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Individual/Family Health

Colorado Bill Would Allow Employers To Reimburse Employee Premiums

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The 2011 Colorado legislative session is now underway, and Senate Bill 19 will be particularly interesting to watch. Since 1994, Colorado has had a law that bans employers from reimbursing employees for individual health insurance premiums. If any portion of the premiums for such plans are paid or reimbursed by the employer, the Colorado Division of Insurance considers the employer to have created a small group health insurance plan, and the plan must adhere to small group regulations (this impacts things like underwriting, and also has tax implications for the employer). […]

Health Care Costs Are The Driving Factor Behind Premium Hikes

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I’ve long supported the idea that our health care system was in need of reform that would make care more affordable and accessible to everyone, regardless of their health or financial situation. But I’m starting to feel a bit frustrated by what feels like an over-emphasis on regulation of health insurance carriers and not enough focus on ways to actually control the cost of health care (including over-utilization). If people are thinking of this process as health insurance reform rather than health care reform, it’s doomed to failure. […]

Humana 2011 Rates Are Official

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Clients in Colorado can now get quotes and apply for HumanaOne with effective dates of 1/1/2011 or later.  Remember, these will include maternity coverage as a base benefit.  Existing members with an Enhanced, Copay, HSA, or Value plan will receive these benefit changes at the time of their renewal. For clients who have an Autograph,… Read more about Humana 2011 Rates Are Official

Double Digit Premium Increases Continue In Colorado

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The Colorado Division of Insurance issued a press release on Monday, addressing the fact that health insurance premiums in Colorado are continuing to increase. They reiterated some numbers from earlier this fall, noting that less than 5% of the overall rate increases for next year can be attributed to changes implemented by federal health care reform. The vast majority of the rate hikes that insureds will see in 2011 are due to factors that have been driving health insurance premiums for years, long before federal reform became an issue. As long as the cost of health care continues to rise, the cost of health insurance will rise along with it. […]

Consumer Reports Health Insurance Rankings

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I recently picked up a copy of the November issue of Consumer Reports, which included a section about health insurance. The article featured an interview with President Obama, and a good overview of how the changes included in the PPACA will impact consumers. In addition, Consumer Reports published a ranking of 227 HMO and POS (point-of-service) plans (you have to subscribe to Consumer Reports Health in order to be able to see the details online), according to data compiled by the National Committee for Quality Assurance (NCQA). […]

The Future Of Employer Based Health Insurance

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[…] I can’t imagine huge numbers of people simply opting to be uninsured if employers stop offering coverage, especially once individual health insurance is guaranteed issue and pre-existing conditions are no longer an issue. I would guess that in 2014 we will see at least some shift away from employer-sponsored coverage in favor of individual health insurance, but I imagine that plenty of employers will continue to offer at least some level of coverage as a way to attract and retain quality employees.

Most Americans Do Not Get To Make Their Own Health Insurance Choices

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This article is not the first I’ve seen that calls into question whether Obama was being truthful when he said that health care reform would be structure so that people would still be able to keep their existing health insurance if they wanted to. And it would seem that his statements did amount to a bit of over-promising. But even before the PPACA came up for a vote, many Americans weren’t in control of whether or not they got to keep their existing health insurance. […]

Grand Rounds Submissions

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We’re honored to be hosting the next Medical Grand Rounds on November 30th. Grand Rounds is a weekly gathering of the best health and medical articles written by doctors, nurses, students, patients, and others in health care related professions.

Please submit your favorite articles to Louise at louisen78 [at] gmail [dot] com before 10:00pm MST of November 29, 2010.

Please include the authors name, article title, url, and a brief description of the article.

This week, enjoy the first Grand Rounds to ever be hosted on Facebook by Amanda Brown DVM

430 People Already Enrolled In GettingUsCovered

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[…] Even when policies are free or very low cost (such as Medicaid or Child Health Plan Plus), a significant number of eligible individuals continue to go without coverage, for a myriad of reasons. So it stands to reason that plenty of uninsured people who are eligible for GettingUsCovered won’t apply. Some likely aren’t aware of the availability, and many others simply can’t afford to pay the premiums. But apparently Colorado is enrolling people at a fairly fast pace – as of November 1, there were 20 states that had fewer than 50 people enrolled in their newly-created high risk pools.

