Health Insurance Blog

Research gathered from pre-election surveys compiled by the Kaiser Family Foundation in conjunction with researchers from Harvard School of Public Health has not surprisingly shown that health care reform is a very important issue in the upcoming election.  Seventy percent of registered voters believe that significant changes are needed in our existing health care system.  Among Obama supporters, health care reform ranked as the second most important issue in the upcoming election and forth among McCain supporters.   Supporters of both candidates both agreed that the top priority of health care reform should be affordable health insurance.

There has been a considerable amount of discussion surrounding the health care proposals from presidential candidates Obama & McCain, however state-level health care plans haven’t received much attention.

Arizona in particular has a health care initiative on the ballot called Arizona Proposition 101.  If this proposition were to pass, the state of Arizona would be blocked from enacting a universal health care plan.  Essentially it would block Arizona from moving towards a health care platform like the one that is currently in place in Massachusetts, which requires all residents to purchase health insurance or pay a fine.  In addition, if Proposition 101 passes it will serve as a basis for a legal challenge should the federal government move towards a national health insurance mandate.

More information about health insurance in Arizona.

A brief prepared by Mark Farrah, ranks health insurance companies across the nation based on their enrollment of individuals & families in non-group health plans, i.e. individual health insurance.

In the private health insurance marketplace there are an estimated 17 million individuals enrolled in non-group health insurance coverage purchased directly from insurance companies, although only just over 11million in membership was captured in this analysis which relied on NAIC and CA Dept of Managed Care Data.

Major medical health insurance plans make up the vast majority of non-group health plans, but limited benefit plans make up a material portion and are growing in popularity as health insurance premiums continue to outpace wage increases.

The brief found that 229 health plans were offering major medical health coverage to individuals & families.

The rankings were as follows:

1. Wellpoint/Anthem (BCBS in 11 states)      21% market share
2. HCSC (BCBS in 4 states)                              7%
3. BCBSNC                                                      4%
4. BCBSFL                                                       4%
5. Regence (BCBS in 4 states)                         4%
6. United HealthCare                                     3%
7. Aetna                                                         3%
8. Humana                                                     3%
9. BCBSMN                                                     2%
10. Assurant                                                    2%
11. Other (219 companies)                            46%

In the limited Benefit Plan marketplace, United American maintains a dominant position with 70% market share.

The most surprising finding in the major-medical health insurance rankings is that Blue Cross Blue Shield of North Carolina as the 3rd highest membership across the country, covering over 350,000 individuals with their Blue Advantage offering for individuals despite covering a service area that is limited to the state of North Carolina.

Gary Bolt, and Bruce Allen deserve much praise for their work managing the individual direct sales unit at BCBSNC.

The Centers for Medicare and Medicaid Services (CMS) announced in a memo to health insurance companies that they have a plan to combat rapidly rising commissions paid out to insurance agents selling private Medicare Advantage plans.  Some health insurance companies are paying as much as $600 to an agent for an enrolled member. Three of the market leaders in selling Medicare Advantage plans include Aetna, Humana, and United Healthcare.

Rules that CMS put in place Sept. 15 to prevent “churning” (encouraging customers to enroll in a different plan each year so the agent can receive a higher commission associated with the first year of enrollment in a health plan) have had the unintended consequence of increasing agent commissions across the board.

It appears as if new changes will be put in place to correct this problem next year as both Senate Finance Chairman Max Baucus, as well as Pete Stark, who chairs the House Ways and Means Health Subcommittee have mentioned plans to cap commissions.  In addition, both Humana and UnitedHealth have weighed-in supporting CMS corrective action.

AP reporter Kevin Freking weighed on on McCain’s health care proposal and how the encouraged interstate shopping for health insurance might effect the market.  Mr. Freking’s take is that the interstate shopping would clearly benefit younger healthier Americans that are healthy enough to purchase health insurance from a health insurance company in a state that has few consumer protections and thus can offer individual health insurance at a much lower cost. However, as healthy individuals from heavily regulated states (such as New York) begin buying health plans across state lines from states that do not require mandated benefits they don’t need, the health coverage from the heavily regulated states will continue to spiral upward in cost, as the only customers who will continue to purchase from those states are the ones who have no choice due to their health conditions, and who are very expensive to insure.

McCain has acknowledged the need to help the chronically ill folks who could be left behind without government assistance and has proposed a guaranteed acceptance health plan run by the state and governed by a board representing health insurance companies, businesses and consumers.  Health insurance rates would be capped at 150% of the standard plan sold in the state.  This plan would essentially build on programs running in 34 states already as of the end of 2007.

