Between Now & Then: Covering New Ground in Health System Shift

[quiet.american]

Found this to be a pretty good piece on challenges that are cropping up as the healthcare system readies for serious change in 2014

http://www.nytimes.com/2010/08/03/health/policy/03insurance.html?ref=barack_obama">NYT: Covering New Ground in Health System Shift

EXCERPT: Consumers could see higher premiums because of the additional benefits and protections they receive in the coming year. The new law prohibits lifetime limits on the dollar value of benefits, requires coverage of preventive services without co-payments, allows young adults to stay on their parents’ insurance and empowers consumers to appeal health plan decisions.

(That said -- )

¶Insurers run a risk if they raise rates too much. Federal and state officials can require them to justify any “unreasonable premium increase.” And if they show a pattern of excessive or unjustified rate increases in the next few years, they can be excluded from participation in the exchanges.

The new law requires insurers to spend at least 80 percent of every premium dollar on medical care and activities to improve its quality. This “medical loss ratio” could be a boon to consumers, as Congress intended. But some insurers may curtail sales to individuals or small businesses if they find the requirements too difficult to meet.

The insurance superintendent in Maine, Mila Kofman, cited that concern in asking the federal government for an exemption from the medical loss ratio requirement. “Absent a waiver, I believe that the federal standard may disrupt our individual health insurance market,” said Ms. Kofman, a strong supporter of the new law.

EXCERPT: The political risks are also significant. Politicians promised that the new law would rein in health costs, and voters may be irked if premiums continue to rise much faster than their earnings.

Lawmakers can deflect some of the criticism by blaming insurers. Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said insurers like Aetna and UnitedHealth had a duty to hold down premiums in 2011 because they were racking up “huge profits.”

Representative Pete Stark, Democrat of California and chairman of the Ways and Means Subcommittee on Health, said insurers should “return those windfalls to enrollees in the form of reduced premiums.”

For the moment, President Obama has the upper hand. Congress gave him sweeping power to regulate the industry for the benefit of consumers. Administration officials said they would be tough on the industry, but, for the law to succeed, they need large numbers of insurance companies to compete in the new regulated marketplace.

[Cha]

1. This is key..thank you, q.american..

"For the moment, President Obama has the upper hand. Congress gave him sweeping power to regulate the industry for the benefit of consumers."

[quiet.american]

3. That is key, and that's what's driving the teabaggers nuts! nt

[firedupdem]

2. Excellent. Thanks for posting this info! n/t

[quiet.american]

4. Thanks for checking it out, FiredUpDem! nt