HEALTH CARE REFORM
December 14, 2011
Important Health Reform Data
Are you on a group health insurance plan? Beginning in 2012
you will now be charged a $1 monthly fee per number of
covered lives. In the second year this fee jumps up to
$2. Click on this link for more details on this charge.
November 3, 2010
do yesterday’s elections mean to Health Reform? Not much…for
I asked friend and client, Scott Rodli, a University of
Montana law school graduate and someone who has closely
followed this issue, his opinion on yesterday’s elections
and how they affect Health Reform.
His response is simple and interesting.
October 30, 2010
No, not ‘Poltergeist’, rather, the insurance changes from
the new health reform laws have arrived.
We’re now seeing changes from the carriers we represent in
response to the Health Reform Law.
Are you affected?
Today I’m addressing one of the most significant changes
we’ve seen, lifetime maximums have been removed from health
Is this a big deal?
Well…honestly…since I’ve never seen one reached so I didn’t
really feel it was. However, I asked Stan Seagraves, M.D. if
in his experience he considers this a big deal. I found what
he had to say fascinating…click
here to read his response: Lifetime Maximum - A
(P.S. According to a March 2009 study by
PricewaterhouseCoopers, their #’s vary slightly from Dr.
Seagrave’s statistics – their findings revealed 55% of
individuals with employer provided health insurance are
subject to lifetime limits; more than 20% are subject to
lifetime limits of $1 million; another 32% are subject to
limits of $2 million or more.
October 19, 2010
WHO CAN WE TRUST?
the course of the past week we’ve discussed four quotes by
Kathleen Sebelius in an op-ed piece printed in the Wall
Street Journal on September 28th (see link below).
And frankly, my concern over these quotes has increased.
If they were stated by anyone other than the person in
charge of implementing the new health reform, I would be
But I am wondering if Ms. Sebelius is misguided in both
her analysis of the situation and what the solutions should
be. Do you agree?
Today we look at the final quote that stood out to me:
Quote #4: “The Affordable Care Act is bringing
some basic fairness to our health insurance market. So
when I learned that a handful of insurers around the
country are blaming their significant rate increases on
the new law—even though the facts show that the impact
of the law on premiums is small, just 1% to 2% declining
over time—I let them know that we'd be closely reviewing
their rate hikes.”
I actually partially agree with Ms. Sebelius on this
issue. The only way there is any hope we can agree on a
solution is if there is transparency from all parties
involved. This includes Insurance Companies, Health Care
Providers as well as government institutions.
Just as yesterday I expressed concern that Ms. Sebelius
is unreasonably and inaccurately implying the source of the
problem of health care is insurance companies, similarly
insurance carriers need to be transparent and accurate about
their premium increases.
The bottom line:
1. We need accuracy from our health reform leaders as to
both the root of increasing health care and health insurance
2. We need transparency from insurance companies as to
the cause of their premium increases (Is it increased
profits? Is it health reform laws? Is it rising health care
3. Most importantly – we need citizens like you and I to
begin paying attention so we do not get stuck with something
that not only is financially unaffordable for our country,
but does not reduce the quality of health care and health
insurance coverage that you’ve come to enjoy.
October 18, 2010
Our focus needs to be on the root
of the problem!
The third quote by Kathleen Sebelius from her letter written
to WSJ a few weeks ago:
“Over the past decade, Americans have seen what happens when
insurance companies have free rein. The cost of health
insurance has more than doubled, while millions of
hard-working Americans lost their coverage or drained their
savings to keep up with premiums. Employers—big and
small—have struggled mightily to absorb these cost increases
and have been losing the fight.”
At the risk of appearing to defend insurance carriers, which
certainly is not my intent, I question Ms. Sebelius
implication that the cost of health insurance has doubled
because insurance carriers have had “free rein” as opposed
to the fact that health insurance has risen along with - and
as result of – rising health care costs.
As the Health and Human Services federal secretary
overseeing the implementation of the new health reform, I
certainly hope that Ms. Sebelius is focusing on the root
issues of unaffordable health care, and not ancillary
(though still important) issues.
October 15, 2010
But who will pay for it?
continue our analysis of four quotes from a letter
contributed by Kathy Sebelius, U.S. secretary of Health and
Human Services to the Wall Street Journal a few weeks ago.
