Advantages of Getting Individual Health Insurance

Health insurance covers all the medical expenses generated by illness or diseases. All the conditions covered by the health insurance are stated in the health insurance policy. Health policy is a legal contract. The price of the legal contract is called the premium. Health insurance is a contract that provides money to cover for the policyholder’s medical expenses. Because medical treatment nowadays is increasing each year, it is important that we are equipped with individual health insurance plans.
Individual health insurance plans are the coverage that a person buys independently.

Health insurance is often provided for people as an employment benefit. State and federal government also are responsible in giving out health insurance to individuals who are: over sixty-five years of age, those receiving public assistance and those with certain disabilities like blindness and end-stage renal disease. Usually, employers and government programs are the ones who provide most health insurance coverage to individuals. However, 5% of the American population acquires individual health insurance plans. Individual health insurance plans have many advantages.

1. If you are a policyholder then you don’t have to worry about where to get the money to pay for the hospitalization, doctor’s fees and other medical expenses because the health insurance company will cover all the expenses. The costs of medical care and treatment have been increasing lately that many people are now realizing the importance of having the right health insurance coverage to protect them in the years to come.

2. Those people who have individual health insurance plans have an easier access to proper treatment and care compared to those people who are uninsured. This is also the reason why many Americans who are not qualified for voluntary public insurance want to have individual health insurance plans for their own purpose. Aside from that, their dependents or other members of their family can also benefit from the health insurance. These are just some of the many advantages of having individual health insurance plans.

At present, there are about 47 million individuals in the United States who are uninsured. According to a recent National Survey, most of these people do not have health insurance because of the very high cost of health insurance coverage. But, if you do not have any health insurance coverage, it will cause some problems not only to you but to your families as well because you’re going to have to pay for the medical expenses out of your own pockets.

Uninsured individuals are mostly the ones who do not receive the proper medical care and treatment. Usually, uninsured individuals suffer a lot because their illnesses or diseases are taken for granted and they cannot afford to get the proper medical care and treatment that they deserve.

The secret in finding the right individual health insurance plans is to know how to find what you are looking for. We all know that finding individual health insurance plans isn’t an easy thing to do. There are a lot of health insurance companies nowadays that it’s very confusing what health insurance policies are right for you and for your budget. You should look at exactly what sort of coverage do you need.

Take time to sit down and list out carefully what medical services suit your needs in times of accidents or unexpected illness. And when you have decided what you need then you need to look for individual health insurance plans that you can afford. You can find a lot of health insurance companies online that offers affordable individual health insurance plans for you and your family so that you will have peace of mind knowing that you’re covered when you or any member of your family gets sick or involved in accidents.

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Five Ways to Cut your Health Insurance Costs

Nearly one-third of all health-insurance premiums increased to 30 percent or more. At that rate, the average cost of health insurance per employee will exceed ,000. Seventy-three percent of senior executives believe health-care costs will continue to increase 20 percent or more each year for the next three years. The message here is clear: If you haven’t already gotten serious about cutting your company’s health-insurance costs, now is the time. It can be done. The first thing you should do is learn how the system works–or doesn’t work. Most small employers spend fewer than four hours a year thinking about their company health plans. Learn what your options are. Your insurance agent can help you shop for cheaper plans. But don’t stop there. Compare plan benefits, insurance-company records, and service guarantees.

Consider Blue Cross and Blue Shield plans and HMOs (health-maintenance organizations), even if your agent doesn’t handle them. The Blues in some areas, offer clear advantages to small companies. Experts regard HMOs as the best buys in health care. Find out if your company is eligible for new, low-cost health insurance plans now available in five states. In addition, foundation-funded pilot projects in several parts of the country are demonstrating that it is possible to cut health-coverage costs 30 to 40 percent. In short, health insurance isn’t as simple as it used to be. And the pace of change is accelerating, offering new hope for a truce in the business battle with exploding health-care costs. The next couple of years present as much potential for change as at any time in the past 20 years. You can be part of that change by putting at least some of the following 5 ideas to work for your company.

1) Increase Cost Sharing By Employees

This recommendation is at the top of every consultant’s list. Small companies tend to pay far more of their workers’ total health-care bill than large companies do. Yet research shows that insulating employees from the costs of care encourages unnecessary use of health services. Fifty-two percent of the companies responding to the Nation’s Business health survey said they pay 100 percent of their employees’ health-insurance premiums. But 45 percent said they intended to implement or increase employee contributions to these premiums. An equal number said they plan to increase employee deductibles. Insurance companies first attached 0 deductibles to major-medical plans in the early 1950s. But 40 percent of employers still set deductibles at 0 or less. Raising a 0 deductible to 0 would cut premium costs for single coverage by about 11 percent. A 0 deductible would cut costs by about one-fourth. A ,000 deductible would save about one-third.

2) Allow Employees To Pay For Health Premiums With Tax-Free Dollars

Set up a so-called flexible spending account, which allows your employees to pay their share of health-insurance premiums and un-reimbursed health-care expenses with pretax dollars. A flexible spending account could save employees 20 cents to 35 cents on the dollar, because state and federal income taxes and Social Security taxes are not imposed.

Moreover, the company saves by reducing the employee’s base salary on which it pays Social Security and other taxes. Hire an outside payroll accounting firm to handle the paperwork. You can pay the service fee and still come out with a net savings. The monthly administration fee would run between and per employee.

3) Transfer High-Risk Employees To The State’s High-Risk Pool

Insurance premiums soar whenever someone in a small-group plan becomes very ill–with cancer or heart disease, for example. As an employer, you should explore the possibility of moving employees with serious health problems into a state high-risk pool and then negotiating a lower premium for the healthy members of your group.

