Health Access WeBlog

David Lazarus at the LA Times had an excellent column last weekend about health insurers charging men and women different rates. When Blue Shield and other insurers admit they're charging women higher premiums because they are higher "risks'' (Read: more expensive), they're coming clean about the industry's already discriminatory practices against women. Though, in doing so, it further widens the gap between what women and men pay for health care. Women will wind up spending more, not only to *buy* care, but also to *use* care, as has been the case.

Since the steady increase of high-deductible health plans (and in the absence of stronger consumer protections such as community rating and minimum benefit standards) insurers have been permitted to passive aggressively charge women more based on the fact that women are trying to be conscientious about their health.

A Harvard Medical School study last year found women ages 18-64 with consumer-directed health policies wound up spending 218% more on health care than men. "High-deductible plans punish women for having breasts and uteruses and having babies,'' said Dr. Steffie Woolhandler, one of the authors of the study.

We require various gynecological exams. We need birth control pills (as a result of co-activities with men). Sometimes we have babies (as a result of said co-activities) -- though high-deductible plans don't cover maternity anyway. We go to the doctor when we hurt. We generally seek more preventive care than men. Hmmmm. And I thought I was just being responsible.

A world that allows high-deductible plans to proliferate -- as envisioned by John McCain -- is essentially a world that legitimizes deadbeat insurers, who want to thrust more and more costs onto women in the name of keeping prices low. But for whom?

Labels: Affordability, Insurers, InTheNews, Underinsurance

posted by Hanh Kim Quach | Permalink | 12:00 PM

As we continue to struggle with how to get more people coverage, I'd suggest a look at this Kaiser Family Foundation report from February. The study looks at people who can't get public coverage and aren't offered insurance through their jobs.

Among the findings:

At 400% of poverty, the outer limit of an income that could qualify for subsidies in California (under last year's health reform discussions), only 25% of family purchased coverage on the individual market.
At 1000% of poverty, fewer than half (49%) of families purchased coverage.

Self-employed families, who receive tax credits on the premiums took up coverage at ever-so-slightly higher rates:

At 400% of poverty, about 30% purchased coverage
At 1000% of poverty, 58% took up coverage

The study, however, did not take into consideration the regulatory atmosphere -- whether individuals *wanted* to buy coverage, but were denied because of pre-existing conditions, or priced out because of their health histories -- all important factors as we go forward.

So the upshot is this: health coverage on the individual market isn't that attractive to lots of people and policymakers are going to have to find a way to make it more so, including subsidies that "may need to extend higher up the income scale than some policymakers may prefer.''

Labels: Affordability, Insurers, Research, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 11:46 AM

Dr. Prem Reddy, owner of Prime Healthcare Services, is running around terrorizing 6,000 Southern California Kaiser Permanente members -- sending them enormous hospital bills (via an aggressive collection agencies) and telling them to pay up, or ruin their credit. See the story here. One patient featured is being asked to pay $50,739.70 in full by June.

The company, with 9 hospitals Southern California, is demanding payment for emergency services that are currently under dispute with Kaiser. The patients are being told they must come up with the money to pay for their treatment (the portion that Kaiser is disputing and has not agreed to pay).

The tactic being used by the hospital chain is called "balance billing,'' where patients are asked to pay the difference between what the hospital billed, and what the insurance company paid. The Schwarzenegger Administration has been working on regulations to ban this practice, and in a strongly worded notice releasing their proposed rules, accused providers -- such as hospitals and physicians -- who engage in this behavior of using "innocent enrollees'' as "bargaining chips in an unfair provider billing pattern'' that leads to "long-term harm o the enrollee's health, safety and financial stability.''

Coincidentally -- the Administration's Department of Managed Health Care will hold a hearing on this very issue in Irvine on Wednesday, the heart of Orange County where three of Prime's hospitals are located (and presumeably many of the recipients of these giant bills.)

Testimony anyone?

(Relatedly, AB1203 by Mary Salas would ban this practice.)

Labels: Affordability, BalanceBilling, Hospitals

posted by Hanh Kim Quach | Permalink | 12:56 PM

Sen. Hillary Clinton said in The New York Times today that she wanted to cap health insurance premiums to no more than 5 or 10 percent of income. The statement gives a bit more specificity to her universal health care plan. Obama has also supported the capping of insurance rates, though without putting a number out.

