The Center for Public Integrity

Having trouble understanding what your health plan actually covers? Confused about what to do if the plan refuses to pay for care your doctor says you need? Convinced your insurer goes out of its way to make that “explanation of benefits” statement incomprehensible?

Welcome to the club — a big and growing club. Despite paying lip service to the importance of communicating in “plain English,” insurers are actually being more obtuse than ever, according to J.D. Power and Associates, which conducts a study every year to measure member satisfaction among the nation’s largest health plans.

The study annually examines seven key factors that determine member satisfaction — coverage and benefits; provider choice; information and communication; claims processing; statements; customer service; and approval processes. Recent results aren’t promising. In fact the 2011 study, released in March, showed that overall member satisfaction not only isn’t improving, it is at the lowest point since the company began conducting its annual survey of health plan members in 2007.

The 2011 study also found that more than one-half (57%) of health plan members surveyed said that they were either required or had chosen to make changes involving cost or coverage during the past year — “continuing a trend where more members say they are powerless in being able to control costs on their own.”

J.D. Power and Associations, as you may know, surveys customers in a host of industries. Sadly, you probably won’t be surprised to learn that the satisfaction of health insurance plan members is among the lowest across the industries in which J.D. Power conducts research. Lower, even, than satisfaction levels with mortgage companies and banks.

J.D. Power also found last year that only 40% of the 34,000 respondents to its survey of health plan members said they fully understand what is included in their benefits packages.

In his quest to win the Republican presidential nomination, Texas Gov. Rick Perry is perpetuating a convincing hoax: that implementing Texas-style tort reform would  go a long way toward curing what ails the U.S. health care system.

Like his fellow GOP contenders, Perry consistently denounces “Obamacare” as “a budget-busting, government takeover of healthcare” and “the greatest intrusion on individual freedom in a generation.” He promises to repeal the law if elected. 

Unlike those in the “repeal-and-replace” wing of the Republican Party, however, Perry has emerged as leader of the “repeal-and-let-the-states-figure-it-out” wing that believes the federal government has no legitimate role in fixing America’s health care system.

“To hear federal officials tell it, they’ve got all the answers on health care and it’s up to the rest of us to sit, wait and embrace whatever solution—if any—they may eventually provide,” Perry wrote in a newspaper commentary in 2009.  “I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.”

Even as he points with pride to the alleged benefits of malpractice and other tort reforms that have been enacted during his tenure as governor of Texas, Perry says he is opposed to tort reform at the federal level. He cites the 10^th Amendment to the Constitution, which states-rights advocates say limits the role of the federal government.

If NBC’s David Gregory had asked just a couple follow-up questions of  Michele Bachmann on Meet the Press last Sunday, he would have found that her anecdote about  how “Obamacare” will lead to economic ruin doesn’t stand up to scrutiny.

In fact, he would have found that the financial problems of the Iowa employer she cites to bolster her point are far more likely the result of the economic policies of former President George W. Bush. 

In answering Gregory’s question about how she would “turn the economy around within several months” if elected president, as she recently promised to do, Bachmann pledged to repeal both the health care reform law and the Dodd-Frank Act, which Congress enacted last year to reform the way financial institutions are regulated.

“I'll tell you the biggest job killer right now, because I'm all across Iowa asking people, business people tell me it's Obamacare and it's the Dodd-Frank law,” Bachmann said. “Dodd-Frank is drying up credit for businesses. And I have the repeal bill for Dodd-Frank.”

She went on to promise to repeal health care reform, too.

“People want that gone. It is absolutely without a doubt a job killer. I was just at a business in Indianola, Iowa. They've let half of their workforce go, over 100 employees.”

The implication, of course, was that the employer had to let all those workers go because of health care reform.

Gregory didn’t challenge her, so I started trying to find the Indianola employer that had axed so many jobs because of Obamacare.

I was especially curious because the portions of the law that will have the greatest impact on some businesses have not even taken effect yet. A provision that has gone into effect, which provides tax credits to small businesses that offer health care coverage for employees and help subsidize it, has actually been a boon to many firms.

On the campaign trail in Iowa last week, former corporate executive and Republican governor of Massachusetts Mitt Romney shot back at hecklers who were challenging his stance that it would unfair and unwise to raise taxes on wealthy individuals and corporations to reduce the deficit.

