Let me repeat: I am excited for ObamaCare. I believe single payer -- in the form of Medicaid or Medicare for all -- is coming soon. Why the optimism? Well, The Centers for Medicare & Medicaid Services (CMS) has just released a new set of draft rulesgoverning how the Affordable Care Act (i.e. ObamaCare) will work.
I'll highlight a few sections, but first let me state how exciting it is that the organization responsible for our existing public health schemes -- Medicare and Medicaid -- is responsible for making these rules. Yes, of course, that's just common sense and it's not some sort of amazing progressive policy achievement, but it sounds nice to have the folks in charge of Medicare dishing out the discipline for the profiteers at Aetna, Cigna, WellPoint, and United Healthcare.
Follow me below the fold. This is a long diary, but the highlighted rules can be skimmed without losing the analysis.
Guaranteed Availability of CoverageAs Aetna CEO Mark 'Americans should suffer' Bertolini has argued in the past, the old way of doing business for insurance companies is over -- no longer can they make ginormous profits off of attracting the healthy and dumping the woman with breast cancer at the mercy of the for-profit hospital's charity department. Given that in 2014 anyone with cancer, diabetes or heart disease will able to choose to 'burden' (I employ the harsh diction to provide insight into how big-profit insurance executives view patients) Aetna, Cigna or Blue Cross -- just because they like the company's logo design -- with their disease, insurance companies face a future in which they are not really insurance companies, but instead highly-privatized public utilities. At some point, the insurers will decide it makes more sense to just focus on administering programs for the government -- as will be the case with Vermont's Green Mountain Care single payer scheme -- and leave the entire idea of actually 'insuring' people behind in the dustbin of history.
Health insurance issuers generally would be prohibited from denying coverage to people because of a pre-existing condition or any other factor. Individuals generally would need to buy coverage during open enrollment periods. In addition, individuals would have new special enrollment opportunities in the individual market when they experience certain losses of other coverage.
Fair Health Insurance PremiumsAgain, as the Aetna CEO has already made clear, it's game over for profiting from the ability to choose not-sick people over sick people. Further, many states -- ones like California, Massachusetts, New York, Connecticut and Vermont -- will gladly impose tougher rules for health insurers than their friends in Congress would deem acceptable. Look for a glorious union of health insurers departing state markets and state governments deciding to pursue single payer. California's legislature passed single payer legislation several times in the past only to have the Governator veto it every time. Well, now California has a Democratic super majority, an intensely pro-consumer insurance regulator, and a Democratic governor. Yes, AHIP, you should be scared, because if the world's eighth largest economy goes single payer in 2017, it's pretty much game over for your profiteering ilk. Indeed, Vermont has already created and made public the branding for its single payer program. Lastly, a big reason insurers have been able to abuse customers for so long has indeed been the lack of transparency about pricing and what's included in a plan -- this legislation shines the light of day on deceptive and manipulative big-profit insurer pricing and plan design practices.
Health insurance issuers in the individual and small group markets would only be allowed to vary premiums based on age (within a 3:1 ratio for adults), tobacco use (within a 1.5:1 ratio and subject to wellness program requirements in the small group market), family size, and geography. All other factors – such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry – would no longer be able to be used by insurance companies to increase the premiums for those seeking insurance.
Under the law, states can choose to enact stronger consumer protections than these minimum standards. In addition, starting in 2017, states have the option of allowing large employers to purchase coverage through the Exchanges. For states that choose this option, these rating rules also would apply to all large group health insurance coverage. These proposed rules standardize how health insurance issuers can price products, bringing a new level of transparency and fairness to premium pricing.
Single Risk PoolWell, a single risk pool is what single payer is all about. Of course, with real single payer, we'd all pay taxes into the same pool with no middle men, but this is a tiny step towards consolidating premium dollars in one place -- as they should be. This rule doesn't allow insurers to game the system by creating different products to appeal to sick versus healthy people.
Health insurance issuers would be required to maintain a single statewide risk pool for each of their individual and small employer markets, unless a state chooses to merge the individual and small group pools into one pool. Premiums and annual rate changes would be based on the health risk of the entire pool. This provision prevents insurers from using separate insurance pools within markets to get around the market reforms and to charge people with greater health problems higher premiums by increasing their premiums at higher rates than other, healthier risk pools.
Guaranteed Renewability of CoverageYes, ObamaCare will kill jobs. It will kill the jobs of the people insurers have employed for decades to figure out how to take away coverage from sick people -- an appalling job highlighted in the horror-torture genre film, Saw VI. (Yes, Saw VI was devoted to highlighting the cruelty and brutality of for-profit insurance company underwriting and rescission.)
The proposed rule would reaffirm existing protections that individuals and employers have with respect to coverage renewal. For example, these protections would prohibit issuers from refusing to renew coverage because an individual or employee becomes sick or has a pre-existing condition.
In addition, the proposed rule includes some additional provisions to protect consumers and increase choice for small employers.
The Affordable Care Act is a Big Fucking Deal, and we all should be excited about the discipline insurers are going to receive in short order. I truly believe, like Forbes' Rick Ungar, that sooner rather than later we will not recognize America's health insurance landscape.
Best of all, Republican intransigence and absurdity has resulted in America's greatest social policy progress in 60 years having a Democrat's name all over it -- Obama really does care about America.