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About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

Colorado’s Medicaid Expansion Plans Make Sense

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Governor Hickenlooper’s announcement last week that Colorado plans to expand Medicaid eligibility to more than 160,000 childless adults has been met with much debate from both sides of the political spectrum.  The voices opposed to the expansion come mainly from an economic perspective, saying that we just can’t afford to cover more people with Medicaid.  And as is usually the case, there are wildly different estimates of how much the Medicaid expansion will cost and/or save the state over the next decade:  The Kaiser Family Foundation says that the move will cost Colorado $858 million over the next decade, while Governor Hickenlooper’s office says that it will save $280 million instead.

Colorado Medicaid Expansion DebateAfter all of the money talk from the CBO and all of the special interest groups over the last few years regarding various aspects of the ACA, I think a lot of people have become numb to the numbers.  Predictions of how much any healthcare legislation will cost or save over any lont-term time horizon really depend on who is doing the study and what variables they took into consideration.  And we have to bear in mind that laws and reforms and healthcare in general are not static entities; they’re constantly changing, which makes long-term financial predictions murky at best.  Even if we could control for every single current variable and come up with an accurate picture of the cost and/or savings implications of the Medicaid expansion, we can’t know what additional changes might be made in the future that will increase or decrease the predicted amounts.  Given that reality, as well as the dramatically different financial predictions out there, I think it’s best to assume that the actual numbers will […]

CLASS Act Officially Nixed From The ACA In Fiscal Cliff Deal

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[…] CLASS wasn’t going to be financially viable, and the first try just didn’t work. But that doesn’t mean we can just forget about it and move on. One way or another, long term care costs have to be addressed relatively soon. My prediction is that a new bill will be crafted in the next couple of years to create a solution similar to CLASS but hopefully with a more solid financial groundwork. But I think lawmakers might wait until 2014 – after the ACA has been more fully implemented and health insurance coverage is more widespread than it is today – to take action.

Senator Aguilar Pushes For Universal Healthcare In Colorado

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Senator Aguilar’s plan for universal healthcare in Colorado is based on a genuine need: even with current and planned state and federal healthcare reforms, there will still be a lot people in Colorado without health insurance. The CBO estimates that on a national level, we’ll have 30 million uninsured people in the US a decade from now. That’s taking into account the fact that SCOTUS struck down a provision in the ACA that would have required states to expand their Medicaid programs. States have flexibility with that now, and some will likely choose not to expand. Colorado, however, is expected to expand its Medicaid program (not surprising, given how much work the state has already done on that front). The uninsured population in Colorado hovers somewhere in the 600,000+ range, depending on how and when the samples are studied. If the ACA is expected to reduce the national uninsured population from 53 million to 30 million, and taking into account the fact that Colorado will likely be one of the states that opts for Medicaid expansion, I would say it’s reasonable to expect that the uninsured population here will be reduced by at least 50% once the ACA is fully implemented. But that still potentially leaves a few hundred thousand people – not an insignificant number by any stretch – with no health insurance. Those are the people Senator Aguilar is trying to help.

The Driving Factors Behind Inpatient Cost Increases

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[…] it may not be what you’d guess. The study he references looked at inpatient costs from 2001 to 2006 (admittedly a bit out of date now, but still relevant and interesting data) and found that the biggest increases were in “supplies and devices”, ICU, and hospital room and board – all three of those areas had double digit percentage increases in costs from 2001 to 2006. I would be very curious to see another column on that chart with 2012 numbers and the corresponding percentage increases… are those three areas still the culprits, or have others (like pharmacy?) surpassed them?

