Category: Health Insurance

Why Would Health Insurers Learn From Life or Auto Insurers?

Businessman Sitting at His DeskDori Zweig at FierceHealthPayer has written a good article with examples of how life and auto insurers provide excellent customer service, and encouraging health insurers to do the same. It would be a great idea and there are no shortage of consultants providing advice on health insurers to do exactly that. There are entire conferences dedicated to the topic.

Unfortunately, there are significant differences between health, life, and auto insurance that mitigate health plans’ interest in replicating the excellent service we’ve seen from other types of insurer:

Who’s To Blame For Doctors’ Cash Flow Crisis?

Doctors never cease from complaining about insurers’ bureaucracy. It’s one reason why they cannot stand the repeated Medicare “doc fixes” that have occurred at least once a year for over a decade: When Congress does not increase the physician fee schedule before the previous fix runs out, they fear that Medicare contractors will slow roll their claims, creating a big cash flow problem.

(That’s one reason why the lobbyists supporting today’s fiscally irresponsible “doc fix” waited until March 19 to let us know it was coming to the House of Representatives. Last year’s fix expired on March 31. Delaying until the last minute means the lobbyists can more easily drive politicians into a panicked herd and head them off a fiscal cliff.)

The cash flows can be observed by patients, who receive physicians’ invoices and insurers’ Explanation of Benefits (EOBs). One reader went to the doctor on July 31, 2014. As shown in the graphic below, the health plan processed the claim on August 25 and mailed it to the beneficiary on August 29.

“Next Frontier” – Health Plans Covering Yoga?

When a leading benefits consultant writes an article in the Harvard Business Review recommending that health plans should cover yoga, it should be glaringly apparent that we have perverse incentives in U.S. health benefits:

Cigna insurance CEO David Cordani says the Centers for Medicaid and Medicare Services’ recent payment changes that emphasize quality over quantity in healthcare will shift the focus on “sick care to more well care.” But a widespread embrace of diet, fitness and other wellness programs is still a way off……”

Insurers should cover “new wellness- and prevention-oriented treatments such as yoga and meditation, Sukanya Soderland, a partner in consulting firm Oliver Wyman’s health practice, wrote recently in the Harvard Business Review. (Jayne O’Donnell & Laura Ungar USA Today)

The Kline-Ryan-Upton Republican Off-Ramp from Obamacare

Tomorrow is the day the Supreme Court hears oral arguments in King vs. Burwell, and all the talk is about what Congress will do if the Supreme Court directs the Administration to obey the law by not paying subsidies in the majority of states, which have declined to establish their own Obamacare exchanges and defaulted to the federal one.

The Wall Street Journal ran an op-ed (available by subscription) by John Kline, Paul Ryan, and Fred Upton, who chair committees of jurisdiction in the House of Representatives that will be tasked with proposing a Congressional response to this decision. Here’s what they write:

Let people buy insurance across state lines. Stop frivolous lawsuits by enacting medical-liability reform. Let small businesses band together so they get a fair deal from insurance companies.

When Will Obamacare Enrollment Close?

When I last wrote about Obamacare’s open enrollment (on January 23), I promised readers that I would not write about it again until open season had wrapped up.

I thought we’d be there by now. After all, it was supposed to close on February 15.

No such luck. First, because of glitches in the website and other hassles, the federal government and some states extended open season by one week.

Now, the Administration has been caught by surprise by April 15, tax day. The problem seems to be that six million Americans will be required to pay the (unconstitutional) fine for not having bought Obamacare insurance in 2014. Unfortunately, 40 percent of adults are unaware of the penalty.

Are Employers Who Dump Workers Onto Medicaid Corporate Welfare Queens?

There have been a lot of predictions about the future of employer-based health benefits under Obamacare. Reports suggest that increasing numbers of small businesses are dropping health benefits and sending their employees to Obamacare’s insurance exchanges, where they are partially subsidized.

Other businesses have found a bigger cost-shifting approach. BeneStream, a new benefits advisor, advises employers how to make their workers dependent on Medicaid, a welfare program fully funded by taxpayers. And businesses are taking advantage of its advice.

So: Are these employers corporate welfare queens?

Gallup’s Easily Misunderstood Health Insurance Survey is Out

For many months, I have struggled with the Gallup-Healthways survey of health insurance, which I criticized in a previous entry. Of all the surveys of health insurance it is the least informative, and I wish the Gallup folks would give their results better context. Unfortunately, because it is the timeliest, the media get excited about it, especially since Obamacare started.

The latest survey, which covers the 4th quarter of 2014, reported that the “uninsured rake sinks to 12.9 percent”. Just look at the graph: What a nosedive in the number of uninsured Americans! Well, not so fast.

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Obamacare’s Effect on Uninsured is Trivial

At the end of 2014, Jason Furman and Matt Fiedler of President Obama’s Council of Economic Advisers published an analysis of the uninsured in the first half of 2014. The two economists boasted that “2014 has seen largest coverage gains in four decades, putting the uninsured rate at or near historic lows.”

Their own graph shows how exaggerated and misleading this claim is.

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CROmnibus and Cronyism for Blue Health Plans?

Despite the end of Obamacare’s “bailout” for health insurers, some of our friends who seek to repeal and replace Obamacare insist on finding a crony capitalist under every bed and in every closet.

Yuval Levin, at National Review Online, appears to have been the first to identify an adjustment to an insurance regulation, buried in the CROmnibus, as “cronysism” for non-profit Blue Cross and Blue Shield health plans. This has been picked up by Louise Radnofsky at the Wall Street Journal and Timothy P. Carney at the Washington Examiner.

Mr. Carney notes that there is “no clear right or wrong in this matter,” but criticizes the adjustment for “providing Obamacare relief for exactly one corporation.” However, the relief does not apply to “exactly one corporation.” It applies to all Blue Cross and Blue Shield plans.

Consumer-Driven Plans Continue to Grow

Consumer-driven health plans seized five more points of market share in the employer-based benefits market, according to Mercer’s latest report:

  • Mercer survey finds average total health benefit cost per employee rose 3.9% in 2014;
  • Enrollment in high-deductible, consumer-directed health plans (CDHPs) jumps from 18% to 23% of all covered employees following a surge of new implementations;
  • Nearly half of large employers (48%) now offer a CDHP, up from 39%;
  • Private exchanges used by 3% of large employers, with 28% likely to make the shift within five years.

Figure 4 shows that consumer-driven plans are poised to continue their growth. The growth of private exchanges is also good news.

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