The Senate HELP Committee held a very interesting hearing on health insurance gender discrimination. It has not been a subject that has come up much in the current debate, but for women often paying twice as much as men for the same insurance coverage, it’s crucial. Marcia Greenberger of the National Women’s Law Center described it as being a woman equaling a “pre-existing condition.” Legislation in both chambers of Congress would eliminate gender discrimination and mandate certain treatments and procedures specific to women for all health care coverage.
At Thursday’s hearing, many women had examples of individual policies that require women to pay more than men in some states, including Idaho, where insurers who issue individual policies can use age, sex, geography and whether a client smokes as factors in determining premiums. Some women attended the hearing wearing T-shirts that said, “I am not a pre-existing condition.” [...]
The committee also heard from women such as Peggy Robertson of Colorado, who read a letter from her insurance company. Robertson testified that because she’d already given birth via cesarean, when she tried to get an individual policy in Colorado, her insurance company considered it a pre-existing condition and wouldn’t insure her unless she could prove she’d been sterilized.
That “put me on the edge of my chair,” said the chairwoman of the committee, Sen. Barbara Mikulski, D-Md., calling it “offensive and morally repugnant.”
Yes, we’re talking about coercing sterilization in the United States of America. Courtesy of the insurance industry.
As we’ve read about in recent weeks, procedures like maternity care and mammograms are often not covered by insurers; the latter has become a major factor in the New Jersey Governor’s race, as the Republican nominee Chris Christie wants to allow insurers to drop coverage for mammograms. Greenberger added additional facts in her testimony:
Our research included an extensive analysis of gender rating, the practice under which insurers charge men and women different premiums for coverage. We found that in the individual insurance market, women can pay dearly because of this rampant practice. At age 25, for instance, women are charged as much as 45% more than men for coverage, and at age 40 they are charged as much as 48% more than men. Even with maternity care excluded, the variations in the differentials totally undermine any claim that these differences are actuarially driven.
For instance, we found that the best-selling health plans in Phoenix , Arizona charged a 40-year-old woman anywhere from 2% to 51% more than a 40-year-old man for identical coverage. In Lincoln , Nebraska a woman of that age was charged anywhere between 11% and 60% more than a man.
I don’t see how it is acceptable to give an industry that practices routine discrimination against the majority of Americans – whether it’s the sick, the elderly, or women – expanded power and a monopoly on a large market in the name of “reform.”
Not content having embarrassed themselves once this week with a “study” of health reform that doesn’t look at any of the elements of health reform, AHIP has done it again. Blue Cross Blue Shield has sponsored this report, put together by the accounting firm Oliver Wyman, claiming that premiums will rise 50% on the individual market and 19% on the small group market should health reform pass.
Once again, the report doesn’t factor in almost everything in the bill that would mitigate the premium increases, though it does come to a slightly better conclusion than the original AHIP report from PricewaterhouseCoopers, the one that they immediately distanced themselves from. The White House characterized it this way – “if the AHIP report was a $3.50 bill, this one’s a $3.00 bill.”
As Ezra Klein points out, the real value in these reports is how it shows the bankruptcy of the insurance industry as a whole, and how they simply cannot conceive of anything resembling a legitimate market for their services:
Essentially, they’ve spent so long pricing the sick and the old out of the individual market that they don’t really know what to do when they’re allowed back in [...]
This is the house they’ve built: an insurance market where plans are written for the healthy and all legal efforts are made to exclude the sick. That’s meant premiums are somewhat lower than they’d otherwise be, but only because the people who most need health-care insurance aren’t able to afford it, or in some cases, aren’t able to convince anyone to sell it to them. Now that arrangement is ending and they’re scared that they can’t provide an affordable product to the people who need it. They may be right, but it’s evidence of how deeply perverse their business has become, not of what’s wrong with health-care reform. When they say that the individual market would be cheaper in the absence of health-care reform, they’re saying the individual market would be cheaper if they could continue refusing to sell affordable insurance to people who need health-care coverage.
