[…] Denying arbitrary “non-emergent” ED claims for Medicaid patients doesn’t seem like a way to actually reduce ED overutilization. Instead, it seems like a way to cut Medicaid costs by increasing the number of unpaid claims that EDs have to write off each year. In order to cover their costs, hospitals will have to further increase prices for privately insured patients. That in turn causes health insurance premium hikes, which leads to calls for negotiations to artificially lower premiums. Where does it end?
Blog
A Good Trend In Medicare Spending
[…] She specifically addresses Medicare costs, but it stands to reason that the same cost-saving strategies and paradigm shifts will also help to lower healthcare costs that are being reimbursed by private health insurance carriers. Not only do private carriers tend to follow Medicare’s lead, but the focus on value over volume from a provider perspective will benefit everyone, as it’s unlikely to be applied only to Medicare patients.
Negotiating Premiums Doesn’t Lower The Cost Of Healthcare
[…] How would it help to have health insurance exchange boards negotiating with health insurance carriers to try to lower premiums – without addressing the root problem, which is the ever-increasing cost of healthcare? […] Much of the focus of the healthcare reform rhetoric has been on health insurance (availability, premiums, etc.), and some important issues have been addressed in the process. But we cannot continue to focus primarily on the cost of health insurance (or try to artificially lower it) without reducing the cost of healthcare.
Decline And Rate Up Statistics – Interesting But Confusing
[…] Your policy will cost the same amount regardless of whether you use a broker, but an experienced broker will be able to help you make sense of the plan comparison information, including the underwriting statistics. A policy or carrier’s statistical likelihood of declining or rating up any one application isn’t really relevant to each specific client… what is relevant however, is each carrier’s underwriting guidelines for the particular pre-existing condition the applicant has. […]
Runaway Health Care Spending, But Do Families Really Earn Nearly $100K?
[…] Although I’m a bit perplexed by the $99,000 median household income figure cited in the Rand study, I think that the gist of the study – basically the fact that health care is eating up a huge portion of family and government income in America – is important for people to understand. We can’t tackle a problem without first knowing what the problem is. And one of the obstacles in the way of curtailing health care costs in the US is that our current system is so convoluted and complex that it’s nearly impossible to see all the areas where health care spending is impacting us – at the federal, state, and household levels.
Colorado DOI Improving Transparency Of Rate Review Process
[…] This should help boost public participation in the rate review discussion, and add to the general understanding of how the rate review process works. The DOI is obviously working hard to create as much transparency as possible with regards to rate increases. Rates will continue to increase as long as the cost of health care continues to climb (and as long as we continue to increase our utilization of health care) but at least the logic behind the rate increases will be more clear.
Low Enrollment And Adverse Selection In High Risk Pools
[…]CoverColorado – the high risk pool that Colorado has had in place since the early 90s – instead allows eligible applicants to enroll as soon as they are without another coverage option, but makes them wait to receive coverage for pre-existing conditions if they have been uninsured prior to applying. That system encourages people to sign up as soon as they are eligible rather than waiting until they need care. It would seem that the federally-funded high risk pools might be able to boost their enrollment and also avoid adverse selection by switching to a similar eligibility model.
ACOs in the Health Wonk News
my favorites had to do with accountable care organizations (ACOs). Much like health insurance exchanges, ACOs are a bit of a buzz word these days, but are often misunderstood. Of course things like that tend to lend themselves well to consulting gigs, and Paul Hsieh of Pajamas Media points out that the initial phases of development and implementation of ACOs has already created a consulting niche that is raking in huge amounts of money from hospitals and doctors who want to figure out the best way to design their ACOs. $25,000 a day for […]
Federal Requirements For State Exchanges
[…] The guidelines that HHS set forth were designed to make sure that state-specific exchanges meet basic minimum standards, while still allowing the states to accomplish many of those standards however they see fit. And although some would criticize HHS for being too restrictive, others have said that the agency did all they could to keep things as simple and flexible as possible. […]
Health Insurance For Everyone Is Just The Beginning
[…] Insuring the entire population isn’t going to solve all of our healthcare woes. For starters, even with health insurance, healthcare can still be unaffordable. And even if we were to make health insurance more comprehensive than it is now, with lower out-of-pocket costs (not likely, as the trend over the last decade has been towards higher out-of-pocket costs in order to keep premiums from increasing even faster than they already do), there would still be more than one in five people without realistic access to care – for reasons that aren’t directly related to paying for care. […]
COBRA Subsidies Coming To An End
[…] The subsidy program was extended to help people who were involuntarily terminated on or before May 31, 2010, and allowed them to receive up to 15 months of COBRA premium assistance. For most people who qualified for the subsidies, the 15 months has already ended. But for the last people who qualified – those who were laid off in the final days of May, 2010 – the 15 months of premium assistance will come to an end next week. […]
Balancing Interests In The Colorado Health Insurance Exchange
[…] The Colorado exchange has received some early criticism based on the make-up of the board, as several board members have ties – direct and indirect – to the health insurance industry. I’ve noted that my own opinion is that it would tough to implement a successful exchange without the knowledge of the health insurance industry that those board members bring to the table. But I think that the board’s election of Hammer to lead them does help to balance things out and make sure that the consumer voice is heard alongside that of the health insurance industry. […]
Thoughts On Direct-Pay PCPs
[…] Those are a few of the thoughts that come to mind when I think about direct-pay medical care. I can see pros and cons to the idea, and I’m sure that there are many PCPs who would love the chance to focus more on medicine and less on administration/payer issues. But I think that most PCPs also want to make sure that everyone – regardless of financial status – has realistic access to medical care. And I’m just not sure that would be the case if more PCPs started pulling out of the health insurance networks – especially the networks that serve low income populations.
