Exchange Board approves Essential Health Benefits standard – false choice between benefits and cost

Yesterday the CT Health Insurance Exchange Board approved CT’s version of the Essential Health Benefit (EHB) package under the Affordable Care Act (ACA). As of January 1, 2014 individual and small group plans will have to cover at least the EHB services. The ACA required that the EHB include at least ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse care, prescriptions, rehab and habilitation services, lab services, preventive and wellness care including chronic disease management, and pediatric care including vision and dental care. States have several plan EHB options including large commercial plans, federal and state employee plans. After long, contentious deliberations, two exchange committees of experts and stakeholders agreed on a moderate, compromise choice based on ConnectiCare’s HMO plan that includes all state mandates. The committees recommended that compromise to the Exchange Board. While the Board eventually approved the committees’ recommendation, there was a great deal of discussion about reducing the “richness” of the plan in the interest of “affordability”. Board members noted that the recommended plan is “richer” than what is offered now in CT. They failed to note that one of the main points of reform was to improve the “value” of health insurance so it truly covers what people need. If what is available now was sufficient, we wouldn’t have needed reform. The Board wants the legislature to “revisit” legislatively mandated benefits next year, eliciting groans from lobbyist and advocate observers in the room. Unfortunately there was no meaningful discussion about the potential for ongoing payment and delivery innovations successful in many other states, to provide flexibility that improve quality, access, patient satisfaction while controlling costs. The Board includes no independent consumer advocates and several insurance industry representatives. Consequently the Board is locked in the narrow false choice between mandated benefits and affordable premiums. That very old, very simplistic dialogue only spirals downward into worse care and upward into skyrocketing costs. The Board is missing a massive opportunity to learn from innovators and truly reform CT’s health care landscape.

Join us for Consumer Conversations: the CT Health Insurance Exchange

January 1, 2014 every CT resident will be required to secure health coverage. The CT Health Insurance Exchange is being developed under the Affordable Care Act to be a fair, user-friendly marketplace for consumers and small businesses to buy decent coverage, hopefully at an affordable price. The Exchange has not heard consumer voices, does not include any independent consumer Board members, and is dominated by insurance interests. Small Business for Healthy CT and the CT Health Policy Project have invited Kevin Counihan, CEO of the exchange, to meet with consumers and small businesses to learn what consumers need and how to make the exchange a success. We will also be joined by Christine Hager, Regional Director of HHS, the federal agency funding the exchange. The meeting will be October 26th from 8:30m to 11am at the Pond House Grille in Glastonbury. To register, click here.

The Cost of Mandatory Maternity Benefits in California

Under CA SB 222, all individual & family health insurance plans in California were required to provide, or add and provide, mandatory maternity coverage to all plan members. 

Prior to July 1, 2012 when the mandate went into effect, plans offering maternity coverage were priced higher in terms of monthly premium to reflect actuarial maternity benefit utilization.  

Because the PPACA allows HHS (federal) to review and approve or reject insurance company rate increases on health plans that are 10% or more, and because the California Insurance Commissioner can make enough bad press for a carrier (he currently does not have rate authority in California--that is pending under AB 52), insurance carriers had to add the benefit and try to make the plans actuarially sound. 

Looking at California's two largest PPO insurers for individual & family plans (HMO plans were and are always required to provide maternity benefits) the effect is a bit stunning.

Blue Shield Life & Health (Blue Shield of California)
On April 17, 2012 I blogged the impending closure and replacement of almost every Blue Shield Life & Health PPO plan.  

The new plans released for July 2012 by Blue Shield Life & Health included the mandated maternity benefits and the competitive premiums for the 'new' PPO plans were initially anywhere from 20-30% above the cost of Blue Cross' similar comparative PPO product.  Initially the Blue Shield plans were a bit difficult to sell against Blue Cross lower premium plans.

As of this writing, Blue Shield Life & Health PPO plans appear stable in the mandated CA market.

Anthem Blue Cross Life & Health (Blue Cross of California)
Unlike Blue Shield, Anthem Blue Cross chose to continue their existing PPO plans into the new mandate and pricing was continued on many plans below the Blue Shield premium levels for comparative coverage.  Rate changes were kept low most likely to avoid HHS rate change scrutiny and bad press.  

