House votes to repeal anti trust exemption for insurance companies

February 24, 2010 — In a rare display of bipartisan unity, the US House of
Representatives this afternoon passed, by a lopsided vote of 406 to 19,
legislation that would end health insurance companies' 65-year exemption
from a variety of federal antitrust rules.

Supporters of the bill — the Health Insurance Industry Fair Competition Act,
which would repeal portions of the McCarran-Ferguson Act, passed in 1945 —
argue that it will restore competition to the health insurance market, which
surveys have shown has become increasingly dominated in many areas by 1 or 2
insurers.

"It's time for Washington to decide whether we stand with patients or
profiteering, whether we believe in market competition or a collusion
between politicians and insurance companies," said freshman bill cosponsor
Rep. Tom Perriello (D-VA) in the run-up to the vote.

But skeptics, many in the GOP, charge that the repeal will have a negligible
effect on premiums and that it will do little to address the consolidation
issue — in fact, the Federal Trade Commission and the Department of Justice
already have the authority to examine the antitrust implications of health
insurer mergers and acquisitions.

Citing the Congressional Budget Office, which predicted a small effect on
premiums because states already had laws on their books that outlaw
practices that would be prohibited under the bill, including bid rigging and
price fixing, Rep. Lamar Smith (R-TX) argued during floor debate that "some
may wish upon a star, but this bill is a dim bulb."

Still, dim bulb or not, most House Republicans were not inclined to buck the
popular backlash against insurance companies and vote against the bill.
Some Republicans who ended up voting for the bill nevertheless argued during
the procedural portion of the debate for its amendment. Among other things,
they argued for an amendment that would permit insurance companies to share
historical loss data and actuarial services — a provision, they said, that
would be especially beneficial to smaller insurance companies. The
resolution barring amendments prevailed, however, and Republicans such as
Rep. Dan Lungren of California used a portion of their floor time to argue
for what they say would be more effective cost-control legislation — medical
malpractice reform.

The bill will not affect property and casualty insurers, including medical
malpractice carriers, which will maintain their antitrust exemptions.
Action now moves to the Senate, where the measure may need a supermajority
of at least 60 votes to move forward.

Back by popular demand. First Blog post August 8, 2009

President Obama called for a bipartisan health care summit that begins tomorrow, February 25, 2010. I have heard from several readers of this blog to re-post my first entry. Enjoy AGAIN

Saturday, August 8, 2009
Welcome to Health Care Now. This Blog is dedicated to fixing a very broken health care system in the USA.

There can be no real health care reform without insurance and pharmaceutical industry reform. Health Insurance and Pharmaceutical Companies DO NOT PROVIDE HEALTH CARE. These companies are in busines to make money for their shaeholders and executives. Check this out!


UnitedHealth CEO
Stephen J. Hemsley
2007 Compensation
$13.2 million
2008 Compensation (Forbes)
$3,241,042
Former Managing Partner and CFO of Arthur Andersen (BusinessWeek)
Total Value of Unexercised Stock Options (Forbes)
$744,232,068
2009 Options Exercise
$127,001,281
Value of Wayzata, Minnesota Home (Hennepin County Assessor)
$6,640,000
Articles:
Hemsley returns $190 million in stock options acquired as a result of practices found to be fraudulent by the SEC (American Medical News)

CIGNA CEO
Edward Hanway
Five-Year Compensation, as of April 30, 2008 (Forbes)
$120.51 million
Total Value of Unexercised Stock Options (Forbes)
$28,881,000
Value of New Jersey Beach Home (Cape May County Assessor)
$13,607,400
Articles:
The family of a 17-year-old girl who died hours after CIGNA reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday.
Hundreds of entertainment industry workers in California and New Jersey who buy health insurance as a group are being hit with a rate increase that will raise some family-plan premiums to more than $44,000 a year.

Humana CEO
Michael McCallister
2007 Compensation
$10.3 million
2008 Compensation (Forbes)
$1,017,308
Five-Year Compensation Total (Forbes)
$15.1 million
Total Value of Unexercised Stock Options (Forbes)
$60,865,194
2006 Options Exercise (SECForm4)
$22,294,710
Value of Park City, Utah Home (County Assessor)
$6,978,380
Articles:
Humana abandons senior citizens in Florida, returns after Republicans pass new Medicare law, upping HMO payments by ~ 25% (NY Times)

Aetna CEO
Ronald A. Williams
2007 Compensation
$23 million
2008 Compensation (Forbes)
$24,300,112
Total Value of Unexercised Options (Forbes)
$194,496,797
Williams is in the top ten of Forbes'"$100 Million CEO Club."
Articles:
Health insurance giants Aetna and CIGNA, along with others, became the latest targets of a wide-ranging probe launched by New York Attorney General Eliot Spitzer, according to USA Today. (source)

