Health insurers could be allowed to bypass some key "reforms". Senate bills provide loopholes

[Better Believe It]

Health insurers could be allowed to bypass some key reforms
Senate bills would include loopholes for proposed 'exchange'
By David S. Hilzenrath
November 15, 2009

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.

One Senate bill would preserve the possibility that insurers could tailor policies to draw healthy individuals out of the new markets, leaving coverage less affordable for those who stay behind.

"It's a leak in the system," said Karen L. Pollitz, a professor at Georgetown's Health Policy Institute. "It returns you to problems that we have today."

Senate bills guarantee that certain basic reforms -- such as requiring insurers to accept people regardless of preexisting medical conditions and banning annual and lifetime limits on coverage -- would apply both inside and outside the new markets for individuals and small businesses. But that would not be true for a host of other requirements intended to help consumers compare health plans on an apples-to-apples basis and force insurers to compete more directly on price.

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's 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.

Similarly, outside the exchange, the bill drafted by the Senate Finance Committee would not regulate the marketing of individual coverage, nor would it require that health plans be rated based on quality and price.

The Senate health committee would give plans operating outside the exchanges another break: Only those inside an exchange would have to pay a surcharge -- as much as 4 percent of premiums -- to defray the exchange's overhead costs.
Read the complete article at:

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

[Ruby the Liberal]

1. Shocking.

:eyes:

[dflprincess]

2. So why would any plan participate in the exchange?

Think of all the time they've wasted on this scam when they could have been working on real solutions.

[Greyhound]

3. What a surprise...

:wtf:

[liberal_at_heart]

4. Well there's a shocker