by Admin. | Aug 31, 2010 | latest health insurance news, NY News
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So how does your Health Insurance Company rank? Click here to find out.
“Each year, NYSID and DOH receive complaints about health insurers from consumers and health care providers. After reviewing each complaint, the State determines if the health insurer acted appropriately. If the State determines that the insurer did not act in accordance with their statutory and contractual obligations, the health insurer must resolve the problem”
According to the report, a better rank means that the health insurer had fewer upheld complaints, relative to its size. If the ratios are the same, the health insurer with the largest premium is ranked higher.
As usual the leading insurers with the most market share rank in the middle. The #1 insurer based on membership, Empire Blue Cross, received # 6 ranking. Highly regarded Aetna got # 8. Using this as a gauge, highest ranked insurers such as MVP, Independent Health and Community Blue (Healthnow) ought to be the way to go. As an example, local Mid Hudson Valley privately owned MVP had 117 complaints with just 7 upheld or 6%.
The numbers would suggest that the smaller size of an insurer the better they are at customer service and reducing complaints. This is unfortunately contrary to what we are seeing in the industry. Health Net has existed the northeast recently, GHI and HIP merged to form Emblem, Oxford was taken over by United Health Care and Empire is owned by Anthem and no longer a non profit. We are seeing recent examples of this turned outside the region as well. Moody’s, New York, points to recent notifications that Blue Cross Blue Shield of Delaware, Wilmington, Del., signed an affiliation agreement with Highmark Inc., Pittsburgh, and that HealthSpring, Nashville, Tenn., agreed to acquire Bravo Health, Baltimore.
So how does an MVP afford to invest in technology and new products? Regulators may frown on the big boys from swallowing them up but its a good guess that new affiliations with similarly sized small companies will be shaping the future landscape of private Health Care.
by Admin. | Aug 5, 2010 | healthcare, latest health insurance news
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The showdown is over and 45,000 Westchester Empire Blue Cross residents can now breathe a sigh of relief. The majority of the Westchester hospitals belong to this network – Lawrence Hospital Center,Northern Westchester Hospital, Phelps Memorial Hospital Center and White Plains Hospital Center.
While these hospitals were covered on emergencies and the physicians were unaffected it still posed an inconvenience. physicians were rerouting patients to participating hospitals such as Westchester Medical Center in Valhalla.
As I posted in prior blogs these tight negotiations will be the new norm as regional hospital systems have logically evolved to gain leverage in the market. Unlike in past negotiations this one has been a thriller as contracts have not been renewed since April 1. The PR campaign was heavy on both sides with political pressures coming down form the State, board of directors and passionate letter writing campaigns.
Ironically we are seeing the opposite trend from insurers who are building smaller networks focused on smaller regional hospitals and medical centers. The article in NYT, Insurers Push Plans That Limit Choice of Doctor, discusses how this model may possibly work in the new Obama Care. Many may be willing to make network concessions with savings of 15%. We are seeing this trend already with offshoots from insurers such as a 5 Boroughs plan – Aetna NYC HMO, Atlantis and Emblem CompreHealth HMO. We expect Empire and Oxford to come out with something similar. Our clients will be closely monitoring these networks.
So in an odd twist a Stellaria Hospital system may be the only hospital a Westchester resident can go to with a possible NYC hospital systems alliance such as Columbia Presbyterian Hospital/New York Cornell.
Either way Empire residents here will be sleeping soundly knowing that they are not limited, for now.
by Admin. | Jan 20, 2010 | Health Care Reform, latest health insurance news
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The people have spoken it seems as Democrats lost a key Senate seat occupied for nearly 50 years to Republican Scott Brown. The irony of course is that Massachusetts is a progressive state taking the lead in health care reform. The state has had mix success with reform. According to a Money.com article http://money.cnn.com/2009/01/26/smallbusiness/massachusettes_healthcare_mandate.fsb/index.htm the the real danger of reform is that regulators keep adding mandates and reforms that adds to the costs.
Small businesses are struggling in this uncertain economy and are fearful of regulators. NYS has already added a sales tax in Summer of 2009 and almost passed a second surcharge in the Fall. The real concerns are costs and the Health Care Reform Bill barely touches 1.5%/year savings over 10 years, http://www.reuters.com/article/idUSTRE54A01P20090511.
Flaws in the Reform Bill are that people can choose to go uninsured and come back on when they’re sick without a pre-existing condition waiting period. This adds to the cost as someone could defray costs by not paying into the system and just buy back into it as needed. Imagine if we can do that with Auto Insurance? With so many progressive state programs for low income the people most commonly winging it are high middle income and younger people.
