September 15, 2009
Insurance Companies Cancelling Health Insurance of Sick Patients
With President Obama’s speech to Congress last night outlining the details of his overhaul of healthcare in the United States, one interesting point popped up - the fact that Obama would guarantee that insurers could not reject people because of preexisting conditions. Health insurance companies are increasingly citing the failure to disclose preexisting conditions as a means to cancel policies and deny benefits to people in need of care. The term for this is "Post Claims Underwriting". What this means is that the insurance companies will not investigate someone for verification of entitlement to coverage until after they are sick and need the insurance. Of course, if they then determine the person is sick but not qualified they cancel the coverage and the sick consumer is left with no insurance.
Insurance companies are using the term "rescission" to refer to the cancellation of insurance coverage due to a company being misled. Rather than trying to mislead companies, omissions of preexisting conditions seem to be honest mistakes by people filing out increasingly complex forms. There have been countless stories about how people have signed up for health insurance, only to have their policies later cancelled when they need care. No one knows how often policies are cancelled because of a variety of different state laws and policies in place, however, the practice has become rampant enough to result in numerous lawsuits and new regulations put in by states throughout the country.
In the past year and a half, California has fined the five largest insurers in its state almost $19 million for cancelling the policies of individuals who became sick. One insurance company even admitted offering bonuses to employees who were able to find reasons to cancel policies. President Obama has been trying to gain support for his healthcare overhaul in part tapping into consumer dissatisfaction with the insurance industry, an industry that has never been popular among the American people. His plan for healthcare overhaul includes restricting insurance companies from screening for preexisting conditions, however, this still might not save people from having their policies cancelled. With new regulations, insurance companies might not necessarily cancel the policies of those individuals with undisclosed preexisting conditions, however, a company might institute further preauthorization requirements on services for certain patients, which might discourage such patients from renewing their policies. Lawsuits continue to be instituted against insurance companies who have cancelled policies. Rather than fight fraud, rescission has devolved into a backdoor route for insurance companies to stop paying the medical bills of people in their time of greatest need.
August 19, 2009
Coverage at the county level...
Plenty has changed since 2006, the latest year that the uninsured of California was counted by the U.S. Census. But even then, many months before the current recession hit, the percentage of people living without health insurance in our state was startling.
This week, the Sacramento Bee laid out the statistics, finding quite a disparity between those with health insurance and those without. Just in the five-county region The Bee covers, Yolo County posted an uninsured rate of 22 percent of people under 65, while the more prosperous Placer County -- with more employment-based coverage -- posted a 13.7 percent rate.
That's quite a disparity, and the article by Phillip Reese and Anna Tong is worth reading. But the Bee doesn't limit information to its circulation area, it also posts online a comprehensive rundown of each of California's 58 counties' uninsured rate, along with an interactive map of the state and rollover charts.
Here's a sampling of what the authors wrote:
"The uninsured present an immense fiscal and public health challenge: 18,000 Americans die each year because they aren't covered, according to the Institute of Medicine, a nonprofit research organization. This is because having insurance is closely tied to health outcomes: The uninsured won't see a doctor regularly, and if they seek care it is likely to be inadequate or too late.
Moreover, the uninsured are a cost for society: One economist recently estimated the tab at $56 billion per year, 75 percent of which is paid by governments. In cash-strapped California, that cost is critical: 6.6 million residents went uninsured in 2007, more than in any other state, according to the California Healthcare Foundation."
You can bet that, with massive layoffs and small businesses closing since that Census count, the number of those among us -- members of our communities -- who are going without health insurance is a great deal larger. Factor in the Governor and Legislature's cuts in health and insurance programs for lower-income Californians, their children and the elderly, and you get an unimaginable sum of fellow Californians without access to affordable, quality health care -- notably, preventative health care, with better outcomes.
This is what the conversation about health care reform boils down to, not pumped-up talking points and hyper-emotive protests based on misinformation. This is not a partisan issue. It is a people issue. And the bottom line is that the majority of Americans have already voted -- for substantive change for a better future for our country.
August 06, 2009
California Offers Lessons on Insurance Exchanges
As Congress debates creating insurance "exchanges" as part of a health-care overhaul, the failure of a similar effort in California may offer important insights, former participants in the program say.
From 1993 to 2006, small businesses in California could buy health insurance through an exchange run initially by the government, and later by a nonprofit group.
