The Wonk Room

Insurer Admits Industry Could Circumvent Proposed Regulations »

During today’s Michigan Business and Legislative Forum, which the Wonk Room attended, a representative of Blue Cross Blue Shield of Michigan admitted that insurers could circumvent the market regulations proposed as part of health care reform.

In answering a question about insurer market share, Mark Cook, Vice President of Governmental Affairs at BCBS Michigan, criticized for-profit insurers for maximizing their profit margins by only covering the healthiest and youngest applicants. “[I]f you have a business model that basically says, ‘I’ll take 25-year-olds until they get sick.’ That’s a great business.”

Cook conceded that health reform would not eliminate such risk selection. In a separate conversation with the Wonk Room, Cook agreed that that despite industry concessions to accept applicants with pre-existing conditions, existing health reform measures would not prevent insurers from designing benefit packages that excluded sicker populations:

WONK ROOM: I’m just wondering in terms of designing benefit packages the standards in the bill, at least the ones I’ve seen, at least the Baucus ones are actuarial standards, so you can design packages that kind of hide packages behind high deductibles, things like that.

COOK: Yeah I suppose there could be some , um, some industry folks could take, how do I want to put this? Could take, um, a low benefit design and try to market it heavily to a young, healthy population or something like that.

WONK ROOM: Right, you can design packages that attract different pools, right?

COOK: I suppose there could be some gaming that goes on around that if that is the design that ends up happening.

Watch it:

The Baucus bill requires insurers participating in the Exchange to offer plans in four different tiers. Each plan would have to meet a different actuarial-value. In the silver tier, insurers would have to cover 73% of the health care expenses of an average population; the remaining 27% would be picked up by individuals.

But Sarah Lueck at the Center on Budget and Policy Priorities warns, and Cook seems to agree, that “an actuarial-value standard on its own” would not prevent insurers from designing packages that would attract healthier applicants and deter “enrollment by those in poorer health.” “For example, insurers could offer a benefits design that omits or severely limits services needed by people with serious medical conditions, while offering richer benefits in other areas such as vision care or health-club memberships. In that way, an insurer could meet an actuarial standard while designing a package calculated to deter sicker people (by failing to cover basic services they need) and attract healthy ones.” Insurers could offer cheaper preventive services without any cost sharing but cover more expensive services only after a high deductible is satisfied.

As former health insurance executive Wendell Potter explained in an interview with ThinkProress, insurers would “like to move us all into high deductible plans.” “[The would like to] have high deductibles that we would all have to meet and or [move us] into these limited benefit plans that are very skimpy and don’t cover you, don’t cover what you need. That way, when you do get sick, they’re not on the hook to pay you anything. They would love to have you enrolled in these.”

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Health Insurers To Baucus: Allow Us To Charge Older People 5X More Than Younger Americans

Chairman Max Baucus’s (D-MT) original mark of the Senate Finance Committee’s health care bill used a modified community rating formula that allowed private insurers to charge older people five times more for coverage than younger people, a ratio that far exceeded the Kennedy and House bills’ 2:1 rating. On Tuesday the Chairman modified his mark with an amendment that lowered the rating to 4:1 and sparked a harsh response from the health insurance lobby.

In fact, today, in its second letter to the Chairman, America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni criticized Baucus — who is already requiring all Americans to purchase private health insurance — for improving the affordability measure. “If age bands are narrowed or “compressed” too much, premiums will rise significantly for these individuals, making coverage unaffordable, and resulting in a smaller and less stable pool, and higher premiums for everyone,” the letter warned:

The Mark’s original age band of 5:1 already reflects compression, relative to the natural distribution of underlying health care costs across age groups, and sets a balance whereby younger individuals are cross-subsidizing the cost of coverage for older Americans…For these reasons, we respectfully urge that you restore the age band to 5:1.

Ignagni and the health insurers support modified community rating and believe that in order for insurance pools to function, younger people must subsidize the costs of the sick. But insurers are apparently concerned that a 4:1 community rating would jeopardize the industry’s ability to attract a significant number of young people into high deductible policies outside of the exchange (in the remaining individual market). A 4:1 community rating would force insurers to charge younger people higher premiums and would presumably attract fewer enrollees; a 5:1 community rating would allow insurers to charge older people more and market more “affordable” (read: high deductible) policies to young and healthy applicants who pay more in premiums than they file in claims.

As former health insurance executive Wendell Potter explained in an interview with ThinkProress, insurers would “like to move us all into high deductible plans.” “[The would like to] have high deductibles that we would all have to meet and or [move us] into these limited benefit plans that are very skimpy and don’t cover you, don’t cover what you need. That way, when you do get sick, they’re not on the hook to pay you anything. They would love to have you enrolled in these.”

Watch it:

For more on ThinkProgress’ interview with Wendell Potter, click here, here, here, and here.

