Weekly rounds June 28, 2013

June 24-28, 2013It seems to have been a busy week in health care news, and I found it difficult to settle on what interested me the most. But here are my picks:

Coke for breakfast?

Apparently that is one of the marketing strategies Coca-Cola is considering to increase its sales in the United Kingdom. It is not clear whether they mean to actually pitch the idea that a Coke would be a great accompaniment to a bowl of oatmeal (maybe an Egg McMuffin) or they mean to develop a new line of beverages to compete with tea and coffee. But sales of … Continue reading

Weekly rounds May 31, 2013

Ready, Set, . . .

With the implementation of the Affordable Care Act (ACA) fast approaching, and summer deadlines for insurance companies that want to offer plans on the new insurance exchanges, this week has seen a lot of news stories related to Obamacare.

California revealed its new exchange plans and the first look seems to indicate that premiums will be much lower than anticipated, even though several of the largest insurance companies opted out of participating in the exchanges.

But a closer look at the plans reveals two important considerations:

  1. The plans are “narrow-network” plans. To keep costs
Continue reading

The cost of cancer

Cancer and bankruptcy

A large study looking at the cost of cancer was released yesterday by the Hutchinson Institute for Cancer Outcomes Research in Seattle. It offers a somber but perhaps not surprising conclusion that cancer patients are “2.5 times as likely as others [non cancer patients] to file for bankruptcy.”

The highest rates are seen among young women, largely because young people are often uninsured, have little savings, and have part-time or entry-level jobs. But as the study points out, even those with insurance can face “financial distress” because of the high cost of deductibles, co-pays and other non-covered … Continue reading

The high costs of medical mistakes

I mentioned in a previous post that three years ago my husband almost died from a series of medical, um, misjudgments, let’s say. I know sometimes things go wrong for no reason, but I also know his three-day ICU stay could have been prevented.

He never received a “mea culpa” from the doctors or hospital; all we got were the medical bills. Our insurance, a catastrophic/health savings account (HSA) plan, paid 100% of the costs after we met our deductible and out-of-pocket maximum ($10,000). At that point we stopped receiving bills, so I don’t know the exact total of … Continue reading

Tragedy’s heavy toll

Like many others, I’m still trying to understand Monday’s horrific bombings at the Boston Marathon. Who did this, and why?

What I do know is that our emergency response and medical teams are the best in the world; I used to work in the OR of a large, level-one trauma center and have seen these teams in action. The injured will receive swift and highly-skilled care without regard to pre-existing conditions or insurance status.

However, a different team, the patient accounts personnel, will work quickly to document victims’ names, addresses and insurance carriers (if any).

It seems a second tragedy … Continue reading

Should smoking be considered a pre-existing condition?

That is the opinion of the health exchange boards in Washington, D.C., California, Connecticut, Massachusetts, Rhode Island and Vermont (so far).

Each state (and D.C.) that creates a health insurance exchange under the Affordable Care Act (ACA) has an exchange board that is responsible for establishing certain rules and guidelines. Some definitions in the federal reform law have proved to be ill-defined and open to interpretation, such as “pre-existing condition.”

Most insurers that sell individual health plans charge smokers higher premiums because smokers … Continue reading

Obamacare: A double whammy for some

A few days ago, more bad news came out about the cost of individual health insurance in 2014. The Society of Actuaries (the financial risk experts that determine insurance costs) reported that next year insurance companies must anticipate paying out at least 32% more in medical claims.

The Affordable Care Act (ACA) will require insurance plans to provide more comprehensive coverage (essential benefits) and cover millions more people with pre-existing conditions. There is considerable doubt about how many young, healthy people and how many small businesses will participate in the insurance exchanges. If they don’t, premiums will rise even … Continue reading

Man the lifeboats

Under the Affordable Care Act (ACA), small businesses and individuals will be offered “robust” coverage and “affordable” premiums on the soon-to-be-running health insurance exchanges.

By grouping together these two traditionally under-served populations, the risk pool will become large enough (theoretically) to allow everyone (most notably those with pre-existing conditions) access to health insurance, and will help keep premiums affordable (again, theoretically).

