[…] There’s no simple answer to all of this. We’re trying to create a somewhat universal health insurance system based on a conglomeration of government-run health insurance, private coverage from hundreds of carriers, eligibility for coverage that is tied to employment and state of residence, and also based on income levels… of course it’s going to get complicated. Hopefully the suggestions raised by this report will help to guide regulations that will ensure health insurance coverage that is as gap-free as possible for most Americans.
A Blurry Line Between Advertising And Journalism
[…] Posts like this are good to keep in mind whenever we read stories in the media regarding new technology in healthcare, recommendations for medical treatment, and cutting-edge pharmaceuticals. Is the article truly research-based journalism, or is it a press release in disguise? Was the magazine/newspaper/website paid to run the article, or did the author receive an incentive to write the article in a particular fashion? […]
Uninsured Americans Virtually Unable To Pay For Hospitalizations
[…] A new report from HHS paints a pretty bleak picture of the ability of uninsured Americans to pay for their own medical care. Looking at all uninsured families in the US, the median amount of savings is $20 (the study considered only assets that could be easily liquidated: bank accounts, stocks, bonds, retirement accounts, CDs, money market accounts, and mutual funds). That won’t go far when it comes to paying for a hospital bill. Even uninsured families at the high end of the asset scale had an average of less than $13,000 in financial assets. […]
The Future Of PCP Availability For Medicare Beneficiaries
[…] He tackles the question of whether Medicare beneficiaries have to wait longer than privately insured patients for a routine appointment, and finds that they do not. In fact, it appears that the opposite is true, with more privately insured patients reporting that they had to wait longer than they wanted to get an appointment (although most insureds, regardless of whether they had Medicare or private health insurance, were able to get appointments within the time frame they wanted).[…]
Federal House Votes To Defund Health Insurance Exchanges
[…] One of the provisions of the PPACA is for the federal government to assist the states in funding the creation of health insurance exchanges. In a largely symbolic vote, the US House of Representatives voted last week to block that funding. HR1213 would prevent the federal government from spending money to help the states set up their own health insurance exchanges. It passed in the Republican-dominated House, but […]
DOI Report On Small Group Coverage In Colorado
The Colorado Division of Insurance recently released the 2010 small group market report. The number of employers in Colorado offering small group health insurance dropped by 10% compared with 2009, and the number of Colorado residents with small group health insurance coverage dropped by 7%. The report contains comprehensive data on the availability of coverage, carriers in the small group market, pricing, and how the rating flexibility laws have impacted the market. […]
CHP+ Premiums Will Result In More Uninsured Kids
[…] However, the real world is not always ideal. The Post editorial makes some very good points, and I don’t doubt that if CPH+ moves to a monthly premium system this summer, there will be some kids who lose their coverage, and fewer children will enroll in the future compared with how many would have enrolled if monthly premiums were not part of the deal. […]
Child-Only Plans Returning To Colorado
[…] But presumably if the child is eligible for coverage through a parent’s employer, individual health insurance carriers would not be required to offer the child a child-only policy. As we’ve noted in the past, child-only policies represent a very small fraction of the individual health insurance market, but within the child-only market, it would seem that there are a lot of children who are also eligible for other creditable coverage (albeit more expensive coverage…). It will be interesting to see if this becomes an issue once all the carriers return to the child-only market. […]
Is It Even Possible For Patients To Be Consumers?
[…] Dr. Perednia makes some excellent points about the inability of patients to be true “consumers”, even in cases where they have their own money on the line. He notes that if you call your doctor’s office to find out the price of a procedure, they won’t be able to tell you because there are too many complexities in the health insurance system for the doctor to give you an accurate idea of what the cost will be. And if you call your health insurance carrier directly […]
Colorado House Approves Child-Only Health Insurance Bill
The language of the law was modified to include open-enrollment periods during which children could apply for coverage, and last September the Colorado Division of Insurance officially designated those open-enrollment periods as January and July each year. The idea was that with open-enrollment periods rather than constant access to new policies, parents would be less likely to wait until a child was sick to seek coverage. But even with the open-enrollment periods, only two carriers – Rocky Mountain Health Plans and […]
SB200 Advances In the Colorado Senate
[…] Regardless of whether you support the federal healthcare reform laws, it’s hard to see how it would be better for Colorado to forgo creating a state-specific exchange. Doing so would mean that Colorado would have to participate in a federally-run exchange instead, and obviously such a program is not going to be geared to the specific needs of the people and businesses in Colorado. So although there are still likely to be plenty of legal battles over the Constitutionality and implementation of the federal healthcare reform law, it makes sense for states to move ahead in creating their own exchanges.
Potential ACO Models
[…] The article delves into the Medicare savings that the government is hoping to realize as a result of ACOs, and also discusses several potential ACO models that are currently in use by various health plans around the country. If you’re curious about how ACOs might work, the ACP Internist article is a good primer.
Differing Views On Paul Ryan’s Health Care Reform Proposal
Last week’s Health Wonk Review included several articles about Rep. Paul Ryan’s “Roadmap for America’s Future”, which includes significant changes in Medicare and Medicaid, and a repeal of the Affordable Care Act. This article from Avik Roy is particularly interesting, and raises some valid points in support of some aspects of the proposed budget reforms. But there are definitely problems with some of the radical changes being proposed. […]
Controversy Surrounding The Expansion Of Medicaid
[…] It’s true that we can’t just keep expanding Medicaid without figuring out ways to fund the expansion, but we also can’t ignore the needs of the uninsured population, many of whom are uninsured because of the cost of health insurance (even if they might not technically qualify for Medicaid under the current rules). Regardless of the future of the federal Medicaid mandates, hopefully the focus of the state leadership will be on finding additional ways to generate funds and increase efficiency in order to be able to provide real access to health care for as many Colorado residents as possible.
