Nation’s Largest RN Organization Says Healthcare Bill Cedes Too Much to Insurance Industry
By National Nurses United
December 21, 2009
The 150,000 member National Nurses United, the nation’s largest union and professional organization of registered nurses in the U.S., today criticized the healthcare bill now advancing in the U.S. Senate saying it is deeply flawed and grants too much power to the giant insurers.
“It is tragic to see the promise from Washington this year for genuine, comprehensive reform ground down to a seriously flawed bill that could actually exacerbate the healthcare crisis and financial insecurity for American families, and that cedes far too much additional power to the tyranny of a callous insurance industry,” said NNU co-president Karen Higgins, RN.
NNU Co-president Deborah Burger, RN challenged arguments of legislation proponents that the bill should still be passed because of expanded coverage, new regulations on insurers, and the hope that it will be improved in the House-Senate conference committee or future years.
“Those wishful statements ignore the reality that much of the expanded coverage is based on forced purchase of private insurance without effective controls on industry pricing practices or real competition and gaping loopholes in the insurance reforms,” said Burger.
Further, said NNU Co-president Jean Ross, RN, “the bill seems more likely to be eroded, not improved, in future years due to the unchecked influence of the healthcare industry lobbyists and the lessons of this year in which all the compromises have been made to the right.”
“Sadly, we have ended up with legislation that fails to meet the test of true healthcare reform, guaranteeing high quality, cost effective care for all Americans, and instead are further locking into place a system that entrenches the chokehold of the profit-making insurance giants on our health. If this bill passes, the industry will become more powerful and could be beyond the reach of reform for generations,” Higgins said.
NNU cited ten significant problems in the legislation, noting many of the same flaws also exist in the House version and are likely to remain in the bill that emerges from the House-Senate reconciliation process:
The individual mandate forcing all those without coverage to buy private insurance, with insufficient cost controls on skyrocketing premiums and other insurance costs.
No challenge to insurance company monopolies, especially in the top 94 metropolitan areas where one or two companies dominate, severely limiting choice and competition.
An affordability mirage. Congressional Budget Office estimates say a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, $9,000, on healthcare exposing too many families to grave financial risk.
The excise tax on comprehensive insurance plans which will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of high-deductible plans, and lead to more self-rationing of care and medical bankruptcies, especially as more plans are subject to the tax every year due to the lack of adequate price controls. A Towers-Perrin survey in September found 30 percent of employers said they would reduce employment if their health costs go up, 86 percent said they’d pass the higher costs to their employees.
Major loopholes in the insurance reforms that promise bans on exclusion for pre-existing conditions, and no cancellations for sickness. The loopholes include:
Provisions permitting insurers and companies to more than double charges to employees who fail “wellness” programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
Insurers are permitted to sell policies “across state lines”, exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
Insurers can charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
Insurers may continue to rescind policies for “fraud or intentional misrepresentation” – the main pretext insurance companies now use to cancel coverage.
Minimal oversight on insurance denials of care; a report by the California Nurses Association/NNOC in September found that six of California’s largest insurers have rejected more than one-fifth of all claims since 2002.
Inadequate limits on drug prices, especially after Senate rejection of an amendment, to protect a White House deal with pharmaceutical giants, allowing pharmacies and wholesalers to import lower-cost drugs.
New burdens for our public safety net. With a shortage of primary care physicians and a continuing fiscal crisis at the state and local level, public hospitals and clinics will be a dumping ground for those the private system doesn’t want.
Reduced reproductive rights for women.
No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay. Nothing changes in basic structure of the system; healthcare remains a privilege, not a right.
“Desperation to pass a bill, regardless of its flaws, has made the White House and Congress subject to the worst political extortion and new, crippling concessions every day,” Burger said.
“NNU and nurses will continue to work with the thousands of grassroots activists across the nation to campaign for the best reform, which would be to expand Medicare to cover everyone, the same type of system working more effectively in every other industrial country. The day of that reform will come,” said Ross.
