Nevada State Senator Mike “Dangerous Driver” Roberson predicts his Republican caucus will control the 2013 Senate, State Senator Mo Dennis (D-LV) begs to disagree. [NNB] Republicans would like to pick up the Clark District 6 seat, currently held by Allison Copening (D-LV). Having a heated contest for a State Senate race isn’t exactly news — what is interesting is that the GOP candidate, Mark Hutchison is leading Governor Sandoval’s challenge to the Affordable Care Act and Patients’ Bill of Rights.
What is it that Mr. Hutchison would like to see reversed? It’s all well and good to appeal to the GOP/Tea Party knee jerk reaction to repeal “Obamacare” in general, but some voters may find it hard to swallow the specifics.
If “Obamacare” is repealed the following items will be lost:
(1) There will be no online reference site on which consumers can compare health insurance plans to see which one fits family needs and resources.
(2) There will be nothing to prevent a health insurance corporation from refusing to coverage to children who are deemed to have a pre-existing condition.
(3) There will be nothing to prevent a health insurance corporation from arbitrarily rescinding a policy when a policy holder becomes ill or injured.
(4) There will be nothing to prevent a health insurance corporation from placing lifetime limits on a health insurance policy. If a person or family members is seriously ill or injured, and the limit is hit — YOYO (you’re on your own).
(5) There will be no regulation of annual limits on health insurance coverage.
(6) There will be no external review process for challenging the decisions of health insurance corporations.
(7) There will be no independent offices in the states to assist policy holders with questions about enrollment, rights and responsibilities, health education, and complaints and appeals.
In short, the health insurance giants can revert to the very practices which drove people away from affordable health care — junk policies with benefit limits, pre-existing condition policies which excluded infants born with birth defects, arbitrary rescission of coverage when a person became ill. But wait! There’s more:
(8) Small businesses will lose their tax credits for making health insurance available to their employees. Phrased in common Republican parlance, this means a tax increase for small businesses which provide health insurance plans for their workers.
(9) There will be no requirement that health insurance policies cover preventative services like mammograms, prostate cancer screening, and colonoscopies.
(10) There will be a decrease in the procedures available to the government to reduce waste and fraud in Medicaid, Medicare, and CHIP programs.
(11) There will be no improved access to health insurance coverage for individuals with pre-existing conditions.
(12) Parents will not be able to help their children (under 26) by putting them on their own insurance plans.
(13) There will be no program to help early retirees maintain their employer-plan health care coverage.
(14) There will be no incentives for states to administer procedures for challenging unreasonable health insurance rate hikes.
Does repealing “Obamacare” still sound like a good idea? Tax increases for small businesses that offer health plans? No requirement that basic health insurance policies cover preventative screenings? Decreased resources to fight waste and fraud in Medicaid, Medicare, and CHIP? Returning to the Bad Old Days when a health insurance corporation could arbitrarily rescind a policy when a person or family member was ill or injured? And, no way to challenge unreasonable rate hikes?
(15) The program to provide state loans, loan forgiveness, and scholarships to those who want to train as primary care providers in under-served areas. There will no longer be a program to help support primary care providers in rural areas, which constitute 68% of the under-served parts of the country.
(16) There will be no funding for community health center construction. On February 19, 2011 the Republican controlled House of Representatives voted to cut $1.3 billion from the health center program. [Change.Org] Representatives Heck (R-NV3) and Heller (R-NV2) voted in favor of these funding cuts. [roll call 147]
(17) There will be no further efforts to help senior citizens with prescription medication costs to close the infamous “do-nut hole.”
(18) There will be no requirement that there be free preventative health care services for senior citizens, and..
(19) There will be no further efforts funded to improve care for senior citizens after they leave a hospital.
(20) There will be no task force assigned to make suggestions to Congress about how to reduce costs and prolong the availability of the Medicare program.
(21) There will be no further efforts to improve home based health care services for disabled people.
Not to be too blunt about it, but this isn’t exactly a recipe for Keeping Grandmother Healthy Longer.
(22) However, here’s the provision that has the health insurance corporations beating the drum for repeal:
“To ensure premium dollars are spent primarily on health care, the law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals, because their administrative costs or profits are too high, they must provide rebates to consumers.” [HHS]
Notice that the law doesn’t require the insurance giants to spend 85% of their total revenues on health services and health care quality improvement. It requires that they spend 85% of the PREMIUMS COLLECTED on health care services.
