A perfect storm is headed for Anthem...

Tuesday, March 02, 2010

Anthem Blue Cross continues to be in the white hot spotlight over its 39% premium hike.
Just consider the breadth of inquiries closing in on Anthem:

• Angry, outspoken consumers. Anthem has about 800,000 individual policy holders in California, many of them now calling for a public option or a consumer walkout on Anthem.
• The Assembly Health Committee Chair Dave Jones, who has long pushed a bill to regulate rates for health insurers. Watch for AB 2578 to be heard later this month. Assemblyman Jones is also seeking subpoena power to get more information from Anthem Blue Cross.
• Insurance Commissioner Steve Poizner has appointed an independent actuary to evaluate Anthem's premium increases, especially to see if their policies meet minimum loss ratio standards.
• Attorney General Jerry Brown has subpoenaed financial records and other documents from Anthem and California's other top health insurers to investigate whether rates are being raised unfairly.
• Congressional subcommittee members, including Rep. Henry Waxman (D), held a hearing last week to demand that executives from Anthem's parent corporation, WellPoint Inc., justify the rate increases -- effectively making Anthem Exhibit A for the case for health care reform and insurer regulation.
• Consumer Watchdog, which has filed a lawsuit in Ventura, accusing Anthem of closing certain "blocks of health insurance business" to new business without offering comparable options, thereby ensuring that rates rise for those stuck in those policies. Duke Hefland writes in the Los Angeles Times that "plaintiff Randy Freed, 55, of Santa Barbara County, and his wife, Donna, were left with higher premiums and no options to shop around.
• President Obama has repeatedly cited the 39% hikes as cause for substantial health reform, kick-starting the health reform legislation in Congress.
• And tomorrow, on Wednesday, March 3, U.S. Health and Human Services Secretary Kathleen Sebelius is hosting what she is billing as a conversation with top executives of WellPoint, Aetna, CIGNA and the Health Care Service Corporation. The topic: How do the companies justify their double-digit premium increases and what can be done to keep them in check?

The scrutiny is warranted. The question is what will come of it... both in terms of information, and in terms of reform.

Labels: Affordability, BlueCross, YearOfReform

posted by Cynthia Craft | Permalink | 2:48 PM


 

Anthem Blue Cross seizes the political moment

Friday, February 05, 2010

It's not like Captain Renault is going to burst into Anthem Blue Cross' boardroom and announce he's "shocked!...shocked!" to see more consumer-gouging taking place.

We doubt that anyone is surprised to see Anthem Blue Cross seizing the day and aggressively hiking fees in California -- again -- for individual policy holders.

Never mind that containing costs of health coverage has been a major part of the national conversation for a year now. What matters to Anthem's parent corporation, Wellpoint, located in Indiana, is that the conversation is now down to a hushed whisper, thanks to the Party of No in Washington D.C.

And when it comes to reading political tea leaves, "no" means "yes" to Anthem Blue Cross, which for the second year in a row is increasing premiums by 30 to 39 percent. For Century City podiatrist Mark Weiss, 63, that means his and his wife's annual health insurance bill rises from $20, 184 to $27,336. Wow.

Weiss, who has been a member of Blue Cross for 30 years now, thinks "it's just unconscionable." So do a whole lot of other people -- who need to continue speaking up about it.

Read all about it in an article by Duke Hefland in the Los Angeles Times. Also, go to sickofbluecross.com to register your opinions and tell your story about being price-gouged by Anthem Blue Cross.

Labels: Affordability, BlueCross, CostContainment

posted by Cynthia Craft | Permalink | 9:43 AM


 

Affordability is the key...

Monday, January 11, 2010

It's worth repeating, at the beginning and the end of the health reform discussion: Affordability is paramount. As the House and Senate begin their negotiations over a final health reform bill, that needs to be the central question: does the bill provide people the help they need to afford coverage? This is important for people and for policymakers, as policy and as politics.

That's the subject of the letter was signed by more than 750 organizations, organizational leaders, congregations, clergy and local and state elected officials, from 46 states, representing more than 100 million people.

The United States is closer than ever before to making quality affordable health care available to all families.

Yet, health care reform can only succeed if it makes coverage truly affordable for
ordinary families who are finding it more and more difficult to get the care they
need. Requiring people to purchase health insurance that costs too much and
covers too little would frustrate the fundamental goals of health reform and
undermine the public support needed to pass and sustain reform.

The House of Representatives has passed health reform legislation that would
cover 36 million people, 96 percent of all legal residents. The House covers five
million more people than the Senate. We urge you to support the coverage
provisions in the House bill, so that millions of Americans are not left uninsured
after the passage of comprehensive health reform.

On the critical question of making coverage affordable, the House legislation sets
premiums and out-of-pocket costs at levels that are likely to be affordable to lower-income working families. The House does a much better job in protecting lower-income people. The Senate approach provides somewhat better protections for middle-income workers, but would require lower-wage workers to buy insurance that costs many thousands of dollars more than the House legislation. We urge you to take the best elements of both approaches to create legislation that would protect all families from costs they cannot afford.

The letter was sponsored by our partner groups Community Catalyst, PICO, SEIU, Center for Community Change, and many other groups. We were pleased to be work with and be joined by dozens and dozens of key California leaders in this effort.

Labels: Affordability, YearOfReform

posted by Anthony Wright | Permalink | 12:00 PM


 

Medical bankruptcies are rising....

Wednesday, November 25, 2009

Even as reform makes its way through Congress, medical bankruptcies -- a term hardly known 20 years ago -- appear to be on the rise, says the New York Times.

Labels: Affordability, MedicalDebt, YearOfReform

posted by Cynthia Craft | Permalink | 10:40 AM


 

Dear Patient...

Tuesday, November 03, 2009

This story’s a shocker – a sad, tragic shocker. Again, it’s from the Central Valley. Again, the money-maker in our health care system comes across as the bad guy.

The Sacramento Bee’s Sam Stanton reports on a heinous billing mistake that sent the parents of a deceased 23-year-old Sacramento college student into a devastating emotional tailspin. You’ll have to read it to believe it.

Less than two weeks after their son was brutally beaten to death in his dorm room, the bill from UC Davis Medical Center arrived. Addressed “Dear Patient,” it was the sort of “Dear John” letter the hospital sends to indigent patients who go to the emergency room because they don’t have insurance.

Trouble is, the family had insurance – and had just lost their son.

When you read the story you’ll be horrified at the letter’s clinical, uncaring language – not to mention its message.

The dollar-amount of the bill raises questions as well. For a 5-minute (unsuccessful) attempt at resuscitating the young man, UCDavis charged $29,186.50.

Even if this was a mistake, patients get horrendously huge hospital bills every day in California. There were some protections that were put in place in 2006, that are detailed at our newest website, www.HospitalBillHelp.org, that provides some step-by-step assistance to families in this predicament.

But the story makes you wonder about our health system in general. And when you think about what the UCDavis medical system represents – that it’s really part of California’s public universities – questions about accessibility, accountability and morals arise, too.

We need health reforms where families don't face such financial pain, especially at the same time that they are going through such stress and grief that led them to the hospital in the first place.

Labels: Affordability, Hospitals, YearOfReform

posted by Cynthia Craft | Permalink | 9:17 PM


 

Fresno County workers see coverage hikes...

In yet another sign that affordability needs to be front-and-center in health care reform, the Fresno Bee has a story titled “Valley Workers feel pain of costlier coverage.”

Not too many years ago, Fresno County workers received their medical coverage for free as a benefit for working for the county. Now, the Bee says, these county workers will likely dig deeper into their slim pockets for another 9% to 19% to cover the costlier premiums.

Workers across California are expected to see coverage increases this open-enrollment season. It makes you wonder how the state’s economy is ever supposed to recover when people have less and less money in their paychecks to cover the basics.

It’s the proverbial vicious cycle: Businesses are selling fewer goods and services because consumers have less money to spend. Premium hikes from our ever-more-expensive current health care system come along, and consumers have even less to spend. Businesses suffer even greater losses and...well, you get the picture.

Labels: Affordability, Insurers, YearOfReform

posted by Cynthia Craft | Permalink | 7:25 PM


 

Again, affordability is the key!

Friday, September 04, 2009

While there's been a lot of concern in federal health reform about the public health insurance option, I am more concerned with the possible scaling back of affordability subsidies. Partially because of concern for the size of the number, and partially because some don't want to have to raise the needed revenues, there is talk in the Senate and even in the White House about to make the bill cost less, from about $1 trillion over 10 years to about $700 million.

The cost of the bill is for the subsidies and assistance to low- and moderate-income families to afford health coverage. Do they do enough? Former LA Times Sacramento reporter Jordan Rau at Kaiser Health News reports on this issue with some real examples, no doubt informed by his experience reporting on the California attempt at health reform in 2007-8, as that was the core issue here: what is affordable?

However appealing it sounds, scaling the cost of the bill back is to make low- and moderate-income families pay more in premiums and/or out-of-pocket costs, or get less in terms of benefits. For many, it will still be an improvement over the current status quo, where people struggle to makes ends meet, or simply go uninsured and fully exposed to medical debt and bankruptcy. But as Ezra Klein at the Washington Post indicates, if the bill is scaled back too much, the reform collapses.

Affordability was the issue in *the* key issue in the California debate, it is *the* issue now.

I am glad that Kevin Drum at Washington Monthly, and Karen Tumulty at Time's Swampland have picked up on Jordan's article to highlight this issue. It's as fundamental as anything else in this debate.

