New Health Insurance Rules Would Let Consumers Compare Plans In “Plain English”
What would your health insurance cover if you got pregnant? How much could you expect to pay out of pocket if you needed treatment for diabetes? How do your plan’s benefits compare with another company’s?
Starting as soon as March, consumers could have a better handle on such questions, under new rules aimed at decoding the fine print of health insurance plans.
Regulations proposed by the Obama administration on Wednesday would require all private health insurance plans to provide current and prospective customers a brief, standardized summary of policy costs and benefits.
To make it easier for consumers to make apples-to-apples comparisons between plans, the summary will also include a breakdown estimating the expenses covered under three common scenarios: having a baby, treating breast cancer and managing diabetes.
Officials likened the new summary to the “Nutrition Facts” label required for packaged foods.
“If you’ve ever had trouble understanding your choices for health insurance coverage . . . this is for you,” Donald Berwick, a top official at the Department of Health and Human Services, said at a news conference announcing the proposal.
“Instead of trying to decipher dozens of pages of dense text to just guess how a plan will cover your care, now it will be clearly stated in plain English. . . . If an insurer’s plan offers subpar coverage in some area, they won’t be able to hide that in dozens of pages of text. They have to come right out and say it.”
Industry representatives said complying could prove onerous for insurers. “Since most large employers customize the benefit packages they provide to their employees, some health plans could be required to create tens of thousands of different versions of this new document — which would add administrative costs without meaningfully helping employees,” Robert Zirkelbach, press secretary for the industry group America’s Health Insurance Plans, said in a statement.
Insurance shoppers would also have to keep in mind that their actual premiums could change after they finalized their application, particularly in the case of plans for individuals, which can continue to adjust benefits based on detailed analysis of members’ health history over the next three years. (After 2014, the health-care law will essentially limit insurers to considering only three questions about applicants: how old they are, where they live and whether they smoke.)
The regulation, which is subject to a 60-day public-comment period, essentially fleshes out details of a mandate established by the the health-care law. But it also clarifies a question that the law left somewhat ambiguous: How soon into the application process can shoppers get the summary from insurers?
The regulations would require insurers to provide the summary on request, rather than waiting until someone applies for a policy or pays an application fee, a position that drew praise from consumer advocates.
“If consumers are really going to be able to compare their options, they should be able to easily get this form for any plan that they would like to consider,” said Lynn Quincy, senior health policy analyst for Consumers Union, the nonprofit publisher of Consumer Reports.
In addition to supplying the summary on demand, insurers would have to automatically provide it before a consumer’s enrollment, as well as 30 days before renewal of their health coverage. Plans must also notify members of any significant changes to their terms of coverage at least 60 days before the alterations take effect.
The summary form, which can be sent by e-mail, must be no longer than four double-sided pages printed in 12-point type. In addition to listing a plan’s overall premiums, co-pays and co-insurance amounts, it must include charts specifying the out-of-pocket costs for a range of specific services. A copy can be viewed at www.healthcare.gov/news/factsheets/labels08172011b.pdf.
By: N. C. Aizenman, The Washington Post, August 17, 2011
First Secession, Now Contempt: An Ugly Start To Rick Perry’s Campaign
“If This guy prints more money between now and the election, I dunno what y’all would do to him in Iowa, but we would treat him pretty ugly down in Texas.”
Thus spoke Republican Gov. Rick Perry on Monday, referring to Ben Bernanke, chairman of the Federal Reserve Board. You might chalk the remark up to a weak attempt at humor —if you watch the video, you’ll hear a few nervous laughs from the small crowd — but then Mr. Perry went on in an even less appropriate vein.
“Printing more money to play politics at this particular time in American history is almost treacherous, or treasonous, in my opinion,” Mr. Perry said.
“To play politics”? Mr. Bernanke was appointed chairman of the Fed by a Republican president, George W. Bush. He was reappointed by a Democratic president, Barack Obama, in an acknowledgment of how indispensable he had become in a time of crisis. In fall 2008, when global finances threatened to spin out of control, Mr. Bernanke responded with a steeliness that may have saved the country from disaster far worse than the severe downturn it has experienced.
That’s our view; it’s the view, we’d wager, of most economists. Mr. Bernanke’s actions had the support of both Mr. Bush and then-candidate Obama, of Republican Treasury Secretary Henry Paulson and future Democratic Treasury Secretary Timothy F. Geithner. And in the years since, Mr. Bernanke and his team have done as much as the Fed should do to get the economy moving again.
Now, if Mr. Perry disagrees, that’s fine. The actions of the Fed leading up to, during and after the crisis will be studied and critiqued for decades. Maybe Mr. Perry could have done better; we’ll be interested to hear about his economic program in the days to come.
But there has never been a whisper, let alone any evidence, that Mr. Bernanke’s actions have been motivated by anything but patriotism and determination to see the U.S. economy regain its footing. There was never a whisper, let alone any evidence, that the Republican-appointed Fed chairman sought to help Republican candidate John McCain in 2008, and there is no reason to believe he is playing politics now.
If Mr. Perry has evidence to the contrary, he should present it. If not, he should apologize.
But questioning his opponents’ good faith seems to be part of Mr. Perry’s early playbook. He already has disparaged Mr. Obama for not serving in the military, something that Mr. McCain — with far greater claim on the nation’s gratitude for his military service than Mr. Perry has — never stooped to. And when asked whether Mr. Obama loves his country, Mr. Perry responded, “I dunno, you need to ask him. . . . You’re a good reporter, go ask him.”