The result of not replacing the plans with new plans a higher premium levels (see Blue Shield) has seen the following since March, 2012.

Clear Protection Plus 5000 Closed
CoreGuard Plus 10000 Closed
CoreGuard Plus 7500 Closed
Lumenos HSA 5000 w/Maternity Closed
Clear Protection Plus 1000 Closed

Effective November 1, 2012

SmartSense Plus 1000 standard Rx Closed
SmartSense Plus 1000 upgrade Rx Closed
Lumenos HSA 3000 Single  Closed
Lumenos HSA 4500 Single Closed
Lumenos HSA 3500 Family Closed
Lumenos HSA 1500 Closed

11 PPO plan closures in the last six months.  Members on those PPO plans (except the Lumenos 5000 w/Maternity) are allowed to remain on the plan and in some cases may add new family members.  However, all of these plans are closed for new enrollments except family members as mentioned.

As we move towards full implementation of Healthcare Reform, it will be interesting to see what the insurance carries do both in terms of QHP (Qualified Health Plan) implementation and existing plan pricing.

Dave
www.davefluker.com

Anthem Blue Cross CA Closing More PPO Plans 2012

Anthem Blue Cross (Blue Cross of California and Blue Cross Life & Health) has announced additional closures in California for individual & family health plans.  

In addition to the plan closures earlier this year (2012) which were posted on my blog, the following individual & family health plans will close on November 1, 2012:

*SmartSense Plus PPO 1000 Standard Rx

*SmartSense Plus PPO 1000 Upgrade Rx

*Lumenos 3000 HSA PPO (single)

*Lumenos 4500 HSA PPO (single)

*Lumenos 3500 HSA PPO (family)

*Lumenos 1500 HSA PPO

Members currently enrolled in these plans may stay on the plan after it closes on November 1.  Applications for enrollment into any of these plans will not be accepted after October 16, 2012. Applicants may enroll in these plans so long as their effective start date is prior to November 1, 2012.

Dave

www.davefluker.com

Blue Shield CA Medicare Plan Changes Coming

Blue Shield of California has announced some changes for Medicare beneficiaries in California. Medicare Supplement plans will have a plan premium rate change effective December 1, 2012. I will post the December California Medicare Supplement rates on my site 
(Medicare Supplements) in a few weeks. In the meantime I have the rates available for quoting via telephone or e-mail. In addition, 

Blue Shield CA will be adding two new Medicare Supplements to their portfolio. Additions will include High Deductible Plan F and Plan N. The current $20 per month "new to Medicare" discount will be reduced to $15 per month for those enrolling in Medicare Part B for the first time. As always, Blue Shield of California Medicare Supplement Plans include the Silver Sneakers health club membership at no additional cost. For more information about Blue Shield Medicare products, visit my web site. 

Dave 
www.davefluker.com

CT Health Insurance Exchange and other briefs posted

The CT Health Policy Project’s 2012 candidate briefing book on CT’s health is posted – including a brief on the CT Health Insurance Exchange. In addition, this year’s book includes briefs on twelve other timely issues including health care cost drivers, Accountable Care Organizations, and CT & national health reform. The briefing book is part of www.cthealthbook.org – our resource library on health care issues and solutions facing CT.

The Medicaid Controversy––The Republican Governors Should Put Up or Shut Up

Indiana, New Mexico, and Wisconsin are asking the federal government
to exempt people making between 100% and 133% of the poverty level from
the upcoming Medicaid expansion.

These Republican governors need to put up or shut up.

Ever since the passage of the Affordable Care Act (ACA), Republican governors have been clamoring for block granting Medicaid.

The Supreme Court ruled that a state

Romney Intends to Repeal “Obamacare” in 2013—Has He Thought Through the Unintended Consequences If He Does?

Romney says he will repeal “Obamacare” if he is elected. Given that this has been part of his platform from the beginning of the campaign he is entitled to do that if he wins.

I did not support passage of the Affordable Care Act (ACA) in 2010 because I saw it as an unaffordable entitlement expansion with no real hope of containing costs.

