So what do these handmaidens of the big health insurance industry want? As the Secretary's letter points out,
Your letter identified four areas for greater state flexibility. Specifically, you called for the ability to (1) exercise maximum flexibility to operate exchanges, and in particular to select the insurers that will participate in the exchange, (2) give states authority to determine essential health benefits that participating plans must offer, (3) waive provisions that might inhibit the availability of consumer-driven plans and health savings accounts (HSAs), and (4) enroll Medicaid beneficiaries into private plans without HHS approval.Translation: Republican governors want the power to (1) subjugate the health insurance exchanges to the whims of the health insurance industry without accountability, (2) continue to allow house insurance plans to be termed "health" insurance plans in which the "insured" can't afford to actually use any care, (3) make sure insurance companies have to pay as little as possible to actually provide care (I suppose that way they will have more money to stuff the campaign coffers of these corporate callgirls, I mean Republican governors), and (4) let private health insurance take over Medicaid and make the poor pay huge copays and deductibles.
No way. That was the response they got from the administration. Sebelius points out the already available broad range of flexibilities that states have in implementing the law as well as the exchanges, but she also makes it clear that she's not willing to let the insurance industry and their buddies off the hook. First, flexibility within a system of consumer protection and expansion of consumer choice, rather than to limit it, as the GOP governors wanted.
Selection of Qualified Plans in the Exchanges. In a majority of states today, a small number of health insurance issuers dominate the market, sometimes offering only a single plan or product. In implementing their exchanges, states have the option to allow all insurers to participate in the exchanges (the Utah model), or they can be more active purchasers in shaping available choices (the Massachusetts model). Either way, the exchanges will stimulate broader competition, and consumers will end up with more and better choices.This is a pretty good setup. Sebelius is expressly making the Republicans choose between competition - which they so claim to be for - and their corporate benefactors, to whom their loyalty truly belongs. Then, she sets them straight on their demand that insurance company be allowed to continue their practice of selling junk insurance (which the law will end):
Essential Health Benefits. In today's market, many individuals and families have limited health insurance options available to them. The number and quality of options typically depend on applicants' age and health status, and employees of small businesses often have only a single choice. Exchanges will expand consumer choice and give consumers the information they need to comparison shop among their expanded choices. All plans in the individual and small group markets inside or outside of the exchanges - will provide essential health benefits, which, by law, will be modeled after what a typical employer currently provides today in the private sector. But the law and how states implement it allow a diversity of plan types and benefit designs in exchanges, and states continue to have the option to require coverage of specific, additional benefits.Note how well she not only knocks out the meme of "let people buy junk insurance!!!" but also makes the case as to why a set of federal minimum standards are needed. Obviously, states had all this time to fix the problem and make sure their citizens get good insurance and not a plan that covers everything except for what you need and when you need it. They have failed to ensure the health care safety of their citizens. The minimum standards are there to ensure that everyone has comprehensive coverage and that health care emergencies don't become the reason for people to lose everything they have worked hard to earn.
And of course, the Secretary is quick to point out, states retain every flexibility to hold their insurance companies to an even higher standard of accountability and consumer and patient safety by require them to provide more benefits. But not less. Sorry.
After this, Sebelius takes on the golden goose for the insurance industry and the Republican one-size-fits all solution to health care: high deductible health savings accounts (what, you don't have savings? Too bad. Eat cake.). In her response, she points out that consumers retain the flexibility to pay for a plan with higher cost sharing and lower premiums, but that they cannot be forced into this "bronze" plan as their only affordable option.
Consumer-Driven Plans. Low-cost, high-deductible plans, including those coupled with HSAs, are growing in popUlarity. The cost sharing limits required by the essential health benefits package mirror the current out-of-pocket maximum for HSAs under the Internal Revenue Code. Exchanges will offer new choices for consumers because health insurance issuers may offer a variety of plans with broad parameters; consumers who are willing to accept higher cost-sharing in exchange for lower premiums may purchase different levels of coverage. The "bronze" plans and catastrophic coverage for young adults will provide opportunities for expanding enrollment in consumer-driven plans coupled wi th HSAs. At the same time, exchanges will also improve consumer awareness ofoptions by making it easier to compare plans.Ouch. I don't think I could have said it any better.
Lastly, Sebelius makes clear the administration's commitment to publicly funded and publicly provided health care for the poor, and rejects the idea that states can just enroll Medicaid patients in private plans with expensive provisions and in the process rob Medicaid of both its popularity and funding.
Medicaid Flexibility. The Affordable Care Act expands and simplifies Medicaid coverage and provides states with more opportunities to align Medicaid with private health insurance. More specifically, the law permits states to restructure Medicaid coverage to look more like typical private employer coverage, as Medicaid managed care organizations and commercial insurers move into each other's markets and create new opportunities to enhance continuity ofcare across Medicaid and commercial populations.So the law already requires Medicaid to be structured so that it is more in line with private employer insurance benefits, but that's not enough for the Republicans. They want to take Medicaid patients and hand them over to the private industry, while also requiring no accountability for them. But, as Medicaid starts to look more like private employer insurance in terms of benefits but continue to cost a fraction of it, could the GOP gub's be worried that people will catch onto the fact that public insurance is far more efficient? Hmm.
By the way, as the governors continue their assault at the state level, Republicans in the US House are of course mounting their own offensive against the historic health reform law by trying to defund it. But this year many new benefits of the law are on track to come on board, and the administration is not waiting for a permission slip from Speaker Boehner, it seems. But if the GOP succeeded, here is what they would be eliminating just this year:
Anyone up for this? If not, we need to fight this effort. We need to do everything we can. At the state level as well as at the federal level.
- 10% Medicare pay bonuses for select primary care services provided by certain types of primary care physicians. The bonuses will be paid automatically on a quarterly basis and last through 2015.
- 10% Medicare pay bonuses for major surgical procedures performed by general surgeons who practice in designated health professionals shortage areas. The bonuses will be paid automatically on a quarterly basis and last through 2016.
- 50% reduction in pay for the second and following ultrasound, CT, or MRI imaging service(s) provided on a single date of service for the same patient.
- 50% discount on brand-name prescription drugs for Medicare beneficiaries who reach the Part D coverage gap.
- Medicare coverage of an annual physician visit so beneficiaries can develop a personal preventive care plan.
- The elimination of co-payments, coinsurance and deductibles for most Medicare-covered preventive services.
- The first redistribution of unused Medicare residency slots since 2003. The redistribution is scheduled to take effect on July 1 and could affect up to 1,000 slots.
Oh, by the way, as a parting thought, you know how much I have heard from the faugressive "professional" left in defense against this assault? What is that I hear, crickets? I stand corrected. Crickets are louder.