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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.

Will Tax Credits Be Available In Federally-Run Exchanges?

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[…] Both arguments are interesting, and very convincing. I read Jost’s first, and found myself nodding in agreement all the way through. But then when I read Cannon and Adler’s response, I also found their points to be compelling and hard to refute. This could be the sort of issue that many people would see as splitting hairs, but on an issue as contentious as the PPACA, I can see this debate getting quite a bit of traction over the next year as the exchange implementation process churns along. And it makes me glad that Colorado took the initiative early on (despite a lot of political wrangling) to begin the process of creating our own exchange. I know there are many flaws in the PPACA, and that the yet-unanswered question about how the exchanges will be funded starting in 2015 is a valid concern. But it still seems like a better solution than sitting back and waiting for the federal government to set up an exchange for us that 1) would not be tailored to our state’s specific needs and 2) might make Colorado residents ineligible for much-needed tax credits to help pay for health insurance.

5280 Magazine Needs Denver Area Self-Employed for Health Insurance Article

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Are you a Denver area resident who’s self-employed and had to navigate getting individual health insurance? Or do you fall somewhere in this description—“the self-employed, freelancers or ‘accidental entrepreneurs’ who started their own business or began doing freelance/contract work after being laid off from full-time positions during the economic turmoil of recent years”?

I’m writing a short article for 5280 magazine and would like to talk to about your experience. I would ask a few questions and potentially use a few short quotes. It should take about 10-15 minutes. I would be glad to speak at your convenience, but it will need to be during the week of July 30. You may contact me at [email protected] or 719-649-3634.

Hospital Bills Waived For Many Aurora Shooting Victims. But What About Victims Of Less-Publicized Violence?

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The tragic shooting at a movie theater in Aurora last week has horrified all of us in Colorado and across the country.  In addition to the 12 people who were killed, 58 more were shot and have required medical care that ranged from relatively minor to very major.  And while we don’t know the health insurance status of the victims (to my knowledge that information hasn’t been released), we do know that The Dark Knight’s audience included a large number of young adults, which is the population most likely to be uninsured in Colorado.

Five years ago, when the Lewin Group was preparing data for the Colorado Blue Ribbon Commission, they found that 38.7% of 19 – 24 year olds in Colorado were uninsured, as were 27.1% of 25 – 34 year olds (see the graph on page 6).  Those two age groups were significantly more likely to be uninsured than any other age group.  More recent data from the Colorado Health Institute found that 27.7% of 19 – 34 year olds in Colorado had no health insurance in 2011, up from 22.7% in 2009 (the increase comes despite the fact that starting in 2010 the PPACA allowed young adults to remain on their parents’ health insurance policies up to age 26).  As with the earlier Lewin Group study, that age group is far more likely to be uninsured than any other age group in Colorado.

So now the 58 surviving victims of the theater massacre will need medical care that ranges from relatively minor to very major.  Some have already been discharged from the hospital, while others will likely remain there for a while.  Three of the five hospitals in the Denver metro area that are treating the shooting victims have agreed to waive most or all of the hospital bills incurred by the victims.  The other two hospitals – University of Colorado Hospital and Denver Health – haven’t said what their specific policy will be with regards to medical bills for the shooting victims in their care, but those are Colorado’s top two safety net hospitals and they provide hundreds of millions of dollars worth of free care to uninsured patients each year.

It’s reassuring to know that the theater shooting victims – quite a few of whom likely have no health insurance – will have at least some help with their immediate hospital bills.  What’s less clear is the financial implications for the more gravely injured victims as they move forward with their treatment after being discharged from the hospital.  Physical and occupational therapy, outpatient follow ups, mental health treatment to cope with the trauma – these expensive services are likely to be a big part of some of the victims’ lives for the foreseeable future.  Individual health insurance is still medically underwritten (until January 2014), so it would be difficult or impossible for uninsured victims to obtain health insurance now to cover future medical bills related to the shooting (CoverColorado and GettingUSCovered – the state’s high risk pools – are an option available to people with pre-existing conditions).  They may be able to obtain health insurance through an employer group plan, but the ones who are uninsured likely didn’t […]

