High unemployment in 2009 squeezed private health coverage and enrollment in publicly subsidized managed care plans, according to health insurance ratings agency A.M. Best Co.
In a latest report, commercial enrollment among publicly traded insurers dropped by 2.3% or 2.3 million members through the first nine months of 2009. No overall reversal is expected until employers start hiring, the agency said.
The findings are reflective in recent reports by major insurers, which indicated significant enrollment drops in 2009 compared to 2008. Aetna, UnitedHealth Group Inc, WellPoint, Humana Inc., and CIGNA all have reported enrollment drops. The enrollment losses have been tied to reduced jobs, and a reduced number of people covered by employer-sponsored health insurance.
CIGNA, for instance, reported that medical membership fell 5.5 % to 11 million in the final quarter of 2009, compared to the final quarter of 2008. Enrollment fell less than 1% from the third to fourth quarter of last year, according to the company. Enrollment is expected to range from a 1% loss to a 2% gain in 2010.
WellPoint and UnitedHealth Group also reported enrollment drops that slowed over the final two quarters of 2009 and both said they expect continued losses into 2010. Aetna's fourth-quarter earnings fell 15% as the health insurer stated it continued to feel the effects of inadequate pricing, as well as pressures from the economic downturn.
The A.M. Best report also noted:
Medicaid managed-care enrollment and private insurance subsidies for laid-off workers under the economic stimulus legislation increased.
Demands on state budgets stemming from the weak economy and the “rising demand” for safety-net insurance are expected to make Medicaid rate increase negotiations difficult.
Lower rate increases are expected to continue for Medicare Advantage plans, which saw enrollment wane to 10.4% last year. Insurers paid off debt and fewer took on new debt in the first nine months of 2009.
In the health insurance sector, five mergers and acquisitions were reported last year, compared with 17 the prior year.
Many health plans are unsure about the future and are searching for answers. The news isn't always good.
Health plans are under constant pressure to be more affordable yet more efficient. But so much really depends on the members themselves. Health plans have their fingers crossed as they try to stem the tide of overwhelming healthcare costs, with or without help from Washington, says Jan Berger, chief medical officer for Silverlink Communications Inc.
Berger knows of what she speaks. Berger specializes in healthcare communications, and spends much of her time speaking with health plan leaders. Berger was previously senior vice president and chief clinical officer for CVS Caremark. She has been involved in the National Committee for Quality Assurance and serves as editor-in-chief of the American Journal of Pharmacy Benefit.
As the country debates healthcare reform, Berger says we have to look at where we are, and learn where we went. She recalls health plans and others were so convinced back in the 1990s that HMOs were the way to go and "we were Dr. Nos!" In that era, HMOs were quick to deny coverage, and the insurance jungle became a battleground between patients and insurers what should be covered or not.
Basically, as a health plan executive, you look at both ends of the spectrum and the idea is to bring in consumers with incentives to effectively change the health plan landscape and lower costs dramatically. It involves sorting through everything from the age-old issue of prescription drugs to the relatively new programs, programs such as value-based insurance design.
It's a risky proposition. But it can be done. It's as easy (or difficult) as throwing out the trash, Berger says. (We'll get to that later).
The pharmaceutical aspect of healthcare has really been lost in the shuffle in the healthcare debate. But patients are continually facing significant out-of-pocket medication expenses that Berger says will lead to more "non-adherence"—patients not paying attention to what they should be taking"—no matter what physicians want, no matter what health plans want. Eventually one of every two medical consumers become non-adherent in using their medicine within 12 months of medical therapy, according to Berger's figures. The result is significant because there are often severe setbacks, or as Berger puts it, "adverse impact" on the individual's health, and more costs for health plans.
As the Medicaid rolls increase, it will be important "that a primary care provider and others work to educate and support the patient to assure they will have the correct medication to maximize the efficacy, and therefore, value of the new medications," Berger says.
Having participants, plans, hospitals and physicians working together is a big part of the value-based insurance programs that Berger and other proponents see as the wave of the future to keep costs down. The idea is to encourage better use and compliance of high-value health services and adjust copays as a result. The plan also places more reliance on wellness programs to reward employees who help themselves.
