Colorado Representative Janak Joshi (R, Colorado Springs) is continuing his efforts to get government out of healthcare, but his latest bill died in a 9-2 vote in the House Health, Insurance and Environment Committee, with the no votes coming from both political parties. Joshi’s defeated bill would have repealed the 2011 law that created Colorado’s… Read more about Committee Kills Bill That Would Have Repealed Colorado Exchange Law
Health Care Reform
[…] With HSA-qualified plans, there have long been concerns that policy-holders are more likely to avoid necessary as well as unnecessary treatments, in an effort to save money. This is because the plan structure usually doesn’t cover any costs except preventive care until the insured has met the deductible. With the sort of value-based plan design being tested in the San Luis Valley HMO program, care that has a high level of evidence-based backing might be covered with no cost-sharing, while other treatments require some financial contribution from the patient. So it’s not the same as an HSA-qualified plan’s structure that just relies on a high deductible to deter a patient from seeking excessive care. And instead of putting all of the burden on the patient, the value-based insurance design incorporates a team approach, with involvement from patients, doctors and health insurance carriers. All in all, it seems like an excellent idea.
[…] 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.
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
[…] 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.
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
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 […]
[…] 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. […]
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 […]
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 […]
[…] The wealthiest older Americans can probably easily wait until 67 for Medicare. In 2014, individual health insurance will be guaranteed issue, and if paying the premiums is not a problem, that’s a viable alternative for some people. But most Americans are not wealthy enough for those premiums to be easily affordable, even with premium subsidies. More than a few 65 and 66 year olds would likely opt to go uninsured until they reached the new Medicare age, and that brings it’s own host of problems – for the individuals and for taxpayers, hospitals and the entire healthcare system. For people struggling to make ends meet, an extra two years of either being uninsured or stretching to pay health insurance premiums could be a very big deal indeed. And as Maggie points out, it doesn’t even end up saving money.
The proposal to raise Medicare eligibility to 67 is short-sighted and based on the premise that Medicare is an “entitlement” (what about the fact that recipients have been paying into it for decades, to cover the cost of previous retirees’ care?). I suppose it makes sense – at first glance – that we can reduce the amount spent by Medicare if we make people wait an extra two years to enroll. But the practical realities would be a different story: people putting off medical care until age 67 (at which point illnesses might be more progressed and more expensive to treat), people going uninsured, higher premiums within the Medicare system without the younger members enrolled, higher costs borne by employers who cover the cost of healthcare for workers and retirees, and the list goes on. […]
For the first couple years after the Affordable Care Act was signed into law, everything seemed to be a bit up in the air. There was almost constant bickering about the subtle nuances of the legislation, along with uncertainty from both sides of the political spectrum insofar as whether or not the law would stand the test of time. The Supreme Court had to weigh in, and we also had a major election cycle midway between the signing of the law and the enactment of many of its main provisions.
Most of that has settled down now. SCOTUS upheld the law. And there was no election upheaval in Congress to tilt the legislative body towards a crowd that would be likely to repeal it. States – like Colorado – that had been working towards setting up a health benefits exchange can continue to do so without as much worry that their work might be in vain (there had been some concern that the law would be tossed after states had invested a lot of time and money in the exchange-creation process). We are just over a year out now from January 2014, when many of the major provisions of the ACA will go into effect; it seems relatively certain at this point that the ACA will continue to move forward now that some of the potential roadblocks are in the rearview mirror.
Several provisions of the Affordable Care Act – ACA have already been implemented over the past two years: Young adults can remain on their parents’ health insurance policy until […]
[…] Tim’s article is an excellent primer on the implementation of healthcare reform, specifically in terms of the health benefits exchanges that need to be up and running by October 2013, when enrollment is scheduled to begin (health insurance effective dates wouldn’t start until January 1, 2014, but people should be able to start enrolling next October). That’s less than 11 months away, and there’s still a lot of work to be done. Colorado has been working on its health insurance exchange for some time now, and has made a lot of progress so far. We’re one of the states that has selected a benchmark plan for essential health benefits, and much of the groundwork for Colorado’s exchange has already been done. But in addition to the nitty gritty logistics of setting up the exchanges, there are still plenty of legal and administrative bumps that will need to be ironed out. When the ACA was signed into law in early 2010, the implementation of exchanges and the majority of the law’s “teeth” in 2014 seemed like a long way in the future. That is now just over a year away, with exchange enrollment beginning in less than a year. And there’s still plenty of work to be done, especially in states that haven’t made much progress on their exchange implementation yet. […]
[…] He notes that the problem of access to care has been well addressed: 30 million additional Americans will soon have health insurance coverage (although we have to bear in mind that health insurance coverage and actual access to care are not necessarily the same thing, especially if the health insurance in question is Medicaid or another public plan). But he goes on to point out that affordability and quality are areas with some wrinkles that still need to be ironed out.
