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Health Insurance Reform

Open Enrollment For Individual Health Insurance Plans Starting in 2014

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Ever since the PPACA was first being discussed, the individual mandate has been touted as a buffer to protect health insurance carriers – and in turn, policyholders – from adverse selection that would otherwise certainly occur in a guaranteed issue individual market.  It seemed that as long as people were required to maintain health insurance coverage, adverse selection would be minimized and people would be unlikely to purchase health insurance only during periods of sickness. But there was still enough concern about adverse selection that HHS issued a proposal for open enrollment periods in the individual market starting next year.  This proposal was released at the end of November, and the specific details regarding the open enrollment period are on page 70595 of this Federal Register.

Open Enrollment For Individual Health Insurance Plans Starting in 2014To sum it up, they’re proposing an initial open enrollment period for individual/family health insurance that starts in October 2013 and runs through the end of March, 2014 (a six month window in order to accommodate the large influx of initial applications), and then open enrollment periods that mirror Medicare’s: October 15th until December 7th each year.  Beyond that window, only “qualifying event” applications would be allowed for […]

How the Affordable Care Act Affects You

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For the first couple years after the Affordable Care Act was signed into law, everything seemed to be a bit up in the air.  There was almost constant bickering about the subtle nuances of the legislation, along with uncertainty from both sides of the political spectrum insofar as whether or not the law would stand the test of time.  The Supreme Court had to weigh in, and we also had a major election cycle midway between the signing of the law and the enactment of many of its main provisions.

Most of that has settled down now.  SCOTUS upheld the law.  And there was no election upheaval in Congress to tilt the legislative body towards a crowd that would be likely to repeal it.  States – like Colorado – that had been working towards setting up a health benefits exchange can continue to do so without as much worry that their work might be in vain (there had been How the Affordable Care Act, Obamacare, Affects Yousome concern that the law would be tossed after states had invested a lot of time and money in the exchange-creation process).  We are just over a year out now from January 2014, when many of the major provisions of the ACA will go into effect; it seems relatively certain at this point that the ACA will continue to move forward now that some of the potential roadblocks are in the rearview mirror.

Several provisions of the Affordable Care Act – ACA have already been implemented over the past two years:  Young adults can remain on their parents’ health insurance policy until […]

2012 Obamacare Premium Rebates (Infographic)

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Did you receive a health insurance premium rebate this year? If so, how much was it? We created a simple visualization of how the PPACA (Obamacare) health insurance premium rebates break down between the individual/family, small group and large group markets and how Colorado’s rebates compared to the national average.

2012 Obamacare Colorado Health Insurance Rebates

Health Insurance Premiums And The ACA

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[…] We wrote a couple years ago about the Colorado Division of Insurance bulletin that laid out the reasons for rate increases in 2010 – almost all of them were the same factors that had been driving health insurance premiums for the previous decade; only 5% of the total premiums could be attributed to the ACA. […] The predicted long-term cost savings from the ACA are definitely not a sure thing. But we need to keep in mind that many of the substantial changes included in the law have not yet taken effect. And many of the changes that have been implemented are those that tend to increase short-term costs and/or utilization of care. […]

Individual Health Insurance Mandate From A Perspective Of Compassion

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[…] I’ve usually addressed the issue of the individual health insurance mandate in terms of how guaranteed issue health insurance would impact premiums in the absence of an individual mandate.  The mandate – regardless of its popularity – just seems like the most practical way to go if we’re in agreement that individual health insurance should be guaranteed issue.

Maybe we should also be looking at the individual health insurance mandate from a more compassionate, human angle too.  There has long been a bit of a harsh undertone in the healthcare reform discussions when it comes to people who are […]

Healthcare Fact Checking the Presidential Debate in Denver

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I think that political debates would be a lot more fun (and educational) to watch if non-partisan fact checkers were allowed to sit off to the side and hold up “pants on fire” signs when appropriate. But the next best option is the plethora of online fact-checkers who can help us sift through the statements. It’s generally been acknowledged that there were more than a few half-truths and outright lies in last night’s 1st Presidential debate here in Colorado at the University of Denver.

Specifically regarding healthcare and health insurance reform, there are a couple of PPACA-related points that need further comment. First, we have the comment from Romney regarding the “unelected board, appointed board, who are going to decide what kind of treatment you ought to have.” He’s referring to the Independent Payments Advisory Board (IPAB), whose job is to oversee general Medicare spending. They are allowed to reduce Medicare payments to hospitals with high re-admission rates and recommend ways to reduce wasteful Medicare spending through new innovations. But they cannot restrict benefits, alter Medicare eligibility, or make any decisions regarding treatment options. […]

How Does Health Care Reform Impact HDHPs and HSAs?

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Will HSA qualified health insurance plans and Health Savings Accounts (HSA) still exist after the majority of the remaining PPACA changes are implemented in 2014?  That’s a question that we often hear from Colorado health insurance clients who are concerned about their existing HSA qualified high deductible health plan (HDHP)/HSA, as well as people who are considering an HDHP but uncertain about the future of that type of health insurance.

In terms of direct impact, the PPACA changes very little about HDHPs and HSAs.  There are only two […]

More About Colorado’s Kaiser Permanente Benchmark Health Insurance Plan

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Yesterday’s article about Colorado selecting a benchmark health insurance plan for individual and small group policies sold starting in 2014 has raised a few more questions and I wanted to clarify some details.

