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)

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)

Rationing: It’s a dirty word.  Some politicians and activists warn of the dangers of a public option that would have the government ration out health care, and point to Europe as a cautionary tale; others claim that care is already being rationed indirectly by a patient’s health insurance plan. Either way, the thought of being denied needed medical treatment because of a callous calculation is scary. Costs need to be cut, either by the federal government or private insurance companies looking to maximize their profits–therefore, everyone’s looking for whatever procedures may be considered unnecessary and wasteful.

How do you know if you’re a victim of rationing, as opposed to a recipient of high-quality, sensible health care? In Newsweek magazine, medical school professor Christopher Moore acknowledged this dilemma. Sometimes, excess treatment can hurt the patient more than it helps. Take CT scans, for example. Admittedly, they are costly, with prices continuing to rise (and also being passed onto your family health insurance bill); but CT scanners are amazing medical technology that can identify if a head injury is life-threatening. However, studies have shown that the probability of that being the case are relatively tiny. Meanwhile, there is up to a 1-in-1,000 chance of each CT scan causing eventual death from cancer (due to the radiation involved), even more so for younger patients. The medical risks of doing a CT scan on a teenager with a concussion could outweigh the benefits, even after removing cost from the equation. Keeping a close watch on the patient might be a better bet.

So if your doctor refuses to perform an expensive test or other procedure, it’s very likely that he or she has a legitimate medical reason for it. If you get more affordable health insurance because of the reduced cost, so much the better, but that’s not the #1 priority.  Occasionally, a physician who performs the procedure might be doing it solely to avoid a malpractice lawsuit. The prospect of a government-run public option won’t stop that. Moore insists that a doctor who genuinely believes an expensive procedure is sorely needed won’t let cost concerns stop him or her from ordering it. Let’s hope so.

(Image: Akira Oghaki under CC 2.0)

Obesity has become an epidemic in America, and has been blamed for a significant percentage of rising healthcare costs. In the past, ambulances have had to improvise when transporting morbidly obese patients over 500 pounds to the hospital, and companies have eaten the cost. Now, with an increasingly obese population, ambulance providers are starting to pass the increased cost onto insurers, either public or private. This may be necessary, but it will probably reduce the availability of affordable health insurance policies. As for the uninsured, patients will also have to cover the cost of an ambulance ride themselves.

It’s two-and-a-half times more expensive to transfer an extremely obese patient than one at normal weight, according to the Associated Press. Reasons for this include the need for new vehicles and helicopters with larger doors and lifts, extra-large stretchers, as well as the need to hire more emergency crew members (and have them work longer hours) to lift obese patients. Insurance companies operating in Washington and Oregon already pay increased rates to cover those extra costs, despite fat-acceptance groups considering it to be another example of weight discrimination in medical care. Other advocates of the obese, however, are appreciative of the improvements that allow them to be transported with dignity.

The cost of specialized ambulances will certainly be passed on. Increased regulation in the healthcare reform bill may prevent people from charging extremely obese patients more for a health insurance plan. Therefore, everyone’s plan will cost a little bit more.  Medicare and Medicaid are resisting increased reimbursements, but the industry is fighting for fair compensation for their services. Without it, they claim that they will be unable to provide quality care that serves the needs of a significant percentage of the nation’s people.  Promoting public health (e.g. reaching a healthy weight and not smoking) would do a lot to reduce healthcare costs, and should be part of any healthcare reform. Otherwise, the population of morbidly obese will rise from its current 5%, requiring more specialized, costly care.

(Image: NIOSH – National Institute for Occupational Safety and Health under CC 2.0)

Following her Senate counterpart’s reveal of his healthcare reform plan earlier this week, Speaker of the House of Representatives Nancy Pelosi has now unveiled her chamber’s proposal for expanding affordable health insurance coverage. As expected, the House’s plan is farther-reaching than the Senate’s and more similar to the one outlined by President Obama during his campaign.  Here’s a quick Q&A on Pelosi’s plan:

Q: How much is this going to cost?

A: It’s projected to cost a whopping $894 billion over ten years.