Secondly, the sole prop and individual markets in state such as NY are unaffordable. This is the soft underbelly of the system that we also see as going uninsured especially with so many out of work employees who are working as 1099 consultants. Extending COBRA to 36 months from 18 months staves this problem somewhat. Perhaps extending COBRA even further may work as well even with a small added premium to extend form 36 month 60 month would still be a saving. For example, a single NY non group HMO is $1000/month vs. $400/month for a group plan.
Finally and most importantly is Malpractice and Tort Reform. You cannot discuss Health Care Reform without attacking this issue and The Reform Bill falls short of doing this. The actual cost of Malpractice is less than we realize. Malpractice costs account for only 1% of spending but this leads to another estimated 9% is for “defensive medicine”. According to JAMA– “Defensive spending is described such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents’ lack of confidence in their liability insurance and perceived burden of insurance premiums.”
WIll this shape up to be a repeat of 1994 and dismissed as another failed attempt by Democrats? Perhaps not, so long as premiums are rising 10-20% a change must take place. The President’s singular focus on this issue has moved government to act this far is an a testament to his will. No other president in 50 years has wanted to touch this controversial topic with a ten foot pole Trying to accomplish this in his first term is hubris and a bit naive but at least we have something on the table. A true bipartisan bill may be the most lasting in the long run.
by Admin. | Jan 3, 2010 | COBRA, Dependent Coverage, Health Care Reform, latest health insurance news
Happy Holidays!![Happy 2010](https://alexmillers.files.wordpress.com/2010/01/happy-2010.gif)
As we enter 2010 we want to include some timely information on year end health reform and its possible impacts.
Right before Christmas, The Senate has passed 60-39 its version of a health care reform bill that, if enacted, will impact your business benefits plan more than any federal law in the past half century. The Senate’s bill must still be merged with legislation passed by the House before President Obama could sign a final bill in the new year.
Most measures are expected to take place in 2014. As for the impact on small businesses, The Senate would exempt companies with fewer than 50 workers from having to offer insurance. The House excuses companies with annual payrolls of less than $500,000; firms that are bigger would pay a fee equivalent to a portion of their payroll costs if they don’t offer insurance. That payment would rise to 8 percent of payroll for the largest firms.
Brief Comparison of Senate and House Health Reform Bills
The 10-year, $871 billion health reform bill is designed to extend insurance coverage to 31 million uninsured Americans.
Barring any major changes, the final health care reform bill is expected to:
- Require most employers to contribute to the cost of employee coverage or pay into a health fund, while small businesses would be exempt or receive tax credits.
- Require everyone to carry insurance, with discounts for people who cannot afford it and penalties for people who refuse to buy coverage.
- Create a new marketplace or “Exchange” for individuals and small businesses to comparison-shop for insurance.
- Levy a new excise tax on high-value health plans.
- Provide insurance discounts for those earning less than 400 percent of the federal poverty level (about $73,000 for a family of three).
- Impose new restrictions on insurance practices, such as prohibiting the denial of coverage because of pre-existing conditions, and increase the Medicare payroll tax on high-income people.
Most of these changes will likely be phased in beginning of 2013 and continue up until 2016, although changes to health care Flexible Spending Accounts could occur in 2011. The legislation would place an annual limit of $2,500 on the amount of funds employees can contribute to FSAs.
For more on specifics and timing of the pending legislation, please see Health Care Reform Frequently Asked Questions for employers by clicking here.
It’s important to remember that any dramatic changes would not be immediate. However, there are some things employers can do right now in preparation for the passage of a bill. The most important of these are to stay informed, follow developments and involve your benefits staff and partners.
Employers may also want to begin evaluating their employee demographics and assessing their current health plan design.
- Do you have a balanced health care plan?
- Will you be subjected to the 40% “Cadillac Tax”?
- Will you be subject to pay or play penalties?
- Can you take advantage of Exchange options if low-income employees would receive greater subsidies?
- What would be the overall impact to your budget?
Health care reform is estimated to cost between $890 billion and $1 trillion over 10 years. It would be paid for by a combination of savings to Medicare and Medicaid, along with new sources of revenue from tax changes.
Once a bill is signed into law, we will help our clients with the practical implications of the legislation and its potential impact to organizations.
Our agency has strived to be ahead of the curve and keep our clients within budget regardless. We realize your organization – now more than ever – needs up-to-date information, industry-leading expertise and the assurance a reliable benefits partner can bring to your business. We thank you all for reading our material, referring us business and most of all believing in us!
