PROPOSITION 45 MAY RIDE AGAIN (Regulating Insurance Companies That Sell Healthcare Policies)

Like a reliable bucking bronco used to rodeo participation, Proposition 45 may be down, not out, and capable of rising again if supportive organizations adopt it, revise it, and promote it. 

Among the physicians who were supportive of Prop. 45  we can probably still count on Paul Song and Robyn Young to maintain interest and put up a fight. Doctor Song is reported to have an eye on running for insurance commissioner once Dave Jones has finished his tenure. Young is president of the California Neurology Society and maintains hands-on interest in  medical- political issues in Sacramento and Washington, DC.

What killed Proposition 45 in the November, 2014 voting in California was the widespread perception that regulation of the insurance companies was largely smoke and mirrors. The idea was to allow the insurance commissioner as much authority over the sellers of healthcare insurance as is now allowed with reference to automobile liability insurance.

That meant that the insurance commissioner would be enabled to role back an insurance company's increase in premium it it were judged by the insurance commissioner to be arbitrary, not substantiated by demonstrable need. The insurance commissioner would be judge and jury. 

Careful readers of the proposition quickly realized that what was deemed "arbitrary" might itself be arbitrary and that insurance commissioners might yield to political persuasion. The insurance companies countered with an ad that said doctors, not politicians, should decide medical matters. The obvious riposte was that insurance companies currently readily find ways to deny authorization of care, restricting access to diagnostic studies, specialists, and expensive procedures, sometimes even medicines. The proponents of 45 were caught flat-footed, or when not flat-footed, too penurious to afford proper rebuttal ads. 

The Californnia Medical Association and the Union of American Physicians and Dentists found common ground in opposing 45 -- they agreed that a likely scenario for an insurance company whose increased premium got rebuked would simply be to reduce remuneration to providers such as hospitals, clinics, and physicians. That being so, they opted to oppose the proposition since its obvious effect would be to reduce access to care. The likely next step would be for MPNs (Medical Provider Networks) to fire physicians as fast as possible -- the longer the waiting line for access to care, the lower monthly expenses would be, the higher profits and executive compensation would be,  never mind that overall serious illness would go up. The obvious fly-trap was "insurance  for everybody, medical care for nobody"

As a result these and other medical organizations opposed the proposition even though in their collective guts they may have favored the concept.  Prop. 45 did not cover providers or provider groups because it did not give the insurance commissioner authority to regulate provider reimbursement by the insurance companies.

Now it's up to the proponents to write a proper legislative bill that takes these concepts into account and puts them into legislative language in time for the 2015 legislative session. Since there's a long history on this concept, AB 52 from previous failed legislation, and now Prop. 45 itself, it should be possible to construct a new bill that will tie up these loose ends. The next step will be to get a legislative author and to be available as an articulate sponsor at committee hearings and the like. 

Indeed, since the concept already has traction, my advice is to seek out an appropriate legislator to carry the bill with the understanding  that when he looks over his shoulder he'll see troops in support, not defectors fleeing the political scene. 

OBAMACARE: FURIOUS BACKPEDALLING DETRACTS FROM ALREADY DIMINISHED CREDIBILITY

When is the last time that an American president asked to have the law set aside so that presidential credibility might be restored? How about right now?

Even though California Insurance Commissioner Dave Jones has indicated that California should go along with the president's request to allow older insurance policies that don't meet the required criteria of the Affordable Care Act (ACA) to be extended, Covered California Executive Director Peter Lee says no dice because the state of California cannot force the insurance companies to grant extensions. Covered California voted 5 to 0 that allowing these older policies to continue would undermine the ACA even though President Obama himself, in a spectacularly furious backpedalling gesture, asked for just that. In so doing the president hoped to restore his diminished credibility when he promised so loudly and so often that if you liked your current doctor or your current policy you could retain either or both.

All the same, as of this writing, the ACA is doing well in California. About 80,000 persons have signed up for policies. Nevertheless,  about 220,000 non-compliant policies in California may be extended despite Peter Lee's exhortations otherwise. The reason, however, isn't as much the presidential plea for mercy as it is the insurance companies' assertions that they didn't have enough time to notify clients and don't have enough time anymore to make necessary adjustments.

By now it has become evident that ACA-compliant policies are likely to cost more than the non-compliant policies they replace -- we've already seen the example of the woman who congratulated the president on Obamacare and then found out that she couldn't afford it and would now be worse off than before when she had a non-compliant policy. Now she has none. Evidently, Peter Lee thinks that "none" is a suitable alternative for her. Lee may turn out to be even more of an ideologue than the president himself. It took a while for the president to acknowledge his mistake, but, in due course, he did just that. Meanwhile the ideologues stomp ahead, trampling opposition, no matter how small and desperate they are.

In general, the idea of insurance for all should take hold, but not in an atmosphere of partisan bickering, party affiliation, and ultimate hypocrisy where Congressional representatives, as one of their perks, may seek medical care at any American military hospital on a "prn" basis.

Yessirree,"prn" is the abbreviation for "pro re nata," which means according to need, their needs, not ours. Once again Congress looks out for itself first. Citizens like us get promises, then dregs, then raised premiums that push the ACA into offering policies that often turn out to cost more than the policies they replace. The risk now is that the ACA will protect us out of more health care than it'll provide in return. We hope not lest the ACA become known as the Unaffordable Care Act (UCA).