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Insurance industry 'whistleblower' talks health care reform

Alan Cleaver

For about two decades, Wendell Potter spun carefully crafted public relations messages for Humana and Cigna, the insurance companies where he worked. He recalls convincing consumers that high-deductible insurance plans would be good for everyone; telling them that by paying more, they’d have more skin in the game of their own health.

“I frankly just got so disillusioned and, ultimately, disgusted with what I was doing,” Potter said.

He said through his own research, he knew high-deductible plans were not the best insurance coverage for those with middle-class income.

“The median household income in this country is just barely $50,000,” Potter said. “A family that’s earning $50,000, if they’re in a plan with a high deductible, they face bankruptcy or foreclosure [if something happens]. I’ve talked to a lot of people who have lost their homes and have to declare bankruptcy because they have been in these kinds of plans. They think they have adequate coverage and they don’t.”

In 2008, Potter left the insurance industry and became a consumer advocate. He testified in Congress against high-deductible plans. In 2010, he published a book detailing the ways public-relations practices of the insurance industry affect American health care. 

Now, Potter writes columns and travels around the country to debunk what he calls are “myths” about the Affordable Care Act. The law imposes stricter rules on insurance companies. They can no longer refuse coverage for consumers who have a pre-existing condition, for example. Companies also have to spend at least 80 percent of every dollar of a consumer's premium for patient care and quality improvements, not profits or administrative costs. 

On a recent visit to Columbia, Potter sat down with KBIA's Harum Helmy to chat about health care reform and the insurance industry's response to it. 

Listen to a longer version of the interview.

Highlights from the interview:

You had a good, informative blog post recently about how ObamaCare would introduce more competition, which would benefit consumers. Talk a little bit about that?

“That’s right. That’s another thing I want people to come to understand. It will foster competition. And it actually preserves the system of private insurance companies in this country in ways that are important for people who support private insurance companies and want to have the option of buying private insurance and want to have a choice. Most of us don’t have much of a choice. If you get it through a workplace, we usually get whatever our employers say we’ll have. We don’t get a vote to choose it. Those of us who buy in the individual market often have limited choices, and in most states there are one or two companies that dominate. The Affordable Care Act, through insurance exchanges or maketplaces that will be up and running on Oct. 1, will bring a lot more competition to the health insurance world. So we’ll have a lot more choice. We’ll be able to compare one plan or another in ways we haven’t before. They’ll be required to provide information to us in standard language.

I guess there’s a campaign, maybe, from the insurance industry that this is going to increase [insurance premium] rates, also known as rate shock.

It’s coming from the insurance industry because the motive here is to get people to be afraid of reform, to get people to think that these consumer protections are not in their best interest. It’s deception. The reason they’re doing this is they want Congress or state lawmakers to change the law as its being implemented to benefit insurance companies, to scuttle some of these consumer protections.

You also had a blog post about the loopholes that exist in the Affordable Care Act and how the insurance companies are trying to exploit it. Share about that?

They’re finding out, apparently, that in some circumstances they can sell policies to small businesses and avoid the consumer protections that the law intended. They’re trying to get away with it. I don’t think they can get away with it, because I think the awareness of their effort will bring regulations at the federal level, maybe state level that will keep them from doing that.

Harum Helmy started as KBIA's Health and Wealth reporter in January 2013. She has previously worked at the station as a news assistant, helping assign and edit stories by student reporters. Harum grew up in Jakarta, Indonesia and graduated from MU with degrees in journalism and anthropology in 2011. She's trying to finish up an MA in journalism.
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