[…] Amy Monahan suggested that there could be a law making employees ineligible for coverage in the exchanges if they are eligible for employer group coverage. Or there’s the possibility of a law similar to the one that Colorado designed to protect the state’s high risk pool from a similar scenario – employers here can’t reimburse employees for individual health insurance premiums if they have had a group plan in place within the past twelve months (in the case of the exchanges, they could make employees ineligible for coverage in the exchanges for at least a year after leaving a group plan, assuming they are still eligible for coverage under the group plan and have just opted out). Either option would help to protect the exchanges, but they don’t do much to prevent employers from structuring their health insurance policies to make healthcare significantly more expensive for the sickest employees. […]
A lot of this remains to be seen. The health care reform law still has to be reviewed by the Supreme Court, and we have a major election cycle next year and another full legislative year after that. But if everything about the PPACA remains as it is now, lawmakers will eventually have to address the possibility of self-insured employers designing health insurance plans that encourage their sickest employees to opt for coverage in the exchanges instead.
Health Care Reform
Access To Healthcare In Colorado Worsening
The Colorado Health Access Survey results were released earlier this month, and the results aren’t particularly surprising given the state of the economy for the past few years. The total number of uninsured Colorado residents is now 829,000 – up from 678,000 in 2009. The survey also counts the number of “underinsured” residents (those who aren’t able to afford their out-of-pocket expenses that total more than 10% of their income, or 5% for those below the poverty line). The two categories – uninsured and underinsured – amount to 1.5 million people, which is about a third of the Colorado population.
The 22% increase in the number of uninsured residents came despite strong efforts in Colorado to expand access to Medicaid and CHP+ over the past few years. Without the expansion of those programs, the numbers would undoubtedly be even more bleak. […]
Employer Funding Of Individual Health Insurance Varies By State
Over the past several months, I’ve written a few articles about the legality of employer reimbursement of individual health insurance premiums in Colorado. Our friend and fellow blogger Hank Stern (writing at InsureBlog) found the changes interesting, and noted that the laws surrounding employer reimbursement of premiums vary quite a bit from one state to another (he’s in OH).
Hank and I wrote a joint post about the topic, which he published last week on InsureBlog. Here’s Hank’s description of how the law works in OH (regular readers will note that it’s similar to how things used to be here in Colorado, before HRAs became a major issue, and of course before SB19 passed earlier this year). […]
Combining Patient Satisfaction With Clinical Outcomes And Cost Efficiency
[…] Particularly in the current era of spiraling healthcare costs, it’s a bit troubling to hear that hospitals are doing things like putting in extra elevators so that people don’t have to wait as long for an elevator… all for the sake of boosting their patient satisfaction rankings. Yes, it might increase patient satisfaction by a small margin, but somebody has to pay for it. Renovation projects like that add to the hospital’s overhead expenses, and that leads to increased charges for care at the hospital. Ultimately, health insurance carriers end up paying more for their insureds’ claims, and that translates directly to increased health insurance premiums […]
Cleaner Hospitals Spread Fewer Infections
[…] What is shocking is the fact that hospitals aren’t already at the top of the cleanliness scale. Although we’ve known for more than a century that germs cause disease, there is still a surprising lack of compliance with basic hygiene in the medical profession – even something as simple as hand washing between patients. Jessica’s post describes a study at the Mayo Clinic that involved cleaning high-touch surfaces with bleach wipes twice a day for six months. Their incidence of Clostridium difficile (C. diff) went from one case every few days to one case every three months. Pretty impressive results, and a very easy solution. Sterilizing high-touch surfaces in hospitals should be a matter of routine, but obviously that isn’t yet the case. Maybe the Mayo Clinic study will help to get other hospitals on board in order to reduce the incidence of hospital-acquired infections across the country.
Comparing Wall Street And Healthcare
[…] Should hospital, insurance, and pharmaceutical executives be earning millions of dollars while millions of Americans have no health insurance and no realistic access to healthcare? Should those executives earn their millions regardless of how their company has performed? Or regardless of the overall state of healthcare in this country? Should decision-making at healthcare companies (hospitals, pharmaceutical companies, insurance carriers, device makers, etc.) be based more on the best interests of shareholders and executives, or on what is best for the health of Americans? Do healthcare companies need to be held to a different standard than other corporations, simply because of the importance of the product they provide? […]
More Flexibility With An Individual Health Insurance Plan
[…] For the average person who has had an individual policy for a decade and is late 50s-ish, keeping that individual policy (even though a group plan may become available) might be the ticket to being able to have some flexibility in terms of when to retire. The group plan is guaranteed issue – health conditions won’t be a barrier to getting coverage. But the group plan is also tied to the current employer, and the policy will only be available for a maximum of 18 months after you leave that job (via COBRA). […] Linda’s article is an excellent reminder about the importance of looking at the specifics of your own situation – including long term issues that might outweigh short-term benefits – rather than following conventional wisdom or doing what everyone else is doing.
