Health Insurance News

Good news for America!  2.5 million young adults are now newly covered under their parents plans bringing the percentage of this segment of the population from 34% uninsured to only 29%.  In fact, in 2011 the overall percentage of Americans between 18-64 without insurance dropped from 22.3% in 2010 to 21.3% in 2011.  Another supposed good sign from this is that most of the increase in coverage came from private health plans instead of public programs like Medicaid.

Of course, I would warn America not to get too excited as these numbers are not likely to move too much again until 2014.  And once 2014 rolls around, don’t expect a miracle either.  In fact, unless there is a strong mandate that compels all American’s to get coverage before they need it, than I predict either rates will move to unprecedented levels which will make the Medicaid rolls swell, or the health insurance companies themselves will be regulated out of business which will be a heavy shock to the system.  In either case, eventually we end up with universal health care until the deficit swells and no one will support our egregious consuming habits anymore.

One unintended consequence of this so called victory is that premiums will rise at least 1 – 2% to cover the expansion.  The expansion also highlights how poorly our economy is doing as these young adults continue to move home in record numbers.  Would we have seen this effect had unemployment been closer to 5%?

But still, we are here to celebrate the victory of 2.5 million more Americans getting coverage.

So what is behind the victory?  Well the law that paved the way for this victory was the provision that allows young adults up to age 26 to remain on their parents plan instead of where it used to be which was age 22.  So all the college graduates living at home have now found yet another way to siphon monies from their parents.   In most foreign countries it considered normal to live with your parents till much later in life so I imagine that as globalization changes our country even more we will see even more of this suckling.

And now listen to the gloating from Kathleen Sebelius who needs to take a less myopic view on this reform law.  (I support single payer, but I believe that Obamacare is a disaster.)

“Thanks to the Affordable Care Act, 2.5 million more young adults don’t have to live with the fear and uncertainty of going without health insurance,” Secretary of Health and Human Services Kathleen Sebelius said Wednesday. “Moms and dads around the country can breathe a little easier knowing their children are covered.”

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I believe this is an important issue for many people and I am sure there are at least a few google searches per month on this very topic.  The question of course is does your health insurance plan cover your brand new penis (or lack thereof)?

And in what must be a good sign of fairness under the law, the majority of health insurance companies that are covering this surgery has more than doubled over the past year.  And who is keeping score?  One of the nation’s largest gay rights group who would have no reason to lie or exaggerate.

The exact numbers provided by the Human Rights Campaign in a report to be published Thursday is that 207 of the 636 businesses it surveyed for its annual Corporate Equality Index either are already providing transgender- inclusive employee health benefits or plan to at the start of the new year.  The previous year only had 85 companies that had coverage to pay for this procedure, and the year before that (2009) it was 49, and 10 years ago it would have been 0.

So why the sudden love for transsexuals?  Its because the Human Rights Campaign grades corporations on whether their medical plans cover the whole set of operations including counseling and genital construction (or reconstruction if that is your pleasure) and this plan must cover at least $75,000 worth of surgery.  And if the HRC gives you a 100% than you are listed in their preferred vendors guide for gay, lesbian, and transgender consumers.

Still, it is important to realize, that individual health insurance is probably never going to cover this so don’t be surprised when you bring your new insurance card to the gender reassignment doctor and he tells you gently that you are not going to be covered for your penis removal.  Many insurers still categorize sex reassignment surgery as cosmetic, even though the American Medical Association considers it vital for some people who have been diagnosed with gender identity disorders.

Many of the corporations that expanded their insurance coverage this year are well known companies that appeal to consumers and need to maintain a good relationship with the gay and transgender community such as Apple, Chevron, General Mills, Dow Chemical, American Airlines, Kellogg, Sprint, Levi Strauss, Eli Lilly, Best Buy, Nordstrom, the U.S. division of Volkswagen, Whirlpool, Xerox, Raytheon and Office Depot.

Some companies like Office Depot, cover the procedure but only if it is ruled medically indicated, and not elective.  Office Depot also has started sponsoring gay rights events such as an annual leadership conference held by the National Gay and Lesbian Task Force in order to maintain their top ranking with the HRC.

