Insurance Companies Announce Proposal To Increase Coverage For Hard-To-Insure

An insurance trade group today announced a “series of steps” to expand the number of Americans who have health insurance. “The proposals, approved by a board of the industry’s main trade group, would make it harder for insurers to cancel policies or deny coverage to people with pre-existing medical conditions. The steps would also limit the premiums that could be charged for such people.” The trade off? “The trade group also called on states to provide individual coverage for people who were likely to incur very high medical bills.”

The new proposals call for states to provide affordable coverage to anyone whose medical costs are expected to be at least twice the average. For other higher-risk patients who do not meet those criteria, the insurers would agree to cap the premiums at 150 percent of the market rate.

“‘We are taking responsibility for ensuring that no one falls through the cracks,’ said Karen Ignagni, the chief executive of the trade group, America’s Health Insurance Plans, which is based in Washington.” More realistically, the proposals are at least in part an attempt for insurers to have a stronger say in insurance discussions already underway in several states.

But the industry is also trying to have a greater say in any state changes that may be enacted. Many insurers chafe, for instance, over what they consider an overly regulated approach in Massachusetts, which has created an agency to oversee the market for individual insurers as part of a new law requiring everyone to buy coverage.

“This is advice to the states on how they can create functioning and viable marketplaces,” said George C. Halvorson, the chief executive of Kaiser Permanente, the California insurer, who chairs the trade group.

“Insurers Seek Bigger Reach in Coverage” [New York Times]
(Photo: Getty)

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  1. doormat says:

    Well isnt that nice – the insurance companies want all the profitable, er, healthy people for themselves and want the state (taxpayers) to share the burden for the unprofitable, er um, unhealthy folks.

  2. Boberto says:

    @doormat: DOORMAT: This is exactly how it works now with Managed Medicare and Medicaid. Those patients of more intense acuity and comorbidity are out of the managed care loop (for the most part)

  3. Parting says:

    Pff, insurers are afraid of gouvernment putting their foot down due to all complaints from uninsured.

  4. qitaana says:

    Lipstick on a pig. They still want to cherry-pick the healthy and relatively healthy people, and leave the rest to the taxpayers.

  5. lalala1956 says:

    Note to earth: Medicare and state’s Medicaid expenses already account for almost 45% of all healthcare expenses in the U.S.

  6. kingoftheroad40 says:

    Why is it that if your under 18 and poor or pregnant you get Medicaid and then when you get social security you get Medicare and in between the government says f**k you but congressman and senators get free health care ?
    it’s insane and wrong

  7. Cerb says:

    @kingoftheroad40: Care to rephrase that in a way that makes any sense at all.

  8. ageshin says:

    The problem is that privet health insurance and medicine don’t mix. They don’t mix as the role of the insurance companies is to make money, while the job of medicine is to heal the sick and improve the quality of life of people. Sick people are not consumers, they don’t shop around for services, they are under the care of the doctor. Since the two don’t mix, I say get rid of the insurance companies and move to a single payer system.

  9. uricmu says:

    Health should not be a commodity in the modern world.
    The role of government is to regulate health services pricing or ensure that they are provided at cost (e.g., lab tests) rather than for profit (quest diagnostics)

  10. glater says:

    I think the problem more revolves around the fact that health “insurance” is not health “care”. Insurance is something you get with the expectation that nothing is going to happen, really, or rarely at best. The whole industry is based on hedging bets that the insured event -won’t- happen. Health, however, is not a stable thing. People -need- health care. How often do people make claims on their car or home insurance by comparison? Some more than others, sure – but -everyone- uses health care at some point. We’re trying to treat a private, moneymaking enterprise like it’s a social welfare construct, and it’s not. It’s a capitalist business, for better or for worse. (Worse, in my opinion. Much, much worse. I’m of the opinion that the armed forces should be reduced by half and the money used for education and health care. We’re too prepared for war as a supposedly “enlightened” first-world nation.)

    As people use health insurance, premiums are go up and up, reimbursement percentages to doctors down and down to save profits, and doctor charges up and up to compensate, in an endless loop – til only the rich can afford it. First the poor folks will lose it (have already, really), then it’ll creep into the middle class (as it’s doing now).

  11. forever_knight says:

    not so fast insurance companies. you don’t get to off load the unprofitable customers onto the taxpayers and get all the profitables for yourself.

    AND make it seem like you’re doing US a favor.

  12. Jean Naimard says:

    Seems the insurance companies are shitting in their pants and want to avoid universal federal health insurance…

    In any case, it’s a doomed effort, because universal federal health insurance is inevitable, if big american croporations are to remain competitive, they will need to offload the health insurance of their employees onto the government.

