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Wendell Potter’s take on H.C.

Wendell Potter talks about the health care challenges:

State Insurance Commissioners Take Baton from Congress
Submitted by Wendell Potter

* health
* lobbying
* politics

Now that Congress has taken final action on its health care reform legislation, the reform debate has now shifted to, of all places, Denver.

The legislation that is now the law of the land was just the first step. Despite its size — more than 2,000 pages — the bill in many cases only lays out Congressional intent. In that sense, it is a framework for reform. The law requires that numerous new regulations be written to govern the way health insurers do business, a responsibility that Congress passed on not only to the U.S. Department of Health and Human Services but also to one very influential non-governmental organization: the National Association of Insurance Commissioners (NAIC). The bill mentions the NAIC — an acronym most Americans probably only see once a year when they renew their cars’ license plates — at least 10 times, and it gives the organization some very important assignments.
Insurance Industry Executives Swarm Conference

The NAIC, which comprises the insurance commissioners from all 50 states, the District of Columbia and the U.S. territories, is having its spring meeting today through Sunday in Denver. The fact that more than 1,700 insurance industry executives are also at the meeting should give you an idea of how important the NAIC is to insurers. Just as members of Congress are far out-numbered by lobbyists on any given day in Washington, the commissioners are far, far outnumbered by insurance company executives who come to NAIC’s conferences to try to influence everything the commissioners do.

The NAIC exists to help state insurance regulators achieve five primary goals: “protecting the public interest; promoting competitive markets; facilitating the fair and equitable treatment of insurance consumers; promoting the reliability, solvency and financial solidity of insurance institutions; and supporting and improving state regulation of insurance.”

Every insurance company licensed to do business in the U.S. is regulated by state insurance departments and is assigned an NAIC code. (This is where your car’s license tag comes in. The renewal forms you get from your state, if you live in one that requires you to buy auto insurance, as most do, ask for your insurance company’s NAIC code.)

Congress gave the NAIC so much responsibility because the legislation it passed will largely be implemented at the state level, and states will have substantial flexibility to create new insurance marketplaces and set and enforce standards. To ensure that the marketplaces be as uniform as possible, Congress gave the NAIC the responsibility of developing specific standards pertaining to the creation of the health insurance “exchanges” created by the new law. Because insurance companies will want to sell their policies through the exchanges, they will be “advising” the NAIC as it goes about its work.
Expenditures on Policyholders Considered a “Loss”

The NAIC also will play a key role in making sure insurers spend at least 80% to 85% of what they collect in premiums on medical care for their policyholders, as the new law requires. The amount insurers pay for care is called the medical-loss ratio (MLR). (It’s telling that insurers consider the amount of premium dollars they spend on medical care a loss.) The average medical-loss ratio was 95% in 1993, meaning that 95 cents of every premium dollar insurers collected was paid out in claims. By 2008, the average MLR had dropped to around 80%. At many insurers, the MLR often dips into the 70s or lower.
The Devil is in the Definitions

The insurance industry tried unsuccessfully to strip the minimum medical-loss ratio provision from the bill. It wanted to have the freedom to keep spending less and less on medical care because every dollar not paid out in claims is a dollar that can be used instead to increase profits and to pay CEOs millions of dollars every year. Having lost the battle on Capitol Hill, the insurers are now turning their attention to the NAIC, which Congress gave the responsibility of determining the nitty-gritty details of how insurers will have to comply with the law. Rest assured that the insurers will be pulling out all the stops to persuade the insurance commissioners to make it easy for them to meet the requirements of the new law by manipulating the definition of medical care. One of the things insurers will try to do, for example, is to get the NAIC to let them shift a lot of what insurers now count as administrative expenses into their medical expense category. If that happens, the insurers will look like they’re suddenly spending more on medical care without changing anything at all.

The law also requires the NAIC to help the Department of Health and Human Services develop numerous other regulations, ranging from making sure that documents pertaining to benefits and coverage limitations be standard throughout the industry, to determining how health insurance can be sold across state lines while maintaining consumer protections.
Watching Out for the Consumer’s Best Interests

To ensure that consumers’ interests are at least taken into consideration as the NAIC fulfills its mission, the organization several years ago established a consumer liaison committee. This year the NAIC expanded the committee to include 29 consumer representatives from across the country. I am honored to be one of them, representing the Center for Media and Democracy. Like the commissioners, my colleagues and I are vastly outnumbered by the hundreds of insurance industry executives here at the Denver meeting, but at least we have seats at the table.

During the weeks and months ahead, I will try to keep you informed of how the NAIC fulfills its obligations under the new law. It doesn’t have a lot of time to get everything done. In order to provide the states with enough time to prepare for implementation of health care reform, HHS has to have regulations and standards in place within the next 12 to 15 months, if not sooner, which means the NAIC will need to complete a tremendous amount of work in a short period of time.

