WASHINGTON,
D.C. — The health insurance industry is working on a transformation
that could come right out of "Extreme Makeover."
Long cast as
villains for denying coverage or refusing to pay for treatment,
insurers now are representing themselves as indispensable partners in
health care overhaul.
In their pitch to lawmakers, the companies
say they are in a unique position to help improve quality and root out
waste, saving money so everyone can be covered.
"They are making
inroads," said John Rother, public policy director for AARP. "They are
getting past the rhetoric and starting to talk about more concrete
ideas for improving quality and getting value."
In a big change
from three or four years ago, insurers are writing bigger campaign
checks to Democrats, now the party of power in Washington. The
insurance industry gave $10.7 million to Democratic candidates for
federal office in the 2006 elections, according to OpenSecrets.org.
Last year, it was $20.7 million.
The stakes are high.
If
the industry’s pitch succeeds, insurers will be guaranteed many more
customers. The industry wants all people in the United States to be
required to carry medical coverage, with government providing financial
help for those who cannot afford it.
Even if insurers end up making less per customer because of anticipated consumer safeguards, they still could come out ahead.
But
if the overhaul that President Barack Obama has promised goes against
them, insurers could find themselves trying to compete against a new
government-run health plan offering cut-rate premiums to middle-class
families.
That’s exactly what many liberal Democrats want, and Obama hasn’t taken the option off the table.
"No
one is naive enough to believe that insurers aren’t going to have
problems with parts of this," Rother said. "But they are pushing back
in a rather quiet way."
Said Karen Ignagni, president of
America’s Health Insurance Plans and the industry’s top strategist in
Washington: "We understand we need to come to the table with very
specific solutions."
Ignagni is hedging her bets by building
ties to groups such as small businesses, whose conservative outlook and
grass- roots clout could be crucial.
Yet the industry has won a measure of respect from some longtime adversaries.
"I
have seen very few groups, including the insurance industry, that are
willing to exercise the nuclear option and torpedo reform," said Ron
Pollack, executive director of Families USA, a liberal advocacy group.
"They have participated in a good faith manner."
Others on the
left are not convinced. "Private insurance is the problem," said Carmen
Balber of Consumer Watchdog, a California-based group. "Individuals
can’t afford to be forced into buying private insurance."
If insurers have come to see government as a partner, that’s not as strange as it may seem.
Employer
coverage has dwindled in recent years, but government programs for
older people, children and the poor have grown into a vital business.
The
Medicare prescription drug benefit is delivered by private insurers.
Also, about 10 million older people are signed up in Medicare managed
care plans. Many states operate their Medicaid programs through private
insurers. The same goes for the federally backed State Children’s
Health Insurance Program.
Government programs "are a significant
contributor to growth for us," said Angela Braly, chief executive of
Wellpoint, which covers 35 million people in 14 states. "We think we
can be a significant part of the solution for the uninsured."
Insurance
companies can do more than just pay claims, Braly said. They can use
the data in their files to monitor whether doctors and hospitals are
providing the right level of care not too little, not too much.
For
example, a soon-to-be released study by Wellpoint looks at treatment of
back pain, a condition that costs roughly as much as cancer or diabetes
to treat.
Most back pain clears up in about six weeks, and
national guidelines recommend postponing surgery and sophisticated
imaging tests. But the study found that 35,000 patients had imaging
tests and an additional 1,000 had surgery before the six weeks were up.
Potential savings over a 12-month period: $23.6 million.
In the future, insurers could use such findings to cajole doctors into changing the way they practice.
"We think we can play a central role in delivering value," said Braly.
Wellpoint
says such studies don’t always endorse the low-tech option. Its
research also found that a costly medication for multiple sclerosis was
worth the investment, because it helped patients avoid relapses. But
there’s concern that insurers and government could one day use such
studies to deny coverage for expensive new treatments and diagnostic
tests.
It’s hard to tell whether the industry’s makeover will work.
So
far, the Obama administration doesn’t seem to be sold. While Obama
invited Ignagni to the White House health care summit, he’s also asking
Congress to slash payments to private insurance plans in Medicare. Far
from being efficient, Obama says the plans get 14 cents more on the
dollar than it costs to care for older people in the traditional
program.
On the net: White House health care agenda: www.whitehouse.gov/agenda/health_care/
