Speaking at the Michigan Business and Legislative Forum this morning, Rep. Mike Rogers (R-MI) suggested that health care reform would lead to more breast cancer deaths:
But let me tell you, are we willing to give up that system? Are we willing to have more breast cancer deaths in the United States with this system, to get the 30 million people, which is really means only 18 million people who don’t have coverage. At a $1.8 billion, trillion dollar deficit. That’s the equation we have to ask.
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Rogers, who repeatedly mentioned that he had read the entire House health care bill, argued that the House reform legislation would allow the federal government to use the results of comparative effectiveness research to ration costly treatments.
In reality, the bill authorizes Secretary of Health and Human Services to establish a Center for Comparative Effectiveness Research to “conduct, support, and synthesize research…with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures,” but prohibits the government from applying research findings to coverage decisions. Page 524 of the legislation:
Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.
Of course, Rogers may have found that part of the bill to be boring. “So if you read this thousand page bill — by the way, which they gave us about 12 hours to do and it got riveting right about page 860. Fantastic! Little plot twist in there,” he joked at the event.
During today’s Michigan Business and Legislative Forum, which the Wonk Room attended, a representative of Blue Cross Blue Shield of Michigan admitted that insurers could circumvent the market regulations proposed as part of health care reform.
In answering a question about insurer market share, Mark Cook, Vice President of Governmental Affairs at BCBS Michigan, criticized for-profit insurers for maximizing their profit margins by only covering the healthiest and youngest applicants. “[I]f you have a business model that basically says, ‘I’ll take 25-year-olds until they get sick.’ That’s a great business.”
Cook conceded that health reform would not eliminate such risk selection. In a separate conversation with the Wonk Room, Cook agreed that that despite industry concessions to accept applicants with pre-existing conditions, existing health reform measures would not prevent insurers from designing benefit packages that excluded sicker populations:
WONK ROOM: I’m just wondering in terms of designing benefit packages the standards in the bill, at least the ones I’ve seen, at least the Baucus ones are actuarial standards, so you can design packages that kind of hide packages behind high deductibles, things like that.
COOK: Yeah I suppose there could be some , um, some industry folks could take, how do I want to put this? Could take, um, a low benefit design and try to market it heavily to a young, healthy population or something like that.
WONK ROOM: Right, you can design packages that attract different pools, right?
COOK: I suppose there could be some gaming that goes on around that if that is the design that ends up happening.
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The Baucus bill requires insurers participating in the Exchange to offer plans in four different tiers. Each plan would have to meet a different actuarial-value. In the silver tier, insurers would have to cover 73% of the health care expenses of an average population; the remaining 27% would be picked up by individuals.
But Sarah Lueck at the Center on Budget and Policy Priorities warns, and Cook seems to agree, that “an actuarial-value standard on its own” would not prevent insurers from designing packages that would attract healthier applicants and deter “enrollment by those in poorer health.” “For example, insurers could offer a benefits design that omits or severely limits services needed by people with serious medical conditions, while offering richer benefits in other areas such as vision care or health-club memberships. In that way, an insurer could meet an actuarial standard while designing a package calculated to deter sicker people (by failing to cover basic services they need) and attract healthy ones.” Insurers could offer cheaper preventive services without any cost sharing but cover more expensive services only after a high deductible is satisfied.
As former health insurance executive Wendell Potter explained in an interview with ThinkProress, insurers would “like to move us all into high deductible plans.” “[The would like to] have high deductibles that we would all have to meet and or [move us] into these limited benefit plans that are very skimpy and don’t cover you, don’t cover what you need. That way, when you do get sick, they’re not on the hook to pay you anything. They would love to have you enrolled in these.”