Labels: Affordability, OtherBlogs, YearOfReform

posted by Anthony Wright | Permalink | 3:32 PM


 

A glimpse into the future

Monday, November 17, 2008

This LA Times story about the call to overhaul 401 (k) plans piqued my interest this weekend. It was nearly 30 years ago that businesses began the migration from defined benefit pensions to defined contribution 401 (k) plans, with the idea that workers should manage their retirement. Now, as a generation prepares to retire, relying largely on 401 (k)s, we're learning a couple things -- 1) that this recent monkey business with the stock market is really a disaster for those close to retirement and that's totally unfair, and 2) that people are consumed with life and can't be stock porfolio managers and properly manage their accounts. Here's a telling statement:

.. even Nobel Prize-winning economists have admitted that they don't closely monitor their 401(k) statements -- allowing an initially well-balanced portfolio to become dangerously overexposed to stocks as those investments grow faster than bonds.

So, the reason I call attention to this: the trend in health insurance has long been heading in the direction of 401 (k)s. Marketers alluringly suggest that people need to "take control'' of their health care management and they know "what's best'' for themselves. And voila, we have "consumer-directed health care.''

It all sounds very frontier-ish and exciting and no-nonsensey and take-the-bull-by-the-hornsy. That is, until you have to start calling the insurance company to see if your mammogram is covered, or prenatal care, or orthotics -- then you realize just how very, very small and very, very insignificant -- and very, very alone you are navigating phone trees and call centers in India. And all you really want to know is if you should really worry about that lump in your breast.

Anyway, now, there is serious clamoring for a re-look at the 401 (k). The cows are already out of the barn on that one. We know what happened. We're starting to see the consequences of underinsurance now... So let's not let the same thing happen to health care.

Labels: Affordability, InTheNews, Underinsurance

posted by Hanh Kim Quach | Permalink | 2:35 PM


 

The triple-whammy to workers...

Monday, October 20, 2008

Last week, Health Access was pleased to co-release a Families USA report, "Premiums Vs. Paychecks: A Growing Burden for California's Workers." It was covered in the Sacramento Bee, Contra Costa Times, and the Stockton Record. The basic findings:

* For family health coverage provided through the workplace in California, annual health insurance premiums in the 2000-2007 period rose from $6,227 to $12,194—an increase of $5,967, or 95.8 percent.
* Between 2000 and 2007, the median earnings of California’s workers increased from $25,740 to $30,702—an increase of $4,962, or 19.3 percent.

As if you didn't know from your personal experience, rising insurance costs are vastly outpacing the take-home pay of workers. And what's worse, workers are paying more, and getting less. These premiums are not just costing more, but they are buying less, in terms of benefits. Workers are being asked to pay more, both in terms of share-of-premium, and in terms of out-of-pocket costs, such as co-payments and deductibles. As much as employers are feeling this increase, they are even passing a bigger percentage of the costs along to the worker.

One of the reporters asked if there was advice, but the big solutions to rising health care costs are not individual actions, but collective policy reforms. And that's the challenge for the next few years, at both the state and federal level.

Labels: Affordability, CostContainment, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 10:40 PM


 

It's ALL bad....

Tuesday, October 07, 2008

I missed this story yesterday, but the Wall Street Journal reported that we've got it all wrong -- McCain's plan wouldn't tax the health care benefits we get from our jobs. Wouldn't think about it! And in fact, Obama is lying about it!

(By the way: McCain didn't seem to contest the idea that he was taxing employer-sponsored coverage when it was brought up by others, such as the Commonwealth Fund in their January 2008 analysis, this story in the New York Times from May 2008, or this description of his plan from his own website from February 2008, (which I handily printed out at the time, made into a pdf and highlighted for relevant comparisons). I noticed on his current website, he actually uses slightly different phraseology so he doesn't mention the 'bias toward employer-sponsored health insurance' that he previously references.)

Here's a quick summary:

McCain's health care plan is based on the idea that individuals should have more "choices" when choosing their health insurance, so he gives everyone a $2,500 tax credit ($5,000 for families). That way, people can "choose'' which plans work best, thus "fostering competition and innovation.'' But analyses have revealed that the tax credits would cost $3.6 billion, after he claimed it wouldn't cost the government anything at all (leading many to surmise that the money came from the tax he would impose on employer-sponsored coverage). Forward to this past week, when Obama has begun hitting hard with ads like this against McCain's health plan, and that makes him really mad. So that's what leads to his policy director saying McCain would not tax the middle class. Instead -- McCain's campaign says it wants to target and reduce Medicare (and the 41 million seniors on it) and Medicaid (with its 60 million enrollees).

Is that supposed to make it better?

So basically, rather than tax middle-class Americans -- we're weakening the system that the parents of working middle class Americans rely on? On top of that, we're weakening the safety net that millions of children, disabled, seniors also rely on.

Brilliant!

Labels: Affordability, MediCal, Medicare

posted by Hanh Kim Quach | Permalink | 10:54 AM


 

Squeezing the Middle Class S'more

Friday, September 05, 2008

Mercer Consulting reports that -- again -- employers are likely going to be shifting more health care costs to their workers. As businesses gear up for open enrollment, when workers have to re-enroll, switch health plans, they're finding that health care costs have continued to escalate at unsustainable levels (thrice the rate of inflation.)

To keep premiums down, 59% of employers are deciding they'd rather make copays, deductibles and co-insurance more expensive. This trend has not been going our way -- over the past five years, the average deductible has increased from $1,000 to $1,500 annually.

There's ample evidence out there, like here, here, here and here, that shows higher cost sharing means that patients get less care, which results in them getting sicker and needing more care later. So why does the industry keep returning to their old tricks?

Labels: Affordability, Insurers

posted by Hanh Kim Quach | Permalink | 10:00 AM


 

Deadbeat Insurers

Tuesday, July 01, 2008

David Lazarus at the LA Times had an excellent column last weekend about health insurers charging men and women different rates. When Blue Shield and other insurers admit they're charging women higher premiums because they are higher "risks'' (Read: more expensive), they're coming clean about the industry's already discriminatory practices against women. Though, in doing so, it further widens the gap between what women and men pay for health care. Women will wind up spending more, not only to *buy* care, but also to *use* care, as has been the case.

Since the steady increase of high-deductible health plans (and in the absence of stronger consumer protections such as community rating and minimum benefit standards) insurers have been permitted to passive aggressively charge women more based on the fact that women are trying to be conscientious about their health.

A Harvard Medical School study last year found women ages 18-64 with consumer-directed health policies wound up spending 218% more on health care than men. "High-deductible plans punish women for having breasts and uteruses and having babies,'' said Dr. Steffie Woolhandler, one of the authors of the study.

We require various gynecological exams. We need birth control pills (as a result of co-activities with men). Sometimes we have babies (as a result of said co-activities) -- though high-deductible plans don't cover maternity anyway. We go to the doctor when we hurt. We generally seek more preventive care than men. Hmmmm. And I thought I was just being responsible.

A world that allows high-deductible plans to proliferate -- as envisioned by John McCain -- is essentially a world that legitimizes deadbeat insurers, who want to thrust more and more costs onto women in the name of keeping prices low. But for whom?

Labels: Affordability, Insurers, InTheNews, Underinsurance

posted by Hanh Kim Quach | Permalink | 12:00 PM


 

Dressing up the Individual (Market)

Monday, June 09, 2008

As we continue to struggle with how to get more people coverage, I'd suggest a look at this Kaiser Family Foundation report from February. The study looks at people who can't get public coverage and aren't offered insurance through their jobs.

Among the findings:

• At 400% of poverty, the outer limit of an income that could qualify for subsidies in California (under last year's health reform discussions), only 25% of family purchased coverage on the individual market.
• At 1000% of poverty, fewer than half (49%) of families purchased coverage.

Self-employed families, who receive tax credits on the premiums took up coverage at ever-so-slightly higher rates:

• At 400% of poverty, about 30% purchased coverage
• At 1000% of poverty, 58% took up coverage

The study, however, did not take into consideration the regulatory atmosphere -- whether individuals *wanted* to buy coverage, but were denied because of pre-existing conditions, or priced out because of their health histories -- all important factors as we go forward.

So the upshot is this: health coverage on the individual market isn't that attractive to lots of people and policymakers are going to have to find a way to make it more so, including subsidies that "may need to extend higher up the income scale than some policymakers may prefer.''

Labels: Affordability, Insurers, Research, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:46 AM


 

The timing could not have been better...

Friday, May 09, 2008

Dr. Prem Reddy, owner of Prime Healthcare Services, is running around terrorizing 6,000 Southern California Kaiser Permanente members -- sending them enormous hospital bills (via an aggressive collection agencies) and telling them to pay up, or ruin their credit. See the story here. One patient featured is being asked to pay $50,739.70 in full by June.

The company, with 9 hospitals Southern California, is demanding payment for emergency services that are currently under dispute with Kaiser. The patients are being told they must come up with the money to pay for their treatment (the portion that Kaiser is disputing and has not agreed to pay).

The tactic being used by the hospital chain is called "balance billing,'' where patients are asked to pay the difference between what the hospital billed, and what the insurance company paid. The Schwarzenegger Administration has been working on regulations to ban this practice, and in a strongly worded notice releasing their proposed rules, accused providers -- such as hospitals and physicians -- who engage in this behavior of using "innocent enrollees'' as "bargaining chips in an unfair provider billing pattern'' that leads to "long-term harm o the enrollee's health, safety and financial stability.''

Coincidentally -- the Administration's Department of Managed Health Care will hold a hearing on this very issue in Irvine on Wednesday, the heart of Orange County where three of Prime's hospitals are located (and presumeably many of the recipients of these giant bills.)

Testimony anyone?

(Relatedly, AB1203 by Mary Salas would ban this practice.)

