Health insurers drop coverage for children ahead of new rules

[cal04]

Source: The Hill

Health plans in at least four states have announced they're dropping children's coverage just days ahead of new rules created by the healthcare reform law, according to the liberal grassroots group Health Care for America Now (HCAN).

The new healthcare law forbids insurers from turning down children with pre-existing conditions starting Thursday, one of several reforms Democrats are eager to highlight this week as they try to build support for the law ahead of the mid-term elections. But news of insurers dropping their plans as a result of the new law has thrown a damper on that strategy and prompted fierce push-back from the administration's allies at HCAN.

The announcement could lead to higher costs for some parents who are buying separate coverage for themselves and their children at lower cost than the family coverage that's available to them.

"We’re just days away from a new era when insurance companies must stop denying coverage to kids just because they are sick, and now some of the biggest changed their minds and decided to refuse to sell child-only coverage," HCAN Executive Director Ethan Rome said in a statement. "The latest announcement by the insurance companies that they won't cover kids is immoral, and to blame their appalling behavior on the new law is patently dishonest.

Read more: http://thehill.com/blogs/healthwatch/health-reform-implementation/119823-insurers-drop-childrens-insurance-plans-ahead-of-new-rules

---

The issue had largely dropped out of sight since then, but insurers including WellPoint and CoventryOne have announced in recent days that they're dropping children's coverage in California, Colorado, Ohio and Missouri, according to HCAN.

[dflprincess]

1. I'm shocked, shocked I tell you

to hear insurance companies would try to find ways around the law.

Who would have thought they were so dishonest? :sarcasm:

[ixion]

16. Indeed. If only there had been warnings... oh, wait

there were plenty of warnings from a very vocal group of us on DU. We were told to STFU.

[dixiegrrrrl]

51. Yep. I remember that well.

In fact, I remember being told to shut up on several issues which have proven to result as we predicted.

[Xipe Totec]

2. Universal, Single Payer Health Care

Why do we need insurance companies?

[freebrew]

10. + 1 brazilian

n/t

[Jkid]

12. I was about to say that.

They knew this was going to happen, but instead choose the path of least resistance.

[kestrel91316]

15. [phone] 000

We don't. We just need more people to figure that out.

[JDPriestly]

17. Exactly. If the insurance companies can't afford to insure

people with pre-existing conditions, then bring in a public option. That's what was needed in the first place.

Americans will eventually realize that single payer is the only kind of insurance system that works for everyone.

[Xipe Totec]

20. Some things are natural monopolies

Like power utilities, and transportation, and insurance.

They are too important to be governed by a profit motive.

If insurance companies want to work as utilities, then fine, let them live.

If they don't, fuck them.

[Recursion]

37. That was the idea behind Blue Cross

It didn't exactly work out, though.

[NorthCarolina]

18. Why?

Because the DLC tells us we do. End of story.

[Xipe Totec]

19. I don't know why, but I sense sarcasm in your tone...

:evilgrin:

[leeroysphitz]

31. Word.

[drm604]

3. Insurance companies, trying to game the system?

Surely the wonderful caring people at the insurance companies would never do such a thing?

I guess I should add this: :sarcasm:

[Xithras]

7. They're not gaming anything.

They're using it exactly the way our "leaders" designed and intended.

[davidwparker]

13. +1

Right.

[Abq_Sarah]

21. This is a congress screw up

If companies are prohibited from turning down children with pre-existing conditions, that requirement should have been combined with a mandate that all children be covered on that date. Instead, there's a four year gap.

[Recursion]

32. The gap is a big problem; the timing is one of the worst things about the bill

Though the end result of this is that some parents will now have to get a group policy at work rather than a separate one for their children. OTOH it's pretty much by definition the non-sick kids who are being dropped, because otherwise they wouldn't be able to get individual policies.

[blueworld]

34. And there's one additional little gimmick to contend with

The insurers have the right to only allow enrollment of children under 19 during "open enrollment" periods (as regulated by individual state laws).

I agree with your point, however with that "open enrollment" period loophole, some families could rack up months of financial devastation before they're permitted to enroll a child with say, leukemia.

