ONTD Political

U.S. Set to Sponsor Health Insurance

1:49 pm - 10/29/2012
U.S. Set to Sponsor Health Insurance

The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.

These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.

Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide. The personnel agency has earned high marks for its ability to secure good terms for federal workers through negotiation rather than heavy-handed regulation of insurers.

John J. O’Brien, the director of health care and insurance at the agency, said the new plans would be offered to individuals and small employers through the insurance exchanges being set up in every state under the 2010 health care law.

No one knows how many people will sign up for the government-sponsored plans. In preparing cost estimates, the Obama administration told insurers to assume that each national plan would have 750,000 people enrolled in the first year.

Under the Affordable Care Act, at least one of the nationwide plans must be offered by a nonprofit entity. Insurance experts see an obvious candidate for that role: the Government Employees Health Association, a nonprofit group that covers more than 900,000 federal employees, retirees and dependents, making it the second-largest plan for federal workers, after the Blue Cross and Blue Shield program.

The association, with headquarters near Kansas City, Mo., was founded in 1937 to help railway mail clerks with their medical expenses, and it generally receives high scores in surveys of consumer satisfaction.

Richard G. Miles, the association’s president, expressed interest in offering a multistate plan to the general public through insurance exchanges, but said no decision had been made.

“Our expertise in the Federal Employees Health Benefits Program would be useful in the private marketplace,” Mr. Miles said in an interview. “But we are concerned about the underwriting risk in providing insurance to an unknown group of customers.”

To be eligible to participate in the multistate program, insurers must be licensed in every state. The Government Employees Health Association recently bought a company that has the licenses it would need.

The new health care law stipulates that at least one of the multistate plans must provide insurance without coverage of abortion services. If a plan does cover abortions, it must establish separate accounts, one with money for abortion and one for all other medical services.

National insurance plans will be subject to regulation by the federal government, state insurance commissioners and state insurance exchanges. That mix could cause confusion for some consumers who have questions or complaints about their coverage.

The federal standards will pre-empt state rules in at least one respect: the national health plans will automatically be eligible to compete against other private insurers in the new exchanges, regardless of whether they have been certified as meeting the standards of those exchanges.

The administration has promised to “work cooperatively with states.” But it is unclear whether the government-sponsored plans will have to comply with all state laws and consumer protection standards; whether they will have to comply with state benefit mandates; and whether they will have to pay state fees and taxes levied on other insurers to finance exchange operations.

The National Association of Insurance Commissioners, which represents state regulators, expressed alarm at the prospect of a double standard.

“It is absolutely essential that multistate plans compete on a level playing field with other qualified health plans, which are subject to state insurance law,” the association said in a letter to the Office of Personnel Management.

Consumer groups expressed similar concerns. The national insurance plans and other carriers must be subject to identical standards, they say, or consumers cannot make valid comparisons.

“Multistate plans have real potential benefits for consumers,” said Ronald F. Pollack, the executive director of Families USA, a liberal-leaning consumer group. “But there is also potential trouble if the multistate plans are exempted from some consumer protection standards.”

Robert E. Moffit, a senior fellow at the conservative Heritage Foundation, said he worried that “the nationwide health plans, operating under terms and conditions set by the federal government, will become the robust public option that liberals always wanted.”

Insurers are pleading with the Office of Personnel Management to provide more detailed guidance.

“We are concerned that O.P.M. has not yet released rules specifying the requirements for the multistate plan,” said Jay A. Warmuth, a lawyer at UnitedHealth Group, one of the nation’s largest insurers.

Rules for the new program have been under review by the White House for three months, and officials said they would be issued soon.

Source

OP: So, what do you all think? Can these two national plans be considered the public option or are they going to force the other insurance companies to play on a national level? For those of you outside the US, laws were passed that forbid national plans and, at most, the companies compete with one or two other insurers (which is why insurance is expensive here -- they have a near monopoly.)
shortsweetcynic 29th-Oct-2012 08:55 pm (UTC)
I don't know, but I'm intrigued. I've made it a personal goal to find health insurance one way or the other by the time the new year rolls around, and I'm genuinely curious how this is going to play into that.

I think it's about as close to public option as we'll get.
maynardsong 29th-Oct-2012 10:41 pm (UTC)
Can this happen before December 13 that would be awesome.
bushy_brow 29th-Oct-2012 11:45 pm (UTC)
YES PLEASE, AND THANK YOU!

