UPDATE: Because of the huge public outcry, Blue Cross has backed off on the policy.

As I think I've pointed out before, most of the Blues are considered to be "non-profit" in order to get certain privileges. But they are usually just parent companies for dozens of for-profit subsidiaries - with whom they contract over-priced services to earn nice, hefty profits.

We can expect more abuses (and more price inflation) if the insurance exchange makes the same mistake and treats them as actual non-profits:

One of the worst abuses of the private insurance industry is known as recission, where insurers decide to revoke the coverage of their customers for frivolous reasons. The Los Angeles Times reports today that one of the nation’s largest insurers, Blue Cross of California, has “notified [its] policyholders” that their coverage could be “immediately dropped” if they miss even a single payment:

Amid a national debate on how to make the healthcare system friendlier and more accessible, and as millions of people grapple with the loss of jobs and homes, what does insurance heavyweight Blue Shield of California do? It decides to take a key benefit away.

The company has notified individual policyholders that their coverage could be immediately dropped if they miss a single payment — or so it seems. Blue Shield says in a letter to customers that they can reapply for insurance, but with potentially higher premiums and stricter conditions.

Thankfully, a California law that mandates minimum grace periods and a decision by the company that will allow for a 28-day grace period will keep Blue Cross from immediately dropping people from coverage, as their letter threatens. The LA Times goes on to note that the the company’s pronouncement comes “after last year’s announcement that Blue Shield and Anthem Blue Cross agreed to pay a total of $13 million in fines after cancelling the policies of more than 2,000 Californians after they became ill.”

File this one under "Law of Unintended Consequences" and hope to God someone brings this to the attention of the relevant parties:

Where are the chips falling, so to speak, when it comes to the popular State Children’s Health Insurance Program (SCHIP)? The press ought to be finding out, and fast. Last week, the Children’s Defense Fund sent me an invitation for an informational call discussing SCHIP’s future: “If the Senate doesn’t take a stand for children in the next days or weeks, our worst fears could clearly come to pass.” The dire-sounding invite piqued my interest, especially since I had read in the House bill that SCHIP would be repealed. What was going on?

It turns out that the House indeed wants to repeal the program and require kids to get coverage via the insurance exchange, the government’s soon-to-be gigantic brokerage service. Their parents, of course, would be getting subsidies to help buy coverage, courtesy of the U.S. taxpayer. Rep. John Dingell, a Democrat no less, touted the advantages of dumping SCHIP. One advantage: the program wouldn’t be subject to the periodic and occasionally problematic Congressional reauthorizations that threaten its existence. Dingell said kids could have the same insurance as their parents—an incentive to force parents to cover their kids. (Sometimes parents, daunted by bureaucratic red tape, don’t enroll their children even if they are eligible.)

Another reason for killing SCHIP, some believe, is to force kids into the new exchange’s risk pool. Kids are usually healthy; bringing them into the pool may help spread the risk and keep premiums somewhat lower for the sick people whom insurers would have to cover.

But in return, kids would be hurt, says Alison Buist, director of child health at the Children’s Defense Fund. She told me that if the House provision were to take effect, kids might lose some valuable and comprehensive benefits now available to kids on Medicaid and SCHIP. If parents, strapped for cash, had to shop in the exchange, they might choose low-cost insurance with skimpy benefits and pay more out-of-pocket than SCHIP currently requires them to pay. SCHIP rules limit a family’s out-of-pocket costs to five percent of their income. States don’t even impose the five percent, Buist said, because they have found parents with low incomes couldn’t pay that much. So it seems that there’s a cost shift here—making poor families pay more so that sick (and most likely older) people buying in the exchange would pay less.

The more I see of this Frankenstein plan, the more I see we need single-payer universal coverage. Period.

John Aravosis uncovers an amazing nugget in TIME Magazine. Apparently, there are Democrats who saw Rep. Joe Wilson yell "You Lie!" at the President of the United States and thought, "that guy has a point." And they happen to be the ones writing the health care bill in the Senate Finance Committee.

The controversy over Republican Rep. Joe Wilson's shouting out "You Lie!" at the President over his claim that illegal immigrants wouldn't benefit from health-care reform apparently sparked some reconsideration of the relevant language. "We really thought we'd resolved this question of people who are here illegally, but as we reflected on the President's speech last night we wanted to go back and drill down again," said Senator Kent Conrad, one of the Democrats in the talks after a meeting Thursday morning. Baucus later that afternoon said the group would put in a proof of citizenship requirement to participate in the new health exchange — a move likely to inflame the left.

So many things wrong with this, starting with caving to an extremist. But it's worse than that on the policy end. The exchanges are just health insurance purchasing centers, like a Wal-Mart for insurance. You don't have to receive a subsidy to buy insurance on the exchanges; in fact, if your family makes over $88,000 a year, you can't be eligible for a subsidy, though you can still purchase there. What Conrad is saying is that he would make it illegal for a non-citizen to BUY something.

Not only that, but proof of citizenship laws, which we don't have in most states for voting, are onerous and disproportionately tilted away from the poor and the elderly, as well as potentially restrictive to legal immigrants with green cards, in this case. As the New York Times says today:

Should we take a harder line? Force people to prove citizenship in emergency rooms? That’s illegal, for good reason. Make verification requirements so onerous that not a single illegal immigrant slips through? Very expensive, and not smart. It would be highly likely to snag deserving citizens — like old people who don’t have their original birth certificates. And besides, we’ve tried that: A House oversight committee reviewed six state Medicaid programs in 2007 and found that verification rules had cost the federal government an additional $8.3 million. They caught exactly eight illegal immigrants.

In the case of an epidemic, like swine flu, should illegal immigrants go untreated so they can infect legal residents and American citizens?

Hard-line Republicans insist that they will fight for citizenship verification. They could, in theory, get the country to spend whatever it takes to do that and proudly report back to their voters. But there is a line beyond which antipathy to the undocumented can be damaging to those voters’ health, not to mention the federal budget. Mr. Wilson and his admirers seem to have crossed it.

Not to mention the fact that buckling to these demands will not get one Republican vote on any health care bill.

This is the Senate Finance bill, not the overall bill. But Democrats are so wishy-washy when it comes to, well, anything, that we actually could see this rotten, xenophobic, piss-poor policy in a bill supposedly designed to expand access to health care.

I know a lot of money has been flowing to Joe Wilson's opponent in 2010, but a far better use of those dollars would be to funnel them toward primary opponents for Kent Conrad and Max Baucus.

UPDATE: Conrad is now clarifying that there would be no federal subsidies, and requiring proof of citizenship would just be used to determine qualification for government assistance. Of course, you end up with the same problem, then; those without proper proof of ID would have trouble getting subsidies that could be available to them. The larger point is that there was no need to react to a teabagger yelling and screaming. This was already implicit in the bill, and allowed for the HHS Secretary to determine a best practice. This blunt instrument is not the way to do it, and makes Democrats look weak (but that's redundant).

UPDATE II: As this GAO report notes, checkpoint systems like Baucus and Conrad want were implemented under the Bush Administration to ensure undocumenteds didn't get on Medicaid, and for every $100 they spent, 14 CENTS in Medicaid savings were achieved. It's wasteful and spiteful!