The Insurance Accountability and Transparency Act (IATA)

Health
,
1

The Insurance Accountability and Transparency Act (IATA)

[Draft Work in Progress]

Table of Contents

Introduction

The healthcare system has evolved with insurance companies shifting from non-profit to for-profit entities, exerting significant influence over medical decisions, patient care, and treatment options. (See Observation: Insurance Corporations are for profit businesses)

The Insurance Accountability and Transparency Act (IATA) seeks to realign these practices with patient health outcomes rather than financial gain, addressing ethical violations, patient harm, and financial burdens.

Purpose

IATA aims to:

  • Reform the insurance industry to prioritize patient care over profit.
  • Enhance transparency in insurance practices and spending.
  • Empower healthcare providers with decision-making autonomy.
  • Prevent insurance companies from engaging in practices detrimental to patient welfare.
  • Ensure insurance does not unduly influence medical treatment.

Key Provisions

Health Savings Accounts (HSAs)

  • Expansion: Make HSAs available to all employees receiving insurance through employment, promoting individual choice in healthcare services.
  • Investment Privileges: Allow HSAs the same investment privileges as insurance companies to grow healthcare funds.
  • Safety Net: Implement mechanisms to ensure access to necessary care for those with insufficient funds.
  • Increase Limits: See Increase contribution and investment amount for HSAs

Decision-Making Autonomy

  • Provider Control: Healthcare providers shall have the final say in all aspects of patient care, including diagnostics and treatment decisions, based on medical necessity rather than insurance policy constraints12. Insurance coverage decisions must align with medical judgments to prevent any delays, denials, or changes in care due to administrative tactics or financial considerations.
    (Example testimony)

Insurance for Emergencies and Chronic Conditions

  • Redefinition of Role: Insurance should cover primarily emergencies, chronic health conditions, and long-term disabilities, reducing insurer control over routine care.

Transparency in Insurance Practices

  • Medicare Spending: Require detailed reporting on how Medicare funds are allocated, differentiating between healthcare and other expenditures5.
  • Data Transparency: Insurers must publish data on claim denials, reasons, and outcomes to ensure accountability.

Scope of Practice

  • Unrestricted Practice: Regulations must reflect the full scope for which healthcare professionals are educated, particularly for professions like chiropractic physicians4.

Remedies for Unethical Practices

  • Penalties for Overreach: Implement strict penalties for insurers dictating unnecessary procedures or denying care without medical justification.

  • Appeals Process: Establish an expedited, transparent appeals process for coverage denials, supported by legal aid for patients.

  • Financial Protection: Advocate for transparency in emergency care billing, ensuring patients receive upfront cost information where legally feasible.

  • Prohibition of Unethical Collusion: Strictly prohibit insurance companies from colluding with pharmaceutical companies to incentivize healthcare providers to administer treatments, especially those under Emergency Use Authorization (EAU), that do not meet standard safety protocols. Address the mislabeling of EAU therapeutics as vaccines, ensuring clear communication to maintain ethical standards and informed consent.

    • Mandatory Disclosure of Collusive Practices: Require insurance companies to disclose any arrangements or incentives with pharmaceutical companies that could influence medical decisions.

    • Ethical Training and Standards: Mandate that insurance companies support or provide ethical training for healthcare providers, emphasizing deontological ethical standards.

    • Patient Informed Consent: Reinforce the requirement for detailed, honest communication with patients about the nature of any EAU product.

    • Regulatory Oversight and Penalties: Establish severe penalties for engaging in these unethical practices.

Implementation

  • Regulatory Oversight: A dedicated body under HHS will oversee compliance, with a special focus on monitoring and preventing collusive practices between insurance and pharmaceutical sectors.
  • Public Education:Launch campaigns to educate not only on rights and insurance practices but also on the ethical implications of medical decisions influenced by industry incentives.
  • Subsidize Alternative Options: Support the formation of non-profit cooperative insurance alternatives to address the for-profit model, providing Americans with more coverage choices.
  • Phase-In Period: Allow insurers a transition period to adapt to new regulations, including those aimed at preventing unethical collusion.

Conclusion

IATA aims to recalibrate the healthcare systemā€™s focus from profit to patient welfare, addressing insurance industry overreach. By fostering transparency, autonomy, and ethical practice, this Act, alongside PATA, seeks to ensure decisions are made based on medical necessity, enhancing healthcare outcomes.