4) Switches To An Open-Enrollment Blue Cross And Blue Shield Plan

Blue Cross and Blue Shield plans operate as de facto high-risk pools in a number of states by providing “open enrollment” periods during which any group can buy insurance. Among the 74 Blue Cross and Blue Shield organizations nationwide, 21 offer open enrollment. All the Blues once used community rating to set premium levels. But that began to change in the 1960s when commercial insurers started to lure away firms with low risks by offering them cheaper health insurance.

5) Replace Your Traditional Health Plan With An HMO

Unlike traditional health insurance, HMOs cover all medical needs, including routine preventive care, for a flat monthly fee that typically is less expensive than traditional health insurance. Moreover, two types of HMOs, the staff and the group models, have proven to be more effective at controlling costs than any other form of health-care delivery. Staff models employ physicians directly and put them on salary.

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Vote On Health Insurance Mandate

Voters in Arizona, Colorado and Oklahoma will have the chance Tuesday to repudiate the new health care law’s keystone provision, one that requires almost everyone to have health insurance or face a tax penalty beginning in 2014. Easy To Insure ME has the answers

Ballots in the three states include proposed amendments to the states’ constitutions that would prohibit the enforcement of the individual mandate and other provisions of the law. They echo a measure that Missouri voters approved by more than 70 percent in August. Legislatures in several other states, including Georgia, Idaho, Louisiana and Virginia, have also passed state laws with similar language.

But the ballot initiatives have set off a fierce debate: If they succeed, will they have any effect?

Critics of the referenda say they’re nothing more than a political gesture, misleading voters to believe that amending their state constitutions would allow them to opt out of the health care law. Given that the Supreme Court will likely have the final say on the constitutionality of the law before 2014, the public’s vote wouldn’t impact the national law, they say.

Some policy analysts agree.

“To me it’s more of a polling statement,” said Elizabeth McGlynn, an associate director at the RAND Corp., a nonprofit research organization based in California that has no position on the amendments. “It’s not clear to me in this case that the federal law wouldn’t override state mandate … that will be something the courts decide. … It’s not really clear to me what that does at the state levels.”

Proponents argue that the amendments have a strategic function beyond the scope of individual states.

“As more and more states pass these kinds of amendments … it’s going to embolden legislative action to repeal or defund legislative provisions” of the federal health law, said Robert Alt, deputy director of the Center for Legal and Judicial Studies at the Heritage Foundation, a conservative think tank in Washington.

‘New Avenues Of Litigation’

Having the new amendments in place would give states greater standing in the current litigation brought by 20 states against the federal law, says Christie Herrera, a director at the American Legislative Exchange Council (ALEC), which has provided model legislation used by several states.

If the Supreme Court were to uphold the individual mandate in that case, a state constitutional amendment would “open new avenues of litigation,” she said. States could also file suit to argue that the health law violates their 10th Amendment rights to keep powers not otherwise delegated to the federal government by the U.S. Constitution.

Opponents of the ballot amendments say the measures could complicate health care issues within the states.

Dr. Michael Pramenko, president of the Colorado Medical Society, which opposes the ballot initiative, said the amendment could affect any state efforts to set up a program to expand insurance coverage. “It would tie our hands at the state level,” he said, adding that the amendment would prevent the state from setting up its own version of the individual mandate, independent of the federal government, in the future.

The proposed amendments in Arizona, and Oklahoma are nearly identical, while the Colorado amendment differs in subtle but significant ways. The measures are centered on a few key provisions: that no individual can be forced to participate in a public or private health plan; that a person’s ability to make or receive direct payments for medical services cannot be restricted; and that no one should be forced to pay a penalty for failing to enroll in a health plan.

Colorado Controversy

The Colorado amendment makes clear that it applies only to state efforts to impose such requirements.

The amendments do not deal with some of the other preparations for the health law that are falling to states, such as the health insurance exchanges and the expansion of Medicaid that will begin in 2014.

“They’re operating on two bandwidths,” trying to oppose the federal law while also trying to implement it, said McGlynn. “Most of what states are going to have to do, they don’t get to avoid through these amendments.”

Colorado’s situation is unique because its amendment was brought to the ballot through citizen initiative, and doesn’t follow ALEC model legislation as closely. Its language allows for a much broader interpretation of the measure than other states have allowed for, argued Alec Harris, a policy analyst at the Colorado Center on Law and Policy, which opposes the amendment.

“It’s getting billed as — and people seem to view it as — a referendum on federal health reform,” Harris said. “This has no ability to do anything about federal health reform.”

Instead, Harris says, the language of the bill, which prohibits “the state of Colorado, its departments and agencies” from requiring that a person participate in a health plan, could interfere with the state’s auto-enrollment of Medicaid and Child Health Plan Plus beneficiaries.

“Quite a bit of this stuff doesn’t go away even if the Affordable Care Act is ruled … completely constitutional,” Harris said. “It’s the unintended consequences that we’re worried about.”

The president of the Independence Institute, which drafted the amendment, disagreed. “It doesn’t stop the government from offering all sorts of alternatives and plans,” said Jon Caldara. “… Really it means that the state legislature can’t mandate that people should buy something they don’t want to by without getting voter approval.”

Reduce Your Health Insurance Costs

Health care has been the subject of debate for the United States over the past decade. Although many citizens feel divided on the issue, there are a few things you may want to consider in order to keep health insurance costs at a minimum. People are able to choose between various health insurance plans to fit their specific needs, which can potentially help to lower costs. The down side to this kind of plan is that it may require larger out-of-pocket costs when individuals want to go to an out of network health care provider. Regardless of your situation, there are several ways to reduce health insurance costs.

