PNHP

Why patients disenroll from private Medicare Advantage plans

pnhpf3a

Why patients disenroll from private Medicare Advantage plans

Why Consumers Disenroll from Medicare Private Health Plans

Medicare Rights Center
Summer 2010

This report analyzes data and case notes from the 475 cases presented in 2009 by consumers who called us about disenrolling from Medicare private health plans.

Reasons for Disenrollment (percentage of calls)

24.8% – Provider access problems
21.5% – Misinformation/marketing abuse
19.4% – Coverage problems for medical services
19.4% – Systems/data transfer problems
8.6% – Cost-sharing too high
7.2% – Part D coverage problems
3.2% – Premium increase

Provider Access Problems

The consumer problems in this category incorporate a wide range of provider access issues. They include general complaints and lack of understanding about the limits on provider access imposed by network-based plans, as well as specific concerns, such as the potential interruption of a valued relationship with a doctor who is being dropped from the plan’s network. Provider access problems are often prompted by an acute episode of illness or diagnosis; consumers seek to disenroll when their current plan will not cover care from a home health agency, skilled nursing or other rehabilitation facility, or from a particular specialist, such as a facility or doctor specializing in cancer treatment. This category also includes cases where consumers were misinformed about the limits on provider access before joining.

Disenrollment Due to Cancer 
 
Cancer diagnoses are implicated in a relatively small percentage — less than 5 percent — of the disenrollments, but these cases are some of the most heart-wrenching and most difficult to resolve for Medicare Rights Center caseworkers.

The majority of cancer disenrollment cases — 63.6 percent —  however, involve provider access. The limitations of the private plan networks become apparent after the consumer is referred to a hospital or cancer specialist that is out of network. Treatment of rare or advanced cancers in particular triggers referrals to specialty facilities, such as M. D. Anderson in Houston or Memorial Sloan-Kettering in New York City. During the open enrollment periods, the disenrollments are generally effective the following month. When a person is diagnosed with cancer outside of the open enrollment periods, however, rules that lock consumers into their Medicare Advantage plans for the year generally prevent disenrollment (unless the case also concerns misrepresentation or marketing fraud, as is sometimes the case), and therefore may impede access to the most appropriate cancer treatment facility.

http://www.medicarerights.org/pdf/Why-Consumers-Disenroll-from-MA.pdf

Comment: 

By Don McCanne, MD

This survey does not quantify the extent of patient dissatisfaction with Medicare Advantage plans since it was limited to individuals calling the Medicare Rights Center to find out about disenrolling from the private Medicare Advantage plans. But it does provide us with an understanding of why patients want out of their plans. First and foremost patients complain of a “lack of understanding about the limits on provider access imposed by network-based plans.”

The second most common complaint was about misinformation and marketing abuse. This was the primary reason for provider access complaints – the Medicare beneficiaries did not understand that their access would be limited to physicians in plan networks.

This has certainly been infuriating for those who have lost their choice of physicians by enrolling in the Medicare Advantage plans, but it has much greater implications under the Patient Protection and Affordable Care Act. Virtually all plans will have network-based restrictions.

President Obama promised us choice of health plans, but the marketing of his proposal was silent on the fact that virtually all of the plans would have limited access – limited choice of physicians and hospitals – because of provider network restrictions.

With the traditional Medicare program, everyone has free choice of their health care professionals and institutions. That should have been a prime goal of health care reform. It still can be should we decide to enact a single payer national health program – an improved Medicare for everyone.

Improve and strengthen Medicare by expanding it to all

The following text is the testimony that Dr. Margaret Flowers presented to the National Commission on Fiscal Responsibility and Reform at its June 30 hearing in Washington. Dr. Flowers is congressional fellow for Physicians for a National Health Program.

I am Dr. Margaret Flowers and I am here today on behalf of Physicians for a National Health Program, the leading physician research, education and advocacy organization in support of a truly universal single-payer health system in the United States. I will speak specifically about the contribution of health care costs to our national deficit and the evidence-based remedy to control these costs.

When compared to health care in other advanced nations, the United States excels in only one area – the amount of money spent per capita per year. Despite our high spending, the U.S. leaves a third of the population either uncovered or underinsured and thus vulnerable to financial ruin.

Medical debt is a leading cause of bankruptcy and foreclosure in our nation despite the fact that most families declaring medical bankruptcy had insurance when they began incurring such debt.

Our health outcomes are relatively poor, placing us 37th in the world, and we rank the highest in preventable deaths, over 100,000 preventable deaths per year, when compared to other advanced nations. It is clear that we are getting poor value in return for our health care dollar.

Health care costs, which are rising 2.5 percent faster than our GDP, are a leading driver of our financial deficit. In fact, if our health care costs were comparable to those in other advanced nations, which provide nearly universal health care with better outcomes, we would currently experience a budget surplus.

The recent health legislation, misleadingly titled the Patient Protection and Affordable Care Act (PPACA), lacks proven cost controls and is predicted to cause U.S. health care costs to rise faster than if there had been no reform at all (Centers for Medicare and Medicaid Services, April 2010) despite continuing to leave tens of millions out.

Given the impact of health care costs, members of this commission may attempt to decrease the deficit by cutting our public health insurance programs, Medicaid and Medicare; however, doing this would be a mistake because it would increase poverty, worsen health outcomes and increase costs.

