Health Insurers Discussed Delaying Covering Children with Pre-Existing Conditions

by LAS

According to a March 28 story in the New York Times, and just days after President Obama signed the historic healthcare bill into law, insurance companies were insistent that they did not have to provide coverage to children with pre-existing conditions. President Obama called that element of the healthcare bill a 'centerpiece' of the new law.

President Obama, speaking at a rally in Virginia on March 19, said, “Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.”

This provision of the reform bill was meant to protect youngsters who suffer from conditions such as leukemia, cystic fibrosis, birth defects, sickle cell disease, etc from being denied coverage under current business practices.

But the insurance industry tries to redefine what 'is' is, and what 'coverage' and 'insurance' mean.

While insurers agree that if they write a policy for a child, that they must cover pre-existing conditions. However, they still feel that they are not compelled to write a policy for a given child, and that at any rate this provision does not go into effect until 2014.

A few days after expressing their reluctance to implement this provision of the healthcare reform bill, the industry was compelled to announce that they would, in fact, observe this feature of the new law. But that came only after public outrage at insurance industry statements, including criticism from Senator John D. Rockefeller, among others.

According to the New York Times: Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate commerce committee, said: “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”

The new law says that health plans and insurers offering individual or group coverage “may not impose any pre-existing condition exclusion with respect to such plan or coverage” for children under 19, starting in “plan years” that begin on or after Sept. 23, 2010.

But, insurers say, until 2014, the law does not require them to write insurance at all for the child or the family. In the language of insurance, the law does not include a “guaranteed issue” requirement before then. This is what ignited the firestorm of protest and criticism from those in Congress and the reform movement.

SOURCE:
Pear, Robert, Coverage Now for Sick Children? Check Fine Print, March 28, 2010, New York Times, http://www.nytimes.com/2010/03/29/health/policy/29health.html

Movement for Federal Controls of Insurance Industry Misguided

by L.A.S.
The federal government has seized on the problems with one segment of one company, AIG, as a pretext for more government control of the whole insurance industry. The truth is that the insurance division of AIG, American General, was doing just fine (and BTW was under state regulation). The problems were in the division that was already supposedly being supervised by the federals, the Financial Products Corp., which indulged in risky equities investment.
However, neither do I see any value in creating an optional federal charter, called an OFC. The OFC would give insurance companies the option of being regulated at the state or at the federal level. One must acknowledge that in some states, it is possible for the insurance commissioner's office to be much too cozy with the industry, and refrain from too close scrutiny of financial records or safety.
I have mixed feelings about this proposal, I admit. I have already opined on the frustration of not being able to buy certain riders or products in one state that are easily available in another state, simply because the insurance commissioner's office of one state decided to allow that product.
The Financial Regulatory Reform report strongly recommends the creation of an Office of National Insurance (ONI). One of the jobs proposed for this ONI is the identification of insurance companies that should be supervised as Tier 1 Financial Holding Companies (FHCs). A Tier 1 FHC is defined as a holding company “whose combination of size, leverage and interconnectedness could pose a threat to financial stability if [they] failed.” They would come under the supervision of the Federal Reserve who would supposedly hold them to a higher standard and do everything to prevent these companies from failing.
Insurers are expressing concern that the Fed would not be working in harness with an actual insurance regulator. This is in contrast with the rest of the financial services industry which has a federal regulator in the SEC. The Fed would not concern itself with solvency, but rather with the company's impact on the overall economy.
The Fed already has many critics of its authority. Does it really serve anyone's best interest to allow it to insert itself into another segment of the finance industry, when it already seems stretched to the limit in trying to monitor the banking industry?
Besides the creation of the ONI and an expansion of the Fed, the report is also spurring talk of creation of a Consumer Financial Protection Agency (CFPA). This agency is supposedly going to represent consumer interests at the administrative level regarding credit, mortgage and title insurance coverage. Whether it will also monitor the insurance industry in spite of intense lobbying against it, is anyone's guess at the moment.
Again, I have mixed feelings about this new agency. Much depends on exactly who will be appointed to serve in this agency and whether they will just be another shill for the industry. The devil is always in the details.
On the one hand, it has the potential to finally bring the credit industry to heel and cap interest rates on credit cards and other abuses. Have you never wondered why your credit card bills are always addressed to processing stations in Delaware and Dakota? That is because those states have no cap on credit card interest rates or any other meaningful regulation. It would also give consumers the option to buy new plain-vanilla insurance products and provide transparent pricing.
On the other hand, adding another layer of bureaucracy because the regulators we have, failed to do their job, is hardly cost-efficient. It is hardly an example of good government. Although if the Congress writes the bill so as to streamline (make that read 'fire') ineffective federal agencies like the SEC or FINRA (the SEC's enforcement arm) or the Federal Reserve itself, then that would be a net gain for consumer rights and for the bean-counters.
If any or all of the existing agencies had been doing their job, and regulating the finance and investment community, we might have averted the bloodbath of last summer and fall. How did earlier administrations allow the annulment of the Glass-Steagall rules? Rules that had prevented a recurrence of the errors and wild ways of the heady 1920's?
And then there is the really scary problem that is not addressed by any legislation anywhere, and that is that most of the people working for the federal government just cannot understand the complicated financial instruments now being used and marketed across the globe. What if Congress convened a hearing or an investigation into bank failures, and the crooks got off because our representatives really don't know a bundled mortgage from a certificate of deposit? Or an ARM from their leg??
Sorry to joke, but tragically, the American public does not generally have senators and representatives who can fathom the technical jargon of the industry. It is not that they are dumb; they are just in the dark. As are we all.