Berger has been a supporter of the American Association of Preferred Provider Organizations, which has recommended using value based health care to improve results for payers. In a 2009 white paper, the AAPPO noted, "Successful [value-based] programs use the levers of information, motivation, and financial incentives to encourage new behaviors" such as:
Better eating, more exercise
Taking essential medications regularly
Making better choices—such as a high-performing physician.
The full-blown scope of value-based insurance has yet to be discussed on Capitol Hill, Berger contends. "Value-based insurance was one of the areas that was discussed during the healthcare debates. It was focused mostly on medications," she says. "At this time, Medicaid and Medicare have limits on the incentives that can be used in value-based insurance design."
Berger equated progress in health plan reform to environmental changes in the country—slow going, but an inexorable force.
"Years ago, people would throw garbage out the window and littering was a terrible problem in this country. Then it became a point you were embarrassed if you threw something out the window. Society as a whole rewarded those who didn't. It created a stigma for those who did."
Indeed, in 1965, the government realized that garbage had become a major problem and Congress passed the Solid Waste Disposal Act, which called for the nation to find better ways of dealing with trash. By 1986, Rhode Island passed the first mandatory recycling law.
Progress. Like any of these movements, whether anti-garbage campaigns, or even the cultural war against smoking, the move to get more consumers involved in their own healthcare can certainly happen, but it is tenuous and takes a long time. In healthcare, we're really relying mostly on patients themselves, ensuring they take those moments to exercise, and don't cut their pills in half—to save a few bucks, a move that may haunt them later on.
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President Obama rolled out his plan to combat childhood obesity as First Lady Michelle Obama and Health and Human Services Secretary Kathleen Sebelius looked on in an Oval Office ceremony, saying "this has enormous promise" to improve health of children. The administration hopes to "solve the problem" of obesity within a generation.
Obama signed a presidential memorandum that creates a 90-day plan that involves a task force to provide "optimal coordination" to "tackle one of the most urgent health issues that we face in this country and that is the increase of childhood obesity."
The White House released a memorandum that said the Obama Administration "is committed to redoubling our efforts to solve the problem of childhood obesity within a generation through a comprehensive approach that builds on effective strategies, engages families and communities, and mobilizes both public and private sector resources."
Nearly one-third of American children are overweight or obese—a rate that has tripled in adolescents and more than doubled in younger children since 1980, according to the White House. One-third of people born in the year 2000 or later will eventually suffer from diabetes over the course of their lifetime, while many others face chronic-obesity-related health problems, such as heart disease, high blood pressure, cancer, and asthma.
"We think that this has enormous promise in improving the health of our children, in giving support to parents to make the kinds of healthy choices that oftentimes are very difficult in this kind of environment. And so I just want to say how proud I am of the First Lady for her outstanding work," Obama said.
The coordinated effort involves private sector companies, nonprofits, and government agencies.
When the Massachusetts Attorney General's Office released a recent report sharply critical of the state's healthcare costs, one of the office's most often used words was "driver"—referring to hidden forces steering potentially out of control expenses.
Reacting to the AG's decision, health insurers' major lobby in Washington blames hospital consolidation as an often ignored reason for the soaring price of healthcare.
"The data shows that [hospital consolidation] has increased healthcare costs—with a higher price for healthcare services," says Robert Zirkelbach, spokesman for the America's Health Insurance Plans. "It's something that hasn't been paid attention to. It's certainly something we're looking at."
Zirkelbach pointed to studies and reports:
Hospitalization markets have increased their concentration by 47% during a 13-year period from 1990 to 2003, according to the Robert Wood Johnson Foundation. In addition, the foundation reported 88% of U.S. metropolitan areas have highly concentrated hospital market areas.
Significant price increases for hospital services after mergers—including findings by the Federal Trade Commission and Department of Justice after extensive 2002 and 2003 hearings—and reports from the Institute for Health Care Management and the Robert Wood Johnson Foundation.
