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Archive for the ‘Health Insurance’ Category

Week of August 29, 2011

The Congressional Budget Office (CBO) last week released an updated report on the nation’s budget and economic outlook that comments on a number of health care policy issues. First, the CBO says that if another physician payment “fix” is enacted by Congress (as has happened every year since 2003), then spending on Medicare could be significantly more than the amount projected in CBO’s baseline. Under current law, Medicare physician payments rates are scheduled to be reduced, but if those rates stayed the same through 2021 then Medicare outlays over the next 10 years would be 0 billion more than projected. The CBO also estimates that federal Medicaid spending will increase by less than 1 percent this year, compared to an average annual increase of 8 percent between 2000 and 2009. The slowdown is due to the expiration of increased federal assistance to the states for Medicaid in 2009 and 2010. Finally, CBO is anticipating a one-year delay in the implementation of the Community Living Assistance Services and Supports (CLASS) Program created under the Affordable Care Act (ACA). CBO projects the program won’t begin collecting premiums until 2013. Some in Congress have called for repeal of the ACA provision creating the CLASS program because of its long-term cost.

States  

Aetna participated in one of two “Exchange Listening Sessions” hosted by the Department of Health and Human Services (HHS) for community organizations and nongovernmental stakeholders. The meeting opened with an overview of the Notices of Proposed Rule Making (NPRM) on Exchanges, Plan Standards, Eligibility and Enrollment; Medicaid Eligibility and Enrollment and Tax Credits. Comments from advocacy groups essentially called for the following:

    Seamless interfacing of the eligibility system for Medicaid recipients, particularly the population impacted by the coverage expansion
    Credentials of Navigators (requiring more from community groups to avoid broker dominance)
    Parameters to constrain states from using flexibility as a guise to retreat from ACA requirements
    Improved foreign language translations of the material on the HHS website
    Stricter scrutiny of exchange board membership
    Alignment of Medicaid eligibility/enrollment rules with an exchange open enrollment period
    Integrating the exchanges with other public service agencies
    Requiring all carriers to contract with essential service providers

Joel Ario, Director, Office of Health Insurance Exchanges, remarked that the overarching goal of the exchanges was to expand consumer protections through greater transparency. His response to concerns about adverse selection was to point to the availability of the “young invincible” policy and the “3 Rs” — risk adjustment, risk corridors and reinsurance — as solutions. Regarding the potential for exchange products to not be affordable, Ario said the goal of the exchanges is solely to expand access and that the cost issue will be addressed by exchanges becoming “active purchasers”.
 
CALIFORNIA: As expected, consumer groups are threatening to push for a measure on the November 2012 ballot that would let voters decide on whether rate regulation of health insurance premiums should be allowed. Consumer groups plan to prepare the ballot language and submit the measure to the state Attorney General by November. Then the group will start collecting the 700,000 signatures necessary to qualify for the ballot. Exactly what the ballot language would require is not yet known, but it would likely look similar to legislation currently pending in the legislature.  The legislation would require prior approval of all health insurance rates, payment of intervener fees, approval of employer benefit design changes and rate rollbacks. Consumer groups seem to be turning their attention toward a potential ballot measure rather than the legislative vehicle since the bill has come under strong opposition from not only health insurers and business groups but also CalPERS, the League of Cities and the State Department of Finance.  

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In other news, the California Health Exchange Board selected Peter Lee as its Executive Director.  Most recently Lee was deputy director for the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services. Lee previously served as executive director and CEO of the Pacific Business Group on Health. That role is similar to the one that the exchange is expected to play on behalf of individuals and small businesses.
 
IDAHO: The legislature’s interim Health Care Task Force met last week to address issues that include federal health care reform and the future Idaho Health Insurance Exchange. Despite his hostility toward federal health care reform and his executive order prohibiting many activities that would implement the ACA, Governor C.L. “Butch” Otter indicated that the state would continue efforts to establish an exchange. Otter argued in support of the state’s acceptance of federal grant money to establish the exchange, stating that Idaho could see the loss of significant federal funds without quick action. Otter pointed out that failure to establish a state-based exchange would devastate health insurance agents in the state and would allow the federal government to dictate health insurance policy for Idaho. Noting that he does not need approval from the task force or legislature to apply for the grant money, the governor indicated that he had made the decision to pursue federal funds for an exchange.