Wednesday, December 23, 2009
Monday, December 21, 2009
United Health Care profits soar 155 percent on Medicare
United Health Care profits soar 155 percent on Medicare plans
By Jerry Mazza
Online Journal Associate Editor
Sep 25, 2009
United Health Care’s 155 percent profits on Medicare plans must be a company record, especially in a down economy, and an embarrassing fact, particularly as the concervatives on the Senate Finance Committee fight to preserve the present payment structure of United Health Care and its fellow private insurance companies.
Private insurance plans in Medicare cost up to 19 percent more than it would cost to care for the same people in the public Medicare program. But then, we know whose pockets the Republicans and Blue Dog Democrats are really stuffing.
And never mind, as the Medicare Rights Center points out, “Private plans came into the Medicare program with the claims that they could save taxpayers money.” Right and I’ve got a bridge in Brooklyn I can let you have for cheap. The fact is, “they [the Private Plans] cost between 12 percent and 19 percent more per person than the public Medicare program, amounting to $5 billion per year in over-fattened costs to taxpayers.”
I guess this must be the advantage in the Medicare Advantage plans, only it’s for United Health Care and friends not the USA and its taxpayers. In fact, as Families USA reported, “Overpayments to Medicare Advantage plans and those regional PPOs could easily cost more than $60 billion over the next 10 years . . .” Hey, piece of cake, right?
And as Families USA noted, “As part of the 2003 Medicare Modernization Act, Congress has substantially increased payments to Medicare Advantage plans. They’re overpaid in comparison to traditional Medicare.” Modernization, you understand, means privatization here, thanks to George Bush and now Barack Obama and Congress, God love them if she can.
For instance, in 2005, Medicare overpaid private plans by at least 7 percent per beneficiary. And you, Mr. and Mrs. Taxpayer, lost $2.7 billion in 2005 to private Medicare Advantage plans and their parent insurance companies. Then, in 2006, under a new payment formula [woo, woo], overpayments to plans were 11 percent per beneficiary (that is, after accounting for health care status). And now in 2009, up in the 19 percent range. Nothing like HMOs and PPOs saving us money.
See, they keep telling innocent seniors that they will suffer (even more) if they lose their Medicare Advantage plans. Don’t believe it, folks. Medicare Advantage plans can hurt people with Medicare. Two studies found that people could end up actually paying higher out-of-pocket costs in a private plan than in straight Medicare, or in one private plan over another. I mean, the minute you let those dogs in, they’re gonna bite you, not protect you.
A study by MedPac found that a share of Medicare private health plans have high cost-sharing for “nondiscretionary” services such as chemotherapy. Like say, looking at some of the costs for a 70-yer old male with advanced colon cancer, the study showed out-of-pocket charges of $7,100 for one plan, $6,500 for a second plan and $1,900 for a third plane. You’re rolling the dice for your life with all this razzle dazzle. So, buyer beware!
Another study, by the nonpartisan [could that be] Commonwealth Fund found that out-of-pocket costs for private health plan members vary widely not only by your plan benefit package but by your health status. The report says that costs for plan members in poor health are actually higher than public Medicare in 19 out of the 88 private Medicare Advantage (MA) plans looked at. “Despite the high payments, relative to fee-for-service [public Medicare] costs, that MA plans receive from Medicare to enrich enrollee benefits, these plans may not always be a good deal for sicker beneficiaries who use more health services.”
A little bit of backstory
Medicare, the federal health insurance program for people over the age of 65 and those with severe disabilities, contracts with private health insurance plans that compete with the public Medicare program for membership. So, you have a choice, and I would recommend staying away from the “Advantages.” You’re somewhat better off with the Medigap programs that simply fill in the holes, like co-pays, yearly deductibles, and allow you to go to whatever doctor you want to.
That said, according to the Kaiser Family foundation, here is a quick look at private plans in Medicare through 2006 . . .
