Health Insurance and Health Care Reform Won’t Meet August Deadline

Health Insurance and Health Care Reform Won’t Meet August Deadline in Individual Health Insurance

Malcolm Smith, the Senate's top Democrat, conceded yesterday that the chamber won't pass an overhaul of health care and health insurance by August. In a townhall meeting that same day, President Obama accepted this fact, as long as he sees "folks working diligently and consistently,” reports The Wall Street Journal.

While Nancy Pelosi confirmed that the house bill would pass before the summer recess, the Senate Finance Committee is singing a different tune. They remain deadlocked over key details, not least of which is how to pay for the plan. The Senate Finance Committee is notably the only group trying to craft a bipartisan bill.

But concern over cost is rising across the board.

Nine Senate Democrats have addressed a letter to Senate Finance Chairman Max Baucus, protesting that too little focus has been given to keeping down health costs.

House Republican leader John Boehner of Ohio said Thursday, "Despite what President Obama claims, the bill he is promoting today will make health care even more expensive."

Even at the friendly townhall meeting in Ohio, a 14-year-old incoming high-school freshman asked the president if he was pushing too much, too fast. Mr. Obama replied that, "Reform may be coming too soon for some in Washington, but it's not soon enough for the American people. We can get this done."

But this kind of response is garnering another growing criticism of the current administration: That their solutions are based on rhetoric and not reality. 

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Health Insurance Industry Jumps in With Major Ad Campaign

Health Insurance Industry Jumps in With Major Ad Campaign in Individual Health Insurance

The health insurance industry stepped into the ring this week with a seven-figure ad campaign, reports The Washington Post. While it is a notably more subtle approach than the Harry and Louise ads they scuttled at the Clintons’ health care plans 15 years ago, it still has its barbs.

America’s Health Insurance Plans (AHIP) ads promote the idea that everyone should have health insurance. They argue that health reform would not only help millions of Americans get care, but that it would also vastly expand the market, stating, “If everyone’s covered, we can make health care as affordable as possible.”

Of course, this harkens back to our earlier post on Wal-Mart’s endorsement of an employer mandate. Ever since it became clear that some form of health care reform would indeed materialize, major players have been getting on board in order to secure certain provisions. In Wal-Mart’s case, it was to guarantee a trigger mechanism to contain costs.

For AHIP, it is a sort of escape hatch in a proposed system of consumer protections. They have made it clear they would like to see the public option vanish from the bill entirely.

To support this contention, the ads have included data from a poll by The New York Times and CBS that, "77 percent of Americans are satisfied with their existing health insurance coverage."

Critics were quick to point out that the same poll included statistics that argued otherwise. For example, by 72 to 20 percent, Americans favor the creation of a public plan. Respondents also felt that government would do a better job than private insurers of limiting health care costs and providing coverage.

In addition, a Kaiser Family Foundation poll, compiled at the request of The Washington Post last year, suggests that the people who like their health plans the most are the people who use them the least.

AHIP’s 30-second ad will run for a week. The debate that has ensued will no doubt go much longer.

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Blue Cross Blue Shield of Florida To Sell Health Insurance Plans In Storefronts

Blue Cross Blue Shield of Florida To Sell Health Insurance Plans In Storefronts in Individual Health Insurance

In an interesting retail turn of events, Blue Cross Blue Shield of Florida announced they will start selling health insurance through retail storefronts — much like how cell phone companies currently sell coverage plans.

The storefronts will open up to eight retail stores in the state, including the Miami-Dade area, reported the Miami Herald.

“Health insurance is complicated and we know it. Some people like face-to-face interactions, and that’s what we’re providing,” Doug Bartel, spokesperson for BCBS of Florida.

One of the biggest reasons for the move is that many small companies, in Miami in particular, don’t offer employer-sponsored group health insurance, so there are a lot of residents looking for affordable Florida health insurance.

Bartel also said that BCBS of Florida wants to make sure they offer plenty of alternatives to getting information about health insurance.