Medicare Part D Needs Price Negotiating Power

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[…] very clearly how we could save $20 billion per year if the feds could negotiate drug prices with pharmaceutical manufacturers. That’s forbidden by the language of the original legislation that created Medicare Part D (I know, it’s ridiculous, but that’s how it is), so it would require some legislation at this point to change things. Nobody in power seems to want to address this issue, probably because pharmaceutical companies make such large campaign contributions. But as I’ve pointed out several times, they also earn huge profits (far more than any health insurance company, although health insurance companies are the ones that are repeatedly targeted by the media as having excessive profits). Maybe it’s time for a change.[…]

Health Insurance And Genetic Testing

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[…] Is it fair to say that health insurance carriers shouldn’t be able to use genetic testing information during underwriting, but that they should have to pay for preventive healthcare that results from genetic testing? I don’t think there’s an easy answer there. It’s hard to put a price tag on health and life, and it’s difficult to say that a person who is making such a hard decision should also be faced with a potentially very large medical bill at the same time. But if we’re going to categorically state that genetic testing cannot be used to the advantage of health insurance carriers, it’s hard to turn around and say that the carriers should also be required to pay for treatment that comes about as a result of that same testing.

What do you think? As technology moves forward, I have no doubt that genetic testing will become more routine, and various preventive measures based on those tests will likely become fairly commonplace. If they become a larger part of our general healthcare process, I would say that it’s reasonable to assume they will also be covered more frequently by health insurance carriers. And as of 2014, some of the issues addressed by GINA will become moot points too, as health insurance will all be guaranteed issue. So this is a subject that might just work itself out naturally over the next decade or so. But for now, it does leave plenty of room for debate.

What Should Health Insurance Cover?

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The reason we have health insurance is to protect against the things we don’t expect to happen. The things we can’t foresee. The things that would blow though most households’ life savings very quickly. Doctor visits, routine medications, even the occasional trip to urgent care – these are relatively predictable. And relatively inexpensive, compared with the cost of care for a serious illness or injury.

If health insurance did cover everything, without any additional out-of-pocket costs for the insured, health insurance premiums would go up by about as much as people currently spend on out-of-pocket costs. Health insurance carriers would have to start generating enough revenue to cover those claims, and that would translate directly into higher premiums for everyone.

I know that the comparisons between health insurance and auto or home insurance have been made many times, but I’ll bring it up again here. When you buy car insurance, you don’t expect it to cover oil changes, new tires, or even a whole new engine if your car ends up needing one. When you buy home insurance, you don’t expect it to pay for home maintenance or repairs. In both cases, we expect the insurance to cover the unexpected. We know that if we have a car or a house, they’re going to need maintenance. And we know that we’ll have to budget for those things, however much we might dislike that fact. We hope that we never have to use our car insurance or our homeowner’s insurance. The same should be true of our health insurance. It’s there in case something unforeseen and expensive occurs (and it’s useful to remember that “expensive” is a relative term… although $1000 is “expensive” as far as most family budgets, it’s a tiny fraction of the total medical bill that would be incurred in the event of a major illness or injury). When you take that view of health insurance, it becomes a more realistic product. With most policies, the money you’re paying in premiums is not intended to cover routine, minor healthcare (with the exception of preventive care). But it will cover the potentially enormous claims that could result from a serious illness or injury.

Should Dental Insurance Be Included On Health Insurance Policies?

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[…] One possible solution would be for dental insurance to get wrapped in to health insurance policies, both private coverage and Medicare (the majority of seniors in Colorado have no dental insurance, because it’s not part of Medicare). If dental insurance were absorbed into health policies, the premium increases might not be significant. Maternity coverage is a good example of how this could work. In the past, maternity coverage was only available on a few individual health insurance policies in Colorado, as a separate rider that had to be added to the basic coverage. The cost for this rider was prohibitive, because the only people who were adding it were the ones who were planning to use it. But for almost two years now, all new individual policies in Colorado have included maternity coverage, and premiums have definitely not increased by as much as maternity riders used to cost (premiums have gone up, as they had done for years prior to the maternity mandate, but there are many factors involved). If dental coverage were included in health insurance policies, the administrative overhead for these plans could be rolled in with the administration of the health plans, and there would be more people who had coverage and weren’t using it often – their premiums could offset the cost of dental care for people with significant claims. […]

