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Jon Stewart Interview With Sebelius Focuses Mostly On Health Insurance

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[…] I get the point that Stewart and Sebelius were making. They were addressing the aspects of the ACA that most directly impact people, since health insurance tends to be where most of us interact with healthcare costs. And the interview did – very briefly – touch on healthcare costs when Stewart mentioned that one of the reasons wages have stagnated is because “healthcare costs keep going up.” That is a key point, but they seemed to only be addressing it from the standpoint of health insurance premiums continuing to go up. It’s true that the actual check the employer writes each month to cover healthcare is paid in the form of health insurance premiums. But we have to address the root cause here, rather than just trying to figure out how to reign in premiums.

Steward did ask – in his usual joking manner – whether we all need to start exercising and eating better, which also touches briefly on the idea that a healthier nation would have lower healthcare costs. But overall, nearly the entire interview focused on how the ACA will impact health insurance. While that makes for an interesting interview, it also presents the ACA (at least as far as pop culture is concerned) as health insurance reform rather than healthcare reform. While there were definitely aspects of health insurance that needed reform, addressing health insurance as if it’s the crux of the issue is very much putting the cart before the horse.

A Look At Canadian And US “Mini-Med” Health And Dental Insurance

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[…] Glenn notes that although most people there have provincial health insurance policies, they often get additional coverage from their employers for things like prescriptions and dental care. And he points out that all too often, people think that they’re “covered” just because they have a health insurance card in their hands – even though the coverage might have very low annual limits. Of course that only becomes a problem when you have a catastrophic claim, which is of course when you need your health insurance the most.

Although the ACA has nixxed lifetime benefit maximums on health insurance policies here in the US, significantly increased annual maximum thresholds, and designated several categories of “essential benefits” that must be covered at specified levels, HHS has granted plenty of waivers for employers who are offering “mini-med” policies to their workers. These policies are far from being a safety net in the event of a catastrophic illness or injury, and often only cover a few thousand dollars in benefits per year. They remind me a lot of the type of policies Glenn is describing. […]

A Visual Of Our Healthcare Spending

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[…] This RAND Corporation infographic paints a pretty clear picture of how healthcare costs have increased over the past decade (specifically, the data refers to 1999 – 2009). Healthcare spending nearly doubled in that time frame, from $1.3 trillion to $2.5 trillion, but the second graphic shows how our complicated method of paying for healthcare makes it harder for the average family to see how their own healthcare costs have been impacted. The last graphic in the series shows what the average family could have done with the extra $2880 they would have had in 2009 if healthcare costs had grown during the 2000’s at the same rate they did in the 1990’s (GDP + 1%). Given how cash-strapped a lot of families have been for the past few years, I’m sure an extra three grand could have made a big difference. […]

Anthem Blue Cross Blue Shield’s New Medical Home Program In Colorado

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[…] I can obviously see how this structure can result in lower costs, and I particularly like the fact that it will be paying primary care doctors for “non-visit” services that are not currently reimbursed (the example given in the press release is “preparing care plans for patients with multiple and complex conditions” but I can see how this could be extended to other areas of care and could help to move away from the current ten minute visit + diagnosis + prescription scenario that is so common). But particular care will need to be taken to make sure that the end result is truly healthier patients, as well as lower healthcare costs.

A measure of patient satisfaction could also be beneficial here. This is a tough one though, as patients might tend to have less of a focus on the overall picture (outcome + cost) and more focus on the factors that directly and immediately impact them, such as outcome and convenience. Cost is a factor for patients, but since most of us have health insurance, we tend to be largely insulated from the immediate costs of our healthcare. We get the annual rate increase notification or a letter from our employer saying that our deductible and copays are going up, but most patients probably don’t consider how their own healthcare usage directly impacts the overall “big picture” of healthcare spending (and thus the resulting health insurance premium hikes). But in general, a program that results in an overall improvement in patient health and lower costs should also end up with satisfied patients. Things like more face-time with their primary care doctor (who is being compensated for keeping the patient healthy, not just fixing problems once they occur) ought to improve patients’ overall perception of the care they are receiving. […]

Health Wonk Review – Campaign 2012 Edition

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All of the vote candidates are well qualified and knowledgeable about healthcare, from many different angles.  And they all write quite convincingly.  Some take polar opposite positions, while others lean more toward the center.  I’ll summarize each candidate’s platform, and you can get all the details by clicking on the names.  Once you’re finished, cast your vote for your favorite in the comments.  Be warned, however – you will have a hard time choosing!

