Insurers Argue Over Details

In the wake of the new health care laws, insurance companies are scrambling over details to reorganize in an effort to lessen the blow of the new plan.

Senator John D. Rockefeller IV fears that insurers are affecting how regulators interpret the recent health care legislation, according to a New York Times article.

The new law makes it mandatory for health insurers to spend at least 80 cents of every dollar they collect from premiums on the welfare of the patients.

State regulators are just now deciding on the exact implications and guidelines of this rule. Insurance companies are fumbling around trying to find a way to ensure their profit remains. WellPoint, which operates Blue Cross plans in more than 12 states, wants the cost of doctors’ credentials verification in its networks included. Insurance companies like Aetna argue that ferreting out fraud by identifying doctors performing unnecessary operations should count the same way as programs that keep people who have diabetes out of emergency rooms, according to the article.

There are even some insurers who are arguing over details of what should and shouldn’t be considered part of insurance premiums. They say that everyday business expenses, such as investment taxes and insurance agent commissions, should be a part of the premiums. If approved, it would make it considerably easier for them to reach the 80-cent requirement.

“The calculation of what is called the medical-loss ratio is crucial to insurance companies, because the law requires them to refund money to consumers if they spend too much on administrative costs,” says the New York Times article.

The article states:

But consumer advocacy groups and others see the insurers’ proposals and their lobbying for a more expansive definition of what would be permitted as an effort to water down the law by including too many administrative costs under the umbrella of patient care. ‘A lot of what they are hoping to shift over there does not — and should not — qualify to improve an individual policyholder’s quality of care,’ said Wendell Potter, a former insurance executive who now is critical of the industry and represents consumers in the discussions with state regulators.

Some Democrats argue against the amount of influence the insurers have.

On Tuesday, Senator John D. Rockefeller IV, Democrat of West Virginia, sent a letter to regulators expressing his concern that the insurers could have too much influence on how the regulations were being drafted. By his reckoning, insurers and their compatriots have submitted nearly 160 comment letters, totaling more than 600 pages, to the state regulators. Consumer advocates have submitted just 23, he wrote.

The debate has really seemed to grow recently as the National Association of Insurance Commissioners, which represents the state regulators, is expected to submit a final draft of its work as early as next month to Kathleen Sebelius, the secretary of health and human services, for certification, according to the article.

Many insurers believe that the language is too broad and doesn’t take into account the many programs that help patients and thus, should be considered a part of improving quality and consequently, the 80-cent minimum.

Many believe the new rules stand to reduce health care quality and raise costs.

“Notwithstanding any benefit from a financial perspective, we are fundamentally impacting the quality of care for the patient,” said Dr. Lonny Reisman, Aetna’s chief medical officer, according to the article.

Alissa Fox, an executive at the Blue Cross and Blue Shield Association, also states in the article that if the plan doesn’t work, they’re not going to be spending premium dollars on programs that aren’t effective.

Revere America fears how this government-controlled health care is, among other things, leading toward a reduction in quality of care. We stand committed to seeing the health care law repealed and for a new, reformed system to restore our freedoms and make health care what it should be.