These reports show higher prices for consumers and insurers that do not lead to better care, he says.
The report from the Robert Wood Johnson Foundation says "research suggests that hospital consolidation in the 1990s raised inpatient prices by at least 5% and likely significantly more. Prices increase 40% or more when merging hospitals are closely located."
Generally, when "hospitals merge, prices rise for consumers and quality declines," according to Zirkelbach.
The issue of hospital consolidation was raised the Massachusetts Attorney General's Office preliminary report that found Massachusetts insurance companies pay some hospitals and doctors twice as much as others for essentially the same patient care. The report suggested the state's best-paid providers were the main driver of the state's soaring healthcare costs.
Attorney General Martha Coakley says the findings "raise concerns that existing systemic disparities in reimbursement may, over time, create a provider marketplace dominated by very expensive "haves" as the lower and more moderately priced "have nots" are forced to close or consolidate with higher paid systems.
The attorney general's report notes that the Massachusetts Association of Health Plans concurs with the findings that "approximately 75% of total healthcare costs" are attributed to price—not utilization.
"Although our investigation continues, it is clear that prices paid for healthcare services reflect market leverage," according to the report. "As a greater portion of the commercial healthcare dollar shifts, for reasons other than quality or complexity to those systems with higher payment rates and leverage, costs of the overall system will increase and hospitals with lower payment rates and leverage will continue to be disadvantaged."
Zirkelbach indicated that Massachusetts Attorney General's findings appear to be credible. In a statement, the Massachusetts Association of Health Plans noted, "The AG's interim report on provider payments is an important first step, but there are other aspects of healthcare costs that also need to be examined in order for there to be a more complete and balanced understanding of healthcare cost drivers and how to address concerns over rising costs. Increasing transparency and accountability among all healthcare stakeholders can only help this effort."
The American Hospital Association declined to comment on the Massachusetts report or the America's Insurance Plans assertion.
Spokesman Matt Fenwick referred to an AHA finding that it approves hospital pricing transparency, noting "people deserve meaningful information about the price of their hospital care. Hospitals are committed to sharing information that will help people make important decisions about their healthcare."
Potential climate change litigation affecting insurers may be just beginning. A potential flood of lawsuits "will pose a challenge" especially because of demands for insurance carriers to cover defense costs or other liabilities, says attorney Stephen Rosenberg of Boston, writer of the Boston ERISA and Insurance Litigation Blog.
"Everything eventually makes its way through the insurance industry, in terms of any types of new lawsuits or liability theories," Rosenberg wrote. "Litigation over climate change will be no different. The suits are coming."
While the credibility of any potential climate change lawsuit has yet to be determined, "they will pose challenges for the insurance industry because the development of theories of liability in this area will eventually lead to demands for insurance carriers to cover the defense costs or liabilities arising from those theories," according to Rosenberg.
Health insurers are being asked to react to potential climate change because of its potential to compound current health issues, such as asthma; people exposed to hurricanes and floods; heat-wave related health issues; and more airborne allergens, rising temperatures, greater humidity, wildfires, and dust and particulate pollution may "considerably exacerbate" upper respiratory disease and cardiovascular disease, according to the National Association of Insurance Commissioners (NAIC).
Rosenberg, whose legal specialty includes insurance law, says he expects climate change litigation against healthcare insurers to be similar to asbestos and pollution cases. "This will raise a whole host of issues for carriers that will mimic the types of issues that played out with regard to the large scale—and often unanticipated—exposure posed by environmental litigation and asbestos, only on a broader and probably even more complicated level."
From the insurers' standpoint, much of the argument may rest on "no credible evidence " that the climate change caused health damages. While insurers can "make holes" in any plaintiff arguments, the potential "defense costs alone will be huge," he says.
A worldwide insurer, Swiss Re, predicted last year that lawsuits related to climate change can advance quicker than asbestos litigation and have a significant impact on insurers. "We expect, however, that climate change-related liability will develop more quickly than asbestos-related claims and believe the frequency and sustainability of climate change-related litigation could become a significant issue within the next couple of years," Swiss Re stated in a report.
