[…] So although I agree with Senator Lundberg when it comes to what’s available in Colorado, I don’t think we can necessarily extend that generalization to all states. And the subsidies (only available in the health insurance marketplaces, aka exchanges) have to be taken into consideration too, since those are the overwhelming “carrot” that officials are hoping to use to entice millions of currently uninsured middle-income Americans onto the health insurance rosters. In a state like Colorado, we probably could have done just fine by adding subsidies to our current system. We already had a solid high risk pool (not all states did) and we’ve already been making progress in terms of general reform and access to care. So the changes brought by the introduction of the ACA and the health insurance marketplace in Colorado might not be as significant as they will be in other states. That perspective – as well as the idea that we’re all in this together as a country rather than a bunch of isolated states – is helpful in terms of understanding “why all the fuss” about setting up marketplaces that might seem to duplicate a lot of existing services. In some places, yes. In others, definitely not.
Archives for January 2013
It’s a Health Insurance Marketplace, Not An Exchange
HHS has officially started referring to “marketplaces” instead of “exchanges” when describing the state-based online venues where people will be able to purchase health insurance and receive income-based subsidies starting in 2014. Some are calling this a sign that HHS is desperate to garner approval for the ACA-created system for purchasing individual and small group… Read more about It’s a Health Insurance Marketplace, Not An Exchange
Small Improvements In Healthcare Lead To Big Overall Cost Savings
[…] Both of these scenarios describe changes that need to be made anyway in order to improve healthcare outcomes (fewer injection errors and fewer c-sections would be better for patients), and together they would result in $10 billion in healthcare cost savings. If we identify numerous similar situations – and implement changes needed to make improvements – we could make significant headway in reducing the cost of healthcare, which would in turn reduce the price of health insurance.
Strengthening The ACA Individual Mandate
Many people have expressed concerns that the mandate portion of the ACA isn’t strong enough to balance out the expected sharp increase in premiums that will accompany guaranteed issue coverage starting next year. Open enrollment windows are a possibility, but I’m not the only person who has noted that compressing each year’s applications into a… Read more about Strengthening The ACA Individual Mandate
Individual Health Insurance Premiums And The ACA
Chris Fleming hosted the Inauguration Edition of the Health Wonk Review this week at Health Affairs Blog, and it’s an excellent compilation of articles. The article written by one of our favorite bloggers, Maggie Mahar, about health insurance premiums in 2014 and beyond caught my attention, because that’s an issue we’ve been watching closely for some time. It’s a question that’s on a lot of minds right now – especially for people who buy their own health insurance and are in the segment of the population that is most likely to experience changes (in coverage, premium, how policies are purchased, etc.) in 2014. Jay and I not only work in the individual health insurance industry, but we’re also policyholders – we’ve have individual health insurance since 2003. We’ve had two carriers and several plan designs over the last decade, and we’ve experienced double digit percentage rate increases nearly every year (somewhat offset by the fact that we’ve been willing to increase our deductible and out-of-pocket limits several times).
We currently pay just over $400/month (for our family of four) for an Anthem Blue Cross Blue Shield CoreShare plan with a $3500 deductible and another $3500 in coinsurance. We know that our rate will go up in the fall – it always does – but how much? How much will prices go up for all of our clients who are covered by all of the biggest health insurance carriers in Colorado?
I don’t know the answer to that question. And I don’t think that anyone really does. The post Maggie wrote references an article from Bob Laszewski that predicts rate increases of 25 – 50%, with some rates actually doubling, while Maggie’s prediction is more along the lines of a price decrease for people who qualify for subsidies, with an average price increase of just over 10% for those who don’t (anyone making more than 400% of FPL). The answers seem to change based on who’s doing the math, and it would be disingenuous to say that all of the numbers are objective. In general, I’ve found that the people who support the ACA are more likely to predict small rate increases and smooth sailing next year, while those who oppose the law are likely to predict large rate increases and general doom and gloom.
Here’s what I do know.
The MLR (medical loss ratio) has already been in effect for two years. Carriers have had to limit their overhead to 15 – 20% of premiums since […]
Tobacco Cessation And Health Insurance
[…] Although higher health insurance premiums do provide a financial deterrent to smoking, the number of smokers who try and fail to quit every year is testament to the powerful nature of nicotine addiction. Providing real support in the form of therapy and/or medication designed to help smokers kick the habit seems like a better solution. Including smoking cessation treatment in the list of preventive services that must be covered by all health insurance plans without cost sharing was a good provision of the ACA. But a study released last fall indicates that implementation of the provision has been inconsistent at best. Hopefully this issue will be fully resolved as new health plans are designed heading into 2014, and tobacco cessation will no longer be a grey area when it comes to health insurance benefits and provider reimbursement. […]
A Little Flurry of Snow in Northern Colorado Today!