References and Historical Context

Footnotes

[1]: Wickline v. State of California (1986) - A landmark case for insurer liability in medical decisions.

[2]: Pegram v. Herdrich (2000) - Examined insurer decision-making in healthcare.

[3]: Controversies over emergency drug authorizations during crises.

[4]: State-level legal challenges on chiropractic scope of practice.

[5]: GAO reports on Medicare spending transparency.

[6]: McCarran-Ferguson Act

[7]: Health Insurance Portability and Accountability Act

[8]: Wickline v. State of California

[9]: Affordable Care Act - For historical context only.

[10]: Federal Trade Commissionā€™s Role in Health Care

[11]: Health Insurance Practices

[12]: Impact of Insurance on Diagnostic Practices

[13]: Medical Debt and Bankruptcy

[14]: Legal Actions Against Insurers

Out of Votes? Answer this Poll!

  • 100% Agree
  • Mostly agree, but with reservations
  • Half agree/disagree
  • Mostly disagree, but agree with some of this
  • 100% Disagree
0 voters

Note: If you have any reservations, or disagree with items, please explain what and why and improvements or solutions to integrate into the proposal. Thank you!

4 Likes
2

This is very long again. Too many topics in one. Itā€™s ok to make an outline but keep to one topic. If you want to do multiple topics then make separate polcies and merge them in so people can click on them to see if they support them. For example if you are going to put mandatory review boards you need to explain exactly how that would happen. Otherwise, this would not get any support. Review boards do not work currently. They can be corrupted and have underlying motives different from the goals. Too much oversight is the problem. So I would take those out until you can come up with one that actually works. Otherwise, it would not get support because review boards are harmful. I touched on this in previous comments.

Also profit caps wonā€™t work. That is how the insurance companies make money to pay for claims. The problem is that is their focus. They are trying to make the investors happy. You would need to figure out how an insurance company can successfully pay for all claims if they are capped. The issue really is that citizens are too dependent on the insurance industry instead of taking responsibility to pay cash for services that help them.

In regard to practice - In some cases, X-rays are required by standard of care prior to MRI. They each show different things. There is basically an escalation process and a rule out process. However, insurance companies should not be dictating this process. This should be the provider. So if the provider sees that an MRI is the first step they should be able to make this choice without first sending for an X-ray. So I would word this to indicate this should be under provider decision making not insurance decision making or insurance policy writing.

With Provider Control I would also clarify that Providers have medical decision not insurance companies. The insurance industry will likely use final say to delay tactics and many steps delaying care to get to the final say. Ultimately delaying the care for the patient and causing harm to them. And likely changing the decision by the time it is even accepted because the patientā€™s condition has changed.

Repurposed Drugs and Emergency Use - remove the proven. Proven means it has to have specific research for that specific condition. It takes away the Healthcare Providerā€™s ability to use drugs off label and repurpose them. Off label means the provider uses their education and knowledge of the anatomy and physiology along with the physiological effect of the drug to clinically determine if it applies to a condition or disease process. It costs a lot of money to research a drug and they can only be researched for one thing per experiment. So they will not research every application of a drug. This is why off label use comes into play where the doctor can apply their education and knowledge to use the drug off label. It will not be proven.

Somewhere there was something about out of pocket expenses. Thatā€™s not really going to work. It makes people dependent on insurance. If this refers to out of pocket for emergency care such as when they end up in the ER. There is a difference in the billing for Hospitals versus private clinics. The rules are different. Private clinics are currently required at least in some States to provide the patient up front with the costs and what is included. But Hospitals are not required to do this in all States. There is a law that patients do not have to sign a form saying they agree to the charges but not everyone is aware of it so they sign the form the Hospital gives them because they are in an emergency situation. I will try find this again.

The ACA has to come out. Nobody is in favor of the Affordable Care Act.
It doesnā€™t work. That will impact support for beneficial issue. Iā€™m not sure if you are including this for historical context only or as part of the policy?

We donā€™t want to do what government currently does which is sneak topics into bills and make them too large. The comments are just from a quick scan. Iā€™ll have to go back through and look at the remedies.