Q: How is the government planning to pay for reform?

A: It will raise income taxes on couples making over $1 million and individuals making over $500,000 yearly. In addition, Medicare spending will be cut by an unknown amount.  Liberal representatives also floated the idea of having the government dictate the rates paid to health care providers by the public option, but moderates managed to strip out that provision. (The government, as well as private insurers, will instead negotiate payment rates with hospitals and doctors.)

Q: Is a public option included?

A: Yes. Unlike the Senate version, the House’s bill doesn’t allow states to opt out of it. So far, it doesn’t include a so-called “trigger” either.

Q: Will illegal immigrants be covered by the public option?

A: As of now, it’s unclear. That’s one of the main sticking points preventing the House bill from reaching a vote. However, remember that illegal immigrants are already receiving a form of public healthcare: hospital emergency rooms are required to serve everyone who comes in.

Q: What about abortion? Will it be covered?

A: That’s another controversial topic that will see much debate before the bill hits the House floor. A handful of pro-life Democrats will probably try to have abortion coverage removed from the public option in order for it to receive their votes. Meanwhile, some pro-choice representatives oppose a bill that doesn’t include abortion services. Either way, the Democrats have a solid majority in the House and can afford to lose some votes in either direction.

Q: What if I have a pre-existing condition and can’t get insurance?

A: These reforms are supposed to change that. Health insurers will no longer be allowed to deny coverage to people with pre-existing conditions. They won’t be able to charge those with pre-existing conditions significantly more, either.

Q: When will healthcare reform take effect?

A: It’s hard to believe, but the bill won’t fully kick in until 2013. By then, a mandate will require everyone who can afford it to buy health insurance. They can be insured via the newly created exchange (consisting of private insurers, in addition to the public option), by their employer, or an existing government program such as Medicare or Medicaid.

Q: But I need health insurance now! What can I do in the meantime?

A: The government is putting together a temporary program to insure individuals and families that have been rejected by private insurers. Otherwise, do you really want to wait for the government’s health insurance plan? Keep in mind that the House bill needs to be reconciled with the Senate bill before there’s a final vote, and that could take months.

(Image: U.S. House of Representatives Portrait)

Over the past week or so, the public option has been on a roll. Democratic leaders of Congress have insisted that some form of a public option be included in their healthcare reform bill, considering it an essential step in providing the nation with more affordable health insurance. It wasn’t going to be an easy battle. Senator Joe Lieberman has expressed his opposition to such a government-run plan. The independent senator–who used to be a Democrat and still caucuses with the party–cites budget concerns as his primary reason for rejecting it, and believes it isn’t the right time to go into even deeper debt. A less charitable view is that he wants to continue receiving funds for his re-election from major health insurance companies, many of which are headquartered in his home state of Connecticut. Only Lieberman himself knows his motivations for sure.

Lieberman has stated that he will vote with Harry Reid in the initial procedural vote that allows the bill on the full Senate floor for further debate, but vows to be part of the inevitable Republican filibuster against any final bill that includes the public option health insurance plan. Leaders should take him seriously, since he’s well-known for switching sides: he even campaigned for John McCain during last year’s presidential campaign. Nobody said getting 60 votes in the Senate would be easy; don’t be stuck without a health insurance plan in the meantime.

(Image: Official U.S. Senate Portrait)

A recent story in the Boston Globe, while sad, has given me a deeper appreciation of those health insurance companies that provide mental health coverage. During a therapy session at Massachusetts General Hospital’s Bipolar Clinic, a patient with bipolar disorder stabbed his psychiatrist. The psychiatrist is recovering, thankfully; the patient was soon killed by a security guard after he failed to stop.

Many people forget that psychiatrists are also medical doctors that treat a variety of conditions and put themselves in harm’s way each day. While it appears that this particular patient was too far gone, millions of individuals with mental health disorders have seen significant improvements with the help of psychiatric treatment. People who need treatment are more likely to get it if they have health insurance with mental health coverage. There are insurance plans that cover most or all of the cost of psychiatric and therapy visits, as well as medications.

