White House Versus Wellpoint

[babylonsister]

http://theplumline.whorunsgov.com/health-care/white-house-versus-wellpoint/

White House Versus Wellpoint
Greg Sargent


There’s been a new dust-up between the White House and a big insurance company that — the particulars of the case aside — really tells us something important about what the passage of Obamacare stands to mean.

As you may have heard, yesterday Reuters broke the startling story that the insurance company Wellpoint appears to be routinely dropping coverage for women with breast cancer. The charge: The company’s using a computer algorithm that automatically targets policyholders recently diagnosed with breast cancer with fraud investigations that appeared designed to provide a pretext to drop their policies.

This practice will soon become illegal under Obamacare. And the news prompted a toughly-worded letter from HHS Kathleen Sebelius to the company demanding that the company cease and desist immediately.

Well, now Wellpoint has responded to Sebelius in a new letter that strongly contests the charges. The letter also refers people to this long response that purports to debunk the Reuters story point by point.

But put the particulars of this aside for a sec. Whoever’s right, soon this type of alleged insurance company behavior will be illegal, because the new law prohibits insurance companies from rescinding policies, except in cases of outright fraud or deception.

That means charges like this could ultimately result in a criminal investigation of some kind. Which means vast new enforcement power to get to the truth in situations like these, rather than seeing them dissappear in a welter of he-said-she-said recriminations. It won’t merely be a matter of urging companies to do the right thing. That alone will mean a dramatically different landscape.

**************************************

Update: Edited slightly for clarity; here’s how Reuters characterizes the allegations: “WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies.”

[RUMMYisFROSTED]

1. I wish.

[lob1]

2. I heard yesterday on MSNBC that the maximun penalty for breaking the

law is $100 a day. In other words, there is no penalty to stop them.

[pnwmom]

3. The maximum penalty if they are seen deliberately flouting the law

would be to have the Administration decide to push for Medicare for all.

[IndianaGreen]

5. The Administration has chosen to cut Medicare instead

perhaps to make it fail, and push more people into private insurance. There are strong reasons why seniors do not support the new HCR law.

[ClarkUSA]

7. "The Administration has chosen to cut Medicare instead"?? Anti-HCR Republicans said that ad nauseum.

They were lying and trying to conflate the fact that HCR will cut $500B in fraud and waste.

What are you doing? Do you have credible proof from an unbiased source of the "strong reasons why seniors do not support the new HCR law"? You do know that AARP supported HCR, right?

[IndianaGreen]

11. The Administration's own Health and Human Services Department said that

A report by economic experts at the Health and Human Services Department said the health care remake will achieve Obama's aim of expanding health insurance — adding 34 million Americans to the coverage rolls.

But the analysis also found that the law falls short of the president's twin goal of controlling runaway costs. It also warned that Medicare cuts may be unrealistic and unsustainable, driving about 15 percent of hospitals into the red and "possibly jeopardizing access" to care for seniors.

<snip>

Medicare warning

The report's most sober assessments concerned Medicare.

In addition to flagging the cuts to hospitals, nursing homes and other providers as potentially unsustainable, it projected that reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular program. Enrollment would plummet by about 50 percent, as the plans reduce extra benefits that they currently offer. Seniors leaving the private plans would still have health insurance under traditional Medicare, but many might face higher out-of-pocket costs.

In another flashing yellow light, the report warned that a new voluntary long-term care insurance program created under the law faces "a very serious risk" of insolvency.

http://www.msnbc.msn.com/id/36726295/ns/politics-health_care_reform/

Obama is doing to Medicare what only Ronald Reagan could dream about!

[pnwmom]

26. The huge yearly increases are clearly unsustainable. And Medicare Advantage

was a waste of the taxpayers money, since the private insurers weren't managing care as effectively as Medicare.

[pnwmom]

9. The cuts were from Medicare Advantage,

which were actually private plans that turned out not to be cost effective.

They should have been cut anyway.

Seniors who understand that their children and grandchildren also need healthcare DO support the new law.

[IndianaGreen]

12. Medicare Advantage was not the only one taking a hit

Medicare warning

The report's most sober assessments concerned Medicare.

In addition to flagging the cuts to hospitals, nursing homes and other providers as potentially unsustainable, it projected that reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular program. Enrollment would plummet by about 50 percent, as the plans reduce extra benefits that they currently offer. Seniors leaving the private plans would still have health insurance under traditional Medicare, but many might face higher out-of-pocket costs.

