National Nurses United

RAD_March REV 4/1/10 3:23 PM Page 17 Rose Ann DeMoro Executive Director, National Nurses United Diary of a Wimpy Healthcare Bill The new federal law fails to challenge the stranglehold of insurance companies on our health system. assage of President Obama's healthcare bill proves that Congress can enact comprehensive social legislation in the face of virulent rightwing opposition. Now that we have an insurance bill, can we move on to healthcare reform? As an organization of registered nurses, we have an obligation to provide an honest assessment, as nurses must do every hour of every day. The legislation fails to deliver on the promise of a single standard of excellence in care for all and instead makes piecemeal adjustments to the current privatized, for-profit healthcare behemoth. When the boasts—comparing the bill to Social Security and Medicare, probably to mollify liberal supporters following repeated concessions to the healthcare industry and conservative Democrats—fade, a sobering reality will probably set in. P What the bill does provide Expansion of government-funded Medicaid to cover 16 million additional low-income people, though the program remains significantly under-funded, which limits access to its enrollees as its reimbursement rates are lower than either Medicare or private insurance with the result that some providers find it impossible to participate. Though the federal government will provide additional subsidies to states, those expire in 2016, leaving the program a top target for budget-cutting governors and legislatures. Increased funding for community health centers, thanks to an amendment by Senator Bernie Sanders that will double the number of health center sites nationally and the number of patients they serve over the next five years. Reduction—but not elimination—of the infamous "donut hole" gap in Medicare prescrip- tion drug coverage which requires enrollees to pay the full cost of medicine out of pocket. Insurance regulations covering members' MARCH 2010 dependent children until age 26, and restricting limits on annual and lifetime insurance coverage. Permission for individual states—though weakened from the version sponsored by Rep. Dennis Kucinich—to waive some federal regulations to adopt innovative state programs like an expanded Medicare. All of these reforms could, and should, have been enacted on their own without the poison pills that accompanied them. umented immigrants, the rest mostly those who are still unable to afford the everincreasing cost of private insurance. Where the bill falls short Significant loopholes in the much-touted insurance reforms. Insurers will be able to: The mandate forcing people without coverage to buy insurance. Coupled with the subsidies for moderate-income people not eligible for Medicare or Medicaid, the result is a gift worth hundreds of billions of dollars to the very insurance industry that created the present crisis through price gouging, care denials, and other abuses. Inadequate healthcare cost controls for individuals and families. Insurance premiums will continue to climb. Proponents touted a "robust" public option to keep the insurers "honest," but that proposal was scuttled. The administration also dropped its plan to crack down on rate hikes with a federal insurance authority, a promise made after Anthem Blue Cross of California announced 39 percent premium hikes. No standard benefits package, only a circumspect reference that benefits should be "comparable to" current employerprovided plans. Even in the regulated state exchanges, insurers remain in control of what they offer and what will be a covered service. Insurers are likely to design plans to attract healthier customers, and many enrollees will likely find the federal guarantees do not protect them for medical treatments they actually need. It's not universal. By 2019, 23 million will remain uninsured, one-third of them undocW W W. N A T I O N A L N U R S E S U N I T E D . O R G No meaningful restrictions on insurers denying claims they don't want to pay for. Propo- nents cite a review process on denials, but the "internal review process" remains in the hands of the insurers, and the "external" review will be up to the states, many of which have systems in place that are dominated by the insurance industry with little enforcement mechanism. n More than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions. n Sell policies "across state lines," avoiding patient protections passed in other states. n Charge three times more based on age plus more for certain conditions, and use marketing techniques to cherry-pick healthier, less costly enrollees. n Continue to drop coverage (rescissions) for "fraud or intentional misrepresentation" —the main pretext insurance companies now use to purge sick people from their rolls. n Charge significantly more for policies for children with pre-existing conditions. Confusion over the requirement that insurers agree to sell policies to families with sick children cropped up only after the bill was signed, one of many 'fine print' loopholes likely to emerge. Taxing health benefits for the first time. Though modified, the tax on benefits remains, a 40 percent tax on coverage with value exceeding $10,200 for individuals or $27,500 for families. With no real checks on premium hikes, many plans will reach that amount by the start date, 2018. The result will be more cost-shifting from employers to workers and more people switching to skeletal plans that leave them vulnerable to financial ruin. N AT I O N A L N U R S E 17

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