Charity, it is said, begins at home. But as Tuesday's Wall Street Journal suggests, charity clearly ends with America's health insurance companies. As the Journal reports, insurers are battling charities and hospitals who have launched pilot programs to help pay for the health care premiums of lower-income Americans. But the carriers' campaign to prevent potentially sicker, more costly patients from becoming their customers isn't just cruel. As it turns out, the same insurers accusing hospitals of a conflict of interest are squeezing them using newly acquired billing services and increasingly limiting your choice of doctors to the physician practices they now own.

As the Journal explained, charities in states like California have realized that small monthly stipends could enable those earning too much (that is, over 138% of the federal poverty level) to qualify for Medicaid to afford the purchase of subsidized insurance of the state health care exchange. And in the states which rejected the Medicaid expansion, hospitals which will be losing out on disappearing funds for treatment of the uninsured are fast concluding that helping them buy coverage will help their own bottom lines:

A Better LA, a decade-old Los Angeles nonprofit, said last week it was signing up 50 low-income people for health plans in California's health-insurance marketplace. The charity, which said it has the blessing of the state agency overseeing the marketplace, will pay $50 to $100 a month to cover the share of the people's premiums not already financed by federal subsidies.
Those 50 people are at the vanguard of a push that could shift the balance between hospitals and insurers across the nation. Nonprofits, including some hospitals, say paying premiums would ensure coverage for people currently uninsured who can't afford even a small monthly payment for health insurance.

So far, the Department of Health and Human Services (HHS) has offered contradictory guidance on charitable support which might the mix of the newly insured towards the unhealthy and so drive up premiums. But America's health insurers, who are spending $500 million just on local television ads in 2014 to win new customers during the enrollment period for the Affordable Care Act, are none too happy about that prospect. As Karen Ignani, President and CEO of America's Health Insurance Plans (AHIP) complained:

"It is a conflict of interest for hospitals and drug companies to pay patients' premiums and cost-sharing for the sole purpose of increasing utilization of their services and products."

It may be true that the prospect of thousands of new, potentially sicker and costlier policyholders could have some impact on the insurers' bottom lines. But their protests should be taken with a very large grain of salt. Thanks to the carriers' own conflicts of interest, those bottom lines look very healthy, indeed.
As Kaiser documented in April 2012 ("Conflicts Arise As Health Insurers Diversify"), insurers are rapidly acquiring physician practices, billing companies and research firms:

As insurers eager to add revenue streams convert themselves into diversified health-services companies, they often buy traditional business adversaries, including physician groups and hospital consultants such as EHR. They're also buying technology companies and research firms that serve medical-care providers, raising questions not only about independence but about the privacy of patient information.

The result is that insurers are increasingly limiting patients' choice of doctors to the carrier's own narrow network of physicians. Meanwhile, the vertical integrated insurers turn to their newly acquired billing arms to avoid paying hospitals and doctors for the care they provide.
UnitedHeathcare, which was recently blocked by a federal judge from dropping 2,200 doctors from its Medicare Advantage network in Connecticut, provides a case in point. UnitedHealthcare has been at the forefront of insurance carriers buying out not just entire physician practices, but billing resolution firms doctors and hospitals use to make they get paid by insurers--like UnitedHealthcare. In 2012, UHC moved to strengthen its presence in Florida, where 10 percent of all Medicare beneficiaries live:

UnitedHealthcare, the giant nationwide insurer, is making a major move in South Florida by announcing Tuesday it has agreed to purchase two Miami-Dade based Medicare and Medicaid insurance plans that have more than 100,000 members and eight clinics.

The acquisitions of Medica and Preferred Care Providers in Florida followed UnitedHealthcare's purchase of California-based Monarch Health Care in the fall of 2011. By February 2012, Blue Shield of California brought suit for $10.5 million in damages against the newly acquired 2,300 physician network which had been folded into UnitedHealth's Optum health services unit. As the Wall Street Journal reported:

Among the allegations: that Monarch sought to steer Blue Shield members away from Blue Shield and toward competing health plans, and that its doctors started declining to see some Blue Shield members. The complaint says these moves violated Blue Shield's contract with Monarch, which the insurer has previously said will end on May 1.
"It seems crazy to be contracted with someone who's a direct competitor, and share everything you design with them," said Juan Davila, senior vice president for network management at Blue Shield, which has 3.3 million members. Blue Shield felt its "worry was proved true" by Monarch's alleged actions, he said.

According to the web site Modern Healthcare, Blue Shield also alleged that "Monarch physicians were refusing to make appointments with Blue Shield members and that Monarch is urging Blue Shield members to switch health plans via recorded phone calls."
Patients, doctors, hospitals other insurers and state regulators are right to be worried by insurers like UnitedHealthcare gobbling up physician practices, only to then limit policyholders to their own proprietary networks. As Bridget Maehr, senior financial analyst at A.M. Best Co. put it:

"It isn't so much about them getting into the business of care delivery as it is creating access for their members."

And among those members, the insurers insist, they don't want any charity cases.