Ladies and gentlemen, here are your candidates for Wonkiest Health Wonk 2012:

Anthony Wright‘s camp is taking issue with Rep. Dave Camp’s position that the ACA is the reason for the decrease in the percentage of employers who offer health insurance benefits and the increase in premiums (both trends that were well established long before the ACA was crafted, and as Anthony points out, most of the provisions of the ACA haven’t been implemented yet).  Rep. Camp quoted Wright on his website, and mis-used the words to support his position that the ACA is to blame for the current problems.  Anthony is – quite understandably – unimpressed.

Joe Paduda‘s platform is all about taking aim at Mitt Romney’s enjoyment of firing people – and insurance companies.  Although it sounds nice (and very “free-market-y”) to say that if you don’t like your health insurance company you can just fire them, that isn’t usually the case.  Joe explains how most people have limited options (if any at all) when it comes to their health insurance, particularlySIA2008-1616 if they have any health conditions.  Firing ones health insurance carrier isn’t really a possibility for most of the population.  Joe’s common sense approach should win over a lot of voters.

Gary Schwitzer‘s campaign is focused on calling out half-truths and shoddy journalism.  He cites an example of an ABC News segment that purports to be a journalistic look at a new “lifesaving” technology.  But it might just be blatant self-promotion on the part of the doctor being interviewed.  And even worse, it might convince countless viewers that they need the same high-tech test (along with several others that are mentioned in the story), despite the far less flashy stories about the comparative effectiveness data that indicate that the tests in question aren’t really useful for low-risk individuals.  And that leads to over-utilization of healthcare.  Which leads to increased healthcare spending.  Which leads to higher health insurance premiums.  Which leads to more people […]

Retiree-Only Health Insurance Plans And The ACA

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[…] Sandy’s daughter ended up getting an individual health insurance policy for $143/month. But individual health insurance in Colorado is medically underwritten (and will be for almost two more years until the guaranteed-issue provision of the ACA begins in 2014), which means that she had to be relatively healthy in order to qualify for coverage and/or avoid an underwriting rate increase. The benefit of the ACA rule that allows young adults to remain on their parents’ plan is that there is no need for additional underwriting – the coverage is continuous, regardless of any new medical issues that might have arisen since the plan was originally purchased. This can be very useful for young adults with pre-existing conditions who haven’t yet secured a job that provides guaranteed issue group health insurance coverage.

I don’t know what percentage of the population is covered by retiree-only health plans, but it seems that group might be more likely than others to have children who are young adults. I’m sure Sandy and her husband aren’t the only parents to have found out that the ACA doesn’t apply to their retiree-only health plan. […]

A Brain Teaser Cavalcade Of Risk

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[…] Jaan Sidorov’s article about health insurance exchanges is really good (and I had to read it to figure out the correct answer to the question for his post – it was one of the two I missed). He notes that it’s a bit illogical that so many of us are willing to spend hours comparison shopping for a new TV, but feel put out if we have to spend much time at all comparison shopping for health insurance. And he laments the fact that health insurance exchanges are in their very early days but already are being dismissed by some as too complicated for the average consumer to figure out.