Labels: Affordability, BalanceBilling, Hospitals

posted by Hanh Kim Quach | Permalink | 12:56 PM


 

Beyond HillaryCare

Friday, March 28, 2008

Sen. Hillary Clinton said in The New York Times today that she wanted to cap health insurance premiums to no more than 5 or 10 percent of income. The statement gives a bit more specificity to her universal health care plan. Obama has also supported the capping of insurance rates, though without putting a number out.

I like that she is talking about tying the cost of health care to income. As we in the advocacy world know -- and too many consumers have experienced -- health care costs are extremely regressive and it's smart to begin introducing the public to that connection.

That said, we also need to begin introducing the concept of capping out-of-pocket costs as well, something that was not included in the story. Cheap plans that cost about $150/month or less are abundant, meaning coverage would cost about 6% a year ($1,800/year) for a person earning $30,000 a year. The problem is that they cost a lot to use.

Office visits aren't covered until the deductibles are met (or limited office visits are available.)
Prescription drugs aren't covered. If they are, brand name drugs aren't. Neither is maternity. Deductibles range from $2,500 to $5000. Out-of-pocket maximums, for one person, could be up to $8,000.

True, not everyone spends up to the out-of-pocket maximum, but in order to get any kind of value out of health coverage, a person would need to meet the deductible. That would mean that person earning $30,000 a year, who meets their deductible on such a plan would be spending 20% of their income on health care. That's a lot.

What's even worse is if you had an unexpected medical emergency, and had to spend up to the out-of-pocket max, that would be about one-third of a $30,000-a-year income. Not fair.

In California, we have spent a lot of time talking and thinking about the affordability of coverage -- both to buy and to use. In AB8, the legislation that the governor vetoed last fall, the affordability limit that we liked was that families that earned less than 300% of the poverty level ($63,600 for a family of four) would have both premiums and out-of-pocket costs capped at 5%.

For ABx1 1, we took a different approach. Families with incomes up to 400% of poverty ($84,800 for a family of four), would spend no more than 5.5 percent on premium. This premium was pegged to a plan that -- while having a $2,500 deductible -- also included “prescription drugs, physician visits, and preventive services, including the services to manage chronic conditions, outside of the deductible. ''

Increasing health care costs are a real thing and is scary. Ignoring out-of-pocket costs as part of that equation would be ignoring the fastest growing part of health care and that needs to be part of the policy discussions.

Labels: Affordability, InTheNews

posted by Hanh Kim Quach | Permalink | 10:19 AM


 

A BIG, unfortunate and expensive illustration for health reform

Monday, December 03, 2007

The Wall Street Journal had this tragic story last week about a Merced man -- who was insured -- but still socked with a $1.2 million hospital bill (not counting thousands in doctor's office bills also).

What happened to Jim Dawson, of Merced, that landed with debt that could bankrupt him is a textbook example of what health consumer advocates have been fighting to reform for years.

Dawson had a good job with Valero Energy Corp., a big oil refinery. He had Valero-sponsored comprehensive health insurance policy, and a regular primary care physician who knew his medical history, *should* not have been vulnerable to medical-financial angst. That's at least what many think. But Dawson's story shows how anyone can be vulnerable.

First thing that went wrong: His primary care physician, and subsequent specialists were not able to diagnose a staph infection until six months after his first doctor's visit -- and by that time, the infection had ended up in his blood stream.

Next: He ran up against a lifetime cap on his health coverage -- a max of $1.5 million (which, incidentally is considered generous. Most policies have a cap of $1 million, but where set in the 1970s when the purchasing power was equal to $6 million today, according to WSJ)

Lastly: Dawson and his wife, in combing through their hospital bills, realized the hospital had inflated various items at tens and hundreds of times their actual cost on the street. For instance, stockings for $791, when they could have purchased them for $12; oxygen for up to $6,675 PER NIGHT, when it could have been rented for $250. All those numbers added up to "Disneyland numbers,'' admitted the hospitals chief medical officer.

The Dawson case highlights a number of issues:

*DISCLOSURE OF QUALITY AND COST:

Dawson visited many providers who were unable to accurately diagnose him at first. Still, Dawson (or his insurance) paid all these providers full price for their conjecture. If providers were asked to account -- or disclose -- for why Dawson's staph infection went undiagnosed for so long, then

1. Dawson's infection would not have spread as far or been as costly and
2. Other consumers could decide whether or not to see that provider.

* LIFETIME CAPS:

The fact that lifetime caps have not been reset since the 1970s, combined with costly medical technologies that are used in health care will mean that more and more Americans will reach their lifetime caps.

* HOSPITAL OVERCHARGING

Even the chief medical examine at Dawson's hospital admitted his bill amounted to "Disneyland numbers.'' Given that Dawson's hospitalization occurred earlier this year, he should qualify for a discounted rate under AB774 (Chan), which was enacted in January. It requires hospitals to offer the Medicare-negotiated rate for patients who are uninsured, or spend more than 10 percent of their annual income on health costs.

Unfortunately, until this is sorted out, the Dawsons are making $30 payments to various hospitals. At that pace, with at least $1.2 million in the red, I estimate it will take them 3,333 years to pay off (not including interest).

Labels: Affordability, Hospitals, InTheNews, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 1:50 PM


 

Strange bedfellows

Saturday, December 01, 2007

Insurance agent Alan Katz responds on his blog to my recent post about the need for an affordability standard in the context of an individual mandate. In my comments, I did mistakenly lump him in with the Governor and some insurers, who have publicly taken a hard-line "no exemptions" position. Unfortunately, they don't have blogs I can link to like Mr. Katz does.

He concurs that there's needs to be a "safety valve" for consumers--as well as in other parts of the reform package. We agree. Now only if we can get the Governor there.

I hope that this article by the AP's Laura Kurtzman on the individual mandate and affordability helps.

Labels: Affordability, IndividualMandate, YearOfReform

posted by Anthony Wright | Permalink | 12:01 AM


 

Not just a word, but a challenge

Wednesday, November 28, 2007

As health reform negotiations go on, I continue to be puzzled why the Governor has yet to publicly budge on having some--*any*--affordability standard for individuals in the context of a mandate. Any other politician, concerned about voter reaction, would not just include affordability in their plan, but lead with it. The presidential Democratic candidates, like Clinton, Obama, and Edwards, both provide assurances to voters than coverage will be affordable, both in terms of costs (tied to a percentage of their income), or in terms of benefits (for example, saying that people should have access to coverage as good as what Congress gets).

Some, like health care blogger Alan Katz, have criticized the notion of an affordability exemption--saying it undermines the point of a mandate. The Governor's team asks, "don't you want universal coverage?" Of course, but I think they misunderstand the point.

Our goal is not an exemption. Our goal is to get people covered. The affordability standard is a challenge, to insurers to keep costs down, and to policymakers to provide the subsidies needed to low- and moderate-income Californians.

If we have the cost containment and appropriate subsidies in place, then any mandate--even with an affordability standard--would be universally applied, and everybody would have affordable coverage. We've reached the goal. However, if the costs continue to rise or subsidies are not there, then let's not have an unlimited legal requirement placed solely on individual consumer's shoulders.

There is a conversation to be had about what is affordable, with regards to premiums, out-of-pocket costs, and benefits, but it amazing to me that we are still talking about whether an affordability standard should even exist in the first place.

Labels: Affordability, YearOfReform

posted by Anthony Wright | Permalink | 10:36 AM


 

Willing, but Unable....

Tuesday, November 27, 2007

An article in this month's Health Affairs (subscription required) breaks down why the U.S. Census Bureau's statistic pointing out that one-third of "higher income'' Americans is uninsured is misleading. The Census statistics are an important source for health coverage data and is also used by the federal government to allocate funds.

In 2006, according to Census statistics, more than one in every three Americans (37.8%) lived in a household with income higher than $50,000.

But, the Health Affairs article points out"...many of the uninsured who live in higher income households do not fit a profile of "financially able but unwilling.''

Moments when income is "high" could be a temporary, as with self-employed or transient workers. So are moments of uninsurance, when a person is between jobs.

Additionally, "households'' does not equal "one family.'' Many of these "households" have many generations living under one roof: adult children at home who are contributing to the family income, but are not allowed to glom onto their parents' policy; parents living with their adult children, who need to purchase separate policies. Adults in "high income'' households could also be in roomate situations, and therefore need separate policies. So if you separate out the individual family units, earnings are far below the $50,000 to $75,000 mark.

That's why the debate about affordability of health care in this year's reform efforts is so essential. Policymakers need to find a way to help this middle-income group, sandwiched between super-poor and super-rich find affordable and meaningful health coverage.

As the report shows, being uninsured is not a symptom of being "young, invincible'' and brazen as many would like to believe, but more because insurance simply costs too much for people who are trying to survive by pooling their resources and huddling under one roof.

Labels: Affordability, InTheNews, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 8:00 AM


 

Poor Credit. Bad Credit.

Tuesday, October 23, 2007

Gov. Schwarzenegger doesn't get much credit for his plan to to give tax credits for health coverage to middle-income Californians. A new analysis by the California Budget Project concludes the plan wouldn't help many people and could create the perverse incentive for businesses to drop coverage -- rather than increasing it.

Here are the highlights:

• 70% of Californians between 250% and 350% FPL (the qualifying income for the tax credits) would be disqualified because they have access to coverage on the job.
• That tax credit only applies to "minimum'' coverage -- a high deductible plan. If families want more coverage, they don't get a tax credit for it, which would encourage the use of plans with $10,000 deductibles for families who make $72,275 (for four people) annually.

To see the report, and other things the Budget Project has written, visit www.cbp.org.

