Health Advocates: Senate Plan Encourages Discrimination

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Friday, January 08, 2010 at 6:00 am
Sens. John Ensign (R-Nev.) and John Kerry (D-Mass.) (WDCpix)

Sens. John Ensign (R-Nev.) and John Kerry (D-Mass.) (WDCpix)

Insurers and employers could penalize workers thousands of dollars for pre-existing conditions under the Senate’s health-care reform bill, according to a long list of academics, advocates and medical societies, which are pushing for elimination of the provision.

The proposal threatens to undercut a central goal of the Democrats’ health-care reforms: to eliminate the common practice of basing premium rates on the health of patients.

At issue are employer-based wellness programs, which aim to prevent common conditions related to smoking, overeating, lack of exercise and other unhealthy behaviors — conditions such as diabetes, hypertension and high cholesterol. Both the House and Senate bills promote such programs, but the Senate bill, critics argue, would allow employers to raise rates on all of their workers, then lower them only for folks who meet certain wellness targets. Such a system would effectively force less healthy workers to subsidize the insurance plans of those more fit — an unfair penalty in the eyes of many medical groups.

[Congress1]“Incentives quickly become penalties for those who can’t meet the requirements,” said Sue Nelson, vice president for federal advocacy at the American Heart Association. “This would really become medical underwriting by another name.”

Current regulations allow group plans to offer rewards up to 20 percent of premium rates for employees who meet certain health goals. The Senate health-reform bill would effectively make that rule law, while also bumping up the variation allowance to 30 percent — roughly $4,000 for the average family plan. The Senate bill would also allow officials at the Health and Human Services Department to go even higher — up to 50 percent.

Outside of the group market, the Senate provision would also create a 10-state pilot program testing the advantages of the wellness incentives for individuals buying insurance on their own.

The provision was championed by Sens. Tom Carper (D-Del.) and John Ensign (R-Nev.), both members of the Senate Finance Committee, who argued during the panel’s health-reform debate that such market-based incentives for healthy living will put a considerable dent in the nation’s skyrocketing health care costs.

“Voluntary employee participation in these areas should naturally be reflected in lower healthcare costs,” Ensign said. “This isn’t just about offering financial incentives; this is about making Americans healthier.”

Numbers from the Centers for Disease Control and Prevention back Ensign’s claim. The cost to treat smoking-related ailments is more than $96 billion each year — roughly $1,400 per smoker, CDC estimates. For obesity, the cost burden is even higher, representing as much as $147 billion in annual medical expenses — also about $1,400 per patient, CDC says.

Critics of the Ensign-Carper provision don’t dispute those figures. But they worry that lowering premiums for some workers — those that hit their wellness marks — would inevitably mean hiking rates on those who didn’t.

“When you start picking people off on an individual basis [and] reducing their premiums individually,” Sen. John Kerry (D-Mass.) said during the Finance Committee markup, “you do not adjust for what else may be happening within that [coverage] universe, and then other people are picking up the overall costs.”

Ensign’s response to Kerry last September (effectively: “Exactly! Sicker people should pay more.”) highlights the central disagreement between the two sides of the debate.

Let us just say that you had 100 people and 25 people decided to get healthier and it lowered the amount of money that you had to spend for those 100 people. Not all 100 should benefit in that. Only the 25 that made the difference should benefit in that. That is fairness.

I mean, if the 25 are the ones who are changing their behavior and that is the reason you have to spend less, they should be the ones rewarded, not the people who did not change their behavior.

Members of the Finance Committee approved the amendment overwhelmingly, 18 to 4.

A similar provision, sponsored by Sen. Tom Harkin (D-Iowa), was attached to the health reform bill in the Senate Help, Education, Labor and Pensions Committee last summer.

At least one former insurance industry executive argued this week that it will take little time for companies to exploit the loophole in the Senate bill.

“Insurers can smell profits a mile away,” said Andrew Kurz, former chief financial officer at Blue Cross-Blue Shield Wisconsin. “This is a loophole they will drive right through on day one.”

Nelson, of the American Heart Association, conceded that the wonky issue is “tremendously complex,” making it difficult for critics of the Senate provision to get their message across. She said that advocates were able to speak directly with House lawmakers about the provision, but didn’t have similar luck winning an audience in the upper chamber.

“I wish,” she said, “we had had that opportunity in the Senate.”

