by LAS
Please see the latest column from Wendell Potter, the insurance industry whistle-blower, on the pages of PR Watch, a watchdog and consumer service at PR Watch dot org. Potter discusses what provisions of the new healthcare reform bill are worrying insurance industry execs and why, and how they hope to pull the teeth from the new law. Take for example the Medical Loss Ratio (aka MLR).
To quote Mr. Potter: The insurance industry tried unsuccessfully to strip the minimum medical-loss ratio provision from the bill. It wanted to have the freedom to keep spending less and less on medical care because every dollar not paid out in claims is a dollar that can be used instead to increase profits and to pay CEOs millions of dollars every year. Having lost the battle on Capitol Hill, the insurers are now turning their attention to the NAIC, which Congress gave the responsibility of determining the nitty-gritty details of how insurers will have to comply with the law.
Rest assured that the insurers will be pulling out all the stops to persuade the insurance commissioners to make it easy for them to meet the requirements of the new law by manipulating the definition of medical care. One of the things insurers will try to do, for example, is to get the NAIC to let them shift a lot of what insurers now count as administrative expenses into their medical expense category. If that happens, the insurers will look like they're suddenly spending more on medical care without changing anything at all.
The devil is ever in the details. And if you let the devil define all the terms of the law's provisions, then the industry will have gutted the law without seeming to have lifted a finger to do so.
So keep an eye peeled for shifty little maneuvers like this. And more power to Mr. Potter. Read the last column of his at http://www.prwatch.org/node/8977.
Thursday, April 1, 2010
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
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
Thursday, March 4, 2010
Steep Increases in Health Insurance Premiums Cited as Reason to Pass Reforms NOW
by L.A.S.
Several stories are in the news and are the talk around water coolers everywhere, regarding the steep increases in premiums for individual health insurance. As millions of Americans face unemployment and losing their group health coverage, they eventually fall past the coverage period for COBRA extensions of their group plan.
Shopping for healthcare insurance on their own has provided many rude surprises. It is made worse by the steep increase in premiums over the past year, in some cases hitting 40 to 60 percent.
Insurers say that healthy people are opting to go without insurance coverage, leaving the insurers to issue policies to the sicker people filling out applications.
That may be true, but increases of 8.5 percent all the way up to 60 percent can put one in the emergency room with chest pains!! Those percentages appear in a Chicago Tribune story on this problem. The Illinois insurance commissioner's office apparently does not receive information from insurance carriers regarding premium increases on an annual basis, although many states do.
Premiums commonly reach $1000-2000 per month for individual policies. This pushes people into choosing between paying for rent-food-utilities OR for health insurance coverage.
The recent increases have spurred increased attention from the Obama administration and calls to pass healthcare reform now. HHS Secretary Sebelius convened a meeting with the CEO's of several larger insurance carriers to discuss the recent premium hikes in the White House Roosevelt Room.
The CEO's of the following insurers came to the White House: Wellpoint, Aetna, Cigna, UnitedHealth Group and other companies not named. Also state insurance commissioners from Kansas, West Virginia and Pennsylvania came.
Ronald Williams of Aetna praised the administration for bringing them together to discuss the problem and said “this is what we need more of, everyone at the table collaborating.”
The Kansas insurance commissioner, Sandy Praeger, stated that “people are reaching the breaking point.”
Related stories:
Individual health insurance policy premiums soaring; Illinois consumers to pay up to 60 percent more, data show, www.chicagotribune.com/business/ct-biz-individual-health-insurance-premiums-mar04,0,223417.story
Sec'y Sebelius huddles with insurers, states over double-digit health insurance rate increases, www.chicagotribune.com/business/sns-ap-us-health-insurers,0,1976793.story
Several stories are in the news and are the talk around water coolers everywhere, regarding the steep increases in premiums for individual health insurance. As millions of Americans face unemployment and losing their group health coverage, they eventually fall past the coverage period for COBRA extensions of their group plan.
Shopping for healthcare insurance on their own has provided many rude surprises. It is made worse by the steep increase in premiums over the past year, in some cases hitting 40 to 60 percent.
Insurers say that healthy people are opting to go without insurance coverage, leaving the insurers to issue policies to the sicker people filling out applications.
That may be true, but increases of 8.5 percent all the way up to 60 percent can put one in the emergency room with chest pains!! Those percentages appear in a Chicago Tribune story on this problem. The Illinois insurance commissioner's office apparently does not receive information from insurance carriers regarding premium increases on an annual basis, although many states do.
Premiums commonly reach $1000-2000 per month for individual policies. This pushes people into choosing between paying for rent-food-utilities OR for health insurance coverage.