Unless the diagnosis of such an illness overrides the "open enrollment" crap, I'm rather certain the insurers will be crawling on their fat bellies to get through that hole.

Edit: typo

[dixiegrrrrl]

52. "This is a congress screw up"

Uhhhh...no.
It went the way all those insurance "donations" intended it to go.

[golddigger]

4. I feel a strongly worded letter coming.

[Safetykitten]

5. Hey Mel! Another serving of crow, make it big!

[CurtEastPoint]

6. Wellpoint's Braly: The ICON of greed in the HI industry...

The president and CEO of health insurer WellPoint Inc. received a 51 percent boost in compensation in 2009, mainly on larger grants of stock options and a performance bonus as profit and shares gained ground.

Angela Braly's overall compensation rose to $13.1 million from $8.7 million in 2008, according to a filing with the Securities and Exchange Commission on Friday. Her salary rose less than 1 percent to just over $1.1 million. She received a performance bonus of $1.5 million, a sharp jump from $73,810 a year prior.

The bulk of her compensation came from a 40 percent boost in restricted stock and stock options, totaling just under $10.2 million. The boost came as the company's stock price steadily gained ground over the year, closing 38 percent higher at $58.29.

Profit also surged in 2009 to $4.75 billion, or $9.88 per share, from $2.49 billion, or $4.76 per share, because of the sale of its NextRx subsidiary to Express Scripts. Even without the sale, the company said it would have earned $6.09 per share.

[Safetykitten]

8. Oh honey....

"If the insurance companies can casually turn their backs on sick children now, who will they abandon next?"

[Odin2005]

9. Those fucking BASTARDS!

[sakabatou]

11. Motherfuckers...

[think]

14. Single payer is making more sense all the time

Health insurance companies are once again showing why they can't be trusted and why we don't need them.....

[Recursion]

35. Find a way to pay for it and I'm on board

At the current premium rate, Medicare for all would cost $900 per person per month (graduated down as you age and have contributed more to the trust fund -- but that trust fund is expected to run out of money in 2029, so we'll need to increase Medicare levies also).

Simply spread all current healthcare costs among everyone and we all pay $600 per person per month (with no graduation).

If we paid all providers at Medicare levels it comes down to about $450 to $500 per person per month depending on how you define certain things. But, it's not clear health care providers (particularly general practice doctors) could survive at that level of reimbursement. Have you tried to find a GP that takes Medicaid lately?

Options 1 and 3 assume a $1000 deductible like with the unsubsidized Medicare Part A.

Insurance plans through non-profits (like mine, or many people in Blue Cross) are not cheaper than insurance plans through for-profits. As good as it feels to rail against profit motive, it doesn't seem to be raising prices, and profit is being capped starting this year anyways (it's capped at 15%; industry wide it averages at 5%). And as much as we hate CEOs raking in tens of millions of dollars, that's a drop in the bucket. Requiring CEOs to work for free would not change the financial reality of how expensive health care is. Denied claims are a problem with private insurance (non-profit or for-profit), but Medicare denies claims at twice the average rate of private insurers, and at a higher rate than any private insurer. Those of us with private insurance end up paying for those denied treatments (which is part of why our coverage costs so much). Medicare can work the way it does because those of us with private insurance subsidize it through our premiums, which go to health care providers to make up their loss on Medicare, in addition to our paying into the trust fund through payroll levies. If we're all on Medicare that won't work anymore, and providers will either have to make less money or charge Medicare more.

We're much less healthy than most other industrialized countries, and our providers make more than most other industrialized countries. Both of those mean universal coverage is going to end up being very expensive, however we pay for it.

Contrary to our own talking point, the insured and the uninsured use emergency rooms at the same rate. Increasing coverage will increase costs, as people seek medical care they've been avoiding up until now, and the parity I just mentioned makes it difficult to argue it will decrease emergency room visits.

Finally, the 23 million illegal immigrants in this country are not included in any of the above calculations, but they will still require medical services, which we will have to subsidize one way or another.

[No Elephants]

39. I call bs. Embedded in your claim are all kinds of assumptions you don't discuss.

Is health care really costing us an average of $900 per person, from age 1 minute to age 115? Doesn't sound right, but, if it is, there are ways we can get costs down.

