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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.

John Roberts and the PPACA SCOTUS Ruling

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[…] Now that the ACA has been upheld by the high court, the states can continue their work to create health benefits exchanges with some degree of certainty that they are not wasting their time (Colorado has been making progress on its exchange for well over a year already, but there’s still much to be done).  There is of course an election cycle coming in a few months, and a full legislative year in 2013 that could result in changes – big or small, depending on the political outlook of the next congress – to the existing law.  But the fact that the Supreme Court has upheld the law as legally valid gives it a lot more credibility than it had yesterday.

There has been some surprise in the blogging world that Justice John Roberts sided with the majority on this one.  Many expected him to be of the opinion that the individual mandate and/or the entire ACA were unconstitutional.  But it’s important to note that at the time he was nominated by George W. Bush, his pro-government views were regarded as a positive attribute by conservatives.  Think back to the things that the government was trying to do in the middle of the previous decade.  Wire tapping, TSA expansion, indefinite detainment of suspected enemy combative in the war on terror, etc.  Those were issues where the government was pressing for more control, and conservatives were generally in support of that.  With a new administration led by a Democrat, there are different areas in which[…]

160th Cavalcade Of Risk – Colorado Wildfire Season Edition

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The news in Colorado for the past few weeks has been dominated by stories of wildfires, and there seems to be a new one every few days.  Watching footage of houses burning and courageous firefighters battling the blazes definitely brings to mind all sorts of risk-related thoughts.  We send our best wishes to everyone living in the areas that have been hit by the recent fires, and hopefully Colorado will get some good rain very soon. We’re very thankful for the firefighters and we’ve mixed in historic images of heroic firefighters from the past.

firefighters With that in mind, welcome to the 160th Cavalcade of Risk.  We’ve been participating in the Cavalcade for nearly six years, and we’re always honored to get the privilege of hosting.  The Cav is all about risk, and with that in mind I wanted to share one of the best articles I’ve seen in a long time on the topic of risk.  Mr. Money Mustache lives just down the road from us, in Longmont.  He’s got quite a way with words, and his blog is both informative and entertaining.  This article that he wrote about the illusion of safety is a must-read.

Jason Shafrin, aka The Healthcare Economist, brings us a solemn article about suicide among veterans from the wars in Iraq and Afghanistan.  Sadly, more veterans have died from suicide than from enemy fire.  This article sheds light on the very real need for better mental health support for our armed forces, both during and after their deployments.

In a similar sobering fashion, Julie Ferguson of Workers’ Comp Insider discusses domestic violence at work – both in terms of violence that occurs in workplaces and violence in homes or other2 locations that can result in injury or death for first responders.  Julie describes the four main types of workplace violence – one of which is domestic violence – and explains why employer cannot afford (financially or morally) to ignore the problem of domestic violence in the workplace.

Switching to happier news, in a short – and very sweet – post, Hank Stern of InsureBlog shares a new study that found the secret to health is 3.5 ounces of dark chocolate every day.  Sounds good!  Of course, for optimal benefits, it should probably be combined with all that other stuff we know is good for us… good diet, plenty of exercise, water, sleep, etc.  That includes red wine, right?

Jaan Sidorov runs the excellent Disease Management Care Blog, and gives us his thoughts on pharmaceutical company coupons.  Drug copays are set by health insurance carriers to reflect the greater cost associated with brand name prescriptions, and the higher copays for brand name drugs usually serve as an incentive for patients to opt for lower copay generics.  But if the pharmaceutical company provides coupons that mitigate most of the copay for the brand name drug, the end result is higher cost for health insurers.  But Jaan wonders what would happen if the insurance carriers were to fight back and offer their own coupons?  Whatever the […]

Health Insurance For Seasonal Fire Fighters

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[…] In order for these seasonal fire fighters to have health insurance coverage, they have to apply for individual policies or have coverage through a spouse’s group policy. On the upside, most of them are in excellent physical health, since that’s pretty much a job requirement. That means that underwriting on an individual policy isn’t as likely to be a problem as it is for the general population. But it’s important to be aware that some individual health insurance carriers include occupation and/or hobbies in their underwriting guidelines. In Colorado, there are a few carriers that ask questions on the application to determine whether the applicant engages in any high-risk jobs or hobbies. Wildland fire fighting falls under that category, which means that it’s unlikely that the applicant would be approved for coverage by a carrier that includes occupational risk it its underwriting.

