Health Insurance News

The current bill as it stands now still has plenty of loopholes to guarantee the health insurance industry its profits are able to continue.

For one, disclosures about the health insurance plans that help the public understand what their buying are still missing from the legislation.  In other words, its still very simple for the health insurance companies to hide important facts about their plans and policies.

Another alarming fact is that the health plans would still be allowed to discourage the ill from applying and enrolling  if they operate outside the health insurance exchange.  Additionally, they would be allowed to limit the choice of medical providers and thus would most likely use the low income health providers like the county hospitals to keep costs down.

So, the health insurance companies that operate outside the health insurance exchange would still be doing whatever they want (the status quo) like Mega Life and Health did in Massachusetts where they continue to rip off tons of Massachusetts residents daily.

Additionally, this would allow the insurance companies that operate outside the realm of the Insurance Exchange to only take the healthy people which would drive up the costs for the companies inside the Exchange including the Government Public Option.

At least the House bill in its current incarnation made it mandatory for all health plans to be inside the exchange if they wanted to offer a new plan.

The Senate health committee would give plans operating outside the exchanges another break: Only those inside an exchange would have to pay a surcharge — as much as 4 percent of premiums — to defray the exchange’s overhead costs. That could allow outside plans to undersell inside plans. In a written response to questions, the committee’s Democratic staff said it would not work out that way because plans inside the exchanges would have to spend less on marketing.

Why are the Democrats in the Senate and House allowing these loopholes?  Supposedly as a way of encouraging choice is their answer.  And keep in mind how strong the health insurance lobby is, who have been pushing hard to keep plans outside the exchange.

Karen Ignagni, president of America’s Health Insurance Plans, wrote that offering plans to individuals outside the exchange would “improve choices for individuals and employers.”

One of my biggest concerns as a health insurance broker is how complicated and different all of these health insurance options are right now.  As a result it becomes very difficult for me to explain the myriad of options to the clients that we get and service.

The health committee bill would cut through some of the confusion by offering three tiers of coverage within exchanges. Plans competing within each tier would be required to have the same actuarial value, meaning that overall they cover the same percentage of anticipated expenses.

The health reform bill as it stands right now allows this craziness to continue at the expense of the consumer.

Even within the exchanges, there could be limits to consumer protections. The health committee bill would not explicitly guarantee consumers the right to an external appeal when a health plan refuses to pay for medical services. The right to an external appeal is a hallmark of the health-benefits program for federal employees, which has served as a model for the proposed exchanges.