordable for individuals, making sure insurance is affordable at work, and making sure middle-class health plans aren't taxed. By holding insurance companies accountable we mean giving regulators a national exchange so insurance plans in the exchange are subject to the same stringent rules and creating a public health insurance option to hold private insurance companies accountable.

So, what does the President's plan do?

(Note: The plan starts from the Senate bill as a foundation so any changes listed in the overview of the President's plan [pdf] are changes to the Senate bill.)

Affordability for individuals

The President's plan merges the tax credit schedules of the House and Senate bills for the subsidies an individual or small business would get if they buy health care on the exchange.

As noted previously, the House bill provided much more generous tax credits to lower income people so they could truly afford health care while the Senate bill was more generous for the middle class. The President's bill has merged these two in a way that makes health care more affordable to both low and middle income people.

Here's what the subsidies look like in the President's bill compared to the House and Senate bills:

Affordability at work

The House bill included a crucial "pay or play" provision that would have required employers to provide good health care at affordable prices to their employees and help small business afford it. If a business didn't provide health care, it would have had to pay a fee to the government to offset the cost to government of providing health care for uncovered workers.

The Senate, by contrast, does not require all businesses to contribute their fair share. Instead, they'd only pay $750 per worker per year if they left them uncovered and the worker qualified for a subsidy in the exchange.

The President's plan, though not a full "pay or play" system, moves towards reconciling the House and Senate bills. If a business does not offer coverage, it must pay $2,000 per worker to help cover the cost of insuring its employees. The White House estimates that this amount is one-third less than the average amount businesses would pay under the House proposal.

Taxing middle class plans

The excise tax in the Senate bill would tax many middle class health care plans, making coverage worse and more expensive. The House finances their health care bill by taxing those that can most afford it—households making more than $1 million per year.

The President's plan does not do away with the excise tax entirely, but it makes some significant changes. The threshold at which the tax kicks in was moved from $23,000 as the cost of a health care plan in the Senate bill to $27,500 for families and from $8,500 to $10,200 for individuals. This would likely exempt millions of middle-class people from the tax.

In addition, dental and vision benefits won't be part of the cost calculation, in effect raising the threshold higher.

The thresholds will be pegged to inflation plus 1 percent and will automatically go upwards if "health costs rise unexpectedly quickly between now and 2018″ when the tax is set to phase in.

Finally, there will be adjustments in the threshold for businesses that have higher costs due to the gender or age makeup of their employees.

Health Insurance Exchange Design

The President's plan maintains the state-based exchange design in the Senate bill instead of a more robust, national one. The President proposes giving the Department of Health and Human Services and state regulators the authority and funding to question and block rate increases like we've seen recently from Anthem/WellPoint in California.

Igor Volsky at Think Progress has a rundown of what the new policy would do:

The final Senate health care bill already bars insurers with excessive rate hikes from participating in the insurance exchanges but this new provision would go a step further, federalizing the states’ traditional and somewhat uneven role in monitoring insurance rate increases. At least 25 states have some “form of a prior approve process for premium increases,” but state governments often lack the resources or political will to keep insurers in check. Obama’s provision is both politically and substantively significant. It protects consumers from unreasonable rate increases but also prohibits insurers from dramatically increasing rates during the elections of 2010 and 2012 or the period between the passage of comprehensive reform and implementation.

Democrats were worried that insurers would exploit the interim period to boost profits ahead of the new insurance regulations. The federal government’s new rate review powers could blunt at least some of the anticipated increases. Here is how rate review would work:

- Insurance companies would have to justify unreasonable premium increases.

- The Secretary could deny or modify health insurance rate increases that are found to be unjustified.

- The Secretary would determine whether states have the capability to conduct rate reviews.

- Establishes a Health Insurance Rate Authority to advise the Secretary. It will have seven members, including consumer representatives, an insurance industry representative, a physician and other experts like health economists and actuaries

Since conservatives will surely claim that rate review is some kind of government takeover of private industry or a burdensome new federal requirement for insurers, it’s important to note that states that have instituted [the rate review process] house profitable insurance companies and maintain competitive and vibrant markets. Families USA has more on that here.

Public Option

There is no public health insurance option in the President's bill.