“As the private market for health insurance has evolved, Medicare has been modified so that beneficiaries can elect to get their Medicare benefits through a qualified private plan rather than the traditional fee-for-service Medicare program. Authorized in 1982, the Medicare risk-contracting program provided for enrollment in health maintenance organizations (HMOs).
“In 1997, Congress expanded private plan authority to include preferred provider organizations (PPOs), provider-sponsored organizations (PSOs), and private fee-for-service (PFFS) plans as the Medicare risk-contracting program was absorbed into Medicare+Choice (M+C). The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) replaced M+C with the Medicare Advantage (MA) program in 2004, raising payment rates and making other changes in anticipation of the Medicare drug benefit in 2006.”
So you can see for yourself how the cats were let in the door under the guise of “modernization,” “improvement” and so on. Take note that the name changes for the private health plans went through as they contracted with Medicare. “Medicare risk-contracting program,” not so appetizing, became “Medicare+Choice,” tastier, to “Medicare Advantage.” Delicious! Now gimme some of that. I want my advantage.
Yeah, well, it’s time to put back the advantage where it belongs, in the hands of the folks with Medicare, not in the coffers of the fat cat insurance companies. Let Medicare plans compete if they want, say, even if we descend to a public option if or if . . . who knows . . . to rampant socialism . . . and a Single-Payer (America-Care as one writer proposed), if they dare. Yea! Though be prepared for some kind of goulash, with a little bit of this and little bit of that and a lot of it all for the private sector.
Jerry Mazza is a freelance writer living in New York City. Reach him at gvmaz@verizon.net. His new book, “State Of Shock: Poems from 9/11 on” is available at www.jerrymazza.com, Amazon or Barnesandnoble.com.
Copyright © 1998-2007 Online Journal
Email Online Journal Editor
By Jerry Mazza
Online Journal Associate Editor
Sep 25, 2009
United Health Care’s 155 percent profits on Medicare plans must be a company record, especially in a down economy, and an embarrassing fact, particularly as the concervatives on the Senate Finance Committee fight to preserve the present payment structure of United Health Care and its fellow private insurance companies.
Private insurance plans in Medicare cost up to 19 percent more than it would cost to care for the same people in the public Medicare program. But then, we know whose pockets the Republicans and Blue Dog Democrats are really stuffing.
And never mind, as the Medicare Rights Center points out, “Private plans came into the Medicare program with the claims that they could save taxpayers money.” Right and I’ve got a bridge in Brooklyn I can let you have for cheap. The fact is, “they [the Private Plans] cost between 12 percent and 19 percent more per person than the public Medicare program, amounting to $5 billion per year in over-fattened costs to taxpayers.”
I guess this must be the advantage in the Medicare Advantage plans, only it’s for United Health Care and friends not the USA and its taxpayers. In fact, as Families USA reported, “Overpayments to Medicare Advantage plans and those regional PPOs could easily cost more than $60 billion over the next 10 years . . .” Hey, piece of cake, right?
And as Families USA noted, “As part of the 2003 Medicare Modernization Act, Congress has substantially increased payments to Medicare Advantage plans. They’re overpaid in comparison to traditional Medicare.” Modernization, you understand, means privatization here, thanks to George Bush and now Barack Obama and Congress, God love them if she can.
For instance, in 2005, Medicare overpaid private plans by at least 7 percent per beneficiary. And you, Mr. and Mrs. Taxpayer, lost $2.7 billion in 2005 to private Medicare Advantage plans and their parent insurance companies. Then, in 2006, under a new payment formula [woo, woo], overpayments to plans were 11 percent per beneficiary (that is, after accounting for health care status). And now in 2009, up in the 19 percent range. Nothing like HMOs and PPOs saving us money.
See, they keep telling innocent seniors that they will suffer (even more) if they lose their Medicare Advantage plans. Don’t believe it, folks. Medicare Advantage plans can hurt people with Medicare. Two studies found that people could end up actually paying higher out-of-pocket costs in a private plan than in straight Medicare, or in one private plan over another. I mean, the minute you let those dogs in, they’re gonna bite you, not protect you.
