Category: Mandating Insurance

Geisinger Health Plan enrolls more than 20,000 through Obamacare – themorningcall.com

 

Geisinger Health Plan, a health insurance company serving Lehigh, Northampton and 39 other Pennsylvania counties, added more than 20,000 members during the first open-enrollment period under the federal Affordable Care Act, the company announced Monday.

"We are extremely happy with the number of individuals who selected Geisinger Health Plan for their health insurance coverage," says David Brady, vice president of health care reform and commercial business development. "We felt it was important to offer individuals who were shopping on the marketplace a choice of coverage options that focused on quality and customer service. Based on our results, Pennsylvanians agreed."

Geisinger Health Plan offered 26 plans on the federal marketplace and GeisingerMarketplace.com, its private site, the company said in a statement.

Geisinger Health Plan enrolls more than 20,000 through Obamacare – themorningcall.com

Market, insurers will keep premiums low, analysts say

Just how much premiums will change depends on the state you live in, Kingsdale said.
Individual premiums decreased when Massachusetts’ health care took effect, he said, because the state already had high-priced and insurers were not allowed to turn away the sick and could not charge large premium differences based on age, gender and health.
“Other states will see exactly the opposite happen,” he said. “Their premiums tend to be quite low, but they’re getting skimpy insurance.”
In Oregon, Ario said, large differences in premium prices have already appeared.
In one case, a 40-year-old non-smoker in Oregon could buy a low-cost or bronze-level plan for $162 a month from one company or the same plan from another for $400 a month, Ario said. Anti-trust laws prevented the insurers from comparing pricing before developing their premiums.
When the companies with the higher rates saw their competitors’ lower premiums, he said, they asked the state to allow them to file for reduced premiums.
“The good news is that in most marketplaces, there will be some carriers that will be bold and price competitively to get more market share,” Ario said.

Market, insurers will keep premiums low, analysts say

For a quick rundown on what the “gold, silver, and bronze” plans will cover, go here.

The ACP Advocate Blog by Bob Doherty: Irony

The ACP Advocate Blog by Bob Doherty: Irony

Good piece on the GOPs history of advocating for an individual mandate – until Democrats suported it:

In 1990, the conservative Heritage Foundation developed a plan for universal coverage that described the individual mandate as a “social contract” between the government and individuals:“Under this social contract, the federal government would agree to make it financially possible, through refund able tax benefits or in some cases by providing access to public-sector health programs, for every American family to purchase at least a basic package of, including catastrophic insurance. In return, government would require, by law every head of household to acquire at least a basic health plan for his or her family.”
The individual mandate was then incorporated into bills proposed by GOP stalwarts Orrin Hatch (R-UT) and Chuck Grassley (R-IO) as an alternative to “Hillary Care.” It later became a lynchpin of the Massachusetts health reform plan championed by then governor (and likely 2012 presidential candidate) Mitt Romney (R-MA).
That was then, this is now.
The Heritage Foundation now argues that the individual mandate is “unprecedented” and “unconstitutional”- conveniently ignoring its own past ownership of the idea. A few days ago, Senator Hatch hailed the Virginia judge’s decision to overturn the individual mandate as “a great day for liberty. Congress must obey the Constitution rather than make it up as we go along. Liberty limits on government, and today those limits have been upheld.”

O’Neill Institute » Legal Solutions in Health Reform » The Constitutionality of Mandates to Purchase Health Insurance

O’Neill Institute » Legal Solutions in Health Reform » The Constitutionality of Mandates to Purchase Health Insurance

Paper Summary
Health insurance mandates have been a component of many recent health care reform proposals. Because a federal requirement that individuals transfer money to a private party is unprecedented, a number of legal issues must be examined.
This paper analyzes whether Congress can legislate a health insurance mandate and the potential legal challenges that might arise, given such a mandate. The analysis of legal challenges to health insurance mandates applies to federal individual mandates, but can also apply to a federal mandate requiring employers to purchase health insurance for their employees. There are no Constitutional barriers for Congress to legislate a health insurance mandate as long as the mandate is properly designed and executed, as discussed below.
This paper also considers the likelihood of any change in the current judicial approach to these legal questions.
Download the Executive Summary (2pp.)
Download the Paper (25pp.)

About the Author
Mark A. Hall, J.D., is the Fred D. and Elizabeth L. Turnage Professor of Law and Public Health at Wake Forest University School of Law and School of Medicine. He is also an Associate in Management at the Babcock School of Management, all of which are located in Winston-Salem, NC.

And, courtesy of Scott R. of DFA,

“Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.” – Mitt Romney, 2006

Hawaii’s Lessons – NY times

In Hawaii’s Health System, Lessons for Lawmakers

Since 1974, Hawaii has required all employers to provide relatively generous health care benefits to any employee who works 20 hours a week or more. If health care legislation passes in Congress, the rest of the country may barely catch up.