The plan was undermined when some businesses with relatively healthy workers bought policies more cheaply directly from insurers, bypassing the exchange. That left the exchange with a shrinking pool of less-healthy workers, forcing rates higher and prompting many insurers to withdraw. Managers chose to shut the program in 2006 when one of three remaining insurers withdrew.
"There are definite lessons to be learned," said John Ramey, who as former head of the Managed Risk Medical Insurance Board helped implement California's exchange. "We learned them the hard way out here."
Among those lessons, he and others said: Employers and individuals who qualify must be required to obtain health insurance through the exchange. Failing that, John Grgurina, who ran California's exchange from 2002 until it ended, said government must impose rules governing rates and eligibility to protect the exchange from attracting a disproportionate share of high-risk people.
An exchange aims to get better prices for coverage by banding together businesses and individuals. Insurers would have an incentive to join an exchange because they would gain access to more potential customers. Individuals and employees of businesses that participate in an exchange would be able to chose from the available plans and pay the same rate.
Exchanges, either on a regional basis or a single national one, are likely to be a part of any final health-care legislation. Late Friday, the House Energy and Commerce Committee approved its health-care bill, though a full House vote won't come until the fall.
President Barack Obama on Saturday praised the House committee's action and urged lawmakers to "build upon the historic consensus."
The compromise proposal agreed to in the House Friday exempted more businesses from the mandate to provide coverage to their employees and offered subsidies to fewer individuals to buy insurance through an exchange, which would shrink the number of potential participants.
Each of the three major bills -- one in the House and two in the Senate -- would create one or more exchanges. The specifics vary, but most of the proposals would impose more regulations than the failed California program, which analysts say would help the exchanges compete.
Despite California's struggles, insurance exchanges are still the most effective way to expand coverage, said Elliot Wicks, a health-care consultant who wrote a report on the California program. The report, released last month, was commissioned by the California HealthCare Foundation, a private independent nonprofit.
Veterans of the California effort said the ultimate effectiveness of any exchange would rest on details that have yet to be worked out. They said the pool of people in an exchange should be as broad as possible, to spread both risk and administrative costs.
December 17, 2008
Public Health Insurance Would Be Too Good and We'd Like It Too Much
A common thread is emerging in the right wing response to healthcare reform. Its opponents aren't claiming that public healthcare will be bad. Rather, they are terrified that the new system will be so good that no citizen would buy expensive private insurance--or vote for politicians who wanted to take public insurance away.
The Obama team is sending clear signals that healthcare reform is a core economic issue, and the health insurance industry is becoming increasingly anxious by the future administration's determination to bring healthcare costs under control. Some Americans are seeing their healthcare premiums rising at four times the rate of inflation, if they have insurance at all. Healthcare reform is a pocketbook issue for all of us, according to the Obama team.
In tough economic times it might be tempting to postpone healthcare reforms, but Obama is adamant that delay would be a false economy.
In the American Prospect, Joanne Kenen and Sarah Axeen support claims about the high cost of doing nothing:
A recent report by the New America Foundation's health-policy program estimates that the cost of doing nothing about health care, including poor health and shorter lifespan of the uninsured, is well above $200 billion a year and rising. That's enough to cover the uninsured and still have some left over for other public-health needs.
If healthcare costs continue to rise at their current rates, it will cost $24,000/yr to insure a family of four by 2016, an 84% increase from today. At these rates, half of American households would have to spend at least 45% percent of their income to be insured.
In the Nation, Willa Thompson describes how a bicycle crash made her appreciate the connection between healthcare and politics. Thompson was 21 years old when she suffered major injuries after a collision with a truck. Luckily, she was covered by her parents' medical insurance until she turned 22. She later realized that if she had been just a few months older when the accident happened, she wouldn't have been able to pay for her medical care.
We all agree that something needs to be done. Let's briefly review the options that have been proposed so far. Obama wants to provide healthcare for all by requiring private insurance companies to cover everyone and creating a public health insurance plan to compete with private insurers. The second part of his plan is the public option that Republican opponents are so scared of.
December 02, 2008
Why is single-payer health reform not viable?
When it comes to health care reform in America, there is a relatively simple solution that will cover everyone's basic health care, control costs and save businesses, most people and the country a lot of money.