Other changes

In addition, the President's plan would:

fully close the donut hole for prescription drugs under Medicare by 2020
put more money into community health centers
some changes in the individual mandate, plus allowing people to opt out of purchasing insurance entirely if they're below the tax filing threshold of $18,700 per year for families
gets rid of "pay for delay" which allows branded pharmaceutical companies to keep generics off the market by paying the generic maker to stay out
$10 billion in more tax on big PhRMA
fully funds the Medicaid expansion for states until 2017, funds it at 95% until 2019, and funds it at 90% going forward after that
gets rid of the special deals like Senator Nelson's cornhusker kickback
is fully paid for and reduces the deficit over 10 and 20 year periods

The Wonk Room has more.

————————–

Perhaps more significant than the proposal this morning was Pfeiffer's comments on the strategy for passing the President's plan:

The President expects and believes the American people deserve an up or down vote on health reform. The proposal was designed to ensure we can get that if the opposition decides they will filibuster health reform.

Heading into the Thursday summit, the President has a plan on the table that the administration believes represents a compromise between Democrats in the House and the Senate with no large token policy given to Republicans before they arrive at the negotiating table that wasn't already in one of the two bills. And the plan was designed to pass via reconciliation.

Most Republicans have yet to formally RSVP to the summit or post their unified plan online as the White House has done. It's still an open question whether Republicans can coalesce around one plan, as opposed to the multiple, non-serious proposals they've released so far. And the President has told them that he hopes they come to the summit in "good faith." The rest of America? We know we need health reform finished, we know we need it finished right, and we know that it will take the Democrats in Congress to get it done.

And we're making our voices heard. On Wednesday, the day before the summit, we're mobilizing with MoveOn.org and dozens of other partners to let Congress hear from us one million times. This barrage of action will come as Melanie's March—a group of health insurance company survivors walking 135 miles from Philadelphia to Washington in honor of Melanie Shouse, a health-care activists who died because she didn't have affordable health care—concludes with a rally in Washington.

How Many More Melanies Must Die Before We Have Health Care Reform?

Isaiah J. Poole — Tue, 16 Feb 2010 14:01:42 -0500

A health care reform bill signed in 2009 might not have come in time to save the life of Melanie Shouse, who died of breast cancer last month at the age of 41. But what we do know is that the lives of thousands of other women like her are at risk because, one year after Congress and the Obama administration began working on health care reform, legislative progress is gridlocked. And, as Melanie's friends and family know, gridlock equals death.

Her story has inspired organizers around the country associated with Health Care for America Now to dedicate Wednesday as a day of health care action designed to send the message that Congress should listen to the people on health care reform, not the insurance companies. Dozens of protests and other activities are being planned to break the deadlock that has been created not by progressives—as Republicans and Democrats such as departing Sen. Evan Bahy have been alleging—but by conservatives and their co-conspirators in Congress who have been taking their marching orders from the insurance industry and other health care business interests.

The anchor event is a march from Philadelphia to Washington by friends and supporters of Melanie. That march is timed to arrive in Washington just before President Obama's planned bipartisan health care summit at the White House.

People's World writer Tony Pecinovsky spoke to Melanie before she died:

"When I first noticed a small lump on my breast, denial seemed the only option," Ms. Shouse told this news site at a Jobs with Justice, MO State Workers' Union rally held outside of a Department of Social Services office here. ...

When she first found the lump in her breast she didn't know what to do. She couldn't afford the $5,000 deductible her catastrophic health insurance policy required.

"For weeks after diagnosis," Melanie told me, "I was in a state of near panic regarding how I would pay for treatment. I had no savings and no real assets, and no idea how I was going to cover these monumental co-pays and deductibles."

"And with this prize-winning pre-existing condition, I had no opportunity to seek a better private health plan. I was shut out of the market," she concluded.

Ms. Shouse, like many people throughout the nation, faced a recalcitrant and irresponsible health care system. She faced a system that cared more about profits than life. And until the end, Melanie bravely faced that system and spoke truth to power.

At a health care rally last November, Ms. Shouse said, "we need to take on the big insurance monopoly and liberate American families from the slavery of skyrocketing insurance premiums and canceled coverage, which leave millions of us in a state of perpetual fear and insecurity..."

Marc Stier, a publicist for Melanie's March, wrote on the march's official site:

Melanie did everything she could to fight for health care, not just for herself, but for all of us. President Obama, who knew Melanie as a volunteer on his campaign, said: “She was fighting that whole time not just to get me elected, not even to get herself health insurance, but because she understood that there were others coming behind her who were going to find themselves in the same situation and she didn’t want somebody else going through that same thing.” It was a long road for Melanie, but she never gave up.