Colorado’s Average 2012 Premium Increase Is The Smallest Since 2000
[…] I’m sure there will still be people who falsely claim that Colorado’s maternity mandate and federal reform are the reason for any increase. But when we place the 2012 increase in context with the increases we’ve seen over the past decade, it becomes harder to blame recent reform laws for the 2012 premium increases. I’m glad to see that after a year of having guaranteed issue coverage for children, no lifetime maximums, more comprehensive preventive care, and maternity benefits on all new and renewed individual policies, we are seeing the lowest average rate increase in over a decade.
Employer Reimbursement Of Premiums Causing Applicants To Be Declined
[…] I know that the law was written with good intentions, but we’re noticing that it’s the employees – the applicants who are trying to get individual health insurance policies – who get the short end of the stick. It’s the employees who end up getting their health insurance application declined. It’s the employees who end up having to pay for their own premiums in order to obtain coverage, even if they thought that they were going to be able to rely on some level of reimbursement from their employer.
Millions Of Uninsured Children Are Eligible For Public Health Insurance
[…] The first sentence of Jason’s article is the most striking: The fact that there are 4.3 million uninsured children in the US who are eligible for Medicaid or CHIP (Children’s Health Insurance Program). Obviously, not all states are pushing hard to enroll all (or even most) Medicaid/CHIP eligible children in those programs. And although Colorado received a $13.7 million grant last year thanks to the increased enrollment in the state’s Medicaid program, the expansion of public health insurance programs in Colorado has not been without criticism. Especially in the current economic climate, it’s hard to see how government health insurance programs could afford to insure an additional 4.3 million children. […]
Comparative Effectiveness Research Fee To Be Added To Premiums In 2012
[…] This fee is similar to the one that is assessed to pay for CoverColorado (except that it’s a much smaller amount). Basically, carriers will collect the fee from members and then pass the money on to the Patient-Centered Outcomes Research Institute, much the way carriers pass on the CoverColorado fee. The fee will not be counted as premiums for the purpose of calculating medical loss ratio numbers, and should not be confused as being part of the premium that we pay for our health insurance.
Possible Solutions For Long Term Care Funding Problems
[…] As long as we’re looking at a fragmented public/private hodge podge of long term care funding that includes Medicaid, private long term care insurance, private assets, and help from family and friends, I think it’s important that we look for ways to make things as fair as possible and also keep Medicaid financially afloat. The CLASS Act got nixed from the ACA, but the problem of funding long term care isn’t going away, and is only going to grow as the baby boomer generation ages. John’s article is a good one to read if you’re interested in possible solutions.
Real-Time Tracking Of Healthcare Costs
[…] Obviously we have to avoid cutting corners just for the sake of lowering costs at the expense of patient outcomes (again, including patient outcomes when we compare the cost data would help to prevent this problem). But I have no doubt that there are other healthcare expenses that could be eliminated without compromising patient outcomes. In many cases, the providers might just be unaware of the actual costs that are being incurred – Dr. Fogelson’s idea for a real-time digital tracker would help to keep cost in the front of everyone’s mind.
Health Insurance Exchange Payroll and Admin Expenses
[…] One of the comments on the post was from Dede de Percin, the Executive Director of the Colorado Consumer Health Initiative (CCHI). […] Dede’s comment on my article referenced the point I made about consumers not having to pay additional fees to have a broker. Basically, health insurance is priced the same whether you go directly through a health insurance carrier (calling Anthem Blue Cross Blue Shield directly, for example) or through a broker (who will compare options from multiple carriers for you). Dede made this point:
“While a consumer or business doesn’t not pay a health insurance broker directly, broker fees and commissions are paid by the insurance companies – and rolled into […]”
Conflicting Data Regarding Medical Costs
[…] These numbers are much more in line with the rise in health insurance premiums that we’ve seen over the past few years. I have no explanation for why the data from the two sources is so dramatically different in terms of medical trend in 2010, but if the trend was really closer to 7.5% rather than 1.7%, the health insurance premium increases would be a lot easier to understand. […] In addition to the MLR rules, some states (including Colorado) have implemented strict review processes for rate hikes. The ACA now calls for insurers who propose a rate hike of 10% or more […]
Stuck In A Mini-Med
[…] So he applied for an individual policy with Anthem Blue Cross for his family, and was approved. But then when he tried to cancel his mini-med plan, his employer told him that he couldn’t cancel it until the open enrollment period next April. It would seem that trapping enrollees into a year-long contract with a mini-med plan is not in line with the spirit of the HHS guidelines that call for full disclosure regarding the waivers and directives to steer enrollees towards healthcare dot gov if they are interested in getting a policy that does comply with the ACA rules regarding annual policy limits. […]
Grand Rounds – Colorado Fall Colors Edition
Henry Stern of InsureBlog brings us an interview with the whistleblower who has brought a lawsuit against LabCorp for allegedly charging a lower price to United HealthCare than to Medicare. The post is particularly interesting because Hank adds his own thoughts after the interview, and he sees things a little differently than Andrew Baker (the whistleblower). Hank agrees that it does look like LabCorp lowered their fees for UHC […]
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.
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.
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. […]