The Elusive Nature Of Healthcare Costs

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[…] I’m still a fan of consumer directed health plans, high deductibles, and HSAs. I think that they can be useful tools to help people keep their health insurance premiums as low as possible and also (if an HSA is involved) set aside pre-tax money to cover potential future medical bills. But they are not a panacea. They are probably not a good solution for anyone who has a chronic illness that needs ongoing, expensive care. They don’t work so well for people with very little money who would struggle to cover the relatively high out-of-pocket costs and would not likely be able to fund an HSA. And no matter how great the actual consumer directed health plans are, the fact remains that transparency with regards to healthcare costs is still quite elusive. For some procedures, it can be relatively easy to get a set figure up front in terms of how much it’s going to cost. But much of the time that number can be difficult or impossible to pin down. Obviously, complications can arise in any medical situation (and the resulting increase in costs would make earlier estimates irrelevant). But even without factoring in complications, “shopping around” for healthcare is often an exercise in futility. In order to make consumer directed health plans more effective, there is much work to be done with regards to cost transparency.

Colorado House Passes Resolution To Repeal ACA

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[…] Although the Republican-led Colorado House passed the measure, Democratic lawmakers were not impressed. They chided the Republicans for wasting time and money on a resolution that isn’t going to end up going anywhere (presumably because of the extremely slim chances of having two thirds of the states pass a similar measure).

Given the fact that the legality of the ACA is going to come before the Supreme Court this year, I agree that the new Colorado resolution seems like a waste of legislative time. The Supreme Court will tell us whether or not the federal government has the right to make health insurance mandatory, and the states that are taking the opposing position on the matter have already joined in a lawsuit to express their position. Hopefully Colorado’s lawmakers will work together from both sides of the aisle and move on to other issues that are facing the state.

Thoughts On The Supreme Court’s Look At The ACA

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[…] Joe’s take on the court battle is that the Supreme Court is unlikely to go against the majority of the lower courts that have ruled in favor of the constitutionality of the individual mandate. And he’s got lots of other well-thought-out opinions on the subject – his post is a must read if you’re interested in the legality of the ACA.

Personally, I’m with Joe on this one. I believe that opting to go without health insurance is in fact opting to self-insure, since the likelihood of people needing no medical care at all is slim. For people who can truly afford to self-insure, there might be an argument to be made in terms of their right to do so (Rush Limbaugh? Maybe. The rest of us who don’t earn $33 million per year? Not so much). But for the majority of the population, being uninsured means that potential healthcare bills – especially the big ones – will be paid by the rest of the population via higher healthcare costs and increased health insurance premiums. There’s no realistic way for hospitals to recoup costs from uninsured patients who have no ability to pay, especially if the bills are significant. And it might be well within the boundaries of the law to require people to not pass that risk off onto other people.[…]

Claims Expenses In New Colorado High Risk Pool Are Double The National Average

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[…] I realize that premiums cover a very small portion of the claims expenses incurred by the high risk pools, so perhaps it’s a better move from a financial standpoint to limit enrollment in the high risk pool. But expanding eligibility and increasing enrollment numbers have been discussed numerous times since the pools started operating in 2010. I haven’t seen any specific details explaining why Colorado’s per-member claims expenses are so much higher than they are in other states with similar programs. It could be that it’s random, but if that’s the case we should expect to see Colorado’s numbers even out with other states as time goes by. If we don’t, we can assume that there’s something specific to Colorado that is causing the difference – either healthcare is far more expensive here, or our federally funded high risk pool is enrolling applicants who are – on average – far sicker than applicants in other states. Once the program has had another year of claims data, it will be interesting to revisit the numbers and see whether Colorado is still spending significantly more than other states, or whether the numbers have started to equalize.

Cavalcade Of Risk In Its Sixth Year And Going Strong

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Political Calculations just hosted their fifth Cavalcade of Risk this week, with their trademark rating system for articles.  Be sure to check it out.  IronMan pointed out that blog carnivals have largely been surpassed by social media platforms when it comes to sharing interesting posts and getting exposure for new blogs – and he gives… Read more about Cavalcade Of Risk In Its Sixth Year And Going Strong

Obesity As A Factor In Healthcare Spending

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[…] I think that the dichotomy remains when it comes to discussions about obesity: on the one hand, we see lots of articles and advice telling us to love our bodies at any size, and on the other hand we have studies like the one that illustrates the cost to public health insurance programs that is directly attributable to obesity.