There are several reputable individual health insurance carriers in Colorado that do not use occupational risk in their underwriting assessments, and these are obviously a better choice for anyone who has a high-risk job. A good broker can steer an applicant towards the carriers that don’t use occupational risk as part of their underwriting. Combined with the workers’ comp that covers the fire fighters while they’re on the fire line, a solid individual health insurance policy – which provides significant flexibility since it isn’t linked to employment – can help to create a safety net for the people who put a lot on the line to keep the rest of us safe. In the current scenario, this is the best option. But it does seem like it would be a good idea for the Forest Service to allow seasonal fire fighters to at least have the option of purchasing – via payroll deduction – the same health insurance that their full-time coworkers get.

SCOTUS Lead-Up Health Wonk Review, And The Free Market Nature Of The ACA

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[…] Under the ACA, most health insurance carriers, hospitals, medical offices, pharmaceutical companies, device makers, etc. will all remain privately operated, in the free market. It’s true that the ACA establishes some guidelines that the private entities – and individuals – must follow. Individual health insurance will be guaranteed issue by law, and everyone will be required to purchase health insurance (assuming that the individual mandate isn’t overturned by the Supreme Court), with subsidies helping many families cover the cost. But the products that will be purchased – health insurance and healthcare – will still be primarily in the private sector. I think Justin makes some very good points, especially at the end of his article when he talks about the future. The ACA is by no means perfect, and I believe it will need plenty of tweaks over the years, even if it’s upheld in its entirety by the court. But if it’s overturned and we wait several more years to implement a replacement, we might find that it ends up being a far less free-market-friendly approach.

Aetna, Humana and UnitedHealth Vow To Maintain Some Aspects Of ACA, Regardless Of Court Decision

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Much of the healthcare community is eager to hear what the Supreme Court has to say – likely next week – about the ACA. Given how polarized the topic of healthcare reform has been over the past few years, there’s no way that any decision is going to please more than about half of the country, although the court has the option of picking and choosing various parts of the law to uphold or overturn as it sees fit.

Some aspects of the ACA have already been implemented and have proven to be very popular. A few of the country’s biggest health insurance carriers have stated that they will keep some of the most popular ACA provisions – even if the law is overturned. Aetna, Humana, and UnitedHealth have said that they will continue to offer preventive care with no cost-sharing, allow young adults to remain on their parents’ health insurance policy through age 26, and maintain the third-party appeals process that insureds can use if a claim is denied. Humana and UnitedHealth have also said that they will continue to have no lifetime benefit maximums on their policies and ban rescission except in cases of fraud. […]

Will Exchanges Really Be Able To Provide Lower Cost Health Insurance?

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[…] It will be interesting to see how health insurance premiums in both the individual and small group market look in 2014 when the exchanges get underway, and then again in 2015. If we do see a significant reduction in the cost of small group health insurance via the exchanges, I have no doubt that plenty of small businesses will be eager to set up group plans for their employees – we already know that cost is the primary barrier, and that a lot of businesses would like to offer health insurance but simply cannot afford to do so. But I also wonder whether we might see trends in premium increases that are similar to what we have now, even within the exchange. In order to really get a handle on health insurance premiums, we have to find effective ways of controlling healthcare costs first. The ACA included numerous cost-control provisions, but it remains to be seen how effective they will be. The exchanges are a good way for people and businesses to be able to shop for health insurance and coordinate their coverage with their federal health insurance subsidies. But the exchanges cannot address the actual cost of healthcare, which continues to climb much faster than inflation.

A Look At Project Health Colorado

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A relatively new website – Project Health Colorado – is drawing visitors from all across the state who wish to share their ideas about healthcare and healthcare reform in Colorado.  The project is funded byThe Colorado Trust, and has several prominent partners who share the goal of access to healthcare for everyone in Colorado.  You can read more about the goals and vision of the project in this editorialwritten by Christie McElhinney, The Colorado Trust’s VP of Communications and Public Affairs.

