PNHP

"Narrow networks" take away choice

"Narrow networks" take away choice

Health Net set to offer discounted insurance

By Ken Alltucker
The Arizona Republic, November 3, 2011

Health Net of Arizona is teaming with Banner Health to offer a new health-maintenance-organization insurance plan that allows businesses and their workers access to discounted care if they agree to limit their network of health providers.

The Health Net ExcelCare HMO plan offers customers a network exclusively made up of Banner Health Network medical providers and Banner Health hospitals.

Although it’s Health Net’s initial foray into “narrow networks” in Arizona, the health insurer said that it has had success enticing both large and small employers in California to choose similar plans with slimmed-down networks.

Health Net has been among the most aggressive in promoting HMO plans with narrow networks, but other insurance companies such as Aetna and UnitedHealth Group have also offered such plans.

http://www.azcentral.com/business/articles/2011/11/01/20111101health-net-offer-discounted-insurance.html

Comment: 

By Don McCanne, MD

“Narrow networks” – sharply limiting the network of physicians and hospitals that the insurer will cover – is yet another example of private insurer innovation in their marketed products. Only in the private sector can taking away patients’ choices in their health care professionals and institutions be considered an improvement in product design. A public single payer system would be designed to enhance access, not restrict it.

“Narrow networks” take away choice

Health Net set to offer discounted insurance

By Ken Alltucker
The Arizona Republic, November 3, 2011

Health Net of Arizona is teaming with Banner Health to offer a new health-maintenance-organization insurance plan that allows businesses and their workers access to discounted care if they agree to limit their network of health providers.

The Health Net ExcelCare HMO plan offers customers a network exclusively made up of Banner Health Network medical providers and Banner Health hospitals.

Although it’s Health Net’s initial foray into “narrow networks” in Arizona, the health insurer said that it has had success enticing both large and small employers in California to choose similar plans with slimmed-down networks.

Health Net has been among the most aggressive in promoting HMO plans with narrow networks, but other insurance companies such as Aetna and UnitedHealth Group have also offered such plans.

http://www.azcentral.com/business/articles/2011/11/01/20111101health-net-offer-discounted-insurance.html

“Narrow networks” – sharply limiting the network of physicians and hospitals that the insurer will cover – is yet another example of private insurer innovation in their marketed products. Only in the private sector can taking away patients’ choices in their health care professionals and institutions be considered an improvement in product design. A public single payer system would be designed to enhance access, not restrict it.

IBEW International Convention Endorses Single Payer

By Kay Tillow
All Unions Committee For Single Payer Health Care–HR 676, 11/02/2011

The 38th convention of the International Brotherhood of Electrical Workers (IBEW) has endorsed single payer health as a solution to the nation’s health care crisis.

The 3,000 delegates who attended the IBEW convention called upon “…our international officers (to) do everything in their power and authority to work with other groups and elected officials to build support and action for universal single payer health insurance….”

The IBEW represents over 725,000 members in the United States and Canada and is one of the largest building trades unions affiliated with the AFL-CIO.  The September 2011 convention was held in Vancouver, Canada.

Ed Hill, IBEW International Union President who presided at the convention, said afterwards:

“The IBEW believes that single-payer health insurance in the United States is a worthy long-term goal.  While a national single-payer system currently has little chance of becoming a reality in the near future, the 38th IBEW International Convention wanted to go on record in support of the concept in order to help nudge the debate forward and keep the issue in front of elected officials.”

Resolution 60 on single payer, which was submitted by IBEW Local 23 in St. Paul, Minnesota,  and passed by the convention, cites the fact that the United States is spending 16 percent of our Gross Domestic Product on health care but:

“…(T)he battle with employers is on-going concerning the increases in health care costs;  battles which for the most part we are losing in the form of costs being passed on to our members;”

Resolution 60 states that, “…(R)etirees who have previously sacrificed to obtain health care benefits are now being stripped of those benefits;”

and says that “a universal single payer health care plan would reduce wasteful costs to all Americans while continuing to provide excellent health care coverage.”

