From insurers? Read the fine print…

Among the positive signs for health reform this week was a New York Times article by Robert Pear, entitled “Health Insurers Offer to Accept All Applicants, on Condition.”

The news: the main insurance industry lobby is willing to support “guaranteed issue”–that everybody gets access to coverage–as long as there is an “enforceable individual mandate”–that everybody has to get coverage.

This isn’t a foreign concept to California health reformers: last year, most insurers were willing to consider such new rules for the individual market. But our biggest insurer, BlueCross (Wellpoint/Anthem), was opposed to any change. That the two trade groups, America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, have made this statement, etiher suggests there is movement… or they are trying a different tactic.

Some, like Jonathan Cohn of The New Republic and Ezra Klein of The American Prospect, say that guaranteed issue also needs to include community rating: the notion that insurers cannot just deny you for your health status, but cannot charge you differently either. It’s an important point, and AHIP is silent, at best, on the issue.

Health Care for America Now makes a broader point:

“The leading insurance industry representative, America’s Health Insurance Plans, came out and said they would stop denying people coverage due to pre-existing conditions. Of course, what they didn’t say tells the real story:
* They said nothing about lowering their prices so working families can afford their insurance.
* They said nothing about reigning in their bureaucracy, designed to find ways to deny you the care you’ve paid for.
* They said nothing about cutting the multi-million dollar salaries they pay their
CEOs, while they charge working families skyrocketing premiums.
Click to send a message to AHIP.

To reemphasize the point: During our health reform debate in California last year, we recognized in order to force consumers, even a small percentage, to buy in the individual market, you needed to do a lot more than guaranteed issue to make that situation hospitable for consumers.

We actually issued a short chart, called “Beyond Guaranteed Issue: Many Consumer Protections Needed in the California Individual Insurance Market,” showing what protections Massachusetts already had in place, and some they needed to add, and California frankly needed even additional reforms. From rate oversight to better defined benefits, from a medical loss ratio to a public plan option, there’s a lot more to do to make the individual market even workable enough for consumers. And AHIP seems to be still opposed to those reforms.

Health Access California promotes quality, affordable health care for all Californians.
VIEW THE FILE Individual Mandate

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