Quote #2 “…In the mid-1960s, for example, some
claimed Medicare would put our country on the path to
Indirectly Ms. Sebelius is holding up Medicare as guide for
success of the new health reform.
This not only always surprises me, it concerns me and
supports my primary hesitancy that we will be able to afford
the new health reform.
Two interesting facts as you consider this quote:
1. Kathy Sebelius not only oversees the new health
reform legislation, her department also oversees
2. The link below is an article by the Washington
Post on August 6th of this year recapping the published
report by the government on the financial forecast for
Medicare. Though the report indicated that medicare
funds won’t be depleted until 2029 instead of the
previously estimated 2017 (think about that sentence),
the article points out that estimate was based on some
very optimistic assumptions.
Again, I support all of us working together to resolve the
health situation, but are the decisions being made
financially feasible? How will it be paid for and who will
pay for it?
P.S. As I was working on this I saw an announcement
that the Social Security Administration said there will be
no increase in benefits next year -- the second year in a
row without an increase for more than 58 million retirees
and disabled Americans.
Dear Montanans, when we’re already trying to figure out how
to finance Social Security and Medicare we MUST educate
ourselves and get involved in health reform so we can ensure
we have selected a workable and financially feasible
October 14, 2010
PUZZLER – When insurance goes up –
Whose fault is it?
Sept. 9th the Wall Street Journal printed a letter written
by Kathleen Sebelius, Health and Human Services Secretary.
In her piece, four quotes stood out to me that deserve
deeper examination, we will one of these quotes each day.
The first quote was her opening paragraph:
In the last two weeks, my department has been accused of
"thuggery" (this editorial page) and "Soviet tyranny" (Newt
Gingrich). What prompted these accusations? The fact that we
told health-insurance companies that, as required by law, we
will review large premium increases and identify those that
The last line of the paragraph is what caught my attention,
“we will review large premium increases and identify those
that are unreasonable.”
“that are unreasonable”?
The government having the authority to determine what are
reasonable or unreasonable premium increases concerns me.
I fully agree that rising health care and health insurance
costs are a concern…especially to hard-working Montanans.
I also believe that transparency from insurance carriers in
regards to why premiums keep rising are important. Wouldn’t
you like to understand specifically what is behind these
increases? I know I do. Because If we know that, then we
perhaps we can better evaluate the health care costs behind
those raised health insurance premiums.
But are you convinced the government should have the final
say in premium increases. In the long run, what will this do
to insurance companies? If they cannot make a profit, who
will provide health insurance? How can competition exist?
What will your choice become for health insurance plans?
I’m not convinced…but I would like to hear more as to why
this will resolve this issue, wouldn’t you?
Whether you agree or disagree…please get involved. It is
time Montanan’s step forward and make their voice heard as
we are in a critical phase of health reform.
Admittedly, as a health insurance agent my viewpoint may
appear slanted, but all the same I think that if the
government is going to begin controlling what insurance
companies may or may not charge it is critical they identify
and communicate the definition of “unreasonable”.
Certainly a strong and healthy economy is reliant on
reasonable consumer practices…but is it not also reliant on
companies allowed to maintain profitability. I am not
attempting to be a defender of health insurance
companies…but I do have concerns that the government
determining what is, and is not, fair pricing is a slippery
October 11, 2010
Q: Is Kathleen Sebelius the most powerful woman in the
As the U.S. secretary of Health and Human Services - which
means she not only oversees both the Medicare and Medicaid
programs but also has been granted the authority to
implement the new health care system - arguably her decision
may affect your life more than any decisions made by any
other female leader of the United States. So perhaps she is
the most powerful woman in the country.
This being the case, we probably should be listening to what
she has to say.
Recently Kathleen Sebelius wrote an op-ed piece for the Wall
Street Journal defending her department and recent decisions
by her department regarding health care reform that had
received a lot of criticism from different (generally
politically conservative) organizations.
In this piece she made four comments that really stood out
to me that are worthy of closer scrutiny. In the next four
days, I will point out these four quotes to you and explain
why they deserve your attention.
Tomorrow we’ll examine the following paragraph, found early
on in the article.
