Health Insurance Industry Policy between 2010 -2014 – Impact on the Average American Life

July 10, 2010

By Padmini Arhant

Further to the article published on this website – “Amendments to National Health Care Legislation,” 04/07/2010 under “Health,” category, the predicted Insurance industry practice is taking toll on ‘average’ American lives.

Source: Bay Area News Group July 4, 2010

By Sandy Kleffman – – Thank you.

“Health Care Nightmare,” – Minor conditions lead to major insurance costs

Ralf Burgert had no idea how costly toenail fungus could be.

The San Rafael resident got rid of the common infection by treating it with the prescription medication Lamsil. But he could not believe the reaction when he applied for a health insurance policy on the individual market a short time later.

Because of the toenail fungus, an insurer informed him, he would be in a higher-risk insurance pool with a 50 percent jump in premiums.

Consumer advocates say they are often perplexed by the minor health issues that can create serious problems for people seeking health insurance. Each company sets its own policies.

People have been rejected for such common conditions as acne and high blood pressure, said Judy Dugan, research director for Consumer Watchdog.

“If you are pregnant, (insurers) will run the other way screaming,” she added.

“They don’t want to insure a baby until they have looked it over to make sure it’s absolutely healthy.”

A Fremont doctor said she was shocked when one insurer rejected her application because of her eczema, seasonal allergies and a brief bout with viral meningitis, despite a full recovery.

At age 45, Angelique Green, chief medical officer of the Tri-City Health Center, considers herself very healthy, with low cholesterol. She has never smoked, and her hobby is hip-hop dancing.

“To say no to somebody and not even try to work with them, that’s just wrong,” she said.
“It was very frustrating.”

Consumer advocates say they want to make sure that insurance companies do not become more aggressive with denials or dramatically hike premiums for those with pre-existing conditions during the next four years.

“The insurers now compete based on their ability to deny (coverage) to anybody who might actually need care,” Wright said.

“That will change, but not in the near term, and that’s a problem we will have to reckon with.
“It’s particularly important to be vigilant between now and 2014,” he said.

“We would like to see that the regulators closely monitor the denial rates for pre-existing conditions and the reasons for the denials.”

Insurance industry representatives call such concerns misguided and say they do not expect any major changes in underwriting policies before 2014.

“We have a competitive market in California, so health plans want people to buy their coverage, and they will charge a competitive price,” said Patrick Johnston, president and CEO of the California Association of Health Plans.

He noted that the insurance industry generally supported eliminating medical underwriting and guaranteeing coverage to applicants, as long as the change came with a government mandate that most people buy insurance.

Pre-existing conditions are not an issue for the 21 million Californians who have group insurance, usually provided through employers, because group plans accept people regardless of their medical histories.

But they can be a big worry for the 2.5 million Californians who buy insurance on the individual market.

California and many other states will soon set up new high-risk pools for those who have found it difficult or impossible to obtain coverage.

California will receive $761 million to fund this new pool, a dramatic increase over the $33 million for the state’s existing high-risk pool. But this money will not cover everyone with pre-existing conditions, and some may find the still-to-be-determined premiums too costly.

As a result, many people with pre-existing conditions are expected to remain in the individual market during the next four years and experience frustrations as they attempt to find coverage, consumer advocates say.

Consumer advocates such as Wright say people with pre-existing health conditions often encounter serious problems in obtaining coverage that hopefully will be resolved in 2014.

“Many people find it bewildering that it’s exactly the people who need coverage who are the ones who cannot get it,”

As more and more people get denied for smaller and smaller medical problems, both the industry and individuals have figured out that this is not sustainable,” he said.

“The system is broken.”

Redwood City resident Terri Mullen agrees. When she experienced work-related stresses in 2008, her doctor suggested she see a therapist and try anti-anxiety medication. Little did she realize the problem this would cause.

When she later applied for an individual insurance plan, a firm told her she would be in a high-risk pool with much higher premiums because the therapy and medication were signs of a serious mental illness.

Now, she says, “I’m not stressed out anymore – I’m mad.’

By Padmini Arhant – Health Care Snags Drags on…

As noted in the cited article, the victims’ experience is precisely the reason for the requirement on the health care reform to be effective immediately rather than in 2014.

Although, the health insurance industry like other Wall Street behemoths dictate their terms and conditions in every legislation to water down the impact, the legislators still hold the key to an effective and meaningful law on every national issue from financial, energy to health care bills.

It’s not surprising to note the insurance industry representatives’ emphasis on ‘the government mandate to buy insurance,’ to enable the industry compliance with respect to pre-existing conditions and coverage offer to applicants.