In addition to asking people to take a more objective look at whether any of their health problems could be related to weight, Maybe lifestyle issues should be more of a priority during doctor visits. I believe that most doctors do at least mention in passing the importance of eating a healthy diet and being physically active, but perhaps they could spend more time on the issue, and make a bigger deal of it. The ad campaign featured in the CHI article indicates that people are poor judges of where they stand when it comes to their own weight. So instead of asking people to just figure it out on their own, maybe it should get more attention as a cornerstone of healthcare interactions between patients and their doctors. This makes particular sense when the patient is suffering from obesity-related diseases or showing precursor symptoms. And since money is a powerful incentive, HHS could provide doctors with information to distribute to patients regarding the additional lifetime healthcare costs one will incur as a result of being obese. As health insurance deductibles continue to climb and patients find themselves responsible for more and more of their healthcare costs, this could be an incentive to focus on a healthy diet and daily physical activity.

Overutilization Of Prescription Drugs

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[…] Half of all Americans take at least one prescription drug. Prescription costs have skyrocketed over the past couple decades. When we got into this industry ten years ago, we saw lots of individual health insurance policies that offered prescriptions with simple copays based on whether the drug was generic or brand name. These days, nearly all of the carriers in Colorado have separate prescription deductibles (our family’s Anthem policy has a separate $2000 deductible for prescriptions), or ever-increasing prescription copays. And a lot of carriers have added a fourth tier to their prescription categories – drugs in that tier are generally quite pricey and patients generally have to pay a percentage of the cost rather than a flat copay.

We owe it to ourselves to seriously consider whether our over-reliance on prescriptions is actually beneficial in the long run, both from a health perspective and a financial one.

The Ineffectiveness Of Asset Testing For Public Health Insurance Eligibility

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Every once in a while, we see a story about someone taking tremendous advantage of public assistance programs. And those stories tend to stick with us. They get repeated and passed along and before we know it, there starts to be a pervasive feeling that such incidents are much more common that they actually are.

In an ironic twist, Colorado Republican lawmakers are calling for the state to return to a system of asset testing for Medicaid recipients… right on the heels of Colorado receiving a $26 million grant from the federal government because of the state’s efforts to expand access to Medicaid and CHIP. Colorado received the grant money last week after increasing Medicaid/CHIP enrollment significantly over the past year. In order to qualify for the grant, the state had to implement at least five of the provisions that are known to improve access to public health insurance for children, and one of those provisions is the “liberalization of asset requirements”. […]

Colorado Gets $26.1 Million Award For Insuring More Children

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For the second year in a row, Colorado has received a significant grant from the federal government (funded under the Children’s Health Insurance Program Reauthorization Act) to help fund the state’s Medicaid system. A year ago, Colorado received $13.7 million. Last week, Colorado got $26.1 million – the third highest amount awarded to any of the states that qualified for the performance bonuses this time around. Colorado was one of the states with an enrollment increase of more than 10%, which qualified for a higher “Tier 2” bonus award. The program awarded a total of over $296 million at the end of 2011, and it was spread across 23 states, as opposed to only 15 that qualified a year earlier.

In order to qualify for a bonus, a state has to implement at least five of the eight provisions that have been proven to increase enrollment and retention numbers for Medicaid and CHIP, and the state has to also prove that they have had a significant increase in the number of children enrolled in Medicaid during the year.
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Prescreen Simplifies CoverColorado Eligibility Process

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[…] If the health insurance carrier issues a denial letter based on the prescreen, that denial letter can be used as proof of eligibility for CoverColorado. The applicant can then proceed with an application for CoverColorado and include the denial letter.

The prescreen is intended to replace the need for an applicant (with one or more of those 21 medical conditions) to submit a complete application to a private carrier in order to receive a letter of decline and thus be eligible for CoverColorado. The prescreen is definitely shorter and easier to complete than a full application.

