The
Insurance Industry’s No-Lose Situation
By
Phil Mattera for the Dirt Diggers Digest
Many
voices are speaking out about the Republican effort to undo the Affordable Care
Act, but one party diligently refrains from public comment: the insurance
industry.
While
the industry is undoubtedly exerting its influence in the closed-door
negotiations to restructure the wildly unpopular GOP bill, it is not airing
those views more widely.
It
doesn’t have to, because the healthcare debate between the two major parties is
largely a disagreement on how best to serve the needs of Aetna, Anthem and the
other big players.
The
ACA, of course, was built on the premise that government should expand coverage
largely by providing subsidies to help the uninsured purchase plans from
private companies.
When
those companies became dissatisfied with the composition of their new client
base and starting jacking up premiums in response, ACA supporters were put in
the position of advocating for new insurer financial incentives.
Meanwhile,
the Republicans are seeking to help the industry by rolling back Medicaid
expansion and allowing it to return to the pre-Obamacare practice of selling
bare-bones junk insurance, which would be the only kind that many people could
afford after subsidies are decimated.
This
is probably a no-lose situation for the insurers: either they get paid more to
provide decent coverage or they are freed to sell highly profitable lousy
plans.
All those legislators catering to insurers one way or the other are forgetting that healthcare reform was made necessary by the ruthless behavior of that same industry.
If
those companies had not been denying coverage whenever possible, it would not
have been necessary for the ACA to set minimum standards.
And
if those firms had not been raising premiums relentlessly, it would not have
been necessary for the ACA to take steps — which turned out to be inadequate —
to try to restrain costs.
The
industry’s unethical practices are not limited to the individual marketplace.
The big insurers have also exploited the decision by policymakers to give them
a foothold in the big federally funded programs: Medicaid and Medicare.
As
Senate Republicans were cooking up their repeal and replace bill, the U.S.
Attorney’s Office in Los Angeles joined two cases against one of the
industry’s giants, UnitedHealth Group. The whistleblower suits accuse the
company of systematically overcharging the federal government for services
provided under the Medicare Advantage Program.
The
complaints in the cases allege that UnitedHealth routinely scoured millions of
medical records, searching for data it could use to make patients seem sicker
than they actually were and thus justify bigger payments for the company, which
was also accused of failing to correct invalid diagnoses made by providers.
Either
way, the complaints argue, UnitedHealth was bilking Medicare Advantage, which
was created on the assumption that bringing the private sector into a
government program would cut costs.
Such
assumptions continue to afflict federal health policy as a whole. Too many members
of Congress continue to worship the market in the face of all the evidence that
the private insurance industry cannot be the foundation of a humane healthcare
system.
