Colorado Health Insurance Insider

No-cost broker assistance.

You are here: Home / Archives for Health Care Reform

Health Care Reform

A Possible Alternative To The Individual Mandate

By

[…] Guaranteed-issue health insurance is expensive. When it’s enacted without a mandate requiring people to buy it, the premiums can become out of reach very quickly. In Colorado, group health insurance (all eligible employees are guaranteed enrollment, regardless of medical history) is significantly more expensive than individual health insurance (medical underwriting applies until 2014 when the guaranteed issue provisions of the ACA kick in). But since employers usually pay at least a chunk of the premiums, people aren’t generally aware of the full cost of group health insurance. In the individual market, that cost will be more transparent (subsidies – also created by the ACA – will be a significant help for a lot of families).

Any way you look at it, the claims expenses will be high once all health insurance is guaranteed issue. I would assume that individual health insurance premiums will start to look more like group premiums as the years go by. The goal of increasing premiums for late enrollees should be three-fold: To make the practice of waiting to purchase health insurance until one is sick seem less attractive; to make sure that there are enough total premium dollars collected to pay for the total claims submitted; and to make things as fair as possible for people who opt to have health insurance all the time, even when they’re perfectly healthy. Those people should not be paying the lion’s share of the total premiums.

I agree with Jason that if this model were used, it should be up to the carriers – with regulatory oversight – to set the premium adjustments rather than having the government set the prices. But I think that if we use this model to try to accomplish all three of those goals I outlined, the premium adjustments for late enrollees would have to be pretty significant.

Colorado Expands Access to Medicaid For Adults With A Lottery System

By

[…] Unfortunately, the eligibility guidelines will eliminate all but the very lowest income people. In order to qualify, an applicant has to have an income of no more than 10% of the Federal Poverty Level – that amounts to $90 a month for a single person or $125/month for a married couple. As low as those numbers are, officials estimate that there are 50,000 adults in Colorado who would qualify based on those income requirements. And the Medicaid program only has room to enroll 10,000 of them – hence the lottery system.

I have to wonder what percentage of those 50,000 people will submit applications though? Back when the ACA created high risk pool health insurance programs in every state, they predicted that up to 375,000 people might enroll in 2010 alone. But as of early 2012, the high risk pools had actually enrolled about 50,000 people. Obviously cost is an issue – the high risk pools have significant premiums that may be out of reach for a lot of uninsured people, and that shouldn’t be a factor for the Medicaid expansion program. But there’s still the problem of getting information out to the people who might qualify, and getting them to submit applications – especially if they know that submitting an application is no guarantee of coverage, since the program is going to use a lottery to select 10,000 people to enroll.

Even though the income requirements are extremely low and the program only has the means to insure 20% of the eligible population, this is another step that Colorado is taking to try to insure more people. We’re slowing making progress there, due largely to the state’s efforts to expand access to public health insurance programs. We have a long way to go (currently ranked 24th out of 50 states for the percentage of our population that’s uninsured) but small changes like this one are better than no change at all.

Health Wonk Bloggers Think The Supreme Court Will Rule In Favor Of The ACA

By

[…] When I browsed around on most of the mainstream media regarding the Supreme Court and the ACA, I kept seeing predictions that the Court will ultimately find the individual mandate unconstitutional and either strike down that part of the law or return the whole ACA back to congress for a re-do (based on perceived negativity towards the law on the part of the Justices). But interestingly enough, all three blog posts in the HWR that dealt with this issue had the opposite opinion (and of course, at this point, all we can do is speculate and have opinions – nobody really knows how the Court will rule). They all take the position that the court is likely to rule in favor of the ACA and the individual mandate, or at least that the reports saying that the mandate is doomed are greatly exaggerated.

Sage’s article also notes that the Justices seem to be well aware of the problem of adverse selection (an issue that we’ve written about numerous times – guaranteed issue without a mandate either results in significant adverse selection or exorbitant health insurance premiums and few options for coverage). This is one of the major concerns that arises if we talk about doing away with the individual mandate, so it’s good that the Supreme Court is taking it into consideration (Sage notes that the lower courts didn’t seem to do so).

Now we just have to wait three months to see who’s right.