Coventry CEO
Allen Wise
CEO from 1996-2004, and from January 2009-Present
2004 Compensation (Forbes)
$13,052,799
2006 Sale of Stock
$14,458,251
2006 Options Exercised
$2,895,000
2005 Sale of Stock
$46,410,695
2005 Options Exercised
$6,709,564
2004 Sale of Stock
$12,826,756
2004 Options Exercised
$4,798,000
Value of Hilton Head, SC Home (Beaufort County Assessor)
$3,275,500

WellPoint CEO
Angela Braly
2007 Compensation (secinfo)
$9,094,271
2008 Compensation (Forbes)
$9,844,212
2006 Sale of Stock (SECForm4)
$4,858,585
2006 Options Excerise (SECForm4)
$4,566,124
Value of Indianapolis Home
$1,987,700

This is just a handful of health insurance executives. None of these people have ever diagnosed or treated any patient in their executive capacity. In fact, they participate in developing company policy that limits health care to their policy holders and in many cases deny health care to their policy holders. Withholding funding for health care is how these obscene salaries are paid.

Remove health insurance companies from the equation and all this money could actually be used to provide health care for those in need.
Posted by Doc at 5:41 AM

Anthem Blue Cross BUSTED in California

Insurance Commissioner Poizner Announces Hundreds of Legal Violations During an Investigation of Anthem Blue Cross' Practices

Insurer Faces Multimillion Dollar Fine After Review Finds 700 Plus Claims Handling Violations

California Insurance Commissioner Steve Poizner today announced that an investigation of consumer complaints filed against Anthem Blue Cross' claims handling practices has uncovered more than 700 violations of state law.

"When consumers pay their premiums every month, they expect insurance companies to uphold their part of bargain and pay claims quickly, correctly and comply with all other legal requirements," Commissioner Poizner said. "Our investigation has revealed more than 700 instances where Anthem Blue Cross has violated the state's claims handling laws. From a failure to respond when the Department of Insurance requested information to investigate complaints to misrepresenting the facts to consumers, these are serious violations and if they are proven in the enforcement action, Anthem Blue Cross will be held liable for them."

The California Department of Insurance (CDI) investigated consumer complaints filed against Anthem Blue Cross' claims handling practices in 2006 through 2009. This review found more than 700 violations of the law. The maximum penalty for each violation is $10,000, if the action was found to be willful.

Specifically, the market conduct exams found the following violations of law:

Type of Violation
Quantity

Failure to pay claims in 30 days 277 violations
Failure to respond to the CDI in reasonable time so we can investigate complaints 143 violations
Misrepresenting facts or policy provisions to insureds 66 violations
Failure to pay Interest on unreimbursed claims 25 violations
Failure to pay or contest a claim within 30 days 21 violations
Unreasonably low settlement offers 22 violations
Miscellaneous delays and other claims handling violations 178 violations



The official Accusation and Order to Show Cause will be filed with the Office of Administrative Hearing later today. When it is filed, it will be posted on the CDI Web site.

During the last three years, CDI has finished 10 market conduct exams of the top health insurers. Six exams were completed and four are in progress. So far, three of the six completed exams have resulted in enforcement actions and led to groundbreaking agreements with insurers that helped 4,000 consumers regain access to insurance after their coverage was improperly rescinded. They also led to the following actions:

· Anthem Blue Cross: $1 million fine, offer of new insurance for those who had their insurance policies rescinded, reimburse consumers for out-of-pocket expenses and take corrective action

· Blue Shield: Offer of new insurance for those who had their insurance policies rescinded, reimburse consumers for out-of-pocket expenses and take corrective action.

· Health Net: $3.6 million fine, $7.2 million in waived insurance premiums, offer of new insurance for those who had their insurance policies rescinded, reimburse consumers for out-of-pocket expenses and take corrective action.

FINALLY SOME LEADERSHIP

Obama backs repeal of insurer antitrust exemption

By Patricia Zengerle Patricia Zengerle
WASHINGTON (Reuters) – The Obama administration on Tuesday threw its weight behind a bid to repeal an anti-trust exemption protecting health insurers, keeping the industry in its crosshairs as it prepares to host a bipartisan summit on revamping healthcare.

"Today the president announced the administration's strong support for repealing the anti-trust exemption currently enjoyed by health insurers," White House spokesman Robert Gibbs said at a daily news briefing.

On Thursday, President Barack Obama will host a healthcare summit, the latest step in his uphill battle to break an impasse in Congress over a sweeping overhaul of the $2.5 trillion industry, one of Obama's domestic policy priorities.

"At its core, health reform is all about ensuring that American families and businesses have more choices, benefit from more competition and have greater control over their own healthcare. Repealing this exemption is an important part of that effort," Gibbs said.