The recent increases have spurred increased attention from the Obama administration and calls to pass healthcare reform now. HHS Secretary Sebelius convened a meeting with the CEO's of several larger insurance carriers to discuss the recent premium hikes in the White House Roosevelt Room.
The CEO's of the following insurers came to the White House: Wellpoint, Aetna, Cigna, UnitedHealth Group and other companies not named. Also state insurance commissioners from Kansas, West Virginia and Pennsylvania came.
Ronald Williams of Aetna praised the administration for bringing them together to discuss the problem and said “this is what we need more of, everyone at the table collaborating.”
The Kansas insurance commissioner, Sandy Praeger, stated that “people are reaching the breaking point.”
Related stories:
Individual health insurance policy premiums soaring; Illinois consumers to pay up to 60 percent more, data show, www.chicagotribune.com/business/ct-biz-individual-health-insurance-premiums-mar04,0,223417.story
Sec'y Sebelius huddles with insurers, states over double-digit health insurance rate increases, www.chicagotribune.com/business/sns-ap-us-health-insurers,0,1976793.story
Monday, February 15, 2010
Congress demands explanation of California Blue Cross' rate increases when profits are up
by L.A.S.
California's Blue Cross operations must be doing great. They experienced record profits in a troubled economy in 2009, yet have raised rates as much as 39 percent. The Los Angeles Times reported on Jan. 28 of this year that Wellpoint's profits soared eightfold.
This news was shortly followed by an article on Feb. 4 in the same paper that Anthem Blue Cross was raising rates on individual health policies in California, in some cases by as much as 39 percent. The same paper reported on Feb. 10 that Congress was opening a probe into Anthem Blue Cross; the Department of Health and Human Services (HHS) was also interested in the case.
Wellpoint is the corporate parent of Anthem Blue Cross; its profits soared to 4.7 billion dollars last year, a record for them and extremely impressive in the current economic climate. There might be a link behind the improved profits and the fact that Blue Cross dumped 1.4 million policyholders last year, who were no doubt the most-expensive-to-insure and the least-desirable-actuarially.
Besides these U.S. government departments, interest in this development has also been expressed by public-interest or progressive social/political organizations such as MoveOn. You might like to visit the latter's website at MoveOn dot org where they are gathering signatures for an electronic petition demanding an explanation and rollback of the Blue Cross rate increases.
The need for prompt intervention in this corporate abuse is needed because not only is Blue Cross refusing to explain the rate increase, it is threatening to deliver further rate increases without warning. Even though many states require stringent reporting and forecasting of claims and payouts, there is no national regulation of rate increases. By that I mean, no limits on how much they can raise rates, nor on how often they can raise rates. This is the next best thing to having a license to print money.
So far, Blue Cross is stonewalling on an explanation and will continue to do so until this issue becomes a public-relations problem. That is why I urge you to spread the news of this case and to sign petitions, write letters to the editors, and blog AND do whatever else you can think of to be a thorn in Blue Cross' butt.
UPDATE: As of Monday, Feb. 15, Blue Cross announced that they will delay the rate increases for two months. This is evidence that public pressure has made them uncomfortable, but a short delay is not enough. Keep applying the pressure and we believe that they will be forced to abandon the effort.
California's Blue Cross operations must be doing great. They experienced record profits in a troubled economy in 2009, yet have raised rates as much as 39 percent. The Los Angeles Times reported on Jan. 28 of this year that Wellpoint's profits soared eightfold.
This news was shortly followed by an article on Feb. 4 in the same paper that Anthem Blue Cross was raising rates on individual health policies in California, in some cases by as much as 39 percent. The same paper reported on Feb. 10 that Congress was opening a probe into Anthem Blue Cross; the Department of Health and Human Services (HHS) was also interested in the case.
Wellpoint is the corporate parent of Anthem Blue Cross; its profits soared to 4.7 billion dollars last year, a record for them and extremely impressive in the current economic climate. There might be a link behind the improved profits and the fact that Blue Cross dumped 1.4 million policyholders last year, who were no doubt the most-expensive-to-insure and the least-desirable-actuarially.
Besides these U.S. government departments, interest in this development has also been expressed by public-interest or progressive social/political organizations such as MoveOn. You might like to visit the latter's website at MoveOn dot org where they are gathering signatures for an electronic petition demanding an explanation and rollback of the Blue Cross rate increases.
The need for prompt intervention in this corporate abuse is needed because not only is Blue Cross refusing to explain the rate increase, it is threatening to deliver further rate increases without warning. Even though many states require stringent reporting and forecasting of claims and payouts, there is no national regulation of rate increases. By that I mean, no limits on how much they can raise rates, nor on how often they can raise rates. This is the next best thing to having a license to print money.