It's called a single-payer health plan, where the government collects taxes to finance national health insurance. The government, which is the "single payer," covers all citizens and pays the bills when they visit private (or public) doctors, hospitals and other facilities for medical care.
All would have basic coverage, regardless of whether they have a job, or where they work. Nobody gets billed for basic care. No-body goes broke because of medical bills.
Yet this option has been declared "off the table" by Sen. Max Baucus, D-Mont., who's among those leading the charge for health care reform in America.
Top Democrats who will be deciding policy in America in 2009, including Baucus and President-elect Barack Obama, say single-payer is "not politically feasible," because the public won't strongly support it.
What they really mean is that when it comes to health care reform, they don't want a political fight with some of the nation's most powerful financial interests, which have the resources and the motivation to turn public opinion against meaningful reforms.
These interests include the health insurance industry, pharmaceutical drug companies, some hospitals, highly paid medical specialists, medical suppliers and others who now profit handsomely from our current system - and who could no longer command those profits under a single-payer system or an alternative form of a national health plan.
November 26, 2008
1.3 million Cal kids lack health insurance
The nation has 8.6 million children who lack public or private health insurance and 1.3 million of them are in California, Families USA, a Washington-based advocate for expanded health access, says in a report based on new census data.
California, the nation's most populous state, is just behind Texas in the numbered of medically uninsured children, Families USA says, and at 12.5 percent has the nation's 12th highest rate. Texas is No. 1 at 20.5 percent.
Families USA, confirming previous reports, says that 88.2 percent of uninsured children come from families with at least one working adult. Families without earned income usually qualify for one of the public medical plans such as Medi-Cal. It's been estimated that more than 6 million of the state's 38 million residents lack health insurance.
Last year, Gov. Arnold Schwarzenegger tried and failed to gain legislative approval of a plan to cover virtually all of California's uninsured residents. The full Families USA report is available here.
November 24, 2008
Sudden health-care changes unlikely in California
November 19, 2008
California farmers, ranchers struggle over health care costs
California’s farmers and ranchers are struggling with health care bills that, in some instances, threaten the viability of their family businesses, according to a report Wednesday by the Access Project and funded by the California Endowment.
The report finds that while almost all farm and ranch operators have health insurance, one in five says that California insurance premiums and other out-of-pocket health care costs are causing financial difficulties for themselves and their families.
These families report spending 37 percent of their income on health care coverage and medical costs.
“A better term for health insurance that leaves nearly one in five purchasers in financial jeopardy might be called ‘product failure’,” says Carol Pryor, a report author and policy director for the Access Project.
The survey also found that more than three in 10 farmers and ranchers (31 percent) are spending at least 10 percent of their annual income on health insurance premiums, prescriptions and other out-of-pocket medical costs. Spending this much on health care is a commonly used indicator of financially burdensome health care costs, the report’s authors say.
Farm and ranch operators are especially hard hit because they are often forced to buy insurance on the individual, non-group market, where insurance generally costs more and covers less, says the report.
The study shows that on average, those farmers and ranchers purchasing insurance in the non-group market spent almost twice as much on health care as those who got their health care coverage through off-farm or off-ranch employment. The median amount spent by farmers and ranchers who got insurance on the non-group market was $8,500 a year (including premiums and out-of-pocket costs), compared to $4,630 spent by people who got insurance through employment off the farm or ranch.
Three in 10 of the study’s respondents purchased health coverage directly on the open market. Nationally, only 8 percent of Americans obtain their health insurance this way.
“Right now farmers are faced with increasing costs for everything – fuel, feed, fertilizer. Adding exorbitant health care costs on top of these expenses is simply not sustainable and threatens the viability of family farm operations,” says Lynn McBride, director of the California Farmer’s Union.
One-fourth of those surveyed (26 percent) report having to draw on other financial resources to cover the costs of care. Of these respondents, 70 percent dipped into family savings and nearly one in three (29 percent) incurred credit card debt or increased existing debt. Others took out a loan, borrowed against their farm, withdrew money from a retirement account or turned to friends and family for help.
October 30, 2008
Grim Health Picture For California's Low-income Kids
There are some positives - the number of overweight children in California declined slightly and preschool enrollment increased. Yet the overall health picture, especially for California's low-income kids, is grim according to a new research brief "Trends in the Health of Young Children in California" by the UCLA Center for Health Policy Research and sponsored by First 5 California.