The problem lies with the insurance industry’s policy against the mandatory subscribers with pre-existing illnesses and affordability factor for comprehensive quality care even in 2014 and thereafter.

Meanwhile, the insurance industry is determined to continue the status quo with coverage denial and placing subscribers under high-risk pool for minor ailments between now and 2014.

Since it’s a life and death matter, those who are declined coverage by the insurers face the worst possible situations as there is no guarantee to their health care access until the health care legislation becomes the law in 2014.

Despite the expected federal funding increase to the states to address the high-risk pool, the amount projected as inadequate to cover the patients with pre-existing illnesses forcing them to deal with the escalating premium costs in the market for individual subscribers.

That’s why the ideal solution to all of these issues would be to amalgamate the existing federal programs such as Medicare, Medicaid, CHIP, VA, COBRA and establish a “Single Payer” system for a “Universal Health Care” made available now to save life.

Nations thrive with healthy population contributing to a productive and prosperous economy.

It’s never too late to enhance the health care law for health care is a necessity and not a privilege.

Thank you.

Padmini Arhant

Amendments to National Health Care Legislation

April 7, 2010

By Padmini Arhant

The health care legislation was signed into law in late March 2010. Subsequently, there is lot of disappointment to the effects of law and the insurance industry obligations that appear to contain many loopholes resembling the status quo.

Hence, upon reviewing the major components of the bill per the statements from the President’s letter, along with the data made available by Congress and the Congressional Budget Office,

It’s clear that amendments are necessary to protect ‘average Americans’ interests from the health industry behemoths.

Statements from the President’s letter:

“Now we need to begin the process of implementing these historic changes.

To ensure a successful, stable transition, many of these changes will phase into full effect over the next several years.”

1. “But for millions of Americans, many of the benefits of reform will begin this year – some will even take effect this week.”

Recommendation: Although, it’s claimed that the uninsured with pre-existing conditions would be covered beginning this week, the data should be provided for public knowledge.

The insurance companies willing to offer coverage to the uninsured population with pre-existing conditions including the information on the eligibility, the premium costs and the federal funding source is essential to confirm the benefit.

2. “Uninsured Americans with pre-existing conditions can join a special high-risk pool to get the coverage they need, starting in just 90 days.”

Recommendation: “High-risk” pool coverage starts effective immediately and not in three months’ time.

Insurance industry must note that this is a health issue and not a decision about any recreational activity or a vacation.

For some it could be a life threatening illness requiring urgent medical intervention.

Moreover, in the absence of specifics from the insurance industry – on coverage costs, limits and treatment level, the patients could be inhibited from seeking the comprehensive coverage they might need for their health problem.

3. “And Americans with insurance will be protected from seeing their insurance revoked when they get sick, or facing restrictive annual limits on the care they receive.”

Recommendation: This legislative law applies to the ‘currently insured,’ who are pre-screened and selected as the ‘low risk’ subscribers.

However, the law must be extended to the uninsured regardless of medical history.

4. “We passed this reform for 5th-grader Marcelas Owens, whose mother died because she didn’t get the health care she needed after she got sick, lost her job and her health insurance. Marcelas’ message to Congress was simple: “Finish health care reform. No other kid should lose their mom because they don’t have health care.”

We passed this reform for Natoma Canfield, who wrote to tell me that she could no longer afford her health insurance policy. Since losing her health insurance coverage in January, Natoma has been diagnosed with Leukemia and is fighting for her life.

Recommendation: In order to protect victims of such tragic situations, the Medicaid and Medicare (if age qualified) expansion is vital as suggested below.

5. We passed this reform for Ryan Smith, a small business owner with five employees. Ryan was doing his part to provide health insurance to his employees, but cannot keep up with rising health care costs.

Small businesses will receive significant tax cuts, this year, to help them afford health coverage for all their employees.

Recommendation: The public option is the reliable option for Small business and self-employed individuals struggling to compete in the dire economy.

Because, it’s being facilitated through tax cuts (federal funding) to enable their private coverage,

The public option is the ideal choice that would produce savings for this demography and the government.

6. “Early retirees will receive help to reduce premium costs.”

Recommendation: Again, the burden is shifted from the insurance industry to the taxpayers via federal help.

Instead, the Medicare threshold should be lowered from 65 to 55 in the amendment that would adequately address the issue.

7. Young people will be allowed coverage under their parents’ plan until the age of 26.

Recommendation: It should be at no additional costs to the subscribers.

8. Children will be protected against discrimination on the basis of medical history.

Recommendation: It’s verified to be true for the ‘insured’ but not the uninsured.

