A new consumer group, Allied Citizens for Healthcare Equity (ACHE), announced its formation today at a press conference in Helena.
M. Susan Good, executive director of the group, emphasized that the purpose of the 501c4 organization is to protect consumers from business practices by some insurers that make it difficult for Montana citizens to get the quality healthcare that they deserve.
"ACHE's mission is to ensure Montana's continued to access to some of the very best healthcare in the world, an advantage that we have within our borders. Montana has few people and so we are not a state that has many insurance companies to choose from. It is vitally important that no single insurer gets a hammerlock on us. Lack of real competition in any arena guarantees two things; high prices and poor service."
"In the ten years that I have worked with healthcare reform issues, I have witnessed proposed consumer protection reforms being opposed by the same groups over and over again. Necessary reforms are met at the Legislature with the same threat, time and again -insurers threatening premium increases- if even the measure is straightforward."
During the last legislative session, the same insurers squawked about a bill that would have made managed care organizations that put their bottom lines ahead of the patients' well being to be held liable for a decision that denies patients the healthcare that they need. The threat was the same; passage of the bill would increase premiums and cause a flood of lawsuits. Even though the testimony at the hearing stated that in Texas where this is already the law, premiums did not go up appreciably, and there was only one lawsuit that had been brought to trial, the insurers killed that provision of the bill."
We have all heard the horror stories on the six o'clock news about what happens when some managed care companies put their bottom lines ahead of their patients' health. Patients are forced to cope not only with their own medical crisis, but face additional stress when their claims are capriciously denied. Often the company person making the call about what will be paid and what will not be paid is not even a doctor. Imagine yourself desperately ill, and having to fight a faceless bureaucracy at the same time. No one would have to be subjected to that. But they are.
After the patient has argued with the insurer and getting no results, in Montana, he has a couple of options. He can retain an attorney, or he can go to the Insurance Commissioner's office for help. There are 363 cases against one insurer awaiting resolution right now. These cases, piling up for over three years represent Montanans who suffer not only physical suffering, perhaps a life threatening health crisis, and have to take the time and energy to fight with their insurance company. The Commissioner's office does a great job, in trying to resolve the issues in a fair way. It shouldn't have to come to this. If 363 Montanans have taken the steps to file formal complaints, how many more have suffered in silence. We at ACHE want to help people who have paid their premiums faithfully, believing that they would be protected when the need it, only to be denied when they get sick."
I have followed managed care for years, and while it does have
some advantages, it has not been the panacea that insurers held
it out to be. While our fee for service way of doing business
certainly had room for improvement, proponents of managed care
threw the baby out with the bath water. While some costs have
been contained in some areas, there is no doubt that managed care
inherently has problems of its own.
Every month brings a new report of abuse by the system. This
weeks JAMA states that 'managed care organizations are not doing
and adequate job of caring for the 100 million Americans with
chronic illnesses" (JAMA, June 2, 1999,page 2045). Premium
costs are on the rise too.
There is a way to measure the quality of healthcare that a patient receives from a managed care organization. The National Committee for Quality Assurance has a database called Quality Compass that measures just how responsive a company is in meeting the healthcare needs of its patients. Although the accreditation process is expensive, it is the best way to find out just how a company's quality of care measures up. To date, no managed care company in Montana is accredited. How are Montanans to know for sure that medical care that they need will be there when they need it? ACHE intends to find out.
When BCBSMT claimed that making them responsible for their financial decisions would increase premiums a few months back; I took it on myself to investigate why that was necessary. My first stop was at the Insurance Commissioner's office to have a look at their annual report. It is a matter of public record. What I found was shocking. The top officers of this particular Health Services Corporation enjoyed increases in compensation of around 30% in one year. I was especially interested to find that they pay their lobbyists more than they pay their medical director, a physican. In fact, the medical director was the lowest paid individual on the schedule. Furthermore, according to the Insurance Commissioner's office, several millions have been set aside for what is known in corporate circles, as 'golden parachutes', retirement bonuses.
All of this is being accomplished while BCBSMT enjoys unique status. They pay no premium taxes. Other health insurers in Montana pay the tax. While enjoying this tax holiday, BCBSMT has what can be called a net worth of around $57 million. They have nearly $45 million in invested in the stock market; all investments made with tax-free money. As the accompanying chart shows, BCBSMT is also acquiring for profit insurance agencies and a few managed care companies as well. How is that possible? We don't know, now.
As we stand here today, ACHE has many more questions than it has answers for Montanans. But be assured of this, ACHE will ask the questions, and we will share our information with the citizens of this state.
In order to better serve the public, ACHE has established a hotline that will assist patients in finding out what their problems are, and will suggest ways that they can get the healthcare they need, healthcare that premium dollars have been paying for all along.
In addition, ACHE has a website, for more information about
the organization, and how it is working to protect patients from
abuse. All information will be kept confidential, since many
people are concerned about reprisals from their insurer.