[…] 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.
Health Insurance Reform
Decline And Rate Up Statistics – Interesting But Confusing
[…] Your policy will cost the same amount regardless of whether you use a broker, but an experienced broker will be able to help you make sense of the plan comparison information, including the underwriting statistics. A policy or carrier’s statistical likelihood of declining or rating up any one application isn’t really relevant to each specific client… what is relevant however, is each carrier’s underwriting guidelines for the particular pre-existing condition the applicant has. […]
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. […]
Seeking Certainty
[…] And finally, if the Supreme Court is going to hand down a ruling like the one we got from the Appeals Court last week, we need to know that as soon as possible too. If the individual mandate does indeed end up being tossed out, the health care reform law will need an awful lot of compromises and revisions in order to make it tenable. Perhaps I’m being overly pessimistic, but given the level of compromise we’ve seen from the political system over the last decade or so, I have a hard time seeing how the PPACA could go on with one of its major provisions deleted. […]
Standardized Policy Descriptions Coming Soon
The Colorado Health Plan Description Form isn’t exactly the same as the forms that HHS will require carriers to make available next year, but it’s similar in many ways, and carriers in Colorado have been issuing these standardized plan summaries for nearly 14 years. As well as outlining the coverage provided, the new forms will include “coverage examples” that will show potential customers how the plan would cover three common medical scenarios: breast cancer, maternity care, and diabetes. […]
August Open Enrollment Period For Child Only Policies In Colorado
For parents looking for child-only policies in Colorado, we are in the middle of the 2011 open enrollment period, which will end August 31st. All carriers that offer individual health insurance policies for adults must also offer (during open enrollment periods only) at least one plan option for a child applying without an adult on the policy. This is pursuant to Colorado Senate Bill 128, which was signed into law earlier this year. Following the passage of SB128, the Colorado Division of Insurance stepped in to clarify the issue with emergency regulation E-11-03, which has specific details about the implementation of the law. […]
The Challenge Of Creating Unbiased Health Insurance Exchanges
[…] In order to attract high-quality health insurance carriers to the exchanges, we have to make sure that the exchanges represent a business environment that is appealing to carriers. We also have to make their appealing and fair to consumers, in order to attract enough people into the exchanges. To work well, the exchanges will need to have a delicate balance between the interests of consumers, providers, and health insurer carriers, with no one group more heavily favored than another.
HHS Guidelines For Women’s Healthcare
HHS today announced new PPACA guidelines pertaining to women’s health, listing several services that must be covered by health insurance plans with no cost sharing by the insured. In scrolling through healthcare news this morning, I saw numerous headlines stating that birth control and breast pumps must be covered by health insurance with no copays. This is true, but the requirements don’t take effect for another year (August 1, 2012) and will apply to new policies that begin on or after that date. […]
A Good Summary Of The HHS Proposed Regulations For Exchanges
[…] The proposed regulations from HHS for the exchanges come to 244 pages, but Timothy notes that they are “practical, sensible, and functional” and that HHS tried to simplify things wherever possible, rather than complicate them. For anyone who wants to get the gist of the proposed regulations without reading the 244 pages that HHS released this month, I highly recommend that you check out Timothy’s article. […]
Grand Rounds – It’s All About Personal Responsibility
[…] Even when people really need a major wake-up call (their life literally depends on it), doctors feel like they have to tread very softly in order to avoid hurting feelings. And there’s also the problem of time: most providers have so many patients to see in a day that they don’t have time to have in-depth conversations about lifestyle choices. The growing shortage of primary care docs (especially after 2014 when millions of previously uninsured Americans will have health insurance and will be looking for a doctor) isn’t likely to help that problem.
Is High Risk Pool Eligibility Guideline Hampering Enrollment?
[…] In terms of underwriting actions for less serious conditions (those that don’t result in a decline), GettingUsCovered only takes people who have been offered a policy with an exclusion rider… which most carriers don’t do anymore. Perhaps this is resulting in GettingUsCovered being comprised mostly of members who have a condition that would result in a decline in the individual market, while CoverColorado has those members as well as members who have less serious conditions that simply result in a higher-priced policy in the individual market.
Expanding Eligibility For Federally Administered High Risk Pool Coverage
[…] The 27 states (including Colorado) that administer their own PCIPs have been notified by HHS that they can modify their programs in a similar manner. As of this morning, the GettingUSCovered website still has the same eligibility guidelines that it has always had: a letter from a private carrier stating that the applicant has been declined, or approved with an exclusion on a pre-existing condition. […]
Medicare Trustees Report Not So Gloomy
[…] One way or another, we need to seek solutions that will enable Medicare to pay the 10% shortfall that is currently predicted for a decade from now. That can be accomplished by cutting costs, increasing revenues, or both. But we don’t need to start from scratch and overhaul the entire system, especially with the improvements that the PPACA has already created.
