July 01, 2008
Californians Not Getting the Health Care They Need
Call them stoic, call them cost-conscious, call them under- or uninsured...but almost 20 percent of the U.S. population either went without or delayed needed medical care at sometime during 2007. That figure is up from 14 percent in 2003, and if you are counting, is an additional 9.5 million Americans who didn't get the medical care they needed in 2007.
People had numerous reasons why they had postponed or had completely forgone medical care for themselves during the year. Chief among them was out-of-pocket medical costs and deductibles they couldn't afford to pay, followed by a list that included things like a lack of acceptable clinic hours of operation, difficulty getting to clinics during working hours, problems with doctors being overbooked that resulted in difficulty getting timely appointments, and doctors and hospitals not accepting their insurance plans.
It wasn't just people without medical insurance that were avoiding medical visits, but both people with and without insurance that were either delaying or forgoing medical care, according to a random national phone survey. The survey was conducted by the Center for Studying Health System Change, a nonpartisan policy group, who called 18,000 people, with a 43 percent response rate.
The study's lead author, Peter Cunningham, noted that as health care costs increase, a larger share of cost, often in the form of higher deductibles, is being shifted to people and families, requiring them to pay more out of their own pockets. "To the extent that health insurance cost increases are passed on to individuals, continued declines in access to care are inevitable," wrote the co-authors of the study.
Karen Ignagni, chief executive of America's Health Insurance Plans, an insurance-industry trade group, feels that a variety of issues need to be addressed by policy makers to make surgery, medical imaging, and specialty drugs more affordable to the general public, and to standardize quality of care among providers. The cost of drugs and services has risen at a rate at least twice that of inflation for several years, making it more difficult for even those with health insurance to pay for medical care.
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Posted by healthinsurance at 01:13 PM | Comments (0)
June 26, 2008
California Health Insurance Companies Spend $10.3 Billion On Administration And Profit
Private California health insurance companies regulated by the Department of Managed Health Care (DMHC) spend $6 billion each year on administration, and divert an additional $4.3 billion to profit, according to a report released by the California Medical Association (CMA). Prepared using data obtained under the Knox Keene Act, the report breaks down how private health insurance companies spend their revenues.
"This report paints in stark terms why health care costs are skyrocketing for Californians," said Dr. Richard Frankenstein, M.D., President of CMA. "Health insurance companies in California spend billions of California's health care dollars each year on administration, and for-profit insurers divert billions of dollars more to profit. Californians' health care dollars should be spent on health care, not on bureaucracy."
Currently, private health insurance companies regulated under Knox Keene - representing some 60% of the health insurance market - are required to spend no more than 15% of their revenues on administrative costs. CMA and other health care advocates believe the statute includes profits as administrative costs; health insurance companies exclude profits from the 15%, allowing them to spend as little as they want on actual health care. SB 1440, a bill authored by Senator Sheila Kuehl and sponsored by CMA, would require insurance companies to spend 85% of their revenues on health care, driving down health care costs for consumers and potentially making coverage more affordable.
"It's not acceptable for us to ignore such massive waste in the Californian insurance industry when Californians are being bankrupted by rising health insurance premiums and gutted benefits," stated Senator Kuehl. "California consumers have a right to know that there is a basic formula in the law for how much of their money is actually being spent on medical care. This is the least we should be doing."
If SB 1440 had been in effect in the last reporting year, HMOs would have spent $1.1 billion less on administrative costs and profit - money that would have gone instead to provide health care to their policyholders. Blue Cross policyholders alone would have benefitted from $700 million more in health care that instead went to administrative costs and profit.
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Posted by healthinsurance at 03:28 PM | Comments (0)
June 22, 2008
It's 'buyer beware' in California individual health insurance market
More than 2 million Californians purchase their own medical coverage – a number that's growing as fewer employers offer group coverage.
Thwarted in their efforts to overhaul the state's health care system, consumer advocates are now concentrating their efforts instead on tightening regulation of that market.
Unlike the heavily regulated group insurance market, advocates say the California individual insurance market is rife with "junk insurance" policies that provide minimum benefits, such as hospital-only coverage, and don't set limits on out-of-pocket expenses.
Advocates say it's often impossible to determine what a plan does or doesn't cover, and some consumers – like Mary McCurnin and Ron Bednar of Rancho Cordova – find out too late after they run up thousands of dollars in medical costs.
Sen. Darrell Steinberg's Senate Bill 1522, which is sponsored by the consumer advocacy coalition Health Access California, would standardize the individual insurance market and limit out-of-pocket expenses.
California health plans would be split into five tiers to allow consumers to compare prices and better understand what they were buying.
"Consumers have the right to basic information about what they're buying," said Steinberg, D-Sacramento. "This bill is all about transparency, about ensuring that so-called junk insurance is no longer a part of the market."
SB 1522 is one of more than a dozen Democratic bills targeting the insurance industry that are moving through the Legislature.
Other bills would block insurers from canceling policies of patients needing costly care and would require insurers to spend at least 85 percent of their earnings on California medical care.
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Posted by healthinsurance at 04:27 PM | Comments (0)
June 16, 2008
LAO Confirms California Single Payer Reduces Health Care Spending
This is my fifth essay for 2008. I interrupt my presentations on the current budget crisis to report on a confidential analysis of SB 840, my legislation creating a single payer health insurance system in California, requested by anonymous members of the Assembly [the requesters’ names are not revealed, as a matter of course, by the Legislative Analyst’s Office (LAO)] and conducted, in the middle of their budget analyses, by the California Legislative Analyst’s Office. My first 2008 essay was an update on the 2007 “year of California health reform”. The second set out some background information on actions taken by the legislature to re-balance the 2007-2008 budget given shrinking revenues. The third reviewed the Governor’s budget as he presented it in January of this year. This essay will analyze the LAO review of a single payer system for California.
Why the Legislative Analyst Looked at SB 840:
The LAO, in addition to their yearly on-going analysis of state spending and the budget, receives requests from members of the Legislature to look at the fiscal impacts on the state of various legislative measures. You may recall that during the discussion of the omnibus health measure put forward by the Governor and then-Speaker Fabian Nunez, Senate President pro-temps Don Perata asked the Legislative Analyst’s Office to report on the potential impact of the bill on State finances. In so doing, the LAO took into account a proposed funding initiative the Governor had submitted for the next ballot go-round which, if adopted by the people, would have set out a plan to fund the measure to be put on the ballot later in the year.
The LAO’s report was presented to the Senate Health Committee and the programmatic bill did not pass the Committee. The funding mechanism was not in front of the Committee and did not go on the ballot.
Following the defeat of that California insurance bill, three members asked the LAO to analyze SB 840, not only for its impact on State spending (which was found to be favorable), but also for the larger issues raised in funding the new program.
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Posted by healthinsurance at 09:36 PM | Comments (0)
June 13, 2008
California Gets Failing Grade on Consumer Health Protections
Key health reform bills got a boost today with the unveiling of a national report that compared California to other states in terms of consumer protections for individual California health insurance.
Key health consumer advocates stated that insurance companies can deny health coverage to people with pre-existing conditions, refuse to pay for services needed to treat common ailments, and yank policies and deny payments when a consumer faces a rash of medical bills, and California (and other states) have little authority to protect consumers from such abuses.
Health Access California has based our comments today on a study published by Families USA, the national organization for health care consumers. Titled “Failing Grades,” the study reviews whether key protections are provided to healthy consumers to prevent insurance company abuses in California, as well as each of the other 49 states and the District of Columbia.
Without the purchasing power of group coverage, a Californian getting insurance as an individual is simply at the mercy of the big insurers, with few consumer protections. This report shows that California needs to tame our wild, wild west of an individual insurance market, and place new oversight over the insurance companies. This report places a spotlight on key bills pending in the California legislature, to ensure that coverage has value, and is there when the consumer needs it.
Bill up for key committee votes in the next few weeks will spotlight the need for significant new consumer protections, especially in the individual insurance market where consumers have little purchasing power and are simply at the mercy of big insurance companies.
THE STUDY:
The findings in the Families USA report show that consumers in most states are unprotected from many of these abuses.
• Only five states prohibit all California health insurance companies from cherry-picking the healthiest consumers and excluding everyone else. California allows for denying people for “pre-existing conditions,” even minor ones.
• In 35 states and the District of Columbia, there are no limits on how much insurers can increase premiums based on an individual’s health status. An additional six states have limits that still allow dramatic variations in premiums. California allows unwarranted increases in premiums.
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Posted by healthinsurance at 07:15 PM | Comments (0)
June 11, 2008
California Health Insurance: Extreme Matrimony Edition
Some couples, straight and gay, are finagling wedding dates to quickly get both spouses on a company plan. Other married couples cruising for a breakup can at least agree on postponing divorce to keep both people on the existing California health plan of one of them. And some self-employed people are hiring workers just to qualify for group insurance, Dow Jones Newswires’ Victoria E. Knight reports.
The rub is basic. Under federal law, insurers have charge the same for premiums for everybody in an employer-sponsored insurance plan–no matter their health. But try buying health insurance on the open market, and you may face high prices or rejection, depending on your medical history.
One planner told Knight about a client, a woman in her mid-50s, who moved up her wedding so that her fiance, would also become eligible for health benefits offered to workers and spouses as part of a corporate buyout package at her job.
A business owner in California, covered under a small group insurance plan, put her husband on the payroll largely for insurance reasons. “I hired my husband to run my office and manage the IT,” the woman told Dow Jones, who asked not to be named for fear of drawing the attention of insurers.
