January 2012

Retiree-Only Health Insurance Plans And The ACA

by Louise January 27, 2012

[...] Sandy’s daughter ended up getting an individual health insurance policy for $143/month. But individual health insurance in Colorado is medically underwritten (and will be for almost two more years until the guaranteed-issue provision of the ACA begins in 2014), which means that she had to be relatively healthy in order to qualify for coverage and/or avoid an underwriting rate increase. The benefit of the ACA rule that allows young adults to remain on their parents’ plan is that there is no need for additional underwriting – the coverage is continuous, regardless of any new medical issues that might have arisen since the plan was originally purchased. This can be very useful for young adults with pre-existing conditions who haven’t yet secured a job that provides guaranteed issue group health insurance coverage.

I don’t know what percentage of the population is covered by retiree-only health plans, but it seems that group might be more likely than others to have children who are young adults. I’m sure Sandy and her husband aren’t the only parents to have found out that the ACA doesn’t apply to their retiree-only health plan. [...]

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A Brain Teaser Cavalcade Of Risk

by Louise January 26, 2012

[...] Jaan Sidorov’s article about health insurance exchanges is really good (and I had to read it to figure out the correct answer to the question for his post – it was one of the two I missed). He notes that it’s a bit illogical that so many of us are willing to spend hours comparison shopping for a new TV, but feel put out if we have to spend much time at all comparison shopping for health insurance. And he laments the fact that health insurance exchanges are in their very early days but already are being dismissed by some as too complicated for the average consumer to figure out.

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The Elusive Nature Of Healthcare Costs

by Louise January 25, 2012

[...] I’m still a fan of consumer directed health plans, high deductibles, and HSAs. I think that they can be useful tools to help people keep their health insurance premiums as low as possible and also (if an HSA is involved) set aside pre-tax money to cover potential future medical bills. But they are not a panacea. They are probably not a good solution for anyone who has a chronic illness that needs ongoing, expensive care. They don’t work so well for people with very little money who would struggle to cover the relatively high out-of-pocket costs and would not likely be able to fund an HSA. And no matter how great the actual consumer directed health plans are, the fact remains that transparency with regards to healthcare costs is still quite elusive. For some procedures, it can be relatively easy to get a set figure up front in terms of how much it’s going to cost. But much of the time that number can be difficult or impossible to pin down. Obviously, complications can arise in any medical situation (and the resulting increase in costs would make earlier estimates irrelevant). But even without factoring in complications, “shopping around” for healthcare is often an exercise in futility. In order to make consumer directed health plans more effective, there is much work to be done with regards to cost transparency.

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Colorado House Passes Resolution To Repeal ACA

by Louise January 23, 2012

[...] Although the Republican-led Colorado House passed the measure, Democratic lawmakers were not impressed. They chided the Republicans for wasting time and money on a resolution that isn’t going to end up going anywhere (presumably because of the extremely slim chances of having two thirds of the states pass a similar measure).

Given the fact that the legality of the ACA is going to come before the Supreme Court this year, I agree that the new Colorado resolution seems like a waste of legislative time. The Supreme Court will tell us whether or not the federal government has the right to make health insurance mandatory, and the states that are taking the opposing position on the matter have already joined in a lawsuit to express their position. Hopefully Colorado’s lawmakers will work together from both sides of the aisle and move on to other issues that are facing the state.

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Thoughts On The Supreme Court’s Look At The ACA

by Louise January 20, 2012

[...] Joe’s take on the court battle is that the Supreme Court is unlikely to go against the majority of the lower courts that have ruled in favor of the constitutionality of the individual mandate. And he’s got lots of other well-thought-out opinions on the subject – his post is a must read if you’re interested in the legality of the ACA.