Sometimes it is possible to negotiate with health care providers. You should make it a point to do this on an annual basis to make sure that you are receiving the best possible coverage at the lowest price point. You should even consider shopping around to other health care companies and getting a bid from them in order to make price comparisons. With today’s technology, it is now possible to compare health insurance quotes online. You want to be careful when you find a plan that is very inexpensive. Sometimes these plans will actually cost you more in the long run. Be sure to read any fine print and to call the insurance company if you have any questions. Easy To Insure ME has the answers

Another good way to reduce health insurance costs is to look at deductibles. Figuring out the right insurance coverage for you can be tricky, so try out a few different scenarios to see how a change in deductibles will affect the monthly price of insurance. Changing the deductibles could potentially bring down the premium. You may want to keep in mind that there are additional benefits you may want to inquire about. These can include dental, vision, or maternity benefits.
Once you have decided on a health insurance plan and you are need of a doctor, you should contact your health care providers to see which doctor’s are within your network. You always have the option of comparing prices for different medical services and can decide to go to the most affordable provider. Sometimes, if a hospital is aware that you are comparing prices, they are typically willing to negotiate a lower price for your medical visit.

The most important aspect of saving money on health insurance is to carefully check all of your medical bills. A lot of mistakes can be made in billing, which will ultimately affect the amount of money you will be paying. Health insurance companies and health care providers can make mistakes when billing so keep an eye out. If you notice a problem with your bill, contact your health insurance company and physician to notify them of the mistake

GOP’s Challenge to Health Care Reform

Imagine for a moment a sudden outbreak of smallpox (weaponized smallpox, if your taste runs to Jack Bauer-style scenarios). Airborne, highly contagious, deadly, it has the capability of spreading across the country and beyond in weeks, if not contained with a program of vaccination–vaccination not for a few, but for everybody, as soon as possible. Easy To Insure ME has the answers

If Congress passed emergency authorization for the program, would you want a judge to block it? What if some citizens preferred not to be vaccinated? What if they promised Scout’s honor not to get smallpox, or if they did, not to give it anyone else?

Would you want the judge to halt the program on the grounds that not getting vaccinated was “inactivity,” and thus beyond Congress’s power over “to regulate commerce with foreign nations, and among the several states, and with the Indian Tribes?” Those who refused vaccination might act as reservoirs of the disease, and thus affect commerce. What if the judge conceded that point, but said Congress still couldn’t reach them because they weren’t voluntarily in the stream of commerce?

What if the judge blocked the program because Congress relied on private medical personnel to administer the vaccine? Congress could have created a program by which thousands of full-time federal employees would give the inoculations–that would be constitutional–but using non-employees made the program unconstitutional. Would that make sense?

While the disease spread, and hundreds or even thousands died, would you thank the judge for his fidelity to the pre-1937 vision of the Commerce Clause? Or would you think that, no matter what was written in the judge’s order, the irretrievable spread of the epidemic really had affected commerce and should have been stopped?

These reflections were spurred by the decision Monday in the case of Virginia v. Sebelius, the lawsuit brought by Ken Cuccinelli, Virginia’s right-wing zealot attorney general, to spare the uninsured of his state the indignity of government-funded health care. Judge Henry Hudson of the United States District Court for the Eastern District of Virginia agreed with Cuccinelli that the so-called “individual mandate” provision of the Act exceeds the Commerce Clause because it seeks to “compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market.”

For those of you scoring at home, currently it’s Affordable Health Care Act 2, right-wing opponents 1. Two federal district courts have upheld the program; Judge Hudson is the first district judge to hold against it. That’s neither here nor there–the final score will almost certainly be a best-of-nine championship series played here in Washington at the Supreme Court. But it does underline that the issues in the case are close. The weight of academic opinion so far supports the Act, but some of the very brightest (and perhaps not coincidentally most conservative) of my colleagues disagree.

Readers would do well to discount the importance of Judge Hudson’s decision, which is about as significant as an early NBA playoff game. And partisans might nurture the Christmas spirit by refraining either from the right-wing spike dance or the progressive chant of “You’re blind, ump!” These are hard issues; federal judges, by and large, don’t ask for these cases to land in their courtrooms. Having read the opinion, I see nothing in it to suggest that Judge Hudson is not doing his duty to construe the statute as he reads it, compare it with the Constitution as he understands it, and announce whether the two go together. His opinion was respectful to both sides and–in stark contrast to the intemperate earlier interim decision of Senior Judge Robert Vinson of a Florida district court–devoid of inflammatory rhetoric, judicial triumphalism, or talk-radio style taunting. No one can seriously argue that the judge did not earn his salary.

I do think, however, that Judge Hudson’s opinion is wrong. Grievously wrong. Threat-to-the-nation-from-rampaging-smallpox wrong.

Here’s why I think so. The argument that “inactivity” is beyond the reach of the Commerce Clause sounds reasonable. That’s because, like most serious fallacies, it’s half true. Last summer, Sen. Tom Coburn asked Supreme Court nominee Elena Kagan whether Congress could require individuals to eat vegetables three times a day.

The cheeky Kagan responded, “Sounds like a dumb law.” And a law that requires eating vegetables (or joining a gym, or subscribing to a newspaper) really is a dumb law. There is no overarching national necessity behind it. It’s hard to imagine Congress claiming with a straight face that vegetable portions were an emergency, or that they needed to be regulated as part of a comprehensive scheme.

That’s the answer to those who will shortly post below that “‘Professor Epps, if that is really what he is, clearly believes Congress can regulate all human activity.” (Good to see you guys again, by the way.) Congress can’t regulate everything; what it can regulate is everything that needs to be reached as part of a comprehensive scheme required by a necessity that affects the nation.

Health care is such a necessity. Before Republicans hit upon the argument that health care isn’t part of commerce, they harped for years on the dangers of regulating “one-sixth of the economy.” After years of debate (more than half a century in fact) and extensive fact-finding, Congress decided that health care could only be provided effectively through a nationwide program.

