Tag: "health insurance"

Maybe The Government Should Just Not Ask People If They Are Uninsured?

Sir John Cowperthwaite was the Financial Secretary of the British Colony of Hong Kong when it began to boom in the 1960s:

Asked what is the key thing poor countries should do, Cowperthwaite once remarked: “They should abolish the Office of National Statistics.” In Hong Kong, he refused to collect all but the most superficial statistics, believing that statistics were dangerous: they would led the state to to fiddle about remedying perceived ills, simultaneously hindering the ability of the market economy to work. This caused consternation in Whitehall: a delegation of civil servants were sent to Hong Kong to find out why employment statistics were not being collected; Cowperthwaite literally sent them home on the next plane back. (Alex Singleton, The Guardian)

What does this have to do with health insurance? The Wall Street Journal’s Jo Craven McGinty reports on the Census Bureau’s rejigging of its measurement of how many Americans are without health insurance:

New Ventures Make Obamacare Exchanges Less Relevant Than Ever

One theme of this blog is that Obamacare exchanges make as little sense for health insurance as a DMV-operated exchange for car insurance, or a HUD-operated exchange for homeowner’s insurance. Just shut them down.

We’re not the only ones who noticed:

Looking to provide health insurance to the 53 million Americans who don’t get benefits from their employers, Stride Health has raised $13 million in new funding.

Venrock led the Series A round, with participation from Fidelity Biosciences and previous investor NEA, which brings Stride’s total venture funding to $17.5 million.

For the freelancers and independent contractors who make up one third of the U.S. labor force, Stride offers a hassle-free alternative to Healthcare.gov.

After you enter your own data, including age, gender, location, and illness history, Stride’s forecasting model evaluates how much care you’ll use throughout the year, prices it on every health plan, and couples it with the coverage price to show you the total cost of each plan. (Christine Magee, TechCrunch)

Private investors are putting their own capital at risk to launch a business to compete against a government monopoly. That shows how useless Obamacare’s exchanges are.

Price’s Empowering Patients First Act Gets Better with Age

220px-Tom_Price(A similar version of this Health Alert was published by Forbes.)

You’ve got to give credit to Congressman Tom Price, MD: He introduced his first post-Obamacare bill as early as 2009 and has reintroduced an updated version in every Congress since then. The latest Empowering Patients First Act (H.R. 2300), introduced this month, is the fourth iteration.

Many critics complain Republicans in Congress have taken too long to develop an alternative to Obamacare. However, President Obama is running the show until January 2017. It is responsible for Congressional Republicans to take all the time and space they need to develop their alternative for the next president’s consideration.

A fully baked repeal and replacement bill today would serve no purpose, while doing nothing until a president committed to patient-centered health reform takes office risks a confused mess of lobbyists’ priorities thrown together by politicians who barely know what they are doing – a Republican Obamacare, in other words.

The most important improvement is a universal tax credit, adjusted by age, to every American who chooses to buy individual health insurance: $1,200 for those aged 18 to 35, $2,100 for those between 35 and 50, $3,000 for those over 50 and $900 per child. Dr. Price’s previous bill had tax credits, which were not adjusted by age, but by income. Of course, Obamacare’s tax credits phase out by income, which causes very high effective marginal income tax rates at certain income thresholds.

Obamacare Premiums Explode

The Wall Street Journal has reviewed health plans’ rate filings for 2016 in Obamacare exchanges:

In New Mexico, market leader Health Care Service Corp. is asking for an average jump of 51.6% in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3% increase. In Maryland, market leader CareFirst BlueCross BlueShield wants to raise rates 30.4% across its products. Moda Health, the largest insurer on the Oregon health exchange, seeks an average boost of around 25%.

All of them cite high medical costs incurred by people newly enrolled under the Affordable Care Act. (Louise Radnofsky, “Health Insurers Seek Healthy Rate Boosts,” May 21, 2015)

Families USA: One Third of Low-Income Obamacare Beneficiaries Cannot Afford Care

One of Obamacare’s biggest cheerleaders, Families USA, has published new research showing that one third of low-income Obamacare beneficiaries have not obtained medical care due to cost in 2014:

Lower- to middle-income adults who were insured for the full year were significantly more likely than those with higher incomes to forgo needed care because they could not afford it: Nearly one-third (32.3 percent) of lower- to middle-income adults didn’t get needed medical care (excluding dental care) because they could not afford it. (p. 14)

But don’t you worry, Families USA has not thrown in the towel on Obamacare yet:

Since its passage in 2010, the Affordable Care Act (ACA) has made tremendous progress in improving access to health insurance and health care for millions of Americans. Approximately 14.1 million previously uninsured Americans gained health insurance between the beginning of open enrollment in October 2013 and March 4, 2015.

