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The Health Companies fight back….Lobby for changes in the new Healthcare Law and some will simply get out of the business……

This is going to get ugly…..

Some Healthcare Insures simply do not want to stop the old way of doing business..

They are trying to water down the new law by going to Congress and the states legislatures and trying to get the new law changed, re-written or trown away…

So companies are threating to get out of the business because they can’t cover just the premium patients and keep the extra money for themselves…

In writing the law….

Congress left a ton of loop holes ……

The Healthcare insurers are checking everyone of them….

It is sickning…….

“The health insurance industry has shifted its focus from opposing health care reform to influencing how the new law will be implemented,” Mr. [ Virgina Senator ] Rockefeller said.

The law requires insurers to spend a minimum percentage of premiums on health care services and “activities that improve health care quality” for patients.

Insurers are eager to classify as many expenses as possible in these categories, so they can meet the new test and avoid paying rebates to policyholders.

Thus, insurers are lobbying for a broad definition of quality improvement activities that would allow them to count spending on health information technology, nurse hot lines and efforts to prevent fraud. They also want to include the cost of reviewing care by doctors and hospitals, to determine if it was appropriate and followed clinical protocols.

Some consumer advocates, like Carmen L. Balber of Consumer Watchdog, favor a strict, narrow definition of quality improvement activities, limited to those activities that produce measurable benefits to individual patients.

But Alissa Fox, a senior vice president of the Blue Cross and Blue Shield Association, said that if the definition was too narrow, “health plans will come under enormous pressure to cut back quality improvement activities, including highly effective programs to reduce hospital infection rates.”

Another lobbying group, America’s Health Insurance Plans, said efforts to curb fraud directly benefited patients. “If fraud could be eliminated, billions more dollars would be available to pay for care,” said Randi Reichel, a lawyer who works for the insurers.

But Charles N. Kahn III, president of the Federation of American Hospitals, a trade group, said he feared that the quality improvement category would become a “catchall for a wide variety of expenses not directly related to patient care.”

Timothy S. Jost, a law professor at Washington and Lee University in Lexington, Va., said insurers wanted to include costs they incurred in deciding whether to pay claims. A major function of such activities, he said, is to “deny services to enrollees and to contest their claims.”

“It is inconceivable that Congress intended these costs to figure into the formula used to calculate rebates,” Mr. Jost said. “On the other hand, Congress did want to protect activities that demonstrably improve the quality of care.”

Under the law, insurers in the large group market are generally supposed to spend 85 percent of customers’ premiums on “clinical services” and quality-enhancing activities. The minimum is 80 percent for coverage sold to individuals and small groups.

Insurers and insurance regulators say that some companies will be unable or unwilling to meet the new standards…….

More……..

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May 15, 2010 - Posted by | Blogs, Breaking News, Counterpoints, Government, Health, Healthcare, Law, Media, PoliticalDog Calls, Politics, The Economy, Updates | , , , ,

2 Comments »

  1. […] This post was mentioned on Twitter by James Finley. James Finley said: The Health Companies fight back….Lobby for changes in the new Healthcare Law and some will simply get out of the b… http://wp.me/pAL4p-2S8 […]

    Pingback by Tweets that mention The Health Companies fight back….Lobby for changes in the new Healthcare Law and some will simply get out of the business…… « PoliticalDog101.com -- Topsy.com | May 15, 2010 | Reply

  2. the Health Control bill is MASTERFUL con work

    even Andre Bauer called it”Universal Coverage”

    I blew my chance to correct him

    Obama is so smooth just like Hot Chocolate tobacco

    Comment by Timothy Leal | May 15, 2010 | Reply


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