NAIC has adopted a regulation that requires insurance companies to complete an annual eight-question survey about their financial risks associated with climate change and what actions they are taking to respond to those risks. The survey will assess insurers' risk assessment and management efforts and allow regulators to follow up with questions if necessary, according to the NAIC.
The survey includes questions about what insurers are doing to reduce greenhouse gas emissions, whether they have a climate change statement of policy, whether they consider climate change as they choose investments, what they have done to encourage policyholders to reduce losses caused by climate-influenced events, how they are engaging their members on the topic of climate change, and how climate change could impact the insurer's investment portfolio.
The policy will require all insurance companies with annual premiums of $500 million or more to complete the Insurer Climate Risk Disclosure Survey and submit them to the state insurance commissioner where the company is domesticated. The first reporting deadline is May 1.
"Climate change will have huge impacts on the insurance industry, and we need better information on how insurers are responding to the challenge," said Pennsylvania Insurance Commissioner Joel Ario, who chairs the NAIC Climate Change and Global Warming Task Force, in a recent announcement about the new requirement.
The American Nurses Association (ANA) supports the Obama Administration's 2011 proposed budget that generally maintains previous funding levels for registered nursing programs. But the Visiting Nurse Associations of America (VNAA) says that "serious concerns remain" about possible budget cuts that could significantly impact home health.
Even the ANA, which praised the president's resolve to strengthen nursing programs, acknowledges most of the funding is not ideal.
"Obviously we would have loved to see an increase in funding," says Rachel M. Conant, associate director, department of government affairs, for the American Nurses Association, which represents 2.9 million registered nurses. "But with this economy, a lot of programs remained flat, and we're very fortunate. And I'm happy there is a commitment to nurse education funding."
The administration plans to spend $244 million toward the recruitment, education, and retention of 20,000 nursing students and registered nurses. The ANA said in a statement that the budget proposal "clearly demonstrates [the President's] continued commitment to strengthen the nursing workforce and improving access to health services."
If implemented, the new budget would channel funds toward "recruiting student nurses, training, and different workforce development programs for comprehensive education," Conant says.
Nursing is confronting a shortage among staff as well as faculty, which are needed for nursing instruction, Conant says. Nursing school enrollment and graduation surveys increased enrollments in bachelor's programs over the past year. Yet more than 40,000 qualified applications were turned away in 2009 because of faculty shortages, according to the American Association of Colleges of Nursing (AACN).
AACN officials applauded the administration's decision to keep level fund the Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) despite federal budget constraints.
The decision represents a 3% increase for the National Institute of Nursing Research, which would "advance nursing science and help to translate its initiatives for improved quality patient care," AACN president Fay Raines said in a prepared statement.
"President Obama has demonstrated a continued dedication to nursing education and research at a time when the economic reality adds significance to even the smallest increases," Raines said.
VNAA, however, stated in a press release that "serious concerns remain" about how much Medicare home health and hospice will be cut to achieve $150 billion in assumed savings over 10 years as outlined in the Obama budget proposal.
Andy Carter, VNAA president and CEO, said in a press release it is difficult to determine from the Obama plan how the administration expects to achieve those savings, adding that Medicare home health care cuts proposed in Congress range from $39 billion to $57 billion.
"We are extremely disappointed again with the high level of home health and hospice cuts assumed in the President's proposed budget," said Carter. "While we await details, all we can do now is continue fighting for a more moderate approach to these across-the-board cuts that threaten access to home healthcare, especially for vulnerable low-income, high-complexity patients served by nonprofit providers."
Carter added, however, that he was encouraged by proposals in the budget to strengthen Medicare anti-fraud actions.
Despite other issues in the budget, there is one area of nursing that would get a funding increase, Conant says. The White House budget includes $169 million—an increase of $27 million above the 2010 budget—for the National Health Service Corps (NHSC). The program is designed to deliver primary health providers, which includes nurse practitioners, to underserved areas. In exchange, these nurses would receive a portion of their student loans paid off.