FEHB Health Insurance Now Available For Seasonal Firefighters

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[…] The federal Office of Personnel Management (OPM) issued a ruling yesterday – effective immediately – that grants seasonal firefighters access to health insurance through the Federal Employees Health Benefits Program (FEHB), which allows federal employees to select from among several private health insurance policies. Normally, eligibility for FEHB requires an employee to have completed a full year of service. This is not possible for seasonal firefighters, since they are employed for temporary positions during the fire season, usually for only six months at a time. So until OPM issued the new rules, seasonal firefighters were never eligible for health insurance through FEHB. Their only real options were to obtain health insurance as a dependent on a spouse’s plan, or to apply for coverage in the individual market – which is subject to underwriting (and some individual carriers won’t accept applicants who have high risk jobs).
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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 […]

Health Insurance For Seasonal Fire Fighters

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[…] In order for these seasonal fire fighters to have health insurance coverage, they have to apply for individual policies or have coverage through a spouse’s group policy. On the upside, most of them are in excellent physical health, since that’s pretty much a job requirement. That means that underwriting on an individual policy isn’t as likely to be a problem as it is for the general population. But it’s important to be aware that some individual health insurance carriers include occupation and/or hobbies in their underwriting guidelines. In Colorado, there are a few carriers that ask questions on the application to determine whether the applicant engages in any high-risk jobs or hobbies. Wildland fire fighting falls under that category, which means that it’s unlikely that the applicant would be approved for coverage by a carrier that includes occupational risk it its underwriting.

There are several reputable individual health insurance carriers in Colorado that do not use occupational risk in their underwriting assessments, and these are obviously a better choice for anyone who has a high-risk job. A good broker can steer an applicant towards the carriers that don’t use occupational risk as part of their underwriting. Combined with the workers’ comp that covers the fire fighters while they’re on the fire line, a solid individual health insurance policy – which provides significant flexibility since it isn’t linked to employment – can help to create a safety net for the people who put a lot on the line to keep the rest of us safe. In the current scenario, this is the best option. But it does seem like it would be a good idea for the Forest Service to allow seasonal fire fighters to at least have the option of purchasing – via payroll deduction – the same health insurance that their full-time coworkers get.

Aetna, Humana and UnitedHealth Vow To Maintain Some Aspects Of ACA, Regardless Of Court Decision

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Much of the healthcare community is eager to hear what the Supreme Court has to say – likely next week – about the ACA. Given how polarized the topic of healthcare reform has been over the past few years, there’s no way that any decision is going to please more than about half of the country, although the court has the option of picking and choosing various parts of the law to uphold or overturn as it sees fit.

Some aspects of the ACA have already been implemented and have proven to be very popular. A few of the country’s biggest health insurance carriers have stated that they will keep some of the most popular ACA provisions – even if the law is overturned. Aetna, Humana, and UnitedHealth have said that they will continue to offer preventive care with no cost-sharing, allow young adults to remain on their parents’ health insurance policy through age 26, and maintain the third-party appeals process that insureds can use if a claim is denied. Humana and UnitedHealth have also said that they will continue to have no lifetime benefit maximums on their policies and ban rescission except in cases of fraud. […]

Governor Hickenlooper Says Reform Can Succeed Without An Individual Mandate

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Colorado Republicans have pounced on statements that Governor Hickenlooper made on Colorado Public Radio yesterday regarding the individual mandate. Although Governor Hickenlooper did not say that he’s opposed to the individual mandate, he expressed his belief that he doesn’t “think you have to mandate it if you craft it properly.” Since the individual mandate is without a doubt the most controversial aspect of the ACA, the governor’s words will be significant for both sides of the debate. A spokesperson for the governor’s office noted that Hickenlooper was discussing a hypothetical situation that could arise if the Supreme Court strikes down the individual mandate next month but leaves the rest of the ACA intact. Colorado has already done quite a bit of work on the state’s health benefits exchange, but the exchanges are currently being based on the assumption that health insurance will be mandatory in 2014. If the Supreme Court does away with the individual mandate but keeps the rest of the ACA, it will be a challenge for states to create health benefit exchanges that can operate efficiently without an individual mandate. […]

Beware A Scam Targeting Health Insurance Consumers

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The Colorado Division of Insurance notified us today of a new scam that is targeting Colorado health insurance consumers.

People have been getting phone calls from someone who claims to be with the “Colorado Insurance Commission” (there is no such agency – it’s called the Colorado Division of Insurance), telling the potential victim that his or her Colorado health insurance carrier has been taken over by the state.  Then the caller says that the state sent the insured a check for $399 to refund copays, but that it was returned by the post office.  The caller then offers to direct deposit the $399 into the insured’s bank account – and of course asks the person to provide bank account details in order to facilitate this.