Resolution 60 also calls for sending a copy of the resolution “… to all elected officials in the United States House and Senate and to all elected state legislators.”

http://unionsforsinglepayer.org

Dave Zweifel on single payer

Plain Talk: Health care solution is simple: single-payer

By Dave Zweifel
The Capital Times, November 2, 2011

The answer to the nation’s health care crisis is staring everyone in the face, yet as a country we continue to refuse to come to grips with it.

It is far from rocket science. What this country simply needs is a single-payer national health insurance program that covers all American citizens from the day they’re born to the day they die — just as other advanced countries have done for decades.

We could finance health care coverage for every American by taking the resources that employees and employers are pumping into the current broken system and still have money left over for a substantial tax cut, not to mention that it would put U.S. employers back on a level playing field with their competitors in the world market.

Yet we refuse to even put that debate on the front burner where it belongs, plodding along with a system that with each passing year continues to hurt more and more Americans in many different ways.

(Dave Zweifel is editor emeritus of The Capital Times.)

http://host.madison.com/ct/news/opinion/column/dave_zweifel/article_e26dbb61-a1d2-5a03-86b6-ff2e6524596f.html

Comment: 

By Don McCanne, MD

As the implementation of the Affordable Care Act unfolds, it becomes ever more evident that it won’t accomplish our goals and that we will need to enact a single payer national health program.

Dave Zweifel on single payer

Plain Talk: Health care solution is simple: single-payer

By Dave Zweifel
The Capital Times, November 2, 2011

The answer to the nation’s health care crisis is staring everyone in the face, yet as a country we continue to refuse to come to grips with it.

It is far from rocket science. What this country simply needs is a single-payer national health insurance program that covers all American citizens from the day they’re born to the day they die — just as other advanced countries have done for decades.

We could finance health care coverage for every American by taking the resources that employees and employers are pumping into the current broken system and still have money left over for a substantial tax cut, not to mention that it would put U.S. employers back on a level playing field with their competitors in the world market.

Yet we refuse to even put that debate on the front burner where it belongs, plodding along with a system that with each passing year continues to hurt more and more Americans in many different ways.

(Dave Zweifel is editor emeritus of The Capital Times.)

http://host.madison.com/ct/news/opinion/column/dave_zweifel/article_e26dbb61-a1d2-5a03-86b6-ff2e6524596f.html

As the implementation of the Affordable Care Act unfolds, it becomes ever more evident that it won’t accomplish our goals and that we will need to enact a single payer national health program.

Health care solution is simple: single-payer

By DAVE ZWEIFEL | Cap Times editor emeritus
The Capital Times (Madison, Wis.), Nov. 2, 2011

The answer to the nation’s health care crisis is staring everyone in the face, yet as a country we continue to refuse to come to grips with it.

Late last month, the state’s secretary of health services, Dennis Smith, held hearings to let people sound off about planned cuts to Wisconsin’s BadgerCare and Family Care programs. The state says it needs to reduce health care spending by some $554 million over the next two years, which is likely to leave tens of thousands of Wisconsin low-income citizens without health care coverage once again.

At around the same time Smith was holding his hearings, former Wisconsin governor and U.S. health secretary Tommy Thompson was telling a WisPolitics.com luncheon audience that American companies often find themselves at a competitive disadvantage because their health insurance costs are so much higher than those of companies in other countries.

But neither Smith nor Thompson, nor most of our state and national leaders, can bring themselves to a simple obvious solution to this continuing quandary that has faced Americans for the past several decades.

It is far from rocket science. What this country simply needs is a single-payer national health insurance program that covers all American citizens from the day they’re born to the day they die — just as other advanced countries have done for decades.