What makes this post especially interesting is Maggie’s equally well-though-out response that she included in the HWR. Be sure to read what both of them have to say. Maggie references a couple of her previous posts and provides plenty of evidence to back up her premise that affordability and quality of care are both being addressed and that the solutions are working (or will be soon). Definitely an interesting collection of views from two of our favorite healthcare writers.
[…] We wrote a couple years ago about the Colorado Division of Insurance bulletin that laid out the reasons for rate increases in 2010 – almost all of them were the same factors that had been driving health insurance premiums for the previous decade; only 5% of the total premiums could be attributed to the ACA. […] The predicted long-term cost savings from the ACA are definitely not a sure thing. But we need to keep in mind that many of the substantial changes included in the law have not yet taken effect. And many of the changes that have been implemented are those that tend to increase short-term costs and/or utilization of care. […]
[…] I’ve usually addressed the issue of the individual health insurance mandate in terms of how guaranteed issue health insurance would impact premiums in the absence of an individual mandate. The mandate – regardless of its popularity – just seems like the most practical way to go if we’re in agreement that individual health insurance should be guaranteed issue.
Maybe we should also be looking at the individual health insurance mandate from a more compassionate, human angle too. There has long been a bit of a harsh undertone in the healthcare reform discussions when it comes to people who are […]
[…] But if we’re looking at an ACA alternative, I would say that the major issue that causes health insurance to be dramatically more expensive in some states has more to do with health insurance being guaranteed issue (without a mandate that everyone purchase health insurance) and less to do with specific laws regarding coverage details. I’ve written in the past about some of the problems that could go along with selling health insurance across state lines, but Bob and Joe’s point about no state having truly affordable health insurance is really the crux of the issue. In order to make health insurance more affordable, we have to get a handle on the cost of care, since that’s what drives health insurance […]
I think that political debates would be a lot more fun (and educational) to watch if non-partisan fact checkers were allowed to sit off to the side and hold up “pants on fire” signs when appropriate. But the next best option is the plethora of online fact-checkers who can help us sift through the statements. It’s generally been acknowledged that there were more than a few half-truths and outright lies in last night’s 1st Presidential debate here in Colorado at the University of Denver.
Specifically regarding healthcare and health insurance reform, there are a couple of PPACA-related points that need further comment. First, we have the comment from Romney regarding the “unelected board, appointed board, who are going to decide what kind of treatment you ought to have.” He’s referring to the Independent Payments Advisory Board (IPAB), whose job is to oversee general Medicare spending. They are allowed to reduce Medicare payments to hospitals with high re-admission rates and recommend ways to reduce wasteful Medicare spending through new innovations. But they cannot restrict benefits, alter Medicare eligibility, or make any decisions regarding treatment options. […]
Throughout the entire healthcare reform process, Colorado has been one of the states working hardest to make healthcare for everyone a priority. Even before healthcare reform became a national issue, the Colorado Blue Ribbon Commission was actively working on the problem (and many of the recommendations that the Blue Ribbon Commission recommended ended up being quite similar to reforms that subsequently were included in the PPACA). So it’s not surprising that the Colorado health exchange is moving ahead on schedule to meet the target of being able to start enrolling people and small businesses in the exchange as of October 2013 (January 2014[…]
Will HSA qualified health insurance plans and Health Savings Accounts (HSA) still exist after the majority of the remaining PPACA changes are implemented in 2014? That’s a question that we often hear from Colorado health insurance clients who are concerned about their existing HSA qualified high deductible health plan (HDHP)/HSA, as well as people who are considering an HDHP but uncertain about the future of that type of health insurance.
In terms of direct impact, the PPACA changes very little about HDHPs and HSAs. There are only two […]
David points out that healthcare isn’t like a shopping spree at the mall. He believes “… that patients actually just want to get better and that they will be willing to forego expensive services and products when it makes sense to do so.” I agree. And David links to a study that found evidence-based decision aids can indeed […]
Yesterday’s article about Colorado selecting a benchmark health insurance plan for individual and small group policies sold starting in 2014 has raised a few more questions and I wanted to clarify some details.
This publication from the Colorado Division of Insurance, the Health Benefit Exchange and the Governor’s office is an excellent resource and answers a lot of frequently asked questions. It was released earlier this summer, before the Kaiser small group plan was selected, so it includes details about all nine options that were considered as possible benchmark plans. The Kaiser small group plan that was ultimately picked as the benchmark is listed on page 11 as option A, under “one of the three largest small group plans in the state”.