This publication from the Colorado Division of Insurance, the Health Benefit Exchange and the Governor’s office is an excellent resource and answers a lot of frequently asked questions.  It was released earlier this summer, before the Kaiser small group plan was selected, so it includes details about all nine options that were considered as possible benchmark plans.  The Kaiser small group plan that was ultimately picked as the benchmark is listed on page 11 as option A, under “one of the three largest small group plans in the state”.

The 2011 Colorado health insurance plan description for the Kaiser policy is here if you’re interested in the plan specifics.  We had a question from a reader who wondered whether chiropractic care would be covered, but it’s listed as “not covered” on the plan description form (item number 30).  It’s important to note that cost sharing details like deductible, coinsurance and copays are not part of the benchmark program.  The concept of benchmark here only applies to the benefits provided by the Kaiser Permanente health insurance plan.  The deductible on the Kaiser health insurance plan is $1200, but that DOES NOT mean that all policies will have to have a $1200 deductible in 2014.  In order to be sold in the exchanges, health insurance plans will have to cover at least 60% of costs in order to qualify for a “bronze” designation.  And there will also be silver, gold and platinum ratings, so there will still be plenty of variation in terms of cost sharing.

If Colorado had not selected a benchmark plan, HHS would have picked one for us.  HHS would have […]

Colorado Selects Kaiser Permanente As Its Benchmark Health Insurance Plan

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Last December, HHS made it clear that they were giving states a lot of flexibility in determining what plan would serve as the benchmark for the state’s “essential benefits” for individual and small group health insurance policies that would be sold starting in 2014.

After months of consideration, Colorado has selected Kaiser Permanente’s small group plan as a benchmark.  This is the largest small group plan in the state, with almost fourteen thousand members, and was selected by a group of officials from the Colorado Division of Insurance, the Governor’s office, and the health benefits exchange.  The Division of Insurance will be taking comments until next Monday before making a final announcement, and you can contact them by email ([email protected]) if you’d like your comments to be considered.

The Kaiser plan covers services in the ten areas that are required by the PPACA (ambulatory patient services, emergency care, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription medications, rehabilitative services, lab work, preventive care/disease management, and pediatric care), which means that it will serve as a benchmark for services in those areas without the DOI having to add additional coverage minimums.  In addition, the Kaiser plan was generally considered to be a good balance between comprehensive coverage and affordable coverage.  It’s not the most comprehensive policy out there (the much maligned “Cadillac plans” offer more benefits), but it provides […]

Most Colorado Residents Have Health Insurance

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This article about the state of healthcare and health insurance in Colorado is an interesting one, and it provides plenty of good, factual information.  However, I was a bit perplexed by a quote from Dr. Ned Calonge, president and CEO of The Colorado Trust, who says “We’re reaching a tipping point where there will be more people who are uninsured than are insured.”  This comes after some statistics that highlighted the decline in the number of Colorado residents who get health insurance from their employers:  currently 57.8% of employers, compared with 63.7% two years ago.

I’m not really clear about the meaning of Dr. Calonge’s quote about a “tipping point”.  I am not in any way minimizing the importance of increasing the number of people in Colorado who have health insurance and improving access to healthcare for everyone.  Those are certainly the goals we should be working towards.  But we are in no way close to a point where Colorado will have more uninsured people than insured people.  The state currently has a population of 5.1 million people.  Although the number of uninsured people in Colorado is quite high (829,000), it’s nowhere near half of the population.  We are not close to having more uninsured people than insured people.

I wonder if the distinction was regarding the number of people who get their health insurance from an employer?  If the current trends continue, we could indeed see a point in the near future when the number of people who get their health insurance from an employer will be lower than the number who don’t.  But it’s important to keep in mind that the people who don’t get health insurance from an employer are not necessarily uninsured.  In fact, most of them have health insurance.  Some get it from the government (eg. Medicare, Medicaid, CHP+) and some purchase individual policies.  The article I linked to above includes a graph that shows where people in Colorado get their health insurance, and although it’s true that the percentage of uninsured residents increased while the percentage of people who get their health insurance from an employer decreased, we should also note that the percentage of people with individual health insurance, Medicare and Medicaid all increased in that same time frame (2009 to 2011).

So although Colorado has a long way to go in terms of getting everyone in the state insured, we’re not close to a point where the uninsureds outnumber the insureds.

I Thought Insurance Companies Couldn’t Decline Due To Pre-Existing Health Conditions Anymore?

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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?”

I’ve written a quick (yet detailed) answer to the question: “I thought they couldn’t decline people because of pre-existing health conditions” here.

Healthcare Reform Progress In Colorado

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[…] 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?

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[…] 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

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[…] 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

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[…] 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

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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.

firefighters 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 other2 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

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[…] 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.

A Look At Project Health Colorado

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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

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[…] 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

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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.

How Individual Health Insurance Measures Up

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[…] 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.

Details From Anthem On Preventive Care And Contraceptive Coverage

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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

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[…] 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. […]

A Possible Alternative To The Individual Mandate

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[…] 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.

Semantics In The Supreme Court Healthcare Arguments

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[…] 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.