Who created sub-par health insurance plans?
American Eagle Financial Services
Late last year, the Affordable Care Act (ACA) got rid of “sub-par” health plans for all Americans and then ensured quality health plans are now available for everyone. The question some are asking, though, is how did “sub-par” health insurance plans become so predominant in the market place if they are so bad?
Here is what the president said at the American Medical Association Meeting back in July 2009 — and repeated some 30 times in the following three and a half years, as did the media.
"No matter how we reform health care, we will keep this promise: If you like your doctor, you will keep your doctor. Period. If you like your health care plan, your will keep your health plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: Fix what's broken and build on what works."
Here’s the problem with these statements that apparently no one thought about or bothered to consider. States have a state department of insurance with a state commissioner. Each state's department of insurance has a regulatory mission: to ensure that citizens of their state are provided with access to adequate and reliable insurance protection; that the insurance companies selling policies are financially sound to support payment of claims; that the agents selling company policies are qualified and conduct their business according to statutory and regulatory requirements, as well as acceptable standards of conduct; and that the insurance policies are of high quality, are understandable and are fairly priced.
You would think that, prior to the president's signing of the Affordable Care Act on March 21, 2010, every health insurance policy purchased in each state by an individual or through a company or other approved entity was an approved plan that met that state's regulatory requirement, including but not limited to being of high quality, understandable and fairly priced. After all, that is not only the regulatory mission of each state department of insurance, but it is also the fiduciary responsibility of each state insurance commissioner to ensure its citizens are not being defrauded or unfairly served by the insurance companies.
Well, that’s what a reasonable person would think, so how did we end up with so many people having their insurance policies canceled? And how did some five million or more insurance policies, all across the country all of a sudden become sub-par? This flies in the face, it would seem, to the regulatory requirements of all these 50 state department insurance commissioners, doesn’t it?
Or did they just allow sub-par policies to be sold by “bad apple” insurance companies and stand back while their citizens were spending their hard-earned money on sub-par policies that the insurance commissioners had approved to be sold in their states? Actually, what we find out is that all these policies that have had a letter sent to their policyholders became sub-par as a result of the ACA or, as it is more commonly known, Obamacare.
The ACA mandated all health insurance policies provide certain minimum benefits, regardless of need, to be considered an approved health insurance plan. Consequently, all plans that do not meet these new minimum requirements under the ACA become "sub-par" plans.
Plans that were submitted, reviewed, met state regulatory requirements, marketed, sold and purchased according to each state's regulatory requirements as “insurance policies that are of high quality, understandable and fairly priced," became "sub-par" as a direct result of ACA law.
And these insurance companies that marketed, sold and paid claims on these approved plans complied with their state regulatory requirement “that the insurance companies selling policies are financially sound to support payment of claims; that the agents selling company policies are qualified and conduct their business according to statutory and regulatory requirements.” It was after ACA law that these same insurance companies became the “bad apple” insurance companies you hear the White House and pundits attacking.
So what makes all these plans sub-par, and why are we hearing how much more expensive these plans are (not counting any “subsidy” that might be applied as a result of passing tax money to individuals and/or families who meet the new entitlements)?
The following are the provisions that all plans now have to offer. This does not consider if the consumer “wants” to purchase these features or sees these requirements as a benefit, nor does it matter if the consumer “needs” or will even use these features.
- Maternity and newborn care (even though the consumer could be a 55-year-old male with kids out of the nest)
- Mental health and substance abuse counseling and treatment
- Prescription drugs
- Pediatric services
- Behavioral health treatment
- Rehab treatment
- Dental and vision care
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease for men and women of certain ages
- Blood pressure screening for all adults
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults over 50
- Depression screening for adults
- Diabetes (type 2) screening for adults with high blood pressure
- Diet counseling for adults at higher risk for chronic disease
- HIV screening for everyone ages 15 to 65 and other ages at increased risk
- Immunization vaccines for adults—doses, recommended ages and recommended populations vary: hepatitis A, hepatitis B, herpes zoster, human papillomavirus, influenza (flu shot), measles, mumps, rubella, meningococcal, pneumococcal, tetanus, diphtheria, pertussis, varicella
- Obesity screening and counseling for all adults
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Syphilis screening for all adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Anemia screening on a routine basis for pregnant women
- Breast cancer genetic test counseling (BRCA) for women at higher risk for breast cancer
- Breast cancer mammography screenings every 1 to 2 years for women over 40
- Breast cancer chemoprevention counseling for women at higher risk
- Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
- Cervical cancer screening for sexually active women
- Chlamydia infection screening for younger women and other women at higher risk
- FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity
- Domestic and interpersonal violence screening and counseling for all women
- Folic acid supplements for women who may become pregnant
- Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- HIV screening and counseling for sexually active women
- Human papillomavirus (HPV) DNA Test every three years for women with normal cytology results who are 30 or older
- Osteoporosis screening for women over age 60 depending on risk factors
- Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk
- Sexually transmitted infections counseling for sexually active women
- Syphilis screening for all pregnant women or other women at increased risk
- Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
- Urinary tract or other infection screening for pregnant women
- Well-woman visits to get recommended services for women under 65
- Autism screening for children at 18 and 24 months
- Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
- Blood pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
- Cervical dysplasia screening for sexually active females
- Depression screening for adolescents
- Developmental screening for children under age three
- Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
- Fluoride chemoprevention supplements for children without fluoride in their water source
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns
- Height, weight and body mass index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
- Hematocrit or hemoglobin screening for children
- Hemoglobinopathies or sickle cell screening for newborns
- HIV screening for adolescents at higher risk
- Hypothyroidism screening for newborns
- Immunization vaccines for children from birth to age 18—doses, recommended ages, and recommended populations vary: diphtheria, tetanus, pertussis, haemophilus influenza type B, hepatitis A, hepatitis B, human papillomavirus, inactivated poliovirus, influenza (flu shot), measles, mumps, rubella, meningococcal, pneumococcal, rotavirus, varicella
- Iron supplements for children ages 6 to 12 months at risk for anemia
- Lead screening for children at risk of exposure
- Medical history for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
- Obesity screening and counseling
- Oral health risk assessment for young children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years
- Phenylketonuria (PKU) screening for this genetic disorder in newborns
- Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
- Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
- Vision screening for all children