[…] When it came to the mandate, however, things got a little stickier. I believe that lawmakers understood that allowing people to purchase health insurance without medical underwriting, while also allowing them to choose whether or not to obtain coverage, would amount to much higher premiums for the people who choose to have coverage. Initially they drafted a reasonably strong mandate, but caved in to criticism and weakened the mandate to the point where the fine for not carrying health insurance will only amount to a fraction of the cost of buying a policy […]
Imerica Placed In Rehabilitation
[…] If it is determined that Imerica can be rehabilitated, they will continue to do business under the rehabilitation plan. If not, Imerica would be liquidated, and policyholder claims not paid by Imerica would become the responsibility of the life and health insurance guaranty funds in the states where Imerica was licensed. In Colorado, this group is known as the Life and Health Insurance Protections Assocation (LHIPA). LHIPA has a maximum benefit of $500,000 for major medical insurance, which is significantly lower than most of the benefit maximums offered on private health insurance policies in Colorado (including Imerica, which offered policies with lifetime maximums ranging from $2 million to $8 million) […]
An Office Visit In France
The Healthcare Economist’s Jason Shafrin has written an interesting article about how the French healthcare system utilizes hyperbolic discounting in order to avoid moral hazard. Basically, their system requires the patient to pay up front for a visit to the doctor, but then health insurance reimburses the patient 70% of the cost. This has two advantages over a system like ours which only requires the patient to pay their copay at the time of service. First, it conveys the value of the visit. Here in the US, people who have health insurance with copays for office visit are often unaware of the actual cost of the visit. They pay their copay and the rest is billed to the health insurance company. People who read their EOBs will see the actual billed amount and the amount that the insurance company paid, but I doubt that everyone reads their EOBs […]
Addressing The Problem Of Cost
Ezra Klein recently interviewed George Halvorson, Chairman and CEO of Kaiser Permanente (which operates our largest HMO here in Colorado). Both the questions and answers were insightful and on target in terms of addressing the cost conundrum that is so often glossed-over in the health care reform debate.
Mr. Halvorson pointed out that while many developed countries have some form of private health insurance, they also have medical fee schedules that are set by the government and are far lower than average costs for the same procedures in the US. When average fees for various medical procedures in several countries are shown on graphs, the US bar looks like a giraffe standing in a herd of gazelles.
But Halvorson acknowledged that while fees in other countries are even lower than Medicare reimbursement amounts here in the US, half of hospitals here are losing money, and do so especially when they treat Medicare patients. So it’s not as simple as just saying that we need to create set fee schedules that are more in line with those of other countries […]
Grand Rounds Vol. 6 No. 8
How To Cope With Pain brings us a truly amazing video. It’s a reminder to be thankful for all that we have, and for the things in life (like this video) that inspire us. It’s well worth the five minutes it takes to watch it.
Amy Tenderich of Diabetes Mine shares a “would you rather…?” moment from her 9-year old daughter. It’s a poignant reminder, seen through the eyes of a child, that all of the parts of our lives – even the bad parts – combine to make us who we are […]
Health Wonk Review
Welcome to the Health Wonk Review. 2009 has been an exciting year for health care reform, and last Saturday’s passage of HR3962, the Affordable Health Care for America Act, has given us plenty to talk about. For anyone who hasn’t kept up on the details of the House reform bill, I want to start things off with a four-part series from Tim Jost, who holds the Robert L Willett Family Professorship of Law at the Washington and Lee University School of Law. His articles were published at Health Affairs Blog, and amount to an excellent primer, written in plain English, for people who want to understand HR3962, but don’t have time to read all 1990 pages […]
Accepting Grand Rounds Submissions
We will be hosting Grand Rounds, the weekly collection of great health and medical blogging, on Tuesday, November 17th. Please send me your article to louise (at) healthinsurancecolorado (dot) net, indicating Grand Rounds in the subject. Please do so before midnight on Sunday, November 15th, mountain time.
Optional theme, because of the upcoming Thanksgiving holiday, will be articles about something you’re thankful for.
The theme is optional. Grand Rounds will include all other important topics you write about. Looking forward a thankful edition!
HB1355 Now In Effect For All Small Groups In Colorado
[…] Critics are questioning why insurers keep bringing up HB1355, as the trend in national health care reform these days is towards guaranteed issue health insurance without underwriting – which is what HB 1355 was all about. But while HB1355 was beneficial to groups with unhealthy members, the majority of small groups in Colorado had a discount before HB1355 took effect. And if those groups are unable to afford their new, higher rates, they can opt to cancel their coverage – which leads to higher prices for groups that remain covered. On a national level, as far as individual health insurance is concerned, HB1355 should be considered a warning sign. Getting rid of medical underwriting is the right, and fair, thing to do. But not if people can come and go as they please in the insurance system. We’ve seen what the impact will be on premiums if guaranteed issue coverage takes effect without a strong mandate requiring people to carry health insurance. I think this is why insurers are still bringing up HB1355. It’s impacting all small groups in Colorado now – there’s no more putting it off. And significant rate hikes for healthy groups should serve as a warning for what we’ll likely see in the individual market if reform passes without a way to make sure that everyone is part of the insurance pool.
