Health Care Stocks Are Hot Again, Lobbyists Win!

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Health Care Insurance Company Stocks "On Fire!" – They’re Winning, We’re Losing



If you need a guide to the health reform debate in Washington, take a look at health insurance company stocks.

When the debate is going the right way – towards quality, affordable health care for everyone, towards getting people out from under the insurance industry’s crushing monopoly – insurance company stocks take a dive. When the debate is moving against what America wants – towards more private industry, less insurance regulations, and the like – health care stocks soar.

Right now, they’re soaring. The Indianapolis Star goes into more detail:

Shares of the Indianapolis-based health insurance giant surged to a 52-week high Thursday as the prospects for a new government-run "public option" health plan faded amid intense Senate debate. WellPoint rivals Cigna and UnitedHealth Group also hit 52-week highs.

It’s a sign, more than one observer suggested, of victory for private health insurers, which strenuously fought the Public Option.

"Obviously, the market thinks WellPoint’s a winner," said Daniel Evans, chief executive of Clarian Health, an Indianapolis-based hospital system. "If the public option is no longer on the table, then WellPoint is a winner because it’s not threatened by a government competitor."

Wall Street is what has turned our nation’s health care companies into profiteers.

16 years ago, before most of the insurance companies were publicly traded, they spent 95% of premium dollars on health care. That level is comparable to Medicare, which spends 97% of premium dollars on care. But once these companies went public and started trading on Wall Street, the relentless drive for profit drove down that percentage to where it sits today, at 81%.

Wall Street pressures directly caused insurance companies to deny more care. Wall Street accelerated the process by which insurance companies deny as much care as they can, which forces more people into bankruptcy (when they have to pay out of pocket for care their insurance company won’t cover) and leaves millions uninsured (if you’re bankrupt, it’s hard to pay premiums). And being uninsured can be a death sentence.

The way Wall Street responds to the health care debate drives these companies. When insurance company stock prices catch fire as the public health insurance option is killed in the Senate, you can bet that these companies are watching and feel supported in their effort to kill any and all health reform that would hurt their bottom line.

Wall Street-run health care is the driving reason that if the insurance companies win, we lose.

Wall Street run health care is making huge profits right now. It’s also making Americans sicker and sicker. A health care reform bill that does not take away Wall Street’s power – one without a public option, one that doesn’t mandate insurers spend 90% of their premiums on care, one without strict regulations on denying care or charging more to certain customers – will tacitly support the way the health care business works now, with Wall Street in charge.

The Senate bill, in too many ways, is the Wall Street bill. The House bill stands up to Wall Street. That’s presents real problems for the American people, problems that must be fixed before this bill is sent to the President’s desk.



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Sources: Firedoglake, The Indianapolis Star, MSNBC, Morning Joe Show, AP, Google Maps

Health Care Insurance Companies Denied Coverage For Pregnancy & Acne...Blatant Discrimination

(Pres. Obama targets Health Care Insurance companies.)

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Acne, Pregnancy Among Disqualifying Conditions

A proposal to make preexisting health conditions irrelevant in the sale of insurance policies could help not just the seriously ill but also people who might consider themselves healthy, documents released Friday by a California-based advocacy group illustrate.

Health insurers have issued guidelines saying they could deny coverage to people suffering from such conditions as acne, hemorrhoids and bunions.

One big insurer refused to issue individual policies to police officers and firefighters, along with people in other hazardous occupations.

Some treated pregnancy or the intention to adopt as a reason for rejection.

As Congress and President Obama work on legislation to overhaul the nation's health-care system, one of their main objectives is to stop insurers from denying coverage on the basis of health status. Proposed legislation would prohibit insurers from denying coverage to individuals with preexisting conditions or charging them higher premiums because of their medical history -- practices known as medical underwriting.

Even the insurance lobby has endorsed that goal as part of a larger reform package in which the government would extend coverage to the uninsured, greatly expanding the market for insurance.

Guidelines that insurance companies have written for professionals involved in selling policies offer a glimpse inside the underwriting process.

"What these documents show is the lengths to which insurance companies are willing to go to make a profit," said Jerry Flanagan, health-care policy director of the advocacy group Consumer Watchdog, which distributed the documents Friday. "What it shows is that insurance companies want premiums without any risk."