Seven percent of Americans said that in the past year they or someone in their household decided to tie the knot mainly so one spouse would be eligible for the other’s California health coverage, according to a survey by the Kaiser Family Foundation. We were a little skeptical about the figure, which by our calculation seemed a bit high, but have little doubt that insurance worries weigh heavily on millions, married or otherwise.
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Posted by healthinsurance at 09:00 PM | Comments (0)
June 05, 2008
Aetna Introduces Dental-Only Insurance Plans for Individuals and Their Families
Aetna (NYSE:AET) announced today that it has begun selling stand-alone dental plans to individuals and families, which are now effective as of June 1, 2008. These new products will initially be offered in Arizona, Delaware, Illinois and Pennsylvania, with plans to expand their availability to additional states in the future.
Individuals, including those who are eligible for Medicare, will be able to purchase these plans at any age. In addition, there will be no medical underwriting, meaning that individuals are automatically accepted if they apply (prices will vary based on age and geographic region).
There will be two PPO-style options for individuals to choose from - the Aetna Individual Advantage(SM) Dental PPO Plan and the Aetna Individual Advantage(SM) Dental PPO Plus Plan. Both plans will give members access to Aetna's PPO network of participating dental practices, which includes more than 105,000 available dental practice locations throughout the country.
Individuals can find more information on these plans and purchase them directly at www.aetna.com/buydental or by calling 1-877-243-3682.
"The fact that 47 million individuals in our country do not have health insurance is often mentioned, but it is rarely noted that more than twice as many individuals lack dental insurance," said Frank McCauley, head of Aetna's Consumer Business Segment. "We believe that a stand-alone dental product will help increase access to important dental care."
Aetna's Emphasis on Dental Health
AdvertisementRecently, numerous studies have demonstrated the connection between dental health and overall health. This includes research conducted by Aetna and the Columbia University College of Dental Medicine that shows a correlation between periodontal disease and individuals with chronic conditions, including people with diabetes or heart disease.
"Our research with Columbia indicates that promoting preventive dental care can have an impact on the overall wellness of our members," said Alan Hirschberg, head of Aetna Dental.
In addition to this research, Aetna has worked with Columbia to develop a number of continuing education courses for participating dentists on the connection between dental health and overall health. Columbia also provides the content for Aetna's dental education website, Simple Steps to Better Dental Health(R).
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Posted by healthinsurance at 09:16 AM | Comments (0)
June 03, 2008
Health Insurance Lacking Among Young Adults in California
When it comes to health insurance, the 19th birthday is a milestone. Young adults are usually dropped from their parents' insurance unless they go to college full time.
Researchers from the Commonwealth Fund have reported that the number of uninsured young adults climbed to 13.7 million in 2006, an increase of 400,000 from the previous year.
They also found that 38 percent of high school graduates who don't attend college and 34 percent of college graduates go without health insurance during the year after graduation.
Young adults typically work low-paying jobs where employers are less likely to offer them coverage.
Researchers said health insurance is especially important for young adults because they have a high rate of pregnancy, serious injuries, and HIV diagnoses.
To help combat this lack of insurance coverage, 20 states have passed legislation that extends family private insurance coverage for young adults into their 20s.
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Posted by healthinsurance at 09:34 PM | Comments (0)
June 01, 2008
Stephen Barkalow focuses on health care, education
Many of the problems plaguing California, notably the economy and education, can be ameliorated by focusing on fixing the ailing health care industry, according to Assembly candidate Stephen Barkalow.
When he first became active in the political arena, he wanted to focus on education and health care reform.
“But then I saw that they all bleed together,” he said. “I decided to focus on the issue that affects us the most.”
Barkalow has been a practicing chiropractor for about three decades. In his practice, he sees about 30 patients per day.
For 15 years, he’s been actively lobbying Sacramento for changes to the health care industry, especially in the for-profit health insurance industry.
About 20 million people in California are privately insured or have obtained coverage through their places of employment. Altogether, they are paying out billions in premiums, but private insurance companies keep 50 percent, said Barkalow.
This is having severe negative financial impacts on consumers, and leading to an overall decline in the health care industry, he said.
He says that if California takes a stand against for profit health insurance companies, it will give money back to consumers and pump billions back into the economy. Some states, said Barkalow, require their health insurance companies to pay out 90 percent.
“If we change these things, that money stays in our pockets,” he said. “We would keep $50 billion. Across the board we’d have a healthier California.”
Barkalow says he supports a universal single-payer system, which he says can be quickly created.
He has refused campaign donations and endorsements from special interest groups like the Sierra Club, instead focusing on private individuals.
“I didn’t want to be obligated to anyone,” he said. ‘The special interest to me is the voter.”
Californians, click here for cheap health insurance!
Posted by healthinsurance at 07:23 PM | Comments (0)
May 29, 2008
Poll: 7% of Americans marry for health insurance
Some people marry for love, some for companionship and others for status or money. Now comes another reason to get hitched: health insurance.
In a poll released Tuesday, 7 percent of Americans said they or someone in their household decided to marry in the past year so they could obtain health care benefits via their spouse.
"It's a small number, but a powerful result, because it shows how paying for health care is reflected not only in family budgets, but in life decisions," said Drew Altman, president of the Kaiser Family Foundation, which commissioned the survey as part of its regular polling on health care.
The survey found that the costs of health care outranked housing expenses, rising food prices and credit card bills as a source of concern.
Of those surveyed, 28 percent said they had experienced serious problems because of the cost of health care, nearly tied with 29 percent who had problems getting a job or a raise.
Gasoline prices were the top economic worry, with 44 percent saying they had serious problems keeping up with increases at the pump.
Health care inflation has been rising at about twice the rate of economic growth.
Therefore, it may be no surprise that nearly one-fourth of Americans decided to keep or change jobs in the past year because of health insurance.
The Kaiser polls, conducted April 3-13, surveyed a nationally representative sample of 2,003 adults and have a margin of error of plus or minus 3 percentage points.
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Posted by healthinsurance at 11:36 AM | Comments (0)
May 26, 2008
What Is The Difference Between Health Insurance Companies In California?
Whether you already know it or not California has a lot of options for health insurance. There are companies that we all heard of and there are some companies that we never heard of. With all the Health Insurance Companies out there you might be wondering what the differences are and which one is right for you.
First in state of California the health insurance companies you should be looking at are; Aetna, Assurant, Blue Cross, Blue Shield, HealthNet, Kaiser, Nationwide, PacifiCare, Celtic and new company that is going to be available in state of California is Golden Rule. These are the largest health insurance carriers that are available in the State of California.
If you are looking at any other company that was not mentioned previously, use caution. With all the health insurance premiums going up there are companies that prey on people with low premiums and coverage that does not cover anything. They are just out there to make a quick buck buy collection as much premiums as they can before you cancel your coverage. Stay away from companies that you never heard of, not matter what they tell you. If you hear something like, “affordable health insurance for self-employed”, run.
Second what you have to understand that the actual cost of insurance no matter what company you go with is about the same. So how do insurance companies have so many different plans with different premiums? If it is a large insurance company and the company ran efficiently that is how you get great premium with great coverage. What creates variety of prices for insurance coverage is the creative aspect of the insurance company designing their plans. The way they do it is by deductibles, co-pays, co-insurance, drug coverage deductibles, whether the plan covers brand name drugs or generic drugs only, maternity coverage, maximum out of pocket, deductible and co-pays for all kind of different services.
The name we all know is Blue Cross Blue Shield. Blue Cross has been around since the recession of 1929, and it used to cost only 1 cent a day. The times have changes since then, but the Blue Cross name is still around. Blue Cross has been over the years the most stable largest health insurance provider in the United States. Their strategy is to keep rates stable and have stable rate increases. While most other plans might lower their rates to get more people on their coverage and then keep increasing their rates. There fore as some plans might be more attractive in premiums at the moment over time eventually they have to catch up with the actual market health insurance cost. Sometime the company has to charge people more for health insurance in the future so they can give more affordable rates today. Blue Cross will give the one of the largest varieties of plans to choose from and you can always downgrade a plan without going through underwriting is the monthly premiums because to expensive.
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Posted by healthinsurance at 02:21 PM | Comments (0)
May 22, 2008
California Insurance Regulator Touts Value of Personal Health Records
Today, the Department of Insurance is expected to issue a report that urges Californians to use personal health records, the Sacramento Bee reports.
The report found that PHRs are efficient, secure and increasingly widely available. PHRs also can provide consumers with a better way to manage their health care and deal with health insurance claims, according to the report.
PHRs usually include patients' information on:
-Prescriptions;
-Hospitalizations;
-Physician visits;
-Lab tests;
-Outpatient procedures; and
-Family medical history.
PHRs do not include clinical information contained in electronic health records used by doctors and hospitals, the Bee reports.
Privacy Issues:
Some patient privacy advocates are skeptical about some of the PHR platforms, such as those offered by Microsoft and Google, and question whether security protections are adequate.
However, state officials on Monday said that PHRs already available through insurers such as Aetna, Blue Shield and Kaiser Permanente are secure.
The Department of Insurance also is expected to create a working group to help patients transfer their PHRs when they change health insurers (Glover, Sacramento Bee, 5/20).
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Posted by healthinsurance at 09:37 AM | Comments (0)
May 15, 2008
Kaiser agrees to offer coverage to 1,000 canceled patients
Kaiser Permanente has agreed to offer insurance to 1,092 individuals whose policies were inappropriately canceled after they got sick and to refund money paid to the health plan for medical care.
The health plan has also agreed to provide a fair and speedy process to resolve any additional expenses incurred due to a gap in coverage, Kaiser officials and state regulators announced Thursday.