As is pretty much always the case when someone calls and wants your bank account information over the phone, this is a scam.  DO NOT GIVE YOUR BANK ACCOUNT INFO TO ANYONE WHO CALLS YOU, no matter how legitimate their claim might sound.

If you get a call like this, you can report it to local law enforcement.  If you ever get a call from someone who wants your bank account information – for any reason at all – you can hang up and then call the company in question directly (for example, in this case you could just call your health insurance carrier and find out right away that no part of the caller’s statement is true).  Once you’ve determined that the original call was a scam, report it to law enforcement.

The Colorado Division of Insurance wants consumers to be aware of this scam.  And again, legitimate organizations don’t call people and ask for banking information over the phone.  A general rule is that you shouldn’t give out that information to anyone unless you were the one who initiated the communication.

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.

Medical Underwriting Makes Individual Health Insurance Much Less Expensive Than Group Coverage

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[…] But although there are differences between group and individual coverage that can account for some of the price variation, by far the biggest factor is medical underwriting. The Zane Benefits article points out that 80% of healthcare costs come from 20% of the population – individuals with serious, ongoing health conditions. Group health insurance is required to accept all eligible employees, but individual health insurance carriers use medical underwriting to eliminate the sickest applicants from the pool of insured members (70 % – 90% of applicants in the individual market are accepted and offered a policy – there is quite a bit of variation in underwriting guidelines from one carrier to another and from one state to another). This mean that individual policies are covering people who are generally healthier than the average of the entire population. And that translates to lower healthcare costs in the individual market. […]

New Healthcare Price Comparison Database Coming Soon In Colorado

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[…] Happily, it looks like we’re going to be getting a good healthcare price comparison database here in Colorado next year. This article from Kaiser Health News has all the details, and it looks promising. As the article states – and as we’ve noted here many times – healthcare costs sometimes seem to have little rhyme or reason. They can vary widely from one provider to another and from one area to another without much of a difference in quality of care or patient outcomes. But there are also some variables that have a justifiable impact on healthcare cost variation, such as the overhead expenses associated with teaching hospitals and hospitals that treat a higher-than-average number of uninsured patients. It sounds like the All Payor Claims Database is addressing those issues, so it will be interesting to see how the database accounts for them. I also like the fact that providers will be able to see how they compare with other providers before the data is released to the public, in order to allow the providers to start making improvements where necessary.

I can see this comparison tool – especially given how comprehensive it looks to be – being very beneficial for Colorado residents, and also helping to foster more competition among healthcare providers in the state.

Care Management Outsourcing

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[…] outsourcing of care management and the success of MedAssurant, a data-driven healthcare solutions company that works with provider organizations that care for more than a third of the US population.

With healthcare providers feeling the squeeze both in terms of reimbursements for care and time spent on administration, it makes sense that outsourced care management could be an important part of a medical office’s business plan. Utilizing economies of scale in this manner could save time and money for medical offices, and streamlined care management is likely to be popular with health insurance carriers too. As Jaan points out, MedAssurant has very savvy customers (including health insurance carriers and healthcare provider organizations) and a solid track record, so the service they are providing is obviously valuable and beneficial.

Taxes And Individual Health Insurance

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[…] Greg’s most recent article deals with the way that our tax code treats health insurance premiums. Medicare and Medicaid premiums are obviously subsidized by tax dollars. But group health insurance premiums are also subsidized, since the premiums that employers pay on behalf of their employees are not included in the employee’s taxable income.

People with individual health insurance usually don’t get such a benefit. The self-employed get to deduct individual health insurance premiums on the 1040, but there are plenty of people who purchase individual health insurance and are not self-employed. Early retirees are a good example, as are people who buy their own health insurance because their employer does not provide it.

Greg’s article goes beyond what we usually see on this topic (ie, pointing out the inherent unfairness of not allowing similar tax treatment for all health insurance premiums, regardless of whether the coverage is group or individual). He delves into what the possible implications could be for the individual health insurance market if the tax code were changed to a more equitable system. His prediction includes millions of additional people entering the individual market (thanks to a switch from group to individual coverage), more lenient underwriting standards in the individual market, more innovative products available to consumers, and more competition in the individual market. Check out his article for all the details – definitely some good food for thought.

