Another ACA victory: The PoopStrong Effect

Click here for more info!It has not ceased to amaze me just how many stories of people who have been helped by the ACA continue to come out of the woodwork.

The most recent one to hit the media’s attention is that of 31 year-old Arijit Gurha, a graduate student at the University of Arizona who was recently diagnosed with stage 4 colon cancer.

Unfortunately for him, his Aetna student health plan had a $300,000 lifetime benefit limit.  Needless to say, the plan offered little protection to him once his cancer was discovered.

Arijit’s story has a happy ending, thanks to three very different aspects of the ACA: (1) a new provision that says that student health plans can no longer have lifetime benefit limits or unreasonable annual limits, (2) the new pre-existing condition insurance plan, and (3) the new scrutiny that the ACA has brought onto both health insurer profits and spending through the new MLR rules, and on consumer protections.

See, Arijit was eventually given the option of securing coverage through a newly renegotiated student health plan or the PCIP.  However, his six months spent undergoing lifesaving cancer treatments with no health insurance benefits left him with over $100,000 of debt.

His fundraising blog, aptly titled, helped him raise some money, but it wasn’t enough.  So, Arijit decided to put Aenta’s feet to the fire by utilizing his Twitter account.  The New York Times’ Well Blog has a great account of the conversation that ensued, which you can read here.  But the amazing thing is that IT WORKED.  Yes, that’s right, in the end, Aetna agreed to pay the over $100,000 debt he had accrued since hitting his lifetime max.

How was this possible, you ask? Well basically, it had to do with what I’d like to refer to as the PoopStrong Effect.  Basically, because of the new consumer protections written into the ACA, health insurance profits and spending have begun receiving a whole lot of attention from the mainstream media.  Pair this with a young person with an incredibly compelling story and the power of the internet behind him, and a forthcoming law that will change the rules in his favor, and you’ve got yourself the perfect conditions to bring forth some serious health plan PR damage control.

Two years ago, before the ACA became law, the PoopStrong Effect would have never been possible.  Remember the 2007 Michael Moore film “Sicko”? A great conversation starter, but it didn’t do much to help the folks profiled in the film who had suffered from insurance industry abuses.  Yet today, a young guy with cancer and a twitter account is able to move a mountain.

The landscape has certainly changed, hasn’t it? And for that, we can thank the ACA.


That’s right – its health insurance rate review time! This means that our health insurance plans are now diligently submitting their proposed rate increases to the Department of Financial Services (DFS) for approval.  Some of you may have already received a letter from your health plan letting you know that they plan to “adjust” your premium rate.  Health plans are required to give you 120 days notice of any proposed rate increases (and 60 days notice before the approved increase goes into effect).

It’s up to DFS to decide whether the proposed rate increases are necessary.  Comments and objections from policyholders and the public can be submitted for up to 30 days after a health plan submits its application for an increase.  You can find any pending rate increase applications, and supporting documentation, on the DFS website by clicking here.

HCFANY is, of course, on top of this and is once again submitting comments on proposed rate increases.  First on the agenda is Oxford/United Healthcare, which is requesting rate increases of between 15.1% and 46.5% for its various small groupproducts.  After combing through the supporting documentation provided by the plan – particularly around medical trend and member migration – we are not convinced that that increases of this magnitude are necessary.  Our recommendation to the DFS is that the proposed rate increases be denied.

Click here to read HCFANY’s comment to the DFS in response to the proposed rate increase for Oxford Health Plans (NY), Inc., Oxford Health Insurance, Inc., and UnitedHealthcare Insurance Company of New York.

If you’d like to submit your own comments to the DFS, you can do so online by clicking here, or via regular mail to:

Mr. Charles Lovejoy
Health Bureau
New York State Department of Financial Services
25 Beaver Street
New York, NY 10004

Or dinner!  Or drinks!  Or whatever else it is that you’d like!

See, as part of the ACA, insurers who offer health coverage to individuals and small businesses must spend at least 80% of what their enrollees pay in premiums on health care claims and quality improvement activities (in NY, state law actually requires this to be slightly higher, at 82%).  The other 20% or so can be used for administrative expenses like marketing and profits.  For large employer plans, insurers have to spend at least 85% on claims and quality improvement.

These new rules went into effect on January 1st of last year, which means the rebates have now started to trickle down to us real folks.   Here in New York, some of us have already gotten our rebates.  A new report issued by the Kaiser Family Foundation (KFF) is estimating that rebates in New York will average around $150 for people who buy insurance on their own, and $125 for small business enrollees.  For large employer enrollees, rebates are expected to average $142.

In total, individuals and businesses in the US are expected to get back a total of $1.3 billion – that’s no small peanuts.  Thanks health reform!

Click here to read the full KFF report, titled “Insurer Rebates under the Medical Loss Ratio: 2012 Estimates.”

Or, to learn more, here are a couple more articles on the subject from around the Web:

Did anybody watch this? On Monday, U.S. Secretary of Health and Human Services Kathleen Sebelius made a guest appearance on the Daily Show to talk about the Affordable Care Act.

She does a pretty good job of hashing out what’s in the law and what’s not, and Jon Stewart is, as always, just charming.

In case you missed it, you can still watch the full interview, in two parts, on the Daily Show website.  Click here to watch.