The Human Rights Campaign also found that corporate America is far ahead of the public sector in terms of providing job protections for transgender people.

Half of the Fortune 500 corporations and 80 percent of the companies the campaign surveyed have equal employment opportunity provisions that prohibit discrimination on the basis of gender identity of gender non-conformity, according to the new index. Only 16 states, by contrast, have laws designed to protect transgender people from job and housing discrimination.

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In a controversial decision (especially among health insurance brokers), the Obama administration issued or rather reissued a rule that is likely to crush many health insurance agents.  Fees or commissions paid to us by insurance carriers won’t count as medical care under the MLR rule.

Some people like David below doubt that brokers (like me and my company East Coast Health Insurance) even satisfy a need.  Read his charming thoughts;

Will someone please tell me what value a health care insurance broker offers consumers. In 2014, the exchanges will open up and anyone with a computer can go online to purchase a plan that suits their needs. Why do we need brokers after January 2014? In my view, they are just adding to the already outrageously high cost of health care that currently pushes over 50 million Americans out of the market and also made sure that another 25 million that are under-insured and don’t know what coverage they have until they go to use it and find out they’ve been seriously restricted. Face it folks, AHIP, the AMA and PhRMA have ruined America’s health care system. They had their chance to make things work for consumers and they chose profits ahead of consumers. Americans need Obamacare and, further still, they need a Robust Public Option included in every health care exchange. The sooner we make health care work for the consumer, the sooner we will take back control of America’s health care system.

Do you know what they are doing now?  Selling minimeds!  Minimeds exist mostly to rip off people as they won’t cover any meaningful expenses should you need them too.  People can and will die from this coverage.  If I had my wish I would kick these shysters out of the business merely to validate our argument that brokers do provide a benefit.  By the way, if anyone that works for a minimed shop or carrier actually has a minimed on themselves I will pay them $500.  That’s how sure I am that while they sell this garbage all day, they carry real coverage on themselves.

In the end the consumer advocates won by arguing that commissions are clearly administrative costs and removing them would make it easier for insurers to avoid paying the required rebates to consumers. Those rebates will go out next year to individuals and small-business policyholders whose insurers fail to hit spending targets this year. The rebates could come in the form of reduced premiums or actual tax free rebate checks.

The rebates just became tax free as under an earlier rule, rebates to employers would have been taxable, so the final rule legislates that any rebates given for employer policies should be in the form of lower premiums or “in other ways that are not taxable.”  It will then be up to the employer or group policyholder to “ensure that the rebate is used for the benefit of subscribers.” In addition, the rule requires insurers to provide notices of rebates not only to the employer, but also to the enrollees.

“If your insurance company doesn’t spend enough of your premium dollars on medical care or quality improvement this year, they’ll have to give you rebates next year,” said CMS Acting Administrator Marilyn Tavenner, who is in her first day as chief of the agency. “This will bring costs down and give insurance companies the incentive to focus on what matters for patients – high quality health care.”

Just to be clear though, we are not dead yet as the final rule does not explicitly address the plea from brokers and agents, instead leaving the calculation of administrative costs unchanged from the original draft.

While many will argue that the broker commission is a benefit to consumers and that it will slow premium growth is partially correct.  Though partially in my opinion amounts to less than 10%.  Anyone that believes health care and health insurance costs rise due to health insurance companies needing to make profits is completely incorrect.  However, insurance companies will likely stop doing business with hospital and providers that let fees continue to rise.  We are seeing Aetna and UHC currently battling hospitals in North Florida on this very matter.

In conclusion, it is not necessarily the health insurance companies that are corrupt but the hospitals.  If you don’t think that the medical field is becoming a bubble check out its growth over the last 10 years.  It is likely to make the housing crash look like a fart next to Staten Island.

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Positive news out of Florida for a change.  Our state (East Coast Health Insurance makes its home in Deerfield Beach, Florida),  leads the nation in lowering the rate of uninsured children, according to a study released Tuesday.  (The downside is that adults continue to sacrifice coverage.  Florida also is near the top for uninsured adults).

As of 2010, 12.7% of Florida children are uninsured which is a significant drop from the 16.7% it was in 2008.  The current total of uninsured children in Florida is 506,934, says the report by researchers at the Georgetown University Center for Children and Families.

