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Monday, June 08, 2009

But does it stop insurers from jerking people around?
Posted by Jill | 5:50 AM
Does it ensure that insurance companies actually provide COVERAGE when it's needed, instead of jerking patients around to see just how hard you'll fight for reimbursement?

I don't see any mention in this article about Edward Kennedy's plan for health care reform about an end to the insurance company practice of having gum-chewers in cubicles act as an impenetrable wall between patients and needed treatment:
The bill "reflects a revamping of the whole insurance system," said Charles N. Kahn III, president of the Federation of American Hospitals.

It would prohibit the denial of coverage based on preexisting conditions and would insist that any insurance policy that includes children must provide that coverage through age 26.

Most striking, the legislation would require that insurers report to the federal government how premiums are being spent -- clinical services, claims processing, etc. -- and give a rebate to beneficiaries if a percentage of the premium does not go to patient benefits. Insurers would be forced to clamp down on administrative costs or profits.

Over the long run, the industry would probably adapt to the new standards, but in the short term it "takes a harsher edge with insurers," said Dan Mendelson, president of Avalere Health, a research and consulting firm.


Modeled after a Massachusetts reform implemented three years ago, the Kennedy approach would insist that everyone buy insurance, though subsidies would be given to people who could not afford it. The draft document suggests offering premium aid to people earning as much as 500 percent of the poverty level, or $110,000 for a family of four. That idea has Republicans outraged and fellow Democrats nervous about the cost.

Rep. Jim Cooper (D-Tenn.) said the draft by Kennedy aides and other ideas circulating among party leaders are unrealistically generous, while an employer mandate hurts workers and consumers.

"Congress just doesn't get it," he said.

One would think that the insurance companies would LOVE this plan, because it mandates more customers for them without in any way asking them to actually deliver services. It's one thing for insurance companies to have to provide "coverage" (i.e. get paid premiums) for pre-existing conditions. It's quite another to get them to actually pay.


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Blogger Jayhawk said...
That's because Kennedy's plan doesn't address health care reform, it tinkers around with health insurance reform, and it doesn't really do anything of any great reforming nature. Of the prople who are declaring bankruptcy due to medical bills, despite having health insurance, the "reform" will save none, and the number who suffer that fate will increase because more people will have health insurance. Think about it, the newly insured are going to be the ones who could not previously be insured, so they will incur the most medical bills, which the insurance will not pay in full, or ate all, so medically insured bancrupties will increase by large numbers.