Archive | Healthcare RSS feed for this section

So you think you will keep your employer-based health benefits; forces at work say you won’t

22 May

The employer contribution is what?

Many Americans pride themselves on being independent. self-sufficient, able to do things for themselves, make their own choices. They may get to put that decision-making ability to the test in the years ahead and passing that test will be very important … and costly. Obamacare provides many incentives for employers of all sizes to drop health care benefits, but that is not the point of this post.

The High Deductible Health Plan (HDHP) is the first step toward a defined contribution approach whereby the employers liability is limited in favor of more financial risk for the employee. But even that is not the issue today.

As you may know, come 2014 Obamacare establishes state health insurance exchanges. These exchanges will offer several health insurance plans that will be chosen by individuals for their coverage. Large employers are not eligible for the exchanges . . . and now we come to the point. At least one large U.S. consulting firm is on the road to offer private exchanges for large employers. Here is the essence of the idea, the employer drops all its health benefits and instead offers enrollment in a private health insurance exchange. The employer contributes a set amount and the employee chooses the health insurance he wants and pays any difference in premium. Let me repeat that, the employer contributes a set amount and the employee chooses the health insurance he wants and pays any difference in premium. In effect the employer is out of the process and the employee is on his own to select coverage and deal with the insurer and the exchange thereafter.

As the article points out, proponents of exchanges provide an analogy with the demise of defined benefit pensions in favor of defined contribution 401(k) plans. This is quite valid as both take the financial burden and obligation from the employer and shift most of it to the employee with no guarantees for the future. How appealing does that sound?

The unsaid but obvious point of all this is the advantage for the employer. The employer gets to set the contribution amount with little regard for premium increases and the employee gets to pay the balance of each year’s increase. That’s why employers may like the idea, the primary purpose is to save the employer money. Some experts will tell you that will make employees better consumers. It may also make them poorer (that is unless employers share their savings in the form of higher wages..he said with a smirk). As long as we are into analogies, how well are employees doing with retirement savings in the 401(k) as opposed to being a participant in a traditional pension plan?

According to our informal poll [see poll in right margin] many people say they welcome the idea of taking employer money and selecting their own insurance. Let’s hope they still like the idea after the first year.

One thing is undeniable, the relationship between employer and worker is changing and in the process the worker’s re$pon$ibility in increa$ing.

The following is from an article in th May issue of Employee Benefit News and is part of an interview with the CEO of Aon Hewitt, one of the largest Hr and employee benefits consulting firms.

Can you give a little bit of background on your health care exchange and how it’s going?

Savacool: Let me draw a parallel for you to the retirement pension market. If you compare 1980 to 2005 and you look at retirement plan participants – I’m going to contrast this to health in a minute – 61% of participants were in active retirement and DB plans and 39% were in other DC plans, such as thrift saving plans and profit-sharing plans. And none were in 401(k) plans. Today, 62% are in 401(k) plans, 11% in other DC and only 28% in DB plans. So, we’re essentially moving from a group-based or a company-sponsored plan to a more individual level of responsibility.

When you look at that trend and you look at health care, there’s a parallel track happening. This is really parallel to the DB-to-DC transition.

I draw the parallel to health care. If you look at 1988, 73% of enrollments were in conventional plans, about 16% in HMOs and only 11% in PPOs. Today (2011), only 1% are in conventional plans, 17% in HMO, 55% in PPOs and 17% in quasi-defined-contribution kinds of plans.

So, when you think about where exchanges fit in this, and you look at the transition to an individual level of responsibility and moving from a self-insured to an insured marketplace, you get a trend toward the utilization of exchanges, both for retirees and for active employees.

We entered the business in the retiree exchange business and have had great success. In fact, the demand this year, the rate of growth and the utilization of exchanges to both advise and then place the health insurance is growing pretty significantly. When we look at our large corporate employers – we have about 562 that we surveyed recently – what we found is that 94% of those employers are committed to offering and financially supporting health benefit coverage for their workforce in some form.