One Florida resident said they liked using the Internet, but would rather have a one-on-one experience when it comes to purchasing a policy.

It makes sense that people want some kind of advice when purchasing something as important as health insurance. Still, this effort seems like it’s going to be a lot of overhead for the insurer.

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Seniors To Save More On Prescription Drugs

Seniors To Save More On Prescription Drugs in Individual Health Insurance

This week, the big pharmaceutical companies agreed to help seniors better afford their prescription drugs, particularly when they reach a major gap in coverage with their Medicare Part D plans.

With Medicare prescription drug coverage, informally known as Medicare Part D, seniors have all their prescription drugs covered up until they reach $2,700 in total costs for the year. After reaching $2,700, seniors get zero coverage until those costs go over $6,100.

It’s a whopping $3,400 gap, commonly known as the “doughnut hole.”

Now, drug companies say they’ll give seniors a 50 percent discount for their medication if they fall in the doughnut hole, reported The New York Times.

President Obama hailed this move as a “historic agreement to lower drugs costs,” but as the Times article pointed out, the federal government might not reap any of the benefits.

Because the half-off discount only eases out-of-pocket costs for seniors who reach the doughnut hole, the government gets left out of the deal.

But really, if we had to pick who would save money between the people and the government, we ought to choose the people every single time.

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Will Health Insurance Co-ops Answer Reform's Biggest Question?

Will Health Insurance Co-ops Answer Reform's Biggest Question? in Individual Health Insurance

The biggest question is of course: Will Congress enact a public health insurance plan?

If not, there’s now an alternative. Last week, the U.S. Senate Finance Committee offered the idea of health insurance cooperatives to take the place of that pesky “public” health insurance plan idea.

U.S. Senator Kent Conrad, the Finance Committee member who proposed the co-ops, said it was designed mostly to compromise with Republicans who are so adamantly against a public plan.

According to a Time Magazine article, 50 separate cooperatives would be created for each of the 50 states.

Because the co-ops would be required to self-insure by covering the cost of claims entirely with premiums paid by members, the name of the game would be volume. The more members a cooperative had to pay premiums, the easier they’d be able to keep costs low. Lower population states would be able to join with other states nearby to form regional cooperatives.

To start up the co-ops, the government would initially have to kick in some $4 billion.

But unfortunately for this back-up plan, there’s been little success with health insurance cooperatives, according to the Time article.

Most cooperatives have a hard time staying financially solvent and keeping its members and providers happy. The two exceptions are Seattle’s Group Health and Minneapolis’ Health Partners. Both have enjoyed success largely because they provide both health insurance and health care services — with their own networks of physicians, hospitals, and clinics.

Unless the government can execute the co-op idea perfectly, it could easily crash and burn. Politically speaking, co-ops might seem less controversial, but without confidence in a solid plan, it too could just be a pipe dream.

So far, it doesn’t look like co-ops are the answer.

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Report: Health Insurance Fraud Increasing

Report: Health Insurance Fraud Increasing in Individual Health Insurance

Health insurance fraud is on the rise. Lt. Robert Sebby, who investigates medical identity theft cases, blames unemployment and the failing economy, reports the Las Vegas Sun.

Our migration to electronic medical records probably isn’t helping much either.

Pam Dixon, executive director of the nonprofit World Privacy Forum and author of a report on medical identity theft, warns that without extensive safeguards, we are going to see this type of crime skyrocket.

Remember the medical clerk in Florida a few years ago who downloaded the records of more than 1,000 Medicare patients and gave them to a relative, who made $2.8 million in fraudulent claims with them?

While we agree with the president’s call for electronic medical records (EMR), we hope that it is done with strategy and foresight. A lot of strategy and foresight. Who wants to get a surprise bill for a diabetic’s dialysis in Maryland or an addict’s prescription swindle in Oregon?

