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Health Reform Battle is NOT Yet Over
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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.'"

 
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Published 01/31/2012 - 7:33 a.m.  CDT

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