To the question I often get asked, “Are employers bailing out?” – the answer is no. They’re going to change the solution set that provides for health care coverage, but they are unlikely to exit. We are executing right now on our strategy related to our retiree health care exchange, and we’re in the process of building a corporate exchange for those who can’t access the state exchanges because they’re too big, they have more than 1,000 employees.

The interest from employers is high. We think it’s in their best interest, and we’re working with the insurance markets to define that.

Are you thinking about competing with state exchanges in the future?

Savacool: It doesn’t compete with the state exchanges. It really is complementary. In fact, we spent time at the White House meeting with members of President Obama’s staff on health care reform and the exchanges for state governments and U.S. companies; I think I’ve been there three times in the last six months to talk with them about that. Because they really are complementary, and as the exchange network, if you will, develops, everyone from very large, jumbo-level employers to small businesses will be able to avail themselves of the opportunity to participate in that.

How that ultimately lands between those who choose to participate in the state exchanges on behalf of their employees, they do a contribution of sorts, and those who participate in some industry combination – that’s all developing. But the concept, the important message, is that the concept of combining the capability of accessing the insurance markets in a very efficient way, in providing advice to those in terms of the best health care options for them and placing that insurance is very much here to stay.

How are you envisioning the structure?

Savacool: You would have a set of options that might be in a metallic kind of structure – bronze, platinum, gold, etc. – that have different attributes. Think of grouping your health care plans into different selections that are grouped based on carrier, design and price point. So you, as a prospective health care insurance consumer, can make choices: Carrier A through D, you can choose a design that works for you that has different coverage options, different deductible options, and then there’s a price point associated with each of those. So you would contact the exchange, talk through your health care needs. You would get advice in the form of what the different options were, and then you would make a choice around that. Your employer would contribute a subsidy to a certain level and then you would pay the difference to the extent that there was one.

So there are a lot of moving pieces, and given the amount of advice that needs to happen with respect to exchanges, we think that we’re really well-positioned based on our expertise.</

And then there is this from Information Week Health Care

Towers Watson To Acquire Extend Health

Benefits and talent management consulting firm plans to buy online health insurance exchange provider Extend Health for $435 million.

By Marianne Kolbasuk McGee

May 15, 2012 11:59am

Professional services firm Towers Watson has signed an agreement to purchase Extend Health, an online health insurance exchange for supplemental Medicare coverage, for $435 million.
The addition of Extend Health’s health insurance exchange technology infrastructure, call centers, and existing base of 75 carriers represented in its online marketplace will help Towers Watson–best known for workplace benefits and talent management consulting services–to expand its offering into helping clients provide their retirees with assistance in purchasing private health insurance, including supplemental Medicare health plans.

Related articles

Final Word: Task Force Recommends Against PSA-based Screening for Prostate Cancer

21 May

Once again challenging conventional wisdom, new evidence shows more health care is not always the best health care. Such evaluations should be welcomed because first they mean better, less risky health care and second, they help manage costs. Some cynics will see such recommendations and changes as rationing. Quite the contrary; we need more reassessment of the health care we receive and how we receive it. We have all grown up believing more health care is always desirable We often overlook the risks associated with the care and tests we receive.

Evidence Show Harms of PSA Testing Outweigh the Benefits

PHILADELPHIA, May 22, 2012 – Following a period for public comment, the United States Preventive Services Task Force (USPSTF) released its final recommendation for prostate cancer screening. The Task Force now recommends against PSA-based screening for all men, regardless of age. The final recommendations are being published early online in the May 22 issue of Annals of Internal Medicine, the flagship journal of the American College of Physicians (ACP).

The Task Force last published recommendations on prostate cancer screening in 2008. At the time, researchers concluded that there was no evidence to support PSA testing for men over the age of 75. An independent panel of experts reviewed evidence published since 2008 and concluded that the harms of PSA testing outweigh the benefits regardless of age. The Task Force considers health benefits and harms, but not costs, when developing recommendations.

