Health Insurance | HealthyCal
 

Posts Tagged health insurance

  

Bill would mandate maternity coverage

Published: February 2, 2011 | No Comments

By Daniel Weintraub

The chairwoman of the Legislative Women’s Caucus has introduced a bill that would require health insurance plans marketed to individuals to include comprehensive maternity coverage.

Current law already requires Health Maintenance Organizations and group insurance plans to cover maternity services. But individual plans are exempt from that rule. The percentage of such plans offering maternity coverage has dropped from 82 percent in 2004 to 19 percent in 2009, according to Sen. Noreen Evans, D-Santa Rosa, the author of the bill.

“The status quo singles out women, narrows their health options, and forces them into a market scheme that makes finding comprehensive coverage more difficult and expensive,” Evans said in a statement released by her office. “These women are responsible actors, seeking to purchase health insurance out of their own pocket. Forcing these women to pay higher costs, and often nudging them out of the market altogether, simply because they are women who may become pregnant is fundamentally wrong.”

SB 155 is supported by the American Congress of Obstetricians & Gynecologists. The group says prenatal care is essential, improving outcomes for mothers and babies, and, ultimately, saving money.

The insurance industry has opposed similar legislation in the past, contenting that mandates requiring coverage for specific services limit consumer choice and drive up the cost of policies for everyone.

 

3.4 million Californians would get coverage through federal reform

Published: January 5, 2011 | No Comments

By Daniel Weintraub

About 3.4 million Californians who would otherwise be without health insurance will have coverage by 2016 if the federal health reform approved last year is implemented on schedule, according to new research published in the journal Health Affairs.

The boost in coverage would mean that 96 percent of Californians under age 65 who are legal residents in the U.S. would have some form of private or public health insurance, according to the article, by Peter Long, president and chief executive officer of the Blue Shield of California Foundation, and Jonathan Gruber, a health economics expert and professor at the Massachusetts Institute of Technology.

That would cut the rate of uninsured in the state by more than 50 percent.

The change is expected to mean a major expansion of Medi-Cal, the state’s program for the poor, with 1.7 million additional people enrolling in the program, most of them paid for by the federal government. Another 4 million people are expected to get coverage through a new health exchange that the state will manage as a clearinghouse for private insurance companies offering standardized plans to individuals who can’t get coverage elsewhere.

Another big change anticipated by the authors: employers, especially small employers, will cover fewer people. The paper estimates that about 870,000 fewer people would have their coverage through an employer after the plan is fully implemented. This is the net result of several different factors, including about 1.5 million employees losing their coverage once their employers see that their workers would get a better deal using subsidies to buy insurance through the state-run exchange, while about 900,000 people who had previously turned down coverage from their workplace would now accept it, because of a federal mandate requiring nearly everyone to have insurance.

The authors’ model estimates that about 330,000 Californians who had insurance at the time the law was implemented would lose it, mostly because their employers stopped offering coverage and the individuals could not afford to buy it on their own, even with subsidies from the federal government.

Of those who remain uninsured in 2016, the largest group, about 40 percent, would be undocumented immigrants, who are not eligible for the subsidies under the new law.

Of the rest, about 60 percent would not be subject to the mandate requiring individuals to have coverage, because the costs would exceed 8 percent of their income or their income would be below the threshold triggering a penalty for failure to buy coverage.

Looking at the roll-out of the plan from a regional perspective, Long and Gruber estimated that Los Angeles County would account for about half of the reduction in the number of uninsured in the state. San Diego would see the largest decline in the percentage of its residents without insurance, and would be the only area of the state to see an increase in employer-sponsored coverage.

The authors estimate that the plan would have a $12.6 billion positive impact on California households. This includes $4.8 billion in higher wages that employers would pay instead of health premiums, $4.4 billion in subsidies to people buying coverage through the exchange, and a $3.4 billion increase in state and federal spending on public programs for the poor.

That benefit would be targeted most at low-income households, and in fact, people with very high incomes would see an increase in their costs, according to the paper.