Kaiser is the first of five large California health plans to reach settlement with the state Department of Managed Health Care over the controversial practice of rescinding individual insurance coverage after patients got sick, claiming they had pre-existing conditions and did not qualify for coverage.
The agreement includes a $300,000 fine against the health plan and a potential fine of $3 million if Kaiser fails to pass a survey of its practices by state regulators within the next 18 months.
An agreement with Health Net Inc. is pending. It will cover 85 individuals who had their policies canceled since 2004, said agency director Cindy Ehnes. Her department is in discussions with the other three plans: Anthem Blue Cross, PacifiCare and Blue Shield of California.
"Kaiser is the first to step up," Ehnes said in a press call Thursday. The $300,000 fine and potential $3 million penalty are unique to Kaiser, she said. Other settlements will reflect the circumstances at other health plans.
Jerry Fleming, national health plan manager for Kaiser, dubbed the deal as a "fresh-start" program that will immediately provide coverage for individual members whose policies were rescinded with no medical questions asked.
Kaiser voluntarily halted the controversial practice, known as "rescission," in October 2006 after questions were raised about the application survey used.
On April 17, Ehnes ordered the five health care plans to immediately reinstate coverage for 26 people whose insurance benefits were wrongly canceled after they filed claims -- and ordered a review of thousands of additional cases.
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Posted by healthinsurance at 02:10 PM | Comments (0)
May 13, 2008
California Health Insurers Must Reinstate Policies
Chalk one up for sickly patients. California regulators have ordered insurers there to reinstate the health insurance policies of 26 people who lost their coverage after the insurers claimed they had lied on their applications, according to news reports. The 26 cases represent the most egregious examples of insurers wrongly "rescinding" policies, typically for inadvertent errors. The person gets sick and starts making expensive claims, and the insurer cries "fraud!" The patient says "forgot!" or sometimes "say what?" For example, one woman I spoke with on this topic had answered "no" when asked if she'd been treated for cancer in the past 10 years. Later her policy was yanked because the insurer claimed that regular blood work she had to ensure her earlier cancer had not returned constituted cancer treatment.
Now California begins a case-by-case review of thousands of rescissions in the past four years, and it may be that these 26 are the tip of a fairly hefty iceberg. And consumer advocates say there's no reason to believe this issue is confined to California. They expect similar cases to begin emerging elsewhere.
These problems arise in the individual health insurance market, where people buy policies on their own. That market is much more loosely regulated than the group market—and often more problematic for patients—as I discussed a few months ago.
Right now, only about 5 percent of people buy insurance this way. But if Sen. John McCain has his way, many more would very likely start buying health insurance on their own. The presumptive Republican nominee has proposed eliminating the tax break that employees currently get on their health insurance benefits and instead giving people a tax credit of $2,500 for individuals and $5,000 for families to put toward buying coverage. I also wrote today about the presidential candidates' healthcare reform proposals.
Many policy analysts see merits to the restructuring that McCain proposes, but they argue that without better regulation of the individual market, people who are older or sick won't be able to get affordable health coverage, or any coverage at all. They point to what's going on in California as an example of the kind of problems that can occur. "Look at the rescission mess in California," said health policy analyst Robert Laszewski, when I interviewed him for the election health reform piece. "The Democratic nominee will stand up and say, 'John McCain will throw you to the market wolves.' " McCain is expected to elaborate on his healthcare reform proposal at the end of April. Maybe at that time he'll offer details about how he plans to protect consumers from predatory insurance practices.
As for this rescission mess, I'd like to hear from people who've experienced problems similar to what's occurring in California. Is this just a left coast phenomenon, or is it happening elsewhere, too?
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Posted by healthinsurance at 11:49 AM | Comments (0)
May 08, 2008
Single-Payer Healthcare: a Reality for California?
As a nurse, I have seen countless examples of the devastating outcomes that result when people do not have access to care due to lack of insurance. Just last week, I visited a 35-year-old cancer patient to help her manage oxygen treatments at home. She had beaten breast cancer at age 25. However, she was a restaurant worker and did not have health insurance; consequently, once she started working again, she no longer qualified for MediCal and could no longer see a doctor to be screened for recurrence. Sadly, when the cancer did come back it was not detected until she went to the ER one night when she could no longer breathe. Cancer metastases cover most of both her lungs. As she can no longer work, she is once again eligible for MediCal. Unfortunately, this coverage has come too late to save her life. I wish this story was an isolated event, but the fact is 18,000 people die in the U.S. every year solely because they do not have health insurance. A single-payer system would not only give access to care to the millions of currently uninsured, it would also create a better environment for all healthcare workers to practice in.
The reality of a single-payer system for California may not be as far away as you think. Senate bill 840 – a proposal for single-payer healthcare in California – was passed on the floor of both the Senate and the Assembly last year (only to be later vetoed by the governor). It will be re-introduced in the upcoming months. State Senator Sheila Kuehl, author of SB840, explains the rationale behind the bill: “SB 840 would replace insurance companies with a statewide trust fund that collects premiums paid by employers and individuals. The creation of a single state fund reduces the administrative portion of California’s healthcare costs from nearly 30 percent to under 10 percent. With everyone in one pool, which spreads the risk as widely as possible, no one would be denied coverage for a preexisting condition. Individuals would be free to change jobs, start a business, go to school or start a family without losing coverage or doctors they trust.”
SB 840 is good for the practice of healthcare, as well. Under this new system, decision-making would be returned to physicians and advanced practice nurses as treatment options would no longer be determined by what is covered by each individual’s insurance plan. SB 840 would end uncompensated medical care by ensuring that everyone has a payer. Paperwork would be infinitely streamlined and medical offices would no longer need teams of administrators to argue for authorization and bill dozens of different insurance companies every month. Practices will be able to refocus their staffing on nurses and other providers, which will increase the quality of care and decrease medical errors. Continuity of care will improve as patients are no longer forced to change medical groups when they switch jobs or their employers switch plans. This will lead to more meaningful, long-term relationships between providers and patients – improving quality of care and patient safety.
Click here for your free California health care quote now!
Posted by healthinsurance at 01:56 PM | Comments (0)
May 06, 2008
Health care reform - what are the chances?
There is a retty good chance of implementing successful health care reforms in this country making health care available to more people and to provide affordable health insurance to more families and individuals. Probably there is 60:40 chance or better that there will be major reform in the next Congress.
Here's why.
Sen Ron Wyden's (D OR) Healthy Americans Act has six D and six R Senate cosponsors, including Bob Bennett (R UT). There is broad bipartisan support for the bill, which mandates universal coverage.
WalMart and the SEIU back the bill.
The National Federation of Independent Businesses backs some form of 'universal' reform.
Both Democratic Presidential candidates back major reform.
Congress has been stung by criticism of its inability to get much done - and health care reform is something big that needs doing.
Many of the Fortune 500 back reform, including automakers, service companies, and manufacturers. And the unions that represent their workers do too.
This impressive array of supporters is opposed by...well, it must be opposed by some groups, companies, politicians, lobbies, but it is hard to find much in the way of opposition, at least using internet search engines. We can look to California to find out how and why their efforts to pass reform failed. A loose coalition, comprised of Republican legislators, Blue Cross of California [WellPoint], the state Chamber of Commerce, and the tobacco industry joined together to oppose the bill, and their efforts got a major push from legislators' deep concerns about the cost of the initiative and the Golden State's financial straits. A closely related issue is the concern by many that states, acting alone, cannot enact meaningful reform for the simple reason that 1/3 of all health care dollars are controlled (to a great extent) by the Feds, and if these dollars, and the care they pay for and members they cover aren't integrated into a comprehensive reform measure, the effort is doomed to fail. Cost shifting, contradicting priorities, differing measures of success and evaluation methodologies will result in a confused, bifurcated system that serves neither population well.
Similarly, the problems emerging in Massachusetts and Maine make it less likely that states will successfully pursue reform measures. Instead, the states, a powerful lobbying group in and of themselves, will likely join others to support national reform.
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Posted by healthinsurance at 12:19 PM | Comments (0)
May 01, 2008
Cracking down on fraud in California managed health care
Are you uninsured? Unfortunately, you are not alone. In California, out of a total population of nearly 36 million people, 18.4 percent do not have health insurance coverage. Some lost their insurance when they lost their jobs. Others may be working, but their jobs don't provide health insurance benefits. Whatever the reason, finding and keeping health insurance can be difficult.
This week is Cover the Uninsured Week, a national effort to highlight the fact that too many Americans are living without health insurance and to encourage all of us to come together and seek solutions.
We know that reaching the goal of affordable and stable health care for all requires changes in public policy. Governor Schwarzenegger continues to work towards covering everyone regardless of ability to pay or preexisting health conditions. The California Department of Managed Health Care (DMHC), under his leadership, has been working to increase quality, affordable forms of comprehensive health insurance.
In the absence of successful efforts to reform our health system, however, alternatives to health insurance have cropped up in the marketplace. One is a discount health plan -- which may not be truly offer a worthwhile discount and may even be fraudulent.
The idea behind a discount health plan is a membership program which offers reduced-rate health care services to the public. These plans typically charge an annual membership fee and a monthly payment in exchange for a list of health care providers who will deliver services to members at a discounted rate. Members must then pay directly for the health services. The discount plan is not insurance; meaning that neither the plan nor any other entity assumes financial risk to pay providers for delivering services. It is more of a pay-as-you go service, but at less cost than the normal fee that an uninsured person would pay.
Click here for cheap California health insurance. Get your free quote now!
Posted by healthinsurance at 02:25 PM | Comments (0)
April 29, 2008
California voters feel let down on health care plan
Just a few months after the governor's state health-reform proposal collapsed, it appears California voters liked his idea by a landslide. And now they're feeling more insecure and pessimistic than ever about the future of medical coverage.