Health Insurance Stocks Rally With Release Of Baucus Health Bill

Earlier this morning Senate Finance Committee Chair Max Baucus (D-MT) unveiled his committee’s health care bill, which has no public option and mandates that everyone buy insurance. While Baucus has failed to garner support from any congressional Republicans and has outraged progressives, there has been one very positive response to his proposal.

Following Baucus’ announcement, HealthNet shares increased by 3%, United Health Group Inc shares rose by 2.7%, Humana Inc. grew by 2.6%, Wellpoint stock gained 1.7% and Aetna Inc rose 1.6%:

Earlier this week, ThinkProgress interviewed Wendell Potter — a former health insurance executive — who pointed out that “every time there is an article in a big newspaper questioning the success of progressives in getting a good bill passed, the stock will go up.” “The analysts/investors don’t think any good reform is going to happen, or anything that would happen that would adversely affect the insurance companies,” he said. Watch it:

In fact, since the President signaled that he is backing away from the public option, health insurance stocks have been on the rise. “Health-care investors are starting to breathe a sigh of relief as they feel the worst case could be averted,” John Sullivan, director of research at Leerink Swann, told the Wall Street Journal in August. “Health-care stocks have risen 22% since late February, when President Barack Obama began his push for an overhaul; the overall market is up 38%” between late February and August.

Pelosi Stands By Public Option: We Won’t Pass The ‘Private Insurance Profit Perpetuation Act’

Today, in testimony before the Democratic Steering and Policy Committee Forum on Health Insurance Reform, health care whistle blower Wendell Potter reminded Congress why a public option is essential to reform. If Congress fails to create “a public health insurance option to compete with private insurers, the bill it sends to the President might as well be called, ‘The Insurance Industry Profit Protection And Enhancement Act,’” Potter said.

At the end of the hearing, House Speaker Nancy Pelosi (D-CA) agreed with Potter. “You cited a public option as one way for it to reach its achieve its goal,” she told him. “We will be passing the ‘Private Insurance Profit Perpetuation Act.’ We have no intention of doing that”:

Mr. Potter, you said it well when you said if we do a plan that doesn’t really achieve its goal, and you cited a public option as one way for it to reach its goal, we will be passing the ‘Private Insurance Profit Perpetuation Act.’ We have no intention of doing that. We want the private sector to thrive — we don’t want our members to go into an exchange where they only have one choice, where there’s sole sourcing. But that the public option provides that competition.

Watch it:

Potter has harshly criticized Sen. Max Buacus’ (D-MT) proposed framework for reform, calling the bill “an absolute gift to the industry.”

“A public option must be created to provide true choice to consumers or reform will fail to fix the root of the severe problems that have been caused in large part by the greedy demands of Wall Street. By creating a strong public option and restricting the insurance companies’ ability to enrich executives and investors at the expense of taxpayers and consumers, HR 3200 [the House health bill] will truly benefit Americans,” Potter said in his opening statement. “The Baucus plan, on the other hand, would create a government subsidized monopoly for the purchase of bare bones high deductible policies that would truly benefit big insurance. In other words, insurers would win, your constituents would lose.”

Health Insurance Insider Slams Baucus Bill: ‘An Absolute Gift To The Insurance Industry’

On the eve of the Senate Finance Committee’s release of its much anticipated health care plan, Wendell Potter – the insurance industry whistle blower and former communications director of health insurance giant Cigna – called the Baucus framework “an absolute gift to the industry.” “And if that is what we see in the legislation, [America’s Health Insurance Plans chief] Karen Ignagni will surely get a huge bonus,” Potter said at a briefing for reporters.

The bill establishes a new regulated health insurance exchange and compels every American to purchase qualified health insurance coverage by 2013. Americans with employer-sponsored insurance can stay in their existing plans, while the uninsured would have to enroll in an expanded Medicaid program, a new plan in the Exchange or the now-regulated individual health insurance market. According to a report released by the Congressional Budget Office, the bill would cover 94% of Americans and cost $880 billion over 10 years.

Potter argued that the lax employer requirements would shift the cost and risk of coverage onto the individual and maintained that the bill’s ‘network of cooperatives‘ would be unable to compete in today’s concentrated health insurance markets. “The co-ops won’t stand a chance,” he concluded.

Reform must also do more to regulate insurers, who have agreed to accept applicants with pre-existing conditions but are insisting on benefit and rate flexibility. Potter argued that the benefit package standards in the Exchange and the high deductible option for younger beneficiaries would allow insures to design almost anything that they can sell in the health market place and push the country towards consumer driven health care.

Under the Baucus legislation, private insurers could also charge older individuals up to five times more for coverage. “You’re just using age as a proxy for health status,” Uwe Reinhardt, an economics professor at Princeton University told the New York Times. Reinhardt estimates that “Senator Baucus’s age-rating plan would allow insurers to cover roughly 70 percent of the additional risk they’d take on by being required to accept all comers, regardless of health.”