The American Medical Association
reports HERE that "as health system reform enters the implementation phase,
insurers and policymakers are starting to exchange blows over exactly
how new regulations and restrictions on health plans will roll out. New
bills to give the government more clout in the process already have
emerged."
"The Obama administration is working with insurance companies...but
Democrats also have come down hard on the industry after some health
plans said in advance of reform implementation that they were raising
premiums by significant amounts. The lawmakers want to give the Health
and Human Services secretary new power to reject such hikes if they are
deemed unjustifiable."
"HHS Secretary Kathleen Sebelius said she is pleased health plans are
working proactively with her to implement a provision in the health
reform law allowing dependents to stay on their parents' coverage to age
26. Several major insurance companies said they will offer this
coverage before the health reform law's September deadline. The insurer
WellPoint, under pressure from lawmakers, also announced April 27 that
it would stop the practice of rescissions in the individual market
starting May 1, also months ahead of a federal requirement to do so.
UnitedHealth Group announced the next day that it would cease
rescissions immediately."
"Sebelius predicted that implementing some of the law's tighter
regulations of health plans would be "hand-to-hand combat." For example,
some health plans suggested that a provision in the law aimed at ending
coverage denials for children with preexisting conditions would not
actually mandate such a change the way it was written. HHS immediately
said it would issue rules, if necessary, to enforce the requirement,
which takes effect in September."
"The health reform law will phase in additional insurance industry
regulations over the next five years, governing health plan decisions on
spending, benefits and coverage."
"Feinstein's bill would give the HHS secretary the power to reject
premium increases found to be unreasonable. Because some states already
conduct some type of rate review, the federal review would cover only
the remaining states..."
"Some health plans have begun adjusting their accounting to meet the
law's requirement that plans spend 80% of premiums on actual health care
starting next year. WellPoint, for example, said it will count disease
management, medical management and a nurse hot line -- among other
spending once considered administrative -- as health care expenses."
"The insurance industry and its Capitol Hill allies point out that
health plan profits account for a very small fraction of total annual
health spending -- by some accounts about $15 billion out of more than
$2.5 trillion."
"Sen. Tom Coburn, MD, (R, Okla.) said at the HELP hearing that health
plans' profits may be excessive, but they are not the main problem with
the U.S. health system. 'We continue to treat the symptoms and not the
disease, and the disease is costs.'"