The brief found that two-thirds of California children are without health insurance are from low-income families. Low-income children utilize community clinics for primary care at three times the rate of higher income children. And the proportion of children enrolled in private health insurance is shrinking - while the reliance on public programs is growing.
"The research suggests there has been a steady erosion of health care and health access for the most vulnerable children," said David Grant, lead author of the policy research brief and director of the California Health Interview Survey (CHIS). "As Californians, we have a lot of work to do to reverse the trend."
The research brief examined trends in health among Californian children from a wide range of ethnicities and economic backgrounds. It is based upon an analysis of data collected by CHIS, the nation's largest state health survey, in 2001, 2003 and 2005. Conducted by the UCLA Center for Health Policy Research, CHIS surveys up to 50,000 Californians - including up to 10,000 children - every two years.
"There is no higher priority than the health and well-being of our children," said Kris Perry, executive director of First 5 California. "This research brief provides a valuable reminder of where our priorities must be, even at a time of scarce resources."
Researchers drew upon those interviews for "Trends in the Health of Young Children in California."
Among their findings:
Fewer overweight children: The prevalence of overweight children ages 0-5 dropped slightly in California from 14% in 2001 to 12% in 2005. There were steep drops in Riverside County (16.2% in 2003 to 12.4% in 2005) and San Bernardino County (16.2% in 2003 to 8.4% in 2005). Los Angeles County also dropped (14.3% in 2003 to 12.8% in 2005) as well as Alameda County (13.4% in 2003 to 8.9% in 2005) and San Diego County (12.9% in 2003 to 8.5% in 2005).
No improvement in health insurance coverage: The proportion of children ages 0-5 in California who lacked health insurance for all or part of the previous year - one in ten children - remained unchanged between 2001 and 2005.
October 08, 2008
ABC's Dr. Tim Johnson, 15 Years of Shilling for Universal Health Care
ABC's liberal medical editor, Dr. Tim Johnson, appeared on Wednesday's "Good Morning America to boost Barack Obama's universal health care plan and critique the more market oriented proposals of John McCain. Co-host Robin Roberts began the segment by seriously asserting, "We're not endorsing one plan over the other. We're just showing the differences between the two."
But after she mentioned Obama's assertion during Tuesday's presidential debate that health care is a right, Johnson marveled, "But, I'm struck by the language of the right to life, liberty and the pursuit of happiness. Without good health, and that usually means without good health care, it's hard to have those other rights." Johnson, despite being a doctor, adopts the standard, liberal positions of most journalists and has a 15 year-plus history of advocating universal health care, including once asking if Republicans who opposed the policy were "immoral."
Regarding Senator McCain's idea to give people the opportunity to buy individual plans, even if they don't have an employer, Johnson criticized, "That's a difficult thing to do because there are so many different plans marketed." Accentuating the negative, he added, "So, you've got to do a lot of work on your own and read the fine print. It's a very difficult job for an individual."
Johnson found no such criticisms for Senator Obama's proposal. After describing the various health insurance plans the Democrat would offer, he approvingly observed, "But these plans will have been vetted by the government, just like they do for federal employees...But you know they've been vetted for basic care and coverage and that the cost is fair."
October 05, 2008
California Health Coverage Costs are a Bit Lower
Cost increases for California health insurance premiums are lower this year, and although California’s are higher than some other states, they are also still lower than in previous years.
The Kaiser Family Foundation and Health Research and Educational Trust confirm what news wires also are reporting: nationally, the rise in cost of health care premiums is about 5 percent. This continues a trend from 2007, when a similar small cost increase was instituted.
However, according to Randy Jones of Hometown Insurance Services in Solvang, in California premiums are somewhat higher: “Ours in California, the rate went up higher than that. We’re getting a 10 percent rise,” he said.
Although the national increases were reported at the end of September, California’s current insurance rates are more difficult to come by. Insurance industry and regulatory agency figures found on the Internet indicate the 10 percent rise is in the ballpark.
“If increases aren’t as bad this year, they were pretty horrendous last year,” Jones continued. One reason California’s premiums are not shooting up, he said: “We’re healthier.”
Another reason that California’s health insurance premiums have stayed relatively low, according to Jones, is the result of a ballot measure from about 15 years ago. That measure was approved by voters, capping punitive damage amounts. “So insurance companies don’t have to approve every little thing for fear of being sued,” Jones said. “But the quality of California health care hasn’t changed.”