Following the governor, representatives from the Idaho Department of Health and Welfare (Richard Armstrong, Director) and the Idaho Department of Insurance (Bill Deal, Director) made the case that action is necessary to address unsustainably high health care costs and inefficiencies in the marketplace. Specifically, they argued that operating the exchange at the state level allows the state to continue to govern the market, decide which carriers participate and pursue state-specific policies to assure competition and choice. According to regulators, the planning process for the exchange is underway and has thus far focused on obtaining stakeholder input and developing background research. Armstrong and Deal pointed to four potential courses of action for the state: apply for funding for an Idaho exchange; wait for lawmakers to decide options for an exchange; return/accept funding for an Idaho exchange based on state decisions; and decline to pursue additional federal grants, forfeiting the opportunity to decide on an exchange at a later date.
 
MICHIGAN: A 1.0 percent medical claims tax has passed both houses of the legislature and is now headed to Governor Rick Snyder for his signature. Having originated the idea in the Administration’s initial budget, the governor is fully expected to sign it.  The tax replaces the existing 6 percent tax on the state’s Medicaid HMOs and the .2 billion it raises for the Medicaid program. The law allows for a maximum of 0 million to be collected from the medical claims tax, which would permit the state to receive another 0 million in federal matching Medicaid dollars for calendar years 2012 and 2013.  Aetna argued against the legislation, as did many Aetna customers. The tax was not defeated, but opponents were able to mitigate portions of the tax, including: 1) the sunset date was moved up from 2016 to January 1, 2014; 2) the start date for tax payments was moved back to 30 days after the end of a quarter rather than payable monthly beginning in October 2011; and 3) a hard cap of 0 million is ensured in 2012 and 0 million with medical inflation in 2013, rather than a soft cap that could have potentially made payers liable for millions more each year.
 
NEW JERSEY: Last week the state Senate took action on a bill that would create the New Jersey Health Care Reform Implementation Council, with the intent of positioning the state to comply with new health care reform rules and regulations and reap additional federal assistance.  The newly established council would be a 29-member panel of experts, policymakers, health care providers, academics and advocates to make recommendations for keeping New Jersey in compliance with federal health care reform and ensure the state maximizes federal aid. Under the bill, council members would serve for a period of five years, with the expiration of the first term in office staggered to continue the operations of the council. The council would be required to report to the governor and the legislature annually as to their activities and policy recommendations.  With the full Senate’s approval, the bill now moves to the Assembly for consideration.
 
OKLAHOMA: Insurance Commissioner John D. Doak recently commented on the existence of faith-based health care sharing ministries and his department’s ability to respond to related consumer complaints. In the latest issue of the “Commissioner’s Corner,” Doak said that while faith-based sharing organizations might be an option to make health care more affordable, consumers cannot bring consumer complaints to the Oklahoma Insurance Department for resolution. Instead, they will have to settle any potential disputes with their health-care sharing ministry on their own.  He encouraged consumers to consider this factor as they weigh the decision on whether to join a health-care sharing ministry.
 
WASHINGTON: Governor Chris Gregoire has announced that she is bringing back Fred Olson as her deputy chief of staff.  He served in that role until December 2006, when he decided to retire. Olson, is a former reporter and managing editor of The Olympian, and has held posts at the Attorney General’s Office and Department of Ecology.

WISCONSIN: The Office of Free Market Health Care (OFMHC) has released a report titled “The Impact of the ACA on Wisconsin’s Health Insurance Market” that forecasts specific impacts on the individual and small group markets through 2016.  The Department of Health Services contracted with Gorman Actuarial, LLC and Jonathan Gruber of MIT in 2010 to conduct the report.  The report includes the following findings:  1) by 2016, the number of uninsured is projected to decrease by 340,000, or 65 percent; 2) 57 percent of the individual market (91,000 members) will be eligible for tax subsidies within the exchange; 3) the individual market will experience premium increases as compared to pre-reform premiums; 4) after the application of tax subsidies, 41 percent of the individual market will experience premium decreases as compared to pre-reform premiums; 5) the merging of the individual market with the HIRSP market will increase individual market premiums by 16 percent; 53 percent of the small employer groups will experience a premium increase as compared to pre-reform premiums;  6) in 2016 the traditional individual market will see an 83 percent decline, losing 150,000 members, while the newly reformed market will grow to 320,000 new enrollees.

