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Shelly Bloom is president of the Pennsylvania Association of Health Underwriters (PAHU), an organization made up of licensed insurance professionals who specialize in health insurance and employee benefits. She can be reached at 717-412-3004 or [email protected]

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Now that the U.S. House of Representatives voted to repeal President Obama’s Patient Protection and Affordable Care Act (PPACA), some in the media are saying that this vote was empty since the Democratic controlled Senate would not concur. I respectfully disagree.

Independent from political rhetoric and recognizing that health care cost controls need to be enacted, a big underlying reason for the vote is a belief that PPACA is an expansion of the federal government amounting to in effect to a government takeover of the American health care and health insurance system. Many Democratic supporters of the new law say that this assertion is incorrect in that government is not explicitly taking over health insurance.

Their view stems from their rendering of the word “takeover.” If defenders of the PPACA define it as the government coming in and directly operating all the insurance companies as it did with General Motors, then, technically, they are correct. However, control is another type of takeover. If you conclude that government rewrote the rules for health care and micromanages how the entire health insurance system operates under its direction, then that’s a de facto takeover.

Please read the following statements below and decide for yourself whether or not the Patient Protection Affordable Care Act is a federal takeover of our healthcare system.

• The McCarran-Ferguson Act passed in the 1940s said that states regulate insurance. Now the federal government regulates health insurance or tells the states how they will regulate health insurance.
• The U.S. Department of Health & Human Services (HHS) now gets to review any health insurance price increase more than 10%, according to its Dec. 21, 2010, statement, something formally reserved for the state insurance departments.
• Any health insurance plan that is not grandfathered (in place before March 23, 2010, without any reductions in benefits) must provide first-dollar payment by an insurance company for preventive care services as defined by an HHS committee.
• The states used to have the power to decide what minimum benefits a plan would have. By 2014, HHS will decide what coverage is included for all plans.
• Until faced with tremendous public pressure and forced to reverse itself, HHS even said that a business which did not reduce benefits and simply changed insurance companies to get a better deal would lose its grandfather status and have to include all the new benefits and resulting increases in premiums.
• The new law dictates how much an insurance company can have to pay its bills, pay for marketing, employee salaries, utilities, investments, etc. Although the goal is to have the lion’s share go toward medical claims, its consequence will be to drive smaller companies out of the market altogether because they may not be able to make this government-dictated arbitrary level. If the federal government dictates what a private sector insurance company spends premiums on, is that not control?
• A federal requirement that everyone have health insurance or pay a fine sounds like a takeover. A federal requirement that businesses over a certain size have to offer health insurance or pay a minimal fine sounds like the government wants businesses to stop offering health insurance to employees and instead put them into the new government-sanctioned health insurance exchanges, where people can compare prices and buy coverage. The nice tax credits to help individuals purchase insurance is only available if the insurance is in the exchange and private-sector companies outside of the exchange are frozen out of offering the subsidies.
• A good example of this slippery slope toward government taking over health care is found with the much-touted small business health insurance premium tax credits, which will only be eligible for businesses giving up the private sector for the government-run exchanges in 2014.

In this legislation of over 2,000 pages, there are numerous other examples of the federal government showing a bias against the private sector and for its own control over health care but these examples of health insurance takeover/control serve to get the point across.

The Patient Protection and Affordable Care Act is social engineering by a federal government that believes that it must control health care and health insurance. Hopefully, if repealed, Congress can look at what health insurance and health cost control legislation will better meet the goals of reform without a government takeover.

7 Responses

1. Rosie Says:
   January 24th, 2011 at 2:58 pm

   If the PPACA is repealed, chances are that Congress will do NOTHING to deal with out of control health care costs. If you honestly think they will, then I cannot help but wonder about your intelligence.

2. Alan Davidson Says:
   January 25th, 2011 at 2:34 pm

   Really Rosie?

   My premiums went up three times since the new plan and I even received a new increase last week and the reason stated in the letter was “due to the new Affordable Health Care Act”.

   In addition, my drug prices have gone up and my deductible went up. All while this ObamaCare came about.

   So tell me Rosie, how did this fantastic plan “deal with out of control health care costs”?

3. Chris Says:
   January 25th, 2011 at 2:58 pm

   Nice article but if you think PPACA is a takeover then you’re obviously a Nazi. Just ask Rep. Cohen.

   Rosie, you imply that health costs have gone down, or will, under PPACA. Where is your evidence? Gas and grocery prices have gone through the roof recently. What should/can congress do about that?

4. Broker Says:
   January 26th, 2011 at 11:35 am

   Shelly writes: If you conclude that government rewrote the rules for health care and micromanages how the entire health insurance system operates under its direction, then that’s a de facto takeover.

   If that is the definition, then government took over the health care industry a long, long time ago. HIPAA was passed in the 1990′s by Clinton and a Republican Cogress. It micromanages the entire health insurance system. ERISA was passed in the 1970′s by Richard Nixon and a Democratic Congress. It rewrote the rules for health care. And of course there is Medicare passed in the 1960′s which did both. On top of the fact that the U.S. Government is the largest purchaser of health care services in the world (through Medicare, Medicaid and the Veteran’s Admin) I would say that the government takeover of health care occurred way before Obamacare.