Colorado Premiums Rising Faster Than National Average
Across the US, employers will see a 9% increase in health insurance premiums next year. But in Colorado, the increase will be an average of 11.8%. The Lockton Group has released its 2010 Colorado Employer Benefits Survey Report, and it indicates that Colorado will see bigger premium increases than the country as a whole. This puts Colorado businesses at a disadvantage in terms of direct operating expenses, as health insurance makes up a large portion of business overhead. It also makes it harder for Colorado businesses to compete for the best employees, since premium increases are being passed along to employees in the form of higher premiums and fewer benefits. Not surprisingly, Colorado businesses are much less likely to offer pricey HMOs than they were a decade ago (32% now, versus 89% in 2000), and far more of them are offering HSA qualified, high deductible health insurance policies (which have lower premiums) for their employees (27% now, versus only 3% in 2003).
Colorado residents tend to be healthier than the average American. We’re thinner, and have lower incidence of hypertension and diabetes than most of the rest of the country. So why would health insurance rates be rising faster here than in the rest of the country? My guess is that it has something to do our higher-than-average percentage of the population without health insurance. 17.2% of Colorado residents are uninsured, compared with national numbers that tend to be in the 15 – 16% range. When uninsured patients are treated by our health care providers (emergency rooms are a good example of this), the providers have to recoup their losses somehow. This usually translates into higher reimbursement rates being negotiated with health insurance companies. The insurance companies pass on their higher costs to customers in the form of higher premiums and/or reduced benefits. […]
Health Insurance Premiums And The Public Option
David Williams has written an insightful article about how big business concerns about a public health insurance option might be overly dramatic. I do understand the concerns that business owners have, since they believe that a public option will lead to costs being pushed onto private health insurance carriers, who in turn would charge higher premiums. There is no doubt that businesses have felt the sting of rising health insurance premiums for years now. In Colorado, employer-sponsored health insurance premiums rose by almost 87% between 2000 and 2009, while wages increased by only 20.5% over those years. Employees are increasingly seeing higher premiums deducted from their pay, combined with higher deductibles and copays. But employers still pay the lion’s share of many employees’ health insurance premiums, and the prospect of even higher premiums isn’t likely to sit well with them […]
Women And The House Health Care Reform Bill
Not surprisingly, House Democrats are going after the female vote by including several provisions in the current draft of their health care reform bill that are designed to expand coverage and reduce premiums for women. For starters, the bill includes a ban on using gender as a factor in setting premiums. This will result in lower premiums for women, but higher premiums for men. In Colorado, men are currently more likely than women to be uninsured. Raising their rates to compensate for lowered rates for women might result in more men being uninsured. But in terms of overall fairness, it does make sense to charge the same rates for men and women.
Specifically forbidding the practice of denying coverage to domestic violence victims is also part of the House bill, and will likely receive widespread support from both women and men alike. But in the eight years since we started selling medically underwritten health insurance, I can’t remember a single time that an applicant was declined for being a victim of domestic violence, nor have I ever seen a question on any application asking if the applicant has been abused. So while this provision makes sense, and will no doubt be beneficial for a few people, I imagine its strongest impact will be in helping to rid us of “blaming the victim” mentality […]
Health Insurance Premiums And Age
How much should age play a part in determining health insurance premiums? That’s a question that lawmakers are debating, and one that might require an answer that is more strategic than it is fair. In general, older people have higher health care bills than younger people. Because of their lower claims, younger people currently pay much lower premiums for health insurance than older people. But they continue to be the most uninsured segment of our population.
In 2007, the Lewin Group released a report for the Colorado Blue Ribbon Commission for Health Reform. It showed that 38.7% of Colorado residents age 19 – 24 were uninsured. This was far more than the next highest category (27.1% of people age 25 – 34 were uninsured). Several factors contribute to the high percentage of young people who are uninsured. They tend to be healthy, and thus aren’t as likely to see the value in health insurance. They tend to work in entry-level jobs that aren’t as likely to provide health insurance benefits. And they usually have lower incomes than older workers, making health insurance – even if it is cheaper for them – harder to afford […]
Imaging And Primary Care Doctors
[…] When Jay hurt his knee a couple years ago, an MRI was done prior to surgery. We have an HSA qualified health insurance policy, and at the time our deductible was $3000. So we paid for the MRI ourselves, and it amounted to more than a third of the deductible. And that was after Humana reduced the bill to the network negotiated amount. MRIs have helped to make medicine a much more exact science, but they are not cheap.
