[…] And finally, if the Supreme Court is going to hand down a ruling like the one we got from the Appeals Court last week, we need to know that as soon as possible too. If the individual mandate does indeed end up being tossed out, the health care reform law will need an awful lot of compromises and revisions in order to make it tenable. Perhaps I’m being overly pessimistic, but given the level of compromise we’ve seen from the political system over the last decade or so, I have a hard time seeing how the PPACA could go on with one of its major provisions deleted. […]
The Colorado Health Plan Description Form isn’t exactly the same as the forms that HHS will require carriers to make available next year, but it’s similar in many ways, and carriers in Colorado have been issuing these standardized plan summaries for nearly 14 years. As well as outlining the coverage provided, the new forms will include “coverage examples” that will show potential customers how the plan would cover three common medical scenarios: breast cancer, maternity care, and diabetes. […]
For parents looking for child-only policies in Colorado, we are in the middle of the 2011 open enrollment period, which will end August 31st. All carriers that offer individual health insurance policies for adults must also offer (during open enrollment periods only) at least one plan option for a child applying without an adult on the policy. This is pursuant to Colorado Senate Bill 128, which was signed into law earlier this year. Following the passage of SB128, the Colorado Division of Insurance stepped in to clarify the issue with emergency regulation E-11-03, which has specific details about the implementation of the law. […]
[…] Some lawmakers have proposed making people pay higher deductibles or doing away with first-dollar coverage on Medigap policies, with the idea being that if people have more of their own money on the table, they would be less likely to over-utilize non-essential healthcare. The problem, of course, is that seniors who are already struggling to pay for healthcare would be more likely to skip necessary care if they had to come up with additional money to pay for it. […]
[…] We need exchanges that are easy to navigate, accessible for people who are not fluent in English, and that provide seamless access to the subsidies that the PPACA provides to help people afford health insurance. I’ve already pointed out that we’re going to have to walk a fine line in terms of keeping things fair for both insureds and insurers, in order to attract as many enrollees and high quality insurers as possible to the exchanges. […]
[…] In order to attract high-quality health insurance carriers to the exchanges, we have to make sure that the exchanges represent a business environment that is appealing to carriers. We also have to make their appealing and fair to consumers, in order to attract enough people into the exchanges. To work well, the exchanges will need to have a delicate balance between the interests of consumers, providers, and health insurer carriers, with no one group more heavily favored than another.
HHS today announced new PPACA guidelines pertaining to women’s health, listing several services that must be covered by health insurance plans with no cost sharing by the insured. In scrolling through healthcare news this morning, I saw numerous headlines stating that birth control and breast pumps must be covered by health insurance with no copays. This is true, but the requirements don’t take effect for another year (August 1, 2012) and will apply to new policies that begin on or after that date. […]
[…] But in terms of being a comparison-shopping website for health insurance, I’m struck by how much that sounds like the service we’ve been offering our clients for years. The exchanges will function mostly online, which was a transition we made back in 2003 when we established our website and started working with carriers to get online applications for our clients. We realized soon after getting into the health insurance industry that there is no one-size-fits-all when it comes to health insurance, and that it didn’t make sense to only represent one or two carriers. […]
[…] The proposed regulations from HHS for the exchanges come to 244 pages, but Timothy notes that they are “practical, sensible, and functional” and that HHS tried to simplify things wherever possible, rather than complicate them. For anyone who wants to get the gist of the proposed regulations without reading the 244 pages that HHS released this month, I highly recommend that you check out Timothy’s article. […]
[…] Because of the new law, employers can now use wage adjustments to reimburse employees for individual policies (as long as they haven’t had a group policy in the past twelve months), which wasn’t allowed at all in the past. But the use of HRAs to fund individual policies can now only be done if the employer hasn’t had a group policy in the past twelve months, and that restriction wasn’t found in the DOI final agency order regarding HRAs. […]
[…] Chances are, if you have a claim on your home or auto policy, it will be because of a one-time incident like a fire or a car accident. That can be the case with a health claim too, of course, but many times a large claim on a health insurance policy can be the result of a chronic condition or one that will need extensive long-term treatment. A person might have health insurance at the start of the ordeal, but may lose coverage as time goes on […]
[…] In terms of underwriting actions for less serious conditions (those that don’t result in a decline), GettingUsCovered only takes people who have been offered a policy with an exclusion rider… which most carriers don’t do anymore. Perhaps this is resulting in GettingUsCovered being comprised mostly of members who have a condition that would result in a decline in the individual market, while CoverColorado has those members as well as members who have less serious conditions that simply result in a higher-priced policy in the individual market.