Best Health Insurance Companies In Colorado

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We recently got a call from a client who mentioned that he had done a Google search for the “best health insurance companies in Colorado” and his concern was that Anthem Blue Cross Blue Shield was not on the top ten list that he said came up as the first search result.  We were a… Read more about Best Health Insurance Companies In Colorado

Kaiser Will Soon Be Available In Northern Colorado

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[…] The new Kaiser facilities will be in Fort Collins at Harmony and Ziegler, and in Loveland at I-25 and Hwy 34. For hospital services, Kaiser is partnering with Banner Health and members will be able to use McKee Medical Center in Loveland and North Colorado Medical Center in Greeley. The medical offices in Fort Collins and Loveland will offer a wide range of services (primary care, lab work, pharmacy, and x-rays, and mammograms will be available at the Loveland office), and are expected to begin providing care by the fall of 2012. A medical office is projected to open in Greeley by 2014. Between now and then however, northern Colorado Kaiser members will be able to see doctors at the Fort Collins and Loveland offices, as well as physicians on the Banner Health network.

Kaiser is planning to offer group coverage to employers in northern Colorado by October 1, 2012. Individual and family coverage should be available sometime next year.

IRS 2013 HSA Contribution Limits

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The IRS announced that the 2013 HSA contribution limit for an individual would increase by $150, from $3,100 to $3,250. The family contribution limit is increasing from $6,250 to $6,450 (+$200).

The maximum annual out-of-pocket increased as well. The individual out of pocket maximum is going from $6,050 to $6,250. The family out of pocket maximum is increasing from $12,100 to $12,500.

The minimum deductible on an HSA qualified plan also increases from $1,200 to $1,250 for individuals and increases from $2,400 to $2,500 for families.

What are the 2012 HSA Contribution Limits?

According to the Patient Protection and Affordable Care Act, OTC drugs may be reimbursed only if there is a prescription.

Non-medical withdrawals from an HSA are taxable income and subject to a tax penalty, which increased from 10% in 2010 to 20% in 2011 and remains the same for 2013.

Exception to the IRS tax penalty for non-medical withdrawals:
The tax penalty does not apply if the withdrawal is made after you:
1) Attain age 65;
2) Become totally and permanently disabled; or
3) Die.

More details and research about HSAs and HSA qualified plans.

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. […]

Despite IT Problems, Report Gives Colorado High Marks On Exchange Progress

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[…] On the upside, the Urban Institute report gives Colorado props for making good overall progress on setting up the health benefits exchange. Despite the political hot seat that health care reform has been for the past few years, Colorado lawmakers managed to work together to create the framework for our health benefits exchange last year. We have a board of directors in place and the state is moving forward as fast as possible to get things in place for the exchange to be up and running in 2014. A lot is still unknown with regards to the future of the ACA, since the Supreme Court still has to issue their ruling in June regarding the legality of the individual mandate. But if the ACA remains in place and the health insurance exchanges become reality across the country, it’s safe to say that Colorado will be ahead of the curve in terms of getting the bugs ironed out.

The Urban Institute report notes that Colorado had a head start on a lot of the reform issues thanks to the 2008 Blue Ribbon Commission Report. Remember back when that was the big news in health care reform in Colorado? Before health care reform became such a divisive topic across the country, Colorado was working to come up with solutions to many of the problems with our health care system. Some of the recommendations of the Blue Ribbon Commission are very similar to the new guidelines in the ACA, and Colorado had been taking active steps for the past four years to implement the Blue Ribbon recommendations. If the ACA remains in place, it should be a bit easier for Colorado to make the necessary transitions over the next few years, thanks to the progress the state has already made on its own.

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.

Colorado Expands Access to Medicaid For Adults With A Lottery System

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[…] 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 Insurance And Newborns

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Last week, we got a call from a lady who had several questions about maternity and newborn coverage. She lives here in Colorado and has her health insurance with one of the state’s large, reputable carriers. She had called her health insurance carrier to see how maternity coverage works (it’s a group policy) and the person she spoke with told her that her policy wouldn’t cover the baby after it’s born, since the baby isn’t named on the policy as a member.

Huh?

Colorado law requires health insurance carriers to add newborns to a parent’s policy as of the date of birth, with no medical underwriting. This automatic coverage is good for the first 31 days after the baby is born. In order to continue the baby’s coverage after the first month, the carrier has to be notified of the new addition to the policy within the first 31 days after the baby is born. No underwriting is allowed as long as the carrier is notified of the baby’s birth within that time frame. […]