Health Insurance News

With health reform getting dangerously close to an end, seemingly all the players involved in the health-care reform want you to be terrified.  The Republicans want to scare with the big S word Socialism and the Democrats want you to believe that this is the salvation that everyone has been waiting for.  Of course like dancing in a movie theater, they are very wrong.  (That joke comes from the great idea of the local Muvico putting a Salsa dance club in their West Palm Beach location.)

Of course this whole mess currently being debated by the Democrats is huge, it could reshape our entire financial system, remember health care is nearly a third of our GDP.  But the bill that is being presented does almost nothing to control costs and will in fact raise health insurance premiums for many people.  Of course like eating a 10 pound hamburger, you have to start somewhere, so East Coast Health Insurance actually supports this bill, though we don’t care for it at all, but believe our current course of action is also just as unsustainable.  We applaud the Democrats for being courageous enough to risk their political careers on this garbage legislation.  Hoorah.

Looking at the numbers, the entire bill is seemingly more expensive than our defense budget, and comes in with a $900 billion price tag.  This reflects 10 years and breaks down to a smooth $90 billion per year.  Remember however that in the context of health care spending this is actually like a Cuban life raft, very tiny.  Health care costs are about 2.3 trillion a year, so this would amount to a small appetizer at an Applebee’s.

Additionally, the bill doesn’t even start till 2014, so this number figured for inflation and with the current rise in health care cots will only be about 4% of the entire American health care spending.  in the year 2016 health care is expected to be $3.7 trillion, so it gets smaller each year.

Another great fact is that this bill will kick the health insurance companies right in the groin.  While many have speculated that this bill will make them more profits the truth is that only a couple of companies might do better but the majority will take one on the chin and end up in some other business or go bankrupt altogether.  By 2019 it is expected to insure an additional 30 million people, of course by that time we will all be wearing 10 pound sunglasses and have skin cancer from global warming but at least we will have health coverage to remove all those sun spots and moles.  Additionally, it is estimated that 90% of Americans will be insured, while the uninsured will be mostly illegals and space aliens.

But when it comes to cost controls this bill is an absolute failure.  And more important then our health insurance problem is our financial solvency as a nation.  I don’t care what anyone says or what pills the GAO has taken while they performed this study.  Health care is getting to expensive and this bill just shrugs it off like a bad sign from a drunk catcher.  No one is going to care about their deductibles when they can’t afford to eat.  Do I have a solution to health care costs?  I have a few ideas including tort reform and such that this bill has just ignored, but I can’t really agree with passing this bill due to this fact.  But I do agree to it, because I know that it will start the conversation for a single payer system which this bill will inevitably result in.

Make no mistake, Pelosi has said it herself this bill is designed to cripple our health insurance companies which is a necessary evil in order to solve this issue, and because they are not going to go away quietly this bill lets them think that they have a victory, but 10 years from now, they will be looking for benefits themselves.

But changing the growth of the health-care system is a lot harder than just cutting a few dollars here or there. It requires us to change how doctors practice medicine, or how much medicine people buy or how much they need — or maybe all three. We’re doing a lot on health-care reform this year, but we’re not doing that much. And we shouldn’t fool ourselves into thinking otherwise. We’ll be back at this again, and soon.

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The Democrats are starting to sweat like a garbanzo bean at a kosher picnic.  Just when health care reform seemed inevitable, the death of Senator Kennedy has changed the game at this late hour.  House and Senate Democrats along with a certain President Obama are working around the clock to speed this legislation through by uniting the two health reform bills from the Senate and the House.

If the Republicans are able to fill Senator’s Kennedy over-sized former seat, then the health reform bill arrives DOA as the Senate will lose its 60th vote.  The fate of health care reform has been left in the hands of people that don’t know how to pronounce words like car or park.  People that have perfect the art of the baked bean.  Yes I am talking about Boston.  A city where a girl once broke my heart, and now can effectively end health care reform.  One has to wonder if the people of Massachusetts even know that this bill lies in their hands.