It should be noted however that all 21 of the medical conditions listed on the prescreen questionnaire are also included on the list of medical conditions that automatically make an applicant eligible for CoverColorado. This list of conditions has long been an option for CoverColorado eligibility, and it is more comprehensive than the new prescreen list (it includes the 21 conditions on the prescreen as well as 13 others). […]

Interesting Reading In The HHS Bulletin On Essential Health Benefits

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[…] I particularly appreciated Jaan’s link to this bulletin about Essential Health Benefits from the Center for Consumer Information and Insurance Oversight. It’s a comprehensive look at how EHB will be defined based on the current proposal from HHS, and it includes a call for public comment between now and the end of January 2012. In reading through the bulletin, I was especially interested in the bottom of page 7. They note that in states that mandate coverage for in-vitro fertilization, the mandate increases average health insurance premiums by about one percent. And in states that mandate coverage for Applied Behavior Analysis (ABA) therapy for autism, that mandate results in average premiums being 0.3% higher than they would be without it.

We’ve written a few times about infertility treatments and health insurance, and it’s always generated a lot of (usually quite polarized) comments. People tend to feel strongly one way or the other, often based on their own experiences or those of friends and family members. People who have had to fork over tens of thousands of dollars to pay for IVF tend to be more sympathetic to the idea that health insurance coverage of fertility treatments would be a good thing. Those who have been able to conceive without medical interventions and those who have no desire to have children tend to balk at the idea of paying higher health insurance premiums to cover fertility treatments for other people. But would knowing that mandates on fertility treatment have only increased premiums by about one percent make a difference in how those people feel? […]

Kaiser Permanente Pays Colorado Adults To Lose Weight And Keep It Off

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Since last April, Kaiser Permanente has been offering cash to Colorado adults who lose weight and keep it off through their Weigh and Win program. Researchers have long known that cash is a powerful incentive, and the Kaiser program utilizes that motivation factor to encourage people to lose weight and establish a healthier lifestyle. Participants are eligible to receive quarterly checks for up to nine consecutive months after their second weigh-in at one of the Weigh and Win kiosks, as long as they continue to lose weight or keep off the weight they lost between their first and second weigh-ins.

The program is available to Colorado adults age 18 and up who have an initial BMI of at least 25. Those with a BMI of less than 25 are eligible to win prizes by completing weekly journals, weighing-in at the kiosks quarterly, and reading emails from the Weigh and Win program, but the cash rewards are only available based on weight loss for participants who start with a BMI of at least 25. […]

Record High Number Of Colorado Residents Enrolled In Medicaid

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This short clip from Colorado Public News is well worth watching. It’s only a few minutes long but highlights the need for Medicaid among families who rely on the program, the controversy surrounding the expansion of Medicaid, and the impact that the recession has had on Medicaid enrollment in Colorado over the past few years.

The video notes that Colorado has experienced a 55% increase in Medicaid enrollment since 2007. This is likely due in large part to the recession, but Colorado has also taken active steps to expand access to public health insurance programs like Medicaid in recent years, and it’s reasonable to assume that this is driving some of the increase in enrollment. […]

Division of Insurance Website Receives Praise From HHS

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A few months ago, I wrote about the new website that the Colorado Division of Insurance has created to improve transparency in the health insurance market. I particularly liked the features of the site that allow consumers to see how the rate filing process works and track a health insurance carrier’s rate increase history. Colorado used money from a $1 million grant from HHS last year (a provision of the PPACA) to create the website, and it’s obvious that the Division of Insurance is taking the goal of transparency seriously.

I’m a bit late to this party, but I just read a news release from the Division of Insurance from back in September noting that the HHS Regional Director, Marguerite Salazar, commended the Colorado Division of Insurance for the website, calling it a “shining example of consumer-friendly and transparent information…” […]

When Advertising Masquerades As Journalism

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[…] The days of news being disseminated once per day via newspapers and a few times a day via morning and evening TV and radio news programs are long gone. News is updated constantly now, and people expect to see brand-new stories every time they go online. There are fewer trained journalists ready to carefully research and write the news stories, and plenty of bloggers and freelance writers who are more than willing to write articles for anyone who will pay them to do so. And not all of those articles disclose the fact that the writer may have been paid for the story by a party that has a vested interest in the story getting out.

