Health Insurance and You!!

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?

It seems like all individual health insurance plans in Colorado will soon be required to carry maternity health insurance.

Our own viewpoint — regulation of this sort is sometimes necessary to ensure access to necessary services. But all regulation comes at a cost. Our hope is that addition of this mandate will not raise premiums by so much that affordability becomes an issue. Health Plans in Colorado right now for a 38 year old woman begin in Denver begin at about $66/month for a high deductible plan.

To your health,
Chini

Another NPR article discusses how it is difficult for new graduates to find health insurance, although reform is now passed.

If you are a new graduate, below are some quick thoughts on how to be smart about your health insurance:

1. If you have a condition like Asthma, as one of the new graduates in this article does, you are clearly best off being in a group plan offered by a parent even if you have to wait for a few months. Individual plans that you can buy on the market are under-written, which means that there are a range of health conditions which will cause you to be declined. If you have a pre-existing condition, please check out the feature title “Will you qualify?” next to each plan at getinsured.com health insurance plan selector.

2. If you are healthy and would qualify for individual health insurance easily, usually you can save money by shopping — again it will take you less than 5 minutes to find if a health insurance quote will save you $$. Some times, it can be several hundred dollars a month.

3. If your parent’s employer offers you health insurance regardless as a free benefit — you should absolutely consider it when it is offered. Free trumps paying money

To your health,
Chini

I just came across this rather heart-rending tale of the risks of being under-insured.

Families like the Martins (depicted in the story above) are struggling to make ends meet. I’m hopeful that reform would help families like the Martins afford better health insurance plans. But for now (and pretty much until 2014), families with stretched budgets are very likely to accept the insurance plan offered by one of their part-term employers, even if it is not the plan that is perfect for their family situation. In this case, it came back to bite them, in the form of health bills that they are needing to pay for expenses incurred — about $400/month.

Our recommendation is this — when you’re backed into a corner with a stretched family budget — and you know your health plan is not perfect, please do consider targeted forms of health insurance coverage. An accident medical plan would pay for any medical expenses incurred in virtually any form of accidents. An E.R. plan would pay for E.R. visits. Usually, such plans pay for coverage in addition to your usual health insurance plan. Also, they can be quite affordable, under $50/month.

To your health,
Chini

In the near future you may find your state legislature playing the role of the tooth fairy, protector of children’s gums and enemy of plaque. According to today’s New York Times, a new regulation calls for all Massachusetts children who attend preschool or daycare for more than four hours each day, or who eat lunch at school to brush their teeth in class.

In spite of the fact that parents may choose to opt out of the requirement, there is a very vocal outcry against the new mandate. Parent protesters are citing a variety of objections including concerns about spreading germs, swallowing fluoride, over-burdening caregivers and even wearing away tooth enamel from over-brushing. (see Mom’s Nation blog) Many parents are just shocked at the level of government intrusion into their children’s personal hygiene. What’s next? Mandating that children wash their hands after using the bathroom? Hmmm, sounds like a good idea to me. That would certainly be an effective way to prevent the spread of many illnesses. But, back to teeth.

Maybe parents would be less outraged if they knew about a study conducted by British medical researchers that found tooth decay reduced by 11-30% in under-privileged five year-olds who brushed at school. It’s an impressive finding. Or maybe they aren’t aware of the connections between oral health and coronary disease. Even if a child were a paragon of oral hygiene virtue, a little extra brushing after meals is not a bad thing. I would trust most daycare providers who manage to feed and change their charges without causing epidemics to assist children in brushing their teeth. Imagine the health complications, pain and expense saved by all that prevented tooth decay.

As for government reach – I recall similar outrage aimed at legislators who passed mandatory child car seat laws. But the early opposition evaporated and we are left with a law that has become second nature to us all. Who would think of putting a toddler in a car without first strapping him into an appropriate safety seat?

In a nation that spends over $100 billion on dental care (according to the Dep’t of Health and Human Services), it makes sense to train children early in health-sustaining habits. To Massachusetts parents I say: get over it. To everyone else I say: let’s watch to see the outcome of this practice and consider following in the steps of our neighbors to the East. What an easy way to help make our children healthier.

Here is a story I heard from a friend, an adult with a chronic illness. During an appointment with her Primary Care Physician last week she inquired about her flu vaccination status. He told her that she needed the seasonal flu vaccine and if possible, the H1N1 (swine flu) vaccine. He provided the seasonal flu vaccine, but said he did not have the H1N1 and had no idea about when or if it might come. The next evening, the doctor’s assistant called my friend and told her to go to his office right away for her H1N1 vaccine. He had just received a batch and was saving a shot for her.