Since its enactment nearly 45 years ago, Medicare has substantially lowered poverty among the elderly. Studies show that health disparities in the U.S. start decreasing when our population reaches the age of 65. And the cost of health care per beneficiary is rising more slowly for those on Medicare than for those with private health insurance.

Medicaid and Medicare have not caused our rising health care costs but are victims of our fragmented and failed market-based model of health care financing. Shifting the cost of health care from the taxpayer to the patient will not magically make these health care costs disappear or become sustainable.

The solution to our economic crisis is to jettison the costly failed market model of health care and adopt a publicly financed and independently delivered national improved Medicare for All. This is commonly known as “single payer.” A national improved Medicare for All system has myriad benefits:

* Administrative savings of approximately $400 billion per year, which is enough to provide comprehensive high quality health care to all who are uninsured and underinsured.

* Ability to negotiate for pharmaceutical prices as a monopsony which would lower costs by about 40 percent and bring our prices in line with those of other advanced nations.

* Inherent cost controls of global budgeting for health facilities, negotiated fees, bulk purchasing and rational, rather than profit-driven, allocation of capital expenditures and health resources.

* Ability to identify outliers and develop quality improvement tools.

* Eliminate the burden of rising employee health care costs on businesses.

* Enhance the competitiveness of U.S. products in international markets.

* Liberate our population to pursue advanced education or entrepreneurial enterprises.

* Allow older workers to retire which would increase job opportunities for our younger workers.

* Stimulate the economy because families would have more money for discretionary spending.

* Improve the health, and therefore the productivity, of our workforce.

* Eliminate bankruptcy and foreclosure due to medical debt.

* Eliminate the spend-down required for those who need long-term care funded by Medicaid.

* Provide true health security to our population so that nobody has to choose between necessary medical care and other necessities such as housing, food, education and clothing.

Given these multiple economic benefits – and I have not begun to describe the ways in which national improved Medicare for All would improve patient choice and quality of health care – it is no surprise that the single payer approach is supported by the majority of those in the U.S. and the majority of American physicians. This was evident once again last Saturday in the town meetings sponsored by America Speaks when participants across the nation demanded single payer as an option to solving the health care crisis and 71 percent voted not to cut Medicaid and Medicare.

Private health insurance is rapidly becoming a thing of the past. There is a steady trend in fewer people being enrolled in employee-sponsored health plans. This is expected to increase under PPACA as businesses have an incentive to drop insurance benefits and pay the lower cost penalty.

There is a steady trend in people choosing high deductible plans which leave them financially vulnerable in their time of need. As people enter the individual market, those with health conditions will find it difficult to afford adequate insurance.

The trends for those who are uninsured and underinsured will continue upward. Under PPACA, billions of public dollars will be used to subsidize rising private insurance premiums for policies that cover fewer and fewer services. The result is a flow of patient and public dollars into the coffers of private insurance corporations with declining return in terms of health care. This trend is not sustainable.

The alternative scenario of a national improved Medicare for All will save lives and save money. National improved Medicare for All will place our nation on the path of becoming one of the best health systems in the world – something of which we can all be proud.

This commission has the ability to recommend creating a financially sustainable universal health system. I urge the members of this commission to recommend addressing the deficit through adopting this most popular approach: national improved Medicare for All. Don’t cut Medicare. Protect it, improve it and expand it to cover everyone.

RECOMMENDATION: HMO exemption in state single-payer legislation must be specific and narrow

By David Himmelstein, Kip Sullivan & Steffie Woolhandler
PNHP 2010 Spring Newsletter

The single-payer model precludes private insurance that duplicates the public coverage – a measure required both to control costs and to avoid the emergence of two-class care. The question of how to treat nonprofit, staff- and group-model HMOs is complex because they combine a nonprofit provider of care (clearly acceptable in a single-payer model) with a private insurance plan (which is not acceptable). After much debate, PNHP decided to include such organizations in its proposals, but with tight restrictions to minimize the problems inherent in the insurance component of HMOs.

Because the term “HMO” has been used to cover a wide variety of insurers, it is important that legislation clearly define the parameters for HMOs that could participate in a single-payer system, and spell out the restrictions on participating HMOs. Failing this, private insurers would surely exploit any exemption for HMOs to maintain their stranglehold on the health care system.

Both PNHP’s proposals and H.R. 676 (the single-payer legislation sponsored by Rep. John Conyers; you can find the legislation on the PNHP website at: https://pnhp.org) have spelled out the key features that distinguish HMOs allowed to continue under a single-payer system from those that would be proscribed. Specifically, participating plans must:

(1) be nonprofit;
(2) “actually deliver care in their own facilities” through salaried
physicians who are employees (not contractors) of the HMO;
(3) not use their capitation or budget payments to cover hospital services (hospital services would be paid for through a global budget paid directly to the hospital); and
(4) not offer financial incentives based on utilization.

Very few HMOs will qualify under this definition.

When single-payer supporters in California drafted single-payer legislation (the current version is S.B. 810), they inserted language into the bill that was intended to exempt Kaiser Permanente. However, the language used in the bill leaves the door open to many private insurance firms who could label themselves “integrated health care delivery systems,” “independent practice associations,” or “integrated service networks” and hence qualify them to receive global budgets or capitation payments from the single payer.