    Oh, and to the wingnuts who say ­”I don’t wanna pay for someone else’s health care”, I ask them if they bitch having to buy car insurance so “they pay for someone else’s car repairs”. Of course not, because they are addicted on subsidized socialist roads…

  13. HRHKingFriday says:

    @Jean Naimard: I”m pretty sure they already do that in the form of Medicare/Medicaid.

    I have to disagree though, about the inevitability of federal health insurane. Yes, its something that a lot of people desperately want. But not even the democrats running in ’08 really support it. Hillary’s plan isn’t the same as the one she came up with in the 1990s, its really just a glorified form of the Massachusetts plan.

  14. darkened says:

    I feel this is a very fair and balanced solution. This method has already been implemented for car insurance. States realizing some of the most accident prone drivers would eventually not be able to get car insurance anymore but would continue driving anyway costing more to the entire state than it would be to offer them a state subsidized insurance plan with very high premiums. I believe the car ones are offered directly though common insurers as a requirement by law, at least in my region.

    This would share the same part of that, as much as I am not for socializing our systems, this is one of the needed exceptions. Knowing that the highest at risk people for medical treatment can’t get health insurance they will goto the ER for anything and give no id/false information, or just get bills and never be able to pay. Instituting this will give them more access to preventive care and routine care at doctors offices instead of burdening the hospital system even more and regardless making the rates increase for all of us anyway.

  15. SonicPhoenix says:

    I see a lot of comments here saying how unfair it is that the insurance companies want to offload their most costly customers on the state. Not that I’m supporting this but I’d like to share a little story about my quest to find out why a 3 mile trip to the hospital in an ambulance which was little more than a taxi ride (no IV inserted, no meds applied, no intensive medical procedures performed) was billed to me and subsequently picked up by the insurance company at almost $1000 dollars.

    I spoke with a friend of mine who works as an EMT and asked him about this. He informed me that the government (at least in NY) stipulates how much can be billed for an ambulance call to a Medicare or Medicaid customer. The stipulated amount is actually far below the average cost to perform the ride-out since a large proportion of Medicare calls are to elderly people who require more costly procedures and medications even during the short ambulance rides to the hospital. Due to the fact that they lose so much money on the Medicare and Medicaid calls, the ambulance companies are forced to raise their rates for everyone else, which includes people with private insurance and the uninsured. Now if you’re uninsured to begin with, you probably don’t have $1000 or more for the ambulance ride so you either work something out at a much-reduced rate or you declare bankruptcy and the ambulance company has to raise the rates for the privately insured even higher to compensate. Which leaves the lion’s share of the payouts to the privately insured. So in effect the private insurance companies (and the people paying premiums for private insurance) are subsidizing ambulance rides for the Medicare and Medicaid insured due to government stipulations.

    So before you start criticizing the insurance companies for wanting the government to pick up the tab for some of the more costly customers, think about whether turnabout is fair play. The next time you start wondering about why gauze is billed to you at $5 or why your ambulance/taxi ride cost $1000 or more, start wondering about whether the government stipulated an arbitrarily low price for everyone else, causing either you or your insurance company to make up the difference.

  16. consumerd says:

    ya know I have a big question for everyone here and anyone who reads…

    If supposedly Canada, France and great britan (sp?) Can do it better with government controlled healthcare, what really is stopping us? Is it the fact that we don’t bother to stand up to government? or are we just going to go to foreign countries for healthcare? After all if a woman with cervical cancer diagnosed in the states can’t get treatment, why can she get better care (being a common law wife for a guy in Canada) in Canada?

    Doesn’t it just make you sick?

    When will you start asking your congress for change?

  17. RvLeshrac says:

    @david_consumerist:

    But, but, but, they can’t do it better! This is AMERICUH, and WE’RE NUMBAR OEN!

    But, seriously, the problem is that a large percentage of our population doesn’t understand that a healthier populace is a happier populace, and a happier populace is ‘worth more’ in GDP – they work a bit better.

    They instead look around and say ‘I’m not paying for someone else’s health care!’ and then go piss off and use the subsidized roads, police/fire service, etc, etc, etc.

  18. Elviswasntmyhero says:

    “Americans spend more money for less coverage and care because we are the only industrialized country to allow for-profit insurance companies to be middlemen in our health system. In their drive to enroll healthy (and profitable) patients and screen out the sick, private insurers waste vast sums on billing, marketing, underwriting, utilization review and other activities that enhance profits but divert resources from care and hassle patients and physicians. The paperwork they inflict on doctors and hospitals wastes hundreds of billions more each year. Replacing private insurance companies with a single-payer public program – “Medicare for All” – would save more than $350 billion per year, enough new money to provide guaranteed comprehensive health benefits for all. (New England Journal of Medicine, 2003)”

    http://www.sickocure.org

    http://www.pnhp.org