The story made me think about how many people may be confused about all the information floating around about seasonal and H1N1 vaccines. I did my own informal research and found several sites helpful.

The CDC has two very informative and easy to understand sites, posted just a couple of days ago. The first one provides answers to frequently asked questions about seasonal flu, and the second provides answers for H1N1 related questions including who should and should NOT get the shot, where and when it is available and more.

I am convinced that getting vaccinated as soon as possible is a far better alternative to suffering from either flu. But not everyone is similarly inclined. In fact, I have heard that there are some celebrities advising people not to get a shot. Please, don’t listen to them, and for that matter, don’t listen to me. Ask a doctor or nurse whom you trust and get his or her opinion.

It’s Free…
Because the government feels strongly that this is a public health issue, it is paying for H1N1 vaccine. Other than a possible service charge that may be covered by your insurance provider it’s free. But even if you do have to pay a $25 fee to a clinic, isn’t that ultimately more cost effective than getting sick, paying for medicine and missing work?

…and it is Available
According to the CDC, the US government has procured 250 million doses of H1N1 vaccine, enough for everyone who wants it. Vaccine is being shipped to clinics every day. I looked online for a flu clinic near my home and found a list of locations, dates and phone numbers. Appointments are required and preference is given to people in high-risk groups. You can also go to www.flu.gov for a list of both seasonal and H1N1 flu clinics in your area and for the answers to most frequently asked questions.

Have you had trouble getting information? Will you get vaccinated? Do you have other sources of reliable information to share? Please share your story with us.

Wherever you go today, the topic of conversation is the new federal guidelines regarding mammograms and self-testing to detect breast cancer. This is a highly charged issue. After all, who doesn’t know someone who has had a brush with this ubiquitous disease? In addition to our reasonable fear of cancer, the discussion is taking place against the backdrop of health reform. Here are the two sides of the conversation.

Testing at 40
Many people are appalled and frightened by the new guidelines. The public has been taught since the beginning of time that women have to conduct monthly self-exams and have annual mammograms starting at the age of 40. We have been told that early detection saves lives. There seems to be no shortage of stories about young women who would have succumbed to the disease had they not found a tumor in a mammogram.
Furthermore, these new guidelines were issued by a federal agency, the United States Preventive Services Task Force, which according to the New York Times, arrived at the exact opposite conclusion after conducting studies only seven years ago. If your life, or the life of someone you love is at stake, why would you take a risk that a few years down the road they will reverse direction again?
Finally, because the recommendations were made by a federal agency people fear that any new government-influenced health care system will not pay for the tests. For more on this go to www.breastcancer.org

Testing at 50
The argument for postponing mammograms and foregoing self-exams seems coolly logical. The efficacy of mammography as a life-saving procedure has been the subject of debate for years. This is not the first study to suggest that mammograms do not save lives. In fact, researchers argue that mammograms cause harm because they force people to undergo an untold number of unnecessary, painful, costly and anxiety-creating procedures for cancers that may not be life-threatening.
Additionally, it is important to remember that the guidelines do not suggest that women who may be deemed at high risk of developing cancer should not be screened early. If a doctor finds that a patient is at risk either from medication, lifestyle, genetic testing or something else, a mammogram can be ordered regardless of the patient’s age.

Patients will be calling their doctors en masse over the next week seeking advice on this subject. You may want to be one of those callers.

Since 1985, many laid off workers have been protected by the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows workers the option of keeping the health insurance coverage they had while employed for up to 18 months, as long as they can pay the full amount of the premium.

According to the Kaiser Family Foundation, a not-for-profit foundation focusing on major health care issues, the number of people taking advantage of COBRA is not available. But one study implies that only 19% of eligible people were using COBRA in early 2009. Because employer-sponsored programs cover on average 83% of health insurance premiums, individuals who find themselves laid off have the double-edged burden of a fourfold increase in their health care costs and the loss of their incomes. It is not at all surprising that so few people choose to continue their coverage.

Last March, as a part of the economic stimulus package known as the American Recovery and Reinvestment Act of 2009 (ARRA), the federal government began offering substantial subsidies to help laid off workers pay their COBRA health insurance premiums for nine months. The package offers unemployed workers a 65% discount in the cost of their premiums. The program has proven effective in that Kaiser estimates that twice as many eligible people are keeping their health insurance benefits.

Those who were among the first to apply for the ARRA subsidies are coming to the end of their eligibility for the federal discount. And eligibility to begin receiving the discount is ending in two months. While congress is considering a bill to extend the subsidies, many people are finding themselves in a difficult situation. Should they stay on COBRA even though their costs may skyrocket, or should they seek other less expensive options?

