By M.J. Ellington
DAILY Staff Writer
MONTGOMERY — Financial surprises in the state's employee/retiree health insurance costs in 2005 will mean savings for state agencies and some individuals on the plans in 2006.
Because of cost savings measures put into place in 2004, the State Employees Insurance Board approved a $7.6 million credit toward the 2006 health insurance expenses of state agencies, said SEIB Deputy Administrator Gary Matthews.
State employees who have flexible spending accounts as part of their health coverage will get a $50 credit to their accounts in January. Retired state employees will get a one-time reduction in their January health insurance premium up to $50, Matthews said. The total employee/retiree credit will be $1.4 million.
Although some of the insurance board's cost-saving measures began in 2004, Matthews said the savings credits are due to lower than expected health claims costs for 2005, not the broader changes adopted by the Legislature in 2004.
Extra charge for smokers
The insurance board's Matthews believes it will take two to five years before the state knows the real effect of the broader 2004 reform measures. Some measures, including an extra charge for smokers, are intended to encourage healthy behavior.
The effects of other measures, such as coverage for young people who retire from the state and go to other jobs, are just beginning. "People are just becoming familiar with the options that are available," Matthews said.
Most measures adopted by the Legislature in a 2004 special session that Gov. Bob Riley called on health reform did not go into effect until Oct. 1 of this year.
Riley said spiraling state employee health insurance costs and doom-and-gloom projections for the future were the reason for the changes.
Legislation from the session paved the way for the increased health insurance rates for employees who smoke and retirees who work fewer than 25 years.
It also gave broader powers to the state employee and education insurance boards to adjust premium rates and established a state flexible benefits plan for school employees.
The premium surcharge for people who smoke is $20 a month.
Matthews said he cannot reveal information about individual health accounts, but Gov. Bob Riley already acknowledged that he pays the surcharge.
The Retirement Systems of Alabama's January newsletter said others who pay to light up include retirement systems CEO David Bronner and state Finance Director Jim Main.
Friday, December 30, 2005
Can FSAs or HSAs pay for health insurance?: Financial News - Yahoo! Finance
Q&A from bankrate.com
Dear Tax Talk,
Can you use an FSA to pay for health insurance premiums if you have no benefits through your work? If you are allowed, can you have an HSA as well and just use your FSA to pay premiums?
-- Ken
Dear Ken,
A health flexible spending arrangement (FSA) allows employees to be reimbursed for medical expenses on a pre-tax basis through a plan sponsored by their employers. The plan is usually funded by voluntarily deferring part of your salary into the FSA plan.
A health savings account (HSA) is a tax-exempt trust or custodial account that you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. You must be eligible to qualify for an HSA. It is similar to an IRA, but rather than providing for retirement, it can be used to cover medical expenditures.
Generally, neither plan can pay health insurance premiums. However, an HSA in certain limited circumstances can pay premiums. In an HSA you can treat premiums for long-term care coverage, health-care coverage while you receive unemployment benefits or health-care continuation coverage required under federal law as qualified medical expenses.
If you are age 65 or older, you can treat insurance premiums (other than premiums for a Medicare supplemental policy, such as Medigap) as qualified medical expenses for HSAs. IRS Publication 969 has additional information on HSAs and FSAs and how to qualify under either.
Dear Tax Talk,
Can you use an FSA to pay for health insurance premiums if you have no benefits through your work? If you are allowed, can you have an HSA as well and just use your FSA to pay premiums?
-- Ken
Dear Ken,
A health flexible spending arrangement (FSA) allows employees to be reimbursed for medical expenses on a pre-tax basis through a plan sponsored by their employers. The plan is usually funded by voluntarily deferring part of your salary into the FSA plan.
A health savings account (HSA) is a tax-exempt trust or custodial account that you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. You must be eligible to qualify for an HSA. It is similar to an IRA, but rather than providing for retirement, it can be used to cover medical expenditures.
Generally, neither plan can pay health insurance premiums. However, an HSA in certain limited circumstances can pay premiums. In an HSA you can treat premiums for long-term care coverage, health-care coverage while you receive unemployment benefits or health-care continuation coverage required under federal law as qualified medical expenses.
If you are age 65 or older, you can treat insurance premiums (other than premiums for a Medicare supplemental policy, such as Medigap) as qualified medical expenses for HSAs. IRS Publication 969 has additional information on HSAs and FSAs and how to qualify under either.
Thursday, December 29, 2005
Auto insurance crackdown expanded to Chelsea
December 27, 2005
CHELSEA, Mass. --State and local officials on Tuesday announced a campaign to crack down on automobile insurance fraud here, a move that follows similar anti-fraud efforts in Lawrence and other cities with high claims rates.
A task force in Chelsea, immediately north of Boston, will be the eighth such group created since fraud enforcement was stepped up in Lawrence in late 2003.
The Chelsea task force is a joint effort by the Insurance Fraud Bureau of Massachusetts, Chelsea police, the Suffolk district attorney's office and the state attorney general.
Authorities announced the campaign beneath a billboard erected to publicize a telephone hot line people can call to report insurance fraud.
Among other things, investigators will look into cases in which drivers are suspected of staging accidents so they can file insurance claims and receive compensation for injuries. Last year, 62 people claimed injuries for every 100 accidents in Chelsea, compared with a statewide rate of 36 such claims for every 100 collisions.
Insurers say a crackdown in Lawrence reduced claims there by $28.7 million in 2004 compared with the previous year. The decline helped trigger a planned reduction in Lawrence's 2006 auto insurance rates that is greater than the average 8.7 percent cut statewide.
Other task forces were formed in Boston, Brockton, Lowell, Lynn, Randolph and Springfield/Holyoke.
CHELSEA, Mass. --State and local officials on Tuesday announced a campaign to crack down on automobile insurance fraud here, a move that follows similar anti-fraud efforts in Lawrence and other cities with high claims rates.
A task force in Chelsea, immediately north of Boston, will be the eighth such group created since fraud enforcement was stepped up in Lawrence in late 2003.
The Chelsea task force is a joint effort by the Insurance Fraud Bureau of Massachusetts, Chelsea police, the Suffolk district attorney's office and the state attorney general.
Authorities announced the campaign beneath a billboard erected to publicize a telephone hot line people can call to report insurance fraud.
Among other things, investigators will look into cases in which drivers are suspected of staging accidents so they can file insurance claims and receive compensation for injuries. Last year, 62 people claimed injuries for every 100 accidents in Chelsea, compared with a statewide rate of 36 such claims for every 100 collisions.
Insurers say a crackdown in Lawrence reduced claims there by $28.7 million in 2004 compared with the previous year. The decline helped trigger a planned reduction in Lawrence's 2006 auto insurance rates that is greater than the average 8.7 percent cut statewide.
Other task forces were formed in Boston, Brockton, Lowell, Lynn, Randolph and Springfield/Holyoke.
Family health insurance program starts Sunday
December 29, 2005
SPRINGFIELD -- An additional 56,000 low-income families will be eligible for state-sponsored health insurance starting Sunday.
An expansion in the FamilyCare program raises the qualifying income limit to 185 percent of the federal poverty level, or about $36,000 for a family of four.
''When parents are healthy, they're better able to deal with the challenges of raising their children, and are more productive at work,'' Gov. Rod Blagojevich, who has made health care for the poor a priority of his administration, said in a prepared statement.
Children of low-income working parents also are eligible for state health care through the KidCare program, which is open to families making up to 200 percent of the federal poverty level.
SPRINGFIELD -- An additional 56,000 low-income families will be eligible for state-sponsored health insurance starting Sunday.
An expansion in the FamilyCare program raises the qualifying income limit to 185 percent of the federal poverty level, or about $36,000 for a family of four.
''When parents are healthy, they're better able to deal with the challenges of raising their children, and are more productive at work,'' Gov. Rod Blagojevich, who has made health care for the poor a priority of his administration, said in a prepared statement.
Children of low-income working parents also are eligible for state health care through the KidCare program, which is open to families making up to 200 percent of the federal poverty level.
More low-income families eligible for state health insurance starting Sunday
December 28, 2005 - An additional 56,000 low-income families will be eligible for state-sponsored health insurance starting Sunday.
An expansion in the FamilyCare program raises the qualifying income limit to 185 percent of the federal poverty level, or about $36,000 for a family of four.
"When parents are healthy, they're better able to deal with the challenges of raising their children, and are more productive at work," Gov. Rod Blagojevich, who has made health care for the poor a priority of his administration, said in a prepared statement.
Children of low-income working parents also are eligible for state health care through the KidCare program, which is open to families making up to 200 percent of the federal poverty level.
Families may enroll in FamilyCare and KidCare online at www.kidcareillinois.com or by calling toll-free at (866) 4-OUR-KIDS or (866) ALL-KIDS.
The programs are aimed at families who earn too much to qualify for the Medicaid health care program but too little to buy private insurance. The federal government pays 65 percent of the programs' costs.
Blagojevich earlier this month announced preregistration for a new program called All Kids, which essentially offers insurance to all children in the state, based on their families' ability to pay.
An expansion in the FamilyCare program raises the qualifying income limit to 185 percent of the federal poverty level, or about $36,000 for a family of four.
"When parents are healthy, they're better able to deal with the challenges of raising their children, and are more productive at work," Gov. Rod Blagojevich, who has made health care for the poor a priority of his administration, said in a prepared statement.
Children of low-income working parents also are eligible for state health care through the KidCare program, which is open to families making up to 200 percent of the federal poverty level.
Families may enroll in FamilyCare and KidCare online at www.kidcareillinois.com or by calling toll-free at (866) 4-OUR-KIDS or (866) ALL-KIDS.
The programs are aimed at families who earn too much to qualify for the Medicaid health care program but too little to buy private insurance. The federal government pays 65 percent of the programs' costs.
Blagojevich earlier this month announced preregistration for a new program called All Kids, which essentially offers insurance to all children in the state, based on their families' ability to pay.
Wednesday, December 28, 2005
Low-Cost Auto Insurance Expands to Six Calif. Counties
From Insurance Journal
December 27, 2005
A state law taking effect in 2006 will allow low-income residents in Alameda, Fresno, Orange, Riverside, San Bernardino and San Diego counties, to get driver's insurance for less that $400 beginning April 1, according to the Alameda Times-Star.
Until now, a pilot program has been limited to San Francisco and Los Angeles county residents. But next year it will expand to six more counties under a bill written by state Sen. Martha Escutia, D-Whittier.
In 2000, a bill was imposed as a counter-measure to earlier legislation that made car insurance a requirement for all California drivers. The program, administered by the California Automobile Assigned Risk Plan, has provided car insurance for low-income San Franciscans at a rate of $314 a year. Drivers 19 or older with an income level at 250 percent of the poverty line -- about $23,000 for singles and $47,000 for families of four -- that have been licensed for three years could qualify for a discount.The program also broadens the value of a car that can be insured increases from $12,000 to $20,000.
Coverage includes $10,000 in bodily injury or death per person, $20,000 bodily injury per accident and $3,000 property damage per accident ? all of which are below the state's established coverage minimums. No coverage is provided for the applicant's vehicle.
When the bill was first introduced, the program was opposed by State Farm, the Association of California Insurance Companies and the Pacific Association of Domestic Insurance Companies, according to the paper. The groups questioned how well it was working in the two pilot counties, noted that some participants already had insurance and were just taking advantage of the cheaper rates and suggested that a significant percentage of enrollees were dropping out once they got their cars registered.
The three groups dropped their opposition, however, and the Personal Insurance Federation of California got behind the plan, when Escutia agreed to have the program expire in 2011.
"We still have some concerns with the program, but at the end of the day, Sen. Escutia made a good-faith effort and we're willing to see how it works for the next few years," ACIC President Sam Sorich told the paper.
The program does not involve any state subsidies, but it does force insurance companies to offer the program to qualified applicants on a "fair share" basis, tied to the level of business they're doing in the state.
December 27, 2005
A state law taking effect in 2006 will allow low-income residents in Alameda, Fresno, Orange, Riverside, San Bernardino and San Diego counties, to get driver's insurance for less that $400 beginning April 1, according to the Alameda Times-Star.
Until now, a pilot program has been limited to San Francisco and Los Angeles county residents. But next year it will expand to six more counties under a bill written by state Sen. Martha Escutia, D-Whittier.
In 2000, a bill was imposed as a counter-measure to earlier legislation that made car insurance a requirement for all California drivers. The program, administered by the California Automobile Assigned Risk Plan, has provided car insurance for low-income San Franciscans at a rate of $314 a year. Drivers 19 or older with an income level at 250 percent of the poverty line -- about $23,000 for singles and $47,000 for families of four -- that have been licensed for three years could qualify for a discount.The program also broadens the value of a car that can be insured increases from $12,000 to $20,000.
Coverage includes $10,000 in bodily injury or death per person, $20,000 bodily injury per accident and $3,000 property damage per accident ? all of which are below the state's established coverage minimums. No coverage is provided for the applicant's vehicle.
When the bill was first introduced, the program was opposed by State Farm, the Association of California Insurance Companies and the Pacific Association of Domestic Insurance Companies, according to the paper. The groups questioned how well it was working in the two pilot counties, noted that some participants already had insurance and were just taking advantage of the cheaper rates and suggested that a significant percentage of enrollees were dropping out once they got their cars registered.
The three groups dropped their opposition, however, and the Personal Insurance Federation of California got behind the plan, when Escutia agreed to have the program expire in 2011.
"We still have some concerns with the program, but at the end of the day, Sen. Escutia made a good-faith effort and we're willing to see how it works for the next few years," ACIC President Sam Sorich told the paper.
The program does not involve any state subsidies, but it does force insurance companies to offer the program to qualified applicants on a "fair share" basis, tied to the level of business they're doing in the state.
Insurance for kids
By MIKE SCHWARTZ / The Press-Enterprise
While public attention recently has focused on Medicare Part D insurance prescription program for seniors, California's population of uninsured children, who number about 800,000, has largely eluded media scrutiny.
"These are kids who fall in and out of health insurance all -- or part -- of the year," said Jeff Okey, a spokesman for California Endowment, a private foundation seeking to expand access to affordable, quality health care for underserved Californians.
Children often bounce out of Medi-Cal, Healthy Families or other public programs for which they still qualify when parents don't pay premiums; relocate; miss official mailings; or fail to recertify (usually every six months), Okey said.
"It's interesting that as a society we don't think that's a big problem, or at least don't talk about it that much," said Peter Long, the foundation's senior program officer.
Established in 1996, the California Endowment has set a goal of health insurance for all California children within the next two or three years, Long said.
The foundation took a leap forward this month by awarding $7.5 million in grants to local Children's Health Initiatives (CHI) in 18 counties, including Riverside and San Bernardino.
Children's Health Initiatives are public/private partnerships of health-care providers, business leaders, advocacy groups, foundations, city and county officials, public health leaders and educators.
Each enrolls kids into the state-run Medi-Cal and Healthy Families programs, while also making available private Healthy Kids insurance for children ineligible for public programs.
For a modest premium and co-pay, Healthy Kids offers full medical insurance, dental insurance, vision insurance, prescription and mental health benefits from birth through 18.
Since starting in 2001, Children's Health Initiatives has directly covered more than 80,000 California children and helped enroll an estimated 80,000 kids eligible for state-run programs. Today, nearly 90 percent of California kids receive coverage through a CHI, commercial or public health insurance program.
The new grants will provide enough funding to cover nearly 8,000 children statewide. Funding for Riverside and San Bernardino counties -- to total $600,000 and $350,000, respectively -- will cover almost 1,000 kids in the Inland area.
According to a 2003 survey, about 56,000 children were uninsured in Riverside County and 58,000 in San Bernardino County all or part of that year compared with about 985,000 Inland Southern California children with year-round coverage.
While public attention recently has focused on Medicare Part D insurance prescription program for seniors, California's population of uninsured children, who number about 800,000, has largely eluded media scrutiny.
"These are kids who fall in and out of health insurance all -- or part -- of the year," said Jeff Okey, a spokesman for California Endowment, a private foundation seeking to expand access to affordable, quality health care for underserved Californians.
Children often bounce out of Medi-Cal, Healthy Families or other public programs for which they still qualify when parents don't pay premiums; relocate; miss official mailings; or fail to recertify (usually every six months), Okey said.
"It's interesting that as a society we don't think that's a big problem, or at least don't talk about it that much," said Peter Long, the foundation's senior program officer.
Established in 1996, the California Endowment has set a goal of health insurance for all California children within the next two or three years, Long said.
The foundation took a leap forward this month by awarding $7.5 million in grants to local Children's Health Initiatives (CHI) in 18 counties, including Riverside and San Bernardino.
Children's Health Initiatives are public/private partnerships of health-care providers, business leaders, advocacy groups, foundations, city and county officials, public health leaders and educators.
Each enrolls kids into the state-run Medi-Cal and Healthy Families programs, while also making available private Healthy Kids insurance for children ineligible for public programs.
For a modest premium and co-pay, Healthy Kids offers full medical insurance, dental insurance, vision insurance, prescription and mental health benefits from birth through 18.
Since starting in 2001, Children's Health Initiatives has directly covered more than 80,000 California children and helped enroll an estimated 80,000 kids eligible for state-run programs. Today, nearly 90 percent of California kids receive coverage through a CHI, commercial or public health insurance program.