Labels: Affordability, Schwarzenegger, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 1:32 PM


 

Scraping by

Wednesday, October 17, 2007

The California Budget Project today released its annual "Making Ends Meet" report detailing what families would actually need to earn to survive in this state. This is a much more reliable measure of poverty than what is typically used to determine public program eligibility, etc -- the federal poverty level, which was set in the 1960s based on the price of food and not updated since.

What CBP found is that families (with children) need to earn between three to four times the minimum wage in order to pay for basic needs -- rental housing and utilities, food, transportation, health care and other essential costs.

Comparing CBPs numbers to:

• Minimum wage at $7.50 an hour;
• The median hourly wage of $17.42 (in 2006),

we can see that families are barely making it -- earning between $17.39 and $24.22 an hour.

Relative to health care, the California Budget Project found families spending between 15.3 to 22 percent of their earnings on health care. These are families who aren't able to get coverage through work and don't qualify for public coverage.

That's what makes our push for affordable health care even more important.

Labels: Affordability, InTheNews, YearOfReform

posted by Hanh Kim Quach | Permalink | 12:57 PM


 

Governor introduces health reform language....

Tuesday, October 09, 2007

After 10 months, Gov. Arnold Schwarzenegger released the highly anticipated legalese to accompany his 10-page health reform concept paper released in January. This 220-page draft seems to have grown since last week, when a 195-page version was circulating for comments. My colleague Anthony posted comments and analysis about last week's language -- which was not claimed by the governor -- here and here and remains relevant to the latest document.

Here's a quick take on some of the new elements of the plan:

One new wrinkle: All employers -- not just those with more than 10 workers -- would be required to contibute to employee health care. Businesses would be asked to contribute, based on a sliding scale, of between 1 and 4 percent. AB8 (Nunez/Perata), which is the Legislative leaders' proposal, requires a 7.5 percent minimum contribution from employers. Ken Jacobs at the UC Berkeley Labor Center explains in this Sacramento Bee editorial why that 7.5 percent figure is important. (Essentially, businesses in the state already contribute an average of 8 percent and we shouldn't lower the bar and allow businesses to abrogate their current responsibilities.)

Another new thing this week seems to be the addition of revenues from the state lottery. The governor's idea is to lease the operation of the lottery to a private company (though he specified that the concept did not involve privatizing the lottery), which would -- i suppose -- sell more tickets and make more money? This idea, Schwarzenegger said, is meant to supplant talk of a sales tax increase.

Lastly, Bill Ainsworth at the San Diego Union Tribune asked the governor about affordability. Under this plan, Californians earning more than 350% of poverty ($72,275 for a family of four), would be responsible for buying their own coverage without any help at all (either subsidies or tax breaks). Such a family -- in today's insurance market -- could spend nearly $7,000 a year on premiums alone. The premiums alone are nearly 10 percent of the family income. And that's for coverage that isn't that great ($3,000 deductible, $500 prescription drug deduction, and $10,000 out-of-pocket maximum).

The governor conceded that affordability was an issue, "We need to help people especially if it costs more than 5 percent'' of their income. All the figures in the current bill, he said, are up for negotiations.

Stay tuned for more....

Labels: Affordability, Legislation, Sacramento, Schwarzenegger, YearOfReform

posted by Hanh Kim Quach | Permalink | 10:32 PM


 

Humanely affordable

Monday, October 08, 2007

Of the many brain-stumping issues in the health reform debate, the one that seems to provoke the most visceral reaction from all sides seems to be: how to make health care affordable.

The past decade, we've all been the victims of health premiums that increase at three times the pace of our salaries ... and everything else. We've noticed that the health plan just doesn't cover as much as it used to. And deductibles and co-pays are popping up where they weren't before.

It's gotten so bad that more than 3,000 consumers from all over the state have submitted cards and keys with their health care stories, to be delivered to the Governor's offices this week.

But what are people actually spending? A helpful report released last month by the UC Berkeley Labor Center answers that question. Researchers crunched data from the national Medical Expenditure Panel Survey -- shows what people are spending on health care.

The numbers, for some, are bleak.

A family of four, earning the median income in California -- $74,801 -- who is moderately healthy, and has regular health care expenses can expect to spend, at most, 5 percent of their income on health coverage AND out-of-pocket costs if they have to go out on their own and buy health coverage on the open market (meaning they don't get it through work.) If you can get coverage from your job, however, they'll end up spending just 2 percent of their income. Pretty good deal.

On the other hand, if someone gets in a car accident, or breaks an arm, or is diagnosed with cancer or diabetes, the numbers are much more overwhelming. Even with coverage on the job, such a family could find themselves spending more than $6,000 to buy the coverage AND use the coverage. Those who have to go out and buy their insurance on their own would spend nearly $12,500 (16.7 percent of their income).

As this Health Access report from earlier this year shows, the majority of Californians -- 60% -- have assets of less than $12,000 (excluding home equity). So that means they'd have to empty their savings, liquidate their car, their 401ks, furniture, to pay for one year's medical bills. That doesn't innoculate them from getting sick the following year, either, when there is nothing to sell off to pay the hospital bill.

So as we continue debating what to do with AB8, health reform in California and nationally, someone should take a look and listen to what consumers are actually spending and ask themselves, is this right?

Labels: Affordability, YearOfReform

posted by Hanh Kim Quach | Permalink | 12:05 PM


 

If a tree falls in a forest...

Tuesday, September 25, 2007

Another year, another health premium increase.

As workers prepare for the open enrollment period in a few months, they'll notice a bigger chunk missing from their paychecks. In 2008, workers will pay about 10.1 percent MORE (that includes premiums and out-of-pocket costs. Ouch) than they have in previous years. The Wall Street Journal today reports on a trend that we've been watching closely, which is the gradual and heavy shift of health care costs from businesses to consumers.

Health premiums, many are aware, have been increasing at a rate two to three times inflation. But the increase has slowed a bit, due to the fact that "employers have been....passing a significant percentage of costs to employees,'' the article says. This creates even bigger costs later, as employees/workers are getting sicker because they're skipping preventative care and their meds.

"They're essentially trading preventative care now for "rescue care'' later,
which will lead to unhealthy employee populations, a decrease in employee
productivity and ultimately -- higher health-care costs,'' said the expert from Hewitt's Health Management Consulting business.

So even though workers aren't taking up the high-deductible plans, which more blatantly shiftsmore costs onto them, workers are seeing more of a crunch in their pocketbooks through traditional plans -- an average of $3,597 a year, which includes premiums, co-pays, deductibles and co-insurance. That's a lot.

That's why, this year consumer groups adamantly insisted that health costs be "affordable'' for consumers -- meaning the cost of premiums and deductibles and other out-of-pocket costs be no more than 5 percent of a person's annual income -- as was ultimately passed in AB8 (Nunez/Perata), which Gov. Schwarzenegger has threatened to veto.

Labels: Affordability, InTheNews, YearOfReform

posted by Hanh Kim Quach | Permalink | 2:31 PM


 

Creeping Costs....

Tuesday, September 18, 2007

Lots of press last week made a big deal of the fact that health care premiums were inching up 6.1 percent, rather than the usual gazillion percent of years past. Some even gave passing mention to how consumers were paying more out-of-pocket.

But a close look at the KFF-HRET 2007 Employer Health Benefits Survey gives us a good view of exactly how much out-of-pocket costs are creeping upward.

Many, rightly, fixate on deductibles. For instance, in 2000, only 1 percent of workers had deductibles higher than $1,000; now 10% of workers have deductibles at that level.

Deductibles are part of the picture, but not the whole thing.

This year, for instance, the survey started tracking separate "hospital'' deductibles that consumers would have to pay, on TOP of their regular deductibles. More than half of plans are now imposing those fees. Some plans have also started imposing separate prescription drug deductibles, but that's not reflected in this year's survey -- yet.

Another interesting finding -- we're getting nickled and dimed to death by co-pays. Just three short years ago (2004), 68% of patients had copays of less than $15; now 45% have copays at that level. Meanwhile, in the same period, the number of people paying between $20-$25 per visit nearly doubled.

As we head into Round two of health reform in California, let's not forget about these pesky out-of-pocket costs. Assembly Speaker Fabian Nunez and Senate Leader Don Perata wisely added -- at the last minute -- language in their AB8 that would limit consumers' out-of-pocket costs. Let's make sure it stays that way.

(And 'Hi.' I've been neglecting this for a bit, but now I'm back on.)

Labels: Affordability, InTheNews, Nunez, Perata, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 2:33 PM


 

"When is something less than nothing?''

Friday, August 10, 2007

That's what yesterday's USA Today article asks, in response to a recent JAMA study finding that underinsured children are vaccinated at lower rates than uninsured children.

For those buying health insurance through a group (such as work), in California, consumer protections guarantee that even flimsy health plans are required to provide preventive care for children following the American Academy of Pediatrics guidelines, which includes immunizations.

However, if you're buying coverage on your own -- it's not only more expensive, but as this study shows, it also doesn't cover the essentials.

The study confronts the insurance company's lines about creating "innovative'' products. Innovation comes at the consumers' expense. They argue that the reason health care is "expensive'' in California is because people have to pay for health coverage they don't need. But without "mandates'' this is what happens -- children don't get properly immunized, cancers don't get discovered, diabetes doesn't get treated.

And I would argue that in California -- the mandates aren't enough -- given that 464,000 children who have insurance in the individual market are not guaranteed proper preventive care in their most formative years.

Labels: Affordability, InTheNews, Prevention, Underinsurance

posted by Hanh Kim Quach | Permalink | 3:07 PM


 

Testing the Tensile Strength of our finances

Monday, July 09, 2007

It seems that health plans are really trying to test the limits of consumer finances. A report released last month from Health Affairs tells how consumers are getting hosed from both directions .... but the moral of the story is, it's still better to buy coverage through a group, than as an individual.