The potential for confusion was illustrated in Minnesota where legislators introduced legislation (S.F. 2324 / H.F. 2522) modeled on SB 840 (the predecessor to S.B. 810) in May 2007. The drafters stated their intention to exclude private health plans, including HMOs. However, an analysis by the research office for the Democratic Farmer Labor Party caucus in the Minnesota House of Representatives stated that the bill did permit “health plans” to participate.

To avoid confusion, and the possibility that private insurers could slip through a loophole, we recommend that any single-payer legislation that proposes to exempt HMOs use either H.R. 676’s definition of “HMO” or a similarly narrow and specific definition.

What do the revised Anthem Blue Cross prices mean?

WellPoint Scales Back Rate Increases Sought in California

By Avery Johnson
The Wall Street Journal
July 1, 2010

Health insurer WellPoint Inc. is backing off its plan to increase prices by as much as 39% for individuals in California, instead seeking rates for this year that it said would result in a $100 million loss for the company there.

On Wednesday, WellPoint’s Anthem Blue Cross unit told the California Insurance Department that it wants to increase prices for individual policyholders by an average of 14%, down from the 25% average it had previously sought.

“The actual rates we would need are higher than this, but we made a business decision to get a rate implemented,” said Brian Sassi, WellPoint’s president and chief executive of its consumer business unit.

Wellpoint had been hammered for months by the Obama administration and consumer advocates over the size of its initial rate proposal. Angela Braly, its chief executive, and other insurance executives contend that the rising cost of care and demands for higher reimbursement from providers are driving premiums—and that the federal health-overhaul law didn’t do enough to control costs.

WellPoint plans to file 2011 rates in California that do cover costs, they said.

Len Nichols, a health economist at George Mason University, said that WellPoint has “been asserting the point that, ‘You’ve got to understand we can’t control costs.’ And that point has been made, and the message has been heard.”

http://online.wsj.com/article/SB10001424052748704334604575339284211797328.html?mod=googlenews_wsj

Comment:

Don McCanne, MD

After withdrawing a request for an average 25 percent increase in premiums for individual health plans in California, Anthem Blue Cross is now asking for an average 14 percent increase, which they claim will result in a loss that they will make up with 2011 premium increases. With medical inflation, a further increase in adverse selection, and an adjustment to eliminate losses, next year’s premium increases will be even more intolerable.

The Obama administration and members of Congress are critical of these increases, blaming Anthem Blue Cross for excessive profits – as if a $100 million loss in this market somehow reflects egregious profits (though, of necessity, they are profitable in other markets).

Obama and Congress are totally off target when they blame the private insurers. The private insurance model does not and cannot work to control costs and insure everyone, no matter how much market advocates wish it could. It is Obama and Congress who bear much of the blame because they were the ones who decided to keep the private insurers in charge.

Although we can blame our elected leaders now, if we don’t communicate to them clearly that they must bring us the reform that we need – a single payer national health program – then we will be left with only ourselves to blame.

Single-payer advocate: 'Don’t shred our safety nets'

By Katie Robbins

The following text is the testimony that Katie Robbins, national organizer for Healthcare NOW (www.healthcare-now.org), presented to the National Commission on Fiscal Responsibility and Reform on June 30 in Washington.

Thank you for this opportunity to testify. My name is Katie Robbins and I am here on behalf of Healthcare NOW, an organization founded in 2004 to support bill H.R. 676, “the U.S. National Health Care Act” or Expanded and Improved Medicare for All. With membership in 50 states, Healthcare NOW has broad support for single-payer health care.

Healthcare NOW opposes any consideration of cutting, privatizing or raising age eligibility for Social Security, Medicare, and Medicaid.

We seek to strengthen, not weaken, our social safety net. If passed, H.R. 676 would establish a national single-payer Medicare for All system granting everyone in the United States access to comprehensive, high-quality health care using our existing privately run infrastructure and a progressive financing that will guarantee coverage for all necessary medical care without financial or other barriers.

According to Harvard University studies, eliminating the waste of the multi-payer private insurance industry and moving to a single-payer system will save $400 billion a year. More savings are found in cost controls that a single-payer system can provide such as negotiating drug costs and medical equipment, and global budgeting for hospitals.

Since H.R. 676 was introduced in 2003, it has received tremendous support including endorsements by 582 union organizations in 49 states, the U.S. Conference of Mayors, 63 local governments which include 10 of the nation’s 30 largest cities, the Episcopal Church, the United Methodist Church, the Presbyterian Church, the Unitarian Universalist Church, the Union for Reform Judaism, the United Church of Christ, and the Buddhist Peace Fellowship, and the majority of nurses, patients, and physicians.

Broad support for a single-payer Medicare for All system continues even after the new health law has passed. For example, this past Saturday, June 26, America Speaks, a privately run company, organized “town hall meetings” in 20 cities across the country to discuss the nation’s deficit. America Speaks received funding linked to the Peter Peterson Foundation; the same foundation which is also funding staff to this Fiscal Commission. (Peterson is known to be vocally in support of cutting and privatizing Social Security and Medicare.)