I like that she is talking about tying the cost of health care to income. As we in the advocacy world know -- and too many consumers have experienced -- health care costs are extremely regressive and it's smart to begin introducing the public to that connection.

That said, we also need to begin introducing the concept of capping out-of-pocket costs as well, something that was not included in the story. Cheap plans that cost about $150/month or less are abundant, meaning coverage would cost about 6% a year ($1,800/year) for a person earning $30,000 a year. The problem is that they cost a lot to use.

Office visits aren't covered until the deductibles are met (or limited office visits are available.)
Prescription drugs aren't covered. If they are, brand name drugs aren't. Neither is maternity. Deductibles range from $2,500 to $5000. Out-of-pocket maximums, for one person, could be up to $8,000.

True, not everyone spends up to the out-of-pocket maximum, but in order to get any kind of value out of health coverage, a person would need to meet the deductible. That would mean that person earning $30,000 a year, who meets their deductible on such a plan would be spending 20% of their income on health care. That's a lot.

What's even worse is if you had an unexpected medical emergency, and had to spend up to the out-of-pocket max, that would be about one-third of a $30,000-a-year income. Not fair.

In California, we have spent a lot of time talking and thinking about the affordability of coverage -- both to buy and to use. In AB8, the legislation that the governor vetoed last fall, the affordability limit that we liked was that families that earned less than 300% of the poverty level ($63,600 for a family of four) would have both premiums and out-of-pocket costs capped at 5%.

For ABx1 1, we took a different approach. Families with incomes up to 400% of poverty ($84,800 for a family of four), would spend no more than 5.5 percent on premium. This premium was pegged to a plan that -- while having a $2,500 deductible -- also included “prescription drugs, physician visits, and preventive services, including the services to manage chronic conditions, outside of the deductible. ''

Increasing health care costs are a real thing and is scary. Ignoring out-of-pocket costs as part of that equation would be ignoring the fastest growing part of health care and that needs to be part of the policy discussions.

Labels: Affordability, InTheNews, PresidentialCandidates

posted by Hanh Kim Quach | Permalink | 10:19 AM

The Wall Street Journal had this tragic story last week about a Merced man -- who was insured -- but still socked with a $1.2 million hospital bill (not counting thousands in doctor's office bills also).

What happened to Jim Dawson, of Merced, that landed with debt that could bankrupt him is a textbook example of what health consumer advocates have been fighting to reform for years.

Dawson had a good job with Valero Energy Corp., a big oil refinery. He had Valero-sponsored comprehensive health insurance policy, and a regular primary care physician who knew his medical history, *should* not have been vulnerable to medical-financial angst. That's at least what many think. But Dawson's story shows how anyone can be vulnerable.

First thing that went wrong: His primary care physician, and subsequent specialists were not able to diagnose a staph infection until six months after his first doctor's visit -- and by that time, the infection had ended up in his blood stream.

Next: He ran up against a lifetime cap on his health coverage -- a max of $1.5 million (which, incidentally is considered generous. Most policies have a cap of $1 million, but where set in the 1970s when the purchasing power was equal to $6 million today, according to WSJ)

Lastly: Dawson and his wife, in combing through their hospital bills, realized the hospital had inflated various items at tens and hundreds of times their actual cost on the street. For instance, stockings for $791, when they could have purchased them for $12; oxygen for up to $6,675 PER NIGHT, when it could have been rented for $250. All those numbers added up to "Disneyland numbers,'' admitted the hospitals chief medical officer.

The Dawson case highlights a number of issues:

*DISCLOSURE OF QUALITY AND COST:

Dawson visited many providers who were unable to accurately diagnose him at first. Still, Dawson (or his insurance) paid all these providers full price for their conjecture. If providers were asked to account -- or disclose -- for why Dawson's staph infection went undiagnosed for so long, then

Dawson's infection would not have spread as far or been as costly and
Other consumers could decide whether or not to see that provider.

* LIFETIME CAPS:

The fact that lifetime caps have not been reset since the 1970s, combined with costly medical technologies that are used in health care will mean that more and more Americans will reach their lifetime caps.

