Archive for November, 2008
Insurers Make Pitch On Health Coverage - Steven Wevodau
WASHINGTON (AP) - The health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions - but in return it wants lawmakers to mandate that everyone buy coverage.
Lawmakers have signaled their intent to craft health care legislation early next year, and the insurance industry’s support would make passage easier. That legislation is expected to closely track the proposals of President-elect Barack Obama. However, Obama separated himself from his Democratic challengers by opposing an individual mandate for adults to buy health insurance.
More lawmakers may agree to a mandate if it means the insurance industry will back those efforts. They’ll remember it was the industry’s opposition 15 years ago that helped scuttle former President Clinton’s health plan.
The board of directors for America’s Health Insurance Plans agreed to the trade-off Nov. 17. The board endorsed the proposal after a series of hearings in various states.
“We hope this will be a contribution to help members of Congress fashion their proposal,” said Karen Ignagni, president and chief executive officer of the trade group. “We’re going to provide all the technical background that we have assembled, all the experience we’ve assembled at the state level, and we’re going to work very hard with members of Congress on both sides of the aisle.”
POSTED BY STEVEN WEVODAU
The Coming Health-Care Tsunami - Steven Wevodau
The current discussion about health care “reform” on Capitol Hill through increased federal spending has an almost surreal quality to it. The unfunded liability of Medicare and Social Security stands at more than $99 trillion. More than $84 trillion of this comes from Medicare - approximately $17 trillion alone from the prescription-drug entitlement enacted by the Republican Congress and signed into law by President Bush in 2004. That comes to approximately $1.3 million per family of four, more than 25 times the average household’s income, notes Richard Fisher, president and CEO of the Federal Reserve Bank of Dallas. None of the policy choices for paying for health-care reform is pleasant. They begin with massive tax increases and cuts in promised Medicare benefits. Whatever those failed to accomplish would come from reductions in spending on everything from national defense and military veterans to environmental protection.
President-elect Barack Obama and the Democrats, who will command sizable majorities in both houses of the 111th Congress, are poised to make the fiscal burden much worse - while jeopardizing the ability of private citizens to choose the best health care solutions for their families. When Mr. Obama says that no American should be denied health insurance because of pre-existing conditions or illness, he is effectively telling them that even if they smoke, abuse drugs or become obese, the government will force private insurers to cover them at the same premium. (This is usually referred to as a “shall issue” or “community rating” policy.) It is a perfect formula for driving many private insurers out of business and replacing them with a government-run monopoly.
On Capitol Hill, prominent Democrats are signaling that they will be no less irresponsible. House Ways and Means Committee Chairman Charles Rangel says Congress should be prepared to circumvent “pay-go” rules limiting deficit spending in passing health care legislation. Senate Finance Committee Chairman Max Baucus wants to expand Medicare to cover people between ages 55 and 64 and to require every American to buy health insurance from something called an Independent Health Coverage Council - a panel of government bureaucrats who will tell people what benefits they must have. The Baucus plan includes provisions that would require “all except the smallest businesses” to either offer health insurance to all of their employees or pay higher taxes. Like Mr. Obama, Mr. Baucus would impose “community rating” or “shall issue” policies. The Montana Democrat would also expand government programs, including Medicaid and the State Children’s Health Insurance Program, which will almost certainly encourage people to substitute government coverage for employer-provided coverage. And Mr. Baucus would also establish a government-run health insurance program to compete with those offered by the private sector.
Meanwhile, this newspaper has reported that from his sickbed, Sen. Edward Kennedy has been orchestrating meetings with lawmakers and lobbyists in an effort to craft his own legislation to expand the federal role in health care. During the presidential campaign, aides to Mr. Obama attended the early closed-door meetings on Capitol Hill. Participants in the talks included Democratic and Republican congressional staffers as well as a wide variety of interest groups with stakes in health coverage, including the U.S. Chamber of Commerce; the AFL-CIO; the National Federation of Independent Business; the National Retail Federation; the American Medical Association and the AARP. One of those who participated in the initial talks is Rep. Mike Enzi of Wyoming, who is the ranking Republican on the Senate health committee chaired by Mr. Kennedy. Aides to Mr. Enzi have told this newspaper that their boss is receptive to a “bipartisan” plan.