The homepage of Project Health Colorado has five questions that visitors which visitors can answer with a simple yes or no.  Overwhelmingly, the current responses indicate that people are not particularly satisfied with the healthcare system.  The first question asks “Is healthcare in Colorado working?” and 71% of the respondents have answered “no.”  71% of respondents have also answered “yes” to the question about whether they’ve ever had to choose between healthcare and other needs.

In addition to asking people what they think of the current healthcare system, the website also has a page where visitors can suggest suggestions for fixing the healthcare system.  The suggestions that have been posted so far run the gamut from single payer healthcare to completely free market healthcare with no government involvement at all.  Some people suggest an increase in individual responsibility (for example, requiring people who are overweight or who smoke to pay more for their healthcare) while others advocate a more collective system where everyone receives healthcare and tax dollars are used to fund it.  The suggestions mirror a lot of the very diverse opinions that have been offered all across the country over the past few years as healthcare reform has taken center stage in our political system.

I agree with The Colorado Trust and their partners on this project that access to healthcare for everyone in Colorado is an excellent goal.  Health insurance for the uninsured population and affordable healthcare for everyone are vitally important in order to improve the overall health and security of the people of Colorado.  However, I can’t help but notice that the questions on the Project Health Colorado homepage are a bit leading, and perhaps biased towards getting simple answers that highlight a desire to have better healthcare without enough focus on the costs of achieving those goals.  There is no question asking […]

Healthcare Costs Expected To Increase By 7.5% Next Year

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[…] Average out-of-pocket exposure on health insurance policies has been steadily increasing over the last several years (in the individual and small group market as well as the large group market).  Choosing a policy with a higher deductible and/or copays is the easiest way to mitigate premium increases, and it’s a popular option among employers and individuals who purchase their own health insurance.  Ten years ago, Jay and I had a health insurance policy with a $1000 deductible per person.  Now we have a $3500 deductible per person, plus an additional $3500 in coinsurance on an Anthem Blue Cross Blue Shield Core Share policy.  If we had stuck with a $1000 deductible all these years, our health insurance premium would be far higher than it is today.

The study Jason references notes that high deductible health insurance policies accounted for 4% of the market in 2006.  Over the next five years, that share increased to 17% by 2011.  My guess is that it will continue to increase as long as healthcare costs keep climbing at the rate that they have over the past decade.  If cost controls succeed at bringing healthcare cost increases more in line with other consumer price increases (projected to be 2% next year) over the next few years, I imagine that the popularity of high deductible health insurance policies will wane a bit.  There will always be people who are drawn to the tax advantages of HSA-qualified health plans, but a lot of individuals and employers who opt for higher deductibles are doing so in order to make their premiums more manageable.  As long as we continue to have healthcare costs that are climbing at a rate that far outpaces inflation and overall consumer price increases, we will likely see high deductible health insurance plans accounting for an ever-increasing segment of the market.

In addition to a shift towards higher deductible health insurance, large groups also have an increasing focus on wellness programs, which might make their employees less likely than the overall population to need healthcare.  This is another possible explanation for why health insurance premiums in the large group market are expected to climb an average of only 5.5% next year, even with an overall 7.5% increase in healthcare costs.

New Colorado Law Bans Trans Fats In “Competitive Foods” In Public Schools

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I wrote last week about Colorado Governor Hickenlooper’s commitment to improving the overall health of our state’s population, and it’s fitting that he had just signed into law a bill that will ban trans fats in Colorado’s public schools – sort of – starting in the fall of 2013. Colorado Senate Bill 68 will ban trans fats on school premises, except for foods that are part of “a meal program of the United States Department of Agriculture”. The ban also does not apply to food that is distributed via a fundraiser. […]