The primary goal of prostate cancer screening programs is to save lives and prevent symptomatic disease. The Task Force considered two major trials of PSA testing in asymptomatic men to assess the life-saving benefits of PSA testing. The first trial, conducted in the U.S., did not demonstrate any prostate cancer mortality reduction as a result of screening. The second trial, conducted in seven European countries, found a reduction in prostate cancer deaths of about one death prevented per 1,000 men screened in a subgroup of men aged 55 to 69 years, mostly in two countries. Five of the seven countries reporting results did not find a statistically significant reduction in deaths.

Strong evidence shows that PSA screening is associated with significant harms. Nearly 90 percent of men with PSA-detected prostate cancer undergo early treatment with surgery, radiation, or androgen deprivation therapy. Evidence shows that up to five in 1,000 men will die within one month of prostate cancer surgery and between 10 and 70 men will survive, but suffer life-long adverse effects such urinary incontinence, erectile dysfunction, and bowel dysfunction.

According to William J. Catalona, M.D., Medical Director of the Urological Research Foundation and author of an accompanying editorial, the Task Force recommendation has underestimated the benefits and overestimated the harms of prostate cancer screening. He and his co-authors argue that the Task Force — whose panel does not include urologist or cancer specialists — largely bases its recommendations on flawed studies with inadequate follow up time. In addition, the Task Force recommendations focus on mortality and do not take into consideration the substantial illness related to living with advanced cancer.

Editorial co-author, Dr. Henry Lynch, Director of the Hereditary Cancer Center at Creighton University, adds that the Task Force recommendations also leave out high-risk populations and younger men. The authors express concern that the new recommendations will take Americans back to an era when prostate cancer was often discovered at advanced, incurable stages.

“The recommendations of the USPSTF carry considerable weight with Medicare and other third-party insurers,” Dr. Lynch said. “My colleagues and I strongly believe that the Task Force recommendations should not be used as justification by insurers, including Medicare, to deny diagnosis of prostate cancer to the male population at risk.”

Yet, according to Otis W. Brawley, MD, MPH, Chief Medical Officer of the American Cancer Society, and author of a second accompanying commentary, overdiagnosis makes screening seem to save lives when it truly does not. Many men are diagnosed with prostate cancer that may never have progressed within their lifetime. Yet because they were screened and treated, they think screening saved their lives.

“Many people have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found,” wrote Dr. Brawley. “There is little appreciation of the harms that screening and medical interventions can cause.”

In October 2011, the Task Force posted its draft recommendations for public comment. At the time, the Task Force had given PSA screening a grade “D,” meaning that physicians should not offer the test because the harms outweigh the benefits. Many people who commented on the recommendations urged the Task Force to change the recommendation to a grade “C,” meaning physicians could provide the test to patients who request it. However, no new evidence was presented. The recommendation remains unchanged.

While the recommendation clearly states that physicians should not offer PSA screening, the Task Force says it leaves the ultimate power in the hands of the health care providers.

“The USPSTF recognizes that clinical, policy, and coverage decisions involve more considerations than evidence alone,” said Task Force Chair, Virginia A. Moyer, MD, MPH of Baylor College of Medicine in Houston, TX. “Clinicians and health care providers should understand the evidence but individualize decision-making to the specific patient or situation.”

About Annals of Internal Medicine
Annals of Internal Medicine is one of the five most widely cited peer-reviewed medical journals in the world, with a current impact factor of 16.2. The journal has been published for 82 years. It accepts only 7 percent of the original research studies submitted for publication.

And then there is this from the New York Times May 16 regarding new studies indicating the high levels of HDL (good cholesterol) may not be related to lower heart disease risk.

I often see patients in the clinic with low HDL levels who ask how they can raise it,” Dr. Kathiresan said. “I tell them, ‘It means you are at increased risk but I don’t know if raising it will affect your risk.’

“That often does not go over well, he added. The notion that HDL is protective is so entrenched that the new study’s conclusions may prove hard to accept, he and other researchers said.