Straightening out stolen health care is a special kind of red tape nightmare. Strict patient privacy laws and the decentralized bureaucracy of insurance providers complicates things to Kafka-esque levels.

So, let’s indeed proceed into the brave new world of computerized medical records, but let’s make sure that part of the $19 billion earmarked for the job is used to adequately protect patients’ information.

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Public-Private Health Insurance Plan Launched In Miami

Public-Private Health Insurance Plan Launched In Miami in Individual Health Insurance

As the health insurance and health care debate rolls on in Washington, a new health plan launched today in Miami, Florida, reported the Miami Herald.

But this new Florida health insurance plan is special for one big reason: it’s a public-private health plan.

Yes, one of the biggest sticking points for lawmakers, lobbyists, and health industry executives on Capitol Hill has just went through in Florida.

It did, though, take the county five years to finalize.

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Kaiser Family Foundation Poll Finds Americans Support Health Reform, Taxing The Wealthy To Pay For Care, and Skip Care Because of Costs

Kaiser Family Foundation Poll Finds Americans Support Health Reform, Taxing The Wealthy To Pay For Care, and Skip Care Because of Costs in Individual Health Insurance

Every month, the Kaiser Family Foundation does a tracking poll that’s devoted specifically to health care and health insurance.

The results they get from this poll are pretty insightful, and provide a decent gauge of where the current public opinion stands in regards to the health industry.

Here are a few of the juicy tidbits from the April tracking poll, as reported by Medical News Today:

               
• 59% say health care reform is “more important than ever”
               
• 36% skipped doctor and dentist check ups because of high costs
               
• 26% say someone in their household had trouble paying health care bills in the past year
               
• 71% support raising taxes for high-income Americans to pay for health care reform
               
• 67% “strongly” or “somewhat” favor a public health insurance plan to compete with private plans

So what does it all mean?

We see that public option is starting to heavily lean in the direction of “action now” on health care and health insurance reform, and that a growing number of Americans are starting to feel the burn of rising costs.

Politically speaking, this is great news for lawmakers itching to pass sweeping reform. The Kaiser poll suggests they’ll have majority support, and may be able to push through the broadest and most comprehensive health care legislation in recent history.

But take these polls with a grain of salt. While they’re a snapshot of public opinion in the now, things can change like the blink of an eye — especially with our current and fluctuating economic problems.

And as most can guess, Democrats and Republicans don’t so much agree on how we go about reform.

Ah the joys of health care politics.

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Blue Cross Blue Shield of Michigan Decides To Raise Rates for Individual Health Insurance Policies

Blue Cross Blue Shield of Michigan Decides To Raise Rates for Individual Health Insurance Policies in Individual Health Insurance

In light of a $144.9 million loss in 2008, Blue Cross and Blue Shield of Michigan has decided to make some changes that will affect rates for their individual health insurance plans.

The Wolverine State’s largest health insurer will also stop further enrollment for a few of their older, less expensive health plans, such as the Individual Care Blue individual plan, reported the Detroit News.

There’s a catch. Before BCBS of Michigan can increase rates for their individual plans, they have to get approval from the state. So far, no word on their chances of getting these rate-ups approved, but we expect BCBS to push hard to get them.

So why does Blue Cross want to raise rates?

Because BCBS of Michigan is the state’s “insurer-of-last-resort,” they’re required by law to accept all applicants into a plan regardless of their health history.

At some point, as the insurer would point out, they’ll be paying more for health care bills then receiving revenue in health insurance premiums — which is why they want to increase rates.

They’re asking the state to raise rates for individual health plans by 56 percent, 42 percent for group conversion plans which is extended coverage from an employer after a job loss, and 31 percent for Medicare Supplement plans (also called Medigap plans).

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Health Insurance Companies To Get Lower Payments For Medicare Advantage Plans Next Year

Health Insurance Companies To Get Lower Payments For Medicare Advantage Plans Next Year in Individual Health Insurance

This week, the Centers for Medicare and Medicaid Services announced they will cut the payments to health insurance companies for Medicare Advantage plans by 4 to 4.5 percent.

