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anonymous at 09/16/2008 18:24:33

IA average premium = $98

NY Average premium =  $388

If the sate lines are opened for coverage -the guy in IA is sad and the guy in NY is happy b/c the national average will dip.  Usual Customary and Reasonable charge is a loop hole for the insurance carrier to charge whatever the hell they want and permisson to deny claims. 

 HDHP is a fad and will become the only choice of coverage in 10 years if the system is not revised. 

klaus illian, CLU at 09/04/2008 17:45:43

Any changes to market-driven plans, pools or the like is going to be a temporary fix at best while at worst, these changes will lead to mass confusion for the average consumer.  For all their efforts, managed-care health insurance companies will die a slow death.  They are struggling valiantly but the course is irreversable.  Why have mainline insurance companies, like Prudential Insurance Company of America and many others, exited the health insurance market?  Because health care is maintenance, and thus not insurable.  Study Insurance 101: there are three factors that must be in place for insurance to be marketable and stabile.  They are: large numbers, ascertainable risk and preventing adverse selection.  I'm not going to go into any detail, suffice it to say that health insurers can't ascertain the potential claims as fast as medical technolgy is changing; they are always raising their premiums and hoping the increases are enough.  The result isn't insurance; it's more akin to a cost-plus profit maintenance contract.  It doesn't matter how much they pay out as long as they can charge premium to cover their expenses.  The insurers are doing a good job of preventing adverse selection-- being saddled with too many high-claims customers-- but they do so by rejecting applicants due to their health histories or by waiving coverage on claims having to do with pre-existing conditions.  Insurers are forcing more and more people onto public sector plans, keeping the most profitable book of business, while at the same time pointing to the excessive claims of those same public insurance plans that cover the elderly, disabled, the ill and the poor.  They then very proudly claim private insurers do a better job of controlling costs.  We can't have both market-driven insurance and universal coverage.  Insurance companies need to make a profit; that's the reason they are in business; that's why I have a business-- potential profit!  Insurers will NEVER agree to insure every applicant that comes along.  Nor should they be forced to do so; it's bad enough that medical providers are forced into treating all emergency cases regardless of their ability to pay.  Just imagine government passing a law that says Home Depot must sell building supplies to everyone affected by Hurricane Gustav, regardless of their ability to pay!  But most importantly, health insurance doesn't meet the criteria for insurance; life and casualty insurance does!  The sooner everyone realizes we have a ticking time-bomb, the sooner we can reform this country's health care system as well as the way we finance health care.  The two are separate but equal issues.  And then health insurance companies can go back to marketing profitable, real insurance , like supplemental health plans. dental insurance and prescription drug plans along with the staples such as life and casualty coverage. 

The Libertarian Guy at 09/01/2008 13:27:23

  I am new to this site and have a question if I may.  Do the regualtions that prohibit sales of insurance across state lines originate with the McCarran-Ferguson Act of 1948?

MJW, springfield, MO at 08/31/2008 22:05:51

Matthew Heath in Birmingham, AL with Innovative Benefits Consulting at 08/29/2008 12:39:41

The pre existing issue would not be a issue if our health insurance wasnt tied to the Job.  Now this is a big problem.  75% of medical bancruptcies happen to people who had HAD health insurance with their employer.  The second you become to sick or injured in an accident and can no longer return to work you lose your health insurance.  According to the Department of Labor 4 out of 10 working Americans change jobs every year.  Meaning that they lose their health insurance.  Surprise surprise, 40% of the uninsured are uninsured for less than 4 months.  To me that is a function of having to wait 90 days to enroll in the next employer plan.  If people owned their health insurance in the first place they wouldnt have to change plans everytime they changed Jobs.  Pre x wouldnt be a problem because they wouldnt be changing jobs because of job lose of change.  You may be right about the UCR being local as opposed to national.  I do believe it is more complicated than that.  I am not positive about it.  Just for everyones info I design portable health plans for companies.  Called a Defined Contribution Health Plan.  The employer gives the EE a fixed monthly allowance and the EE chooses to keep the group plan or purchase their own individual plan.  If they want their own plan and can not get one because of conditions we get them on the state AHIP plan, which is a guaranteed indovidual plan with no Pre x.  AHIP has a great proposal for a Guaranteed Access Plan for those that would like to purchase their on portable plan but can not because of health.  Remember, pre x wouldnt be the problem it is today if health insurance wasnt tied to the job.  Most people that I deal with are healthy enough to where they can get their own plan with no Pre x.  Some may be rated up a little because of conditions but they are still paying less than the group plan.  If they have an HSA, which is 90% of what I do, they can use the HSA to cover things as well. 

