Insurance exchange may have loophole

[SHRED]

'A leak in the system'
Insurers could draw healthy people out of new markets

By David S. Hilzenrath
Sunday, November 15, 2009; 8:49 AM

Nobody wants to spend a lot of time, energy -- and taxpayer money -- and end up back where they started. But that's what could happen with one of the principal elements of health reform, the so-called exchange or gateway.

Legislators are designing this new insurance marketplace to protect consumers from many of the pitfalls and inequities in the current system. But even as they focus on the details of how the marketplace will work, senators have indicated that they would allow insurers to continue operating outside it, much as the health-insurance lobby has sought.

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/13/AR2009111303160.html

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Dem or Repub, Con or Lib, Left or Right, all labels melt away in the face of our Corporatist ran government.

Capitalism at all costs...even Democracy.


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[valleywine]

1. I think it is a very informative article and Harry and the

group will have to work hard to close these loops in the Senate bill in order to have a good bill for Obama to sign.

....The health committee bill would cut through some of the confusion by offering three tiers of coverage within exchanges. Plans competing within each tier would be required to have the same actuarial value, meaning that overall they cover the same percentage of anticipated expenses.

But under the health committee bill, insurance policies offered outside the exchanges would not have to conform to the three tiers, leaving consumers with the challenge of having to make apples-to-oranges comparisons.

The secretary of Health and Human Services would be required to establish an "essential health benefits" package," but it would not be essential that policies outside the exchange include those benefits.

Outside the exchanges, people could buy policies that do not provide the basic coverage required to satisfy the terms of the individual mandate (the requirement that everyone have insurance coverage), thus exposing themselves to penalties.

Even within the exchanges, there could be limits to consumer protections. The health committee bill would not explicitly guarantee consumers the right to an external appeal when a health plan refuses to pay for medical services. The right to an external appeal is a hallmark of the health-benefits program for federal employees, which has served as a model for the proposed exchanges.

[ipaint]

2. Harry and the group will give the ins. companies exactly what they want

minus a couple minor inconsequential adjustments to give the much pandered to middle class the appearance of reform.

[slipslidingaway]

3. Insurance companies will find the loopholes...

snip>>

"...For example, the bill written by the Senate health committee would not require insurers operating outside the marketplace to provide standardized disclosures about what they cover.

It would not prohibit health plans outside the exchanges from using marketing practices that discourage the seriously ill from enrolling, nor would it demand that they offer "a wide choice" of medical providers -- including "essential community providers . . . that serve predominantly low income, medically-underserved individuals," as the bill prescribes for insurers inside the exchanges.

Perhaps the sharpest dichotomy is that, under the health committee proposal, certain standards governing the nature and extent of covered benefits would apply only to policies sold inside the exchanges.

All of those factors contribute to the possibility that insurers might offer cheaper, less comprehensive policies outside the exchanges and entice healthier people to leave the new markets. That would leave the exchanges responsible for sicker people who are more expensive to insure..."

[subterranean]

4. Would those less "cheaper, less comprehensive" polcies qualify

as acceptable coverage? My understanding is that in order to avoid the penalty tax, you would have to prove you have health insurance that meets the minimum standards for coverage. How would these supposedly cheaper policies outside the exchanges fit in?

[slipslidingaway]

6. Not sure of the details, but you can bet the insurance companies....

will know how to get around the legislation.

[Blue State Blues]

5. They'll find the loopholes because they WROTE the loopholes

that's what comes from allowing an abusive industry to have a seat at the table.

[slipslidingaway]

7. Exactly and the people needed someone at the table who would point out...

the potential problems and we know most of them were excluded from the discussions.