But there is a problem: small businesses are jumping ship.

According to the National Review Online, “Small firms and the specialized insurers that serve them may have found the lifeboats (to borrow Texas governor Rick Perry’s comparison of … Continue reading

Medicare: No longer the light at the end of the health care tunnel

During the presidential campaign last year, Paul Ryan, the vice-presidential candidate, presented his plan for what we all know is much-needed Medicare reform (too many baby boomers; too little money). Under his plan, seniors would choose a  “Medicare certified” private health insurance plan and, depending on the senior’s income, a percentage of the premium would be subsidized.

His plan sounds a lot like the new health insurance exchanges that are set to begin in 2014, doesn’t it?

Yesterday, an article on the National Review Online caught my attention because the author presented a compelling scenario by which the government could … Continue reading

A possible silver lining to Obamacare

Last fall I blogged about an inherent unfairness in our health insurance system. (I know, there’s more than one.) In short, those with employer-sponsored insurance (ESI) generally have lower premiums, lower out-of-pocket costs, and better coverage than those of us that buy health insurance through the individual market.

With the new insurance exchanges, the Affordable Care Act (ACA) is supposed to decrease costs and improve coverage. Because of the law’s mandates for preventive services and essential benefits, coverage will be more equitable with the large, ESI plans. Whether premiums will be more affordable continues to be a topic of much … Continue reading

Got (breast)milk?

I was surprised recently when I read the following article on Kaiser Health News: Nursing moms get free breast pumps from health law.

Really?

So I went to Healthcare.gov, the official website of the Affordable Care Act (ACA) and found the expanded list of essential benefits/preventive services for women that went into effect on August 1, 2012. Breast pumps, listed under “Breastfeeding Support, Supplies and Counseling,” are indeed considered “preventive” and must be covered without cost sharing (co-pays or deductibles).

According to the factsheet: “Breastfeeding is one of the most effective preventive measures mothers can take to protect Continue reading

Will coverage for pre-existing conditions really be affordable?

The Pre-Existing Condition Insurance Plan (PCIP) was created by the health reform law and enacted in 2010 to provide coverage for low and moderate-income people who could not buy health insurance because of a pre-existing condition—the “uninsurables”.

The plan was to be funded through 2013 until the law’s signature provision—that insurers could no longer exclude those with pre-existing conditions—kicked in on January 1, 2014.

Sadly, the plan has already run out of money and enrollment was suspended February 16th, leaving many thousands without access to health coverage until at least 2014.

Related story from Kaiser Health News: Feds increase Continue reading

Premiums, mandates and penalties

I posted a couple weeks ago that health insurance companies wanted to increase the penalty I mean tax on people who ignored the individual coverage mandate. The companies fear the penalty tax, only $95 the first year, is not stiff enough.

Well, according to recently released information from the IRS and the Department of Health and Human Services (overseers of the health law), the insurance companies have cause for worry. Not because so many people will ignore the mandate, but because so many people will be exempt.

Related reading from National Review Online: Obamacare’s pressure points

Who will be exempt? … Continue reading

Taxes, income and subsidies

Yesterday, the IRS finally began processing 2012 tax returns.

In 2014, if and when you apply for individual health insurance through one of the state-run exchanges, it will be important to know your 2012 income. Why? Because that figure will determine whether or not you will be eligible for a federal tax credit to help cover the cost of premiums.

In a previous post, I explained how the federal subsidies will work. In short, individuals and families earning up to 400% of federal poverty level (FPL) will be eligible, and the savings could be substantial—over $10,000 a year in some … Continue reading

Obamacare’s Y2K: Coverage for pre-existing conditions

Starting in 2014, one of the signature features of the Affordable Care Act (ACA) will be implemented: No adult with a pre-existing condition can be denied health insurance.

But it seems from recent news reports that both the administration and the nation’s health insurance carriers are getting a little nervous about exactly how much that will cost and whether sufficient funds will be available.

In theory, the individual mandate ensures that enough healthy young people buy insurance to keep premiums affordable and provide enough money to cover the care of the already sick. But no one knows with any certainty … Continue reading