Consumer Watchdog argues that consumers should be given the option of enrolling in a government-run health plan. It obtained the documents from a California insurance broker, Flanagan said.

A PacifiCare "Medical Underwriting Guidelines" document from 2003 lists under "Ineligible Occupations" such risk-takers as stunt people, test pilots and circus workers -- along with police officers, firefighters and migrant workers.

Uninsurable conditions included pregnancy, and being an "expectant father" was grounds for "automatic rejection." So was having received "therapy/counseling" within six months of the application. There was also this more general disqualifier: "currently experiencing/experienced within the last 12 months symptoms for which a physician has not been consulted."

The PacifiCare document "is completely outdated and predates the acquisition of PacifiCare by United Healthcare," Cheryl J. Randolph, a spokeswoman for the parent company, said by e-mail. She declined to provide current underwriting documents.

"Underwriting enables insurers to adequately assess risks, keeping premium costs lower for more consumers," she added.

Health Net guidelines for 2006 say that people could be denied coverage or charged higher premiums if they were taking certain medications, including Zyrtec, an allergy remedy, and Lamisil, which is widely advertised as a treatment for toenail fungus.

Pregnant women could be rejected, as could expectant fathers, the document said.

A Health Net spokeswoman did not respond to requests to comment.

Blue Cross of California guidelines for 2004 said potential disqualifiers included chronic tonsillitis and, under certain circumstances, varicose veins.

Kristin E. Binns, a spokeswoman for parent company WellPoint, said by e-mail that she could not comment on the guidelines because they are from years ago.



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Sources: Washington Post, MSNBC, Huffington Post, Google Maps

Health Care Insurance Companies Frequently Deny Eligible Claims For No Good Reason

(Rep. Kucinich (D-OH) Questions Execs. From 6 Of The Largest Insurance Co's On The Fatal Effects Of Denied Claims.)





In Health Care, Number of Claims Denied Remains a Mystery

Are health insurance companies generally being fair and honest when they reject claims from policy holders?

That would seem to be an important question in deciding how best to fix the U.S. health system. But it hasn’t been a focus of the raging health-care debate -- possibly because the answer is not publicly available.

“This is one of the dark corners of the black box that is private health insurance,” said Karen Pollitz, a professor at the Georgetown University Health Policy Institute.

Data on how often insurance claims are denied -- and for what reasons -- is collected and analyzed by the insurance companies themselves. But except in California, the companies aren’t required to provide those records to any state or federal agency. “The number is knowable, but not known by regulators or policy makers or patients,” Pollitz said.

The main Health-Care Reform bill being considered in the House does seek to address the matter. It would require health insurance companies to report data on claims policies, practices and denials to a central commissioner.

The issue of claims surfaced recently in California. The state Nurses Association issued a press release saying that data it obtained from the Web site of the state’s Department of Managed Health Care showed that in just the first half of 2009, California’s six largest HMOs had rejected more than 31 million claims -- 21 percent of those they had received.

The way the nurses group tells it, state officials didn’t even know they had the data.

Don DeMoro, a policy director for the nurses’ association, said that he received a phone call from the managed care department after its press release came out.

“They said, "You couldn’t have gotten this data from us. We don’t collect it ourselves,"” DeMoro said. “"The data is there," I told them, "but it’s hard to find." I walked them through the steps and waited while they clicked through their own Web site. Once they saw that the data was there, they politely said, "Thank you" and hung up.”

Lynne Randolph, spokesperson for the state agency, said she does not know what DeMoro might have been told, but said, “We’ve always known about this data.”

(To check the California data, go to the managed care agency's searchable financial reports. On the pull down menu, select "full service", choose a company name and "annual". When the list comes up, click on the company name and you will download a spreadsheet. The claims data is contained on the tab labeled ‘Schedule G.’)

In any case, Randolph contends that the nurses’ group misrepresented the meaning of what it found. She said the total number of “claims denied” include duplicate claims and claims that were eventually appealed and accepted, in addition to actual denials. “You can’t just look at the numbers in schedule G,” she said. “I guess it might look that way to a layman, but that data obviously does not reflect actual denials.”

Tim Labas, assistant deputy director in the Office of Health Plan Oversight at the state agency, estimated that the actual denial rate across the board in California is probably somewhere between 10 and 20 percent. “That might still seem high,” he said. “But there are legitimate reasons why claims are denied.”