Sorry I didnt spell check

bart ingles at 08/29/2008 12:06:27

As usual I find myself stuck squarely in the middle in this debate. I don't favor federal mandates for guaranteed issue or community rating, but I do favor a federal tax credit with restrictions roughtly mirroring the pooling function provided by the present employer exemption.

In other words rather than guaranteed issue, there should be guaranteed renewal and portability between insurers for anyone who has maintained continuous coverage.  Rather than community rating, keep form of group rating already used in group plans, which allow for risk segmentation by age and geography but not by health status.

Individual policies that don't meet these requirements should still be available, but should not qualify for the tax exemption.

The feds would still need to come up with a set of rules to define what constitutes a qualified risk pool, but the actual insurance regulations already exist as HIPAA Title I. The tax credit provides the motivation, so there should be no need for federal mandates.  The feds would still need to finance the tax credit, but this would still cost less than other proposals.

If a qualified tax credit were adopted at the federal level, states would have less incentive to impose their own mandates.

clickbroker.blogspot.com at 08/28/2008 16:03:01

Does a National Health Insurance Market promote Consumer Choice?

Many commentators have tried to convince the public that a national market for private individual health insurance would bring greater choice and lower premiums.  Shop across state lines, avoid unneeded mandates, and find that utopian plan that exactly meets your needs and budget.  And most important, don’t pay for what you don’t need.  Sounds great!

In "National Market is Not the Savior of State Regulated Private Health Insurance", I wrote that the national market lobby does not want unified federal health insurance regulation.  Their pro-choice agenda involves maintaining 51 different sets of regulations for the 50 states and Washington DC.  In their utopian market; any person in any state can select a policy conforming to the regulations in any other state or Washington DC.

The proponents are somewhat deceiving in presenting their case as consumer choice.  The reality is they are selling insurance company choice rather than consumer choice.  The insurers would follow the precedent set by the credit card industry.  The behavioral model would be for the insurance companies to adopt the regulations from the state most advantageous to them.  The shopping is actually done by the insurers rather than consumers.

Consumers can only shop for policies offered by insurance companies that have established infrastructures in their metropolitan area.  Insurers cannot do business without networks of doctors, hospital and labs.  So a Los Angeles resident could not buy a policy from a company only currently doing business in New York City, no matter how much he likes New York’s regulations.

With most of the independent Blues converted into for-profit enterprises and merged into WellPoint (WLP), consumers are left with only a few national companies selling individual policies.  Let’s imagine how these large private health insurers would behave in a national market.  They would target one or two states that would be willing to adopt their platform as regulation, just like the credit card companies.  Then the insurers would apply their favored business model to all the states where they operate.  Opponents call this a race to the bottom.

Once consumers understand that a national market brings no more choice and less protection, they will surely reject this concept.  Unless I can force private insurance companies doing business in my state to adopt New Jersey’s guaranteed issue regulation, what’s in it for me?

http://clickbroker.blogspot.com

Click Broker at 08/27/2008 17:39:18

The Wall Street Journal “Ranks of Uninsured Fell in '07, Census Says” reports that the number of Americans without health insurance dropped to 45.7M in 2007 from 47M in 2006 due to an increase in government insured of 2.7M.  Medicaid increased by 1.3M, Medicare by 1M and military healthcare programs by 400K.  Americans enrolled in private health insurance policies decreased to 67.5% in 2007 from 67.9% in 2006.