Once again thank you and we wish you and your family a wonderful Holiday Season!
by Admin. | Nov 2, 2009 | latest health insurance news, Uncategorized, United Healthcare
Health Care Reform!![3740711378_3b39509830 3740711378_3b39509830](https://5zs2d3.p3cdn1.secureserver.net/wp-content/uploads/2009/11/3740711378_3b39509830.jpg?w=300)
Americans woke up earlier today to the new Health Care Reform House Bill, “Affordable Health Care for America Act. HR 392”, which completes an important 1st step of 3 stages of a final bill. While I didn’t quite make it through the 1990 page there are couple of items that stood out.
According to The Associated Press the Congressional Budget Office concludes that the public option might actually cost consumers more than private coverage. The bill is expected to fetch close to $1 trillion dollars over 10 years. However, the bill could lead to $104 billion net reduction in deficit by spending cuts, revenue raisers and other bill provisions.
- The bill would create a Health Insurance Exchange system that individuals could use to buy health insurance from private insurers and government-run plans.
- The bill also would provide incentives for the creation of nonprofit, state-based health insurance cooperatives.
- The public option plans would have to negotiate their own rates with providers, rather than using the ultra-low Medicare rates.
- Individual responsibility: A “shared responsibility” section that would take effect in 2013 and covers both individuals and employers. The max tax for individuals would be either 2.5% of persons AGI or cost of average health insurance premiums.
- Employer responsibility: would impose a tax equal to 8% of employee wages on employers over a minimum size that failed to provide health coverage. The payroll tax would be lower for employers with $500,000 to $750,000 in payroll, and 0% for employers with less than $500,000 in payroll costs.
- Forbid plans from basing premiums or denials of care on factors such as pre-existing conditions, race, or gender.
- Close the Medicare Part D prescription drug program “doughnut hole”.
- Provide “affordability credits” to help individuals and families who meet income requirements pay their health insurance premiums, and provide health insurance subsidies for small businesses.
- Require the secretary of Health and Human Services to negotiate drug prices on behalf of Medicare beneficiaries.
- Expand Medicaid.
How will this be paid for? The new costs would be paid for according House Democrats by “making Medicare and Medicaid more efficient, imposing 5.4% tax surcharge on individuals with adjusted gross incomes over $500,000 and married couples with adjusted gross incomes over $1 million; and adopting other tax measures.”
Our reaction is that without a greater focus on health care costs, families and employers will not be able to afford coverage. Health care has tripled in a span of 15 years since 1984 to over $2 trillion and is expected to increase to $3.1 trillion by 2012. Most uninsured have programs available that were absent when I was growing up. You can still be middle class and qualify for state subsidies. Example for NYS is Healthy NY for small businesses and sole prop. as well as Family Health Plus and Child Health Plus.
In the absence of tort reform, however, and an expected 21% reduction in Medicare reimbursement this will negatively affect providers. In speaking with our client physician groups and national polls this could lead unintended consequences such 25% retirement and reduction of new physicians. Could this lead to more prescribing privileges and responsibilities for Physician Assistants, Nurses and Pharmacists?
Malpractice costs account for only 1% of spending but this leads to another estimated 9% is for “defensive medicine”. According to JAMA– “Defen
sive spending is described such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents’ lack of confidence in their liability insurance and perceived burden of insurance premiums.”
The issue of private competition is a big factor. According to Kelly Loussedes, of National Association of Health Underwriters, “By injecting more competition into the insurance market, this might seem like an intelligent way to lower overall health care costs. A “public option” would simply shift health care costs onto private payers — and undermine the private insurance system”. We question how real the private sector can compete with a public plan
however, well intentioned it may be.
In addition, most uninsured in progressive states such as NY are young people who elect not to pay now, illegal residents and people who earn over $50,000 but decide to opt out. The issue how strong is the requirement for individuals to participate? If its like Massachusetts with only a $1500 penalty or not enforced then this creates actually much more costs.
According to Mark Wagar President of Empire Blue Cross, “fewer businesses and individuals purchase private coverage and enrollment shifts to high cost Medicaid coverage, further increasing State funding burdens. In turn, too many people delay needed services, resulting in increased costs for urgent care for hospitals and physicians when care becomes critical.” He goes on to say that in NYS where the non group individual market is unaffordable now “The presence of an effective mandate – alone – would reduce the cost of individual coverage in New York by
over 60 percent and enroll 8 times as many New Yorkers in coverage than today because of improved affordability.”
Progressive countries such as Denmark and France have actually moved to private sector. According to our client Lisa Halpern of Euro Center USA , which works with a Danish travel insurance company for expatriates, “Denmark’s public single payer system had to include the private sector starting more than 20 years ago. This has become increasingly popular in recent years because the public had trouble accessing physicians without longer waiting times, diagnostics and private hospitals. The Private Insurance has also benefitted as a tax deduction for private companies offering additional health insurance.”