As a comparison of  the competing health care plans, McCain’s plan focuses on changing the tax code to expand health coverage, particularly the individual health insurance marketplace, while Barack Obama’s plan aims to subsidize the cost of health insurance for low-income families so that they could afford to purchase coverage.

Both health care plans have their warts, and both plans have their critics.

Things you should consider when shopping for a health insurance plan for you and your family.

Make sure your family doctor or any specialists that you typically use or plan to use in the future are in the network.  Co-pays and co-insurance percentages will be higher to utilize service from out of network doctors.  Some health plans may not provide any out of network benefits.

If possible, research your health care spending done in previous years and figure out what you might need going forward (i.e. if you see that you rarely if ever require prescription drugs, it might not make sense to enroll in a health plan that includes prescription drug benefits if the additional expense is high.)

If your health care utilization is typically low, and your family is in good health, a high-deductible health plan might be a good option.

If your spouse has health insurance coverage through his or her employer, check to see if the portion on the monthly premium that the employee pays is more or less than what you would pay with your employer sponsored plan or individual health insurance plan.

Does the health insurance plan offer a wellness plan, or alternative medicine discounts which could save you money.

You can shop and compare individual health insurance plans here at healthinsurancesort.com.   Some other resources that might be useful include your state department of insurance, or if age 65 or older, www.medicare.gov.

Aetna CEO Ron Williams recently called for health care reform to include a mandate to purchase individual health insurance.  He stated

“Some people can afford health insurance and choose not to be covered,” he said. “Others should get a tax subsidy or credits to purchase insurance.”

Williams went on to state that nearly 20% of uninsured Americans (9 million) earn more than $75,000 per year, and should be able to afford health insurance but choose not to.  Another 10% are college students.

Health care costs can be better controlled if more people are insured and if a health plans risk pool is more evenly distributed between healthy and sick individuals.  If Healthy people choose not to be covered because they don’t utilize the benefits, and only people who desperately need health insurance purchase it, the cost of coverage becomes much higher.

Williams also commented on Senator McCain’s health care proposal stating that while it contains some good points, the tax incentives it would clearly weaken the employer-sponsored health care system which is the backbone of the market.

Medical Mutual of Ohio announced that 11 disks contained personal information on more than 36,000 Ohio retirees is missing and believed to be somewhere within the postal system.

The retiree groups that are affected include:

• The School Employee Retirement System (SERS) and its employees
• The State Teachers Retirements System (STRS)
• Ohio Police and Fire Fund and
• The Ohio Highway Patrol Retirement System.

The disks were part of a typical mailing to the reitiree groups for the purpose of claim reconciliation.  Medical Mutual is taking steps to insure the security of customer information and has offered to provide credit monitoring services, free credit reports, and a hotline to answer questions and help with resolving potential fraud.

members of the Ohio Retirement System with questions or concerns about this issue may call 800-854-8139.

More information about Ohio health insurance and Medical Mutual.

The Blue Cross and Blue Shield Association recently released the findings of a research study which concluded that health insurance shoppers are much more vigilant about both their health as well as their health care related costs when they are enrolled in a consumer-directed health plan (CDHP).

Specifically, the report entitled 2008 CDHP Member Experience Survey found that members enrolled in CDHPs were:

• 30% more likely to track their health care expenses and
• 27%  more likely to ask their doctor about the costs of treatments before moving forward

In addition, enrollees were more proactive in seeking preventative care such as check-ups, physicals, and preventive screenings.

In aggregate, Blue Cross Blue Shield member health plans cover more than 4.4 million members nationally with CDHPs, of which about two-thirds are enrolled in health savings accounts.

visit http://www.bcbs.com/news/bluetvradio/consumerdriven2008/ for a webcast of the complete presentation.

A recent report released by First Focus (www.firstfocus.net) examines how the presidential candidates health care reform plans will impact children, and identifies pros and cons with each plan, as they relate to children.  The report also takes into account the unique health care needs of children including the impacts of tax credits, purchasing private health insurance across state lines etc.

Recently, there has been a significant amount of time spent by various organizations analyzing each candidates respective health care plans and postulating about what the impacts might be.  However, this is the first study that we have seen to specifically address what the impacts might be on children’s health coverage specifically.  The report was commissioned by First Focus and authored by Peter Harbage, Hilary Haycock, and Michael Odeh of Harbage Consulting, LLC.

The report can be viewed at http://www.firstfocus.net/pages/3519/.

note:  First Focus claims to be a bi-partisan group, but the report clearly seems to be biased against McCain’s plan.  For example, the report claims that the ability to purchase health insurance across state lines will result in million children losing coverage due to the absence of mandated benefits.  The ability to purchase health insurance across state lines, is an option but will not change a families ability to purchase coverage within a state of residence that currently has desired mandated benefits in place.