Downsides To Raising The Medicare Eligibility Age

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[…] The wealthiest older Americans can probably easily wait until 67 for Medicare. In 2014, individual health insurance will be guaranteed issue, and if paying the premiums is not a problem, that’s a viable alternative for some people. But most Americans are not wealthy enough for those premiums to be easily affordable, even with premium subsidies. More than a few 65 and 66 year olds would likely opt to go uninsured until they reached the new Medicare age, and that brings it’s own host of problems – for the individuals and for taxpayers, hospitals and the entire healthcare system. For people struggling to make ends meet, an extra two years of either being uninsured or stretching to pay health insurance premiums could be a very big deal indeed. And as Maggie points out, it doesn’t even end up saving money.

The proposal to raise Medicare eligibility to 67 is short-sighted and based on the premise that Medicare is an “entitlement” (what about the fact that recipients have been paying into it for decades, to cover the cost of previous retirees’ care?). I suppose it makes sense – at first glance – that we can reduce the amount spent by Medicare if we make people wait an extra two years to enroll. But the practical realities would be a different story: people putting off medical care until age 67 (at which point illnesses might be more progressed and more expensive to treat), people going uninsured, higher premiums within the Medicare system without the younger members enrolled, higher costs borne by employers who cover the cost of healthcare for workers and retirees, and the list goes on. […]

Health Insurance Premiums Mirror Healthcare Costs

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[…] Colorado has taken a much more proactive and transparent position in terms of the rate review process, and we’ve written about it several times.  Although rate increases on health insurance policies are frustrating when they continue to far outpace inflation, they’re being driven largely by the increases in the cost of healthcare.  But most of us are very insulated from the cost of our healthcare.  Since the bills go to our health insurance carriers, many people don’t really know how much it costs to have any sort of significant medical treatment.  We know how much our health insurance costs though, and when the price goes up, we feel it.  Even though the price increase is directly linked to the increases in healthcare spending, we’re much more likely to focus on the Health Insurance Premiums Mirror Healthcare Costshealth insurance premiums, since those are the bills we pay ourselves (this is especially true for people who buy their own individual health insurance, without assistance from an employer). […]

How the Affordable Care Act Affects You

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For the first couple years after the Affordable Care Act was signed into law, everything seemed to be a bit up in the air.  There was almost constant bickering about the subtle nuances of the legislation, along with uncertainty from both sides of the political spectrum insofar as whether or not the law would stand the test of time.  The Supreme Court had to weigh in, and we also had a major election cycle midway between the signing of the law and the enactment of many of its main provisions.

Most of that has settled down now.  SCOTUS upheld the law.  And there was no election upheaval in Congress to tilt the legislative body towards a crowd that would be likely to repeal it.  States – like Colorado – that had been working towards setting up a health benefits exchange can continue to do so without as much worry that their work might be in vain (there had been How the Affordable Care Act, Obamacare, Affects Yousome concern that the law would be tossed after states had invested a lot of time and money in the exchange-creation process).  We are just over a year out now from January 2014, when many of the major provisions of the ACA will go into effect; it seems relatively certain at this point that the ACA will continue to move forward now that some of the potential roadblocks are in the rearview mirror.

Several provisions of the Affordable Care Act – ACA have already been implemented over the past two years:  Young adults can remain on their parents’ health insurance policy until […]

Individual Health Insurance After Donating A Kidney

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This recent AARP article caught my attention last week.  My father lost his kidneys in 2001 as a result of Wegener’s Granulomatosis, a rare autoimmune disease.  In August, he was the recipient of a kidney generously donated by the family of a young man who had passed away.  And this fall, for the first time in 11 years, he’s been able to go about his life without being tethered to a dialysis machine every evening.  So I’m drawn to stories about kidney transplants, living donors, or families who choose to donate a deceased loved ones organs.