Bill Kraus, who was a confidant of the late Wisconsin Republican Gov. Lee Dreyfus, in a column on FightingBob.com last week traced the sad history of America’s health system. He went back to the days of Franklin D. Roosevelt, pointing out that Secretary of Labor Frances Perkins first proposed a national health care plan as part of the president’s vast New Deal program aimed at ending the Great Depression.

Before Congress was able to seriously debate the plan, World War II intervened, but it was revived again by President Harry Truman, only to run into stiff opposition from a Congress that was sympathetic to the American Medical Association and the U.S. Chamber of Commerce.

“The AMA exploited the power of the Chamber of Commerce to expand the fledgling health insurance industry by convincing its insurance company members to go into that business despite the dim prospects that (they) could make a profit,” Kraus wrote. “Over time the insurance industry solved the profit problem and private health insurance became a member of the status quo which is committed to protecting the status quo against change.”

The insurance lobby and others who benefit from the current system — decrying what they call “socialized medicine” — beat Richard Nixon when he tried to reform health care, destroyed Bill Clinton’s plan in the 1990s and now continue to fight tooth and nail against Barack Obama’s plan, which promises to at least provide health care coverage to most Americans but hasn’t been able to stem the rising costs.

“These oversights brought the shortsighted Chamber of Commerce into the battle against ‘socialized medicine’ again despite the woes many of their members were experiencing as they tried to price the products they were trying to sell abroad competitively,” Kraus noted.

So what we have today is a system that costs Americans nearly double the cost of single-payer national health insurance — in short, Medicare for all — in countries like England, France, Germany, Canada and even China.

We could finance health care coverage for every American by taking the resources that employees and employers are pumping into the current broken system and still have money left over for a substantial tax cut, not to mention that it would put U.S. employers back on a level playing field with their competitors in the world market.

Yet we refuse to even put that debate on the front burner where it belongs, plodding along with a system that with each passing year continues to hurt more and more Americans in many different ways.

Dave Zweifel, editor emeritus of The Capital Times, has been with the newspaper since June 1962, a day after he graduated with a journalism degree from the University of Wisconsin-Madison.

http://host.madison.com/ct/news/opinion/column/dave_zweifel/article_e26dbb61-a1d2-5a03-86b6-ff2e6524596f.html#ixzz1cYgAiYy1

Roll cuts won’t aid Medicare

By Jonathan D. Walker, M.D.
The Journal Gazette (Fort Wayne, Ind.), Oct. 30, 2011

When it comes to our health care system, sometimes the obvious thing is the wrong thing. For instance, it seems obvious that if Medicare is a big part of government spending, we simply need to reduce the number of people on Medicare to save money. Unfortunately, what seems obvious on the surface can backfire in practice.

There is a proposal to raise the Medicare eligibility from 65 to 67 years of age. Sen. Dan Coats discussed it just last week at the Chamber of Commerce. That sounds like it would save a lot of money, but it doesn’t. The Kaiser Family Foundation, a nonpartisan organization that evaluates health care issues, estimated that raising the age will save about $5.7 billion. Medicare pays out more than $500 billion a year, so it saves only about 1 percent.

Plus, someone else will have to cover the cost of caring for those people. It is estimated that those 65- and 66-year-olds will end up with an additional $3.7 billion in out-of-pocket costs when they lose Medicare. In addition, their employers will need to get them insurance, and people in that age range are expensive to insure – for-profit insurers are reluctant to cover them. Employers would have to pay an additional $4.5 billion for their insurance, and that means higher costs for the rest of us.

This next problem shows how complex our health care system is. Compared to other patients on Medicare, 65- and 66-year-old patients are relatively healthy. When they are taken out of Medicare, the result is that Medicare has to cover a risk pool that is sicker. Those younger and healthier 65- and 66-year-olds are no longer paying premiums into Medicare, so it costs us more to insure everyone over 67.

But those same 65- and 66-year-olds are sicker compared to younger people, so when they are added to the risk pool of people below 65, they drive up the cost of insuring everyone below that age. All this means that both private insurance and Medicare costs would be driven up, estimated to cost the rest of us about $2.5 billion. Finally, some of them will end up on Medicaid, costing states about $700 million.

