Insurers Spin Court Decision on Health Insurance Mandate

When I testified before Congress last year, I told lawmakers that if they passed a health care reform bill with an individual mandate but no public option, they might as well call their bill the “Health Insurance Profit Protection and Enhancement Act.” Well, of course, that is exactly what Congress did, but they didn’t change the name of the new law as I suggested.

I was as upset as anyone that the public option was stripped out, but I nevertheless later said that Congress should still pass the bill because of the protections it contained against common predatory practices by insurers, like canceling breast cancer patients’ insurance in the midst of treatment and refusing to sell coverage at any price to people with pre-existing conditions. The bill also expands Medicaid to encompass several million Americans who cannot afford to buy overpriced and often inadequate health insurance.

I have no doubt the insurance executives I used to work with were doing high fives when the public option bit the dust, and their favorite part of the bill — the mandate that will require us to buy their insurance products if we’re not eligible for an existing public plan like Medicare, Medicaid or the VA program — became the law of the land.

After the recent ruling by the federal judge in Virginia that the mandate to purchase health insurance is unconstitutional, however, I’m sure my old buddies who are still in the industry are downright apoplectic.

As I noted in my essay in Newsweek last month, the insurers, and the Republicans they helped to elect to Congress, have a real dilemma on their hands. The Republicans led voters to believe that the new health reform law represents a “government takeover” of our health care system (it certainly does not, not by a long shot) and promised to “repeal and replace it.” Several politically-ambitious GOP attorneys general (and one Democrat) filed lawsuits challenging the constitutionally of the individual mandate so prized by the insurers.

Now that the Virginia judge has sided with those AGs and other plaintiffs, the insurance industry flacks (like I used to be) are now spinning in overdrive.

Check out the Bloomberg story about the judge’s decision. The headline alone says it all: “Lack of Health Mandate Would Lead to Skyrocketing Costs, Insurers Say.” Read it if you’re interested in seeing how the insurers are spinning this story, and how they will continue to spin it until Congress and the Republican-appointed judges drop their charade of dismantling the new law. What they really want to accomplish, and what consumer advocates need to keep an eye on, is having Congress figure out how to strip out the new regulations and consumer protections in the law. That’s what they don’t like.

Why? Because Wall Street doesn’t like them. Investors are afraid that if insurers have to play fair for a change, they won’t make as much money. They have enjoyed skyrocketing profits lately, especially this year. The prospect that a reform law would include decent consumer protections but no individual mandate scares the bejesus out of them. Hence, the spin that we are in for skyrocketing health care costs if the Virginia judge’s decision is upheld.

The thing to keep in mind is that, despite the headlines and hype, this is just one judge’s opinion. Others have gone the other way. We are a long way from knowing if, and how, the new health reform act will ultimately be implemented.

Watch this space.

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9 thoughts on “Insurers Spin Court Decision on Health Insurance Mandate”

  1. I can’t thank you enough for writing your book and for educating all of us about the health care industry. I really appreciated the book and appreciate your continuing articles to update us on what is happening. I am currently unemployed, hoping for continued unemployment benefits while continuing to look for work. If work is not forthcoming I may have to become a political activist. How do you suggest a 59 year old non politician get started in trying to be one? 🙂 Any way – thanks again for all that you do.
    Janene Bendrick
    Harrisburg, PA

  2. I thought too the news story about his potential conflict of interest was pretty interesting too as the company he invested in 13 years ago is not the same company just as your old company is not the same as it is today:)

    Consumers are held accountable for their associations and so should be judges and in this day and age where image is everything, good an bad, some smart Algo Men for the judges and members of Congress would be in line to help them understand the complicated mathematical formulas used by health insurance companies and yes I agree with your opinion on the public plan, the missing part of the entire puzzle. Insurers almost need to return back to a non profit business model as for profit is not going to cut it.

  3. Mr. Potter, I just heard about your book and am starting to read the free sample section that’s allowed with Kindle. I think it and you are a total fraud. If you spent 20 years lying to us as a corporate PR stiff, you haven’t stopped now that you are a freelance author.
    I’m running into so many lies by you that I’m choking.
    #1: In the very first sentence of your book you make the oft-repeated, but false accusation that “45,000 die in America every year beacause they have no health insurance” which, while great bluster, ignores the fact that the current American health care system is setup to provide free health care for those who cannot afford health insurance. So instead of clarifying the “health care vs. health insurance” difference, you elected to open your book with this oft-repeated lie.
    #2: Profits at CIGNA over the past 3 years are nothing to write home about in terms of profit margins. Average net profit margin for the 3 year period ended Dec. 2009 ($2.7b on $55.1b in revenues) comes in under 5%, not eye-popping or even noteworthy for the insurnace industry and not eye-popping or noteworthy for any industry for that matter.
    #3. The “47th in life expectancy at birth behind Bosnia” is a well-crafted lie woven together by U.N.-sponsored countries who hate America. In fact, Fact: the U.S. is #1 in saving premature babies, proven by the fact that only in the U.S. will 997 out of every 1,000 babies carried to term be living on year later – no country on earth compares to this statistic, which is why nobody you know flys to Bosnia or Cuba for healthcare and never will. The U.S. leads the world in saving premature babies and often spends up to $750,000 in doing so; no other country is this generous. According to the University of Iowa, 72% of tiny, premature babies less than 14 oz. at birth are born in the U.S. Moroever, infant mortality in the U.S. is tied to our highly unique culture and population demographics. Many women in U.S. delay having babies until they are 35,40 or even older. This negatively affects infant mortality stats. Our advanced fertility treatment programs also produce many more multiple-infant births that any other country on earth, which greatly increases chance of a baby dying pre-birth. And countries that rank ahead of us in life expectancy are small, even tiny countries like Iceland, who has a homgeneous population of 300,000 – less than Rockford, IL. The U.S. conversely, is a huge nation of immigrants who often bring chronic and critical healthcare issues with them across the border. Japan’s population is 99 homegeneous, while the U.S. is heterogeneous at 67% Caucasian, 14% HIspanic, 12% black and 4% Asian. We’re nothing like Japan, Iceland or Sweden and providing healthcare to these different groups is enormously expensive because we thus have so many healthcare exposures that the other countries don’t have. Your refusal to recognize this is a lie of omission.
    I have more facts – many more – to refute you lies, but want to see if you post my post before spending the time to correct your lies.

