Edwards Campaign Press Release - John Edwards Announces Bold Policy To Prevent Health Insurance Company Abuses And Protect American Families

As part of "Building a Better America" week, Edwards calls for stronger insurance laws to prevent abuse and ensure American families can get the care they need

Manchester, NH – As part of "Building a Better America Week," John Edwards announced today a bold policy to improve the quality of health care in America by taking on health insurance companies and preventing the abuses and gaps in health coverage that put millions of Americans at risk.

"My proposal for universal health care will cover every man, woman and child in America – but that's not enough," said Edwards. "Right now, even families that have health insurance are often unprotected from catastrophic events, as insurers reject legitimate claims, impose coverage caps, and look for technicalities to cancel policies.

"The truth is, the American health care system is broken because wealthy health insurance corporations and their lobbyists have rigged the system against the American people," continued Edwards. "I have spent my entire life fighting and beating those same special interest groups to protect the rights of regular Americans, and that's exactly what I'll do as president."

Edwards is the only candidate for president who has never taken a dime from Washington lobbyists or special interest PACs, and he's the only candidate the American people can trust to stand up and fight for them against big health care companies.

Under the Edwards plan, insurance companies will be required to sell insurance to everyone, regardless of their preexisting conditions, and prevented from denying coverage after a condition develops. Edwards will put a stop to the practice of charging more to individuals with certain occupations or with pre-existing conditions, and will set national accounting standards requiring insurers to spend at least 85 percent of their premiums on patient care. Edwards will empower consumers by forcing insurance companies to be more honest and transparent about what they will ultimately cover and making sure all insurers guarantee comprehensive benefits. Edwards also called for an updated bill of rights for patients and providers.

To strengthen oversight and maintaining insurer accountability, Edwards will create Health Care Markets and offer advocates to help patients negotiate with insurance companies. And to increase competition and stop insurance company monopolies, Edwards will block mergers that could hurt consumers, doctors and hospitals. Also, his new public insurance plan will increase competitive pressures on private insurers to hold down their costs and deliver better coverage.

For further details on Edwards plan to take on health insurance companies, please see the "Taking on Health Insurance Companies to Help Families" paper included below.

Taking on Health Insurers to Help Families and Prevent Abuses

The American health care system is broken. There are 47 million Americans who lack health insurance, and 18,000 people die every year as a result. Health care costs are skyrocketing and premiums are up 90 percent since 2000. Even families with insurance are often unprotected from catastrophic events when insurers fight legitimate claims, impose coverage caps, and seek excuses to revoke coverage when its needed most. Half of families entering bankruptcy are driven there by high medical costs. Many people who have health insurance are "underinsured" and postpone needed health care because of their meager coverage. [Census Bureau, 2007; IOM, 2002; KFF, 2006; Warren et. al., 2005; Consumer Reports, 2007]

As senator, John Edwards championed the Patients' Bill of Rights to fight managed care and insurance company abuses. Now more than ever, the health insurance industry needs to be kept honest. While companies have an obligation to treat their customers with fairness and dignity, too often companies put their own profits and executive pay first. Today, Edwards outlined his plan to make sure that families with insurance have the health care safety net they pay for and need.

Insurance Industry Abuses: The current health care system is broken, often letting down even families with insurance. The abusive behavior of insurance companies includes:

• Designing confusing forms and procedures that make it very difficult for patients to claim the benefits they deserve and forcing patients to hire paperwork consultants. [Pryor et. al, 2007; NY Times, 10/13/2005]
• Using complex and unfair rules to cancel insurance policies after people get sick, despite accepting past payments. California regulators fined one insurer, Blue Cross of California, $1 million for violating state rules and abusively canceling insurance policies from 2004 to 2006. Another insurer, Health Net, paid bonuses based upon the number of patients whose policies were canceled for technicalities. [Pryor et. al, 2007; Sacramento Bee, 8/29/2007; LA Times, 3/28/3006 and 11/9/2007]
• Wrongly denying medical treatment needed to live and covered by insurance. [Wall St. Journal, 11/16/2007]
• Charging patients more for "out-of-network" doctors at "in-network" hospitals, leading patients to unwittingly incur thousands of dollars in bills despite trying to follow the rules.
• Creating procedural barriers and paperwork that keep doctors from providing needed care.