It was also revealed that the law is interpreted by the insurance industry as a discretionary action. Otherwise, a non-committal response and even coverage denial to this piece of legislation.

Therefore, imposing penalties for failure to comply will make the law effective.

9. We’re also making investments to train primary care doctors, nurses, and public health professionals.

Recommendation: It’s a step in the positive direction.

To make the investment worthwhile, it’s imperative to utilize the health care services for Medicare, Medicaid, CHIP, VA patients as well as the ‘Public Option’ subscribers rather than the private industry solely benefiting from it.

10. “State-level consumer assistance programs to help patients understand and defend their new rights” –

Recommendation: This could create variation in practice allowing the insurance and the health care industry to circumvent the respective state laws as seen in the environmental matter on carbon emissions, leading the environmental agency to adopt a standard law across the country.

That’s why, the independent and non-profit ‘National Consumer Health Rights Agency,’ would be ideal to deliver the service.

“In Marcela, Ryan, Natoma, my mom and so many other Americans, we are reminded of what this fight was about. It wasn’t about politics. It was about doing the right thing, and taking care of the hardworking people that make our country great.”

It would be beneficial to the suffering population upon incorporating the above recommendations and the amendments listed below.
By Padmini Arhant

Amendments to the National Health Care Legislation

Since the health care legislation is already passed, the applicable changes should be rapid without any legislative rigmarole.

1. Effects of law commencing in 90 days, 6 months and within a year must begin tomorrow and no later than April 12, 2010 to accommodate all different health situations experienced by those who are ill at present.

2. The contentious settings in 2014 and 2019 for full effects should be brought forward to June 2010.

3. Simultaneously, the tax laws scheduled for 2013 and 2018 should be modified to be effective immediately.

Accepting the uninsured patients as new subscribers should not be a daunting task given the resources and the established system that are currently in place.

In addition, the federal funding for private insurance coverage should be diverted to ‘public option,’ program, CHIP, Medicaid and Medicare expansion notwithstanding the VA patient care.

4. Introduction of public option to induce real competition is the hallmark of the amendment.

5. Lowering the Medicare eligibility threshold from 65 to 55 as agreed by most legislators in Congress during the health care debate.

6. Medicaid expansion to the unemployed and senior citizens falling short on prescription drug expenses despite the $250 rebate upon them reaching the coverage gap.

NB: The votes are available in the House and the Senate to pass these rules via ‘the reconciliation process,’ if the bipartisanship remains impossible.

7. Revive the deal with the health care service and Big Pharma on the estimated $500 billion dollar savings that was initially committed by the industries.

8. Jan 1, 2011 – Enactment calls for ‘marketplace’ insurers to invest premium dollars on medical services by 80 percent for individuals and small plans, whereas the large groups by 85 percent respectively.

Recommendation: Monitoring is essential to ensure such practice among the insurers.

The law would be redundant without oversight.

Independent and non-profit ‘National Consumer Health Rights Agency,’ is appropriate for it would prevent breach of the investment criteria.

9. Anti-trust laws passed by Congress should be extended for a longer period i.e. until 2020.

10. Mandatory insurance should be based on affordability and individuals without sufficient financial means automatically qualify for federal medical program via public option at a lower competitive cost and not higher than the private sector as determined earlier to boost the private insurance sales, during the health care legislative process.

Alternatively, the Medicaid program should be accessible for these individuals and families experiencing sudden change in status due to loss of family income generating an insurance lapse in premium payments.

These changes will provide for all Americans.

The health care reform would be meaningful with the all of the above recommendations and amendments.

Those who contribute to these enactments need not be concerned about their re-election for they will be guaranteed a victory in November, 2010.

The legislators from both sides of the aisle could make this happen by showing their willingness to prioritize their constituent’s physical health over the special interests’ financial gains.

Ultimately, the power lies in the citizen’s vote regardless of corporate campaign financing.

‘Change’ is made possible by the people in a democracy and not the profit seekers.

If there is will, there is a way.

Thank you.

Padmini Arhant

P.S: Comprehensive analysis on National Health Care Legislation was previously published on March 29, 2010 under “Health,” Category on this website.

Universal Health Care – The Ideal Remedy

March 4, 2010

By Padmini Arhant

Health care reform has consumed significant time without any consensus on the important national crisis.

The last week bipartisan summit confirmed the status quo.

Now the discussion is held on passing the legislation in different format. Some advocating for piece meal legislation while others believe in the consolidated package approval.

Those who opposed the reform from the beginning remain steadfast in their opposition to saving lives for political and personal interest. The obstinacy speaks volume about their commitment to public service.

The back and forth exchange is counterproductive when an alarming proportion, an estimated 45,000 young and old people are dying every year.

