Insuring Resources Commentary:
So what has happened in the three months since health care reform passed Congress and Pres. Obama signed it March 23rd?
Premiums have continued to rise and health care reform rules are slowly taking shape. In the end will the new rules help?
I believe in some ways they will, more people will become insured, young adults will have greater access through their parent's plans, pre-x will be eliminted for children this October and in 2014 for adults.
BUT, will premiums go down? Probably not because the bill does virtually nothing to stem the tide of rising health CARE costs, that's where the price drivers are.
We need incentives for quality and efficiency.
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See this article concerning new premium increases PRIOR to health care reforms implementation.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/06/26/ED011D46ND.DTL&type=health
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Showing posts with label pre-existing conditions. Show all posts
Showing posts with label pre-existing conditions. Show all posts
Tuesday, June 29, 2010
Wednesday, April 7, 2010
State of WI Creates Office of Health Care Reform
Insuring Resources News Update:
State creates health care reform office
By Guy Boulton of the Journal Sentinel
Posted: April 7, 2010 10:14 p.m. |
Gov. Jim Doyle has created an Office of Health Care Reform to prepare for the sweeping changes from health care reform that take effect in 2014.
Those tasks will range from developing an exchange, where individuals and small businesses will be able to buy health insurance, to helping people understand the pending changes.
"Our direction now is pretty simple. It isn't to rehash the political debate," Doyle said at Froedtert Hospital on Wednesday. "It isn't just to fight this all out. It is to make sure we are really looking out for Wisconsin citizens."
The new office will be overseen by Karen Timberlake, the secretary of the Department of Health Services, and Sean Dilweg, the state insurance commissioner.
Some changes from the new law take effect immediately.
Small businesses that provide health benefits to their employees, for example, may be eligible for tax credits this year, Doyle said. The new Office of Health Care Reform will help make small businesses aware of the credit.
But implementing the most significant changes will take years. And designing easy-to-use exchanges - basically Web sites - will be one of the key tasks.
The health plans sold on the exchange will be required to offer a minimum standard of benefits, enabling consumers to make apples-to-apples comparisons when shopping for health insurance.
The exchanges are expected to offer a choice of benefit packages from a variety of insurance companies. People and families with incomes of up to 400% of the federal poverty level - $88,200 for a family of four this year - also will be eligible for subsidies to offset the cost of the coverage.
The sites also could provide consumer information on a health plan's performance.
The exchanges could be one of the most significant changes from the new law, with some economists contending they could increase competition among health insurers by allowing consumers to easily compare plans and their costs.
But the exchanges also could force insurance agents who sell individual policies out of the market. For one thing, health insurers will not have to pay sales commissions for the policies sold on the exchanges.
The exchanges also could affect agents and brokers who focus on small businesses.
Dan Schwartzer, executive vice president of the Wisconsin Association of Health Underwriters, which represents agents and brokers, said the effect is uncertain. But he said most small businesses probably would continue to work with agents because of their understanding of the market.
Doyle said he hoped to have an exchange up before 2014. But how that would work is unclear.
Before 2014, health insurers will not be required to cover people with pre-existing conditions. Health plans also would not be required to offer a minimum set of standard benefits, making apple-to-apple comparisons difficult. And small business rates would remain tied to the medical claims of their employees.
Schwartzer also noted that setting up the exchanges before 2014 could cause additional confusion when the new regulations kick in.
State creates health care reform office
By Guy Boulton of the Journal Sentinel
Posted: April 7, 2010 10:14 p.m. |
Gov. Jim Doyle has created an Office of Health Care Reform to prepare for the sweeping changes from health care reform that take effect in 2014.
Those tasks will range from developing an exchange, where individuals and small businesses will be able to buy health insurance, to helping people understand the pending changes.
"Our direction now is pretty simple. It isn't to rehash the political debate," Doyle said at Froedtert Hospital on Wednesday. "It isn't just to fight this all out. It is to make sure we are really looking out for Wisconsin citizens."
The new office will be overseen by Karen Timberlake, the secretary of the Department of Health Services, and Sean Dilweg, the state insurance commissioner.
Some changes from the new law take effect immediately.
Small businesses that provide health benefits to their employees, for example, may be eligible for tax credits this year, Doyle said. The new Office of Health Care Reform will help make small businesses aware of the credit.
But implementing the most significant changes will take years. And designing easy-to-use exchanges - basically Web sites - will be one of the key tasks.