Families with incomes below 133 percent of the federal poverty level would see a benefit averaging about $1,086, thanks to paying lower taxes as part of the law. People with incomes between 133 percent and 199 percent of the federal poverty level would see a gain of about $2,000 per year.

Most middle-income families would see little change in their costs due to the plan. Only families with incomes of 10 times the federal poverty level, or about $220,000 for a family of four, would experience an increase in costs, losing about $3,000 a year because of the higher Medicare payroll tax.

The authors note that $3,000 for a family earning 15 times the poverty level would amount to less than 1 percent of their income, while the $1,086 benefit for a family of four at the poverty level would represent an increase of 5 percent of their annual income.

Note: Access to the full article is restricted on the Health Affairs web site. A link will be provided today through the Blue Shield of California Foundation web site here.

.

 

New rules require insurers to justify rate increases

Published: December 21, 2010 | No Comments

The Obama Administration has rolled out new rules requiring health insurers to justify any annual rate increases of more than 10 percent.

The proposed regulations, unveiled Tuesday by Health and Human Services Secretary Kathleen Sebelius, represent an escalation of federal involvement in a field historically left to the states.

But the White House said only 26 states have the power to block unreasonable rate increases, and many states lack the resources to effectively police the insurance industry. The new federal rules will come with $250 million set aside in the health reform bill to beef up state regulatory bodies, which will implement the 10 percent rule and examine the insurers’ justification. In states that still cannot handle the increased workload, the federal government will perform the review.

States that don’t now have the power to block rate increases, including California, won’t get that power under the new federal regulations. But they will have the ability to force companies to publicly defend their rates. In theory, that increased level of transparency will lead to smaller increases.

California Gov. Arnold Schwarzenegger signed legislation in October that requires insurance companies to give 60 days public notice before raising rates and to provide more information justifying their rate increases to state regulators.

Here is an HHS statement on the regulation.

–Daniel Weintraub

 

Federal judge rules against Obama health care plan

Published: December 13, 2010 | 1 Comment

A federal judge in Virginia has ruled that it is unconstitutional for the federal government to require people to buy insurance — a crucial piece of the health reform bill passed earlier this year.

Judge Henry Hudson ruled that the so-called individual mandate in the health reform law oversteps the power of Congress to regulate interstate commerce under the Commerce Clause in the US Constitution.

Although the judge’s ruling applies only to the mandate, that provision, scheduled to take effect in 2014, is a key part of the law. Without it, another much more popular provision — the rule prohibiting insurance companies from denying coverage to people with pre-existing conditions — would be difficult to sustain.

If insurance companies must sell policies to anyone, even if they are already sick or injured, and people are not required to buy insurance when they are healthy, consumers would have a strong incentive to not buy coverage until they needed it. That would be like letting people buy fire insurance while their house is on fire.

The idea of the individual mandate is to spread the risk in health insurance as broadly as possible by requiring everyone to have coverage. People who couldn’t afford it would be subsidized by the government.

The case is expected to be appealed, and to eventually reach the US Supreme Court.

But Hudson found that it would be unconstitutional for the federal government to require people to buy a private product — health insurance. He found nothing in the constitution or in case law that allows the government to impose such a requirement. It’s one thing, he said, to regulate economic activity. It’s an entirely different thing to regulate inactivity.

Here is a key paragraph from Hudson’s opinion:

A thorough survey of pertinent constitutional case law has yielded no reported decisions from any federal appellate courts extending the Commerce Clause or General Welfare Clause to encompass regulation of a person’s decision not to purchase a product, notwithstanding its effect on interstate commerce or role in a global regulatory scheme. The unchecked expansion of congressional power to the limits suggested by the Minimum Essential Coverage Provision would invite unbridled exercise of federal police powers.

The Obama Administration had argued that the mandate’s enforcement mechanism, a fine on those who failed to buy coverage, was really a tax, and outside the court’s purview in this case. But the judge said the fine was not a tax — and noted that the Administration said the same thing during the debate over the bill.

