One of the most common questions lately: I was declined for health insurance due to a pre-existing health condition. I thought insurance companies couldn’t look at our pre-existing health conditions anymore because of [the PPACA] ObamaCare?”
Health Care Reform
Will Tax Credits Be Available In Federally-Run Exchanges?
[…] Both arguments are interesting, and very convincing. I read Jost’s first, and found myself nodding in agreement all the way through. But then when I read Cannon and Adler’s response, I also found their points to be compelling and hard to refute. This could be the sort of issue that many people would see as splitting hairs, but on an issue as contentious as the PPACA, I can see this debate getting quite a bit of traction over the next year as the exchange implementation process churns along. And it makes me glad that Colorado took the initiative early on (despite a lot of political wrangling) to begin the process of creating our own exchange. I know there are many flaws in the PPACA, and that the yet-unanswered question about how the exchanges will be funded starting in 2015 is a valid concern. But it still seems like a better solution than sitting back and waiting for the federal government to set up an exchange for us that 1) would not be tailored to our state’s specific needs and 2) might make Colorado residents ineligible for much-needed tax credits to help pay for health insurance.
Colorado Health Benefits Exchange Allowed To Submit Grant Application – But It’s Still Controversial
[…] But Lundberg’s concerns are still quite valid. The problem of long-term funding – and the question of how many people will utilize the exchange – is something that will have to be solved in order to keep the exchange functional after the federal money is used up. There was a big push to create high risk pool health insurance programs in all 50 states as soon as the ink dried on the PPACA (no doubt this was a very good thing for people in states that previously had no high risk pool option at all), but enrollment was a lot slower than expected. The exchange has to be prepared for enrollment numbers that may be lower (or higher?) than anticipated, and make sure that financially the exchange is able to sustain itself regardless of the level of initial participation.
Although the long-term funding question is unresolved at this point, it would seem that the only viable option is to move ahead with the creation of the exchange. They have less than 18 months now to get everything ready to go for January 1, 2014, and it makes sense that the funding problem has to be worked out in tandem with all of the other administrative questions. If they try to fix the funding issues first, they may not be able to get everything else done in the time they have left. If the federal government is giving out grants to states working on setting up their own exchanges, it seems to be in Colorado’s best interest to take advantage of that and at least submit an application for the grant money.
Success In Reducing Overutilization Of Medical Imaging
[…] Similar strategies – that utilize a variety of tactics introduced together – could likely be helpful in reducing healthcare spending in other areas, like pharmaceuticals for example. Health insurance carriers could be involved in the solution (with more prior authorizations or computer systems that prompt doctors to always start with the lowest-cost drug and then work up, etc.) but with buy-in and cooperation from medical providers, the public and the pharmaceutical industry itself, the impact would likely be far more impressive.
Colorado Health Insurance CO-OP Receives Loan From HHS
At the end of July, the first of Colorado’s health insurance CO-OP plans got a $69 million loan from HHS as part of a push by the ACA to develop consumer-owned-and-operated health insurance plans (“CO-OP” is short for Consumer Oriented and Operated Plans). The CO-OP is sponsored by Rocky Mountain Farmers Union and the bulk of the loan from HHS will be put in reserve to fund claims expenses for initial enrollees. As premium dollars are collected, the loan will be paid back to HHS.
Colorado Senator Irene Aguilar introduced a bill last year to create a state-wide Colorado health insurance co-op, but the bill was tabled in May 2011 after passing its second reading in the Senate.
The new CO-OP being created with the loan money will be especially focused on rural areas of Colorado – which are generally underserved in terms of health insurance options. In addition, residents in rural areas are often already familiar with the concept of co-ops for other services like utilities. So a Colorado health insurance plan that is owned and operated by its members should be an especially good fit.
The CO-OP will begin marketing plans next fall with policy effective dates starting January 1, 2014, and is hoping to enroll 10,000 Colorado residents in its first year. Unlike most commercial health insurance plans available in Colorado, the CO-OP will be able to direct profits back into the plan in the form of lower premiums and/or higher quality service rather than sending profits to shareholders. And while most health insurance carriers that do business in Colorado are multi-state organizations, the CO-OP will be a local plan based here in Colorado (Rocky Mountain Health Plans is another example of a local, non-profit health insurance option for people in Colorado).
The CO-OP expects to be available both through the Colorado Health Benefits Exchange (aka “the exchange”) and also via independent health insurance brokers and agents. An innovative new health insurance product – especially one that strives to serve populations that are underserved by our current health insurance industry – is good news for Colorado, as it should foster more competition among the existing health insurance carriers in the market. Congratulations to Rocky Mountain Farmers Union for the approval from HHS for the loan to get the CO-OP going!
Colorado Hospital Payment Assistance Act Takes Effect Next Week
[…] To sum up the new law, hospitals will be required to charge uninsured patients earning less than 250% of FPL (and who are not covered by the Colorado Indigent Care Program) no more than the lowest negotiated price the hospital has with a private health insurance carrier. In addition, hospitals will have to clearly post their financial assistance, charity care and payment plan information so that patients will be aware of the financial options that are available.
In an article I wrote last week about the shooting victims in Aurora, I noted that although highly publicized tragedies tend to generate a lot of financial support (and in this case some of the hospitals treating the victims have offered to waive charges), there are many other people suffering from all sorts of injuries and illnesses whose cases do not receive media attention and who are crippled by the cost of their care. The Hospital Payment Assistance Program will hopefully provide some measure of relief for uninsured Coloradans who find themselves in need of hospital care in the future.