America Speaks claimed that all options would be considered, yet the materials distributed at the events did not include an option to support single-payer health care as a means of controlling health care costs. Despite efforts to silence support for single payer, many participants demanded the option to vote on a single-payer type health care system, which would ultimately reduce costs by making health care more efficient rather than just cutting services in Medicare and other public sector programs. Participants also voted overwhelmingly for defense cuts and for progressive taxation.

Because cost controls are notably absent from the new health law, the National Commission on Fiscal Responsibility and Reform should listen to what the public is urging them to do, and address meaningful cost control in our health care system, which only a single-payer system can provide, as a means to balance the nation’s budget.

We urge you to address cost controls immediately. Healthcare NOW and our network of supporters and allied organizations urge Congress to work to defeat any bill to cut, privatize or dismantle our social safety net – Social Security, Medicare, and Medicaid. We demand the enactment of an expanded and improved Medicare for All, H.R. 676, to fix our economy and our (still) broken health care system.

Single-payer advocate: ‘Don’t shred our safety nets’

By Katie Robbins

The following text is the testimony that Katie Robbins, national organizer for Healthcare NOW (www.healthcare-now.org), presented to the National Commission on Fiscal Responsibility and Reform on June 30 in Washington.

Thank you for this opportunity to testify. My name is Katie Robbins and I am here on behalf of Healthcare NOW, an organization founded in 2004 to support bill H.R. 676, “the U.S. National Health Care Act” or Expanded and Improved Medicare for All. With membership in 50 states, Healthcare NOW has broad support for single-payer health care.

Healthcare NOW opposes any consideration of cutting, privatizing or raising age eligibility for Social Security, Medicare, and Medicaid.

We seek to strengthen, not weaken, our social safety net. If passed, H.R. 676 would establish a national single-payer Medicare for All system granting everyone in the United States access to comprehensive, high-quality health care using our existing privately run infrastructure and a progressive financing that will guarantee coverage for all necessary medical care without financial or other barriers.

According to Harvard University studies, eliminating the waste of the multi-payer private insurance industry and moving to a single-payer system will save $400 billion a year. More savings are found in cost controls that a single-payer system can provide such as negotiating drug costs and medical equipment, and global budgeting for hospitals.

Since H.R. 676 was introduced in 2003, it has received tremendous support including endorsements by 582 union organizations in 49 states, the U.S. Conference of Mayors, 63 local governments which include 10 of the nation’s 30 largest cities, the Episcopal Church, the United Methodist Church, the Presbyterian Church, the Unitarian Universalist Church, the Union for Reform Judaism, the United Church of Christ, and the Buddhist Peace Fellowship, and the majority of nurses, patients, and physicians.

Broad support for a single-payer Medicare for All system continues even after the new health law has passed. For example, this past Saturday, June 26, America Speaks, a privately run company, organized “town hall meetings” in 20 cities across the country to discuss the nation’s deficit. America Speaks received funding linked to the Peter Peterson Foundation; the same foundation which is also funding staff to this Fiscal Commission. (Peterson is known to be vocally in support of cutting and privatizing Social Security and Medicare.)

America Speaks claimed that all options would be considered, yet the materials distributed at the events did not include an option to support single-payer health care as a means of controlling health care costs. Despite efforts to silence support for single payer, many participants demanded the option to vote on a single-payer type health care system, which would ultimately reduce costs by making health care more efficient rather than just cutting services in Medicare and other public sector programs. Participants also voted overwhelmingly for defense cuts and for progressive taxation.

Because cost controls are notably absent from the new health law, the National Commission on Fiscal Responsibility and Reform should listen to what the public is urging them to do, and address meaningful cost control in our health care system, which only a single-payer system can provide, as a means to balance the nation’s budget.

We urge you to address cost controls immediately. Healthcare NOW and our network of supporters and allied organizations urge Congress to work to defeat any bill to cut, privatize or dismantle our social safety net – Social Security, Medicare, and Medicaid. We demand the enactment of an expanded and improved Medicare for All, H.R. 676, to fix our economy and our (still) broken health care system.

Proof that individuals game the individual mandate

Short-term insurance buyers drive up cost in Mass.

By Kay Lazar
The Boston Globe
June 30, 2010

The number of people who appear to be gaming the state’s health insurance system by purchasing coverage only when they are sick quadrupled from 2006 to 2008, according to a long-awaited report released yesterday from the Massachusetts Division of Insurance.

The result is that insured residents of Massachusetts wind up paying more for health care, according to the report.

“The active members subsidize some of the costs tied to those individuals who terminate within one year,” the report says.

http://www.boston.com/news/health/articles/2010/06/30/short_term_insurance_buyers_drive_up_cost_in_mass/?rss_id=Boston.com+–+Health+news

Report:
http://www.mass.gov/Eoca/docs/doi/Companies/adverse_selection_report.pdf

Comment: 

By Don McCanne, MD

During the reform process the concern was expressed repeatedly that an individual mandate – requiring individuals to purchase their own health insurance – would result in gaming the system. People would enroll when they needed expensive care, and then drop out after the care was completed. The experience in Massachusetts has demonstrated that it did not take long for the public to learn this game, for this is precisely what has happened. Nevertheless, the individual mandate is now the law of the land.

Options being considered to reduce this form of adverse selection include, as examples, allowing open enrollment for only one month per year, or increasing the penalty for remaining uninsured. Although such measures might reduce this tendency to game the system, they will not eliminate it.

