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Historic Expansion of Health Insurance Coverage Cedes Control to Medical/Insurance Industries
Date:12/24/2009

WASHINGTON, Dec. 24 /PRNewswire-USNewswire/ -- The U.S. Senate bill's historic expansion of health care coverage cedes control of a much greater portion of the health care system to the medical and insurance industries. This sweeping legislative act creates a responsibility for federal and state governments to monitor and police these industries and fix failures as they occur. For example:

* While the legislation requires every American to buy coverage under threat of tax fines, provisions requiring health insurers to justify rate increases are insufficient checks on insurance companies seeking to use the mandate as a profit enhancer. Government must ensure that coverage is affordable by requiring insurers to seek "prior approval" of health insurance rate increases, as auto insurers are required to do under California's Proposition 103. The Senate bill's requirement that insurers spend 80% or 85% of the premiums they collect on health care services will--absent strict rate regulation--perversely encourage insurers to raise their premium rates. In the same way that a Hollywood agent who gets a 20% cut of an actor's salary has an incentive to seek the highest salary, insurers will have incentive to increase health care costs and raise premiums so that their 20% cut is a larger dollar amount.

* The "essential health benefits" called for under the mandated policies are left undefined in the legislation. Those benefits must be robustly defined in order to ensure that Americans get the coverage they pay for, rather than the current cycle of delay and denial of care.

* Weak employer penalties may create incentives for employers to drop coverage, pushing workers into the state exchanges where they would be forced to buy individual policies that offer less care for more money. Employers must be required to pay their fair share of the cost of health care.

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