Although, the Senate health care bill without public option is upheld as the ‘adequate’ measure, it continues to be an uphill battle in securing the Senate majority vote.

Despite the public testimonials sharing their harrowing experiences along with the facts on the escalating costs, the universal health care was never an option previously among the ‘Super Majority’ democrats with the exception of few legislators in the House and the Senate.

In 2009, when the democrats were a super majority, they lost a once in a lifetime opportunity to provide the American electorate, the deficit reducing and an affordable health care through universal Medicare.

Not all is lost, since the Democratic members and the administration are forced to consider the reconciliation process – an avenue used by the Republican administration and the members on numerous occasions in the past for the military and the corporate agenda.

However, it’s incumbent on the democratic members to serve the public interest by adopting the Single Payer system, when considering the simple majority rule.

Why is the Universal Medicare, an ideal remedy?

1. It’s simple and cost effective in every sense.

2. The system already exists for seniors via Medicare and the VA health care for the veterans. Further, Medicaid and COBRA are also federal funded programs.

3. Current Medicare coverage to seniors and the Federal funded VA programs are acknowledged as the phenomenal milestone in the national health care, even by the Republican members in the Congress. They appreciate it because they are entitled to the health care privileges as the members of the United States Congress.

4. Therefore, the Medicare expansion for all would resolve the disputed intricacies in the present health care debate.

5. Standard rules on the health care services would effectively address the excessive health care management costs attributed to the rising national debt.

6. Competition among the health care service providers promotes quality including the desirable choices for the insured in seeking the appropriate treatment.

7. Fraud and malpractice could be curtailed under the blanket rule for the industry.

8. Mandatory insurance for all under federal program would ease the burden on the society – the individuals, small businesses and the Corporations. It’s stipulated in the pending legislation, but in the absence of a federal run program the private insurers gain absolute monopoly leading to the ‘business as usual’ environment.

9. Negotiations with the pharmaceutical industry under universal Medicare would also substantially reduce the drug costs. Thus benefiting all.

10. Universal Medicare is a guaranteed protection for it would be available 24/7 regardless of the citizens’ health conditions.

The people of the United States deserve an efficient, cost saving, choice oriented health care system such as the Medicare for all.

Under ‘not-for-profit’ universal health care, otherwise the single payer system, the consumers would invest their premiums in their health rather than the insurance and the health care industry CEO’s wealth.

America should not agree to anything less than a Universal Medicare and it’s legislatively possible through the legitimate reconciliation method, currently decided by the democratic members for passing the unpopular Senate version of the health care bill.

Finally, Healthy People means Wealthy Nation.

Thank you.

Padmini Arhant

Universal Health Care

May 24, 2009

By Padmini Arhant

Health Care is not an individual matter. It’s a national crisis as clearly expressed in President Barack Obama’s message.

“American families are watching their premiums rise four times faster than their wages. Spiraling health care costs are shackling America’s businesses, curtailing job growth and slowing the economy at the worst possible time. This has got to change.”

President Obama’s Health Care Policy aimed at three core principles — "it must reduce costs, guarantee choice, and ensure quality care for every American.”

The combined forces of the Health Care industry represented by the Insurance, Pharmaceuticals, Biotech, Academic institutions (e.g. University of Chicago), Hospitals, Medical Centers and Private Medical facilities not barring Wall Streets’… dominance in the highly commercialized and profit driven enterprise has led to the status quo of the most important economic structure in the society.

Industrialized nations have experimented with both socialized and privatized medicine. Some commonwealth nations viz. United Kingdom, Canada and Australia have blended the national health care with private and taxpayers’ funded policy. In the exclusively privatized medicine, the privileged segment of the society thrives while leaving the remaining population at the mercy of their faith and own ability to bear the financial burden in medical costs. Such situation has forced families to deal with unparallel traumatic and tragic ends.

Meanwhile, socialized medicine despite criticisms benefits most if not all. President Obama’s strategy directed towards the universal concept of sharing the costs and benefits to insure every individual. The proposal is flexible with choices between the government plan and the private sector offer. Also guaranteed in the plan is affordable and quality care, an ideal and a rare combination.

Evidently, the health care costs rising disproportionately to the benefits have contributed to an alarming proportion of the population uninsured and in most cases underinsured, thereby worsening the crisis. Sadly, in both scenarios the patient deprived of longevity in life due to the lack of national health care. Life being uncertain, a private citizen without health insurance is like a fish out of water. It is particularly harsh on the patients who are unwell and more so with the chronically ill struggling between life and death. The impact is even greater among the socially and economically disadvantaged class.