Actually over this period, the news was good in 34 states, as they all had success in reducing the rate of uninsured children.  Nevada however, perhaps not surprisingly has the highest rate of uninsured kids at 17.4%.   The best state?  The one with Governor Romney’s public health plan in Massachusetts which is only 1.5%.  Seemingly, the Massachusetts public plan has fared significantly better than the wild west system in most of the rest of the world.  Texas leads the nation in number of uninsured kids with nearly 1 million although it was able to lower its uninsured rate to 14.5 percent from 17 percent.

The national rate for the uninsured

Nationally, the uninsured rate for children fell from 9 percent to 8 percent from 2008 to 2010, as the number of uninsured children fell by 960,000, the study said.

The drop is probably coming from the new health care reform law and of course the community, state, and federal grants that are being advertized on billboards and television.  However, in Florida most of the expansion is credited to the economy which is literally causing new Medicaid enrollment qualifiers daily.  In other words, someone loses a job or takes a job that leaves them below the poverty line.

CHIP which is a government program that helps families that don’t qualify for Medicaid get their children health insurance also has lowered it barriers to entrance for families.  In Florida that program is known Florida Kid Care.  For instance, just recently the state lowered the penalty for failure to pay CHIP premiums from 6 months loss of eligibility to 60 days.

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A shocking if not predictable research project by the University of Minnesota has identified a loophole in the health reform law that will allow employers to push their portion of health insurance premiums towards the government.

Essentially, hidden incentives in the current health care reform law will lead to employers pushing only their sick and older (higher premiums) employees to the exchange to bring down their overall premium or premium per employee average.  The only companies however that will “enjoy” the loophole are companies that self insure as companies that do not are forced to offer coverage to everyone.

The researchers are saying that unless the loophole is closed the financial viability of the exchanges will become unsustainable.  The exchanges which are the centerpiece of the Obama plan are intended to make it easier to comparison shop for health plans and also to expand access to coverage for the uninsured.  However, the exchanges should only be open to the self employed unemployed or those that are not offered coverage through their job.  Due to this loophole however the exchanges will also be open to those that are employed by companies that self insure.  Currently 6 out 10 workers that have health benefits get them from a self insured employer.

The one question that everyone had anyways even before this loophole was identified was if the health care reform law would incentivize employers to stop offering coverage entirely since they could instead send them to the exchange and pay a fine or be less competitive in the job market.

The point of this study at UM was to anticipate via data modeling, how companies would respond to the health reform law given the harsh economic environment and soaring health insurance costs.

There is some good news to the question of if employers would skip out entirely on insuring their employees and that is the data shows that most employers will offer coverage as opposed to paying the fines.

The bad news though that is the report will show that these plans offered by self insured companies will be structured to only appeal to healthy, low-risk employees by not offering benefits that the government exchanges or;

• Limit the number of specialists in a provider network. The exchange could be more attractive to someone who needs a specialist for an expensive chronic condition.

• Couple high premiums with discounts for participating in wellness programs. Employees who are not in the best of health may not want or be able to participate in wellness discounts, such as going to the gym three days a week.
• Raise deductibles and co-pays. Substantial co-pays or deductibles are unattractive for someone who frequently sees a doctor for a chronic condition. High co-pays don’t matter as much for those who see a doctor infrequently.

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Finally, today the Supreme Court will meet to discuss how to begin the debate on health reform.  I am quite certain that they already know their individual views on it and most certainly those views will be based on their own partisan politics.

Health insurance brokers like me have been waiting over a year now to begin this debate and many of us are on the edge of our seats as we wait to find out what the future (if any) holds for our battered industry.  The main sticking point of course is the individual mandate that requires all Americans to obtain health insurance coverage.

There are currently four pending cases from lower courts that challenge the mandate and the courts will similarly decide if other aspects of the law are Constitutional.   The private conference is scheduled for today, Thursday November 10, 2011.  A decision will be likely be released on Monday but it could come earlier, even this afternoon.

Once they decide to hear the case (likely), by springtime arguments would begin and with any luck June will bring a ruling.  And then if we are lucky, they will also have time to compliment my hair.