At a meeting with the commissioners this afternoon (Friday, March 26), we stressed how essential it is that the consumer perspective not get lost as the NAIC rushes to get the work done. We asked specifically that the NAIC:

* create a publicly-accessible “plan of action” developed with input from consumer representatives;
* fully incorporate consumer advocates into the NAIC health reform work plan;
* prioritize their tasks based on the needs of consumers; and
* significantly expand consumer participation at NAIC proceedings.

Many of the commissioners — in particular Mila Kofman of Maine, who once served as a consumer representative, and Joel Ario of my state of Pennsylvania — expressed support for our requests. We’re hopeful.

HR 4789 and The Public Option: The Way Forward

Health care reform — here’s where we are. The House of Representatives is about to vote on a Senate bill without a public option. It looks like the reconciliation amendment will not have a public option. The House bill had a public option, but once the House passes the Senate bill, that’s history.

Which is why I introduced H.R. 4789, the Public Option Act. This simple four-page bill lets any American buy into Medicare at cost. You want it, you pay for it, you’re in. It adds nothing to the deficit; you pay what it costs.

Let’s face it. Health insurance companies charge as much money as possible, and they provide as little care as possible. The difference is called profit. You can’t blame them for it; that’s what a corporation does. Birds got to fly, fish got to swim, health insurers got to rip you off. And if you get really expensive, they’ve got to pull the plug on you. So for those of us who would like to stay alive, we need a public option.

In many areas of the country, one or two insurers have over 80% of the market. They can charge anything they want. And when you get sick, they can flip the bird at you. So we need a public option.

And they face no real competition because it costs billions of dollars just to set up a national health care network. In fact, the only one that’s nationwide is . . . Medicare. And we limit that to one-eight of the population. It’s like saying that only seniors can drive on federal highways. We really need a public option.

And to the right-wing loons who call it socialism, we say, “if you want to be a slave to the insurance companies, that’s fine. If you want 30% of your premiums to go to ‘administrative costs’ and billion-dollar bonuses for insurance CEOs who figure out new and creative ways to deny you the care you need to stay healthy and alive, that’s fine. But don’t you try to dictate to me that I can’t have a public option!”

And there is a way left to get it. By insisting on a vote on H.R. 4789. Three votes on health care, not two. The Senate bill, the reconciliation amendments, and the Public Option Act.

We got 50 co-sponsors for this bill in two days. Including five powerful committee chairman. But we need more.

Sign our Petition at

Call. Write. Visit. Do whatever you can do to get you Congressman to co-sponsor this bill, and push it to a vote. Right now, before it’s too late.

Let’s do it!

The Health Care Summit Was Fine. Question Time Would Be Better.

— By David Corn

The health care summit hosted by President Barack Obama on Thursday predictably did not yield any bipartisan breakthrough. But as I explained in my column, it was quite valuable:

It clarified the situation. Though much of the conversation consisted of participants pushing pre-existing talking points, the debate made the obvious really obvious: Obama and his Republican foes are miles apart in ideological and policy terms. As the hours went by, Obama engaged in wonky exchanges with the Rs—sometime calling them out on key factual disputes, such as whether the Congressional Budget Office said his overhaul would lead to higher premiums. (Obama got the better of that argument.) But all this back and forth kept illustrating the basic divide. The Republicans do not believe it is Washington’s mission to take major action to challenge the insurance industry and extend coverage to most of the nation’s citizens without health insurance. Instead, they want to move, as they repeatedly said, “step by step.” But the Democrats believe that the only way to cure the health system of its ills is to adopt comprehensive change.

This gabfest highlighted the irreconcilable differences. The Rs don’t think the Ds and government can handle such a big and expensive job. The Ds don’t think the Rs and the insurance industry can remedy the problems with small measures. And the meaning of all this unavoidable: if the president and the congressional Democrats want to pass any version of comprehensive health care reform, they will have to do it by themselves, using whatever legitimate legislative procedures are available. The summit clarified the situation.

The health care summit also showed the value of direct engagement between the president and the opposition—and the need for establishing the practice of Question Time. After Obama and House GOPers last month held a gripping Q&A at a Republican retreat, a cross-partisan group of bloggers, techies, and political consultants (myself included) initiated the Demand Question Time campaign, calling on Obama and the Republicans to hold such public and televised sessions on a regular basis. Neither the White House nor the House Republican leaders have yet signed on. But the health care summit has been cited by political observers as a sequel to that earlier face-off.

The summit, though it indeed supports the case for Question Time, was a bit different than what institutionalized Question Time might look like. The health care meeting was long, clocking in at seven hours. And the need to move ploddingly through a long list of Republican and Democratic speakers—many of whom were there to present talking points and help their respective party position itself for the health care endgame—made the event seem stilted at times. There were some rather significant policy-related exchanges. Yet this single-issue event lacked the dynamism of the shorter and less formal session at the Republican retreat. And because of its length, the summit will likely not be watched in its entirety by as many people as the earlier Q&A. (MSNBC cut away in the afternoon to show an Olympics hockey game, and Fox News and CNN often interrupted the proceedings to air the analysis of their commentators.)