There are quite a lot Americans who are living without health insurance today. It is not a proud thing to admit, but the government is trying to do things to help them. The death toll is high enough, and medicine is expensive, so you do need to sort something out. You don’t have to wait for the government if you can get it yourself.  And many times it is actually available at a much cheaper price then you may imagine. Easy To Insure ME has the answers

Even if you cannot afford comprehensive health insurance, you can start with whatever little you do have and build up from there. Anything might occur for which you need medical attention at any time, and the health insurance package you get today could be what saves you.

Think of it this way. Without health insurance, you are a sitting duck for any disease or medical condition out there. When the day arrives and the doctor insists that you have to make payment before you can get the healthcare you need to stay alive, you may find things very uncomfortable for you. And you could have taken care of it with a simple health insurance package.

It would be a shame to die of a disease simply because you could not afford to pay for the treatment or procedure. If you had health insurance perhaps things would not have gotten so out of hand. That would be your fault and no one else’s, as it is perfectly possible to get a policy established with a minimum of fuss.

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One very quick way to approach the situation is to get some affordable health insurance quotes online that can quickly give you an idea of the type of prices that you may have to pay for health insurance cover.

If you cannot pay for your health insurance yourself, ask if you employer can help. It could beconsidered  in the same terms as a small loan perhaps, one that you may have to pay back to them eventually. Or it could be a small deduction from your salary, which is even more common. Regardless, however small the package you can get, it is better than nothing at all.

If you plan to live for very long on this earth, you want to see that you have health insurance. It is important. With people dying from treatable causes only because they can’t afford the treatment, you certainly don’t want to be one of them.

I never understood the importance of a health insurance plan until I saw the movie ‘John Q.’ All of a sudden I realized I had been walking the tightrope my whole life. I could suddenly find myself in a situation in which I cannot afford the medical attention I needed, and that would be a big problem. I changed that status immediately and got covered because it hit me how big a problem it could end up being.

Sure health care in the United States is not cheap, and that is why there is such a huge market for health insurance as there is today. Thankfully, affordable health insurance is all around you if you have the sense to go for it. Sincerely, you don’t have to have the most expensive policy out there. Something simple and basic should do until you have more funds.

It doesn’t matter that you are not rich. You need to get this figured out. The fact is that with health insurance you can have the insurance firm paying your medical bills every time you have to seek medical attention. All it takes is ensuring that your monthly premiums are paid in good time.It is definitely an expense. But it is unfortunately a basic one that you should be having. The days when health insurance was a luxury are long past. We live in a dangerous world, and you need to buckle down and get it sooner rather then later.

The latest rollout of the federal health care overhaul offers consumers a rebate if their insurers spend too little on actual medical care and too much on administrative costs. Easy To Insure ME has the answers

But Floridians may miss out on the rebates that will start in 2012.

Pressed by the insurance industry, state regulators will soon ask the federal government for a waiver from the requirements, which begin Jan. 1.

The Florida Office of Insurance Regulation confirmed Tuesday it will request a reprieve until 2014, when the health care law’s coverage guarantees kick in.

In a written statement, the office said enforcing profit limits in 2011 could “disrupt” the insurance market in Florida, where 4 million people are uninsured. Commissioner Kevin McCarty was not available for questions.

The state already is suing to overturn the health care law.

The new requirements are supposed to help increase the value of coverage for consumers and make health insurers “more accountable” by publicly reporting spending and premiums, federal health officials say.

Consumer advocates, such as Consumers Union, publisher of Consumer Reports, largely consider the requirements a win. The idea of a waiver — similar moves are afoot in Georgia, Iowa, Maine and South Carolina — got a tepid response.

“We generally feel the industry does cry wolf,” said Walt Dartland, executive director of the Consumer Federation of the Southeast. “Our position is generally when we have an issue like this, we’re against the waiver — you’ve got to prove that.”

Essentially, the rules require insurers that offer small group and individual health plans must spend 80 percent of their revenue on care outside administrative costs. Large group insurers — plans covering 50 or more people — must spend 85 percent of their revenues on care.