To sum it up, Radburn Royer is a healthy 57 year old who donated a kidney to his daughter four year ago, after her own had failed as a result of lupus.  Prior to donating a kidney, Royer was covered by Blue Cross Blue Shield of Minn.  It’s unclear what his health insurance status was in the interim, but last year he reapplied for coverage with them and Individual health insurance kidney donorwas turned down.  He’s appealed several times, but for now he’s covered by his state’s high risk pool (he has to pay $130 more per month for his coverage and has a higher deductible, both of which are common in high risk pools).

Individual health insurance in Colorado is underwritten just as it is in Minn., but underwriting guidelines usually vary from one state to another and from one carrier to another.  So we contacted three of the top individual health insurance carriers in Colorado to see how they would underwrite an applicant who had previously donated a kidney.  Cigna, Humana and Anthem Blue Cross Blue Shield all said that as long as the donor had been released from medical care and had normal blood pressure and blood lab results, the most likely underwriting outcome would be acceptance with a standard rate.

At first glance, this seems to be at odds with the situation experienced by Royer, but maybe it’s not.  The AARP article notes that Royer underwent […]

[…] In the context of kidney donation, it’s important that potential donors not be inadvertently scared off by AARP’s article.  Kidney donors are heroes – anyone who had received a transplant will attest to that fact – and they save lives.  The study that I linked to above followed donors for 20 – 37 years after their transplants.  While some donors did end up having kidney problems, the majority had normal kidney function 20 – 37 years out from surgery, and would likely not have a problem obtaining individual health insurance, even prior to it being guaranteed issue in 2014.  Most people who are healthy enough to be accepted as a donor will continue to be healthy after they donate a kidney.

Election Thoughts – Healthcare Reform And Exchanges

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[…] Tim’s article is an excellent primer on the implementation of healthcare reform, specifically in terms of the health benefits exchanges that need to be up and running by October 2013, when enrollment is scheduled to begin (health insurance effective dates wouldn’t start until January 1, 2014, but people should be able to start enrolling next October).  That’s less than 11 months away, and there’s still a lot of work to be done.  Colorado has been working on its health insurance exchange for some time now, and has made a lot of progress so far.  We’re one of the states that has selected a benchmark plan for essential health benefits, and much of the groundwork for Colorado’s exchange has already been done.  But in addition to the nitty gritty logistics of setting up the exchanges, there are still plenty of legal and administrative bumps that will need to be ironed out.  When the ACA was signed into law in early 2010, the implementation of exchanges and the majority of the law’s “teeth” in 2014 seemed like a long way in the future.  That is now just over a year away, with exchange enrollment beginning in less than a year.  And there’s still plenty of work to be done, especially in states that haven’t made much progress on their exchange implementation yet. […]

Going Without Health Insurance

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You may already be familiar with the blog Zen Habits.  It’s a very popular site with hundreds of thousands of readers.  It’s written by Leo Babauta, who has authored numerous ebooks and paper books and has over a hundred thousand followers on Twitter (he’s following three people – all those followers he has are just interested in what he has to say).  When he writes something, it gets read and shared and talked about.  I’ve been reading – and enjoying – his site for a few years, and I usually find myself nodding in agreement with whatever he’s written.

But his most recent post threw me for a bit of a loop.  He explains his rationale for not having health insurance for his family (he and his wife and six kids), and goes into a detailed description of how you, too, can make health insurance a bad bet.

The peace of mind not going without health insuranceI have no idea what his full financial situation looks like.  He often writes about being a minimalist, so I know he’s not spending lots of money on material stuff.  They do like to travel and recently spent several weeks in Europe – that doesn’t come cheap, but it’s a great experience for adults and children alike.  He has a very successful blog and several books, so I have to imagine he’s not poor.  And yet Leo Babauta considers going without health insurance to be a reasonable risk.