The Kaiser study showed that not only insurance premiums have shown a steady increase. “Cost sharing for medical services has also increased in recent years. The percentage of employers sponsoring insurance and the percentage of workers covered by employer-sponsored insurance remained stable over the past year.”
September 16, 2008
California Legislature Drops Some Health Cuts From Budget
Early this morning, the California Legislature approved a budget proposal for fiscal year 2008-2009 that avoided some cuts to health care and other programs, the San Jose Mercury News reports. Democrats widely opposed the proposed cuts (Zapler, San Jose Mercury News, 9/16).
The proposal does not eliminate dental services for adult Medi-Cal beneficiaries or impose new restrictions on Medi-Cal services for undocumented immigrants. Medi-Cal is California's Medicaid program (Halper/Rau, Los Angeles Times, 9/16).
Beyond those already introduced by Senate Democrats, the budget agreement does not include cuts to California health care, human services or education programs, according to information Ventura County officials received from the California State Association of Counties (Biasotti, Ventura County Star, 9/16).
Healthy Families, Medi-Cal
The budget retains a provision to increase monthly premiums for Healthy Families, California's version of the State Children's Health Insurance Program (Los Angeles Times, 9/16).
The proposal would restore most of the 10% cut in Medi-Cal payments to health care providers beginning in March 2009 (Lin, AP/San Francisco Chronicle, 9/16). California's Medicaid reimbursement rates will remain the lowest in the U.S. even after the cuts are restored, according to the Los Angeles Times.
September 04, 2008
California Children at Risk of Losing Health Insurance Coverage
Thousands of California children could lose health insurance coverage in the coming months as a result of changes in Medi-Cal rules and decreased funding for local efforts that have provided coverage to children, the Los Angeles Times reports. Medi-Cal is California's Medicaid program.
State lawmakers will require parents of children enrolled in Medi-Cal to renew their enrollment every six months.
The administration of Gov. Arnold Schwarzenegger (R) projects that the requirement will contribute to a drop in Medi-Cal enrollment over the next two years of about 196,000 children.
State lawmakers also have increased monthly premiums for Healthy Families, California's version of the State Children's Health Insurance Program, by $2 to $3 per child.
As a result, the state estimates that the parents of 19,000 children no longer will receive coverage through the program by July 2009.
The changes to Medi-Cal and Healthy Families were approved as part of a larger effort to address the state budget deficit.
Beyond changes to Medi-Cal and Healthy Families rules, children also could lose coverage because of funding challenges faced by local initiatives operating in 30 counties. The efforts target children who are ineligible for Medi-Cal or Healthy Families because of income or citizenship requirements.
The initiatives are funded largely by private philanthropies and local First 5 commissions, which disburse funds from a state tobacco tax for early childhood health care and education efforts.
Wendy Lazarus, co-president of the advocacy group Children's Partnership, estimates that enrollment in the efforts has dropped by 8,000 over the past two years.
August 13, 2008
California health insurance ambition narrows
Seeking to salvage two years of efforts to completely remake California's health insurance system, Gov. Arnold Schwarzenegger and Democratic legislators are nearing deals intended to rein in costly, meager medical insurance policies sold directly to individuals.
In the final weeks of the legislative session, they are negotiating measures that would limit insurer profits on California individual insurance plans, require plans to provide a minimum set of benefits and restrict insurers' ability to cancel policies retroactively.
The new focus reflects how far Schwarzenegger remains from his original healthcare goal: to orchestrate medical insurance for the 5 million Californians who lack it. Despite a year of strenuous campaigning for his vision, which garnered attention nationwide, the state Senate rejected that $14.9-billion plan in January.
Many of the concepts now under discussion were included in that proposal. Although most California insurers supported the governor's broader effort because it would have created millions of new customers, the industry is uniformly resisting the current push to circumscribe some of its most lucrative products.
Three million Californians buy health insurance on their own rather than through employers. Insurers keep health insurance premiums low -- and profits high, their critics say -- on some individual policies by limiting the services they cover. Such plans may exclude prescription drugs and maternity services, for example; others may cover only hospital visits.
Many of the policies have big deductibles and require patients to pay large portions of their expenses, costing them much more than coverage obtained at workplaces.