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It’s called the “medical loss ratio.” If it’s too high, rebates will become due in 2012 in an account credit or payment.

Nationally, 9 million people would be eligible for rebates averaging 4 for individual policies, according to the U.S. Health and Human Services Department. Group plan figures weren’t available, nor were Florida rebate values.

The new rules announced Monday apply to 75 million Americans. Self-insured plans aren’t included.

Currently, Florida requires insurers to operate at 65 to 70 percent loss ratios. The insurance office plans to ask for a waiver for the small group and individual markets, though it said it needs at least two more weeks to finish the request. U.S. Health and Human Services Secretary Kathy Sebelius would decide whether to grant it.

After months of federal review, insurers won breaks but failed to get a broader array of business costs factored into medical spending. For example, plans with fewer than 75,000 members will get adjustments to help them comply, and ones with fewer than 1,000 members will be exempt from the rebates.

Nearly all taxes can be figured into the ratio, as well as spending to improve health care.

And states can win waivers to use lower rates if they show insurance would be disrupted by higher requirements.

Florida insurance executives complained the tougher requirements will disrupt their finances and limit their ability to insure people.

Without a waiver, some insurers could be forced to lower their rates to meet the threshold or find a creative way to pay for rebates, said Blue Cross Blue Shield of Florida executive Randy Kammer, a member of the industry-dominated Florida Health Insurance Advisory Board, which endorsed a waiver in September.

Blue Cross Blue Shield of Florida, the state’s largest insurer, expects to meet the requirement. A nonprofit, the insurer faces less financial pressure from Wall Street, said Kammer, vice president for regulatory affairs and public policy.

But others face steeper costs. About 45 percent of people nationally who buy their own insurance are in plans exceeding the limits, according to federal officials

An analyst for Citigroup estimated last month that Golden Rule, a subsidiary of United Healthcare, would face .1 million in rebates for its 119,000 insured Floridians, based on 2009 figures.

That’s a 9 average rebate in Golden Rule’s biggest state.

At a Sept. 24 state hearing to gather evidence for the waiver, Golden Rule vice president Mike Corne warned that customers could face fewer options for insurance because of the crunch imposed by tougher profit limits.

Customers, who often seek Golden Rule individual policies absent a workplace plan, could find fewer companies willing to add new policies, and fewer businesses seeking a place in the market, said Corne, arguing for a phased approach.

“We will figure out how to adjust our business model, but I think we would be better off with handling this over time,” Corne said.

An article in the Thanksgiving edition of the Atlanta Journal-Constitution shows the myriad inconsistencies and irrationalities of the new health insurance overhaul law — dubbed “health care reform” — and spells out how the federal government is paving the way for the demise of the health insurance broker. Easy To Insure ME has the answers

Some incredible excerpts taken directly from the story, and my highly insightful comments:

“The process of creating this new way to shop for health insurance will be costly and enormously complicated.” — Duh, they want to reinvent the wheel…of course it’s going to be expensive and cumbersome! Imagine, if you will, the federal government requiring the states to come up with a plan to create a new distribution system for consumers to buy food products, even though we already have  a system called “the grocery store.” A daunting task? You bet! And frankly, not necessary.

“States that take on the task of running an exchange will have a significant amount of discretion that will determine the level of competition, the amount of choices for consumers and ultimately whether market forces work to help control insurance costs, as the law intends.” — So, the Obama Administration and Congress believe that the states should control competition among privately owned businesses, and also allow them to determine whether or not to allow the market to control costs. Yeah, show me any state or federal agency that allows the American public to determine how much taxes are taken and what is spent by the government, and I will show you a pit bull that prefers bon bons over raw meat. The states will determine whether or not the market should dictate costs? Which way do you think they will go with that…set the costs themselves, or allow the market to do it?

“Anybody who shops on the Web today for products where they can go up there and put in preferences and pull up a set of choices that are relevant to those preferences, for a hotel or an airline or whatever, that is the vision of the exchange for health care,” said Joel Ario, director of the Office of Health Insurance Exchanges at the U.S. Department of Health and Human Services. — OK, if that isn’t seen as an overt indication that the Obama Administration and its operatives consider the broker to be completely irrelevant in the health insurance distribution process, then I don’t know what does. It is reminiscent of earlier this year, when a staff blogger at USA Today wrote that the health exchange system originally proposed by the House would imitate Travelocity, since the fed would control the entire thing, which the Senate version (closer to what we now have) would allow the states to manage it. It appears, however, that Mr. Ario, a onetime Pennsylvania insurance commissioner who worked directly with carriers and brokers, has swallowed the Kool-Aid and seems to think that providing health care coverage is as easy as reserving a room at Motel 6.