Seeking Certainty
[…] And finally, if the Supreme Court is going to hand down a ruling like the one we got from the Appeals Court last week, we need to know that as soon as possible too. If the individual mandate does indeed end up being tossed out, the health care reform law will need an awful lot of compromises and revisions in order to make it tenable. Perhaps I’m being overly pessimistic, but given the level of compromise we’ve seen from the political system over the last decade or so, I have a hard time seeing how the PPACA could go on with one of its major provisions deleted. […]
Standardized Policy Descriptions Coming Soon
The Colorado Health Plan Description Form isn’t exactly the same as the forms that HHS will require carriers to make available next year, but it’s similar in many ways, and carriers in Colorado have been issuing these standardized plan summaries for nearly 14 years. As well as outlining the coverage provided, the new forms will include “coverage examples” that will show potential customers how the plan would cover three common medical scenarios: breast cancer, maternity care, and diabetes. […]
August Open Enrollment Period For Child Only Policies In Colorado
For parents looking for child-only policies in Colorado, we are in the middle of the 2011 open enrollment period, which will end August 31st. All carriers that offer individual health insurance policies for adults must also offer (during open enrollment periods only) at least one plan option for a child applying without an adult on the policy. This is pursuant to Colorado Senate Bill 128, which was signed into law earlier this year. Following the passage of SB128, the Colorado Division of Insurance stepped in to clarify the issue with emergency regulation E-11-03, which has specific details about the implementation of the law. […]
Healthcare Topics In The Cavalcade Of Risk
[…] Some lawmakers have proposed making people pay higher deductibles or doing away with first-dollar coverage on Medigap policies, with the idea being that if people have more of their own money on the table, they would be less likely to over-utilize non-essential healthcare. The problem, of course, is that seniors who are already struggling to pay for healthcare would be more likely to skip necessary care if they had to come up with additional money to pay for it. […]
More On Health Insurance Exchanges
[…] We need exchanges that are easy to navigate, accessible for people who are not fluent in English, and that provide seamless access to the subsidies that the PPACA provides to help people afford health insurance. I’ve already pointed out that we’re going to have to walk a fine line in terms of keeping things fair for both insureds and insurers, in order to attract as many enrollees and high quality insurers as possible to the exchanges. […]
The Challenge Of Creating Unbiased Health Insurance Exchanges
[…] In order to attract high-quality health insurance carriers to the exchanges, we have to make sure that the exchanges represent a business environment that is appealing to carriers. We also have to make their appealing and fair to consumers, in order to attract enough people into the exchanges. To work well, the exchanges will need to have a delicate balance between the interests of consumers, providers, and health insurer carriers, with no one group more heavily favored than another.
HHS Guidelines For Women’s Healthcare
HHS today announced new PPACA guidelines pertaining to women’s health, listing several services that must be covered by health insurance plans with no cost sharing by the insured. In scrolling through healthcare news this morning, I saw numerous headlines stating that birth control and breast pumps must be covered by health insurance with no copays. This is true, but the requirements don’t take effect for another year (August 1, 2012) and will apply to new policies that begin on or after that date. […]
Comparison Shopping For Health Insurance
[…] But in terms of being a comparison-shopping website for health insurance, I’m struck by how much that sounds like the service we’ve been offering our clients for years. The exchanges will function mostly online, which was a transition we made back in 2003 when we established our website and started working with carriers to get online applications for our clients. We realized soon after getting into the health insurance industry that there is no one-size-fits-all when it comes to health insurance, and that it didn’t make sense to only represent one or two carriers. […]
A Good Summary Of The HHS Proposed Regulations For Exchanges
[…] The proposed regulations from HHS for the exchanges come to 244 pages, but Timothy notes that they are “practical, sensible, and functional” and that HHS tried to simplify things wherever possible, rather than complicate them. For anyone who wants to get the gist of the proposed regulations without reading the 244 pages that HHS released this month, I highly recommend that you check out Timothy’s article. […]
Employer Funding of Individual Health Insurance – The Rules Are Changing
[…] Because of the new law, employers can now use wage adjustments to reimburse employees for individual policies (as long as they haven’t had a group policy in the past twelve months), which wasn’t allowed at all in the past. But the use of HRAs to fund individual policies can now only be done if the employer hasn’t had a group policy in the past twelve months, and that restriction wasn’t found in the DOI final agency order regarding HRAs. […]
One Size Does Not Fit All
[…] A person with a set amount of money that can be devoted to life insurance premiums will be able to purchase significantly more face value if she goes with term coverage. But the insurance will be in place for the rest of her life if she goes with permanent coverage (assuming she doesn’t cancel it). There’s no one-size-fits-all answer to whether term or permanent life insurance is a better option, and it depends largely on the person’s budget, face value needs, and long term planning. […]
Grand Rounds – It’s All About Personal Responsibility
[…] Even when people really need a major wake-up call (their life literally depends on it), doctors feel like they have to tread very softly in order to avoid hurting feelings. And there’s also the problem of time: most providers have so many patients to see in a day that they don’t have time to have in-depth conversations about lifestyle choices. The growing shortage of primary care docs (especially after 2014 when millions of previously uninsured Americans will have health insurance and will be looking for a doctor) isn’t likely to help that problem.