That’s not the kind of business anybody should be working to protect.
In a late-effort push to alter or torpedo health care reform, the major lobby for private insurers has made a multi-state, million-dollar ad purchase claiming that seniors will see their care cut under Democrat-crafted legislation.
America’s Health Insurance Plans (AHIP), which released a highly critical (and widely criticized) report slamming the Senate Finance Committee’s reform proposal, has quietly put out a new spot claiming that millions of seniors will see their Medicare slashed by Congress.
“Is it right to ask 10 million seniors on Medicare advantage for more than their fair share?” the ad asks. “Congress is proposing over 100 billion in cuts to Medicare advantage. The non-partisan Congressional Budget Office says many seniors will see cuts in benefits.”
You can see the ad here. It’s airing in swing states with Democratic Senators: Pennsylvania, Colorado, New Mexico, Missouri, Louisiana and Nevada.
One of two things is going on. The industry may truly be worried about the shape of reform and whether or not it will preserve its profits. Or they are giving space to the Baucus bill, the only one without a public option and the friendliest to their interests, so that liberals can be motivated to pass it or something like it. Savannah Guthrie just said this on MSNBC:
I think there will be courtship of those moderate Senators, but look, one thing I heard this morning here at the White House was that the insurance company report, the Price Waterhouse Cooper report, has actually been helpful to some extent (now granted this may be spin but let me just tell you what their argument is) is helpful because some of the liberal Senators who are concerned that the Baucus bill was just way too easy on the insurance companies, now have some cover. If the insurance companies think it’s so objectionable that they’re getting off the train and writing this report and signalling they’re no longer at the bargaining table on health reform, it must be something that really hurts them.
Reform advocates are having NONE of that. MoveOn has slammed the Baucus bill, which just passed the Senate Finance Committee, in a video featuring health care hero and former CIGNA executive Wendell Potter.
“Take it from me, the Senate Finance bill is a dream come true of the health insurance industry. If there is not public option insurance companies aren’t going to change. The choice of a public health insurance option is the only way to keep insurance companies honest.”
This is only the beginning of the health care fight, not the end. But the insurance industry has laid their cards on the table. They are against reforming the system in any way that cuts into their profits. And they should not be appeased with a forced market and a monopoly on insurance.
Rocky Mountain Health Plans, an insurance company in Colorado, has denied coverage to a four month-old child on account of “obesity.” How dare the kid not moderate his portions!
By the numbers, Alex is in the 99th percentile for height and weight for babies his age. Insurers don’t take babies above the 95th percentile, no matter how healthy they are otherwise.
“I could understand if we could control what he’s eating. But he’s 4 months old. He’s breast-feeding. We can’t put him on the Atkins diet or on a treadmill,” joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. “There is just something absurd about denying an infant.”
Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.
” ‘Your baby is too fat,’ she told me,” Bernie said.
Rocky Mountain Health Plans’ alibi is that as long as everybody denies coverage for a pre-existing condition, they will too.
So essentially, the insurance industry is telling this family to starve their child as the only way to get him health insurance.
That, or the baby should learn some personal responsibility and take care of himself better. Maybe push-ups.
UPDATE: A happy ending on this one. Rocky Mountain Health plans relented and will no longer consider an infant’s added heft a pre-existing condition. Unfortunately, there aren’t enough newspaper articles in the world to help everyone abused by the insurance industry.
Here’s a nice detail from an LA Times story about Hilda Sarkysian:
Surrounded by supporters, Hilda Sarkisyan marched into Cigna Corp.’s Philadelphia headquarters on a chilly fall day, 10 months after the company refused to pay for a liver transplant for her daughter.
“You guys killed my daughter,” the diminutive San Fernando Valley real estate agent declared at the lobby security desk. “I want an apology.”
What she got was something quite different.