A lot of us are frustrated that, after mobilizing for over a year to reform health care, rein in Wall Street, create good jobs, win workers’ rights, and combat global warming, we are still waiting for the change we voted for. But we’re not giving up either.

Earlier today, Campaign for America's Future co-director Roger Hickey urged the organization's activists to participate in Wednesday's activities and to support Melanie's March.

"Last week, we learned that in 2009, during the worst recession this country has seen in generations, the insurance companies posted record profits and cut millions of people from their rolls. They'll stop at nothing to kill health care reform, and their Republican buddies are eager to help them," Hickey wrote.

"Congress needs to hear us loud and clear. No more excuses. We voted them into office for a reason—to bring change, and that starts with guaranteeing everyone quality, affordable health care. We've got to stand up and make sure they don't turn back now, not when we're so close."

The Case Against A Health Insurance Excise Tax

Isaiah J. Poole — Wed, 09 Dec 2009 17:24:40 -0500

Lawmakers in Washington are close to a consensus view that the Senate's excise tax on higher-cost health plans is a good idea. Here's the problem: The consensus is wrong. The misnamed "Cadillac tax" is unfair and unwise.

While it's been couched in other terms – "bending the cost curve," etc. – this is a tax on middle-class Americans, pure and simple. The cost reduction effects are highly theoretical, but the pocketbook effect is immediate and real.

Here are some key arguments against this tax:

It's based on flawed logic: Adherents would have you believe that the excise tax will change the way people use medical services – for the better. But the Association of Federal Health Organizations in November found that such an excise tax would raise costs for basic coverage and limit choices for millions of consumers; its impact goes far beyond “luxury” services or “unnecessary” care.
It's a tax on middle-class Americans: They call it a "Cadillac tax" because it was originally pitched as a way to make wealthy executives pay for their luxury plans. But this tax will hit middle-class families the hardest, adding thousands of dollars a year to family insurance premiums. And, because health plan costs are rising much faster than the tax's inflation index, it will hurt an increasing number of middle-class families every year.
It's anti-union: Many American unions traded real wages and other forms of income in order to ensure that their members got decent health coverage. Taxing those benefits will provide employers with an excuse to break their promises and cut these benefits, while giving nothing back in return.
It's bad politics: This tax is likely to hurt politicians who support it, and hurt Democrats’ chances in 2010. This is true nationwide, and especially in some states and regions where it can least afford to alienate core constituencies.
It could promote bias in hiring: Health plans become costly for a variety of reasons. Benefit design, the target of the tax, is only one reason. This tax does little to distinguish cost drivers – like geographical variations in health costs, an aging workforce and other demographic factors – and could make employers reluctant to hire certain workers.
Campaign promises are being broken: A number of candidates in last year's elections, including the President, promised voters that health reform would not result in new taxes for the middle class. They also promised voters that "if you like the plan you have now, you can keep it." This tax not only breaks the first promise, but also the second. Employers will cut current health plans in order to avoid this tax.
It will effect one in every five employer plans: The excise tax could hit up to 19 percent of medical packages offered by employers in 2013, the first year it goes into effect. Even federal workers are not spared. Report findings indicate that single enrollees would be hit by a tax surcharge (or benefit cut) in the first year of the tax, and that their average cost over ten years would be $1,600 per year. Family plans were projected to face a $5,500 annual tax per year by 2022.

Impact of the Insurer Fee and the Excise Tax on the Federal Employees Health Benefits Program

Isaiah J. Poole — Wed, 09 Dec 2009 13:46:57 -0500

The annual insurer fee and excise tax in the proposed Patent Protection and Affordable Health Care Act pending in the Senate would have a significant negative impact on the Federal Employee Health Benefits Program. The annual insurer fee would lead to increased premiums, and in order to avoid the excise tax, plans would be forced to reduce benefits.

Additionally, when considered in tandem, the annual insurer fee and the excise tax create a vicious cycle; the annual insurer fee would push premiums ever closer to, or over, the excise tax threshold which in turn would force carriers to reduce benefits at an even faster pace in order to avoid the excise tax.

This squeeze play will be exacerbated by the fact that the PPACA indexes the excise tax thresholds to the annual Consumer Price Index for all Urban Consumers (CPI-U) increase plus one point. Because the CPI-U rises much more slowly than the medical costs that make up the vast majority of carriers’ costs, upward adjustments to the excise tax thresholds would not be sufficient to mitigate the rate of benefit cuts.

