Insurance Industry

The nation's two largest health insurers have been pressuring employees to lobby against healthcare reform in Congress in violation of a California law against coerced political activity, a consumer group alleged Wednesday. Consumer Watchdog in Santa Monica has asked California Atty. Gen. Jerry Brown to investigate its claim that UnitedHealth Group and WellPoint Inc. pushed workers to write their elected officials, attend town hall meetings and enlist family and friends to ensure an overhaul that matches their interests.

Healthcare overhaul legislation moving through the Senate Finance Committee would put crucial rule-making authority in the hands of a private association of state insurance commissioners that consumer advocates fear is too closely tied to the industry. The National Assn. of Insurance Commissioners currently writes model laws and regulations that individual states are free to accept or discard. Under the bill by Sen. Max Baucus (D-Mont.), it would craft a model rule governing "health insurance rating, issuance and marketing requirements" that would become "the new federal minimum standard without any further congressional action."

Despite growing frustration with the way health insurers deny medical treatments, major healthcare bills pending in Congress would give patients little new power to challenge those sometimes life-and-death decisions. "Right now, the deck is stacked against patients," said Bryan Liang, director of the Institute of Health Law Studies at California Western Law School in San Diego. "Healthcare reform is not going to change the ball game." Yet a patient's ability to fight insurers' coverage decisions could be more important than ever because Congress, in promoting cost containment and price competition, may actually add to the pressure on insurers to deny requests for treatment.

The White House will not commit to healthcare legislation that would cap insurance premiums or tax benefits, taking a wait-and-see approach as congressional negotiators seek a deal, advisors said Sunday. President Obama will not demand that a final bill include a government-run plan as a way of driving down costs through competition, though that's his preference, they said. "There will be compromise. There will be legislation, and it will achieve our goals: helping people who have insurance get more security, more accountability for the insurance industry, helping people who don't have insurance get insurance they can afford, and lowering the overall cost of the system," senior advisor David Axelrod said on ABC's "This Week."

As President Obama's push for a healthcare overhaul moves toward its final act, the oft-vilified health insurance industry is on the verge of seeing a plan enacted that largely protects its financial interests. That achievement, should it stand up in the final legislation, would be the capstone of a sophisticated lobbying and strategic campaign that began even before Obama was elected president. The specifics of the healthcare legislation are still being hashed out on Capitol Hill, and key details will evolve in the days ahead.

A tactic used by insurance companies to deny expensive behavioral therapy to autistic children has been deemed illegal by a Los Angeles judge. In a preliminary ruling, Los Angeles County Superior Court Judge James C. Chalfant found that Kaiser Permanente's refusal to pay for a child's autism treatment because the provider was not licensed by the state runs counter to California's Mental Health Parity Act. That act requires insurers to cover care...

Under the healthcare proposals now before Congress, insurance companies would no longer be able to charge higher prices to policyholders who had diabetes or cancer, became pregnant or were severely overweight. But the far-reaching clampdown on insurers leaves one highly controversial element untouched: the issue of charging higher premiums to older policyholders than to younger, presumably healthier consumers who are less likely to file costly claims. Under the provisions of the bill passed by the House on Saturday, as well as in the probable Senate version, insurers will be able to charge middle-aged consumers at least twice as much as they do younger customers.

Re: David Lazarus' consumer column, "Health insurers pull a fast one," March 29: What a novel concept, charging different prices for different levels of service. If you live in a state that mandates coverage of ob/gyn, mental health, mammograms and wigs for chemotherapy patients in order to sell insurance, you are paying for them regardless of whether you use any of them. Most other types of insurance are structured to protect against catastrophic problems. If you could get an oil change and new spark plugs simply by making a $10 co-payment, auto insurance would be unaffordable for many of us too. Let's have a cafeteria of health insurance coverage with deductibles that encourage us to take better care of ourselves.

Re: Michael Hiltzik's business column, "Why aid those at the root of health crisis?" Aug. 3: As a senior concerned about healthcare, I have followed the debate very closely. Hiltzik has presented the issues succinctly, comprehensively and pragmatically. Why are Republicans so adamantly against the public option when it does not stop anyone from obtaining private coverage should they choose to do so? There is little question that private insurers would lower premiums to be competitive.

Re "Healthcare insurers get upper hand," Aug. 24 I have just read the article on the health insurance industry, and I say "throw the bums out." The vast majority of Americans are overwhelmed by healthcare insurance costs and co-pays and cannot continue under the present system. It appears that the insurers came to the table as wolves dressed in sheep clothing. We are in a perilous time; we all must work together to see improvement. That is not socialism -- just common sense, from which we all benefit.