Also, who said premiums should remain the same for everyone, as they are for current Medicare recipients? What's the rationale? We never made that contract with anyone; and people are paying private insurers a hell of a lot more. And those who are not already paying private insurere a hell of a lot more soon will be, when mandates kick in. So why on earth would they expect Medi care level coverage at around only $90 per month?

In general, your post has holes in it big enough for several trucks to float through.

[Recursion]

40. I'm happy to discuss them

Is health care really costing us an average of $900 per person, from age 1 minute to age 115?

No, it costs $600 per person, from age 1 to age 115. $900 is the unsubsidized Medicare premium for parts A and B. It makes sense that would cost more, since Medicare recipients are older than the population average.

Also, who said premiums should remain the same for everyone, as they are for current Medicare recipients?

I never said they would all be the same, I said if they were, they would be between $400 and $600 per month depending on how much less we are willing to pay doctors, etc. That seemed rational since currently Medicare premiums are all the same; anyone who pays less than $900 (that is, just about everybody) is being subsidized by the trust fund they paid into over the course of their career.

We never made that contract with anyone; and people are paying private insurers a hell of a lot more.

Actually $500 sounds about normal for the individual + employer contribution to private insurance; maybe a little high, in fact.

[diane in sf]

49. Pay for it by taxing the rich--they've been shirking their share of taxes, tax any income over

$1M a year at a marginal rate of 90%.

[Recursion]

50. I'm all for that idea

Now, get it through Congress.

All jokes aside, I would love that level taxation, and we both know it ain't gonna happen. We're having to pull teeth to get things back to where there were under Clinton.

But the fact remains, we will either need a massive new infusion of money, a massive increase in debt, or a massive drop in how much we pay health care providers, or we won't be able to cover everyone.

[keepCAblue]

22. Mad As Hell Doctors ... coming soon to a city near you. Get on board!

http://madashelldoctors.com/

The Mad As Hell Doctors California Tour 2010.
22 Cities. Over two dozen venues. Thousands of supporters.
Sept. 23-October 12.
One Message! Single Payer or Bust.
Daily updates on Facebook, Twitter, and Youtube!
Get Mad. Stay Mad. Make History.

We hope to share with you our passion that America must achieve sustainable high quality health care for all as soon as possible.

[xxqqqzme]

23. Has anyone mentioned this to Gibbs?

It's a little update he might need for future reference. Asshat!

[No Elephants]

41. Yes, but he accused them of faulty thinking due to drugging and implied they held such views only

because someone was paying them to hold them. And then, Obama scolded them for groaning and complaining. (Luckily, Rahm was in Chicago, measuring the windows in the Mayor's manse, or the WH might have done itself even more damage.)

[eridani]

24. So who is surprised? n/t

[chill_wind]

25. K & R

:nuke: :nuke: :nuke: :nuke:

[unkachuck]

26. "...refuse to sell child-only coverage,"

....corporate greed at it's finest....

....why are we fucking around with these corporate scumbags? Why don't we have Medicare for all?

[Recursion]

33. Because nobody wants to pay for it or cut payments to doctors

A full Medicare-for-all system at current provider reimbursement levels would cost about $500 per person per month. A Medicare-for-all system with the current premiums would cost $900 per person per month. And in both cases that's with the $1000 Part A deductible. But it's not clear hospitals and doctor's practices (particularly GPs) could stay open receiving only Medicare-level reimbursement.

[lildreamer316]

27. If ppl in the administration/congress couldn't see this coming, then they're dumber than I thought.

I mean really. How did so many of them rise to the top, so to speak, if they didn't have the brilliance to do the job? I know the answer to that, but it had to be said. Hell, I didn't finish college and this does not surprise me in the least..and if I'd had all the time to learn fully about the whole insurance issue like many of them did, SURELY I would actively seen this coming down the pipe! It's fairly predictable corporate behavior.
Duh. And it's so irritating to see them try to act surprised/offended about it.

[area51]

28. It's long past time to get rid of the mafiosi middle-men

We don't need to buy insurance to have access to help from the police or fire departments, nor do we have to buy insurance to send our children to school, nor do we buy "library insurance" to check out books. 1700's France had the right idea for people like the health insurance companies.

