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Wendell Potter

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Taking the Initiative in a Struggle Against Excessive Rate Increases

Posted: 02/20/2012 10:58 am

The biggest applause line Senator Diane Feinstein (D-Calif.) got at a gathering of Democratic Party activists last week came when she endorsed a ballot initiative to give the California Insurance Commissioner power to reject excessive health insurance rate increases.

Consumer advocates there decided to go the ballot initiative route after the insurance industry's friends in the legislature blocked a bill last year that would do the same thing. Feinstein became the first Californian to sign a petition. Insurance Commissioner Dave Jones became the second. To get the measure before voters in November, the advocates, led by Santa Monica-based Consumer Watchdog, must collect half a million more signatures.

In her San Diego speech before the party faithful, Feinstein pointed out that in the first quarter of this year, the five largest health insurers -- UnitedHealth, WellPoint, Aetna, CIGNA and Humana -- posted profits of $3.6 billion, 16 percent more than the same period a year earlier. One of the ways those companies were able to achieve such Wall Street-pleasing success was by jacking up the rates on policies bought by individuals and small businesses. While most of these policyholders dug deeper into their pockets to avoid joining the 50 million Americans who are uninsured, many others had no choice but to let their coverage lapse.

As Feinstein noted, thousands of Californians have been forced into the ranks of the uninsured in recent years because of policies being priced beyond the ability of individuals to pay. She said many people in the state had received rate increase notices twice over the past year alone.

According to the California HealthCare Foundation, health insurance premiums in the state increased 153 percent from 2002 to 2011, more than five times the rate of inflation for other goods and services during the same period. As a consequence, a growing number of the state's residents have been priced out of the health insurance market.

And this is not a situation unique to California. A review of financial statements filed with the Securities and Exchange Commission shows that while the five biggest insurers earned billions in profits last year, the number of people enrolled in what they call "fully insured policies" -- primarily employees of small businesses or individuals who have no alternative but to buy coverage on their own -- decreased.

That is a continuation of a trend that's now several years old. The vast majority of the big five's membership comes from service agreements they have with large employers, not from actually insuring individual Americans. The companies have, in essence, transformed themselves into benefit administrators for big corporations that self-insure and for the Medicare and Medicaid programs. It's no longer even accurate to refer to those five companies as insurers. They certainly don't. If you look at their websites, you'll see that they call themselves "health services" companies or the like. You'll be hard pressed to find the word "insurance" on their sites or in their promotional materials. That's because the number of people they actually insure continues to dwindle.

While the big five reported covering 3.5 million more Americans at the end of 2011 than at the end of 2010 -- from 106.5 million to 110 million -- the number of people enrolled in their individual and small business plans actually declined by more than 400,000. The enrollment gains came almost exclusively from their "administrative services only" customers.

The federal Affordable Care Act should reverse that trend when the states get their health care "exchanges" (online marketplaces) up and running by 2014, as required by the law. Starting that same year, insurers can no longer refuse to sell policies to people because they've been sick in the past. Additionally, the requirement that all of us must have coverage will become effective.

While the law grants the Secretary of Health and Human Services the ability to question rate hikes of 10 percent or more and to proclaim such increases excessive, it doesn't give regulators at either the state or federal level to the authority to reject them. Which is why consumer advocates in California are hard at work to get the requisite number of signatures to get the initiative on the ballot. While the state's insurance commissioner can reject excessive auto insurance rate increases, he doesn't have the authority, which regulators in several other states have, to block exorbitant health insurance hikes from taking effect.

Feinstein said at the San Diego party conference that a growing body of evidence indicates that California insurers are raising rates in the individual and small group markets even higher than usual this year in anticipation of being required to insure everyone who applies starting in 2014. That, too, is not limited to California. As enrollment statistics reported by the big five earlier this month show, it is a nationwide phenomenon. A former insurance commissioner in Missouri told me recently that agents and brokers have told him that insurers are now rejecting far more individual applicants than usual and hiking premiums much higher than in previous years.

When insurers behave this way, they are demonstrating that they care more about their bottom lines than their policyholders. Which makes it all the more imperative for California voters to sign those petitions and vote for the ballot initiative this fall.

