ANALYSIS: ‘Occupy Wall Street’ should also take aim at health insurance companies

Introduction

The lobbyists for U.S. health insurers surely have to be feeling a little uneasy knowing that thousands of Occupy Wall Street demonstrators who have been marching and protesting in Washington as well as New York and other cities might target them in the days ahead. After all, the headquarters of the insurers’ biggest lobbying and PR group, America’s Health Insurance Plans (AHIP), at 601 Pennsylvania Avenue, N.W., is just blocks away from Freedom Plaza, where the demonstrators have set up camp, and problems with health insurers appear to be near the top of the list of protesters’ concerns.

Health Care for America Now, an umbrella advocacy group that played a key role in the health care reform debate, last week analyzed the 546 comments that had been posted by then on “We are the 99 percent” Tumblr site. It found that 262 of the comments mention such problems as getting denials for doctor-ordered care from their insurance companies and having to forego treatment because of hefty out-of-pocket costs.

In my book, Deadly Spin, I wrote about how the “Wall Street takeover” of the American health care system has created many of the problems mentioned in the Tumblr site. I also described how AHIP offices have often been command central for developing and implementing coordinated efforts to derail health care reform efforts in the past and how the organization helped shape major provisions of the Affordable Care Act, which Congress passed last year.

Over the past few years, many of the largest health insurance firms have converted from nonprofit to for-profit status and have been acquired by huge corporations whose stock is traded on the New York Stock Exchange. Today, more than one-third of all Americans are enrolled in a health benefit plan owned and operated by just five large insurers — a group that last year hauled in nearly $12 billion in profits. These companies have grown so big and powerful that they now often determine who has access to affordable care and who doesn’t. Their business practices, condoned by investors and Wall Street analysts alike, have contributed to the growing number of Americans without health insurance— more than 50 million of us at last count.

I worked for two of those large companies, Humana and CIGNA, during my nearly 20 years in the insurance industry, and I participated in many strategy meetings at AHIP’s offices in Washington where plans were hatched to influence public policy.

I am now watching how AHIP is getting Obama administration officials to write the regulations required by the Affordable Care Act in ways that benefit insurance companies more than consumers. And I have talked to administration officials who have quit their jobs in disgust as the White House has repeatedly sided with insurers rather than consumer advocates, as important regulations were nearing completion.

Here’s an example. Earlier this summer, the administration announced rules pertaining to new rights we supposedly now have, thanks to the Affordable Care Act, to appeal decisions made by insurers that don’t go our way. When the Department of Health and Human Services quietly released the regulations in late June, consumer advocates realized that insurers had, for all practical purposes, written them.

As Sabrina Corlette of Georgetown University’s Health Policy Institute wrote, the administration narrowed the range of issues consumers can appeal, gave insurers up to 72 hours, rather than 24 hours, to made decisions on emergency care claims and weakened a provision requiring health plans to provide enrollees with information about their appeal rights in understandable language. Administration officials also cut in half the number of days patients have for appeals and allowed insurers to frequently choose their own “judge and jury” when their enrollees request an external review.

Just last week, AHIP’s muscle was on display when the Institutes of Medicine released guidelines for the Obama administration to follow in establishing the “essential benefits package” that all health plans will have to offer on the health care exchanges, or insurance marketplaces, beginning in 2014.

In January, an AHIP executive warned the IOM about making the benefits package too “rich.” Insurers want the package to be as skinny as possible, which will enable them to continue selling plans that, in many cases, are inadequate for many peoples’ needs.

The IOM’s recommendation is almost exactly what AHIP suggested.

So if the Occupy Wall Street demonstrators want to show up in front of the offices of some of the most important and influential people in Washington, whose strings are pulled by a handful of people on Wall Street, they will not want to miss 601 Pennsylvania Avenue, N.W. Trust me on this.