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

What do yesterday’s elections mean to Health Reform? Not much…for now.

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.

Thanks Scott!

October 30, 2010

“They’re Here”

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 insurance policies.

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 Caregiver's Perspective

(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.

www.pwc.com/us/en/healthcare/publications/lifetime-limits-impact.jhtml

October 19, 2010

WHO CAN WE TRUST?

Over 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 less bothered.

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 costs.

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 costs?)

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.

http://online.wsj.com/article/SB10001424052748704082104575515851336184716.html

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?

We 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 socialism.”

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 Medicare.

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.

http://www.washingtonpost.com/wp-dyn/content/article/2010/08/05/AR2010080500643.html

http://www.washingtonpost.com/wp-dyn/content/graphic/2010/08/05/GR2010080507343.html

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 situation.
 

October 14, 2010

PUZZLER – When insurance goes up – Whose fault is it?

On 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 are unreasonable.

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 slope.

October 11, 2010

Q: Is Kathleen Sebelius the most powerful woman in the country?

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 unreasonable.

Here is the link to the article: http://online.wsj.com/article/SB10001424052748704082104575515851336184716.html

Stay tuned.

September 30, 2010

“Why 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 consequences?

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 should be.

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 sufficient coverage.

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 prepared.

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 your thoughts.

http://online.wsj.com/article/SB10001424052748703431604575522413101063070.html

September 23, 2010

Many of the health care reform laws go into effect today,  but do they really?

Following 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 June 1st.

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 You?

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 a concern.

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

September 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 once?”

The answer may surprise you, but Yes, a child can be on the parent's plan as a dependent, as well as their own employer's plan.

Please continue to e-mail me your questions at debbie@mymontanahealthinsurance.com.

Coming soon – an interview with a local business-owner as well as another contribution by Stan Seagreaves M.D.

****UPDATE****

I 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 Transition website”

www.healthcaretransitionmt.com

September 15, 2010

MISSOULIAN ARTICLE BETTER NEWS FOR SMALL BUSINESSES THAN I FIRST THOUGHT!

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 computation.

Here is a helpful web-site www.irs.gov/newsroom/article/0,,id=220839,00.html that explains the calculation and how part-time employees are counted.

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 $50,000.

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 Research (bber.unm.edu/econ/us-wage.htm) 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 maximum!

www.familiesusa.org/resources/newsroom/press-releases/2010-press-releases/mt-small-business-1.html

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

Your 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 debbie@mymontanahealthinsurance.com

September 8, 2010

Today’s, 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 profitability.

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.