Insurance industry AGREES to fix kids coverage gap after PRESSURE from HHS Sec. Sebelius

[bigtree]

1 hour ago


After nearly a year battling President Barack Obama and congressional Democrats over the health care overhaul, the insurance industry says it won't block the administration's efforts to fix a potentially embarrassing glitch in the new law.

In a letter to Health and Human Services Secretary Kathleen Sebelius, the industry's top lobbyist said Monday insurers will accept new regulations to dispel uncertainty over a much-publicized guarantee that children with medical problems can get coverage starting this year . . .

"Health plans recognize the significant hardship that a family faces when they are unable to obtain coverage for a child with a pre-existing condition," Karen Ignagni, president of America's Health Insurance Plans, said in a letter to Sebelius. Ignagni said that the industry will "fully comply" with the regulations, expected within weeks.

. . . Ignagni's letter to the administration followed a sternly worded missive from Sebelius to the industry earlier in the day. The administration's top health care official forcefully tried to put an end to questions about the law's intent and wording.

"Health insurance reform is designed to prevent any child from being denied coverage because he or she has a pre-existing condition," Sebelius wrote to Ignagni. "Now is not the time to search for nonexistent loopholes that preserve a broken system."

"The term 'pre-existing condition exclusion' applies to both a child's access to a plan and his or her benefits once he or she is in the plan," Sebelius wrote. The new protections will be available starting in September, she said . . .


read more: http://www.google.com/hostednews/ap/article/ALeqM5jYnajhWrPEXihcCrpRNfUKN7rN-AD9EOSK0O0

[dipsydoodle]

1. Can anyone think of an analogy

whereby you can insure a certainty ?

I'm not saying pre-existing conditions shouldn't be covered - just that it ceases to insurance. Could you for example insure a car after an accident and claim for that accident ?

[Warren Stupidity]

5. That is why there is a mandate for universal participation.

Yes the analogy is seriously bad drivers.

[CTyankee]

13. This just shows the unarguable contradiction in terms of trying to fix health care

without a public option. It is as plain as day that private, for profit health insurance companies CANNOT make a profit without denying sick people coverage. They exist to make a profit. You cannot make a profit covering sick people. Ergo, this scheme cannot work...this realization came REAL fast, didn't it?

[TwilightGardener]

21. You can have a pre-existing condition and never end up costing your insurance co.

with that particular condition. Some can have Type 2 diabetes and control it very well with diet and exercise, maybe not indefinitely, but for a long time. Some can have hypertension that responds to meds that aren't very expensive. Some diseases flare and then go into remission for long periods of time. And of course, there's always the healthy to boost your profits. I'm not worried about insurance co's making money, they'll do just fine.

[Bluenorthwest]

22. This is just why we need Public Option

We do not need to find the right analogy, we need Single Payer, pirates out of the picture. And honey, I am not an object. Not a car. Stop calling my loved ones things. We are not cars, we are human beings. And you are straining to rationalize a half assed and corrupt 'reform'. Your agenda involves my family being called objects, not having equal rights, on and on and on.
No analogy will make this into a good bill. But keep trying.

[dipsydoodle]

39. What are you on about ?

I'm not straining to rationalise anything. I was simply stating that if the probability is 1 then you can't call it insurance which is based on risk and uncertainty neither of which apply to a definate event. The only coverage which would truly provide what you need is socialised medicine of some description. Incase you hadn't bothered to look I'm UK and with our NHS we're covered conception to grave so no such thing as preconditions.

[dkf]

2. It beats me how one lobbyist can promise behavior from every single insurance company out there.

I'll believe it when I see it

[bigtree]

3. we were willing to believe them when they claimed they could ignore the law

This is the 'industry' admitting they can't successfully resist following the law or persist in opposing administration efforts to define and implement the provisions. If the insurance companies thought they had a chance in hell of holding out (or if the administration had encouraged them by remaining passive in the face of their objections) they would still be fighting.

[dkf]

6. No, I think they are doing it as a PR thing.

After all, they don't want to give ammunition to people who want to get rid of the mandate. That is the cash cow of this piece of legislation.

[Warren Stupidity]

4. Oh I guess all those determined to portray this bill as fail will have to find a new attack point.

It seems the executive branch remains the authority on how legislation is administered.

[MannyGoldstein]

7. Dupe, And It Doesn't Help Kids Anyway

Dupe of: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=102&topic_id=4325430&mesg_id=4325430

And there's no cap on premiums for kids with pre-existing conditions, so this is nonsense anyway: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=102&topic_id=4325430&mesg_id=4325555

[bigtree]

9. let's take a moment here to refute those who claimed the protection wouldn't be honored

. . . then we can deflect from that smackdown of the hysterical bleatings of several critics here and have your debate about premiums.

[MannyGoldstein]

14. It's Kabuki Theater

As a functional matter, it won't be honored.

"Sure you can have coverage, it's $100,000 a year, chump" is no different than "hit the road, chump".

[bigtree]

15. I look forward to the reports from folks who are helped by this provision

. . . turning your kabuki theater into a reality show.

[MannyGoldstein]

16. You're Thinking The Insurers Won't Hike Premiums On Kids Who Get Sick?

I wish I shared your optimism.

[bigtree]

17. I agree they will rise

Will folks still need and purchase coverage? I believe they will.