Lack of Competition: In 299 of 313 markets recently surveyed, one health plan controls at least 30 percent of the market for health maintenance organizations and preferred provider organizations. In the last 12 years, the Department of Justice has only challenged two of more than 400 insurance company mergers. There is a merger pending in Nevada that would put 80 percent of the state's HMO market in the hands of one insurance company. High levels of market consolidation raises concerns that the insurance market may not be competitive, hurting the health care system. [AMA, 2007; Velazquez, 2007]

Huge Levels of Executive Pay: As premiums skyrocket and some patients are denied care they need, insurance company CEOs are often paid tens of millions of dollars a year. In 2006, it was reported that the CEO of one of the world's largest insurers, UnitedHealth Group, had been awarded an astonishing $1.1 billion in stock options, enough to cover roughly 750,000 uninsured children with health insurance for one year. [AFL-CIO, 2007; NY Times, 10/16/2006]

Fighting for Families' Rights to Basic Insurance

John Edwards has fought special interest groups his entire career and knows that we need a health care system that works for everyone. His health plan will reform the health insurance industry to help us all get the insurance we need. Today, he proposed new laws to prevent abuses, stronger enforcement of insurance rules, and more competition and choice in insurance markets. Americans will no longer be on their own against insurance companies.

Tough New Insurance Laws:

• Insurance that Is Always There: John Edwards will stop insurance industry "rescissions," the practice of dropping individuals from insurance for technical reasons after they need their coverage. Edwards will pass a guaranteed issue law requiring insurance companies to sell insurance to everyone, regardless of their preexisting conditions, and preventing from denying coverage after a condition develops.
• A Fair Price for Good Insurance: Today, insurance companies will charge certain occupations and individuals with preexisting conditions more for insurance, such as police officers, firefighters, and construction workers. Edwards will put a stop to this practice, requiring community rating so that all people have access to insurance at a fair price.
• Ensure that Premiums Help Patients: Enacting health care reform to expand insurance to all families also requires establishing new rules so insurance companies cannot continue charging hardworking families excessive premiums, while pocketing the savings. Edwards will require insurers to spend at least 85 percent of their premiums on patient care as several states already do. The plan will force insurers to cut wasteful spending and pass savings on to families and employers.
• Empower Consumers: John Edwards will remove the mystery in what insurance companies cover. New "truth-in-insuring" rules will require insurance companies to be transparent and honest about what they will ultimately cover. The rules will set standards on explaining private insurance products and understandable medical bills.
• Guaranteed Comprehensive Benefits: Some states mandate that insurance companies must provide benefits like preventive care to children and screening tests like mammograms. Some insurance companies leave out these common-sense procedures. Under the Edwards plan, every American will have comprehensive benefits including preventive care and important tests.
• Creating a Bill of Rights for Patients and Providers: Now more than ever, Americans need a Patients' Bill of Rights for insurance and managed care companies. In 2001, John Edwards fought for the original Bill of Rights, which passed the Senate but was eventually blocked by insurance company lobbyists. As president, Edwards will help create an updated Bill of Rights to solidify the protections discussed in 2001 and reflect today's need to reform insurance companies' practices.

It is also time to protect doctors and hospitals from insurance company abuses. By making it difficult for health care providers to collect on their claims, insurance companies make it difficult for patients to get the care they need. Complex forms, long hold times on the phone, and inappropriate denials of payment for needed treatments are just some of the insurance company tactics. Edwards will develop strict rules for insurance companies that will make it easier for doctors and hospitals to get paid for and deliver needed care.

Stronger Enforcement:

• Maintaining Accountability: All Americans need and deserve a strong line of protection against insurance companies. Edwards will revolutionize the individual and small group insurance markets with his new Health Care Markets, which will negotiate plans and carefully enforce protections for families. Edwards will also ask the Department of Justice and work with states to oversee insurance markets.
• Create an Advocate for Patients: In California, when a patient has a dispute with a managed care company, the state reviews the case to make sure the company acted within the law. Every patient deserves an advocate when he or she needs it. Edwards will look to models like California's and build a national resource for regular people to get the help they need in negotiating with for insurance companies and HMOs. Edwards will also establish a medical home for Americans with chronic diseases, giving patients a primary care doctor who can advocate against insurance companies for needed care.

More Competition

• Stop Insurance Company Monopolies: Edwards will apply rigorous standards and block mergers that could hurt consumers, doctors and hospitals. He will direct the U.S. Department of Justice to conduct an immediate and comprehensive review of the health insurance market and make recommendations on how to ensure a competitive market. Where monopolies already exist, he would break them up to ensure competition. He will also revisit the insurance company exception to the nation's antitrust laws.
• New Competition for Private Insurers: The Edwards plan creates new choices for American families. The new Health Care Markets will be available to everyone who does not get comparable insurance from their jobs or a public program and to employers who choose to join rather than offer their own insurance plans. Families and individuals will choose the plan that works best for them. The markets will include a new public plan similar to Medicare. If enough people choose the public plan, then the US will evolve towards a single-payer plan. As a result, private insurers will face new rules and competitive pressures to hold down their costs and deliver better coverage.