But based on all of the information made public thus far, the plan that will be proposed by the Obama administration and its congressional allies would be a disaster for the American people. It would result in massive increases in federal spending, higher federal taxes and taxpayer debt being passed on to our children and grandchildren. It would also reduce consumer choice and drive many private insurers out of the market, leaving all but the wealthiest Americans with little choice but to receive care from the resulting government monopoly.
Notably absent from the current discussions is any mention of market-based solutions like health savings accounts or association health plans - which permit people to join trade associations and other private groups which operate across state lines in order to obtain health insurance. Rather than bargaining with Mr. Kennedy over minor changes to a terrible bill, the Republican minority should be offering the American people a real alternative.
POSTED BY STEVEN WEVODAU
Eastern Life & Health Insurance Company Appoints COO and Director of Sales and Agency Relations
11:41am 11/28/2008
Delayed quote data
EIHI 8.72, -0.26, -2.9%) announced today that it has appointed Curt Melville as Chief Operating Officer and Marc Blevens as Director of Sales and Agency Relations. Eastern Life & Health Insurance Company (ELH) is a wholly- owned subsidiary of EIHI.
Harney voices concern over health cover increase
CHARLIE TAYLOR and PATSY McGARRY
Minister for Health and Children Mary Harney said today that price increases in health insurance premiums would be a “major burden for many families” while Fine Gael warned that the hikes could lead many people to cancel their cover.
VHI and Quinn healthcare announced this morning they are to raise premiums by 23 per cent and 16 per cent respectively from the beginning of 2009.
Quinn healthcare said that its price increases were “mainly due” to the new Government levy and the 20 per cent rise in private bed charges.However, VHI said its price hike was not connected to the introduction of the levy.
Speaking at a commermorative conference in Crumlin Hospital this afternoon Ms Harney said she was “very concerned at the huge price increases (in health insurance premiums) announced today” which she felt would be “a major burden for many families.”
She emphasized however that the VHI had absorbed the recent Government health insurance levy, as it has said it would, and pointed out that if it weren’t for that levy health insurance premiums “would increase four-fold’” for many people.
The Government had yet to receive clearance from the EU, she said.
Fine Gael’s health spokesman Dr James Reilly said that the increased prices were due ‘ill-judged’ measures introduced by the Government.
“Government actions in imposing a health insurance levy and increasing bed charges have distorted the health insurance market to such an extent that it is pricing customers out of the market,” said Dr Reilly.
He said that many young people would be likely to cancel their cover due to rising prices and voiced concern for older people who may lose their medical cards and not be able to afford health insurance.
“If the Government had wanted to completely mess up competition in the health insurance market they couldn’t have done a more thorough job. Instead of meeting the challenge of re-designing risk equalisation the Minister has foisted interim measures on the health insurance system which have made things worse for everyone,” said Dr Reilly.
“The Government has made the health service a vicious circle – they’ve undermined the public health system at every turn, they promoted private medicine but made an unmitigated mess of the private health insurance market and in a financial crisis they have targeted patients to pay for their mistakes,” he added.
© 2008 irishtimes.com
POSTED BY STEVEN WEVODAU
Health Insurers See ”Universal” Opportunity
POSTED BY STEVEN WEVODAU
Health insurance companies such as Humana and UnitedHealth always seem to pay a price for “gifts” from the federal government.
Over the past several years, they have pocketed billions of dollars in government subsidies selling private Medicare plans. They know that Democrats aim to cut those bonus payments, however, so they’re searching for new ways to grow. They see universal health care, which could turn 46 million uninsured Americans into potential customers, as their next big opportunity.
President-elect Barack Obama has regularly listed universal health care among his top priorities. Even so, some experts believe, the new president must address his prime concern — the economic crisis — before he can think about launching an expensive health care program. As a result, they say, private insurers will likely endure the looming Medicare cuts with little opportunity to offset those losses.
“There isn’t going to be a growth driver in the health insurance business for the next few years,” predicts Robert Laszewski, an industry consultant who serves as president of Health Policy and Strategy Associates. “It’s going to be very bad times relative to the very good times” health insurance companies have enjoyed.