But the practical reality of killing the Affordable Care

Obama vs. Romney: A Detailed Analysis of Mitt Romney’s Health Care Reform Plan

Let’s take a look at Mitt Romney’s Health Care plan using his own outline ("Mitt’s Plan") on his website.

Romney's approach to health care reform summarized:

"Kill Obamacare" - There seems to be no chance Romney would try to fix the Affordable Care Act––he would repeal all of it.
No new federal health insurance reform law - There is no indication from his policy outline that he would try to

SB 1431 Moved to Inactive File

On August 31, SB 1431 was moved to the Inactive File. This bill was ordered to inactive file on the request of Assembly Member Charles Calderon.

Inactive file bills may be opened again at a later date for reconsideration. As of now, it appears that SB 1431 (the "stop-loss" bill) is no longer on the table in California.

Small group plans may continue to utilize current 'self-funded' plans for their employee health benefits.

SB 1431 Status

Previous Blog updates on SB 1431:

July 24 SB 1431 Update

May 21 SB 1431 Update

April 20 Original SB 1431 Blog Post


Dave
www.davefluker.com

As always, for specific information on health insurance plans and programs, visit my site using the link above

Insurance Company Shenanigans – Part 2

If you live in CT and are insured through Golden Rule, now also known as United Healthcare’s United HealthOne; you should read the State of Connecticut’s Insurance Department notice # 509542, dated 8/17/2012. They filed a rate increase of 9.9% which the State of Connecticut cannot deny; since they filed it saying they will reimburse policy owners if they don’t spend 80 cents of every dollar on medical expenses. Let me interpret for you; according to the State of Connecticut, they are charging 3.3% more than they should be charging. Basically, on average, they are charging and collecting $380 more per year next year than this year; or by the State’s estimate $125 more per year than they should be charging you! Doesn’t sound like much, but consider this: you are financing the operations of a company that paid its CEO over $50 million in salary and benefits just a couple of years ago! Is this fair? Consider that $125 is the average, and that people with family plans are overpaying by far more than $125 per year to finance this $100 billion dollar corporation. Tony Pinto

Insurance Company Shenanigans – Part 1

In case you’re wondering why you don’t hear insurance companies complaining about Obamacare; it’s because they are big winners and don’t want to rock the boat. Insurance companies are “limited” to either paying out 80% of every dollar collected in the Individual and Small Group business market or 85% of every dollar collected in the Large Group business market. What this means is that they can keep 20% or 15% of every dollar respectively for themselves to cover their operational costs and create profits for them. Think about that… In the Individual and Small Group markets, they can keep 20% for themselves to pay their expenses and fill their pockets. Doesn’t seem like a big number; but, this means that the more expensive in dollars the health plan is; the more they make in profit. For example; if you buy a health plan that costs $400 per month with high co-payments; they can make $80 per month at-most at 20%. However; if you buy a health plan that costs $600 per month with lower co-payments; they can make $120 per month at 20%. Interesting, isn’t it… The more a health plan costs; the more profitable it can be for the insurance company. Tony Pinto

When choosing a plan in the exchange, actuarial value just a starting place

A new real-world analysis by the Commonwealth Fund demonstrates devil in the details of the bronze/silver/gold/platinum health plan actuarial value levels designed to guide consumers and small businesses choosing plans in the new insurance exchanges. The metal categories were designed to organize and make sense of confusing choices and combat deceptive insurance industry marketing practices. The analysis describes the very different costs and coverage available to individuals under plans from the same metal category. In some cases a “better” plan based on actuarial value can end up costing consumers more depending on their costs during the year. Unfortunately it is very difficult for most consumers to predict their future health costs – isn’t that why we have insurance in the first place? The study concludes, “actuarial value is a useful starting point for selecting a plan, but it does not pinpoint which plan will produce the best overall value for a particular person.” So much for making things simple. As of January 2014, consumers will be required to secure health coverage under federal law. Individuals eligible for premium subsidies must purchase coverage in the new state insurance exchanges. Leadership of CT’s Health Insurance Exchange, now developing, has been criticized as dominated by insurers and lacking independent consumer representation.