What is in the New ARRA Law that Obama signed? Some details on COBRA changes, while we wait for details on implementation.

by L.A.S. --

While the thousand-page ARRA law (American Recovery and Reinvestment Act) became law on March 1, 2009 when President Barack Obama signed it on Feb. 17, your employer was awaiting the details on the law in order to be in compliance with it. This means as a practical matter that thousands desperately waiting for help in keeping up their former employer's insurance under COBRA provisions could not be assured of a smooth transition to the emergency provisions of the law.

The law itself is written rather vaguely and so employers are scrambling for guidelines on implementation of the new rules. Granted, the ARRA law was written under pressure and so some parts are less defined than others.

THE OLD COBRA LAW: a qualified beneficiary who elected to continue health insurance coverage under his former employer's group plan had to pay the full premium, plus a small percentage (two percent) toward handling fees.

THE NEW COBRA LAW: Employees who were terminated between Sept. 1, 2008 and Dec. 31, 2009 “due to an involuntary loss of employment” will have 65 percent of the premium subsidized by the federal government for a period of UP TO nine months. Included in the group of employees covered by this new provision are those former employees who already declined COBRA coverage. Former employees will be covered for a total of 18 months: nine months of subsidized coverage and nine months of unsubsidized coverage.

The subsidy is NOT available to employees whose modified adjusted gross income exceeds $145,00 (or $290,000 for joint filers). Those with incomes between $125,000 and $145,000 will see a proportional decrease in their subsidy.

The subsidy is supposed to paid out of credits against the employer's payroll tax liability. In other words this is an immediate tax exemption for the employer and should not be a crushing burden to them financially. Anyone who claims otherwise is not understanding the ARRA provisions.

To restate it more simply: eligible individuals pay 35 percent of the total premium while the employer pays the other 65 percent, which is then reimbursed to the employer as a tax credit.
Some confusion may exist over some proposals that did not become part of the final bill. One major item that was changed was the proposal to allow those former employees over age 55 to re-enter the COBRA umbrella of coverage, at least until they became Medicare eligible or obtained coverage through another employer. Again, that proposal failed to become part of the final bill.

Other proposals that died in the talking phase includes one that would have extended coverage under COBRA ; it would have been far too costly and would have essentially rewritten the whole COBRA program. While we might discuss such issues again one day, it was deemed entirely inappropriate for emergency or stimulus legislation.

Will the sickest former employees likely rush to get covered under this new COBRA provision? It is likely that the answer will be yes, just because of the fact that people with ongoing health issues need uninterrupted checkups and medications. People do not elect COBRA unless they already have health issues that make it difficult to be accepted for other health insurance policies.

Nevertheless, one must bear in mind that for most people, even those with serious health challenges, do recover and return to the realm of the healthy.

The other significant part of the ARRA bill which impacts health care costs is the provision to speed up conversion of medical records to an electronic, computerized form. Nineteen billion dollars was earmarked for this huge effort. We already have the proven example of the VA which has converted its medical records to an electronic format, and has seen it raise levels of accuracy and speed of transmission to other providers.

A major barrier to this conversion is agreeing on a format that is compatible with the majority of providers, and observing the laws regarding privacy and security of medical records as per HIPAA requirements. While the impetus for writing the HIPAA law was to maintain security of medical records when electronically submitted to insurers, it is at times used to block or deny proper access to those medical records.