In the last two weeks, my department has been
accused of "thuggery" (this editorial page) and "Soviet
tyranny" (Newt Gingrich). What prompted these
accusations? The fact that we told health-insurance
companies that, as required by law, we will review large
premium increases and identify those that are
Here is the link to the article:
September 30, 2010
does my ‘Big Mac’ cost more?”
One of the headlines in today’s Wall Street Journal states,
“McDonald’s May Drop Health Plans” (see link below).
Three items in this article stood out to me:
1. The article uses the term, “Unintended
Consequences” of the new health reform. That is well
phrased because that has been one of my concerns of this
health reform passage all along. The bill was 2700 pages
long. As time passes, what language will we learn exists
in those 2700 pages and what will be the unintended
2. What are “Mini-med” plans? This is the type of
coverage McDonald’s offers 10,500 of its workers and
McDonald’s fears that new requirements by the government
on these types of plans will make them unaffordable for
McDonald’s to continue to offer.
3. What are “Medical Loss Ratios”? I would love to go
into more detail on Medical Loss Ratios as I think they
are an issue that will really impact the future of
health care coverage, but too few people yet understand
that. Simply put, Medical Loss Ratios are a minimum %
assigned by the government that health insurance
companies must spend toward “benefits” (as opposed to
administrative costs, sales costs, etc.).
In theory, Medical Loss Ratios make sense. But where it gets
confusing is defining exactly what are considered
“benefits”, as well as determining what a reasonable ratio
It will be interesting how this plays out, but in the
meantime these are my recommendations:
Recommendation #1: I am unaware of any
“Mini-Med” plans offered in Montana (not including
‘supplemental’ policies such as MegaLife or Aflac which
are quite popular in Montana). But if your current
health insurance plan has any benefit caps, please talk
to me as too often we’ve seen people get in financial
trouble because their health insurance plan lacked
Recommendation #2: It is time all of us become
more educated about this health care reform. Whether you
are for it or opposed to it, all of us need to
understand it because as time progresses there will more
“unintended consequences” for which we need to be
Recommendation # 3: Begin thinking about and
researching what you believe the solution should be. As
the opposition to the current legislation continues to
grow, it is hard for me to believe there won’t be
changes down the road. Do you believe a “Single Payer”
system is the solution? Do you believe mandated HSA's
are the solution?
Either way, it is time all of us become more educated and
understand the ramifications or ‘unintended consequences’ of
each option so together we can work toward the best solution
for all of us.
Email me what you think we should do! I’d love to post
September 23, 2010
Many of the health care reform laws go into effect today,
but do they really?
are the new rules that in theory go into effect today:
Preventive services will be covered without any cost
sharing by the insured
Lifetime maximums will be removed
Children up to the age of 26 can remain on their
parent's policies; and
Children up to the age of 19 can have insurance without
any pre-existing conditions.
However, in reality, it is impossible for insurance
companies to immediately comply. Therefore, here is what
Montanan’s can expect:
On the bright side, several Montana insurance companies
enacted the regulation regarding children up to the age
of 26 staying on their parent's plan prior to 9/23. For
example, BlueCross/BlueShield made this change effective
Beginning October 1st, for new group plans, all of these
regulations will be enforced. For existing plans, the
new benefits will become effective on the plan renewal
date. So, it is possible if your particular group plan
does not renew until April 1, 2011, you will not see
these enhanced benefits until then.
And regarding children, BlueCross/BlueShield Individual
plans will accept children without any pre-existing
conditions January 1, 2011. Some insurance companies are
no longer going to offer child only policies. They will
only accept the children when they are listed as a
dependent on their parent's policy.
September 22, 2010
Health Reform + Tanning = Affect
A unique aspect of the new health reform law is that it
includes a 10% tax on tanning services. I interviewed Misty
Burks, owner of Misty’s Tanning & Ultimate Salon, her
opinion on the tax.
Misty thought it a little odd that health care reform
would target tanning services and not cosmetic surgery. She
said that many naturopaths say that tanning in moderation is
actually good for you as it gives the body the needed
Vitamin D, especially during the winter months. She said
tanning, as in anything, should be done in moderation.