The new grants will provide enough funding to cover nearly 8,000 children statewide. Funding for Riverside and San Bernardino counties -- to total $600,000 and $350,000, respectively -- will cover almost 1,000 kids in the Inland area.
According to a 2003 survey, about 56,000 children were uninsured in Riverside County and 58,000 in San Bernardino County all or part of that year compared with about 985,000 Inland Southern California children with year-round coverage.
Tuesday, December 27, 2005
Health-care deductions for self-employed Q&A
Q&A from Bankrate
Dear Tax Talk,
Health insurance premiums are allowed as an adjustment to earnings for the self-employed. Is the amount paid over the premium for medical services and prescriptions, in the case of a $1,000 deductible and the 20 percent paid out of pocket, tax deductible for the amounts that may exceed the insurance deductible?
-- Ken
Dear Ken,
An individual with self-employment earnings, including self-employment earnings passing through from a partnership, can claim as an adjustment to adjusted-gross income, or AGI, (line 29 of Form 1040) the premiums paid on a health insurance policy maintained under that business.
The deduction arriving at AGI is limited to the earnings from the business reduced by the deduction for one-half of your self-employment tax (line 27 of Form 1040) and any pension plan contributions deducted on line 28 of Form 1040. Only the amount paid for premiums is deductible as an adjustment to AGI. Any medical expenses such as deductibles, prescriptions and patient co-pays are considered medical expenses deductible as an itemized deduction on Schedule A. In addition, any premiums that exceed the deductibility limit because of income limitations can be deducted on Schedule A.
You can also claim on line 29, subject to the income limitations, amounts paid for long-term-care insurance. You can include premiums paid on a qualified long-term-care insurance contract for you, your spouse or your dependents when figuring your deduction. But, for each person covered, you can include only the smaller of the following amounts.
1) The amount paid for that person.
2) The amount shown below. (Use the person's age at the end of the year.)
a) Age 40 or younger - $260
b) Age 41 to 50 - $490
c) Age 51 to 60 - $980
d) Age 61 to 70 - $2,600
e) Age 71 or older - $3,250
A qualified long term care insurance contract is defined as one that only provides coverage of qualified long-term-care services, such as nursing home or in-home nursing care.
Dear Tax Talk,
Health insurance premiums are allowed as an adjustment to earnings for the self-employed. Is the amount paid over the premium for medical services and prescriptions, in the case of a $1,000 deductible and the 20 percent paid out of pocket, tax deductible for the amounts that may exceed the insurance deductible?
-- Ken
Dear Ken,
An individual with self-employment earnings, including self-employment earnings passing through from a partnership, can claim as an adjustment to adjusted-gross income, or AGI, (line 29 of Form 1040) the premiums paid on a health insurance policy maintained under that business.
The deduction arriving at AGI is limited to the earnings from the business reduced by the deduction for one-half of your self-employment tax (line 27 of Form 1040) and any pension plan contributions deducted on line 28 of Form 1040. Only the amount paid for premiums is deductible as an adjustment to AGI. Any medical expenses such as deductibles, prescriptions and patient co-pays are considered medical expenses deductible as an itemized deduction on Schedule A. In addition, any premiums that exceed the deductibility limit because of income limitations can be deducted on Schedule A.
You can also claim on line 29, subject to the income limitations, amounts paid for long-term-care insurance. You can include premiums paid on a qualified long-term-care insurance contract for you, your spouse or your dependents when figuring your deduction. But, for each person covered, you can include only the smaller of the following amounts.
1) The amount paid for that person.
2) The amount shown below. (Use the person's age at the end of the year.)
a) Age 40 or younger - $260
b) Age 41 to 50 - $490
c) Age 51 to 60 - $980
d) Age 61 to 70 - $2,600
e) Age 71 or older - $3,250
A qualified long term care insurance contract is defined as one that only provides coverage of qualified long-term-care services, such as nursing home or in-home nursing care.
The health insurance meltdown
By John E. McDonough | December 27, 2005
BUSINESS GROUPS ACROSS the Commonwealth are mobilizing against a proposed 5 to 7 percent payroll assessment on employers who don't provide health insurance to their workers. This assessment, approved by the Massachusetts House of Representatives in November, is part of their health reform plan now before a House-Senate conference committee. This debate is of enormous consequence for business -- and for everyone. Here's why.
Nationally, employer-sponsored health insurance coverage is undergoing a meltdown. The Kaiser Family Foundation reports that the percentage of employers who cover their workers declined from 69 percent in 2000 to 60 percent in 2005. That's an alarming drop in five years. The journal Health Affairs documents that the number of uninsured Americans grew by 6 million between 2000 and 2004, primarily because of a drop in employer-sponsored coverage among adults. This jump occurred as the number of Americans with government-sponsored coverage increased.
Massachusetts did not avoid this trend -- it was a trendsetter. The Economic Policy Institute reports that between 2000 and 2004, Massachusetts suffered the third largest decline in workers receiving employer-provided health insurance of any state, 5.6 percent, after Virginia and Arkansas.
Some suggest inadequate coverage occurs only among economically vulnerable employers. It's not true, as last fall's confidential Wal-Mart memo on their employee health benefits program reveals: ''In 2004, 38 percent of enrolled Associates [Wal-Mart employees] spent more than 16 percent of the average Wal-Mart income on healthcare. . . . In total, 46 percent of Associates' children are either on Medicaid or are uninsured."
It's not just Wal-Mart, as a 2005 Massachusetts government report on employers with workers who obtain health benefits through MassHealth or the state's Uncompensated Care Pool shows: Dunkin' Donuts, Stop & Shop, Wal-Mart, McDonald's, and Unicco (janitorial services), head the list -- costing taxpayers more than $12 million in medical services for these workers.
The race to the bottom in health insurance coverage is on. Employers who provide decent health coverage, and their workers, pay higher premiums and taxes to cover employers who don't. Employers who provide coverage pay $160 million annually to finance the Commonwealth's Uncompensated Care Pool; a larger cost-shift is embedded inside everyone's health insurance premium. As the loss of employer-sponsored coverage accelerates, the size of this cost shift grows.
In short, the employer health insurance meltdown threatens everyone -- not only the 532,000 uninsured in Massachusetts.
National data shows employers pay, on average, 12 to 15 percent of gross payroll to provide health insurance. The Massachusetts House payroll assessment does not mandate employers to provide health insurance and does not require employers to pay an assessment even close to that level: 5 percent for employers with 11 to 100 workers, and 7 percent for firms with more than 100 workers.
Some question whether the House plan creates an incentive for employers now offering coverage to drop it and pay the assessment instead. That will not occur because many middle- and upper-income workers in those firms would have to obtain individual coverage on their own, and the payroll assessment revenue would not directly benefit the firm's own workers. Firms dropping coverage would be disadvantaged in competition for good workers.
Others suggest the assessment would lead employers to leave Massachusetts. As the 2005 state survey makes clear, firms that provide no coverage or inadequate coverage, such as Dunkin' Donuts, may leave the state, but can't take their business with them. Overwhelmingly, businesses in Massachusetts that could move to Tennessee or Taiwan cover their workers -- and pay higher premiums to subsidize care for employers that don't.
Businesses opposing the House plan suggest government, consumers, and taxpayers should shoulder the burden to fix our health coverage crisis. Their opposition raises the larger, important question -- what should the responsibility of employers be in providing health insurance to workers? If we don't confront this question now, the answer will not get easier.
Overwhelmingly, opinion polls show the public supports a shared solution involving government, individuals, and employers. A November poll by Gerry Chervinsky found 66 percent of Massachusetts residents support the House payroll assessment.
As the conference committee attempts to craft a health reform compromise, business groups will advertise their opposition to the assessment, confusing the public about the real stakes in health reform. One group calls their effort ''Massachusetts Businesses for Real Health Reform."
Real reform requires everyone -- government, individuals, and businesses -- to be part of the solution.
BUSINESS GROUPS ACROSS the Commonwealth are mobilizing against a proposed 5 to 7 percent payroll assessment on employers who don't provide health insurance to their workers. This assessment, approved by the Massachusetts House of Representatives in November, is part of their health reform plan now before a House-Senate conference committee. This debate is of enormous consequence for business -- and for everyone. Here's why.
Nationally, employer-sponsored health insurance coverage is undergoing a meltdown. The Kaiser Family Foundation reports that the percentage of employers who cover their workers declined from 69 percent in 2000 to 60 percent in 2005. That's an alarming drop in five years. The journal Health Affairs documents that the number of uninsured Americans grew by 6 million between 2000 and 2004, primarily because of a drop in employer-sponsored coverage among adults. This jump occurred as the number of Americans with government-sponsored coverage increased.
Massachusetts did not avoid this trend -- it was a trendsetter. The Economic Policy Institute reports that between 2000 and 2004, Massachusetts suffered the third largest decline in workers receiving employer-provided health insurance of any state, 5.6 percent, after Virginia and Arkansas.
Some suggest inadequate coverage occurs only among economically vulnerable employers. It's not true, as last fall's confidential Wal-Mart memo on their employee health benefits program reveals: ''In 2004, 38 percent of enrolled Associates [Wal-Mart employees] spent more than 16 percent of the average Wal-Mart income on healthcare. . . . In total, 46 percent of Associates' children are either on Medicaid or are uninsured."
It's not just Wal-Mart, as a 2005 Massachusetts government report on employers with workers who obtain health benefits through MassHealth or the state's Uncompensated Care Pool shows: Dunkin' Donuts, Stop & Shop, Wal-Mart, McDonald's, and Unicco (janitorial services), head the list -- costing taxpayers more than $12 million in medical services for these workers.
The race to the bottom in health insurance coverage is on. Employers who provide decent health coverage, and their workers, pay higher premiums and taxes to cover employers who don't. Employers who provide coverage pay $160 million annually to finance the Commonwealth's Uncompensated Care Pool; a larger cost-shift is embedded inside everyone's health insurance premium. As the loss of employer-sponsored coverage accelerates, the size of this cost shift grows.
In short, the employer health insurance meltdown threatens everyone -- not only the 532,000 uninsured in Massachusetts.
National data shows employers pay, on average, 12 to 15 percent of gross payroll to provide health insurance. The Massachusetts House payroll assessment does not mandate employers to provide health insurance and does not require employers to pay an assessment even close to that level: 5 percent for employers with 11 to 100 workers, and 7 percent for firms with more than 100 workers.
Some question whether the House plan creates an incentive for employers now offering coverage to drop it and pay the assessment instead. That will not occur because many middle- and upper-income workers in those firms would have to obtain individual coverage on their own, and the payroll assessment revenue would not directly benefit the firm's own workers. Firms dropping coverage would be disadvantaged in competition for good workers.
Others suggest the assessment would lead employers to leave Massachusetts. As the 2005 state survey makes clear, firms that provide no coverage or inadequate coverage, such as Dunkin' Donuts, may leave the state, but can't take their business with them. Overwhelmingly, businesses in Massachusetts that could move to Tennessee or Taiwan cover their workers -- and pay higher premiums to subsidize care for employers that don't.
Businesses opposing the House plan suggest government, consumers, and taxpayers should shoulder the burden to fix our health coverage crisis. Their opposition raises the larger, important question -- what should the responsibility of employers be in providing health insurance to workers? If we don't confront this question now, the answer will not get easier.
Overwhelmingly, opinion polls show the public supports a shared solution involving government, individuals, and employers. A November poll by Gerry Chervinsky found 66 percent of Massachusetts residents support the House payroll assessment.
As the conference committee attempts to craft a health reform compromise, business groups will advertise their opposition to the assessment, confusing the public about the real stakes in health reform. One group calls their effort ''Massachusetts Businesses for Real Health Reform."
Real reform requires everyone -- government, individuals, and businesses -- to be part of the solution.
Monday, December 26, 2005
Officials set to crack down on insurance fraud in Chelsea
CHELSEA, Mass. State and local officials will launch a new effort tomorrow aimed at fighting auto insurance fraud in Chelsea.
A new task force is being created as part of a state panel that combats insurance fraud around Massachusetts. Similar task forces have already been established in other cities and towns.
During the kickoff in Chelsea tomorrow near Eastern Avenue, officials will unveil a billboard that publicizes a hot line for people to call to report insurance fraud.
A statewide crackdown on auto insurance fraud started when a Lawrence grandmother died in a staged car accident two years ago.
A new task force is being created as part of a state panel that combats insurance fraud around Massachusetts. Similar task forces have already been established in other cities and towns.
During the kickoff in Chelsea tomorrow near Eastern Avenue, officials will unveil a billboard that publicizes a hot line for people to call to report insurance fraud.
A statewide crackdown on auto insurance fraud started when a Lawrence grandmother died in a staged car accident two years ago.
Consumer-directed health plans slow to catch on
Laura Moretz
The Business Journal Serving the Greater Triad Area
Consumer-directed plans still could end up being a revolutionary approach to the way employers offer health insurance, but the uprising has not yet gained a foothold.
Such health plans offer employees a high-deductible policy in return for lower premiums and the establishment of some form of tax-preferred savings account. The idea behind the concept is that if employees have more control over their health care spending, they will be more interested in helping cut costs.
But so far, only about 1 percent of North Carolina's employer-sponsored health plans are consumer directed, according to a recent Mercer Health and Benefits survey that gathered information from 79 employers.
That's a small percentage, but the rate of growth is helping the concept gain momentum, according to those who are selling such products.
Douglas "Slade" Lewis, director of small groups sales in North Carolina for UnitedHealthcare, said that 15 percent of his sales this year were for consumer-driven plans. He expects that number to grow to 30 percent by the end of next year, thanks in part to the company's acquisition of Definity, which had a national footprint in offering such products.
Even so, there were surprises in the first year of sales, Lewis said. He was told the plan would sell only to the smallest groups, with one or two members. But several groups that bought the plans had as many as 14 members.
Lewis had also heard that only the healthy and wealthy would buy consumer-directed plans. But 30 percent of Definity's sales are to clients who earn $50,000 or less, he said.
Still, it pays for employers to go slowly, and at least initially offer a consumer-directed plan as one of two or more choices, Lewis said.
"What we recommend is that the employer fund the employee cost for both plans," he said. "We recommend that the employer prefund the (savings) account with savings on premiums."
When you minimize the employee's initial risk, they are more likely willing to try, he added.
A long-term strategy
Blue Cross and Blue Shield of North Carolina recently rolled out a consumer-directed plan for individuals.
John Roos, vice president of sales and marketing for Blue Cross, said the plan already comprises 10 percent of sales to individuals. The company is offering a consumer-directed plan for small groups, too, but it won't know what the group totals are until next month.
Keith A. Kiser, a regional employee benefits manager and senior vice president for BB&T Insurance Services, said that employers who want to move to a consumer-directed plan should have a three- to five-year strategy.
It's key to give employees a choice, he said. For example, an employer might pay the premiums for a consumer-directed plan, then allow those who want less risk to pay the difference for the traditional policy.
"The communication and the education is absolutely critical, and we think you have to start that 12 to 14 months before you start plan," he said.
Lisa Caldwell, the vice president of human resources for Reynolds American Inc. and its subsidiary, R.J. Reynolds Tobacco Co., said that her company retooled its benefits this year. It offers four levels of premiums and deductibles for both a traditional indemnity plan and for the company's HMO, Winston-Salem Healthcare.
"We probably embarked on the most comprehensive communications plan that we've ever done to really educate employees as well as to communicate the changes," Caldwell said.
The company named the levels Platinum, Gold, Silver and Bronze. The Platinum plan offers the lowest deductible, the highest premium and the richest benefits.
"Quite frankly, the platinum plan places less risk on the employee," Caldwell said. "Preliminary results say just a few tiptoed into the higher deductible plans. But it is an indication that there are employees interested."
Educating the masses
Steve Graybill, an analyst at Mercer, said the adoption rate of consumer-directed plans is slow because the concept needs to be taught to employees:
"I think people have become lazy. They say, 'I've got a $20 co-pay.' Price is not a decision factor for them. It's only time."
But when Mercer offered Graybill the choice of a consumer- directed plan with a health savings account, he decided it wasn't for him. He chose a traditional plan because he has a child with asthma and expects regular doctor visits.
"I looked at the additional liability that I was taking on. But the important thing is that I went through a thought process that I wouldn't normally have done."
Paul Goldbeck, a senior vice president at Aon Consulting's office in Winston-Salem, said employees in his office chose between a preferred-provider plan and a high-deductible plan with a health reimbursement account.
Many of his co-workers took a scientific approach, he said. "People sat down and created spreadsheets. They went into a lot of detail about what they were going to get back, the per-pay-period cost."
It was a simpler process for Goldbeck.
"I looked at it in terms of 'How much am I going to save on payday?'" He chose the consumer-directed plan because it increased his take-home pay.
"It was a significant difference. I couldn't not do it. I took most of what I saved on the premium and threw it into my flexible spending account," he said.
Goldbeck compares the decision process to that of buying car or house insurance. "It's all connected to risk aversion," he said. "There are those who would prefer to pay more on payday, and those who would prefer to save more on payday."
Trendlines developing
Eddie Vaughn, an actuary and managing consultant for Findley-Davies in Greensboro, said he's seen larger employers adding consumer-directed plans to their offerings more quickly than smaller employers.
