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Tag Archives: Health Insurance Coverage
The Problem With One-Size-Fits-All Health Insurance
Cartoon – Victory for the Average American
Winners and losers in the health-care industry under President Trump
With much about President-elect Donald Trump’s health-care agenda still unclear, the health-care industry’s initial response to his election has been scattered. Hospital stocks were down. Health insurers’ stock prices were mixed. Pharmaceutical and biotech stocks, on the other hand, got a big bump.
Trump’s clearest policy position in health care has been his commitment to repealing the Affordable Care Act and replacing it with another policy. But the responses to his election varied in large part because the details of exactly what would replace the Affordable Care Act and how that transition would occur have been vague. Without knowing those details, it’s hard for investors to have a clear response, said Benjamin Isgur, a leader in the PwC Health Research Institute.
“These health organizations are like large ships, and you can’t turn them on a dime,” Isgur said. “When you think back to what it took to get ready for the ACA, for many health-care companies, it was two to three years of developing plans and provider networks and marketing plans. . . . There’s a lot of work that is required to implement any new program.”
As Insurers Cut Brokers’ Commissions, Consumers May Have One Less Tool For Enrollment
With open enrollment set to begin today, some health insurance brokers are already fielding questions about coverage and whether existing plans will still be available next year. For an increasing number of brokers, there’s also another question: Will they get paid?
Some insurers — including Cigna and Aetna — will not pay licensed agents and brokers a commission for helping people enroll in individual health insurance coverage for 2017 in many states, while others have reduced their commissions. They join United Healthcare, which dropped commissions on new business this year in many states.
That is already prompting some brokers to step back from the exchanges when open enrollment begins this week, which could be a hurdle for consumers who normally would seek help from brokers in navigating the complexities of insurance coverage. (Government-supported navigators are still available.)
In Nevada, where the largest carrier in the state has cut commissions for new business and another has dropped payments to $10 a month per customer, broker Vickie Mayville is weighing her options.
“It sometimes takes four hours to ensure clients have the right plan,” said Mayville, who runs her own agency in Las Vegas. “I will help my clients and anyone referred to me, but I’m not actively seeking out new clients.”
ER visits continue, despite insurance
Emergency rooms and hospitals are among the most expensive places to get health care. One of the big selling points for Obamacare was the idea that if people get insurance, they’ll have better preventive care and end up in the ER a lot less.
Today we have new data that buries that idea.
Though people with insurance are taking advantage of more preventive care, they’re also still going to the ER. A prior study, done by the same economists, found when you give people insurance, they use more health care services — more doctor’s visits, flu shots, prescriptions, even hospitalizations.
Dr. Renee Hsia, of the University of California San Francisco Emergency Department, said she treats many insured patients.
“We have noticed that as our patient population gets older and frailer and we have more complex diseases, there are higher-acuity things presenting to the ED,” she said.
Hsia said other reasons the insured keep showing up include patients’ doctors sending them to the ER, or people can’t get a primary care appointments quickly.
Harvard economist Kate Baicker, one of the co-leads on the paper, said people need to be clear about the impact of insurance.
“Insurance makes the emergency department affordable,” she said. “People didn’t go [when they were uninsured] because of the big bill they got when they showed up. Now that it’s more affordable, people go more.”
Based on their findings, Baicker said insurance also improves people’s financial security and reduced their rate of depression.
Narrow networks: savings at what cost?
You probably chafe a bit every time you learn that a certain doctor or hospital isn’t part of your insurance network. Narrowing the scope of your network helps insurers save money. They can drive hard bargains with doctors and hospitals to get lower prices and walk away from higher-priced ones.
Increasingly, insurers are offering narrow network plans. Would you enroll in one? So long as quality doesn’t suffer, consumers should welcome the lower premiums they may offer.
Researchers at the Leonard Davis Institute at Penn analyzed the relationship between network size and premiums for plans offered in the Affordable Care Act marketplaces. Plans with very narrow networks (covering care by less than 10 percent of physicians) charged 6.7 percent lower premiums than plans with much broader networks (covering care by up to 60 percent of physicians). This translates into an annual savings for an individual of between $212 and $339, depending on age and family size. For a young family of four, the savings could reach nearly $700 per year.
“Marketplace consumers are looking for value,” said Daniel Polsky, the University of Pennsylvania health economist who led the study. “That level of savings could be a very good deal for consumers, but whether these plans provide value depends on how they are achieving those savings.”
One way plans might save money could make it harder for patients to get care — so that they get less of it. Narrow network plans may do this if they don’t cover enough nearby providers, with the ones they do cover too busy to take new patients in a timely fashion. Clearly this would be especially problematic if appointments with one’s preferred primary care doctor are hard to obtain.
Are today’s narrow network plans actually doing this? Until recently, we had no data to answer this question. But two studies published earlier this year — one focused onMassachusetts, the other on California — provide some insight.
A closer look at single-payer health care and how it works
http://hub.jhu.edu/2016/10/11/single-payer-health-care-101/
Johns Hopkins experts explain health insurance alternative mentioned during presidential debate
During Sunday’s heated presidential debate, an audience member raised the issue of health care, asking Hillary Clinton and Donald Trump about their plans to bring down costs and to make coverage better.
Both of the candidates’ responses included references to a “single-payer plan.” What does that mean, and could it work in the U.S.? For insight, we turned to experts from Johns Hopkins University’s Bloomberg School of Public Health.
In a segment of WYPR’s On the Record on Monday morning, Bradley Herring, an associate professor in the Department of Health Policy and Management at the Bloomberg School, explained what a single-payer system is and how it works.
Image caption:Bradley Herring (left) and Gerard Anderson
“The simplest way to think about a single-payer system is one in which the government is the single payer for all health care services for all citizens,” Herring said.
Countries around the world have successfully adopted single-payer health systems. An obvious example—and the one Trump pointed to in the debate—is Canada.
What Would A Public Insurance Option Look Like In California?
What Would A Public Insurance Option Look Like In California?
The “public option,” which stoked fierce debate in the run-up to the Affordable Care Act, is making a comeback — at least among Democratic politicians.
The proposal to create a government-funded health plan, one that might look like Medicare or Medicaid but would be open to everyone, is being reconsidered at both the federal and state levels.
Amid news that two major insurers were pulling out of Affordable Care Act exchanges, 33 U.S. Senators recently renewed the call for a public option. The idea was first floated, then rejected, during the drafting of the federal health reform law, which took effect in 2010.
Democratic presidential candidate Hillary Clinton includes a public option in her campaign platform, and President Barack Obama urged Congress to revisit the idea in a JAMA article published in August.
Dave Jones, the elected regulator of California’s private insurance industry, endorsed the idea of a state-specific public option in an interview last month with California Healthline, though he did not specify how it might work.
“It would look just like an insurance plan,” except that the state would pay for medical care, potentially set up the network of doctors and hospitals, and make rules about paying providers, Kominski said. Private industry could be involved in these or other aspects of running the health plan, much as they do in Medicare Advantage and managed care Medi-Cal.California may be uniquely poised for a public plan — but the state may not need one, according to Gerald Kominski, Director of the UCLA Center for Health Policy Research.
Creating a public option in California may not be necessary at present, since the state currently has sufficient competition in the private insurance market, Kominski said. But he said policymakers could choose to implement a public option now as a backstop against a potential future scenario in which private insurers scaled back their California plan offerings.
Understanding the Value of Medicaid
Today, Medicaid provides coverage to nearly 73 million people — kids, low-income working adults, seniors, and people with disabilities — making it the nation’s largest insurer.
HENRY KOTULA 