  4. Thank you for your work! Finally an insider to help the masses fight against the inherent corruption and massive lies we hear on a daily basis.
    I too think this lawsuit and all the others will go away quietly when these guys get paid off just like Congress has been for centuries.

  5. @7kidchaos: Wow, are you kidding me?! America’s racial/ethnic diversity is a major impediment to its not having better health outcomes? Where are your statistics proving that having three black people and two Asian people in the same classroom make it harder to keep people healthy? And, in case you’re a xenophobe, you might want to read the study that found Hispanic immigrants often have longer life expectancies than American-born citizens ( You’re putting forth a ridiculously transparent “straw man argument” – it’s not diversity that hurts America’s health outcomes, it’s our ridiculously inefficient and unjust health care financing system that, as Walter Cronkite once said, “is neither healthy, caring, nor a system.”

    Thank you, Mr. Potter, for all that you’re doing to save this country and its people from a horrifically cruel and unjust manner of financing health care. I hope that you will continue to fight for a public option and “real” reforms during the implementation of the ACA.

  6. @tkidchaos…I am one of the vastly underinsured…tell me where I can get free health care if I develop a life threatening or serious illness? Please! Or anything more significant than a free clinic can offer that my ridiculously high deductible can’t cover and I can’t afford. Back up your statistics and provide the actual number of births via in vitro/live births as a % of total and ditto for the woman’s age. More BS spin and slicing and dicing of statistics. I have no doubt they would not stand up to scrutiny. And honestly, your argument that these smaller countries enjoy better health because of their lifestyle or demographics (and I don’t necessarily believe your BS) only convinces me even more that the US with it’s diversity needs single payer all the more. Good job!

  7. I haven’t had an opportunity to read Mr. Potter’s book, as I just found out about it from another healthcare industry worker- whose empoyer gave her his copy to read. I have only been employed in this field for approximately a year and a half, filing insurance claims for a variety of providers. I can assure everyone that if even Walmart and Sears, or any number of small locally owned businesses operated as corruptly as the health insurance industry, board members and owners alike would be setting in prison or at least awaiting trial or sentencing.

    The American Public is overall extremely ignorant of how visciously they are being abused by Corporate America, stupidly choosing instead to concentrate on what those in power dangle in front of them – is their ball team winning, so-& so’s stance on abortion (not a “light” issue but an always excellent way to misdirect the public’s attention), and how evil “government” is.

    The government has been bought and paid for by Corrupt Corporate America and yet ignorant people continue to support these corrupt lawmakers, choosing instead to thoughtlessly regurgitate memorized slogans. My favorite example of this is Miss Blondie Elizabeth on ABC’s “The View”. She repeatedly vomits ignorant memorized slanted slogans and facts anytime the Republican party or any member of the party is slighted by anyone. She seems to never engage her brain in actual thought. Then just before an election in San Francisco where a proposition to decriminalize prostitution was on the ballot, she actually listened to the reasoning in support of the prop and conceded that it might be a good idea – but it would need to be highly regulated by the government to prevent corruption!!! WAKE UP Elizabeths!!!! Lack of appropriate governing has DESTROYED the best country on earth.

    I would recommend that any healthcare workers reading this blog request that signs be placed in conspicuous areas (like physicians waiting rooms) encouraging all to read Mr. Potter’s book. And by the way – I do not have nor can I possibly afford any kind of health insurance. And at $23,000/ year, I am much too wealthy to qualify for Medicaid. Pity poor stupid me for thinking a public option was a wonderful idea…President Obama, I’ll vote for you a second time, but that Public Option best be a actual fact of life or we might as well all move to Ecuador.

  8. @7kidchaos: perhaps you should research your “facts” a bit more before “refuting” them. As for the “oft-repeated lie” that 45,000 people die in the US each year due to lack of medical insurance, the statement comes from the Harvard Medical Study published in 2009.
    In the US for most states one must have total household income below 200% of the Federal Poverty level and be uninsured to qualify for Free Medical Care.

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