Lawmakers working on a national health care fix have much to learn from the past 35 years in Hawaii, President Obama’s native state.

Among the most important lessons is that even small steps to change the system can have lasting effects on health. Another is that, once benefits are entrenched, taking them away becomes almost impossible. There have not been any serious efforts in Hawaii to repeal the law, although cheating by employers may be on the rise.

But perhaps the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 — the second-highest in the nation.

Despite this, Hawaii’s health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation’s lowest. Hawaii residents live longer than people in the rest of the country, recent surveys have shown, and the state’s health care system may be one reason. In one example, Hawaii has the nation’s highest incidence of breast cancer but the lowest death rate from the disease.

Bottom line? Employer mandate ensures near universal health care. Duh.

Congressional Republican’s Healthcare Reform Questionnaire

I live in the Pittsburgh are, specifically in Republican Congressman Tim Murphys’s district.

Today we received an “Important Survey on Pending Healthcare Legislation” from the Congressman. I was impressed by the straight forwardness of the questions (the subtle subtext was that you must be a complete moron to want our health care system to change) and by the clear headed, willful ignorance of the actual issues involved in reform displayed by the survey writers.

And awaaay we go…

Okay, in fairness, the first six questions weren’t bad: do you have insurance, what kind, how is it, is it getting more expensive, do you believe the system is broken, and what priority should it be for Congress.

7. Do you favor a healthcare system that is run by the private sector or the government? (Private, Govt, combination, unsure)

Let’s see, I want the highest quality system in the world with costs far lower than our current system. Looking around the world I see that France, a government administered single payer system is the best in the world, and Germany, with a government regulated social health insurance system administered by private, not for profit insurers is right behind it. Low cost, high quality, waiting times like ours are now… OK, I choose either Government Run like France or a Hybrid system like Germany’s.

8. Would you be willing to pay higher taxes to guarantee heath insurance for all Americans?

This is why I’m writing this diary, because this question always sets me off. I would be willing to pay higher taxes because, if we do this correctly (see question 7), I will no longer be paying insurance premiums. If we do it really well (see question 7), I will actually end up paying significantly less for my healthcare overall, because we will eventually squeeze out the tremendous waste, overhead, and obscene profit currently embedded in our system.
What really ticks me off about this is the blatant intellectual dishonesty (or it could be simply ignorance, I can be charitable) on display. It does not require a degree in economics to understand that we pay for health care in many ways, but primarily we pay for it through our compensation packages: our insurance premiums come out of our wages! Ask anyone who’s had stagnant wages over the past decade whether or not health care costs come out of their wages.
Have no republicans *ever* looked at a study on comparative international health care? Do they not know that we pay way more than any other country in the world. Per capita, as percentage of GDP, however you want to slice it: we have the most expensive system on the world and the Republicans seem to think the only fix is to add costs?

9. Do you think a private sector healthcare system can be improved to provide coverage to more Americans at a lower cost than a nationalized plan?

I have to confess my initial impulse was a *big NO*, but, thinking of Germany, Switzerland and the many other countries using a hybrid public-private system of Social Health insurance, I will answer a qualified yes.

If we follow the models provided for us around the world and regulate the private insurers (i.e., a 3 or 4 millimeter long leash), it can be done. The discipline that would be required for our Congress to resist the money that would surely be thrown around does make me despair that it is near impossible. But, it has been done the world over, so, I can dream, can’t I?

Germany, again, provides an interesting model because it uses private, but not for profit, insurers (sickness funds) to do the administration. Everywhere in the world but here, not for profit means not for profit and not for profits don’t accumulate billions in “reserve funds” or pay executives millions of dollars a year.

10. What is your main concern with your current health insurance coverage or plan? Not portable/tied to employer, lack of transparency, too many restrictions on providers/rationing, out of pocket expenses, or other.

Props where they are due for this question. I hope his Democratic constituents give him an earful on these! All of the above is the obvious answer for me, but I just have to take up the choice/rationing bit.

Republicans are always focused on choice of insurer or of insurance plans, as if where you go to the hospital or which doctor you go to is an afterthought. Like every major market in the country, Pittsburgh has essentially 2 insurers. We switched plans a couple years ago *within* one of those insurers and we went from having my wife’s skin cancer specialist on one plan to her breast specialist on the other. But at least I could choose my plan!

My prior manifesto on rationing is here.

11. Should the government require that every American have health insurance?

Germany requires everyone in the bottom 4/5ths income to participate in a sickness fund. The upper fifth can opt out: 3/4 don’t, leaving the wealthiest one fifth in the private market. I can live with that.

