Health Insurance and You!

As we have written previously, the White House issued a rule earlier this year that employer-sponsored health insurance plans must offer free birth control services for their employees. Since the policy applies to all employers – including many religious hospitals, charities, universities, and other organizations that oppose contraception – it was met with considerable resistance and has been debated on the legislative floor and all over the media during the past few weeks.

In response to that outrage, wrote Kathleen Hunter of Bloomberg, the Obama administration announced a compromise on February 10 that would require insurance companies, rather than religious organizations, to cover contraception for those organizations.

But many were still unsatisfied. And so, Republican Sen. Roy Blunt of Missouri proposed the Respect for Rights of Conscience Act, also known as the Blunt Amendment, which would have allowed employers to opt out of covering contraception for moral reasons. According to an article by David Morgan and Thomas Ferraro of Reuters, the amendment was tacked on to an unrelated transportation bill, and did not explicitly relate to birth control. Rather, its language would allow employers to choose not to cover a variety of benefits, such as prenatal care, childhood vaccines, and cancer screenings.

The Senate voted 51-48 against the amendment yesterday, with votes falling largely along party lines. One Republican, Sen. Olympia Snowe of Maine, voted against the amendment, and three Democrats voted in favor of it.

According to a recent poll by the Kaiser Family Foundation (KFF), described in a blog post by Julie Rovner and Scott Hensley of NPR, the public generally agrees with the Senate’s decision. Overall, 63% of Americans support health insurance coverage of birth control. KFF parsed the votes along age, gender, and political lines, and found that younger adults, women, and Democrats were most likely to support the requirement. According to an article by Laurie Kellman of the Associated Press, another poll by CBS News and the New York Times had similar results, finding 61% of Americans in favor of contraception coverage and 31% opposed.

So, what happens now? The U.S. House will be deciding on its next steps soon, said House Speaker John Boehner at a news conference yesterday, wrote J. Lester Feder of Politico. During the past month, the House has held several hearings on the issue, but no bills have been introduced so far.

Recently, there has been good news and bad news about the federally-run preexisting condition health insurance plans (PCIPs), which were created through 2010’s health overhaul to provide insurance to people who have been denied coverage by private insurers. PCIPs are temporary and will be phased out when health reform is fully implemented in 2014. From then on, insurers will no longer be allowed to deny coverage based on a preexisting health condition.

Since last summer, when the plans were launched, almost 50,000 people have enrolled, according to an article by Sarah Kliff of the Washington Post. A report released late last week by the Obama administration describes the progress made so far. States had the option of creating their own high-risk pools, which 27 have done, many in concert with existing state programs. The remaining 23 states and the District of Columbia have opted into the federal program. For patients with existing health conditions, PCIP premiums tend to be lower than those in the individual market, although plan members usually have costs beyond their premiums. Plan membership is growing quickly, with about 8,000 new applications per month nationwide during the last few months of 2011.

That’s the good news.

But on the flip side, the same report found that per-patient costs were much higher than expected. When PCIPs were first proposed in 2010, analysts expected a yearly cost of $13,026 per person. Last week’s report, however, increased that estimate to $28,994 per person. The discrepancy was even more dramatic in some states. In California, for example, writes Kamal Menghrajani in a blog post for KQED, the program was estimated to cost about $12,000 per person, but ended up with an annual per-person cost of more than $37,000.

In an article for The Hill, Julian Pecquet  explains that most of the costs so far have stemmed from coverage for cancer treatment (27% of costs), heart disease (18.6%), post-surgical care (18%), and degenerative joint diseases (14.4%). PCIP enrollees also tend to skew older than the average population, with two-thirds of plan members over age 45. Interestingly, though women are less likely to lack coverage than men, most of the program’s enrollees are women.

On one hand, the high costs show that PCIPs are reaching and serving the types of patients they were created for: people with unmet medical needs who can’t get coverage anywhere else. But skeptics say that the costs may stem from how the program is structured. For example, to be eligible to enroll, people need to be uninsured for at least six months. During those six months, Ms. Kliff writes, many patients put off or skip needed treatment and medications due to cost. As a result, once they’re enrolled in a PCIP, they have a pent-up need for treatment, and may even have suffered health consequences by waiting.