Each day, 273 people die due to lack of health care in the U.S.; that's 100,000 deaths per year.

We need single-payer health care, not a welfare bailout for the serial-killer insurance agencies.

We don't need the GingrichCare of mandated, unregulated, for-profit insurance that is still too expensive, only pays parts of medical bills, denies claims, and bankrupts and kills people. Republinazi '93 plan:

"Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005."

"We will never have real reform until people's health stops being treated as a financial opportunity for corporations."

[Vinca]

29. All they do is shuffle paper and money (the money toward themselves).

Insurance companies provide ZERO medical care. If dumping kids isn't reason enough to get that single-payer bill on the floor, I don't know what is.

[Recursion]

36. There are plenty of non-profit insurance companies

They aren't any cheaper. Unless we solve the cost of health care delivery itself, it's going to be very expensive to pay for health care no matter how we organize the payment.

[No Elephants]

43. What does that have to do with the price of tea in China? Not for

profit private companies have less than nothing to do with government administered health insurance.

[Recursion]

44. "Shuffle money (towards themselves)"

Non-profits aren't doing that (there's no profit motive there).

Yes, insurance companies take in money and pay it out, which is "shuffling money around". That's something that somebody has to do. Nobody has ever demonstrated that putting all that shuffling under one Federal program will actually make health care affordable. Health care is not affordable right now, which is why the system is breaking in so many ways. I have nothing against single payer (it has some clear advantages) but I simply don't believe that it would magically make health care affordable, and I would be very worried about what we would have to do to pay for it.

[KamaAina]

47. No profit motive there?

Pshaw. In Hawai'i, for instance, the market is dominated by a nonprofit, HMSA (Kaiser, a distant second, is also a nonprofit).

Obviously HMSA doesn't have any shareholders -- so what they do is they pay obscene Wall Street-style bonuses to their top brass. :eyes:

[Recursion]

48. Which contributes how much to the problem?

How much were the bonuses? 10 million? 20?

How much impact would freeing up that money have?

[dflprincess]

45. Medical costs are not the only thing driving premium increases.

The non-profit companies still have executives that are making big salaries and bonuses and still have the expense of paying commissions to insurance brokers and reps for selling their product. Every insurance company, both profit and non-profit pay out millions every month just in broker commissions.

These are just two expenses a single payer plan would not have.

In Minnesota the non-profits are allowed to spend 18% (last I heard) on expenses other than claims. As costs not related to claims go up, so do premiums. That way the companies stay at or under that the 18%

Medicare currently has admin cost of 3%.

Medical costs would drop if everyone had access to health care as soon as they need it. What drives costs in the U.S. is that too many people put off seeing the doctor until a situation becomes urgent (and more expensive).

[Recursion]

46. I agree with the premise; the data don't agree with us in some ways

The non-profit companies still have executives that are making big salaries and bonuses and still have the expense of paying commissions to insurance brokers and reps for selling their product. Every insurance company, both profit and non-profit pay out millions every month just in broker commissions.


Yes, sales and advertising do add costs; I agree. As you point out, MN caps non-claim expenses at 18%. Federally, all non-claim expenses everywhere are about to be capped at 15%. But pretty much every company stays well below that already. And again, a 10-million-dollar bonus to a CEO, as abhorrent as it is, is a drop in the financial bucket. Currently no plan I've seen anything about is going to have to struggle to meet the 15% cap. So eliminating all non-claims expenses (clearly impossible, even for Medicare) would cut the $600 per person per month we have to spend one way or another to $510 per person per month. Still not affordable.

Medicare currently has admin cost of 3%.

And it is bankrupting GPs, who have to overcharge privately insured people to make that up.

Medical costs would drop if everyone had access to health care as soon as they need it. What drives costs in the U.S. is that too many people put off seeing the doctor until a situation becomes urgent (and more expensive).

See, I totally believe that too, but it turns out uninsured people use emergency rooms and urgent care facilities at the same rate insured people do. So it's not driving them to the emergency room any more than the rest of us (though conceivably each individual visit could be more expensive; I haven't seen any data on that).