Should the Republicans win the seat, there would only be a window of a day or two to get the bill passed, and even if it would pass, the Democrats would certainly suffer from the public’s wrath for this kind of deal making.  That much is certain.  There can be no doubt about it, Boston has been given a great power, and of course the irony is that the father of the health reform bill, the great Senator Kennedy is the reason for this late pressure.

Senator Harry Reid claims the negotiations are pretty close to reconciliation while the White House has said that there has been no final agreements or a final package.  The next step would be sending the bill to the CBO to examine the costs and extent of coverage, but again the bill has to be agreed upon in these backroom negotiations first, and by only the Democrats who are the only ones debating it.

The election comes the day after the three-day Martin Luther King Jr. holiday weekend – and on the last day of Obama’s first year in office. Snow is forecast for Monday, and many locals head south for warmer weather or north to go skiing during the shortened workweek.

On Friday, Republican and Democratic heavyweights campaigned for both candidates.

At a rally in Boston’s North End, former New York Mayor Rudolph Giuliani urged voters to elect Brown for his anti-terror credentials.

“His election, I believe will send a signal – and a very dramatic one – that we’re going in the wrong direction on terrorism,” said Giuliani, who opposes the administration’s decision to have the trial of Sept. 11 terror suspects in New York City.

Former President Bill Clinton was making two appearances in Massachusetts despite his duties as a special envoy to earthquake-ravaged Haiti, another sign of the stakes. “You just have to decide if you want to pick the person who gets to shut America down,” Clinton told voters at one stop.

Sen. John Kerry, recovering from hip replacement surgery, took the stage at one event with the help of Kennedy’s cane. And Kennedy’s widow, Vicki Kennedy, planned to join Coakley at her first canvassing event in Boston on Saturday.

Kennedy, who died Aug. 25 of brain cancer, also was elected to the Senate in a special election on Nov. 6, 1962. He took office the next day, Nov. 7. It was the seat his brother, John F. Kennedy, vacated when he became president in 1961. The Democrats have held the seat since JFK was elected in 1952.

Crazy Ole Senator Nelson

The other thorn in the rear is Senator Nelson’s extortion attempt, which has been criticized by members of his own party, ex Presidents (Clinton), and even angry school children who now officially hate Nebraska.  To pacify everyone Obama and Federal lawmakers have decided instead to increase Medicaid federal funding in all states, though where the money would come from is unclear, with many suggesting that it will be soon be time for street begging.

The increase in the Medicaid program is a key element in the bill’s overall goal of expanding health coverage to millions who lack it. The bill also envisions creation of new insurance exchanges, federally regulated marketplaces where consumers can shop for coverage. Individuals and families at lower incomes would receive federal subsidies to defray the cost.

The legislation would curb insurance industry practices such as denial of coverage because of medical problems and charging higher premiums to people in poor health.

At the White House, spokesman Robert Gibbs was unequivocal that Obama’s effort would prove successful. “As you heard the president say yesterday, we’re going to get health care done,” he said.

Not everyone was quite so certain, particularly given poll results from Massachusetts that showed Republican Scott Brown within reach of an upset over Democrat Martha Coakley in a three-way race.

“If Scott Brown wins, it’ll kill the health bill,” said Rep. Barney Frank, D-Mass, reflecting that the Republican would provide opponents of the health care bill a decisive 41st vote to uphold a filibuster and block passage in the Senate. Frank predicted Coakley would ultimately prevail and thus preserve the essential 60-vote Senate majority. Obama hurriedly scheduled a weekend campaign trip to the state.

Even so, Frank’s remark sent shudders through the ranks of Democrats.

The president called on Congress in his inaugural address a year ago to send him legislation that would remake the health care system, including expansion of coverage, new regulations on industry and unprecedented measures to slow the rise in health care costs generally.