* HOSPITAL OVERCHARGING

Even the chief medical examine at Dawson's hospital admitted his bill amounted to "Disneyland numbers.'' Given that Dawson's hospitalization occurred earlier this year, he should qualify for a discounted rate under AB774 (Chan), which was enacted in January. It requires hospitals to offer the Medicare-negotiated rate for patients who are uninsured, or spend more than 10 percent of their annual income on health costs.

Unfortunately, until this is sorted out, the Dawsons are making $30 payments to various hospitals. At that pace, with at least $1.2 million in the red, I estimate it will take them 3,333 years to pay off (not including interest).

Labels: Affordability, Hospitals, InTheNews, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 1:50 PM

As health reform negotiations go on, I continue to be puzzled why the Governor has yet to publicly budge on having some--*any*--affordability standard for individuals in the context of a mandate. Any other politician, concerned about voter reaction, would not just include affordability in their plan, but lead with it. The presidential Democratic candidates, like Clinton, Obama, and Edwards, both provide assurances to voters than coverage will be affordable, both in terms of costs (tied to a percentage of their income), or in terms of benefits (for example, saying that people should have access to coverage as good as what Congress gets).

Some, like health care blogger Alan Katz, have criticized the notion of an affordability exemption--saying it undermines the point of a mandate. The Governor's team asks, "don't you want universal coverage?" Of course, but I think they misunderstand the point.

Our goal is not an exemption. Our goal is to get people covered. The affordability standard is a challenge, to insurers to keep costs down, and to policymakers to provide the subsidies needed to low- and moderate-income Californians.

If we have the cost containment and appropriate subsidies in place, then any mandate--even with an affordability standard--would be universally applied, and everybody would have affordable coverage. We've reached the goal. However, if the costs continue to rise or subsidies are not there, then let's not have an unlimited legal requirement placed solely on individual consumer's shoulders.

There is a conversation to be had about what is affordable, with regards to premiums, out-of-pocket costs, and benefits, but it amazing to me that we are still talking about whether an affordability standard should even exist in the first place.

Labels: Affordability, YearOfReform

posted by Anthony Wright | Permalink | 10:36 AM

An article in this month's Health Affairs (subscription required) breaks down why the U.S. Census Bureau's statistic pointing out that one-third of "higher income'' Americans is uninsured is misleading. The Census statistics are an important source for health coverage data and is also used by the federal government to allocate funds.

In 2006, according to Census statistics, more than one in every three Americans (37.8%) lived in a household with income higher than $50,000.

But, the Health Affairs article points out"...many of the uninsured who live in higher income households do not fit a profile of "financially able but unwilling.''

Moments when income is "high" could be a temporary, as with self-employed or transient workers. So are moments of uninsurance, when a person is between jobs.

Additionally, "households'' does not equal "one family.'' Many of these "households" have many generations living under one roof: adult children at home who are contributing to the family income, but are not allowed to glom onto their parents' policy; parents living with their adult children, who need to purchase separate policies. Adults in "high income'' households could also be in roomate situations, and therefore need separate policies. So if you separate out the individual family units, earnings are far below the $50,000 to $75,000 mark.

That's why the debate about affordability of health care in this year's reform efforts is so essential. Policymakers need to find a way to help this middle-income group, sandwiched between super-poor and super-rich find affordable and meaningful health coverage.

As the report shows, being uninsured is not a symptom of being "young, invincible'' and brazen as many would like to believe, but more because insurance simply costs too much for people who are trying to survive by pooling their resources and huddling under one roof.

Labels: Affordability, InTheNews, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 8:00 AM

Gov. Schwarzenegger doesn't get much credit for his plan to to give tax credits for health coverage to middle-income Californians. A new analysis by the California Budget Project concludes the plan wouldn't help many people and could create the perverse incentive for businesses to drop coverage -- rather than increasing it.

Here are the highlights:

70% of Californians between 250% and 350% FPL (the qualifying income for the tax credits) would be disqualified because they have access to coverage on the job.
That tax credit only applies to "minimum'' coverage -- a high deductible plan. If families want more coverage, they don't get a tax credit for it, which would encourage the use of plans with $10,000 deductibles for families who make $72,275 (for four people) annually.

To see the report, and other things the Budget Project has written, visit www.cbp.org.