[dflprincess]

54. Delaying medical treatment does not always mean a trip to the ER

Delaying nearly any treatment will make the condition more expensive to deal with even if the delay does not land you in the ER.

Medicare's low administration costs are not what's bankrupting GPs, it's the low reimbursement rate on claims. If the admin costs weren't as low as they are they'd probably be paying the GPs even less.

Maybe no plans will struggle to meet the 15% cap because, as Wendell Potter pointed out, they're crooked and will find ways to make it look like they're meeting it when all they're really doing is finding a way around it - and one way around it is to raise premiums. (Note, the cap Minnesota imposes is only on non-profit HMOs. UnitedHealth Group, even though it is based in Minnesota, chose not to sell an HMO product there to avoid being subject to the state laws regarding non-profit "coverage" and audit by the attorney general's office.)

When you're talking about billions of dollars, there is a big difference between 15% and 3% in admin costs.

And it's not just the bonus to the CEO, it's the bonuses to all the executives, the sales force, the travel expenses, the "campaign contributions" (once called bribes) and all the other ways the insurance companies waste money in ways a public program would not.

[QC]

30. But who could have predicted that they would do this?

Besides anyone with two or more functioning neurons, I mean.

[newtothegame]

38. No surprise here. You make a type of coverage more expensive for them, they won't offer it.

It's pretty simple.

[Recursion]

42. They're making the family get a family policy

Yes, it will cost more. Increasing access was always going to cost more. Who thought this was going to make things cheaper, and why?

[AngryAmish]

53. Unexpectedly?!?!

Rational behavior according to their incentives.

[county worker]

55. We just may get a public option by default.

If insurance companies stop selling coverage for enough people just maybe the powers to be will see the wisdom in a public option taking the place of these companies. Also the same insurers are raising premiums on almost everyone. There is no competition without a public option! The HCR bill is so weak I hate to see the Dems trying to defend it as if it were some cure all.

[kpete]

56. Health Insurers' Move to Drop Child Policies (Ahead Of Thursdays Mandate) Draws Criticism

Source: Wall Street Journal

By AVERY JOHNSON

A move by insurance companies to stop selling child-only policies is drawing criticism ahead of Thursday, when the federal health overhaul will require insurers to cover sick children.

Aetna Inc., Cigna Corp., WellPoint Inc., Humana Inc. and UnitedHealth Group Inc.'s Golden Rule subsidiary say they will no longer sell new child-only policies. The new law requires them to accept applications from sick children on insurance policies that they sell, but doesn't require them to sell a policy individually to children in the first place. Insurers said children with pre-existing conditions will be able to apply for coverage on their parents' plans.

"The new federal rules required guaranteed-issue coverage for individuals under 19 without regard to affordability," said Matt Wiggin, an Aetna spokesman. "So folks seeking coverage would be those who need immediate services for high-cost conditions."

Mr. Wiggin says the insurer made the decision to protect its existing child-only policyholders from increasing premiums. Aetna has only discontinued the sale of new policies, he said.

Read more: http://online.wsj.com/article/SB10001424052748704129204575506311917901960.html

[Nite Owl]

57. One of many loopholes that

they put in the bill. I'm sure we will see many more.

[bc3000]

58. They might just be in store for a stern warning!

[SnoopDog]

59. If insurance companies refuse to cover children...then it is time to place them..

under Medicare.

F*ck the g-d insurance thieves..... The US Government must step in. Period.

[ManiacJoe]

66. You misread the article.

[AC_Mem]

60. And so - we watch

We watch the insurance companies try to find ways to deny affordable health care to Americans. While they are showing their true colors, Washington should be taking notes and sealing the holes with amendments.

We know that the health care law is going to evolve as it moves forward into our lives. As we uncover deceptive and inhumane practices, we jerk their chain and pull them back into line so that they do what they are supposed to do.

The insurance companies are getting 31 million new payers; they should be getting it together to offer programs that could actually be morally ethical and in line with the new laws. They may find, to their surprise, that they end up making quite a business out of it.

I wonder what it would be like if one large insurance company decided to EMBRACE the new health care law and build a business that helped it be successful for both those individuals who desperately need it, encourage health care initiatives that would trickle down to the customers, sponsor wellness clinics and watch their own insurance business grow for all the right reasons. In other words, manifest what the President originally envisioned as best we can with the law we have to work with.