Obama has made an unusual commitment in time and energy to the negotiations at the White House, essentially serving as a referee on key issues that the House and Senate leaders could not resolve.

Beyond that, he was willing to reopen issues where the two bills were identical. One example involved the patent protection that drugmakers would receive for their biotech drugs from generic competitors. The president wants to give generic makers quicker entry into the marketplace, and the pharmaceutical industry’s top lobbyist, former Rep. W.J. Tauzin, sent an e-mail threatening to oppose the legislation if that happened.

Even with an agreement on cost and coverage issues, Obama and congressional Democrats would have to resolve controversy over abortion, coverage of immigrants and other issues before sealing a final compromise.



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In what is sure to be the most fun since bed wetting, the United States has both houses of Congress recklessly trying to reconcile their versions of the health reform bill.  In what is surely to become the most complex piece of legislation this side of the tax code, even President Obama has joined the fray.

With the State of the Union address quickly approaching President Obama has promised the Dark Sith Lords that elected him, that there will be some kind of progress on this bill which is so full of compromises and kickbacks that even  former Communist Russia has rolled over in its grave.  Additionally, the Senate race in Massachusetts has become a pressure point for the Democrats who can’t afford to lose that seat to a Republican or risk losing their 60th vote in the Senate to pass this bill.  And that race has been getting tighter than a ghetto haircut.

In a joint statement Wednesday night, Mr. Obama, Ms. Pelosi and Mr. Reid said they had made “significant progress in bridging the remaining gaps” between the House and Senate bills. Having worked through all aspects of the legislation, they said, “We’re encouraged and energized.”

Of course many insiders suspect that they are fibbing as the Cornhusker Kickback is causing substantial problems for the bill, and the lawsuits are piling up as fifteen states have Attorney Generals figuring out how to file a suit and if the Supreme Court will even hear it.   There is now talk of a second lawsuit which will claim that mandating health insurance coverage is unconstitutional, which very well might be true.  On the other hand, Universal Health Coverage is most definitely not unconstitutional and would very likely pass the smell test.

Issues that still remain to be reconciled include whether or not to turn the United States into a Socialist Republic, whether or not to tax employer based plans that are “too benefit rich,” and whether to increase the payroll tax to help pull Medicare out of bankruptcy.  Ok the first one was not an issue.

And for me as a health insurance broker, the most important issue is the Health Insurance Exchange issue, which would be either a National Single Health Insurance Exchange or various dozens of state health exchanges which is the Senate version.  The Democrats would like to see these exchanges become competitive markets where consumers would be able to shop and compare policies with federal subsidies.

“Health care reform should be financed by tax surcharges on the wealthy and not by taxes on health insurance plans offered to middle-class workers, older persons and union members,” said Representative Lynn Woolsey, Democrat of California and co-chairwoman of the Congressional Progressive Caucus.

The chairmen of Verizon and AT&T weighed in with their concerns. In a letter to Congress joined by two union presidents, the executives, Ivan G. Seidenberg of Verizon and Randall L. Stephenson of AT&T, said the excise tax would “impact health plans covering tens of millions of workers” in various industries.

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The current bill has proposed Medicare cuts to staging UFC brawls with Senior Citizens, the savings that have been estimated in the proposed Medicare cuts  that add up to billions in savings and revenue.

As a result of the skewed numbers, lawmakers know that are going to need to  raise hundreds of billions of dollars for subsidies to help low- and middle-income families afford health insurance.  Due to promises from President Obama, borrowing the money is off the table, as health care reform has been guaranteed to not add to the nation’s budget deficit.

But who really matters is the CBO or the Congressional Budget Office, who are non-partisan and have estimated the House Bill to cost nearly $1 trillion while the Senate Bill (which has to public option) to be about $871 billion.  And they have estimated the Senate bill would reduce budget deficits by $132 billion.  Of course, what this really means is that the US government would be less broke but still very much broke.

To arrive at these numbers the CBO has counted $438 billion in Medicare and Medicaid cuts over the next decade, including shaving the Medicare Advantage plan payments to health care professionals.