Readers, have you considered signing up for a PCIP? Do you have any ideas for how this program can cut its costs while continuing to fill its purpose?

Today, California’s Office of the Patient Advocate released its annual report card rating some of the state’s most popular health insurance plans and companies. Included in the report were California’s nine largest HMOs, six largest PPOs, and 212 medical groups.

According to an article and accompanying image by Sandy Kleffman of the Bay Area News Group, the HMOs and PPOs were given one to four stars on several factors, such as how well the quality of care met national standards, customer service, asthma care, and care for other specific health conditions. For insurance plans, ratings were based on member experiences and clinical quality measures. For the medical groups that worked with these insurance plans, ratings were based on patient experiences and clinical quality measures, and were sorted by county.

The results were mixed, writes Ms. Kleffman. For example, the state’s insurance plans have become better at caring for diabetes patients, a change that could be attributed to previous report cards, which identified diabetes care as a problem area. Now, the state’s plans exceed national standards on most diabetes care measures. On average, they have also improved at controlling high blood pressure and cholesterol, writes Chad Terhune of the Los Angeles Times.

OPA hopes for similar improvement in care for more health conditions identified by the report, for which California failed to meet national standards. Among them are flu shots for adults, care for children with ADD, treatment for substance abuse, and testing for lung disease. According to OPA director Sandra Perez, quoted in Mr. Terhune’s piece, releasing the report card data publicly will urge providers to improve their quality of care and health plans to change their policies.

Customer service was also lacking, the report found. All but one of the health plans that were rated scored one or two stars in this category, which included unexpected costs, accuracy of claims, and resolution of complaints.

Readers, how would you rate your insurance plan? What factors do you consider most important?

Last summer, the U.S. Department of Health and Human Services (HHS) announced its plan to create a standardized, simplified set of health insurance forms that insurers would be required to use. The goal was for all insurance plans to be comparable, side-by-side, so that customers could have a more streamlined shopping experience – devoid of fine print. After reviewing several versions of the forms, which resemble food nutrition labels, HHS released a draft and opened it for comments from the public.

Now, about two weeks later, the Department has finalized the forms’ design, which you can view here. According to Noam M. Levey of the Los Angeles Times, the forms include basic information such as deductibles and co-payments, for both in-network and out-of-network providers. The plans are illustrated through two examples: diabetes management and pregnancy. In addition to the standardized forms, customers will also receive longer booklets with all of the details of a plan.

Information on premiums, which many consumer advocates had hoped the forms would include, is noticeably missing from the finalized versions. Susan Jaffe of Kaiser Health News writes that the advocates hope to reinstate price information in 2014, when insurers will no longer be allowed to change premium costs based on preexisting conditions.

Originally, insurance companies were supposed to start using the new forms in March of this year. But because of delays in coming up with a final design, the deadline was pushed back to this September. That gives insurers about six months to start complying with the rules, which they say will still be quite a rush, given the large number of plans offered by each company; according to an article by Sam Baker of the Hill, insurers had hoped to have about 18 months.

Late last month, the White House issued a new rule that health insurance plans must offer free birth control services for their employees. The policy, which has many religious leaders and conservatives up in arms, applies to all employers, including Catholic hospitals, charities, universities, and other organizations. With the 2012 presidential election just months away, politicians and analysts on both sides of the issue have been weighing in before the rule takes effect next year.

Yesterday, House of Representatives Speaker John Boehner added his opinion to the mix, calling the policy an “attack…on religious freedom” and promising to overturn it, wrote Thomas Ferraro and Matt Spetalnick of Reuters. Rep. Boehner has taken a first step in that direction by asking the chairman of the House Energy and Commerce Committee to draft a bill to reverse the ruling, adds Jennifer Steinhauer of the New York Times. Such a bill would have an easier time passing the Republican-dominated House than the mostly Democrat Senate.

