Filed Under:Markets, Employee Benefits

Health cost fight boils over

Tempers are erupting. (U.S. Geological Survey photo)
Tempers are erupting. (U.S. Geological Survey photo)

As members of the health insurance community crowded into Seattle this week for the America's Health Insurance Plans (AHIP) annual meeting, the war over efforts to control costs heated up.

AHIP opened the AHIP Institute event by offering a package of efforts to tweak the Patient Protection and Affordable Care Act (PPACA) to make health insurance system change easier on patients. 

AHIP Chairman Mark Ganz, the president of a Portland, Ore., carrier -- Cambia Health Solutions -- greeted attendees with a blog entry emphasizing health insurers' deep concern for the well-being of patients. He talked about Cambia's new palliative care for people with serious illnesses.

While Cambia was greeting meeting exhibit hall visitors with Stumptown coffee, and MedImpact -- a company that uses a drug-by-drug bidding process to choose mail-service drug providers -- was drawing visitors to its booth with organic, vegan Mighty-O Donuts donuts, the House Energy & Commerce health subcommittee was holding a hearing on the effects of PPACA on patients' access to health care providers and prescription drugs.

Dr. William Harvey, a radiologist, talked about how health plan provisions that have little effect on healthy patients, such as $60 co-payments for "specialty drugs," may have a severe effect on patients with conditions such as multiple sclerosis and rheumatoid arthritis that may respond best to expensive biologic treatments.

"Many patients decline the treatment based on cost," Harvey said, according to a written version of his testimony posted on the committee website. "In many cases, when patients fail to access these treatments, they become disabled and can no longer remain in the workforce, thus costing the federal government money on disability."

Harvey and Monica Lindeen, the Montana insurance commissioner and president-elect of the National Association of Insurance Commissioners (NAIC), also talked about the effects of narrow or rapidly changing health plan provider networks.

Limiting network size clearly helps lower coverage costs, Lindeen said. "It is important for regulators to be mindful of the premium impact of requiring insurers to maintain broader networks," she said. But "we must also be vigilant about cost-cutting measures that negatively impact the quality of care that patients receive."

Meanwhile, outside of Washington and the AHIP meeting, the Pharmaceutical Research and Manufacturers of America has been publicizing an analysis by Avalere Health that shows that more than one-fifth of the new "silver level" PPACA exchange plans require coinsurance of 40 percent or more for all drugs in a class.

The Avalere report, demonstrates that the majority of plans in the health exchanges are placing a significant out-of-pocket burden on patients with serious illnesses by requiring high-cost sharing for all medicines used to treat certain conditions," the drug manufacturers' group says.

My Life Is Worth It -- a nonprofit group that came to public life in May with a booth at the annual meeting of the American Society of Clinical Oncology -- has been making aggressive use of social media during the AHIP event to get the attention of insurers, drug makers and policymakers. On Twitter, for example, the group directed tweets at AHIP and called on the group to "put patient needs first."

"There is NO average patient," the group tweeted. "As patients, we are not pawns in an industry fight between @AHIPCoverage and @PhRMA," the group said in another tweet. "We are the only reason both groups make money."

Health insurers themselves may be resisting a mechanism meant to cut their rates -- use of multi-carrier exchanges.

Array Health Solutions, an insurance exchange technology company, has come out with survey data showing that insurers would prefer to sell through single-insurer exchanges than multi-insurer exchanges. About 76 percent of the health insurers the company polled expected to be selling coverage through the multiple-carrier PPACA public exchange system on Jan. 1, 2015.

But, in the private exchange sector, about 56 percent expect to be selling coverage through single-carrier systems in 2015, compared with just 32 percent that expect to be selling through multiple-carrier systems, Array Health reports.

AHIP countered efforts to impose new state or federal health plan provider network requirements with results from a voter survey it commissioned. About 94 percent of the privately insured voters surveyed said they were very or somewhat satisfied with the size of their own health plans' provider networks.

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