Public Option? Not So Fast, Say Health Insurers

 The nation's biggest health insurers are making it perfectly clear to lawmakers looking to fulfill campaign promises to establish a public option: you will face a massively financed lobbying and PR campaign if you even try.

And this isn't just in Washington. The industry has unleashed campaigns in at least two states so far -- Colorado and Connecticut -- where legislators are hoping to establish state-based public option plans.

Why do insurers care so much? When the status quo is extraordinarily profitable for most of them, they don't want a new competitor that might disrupt the insurance market. As a result, they're funneling millions of dollars collected from policyholders and taxpayers into what for all practical purposes is a front group to protect their ever-increasing profits.

Just recently we learned that CVS Health, which owns Aetna, alone poured $5 million into that group -- the Partnership for America's Health Care Future -- which is funded primarily by insurers and for-profit hospital chains, and run out of the PR and lobbying firm Forbes Tate.

The legislation in Connecticut facing fierce opposition from the insurers has the backing of State Comptroller Kevin Lembo and several Democratic legislators, but Gov. Ned Lamont (D) has remained quiet on the bill so far.

To try to move the governor into their camp, the CEOs of five insurers that do business in the state, including two that are based there, Cigna and Aetna, sent him a letter this month implying they would move jobs out of the state if the public option bill became law.

This tactic worked 2 years ago when lawmakers seemed to be on the verge of getting a similar bill to the governor's desk. According to published reports quoting Lembo, Cigna CEO David Cordani threatened that the company would leave Connecticut if a public option was established -- and this was despite the fact that Cigna doesn't sell coverage on the state's exchange and has relatively few large group customers in Connecticut. Cigna acknowledged it lobbied against the bill but denied the threat.

In response to the letter to Lamont, signed by CEOs of companies like Anthem and Cigna, Lembo issued a statement noting that insurers posted record profits during the pandemic and asked, "When will enough be enough ... Are legislators going to serve their constituents or do five corporations determine what becomes law in our state?"

Lawmakers and Connecticut residents are also hearing from Connecticut's Health Care Future, an offshoot of the Partnership. The Partnership spent heavily on TV and social media ads in Iowa and other states in the run-up to the Democratic primaries and caucuses last year. The ads attacked both Medicare for All, supported by Senators Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.), and the public option, which President Biden and other Democratic contenders backed.

Consistent in all the ads were messages like the ones I used to help write for similar front groups when I led communications at Cigna and worked with my peers across the industry to squash reforms our companies didn't like. The Partnership's ads claim that Medicare for All and even a public option would lead to higher taxes, job losses, and long waits for care. Left out of the ads: any mention of the fact that people would no longer have to pay premiums to insurers if they could enroll in Medicare or a public option.

The Partnership's affiliate in Colorado, Colorado's Health Care Future, is using essentially the same messaging, even though the legislation in that state is substantially different from the Connecticut bill. The Colorado legislation would give private insurers 2 years to begin to bring down the cost of healthcare, and the public option would only go into effect if they could not achieve the benchmarks set by the bill. One of the group's claims in Colorado is that a public option would lead to the closure of rural hospitals in the state. No mention is made of the fact that one of the Partnership's funders, HCA Healthcare, recently disclosed that its Colorado hospital's profit margins were more than 40%.

For-profit insurers are bigger, richer, and more powerful than ever. Recent mergers and acquisitions have bulked these companies up to the point that CVS Health is now No. 5 on the Fortune 500 list of American companies. UnitedHealth Group comes in at No. 7.

Their growth has been primarily at the taxpayers' expense. A whopping 72.4% of UnitedHealthcare's revenues in the U.S. during the first quarter of 2021 came from their government business, primarily through Medicare Advantage, Medicare Supplement plans, and the state Medicaid programs they manage. For several quarters, those programs have been their biggest -- and often only -- source of enrollment growth.

Medicare Advantage in particular has become a cash cow for big insurers. And history shows that the companies conduct business right on the line of what is legal -- often crossing it to maximize profits. Just recently, an analysis by HHS found that Humana overcharged CMS by nearly $200 million in just a single year (2015).

Insurers spend huge amounts lobbying Congress to keep the federal spigot flowing. And they have ramped up their Washington lobbying budgets to new heights this year, not only to protect their Medicare Advantage profits and to secure tax dollars to cover laid-off workers' COBRA premiums, but also, to keep a public option at bay. America's Health Insurance Plans spent more money lobbying Congress during the first 3 months of this year -- $3.9 million -- than any prior quarter. Centene, a big player in Medicare Advantage and Medicaid, increased its first quarter lobbying spend by 80%.

The big insurers have gotten bigger and more profitable as they've figured out how to game the system to their advantage in Washington and state capitals -- and they are prepared to spend whatever it takes to maintain that advantage. They certainly do not want a new competitor in the game that might be able to change the rules they've established. The status quo -- and its emphasis on profits over care -- suits them just fine.

Wendell Potter is a former vice president of Cigna turned whistleblower against the health insurance industry. He now leads the non-profit Center for Health & Democracy. After leaving the industry in 2008, he testified before Congress about the industry's abuses and became an advocate for systematically reforming America's healthcare system.

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/92368