Single payer countries, you’re just in. Period.

Either works for me.

12. Should the government require that all health insurance companies provide a “Basic Plan” option…so that families could shop around?

Not the ultimate solution, but since something like this will probably find its way into the reform, here is my proposal. it comes from an old Adam Tobias book on the insurance industry called “The Invisible Bankers.”

I’d like a truth in insurance statement, like a truth in lending statement on a loan or, even better, an energy sticker on an appliance. I can imagine lots of information on this sticker, but the really interesting one would be the one I stole from Tobias: *”This policy, on average, will pay out xx cents on every premium dollar paid.”* I’ll leave you to cogitate on that.

13. Should the government create and manage a public health insurance plan that would compete for business alongside private insurance plans?

If you’ve read this far, you know my answer: Well, it’s better than nothing!. But, seriously, considering how un-progressive this legislation is going to ultimately be, we have to draw a line in the sand somewhere, and this should be where we draw it *at an absolute minimum.*

14. Should people on Medicaid have the option of purchasing private health insurance with a voucher to shop around for the best coverage, rather than have only the option of government insurance?

I happen to think Medicaid has lots of problems. Not the least is its very low reimbursement rates in many big states resulting in de facto rationing.

So I am against using Medicaid as the vehicle to expand coverage, but I know others feel differently.

15. Should the government offer tax credits to individuals to help offset the cost of health insurance?

I think the phrase “magic bullet” must have been invented just to cover the Republican love affair with tax cuts. Or that one about having only a hammer as a tool and every thing looking like a nail. One of those.

16. Should the government allow individuals to purchase health insurance from any state and shop nationally for the best price?

Don’t care, won’t help, but I can’t help but notice that on issues of privacy, national security and torture, republicans say “we,” but on social justice issues, it’s “the government.” Just sayin’.

17. Should the government mandate that private insurance companies cannot turn away patients with pre-existing conditions?

I’ll vote yes, but it provides a teaching opportunity. What happens in Germany or Switzerland, you may ask, if a particular insurer gets a disproportionate care of sicker patients who cost them more? Since they can’t charge higher premiums based on this and can’t drop people, what happens? Risk adjustments are made and the companies get adjusted funds from the government. This is being proposed here, as well.

And finally, just to remind the pipples why they hate government and really hate all this “social justice” nonsense that the Pope and Winston Churchill are so hopped up on:

18. Any government assistance will require taxpayer funds to cover the cost. Which of the following proposals would you support to pay for health care reforms, and for the government to cover the uninsured?(nat’l sales tax, higher payroll taxes, marriage penalty, cell phone taxes, sin tax on soda, sin tax on alcohol, tax on charitable donations,raise income taxes, penalize employers for not providing insurance, tax on insurance, tax on health care expense, tax on future health care needs (?), tax on Rx drugs, raise taxes on oil refineries, taxes on power companies, taxes on US companies doing business overseas, taxes on dividend income, raise capital gains taxes, inheritance tax – phrased “tax you family assets on death” LOL.

So, if you weren’t steamed before, I bet you are now. I refer you back to answer 7 for the inanity of this question, but in the best Republican tradition of ginning up resentment among the citizenry, I give you, “the list.”

Cheers,

Support Growing for Major Changes to Health-Care System

Support Growing for Major Changes to Health-Care System:

Most notably, the group, known as the Health Reform Dialogue, calls for creating an ‘individual mandate’ that would require every American to have some type of health coverage. Anyone who cannot afford insurance would be eligible for subsidies or expanded government programs such as Medicaid.

‘We should seek to ensure coverage for all,’ the group concluded after six months of private, professionally facilitated negotiations.

The results are noteworthy because it is the first time that such a varied mix of special interests — ‘strange bedfellows,’ in the words of one participant — have coalesced around significant changes to the U.S. health system. The signers include the American Medical Association, the National Federation of Independent Business, two hospital groups, AARP and the liberal
consumer advocacy group Families USA.

‘We’re narrowing the range of disagreement,’ said Karen Davis, president of the Commonwealth Fund, a nonprofit private health-care foundation that was not involved in the effort. It is striking, she observed, that the Health Reform Dialogue and influential lawmakers have all but ruled out the prospect of a European-style single-payer system, opting instead to build on the existing employer-based insurance arrangements.

Equally striking, however, were the fundamental questions left unaddressed by the group of health-care heavyweights.

‘A day late and a dollar short,’ said one participant who spoke on the condition of anonymity so as not to jeopardize continuing participation.

The coalition’s report is silent on whether employers have a responsibility to contribute to the cost of care, and it does not address the idea of creating a government-sponsored insurance program that would be available for anyone having difficulty buying coverage.”

