A Word to the Wise

College Health Plans Don't Always Cover Student Athletes

"Many student athletes have medical insurance through their parents, but often these plans exclude coverage of injuries sustained during participation in varsity sports and injuries that require out-of-state treatment. Some colleges purchase secondary policies to fill the gaps left by students' family plans, but even these plans have disclaimers that could leave students uncovered in some situations."

Here We Go...

From the New York Times -

Health Insurers Agree to End Higher Premiums for Women

AHIP (America's Health Insurance Plans) has basically said to the federal government "if you make everyone buy health insurance then we'll stop charging more to women and sick people".
guarantee

Makes sense. There are civil libertarians that are going to be bothered by this, but if we all have to pay for the uninsured to go and clog up the emergency rooms, then we have a pretty big incentive to fix the mess in which we now find ourselves.

People who can afford it will buy private insurance, and those who cannot will be subsidized by the government. This will do very little to control cost, but it's a small step towards addressing the health care crisis in this country. Hopefully people will at least get a little healthier.

Here We Go Towards Nationalization...

From The Buffalo News -

[New York] State Attorney General Andrew M. Cuomo on Tuesday threatened to sue Excellus BlueCross and BlueShield and Univera Healthcare for fraud, accusing them of fraudulently using nine-year-old rate information from an already faulty database to reimburse out-of-network doctors and hospitals.

If you have a dispute with an insurer for something like an out-of-network charge, be aware that insurance companies are not acting in your best interest. They use these opportunities to squeeze every dime they can out of people whom they figure are too small to fight back. Do your best to fight it yourself, but if you can't handle it, try a medical billing advocate.

You're Covered

^{This is a fairly recent Florida Statute that you should know about. Dependents are now covered until age 25 (and possibly extended to age 30), as long as they meet the requirements that historically have applied to university students.}

¹627.6562 Dependent coverage.--

(1) If an insurer offers coverage under a group, blanket, or franchise health insurance policy that insures dependent children of the policyholder or certificateholder, the policy must insure a dependent child of the policyholder or certificateholder at least until the end of the calendar year in which the child reaches the age of 25, if the child meets all of the following...

Read the entire statute here.

Mmm, Deep-Fried Southern Favorites...

"Alabama, pushed to second in national obesity rankings by deep-fried Southern favorites, is cracking down on state workers who are too fat."

State employees will begin paying $25/month for their health insurance if their BMIs are at or above 35 (which would put them well into the "obese" category that starts at 30). There are problems with the BMI as a measuring tool, since the only components are weight and height, and just because you're thin does not mean you're healthy. Anyway, it's an interesting trend and one to watch for in other states and nations (and I guess nation states).

Here's the article, by the way. I, like, totally almost forgot.

I Think This Is Campaign Issue #2 (After Iraq)

From Fortune Magazine -

Why McCain Has the Best Health-care Plan

"Here's where [McCain's plan] gets interesting. Employers would no longer be able to buy more health care with $9,000 of their employees' money than the workers could buy on their own. The raison d'être for corporate health benefits would vanish. Employers have another compelling reason to pass the ball to the employee: While wages are rising around 3% ayear, their health-care costs are growing at three times that rate. 'I predict that most companies would stop paying for health care in three to four years,' says Robert Laszewski, a consultant who works with corporate benefits managers. Hence, an employer that pays $9,000 for your benefits would simply pack an extra $9,000 a year into your paycheck. (Why? Because in a competitive labor market, companies would have to hand over that cash to employees or risk losing them.) So you'd have $6,000 after tax, plus the $5,000 family credit, to buy insurance. That's $11,000 in new cash that employees can set aside for health care."

"The [Democrat] standard benefits package isn't just a bad idea because it will substantially raise the cost to taxpayers. It will also make it virtually impossible for Americans to buy insurance tailored to their needs. Suppose you're one of those 25-year-olds. You probably don't want to spring for a full-blown plan that covers old-age diseases like Alzheimer's and would rather save some money and go with a low-premium, high-deductible plan. But the Democrat approach requires that any competing plans be "actuarily equivalent" (Clinton's term) to the federal employee plan - which translates as a generous minimum standard for health insurance. 'With that mandate, you rule out high-deductible plans,' says Gruber. 'It would make it very difficult to design one that would qualify.'"