“When people see numbers in the abnormal range they want to do something about it,” Dr. Kathiresan said. “It is very hard to get across the concept that the safest thing might be to leave people alone.”

Attacks on Obamacare are attacks on women’s health and well-being.

16 May

The title of this blog post is taken from a call out statement contained in a report prepared by the Center for American Progress as is the quote below. This type of reporting, propaganda or whatever you want to call it represents the worst of politics. The intent is to further polarize Americans by segmenting this group or that and playing on elements of their self-interest.

A quick reading of the first paragraph below and some would conclude that 45 million women first obtained these services because of Obamacare [note how suddenly the President's supporters have adopted the once pejorative "Obamacare."]. The reality is that the 45 million who had such service, most of whom would have had them in any case, have gotten them for “free” and the “free” part is supposed to be a good thing. There probably is no need, but I can’t help but remind readers these services are not “free” at all and such claims are further evidence of either the naivety of proponents or simply their overwhelming desire to promote their agenda despite the facts.

And of course, we can’t forget the insurance industry abuses against women. Never miss an opportunity to take a shot at the scapegoat of choice.

Denial of coverage for “gender-related pre-existing conditions”…  as opposed to non-gender-related conditions? Has anyone ever stopped to ask why all these people women, men or otherwise waited until they had pre-existing conditions to apply for insurance?  Has anyone asked why children were prevented from coverage for pre-existing conditions when it was universally possible to enroll a newborn without such restrictions provided such enrollment occurred within a certain period?  Employer plans have always required a new child or spouse to be enrolled within a specific number of days or to wait until the next open enrollment period. Is that unreasonable to protect against gaming the system and to protect the employer and fellow workers against adverse selection costs? Oh wait, it does require the exercise of personal responsibility and we all know that is a no, no.

Thanks to Obamacare, more than 45 million women have already taken advantage of recommended preventive services, including mammograms, pap smears, prenatal care, well-baby care, and well-child care with no cost sharing such as co-pays and deductibles. Starting this August, millions more will be able to obtain contraception, annual well-woman care (a visit with a gynecologist), screening for gestational diabetes, breastfeeding counseling and supplies, and screening for sexually transmitted infections, including HIV and the Human papillomavirus—again at no extra cost.

In addition, women will no longer encounter discrimination in the health insurance market in the form of lost maternity coverage, higher premiums due to their gender, and denials of coverage for gender-related pre-existing conditions. Indeed, close to 9 million women will gain coverage for maternity care in the individual market starting in 2014. And provisions in the new health law that protect everyone will especially benefit women, who utilize the health care system the most.  In short, Obamacare will increase health insurance coverage for women, lower their health care costs, and end the worst insurance industry abuses against them.

Look past the rhetoric on both sides of the health care debate, look at the unintended consequences of the promises made. Consider the promises of “free.”

Related articles

Massachusetts seeks to cap growth in health care spending-it’s time to ask HOW

15 May

Pending legislation in the Bay State would target the growth in health care spending to the growth in the Gross State Product (similar to national gross domestic product) give or take a little. The average currently is 3.6% annually.

This is a worthy goal, but waving a magic legislative wand does not make things happen. The Affordable Care Act attempts something similar using the Medicare Payment Advisory Board and many people are up in arms over what they see as a potential move toward rationing. Keep in mind that the growth in health care costs is not primarily caused by the increase in individual fees, but the growth in utilization and the type of utilization (more, and more complex, expensive tests).

In addition, providers must deal with reduced payments and new constraints from the federal government. This is especially true for hospitals.

So, to meet preset spending targets what has to happen? The most obviuous is that all providers must reach an optimum level of efficiency. However, beyond that the care that is provided must change. In other words, less care and less intensive care must be provided. If that means that patients receive better care, only necessary care and no more that’s great. On the other hand, in the unlikely event that is achieved but gross spending does not reach the target, then what?

We are back to the fundamental question applicable to all political solutions … how?

