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Individual/Family Health

Women And The House Health Care Reform Bill

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Not surprisingly, House Democrats are going after the female vote by including several provisions in the current draft of their health care reform bill that are designed to expand coverage and reduce premiums for women. For starters, the bill includes a ban on using gender as a factor in setting premiums. This will result in lower premiums for women, but higher premiums for men. In Colorado, men are currently more likely than women to be uninsured. Raising their rates to compensate for lowered rates for women might result in more men being uninsured. But in terms of overall fairness, it does make sense to charge the same rates for men and women.

Specifically forbidding the practice of denying coverage to domestic violence victims is also part of the House bill, and will likely receive widespread support from both women and men alike. But in the eight years since we started selling medically underwritten health insurance, I can’t remember a single time that an applicant was declined for being a victim of domestic violence, nor have I ever seen a question on any application asking if the applicant has been abused. So while this provision makes sense, and will no doubt be beneficial for a few people, I imagine its strongest impact will be in helping to rid us of “blaming the victim” mentality […]

Health Insurance Premiums And Age

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How much should age play a part in determining health insurance premiums? That’s a question that lawmakers are debating, and one that might require an answer that is more strategic than it is fair. In general, older people have higher health care bills than younger people. Because of their lower claims, younger people currently pay much lower premiums for health insurance than older people. But they continue to be the most uninsured segment of our population.

In 2007, the Lewin Group released a report for the Colorado Blue Ribbon Commission for Health Reform. It showed that 38.7% of Colorado residents age 19 – 24 were uninsured. This was far more than the next highest category (27.1% of people age 25 – 34 were uninsured). Several factors contribute to the high percentage of young people who are uninsured. They tend to be healthy, and thus aren’t as likely to see the value in health insurance. They tend to work in entry-level jobs that aren’t as likely to provide health insurance benefits. And they usually have lower incomes than older workers, making health insurance – even if it is cheaper for them – harder to afford […]

How The Pharmaceutical Industry Drives Health Care Costs

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My father has been on dialysis for eight years. He has Wegener’s Granulomatosis, a rare autoimmune disease, and it destroyed his kidneys very suddenly in 2001. His illness came out of the blue, following a lifetime of good health, and has given my parents an up-close look at our health care system. Because he has kidney failure, my father qualified for Medicare. But until the advent of Medicare Part D in January 2006, my parents had to pay for all of his medications out of pocket.

Dialysis does not remove phosphate, so my father has to be on a drug that prevents phosphate from building up in his blood. In 2002, he was on PhosLo, a brand name drug, because the generic wasn’t available. At that time, a three month supply cost $108.25. Now, seven years later, he takes the generic version (calcium acetate) and a three month supply is $528.29 (a 488% increase in price). Humana, his Medicare D carrier, picks up the tab, but we all know that claims […]

What Guaranteed Issue Without A Mandate Looks Like

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[…] Yes, companies like Wellpoint are in business to make a profit. But that doesn’t mean that everything they say in the health care reform debate should be dismissed. If we don’t make sure that everyone becomes part of the health insurance pool, we’ll likely be looking at fewer health insurance companies and far higher premiums after a few years of guaranteed issue policies.

How Current Reform Proposals Would Impact Colorado Premiums

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[…] Wellpoint actuaries have crunched the numbers and come up with their best estimates as to how premiums would be impacted in the 14 states where Wellpoint operates. Colorado is one of those states, and for the first time we’re able to see a detailed analysis of what would likely happen to premiums for people here. […]

Increased Cost Sharing Reveals The True Cost Of Health Care

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[…] There’s no doubt that a co-insurance based system would make people more aware of what health care actually costs. Nobody should have to devote their life to trying to obtain coverage for a serious medical problem, but on the other end of the spectrum, perhaps nobody should be paying only $15 to see a doctor, and a deductible of a couple hundred dollars a year. […]

Obesity As A Pre-Existing Condition

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[…] I can see the benefit to making sure that everyone gets accepted for health insurance, as it’s counterproductive for society as a whole to have people who are uninsured. But I believe that it makes sense for obese applicants, and tobacco users, to pay more for their health insurance in order to offset the higher claims they are statistically likely to have. […]

Expanding Access To Cover Colorado

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I have often wondered about the feasibility of Cover Colorado expanding their eligibility to attract healthier applicants and perhaps improve their loss ratio. The state high risk pool health insurance policy – has claims expenses that far exceed premiums collected. Fees on private health insurance companies and a grant from Medicare help to make up the difference. […]

John Mackey And Health Care Reform

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[…] But with any commodity in the marketplace, there will always be people who can’t afford it. The life or death nature of access to health care makes it too important to place it on the same shelf as cars and jeans and high-end organic potato chips. It people can’t afford (and thus don’t purchase) those things, they will still be ok. The same can’t really be said for health care.