….

“A government-controlled plan available to every American will push 160 million Americans now in private plans into a one-size-fits-all bureaucratic plan,” said Nick Simpson, spokesman for Rep. Roy Blunt (R-Mo.).

I love that last bit by Rep. Blunt. If by push, he means that by being cheaper, more efficient and consumer friendly, public plans would be able to out compete the very inefficient private insurers, then yeah, they’ll be “pushed.”

A Public Health Insurance Plan | OurFuture.org

A Public Health Insurance Plan OurFuture.org:

As the ball rolls along in our debate, one thing that keeps coming up is the idea that everyone must have insurance. Being forced to buy insurance from a private insurer ($15K a year at our house – from a “not-for-profit” !) is obviously not an option for most, especially considering the median family income is only about $60K. Medicare spends anywhere from $6K to $14K per enrollee (65 and over, mind you). So can a public option be the solution?

Here are the key findings of the report, but you can click the link above to get the full report, an executive summary and a PowerPoint show.

The report contains these findings:
• Medicare has controlled health care costs much better than have private health insurers over the last 25 years.
• The private insurance market is highly consolidated and needs competition from a public health insurance plan to lower skyrocketing premiums.
• Administrative costs are dramatically lower under public health insurance plans,
resulting in enormous savings to the system.
• The bargaining power of public health insurance plans significantly reduces provider costs.
• In a head-to-head competition, the public Medicare plan is much better at containing costs than private Medicare Advantage plans.
• Independent analyses show substantial savings can be achieved from a public health insurance plan that competes with private insurance plans.
• Quality and effectiveness innovations occurring under the public Medicare plan show that public health insurance plans have greater potential to drive the quality revolution than do private plans.
• Public health insurance plans increase choice, competition and accountability.

EzraKlein Archive | OBAMA’S HEALTH CARE PLAN EXPECTS AN INDIVIDUAL MANDATE.

EzraKlein Archive The American Prospect:

“Administration officials have been very clear on what the inclusion of ‘universality’ is meant to communicate to Congress. As one senior member of the health team said to me, ‘[The plan] will cover everybody. And I don’t see how you cover everybody without an individual mandate.’ That language almost precisely echoes what Senate Finance Chairman Max Baucus said in an interview last summer. ‘I don’t see how you can get meaningful universal coverage without a mandate,’ he told me. Last fall, he included an individual mandate in the first draft of his health care plan.

“The administration’s strategy brings them into alignment with senators like Max Baucus. Though they’re not proposing an individual mandate in the budget, they are asking Congress to fulfill an objective that they expect will result in Congress proposing an individual mandate. And despite the controversy over the individual mandate in the campaign, they will support it. That, after all, is how you cover everybody.”

While I favor a single payer system as the best solution, it doesn’t take a rocket scientist (or Ezra Klein) to see where the winds are blowing.

I have become comfortable with this approach. Although mandates have not worked out as well as we’d like in Massachusetts, it is hard to argue that they have not worked in Switzerland, Germany, Japan and other countries. I would argue that the chief differences are two:
1.) Spending enough money to actually give everyone a comprehensive benefits package (think Medicare, not Medicaid)
2.) Serious regulation of private insurers so that they cannot cherry-pick, deny, drop, obfuscate, etc

If we spend enough money in some private-public mix and if we regulate the insurers so they function more like the contractors who cut the checks for Medicare (the regional “carriers”) and we subsidize those who cannot afford health care or insurance, we may not have single payer, but we will at least have a truly universal, fair, system.

AND THEN, if we still think we need to, we can work on transitioning to a true single payer system.

OK, let me have it.

Cheers,

AMNews: June 2, 2008. Individual health insurance: Are mandates ready for prime time? … American Medical News

AMNews: June 2, 2008. Individual health insurance: Are mandates ready for prime time? … American Medical News:

“Last fall, Laura Allen didn’t think Massachusetts’ law requiring everyone to have health insurance would affect her life. She had a customer service job at a rubber stamp company that provided coverage.

But then the 42-year-old Easton, Mass., resident was told she would be laid off before the end of the year. And the new state law imposed a $200 tax penalty on anyone uninsured on Dec. 31, 2007.”

An overview of mandated insurance coverage from Massachusetts to California to the Federal proposal.

But scrolll way down for the public opinion table showing 68% support for mandated insurance:

“The majority of Americans favor the concept of requiring everyone to have health insurance, with government help for those who can’t afford it, according to a June-October 2007 poll of 3,500 adults.
Strongly favor 40%
Somewhat favor 28%
Somewhat oppose 12%
Strongly oppose 13%
Don’t know/refused to answer 7%

Source: Commonwealth Fund Biennial Health Insurance Survey”