Stacey Ritter Lost Everything. CIGNA's CEO Gets Another House

Jason Rosenbaum — Thu, 01 Oct 2009 13:27:49 -0400

Meet Stacie Ritter. She's a hardworking mother of twins who lives in Pennsylvania.

Her daughters, now 11, were diagnosed with leukemia when they were four. They both needed stem cell transplants and other cancer treatments. The twins survived, but the glands controlling their growth were damaged beyond repair from the treatment. To continue growing, they needed doctor-recommended growth-hormone injections regularly.

Stacie's husband's company switched to CIGNA health insurance, and CIGNA refused to cover the hormone shots. Each time Stacie takes her daughters to the doctor for the shots, it costs her $440. Between the cancer treatment and the denied care, Stacie and her husband had to file for bankruptcy.

Meet Ed Hanway. He's the "hardworking" CEO of CIGNA, a leading health insurance company.

Last year, Hanway made $12.2 million. That's $5,883 an hour, enough to cover 12 of the treatments Stacie's daughters need every hour. He has $28 million in stock options. He owns a beach house in New Jersey worth $13 million, one of many mansions he possesses.

Hanway runs CIGNA, which made $7 billion dollars in the last eight years [pdf]. How does CIGNA make money? By denying claims from people like Stacie. You see, if they had to pay for treatment like what Stacie's daughters need, they couldn't make anywhere close to $7 billion dollars.

This isn't right.

It isn't right that Hanway can make more money than the average American family every hour, and Stacie has to go bankrupt trying to care for her daughters. And it isn't right that a company in America can base their business off of hurting and bankrupting other people, denying them needed health care.

Stacie isn't taking this sitting down. Watch:

Today, Stacie is off to one of Hanway's mansions in Pennsylvania. She's going to ask him to put her up, so she can afford the treatment Hanway's company denies her. And she's not going to take no for an answer.

Stacie lost everything, while Hanway made even more money. Hanway won, Stacie lost, but she's fighting back.

You can help spread the word about Stacie's story at www.sickofit.net. And check back soon for updates on how Stacie's confrontation went.

WellPoint: Poster Child for Health Insurance Reform

Peter Dreier — Tue, 22 Sep 2009 09:44:20 -0400

Citizens will pay a visit today to WellPoint's Indianapolis headquarters to protest the giant insurance company's abusive practices and its opposition to real health care reform.

The rally is one of a nationwide wave of protests today in about 150 cities - including events outside the Cigna headquarters in Philadelphia and the United Health Group headquarters in Minneapolis -- to highlight the private health insurance industry's misdeeds and to call for reform that guarantees good, affordable health care and includes the choice of a strong national public health insurance option.

Activists also plan to rally in Milwaukee today, where WellPoint CEO Angela Braly will deliver the keynote speech at Marquette University's annual Business Leaders Forum luncheon at the Alumni Memorial Union on campus.

The Los Angeles rally will target WellPoint's California subsidiary, Anthem Blue Cross, whose offices are located at 801 S. Figueroa St ., starting at 11 am.

The national day of protest is sponsored by Health Care for America Now (HCAN), a broad coalition of community and religious groups, unions, MoveOn.Org, and others. HCAN expects that today's events, and those in subsequent weeks, will re-energize a grassroots movement and push Congress -- including several conservative Senate Democrats now resisting a public option -- to enact significant reform.

WellPoint, the nation's largest health insurance company in terms of membership, has become one of the poster children for why reform is needed.

With 35 million customers, one of every nine Americans is a member of a WellPoint health plan. Its annual sales of $60 billion netted corporate profits of $2.5 billion last year.

WellPoint is one of the insurance industry giants leading the charge against President Barack Obama's plan to create a "public option" - essentially an expansion of Medicare for working families - to create more competition and give consumers more choices.

Ironically, WellPoint is one of a handful of insurance companies that have a virtual iron grip on the insurance market in almost every state. The American Medical Association reports that 94 percent of insurance markets in more than 300 metropolitan areas are now highly concentrated. WellPoint runs Blue Cross-Blue Shield plans in 14 states. In Maine, for example, WellPoint controls 78% of the health insurance market. It dominates the market in Missouri, with 68% of the business, as well as in its home state of Indiana (60%), Georgia (61%), New Hampshire (51%), Kentucky (59%), Connecticut (55%), Virginia (50%), Ohio (41%, with the next largest company garnering only 17% of the market), and Colorado (with 29%, larger than runner-up United Health Group, with 24% of market share). In New York and California, WellPoint ranks second, with 21% and 20% of the health insurance market, respectively, in those two huge states.