Healthcare Reform After The Supreme Court Rules

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I would say that the impacts she describes would also apply here in Colorado, even though we’re not quite “active” according to the criteria on the State Reforum chart.  The three criteria on the chart that Colorado has not officially met are areas where the state has been making progress already, so I would say that we’re not too far off from getting a score of five or more.  (For example, Medicaid expansion has been a priority here for a few years, and the Colorado Division of Insurance has made changes to bring more transparency and accountability to the health insurance rate increase review process.  Those two issues are part of the criteria on the chart that Colorado has not yet fulfilled).  And given the Governor’s commitment to expanding health insurance coverage to as much of the state’s population as possible, I would say that Colorado will continue to take steps to reform healthcare over the next few years, even if there ends up being little or no federal framework for reform.  But as Sonya pointed out, if the entire ACA is struck down, the state will have to start from scratch on a lot of issues.  In some regards, however, Colorado has already passed laws that address various individual aspects of healthcare reform – things likegender-neutral premiums and maternity care, for example.  Those will not be impacted by a ruling on the ACA, since they are independent of federal law and apply only to health insurance policies sold here in Colorado.

Colorado Governor Committed To Improving The Health Of Colorado Residents

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Colorado Governor Hickenlooper stated last week that he believes healthcare reform can be successful even without a mandate.  We’ll know later this month what the Supreme Court decides as far as the constitutionality of the individual mandate and the fate of the rest of the ACA if they determine that the individual mandate cannot be included in the law.  But Governor Hickenlooper is obviously committed to some form of healthcare reform in Colorado, regardless of how things shake out on a national level.

Hickenlooper addressed an international conference of wellness experts yesterday in Aspen, and said that although he has concerns about the downsides of becoming a “nanny state”, he believes we need to take some significant measures in order to improve the overall health of the Colorado population – if for no other reason than the significant economic impact of poor health and obesity.  Even though Colorado is still the leanest state in the US, the percentage of obese adults has been steadily increasing over the past two decades, and it climbed above 20% last year for the first time.

Although Hickenlooper didn’t discuss any Colorado-specific plans with regards to taxing or banning super-sized sodas or other junk food, he mentioned Mayor Bloomberg’s initiatives in NY to ban sodas larger than 16 ounces in places like restaurants and movie theaters.  He spoke of his general opposition to such laws (presumably because they can be seen as the state meddling too much in personal affairs), but noted […]

Governor Hickenlooper Says Reform Can Succeed Without An Individual Mandate

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Colorado Republicans have pounced on statements that Governor Hickenlooper made on Colorado Public Radio yesterday regarding the individual mandate. Although Governor Hickenlooper did not say that he’s opposed to the individual mandate, he expressed his belief that he doesn’t “think you have to mandate it if you craft it properly.” Since the individual mandate is without a doubt the most controversial aspect of the ACA, the governor’s words will be significant for both sides of the debate. A spokesperson for the governor’s office noted that Hickenlooper was discussing a hypothetical situation that could arise if the Supreme Court strikes down the individual mandate next month but leaves the rest of the ACA intact. Colorado has already done quite a bit of work on the state’s health benefits exchange, but the exchanges are currently being based on the assumption that health insurance will be mandatory in 2014. If the Supreme Court does away with the individual mandate but keeps the rest of the ACA, it will be a challenge for states to create health benefit exchanges that can operate efficiently without an individual mandate. […]

Beware A Scam Targeting Health Insurance Consumers

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The Colorado Division of Insurance notified us today of a new scam that is targeting Colorado health insurance consumers.

People have been getting phone calls from someone who claims to be with the “Colorado Insurance Commission” (there is no such agency – it’s called the Colorado Division of Insurance), telling the potential victim that his or her Colorado health insurance carrier has been taken over by the state.  Then the caller says that the state sent the insured a check for $399 to refund copays, but that it was returned by the post office.  The caller then offers to direct deposit the $399 into the insured’s bank account – and of course asks the person to provide bank account details in order to facilitate this.

As is pretty much always the case when someone calls and wants your bank account information over the phone, this is a scam.  DO NOT GIVE YOUR BANK ACCOUNT INFO TO ANYONE WHO CALLS YOU, no matter how legitimate their claim might sound.

If you get a call like this, you can report it to local law enforcement.  If you ever get a call from someone who wants your bank account information – for any reason at all – you can hang up and then call the company in question directly (for example, in this case you could just call your health insurance carrier and find out right away that no part of the caller’s statement is true).  Once you’ve determined that the original call was a scam, report it to law enforcement.