It is the structure of the financing system that is fundamentally flawed. It cannot be fixed merely by tweaking the mandate, nor by tweaking the thousands of other provisions in this dysfunctional system. It needs to be replaced with a structurally sound system.

With a single payer national health program the issue of an individual mandate would be moot since everyone would be enrolled, automatically, throughout life.

Scare Tactics, Spin and Health Care

Liberals and Single-Payer

By HELEN REDMOND
Counterpunch, June 29, 2010

Liberals are on a mission to convince a skeptical public the Patient Protection and Affordable Care Act (known by the last three letters, ACA) should not only be supported, it’s actually a good piece of legislation, a step in the right direction. Nothing could be further from the truth.

In their article on the website Salon.com last month titled “A Practical Guide Forward for Progressives on Health Care,” authors Ellen R. Shaffer and Judy Norsigian admonish health care activists, particularly supporters of single-payer, for not enthusiastically promoting the ACA. Then they warn if we don’t stop “simmering” because we’re “convinced that it [the ACA] did too much for private insurers and too little for average Americans,” we’re playing into the “right’s hand.”   

It is incomprehensible how two long-standing feminists, articulate champions of a women’s right to control their bodies, Norsigian’s Our Bodies Ourselves — a seminal book that launched the movement for women’s rights in health care — could compromise away their core values and beliefs and shill for a piece of legislation that further restricts women’s reproductive rights. The Stupak-Pitts Amendment should have been an automatic deal breaker for anyone pro-choice. In a second slap in the face to women, President Obama signed an executive order ensuring no federal money could be used for elective abortions even though the Hyde Amendment already guarantees it. Shaffer and Norsigian should have been outraged at Obama’s placating of anti-abortion fanatics. These fierce advocates for women’s health should have publicly denounced and withdrawn their support for the misogynist legislation. Instead, they supported the Democrats who bargained away a woman’s right to control her own body to rabid Blue Dogs and religious plankton, thus eroding abortion rights even further.  

No mention of the restriction on abortion in their article (except to say they were “disappointed”), or the life changing impact it will have on women, especially poor women. Instead they recommend: “Progressives should appreciate that he [Obama] overcame obstacles that have sunk every reform effort over the past 10 years and managed to sign a bill into law.”

Shaffer and Norsigian, in one of America’s longest and most politically toxic traditions aimed exclusively at the left, tell us to suck it up, stop criticizing the president, the Democratic Party and inadequate legislation no matter how disgusted or disappointed you feel. Or else! Or else you, yes you the two women write, are “… handing control of the country back to the most extremist Republican Party in history.”

Really? More extreme than Reagan or the Bushes?   

When Democrats in power sell out to corporate interests, pass legislation that falls far short of campaign promises and their populist rhetoric resonates less and less with an angry electorate, “progressives” in the Democratic Party set themselves two tasks: scare and spin. They create panic and fear of the Republican Party regaining congressional seats, the presidency and exaggerate, lie (or lies of omission) about the effects of reform legislation.

The passage of the ACA is a classic example. In the end, desperate for a victory no matter how hollow, establishment liberals were willing to concede anything in order to pass anything.

Norsigian and Shaffer assert the insurance industry is “predatory, dishonest and parasitic” and admit “we would be better off without it.” They’re right, but they don’t believe it’s possible to put them out of business. Instead, we must always and everywhere be vigilant, forever engaged in thousands of battles against every insurer, in every state, as well as ready to fight with employers who eliminate benefits, increase cost sharing, discriminate against women or drop coverage.

These separate battles have been going on for decades. It’s a divide and conquer loser strategy. The predatory, dishonest and parasitic insurance industry has to be eliminated. That is the lesson we have learned the hard way over decades in this country and that is the prerequisite to create the health care system Norsigian and Shaffer say they want. Yet the authors were not active in the nation-wide, grassroots single-payer movement. Instead they supported the public option: another dead end proposal and diversion from the struggle for single-payer.

Their article struggles unconvincingly and in a patronizing tone to convince those of us who wanted fundamental change (single-payer) to abandon that goal and work to improve the ACA.

Norsigian and Shaffer tell us there are four myths about the legislation that have duped us into less than sanguine support of ACA.

Myth: “Progressive activists should ignore or undermine the new law which will get us to single payer more quickly.”

Single-payer activists aren’t ignoring the new law, we are vocal critics of it. We unapologetically opposed the passage of the ACA because it enriches and further entrenches the insurance industry. Our mission is to continue exposing insurance company abuses. It’s not hard to do because of their sheer audacity. A few days after the bill was signed, insurers argued coverage of children with disabilities wouldn’t begin immediately as President Obama had publicly announced. In Massachusetts, the predators tried to increase premiums up to 30 percent. This month Obama summoned the parasites to a private meeting at the Whitehouse and warned them not to use the bill “as an opportunity to enact unjustifiable rate increases that don’t boost care and inflate their bottom lines.” Does anyone believe the insurers won’t?    

Ron Pollack of Families USA, Kathleen Sebelius, the Secretary of Health and Human Services, the remnants of Health Care for America Now (HCAN) have launched a national campaign to sell the bill to the public. Single-payer supporters need to be similarly engaged but in the opposite direction, to expose and explain the not-so-fine print of the ACA: no caps on premiums; allows for gender rating in large group plans with more than 100 hundred employees; permits employers and insurers to charge three times more based on age and certain health conditions; Stupak-Pitts anti-abortion amendment; and millions of undocumented immigrants denied health care.     

