For months now, one of the main arguments against the PPACA is that it doesn’t address health care costs or provide a means to pay for the reforms that it includes. Opponents of the reform law have used the money argument to drum up support for their cause, and – along with opposition to the individual mandate requiring everyone to have health insurance starting in 2014 – it remains one of the first things that people will mention when asked why they oppose the PPACA. […]
health insurance
High Risk Pool Eligibility
[…] 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. […]
Some Mini-Med Policies Are Better Than Others
This week’s Grand Rounds included an article by David Williams about mini-med plans that I thought was worth sharing. David explains that although he’s not a fan of mini-med policies, sometimes they are indeed better than nothing. Mini-med policies come in all shapes and sizes, and David’s article describes policies with $25,000 or $50,000 benefit maximums… a far cry from the $2,000 maximum policies that I wrote about earlier this month. […]
Mega And Mid-West Being Investigated Again
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. […]
NAIC Considering Transitional Period For New MLR Requirements
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
[…] 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
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
[…] 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.
Wal-Mart To Offer HRA For Employees
[…] The extra $1000 per worker that Wal-Mart is planning to contribute to the HRAs will definitely help employees to offset routine costs, and will hopefully encourage more of them to enroll in the company’s health insurance policy. But it will still be a struggle for many families to come up with the rest of the high deductible in the event of a serious illness or injury, if the family relies on wages from Wal-Mart to cover all of their living expenses.
Mini-Med Plans Don’t Really Help Workers
[…] 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
[…] 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.
Opposing Viewpoints On Amendment 63 In Colorado
Voters in Colorado will decide the fate of Amendment 63 next month, and the issue is definitely one of the more divisive ones on our ballot this year. The Denver Post ran a couple of editorials over the weekend that address both sides of the debate, and they’re both worth reading. Bob Semro, a policy analyst with the Bell Policy Center, explains why Amendment 63 is a bad idea, while Jon Caldera and Linda Gorman, both with the Independence Institute, detail the virtues of Amendment 63. […]
Narrow Provider Networks Not Likely To Please Patients
[…] As David pointed out, there’s also likely to be frustration for patients as providers move in and out of networks. This can happen regardless of the size of a network, but if networks are purposely kept small, it’s more likely to happen. Patients tend to be wary of having to find new doctors, and having to do so simply because of network changes isn’t likely to make people happy. Hopefully the idea of narrow provider networks won’t become a widespread trend with employers, medical providers, or health insurance carriers.
Regulators And Insurers Still Working On Child-Only Coverage Issue
[…] So far, none of the carriers who had backed out of the child-only market have commented on whether the open enrollment periods might make them change their minds, but AHIP (America’s Health Insurance Plans) has said that they are continuing to work with regulators to try to find solutions that would make the child-only market feasible for insurers in the future.
CBS Story Leaves Out Important Options For Kids
[…] As I said, I have no knowledge of this particular family’s situation. But child-only policies have always been rare, and there is usually another option for those children to obtain coverage. They can be covered as a dependent on a parent’s policy (which can now include policies in the individual market), by Cover Colorado, or possibly by Medicaid or CHP+. Even situations like Thomas Wilkes, who was maxing out the lifetime caps, now has a solution because Healthcare Reform has removed lifetime maximums. There is a long way to go, and this situation is frustrating. But if you ever hear anybody say that they have no options to get their child covered in Colorado, please pass this information along. I hope that Mr. Serrano signs Maria up for some health insurance today, whether it is on a family policy with him, Cover Colorado, or CHP+. We should not be hearing anymore stories about uninsured children simply because their parents aren’t aware of the options available.
Colorado Division Of Insurance Still Reviewing Rates
We mentioned last week that the Colorado Division of Insurance had not yet approved rates past 9/23 for several carriers, and unfortunately, that is still the situation. For carriers that allow any effective date, quotes can still be generated for 9/22, but carriers that only allow 1st and 15th of the month effective dates are unable to quote new policies now (and have been since 9/15) if their rates have not been approved. This is causing a bit of a traffic jam for people who are searching for a new individual health insurance policy right now. […]
Doctors Contracting Directly With Patients
[…] Personally, I would be open to the idea of seeing a family practice doctor who doesn’t contract with health insurance carriers, and paying for routine care out of pocket, if there were some way to combine that with a discount on our health insurance premiums… If the DocTalker Family Medicine idea were to become more widespread and if insurers could account for this type of care when setting premiums, I can see it making a lot of sense for healthy families who want to use health insurance for large medical bills and budget for smaller bills themselves.
Healthcare.gov A Good Resource For Brokers
I spent some time on the Healthcare.gov website this morning, and found some great resources that could be particularly helpful for people with pre-existing conditions who are unable to obtain coverage in the individual market. The website was set up in conjunction with the PPACA and was designed to help people navigate the myriad of health insurance options available, along with the changes that will happen over the next few years as the provisions of the PPACA go into effect. […]
Quoting Blackout On Most Plans and Effective Dates
Many plans with most carriers still haven’t gotten the rates approved past 9/23. These plans with carriers like Anthem BCBS can still be quoted with effective dates of 9/22 and before.
Carriers like Cigna only have 1st and 15th of the month effective date options. Therefore, rates and plans are not being quoted at all until the DOI approves their rates. Hopefully any moment.
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Health Wonk Review – Politics, Money and Health
Welcome to the Health Wonk Review. Health care costs, politics, and the economics of health care seemed to be the prevailing themes in the submissions this time, and there are some great ideas floating around here. Enjoy! […]
Access To Primary Care Is Only One Piece Of The Puzzle
[…] We need to make sure everyone has health insurance (first step in expanding access). We need to make sure there are enough primary care physicians (and other care providers) to go around. And then we need a systematic, coordinated effort between health care providers, hospitals, and health insurance carriers to make sure that everyone is on the same page. Expanding access to primary care is part of the solution, but it will only work in tandem with the other parts.
Colorado Hospitals Expanding
[…] I understand that each hospital needs to bring in enough money to pay staff, maintain the facilities, and – in the case of for-profit hospitals – make a profit for shareholders. But overall healthcare costs aren’t helped by duplication of facilities and high-tech medical gadgets. There has to be a balance between providing the excellent medical care, keeping things at least somewhat convenient for patients, and keeping medical costs under control. […]
Nothing Is Free
[…] For people with chronic health conditions who meet their deductibles every year, the savings with a high deductible health plan might be small or non-existent, and in those cases, more comprehensive coverage might make sense. But for people who are healthy, and insuring against potential future medical costs, it typically makes sense to minimize the amount that you’re guaranteed to pay (premiums) and accept a little bit higher exposure to amounts that you might have to pay (medical expenses that fall below the deductible). […]
Guaranteed Issue Policies For Children Happened Too Quickly
[…] Regardless of the practicalities involved, there’s no doubt that the headlines about insurers ceasing to issue child-only policies is generating some ill will and bad PR for insurance carriers. Either lawmakers knew that would happen, or else they put very little thought into considering the details of how insurers would go about making children’s coverage guaranteed issue a mere six months after the bill was signed into law, and just added the provision as a feel-good part of the bill.
More Americans Skipping Medical Care
[…] Copays and deductibles have risen for most families over the last few years, even those who don’t have policies that qualify as high deductible. And at the same time, economic stability has decreased for most families. This isn’t a good combination, and Joe’s right about the fact that when people skip necessary routine medical care, it will likely lead to increased medical costs (and declining health) in the future.