These near-monopolistic conditions -- where one or two companies dominate the insurance market --allow big corporations like WellPoint to drive up premiums, restrict coverage, and take advantage of consumers. Nationwide, health insurance premiums have been rising much faster than family incomes. No wonder WellPoint wants to quash potential competition from a public option.

To thwart such competition, and to limit government regulation of its practices, WellPoint has spent millions of dollars - dollars it gets from the families and businesses paying sky-high premiums - to wield political influence.

According to the non-partisan Center for Responsive Politics, WellPoint employees and associates have contributed more than $922,000 to federal political campaigns over the past two and a half years. And the corporation has spent $7.8 million lobbying Washington policymakers over the same time period.

Not surprisingly, these legal bribes aren't given out randomly. The top recipients are key members of the Senate and House with influence over health care policy, including Senator Max Baucus (D-Mont.), the chairman of the Senate Finance Committee and a leading opponent of the "public option" in health care reform.

Moreover, WellPoint is a seasoned player in the Washington "revolving door" game. For example, WellPoint's former Vice President for Public Policy and External Affairs, Elizabeth Fowler, now serves as Senior Counsel to Baucus. Fowler's predecessor in Baucus' office, Michelle Easton, currently lobbies for Wellpoint as a principal at Tarplin, Downs, & Young, a well-connected lobbying firm.

Leading the charge against health care reform is WellPoint CEO Angela Braly, the company's chief lawyer before moving up the corporate ladder to the top job in 2007. Last year WellPoint paid Braly $9.8 million. She lives in a 16,013 square foot mansion at 832 Alverna Drive in Indianapolis, valued at $1.98 million, according to the county assessor's office. She serves on the board of directors of America's Health Insurance Plans, the industry's powerful lobby group.

According to Forbes, Braly's top priority is to "keep WellPoint a money machine." To help her, Braly has the backing of a powerful board of directors. The 16 other WellPoint directors have a web of corporate and political connections that supplements the company's campaign contributions and lobbying expenditures.

One is Susan Bayh, wife of Evan Bayh, the Democratic Senator from Indiana. She is a former attorney with the giant Indianapolis-based drug company Eli Lilly & Company. She is also a director of Curis (a drug company), Dendreon (a biotechnology company), Dyax (a biopharmaceutical company), and Emmis (a media corporation that owns radio stations and magazines). In the last two years, according to the Indianapolis Star, she has earned more than $2 million serving on the boards of these corporations. Her husband recently told an Indiana newspaper that he is an "agnostic" regarding the public option. That means he's sitting on the fence, trying to decide which side he's on -- the insurance industry or the majority of people of Indiana.

Another WellPoint director is William "Bucky" Bush, younger brother of former President George H.W. Bush, and the uncle of former President George W. Bush. He is chairman of the board of Bush-O'Donnell & Company, a St. Louis-based investment management firm, and former chair of the Missouri Republican Party.

Donald W. Riegle Jr. is another WellPoint director with political connections. He is a former Democratic Senator from Michigan (1976-1995). Since 2001 he has been chairman of government relations for APCO Worldwide, a DC-based lobbying firm that has been working secretly for years for AHIP, the insurers' trade group. He was also, until earlier this year, a director of Stillwater Mining Company, based in Montana, Baucus' home state.

Larry C. Glasscock, Braly's predecessor as WellPoint CEO, remains chairman of WellPoint's board and is also a director of Sprint Nextel (the giant telecommunications corporation) and Zimmer Holdings (an Indiana-based manufacturer of artificial hips and knees). William G. Mays is the CEO of Mays Chemical Company, based in Indianapolis. He also is on the board of Vectren, an energy company serving Indiana and Ohio. Ramiro Peru is chief financial officer of Saint Corp., a holding company of Swift Transportation Co., and previously CFO of Phelps Dodge, a mining company. Peru is also a director of Tucson Electric Power Co., and Unisource Energy Services, a utility based in Arizona. Warren Jobe, like Peru, is on the boards of both WellPoint and Unisource. Until his 2001 retirement, Jobe's day job was senior VP of Southern Company, a huge Atlanta-based utility. He is also on the board of the Atlanta-based HomeBanc Corp. and chairman of the board of trustees of Oglethorpe University.