The only people that have been forthright has been the December Department of Health and Human Services (HSS) report which identified some of the cuts as “unrealistic” and could actually reduce access to health care and health insurance. Rudolph Penner, a fellow at the Urban Institute, said it would be “very hard” politically for Congress to ultimately allow the cuts to occur.  Which means that in order to get elected none of the proposed cuts to Medicare would actually even take place once the angry group of AARP lobbyists starts threatening to pull support from candidates.

•A new long term care health insurance program for seniors would collect $72 billion over 10 years by offering long term care coverage through employers much as Social Security did at its inception, even though government reports have raised questions about its long-term sustainability.  Because just like Medicare eventually the costs would be overrun by a glut of baby boomers retiring.   Current, active workers would pay into the program for five years before becoming eligible for nursing home or in-home care subsidies.

Just as Social Security did, the program will lower deficits at least in the immediate future because millions would pay premiums while only a few will be eligible for benefits, but that will change over time.  Unlike Social Security this program would be optional meaning that only the sick would elect coverage in an extreme case of moral hazard.

Supporters, including Larry Minnix, president of the American Association of Homes and Services for the Aging, note that the law requires the program to pay for itself for 75 years. “It is self-sufficient and solvent.”

Democratic congressional leaders are working to reconcile the bills for a final vote.

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After the Senate version of the health reform bill was passed without a public government run health insurance option, it seems that the House Democrats are abandoning hope for it as well.  But they are  pushing for other measures to control the private health insurance companies.

Nancy “The Axe” Pelosi and other Dems have told President Obama in recent meetings that though the public option seems as likely as clean tapwater in New York, they do plan on stripping the health insurance companies of an exemption from anti trust laws.  This provision was not in the Senate bill, but they hope to add it in the final reconciliation between the two House and Senate health care bills.

Health Insurance Exchange Anyone?

The other big plan?  To ruin my company by proposing a nationwide health insurance exchange regulated by the Federal Government where you lucky private consumers would shop for private coverage from approved companies.  Translation?  You will be buying health insurance from big political donors. The Senate bill will also provide a state-based system of exchanges.

The next target of the House Democrats is to tell the health insurance companies how to spend their revenues, which is to dictate limitations on salaries, bonuses, etc.  The ceiling is expected to be 80-85% depending on which provision is adopted.

Health Reform Lives Albeit Without Important DNA and Chromosomes

The major issues left in reconciling the two bills in time for Obama’s State of the Union slated for late January or early February is government intrusion into the private health insurance market, the proposed tax on Cadillac health insurance plans, and of course everyone’s favorite topic, abortions… It’s whats for dinner.

Ok I digress and apologize for that horrendous joke.

The death of the public option found in the House bill has drawn contention from Senate Democrat moderates whose votes were necessary to pass any bill.  Apparently even a proposal to expand Medicare to younger Americans was nixed.  I support this idea wholly as it would help the most affected part of the population who cannot afford insurance as a whole anyways.

“We are optimistic that there is much that we have in common in both of our bills and that we will resolve or reconcile this legislation in a way that is a triple A rating: affordability for the middle class, accountability for the insurance companies, and accessibility to many more people in our country to quality, affordable health care,” she said.

While Obama favors a government option, he has said repeatedly it is only a small part of his overall effort to remake the health care system, and is not essential.

Pelosi and Senate Majority Leader Harry Reid, D-Nev., have expressed optimism about chances for a swift agreement, but there appears to be relatively little maneuvering room. That is particularly true in the Senate, where 60 votes will be needed to overcome a Republican filibuster, and any change carries the risk of alienating a Democrat whose vote is crucial.

The bill’s future is further complicated by a scheduled Jan. 19 election in Massachusetts. Some polls show Democrat Martha Coakley in a closer-than-expected race against Republican Scott Brown and an independent contender. The winner will replace Sen. Paul Kirk, who became the 60th member of the Democratic caucus when he was named to his seat as successor to the late Sen. Edward M. Kennedy.