Also the profit regulation needs to be removed because the insurance companies do need to be able to make as profit as possible to pay for the catastrophic injuries and conditions that can occur. I think this has to be approached differently. Encouraging education of the public to understand that they should be paying out of pocket and using HSAā€™s for wellness and preventative care is important.

Is there a reason the historical context and legal framework is included? Everything after that I will have to read later. Itā€™s a lot. I think you need to remove things that are unnecessary to the actual policy itself. If you are going to put historical context or additional information I would just use citations instead so it is clear it is not part of the actual policy but a reference. Also, place them after the policy itself so that it is clear they are references and not part of the policy. It gets too long. Itā€™s too much for people to digest.

1 Like
3

It does look good but I think we need to thin it down to focus on the policy alone. If there is anything extra that could be put at the bottom. The policy conclusion can remain with the policy and then have a note that states references and historical context are included below but are not part of the policy itself. Or something to that effect.

Needs to be easy for the public to read and comprehend.

4

It would be far more efficient collaboratively wise, to work in the draft directly, so you can comment on, or make edit suggestions and notations per area, such as with a cloud based doc in Google Drive, or Office 365 (which is why I recommend a DM to coordinate that). The critiques as they stand now, arenā€™t as ideal as they negate the work, rather than build upon and refine it in a way to increase productivity between both our time on it. I also donā€™t necessarily agree that proposals should be so dumbed down and simplified to the degree you imply. Important nuance and details should not be omitted or left out as the purpose of these proposals is to address the root problems and ideate the solutions and the problems are COMPLEX. You canā€™t address complex problems with paired down proposals with no details on addressing the complexities. So, thereā€™s perhaps a middle way between our extremes that makes the most sense.

1 Like
5

I think the policy is lost in all the history. Itā€™s not dumbing it down. It is organizing it so that people understand what part is actually the policy and what is reference material.

There are too many topics in one.

6

If you want to include the policies please merge them into the new policy so they can be referenced. Please feel free to make comments for changes on them also. Thank you.

and

and

7

Hello @DRSE,

Iā€™ve incorporated your feedback to refine the outline. While your observations were already included, Iā€™ve now made them more prominent by placing them above the footnotes. Here are the key changes:

  • Streamlined the document by focusing on the core policy provisions.

  • Removed profit caps, instead suggesting transparency in how premiums are used.

  • Clarified provider autonomy in medical decisions to ensure insurance practices do not override medical necessity.

  • Removed ā€œprovenā€ from the repurposed drug usage section to allow for off-label use by providers.

  • Moved historical context and legal framework to a separate section for clarity.

  • Simplified the structure to enhance readability while maintaining necessary detail.

I acknowledge your point about length and complexity, especially from the perspective of public engagement. However, in legislative proposals, detail is crucial for ensuring clarity, specificity, and comprehensive coverage of issues. While this version is streamlined for discussion, keep in mind that a policy ready for legislative sponsorship would be significantly more detailed and complex, similar to the longer proposals Iā€™ve provided for PATA and the Establishment of the Separation between the Corporatocracy and the State. All policy proposals should be refined where warranted but ultimately must be built upon with increasing clarity and specificity to address each problem and proposed solution. They require historical context, legal precedents, as well as case studies to be effective at addressing the fundamental problems within the present dysfunctional social frameworks.

8

However, that is a concern that some in the public have expressed. For this platform itā€™s best to stick to the policy itself. There are actually a couple policy suggestions posted by others to address that issue. Iā€™ll try to locate them for you to read.

9
1 Like
10

A few of the other suggested changes are merged to that one. For example:

1 Like
11

Yep, in light of your response on both PATA and IATA @DRSE,

Just today, Iā€™ve taken the liberty of dividing each policy solution in PATA into SEPARATE Acts within subsections, allowing them to be treated as individual pieces of legislation. This approach not only answers the call for the single-issue act method but also organizes the content in a more accessible manner. Now, people can provide feedback or suggest improvements on each core concept without the umbrella act becoming overwhelmed with detail.

My initial workaround for character limitations was to add content in the comments and link back to it. However, Iā€™ve realized this isnā€™t as efficient as incorporating observations directly into policy proposals as detailed contributions.

