Health Insurance and You!

Two-thirds of California is experiencing a shortage of doctors, according to the Huffington Post. Almost 30 percent of California’s physicians are above the age of 60, and the problem may well be getting worse. More doctors are close to retirement in California than in any other state in the country.

There is also a cultural component to the issue. Californian Latinos, for example, comprise over 35 percent of the state’s population – but only 5 percent of our physicians. Furthermore, patients and providers often have better exchanges when the patient can relate more readily to the physician. This relation can further increase the quality of primary care.

However, there are a limited few areas in California which meet the US Department of Health and Human Services’ recommendation of 85-100 specialists for every 100,000 people. These include the Greater Bay Area, the Sacramento Area, and Orange County. But even these areas’ futures in terms of primary care physicians are not necessarily secure: by 2014, the LA Times reports, the Los Angeles County may have a serious shortage of doctors across the board – even at the coroner’s department. This severe deficiency of physicians is likely to have an effect on Californians in the foreseeable future despite any progress with the health care overhaul.

Major providers have been promoting more cost-effective health plans with lower premiums that offer customers a more limited array of doctors and hospitals, as reported by the New York Times. These plans are most likely to draw in small businesses, which typically tend to be more cost-conscious, that make insurance available. They tend to have higher deductibles and low premiums. Insurers say that companies that invest in these limited plans may reduce their premiums by as much as 15 percent.

The limited group plan’s network of doctors tends to run smaller than most traditional plans, which would narrow down options and potentially restrict customers for receiving full and proper coverage. At the same time, these plans are the more pragmatic option for cash-strapped businesses. They are also generally convenient for employees who tend to be normally healthy and require little in the form of medical attention.

However, the quality of these limited-but-affordable health care plans has been called into question by the public. While insurers have assured customers that the plans do not sacrifice quality coverage for affordability, it comes down upon the consumers in the end to do the legwork and ensure that they are receiving adequate coverage. These plans may prompt customers to think about buying an individual health plan to retain a wider range of providers

How do you feel about these limited-network group plans?

As of July 7, Gov. Arnold Schwarzenegger stands poised to fully execute an essential portion of the national healthcare overhaul by bolstering California’s review of health insurance rates, as reported by the LA Times.

In the past Schwarzenegger has opposed regulating rates and, as part of the healthcare overhaul, has proposed a program to evaluate and publicize the rates. Any changes in the costs of healthcare services would also be publicized on state sites before implementation.

Schwarzenegger has sought a million-dollar federal grant to implement this program. A large portion of the money would be allotted to actuaries for the appraisal and evaluation of any premium hikes, a key requirement of the healthcare law. They would ensure that any increases in rates “reflect increases in the core cost of providing health care”, according to healthycal.com. Some of the money would also aid in educating consumers on the rate-setting process.

The Legislature is also considering allowing regulators authority to reject “unreasonable” premiums. While Democrats have supported a full regulation of rate hikes, Schwarzenegger has not indicated in his grant proposal that this is likely to happen. The requested grants will be announced in August of this year.

Once applied, Schwarzenegger’s interpretation of the healthcare overhaul law will greatly increase the transparency of insurers’ rate-setting processes and policies. It will further educate consumers and provide them a greater say within the marketplace. On the whole, the playing field would be made more level to some extent, with consumers more savvy to insurance companies’ workings.

What do you think: would you rather see the rates be capped and regulated by the government, or would you prefer greater transparency in rate changes and prices determined by the free market?