Labels: Affordability, Schwarzenegger, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 1:32 PM

The California Budget Project today released its annual "Making Ends Meet" report detailing what families would actually need to earn to survive in this state. This is a much more reliable measure of poverty than what is typically used to determine public program eligibility, etc -- the federal poverty level, which was set in the 1960s based on the price of food and not updated since.

What CBP found is that families (with children) need to earn between three to four times the minimum wage in order to pay for basic needs -- rental housing and utilities, food, transportation, health care and other essential costs.

Comparing CBPs numbers to:

Minimum wage at $7.50 an hour;
The median hourly wage of $17.42 (in 2006),

we can see that families are barely making it -- earning between $17.39 and $24.22 an hour.

Relative to health care, the California Budget Project found families spending between 15.3 to 22 percent of their earnings on health care. These are families who aren't able to get coverage through work and don't qualify for public coverage.

That's what makes our push for affordable health care even more important.

Labels: Affordability, InTheNews, YearOfReform

posted by Hanh Kim Quach | Permalink | 12:57 PM

After 10 months, Gov. Arnold Schwarzenegger released the highly anticipated legalese to accompany his 10-page health reform concept paper released in January. This 220-page draft seems to have grown since last week, when a 195-page version was circulating for comments. My colleague Anthony posted comments and analysis about last week's language -- which was not claimed by the governor -- here and here and remains relevant to the latest document.

Here's a quick take on some of the new elements of the plan:

One new wrinkle: All employers -- not just those with more than 10 workers -- would be required to contibute to employee health care. Businesses would be asked to contribute, based on a sliding scale, of between 1 and 4 percent. AB8 (Nunez/Perata), which is the Legislative leaders' proposal, requires a 7.5 percent minimum contribution from employers. Ken Jacobs at the UC Berkeley Labor Center explains in this Sacramento Bee editorial why that 7.5 percent figure is important. (Essentially, businesses in the state already contribute an average of 8 percent and we shouldn't lower the bar and allow businesses to abrogate their current responsibilities.)

Another new thing this week seems to be the addition of revenues from the state lottery. The governor's idea is to lease the operation of the lottery to a private company (though he specified that the concept did not involve privatizing the lottery), which would -- i suppose -- sell more tickets and make more money? This idea, Schwarzenegger said, is meant to supplant talk of a sales tax increase.

Lastly, Bill Ainsworth at the San Diego Union Tribune asked the governor about affordability. Under this plan, Californians earning more than 350% of poverty ($72,275 for a family of four), would be responsible for buying their own coverage without any help at all (either subsidies or tax breaks). Such a family -- in today's insurance market -- could spend nearly $7,000 a year on premiums alone. The premiums alone are nearly 10 percent of the family income. And that's for coverage that isn't that great ($3,000 deductible, $500 prescription drug deduction, and $10,000 out-of-pocket maximum).

The governor conceded that affordability was an issue, "We need to help people especially if it costs more than 5 percent'' of their income. All the figures in the current bill, he said, are up for negotiations.

Stay tuned for more....

Labels: Affordability, Legislation, Sacramento, Schwarzenegger, YearOfReform

posted by Hanh Kim Quach | Permalink | 10:32 PM

Of the many brain-stumping issues in the health reform debate, the one that seems to provoke the most visceral reaction from all sides seems to be: how to make health care affordable.

The past decade, we've all been the victims of health premiums that increase at three times the pace of our salaries ... and everything else. We've noticed that the health plan just doesn't cover as much as it used to. And deductibles and co-pays are popping up where they weren't before.

It's gotten so bad that more than 3,000 consumers from all over the state have submitted cards and keys with their health care stories, to be delivered to the Governor's offices this week.

But what are people actually spending? A helpful report released last month by the UC Berkeley Labor Center answers that question. Researchers crunched data from the national Medical Expenditure Panel Survey -- shows what people are spending on health care.

The numbers, for some, are bleak.

A family of four, earning the median income in California -- $74,801 -- who is moderately healthy, and has regular health care expenses can expect to spend, at most, 5 percent of their income on health coverage AND out-of-pocket costs if they have to go out on their own and buy health coverage on the open market (meaning they don't get it through work.) If you can get coverage from your job, however, they'll end up spending just 2 percent of their income. Pretty good deal.