“Corporations are people, my friend,” Romney said. “Everything corporations earn ultimately goes to the people. Where do you think it goes? Whose pockets? People’s pockets! Human beings, my friend.”

Democrats were quick to pounce. Rep. Debbie Wasserman Schultz of Florida, chairwoman of the Democratic National Committee, said of Romney’s remarks: “It is a shocking admission from a candidate—and a party—that shamelessly puts forward policies to help large corporations and the wealthiest Americans at the expense of the middle class, seniors and students.”

It’s fair to say that not everyone in Florida shares Wasserman Schultz’s point of view, certainly not her Republican governor, Rick Scott, and the folks who work for him at the state’s Department of Management Services (DMS).

Last week I wrote that DMS, on orders from Scott, planned to eliminate state workers’ choice of HMOs from two or three to just one. By doing so, DMS says the state will save $400 million over two years.

The irony—or hypocrisy, if you will—of this decision is that Scott was one of the most vocal opponents of federal health care reform. The front group he set up and funded, Conservatives for Patients’ Rights, claimed in TV ads that the legislation favored by Democrats would effectively end “choice and competition” in health care, resulting in people losing the ability to choose their own doctors and health plans.

The folks at DMS were not happy with the way I characterized their decision to effectively end choice and competition in health care for Florida state workers.

As he was gearing up to run for governor of Florida, Republican Rick Scott emerged as one of the most vocal opponents of what he and others began referring to as “Obamacare.”

Scott created, chaired and bankrolled a group called Conservatives for Patients’ Rights that spent millions of dollars on TV commercials attacking health care reform, especially a proposal calling for the federal  government to create a public health insurance option to compete with private insurers.

In one ad, the narrator said the votes of a few key senators could determine whether or not Americans would be able to keep their own doctors and their own health insurance plans. The implication was clear — people would lose the ability to choose their own doctors if health reform passed.  

Trouble was, it wasn’t true. The public option considered by the Senate at that time would have affected relatively few Americans—just three to four million, according to the Congressional Budget Office—and it would have negotiated rates with doctors exactly as private plans do. It would have been nothing more than an additional option for some people. It would not have reduced choice for anyone.

But to hear Scott and his group tell it, it would have led to the demise of choice and competition in health care.

Well,  guess what. A few days ago, Scott,  now governor of Florida, said he had  decided to reduce choice and competition that state workers have enjoyed for years.

Florida state employees, who currently can choose among two or more competing HMOs, are being told that all but one of their HMO choices are being eliminated and that bureaucrats in Scott’s Department of Management Services (DMS) have already decided which HMO they will be enrolled in come January 1, 2012.

Dr. Bruce Kinosian still makes house calls, and he’s proud of it.  In fact, he introduces himself as a physician who goes to see his patients in their homes rather than insisting that they come to see him at his office.

He’s convinced that if more doctors did what he does, we could eliminate billions of dollars we currently spend in this country in an often-futile—and almost always incredibly expensive—effort to get people well.

Much of that savings, he says, would accrue to the Medicare program, making it unnecessary for Congress to even consider eliminating benefits or raising the eligibility age.

Kinosian, associate professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia, is a leading advocate of the Independence at Home (IAH) program, which quietly has been saving the Department of Veteran’s Affairs (and taxpayers) lots of money—and improving the quality of life for thousands of veterans—for nearly three decades.

The IAH health care delivery model is designed to focus on the growing number of people with high cost multiple chronic conditions. It not only provides primary care to these patients in their homes, but it also coordinates their care when they have to go to the hospital or nursing home.

The VA’s IAH program, which has grown over the years to serve veterans in almost every state, has compiled enough statistics by now to demonstrate that this approach to care really works. An analysis of data from a 2002 VA study of more than 11,000 patients showed that after veterans were moved to an IAH program that year, hospital days dropped by 62 percent and nursing home days by 88 percent. Overall costs fell by 24 percent. As spending went down, patient satisfaction went up. The VA says veterans consistently give the program a high satisfaction rating, no doubt in part because patients enrolled in the program are living longer than their counterparts who are not.