But when Mercer offered Graybill the choice of a consumer- directed plan with a health savings account, he decided it wasn't for him. He chose a traditional plan because he has a child with asthma and expects regular doctor visits.
"I looked at the additional liability that I was taking on. But the important thing is that I went through a thought process that I wouldn't normally have done."
Paul Goldbeck, a senior vice president at Aon Consulting's office in Winston-Salem, said employees in his office chose between a preferred-provider plan and a high-deductible plan with a health reimbursement account.
Many of his co-workers took a scientific approach, he said. "People sat down and created spreadsheets. They went into a lot of detail about what they were going to get back, the per-pay-period cost."
It was a simpler process for Goldbeck.
"I looked at it in terms of 'How much am I going to save on payday?'" He chose the consumer-directed plan because it increased his take-home pay.
"It was a significant difference. I couldn't not do it. I took most of what I saved on the premium and threw it into my flexible spending account," he said.
Goldbeck compares the decision process to that of buying car or house insurance. "It's all connected to risk aversion," he said. "There are those who would prefer to pay more on payday, and those who would prefer to save more on payday."
Vaughn can't talk about specific clients, but his company offered him a consumer-directed plan this year.
"We have six people in Greensboro. Half of us have elected to go with it," he said. "It was structured in a way that it presents pretty good savings for the individual."
Vaughn chose the consumer-directed plan for his family. "For us, it ends up being less expensive. Even with two kids -- 13 and 15 -- they may need to go in for two visits a year. Generally speaking, for those whose casual use of health care is light, it tends to be a better deal."
His company makes a quarterly contribution to employees' health savings accounts, but, he said, large families or people who have chronic medical conditions will be better served through a traditional plan.
According to a recent survey by the Employee Benefit Research Institute, consumer-driven plans may drive some consumers away from seeking medical care.
About 35 percent of those with consumer-directed plans reported delaying or avoiding medical care, compared with 17 percent of those with comprehensive health plans.
The Business Journal Serving the Greater Triad Area
Consumer-directed plans still could end up being a revolutionary approach to the way employers offer health insurance, but the uprising has not yet gained a foothold.
Such health plans offer employees a high-deductible policy in return for lower premiums and the establishment of some form of tax-preferred savings account. The idea behind the concept is that if employees have more control over their health care spending, they will be more interested in helping cut costs.
But so far, only about 1 percent of North Carolina's employer-sponsored health plans are consumer directed, according to a recent Mercer Health and Benefits survey that gathered information from 79 employers.
That's a small percentage, but the rate of growth is helping the concept gain momentum, according to those who are selling such products.
Douglas "Slade" Lewis, director of small groups sales in North Carolina for UnitedHealthcare, said that 15 percent of his sales this year were for consumer-driven plans. He expects that number to grow to 30 percent by the end of next year, thanks in part to the company's acquisition of Definity, which had a national footprint in offering such products.
Even so, there were surprises in the first year of sales, Lewis said. He was told the plan would sell only to the smallest groups, with one or two members. But several groups that bought the plans had as many as 14 members.
Lewis had also heard that only the healthy and wealthy would buy consumer-directed plans. But 30 percent of Definity's sales are to clients who earn $50,000 or less, he said.
Still, it pays for employers to go slowly, and at least initially offer a consumer-directed plan as one of two or more choices, Lewis said.
"What we recommend is that the employer fund the employee cost for both plans," he said. "We recommend that the employer prefund the (savings) account with savings on premiums."
When you minimize the employee's initial risk, they are more likely willing to try, he added.
A long-term strategy
Blue Cross and Blue Shield of North Carolina recently rolled out a consumer-directed plan for individuals.
John Roos, vice president of sales and marketing for Blue Cross, said the plan already comprises 10 percent of sales to individuals. The company is offering a consumer-directed plan for small groups, too, but it won't know what the group totals are until next month.
Keith A. Kiser, a regional employee benefits manager and senior vice president for BB&T Insurance Services, said that employers who want to move to a consumer-directed plan should have a three- to five-year strategy.
It's key to give employees a choice, he said. For example, an employer might pay the premiums for a consumer-directed plan, then allow those who want less risk to pay the difference for the traditional policy.
"The communication and the education is absolutely critical, and we think you have to start that 12 to 14 months before you start plan," he said.
Lisa Caldwell, the vice president of human resources for Reynolds American Inc. and its subsidiary, R.J. Reynolds Tobacco Co., said that her company retooled its benefits this year. It offers four levels of premiums and deductibles for both a traditional indemnity plan and for the company's HMO, Winston-Salem Healthcare.
"We probably embarked on the most comprehensive communications plan that we've ever done to really educate employees as well as to communicate the changes," Caldwell said.
The company named the levels Platinum, Gold, Silver and Bronze. The Platinum plan offers the lowest deductible, the highest premium and the richest benefits.
"Quite frankly, the platinum plan places less risk on the employee," Caldwell said. "Preliminary results say just a few tiptoed into the higher deductible plans. But it is an indication that there are employees interested."
Educating the masses
Steve Graybill, an analyst at Mercer, said the adoption rate of consumer-directed plans is slow because the concept needs to be taught to employees:
"I think people have become lazy. They say, 'I've got a $20 co-pay.' Price is not a decision factor for them. It's only time."
But when Mercer offered Graybill the choice of a consumer- directed plan with a health savings account, he decided it wasn't for him. He chose a traditional plan because he has a child with asthma and expects regular doctor visits.
"I looked at the additional liability that I was taking on. But the important thing is that I went through a thought process that I wouldn't normally have done."
Paul Goldbeck, a senior vice president at Aon Consulting's office in Winston-Salem, said employees in his office chose between a preferred-provider plan and a high-deductible plan with a health reimbursement account.
Many of his co-workers took a scientific approach, he said. "People sat down and created spreadsheets. They went into a lot of detail about what they were going to get back, the per-pay-period cost."
It was a simpler process for Goldbeck.
"I looked at it in terms of 'How much am I going to save on payday?'" He chose the consumer-directed plan because it increased his take-home pay.
"It was a significant difference. I couldn't not do it. I took most of what I saved on the premium and threw it into my flexible spending account," he said.
Goldbeck compares the decision process to that of buying car or house insurance. "It's all connected to risk aversion," he said. "There are those who would prefer to pay more on payday, and those who would prefer to save more on payday."
Trendlines developing
Eddie Vaughn, an actuary and managing consultant for Findley-Davies in Greensboro, said he's seen larger employers adding consumer-directed plans to their offerings more quickly than smaller employers.
But when Mercer offered Graybill the choice of a consumer- directed plan with a health savings account, he decided it wasn't for him. He chose a traditional plan because he has a child with asthma and expects regular doctor visits.
"I looked at the additional liability that I was taking on. But the important thing is that I went through a thought process that I wouldn't normally have done."
Paul Goldbeck, a senior vice president at Aon Consulting's office in Winston-Salem, said employees in his office chose between a preferred-provider plan and a high-deductible plan with a health reimbursement account.
Many of his co-workers took a scientific approach, he said. "People sat down and created spreadsheets. They went into a lot of detail about what they were going to get back, the per-pay-period cost."
It was a simpler process for Goldbeck.
"I looked at it in terms of 'How much am I going to save on payday?'" He chose the consumer-directed plan because it increased his take-home pay.
"It was a significant difference. I couldn't not do it. I took most of what I saved on the premium and threw it into my flexible spending account," he said.
Goldbeck compares the decision process to that of buying car or house insurance. "It's all connected to risk aversion," he said. "There are those who would prefer to pay more on payday, and those who would prefer to save more on payday."
Vaughn can't talk about specific clients, but his company offered him a consumer-directed plan this year.
"We have six people in Greensboro. Half of us have elected to go with it," he said. "It was structured in a way that it presents pretty good savings for the individual."
Vaughn chose the consumer-directed plan for his family. "For us, it ends up being less expensive. Even with two kids -- 13 and 15 -- they may need to go in for two visits a year. Generally speaking, for those whose casual use of health care is light, it tends to be a better deal."
His company makes a quarterly contribution to employees' health savings accounts, but, he said, large families or people who have chronic medical conditions will be better served through a traditional plan.
According to a recent survey by the Employee Benefit Research Institute, consumer-driven plans may drive some consumers away from seeking medical care.
About 35 percent of those with consumer-directed plans reported delaying or avoiding medical care, compared with 17 percent of those with comprehensive health plans.
Lafayette schools' health insurance: cut or raise $1.6 million
LAFAYETTE, La. Rising health care costs across the country are causing problems in the Lafayette Parish school system.
Officials with Lafayette Parish schools say the system's self insurance fund faces a deficit of more than one-point-five (M) million dollars.
The board's insurance committee and employee insurance advisory committee will meet in January to discuss the matter. The insurance committee is expected to recommend a premium increase by April for the following school year.
Nearly 47-hundred people are enrolled in the group insurance plan, which provides medical, prescription and other benefits.
School Board member David Thibodaux has urged the insurance committee to find an alternative to raising premiums.
But board member Judy Cox says the district has "Cadillac" insurance and has to change.
Currently, the Lafayette school district pays about two-thirds of the overall cost of the plan.
Officials with Lafayette Parish schools say the system's self insurance fund faces a deficit of more than one-point-five (M) million dollars.
The board's insurance committee and employee insurance advisory committee will meet in January to discuss the matter. The insurance committee is expected to recommend a premium increase by April for the following school year.
Nearly 47-hundred people are enrolled in the group insurance plan, which provides medical, prescription and other benefits.
School Board member David Thibodaux has urged the insurance committee to find an alternative to raising premiums.
But board member Judy Cox says the district has "Cadillac" insurance and has to change.
Currently, the Lafayette school district pays about two-thirds of the overall cost of the plan.
Health insurance at issue in Endicott
By DENA PAULING
Press & Sun-Bulletin
ENDICOTT ? Days before two new village officials take office, Endicott trustees will decide whether they should eliminate their health insurance in 2007.
The resolution would affect part-time elected officials and would save $12,000 annually per person, said Trustee Joseph Conte, who came up with the proposal.
"I don't think we should have it when we don't give it to the part-time employees and we work less," said Conte, who expected the majority would vote Tuesday in favor of eliminating the health insurance. "I don't consider myself a privileged person."
Conte's resolution was first mentioned during the trustees' Dec. 12 meeting, but trustees Betty Havel and Matt Pasquale quickly said they did not want to vote until it was discussed further.
Havel, who was re-elected to another term in November, will be affected by the resolution. Pasquale, who has one year left in his two-year term, will only be affected if he is re-elected to another term.
Trustees were each paid about $4,500 under the 2004-05 village budget.
All trustees and the mayor are eligible for the insurance, though some may choose not to take it because they are already enrolled in another plan or don't agree with it. Conte and Mayor Joan Hickey Pulse said they did not take the insurance when they took office.
Some villages have already eliminated such health insurance plans for elected officials. Johnson City, for example, took a similar action in 1992, shortly after Mayor Harry Lewis took office, village Clerk-Treasurer Tom Augostini said.
"It was more about principle," he said, referring to the board's decision 13 years ago. "They are considered part-time employees ? why are we offering them health insurance?"
There was a time, he said, when health insurance was cheap and did not burden local governments' and patients' budgets like it does today.
"Health insurance is just exploding way beyond the cost of living," he said.
Press & Sun-Bulletin
ENDICOTT ? Days before two new village officials take office, Endicott trustees will decide whether they should eliminate their health insurance in 2007.
The resolution would affect part-time elected officials and would save $12,000 annually per person, said Trustee Joseph Conte, who came up with the proposal.
"I don't think we should have it when we don't give it to the part-time employees and we work less," said Conte, who expected the majority would vote Tuesday in favor of eliminating the health insurance. "I don't consider myself a privileged person."
Conte's resolution was first mentioned during the trustees' Dec. 12 meeting, but trustees Betty Havel and Matt Pasquale quickly said they did not want to vote until it was discussed further.
Havel, who was re-elected to another term in November, will be affected by the resolution. Pasquale, who has one year left in his two-year term, will only be affected if he is re-elected to another term.
Trustees were each paid about $4,500 under the 2004-05 village budget.
All trustees and the mayor are eligible for the insurance, though some may choose not to take it because they are already enrolled in another plan or don't agree with it. Conte and Mayor Joan Hickey Pulse said they did not take the insurance when they took office.
Some villages have already eliminated such health insurance plans for elected officials. Johnson City, for example, took a similar action in 1992, shortly after Mayor Harry Lewis took office, village Clerk-Treasurer Tom Augostini said.
"It was more about principle," he said, referring to the board's decision 13 years ago. "They are considered part-time employees ? why are we offering them health insurance?"
There was a time, he said, when health insurance was cheap and did not burden local governments' and patients' budgets like it does today.
"Health insurance is just exploding way beyond the cost of living," he said.
Thursday, December 22, 2005
Child-Care Workers Protest Changes in Health Insurance
By The Providence Journal, R.I.
Dec. 21--PROVIDENCE -- Home-based child-care providers accused the governor and General Assembly of "trying to kill" them with changes that make some providers ineligible for reduced-rate health insurance.
Those strong words belong to Grace Brown, a child-care provider from Providence who lost her health insurance due to the new rules.
"Believe me, one of us here is going to die because we don't have the proper health coverage," Brown said at a demonstration outside the State House last night.
About 50 people donned hats, scarves and mittens to join in the procession. Headed by a sign proclaiming, "Medical coverage should be a human right, not a privilege," they marched around the ice-glazed plaza along Smith Street, chanting, "Restore health! Restore hope!"
The child-care workers are angry over a $1.2-million cost-cutting move the state's overwhelmingly Democratic lawmakers made this year at Republican Governor Carcieri's request. What is at stake is eligibility for reduced-cost health insurance, at rates that range, depending on income, from $61 to $130 a month for family coverage.
The lawmakers changed the rules in three ways: They raised from $1,800 to $7,800 the minimum a worker would have to earn every six months from taking care of eligible children to qualify for state-subsidized health care. Where before home-based child-care workers could qualify for the low-cost health care by taking in only one child, they now have to take in at least two every 26 weeks. And the lawmakers adopted an earnings cap that limits eligibility to child-care workers making less than 350 percent of the Federal Poverty Level which, today, means less than $56,315 annually for a family of three, for example.
The demonstration's organizers said the cutoff applies to household income, so it would include a spouse's income, even though only the child-care provider and his or her minor children -- not spouses -- qualify for the subsidized health insurance. (The demonstration was organized by District 1199 of the Service Employees International Union, the same union that's championing child-care workers' right to unionize.)
But looked at another way, the child-care workers can still have significantly higher household incomes than anyone outside their ranks and would be allowed to have and still qualify for some form of state-funded health-care coverage. Eligibility for the state's RIte Care eligiblity is capped, for example, at 185 percent of the Federal Poverty Level, which for a family of three -- whether a two-parent family or a single parent with two children -- is capped at $29,767 a year.
Norma Tetrault, a child-care provider from Pawtucket, said she was sick a few weeks ago, and had to beg her doctor to see her because she'd lost her insurance. The doctor agreed to charge her just $35, and gave her medication from his office supply, she said.
"What kind of child care do you think I'm providing when I'm sick like that, coughing all over the place, and I can't even get to a doctor?" Tetrault asked rhetorically.
Taking a more lighthearted tone, the demonstrators sang Christmas-song spoofs: "Health Care for All," to the tune of "Joy to the World" (sample lyrics: "Health care for all Rhode Island's kids and those who care for them. Let every heart in the State House listen to our song. . ."), and "Budget Night," to the tune of "Silent Night" ("Round yon State House, politicians making deals and cruel decisions, cut our health care to pieces...")
Last night, the demonstrators clearly sought to draw attention to their cause as the 2006 session's opening looms. "I am here tonight because I have hope, and I have faith, and I believe that the General Assembly will restore our health care," said Monica Marshall, a daycare provider from Providence.
According to the printed program for the demonstration, Marshall works an average of 14 hours a day, and devotes "most of her earnings" to child-care expenses. Marshall said she is diabetic, and can no longer afford to take her medication three times a day, as recommended. She also went without a flu shot this year because she lost her health coverage, she said.
Before the new rules took effect at the beginning of October, a total of 976 people -- including 581 home-care providers and 458 of their dependents -- were eligible for the state subsidized health-care coverage, according to the state Department of Human Services.
After the new rules went into effect, only 393 of the 518 child-care workers reapplied and only 251 of them were deemed eligible. The other 142 who applied were rejected as ineligible for a variety of reasons: six are no longer working as child-care providers; 68 exceeded the income cap by an average of $1,000 a month; another 41 did not meet the new earnings threshold; and 27 failed to provide all the required information, including documentation of their income.
In their own tally of the toll taken by the new law, the union organizers also count the 116 who did not reapply for the state-paid health coverage -- and 9 others who declined it -- after the new rules took effect.
Dec. 21--PROVIDENCE -- Home-based child-care providers accused the governor and General Assembly of "trying to kill" them with changes that make some providers ineligible for reduced-rate health insurance.
Those strong words belong to Grace Brown, a child-care provider from Providence who lost her health insurance due to the new rules.
"Believe me, one of us here is going to die because we don't have the proper health coverage," Brown said at a demonstration outside the State House last night.
About 50 people donned hats, scarves and mittens to join in the procession. Headed by a sign proclaiming, "Medical coverage should be a human right, not a privilege," they marched around the ice-glazed plaza along Smith Street, chanting, "Restore health! Restore hope!"
