10 Ways Insurance Companies Will Get Out of Reforming

March 31, 2010 | Last updated: July 31, 2020

If you thought that the health care reform bill was so expertly thought through as to prevent health insurance companies from engaging in the same end run around regulation practiced by the credit card companies, then Dan Froomkin has some news for you: You’re naive. Far be it from insurance companies to spend the next four years until the implementation of health care reform begins figuring out how to operate under a new regulatory framework; instead, they’ll use their massive profits to figure out as many ways as possible to screw their customers before the rules go into effect, and as many ways as possible to get out of complying with the new rules. Let us count the ways.

1. Raising premiums

There is absolutely, positively no prohibition on companies raising premiums at outrageous rates until 2014 — so they’re not going to stop. And politicians in Washington might scream, but the volume will be far less next year because the President won’t have a reform bill to pass.

2. Kicking people out for pre-existing conditions

The insurance industry may have relented about using pre-existing conditions to determine children’s eligibility, but they’re not about to let adults with pre-existing conditions qualify for insurance coverage one minute sooner than 2014 — and the way they floated the idea that the law didn’t really totally require them to accept children with pre-existing conditions is a hint that they’re desperately looking for a similar loophole in 2014 and beyond.

3. Changing your insurance plan

Remember how President Obama said that if you liked your insurance plan, you wouldn’t have to change? Well, the health reform bill won’t make you, but your insurance company might. They’re busy shutting down and restricting access to managed care plans (HMOs) and pushing current customers into high-deductible plans, where customers have to pay all expenses out of pocket before the insurance company picks up a dime. In other words, customers pay a (relatively) small premium each month and then the first $2,500 of their health care each year before the insurance company begins to cover a percentage of the costs of their medical care.

4. Making life more difficult for doctors

One great way to reduce insurance company payouts is to make it more difficult for doctors to file claims, which insurance companies are already planning on doing.

5. Tightening up internal practices

That’s a euphemism for giving patients and doctors enough of a run-around trying to get bills paid to convince them to give up asking for reimbursements.

6. Marketing only to healthy people

Healthy people are the cheapest to insure, and people tend to gravitate toward marketing materials that look like them. But if they make certain drugs hard (or impossible) to find on pharmaceutical formularies, or put up physical barriers to obtaining the insurance, they can (and likely will) keep more elderly and sick people from even applying for their insurance.

7. Re-label current overhead expenses at health care

When the reform finally takes full effect in 2014, insurance companies will have to spend 80 percent of their premiums on care for their customers. Thus, in order to make more money, they’ll have to increase the money you spend on care, or figure out a way to classify expenses currently deemed “overhead” as “health care for you.” Luckily, they’ve got an army of lawyers and accountants more than willing to assist.

8. Taking full advantage of the unhealthy behavior premium

In the reform, insurers are allowed to makes premiums 50 percent more expensive for consumers who engage in “unhealthy” behaviors, which was intended to allow them to continue charging smokers higher premiums. But there are lots of behaviors deemed “unhealthy.” Have more than one sexual partner? Neglect to get 30 minutes of cardiovascular exercise a day? Love sweets? Drink carbonated, caffeinated sodas? All those behaviors, and many more, are considered risky by the medical profession and could make your insurance far more expensive than you think.

9. Charging old people as much as they can

The law allows insurers to charge people between 55 and 65 (the current age of Medicare eligibility) three times more than people 54 and under. So on their fifty-fifth birthdays, some customers could get new, higher insurance bills that put readjusted mortgage bills to shame — and there won’t be anything remotely illegal about it.

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  • Lobbying to make the most of the loopholes that exist and create others **

It likely goes without saying that all the money and lobbying time that went into watering down health care reform and trying to keep it from passing aren’t just going to stop flowing to Washington. Rather, as the Department of Health and Human Services spends its time promulgating rules to govern the various reforms in the bill, lobbyists will simply switch their focus from the Hill to HHS. We know what they want — to limit the effect reform will have on their bottom line — and they know how they’ll get it: through the regulatory process.