Ironically, Republican opponents concede that if Congress had passed a mandatory program funded by payroll and income taxes–a kind of Medicare for all ages–their challenge would have no merit. (In case the supple Cuccinelli later decides to reverse field, I personally saw him say this on October 21, 2010, at the Washington Legal Foundation.) Those taxes would of course be no less compulsory than the “mandate.” But Congress’ partial reliance on the private market (which in other contexts Republicans rhapsodically defend) somehow guts the nation’s power to solve its health care problem.

Well, everybody’s got to have an argument, and the right has settled on this one. But conservatives should be careful what they wish for. Every constitutional decision is to be weighed not only (or even primarily) by the specific facts at issue, but by the potential mischief of the precedent that will be set. A decision voiding the health care act would strike at the heart of our nation’s ability to deal with situations like my smallpox hypothetical.

Wait a minute, you say, health care regulation isn’t like a smallpox epidemic. No? Certainly health care is a life-or-death issue for millions of Americans, including many who will be insured under the Act but will fall through the cracks in the current system. Who could seriously claim that the 50.7 million people who currently have no health care do not constitute an emergency?

A judge, to strike down the Act, must conclude that no reasonable Congress could have concluded that the situation needed nationwide, comprehensive regulation. And that no reasonable Congress could have concluded that the “mandate” is a key part of a comprehensive scheme to ensure near-universal coverage. Because if both those things are true, then the “inactivity” of refusing to take prudent care to prepare for an individual’s health care needs is as potentially damaging as the “inactivity” of refusing needed vaccination at a time of epidemic.

What if these “inactive” individuals promise will really never, never, contract a catastrophic sickness or suffer a devastating injury, that neither they nor their children will ever, ever appear in an emergency room as uninsured patients? That rings as hollow as my hypothetical objectors’ promise not to get or spread smallpox. These things aren’t voluntary; taxes, sickness, death–you can’t opt out, no matter how you try. And, I’m sorry to the hard-core libertarians out there, you cannot agree to waive life-saving care for your children. That argument was over long ago.

The “inactivity” argument depends on the idea that the Constitution prohibits the United States from running a modern economy, in which all of us are involved by virtue of our membership in the nation. As in any highly industrialized nation, we’re all in this together. And if we adopt an old-fashioned minimal view of national authority, we will have confirmed that 21st century America has chosen decline over economic leadership.

I make no predictions. Judge Hudson’s logic may very well prevail–especially if the conservative majority of the Supreme Court, a year or two hence, cannot resist the temptation to deliver a knockout blow to a president they despise. But such a decision would sow mischief in at least two ways. First, stripping this country of its first modern health care system would deform the Constitution, set back the cause of effecting legislative self-government, and spread suffering over decades or even generations.

That may not matter so much to those who make the decision. Federal judges, like state attorneys general, are covered by generous health-insurance programs, and may not feel the whole thing is such a big deal. And our current Justices make no secret of their seething contempt for America’s legislature.

But if history teaches us anything, it teaches that emergencies come like thieves in the night, and that when they do, we look to government to step in. A strong nation preserves the tools it may need to avert disaster. Throwing those tools away would be an even greater mischief.

If the United States finds Congress’s powers gutted because of this partisan dispute, we will one day have reason to regret it.

Health Reform Will Survive?

Despite brave and bullying promises from Republicans to repeal the health reform “monstrosity” this past week, they can’t do it. Not in the next two years, and maybe not even in 2012, no matter who wins the presidency. Why? For now, because even if the Senate agreed with the House and passed a repeal bill, President Obama would veto it. By 2012 the growing number of Americans (more than half) who already like provisions of the new law, will want to keep them. Easy To Insure ME has the answers

If not repeal then, what about death by a thousand cuts? Most policy analysts believe that there are several provisions of the law that could well be revised or starved, if not outright repealed. Most of those provisions will mean little to the American public (e.g. the Independent Payment Advisory Board (IPAB), the Center for Innovation in Medicare, the Patient Outcomes Research Institute (PCORI), the 1099 reporting requirements), but at least the first three are key to cost control in the long run. The much debated individual mandate, requiring everyone to have insurance, is making its way through the courts and could well end up in the Supreme Court, where the outcome is unknown. Republicans have vowed to have hearings every week next year, many of which will focus on the health reform law. The goal of those hearings is to stab health reform in its heart over and over again, and advocates for health reform can only hope that Americans are too busy trying to survive to listen to C-SPAN.

There are at least four groups of Americans who will gain a lot from health reform and who should push back on repeal or revision – 1) Those who can’t buy any insurance because they are or have been sick 2) Those who can’t afford insurance even if they are well, 3) Those who are employed but would love to leave their job but are afraid of losing their insurance, and 4) Those whose livelihoods depend on getting paid for providing care (i.e. doctors, nurses, hospitals, pharmaceutical companies, etc.) The latter category is a huge constituency for most of the basic aspects of the health reform law, since the burden of the uninsured on hospitals and doctors is becoming unsustainable. Even the health insurer constituency supports aspects of health reform like the individual mandate, since if everyone is “in”, the healthy can subsidize the sick in a reasonable way.

The most important question to ask now is: What would the Republicans propose IF they could repeal health reform? Unfortunately, their answers are as old as the debate itself. There is absolutely nothing new in the pledges to America of Reps. Cantor and Boehner. They make the same old talking points they have been making for 20 years: 1) Selling insurance across state lines; 2) malpractice reform; and 3) more personal responsibility for health care. These solutions sound innocuous but they will not solve either the crisis of the uninsured or the need to bring costs down. John Goodman has made some good points about the value of selling insurance across state lines, but his argument relies primarily on a public that is willing to pay less to get less, and then not whine when they get sick and want more! Selling insurance across state lines means that insurance companies will base themselves in states that have little regulation and few mandates to cover things like maternity care or even emergency services. Malpractice reform has been shown over and over again to contribute less than 2% to the costs of health care, so while it is a good idea, it is not “the” answer to the most pressing health reform issues. And more personal responsibility usually translates into high deductible plans that requires the member to spend 00 or more out of their pocket before any serious coverage kicks in. These “consumer driven” plans, as they are called, are much the same as the high deductible plans that many Americans currently hold, although occasionally they cover doctor visits with a co-pay. They are based on the theory that buying medical care is like buying a car or a refrigerator, which of course it is not.