One easy fix would be for Congress to impose a health care tax and then offer a credit of an equal amount to anyone who could show proof of coverage. That would have the same effect as the mandate but would clearly rest within the taxing powers of Congress.

That would have been an easy fix, if the Democrats still controlled Congress. But Republicans are not going to pass such a tax, and their opposition will be even greater if it is portrayed as a way to save the reform legislation.

 

Nearly 6 million Californians lack access to jobs-based health coverage

Published: November 30, 2010 | 1 Comment

Living in a household with someone who has a job is no guarantee that a Californian will have access to job-based health insurance, according to a report from the UCLA Center for Health Policy Research.

About 20 percent of Californians under age 65 who live with at least one person who is employed did not have access to job-based health insurance in 2007, the UCLA policy brief said. That’s 5.7 million people.

And adults who lacked access to job-based coverage generally found it difficult to obtain health insurance at all. Only one-third had done so, through Medi-Cal, private insurance or a parent’s health insurance plan.

Children do better, thanks to public programs that subsidize their coverage. Nearly 60 percent found coverage through Medi-cal or the Healthy Families program and 7.5 percent had private insurance.

See the full policy brief here.

–Daniel Weintraub

 

Republicans will find it harder to repeal health reform than it was to campaign against it

Published: November 3, 2010 | No Comments

By Daniel Weintraub

Newly ascended Republicans in Congress say one of their first goals will be to repeal the health care reform law Democrats in Congress and President Barack Obama enacted in March.

But that task is likely to prove more difficult than they believe, or at least harder than Republican politicians are letting on to their supporters.

Republican leaders on Wednesday were citing a CBS News exit poll that found nearly half of voters saying they wanted the law repealed. But as Obama pointed out in a post-election press conference, that also means that half of the voters want the law preserved.

Besides, those impressions, especially the negative ones, are based largely on opponents’ characterization of the reform as a federalization of health care, a big-government over-reach that will fundamentally change the way most people get their insurance and their care. Rep. Eric Cantor of Virginia, expected to be the majority leader once Republicans take control of the House, called the law an “abomination” and said he expected to have a bill to repeal it on the floor of the House “right away.”

But Republicans know they have no chance to repeal the entire bill with the Senate still in Democratic hands and Obama in the White House. So they instead will try to chip away at it, piecemeal. But the American public might not be as supportive of that approach, because many of the individual pieces of the plan are far more popular than the concept of a big, comprehensive, government-led overhaul. The parts of this many-faceted law are more popular than the whole.

Republicans, for instance, are unlikely to try to repeal provisions that will prohibit insurance companies from denying coverage to people based on pre-existing conditions, or allow families to keep adult children on their policy until age 26. Both ideas are very popular with the public. Other pieces will make preventive care available without out-of-pocket charges and prevent insurers from using errors in consumers’ applications to justify rescinding coverage to people after they get sick.

GOP lawmakers could try to roll back the bill’s requirement that every individual have insurance, either through an employer or on their own, probably the least popular provision in the bill. But many Americans who have coverage now might see that mandate as a way to get “free riders” to take responsibility for their own care. Also, Republicans know that if they repeal the mandate, they would wreak havoc on the insurance market if they left in place the more popular requirement that insurers sell to all comers, because without the mandate, people would have a big incentive to simply wait until they were sick to buy insurance.

Republicans are also not likely to try to repeal subsidies for small employers to help them buy coverage. They might try to repeal the bill’s subsidies for low-income people, but that’s hardly a huge rallying point for their supporters. In other words, if they can’t repeal the entire program in one swoop, and they can’t, at least until 2012, they will find it very difficult to build broad public support for incremental roll backs.

Obama mentioned some of the more popular parts of the bill in his press conference Wednesday and, while saying he would work with Republicans to tweak it, he all but dared them to try to repeal it.

“I don’t think that you’d have a strong vote for people saying, you know, “Those are provisions I want to eliminate,” the president said.

He added: “Now if the Republicans have ideas for how to improve our health care system, if they want to suggest modifications that would deliver faster and more effective reform to a health care system that, you know, has been wildly expensive for too many families and businesses, and certainly for our federal government, I’m happy to consider some of those ideas.”

