By Steve Schulte of
<a href="http://www.healthadvocatesolutions.com/index.html%22%3EHealth Advocate Solutions</a>
Please respond or inquire at (213) 999-1227
Now that the threat by Blue Shield of CA to raise individual premium rates by as much as 59% is behind us, it's worth examining whether there are lessons in this case for the future of implementing healthcare reform.
Even as we progress, don't overlook the fact that BS of CA backed down under tremendous pressure---notably from CA Insurance Commissioner Dave Jones (an elective post). Expect to see similar acts played out in the coming months.
In my view there are, in fact, several lessons to be gleaned.
1. MOST INSURERS WILL BE MORE INTERESTED IN PROTECTING THE BOTTOM LINE OF THEIR COMPANIES THAN IN OFFERING BETTER ACCESS, BENEFITS OR COST CONTROLS TO CONSUMERS.
Fine, you might say. Companies are meant to protect the interests of their shareholders.
True, but this canard underestimates the role that insurers are given in the new law. The responsibilities to set prices, determine benefit levels, assign medication pricing and so on. Lots of leeway and plenty of room to veer from the public interest. And, given their immense government relations engines assume the insurers will be writing many of the rules.
2. DON'T EXPECT THE FEDERAL GOVERNMENT TO BE AN AGGRESSIVE INFORCER OF THE NEW HEALTHCARE REFORM LAW.
This is brought home clearly by noting a recent White House meeting between President Obama and several governors. The President made it clear he will go along with state variations from the new heatlhcare model in 2014 as long as these variations do not cover fewer people, cost more to consumers or add to the federal deficit.
The law originally allowed this breadaway in 2017, but legislation authored by Wyden of OR and Brown of MA allows for the earlier date. Expect lots of differences, confusion and loss of consumer protections.
Therefore, while one might wish that Secretary Sibelius or the President had helped to clear the air on the CA rate hike request, it was not meant to be. No doubt there are complex reasons for this, but it means the administration with probably not be a hero in this drama.
3. THE INDIVIDUAL STATES WILL HAVE A KEY ROLE IN DETERMINING THE PRECISE ROLLOUT OF HEALTHCARE REFORM. ARE THEY READY?
One of the lessons from the Gulf Oil Spill was that the feds were not prepared or of a caliber to manage the horrific event. They simply did not have the capacity to respond and had to rely on BP and other companies.
I expect that many states will be in a similar position vis a vis the rollout of healthcare reform. States like Vermont, Massachusetts and Maine have set strong examples for better ways to manage and deliver care to their publics. Certainly Hawaii has been a strong leader as has Oregon, as least in how it handles Medicaid.
Still that means five states out of 50 have done a good job. Even if I have left some out of my lists that allows for lots of variance, inequity and cost control problems.
4. THERE WILL BE AN ADDITIONAL THREAT FROM SOME INSURERS: A TWO-HEADED HYDRA THAT COULD SWAMP REAL REFORM.
On the one hand, some insurers will threaten to leave markets if state officials are serious about healthcare reform. Although a hollow threat from these bottom-feeding companies, other states hungry for business will welcome them.
It is certainly plausible that they are doing this indirectly right now by "cleansing the rolls" of sicker individuals (hence a rate hike....). Insurers might be hoping to drive clients with health problems to the state exchanges like the one being established in CA. But if this is true, what is insurance for?
On the other hand, with states in serious financial condition and cutting back on most social, health and educational programs is it likely that we could see more giant social dramas like the one in WI over collective bargaining being withdrawn from public employees? Think about it: healthcare affects far more people than collective bargaining.
Any way you look at it the states face enormous challenges here. It's hard to be optimistic and we badly need some success stories that provide good examples.
5. WITH ALL OF THIS, IS THERE ANY CHANCE WE COULD SEE MOVES TO IMPROVE THE FEDERAL LAW IN TERMS OF BENEFITS, COVERAGE, ACCESS TO CARE AND SO ON?
This does not seem likely, at least in the short term. In fact, it must be noted that some Republicans and Tea Party members are ACTIVELY trying to repeal or at least to gut healthcare. The courts seem to be assisting. Expect the confusion to continue for a long time.
(Remember: the federal law does not mandate that insurers accept everyone regardless of condition until 2014. Also, there will be no sensible taxation of high premium (Cadillac plans) until 2018.)
Lots of reasons here to stay closely involved---and in touch with your legislators.
Your thoughts?
To respond to this blog, email steve6schul@yahoo.com