20120510-093545.jpg

The A priori of health care-why ALL health care is unaffordable

14 May

The following is from a recent article in Health Affairs.

Abstract

The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper’s analysis of national survey estimates found that access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist. We also found that children—many of whom qualify for public coverage through Medicaid and the Children’s Health Insurance Program—generally maintained or improved their access to care during the same period. This provides a reason for optimism about the ability of the coverage expansion in the Affordable Care Act to improve access for adults, but it suggests that eliminating the law or curtailing the coverage expansion could result in continued erosion of adults’ access to care.

While I do not make light of the problems many people face who do not have health insurance, nor do I deny the need for expanded coverage, I find the basic assumption that virtually nobody can afford even modest health care intriguing. Look at the above abstract, could it be that half of the people in the group did not need to see a doctor or that they chose not to see a doctor or dentist for reason unrelated to their coverage status? Could it be that children received more care because much of the care was free or that children naturally use services more than twenty somethings?

I have written on this concept many times before, but I still find it fascinating and one of the reasons we may never truly solve the health care problem even if we evolve to a single payer system.

I am convinced the average person does not see any health care expense as something they should be responsible to pay. Consider all the goods and services a person buys in a year beyond the very necessities of food, clothing and shelter and then tell me where paying for a doctors office visit lies in the list of priorities. 

The fact is when we decide what we cannot afford, health care is near the top of any list ahead of real necessities like going out to eat, a trip to Disney for the family or even a weekly trip to the nail salon (think “The Pill” unaffordable co-pay).

Of course I am not talking about catastrophic level expenses for which we all need insurance, but that is a long way from buying supplemental coverage to pay our 20% coinsurance or mandating an array of services to be “free”. Heck, seniors routinely buy Medi-gap coverage to pay for things they paid for themselves before they had Medicare without any cost-benefit rationale.

Does anyone seriously think that those now free services are not actually affordable to most people if they chose to spend their discretionary dollars that way? Rather, we need to make them free because we know people will always choose to spend their money otherwise even when it is in their best interest to receive the health care.

Think how different and more affordable health care would be if the only coverage available was for hospitalization, medical and surgical care inpatient and fixed dollar benefits for laboratory, x-rays and the like … exactly the way it was when I started working in the health benefits field in 1961.

New Report: Employers will save billions by dropping health care benefits…it’s not a good thing!

7 May

The House Ways and Means Committee has released a report showing the potential savings large employers could realize by dropping their health benefits, paying a fine and turning employees loose on the individual insurance market. Admittedly this is a highly political document that draws conclusions of a questionable nature in the real world.  However, the very idea that employers will seriously consider dropping employee coverage is scary.  There are big dollars at stake here and no doubt there are some CFOs and CEOs who would very much like to get out from under the unpredictable costs of health care benefits…as many have already done for their retired employees.

Take our new poll

One can make a case that this coverage should not be linked to employment. In addition, workers who receive employer-sponsored coverage clearly have an advantage over those who must purchase coverage on their own.  Neither point makes the case for throwing the baby out with the bath water (a reference to the medieval practice of giving babies the last bath in the same water during the annual family washing).

I spent nearly fifty-years designing and managing health benefit programs for a Fortune 200 company.  I know the value this type of coverage provides to tens of millions of workers and their families.

Employer coverage provides a wide arrange of benefits beyond the financial advantages for workers. Virtually all large employer plans are self-insured; only the use of health care by the workers and their families are considered in setting premiums.  This means that workers can affect the cost of their care. Employers negotiate the best deal for administrative costs.  Most employers hear and resolve disputed claims or oversee the process if outsourced. Employers communicate extensively with employees about their benefits and health care issues.  Employers provide an array of services and programs to assist employees in obtaining care and manage their care and costs.  Employers have an incentive to manage costs beyond any applicable to an insurance company. Many employers will assist their workers in dealing with problems, they handle enrollment, and even assist workers negotiating with high fee, non-participating providers.  Most large employers provide several choices in health plan options.