The state officials said they consider the claims data they collect to be a kind of early warning system. If they notice large jumps in claims denials for an insurance company, they have the authority to request more specific information, said Mark Wright, an official in the health plan oversight office. The office said it could not cite an example of when it made such a request.

“We could require the insurance companies to report all of the data to us, but I think it would just be too much information for us to handle,” Wright said. “We’d be overwhelmed.”

The National Association of Insurance Commissioners (NAIC), whose stated mission is to “assist state insurance regulators, individually and collectively, in serving the public interest” said the group did not know the state reporting requirements for insurance companies, nor does it collect data on the actual number of claims denials.

State regulators tend to focus on individual complaints from consumers. But only a fraction of consumer problems with health insurance result in formal complaints.

A national survey published by the Kaiser Family Foundation in June 2000 found that 51 percent of those surveyed had experienced some type of problem with their health insurance, but only two percent had made a formal complaint. Nearly 90 percent of those surveyed could not name the agency that regulates health insurance in their state.

In recent testimony before the House Subcommittee on Domestic Policy, Pollitz, the Georgetown professor, said that collecting claims data is important because “regulators must be able to monitor patterns of health insurance enrollment and disenrollment in order to know whether insurers are avoiding or shedding.”

Robert Zirkelbach, spokesperson for the insurance industry’s trade association, America’s Health Insurance Plans (AHIP), said his organization had not taken a position on the proposed reporting requirement in the House bill.

AHIP represents, among others, UnitedHeathOne, Wellpoint, Inc., Aetna, Inc., Humana, Inc., CIGNA Healthcare, and the Health Care Service Corporation, all of whom sent executives to testify before the subcommittee on Thursday.

AHIP submitted testimony to the record as well, noting that the organization had completed an internal investigation of 700 million claims voluntarily submitted by 19 unnamed insurance companies in 2006 and found the denial rate to be only about 2.36 percent.

But Pollitz said that consumers and regulators, not insurers, need more “detailed, descriptive information about how coverage works.” This data about health insurance is generally lacking at both the federal and state levels.

Last year the House Committee on Oversight and Government Reform requested information from 50 state health insurance regulators. They found that most states didn't know the answers to basic questions. Only four states -- Hawaii, Kansas, Texas, and Washington -- knew how many times insurers had dropped people’s coverage. Only ten states knew how many individual health insurance policies were in effect in their jurisdictions. More than one-third of state commissioners did not know which health insurance companies even offered policies in their state. The federal agency responsible for maintaining health insurance standards and oversight, the Center for Medicare and Medicaid Services, does not gather compliance data, nor does it track state enforcement.

“It is time for the federal government to take a more active role in health insurance regulation,” Pollitz said.



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Sources: Huffington Post Investigative Fund, C-Span, Democratic Underground, OpenCongress.org, wpso.dmhc.ca.gov, Ohio Quotes, Insurance Finder, Day Life, Google Maps

CIGNA Whistle Blower Confesses "Sick Customers Were Dumped To Please Investors"

Huffington Post, CBS News----


Nebraska's Democratic United States Senator Ben Nelson is one of the holdouts on national health care reform, after accepting big bucks from the health insurers -- ranking #10 in the Senate for taking health insurance cash. He met his match in the Senate Commerce Committee today when a former CIGNA executive came to Congress with a simple message:

"My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick - all so they can satisfy their Wall Street investors."

Potter testified that:

I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand -- or even to obtain -- information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world.

Woof! Wendall Potter may be the secret weapon that wins passage of health care reform in America. Read his full testimony here.

The health insurance Potter described today is hardly the one Congress would want to extend to 47 million more Americans. Potter makes as good a case for the need for a public option to the for-profit market and for health insurer accountability as I have heard yet in Congress, just as the president goes on ABC tonight to make his case. Senator Jay Rockefeller, who chaired today's hearing made an eloquent and passionate plea for change too.

He also released a report showing how patients are being screwed by insurance fine print. Reformers are finding their stride. The more the focus on insurers, the stronger this reform horse will run.


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Sources: Huffington Post, CBS News, Commerce.Senate.gov, CIGNA, Google Maps