Cigna employees, looking down into the atrium lobby from a balcony above, began heckling her, she said, with one of them giving her “the finger.”
There’s video of this confrontation. Check it around 3:40:
Sadly, this exchange is the only ledge on which the Sarkysians can hang a wrongful death lawsuit on CIGNA. A judge threw out the case on the basis of a 1987 ruling from the Supreme Court as well as ERISA (the Employee Retirement Income Security Act), which bars individuals from holding insurers of employer-paid health care plans responsible for their coverage decisions, but they can claim that the finger incident caused them “emotional distress.” Even Hilda Sarkysian calls this absurd: “They kill a beautiful 17-year-old girl, and I get to go after them for a finger? That’s sick.”
But of course, the insurance industry sticks their proverbial middle finger up at the country every day, with plans that cost more every year for the same coverage, companies that rescind policies when patients want to use them, and byzantine rules that they use to get out of providing care. The only surprise about this gesture is that it’s not one of the health insurer’s corporate logos.
Monthly premiums for Blue Cross coverage for them and their three daughters have soared over the years to almost $2,000, Scaglione says.
She estimates that in the past six years, the family has spent more than $140,000 on premiums and co-payments.
Yet when she tried to switch from the family’s expensive individual insurance to a Blue Shield group plan that’s more affordable, she said, she and her oldest daughter were denied coverage. She said neither of them has the medical conditions that were listed as reasons for being denied – bronchitis and a skin ailment.
“I have three children,” said Scaglione, 47. “We have to have insurance. Stitches may be required. A broken bone may have to be set. We have no chronic diseases. We’re a normal family. This is crazy.”
Consumer advocates consider their story emblematic in many ways of complaints that plague the entire health insurance industry.
“We’ve seen people denied for things as minor as heartburn,” said Anthony Wright, executive director of Health Access California, a statewide health advocacy coalition. “It gets to the point where living is a pre-existing condition.
Mrs. Scaglione’s health insurance coverage costs three times as much as the family’s MORTGAGE. And she can’t get out of it and into a group plan, because Blue Shield flat-out invented reasons to deny the coverage. She has demanded to see the medical records that show her daughter having bronchitis and her having a skin condition called rosacea, but the health insurer refused the request.
As the debate continues, the Scagliones remain among California’s 3 million consumers in the pricey individual insurance market.
“I wonder how many other families are like ours,” Scaglione said. “What’s the option, to be uninsured? This forces me to stay with our same plan. Premiums will go up and up and up. What, do we not feed the kids? It gets to the point of being absurd.”
Blue Shield of California can be reached at (866) 256-7703. You might want to ask them what health care ailments they think you have of which you’re unaware.
News outlets are starting to report on Anthem Blue Cross and Blue Shield, a subsidiary of WellPoint, suing the state of Maine to guarantee a 3% profit for themselves. Here’s a report from the Maine Public Broadcasting Network:
The state and Maine’s largest private insurer Anthem Blue Cross Blue Shield are locked in a legal battle over how much profit Anthem should be able to make. Earlier this year, Maine’s insurance superintendent Mila Kofman denied Anthem’s request to raise rates for its individual insurance products, calling it “excessive,” and instead approved an increase that leaves Anthem without a profit margin for providing those 12,000 policies. Now Anthem has filed suit to get the decision overturned.
“Superintendent has noted that Anthem’s done pretty well.” Janet Mills is the Maine Attorney General who is representing the superintendent of insurance. Mills’ office counters that Anthem averaged a 3.2 percent profit margin in its individual line of products for the nine years that the company has been in Maine. And that going a year without a profit from those products will not drain the company.
“She found that in fact that had contributed to $17.5 million and that its executives were pocketing rather large salaries and bonuses.” Anthem spokesman Chris Dugan did not comment on the lawsuit beyond acknowledging that it had been filed. In a brief filed with the Maine Superior Court, however, Anthem calls a 0 percent profit margin unfair and unprecedented; it says it wants to have a profit margin of at least 3 percent.