[…] I would add that the advertising tactics Trudy mentions also apply to regular health insurance plans too – not just those related to Medicare. Unfortunately, health insurance advertising can sometimes get a bit murky. If in doubt, always ask for more details or get a second opinion… and as with most things, if it sounds too good to be true, it probably is (there’s no such thing as comprehensive individual health insurance for $150/month for a family of four with no deductible and all pre-existing conditions covered).
[…] This is a good example of how similar legislation does not necessarily have the same support or outcomes in different states. That’s not to say that the Health Care Affordability Act is universally supported in Colorado – it’s not. But it’s working relatively well as a vehicle to fund Medicaid here and to support Colorado hospitals that treat a large number of uninsured patients.
[…] Overall, the survey is very thorough, the questions are mostly objective, and the data obtained from 1300 employers is no doubt a useful barometer of current employer attitudes towards health care reform. But I imagine that if the sentence about assuming that exchanges will make individual health insurance easy and affordable had not been included, the number of employers who said that they plan to drop their group plans might not have been so high. Time will tell.
[…] If the rates are justified, they’ll likely be approved – even if the amount of the increase is distastefully large. The DOI is not trying to keep premiums artificially low or force carriers to cut out legitimate claims expenses. Having rates approved by the DOI does not mean that the people of Colorado get smaller-than-average premium increases. Rather, it means that although our rate increases are sometimes substantial, we know that those rates are justified as a reflection of increasing claims costs.
[…] The Dartmouth study results might seem counter-intuitive, since we often assume that as long as people are getting regular care by a PCP, they will be more able to avoid expensive hospitalizations. That appears to be true, but the lower cost office visits and outpatient treatments add up faster than one might expect, and would actually exceed the cost of the hospitalizations that they would prevent. […]
[…] Even if parents with kids in CHP+ do smoke and buy lottery tickets at a higher rate than parents with private health insurance, what’s to make us think that they would all of a sudden stop spending money on those things and instead pay premiums for CHP+? Is our goal to punish those parents for what better-off families view as poor choices, or is the goal to make sure that as many kids as possible have health insurance? If it’s the latter, then the point made by Senator Brophy is irrelevant.
[…] One way or another, we need to seek solutions that will enable Medicare to pay the 10% shortfall that is currently predicted for a decade from now. That can be accomplished by cutting costs, increasing revenues, or both. But we don’t need to start from scratch and overhaul the entire system, especially with the improvements that the PPACA has already created.
[…] If the government can tell the health insurance carriers that no more than 15 – 20% of premium dollars can be spent on administrative expenses, including profits, why can’t similar guidelines be enacted for the pharmaceutical industry? Perhaps then we wouldn’t need to worry as much about who is going to pay the cost of prescription drugs for seniors. And maybe individual health insurance policies could start covering prescriptions with basic copays again.
The Colorado legislative session that wrapped up this month was a busy one for Colorado-specific health care reform. Despite a few bumps in the road, SB200 passed, which means that Colorado is now on its way to creating a health insurance exchange that will address the particular needs of individuals and small businesses in the state. Although this bill was controversial simply because the whole idea of exchanges is too closely tied with the PPACA […]
[…] There’s no simple answer to all of this. We’re trying to create a somewhat universal health insurance system based on a conglomeration of government-run health insurance, private coverage from hundreds of carriers, eligibility for coverage that is tied to employment and state of residence, and also based on income levels… of course it’s going to get complicated. Hopefully the suggestions raised by this report will help to guide regulations that will ensure health insurance coverage that is as gap-free as possible for most Americans.
[…] A new report from HHS paints a pretty bleak picture of the ability of uninsured Americans to pay for their own medical care. Looking at all uninsured families in the US, the median amount of savings is $20 (the study considered only assets that could be easily liquidated: bank accounts, stocks, bonds, retirement accounts, CDs, money market accounts, and mutual funds). That won’t go far when it comes to paying for a hospital bill. Even uninsured families at the high end of the asset scale had an average of less than $13,000 in financial assets. […]
[…] He tackles the question of whether Medicare beneficiaries have to wait longer than privately insured patients for a routine appointment, and finds that they do not. In fact, it appears that the opposite is true, with more privately insured patients reporting that they had to wait longer than they wanted to get an appointment (although most insureds, regardless of whether they had Medicare or private health insurance, were able to get appointments within the time frame they wanted).[…]
[…] One of the provisions of the PPACA is for the federal government to assist the states in funding the creation of health insurance exchanges. In a largely symbolic vote, the US House of Representatives voted last week to block that funding. HR1213 would prevent the federal government from spending money to help the states set up their own health insurance exchanges. It passed in the Republican-dominated House, but […]