Archive for February 4th, 2010

My Hospital Discounts are Better Than Your Discounts

Thursday, February 4th, 2010

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Well trained health insurance salesmen and company representatives derive sales by convincing prospective clients that their hospital contracts are better than any other out there. “My discounts are better than your discounts, and I can prove it” exclaim many in the business. “Just give me a sample of your old claims and I will re-price them through our PPO network. Since you have XYZ Company currently, I know through experience that I can save you 20% or more off your claims.”

And so the disco-discount games begin.

Editor’s Note: Brownsville Independent School District was promised a $4-5 million claim savings by changing from the HealthSmart network to the Texas True Choce Network last year.  Has that happened?

ObamaCare on Hold (For Now)

Thursday, February 4th, 2010

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The suspension of action on health care reform in the Senate, triggered by the upset election of Scott Brown to the Senate from Massachusetts, is now in its second week with no end in sight.  What started out as a methodical, plodding health reform effort in 2008 and then became an every-committee-for-itself approach in the summer of 2009 is now in Limbo. Democrats can’t figure out how to actually pass something without offending the anti-incumbent, anti-Congress mood of the electorate, with November’s elections a scant nine months away. Republicans can’t figure out whether to hold the line against any health reform or join with moderate Democrats to stand behind a truly bipartisan bill. The State of the Union speech did little to move the needle on health reform as the President gave no specifics on policy and nothing on process. Congress returns this week from the party “retreats” (get out of town to caucus privately), and the next week or two may provide some indication on which health care reform pathway Congress will choose. Right now, the prospects for something passing are still above 60 percent, but the content of a bill is totally up in the air. 
 
To take some pressure off, Speaker Nancy Pelosi is suggesting passing a number of narrowly focused health bills to accomplish something and, if crafted carefully, to garner Republican support on a health care item or two. First up seems to be the effort to repeal parts of the industry’s McCarran-Ferguson antitrust exemption, as to health and medical malpractice insurers. It seeks to outlaw price-fixing, bid-rigging and market allocations. Truth be known, the bill is a hollow gesture in that it neither repeals McCarran-Ferguson nor outlaws anticompetitive
practices that are not already prohibited by McCarran- Ferguson. Unfortunately, it may hurt small insurers who need pooled claim and loss data to fairly assess risk, and it could chill quality initiatives. 
 
Senate Democrats last week passed a ”pay-as-you-go” budget restraint law to require that new bills not go forward unless fully funded, i.e., new revenue must be found or some other program’s funding curtailed. But the very same bill exempts upwards of $250 billion from the rules, just in case Congress wants to permanently eliminate reductions in reimbursement for Medicare physicians but doesn’t want to pay for that.

Editor’s Note: This is an excerpt from today’s Aetna Report to their agency force