Wendell Potter states the obvious in his new book, "Deadly Spin" -- namely, that insurance companies really, really want the individual mandate. They just want those pesky consumer protections gone:

It is ironic, of course, that the requirement to purchase insurance has become the centerpiece of Republicans’ condemnation of the new law and their court challenge of its constitutionality. Insurers have no reason to worry, however, because they fare very well when the Republicans are in charge. Their profits soared—as did the number of Americans who are uninsured and underinsured—during the Bush years and Republican control of Congress.

The real reason insurers want the GOP leading Congress again is not to repeal “Obamacare,” but to try to gut some of the provisions of the law that protect consumers from the abuses of the industry, such as refusing to cover kids with preexisting conditions, canceling policyholders’ coverage when they get sick, and setting annual and lifetime limits on how much they’ll pay for medical care. Insurers also hate the provision that requires them to spend at least 80 percent of premium revenues on medical care, as well as the one that calls for eliminating the billions of dollars that the government has been overpaying them for years to participate in private Medicare plans. (Be on the lookout for a death panel–like fearmongering campaign to scare people into thinking, erroneously, that Granny and Pawpaw will lose their government health care if Congress doesn’t restore those “cuts” to Medicare.)

Insurers are not waiting for all their new members of Congress to be sworn in to get what they want. They and their big-business allies are already pressuring the Obama administration to waive or delay the implementation of provisions they don’t like, all the while working behind the scenes not only to protect the individual mandate but to have the government enforce it with much greater gusto. The one thing the industry didn’t like about the mandate provision was that the penalties for not buying their overpriced products won’t inflict nearly enough financial pain.

Retiring Sen. Judd Gregg (R-N.H.), who once had been a part of the repeal-and-replace brigade, provoked the wrath of conservative pundits shortly before the midterm elections when he said, in a moment of unguarded candor, that repealing the law was not realistic. Instead, he said, the GOP should focus on “retooling” it. You can be certain that insurance-industry lobbyists will be helping their newly expanded congressional caucus determine what needs retooling. As my former Cigna colleague Bill Hoagland, the company’s top lobbyist, told the As-sociated Press a few days ago: “If you ended up repealing [the individual mandate], the whole thing blows up. It doesn’t work. The cost would explode.” In other words, feel free to repeal those pesky consumer protections, but keep your hands off our mandate.

They didn't use those words, but that's what they're saying, nevertheless. There are two principles at stake here: First, that discrimination against sick people is a thing of the past; and second, that the days of cherry-picking insured groups are over.

Either insurance companies can get on board, or else they are begging for Lynn Woolsey's newly-revived public option to become the law of the land. They certainly appear to be crying out for one. Here are a couple of stories that prove the point:

Insurers stop writing policies for children

This story could likewise be headlined "Insurers throw hissy fit, kick and scream on the floor, choose those least able to defend themselves as targets."

Nothing screams public option like screwing kids. Via MSNBC:

Some major health insurance companies have stopped issuing certain types of policies for children, an unintended consequence of President Barack Obama's health care overhaul law, state officials said Friday.

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Clearly, passing this health-care bill is just the beginning, because it doesn't really contain strong regulatory powers. It was pulled under reconciliation rules, and Obama reportedly will try to introduce it later:

WASHINGTON -- A Democratic plan for new federal power over health insurance rates was dropped Thursday from the final health care bill, squeezed out by the way the Democrats are pushing the bill through Congress.

Rolled out with fanfare just weeks ago, the Democratic plan was a response to double-digit rate increases proposed by health insurance companies in California and elsewhere.

It was first proposed by Sen. Dianne Feinstein, D-Calif., then picked up by President Barack Obama.

It would have given the federal government the power to reject proposed rate increases. It also would have allowed the secretary of health and human services to order insurance companies to give back part of premiums if the government decided that the companies spent too much of their incomes on salaries or advertising.