Healthcare Reform Progress In Colorado
[…] 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.
Does GSK Case Show A Need For Profit And Admin Caps In the Rest Of the Healthcare Industry?
[…] 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.
Special Edition Health Wonk Review – SCOTUS And The PPACA
[…] 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
[…] 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
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.
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 other
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 […]
SCOTUS Lead-Up Health Wonk Review, And The Free Market Nature Of The ACA
[…] 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
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?
[…] 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
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
[…] 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.
Healthcare Reform After The Supreme Court Rules
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.
Governor Hickenlooper Says Reform Can Succeed Without An Individual Mandate
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. […]
How Individual Health Insurance Measures Up
[…] 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
[…] 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?). […]
Medical Underwriting Makes Individual Health Insurance Much Less Expensive Than Group Coverage
[…] But although there are differences between group and individual coverage that can account for some of the price variation, by far the biggest factor is medical underwriting. The Zane Benefits article points out that 80% of healthcare costs come from 20% of the population – individuals with serious, ongoing health conditions. Group health insurance is required to accept all eligible employees, but individual health insurance carriers use medical underwriting to eliminate the sickest applicants from the pool of insured members (70 % – 90% of applicants in the individual market are accepted and offered a policy – there is quite a bit of variation in underwriting guidelines from one carrier to another and from one state to another). This mean that individual policies are covering people who are generally healthier than the average of the entire population. And that translates to lower healthcare costs in the individual market. […]
Too Big To Fail?
[…] Given the large market share that some hospital systems and health insurance carriers have in other states, I wonder if those organizations might already be “too big to fail”, even before ACOs come into the picture? Would the financial collapse of one of those systems be too much of a destabilizing factor and require a government bailout in order to protect the communities served by the healthcare organizations?
So far, we haven’t seen such a scenario. In general, when a healthcare organization leaves the market, it is bought out by another organization that is more financially sound (for example, Celtic agreed to take over World and American Republic’s insureds last year when those companies left the market). This happens quite often with hospitals and small-ish health insurance carriers. But the titans of the financial industry that had to be bailed out in 2008 were not the “small-ish” banks – they were huge organizations that everyone thought were very sound. If something like that were to happen to healthcare organizations – either insurers or large hospital systems – would a bailout be necessary in order to stabilize the healthcare system?
I assume that ACOs are being crafted with a bit more care and transparency than what went into CDOs. And hopefully the lessons learned in the financial markets crisis will be well-remembered as healthcare market overhauls are created.
Details From Anthem On Preventive Care And Contraceptive Coverage
Last week we added a post about contraceptive coverage under the PPACA and what changes people could expect to see starting in August. We just received an information sheet regarding this subject from Anthem Blue Cross Blue Shield, and wanted to share it with our readers. It will be useful for our Anthem clients, and is also helpful to give people a rough idea of how the contraceptive coverage will be implemented by most carriers. There may be some small variations from one carrier to another, but in most cases things will be similar across the board, since federal legislation is guiding the changes.
The Anthem preventive care info sheet is relevant in Colorado and nine other states where Anthem operates Blue Cross Blue Shield plans, and applies to individual health insurance as well as small and large group plans.
The Anthem info sheet specifically notes that sterilization procedures for men are not included in the new contraceptive coverage – which is the conclusion I came to last week after quite a bit of reading on the subject – since all of the guidelines apply to adding contraceptive coverage to preventive care for women rather than preventive care in general. […]
Contraceptive Coverage And The PPACA
[…] Anyway, assuming that we’re talking about contraceptives for women, new health insurance policies – except those that are exempt based on religious reasons – will cover contraception with no copays or deductibles. Non-grandfathered plans (grandfathered means that the policy was in effect prior to the PPACA being signed into law and that the plan has not made any significant changes since then) will have to start covering contraceptives as of each plan’s renewal date. This is similar to how the state maternity mandate worked in Colorado last year. New policies had to start covering maternity on January 1, 2011. But existing policies added it throughout the year as each plan renewed (for example, my family’s health insurance plan renews each year in November, so our maternity coverage didn’t begin until November 2011). This brief from the Kaiser Family Foundation website has a lot of good information regarding contraceptive coverage and should help to clarify the issue a bit. […]
Despite IT Problems, Report Gives Colorado High Marks On Exchange Progress
[…] On the upside, the Urban Institute report gives Colorado props for making good overall progress on setting up the health benefits exchange. Despite the political hot seat that health care reform has been for the past few years, Colorado lawmakers managed to work together to create the framework for our health benefits exchange last year. We have a board of directors in place and the state is moving forward as fast as possible to get things in place for the exchange to be up and running in 2014. A lot is still unknown with regards to the future of the ACA, since the Supreme Court still has to issue their ruling in June regarding the legality of the individual mandate. But if the ACA remains in place and the health insurance exchanges become reality across the country, it’s safe to say that Colorado will be ahead of the curve in terms of getting the bugs ironed out.
The Urban Institute report notes that Colorado had a head start on a lot of the reform issues thanks to the 2008 Blue Ribbon Commission Report. Remember back when that was the big news in health care reform in Colorado? Before health care reform became such a divisive topic across the country, Colorado was working to come up with solutions to many of the problems with our health care system. Some of the recommendations of the Blue Ribbon Commission are very similar to the new guidelines in the ACA, and Colorado had been taking active steps for the past four years to implement the Blue Ribbon recommendations. If the ACA remains in place, it should be a bit easier for Colorado to make the necessary transitions over the next few years, thanks to the progress the state has already made on its own.