Will the Lobbyists Make Meaningful Health Care Reform Impossible?

Maggie Mahar joins us today. She responds to a recent post here by Brian Klepper. Brian argued that health care reform will be a very difficult thing to do in the near term. At the top of Brian's concerns is the the impact lobbying money has on the ability of the Congress to achieve real reform. While Maggie agrees that special interest money is a big factor, she argues there are other reasons to

State High Risk Pools For the Uninsured--Who Would Want To Be In Them?

What do we do with people who are uninsurable because they have a pre-existing medical condition?That is a particularly important question as both McCain and Obama propose reforming American health care by building on the private health insurance system.One of the solutions being discussed--by McCain among others--is to use state-based risk pools. Under McCain's plan heavily dependent on an

Required Reading for Health Care Analysts and Coventry Health's "Sort of" Informative Conference Call

Joe Paduda, writing over at Managed Care Matters, has a post any health plan investor should read.He laments that the analysts just weren't asking the right questions and weren't tough enough during last week's Coventry Health earnings call.With my 35 years in the health insurance business, I have to agree with him. He's dead on.Beyond Joe's comments, I noted that management used the precise term

If McCain Picks Romney He Will Never Again Be Able to Criticize Obama's Health Plan

Mitt Romney seems to be at the top of the list when it comes to speculation over who John McCain will pick for his vice presidential running mate. I am not sure if that is what John McCain is thinking as much as the Romney people, trying to boost their guy, want us to think.But if McCain picks Romney, it will make for an interesting health care debate this fall.The Obama Health Plan is a virtual

The End of Medicare Private Fee-For-Service--the Questions to Ask the Health Plans During Earnings Season

Now that we know private fee-for-service (PFFS) is dead on January 1, 2011 in all but the most rural markets, how will the health plans who have significant PFFS business respond?UnitedHealth is the first health plan to report earnings this quarter and I thought they had the right answer. From their earnings call transcript (Ovations CEO commenting):We have had a strategy of deliberately

Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?

Our good friend Brian Klepper joins us after a bit of a summer break. This time he examines the dynamics of health care reform and questions just how optimistic we should be that progress will be made.Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?By Brian KlepperThose who wait, ever hopefully, for real health reform might want to take a deep breath and take stock of a few

Health Insurance Industry Stupidity—It’s a Rout From Here On Out

Why the health insurance industry allowed itself to be put in the place they were put by the Democrats yesterday is beyond me.With the Senate voting 70-26, and the House 383-41, to override President Bush’s veto of the bill to erase the 10.6% Medicare physician fee cut and pay for it with changes that will end the Medicare private fee-for-service program in 2011, the health insurance industry’s

The National Coalition On Benefits' Oppostion to the Wyden-Bennett "Healthy Americans Act"--Maybe They Like It After All?

The National Coalition on Benefits is a group of more than 150 of America's biggest corporations as well as the U.S. Chamber of Commerce and the Business Roundtable.They wrote a letter to Senators Ron Wyden (D-OR) and Bob Bennett (R-UT), cosponsors of the bipartisan "Healthy Americans Act," telling them that their bill was a non-starter because it dared to mess with ERISA. The Wyden-Bennett bill

Underwriting Cycle or Medical Trend Rate Cycle?

Analysts trying to predict the future of the health plan business who are looking for an underwriting cycle will miss the real turns in the market.Recent health plan earnings issues have once again raised the question, do we still have an underwriting cycle, and are we entering one?In my mind, anyone trying to understand the profitability of the health plan business who concentrates on whether or

"Wall Street Comes to Washington"

The event I look forward to every year is "Wall Street Comes to Washington," Paul Ginsburg's (Center for Studying Health System Change) annual merging of Wall Street and policymakers in a lively discussion of health care from both perspectives.The last few years I have gotten to participate on the health insurance market panel. The session also had a panel concentrating on hospital, physician,

The Next Medicare Physician Fee Cut--17 Months, 20 Days, and 13 Hours to Go

The "Medical Home"--A real Solution?Now that this year's fight over Medicare physician fees is all but over, it is important to turn to real solutions.The recent Senate and House vote to kill the 10.6% physician fee cut only defers the problem for 18 months.On January 1, 2010, the Medicare physicians are slated to get an automatic 21% fee cut!More importantly, the Medicare physician fee structure

Senate Votes 69-30 To Rescind Medicare Physician Fee Cuts and Cut Medicare Advantage to Pay For It

Ted Kennedy came to the Senate floor and led Senate Democrats to an amazing victory in their first real attempt to rein-in private Medicare spending and rescind the 10.6% physician fee cuts.The veto-proof margin puts President Bush's threat to veto the Senate bill, that was approved by the House on another veto-proof 354-59 vote just before the holiday, in doubt. Why bother?I was not surprised to

So I Guess the HMOs, U.S. Chamber of Commerce, Business Round Table, and Over 150 Big Corporations Are Opposed to McCain's Health Plan?

That's the only conclusion I can come to after having read the letter the National Coalition on Benefits has written to the authors of the Wyden-Bennett Healthy Americans Act.Wyden-Bennett is a comprehensive health care reform proposal that would largely replace the existing employer-based system of health insurance with one based on individual responsibility and individuals purchasing coverage.

State of California "Fearful" of Enforcing $1 Million Fine Against Wellpoint/Anthem Blue Cross for "Illegal" Health Insurance Policy Rescissions

Crazy as it sounds an AP story on Thursday reported that the California Department of Managed Care "didn't even try to enforce a million-dollar fine against health insurer Anthem Blue Cross because they feared they would be outgunned in court."Last year the department announced that it would fine the insurer for improperly rescinding individual heath insurance policies in the midst of the

What Do We Need to Do to Fix the Medicare Physician Payment Problem?

Whenever the subject of Medicare physician fee payments comes up on this blog, the reaction from physicians, particularly primary care docs, is predictable: "You can't cut us, we haven't had a Medicare raise in years, we are already dramatically underpaid, and if Medicare cuts our payments we are going to stop taking Medicare patients."There is no doubt that doctors have a point--particularly the