A Republican upset would deprive Democrats of their 60th vote.

Some House Democrats say the proposed government insurance option remains alive, although they speak publicly of its possible demise as long as insurance companies aren’t let off the hook.

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All the states are biting their proverbial fingernails in anticipation of the health reform bill, all perhaps with the exception of Nebraska due to the great Cornhusker Kickback of 2009 where they managed to the get the US government to pay a significant portion of their Medicaid bill.

Let us not forget that many states are teetering on the verge of literal bankruptcy and are busy issuing bond offerings and even selling public utilities to help pay for current liabilities.  Many of our states have lost millions and billions in annual property tax revenues and sales tax revenues due to the continuing recession.

Seemingly, all state governors regardless of party affiliation are vocally worried that the health care reform bill will bury their states into a deeper financial hole, some more than others.

Time Magazine has identified four major factors that have the states soiling their collective diapers in advance of the health reform act which will somehow be absorbed by state governments more than Federal governments where the bills are actually being passed.

1. A Bigger Medicaid Tab

The number 1 cost that will effect our US states is of course Medicaid where due to the absence of a public plan, enrollment is expected to jump to a level not seen ever.  As there are 31 million uninsured, it is estimated that nearly half of them will be eligible for the state run Medicaid program.

The Senate bill would make eligible anyone earning up to 133% of the federal poverty level (for a family of four, an income of about $29,300 a year); the House bill would lift that threshold to 150% of poverty (or about $33,000 for a family of four).

Why Medicaid?  Because it is the cheapest way to cover the bulk of Americans through an already established program that is already over budget.  Both House and Senate bills would pay the states’ share of the cost of the new patients over the first two years and up to 95% after that. But states would still face an enormous new financial obligation. There is also the question of finding enough providers to care for 15 million new patients. “It is a huge load on the states at a time when we are still climbing out of the recession,” Tennessee Governor Phil Bredesen said this week in Nashville. His state — already facing $1.5 billion in budget cuts this year and next — has estimated that the Senate version would cost it an additional $735 million from 2014 to 2019 and that the price tag of the House bill would be nearly double that. California Governor Arnold Schwarzenegger was one of the few prominent Republicans to favor the Obama health care reform effort. Now he is calling on Congress to “rethink it.” In a Dec. 22 letter to Speaker Nancy Pelosi, he wrote, “When asked for my support, I was assured that federal legislation would not increase costs to California.” Instead, a state with a $21 billion budget deficit is looking at what Schwarzenegger calls a “crushing new burden” of at least $3 billion a year.  

2. New Regulatory Burdens

Can states enforce the dramatic new health insurance regulations called for in reform legislation?  The current bill is expected to at least mandate coverage and possibly or even probably set prices.  Thus state legislatures would have to enforce the new rules, a process that could be will be surely burdened by partisan issues.

But even if states adopted the new federal rules, most state insurance departments would need to bulk up staff at a time when many are experiencing layoffs because of already strapped state budgets. “We would certainly argue that we’re cut to the bone right now,” says Kevin McCarty, head of Florida’s Office of Insurance Regulation, which cut 14 positions in the 2009 fiscal year. New staff members could be charged with rooting out insurers who continue to cherry-pick healthy customers and making sure plans stay solvent despite the crush of new, previously uninsured customers.

What’s the alternative? The Federal Government could enforce the new national rules, but this would require creating a sizable new regulatory bureaucracy, even though one already exists at the state level. The states don’t want that to happen. If the federal bureaucrats assumed regulatory control, says Sandy Praeger, Kansas’ insurance commissioner and chair of the health insurance and managed care committee of the National Association of Insurance Commissioners, “we’d just be left to mop up the mess. We wouldn’t have any authority, but we’d just deal with all the consumer complaints. That, to me, is the worst-case scenario.”

