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Name: Louise
Nickname: Louise
Member since: 2006-09-08 20:22:46
Website URL: http://www.insuranceshoppers.net
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Name: Louise
Nickname: Louise
Member since: 2006-09-08 20:22:46
Website URL: http://www.insuranceshoppers.net
About me:
Facebook profile
How Current Reform Proposals Would Impact Colorado Premiums
November 4th, 2009 at 5:29 pmAdam,
It is in large part because the mandate language in the current reform bill is so weak that we could see such high premiums for young, healthy people. The more people who opt out and choose to pay the fine, the higher premiums will be for people who choose to be insured. Covering pre-existing conditions (which is an aspect of reform that Americans overwhelmingly favor) comes with a price. In order to offset the higher expenses, more people have to join the insurance pool. But if the fine for opting out is low, people will choose to pay the fine. And this perpetuates the problem.
In the Wellpoint study, a full 50% of the premium increase for a young, healthy male, was attributed to the weak mandate language in the reform bill, in anticipation of people opting to pay the fine instead of buying insurance. If the fine were more in line with the premiums, the actual price of a policy would be significantly lower.
You are correct about the fact that premiums from young, healthy policyholders help to subsidize the cost of care for older, and sicker people. But it would do us all well to keep in mind that one day (hopefully) we’ll be old too.
Health Insurance Premiums And The Public Option
November 4th, 2009 at 12:02 pmDavid, I think that’s a possibility in an ideal world, but I’m not holding my breath either. The AMA and other hospital/physician lobby groups aren’t going to quietly accept lower payments for services. One area where I think we do have room to negotiate is with the pharmaceutical industry, which has been enjoying double digit profits (as a percentage of revenue) over the last several years. So I’m curious to see what prescription coverage (if any) would be contained in the public option.
What Guaranteed Issue Without A Mandate Looks Like
November 3rd, 2009 at 4:18 pmJoe,
I do understand your position, but it comes with consequences that I doubt many uninsured-by-choice are really willing to accept. The “freedom to not pay for health insurance if you don’t want it” has to be coupled with the knowledge that if you are unable to pay for your medical care in the event that you need it, you will not be treated (and very few people have millions of dollars lying around in a bank account somewhere to pay for unexpected medical bills). That means that a person who chooses to go uninsured and then suffers a brain bleed after falling on a patch of ice and needs a half million dollar stay in the ICU will agree to die instead. No bankruptcy allowed, no medical care given without proof of payment. That’s really the only fair way to allow the option that you’re proposing. But I seriously doubt that many people would be in favor of that proposal.
Health Insurance Premiums And Age
November 3rd, 2009 at 4:07 pmDon, you make good points. The spiraling cost of health care is an issue that has to be addressed, and seems to be one of the most difficult parts of the reform efforts.
As far as premiums and incomes both increasing with age, what I was getting at was the relative ability and willingness of older workers to pay more for health insurance than younger workers. A 50 year old employee is much less likely to be in a low-paying, entry level job than a 22 year old employee at the same company. Senior level, higher paying jobs tend to come with time, and are rarely available to young workers. This is different from basic cost of living raises that go along with staying in the same position for years at a time (and as you mentioned, really just keep pace with inflation). Obviously not all workers get promotions, but in general, older workers tend tend to earn more than younger workers, simply because of experience. Coupled with possible health conditions that tend to creep in with age, older workers are not only earning more than younger workers, but they are also more acutely aware of the need for health insurance, and less likely than younger workers to choose to spend their money on something else and go uninsured.
What Guaranteed Issue Without A Mandate Looks Like
October 27th, 2009 at 10:13 amDon,
Part of the currently proposed legislation would include restrictions limiting the cost of health insurance for older people to a maximum of three times the cost of coverage for younger people, so there wouldn’t be as much of a disparity in pricing as there is now.
In addition, the rules about guaranteed issue coverage would end up helping older, sicker individuals, as they would pay lower premiums than they do now.
As long as we have a strong mandate requiring all of the healthy people to have coverage, claims made by older and/or sicker people wouldn’t be as much of a burden on the system. But if we continue with the weak mandate as currently written, I believe that premiums will become even more expensive for the people who continue to have coverage in the future (since more and more healthy people will choose to go uninsured, knowing that if they become ill, they can get coverage with no pre-existing condition limitations).
In addition, I prefer policies that keep the same pricing structure for new and existing policies, as opposed to carriers that raise prices on existing policies faster than rates on new policies. I would like to see all carriers switch to this model, as it forces them to keep premiums competitive for all members, and doesn’t punish people who get “stuck” on a policy because of a medical condition.