Catholic bishops support a reversal, according to Mr. Ferraro and Mr. Spetalnick. They say the decision interferes with the religious freedom of groups that are against contraceptives and birth control. Some Democrats agree as well. For example, Sen. Bob Casey of Pennsylvania released a statement last Friday saying that while he strongly backs efforts to increase access to contraception, he doesn’t think religious organizations should be forced to contradict their own beliefs.

President Obama responded to Boehner’s comments by reconfirming the ruling. He and others in favor of the decision say that women should have access to birth control no matter where they work, and to deny them that access is an attack on women’s rights and health.

According to an analysis by Rachel Zoll of the Associated Press, published today, a compromise may be on the horizon. The White House doesn’t plan to reverse the ruling, but may revise how strongly it is enforced.

During the past few months, we have covered the story of the Community Living Assistance Services and Supports (CLASS) program, health reform’s program for long-term care insurance. While it was being debated and in the months following its enactment, various groups and analysts expressed doubts about whether the program could pay for itself. (Last year’s health overhaul required CLASS to be solvent for at least 75 years, explains Igor Volsky of Think Progress). Last October, echoing those worries, the Obama administration decided to drop the program.

Now, the formal repeal of CLASS is proceeding through the legislature. In November, the House Energy and Commerce Committee voted in favor of repeal. And yesterday, writes Sam Baker of The Hill, the House Ways and Means Committee voted the same way. The next step is a House floor vote, which will take place next month.

While Congressional Republicans are largely against the program and the health reform law in general, Mr. Baker says, Democrats say that CLASS targeted a serious problem – the fact that most Americans are unprepared for the expenses of long-term care – and that while this particular program was not viable, the government should continue to search for an alternative that is more financially sound.

Although CLASS was dropped, not everyone supported its outright repeal, Mr. Volsky elaborates. Many of those who supported the intent of the program were against its repeal, arguing that it could instead be modified and its financial model strengthened. But those in favor of repeal believe that it needed to be removed formally and legally, rather than simply abandoned, Mr. Baker writes.

Neither home care nor nursing home residency are covered by Medicare. While CLASS is no longer an option for those who may need long-term care, a variety of affordable long-term care insurance plans are available on the individual market. If you’re interested, our reference page on long-term care is a good place to get started.

During the past couple of weeks, much public attention (and TV airtime) has been devoted to the Republican Party debates. Kaiser Health News has compiled videos and transcripts of the candidates discussing health care and health insurance issues, and below, we use those resources to summarize what each candidate had to say. In alphabetical order:

Newt Gingrich

• On health cost control: Former Speaker Gingrich supports the Ryan/Wyden health bill, which expands consumers’ options for Medicare. He would also push for improved surveillance of health criminals, citing data that Medicare and Medicaid lose $100 billion per year to theft.

Jon Huntsman

• On health cost control: Gov. Huntsman agrees with Paul Ryan’s budget, which would cut the budget by about $6.2 trillion over ten years and would affect all programs, including Medicare and defense. He also supports means-testing for entitlement programs, including Social Security and Medicare, among the wealthiest Americans.

Ron Paul

• On contraception: Rep. Paul explains that the Fourth Amendment protects’ privacy, which can be extended to contraception, and the Interstate Commerce Clause protects the right to sell contraceptives across state lines.
• On health insurance: Paul believes that seniors should have the same variety of health coverage that other adults have – including a similar range of comprehensiveness and cost. Later in the same debate, Paul distinguishes between entitlements and rights, stating that the only type of right is the one to liberty.

Mitt Romney

• On contraception: Gov. Romney states that no state wants to ban contraception, and that he can’t imagine any state doing so. As to whether states have the right, he does not know and considers the question irrelevant. However, he does believe that the Supreme Court should overturn Roe v. Wade, the landmark 1970s abortion case.
• On health cost control: Romney supports shrinking the size of government and its spending in order to reduce costs. By cutting health reform, he says, the government would save $95 billion per year and businesses would save as well.

