Perriello aims to end health insurance antitrust exemption
A major health reform bill sponsored by U.S. Rep. Tom Perriello, D-Ivy, is expected to come up for a vote this week in the House.
Perriello’s measure—co-patroned by fellow freshman Democrat Betsy Markey of Colorado—would repeal the health insurance industry’s antitrust exemption that has been on the books since 1945.
The Democrats’ two-page bill would “end special treatment for the insurance industry that allows them to fix prices, collude with each other, and set their own markets without fear of being investigated,“ a statement from Perriello’s office said.
In other words, Perriello’s bill aims to allow the federal government to investigate health insurance industry price-fixing allegations.
“It’s time for Washington to decide whether we stand with patients or profiteering, whether we believe in market competition or collusion between politicians and insurance monopolies,“ Perriello said. “It’s time to end the monopoly protections that Washington has protected for decades as prices skyrocketed. It’s time for a simple, clean bill—no carve-outs or special deals—that forces insurance companies to compete. It’s time to put patients and cost relief first. Americans deserve to know who stands with them against the price gouging of middle-class and working-class folks.“
The idea to remove the insurance industry’s antitrust exemption was part of the health care reform that narrowly passed the House in November. Perriello voted in favor of the health care bill, while Markey voted against it. The antitrust exemption removal was not included in the Senate’s version of the health care legislation.
The Democrats’ bill seeks to put forward one piece of health care reform that might win bipartisan support, rather than the comprehensive—and controversial—health care reform that appears to be stalled in Congress.
Reader Reactions
the answer is, YOU CAN. I buy private insurance as an individual. It is very limited because that is all I can afford. All I had to do was sign a document that stated I was aware that my plan does not meet the standards set for insurance in Va. (and it certainly doesn’t include chiropractic, as you say) Pretty simple. People that complain about being forced to buy insurance that covers too much generally are just repeating talking points they heard somewhere—and often get their insurance through an employer or the government, so they don’t have real experience in this arena. I can tell you from experience that over-insurance is not the problem.
I still pay a lot of money for my plan. The plan is so long and complicated, i really don’t know what it does and doesn’t cover. The list of exclusions is about 30 pages long. I pay over 200 dollars a month for this, just in the hopes that it might cover me if I get really sick—but really, I have no idea. I would feel much more confident if I had a plan approved by the State.
Re: Out of State Insurance
The difference in rates between plans which sound identical in Virginia and Pa. or NJ or Fl is the DETAILS. Each state sets their own insurance laws. This means whats covered. Chiropractic care, free shoes for diabetics, prenatal care, mental health, drug abuse, the list goes on and on of variations in state law regarding what MUST be included in the policy. These things affect prices. Why can’t I buy a policy from Alabama that doesn’t include chiropractic if I want? It costs less than the Virginia policy but it’s mandatory in Virginia, so I pay for what I don’t want. This applies to health care and auto insurance as well.
Interesting discussion. One ppint that has not been made. Insurance companies all choose the states in which they wish to do business. When any state (recent examples: Florida, California) starts believing that they can demand insurers to do this or to do that, the results, if not palatable to the insurance company, will simply be to pull out of the state and choose not to do business there. If you want to start moving toward a solution, first look to what is causing the problem: Your elected officials. They are the people passing the laws that allow all of this to take place. Wonder why? Look at the amount of money (bribes) accepted by the group. Our corrupt political system is the source of every single problem being faced in this country today. If you doubt that, provide me with the issue you believe that they haven’t caused.
“I have since left MJH, shortly after Y2K, but I don’t have any reason to believe that the financial folks there look to bury anyone in debt—if so, I’d like to hear about it. Not to say that you cannot rack up some pretty hefty charges, there, or anywhere”
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I agree, the individuals at MJH don’t want to bury anyone in debt. Nonetheless, in our current system, those that are uninsured and many more that are under insured DO get buried in debt. And you are right, most (after they go through their savings and sometimes lose their homes and jobs), don’t end up paying most of their bills. So, as you say, the hospital “writes it off”—Here lies a big problem with cost….those without adequate insurance don’t pay bills, the hospital treats them for free and “writes off the cost”—but then they have to make up for that huge loss by charging WAY more money for services…Those that pay have to pay much more to cover those that don’t pay….when doc’s and hospitals raise their rates to make up for all the unpaid bills, insurance costs a lot more. You have just laid out a very compelling argument for the individual mandate (i recognize their are valid arguments against it)
There is antiboyd giving poor advice to seniors, again.
Yes there is a Hunama plan with no monthly premium, but it does not include drug coverage. Then seniors have to buy there own drug plan which costs more then the $20 monthly premium. Now just why would anyone in their right mind suggest such a plan to a senior, when they can get both plans for zero dollars. Reputations mean alot, but someone here should just keep quiet, for they are certainly ruining their own reputation
There are 2 plans in this area which have no monthly premium and have drug benefits provided.
Cigna and Optima both have plans with no premiums and include drugs.
I like the Optima plan. One thing I liked was the cat scans, MRI’s, used the medicare 20% of negotiated rates.
I had a cat scan under Humana and I had to pay $125.00 co-pay. Had I been under the 20% medicare rate I would have had a co-pay of $84.00.
This is where the HMO’s are riping the public off. Some HMO’s have that flat co-pay which is higher then if someone were under medicare for the specialty items. They get the money from Medicare for the treatment, but make more money from the patient.