Others still see a real chance for meaningful reform. They believe that the economic crisis has been caused in part by skyrocketing health care costs, which have been blamed for half of all personal bankruptcies and the decline of giant corporations such as General Motors and Ford . As a result, they feel that the country’s leaders must address both issues at the same time.
Sheryl Skolnick, senior vice president of CRT Capital Group, belongs to that camp. The veteran health care analyst predicts that Democrats will pounce on the “irresistible opportunity” to pass a comprehensive health insurance bill now that they have the power to do so.
U.S. Companies Reduce Raises, Bonuses, Benefits To Cope Up With Economic Crisis
New York, NY (AHN) - Of 1,000 medium to large U.S. companies surveyed by human resources company Mercer in October, 40 percent will cut the budget allocated for salary increases in 2009. The reduction is part of the cost-cutting measures to be adopted by American firms to cope up with the global economic crisis.
The other measures to be put in place include reducing bonuses, separations packages and other employee benefits. Many workers understand the need for these benefit cuts, but Mercer warned of a backlash and possible dip in employee morale if the reductions would only apply to rank-and-file employees while not on company officials.
Michal Ann Strahilevitz, business professor at Golden Gate University, explained to USA Today, “More and more Americans are noting the huge disparity in income that exists in American businesses today… You want motivated employees, not angry ones. If you want to retain employee loyalty and morale, either start the cuts at the top or don’t cut at all.”
Another survey by Battalia Winston found out that 62 percent of companies will grant the same level or lower bonuses as last year’s, while only 6 percent will hike their bonuses. Human relations consulting company Watson Wyatt, in an October survey of 248 firms, discovered 25 percent of U.S. business plan to stop hiring for the next 12 months and 25 percent will increase employees’ contribution to health care.
An earlier Mercer survey said that American employers kept health benefit cost increases in 2008 for the fourth consecutive year, which meant they passed on the higher cost to workers. The same study said consumer-directed health plans are offered by 20 percent of large employers, up from 14 percent in 2007.
The health care promise Obama is bound to break
By John Merline
Presidential candidates make many promises that, when circumstances change and political realities intrude, get modified or broken. Just ask George H.W. Bush or Bill Clinton. Here’s one campaign promise President-elect Barack Obama is virtually guaranteed to break: He’ll cut health insurance premiums by $2,500 a year.
That promise was a centerpiece of Obama’s health care pitch to voters. But a closer look at his plan shows that he will have a very difficult, if not impossible time, making good on that vow.
The $2,500 figure comes from an estimate by unpaid Harvard University advisers to Obama’s campaign. They calculated that if you inject more information technology (IT) into health care, manage diseases better and cut extraneous paperwork, you could save about $200 billion a year in health spending — or about $2,500 off the average family’s health insurance bill.
Obama’s advisers figure that more IT would save $77 billion, based on a report from the RAND Corp., a prominent research organization. Makes sense. After all, IT saves money in the private sector by improving efficiency. But when the Congressional Budget Office looked at the RAND report, it found serious problems, including that researchers had excluded studies, even those published in peer-reviewed journals, “that failed to find favorable results” from adding more IT in health care.
Meantime, a comprehensive look at ways to cut health care costs by the independent Commonwealth Fund pegged annual savings from IT at just $29 billion — and not until 2017.
Obama’s experts also claim that $46 billion a year could be saved by cutting administrative overhead. Anyone who has come in contact with the health care system knows it’s paperwork heavy. Administrative costs today eat up about 14% of benefits.
Even so, whether Obama’s health plan, which also adds multiple layers of regulation on the insurance industry, will cut that paperwork load is debatable. Increased government intrusion into private markets rarely, if ever, cuts paperwork costs.
The rest of Obama’s savings — $81 billion — come from efforts aimed at improving disease management, care coordination and the like. Such savings are possible, but making them a reality will be difficult.
Even if Obama did save all this money, he’d still be hard-pressed to deliver those premium cuts, because other parts of his plan would almost certainly drive up costs.