Just enough snow came through the Fort Collins area for the kids to plow… and mow. We’re hoping the mountains get a lot for skiers and snowboarders. We put the kids to work in the yard. Plowing…
And mowing…
Here is a video of the front end loader in action plowing the snow off of the porch! It was a gift from a friend and is their favorite toy…
Open Enrollment For Individual Health Insurance Plans Starting in 2014
Ever since the PPACA was first being discussed, the individual mandate has been touted as a buffer to protect health insurance carriers – and in turn, policyholders – from adverse selection that would otherwise certainly occur in a guaranteed issue individual market. It seemed that as long as people were required to maintain health insurance coverage, adverse selection would be minimized and people would be unlikely to purchase health insurance only during periods of sickness. But there was still enough concern about adverse selection that HHS issued a proposal for open enrollment periods in the individual market starting next year. This proposal was released at the end of November, and the specific details regarding the open enrollment period are on page 70595 of this Federal Register.
To sum it up, they’re proposing an initial open enrollment period for individual/family health insurance that starts in October 2013 and runs through the end of March, 2014 (a six month window in order to accommodate the large influx of initial applications), and then open enrollment periods that mirror Medicare’s: October 15th until December 7th each year. Beyond that window, only “qualifying event” applications would be allowed for […]
Colorado’s Medicaid Expansion Plans Make Sense
Governor Hickenlooper’s announcement last week that Colorado plans to expand Medicaid eligibility to more than 160,000 childless adults has been met with much debate from both sides of the political spectrum. The voices opposed to the expansion come mainly from an economic perspective, saying that we just can’t afford to cover more people with Medicaid. And as is usually the case, there are wildly different estimates of how much the Medicaid expansion will cost and/or save the state over the next decade: The Kaiser Family Foundation says that the move will cost Colorado $858 million over the next decade, while Governor Hickenlooper’s office says that it will save $280 million instead.
After all of the money talk from the CBO and all of the special interest groups over the last few years regarding various aspects of the ACA, I think a lot of people have become numb to the numbers. Predictions of how much any healthcare legislation will cost or save over any lont-term time horizon really depend on who is doing the study and what variables they took into consideration. And we have to bear in mind that laws and reforms and healthcare in general are not static entities; they’re constantly changing, which makes long-term financial predictions murky at best. Even if we could control for every single current variable and come up with an accurate picture of the cost and/or savings implications of the Medicaid expansion, we can’t know what additional changes might be made in the future that will increase or decrease the predicted amounts. Given that reality, as well as the dramatically different financial predictions out there, I think it’s best to assume that the actual numbers will […]
CLASS Act Officially Nixed From The ACA In Fiscal Cliff Deal
[…] CLASS wasn’t going to be financially viable, and the first try just didn’t work. But that doesn’t mean we can just forget about it and move on. One way or another, long term care costs have to be addressed relatively soon. My prediction is that a new bill will be crafted in the next couple of years to create a solution similar to CLASS but hopefully with a more solid financial groundwork. But I think lawmakers might wait until 2014 – after the ACA has been more fully implemented and health insurance coverage is more widespread than it is today – to take action.
Senator Aguilar Pushes For Universal Healthcare In Colorado
Senator Aguilar’s plan for universal healthcare in Colorado is based on a genuine need: even with current and planned state and federal healthcare reforms, there will still be a lot people in Colorado without health insurance. The CBO estimates that on a national level, we’ll have 30 million uninsured people in the US a decade from now. That’s taking into account the fact that SCOTUS struck down a provision in the ACA that would have required states to expand their Medicaid programs. States have flexibility with that now, and some will likely choose not to expand. Colorado, however, is expected to expand its Medicaid program (not surprising, given how much work the state has already done on that front). The uninsured population in Colorado hovers somewhere in the 600,000+ range, depending on how and when the samples are studied. If the ACA is expected to reduce the national uninsured population from 53 million to 30 million, and taking into account the fact that Colorado will likely be one of the states that opts for Medicaid expansion, I would say it’s reasonable to expect that the uninsured population here will be reduced by at least 50% once the ACA is fully implemented. But that still potentially leaves a few hundred thousand people – not an insignificant number by any stretch – with no health insurance. Those are the people Senator Aguilar is trying to help.