So far, Blue Cross is stonewalling on an explanation and will continue to do so until this issue becomes a public-relations problem. That is why I urge you to spread the news of this case and to sign petitions, write letters to the editors, and blog AND do whatever else you can think of to be a thorn in Blue Cross' butt.
UPDATE: As of Monday, Feb. 15, Blue Cross announced that they will delay the rate increases for two months. This is evidence that public pressure has made them uncomfortable, but a short delay is not enough. Keep applying the pressure and we believe that they will be forced to abandon the effort.
Tuesday, January 26, 2010
Your Health Insurance Industry Spent $38 Million NOT on Health Care, but on LOBBYING Congress; and, Pre-existing Conditions Covered Only for Minors?
by L.A.S.
There is no recession in the lobbying industry. In fact, you might be cheered to note that the major insurers increased their lobbying budgets by anywhere from 7 to 80 percent. Yes, I said 80 percent. Little-big Humana upped its investment (ahem) in our Congress by 80 precent, to hit a mere $3.2 million dollars that might have paid for a life-saving surgery or two.
The increase looks large because their budget is tiny compared to America's Health Insurance Plans(AHIP), which spent a total of $8.9 million on lobbyists.
And what would YOU have done with that money? Probably spend it on worthless stuff like groceries and gas and rent -- nothing that helps the real economy grow.
But that is water under the bridge now and money gone down the tubes. It is spent, and we have to buckle down and make our voices heard above the din.
One of the things that has been quietly dropped in this season of healthcare reform is the notion of covering everyone regardless of pre-existing conditions. Now we find that only minors will be guaranteed that right. Yes, slipped in between the cracks of the newest version of reform poroposals is one that says children 19 and under will be guaranteed coverage without regard to any pre-existing conditions. According to another story on Alternet:
“The challenge for Democrats: a ban on denying coverage for those with pre-existing conditions went hand-in-hand with a requirement that all Americans carry insurance. Insurance companies conceded that they would accept all patients, regardless of health history, but only if everyone was required to have insurance, which would spread the cost of insuring the sick across a wider pool. Without an insurance mandate, a pre-existing ban would mean that premiums would almost certainly rise.”
Whoa. Wasn't that going to be UNIVERSAL, in those heady days when we thought that a major reform bill might get pushed through?
Insurers wanted that provision to be linked to mandatory purchase of insurance by everyone; that was the only way that risk could be spread out among the whole population.
Details of any reforms for this year (if any) are sketchy at best. But if this is the best that can be done for America, then I wonder if it is worth all the paper it will be printed on.
See whole stories at the AlterNet website at --
http://www.alternet.org/story/145389/are_democrats_dropping_the_ban_on_preexisting_conditions http://blogs.alternet.org/speakeasy/2010/01/25/health-insurers-spent-38-million-lobbying-congress-in-2009/
There is no recession in the lobbying industry. In fact, you might be cheered to note that the major insurers increased their lobbying budgets by anywhere from 7 to 80 percent. Yes, I said 80 percent. Little-big Humana upped its investment (ahem) in our Congress by 80 precent, to hit a mere $3.2 million dollars that might have paid for a life-saving surgery or two.
The increase looks large because their budget is tiny compared to America's Health Insurance Plans(AHIP), which spent a total of $8.9 million on lobbyists.
And what would YOU have done with that money? Probably spend it on worthless stuff like groceries and gas and rent -- nothing that helps the real economy grow.
But that is water under the bridge now and money gone down the tubes. It is spent, and we have to buckle down and make our voices heard above the din.
One of the things that has been quietly dropped in this season of healthcare reform is the notion of covering everyone regardless of pre-existing conditions. Now we find that only minors will be guaranteed that right. Yes, slipped in between the cracks of the newest version of reform poroposals is one that says children 19 and under will be guaranteed coverage without regard to any pre-existing conditions. According to another story on Alternet:
“The challenge for Democrats: a ban on denying coverage for those with pre-existing conditions went hand-in-hand with a requirement that all Americans carry insurance. Insurance companies conceded that they would accept all patients, regardless of health history, but only if everyone was required to have insurance, which would spread the cost of insuring the sick across a wider pool. Without an insurance mandate, a pre-existing ban would mean that premiums would almost certainly rise.”
Whoa. Wasn't that going to be UNIVERSAL, in those heady days when we thought that a major reform bill might get pushed through?
Insurers wanted that provision to be linked to mandatory purchase of insurance by everyone; that was the only way that risk could be spread out among the whole population.