Of the four lawsuits, the lawsuit brought by 26 states is likely to get the nod based on the fact that the federal government has been reviewing that one and it has the most prominent legal questions.

Other questionable aspects of the law that the court will likely review include the Medicaid expansion and the new employer requirements.  The main other issue is called the Anti-Injunction Act which itself bars reviewing the individual mandate until the law goes into effect in 2014 as obviously no one has anything to complain about yet until the “damage occurs” so to speak.

It has been a precedent until now that Americans must file a tax before they can challenge it in court — applies to the health law’s penalties.  At the end of the day though there has been much dissension on this issue from other courts.

The Last Big Question

Will the justices take up the severability question separately?  This is a question of assuming the individual mandate is ruled against, does anything else go with it?  Maybe the entire act becomes illegal.  The Obama people will likely want to spend considerable time arguing this as a hedge in case one part is struck down as in the baby and the bathwater.  The current Obama argument specifies that only two insurance reforms can be combined under the mandate — requirements that insurers accept all applicants even if they have pre-existing conditions and apply so-called community rates.  Obviously everyone else wants the whole bathtub and the house thrown away with the baby.
Will one of the justices recuse?

Advocacy groups have tried to put public pressure on Justices Elena Kagan and Clarence Thomas to remove themselves from the case. Opponents of the law argue Kagan should recuse because she may have been involved in the strategy against the lawsuits while she worked in the Obama administration. Supporters of the law argue Thomas has a conflict because his wife is working to defeat the law. Neither have indicated yet that they would recuse themselves from deciding the case — and neither is expected to. But it would be noteworthy if they didn’t participate in this week’s discussion on how to move ahead.

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They’re Taking Our Jobs

The one thing that is becoming crystal clear about the ObamaCare health reform act is that no one understands it or more importantly understands its implications.  Recent data “published this week by a left-leaning policy think tank contradicted Republican claims that the law will exacerbate unemployment rates — but it also undercut the assertion by House Minority Leader Nancy Pelosi, D-Calif., that the law will create jobs.” So does this mean the net effect is 0 jobs?  Probably not, and if so no one can prove it.  The think tank the Urban Institute claims in its study, The basic conclusion is that the ACA will not have a noticeable effect on net levels of employment.” So essentially, this enormous change to the economic and social government has the potential to cause job losses, but that it should be under the right circumstances, ultimately be offset by employment increases triggered by other provisions.

Aetna Sues for Incredible Medical Bills

In the ultimate display of irony a recent news report has health insurer “Aetna Inc suing six New Jersey physicians over medical bills it calls ‘unconscionable,’ including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74.”

Yes, you read that correctly.  I only wonder if Aetna even paid the bills and then sued or sued in lieu of paying the claims.  Bloomberg News adds, “The lawsuits could help determine what pricing limits insurers can impose on ‘out-of-network’ physicians who don’t have contracts with health plans that spell out how much a service or procedure can cost.” In particular, Aetna’s “lawsuits, filed in superior court in Camden, New Jersey, over the last eight months, allege the defendants violated New Jersey Board of Medical Examiners rules against excessive fees, and seek triple damages under state insurance- fraud laws against filing false or misleading claims.”  So this piece might not have much to do with current health care reform news but it might have long reaching effects down the line.

GAO Analysis Finds That Health Insurance Denials Frequently Reversed On Appeal.

The Government Accountability Office, the investigative arm of Congress, has been busy fulfilling the requirements of these denials laws, which call for reports on various concerns from credit and debit card fees to the advice that workers are receiving about their 401(k) plans to application and coverage-denial rates for private health insurance.” The GAO reviewed data that “indicated that health insurance denials are frequently reversed on appeal.” Notably, “the GAO found that 39 percent to 59 percent of appeals filed with insurers in those states resulted in the insurer reversing its coverage denial.” So, a good piece of advice is to file an appeal if you are denied coverage.

Insurers Seek Growth Elsewhere

One big change that has been reflected in the stock prices of the health insurance sector (its way up) has been worried insurers to new business lines.

Where are they investing? In acquiring less-regulated companies that could yield strong profits and make the main business – insurance – more lucrative. The purchases also could increase insurers’ control over more parts of the health system.