[MannyGoldstein]

23. You Don't Think That Rates Will Be Hiked So As To be Unaffordable?

Which is the same thing as saying "go away"?

I'm pretty sure that insurers will dump any kid that's very risky - insurer's are in business to make profit, not to help kids.

[bigtree]

25. for some, yes

... and others will be forced to succumb to the hikes.

Rate hikes and premium abuse are what I believe will drive the debate in favor of moving forward with competition like the PO. Also, I don't think the administration (or lawmakers) will remain passive in the face of sharp hikes. The political wind hasn't subsided for further reforms, and the air of dissatisfaction may well drive legislators to a remedy.

The industry still makes money by including folks with PECs. The majority manage their illnesses successfully, the rest of the risk is absorbed by the increased pool of insured. But you are right that there will be price pressure from the industry as they look to cover their expenses.

[ixion]

8. After decades of Insurance company fraud and abuse

all of a sudden the Insurance Industry credible and forthcoming. Yeah, right. They'll 'fix' it. I'll bet they 'fix' it good.

The Fox is in the Hen House. I repeat: The Fox is in the Hen House.

[bigtree]

10. they're really saying they don't have the ability to legally refuse

... or else they'd still be fighting the regulation.

Now they still can and will look for ways to recover their expense through higher premiums, but they are still obligated within the law and they are admitting this in the face of HHS's strong assertion they intend to defend the law.

[ixion]

11. personally, I won't take what they say at face value

given their history.

You better believe they have armies of lawyers looking for all the possible loopholes are I type this.

[bigtree]

12. I'm not

I'm taking the HHS Secretary's word that she intends to implement and enforce the law. The industry is responding to that authority in their backpedaling.

[Bluenorthwest]

24. Do you think our government has the ability to

give constant oversight and case specific rulings? What is the branch that will be doing this? Insurance is a huge industry, where is the funding for the oversight and enforcement mechanism? Do you think HHS can suddenly without expansion, simply deal with all the issues? How?

[bigtree]

26. HHS is the primary enforcer in the legislation

I believe they can act in concert with the Justice Dept. in some cases. I also see the problem of funding their enforcement efforts, but there will be appropriations. That's where we'll determine the extent of the commitment to regulate the new provisions.

[Bluenorthwest]

28. Bush said to FEMA- you are now DHS organize accordingly

but they were not funded for that resetting of priorities nor for the new duties. They were told 'there will be appropriations' but there were not. Much talent walked away from the agency, because of being told to do the impossible, and because they could see the eventual outcome, which we all wound up calling 'Katrina'.
And there is a cautionary tale to be taken with great attention by those who claim Sebelius can personally handle all of this. She can not because no one person can.
All of this would have been attended to in a good piece of legislation, not left for later, as an afterthought.

[bigtree]

30. well, we'll see

... this isn't the Bush administration.

[Jeff In Milwaukee]

18. But....But....

They said that the government wouldn't enforce the regulations!

[ixion]

31. Uh, there is a major difference between making a claim and acting on it

so it remains to be seen.

[Paper Roses]

19. I bet my last dime that insurance companies-all of them- have a staff

whose only job right now is to read the health care legislation to find loopholes to exploit. They may have been too hasty to announce they found this one.
Might cause some of our Congress critters to actually read the damn thing with a little more of a keen eye.

I am sure more loopholes will be found once the pro's get this whole thing sorted out.

Good grief, how bad is it when something so major is signed without reading. No-one I know would ever sign anything without reading it first. Simple logic, know what you are committing to.

My opinion of Washington politico's gets lower by the day. Sure, there are a few good men and women but the majority seem to sit on the seat of their pants waiting for something to happen so that they can say it was not their idea. No mea culpa there.

[bigtree]

20. I have some confidence in HHS Sec. Sebelius

She was an insurance commissioner before she became governor. This administration looks to be keen on enforcing the new provisions of the Health Act.

[Bluenorthwest]

27. This is a new, huge resposibility

I have some confidence in Sebelius as well. But having confidence in the Sec does not make the department instantly large enough to function as an oversight and investigation unit, to gather complaints, see them though, all of this with a rival that is a huge, wealthy industry with more lawyers than Pismo has clams.
Explain how that will be done. Without a new agency. Without new hires. Without dropping other balls. HHS can suddenly take on one of the largest jobs in government, ever, without so much as taking on some new temps?

[bigtree]

29. this is what HHS does

. . . much of the enforcement done through the Office of Inspector General.

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452 (as amended), is to protect the integrity of Department of Health and Human Services (HHS) programs, as well as the health and welfare of the beneficiaries of those programs. The OIG has a responsibility to report both to the Secretary and to the Congress program and management problems and recommendations to correct them. The OIG's duties are carried out through a nationwide network of audits, investigations, inspections and other mission-related functions performed by OIG components.
http://www.oig.hhs.gov/organization.asp

We'll have to track the commitment of funds through appropriations. (hard slog)

[Echo In Light]

35. Count on it

[bigtree]

32. .

[AnArmyVeteran]

33. I'm sure Bush's Health and Human Services Secretary would have done the same thing LOLOLOL

[area51]

34. lol

"... efforts to fix a potentially embarrassing glitch in the new law."

Uh, no. More like efforts to exploit a lucrative loophole in legislation written by the insurance companies by their paid puppets in congress.

[Echo In Light]

38. That's about the size of it

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