Health care reform has moved from being a bill to being a law. Part of the law is this: Insurers may no longer exclude children under age 18 for a pre-existing condition.

Insurers raise their middle finger to us and say, "Well, that's not exactly what the law says. As we see it, we may have to stop excluding children's conditions in situations where we already cover them for other medical needs, but there's nothing saying we have to issue new policies."

Yes, this is what they are arguing. The ink is not dry on the law yet, the reconciliation bill has not even been signed into law yet, but that doesn't matter to these beasts. It is their plan to be dragged kicking and screaming into the 21st century clutching their teabags, whining and dragging their feet at every turn.

From the New York Times:

Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.

First, this doesn't affect policies covering children under group insurance provided by an employer, because the law clearly uses the words "shall continue to provide" with regard to those dependents.

This particular argument would apply to someone applying for insurance for their child as an individual policy.

Second, there is absolutely no question that the intent (or what is generally called the "spirit of the law") is for pre-existing conditions exclusions to be ended THIS YEAR for ALL CHILDREN under the age of 19. Period.

With legislation this broad, there will always be areas where either a technical correction is needed or a regulation. It's likely that a regulation will suffice to create the clear bridge from no exclusions to guaranteed issue. Frankly, if insurers think it's a good idea to continue to thumb their collective noses at the Congress and President of the United States by either creating or inventing loopholes, they're likely to find themselves without any leverage and little voice in what their future regulatory environment will look like.

They know the spirit and intent of the law. They think they've found a loophole to exploit for PR gains only, since clarification will be forthcoming:

A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.

One thing is guaranteed: Picking on children and finding excuses to let them linger with illnesses that either bankrupt their parents or force them onto state Medicaid rolls is not going to make them more popular in Washington, nor with the general public. When insurers exclude newborns with heart defects requiring immediate surgery, it doesn't play well in the news. This is what they will no longer be able to do, and what they've come to expect they are entitled to do anyway.

We are watching one of the most powerful lobbying machines in the United States squeal in anger at its defeat. It's likely to squeal louder before it is vanquished entirely or dies a natural, long overdue death.

Update 4:10pm HHS Secretary Kathleen Sibelius confirms that regulations will require all insurers to cover children AND issue new policies to children regardless of pre-existing conditions.

"To ensure that there is no ambiguity on this point, I am preparing to issue regulations in the weeks ahead ensuring that the term 'pre-existing condition exclusion' applies to both a child's access to a plan and to his or her benefits once he or she is in the plan," the secretary added.

Co-author Rep. Tom Perreillo (D-VA) to Insurance Companies: "Be afraid, be very afraid..."

A positive step in the right direction:

By a vote of 406-19, the House passed the Health Insurance Industry Fair Competition Act (HR 4626), introduced by Reps. Tom Perriello (D-VA) and Betsy Markey (D-CO). This bill is designed to restore competition and transparency to the health insurance market – by repealing the blanket antitrust exemption afforded to health insurance companies by the McCarran-Ferguson Act of 1945. Under this legislation, health insurers will no longer be shielded from legal accountability for price fixing, dividing up territories among themselves, sabotaging their competitors in order to gain monopoly power, and other such anti-competitive practices.

Over the last several years, the health insurance industry has become increasingly concentrated–giving consumers fewer and fewer meaningful choices in shopping for health insurance. According to a recent study by the AMA, there have been more than 400 mergers among health insurers in the past 14 years. [..]

This bill is also necessary because, over the years, health insurers have been able to use this antitrust exemption to block court actions regarding anti-competitive behavior. In Ocean State Physicians Health Plan, Inc. v Blue Cross & Blue Shield of Rhode Island, the First Circuit Court – citing the McCarran-Ferguson antitrust exemption – overturned a jury verdict against the dominant health insurer for using its monopoly power to put financial pressure on area employers to refuse to do business with a competing HMO.

