Category Archive - Issues and Opinion

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Health Insurance Plan Agents May Suffer Under Reform

Friday, August 27th, 2010
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Image: Jennifer Feuchter under CC 3.0

Although healthcare reform tries to help many, it will end up hurting at least some. For example, the business model of many health insurance brokerages and agencies is in danger.

Provisions involving medical loss ratios, which include agent commissions in the “administrative” category that will be regulated and limited, will have a negative effect. In addition, brokerages may be made redundant by the state insurance exchanges and accompanying websites that must be launched by 2014. On the bright side for them, the National Association of Insurance Commissioners passed a resolution that affirmed the importance of licensed insurance professionals.

With the possibility of a double-dip recession looming, more job losses is obviously a downside. However, industry experts predict that these companies have several options for adaptation. Hopefully, their experience in navigating the complexity of the market and helping people decide on a health insurance plan will still be in demand. Their compensation model may also be adjusted in favor of flat fees instead of commissions.

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Republicans Vow To Repeal Healthcare Reform If They Win Midterms

Friday, August 20th, 2010

Image: Republican Party of Shelby County under CC 3.0

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The heated midterm election battles are underway. Control of the House of Representatives and Senate is at stake in November. Democrats are looking to retain their majority, but what if they don’t?

Tennessee Republican representative Marsha Blackburn recently stated that the GOP will repeal the Obama administration’s healthcare reform law if they regain control. The law is controversial largely due to provisions that create a mandate for individuals and companies to buy a health insurance plan.

However, Rep. Blackburn’s promises may be more election rhetoric than reality. While the Republican party may take a few steps in the direction of eliminating the law, President Obama is guaranteed to veto any bill that would repeal it. Although political pundits predict that Republicans may win a significant number of seats, they may not reach the essential two-thirds of the Senate that would be necessary to override a presidential veto.

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Statistics About Massachusetts’ Uninsured

Wednesday, August 18th, 2010
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Image: David Paul Ohmer under CC 3.0

Largely due to the state’s first-in-the-nation healthcare reform, Massachusetts residents are the most likely in America to have a health insurance plan. Still, the expansion has not succeeded in providing universal coverage. Why?

A recent study from the Urban Institute and the Robert Wood Johnson Foundation’s State Access Reform Evaluation looked to identify the 4.1 percent who were still uninsured.

Here are their findings on the average Massachusetts resident without health insurance:

  • From 19 to 64 years old
  • male
  • an ethnic or racial minority (African-American, Hispanic, etc.)
  • unmarried
  • lack of proficency in the English language; either their own or that of an adult who lives with them
  • less educated
  • not a U.S. citizen
  • more likely to be unemployed
  • could be eligible for public Medicaid coverage

The study’s authors believe that the state’s message may not be getting across to its attempted demographic. Suggestions include rewriting the program information in order for it to be understandable with a 4th to 8th grade reading level.

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Health Coverage and HIV/AIDS

Tuesday, July 13th, 2010

Image: Sully Pixel under CC 3.0

With its affordable health insurance legislation under its belt, the Obama administration has begun tackling a new health issue: the HIV/AIDS crisis. Although new infections have slowed since their peak in the ’80s, many people are still affected.

It is a two-pronged effort, aimed at reducing new infections while increasing access to health care for those who already have it. Instead of allocating significant amounts of new funding, existing funding will be redirected to high-risk populations like African-Americans and gay/bisexual men.

Some fear that the new comprehensive strategy won’t be enough, however. The economy has resulted in many people losing their jobs, which for many also means losing health coverage. Although there are medications that allow HIV patients to live longer and healthier lives, they are still very expensive. The out-of-pocket cost is almost out of reach for the uninsured. In addition, a person with HIV or AIDS would find it almost impossible to buy health insurance on the open market for the next several years.

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Your Health Coverage Can Be Canceled for One Penny

Friday, July 9th, 2010


Image: stevendepolo under CC 3.0

In order for your coverage to remain secure, it is essential to pay every single penny of your health insurance premium–literally.

A woman with cancer lost her job, but got COBRA to continue her group health insurance benefits. Last year’s stimulus package gave her a 35% subsidy to help cover the cost. However, her insurance company never sent her the reduced bill.

Therefore, she calculated the smaller amount herself and sent in the premium. Unfortunately, the insurer’s calculations didn’t agree: they said her payment should be one cent higher. As a result, they canceled her plan entirely for nonpayment! She was unable to send a check for $0.01 because she was in the hospital undergoing chemotherapy at the time.

The good news is that they eventually overturned their decision and reinstated her coverage.

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Germany Struggling With Health Insurance Costs, Too

Wednesday, July 7th, 2010

Image: Aenneken under CC 3.0

While the Germans are dominating the World Cup, the situation regarding their health insurance doesn’t look so bright. Just like the United States, their economy has been dealt several blows, and the nation is dealing with a major budget deficit.

Some believe that more direct government intervention will lower the cost of affordable health plans in the U.S., but Germany is proving that point wrong. Chancellor Angela Merkel (the German equivalent of our president) recently agreed to increase premiums for virtually all residents, from 14.9% to 15.5% of their gross pay–split between employers and employees. Insurers will also be allowed to ask for an extra premium to cover additional costs.

On the positive side, nearly 90% of the population is covered through their mandate. Unfortunately, they have failed to control severe jump in health care expenses.

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ER Visits To Jump With More Health Coverage

Monday, July 5th, 2010

Image: aaron_anderer under CC 3.0

Most people would assume that an increase in the percentage of those with health coverage would result in fewer people going to the emergency room. After all, they would have primary care doctors and the means to get preventative treatment early. That was actually one of the arguments for health insurance reform.

Unfortunately, it may not turn out that way. ERs are actually likely to become even more crowded! There is a shortage of family physicians that won’t be remedied for years. Medicaid patients–not the uninsured–are the most likely to utilize emergency services.

A preview of what may be coming: emergency room visits increased by 4-7% in Massachusetts after that state passed universal healthcare reform.

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Can Online Chat Make For A More Affordable HMO?

Tuesday, June 29th, 2010

Health insurers want to save money on customer service. At the same time, policyholders are increasingly connected. The UPMC Health Plan is a health insurance company that believes live online chat can do both.

Employees will be trained to handle policy and claim questions through their website. They hope that the technology will make it easier to provide affordable HMO products.

If their innovation is more successful than previous Internet attempts in terms of customer satisfaction, it could spread across the industry.

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Americans Spend Double On Health Insurance, With Worse Results

Thursday, June 24th, 2010

A study from the Commonwealth Fund compared the health care systems of several developed nations. Unfortunately, the United States was again ranked at the bottom.

The survey found that, on average, Americans spent over $7,000 on health expenses in 2007. Still, their quality of care was not the highest. The authors blame the inequitable patchwork of individual, employer-provided, and public health insurance plans that leave millions uninsured.

So if the USA isn’t on top, who is? The Netherlands had the highest overall score. Maybe our health insurance system could learn from the Dutch.

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Do New York Courts Have A Medical Malpractice Soultion?

Monday, June 21st, 2010

The medical malpractice system has been heavily criticized for its contribution to soaring health insurance premiums. Many doctors practice defensive medicine–performing far too many expensive tests and procedures that are unnecessary, in order to avoid lawsuits.

A judge in New York thinks he has a soultion: treating all parties involved like people. Many families want vindication and justice, instead of extremely large sums of money. By having doctors and nurses apologize for any mistake, he has convinced victims to take smaller settlements as opposed to choosing a jury trial.

The affordable health insurance reform law sets $3 million aside for studying these methods to see if they can work nationally.

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