ETA: I hope Texas doesn't find a way to screw this up, but I'm sure it will. :-/

Edited at 2012-10-29 11:46 pm (UTC)
sarien 30th-Oct-2012 12:58 am (UTC)
Thank you for reminding me that I live in Texas now and we can't have nice things because of idiots in charge (and people who vote for said idiots).
bushy_brow 30th-Oct-2012 02:59 am (UTC)
Sorry. :-(
shortsweetcynic 30th-Oct-2012 11:24 am (UTC)
ugh...i forgot, that's like the entirety of the republican platform down here in FL right now, is blocking obamacare at every turn.

they really want me to die of a funny freckle, apparently. because lol preventative care.
bushy_brow 31st-Oct-2012 12:23 am (UTC)
What is this "preventative care" of which you speak? O.O
caerfrli interstate insurance could be a disaster.29th-Oct-2012 11:49 pm (UTC)
If all insurance companies could sell across state lines they'd all move their headquarters to the state that benefits the companies the most and the policy holders the least, just as banks and credit card companies have done.
furrygreen Re: interstate insurance could be a disaster.30th-Oct-2012 04:30 am (UTC)
As opposed to how it is now in with insurance companies have almost absolutely zero competition and are allowed to charge whatever the hell the want? Actually, this is how it already is with insurance companies. ;P You just don't realize it because there is no competition. I mean, look at car insurance. The sky hasn't fallen because car insurance companies compete nationally.
tabaqui 30th-Oct-2012 12:38 am (UTC)
I hope this works and we can find health insurance we can afford. Sick to death of not having any and always being paranoid about 'what if my daughter gets hurt/really sick?'
jwaneeta 30th-Oct-2012 01:02 am (UTC)
GOOD
ebay313 30th-Oct-2012 04:23 am (UTC)
"laws were passed that forbid national plans and, at most, the companies compete with one or two other insurers"

Are you talking about at a national level? This seems to be similar to what Mitt Romney said in one of the debates about current limits on the number of insurance companies (he claimed two) limiting the free market, which I didn't understand at the time and am clearly still confused about. Could someone please elaborate on this?
furrygreen 30th-Oct-2012 04:41 am (UTC)
Although there are insurance companies that have various branches in multiple states (let's say BCBS), you can't buy a BCBS policy from another state even if BCBS is the only insurance company in your state. So, BCBS policy in the next state over may be $100 a month cheaper for the exact same policy in the other state but that's SOL for you. Most states have only two or so insurance companies that you can get policies from so it's a near monopoly across the board (this doesn't include medicare, medicaid, or gov'n insurance.)

As for Mitten's talking about this, well, that's more of Mitten's BS. It was set up this way via the healthcare industry lobbyists. I'm sure it went something like "if there is competition, patient quality care will go down". Mitten's wouldn't change this.
ebay313 30th-Oct-2012 04:50 am (UTC)
Thanks, that makes more sense. We have way more than 2 companies who offer insurance in my state which is what confused me originally. I get it now though- that policies within a company have to be set per state, so I can only buy BCBS MI plans, not BCBS OH plans
furrygreen 30th-Oct-2012 06:25 am (UTC)
A lot of the insurance companies that go by other names are owned by the same companies. BCBS, for example, is comprised of around 38 different companies.
ebay313 30th-Oct-2012 07:01 am (UTC)
Looking at BCBS's wikipedia page I don't recognize any of their companies (aside from under the BCBS name) as ones in this state, so while I don't know how many companies do offer plans in my state specifically, it appears to still be more than 2.
furrygreen 30th-Oct-2012 07:12 am (UTC)
You're probably right.
baked_goldfish 30th-Oct-2012 04:41 am (UTC)
Everyone I know with GEHA loves that shit. Anecdote, I know, but still.
liz_marcs 30th-Oct-2012 02:54 pm (UTC)
*raises hand*

And I will back you. My family had it while I was growing up. My parents have it as retirees. Best damn thing ever.
sashafarce 30th-Oct-2012 04:50 am (UTC)
I wonder what happens to PCIP (if anything) with this plan. Is this supposed to be happening soon or in 2014? Will they take pre-existing conditions or will that too wait until 2014? I have PCIP (pre-existing temporary plan mandated under the ACA and it is slow but has literally saved my life) but my mom loses Medicaid eligibility in January and the only thing that keeps her alive is a once-weekly outpatient visit to the hospital that she will no longer be able to go to. Something needs to be done about people who fall into the cracks and I hope something like this will be what helps.
boundbyash 30th-Oct-2012 05:25 am (UTC)
As a Canadian who has been trying to follow the health care debate in the U.S., I find some of this confusing. For instance - is the federal government going to offer health plans that the American people will have to pay for, or will the plans be free? If they're not free, what is the difference between them and regular health plans? I thought the original goal was to provide health care insurance to the millions of Americans who don't have any; if they have to pay for this federal health insurance, what has changed? I'm sure I'm missing something, I just don't know what.