Simply expanding insurance coverage, which is the main goal of Obama’s plan, would boost spending. A study published in the journal Health Affairs calculates that covering all the uninsured would increase the amount they spend on health care by $122.6 billion a year because people with insurance buy more health care.
Absent some form of price controls, this sharp increase in demand for medical service would push up costs for everyone.
Obama also proposes to end the insurance industry’s practice of restricting coverage based on pre-existing conditions. But a study by actuarial Milliman Inc. found that when several states implemented “guaranteed issue” — the formal name for Obama’s reform — insurance premiums rose.
None of this is to say that reforms aren’t needed, or that we shouldn’t do what we can to control costs and expand coverage. But Obama’s promise that he can deliver more health care to more people while painlessly cutting costs is just not possible. At least, not in the real world.
John Merline is a former USA TODAY editorial writer
More regulation
Fuzzy math
A.M. Best Completes Review of Health Insurer Public Data Ratings
OLDWICK, N.J.–(BUSINESS WIRE)–November 25, 2008–A.M. Best Co. recently completed its annual review of public data (pd) financial strength ratings (FSRs) for health maintenance organizations (HMOs). A.M. Best has upgraded the FSRs of 21 HMOs, downgraded 19 HMO FSRs, affirmed 107 HMO FSRs and assigned seven HMO FSRs.
The companies’ Best’s public data (pd) ratings reflect a quantitative analysis of each company’s results based on publicly available financial information. This quantitative analysis includes a review of important tests in three categories: balance sheet strength, operating performance and business profile. Best’s pd ratings do not include analysis based on interaction with insurance company management or non-public financial information.
Over the past year, pd rated HMOs had approximately the same number of downgrades as upgrades. The majority of the companies are single state HMOs, which include Medicaid and Medicare insurers, as well as Delta Dental Plans and Blue Cross Blue Shield Plans. Although the overall health insurance market continues to exhibit continued profitability and improved risk-adjusted capitalization, a number of pd rated HMOs were downgraded.
The pd rated HMO downgrades were due to weak risk-adjusted capitalization, unfavorable operating performance, higher than average asset allocation to equities, negative operating cash flows and product concentration, particularly in Medicare and Medicaid products. In a number of regional markets, local health plans experienced significant competitive pressures from Blue Cross Blue Shield (BCBS) plans and strong regional and national health insurance companies. Unfavorable operating performance was primarily driven by poor results in the commercial line of business. In many cases, the medical loss ratio had spiked 100-basis points or higher to the high 80s or low 90s. Furthermore, due to today’s capital market instability, extra scrutiny was placed on the balance sheet, specifically investment exposures.
While many of the smaller local HMOs generally have conservative investment portfolios comprised mostly of investment grade government securities, there were some that did have some indirect subprime mortgage exposure. In addition, the current market volatility in conjunction with higher than average asset allocation of stocks and non-investment grade bonds resulted in a higher asset risk-based capital charge, which weaken a HMOs’ capital position. However, favorable changes to both Medicare and Medicaid reimbursements have resulted in significant revenue growth for some and concentration risks for a number of local HMOs. This concentration in either Medicare or Medicaid has hindered HMOs’ ability to remain flexible in a market where reimbursements are driven by federal or state governments.
The pd rating upgrades were primarily driven by a combination of considerable capital and surplus growth, return of revenues of approximately 5.0% or higher, continuation of improving operating results and a medical loss ratio in the mid-80s. The combination of lower medical costs and sustained underwriting gains demonstrated pricing discipline and strict underwriting guidelines. This enabled the healthcare organizations to report improvement in their risk-based capitalization.
The pd rating affirmations were a result of favorable performance without operations and risk-adjusted capitalization levels that deviated from outside the norms for current rating levels.
A.M. Best expects that the sustainability of future earnings for any health plans will be challenged by a number of factors. These include the increasing competition from national and regional health insurance companies, continuation of moderating medical trends, investment exposure, constraints on capital raising efforts and reliance on either Medicare or Medicaid for growth.
A.M. Best Co., established in 1899, is the world’s oldest and most authoritative insurance rating and information source. For more information, visit A.M. Best’s Web site at www.ambest.com.