A study by MedPac found that a share of Medicare private health plans have high cost-sharing for “nondiscretionary” services such as chemotherapy. Like say, looking at some of the costs for a 70-yer old male with advanced colon cancer, the study showed out-of-pocket charges of $7,100 for one plan, $6,500 for a second plan and $1,900 for a third plane. You’re rolling the dice for your life with all this razzle dazzle. So, buyer beware!
Another study, by the nonpartisan [could that be] Commonwealth Fund found that out-of-pocket costs for private health plan members vary widely not only by your plan benefit package but by your health status. The report says that costs for plan members in poor health are actually higher than public Medicare in 19 out of the 88 private Medicare Advantage (MA) plans looked at. “Despite the high payments, relative to fee-for-service [public Medicare] costs, that MA plans receive from Medicare to enrich enrollee benefits, these plans may not always be a good deal for sicker beneficiaries who use more health services.”
A little bit of backstory
Medicare, the federal health insurance program for people over the age of 65 and those with severe disabilities, contracts with private health insurance plans that compete with the public Medicare program for membership. So, you have a choice, and I would recommend staying away from the “Advantages.” You’re somewhat better off with the Medigap programs that simply fill in the holes, like co-pays, yearly deductibles, and allow you to go to whatever doctor you want to.
That said, according to the Kaiser Family foundation, here is a quick look at private plans in Medicare through 2006 . . .
“As the private market for health insurance has evolved, Medicare has been modified so that beneficiaries can elect to get their Medicare benefits through a qualified private plan rather than the traditional fee-for-service Medicare program. Authorized in 1982, the Medicare risk-contracting program provided for enrollment in health maintenance organizations (HMOs).
“In 1997, Congress expanded private plan authority to include preferred provider organizations (PPOs), provider-sponsored organizations (PSOs), and private fee-for-service (PFFS) plans as the Medicare risk-contracting program was absorbed into Medicare+Choice (M+C). The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) replaced M+C with the Medicare Advantage (MA) program in 2004, raising payment rates and making other changes in anticipation of the Medicare drug benefit in 2006.”
So you can see for yourself how the cats were let in the door under the guise of “modernization,” “improvement” and so on. Take note that the name changes for the private health plans went through as they contracted with Medicare. “Medicare risk-contracting program,” not so appetizing, became “Medicare+Choice,” tastier, to “Medicare Advantage.” Delicious! Now gimme some of that. I want my advantage.
Yeah, well, it’s time to put back the advantage where it belongs, in the hands of the folks with Medicare, not in the coffers of the fat cat insurance companies. Let Medicare plans compete if they want, say, even if we descend to a public option if or if . . . who knows . . . to rampant socialism . . . and a Single-Payer (America-Care as one writer proposed), if they dare. Yea! Though be prepared for some kind of goulash, with a little bit of this and little bit of that and a lot of it all for the private sector.
Jerry Mazza is a freelance writer living in New York City. Reach him at gvmaz@verizon.net. His new book, “State Of Shock: Poems from 9/11 on” is available at www.jerrymazza.com, Amazon or Barnesandnoble.com.
Copyright © 1998-2007 Online Journal
Email Online Journal Editor
Thursday, December 17, 2009
Rob from the POOR and Give to the RICH
View this video and then call or write your Senator IMMEDIATELY. The current health care bill in the Senate literally robs from the poor and gives to the rich.
http://www.msnbc.msn.com/id/3036677/#34455431
http://www.msnbc.msn.com/id/3036677/#34455431
Wednesday, December 16, 2009
Screwed AGAIN
Our President has done it again. In his lobbying the Senate for the passage of ANY watered down health care reform bill, the section allowing the importing of pharmaceuticals at much lower prices than what we currently pay has been stricken from the bill. Coupled with the removal of a public option to create competition for policy holders, corporate america is the big winner while WE THE PEOPLE are SCREWED AGAIN.