On the other hand, if someone gets in a car accident, or breaks an arm, or is diagnosed with cancer or diabetes, the numbers are much more overwhelming. Even with coverage on the job, such a family could find themselves spending more than $6,000 to buy the coverage AND use the coverage. Those who have to go out and buy their insurance on their own would spend nearly $12,500 (16.7 percent of their income).

As this Health Access report from earlier this year shows, the majority of Californians -- 60% -- have assets of less than $12,000 (excluding home equity). So that means they'd have to empty their savings, liquidate their car, their 401ks, furniture, to pay for one year's medical bills. That doesn't innoculate them from getting sick the following year, either, when there is nothing to sell off to pay the hospital bill.

So as we continue debating what to do with AB8, health reform in California and nationally, someone should take a look and listen to what consumers are actually spending and ask themselves, is this right?

Labels: Affordability, YearOfReform

posted by Hanh Kim Quach | Permalink | 12:05 PM

Another year, another health premium increase.

As workers prepare for the open enrollment period in a few months, they'll notice a bigger chunk missing from their paychecks. In 2008, workers will pay about 10.1 percent MORE (that includes premiums and out-of-pocket costs. Ouch) than they have in previous years. The Wall Street Journal today reports on a trend that we've been watching closely, which is the gradual and heavy shift of health care costs from businesses to consumers.

Health premiums, many are aware, have been increasing at a rate two to three times inflation. But the increase has slowed a bit, due to the fact that "employers have been....passing a significant percentage of costs to employees,'' the article says. This creates even bigger costs later, as employees/workers are getting sicker because they're skipping preventative care and their meds.

"They're essentially trading preventative care now for "rescue care'' later,
which will lead to unhealthy employee populations, a decrease in employee
productivity and ultimately -- higher health-care costs,'' said the expert from Hewitt's Health Management Consulting business.

So even though workers aren't taking up the high-deductible plans, which more blatantly shiftsmore costs onto them, workers are seeing more of a crunch in their pocketbooks through traditional plans -- an average of $3,597 a year, which includes premiums, co-pays, deductibles and co-insurance. That's a lot.

That's why, this year consumer groups adamantly insisted that health costs be "affordable'' for consumers -- meaning the cost of premiums and deductibles and other out-of-pocket costs be no more than 5 percent of a person's annual income -- as was ultimately passed in AB8 (Nunez/Perata), which Gov. Schwarzenegger has threatened to veto.

Whatever happens with AB8, it's why the health reform conversation is so important to have this year. Without it -- this shift would be happening whether consumers had a voice or not.

Labels: Affordability, InTheNews, YearOfReform

posted by Hanh Kim Quach | Permalink | 2:31 PM

Lots of press last week made a big deal of the fact that health care premiums were inching up 6.1 percent, rather than the usual gazillion percent of years past. Some even gave passing mention to how consumers were paying more out-of-pocket.

But a close look at the KFF-HRET 2007 Employer Health Benefits Survey gives us a good view of exactly how much out-of-pocket costs are creeping upward.

Many, rightly, fixate on deductibles. For instance, in 2000, only 1 percent of workers had deductibles higher than $1,000; now 10% of workers have deductibles at that level.

Deductibles are part of the picture, but not the whole thing.

This year, for instance, the survey started tracking separate "hospital'' deductibles that consumers would have to pay, on TOP of their regular deductibles. More than half of plans are now imposing those fees. Some plans have also started imposing separate prescription drug deductibles, but that's not reflected in this year's survey -- yet.

Another interesting finding -- we're getting nickled and dimed to death by co-pays. Just three short years ago (2004), 68% of patients had copays of less than $15; now 45% have copays at that level. Meanwhile, in the same period, the number of people paying between $20-$25 per visit nearly doubled.

As we head into Round two of health reform in California, let's not forget about these pesky out-of-pocket costs. Assembly Speaker Fabian Nunez and Senate Leader Don Perata wisely added -- at the last minute -- language in their AB8 that would limit consumers' out-of-pocket costs. Let's make sure it stays that way.

(And 'Hi.' I've been neglecting this for a bit, but now I'm back on.)

Labels: Affordability, InTheNews, Nunez, Perata, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 2:33 PM

That's what yesterday's USA Today article asks, in response to a recent JAMA study finding that underinsured children are vaccinated at lower rates than uninsured children.

