Matthew Holt

I’m not sure that’s how Uwe meant it!

The AP has a puff piece on the greatness of Karen Ignagni. Well greatness if greatness is defined as doing anything it takes to screw the nation on behalf of her organization’s members, all the while telling bold face lies about their activities. But the lies of Karen Ignagni have been well documented here on THCB and we don’t need to rehash them now.

But then the AP reporter Erica Werner quotes Uwe Reinhardt and has this somewhat remarkable passage:

"Whatever AHIP pays her, it's not enough. She's unbelievably effective," said Princeton economist Uwe Reinhardt. "It's just amazing what she's achieved for them against all odds." Ignagni's total compensation, according to AHIP's most recent filing from 2007, was $1.58 million, which includes $700,000 in base salary, $370,000 in deferred compensation and a bonus. Ignagni won't say how many hours a week she works. The number's so high it's embarrassing, she said.

Among successes cited by Reinhardt and others is helping persuade the Bush administration to develop private insurance plans within Medicare that are producing unexpectedly high payments for private insurers. When Congress was considering expanding a children's health insurance program in 2007 by taking money from the private Medicare Advantage plans, Ignagni worked successfully to stop it. Those private plans are being targeted again by Obama, who wants to squeeze them to pay for his health care agenda. Ignagni's industry group is organizing older people to defend the plans.

There’s lots of more puffery about how she’s good at building consensus among the diverse interests in her group. My take on that is “we’ll see”.

AHIP has been unified because it had a pliant Administration in place for the last eight years that encouraged private businesses to rip off the taxpayer. And Medicare Advantage and private FFS plans were keen to step up to the plate. All the while the big plans (the old GHAA plans) gave up managing care and instead started imitating the bad behavior of the old HIAA mob. HIAA boss Chip Kahn may have lost the job when HIAA merged with AAHP, but Ignagni has well represented the transition from old style population-health managed care into a combination of sucking off the public teat and turbocharging the screwing over of the individual market. The two signal events in all of this were United Healthgroup’s purchase of looney Rooney’s Golden Rule for the better part of a billion dollars, and the merger of AAHP with HIAA (the smaller plans). That showed that big for-profit plans (and the rest of them) were happy to exploit the new Republican reality of no reform and no regulation for all it was worth. The piling on in the Medicare Modernization Act, with the introduction of private Medicare FFS and the vast (and unnecessary) increases in payments to Medicare Advantage plans, was just health care’s version of taking Halliburton’s lessons.

Now things are different and that leads to a problem for AHIP. The smaller plans in AHIP make all, and plenty of the larger ones make lots, of their money from shenanigans in the individual market. Blue Shield of California this very week is in court to defend its practice of recissions. Blue Shield says that it wants reform that would obviate the need for that kind of scummy behavior, but I’m not sure if that view is universal within the AHIP board. Ignagni has apparently sheparded the insurers towards that opinion. George Halvorson (of KP) is quoted in the AP piece as saying she got them to the agreement on giving up underwriting. He also essentially came to the conclusion that there’s no room for the schlockmeisters when I interviewed him in April.

But we’ll actually see when the final deal is cut whether the insurer coalition holds, and whether Ignagni continues to front for the interests of profit-maximization for her members by telling a pack of lies, or whether she (and AHIP) accept a deal which will turn them into regulated utilities that perform a useful role in the health care system a la Switzerland.

But really, did Uwe actually mean that Ignagni securing huge payments for Medicare Advantage and worse denying kids insurance at the cost of her members profits were “achievements”? I think not. My guess is that Uwe was being gently ironic and that the AP reporter missed the joke. On the other hand, Uwe says that she did all this against the odds?

Hardly. Getting Tom Delay to help you loot the Federal government was not a tough job. Getting the health insurers to take a reasonable and rational role in the future of health care will be.

6 replies »

  1. Maybe Prof Reinhardt’s positivity about Ms Ignagni has to do with position on the board of directors of Amerigroup, one of the larger US for-profit health care insurers/ managed care organizations.
    Amerigroup would appear to be a prominent supporter of AHIP.
    See this post on Health Care Renewal for more about Prof Reinhardt’s board positions:

  2. Mr. Holt:
    Your blog has continually exaggerated the problems associated with Medicare Advantage, so we don’t need your santimonious rants about Karen Ignani. As I’ve pointed out several times, while it would not bother me if Congress eliminated the private FFS plans in the Medicare Advantage program, intellectual honesty requires that you (along with Paul Krugman and everybody else who writes half-truths about this topic) to acknowledge that roughly half of the “excess” payments to health insurers end up going in the pockets of beneficiaries in the form of lower co-payments and additional benefits. But you can’t handle the truth.