On his Forbes blog Avik Roy writes:

Free-market reforms, on the other hand, would increase consumer choice, by giving workers control over their own health dollars. Under a free-market system, workers could stay with their employer’s plans, or buy insurance on their own that better suits their needs. For example, young, healthy workers could take dollars out of their company’s expensive plan and steer them towards high-deductible insurance combined with a health savings account.

Note to Mr. Roy, most workers do not want more choice and indeed are afraid of choice, afraid of making the wrong choice. Large employers are already adding HDHPs within their array of choices and this allows the experience for the entire group to be aggregated.  Setting up a system that allows young, healthy workers to leave the employer plan is called adverse selection and would add to the cost of coverage for the remaining workers and the employer eventually creating a death spiral as new young individuals are employed.

In summary, workers are far better off within an employer sponsored plan than they would be on their own deciding which plan and insurer to use and then having only the insurer selected to deal with problems and concerns that arise.

While there is no indication that large employers are seriously considering dropping health benefits en mass, with escalating costs and the growing number of federal mandates and compliance requirements that situation could change in the future. It would not be a good thing, be careful what you wish for.

Washington, DC – Today, in a new report prepared for Ways and Means Committee Chairman Dave Camp (R-MI), data from America’s Fortune 100 companies show they could save hundreds of millions of dollars a year under the new health care law by simply terminating health insurance for their workers and dumping these employees into taxpayer-funded health care exchanges.  

More than 70 percent of America’s Fortune 100 companies detailed their health care costs for the Committee, providing the ability to analyze how those self-reported costs would compare to ending employer-sponsored insurance and paying the employer mandate penalty.  Based on an aggregation of the data received, if the 71 Fortune 100 companies that replied to the survey ceased to offer health care coverage and paid the employer mandate penalty, they could save a total of:

  • $28.6 billion in 2014 (an average savings of over $400 million per company) and
  • $422.4 billion from 2014-2023 (an average savings of nearly $6 billion per company).

“The findings of the report, along with existing research, show that the Democrats’ health care law threatens the stability and sustainability of the employer-based health insurance system,” said Camp.  “Anyone who gets insurance through their job should be worried about what will happen next, because there is a distinct financial incentive for employers to terminate health care coverage under the Democrats’ health care law.  It is clear to me that because of this law, Americans will not be able to keep the health care plan they have and like.  American workers and taxpayers simply cannot afford to have this law remain on the books.”

The report is entitled “BROKEN PROMISE:  Why ObamaCare Will Force Americans to Lose the Health Care Coverage They Have and Like.”  Click here for the key findings, and here for the full report.

Related articles

Insurance company profits and your health insurance premiums

3 May

Spurred on by the President’s rhetoric, many Americans believe that insurance company profits are the cause of high health care costs and premiums. The facts are otherwise of course, but the perception persists.

Look at the informal poll I am taking (right margin) and you will see close to 20% of those casting their vote (as of April 26) believe insurance company profits are the MOST significant cause of high health care costs.

Let’s look at some numbers. WellPoint, one of the largest health insurance recently reported a profit of $856.5 million. That’s a lot of money to be sure and no doubt some politician would be delighted to talk about record profits (which it isn’t by the way). Now consider that WellPoint had 33.7 million members as of March 31. Do some simple math and you see that the profit is equal to $25.42 per member. Even given a family of four may be counted as four members, that’s $100.84 a year out of a total premium of perhaps $12,000 or more. At the same time WellPoint reported a loss ratio of 83.3% meaning over 83% of each premium dollar was used to pay claims.

So, what is the most significant cause of high health care costs? Cast your vote.

Are we missing the mechanics of the mandate?

24 Apr

“Ironically, it is this aspect of Obamacare’s individual mandate—the fact that it forces Americans to consume health care above and beyond their actual needs—that may be its undoing at the Supreme Court. “A young, healthy individual targeted by [Obamacare’s] mandate consumes about $854 in health services each year,” said Justice Alito in last month’s oral arguments. “Isn’t it the case that what this mandate is really doing…is requiring them to subsidize services that will be received by somebody else?”