Some insurers have moved into technology (including United messing around with SEO), health-care delivery, physician management, workplace wellness, financial services and overseas ventures in wide-ranging efforts to mitigate the new rules imposed by the law. Since June 2009, seven of the nation’s largest insurers have made 25 major deals, and only six of those acquisitions run health plans, according to an analysis of data collected by FactSet Research Systems, a private company.

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With news of the House Republicans offing the health reform bill, one can only think what wonderful symbolic action might be next for them.  Maybe they should consider symbolically voting away bad dreams for children as who wants that?  Or maybe the should symbolically vote on extending Christmas to be everyday of every year.  Both of these symbolic votes would be equally effective to the vote this morning on repealing health reform.

So who voted to repeal the bill from the democratic ticket?  Writing in the Huffington Post (1/20), Lucia Graves notes that the three Democrats who backed the repeal were Dan Boren (OK), Mike McIntyre (NC), and Mike Ross (AR). The Hill (1/20, Millman) reports in its “Healthwatch” blog, “Democratic support for the repeal measure fell far below the projections of some high-profile Republicans. Earlier this week, Rep. Steve King (R-Iowa) predicted this week that 15 Democrats would vote for repeal.” Meanwhile, “earlier this month, Energy and Commerce Committee Chairman Fred Upton (R-Mich.) predicted the repeal vote would gain some bipartisan backing.”

A Promise Kept

So now that the GOP in the House has met their campaign promise to voters, they will have more time to start working on other important issues like these crazy death panels.  But what does the public feel about health care reform now you may ask?   On NBC Nightly News (1/19, story 3, 2:10, Williams), Chuck Todd discussed the new NBC News/WSJournal poll, which found that “45% oppose repealing” the healthcare law, and “45% favor repealing it. And it is ideological. Democrats are against it, Republicans are for it. It really does split down the middle.”  However what the NBC poll doesn’t show is that many that favor repealing, want to repeal it because it is not “liberal enough,” and does not completely socialize medicine as it is in the rest of the free, bankrupt world.  (To be fair we are bankrupt too).

So Now Save Us (Symbolically Speaking) from Death Panels & Abortion Funding

“House Republicans will follow their health care law repeal vote with a more targeted attack: legislation to take down provisions that they contend allow for taxpayer funding of abortion.” Politico adds that “anti-abortion legislators will introduce the No Taxpayer Funding for Abortion Act as H.R. 3 on Thursday. The bill intends to prevent federal funding for abortion procedures by codifying the Hyde Amendment, which has long barred federal agencies from paying for abortions.” However, “supporters of abortion rights have long argued that the health reform law does not allow for taxpayer funding of abortion and has the necessary safeguards to prevent public funds from being spent on the procedure.”

Where Do We Go From Here?

Now that the repeal passed through the House it heads to the Senate where it will be debated literally to death, before being upheld by the entirely Democratic Senate.  ” While the “Senate showdown may not begin for several weeks,” it “promises to be substantially messier and more drawn out than the debate just completed in the House.” The Times says, “The result could be a return to bitter, partisan gridlock ahead of a budget confrontation in March, when the health law repeal could become intertwined with a debate over federal spending.”

Remember the Republicans have a great old plan to strangle the health bill to death by withholding funding.  But of course now the GOP’s real work begins. “The next steps — hearings, testimony from administration officials, funding cuts — lack the punch of a straight repeal vote, but Republicans said they will keep at it, hoping the end result is the same: stalling implementation of the $900 billion law.” In addition, “Republicans promise to hold a series of hearings and oversight investigations into the law, attempt to repeal individual provisions and craft an alternative health care plan. Some of the first issues they will tackle are the cost of the law, the mandate on larger employers to provide coverage and the impact of the legislation on the states.”

And What About Malpractice?

Most importantly (and rightfully so) are proposals to revamp the medical malpractice liability system. Changing the liability system is a longtime priority of many physicians and Republicans, who blame it for increasing health care costs. That is the focus of a Thursday hearing in the House Judiciary Committee that Chairman Lamar Smith said will lay the groundwork for replacing the law.” In contrast, “Democrats have resisted changes — such as proposals to cap damages — and sided with trial lawyers and consumer groups who say injured patients deserve to be compensated,” although “President Obama has said the current system does not serve patients or doctors and indicated he would support alternatives.”

