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Controls urged for medical insurers

Times Staff Writer

Saying the healthcare debate here was not sufficiently focused on curbing insurers’ profits, some lawmakers and consumer groups are backing a new effort to regulate medical insurance rates the same way the state controls auto coverage costs.

Gov. Arnold Schwarzenegger has proposed that insurers be required to spend at least 85% of premiums on actual medical care, as HMOs in California now must do. But a new proposal by Assemblyman Dave Jones (D-Sacramento) would go further by requiring insurers to obtain state approval for annual premium increases above 7%.

“I introduced this measure to make sure affordability is injected into the debate,” Jones said at a new conference Wednesday.

Healthcare premiums have grown at four times the rate of wages and inflation this decade, and many advocates complain the free market has failed to rein in profits taken by private insurers.

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The role of corporate administration and profit in the escalating premiums is one of the most contentious topics in this year’s debate.

Many experts say rising costs are primarily due to new technologies and tests as well as a population that is older and more obese, requiring greater care. But some for-profit insurers take profits of as much as 10% on every premium dollar.

Aetna Health Plans of California spent 9.8% of premiums on administration in the fiscal year ending in 2005, according to an analysis by the California Medical Assn., and kept 11.5% as profit. Blue Cross of California spent 11% of premiums on administration and kept 10% as profit, the analysis showed.

Christopher Ohman, CEO of the California Assn. of Health Plans, called Jones’ measure a “distraction” from bigger problems and said states with rate regulation, such as Georgia and New York, have experienced premium increases similar to those in California.

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Instead of reducing premiums, Ohman said, the bill would place “a whole new administrative load on the healthcare premium” because insurers would have to justify their rates.

Many administrative costs are for projects lauded by advocates of change. They include putting records in electronic form for greater efficiency and performing studies on what medical techniques work best.

But insurers also spend large sums on marketing, lush salaries for top executives and underwriters who help companies weed out potentially expensive customers.

The Foundation for Taxpayer and Consumer Rights, the Santa Monica-based advocacy group behind the push for regulated auto insurance rates in California, reported that insurers’ profits have grown 170% in the first half of this decade.

The foundation, one of the backers of Jones’ bill, also said that since 2002, four insurers -- Blue Cross of California, PacifiCare, Health Net and Aetna -- have sent $3.2 billion of California premiums to their national parent companies as profit.

Jerry Flanagan, an advocate at the foundation, said that California’s success in regulating auto rates through Proposition 103 in 1988 showed that such oversight saves money. Between 1989 and 2003, auto premiums dropped 7% in California while premiums in the rest of the country increased 47%, he said.

However, a 2004 report by the Rand Corp. said it was inaccurate to compare the two industries. The report said good-driver discounts, stronger seat belt laws, strict enforcement of drunk-driving laws and other changes were responsible for the drop, and that insurer profits actually have increased since regulation started.

The Rand report was funded by the California Health Care Foundation, an Oakland nonprofit created as a condition of state approval for Blue Cross to convert from a nonprofit to a for-profit organization.

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Jones’ bill is endorsed by the Consumer Federation of California, the California Public Interest Research Group and California Church Impact. Two Democratic lawmakers with leadership positions on healthcare, Assemblyman Hector De La Torre of South Gate and Sen. Sheila Kuehl of Santa Monica, said in interviews that they supported the idea of regulating insurers.

Del La Torre said healthcare is as essential a service as the utilities that California regulates. “They deserve the scrutiny we give to electricity or to water,” he said of health insurers.

Kuehl, who has a bill that would abolish private insurers altogether in favor of a state-run system, agreed that it should be included in the debate.

None of the major parts of the healthcare sector, such as doctors and hospitals, are backing the proposal.

Dustin Corcoran, the chief lobbyist for the medical association, said his organization is concerned that regulators could limit funds that doctors need to provide the best medical care.

“While we are opposed to the legislation, we share the sentiments of the author about insurers’ runaway profits,” he said.

The proposal was not included in the plans that the Democratic leaders of the Senate and Assembly have offered as alternatives to Schwarzenegger’s proposal. But advocates said all of those plans would be improved by direct regulation of insurers.

“At least there would be an outside regulatory process that can understand why rates are going up 30% if need be,” said Leilani Aguinaldo, a lobbyist for the Consumer Federation.

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jordan.rau@latimes.com


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