Archive for December 22nd, 2010

Christmas Cheers From Kathy

Wednesday, December 22nd, 2010


The cost of health insurance for the average working American more than doubled over the last decade, leaving many Americans feeling like they’re at the mercy of insurance companies, with no control over when the next exorbitant rate hike was coming.

That’s not okay. And now it’s starting to change.

Just yesterday, we announced a proposed new policy to help hold insurance companies accountable. These new proposed rules would allow the Department of Health and Human Services, in coordination with states, to require many insurers to publicly disclose and justify unreasonable rate increases.

For too long, it’s been all too common to open your mailbox this time of year and find a letter from your insurance company saying your premiums are going up 20, 30, or 40 percent – often with little or no explanation. 

Whether it’s insurance for yourself, your family, or your small business, this is the kind of news that not only spoils your holidays, but can also endanger your health care coverage – and your health.

These new rules bring unprecedented transparency and oversight to insurance premiums to help states reign in excessive and unreasonable rate increases that have made insurance unaffordable for so many families.

Rather than explain all the details in an email, here is a video where I explain the new proposed rules and why they are important for your health:

Click Here to Watch My White House White Board Video

We believe that shining a light on insurance premiums will convince more insurers to think twice before submitting large rate hikes, the impact of which will be felt by millions of Americans.

This is our latest step to put health care where it belongs – in the hands of consumers instead of insurance companies. 

Please help to spread the word and share this video with your friends and family this holiday season. And for more on our efforts to hold insurers accountable, read this blog.

Happy Holidays,

Kathleen Sebelius
Secretary of Health and Human Services

Editor’s Note: Below are a few uncensored comments received from readers of this blog:

COMMENT 1 –these people are smoking something…where is the ceiling on and the transparency concern for hospital bills, hospital pricing, and the automatic 1/2- to 1% per month inflation built into their charge-masters ?After all, about 75% of health insurance premium is the cost of paying claims at hospitals deliver me from these idiots
COMMENT 2 –Hey Kathy, You stupid fucking bitch, why the hell do you think insurance costs have gone up??? Why are all the insurance companies pulling out of Massachusetts? You stupid fucking bitch!!!!!!!! Have you heard that medical costs have gone up you ignorant slut!???
COMMENT 3 –Just a thought for Ms. Sebellus to consider. And  keep in mind that I am no fan of insurance carriers.  But here is my radical thought : Perhaps it is the cost of health care itself that needs to be addressed. In other words , the premiums charged by carriers are a symptom , but the cost of care is the disease. I have no doubt that there are carriers who are trying to capitalize on the reform legislation to increase rates , but  why does the government focus exclusively on the  insurance companies ?  Self funded employers are seeing increases as well ; doesn’t that indicate the problem is not simply the carriers fault ?  Sometimes I think the government does a survey and says “ Who can we throw under the bus ? “  when it comes to health care.     The best scapegoats : the insurance companies. Every day I see medical providers charging outrageous  amounts that have no relation to the cost to provide the service.  Pharma  and medical device manufacturers have margins that dwarf the insurance companies .  Yet the focus , when the topic is cost of care , is always those greedy insurers.   I don’t get it.  Again , no fan of insurers , but I don’t think these folks down in DC are  thinking some of this through very well. How is that for an understatement ?
COMMENT 4 – How great is that! By the way…the government solver of all things too costly for insurance…..a friend in the business just told me his Medicare Part D premiums went up by 30%. Hey Kathy, where is the fucking federal government oversight on that fucking plan? Oh, that’s right, you don’t know or care about that….you ignorant slut!
COMMENT 5 – Reading the latest crap the beauracraps come up with makes my blood pressure go up, I’m gonna go have a beer right this minute. ps-thanks for the excuse!

Health Insurance Rate Hikes: Unreasonable if Excessive, Excessive if Unreasonable

Wednesday, December 22nd, 2010

| December 21, 2010

A lawyer friend once joked to me that every time the government passed a regulation based around the word “reasonable,” it meant full employment for another class of lawyers. Between the FCC—which earlier today gave itself the right to determine what counts as “unreasonable” network management on the Internet—and a new rule governing health insurance rate increases released by the Department of Health and Human Services, the government put a lot of lawyers to work today. As The New York Times reports:

The new health care law, signed in March by President Obama, calls for the annual review of “unreasonable increases in premiums for health insurance coverage.” The law did not define unreasonable.

But HHS did! If a health insurer proposes a rate hike of more than 10 percent, the rate review process kicks in. That doesn’t mean, however, that there’s a bright line to determine what counts as unreasonable.

Under the new regulation, a federal health official said, “we are not setting an absolute numerical standard for whether a rate is unreasonable.” Instead, the proposed rule lays out factors to be considered. It says that a rate increase will be considered unreasonable if it is excessive, unjustified or “unfairly discriminatory.”

A rate increase is defined as excessive if it “causes the premium charged for the health insurance coverage to be unreasonably high in relation to the benefits provided.”

In addition, under the rules, the assumptions used in calculating a rate increase must be based on “substantial evidence.”

Thanks to this clarifying list of descriptors, it’s all makes sense now: A rate hike is unreasonable if it’s excessive. It’s excessive if it’s “unreasonably high.” If you’re worried that this sounds circular, then let me suggest that you hop on the Gravitron, start spinning, and let me know when you can’t tell which way is up.

Whatever. HHS might as well have just declared that “they’re unreasonable when they’re too damn high, and that’s whenever we say so. The end!” These regulatory definitions are all spin, and they’re all mostly worthless; evidence becomes “substantial” whenever HHS says it does, based on whatever it wants: legal criteria, regulatory intuition, coin-toss, or the winner of a three-out-of-five Twister tournament.

Earlier this year, when a group of state insurance commissioners was putting together recommendations to HHS for a different regulations, one of them noted its potential impact and said very earnestly that “we don’t want to drive companies out of business by being arbitrary.”

That’s a nice sentiment, but it’s more than a little clueless: When writing guidelines for essentially discretionary rules like those we saw today, the entire regulatory process is arbitrary. There’s no reason that insurers should be forced to spend some specific percentage of their premium revenue on clinical expenses, no correct definition for what counts as a clinical expense or an administrative expense, and no matter how many unpleasant-sounding adjectives you pack into your regulatory definition book, no non-arbitrary way to determine which rate hikes are unreasonable.