[…] This should help boost public participation in the rate review discussion, and add to the general understanding of how the rate review process works. The DOI is obviously working hard to create as much transparency as possible with regards to rate increases. Rates will continue to increase as long as the cost of health care continues to climb (and as long as we continue to increase our utilization of health care) but at least the logic behind the rate increases will be more clear.
Individual/Family Health
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. […]
More On Health Insurance Exchanges
[…] We need exchanges that are easy to navigate, accessible for people who are not fluent in English, and that provide seamless access to the subsidies that the PPACA provides to help people afford health insurance. I’ve already pointed out that we’re going to have to walk a fine line in terms of keeping things fair for both insureds and insurers, in order to attract as many enrollees and high quality insurers as possible to the exchanges. […]
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. […]
Employer Funding of Individual Health Insurance – The Rules Are Changing
[…] Because of the new law, employers can now use wage adjustments to reimburse employees for individual policies (as long as they haven’t had a group policy in the past twelve months), which wasn’t allowed at all in the past. But the use of HRAs to fund individual policies can now only be done if the employer hasn’t had a group policy in the past twelve months, and that restriction wasn’t found in the DOI final agency order regarding HRAs. […]
Health Insurance Does Not Always Prevent Medical Debt
[…] Chances are, if you have a claim on your home or auto policy, it will be because of a one-time incident like a fire or a car accident. That can be the case with a health claim too, of course, but many times a large claim on a health insurance policy can be the result of a chronic condition or one that will need extensive long-term treatment. A person might have health insurance at the start of the ordeal, but may lose coverage as time goes on […]
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.
Call For Grand Rounds Submissions
We’re honored to be hosting Grand Rounds next week, on June 28th. Please send me your medical/health care posts by 8pm mountain time on Sunday, the 26th. No theme this week – just pick your favorite recent post. Submissions can be emailed to me at louisen78 [at] gmail [dot] com. I look forward to reading your articles!
Biased Language In Employer Health Insurance Survey
[…] Overall, the survey is very thorough, the questions are mostly objective, and the data obtained from 1300 employers is no doubt a useful barometer of current employer attitudes towards health care reform. But I imagine that if the sentence about assuming that exchanges will make individual health insurance easy and affordable had not been included, the number of employers who said that they plan to drop their group plans might not have been so high. Time will tell.
Rate Review Process Does Not Keep Premiums Artificially Low
[…] If the rates are justified, they’ll likely be approved – even if the amount of the increase is distastefully large. The DOI is not trying to keep premiums artificially low or force carriers to cut out legitimate claims expenses. Having rates approved by the DOI does not mean that the people of Colorado get smaller-than-average premium increases. Rather, it means that although our rate increases are sometimes substantial, we know that those rates are justified as a reflection of increasing claims costs.
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. […]
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.
DOI Report On Small Group Coverage In Colorado
The Colorado Division of Insurance recently released the 2010 small group market report. The number of employers in Colorado offering small group health insurance dropped by 10% compared with 2009, and the number of Colorado residents with small group health insurance coverage dropped by 7%. The report contains comprehensive data on the availability of coverage, carriers in the small group market, pricing, and how the rating flexibility laws have impacted the market. […]
CHP+ Premiums Will Result In More Uninsured Kids
[…] However, the real world is not always ideal. The Post editorial makes some very good points, and I don’t doubt that if CPH+ moves to a monthly premium system this summer, there will be some kids who lose their coverage, and fewer children will enroll in the future compared with how many would have enrolled if monthly premiums were not part of the deal. […]
Child-Only Plans Returning To Colorado
[…] But presumably if the child is eligible for coverage through a parent’s employer, individual health insurance carriers would not be required to offer the child a child-only policy. As we’ve noted in the past, child-only policies represent a very small fraction of the individual health insurance market, but within the child-only market, it would seem that there are a lot of children who are also eligible for other creditable coverage (albeit more expensive coverage…). It will be interesting to see if this becomes an issue once all the carriers return to the child-only market. […]
Is It Even Possible For Patients To Be Consumers?
[…] Dr. Perednia makes some excellent points about the inability of patients to be true “consumers”, even in cases where they have their own money on the line. He notes that if you call your doctor’s office to find out the price of a procedure, they won’t be able to tell you because there are too many complexities in the health insurance system for the doctor to give you an accurate idea of what the cost will be. And if you call your health insurance carrier directly […]
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 […]
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.
HHS To Stop Accepting Early Retiree Reinsurance Applications After May 5, 2011
[…] Although the program has proven quite popular – as of last month, HHS had approved approximately 5850 applications – one of the concerns from the beginning was that the $5 billion allocated to the ERRP might not be sufficient to last until 2014. HHS said from the start that they would only accept applications as long as they had enough available funding. They have now announced that they will not accept any new applications after May 5, 2011. […]
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.
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. […]