The health plans sold on the exchange will be required to offer a minimum standard of benefits, enabling consumers to make apples-to-apples comparisons when shopping for health insurance.
The exchanges are expected to offer a choice of benefit packages from a variety of insurance companies. People and families with incomes of up to 400% of the federal poverty level - $88,200 for a family of four this year - also will be eligible for subsidies to offset the cost of the coverage.
The sites also could provide consumer information on a health plan's performance.
The exchanges could be one of the most significant changes from the new law, with some economists contending they could increase competition among health insurers by allowing consumers to easily compare plans and their costs.
But the exchanges also could force insurance agents who sell individual policies out of the market. For one thing, health insurers will not have to pay sales commissions for the policies sold on the exchanges.
The exchanges also could affect agents and brokers who focus on small businesses.
Dan Schwartzer, executive vice president of the Wisconsin Association of Health Underwriters, which represents agents and brokers, said the effect is uncertain. But he said most small businesses probably would continue to work with agents because of their understanding of the market.
Doyle said he hoped to have an exchange up before 2014. But how that would work is unclear.
Before 2014, health insurers will not be required to cover people with pre-existing conditions. Health plans also would not be required to offer a minimum set of standard benefits, making apple-to-apple comparisons difficult. And small business rates would remain tied to the medical claims of their employees.
Schwartzer also noted that setting up the exchanges before 2014 could cause additional confusion when the new regulations kick in.
Friday, October 16, 2009
This is madness
This is what our crazy system has driven some people to do. The military health insurance system (TRICARE) covers pre-existing conditions so this man joined the army to try to save his wife's life because that's the only reasonable soultion he had.
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A family’s health-care struggle
After losing his job, he joins the Army so his wife can battle cancer
From the Oct. 16th Milwaukee Journal Sentinel Online edition
On a rainy morning in mid-October, Bill Caudle joined the Army.
An unremarkable occurrence, except just about everything about it was remarkable.
Caudle is 40. He was laid off from his job of 20 years. And his wife, Michelle, 39, was sick with ovarian cancer. Indeed, Bill Caudle was leaving precisely because his wife was sick.
His severance package had provided several months’ salary, but by August the paychecks were winding down. Soon the cost of his family health coverage was going to triple, then a few months after that, nearly triple again. They needed health-care coverage so Michelle could fight her cancer.
The solution: a four-year hitch in the Army.
The two are not fond of politics. They have paid little attention to the shouting over health-care reform. They have not gone to any of the town hall meetings.
But this year the national story of lost jobs became their story. And the saga of families losing health insurance was about to become theirs, too.
Except that Bill wouldn’t let it.
Look for their story in Sunday’s print editions of the Journal Sentinel and on JSOnline on Monday.
-----------
A family’s health-care struggle
After losing his job, he joins the Army so his wife can battle cancer
From the Oct. 16th Milwaukee Journal Sentinel Online edition
On a rainy morning in mid-October, Bill Caudle joined the Army.
An unremarkable occurrence, except just about everything about it was remarkable.
Caudle is 40. He was laid off from his job of 20 years. And his wife, Michelle, 39, was sick with ovarian cancer. Indeed, Bill Caudle was leaving precisely because his wife was sick.
His severance package had provided several months’ salary, but by August the paychecks were winding down. Soon the cost of his family health coverage was going to triple, then a few months after that, nearly triple again. They needed health-care coverage so Michelle could fight her cancer.
The solution: a four-year hitch in the Army.
The two are not fond of politics. They have paid little attention to the shouting over health-care reform. They have not gone to any of the town hall meetings.
But this year the national story of lost jobs became their story. And the saga of families losing health insurance was about to become theirs, too.
Except that Bill wouldn’t let it.
Look for their story in Sunday’s print editions of the Journal Sentinel and on JSOnline on Monday.
Tuesday, August 18, 2009
Reform without the Public Plan Option- It could look like this
What will reform look like?
I have consistently predicted that health care reform passage will not include a public plan, government run program. I don't see how it will get the votes needed. In a previous post I gave the pros and cons and more recently posted how agents might still be able to sell the public plan option which makes the cost more even with private plans.
Moving on let's look at what's possible without the public plan option.
I'll discuss two possibilities to use as the mechanism to get competition without a true public plan.
1- the Co-op model run by private, non-profit state based consumer friendly entities with strict implementation regulations by the feds with the carrot of seed money.
2- Medicare Advantage-like health plans regulated and contracts enforced by the feds BUT, not run by the feds.