What should we watch for in the next year or so? Regular hearings by Congress which will require key Administration officials to spend time preparing for and defending health reform; symbolic gestures like bills that have no chance of passage but will appear like “progress” for those that oppose health reform; provisions that take away the money (or try to) from the implementation of full reform in 2014; and countless provisions of the law attached to other bills like defense that make them hard to vote down. Symbolic politics is just that. It is symbolic not action. It does not solve problems. It makes Washington politicians “look” like they are solving problems. But in the end, Americans and their families who are not lucky enough to be completely healthy with jobs and health insurance, will struggle to get coverage and keep it. Buyer beware, you say? Voters already rejected that idea. But if you voted differently, you need to pay attention to what is about to happen and help your friends and families understand the real purpose of these activities. It will be more important than ever to keep refuting the lies and misrepresentations of health reform.

health care reform failed to cure prices

The health-care law of 2010 is, as Vice President Biden put it, a “big [expletive] deal.” It sets us on the road to universal health insurance. It is a favorite target for Republicans gunning to take over Congress. Lawmakers who supported it could lose their jobs. And it will remain a central focus after the midterms, as Democrats defend it against legal and political challenges through 2014, when it takes full effect. Easy To Insure ME

But the Democrats’ effort to sell the law to the public may be undermined by what even some ardent supporters consider its biggest shortfall. The overhaul left virtually untouched one big element of our health-care dilemma: the price problem. Simply put, Americans pay much more for each bit of care — tests, procedures, hospital stays, drugs, devices — than people in other rich nations.

Health-care providers in the United States have tremendous power to set prices. There is no government “single payer” on the other side of the table, and consolidation by hospitals and doctors has left insurers and employers in weak negotiating positions.

“We spend fewer per capita days in the hospital compared with other advanced countries, we see the doctor less frequently, and we swallow fewer pills,” said Jon Kingsdale, who oversaw the implementation of Massachusetts’s 2006 health-care law. “We just pay a lot more for each of those units than other countries.”

The 2010 law does little to address this. Its many cost-control provisions are geared toward reducing the amount of care we consume, not the price we pay. The law encourages doctors and hospitals to join “accountable care organizations” that have financial incentives to limit unnecessary care; it beefs up “comparative effectiveness research” to weed out inefficient treatments; and it will eventually tax the most expensive insurance plans to restrain consumers’ superfluous use of health care.

Such measures could reduce redundant tests, emergency room visits and hospital readmissions, which would help control the costs of Medicare, where the government sets rates. But they are less likely to lower prices outside Medicare and stem the growth of private insurance rates.

The main reason for this is politics. Remember how drawn-out the health-care battle was? It started in the spring of 2009 and was waged for a full year. The bill’s proponents in the White House and in Congress had some inkling of how tough the fight with the insurance companies would be. Taking on hospitals, doctors, and drug and device manufacturers as well — the people you’d face in a showdown over prices — might have been fatal.

So there was no price fight. The law will go on to face a likely post-midterm Republican onslaught — and dismantling it may be easier if Americans think it does little to restrain costs. It is one of those fine political ironies: The law derided as socialism may have had an easier time winning favor from a skeptical public if it was, well, a little more socialist.

It’s pretty far from socialist as it stands. The administration decided not to seek lower drug rates for Medicare, and it didn’t press for a “public option,” a government-run insurance plan that people under 65 could buy into. While supporters of the public option sold it as a way to compete with insurers, the real target was hospitals and doctors. A public option would have created a nationwide purchaser of health care that could have exerted leverage on providers to cut prices. This would have lowered the law’s costs by reducing the subsidies needed to make insurance affordable.

To avoid the wrath of hospitals and doctors, proponents of the bill rarely emphasized this cost-control argument. Nonetheless, when conservative “Blue Dog” Democrats weakened the public option in committee, they cited opposition from providers. And when the bill’s supporters floated a close alternative to the public option — letting people over 55 buy into Medicare — the reaction from Sen. Olympia Snowe, the moderate Maine Republican, said it all: “I am talking to a lot of my providers . . . and I know they are mighty unhappy.” Snowe exposed where the lobbying strength lay: No senator ever spoke of listening to “my insurers.”

“The public hates the insurance industry and trusts doctors and hospitals,” said Richard Kirsch, head of the liberal coalition Health Care for America Now. “But what killed the public option was the hospitals, not the insurance industry.”

Politicians wanted to avoid a confrontation over providers’ prices. So a different policy argument took hold: The real reason everything cost so much was the overuse of health care, not the actual prices of treatment.
This argument came primarily from Dartmouth College researchers who had amassed data showing wide disparities in Medicare spending among different regions. Hospitals in the lower-spending areas, mostly in the Upper Midwest and the Northwest, seized on the study to argue that the key to controlling costs was to reward providers like them. The case was popularized by Atul Gawande’s widely read New Yorker article in June 2009 focusing on McAllen, Tex., one of the highest spenders in the Dartmouth rankings. If health-care delivery in places such as McAllen could be brought in line with lower-spending places such as the Mayo Clinic’s home town, Rochester, Minn. — through the formation of integrated networks of salaried doctors — costs could be reined in.

The theory caught fire at the White House. It gave President Obama and his then-budget guru Peter Orszag a way to talk about costs without taking on doctors and hospitals; instead, the White House could simply differentiate between providers that offer “value” and those that don’t.