Semantics In The Supreme Court Healthcare Arguments

By

[…] Although a lot of Americans have a problem with the idea of the government telling them they have to purchase a product like health insurance (and of course, there is concern that such a precedent could pave the way for other mandates that we haven’t thought of yet), the problem of providing unreimbursed healthcare for uninsured patients is a very real issue for providers. And unfortunately, the end result is that hospital overhead is higher (to cover the unreimbursed care) and those higher charges end up being passed on to health insurance carriers. Which means that health insurance premiums increase to cover the higher claims expenses. There is no “free” care. For all but the most wealthy among us, “self-insuring” really just means relying on luck. And luck doesn’t usually hold out forever.

Few Changes For Colorado’s Health Report Card, But Obesity Rises To 22%

By

Since 2006, the Colorado Health Foundation has been grading the state on a variety of health-related measures reported on the Colorado Health Report Card each year. The 2011 report card was just released this week. The overall rankings haven’t changed much over the past couple years. The 2009 report card looks very similar to the 2011 version. The Healthy Children score rose from a D+ two years ago to a C- now. But the Healthy Aging score slipped from a B+ on the 2009 report card to a B in 2011 (after improving to an A- in 2010). The other three categories were unchanged from their results two years ago. […]

Another Perspective On Healthcare Spending In The US

By

When the values are graphed, the US appears to be a significant outlier. Our per-capita GDP does put us near the top of the scale, but our per-capita healthcare spending is dramatically higher (to the tune of more than 50% higher) than any of the other countries, even those that have a similar or higher GDP.

Jaan lets out his inner economist in this post, and provides interesting reasoning to explain the US position on the per-capita GDP/healthcare spending graph. His discussion about our wealth inequality may be a key factor. One would otherwise expect Luxembourg and Norway (with per capita GDP higher than or equal to the US) to have healthcare spending that is similar to that of the US. But since our healthcare spending is tallied on the per-person basis, our wealth inequality might make the average spending data appear skewed.

In addition to comparing our healthcare spending to religious tithing (where one is expected to give 10% of ones income to the church), Jaan notes that our willingness to spend more on our healthcare “doesn’t mean that we’re getting our money’s worth…”

Colorado AG Will Have A Seat In Supreme Court Chambers For ACA Arguments

By

Soon after the ACA was signed into law in 2010, Colorado’s Attorney General John Suthers joined with AGs from around the country (26 states in all) to file a lawsuit challenging the legality of the individual mandate. It was particularly interesting in Colorado because there were only a handful of states where the governor and the AG disagreed about the legality of the individual mandate – Colorado was one of them.

The fight over the constitutionality of the ACA has been winding through the court system for the last two years, and has predictably made its way to the Supreme Court. The Supreme Court will hear oral arguments for and against the ACA next week. The 26 AGs who filed the lawsuit challenging the ACA requested that all of them be allowed to sit in on the arguments, but the Supreme Court granted them six seats instead. John Suthers is one of the six AGs who will be allowed to sit in the Supreme Court chambers next week to hear the ACA arguments.

The Supreme Court schedule for the oral arguments includes 90 minutes on Monday, March 26th to discuss whether to throw out the challenges to the ACA on a technicality. Then on Tuesday, they’re planning a two-hour session where the federal government and the plaintiffs can present their arguments for and against the legality of the individual mandate. Then on Wednesday, the court will be hearing arguments for 90 minutes regarding whether the rest of the ACA could […]

Will Healthcare IT Lead To Lower Healthcare Costs?

By

[…] My guess is that increased HIT will eventually (after the hiccups and bugs are worked out) result in more efficient care, better coordination of care between multiple doctors, fewer medical errors, and more streamlined health insurance claim processing. After reading the articles by McCormick et al and Mostashari, I think it’s clear that there’s some controversy in terms of whether HIT will lead to lower costs. I do think that HIT is coming one way or the other. It’s 2012. Most Americans are walking around with a touch screen mini computer in their pockets. We expect lightening fast internet connections and instant access to virtually any data we can think of. HIT will have to keep up, simply because technology keeps improving and it has to follow suit. But we’d be wise to carefully consider empirical data as much as possible in order to implement systems that have the best chance of success in terms of improving care and also lowering costs.

