Amidst the tedium of waiting for the Supreme Court to make its decision regarding the Patient Protection and Affordable Care Act, almost any ACA-related news is fodder for coverage. So there was a ripple of excitement a few days ago when the mighty UnitedHealthcare announced which provisions of the ACA it says it will cheerfully continue, even if the law is ruled unconstitutional.
In a statement released without fanfare, Stephen J. Hemsley, president and CEO of UnitedHealth Group, outlined five coverage options it expects to continue:
- preventive healthcare without copayments
- coverage of dependents up to age 26
- lifetime policy limits
- rescissions
- appeals
"The protections we are voluntarily extending are good for people's health, promote broader access to quality care and contribute to helping control rising health care costs. These provisions make sense for the people we serve, and it is important to ensure they know these provisions will continue," said Hemsley in the release.
Not to be outdone, the UnitedHealthcare announcement was quickly followed by me-too proclamations from Aetna and Humana. Now the Blue Cross Blue Shield Association, which represents 38 Blue insurers across the country, has added its support to continuing those five provisions.
These are admirable positions. But before we get too carried away with the accolades, let's take a look at what the health insurers have really done. They've simply identified coverage options that are popular with consumers and politicians and agreed to continue offering them.
Coverage of dependents up to age 26, for instance, has consistently ranked high in consumer surveys and House Republicans have specifically mentioned that provision as important to their repeal-and-replace approach to healthcare reform.
The five provisions promised to be extended are also relatively inexpensive for insurers, notes Avram Goldstein, communications and research director for the advocacy group Health Care for America Now.
The announcements by UHC, Humana, Aetna, and others leave open to question what will happen to pre-condition underwriting based only on age, premium rating area, family composition, and tobacco use. What about guaranteed issue? And where do they stand on medical loss ratio requirements? Will insurers continue to limit administrative costs to 15% to 20% of premium income?
"While I believe UnitedHealthcare has been active in health system reform, it would be interesting to know where UHC stands on issues of real impact, such as promotion of the various provisions related to payment reform and changes in how care is delivered," says Larry Boress, president and CEO, Midwest Business Group on Health. The group's 100 members represent over 3 million lives and spend more than $3 billion on healthcare benefits each year.
I had follow up questions for insurers about the issues raised by Larry Boress and others; unfortunately, I was referred back to their original press statements for answers.
Surely health insurers realize that stakeholders, including providers and members, will be looking for more information about how healthcare reform will continue in a non-ACA world. "The tougher discussion, if the individual mandate is set aside, will be how the guaranteed issue and community rating requirements of the ACA will be negotiated. Otherwise, plans will have no choice than to raise premiums substantially," says Paul Keckley, Ph.D., executive director, Deloitte Center for Health Solutions.
There's a statement in the UHC release that hasn't received very much attention. It refers to pre-existing coverage for children: "UnitedHealthcare recognizes the value of coverage for children up to age 19 with pre-existing conditions. One company acting alone cannot take that step, so UnitedHealthcare is committed to working with all other participants in the healthcare system to sustain that coverage."
Coverage for children with pre-existing conditions is already in effect but isn't popular with insurers. In 2014 the ACA will ban pre-existing clauses for everyone.
So far, other insurers have been mum on the topic of pre-existing conditions. But health industry stakeholders know it's this type of expensive coverage that will be difficult to continue if the ACA ceases to exist.
And so we wait for the Supreme Court decision.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