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I know that many of my fellow health insurance brokers are just itching for the House vote next week preying for a vote against the health bill by the new Republican House members which of course could lead to a total recission at the Senate, and then finally a crescendo when Obama signs to repeal his own law!  I also know that many Christian evangelists are holding out hope that Jesus may return this year and end the earth except for the agnostics and non believers who of course will have to walk the earth which won’t be a fun place without the Christians.

The question is which of these things have a better chance of happening in 2011.  Well, I am Jewish so I really hope number 2 doesn’t happen, but on the other hand, number one seems like a bad break for my thriving health insurance brokerage which is doing pretty well these days at the top of Google.  But of course the question wasn’t which one would I rather see happen but which one has a better chance, and sadly I am picking number 2 based on the fact that according to many versions of the bible it happened once before.  The same can’t be said for a President repealing his own legislation.

In any event there were a couple of great Florida health insurance articles (the link points to my own great site on the topic not the articles which I am about summarize anyways) about the fact that Florida has done absolutely 0 so far in preparing for 2014 regarding setting up a health exchange.  Many of my fellow brokers are preying that we don’t become like the extinct travel agent or worse like those people that sell their organs on Craigslist (that’s not a great analogy, but I wanted to reference that great money making idea for my fellow brokers looking for alternative ways to generate money).

The two main threats being that MLR will make it impossible to pay commissions and worse that health exchanges will be the only avenue to buy health insurance, and that the exchanges won’t need agents.

Our state (Florida) has a NAHU meeting yesterday and some top insurance reps warned us to take an active role in setting up the health insurance exchanges in order to be like the great state of Utah which in fact already has a health insurance exchange albeit with awful commissions at 7 percent.  Don’t ask me how agents will be involved when someone shops for health insurance in Utah as that seems as ridiculous as WalMart letting me open a mini Walmart in my car where I can sell guns and ammo near an Arizona shopping center.

The four executives on the panel at Thursday’s forum, which was hosted by Tampa Bay Association of Health Underwriters (TBAHU, we are a member of the Miami chapter in fact) included Jonathan Anderson of Blue Cross Blue Shield of Florida and Sherry Baker of Aetna.  Sherry Baker is currently trying to figure out if she can afford to pay my agency higher commissions based on our outrageously high production than most other brokers.  So if you read this Sherry, for the love of God, please say yes and I in return will get an Aetna tattoo on my genitals.

The four had remarkably similar views on the health-reform law, mostly positive. It has some flaws, they said, but it will bring coverage to many millions of uninsured Americans, most of them healthy enough to improve the risk-pools. In other words: Lots of new business.

Bottom line, said Anderson from Blue Cross, “4.2 million Floridians don’t have insurance, and we have got to find a way to help them find coverage.”

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With health care reform ready to sick its ugly teeth into our health care system, I have been at a loss in order to continue upgrading this site based on helping people shop and understand health insurance.  Because of the coming changes as of 9/23 and then even more changes coming on 10/1 and then even more unpredictable craziness to follow over the next three years, I am terrified of having to update this entire site with each change as I will end up spending my entire life rewriting the same articles again and again.

So what am I to do?  All I can think to recommend to people is that they call us at 888-803-5917 to get live assistance or email us with their unique situations.

I totally support this reform and lets not forget how bad health care was getting before it, but on the other hand I don’t remember it being this absurd.  I can’t even shop plans right now with an effective date of 2 weeks away as no companies have approved plans!  Yes that’s right I can’t sell health plans if they have an effective date of more than 2 weeks from now.   And prices?  They are even more unobtainable for most Americans.  With local government going bankrupt in the face of poor central banking planning, there are even less subsidies available for those Americans that can’t afford coverage.

Yes somehow, a bad situation has become worse.  Its not a question of politics or opinion, its a life and death situation and sadly there is no answers for people that can’t obtain health insurance right now nor is there a shining light on the horizon.  But like I said our brokers at East Coast Health Insurance know health insurance and health reform and can help you find the program or plan from the insurance companies or the government itself, so give us a whirl you have nothing to lose.

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