Tag: health insurers
Let Me Tell You Why People Hate Health Insurance Executives

Let Me Tell You Why People Hate Health Insurance Executives

There is no condoning the cold-blooded murder of a UnitedHealth Group executive in predawn Manhattan. Moments after Brian Thompson was shot dead, a torrent of unsympathetic posts flooded social media. I was surprised by both the brazen attack and the unveiled congratulations to a killer. The reasons for the anger, however, I understood very well.

I have my own story. I shared it after the insurer had launched its cruel "Delay Deny Defend" strategy to avoid covering my husband's cancer treatment. Those three words became the title of a 2010 book on the subject, written by Rutgers University law professor Jay Feinman. They may have been the inspiration for the words etched on bullet casings found at the crime scene: "deny," "defend" and "depose."

For years, my husband and I had no serious health issues. We would go to a doctor for annual checkups, and that was it. We were ideal customers for UnitedHealth or any other insurer.

But then my husband was diagnosed with complicated liver cancer. Our plan stipulated that we use doctors in the insurer's network but that if we needed specialized care elsewhere, United Healthcare would cover it. Our network doctor, an expert in liver cancer, told us in no uncertain terms to go to Deaconess Hospital in Boston. Deaconess then offered the cutting-edge treatment my husband needed — and was only a 50-minute drive away.

The doctor obviously anticipated the battle we faced in getting the insurer to cover it. As we walked out of his office, he whispered, "Mortgage the house."

We would have done just that and sued UnitedHealth later had we not fallen victim to the "delay" scheme. The company repeatedly implied that it would seriously consider covering the treatment. To get there, we had to go through an appeal process. That meant speaking to a "handler" who said our case would be reevaluated. About a week later, a one-sentence rejection letter would arrive by snail mail. But it included a number we could call to challenge the verdict. Around we again went.

We could never talk to anyone who made decisions. We couldn't get anyone there to talk to our doctor. At one point, we were told to seek treatment at a now-failing community hospital. The handler told us that the person sending us there was "a nurse" as though that was reassuring.

My husband, an ex-Marine, was a tough customer. He said that dealing with the insurer was worse than dealing with the cancer.

We had fallen into those traps, which Feinman explained, were designed "to wear down claimants" and "flat-out deny" valid claims. Should the policyholder sue, the insurer would unleash a team of lawyers who excelled at swatting away plaintiffs.

Because insurers put the premium payments into investments, delaying payouts also enabled them make more money.

In serious cases, one suspects that delaying tactics are also intended to wait out the life of the patient: The policyholder would die before the insurer had to spend money on medical care. We finally said "the hell with waiting" and went to Deaconess for treatment.

Some months after a grueling round of chemo, my husband died. I'll never know for sure whether the delay hastened that outcome. I do know that the then-CEO of United Healthcare — widely known as William "Dollar Bill" McGuire — later walked off with a $1.1 billion golden parachute after having raked in $500 million.

One last note: Project 2025, the right-wing blueprint for a second Trump term, would, among other things, let Affordable Care Act insurers discriminate against preexisting conditions. It would deregulate Medicare Advantage plans, which are run by private insurers, and herd more Medicare beneficiaries into them.

You've been warned.

Reprinted with permission from Creators.

Federal Funds Earmarked To Offset Affordable Care Act Insurer Losses

Federal Funds Earmarked To Offset Affordable Care Act Insurer Losses

By Noam N. Levey, Tribune Washington Bureau

WASHINGTON — The Obama administration has quietly adjusted key provisions of its signature health care law to potentially make billions of additional taxpayer dollars available to the insurance industry if companies providing coverage through the Affordable Care Act lose money.

The move was buried in hundreds of pages of new regulations issued late last week. It comes as part of an intensive administration effort to hold down premium increases for next year, a top priority for the White House as the rates will be announced ahead of this fall’s congressional elections.

Administration officials for months have denied charges by opponents that they plan a “bailout” for insurance companies providing coverage under the health care law.

They continue to argue that most insurers shouldn’t need to substantially increase premiums because safeguards in the health care law will protect them over the next several years.

But the change in regulations essentially provides insurers with another backup: If they keep rate increases modest over the next couple of years but lose money, the administration will tap federal funds as needed to cover shortfalls.

Although little noticed so far, the plan was already beginning to fuel a new round of attacks Tuesday from the health care law’s critics.

“If conservatives want to stop the illegal Obamacare insurance bailout before it starts they must start planning now,” wrote Conn Carroll, an editor of the right-leaning news site Townhall.com.

On Capitol Hill, Republicans on the Senate Budget Committee began circulating a memo on the issue and urging colleagues to fight what they are calling “another end-run around Congress.”

Obama administration officials said the new regulations would not put taxpayers at risk. “We are confident this three-year program will not create a shortfall,” Health and Human Services spokeswoman Erin Shields Britt said in a statement. “However, we want to be clear that in the highly unlikely event of a shortfall, HHS will use appropriations as available to fill it.”

The stakes are high for President Barack Obama and the health care law.

Although more than 8 million people signed up for health coverage under the law, exceeding expectations, insurance companies in several states have been eyeing significant rate increases for next year amid concerns that their new customers are older and sicker than anticipated.

Insurers around the country have started to file proposed 2015 premiums, just as the midterm campaigns are heating up. Obamacare, as the law is often called, remains a top campaign issue, and big premium increases in states with tightly contested races could prove politically disastrous for Democrats.

If rates go up dramatically, consumers may also turn away from insurance marketplaces in some states, leading to their collapse.

Proposed increases in a few states where insurers have already filed 2015 rates have been relatively low, with several major carriers seeking just single-digit hikes. But insurers in closely watched states, such as Florida, Pennsylvania, North Carolina and Arkansas, are still preparing their filings.

“It’s absolutely paramount to keep premiums in check,” said Len Nichols, a health economist at George Mason University who has advised officials working on the law.

The state-based marketplaces, which opened last year, allow consumers who do not get health coverage at work to shop among plans that meet basic standards. Sick consumers cannot be turned away, and low- and moderate-income Americans qualify for government subsidies to offset their premiums.

To stabilize this new system, the law set up a complex system of funds, including one known as the Temporary Risk Corridors Program, that collects money from insurers and transfers it from companies with healthier, less expensive consumers to those with sicker, more costly consumers.

This system was supposed to pay for itself, as does a similar one used to shift money between drug plans in the Medicare Part D program.

But insurance industry officials have grown increasingly anxious about the new system’s adequacy.

Pressure is most acute on insurers in states where healthy consumers were allowed to remain in old plans that are not sold on the new online marketplaces, an option Obama offered to states amid a political firestorm over plan cancellations last year. The president had promised people would be able to stick with their plans.

The renewal temporarily solved a political problem for the White House, but created a new one. Maintaining these old plans kept many healthy consumers out of the marketplaces, making the pool of new customers less healthy and therefore potentially more expensive for insurers, according to experts.

In a series of White House meetings over the last several months, Obama and other senior administration officials have sought to persuade insurance company CEOs to nonetheless hold rates in check, arguing that the marketplaces would stabilize over time.

But with proposed 2015 rates beginning to come in, the administration acceded to industry demands for a clear guarantee that more money would be available to cover potential losses.

“In the unlikely event of a shortfall for the 2015 program year, HHS recognizes that the Affordable Care Act requires the secretary to make full payments to issuers,” the regulation published Friday notes. “In that event, HHS will use other sources of funding for the risk corridor payments, subject to the availability of appropriations.”

That language allows the administration to tap funds appropriated for other health programs to supplement payments to insurers, according to administration and industry officials.

AFP Photo/Karen Bleier
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