Remember, the new rates offered by the Maine Superintendent do not prevent Anthem from making a profit; they can do that the same way other companies might do so in a recession, by cutting overhead costs and lowering executive salaries and taking up more efficient management of their business. But as I’ve reported and as Igor Volsky confirms, Anthem wants the state of Maine to guarantee a 3% profit as a Constitutional right:
A 0% risk and profit charge, by definition, builds in no cushion for any of the risk that Anthem BCBS takes on by selling Individual Insurance Products in Maine. In addition, with a 0% risk and profit charge under the Superintendent’s approved rates, Anthem BCBS will not be able to provide any contribution to the surplus of the Company…Anthem BCBS — a for-profit Company — cannot be required to operate its highly risky Individual Insurance Products essentially as a non-profit company that must offset losses generated by the Individual Insurance Products through its group insurance business in Maine.
This is a fantasy argument from a legal perspective. The Superintendent works for the people, not Anthem BCBS, and she is not required to provide a profit margin for it or any company as an inalienable right. Anthem is a very profitable company already, and the individual market they want to jack up 18.5% represents a small portion of their business (about 6%) which has brought in $17 million dollars over the last decade. The Superintendent can say no, under the law, to allowing Anthem to charge an “additional $12 million in annual premiums for the same level of benefits.” She does not have to guarantee Anthem a profit. WellPoint may be able to cut their own employee health care, but under the regulations of Maine, they cannot squeeze their customers without the Superintendent stepping in to protect them.
The Wonk Room has provided copies of the briefs in the case here and here.
It goes without saying that Maine is a linchpin of health care reform, given the position of their moderate Republican Senators. Maybe they should look into what’s happening in their own state.
In my post about closing in on the insurance industry, I mentioned the case of Dawn Smith, a MoveOn member and CIGNA who suffers from a treatable brain tumor. She spent two years being denied treatment for her tumor, and has seen her premium costs rise consistently since being diagnosed, and then, CIGNA raised her medication a whopping 10,000%. Dawn wrote a letter to CIGNA’s Chief Medical Officer asking how they could do this:
Dr. Kang:
As you probably know, your company has denied me needed care for two years while I suffer from a debilitating but treatable brain tumor. I pay my $753.47 premiums. I follow the proper procedures. But CIGNA refuses to give me the care I need.
Instead, you keep increasing my prices. First my premiums rose by hundreds of dollars, and now my prescription costs are going up by more than 10,000%.
What makes you think you can treat sick people this way? When will you stop doing this to me and the thousands of people like me who are suffering? And if you solve this latest problem, how do I know you won’t do this to me again next week–that you’re actually changing your ways and not just trying to make your PR problem disappear?
Please answer these questions. I need to know, for the sake of my health and my life. Many others have signed this letter too, to support me and make sure I get answers.
Respectfully,
Dawn Smith
MoveOn asked people to join Dawn in signing the letter, and over 100,000 did.
In the comments to the post asking people to co-sign Dawn Smith’s letter, a representative from CIGNA responded in the comments:
CIGNA has spoken with Ms. Smith and successfully resolved the issue pertaining to this matter. We originally filled the prescription as prescribed by Ms. Smith’s doctor.
CIGNA learned through a third party political organization that Ms. Smith’s prescription mistakenly did not specify “brand name needed”. We have been in contact with both Ms. Smith and her physician and have corrected the inaccuracy. Customer service and satisfaction is important to us, we remain committed to working with our customers and physicians to ensure they receive the highest level of service.
Without that third party political organization – MoveOn – raising the profile of Dawn’s case, there is probably no chance CIGNA would have responded so swiftly. But there’s more to do. CIGNA may have agreed to lower the drug costs, and allowed various tests to go forward, but she is not giving up the fight. She wants answers about why she was denied treatment for two years, and why she and so many others have to suffer because CIGNA wants to maximize their profits. Dawn talked about her story in this video, and how it’s not unique, but sadly the norm for a rapacious insurance industry that happily takes premium cash but resists giving it out in health care costs.