"The Democrat proposals have some additional drawbacks. First, the Dems want to heavily regulate the insurance industry by limiting everything from profits to marketing expenses. If the earning power of insurers is determined by federal regulators, their pricing will be too, and thus they will evolve into the equivalent of public utilities. Would you rather have medical prices set by fiat or by nationwide market competition?"

"Second, the Democrat plan exacerbates the fundamental problem in the American health-care system, which is that no one has any incentive to care about price. (How much is that MRI center charging for your ankle scan? Who cares? Just hand over the $50 co-pay and never you mind.) Creating a huge new medical superstructure would shift far more spending to third-party providers, chiefly the federal government, giving consumers even less incentive to concern themselves with the price of an MRI - or any other service, from an elective wart-removal procedure to a life-saving heart bypass. 'The Clinton and Obama plans would enormously increase total health-care spending, but disguise the extra costs by shifting them to taxpayers,' says John Sheils of the Lewin Group, a research firm that does statistical modeling for health-care plans."

Mess with Texas

You might already know that Texas has the highest percentage of uninsured in the country (25%). That rate is a bit inflated because it counts many illegal immigrants, but that's the reality of the situation (and one shared by many border states). It affects hospital emergency rooms and the insurance premiums that Texans pay. It affects how long you will wait in an emergency room if you need urgent care.

The Austin American-Statesman has a pretty recent article about the plight of several Texans who are without health insurance or have gone without it for some time and suffered financial and/or health-related hardship because of it. It's pretty easy to imagine this happening to a friend or relative.

Whatever you think of the politics of the situation, you'd better protect yourself. Health insurance is not a luxury. It should be as much of a priority as keeping the lights on in your house and food in the fridge. You should not have leather seats in your car or a DVD player or expensive new jeans but no health insurance.

Something has to change in the Lone Star State.

Usual and Customary

How do you like the banner ad above this post? Ha ha.

New York State Attorney General Andrew Cuomo has filed a lawsuit against UnitedHealth Group, as well as subpoenaed the other major insurers in the Empire State regarding pricing practices. When an insured person goes to a health care provider outside of his or her network, reimbursement is based on what are called "usual and customary" rates. Well, there is an obvious conflict of interest if the company that calculates those figures is owned by UnitedHealth.

From the New York Times -

"Citing an example of what he said was a pattern of underpaying for care, Mr. Cuomo said his office had compared the prevailing market rate for a doctor visit to the amount Ingenix had calculated as usual and customary. While doctors in the metropolitan New York City area typically charged $200 for an office visit, he said, Ingenix calculated the rate at only $77. Under a typical plan, the insurer would pay 8o percent of the $77, or only $62. The patient was responsible for covering the remaining $138 balance."

This is a very good reason to get to know the details of your health insurance plane. Once you have an emergency, it's often too late to figure it out until after the bill arrives. That is one of the reasons consumer-directed health plans are effective. They get people thinking about these potential problems before they occur.

Shop Around

Newt.org has a clip of a little anecdote delivered by Newt Gingrich, in case you were thinking of some other Newt. He discusses the kind of market efficiency that is potentially attained by employing HSAs with the example of an expensive sleep apnea machine.

The Battle of the Bulge

You've most likely heard about Michael Moore's latest "documentary", "Sicko". Larry King hosted an interview/debate between Moore and Dr. Sanjay Gupta that took place last night regarding the film, and Dr. Gupta's review of it.

Moore seems unable to have a calm and rational discussion unless it is with someone who doesn't challenge him. You may have noticed this in other interviews. I find it interesting how Moore ridicules Dr. Gupta's Indian heritage, and I wonder if he will be criticized for it. Of course, I've just made fun of Moore's obesity in the title of this post, in case you didn't notice. Please watch as Michael Moore shakes his head throughout the news piece, no matter what Gupta is saying, even when making comments that aren't critical of the movie.

