Insurance companies lose their antitrust exemption with the Passage of The Competitive Health Insurance Reform Act of 2020
Insurance companies have long had an exemption from anti-trust violations as a result of a 1944 Supreme Court Case, United States v. South-Eastern Underwriters Association, the Court established that the business of insurance constitutes “interstate commerce,” and therefore is subject to Congressional oversight under the Commerce Clause of the Constitution. This decision specifically held that the Sherman Act – the federal antitrust statute – applied to insurance. Along with the stimulus bill, was the passage of the Competitive Health Insurance act of 2020 which was included as part of the act and amends this court ruling so insurers are now subject to antitrust violations. As they often do, they will lobby to weaken or nullify this piece of legislation with their deep pockets of premium dollars from consumers such as yourself.
Insurance companies’ actions over the past 30 years have resulted in less competition, higher prices for healthcare services and coverage, and mega healthcare systems that have done little for the quality of healthcare but have steadily made it cost more. Wall Street saw that there was an opportunity and purchased practices that pushed up prices further for consumers and also resulted in surprise medical bills that were absurd.
In NJ, systems such as Horizon introduced Omnia which formed tiers that unbelievably made larger more expensive systems cost less while smaller systems and providers with less clout and often lower prices were placed in their more expensive tier. This included chiropractors where are among the most cost-effective providers for musculoskeletal care in NJ. As a result, people still visit chiropractors but will often choose other less effective and expensive services first costing the system more and then laying out huge deductible sums to have their problems resolved by a more effective practitioner. The Antitrust exemption allowed them to get away with this and avoid class-action suits. You the consumer are paying the price even when your company self insures, as half of them do since these actions caused huge industry consolidation and healthcare monopolies throughout NJ.
Ironically, physicians have always had an anti-trust provision preventing them from organizing and fighting back. This allowed insurance companies to conspire and price fix with impunity. Removing the exemption through The Competitive Health Insurance Reform Act leveled the playing field but maybe too little too late as many formerly independent providers are now working for larger tier1 hospital systems which was the only way they could be a preferred tier 1 provider. Many small practices have been driven out of business by insurance companies’ predatory practices or sold to larger practice systems or hospitals making them reducing competition.
The exchanges are a joke, with people being driven out of their insurance by high prices, high deductibles, and few good choices. Each year the premiums continue to rise in this insurance-manipulated market which justified their higher premiums with higher costs caused by their marketplace actions. Is it any wonder insurance companies don’t want to compete with a public option or an expansion of Medicare? Their narratives of socialism, lack of choice, etc, were lies according to a Cigna Executive Wendell Potter who came up with them in the 1990s and now praises Canada’s single-payer system. The Harry and Louise campaign sidelined the Clintons Attempt to overhaul healthcare in the 1990s using this campaign. Insurers continue to use their marketing muscle and propaganda approach to expand into Medicare Advantage plans which offer less choice and more problems than Medicare itself, but they offer a free gym membership or another superficial perk to make it look better while limiting patient choice, paying doctors less and having more problems getting claims paid.
While President Trump may have his detractors, the signing and passing of this bill may be his biggest achievement in office. Even Obama under the Affordable Healthcare Act legislation had this as part of its negotiation but failed to pass it.
Will Congress finally act to pass the Chiropractic Modernization act which will give chiropractors full coverage under Medicare for the first time? Congress has a growing list of sponsors. Will the newest Senate be sponsoring this next? Will antitrust lawsuits be able to advocate for those financially harmed by years of activities by health insurers who have used vendors or tiered plans to harm physicians and patients alike in the interest of lining their pockets?
Perhaps change is finally gonna come.