NN&I - July 2010
Health Care Beat 14 Nephrology News & Issues July 2010Subscribe to our free eNewsletter at www.nephronline.comHealth care reform still formingBy Thomas KeatingPresident Barack Obama gave a speech from the Oval Office June 15 to address America about the ongo -ing BP/Deepwater oil spill crisis in the Gulf of Mexico. One day earlier, Obama addressed another problem in the United States that also requires gov -ernment involvement to plug an ever- spewing system: health care. When Congress passed the health care reform bill March 23, its aim was to expand access to coverage by set -ting up competitive insurance markets, provide tax credits for many who can't afford premiums now, mandate that most Americans carry health insur -ance, and bar insurers from turning away people in poor health. But the "reforming" part wasn't close to being finished. Most of the aforementioned core provisions don't take effect until 2014, and regulation writers at the Department of Health and Human Services are filling in blanks that law-makers left on critical consumer issues, such as guaranteed coverage for chil -dren with health problems. A House Democrat has introduced legislation to let federal employees keep young adult dependents on the government health plan this year, instead of making them wait until January. On June 14, the American Medical Association's 2010 National Health Insurer Report Card was released, which found that 20% of U.S. medical claims annually are processed inaccu -rately by health insurers, resulting in an estimated $777.6 million in unnec-essary administrative costs. Currently, the health care system spends as much as $210 billion annually on claims processing. Meanwhile, the National Association of Insurance Commissioners, represent -ing state officials, says the government should take steps to prevent disruption of the individual insurance market. Specifically, the group is drafting a recommendation that urges the gov -ernment to allow a gradual three-year transition in states where the new requirement, which takes effect Jan. 1, could destabilize the market. Without a transition, insurers "may cancel individual policies, if the terms of the policies permit cancellation, and cease offering these plans," says a document prepared by the associa-tion. "This potential withdrawal could have a severe impact on the currently insured, who would lose their policies, and could also limit the choices avail-able to prospective purchasers." The law will require many insur -ers to spend a larger share of their premium revenueat least 80%on medical care (and quality improvement activities), rather than administration, expenses, and profits. Insurers must refund money to consumers if they do not meet the standards, known as medical-loss ratios. According to The New York Times, which used annual statements filed by insurers, the association has compiled a database of more than eight million people who have individual coverage from more than 400 insurers. Nearly half of these policyholders had cover -age from about 70 insurers whose loss ratios were less than 75% in 2009. The Obama administration also had a message June 14 for employers who want to keep federal bureaucrats from rewriting the rules for their company medical plans: Do not hike up costs for workers, and you will not have to worry about interference from the new health care law. "What we don't want is a mas- sive shift of costs to employees," said Health and Human Services Secretary Kathleen Sebelius. And for those individuals who want to keep the health insurance they already had? Regulations released June 14 will help determine which people who like their health plans will be able to keep them once the health overhaul takes full effect, The Washington Post reported. The regulation on "grandfa -thering," or exempting existing health plans from certain requirements, will mean an individual plan could offer more benefits, and it could cost more. The law lets administration regula -tors determine what changes to plans employers could make without losing the exemption. Every day, another player fights for their well-being and every provision of the bill gets analyzed. Everybody is trying to get their fingerprints on the piece of pottery as it's being formed. And it could be years of this spinning around until the clay hardens. Mr. Keating is NN&I's managing editor. HCB_NNI0710_2.indd 14 6/16/10 1:36:01 PM
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