In a surprise move last week, nine of the largest providers of health insurance under the Medicare Advantage program and the trade group that represents them agreed to tighten marketing and sales rules that federal lawmakers said have become far too lax and have opened the door for unlawful sales tactics.
The deal, however, was viewed by some lawmakers and state officials as a means to shape potentially broader-reaching legislation from Congress.
In a meeting with members of the Senate Finance Committee, Karen Ignagni, president and chief executive officer of Americas Health Insurance Plans, outlined details of the proposal, which would ban door-to-door marketing, cold calls and cash incentives used to bolster enrollment.
In addition, the group asked lawmakers to back their proposal either through legislation or other means as a way to give it more teeth. Through regulation or legislation, we can accomplish more and ensure that beneficiaries are absolutely protected while still being able to access the best information to make their healthcare decisions, AHIP spokesman Mohit Ghose said.
The deal, which was drafted by AHIPs board of directors, would put into place several backstops to help ensure that seniors are not being enrolled in a private plan without fully understanding the fine print. Its aimed at addressing lingering sales and marketing problems that have come to light within the program and comes after a growing number of complaints from seniors who say they were duped into enrollment. The AHIP proposal would also give states more oversight of the sales agents and the companies that hire them, Ghose said.
But state insurance officials said that the AHIP proposal doesnt break any new regulatory ground, and its call for increased CMS oversight is misplaced. The things they outline are really things that the states are already doing, said Oklahoma Insurance Commissioner Kim Holland. She said that the AHIP proposal wouldnt give states the needed authority to oversee market conduct, or the way that an insurance company does everything from marketing and selling of their products to how they actually pay out claims. AHIP would keep the CMS in that position, not individual state commissioners, she said.
Increased state powers likely would be a part of a Senate bill to be introduced this year. In a written statement, Senate Finance Committee Chairman Max Baucus (D-Mont.) lauded AHIPs directive as a huge step forward, but added that legislation he plans to introduce would likely be stricter.