Overuse, can be a health concern, just as overeating can be
Misty said her business pays the 10% tax when paying
their quarterly taxes to the IRS. This 10% is passed on to
the consumer. So, when a tanning session used to cost $5, it
is now $5.50. She said they have not had any complaints from
customers, and they are relieved that the increase is only
the 10%. Misty said some salons have used this as a reason
to raise rates even more than the 10%. She has seen no
decrease in tanning because of this tax, and with cold
weather just around the corner, the tanning business will be
busier than ever.
Thank you, Misty, for this insight!
September 21, 2010
9th we reviewed the new requirements that children up to
age 26 must be included on their parent’s policy.
A reader asked , “So, if the child does get a job and
health insurance can they be covered under two plans at
The answer may surprise you, but Yes, a child can be on
the parent's plan as a dependent, as well as their own
Please continue to e-mail me your questions at
Coming soon – an interview with a local
business-owner as well as another contribution by Stan
was just notified by Blue Cross Blue Shield that they have
developed a web-site that addresses the Small Business Tax
Credit discussed yesterday (see below) – here is the
announcement and the link to the calculator. I tried it out
and found it very helpful!
“Blue Cross Blue Shield of Montana is pleased to announce
the development and launch of the Small Business Tax Credit
Calculator for you, your customers, and prospective
customers to estimate the amount of Tax Credit they may be
eligible for under the PPACA Legislation.
The Tax Calculator is accessible though our Health Care
September 15, 2010
ARTICLE BETTER NEWS FOR SMALL BUSINESSES THAN I FIRST
Sunday’s Missoulian discussed the New Health Care Tax
Credit. Here are the three items from the article I found
most relevant to Montana small businesses.
1. One qualification for the tax credit is that employers
are required to pay at least 50% of the cost for the
employee. However, in Montana it is already a requirement
that employers contribute a minimum of 50% and some plans
even require 60% contribution.
So if you’re already providing health benefits to your
employees you should already be in compliance!
2. Maximum credit applies to employers who have 10
employees or less. The key word there is ‘maximum’. You can
still qualify for partial credit if you have more than 10
employees. The credit isn’t phased out until you exceed 25
full-time employees…and owners are not included in this
Here is a helpful web-site
that explains the calculation and how part-time employees
3. Another maximum credit stipulation is that average
annual wages are $25,000 or less.
First, again, this is for the ‘maximum’ credit and it
isn’t fully phased out until average annual wages exceed
Second, how many businesses will meet this stipulation?
I did a little research on average wages in Montana and
according to a survey by the Bureau of Business and Economic
the average wages in Montana are $33,299.
That is obviously quite a bit higher than $25,000 but
then I came across this article by Families USA that says
94% of Montana Small Businesses are eligible for Health Care
Tax Credits and as many as 8,300 should qualify for the
My conclusion? This tax credit may be a boon for most
small businesses in Montana – employers, keep this
information on hand for next April 15th!
September 9, 2010
adult children and health insurance
Health insurance companies will be required to include
children up to the age of 26 on their parent’s policies.
The law goes into effect September 23, 2010. Companies
must comply by October 1, 2010.
There are no restrictions. They do not have to be a
student, and can even be married (but their spouse or
children cannot be on this plan).
Benefit: This helps give our children additional time to
secure employment with health insurance benefits.
Drawback: There may be a possible increase in premium.
For more details, email Debbie at
September 8, 2010
Wall Street Journal headline “Health Insurers Plan Hikes”.
According to the WSJ, (http://online.wsj.com/article/SB10001424052748703720004575478200948908976.html),
insurance carriers in other states have filed requests with
their state regulators to raise premiums due to additional
costs resulting from new preventative care mandates.
Undoubtedly skeptics will proclaim this a ruse by the
insurance carriers to make more money; the insurance
companies in turn will insist it is necessary for
Without access to their actuarial statements we don’t
know for certain who is right.
However, we do know the health reform act has required
companies to cover some procedures that weren’t previously
covered. This is good news for patients, but obviously it is
going to result in additional costs that someone down the
line will have to pay for.
There is a silver lining for Montanans – because primary
carriers like Blue Cross Blue Shield, New West and
Allegience already offer some sort of preventative benefits,
similar rate increases shouldn’t be as extreme as other
states are experiencing.
We will continue to monitor this situation.