In other words, in order to save the government $5.7 billion, we have to pay at least $11.4 billion, mostly because it is so much cheaper to cover people with Medicare than with private insurance. Furthermore, a lot of those 65- and 66-year-olds would no longer be able to afford insurance at all, so their health would suffer.

Raising the Medicare age is one of those things that seems like a great idea, but we would be paying at least $2 to save the government $1. There are far more effective ways for Medicare to save money without compromising care, but politicians and lobbyists don’t want to go there.

Dr. Jonathan D. Walker is a member of Hoosiers for a Commonsense Health Plan. He wrote this for The Journal Gazette.

http://www.journalgazette.net/article/20111030/EDIT05/310309977/1144/EDIT05

Health Care Blues – or, Why Exactly Don’t We Have Single-Payer National Health Insurance?

By J. Wesley Boyd, M.D., Ph.D.

Imagine the following exchange on the phone:

“Is this 911?”

“Yes.”

“I have an armed intruder in my house. Please send the police right away. I’m afraid he’s going to kill us all.”

“I’m sorry. From our database, I see the household you are calling from does not have anyone who is employed and therefore you are not entitled to police protection. You’ll have to fend off the intruder yourself. Bye.” (Click.)

Or imagine this scenario, which might hit a bit closer to home for those of us who have a family member who is employed:

“Is this 911?”

“Yes.”

“I have an armed intruder in my house. Please send the police right away. I’m afraid he’s going to kill us all.”

“I see from our database that your employment provides you with our Best Blue police coverage. Best Blue is a wonderful protection plan. We will be able to send an officer out just as soon as we receive your credit card number for your $10 co-pay. Also, once the officer arrives – assuming your credit card payment is approved by MasterCard – he will be able to use his revolver to stop the intruder but not his shotgun. You’ll have to pay the full cost of shotgun coverage yourself. With the Blue plan, the officer can pursue a suspect on foot free of charge to you, but if the officer needs to pursue in his cruiser, you would have to foot (I’m so sorry for the pun) that bill yourself. Also, we would not be able to provide you with the aerial support that we provide our Gold members but, don’t worry, almost nobody needs that kind of service. And finally, as it states on page 28 of your coverage manual, Blue coverage does assume you are at least a Brown Belt in Karate, so that statistically you would be able to fend off intruders half of the time by yourself . . .”

Sounds pretty bizarre, right? But we Americans accept the same reasoning all of the time with respect to our health care coverage. And it’s going to get even more interesting — and that’s a euphemism — once national health reform is fully implemented.

Why is that? Because the simplest and fairest and most ethical and least costly option for health reform, namely single-payer national health insurance, is not the law of the land.

For more, see Physicians for a National Health Program: pnhp.org.

J. Wesley “Wes” Boyd, M.D., Ph.D., is on faculty in psychiatry at Harvard Medical School, is a staff psychiatrist at Children’s Hospital Boston and at Cambridge Health Alliance (CHA), and is the founder and co-director of the Human Rights and Asylum Clinic at CHA.

http://www.jwesleyboyd.com/

Medicare Advantage patients for sale on Wall Street

How much are you worth to HMOs?

By Carol Gentry
Health News Florida, October 28, 2011

Medicare health plan members are worth more than any other category of enrollee in a merger or acquisition deal, Wall Street analysts say.

In fact, they’re worth four times as much as members of employer-based plans and five times as much as members of Medicaid plans, according to a report from Goldman Sachs researchers Matthew Borsch and Samuel Wass.

By their calculations, Medicare Advantage (HMO or similar managed-care plan) enrollees have a “value per member” of $6,000 in a merger or acquisition.

That compares with $1,500 for commercial plans – the ones that employers offer but in which the insurer takes the financial risks – and $1,200 per member for Medicaid plans.