The funding increase would add 400 NHSC clinicians to the more than 8,100 people currently in the program, she says. The program is designed to provide essential primary and preventative care services in healthcare facilities across the country.
State legislatures are getting fired up over health insurance.
In Virginia on Monday, the conservative Tea Party successfully spurred lawmakers in Richmond to endorse measures opposing any proposed federal government healthcare insurance mandates. On Tuesday, Kansas joined the fray, also opposing any insurance mandate. At least 31 states have enacted similar measures and several more are expected to follow.
"I see this as a political protest with positions being staked out, the battle lines being drawn," says Mark A. Hall, a professor of law and public health at Wake Forest University, regarding the states' actions. "The states are subject to federal law and that won't hold up in court," Hall says bluntly.
Health insurance leaders are watching the state lawmakers' decisions—and they are not happy about it.
"Experience in the states has shown that market reforms without a personal coverage requirement can have significant unintended consequences, including higher healthcare costs for current policyholders," says Robert Zirkelbach, spokesman for America's Health Insurance Plans, the insurance lobby.
Despite the fanfare, other legal experts agree with Hall that the states' decisions don't appear to have much legal clout. State representatives say otherwise.
Altogether, 35 states are expected to file amendments to their state constitutions or statutes rejecting health insurance mandates, according to the American Legislative Exchange Council, a nonprofit group that promotes limited government. It is coordinating the state effort.
Under the state anti-mandate plans, each state would assert a state-based right for people to pay medical bills from their own pocketbooks and prohibit penalties against those who refuse to carry health insurance. The movement began to pick up steam after the Massachusetts election gave Senate Republicans the filibuster power to halt healthcare reform legislation.
Besides Kansas and Virginia, the states that have filed amendments banning mandatory health insurance are: Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Washington, West Virginia, and Wyoming.
"This is a battle that has been fought before and won before," says Christie Herrera, director of ALEC's Health and Human Services Task Force. "States may protect individual liberties to a greater extent than the U.S. Constitution allows. And the courts must balance the competing interests."
But constitutional law experts question the legal impact of the state measures because of what they term the overriding clout of the federal law.
The country has a long history of states fighting the federal government over the priority of laws, stretching to the early days of the Republic, according to Michael Dorf, a constitutional law professor at Cornell University. "Federal law prevails in this country," he says.
Referring to the rash of state legislation opposing insurance mandates, Dorf says, "The point is for state legislators to convey to their constituents how they feel, and in turn that message to their congressmen—to keep them from acting. … The audience is really the congressional delegation."
Health plans are supporting the Obama Administration's 2011 proposed budget in areas of combating childhood obesity, initiating wellness programs, creating smoking cessation programs.
The largest allotment is $1 billion to improve children's access to healthy meals through reauthorization of the school meals program and other child nutrition programs.
The anti-obesity plan reflects what many insurers say they are trying to do.
First Lady Michelle Obama has been the key figure in the administration's efforts to combat obesity.
"The First Lady is encouraging a comprehensive, collaborative approach in the community to address childhood obesity," says Trish Hubbell, spokeswoman for Blue Cross Blue Shield of Michigan. "This is similar to the way in which [we] are tackling this problem."
"Obesity is a major contributor to such chronic diseases as cardiovascular disease, Type 2 diabetes, and certain forms of cancer, "Hubbell says. "We know that healthier lifestyles would reduce the prevalence of these diseases, reduce healthcare costs, and improve quality of life."
Elizabeth Sell, spokeswoman for Aetna, also supports the plan. "Aetna agrees wholeheartedly with Mrs. Obama that the fight against childhood obesity should be a national health priority," says Sell. "The initiatives are in alignment with many initiatives currently being supported by Aetna, particularly in the areas of creating health work sites, mobilizing the medical community, and improving the health of our communities."
In the proposed 2011 budget, the Obama administration also seeks to allot some $10 million in a federal employee workplace initiative to implement prototype wellness programs with a goal of healthcare promotion and lower healthcare costs.