That's the gist of a new survey released today by the non-partisan Field Poll and paid for by the private California Wellness Foundation.
A whopping 72 percent of voters interviewed by pollsters said they generally favored Gov. Arnold Schwarzenegger's plan, even as they had some concerns about the funding scheme.
"The governor and the Legislature were clearly on the right path," pollster Mark DiCamillo said. "They had the support of the public."
But Sacramento politicians also faced a budget shortfall roughly equal to the $14.7 billion cost of the health-care bill. The proposal died in the state Senate's health committee, winning only one vote from a Democrat.
"It was a bad circumstance of timing," DiCamillo said. "The budget was under pressure from every quarter to just maintain."
Still, some supporters of the bill feel vindicated today.
"This was absolutely a blown opportunity," said Elia Gallardo, government affairs director for the California Primary Care Association. The organization lobbies for community clinics, which stood to gain about $140 million a year. She said one-fourth of the 4 million clinic patients don't have health insurance.
To those polled, the future of health reform looks bleak. Three times as many expect the health care system to get worse in five years as think it will improve - 39 to 13 percent. The Field Poll found the same sense of impending catastrophe in a similar survey in 2006. But in some specific categories, such as losing coverage completely, worries appear to be running higher today.
Like most surveys of this type, the Field Poll interviewed a small sample of voters, in this case 1,202, who more or less reflected the state's political and demographic diversity.
Jose Mora, a retired Democrat from Morgan Hill, supported the health insurance plan even though he didn't think its new fees, taxes and mandates would have covered the full cost.
Californians, click here for your free health insurance quote now!
Posted by healthinsurance at 04:21 PM | Comments (0)
April 24, 2008
Health insurance a matter of life and death: study
Whether or not a person has health insurance can mean life or death, according to “Dying for Coverage” a recent Families USA report for all 50 states and the District of Columbia. The report revealed the number of Americans expected to die in each state, each week because they don’t have health care coverage.
Families USA is a national non-profit that advocates for affordable, high quality health care.
Using data from a 2002 groundbreaking national federal study, Dying for Coverage demonstrated direct links between a lack of health coverage and deaths from health-related causes. It found more than 7 working-age Texans die each day due to a lack of health insurance. “Our report highlights how our inadequate system of health coverage condemns a great number of people to an early death, simply because they don’t have the same access to health care as their insured neighbors,” said Ron Pollack, executive director of Families USA.
“Health insurance really matters in how people make their health care decisions,” he continued “We know that people without insurance often forgo checkups, screenings and other preventive care.” The study was released April 8.
For Khalilah Ali, a Dallas based family nurse practitioner, the findings are no surprise. Her Supreme Wisdom Family Health Clinic specializes in serving the medically underserved. “People in Dallas that don’t have health insurance are usually referred to Parkland Hospital, the place where President John F. Kennedy died. They have very long waits and I believe receive substandard care. Health insurance makes the difference,” she said.
Mrs. Ali drives around Dallas making house calls like country doctors of days gone by. “There is an epidemic of high blood pressure and diabetes in the Black community. For many people even when they have medicine, they save it so they don’t run out. That can be deadly because their blood pressure is always high.
“Even the seniors who have Medicare which only pays 80 percent, many still can’t afford to buy their prescriptions. So they take half of their medicine, or cut the pills in half, or only take it when they have symptoms of their illness,” she said.
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Posted by healthinsurance at 02:43 PM | Comments (0)
April 22, 2008
The Truth About Mandatory Health Insurance
Hillary Clinton's supporters attacked Barack Obama [in January] for not proposing a federal mandate that every American buy health insurance. Mr. Obama's health insurance plan, they said, is a "Band-Aid" for the nation's gaping wound: 47 million people without health insurance. Mrs. Clinton would require all Americans to get coverage. Presidential candidate John Edwards and Christopher Dodd say they would, too. Not Mr. Obama.
Imposing a federal mandate is a hot issue on the campaign trail. It's also a burning issue in Congress, where Democratic Sen. Ron Wyden and Republican Sen. Bob Bennett are pushing the Healthy Americans Act, which would require everyone not in Medicaid or another government program to get health insurance.
'Shared Responsibility'
But is mandatory health insurance really a good idea? Requiring catastrophic coverage (our parents called it major medical) probably is smart. This would ensure that a person who is hurt in a car accident or diagnosed with a costly illness can pay his own medical bills, instead of being a burden on society.
But catastrophic coverage is not what the mandate advocates want. They would require that everyone have comprehensive health insurance, covering preventive and routine care.
The rationale for this mandate is not personal responsibility but "shared responsibility," a polite way of saying shared costs. Requiring comprehensive coverage, the argument goes, will make it affordable for the sick, by pulling the young and the healthy--neither of whom use these health services very much--into the insurance pool. Advocates also argue that requiring this type of coverage will cure overcrowded emergency rooms and help tame skyrocketing health care costs.
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Posted by healthinsurance at 02:34 PM | Comments (0)
April 17, 2008
California Managed Care Dept Plans Rescissions Announcement
California Department of Managed Health Care Director Cindy Ehnes plans to make an announcement Thursday afternoon regarding reinstatement of health coverage for consumers whose policies were rescinded by various insurers.
The announcement involves consumers whose policies were dropped by WellPoint Inc.'s (WLP) Anthem Blue Cross, UnitedHealth Group Inc.'s (UNH) PacifiCare, Health Net Inc. (HNT) and the nonprofit Kaiser Foundation Health Plan and Blue Shield of California, said department spokeswoman Lynne Randolph.
Ehnes, whose department has investigated rescission practices at those plans since 2005, has scheduled a news conference for 1 p.m. PDT in Sacramento. California already has levied fines for rescissions against several health insurance plans that offer individual policies in the state. Last fall, the state fined Health Net $1 million for failing to disclose a link between employee bonuses and the cancellation of individual insurance policies.
The state's managed-care regulators aim to stop what they consider an illegal industry practice: rescinding individual health coverage, sometimes after members have become sick, based on inadvertent or insignificant omissions on enrollment applications.
Ehnes and California Insurance Commissioner Steve Poizner last year proposed joint regulations to protect consumers in the individual health-insurance market from illegal rescissions.
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Posted by healthinsurance at 11:49 AM | Comments (0)
April 11, 2008
Insurance system of U.S. in shambles
One of the big issues for the upcoming presidential election in November is healthcare. Democrat candidates Barack Obama and Hillary Clinton, in some form or another, want to mandate that individuals be required to purchase healthcare coverage. Republican candidate John McCain wants to allow for tax breaks that would help cover the cost of insurance, but he has resisted any steps toward a mandatory requirement to purchase health insurance. But what happens when your health insurance provider decides to stop providing?
Patsy Bates, a California hairdresser, was diagnosed with breast cancer in 2003. She did have health insurance through Health Net, a for-profit health insurance provider in California. But, a few months into her cancer treatment, Health Net suddenly decided they were going to cancel her insurance policy.
“In fact, she was in the hospital getting prepped for surgery when she first learned Health Net was dropping her,” according to a Nov. 9, 2007, report by Bill Whitaker of CBS News. Bates, still in need of treatment, was stuck up the proverbial creek without the proverbial paddle. Bates was forced to quit her cancer treatment regimen until she found a charity to pay for it. She was also hung out to dry for $129,000, the cost of the treatments she received that Health Net refused to pay for.
So what happens when we’re all mandated to buy healthcare and then, when we get sick, our (for-profit) insurance provider drops us like a hot rock? Sounds like a big, fat, mandatory payday for the insurance companies, if you ask me! And, if you just happen to have any “pre-existing” conditions before you’re mandated to purchase health insurance, it’s an even bigger payday for the health insurance companies. Luckily, at least for Bates, in this case the good guys won.
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Posted by healthinsurance at 05:47 PM | Comments (0)
April 08, 2008
Who’s Opposed to Informed Choices on Health Insurance by Californians?
I'm a good bargain shopper. (My prize: 10-piece set of top tier Calphalon pots once for $70) Here are my rules for assessing a good bargain:
1. Is it a known product (do I know it's a quality product -- like Calphalon)
2. If it's marked down, is it a good price compared to other similar products
3. Lastly, will I use it (because it does me no good to get a good deal on shoes if I'm not going to wear them...and I've done this way too much).
This mental checklist is meant to ensure that the product is of value to me.
Which brings me to the letters submitted by the health insurance industry SB 1522 (Steinberg), which create standards for health insurance that would enable any person to go through such a checklist when buying insurance on their own. (See our Fact Sheet on SB 1522.)
In short, SB1522 would:
1. Classify health plans into five "tiers'' so consumers would know what they were buying - i.e. a top tier plan means comprehensive, bottom tier means "catastrophic.'' (Known/quality product)
2. Insurers would have to have at least one plan in eacth tier, enabling apples-to-apples comparisons.
3. Establish minimum benefits, which would weed out junk insurance -- such as "hospital only'' plans that barely covers the hospital visit. (will I/can I use it?)
Let's step back a bit. Let's say you don't receive health insurance on the job now and have to go out and scavenge for a decent plan. Go to http://www.insuremyhealth.com/ and you'll get hit with 107 plans with all manner and range of co-pay, deductible, premium, office visit policies.