The researchers prepared the analysis in the wake of Monday’s announcement that Cigna will buy HealthSpring, a holding company that includes Medicare plans in 11 states and Washington, D.C. that encompass 340,000 members.

Other analysts have also noted the mega-insurers’ growing desire to acquire Medicare customers. As Carl McDonald of CitiGroup wrote today in a note about Universal American: “It’s hard to overstate how much the attitude of the largest plans …has changed toward the Medicare business in just the last six months.”

United Health Group was first to discover the pot of gold Medicare plans offered and bought PacifiCare in 2005, as McDonald notes, but now WellPoint, Cigna and Aetna are waking up.

http://www.healthnewsflorida.org/top_story/read/how_much_are_you_worth_to_an_hmo

Comment: 

By Don McCanne, MD

Bet you didn’t realize that by signing up with a taxpayer-financed, private Medicare Advantage plan you can command a price of $6000 for the sale of yourself when your plan is acquired by another plan. Well, actually you don’t get the $6000. Neither does it revert to Medicare and the taxpayers. No, it goes to the top 1 percent, while leaving the 99 percent of us once again dumbfounded.

What price does a person in the traditional Medicare program command? What a ridiculous question. Medicare doesn’t buy and sell patients. That happens only when Medicare patients are privatized. Selling patients is a function limited to private plans, not public social insurance programs.

When are we finally going to say that we are not for sale to the 1 percent? Since it was Congress that arranged the sale, let’s Occupy Congress!

Medicare Advantage patients for sale on Wall Stree

How much are you worth to HMOs?

By Carol Gentry
Health News Florida, October 28, 2011

Medicare health plan members are worth more than any other category of enrollee in a merger or acquisition deal, Wall Street analysts say.

In fact, they’re worth four times as much as members of employer-based plans and five times as much as members of Medicaid plans, according to a report from Goldman Sachs researchers Matthew Borsch and Samuel Wass.

By their calculations, Medicare Advantage (HMO or similar managed-care plan) enrollees have a “value per member” of $6,000 in a merger or acquisition.

That compares with $1,500 for commercial plans – the ones that employers offer but in which the insurer takes the financial risks – and $1,200 per member for Medicaid plans.

The researchers prepared the analysis in the wake of Monday’s announcement that Cigna will buy HealthSpring, a holding company that includes Medicare plans in 11 states and Washington, D.C. that encompass 340,000 members.

Other analysts have also noted the mega-insurers’ growing desire to acquire Medicare customers. As Carl McDonald of CitiGroup wrote today in a note about Universal American: “It’s hard to overstate how much the attitude of the largest plans …has changed toward the Medicare business in just the last six months.”

United Health Group was first to discover the pot of gold Medicare plans offered and bought PacifiCare in 2005, as McDonald notes, but now WellPoint, Cigna and Aetna are waking up.

http://www.healthnewsflorida.org/top_story/read/how_much_are_you_worth_to_an_hmo

Bet you didn’t realize that by signing up with a taxpayer-financed, private Medicare Advantage plan you can command a price of $6000 for the sale of yourself when your plan is acquired by another plan. Well, actually you don’t get the $6000. Neither does it revert to Medicare and the taxpayers. No, it goes to the top 1 percent, while leaving the 99 percent of us once again dumbfounded.

What price does a person in the traditional Medicare program command? What a ridiculous question. Medicare doesn’t buy and sell patients. That happens only when Medicare patients are privatized. Selling patients is a function limited to private plans, not public social insurance programs.

When are we finally going to say that we are not for sale to the 1 percent? Since it was Congress that arranged the sale, let’s Occupy Congress!

Insurers obliterate distinction between health plans and stop-loss insurance

Self-funded health plans under attack in New Jersey

By Joanne Wojcik
Business Insurance, October 30, 2011

In an Oct. 25 letter to Thomas Considine, commissioner of the New Jersey Department of Banking and Insurance, the Self-Insurance Institute of America Inc. asked the department to rescind a bulletin it issued this month that alleges stop-loss insurers are “cherry-picking” employer groups with good claims experience.

