Why does the Health Care Industry give so much money to Brian Maienschein?

Sacramento Report: Maienschein’s Mammoth Campaign Cash Haul 
By Sara Libby
VOSD
Oct 14, 2016

 Assemblyman Brian Maienschein has more campaign cash for his re-election bid than almost any other state lawmaker in California. He’s racked up 441 donations adding up to $692,002, according to recent filings, and has a whopping $1.22 million cash on hand – second only to the speaker of the Assembly.

Todd Gloria, for comparison, is running to represent the Assembly district next door and reported $277,617 on hand.

 Maienschein’s robust fundraising is made all the more unusual because the district he represents, which encompasses Poway, Rancho Santa Fe and the northeastern communities of San Diego, is not considered especially competitive.

Mainschein has defeated his challenger in the last two general elections by over 40 points. He finished first in the June primary by 15 points over Democrat Melinda Vasquez.

It’s possible that Maienschien is stockpiling funds for a run at higher office that requires a bigger spend. Candidates can roll over any excess money that they have at the end of the campaign into the next cycle, and 2020 will be a big year for down-ticket Republicans who usually see electoral gains in presidential election off-years. Perhaps most importantly, in 2020, Republican Sen. Joel Anderson has said he plans to vacate his seat to run for the County Board of Supervisors. Anderson’s district overlaps considerably with Maienschein’s, which would make it a natural target.

 Many of the campaign donations Maienschein’s received come from the health care industry. Of the companies that donated, $228,024.50 came from the health care industry (broadly defined to include insurance companies, pharmaceutical and medical device manufacturers, and occupational political action committees.) In his time in the Assembly, Maienschein has championed legislation amenable to this cluster of industries, putting forward a number of measures related to health care and mental health facilities in the 2015-2016 legislative session. Health care and life sciences comprise a major portion of the regional economy, bringing more than $38 billion into the region 2014 in wages alone...

Kaiser, which has long claimed to practice preventive medicine, to raise rates 9.2 per cent, on reinstated policies

Apparently, Kaiser Permanente wasn't so interested in preventive medicine as it claimed. When required to provide preventive care, it raises rates.

Kaiser to raise rates on reinstated policies
The proposed 9.2% boost would cover higher costs associated with Obamacare
By Kristen Consillio
Star Advertizer
Nov 30, 2013

Kaiser Permanente Hawaii plans to boost rates by an average 9.2 percent for 11,000 individuals who were earlier notified their health insurance policies would be canceled at year's end because they did not meet the minimum requirements of the federal Affordable Care Act.

The state's largest health maintenance organization said it filed the proposed rate hike this week with the Insurance Division to cover higher projected medical expenses next year, costs associated with an aging population and taxes and fees related to the federal Affordable Care Act...

California doctors sue Aetna for coverage denials

Is it possible that both the doctors and the insurance companies are ripping off patients? Doctors are apparently getting kickbacks for referring patients.

California doctors sue Aetna for coverage denials
Jul 3, 2012
By Toni Clarke
(Reuters)

Thousands of doctors in California are suing the health insurance company Aetna Inc claiming the company routinely denies patients access to out-of-network doctors even when the patient has purchased a policy giving them the right to choose providers.

The lawsuit, filed in the Los Angeles County Superior Court, accuses Aetna of threatening patients with denial of coverage if their members visit doctors outside the Aetna network of providers, and of threatening doctors with having their Aetna contracts terminated if they refer patients outside the network.

The lawsuit was brought by the Los Angeles County Medical Association, California Medical Association and a coalition of health care organizations and providers.

Aetna claims the suit is in retaliation for a suit filed by Aetna in February claiming several California providers, including Bay Area Surgical Management (BASM)and seven ancillary facilities, sent Aetna members to BASM without revealing that physicians had an ownership interest in the facility or were getting paid by BASM for their referrals.

"We have sued some of these same doctors and surgery centers named in the suit for their egregious billing practices in February of this year," Cynthia Michener, a spokeswoman for Aetna, said in an email. "This is a countersuit disguised as a class action lawsuit."

Michener said Aetna would "continue to pursue medical providers whose charges are so grossly out of line."

She cited as examples facilities and doctors who have charged $73,536 for a kidney stone fragmentation when an average in-network charge would be around $7,612. Or those that have charged $37,572 for a knee procedure that would cost about $10,500 with an in-network physician.

