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Anthem vs. America vs. A National Plan

Many of you may not have heard about the legal case in Maine.  Anthem BC/BS (a company owned by Wellpoint) raised their premiums for individual policy holders 18.5% this past year.  The problem is the Maine thought the increase was too much money and lowered them down to 11%.  Anthem built their increase on a 3% profit margin and money held back for reserves or unanticipated risks.  Maine built their legal case on the assumption the insurance executives are paid too much money.  Well, that’s not exactly what is in their legal filings but it’s what the Attorney General from Maine said on the news.  Then it was stated as a case for a national plan…

Here’s my problem – I really want healthcare reform.  I also want to make sure every American has access to affordable health insurance via a heavily regulated private sector.  No government plan.  My issues with the Maine/Anthem battle is we do not have reform yet and it seems a little “un-American” for individual states to push their own agenda on the insurance industry without other meaningful reforms.  You will see in my previous blogs that I do not think the insurance industry should get a free pass.  I think excessive compensation needs to be addressed via premium reform, competition, and tighter regulation on the industry.  Not individual states deciding someone makes too much money.  To start a national plan right away has the potential, in my mind, to be completely disruptive to our current healthcare delivery system -most importantly, hospitals and doctors.  We may need to fix the system, but doing it overnight with a government plan that would regulate payments could create access issues for patients and a financial crisis for the providers.  You can not change their payment mechanism overnight and expect the system to function smoothly.

There is no doubt many people in Maine, as well as across this country, are struggling with high insurance premiums.  There is also no doubt we need to fix the problem now.  And that is what we are trying to make sure happens in Washington.  But let’s be careful how we move forward.  We need the insurance markets to work efficiently and fairly. Clearly they do not do that well today.  I believe the plan in Senate will move us in the right direction.  Then if the insurance industry still does not work, we can start talking about a government plan, just not yet.

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