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February 04, 2010 11:41 PM UTC

Markey: Remove Health Insurance Anti-Trust Exemption

  • 63 Comments
  • by: Phoenix Rising

( – promoted by Colorado Pols)

Rep. Betsy Markey (CO-04) has teamed up with fellow freshman Rep. Tom Perriello (VA-05) to introduce a simple standalone bill to rescind the health insurance industry’s anti-trust exemption.

“I’ve heard from tens of thousands of Coloradans across my district, and though people’s opinions may vary, the common message is clear: the current health care system is crushing our families and businesses,” said Rep. Markey. “Support for removing this unfair exemption cuts across party lines, and is a major piece of common ground that I’ve been working toward in our country’s health care debate. This is about bringing sorely-needed competition back into an industry that has for too long wielded monopoly control over hard-working American families.”

Say what you will about the current Democratic Congressional leadership, they seem to have found their stride when it comes to picking the right potentially vulnerable Representatives and Senators to deliver messages of real reforms.  This is a simple bill that removes a special protection which the health insurance industry doesn’t deserve, and which everyday people can get behind.

Comments

63 thoughts on “Markey: Remove Health Insurance Anti-Trust Exemption

    1. The House already passed a bill with this in it.  The Senate didn’t.  Politically, this is a great idea.  Trying to make progress on health care reform?  Not really.

      Let’s see the House Dems run a bill or two with elements from the Senate bill.  Then we might see some progress.  Don’t get me wrong, politically I’m all for making the Republicans and DLC Dems have to vote on this issue.  But deep down, I want to see progress, I’m desperate for progress.

      1. The current plan on health care reform is still passing the Senate Bill plus some House reconciliation provisions.  House Democrats will not vote on the Senate bill as passed unless they see some reconciliation provisions from the Senate that fix certain issues.  It’s odd – they don’t trust the Senate to Do The Right Thing after they rubber-stamp the Senate bill…

        So instead, the House will propose some fixes (e.g. removing the Cornhusker buyoff, adjusting the balance between the so-called “cadillac” tax and other revenues).  Those fixes, which all have to be budgetary in nature, will go back to the Senate under reconciliation rules.  The Senate will pass them with a minor (pre-agreed upon) change and send them back to the House, which will vote to send both the original Senate bill and then the reconciliation package to the President’s desk.

            1. The Senate bill as passed has the Nebraska deal. If they do pass a reconciliation bill to amend the Senate bill, the Nebraska deal will almost certainly be removed or broadened to include all states (which would be preferable).

  1. This is an idea that is overdue.  Good for them to pursue it.  This bill seems obvious to me, but has there been any polling on the public feeling about the insurance company monopoly?

    The other issue is the Senate.  How will this ever make it through the Senate?  Will Republicans use the filibuster on it?  Probably.  I’ve not heard of a Republican who supported this item.  Does anyone know?  Snowe? Collins?

      1. This is part of the strategy some people (including myself) have been advocating since the MA-Sen election.  Put up simple bills which make common sense to people.  Make Republicans own failure to pass these reforms, or hope they back down.

    1. back in the days before cloture a filibuster actually meant something. I say the Democrats let the Republicans try to filibuster this bill in the Senate. All of Washington would come to a grinding halt because Republicans want to protect the anti-trust exemptions of insurance companies. There is really NO WAY to spin that positively.

  2. From all the health policy wonks I’ve heard talk about, this concept either would do no good (which I suppose makes it a mere political calculation) or would actually do harm by weakening the insurers’ hand against providers.

    Repeat after me, insurers are not the main problem with our health insurance system. They have some bad habits that need to be fixed, but the real problem is the per-unit cost of care is simply too much…that is a problem with providers, not insurers. The main reason a single-payer is more efficient than our insurance system is the ability to put pressure on providers.

    1. I guess it got us where we are today.

      If that were the case then why is healthcare per capita so much less expensive in other countries with “socialized” systems without private health insurers to look after our interests ?