Michener was not immediately able to say what the average cost of these procedures would have been in out-of-network facilities that are not being sued by Aetna.

The lawsuit brought by the physicians accuses Aetna of false advertising, breach of contract, unfair business practices, and both intentional and negligent interference with healthcare providers.

The lawsuit seeks an end to the practices, an immediate injunction, compensation for patients and physicians and punitive damages.

"Despite making tens of millions of dollars selling policies with out-of-network benefits, Aetna has engaged in a campaign to retaliate against its members who attempt to use their out-of-network benefits, and the physicians who refer these members to out-of-network providers," the lawsuit states.

Health insurance premiums climb faster in 2011

Health insurance premiums climb faster in 2011
By Alina Selyukh
Reuters
Sep 27, 2011

The cost of health insurance continues to climb for companies and workers, with annual family premiums this year growing at a pace triple that of 2010 and outpacing wage increases, according to a survey.

As the United States continues to grapple with a stubbornly weak economy, family premiums in employer-sponsored health plans jumped 9 percent this year and single premiums rose 8 percent, compared with 2010's 3 percent and 5 percent, the Kaiser Family Foundation's annual study, published Tuesday, found.

"We're probably on a more modest side ... but even with a 5 percent increase in a premium (that our workers saw) this year, they didn't get a 5 percent raise," said Jeff Franck, a compensation and benefits manager at Altru Health System, which employs about 3,700 people in North Dakota and Minnesota and participated in the survey.

Health insurance, unlike other industrialized countries, is largely provided by employers. Although the latest Census found more Americans losing company-sponsored insurance, almost 170 million Americans were on employer-based plans in 2010.

Kaiser and the Health Research & Educational Trust surveyed 2,088 randomly selected public and private employers large and small earlier this year.

The survey found that, on average, employees are contributing 28 percent, or about $4,129, a year toward employer-sponsored family plans. That is 131 percent more than a decade ago.

Including employers' contributions, the overall premium has increased 113 percent since 2001 to $15,073 a year.

More workers, especially in smaller firms, continue to join high-deductible health plans. Thirty-one percent of covered employees this year have to pay at least $1,000 in single plans before coverage kicks in, up from 27 percent last year.

The survey also highlighted some early results of President Barack Obama's healthcare reform.

Under one of the few provisions already in effect, people under the age of 26 are now allowed to remain covered by their parents' insurance plans to curb historically high uninsured rates in that age group. The Kaiser survey estimated that U.S. companies have added 2.3 million young adults to their parents' family health policies.

Franck at Altru Health pegged much of the premium costs' increase at his company to adding children of his employees onto their plans.

That part of the healthcare reform was not meant to cut costs, and many cost-cutting provisions have yet to kick in, said Kaiser President and Chief Executive Drew Altman.

"There are a variety of factors that could have been responsible for (premium increases), but the major reason is not the healthcare reform," he said.

Although the survey did not study contributing factors, Altman echoed other analysts in suggesting that insurance companies had planned their premiums in expectation of more people going to the doctor or buying medications as the economy improved -- which did not happen.

Insurers have generally attributed the need to raise premiums to growing underlying medical care costs as coverage also continues to expand. Both have fed into a heated debate over the future of healthcare spending, which for several decades has grown faster per person than the nation's economic output, according to the Congressional Budget Office.

Slowing down those soaring costs is one of the main issues on the agenda of a bipartisan congressional deficit-reduction panel that is due to make recommendations by November 23 on how to slash the U.S. budget deficit by at least $1.2 trillion.

(Reporting by Alina Selyukh in Washington; editing by John Wallace)

State Senate health chairman doing business with Kaiser

State Senate health chairman doing business with Kaiser
A firm owned by Sen. Ed Hernandez, who derailed legislation opposed by the
nonprofit health group, leases office space to Kaiser Permanente. An advocacy
group seeks his ouster from the chairmanship.
By Patrick McGreevy
Los Angeles Times
September 18, 2011

A Southern California lawmaker who helped defeat legislation opposed by Kaiser is benefiting from a business relationship with the nonprofit health group.

The proposal, which died in the Legislature earlier this month after a dispute
over its provisions, would have required state approval for health insurers
including Kaiser to raise their rates.

State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee,
owns a corporation that leases an office building to Kaiser Permanente in Baldwin Park. Since 2006, Kaiser has paid Hernandez's firm about $387,000 to lease the building. The current rent is $5,752 a month.