Playing With Fire

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I just read this article from NPR and Kaiser Health News about Lyn Robinson, a 52 year old woman who has chosen to be uninsured. Lyn is very healthy. She leads an active life and takes good care of herself. She pays out of pocket for alternative health care like acupuncture and chiropractic care – things that often aren’t covered by health insurance policies anyway. […]

Setting Minimum Standards For Health Insurance Policies

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[…]In Colorado, we have the health plan description form that is standardized and makes comparing plans somewhat simple. But it tends to get buried in marketing materials, and is often overlooked by consumers. I would take this a step further and make sure that all plans – regardless of where they are sold – clearly state the important details up front.[…]

Fines Are Not The Same Thing As Taxes

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[…] Most people without health insurance aren’t uninsured by choice, and don’t need the threat of a fine to motivate them to try to get coverage. The fines are to motivate people who can afford health insurance but would otherwise choose to go without (potentially transferring the cost of a significant emergency room bill onto the population that does pay for health insurance). […]

Colorado Senator Morgan Carroll On Health Insurance

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Colorado state senator Morgan Carroll has written a very persuasive article about why we should end gender-based pricing in the individual health insurance market. I agree that it makes more sense to average premiums across the entire population, but I also understand that doing so would mean a rate increase for men to offset the rate decrease for women. […]

Why Mandatory Health Insurance Makes Sense

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[…] no matter how careful we are, we never really know what is around the bend when it comes to our health. Accidents can happen to even the healthiest people. Freak illnesses can strike otherwise healthy people. And when these situations arise for people who are uninsured, the cost is eventually borne by those who have health insurance.

The Impact Of Medical Underwriting On Premiums

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[…] Many proponents of a shift away from medical underwriting want to require everyone to carry health insurance. That would help spread the cost of care across a larger population, and would likely help to contain the price increase that we would see if medical underwriting were to cease. But my guess is that we would still see a rather dramatic increase in premiums.

Drug Industry Wrongs Impacting Health Insurance Benefits

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Pfizer was also illegally marketing Bextra, Lyrica, and Zyvox. They have settled for a record $2.3 billion, but Dr. Zhang points out that the sum is equal to three weeks of sales at Pfizer. Seems a bit paltry when you think about it. It’s like fining the average family a couple thousand dollars. Sure, it would sting a bit, but it wouldn’t really take that long to pay it off and forget about it. […]

Outcome Based Incentives For Doctors

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[…] In order to truly provide quality care, a doctor is likely going to have to spend more time with sicker patients. This should be reflected in how the doctor is compensated, along with the outcome-based incentives. There are ways to implement an outcome-based incentive system for doctors while at the same time making sure that they aren’t encouraged to avoid the sickest patients.

Marketing in Disguise

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I almost tossed it. But then I saw the notice across the front of the envelope: “Attention Rural Co-operative Members. You may now qualify for a Hospitalization Policy that helps pay outpatient expenses.” My curiosity was piqued, given the health insurance co-op ideas that have been tossed around this summer […]

Differing Opinions On Health Care Reform

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[…] What makes this story different from most of the other ones out there is that Loralee got to speak with Valerie Jarrett at BlogHer last month, and has written a very detailed post about the experience. Loralee describes herself as a moderate Republican, but is very much in support of health care reform as proposed by the current administration. […]

The Counter Productive Death Panel Concept

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[…] There are two sides to the health care debate, and plenty of misconceptions. Genuine access to health care for all Americans is vitally important. But so are the financial implications – both on a personal and national level – of any health care reform bill. To discredit either side flippantly is disingenuous, but so is using terms like “death panel” to incite fear and anger instead of rational discourse.

Cooperatives And The Colorado Health Insurance Market

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[…] One of the criticisms of the private health insurance industry is that there isn’t much real competition. Proponents of the co-op idea believe that co-ops would increase competition and thus drive down costs. I’m sure that this is the case in some markets, but here in Colorado we have a pretty robust health insurance market, with lots of companies competing with each other. […]

Not Just Health Insurance That Needs Reform

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Has anyone else noticed that the the term “health insurance reform” has started to be used in place of the term “health care reform”? Perhaps reform proponents are counting on the poor perception of the health insurance industry held by many Americans. By renaming the reform, perhaps they believe that more people will support it. […]