"This initiative will implement prototype wellness programs in select locations that will be rigorously evaluated for their ability to produce a healthier workforce and lower healthcare costs," the budget document stated. "By encouraging the adoption of these programs, we can improve the productivity of our workforce, delay or avoid many of the complications of chronic disease, and slow medical cost growth."
In addition, the administration proposes more than $20 million for a Center for Disease Control and Prevention initiative to reduce the rates of morbidity and disability because of chronic disease in up to 10 of the largest cities. These cities will be able to incorporate the lessons learned from implementing evidence-based prevention and wellness strategies of the Recovery Act's Communities Putting Prevention to Work Initiatives. Officials of the federal Department of Health and Human Services were not available to comment on the specific plans.
Obama administration officials also announced plans to spend $954 million to help prevent smoking and tobacco use.
Overall, health plans support the efforts to "promote [disease] prevention and wellness, and encourage people to live healthier lifestyles," says Robert Zirkelbach, spokesman for America's Health Insurance Plans. "In fact, health plans have pioneered programs to promote [disease] prevention, address obesity, and help people to quit smoking."
HealthNet Inc., today announced a net loss of $49 million for 2009, as well as fourth-quarter earnings losses, which the company attributed to the sale of its Northeast business and company strategies related to other transactions, according to the company.
The reported adjusted net income for the full year of 2009 was $235.1 million, which is compared to adjusted net income for the full year of 2008 of $199.1 million.
The fourth-quarter report in 2009 showed a net loss of $45.2 million, or $.43 per share.
The fiscal losses in the fourth quarter related to:
$137.3 million in charges related to the Northeast businesses, including $105.9 million for the loss on the sale, as well as $27 million in cash charges, primarily for legal and regulatory costs, and fees and severance related to the sale. The company finalized the sale of the Northeast businesses on December 11, and received $350 million in cash at closing, according to Health Net.
$15.3 million in cash charges related to the company's operations strategy and other expenses.
Despite the news, HealthNet officials are upbeat.
"We are pleased with our fourth quarter and full-year 2009 results," said Jay Gellert, president and chief executive officer of Health Net Inc, the Woodland Hills, CA-based health insurer with more than 6 million members. "We completed our strategic review and closed the sale of the Northeast businesses. Also, as expected, our Medicare Advantage and Part D businesses returned to a solid level of performance after a difficult 2008."
"We are very pleased with our operating performance in 2009, especially in light of a challenging environment," said James Woys, Health Net's chief operating officer. "For example, commercial healthcare costs in the fourth quarter were adversely affected by higher utilization related to both the H1N1 flu and COBRA. Excluding these two effects, the commercial medical care ratio in the Western health plans improved both quarter-over-quarter and year-over-year."
"We believe we are well-positioned to attract customers seeking value in these challenging economic times with our low-cost, narrow network products. We continue to believe that we can achieve our 2010 full-year earnings guidance," said Gellert.
First Lady Michelle Obama is taking on a bloated nation and health insurers may one day have to help.
Health plans are now trying voluntarily with wellness, fitness, and disease management programs, but those offerings could become mandatory as the nation searches for ways to reduce health costs. Will insurer programs help pare the pounds?
While the First Lady gets ready to launch a major anti-obesity initiative, the beer ads, and fast-food ads will be a part of the Super Bowl commercial ritual. While watching, the calories will pile on probably a lot more than tacklers taking on Peyton Manning.
America is a contradictory place.
Michelle Obama announced her crusade against obesity, particularly child obesity, last week in a news conference with Health and Human Services Secretary Kathleen Sebelius. Later next week, she is expected to finalize her specific plans and announce those proposals.
Execs who run health plans aren't exactly sure what she'll release, but nobody seems to be worried about any "requirements." Indeed, the Obama Administration's war against fat has trimmed down, reflective of the overall healthcare package, which is being sliced and diced in the Senate and House conference rooms.
When Obama and Sebelius announced their plans to combat obesity, they emphasized the importance of wellness plans, being initiated across the country by employers, various health advocacy groups, and insurance companies.