It’s a promise kept by the Obama Administration who said they would cut the private Medicare plans partly to help fund a major health care and health insurance overhaul, reported the Wall Street Journal.

According the WSJ article, insurers had expected these cuts — but not until 2011.

So if and when these cuts go through, what does it mean for the average policyholder in their Golden Years?

The general word from the insurance industry is that those who have Medicare Advantage will see either reduced benefits or increased premiums. Most likely it would be the latter because, honestly, raising rates probably less of a hassle for insurers.

The Blue Cross Blue Shield Association said the increases would average out between $50 and $80, wrote the WSJ article.

So what will these rate increases do to the some 10 million people are enrolled in Medicare Advantage plan? Maybe more will drop it and move to regular Medicare. Maybe insurance companies are making too much of a stink and the Medicare Advantage market won’t be drastically affected.

As we seem to say a lot here… we’ll have to wait and see.

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Government Slow To Reimburse COBRA Health Insurance Premiums

Government Slow To Reimburse COBRA Health Insurance Premiums in Individual Health Insurance

Under the American Recovery and Reinvestment Act of 2009 (ARRA), the government is offering to pay 65 percent of premiums for COBRA continuation health insurance coverage if you involuntarily lost your job between September 1, 2008 and December 31, 2009.

According to the U.S. Department of Labor (see the excerpt below), laid-off workers were supposed to not have to worry about fronting the premiums and the employers/plan administrators would be the party to get the 65 percent reimbursement from the government.

Q10: How does the 65% premium subsidy get paid to me?
You will not receive a payment. Assistance Eligible Individuals are responsible for paying only 35% of the COBRA premium for the period of coverage. The remaining 65% of the premium is reimbursed directly to the employer, plan administrator, or insurance company through a payroll tax credit.

But an article in the Washington Post said everything might not be working as planned.

The author described his situation where he was required to pay his COBRA continuation premium of more than $1,400 a month or his coverage would be cancelled. Instead of paying 35 percent of the premium to his former plan administrator, he had to front the money and wait for reimbursement.

In the article, the author heard these reimbursements might not be made available until this summer.

That’s much too long, and frankly it’s an outrage this is happening. The DOL clearly states that it’s the employers/plan administrators that have to put up the cash.

We’ll keep our ears open for similar situations, but we hope this isn’t common. Let us know if it is.

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Response to a Consumer Reports Article About Individual Health Insurance

Response to a Consumer Reports Article About Individual Health Insurance in Individual Health Insurance

In an article by Consumer Reports, authors claim that there are seven signs that an individual health insurance plan might be “junk.” We thought we’d tackle a few of their claims and provide an alternative look on what they said.

• Claim: Never to buy a plan with limited benefits or a plan labeled ”not major medical.“
  First off, don’t buy a health plan from any company that’s not reputable. If an unknown insurer labels a plan “not major medical” then it’s probably not from a company worth dealing with.
  
  When there’s a warning against “limited benefits” it can actually be misleading. Those who are looking to cut down on their monthly premiums and want to “trim the fat” of their health plan (i.e. don’t want to pay for benefits they won’t use), a plan with limited benefits might be a viable option.
  
  For example, a single male wouldn’t want to pay for maternity care for his individual health insurance plan, but that same male would pay for maternity care under an employer-sponsored plan. That’s because everyone pays and shares a pool of benefits with employer coverage.


• Claim: Coverage limits should not be lower than $100,000.
  This claim is right of the bat misleading. This almost suggests every plan you search for are going to be skinny on overall coverage limits (in insurance terms, this is called lifetime maximum coverage). This is not the case.
  
  Consumer Reports is correct when they say your lifetime limit shouldn’t be lower than $100,000 — but the lifetime maximum for most plans from reputable insurers will come in around $1 to $2 million. And by the way, a million-dollar lifetime maximum will not super-size your premiums.