Funding Cover Colorado

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For nearly two decades, Cover Colorado has been providing health insurance to people in Colorado who don’t have access to group health insurance coverage and have pre-existing conditions the make them uninsurable (or unable to get coverage without exclusion riders or rate increases that put their premium above that offered by Cover Colorado) in the individual health insurance market. While we’re lucky to have such a resource, it doesn’t come cheap […]

Health Reform Not Having Much Impact On Colorado Premiums

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Although the increases we’ve seen this year are similar to what we’ve seen over the last several years, there have been more questions since the PPACA was signed into law in March about whether federal health care reform is the driving factor for this year’s increases. To clarify, the Colorado Division of Insurance has released a statement noting that federal health reform is responsible for less than 5% of the total health insurance premium increase in Colorado this year. […]

High Risk Pool Eligibility

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[…] There is another significant difference between Cover Colorado and GettingUsCovered, in terms of eligibility. Both plans allow eligibility for applicants who have one of several specific medical conditions, and both plans accept applicants who have either been declined by a private insurance company or offered coverage with a pre-existing condition exclusion. But while Cover Colorado also allows people to enroll if they have been offered a private policy with a rate that is higher than a comparable Cover Colorado plan, GettingUsCovered does not allow this option. […]

Mega And Mid-West Being Investigated Again

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A west coast legal firm has launched an investigation into the market conduct of Mega Life and Health Insurance Company and Mid-West National Life Insurance Company. Their parent company, HealthMarkets, Inc., is also being investigated, along with the two shareholders (Blackstone Group, L.P. and Goldman Sachs Group, Inc.) who purchased HealthMarkets in 2006 for $850 million. […]

The Wisdom Of Evidence Based Medicine

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David mentioned that “…ideologues would call this rationing.” I couldn’t agree more, and I think that research like this is the best defense against those who criticize any sort of evidence-based medicine that results in less treatment – but better or equally good outcomes. The word rationing has a bit of a negative connotation in our culture. It conjures up images of people standing in line for hours to get a loaf of bread, or only being allowed to buy five gallons of gasoline at the pump. It makes us think of hardship and having to do without things that we need. I believe that people who are opposed to scientific, evidence-based medicine are capitalizing on the public’s general dislike of the concept of rationing […]

NAIC Considering Transitional Period For New MLR Requirements

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The National Association of Insurance Commissioners is meeting this week to figure out the specifics of how the new medical loss ratio (MLR) rules should be implemented, and they’ll be voting on the issue tomorrow. Basically, health reform law calls for health insurance carriers to be spending 80 – 85% of premium dollars on medical care as of January 1, 2011. But the insurance industry would prefer to see the increased MLRs phased in gradually. They say that they can meet the new MLR requirements over the next few years, but that trying to do so all at once by the first of the year will only serve to drive some carriers out of business entirely. […]

Baseless Fear Mongering Hurts The Healthcare Reform Debate

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[…] There’s nothing wrong with being opposed to all or part of the health care reform law. However, it’s not factual to call the PPACA “socialism”. It’s does a disservice to voters to say that the reform law contains “death panels”. It’s not factual to say that patients will have to go to a bureaucrat before seeing his or her doctor. Spreading this sort of misinformation is truly harmful to the debate. Rather than discussing the actual facts of the law and searching for sensible solutions and compromises, fear-mongering sound bites with no basis in reality only serve to get people riled up.

Maternity Coverage In The Individual Health Insurance Market

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The House Committee on Energy and Commerce released a memorandum this week detailing the practices of the four largest private health insurance carriers (Aetna, Humana, UnitedHealth Group and Wellpoint) regarding maternity coverage on individual policies. For anyone who is familiar with the individual health insurance market, the details of the memo will come as no surprise. But since the majority of Americans are covered by group health insurance plans that cover maternity just like any other claim, the details of how maternity coverage works in the individual market may be eye-opening for a lot of people. […]

A Compromise That Makes Sense For Child-Only Policies

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[…] Even with guaranteed issue open enrollment periods for child only policies, insurers would definitely be taking on an increased risk compared with what they had when all individual policies were medically underwritten. If insurers could be allowed to continue to accept healthy kids (who present less of a financial risk to the carriers) throughout the year, this would help to offset the losses that they would incur by insuring the unhealthy kids who enroll during the open enrollment period. Regardless of whether that’s in line with the “language and intent” of the PPACA, it makes sense in the real world.

Mini-Med Plans Don’t Really Help Workers

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[…] HHS wants to protect employees from losing their mini-med plans, and has issued the waivers in order to help those employees keep their policies in place. But I wonder if that’s actually the best thing for the workers involved? Some of the policies in question might be better plans that have annual limits nearly as high as the minimum required by the PPACA. But is it really beneficial to workers if we help them keep policies with $2000 annual caps?

The Perils Of Not Having An Individual Mandate

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[…] Are we comfortable with allowing emergency services providers to turn away patients who are uninsured and cannot pay upfront for their care? If we are not, then the rest of us are paying for their care (indirectly, through higher health insurance premiums). And if we are, we find ourselves right back in the debate about whether it’s ok for firefighters to watch a house burn to the ground because the homeowner didn’t pay his fire protection fee. It seems that we all like having choices until we make the wrong choice one day.