The child-care workers are angry over a $1.2-million cost-cutting move the state's overwhelmingly Democratic lawmakers made this year at Republican Governor Carcieri's request. What is at stake is eligibility for reduced-cost health insurance, at rates that range, depending on income, from $61 to $130 a month for family coverage.
The lawmakers changed the rules in three ways: They raised from $1,800 to $7,800 the minimum a worker would have to earn every six months from taking care of eligible children to qualify for state-subsidized health care. Where before home-based child-care workers could qualify for the low-cost health care by taking in only one child, they now have to take in at least two every 26 weeks. And the lawmakers adopted an earnings cap that limits eligibility to child-care workers making less than 350 percent of the Federal Poverty Level which, today, means less than $56,315 annually for a family of three, for example.
The demonstration's organizers said the cutoff applies to household income, so it would include a spouse's income, even though only the child-care provider and his or her minor children -- not spouses -- qualify for the subsidized health insurance. (The demonstration was organized by District 1199 of the Service Employees International Union, the same union that's championing child-care workers' right to unionize.)
But looked at another way, the child-care workers can still have significantly higher household incomes than anyone outside their ranks and would be allowed to have and still qualify for some form of state-funded health-care coverage. Eligibility for the state's RIte Care eligiblity is capped, for example, at 185 percent of the Federal Poverty Level, which for a family of three -- whether a two-parent family or a single parent with two children -- is capped at $29,767 a year.
Norma Tetrault, a child-care provider from Pawtucket, said she was sick a few weeks ago, and had to beg her doctor to see her because she'd lost her insurance. The doctor agreed to charge her just $35, and gave her medication from his office supply, she said.
"What kind of child care do you think I'm providing when I'm sick like that, coughing all over the place, and I can't even get to a doctor?" Tetrault asked rhetorically.
Taking a more lighthearted tone, the demonstrators sang Christmas-song spoofs: "Health Care for All," to the tune of "Joy to the World" (sample lyrics: "Health care for all Rhode Island's kids and those who care for them. Let every heart in the State House listen to our song. . ."), and "Budget Night," to the tune of "Silent Night" ("Round yon State House, politicians making deals and cruel decisions, cut our health care to pieces...")
Last night, the demonstrators clearly sought to draw attention to their cause as the 2006 session's opening looms. "I am here tonight because I have hope, and I have faith, and I believe that the General Assembly will restore our health care," said Monica Marshall, a daycare provider from Providence.
According to the printed program for the demonstration, Marshall works an average of 14 hours a day, and devotes "most of her earnings" to child-care expenses. Marshall said she is diabetic, and can no longer afford to take her medication three times a day, as recommended. She also went without a flu shot this year because she lost her health coverage, she said.
Before the new rules took effect at the beginning of October, a total of 976 people -- including 581 home-care providers and 458 of their dependents -- were eligible for the state subsidized health-care coverage, according to the state Department of Human Services.
After the new rules went into effect, only 393 of the 518 child-care workers reapplied and only 251 of them were deemed eligible. The other 142 who applied were rejected as ineligible for a variety of reasons: six are no longer working as child-care providers; 68 exceeded the income cap by an average of $1,000 a month; another 41 did not meet the new earnings threshold; and 27 failed to provide all the required information, including documentation of their income.
In their own tally of the toll taken by the new law, the union organizers also count the 116 who did not reapply for the state-paid health coverage -- and 9 others who declined it -- after the new rules took effect.
State drives up cost of auto insurance
BY EMILY LE COZ
Daily Journal
As if high gas prices haven't pushed driving costs up enough, you may be about to see an increase in our your vehicle insurance.
Under new mandatory automobile liability limits, effective Jan. 1, Mississippi motorists must carry limits that include $25,000 for bodily injury or death of one person, $50,000 for bodily injury or death of two or more people, and $25,000 for injury or destruction of others' property.
The move also will affect anyone carrying optional uninsured or underinsured motorist liability at less than the 25/50/25 rate.
Current minimum limits are 10/20/5 - or $10,000 for bodily injury or death of one person, $20,000 for two or more, and $5,000 for injury or destruction of property.
State lawmakers approved the increases this year to protect drivers from out-of-pocket costs associated with inadequate insurance coverage.
For example, if a driver with today's minimum coverage hit a vehicle causing $20,000 in damage, that driver's insurance would pay only $5,000 toward the damages. The driver himself would have to come up with the rest.
If the driver couldn't afford the additional $15,000, the other vehicle's owner would have to use his optional, underinsured motorist coverage. That could cause his own rates to increase.
"I think it's a good idea," said Smithville driver Bill Leech. "Even if I pay more for my insurance, it'd be worth it in the long run. As long as it's not too much more."
More uninsured motorists possible
But some worry that higher premiums actually will boost the number of uninsured motorists because those already struggling to make minimum insurance payments simply will drop their policies.
"There will be a lot more people driving without insurance, and the ones that do have it will be paying for the consequences," speculated Tupelo driver Janet Arthur. "I think it's wrong to change it. You've got senior citizens, and people at my age at 55 who have got other bills to pay. We're not all Donald Trump."
Legislators and the state Insurance Department considered the possibility of more uninsured drivers because of the rate increases, said insurance commissioner George Dale.
"But our argument was that our limits are so low that we needed to raise them," he said.
Mississippi already has one of the nation's highest rate of uninsured motorists with roughly 30 percent driving without coverage.
Individual increases will vary
Policies will not change automatically Jan. 1, Dale said. Instead, people with the current minimum limits will see a change when their policy comes up for renewal.
No one can say exactly how much premiums will increase for the affected policy holders, because rates depend on many factors - driving history, vehicle information, credit rating, for example.
University of Mississippi chair of insurance Larry Cox said some premiums would go up substantially for people paying at minimum level.
Others, like Debbie Shempert of Renasant Insurance in Tupelo, said "it's not a huge increase to go from the current limits to the ones in January."
State Farm spokeswoman Susan Lamey said additional financial burdens for affected policyholders "will be minimal."
Daily Journal
As if high gas prices haven't pushed driving costs up enough, you may be about to see an increase in our your vehicle insurance.
Under new mandatory automobile liability limits, effective Jan. 1, Mississippi motorists must carry limits that include $25,000 for bodily injury or death of one person, $50,000 for bodily injury or death of two or more people, and $25,000 for injury or destruction of others' property.
The move also will affect anyone carrying optional uninsured or underinsured motorist liability at less than the 25/50/25 rate.
Current minimum limits are 10/20/5 - or $10,000 for bodily injury or death of one person, $20,000 for two or more, and $5,000 for injury or destruction of property.
State lawmakers approved the increases this year to protect drivers from out-of-pocket costs associated with inadequate insurance coverage.
For example, if a driver with today's minimum coverage hit a vehicle causing $20,000 in damage, that driver's insurance would pay only $5,000 toward the damages. The driver himself would have to come up with the rest.
If the driver couldn't afford the additional $15,000, the other vehicle's owner would have to use his optional, underinsured motorist coverage. That could cause his own rates to increase.
"I think it's a good idea," said Smithville driver Bill Leech. "Even if I pay more for my insurance, it'd be worth it in the long run. As long as it's not too much more."
More uninsured motorists possible
But some worry that higher premiums actually will boost the number of uninsured motorists because those already struggling to make minimum insurance payments simply will drop their policies.
"There will be a lot more people driving without insurance, and the ones that do have it will be paying for the consequences," speculated Tupelo driver Janet Arthur. "I think it's wrong to change it. You've got senior citizens, and people at my age at 55 who have got other bills to pay. We're not all Donald Trump."
Legislators and the state Insurance Department considered the possibility of more uninsured drivers because of the rate increases, said insurance commissioner George Dale.
"But our argument was that our limits are so low that we needed to raise them," he said.
Mississippi already has one of the nation's highest rate of uninsured motorists with roughly 30 percent driving without coverage.
Individual increases will vary
Policies will not change automatically Jan. 1, Dale said. Instead, people with the current minimum limits will see a change when their policy comes up for renewal.
No one can say exactly how much premiums will increase for the affected policy holders, because rates depend on many factors - driving history, vehicle information, credit rating, for example.
University of Mississippi chair of insurance Larry Cox said some premiums would go up substantially for people paying at minimum level.
Others, like Debbie Shempert of Renasant Insurance in Tupelo, said "it's not a huge increase to go from the current limits to the ones in January."
State Farm spokeswoman Susan Lamey said additional financial burdens for affected policyholders "will be minimal."
Colorado insurance commissioner approves health care merger
DENVER (AP) - Colorado's insurance commissioner is giving his approval to the proposed multi-million-dollar merger involving UnitedHealth Group and PacifiCare Health Systems.
Colorado was the last of ten states to approve the planned $9.2 billion merger.
UnitedHealth will divest parts of PacifiCare's commercial health insurance business in Boulder and in Tucson, Arizona to deal with antitrust concerns.
Commissioner David Rivera says the deal between UnitedHealth and the state bars merger costs from being passed on to consumers through higher premiums.
UnitedHealth also agreed to meet goals including faster resolution of calls, claims and appeals from health providers, and complaints forwarded from the state's insurance division.
UnitedHealth's takeover of PacifiCare is the second-largest merger in the hospital managed-care industry.
It would create one of the nation's largest private health plan providers, with about 26 million subscribers.
Colorado was the last of ten states to approve the planned $9.2 billion merger.
UnitedHealth will divest parts of PacifiCare's commercial health insurance business in Boulder and in Tucson, Arizona to deal with antitrust concerns.
Commissioner David Rivera says the deal between UnitedHealth and the state bars merger costs from being passed on to consumers through higher premiums.
UnitedHealth also agreed to meet goals including faster resolution of calls, claims and appeals from health providers, and complaints forwarded from the state's insurance division.
UnitedHealth's takeover of PacifiCare is the second-largest merger in the hospital managed-care industry.
It would create one of the nation's largest private health plan providers, with about 26 million subscribers.
Wednesday, December 21, 2005
American Healthways to Provide Disease Management Services to Blue Cross Blue Shield Northern Plains Alliance
NASHVILLE, Tenn.--(BUSINESS WIRE)--Dec. 20, 2005--
Company Contracts with Newly Formed Regional Medicare Advantage Plans' Medical Management Vendor for Congestive Heart Failure Program
American Healthways Inc., (NASDAQ: AMHC) today announced a three-year disease management agreement with Blue Cross and Blue Shield of Minnesota, who has been contracted to provide medical management services for the Medicare Advantage plans offered across the region by the Alliance.
The Alliance includes the independent Blue Cross and Blue Shield licensees in the states of Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming. These seven states comprise Medicare Advantage Region 19. Under the contract, American Healthways will offer a congestive heart failure program tailored specifically to serve the needs of Medicare beneficiaries.
"Medicare Advantage, as a result of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, represents a significant opportunity for disease management, and we look forward to applying our experience with Medicare populations in this new market to help improve the health of seniors, improve quality and reduce costs," said American Healthways President and CEO Ben R. Leedle, Jr.
American Healthways was chosen by the Centers for Medicare and Medicaid Services (CMS) to launch a three-year voluntary pilot program in Maryland and D.C. to serve nearly 20,000 beneficiaries in the area with complex diabetes and/or congestive heart failure. The Company launched the Maryland and D.C. Medicare Health Support pilot last August and is participating as a subcontractor on another pilot in Georgia. In total, there are eight Medicare Health Support pilots being conducted by CMS in various regions of the country for about 160,000 beneficiaries with these diagnoses.
Company Contracts with Newly Formed Regional Medicare Advantage Plans' Medical Management Vendor for Congestive Heart Failure Program
American Healthways Inc., (NASDAQ: AMHC) today announced a three-year disease management agreement with Blue Cross and Blue Shield of Minnesota, who has been contracted to provide medical management services for the Medicare Advantage plans offered across the region by the Alliance.
The Alliance includes the independent Blue Cross and Blue Shield licensees in the states of Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming. These seven states comprise Medicare Advantage Region 19. Under the contract, American Healthways will offer a congestive heart failure program tailored specifically to serve the needs of Medicare beneficiaries.
"Medicare Advantage, as a result of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, represents a significant opportunity for disease management, and we look forward to applying our experience with Medicare populations in this new market to help improve the health of seniors, improve quality and reduce costs," said American Healthways President and CEO Ben R. Leedle, Jr.
American Healthways was chosen by the Centers for Medicare and Medicaid Services (CMS) to launch a three-year voluntary pilot program in Maryland and D.C. to serve nearly 20,000 beneficiaries in the area with complex diabetes and/or congestive heart failure. The Company launched the Maryland and D.C. Medicare Health Support pilot last August and is participating as a subcontractor on another pilot in Georgia. In total, there are eight Medicare Health Support pilots being conducted by CMS in various regions of the country for about 160,000 beneficiaries with these diagnoses.
Bring all under health insurance umbrella
By Penny J. Gardner
(December 21, 2005) ? Given the annual commotion about the area's health insurers' rate increases ("Health insurers' rates surge," Democrat and Chronicle, Nov. 29), it's time to take a hard look at where the annual ritual of open enrollment takes us.
Our viewpoint ? that of a nonprofit facility that offers free medical care and social support to uninsured people ? is that year after year, we're dancing a dance of futility. I believe we must take a look at why the United States is the only industrialized nation that does not provide universal health insurance to cover all its citizens.
Right now, the nation is pricing itself out of its ability to care for our citizens.
For most people between ages 19 and 64, health insurance is based on the status of employment. In recent years, however, we've seen layoffs increase, including at Eastman Kodak Co., Delphi and other Rochester corporations. Laid-off employees and their families are left out in the cold. Sometimes they come to Mercy Outreach Center and other facilities that facilitate medical care at no cost.
We now conduct about 5,000 clinical visits a year, both walk-ins and by appointment, up significantly from previous years. We rely on the generosity of physicians, dentists, nurses, chiropractors and other providers who donate time and expertise to make this happen. Unfortunately, calendars fill up quickly and many uninsured people must be turned away; sometimes they go to emergency departments when all they really need is basic primary care.
Employers large and small are now trying to figure out how they'll pay for all or part of the rising costs of their employees' heath insurance. Shift more costs to the employee? Lay people off? (It was recently estimated that General Motors adds $1,500 to every vehicle it sells just to cover the cost of health insurance for its employees. This cost was one of several factors that led GM to announce its downsizing.) And despite various state-sponsored insurance programs, we still see the number of uninsured rising.
We're told that the rising premiums are prompted by increased use of health care by an aging population as well as the introduction of new medical equipment and technologies, and the availability of new drugs. We hear these same rationalizations every year. There has to be a better way.
Diabetes, hypertension and other chronic diseases; breast cancer and other crisis conditions; infections and other short-term illnesses; and accidents and emergencies happen to everyone, not just those covered by insurance.
We know that hospitals, health care professionals, drug and equipment manufacturers, and insurers must be financially solid and cannot operate at a deficit. Proponents of universal health care coverage make no claim to the contrary.
Providers, insurers, local and state governments, employers and employees have become quite expert in the microcalculation of rates, premiums, risk, reimbursement, outcomes and all the other factors.
Is there a leader from any of these sectors who can help direct this medical and administrative expertise toward the nobler goal of assuring health care for everyone? From a financial and a moral perspective, it's the right thing to do.
Should universal health care coverage come into being, perhaps it would signal an end to the activities of facilities like ours. Should that day come, I will be happy to close our doors for good.
(December 21, 2005) ? Given the annual commotion about the area's health insurers' rate increases ("Health insurers' rates surge," Democrat and Chronicle, Nov. 29), it's time to take a hard look at where the annual ritual of open enrollment takes us.
Our viewpoint ? that of a nonprofit facility that offers free medical care and social support to uninsured people ? is that year after year, we're dancing a dance of futility. I believe we must take a look at why the United States is the only industrialized nation that does not provide universal health insurance to cover all its citizens.
Right now, the nation is pricing itself out of its ability to care for our citizens.
For most people between ages 19 and 64, health insurance is based on the status of employment. In recent years, however, we've seen layoffs increase, including at Eastman Kodak Co., Delphi and other Rochester corporations. Laid-off employees and their families are left out in the cold. Sometimes they come to Mercy Outreach Center and other facilities that facilitate medical care at no cost.
We now conduct about 5,000 clinical visits a year, both walk-ins and by appointment, up significantly from previous years. We rely on the generosity of physicians, dentists, nurses, chiropractors and other providers who donate time and expertise to make this happen. Unfortunately, calendars fill up quickly and many uninsured people must be turned away; sometimes they go to emergency departments when all they really need is basic primary care.
Employers large and small are now trying to figure out how they'll pay for all or part of the rising costs of their employees' heath insurance. Shift more costs to the employee? Lay people off? (It was recently estimated that General Motors adds $1,500 to every vehicle it sells just to cover the cost of health insurance for its employees. This cost was one of several factors that led GM to announce its downsizing.) And despite various state-sponsored insurance programs, we still see the number of uninsured rising.
We're told that the rising premiums are prompted by increased use of health care by an aging population as well as the introduction of new medical equipment and technologies, and the availability of new drugs. We hear these same rationalizations every year. There has to be a better way.
Diabetes, hypertension and other chronic diseases; breast cancer and other crisis conditions; infections and other short-term illnesses; and accidents and emergencies happen to everyone, not just those covered by insurance.