Rick Santorum

• On contraception: Sen. Santorum believes that while privacy is protected under the Constitution, Roe v. Wade is not about privacy and should be overturned.
• On health cost control: Santorum supports means-testing for entitlement programs such as and reducing subsidies for the wealthiest Americans. He also believes that in order to reduce dependency, food stamps, Medicare, and housing programs should no longer be entitlements, and should instead be managed by the states as block grants. Beneficiaries should be required to work and should only receive benefits for a limited time.
• On health insurance: Santorum has supported health savings accounts for many years, in order to make the private sector health care system more “bottom-up” and consumer-based. He cites the Medicare Advantage program and Medicare Part D, which have transformed Medicare, as more examples of the premium support model he believes in.

See video and transcript on contraception (ABC News/Yahoo debate).

See video and transcript on other issues (Meet the Press debate).

Whether or not Supreme Court cases should be televised has been debated many times over the years. And since the Bush vs. Gore presidential election case in 2000, no Supreme Court case has had the level of public interest as the fate of 2010’s Affordable Care Act, for which five and a half hours of oral arguments were recently scheduled for March 26-28 of this year.

Now that the arguments have been scheduled, speculation has sprung up again about whether the case will be shown on TV. Recent surveys show the public leaning towards yes. One poll by USA Today and Gallup, reports Joan Biskupic of USA Today, found that 72% of respondents supported allowing cameras for the health reform arguments, with a majority supporting broadcast of Supreme Court arguments in general. Similarly, writes Joe Palazzolo of the Wall Street Journal’s Law Blog, a poll of the blog’s readers found that 55.6% favored televising the arguments.

So what are the issues at stake? Those who support televising Supreme Court cases, which include some members of Congress and media leaders, say that it would educate the public and encourage interest in what the Court does. Being able to see cases in their entirety, rather than reading someone else’s summary, would allow individuals to interpret the arguments on their own. Proponents also mention that written transcripts and audio recordings of oral arguments are already available soon after they take place – and in some states, video.

Those who don’t want the health reform case broadcast argue that televising one case would put pressure on the Court to televise other cases. They also worry that politics would enter the picture, and that choice sound bites that don’t necessarily show the whole picture would be taken out of context. Having a camera in the room may change the dynamics between Supreme Court justices, who will know their every move is being watched. In addition, some say that televising arguments would go against the constitutional separation of powers.

As of now, C-SPAN and 46 other media organizations have requested that the Supreme Court allow the case to be broadcast. The Court has not yet responded.

Readers, what is your take on this issue? Should the health reform arguments in March be televised? Should all Supreme Court cases be shown on TV?

Online health insurance exchanges run by the states and federal government are a key part of health reform. But how will these exchanges work? Will an online interface make it easier to enroll, manage your account, and find providers?

Here’s your chance to find out. GetInsured.com, along with several other companies, has developed sample modules for Minnesota’s state-based exchange, designed to give you a sense of what the exchange will look like and an opportunity to offer feedback. As the Minnesota Department of Commerce mentions on its module testing website, the exchanges will allow you to:

• For individuals – determine eligibility and enroll
• For small businesses – determine eligibility and enroll
• View the options and costs of various health plans
• View a list of certified brokers and navigators
• Find information on doctors and hospitals
• Aggregate and pay premiums
• Administer your account

We’ve developed sample modules for individual and small business eligibility, broker and navigator lists, and information on providers. Our demo isn’t fully functional, so you can’t use it to actually enroll in coverage, but we hope you’ll get a good taste of what we’re planning.

So, readers, we urge you to try it out. And please let us know what you think, either in the comments below or through the demo’s survey. Our goal was to create an exchange that is comprehensive, easy and quick to use, and maybe even educational and fun. Did we succeed?

More on the online demos, from Elizabeth Stawicki of Minnesota Public Radio:

• 12/5/11: Minnesotans can test drive health care exchanges starting Monday [text]
• 12/5/11: Health exchange demonstrations online for public review [audio and text]