You can help Dawn by adding your name to a statement of support for her that will be delivered to CIGNA CEO Edward Hanway.
Fighting the insurance industry is a game of inches, but a collection of voices can make a difference. With some help from Congress, we can move toward a system of health care that doesn’t involve ganging up on the insurance industry to force them to do the right thing.
Many of us already knew that Alan Grayson was a fearless champion against the rich and powerful. His notoriety this week for comments about the Republican plan for health care therefore did not come as a shock. His floor speech and his unwillingness to back down afterward have set a new standard for how Democrats deal with Republican hissy fits, where they get all offended by some comment or another and demand an apology and ritual humiliation. Their goal is to control the narrative and put any Democratic use of moral language out of the bounds of acceptable political debate, a standard that doesn’t apply to them.
Grayson DEMOLISHED this tactic. And he did so by continuing to tell the truth and never backing down. And by the end of the week, many were joining him. Yes, they said: why does the GOP have no plan for health care? Why have they allowed thousands to die for a lack of coverage for years without articulating any strategy to deal with the crisis? Why would Republicans try to make an example of Grayson when their members have been using vile language for months, slandering the health care legislation with lies about “death panels” and rationing and people “being put to death by their government,” in the words of Virginia Foxx? How could Republicans think there is no crisis in health care when so many are dying?
In a second, this has become the narrative of the week on health care. And Alan Grayson led the way. He just might lead the Congress to a better bill.
Brave New Films celebrates Alan Grayson’s contribution to the debate with this video.
Let Rep. Grayson know you have his back. And join the I heart Grayson Facebook group. He really deserves the attention he’s getting.
Lots of groups are taking action against the insurance industry and their attempts to get a forced market for themselves and increase their profits at the expense of their customers.
Health Care For America Now has a new ad spotlighting Stephen Helmsley, the CEO of UnitedHealth Group, and his $57,000-an-hour lifestyle, contrasted against the thousands of families who have experienced a medical bankruptcy:
In connection with that, SEIU is encouraging supporters to take out Craigslist ads seeking to rent a room in an insurance company CEO mansion. They have the Craigslist sites for Philadelphia (CIGNA’s Edward Hamway), Minneapolis (UnitedHealth’s Stephen Helmsley) and Indianapolis (WellPoint’s Angela Braly), and sample “room for rent” ads to work from. A sample:
Bankrupt Mother of Two, Seeking Room @ Insurance CEO Mansion
I’m seeking a room to rent in Cigna CEO Ed Hanways $13.6 million dollar mansion. (We’ll take a room in one of his three beach homes, too.) My family would be very quiet and courteous housemates, and given the size of Ed’s mansion, he won’t even hear us! I’ll be bringing along my two twin girls, both of whom were diagnosed with cancer at the age of four. CIGNA is refusing to pay for the human growth hormone they need to grow properly – and the out-of-pocket expenses for this treatment are…
What makes you think you can treat sick people this way? When will you stop doing this to me and the thousands of people like me who are suffering? And if you solve this latest problem, how do I know you won’t do this to me again next week–that you’re actually changing your ways and not just trying to make your PR problem disappear?
Please answer these questions. I need to know, for the sake of my health and my life. Many others have signed this letter too, to support me and make sure I get answers.
CIGNA has spoken with Ms. Smith and successfully resolved the issue pertaining to this matter. We originally filled the prescription as prescribed by Ms. Smith’s doctor.
CIGNA learned through a third party political organization that Ms. Smith’s prescription mistakenly did not specify “brand name needed”. We have been in contact with both Ms. Smith and her physician and have corrected the inaccuracy. Customer service and satisfaction is important to us, we remain committed to working with our customers and physicians to ensure they receive the highest level of service.
Good for Dawn Smith, but this won’t stop us from fighting.
