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Hospital Bills Waived For Many Aurora Shooting Victims. But What About Victims Of Less-Publicized Violence?

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The tragic shooting at a movie theater in Aurora last week has horrified all of us in Colorado and across the country.  In addition to the 12 people who were killed, 58 more were shot and have required medical care that ranged from relatively minor to very major.  And while we don’t know the health insurance status of the victims (to my knowledge that information hasn’t been released), we do know that The Dark Knight’s audience included a large number of young adults, which is the population most likely to be uninsured in Colorado.

Five years ago, when the Lewin Group was preparing data for the Colorado Blue Ribbon Commission, they found that 38.7% of 19 – 24 year olds in Colorado were uninsured, as were 27.1% of 25 – 34 year olds (see the graph on page 6).  Those two age groups were significantly more likely to be uninsured than any other age group.  More recent data from the Colorado Health Institute found that 27.7% of 19 – 34 year olds in Colorado had no health insurance in 2011, up from 22.7% in 2009 (the increase comes despite the fact that starting in 2010 the PPACA allowed young adults to remain on their parents’ health insurance policies up to age 26).  As with the earlier Lewin Group study, that age group is far more likely to be uninsured than any other age group in Colorado.

So now the 58 surviving victims of the theater massacre will need medical care that ranges from relatively minor to very major.  Some have already been discharged from the hospital, while others will likely remain there for a while.  Three of the five hospitals in the Denver metro area that are treating the shooting victims have agreed to waive most or all of the hospital bills incurred by the victims.  The other two hospitals – University of Colorado Hospital and Denver Health – haven’t said what their specific policy will be with regards to medical bills for the shooting victims in their care, but those are Colorado’s top two safety net hospitals and they provide hundreds of millions of dollars worth of free care to uninsured patients each year.

It’s reassuring to know that the theater shooting victims – quite a few of whom likely have no health insurance – will have at least some help with their immediate hospital bills.  What’s less clear is the financial implications for the more gravely injured victims as they move forward with their treatment after being discharged from the hospital.  Physical and occupational therapy, outpatient follow ups, mental health treatment to cope with the trauma – these expensive services are likely to be a big part of some of the victims’ lives for the foreseeable future.  Individual health insurance is still medically underwritten (until January 2014), so it would be difficult or impossible for uninsured victims to obtain health insurance now to cover future medical bills related to the shooting (CoverColorado and GettingUSCovered – the state’s high risk pools – are an option available to people with pre-existing conditions).  They may be able to obtain health insurance through an employer group plan, but the ones who are uninsured likely didn’t […]

Walgreens, Anthem Blue Cross Express Scripts Agreement Reached

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Express Scripts and Walgreens have come to a multi-year agreement for Walgreens to participate as an in-network retail pharmacy. Anthem Blue Cross Blue Shield of Colorado members will be able to use their prescription drug benefits at Walgreens locations beginning Sept. 15, 2012.

Walgreens was in a situation where it needed to get this deal figured out. They were losing millions, not just in prescription drug sales, but the people who weren’t in the store filling their prescriptions also weren’t in the store to buy juice, toilet paper, grills, etc…

Healthcare Reform Progress In Colorado

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[…] Although I frequently read and write about Colorado’s healthcare reform progress, I wasn’t aware of the work being done by the Colorado Regional Health Information Organization (CORHIO) before I read Anne’s article.  Although the PPACA has put a lot more emphasis on electronic health records and healthcare IT, Colorado has been working on its own system with CORHIO.  The program is working with healthcare providers to implement health information exchange between providers – saving time and money in the process – and improve the overall quality of care for Colorado patients.  CORHIO goal is to have health information exchange implemented in every community in Colorado by 2015, with at least 85% of providers in the state enrolled in meaningful use EHRs by that time.

Anne also writes about the Colorado Health Benefits Exchange (which has received high marks for its progress so far) and notes that it “…will enable up to 960,000 Coloradans to purchase health insurance at a discounted rate.”  The exchange has a lot of excellent features, and will no doubt be a solid resource for individuals and small businesses in Colorado.  But in order to avoid confusion I think we should point out that the “discounted rate” likely refers to the government subsidies that will be provided to help people pay their health insurance premiums.  Subsidies will be available for people earning up to 400% of the federal poverty level, which is roughly $92,000 in 2012 for a family of four.  This means that the majority of the population will qualify for subsidies, and that will indeed amount to a lower premium in terms of what the individual will have to pay out of pocket for health insurance.  But I think that there could be widespread misunderstanding in terms of what the exchange will be and what it can provide.