The "choice'' argument: Insurers argue that SB1522 will lead to a reduction in consumer choice. First off, their argument is bogus. Choice will still exist; it will just be more organized and limited. And limiting choice for consumers is actually a good thing, according to research on a parallel issue-401(k)s (the research on choice can also be applied to choosing ice cream, jams and insurance policies):
"...Findings from this study show that an extensive array of options can at first seem highly appealing to consumers, yet it can also reduce subsequent motivation to purchase this product...the very act of making a choice from an excessive number of options might result in "choice overload,'' in turn lessening both teh motivation to choose and the subsequent motivation to commit to a choice....''
That research correlates with private polling of uninsured and individual market participants, which also reveals that consumers do not have confidence in their understanding of what the insurance plans provide, nor do they trust the literature that is provided by the plans.
SB1522 would provide choice, but in an organized fashion so that consumers could go through their mental checklist and feel comfortable about a "known product'' and make comparisons against other plans.
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Posted by healthinsurance at 04:24 PM | Comments (0)
April 03, 2008
Cautionary Health Care Tales
The collapse of health reform in California and ominous signs from Massachusetts spell big trouble ahead for reforming the nation's health care system no matter who is elected President. The lessons from those states, which have tried hard to bring insurance coverage to all residents, are worth heeding for anyone sitting in the White House next year. They also raise the question of whether it is possible, either fiscally or politically, for states to do the job. Indeed, failure in California and troubles in Massachusetts indicate that the underlying problems that bedeviled reform efforts fourteen years ago are still with us, and could doom yet another attempt to change the American way of health care.
Although Hillary Clinton and Barack Obama try to distinguish between their plans, both are variants of the Massachusetts model. That scheme requires everyone to get health coverage, and it imposes tax penalties on people who don't -- the so-called "individual mandate." In both Obama's and Clinton's plan, people do not have a right to health insurance, as is the case in truly universal national health insurance systems, such as in France and Canada, where everyone is guaranteed coverage, with care paid for through a broad-based tax. Instead, both candidates have used the word "universal" to describe a potpourri of options that could bring coverage to some portion of the population currently not covered while keeping commercial insurance in the game. Clinton's plan includes an individual mandate. Obama would require coverage only for children and touts cost-control measures that he says would lower premiums so much that the uninsured could afford them, obviating the need for a coercive mandate. Clinton would boost coverage by requiring large employers to cover their workers, giving incentives to smaller ones to do the same. Obama would make employers provide "meaningful" coverage or contribute to a public plan. Both proposals call for some sort of public alternative that people can buy into if they don't like the market choices, and both try to control medical costs with weak remedies like improved information technology and better care coordination.
Significantly, the premium subsidies and tax credits that Clinton, Obama, and John McCain support to help low-income families buy insurance are a traditional Republican strategy that President Bush has pushed for years. But at least 55 percent of the uninsured already pay no taxes, so unless the credit is made available to non-tax filers, this approach would leave lots of people without coverage. To be useful, subsidies must be high enough to help families pay the annual insurance premiums -- now averaging about $12,000 -- but low enough so the government doesn't go broke. And therein lies the devil that killed reform in California and could do in the much-hailed Massachusetts plan as well: the money just wasn't there.
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Posted by healthinsurance at 01:27 PM | Comments (0)
March 29, 2008
Clinton Details Premium Cap in Health Plan
Senator Hillary Rodham Clinton said in an interview on Wednesday that if elected president she would push for a universal health care plan that would limit what Americans pay for health insurance to no more than 10 percent of their income, a significant reduction for some families.
In an extensive interview on health policy, Mrs. Clinton said she would like to cap health insurance premiums at 5 percent to 10 percent of income.
The average cost of a family policy bought by an individual in 2006 and 2007 was $5,799, or 10 percent of the median family income of $58,526, according to America’s Health Insurance Plans, a trade group. Some policies cost up to $9,201, or 16 percent of median income.
The average out-of-pocket cost for workers who buy family policies through their employers is lower, $3,281, or 6 percent of median income, according to the Kaiser Family Foundation, a health research group.
A cap on premiums has been part of Mrs. Clinton’s universal coverage proposal since she announced it in September. Her published plan did not disclose her thinking on where to place the cap. She also said in the interview that she preferred to set the limit at a single level for all Americans rather than varying it by income.
Mrs. Clinton, a New York Democrat, set out a comprehensive approach to her signature issue of health care in three speeches last year, but she has been criticized for not providing details on several crucial components. She largely continued that approach in the interview, saying she would leave particulars like the eligibility criteria for her proposed health insurance tax credits to negotiations with Congress.
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Posted by healthinsurance at 07:40 PM | Comments (0)
March 25, 2008
Must you buy health insurance?
An important element is being overlooked in the healthcare debate between the Democratic presidential candidates: namely, whether the plans they propose are constitutional.
The largest difference between their healthcare plans is that Sen. Hillary Rodham Clinton would "mandate" that everyone (with limited exceptions) purchase private health insurance. Although Sen. Barack Obama's plan also contains a mandate, it is much narrower – it is required only for children. Mr. Obama relies principally on subsidies, economies of scale, and regulation to achieve his version of universal coverage.
Are health insurance mandates constitutional? They are certainly unprecedented. The federal government does not ordinarily require Americans to purchase particular goods or services from private parties.
The closest we come is when government imposes a condition on the grant of discretionary benefit or permit. For instance, in most states, you must have auto insurance to drive a car, or you are required to install fire sprinklers when building a new house. But in such cases, the "mandate" is discretionary – you don't have to drive a car or build a house. Nor do you have a constitutional right to do so.
But Americans do have a constitutional right to live in the United States. Accordingly, neither federal nor state governments can require you to purchase health insurance as a "condition" for residency. The Supreme Court has drawn a distinction between requirements that are flat-out imposed by government and those imposed as a condition for discretionary benefits.
The health insurance mandate proposed by Clinton is similar to the one enacted in Massachusetts under former Gov. Mitt Romney and the plan proposed by Gov. Arnold Schwarzenegger for California. These "unfunded mandates" are unlike any form of government regulation we've seen.
In making the case for her plan to mandate private health insurance, Clinton said in a recent Democratic debate that not doing so "would be as though Franklin Roosevelt said, 'Let's make Social Security voluntary,' or if President [Lyndon] Johnson said, 'Let's make Medicare voluntary.' "
In fact, under the law, there's a big difference between participation in a government health program funded by taxes and privatizing such a program, with individuals forced to purchase private health insurance.
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Posted by healthinsurance at 01:45 PM | Comments (0)
March 23, 2008
Report: Health insurance a matter of life or death
Each day, local newspapers run obituaries of Iowans who have died. Causes of death range from cancer to car accidents. It's unlikely anyone recalls seeing "lack of health insurance" as a reason for death.
However, about three obituaries each week should list that cause, according to a new report from Families USA, a national organization for health-care consumers. Nearly three Iowans die each week in part because they don't have health insurance, the report found. Many have serious illnesses that could have been treated effectively if detected earlier.
"The conclusions are sadly clear - a lack of health coverage is a matter of life and death for many Iowans," said executive director Ron Pollack.
This is relevant information as the lawmakers consider health reforms. Much of the conversation at the Statehouse is centered on insuring children - a less costly and easier group to cover because many are eligible for government programs.
It's a reminder that health reform must address coverage for this demographic of Americans. Unlike children and seniors, they frequently aren't eligible for government health insurance unless they're poor or disabled. Private health insurance may not be offered through an employer or is unaffordable.
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Posted by healthinsurance at 08:24 PM | Comments (0)
March 18, 2008
Physicians put price tags on California health care
Then came Medicare and health insurance, and no one knew what doctors were charging, what insurers were paying and what patients were getting for their premiums.
Enough, decided Dr. H. Lee Adkins, a primary care physician who runs Ft. Myers Family Medicine in Florida.
Adkins recently changed his Web site, posting what he charges for everything from office visits to lab work. For example, an initial office visit can run from $75-$100 or $125, while lab work varies from $8 for a glucose blood test to $100 for the human papilloma virus.
His move is part of a national push toward greater transparency in health care, as more Americans go without health insurance and there's expected to be an increase in people moving to high-deductible health plans that force them to consider the cost of services.
Thirty-three states, including California, Florida, and Michigan, have laws that require price transparency, according to the Deloitte Center for Health Solutions. Some medical and policy experts believe greater transparency will lower care costs.
"What triggered it with me is when I started seeing everyone laid off," Adkins said.
Nationally, 47 million Americans are without insurance, according to industry reports. The figure is likely to grow as the economy slides. Fearing the cost of care, many who are uninsured won't seek help until their conditions land them in emergency rooms.
Adkins then started considering the number of Americans who are expected to move into consumer-driven health plans: high deductible, low-premium products that are generally linked to a medical savings account or reimbursement agreement. Twenty-four million Americans were enrolled in consumer-driven plans as of January 2006, according to the Government Accountability Office, the latest data available.
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Posted by healthinsurance at 10:46 AM | Comments (0)
March 14, 2008
The Next Failure of Health Care Reform
A major problem -- if not the major problem -- for many people living in the U.S. is the difficulty of accessing and paying for medical care when they are sick. For this reason, candidates in the presidential primaries of 2008 -- the Democrats more often than the Republicans -- have been recounting stories about the health-related tragedies they have encountered in meetings with ordinary people around the country (an exercise conducted in the U.S. every four years, at presidential election time). These stories tell of the enormous difficulties and suffering faced by many people in their attempts to get the medical care they need. I have been around long enough -- I was senior health advisor to Jesse Jackson in the Democratic primaries of 1984 and 1988 -- to know how frequently Democratic candidates, over the years, have referred to such cases. The only things that change are the names and faces in these human tragedies. Otherwise, the stories, year after year, are almost the same.