  3. I could not agree more with you. I still find the shameless and shameful behavior of the Senate Finance Committee under Senator Baucus astonishing in that he personally and no doubt the other members of the Committee continue to hold hearings with the same cast of nonsense-spewing lobbyists or other representatives of vested interests while excluding physician advocates of single payer/insurer at every turn.
    I hope those advocates, physicians in particular, continue to do their best to raise noise about this fact.

  4. Jeez, Matthew! She’s a LOBBYIST. (worth putting “Thanks for Smoking” on your Netflix list to refresh your memory). It’s her JOB to advocate for her members. You might not like what her members do as businesses, but she has, in fact, done a remarkable job of protecting them. Uwe was not ironic here. He’s down in Washington all the time and is really well connected, particularly on the Democratic side of the aisle. She’s played a weak hand brilliantly.
    The Health Insurance Exchange is the key to all of this. It is basically the regulatory weir through which all the new money (and all the old money) passes in Obama’s plan. It will basically set federal standards for what has been, forever, a state regulated business. You may be pissed off about how Congress and past Presidents have treated this industry but health insurers have, in most states, absolutely DOMINATED their state regulatory systems. That’s where the real scandal is, not only in your pathetic state but nearly everywhere.
    What you ought to be focusing your passion on is the new rules. That’s what all this maneuvering is about. The insurers know they are going to pay some kind of price (as appropriate given the circumstances) for twenty or thirty million new members. What is the price? What do they earn on all those new revenues? What changes in business rules happen in the transition? Stay tuned.

  5. One amendment to my post. I did see one bright spot in the mess.
    Listed in both the Senate Finance Committee’s policy options and the Baucus “Call to Action” plan was “Create a new public plan, similar to Medicare, available to individuals and small businesses.” (Baucus) or “Create a new public plan to be offered through the Exchange that will be subject to the same rating and risk adjustment rules as the private plans. The public plan could be administered by the federal government, by multiple third-party administrators, or by the states.” (Senate Proposed Option A)
    Call it blackmail if you wish, but the “public plan” strikes me as important as a loaded gun to a security guard and be part of any proposal.

  6. The Kaiser people have a link where you can compare all the plans on the table in Congress and compare them a multitude of ways. Being a glutton for punishment I printed out the 17-page complete list, then proceeded to cut and tape them together in a dining table sized spreadsheet for comparison.
    Including the ambiguously worded plan from the administration there are eight different proposals, including one that has been advanced every year since 1957. Three of the proposals are politically dead on arrival, but the other four (leaving out the administration’s “guideline” plan) look like an insurance industry’s wet dream. No matter what happens, the insurance industry is looking at a revenue stream that dwarfs anything in their experience, even with the advent of managed care. I don’t know what an “insurance exchange” is but I suspect it is the insurance companies’ equivalent of “credit default swaps” (and equally full of speculative potential for clever people who have absolutely NOTHING to do with delivering health care to suck up small fortunes).
    As I realized what was happening I almost tossed the whole thing and quit reading, but it looks like half a loaf is better than none at all, which seems to be President Obama’s approach to just about everything. A letdown for those of us whose hopes were swollen out of reason, but a disappointment nevertheless.
    To make matters worse, Bill Moyers had a couple of guys on his program talking about the single-payer alternative. I got so down I turned it off. Sensible as it is, the single-payer idea is still waaay down the pike. All I can conclude is that once everyone is under the umbrella, everyone connected with the system better do right or the private sector, specifically insurance, will be next to join the ranks of the unemployed.
    The Senate Committee must move quickly to put a plan together and link hands with their colleagues in the House. It will be an uphill battle to get anything past the steamroller of disinformation forming against anything representing change. It’s time to find a way to move people away from single-payer ideals, simplify and clarify details of a plan and lock arms with the insurance industry to push a plan through the Congressional sausage grinder ASAP. Time is wasting.