 
 
 

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HUFFPOST SUPER USER
tmrn31m
12:07 AM on 02/21/2012
The highest paid company employee in america last year works in the california health care industry. He made 135 million dollars last year alone. That is money that should have been used for actual health care on actual patients. Not siphoned off to reward someone for nothing except greed. Not to some guy sitting at a desk doing nothing but congratulating himself, and then rewarding himself monetarily for the good job congratulating himself. This is why healthcare is too expensive. It has gotten away from doctors and nurses and has run towards accountants, politicians and lawyers.
Yasmine
the DEFENDER in CHIEF
12:06 AM on 02/21/2012
MEDICARE for ALL..............and some kind of reduction of services for END of LIFE problems.

this is the real solution Mr Potter.
HUFFPOST SUPER USER
DJleary
11:50 PM on 02/20/2012
First of all- quoting Dianne Fienstien is just poor taste. The woman killed the Public Option in it's cradle.
She is a disgrace.
Otherwise- getting tired of Wendall. Excess raete increases are what exactly??
My wife just dropped her insurance finally after a 25% rate hike- AGAIN- on a get nothing policy.
04:15 PM on 02/21/2012
Republicans and a handful of democrats in the senate killed any public option.
HUFFPOST SUPER USER
DJleary
09:12 PM on 02/21/2012
She was one of them and that's why it's pathetic to quote her.
HUFFPOST SUPER USER
jstrate
11:26 PM on 02/20/2012
Would the insurance companies like to be rid of these individual policies altogether? I suppose they keep charging higher premiums because of all of the uncertainty around what they will have to pay out due to adverse selection (the higher the premiums, the more likely that it will only be the sickest that purchase policies). How do you pick only the cherries? Only insurance companies that are the best cherry pickers beat the competition in the market for individual policies. No insurance company really wants to cover individuals with preexisting conditions or chronic health problems. You get what you pay for and oftentimes, as the author points out, much less.
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HUFFPOST SUPER USER
Ally Solver
Problem Solver Extraordinaire
08:30 PM on 02/20/2012
If states limit insurance company rates, the insurance companies could decide to withdraw from the state. This could leave everyone buying insurance from the state government. This would lead to eventual higher prices and lower quality health care. Why? Because it is socialism. Socialism never works.

Censorship is evil.
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HUFFPOST PUNDIT
larmarch5
01:46 AM on 02/21/2012
Medicare for all solves the problem. Cuts out the profiteer middle men.
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HUFFPOST SUPER USER
Ally Solver
Problem Solver Extraordinaire
12:48 PM on 02/23/2012
And when there is no alternative, the quality will decrease and the cost will go up just like all government programs.

Profit is not evil, except to individuals that can not make any.
03:00 AM on 02/21/2012
You do understand that simply stating "Socialism never works" doesn't actually mean that socialism never works... I think you'll find that Norwegians, Swedes, Germans and even Canadians would vehemently disagree with you - these countries all enjoy a far better quality of life than do Americans.

As for state-run health care, Medicare is administered much more efficiently than any private insurance company - that is a fact. When the state has to answer to its taxpayers for their state-run health care, exorbitant profit-making goes out the window and is replaced with a far better system of preventative medicine, which lowers the cost all around and is by far in the best interests of actual patients. Here in the US, most of us are paying 12 months of overpriced premiums plus the deductible and co-pays every year without receiving any benefit at all. Is this really what you'd want to choose over a modest tax-increase that would replace an inefficient, profit-oriented, private system whose best interests are served only when the general population is unhealthy?

I think if you check your facts, and don't just regurgitate the usual anti-socialist rhetoric, you'll find that people who live in socialist countries with universal, state-run health care are quite happy with the service they get. Doctors are paid less, hospitals are owned by the state and are non-profit, and a focus on preventative care ensures a healthier population, for less money all around.
07:47 AM on 02/21/2012
Well said. Indeed very well said.

F&F
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HUFFPOST SUPER USER
Ally Solver
Problem Solver Extraordinaire
12:47 PM on 02/23/2012
Comparing Norway, Sweden, et al to the United States is like comparing apples to oranges.

Medicare will never be as efficient as private insurance companies. Remember, government is never as efficient as private industry.

Profit is only evil to those who can not make any.

Do you really understand the structure of the medical cost and payment system?

It is not about rhetoric, it is about learning that socialism does not work for society as a whole, just for certain special interest groups.
HUFFPOST PUNDIT
ThatsTheTheWayItIs
religion, ideology, partisanship are delusional
08:13 PM on 02/20/2012
Everything covered by insurance costs society more than if we paid for it ourselves.