On the other hand, medical research is a hot topic. New research is constantly being conducted and not all of it is biased or funded by companies with a conflict of interest. We just have to be careful when we read medical “news”. Check the sources. If the story is about a study, look to see who funded the study. If the story openly promotes a particular product (or hospital, or health insurance policy, or a specific cutting-edge treatment, etc.), it’s wise to question whether the story is actually unbiased, researched medical journalism, or advertising pretending to be news. […]

HHS Allowing States To Define Essential Benefits In The Exchanges

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[…] Colorado already has a comprehensive small group benefits mandate. Until this year, one of the most glaring differences between small group and individual plans was that individual policies in Colorado were not required to cover maternity. But that changed in January when all new and renewing individual policies had to begin covering maternity. I would say that the primary difference now between most of the individual plans and small group plans in Colorado is that the small group policies are guaranteed issue, whereas the individual plans are medically underwritten. But in 2014, when the exchanges get underway, the individual policies will be guaranteed issue too. Individual policies are still quite a bit less expensive than group policies in Colorado, but I wonder if that will change too once the exchanges get underway? It would seem so, since the benefits and underwriting will be virtually identical.

The small group market in Colorado is already quite structured by state mandates. The individual market also has quite a few mandates, including the new maternity benefit mandate. But it appears that the individual policies that are sold in the exchanges beginning in 2014 will have benefits at least as comprehensive as the benefits offered by the largest small group plans in Colorado. That means that “bottom of the heap” individual plans (ie, the ones with tons of fine print and huge holes in their coverage) probably won’t be making an appearance in the exchange, or at least not without a serious overhaul. […]

Colorado Child-Only Open Enrollment Details For January 2012

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The next open enrollment for child-only policies is almost here, so I thought it might be helpful to provide some specific details in terms of what policies are available and what parents should expect when submitting child-only applications next month.

The first open enrollment window in 2012 will be the month of January. Applications for child-only policies have to be submitted between January 1 and January 31. Application not submitted by the end of January will have to wait and re-submit in July, which is the second open-enrollment period of the year. For most carriers, each child in a family will have to have a separate application.

All eligible child-only applications submitted during the open enrollment period are guaranteed issue, so the child cannot be refused coverage. However, the applications are still medically underwritten and the rate can be increased by up to 200% based on the child’s medical history (so if the standard price is $100, the policy could actually be assigned a rate of $300, which is equal to a 200% rate increase).

Colorado Senate Bill 128 requires all Colorado health insurance carriers that offer coverage for adults to also offer child-only plans during the two annual open enrollment windows. But the bill does not require carriers to provide guaranteed issue coverage for children who are eligible for health insurance from another source (other than a high risk pool like CoverColorado or GettingUSCovered – see the bottom of page 4).

Most Colorado carriers have selected one or two plan designs that will be available for child-only applications next month. To give you an idea of what is available in Colorado for child-only coverage, we’re providing information here regarding child-only options from six of the top individual health insurance carriers in the state. […]

Access To A Mini-Med Group Plan Does Not Prevent CoverColorado Enrollment

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[…] The person I spoke with at CoverColorado checked with a supervisor and then told me that mini-meds are an exception to CoverColorado’s rule banning eligibility for people who have access to group health insurance. In order to qualify, the applicant has to provide the usual proof of eligibility along with proof that their employer’s group health plan is a mini-med. This can be the declarations page from the policy or marketing materials for the plan (which now have to include language indicating that the plan has been granted a waiver by HHS and does not meet the minimum benefit requirements defined by the PPACA).

Hopefully this will clarify things for others in a similar situation. Normally, access to a group health insurance policy (even if it’s one you don’t like or your doctor isn’t on the network, etc.) makes a person ineligible for CoverColorado. But if that group plan happens to be a mini-med and you also meet the other eligibility criteria for CoverColorado, you can submit an application to CoverColorado.