A recent New York Times highlighted Maine’s attempts at comprehensive healthcare reform. Their experiences serve as a cautionary tale for Congress.   The state established a public health insurance plan, expanded Medicare and Medicaid eligibility, and banned insurers from refusing to cover people with pre-existing conditions, but those actions have done  little to insure more of its residents.  Contrary to the promises of public option supporters, health care costs have only continued to rise in the state.

Reasons for the high health care costs range from the state-specific to the general. Unlike the bill that recently passed the House of Representatives, Maine’s healthcare reform legislation didn’t include a mandate to buy health insurance plans. It’s a vicious cycle: forcing health insurance companies to offer policies to unhealthy people with pre-existing conditions raises the rates for younger people; young adults will be even less likely to buy health insurance if their premiums go up, which results in the insurer’s risk being spread among less people. In the end, the older, unhealthier population remains in the pool and must contend with less affordable health insurance. Therefore, there is a larger uninsured population.

Granted, Maine is a market dominated by just one private health insurance company (which, with its effective monopoly, can increase premiums to their liking); and its population is older, sicker, and poorer than the U.S. in general. Senator Olympia Snowe points to her state as a cautionary tale of what may happen if drastic changes are made too fast. Snowe is a Republican that supports healthcare reform but is against the public option. Budgeting problems have caused Maine to cap enrollment of its own public option health insurance plan at under 9,000. The federal government, unlike most states, is allowed to run a deficit. However, it isn’t exactly rolling in the money right now either.

The reform bill passed in the House has the potential to change what all health insurance plans cover. An amendment proposed by Bart Stupak, which passed in the House of Representatives, prevents federal funding from being used to buy any health insurance plan that offers coverage of elective abortions. In exchange for the votes of pro-life Democrats essential to pass the legislation, the healthcare reform bill was modified. The previous language only prevented government money from being used directly to pay for an abortion.

Obviously, the public option will not include abortion coverage. However, the ban extends to private health insurers participating in the government’s insurance exchange. Low- and medium-income individuals and families will receive subsidies in order to buy a health insurance plan. A compromise proposed by Speaker Nancy Pelosi, which would serve to distinguish private dollars from federal money and allow insurers to cover abortion services with solely the latter, was rejected. Many people with employer-provided or individual health insurance have abortion coverage provided in their policies. In order to enter the potentially lucrative exchange market, insurers might eliminate that coverage entirely.

Those who pay for their entire health insurance policy out-of-pocket will still be allowed to buy plans that provide abortion coverage, although the availability and affordability of these plans will most likely decrease. Pro-choice advocates, such as Planned Parenthood, are crying foul.

Interestingly, the amendment received 240 votes–higher than the actual bill’s margin of victory. Assuming that many pro-choice Democrats voted against it, this result means that a significant portion of Republicans voted for the amendment. Whether they wanted to salvage something they wanted out of a bill that was almost certain to pass or sabotage the bill by creating a schism between Democrats, they decided to amend a bill while rejecting the bill itself.

(Image: mahalie under CC 2.0)

Health insurance providers, both public and private, are looking for ways to cut spending. One of their strategies is to deny claims for treatments they deem unnecessary. The effectiveness-testing studies receiving funding in Congress’ healthcare reform bill is a case in point. While that’s a laudable goal, what if your doctor recommends an unusual course treatment?

Experts recommend that you never tell your health insurance plan that you are receiving an “investigational” or “experimental treatment; or if you are enrolled in a clinical trial. These phrases are codewords that make insurers more likely to look closer and reject your claims. First off, health insurance plans will cover treatment your physician considers medically necessary. When it comes to insurance, you obviously shouldn’t lie (that could lead to cancellation of your policy, leaving you uninsured); but you also shouldn’t give more information than is specifically asked for.

You may even be wrong about the experimental status of the procedure. Some procedures aren’t typically used, but are proven medically effective nonetheless. In that case, health insurance plans should cover it. Check with your doctor, even if he or she used wording such as wanting to “experiment with a treatment”. Don’t let semantics cost you!

Continuing the use of technology that fueled his successful presidential campaign, President Barack Obama is now using Facebook and other social media sites to push the Democratic healthcare reform bill. By reaching the younger demographics most supportive of the public option where they congregate, Obama hopes to motivate them to call their representatives and express their support of reform. Generations X and Y live on the Internet, and are also the portion of the population most likely to be uninsured. Some of them might think that they’re healthy now and therefore invincible, but others realize the importance of having a health insurance plan at any age.