The Colorado Division of Insurance wants consumers to be aware of this scam.  And again, legitimate organizations don’t call people and ask for banking information over the phone.  A general rule is that you shouldn’t give out that information to anyone unless you were the one who initiated the communication.

How Individual Health Insurance Measures Up

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[…] So although it’s true that out-of-pocket costs are higher in the individual market (likely due in large part to people opting for policies that are less expensive), if we combine the premiums and the out-of-pocket costs, the total expenses are lower in the individual market ($8,821 in the individual market versus $15,158 in the group market, using Colorado private sector family premiums for the group data). To ignore cost when comparing the policies is to leave out a large piece of the equation.

The Commonwealth Fund study mentions maternity coverage as an example of a benefit that is often not included on individual policies, thus earning them a “tin” rating. In Colorado, maternity is now included on all policies that have been issued or renewed since January 2011 (the data for the study was collected in 2010). But in many states, maternity coverage in the individual market is rare and/or quite expensive as an optional rider. This will change in 2014, and based on our observations of the Colorado individual market over the past year and a half, I would say that the change will be a positive one. But given the fact that so many individual policies did not include maternity coverage in 2010, I’m curious as to what percentage of individual health insurance plans would have earned at least a “bronze” ranking if maternity had been excluded from the data. If we don’t count maternity, how do individual health insurance plans measure up? Most individual plans (assuming they aren’t mini-meds or some sort of limited benefit coverage) in Colorado in 2010 covered complications of pregnancy and charges incurred by a newborn (eg, a premature baby who is in NICU for weeks). But routine maternity care was included on very few individual plans in Colorado prior to 2011. Given that fact, and the fact that all new individual plans in Colorado now have maternity coverage, I’d be curious to see how individual and group plans compare in 2012.

Overall, I think that The Commonwealth Fund study is a good one. It highlights the out-of-pocket exposure that people have in the individual market, and it’s true that the average plan in the individual market has higher out-of-pocket exposure than the average plan in the group market. But to make the comparison without also looking at the premium costs in each market seems a bit disingenuous. If individual health insurance were two to three times as expensive as it is now, it could cover more costs for members with less cost-sharing. But that doesn’t seem like a good solution either.

A Shared-Risk Success Story

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[…] In addition to beating their target financially, the program has also resulted in happier patients, increased market share for Blue Shield, fewer patient readmissions (likely due to the comprehensive patient discharge program that they created, and better chronic care management), a significant decrease in the number of inpatient days per thousand members, and far lower start-up administration costs than are typically projected for ACOs (although they note that they worked with existing programs and already-established relationships, so they weren’t building an ACO from scratch. But I imagine that would likely be the case with most ACO creation?). […]

Medical Underwriting Makes Individual Health Insurance Much Less Expensive Than Group Coverage

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[…] But although there are differences between group and individual coverage that can account for some of the price variation, by far the biggest factor is medical underwriting. The Zane Benefits article points out that 80% of healthcare costs come from 20% of the population – individuals with serious, ongoing health conditions. Group health insurance is required to accept all eligible employees, but individual health insurance carriers use medical underwriting to eliminate the sickest applicants from the pool of insured members (70 % – 90% of applicants in the individual market are accepted and offered a policy – there is quite a bit of variation in underwriting guidelines from one carrier to another and from one state to another). This mean that individual policies are covering people who are generally healthier than the average of the entire population. And that translates to lower healthcare costs in the individual market. […]

New Healthcare Price Comparison Database Coming Soon In Colorado

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[…] Happily, it looks like we’re going to be getting a good healthcare price comparison database here in Colorado next year. This article from Kaiser Health News has all the details, and it looks promising. As the article states – and as we’ve noted here many times – healthcare costs sometimes seem to have little rhyme or reason. They can vary widely from one provider to another and from one area to another without much of a difference in quality of care or patient outcomes. But there are also some variables that have a justifiable impact on healthcare cost variation, such as the overhead expenses associated with teaching hospitals and hospitals that treat a higher-than-average number of uninsured patients. It sounds like the All Payor Claims Database is addressing those issues, so it will be interesting to see how the database accounts for them. I also like the fact that providers will be able to see how they compare with other providers before the data is released to the public, in order to allow the providers to start making improvements where necessary.