But the Dartmouth rankings, and the concept they supported, did a “disservice” to the debate, said Robert Berenson of the Urban Institute. For one thing, he and others say, the figures overstate regional differences in Medicare spending, which shrink when socioeconomic factors are taken into account. Second, rates of Medicare spending are not necessarily representative of health-care spending for people under 65. Some of the places that do well in the Dartmouth rankings charge high prices for non-Medicare patients — and were, not surprisingly, among those pushing hardest against a public option.

More broadly, the skeptics argue that merely providing care in smaller quantities will not sufficiently lower costs. They note that Americans already have shorter hospital stays and fewer doctors’ visits than people in other advanced countries. What sets us apart is our high prices for these health-care “units” — a finding trumpeted in a landmark 2003 paper by Princeton’s Uwe Reinhardt and others titled “It’s the Prices, Stupid.” The price problem is only getting worse, researchers and antitrust investigators have found, because of consolidation among providers, and it could be exacerbated by goading them to form even bigger networks.

But the notion that we pay more, despite using health care less, never caught on during the long march to reform. The main culprits driving our health-care costs were deemed to be inefficient doctors in a few corners of the country and demanding consumers — say, people seeking unnecessary surgery or patients with unhealthy habits and chronic conditions.

The camp that believes volume is the main problem disputes the idea that bigger networks of hospitals and doctors would make the price problem worse. “The more we’re able to encourage integrated systems of care, the better,” the new Medicare director, Donald Berwick, a Dartmouth data champion, told me before his nomination by Obama.

Berwick and his allies say they never meant for overuse of care to become the sole focus. Elliott Fisher, the lead Dartmouth researcher, said he did not intend for his data to be “interpreted as letting off the hook” those providers that kept overuse in check but charged high prices. “We clearly need to do both” prices and volume, he said.

But we didn’t do both in the health-care law, which raises the question of what will happen once the overhaul proves inadequate to the price problem. Perhaps the public option will be reconsidered, as many liberals hope. Perhaps there will be a new push for lower drug prices. Or maybe there will be a return to the rate-setting that prevailed decades ago, when hospitals, insurers and state officials worked together to agree on prices. Maryland is the only state that still does this, and data suggests that it has kept its cost growth lower than average. Massachusetts is considering a similar approach.

Would such measures have a chance? Perhaps. For one thing, as skeptical as insurers are of government intervention, they are glad to discuss reform that aggressively goes after providers. “We have a major cost problem, and we have to get on with the job of attacking it — with every stakeholder who is responsible for that,” said Karen Ignagni, the insurance industry’s chief lobbyist.

And the public? The Brookings Institution’s Henry Aaron predicts that there may be support for tougher action on high prices once the principle of universal health coverage is established, since taxpayers will be on the hook for more of the cost of insurance. “If we attacked costs right at the front end, [the legislation] would have died,” he said. “Now, we’ll have a mechanism that will force us to address it. There are only so many fronts you can fight a war on at the same time.”

That’s assuming, of course, that the law survives long enough to enjoy any embellishment.

Premium tax would hike health-insurance costs

Why? Because Congress wants to levy a .7 billion premium tax on all private health plans each year for the next decade to pay for reform.

That’s a billion tax.

Health plans will have no choice but to pass these costs on to the consumer. This tax will make it tougher for families to afford coverage, increase the difficulty for small-business owners trying hard to insure workers, and stifle job creation.

In Florida, small businesses are the bedrock of our economy. This tax will hit our economy especially hard. It’s just not what families and small businesses need as they dig their way out of a severe recession.

The Congressional Budget Office evaluated this tax and found it will lead to “higher premiums for private coverage.” The nonpartisan CBO estimated that premiums for individual coverage could rise by as much as 13 percent.

This tax also might be disruptive to policyholders, because it could damage the ability of health plans to deliver all the benefits that members expect.

That’s because Congress is ready to impose this health-insurance tax in 2010. That’s after families have already signed up for coverage for next year, and after small businesses have already negotiated coverage contracts.

The result? Health plans may not receive enough premium to cover the costs of the massive tax, and benefits might suffer.

Unfortunately, health plans have been demonized in the pursuit of reform. But in reality, it’s not true to claim that health plans make a lot of money; their profit margins are actually pretty small.

In 2008, private health plans made .61 billion in total profits nationally, according to Forbes magazine. The industry’s profit margin was just 2.2 percent, ranking health plans 35th out of 53 industries in terms of profitability.

As the president and CEO of SantaFe HealthCare — the parent company of AvMed Health Plans — I am truly concerned by this proposed tax. As one of Florida’s oldest and largest nonprofit health plans, AvMed reinvests its earnings each year to continually improve on the benefits and services it offers to members in Orlando and elsewhere.

Obviously, a health-insurance tax that wipes out most of our annual earnings is counterproductive to our mission. Surely, congressional leaders must grasp that this tax doesn’t make sense.

There are better ways to pay for the systemic health-care reform that AvMed and other health plans support.

Instead of taxing health insurance, Congress should focus on the underlying costs of medical care. We can achieve huge cost savings by ending unnecessary treatments and services, rooting out rampant fraud and ending frivolous medical lawsuits filed by trial lawyers.

Health reform shouldn’t hurt Florida’s families and small businesses. It shouldn’t hamper the ability of health plans to provide benefits.

Time’s running out.