      Could be other factors, I am not being snarky – I am just asking.

      1. Healthcare costs per capita are much less expensive in countries with single-payer systems because the government acts as one giant insurer and can basically dictate how much providers will receive, allowing them to be very aggressive with cost control. Many other countries that do not use single-payer as the basis for universal coverage still have government mandated pricing controls to accomplish the same thing.

        The problem with the U.S. system is that insurance is diffuse so the insurers can’t really press providers very hard or the provider will just refuse to accept that insurance and take patients from another insurer. This means providers are powerful. This bill would make providers even more powerful by making the insurance market even more diffuse. This is like the anti-single payer bill.

        Support this bill if you wish and make insurers the scalp you’ve been after, but either way, this action will do absolutely nothing to help people.

        1. I don’t care what industry we’re talking about, monopoly’s are dangerous and lead to “too big to fail” institutions or corporations with too much power that they hurt Americans, i.e., giant regional insurance companies.

          I get what you’re trying to say, providers costs goes up as medical innovations come to light and so on but your point about the “concept either would do no good or would actually do harm by weakening the insurers’ hand against providers” is way off base.  

          1. A single-player system is essentially a regulated monopoly. How can your first ideal be a true monopoly and your second ideal being making sure we avoid a monopoly at all costs?

            That said, failing to have single-payer, what we could do are:

            A. Regulate pricing by having all providers bill at Medicare rates, no matter who the payer is (adjusting Medicare rates as necessary to make this viable).

            B. Regulate insurers with guaranteed issue, modified community rating, and limits on non-medical expense (i.e. profit) for basic health plans.

            Of course if you do A, the primary argument to allow private monopolies goes away and if you do B, the threat of private monopolies is rather mitigated. Right now health reform is doing B (to perhaps not a sufficient extent) but I don’t see A being politically viable, as such, maximizing pool sizes is the best approach (hence the hope for a national exchange in the House version, perhaps with a national non-profit if not actually a public option).

        2. The problem with the U.S. system is that insurance is diffuse so the insurers can’t really press providers very hard or the provider will just refuse to accept that insurance and take patients from another insurer. This means providers are powerful. This bill would make providers even more powerful by making the insurance market even more diffuse. This is like the anti-single payer bill.

          Insurance is not diffuse.  Most markets are nominated by a few major players.  Insurers collude and doctors can’t.

          Yeah, I’ll just tell United and Aetna to screw off, and I’ll be just fine.  Seriously?!?!

          Before you go all Gertie on me “doctors are greedy”, I’m in favor of single payer, rationing, and paying doctors more for better outcomes.  You’re point of view is just completely at odds with reality.

          1. So let me get this straight, you take me to task for saying insurance is too diffuse and then voice support for the least diffuse manner of organizing insurance (single-payer). I understand the distinction between private and public, and that is relevant, but there is still some logical contradiction involved.

            Many providers do seem comfortable telling Medicaid to screw off, natch. Yes, Medicaid doesn’t pay enough because its financing structure is not well done, but clearly providers do have some initiative. And I reckon they’d tell United and Aetna to screw off if they tried to negotiate Medicaid rates too. The whole reason Medicare is able to have lower rates than private insurers is they have sufficient numbers to make it untenable for providers to ignore…numbers that Medicaid doesn’t offer (in a coherent fashion anyway). So don’t tell me bargaining power doesn’t matter.

            1. I advocate single payer as a matter of social justice and economic efficiency as the squabbles for “I don’t want to pay for your” this, and “you shouldn’t have to pay for his” that come down to being best solved  by everyone paying for everyone’s everything.  One risk and amortization pool, with strong incentives for patients to take better care of themselves and doctors to provide better, not more, care.

              Seeing there is no viable single-payer legislation at this time, doctors’ pathetically weak position at the bargaining table should not be further weakened.

              The knee-jerk Repub docs on the medical websites say screw the whole thing and let’s just have people pay out of pocket for everything, and create a true free market, but I’m not one of them.