There is also evidence that removing this antitrust exemption will result in lower prices and other benefits for consumers. Time and time again, increased competition results in lower prices, increased choice, and greater innovation. A healthy and competitive health insurance market will drive prices down in the health insurance industry, just as we have seen it do in so many other industries where competition is allowed to take hold. Since California passed a law in 1988 that eliminated the state antitrust exemption for the auto insurance industry, for instance, auto premiums for consumers in California have risen by 9.8% while the rest of the country has seen auto premiums rise by over 48%.

An incremental victory, to be sure, but a victory nonetheless. I like what Nancy Pelosi had to say:

The House of Representatives, Mr. Chairman, is called "The People’s House." Today, we live up to that name. By passing legislation that increases leverage for the people by changing the playing field, a playing field that has been dominated by the insurance industry for over 65 years and now it’s the people’s turn. The insurance companies will now be playing on the people’s field.

Rep. Anthony Weiner had the money quote, however, as captured by Think Progress:

You guys have chutzpah. The Republican Party is the wholly owned subsidiary of the insurance industry. They say this isn’t going to do enough, but when we propose an alternative to provide competition, they’re against it. They say we want to strengthen state insurance commissioners and they’ll do the job. But when we did that in our national health care bill, they said we’re against it. They said we want to have competition but when we proposed requiring competition they’re against it. They’re a wholly owned subsidiary of the insurance industry. That’s the fact!

Love it! Of course, there are a couple of senators in the Democratic caucus that we can say the same thing about. I'm looking at you, Ben Nelson and Joe Lieberman.

This will be controversial, to say the least. I wonder on what legal grounds this will be asserted - and how long it will be before the insurance companies lobbyists stop it. (I also wonder why he didn't support the public option, which would have been less directly interventionist than this, and thus, less politically risky.)

You can read the details here:

President Obama will propose on Monday giving the federal government new power to block excessive rate increases by health insurance companies, as he rolls out comprehensive legislation to revamp the nation’s health care system, White House officials said.

[...] The president’s bill would grant the federal health and human services secretary new authority to review, and to block, premium increases by private insurers, and it would create a new Health Insurance Rate Authority, comprised of health industry experts that would issue an annual report setting the parameters for reasonable rate increases based on conditions in the market.

The legislation would call on the secretary of health and human services to work with state regulators to develop an annual review of rate increases, and if increases are deemed “unjustified” the secretary or the state could block the increase, order the insurer to change it, or even issue a rebate to beneficiaries. States would be eligible for a portion of $250 million in grants to finance premium review and approval.

The new rate board would be composed of seven members, including consumer representatives, an insurance industry representative, a physician, and other experts such health economists and actuaries, the White House said. The board’s annual report would offer guidance to the public and states on whether rate increases should be approved.

The corporatist-friendly RAND think tank issued a 2004 report on a similar proposal in California, warning of unintended consequences:

This issue brief evaluates why health insurance premiums are rising and examines the potential long-term consequences of regulating premium costs, using examples from other insurance products such as automobile coverage and workers compensation. The findings underscore that if health care costs continue to rise while premiums are frozen, stringent rate regulation could lead to undesired consequences. These include:

* In the short term, insurers could balance their losses by reducing the quality or quantity of care -- or both.

* Insurers could discourage unhealthy consumers from enrolling in plans, thus increasing the number of uninsured over time.

* If costs continue to rise and premiums are fixed, insurers may exit the market entirely.

* Over the longer term, regulation could discourage expensive treatments and technologies, no matter how beneficial, from coming to market. (A desirable related consequence is that premium regulation could motivate the introduction of cost-saving technologies.)

Recently the Senate passed Sen. Barbara Mikulski's Women's Health Amendment, which requires health insurance companies to provide free mammograms and other preventive health services for women. Sounds good, doesn't it? Women's health needs have traditionally been underserved by the insurance system. But, ironically, the Senate's excise tax will force many women to pay indirectly for these "free" services.