Myth: “The new law won’t save money because the insurance industry is still standing.”   

The reality is the legislation cannot control costs. The cost drivers of the current system remain in place: no regulation on insurance premiums; excessive and wasteful administrative costs; Medicare forbidden to negotiate drug prices; and outrageous insurance and pharmaceutical profits.

Myth: “The insurance industry is still standing because President Obama made a backroom deal.”

Norsigan and Shaffer argue Obama made transparent-to the-public deals with the insurance and drug industries. What planet are they on? The fact is Obama, Kennedy, and Baucus met privately and made deals with America’s Health Insurance Plan’s (AHIP) CEO Karen Ignagi and Billy Tauzin, the former CEO of PhRMA. C’mon. The health industry spent $3 billion lobbying members of Congress from 2008-2009. That money buys behind the scenes access, influence and agreements. Like a thief in the night, Tauzin went to the Whitehouse and demanded and got from President Obama the extension of patents for biotech drugs to 12 years; no drug reimportation from Canada; and no negotiating for drug prices in the Medicare program. I don’t recall the health care summit at the Whitehouse with all the “players” at the table, cameras flashing and videos recording when that billion dollar deal
went down.  

Myth: “The country is ready to go for a Medicare-for-all single-payer system, run by the government.”

The authors believe the public has “mixed feelings about the government.” Not according to numerous polls.

A Kaiser Poll in July, 2009 found 58 percent of Americans support “A national health plan in which all Americans would get their insurance through an expanded, universal form of Medicare for all.” Another Kaiser poll found 49 percent of Americans support “Having all Americans get their insurance from a single government plan.” Doctors want single-payer, too. In 2008, a survey of physicians in the Annals of Internal Medicine found 59% agreed either “strongly” or “generally” with the statement: “In principle, do you support or oppose government legislation to establish national health insurance.”

The authors have “mixed feelings” about a single-payer, government-run health system, it’s not the American people.

At the end of the article the authors assert, “With the new law, we have won policy space to further challenge corporate control, including control of the health care system.” Again, what planet are Shaffer and Norsigian on? How does giving the predatory, dishonest and parasitic insurance industry $447 billion in taxpayer money and a mandate to punish those who don’t buy their defective product help our side to challenge or control them?

John Nichols, a liberal writer for The Nation and some time supporter of single-payer, engages in scare and spin, too. In his article titled, “The Unexpected Winning Issue for Democrats: Healthcare,” he warns Republicans are gearing up to repeal the ACA. Nichols reports Republican Senate candidate Carly Fiorina still has a “Repeal It!” petition on her campaign website. We’re supposed to be afraid of that? Republican nutjob Ron Johnson who is challenging Russ Feingold is a credible threat to overturning the legislation because he asserts, “The health care bill is the greatest assault on our freedom in my lifetime. It must be repealed.” Please! LOL.

Scare tactics applied, Nichols goes on to celebrate a recent poll showing increased support for the ACA, “as imperfect as it may be.” Imperfect is an understatement. Moreover, he’s happy 51 percent of Americans trust Democrats to do a better job [than Republicans] of responding to health care issues. Should undocumented workers, women who want abortions and the 23 million who still won’t be insured in 2019 trust the Democrats?  

Nichols counsels, “Smart Democrats will run as savvy backers of reform who talk about it as a first step…” The legislation is not a first step, it is a step backwards and to argue otherwise is simply dishonest.  

Millions of Americans don’t support the bill because they don’t understand its implications (it’s 2000-pages and regulations are still be written), or they flat out reject the ACA because it doesn’t go far enough; it’s not change they can believe in. And those who oppose the bill are not all Teabaggers, either.

Ultimately for liberals like Shaffer, Norsigian and Nichols the reelection of Democrats trumps the needs of Americans literally dying for fundamental health care reform. Years from now when the ACA is completely discredited and understood as yet another failed attempt to reform the health care system, liberals that engaged in scare and spin tactics and provided cover for a very bad bill that betrays the majority of people will have much to answer for.   

Helen Redmond is a single-payer activist with the Chicago Single-Payer Action Network. She can be reached at: redmondmadrid@yahoo.com

http://www.counterpunch.org/redmond06292010.html

Vermont attorney general’s office must reconsider Leddy decision

Editor’s note: What follows is an open letter from James Marc Leas, an attorney in Burlington to the Vermont Attorney General’s office. The letter is followed by the AG office’s original response.

June 27, 2010

Dear Attorney General Sorrell and Deputy Attorney General Janet C. Murnane:

Thank you for the letter dated June 25, 2010 from Deputy Attorney General Janet C. Murnane. I was very concerned when I submitted my June 21, 2010 letter to you. But now I am far more concerned about violation of the Vermont Commission on Health Care Reform statute than I was then. I request further reconsideration based on the following points.

1. Deputy Attorney General Murnane’s letter admits that “the AARP itself appears to have substantial financial arrangements or relations with several insurance companies; however, we are not aware of any information which shows that Mr. Leddy himself has any relation to any insurance company, official or otherwise.”