        3. Who’s to say that giant insurers like Blue Cross/Blue Shield (Anthem) aren’t colluding with providers to maximize profits anyway.  Provider contracts aren’t exactly public and if the major insurer in a state exerts its control over the market to lower costs, those are just the costs to itself and quite likely its preferred provider network. It’s certainly not in the dominant insurer’s best interest to curb providers’ bad behavior when it gets a cut of the exorbitant profits.

      1. I support single-payer, so that pretty much confirms it.  But Bondo’s point actually makes some sense to me.

        That also shows why health care reform needs to be addressed holistically, and why piecemeal approaches probably won’t work.

        Rising health care costs are what we’re trying to control.  

        But between insurance profits (ability to deny coverage plus the ability to negotiate lower reimbursements to the providers) and the provider’s delivery model (fee for service vs. outcome-based services, utilization rates of hideously expensive diagnostic equipment, etc.), multiple sacred cows remain to be slaughtered.

        The current bill (with any amendments that can pass reconciliation in the Senate) is the best start we have for what will no doubt be a very long path to complete reform.

        1. But the big elephant in the room, which none of our spineless politicians have the guts to address, is the overwhelming greed of the medical establishment.

          The doctors are greedy, big pharma is greedy the private hospitals are greedy and the medical device manufacturers are greedy.

          Single payer can address that.

          1. Single payer sounds like it could be the silver bullet to the health care mess that we find ourselves in but after seeing the last attempt go down in flames with super majorities, i think it’s safe to say it’s no longer a viable solution. We need reform and unfortunately I don’t think there’s any other way of getting it besides the piece-meal strategy.

          2. Medicare isn’t allowed to negotiate with big pharma right now – by law.  Of the lot of them, I give the most leeway to the doctors.  They front a huge student loan bill, pay some reasonably obscene malpractice insurance fees (depending on their profession), and if they’re a GP, they don’t really make a lot.

            Our rural clinic recently cut back hours because the state’s subsidy for them was dropped due to the budget crisis.  They’re busy every minute of every day they’re open, and they’ve been griping about having to cut their patient time in order to meet basic profitability.

          3. I worked hard and tested in the 99th percentile my whole life, did 8 years of postgraduate training, took out student loans the equivalent of the median mortgage, worked 100 hour weeks for four years in residency, and see peers in law and business making more money while I work harder and harder for less and less every year, all the time worrying that an unavoidable mishap will have me sittng in the defendant’s box being judged by a “jury of my peers.”  

            Not to go all Gekko on you, but sometimes “greed is good.”  I want to be paid more for better outcomes not more care, and yes, single payer can deliver that.  But any system meant to improve outcomes has to have proper incentives to deliver them, and yes that means appealing to greed: getting paid more for doing a better job.

    2. In most regions of the country there are one or two major insurers.  The insurance companies definitely have a strong hand in dealing with the local providers already.

      Whether or not provision costs are too high (and I think a case can be made that many are), it’s not a result of too many small insurers none of whom have any power.

      1. Bondo’s comment didn’t make any logical sense.  

        It kind of has a we need to go after them (providers) instead of us (insurers) industry shill ring to it as well.

        1. the negotiations between consumers and insurance companies.

          If there are a limited number of insurers in a market, the consumer can’t very well negotiate a lower premium. Insurance companies are in business to make as much money as they can for their shareholders. That’s all. If they could make more money making widgets they would (and should).

          Bondo never mentions the part of insurance company revenues that goes to profit and administrative costs. These comprise what, 20-30% of revenue? More competition among insurance companies will pressure these costs downward.  

          1. Administrative costs in large group plans are not far off that of Medicare/Medicaid. Costs are higher in small groups (dividing administrative effort among fewer clients) and in individual plans (because they spend so much trying to minimize risk by excluding preexisting conditions). HCR should address these (and it does in its current form).