For those buying health insurance through a group (such as work), in California, consumer protections guarantee that even flimsy health plans are required to provide preventive care for children following the American Academy of Pediatrics guidelines, which includes immunizations.

However, if you're buying coverage on your own -- it's not only more expensive, but as this study shows, it also doesn't cover the essentials.

The study confronts the insurance company's lines about creating "innovative'' products. Innovation comes at the consumers' expense. They argue that the reason health care is "expensive'' in California is because people have to pay for health coverage they don't need. But without "mandates'' this is what happens -- children don't get properly immunized, cancers don't get discovered, diabetes doesn't get treated.

And I would argue that in California -- the mandates aren't enough -- given that 464,000 children who have insurance in the individual market are not guaranteed proper preventive care in their most formative years.

Labels: Affordability, InTheNews, Prevention, Underinsurance

posted by Hanh Kim Quach | Permalink | 3:07 PM

It seems that health plans are really trying to test the limits of consumer finances. A report released last month from Health Affairs tells how consumers are getting hosed from both directions .... but the moral of the story is, it's still better to buy coverage through a group, than as an individual.

Here are the key points:

Between 2003 to 2006, premiums for Small Businesses increased by 53 percent, while those for Individuals increased only 23 percent.

If you were strictly looking at premiums, you'd think the individual market was a good deal. Not so fast.

The Average Deductibles among all Small Business plans was $348. Meanwhile, for individuals, its $2,136 -- six times higher!
Small business plans cap out-of-pocket costs at $2,000 a year. Individual plans cap it at $4,000.

It also matters whether you're sick or healthy.

A patient with Asthma would spend $886 out of pocket if insured through a small business. That person would spend $2,607 if insured on their own.

Policy makers should heed the results of this study as they draft health reform legislation. To wantonly push consumers into an indivdual market where they are not getting much value for their dollar is unfair and may only lead to a need for bigger reforms later. Let's just get it right the first time.

Labels: Affordability, Underinsurance, YearOfReform

posted by Hanh Kim Quach | Permalink | 12:08 PM

A bunch of interesting public opinion polls have come out recently, so I'll summarize a few of the key points from them here.

PPIC released a poll Thursday showing that 72% of Californians think the state's health care system is in need of major changes. (Take THAT Blue Cross!) Voters, however, are a little less confident that the guv and Legislature will be able to broker a deal (49%).

Another interesting point: 72% of voters support the guv's idea to require residents to have health insurance. From my previous readings, I actually thought voters weren't really hot for such a mandate....but I'm wondering if it's the WAY the question was posed that evoked that response.

The question, verbatim, was: "Would you favor or oppose a plan requiring all Californians to have health insurance, with costs shared by employers, health care providers and individuals?"

Lastly, a SURPRISING number of Californains (73%) said the US should provide health coverage to all children, even if it would require higher taxes. Hopefully Congress and Bush, who are in the process of giving the State Children's Health Insurance Program way too little money hear that.

Poll #2 out of Massachusetts: The Kaiser Family Foundation found that two-thirds of Massachusetts residents polled supported the new law, though support dropped to 57 percent when asked about the individual mandate -- which would penalize those that didn't buy coverage.

The most interesting piece of this poll to me was the part asking about affordability of the plans for people forced to buy coverage on their own without subsidies.

Scenario 1 37-year-old single adult, earning $42,000. The plan:

Costs $259 a month
Has a $1,500 deductible; $5,000 maximum out-of-pocket
Allows 3 doctors visits at $25 a year (the rest would be full-price)
After the deductible is met, 20% co-insurance
Generic drugs $15, but brand name drugs would be 50% co-insurance.

62% of respondents said this plan was "unfair;'' 58% said it was an unreasonable amount; 62% said this person would remain vulnerable to high medical bills.

The piece about affordability is key as we in California consider what is reasonable and fair for people to pay. The governor's plan requires a $5,000 deductible and $10,000 maximum out-of-pocket for someone earning $26,000. Looking at what people think in Massachusetts, the super-majority of people would say that's unaffordable.

Labels: Affordability, ExpandingCoverage, IndividualMandate, Schwarzenegger, Underinsurance

posted by Hanh Kim Quach | Permalink | 12:02 PM

The lawyer for a deceased client in LA was a little surprised when she opened her client's bill and found a $1 million .... bill.