To illustrate the point, we can look at a common misperception that exists with regards to the current health insurance market.  It’s widely believed that group coverage is less expensive than individual health insurance thanks to the “group discount”.  In fact, individual health insurance is quite a bit less expensive because of medical underwriting:  group policies have to accept all eligible employees and dependents, regardless of medical history.  This drives up the claims expenses for group coverage and results in higher premiums than medically underwritten individual policies.  That’s just one example, but I can imagine that the health benefits exchanges might be erroneously viewed as a marketplace where customers can get “special deals” on the health insurance.  People shopping in the exchange will be able to know that they’re getting a certain minimum level of coverage and they’ll be able to compare numerous plans side-by-side (in many ways this is similar to what brokers like us already provide).  The subsidy system is also expected to be tied in with the exchange’s policy shopping platform so that any applicable subsidy and the purchase of health insurance can be lumped together in one transaction.  But beyond the subsidy and the inherent competition that will exist among the carriers participating in the exchange, I’m not aware of any other discounted rates for policies that will be sold in the health benefits exchanges that the states are currently creating.

HWR and Malpractice Reform

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[…] Republicans in congress have long argued that the PPACA needs to be “repealed and replaced”, and many Americans are indeed unhappy with the law as it currently stands. A recent NPR poll found that a slight majority of the population favors amending the law rather than repealing it, but either way I wouldn’t be surprised if we see at least some changes to the law between now and 2014 when the bulk of it is set to take effect.

Malpractice reform sounds great in theory. So it’s the sort of thing that people grab onto as a solution, even if it might not really end up having a significant impact on healthcare costs. Huge malpractice cases – especially the ones that the public deem frivolous or ridiculous – tend to get news coverage and stir up all sorts of online commentary and water cooler discussion. We do live in a litigious society, but I would say that substantial malpractice lawsuits get more than their fair share of media discussion. The result is that everyone has heard of someone who was awarded millions in a malpractice case. My family once lived in a small town where the only obstetric practice closed down after the doctors were the defendants in a $23 million malpractice suit. Stories like that end up on the news, and people tend to think that if we could just reform that system, our healthcare costs (and thus our health insurance premiums) would go way down since doctors wouldn’t have to practice as much defensive medicine. But numerous studies have found that malpractice reform wouldn’t have much of an impact on healthcare costs. David’s article delves into a few of the reasons for this. There’s no doubt that the malpractice system could use some reform, but if that approach is used as a cornerstone of a “repeal and replace” strategy, it’s likely to come up short.

FEHB Health Insurance Now Available For Seasonal Firefighters

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[…] The federal Office of Personnel Management (OPM) issued a ruling yesterday – effective immediately – that grants seasonal firefighters access to health insurance through the Federal Employees Health Benefits Program (FEHB), which allows federal employees to select from among several private health insurance policies. Normally, eligibility for FEHB requires an employee to have completed a full year of service. This is not possible for seasonal firefighters, since they are employed for temporary positions during the fire season, usually for only six months at a time. So until OPM issued the new rules, seasonal firefighters were never eligible for health insurance through FEHB. Their only real options were to obtain health insurance as a dependent on a spouse’s plan, or to apply for coverage in the individual market – which is subject to underwriting (and some individual carriers won’t accept applicants who have high risk jobs).
[…]

Laws That Protect Young Workers

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[…] Teens working their first summer job might not have the knowledge or ability to speak up and refuse to put themselves in harm’s way or work more hours than they should. So laws have been crafted to protect them, and it’s up to the employer to understand the rules and follow them. The penalties for not doing so can be steep. This post is a good reminder at this time of year, when many businesses hire teens for part-time work during summer vacation. Especially if you’re an employer who hires young workers for part-time or temporary positions, Julie’s article is well worth the few minutes it takes to read.

Does GSK Case Show A Need For Profit And Admin Caps In the Rest Of the Healthcare Industry?

