California Coalitions on Health Reform Pit Health Insurers Against One Another
By Fran Mayso Lysiak
BestWeek
June 11, 2007
Two coalitions have launched media campaigns on how best to fix the state’s troubled health-care system on the heels of Gov. Arnold Schwarzenegger’s and Democratic lawmakers’ proposals to extend affordable coverage to the state’s 6.5 million uninsured. One coalition, so far only comprised of Blue Cross of California, is pitted against another coalition, comprised of three other health insurers, along with a diverse group of business, labor interests and health-care providers.
Tom Epstein, vice president of public affairs for the nonprofit Blue Shield of California, a member of the “Together for Health Care” coalition, classified each group’s position this way: “We call ours the coalition of the willing and theirs is the coalition of the unwilling.”
Those statements are “100% wrong,” said Blue Cross’s (Nick) Garcia. “In fact, those folks that say that they’re for reform in this other coalition, they need look at what they’ve been doing in the California market — dropping members and getting out of rural counties — and determine if they are truly for reform,” he said.
Blue Cross’ ad campaign says it is against guaranteed issue, “which means they are not in favor of universal coverage,” Epstein contends. Blue Cross doesn’t support everyone being able to buy health insurance “and we believe that’s an essential element for the people of California,” he said.
Blue Shield has supported “guaranteed issue,” which means health insurers can’t deny coverage because of a person’s health status, “but only when paired with an individual mandate,” Epstein said. “That would ensure that you get a broad risk pool of both the healthy and those who need health care,” he said.
That’s “fantastic — if we can achieve a 95% compliance rate with the individual mandate,” said Blue Cross’s Garcia. “We believe that you cannot achieve a high enough compliance rate with an individual mandate to keep our current members’ insurance costs some of the lowest in the nation.”
Jerry Flanagan, health-care policy director for the Foundation for Taxpayer & Consumer Rights, a California-based watchdog group, said compared with Blue Cross, Blue Shield and Health Net are relatively small players in California, with about one-third of Blue Cross’s enrollment of about 8 million.
“This is a basic issue of, if you’re the big guy on the block like Blue Cross, you don’t want to see any changes because a change….poses a risk that you might lose some enrollees or another insurer will get an edge,” Flanagan said.
The Together for Health Care coalition’s health insurers see legislation that requires people to buy health insurance as a way to expand their business. “That’s where the lines are being drawn,” Flanagan said.
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Comment:
By Don McCanne, MD
If you want to know why the private insurance industry should no longer have a role in financing health care, just ask representatives of the private insurance industry to comment on their competitors.
In the California battle of the Blues, one position harms patients by excluding those with health care needs from risk pools that are limited to healthy enrollees. The other position harms patients by requiring them to purchase coverage that is either inadequate or unaffordable for average-income individuals.
It’s not about policies that benefit patients. It’s about policies that protect and improve market share for the private insurers.
Suppose we established our own single public insurance program. Everyone, including those with health care needs, would be included in the single risk pool, and and it would be comprehensive and affordable, made possible through administrative efficiencies and an equitable system of funding.
The irony is that the California battle of the Blues will likely result in a victory for both sides of the private insurance war. Only the patients will lose.