ACA mandates insurers pay out 80% of the money they take in. Meaning, you pay over 25% extra by having insurance, instead of paying for it yourself. I'm 61 and uninsured, and get 25% off for medical, hospital and ER because I pay cash.

And I never get checkups, tests or drugs that ACA mandates I pay for. I'm a scientist, worked in medical imaging. So-called "preventative medicine" does not save money, the CBO says ER use and total medical expense will rise as more get insured by ACA.

ACA mandates insurers pay back 80%, and they'll do that. After that, every extra mandated ACA coverage raises the cost of insurance, more than if people paid for it themselves. That will cost employers more, they will take out of workers wages and raise employer contributions. The extra cost will discourage hiring. The increased cost for individuals will cause more to violate ACA and be uninsured. Millions will become bankrupt because they couldn't afford the bloated medical plan - to pay for drugs for much richer people.
04:20 PM on 02/21/2012
you don't seem to understand how insurance works. Everyone pays a modest amount in, and the ones who need it can get a much larger amount out. One accident or disease would bankrupt 99.5% of people in this coutry.
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RUKidding0
Freedom is Fundamental
06:50 PM on 02/20/2012
Social Democratic Government abuses its power and acts irresponsibly - passing and implementing ObamaCare.

Insurance companies are forced to re-act and anticipate further abuse.

The Law of Unintended Consequences ALWAYS rules with an iron fist.
Yasmine
the DEFENDER in CHIEF
12:08 AM on 02/21/2012
SINGLE PAYER is the real solution.
You do not want any solution.
freedom is fundamental ??
then how can anyone be really FREE if all their essential needs cannot be met ???
YOU NEED to RETHINK Freedom
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RUKidding0
Freedom is Fundamental
09:57 AM on 02/21/2012
I would suggest that YOU NEED to RETHINK Freedom, but, clearly, you are a mindless drone of the social democratic state and original thought is beyond your ability.

However, 75 years of social democratic bastardization of language designed to distort the term, "freedom" into its opposite can help you understand the difference between freedom and its social democratic bastardization.

Unless your mind is entirely shut, see:

http://plato.stanford.edu/entries/liberty-positive-negative/

for a basic explication of the difference between the negative liberty upon which this nation was founded and the positive liberty FDR and other social democrats have designed as freedoms bastardization.
04:24 PM on 02/21/2012
the health care act was a reaction to insurance premiums spiraling out of control. This country pays far more than many other countries for health care and gets worse results. We need much more comprehensive change than the health care act. We should use the model that the countries with the most successful health care use. Single payer.
06:38 PM on 02/20/2012
I am Canadian living under Universal Health Care..

When someone in Canada complains I ask them to take their dog to the veterinarian who is not under Healthcare and see what the costs are..
05:06 PM on 02/20/2012
Much of this article is spot on, IMO. Having worked in states where the Department of Insurance had the power to deny rate increases I could see first hand how the insurance companies scrambled to justify their, often, exorbitant rate hikes. The power to deny, by itself, wasn't enough though. The private sector does have the power to higher sharper and smarter legions of analysts and actuaries to obfuscate and dissemble.

Ultimately Healthcare MUST be Nationalized it really is the only way and struggle against it all you want; it will happen. Just not soon enough for my generation. Believe me, I've had many, many conversations over the years about nationalization...people within the industry are well aware that it is inevitable.
Yasmine
the DEFENDER in CHIEF
12:04 AM on 02/21/2012
DiegoNative

SINGLE PAYER is the real SOLUTION.
faved
HUFFPOST SUPER USER
tmrn31m
12:10 AM on 02/21/2012
Agreed. Single payer system only. Universal coverage for all. Cut the dead weight from healthcare and it becomes cheaper. For example, hospital CEO's that make 135 million dollars a year and do not contribute to actual patient care, only take away from it so they can make the kind of money they do.
02:27 PM on 02/20/2012
Privatized , free Market healthcare for profit is an abomination ! Out of control costs, skyrocketing premiums, more procedures , less care. Healthcare should not be subjected to the greed of the market where someone profits from your illness !
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RUKidding0
Freedom is Fundamental
06:46 PM on 02/20/2012
Healthcare should not be subjected to the greed of the social democratic state where some rent seeking thief and the politicians they support profit from your hard earned income !
09:50 PM on 02/20/2012
Ah, so you're saying that the greedy corporate overlords should profit from your hard earned income! That's a much better system.... RUDrunk?
04:26 PM on 02/21/2012
funny how medicare and the VA do much better at health care with much less money.
HUFFPOST PUNDIT
ThatsTheTheWayItIs
religion, ideology, partisanship are delusional
08:23 PM on 02/20/2012
Then surely you oppose ACA, which mandates that we buy it? I violate Romney Care here in MA, am uninsured because it requires I pay $1000 a year for drug coverage. I'll violate ACA too.
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HUFFPOST SUPER USER
chaz
02:27 PM on 02/20/2012
Again there is a difference between Democrats and Republicans and a massive difference between Liberals and "conservatives".