In the Democratic Party primaries of 1988, for example, candidate Michael Dukakis talked about a young single mother who had two jobs and still could not afford medical insurance for herself and her children. In 1992, Bill Clinton did the same, changing the story only slightly. This time it was the case of a woman with diabetes who could not get health insurance because of her chronic condition. And now, in the 2008 primaries, Hillary Rodham Clinton (whom I worked with on the White House Health Care Reform Task Force in 1993) describes a similar case. This time it is a single woman, with two daughters, who cannot pay her medical bills because her congenital heart defect makes it impossible for her to get medical insurance coverage. And Barack Obama describes similar cases, with the eloquence that characterizes all of his speeches. He frequently refers to his own mother, who had cancer and had to worry not only about her illness but about paying her medical bills.
All these cases are tragic and are representative of a situation faced by millions of people in the U.S. every year. But, I am afraid that unless the winning Democratic candidate, once elected president (and I hope he or she will be), develops a more comprehensive health care proposal than any of those put forward in the primaries so far, we will see the same situation continue. Democratic candidates in the 2012 primaries, and in the 2016 primaries, will still be referring to single mothers with chronic health conditions who cannot pay their medical bills. The proposals put forward by Obama and Clinton underestimate the gravity of the problem in the U.S. medical care sector. The situation is bad and is getting worse: the number of people who are uninsured and underinsured has been growing since 1978.
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Posted by healthinsurance at 04:11 PM | Comments (0)
March 13, 2008
Health Insurance Carrier Aetna Introduces Personalized Health Search From Healthline
Vertical health destination and search engine Healthline has teamed up with US health insurance carrier Aetna to offer what the company is calling Aetna SmartSource -- customized health search. The service, powered by Healthline, will roll out on Aetna’s member self-service website and offer personalized search results based on individual health records and profiles. That means that two different Aetna customers searching for "diabetes type II" will see potentially different results based on their individual health histories.
What's different about this vs. what Microsoft, Google and Revolution Health are doing is that it's all taking place within the context of the existing relationship between insurance provider and customer-patient. Aetna already has the health records and histories of its insureds so there's little or no effort for the users to obtain the benefits (so to speak) of the system. In other words, they don't have to construct detailed profiles or upload information themselves.
What's also interesting is that this is the most developed version of personalized search yet in the market. In the relatively protected context of the existing carrier-insured relationship most of the concerns about tracking and data-mining go away. Aetna won't be using search behavior on its site, presumably, to advertise or market products to its customers.
However, in a cautionary tale about corruption in the US healthcare industry, one of Aetna's competitors in California, HealthNet, had a secret practice of canceling policy holders who were perceived as "expensive" in order to save the company money. It actually tied employee bonuses to the number of customer cancellations they accomplished.
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Posted by healthinsurance at 11:14 AM | Comments (0)
March 11, 2008
Calif. Insurance Rulings GCs Should Watch Out For
California appellate courts tackled a diverse array of insurance issues in 2007 that included health care post-claim underwriting, directors and officers (D&O) liability, employee dishonesty and the scope of the attorney-client privilege in the context of insurance. The decisions in these cases will have a direct influence on business processes for companies across many industries, and California general counsel should be aware of how these rulings may affect their companies.
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Health care. In suits that could have an impact on health insurance claims brought by employees, two recent court of appeal decisions held that "post-claim underwriting" by insurers was a prohibited practice. In Ticconi v. Blue Shield of California Life & Health Ins. Co., 157 Cal.App.4th 707, the 2nd District Court of Appeal held that post-claim underwriting of disability insurance policies is prohibited by Insurance Code §10384. The court allowed a case to proceed where it was alleged that the unlawful conduct was post-claims underwriting in which the insurer rescinded disability insurance policies based on alleged misrepresentations in the applications. The applications were incorporated by reference in, but neither endorsed on nor attached to, the insureds' policies, in violation of Insurance Code §10113 and §10381.5.
Also, the 4th District, in Hailey v. California Physicians' Service, 158 Cal.App.4th 452, concluded that Health & Safety Code §1389.3 precludes a health services plan from rescinding a health insurance policy for a material misrepresentation or omission unless the plan can demonstrate that the misrepresentation or omission was willful or that the plan had made reasonable efforts to ensure that the subscriber's application was accurate and complete as part of the pre-contract underwriting process. The court found that an insurer cannot engage in post-claim underwriting and, given the likelihood of inadvertent error in the application process, required an accurate risk assessment by the health insurance plan, which requires a reasonable check on the information the insurer uses to evaluate the risk at the time of the application.
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Posted by healthinsurance at 12:11 PM | Comments (0)
March 08, 2008
Could Your Health Insurance Be Revoked When You Need It Most?
A series of troubling developments in California's individual health insurance market is bringing national attention to the problem of patients having their coverage taken away when they need it most.
Last month, an arbitration judge ordered California-based health insurer Health Net Inc. to pay $9 million to a cancer patient whose individual coverage was canceled during her chemotherapy treatments in 2004. The judge ordered Health Net to repay $129,000 worth of Patsy Bates' unpaid medical bills and awarded the 52-year-old hairdresser $8.4 million in punitive damages and $750,000 for emotional distress.
It's not just Health Net that's attracting scrutiny. Blue Cross of California, a unit of WellPoint, the nation's largest private health insurer, drew fire recently for sending letters to doctors asking them to verify patients' accounts of their health histories in their applications after the company already had approved their policies. Blue Cross has since stopped the letter campaign.
California's Department of Managed Health Care, which regulates the state's HMO plans, has been investigating consumer complaints about unfair rescissions since 2006. The agency has fined both Blue Cross and Health Net and is in the process of reviewing the practices of other companies that sell individual policies in the state, spokeswoman Lynne Randolph said.
"We don't think it is only happening in California...but California's farther ahead in terms of enforcement," she said. "We had a statute in place that companies must do underwriting up front and a consumer must willfully misrepresent their health condition on an application in order for a company to rescind. We feel that means it can't just be an inadvertent omission."
Insurers say they have a responsibility to ensure applicants are truthful about any preexisting conditions they may have so companies can accurately price policies and hold down costs for all their members. But consumer groups warn that tactics such as tying financial incentives to the number of rescissions an employee makes or involving doctors in investigations after policies have been issued aren't working and may be illegal in some states.
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Posted by healthinsurance at 08:03 PM | Comments (0)
March 06, 2008
Taking the LAO in Context on California Health Reform
THE LAO'S INFLUENCE: While some have seen the LAO report as a factor in the stalling of AB x1 1 and the California health reform this year, I think the evidence shows that it was the easy excuse--rather than the actual reason--for the Senate to stop the bill. (For example, one Senator said that the LAO report was determinative in deciding how to vote, even though that Senator had announced opposition to the proposal months earlier.)
In other words, the LAO report, along with other factors, helped create an environment where a "no" vote was acceptable and even easy. The LAO has no formal decision-making power, but it does have influence, and its decisions do have political consequences.
PLACING REFORM AT A DISADVANTAGE: But the issue as we look forward is the approach used by the LAO, and the context of how that report is used by legislators. Health Access put out a full analysis of the LAO's take on AB x1 1. Basically, the LAO gave a report on AB x1 1 that indicated that the plan could pencil out for about five years, but that also:
• indicated and quantified all the costs and potential risks, but did little to put those risks in context, to indicate how real those risks were (which ended up overstating several risks);
• did not quantify a single cent of savings or upside potential;
• did not evaluate the risks of the status quo, or propose alternatives to the proposal.
To be fair, the LAO had very little time for its analysis, and many analysts are more oriented to warning you about potential risks than potential benefits.
But that's when it is important for the Legislature to place such a report in context. Legislators routinely pick-and-choose what they like and do not like about the LAO says about the budget and other policy proposals, and this should have been no exception. The Legislature should have placed this LAO analysis alongside the voluminous analyses done by various independent experts throughout the year.
WHY DOES THIS MATTER? This matters for the future of health reform. Under the approach used by the LAO, given the certainty that some legislators seemed to seek, then no health reform would ever pass in California.
Budgets fluctuate over time: if legislators seek certainty that health care will be adequately funded in perpetuity, then health reform is not possible. This is not a standard that is met in Canada or Great Britain, or indeed in Medicare or Medicaid. The LAO failed to book a single cent of savings, even though we have ample evidence that the power of group purchasing is effective, both in public and private health care purchasing.
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Posted by healthinsurance at 11:18 PM | Comments (0)
March 02, 2008
Cutting Off California Health Insurance?
Comprehensive healthcare reform has failed in California. But that doesn't mean health insurance companies will, or should, escape scrutiny from state officials.
As reporter Lisa Girion has ably chronicled in this newspaper, insurance companies frequently revoke patient coverage -- a practice known as rescission -- under questionable circumstances. Girion has written, for example, of cancer patients who have lost their insurance in the middle of courses of chemotherapy. Recently she reported that Blue Cross of California mailed copies of health insurance applications to doctors, asking them to check for preexisting conditions that might be used to cancel their patients' policies -- a strategy that, even if legal, violates the spirit of doctor-patient privilege. Not to mention, possibly, the Hippocratic Oath.
In response to troubling tales such as these, California officials are cracking down on insurance companies. Insurance Commissioner Steve Poizner is investigating gaps in PacifiCare's claims process that resulted in more than 100,000 violations of state law. Los Angeles City Atty. Rocky Delgadillo has set up an investigative team to examine rescissions, and has created a website soliciting reports of unfair denials of care. Assemblymen Hector De La Torre (D-South Gate) and Ted Lieu (D-Torrance) have sponsored bills designed to curb egregious rescissions. Those are worthy undertakings and good bills.