5. Rich Says:
   February 1st, 2011 at 9:26 am

   One of the reasons health insurance premiums are out of whack with other products in our economy is due to government interference and dictate. Telling insurance companies they have to refrain from underwriting accurately, or that they must cover people with preexisting conditions with the same premium pricing as health individuals, etc, causes the insurers to adjust their premiums upward throughout the premium-paying population.

   Imagine if government mandated that auto insurers cover horrendous drivers with numerous marks against their driving record such as speeding, drunk driving, and numerous accidents. Now, imagine that these people can not be charged rates higher than everyone else. Do you actually think auto insurance rates would NOT skyrocket into the stratosphere? That’s essentially what has been going on with health insurance, particularly with the more heavily regulated states. The more state mandates, the higher the premiums. If Rosie can’t understand that, it is she that needs her intelligence checked.

6. Tom in Palm Springs Says:
   February 3rd, 2011 at 9:49 pm

   Nothing, let me repeat that NOTHING in this article suggests the government is doing anything to interfere with the healthcare you will receive from your doctor.

   It’s about a law requiring powerful out of control insurance companies to do things like:

   *keeping annual premium hikes under 10%

   *spending at least 80% of the money they take in via premiums on claims (what a radical government takeover idea)

   *keeping parents from getting insurance because they have a child with a pre-existing condition

   *doing away with no coverage for pre-existing conditions, the biggest money maker for the insurance companies

   *promoting the novel idea that in America everyone should have healthcare insurance (i’m tired of paying for the healthcare of 30 million people or more via higher premiums which is what it comes down to. They must pay their fair share through a government subsidy if necessary.

   This article is about someone who sees their cut of the pie shrinking, and doesn’t like it.

   Sorry there isn’t much in the bill that will make your life richer, Ms. Bloom.

   We should sit down and have a heart to heart conversation someday. Problem is, we’d be short a heart.

   Tom in Palm Springs, retired, 35 years in the insurance business, Liberty Mutual, Travelers, Hartford.

7. Tony Ondrusek Says:
   February 4th, 2011 at 9:37 am

   Tom, I respectfully disagree with several of your key points (and a few I agree with):

   1. Annual premium hikes can and should be regulated, but the underlying cause — the actual COST of health care — must first be addressed. This law does nothing — ABSOLUTELY NOTHING — to address health care costs. All it does is deal with insurance companies and who pays for what. It is sort of liking putting restrictions on grocery stores regarding the price of lettuce, when the store has nothing to do with the cost of labor, drought, fertilizers, state laws and taxes, transportation costs, and the like that dictate the cost of the lettuce BEFORE it is sent to the grocery store.

   2. Dictating what a company spends on claims (80% or whatever) is highly irresponsible. Controlling profit margins, while equally irksome and distasteful, is more workable. Telling you, as an agent, that you are only allowed to spend a certain portion of your revenue on gasoline or phone calls could severely hamper your ability to make a profit. Telling a car repair shop that they have to spend a certain amount of their revenue on oil, or a certain kind of wrench, is not smart. But keeping a check on profits (health insurance carriers have a margin of around 4% tops, which is small to begin with) might be a better answer. But still, the entire idea is a bad one.

   3. Non-profits and high-risk pools could be set up to deal with pre-existing conditions, etc., but expecting, for example, that GEICO can adequately provide coverage for someone with a history of totaling five cars at the same rate as someone who has never had an accident is just plain illogical. Systems could and should be set up to humanely deal with hard-luck cases, but telling carriers that they must accept all hard-to-place cases yet not raise rates doesn’t add up, at least not on my calculator.

   4. Everyone who drives should have auto insurance, yet you and I pay for those who do not. That will never go away, and will be the same with health insurance. If what you mean is that everyone should have access to health care, that is an entirely different scenario. And that can be addressed without putting irrelevant laws on the books.

   Finally, your first assertion that this law will do nothing to interfere with the care you receive from your doctor is woefully misinformed. Since those who receive insurance from their employers will likely not be able to keep the insurance they had (President Obama made a big boo-boo with claiming that everyone would be able to keep their coverage if happy…just not true), they may find that they have to find new doctors. That is, if they can find them. If you think that is not the case, do a simple google search for “shortage of doctors” in England, or Canada, or anywhere else where socialized medicine is law. Doctors are leaving the business and there is a dearth of new people who want to get into the business. Here in Baltimore, we have Johns Hopkins Hospital, constantly ranked #1 in the world. They have entire wings devoted to people from other countries, and local hotels cater to patients and their families from other nations. It is big biz here. Can you name me one — not 10, and not even 5 — but just one hospital in another country where Americans routinely flock for superior coverage?

   Yes, our system needs some fixing. But turning it over to a government that has made Medicare, Medicaid, Social Security and the IRS into behemoth examples of inefficiency and corruption is not the right way to do it.

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