Big Health Insurers Go For Big PR Boost With Coverage Promises

United Health Group, Aetna and Humana announced yesterday that even if the Supreme Court overturns the Affordable Care Act or rejects key provisions like the individual mandate, the large insurers promise to continue some popular early initiatives. UnitedHealth, which provides coverage for about 26 million people and is the nation’s largest insurer, was the first to announce that they would:

1) Allow parents to keep children on their plans until they are over 26

2) End lifetime limits on dollars spent on medical care

3) Continue to provide preventive services without co-payments

4) Allow third-party appeals when services are denied

Humana and Aetna pledged later in the day that they would continue similar coverage provisions. Other insurers are sure to follow.

The companies haven’t said how much it will cost them to maintain what one Humana executive calls “common sense” provisions, but my guess is that they’ve done a thorough analysis and realized that keeping healthy young adults in family plans is a no-brainer in financial terms and also gives the insurers a big boost in public relations. Polls have consistently shown that this, along with eliminating co-pays for preventive services like mammograms and immunizations are very popular with consumers.

And they aren’t very expensive. The government estimates that keeping young adults on their parents’ plans and prohibiting lifetime limits on benefits each add less than 1 percent to insurance premiums . As Washington and Lee University law professor Timothy Jost told Kaiser Health News, the UnitedHealth statement seems to indicate that “the provisions are not bankrupting the industry.”

The announcement was well received by Republican opponents of the ACA who have pledged to roll back any provisions of the health law left standing after the Supreme Court ruling. One of their underlying arguments is that government “intrusion” into the health care market is unnecessary and that solutions for both cutting the nation’s health spending and covering more of the uninsured lie in the private market. According to Politico, Michael Steel, spokesman for House Speaker John Boehner, said that UnitedHealth’s announcement “is a reminder that sensible health care reform does not require the massive government takeover in Washington Democrats’ law, which is hurting our economy by driving up costs and making it harder for small businesses to hire.”

Listen long enough to the conservative response to this laudable, yet really not very onerous concession by private insurers and you’d think, “Great, problem solved!” Except it isn’t—not by a long shot.

Earlier this month, a report from the Commonwealth Fund found that in 2011, 6.6 million young adults age 19-25 who would not have been able to stay on their parents’ health plans were able to do so after passage of the Affordable Care Act. But without the rest of the ACA provisions–especially the individual mandate–companies will not have to cover millions of people with pre-existing conditions like cancer or heart disease who struggle to obtain health insurance that is even remotely affordable or provides anything but the most spare coverage. In yesterday’s announcement, UnitedHealth said it won’t cover children with pre-existing illnesses unless other insurers also agree to cover them, and none of the companies have committed to covering adults with pre-existing conditions. Insurers have also said nothing about sticking to the new federal rule that requires them to spend at least 80% of what they collect in premiums on actual medical care and quality initiatives rather than on administrative costs.

Without the ACA there won’t be health insurance exchanges set up in every state to help consumers compare plans; there won’t be a set of essential benefits that all plans participating in the exchanges will have to offer; and most importantly, there will be no subsidies or government tax credits to help low and moderate income Americans afford decent coverage. And instead of expanding Medicaid to cover what the Congressional Budget Office  estimates will be 16 million more of the working poor, the state-federal program will, in one expert’s words, be “in shambles.”

Of course the list of innovations and provisions designed to both expand coverage to 33 million uninsured Americans and rein in the unsustainable growth of health care spending that would be lost if the ACA is overturned or greatly amended is very long. This is broad, wide-ranging legislation with irons in many fires including the smoldering pyre that is Medicare. Private insurers can’t come close to solving our deepening health care woes. As Jost puts it, “I’m glad to hear United [Health] is doing this and I hope other insurers follow suit. But that doesn’t solve the problem of the uninsured, which is why we need the rest of the health bill.”

Exactly.