We know that hospitals, health care professionals, drug and equipment manufacturers, and insurers must be financially solid and cannot operate at a deficit. Proponents of universal health care coverage make no claim to the contrary.
Providers, insurers, local and state governments, employers and employees have become quite expert in the microcalculation of rates, premiums, risk, reimbursement, outcomes and all the other factors.
Is there a leader from any of these sectors who can help direct this medical and administrative expertise toward the nobler goal of assuring health care for everyone? From a financial and a moral perspective, it's the right thing to do.
Should universal health care coverage come into being, perhaps it would signal an end to the activities of facilities like ours. Should that day come, I will be happy to close our doors for good.
Health insurance program on tap
By MIKE DENNISON
Gazette State Bureau
HELENA - Nearly 1,000 Montana small businesses and their employees will be getting a late Christmas present early next year: affordable health insurance.
The insurance, or help in paying for it, comes courtesy of a $13 million state program approved by Montana voters and the 2005 Legislature.
Now, it's on the verge of reality, as the state is enrolling the first of 25 small businesses in a new health insurance pool that offers them affordable group coverage.
Small businesses that already provide health insurance for their workers also can apply for tax credits, effective next year, to help offset the cost. They must have two to five employees to qualify for either aspect of the program, which is dubbed Insure Montana.
State Auditor John Morrison, whose office is implementing the program, said Tuesday the response from businesses has been heavy.
"Business people across Montana are starving for affordable health insurance," he said. "It's the No. 1 pocketbook issue for small businesses in Montana.
"This program is not going to solve the whole problem. But it's a step in the right direction."
In the past few weeks, more than 1,000 businesses have applied to participate. It's a first-come, first-served program, based on available money, and initial funds will pay for about 900 businesses, Morrison's office estimates.
The program has two parts:
A state income-tax credit offered to small businesses that already provide health insurance to employees. The credit will be $100 to $125 per employee per month. As many as 600 businesses will be approved to take part, starting next year.
Small businesses that don't offer health insurance to their employees now can buy it from a health insurance pool. Blue Cross and Blue Shield of Montana will offer two policies through the pool. Companies must enroll in the pool through the state.
The state also will offer premium subsidies to businesses and their workers who get insurance through the pool. Twenty-five businesses already are enrolling, and another 125 applications will be sent out within the week, Morrison said.
By next March, his office hopes to have 300 businesses signed up and buying insurance through the pool.
Employees who get insurance through the pool will get subsidies from the state for 20 percent to 90 percent of their individual coverage costs, depending on their personal income.
The program is financed by increased state tobacco taxes, which were approved by Montana voters in November 2004. Montanans voted then to increase the tax on cigarettes by $1 a pack to $1.70 a pack.
Initiative 149 directed that part of the higher taxes pay for tax credits to subsidize health insurance for small businesses. Morrison said Gov. Brian Schweitzer proposed expanding the program to include the health insurance pool.
State Rep. Alan Olson, R-Roundup, a co-sponsor of the bill that put the program into law, said it will give many small businesses the chance to provide health insurance to their employees.
The measure had bipartisan support during the Legislature, he said.
House Democratic Leader Dave Wanzenried of Missoula, the bill's chief sponsor, said that although it will provide insurance to "admittedly a small number of businesses," it's still a good start at reducing the number of uninsured Montanans, estimated to be 165,000.
The precise number of businesses and employees affected by the program won't be known until early next year. It depends on the number of each business enrolled, how many employees choose to buy insurance and whether they choose to place any of their dependents on the policy.
The program will be expanded if more money becomes available, Morrison said. The state also is applying to the federal government for additional money that could help cover workers whose income is at or below 200 percent of the federal poverty level ($25,600 for a family of two).
Morrison said the plan could be a "successful precedent" of the state teaming up with the private sector to make health insurance more affordable and get more people covered.
"Insure Montana is a concept that needs to be developed much more widely at the state and national level," he said.
Gazette State Bureau
HELENA - Nearly 1,000 Montana small businesses and their employees will be getting a late Christmas present early next year: affordable health insurance.
The insurance, or help in paying for it, comes courtesy of a $13 million state program approved by Montana voters and the 2005 Legislature.
Now, it's on the verge of reality, as the state is enrolling the first of 25 small businesses in a new health insurance pool that offers them affordable group coverage.
Small businesses that already provide health insurance for their workers also can apply for tax credits, effective next year, to help offset the cost. They must have two to five employees to qualify for either aspect of the program, which is dubbed Insure Montana.
State Auditor John Morrison, whose office is implementing the program, said Tuesday the response from businesses has been heavy.
"Business people across Montana are starving for affordable health insurance," he said. "It's the No. 1 pocketbook issue for small businesses in Montana.
"This program is not going to solve the whole problem. But it's a step in the right direction."
In the past few weeks, more than 1,000 businesses have applied to participate. It's a first-come, first-served program, based on available money, and initial funds will pay for about 900 businesses, Morrison's office estimates.
The program has two parts:
A state income-tax credit offered to small businesses that already provide health insurance to employees. The credit will be $100 to $125 per employee per month. As many as 600 businesses will be approved to take part, starting next year.
Small businesses that don't offer health insurance to their employees now can buy it from a health insurance pool. Blue Cross and Blue Shield of Montana will offer two policies through the pool. Companies must enroll in the pool through the state.
The state also will offer premium subsidies to businesses and their workers who get insurance through the pool. Twenty-five businesses already are enrolling, and another 125 applications will be sent out within the week, Morrison said.
By next March, his office hopes to have 300 businesses signed up and buying insurance through the pool.
Employees who get insurance through the pool will get subsidies from the state for 20 percent to 90 percent of their individual coverage costs, depending on their personal income.
The program is financed by increased state tobacco taxes, which were approved by Montana voters in November 2004. Montanans voted then to increase the tax on cigarettes by $1 a pack to $1.70 a pack.
Initiative 149 directed that part of the higher taxes pay for tax credits to subsidize health insurance for small businesses. Morrison said Gov. Brian Schweitzer proposed expanding the program to include the health insurance pool.
State Rep. Alan Olson, R-Roundup, a co-sponsor of the bill that put the program into law, said it will give many small businesses the chance to provide health insurance to their employees.
The measure had bipartisan support during the Legislature, he said.
House Democratic Leader Dave Wanzenried of Missoula, the bill's chief sponsor, said that although it will provide insurance to "admittedly a small number of businesses," it's still a good start at reducing the number of uninsured Montanans, estimated to be 165,000.
The precise number of businesses and employees affected by the program won't be known until early next year. It depends on the number of each business enrolled, how many employees choose to buy insurance and whether they choose to place any of their dependents on the policy.
The program will be expanded if more money becomes available, Morrison said. The state also is applying to the federal government for additional money that could help cover workers whose income is at or below 200 percent of the federal poverty level ($25,600 for a family of two).
Morrison said the plan could be a "successful precedent" of the state teaming up with the private sector to make health insurance more affordable and get more people covered.
"Insure Montana is a concept that needs to be developed much more widely at the state and national level," he said.
Tuesday, December 20, 2005
Individual Health Insurance to the rescue
From the Raleigh News and Observer
Polls in North Carolina and the nation show that even amid wars, natural disasters, investigations and judicial confirmation battles, few issues matter more to average voters than health care. Unfortunately, few issues are fraught with so much complexity, confusion and misunderstanding.
For example, the Economic Policy Institute (EPI) recently published an analysis of census data showing that employer-provided health insurance continues to decline nationwide. According to the report, North Carolina experienced the second-fastest drop in the share of residents getting their health insurance from employers, declining from 64 percent in 2000 to 57 percent in 2004.
EPI estimated the number of those losing employer-based coverage who could qualify for government programs such as Medicaid and S-CHIP. It then insinuated that the remainder were unable to get health insurance and concluded that a government-run, single-payer insurance system was the only appropriate response.
It was remarkable that this report, and subsequent media accounts of it, neglected to mention the existence of the market for individual health insurance, which has been undergoing significant and important changes.
A closer look at the data in the EPI report reveals that while some North Carolina workers are no longer getting health insurance for themselves from their employers, the more significant change involves their spouses and children. Increasingly, North Carolina workers are exercising other options to get coverage for their dependents. There's no mystery why this is so: employer-based dependent coverage is too expensive.
Employees typically pay this entire cost directly out of their paychecks, and are thus strongly motivated to seek alternatives. Those with lower incomes find "free" government insurance attractive -- and state agencies have spent a tremendous amount of time and money trying to convince them of that fact. Those with higher incomes are finding better-priced plans in the individual market or decide to save their forgone premiums in accounts to pay for routine medical care as needed.
The EPI report included a graph illustrating the relationship of the decline in employer-based coverage and increasing enrollment in the government options. This correlation does not necessarily illustrate the "strength of government programs," as the authors say, but rather suggests that an expansion of government-run health insurance sends a clear signal to employers and employees, changing their behavior.
Employers become less likely to offer health benefits, on the assumption that someone else -- the government (taxpayers) -- will foot the bill for their work-force. Employees become less likely to continuing paying for benefits that others in their income level are getting from government. Advocates of government-run health care see all upsides from this, but there are also plenty of downsides: higher costs for taxpayers and private-insurance subscribers, and fewer choices and poorer incentives for those using government insurance.
At the higher end of the income scale, many are finding better opportunities in the individual health insurance market. For healthy individuals, premiums are generally less expensive than a policy through an employer group, plus you get to choose what type of policy you want and you get to keep the policy if your employment changes. Both short-term and regular insurance, purchased through the individual market, have affordable rates because they are medically underwritten. This means that those with predictably lower medical costs will pay less.
Those who have risk factors that lead to higher utilization of medical services will pay more in premiums, or be offered limited coverage, or be denied coverage. In North Carolina, we do have one company (Blue Cross and Blue Shield of N.C.) that will offer coverage to the highest-risk individuals, but the premiums are five to six times the normal rate and unaffordable for most. Again, some cite this difficulty as justifying a single-payer health system, but it doesn't. A better policy would be to set up a high-risk insurance pool.
Thirty-three other states have created such pools, allowing high-risk customers to purchase an individual health insurance policy capped at about 150 percent of what the healthy person would pay. The number of potential users of a high-risk pool isn't as large as many think, and subsidizing it would address the problem at a much lower cost in dollars and intrusiveness than opting for government-run insurance.
Public policy can help drive additional innovation in individual, portable health plans as well as cash-for-service medical practices. The latter can save significant dollars in administrative costs that can be passed along to patients as lower prices. Changes in tax policy to broaden health savings accounts and equalize the tax treatment of group and individual health plans would be welcome. Moving toward increased government control of this market would not be.
Polls in North Carolina and the nation show that even amid wars, natural disasters, investigations and judicial confirmation battles, few issues matter more to average voters than health care. Unfortunately, few issues are fraught with so much complexity, confusion and misunderstanding.
For example, the Economic Policy Institute (EPI) recently published an analysis of census data showing that employer-provided health insurance continues to decline nationwide. According to the report, North Carolina experienced the second-fastest drop in the share of residents getting their health insurance from employers, declining from 64 percent in 2000 to 57 percent in 2004.
EPI estimated the number of those losing employer-based coverage who could qualify for government programs such as Medicaid and S-CHIP. It then insinuated that the remainder were unable to get health insurance and concluded that a government-run, single-payer insurance system was the only appropriate response.
It was remarkable that this report, and subsequent media accounts of it, neglected to mention the existence of the market for individual health insurance, which has been undergoing significant and important changes.
A closer look at the data in the EPI report reveals that while some North Carolina workers are no longer getting health insurance for themselves from their employers, the more significant change involves their spouses and children. Increasingly, North Carolina workers are exercising other options to get coverage for their dependents. There's no mystery why this is so: employer-based dependent coverage is too expensive.
Employees typically pay this entire cost directly out of their paychecks, and are thus strongly motivated to seek alternatives. Those with lower incomes find "free" government insurance attractive -- and state agencies have spent a tremendous amount of time and money trying to convince them of that fact. Those with higher incomes are finding better-priced plans in the individual market or decide to save their forgone premiums in accounts to pay for routine medical care as needed.
The EPI report included a graph illustrating the relationship of the decline in employer-based coverage and increasing enrollment in the government options. This correlation does not necessarily illustrate the "strength of government programs," as the authors say, but rather suggests that an expansion of government-run health insurance sends a clear signal to employers and employees, changing their behavior.
Employers become less likely to offer health benefits, on the assumption that someone else -- the government (taxpayers) -- will foot the bill for their work-force. Employees become less likely to continuing paying for benefits that others in their income level are getting from government. Advocates of government-run health care see all upsides from this, but there are also plenty of downsides: higher costs for taxpayers and private-insurance subscribers, and fewer choices and poorer incentives for those using government insurance.
At the higher end of the income scale, many are finding better opportunities in the individual health insurance market. For healthy individuals, premiums are generally less expensive than a policy through an employer group, plus you get to choose what type of policy you want and you get to keep the policy if your employment changes. Both short-term and regular insurance, purchased through the individual market, have affordable rates because they are medically underwritten. This means that those with predictably lower medical costs will pay less.
Those who have risk factors that lead to higher utilization of medical services will pay more in premiums, or be offered limited coverage, or be denied coverage. In North Carolina, we do have one company (Blue Cross and Blue Shield of N.C.) that will offer coverage to the highest-risk individuals, but the premiums are five to six times the normal rate and unaffordable for most. Again, some cite this difficulty as justifying a single-payer health system, but it doesn't. A better policy would be to set up a high-risk insurance pool.
Thirty-three other states have created such pools, allowing high-risk customers to purchase an individual health insurance policy capped at about 150 percent of what the healthy person would pay. The number of potential users of a high-risk pool isn't as large as many think, and subsidizing it would address the problem at a much lower cost in dollars and intrusiveness than opting for government-run insurance.
Public policy can help drive additional innovation in individual, portable health plans as well as cash-for-service medical practices. The latter can save significant dollars in administrative costs that can be passed along to patients as lower prices. Changes in tax policy to broaden health savings accounts and equalize the tax treatment of group and individual health plans would be welcome. Moving toward increased government control of this market would not be.
King Kong of Health Insurance
From the Denverpost.com
Christmas may come early for the shareholders and top executives of UnitedHealthcare and PacifiCare. With scant public interest and a one-day public hearing, David Rivera, the Colorado Commissioner of Insurance, will decide within the next few days whether to allow these two HMO giants to merge into the King Kong of managed care organizations. If he does approve the merger, the only remaining question will be what, if any, conditions the state might require to ensure that this big gorilla plays well with others, both patients and physicians.
Should the merger go through, these execs will receive a salary and bonus windfall larger than the total amount of 2006 Referendum C tax dollars approved by Colorado voters last month for highways, schools, and health care combined - enough money to almost single-handedly move Colorado from its embarrassingly low ranking in immunized children to the top quartile. It is more than enough money to provide prenatal care to needy, pregnant mothers who are struggling without the benefit of basic medical services. In short, United/PacifiCare will enjoy extravagant profit margins while Colorado continues its race to the bottom with a handful of southern states to see who will have the most working uninsured per capita in the country, a hidden tax we all pay.
Does HMO size matter to your personal physician? Enormously. When a managed care organization insures a quarter or more of the patients in a physician's practice, which will be the case in a merged United/PacifiCare, it can pretty much dictate how, when and where patients will be treated by how much or how little they will cover and reimburse. Your doctor cannot afford to turn down the HMO's contract, however coercive or unfair, any more than most of us could live with a 25 percent pay cut.
Like any business, health insurers weigh their success in profit, measured in terms of a medical loss ratio. What we call the patient's premium dollar is split between your health care and their profit. They view any money spent on your health care as a loss. The lower their "loss," the greater their profit. Without sufficient oversight, this ratio will tend toward the
company rather than the patient.
We do not choose to be sick or injured as though we were buying a pair of shoes. Even the most subtle manipulations by a powerful, unbridled HMO can profoundly compromise your health by restricting who can treat you, where and when you can be hospitalized, and for how long. What prescriptions you may take, how often they are changed without your physician's knowledge or consent, are all part of the business decisions a health plan can make to push that "loss" ratio in the direction of Wall Street instead of Main Street, Colorado. Unless they are reined in, they can strip-mine Colorado's premium dollars and ship them back east with little say by our regulators.
The Colorado Medical Society has urged the insurance commissioner to keep a tight leash on this big gorilla by requiring they adhere to the highest standards of transparency, accountability, fair business practices, and the protection of patient-physician relationship. Colorado's laws concerning the approval of mergers such as this have gathered dust since 1986, untouched by legislative hands. The 1986 Colorado General Assembly could not have anticipated a circumstance where two plans (a combined United/PacifiCare and Anthem/Wellpoint) would cover nearly two-thirds of our private insurance market, and generate profits the size of a small country. A great deal has been left unsaid in those statutes.
Much of the discretion in the matter of this acquisition will therefore be in the hands of the commissioner. In the absence of clear, unambiguous legislative direction, we hope he will exercise his own legal authority and not let this greatly enlarged creature loose.
Christmas may come early for the shareholders and top executives of UnitedHealthcare and PacifiCare. With scant public interest and a one-day public hearing, David Rivera, the Colorado Commissioner of Insurance, will decide within the next few days whether to allow these two HMO giants to merge into the King Kong of managed care organizations. If he does approve the merger, the only remaining question will be what, if any, conditions the state might require to ensure that this big gorilla plays well with others, both patients and physicians.
