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What Do You Want to Ask Karen Ignagni?

In about two hours, I'm going to be taping C-SPAN's Newsmakers program, where I'll be interviewing Karen Ignagni, the head of America's Health Insurance Plans. The interview will air on Sunday.

What do you want me to ask? And as you formulate questions, remember that the point of this is to actually get some useful answers, not just to shout at the speaker. It's not a town hall! If you want some background on Ignagni, Jon Cohn's profile is an excellent place to start.

By Ezra Klein  |  August 14, 2009; 9:33 AM ET
 
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Comments

How much money from people's premiums is the AHIP spending to kill the public plan, and how many uninsured Americans could have insurance if they did not waste it lobbying?

Posted by: JonWa | August 14, 2009 9:59 AM | Report abuse

Can you comment on the role of rescission in maintaining insurance company profitability in the private insurance market. In testimony before congress, industry officials indicate roughly 0.5% of privately insured individuals have their insurance dropped when they suffer a major illness, due to an unrelated preexisting condition. When statistics show that 5% of individuals in the population are responsible for 70% of health care expenditures (and indeed, 1% are responsible for 20%), this indicates that a 0.5% rescission rate could cut insurance company expenditures by over 10%.

Posted by: jimotto | August 14, 2009 10:00 AM | Report abuse

Most analysts indicate that the costs of health care for the uninsured are now shifted to insured Americans, to the tune of about $1100 a year per person. If Congress makes health insurance mandatory, can the industry assure us that premiums for the currently insured will go down?

Posted by: exgovgirl | August 14, 2009 10:00 AM | Report abuse

Have you had conversations with Republican Congressmembers and Senators about the bill? If the final bill is something AHIP can support, do you think you can successfully lobby them to support it?

Posted by: NicholasBeaudrot | August 14, 2009 10:01 AM | Report abuse

Health care reform envisions a public option competing with private insurance on the exchange. There are some examples of public/private competition that seem to work well, so what lessons should be drawn from those examples to make sure we retain competition in the exchange? Are there provisions in the law needed to protect the competition?

Posted by: windshouter | August 14, 2009 10:01 AM | Report abuse

Administrative costs for private health insurance is vastly higher than for Medicare. What value added to society does the industry provide that justifies this additional cost?

Posted by: exgovgirl | August 14, 2009 10:02 AM | Report abuse

Beyond the insurance exchanges and public plan, the health care bill could also regulate health insurance in new ways -- around pre-existing conditions and rescission, for example. Both of these could be addressed within the insurance industry itself. Why haven't they?

If the public plan is not part of a final bill, what other force will encourage insurance companies to adopt these types of policies?

Posted by: rpy1 | August 14, 2009 10:10 AM | Report abuse

How much profit does the insurance industry stand to gain from the passage of HR 3200?

Posted by: wallaceforman | August 14, 2009 10:12 AM | Report abuse

It appears that what may be emerging from Congress will look eerily similar to the Massachusetts plan put into law by Mitt Romney. The "RomneyCare" mandate was sold to the MA taxpayers as a way to drive down costs and premiums. Yet premiums and costs continue to skyrocket in MA (personally, my premiums have risen nearly $2000/year since the mandate went into effect), and the subsidies paid by the commonwealth for those who can't afford it are bankrupting Beacon Hill, having cost nearly 10 times what was originally estimated .

Why should we expect that a national mandate perform any differently? Why is the AHIP selling the idea of a national mandate, when it is such a failure in MA?

Posted by: djdigdoug | August 14, 2009 10:20 AM | Report abuse

Suppose the insurance industry were able to have legislation passed and implement changes to its own policies to solve the health care crisis--that is, arrive at a system that would actually provide a reasonable, cost-effective basic level of health care to everyone in America.

Assume that the industry didn't actually have to negotiate with anyone else but could arrange things as it sees fit. What would the insurance industry's good-faith ideal system look like?

If some portion of the insurance industry's ideal system would involve policy changes within the industry itself, why can't the industry actually just go ahead and implement those changes anyway?

Posted by: Shirk | August 14, 2009 10:28 AM | Report abuse


Why is ending rescission off the table? Or even any discussion of defining 'acceptable' rescission (i.e., when a patient is actively deceptive)? Ironically, for all the fomenting of anti-insurance anger the reform conversation has stirred up, the reform itself is looking to put 'up to' 47 million new customers on the rolls of private insurance. Isn't at least having the conversation around rescission worthwhile?

Posted by: ThomasEN | August 14, 2009 10:29 AM | Report abuse

Two questions. The first is closest to my heart, but the second probably more important in the great scheme of things.

Is the insurance industry prepared to devote serious resources to the development and deployment of open-source, vendor-neutral data formats and communications protocols to simplify medical billing and integrate billing functions with computerized patient record systems?

How can the insurance industry contribute to a new payment model for providers, where payment is related to patient outcomes rather than just services rendered?

Posted by: wankme | August 14, 2009 10:34 AM | Report abuse

Ask to how AHIP is trying to balance the viewpoints of its members. Some of the larger groups, such as Wellpoint, have come out against reform, whereas other MCOs seem to have accepted that reform will happen.

Posted by: GrandArch | August 14, 2009 10:34 AM | Report abuse

I would ask Karen what she thinks of the deal big pharma cut with Obama? Was it money well spent? What does she make of the administration's backpeddaling on their end of the deal? Why shouldn't the public view the pharmaceutical industry's support for the Dem's reform plan and the $80 billion hit as a shakedown by Obama?