3. Insurance Exchanges
Perhaps the least understood aspect of federal health reform is how private health  insurance would be sold on the open market if and when the legislation becomes law. Under the Senate bill, states would be responsible for creating and running new insurance marketplaces, also known as health insurance exchanges. There, individuals and small businesses would purchase private health insurance, receiving federal subsidies if they qualified. The House bill would establish a national exchange, which states could opt out of if they had the capacity to run their own.

Exactly what states will have to do remains unsettled. But it’s likely to be a lot. States may be required to vet some insurance plans to make sure they meet new federal standards. They may have to determine who is eligible for federal subsidies; they may have to build websites to market and rate plans. All that would require expertise and manpower. Massachusetts, which set up an exchange after enacting health reform in 2006, did so quickly and effectively, but Jon Kingsdale, who runs the program, says, “We had a 10% or less uninsurance rate. It’s a well-to-do state. It’s a progressive employer community. And … the fact that a Republican governor championed this was a huge advantage.” In states where some 25% of the population is currently uninsured, like Texas, setting up exchanges could take longer and cost more. And, Kingsdale warns, in states where there is “sustained and organized hostility” to reform (as in red states in the South and Midwest), “that in and of itself could turn a good program bad.”

4. A Fight for Federal Aid
The states are killing themselves to get a piece of the Cornhusker Kickback because as it stands now the Federal Government will pay all of Nebraska’s new Medicaid costs forever. And it’s fueling envy and outrage in the other 49 states. Led by South Carolina’s Henry McMaster, the attorneys general of 13 states — 12 Republicans and one Democrat — have signed on to a letter contending the Nelson deal is unconstitutional.

But that’s not the only issue causing friction among states. Another is the fact that some good deeds will be punished under the health reform measures: states that expanded Medicaid coverage on their own — say, to include low-income childless adults under 65 — will get less federal aid than those that have been stingier with their Medicaid programs.

Because liberal and heavily Democratic states have traditionally been more generous in their Medicaid programs, they are likely to be the ones shortchanged. The biggest beneficiaries, arguably, could be states like Texas, whose lawmakers have waged the strongest rearguard campaign against reform. That may be reform’s biggest political irony of all.

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Rating of Florida Health Plans

Avmed Wins!  Avmed Wins!  In the annual CAHPS Florida Health Insurance Rankings Avmed wins!

CAHPS® 2009

AvMed                                                                               77%

Aetna                                                                                  65%

BCBSFL                                                                              70%

CIGNA                                                                                68%

Humana                                                                             60%

NHP   (Neighborhood Health Partnerships)             64%

United                                                                                 60%

Vista                                                                                     65%

Scores represent the percentage of respondents who rated their plans 8, 9 or10 on a scale of 1 to 10,with 10 being the highest. Florida average=65 percent

For the fifth year in a row, AvMed received the highest overall rating of any statewide Florida plan** in the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.

AvMed prides itself on delivering personalized service to our clients and members. When asked about their overall satisfaction with their plan, 77 percent of AvMed members gave us good or excellent ratings. The state average is 65 percent.

Administered by the U.S. Agency for Healthcare Research and Quality, the annual CAHPS survey asks respondents to rate their health plan in areas including:

· Overall health care provided

· Overall health plan satisfaction

· Satisfaction with personal physician

· Satisfaction with specialist care Health care organizations, employers, individual purchasers, consumers and researchers use CAHPS results to: · · · Assess the degree of patient-centered care Compare and/or report on plan performance Improve available quality of care

Health plans with yourhealthin mind.
AVM-N09-53 AvMed, Inc. (health benefit plan).

