By Wendell Potter
Should he sign a bill that was intended to help many state residents get coverage for cost-effective health care that insurers often refuse to pay for?
Or veto the bill because it is loaded with amendments that will benefit insurers and force many Missourians to pay far more for medical care than they do now?
Senate Bill 262, introduced by Sen. Kiki Curl, D-Kansas City, would require insurers to pay the same for specialty care delivered via telemedicine as for an office visit. Similar bills have been enacted in other states, including Arizona just last month.
But in Missouri, Democrats are now regretting voting for the bill because of amendments added at the last minute that will result in a financial windfall for insurance companies, agents and brokers at the expense of residents.
SB 262 would enable insurers to achieve one of their top objectives: converting HMOs into high-deductible plans. (MORE)
HMO customers enjoy relatively low copayments when they get care from in-network doctors and hospitals. The bill would remove the current requirement that HMO cost sharing be “reasonable” and allow HMOs to impose high deductibles and coinsurance — up to $3,100 for an individual and $6,250 for a family — in addition to copayments.
If Nixon signs the bill into law, Missourians in HMOs who are unlucky enough to get sick or injured next year will have to shell out thousands of dollars more to pay for their care.
Insurers could avoid paying for necessary care in yet another way under the bill as amended.
HMOs would be able to reduce the size of their provider networks, meaning their enrollees would have far fewer choices of doctors and hospitals. HMO members needing care from a specialist not in the network would not be covered.
Insurers would win in another important way.
The bill would reduce from 60 days to 45 days the amount of time the state’s Department of Insurance would have to review and approve a new or modified health insurance policy. If the department doesn’t act within 45 days, the policy would be deemed approved.
Most state insurance departments already are inadequately staffed and resourced. Cutting the review and approval time by 15 days would mean that insurers would gain a significant advantage by being able to sell policies that do not meet federal and state standards.
As if all of this weren’t bad enough for consumers, the amended bill would also make it unlawful for anyone other than a licensed agent or broker to give advice or recommendations to any Missourian about choosing a health plan.
This would be a major victory for agents and brokers who are concerned that their incomes might take a hit when people start shopping for insurance on the online health insurance marketplaces or exchanges that states must have up and running by Oct. 1.
The amendment is an apparent violation of federal law, which states that individuals other than brokers and agents who complete a certain level of training can serve as “navigators” to help people choose plans that are best suited for them.
As now worded, the bill would bar social service organizations from helping low-income people who can’t afford to hire an insurance agent.
Nixon undoubtedly was eager to sign SB 262 before all the special interest-backed amendments were added. It was the first bill sponsored by Curl, a Democrat, who said she was motivated because of the role telemedicine played in saving the life of her father.
Regrettably, the best thing for Nixon to do now is exercise his veto and ask lawmakers to send him a clean bill during the next legislative session. If he signs it, more people will be hurt than helped by SB 262.
Just think on this as you begin to understand what is coming down the pike as October 1st looms closer: CIGNA claim denial rate runs upward of 21%. This is double and triple the denial rates of other HMO insurers.