Lack Of Public Understanding About Healthcare Reform Law

By

This article from Public News Service highlights some of the hurdles the ACA faces in terms of public opinion. An attorney with the Colorado Center on Law and Policy notes that more than 50% of consumers think that the healthcare reform law is creating a new government-run health insurance policy. Given the general unpopularity of government-run programs in general, it’s not surprising that the healthcare reform law has struggled in the court of popular opinion. The public tends to be quite wary of new government programs, especially before they’re in place. Once they’re up and running – like Medicare for example -they sometimes get a bit more popular. But proposing a new government program is generally a good way to get people fired up.

If you’ve been paying attention to the mundane details of the ACA, you know that there’s no new government-run health insurance plan. The public option got nixed from the healthcare reform strategy right from the beginning. The law does expand some of our public health programs that already exist (like Medicaid and CHIP). It seeks to insure most of the currently uninsured population via increased enrollment in private health insurance plans and expanded access to public health insurance. The individual mandate and guaranteed issue individual health insurance will hopefully result in far fewer people without health insurance. In addition, the provision that allows young people to remain on their parents’ health insurance through age 26 is helping to cut down on the number of young Americans without health insurance. […]

Will The Colorado Health Benefits Exchange Be Integrated With Public Assistance Programs?

By

[…] Last summer, lawmakers in Colorado were concerned that federal requirements that visitors to the exchanges be screened for eligibility for Medicaid, CHIP and federal health insurance subsidies would increase enrollment in Colorado’s safety-net health insurance programs. Given the budget woes that those programs have had, the lawmakers were hesitant to make the exchange a “one stop shop” for public assistance programs. But much has also been said about the importance of integrating the exchanges with public benefits programs in order to close the gaps that people can fall into if their incomes fluctuate between eligibility for federal health insurance subsidies and eligibility for Medicaid. This proposal calls for the exchange and the public benefits programs to be interoperable as of January 1, 2014 and integrated as of December 15, 2015. For the sake of simplicity and protecting the needs of low-income families, it seems that the more seamless we can make the health insurance enrollment process (particularly for those who go back and forth between Medicaid and private health insurance), the better.

It will be interesting to see how the separate/interoperable/integrated scenarios for the health benefits exchange and Colorado’s public assistance programs play out over the next couple years as the exchange is created and implemented.

Preauthorizations And Legal-eze: Why Health Insurers Have To Use Them

By

[…] Starting in 2014, health insurance will be guaranteed issue and all of us will be required to have coverage. But until then, individual health insurance is priced based on medical underwriting and (in most cases) slightly less comprehensive benefits than group policies. That’s why it’s less expensive to have an individual policy than a group policy or a guaranteed issue policy like CoverColorado. If health insurance carriers (both individual and group) don’t go over their claims closely and utilize preauthorizations, they run the risk of being defrauded – which will only drive premiums higher than they already are. If they don’t use the specific legal-eze required by state regulations, they will run afoul of the Division of Insurance.

There are plenty of examples of health insurance carriers using unfair or deceptive practices. We’re lucky in Colorado to have a strong Division of Insurance that works hard to protect consumers. Regulations that protect patients and insureds from unfair business practices are largely beneficial (and tend to weed out the shady insurance carriers). But Jaan’s article highlights the fact that health insurance carriers also have to protect themselves. If they don’t, they will end up with premiums that are far higher than the rest of their competition – and that isn’t sustainable.

Too Much Paperwork

By

[…] I don’t know what the solution is here. On the one hand, we need regulation. We know that without it, there are way too many cracks into which all sorts of things can fall. And regulation is meaningless without having a way to objectively measure compliance and progress. But when we reach the point where doctors feel that they’re spending more of their time doing clerical work (eg, filling out compliance paperwork, documenting everything for their lawyers and for their patients’ health insurance carriers, etc.) than interacting with patients, perhaps it’s time to re-evaluate.

This is especially important as the ACA rolls out over the next few years. One of the goals is to make healthcare more efficient. But if we inadvertently end up bogging down the healthcare professionals in a sea of red tape and bureaucracy, efficiency is likely to decline. Hopefully doctors and nurses and other healthcare professionals – who work in the healthcare field on a daily basis – can be consulted to provide input on how best to measure compliance with well-intentioned regulatory programs.