The hospital bill for $962,120 was 20 times what the lawyer had been told her client owed for her four-day stay at the Glendale Adventist Medical Center falling and suffering minor injuries last year, according to an LA Times story today.

That's right. The bill was 20 times higher than what the hospital quoted as $46,106. And what the hospital quoted was 10 times higher than what the insurance company's rate, which was $4,350.

These numbers, while imposing, are typical -- if you're uninsured. The client HAD insurance, and only had to pay $150.

But uninsured? If you're lucky, you'd get the $46,106 bill. Not? You'd better hope Ed McMahon comes knocking on your door with sweepstakes prizes.

Labels: Affordability, Hospitals, InTheNews

posted by Hanh Kim Quach | Permalink | 5:53 PM

We all know gender inequality issues still exist in the workplace. Men still get paid more than women. Fewer women are promoted than men.

Another place where gender discrimination is allowed to tacitly continue is in health care. As recently as 2002, women were charged copays of between $500 and $2,000 to deliver babies. Meanwhile (mostly or only men) who had prostate surgery, back surgery, brain surgery, coronary bypass surgery did not have to pay copays.

(Some might argue that maternity costs more. Not so. Average costs for labor and delivery was $1,980 then. Meanwhile, average costs for surgeries for those other procedures ranged from $4,422 to $29,539 -- okay, now i'm really annoyed).

Why am I upset about this now?

Here's the situation: Gov. Arnold Schwarzenegger and Republican cohorts are constantly calling for "flexibility" that would allow insurance companies to offer consumers more "choice'' and more "affordable'' options.

What they really mean is getting rid of a host of "benefits'' that California wrote into the law years ago to make sure health coverage actually covered health care.

Here are some of the benefits they're talking about. (see a full ist of mandates here) California mandates 23 benefits; six directly relate to women. They include coverage for:

complications of pregnancy, (for plans that provide maternity benefits);
breast cancer screening, diagnosis and treatment;
mammograms;
cervical cancer screening (if policy includes coverage for treatment/surgery of cervical cancer)
prenatal in the Expanded Alpha Feto Protein program, if maternity benefits are included
prescription contraceptive methods (if prescription drugs are part of the benefit package)

Two other mandated benefits are "tweeners,'' while they could apply to both genders, I would say they predominantly apply to women:

diagnosis, treatment and appropriate management of osteoporosis
immediate accident and sickness coverage for each newborn infant and adoptive child.

Of course, the biggest cost for women -- maternity coverage -- is not a mandated benefit and was actually vetoed by Schwarzenegger in 2004 on the grounds that it would make coverage too expensive for everyone. As I pointed out earlier in this post, the collective "we'' pays for a lot of health care that is used primarily by men, including the gov's various heart surgeries.

So don't buy the wrap about "choice,'' "flexibility'' and "affordability.'' It's just another way to help keep women in their place.

Click here for the San Francisco Chronicle's excellent Sunday Op-Ed about women and health care.

Labels: Affordability, Prevention, Schwarzenegger, Underinsurance

posted by Hanh Kim Quach | Permalink | 1:00 PM

In an earlier post, we discussed my appreciation that the Democratic legislative leaders were being intellectually honest that their plan was "near-universal," and not fully “universal,” even though they do dramatically expand group coverage to millions of Californians, and provide more security to millions who have it but are concerned it won’t be there for them when they need it.

Universal is the ultimate goal, but let’s be clear that it is hard to get there. The closest way is through a Medicare-like system, where enrollment is simple and required just once in a lifetime, and which is financed through taxes (based on ability to pay). Medicare comes very close, but still falls just short. At the state level, the only bill that can be called "universal" is Senator Kuehl's SB840.

This has come up on the presidential campaign trail, as some critique presidential candidate Barack Obama’s plan for *not* being universal, and while for some that means not being single-payer, for many others that means not having an individual mandate.

I disagree that an “individual mandate” gets you “universal.” Without a truly automatic enrollment and affordable coverage, the enforcement mechanism would have to be pretty punitive, and the publicly-financed subsidies very generous. And even presidential candidate John Edwards’ plan, which does include an individual mandate, has exemptions for those who aren’t able to afford it. However good it is (and I think there are many good things in it), it is not universal either.