The House of Representatives will most likely be voting on healthcare reform this weekend, and representatives will no doubt be hearing from their constituents about it. Opponents of the Democrats’ reform are fired up, and the Obama administration’s goal is to light that fire under supporters who believe it’s the best way to provide affordable health insurance to the nation. They must hope that Obama’s millions of Facebook friends and Twitter followers keep up with their news feeds and become inspired to get involved in helping him enact part of the change he promised them. Their presence was sorely lacking for Democrats earlier this week, when Republicans won governor’s races in two states in off-year elections–largely fueled by anger over reform, and fears of people scared of losing their existing health insurance plans. We’ll see if Obama’s final push pays off.

Yes, you read that right. South Carolina Representative Joe “You Lie!” Wilson has proposed an amendment to the healthcare reform bill lumbering through Congress, which would require all congresspersons to enroll in the public option health insurance plan. He hasn’t switched sides and decided to vote for the Democrats’ bill; rather, his amendment is a stunt intended to point out what he sees as the failures of the public option.

Ironically, supporters of healthcare reform have pointed to the government-subsidized insurance enjoyed by senators and representatives as evidence that there should be a public option–if health insurance is good enough for our politicians, shouldn’t it be good enough for the rest of us? (In fact, although the federal government subsidizes their healthcare, it is actually administered by private insurers.) Wilson turns that strategy on its head, by saying that if a public option is suitable for average Americans, it should also be suitable for Washington D.C.

It’s quite unlikely the amendment will be ratified in the House. The current language simply allows Congress to sign up for the public option. Most Democrats probably won’t vote for this ‘poison pill’ provision; as they have admitted, most Americans would prefer to keep their existing health insurance. Republicans might vote for it as a lark, although they might refuse to dignify Nancy Pelosi’s bill with any type of ‘yes’ vote. Joe Wilson has 72 hours to get his own mandate into the bill, before it reaches the House floor.

Health insurance companies are constantly in search of ways to save money.  Some of their methods, such as refusing to cover those with pre-existing conditions that their underwriters deem too high risk, have drawn fire from consumers and politicians. Now, some insurers are promoting alternative medicine. With some exceptions, consumers pick up the majority of the costs of services like acupuncture and chiropractic, as well as herbal supplements. While most of these remedies are unproven, they have become increasingly popular with consumers. Therefore, promoting it seems to be a win-win situation for insurers.

Kaiser Permanente and Aetna are among the HMOs that offer dietary supplements and herbs to their patients. However, these supplements aren’t covered in most of their health insurance plans. If someone takes a conventional medication, the cost of their prescription will mostly be covered by their insurer, less a small co-payment. If they use a non-prescription herbal supplement instead, the patient must cover the entire cost out-of-pocket. The same applies when someone visits an alternative practitioner as opposed to a physician.  In that respect, it is financially advantageous for insurance companies to encourage the usage of alternative medicine–although they surely won’t admit it.

Some people want Congress to include alternative medicine coverage in the healthcare reform bill. Do you wish alternative medicine was covered in your health insurance plan?

Although it seems like the Democrats’ healthcare reform bills have been zooming through Congress, Senate Majority Leader Harry Reid predicts that there will soon be roadblocks.  To the chagrin of the Obama administration, Reid believes that a final bill won’t pass before the ball drops on Times Square and 2009 draws to a close. The White House wanted a bill passed prior to Ryan Seacrest’s countdown to the new year. Why is that so important? Well, 2010 is an election year; the entire Congress will be up for re-election. Judging from the few elections held yesterday, things don’t look good for the Democrats. Their prospects will be even worse if the fight to reform the health insurance industry continues to drag on, instead of  allowing the public’s memory to fade.

Unlike the House of Representatives, which is already close to voting on its bill, the Senate may not begin debate until December. There is some speculation that Reid is waiting for the final cost analysis from the Congressional Budget Office. He commented publicly that he doesn’t want to rush such an important bill. However, he is still striving to pass Obama’s top domestic priority by years’ end. They may be worried that waiting too long will make more likely that this administration’s attempt at providing more affordable health insurance will follow the failing path of Clinton’s.

This new development is just another example of why you shouldn’t wait for the public option if you can afford a health insurance plan now.