Plans contain limitations and exclusions. **Highest overall rating of statewide plans reporting Health Maintenance Organization (HMO) and Point of Service (POS) product data (*Health Options filed as HMO only.) to the National Committee for Quality Assurance (NCQA) for the Consumer Assessment of Healthcare Providers and Systems (CAHPS). CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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Blue Cross Blue Shield of Florida has come forward with their vision of health reform, and no you crazy kids it doesn’t involve corporate malfeasance or shooting everyone that doesn’t buy a Blue Cross policy, but it does involve of course increasing profits while maintaining a certain level of health coverage in Florida.  In other words, they picture it as you would if you owned Blue Cross.

The following post is from an email we received outlining the Blue Cross Blue Shield vision of health reform in Florida and nationwide.  If you have the attention span to sit through it, I applaud you.

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Reform

Introduction The number of uninsured is growing at epidemic proportions. Nearly 50 million Americans — one in six individuals — lack appropriate health coverage and access to care. In Florida, nearly four million people are without health insurance.

Unfortunately, these numbers continue to increase, a fact that should come as no surprise since health care costs have risen more than 70 percent over the past seven years. The increase in the cost of health care and, consequently, the cost of coverage, has far outpaced wage increases for the average American. Absent an employer or government subsidy, health care coverage is simply unaffordable for many Americans.

Vision of Reform
Blue Cross and Blue Shield of Florida’s Vision of Reform Blue Cross and Blue Shield of Florida (BCBSF) believes that the severity of the affordability and uninsured issues require a case for transformational change in today’s health care environment. Our vision for reform includes five critical elements: wellness and prevention; evolution in health care delivery; universal coverage; consistent and equitable funding for safety net programs; and personal responsibility.

BCBSF’s Mission is to advance the health and well-being of Florida’s citizens and to work toward a system where appropriate health care is available to all. But we certainly can’t do it alone. Any change for which we advocate can only be accomplished when all of those involved in health care delivery, financing, utilization and supply coalesce to agree on a realistic platform for reform. Until all parties recognize that the current model is unsustainable, it is unlikely change will occur proactively. And if the health care industry doesn’t come together quickly, a declining economy will drive a political agenda that diminishes the positive impact brought by the private sector in terms of innovation and meaningful competition.

Wellness and Prevention BCBSF envisions a medical delivery system that evolves from an illness model to a wellness model. Today, doctors and other providers are paid to treat the sick with very little financial reward for keeping people healthy. This paradigm must be changed. Incentives for preventive medicine and wellness should be offered to both patients and providers. Steady doses of wellness education should be offered beginning at a very young age and continued through one’s entire educational career.

Overall, our health care financing needs to be realigned to reward both the practitioners and consumers who achieve the best health outcomes. Evolution in Health Care Delivery BCBSF and other payers need to work with our provider partners to implement critical changes in medical delivery.

A system that embraces objective, proven clinical standards as the foundation for reimbursement is the goal. Physicians should be rewarded for adherence to these standards and for the enhanced value that efficient, integrated and clinically appropriate care brings to patients.

Protections from legal liability can be legislated to shield clinicians and eliminate the costs caused by defensive medicine and other consequences of malpractice lawsuits. With the total impact on medical expenditures costing $124 billion each year, removing this cost would pay for virtually any version of comprehensive health care reform. Universal Coverage For the insurance industry and medical community to successfully implement system changes that would bring coverage to all Americans, BCBSF envisions the federal government playing a significant role. For those individuals and businesses that do not obtain coverage voluntarily, an enforceable mandate must be created.

Policy studies consistently find that a voluntary system cannot produce universal participation. Our country’s compassion has created a safe haven of emergency room treatment for all. The cost of this care is being borne by a diminishing number of insured. The fundamental principle of spreading risk can only be achieved when all of those capable of paying for their own or their employees’ coverage are mandated to do so with appropriate incentives. Those who do not have the financial ability should receive a meaningful public subsidy. Consistent and Equitable Funding for Safety Net Programs We believe the best approach for funding these programs will spread the risk nationwide.