Indeed, in some respects the administration is putting its money where its mouth is: a few days after the announcement, the White House's proposed 2011 budget was released, which includes plans to reduce childhood obesity rates by budgeting $1 billion to improve children's access to healthy meals, and include $10 million in a federal employee workplace initiative to implement prototype wellness programs.
No mention was made about putting any "requirements" on insurance plans.
That wasn't the case when Sebelius spoke in July 2009 before the Centers for Disease Control and Prevention at a "Weight of the Nation" conference. At that time, Sebelius noted, "The President and First Lady have made investing in prevention and wellness one of their top priorities."
"It's why we're going to require health insurance plans to cover preventative services like the kind of counseling and care that can help people lose weight or keep the weight off in the first place," she said.
These days, as the Obama Administration rather quietly tries to salvage the healthcare reform package, nobody mentions requiring health insurance plans to cover preventative programs.
"We always have difficulties with well-intentioned but unfunded mandates," says Don Bradley, chief medical officer and senior vice president at Blue Cross Blue Shield of North Carolina. "But we are doing (wellness and other programs). The thing is we don't know what works in combating obesity. It's important to launch these projects carefully and analyze what works and what doesn't." The problem isn't simply a matter of burning calories, Bradley says. "It's the behavioral part and the environment."
Insurance has a difficult and contrary role in the nation's fight against fat. On one hand, patients complain about insurers not supporting enough conditions linked to obesity, insurers insist they are doing more than ever to prevent obesity to begin with.
"We strongly support efforts to fight the obesity epidemic—that's a top priority," says Robert Zirkelbach, spokesman for the America's Health Insurance Plans, a major lobby for insurers.
Elizabeth Sell, spokeswoman for Aetna Communications, says the government plan to combat obesity is in alignment with many initiatives currently being supported by Aetna, says Sell.
The stars aren't all aligned. There are just so many issues that tangle insurance and obesity.
"The countless number of available insurance plans and ever changing policies have made it difficult to assess the extent to which obesity treatment and preventions services are covered by third-party insurers. More data is necessary to determine the health needs of persons with obesity," according to the American Obesity Association.
So far, the government has been waging a losing battle against expanding waistlines.
From 1980 to 2004, the prevalence of obesity more than doubled among adults and tripled among children and adults, according to Sebelius' office. Currently, two-thirds of adults and nearly one in three children are overweight or obese. That totals $150 billion a year, which is more than it would cost to treat all the cancers in America, she said. Clearly we're doing something wrong.
Whatever is needed, more insurance plans are getting involved in wellness programs and trying to obtain that data about the health needs of persons with obesity, requirements or not. There are assorted programs out there. And the health plans say they are achieving results.
A study by CIGNA's Healthy Steps to Weight Loss program says its 7,500 participants have lost an average of 9.4 pounds. That's progress.
Health plans also have joined an initiative of the American Heart Association and the William J. Clinton Foundation—the Alliance Healthcare Initiative—aimed at working together to combat childhood obesity. They seek to make together to make sure children get the insurance coverage they need—and the big thing: Insurers are part of the process.
The involvement with wellness programs happens, one bite at a time. It's not all smooth. Last October, HealthLeaders Media reported that an interim final rule from the Genetic Information Nondiscrimination Act of 2008 (GNA) could cripple wellness, disease management and population health management programs, according to employer and wellness groups, health insurances and DMAA: The Care Continuum Alliance.
The law prohibits employers from using generic information for coverage and employment decisions, ranging from promoting to firing. The Wall Street Journal this week quoted some employees saying the law "is stymieing their efforts" to promote employee wellness because it bars them from offering financial incentives about family history.
But Jeremy Gruber, president of the Council for Responsible Genetics, says the Genetic Information Nondiscrimination Act (GINA) poses "only minor limitations on wellness programs and these limitations are easily overcome." As Gruber sees it, wellness programs are—well, OK.
So wellness programs are advancing, with the dollars being poured into them by the Obama Administration. When you "have to" be on a diet, it's tough.
Insurers aren't crazy about being forced by the government to help America shed pounds. The way they figure it, with the wellness programs, the more everyone loses weight, the more health plans gain.