            For all the administrative costs, profit isn’t particularly notable for insurers (especially relative to pharma/DME). The profit margin for insurers is like 3%…and it isn’t growing as fast as overall spending. If we moved to all non-profit, you’d cut a little out of premium costs, but you wouldn’t bend the cost curve. You simply can’t bend the cost curve on the insurance side, it has to be on the payment/provision side.

            1. Administrative costs at the large insurance companies are nowhere near the same as those for Medicare.  That’s one of the reasons there’s a provision in the Senate bill to force insurance companies to pay at least 80% of their premium intake on actual care.

              Medicare currently spends perhaps 3-5% of its “premiums” (such as they are, being government per-patient expenditures) on overhead – and the private companies are whining about a 20% cap!  The House proposed a 10% cap.  Most other countries have an overhead somewhere between 2% and 12%.

                1. A large group plan, as discussed already, has a lower overhead because the insurance company subsidizes large groups with small group and individual plan profits.

                  The overall overhead still comes out from 17% on up – much higher than Medicare.

  3. First, the more I’ve learned about this so-called “exemption,” the more it appears repealing it would be mostly ceremonial.  I would still support the bill, but I don’t think it actually makes one iota of a difference in the actual operations of insurance companies.

    Second, this idea was proposed again, and again, and again, and again by Republicans last year.  So I think Markey is behind the curve.

    1. Would this bill make it so 1-2 insurance companies cannot control a state/region? Over the past few months of health care debate, i’ve heard that there are several states being controlled by potential monopolies.  

      1. If another provider was to try to move in to the area, they would be helped by this bill if they ran into any difficulties related to the monopoly holder.  (E.g. providers with exclusive agreements, under-pricing to maintain the monopoly…)

        1. I may be totally off the mark here, but could that mean that regional insurance companies would be allowed to expand into new markets making them bigger but not big enough to be regulated by the anti-trust law? So to Mongo’s point insurance companies could get bigger as a result of this bill?

          Thanks for the info Phoenix, good stuff to know…  

          1. There’s no restriction on any insurance company being “allowed” to expand to other states; nor would this bill create one.

            A company can hold a monopoly under Sherman even in a single city; if they use their power to prevent others from entering the market, they can be penalized for illegally maintaining their monopoly.  Similarly, a company could be nationwide and be the sole provider in a certain market; provided they don’t abuse their power in maintaining that market monopoly, they don’t fall under Sherman.  It’s the actions in maintaining the monopoly, not the monopoly itself or its size, that matter to the law.

          2. The total size of the company isn’t really the determinant of the pricing power. Under our current system even a national insurer can’t have a national pool. They have a pool for each state because each state has different insurance regulations. So expanding into other states (rather than expanding in a given state) doesn’t really get you a lot of leverage. Let me be clear, the Republican talking point of allowing sales across states, while it would probably benefit bargaining power, would be horrible. I would be the last to say that insurers should be unregulated. Ideally we would expand to national pools by having strong national regulation, not by allowing a race to the bottom in state regulation.

            Hopefully the above will prove to some skeptics here that I am not in the employ of the insurance companies.

            And just to wrap up a few loose ends from other posts, putting the vise to pharma and durable medical equipment manufacturers is of vital importance for cost control as well. I also think better student loan forgiveness and malpractice insurance reform options would be a perfectly reasonable thing to offer providers in exchange for payment reform.

            1. What do pools have to do with negotiating rates for providers?

              A national insurance firm (say United Health) negotiating with a national provider (say Catholic Hospitals) can apply its weight regardless of the differences in state regulations.

              And a large statewide firm wouldn’t get a big discount for being national sized when negotiating with a local clinic.

              1. It is not my impression that provider networks are generally national unless they are operated by the insurer, in which case the whole conversation is a bit secondary and would continue to be so no matter the external anti-trust setting.