I can see this comparison tool – especially given how comprehensive it looks to be – being very beneficial for Colorado residents, and also helping to foster more competition among healthcare providers in the state.

Care Management Outsourcing

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[…] outsourcing of care management and the success of MedAssurant, a data-driven healthcare solutions company that works with provider organizations that care for more than a third of the US population.

With healthcare providers feeling the squeeze both in terms of reimbursements for care and time spent on administration, it makes sense that outsourced care management could be an important part of a medical office’s business plan. Utilizing economies of scale in this manner could save time and money for medical offices, and streamlined care management is likely to be popular with health insurance carriers too. As Jaan points out, MedAssurant has very savvy customers (including health insurance carriers and healthcare provider organizations) and a solid track record, so the service they are providing is obviously valuable and beneficial.

Prescription Drug Reuse And Disposal Programs In Colorado

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Four years ago, we wrote an article about recycling prescription drugs to be used by patients who don’t have health insurance or cannot afford their medications. This has remained a popular post on our blog, and people frequently search our site for information about prescription recycling and/or disposal programs in Colorado. So I wanted to write an updated post with information that we’ve come across in the years since we published that first article. […]

Taxes And Individual Health Insurance

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[…] Greg’s most recent article deals with the way that our tax code treats health insurance premiums. Medicare and Medicaid premiums are obviously subsidized by tax dollars. But group health insurance premiums are also subsidized, since the premiums that employers pay on behalf of their employees are not included in the employee’s taxable income.

People with individual health insurance usually don’t get such a benefit. The self-employed get to deduct individual health insurance premiums on the 1040, but there are plenty of people who purchase individual health insurance and are not self-employed. Early retirees are a good example, as are people who buy their own health insurance because their employer does not provide it.

Greg’s article goes beyond what we usually see on this topic (ie, pointing out the inherent unfairness of not allowing similar tax treatment for all health insurance premiums, regardless of whether the coverage is group or individual). He delves into what the possible implications could be for the individual health insurance market if the tax code were changed to a more equitable system. His prediction includes millions of additional people entering the individual market (thanks to a switch from group to individual coverage), more lenient underwriting standards in the individual market, more innovative products available to consumers, and more competition in the individual market. Check out his article for all the details – definitely some good food for thought.

Too Big To Fail?

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[…] Given the large market share that some hospital systems and health insurance carriers have in other states, I wonder if those organizations might already be “too big to fail”, even before ACOs come into the picture? Would the financial collapse of one of those systems be too much of a destabilizing factor and require a government bailout in order to protect the communities served by the healthcare organizations?

So far, we haven’t seen such a scenario. In general, when a healthcare organization leaves the market, it is bought out by another organization that is more financially sound (for example, Celtic agreed to take over World and American Republic’s insureds last year when those companies left the market). This happens quite often with hospitals and small-ish health insurance carriers. But the titans of the financial industry that had to be bailed out in 2008 were not the “small-ish” banks – they were huge organizations that everyone thought were very sound. If something like that were to happen to healthcare organizations – either insurers or large hospital systems – would a bailout be necessary in order to stabilize the healthcare system?

I assume that ACOs are being crafted with a bit more care and transparency than what went into CDOs. And hopefully the lessons learned in the financial markets crisis will be well-remembered as healthcare market overhauls are created.

Details From Anthem On Preventive Care And Contraceptive Coverage

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Last week we added a post about contraceptive coverage under the PPACA and what changes people could expect to see starting in August. We just received an information sheet regarding this subject from Anthem Blue Cross Blue Shield, and wanted to share it with our readers. It will be useful for our Anthem clients, and is also helpful to give people a rough idea of how the contraceptive coverage will be implemented by most carriers. There may be some small variations from one carrier to another, but in most cases things will be similar across the board, since federal legislation is guiding the changes.