What a major disappointment. President Obama's ratings have dipped to 50% approval and declining in less than a year. This is reflective of how he has abandoned the people who got him elected. He raised hope during his campaign and as soon as he was elected he has caved on every important issue including bailing out wall street and the banks, the escalation of the War in Afghanistan, and Health Care Reform. He promised to end the wars and create REAL HEALTH CARE REFORM. He promised to create jobs. What we will end up with is a health care bill that benefits the insurance industry and pharmaceutical industry. more of our kids dying, while our leaders line their pockets with campaign contributions in exchange for protection.
This is all about the economics of politics. Our elected representatives are all supported by corporate america, and are only interested in maintaining their political power. The deals to protect Big Pharma and the Insurance Industry in exchange for political support is the DC norm. Line our pockets and SCREW THE PEOPLE--this is the real party line. This is the Executive and Legislative branches of our government. Only in politics is bribery and corruption legal.
What a major disappointment. President Obama's ratings have dipped to 50% approval and declining in less than a year. This is reflective of how he has abandoned the people who got him elected. He raised hope during his campaign and as soon as he was elected he has caved on every important issue including bailing out wall street and the banks, the escalation of the War in Afghanistan, and Health Care Reform. He promised to end the wars and create REAL HEALTH CARE REFORM. He promised to create jobs. What we will end up with is a health care bill that benefits the insurance industry and pharmaceutical industry. more of our kids dying, while our leaders line their pockets with campaign contributions in exchange for protection.
This is all about the economics of politics. Our elected representatives are all supported by corporate america, and are only interested in maintaining their political power. The deals to protect Big Pharma and the Insurance Industry in exchange for political support is the DC norm. Line our pockets and SCREW THE PEOPLE--this is the real party line. This is the Executive and Legislative branches of our government. Only in politics is bribery and corruption legal.
Thursday, December 10, 2009
Public Option is Dead
The public health insurance option died on Thursday, December 10, 2009, after a months-long battle with Senate parliamentary procedure. The time of death was recorded as 11:12 a.m. Eastern Standard Time.
Thank you United States Senate, House of Representatives, and President Obama for allowing special interest such as the insuance industry, pharmaceutical industry, and medical device industry to continue to control health care. These companies continue to excessively profit off the sick and injured. You couldn't have done anything worse for the health and well being of all Americans.
Thank you United States Senate, House of Representatives, and President Obama for allowing special interest such as the insuance industry, pharmaceutical industry, and medical device industry to continue to control health care. These companies continue to excessively profit off the sick and injured. You couldn't have done anything worse for the health and well being of all Americans.
Tuesday, December 8, 2009
MAJOR Disappointment for Health Care NOW
Harry Hamburg, AP
Senate Majority Leader Harry Reid, D-Nev., said Tuesday a "broad agreement" had been reached on the public health care option. He would not provide details, but several officials said the government-run option is being dropped.
In place of a government-run plan, originally designed as a way of forcing competition on private industry, officials said the Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage. Additionally, the tentative deal calls for Medicare to be opened to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the 65-and-over population.
The officials who described the details did so on condition of anonymity, saying they were not authorized to discuss them publicly. Despite their reluctance, some senators had talked openly earlier in the day about the progress of the negotiations.
The developments followed a vote on the Senate floor earlier in the day in which abortion opponents failed to inject tougher restrictions into sweeping health care bill, and Democratic leaders labored to make sure fallout from the issue didn't hamper the drive to enact legislation. The vote was 54-45.
Senate Majority Leader Harry Reid, D-Nev., said Tuesday a "broad agreement" had been reached on the public health care option. He would not provide details, but several officials said the government-run option is being dropped.
In place of a government-run plan, originally designed as a way of forcing competition on private industry, officials said the Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage. Additionally, the tentative deal calls for Medicare to be opened to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the 65-and-over population.