Well Duuuh?

See what I really think of this on Health Insurance Illuminated

Take our poll! We need your views on the cost of health care

23 Apr

 

If you look to the right you will see a new poll; what do you think is the single major cause of high health care costs recognizing that there are, of course,  several causes.

Please give us your opinion.

You can click on the results and see how your point of view aligns with other readers of Quinnscommentary.

What if the Affordable Care Act is struck down in whole or part ?

17 Apr

If the Affordable Care Act stays as is, costs are going to continue to escalate. If the Affordable Care Act is struck down, costs are going to continue to escalate. We are faced with not too appealing choices. In the event that the mandate is struck and the balance of the law upheld, we face even higher costs for those who pay for insurance.

Many years ago New Jersey enacted a requirement to accept anyone who wanted coverage. The result was premiums escalating about 30% shortly thereafter. Check healthcare.gov and you will find a plan offered in NJ with a premium an absurd $100,000 a year … talk about self-insurance.

Given those most likely to forego coverage are also least likely to need coverage because they are currently young and healthy, the short-term negative impact may be somewhat overstated, but it is real nevertheless. Congress may have made a serious mistake in creating the national mandate. Rather, it should have left the manner in which adverse selection was dealt with to the states. A two year waiting period to obtain coverage, if initially waived, a surcharge for late enrollment such as used by Medicare, limited benefits for an extended period upon late enrollment are all possibilities.

Regardless of your point of view, it’s very clear that this law was passed without a clear understanding of all the consequences and interrelationships within the health care system. That is too bad, because if the law is struck in total, we are back to square one and billions of dollars in the pubic and private sector will have been wasted and many of the positive initiatives will cease. The likelihood of this or the next Congress starting over is remote.

The good news is that regardless of any law, private insurers are taking the initiative to tackle the real issues of cost and quality. Insurers are focused on new payment models such as Patient Centered Medical Homes, Bundled Payments and Accountable Care Organizations where they attempt to shift reimbursement from fee for service to fee for quality and outcomes. These models also promote care coordination and ultimately improved quality of health care.

This article also appears in the Health Insurance Illuminated blog.

Are you concerned that the Affordable Care Act will be voided in whole or in part?

 

Dont forget to cast your vote in the poll on the right =========>

Rationing health care

15 Apr

One of the scare tactics used by those opposed to major reform in health care is claiming that reform will result in rationing. Simply put, you will not be able to receive all the health care you want anytime you want it (at least not if someone else is paying the bill).

But let’s think about this. Whether it is price controls, premium support, vouchers or limits on what will be paid for, it is all “rationing.” Every proposal, Democratic or Republican must include some cutback we will perceive as rationing.

If we are going to save money and lower the future trend for health care costs, we must spend less money. If anyone thinks we are all going to get the same, unlimited, open-ended health care we now think we need, or that providers will have the same level of income, then we are just kidding ourselves or we are outright fools… go ask the rest of the world!

20120404-172755.jpg

Is a defined contribution health plan in your future?

11 Apr

Whether it is Medicare or your employer health benefits plan, unlimited benefits and unlimited costs are not going to last. The current concept zeroing in on both plans is the defined contribution. This is vastly different from the current defined benefit approach … Think 401(k) plan versus a traditional pension plan.

To learn more about what this may mean to you, read this blog post on Health Insurance Illuminated.

Individual Mandate to Carry Health Insurance Not Popular Among any Group of Voters

9 Apr

Despite what some politicians may promote, the popularity of the individual mandate contained in the Affordable Care Act is not all that high. An opinion poll from Kaiser Public Opinion showed that overall only 32% of those surveyed looked on the mandate favorably, 45% among Democrats, 32% of Independents and 19% of Republicans.