William Ryan is CEO of Banknorth, a Massachusetts-based financial services company. He is a director of Blue Cross and Blue Shield of Maine, the Federal Home Loan Bank of Boston, and Maine Machine Products. Victor S. Liss, retired CEO and now vice chairman) of Trans-Lux Corporation (an electronics company), also serves on the boards of BNC Financial Group, the Bank of Fairfield and Honey Hill Care Center (nursing care facility) and a trustee of Norwalk Hospital in Connecticut. Jackie M. Ward sits on the boards of the Bank of America, SYSCO (a Houston-based food service company), Flowers Foods, and Sanmina-SCI Corporation (a San Jose-based global electronics company). She served as CEO of Computer Generation Inc . George A. Schaefer Jr. retired last year as chairman of the board of Directors of Fifth Third Bancorp, based Cincinnati, Ohio. He sits on the board of Ashland, a chemical company based in Covington, Kentucky.

Sheila Burke, a professor at Harvard's Kennedy School of Government, and a veteran of the George W. Bush adminstration, also sits on the board of the Chubb Corporation, one of the nation's largest property and casualty insurance companies. John Zuccotti, is co-chairman of Brookfield Properties, a real estate firm based in Toronto, and senior counsel of Weil, Gotshal and Manges, a global corporate law firm based in New York City. He also sits on the board of Emigrant Savings Bank and the Dreyfus Investment Corporation. Julie Hill (a California real estate entrepreneur), Jane Pisano (president of the Natural History Museum in Los Angeles and a former executive at the University of Southern California), and Lenox Baker, Jr. (a heart surgeon and president of Mid-Atlantic Cardiothoracic Surgeons in Norfolk, Va.) also sit on the WellPoint board.

These individuals -- and their counterparts on the boards of the other major private health insurance companies -- are not evil people. Many serve on the boards of various charities and are civic leaders in their communities. But in their roles as board members of WellPoint, they serve the interests of the company and thus against the interests of the majority of Americans who want and need health insurance reform.

Forbes wrote that Braly "is trying to put a kind face on this controversial business." Braly gets paid big bucks to defend what is indefensible - WellPoint's slimy practices that put profits over people.

In 2007, for example, WellPoint "settled lawsuits with 10 patients who claimed that their policies were canceled after an injury or diagnosis," according to Forbes. (WellPoint had argued that the patients had concealed preexisting conditions - in other words, that they were sick!)

Parvin Mottaghi's doctors determined, after cardiology tests and laboratory results, that her breathing difficulties resulted from a heart problem, according to the Foundation for Taxpayer and Consumer Rights (FTCR), now called Consumer Watchdog. WellPoint's California subsidiary (now known as Anthem Blue Cross) authorized open heart surgery to repair a defective heart valve. Her doctors performed the surgery at Cedars Sinai on September 1, 2005, but on March 21, 2006, the insurance company rescinded her coverage, leaving Parvin with about $100,000 in medical bills.

Another victim, Michael Norris, was left with $15,000 in medical bills when the insurer retroactively canceled his son's coverage following a surgery.

"WellPoint is getting fat by breaking its promises to patients. Overturning insurance coverage after patients get sick is a devastating abuse that must stop," said Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights. "These illegal retroactive cancellations make a mockery of health insurance." The company ended up paying $10 million, reinstating policy holders' plans and covering their accrued medical expenses.

In 2007, California brought charges against WellPoint's California subsidiary, alleging that the company retroactively canceled health insurance policies of more than 6,000 policyholders. The class action suit ended in a settlement, including a $1 million fine

Forbes also noted that "doctors in several states have filed class actions claiming WellPoint plans withhold payments." In addition, Forbes observed, WellPoint was "the only health insurer in California actively opposing Gov. Arnold Schwarzenegger's plan to provide everyone with health insurance."

On September 2, Consumer Watchdog accused WellPoint and another insurance giant, UnitedHealth Group, of pressuring employees to lobby against healthcare reform in Congress in violation of a California law against coerced political activity, according to the Los Angeles Times. The group asked California Attorney General Jerry Brown to investigate its claim that the two corporations. pressured workers to write their elected officials, attend town hall meetings, and enlist family and friends to lobby for an industry-friendly bill.

On Tuesday, employees at WellPoint's headquarters at 120 Monument Circle in downtown Indianapolis will be able to meet some of the victims of the insurance giant's greed. Several hundred people will rally at noon, including clergy, doctors and nurses, members of labor unions and community groups, and everyday citizens fed up with the health insurance industry's efforts to thwart much-needed reform. Like their counterparts at rallies around the country on the same day, people wronged by WellPoint will share their personal stories. In some cities, protesters will read the stories of those who are no longer alive due to insurance company abuses.