An article by M.P. McQueen in today’s Wall Street Journal quotes one human resources expert who advises that participants should remain on COBRA if they can afford it especially if they or their dependents have any pre-existing conditions. For others, Mr. McQueen exploring their options by comparison shopping for private health insurance plans.

If you find yourself in such a situation, GetInsured.com is a great place to explore your options. Knowledgeable and helpful associates will listen to your situation and provide you with easy to use information about private health plans to meet your health needs as well as your budget.

I found this article funny and, while exaggerated, it shines a light on the inefficiency and lack of customer service in the health care delivery system. It was written by Jonathan Rauch and published on NationalJournal.com. Happy reading!

If Air Travel Worked Like Health Care
Fasten your seat belts — it’s going to be a bumpy flight.
by Jonathan Rauch

“Hello! Thank you for calling Air Health Care, the airline that works like the health care system. My name is Cynthia. How can I give you travel care today?”

“Hi. My name is Jonathan Rauch. I need to fly from Washington, D.C., to Eugene, Oregon, on October 23.”

“Yes, I’d be happy to assist you with that. It does look like we can get you on a flight on January 23 at 1 p.m. or February 8 at 3 p.m. Which would you prefer?”

“Neither. I need to be in Eugene on October 23. As in, the 23rd of October.”

“I’m sorry, we have nothing open on that date. You might try another carrier.”

“I suppose I’d better. Who has availability?”

“I’m afraid I have no way to know that. I have no way to look into their systems.”

“Who would know?”

“You can call them individually and ask. I’m sure you can find one.”

“Look, I don’t have time to call two dozen airlines. It’s important that I get to Eugene on the 23rd. There must be something you can do.”

“Well, it looks like maybe we could squeeze you in on October 26, if you don’t mind departing Washington Dulles at 5:35 a.m.”

“Good grief. All right, I suppose it will do.”

“I’m sorry, sir, we don’t use e-mail to transmit records and other personal or secure documents. We keep our records on paper.”

“Great, thank you, I’ll be happy to make that booking for you. That’s one flight from Washington Dulles to Chicago O’Hare on October 26. Will there be anything else?”

“Wait, hold on. Chicago? I’m going to Eugene. It’s in Oregon.”

“Yes, sir. The Eugene portion of your trip will be handled by a western specialist. We’ll be glad to bring you back from Chicago to Washington, though.”

“You mean I have to call another carrier and go through all this again? Why don’t you just book the whole trip?”

“Sorry, sir, but you do need to make your own travel appointments. We would be happy to refer you to some qualified carriers. May I have your fax number, please? Before I can confirm the booking, we’ll need you to fill out your travel history and send that back to us.”

“Cynthia, I have filled out my travel history half a dozen times already this year. I’ve told six different airlines that I flew to Detroit twice and Houston once. Every time I fly, I answer the same battery of questions. At least a dozen airlines have my travel history. Why don’t you get it from them?”

“We have no way we could do that. We do not have access to other companies’ records, and our personnel have our own system for collecting travel history.”

“But 95 percent of these questions are always the same. Don’t you know that every time I fill out one of these duplicative forms I increase the chance of error? Wouldn’t it make more sense to hold my travel information centrally, so that everyone could see the same thing?”

“Sorry, sir, we have no capability for that, and we do need to have your travel history at least two weeks before you fly.”

“I don’t suppose I could fill out these forms online?”

“No, sir. The forms are only about 30 pages, though. Did you have that fax number, please?”

“I don’t have a fax machine. No one faxes anymore. Just e-mail me the forms.”

“I’m sorry, sir, we don’t use e-mail to transmit records and other personal or secure documents. We keep our records on paper.”

“What century is this? You think paper is secure?”

“We do keep all your travel records on low-acid paper and in fire-retardant file drawers. When someone needs access to your records, we make a photocopy and put them in the mail. Or fax. How many items of luggage were you wanting to bring?”

“Two.”

“OK, good. We suggest you make luggage arrangements with Rapid Air Transport, though of course you’re free to use any luggage company you like.”

“Luggage company?”

“Yes, sir. You’ll need to arrange baggage transport. Would you like a phone number for Rapid, or would you prefer to find your own baggage company? I’m sure Rapid would be pleased to work with you. All you need to do is sign the Personal Travel Records Release form. Where would you like me to mail that?”

“Release form?”

“Yes, sir. You’ll need to sign and fax or mail that back to our Travel Records Department so that we can release your travel records to Rapid. Under the privacy rules, we’re not authorized to tell them when or where you’re flying without your written permission.”

“I suppose I couldn’t just e-mail you this permission, or grant it online?”