Additionally, public subsidies and safety net programs should be equitably funded across the states. Inconsistency in federal and state funding adds to the problem of a disjointed health care system and does not encourage integrated care. Florida has a disproportionate responsibility of caring for seniors in long-term care settings. While an increase in taxes would be necessary, long-term care costs should be part of the Medicare program. Personal Responsibility Finally, BCBSF believes private and public entities, along with the federal government, can create an environment that encourages personal responsibility for each individual. It took only one generation to reduce the number of smokers by half.

We can work together to address and improve conditions that deplete most of our health care dollars; like asthma, diabetes, heart disease and depression. Obesity and diabetes can be significantly addressed through good nutrition and exercise. Can we expect people to take personal responsibility when their neighborhood is unsafe, where there are no sidewalks on which to walk or playgrounds on which to play, and only fast food is available?

When a large percentage of Florida’s adult population is functionally illiterate, how realistic is the expectation that food labels will be read and understood? Clearly, education and resources are the keys to promoting personal responsibility and good health. Let’s work together to put exercise back into our schools, to build and create neighborhoods where children can play in a protected environment and spaces can exist for community markets. How can we eliminate economic and environmental chemical burdens that foster depression and physical illnesses?

We need the commitment to create incentives that promote and pay for early disease intervention and preventive care. BCBSF is not promoting a vision of utopia but rather asking everyone to take a role in building and supporting a long-term view of a healthy Florida and the United States for future generations. As we move forward, BCBSF pledges to continue the dialogue, develop solutions that align with this vision and work with various stakeholders to develop integrated approaches to health care affordability and access.

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Due to the fact that we are more then just a source for the latest health reform updates, I wanted to break from the daily grind of writing about the Washington Health Insurance Reform Debate and instead write a quick post about Aetna’s new health insurance underwriting criteria for individual insurance as it pertains to doctor’s visits to complete undewriting.

For more on health insurance underwriting please visit our main health insurance section.

The following is from a broker update emailed to our office to help expedite the underwriting process.  It pertains to the fact that Aetna requires some kind of health history when submitting an application.  Specifically, Aetna requires that individuals that haven’t seen a doctor for a few years must then go and get a physical.

We want to clarify Aetna’s underwriting requirements when a doctor’s visit is needed in order to underwrite an applicant(s). The doctor’s visit must be performed by a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner/Certified Registered Nurse Practitioner (NP/CRNP) or Physician Assistant (PA).

Aetna Individual and Family Health Insurance Plans Age/timeline requirements

Newborn through age 17: The application must include a doctor’s visit within the past 3 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. The only exception to this policy would be a newborn, under 31 days old, or a newly adopted child who is being added to a policy without underwriting.

Age 18 through age 30: The application must include a doctor’s visit within the past 5 years.  If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required.  A physical must include height, weight, and a blood pressure reading.

Age 31 through age 49: The application must include a doctor’s visit within the past 5 years.  If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. A physical must include height, weight, a blood pressure reading and lab results for blood sugar and cholesterol.

Age 50 and older: The application must include a doctor’s visit within the past 2 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required.   A physical must include height, weight, a blood pressure reading, and lab results for blood sugar and cholesterol.

If the Underwriter determines (either through outreach to an applicant in a phone interview or by review of medical records) that the applicant has not had a doctor’s visit within the required timeframes, the underwriter will close the application.

The underwriter will document what information is required to be considered for enrollment and a written letter will be sent to the applicant to advise that their application has been closed.

Example: A 50 year old applicant applies for coverage with no medical history.  A telephone interview is conducted and at that time, the applicant confirms that he/she has not seen a physician in over 5 years.

At that time, the clinician performing the telephone interview will advise the applicant during the conversation that “To proceed with underwriting your application, the results of a current physical exam is required.  This includes but is not limited to: height; weight; blood pressure; lab results for cholesterol and fasting blood sugar; and past medical history.  Your application can be continued if you submit this documentation to the underwriting department within the next 30 days.  You may fax this information to (866)223-2041.”  The applicant should identify on the fax that this is a “Request to reopen their application” and they should include their closed letter.

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