health insurance


Some Say Obamacare’s ‘Affordable’ Coverage Isn’t So Affordable

(Getty Images)

(Getty Images)

When it comes to the Affordable Care Act, a lot of emphasis has been placed on enrolling the so-called “young invincibles,” young people who tend to be healthy. The new Covered California insurance marketplace opens next Tuesday, and outreach workers across the state are spreading the news about new options and the coveted subsides, available from the federal government in the form of tax subsidies to make insurance more affordable.

But “more affordable” is relative. Kaiser Health News today tells the story of Michelle La Voie, a single mom making $38,000 a year and supporting two teenagers. She wants health insurance, but even with the subsidy she would likely get, she’s still not sure she can afford it. From KHN:

La Voie … would still have to pay $191 a month, or about 6 percent of her income toward the premium. She could also face as much as $2,000 in potential out-of-pocket costs for hospital care and prescription drugs, if she needs those things.

“What’s the point of having [a policy] if I can’t afford to use it?” asks the 47-year-old librarian in upstate Franklinville, New York, referring to the co-pays and deductibles that she might incur if she sought treatment.

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Swapping COBRA For Obamacare Likely A Windfall For Big Business And Consumers

(Getty Images)

(Getty Images)

By Jay Hancock, Kaiser Health News

Health-law provisions taking effect next year could save U.S. employers billions of dollars in expenses now paid for workers who continue medical coverage after they leave the company, benefits experts say.

Insurance marketplaces created by the Affordable Care Act are expected to all but replace COBRA coverage in which ex-employees and dependents can remain on the company plan if they pay the premiums.

Offered a choice between heavily subsidized coverage under Obamacare or paying full price with COBRA “most people are going to choose the exchange.”

“As soon as the law was passed, the question among employers and benefits people was: Is there still going to be a reason for COBRA?” said Steve Wojcik,  vice president of public policy for the National Business Group on Health, an employer group. Offered a choice between heavily subsidized coverage in the health act’s insurance exchanges or paying full price under COBRA, he said, “most people are going to choose the exchange.”

The Consolidated Omnibus Budget Reconciliation Act of 1985, known as COBRA and intended to furnish coverage between jobs, is a burden for employers as well as participants. Continue reading

How More Expensive Health Insurance Might Actually Save You Money

Choosing the right plan can mean keeping money in your pocket. (Getty Images)

Choosing the right plan can mean keeping money in your pocket. (Getty Images)

By Michelle Andrews, NPR and Kaiser Health News

One of the most far-reaching provisions of the federal health overhaul prohibits insurers from refusing to cover people who are sick or charging them more for policies.

Still, for people with serious medical conditions, the online health insurance marketplaces present new wrinkles that could have significant financial impact.

Obviously, premium costs will be an important consideration for consumers. But just as important will be a realistic assessment of what kinds of out-of-pocket costs they could expect with different types of policies and what subsidies they will be eligible for.

Even though the premium for a platinum plan will generally be higher, the out-of-pocket spending cap may be significantly lower than other coverage levels.
The law requires new individual and small group plans sold on the online marketplaces, also called exchanges, and on the private market to cover a comprehensive set of 10 essential health benefits, including prescription drugs, hospitalization and doctor visits. The benefits covered will be similar in all plans, but the proportion of the costs that a consumer pays will vary.

There will be four different levels of plan coverage. Platinum plans will pay 90 percent of covered expenses, on average; gold plans will pay 80 percent; silver plans 70 percent; and bronze plans 60 percent. Continue reading

Advocates Prepare for Confusion and Resistance to Obamacare Among Asians

By Mina Kim, KQED

Doreena Wong will lead a $1 million effort to educate the state's Asian populations on the state-run insurance market Covered California.

Doreena Wong will lead a $1 million effort to educate the state’s Asian populations on the state-run insurance market Covered California.

There’s talk the Obama administration will try to enlist the help of NBA players to sell the federal health law to young men. For its part, Covered California, the state’s new health insurance marketplace, plans to spend millions on an ad blitz and social media strategy. But in a state as diverse as California, one of the toughest challenges will be reaching ethnic communities where English is a second language.

In Orange County’s Little Saigon neighborhood where suburban-style strip malls fill with Vietnamese storefronts, the Affordable Care Act isn’t top of mind.

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Yes, Young Adults DO Value Health Insurance, Poll Shows

By Jordan Rau, Kaiser Health News

(Getty Images)

(Getty Images)

A strong majority of young adults, whose participation in the health law may be key to its success or failure, strongly believe health insurance is important for them and worth the money, according to a new poll.

As California and other states — as well as the federal government — prepare new online marketplaces for people to purchase insurance this fall, the willingness of young people to buy coverage has been a topic of great uncertainty. Their participation in these marketplaces is considered crucial, since the young tend to be healthier than older people and, therefore, will use fewer medical resources, allowing their premiums to help subsidize the care of the old and sick.