• Claim: Lower premiums means insurers are trimming benefits.
  Again, the article is misleading. Your health insurance costs are all about balance and sharing risk. If you have more generous benefits, less out-of-pocket costs, and lower deductibles, you’re going to have higher monthly bills for your coverage. Lower premiums might mean lesser benefits, but it doesn’t mean a “junk” plan by any means.
  
  The key here is to balance what you can afford for your monthly bill with what costs of care you can cover yourself (pay $50 for doctor’s visit instead of $20 and you can find lower premiums).

The real thing to remember is health insurance isn’t like buying an ice cream cone. It’s a complicated product with lots of details. If you’re not sure about what you should buy or you’re afraid you’ll miss some of the fine print, speak with your local insurance agent for advice.

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California Health Insurance Coverage Rate Hit Hard By Recession

California Health Insurance Coverage Rate Hit Hard By Recession in Individual Health Insurance

The now months long with no end in sight recession has hit California health insurance particularly hard, according to a recent report from UC Berkeley.

A staggering 500,000 California residents have lost their health insurance coverage since November 2007, the Berkeley designated start date of the recession, reported the San Francisco Gate.

That means 13.5 percent of all the Americans in the country who lost their health insurance during this recession reside in California.  In total, 3.7 million Americans lost health coverage in total since the start of the recession.

What’s more, the report estimated that another 600,000 might find themselves uninsured in California alone and 4 million nationwide — and that’s even if the economy fully recovers.

Ouch.

“Unless there’s some sort of policy intervention, we won’t see a real recovery from where we are right now. Given population growth and this ongoing decline in coverage rates, the number of uninsured would actually continue to rise, ” said Ken Jacobs, the report’s co-author and chairman of the Berkeley Center for Labor Research and Education.

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New Health Insurance Program Cover Florida Not Attracting Enrollees

New Health Insurance Program Cover Florida Not Attracting Enrollees in Individual Health Insurance

So far, the Florida health insurance program Cover Florida implemented by Governor Charlie Crist hasn’t caught on with residents just yet.

Since January 5, 2009, only 952 residents have signed up for the coverage, reported the Orlando Sentinel — a sign that the program isn’t as good as option as Governor Crist hoped for.

To help combat low enrollment numbers, Governor Crist urged organizations around the state to promote the program.

“Spread the word that affordable health care coverage is available,” said Governor Crist.

The Florida Community Health Action Information Network, a health care advocacy group, wasn’t surprised by the low numbers, wrote the Sentinel article.

“Since subsidies to help low-income people pay their premiums were completely absent from the mix, even fewer of those who might have considered the limited coverage before will do so now in the midst of a recession,” said the group’s policy director, Greg Mellowe.

Interesting take on it.

Does this mean the program is a failure or just another casualty of the poor economy?

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A Friday Consumer Poll: Americans Like Their Health Insurance Coverage, But Think Costs Are Too High

A Friday Consumer Poll: Americans Like Their Health Insurance Coverage, But Think Costs Are Too High in Individual Health Insurance

In a recent CNN/Opinion Research Corporation poll, results founds that Americans are happy with their current health insurance coverage.

Americans are please with the quality of the health care they receive and overall happy with their coverage, reported CNN.

The poll found a whopping 8 in 10 people are satisfied with the quality of health care and health insurance in this country.

But when asked about the costs of these services, satisfaction drops significantly.

Over 75 percent of Americans are “dissatisfied” with overall health care costs in the U.S. and only 52 percent are happy with health insurance rates.

“[The poll results] suggests a prescription for health care reform that Americans can swallow — start by addressing health care costs while allowing Americans to keep their current coverage and their current health care providers,” said CNN polling director, Keating Holland.

Really, this poll isn’t too shocking — back during the 2008 election President Obama and Secretary of State Hillary Clinton advocated the idea of letting Americans keep the coverage they have if they like it.

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