Sunday, December 23, 2007

Christmas came one week early for California insurers Monday.

See full story here.


Christmas for Insurance Corporations! (+)
by: California Nurses Shum
Wed Dec 19, 2007 at 16:56:21 PM PST

(The followign commentary by Rose Ann DeMoro, executive director of the California Nurses Association/National Nurses Organizing Committee, first appeared at the Huffington Post.)

Christmas came one week early for California insurers Monday.

In a present gift wrapped by the California Assembly with Gov. Arnold Schwarzenegger playing Santa, Assembly members passed a bill mislabeled as healthcare reform that will guarantee not health care but millions of new customers for the insurance industry, with California taxpayers paying the bill.

Need more evidence. Look at the list of supporters. They include industry giants, Kaiser Permanente, Health Net, PacifiCare, Blue Shield, Cigna, and Molina Health Care --all among the biggest and most profitable health plans in the state.

California Nurses Shum :: Christmas for Insurance Corporations!
It's not hard to see why they are on board.
Under the new bill, insurers would gain millions of new customers who are either forced to buy insurance under threat of having their wages garnished or facing a lien on their property -- or signed up into private insurance plans through a public pool funded with taxpayer or employer funded subsidies.

The bill passed Monday -- the product of a backroom deal between Schwarzenegger and Assembly Speaker Fabian Nunez -- even eliminated a provision from an earlier draft that would have provided exemptions to the forced insurance for Californians whose costs would exceed 6.5 percent of their income. Now those people will still have the mandate to buy insurance, though they will be eligible for full or partial public subsidies.

It's a disgraceful day when we have our elected leaders shaking down patients and consumers to swell the profits of an industry that became incredibly rich off the pain and suffering of patients who are routinely denied care when they need it most.

Nothing in this plan changes those deplorable practices. Insurers will continue to be able to block care even when recommended by a physician when they brand it as "experimental" or "not medically necessary." They will continue to be able to reject diagnostic procedures and access to specialists.

And, they will continue to be permitted to charge whatever they want. There are absolutely no restrictions on skyrocketing premiums, deductibles, or co-pays. The inevitable result will be more Californians facing bankruptcy for medical debt when they are forced to buy junk insurance they can't afford or self-rationing care even while they continue to pay the premiums.

Proponents of the bill praise the model of a similar Massachusetts law on which the California bill is based. Well, here's what's happening in Massachusetts today. State officials has discovered that since they failed to place any limits on insurance industry price gouging, the state will not be able to continue to afford the subsidies. So they are going to have to reduce payments to doctors and hospitals or sharply increase out-of-pocket costs for patients. That's progress?

This is not health care reform. It's a hijacking of the yearning of the public for genuine overhaul of our health care system. It's Schwarzenegger as a reverse Robin Hood, picking the pockets of patients and the public coffers for the biggest insurers in the land. And it will not stand.

California's State Senate may yet put the brakes on this plan -- not even scheduled to go into effect for four more years.

If California lawmakers want to actually accomplish something today on health care, they should look elsewhere. Thousands of California children face the imminent cutoff of coverage due to the President's veto of the children's health program. Concurrently, with California facing a $14 billion and growing budget deficit, Schwarzenegger is talking about big across the board cuts, including significant reductions in existing health programs.

Let's address these immediate crises -- and then move to enact genuine, healthcare reform such as a single payer, improved Medicare for all approach embodied in HR 676 in Congress and SB 840 in California -- rather than handing out any more presents to a wealthy industry that hardly needs the help.

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by: you @ soon
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Insurance companies demand that schools and other institutions deny wrongdoing (0.00 / 0)
How does the law get enforced in school districts?
It doesn't.

Insurance brokers seem to run our schools-among other institutions.

Keenan and Associates runs San Diego County Office of Education Joint Powers Authority. They also run Kaiser Permanente.>

Rick Rinear, JPA Director Diane Crosier's right-hand man at SDCOE-JPA, says all claims should be "returned as insufficient, late or rejected."

Here's a quote, followed by a more complete document to give the context. My bet is that the link at the bottom will soon be broken by SDCOE-JPA. They seem to cut off access to public records whenever I make a link to them.

Quote by Rick Rinear:

"If a claim is submitted in letter format and is sufficient (in compliance), per the Government Code, the claim should be handled as if submitted on the district's Claim Form; i.e., returned as insufficient, late or rejected."

January 22, 2004
To: JPA Representatives
From: Rick Rinear, JPA Risk Management
Subject: Tort Claim Reporting Form - Revised

We would like to clarify the Tort Claim Reporting procedure, as there has been some confusion about requiring all potential claimants to use a district-written Claim Form.

Effective April 1, 2003, Government Code Section 910.4 (a) requires public entities to provide a standardized Tort Claim Form that claimants use to file their claims for submission to districts.

The standard Claim Form (sample attached), must include information specified in Government Code Section 910 and 910.2. Districts can still consider claims "submitted" without the required form. Districts may consider a written claim without requiring the referenced claim form. The referenced claim form must be available when requested.

We are providing a sample Cover Letter for potential claimants who request the required form. Careful review of a claim is necessary for compliance or late filing.

If considered insufficient (not in compliance), the claim must be returned to claimant within 20 days from receipt. If a claim is submitted in letter format and is sufficient (in compliance), per the Government Code, the claim should be handled as if submitted on the district's Claim Form; i.e., returned as insufficient, late or rejected.

The enclosed sample letter should only be used to forward a claim form to those claimants who request a form from the district.

...Please continue to forward claims when received to San Diego County Schools Risk Management JPA,...Attention: Rodger Hartnett, Property & Liability JPA Claims Coordinator. Rodger or Lisa Adriance-Jensen will recommend what action to take.

The letter above can be found at
at least, until SDCOE breaks the link to this public record.

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