We support taking steps to lower costs as mentioned in prior newsletter
such as negotiating with drug manufacturers and implementation of healthcare cooperatives. On the other hand, we are wary of moving
too quickly on this road of reform and leading to unintended consequences. As debate and legislation is clarifying that a public option is a probability we are concerned if this will lead to big government, wasteful spending, higher taxes and the specter of no private sector.
As the saying goes the madness is in the details. As a fellow business owner we ask that you join us in staying active with your local chamber, legislative rep., editorials and social media forums on this road to reform. We have included some helpful links below.
Get Health Care Right!
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by Admin. | Aug 17, 2009 | COBRA, Dependent Coverage, family health insurance, group health insurance, latest health insurance news, Pharmaceutical Industry, regional health insurance co-ops
Health Care Reform!
Ok so unless you’ve been stuck in the Arctic for a year you’ve been hearing a lot about this heated topic. Everyone has strong feelings about it evidently, I myself included, but I have stayed away from the fray for the most part.
As congress takes their August recess and those who still have jobs are on vacation I thought its a good time to put my two cents into it.
This well done score card brought to you by Empire Blue Cross is a great illustration of the leading proposals and voices in Washington. A nicely published overview by the Lewin Group is actually a great read on the proposed Government Sponsored Health Plan. The analysis covers the bill as it appeared on July 15, 2009.
Bills Key Provisions:
- Require all Americans to purchase health insurance or be fined, although those making less than $88,000 annually would be able to get a subsidy.
- Get rid of copays and deductibles for preventative care
- Make it illegal to deny coverage for pre-existing conditions
- Create a public plan
- Raise taxes for the wealthy – as much at 5.4 percent for incomes above $350,000
But what are we really talking about? A Government Plan to compete with private payers? Really?
The assumption in the study is that the government plan pays Medicare Rates. Provider reimbursements are on average 70% of private insurance reimbursements. The specter of physicians opting out of this plan is rather daunting as they would be giving up the single largest payer.
How does a private insurer compete with a government plan? Imagine a Government-owned subsidized Automobile competing with private companies? Would they not print more tax payer money and pump them up? Oh wait that’s already happened in Detroit, bad example.
The President claims that a government plan does already work and its name is Medicare. Yet, Medicare we are also told will go broke as early as by 2018 reported by Washington Post. Medicare, meanwhile, now pays private insurers to take care of seniors under the Medicare Advantage Plans. It is cheaper for the government to do this than to manage it themselves
As brokers, we work with the AARP Oxford Secure Horizons Program where some plans are $0 premium and include a fairly sizable network.
So which one is it? Does the Medicare plan work now and is proof of what’s to come or is it costly and inefficient and unsustainable?
Clearly the costs are indeed high and I question what insurers are thinking with some of the rate increases. This year, especially, I’ve seen increases of over 20% from the top carriers.
Speaking of Medicare, the Part D Plan in 2003 was just a gift to the Pharmaceutical industry’s under the Bush administration. Many people didn’t realize that the language used barred the U.S. from negotiating drug pricing. How can Canada with an entire population of 33 mill pay 50% on the dollar while 40 million US seniors pay full retail? Coincidentally, the legislators of Medicare Part D earned themselves nice cushy paying Pharmaceutical jobs within 1 year.
Obama has easily gotten concessions from Big Pharma, Insurers and the AMA (provided there is tort reform) already and I applaud him for it. There probably is even more good news to come on this.
What may be an interesting possible outcome are Regional Health Insurance Co-ops. These are a bridge between government and non-government options. The co-op alternative, led by Sen. Kent Conrad (D-ND), continued to gain traction on both sides of the aisle. The plan would call for the creation of nonprofit health cooperatives in lieu of public health insurance options. Said Sen. Baucus, “.The Conrad approach has got legs…it’s quite viable.”
On the House side, Rep. Roy Blunt (R-MO), chairing the Health Care Solutions Group, released an alternative to the House Democratic plan that he “hopes will receive bipartisan support.”
An example of this is GroupHealth in Washington State. “At Group Health, doctors are rewarded for consulting by telephone and secure e-mail, which allows for longer appointments. Patients are assigned a team of primary care practitioners who are responsible for their well-being. Medical practices, and insurance coverage decisions, are driven by the company’s own research into which drugs and procedures are most effective.” A good piece in last months’ NYT. discusses this.
There are many versions of this and perhaps there ought to be Federal provisions and overall guidelines but with regional flexibility afforded to each state. This topic requires further discussion and I will tackle it next month.
Enjoy the rest of your summer!!!