In Milwaukee, Marquette students, members of SEIU, AFSCME, and other unions, MICAH (a coalition of religious congregations), 9-to-5 (an organizing of working women), Wisconsin Citizen Action, and others will start picketing at 11:30 am outside the building where WellPoint CEO Braly will be speaking at a $400-per-table business luncheon. The goal is to "expose WellPoint's shameful business practices and abuse of patients," explained Brian Rothgery, Wisconsin coordinator for Health Care for America Now.

At all rallies around the country -- under the slogan "Big Insurance: Sick of It" -- protesters will demand that Braly and other health insurance company CEOs pledge to do the following:

• Not stand between a doctor and a patient when it comes to deciding what care that patient needs.

• Not deny coverage or raise rates for individuals or businesses based on a pre-existing medical condition and end arbitrary caps on payments for necessary medical care.

• Terminate any policy or incentive that rewards employees financially or otherwise for denying care and rejecting claims.

• Not use any resources - including funds, employees, and facilities -- to lobby against or oppose any aspect of the health reform proposals supported by President Obama and being considered by members of the U.S. Congress, including but not limited to a national public health insurance option

"The health insurance companies are spending $641,000 a day to oppose reform because they profit by keeping the system exactly the way it is," said Richard Kirsch, HCAN's national campaign manager. "They take our money and then deny claims; raise premiums, co-pays, and deductibles at will; fabricate pre-existing conditions; and refuse to cover the treatments our doctors prescribe. Enough is enough. We're holding these events to tell big insurance we're sick of it. We need a guarantee of good coverage we can afford, and that includes giving us the choice of a strong national public health insurance option."

"The current health insurance system makes us sick--as a country," said Justin Ruben, executive director of MoveOn.org, one of the cosponsors of the national day of protest. "If the health insurance industry wins in the health care reform debate, we will all lose. Health care reform with a strong public health insurance option will help lower skyrocketing health care costs and expand coverage to millions of Americans, but the health insurance industry opposes it because they are more concerned with protecting their sky-rocketing profits. It's time they got the message that we need real reform, now."

Peter Dreier teaches politics and directs the Urban & Environmental Policy program at Occidental College in Los Angeles. This article originally appeared in The Huffington Post.

Health Insurance Exchanges: Better United Than Divided

Timothy Stoltzfus Jost — Fri, 31 Jul 2009 10:00:37 -0400

A Working Health Insurance Exchange Must be Federally-Run, Not State-Run

• Exchanges organize the health insurance market, creating large risk pools, making it less costly and easier to compare and choose health insurance.
• House Tri-Committee Bill: Health Choices Administration: independent federal agency to establish and oversee national exchange, while allowing states or groups of states to form their own exchanges with permission.
• Risk adjustment to ensure premiums calculated based on health of members in different plans
• Exchange available to people without employer-sponsored coverage and small employers initially. After year three, Commissioner could open it up.
• Federal government determines which individuals are eligible for premium subsidies up to 400% FPL.
• Senate HELP Bill: Federal government would give states money to establish exchange or “gateway.” There could be multiple non-overlapping gateways in a state or states could band together to establish multi-state gateways. If states preferred, Federal government could establish a gateway for them.
• States oversee exchange to ensure compliance with federal regulations.
• States determine which employers are able to participate in exchange.
• States determine which individuals are eligible for subsidies up to 300% FPL
• Reform not uniform throughout the country

State-by-State Approach to Insurance Reform Tested; It Has Not Worked
• Health Insurance Portability and Accountability Act of 1996: States asked to adopt reforms in individual and group insurance markets; federal fallback authority, like the HELP bill. Many states failed to implement individual market reforms. Federal fallback implementation was slow and uneven.
• Federal compliance oversight has not worked well.
• State regulation of insurance market inadequate to protect consumers and uneven.
• Quality of Medicaid and CHIP programs also varies considerably among the states.
• Some states lack will and/or resources to ensure eligible individuals enrolled in these programs.
• State programs also not helpful to people who are living and working in multiple states.

Medicare, however imperfect, has shown us that we can accommodate local needs while having a national insurance program. From both an efficiency and a consumer satisfaction perspective, establishing a truly national program of exchanges and insurance regulation, as the House draft bill has done, is a far smarter way to go.