As a point of reference, I am using to a system where the provincial government runs a health plan that covers everyone in that province, and the plan is transferrable to any province in the Country. There is no charge for this plan. (Doctors, medical tests, surgeries, hospital stays and more are all included at no charge - we do however have to pay for prescription meds, although those who work and have a good health plan often have these costs defrayed.
furrygreen 30th-Oct-2012 06:44 am (UTC)
is the federal government going to offer health plans that the American people will have to pay for, or will the plans be free?

We'll probably have to pay the bi-monthly premiums and will have a co-pay. What the gov'n is doing, I think, is trying to force the companies into a free market system. Right now in the US, we can't buy insurance from other states (even if it's from the same company.) There are usually only a handful of insurance companies in state so it's a monopoly. That's the reason HC is so god damn expensive and we get such crappy care. I mean, what are we going to do? Go without? Ha.

A public option (a gov'n healthcare plan) was shot down but I think these two plans will probably work about the same. As in, if the other companies want to stay in business, they'll have to compete with the two national plans. And since those two plans will be national, they'll have more subscribers and will thus be cheaper over all.

But it won't be free for the majority. Later on, the bill has provisions that'll help keep costs down, but those are years in the future. (eg, forcing everyone to buy insurance, limit the amount of profit a company can make, pay in terms of results and not procedures, accepting everyone and charging all the same, and higher taxes on higher paying plans are a couple.)

If they're not free, what is the difference between them and regular health plans?

You'd have to read what they offer to know the difference. Each company covers different things. You don't get everything when you buy insurance from a company. Usually, you have the premium to pay every two weeks, a co-pay, and then it'll go down a list. Ah, like, it'll pay 80% of an ER visit up to a limit (say 10k or something) or it'll pay 75% of the cost of drugs. A lot of companies have yearly and lifetime limits in what they'll pay.

if they have to pay for this federal health insurance, what has changed?

The law will force people to buy insurance from one of the various companies. They did this to forestall the "we can't afford to take on the sick people" and the "healthy people won't buy the insurance" whining.
beemo 30th-Oct-2012 01:55 pm (UTC)
There's 3 problems with American health care: It's expensive, many people don't qualify because of "pre-existing conditions" or some other stupid thing, and people aren't required to have it. Some people are insured for no reason other than that they can be, because freedom. Obamacare basically attempts to make health care more accessible, and then forces people to be in the system.

Doctors, medical tests, surgeries, hospital stays and more are all included at no charge

Ontario, Quebec, and British Columbia don't cover a lot of routine medical tests. It costs about $50 to take an ambulance in Ontario, and it seems like hospital stays cost money unless you're placed in a ward and you're receiving government assistance. Newer hospitals are built without wards, in my experience. Quebec has a mandatory prescription drug insurance plan too.

Edited at 2012-10-30 02:05 pm (UTC)
boundbyash 2nd-Nov-2012 03:51 am (UTC)
I didn't mean to imply that in Ontario ALL health costs are covered by the govt., so I apologize if that's the way I came across. In my area, I've never come across a hospital that doesn't have wards, so paying for a hospital stay has never come up. As far as tests go, I'm sure there are some that aren't covered, but in my personal experience I've only had to pay once - $60 for a blood test. I had an MRI done recently that cost me nothing, whereas my best friend in the US had one done that cost her $300 (her health plan picked up the remaining $2300). My point really is that I like never having to worry about going bankrupt due to medical costs. I just keep my fingers crossed that it will always be this way.
beemo 2nd-Nov-2012 04:23 am (UTC)
I feel you. It's just that there's this misconception that everything here is ~*~FREE~*~ and I wanted to clear it up. :)
furrygreen 2nd-Nov-2012 06:29 am (UTC)
Yeah, well, it's basically free. Your $50 dollar ambulance is hundreds, if not thousands, here. You're not going to find a whole lot of sympathy from people in the US. ;P I know you're not asking for that.

It's just the prices here make that look like nothing. My last ER visit (without insurance) was about 30 minutes long. I had 5 minutes with the doctor. Got two shots of morphine and a prescript for a pain pill. That was over $3,000. People here die in police cells, after the hospital kicks those that can't pay for treatment out. Others can't get to an ER doc without going through the creditors hospitals have as a buffer.