Personally, I’m with Joe on this one. I believe that opting to go without health insurance is in fact opting to self-insure, since the likelihood of people needing no medical care at all is slim. For people who can truly afford to self-insure, there might be an argument to be made in terms of their right to do so (Rush Limbaugh? Maybe. The rest of us who don’t earn $33 million per year? Not so much). But for the majority of the population, being uninsured means that potential healthcare bills – especially the big ones – will be paid by the rest of the population via higher healthcare costs and increased health insurance premiums. There’s no realistic way for hospitals to recoup costs from uninsured patients who have no ability to pay, especially if the bills are significant. And it might be well within the boundaries of the law to require people to not pass that risk off onto other people.[...]

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Claims Expenses In New Colorado High Risk Pool Are Double The National Average

by Louise January 17, 2012

[...] I realize that premiums cover a very small portion of the claims expenses incurred by the high risk pools, so perhaps it’s a better move from a financial standpoint to limit enrollment in the high risk pool. But expanding eligibility and increasing enrollment numbers have been discussed numerous times since the pools started operating in 2010. I haven’t seen any specific details explaining why Colorado’s per-member claims expenses are so much higher than they are in other states with similar programs. It could be that it’s random, but if that’s the case we should expect to see Colorado’s numbers even out with other states as time goes by. If we don’t, we can assume that there’s something specific to Colorado that is causing the difference – either healthcare is far more expensive here, or our federally funded high risk pool is enrolling applicants who are – on average – far sicker than applicants in other states. Once the program has had another year of claims data, it will be interesting to revisit the numbers and see whether Colorado is still spending significantly more than other states, or whether the numbers have started to equalize.

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Cavalcade Of Risk In Its Sixth Year And Going Strong

by Louise January 12, 2012

Political Calculations just hosted their fifth Cavalcade of Risk this week, with their trademark rating system for articles.  Be sure to check it out.  IronMan pointed out that blog carnivals have largely been surpassed by social media platforms when it comes to sharing interesting posts and getting exposure for new blogs – and he gives [...]

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Obesity As A Factor In Healthcare Spending

by Louise January 9, 2012

[...] I think that the dichotomy remains when it comes to discussions about obesity: on the one hand, we see lots of articles and advice telling us to love our bodies at any size, and on the other hand we have studies like the one that illustrates the cost to public health insurance programs that is directly attributable to obesity.

In addition to asking people to take a more objective look at whether any of their health problems could be related to weight, Maybe lifestyle issues should be more of a priority during doctor visits. I believe that most doctors do at least mention in passing the importance of eating a healthy diet and being physically active, but perhaps they could spend more time on the issue, and make a bigger deal of it. The ad campaign featured in the CHI article indicates that people are poor judges of where they stand when it comes to their own weight. So instead of asking people to just figure it out on their own, maybe it should get more attention as a cornerstone of healthcare interactions between patients and their doctors. This makes particular sense when the patient is suffering from obesity-related diseases or showing precursor symptoms. And since money is a powerful incentive, HHS could provide doctors with information to distribute to patients regarding the additional lifetime healthcare costs one will incur as a result of being obese. As health insurance deductibles continue to climb and patients find themselves responsible for more and more of their healthcare costs, this could be an incentive to focus on a healthy diet and daily physical activity.

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Overutilization Of Prescription Drugs

by Louise January 6, 2012

[...] Half of all Americans take at least one prescription drug. Prescription costs have skyrocketed over the past couple decades. When we got into this industry ten years ago, we saw lots of individual health insurance policies that offered prescriptions with simple copays based on whether the drug was generic or brand name. These days, nearly all of the carriers in Colorado have separate prescription deductibles (our family’s Anthem policy has a separate $2000 deductible for prescriptions), or ever-increasing prescription copays. And a lot of carriers have added a fourth tier to their prescription categories – drugs in that tier are generally quite pricey and patients generally have to pay a percentage of the cost rather than a flat copay.

We owe it to ourselves to seriously consider whether our over-reliance on prescriptions is actually beneficial in the long run, both from a health perspective and a financial one.

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