Health Plan Lobbyists suggest States 'Guarantee Access' to Potentionally High-Cost Individuals

The New York Times reports (via Health Blog) that the America's Health Insurance Plans (AHIP), the industry's trade association and lobbying force, wants to help individuals with pre-existing medical conditions find health insurance coverage.

The AHIP proposal is titled 'Guaranteeing Access to Coverage for All Americans.' Highlights of the proposal include:

• States should create Guarantee Access Plans to provide coverage for uninsured individuals with the highest expected medical claims costs (greater than 200% or twice the statewide average.) Premiums would be limited to 150% standard market rates.
• Health plans will guarantee coverage to all applicants who are not eligible for the Guarantee Access Plan....up to a predetermined level of participation (for example, 0.5% of the health plan’s insured population in the individual market). Premiums would still be limited to 150% standard market rates.
• Health plans should limit any rescission actions to those based only on information that should have been included in a complete and accurate response to questions asked in a clear and understandable application. [Got that? If the questions are clear and understandable, rescission actions are still an option.]
• Health plans should waive the application of pre-existing condition exclusions for medical conditions that are disclosed by the applicant (unless subject to a rider). [So if coverage is subject to a policy rider, the pre-existing condition exclusions stand.]
• States should provide consumers with access to a third-party review process to resolve disputes involving medical issues related to pre-existing condition exclusions and rescission decisions. [We don't want to be bombarded with disputes to resolve. Let the state take care of that.]

“We are taking responsibility for ensuring that no one falls through the cracks,” said Karen Ignagni, CEO of AHIP, which is based in Washington. “We are providing essentially a coverage safety net,” she said.

Within the proposal, it is recommended that in order the maintain affordability, states will need to:

• Allow health plans to offer features such as:

Pharmacy programs that promote both value and safety [American produced generics];

Disease management, preventive, and care coordination programs that bring evidence-based care into everyday practice [lots of calls from DM folks who specialize in keeping costs down for the insurance company by discouraging costly ER visits and unnecessary trips to see the doctor]; and

New benefit design and payment incentives that reward quality and value [if you choose to use your coverage the way we want you to and see the practitioners we feel provide greater value, it might cost you less in out-of-pocket expenses].

• Create a sliding-scale premium subsidy program with additional assistance for those with high health care costs.
• Fund the Guarantee Access Plans from a broad base of sources, so that coverage remains affordable for those who are currently insured. [That's it states....go find the money while we take care of the less costly customers].

In the Times, the trade association declined to provide any estimates for the cost of its proposals. But executives argued that this approach was not so ambitious as to make it out of reach.

“It won’t break the bank,” said Mr. Gellert.

Whose bank won't it break?

With President Bush insisting that individuals must not be given incentives to leave private coverage and with disagreement as to what constitutes low-income, middle-class, and affordability, America's Health Insurance Plans wants to be viewed as the good guys while they provide the guidelines to justify their position in NOT PROVIDING COVERAGE TO THOSE EXPECTED TO BE MORE COSTLY TO COVER.

Unbelievable!!!

UPDATE: And if you don't believe me, go read what Dr. Wes has to say. Bravo!