My Republican friend John Tsitrian threads an interesting political needle in the Rapid City Journal. He says he supports the intent of House Bill 1067, the controversial Sanford-backed proposal intended to undo 2014’s Initiated Measure 17, which requires health insurers to include any willing provider in their coverage networks. Tsitrian says he agrees with the intent of the bill: insurance companies ought to be able to provide closed-network plans alongside open-network plans, and we ought to be able to choose to save money on a closed-network plan or spend more on an open-network plan. However, Tsitrian places an even higher value on the will of the people:
HB 1067 aims to reinstate that important choice. It does require insurers — in keeping with the original law — to offer at least one plan that will pay for services performed by any willing provider. To that extent, it keeps the intent of the original law intact. Unfortunately, though, it does so by way of a process that stinks: The notion of legislatively tinkering with a law passed by voters just doesn’t stand muster.
Our Legislature, by doing so, is effectively telling us that what we accomplished at the polls doesn’t matter because our government can change what we did by legislative fiat. So while I support the intent, I abhor the method.
Even though I strongly opposed the backers of the original bill (Patient Choice For South Dakota) I really have to agree with their public statement of a week ago that “this bill is an attempt to subvert the legislative process and ignore the will of the people … by Sanford Health or their dozens of lobbyists” [John Tsitrian, “A Good Idea, But Wrong Approach,” Rapid City Journal, 2016.02.03].
Tsitrian would accept changes to Initiated Measure 17 if its backers would kick those changes back to the voters who put the law there in the first place. HB 1067 co-sponsor and insurance salesman Rep. Mark Willadsen (R-11/Sioux Falls) would take issue with Tsitrian’s argument that HB 1067 is an affront to the will of the voters and the initiative process. Below is the full form letter Rep. Willadsen is sending out to folks who contact him about HB 1067; I highlight the portion that may be read as a response to Tsitrian’s complaint:
Dear South Dakota Voter,
Thank you for writing and expressing your views. It is what makes ours the best system in the world!
Please excuse this form letter. It is not the way I would usually like to communicate with you, but because of the number of emails I have had on HB 1067, it is necessary in the interest of time. I’ll try to answer most of the questions many of you have posed, and why I support HB 1067.
First, I would encourage you to READ THE BILL. You can do this easily by going to the Legislative Research Council website at http://legis.state.sd.us. Then click on “Legislative Session”, then choose “2016”. Then choose “Bills”, then choose “Quick Find”, then type in “1067” and the bill information will come up. Go down to the bottom right and choose “printed version” and the bill will come up in the printed form we see and use as Legislators.
First, please note the title of the bill. “FOR AN ACT ENTITLED, An act to promote quality, competition, and freedom of choice in the health insurance market place.” That is exactly what this bill seeks to do. The meat of the bill is the underlined lines starting page 2 on line 14, and the underlined lines in section 2 at the bottom of page 2, extending to page 3, and the underlined lines are the changes proposed. The lines in the bill that are not underlined, are current law. In a nutshell, what it says is that an Insurance Company that complies with IM17 and offers an insurance plan including ANY Doctor that wants to participate in the plan, MAY also offer another plan that has a CLOSED group of Doctors. The CLOSED group of Doctors is the new part, and I believe offers South Dakota insurance consumers a CHOICE of the plan that they want to purchase. The Insurance industry has long believed that by offering a closed group of Doctors, who give the insurance company a discount for participants in the closed plan all going to the closed group of Doctors, (or paying the increase for going to a Doctor outside the closed plan) will result in decreased premiums for the plan participants.
So, I believe that this bill offers South Dakota insurance consumers a CHOICE. If the consumers want to go to any Doctor they want, they can choose the health plan from IM17 that offers coverage for any Doctor. If the consumers are more concerned about the price of their health plan, and willing to go to the Doctors in a closed plan to save money on their premiums, they can choose the closed plan.
WHAT THIS BILL DOES NOT DO: It does NOT KICK SD VOTERS IN THE TEETH. Those voters who want to have access to any Doctor, can still choose to buy the IM17 plan. It does not repeal IM17. The word “repeal” does NOT appear anywhere in the bill. It is not a Sanford plan to overthrow the government. It is a plan that offers SD insurance consumers a CHOICE that they do not have now. Sanford took the lead to bring this plan of choice to South Dakotans. Anyone who tells you that this bill is kicking SD voters in the teeth after they just voted to choose IM17, or that it is repealing IM17 is LYING to you.
2 more facts that you need to know about this bill. #1. It only affects South Dakotans who are insured on individual plans or on a “Small Group” plan. Small Group plans in South Dakota are those who insure 2 – 49 lives. In other words, these plans insure small businesses who have 2 primary named insureds, through 49 primary named insureds, covered under the plan. This bill does not apply to plans where there are 50 or more primary named insureds, as these are covered by ERISA. #2. There are only 4 insurance companies in South Dakota who offer Small Group insurance plans. That’s it, 4. The 4 are Sanford, Avera, Dakotacare, and Wellmark.