Colorado Senator Morgan Carroll On Health Insurance
September 22nd, 2009 at 2:03 pmDon,
Good questions. I’m not familiar with large group, but small group premiums in Colorado are not community rated unless the employer specifically asks for it. Premiums are quoted based on the age of the employee, using 5 year age bands. Premiums for older employees cost more than premiums for younger employees – the same as how the individual market works.
As far as renewal premiums, it depends on the company. Some carriers in the individual market in Colorado use the same rating factors for existing policies as they do for new policies. So a 45 year old female will pay the same premium regardless of whether she has had her policy for 10 years, or just got it last month. Other carriers do not, and people on those plans will find that after several years their policy will be quite a bit more expensive than it would be if they were getting a new policy with the same company. Of course this leads to shopping around – which is great as long as the person is still healthy and able to qualify for another policy.
I believe that if policies in Colorado were to switch to community rating and guaranteed issue, there would be a significant increase in premiums for most people (perhaps not for older people, and for people who currently pay a high premium for a guaranteed issue policy because of pre-existing conditions). But if the provisions to require everyone to get health insurance pan out, I believe this might offset some of the rate increase.
Stimulus Aims To Help Laid Off Workers Retain Health Insurance
September 14th, 2009 at 6:06 pmSabrina,
There are ways to extend Cobra beyond the initial 18 months, but there are very specific conditions that must be met. Here’s a website with details:
http://www.dol.gov/elaws/ebsa/health/employer/c11.htm?c=YNYNNYNYNNYNYY&CHNMW=
If you’re in Colorado, you can apply for Cover Colorado for your daughter (requires that Cobra coverage be exhausted in order to qualify). Here’s their link with more information:
http://www.covercolorado.org
If you’re outside of Colorado, you could check with your state division of insurance to see if there is high risk pool coverage available in your state.
Best of luck to you and your family.
Public And Private Enterprises Can Coexist
August 19th, 2009 at 9:23 amCameron,
Thanks for weighing in, and for the good points you made. I agree that employers are more likely than individuals to make decisions about health insurance based strictly on cost. That said, if an employer stops offering health insurance, the employees would still have an option of purchasing private health insurance much as they do now. Especially if the rules change down the road and pre-existing conditions are no longer a road block for individual health insurance.
I agree completely that the profit made by private health insurance companies is not a major factor in health care costs. I’ve written several articles about this, and addressed the common misperceptions people have about how profitable insurance companies are. I do think that the profitability of the pharmaceutical industry is a factor (in 2007, Johnson & Johnson, Pfizer, AstraZeneca, Wyeth, and GlaxoSmithKline all had profits in excess of 20% of their revenues) that needs to be addressed. I also think that we need to curtail pharmaceutical advertising, both to consumers and to doctors.
I’m a fan of higher deductible, HSA qualified health insurance plans as a way to combat the “sure, I’ll take that x-ray, why not” mentality that you mentioned. If we have to pay for our own non-catastrophic care, we’re more likely to ask about costs and question the necessity of tests.
You make a good point about the problem of paying for all of this, and that’s obviously the sticking point for a lot of the reform possibilities that are on the table. Hopefully we can find a solution that entails enough compromise to satisfy at least some of the people on either side of the debate, and that expands access to care for the millions of people who don’t really have any access at all right now.
Public And Private Enterprises Can Coexist
August 18th, 2009 at 11:52 amJim,
You make good points, and you’re correct that two vastly different industries can’t really be compared. But with health insurance, there are issues that go beyond money. I have to assume that the people who are adamantly opposed to any sort of government intervention into their health care wouldn’t switch to a public health insurance option, even if it were cheaper than their current private health insurance. People who currently can’t afford health insurance would likely be happy with a public option, but I don’t see large numbers of people migrating away from private health insurance to a public plan, simply because the idea of such a plan is not even close to universally supported.
With the shipping of mail and packages, I don’t think many people have an opinion one way or another on the issue of government involvement. I think most of us choose our mail service based on price and convenience, and maybe things like reliability and past experience. But the government versus private enterprise issue doesn’t really come into play. With health care, it would be a very different ballgame, and that might play in favor of the private health insurance that people already have.
Profitability And The Health Insurance Industry
August 14th, 2009 at 12:58 amGrady,
Thanks for the heads up – good attention to detail. Now I’ll know where to look next time. I wonder if the profits in the beer industry have anything to do with the recession? Maybe when things aren’t looking so good financially, people are more inclined to drink?