To be fair, I agree wholeheartedly with the tips he gives for “making health insurance a bad bet“.  Things like eating well, exercising, avoiding excess alcohol, not smoking, driving safely […]

Electronic Medical Records And Data Security

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[…] As David pointed out, we really don’t need to be too worried about our medical data being stolen. Medical identity theft is increasingly a problem, but that generally happens when someone attempts to steal an insured’s identity in order to receive healthcare under the victim’s health insurance policy. Again, no theft of sensitive medical records, but a significant problem. Data security absolutely needs to be a priority as we transition to electronic medical records. But for the most part, the problems are not what people think of first (sensitive medical data being compromised), but rather, theft of credit card numbers and social security numbers, as well as people who try to fraudulently use another person’s health insurance coverage.

Patients Want More Electronic Communication With Doctors

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For the past few years, healthcare information technology has been one of the major players in healthcare reform efforts.  All six hospitals in Northern Colorado are now linked with a medical information sharing program, and medical offices all over the country are getting on board with electronic medical records.  The rise of electronic media in healthcare is not without controversy, but I think that we can all agree that it was – and is – inevitable.  Each year brings newer and better technology, and people (patients and healthcare providers alike) have ever-increasing expectations in terms of the availability of information and communication.

Patients Want More Electronic Communication With DoctorsThus it’s no surprise that a recent survey found that patients want more digital interaction with their doctors.  Half of respondents in the study felt that a past medical problem could have been avoided if their doctor had sent text messages or emails with encouragement, tips and reminders.  Of course, whether electronic communication with doctors would actually have averted the problem is unknown.  What’s important however, are the patients’ perceptions.  68% of the survey respondents said […]

Healthcare Affordability And Quality: Two Perspectives

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[…] He notes that the problem of access to care has been well addressed:  30 million additional Americans will soon have health insurance coverage (although we have to bear in mind that health insurance coverage and actual access to care are not necessarily the same thing, especially if the health insurance in question is Medicaid or another public plan).  But he goes on to point out that affordability and quality are areas with some wrinkles that still need to be ironed out.

What makes this post especially interesting is Maggie’s equally well-though-out response that she included in the HWR.  Be sure to read what both of them have to say.  Maggie references a couple of her previous posts and provides plenty of evidence to back up her premise that affordability and quality of care are both being addressed and that the solutions are working (or will be soon).  Definitely an interesting collection of views from two of our favorite healthcare writers.

Healthcare Overutilization And General Physical Exams

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[…] perhaps we need to consider at least some general physical exams to be overutilization of care. I know – that sounds blasphemous and counter-intuitive. But sometimes we have to abandon our preconceived ideas and look at what the evidence is telling us rather than just accepting what we assume we know to be true. I would say that further and more extensive studies need to be conducted before we make any radical changes as far as general physical exams and well-checks. But we definitely need to be taking a much closer look at healthcare over-utilization. Maybe that’s where we can do our “rationing”, and end up with a win-win for everyone: lower healthcare spending and better patient outcomes.

Health Insurance Premiums And The ACA

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[…] We wrote a couple years ago about the Colorado Division of Insurance bulletin that laid out the reasons for rate increases in 2010 – almost all of them were the same factors that had been driving health insurance premiums for the previous decade; only 5% of the total premiums could be attributed to the ACA. […] The predicted long-term cost savings from the ACA are definitely not a sure thing. But we need to keep in mind that many of the substantial changes included in the law have not yet taken effect. And many of the changes that have been implemented are those that tend to increase short-term costs and/or utilization of care. […]

Individual Health Insurance Mandate From A Perspective Of Compassion

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[…] I’ve usually addressed the issue of the individual health insurance mandate in terms of how guaranteed issue health insurance would impact premiums in the absence of an individual mandate.  The mandate – regardless of its popularity – just seems like the most practical way to go if we’re in agreement that individual health insurance should be guaranteed issue.

