Even though it’s been more than a decade since movie audiences cheered a character who cussed out the HMO insurer that refused to cover her sick son’s care, that spirit of angry consumer activism still pervades the nation’s effort to expand access to health insurance.
It’s alive and well in the federal health-care overhaul bill that Congress passed this year: Among the key provisions is a ban on insurers denying coverage due to a customer’s illness or preexisting condition.
That assurance of coverage was a major victory for consumers — one that Republicans supported, even as they voted in a bloc to oppose President Obama’s signature legislation. With protections against being denied coverage, more of the nation’s 50 million people without insurance should be better off.
Or will they? The fact is, that alone is no guarantee.
The real solution to the uninsured problem lies in the title Congress gave the law: the Affordable Care Act. Only if the reform actually lives up to its name will more Americans be able to actually afford to exercise their right to purchase health insurance.
So the federal government’s plan announced last week to make health insurers support the rationale for rate hikes of more than 10 percent is a reasonable way to keep a lid on costs and avoid arbitrary increases.
The government oversight will be a combined effort by state insurance departments and the U.S. Department of Health and Human Services. Regulators will require insurers to justify steep rate hikes with data on claims, projected medical costs, administrative overhead, and other factors. All this data will be subject to public scrutiny, in effect, requiring insurers to make their case for steep rate hikes directly to consumers.
Insurers are quick to point out that premiums reflect the cost of medical care; in turn, driven by physician and hospital reimbursements, technology, and the cost of covering sicker patients while healthier people drop coverage.
Indeed, those costs will need to be tamed in the long run if health care is to remain affordable. Which is why the health-care overhaul seeks to spread costs by requiring that most people buy insurance. It also promotes savings with computerized medical records, fewer medical errors, and stressing proven treatments.
While those initiatives are phased in, though, it’s critical to avoid exorbitant insurance premium hikes. That’s where the additional federal oversight of insurers could prove helpful.
Insurers who consistently propose unreasonable rate hikes could be barred from insurance exchanges being set up over the next few years. Conversely, the lure of signing up millions of new customers should be a powerful incentive to cooperate in the reform effort to control costs.
It sure beats getting cussed out.