Stimulus Aims To Help Laid Off Workers Retain Health Insurance
July 28th, 2009 at 6:27 pmAndrea,
I’m sorry your mom is going through such a tough time. The COBRA assistance is available to people who were laid off starting September 1 2008, through the end of this year. The stimulus package was set up so that the government will pay the subsidy directly to the COBRA administrator (your mom’s former employer, in this case). She (or you) should contact her former employer and inquire about what can be done. The stimulus package allows workers who were laid off and initially declined COBRA to go back and re-enroll, but I’m not sure about the time-frames involved in that process. Again, contact your mom’s former employer and ask if she can opt to elect COBRA now and get the subsidy. Good luck to both of you.
Stimulus Aims To Help Laid Off Workers Retain Health Insurance
July 23rd, 2009 at 11:29 pmChristina,
Is it COBRA premiums that you have to pay back, or are you still employed there? If you quit your job (as opposed to being laid off), you wouldn’t qualify for the stimulus assistance. I’m not familiar with a scenario where someone has to pay back seven months of premiums. Did you receive benefits under the plan this year? I’m curious as to why the plan remained in force if your premiums weren’t paid up. If you didn’t receive benefits this year, can you drop the policy and apply for individual coverage?
McAllen Might Be Over Simplification, But It Is A Start
July 14th, 2009 at 3:48 pmEvan,
Thanks for the clarification, and for reading my article too! I do see your point about how the problem of rushed health care that isn’t patient-centered is a bigger issue than how we pay for health care. I think that the problems Gawande highlighted in McAllen are present in lots of places, and to some degree go hand in hand with the problem of doctors seeing 30 patients in a day. If a doctor can rush into the room, order a couple tests and write out an Rx, she can move on to the next patient quickly, earn a nice income, and continue to drive up the cost of health care.
There aren’t any quick fixes to the health care problem, and I agree that Gawande’s article shouldn’t be taken as the holy grail of what we should be focusing on in terms of reform. As I mentioned in my article, it’s nice to see a dissenting view now and again. Keeps us all on our toes!
Non-Profit Does Not Necessarily Mean Low Cost
June 21st, 2009 at 11:14 pmSteve,
I’m sorry about your son’s experience with his Assurant policy. But it’s important to note that short-term policies are nothing at all like standard health insurance plans. They’re typically designed to only cover large claims; most have no coverage for doctor visits or prescriptions (or anything at all before the deductible). They also are less expensive and have much more lenient underwriting than regular individual health insurance plans. Short term policies are popular with people who are between jobs or who need a policy to cover them until an employer group policy kicks in, for just-in-case coverage. But beyond that, they can’t really be compared with standard health insurance policies, regardless of whether the carrier is for-profit or non-profit.
Stimulus Aims To Help Laid Off Workers Retain Health Insurance
May 27th, 2009 at 12:01 pmRaymond,
If you go to the Department of Labor website, they have a page devoted to COBRA and the subsidy that is available:
http://www.dol.gov/ebsa/cobra.html
On the left side of the page there is a column of links under the heading “for employees”. The first one is “review of subsidy denials”. Click on that link and you’ll see details about how to request a review if you’ve been denied access to the subsidy. The site includes all of the requirements that must be met, so that you can double check your case and make sure that you do indeed qualify. Then you send your review request and all supporting documents to the DOL. Good luck!
Recycling Drugs To Fill Prescriptions for The Uninsured
May 19th, 2009 at 11:22 amWilliam,
We haven’t yet heard of any outlet for recycling prescriptions. If you find one, please leave a comment with the details.
Hard To Please Everyone With A Single Health Plan
May 3rd, 2009 at 9:47 amDon,
I agree to a point. It does make sense to reward employers who have low unemployment claims, and individuals who work to keep themselves healthy and thus have low health insurance claims.
But what would the implications be for sick people? It makes me nervous to open the door to any more variance in premiums based on claims status (we already have this provision in individual health insurance – initial underwriting uses health history to set premiums for most policies in Colorado) because it would seem to make it even harder for sick people to get and keep health insurance.
But I agree that there needs to be a focus on providing incentives for healthy people to maintain health insurance, rather than a system that rewards people who wait until they need care before seeking out health insurance. Otherwise there’s no effective way to spread costs across the whole population.
Stimulus Aims To Help Laid Off Workers Retain Health Insurance
April 24th, 2009 at 10:26 pmJerry,
Unfortunately I think you’re correct in your conclusion. I visited the DOL website to double check the details:
http://www.dol.gov/ebsa/cobra.html
They refer to the time period from September 1, 2008 to December 31, 2009, and say that the stimulus is available to workers who became eligible for COBRA due to “an involuntary termination of employment that occurred during that period”. My understanding is that it doesn’t matter when the company stopped paying for your health insurance; eligibility is determined from the date you were laid off. But it does sound like your situation is a bit more complicated, since you became eligible for COBRA after September 1. Have you checked with your former employer about this?
