The Ensign Healthcare Loophole
Taken at face value, Senator John Ensign's amendment which was included in the final Senate healthcare bill sounds pretty decent: by meeting "wellness" standards people can receive discounts on their employer-based healthcare premiums. Stop smoking--pay less. Hit a certain weight--pay less. Meet a cholesterol target--you get the idea.
Dems probably should have stopped and realized since the amendment was offered by Ensign it probably wasn't motivated by "wellness" at heart.
In fact, it allows premiums to be raised from current levels, and then "discounts" would reduce the premiums to current rates. People who don't meet the insurance companies' targets could pay up to 30 percent more for coverage, roughly $4000 based on the average cost of family coverage. The amount could increase to 50 percent which is over $6,600 for a family.
There is also the problem that this is biased against people with a genetic predisposition to high blood sugar, hypertension, high cholesterol, being overweight and a host of other often hereditary conditions. It's also biased against a lower-income person working two to three jobs to pay the bills, who has to stop and chow down some fast food between jobs rather than get to the gym where he or she can't afford a membership anyway. It's even biased against communities that don't have grocery stores where they can find fresh fruits and vegetables.
So what does this all mean? Remember a central promise of healthcare reform--even the watered down version--how people with preexisting conditions weren't supposed to be denied coverage or forced to pay more for their insurance? That all sounded pretty good, right? Well, guess again.
"Incentives quickly become penalties for those who cannot meet the target," said Sue Nelson, vice president for federal advocacy at the American Heart Association (AHA). The AHA has led a coalition of more than 200 health and consumer organizations who oppose this Senate provision, including the National Organization for Women, American Cancer Society, the American Diabetes Association, and many mental health groups. "A wellness program could consist solely of a premium surcharge based on a blood cholesterol count over 200. [There] are significant potential unintended consequences such as burdening sicker employees and their families with significant increases in healthcare costs thereby making coverage unaffordable for those who need it the most."
Andrew Kurz, former chief financial officer of Wisconsin Blue Cross-Blue Shield, probably knows as well as anyone what the loophole means for Big Insurance.
"Wall Street demands focus on the bottom line, and insurers comply," he said. "Insurers can spot profits miles away and this is a loophole they will drive right through on Day One. As drafted, this provision will not only harm millions of Americans who will be forced to pay higher premiums. It will harm other efforts to bar insurance companies from discriminating against customers."
Ultimately it's Democrats, not Senator Ensign, who bear the responsibility for the inclusion of this insane provision. (And apparently Chairman Max Baucus spoke against this amendment in Committee before he voted for it in "the spirit of bipartisanship"--thanks again, Max.) Now is the moment to contact your legislators and tell them to rid the final healthcare bill of this gift to insurance--found in Section 2705 of the Senate bill.
© 2010 The Nation