Health insurers for about 65 years have been exempt from federal antitrust laws, which are designed to protect consumers from price fixing and other anti-competitive acts.

The insurance industry said the exemption is narrow in scope and warranted and that its repeal would not lower health care costs.

"Health insurance is one of the most regulated industries in America at both the federal and the state levels," said Karen Ignani, president and chief executive of the industry trade group America's Health Insurance Plans.

"The real focus should be on addressing the rising cost of medical care, which is putting an unsustainable burden on families, employers, and the federal budget," she said.

Gibbs said he expected the House of Representatives to vote on legislation to revoke the exemption over the next few days. Obama's support was transmitted to Congress as a statement of administration policy.

INSURANCE INDUSTRY IN THE CROSSHAIRS

The Obama administration has stepped up its rhetorical attacks on health insurers as it fights to push through the healthcare overhaul. New regulation of health insurers was a key part of the overhaul plan Obama announced on Monday, and administration officials have pointed repeatedly to a premium increases of up to 39 percent set by WellPoint Inc.'s Anthem Blue Cross unit in California as evidence of the need for a healthcare overhaul.

A number of House Democrats have said repealing the antitrust exemption is a high priority.

"We want to open up competition. This bill is about making sure that anyone in America who wants to offer health insurance will do so in a free and open market," House Democratic Leader Steny Hoyer said.

"I surely hope it will pass with a significant bipartisan vote."

Democrats said revoking the exemption would prevent health insurance price-fixing or other anti-competitive practices, but did not offer evidence of any. The industry said state laws already forbid such practices.

The American Medical Association released a study on Tuesday showing that many U.S. insurance markets are dominated by just one or two insurance companies. In 24 of the 43 states covered in the report, the two largest insurers had a combined market share of 70 percent or more, up from 18 of 42 states in last year's report.

The House version of the healthcare revamp bills that have stalled in Congress included a repeal of the exemption. The Senate version did not. Obama's proposal in general more closely resembled the Senate plan, and did not address the antitrust exemption.

A number of consumer groups support repeal, saying states often lack the resources to effectively regulate insurers.

Unhappy with Insurance Companies? Only in America

Sebelius Unveils New Report on Requested Premium Increases in States Across
the Country
Report Highlights Requested Rate Hikes in Connecticut, Maine, Michigan,
Oregon, Rhode Island, Washington

U.S. Department of Health and Human Services (HHS) Secretary Kathleen

Sebelius today unveiled a new report, Insurance Companies Prosper, Families
Suffer: Our Broken Health Insurance System. The report highlights health
insurance premium increases in states across the country and comes shortly
after Anthem Blue Cross announced plans to raise rates on its California
customers by as much as 39 percent, even after its parent company took in a
profit of $2.7 billion in the previous quarter. The complete report is
available at www.HealthReform.gov .
“Over the last year, America’s largest insurance companies have requested
premium increases of 56 percent in Michigan, 24 percent in Connecticut, 23
percent in Maine, 20 percent in Oregon, and 16 percent in Rhode Island, to
name just a few states,” said Sebelius. “Premium increases have left
thousands of families that are already struggling during the economic
downturn with an unpleasant choice between fewer benefits, higher premiums,
or having no insurance at all. Hard-working families deserve better.”
The report examines requested insurance premium increases and notes:
* Anthem of Connecticut requested an increase of 24 percent last year,
which was rejected by the state.
* Anthem in Maine had an 18.5 percent premium increase rejected by the
state last year as being “excessive and unfairly discriminatory” – but is
now requesting a 23 percent increase this year.
* In 2009 Blue Cross Blue Shield of Michigan requested approval for
premium increases of 56 percent for plans sold on the individual market.
* Regency Blue Cross Blue Shield of Oregon requested a 20 percent
premium increase.
* UnitedHealth, Tufts and Blue Cross requested 13 to 16 percent rate
increases in Rhode Island.
* Rates for some individual health plans in Washington increased by up
to 40 percent until Washington State imposed stiffer premium regulations.
Health insurance reform will fix our insurance system, help drive down
costs, put consumer power and choice in the hands of the American people,
and ensure all Americans receive the health care services they need. Reform
will:
* Place additional oversight on health insurance companies to ensure
that people get value for the premiums they pay. Insurance companies will
have to report how they spend the premium dollars that they collect from
their customers. If they spend too much on administrative costs and profits,
they will have to give some of that money back to their customers. Insurance
companies will also have to provide public justification for premium
increases. Consumers can use this information to help decide whether they
want to purchase a particular plan. And if insurance companies are not able
to justify their premium increases, they could be barred from participating
in the health insurance exchanges.
* End Arbitrary Limits Placed on Coverage by Insurance Companies.
Under health insurance reform, families will no longer face lifetime limits
to their benefits, nor will coverage be denied or watered down based on
medical history. As a result, health insurance will provide real protection
from high health care costs.
* End Insurance Company Discrimination. Health insurance reform will
prevent any insurance company from denying coverage based on underlying
health status, including genetic information. It will end insurance
discrimination that charges families more if a family member has or had any
illness, and limit differences in premiums based on age.
* Create Competition Among Insurers with a Health Insurance Exchange.
Health insurance reform creates an “exchange” or marketplace for insurance
competition that will drive down premium prices for Americans. The health
insurance exchange will bring families and plans together into one organized
marketplace so families can compare prices and health plans in order to
decide which quality, affordable option is right for them. Health insurance
reform will guarantee every American a choice of health coverage, even if
someone loses a job, switches jobs, moves, or gets sick.
* Ensure Value in Our Health Care System. By rewarding high-quality
and efficient care, encouraging care coordination, and reducing medical
errors, health reform will slow the growth in health care costs and ensure
value for every health care dollar spent.
* Lower Premiums. The Congressional Budget Office estimates that
reform will streamline administrative costs of insurance companies and bring
more people into the insurance market, lowering premiums of a comparable
plan in the individual market by 14 to 20 percent. That means more money in
the pockets of American families, and the security of having high-quality
coverage.
“Premium hikes in California and across the country are a wakeup call,”
added Sebelius. “It’s time for Congress to pass reform and hand control over
health care decisions back to American families and their doctors.”