The Anthem preventive care info sheet is relevant in Colorado and nine other states where Anthem operates Blue Cross Blue Shield plans, and applies to individual health insurance as well as small and large group plans.

The Anthem info sheet specifically notes that sterilization procedures for men are not included in the new contraceptive coverage – which is the conclusion I came to last week after quite a bit of reading on the subject – since all of the guidelines apply to adding contraceptive coverage to preventive care for women rather than preventive care in general. […]

Contraceptive Coverage And The PPACA

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[…] Anyway, assuming that we’re talking about contraceptives for women, new health insurance policies – except those that are exempt based on religious reasons – will cover contraception with no copays or deductibles. Non-grandfathered plans (grandfathered means that the policy was in effect prior to the PPACA being signed into law and that the plan has not made any significant changes since then) will have to start covering contraceptives as of each plan’s renewal date. This is similar to how the state maternity mandate worked in Colorado last year. New policies had to start covering maternity on January 1, 2011. But existing policies added it throughout the year as each plan renewed (for example, my family’s health insurance plan renews each year in November, so our maternity coverage didn’t begin until November 2011). This brief from the Kaiser Family Foundation website has a lot of good information regarding contraceptive coverage and should help to clarify the issue a bit. […]

Replicating Grand Junction’s Healthcare System

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[…] This is a scenario that I could see being implemented even without a monopoly by one health insurance carrier. Grand Junction aside, if we look at the whole state of Colorado, the top 70% of the health insurance market is comprised of ten carriers. I wonder if it would be possible for medical offices to set up agreements whereby they pool money received from those ten carriers and from Medicare, Medicaid, and CHP+. Then instead of paying physicians directly from the health insurer depending on the insurance coverage of each specific patient, the doctors could simply be paid either a salary or an average reimbursement for each patient, regardless of which insurance that patient had. This would require some restructuring in terms of how medical billing is done, but it would allow medical offices to continue to negotiate competitive contracts with private health insurers (and the higher the contracted rate, the more total dollars the medical practice would have to put into their payment pool).

One of the major factors that contributes to the success of the system in Grand Junction is that doctors there are ok with receiving lower total incomes than they would in other areas that don’t function the way Grand Junction does. When you pool Medicare and Medicaid payments together with private health insurance payments, the public health insurance reimbursements drag down the average payment. In order to make sure that people with public health insurance are receiving equal access to healthcare (which they currently do not, especially those with Medicaid), the per-patient average reimbursement for physicians would have to decrease, since it would mean that more lower-paying patients would be treated. The caveat that doctors would have to be willing to work for a little less money is especially true of specialists, which is where the highest incomes are. […]

Hospital Payment Assistance Program Will Benefit Colorado’s Uninsured Population

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[…] SB12-134 will result in some significant changes in terms of how uninsured patients are billed when they receive treatment in a hospital (note that the bill only applies to hospitals – outpatient clinics, medical offices, and other non-hospital providers will not be impacted). Most people are aware that private health insurance carriers have negotiated rates that are lower than the “retail” price for medical services. Medicare and Medicaid have even lower negotiated prices. The reason SB12-134 is so important is that uninsured patients (usually those who have the least ability to pay medical bills) typically get charged the retail price. There is usually a cash discount available, but most uninsured patients typically don’t have enough cash sitting around to pay the whole bill up front. So – assuming they are able to pay the bill at all – they often end up on a payment plan (sometimes through a third party where interest rates can rival those of credit cards) and ultimately pay far more than any insurance carrier would pay.

SB12-134 applies to medically necessary care provided to uninsured patients who have a family income of not more than 250% of the federal poverty level ($57,625 for a family of four in 2012). And SB12-134 applies only if the care is not eligible for coverage through the Colorado Indigent Care Program (CICP). For those patients, hospitals may not charge more than the lowest rate they have negotiated with a private health insurance plan. This is a huge change from the status quo.

SB12-134 also requires hospitals to clearly state their financial assistance, charity care, and payment plan information on their website, in patient waiting areas, directly to patients before they are discharged, and in writing on the patients’ billing statements. Hospitals will also have to allow a patient’s bill to go at least 30 days past due before initiating collections procedures. […]