There is one other thing I like about the HMO’s. Medicare has a $900 co-pay for the first 5 days of a hospital stay. Wether in 1 day or 5 days. The HMO’s go by a schedule of about $200 per day up to 5 days.
This is another area they make their money. If someone goes in the hospital for 1 day, medicare still pays the HMO as if it was for 5 days. They only have to pay for the one day and pocket the rest.
Pasted below is the medicare.gov link for this area of Virginia.
Don’t believe antiboyd. anti’s advice has much to be desired.
http://www.medicare.gov/MPPF/Include/DataSection/ComparePlans/BenefitsAtAGlance.asp
Just to correct an error in fact. You can indeed get a Humana Advantage plan in Virginia that cost nothing. You can also get a plan that costs something. I have enrolled clients both ways. (Of course, Gordie will say that I am lying about this, because the facts contradict his assertion… but I cannot help that.)
What is true is that the zero cost Humana Advantage plan is available only at age 65 upon open enrollment. “Shopping” plans is not always a wise strategy, but it is your right.
Scottie, you are right that self-pay pays more… when they pay their bills, that is. As to what is fair, I guess that is dependent on one’s perspective. Plans do indeed “bargain” with health care providers. At one time, all was fee for service, based on cost, even Medicare. Then Congress changed the rules by which Medicare reimbursement was calculated… with the help of Harvard University, and the AMA. Later, managed care came along, and insurance companies, too, abandoned FFS, and reasoned that if Medicare could “negotiate” low rates, why not themsleves? So, let’s see, Medicare shifts costs over to private insurance, private insurance shifts costs to self-insured/uninsured, and providers write off what they cannot collect. At MJH, we wrote off all or part of many self-pay balances based on financial need; I have since left MJH, shortly after Y2K, but I don’t have any reason to believe that the financial folks there look to bury anyone in debt—if so, I’d like to hear about it. Not to say that you cannot rack up some pretty hefty charges, there, or anywhere.
As a client base, I have to say, self-pay is not a preferred class of patient. Okay, for non-elective care, perhaps. It is the stuff of urgent care centers and ERs. It is dangerous to generalize, but you are talking about a group that is notoriously non-compliant and difficult to treat. “Buying” healthcare is not—or should I say, should not be, an “AutoZone experience”. If you want quality care, develop a relationship with a quality caregiver. It is a harrowing experience to deal with health emergencies that have been years if not decades in the making, with inadequate history, and an (understanably) surly, impatient, demanding patients.
And, were we to have universal coverage, and were it affordable to all, self-pay would be moot. Wouldn’t exist.
Otherwise, I’ll let a physician, or a nurse, speak directly as to why they would prefer to take care of a patient under Medicare, or an insurance plan, at half the reimbursement. That is, sadly, the marlet place telling you how much they are loathed.
I have nothing good to say about Doctors who opt out of plan networks—that is, however, their choice, not the plans’. Every plan would like to have the participation of the largest network of providers. The reverse is not always the case. There are docs who are totally outside of Medicare and every other network. They do well.
Just as there are Fee for Service Financial Planners, who charge a bundle to clients, and restrict their practice to people with high net worth. Then there are guys like me who work without a fee, and provide services at no net cost to the consumer. What fairness has to do with any of it is beyond me.
Cato you make a good point that insurance companies add the the cost because of administrative overhead….however it is just factually incorrect that when I (or anyone) pays a doctor, lab, hospital etc out of pocket (without insurance) that they will charge less b/c of less paperwork. Those who pay their bills without insurance typically pay around twice as much as the insurance companies pay for any given procedure or appointment. Insurance companies have such a large pool of people that they are able to bargain the docs, hospitals and labs down on prices in exchange for their business. This is very unfair to the people paying out of pocket. It also limits the choices of people who have insurance, as the insurance companies only work within certain “networks” of docs and hospitals who give them cheaper prices in exchange for business.
It is not practical to have a system where the patient pays as they go. So there is $50,000 bill and the patient is suppose to pay that out of pocket.
That is not realistic at all.
It certainly would be helpful to see some type of study about health care is the problem.
From everything I have read, each system feeds of the other. To lay blame on one system in the health care debate is short sighted.
As one debates this issue don’t forget there is a patient in there with many complext issues and health. Issues that as one individual could never solve, unless all one does look at is pay or die.
While single payer is attractive, at least on the surface, depending on how it is enacted it would create either a monopsony or a monopoly, both of which are notoriously underperforming systems.
A solution that I did not see offered here would be to move away from an insurance-based system towards fee for service. After all, health insurance is a garunteed payout for the insurer in the long run, so he has every incentive to charge high rates, knowing that he needs to get his earnings in early before the client get to the point in life where is is frequently ill and becomes a money loser.
Most times, if one offers to pay a doctor directly, they happily oblige, and for less money than they bill the insurance company, as their paperwork and overhead just went down. In such a system insurance would be reserved for more catastrophic illnesses, perhaps with a high-deductible plan. Comments?
Let’s be sure to clear up one very important error in this article. Insurance companies do not set the premium rates that are charged in any state. Guess who does? Your state governement officials, in the form of your insurance commisioner. Secondly, the issue at hand is the cost of healthcare, not the cost of insurance. When the cost of healthcare goes down, so will the cost of insurance. This has been the national diversion provided by your elected officials. We have done absolutely nothing in the national debate to do anything about the cost of healthcare.
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