                1. Most of the national providers are church-affiliated as far as I know.  Some of the urgent care facilities operate across state lines, too – but I don’t know of any that are truly national.  If you want to lump medical device and service providers in the mix, then there are several…

            2. A “pool” is a group of people the insurers throw together to obtain a risk level.  There is nothing legal stopping them from lumping everyone into a single pool and calling it “community rating”.  But the insurance companies gain competitive advantage when bidding for large contracts by offering lower rates to large companies; to do this, they create the fiction that it costs them differently to insure a single person than it does to insure a whole bunch of people.

              They could, if they chose, create a community rating system now for their customers and apply penalties and timeout periods (according to law) for people who come in to their plan with pre-existing conditions.  They don’t, because they’d lose the ability to charge their smaller customers more to offset the smaller income they get from their larger customers – and because unless they all do it, the one that does will get steamrolled in negotiations.

    2. In fact, it was passed by the House in their final HCR bill.

      It didn’t make it into the final bill on the Senate side because Senate Dems were too busy caving to the Republicans and the Nelsons and Liebermans that troll the halls.

      This should be a bipartisan bill and easy to pass on its own.

      As to its usefulness – well, I guess that depends on whether or not the big insurance companies have been using their muscle to push out upstart companies from the regions they control.  Could be a minor thing, could be very useful – I don’t think we know, because with the exemption in place no-one’s tried to make a stink about it.  We do know that in most markets, one or two insurers hold 80+% of the market share.

        1. and then take on the health insurers second (you know if still need be and under certain conditions of course, simple boilerplate stuff, oh and only in certain markets, etc.), as the health insurers would have it  😉

      1. Usually more competition leads to leaner, more efficient companies.

        I’m not convinced that will help in this case.  A major unaddressed issue that I see is that currently, the monopolies have little incentive to modernize or streamline their bureaucracies.

        To lower costs, they currently only use three basic approaches — refuse to cover “bad risks”, deny coverage for specific procedures, or use their market dominance to lower reimbursement costs (the statements I get from my insurer indicates they pay as little as 20% on both large and small items — cost-shifting to smaller insurance companies, the uninsured, or more likely you and me via taxes and rising deficits).

        Adding more competition may moderate these practices to some degree, but also raise premiums as a result (because they have to compete for more expensive customers and service providers).

        What they really need is an external push to modernize and share their medical information to streamline their operations.  Cutting down on the medical errors, redundant procedures and reducing the amount of paperwork and people needed to process each patient/visit/procedure.  I am talking about both the insurance companies and the providers.

        Every time I walk into a doctor’s office and am handed a clipboard to fill out, I see yet another example of how error-prone and wasteful our current health care system is.

        This will take an industry/government information standardizaton agreement.  And many years to implement.  Single-payer would basically do that by default.  Getting private insurance companies and providers to do it on their own is impossible.

    3. Maybe they’ll complain that it should have a tax cut attached or something. In reality of course, Republicans will do whatever big insurance companies want them to do, rhetoric from last year or otherwise.

        1. Seriously.

          Every conservative on this board has railed for months on this very issue. Now it’s proposed by a Democrat and suddenly they all turn away.

          It’s all about power. Nothing more.

    4. Please name one. Show us when they introduced a bill, or even a quote of support.

      Id like to see Republicans support Markey on this but unfortunately her right-wing opponents are sell-outs who apparently do not like competition in the free market.  

  4. Or even just the citizenry?

    I think if we went to single payor, Medicare for all, it would cost what it costs right now. It is just shifting that cost from private to public that is expensive. But, we all know that American products can not adequately compete with foreign products largely because of the costs of health care.

    It is revealing, I think, that the estimated costs of single payor are close to the cost of the wars. Shall we fight useless war or provide America with health care?

    Health care should be a right.

    1. We can guesstimate that simply from the difference between Medicare overhead and private insurance overhead.

      We could further lower Medicare costs by negotiating rates with Big Pharma rather than taking it on the chin like we do now.  At present we subsidize the world’s drug research costs (much like we subsidize the world’s military support structure by providing most of the military).  Time to share.

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