“No. Did you want a list of luggage carriers for your Chicago-Eugene leg?”

“Let me guess. Rapid doesn’t operate out West. I have to find a separate luggage company for the second leg.”

“Yes, sir.”

“And they’ll need more copies of all the same paperwork. And they’ll ask me all the same questions. And I’ll have to arrange to get my travel records to them by mail or fax. And I’ll repeat all this nonsense five or six separate times between here and Eugene, because the providers aren’t equipped to talk to each other and my records aren’t digitized and no two providers use the same system.”

“Yes, sir, that’s right! Did you have a preferred fuelist, or did you want a reference for a company to provide jet fuel for your flight?”

“Fuelist. That would be a fuel specialist, I suppose.”

“We can make a fuel arrangement for you, but please be advised that the fuelist’s charge will be billed separately and you will be responsible for it. We’ll need to know where to have that bill sent.

“May I have your flight-insurance information, please?”

“Millennium Travel Care, group number 068832, ID number RS-3390041B.”

“I’m sorry, sir, we’re not in Millennium Travel Care’s provider network.”

“You’re listed on their website. It says you accept Millennium.”

“We did until last week. If you like, you can pay out of pocket for your ticket.”

“How much would that be?”

“Yes, sir, I’ll be happy to get that price for you. That would be $17,885.70.”

“What? For a flight to Chicago? Does anyone actually pay that?”

“I’m sorry, sir, I wouldn’t know. I can tell you that different clients and insurers pay different rates. For individuals, the rate is $17,885.70.”

“Oh.”

“In a sane system, I would call an airline and it would give me a price for the whole trip, not just for one part of it.”

“Plus tax. And fuel.”

“Is anyone else cheaper?”

“Sir, again, I couldn’t tell you that. Carriers don’t have public rate sheets. Prices are privately negotiated, so there’s really no way you could comparison shop.”

“Oh.”

“Did you want to go ahead, then?”

“No. I DO NOT WANT TO GO AHEAD. I do not want to go anywhere! I want to jump off a cliff!

“This system is insane. It is fragmented to the point of incoherence. Record-keeping is stuck in the 1960s. Communication is stuck in the 1980s. None of the systems talks to the others. Everyone reinvents the wheel at every stage of the process. There is no pricing transparency.

“In a sane, modern system, I wouldn’t have to arrange each leg of my flight myself. I wouldn’t have to fax documents around, find and juggle multiple providers, fill out again and again what are essentially the same forms every time I use a provider.

“In a sane system, I would call an airline and it would give me a price for the whole trip, not just for one part of it. It would sell me a safe round-trip journey, instead a series of separate procedures. It would have back-office personnel using modern IT systems to coordinate my journey behind the scenes. The systems and personnel would talk to each other automatically. At the press of a button, once I entered a password, they would be able to look up my travel history. We’d do most of this stuff online.

“In fact, Cynthia, I would be able to arrange a whole trip with a single phone call!”

“Sir. Please. Calm down and be realistic. I’m sure the system can be frustrating, but consumers don’t understand flight plans and landing slots. Even if they did, there are thousands of separate providers involved in moving travelers around, and hundreds of airports, and millions of trips. Getting everyone to coordinate services and exchange information just isn’t realistic in a business as complicated as travel.”

“Yes. I suppose I’m dreaming.”

“Was there anything else I could help you with?”

“No.”

“My goal today was to provide you with outstanding service. Did I accomplish that?”

[click]

An estimated 26 million Americans are currently without insurance, presumably because the price is too high. Yes, health care reform will help this group of people by subsidizing a basic insurance policy. But the promise of a better deal looming on the horizon is actually causing harm. How many of those who are currently uninsured could afford at least some minimal coverage now but are deferring their purchase while waiting for reform?

We heard in President Obama’s address to Congress that federal reform may take 3-5 years to take effect. I urge everyone to not put off this decision. Individual plans aren’t necessarily more expensive than employer-based plans and can be tailored to offer benefits for an individual’s needs and exclude benefits mandated for employer-based plans. For example, there are low-cost plans available that provide catastrophic coverage. Such an inexpensive plan won’t cover preventive and non-urgent care, but it will pay for treatment in the case of an unexpected accident or serious illness while saving the individual from financial ruin.

Another possibility for those seeking minimal coverage while waiting for federal reform is a short term policy. A short term policy typically lasts six months, and the insurer is not obligated to renew it, but can be an affordable interim solution for some.

There are many people who could and should be getting more coverage than they currently have, rather than waiting for health reform legislation to pass before taking action. And, when a health reform law is passed, those who are eligible can supplement their insurance with more complete, subsidized coverage.