News In Healthcare

Pres­i­dent Obama and Con­gress entered marathon nego­ti­a­tions over health reform bills on this day in 2010. Hope­fully those efforts weren’t for noth­ing. More to come on the sta­tus of Health Care Reform as we get closer to the US Supreme Court review­ing the mat­ter in March.

I am lucky. I have pretty good health insur­ance cov­er­age. But I have heard that peo­ple who do not have health insur­ance or those who don’t have great cov­er­age are check­ing web­sites like Groupon or Liv­ing Social for dis­counts for var­i­ous medical/dental ser­vices. Because I am curi­ous by nature, I checked Groupon to see what dis­counts were avail­able in my area. I found that the dis­counts were for mas­sages and cos­metic work. On Liv­ing Social I found dis­counts for den­tal exams in addi­tion to the stan­dard spa services.

It seems the dis­count sites are not yet pop­u­lar for med­ical ser­vices. This may change depend­ing upon the out­come of the US Supreme Court review of the fed­eral health law. In the mean­time, if you need med­ical ser­vices and you don’t have health insur­ance, don’t avoid the doc­tor. Most med­ical providers will offer dis­counts directly to their patients, even with­out a Groupon coupon.

We are about 2 months away to the US Supreme Court hear­ing argu­ments on the con­sti­tu­tion­al­ity of the fed­eral health law. To help keep track of the briefs filed, the news reports and the analy­sis of the argu­ments, Kaiser Health News has put together a site to help us all keep score. If you want to fol­low the case, this site is def­i­nitely worth check­ing out.

I can­not believe that we needed to con­duct a study in order to know that indi­vid­u­als who under­stand their health insur­ance cov­er­age require­ments, will make bet­ter choices about seek­ing med­ical ser­vices.  The Boston Her­ald recently pub­lished the find­ings of just such a study.  What was found was that indi­vid­u­als who knew what their co-payments were for med­ical ser­vices were more cost-conscious when decid­ing when to seek those med­ical ser­vices.  These indi­vid­u­als were con­sid­ered “savy.”

I don’t call it being savy.  I call it using com­mon sense.  If you know that each emer­gency room visit is going to require you to pay $250 out of your pocket  ver­sus $25 for each physi­cian office visit, com­mon sense says that you will visit your physi­cian and not the hos­pi­tal emer­gency department.

It is not sur­pris­ing that when a new law is issued that requires that 38 mil­lion peo­ple to obtain health insur­ance, that some­one is going to jump in right away and start sell­ing insur­ance cov­er­age to these indi­vid­u­als.  The prob­lem is that the first one in is usu­ally the scam artist try­ing to take advan­tage of the con­fu­sion sur­round­ing the new require­ments and the vul­ner­a­bil­ity of cer­tain seg­ments of our pop­u­la­tion.  Rec­og­niz­ing that the insur­ance scams have already started, Health and Human Ser­vices Sec­re­tary Kath­leen Sebe­lius sent let­ters to the state Attor­ney Gen­er­als and Insur­ance Com­mis­sion­ers on April 6, 2010 warn­ing them of the practices.

The state offi­cials have been asked to be on the look­out for these fraud­u­lent door-to-door insur­ance sales peo­ple and 1–800 schemes.  The state offi­cials are to send bul­letins to their state pop­u­la­tion warn­ing them of these prac­tices.  A sud­den require­ment to cover 38 mil­lion Amer­i­cans is cer­tainly excit­ing to the insur­ance indus­try and those plans that are not above-board will cer­tainly try to max­i­mize their sales.  Before hand­ing over a check to cover the pre­mium pay­ment for your new health insur­ance plan, please be sure to check out your state Depart­ment of Insur­ance web­site or call your Insur­ance Com­mis­sioner to ver­ify the valid­ity of the plan.

In a let­ter to Health and Human Ser­vices Sec­re­tary Kath­leen Sebe­lius, Karen Ignagni head of America’s Health Insur­ance Plans and the nation’s top health insur­ance indus­try offi­cial, said that the indus­try will fully com­ply with new reg­u­la­tions pre­vent­ing cov­er­age denials for chil­dren with pre-existing con­di­tions.  The reg­u­la­tions are expected to be issued within the next few weeks.