Among age groups, the young are considered the hardest sell on insurance, because the coverage mandated under the 2010 health law is more comprehensive — and therefore more expensive — than the catastrophic policies that many now obtain. Young adults are considered more likely to believe they won’t suffer any horrible illnesses or injuries — a trend that has led to them being labeled “young invincibles.”

More than 71 percent of adults 30 or younger say having health insurance is “very important to them.”
The poll found some reason to believe that the young may not shun the health law requirement that they hold insurance starting next January. More than 71 percent of adults 30 or younger say having health insurance is “very important to them,” according to the poll from the Kaiser Family Foundation. When the pollsters put the question differently by asking whether “insurance is something I need,” more than 74 percent of people under age 30 agreed. Continue reading

Advocacy Group Says Anthem Blue Cross Pharmacy Program is Discriminatory

(Paul Wilson/Flickr)

(Paul Wilson/Flickr)

The advocacy group Consumer Watchdog has filed a statewide class action lawsuit against Anthem Blue Cross saying the health insurer is discriminating against HIV/AIDS patients.

Anthem is changing its pharmacy program and will require anyone using drugs from a list of “specialty” medications to use a mail-order pharmacy, approved by Anthem. But patients seeking to fill other prescriptions may still use their local bricks-and-mortar pharmacy. “That’s exactly the kind of targeting and discrimination barred under the Civil Rights Act in California,” Consumer Watchdog attorney Jerry Flanagan says.

In a statement, Anthem denies the change is discriminatory, because the list of specialty medications includes not only HIV/AIDS drugs, but also medicines for other conditions, such as cancer and multiple sclerosis. Anthem says that the practice is already established. From Anthem’s statement:

“For many years, health plans in California and other states have sought, subject to certain exceptions, that specialty drugs be filled by Specialty Pharmacies and received via confidential home or other private delivery location that benefits the member. … This is being done with the knowledge of our regulator and applies to several hundred different drugs for many medical ailments.  Anthem’s policies do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws.”

Marta Green at the Department of Managed Health Care confirmed that there are three similar programs already in place in California from Health Net, Sharp and United Health Care of California. Green declined to comment on Consumer Watchdog’s lawsuit, saying the Department had just received it.

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Insurance Commissioner Criticizes Anthem Blue Cross Rate Hike

By Mina Kim

State Insurance Commissioner Dave Jones says Anthem Blue Cross’s rate hike on small business plans is “unreasonable” … but he’s powerless to stop it. .

Jones says his department actuaries calculated Anthem’s average 11 percent rate hike on small employers would grow to nearly twenty percent in two years. On a call with reporters Tuesday, Jones blasted the insurer for overstating health care costs and for charging policy holders fees that won’t be collected until 2014 under the Affordable Care Act.

“If you look at, on a return-on-equity basis,” Jones said, “the profits that Anthem Blue Cross of California has made, they have been extraordinary.”

Anthem Blue Cross spokesman Darrel Ng disputes Jones’s figures saying the average rate increase is about half what Jones projects and that Anthem’s profits last year, were about one percent. Continue reading

Proposed Ballot Measure Seeks Tougher Health Insurance Rate Regulation

The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)

The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)

In more than 30 states, government insurance departments have the authority to reject what they determine to be excessive rate hikes for health insurance. But not in California. Earlier this month, consumer advocates launched a drive to put an initiative on the November ballot to let voters decide if California’s Insurance Commissioner should have this power.

“Right now, my sole authority over rates, if I find a rate to be unreasonable, is to sentence a health insurer to my website,” joked Dave Jones, California’s Insurance Commissioner, in an interview.

That’s a bit of an overstatement, as his department does review rates, making sure the math is right and ensuring there are no inaccuracies. Still, what the Department is left with is “whatever element of the bully pulpit we have to try to rein those rates in,” Jones says. Continue reading

Just Exactly What IS an Accountable Care Organization?

From CommonHealth in Boston comes this nifty and amusing five minute cartoon that explains the Accountable Care Organization — at least from the patient perspective. How is an ACO different from an HMO? And what does it mean for your health?  (If you’re not familiar with xtranormal, get ready for computer generated voices.)

Related: Health Care Reform Cartoon and Video

How Your Health Care Dollar is Spent

Here’s how the non-profit Blue Shield of California says it spends each health care premium dollar it receives:

(Image: Blue Shield)

(Image: Blue Shield)

What’s significant here is that Blue Shield says it’s spending 85 percent of your dollar on medical care. This is right in line with a requirement of health care reform which has already gone into effect, the “medical loss ratio.” The MLR requires large employer plans to spend 85 percent of revenue on patient care. If they spend less, they must issue a refund to members. Blue Shield also has capped its income (i.e. profit) at two percent. It has pledged to return any income above two percent to its members.