Details of any reforms for this year (if any) are sketchy at best. But if this is the best that can be done for America, then I wonder if it is worth all the paper it will be printed on.
See whole stories at the AlterNet website at --
http://www.alternet.org/story/145389/are_democrats_dropping_the_ban_on_preexisting_conditions http://blogs.alternet.org/speakeasy/2010/01/25/health-insurers-spent-38-million-lobbying-congress-in-2009/
Monday, January 4, 2010
SEC Charges 2 Companies in 'Green" Ponzi Scheme
by L.A.S.
In November the SEC charged four persons and two companies in a so-called 'green' Ponzi scheme. It targeted elderly investors or those nearing retirement to finance a supposedly green housing community that would use biochar charcoal substitute made from organic waste.
The SEC alleges that the "green" representations were bogus, and investors were falsely promised enormous returns ranging from 17% to "hundreds of percent" annually. In fact, the company's environmental initiatives did generate any significant cash, and any returns paid to investors have been funded almost exclusively from other investors' contributions, the SEC says.
Charged in the complaint were Mantria Corp., Speed of Wealth LLC, Wayde and Donna McKelvy, and Troy Wragg and Amanda Knorr in federal court in Denver. Mantria's only source of revenue has been from its resale of vacant lots for its purported residential communities in rural Tennessee, but those did not generate cash with which to pay investor returns because Mantria provided 100% financing for almost all of its vacant lot sales to buyers using other investors' funds.
In November the SEC charged four persons and two companies in a so-called 'green' Ponzi scheme. It targeted elderly investors or those nearing retirement to finance a supposedly green housing community that would use biochar charcoal substitute made from organic waste.
The SEC alleges that the "green" representations were bogus, and investors were falsely promised enormous returns ranging from 17% to "hundreds of percent" annually. In fact, the company's environmental initiatives did generate any significant cash, and any returns paid to investors have been funded almost exclusively from other investors' contributions, the SEC says.
Charged in the complaint were Mantria Corp., Speed of Wealth LLC, Wayde and Donna McKelvy, and Troy Wragg and Amanda Knorr in federal court in Denver. Mantria's only source of revenue has been from its resale of vacant lots for its purported residential communities in rural Tennessee, but those did not generate cash with which to pay investor returns because Mantria provided 100% financing for almost all of its vacant lot sales to buyers using other investors' funds.
See WeRemember dot org to Track Missing Life Insurance Policies
by L.A.S.
Unclaimed insurance policies may total billions of dollars each year just because family members do not know where your life insurance policies are, or what recent changes to your estate have been made.
This is where a company named WeRemember comes in. They can save family members years of struggle and prevent them from getting over the grief of their loss. They may spend years filing lawsuits against each other or a financial advisor.
Joe Palmer, president and co-founder of WeRemember.org, based in Glenview, Ill., became aware of problems that can arise after his grandfather died in an airplane crash. The family did not know where the final will was, and missing paperwork resulted in family members filing lawsuits against each other.
For a one-time fee of $29.95, an individual can sign up on the WeRemember.org Web site. The person fills out a form listing his or her insurance policies, wills, bank accounts and other pertinent data and where each is or who the lawyer is who holds the information. The forms take about 20 minutes to complete, depending on how many policies and accounts there are.
WeRemember.org sends out regular e-mails reminding clients to update their information. When a client dies, WeRemember.org makes phone calls to heirs to let them know they are entitled to a benefit and tells them how to proceed. No truly personal information, policy numbers or benefit amounts are kept by WeRemember.org.
Sounds like a good service to me.
Unclaimed insurance policies may total billions of dollars each year just because family members do not know where your life insurance policies are, or what recent changes to your estate have been made.
This is where a company named WeRemember comes in. They can save family members years of struggle and prevent them from getting over the grief of their loss. They may spend years filing lawsuits against each other or a financial advisor.
Joe Palmer, president and co-founder of WeRemember.org, based in Glenview, Ill., became aware of problems that can arise after his grandfather died in an airplane crash. The family did not know where the final will was, and missing paperwork resulted in family members filing lawsuits against each other.
For a one-time fee of $29.95, an individual can sign up on the WeRemember.org Web site. The person fills out a form listing his or her insurance policies, wills, bank accounts and other pertinent data and where each is or who the lawyer is who holds the information. The forms take about 20 minutes to complete, depending on how many policies and accounts there are.
WeRemember.org sends out regular e-mails reminding clients to update their information. When a client dies, WeRemember.org makes phone calls to heirs to let them know they are entitled to a benefit and tells them how to proceed. No truly personal information, policy numbers or benefit amounts are kept by WeRemember.org.
Sounds like a good service to me.
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