New T.R. Reid Documentary Highlights Greatness In Our Healthcare System

By

[…] Overutilization – driven by supply rather than demand – was another common theme in the program. Basically, that the more healthcare supply we have (eg, scanning machines), the more utilization we have. This accounts for a large part of the huge variation in healthcare costs from one city to another. And in all of the hospitals and medical practices featured on the program, curbing over-utilization has been a high priority. One hospital figured out that blood transfusions during surgery aren’t nearly as necessary as they once thought (and indeed, the patients often do better without them). Given that the total cost of blood transfusions is about $1000/pint (!), that’s quite a cost-saving discovery. In another large clinic, pharmaceutical reps were no longer allowed to visit and they also removed the samples of brand name drugs that once filled their drawers. This was a controversial move, but they analyzed a lot of data provided by their local Blue Cross insurance carrier and found that they could optimize pharmaceutical care for a lot less money – patients had better outcomes and the clinic reduced overall Rx spending by $88/million a year compared with the state average.

The Program also showed and example of how patient-centered medical homes work in the real world. PCMHs are a huge buzz word these days, but the PBS documentary shows one in action, and they did a great job of making it easy for patients to visualize how such a program would work and how it would benefit us – including things like much more face time with doctors, and a reduction in the number of hospitalizations and ER visits. In addition to PCMHs, shared decision making between doctors and patients (another buzz word in healthcare reform) was highlighted as having a positive impact on both utilization and patient satisfaction. […]

Health Wonk Review At The Healthcare Economist

By

[…] One of the most interesting pieces in this edition comes from Avik Roy, writing at Forbes about the historical relationship between political conservatives and individual mandates for health insurance. It’s a long article, but definitely worth reading. The individual mandate is going to be on everyone’s radar this year (if it wasn’t already) once it gets taken up by the Supreme Court. Roy’s piece gives us a bit of perspective on how political viewpoints regarding an individual mandate have changed over the decades.

Nearly Half Of The Uninsured Believe The ACA Won’t Affect Them

By

[…] One of the most interesting parts of the interview is the discussion about Americans’ awareness of the ACA details, and their expectation of whether the bill will impact them directly. Karen notes that a poll conducted by the Kaiser Family Foundation last August found that only half of uninsured Americans had a good understanding of the main provisions of the ACA. This is particularly interesting because the 50 million uninsured people in this country were one of the primary groups that the ACA was aiming to help. In addition, 47 percent of the uninsured felt that the ACA wasn’t going to affect them directly. I have to wonder if there is any overlap between the people who are unaware of how the major provisions in the ACA work, and the people who have expressed an opinion – one way or the other – about whether they support or oppose the ACA. Karen also pointed out that a lot of Americans are getting their information about the ACA from sources like talk radio and cable TV programs. The likelihood that this information is biased and/or overly hyped in one direction or the other is quite high. […]

Jon Stewart Interview With Sebelius Focuses Mostly On Health Insurance

By

[…] 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.

Health Wonk Review – Campaign 2012 Edition

By

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

By

[…] 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. […]

Colorado House Passes Resolution To Repeal ACA

By

[…] 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

By

[…] 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

By

[…] 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.

The Ineffectiveness Of Asset Testing For Public Health Insurance Eligibility

By

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”. […]

Interesting Reading In The HHS Bulletin On Essential Health Benefits

By

[…] 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? […]

HHS Allowing States To Define Essential Benefits In The Exchanges

By

[…] 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. […]

Health Wonk Review And A Thoughtful Look At Life Expectancy

By

[…] Lastly, Roy’s article points out that there isn’t just one “US healthcare system”. Rather, we have Medicare, Medicaid, private health insurance, and millions of people with no health insurance at all. Lumping everyone into one group when it comes to life expectancy doesn’t really tell us how our health insurance funded-healthcare systems are functioning, since there are so many people with sub-par health insurance or no insurance at all. It stands to reason that if we can get everyone covered by health insurance and secure realistic access to healthcare for the whole population, our life expectancy should increase. But that might be simply because of an increased life expectancy for the portion of the population that is currently under-insured or uninsured. It could be that the population that is currently covered by high quality health insurance would continue to have the same life expectancy, which is likely quite a bit higher than the population that is under-insured or uninsured.