Here's how: For one thing, the cost of the services mandated in the Mikulski Amendment will cause even more health plans to exceed the cost cap for the excise tax. And it's expected that 20% of plans will already be over the limit when the tax takes effect. In practical terms, any added costs for new services provided by these plans (like those mammograms) will be taxable. So, in one very real sense, the Senate plans to tax some of this preventive care for women - at a staggering 40% of cost.

The Mikulski Amendment looks like a step forward, but many women will pay for these services indirectly - in the form of higher premiums or increased out-of-pocket costs. One hand giveth and the other taketh away. And speaking of irony ...

Guess who voted for the Mikulski amendment? Some Senators who haven't even committed themselves to voting for the final bill, including Lieberman, Landrieu, and Snowe (who even cosponsored the amendment. Here's an idea: They can make sure these women's services really remain "free" by supporting the Sanders-Franken-Brown Amendment, which would replace the excise tax with a tax on the extremely wealthy (the way the house does it.)

That would remove the irony in the Senate's actions and replace it with fairness.

Steve Benen with the story about the Republican plan to obstruct health-care reform:

We learned yesterday that Sen. Judd Gregg (R-N.H.) has distributed a three-page memo to his Republican colleagues, reminding them of various procedural tactics they can utilize to obstruct, delay, and undermine the debate on health care. Sam Stein called it "the equivalent of an obstruction manual -- a how-to for holding up health care reform."

This morning, Senate Majority Leader Harry Reid (D-Nev.) seized on the document: "The good news is that Senate Republicans finally, at long last, have put a detailed plan down on paper. The bad news is that it's not, as we'd hoped, a plan to make health care insurance more affordable; it's not one to make health insurance companies more accountable; and it's certainly not a plan to reverse rapidly rising health care costs and draw down our deficit.

"The Republican plan we've waited weeks and months to see ... [is] not even about health care at all. The first and only plan Senate Republicans could be bothered to write up is an instructional manual on how to bring the Senate to a screeching halt. We knew that was happening anyway, but they had the audacity to put it in writing."

The Democrats are finally starting to take a look at changing procedural rules.

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For the second day in a row (Monday's show being so chockful o'wingnuttery that we didn't have time to post on it) Glenn Beck devoted two whole segments to the subject of net neutrality.

And for the second night in a row, the discussion featured a guy named Phil Kerpen from Americans For Prosperity, which has a long history of shilling for whatever right-wing corporate agenda it can suck out money for: tobacco interests, health-insurance companies, corporate polluters have all pitched in money so that AFP can variously promote tobacco, lobby against health-care reform (it was one of the original promoters of the Tea Parties) and push the idea that global warming isn't really happening.

And now he's out pushing the notion that somehow, regulating Internet providers so that they cannot determine or limit public access is the same thing as communism. Or something like that. When you have Glenn Beck as your No. 1 cheerleader, logic doesn't actually have to enter into it.

Especially not facts. Because Beck appears to have no idea at all what Net Neutrality is actually all about.

As Timothy Karr explained on Democracy Now last month:

And net neutrality is really the fundamental openness principle of the internet. Whenever you connect to the internet, net neutrality makes sure that you can connect to everyone else who’s on the internet. And this has been a tremendous engine for free speech, for economic innovation, for equal opportunity. And we are now fighting with some very prominent internet service providers, very powerful companies, to try to preserve that fundamental openness, so that whenever we go online we can choose, as users, where we go and what we do via the internet.

Somehow, Beck is able to transform this into an attack on "freedom of speech" -- when it obviously is precisely the opposite.

To guys like Beck, you see, the only threat to our liberties is from the government. Giant corporations that control our means of information, not so much.

Indeed, his argument boils down to a simple proposition: "Freedom" means letting powerful business interests control the public's access to the internet.

Hm. That's some kinda freedom.

ThinkProgress has more:

Continue reading »

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