08 November 2013

Filing False Insurance Claims

In reforming our health-insurance system, the Affordable Care Act requires insurers to offer plans with a minimum set of benefits, and not to spend too much of customers’ premiums on marketing and other things not directly related to patient care. The latter provision has already lowered my medical insurance premiums here in Massachusetts.

The first provision has meant that some bare-bones insurance policies, which didn’t offer much protection when people might actually need it, are no longer available. (Actually, those policies would still be available if health insurers had maintained the same basic terms as when the law had passed in 2010. But of course companies take every good opportunity to raise prices and otherwise change terms for their own profit, so that “grandfather clause” doesn’t apply to most plans.) That’s affected people who, like me, pay for medical insurance themselves.

Speaker of the House John Boehner is now trying to claim that he and his colleagues warned Americans of that problem. On 29 October, his office issued a statement claiming, “House GOP Warned Americans Would Lose Health Plans.” But it pays to take a closer look at the five “warnings” that press release quotes. Do they really address stricter requirements and higher premiums on policies sold to people who self-insure?

Two of those statements come from Boehner himself and his close, if not trusted, colleague Eric Cantor. And neither man said anything about people who buy their own medical insurance. Neither man said anything about how or why health coverage would change. They just said that insurance policies would change, which was an easy guess since insurers already changed their offerings all the time.

Rep. Dave Camp (R-Mich.) did indeed say, as quoted by the Speaker’s office: “So much for the President’s claim that, ‘If you like your health care plan, you can keep your health care plan.’” But Boehner’s office carefully cut out Camps’s preceding paragraph:

Buried deep within the new regulations that will govern employer-provided health coverage is the startling estimate that by 2013, under the most likely scenario, 87 million Americans (1 out of 2 Americans with employer coverage) will no longer be able to retain the health plan they have and like. According to that same regulation, this number could be as high as 117 million Americans (7 out of 10 Americans with employer coverage) being forced to change health plans. And these numbers could be higher if the Obama Administration's assumptions and estimates turn out to be overly optimistic.
Camp was obviously talking about “employer-provided health coverage,” not policies for those of us who self-insure. Boehner’s office was deceptive to present him as saying anything more.

Likewise, the Speaker’s statement quotes Fred Upton (R-Mich.) saying, “When the president said if you like your health-care plan you can keep it, he was just flat-out wrong.” But again the press release removed the adjoining sentence in Upton’s remarks to the Washington Post, shown here: “Look at page 737. I read it.” Upton pointed to that same page on the House floor, and what was his problem with it?
They’re going to make sure that every American verifies that they have health insurance? Maybe they’ll look at page 737 in the health care bill, which says that every business will have to file a new 1099 with the IRS for any $600 business-to-business transaction. So if you’re a homebuilder, and you just happen to show up at that same Chevron or Shell gas station every other week to fill up your car, and you spend more there…or your pick up, and you spend more than $600 for the course of the year there, you’re going to have to file a 1099.
Again, Upton didn’t say a word about policies for people who buy their own medical insurance; all his compassion was for business owners having to follow the law. Furthermore, that provision about 1099 forms was repealed over two years ago. So Upton’s “warning” no longer applies.

The closest thing to an actual prescient warning quoted in the press release from the Speaker’s office was an August 2009 radio address by Rep. Tom Price (R-Ga.), transcribed here. Price did speak directly to the issue of rising standards leading to a higher premium price: “For starters, within five years, every health care plan will have to meet a new federal definition for coverage – one that your current plan might not match, even if you like it.”

But then Price went on to say things like, “Now the President has also said that he thinks the government should compete with your current health care plan.” That was a reference to the “public option,” which President Obama had successfully campaigned on in 2008 but dropped in a largely fruitless attempt to gain more Republican support. Price was speaking months before the passage of the Affordable Care Act. He was “warning” about provisions that weren’t in the final text.

Ironically, Speaker Boehner and his office issued that press release in an attempt to argue that President Obama wasn’t fully truthful. But the Speaker’s statement, when examined fully, shows that Boehner and his staff are willing to conceal the truth. Believing that you’re justified in such a double standard is a hallmark of OIP Derangement Syndrome.

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