Sometimes having the wrong health insurance is even worse than being uninsured. An recent article in Chester County’s Daily Local News made that clear. After becoming unemployed, many people are left in dire straits once their employer’s COBRA coverage expires. With little money, most are only able to buy inferior health insurance plans. At that point, millions of individuals and families become underinsured. Imagine if your insurer refused to cover even one emergency room visit! No wonder some people decide to go uninsured instead; they’d still have to pay for their medical care, but at least wouldn’t still be paying premiums.

Unfortunately, some people doesn’t find out what their health insurance plan does and doesn’t cover until it’s too late.  Avoid the underinsurance trap by reviewing your plan and talking with an insurance agent. The best solution is to find a plan that suits your needs and provides the most value. It’s important to save money on insurance, but don’t forget your health. If you are currently underinsured, you can get an affordable health insurance quote for a better plan.

(Image: Commonwealth Fund)

All of the usual suspects have spoken on healthcare reform: the uninsured, the already insured, politicians, doctors…but McDonald’s? Their CEO, Jim Skinner, recently spoke about affordable health insurance during a meeting in Boston. Like many people, Skinner believes that the current system needs an overhaul as soon as possible. However, he didn’t reveal whether or not McDonald’s supports the public option, preferring to take a cautious approach on the issue.

Skinner’s remarks, as reported in the Boston Globe, mainly focused on the need to protect small businesses in any healthcare reform bill. You may wonder why a massive multinational corporation such as McDonald’s cares about the plight of small business owners. Well, the vast majority of McDonald’s restaurants (85%) are owned by franchisees who operate independently, albeit with support from the corporation. He believes that while increased access to a health insurance plan is important, it shouldn’t come at the expense of small business. There is a possibility that reform might come with an undue burden on companies and franchise owners buying small group health insurance for their employees. If their savings were jeopardized, millions of Americans could lose their coverage. Clearly, this would defeat the purpose of Congress’ health care reform efforts, and would be opposed by McDonald’s.

What does Jim Skinner think about the charge that his company and other fast food restaurants are part of the problem of soaring healthcare costs by promoting obesity? He pointed out the offering of milk and fruit in some children’s Happy Meals, as well as the expansion of the menu to include healthier selections. Above all, it’s a choice to eat at McDonald’s. Although they could certainly do more to support health (i.e. post calorie counts prominently on the menu everywhere, as they are legally required to do by New York City), there is merit to Skinner’s perspective. As a franchise, McDonald’s has a unique perspective on health insurance from both the small business and large corporation side.

(Image: Official McDonald’s Corporate Website)

There has been panic over the H1N1 (a.k.a. swine flu) vaccine shortage. Unfortunately, the pharmaceutical companies responsible for producing the vaccine have had various production problems. These corporations, including GlaxoSmithKline and AztraZeneca, have been working with the U.S. government to get the vaccine out as soon as possible. In addition, as Health & Human Services Secretary Kathleen Sebelius explained to the New York Times, the actual reproduction of the vaccine in eggs chicken eggs has grown slower than expected. While the goal is to get all Americans vaccinated, only 30 million doses of the vaccine will be available by the end of this month.

Still, the situation’s not as scary as it sounds–even though it’s Halloween! Supplies are steadily growing, and H1N1, while serious, is not yet a nationwide pandemic. There’s still time for the vaccine to roll out, which it has been doing. Moreover, it’s only a subset of the population that is at higher risk:

• Children
• Pregnant women
• Teenagers & young adults
• and those with existing health problems.

Those groups need the vaccine as soon as possible, and most clinics have been rationing the vaccine for the moment. High-priority populations are moved ahead of the line, and others will receive any leftover vaccines. Some regions are seeing higher demand than others–and live vaccines for the H1N1 virus eventually expire. The worst scenario is for the vaccine to be thrown away; therefore, it should be then be offered to lower-priority populations, e.g. senior citizens (unlike the seasonal flu, senior citizens aren’t at high risk for the swine flu). Remember also that you only need a single shot of the vaccine for it to be effective.

Does your health insurance plan cover the H1N1 vaccine? It most likely does, if your primary care physician has it. If he or she doesn’t have a supply on hand, there are free and low-cost clinics available from county and state governments, as well as pharmacies like Walgreens and CVS.

(Image: Ben Chau under CC 2.0)