Most elected officials in California are disqualified from actions that could affect
a source of their income, but state legislators exempted themselves from that
restriction in 2002. Such dual interests amount to "what a common-sense person
would consider to be wrong," said Kathay Feng, executive director of California
Common Cause...

Because his role as Health Committee chairman gives Hernandez considerable power over many bills that affect the health industry, a consumer advocacy group has asked Senate leader Darrell Steinberg (D-Sacramento) to remove him.

"This level of income from a company that is constantly before his committee, and whose interests touch upon every level of the committee's work … compromises Senator Hernandez's ability to independently chair the committee," wrote Jamie Court, president of the nonprofit group Consumer Watchdog.

Kaiser's payments were disclosed in Hernandez's annual financial interest report on file with the state. But there was no mention of the business relationship when a
Kaiser representative appeared at a June committee hearing presided over by
Hernandez...

Hernandez voted for the bill when it passed his committee. But he said he would oppose it on the Senate floor unless it was changed so a panel of actuaries, rather than California's elected insurance commissioner and the director of the state's Managed Health Care Department, would rule on any rate increases.

The bill's author, Assemblyman Mike Feuer (D-Los Angeles), said such revisions
would have left consumers unprotected from excessive rate hikes and, without
enough votes to support his version, he shelved the legislation, AB 52...

Health Insurers Making Record Profits as Many Postpone Care

Health Insurers Making Record Profits as Many Postpone Care
By REED ABELSON
New York Times
May 13, 2011

The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care.

Dr. Rebecca Jaffe, in Wilmington, Del., said that after years of resisting generic medicines, more patients were now requesting them to avoid paying hefty co-payments for brand-name drugs.

The UnitedHealth Group, one of the largest commercial insurers, told analysts that so far this year, insured hospital stays actually decreased in some instances. In reporting its earnings last week, Cigna, another insurer, talked about the “low level” of medical use.

Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends. Many defend proposed double-digit increases in the rates they charge, citing a need for protection against any sudden uptick in demand once people have more money to spend on their health, as well as the rising price of care.

Even with a halting economic recovery, doctors and others say many people are still extremely budget-conscious, signaling the possibility of a fundamental change in Americans’ appetite for health care.

“I am noticing my patients with insurance are more interested in costs,” said Dr. Jim King, a family practice physician in rural Tennessee. “Gas prices are going up, food prices are going up. They are deciding to put some of their health care off.” A patient might decide not to drive the 50 miles necessary to see a specialist because of the cost of gas, he said.

But Dr. King said patients were also being more thoughtful about their needs. Fewer are asking for an MRI as soon as they have a bad headache. “People are realizing that this is my money, even if I’m not writing a check,” he said.

For someone like Shannon Hardin of California, whose hours at a grocery store have been erratic, there is simply no spare cash to see the doctor when she isn’t feeling well or to get the $350 dental crowns she has been putting off since last year. Even with insurance, she said, “I can’t afford to use it.” Delaying care could keep utilization rates for insurers low through the rest of the year, according to Charles Boorady, an analyst for Credit Suisse. “The big question is whether it is going to stay weak or bounce back,” he said. “Nobody knows.”

Significant increases in how much people have to pay for their medical care may prevent a solid rebound. In recent years, many employers have sharply reduced benefits, while raising deductibles and co-payments so people have to reach deeper into their pockets.

In 2010, about 10 percent of people covered by their employer had a deductible of at least $2,000, according to the Kaiser Family Foundation, a nonprofit research group, compared with just 5 percent of covered workers in 2008.

Doctors, for one, say patients’ attitudes are changing. “Because it’s from Dollar 1 to Dollar 2,000, they are being really conscious of how they spend their money,” said Dr. James Applegate, a family physician in Grand Rapids, Mich. For example, patients question the need for annual blood work.

High deductibles also can be daunting. David Welch, a nurse in California whose policy has a $4,000 deductible, said he was surprised to realize he had delayed going to the dermatologist, even though he had a history of skin cancer. Mr. Welch, who has been a supporter of the need to overhaul insurance industry practices for the California Nurses Association union, said he hoped his medical training would help him determine when to go to the doctor. “I underestimated how much that cost would affect my behavior,” he said.