MLRs – One Size Does Not Fit All
[…] A state with two functional insurance carriers offering individual policies is obviously going to have a very different marketplace than a state with ten major carriers competing for business. It will be interesting to see how things play out in the states that are granted temporary MLR waivers by CMS. Three years from now, will their insurance markets be able to provide adequate coverage and also comply with the 80/85% MLR guidelines? Or will the waivers morph into something that allows the impacted states to set their own guidelines? Time will tell.
HHS To Stop Accepting Early Retiree Reinsurance Applications After May 5, 2011
[…] Although the program has proven quite popular – as of last month, HHS had approved approximately 5850 applications – one of the concerns from the beginning was that the $5 billion allocated to the ERRP might not be sufficient to last until 2014. HHS said from the start that they would only accept applications as long as they had enough available funding. They have now announced that they will not accept any new applications after May 5, 2011. […]
Bipartisan Support For Colorado Health Insurance Exchange Drying Up
Last week it appeared that Colorado Democrats and Republicans were prepared to work together to begin the process of creating a health insurance exchange for the state. But the bipartisan friendliness didn’t last long. House Majority Leader Amy Stephens (R – Monument) is a co-sponsor of the bill, and has faced a lot of criticism in the past week from conservative Republicans and the Tea Party over her support for the legislation to create the exchange. Stephens has also co-sponsored a bill that would allow Colorado to opt out of federal health care reform laws, and she has made it clear that she does not support the PPACA. But she and other lawmakers on both sides of the aisle felt […]
Never Events – The Healthcare Version Of A Zero Tolerance Policy
[…] If the goal of CMS is to reduce the number of “never events” – but not to discourage doctors from treating high-risk patients who may be more likely to suffer complications – it would seem to make more sense to evaluate reimbursement for “never events” on a case-by-case basis. Zero-tolerance policies rarely make sense when you consider all of the possible scenarios, and the “never events” list basically amounts to a zero-tolerance policy.
Spending Caps Will Help Individual Families But Won’t Reduce Overall Costs
[…] But although the spending caps will be beneficial to families that have large medical expenses, they do nothing to actually address the rising cost of health care, and the over-utilization that is also driving costs. This has been a recurring theme with a lot of the provisions created by health care reform: we’re finding ways to spread the costs in a more equitable fashion, but we’re not really addressing the fact that the total cost burden of health care in this country isn’t sustainable on its current trajectory, no matter how much we spread it out across the population.
High Deductible Plans And Reduced Spending
[…] Most of us agree that we need to find a way to reduce overall healthcare spending, but we also need to make sure that we don’t compromise future healthcare outcomes in the process. While some of the issues mentioned in the study – such as the drop in routine blood tests for people with diabetes – are definitely concerning, we shouldn’t simply assume that a reduction in overall preventive care will automatically lead to poorer health in the future.
Covering Primary Care Expenses With A Clinic Membership
[…] It’s always good to see new innovations that help to expand access to healthcare, and clinic memberships that allow people to cover their day to day medical expenses with a predictable annual fee and low cost appointments is likely to be quite popular, especially among people who can’t afford comprehensive health insurance. But as with any other product, a clear awareness of what you’re purchasing (or being offered, if an employer is covering the cost) will help to avoid future surprises.
Senate Bill 200 Begins The Process Of Creating Colorado Exchange
[…] Senate Bill 200 (the Colorado Health Benefit Exchange Act), co-sponsored by Senator Betty Boyd (D – Lakewood) gets the ball rolling on the health insurance exchange that the state will have to have in place by 2014. Specifically, the bill would create a “nonprofit unincorporated public entity known as the Health Benefit Exchange”. It includes guidelines for the appointment of a 12-member board of directors (9 of whom will be voting members) who will oversee the exchange, and lays out their responsibilities. […]
Good Reading At Grand Rounds And The Cavalcade Of Risk
[…] I wrote last fall about the new high risk pool in Colorado – GettingUsCovered – and how it differs from our existing high risk pool, CoverColorado (which has been operating for two decades). In states like Colorado that have existing state pools in addition to the federally-backed pools, there may be adequate options for people with pre-existing conditions, assuming that funding for both programs holds out until 2014. But in states that only have a PPACA-created pool, there are definitely some cracks to fall through, including the requirement that applicants be uninsured for six months before they can join the pool.
New CoverColorado Provider Fee Schedule
As of April 1, 2011, CoverColorado will be switching to a new fee schedule for reimbursing providers. In the past, CoverColorado has used the Rocky Mountain Health Plans provider network, and doctors were paid according to the RMHP network-negotiated rates when they treated CoverColorado members. The new CoverColorado-specific fee schedule applies to any provider who treats a CoverColorado member, regardless of whether that provider is part of the RMHP network or not. […]
Medicaid Outcomes – Separating Causation From Correlation
[…] But the shortage of doctors who will accept new Medicaid patients could definitely be seen as a significant obstacle to receiving care for people who rely on Medicaid to cover their healthcare costs. It’s likely that there is a long list of reasons why people on Medicaid have poorer health outcomes (and we have to be careful to not mistake correlation with causation). But it’s reasonable to assume that the difficulty Medicaid patients experience in finding a doctor isn’t doing anything to improve their health outcomes.