Critics say you can't put cost controls in either of these above like you can if it were "government-run". And why not? States regulate the sale of health insurance. The NAIC (Nat'l Assoc of Insurance Comm.'s) sets forth model acts and rules on nearly every aspect of health insurance as guidelines for the state regulators to implement. This ain't rocket science, don't let them tell you it can't be done. It can.
Both of these models I identify can be set up with new payment structures like accountable care to reimburse providers for episodes of care, not strictly fee reimbursement. And the reimbursement does not need to mirror the reduced fee structures under Medicare or Medicaid. Don't let them tell you otherwise.
Example-
Let's look to the enactment of HIPAA in the late 90's as an example. The feds passed the law which the states were then required to pass as well with at least the same consumer protections, but the state's could also go beyond the federal minimums. The same can be done here. The "Health Care Reform Act of 2009" could mandate "episodes of care" reimbursement and penalize doctors for hospital readmissions. That will step up quality and reduce cost. Going a step further it could provide incentive payments to health plans and insurers and require providers to implement LEAN processes ( see http://www.healthcarevalueleaders.org/ for details). This can be instituted in the same way as the HIPAA privacy measures that were placed upon health care providers. It can be done on a strict timeline- say by 2015.
There's your cost savings in two distinct options and without a public plan run and operated by the feds. Both include oversight by the feds like Medicare, Medicaid and TRICARE (military). This is nothing new, we've done it for decades, its not socialism. Again, don't let them tell you otherwise.
By the way the Co-ops and the Medicare Advantage-like federal contracted plans could both be structured to set up the elimination of the individual health insurance market by letting individuals join the larger risk pool and lower costs to individuals like the self-employed. Of course it would also eliminate individual underwriting and therefore that dreaded term, "pre-existing condition." Cost savings would also include the elimination of individual state high risk pools which together insure several hundred thousand Americans.
This is the framework that's needed for true health care reform. Please comment and add to the reform discussion.
I have consistently predicted that health care reform passage will not include a public plan, government run program. I don't see how it will get the votes needed. In a previous post I gave the pros and cons and more recently posted how agents might still be able to sell the public plan option which makes the cost more even with private plans.
Moving on let's look at what's possible without the public plan option.
I'll discuss two possibilities to use as the mechanism to get competition without a true public plan.
1- the Co-op model run by private, non-profit state based consumer friendly entities with strict implementation regulations by the feds with the carrot of seed money.
2- Medicare Advantage-like health plans regulated and contracts enforced by the feds BUT, not run by the feds.
Critics say you can't put cost controls in either of these above like you can if it were "government-run". And why not? States regulate the sale of health insurance. The NAIC (Nat'l Assoc of Insurance Comm.'s) sets forth model acts and rules on nearly every aspect of health insurance as guidelines for the state regulators to implement. This ain't rocket science, don't let them tell you it can't be done. It can.
Both of these models I identify can be set up with new payment structures like accountable care to reimburse providers for episodes of care, not strictly fee reimbursement. And the reimbursement does not need to mirror the reduced fee structures under Medicare or Medicaid. Don't let them tell you otherwise.
Example-
Let's look to the enactment of HIPAA in the late 90's as an example. The feds passed the law which the states were then required to pass as well with at least the same consumer protections, but the state's could also go beyond the federal minimums. The same can be done here. The "Health Care Reform Act of 2009" could mandate "episodes of care" reimbursement and penalize doctors for hospital readmissions. That will step up quality and reduce cost. Going a step further it could provide incentive payments to health plans and insurers and require providers to implement LEAN processes ( see http://www.healthcarevalueleaders.org/ for details). This can be instituted in the same way as the HIPAA privacy measures that were placed upon health care providers. It can be done on a strict timeline- say by 2015.
There's your cost savings in two distinct options and without a public plan run and operated by the feds. Both include oversight by the feds like Medicare, Medicaid and TRICARE (military). This is nothing new, we've done it for decades, its not socialism. Again, don't let them tell you otherwise.
By the way the Co-ops and the Medicare Advantage-like federal contracted plans could both be structured to set up the elimination of the individual health insurance market by letting individuals join the larger risk pool and lower costs to individuals like the self-employed. Of course it would also eliminate individual underwriting and therefore that dreaded term, "pre-existing condition." Cost savings would also include the elimination of individual state high risk pools which together insure several hundred thousand Americans.
This is the framework that's needed for true health care reform. Please comment and add to the reform discussion.
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