The officials who described the details did so on condition of anonymity, saying they were not authorized to discuss them publicly. Despite their reluctance, some senators had talked openly earlier in the day about the progress of the negotiations.
The developments followed a vote on the Senate floor earlier in the day in which abortion opponents failed to inject tougher restrictions into sweeping health care bill, and Democratic leaders labored to make sure fallout from the issue didn't hamper the drive to enact legislation. The vote was 54-45.
Friday, December 4, 2009
Aetna Forcing 600,000-Plus To Lose Coverage In Effort To Raise Profits
From the Huffington Post
Health insurance giant Aetna is planning to force up to 650,000 clients to
drop their coverage next year as it seeks to raise additional revenue to
meet profit expectations.
In a third-quarter earnings conference call in late October, officials at
Aetna announced that in an effort to improve on a less-than-anticipated
profit margin in 2009, they would be raising prices on their consumers in
2010. The insurance giant predicted that the company would subsequently lose
between 300,000 and 350,000 members next year from its national account as
well as another 300,000 from smaller group accounts.
"The pricing we put in place for 2009 turned out to not really be what we
needed to achieve the results and margins that we had historically been
delivering," said chairman and CEO Ron Williams. "We view 2010 as a
repositioning year, a year that does not fully reflect the earnings
potential of our business. Our pricing actions should have a noticeable
effect beginning in the first quarter of 2010, with additional financial
impact realized during the remaining three quarters of the year."
Aetna's decision to downsize the number of clients in favor of higher
premiums is, as one industry analyst told American Medical News, a "pretty
candid" admission. It also reflects the major concerns offered by health
care reform proponents and supporters of a public option for insurance
coverage, who insist that the private health insurance industry is too
consumed with the bottom line. A government-run plan would operate solely
off its members' premiums.
http://www.huffingtonpost.com/2009/12/04/aetna-forcing-600000-plus_n_380130.html
American Medical News, which first reported the
story, noted that this is not the first time the
insurance giant has cut the rolls in an effort to
boost profit margins. "As chronicled in a 2004
article in Health Affairs by health economist
James C. Robinson, MD, PhD, Aetna completely
overhauled its business between 2000 and 2003,
going from 21 million members in 1999 down to 13
million in 2003, but boosting its profit margin
from about 4% to higher than 7%."
Health insurance giant Aetna is planning to force up to 650,000 clients to
drop their coverage next year as it seeks to raise additional revenue to
meet profit expectations.
In a third-quarter earnings conference call in late October, officials at
Aetna announced that in an effort to improve on a less-than-anticipated
profit margin in 2009, they would be raising prices on their consumers in
2010. The insurance giant predicted that the company would subsequently lose
between 300,000 and 350,000 members next year from its national account as
well as another 300,000 from smaller group accounts.
"The pricing we put in place for 2009 turned out to not really be what we
needed to achieve the results and margins that we had historically been
delivering," said chairman and CEO Ron Williams. "We view 2010 as a
repositioning year, a year that does not fully reflect the earnings
potential of our business. Our pricing actions should have a noticeable
effect beginning in the first quarter of 2010, with additional financial
impact realized during the remaining three quarters of the year."
Aetna's decision to downsize the number of clients in favor of higher
premiums is, as one industry analyst told American Medical News, a "pretty
candid" admission. It also reflects the major concerns offered by health
care reform proponents and supporters of a public option for insurance
coverage, who insist that the private health insurance industry is too
consumed with the bottom line. A government-run plan would operate solely
off its members' premiums.
http://www.huffingtonpost.com/2009/12/04/aetna-forcing-600000-plus_n_380130.html
American Medical News, which first reported the
story, noted that this is not the first time the
insurance giant has cut the rolls in an effort to
boost profit margins. "As chronicled in a 2004
article in Health Affairs by health economist
James C. Robinson, MD, PhD, Aetna completely
overhauled its business between 2000 and 2003,
going from 21 million members in 1999 down to 13
million in 2003, but boosting its profit margin
from about 4% to higher than 7%."
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