As members of the health insurance community crowded into Seattle this week for the America’s Health Insurance Plans (AHIP) annual meeting, the war over efforts to control costs heated up.
AHIP opened the AHIP Institute event by offering a package of efforts to tweak the Patient Protection and Affordable Care Act (PPACA) to make health insurance system change easier on patients.
AHIP Chairman Mark Ganz, the president of a Portland, Ore., carrier — Cambia Health Solutions — greeted attendees with a blog entry emphasizing health insurers’ deep concern for the well-being of patients. He talked about Cambia’s new palliative care for people with serious illnesses.
While Cambia was greeting meeting exhibit hall visitors with Stumptown coffee, and MedImpact — a company that uses a drug-by-drug bidding process to choose mail-service drug providers — was drawing visitors to its booth with organic, vegan Mighty-O Donuts donuts, the House Energy & Commerce health subcommittee was holding a hearing on the effects of PPACA on patients’ access to health care providers and prescription drugs.
Dr. William Harvey, a radiologist, talked about how health plan provisions that have little effect on healthy patients, such as $60 co-payments for “specialty drugs,” may have a severe effect on patients with conditions such as multiple sclerosis and rheumatoid arthritis that may respond best to expensive biologic treatments.
“Many patients decline the treatment based on cost,” Harvey said, according to a written version of his testimony posted on the committee website. “In many cases, when patients fail to access these treatments, they become disabled and can no longer remain in the workforce, thus costing the federal government money on disability.”
Harvey and Monica Lindeen, the Montana insurance commissioner and president-elect of the National Association of Insurance Commissioners (NAIC), also talked about the effects of narrow or rapidly changing health plan provider networks.
Limiting network size clearly helps lower coverage costs, Lindeen said. “It is important for regulators to be mindful of the premium impact of requiring insurers to maintain broader networks,” she said. But “we must also be vigilant about cost-cutting measures that negatively impact the quality of care that patients receive.”