Here are the key points:

• Between 2003 to 2006, premiums for Small Businesses increased by 53 percent, while those for Individuals increased only 23 percent.

If you were strictly looking at premiums, you'd think the individual market was a good deal. Not so fast.

• The Average Deductibles among all Small Business plans was $348. Meanwhile, for individuals, its $2,136 -- six times higher!
• Small business plans cap out-of-pocket costs at $2,000 a year. Individual plans cap it at $4,000.

It also matters whether you're sick or healthy.

• A patient with Asthma would spend $886 out of pocket if insured through a small business. That person would spend $2,607 if insured on their own.

Policy makers should heed the results of this study as they draft health reform legislation. To wantonly push consumers into an indivdual market where they are not getting much value for their dollar is unfair and may only lead to a need for bigger reforms later. Let's just get it right the first time.

Labels: Affordability, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 12:08 PM


 

Don't take it from us -- here's what others say....

Friday, June 29, 2007

A bunch of interesting public opinion polls have come out recently, so I'll summarize a few of the key points from them here.

PPIC released a poll Thursday showing that 72% of Californians think the state's health care system is in need of major changes. (Take THAT Blue Cross!) Voters, however, are a little less confident that the guv and Legislature will be able to broker a deal (49%).

Another interesting point: 72% of voters support the guv's idea to require residents to have health insurance. From my previous readings, I actually thought voters weren't really hot for such a mandate....but I'm wondering if it's the WAY the question was posed that evoked that response.

The question, verbatim, was: "Would you favor or oppose a plan requiring all Californians to have health insurance, with costs shared by employers, health care providers and individuals?"

Lastly, a SURPRISING number of Californains (73%) said the US should provide health coverage to all children, even if it would require higher taxes. Hopefully Congress and Bush, who are in the process of giving the State Children's Health Insurance Program way too little money hear that.

Poll #2 out of Massachusetts: The Kaiser Family Foundation found that two-thirds of Massachusetts residents polled supported the new law, though support dropped to 57 percent when asked about the individual mandate -- which would penalize those that didn't buy coverage.

The most interesting piece of this poll to me was the part asking about affordability of the plans for people forced to buy coverage on their own without subsidies.

Scenario 1 37-year-old single adult, earning $42,000. The plan:

• Costs $259 a month
• Has a $1,500 deductible; $5,000 maximum out-of-pocket
• Allows 3 doctors visits at $25 a year (the rest would be full-price)
• After the deductible is met, 20% co-insurance
• Generic drugs $15, but brand name drugs would be 50% co-insurance.

62% of respondents said this plan was "unfair;'' 58% said it was an unreasonable amount; 62% said this person would remain vulnerable to high medical bills.

The piece about affordability is key as we in California consider what is reasonable and fair for people to pay. The governor's plan requires a $5,000 deductible and $10,000 maximum out-of-pocket for someone earning $26,000. Looking at what people think in Massachusetts, the super-majority of people would say that's unaffordable.

Labels: Affordability, ExpandingCoverage, IndividualMandate, Schwarzenegger, Underinsurance

posted by Hanh Kim Quach | Permalink | 12:02 PM


 

This is NOT from Publisher's Clearinghouse..

Thursday, June 28, 2007

The lawyer for a deceased client in LA was a little surprised when she opened her client's bill and found a $1 million .... bill.

The hospital bill for $962,120 was 20 times what the lawyer had been told her client owed for her four-day stay at the Glendale Adventist Medical Center falling and suffering minor injuries last year, according to an LA Times story today.

That's right. The bill was 20 times higher than what the hospital quoted as $46,106. And what the hospital quoted was 10 times higher than what the insurance company's rate, which was $4,350.

These numbers, while imposing, are typical -- if you're uninsured. The client HAD insurance, and only had to pay $150.

But uninsured? If you're lucky, you'd get the $46,106 bill. Not? You'd better hope Ed McMahon comes knocking on your door with sweepstakes prizes.

Labels: Affordability, Hospitals, InTheNews

posted by Hanh Kim Quach | Permalink | 5:53 PM


 

Women and Health and the Glass Ceiling

Wednesday, June 27, 2007

We all know gender inequality issues still exist in the workplace. Men still get paid more than women. Fewer women are promoted than men.

Another place where gender discrimination is allowed to tacitly continue is in health care. As recently as 2002, women were charged copays of between $500 and $2,000 to deliver babies. Meanwhile (mostly or only men) who had prostate surgery, back surgery, brain surgery, coronary bypass surgery did not have to pay copays.

(Some might argue that maternity costs more. Not so. Average costs for labor and delivery was $1,980 then. Meanwhile, average costs for surgeries for those other procedures ranged from $4,422 to $29,539 -- okay, now i'm really annoyed).

Why am I upset about this now?

Here's the situation: Gov. Arnold Schwarzenegger and Republican cohorts are constantly calling for "flexibility" that would allow insurance companies to offer consumers more "choice'' and more "affordable'' options.

What they really mean is getting rid of a host of "benefits'' that California wrote into the law years ago to make sure health coverage actually covered health care.

Here are some of the benefits they're talking about. (see a full ist of mandates here) California mandates 23 benefits; six directly relate to women. They include coverage for:

• complications of pregnancy, (for plans that provide maternity benefits);
• breast cancer screening, diagnosis and treatment;
• mammograms;
• cervical cancer screening (if policy includes coverage for treatment/surgery of cervical cancer)
• prenatal in the Expanded Alpha Feto Protein program, if maternity benefits are included
• prescription contraceptive methods (if prescription drugs are part of the benefit package)

Two other mandated benefits are "tweeners,'' while they could apply to both genders, I would say they predominantly apply to women:

• diagnosis, treatment and appropriate management of osteoporosis
• immediate accident and sickness coverage for each newborn infant and adoptive child.

Of course, the biggest cost for women -- maternity coverage -- is not a mandated benefit and was actually vetoed by Schwarzenegger in 2004 on the grounds that it would make coverage too expensive for everyone. As I pointed out earlier in this post, the collective "we'' pays for a lot of health care that is used primarily by men, including the gov's various heart surgeries.

So don't buy the wrap about "choice,'' "flexibility'' and "affordability.'' It's just another way to help keep women in their place.

Click here for the San Francisco Chronicle's excellent Sunday Op-Ed about women and health care.

Labels: Affordability, Prevention, Schwarzenegger, Underinsurance

posted by Hanh Kim Quach | Permalink | 1:00 PM


 

Contest!

Friday, June 01, 2007

In an earlier post, we discussed my appreciation that the Democratic legislative leaders were being intellectually honest that their plan was "near-universal," and not fully “universal,” even though they do dramatically expand group coverage to millions of Californians, and provide more security to millions who have it but are concerned it won’t be there for them when they need it.

Universal is the ultimate goal, but let’s be clear that it is hard to get there. The closest way is through a Medicare-like system, where enrollment is simple and required just once in a lifetime, and which is financed through taxes (based on ability to pay). Medicare comes very close, but still falls just short. At the state level, the only bill that can be called "universal" is Senator Kuehl's SB840.

This has come up on the presidential campaign trail, as some critique presidential candidate Barack Obama’s plan for *not* being universal, and while for some that means not being single-payer, for many others that means not having an individual mandate.

I disagree that an “individual mandate” gets you “universal.” Without a truly automatic enrollment and affordable coverage, the enforcement mechanism would have to be pretty punitive, and the publicly-financed subsidies very generous. And even presidential candidate John Edwards’ plan, which does include an individual mandate, has exemptions for those who aren’t able to afford it. However good it is (and I think there are many good things in it), it is not universal either.

Governor Schwarzenegger’s doesn’t have any exemptions to his individual mandate, and the enforcement remains a troubling discussion. He trumpets his proposal as universal, but it is not. The modeling suggests that about a million undocumented adults, and slices of other populations, will remain uninsured.

Yet from some reporters' point of view, his plan is supposedly more “comprehensive” than the others, yet it really doesn’t help more people. Even though roughly a half-million more people are said to be "insured" under the Governor’s plan than the Nunez or Perata plan, those people would not necessarily be better off. These are folks that are not getting coverage on the job, not eligible for public programs, yet are forced to buy individual coverage.

Without any exemption for affordability, many of these folks will be required to pay for a premium, but will only be able to afford a high-deductible product that requires them to spend thousands of dollars out of pocket before care is covered. Is it better for these people to be required to pay a premium for a product many of them won’t be able to afford to use?

So maybe we shouldn’t call these folks newly insured, because that would imply they got a benefit, as opposed to a burden. Here’s where I need your help. What should we call people who are forced to buy a plan that is more than 5% of their income? Forced to buy a high-deductible plan?

The Unafffordables?
The Burdened?
The Forced Underinsured?
TOUGHs? (Tough Option: Uninsured Greater than High-deductibles?)

Defining this group will allow for better apple-to-apples comparisons between the various plans, between the truly insured, and those who are being made to buy a product that doesn’t make sense for them. E-mail your suggestions to awright@health-access.org. I look forward to your replies.

Labels: Affordability, ExpandingCoverage, IndividualMandate, Schwarzenegger, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 9:59 AM


 

Real stories...

Wednesday, May 30, 2007

I would be remiss if I didn't point out some articles in the papers. Not because Health Access California is mentioned, but because they offer poignant stories from actual California families about our health system today.

* Bill Ainsworth at the San Diego Union-Tribune features real stories of people dealing with high-deductible plans, and how they would be impacted by an individual mandate, for better and worse. A companion story also documents about how people make tough life decisions simply for the security of health coverage.

