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Antitrust exemption for health insurance "becomes an object of reform debate

Dr. John Bender, a family physician in Fort Collins, said that its bargaining power with insurance companies, health groups forces for a small mistake: "We are like mosquitoes them.

About half of patients have either Bender Anthem Blue Cross Blue Shield or United Healthcare – the two companies have 53 percent market share in Colorado – to lose or contract could lead to bankruptcy.

Is prohibited under the antitrust laws for doctors collusion on interest rates and require insurance companies to repay more of their work. But in what some say is the unbalanced policy, insurance is one of the few industries exempt from federal antitrust laws that prohibit price fixing and manipulation of tenders, "the practice of brokers unscrupulous to ensure that companies Please get insurance.

An important objective of the national reform health is to stimulate competition in the insurance sector. Supporters of reform say the competition will reduce costs. Among the latest proposals for the debate in Washington: a race to the antitrust exemption in effect since 1945.

The De insurance industry Health argues that it is engaged in anticompetitive conduct and that the exemption does not protect such behavior anyway.

Medicare is governed by state commissioners of insurance, and repealing the exemption from federal antitrust would only undermine the current regulatory structure, said the national professional organization of industry, America's Health Insurance Plans.

Democratic lawmakers threw himself on the exemption from competition shortly after insurers withdrew its support to proposals for major reform. Insurers, which had supported care reform on the scale last year, unveiled this fall, reports the prediction that health premiums will increase more rapidly than at present in Under the current plans for reform.

"It's just political clash in both directions, "said John Soma, who teaches antitrust law University of Denver Sturm College of Law. "The power of the insurance lobby is simply impressive.

Layers of the complex law

Antitrust includes layers of complex rules, but in its most basic level, insurance companies would have more difficulties in setting rates If you lose the exemption, Soma said. Insurance companies are concerned that the repeal of the exemption from federal jurisdiction, part of 1945 McCarran-Ferguson Act, would end their ability to share data.

It is easy to understand why Life Insurance Companies that are not covered by legislation, may wish to communicate: perhaps take a customer who purchases a terminally ill patient multi-million dollar policy. Medical Malpractice Insurance, which lose their exemption under the bill, sharing sometimes financial information as the automobile and home insurance, reports "the loss of historical data" specific to certain cities a centralized service desk. Other companies then use the data to determine rates.

However, the main objectives of the legislation – insurers – say they generally not share data. They do not say, for example, which reimburses a hospital for knee surgery or quantity to be given to a radiologist for an MRI.

Insurers say the practice of data sharing actually increases competition because it allows companies to penetrate new markets by giving clues about where to establish the percentages.

"Our opponents say is pricing, "said Lawrence Smarr with Medical Insurers Association of America. The company represents companies liability insurance medical belonging to the negligence of doctors.

Smarr is a draw which advocates say the exemption is limited to looking bites "well".

"It is a political movement," said. "Most people America does not understand what is and McCarran-Ferguson does not understand what is the role of states is in the regulation of insurance. "

But David Balto, a former director of policy for the Federal Trade Commission who now works for the Center for American Progress, a leftist thinking, said to eliminate the antitrust exemption is a first step towards increasing competition in the insurance sector.

Competition Rules of conduct among insurers is low in most states, Balto said. A Center for American Studies Recent Progress found no antitrust presented by the national commissioners of insurance and that about one third of the States "brought any significant action to protect consumers."

Health insurance antitrust exemption not needed now because the market is not competitive, "said Balto. But after health care reform health, new companies or cooperatives will emerge and the country will need to keep four or five insurance companies that dominate a given area conspiracy to kill the new competition, they said.

The lack of competition has led to increased profits for insurance companies, reducing the coverage of clients and "an epidemic of fraudulent and deceptive behavior," according to a report by the Center for American Progress.

"A tsunami of mergers of health insurance leads to levels as high concentration of insurance markets that now there are only one or two companies Insurance dominant in many states. And these local monopolies remain unanswered because there are significant barriers to entry and expansion of insurance companies. "

A matter of learning

In Colorado, five companies dominate the market for health insurance. Large companies have swallowed up smaller, particularly in the past year, several insurance companies Small left Colorado.

Anthem officials – the largest insurer in Colorado, with 867,000 "covered lives" – stress that competition is strong in the state. And, they say, doctors often have a strong influence in the negotiations.

In many cities in Colorado, physicians to a specialty such as pediatrics and urology, business groups have formed, in part so they can better negotiate with insurance companies.

Insurers were far more difficult to practice if it contains almost all urologists in the city, said POGAR Janet, Vice-President of the hymn commitment provider.

And in rural areas where doctors are scarce, Anthem has sometimes pay higher rates higher than in the cities to ensure that rural customers the assurance of having a doctor within the network. In the field Gunnison, for example, one general surgeon, POGAR said.

Even by their family doctors account has some bargaining power, "he said.

"It's not fair, you are requesting a rate increase, I'll close the door," he said. "That's just not happening."

But Dr. Brent Keeler, an obstetrician at the clinic for women of Aurora, disagrees. In 27 years, said, was "negotiated" a single contract with an insurance company, the rest was "take it or leave it" offers ", usually Lowball.

Insurers go tell a doctor, "We have other doctors who will take these fees," said Keeler. "The doctor faces a difficult choice. "

It is illegal under federal antitrust law for doctors who are not partners to find what other doctors are paid and ask the same thing. The law criminalizes the price.

Privacy

Health insurance business in Colorado must file premiums they charge their customers with the Insurance Commissioner. But they jealously guard private information on how they reimburse hospital or medical office procedures. They are not required to report the number of state.

Anthem insurance executives declined to disclose its rate average reimbursement of physicians in Colorado, some said it was nearly 115 percent of what the government reimburses Medicare patients.

Anthem executives would say only that the average refund in Colorado is "much higher."

Colorado Insurance Commissioner Marcy Morrison said that is "comfortable" that the industry is adequately regulated and it is unlikely that the price fixing or bid rigging took place.

"The only thing I find disturbing is perhaps in the field of competition," said Morrison. "I see companies growing businesses merging and buying up smaller companies, and I am worried about the size of companies.

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