As such, I intend to produce observations which will be integrated into each respective Act, providing a deeper dive into specific policy areas. This method also serves as an example of how this platform can be used to build policy proposals from observations into detailed contributions, offering a learning opportunity for everyone in the forum. You can see this reflected in the Umbrella PATA act, where Iā€™ve replaced a bullet list of solutions with separate acts. Iā€™ve devoted all of my Sunday to this, and I will need to dedicate additional hours after work, and on weekends to add all the forthcoming observations to supplement each Act.

I will in turn, apply this approach to all my other Policy Proposals as well.

12

We need to double or triple the max HSA savings per year as well, my deductible is $6,000 and you can only put $4,000 into an HSA

2 Likes
13
14

I agree with it all.

1 Like
15

Thanks for sharing the new link @DRSE,

Iā€™ve added it directly in the act. I will incorporate any other relevant observations of yours to flesh each of these areas out the same way.

Best,

Nicole

1 Like
16

I personally think funding of such social programs needs to happen individually, on a state-by-state level.

Let the States fund and establish health care programs and savings accounts for their employees.

Forcing all business to manage a savings account for their employees puts a strain on small time business and gatekeeps economic opportunity for employers.

I hold the same opinion about minimum wages. Labor is overvalued in some sectors, and undervalued in others. Business, States, employers, and employees need the flexibility to adapt the worth of their labor, to determine the allocation of their funds, and the expenditures their businesses take.

While this is a great initiative, I fear that the continued federalization of policy and programs is not in the best interest of the People.

A certain degree of ā€˜income requirementsā€™ should be required for businesses to have to manage HSAā€™s for their employees. A small time orchard could not afford to stay open while also paying into said accounts, thus over-valuing the labor of the job-the same goes for minimum wages. Only large multi-national/regional businesses with large incomes should be required to manage accounts for their employees.

Highlighting the need for limitation of the vertical and horizontal expansion of business through financial dissuasion. Tha being financial roadblocks and regulations specifically for big business, like having to manage HSAā€™s or 401Kā€™s for employees or minimum wages for labor.

17

@EthanHowardMfrr,

With regard to the Savings Account, it doesnā€™t have to be about ā€œforcingā€, per se, but another option for people to be able to participate in if they so desire, instead of only having the option to pay into traditional insurance carriers that have a conflict of interest due to their profit motives and denying coverage. But certainly, I can integrate the language to address affordability for employers should employees seek the savings account option instead of legacy insurance plans. And it need not necessarily be a federal mandate of employers, but an entirely new system that allows for its subsidization, rather than only offset the costs of insurance coverages. The bigger problem with insurance has to do with their power over physicians for diagnostics and care. Unless and until their systems are reformed (ie: they should only be helping to pay for higher cost care when we need it - the purpose for insurance to begin with, not decide which doctors you can see, or the care you can receive), citizens should have a right to divest from it.

1 Like
18

Wonderful, glad to see your well developed adaptability. Iā€™m in support of your proposal, even though Iā€™m lacking in votes.

Maybe add a poll at the bottom for us lacking in votes?

  • No, thatā€™s dumb.
  • Why, what a great idea!
  • Bring back political duels! Hamilton vs. Burr 2 Electric Boogaloo
0 voters

A shorter version of my concerns could be conveyed as such:

Over-regulating the expenditures and account managements of local business can lead to the establishment of unnecessary financial roadblocks for new and developing businesses. Necessary financial roadblocks could be considered for the limitation of horizontal and vertical expansion by conglomerates.

States having opt-in programs for both employees and employers would be inclusive, but should be viewed as a requirement for businesses conducting trade, manufacturing or services at a certain level while as a corporation; hiring a certain amount of employees (+~150).

Otherwise, I canā€™t see why I shouldnā€™t email my local rep. about this right now.

1 Like
19

Thatā€™s a fabulous idea! I didnā€™t know Peopleā€™s votes were limited. Thatā€™s an unfortunate feature limitation. Iā€™m going to add polls to all proposals in light of the out of votes problem for P4P users. Thanks for the suggestion, @EthanHowardMfrr! :pray:

1 Like
20

Yes a direct link between caps on user out of pocket costs and maximum contributions would be helpful. But the HSA and FSA accounts should allow users to calculate their expected out of pocket expenses for co-pays, homeopathic and allopathic costs! The account should be refunded or roll over as the person requests.