Posted by: tbass1 | August 14, 2009 10:56 AM | Report abuse

Do you see the health insurance industry moving away from a traditional insurance business approach--which is about choosing good risks, avoiding bad ones, and pricing premiums correctly--into a position where their business is, at core, more about integrating patient care and building networks of high-quality, good cost providers?

How do you see that happening? What do you think stands in the way of this goal, and do these current reform bills help at all?

How do you plan to overcome the challenge of a lack of public trust in health insurance companies?

Posted by: theorajones1 | August 14, 2009 11:00 AM | Report abuse

1.Since the goal of any corporation is to make money for stockholders and the way for health insurers to obtain a good stock price is to have a low Medical Loss Ratio, Isn't it clear that they make strong efforts both to reduce payments to customers and increase non-medical spending?

2. Since MLR for the large companies is in the 70% to 80% range while the Federal part of Medicare and single payer systems in other countries have MLR's in the 98% to 99% range, couldn't we save hundreds of Billions each year by the elimination of for profit insurance companies?

3. There are 1500 different insurance plans not counting Medicare Part D. They all have various complicated forms for physicians and patients to fill out. Wouldn't we save hundreds of Billions each year by passing to a single payer system like Medicare for All which could have a simple one page form for most treatments as they do in France?

4. Has the $1.4 million your industry spends each day on PR have as one of its purposes to keep the basic facts about single payer systems from the public?

Posted by: lensch | August 14, 2009 11:09 AM | Report abuse

Does AHIP see non-profit insurance groups like Kaiser as a similar threat as the public plan? If not, why? Would AHIP support the expansion of non-profit insurance groups?

(along lines already mentioned by other posters) Is AHIP actively lobbying Congresspeople to support the bill? Are they attempting to correct disinformation that's being spread by both legislators and pundits (read: death panels) through either direct lobbying of legislators or through appearances in the media?

Posted by: MosBen | August 14, 2009 11:13 AM | Report abuse

Oh, does AHIP believe its members can reduce their administrative costs to be more in line with Medicare? If not, why not?

Posted by: MosBen | August 14, 2009 11:16 AM | Report abuse

Why do you think insurance companies have done such a poor job of explaining how they make coverage decisions? Those of us who understand the process know that your medical directors are physicians who use evidence in their decision-making, but the public still thinks it's bean counters.

Posted by: LindaB1 | August 14, 2009 11:26 AM | Report abuse

I would like to know if she really believes that rescission, as it is practiced today*, is something she really believes is good law.

* I'm referring to the practice of automatically reviewing a customers' medical history when they get certain conditions and dropping someone with breast cancer because they didn't disclose acne problems when they were a teen, not the obvious fraud situations.

Posted by: rat-raceparent | August 14, 2009 11:51 AM | Report abuse

LindaB1 - My daughter needed a serious dental operation when she was 14. The insurance company said they would only pay for laughing gas in any dental operation. The surgeon said he would not operate with laughing gas so I paid for the anaesthetic. Did a physician make that decision?

Posted by: lensch | August 14, 2009 12:31 PM | Report abuse

1. Do you believe advanced directives (death panels) are a smart idea for health care reform? If so what would you say to their critics. If not why?

2. Wouldn't a strong public option that provided basic health care and then let private companies insure (sp) anything higher ultimately benefit insurance companies?

Basic preventitive care would create healthier Americans. Healthier Americans would result in fewer payouts by insurance companies (in terms of both frequency of visits and cost of visits)

This seems to work in a countries like France where 85% of the population has supplemental private insurance (encouraged by the govt) Why even fight over the market share?.

Posted by: TheChairman66 | August 14, 2009 12:56 PM | Report abuse

It is not valid to assume that a person who is satisfied with her insurance coverage is not interested in reforming the health care system in the US.
I am insured and happy with the coverage I have.
This does not mean that I oppose health care reform.
The coverage we have is earned through my husband's employer. If he were to lose his job, as millions have in this recession, our access to health care would disappear.
Our system lacks portability, universality, and an equitable provision for basic subsidy for those without access. We pay far more than any other modern country and the results are comparatively poor.
What contribution can the insurance industry make to improving:
-universality of access
-portability of coverage
-uniform definition of basic minimum levels of care?

Posted by: hashihana | August 14, 2009 1:21 PM | Report abuse

LindaB1 - My daughter needed a serious dental operation when she was 14. The insurance company said they would only pay for laughing gas in any dental operation. The surgeon said he would not operate with laughing gas so I paid for the anaesthetic. Did a physician make that decision?

Posted by: lensch | August 14, 2009 12:31 PM | Report abuse


lensch,

at those levels of decision there is a guideline that is used to determine what is covered and what is not. It is based upon generally accepted practices but it is not a do all and end all decision. If a provider shows a legitimate medical reason why he or she needs to use another method than most times that is approved. As you know i believe I'm a health insurance agent within the system that knows how this works and as LindaB1 mentions there is so much disinformation in the system about what is denied and what is not its not funny.

People assume a claim that is paid out of network is denied. No its not. It means somewhere something went off the track. The key is that you need to just ensure it stays on the track.

I spend my days ensuring my clients aren't hurt by the system whether it be doctors, hospitals or insurers doing the hurting.

When you're pushed into a public plan, we go away and you're forced to fend off a governemnt employee who really could care less and has no stake in the game. If my clients aren't taken care of, they find another agent.

Posted by: visionbrkr | August 14, 2009 4:00 PM | Report abuse

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