If you have the time, I encourage you to watch all of the clips in their entirety. Both people make valid points, but Gupta puts forth more sanguine arguments, and clearly has a better haircut.

Dude...

"'I’ve torn my ACL, chipped my front tooth, and had surgery – all without insurance,' said a local snowboarder who wished to remain anonymous. 'Now I have $400 a month automatically taken out of my paycheck because I have $40,000 worth of medical bills. I think I could have afforded health insurance.'"

Read the entire article on Planet Jackson Hole Online.

The importance of reviewing your insurance policy -

"Dawn Sheue at Summit Insurance Services believes that she can find affordable health care for most people in Jackson, especially the ski-toting yahoo. 'You have to know how to play the game,' she explained. 'Health insurance is not something you want to settle into because we never see [premium] rates decrease. That’s the reason we review our clients if not every year, every two years.'"

An important quality in an insurance broker (who works for the insured, rather than an agent, who works for the insurance company) -

"Sheue reviews her client’s premium rates this often to make sure they are getting the most affordable rate out there. 'My loyalty is not with the insurance company but with my client. You’re going to have to move from carrier to carrier every two to three years to get that introductory rate. And that’s how you win the game.'"

The reader comments of the article highlight a growing debate in this country surrounding personal versus shared responsibility. I'll tell you my own personal experience is affected. I play soccer once or twice a week and I am thinking about that high deductible insurance plan when I'm out there, believe you me.

Reader Comments

Too Good To Be True

Health insurer Humana Inc. is rolling out plans that cap premium increases on three-year contracts. It doesn't take too long to figure out that there's nothing so exciting about that news. Humana raises the deductibles on existing plans and can raise them and co-payments during the contract period. Don't be fooled.

"In Chicago, Humana is introducing a plan for businesses with 51 to 99 employees called "No Worry," a health insurance package that caps premium increases for three years at 6 percent annually, or 4.5 percent if businesses also choose a Humana dental plan and agree to certain other terms. In exchange, deductibles can rise from $500 to $2,500 depending on the products being offered."

This is what a Cigna executive had to say:

"It's very easy to cap renewal increases if you are going to substantially reduce benefits," said Pat Boughey, president and general manager of Cigna HealthCare Illinois, a subsidiary of health insurance giant Cigna Corp. "I am not sure what benefit that provides to an employer in the long run."

Read the article in the Bradenton Herald.

The American Prospect Progressive Perspective

Please don't read that title aloud. You'll get saliva all over your computer screen.

Here is an interesting critique by Ezra Klein of the current, employer-sponsored health insurance system.

"There is no earthly reason for employers to control not just their workers' salaries, but their health security, too. There is no justification for a health system that dissuades would-be entrepreneurs from testing their brilliance, or unhappy laborers from striking out on their own, or disgruntled workers from leaving their positions. Nor is there a compelling rationale for forcing employers to assume the moral burden of providing medical coverage, or putting the generous employer at a competitive disadvantage because his competitor offers barebones coverage, or having GM pay more for health care than steel. On every level, in every way, the employer-based system is unjust, inefficient, and unwise. No plan that preserves it should be considered acceptable."

The Twinkie Tax and Trans Fats

There is an article in today's Miami Herald that discusses a growing trend among companies seeking healthier employees.

"After L.L. Bean increased the price for burgers and lowered the price for salads in its cafeteria, fruit and salad bar purchases doubled while fries and burger sales fell by half."

Read the Herald article here.

New York City's Board of Health has just banned trans fats:

"The new requirements will mean that the city’s 20,000 food establishments, from high-end bistros to neighborhood delis, will be barred from using most frying oils containing artificial trans fats by July 1, 2007, and will have to eliminate the artificial trans fats from all of their foods by July 1, 2008. The establishments have to switch to oils, margarines and shortening that meet the limits and bring their menus into compliance."

Read the New York Times article here.