Should the merger go through, these execs will receive a salary and bonus windfall larger than the total amount of 2006 Referendum C tax dollars approved by Colorado voters last month for highways, schools, and health care combined - enough money to almost single-handedly move Colorado from its embarrassingly low ranking in immunized children to the top quartile. It is more than enough money to provide prenatal care to needy, pregnant mothers who are struggling without the benefit of basic medical services. In short, United/PacifiCare will enjoy extravagant profit margins while Colorado continues its race to the bottom with a handful of southern states to see who will have the most working uninsured per capita in the country, a hidden tax we all pay.
Does HMO size matter to your personal physician? Enormously. When a managed care organization insures a quarter or more of the patients in a physician's practice, which will be the case in a merged United/PacifiCare, it can pretty much dictate how, when and where patients will be treated by how much or how little they will cover and reimburse. Your doctor cannot afford to turn down the HMO's contract, however coercive or unfair, any more than most of us could live with a 25 percent pay cut.
Like any business, health insurers weigh their success in profit, measured in terms of a medical loss ratio. What we call the patient's premium dollar is split between your health care and their profit. They view any money spent on your health care as a loss. The lower their "loss," the greater their profit. Without sufficient oversight, this ratio will tend toward the
company rather than the patient.
We do not choose to be sick or injured as though we were buying a pair of shoes. Even the most subtle manipulations by a powerful, unbridled HMO can profoundly compromise your health by restricting who can treat you, where and when you can be hospitalized, and for how long. What prescriptions you may take, how often they are changed without your physician's knowledge or consent, are all part of the business decisions a health plan can make to push that "loss" ratio in the direction of Wall Street instead of Main Street, Colorado. Unless they are reined in, they can strip-mine Colorado's premium dollars and ship them back east with little say by our regulators.
The Colorado Medical Society has urged the insurance commissioner to keep a tight leash on this big gorilla by requiring they adhere to the highest standards of transparency, accountability, fair business practices, and the protection of patient-physician relationship. Colorado's laws concerning the approval of mergers such as this have gathered dust since 1986, untouched by legislative hands. The 1986 Colorado General Assembly could not have anticipated a circumstance where two plans (a combined United/PacifiCare and Anthem/Wellpoint) would cover nearly two-thirds of our private insurance market, and generate profits the size of a small country. A great deal has been left unsaid in those statutes.
Much of the discretion in the matter of this acquisition will therefore be in the hands of the commissioner. In the absence of clear, unambiguous legislative direction, we hope he will exercise his own legal authority and not let this greatly enlarged creature loose.
Monday, December 19, 2005
Misunderstanding Creates Health Insurance Scare
Imagine having a child who needs surgery to save him from a life of pain and possible paralysis, but your insurance company won't allow it.
That's what a Long Island family faced because of a misunderstanding, reported WNBC-TV in New York.
At first glance, little Michael Schindlar looks pretty much like any other 4-year-old.
Aside from being a little small at birth due to being premature, he grew and developed pretty normally until he was about 16 months old.
"He just got quiet, and he was just withdrawn, he wouldn't make eye contact," said Lori Schindlar, Michael's mother. "You'd call his name and nothing."
It took a few months and several visits to the doctor before the Schindlars got Michael properly diagnosed with autism.
"He was so normal one day," said Lori. "It was like someone went in, one night he went to sleep, and someone took him away from us."
A year or so later, Michael had an MRI because he had suffered two seizures. That's when doctors found Michael also had a rare developmental problem called a Chiari malformation, in which the base of the skull is too small for the back of the brain.
The condition causes compression of the part of the brain called the cerebellum, which in turn leads to a whole host of problems, said Dr. Neil Feldstein, of Columbia-Presbyterian Medical Center in New York.
"Pain at the back of the head, top of the neck, sometimes pain radiating into the arms," said Feldstein. "There can be numbness, tingling, there can be speech difficulties, swallowing difficulty, (and it) can lead to spinal fluid buildup in the brain, in the spinal cord."
To ease the condition, patients undergo surgery that creates more room for the brain to grow. Feldstein assured the Schindlars that such a procedure had a successful track record. But then the Schindlars' insurance company said they couldn't pay for the operation.
They couldn't pay "because there was no peer-reviewed literature out there, studies proving that this type of surgery would help the outcome for a child with autism," said Lori.
That's true. However, the surgery wasn't for Michael's autism, it was for his Chiari malformation. Somehow, there was a misunderstanding between the doctor's office and the insurance company that led them to believe the surgery was for the autism.
At that point, the Schindlars called WNBC for help. After some communication between the parties involved, Michael finally got his vital surgery.
The surgery went well. Children with autism who have had this malformation corrected have often seen their autism symptoms get better.
Two weeks after the procedure, Michael was going from a little cranky to calm to very active.
"We're waiting for the 'Mommy' and 'Daddy,'" said Lori. "That would be worth it all."
Michael's parents said that he's had good and bad days since the surgery, at least when it comes to his behavioral issues. Feldstein said that's normal, adding that it could take a year or more to fully heal.
That's what a Long Island family faced because of a misunderstanding, reported WNBC-TV in New York.
At first glance, little Michael Schindlar looks pretty much like any other 4-year-old.
Aside from being a little small at birth due to being premature, he grew and developed pretty normally until he was about 16 months old.
"He just got quiet, and he was just withdrawn, he wouldn't make eye contact," said Lori Schindlar, Michael's mother. "You'd call his name and nothing."
It took a few months and several visits to the doctor before the Schindlars got Michael properly diagnosed with autism.
"He was so normal one day," said Lori. "It was like someone went in, one night he went to sleep, and someone took him away from us."
A year or so later, Michael had an MRI because he had suffered two seizures. That's when doctors found Michael also had a rare developmental problem called a Chiari malformation, in which the base of the skull is too small for the back of the brain.
The condition causes compression of the part of the brain called the cerebellum, which in turn leads to a whole host of problems, said Dr. Neil Feldstein, of Columbia-Presbyterian Medical Center in New York.
"Pain at the back of the head, top of the neck, sometimes pain radiating into the arms," said Feldstein. "There can be numbness, tingling, there can be speech difficulties, swallowing difficulty, (and it) can lead to spinal fluid buildup in the brain, in the spinal cord."
To ease the condition, patients undergo surgery that creates more room for the brain to grow. Feldstein assured the Schindlars that such a procedure had a successful track record. But then the Schindlars' insurance company said they couldn't pay for the operation.
They couldn't pay "because there was no peer-reviewed literature out there, studies proving that this type of surgery would help the outcome for a child with autism," said Lori.
That's true. However, the surgery wasn't for Michael's autism, it was for his Chiari malformation. Somehow, there was a misunderstanding between the doctor's office and the insurance company that led them to believe the surgery was for the autism.
At that point, the Schindlars called WNBC for help. After some communication between the parties involved, Michael finally got his vital surgery.
The surgery went well. Children with autism who have had this malformation corrected have often seen their autism symptoms get better.
Two weeks after the procedure, Michael was going from a little cranky to calm to very active.
"We're waiting for the 'Mommy' and 'Daddy,'" said Lori. "That would be worth it all."
Michael's parents said that he's had good and bad days since the surgery, at least when it comes to his behavioral issues. Feldstein said that's normal, adding that it could take a year or more to fully heal.
State Agency Blesses Second-Largest Health-Insurance Acquisition
By Jesus Sanchez, Times Staff Writer
California Insurance Commissioner John Garamendi today approved the acquisition of Orange County-based PacifiCare Health Systems by insurance giant UnitedHealth Group in an $8.1 billion deal.
In return for the agency's blessing, the companies agreed to, among other things, pay no dividends from PacifiCare's operations for four years after the acquisition and pledged to make more than $200 million charitable contributions and investment in underserved communities.
I continue to be concerned by many trends in this industry," said Garamendi said in a statement. "But today's agreement, particularly its restriction on the distribution of dividends, provides meaningful and substantial benefits for California consumers."
The acquisition would help UnitedHealth, the nation's second-largest health insurer with 22 million members, gain ground on industry leader WellPoint Inc. and tap into PacifiCare's strong Medicare business, positioning the company to capitalize on a prescription-drug benefit scheduled to start Jan. 1.
The deal, which was announced in July, would be the second-largest health-insurance acquisition, after last year's $21-billion purchase of Thousand Oaks-based WellPoint Health Networks Inc. by Anthem Inc., which took the name WellPoint Inc.
While company executives and Wall Street investors have hailed the acquisition, some managed-care experts and consumer groups worried the deal could mean higher costs and fewer choices for consumers. Employers may find they have less leverage in negotiating coverage because there are fewer providers to bargain with, according to some industry observers.
The deal has also caught flak over $345 million in payments that top executives of PacifiCare Health Systems Inc. would receive as a result of the sale. The California Public Employees' Retirement System, a PacifiCare shareholder, has opposed the payments and asked the state Department of Managed Health Care, which is also reviewing the combination, to reject the deal if the payments are included.
Through its Secure Horizons brand name, PacifiCare provides coverage to more than 700,000 seniors on Medicare, making it the nation's largest for-profit provider of such plans. It also offers supplemental plans and heart-disease management to other Medicare recipients.
UnitedHealth executives, who have acquired nearly 10 smaller insurers in recent years, said they were also attracted to PacificCare's specialty programs, such as those for prescription drugs, behavioral health, dental and vision insurance.
PacifiCare began as a nonprofit HMO in 1975 and became for-profit in 1984, rising to No. 172 on the Fortune 500 list. It serves nearly 3.2 million health-plan members and more than 11 million people in its specialty plans.
Cypress-based PacifiCare will remain in Orange County, operating as a subsidiary of UnitedHealth, company officials said. Insurance products would retain the PacifiCare and Secure Horizons brand names.
Most of the company's 10,500 employees ? of whom more than 5,600 are in California ? would keep their jobs, company officials said.
The deal is also being reviewed by the California Department of Managed Health Care, regulators in several other states and the U.S. Justice Department.
California Insurance Commissioner John Garamendi today approved the acquisition of Orange County-based PacifiCare Health Systems by insurance giant UnitedHealth Group in an $8.1 billion deal.
In return for the agency's blessing, the companies agreed to, among other things, pay no dividends from PacifiCare's operations for four years after the acquisition and pledged to make more than $200 million charitable contributions and investment in underserved communities.
I continue to be concerned by many trends in this industry," said Garamendi said in a statement. "But today's agreement, particularly its restriction on the distribution of dividends, provides meaningful and substantial benefits for California consumers."
The acquisition would help UnitedHealth, the nation's second-largest health insurer with 22 million members, gain ground on industry leader WellPoint Inc. and tap into PacifiCare's strong Medicare business, positioning the company to capitalize on a prescription-drug benefit scheduled to start Jan. 1.
The deal, which was announced in July, would be the second-largest health-insurance acquisition, after last year's $21-billion purchase of Thousand Oaks-based WellPoint Health Networks Inc. by Anthem Inc., which took the name WellPoint Inc.
While company executives and Wall Street investors have hailed the acquisition, some managed-care experts and consumer groups worried the deal could mean higher costs and fewer choices for consumers. Employers may find they have less leverage in negotiating coverage because there are fewer providers to bargain with, according to some industry observers.
The deal has also caught flak over $345 million in payments that top executives of PacifiCare Health Systems Inc. would receive as a result of the sale. The California Public Employees' Retirement System, a PacifiCare shareholder, has opposed the payments and asked the state Department of Managed Health Care, which is also reviewing the combination, to reject the deal if the payments are included.
Through its Secure Horizons brand name, PacifiCare provides coverage to more than 700,000 seniors on Medicare, making it the nation's largest for-profit provider of such plans. It also offers supplemental plans and heart-disease management to other Medicare recipients.
UnitedHealth executives, who have acquired nearly 10 smaller insurers in recent years, said they were also attracted to PacificCare's specialty programs, such as those for prescription drugs, behavioral health, dental and vision insurance.
PacifiCare began as a nonprofit HMO in 1975 and became for-profit in 1984, rising to No. 172 on the Fortune 500 list. It serves nearly 3.2 million health-plan members and more than 11 million people in its specialty plans.
Cypress-based PacifiCare will remain in Orange County, operating as a subsidiary of UnitedHealth, company officials said. Insurance products would retain the PacifiCare and Secure Horizons brand names.
Most of the company's 10,500 employees ? of whom more than 5,600 are in California ? would keep their jobs, company officials said.
The deal is also being reviewed by the California Department of Managed Health Care, regulators in several other states and the U.S. Justice Department.
Health coverage debate intensifies
By Tracey Drury
Business First of Buffalo
Most college campuses are pretty dull on a Saturday.
But Nov. 19 was an exception for Medaille College, where more than 200 people from 70 organizations gathered to come up with solutions to the health-care crisis. Nearly two dozen organized labor groups were represented at the event, billed as a "citizen/congressional hearing."
"It is the top issue for us," said Terri Schelter, chairwoman of the Western New York Health Care Campaign, which sponsored and initiated the forum. "One of the problems with solving the health-care crisis is that people just can't get a handle on how to solve it, with all the pieces that play into the mess that we're in."
With large employers scaling back on health-care coverage and workers paying more and more of the costs, unions are scrambling for answers to help their members. That's true for some of the region's largest unions, as the UAW fights to keep the doors open at bankrupt Delphi Corp., as well as smaller groups of skilled trades workers.
Schelter, also legislative political director for CWA 1168 Nurses United, said the issue is compounded for the 4,500 members she represents, as the issue also affects how they're able to do their jobs.
"It's not only a bargaining issue at every contract for union workers, no matter what sector you're in," she said. "The mess we're in with health care and the financing of health care directly affects our staffing."
Health-care providers with smaller staffs are caring for an increasingly susceptible population - one that includes large numbers of the uninsured, who go to emergency rooms and clinics for what could have been routine care, she said.
"The clinics that we still have open in the Kaleida system, they're overrun with patients, and they're sick. It's a matter of just planning health care in general. It's just not being done," Schelter said.
Daniel Boody, president of both the Western New York Area Labor Federation and Painters District Council No. 4, said members are angry and bitter about annual increases in costs.
"Basically, the members are up in arms," he said. "Employers are looking for ways of pushing more of the cost on the employees."
With an average national cost increase of 16 percent over the last three years - and even more in Western New York - most of the 160 local unions in the federation are doing everything they can to contain costs. This includes getting multiple quotes from providers and altering plans with high- and low-deductible options. They're also looking at switching from community ratings to experience ratings or even at becoming self-funded.
"They're constantly looking for ways to cut costs, even if that means higher co-pays. They're looking for lower monthly premiums," he said. "They'd like to see somebody in Washington legislatively push for national health-care coverage."
The only consolation is that most members recognize it's a problem nationwide, faced by non-union contractors as well.
"It's becoming a real struggle - one of the Number One items on everyone's plate right now," Boody said.
Those in the automotive industry know only too well how rising health-care costs are hurting workers. Every increase adds to the cost of cars produced in this country - a factor in why the auto industry is opening new plants across the border in Canada, where universal health care means lower costs. Bob Reynolds, vice president of UAW Local 897 and a 30-year Ford Motor Co. machine repairman, says the issue is hot.
"Why is it cheaper in Canada and more expensive here in the U.S.? How can that happen? How can you just drive across the border and get something cheaper?" he said.
Even though health-care costs have been maintained at a steady level at Ford, Reynolds says the union is looking forward to the next set of negotiations, coming in 2007.
"It's going to be a fight for all of us, obviously," said Reynolds, a newly elected Erie County legislator who will take office Jan. 1. "Health care is going to come up in negotiations for the Big 3 in 2007, and we're trying to deal with it right now."
"What's happening at Delphi has an effect on the whole country, not just here," he said. "It's a tough issue for all of us."
Whether the issue will lead to fundamental changes in how unions negotiate are a possibility too, Reynolds said.
"I'd say we're in a transition, just like this country is in a transition in our manufacturing base," he said.
Richard Lipsitz, business agent for Teamsters Local 264 and political action coordinator for Teamsters Joint Council 46, said health-care costs are "out of control" and said they're responsible for destroying many aspects of labor/management relations - through no real fault of the employers.
Though health-care costs have been part of bargaining-table discussions throughout Lipsitz's 20 years with the union, it's gotten worse. Employers are having trouble competing with non-union competitors.
"You can put Band-Aids on it, but in terms of a serious solution, it can't be done except on a national or statewide basis," he said. "It's become exacerbated in the last five years, and it does coincide with a laissez-faire attitude on the part of the federal government."
A national program seems to be the best solution, Lipsitz said. The U.S., he said, remains the only industrialized nation without a national health-care program.
Still, there are short-term solutions, including moving to a single-provider system.
"It does provide some relief, and I think you'll see more of that," he said. "The government's resources are limited because of taxation, but unless we have a national policy that deals with this issue, I don't see it going away."
A member of the Western New York Health Care Campaign, Lex Liberatore, helped to organize the recent citizens' forum in Buffalo. The main target for the event - and 90 others like it being held across the country - is to get the attention of Congress and get members of local delegations to make it an agenda item.
Despite being the No. 1 or No. 2 issue for voters, finding a solution isn't even on the radar screen, he said.