Well, not actually: Most of the Obamacare “insured” have actually fallen into welfare dependency (Medicaid), and the increase in privately insured is questionable.

Families USA recommends that even more taxpayer-funded healthcare dollars be channeled through health insurers. Investors in health insurers must love these policy prescriptions from progressive advocacy groups.

Did a Health Insurer Pay Ten Times the Cash Price for Surgery?

A story from Arizona is a cloud with a silver lining:

Teresa Anderson was pleasantly surprised how quick and hassle-free her eyelid-lift surgery was at Havasu Regional Medical Center’s outpatient-surgery facility in April 2014.

Weeks later, the bills arrived at her Lake Havasu City home. Her surgeon, anesthesiologist and X-ray provider submitted bills and were paid nearly $2,250.

Only one remained: Havasu Regional’s bill. When it finally arrived last May, what she saw shocked her. An explanation of benefits from her insurer, Blue Cross Blue Shield of Minnesota, showed she and Blue Cross had been billed $38,526 by Havasu Regional for prep work, surgery and recovery lasting less than three hours.

Anderson, who worked for a health-insurance company before her retirement, believes hospital charges like hers explain why the economics of health care are askew. And she isn’t alone. Consumer advocates say such experiences point to the need for more transparency in the pricing of medical procedures.

Before the surgery, Anderson had asked her surgeon’s staff to estimate all costs associated with the surgery. She was considering paying on her own if her insurer denied coverage. The surgeon’s staff quoted a price of $3,500 for the surgery, anesthesia and facility fee if she paid on her own without insurance.

Successful Health IT Deals Are Obamacare Agnostic

(A version of this Health Alert was published by Forbes.)

Obamacare has definitely benefitted the health sector. My Forbes colleague Zina Moukheiber makes the case the Affordable Care Act (Obamacare) and the HITECH Act of 2009 (which channeled 30 billion taxpayer dollars into Electronic Health Records) deserve the credit (or blame) for the explosion of health information technology investments. That is undoubtedly true for traditional Electronic Health Record (EHR) providers like Cerner or Epic, which were boosted by the HITECH Act. In addition, the recently signed Medicare “doc fix” will likely ensure they continue raking in money for a while, because the law increases the EHR burden on physicians.

However, other successful new health IT ventures have prospects quite independent of Obamacare’s risky future. Rather, they appear robust in the face of a wide range of possible futures for U.S. health reform. Because health care is so dependent on government, it is not surprising that adoption of effective IT in health care has lagged behind other sectors, where suppliers have to rely on customers — not government — for revenue. Nevertheless, even a sector so politically protected from disruption as U.S. health care must eventually give way to change. Three examples show this change can come from different directions, despite Obamacare’s straightjacket.

Have Employer-Based Health Benefits Dropped?

Just the other day, my analysis of the RAND Corporation’s survey of health insurance from September 2013 through February 2015 led me to conclude that “economic growth improved coverage more than Obamacare did.”

However, there are other sources that contradict the RAND survey’s conclusions about employer-based benefits. My Forbes colleague Scott Gottlieb, MD, reviews a new report from Goldman Sachs that estimates small employers dropped 2.2 million beneficiaries from coverage, a reduction of 13 percent from 2013.

Last year, Ed Haislmaier and Drew Gonshorowski of the Heritage Foundation concluded that nearly 3.8 million people lost employer-based coverage through June 2014.

Both the Goldman Sachs and Heritage Foundation analysts relied on data from insurers rather than beneficiaries. Nevertheless, I am at a loss to understand how people who lost employer-based benefits would not say so in a phone survey.

At the Health Affairs blog, Marc Berk issues a caution about the “quick turnaround” surveys that are exciting the Obamacare debate, noting that the government itself is relying especially on the Gallup-Healthways survey instead of sober estimates produced by its own Census Bureau and Centers for Disease Control and Prevention.

The surveys agree that more people are dependent on Medicaid and Obamacare exchanges have enrolled a few million. The great divergence is with respect to employer-based health benefits.

Zenefits Raises $500 Million More To Reinvent Small-Biz Health Benefits

Most of us buy small-business health benefits the way our grandparents did when they ran the hardware store. It’s a business in dire need of reinventing. Zenefits looks like the company to do it. The company that was one of the top venture deals in health care last year is looking to repeat, raising $500 million at a $4.5 billion valuation:

This is Zenefits’ third funding round in less than a year and a half. The company raised $15 million in its Series A last January, then added $66 million in an June Series B round that valued it at more than $500 million.

Zenefits offers a cloud-based software-as-a-service human resources platform for small businesses that tries to be an all-in-one solution for compliance, onboarding, payroll, health insurance, and other employee benefits. The key is that the software is free to businesses; Zenefits makes its money as a broker of services, for example earning a fee from health insurers who register new businesses through Zenefits. (Brian Solomon, Forbes)

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: