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My News 

Businessweek.com 

Reported a positive view of the Accountable Care Organization (ACO) The ACO is one of the main programs to reduce health care cost in the new health care law. This is really the 1^st publication that states this type of approach to health care can be successful.  The Gov. is developing this platform for Medicare but there seems to be a huge investment by the health insurance industry in this model. The health insurance industry is suggesting this could save 40%.

If this approach works for Medicare then we will see it in the private insurance markets. This could have a huge impact on Indiana health insurance.

The Indiana insurance Commissioner is asking for a waiver of Patient Protection and Affordable Care Act’s (ACA) 80 percent minimum medical loss ratio (MLR).

The commissioner states that 10% of the health insurance companies have left Indiana. If the waiver is granted that would encourage companies to stay in the individual health market. The commission is only asking the wavier on Consumer driven health plans.

There is a real problem in Indiana’s health insurance market with a lack of competition. There is serious concern that we could lose another large individual carrier.

Aetna recently left the individual market here in Indiana. The risk of loss was not worth the reward. What average people don’t see is that the individual market is not that profitable for the carriers. So now we have new laws on the medical loss ratio that could create even more risk for the carriers to offset individual loses.

I do believe the Commission is acting in the best interest of Hoosiers.

Chairman Max Baucus is not happy about the Mickinsey study that state 30% of employers will drop their group health plans after 2014. Chairman Baucus has order a full disclosure on the methodology of the study.

It will be interesting to see what methodology was used.

Being a health insurance broker with extensive experience in the small group market I think 30% is low. Groups under 100 lives I think we could see 50% of groups drop traditional employer sponsored health plans. This is not to say they will not replace them with some other approach to health care under the health care reform.  If employers can establish other qualified health plans through the exchange or guaranteed issued individual policies they will.

At this point I am not sure how large groups are going to be able to drop group health plans.  These plans are about attracting talented employees and retaining them. 

As Chairman Baucus reviews the methodology of the Mickinsey study he should also review the methodology of how the health care reform law was developed.

Nefouse News

From a coverage standpoint, all health insurance plans have to cover vaccinations at no cost to the insured.  So should your child need $600 worth of immunizations it will cost you nothing.  This was one of the few good things to come out of the health care reform laws.

There is some debate about people being on non grandfathered plan and not eligible for this benefit. Most carriers are not offering non grandfathered plans. The best way to see if you have wellness coverage is to call the number on the back of your insurance card and ask.

In the article there was a doctor quoted about the cost to the insured for these immunizations. This Doctor is not update on the current health insurance coverage. There are also state officials that are not up to date on mandated health insurance coverage.

If you are a parent it is your responsible to know your insurance coverage.  You cannot count on doctors, elected officials or gov. employees,  to be looking out for you.

The reality of these organizations is now becoming known through pilot programs that have been established. POLITICO

On May 12, 10 medical groups participating in a Medicare pilot program that paved the way for the ACO program declared that none would participate if the rule were not substantially modified. This is a huge blow to the ACO model. The providers that have participated in these programs have declared the risk of financial loss is to high.

This is very bad for health care reform because this program was the only staple of trying to control health care costs.

Indiana has been awarded $6.8 Million from the Federal Government to Implement the key provision of the Affordable Health Care Act- Health Insurance Exchange.

Indiana had received a $1 million grant to look into setting up a state based exchange. So the $6.8 million must be an indicator that the DOI is going to move forward with a state based exchange. 

HHS Factsheet

The Employee Benefits Security Administration (EBSA), U.S. Department of Health and Human Services (HHS), the U.S. Treasury Department,   Treasury Department agencies and the Labor Department have postpone the claims appeal process of the health care reform. They are stating they are having problems form a technical standpoint.  If you look at all of these agencies that are involved there is no wonder why they are having problems with this aspect of the new law.

The appeal process in a nut shell is the ability for an insured to appeal a claim that was declined in person with some type of board.  So an good example of this would be on experimental therapy. The insurance company could decline the claim because its considered experimental. With the new health care law anyone could appeal a denied claim and the law is suppose to set up the process for that appeal to happen.   

Grandfather plans are exempt from the appeal process.

It looks like the House Republicans are working on a serious game plan to defund the health care reform laws. The one that I think would have the biggest impact on the law would be the grants for the state based exchanges. If the defunding occurred, it would make it difficult for the states to set up exchanges.  The exchanges are the essential aspect of the new law and how many people are going to buy their health insurance policy.





A state’s waiver proposal must show that it is capable of providing coverage that is at least as comprehensive and affordable as that offered through new state-run health insurance exchanges, which also open in 2014. The state must also provide coverage to as many residents as the exchanges would have, and the proposal must not increase the federal deficit.
opt-out

The states and federal gov. might have a really difficult time make plans affordable with out subsidies. The law has done nothing to really address the cost of care and I think that is where the real problems starts.

When I wrote this yesterday I thought we might hear some positive things about the Revision. Well I was wrong. A Lack Of Flexibility  It looks like the Governors have determined that without flexibility in the law there is no way for the meet the unrealistic expectation of the reform. The federal Gov. might have some problems living up to their own expectations.

PPACA spawns a new form of wage discrimination I had to re post this blog posting because it show some unintended consequences of the reform.

Under the new law if a group over 50 lives has a group health insurance plan in place it is illegal for the employee to pay more than 8% of their house hold income towards health insurance premium. Sounds great right? Wrong!

So the if the avg health insurance premium is $20,000 in 2014 and there are two employees. One employee has a house hold income including benefits of $100,000 and the other one has a total of $30,000. The $100,000 employee will by law pay no more than $8,000 a year for health benefits and the employer picks up the additional $12,000. The other employee  making $30,000 total house hold income will only pay $2,400 leaving $17,600 on the employer.   

If the employer decided to keep a health plan why would they hire lower wage workers?  Why would an employer want to be over 50 employee and face these kind of consequences?

There will be no mid size group health plans with these consequences.