"This is not on the Congressional agenda at all," Liberatore said. "The 70 groups that came to this hearing all agreed on one thing: The system is broken and needs to be fixed."
Liberatore, a volunteer organizer, said participants didn't advocate for a national health program or any other specific remedy. Instead, they sought input on all kinds of ideas with a goal of formulating potential solutions. A follow-up meeting will be held in January.
"None of these groups has an agreed-upon solution, but they have the ability to come together on these issues and to lay out ideas in the hopes Congress will address them," Liberatore said.
The problems are no different for public workers, such as AFSCME 1095, Erie County's blue-collar workforce, which convinced all its unions to agree to one health plan with four coverage options. National health care remains the favored solution, said John Orlando, president of ASFME Local 1095.
"We've instituted some things to slow down the costs of health care," he said. "Naturally, some of the costs did go up and the co-pays, but for the most part we kept the core benefits intact."
To help contain more costs, the union is even looking into issuing an RFP for pharmaceuticals.
"We need to ask the pharmaceutical companies. They've done something unions haven't been able to do, and that's control Congress," Lipsitz said.
Business First of Buffalo
Most college campuses are pretty dull on a Saturday.
But Nov. 19 was an exception for Medaille College, where more than 200 people from 70 organizations gathered to come up with solutions to the health-care crisis. Nearly two dozen organized labor groups were represented at the event, billed as a "citizen/congressional hearing."
"It is the top issue for us," said Terri Schelter, chairwoman of the Western New York Health Care Campaign, which sponsored and initiated the forum. "One of the problems with solving the health-care crisis is that people just can't get a handle on how to solve it, with all the pieces that play into the mess that we're in."
With large employers scaling back on health-care coverage and workers paying more and more of the costs, unions are scrambling for answers to help their members. That's true for some of the region's largest unions, as the UAW fights to keep the doors open at bankrupt Delphi Corp., as well as smaller groups of skilled trades workers.
Schelter, also legislative political director for CWA 1168 Nurses United, said the issue is compounded for the 4,500 members she represents, as the issue also affects how they're able to do their jobs.
"It's not only a bargaining issue at every contract for union workers, no matter what sector you're in," she said. "The mess we're in with health care and the financing of health care directly affects our staffing."
Health-care providers with smaller staffs are caring for an increasingly susceptible population - one that includes large numbers of the uninsured, who go to emergency rooms and clinics for what could have been routine care, she said.
"The clinics that we still have open in the Kaleida system, they're overrun with patients, and they're sick. It's a matter of just planning health care in general. It's just not being done," Schelter said.
Daniel Boody, president of both the Western New York Area Labor Federation and Painters District Council No. 4, said members are angry and bitter about annual increases in costs.
"Basically, the members are up in arms," he said. "Employers are looking for ways of pushing more of the cost on the employees."
With an average national cost increase of 16 percent over the last three years - and even more in Western New York - most of the 160 local unions in the federation are doing everything they can to contain costs. This includes getting multiple quotes from providers and altering plans with high- and low-deductible options. They're also looking at switching from community ratings to experience ratings or even at becoming self-funded.
"They're constantly looking for ways to cut costs, even if that means higher co-pays. They're looking for lower monthly premiums," he said. "They'd like to see somebody in Washington legislatively push for national health-care coverage."
The only consolation is that most members recognize it's a problem nationwide, faced by non-union contractors as well.
"It's becoming a real struggle - one of the Number One items on everyone's plate right now," Boody said.
Those in the automotive industry know only too well how rising health-care costs are hurting workers. Every increase adds to the cost of cars produced in this country - a factor in why the auto industry is opening new plants across the border in Canada, where universal health care means lower costs. Bob Reynolds, vice president of UAW Local 897 and a 30-year Ford Motor Co. machine repairman, says the issue is hot.
"Why is it cheaper in Canada and more expensive here in the U.S.? How can that happen? How can you just drive across the border and get something cheaper?" he said.
Even though health-care costs have been maintained at a steady level at Ford, Reynolds says the union is looking forward to the next set of negotiations, coming in 2007.
"It's going to be a fight for all of us, obviously," said Reynolds, a newly elected Erie County legislator who will take office Jan. 1. "Health care is going to come up in negotiations for the Big 3 in 2007, and we're trying to deal with it right now."
"What's happening at Delphi has an effect on the whole country, not just here," he said. "It's a tough issue for all of us."
Whether the issue will lead to fundamental changes in how unions negotiate are a possibility too, Reynolds said.
"I'd say we're in a transition, just like this country is in a transition in our manufacturing base," he said.
Richard Lipsitz, business agent for Teamsters Local 264 and political action coordinator for Teamsters Joint Council 46, said health-care costs are "out of control" and said they're responsible for destroying many aspects of labor/management relations - through no real fault of the employers.
Though health-care costs have been part of bargaining-table discussions throughout Lipsitz's 20 years with the union, it's gotten worse. Employers are having trouble competing with non-union competitors.
"You can put Band-Aids on it, but in terms of a serious solution, it can't be done except on a national or statewide basis," he said. "It's become exacerbated in the last five years, and it does coincide with a laissez-faire attitude on the part of the federal government."
A national program seems to be the best solution, Lipsitz said. The U.S., he said, remains the only industrialized nation without a national health-care program.
Still, there are short-term solutions, including moving to a single-provider system.
"It does provide some relief, and I think you'll see more of that," he said. "The government's resources are limited because of taxation, but unless we have a national policy that deals with this issue, I don't see it going away."
A member of the Western New York Health Care Campaign, Lex Liberatore, helped to organize the recent citizens' forum in Buffalo. The main target for the event - and 90 others like it being held across the country - is to get the attention of Congress and get members of local delegations to make it an agenda item.
Despite being the No. 1 or No. 2 issue for voters, finding a solution isn't even on the radar screen, he said.
"This is not on the Congressional agenda at all," Liberatore said. "The 70 groups that came to this hearing all agreed on one thing: The system is broken and needs to be fixed."
Liberatore, a volunteer organizer, said participants didn't advocate for a national health program or any other specific remedy. Instead, they sought input on all kinds of ideas with a goal of formulating potential solutions. A follow-up meeting will be held in January.
"None of these groups has an agreed-upon solution, but they have the ability to come together on these issues and to lay out ideas in the hopes Congress will address them," Liberatore said.
The problems are no different for public workers, such as AFSCME 1095, Erie County's blue-collar workforce, which convinced all its unions to agree to one health plan with four coverage options. National health care remains the favored solution, said John Orlando, president of ASFME Local 1095.
"We've instituted some things to slow down the costs of health care," he said. "Naturally, some of the costs did go up and the co-pays, but for the most part we kept the core benefits intact."
To help contain more costs, the union is even looking into issuing an RFP for pharmaceuticals.
"We need to ask the pharmaceutical companies. They've done something unions haven't been able to do, and that's control Congress," Lipsitz said.
Understanding Medicare
New drug plan puzzling for non-English speakers
By Rebecca Vesely, STAFF WRITER Inside Bay Area
Figuring out Medicare's new prescription drug program is hard enough for seniors. What about for those who don't speak English?
In the Bay Area, community groups are racing to make sure the thousands of seniors with limited or no English skills understand the new Medicare drug benefit, called Part D, which starts Jan. 1.
This is important because most of these seniors are very low-income and will see big changes to their drug coverage in just two weeks, advocates say.
In policy speak, low-income seniors and disabled people whose health care is covered by both Medicare and Medi-Cal, the state's health insurance program for the poor, are called "dual-eligibles."
Starting Jan. 1, dual-eligibles' drug coverage will no longer be offered through Medi-Cal. Instead, dual-eligibles will switch over into one of 10 private plans approved by Medicare to cover their drugs.
In Alameda County alone, there are 7,800 dual-eligibles who speak limited English, according to county Supervisor Alice Lai-Bitker's office.
Most of these seniors are immigrants from China, Vietnam, Central America and Mexico. All are here legally, and many are citizens.
All dual-eligibles statewide -- about 1 million seniors and disabled -- received a yellow letter in the past month from the federal Centers for Medicare and Medicaid Services notifying them of the change and telling them which of the 10 plans they have been automatically enrolled in.
If these dual-eligibles don't like the drug plan they were automatically enrolled in, they can switch to one they like better. They are allowed to switch after Jan. 1, but no matter what, their prescriptions will be paid for by a new provider starting the first of the new year.
The problem is that in some cases, these seniors were automatically enrolled in plans that do not cover their specific prescription drugs. So dual-eligibles are being advised to check their medications against the plan they have been enrolled in to make sure they are getting the best deal.
For seniors with limited or no English skills, this task can be insurmountable -- especially since that yellow letter from Medicare notifying them of the change was written only in English.
"Most of our clients are very confused," said Wai Fong, social services manager of Family Bridges, a nonprofit agency that serves people with limited English who are mostly from Asia. "They don't understand that the law has changed."
Many seniors with limited English skills threw away the yellow letter because they didn't understand that it was important, Fong said.
On a recent Saturday at the Family Bridges office in Oakland's Chinatown, seniors clutching their Medicare paperwork and plastic bags full of prescription bottles lined up to get counseling on the new Medicare benefit.
Family Bridges has about 600 clients who are dual-eligible, and nearly all speak limited or no English.
Mee Hui, 76, of Oakland takes eight medications for arthritis and her heart. She points to her right leg and says in a Cantonese dialect that she has chronic and severe pain there from a recent fall.
Hui has her yellow letter from Medicare, and shows it to Yvonne So, a volunteer counselor who speaks the same dialect. The letter informs Hui that she has been enrolled in Blue Cross MedicareRx Value, one of the 10 plans that dual-eligibles are being automatically assigned to.
Using the plan finder tool on Medicare's Web site, www.medicare.gov, So picks up each of Hui's prescription bottles, reads the label, then types the drug name into the computer.
Three of Hui's drugs now covered by Medi-Cal are not covered under any of Medicare's drug plans. These are over-the-counter drugs -- Tylenol, aspirin and an iron supplement. Medi-Cal will still provide these free of charge to dual-eligibles.
In her Web research, So discovers that Blue Cross does not cover several of Hui's other medications. If she stays with Blue Cross -- the plan she's been assigned to by Medicare -- Hui will pay $146.84 a month total for five of her prescriptions.
But if she switches to one of two other plans -- AARP Medicare Rx or United Health Rx -- Hui will pay only $13 a month for her five medications in small co-pays of $1 to $3 each.
So explains all this to Hui, who looks confused, surprised, then relieved. She chooses the AARP plan.
Albert Yee, a retired pharmacist who volunteers at Family Bridges, said the process is so individual because each of the 10 plans have different lists of drugs they cover, called formularies.
"The state had a uniform formulary and seniors paid nothing," he said. "Now there are many different formularies and there's also a co-pay."
Today, under Medi-Cal, Hui gets her eight drugs for free. Starting in January, she will pay $13 a month in co-pays. That's somewhat substantial for dual-eligibles, who make less than $9,570 a year for individuals, and less than $12,830 for couples in California.
What's more, if Hui had not sought help from Family Bridges and had stuck with Blue Cross, the plan she was assigned to, then she would be paying far more -- $1,752 a year for five drugs.
"It makes a lot of difference," Yee said. "Some plans do work and some are really expensive."
The state Department of Health Services this week sent letters to all one million dual-eligibles in the state, reminding them of the change to their drug coverage. Unlike the Medicare yellow letter, the state's letter was sent out in 12 languages.
To ensure dual-eligibles have no lapse in drug coverage, Medi-Cal is allowing pharmacists to refill prescriptions up to 100 days until the end of the year.
Many dual-eligibles will luck out, and the plan they were assigned to will cover all their drugs, with nominal co-pays.
Lai-Bitker, who has dispatched her staff to senior centers to help non-English speakers with the new benefit, said dual-eligibles with limited English skills are most at risk of paying more than they need to for their drugs.
The process of just finding the information can be extremely time-consuming.
At the Fruitvale San Antonio Senior Center in Oakland Wednesday, Sarah Wilson, an assistant to Lai-Bitker, spent half an hour using Medicare's Web-based plan finder to determine whether HealthNet will cover all 12 medications taken by a Vietnamese-speaking senior.
After half an hour of trying to find the information online, Wilson finally gave up and called HealthNet directly to inquire about the 12 drugs.
HealthNet did cover all the drugs, so no changes to coverage were needed. Still, the whole process took nearly an hour.
"A lot of people have been misled to think they don't have to do anything," said Michelle Taylor Lagunas, program manager of the San Antonio Senior Center, of the dual-eligibles. "That's simply not true."
By Rebecca Vesely, STAFF WRITER Inside Bay Area
Figuring out Medicare's new prescription drug program is hard enough for seniors. What about for those who don't speak English?
In the Bay Area, community groups are racing to make sure the thousands of seniors with limited or no English skills understand the new Medicare drug benefit, called Part D, which starts Jan. 1.
This is important because most of these seniors are very low-income and will see big changes to their drug coverage in just two weeks, advocates say.
In policy speak, low-income seniors and disabled people whose health care is covered by both Medicare and Medi-Cal, the state's health insurance program for the poor, are called "dual-eligibles."
Starting Jan. 1, dual-eligibles' drug coverage will no longer be offered through Medi-Cal. Instead, dual-eligibles will switch over into one of 10 private plans approved by Medicare to cover their drugs.
In Alameda County alone, there are 7,800 dual-eligibles who speak limited English, according to county Supervisor Alice Lai-Bitker's office.
Most of these seniors are immigrants from China, Vietnam, Central America and Mexico. All are here legally, and many are citizens.
All dual-eligibles statewide -- about 1 million seniors and disabled -- received a yellow letter in the past month from the federal Centers for Medicare and Medicaid Services notifying them of the change and telling them which of the 10 plans they have been automatically enrolled in.
If these dual-eligibles don't like the drug plan they were automatically enrolled in, they can switch to one they like better. They are allowed to switch after Jan. 1, but no matter what, their prescriptions will be paid for by a new provider starting the first of the new year.
The problem is that in some cases, these seniors were automatically enrolled in plans that do not cover their specific prescription drugs. So dual-eligibles are being advised to check their medications against the plan they have been enrolled in to make sure they are getting the best deal.
For seniors with limited or no English skills, this task can be insurmountable -- especially since that yellow letter from Medicare notifying them of the change was written only in English.
"Most of our clients are very confused," said Wai Fong, social services manager of Family Bridges, a nonprofit agency that serves people with limited English who are mostly from Asia. "They don't understand that the law has changed."
Many seniors with limited English skills threw away the yellow letter because they didn't understand that it was important, Fong said.
On a recent Saturday at the Family Bridges office in Oakland's Chinatown, seniors clutching their Medicare paperwork and plastic bags full of prescription bottles lined up to get counseling on the new Medicare benefit.
Family Bridges has about 600 clients who are dual-eligible, and nearly all speak limited or no English.
Mee Hui, 76, of Oakland takes eight medications for arthritis and her heart. She points to her right leg and says in a Cantonese dialect that she has chronic and severe pain there from a recent fall.
Hui has her yellow letter from Medicare, and shows it to Yvonne So, a volunteer counselor who speaks the same dialect. The letter informs Hui that she has been enrolled in Blue Cross MedicareRx Value, one of the 10 plans that dual-eligibles are being automatically assigned to.
Using the plan finder tool on Medicare's Web site, www.medicare.gov, So picks up each of Hui's prescription bottles, reads the label, then types the drug name into the computer.
Three of Hui's drugs now covered by Medi-Cal are not covered under any of Medicare's drug plans. These are over-the-counter drugs -- Tylenol, aspirin and an iron supplement. Medi-Cal will still provide these free of charge to dual-eligibles.
In her Web research, So discovers that Blue Cross does not cover several of Hui's other medications. If she stays with Blue Cross -- the plan she's been assigned to by Medicare -- Hui will pay $146.84 a month total for five of her prescriptions.
But if she switches to one of two other plans -- AARP Medicare Rx or United Health Rx -- Hui will pay only $13 a month for her five medications in small co-pays of $1 to $3 each.
So explains all this to Hui, who looks confused, surprised, then relieved. She chooses the AARP plan.
Albert Yee, a retired pharmacist who volunteers at Family Bridges, said the process is so individual because each of the 10 plans have different lists of drugs they cover, called formularies.
"The state had a uniform formulary and seniors paid nothing," he said. "Now there are many different formularies and there's also a co-pay."
Today, under Medi-Cal, Hui gets her eight drugs for free. Starting in January, she will pay $13 a month in co-pays. That's somewhat substantial for dual-eligibles, who make less than $9,570 a year for individuals, and less than $12,830 for couples in California.
What's more, if Hui had not sought help from Family Bridges and had stuck with Blue Cross, the plan she was assigned to, then she would be paying far more -- $1,752 a year for five drugs.
"It makes a lot of difference," Yee said. "Some plans do work and some are really expensive."
The state Department of Health Services this week sent letters to all one million dual-eligibles in the state, reminding them of the change to their drug coverage. Unlike the Medicare yellow letter, the state's letter was sent out in 12 languages.
To ensure dual-eligibles have no lapse in drug coverage, Medi-Cal is allowing pharmacists to refill prescriptions up to 100 days until the end of the year.
Many dual-eligibles will luck out, and the plan they were assigned to will cover all their drugs, with nominal co-pays.