Best of luck to you.
Yet Another Out Of Network Charge
April 15th, 2009 at 8:29 pmKevin,
Thanks for this! It’s interesting to note that consumers are often advised to make sure that all of their providers are in-network, rather than just the primary doc and/or facility. I’m curious now to find out more about this rule. I appreciate the heads up!
Health Insurance And Clinical Trials
January 26th, 2009 at 7:44 pmDon,
I haven’t seen that particular provision in the bill, but I will keep an eye on it as it goes to vote and see if any additions are made.
Taxes And Health Care
January 13th, 2009 at 12:12 amDon and Mike,
Thanks for all your comments. I’ve been meaning to come back here with an update. I spoke with our accountant a few weeks ago, and did some research on my own, and came up with the same publication that Mike mentioned. Our situation is described in Example 4 (i) on page 4 of the 2008-1 document. I know there will be more than a few late nights for me over the next month or so as I work on our taxes. But at least I have the health insurance portion under control!
Lowering Our Health Insurance Premiums
December 16th, 2008 at 7:52 pm@Don Levit: The rep told me that it was guaranteed issue since the out of pocket exposure was higher than our current plan, and that our rate was based on our claims history – but I’m not sure if there’s a max rate up in that situation.
Yes, the rate we got with our software would be for a new client with no adverse health conditions.
Lowering Our Health Insurance Premiums
December 16th, 2008 at 6:09 pm@Don Levit: The policy was guaranteed issue for us, because it’s a higher deductible policy. Humana would have made us reapply and go through underwriting only if we wanted to switch to a lower deductible. In this case, they did include our claims history in the quote, and it was $8/month more expensive than the base quote we got with our own quoting software. The billing rep I spoke with said this was because our claims history was included in the rate on the new plan. Considering the fact that our claims this year were quite large (two knee surgeries), I’m happy with an $8/month increase.
The Failings Of The Free Market In Health Care
November 20th, 2008 at 5:08 pm@forHealth: Thanks for your comment, and we’re always glad to get your feedback. You mentioned that
“Freedom in health care exists. I can bypass the insurance companies all together and pay directly for my own health care”
but I’m curious about what the upper dollar limit would be? Most health insurance policies will pay up to several million dollars for a person’s care – and if you switch from one group policy to another, you can effectively reset that limit (not so with individual health insurance, since it would be hard to get approved for a policy with medical underwriting if a person had maxxed out another policy). Some people truly do have enough money to pay for all of their own medical care (people like Warren Buffet and Bill Gates come to mind). But for most of us, a multi-million dollar medical bill would be impossible to self pay.
I don’t mean for my articles to be confusing. I think that health care reform is a very complex topic, and one that is constantly evolving. I feel that in some instances there has been too much government regulation in health care (for example, states that require all health insurance companies to offer policies with no medical underwriting, but with no system in place to keep health insurance premiums in those states from skyrocketing because of the huge claims being paid). On the other hand, there hasn’t been enough regulation on the profit end of the health care system (the whole system, not just health insurance), and that has put upward pressure on prices. It’s not just a matter of more regulation versus less regulation. Instead, I think it’s a case of getting the right regulations in place. And I think that health care is too important to be a fully self-regulated, free market entity. Because if it is, the people without money end up getting the short end of the stick. And while there are lots of things that we can go our whole lives without if we can’t afford them, for most people, health care isn’t one of those things.
Business 101 For Joe The Plumber
October 22nd, 2008 at 2:56 pmJason,
First let me say that I defer to your knowledge of economics, which is far beyond mine. And thanks for reading my article and taking the time to comment. I was trying to limit my article to just the effects of the Obama and McCain plans on small business owners, since that was the position Joe the plumber was taking in his questioning. I didn’t get into the effects on individual citizens or employees – only on those who own businesses that profit in excess of $250,000/year.
But I am curious about your statement that “For businesses, health insurance still counts as a labor costs and would reduce their net profit and thus tax liability.” If health insurance premiums would no longer be tax deductible for businesses under McCain’s proposal, how is this possible? A business can spend whatever it likes, but when it comes to paying taxes and calculating profits, only bona fide tax deductible expenses can be subtracted from net income. For example, a business owner can spend $20,000 on Armani suits to wear to the office, but this isn’t an allowable tax deduction. So even though it may be money that the business spends, it can’t be deducted for income tax purposes. My interpretation of the McCain proposal is that health insurance premiums would no longer be a deductible expense for business owners. Can you expand on this for me?