The suffering exists across the board with hospitals and community health centers/services shutting down as the primary targets of state and national fiscal crisis.

The Insurance industry thus far the most influential entity dictating terms and conditions entirely in their favor from eligibility by eliminating patients with ‘pre-existing illness,’ to co-payments, deductibles and access to health care providers and services. Further, the industry’s excessive intervention in patient care proved intrusive and fatal in many circumstances with lawsuit settlements in millions of dollars.

It doesn’t fall short of forging alliance with drug companies and some health care providers instructing patients to limited care and bypassing vital preliminary tests in the protocol with the substitution of medications overriding the preventive care of early diagnosis, the desirable and sensible approach to saving lives and costs.

Again, the flip side has a potential ethical issue with the health care providers stretching the limit on rigorous testing as an insurance against malpractice lawsuits aside from recovering investment costs on expensive medical diagnostic equipments. Either way, the patient/consumer is the victim of flawed system.

Pharmaceutical and biotech industries exploiting the uninsured and underinsured dying patients in their overzealous marketing and promotion of new drugs developed through volunteer participation in clinical trials have risen lately.

The industries seek immunity in the clinical trial patients’ written consent assuming responsibility to the calculated risks notwithstanding loss of life. The argument may rest on justification to find cure and aid humanity, however it’s not equivalent to actions governed by ethics.

Ironically, the recent medical news reports claimed the terminally ill without insurance mostly volunteered with the hope of getting new life in the unmitigated experimental cure.

There are more compelling facts regarding uninsured pregnant mothers foregoing antenatal and postnatal care, including the newborns from the neonatal attention subsequently leading to serious complications costing the tax payers horrendously in the county hospitals.

In a similar context, the ailing and wounded war veterans returning from war zones for treatment in the state-of-the-art medical center recently stranded by the closure of Walter Reed Memorial Hospital and other V.A medical centers.

The veterans’ post combat care and facilities have deteriorated to an appalling condition in the past years and the veteran affairs legislation initiated by President Obama enacted the medical provision for armed forces personnel.

Youth population has been worst hit in the health care crisis. Teenage pregnancies on the rise along with an epidemic level obesity due to unhealthy food choices surging in the market combined with limited sports activities from the lack of educational funding.

Senior citizens aren’t any better in the health care gamut. The geriatric population is marginalized with skyrocketing drug costs, forcing them to other avenues like Canada to purchase relatively cheaper medications and others travelling to South Asia for surgeries and treatments requiring hospitalization.

In a nutshell, the health care in the United States is in shambles. Policy embracing the health coverage for all Americans in an efficient system that delivers cost effective, valuable care without compromising patient’s health and life in exchange for profits is in order.

Further, the overhauling of the system is imperative with technology-oriented operation in the multifaceted management. Cost saving strategy should focus on the appropriate use of human expertise with complete utilization of qualified health care professionals in the hierarchy such as nurses, nurse practitioners, dieticians/nutritionists, counselors, therapists, technicians and everyone engaged in the wellness program.

Both private individuals and the employers would benefit from the platter with free market competing against the government plans. This would not only promote checks and balances in the highly disorganized and profit motivated sector but also remain competitive in keeping the costs down for the providers and the consumers.

Research and development instrumental for advanced care and United States has been in the forefront in that aspect. Funding stem cell research, regenerative medicine and the promising personalized medicine -‘Genomics’ is the direction for United States to lead the rest of the world.

According to the biotech industry –

“Genomics – Personalized medicine is a movement to use advancing knowledge of an individual’s molecular makeup to provide better preventive care, as well as better diagnosis and treatment.”

Genomics, apart from being revolutionary in the preventive care field, appears far more cost effective as well.

Keeping NIH well funded is representative of commitment towards general well being of the society. Also equally important is the easing of immigration laws for scholars, scientists and students to visit U.S. universities and research centers for scientific exchange programs.

United States isolated as an industrialized nation in the failure to meet the highest challenge with health care. The partisan politics and special interests holding almost every crisis hostage for profits and political agenda is detrimental for their own and the country’s future.

Approval of President Barack Obama’s comprehensive health care including the above recommendations would help the United States earn due recognition on the topic avoided for fear of political backlash.

It’s no longer possible to procrastinate having lost precious time, as too many lives are at stake. The lawmakers taken to the daunting task of doing it right with the issue literally matter to life and death.

The critics, attack the proposal with nick names ‘Robin Hood’ principle of socialized medicine. Nonetheless, the lack of action in health care compares with the paradoxical “DR. Jack Kevorkian” in the society-assisted euthanasia.

Finally, Health Care is a necessity not a choice.

Thank you.

Padmini Arhant