Medicare and Prescription Coverage
[…] If the government can tell the health insurance carriers that no more than 15 – 20% of premium dollars can be spent on administrative expenses, including profits, why can’t similar guidelines be enacted for the pharmaceutical industry? Perhaps then we wouldn’t need to worry as much about who is going to pay the cost of prescription drugs for seniors. And maybe individual health insurance policies could start covering prescriptions with basic copays again.
Health Care Reform In The 2011 Colorado Legislative Session
The Colorado legislative session that wrapped up this month was a busy one for Colorado-specific health care reform. Despite a few bumps in the road, SB200 passed, which means that Colorado is now on its way to creating a health insurance exchange that will address the particular needs of individuals and small businesses in the state. Although this bill was controversial simply because the whole idea of exchanges is too closely tied with the PPACA […]
Handling Income And Job Fluctuations Under The PPACA
[…] There’s no simple answer to all of this. We’re trying to create a somewhat universal health insurance system based on a conglomeration of government-run health insurance, private coverage from hundreds of carriers, eligibility for coverage that is tied to employment and state of residence, and also based on income levels… of course it’s going to get complicated. Hopefully the suggestions raised by this report will help to guide regulations that will ensure health insurance coverage that is as gap-free as possible for most Americans.
Federal House Votes To Defund Health Insurance Exchanges
[…] One of the provisions of the PPACA is for the federal government to assist the states in funding the creation of health insurance exchanges. In a largely symbolic vote, the US House of Representatives voted last week to block that funding. HR1213 would prevent the federal government from spending money to help the states set up their own health insurance exchanges. It passed in the Republican-dominated House, but […]
Colorado House Approves Child-Only Health Insurance Bill
The language of the law was modified to include open-enrollment periods during which children could apply for coverage, and last September the Colorado Division of Insurance officially designated those open-enrollment periods as January and July each year. The idea was that with open-enrollment periods rather than constant access to new policies, parents would be less likely to wait until a child was sick to seek coverage. But even with the open-enrollment periods, only two carriers – Rocky Mountain Health Plans and […]
Facebook Poll: Will the health care reform bill (PPACA) get repealed before 2014?
Do you think health care reform will get repealed? Answer the Facebook poll here:
http://www.facebook.com/home.php?sk=question&id=10150229980216181
Differing Views On Paul Ryan’s Health Care Reform Proposal
Last week’s Health Wonk Review included several articles about Rep. Paul Ryan’s “Roadmap for America’s Future”, which includes significant changes in Medicare and Medicaid, and a repeal of the Affordable Care Act. This article from Avik Roy is particularly interesting, and raises some valid points in support of some aspects of the proposed budget reforms. But there are definitely problems with some of the radical changes being proposed. […]
MLRs – One Size Does Not Fit All
[…] A state with two functional insurance carriers offering individual policies is obviously going to have a very different marketplace than a state with ten major carriers competing for business. It will be interesting to see how things play out in the states that are granted temporary MLR waivers by CMS. Three years from now, will their insurance markets be able to provide adequate coverage and also comply with the 80/85% MLR guidelines? Or will the waivers morph into something that allows the impacted states to set their own guidelines? Time will tell.
Bipartisan Support For Colorado Health Insurance Exchange Drying Up
Last week it appeared that Colorado Democrats and Republicans were prepared to work together to begin the process of creating a health insurance exchange for the state. But the bipartisan friendliness didn’t last long. House Majority Leader Amy Stephens (R – Monument) is a co-sponsor of the bill, and has faced a lot of criticism in the past week from conservative Republicans and the Tea Party over her support for the legislation to create the exchange. Stephens has also co-sponsored a bill that would allow Colorado to opt out of federal health care reform laws, and she has made it clear that she does not support the PPACA. But she and other lawmakers on both sides of the aisle felt […]
Spending Caps Will Help Individual Families But Won’t Reduce Overall Costs
[…] But although the spending caps will be beneficial to families that have large medical expenses, they do nothing to actually address the rising cost of health care, and the over-utilization that is also driving costs. This has been a recurring theme with a lot of the provisions created by health care reform: we’re finding ways to spread the costs in a more equitable fashion, but we’re not really addressing the fact that the total cost burden of health care in this country isn’t sustainable on its current trajectory, no matter how much we spread it out across the population.
High Deductible Plans And Reduced Spending
[…] Most of us agree that we need to find a way to reduce overall healthcare spending, but we also need to make sure that we don’t compromise future healthcare outcomes in the process. While some of the issues mentioned in the study – such as the drop in routine blood tests for people with diabetes – are definitely concerning, we shouldn’t simply assume that a reduction in overall preventive care will automatically lead to poorer health in the future.
Senate Bill 200 Begins The Process Of Creating Colorado Exchange
[…] Senate Bill 200 (the Colorado Health Benefit Exchange Act), co-sponsored by Senator Betty Boyd (D – Lakewood) gets the ball rolling on the health insurance exchange that the state will have to have in place by 2014. Specifically, the bill would create a “nonprofit unincorporated public entity known as the Health Benefit Exchange”. It includes guidelines for the appointment of a 12-member board of directors (9 of whom will be voting members) who will oversee the exchange, and lays out their responsibilities. […]