Comments

46 Comments

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ajm8127
Comment posted January 8, 2010 @ 7:33 am

Ensign is assuming that all people with health problem can take it upon themselves to get healthier. What about people with chronic conditions. Ones caused by genetics. Those people cannot do anything about that. Say, for instance, that you have Crohn's Disease, which is a form of IDB with no known cause or cure. Could you just “decide to get healthier”? You don't just wake up one day and say, “If I go to the gym more, I could cause my immune system not to attack tissue in my digestive tract.”


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Daniel Zimmerman
Comment posted January 8, 2010 @ 4:51 pm

I agree with ajm8127, and would add that for many people, overcoming nicotine addiction or compulsive overeating often proves nearly impossible despite their best efforts. We should not penalize such people, either–especially if they show that they continue to try to quit. Amendments such as this that allow the insurance companies to discriminate against anyone in order to maximize their profits to a scandalous degree deserve only derision and strong opposition from the public.


Paul
Comment posted January 8, 2010 @ 8:01 pm

Health is not a commodity which can be provided by government. Government is good however at interfering with people's private affairs. The last thing one would want if ill is some bureaucratic vulture circling over head trying to dictate what options you have available to you to return to health. The more government intrudes on the patient physician relationship the more one can expect medicine to become bureaucratically cruel, wasteful and based off of concerns other than health.

http://healthjournalclub.blogspot.com/


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murmur55
Comment posted January 9, 2010 @ 3:59 pm

Just accept that good, efficient and effective healthcare for all will cost a lot of money. Adopt a single-payer method for funding and set up physician management groups in each state to deliver care with a layer of oversight to monitor quality.


murmur55
Comment posted January 9, 2010 @ 4:06 pm

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et2010
Comment posted January 20, 2010 @ 12:37 pm

Going to the gym more would be a start. Then you could start by eating a plant based diet, organic of course. Eliminate sugar, coffee, soda's [which contain high fructose corn syrup], never eat anything that contains Aspartame, splenda, high &low, etc. Eliminate tobacco, drugs, household cleaners that contain chemicals, toothpaste with Laurayl Sulphate, Fluoride,and other chemicals. Never eat junk fast food, or anything out of a can. Use Sea Salt. Have any amalgam fillings replaced with composite material, and remove all root canals. They are a source of cancer, and other disease

Get plenty of sun in the summer for Vit. “D”, supplement with “D3″ in the winter. Detox regularly by doing liver, and Gall bladder cleanses, fast occasionally, Don't ask you doctor if a particular medication is right for you, In fact stay away from the doctor unless you have a broken bone, or need a test.

In case you haven't figured it out, it's all about the money. The Pharmaceutical companies will take your money for drugs that will either kill you, or cause you more problems so you will have to buy more drugs to deal with the new problems. They don't care about you, it's all about the money.

Well that's a good start, and you will get healthier because you have eliminated plenty that has caused your immune system to be overloaded. Now it will have more time for your Crohn's, and IBD.

Yes I know what you're thinking, “I can't give all that up”, and “Life is to short”

That's okay, but don't complain when people talk about giving the people who do work at getting healthy a break on the cost of their health insurance. I have insurance, for problems that might arise beyond my control, but haven't been to the doctor in 6 or 7 years, and don't plan on ever going if I don't have to.

Get involved with your own health. It's not rocket science. Just follow the money, and go the opposite direction remembering that your body needs nutrition, not what the food industry pushes at you with inferior products.


ajm8127
Comment posted January 20, 2010 @ 4:40 pm

You make many assumptions there. You obviously do not know what Crohn's disease is or how it affects the body. It is an AUTO-immune disease, meaning the the body's own immune system attacks it's own tissue, mistaking it for a pathogen. so giving the immune system “more time” is actually only going to make it worse. I don't know why I would take medical advice from someone who does not even understand the body's ailments.

I agree with your over all point, but can you honestly tell me that everyone has total control over all of their medical conditions?


Name
Comment posted January 21, 2010 @ 4:35 pm

I know what crohn's is, I had three bouts of it's first cousin ulcerative colitus.Same symptoms without the stomach pain. Yes, I also was told there is no cure. In fact they wanted to do the surgery where they cut the offending colon out and put a bag outside the body to deficate in. I declined. That was about 40 years ago. I got rid of it by water fasting, but it returned twice more because of my diet, and the fact that I was overloaded with toxins to the point that my immune system was compromised.