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[…] The fine against GSK is addressing transgressions that occurred several years ago, and the company notes that they have taken steps to remedy the problems and make sure that similar problems won’t happen again. But it still sheds light on the tremendous marketing machine that is Big Pharma, and the huge sum of money that is earned every year by the pharmaceutical industry. I’m reminded of an article I wrote on the Colorado Health Insurance Insider in the fall of 2010, when the Medical Loss Ratio rules were issued and scheduled to go into effect the following January. I wrote about how the MLR rules (requiring health insurance carriers to spend at least 80% of premiums on healthcare services, with admin costs capped at 20%) would surely drive health insurance carriers to be more innovative and efficient. But I also lamented the fact that the rest of the healthcare industry wasn’t being held to similar standards.

Many Health Insurance Carriers Were Meeting MLR Rules Even Before They Went Into Effect

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[…] Except quite a few carriers were already meeting or exceeding these guidelines two years ago, before any MLR rules went into effect.  The Kaiser Family Foundation looked at the MLR requirements in the PPACA and then compared them with how health insurance carriers were doing in 2010.  The new MLR rules went into effect in January 2011 (nearly a full year before Mr. Ungar’s article was published – his article was just referring to the final determination of what counted as medical expenses and what counted as admin costs).  You can see from the chart that 77% of carriers in the large group market and 70% of carriers in the small group market were already spending premium dollars in line with MLR guidelines prior to the rules going into effect.  In the small group market things weren’t quite as good (43% of carriers – covering 48% of the population insured by individual health insurance – was meeting the MLR guidelines before they went into effect.  Granted, that left quite a few carriers that needed to shape up.  Some of them will, and some of them won’t.  I have no doubt that we’ll see a few of the under-performing health insurance carriers (with high administrative expenses) leave the market over the next few years.  But the high quality carriers – especially the ones that were already meeting the MLR guidelines back in 2010 – will have no problem continuing to spend the vast majority of premium dollars on medical expenses.  So the claim that there is “absolutely no way” private health insurance companies are going to be able to “learn how to get by” under the MLR rules is clearly false.

The PPACA allows for states to be granted waivers for the MLR requirement if HHS determines that the 80% MLR requirement could destabilize the individual and/or small group market in the state.  So if it appears that a large number of health insurance carriers would have to pack up and leave the state, a waiver can be granted that allows the state to gradually phase in the MLR requirements, reaching the 80% mark in 2014 rather than 2011.  17 states plus Guam have filed requests for waivers (Colorado is not one of them), but most have been denied by HHS because it was determined that enough of the individual and small group carriers would be able to meet the 80% MLR rule (or pay out rebates to insureds) and still remain profitable – ie, they were not likely to leave the market because of the MLR rules.

So basically, yes it is possible for the private health insurance industry to meet the MLR guidelines.  Many carriers have been doing so since before the rule went into effect.  Does the rule help to trim the fat?  Absolutely.  And it’s a good way to weed out (or shape up) the inefficient carriers.  But for carriers that were already performing well prior to the PPACA, it doesn’t really change things too much.

Special Edition Health Wonk Review – SCOTUS And The PPACA

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[…] Overall, the rhetoric in the media hasn’t really changed much since the SCOTUS ruling. While it’s true that the PPACA’s legal battle is over, the political one is as fierce as ever, and will probably intensify over the next few months leading up to the election in November. Joe Paduda’s special edition HWR has opinions from both sides of the issue and plenty of good ideas about the future of healthcare reform in the US. Be sure to check it out.

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. […]

ACO Downsides

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Attorney Nina Kallen hosted this week’s Cavalcade of Risk, and it included a couple of interesting entries about the Facebook IPO. Given that we write about health insurance, I especially liked Dr. Jaan Sidorov’s article comparing Facebook and ACOs. His verdict? Well, you’ll have to read his article to get the details, but he’s not particularly impressed with either one. I tend to see ACOs in a relatively positive light, and I think they have a lot of potential for cost savings and creating more of a teamwork dynamic between providers and health insurance carriers. But Dr. Sidorov makes some good points about the potential downsides. As usual, good food for thought from the Disease Management Care Blog.

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?). […]