As someone who has had life saving treatment denied because I had no insurance, I kind of feel strongly about those that want to make an issue over $50. Nothing in life is free. I think most know Canada pays for their insurance (what you hear on the news here is crap.) However, I'll take your $50 ambulance ride in a heartbeat without complaint if it's too much for you. ;P
beemo 2nd-Nov-2012 08:36 am (UTC)
Your system is inhumane and all kinds of fucked up, and I wish to Xenu it were different. D: You have my complete sympathy.

But... Canadians don't usually sit back and admire our health care, unless we're comparing it to yours. There is always room for improvement. Things like $50 ambulance charges are one flaw in a system that is failing, for example, uninsured Canadians who have chronic conditions. We also have a personnel shortage that is going to explode in the next 10-15 years as many Canadian doctors retire. Health care funding and accessibility have been huge issues in every provincial election I've experienced. Being better than the US isn't good enough.
furrygreen 2nd-Nov-2012 11:22 am (UTC)
Well, certainly. There's room for improvement in almost everything.

However, I think that bringing that up in a discussion about the US healthcare system -- by way of pointing out rather trivial payments when compared to our system -- isn't the right place for the discussion. It sounds trite, callus, and a little spoiled to be honest. I'm sorry. What is $50 to an uninsured Canadian with chronic disease is thousands monthly (meds alone can range in the hundreds monthly) without decent care and certainly an early, painful death after losing pretty much all their worldly goods. It is a bit like someone complaining about the rise in food prices to someone who's dying of starvation. Certainly, the rise in prices is a legit problem but trying to point that out to said starving person is rather callus, don't you think?

All I'm saying is that pointing out how you feel Canadian healthcare is failing in a post about US healthcare isn't the right place or way to get your point across. I'm certainly not saying that Canada has no healthcare problems. I think you have a valid claim and I do believe this is a subject that should be discussed. I understand that one hundred percent and agree. I think that healthcare is one of those things people must always be watchful of because it can really get out of hand.

I apologize for jumping on you like this. I'm not trying to attack you or anything.
maladaptive 30th-Oct-2012 02:27 pm (UTC)
We have USAA for car insurance. We pay for it, but it's much cheaper. Like we switched to Geico for a while because the rate for safe drivers was lower, and after some yahoo in a gas station tore off the passenger door*, they jacked the rates up so high we went back to USAA. They're consistently good and fair. I imagine with health insurance, it'll be similar. USAA is limited to vets and their families atm, but the health insurance should have an even bigger pool.

*Apparently gas stations are "streets" so you're at fault if you open the door into "traffic." Despite the fact that it's a gas station and you should expect people getting out of the car. Also you shouldn't be driving fast enough to take someone's door off. ~The more you know~
furrygreen 30th-Oct-2012 02:52 pm (UTC)
after some yahoo in a gas station tore off the passenger door*, they jacked the rates up so high we went back to USAA.

LOL. Sounds like what my sisters insurance company did. She was parked legally in parking lot at a big box store and some idiot backed into her car. Even with the store surveillance footage, they still said she was "driving recklessly" and was "100% at fault". She wasn't even in the car. XD
hammersxstrings 30th-Oct-2012 04:15 pm (UTC)
i lurrveee my usaa insurance.
morbidimpishfae 1st-Nov-2012 01:57 am (UTC)
How does USAA work? Does the car/insurance have to be in the vet's name? (Both my parents were USNavy.)
atomic_joe2 30th-Oct-2012 09:34 am (UTC)
I see some of the comments on here and I am reminded of how lucky I am to have the system we have in Britain.

Sure it's not perfect, and nobody is suggesting it is, but we're still incredibly lucky.
moonshaz 31st-Oct-2012 03:54 am (UTC)
Sure it's not perfect, and nobody is suggesting it is, but we're still incredibly lucky.

That you are! :)
ladygoddess A question30th-Oct-2012 03:16 pm (UTC)
I was injured at work a couple months back and had my injury seen under workman's comp. After two weeks, my injured limb seemed to be okay. Now I'm having persistent and worse pain in that same part of my body. Do you think this counts as a pre-existing condition under my health insurance provider? I've been under their coverage for nearly 18 months.
furrygreen Re: A question30th-Oct-2012 03:49 pm (UTC)
No. Pre-existing condition only refers to medical problems that happened *before* you were covered under an insurance plan. If you had coverage when you got hurt then it's not a pre-existing condition. If you have a condition you didn't tell your insurance company about that happened before you were insuranced by your current insurance than you do have a pre-existing condition (and god help you if they find out. XD)

If you quit or lose your insurance then this becomes a pre-existing condition to whatever insurance plan you're trying to get on in the future. In other words, until the further out Obamacare provisions come into law, don't quit your job and/or try as hard as you can to not be laid off or fired.
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