Dr. Rebecca Jaffe, a family practice doctor in Wilmington, Del., said more patients were asking for the generic alternatives to brand-name medicines, because of hefty co-payments. “Now, all of a sudden, they want the generic, when for years, they said they couldn’t take it,” she said.

The insurers, which base what they charge in premiums largely on what they expect to pay out in future claims, say they still expect higher demand for care later this year. “I think there’s a real concern about a bounce-back, a rebound, in utilization,” said Dr. Lonny Reisman, the chief medical officer for Aetna.

Because they say they expect costs to rebound, insurers have not been shy about asking for higher rates. In Oregon, for example, Regence BlueCross BlueShield, a nonprofit insurer that is the state’s largest, is asking for a 22 percent increase for policies sold to individuals. In California, regulators have been resisting requests from insurers to raise rates by double digits.

Some observers wonder if the insurers are simply raising premiums in advance of the full force of the health care law in 2014. The insurers’ recent prosperity — big insurance companies have reported first-quarter earnings that beat analysts expectations by an average of 30 percent — may make it difficult for anyone, politicians and industry executives alike, to argue that the industry has been hurt by the federal health care law. Insurers were able to raise premiums to cover the cost of the law’s early provisions, like insuring adult children up to age 26, and federal and state regulators have largely proved to be accommodating.

But 2014 and 2015 are likely to be far more challenging, as insurers are forced to adjust to the law’s greatest changes, like providing coverage to everyone regardless of whether they have an expensive pre-existing condition. “I think they’re going to go through a winter,” said Paul H. Keckley, executive director of the Deloitte Center for Health Solutions, a research unit of the consulting firm Deloitte.

And while the slowing down of demand is good for insurers, at least in the short term, the concern is that patients may be tempted to skip important tests like colonoscopies or mammograms. The new health care law will eventually prevent most policies from charging patients for certain kinds of preventive care, but some plans still require someone to pay $500 toward a colonoscopy.

In recent times, insurers have prospered by pricing policies above costs, said Robert Laszewski, a former health insurance executive who is now a consultant in Alexandria, Va. The industry goes through underwriting cycles where the companies are better able to predict costs and make room for profits. “They’re benefiting from a very positive underwriting cycle,” he said.

“Maybe managed care is finally working,” he said. “Maybe this is the new normal.”

Still, he emphasized, health care costs, even if they are rising at 6 percent or 7 percent a year, are increasing at a much faster pace than overall inflation. “We haven’t solved the problem,” Mr. Laszewski said.

Calif regulator: Malpractice insurance too pricey

Calif regulator: Malpractice insurance too pricey
By SHAYA TAYEFE MOHAJER
Associated Press
02/17/2011

Medical malpractice insurance rates might be too high because some insurers are spending as little as 2 or 3 percent of premiums to pay out claims, according to the California Department of Insurance.

Insurance Commissioner Dave Jones said in a statement Thursday that insurers should reduce rates paid by doctors, surgeons, clinics and health providers while his staff scrutinizes the numbers.

"We have found that recent loss ratios—the percentage of every premium dollar the insurer spends on claims—of many medical malpractice insurers are low," said Jones. "Low loss ratios are one indication that premiums may be too high."

Medical malpractice is the failure of a doctor or medical professional to operate with an ordinary level of professional care, which can result in injury or death. Medical professionals are liable to pay damages in such instances, and take out insurance policies to cover such costs.

On average, insurers in California spent nearly 23 percent of collected premiums on claims and other losses.

The state's biggest medical malpractice insurer, Napa-based The Doctors Company, spent only 10 percent of the $179 million collected in premiums on claims in 2009. The company handles about 37 percent of the market in medical malpractice in California.

In a statement, the insurer's executive and general counsel David McHale said the company is committed to working with the state's regulator to charge
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reasonable rates and reflect the realities of the marketplace.

McHale added the company is the only medical malpractice insurer in the state to reduce rates in the past five years, referring to an average 18 percent rate cut for many of its 19,000 policyholders in 2008.

Doug Heller, president of the Santa Monica-based consumer advocacy group Consumer Watchdog, said the problem ends up hurting consumers who suffer because of malpractice and must too often fight insurers to get claims paid.

"The medical malpractice premiums in California have so much extra padding right now because the companies are taking premiums from doctors and hospitals but don't have to pay much out in claims," said Heller, calling on the commissioner to hold rate hearings.