 

Blue Shield Foundation funds county grants to expand health services

Published: September 21, 2010 | No Comments

By Daniel Weintraub

A major health insurance company’s non-profit foundation is giving nearly $2 million to 12 California counties to help them plan for a federally-financed expansion of care to low-income residents.

The grants will help the counties apply for federal money to match what they are already spending on care for the indigent, allowing them to expand that service in advance of changes coming as part of the federal health reform enacted early this year.

“California’s counties have a unique opportunity to expand health coverage to thousands of people who need it today,” Peter Long, president and chief executive officer of the Blue Shield of California Foundation, said in a statement. “I applaud the initiative that county and state leaders are showing to expand access to care in their communities. Our Foundation is pleased to support their efforts.”

The new planning grants are intended to help the counties demonstrate their ability to deliver care more effectively and efficiently, including by providing better preventive care and coordinating care for patients who now bounce from clinic to clinic and doctor to doctor with little coordination of the services and treatment they receive.

 

Schwarzenegger weighs two bills to boost insurance regulation

Published: September 8, 2010 | No Comments

By Daniel Weintraub

California lawmakers last month rejected a bill that would have subjected health insurance companies to the same kind of regulation that auto insurers now face, requiring them to get prior approval from the state when they want to raise their rates. But it is pretty clear that Gov. Arnold Schwarzenegger would have vetoed that bill anyway.

Instead, the Legislature sent the governor two bills that seek to strengthen the state’s oversight of the industry while stopping short of direct rate regulation. It will be interesting to see if these more modest bills, which are still opposed by the insurance industry, escape Schwarzenegger’s veto pen in the weeks ahead.

One of the bills is SB 1163 by Sen. Mark Leno, would require insurance companies to be more open about their plans, disclosing rate increases farther in advance, proving that what they propose is “reasonable,” and making public the calculations that went into their decisions.

The bill would require insurance companies and health plans to notify customers of planned rate increases 60 days before they take effect, twice the current warning period. It also requires the firms to do extensive, independent analyses of their rate increase proposals, submit that information to regulators and make it public.

The other bill is AB 2042, by Assemblyman Michael Feuer, which would prohibit insurers from raising their rates for individual plans more than once a year.

According to an Assembly staff analysis of AB 2042, premiums paid by small employers with up to 50 workers increased 53 percent between 2003 and 2006, from $250 per month to $382. Premiums for individual coverage rose 23 percent between 2002 and 2006, to $259 per month. At the same time, the average policy for an individual paid a smaller share of the costs of a person’s care, dropping from 75 percent in 2003 to 55 percent in 2006.

Leno, Feuer and their colleagues who supported the bills contend that absent rate regulation, more disclosure would help moderate these increases. They cite a plan by Anthem Blue Cross to raise rates by nearly 40 percent this year, which the company withdrew after fierce criticism from lawmakers and consumer activists. The company later conceded that there were errors in its original calculations and withdrew the increase, only to replace it with a smaller one that has since taken effect.

But the industry contends that the bills would do nothing to slow the increase in insurance costs and might even add to the the trend. Premium increases, the firms and their associations say, are driven mainly by increases in doctor fees, hospital costs, drugs, labs and other costs of health care that the insurance companies simply pass on to their customers. Administrative costs, they claim, are a small part of the equation, but even these are likely to increase if the bills become law and the companies are given new burdens to shoulder.

Finally, it’s not yet clear how these new requirements might interact with the new rules coming down from the federal government as a result of the passage of health reform by Congress and President Obama earlier this year.

Many of these same requirements, and perhaps more, could be part of that regulatory package.

The industry says California should wait and see how that shakes out before moving forward.

But supporters of the bills say California should move now to become a model for the nation and to fill gaps that Congress left in its plan.

 
Page 1 of 612345»...Last »
 
 

Home | Cal Health Report | Community Report | Legislation | Ideas | Forums | About Us

©2013 HealthyCal.org