Keep electing REpublicans,conservatives and especially tbaggers and keep getting ******
T-Haight
What was wrong with federalism?
02:25 PM on 02/20/2012
If costs for health insurance in California keep going up, maybe it would be more appropriate to find out what is driving those underlying hikes and address the root causes? A lot of states keep adding requirements that specific procedures or types of specialized treatments be covered, which doesn't come for free.

One thing that is for certain is that if California institutes de facto price controls, availability of health insurance will decline. The last century is full of examples that confirm that price controls reduce the availability of the product or century, and there is no reason why California's health insurance industry would be different.

To be clear, this is a major change that would put California on the path toward less choice and likely on the road to state-funded insurance for all. I'm sure some of the backers of this initiative have that as an unstated objective, but if so, they should be honest about it. Bleeding an industry with regulation prior to moving in for a state takeover based on its lackluster performance is a tactic for banana republics, not honest, open democracies.
HUFFPOST PUNDIT
ThatsTheTheWayItIs
religion, ideology, partisanship are delusional
08:27 PM on 02/20/2012
There is only one "price control" that works: the consumer. When we buy things, we evaluate price-performance, decide if it's really worth it, shop around. Medical insurance prevents all that. We don't know the actual price of the drugs we use, cost the same co-pay. No incentive for us to not use them, or to seek cheaper versions.

I'm 61, older than Medicare and originally it and private policies were "major medical" only. My parents and I paid for everything except hospitals and ERs - and the US spent half as much on medical, as a percent of GDP. The more that got covered, the more we spent.

It's simple: medical plans are like mandatory auto insurance that covers maintenance, repairs and gasoline. Do you think we would spend less on driving with that system - or about twice as much, as we did with full-blown medical plans?
T-Haight
What was wrong with federalism?
12:19 PM on 02/21/2012
I tend to agree with your reasoning.

I have a suspicion (though I have no evidence) that the reason that most insurance is no longer "major medical expenses only" is because of cost creep. I'm only 30, but my parents were able to easily afford getting checkups and routine medical expenses. When I look at the "standard rate" for similar practices for my kids, I'm shocked by how much they are. Covering every little thing via insurance has become a self-fulfilling prophecy because it drove costs up to the point where only those with insurance can pay for anything.
09:55 PM on 02/20/2012
Industries that are out of control, like the healthcare industry, should be bled to death and then run by the state. Hospitals have 12 rates for the same procedures, thanks to different deals made with different insurers. The rates they charge have nothing at all to do with the actual costs. Insurers take only healthy individuals or giant group plans in order to cut their costs and maximize their profits. The people who are left out try to get healthcare and have to pay top dollar because they don't have the power of an insurance company to negotiate rates. And all the time that people are afraid and sick and dying, the hospitals and insurance companies are making record profits.
T-Haight
What was wrong with federalism?
12:23 PM on 02/21/2012
I have a tough time believing you that hospitals and insurance companies are making "record" profits. Many hospitals are run at zero profit as they are either owned by the government (typically the municipality) or run by charities (e.g., Catholic hospitals). Health insurance companies aren't posting profit margins any higher than in comparable industries (typically at the lower end of a band around 5-15%, varrying by year). So where is this evil profit motive that's bleeding everything?

And if the industry is out of control, isn't it possible that excessive government invervention is part of what created the current state of affairs? If this can't be completely ruled out (and I don't think it can), how will additional government restrictions help?
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Democrat in the South
Empathy, the most important word
02:09 PM on 02/20/2012
Last year my large corporate group insurance premiums increased by the largest amount in my lifetime.

But what is killing me and all of us here on the gulf coast is homeowners insurance rates. I have a (2004 built) house with strict hurricane building codes and have never had a claim. I don't live near the water or in a flood zone and my premiums have increased since Katrina over 500%. I don't care what the reasons are, I and most here have been priced out of the market. I simply can't afford to be insured any more. I have to have insurance because I have a mortgage for now. I had to lower my coverage and raise my deductible so high I will never be able to make a claim. I called the insurance commissioner but he basically said, too bad. Suck it up.