The Oct. 3 bulletin alleges that the insurers, which write excess coverage for self-funded group benefit plans, are “selectively marketing coverage to small employers on the basis of health history of that employer’s employees, and denying coverage to employers based on employee health status. The result of this selective underwriting is to “cherry-pick’ groups less likely to incur claims, leaving the groups more likely to incur claims to the state’s guaranteed-issue insured market. This, in turn, drives premiums up for small employers purchasing insured plans.”

Because stop-loss insurance is excluded from the state’s definition of a health benefit plan, it is not subject to the same regulations as fully insured health coverage, the bulletin states. Therefore, the department has invoked New Jersey’s unfair trade practice law, asserting that “the selective marketing and underwriting described herein constitutes an unfair trade practice.”

Simpsonville, S.C.-based SIIA asserts that the department’s contention is “inflammatory and without merit. Stop-loss insurance is a completely different product than commercial health insurance, so it is misguided to conclude that “unfair competition’ exists,” SIIA said in its letter.

The Employee Retirement Income Security Act’s “regulatory exemption for self-insured (self-funded) plans is a persistent thorn in the side of state insurance regulators,” according to a September statement by Timothy Stoltzfus Jost, a law professor from Washington and Lee University School of Law in Lexington, Va., to the NAIC’s ERISA (B) Subgroup.

“This may be acceptable for large employer groups, which have the bargaining power and expertise to protect their employees. But when small-employer packages purchase “self-insured’ packages from insurers, including stop-loss coverage with very low attachment points and administrative services, they are essentially purchasing conventional health insurance, except that it is free from state regulation,” Mr. Jost said.

Moreover, he said “insurers have always had an incentive to market “self-insurance’ to healthy groups, and small businesses with healthy enrollees have always had an incentive to purchase it. The Affordable Care Act, however, increases these incentives…Insurers understand this and are very actively marketing “self-insured’ products to small groups.”

http://www.businessinsurance.com/article/20111030/NEWS05/310309989?tags=%7C74%7C305%7C339

Comment:

By Don McCanne, MD

For smaller employers who want to self-insure their health benefit programs, stop-loss insurance is an imperative. A very large medical bill for one employee or family member could bankrupt a small business. This need to protect against large losses has created a thriving market in self-insured packages from insurers, which escape health plan regulation, yet are beginning to look more like conventional health insurance with extremely high deductibles.

These plans not only provide stop loss coverage at a “low attachment point,” they are now providing administrative services for the employers’ self-insured plans, paying employees’ medical expenses using the employers’ funds. The attachment point – the level at which losses begin to be covered by the insurer – may be $40,000. That is a very low level for a stop-loss plan. Some conventional health plans have deductibles of $50,000. That blurs the distinction between a high deductible in a health insurance plan and a low attachment point in a stop-loss plan.

What is happening is obvious. The insurers are selling these “self-insured packages” as stop-loss plans, avoiding the regulatory oversight for health plans. Yet they actually function as health plans with very high deductibles.

Why does it matter? The insurers can avoid new regulations that prohibit medical underwriting. They are able to cherry pick – limiting the sale of these plans only to businesses with healthy employees, shifting the costs of higher risk employee pools to other programs with guaranteed issue. As Timothy Stoltzfus Jost states, “insurers have always had an incentive to market ‘self-insurance’ to healthy groups, and small businesses with healthy enrollees have always had an incentive to purchase it. The Affordable Care Act, however, increases these incentives…Insurers understand this and are very actively marketing ‘self-insured’ products to small groups.”

The private insurers have an absolute moral obligation to enhance value for their investors, and they must always make every effort to do so. The fault lies not with the private insurers themselves but with a financing model that is dependent on insurers. We need to change the model, switching to a single public insurer.