Health Insurance Exchanges: Better United Than Divided

While much of the debate about health care reform in recent weeks has focused on public plan choice, another key component of reform–the health insurance exchange–has received much less attention. Yet many experts would argue that successful reform rests on whether the health insurance exchanges work. And, the evidence suggests that in sharp contrast with the House tri-committee federally-run exchange concept, the Senate HELP committee exchange concept—which confers substantial responsibility on the states—will not work.

Health insurance exchanges are entities that organize the market for health insurance by assembling individuals and small businesses into larger pools that spread the risk for insurance companies, while facilitating the availability, choice and purchase of health insurance. The exchange concept is relatively noncontroversial and will almost certainly be included in reform legislation.

As is often the case with legislation, however, the devil is going to be in the details with health insurance exchanges. The House legislation establishes a “Health Choices Administration,” a new independent federal agency responsible for administering much of the reform legislation. This agency would establish a single national exchange. States or groups of states could ask for permission to form their own exchanges, but could get permission only if they met statutory requirements.

The Commissioner of the Health Choices Administration would be responsible for enforcing new regulatory requirements imposed on insurers, such as a ban on preexisting conditions clauses or on discrimination based on health status. The Commissioner would also administer the exchange, negotiating contracts with qualified health benefit plans. The Commissioner would work out a risk adjustment scheme to adjust premium payments to insurers based on their risk pool. The exchange would be available to individuals who did not otherwise have “acceptable coverage” and, initially to small employers, but after the third year to all employers as permitted by the Commissioner. Premium subsidies would be provided through the exchange for individuals and families with incomes below 400 percent of the poverty level. The Commissioner would determine eligibility for premium subsidies.

Under the Senate HELP legislation, funds would be available for states to establish exchanges, called gateways. States could elect to establish their own gateways or request the federal government to establish a gateway in their state. Gateways could be state or multi-state based, or several gateways could be established within different parts of a state. Eligibility for employees to participate in the exchange would be determined on a state-by-state basis. If a state failed to establish a gateway within four years, the federal government could step in and establish a gateway itself. The states would be responsible for enforcing the federal regulations on insurance underwriting and benefit packages, and only if a state failed to enforce the laws for four years could the federal government step in to enforce them. Premium subsidies would be available through the gateways, and responsibility for determining eligibility would be delegated to the states.

In sum, with the House bill we get national healthcare reform with federally run exchanges; with the HELP bill we will get reform on a state-by-state basis, eventually, if the states cooperate, with some state exchanges, some regional exchanges, some states with multiple exchanges, and some federally-run state-specific exchanges. Reform will not be uniform throughout the country.

We have tried the state-by-state approach to reform before and it has not worked. The Health Insurance Portability and Accountability Act of 1996 invited the states to adopt reforms in the group insurance market and individual insurance market. Like the HELP bill, HIPAA gave Department of Health and Human Services “fallback” authority to implement the reforms in states that failed to adopt the reforms themselves. Most states had already implemented the group market reforms and those that had not already done so adopted them quickly. The states had been much less active in regulating the individual market and a number of states failed to implement these reforms. Implementation of the law by HHS under its fallback authority was slow and uneven. Testimony presented to the House Oversight Committee last year revealed that compliance oversight by HHS of state compliance has largely ceased. Insurance company regulation continues to vary radically from state to state, with many states doing an inadequate job of protecting consumers. See Families USA, Failing Grades, and Insurance Company Rules, Where is the Referee.

Our experience with the Medicaid and CHIP programs should also give us pause in relying on the states to bring reform. These programs have in certain respects been very successful, making health care available to millions of Americans who would otherwise have been uninsured. But, the quality of the programs varies considerably among states, with eligibility and coverage varying radically from state to state and some states lacking the will and/or the resources to ensure that eligible individuals are enrolled or to deliver good access to care for these programs. Moreover, as we saw perhaps most vividly after Hurricane Katrina, state-based programs are problematic for people who must be out of state for reasons beyond their control as well as for work or leisure. They often leave people without good access to care.

We are the United States of America, not the divided states of America. We need a streamlined health care system that works consistently wherever we are in the country. Medicare, however imperfect, has shown us that we can accommodate local needs while having a national insurance program. From both an efficiency and a consumer satisfaction perspective, establishing a truly national program of exchanges and insurance regulation, as the House draft bill has done, is a far smarter way to go.