* Aurelio Rojas of The Sacramento Bee has the story of Senator Gil Cedillo, not as a legislator, but as a son, dealing with his mother's hospitalization. (Calitics and Working Californians picks up on the story)

That's our organizing is so focused on having California health care consumers simply tell their stories. It is what should inform the current debate on how to make the health system better. (Sometimes, those stories help inform our policy development work. Other times, with the explicit permission of the person, we connect real people with the media, as with the Union-Tribune story. As Victoria Colliver in the San Francisco Chronicle reports, we also did this with Michael Moore's new movie, Sicko.)

Story sharing is the primary work of the Its Our Healthcare! coalition, to make sure that our voices, the voices of California consumers, are front and center in the debate. Check out the constantly-updated website!

Labels: Affordability, InTheNews, OtherBlogs, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 1:28 AM


 

The "hidden" reasons for reform...

Tuesday, May 29, 2007

You don't have to be a fan of the New America Foundation to take sides with it over the unabashedly conservative Hoover Institution.

Dan Walters has a questionable column in today's Sacramento Bee that gives way too much credence to a Hoover study trying to downplay the notion of a "hidden tax" in health care.

The "hidden tax" is a phrase Governor uses a lot, to talk about the amount that health premiums are higher because of the uninsured population. The New America Foundation released a study last year often cited by Schwarzenegger. Families USA had a similar conclusion in 2005 with its study documenting "the increased cost of care."

As I have previously said, I don't like the the Governor's rhetoric around a "hidden tax," he tends to blame the victim: the uninsured person who typically is not offered coverage on the job, is not eligible for public programs, and who finds that buying coverage as an individual is either unaffordable or even unavailable, because of "pre-existing conditions." This rhetoric has consequences: if the problem is that people are uninsured, rather than the barriers that lead them to be uninsured, it's no wonder that Schwarzenegger and New America Foundation both see the "individual mandate" as a solution--something we disagree with.

But it is important to acknowledge that our current fragmented health system comes with a cost, to all of us. One of the problems is the lack of fair and equitable financing, with most employers providing coverage to all their workers, but many that don't.

We all pay more when Wal-Mart and McDonald's pay less. It's the same health care system, of doctors and hospitals, and if some manage to not pay their fair share into the system, we all pick up the burden. (Let's remember, the uninsured get it worst, getting charged more than others and facing collections and bankruptcy. But there are costs that are borne in the overall system.)

In some states, they actually have an explicit fee on insurance to help fund the safety-net hospitals and providers that care for the uninsured. So employers and purchasers are able to directly see, on their bill, how much they are paying for a broken health system that leaves people uninsured.

The New America Foundation, in its analysis defending its work, actually pointed out Hoover didn't question the notion of a "hidden tax," just its size. And the New America Foundation makes a credible case that it is bigger than what Hoover estimates.

The thing that rankled me most about the Walters column was the notion that reducing the "hidden tax" was "the most appealing premise" of health care reform. Let's put aside the millions of uninsured who would get coverage, and no longer live sicker, die younger, and be one emergency away from financial ruin. Let's put aside the community, economic, and public health benefits.

It seems to me that there are other reasons why an *insured* person would want a change in our health system:

* SECURITY: Even insured people recognize that they are one job change, one divorce, or other life event, from being uninsured. Reforms could provide more security that they keep the coverage they have now (through an employer or a universal system), are more likely to have coverage at their next job, are more likely to have a safety net if they fall upon hard time, and are more likely to have coverage even if they get sick.

* AFFORDABILITY: Aside from efforts to simply shift the burden of costs onto consumers, most of the ideas to contain costs in the health care system work better when more people are in the system. Whether its information technology, or prevention, or bulk purchasing, or better planning (not to mention fair financing), the cost savings work best in a universal system, rather than our current a fragmented system where it is hard to implement these efforts. For those who are insured, we can best slow the growth in health care costs better if we deal with the uninsured issue as well.

There's no disagreement that there's a cost to the status quo. But let's recognize the other benefits of reform as well.

Labels: Affordability, CostContainment, Employers, IndividualMandate, InTheNews, Research, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 3:56 PM


 

"Unintended consequences" of BlueCross' ad campaign

Thursday, May 24, 2007

In opposing reforms to prevent them from denying Californians coverage, Blue Cross is bringing up the energy crisis, but the analogy might backfire.

Newspapers and even this blog have already chronicled BlueCross' bad behavior in the marketplace, and their overall opposition to any health care reform.

Now they have launched a $2 million-plus ad campaign, under the name "Coalition for Responsible Healthcare Reform." (The LA Times' Political Muscle covers it here.) Blue Cross should be ashamed, spending millions to retain their ability to deny coverage to Californians.

The ads say "Remember how the rash enery deregulation of the energy market in California spawned power outages and soaring rates? Let's not go there again."

But if the energy crisis is the analogy, then Blue Cross is Enron, taking advantage of an unregulated California market and leading to a blackout of coverage for millions. But even the now-disgraced Enron never had the gall to run ads arguing that they should be allowed to continue to manipulate the market.

Because there are so few rules on insurers now, Californians are concerned now they are one job change or life event away from facing a blackout of coverage. We have over 6 million Californians in a coverage blackout. Frankly, we have tolerated deregulation for too long: new and fair rules would increase the security that Californians have now with their coverage, so they are not denied because of their health status.

BlueCross' ad campaign may backfire with the public. They won't believe BlueCross, and they will make it clear to Californians what we can win with health reform.

DOING A FACT CHECK: I think Californians know better than to believe Blue Cross and their misleading statements, especially the absurd notion that buying health coverage as an individual is affordable now. Their ad won't persuade most Californians that individual insurance is affordable now, from a 50-year old woman in the Bay Area, to anybody that takes a handful of prescriptions a year.

Blue Cross' price comparisons matches apples and oranges. It's different products, different people, and different states:
* The list price in many states does not include the significant mark up for age or those who have even minor health issues.
* The states with "guaranteed issue" are Northeast states which started with higher costs of living and higher insurance costs generally.
* Finally, you can't compare a product that actually covers you when you are sick, to one that will not.

We'll have more later in the day.

Labels: Affordability, BlueCross, InTheNews, OtherBlogs, OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 11:01 AM


 

The money's on the table

Tuesday, May 15, 2007

HEALTH ACCESS UPDATE
Tuesday, May 15, 2007

NEW NUMBERS FOR NUNEZ AND PERATA PLANS ON HEALTH REFORM

* Democratic legislative leaders release financial specifics on health care proposals
* Proposals would cover over two-thirds of uninsured; provide more security for workers
* Momentum for reform prospects, affordability for consumers and employers highlighted

New on the Health Access WeBlog: Theresa Mary Johnson, RIP

Over two-thirds of uninsured Californians would have health coverage under newly fleshed out proposals released by both Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata Tuesday.

The new numbers show how each lawmaker’s health expansion plan would be paid for and provide more specifics on how coverage would be provided. Under the notion of "shared responsibility," the proposals would set a minimum contribution for employers at 7.5 percent of wages (for both full- and part-time workers) toward worker health care; would create a statewide purchasing pool as a new option for employers to cover their workers; would expand public programs; would take advantage of federal tax breaks and matching funds; and would place new rules on insurers and reform the insurance market.

This is the first time that the legislative leaders have released the new figures since they both introduced their health coverage proposals in December, which were both aimed at increasing health coverage among California ’s uninsured. The numbers fill in many blanks for AB8(Nunez) and SB48(Perata/Kuehl), and show how their measures would pencil out in the real world.

The Legislative leaders worked with MIT economist John Gruber (who also modeled Gov. Arnold Schwarzenegger’s proposal), funded by the California Health Care Foundation, to run their plans through a computer model, which came up with the numbers that showed the contributions needed in order to make the health plan balance out. Professor Gruber will be presenting his model tomorrow at the State Capitol.

Here's some information about the two plans with some of the new details:

• Coverage expansion to the uninsured: Both cover 3.4 million (69% of uninsured)
• Minimum employer contribution for health expenditures: Both set it at 7.5% of total Social Security wages (capped at $97,500) on health expenditures (for both full time and part-time employees), or pay an equivalent amount into the California Health Trust Fund
• Employers who are exempted:
• SB48(Perata) has no exemptions.
• AB8(Nunez) exempts business operating for fewer than 3 years, with fewer than 2 employees, or with a payroll less than $100,000.
• Number of Californians in statewide purchasing pool:
• AB8(Nunez): Cal-CHIPP – 3.23 million projected to enroll
• SB48(Perata): Connector – 4.1 million projected to enroll (3.6 million adults, 500,000 children.)
• Estimated premium for individuals: For both: Individuals would pay between 0 to 2.8 percent of income for coverage. Families of four (with only one worker): Up to 4.5 percent on income.
• Requirement on individuals:
• AB8(Nunez): Must take up coverage if employer offers coverage, and it’s deemed affordable.
• SB48(Perata): Individual mandate unless income is below 400% of poverty ($40,840 for an individual, $82,600 for a family of four) OR health coverage is more than 5 percent of a person’s income.
• Assistance for low-income families:
• AB8(Nunez): Families and workers below 300% of poverty ($30,630 individual, $61,950 family of four) would receive some relief if they purchased coverage through their employer (through premium assistance), or through Cal-CHIPP.
• SB48(Perata): Families and workers below 300% of poverty would pay a portion of the estimated $224 (per member per month) premium based on a sliding scale.
• Benefits on which estimated are based: Standard coverage, which includes doctors’ visits, hospital coverage, labs and prescription drugs.
  

IMPACT ON WORKERS AND CALIFORNIANS

Under these proposals, most workers would either have their employer provide health coverage, or would get their coverage through a statewide purchasing pool. In the pool, the contribution for workers to pay toward health care would be based on ability to pay. The pool would also use a Section 125 federal tax break to reduce the cost of coverage. Both proposals provide some kind of relief for workers and families who earn less than 300% of poverty.