The 2011 Colorado health insurance plan description for the Kaiser policy is here if you’re interested in the plan specifics. We had a question from a reader who wondered whether chiropractic care would be covered, but it’s listed as “not covered” on the plan description form (item number 30). It’s important to note that cost sharing details like deductible, coinsurance and copays are not part of the benchmark program. The concept of benchmark here only applies to the benefits provided by the Kaiser Permanente health insurance plan. The deductible on the Kaiser health insurance plan is $1200, but that DOES NOT mean that all policies will have to have a $1200 deductible in 2014. In order to be sold in the exchanges, health insurance plans will have to cover at least 60% of costs in order to qualify for a “bronze” designation. And there will also be silver, gold and platinum ratings, so there will still be plenty of variation in terms of cost sharing.
If Colorado had not selected a benchmark plan, HHS would have picked one for us. HHS would have […]
Last December, HHS made it clear that they were giving states a lot of flexibility in determining what plan would serve as the benchmark for the state’s “essential benefits” for individual and small group health insurance policies that would be sold starting in 2014.
After months of consideration, Colorado has selected Kaiser Permanente’s small group plan as a benchmark. This is the largest small group plan in the state, with almost fourteen thousand members, and was selected by a group of officials from the Colorado Division of Insurance, the Governor’s office, and the health benefits exchange. The Division of Insurance will be taking comments until next Monday before making a final announcement, and you can contact them by email (firstname.lastname@example.org) if you’d like your comments to be considered.
The Kaiser plan covers services in the ten areas that are required by the PPACA (ambulatory patient services, emergency care, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription medications, rehabilitative services, lab work, preventive care/disease management, and pediatric care), which means that it will serve as a benchmark for services in those areas without the DOI having to add additional coverage minimums. In addition, the Kaiser plan was generally considered to be a good balance between comprehensive coverage and affordable coverage. It’s not the most comprehensive policy out there (the much maligned “Cadillac plans” offer more benefits), but it provides […]
This article about the state of healthcare and health insurance in Colorado is an interesting one, and it provides plenty of good, factual information. However, I was a bit perplexed by a quote from Dr. Ned Calonge, president and CEO of The Colorado Trust, who says “We’re reaching a tipping point where there will be more people who are uninsured than are insured.” This comes after some statistics that highlighted the decline in the number of Colorado residents who get health insurance from their employers: currently 57.8% of employers, compared with 63.7% two years ago.
I’m not really clear about the meaning of Dr. Calonge’s quote about a “tipping point”. I am not in any way minimizing the importance of increasing the number of people in Colorado who have health insurance and improving access to healthcare for everyone. Those are certainly the goals we should be working towards. But we are in no way close to a point where Colorado will have more uninsured people than insured people. The state currently has a population of 5.1 million people. Although the number of uninsured people in Colorado is quite high (829,000), it’s nowhere near half of the population. We are not close to having more uninsured people than insured people.
I wonder if the distinction was regarding the number of people who get their health insurance from an employer? If the current trends continue, we could indeed see a point in the near future when the number of people who get their health insurance from an employer will be lower than the number who don’t. But it’s important to keep in mind that the people who don’t get health insurance from an employer are not necessarily uninsured. In fact, most of them have health insurance. Some get it from the government (eg. Medicare, Medicaid, CHP+) and some purchase individual policies. The article I linked to above includes a graph that shows where people in Colorado get their health insurance, and although it’s true that the percentage of uninsured residents increased while the percentage of people who get their health insurance from an employer decreased, we should also note that the percentage of people with individual health insurance, Medicare and Medicaid all increased in that same time frame (2009 to 2011).
So although Colorado has a long way to go in terms of getting everyone in the state insured, we’re not close to a point where the uninsureds outnumber the insureds.
The Centers for Medicare & Medicaid Services (CMS) announced this week the start of a pilot program to enhance primary care via collaboration among CMS, private health insurance carriers and 500 primary care practices in seven regions across the US. 73 of those practices are in Colorado, with 335 participating physicians, and several of the top health insurance carriers in Colorado are participating too: Anthem Blue Cross Blue Shield, Cigna, Humana, Rocky Mountain Health Plans, and United Healthcare, in addition to Colorado Medicaid, Colorado Choice Health Plans, and Colorado Access (a health plan specifically designed for underserved populations).
CMS will be paying participating providers a “care management fee” which is estimated to be about $20 per month per beneficiary, in addition to the usual fee-for-service reimbursements. The private health insurance carriers that are participating have worked out their own reimbursement schedules, but one would assume that the setup will be similar to the one that CMS has devised. […]