Please don’t wait to get help until it’s too late. If you or someone you love is struggling with paying for treatment of their mental illness, get a health insurance quote instead of giving up. I wish you the best of luck.

(Image: Pink Sherbet Photography under CC 2.0)

Finally, we get some more concrete information about the proposed government-run health insurance plan, otherwise known as the public option. It’s already in the House of Representatives healthcare reform bill, but the Senate’s version goes into more detail on what a public option for America would look like. First off, it wouldn’t take effect until 2013; after which it would be included in an exchange (think the Dow Jones or NASDAQ for health insurance), along with private insurers. Small businesses and individuals will be able to take part in the exchange and pool their buying power to buy their health insurance plans at a lower group rate. The idea behind the public option is that, with the government’s negotiating muscle and lack of profit motive, the competition will make healthcare costs lower across the board.  Opponents are skeptical, and believe that there is no way other health insurance providers can compete against governmental subsidies.

Even though the federal government doesn’t need to maximize profits for its shareholders, it still intends to cover most of its costs through the insurance premiums paid by its participants. The Obama administration plans to increase the federal deficit in order to provide initial funding, but hopes to repay the debt through those premiums. However, those revenues may end up smaller than anticipated; the Senate bill also allows states to individually opt out of the public option portion of reform, beginning in 2014. The program will be nationwide by default, but each state can pass legislation excluding itself from it. Further details are unknown; would those states have to pay the portion of federal taxes that goes to cover the public option, or will that money be refunded to their residents so they can buy one of the existing private health insurance plans? It remains to be seen how many state governments would actually take up that offer when all is said and done, but the choice allows some halfhearted “Blue Dog” Democratic politicians from conservative regions to vote for some form of healthcare reform without arising the ire of their constituents.

(Image: Andrew Aliferis under CC 2.0)

There is rumor that the public option may not be as straightforward as one might think. It may only trigger into effect for those of which private health insurance fails. This has numerous implications.

1. The cost of such a plan is cheaper than insuring millions of Americans, it goes to those who need it the most, but then who decides what is need? How do you prevent abuse from both client and private health insurance agency? No one wants to pay so wouldn’t people try to take advantage of a fail safe, trying to make the government pay for it as the first option?

2. What about those without health insurance now? Will they need to buy a “minimal” plan in order to qualify for the fail safe? Again, what makes anyone purchase more options and spend more if they are going to get something for near free if their insurance “fails”?

3, Businesses will sprout using agovernment fail-safe in order to turn profits. Agencies will try to create health insurance plans of their own, charging a small fee to claim the person has health coverage with no substantial benefits. Then when the medical care is needed, relying on the government.

This just goes to show how complex Healthcare Reform is. Any change is going to be so substantial that it will create opportunity for abuse. Topics need to be thoroughly discussed, but not to the point of boredom and entropy.

While making the rounds of the Sunday morning talk shows, Republican Senator (and 2008 Presidential candidate) John McCain stated that he believes that some form of a public health insurance plan will be included in the healthcare reform bill. McCain is a staunch opponent of government involvement in health care, but is certain that the Democrats have enough votes to pass some form of a public option in both chambers of Congress. While it’s looked for awhile as if the House of Representatives’ bill would include that government health insurance plan, prospects for such a provision in the Senate appeared doubtful. However, other legislators shared McCain’s confidence that it would gain the 60 votes required to pass; as well as his doubts that Republicans would filibuster the health reform bill.

Still, the plan that ends up in the final bill may not be the comprehensive Canadian or European-style public program that has been receiving all the attention. It’s very likely that the public option included might be subject to a trigger. Such a trigger option would only take effect if the private market fails to perform to certain specifications, as a sort of safety net. These conditions include the failure to insure a certain percentage of states’ populations over a certain time period, or not achieving enough success in reducing costs. That type of coverage from the federal government isn’t as far reaching as what Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi desire, but is a health insurance plan that has a better change of passing both houses. McCain speculates that the triggered public option is what will probably be included in the bill, as Democrats were burned from their last attempt to pass sweeping health reform during the Clinton administration.

(Image: marcn under CC 2.0)