It is trou­bling that Ms. Ignagni was in a posi­tion where she had say to the fed­eral gov­ern­ment that the health insur­ance indus­try will fol­low the rules and not cause prob­lems.  How­ever it is believ­able that this was required given the recent actions by health plans to hap­haz­ardly rescind cov­er­age based upon pre-existing conditions.

We cur­rently have 47 mil­lion peo­ple with­out health insur­ance.  We have an Admin­is­tra­tion work­ing really hard to come up with a plan to get health insur­ance cov­er­age for those 47 mil­lion peo­ple.  And we have an entire indus­try of health insur­ers “lick­ing their chops over the poten­tial here” — at least that is one indus­try analyst’s opin­ion.  As reported in the LA Times today, the health insur­ance indus­try is work­ing very hard to make sure that what­ever shape the health­care reform takes, that they can reap the ben­e­fits through an almost overnight surge in new mem­bers to cover.

As a small busi­ness owner, I am watch­ing what is going on with the health­care reform with great inter­est as well as great trep­i­da­tion.  As reported by Politico over the week­end, the Sen­ate Health, Edu­ca­tion, Labor and Pen­sions Com­mit­tee, chaired by Sen­a­tor Edward Kennedy, put out draft leg­is­la­tion which would man­date that busi­nesses pro­vide insur­ance to its employ­ees or pay a fee to the government.

Since when did it become cor­po­rate America’s respon­si­bil­ity to cover the health costs of the Amer­i­can pop­u­la­tion?  Now don’t get me wrong.  My com­pany does offer health insur­ance to our employ­ees and as long as we are in a solid finan­cial posi­tion, we will con­tinue to do so.  How­ever, that is my choice to pro­vide that ben­e­fit to my employ­ees.  I don’t know that I am com­fort­able with it being a man­dated cost to doing business.

With the excep­tion of cer­tain occu­pa­tions, employ­ers are not man­dated to pro­vide employ­ees with a place to live or to pro­vide food for their employ­ees.  Employ­ers aren’t required to pro­vide cloth­ing or to pro­vide edu­ca­tion for those peo­ple who choose to work for them.  Peo­ple earn a liv­ing and pro­vide for these neces­si­ties on their own.  What makes health insur­ance dif­fer­ent?  Peo­ple have to have a place to live, food to eat, clothes to wear, and a basic edu­ca­tion.  If we are going to have to have health insur­ance, which I think we should, why will this neces­sity be paid for by busi­ness own­ers as opposed to the indi­vid­u­als?  Why do we need group poli­cies and indi­vid­ual poli­cies?  Why do we need fully-funded group plans and self-funded group plans?  Why can’t we have one set of rules for all policies?

Read­ing the first line of this arti­cle in the New York Times, The Many Hid­den Costs of High-Deductible Health Insur­ance, made me think back to our recent post regard­ing choos­ing the right health insur­ance and the fact that young Amer­i­cans are will­ing to do the research but not sure where to turn for assis­tance. This arti­cle pro­vides a detailed under­stand­ing of what addi­tional costs may be hid­den in the high-deductible health insur­ance plans.

Well­point exec­u­tives are tout­ing the old say­ing, “If it ain’t broke, don’t fix it.”  With the health­care sys­tem in what is called a “cri­sis,” what exactly isn’t bro­ken?  Accord­ing to the Indi­an­napo­lis Star, its Wellpoint’s abil­ity to make a profit.  Well­point wants com­mer­cial insur­ers to extend its cov­er­age into the indi­vid­ual mar­ket­place instead of bring­ing in a pub­lic plan, sim­i­lar to Medicare, to com­pete with it.   To get its mes­sage out, Well­Point spent $1.22 mil­lion lob­by­ing the fed­eral gov­ern­ment in the first quar­ter of 2009, accord­ing to dis­clo­sure forms. That’s a 16 per­cent increase from its lob­by­ing spend­ing in the same period a year ago.