$4 Billion Quarterly Profit NOT GOOD ENOUGH FOR BLUE CROSS

I have not posted in two weeks because I have not fully recovered from reading that Blue Cross generated a fourth quarter FOUR BILLION PROFIT while sending out notices to California individual policy holders that their premiums would be increased up to 39%. I received a message this morning from a follower of this Blog asking why I haven't posted recently. I'm still trying to pull the Blue Cross sword out of my .........

NEW YORK TIMES Editorial
The Lesson of Anthem Blue Cross
Published: February 18, 2010

Clients were understandably furious when Anthem Blue Cross, the largest for-profit health insurer in California, announced huge rate increases for people who buy their own insurance: an average increase of 25 percent, and a 35 percent to 39 percent rise for a quarter of the purchasers. The move also provided a textbook example of why the nation badly needs comprehensive health care reforms.

The reform bills stalled in Congress would put a brake on such out-of-scale premium increases by broadening the pools of insured people to keep average premiums low, by setting up competitive insurance exchanges and by starting to rein in the cost of medical care that is driving up premiums everywhere.
Private insurers in several other states also have sought and won double-digit increases for policies sold to individuals. In one striking case, a Blue Cross Blue Shield plan in Michigan sought a 56 percent average increase in premiums for individually bought policies but settled for 22 percent in a compromise with regulators.

If the increases go through in California, where regulators have limited powers to control rates, Anthem’s enrollees would have to choose between paying the higher price, moving to lower-cost policies, perhaps with a high deductible, switching to another insurer if they can find one to take them, or dropping coverage entirely.

The nation’s largest health insurers reported substantial profits last year over all, but Anthem claims it lost money on the individual market in California. Its parent company, WellPoint Inc., attributed the need for the huge rate increase to a changing mix of customers as the recession forces many people to cut back on expenses.

The company says that healthier customers, gambling that they won’t need much care, are disproportionately dropping Anthem coverage or choosing not to enroll. The less healthy are staying with Anthem, where their higher medical costs are driving up premiums.

WellPoint will be asked to justify the increases at hearings in Congress and the State Legislature. California’s insurance commissioner is investigating whether Anthem will be meeting regulations to spend at least 70 percent of its premium revenues on claims.

It’s hard to know which conclusion would be worse: that Anthem is trying to fleece its individual customers or that Anthem’s rates are actuarially justified by its increasingly unhealthy enrollment pool.

The salient point is that the reform bills pending in Congress could almost certainly prevent this problem from developing. The bills would require everyone to buy health insurance (many with government subsidies). That would create large pools to spread the risk over both healthy and sick enrollees and keep average premiums low. On new insurance exchanges, people who buy their own insurance could benefit from group purchasing power and could choose from an array of policies. Competition among insurers on the exchanges is expected to help keep premiums down.

How about the Republicans’ health care proposals?

They would only address a small part of the Anthem problem. The Republicans reject the idea of mandates to spread the cost of care and instead call for ways for people dissatisfied with their insurer to buy cheaper coverage elsewhere. That could help relatively healthy people but would do nothing for the chronically ill or anyone with pre-existing conditions. They would be stuck in their health plans. State high-risk pools for sick people, another Republican solution, almost always have high premiums and would not provide a safe haven from rate increases in private plans.

Unless Congress passes comprehensive reform, we should expect many more Anthems in our future.