In another flashing yellow light, the report warned that a new voluntary long-term care insurance program created under the law faces "a very serious risk" of insolvency.

http://www.msnbc.msn.com/id/36726295/ns/politics-health_care_reform/

[ClarkUSA]

21. They are indeed from Medicare Advantage, according to your very own quoted source.

"... it projected that reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular program. Enrollment would plummet by about 50 percent, as the plans reduce extra benefits that they currently offer. Seniors leaving the private plans would still have health insurance under traditional Medicare..."

[pnwmom]

25. Continuing on the present path would have been far worse.

I would have preferred single payer or at least a public option. But this reform bill is better than the current mess.

[lob1]

6. I really hope you're right. But they deliberately put in a token punishment

for breaking the law. That wasn't an accident or oversight. It was done intentionally. That's not a good sign. Why would the administration punish insurance companies for using a loophole that the administration signed on to?

[pnwmom]

10. It's not a loophole, it's a penalty. And if that penalty doesn't work,

it will demonstrate to the public and Congress that private insurers can't be trusted to do the job.

[IndianaGreen]

13. The public knows that private insurers don't work, which is why it supported Medicare for all

It is the corporate paid for Congress and White House that put single payer off the table, and then they scuttled the public option.

[pnwmom]

15. I'm not sure ENOUGH of the public understands that. But now the principle

of health care for all -- and no recissions, and no ban on preexisting conditions -- has for the first time been enshrined into law. If the private ensurers flout the new law, they'll have proven that they don't deserve the business.

[IndianaGreen]

17. HCR leaves millions uncovered because it is not a true universal health care system

Recissions are taking place all over the place as we post in DU, Blue Cross is as bad as WellPoint.

[pnwmom]

18. The ban on recissions hasn't taken effect yet, has it? n/t

[katandmoon]

20. There really is no ban. Insurers can still shitcan customers based on what they deem is "fraud."

[ClarkUSA]

23. Absolutely not true. You're ignoring the facts as stated in the OP in favor of baseless polemic.

Here are the facts, if you're interested in that sort of thing:
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=277087&mesg_id=277156

:sarcasm:

[katandmoon]

27. How do you keep missing the "except in cases of outright fraud or deception" phrase in that quote?

Health insurers can and will make it their business to find "except in cases of outright fraud or deception" and nail their customers for it on the flimsiest of evidence, just EXACTLY as they do now.

[ClarkUSA]

29. How did you miss ""vast new enforcement power to get to the truth in situations like these"?

Keep spinning.

[pnwmom]

24. I'll assume you're saying that the ban on recissions hasn't yet taken effect. n/t

[katandmoon]

28. No. I'm saying the ban on recissions isn't worth the paper it's printed on to insurers.

Wellpoint is already ferociously disputing Sebellius' protest of their dropping those breast cancer patients. They will fight just as ferociously to continue to drop whatever patients they possibly can. The new law won't stop them at all, because it doesn't prevent rescission. Rescission is still allowed when insurers can demonstrate fraud on the patient's part. And they will be looking harder than ever to demonstrate that fraud. Anyone who thinks they won't try, and that they won't succeed when they do try, is stunningly naive.

[ClarkUSA]

30. That's your opinion. Where's your proof? n/t

[katandmoon]

4. This shows how toothless "health reform" was. Insurance companies can still rescind policies based

on "fraud," because fraud is still whatever they say it is.

[ClarkUSA]

8. Wrong. This shows there's "vast new enforcement power to get to the truth in situations like these"

Furthermore:

"... soon this type of alleged insurance company behavior will be illegal, because the new law prohibits insurance companies from rescinding policies, except in cases of outright fraud or deception.

That means charges like this could ultimately result in a criminal investigation of some kind. Which means vast new enforcement power to get to the truth in situations like these, rather than seeing them dissappear in a welter of he-said-she-said recriminations. It won’t merely be a matter of urging companies to do the right thing. That alone will mean a dramatically different landscape.

[katandmoon]

14. No, you're wrong. "Health Reform" still allows Wellpoint to do exactly what they did.

[pnwmom]

16. The argument from the insurers has always been that they could be trusted to handle

health care (without recissions and preexisting conditions) as long as they had the entire population of sick and healthy people to draw their business from. If they fail to live up to their claims, the next step is to institute at the least, a public option -- but even better, Medicare for all.

[katandmoon]

19. I wish. But Obama has made it crystal clear he opposes the public option.

So we have this instead -- pretend health care reform, full of so many loopholes and delays that it's a joke.

[ClarkUSA]

22. The facts in the OP contradict you. I gave you proof via a quote, but you are only interested...

... in repeated baseless polemic.