Insurance companies have two revenue streams, premium collections and investment revenue. The new law doesn’t say anything about the way a health insurance corporation spends its investment revenue. It does say that it must spend 85% (or 80%) of its premium collections — paid by its customers for health care ON HEALTH CARE. Not advertising, not CEO salaries, not perks for the corporate headquarters, not stock buy backs…
(22) There will be no reduction of the subsidies paid to health care corporations for offering their highly profitable Medicare Advantage policies. While the opponents of Obamacare are calling the reforms a “government takeover” of health care, the government has been quietly subsidizing the health insurance corporations for offering Medical Advantage plans — even thought these are profit makers for the corporations. We could call this another excellent example of “corporate welfare.”
“Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Traditional Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77% of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The law levels the playing field by gradually eliminating this discrepancy. People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care.” [HHS](emphasis added)
These are the elements of the ACA/Patients’ Bill of Rights that have already gone into effect, while the health insurance corporations have been seeking ways to characterize the reforms as “socialism,” and “a government take-over.” This is a bit disingenuous since what the corporations are really upset about is having to pay for health care services (instead of tossing the premium collections into the overall revenue pot) and losing their government subsidy for the Medicare Advantage plans.
More provisions will be actualized in 2012, and there is a handy one stop listing for these here. It’s a 2014 proposal that has drawn the most fire:
“Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption.”
This is the “individual mandate,” which was originally a Republican idea as a way to get away from single-payer proposals, from Mark Pauly (G.H.W Bush administration:
I see it in the latter way. We thought it was a good idea to do everything possible to encourage people to get insurance. Subsidies will probably pick up the great bulk of the population. But the point of the mandate was that there are a few Evil Knievals who won’t buy it and this would bring them into the system. In our version, the penalty was effectively equal to the premium of a policy. You paid the penalty and you got the insurance. [WaPo]
And from AHIP:
America’s Health Insurance Plans, a trade group, made a stunning announcement, saying it favored universal coverage and supported a law that would stop insurers from rejecting applicants because of preexisting conditions.”Universal coverage is within reach,” the group said in a historic press release.After being adamantly opposed to reform during the Clinton years, AHIP said it had changed its mind — based on one condition: Any reform plan had to require that all individuals have insurance or pay stiff penalties.AHIP’s reasoning was simple: Many of the uninsured are healthy and under age 35. They either have jobs that don’t offer insurance or they didn’t pay for insurance because they were certain they wouldn’t get sick.Having this group in an insurance pool spreads risk. Without an individual mandate requiring them to get insurance, Americans could wait until they got sick and then sign up for insurance — a trend that would mean only sick people would be paying premiums while running up huge bills. In this scenario, healthy people would have no need to buy insurance — a financially disastrous situation for insurance companies. [McClatchy]
It’s interesting that the Free Market idea (individual mandates) has become the lightning rod for criticism since the original notion was to spread risk in a way compatible with health insurance corporation profitability.
The right wing laments about a highly generalized, and all too often false, rendition of health care reform needs to be met with some very specific questions about exactly what part of the health care reforms are objectionable. And, voters need to know that what they find objectionable (junk policies, arbitrary rescission policies, and pre-existing condition exclusions) aren’t what the industry finds objectionable (having to pay for health care services from premiums collected, and losing their government subsidies for Medicare Advantage plans.)
Desert Beacon 
This is a marvelous summary explaining why it would be a great mistake to repeal “Obama care.” I’d suggest one other item to add to the list:
“There would be nothing to prevent insurers from refusing to provide coverage to adults with pre-existing conditions, such as cancer. Without insurance for major diseases, most patients will end up without medical treatment, many will suffer and die needlessly, and many will end up in bankruptcy. The need for coverage for persons with pre-existing conditions is is particularly important since 4% of Americans are cancer survivors. In the US, 1 of every 2 men will be diagnosed with cancer in their lifetime, and 1 of every 3 women will be diagnosed with cancer in their lifetime. In terms of big picture numbers, 1.6 million new cancer diagnoses are made each year in the US. So, during the next decade, there will be 16 million new cancer diagnoses – that number exceeds the combined populations of the cities (not suburbs) of New York, Chicago and Los Angeles.”