Insurance companies are not always villains. To function, they must be able to assess risk and price policies appropriately. Patients who buy individual policies do not deserve a get-out-of-jail free card that lets them lie on their insurance applications. Sometimes, services will be denied. But the vast majority of patients, who are honest, don't deserve a system that is stacked against them, with underwriting practices that make insurance unaffordable even as companies' profits rise. Some patients have become reluctant to use their insurance for treatment or medication because they fear rate hikes. Certainly, spending thousands of dollars in yearly premiums for individual policies, many with high deductibles and co-pays to boot, should buy better "coverage" than that.
We hope, as officials pay closer attention to health insurance practices, to broaden the debate. How might we regulate insurers to assure that risk management doesn't price vast numbers of people out of coverage? How can we ensure that potential price increases don't scare off essentially healthy patients from seeking necessary -- and ultimately cost-saving -- non-emergency care? What is a reasonable profit for an insurance company? And if such a profit is impossible to attain without forcing catastrophic costs on patients, what then?
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Posted by healthinsurance at 12:42 PM | Comments (0)
February 28, 2008
Health Insurers Address Issue of Nixed Policies in California
The health-insurance industry is racing to defuse a growing furor over retroactive policy cancellations that have saddled some patients with big medical bills and sparked lawsuits.
America's Health Insurance Plans, an industry group, is pushing a proposal with state regulators that would give consumers the right to appeal such policy cancellations, known as rescissions, to an external panel, whose decisions would be binding. Some insurance companies, eager for even quicker action, are preparing to roll out their own independent review programs.
The efforts, which are getting a largely positive reception from consumer groups, are emerging amid public outrage in several states against insurers that have voided policies after the beneficiaries started racking up large claims for cancer or other serious illnesses.
Last week, an arbitration judge in California awarded $9.4 million, mostly in punitive damages, to a hairdresser whose medical coverage was canceled by Health Net Inc. The insurer, which acted while the woman was undergoing treatment for breast cancer, claimed that she had falsified information about her weight and failed to mention a heart murmur. The judge ruled that Health Net's conduct was "reprehensible" and unlawful.
Such cases have cast an unflattering light on insurers' practices of investigating individuals' medical histories after they get sick. The insurers say they have the right to rescind policies when policyholders don't disclose pre-existing medical conditions that would have disqualified them from coverage, or when they misrepresent information on their policy application. The companies say they are protecting the integrity of the underwriting process and keeping insurance coverage affordable for customers.
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Posted by healthinsurance at 02:46 PM | Comments (0)
February 26, 2008
Blue Shield of California Foundation Awards $13.1 Million to Improve Patient Safety
Setting a record for its quarterly giving, Blue Shield of California Foundation (BSCF) today announced the award of $13.1 million in grants to nonprofit organizations and programs to improve the quality of patient care through health technology and to expand health insurance for children who do not qualify for public programs.
Nearly half of the money, $5.75 million, will be used to expand the foundation’s groundbreaking program to dramatically reduce the number of hospital-acquired infections (HAIs). After seeing remarkable success in its nine-hospital pilot project, BSCF will use the grant announced today to expand its innovative California Healthcare-Associated Infection Prevention Initiative (CHAIPI) to at least 100 hospitals.
“Hospital acquired infections put lives at risk and increase consumer costs. We want to dramatically reduce those risks by ensuring hospitals have access to innovative new technologies that help pinpoint and stop the spread of infections,” said Crystal Hayling, president and CEO of BSCF. “Given the results we saw in our test program, we expect the broad expansion of this effort to mean 4,000 fewer patients will contract an HAI in the next year, which translates into 30,000 fewer patient days in the hospital, $60 million in avoided costs to patients and hospitals, and nearly $15 million in bottom-line hospital savings.”
In California, an estimated 150,000 patients suffer from HAIs annually, 9,000 of which result in death. Through CHAIPI, participating hospitals will receive support for new technology and collaborative learning opportunities about best practices. While only not-for-profit hospitals can receive funding, this grant is unique because for-profit hospitals are invited to participate in the collaborative learning sessions and will have the opportunity to purchase the technology at a reduced price.
“We look forward to taking CHAIPI to scale because it has the potential to alleviate untold human suffering and save millions of dollars in unnecessary costs, both for patients and our healthcare system,” Hayling said.
Other health and technology grants announced today include:
* $350,000 to the California Health Foundation and Trust to expand its telemedicine program by increasing the number of telemedicine providers and offering technical assistance to those in the field. Telemedicine is vital in rural, underserved areas.
* $115,000 to the California Society of Thoracic Surgeons to study complications of open heart surgery, and to build a single source of clinical data on which to assess and replicate best practices to improve cardiac surgical outcomes.
* $105,000 to the California Children’s Hospital Association for an initiative to reduce catheter-associated and other infections acquired in neonatal intensive care units.
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Posted by healthinsurance at 09:54 PM | Comments (0)
February 24, 2008
Growing pains for UnitedHealth Group
Organized medicine already has offered its reasons why health plan consolidation is troubling for patients and physicians. In late January, California regulators added 133,000 more reasons to the list.
That is the number of violations of state laws and regulations the California Dept. of Insurance says it discovered in just a one-year period investigating the aftereffects of UnitedHealth Group's $9.2 billion purchase of PacifiCare Health Systems. With more than 1.1 million claims examined, that averages out to one reimbursement and claims handling violation for every nine claims. On top of that, the California Dept. of Managed Care, which regulates HMO operations only, found that in the same 2006-07 period, United-PacifiCare mishandled 30% of claims.
Those numbers paint a stark picture of a plan that grew too big and with too little accountability to the patients and physicians who, in the wake of the merger and the market clout it created, had less choice whether to put up with such shoddy service. (Interestingly, as the California insurance regulators point out, one area in which United skipped the growing pains was in its collection of premiums).
The United-PacifiCare example is a warning to regulators about the dangers of health plan mergers -- some 400 in the past decade, many plagued by their own problems -- and it should make them take a long, hard look before considering approval of any such deal.
The case also shows that regulators need to take the strongest action possible to make plans accountable for their misdeeds. History has shown that colossal health plans don't appear to worry much about the occasional fines that pale in comparison to their profits -- it's merely the cost of doing business.
The California situation may mark a striking departure from that pattern. The state could, assuming all violations are found to meet the more serious standard of "willful," to fine United $1.3 billion. That's 100 times more than the national record of $12.6 million it set in December 2007 in fining Blue Shield of California for improper cancellation of individual policies, a penalty the plan is fighting. So far, the California Dept. of Managed Care has issued a $3.5 million fine to United over just the HMO claims.
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Posted by healthinsurance at 07:07 PM | Comments (0)
February 23, 2008
What Now for California Health Care?
Last month the Senate health committee dumped the Schwarzenegger/Núñez Model ABX1 1, California's trend-setting gadget for health-care repair. Senator Sheila Kuehl, who chairs that committee, tossed it for more personal reasons, other than the obvious $14-billion price tag and state budget deficit of similar size.
Senator Kuehl wants to bring back her own model, SB-840, a government automaton that will fry any remaining individual choice in California health care. Governor Schwarzenegger wisely vetoed this legislation in 2006, but it was reintroduced last year and now lurks in Assembly committee. Governor Schwarzenegger vetoed SB-840 because he knows it would create a government monopoly that would tilt the playing field against individual choice, likely past the point of no return.
Senator Kuehl, ironically, noted that a worrisome aspect of ABX1 1, which aimed for “universal” health care through compulsory purchase of private insurance, was a probable “lack of choice” of doctors and hospitals for patients. But under SB-840, California would implement a Canadian-style, government monopoly, health care system that would simply eliminate patient choice in favor of absolute government control.
In return for, at most, a reduction of four percent of current health spending, Californians would pay a heavy price for SB-840. The price would include a dramatic drop in the number of California physicians, long waiting lists for medical services costing an estimated $1 billion each year, and abuse of "free" health care, costing as much as $9 billion – much more than the amount saved by eliminating “profits.”
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Posted by healthinsurance at 06:42 PM | Comments (0)
February 21, 2008
More Heat for California Insurers Canceling Policies
The running saga over California health insurers canceling policies rolls on. Now, the Los Angeles City Attorney is suing an insurer called Health Net for allegedly rescinding coverage when members submit claims for costly treatments.
The suit, filed yesterday, applies to individual policies. A Health Net spokesman told the Los Angeles Times that the company paid $200 million on claims for those sorts of policies last year. He said the company has reviewed its cancellation policies in the past few years and added an internal independent review to “protect people’s rights in a fair and appropriate way,” according to the LAT.
The City Attorney, who last week launched a Web site focused on health insurance, is also opening a criminal investigation into Health Net’s practice of “paying employee bonuses based in part on canceling policies of people who have submitted substantial medical claims,” the LA Times said. The bonuses got the company into trouble with state regulators last year.
Blue Cross of California, which is owned by WellPoint, is appealing a $1 million fine for rescinding individual insurance policies. And last week, public criticism prompted the company to stop sending letters to doctors, asking them to identify omissions in patients’ health insurance applications.
The industry says it rescinding the policies of consumers who have misrepresented their health histories helps prevent health fraud.
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Posted by healthinsurance at 02:33 PM | Comments (0)
February 19, 2008
California Bill Targets Health Insurance Cancellations
Spurred by complaints that Blue Cross of California and other health insurers cancel patients' policies after they get sick, a Southland lawmaker has introduced legislation that would require state regulators to sign off before carriers drop policyholders for allegedly failing to disclose preexisting medical conditions.
Assemblyman Hector De La Torre (D-South Gate) said his bill was prompted by recent letters from Blue Cross to physicians asking them about new patients' health issues that could be used as a reason for canceling coverage.