Now that you know the facts of HB 1067, I hope that you can understand why an insurance professional like me would support a bill for choice for South Dakota insurance consumers. I believe the opposition to HB 1067 is using scare tactics and downright lies to convince you that South Dakotans should not have this choice. Isn’t choice what they campaigned on in 2014?
Sincerely,
Rep Mark Willadsen
District 11
Sioux Falls
Agent for Farmers Insurance Group, 27 years[Rep. Mark Willadsen, e-mail to constituent, 2016.02.02]
Assign Rep. Willadsen one yellow card for advertising his business in an official legislative letter.
Tsitrian doesn’t use the words “kicking SD voters in the teeth” any more than HB 1067 uses the words “repeal Initiated Measure 17.” But I would say it is fair to read both Tsitrian’s and the bill’s text as saying something pretty close to those things. On repeal, consider what Aberdeen physical therapist Lee Goetz said in House Commerce and Energy in yesterday’s opening hearing on HB 1067:
“The large health system owns the insurance company, the hospital, and they employ the physicians and physical therapists among many other employees,” Goetz says. “This bill will allow them to price their insurance products in such a way that it will be cost prohibitive for patients to come to choose their own doctor and physical therapist” [Jenifer Jones, “House Committee Talks Healthcare Costs, Patient Choice with House Bill 1067,” SDPB Radio, 2016.02.03].
Goetz says the “choice” HB 1067 pretends to offer is illusory, as it will allow Sanford’s insurance wing to price the open plans out of reach for consumers and force them to buy Sanford’s closed plans, which will force them to see Sanford’s doctors (ah, sweet vertical integration). Tsitrian sees more prospects for choice with open- and closed-network options, but he sees the Legislative approach with HB 1067 as an affront to voters. Rep. Willadsen thinks they are both liars.
House Commerce and Energy continues its effort to sort lies from truth on the “Any Willing Provider” law as it takes more testimony on HB 1067 at its Wednesday, February 10 hearing.
John Tsitrian ought to run for the legislature.
IM 17 was unequivocal. Here’s Section 1: “No health insurer, including the South Dakota Medicaid program, may obstruct patient choice by excluding a health care provider licensed under the laws of this state from participating on the health insurer’s panel of providers if the provider is located within the geographic coverage area of the health benefit plan and is willing and fully qualified to meet the terms and conditions of participation as established by the health insurer.” Willadsen’s protestations notwithstanding, HB 1067 says that “nothing in this chapter limits a consumer’s ability to purchase, or a health insurer’s ability to offer for sale, health benefit plans that contain less than all of the health care providers which are in a health insurer’s panel of providers.” Getting it down to basics, IM 17 says that health insurers may not exclude while HB 1067 says insurers may exclude. This is indeed a quandary for me, one which I resolve in favor of the electoral process. HB 1067 supporters should just get their acts together and take it back to the voters, making it clear that they are the ones providing real choice to consumers. Personally, I’d love to be able to make a choice between “open” and “closed” healthcare plans
I predicted that this measure was going to be a headache down the road prior to the last election.
Thea and myself also testified against this bill. We are busy contacting other private practice therapists. This is not a good plan!!!
The only way that IM17 could be increasing healthcare costs is through the loss of additional revenue due to vertical integration.
Using the legislature to gut this measure is poor form. The act requires providers to accept the fee schedule used by the insurer, therefore there is a fair bit of liberty that the insurer could take to ensure that an individual still is incentivized to get their procedure “in-house” while still allowing individuals to use any willing provider for less cost intensive services like keeping their primary physician.
Undoing the public’s intent on this is a slippery slope. It is a downright delusion to think that any plan with an open network is going to be affordable for the average consumer. Therefore, the erosion of public intent far outweighs any benefit of this bill. The health care systems should be aware of this and they should be taking steps to cope with this rather than using the legislature to undo it, especially when they are going to want to build political capital to get Medicaid expanded.
On a side note, the debate about health care has long been about how a government system would result in the loss of choice for health care providers yet the most open provider network left in this country is Medicare (and to a lesser extent, Medicaid).
Connie! Thea! Thank you for working hard to beat this bill! Keep recruiting and lobbying!
John, I appreciate your simple, logical reading of IM 17 and HB 1067. And obviously, I support the political call you’re making to trust the voters!
The bill, like a rooster flushing in front of my dogs, will likely fail on a vote of 10-3 or 9-4.
Oops. Fall, not fail
This bill is unnecessary. Any doctor who provides services to a patient with Sanford Insurance only gets reimbursed at the contractual rate according to the Sanford Insurance plan that the patient has. Only doctors that agree to the contractual payments from Sanford Insurance will agree to be a participating, in network, provider with the plan This is a back handed way of trying to gain more business to add to the large monopoly that Sanford is trying to accumulate.
I am all for national health care. But I do think that either in the current system or the old system or in single payer, that it would not be frugal to eliminate the capitalistic advantage of competition. Anyone should be able to go to any doctor of their choice and that is part of competition. Single payer takes the competition out of pricing, but who is good at negotiating on price when on their death bed or rather sick anyways. So we should not throw out the good of the old when we bring in national health care.