Please contact your congressional representative and Florida’s two senators today. Ask them to vote against this harmful health-insurance tax. We can achieve true, lasting reform in better ways.

the new health care law

In an interview today with Nebraska radio station KOGA, Nebraska`s Senator Ben Nelson said he worked to make sure the new health care law wasn`t a government takeover of health care, addressed some of its benefits for Nebraskans and concerns that have been raised about the law. Below are excerpts from the interview. Easy To Insure ME has the answers

Asked about those who are calling for a repeal and replacement, Senator Nelson pointed out that many of the provisions already in effect are making the health insurance market fairer for Nebraskans:

“For those who want to repeal it, it`s going to be interesting to see if they want to repeal this: banning insurers from preventing coverage due to pre-existing conditions. That`s in place. Allowing the purchase of insurance across state lines. . .¦Allowing¨ kids ¦to be on parent`s insurance¨ up until the age of 26. There are a lot of parents struggling right now. They paid for and borrowed a lot of money for a college education. They get out, they can`t find a job. They`d be kicked off the parent`s health insurance plan. And if they had a pre-existing condition, they wouldn`t qualify for individual insurance and if they didn`t have a job they wouldn`t qualify for group insurance. So they could be uninsured. That was taken care of. There were just a number of things that are already in place. . .Right now insurers cannot impose annual and lifetime caps on benefits. They can`t drop a person`s coverage just because they get sick. Those things are already in the -

The senator highlighted the fact that 220,000 Nebraskans – roughly the population of Lincoln – don`t have health insurance. By reducing that number, the new law aims to control costs that are currently passed on from those who don`t have health insurance to those who do:

“There are 220,000 Nebraskans who don`t currently have health insurance. . .The number of people who live in Lincoln don`t have health insurance in Nebraska. And we can`t take the approach of `hey, I have mine, now you get yours.` Many of them can`t qualify easily because of pre-existing conditions.

“When people don`t have health care coverage, they still get health care because they go to the emergency rooms and when they go to the emergency rooms they can`t pay. Guess who that cost is passed on to? Those of us that do have insurance and are able then to pay and our rates are higher.

“This ¦law¨ is aimed at changing that to level the playing field. If we didn`t do something, premium costs due to health care costs are going to continue going up at double digit levels. They`re going to go up in the meantime until all the insurance reforms kick in. But that won`t be because of health insurance reform. It will be because health costs continue to skyrocket. This is all aimed at reducing the impact of that and the increasing cost of health care, which is the driving force for our costs of health insurance.“

Asked about concerns people have with the new law, Nelson said that he worked to ensure that it is not a government takeover of health care and noted that it relies on the existing private system. He drew attention to the fact that some fears people raised haven`t come to pass such as “death panels,“ that he read the entire bill before it was passed, his role in shaping the bill and said that he will be watching the implementation of the bill carefully to make sure it follows Congress` intent:

“But I think people were warned about some things that never occurred. For example, where are the death panels? There aren`t any death panels. We also heard that the law would require people who want public health insurance to be implanted with a microchip. That hasn`t happened and it`s not going to happen. And where`s the rationing we were warned about? But perhaps the scariest thing we heard was a government takeover of health care. Have we seen that? No we haven`t. But it`s controversial; I understand. I worked hard against the public option, which was going to replace the private system. I worked hard to make sure we didn`t get that public option, that we have retained the private system. There`s no public option, no national health insurance plan, no single payer system in the law. So those are the kinds of things that could have happened but didn`t happen because I and some others fought very hard against those things happening.“

Health Insurance Reform From Easytoinsureme Health Insurance Quotes

Federal

Owing to multiple blizzards in Washington, Congress started its President’s Day recess a full week early and conducted no official business last week. However, there was some legislative drama as Senate Majority Leader Harry Reid pulled the rug out from under Finance Committee Chairman Max Baucus by scrapping the Baucus jobs bill (without warning), which contained many health insurance items, and replacing it with a stripped down, narrow jobs bill. Whether the health items Baucus originally inserted with Republican help will make it back to the table remains fuzzy. Among the health items that have been dropped are: the COBRA eligibility extension (to May 31); the “doc fix” (to October, 2010) of Medicare reimbursement rates; and the favorable statutory direction to CMS to calculate the 2011 Medicare Advantage rates “as if” the doc fix were in place.

States

California health insurance The Office of Patient Advocacy released a report card on the state’s HMOs last week. Aetna received 3 out of 4 stars. The goal of the report card is to allow consumers to compare how well health plans use personal medical records and help address conditions such as asthma, arthritis and diabetes.

COLORADO: Governor Bill Ritter held a press conference to announce what he calls “the next round of reforms that represent common sense.” His legislative package includes bills to preclude insurance companies from charging different rates due to a person’s gender, ensure that women have access to breast cancer screening, assure plain language is used in insurance forms, standardize insurance applications and explanations of benefits, and encourage greater use of online tools to enroll people in public programs. Apart from the Governor’s proposals, a bill that would establish a public option was also introduced.

CONNECTICUT: In a short legislative session of only three months, the Insurance & Real Estate Committee wasted no time in putting forth an agenda that includes many concept drafts for repeat legislation from previous sessions. These include prohibiting health insurance copayments for preventive care, limiting prescription drug copayments, prohibiting Social Security disability payment offsets, and exempting the Municipal Employees Health Insurance Plans from the premium tax on small group premiums. In addition, the committee reintroduced legislation that includes nearly a dozen new health benefit mandates. The Council for Affordable Health Insurance, an independent think-tank, says that health insurance mandates could increase premiums in Connecticut by more than 50 percent overall.

GEORGIA: A bill was proposed last week that would impose significant restrictions on insurers’ ability to rescind health insurance policies. Aetna, through the Georgia Association of Health Plans and AHIP, met with the legislator sponsoring the bill to express concerns with the bill.

INDIANA: The legislative session is at halftime, and the insurance agenda is now limited. Most insurance issue bills are officially dead, including a bill that would have prohibited health plan provisions requiring a contracted provider to accept more than a certain number of patients; coverage for dialysis treatment regardless of whether the facility is contracted or not and without certain benefit restrictions; and a bill that would have allowed out-of-network assignment of benefits. However, Aetna is expecting that a bill requiring insurer and HMO annual reporting of premium cost composition, including administrative costs, may be resurrected. A bill that restricts dental insurers and HMOs from establishing fee schedules for non-covered services passed the Senate, with our amendment to accommodate most of the key concerns expressed by opponents of the bill. As the bill stands, dental insurance plans may impose fee schedules for covered services, regardless of whether the plan actually pays for the services rendered.