De La Torre said his bill was needed because insurance companies "were not intending to abide by the spirit" of a law he wrote last year prohibiting carriers from refusing to pay medical bills for previously authorized services.
"We all agree that if someone is lying and doing willful misrepresentation, then they should not be insured," the assemblyman said. "But the insurance companies should not be taking premium dollars from someone and dumping them."
Health insurance companies contend that weeding out people who may not have been forthright when they applied for coverage is an essential part of keeping treatment costs under control.
"We need to make sure that the process for application, rescission and cancellation is fair," said Christopher Ohman, chief executive of the California Assn. of Health Plans. "But we also want to make sure that the millions of people who do the right thing aren't left paying for the relatively few who don't."
Ohman's association represents 40 health maintenance organizations and preferred provider organizations covering 21 million enrollees in California.
Ohman said his group's members were "analyzing the implications" of De La Torre's bill.
The assemblyman's bill is the latest in a series of legislative, regulatory and legal actions in California in response to aggressive efforts by insurers and health maintenance organizations to drop patients who hold individual policies after they've filed claims.
The practice, known in the health insurance industry as rescission, has been the target of growing criticism from patients, physicians and healthcare reform advocates.
In recent weeks, the state Department of Insurance and Department of Managed Health Care levied $1.3 billion in penalties on Cypress-based PacifiCare for alleged improper claims handling and other violations.
Reviewing health insurers' proposed cancellations is an important safeguard, said Dr. Richard Frankenstein, president of the California Medical Assn. Companies should not be "the judge, jury and executioner," he said.
De La Torre's legislation and similar measures are needed in California as stopgap protections for patients at least until state or national policymakers, health insurers and dozens of other consumer and industry groups can agree on a health insurance plan that guarantees universal coverage, healthcare advocates say.
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Posted by healthinsurance at 11:14 AM | Comments (0)
February 17, 2008
Living Without The California Health Insurance Industry
Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," including "pre-existing pregnancies."
The letter wasn't going down well with physicians. "We're outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality," said Dr. Richard Frankenstein, president of the California Medical Assn.
Blue Cross may or may not be within its rights to send out this letter, but they aren't doing anything either illegal or unusual. After all, any profit making insurance company is going to do its best to avoid covering people who are likely to incur large medical expenses. It's just the nature of the beast. If they don't do it, they'll go out of business.
So let's get rid of health insurance companies. They cherry pick clients, add huge administrative costs to the system, and do nothing to drive innovation or bring down costs. What good are they? Tyler Cowen answers:
Let me be clear: the incentives today are screwy. Let me also tell you my ideal world. Insurance companies are judged by honest third party intermediaries. Insurance companies compete like heck to make customers satisfied. Insurance companies monitor doctors, read Robin Hanson, and require evidence-based medicine. Insurance companies which fail at these pursuits either go bankrupt or they must abide by an ex ante contract to permit the exile of their CEOs to Greenland. Every year prices would fall in real terms, quality would improve, and coverage would be expanded. Imagine the whole health care sector working like laser eye surgery or cosmetic surgery.
I believe we know why insurance companies don't work this way, namely monitoring problems; they screw you over instead of serving you and they can get away with it. Go ahead, call me a pollyanna, but modern information technology and measurement can indeed resolve many monitoring problems. We can now monitor central bank performance quite well or show up in Sicily with a credit card and rent a car. Neither was the case forty years ago.
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Posted by healthinsurance at 06:36 PM | Comments (0)
February 14, 2008
Heat is on California Health Insurers
With medical costs rising, record numbers of people losing their coverage and healthcare at the top of the domestic agenda, health insurers found themselves Wednesday in the cross-hairs of regulators, elected officials and law enforcement in California and across the nation.
New York Atty. Gen. Andrew Cuomo said the nation's largest health insurers have rigged rates they pay for physician visits, leaving patients with higher medical bills.
In Los Angeles, City Atty. Rocky Delgadillo has assembled a team of investigators and prosecutors to probe industry practices such as canceling patients' coverage after they get sick. Today he is set to unveil a first-of-its-kind website to solicit information about insurance cancellations and delays and denials of treatment.
The announcements follow a yearlong string of fines and citations against insurers in California. Just last month, amid widening state probes, state Insurance Commissioner Steve Poizner decided to seek as much as $1.3 billion in penalties from Cypress-based PacifiCare as a result of widespread claim problems.
"Our healthcare system is broken, and it's going to take a team effort to fix it," Delgadillo said. "Through our combined efforts, and the efforts of other prosecutors throughout this nation, we can make a real difference in stamping out fraud and abuse, and secure for American consumers the protection they deserve."
The crackdown echoes the frustration of consumers who revolted in the early 1990s against new health maintenance organizations, many of which sought to cut costs by rigidly regulating patients' freedom to choose doctors and limiting the medical care they would cover.
Insurers defend their business practices, saying one of their top goals is to keep health insurance affordable for all. In fact, they say, many of the practices in the spotlight actually are good examples of their value in holding down healthcare costs.
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Posted by healthinsurance at 08:18 PM | Comments (0)
February 13, 2008
Southern California Hospital System Sues Kaiser Permanente
Prime Healthcare Services announced today that eight of its hospitals have filed lawsuits in four different Southern California counties against Kaiser Permanente seeking more than $25 Million for Kaiser's failure to properly pay thousands of claims for emergency medical services provided to Kaiser's HMO members. Under both federal and California law, each of these hospitals were required to provide medical screening examinations to each patient who sought emergency care and such further stabilizing care as was necessary to stabilize the patient's emergency medical condition regardless of the patient's insurance status. Kaiser, as well as other HMOs, is required to reimburse the hospitals for the reasonable and customary value of the emergency services provided. Although Prime Healthcare's hospitals provided emergency care to thousands of Kaiser's enrollees, Kaiser failed to properly reimburse Prime Healthcare's hospitals for the emergency services provided to its members. Instead, Kaiser has routinely denied claims in their entirety, paid only small portions of the claims, and/or reimbursed the hospitals at rates which are far below the reasonable and customary value of the emergency services. For example, Kaiser has failed to pay any portion of Sherman Oaks Hospital's $1.6 Million claim for emergency burn services provided to a critically-injured Kaiser member at the world-renowned Grossman Burn Center who was hospitalized for more than thirty days.
Given the rising costs of providing healthcare and the dramatic increase in the number of uninsured and underinsured patients, many hospitals have been forced to close, file bankruptcy, or limit services. Since 2001 more than 17 hospitals throughout Southern California have closed due to financial constraints and several others were forced to file bankruptcy. As noted by Roger Krissman, Chief Financial Officer of Prime Healthcare Services, "it is especially important that HMOs like Kaiser fairly and properly reimburse providers of emergency medical services because otherwise more hospitals may be forced to close". Mr. Krissman commented further that "Prime Healthcare had no choice but to file lawsuits against Kaiser in order to ensure continued access to healthcare for the members of the communities in which its hospitals are located."
In contrast to financially distressed hospitals, Kaiser reported profits of $1.3 Billion in 2006 and $2.5 Billion in 2007. This is not surprising given that although insurance premiums have increased; the amount of revenue spent on patient care has remained the same or decreased. Rather than spending the increased premiums on patient care, HMOs are using the money on increased layers of bureaucracy and middle management whose job it is to refuse necessary patient care, deny provider claims or find other ways to not pay provider claims properly. According to Dr. Prem Reddy, a board certified Cardiologist and Chairman of Prime Healthcare Services, "HMOs, including Kaiser, ought to be focused on effectively managing patients' care; but unfortunately, they are focused on managing bills". Also, in order to implement a process of working efficiently with Kaiser, Dr. Hassan Alkhouli, Medical Director of Prime Healthcare's Orange County Hospitals, attempted numerous times to arrange for a meeting with Kaiser's utilization managers to address utilization issues but his telephone calls went unanswered.
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Posted by healthinsurance at 07:16 PM | Comments (0)
February 12, 2008
The Defeat of the California Health Bill
The media has widely and falsely reported the California state senate's resounding defeat this week of a universal health care bill as a rejection of a bold plan for universal health care, and as a blow to efforts nationally. In fact, the defeat of this bill--which was cobbled together by Governor Schwarzenegger and the state assembly leader--should be read as a dramatic plea for universal health care. It is a victory for advocates of real reform.
One of the most progressive, heavily Democratic state legislatures in the nation has refused to support a bill that jerry-rigs a set of reforms into the current system and that fails entirely to achieve health care coverage that is adequate, secure, affordable--and universal. Since the leading Democratic presidential candidates are touting proposals that are similar in many respects, they should pay attention.
The California bill required residents to buy coverage and prohibited the insurance companies from rejecting applicants. It subsidized California's poorest residents, and required employers to subsidize coverage for employees. However, the bill declined to closely regulate the cost of premiums, size of deductibles, or extent of coverage. It did require insurers to spend 85% of premium income on health care--which sounded like an incentive for insurers to raise premiums. Tellingly, one of the most trumpeted features of the bill was the exemption from the requirement to buy insurance coverage if the cost of premiums exceeded 5% of a family's income.
In other words, this bill actually assured many people that they wouldn't need to buy health coverage because they wouldn't be able to afford the insurance premiums.
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Posted by healthinsurance at 02:02 PM | Comments (0)
February 11, 2008
UnitedHealth faces stiff fines in California
At the end of 2007, UnitedHealth Group executives vowed to improve their operations and physician relations after saying the company lost 315,000 commercial members, mostly because it mishandled the 2005 acquisition of PacifiCare.
In late January, California insurance regulators offered their own numbers to measure how badly they believed United mishandled the PacifiCare deal.
One number was