When we asked the campaign about these remarks, a spokesman e-mailed, “The Governor never said the President does not love his country.” As to his remarks concerning Mr. Bernanke, “The Governor was expressing his frustration with the current economic situation and the out of control spending that persists in Washington.” But frustration does not excuse accusing people of treason if you don’t like their policies.
In the days after the Jan. 8 shooting of Rep. Gabrielle Giffords (D-Ariz.) and 18 others just outside Tucson, there was widespread revulsion at the nastiness of much political rhetoric and widespread commitment to argue about issues without questioning opponents’ motivations or character. Mr. Perry’s presidential campaign, not yet a week old, suggests he didn’t get the message. We hope he begins to make his case in a way that will reflect better on his own character.
By: Editorial Board Opinion, The Washington Post, August 16, 2011
The 11th Circuit’s Affordable Care Act Decision Cannot Be Squared With The Constitution
The key passage in today’s opinion striking down part of the Affordable Care Act appears on page 113, where the two judge majority explains how they will determine whether this law is constitutional:
In answering whether the federal government may exercise this asserted power to issue a mandate for Americans to purchase health insurance from private companies, we next examine a number of issues: (1) the unprecedented nature of the individual mandate; (2) whether Congress’s exercise of its commerce authority affords sufficient and meaningful limiting principles; and (3) the far-reaching implications for our federalist structure.
This is one way to evaluate whether a law is constitutional, but a better way is to ask whether the law can be squared with text of the Constitution. The Constitution provides that Congress may “regulate Commerce…among the several states,” and the very first Supreme Court decision interpreting this language made clear that this power is “plenary,” meaning that Congress may choose whatever means it wishes to regulate interstate marketplaces such as the national health care market, so long as it does not violate another textual provision of the Constitution.
A law requiring most Americans to either carry insurance or pay slightly more taxes clearly regulates the national market for health care. It determines how people will finance health care purchases. It lowers the cost of health insurance. And it protects that market from something known as an “adverse selection death spiral.” So that should have been the end of the case. The Court cites no provision of the Constitution limiting Congress’ authority to pass this law because no such provision exists.
Instead, it imposes two extra-textual limits on national leaders’ ability to solve national problems. If the law is somehow “unprecedented,” and if a decision upholding the law lacks vague and undetermined “meaningful limit[s]” on Congress’ authority that somehow upset the balance between federal and state power, then the law must be struck down even if the Constitution’s text says otherwise.
Yet even if these two novel limits are taken seriously, the court’s analysis still makes no sense. For one thing, the law is only “unprecedented” in the sense that it preferred a market-driven solution to the problem of widespread uninsurance over more government driven solutions such as Medicare. The truth is that Congress already requires nearly all Americans to purchase health insurance — and they have done so for many years. Every year the federal government collects taxes which are in no way optional. A portion of these taxes are then spent to buy health insurance for the elderly (Medicare) for the poor (Medicaid) and for children (SCHIP).
So the only real question in this case is whether the government is required to first take your money and then buy health coverage for you, or whether the Constitution allows Congress to cut out the middle man.
The Court is also simply wrong to claim that a decision upholding the ACA would necessarily mean that there are no limits on federal power. The Constitution does not simply allow Congress to regulate commercial markets. It establishes that, in Justice Scalia’s words, “where Congress has the authority to enact a regulation of interstate commerce, it possesses every power needed to make that regulation effective.”
Scalia’s rule is important because the ACA doesn’t just require people to carry insurance, it also eliminates one of the insurance industry’s most abusive practices — denying coverage to patients with pre-existing conditions. This ban cannot function if patients are free to enter and exit the insurance market at will. If patients can wait until they get sick to buy insurance, they will drain all the money out of an insurance plan that they have not previously paid into, leaving nothing left for the rest of the plan’s consumers.
Because the ACA’s regulation of the national insurance market cannot function without a requirement that nearly every American carry insurance. this requirement is clearly constitutional under Justice Scalia’s statement that Congress possess “every power needed” to make it’s economic regulations effective. Moreover, upholding the Affordable Care Act under Justice Scalia’s rule would require a court to do nothing more than hold that the Affordable Care Act is constitutional. There is no federal law which depends upon mandatory broccoli purchases, for example, in order to function properly in the same way that the ACA’s preexisting conditions provision can only function properly in the presence of an insurance coverage requirement. Accordingly, the court’s concern that upholding the law would destroy any limits on federal power is unwarranted.
As a final note, it is likely that conservatives will tout the fact that Judge Hull was appointed by President Clinton in the same way that progressives touted Bush-appointed Judge Sutton’s decision rejecting an ACA challenge. The two judges are not comparable, however. Judge Sutton is a former Scalia clerk who stood on the vanguard of the conservative legal movement for many years. Judge Hull, by contrast, is a compromise nominee Clinton selected in order to overcome obstruction from the Republican-controlled Senate.
Hull has a long record of conservative criminal and individual rights decisions. We now know that she is also very far to the right questions of federal power. That is unfortunate, but it also places her well to the right of some of the Supreme Court’s most conservative members.
By: Ian Millhiser, U. S. News and World Report, August 12, 2011
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