Originally published in the Berkshire Eagle.
The Institute of Medicine (IOM) has just released recommendations for the “essential benefits” of the health insurance coverage mandated under the Affordable Care Act (the 2010 federal health reform law). The IOM is the health arm of the National Academy of Sciences, described on their website as “an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.”
“Skimpy coverage” is the best description for the “essential benefits” package the IOM panel has recommended. These bare-bones policies come with unaffordable deductibles and co-payments, as well as uncovered services. Rather than endorsing the more comprehensive coverage plans of large employers, the panel chose coverage similar to that offered by small employers, making these skimpy plans the new standard.
This inadequate coverage will shift costs from corporate and government payers onto families, which will lead to delaying care. Millions of Americans are already underinsured with skimpy insurance policies, and as a result, forego necessary medical care or fail to fill prescriptions they need. Of course, delaying care eventually leads to higher medical costs when patients finally receive treatment, because they are sicker.
Rising deductibles and co-payments over the past two decades have not stopped medical inflation. Costs keep going up, and more and more people suffer financial ruin when they have serious illnesses.
A new study has just been released, by Masscare and Massachusetts Physicians for a National Health Program, about the outcome of our state health reform law four years after its full implementation. This is an important study because the Affordable Care Act is based on the Massachusetts Health Reform Law, which was enacted in 2006. The study finds that the number of uninsured people in Massachusetts decreased by one-half to two thirds. However, most of the gains have come from expansions in publicly subsidized insurance, shifting patients from the previous Free Care Pool, which compensated hospitals directly, to private insurance plans, which are a more expensive way to provide coverage.
In addition, cost-shifting to patients has accelerated due to skimpy coverage in employer-sponsored insurance, especially for policies for small business employees. Since the reform, the use of high-deductible plans more than tripled for Massachusetts residents with private insurance.
Reform has not reduced the burden of medical bills and medical bankruptcy in Massachusetts. The federal Affordable Care Act, like health reform in Massachusetts, will probably have similar mixed outcomes, expanding coverage to the uninsured, but doing this through inadequate insurance policies purchased through private insurance companies, who will reap big profits even as the cost of policies become unaffordable.
As you might suspect, the panel from the IOM who made these recommendations for the federal health reform law is “riddled with conflicts of interest,” according to a protest letter signed by 2,400 doctors, nurses, and health advocates. The IOM panel members include Sam Ho, executive vice president of United Healthcare, and Leonard Schaeffer, a former CEO of Wellpoint, two of the largest health insurance companies.
Last year, a journalist at the Los Angeles Times wrote, “Leaders of Cigna, Humana, UnitedHealth, WellPoint and Aetna received nearly $200 million in compensation in 2009, according to a report, while the companies sought rate increases as high as 39 percent” for insurance premiums. Other members of the IOM panel with conflicts of interest include executives from 3M Health Information Systems, a medical supplier; Milliman, Inc., an actuarial consulting firm with close ties to the insurance industry; and The Blackstone Group, a private equity firm with major health care interests. These health industry ties violate a 2009 recommendation from the IOM itself that those with industry conflicts should be excluded from such panels.
Of course, the IOM panel recommendations were lauded by insurance industry leaders. Health insurance companies, who stand to gain by issuing skimpy insurance policies that patients will avoid using until they are very sick, have attempted to undermine real health reform all along the way. The Lancet, one of the oldest and most respected medical journals has stated: “Corporate influence renders the U.S. government incapable of making policy on the basis of evidence and the public interest.”
No wonder the Occupy Wall Street movement has the support of increasing numbers of American people who are awakening to the effects of corporate influence on our lives. Health insurance policies are just one example.
Single-payer health insurance, an improved and expanded Medicare plan for everyone, would remove corporate influence and greed from our health care insurance system, be cost-effective, and provide comprehensive health care coverage for everyone. Unlike the skimpy coverage suggested by the IOM, a single-payer health care system would actually pay for care when we are sick.
Dr. Susanne King is a Lenox-based practitioner.