It seems that any system that pays physicians – directly or indirectly – to order additional testing will end up with excessive testing, adding to the overall cost of health care. Even doctors with the best of intentions are likely to be swayed by the knowledge that they can boost their paychecks by adding a few MRIs here and there.
I believe that the number of tests a doctors orders should not impact his or her income. And it seems that adding more medical imaging facilities in primary care offices will only increase our already burgeoning health care costs […]
How The Pharmaceutical Industry Drives Health Care Costs
My father has been on dialysis for eight years. He has Wegener’s Granulomatosis, a rare autoimmune disease, and it destroyed his kidneys very suddenly in 2001. His illness came out of the blue, following a lifetime of good health, and has given my parents an up-close look at our health care system. Because he has kidney failure, my father qualified for Medicare. But until the advent of Medicare Part D in January 2006, my parents had to pay for all of his medications out of pocket.
Dialysis does not remove phosphate, so my father has to be on a drug that prevents phosphate from building up in his blood. In 2002, he was on PhosLo, a brand name drug, because the generic wasn’t available. At that time, a three month supply cost $108.25. Now, seven years later, he takes the generic version (calcium acetate) and a three month supply is $528.29 (a 488% increase in price). Humana, his Medicare D carrier, picks up the tab, but we all know that claims […]
What Guaranteed Issue Without A Mandate Looks Like
[…] Yes, companies like Wellpoint are in business to make a profit. But that doesn’t mean that everything they say in the health care reform debate should be dismissed. If we don’t make sure that everyone becomes part of the health insurance pool, we’ll likely be looking at fewer health insurance companies and far higher premiums after a few years of guaranteed issue policies.
How Current Reform Proposals Would Impact Colorado Premiums
[…] Wellpoint actuaries have crunched the numbers and come up with their best estimates as to how premiums would be impacted in the 14 states where Wellpoint operates. Colorado is one of those states, and for the first time we’re able to see a detailed analysis of what would likely happen to premiums for people here. […]
Declined… Now What?
If you’ve been declined for an individual policy by a private health insurance company in Colorado, you do still have other options. I’ll outline them here, and provide links to detailed information that you might find helpful. […]
Conflicts Of Interest In Health Care
[…] Hospitals are in business to make money, just like most of the other players in the health care industry. And hospitals have boards of directors. We know this, but do we know what they do, or who they are? Dr. Roy Poses of Health Care Renewal has written an article about hospital boards that might make your blood pressure rise a notch or two. […]
Increased Cost Sharing Reveals The True Cost Of Health Care
[…] There’s no doubt that a co-insurance based system would make people more aware of what health care actually costs. Nobody should have to devote their life to trying to obtain coverage for a serious medical problem, but on the other end of the spectrum, perhaps nobody should be paying only $15 to see a doctor, and a deductible of a couple hundred dollars a year. […]
Obesity As A Pre-Existing Condition
[…] I can see the benefit to making sure that everyone gets accepted for health insurance, as it’s counterproductive for society as a whole to have people who are uninsured. But I believe that it makes sense for obese applicants, and tobacco users, to pay more for their health insurance in order to offset the higher claims they are statistically likely to have. […]
Expanding Access To Cover Colorado
I have often wondered about the feasibility of Cover Colorado expanding their eligibility to attract healthier applicants and perhaps improve their loss ratio. The state high risk pool health insurance policy – has claims expenses that far exceed premiums collected. Fees on private health insurance companies and a grant from Medicare help to make up the difference. […]
Reducing Demand For Health Care
Dr. William Foster has written a very thoughtful editorial about the state of our health care system, and it’s well worth reading. He points out that as a society, we’re always looking for the latest and greatest in health care, but at the same time we want it to be more affordable. We run more tests and perform more procedures than ever before – and our health care costs reflect this. […]
John Mackey And Health Care Reform
[…] But with any commodity in the marketplace, there will always be people who can’t afford it. The life or death nature of access to health care makes it too important to place it on the same shelf as cars and jeans and high-end organic potato chips. It people can’t afford (and thus don’t purchase) those things, they will still be ok. The same can’t really be said for health care.
Mandate An Important Part Of Reform Efforts
[…] And the only way that health insurance can work is for lots of people to be paying into the system while they are healthy, in order to cover the claims of people who are sick. It makes sense that if all of the healthy people are paying premiums, health insurance companies will be able to afford to pay claims for pre-existing conditions. […]
Playing With Fire
I just read this article from NPR and Kaiser Health News about Lyn Robinson, a 52 year old woman who has chosen to be uninsured. Lyn is very healthy. She leads an active life and takes good care of herself. She pays out of pocket for alternative health care like acupuncture and chiropractic care – things that often aren’t covered by health insurance policies anyway. […]