March 2010 Archives

Even before the ink is dry on the new health care reform law, stakeholders are jumping in with prescriptions for what more needs to be done -- both quickly and in the long term. Of course, opponents are already calling for repeal, and court challenges of the individual mandate are under way. Others would still like to see the physician payment formula fixed this year.

Whether you think the "what next" question means repeal or refinement -- or a long-awaited vacation -- how would you like Congress and President Obama to proceed?

7 responses: David B. Kendall, Jason Rosenbaum, Karen Davis, John C. Goodman, David Cutler, Drew Altman, J. James Rohack

Although health care reform is all but signed, many policymakers and health care experts see its enactment as only a first step in reforming the nation's health care system. While opponents threaten to challenge the individual mandate and other elements of reform in court, even many proponents acknowledge the legislation isn't perfect, and that this is really a starting point.

Now that health reform is a reality, what are your views of the package as passed by the House this weekend? What does it leave undone, and what should be the focus of change or adjustment moving forward? What is your single biggest priority or concern?

11 responses: Bruce Lesley, Darrell G. Kirch, Karen Davis, David B. Kendall, Jason Rosenbaum, Grace-Marie Turner, John Sheils, Grace-Marie Turner, John C. Goodman, Newt Gingrich, Rep. Pete Stark, D-Calif.

Is insurance company consolidation contributing to premium hikes? Would allowing the sale of insurance across state lines make matters better or worse?

HHS Secretary Kathleen Sebelius hammered insurance companies last week about large rate increases, and she listed as one factor reduced competition because of a surge in carrier consolidation. She pointed to a recent American Medical Association report, which found that, in 24 of the 43 states it examined, the two largest insurers had a combined market share of at least 70 percent. That's up from 18 states in the previous report. The AMA also studied 313 metropolitan markets against an index used by federal regulators to determine which markets are "highly concentrated," where insurer consolidation "may have harmful effects on patients, physicians, employers and the economy." The group found that 99 percent of metropolitan markets were "highly concentrated," up from 94 percent two years before. In 54 percent of the metropolitan markets, at least one insurer had a market share of 50 percent or higher, and that's up from 40 percent a year earlier.

Is this consolidation really a problem?

9 responses: Marilyn Werber Serafini, Marilyn Werber Serafini, Jason Rosenbaum, Sally C. Pipes, Paul B. Ginsburg, Tom Miller, Karen Ignagni, J. James Rohack, Uwe Reinhardt

How much should rising insurance premiums be attributed to profits, and how much blame does the industry deserve?

HHS Secretary Kathleen Sebelius continues to attack insurance carriers, while Karen Ignagni, the president of America's Health Insurance Plans, says the problem is a much deeper reflection of unsustainably high costs throughout the health care system.

Who's right? To what do you attribute these premium increases, and what's the answer?

Sebelius this morning faced off with Ignagni at the group's Washington meeting. Sebelius claimed she wasn't there to "vilify or blame insurance companies for all of the nation's health care problems," although her criticisms of the industry were severe. And Ignagni said her group would get back to Sebelius shortly with proposals to improve health reform legislation. Although the two were cordial to each other, the tone was very serious.

After Sebelius' remarks, Ignagni said her group would address several cost-related issues in its recommendations, including making sure that reform bills have more than "de minimus" penalties for failure to purchase policies, which she said would lead to an expensive market of mostly sick people. She said the industry also has ideas about rating bands. In addition, Ignagni wanted to discourage "Medicare cuts." Most academics, she said, are "realizing that the consolidation of the market is making it difficult to negotiate rates." She also wants to see proposals for pilot projects expanded to involve everyone. She added: "We need a failsafe, certification that if costs go up more than expected [in any part of the health care industry], something is done."

Here a full report here.

3 responses: Jason Rosenbaum, Tom Miller, Jason Rosenbaum

President Obama last week sent a letter to congressional leaders indicating his support for including $50 million to fund demonstration projects to test medical malpractice case alternatives such as health courts. HHS Secretary Kathleen Sebelius already has $23 million that she is preparing to hand out in grants for this purpose. Are health courts the solution to the nation's medical malpractice difficulties? What are the best ideas for solving the problem of defensive medicine, and how significant is defensive medicine to lowering health care costs in the country?

Obama wrote:

"My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded."

1 response: John C. Goodman