The following chart shows impacts on both single workers and families.


As the table shows, single workers would spend no more than 2.8 percent of their annual income on coverage; families would spend no more than 4.5 percent on their premiums.

Coverage offered would also be considered comprehensive plans, with "Knox/Keene benefits," which cover doctors, hospital visits, as well as prescription drugs.

Both of these proposals provide a more affordable option for workers than is considered in Gov. Arnold Schwarzenegger’s plan. In Schwarzenegger’s proposal, a worker in the “subsidized” insurance pool person earning between $19,600 to $24,500 (201-250% of poverty) would be asked to spend about 6 percent of their income on premiums alone. That does not include deductibles of $500 and a maximum of $3,000 for the year. In the Schwarzenegger proposal, for families earning more than 250% of poverty, there would be a requirement to buy bare-bones high-deductible plans, with out-of-pocket costs of up to $10,000.

IMPACT ON EMPLOYERS

For many employers, the plans would not have an impact. The plans include a minimum employer contribution of 7.5 percent of wages (for both part- and full-time employees) for health expenses. Assembly Speaker Nunez’ proposal does exempt some smaller businesses. If employers do not wish to spend money on health services themselves, they can contribute an equivalent amount to the statewide purchasing pool, which would use the money to help buy coverage for the workers.

The amount proposed in both plans is far lower than the amount that firms who offer health insurance are already spending for coverage. According to the analyses of both plans, 61.5 percent of businesses already provide health coverage that amounts to an average of 13.8 percent of wages ($79.4 billion total).

However, the Democrat leaders’ proposals require a greater contribution than the 4 percent contribution that was recommended by Gov. Schwarzenegger when he unveiled his plan in January. At that time, the CEO of Safeway, Steve Burd, said the amount was too low. Schwarzenegger also exempted employers with fewer than 10 employees.

OTHER ELEMENTS

Remaining elements that are not addressed here, would remain the same as when introduced initially, such as expansion of Healthy Families to cover all children under 300 percent of poverty, and insurance market reforms to allow people to get coverage regardless of their health status.

WHAT’S NEXT

This is only the first step – of many first steps. Both proposals still must be vetted by each house’s Appropriations committee in the next couple of weeks, which will consider the fiscal implications to the state.

With this financial information, Perata and Nunez’s proposals can be compared alongside two other health reform proposals in the discussion, Gov. Arnold Schwarzenegger’s and Sen Sheila Kuehl’s.

Health Access will continue to provide timely news and analysis as the health reform debate this year continues. For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.

Labels: Affordability, Employers, Legislation, Nunez, Perata, Research, Updates

posted by Hanh Kim Quach | Permalink | 6:50 PM


 

We hate to gloat, but...

Wednesday, May 09, 2007

Health Access' Legislative Advocate, Beth Capell, is beaming.

She's right -- again -- and she's got a Wall Street Journal article, (subscription required) quoting big businesses and insurers such as Marriott International and Aetna, to prove it.

Her unlikely new allies are singing the praises of LOWERING co-pays to cut costs, rather than INCREASING them, as the trend has been the past decade.

"Behind the about-face (on co-pays) is mounting evidence that higher
copayments may not make long-term economic sense. While hey've curbed drug
spending in the short run, studies show they've also discouraged people from
taking essential medicines."

As a result, some employers -- such as Marriott and Proctor & Gamble -- and health plans, mainly Aetna, are reducing or eliminating co-pays for patients with chronic diseases -- such as diabetes, and heart disease.

Since eliminating co-pays on asthma drugs, Pitney Bowes, the giant mail managing company, reports spending 19% less ANNUALLY for EACH asthma patient compared with six years ago.

Mariott reports that the expense of waiving and halving copays is more than paid for by their newfound savings.

"Over the next several years, we think we'll see even better results,'' said
JIll Berger, Marriott's vice president of health and welfare.

Now, Marriott's going *nuts* -- waiving copays all over the place -- on childhood immunizations, mammograms and colonoscopies, the Journal reports.

I'm glad these businesses are "discovering'' the wisdom of this tactic, and frankly, am a little miffed about why others aren't following. It's kind of like getting the oil changed in your car, you do a little regular and preventive maintenance on the front end to avoid something really bad, expensive and hard to explain on the back end.

Hopefully, these new allies can help prosletize on this front, since many of their colleagues have declined to hear it from the experts.

Labels: Affordability, CostContainment, InTheNews

posted by Hanh Kim Quach | Permalink | 10:49 AM


 

The other shoe drops...

Thursday, April 26, 2007

HEALTH ACCESS UPDATE
Thursday, April 26th, 2007


SEN. PERATA'S HEALTH REFORM LEGISLATION CLEARS HEALTH COMMITTEE
* Senate Leader Don Perata’s “pragmatic’’ reform bill clears committee
* Senators urge more work to guarantee affordability
* ROUNDUP: Other bills in Senate Health Commitee

New on the Health Access WeBlog: Additional leg reports; "Near-universal?"; 500th post coming!


A day after his Assembly counterpart passed his health reform legislation in Assembly Health Committee, Senate Leader Don Perata presented his health reform legislation, SB48, for the first time Wednesday in Senate Health. As expected, the bill passed on a party line vote, with Chair of the Senate Health Committee Sheila Kuehl and other Democrats voting to move the measure.

No Republicans voted to move the bill forward, and they did not ask questions, even though the Senate President Pro Tem explicitly stated that "we must have Republicans actively engaged in the discussion. Saying this issue need full debate and should be a "full contact, participant sport," Perata urged lawmakers of both parties to keep working with him on the bill: “While we differ on approach, we all agree something must be done.”

Bluntly saying the bill is "not finished," he also stated that by the time the bill goes to Appropriations in a couple of weeks, the bill will be more fleshed out with specific numbers that can be openly debated, to weigh the trade-offs.

“SHARED RESPONSIBILITY’’ IS THEME AMONG REFORM PROPOSALS

Like Assembly Speaker Fabian Nunez’s AB8, Governor Schwarzenegger’s proposal, and Senator Kuehl's SB840, Perata’s plan relies rhetorically on the notion of “shared responsibility.’’

SB8 would:
• Require every Californian earning more than 400% poverty to have health insurance, or lose personal tax deductions
• Expand coverage to *all* children up to 300% of federal poverty;
• Require employers to spend a percentage of payroll on health care for both full- and part-time workers and their families, or pay an equivalent amount into a state fund that could help fund health care for workers.
• Create a state-run insurance “connector’’ that would negotiate rates and create coverage standards for employers to buy into.
• Require insurers to sell at least one approve plan to any applicant, regardless of health status.
• Combine small group and mid-size group insurance markets.
• Require health plans to spend at least 85 cents for every premium dollar on health care.

Unlike the Nunez and Schwarzenegger proposals, expansions and the “connector’’ purchasing pool would primarily cover workers and their families.

“SB48 is a huge leap to extending coverage to the uninsured, but it does not cover everyone,’’ admitted Perata. “It is shy of universal coverage, but it is a plan that is pragmatic and affordable.”

DISCUSSION ON AFFORDABILITY AND QUALITY

Democratic senators Mark Ridley-Thomas, Darryl Steinberg, Gil Cedillo, and Kuehl, along with advocates weighed in with concerns about whether the plan would actually be “pragmatic’’ for Californians if they could not afford health coverage, yet were forced to buy it.

“This is a very good attempt to cover working people. But our concern is that single people at 400% would have to buy coverage on the market if they are making over $39,000 a year,’’ said Kuehl. She cited that after she is termed out in 2008, she may have this experience herself, perhaps being self-employed or otherwise without employer-based coverage and ineligible for a public program, and just finding it unaffordable to get coverage.

Ridley-Thomas also was concerned that Californians who were not working – for instance, retired or between jobs – would not be able to get insurance through the “connector’’ pool that was negotiated by the state.

Perata said he would continue working on the issue of affordability – and also ensuring that plans met some kind of minimum standards.

STAKEHOLDER TESTIMONY

As with the Nunez bill, groups either gingerly supported or opposed the measure, or even were, as Perata dubbed them, "tweeners."

Supporters, including those seeking amendments, included the 100% Campaign, PICO California, the California Association of Public Hospitals, and AARP, which called health reform a "top priority." The California chapter of the American College of Emergency Physicians said any coverage expansion would help, since the uninsured account for 20% of emergency room visits, and since they don't often get reimbursed, those costs are borne by those with private insurance.

While supporting, the Califormia Medical Association and the association of county health executives urged a Medi-Cal rate increase. Kaiser Permanente was supportive but wanted the "guaranteed issue" requirements to be tied to only the population impacted by the individual mandate--not everybody. Blue Shield argued that the employer fee should not be allowed to be adjusted by regulation.

Some groups that were following the debate did not take position on the Perata bill at the committee hearing. Some groups testified even though not formally stating a support or oppose issue. Health Access California, the California Labor Federation, and SEIU stated their support of several elements but could not support the bill as a whole because of the individual mandate provisions. Health Access appreciated amendments that sought to protect lower-wage Californians and to include consideration for consumers' ability to pay, but such amendments were not applied broadly. The California Labor Federation echoed the concerns about the practical impact of the individual mandate, as well as the message it sends about shifting responsibility away from the collective and onto the individual.

Other groups were opposed, including the California Chamber of Commerce, which said it was concerned about the employer mandate and affordability of coverage for businesses. Other business opponents included the California Manufacturers and Technology Association, the California Restaurant Association. The California Association of Health Underwriters raised concerns from the employer mandate, as well as issues arising from non-compliance. The California Nurses Association also opposed the continued use of insurance companies. A Christian Science organization sought a religious exemption from the individual mandate.