I would also respectfully ask you to consider that Ms. Murnane’s letter admits that Mr. Leddy serves as President of the Vermont AARP and servers on an advisory council of the national AARP. That role is what gives him the relation to the insurers.

Since organizations are not alive, it is the people who run organizations who carry out the official relations for the organization. In his role as top officer of the Vermont AARP Mr. Leddy has the responsibility for official relations of the Vermont AARP with the insurers with which the AARP holds lucrative contracts. In fact, the AARP itself admits that the AARP mission includes providing the health care products and that the Vermont AARP President’s job includes achieving this mission [1].

2. Subsection 901(b)(2)C recognizes that a person can have a connection with the operation of a health care insurer without being an employee of a health care insurer. Ms. Murnane’s letter does not address this possibility though she correctly quotes its terms: “the two nonvoting members with experience in health care shall not … in any manner, be connected with the operation of a health care provider or insurer…”

I would respectfully ask you to consider that facilitating sales of health care insurers connects AARP with the operation of health care insurers. While the AARP states that it does not itself sell health insurance, the AARP does offer health insurance products and license its trademark for the sale of health insurance products by the insurers. By offering itself as the public face that facilitates sales of insurance company products AARP is connected with the operation of health care insurers and is performing an operation of the health care insurers.

The President of the Vermont AARP is responsible for achieving the caring and trustworthy public face the insurers require to sell their wares and for achieving the mission of the AARP, which includes offering these health insurance products for health insurers and licensing the AARP name to health insurers in exchange for hundreds of millions of dollars of licensing revenue from the insurers.

AARP portrays itself as so caring and trustworthy that, not just Jim Leddy, but all of AARP’s state presidents, its entire national board of directors, and all its national officers serve as unpaid volunteers. Where, as here, hundreds of millions of dollars are at stake for the organization, such volunteering appears to be a strategic policy to maintain the needed kind, caring, trustworthy public face that makes the AARP name valuable for its lucrative trademark licensing and its extensive lobbying.

One cannot be a top official of the AARP and not in at least some manner be connected with its offering, licensing and public face operations. The AARP receives half its income from insurers for these operations so this is a substantial part of its efforts. The issue is whether the President of the Vermont AARP is connected with the real and substantial AARP operation of being the public face for the insurers.

Instead of addressing whether the President of the Vermont AARP is “in any manner” involved in the high dollar connection of AARP with health insurers in his role as top official of the Vermont AARP and a member of the AARP national policy council, Ms. Murnane’s letter goes elsewhere. Her letter states, “his unpaid positions with the AARP do not include the authority or responsibility to operate a health care provider or insurer, and the audited records of the AARP make it reasonably clear that the AARP itself is neither a health care provider nor an insurer.”

Her letter does not address the statutory issue of how the President of the Vermont AARP can possibly avoid any connection with the AARP offering, licensing, and public face operation of health care insurers with whom the AARP has hundreds of millions of dollars of revenue from licensing contracts. I would respectfully ask you to consider that it is the fundamental job of the President to act vigorously to ensure the success of the lucrative AARP offering, licensing, and public face operation.

3. Ms. Murnane’s letter admits that the AARP holds contracts with health care insurers. Top officers, including the President of an organization, are responsible for making and performing contracts of the organization. The President of the Vermont AARP is the top responsible person in Vermont [2].

Not only would he be responsible for making or performing business contract with health care insurers, he would also have a fiduciary responsibility to the AARP to keep such lucrative contracts going while offering advice to the commission. This is not a matter of integrity. This is a matter of fiduciary responsibility in his role as AARP President.

Nothing in Ms. Murnane’s letter recognizes or addresses how a President of the Vermont AARP can be said to be free of all such relations, connections, and responsibility for making and performing the lucrative contracts that AARP has with heath care insurers. And how the President can avoid his fiduciary responsibility to AARP to maintain those contracts for that organization while serving on the Commission.

Finally, Ms. Murnane’s letter includes a point that raises a very troubling question about the rule of law in our state. I am shocked by her statement that the level of observance of the law by government officials is determined by what a court would allow, and that in this case a court would allow a substantial level of violation, as long as it is not “a gross departure.” I believe that the public demands the highest level of respect for the rule of law and the highest standard of observing each and every one of the requirements of the law by government officials. Government officials have a duty to set an example for the rest of us. Particularly where political considerations may apply or where the individual has a good reputation for service to the community, the temptation to depart from the requirements of law may be strongest and should be more firmly resisted. The office of the Attorney General weakens his case by resorting to putting on the public record the view that government officials need only observe the absolute lowest possible standard that a court would enforce. Resort to this argument is acknowledgment that Vermont has a problem in the participation of an individual on the commission while he simultaneously serves as the President of the Vermont AARP.

I would ask you to reconsider. I urge you to issue an opinion that an individual cannot serve as the top official of the AARP while serving on the Commission, and that if Jim Leddy wishes to serve on the Commission he should step down as President of the Vermont AARP. Thank you very much for your reconsideration of this important matter.
_________________________________

[1] When Jim Leddy was named AARP Vermont State President in 2008 a news release stated that it was “a vol
unteer position working closely with both staff and volunteers throughout the state to help AARP achieve its mission in Vermont.”