This summit happened because the president, believing it would be of political use, called for the meeting. The Republicans obviously figured it would be politically beneficial to accept his invitation (or to not reject the invitation.) But Question Time should not depend on a president’s political calculation. It should occur on a regular basis. How often? Once a month? Every other month? The exact frequency is not the most important matter. (On Friday morning, I appeared on CNN with Grover Norquist, one of the many conservative proponents of Question Time, and he enthusiastically suggested weekly sessions. That might be too much of a good thing for everyone—including the public.) Regular Question Time should be not too long, perhaps 90 minutes or so. It generally would cover a range of topics, unless the questioners decide to drill down in one area. It should include follow-up questions and plenty of back-and-forth.

The Demand Question Time effort has been picking up prominent endorsers on the left and right. There’s a petition to sign. It has its own online discussion.

The health care summit demonstrated that the national debate is enhanced when the president and his opponents discuss face to face—in full public view—the big and contentious issues of the day. Rep. Kendrick Meek, a Florida Democrat running for Senate, used the occasion to endorse the Question Time campaign. I believe he’s the first congressional official to do so. In a guest editorial for Nate Silver’s, Meek wrote,

Too often, we think of politics in a top-down, hierarchical sense instead of treating it as a two-way street. Holding regular, publicly-televised and webcasted conversations between the President and the people’s representatives has the potential to combat hyper-partisanship and political stagnation….

Even the White House has dismissed the idea of instituting Question Time, claiming it is “going to be hard to recreate the spontaneity that happened.” However, is “spontaneity” really the end goal? Or is it something much greater, a deepening of our democracy and renewal of our basic governing process?

Politicians today are heavily scripted and risk-adverse. Too many are unwilling to reach across the aisle and forge a bipartisan consensus for the good of the country. Question Time would have a healthy effect on me as an elected leader by providing a regular opportunity to hear views that differ from my own.

I understand that Question Time is no panacea to our country’s challenges. There is no magic wand that will suddenly break our political impasse. I do think, however, that it’s worth a shot.

With that first Q&A in Baltimore and with this week’s summit, the president and the Republicans have moved in the direction of Question Time. And on each occasion, they have demonstrated why they should go all the way,

Leave Your Empty Shoes Behind
Send a Message to Your Congressperson

Feb. 15-19, our members of Congress will be back in their districts. Will, Midge, and hundreds of CBHC supporters ask you to go to your congressperson’s office this weekend or next week and drop off a pair of old shoes, slippers, or sandals. Leave a note inside the shoe with your health care reform message.

We’re doing this to represent the people who have already died for lack of health care, and the 50,000 people who will die this year because they are uninsured.

You can find out how your member of Congress voted here. If your member of Congress supports health care reform, thank them. Tell them you know that health care reform will be good for you and good for your family, will benefit seniors by eliminating the Medicare donut hole, and will provide peace of mind and security for all of us.

If your member of Congress voted against health care justice, tell them that the lives of real people are on the line, and that their vote means more Americans will die for lack of health care this year.

They need to know the lives of real people are on the line, and it is about time they listened to hardworking Americans and not the insurance companies that are more interested in their profits than our health.


Washington Post/ABC poll, Feb. 10, 2010.

A new poll from the Washington Post and ABC shows that an overwhelming majority of Americans want Congress to continue working to pass comprehensive health care reform.

This is no time to give up, Congress. You must keep pushing to finish the job! The American people want you to move beyond partisan politics and GET IT DONE and get it done right.

Midge Hough, CBHC member, in front of Rep. Dan Lipinski’s office. Midge is holding a pair of shoes for her 24 year old daughter in law Jenny and a pair of shoes for her unborn grandchild, both of whom died last year because Jenny was uninsured. Watch Midge’s video.

CBHC member Will Wilson shares his health care story at the office of his Representative, Mike Quigley. “Nobody will be able fill my shoes for my family & friends if I die for lack of health care,” said Will. Watch Will’s video.

CBHC’s faith caucus will be conducting “die-ins” in Chicago and Springfield this Tuesday to introduce a new study reporting on the number of Illinoisans who died from 1995-2009 because of a lack of health care, and projections on the number of deaths expected from the same in 2010-2019 if Congress does not pass reform.

Sign up for our weekly conference call for an issue briefing and details of upcoming actions!

Show a little love to CBHC this Valentine’s Day – donate today! Your contribution will be matched dollar for dollar by the Nathan Cummings Foundation.

Please take our survey about your feelings on peaceful civil disobedience and sit-ins (non-arrest) in support of health care justice.
Please forward messages from CBHC widely!

You can use the “Forward to a Friend” link in the top right corner of any message from CBHC to send it on to your organizations, networks, friends and family. Join thousands of others and let your people know what’s happening in health care reform in Illinois!

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