I retired almost thirteen years ago with a host of medical problems including 4 or 5 sinus infections a year. Saw every ENT doctor in the city I live in, and all of them treated me with antibiotics. This of course killed off all the good bacteria in my intestines [which BTW is 80% of your immune system]. The problem was my teeth. I had read that amalgam [mercury] fillings, and root canals were health problems. I had several of both. My teeth wern't bothering me, so I didn't do anything about it for two years. Then I figured that allopathic medicine wasn't up to the task of getting to the problem, I had all the amalgam replaced, and the RC's removed. I haven't had a sinus infection since. [about 9 or 10 years ago]

In addition I got rid of sleep apnea, tinnitus, arthritis in my right hip [[couldn't walk more that 3 blocks because of pain], fibromyalgia in right shoulder, etc. all this in about a month or so after the dental work. All this at great expense by a dental surgeon who BTW agreed with my decision, but made me sign a CYA document stating that he tried to talk me out of it, telling me he could lose his license if the ADA found out. I found out later that there is a meridian chart linking all the teeth to certain organs, and tissues of the body. All the problems I had were linked to the teeth I removed, or replace the mercury amalgam.

I believe the UC is a thing of the past too as I can tell by my stools. They are well structured. No bleeding, diarhea, or constipation. This was accomplished with what I described in my first post as far as diet, and detox, probiotics [not the drug, or health store kind], but a six strain probiotic from “Custom Probiotics” .com. There is said to be trillions of bacteria in the digestive system, and when it gets out of balance trouble starts. The probiotics mentioned aren't cheap, [$165 100 grams], but there are 260 Billion good bacteria in each gram. the drug store kind might have 50, or 75 billion with 2 or 3 strains.

I'm not a doctor, and medical advice is not what I am about. Rather providing food for thought, and some encouragement that you can get well naturally. Don't believe the people that tell you crohn's can't be cured.

My best.


Name
Comment posted January 21, 2010 @ 9:35 pm

I know what crohn's is, I had three bouts of it's first cousin ulcerative colitus.Same symptoms without the stomach pain. Yes, I also was told there is no cure. In fact they wanted to do the surgery where they cut the offending colon out and put a bag outside the body to deficate in. I declined. That was about 40 years ago. I got rid of it by water fasting, but it returned twice more because of my diet, and the fact that I was overloaded with toxins to the point that my immune system was compromised.

I retired almost thirteen years ago with a host of medical problems including 4 or 5 sinus infections a year. Saw every ENT doctor in the city I live in, and all of them treated me with antibiotics. This of course killed off all the good bacteria in my intestines [which BTW is 80% of your immune system]. The problem was my teeth. I had read that amalgam [mercury] fillings, and root canals were health problems. I had several of both. My teeth wern't bothering me, so I didn't do anything about it for two years. Then I figured that allopathic medicine wasn't up to the task of getting to the problem, I had all the amalgam replaced, and the RC's removed. I haven't had a sinus infection since. [about 9 or 10 years ago]

In addition I got rid of sleep apnea, tinnitus, arthritis in my right hip [[couldn't walk more that 3 blocks because of pain], fibromyalgia in right shoulder, etc. all this in about a month or so after the dental work. All this at great expense by a dental surgeon who BTW agreed with my decision, but made me sign a CYA document stating that he tried to talk me out of it, telling me he could lose his license if the ADA found out. I found out later that there is a meridian chart linking all the teeth to certain organs, and tissues of the body. All the problems I had were linked to the teeth I removed, or replace the mercury amalgam.

I believe the UC is a thing of the past too as I can tell by my stools. They are well structured. No bleeding, diarhea, or constipation. This was accomplished with what I described in my first post as far as diet, and detox, probiotics [not the drug, or health store kind], but a six strain probiotic from “Custom Probiotics” .com. There is said to be trillions of bacteria in the digestive system, and when it gets out of balance trouble starts. The probiotics mentioned aren't cheap, [$165 100 grams], but there are 260 Billion good bacteria in each gram. the drug store kind might have 50, or 75 billion with 2 or 3 strains.

I'm not a doctor, and medical advice is not what I am about. Rather providing food for thought, and some encouragement that you can get well naturally. Don't believe the people that tell you crohn's can't be cured.

My best.


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Comment posted August 2, 2010 @ 5:04 pm

The more government intrudes on the patient physician relationship the more one can expect medicine to become bureaucratically cruel, wasteful and based off of concerns other than health.


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