 Grace-Marie Turner’s Wall Street Journal editorial “We Need a National Market for Health Insurance” continues the theme. “The slide toward a government-dominated, taxpayer-supported health sector will continue unless the 45.7 million Americans who don't have insurance now are given more opportunities to buy private coverage.” Turner goes through the standard litany of reasons why healthcare is unaffordable:  state mandates, community rating, and guaranteed issue.  She seals her argument by saying health insurance is three times more expensive in New York than Iowa.  True, New York is a guaranteed issue state, but she neglects to also say that the cost of living is much higher for all goods and services in New York than Iowa. Now let’s look at a fairer comparison.  My limited research shows that Blue Cross premiums were not much different in New Jersey (a guaranteed issue, community rated state) than Florida (a medically underwritten state). Younger people paid a little more in New Jersey and middle age people paid the same or less.  But everyone in New Jersey could sleep knowing they would never be turned down for health insurance.

Turner says state mandates increase the cost of premiums by 20% to 50%.  I find that difficult to believe.  The 80/20 rule would say that premiums are based on the number of high cost medical usage policy holders.  Wouldn’t a reduction in the use of high cost drugs and high cost “latest technology” medical devices and imaging equipment have a greater impact on reducing costs?  Introducing cost-benefit hurdles to American healthcare would do more to reduce premiums than eliminating state mandates.

Turner argues that only a national market for health insurance would create affordable premiums.  Buying insurance based on another state’s regulation would allow Americans to avoid their state’s mandates and save money.  Notice Turner is not calling for federally regulated national standards for health insurance.  She simply says shop the hodge-podge of 50 states’ regulations and find the cheapest premiums.  Will people even know what their buying?

A model for Turners approach currently exists and it’s a failure.  National organizations can offer plans to their members in Florida that do not meet Florida’s regulations.  They must disclose this to applicants.  AARP offers United Healthcare (UNH) policies based on Washington DC regulations to Florida residents 50 and up.  These plans do not guarantee renewability, a requirement of most states.  What we have is less protection for no reduction in premiums.

In order for national market folks to have credence, they must normalize the cost of living differences in premiums between states.  This is the only way to isolate the true cost of mandates.

Turner claims that guaranteed issue will incentivize people to game the system – only buy insurance after they are sick.  Doesn’t this sound like the argument that it’s OK to hurt yourself as long as you prevent the other guy from getting away with it?  Clearly cheating can be prevented by limiting allowable gaps between coverage after guaranteed issue becomes a federal regulation.  This is not the same thing as mandates; it is simply requiring a minimum amount of previous coverage for the opportunity to avoid medical underwriting.  In a free market system non-cheaters need the right to shop unencumbered for health insurance and change policies at will.

 I would support Turner if she was calling for eliminating state regulation of health insurance and for implementing federal regulation, with consumer protections.  To be completely fair, Turner should disclose if she gets her health insurance “guaranteed issue” from her employer, and if she has ever experienced medical underwriting.

klaus illian, CLU at 08/27/2008 14:47:06

I guess my 17 years in the insurance business means I know a bit on the subject also.  Several agents I know will no longer have anything to do with selling health insurance.  The compensation is good but it just isn't worth the aggravation of having to explain rate increases, denied claims and waivers for pre-existing conditions.  Market-driven plans: ha!  That's code language for buyer beware.   Clients don't/can't read the fine print on contracts; clients buy health insurance based on what they can afford and the kind of coverage they think they need, but there is no guarantee that they can afford the coverage in the future nor that coverage is adequate to their health care needs in the future.

Regarding UCR charges: my understanding is these are local and not national.  Low-cost rural areas will have lower reimbursement than high-cost regions like New York City.