WHY THIS BILL? WHY NOW?

This past week, Capitol watchers have seen a flurry of activity on health reform – nearly six months after Gov. Arnold Schwarzenegger declared 2007 to be the “Year of Health Reform.’’

“The stars and the planets may be aligning in a way to allow us to get something substantial done to improve health access and cost.’’ Perata said. "We have a historic opportunity and a responsibility to get it right."

In addition to Tuesday’s passage of AB8, last week, Sen. Sheila Kuehl’s single payer legislation, SB840, cleared her committee. “You know what I think the perfect bill is,’’ said Kuehl, referring to her SB840. “I don’t think this is the perfect, but it’s got some reality base. I see it happening. I see the job of this committee to try and getting it stronger.’’

"I think of your bill and the Speaker's bill as attempting to move us…(toward) extended coverage for some people in California, and attempting to move it in a way that does no harm,'' she said.

She appreciated Perata's willingness to work on further expanding coverage and making sure that coverage is affordable. Kuehl said that once all is said and done, Californians shouldn't be saying, "Why did they do this to me?'' Kuehl continued, "We may find them saying, 'Why didn't they do more for me?,' which is a different question.''

Perata agreed to work with the committee on these issues and reminded lawmakers to be practical about their approach. “Everyone here has one thing in common – they have health insurance. There is a danger of this becoming an academic exercise,’’ said Perata. But there are people without coverage, he said. “That’s the reason SB48 is here – and I’m still supporting SB840,’’

“Why this year? Why this bill? I know the perfect, the better,’’ said Sen. Perata referring to SB840. “But if we can’t do something for someone now, then shame on us.”

OTHER BILLS

Also in committee on Wednesday:
* SB32 (Steinberg) would expand Healthy Families to children in families up to 300% of poverty. An identical bill, AB1 (Laird) passed Tuesday. PASSED
* SB365 (McClintock) would have allowed out-of-state insurers to sell plans in California without abiding by California’s mandates and regulations. FAILED
* SB893 (Cox) would divert First Five tobacco tax dollars to pay to provide health coverage for low-income children. FAILED

For more information, contact the author of this report, Hanh Kim Quach, policy coordinator, Health Access California, hquach@health-access.org.

Labels: Affordability, ExpandingCoverage, Kuehl, Legislation, Perata, Sacramento, Updates, YearOfReform

posted by Anthony Wright | Permalink | 1:16 AM


 

Patients spotlight affordability

Wednesday, April 18, 2007

Here's a section of the press "pool report" by Keith Darce, San Diego Union Tribune, covering the Governor's visit to the emergency department of Scripps Mercy Hospital in San Diego. You can link to the article he wrote, but this is the background he wrote for use for other reporters:

The emergency department was crowded with doctors, nurses and other hospital workers. About 40 patients were in the department, most of them hidden from sight behind drawn privacy curtains.

Schwarzenegger met with three patients, all of whom have health insurance. The governor was quickly ushered to the bedside of Evelyn Hare, 81, of San Diego, who had arrived an hour and a half earlier after suffering side effects from medication.

"Good to see you," Schwarzenegger said. "How are you feeling?"

"I'm feeling much better," Hare replied.

"I wish I could live to 81. You look really great," the Governor said....

Next, Schwarzenegger visited Ivy Harris, who lives in southeastern San Diego. She was making her second visit to the emergency department since Friday due to complications from a March 20 surgery to remove intestinal blockage.

"The hospital is taking good care of me," Harris told the Governor. She questioned Schwarzenegger about how his health care insurance reform plan might affect unmarried women such as herself, and she noted that her out-of-pocket costs for health care have increased substantially in recent years....

Just a reminder that real people are concerned about rising out-of-pocket costs like co-pays and deductibles, and health care reform needs to address the issue, not just the affordability of the premium.

Labels: Affordability, Schwarzenegger, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 10:28 AM


 

The Connector vs. The Terminator

Tuesday, April 17, 2007

To inform our debate about "individual responsibility" in California, let's be clear that the only state in the nation to even try an individual mandate has last week allowed for broad "affordability" exemptions, for 20% of the uninsured. These folks are likely not offered public subsidies or affordable employer-based coverage, yet were facing the penalty of enforcement.

Under the Massachusetts plan, staying uninsured was the least worst option for these uninsured folks: the other option is to be forced to buy a coverage product that they don't have the money for, and given the deductibles and cost-sharing, may not be of particular use or value to them. Under the exemption, it's not great that they stay uninsured, but at least it meets the "first, do no harm" policy test.

I post this schedule not to endorse these standards, but to show that even proponents of the individual mandate need to recognize its problems. The Governor's proposal does not have any exemptions or considerations in this regard.


From "The Connector" in Massachusetts:

An example of what monthly premiums are deemed affordable, based on income under the recommended schedule, is set forth below. As an example, a single individual earning under $15,315 who is not eligible for Commonwealth Care because he or she is eligible for employer-sponsored insurance would not be penalized for passing up the employer-sponsored insurance offer unless it were free. At the other end of the income scale, a single individual earning between $40,001 and $50,000 would not be penalized for passing up the offer if the monthly premium were more than $300.

Singles ---------------------- Couples -------------------- Families w/Children
$0 - $15,315 ($0) ----------- $0 - $20,535 ($0) ----------$0 - $25,755 ($0)
$15,316 - $20,420 ($35) ---- $20,536 - $27,380 ($70) --- $25,756 – $34,340 ($70)
$20,421 – $25,525 ($70) ---- $27,381 - $34,225 ($140) -- $34,341 - $42,925 ($140)
$25,526 – $30,630 ($105) -- $34,225 - $41,070 ($210) -- $42,926 - $51,510 ($210)
$30,631 - $35k ($150) ------ $41,071 - $50k ($270) ----- $51,511 - $70k ($320)
$35,001 - $40k ($200) ----- $50,001 - $60k ($360) ----- $70,001 - $90k ($500)
$40,001 - $50k ($300) ----- $60,001 - $80k ($500) ----- $90,001 - $110k ($720)

Labels: Affordability, IndividualMandate, OtherStates, Schwarzenegger, Uninsured

posted by Anthony Wright | Permalink | 3:46 PM


 

Fine for insurers, fines for individuals

Wednesday, April 11, 2007

OToday, there's a story in the Los Angeles Times by Jordan Rau that talks about what the Governor's office is thinking with regard to enforcing their "individual mandate," including trying to find people though data matching and using fines and other collections techniques.

Let's be clear: there's lots of problems with the "individual mandate," starting with the premise that there's lots of folks who don't want health coverage, before you ever get to the sticky issues of enforcement. (It's also the subject of renewed crosstalk at Daniel Weintraub's Sacramento Bee health care blog.)

The enforcement issues go from deeply troubling to downright scary when the Governor's plan never acknowledges that there's some people who won't be able to afford coverage. As much as the Governor and his health team have said they are willing to consider ideas and that everything is up for negotiation, there has been no evolution of his health plan yet, despite the feedback received and the lessons learned. And that makes the enforcement discussion that much more disturbing.

For example, we are learning a lot from Massachusetts, at the one-year mark of passage of its reform law, and we should be mindful of lessons of what to do and what not to do. They will vote tomorrow on a range of decisions about "affordability," which should inform our own work here in California.

While taking no position on the stances they have taken, our advocacy colleagues at Health Care for All Massachusetts have some early information at their blog.

Labels: Affordability, IndividualMandate, InTheNews, OtherBlogs, OtherStates

posted by Anthony Wright | Permalink | 10:18 PM


 

Product failure

Thursday, March 22, 2007

When you pay for something, you expect it to work – especially if you’re forking over lots of money.

But as some of us know, procedures we thought were covered – in my case, a blood test -- can end up costing us a lot more than we bargained for.

A new report, “The Illusion of Coverage: How Health Insurance Fails People When They Get Sick” is being released by the Boston-based Access Project today. (Read the report at http://www.accessproject.org/). The report details the stories of real people who have struggled with their insurance companies – and why.

One woman, who was diagnosed with multiple sclerosis, was denied coverage to go to a rehabilitation hospital. Instead, she got a walker. Naturally, she thought the walker was covered. It was not. She later received a bill for the walker as well.

One California man is struggling paying off a $150,000 equity loan that was used to pay for his late wife’s bypass surgery and pacemaker.

Reading through the report, you really get the sense of helplessness that an individual feels battling doctors, hospitals, collection companies and insurance companies all at the same time – while they’re recovering.

What gets me, though, is how many individuals blame themselves when they get into this situation. I had interviewed this California man with the $150,000 debt. At the time, he told me “Maybe we should have read the fine print,’’ and found out ahead of time about the $100,000 lifetime cap on his wife’s insurance. Or, he said, maybe she should have taken better care of herself.

Others have echoed the same things: “I wasn’t taking very good care of my weight,’’

When you buy a car, and your car doesn’t work, you don’t blame yourself for being too hard on the car or driving poorly. You drive straight back to the dealer and demand that it be fixed.

Many stores and companies stand behind their products and will refund your money or exchange the product.

But for some reason, insurance and health aren't the same.

When health coverage doesn’t work, people end up with more hassles, more headaches – and debt. And many blame themselves.

The truth is, as the report details, the policies are written in confusing language, and often change from year to year. Employers and insurers don’t educate consumers about changes, leaving many in the dark about what exactly their policies cover.

Just as government steps in to protect consumers against “lemon’’ vehicles, we need the government to step in and protect consumers against “lemon’’ insurance policies.

Labels: Affordability, Research, Underinsurance

posted by Hanh Kim Quach | Permalink | 4:36 PM


 

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