KANSAS: An amended version of S.B. 389 related to dental services passed the Senate Financial Institutions and Insurance Committee on February 11. The amended bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Committee amendments added to the definition of a “health benefit plan” the following: any subscription agreement issued by a non-profit dental service corporation; any policy of health insurance purchased by an individual; the state children’s health insurance plan; and the state medical assistance program under Medicaid. We will continue to update you as this bill progresses and hope to make favorable changes as the bill moves through the House.

MASSACHUSETTS: Governor Deval Patrick filed a 40-page bill that proposes giving the insurance commissioner the power to hold public hearings on rate adjustments and essentially cap health care price increases. Rate increases for individuals would be held to the rate of medical inflation; those sold to employers with 50 or fewer workers could not exceed one and a half times the level of medical inflation. The legislation would also impose a two-year moratorium on any new health benefit mandates. Legislative leaders praised the intent of the governor’s plan but declined to promise support. Strong opposition is expected from medical provider groups. The Governor simultaneously announced emergency regulations to take immediate effect that will require health insurers to submit proposed small business rate increases for review by the state 30 days before they take effect. Several other proposed provisions include a requirement that insurers offer at least one coverage plan with a limited network of health care providers costing at least 10 percent less than health plans with access to more physicians. The Massachusetts Association of Health plans is lobbying in support of a bill introduced by Senate Insurance Chair Richard Moore that would create a cheaper health insurance product for small employers by capping payments to providers at just 10 percent above Medicare rates. The Massachusetts Medical Society is against that proposal.

MISSOURI: An autism coverage mandate bill was amended and “perfected” by the Senate and then sent to the Government Accountability and Fiscal Oversight Committee from which it must emerge before returning to the floor of the Senate. In addition to two mandate-related amendments, a third amendment to the bill allowing for limited cross border sales of health insurance also passed. In its current form, the bill contains a mandated offering of the coverage in the individual market. Coverage is limited to treatment ordered by a licensed physician or psychologist whose treatment plan the carrier is entitled to review every six months. Coverage for applied behavior analysis (ABA) is limited to ,000 annually (down from the ,000 as introduced) for persons under age 21. Meanwhile in the House, a bill containing significant language relating to the credentialing of autism service providers also passed. The bill also contains a mandate to offer coverage in the individual market and to groups of fewer than 25. Groups of 25 to 50 would be entitled to an exemption from the mandate if they could demonstrate an increase in premiums tied to the mandate. The bill limits annual coverage of ABA (,000 for children ages 3-9; ,000 for children ages 9-21). Aetna will continue to monitor the status of these mandates, but it appears fairly clear at this point that something will pass on the issue of autism.

NEW JERSEY: Last week Governor Chris Christie declared a fiscal state of emergency calling a special session of the legislature to lay out his plan for dealing with state’s current .2 billion budget shortfall. His plan calls for significant cuts or eliminations across 375 state programs and withholding 0 million of state education aid. Of note on the program side is a .6 million reduction in Charity Care funding to hospitals, which pays for care to uninsured residents. In legislative action, the Assembly Financial Institutions and Insurance Committee held a three-hour public hearing on out-of-network reimbursement. Much of the hearing focused on the markedly higher billing practices of ambulatory surgery centers and one non-par hospital. Aetna presented testimony regarding its experience with the non-par hospital, citing their disparate year-over-year increase in charges compared to other similarly situated hospitals. Chairman Schaer indicated the committee will work over the next several months to craft a solution.

NEW YORK: With Democratic Senator Hiram Monserrate officially expelled from the Senate, the Democratic majority (31-30) now faces an uphill battle getting the 32 votes needed to pass legislation. However, both the Senate and the Assembly moved forward with a public hearing on the Executive Budget proposal for health, including the section mandating the prior approval of rate adjustments. The Health Plan Association testified on behalf of the industry. If enacted, Governor Paterson’s proposal for an 85 percent medical loss ratio and a prior approval hearing process for all rate adjustments would essentially amount to government control of health insurance, undermining the private health insurance market in New York. Price controls would weaken health plan solvency, hurt providers and virtually eliminate innovation and efficiency. At the same time, the proposal ignores the underlying cause of the increasing cost of health insurance — the increase in the actual costs of health care services.

OKLAHOMA: The second session of the 52nd Oklahoma Legislature convened in Oklahoma City on February 1. Legislators quickly turned to the state’s .3 billion budget deficit described by Governor Brad Henry (D) in his eighth and final state of the state address and FY 2011 executive budget. During his address, the Governor focused on his plans for resolving the .3 billion budget deficit through precise budget cuts. His only reference to health insurance was to encourage the expansion of Insure Oklahoma, a program developed by the state in partnership with small employers to provide affordable health coverage. The legislature is scheduled to adjourn on May 28 but only after addressing a range of legislation including several bills of interest to Aetna.

SOUTH DAKOTA: A dental fee schedule bill (S.B. 108) unanimously passed the Senate Commerce Committee and is expected to be taken up by the full Senate early this week. The bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Aetna will continue to follow the bill’s progress as it progresses.

TENNESSEE: Several bills have been proposed that would make changes to the state’s external review law. Aetna and other industry representatives will be meeting with the Tennessee Department of Commerce and Insurance regarding its proposed changes to the external review law. The bill proposed by the TDCI most closely mirrors the model legislation proposed by the National Association of Insurance Commissioners.

UTAH: The Speaker of the House has introduced a health reform bill addressing health information technology, individual and small group market reforms and transparency. The overarching theme of the reforms is micromanagement of rates and rating factors, and a broadening of the Insurance Commissioner’s authority. The transparency provisions apply plan designs and benefit descriptions submitted by carriers, and would require providers to make available, upon request, a price list for services on both an inpatient and outpatient basis.