Maybe we should also be looking at the individual health insurance mandate from a more compassionate, human angle too.  There has long been a bit of a harsh undertone in the healthcare reform discussions when it comes to people who are […]

ACA Electronic Medical Records – Opposing Views

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[…]Dr. Plested believes that the ACA will lead to rationing (it’s hard to say with certainty that this isn’t true, but Dr. Plested believes with certainty that it is true) and that the Obama Administration wants doctors to adopt the ACA electronic medical records so that treatment specifics can be sent to the Internal Revenue Service and federal health officials. He believes that doctors will then be instructed to pursue a treatment plan “that is preferred by the government.”

Dr. Bender notes that in his own practice, computerized medical records have alerted his office to the fact that less than half of their diabetic patients were being tested at least once every three months (standard of care, and a good way to lower costs since it reduces the number of patients with complications stemming from uncontrolled diabetes), Prior to the introduction of electronic medical records he had no idea that the number was so low. It’s now up to 85%. As far as records being transmitted to the IRS and other government officials, Dr. Bender notes that the IRS would need a subpoena to get his patients medical records, which are locked securely behind several firewalls. […]

Healthy Weekend Fun – Mocha Chip Banana Soft Serve

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The idea of freezing bananas and then blending them into “ice cream” is not my own. I discovered it online a few years ago, and it has since become so popular that I’ve noticed bananas in the grocery store with little stickers on them letting people know that they can be blended into soft-serve style desserts. But the recipe I’m sharing here is my own creation that came about when I started tinkering with the basic blended bananas idea.

It’s quick, easy, and the sweetness in it comes almost entirely from the bananas. What’s not to love?!

Mocha Chip Banana Soft Serve

Ingredients:

2 cups frozen banana chunks
3 Tbsp cocoa
1 scoop chocolate protein powder (try to stick with a brand that doesn’t […]

ACA Alternative Has Some Logistical Limitations

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[…] But if we’re looking at an ACA alternative, I would say that the major issue that causes health insurance to be dramatically more expensive in some states has more to do with health insurance being guaranteed issue (without a mandate that everyone purchase health insurance) and less to do with specific laws regarding coverage details.  I’ve written in the past about some of the problems that could go along with selling health insurance across state lines, but Bob and Joe’s point about no state having truly affordable health insurance is really the crux of the issue. In order to make health insurance more affordable, we have to get a handle on the cost of care, since that’s what drives health insurance […]

How To Better Serve Emergency Room “Frequent Flyers”

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The American College of Emergency Physicians had their annual meeting in Denver, Colorado this week, and presentations involved several new studies pertaining to people who are the most frequent users of emergency room care. I found that article to be fascinating, in part because it dispels so many myths about emergency room “frequent flyers.” We’ve written before about the fact that most emergency room patients do have health insurance and that emergency room overcrowding cannot be blamed on uninsured patients (as is often cited in casual conversation). Although most emergency room visitors do have health insurance, many of them have public health insurance via Medicare or Medicaid. And since the Medicaid rolls are expected to grow significantly over the next several years, it’s likely that ER overcrowding will grow to become more of a problem as some of those Medicaid patients are unable to access primary care outside the emergency room. […]

Healthcare Fact Checking the Presidential Debate in Denver

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I think that political debates would be a lot more fun (and educational) to watch if non-partisan fact checkers were allowed to sit off to the side and hold up “pants on fire” signs when appropriate. But the next best option is the plethora of online fact-checkers who can help us sift through the statements. It’s generally been acknowledged that there were more than a few half-truths and outright lies in last night’s 1st Presidential debate here in Colorado at the University of Denver.

Specifically regarding healthcare and health insurance reform, there are a couple of PPACA-related points that need further comment. First, we have the comment from Romney regarding the “unelected board, appointed board, who are going to decide what kind of treatment you ought to have.” He’s referring to the Independent Payments Advisory Board (IPAB), whose job is to oversee general Medicare spending. They are allowed to reduce Medicare payments to hospitals with high re-admission rates and recommend ways to reduce wasteful Medicare spending through new innovations. But they cannot restrict benefits, alter Medicare eligibility, or make any decisions regarding treatment options. […]