We need someone in health care to step up and show everyone else how it can be done so that there is a living model of success for everyone. THIS IS WHERE AMERICAN INGENUITY COMES INTO PLAY. And - I believe that there are ALLOT of jobs that can come out of this if it is rolled out and implemented for the good of Americans.

[dflprincess]

68. "As we uncover deceptive and inhumane practices"????

Like we haven't always known they were crooks? Even Obama admitted that, back when he said any bill he signed needed a public option to "keep them honest".

The insurance companies have nothing to do with healthcare - they make their money by denying access to it. This insurance bill has nothing to do with healthcare and everything to do with transfering massive amounts of public and private money into the pockets of the private, for profit companies. It was just another bailout of a corrupt industry.

Why anyone would think the insurance companies would all have a "come to Jesus" moment and start behaving differently than they have all these years when they've now been given a license to steal is beyond me.

The only solution is a single payer system.

[AC_Mem]

70. I agree on all your points

And I am not so naive as to believe that the insurance companies would willingly become ethical. They are currently EVIL and certainly not out to help anyone; perhaps you misread my intent.

My point was that, now that we have the new healthcare law rolling out and we are seeing the loopholes that the insurance companies are finding - now is the time to see how to shape the amendments so that we can seal the holes.

Trust the insurance companies? Hardly.

My, let's call it a fantasy for lack of a better word, would be that a company would form that would use the law and create a new model in health care support. I know its just a dream but that's what America is all about, right?

It all starts with a dream.

Peace, and health
Annette

[Francesca9]

61. Big health insurers to stop selling new child-only policies

Source: LA Times

Anthem Blue Cross, Aetna Inc. and others say they will make the move as soon as Thursday when parts of the new healthcare law take effect. They cite potentially huge and unexpected costs for insuring children.

Read more: http://www.latimes.com/health/la-fi-kids-health-insurance-20100921,0,799167.story?track=rss&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+latimes%2Fmostviewed+%28L.A.+Times+-+Most+Viewed+Stories%29

---

Stuck in the middle - no single payer and reduced access to always more expensive health insurance.

The Democrats won't fix it and the Republicans won't either.

[customerserviceguy]

62. Gee, you mean just requiring insurers to do something

wasn't going to work?

That's what we single-payer advocates have been saying all along.

[Lint Head]

63. The Unhealthy Insurance Company 'We are in the business of not giving a shit'

CIGNA is doing the same thing. CIGNA also requires every person to take a health care assessment before they will cover you. This is the way they get around a preexisting condition. CIGNA claims they are just helping people stay healthy.

[sabrina 1]

64. We needed a National Health Care system.

It was already known that these monsters would let Americans die for profit. It is a crime that Democrats saved their failing industry rather than prosecute them for the criminally negligent homicide they were already guilty of.

Now, they are willing to let children die. If this doesn't call for an immediate emergency session of Congress nothing does.

What exactly do they mean by 'national security'? These people are responsible for the deaths of more Americans than any terrorist group could dream of, and what did Democrats do? They rewarded them.

44,000 dead Americans every year since 9/11. That's half a million dead U.S. citizens, killed by our HC INdustry. And who ever thought they would not find a way to keep doing it?

This is just infuriating. Where are all the defenders of this bill now? Were they not told this would happen?

[sabrina 1]

65. Unrec'ing this will not hide the truth that was so predictable all along.

Rec'd and :kick:

I cannot wait until the American people decide they've had enough of this and start taking acting like citizens of a free nation instead of 'team players' in some kind of game.

[Unvanguard]

67. This is actually a vindication of the basic idea behind the health care reform package.

You can't ban discrimination on the basis of pre-existing conditions without also having an individual mandate. Congress thought it could make an exception for children before the mandate comes into effect. It was wrong.

[metapunditedgy]

69. Come on folks. You don't know how much arm-twisting and deal-making

has gone on just to get us this far! What do you want from our elected officials?

On edit: curse you, Joe Lieberman!!! Curse you!

[Milo_Bloom]

71. *SIGH*

Another unintended consequence? Or foreseeable event?