The “AARP mission statement” states, “What Is the Mission of AARP? AARP is a nonprofit, nonpartisan membership organization for people age 50 and over. AARP is dedicated to enhancing quality of life for all as we age. We lead positive social change and deliver value to members through information, advocacy and service. AARP also provides a wide range of unique benefits, special products, and services for our members.”

The “wide range of unique benefits, special products, and services” includes health care insurance products.

[2] No one disputes that the President of BP has an official relation with, a connection with, and is responsible for the contract with the actual drilling company. And not just because he is paid.

Sincerely,
James Marc Leas

Law Office of James Marc Leas

37 Butler Drive, South Burlington, Vermont 05403

The letter from Jane Murmane, deputy attorney general follows:

June 25, 2010

Dear Mr. Leas and Professor Nicosia:

This is in reply to your recent messages to the Attorney General’s Office about the appointment of James Leddy to the Vermont Commission on Health Care Reform. I have reviewed your concerns with Attorney General Sorrell.

As you are aware, Act 128 created this Commission to monitor health care reform initiatives and to make recommendations to the General Assembly. The Act authorized the Speaker of the House to fill one of the nonvoting positions on the Commission. Absent a gross departure from the appointment standards established by the Legislature — something very remote from the circumstances here — the Speaker’s appointment would not be disturbed by the courts.

Nor is the Speaker’s decision subject to approval by the Attorney General. The Attorney General’s Office reviewed Act 128 and the Leddy appointment in response to a citizen complaint. We responded in a public way to the original complaint because the complaint itself was widely publicized. Your messages repeat concerns raised in the prior complaint and add to them by citing other subsections of the appointment statute. The purpose of this message is to respond to your concerns and to confirm our view that there is nothing in any subsection of the statute that would prohibit Mr. Leddy’s appointment to the Commission. The statutory prohibitions and our comments are as follows:

2 V.S.A. § 901(b)(2)(A) provides that “the two nonvoting members with experience in health care shall not … be in the employ of or holding any official relation to any health care provider or insurer or be engaged in the management of a health care provider or insurer…”

Comment: Mr. Leddy is not employed by an insurance company because the AARP is not an insurance company, nor is he “employed” by the AARP. We are informed that he holds an official relation to the AARP in the sense that he is the unpaid president of the Vermont AARP entity and serves as an unpaid member of an AARP advisory council. But, again, the AARP is not an insurance company. The AARP itself appears to have substantial financial arrangements or relations with several insurance companies; however, we are not aware of any information which shows that Mr. Leddy himself has any relation to any insurance company, official or otherwise. Nor are we aware of any information which shows that Mr. Leddy is employed by or holds any official relation to any health care provider.

2 V.S.A. § 901(b)(2)(B) provides that “the two nonvoting members with experience in health care shall not …own stock, bonds, or other securities of a health care provider or insurer, unless the stock, bond, or other security is purchased by or through a mutual fund, blind trust, or other mechanism where a person other than the member chooses the stock, bond, or security …”

Comment: We are not aware of any information which shows that Mr. Leddy owns any securities as described in this subsection.

2 V.S.A. § 901(b)(2)(C) provides that “the two nonvoting members with experience in health care shall not … in any manner, be connected with the operation of a health care provider or insurer…”

Comment: We are not aware of any information which shows that Mr. Leddy is connected with the operation of a health care provider or insurer. His unpaid positions with the AARP do not include the authority or responsibility to operate a health care provider or insurer, and the audited records of the AARP make it reasonably clear that the AARP itself is neither a health care provider nor an insurer.

2 V.S.A. § 901(b)(2)(D) provides that “the two nonvoting members with experience in health care shall not … render professional health care services or make or perform any business contract with any health care provider or insurer if such service or contract relates to the business of the health care provider or insurer, except contracts made as an individual or family in the regular course of obtaining health care services.”

Comment: We are not aware of any information which shows that Mr. Leddy renders health care services or makes or performs contracts with health care providers or insurers. Mr. Leddy holds volunteer positions with the AARP and the AARP makes contracts with health insurers. However, by its terms the subdivision (D) prohibition applies only to persons who themselves provide health care services or perform tasks fairly described as making (negotiating, drafting, signing) business contracts with care providers and insurers, or performing those contracts. It does not apply to every person “holding any official relation to” any entity that renders the services or makes or performs the contracts described in subsection (D). That broad prohibition applies only to persons having an official relation to health care providers and insurance companies, see 2 V.S.A. § 901(b)(2)(A) above, and Mr. Leddy is not such a person.

In summary, we are not aware of any information that would disqualify Mr. Leddy for service on the Vermont Commission on Health Care Reform.

You do note Jim Leddy’s long history of dedicated and honorable public service. We have little doubt that Speaker Smith weighed Mr. Leddy’s considerable experience and expertise in deciding to make the appointment that, again, was his alone to make.

We have opined and reopined that the Leddy appointment did not violate the letter of the law. You remain free to disapprove of and be disappointed by the appointment. You also remain free to express such feelings directly to the Speaker.

Sincerely, Janet Murnane

cc: Speaker Shapleigh Smith (by mail)
Janet C. Murnane
Deputy Attorney General
Vermont Attorney General’s Office
109 State Street
Montpelier, VT 05609-1001

Leas: Attorney general’s office must reconsider Leddy decision