All of the insurance I pay is outpacing pay increases so fast I don't know how we will survive in retirement. We won't. Many here who have paid-for homes have had their wind insurance dropped by their insurance company. Those are mostly older homes that are more vulnerable.

Americans need help from the burdening costs of ALL insurance. I would gladly welcome paying for a "Government" non-profit insurance.

It used to be that having insurance was a no-brainer because it was very affordable. Now it's better to save your money and take you freaking chances.
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HUFFPOST PUNDIT
PenGoddess
We are the Universe
11:49 PM on 02/20/2012
I'm old enough to remember when insurance actually paid you when and if something went wrong, when it was actually a fail safe against disaster. Insurance companies used your money to invest and make enough to cover their claims. It was not a product put forth by an industry in order to make record profits. 
It seems to me that it started going downhill in the mid eighties after Reagan deregulated it...
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HUFFPOST SUPER USER
Cecelia Nunn Haack
Art saves lives
02:07 PM on 02/20/2012
In 2014 uninsured folks like me will be forced to purchase high deductible plans that take away valuable resources from our families and provide us with nothing. Nothing because we will still be unable to afford to get medical care and fill our prescriptions. Nothing because we will still need DNR notices as we won't be able to afford to pay our deductibles should we have a major health incident and need hospitalization. One again, insurance companies win and the average person looses. This is NOT healthcare reform.
HUFFPOST PUNDIT
ThatsTheTheWayItIs
religion, ideology, partisanship are delusional
08:35 PM on 02/20/2012
Exactly right, except the "high deductible" part. You will be prevented from buying such plans, forced to buy a full-blown plan that covers everything with no deductible - which costs more than twice as much as a high-deductible (HD) plan.

A HD plan is like: you pay all your own costs, up until the first (say) $5K in a year, everything above that is paid for. That policy might cost $3K. Instead you'll buy a plan with no deductible, covers everything, and it will cost $6K. So unless you spend more than $3K in a year, you save money with the HD plan.

I don't use checkups, tests and drugs, but ACA requires I buy a plan that pays for them. An HD plan would give me insurance, not force me to pay for others use of services I will never use.

SCOTUS will probably find ACA unconstitutional - BECAUSE it doesn't allow HD plans. Forces us to pay for things we don't use, instead of just insuring ourselves.
09:59 PM on 02/20/2012
I haven't seen any plans that pay for everything after the deductible. Most of them are now $5K deductible and then you still pay at least 20% coinsurance.
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HUFFPOST SUPER USER
Cecelia Nunn Haack
Art saves lives
12:51 AM on 02/21/2012
There has got to be a better solution.
10:03 PM on 02/20/2012
There's one big benefit you get with insurance - they have the leverage to bring the rates down. You *can* negotiate with the hospital or provider to get a better price (see healthcarebluebook.com). But if you have insurance, they can end up getting the provider to settle for 10% of the billed price. And if you're still paying up to your deductible, or paying co-insurance, you'll pay less.
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HUFFPOST SUPER USER
hawkeye58
Open to the truth...
01:52 PM on 02/20/2012
Like most other corporations, the health insurance industry views increasing profits and stock value as their only responsibilities. Those they insure are only seen as the means to acheive both.
HUFFPOST PUNDIT
ThatsTheTheWayItIs
religion, ideology, partisanship are delusional
08:37 PM on 02/20/2012
Insurers are not the problem, the medical and drug industries are. Medicare is single-payer, yet its spending is rising just as fast as private insurance. ACA caps insurer profit and overhead at 20%, Medicare is 5%. The average family policy costs $15K, single-payer like Medicare would still be unaffordable - because insurance is not the problem, and ACA will only make it worse.
10:06 PM on 02/20/2012
No, they're all part of the problem. Insurers invest a lot of resources in not paying the providers, gutting the rates providers charge and making sure only healthy people or large groups are insured. We need transparency in pricing and make sure people come first. For-profit insurance should be phased out completely in favor of a government-run funding pool. If all we're trying to do is spread the risk, there's no way insurance companies should be making billions in profits.
04:38 PM on 02/21/2012
it is a group effort. Don't leave insurance out of it. Why do you think england,or france, pay much less than we do and get better outcomes.