Put Health Care Costs Under The Knife
Nov. 26–Sharon Alt remembers receiving a panicked phone call from her daughter three years ago.
Her then-22-year-old daughter, uninsured and in excruciating pain from an infection, was about to receive treatment in the emergency room. Ms. Alt asked to speak to the doctor.
“My first question was, ‘Does this have to be done in the emergency room or can she go into the doctor’s office later and get treatment?’ ” Ms. Alt said.
That question saved her about $2,500.
“And does she have to have anesthesia? Can we just give her some painkillers instead?” Ms. Alt asked the doctor’s assistant.
That question knocked $1,500 off the bill.
Ms. Alt still relishes trimming a $6,000 medical bill down to less than $2,000. After minor treatment, her daughter left the emergency room and scheduled an appointment with the family physician.
With health care costs steadily rising and family budgets contracting, financial and health care experts recommend that consumers take control over their medical costs like Ms. Alt. Most urge being relentless in asking questions, searching for alternatives and maintaining self-discipline.
Shop for better prescription deals, said Devon Herrick, a health care economist at the National Center for Policy Analysis, a Dallas-based conservative think tank.
“Consider therapeutic alternatives and generics,” Mr. Herrick said. “Compare prices among local pharmacies and reputable online sites.”
Pharmacy strategy
William Linburg, 56, of Dallas had success searching online for Imitrex, a migraine drug, at ProgressiveRX.com. For 10 years, the drug was covered under his employer’s medical plan. But when he left his employer two years ago, he could no longer afford the medication, which cost $28.77 a pill.
With two to three migraines a week lasting eight to 12 hours, Mr. Linburg went online for relief. ProgressiveRX.com found him a generic form of the drug for $3.66 a pill.
“I forwarded them a copy of my doctor’s prescription and within two weeks received my order,” Mr. Linburg said.
Many doctors provide patients with free samples of drugs that pharmaceutical companies are promoting. And increasingly, physicians are distributing coupons for discounts on a particular medication.
Many pharmacies in North Texas, including those at Wal-Mart, Kroger, Target and Walgreen stores, offer generic drugs for $4 a month or $10 for a 90-day supply.
CVS Pharmacy this month began offering a $10 drug plan, which includes a 90-day supply of more than 400 common generic medications and discounts on medical care at its in-store clinics.
Lab work
If lab work is needed, Mr. Herrick suggests shopping around, calling at least two labs to get test prices in advance.
“Check prices for both cash and your insurance plan’s negotiated rate,” Mr. Herrick said. “Paying upfront and filing insurance forms yourself may save significant costs.”
For those with company-provided health insurance, enrolling in a flexible spending account can offer savings, said Debra Squyres, director of human capital consulting at the Dallas office of TriNet, a human resources outsourcing company.
“If you have predictable, fixed expenses for items such as health care or dependent day care, it may be a good idea to explore taking advantage of the tax deferrals offered by FSAs,” Ms. Squyres said.
An FSA allows an employee to put pretax dollars into an account to pay for medical care, but the employee forfeits any unused funds at the end of the year.
If you’re uninsured and receive treatment at a hospital, ask for a written copy of the hospital’s financial assistance guidelines, suggests Gerri Detweiler, credit adviser with Credit.com. Patients can generally download charity care applications online.
The largest hospitals in North Texas are nonprofits, which have mandates to help the uninsured and underinsured. Otherwise, they can lose their nonprofit status.
For example, those who receive care from nonprofit Texas Health Resources Inc., the largest hospital system in North Texas, and have a family income at or below 200 percent of the federal poverty level are eligible for charity care, according to THR’s Web site.
But even patients with income above that may be eligible for charity care.
A THR charity committee reviews applications to determine how much of a medical bill will be forgiven.
Uninsured patients also may negotiate with a for-profit hospital’s billing office to discount their bill down to that charged to a typical insured patient, which is substantially lower. Some hospitals offer a sliding fee scale, which may allow patients to pay according to income and family size.
Stay out of hospitals
Try cutting hospital visits altogether. Doctors say many chronic conditions — such as heart disease, obesity and diabetes — can be prevented or managed through free health fairs and diagnostic facilities to avoid hospitalization.