Lai-Bitker, who has dispatched her staff to senior centers to help non-English speakers with the new benefit, said dual-eligibles with limited English skills are most at risk of paying more than they need to for their drugs.
The process of just finding the information can be extremely time-consuming.
At the Fruitvale San Antonio Senior Center in Oakland Wednesday, Sarah Wilson, an assistant to Lai-Bitker, spent half an hour using Medicare's Web-based plan finder to determine whether HealthNet will cover all 12 medications taken by a Vietnamese-speaking senior.
After half an hour of trying to find the information online, Wilson finally gave up and called HealthNet directly to inquire about the 12 drugs.
HealthNet did cover all the drugs, so no changes to coverage were needed. Still, the whole process took nearly an hour.
"A lot of people have been misled to think they don't have to do anything," said Michelle Taylor Lagunas, program manager of the San Antonio Senior Center, of the dual-eligibles. "That's simply not true."
Sunday, December 18, 2005
Health Insurance choices costly
By ERIC RUTH
The News Journal
Thousands of MBNA workers may soon find themselves out of a job, but the company says they will still get their health coverage -- until their severance packages run out.
After that, laid-off workers who still have not found new jobs must face the prospect of paying for temporary insurance policies, and dealing with a maze of requirements and qualifications that control eligibility. They may soon find that even relatively minor health problems limit their chances to buy new policies, and find themselves paying far more for insurance at a time of financial uncertainty.
Here's a look at the options in Delaware for laid-off workers without health insurance coverage, as spelled out by the Georgetown University Health Policy Institute, the state and other insurance information resources:
COBRA
Large employers with group health plans are required by law to offer employees the opportunity to temporarily continue their group health care coverage. Known as a COBRA policy, it can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition.
After you are laid off, your group health plan has 14 days to notify you about how to get coverage, and you and your family members have 60 days to enroll. The coverage will be retroactive to the time of the layoff, but usually lasts no more than 18 months and is not renewable.
COBRAs offer the benefit of retaining the coverage you had before you lost your job. There are limits on what you can be charged for this coverage, but be prepared for steeper insurance bills. You will have to pay premiums dating to the time of the layoff, and you will be responsible for paying the employer and employee share of the premium, plus a 2 percent fee.
HIPAA coverage
If your COBRA expires, you may be eligible for HIPAA coverage (named after the Health Insurance Portability and Accountability Act). Once you are HIPAA eligible, insurers cannot refuse individual coverage because of medical conditions -- they are obligated to offer at least two policies. The insurers are permitted to charge significantly higher premiums, however, due to health status, age or other factors.
Private individual insurance
In Delaware, you have a limited right to buy private individual health insurance, depending on your health status. Insurers are allowed to refuse or limit coverage based on health conditions, and buyers should be careful to compare differences in coverage from policy to policy before buying. Insurers are required to provide written descriptions of their health plan products.
Remember: Once you have coverage, it cannot be canceled just because you get sick, as long as you pay the premiums.
Interim policies
Insurers also offer limited-time policies, considered useful for short-term breaks in health coverage. These policies usually last two or six months. They are not guaranteed renewable, however, and consumers may end up paying a higher premium for the next short-term policy.
Professional organizations
If you belong to a trade or professional organization, check whether it offers policies to members.
Free or subsidized coverage
If your income falls below a certain level, you may qualify for Medicare health coverage. Contact the state Division of Social Services at 255-9500 or (800) 372-2022 for information.
If your children are 18 or younger, do not have health insurance and meet other qualifications, you may be able to buy low-cost insurance for them through the Delaware Healthy Children Program. Call (800) 996-9969.
The News Journal
Thousands of MBNA workers may soon find themselves out of a job, but the company says they will still get their health coverage -- until their severance packages run out.
After that, laid-off workers who still have not found new jobs must face the prospect of paying for temporary insurance policies, and dealing with a maze of requirements and qualifications that control eligibility. They may soon find that even relatively minor health problems limit their chances to buy new policies, and find themselves paying far more for insurance at a time of financial uncertainty.
Here's a look at the options in Delaware for laid-off workers without health insurance coverage, as spelled out by the Georgetown University Health Policy Institute, the state and other insurance information resources:
COBRA
Large employers with group health plans are required by law to offer employees the opportunity to temporarily continue their group health care coverage. Known as a COBRA policy, it can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition.
After you are laid off, your group health plan has 14 days to notify you about how to get coverage, and you and your family members have 60 days to enroll. The coverage will be retroactive to the time of the layoff, but usually lasts no more than 18 months and is not renewable.
COBRAs offer the benefit of retaining the coverage you had before you lost your job. There are limits on what you can be charged for this coverage, but be prepared for steeper insurance bills. You will have to pay premiums dating to the time of the layoff, and you will be responsible for paying the employer and employee share of the premium, plus a 2 percent fee.
HIPAA coverage
If your COBRA expires, you may be eligible for HIPAA coverage (named after the Health Insurance Portability and Accountability Act). Once you are HIPAA eligible, insurers cannot refuse individual coverage because of medical conditions -- they are obligated to offer at least two policies. The insurers are permitted to charge significantly higher premiums, however, due to health status, age or other factors.
Private individual insurance
In Delaware, you have a limited right to buy private individual health insurance, depending on your health status. Insurers are allowed to refuse or limit coverage based on health conditions, and buyers should be careful to compare differences in coverage from policy to policy before buying. Insurers are required to provide written descriptions of their health plan products.
Remember: Once you have coverage, it cannot be canceled just because you get sick, as long as you pay the premiums.
Interim policies
Insurers also offer limited-time policies, considered useful for short-term breaks in health coverage. These policies usually last two or six months. They are not guaranteed renewable, however, and consumers may end up paying a higher premium for the next short-term policy.
Professional organizations
If you belong to a trade or professional organization, check whether it offers policies to members.
Free or subsidized coverage
If your income falls below a certain level, you may qualify for Medicare health coverage. Contact the state Division of Social Services at 255-9500 or (800) 372-2022 for information.
If your children are 18 or younger, do not have health insurance and meet other qualifications, you may be able to buy low-cost insurance for them through the Delaware Healthy Children Program. Call (800) 996-9969.
Friday, December 16, 2005
Mass. motorists to receive auto insurance rate cut
From the Boston Globe
Massachusetts drivers will get their biggest auto insurance rate cut in 25 years next year, with a ruling by the state insurance commissioner pushing premiums back below $1,000 for the first time since 2003.
In her decision, Insurance Commissioner Julianne M. Bowler set a statewide average premium of $995, a drop of about $95. She also said residents of Lawrence would receive a slightly larger cut because of their efforts to curb fraud.
Bowler's 8.7 percent reduction was about halfway between the 0.1 percent decrease the auto insurance industry was seeking and the 18 percent cut sought by Attorney General Thomas F. Reilly.
Reilly said Gov. Mitt Romney had the chance to cut the statewide average premium by $200, but instead decided to split the money between drivers and insurers. "The whole thing was a scam," he said.
Romney said Reilly reminded him of a fourth grader who promised his classmates to expand recess to two hours. "It's just not reality," he said.
Massachusetts drivers will get their biggest auto insurance rate cut in 25 years next year, with a ruling by the state insurance commissioner pushing premiums back below $1,000 for the first time since 2003.
In her decision, Insurance Commissioner Julianne M. Bowler set a statewide average premium of $995, a drop of about $95. She also said residents of Lawrence would receive a slightly larger cut because of their efforts to curb fraud.
Bowler's 8.7 percent reduction was about halfway between the 0.1 percent decrease the auto insurance industry was seeking and the 18 percent cut sought by Attorney General Thomas F. Reilly.
Reilly said Gov. Mitt Romney had the chance to cut the statewide average premium by $200, but instead decided to split the money between drivers and insurers. "The whole thing was a scam," he said.
Romney said Reilly reminded him of a fourth grader who promised his classmates to expand recess to two hours. "It's just not reality," he said.
Health insurance costs could go through the roof
From BostonHerald.com
By Jennifer Heldt Powell
Health insurance for a family of four could cost a whopping $30,000 a year a decade from now unless drastic steps are taken to curb skyrocketing costs, according to a study to be released today.
Doctors and hospitals have to be more upfront about their charges and consumers must be pushed into being more cost conscious, according to the report by the Massachusetts Business Roundtable.
?Unless the system becomes more affordable, we?re going to crash into a wall,? said Alan MacDonald, head of the business group.
The report was co-written by Harvard Pilgrim Health Care chief Charles D. Baker and Thomas H. Lee, network president for Partners HealthCare, parent of Brigham and Women?s and Massachusetts General Hospital.
The two normally sit on opposite sides of the negotiating table, but in the report they agree that costs are too high and that not enough is being done to bring them down.
The report suggests creating an independent agency that can collect information about health-care costs, quality and how well hospitals and doctors are doing. Among other suggestions, the report calls for more consideration of consumer-driven health plans, which have high deductibles.
If consumers have to pay more of the cost of health care, they are less likely to seek services they don?t need and more likely to choose cheaper providers, MacDonald said.
The report is an update to one done three years ago that called for more transparency in the system.
Only a small amount of progress has been made since then, MacDonald said.
By Jennifer Heldt Powell
Health insurance for a family of four could cost a whopping $30,000 a year a decade from now unless drastic steps are taken to curb skyrocketing costs, according to a study to be released today.
Doctors and hospitals have to be more upfront about their charges and consumers must be pushed into being more cost conscious, according to the report by the Massachusetts Business Roundtable.
?Unless the system becomes more affordable, we?re going to crash into a wall,? said Alan MacDonald, head of the business group.
The report was co-written by Harvard Pilgrim Health Care chief Charles D. Baker and Thomas H. Lee, network president for Partners HealthCare, parent of Brigham and Women?s and Massachusetts General Hospital.
The two normally sit on opposite sides of the negotiating table, but in the report they agree that costs are too high and that not enough is being done to bring them down.
The report suggests creating an independent agency that can collect information about health-care costs, quality and how well hospitals and doctors are doing. Among other suggestions, the report calls for more consideration of consumer-driven health plans, which have high deductibles.
If consumers have to pay more of the cost of health care, they are less likely to seek services they don?t need and more likely to choose cheaper providers, MacDonald said.
The report is an update to one done three years ago that called for more transparency in the system.
Only a small amount of progress has been made since then, MacDonald said.
Your health insurance: Are you getting what you pay for?
MICHAEL J. MAURER
ThisWeek Staff Writer
When a special committee of the Ohio legislature finished work this month, it failed to answer an important question: Are Ohioans getting what they pay for when they buy health insurance?
To explore the answer, ThisWeek, with the help of journalism students from Otterbein College and The Ohio State University, spent five weeks reviewing more than 5,000 insurance filings by more than 94 insurance companies since 1996.
The review found virtually every insurance company operating in Ohio is protecting its own interests at least potentially at the expense of its injured customers, who are buying insurance that they expect will protect them from devastating loss. In some important circumstances, it does not.
The issue is so complex that few ordinary consumers understand it, even in the unlikely event they read their insurance contracts in the first place. The bottom line is, if you are severely injured by someone else, Ohio law may require that your health insurance company be "made whole" for its expenses before you are made whole for your loss.
As one attorney told the commission, when people first become aware of this problem, after it is too late for them to do anything about it, they nearly universally ask, "If that's what the law is, what's the premium for?"
ThisWeek Staff Writer
When a special committee of the Ohio legislature finished work this month, it failed to answer an important question: Are Ohioans getting what they pay for when they buy health insurance?
To explore the answer, ThisWeek, with the help of journalism students from Otterbein College and The Ohio State University, spent five weeks reviewing more than 5,000 insurance filings by more than 94 insurance companies since 1996.
The review found virtually every insurance company operating in Ohio is protecting its own interests at least potentially at the expense of its injured customers, who are buying insurance that they expect will protect them from devastating loss. In some important circumstances, it does not.
The issue is so complex that few ordinary consumers understand it, even in the unlikely event they read their insurance contracts in the first place. The bottom line is, if you are severely injured by someone else, Ohio law may require that your health insurance company be "made whole" for its expenses before you are made whole for your loss.
As one attorney told the commission, when people first become aware of this problem, after it is too late for them to do anything about it, they nearly universally ask, "If that's what the law is, what's the premium for?"
Thursday, December 15, 2005
Ford Workers to pay for health insurance
Times wire report
Thursday, December 15, 2005
DETROIT -- Ford Motor Co.'s active and retired autoworkers, who have long enjoyed some of the most generous benefits in the country, will have to pay monthly contributions and annual deductibles for health insurance for the first time.
The agreement could save Ford $850 million annually if it's ratified by Ford's active workers, the union said. Ratification votes must be completed by Dec. 22. Local unions can schedule votes any time before then, the UAW said.
General Motors Corp. workers voted for a similar deal last month by a 61 percent margin. The UAW said it also was considering a similar deal for DaimlerChrysler AG.
Thursday, December 15, 2005
DETROIT -- Ford Motor Co.'s active and retired autoworkers, who have long enjoyed some of the most generous benefits in the country, will have to pay monthly contributions and annual deductibles for health insurance for the first time.
The agreement could save Ford $850 million annually if it's ratified by Ford's active workers, the union said. Ratification votes must be completed by Dec. 22. Local unions can schedule votes any time before then, the UAW said.
General Motors Corp. workers voted for a similar deal last month by a 61 percent margin. The UAW said it also was considering a similar deal for DaimlerChrysler AG.
Peter Jennings Reporting: 'Breakdown -- America's Health Insurance Crisis'
ABC News
Dec. 15, 2005 ? Peter Jennings' last documentary, "Peter Jennings Reporting: Breakdown ? America's Health Insurance Crisis," premieres tonight on ABC. Throughout his storied career at ABC, Jennings reported over 60 documentaries on subjects ranging from the India-Pakistan conflict to the obesity epidemic ? all stories he believed were deserving of a full hour of prime-time investigation.
In this last documentary, filmed in the months before he was diagnosed with lung cancer, Peter Jennings reports on this country's broken health insurance system, which is threatening American families ? and American businesses.
Jennings reports that the growing number of uninsured affects the health care all Americans receive. He begins by reporting from emergency rooms in Houston, Texas, a city where almost one-third of the population lacks insurance. As more and more of these uninsured turn to emergency rooms for medical care, emergency care for the insured and uninsured alike suffers.
Jennings reports that one of the factors leading to the increasing number of uninsured is the difficulty involved in buying insurance. Even people who can afford the ever-increasing prices can't always get it. In most states, health insurance companies can turn down applicants who suffer from even the most common medical problems, like allergies and acne.
In the past, employer-based health insurance was a reliable place to turn for coverage, but today even that is in jeopardy. Jennings reveals how escalating health insurance costs are putting nearly all American businesses at risk. From small family-owned car repair shops to the once-mighty General Motors, the uniquely American system of employer-based health insurance is becoming unaffordable for small businesses, and unsustainable for large corporations operating in a global economy.
Though Americans often blame insurance companies for the rapidly increasing cost of health insurance, Jennings finds that prices are rising because Americans are using more medical care ? and more expensive care ? than ever before. Since the 1980s, the amount the country spends on medical care has increased by 500 percent. Americans believe that more care is better care, but this is not always the case. According to research from Dartmouth Medical School, more medical care can often result in worse outcomes.
In Peter Jennings' last documentary, he finds that spiraling costs and the growing number of uninsured are all part of a health insurance system in a state of crisis.
Dec. 15, 2005 ? Peter Jennings' last documentary, "Peter Jennings Reporting: Breakdown ? America's Health Insurance Crisis," premieres tonight on ABC. Throughout his storied career at ABC, Jennings reported over 60 documentaries on subjects ranging from the India-Pakistan conflict to the obesity epidemic ? all stories he believed were deserving of a full hour of prime-time investigation.
In this last documentary, filmed in the months before he was diagnosed with lung cancer, Peter Jennings reports on this country's broken health insurance system, which is threatening American families ? and American businesses.
Jennings reports that the growing number of uninsured affects the health care all Americans receive. He begins by reporting from emergency rooms in Houston, Texas, a city where almost one-third of the population lacks insurance. As more and more of these uninsured turn to emergency rooms for medical care, emergency care for the insured and uninsured alike suffers.
Jennings reports that one of the factors leading to the increasing number of uninsured is the difficulty involved in buying insurance. Even people who can afford the ever-increasing prices can't always get it. In most states, health insurance companies can turn down applicants who suffer from even the most common medical problems, like allergies and acne.
In the past, employer-based health insurance was a reliable place to turn for coverage, but today even that is in jeopardy. Jennings reveals how escalating health insurance costs are putting nearly all American businesses at risk. From small family-owned car repair shops to the once-mighty General Motors, the uniquely American system of employer-based health insurance is becoming unaffordable for small businesses, and unsustainable for large corporations operating in a global economy.
Though Americans often blame insurance companies for the rapidly increasing cost of health insurance, Jennings finds that prices are rising because Americans are using more medical care ? and more expensive care ? than ever before. Since the 1980s, the amount the country spends on medical care has increased by 500 percent. Americans believe that more care is better care, but this is not always the case. According to research from Dartmouth Medical School, more medical care can often result in worse outcomes.
In Peter Jennings' last documentary, he finds that spiraling costs and the growing number of uninsured are all part of a health insurance system in a state of crisis.
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