INDIVIDUAL MANDATE WIDELY KNOWN, BUT LEAST POPULAR PART

One of the consistent tenets in public opinion on the ACA is this: while the law as a whole has never gained majority support, many of its component parts—from the relatively narrow to the core and comprehensive—have been consistently popular over the past two years, with the glaring exception of the individual mandate. Currently, in March 2012, only one in three feel favorable toward the mandate, compared to majorities of the public who favor the law’s other provisions, such as tax credits to small businesses that offer coverage, as well as the consumer‐friendly requirement that plans include easy‐to‐understand summaries of their benefits and costs. Not even a majority of Democrats, who favor the law overall, have a favorable view of the mandate (45 percent). And, between November 2011 and March 2012, intense opposition to the mandate (the proportion who say they have a “very” unfavorable view of it), increased eleven percentage points from 43 percent to 54 percent.

Regardless of your point of view, this is not good news because in my view these results demonstrate a lack of understanding of how the insurance system works and a tendency to cherry pick provisions of the Law that add benefits while discounting the consequences.

20120402-203500.jpg

The real reason contraception is “free” under the Affordable Care Act

6 Apr

Most people, including me, think mandated coverage of contraception was a result of the Affordable Care Act and the Institute of Medicine that is charged with making recommendations related to preventive services that should be covered at 100% by health insurance.

Recently, I found a copy of the website my.Barackobama.com dated November 3, 2008.

Here is what it says:

Barack Obama is an original co-sponsor of legislation to expand access to contraception, health information and preventive services to help reduce unintended pregnancies. Introduced in January 2007, the Prevention First Act will increase funding for family planning and comprehensive sex education that teaches both abstinence and safe sex methods. The Act will also end insurance discrimination against contraception, improved awareness about emergency contraception, and provide compassionate assistance to rape victims.

Think Contraception Logo

So you see, the full and “free” coverage of contraception was a long-planned goal and likely had little to do with the IOM recommendation, but more with an ideology that it is the federal government’s responsibility to solve just about any problem American’s face. Here we also see the claim of “insurance discrimination,” key rhetoric in promoting the idea that virtually every health care related expense should be covered and with minimal or no cost.

Once the Affordable Care Act was passed including discretion for the Secretary of HHS to designate preventive services, there was no need for separate legislation.

The President’s perspective may also have something to do with the fact that 72% of black American children are born to unwed mothers and many of those to teenagers. That indeed is a problem for the individuals involved and for society. It is a social crisis, a moral crisis and one that will not be solved by making the pill “free” especially given that many of the people involved already have access to contraception at minimal or no cost.

Related articles

The Obama-Biden promises for health care reform – what happened? Do you still think you can have it all and not pay for it?

5 Apr

President Barack Obama walking with Vice Presi...

 For some reason back in 2008 I printed out the entire Obama-Biden website containing their positions and proposals.  Scanning the health care section recently I found some interesting statements:

“The Obama plan will lower health care costs by $2,500 for a typical family by investing in health information technology, prevention and care coordination.”

“Reduce Costs and Save a Typical American Family up to $2,500.”

“Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year.”

Which is it, “by”, “up to” or “as much as?”  No matter, there is nothing in the Affordable Care Act that saves the typical family $2,500.  You can stretch this definition and say that the subsidies within the exchanges will save some families money and that’s true, but it does not lower health care costs and certainly not through information technology, prevention and care coordination.

“On health care reform, the American people are too often offered two extremes – government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.”

Interesting choice of words, the “extreme” of government-run health care, is “wrong.”

“Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.”

The “fair and stable premiums” will reflect the additional cost of removing all underwriting for insurance coverage.

“Barack Obama will pay for his $50 – $65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.”

LOL . . .

the President’s most recent budget alone contains an additional $111 billion to cover the cost of subsidies for Americans enrolled in the health insurance exchanges.

Of course, rhetoric and  promises that don’t match reality are not unique to Obama-Biden or to Democrats for that matter.  All politicians pander to the wants and fears of the voters, but on occasion it would be nice if the voters held them accountable.

← Older Entries

Follow

Get every new post delivered to your Inbox.

Join 371 other followers