Retail clinics across North Texas, many in Wal-Marts and CVS drugstores, can cost significantly less than an office visit. Most MinuteClinics popping up across North Texas treat common ailments such as allergies, bladder infections and strep throat for $59 to $69.
Prices for 12 common vaccinations range from $30 for a pneumonia shot to $110 for meningitis. Those with insurance may owe nothing, since many policies cover the full cost.
Avoiding the emergency room saved Ms. Alt money on yet another medical crisis. While her husband was whacking weeds in the back yard, some debris flew into his eye.
Instead of the emergency room, Ms. Alt waited until they could visit their ophthalmologist, which cost less than $200.
She’s not heartless, though.
Said Ms. Alt: “Had his eye been bleeding and falling out, I would have taken him to the emergency room.”
CUTTING COSTS
Everyone should:
– Cut office visits. Try actively managing chronic illnesses, such as asthma, diabetes and obesity.
– Participate in free health fairs or visit walk-in clinics, which cost less than half of a doctor’s office visit.
– Call at least two labs to get test prices in advance. You’ll save significantly by shopping for diagnostic procedures, paying upfront and filling insurance forms out yourself.
– Shop for better prescription deals. Compare prices among local pharmacies and reputable online sites.
If you’re uninsured, you should:
– Ask about cash rates and discounts before receiving care. Negotiate the deposit amount to no more than 10 percent of your monthly income.
– Ask the hospital billing office to discount your bill to the rate charged to a typical insured patient.
– Ask for a written copy of the hospital’s financial assistance guidelines.
SOURCES: Credit.com; National Center for Policy Analysis
Health Buzz: Health Insurers Propose Overhaul and Other Health News
Health Insurers Propose Coverage for All
Representatives of the insurance industry told Congress yesterday that they support an overhaul of the healthcare system that would call for them to accept any customer who applies for coverage, regardless of health status, the Associated Press reports. But insurers also favor a requirement for all Americans to have health insurance. Requiring health insurance for all is needed, according to industry analysts, because mandatory inclusion of both healthy and sick people would allow insurers to distribute risk over a larger group of people. Two health insurance trade organizations—America’s Health Insurance Plans and the Blue Cross and Blue Shield Association—put forth separate proposals that each called for coverage of those with pre-existing medical conditions in conjunction with mandating coverage for all Americans.
In September, U.S. News’s Michelle Andrews reported that health insurance premiums are up again. Earlier, she listed four ways to save on your medical bills.
How to Deal With Digestive Problems
The digestive system has many varied and unpleasant ways of asserting itself when the process isn’t going smoothly—all well worth pondering as the holidays approach. But while everyone suffers the occasional Imodium moment, a surprisingly large number of people wrestle every day with more disabling disorders, from Crohn’s disease to gastroesophageal reflux disease and irritable bowel syndrome, which by itself afflicts as many as 1 in 5 people, Michelle Andrews reports. For many, severe pain and the unpredictable need for a bathroom can mean living as prisoners in their own homes.
Andrews explores whether hypnosis and counseling can help ease the symptoms of IBS and Crohn’s disease. Also, U.S. News lists seven common digestive problems and how to end them. And Adam Voiland reports on the growing use of the gluten-free diet, a therapy for celiac disease, in people who don’t have that digestive condition.
Exploring the Usefulness of Hospital Ratings
Last Friday, U.S. News’s Avery Comarow criticized a report in the public policy journal Health Affairs arguing that consumers’ relatively restrained use of hospital ratings and data (such as America’s Best Hospitals) can be blamed on confusion: The ratings and rankings measure different aspects of care, cannot be compared, and often contradict one another. He wrote that consumers can wade through the information, just as families sift through facts and numbers in America’s Best Colleges and other college guides of more than 1,500 pages and cobble together custom lists online by sorting and clicking. He charged the study authors with condescending to consumers and underestimating their capabilities to do the same with hospital data.
This week, Comarow explored whether hospital ratings are a mess, a message, or both. Check out U.S. News’s America’s Best Hospitals special report, including how we conducted our rankings, a glossary of terms, and an in-depth look at Vanderbilt University Medical Center, which is one top hospital.
—January W. Payne
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