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“Most employees of large companies should expect to continue to get their coverage at work, experts said. But some small and medium-size employers could end up dropping their coverage and shifting their workers to the exchange. How many companies might do that is a big unknown.” — speaking as an experienced journalist who seeks to back up blanket statements with facts, I have to say that this is one of the most irresponsible and egregious acts of unprofessional journalism I have seen in recent memory, and also one of the biggest misconceptions if not outright lies proffered by those in favor of state-run health insurance. What facts does the writer use to back up her assertion that “most employees of large companies” will continue with employer-sponsored coverage? Did she quote any employers, to at least show anecdotally that employers will keep employees covered? Or is she relying simply on unnamed “experts,” whose affiliations are conveniently omitted from the story? And “some” small and mid-size companies could put workers on the exchange? Is this again from the “experts?” Or is this complete conjecture? It appears to be. At least the writer is being upfront when she states that it is a “big unknown,” but making such concrete statements such as “most” and “some” and then admitting that it is really unknown, is poor form. In reality, we might see a majority of American workers form both large and small firms pushed onto the exchanges, where they will not only have to find their own insurance (required by law), but pay for it out of their own pockets, at rates that will likely be higher than what the employer was paying in the first place. Nice.

“The way the law is written, some employers will be penalized for failing to offer coverage. But paying the penalty might be more cost-effective than providing the coverage.” — Strike the word “might” and replace it with “will,” and this statement will be accurate. Employers will drop coverage and the employees will be forced to go onto the exchange. And brokers are out of that mix entirely.

Georgia’s governor, governor-elect and attorney general are all against the federal law and trying to thwart it, but are working within the law to ensure that at the state level, at least, it matches to the best of their ability a free market exchange.

Without getting into a big Constitutional question (which, actually, is at the heart of the lawsuits instituted by the states against the law), it is incredible that the top elected officials of our country would enact legislation to force states to do something that they neither want to do nor have the resources to do, and take what some say is a disjointed system of state-based insurance regulation, and turn it into a black hole of regulation and uncertainties that could prove disastrous.

Right now, the broker community is the navigator holding the compass and telescope on the ship, “USS Purchasing Health Insurance.” The federal government has decided that it can do a better job for the crew and passengers, and is putting the broker on a life raft and pushing it out to sea, while telling the passengers that the ride will now be smoother and easier.

The only thing that is missing is Gilligan and the Skipper.

The group health insurance rates at my day job increased 33% this year, after rising just over 30% last year. I have a family of three, and the new health insurance rates are now 11% of my salary, which in my opinion, is too high (while I won’t disclose my actual salary, I will state that I earn a fair amount). The new health insurance rates made me think about getting individual health insurance for my family.

Group vs. individual health insurance? Before we go further, it is important to understand the difference between individual health insurance and group health insurance. Basically, group health insurance plans guarantee all members of the group coverage, regardless of their health risk. Because coverage is guaranteed with group plans, they can be more expensive for relatively healthy individuals than an individual plan, which is priced based on your specific health history. In my case, my family and I are healthy, so it is a good idea to investigate individual health insurance options.
Determine your health insurance needs to find the best plan

When comparing health insurance plans, it’s important to make sure you are not only comparing apples to apples, but also getting the best plan for your needs. Make sure you get the best health insurance plan for your needs, whether that is an HMO plan, PPO plan, high deductible health insurance plan with a health savings account, hybrid, or other. [More on health insurance options].
Finding and purchasing health insurance while self-employed

One of the biggest concerns among the self employed individuals is health insurance costs, which can be expensive. Some self-employed individuals may be eligible for a group health insurance plan if they meet certain criteria, or they may be eligible for other health benefits, such as COBRA benefits. For example, if you are leaving a traditional job to become self-employed, you may be eligible for COBRA. If you are not leaving a job that offers health insurance, then ignore the tip regarding COBRA coverage.