Governor Schwarzenegger’s doesn’t have any exemptions to his individual mandate, and the enforcement remains a troubling discussion. He trumpets his proposal as universal, but it is not. The modeling suggests that about a million undocumented adults, and slices of other populations, will remain uninsured.

Yet from some reporters' point of view, his plan is supposedly more “comprehensive” than the others, yet it really doesn’t help more people. Even though roughly a half-million more people are said to be "insured" under the Governor’s plan than the Nunez or Perata plan, those people would not necessarily be better off. These are folks that are not getting coverage on the job, not eligible for public programs, yet are forced to buy individual coverage.

Without any exemption for affordability, many of these folks will be required to pay for a premium, but will only be able to afford a high-deductible product that requires them to spend thousands of dollars out of pocket before care is covered. Is it better for these people to be required to pay a premium for a product many of them won’t be able to afford to use?

So maybe we shouldn’t call these folks newly insured, because that would imply they got a benefit, as opposed to a burden. Here’s where I need your help. What should we call people who are forced to buy a plan that is more than 5% of their income? Forced to buy a high-deductible plan?

The Unafffordables?
The Burdened?
The Forced Underinsured?
TOUGHs? (Tough Option: Uninsured Greater than High-deductibles?)

Defining this group will allow for better apple-to-apples comparisons between the various plans, between the truly insured, and those who are being made to buy a product that doesn’t make sense for them. E-mail your suggestions to awright@health-access.org. I look forward to your replies.

Labels: Affordability, ExpandingCoverage, IndividualMandate, Schwarzenegger, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 9:59 AM

I would be remiss if I didn't point out some articles in the papers. Not because Health Access California is mentioned, but because they offer poignant stories from actual California families about our health system today.

* Bill Ainsworth at the San Diego Union-Tribune features real stories of people dealing with high-deductible plans, and how they would be impacted by an individual mandate, for better and worse. A companion story also documents about how people make tough life decisions simply for the security of health coverage.

* Aurelio Rojas of The Sacramento Bee has the story of Senator Gil Cedillo, not as a legislator, but as a son, dealing with his mother's hospitalization. (Calitics and Working Californians picks up on the story)

That's our organizing is so focused on having California health care consumers simply tell their stories. It is what should inform the current debate on how to make the health system better. (Sometimes, those stories help inform our policy development work. Other times, with the explicit permission of the person, we connect real people with the media, as with the Union-Tribune story. As Victoria Colliver in the San Francisco Chronicle reports, we also did this with Michael Moore's new movie, Sicko.)

Story sharing is the primary work of the Its Our Healthcare! coalition, to make sure that our voices, the voices of California consumers, are front and center in the debate. Check out the constantly-updated website!

Labels: Affordability, InTheNews, OtherBlogs, Underinsurance, YearOfReform

posted by Anthony Wright | Permalink | 1:28 AM

You don't have to be a fan of the New America Foundation to take sides with it over the unabashedly conservative Hoover Institution.

Dan Walters has a questionable column in today's Sacramento Bee that gives way too much credence to a Hoover study trying to downplay the notion of a "hidden tax" in health care.

The "hidden tax" is a phrase Governor uses a lot, to talk about the amount that health premiums are higher because of the uninsured population. The New America Foundation released a study last year often cited by Schwarzenegger. Families USA had a similar conclusion in 2005 with its study documenting "the increased cost of care."

As I have previously said, I don't like the the Governor's rhetoric around a "hidden tax," he tends to blame the victim: the uninsured person who typically is not offered coverage on the job, is not eligible for public programs, and who finds that buying coverage as an individual is either unaffordable or even unavailable, because of "pre-existing conditions." This rhetoric has consequences: if the problem is that people are uninsured, rather than the barriers that lead them to be uninsured, it's no wonder that Schwarzenegger and New America Foundation both see the "individual mandate" as a solution--something we disagree with.

But it is important to acknowledge that our current fragmented health system comes with a cost, to all of us. One of the problems is the lack of fair and equitable financing, with most employers providing coverage to all their workers, but many that don't.

We all pay more when Wal-Mart and McDonald's pay less. It's the same health care system, of doctors and hospitals, and if some manage to not pay their fair share into the system, we all pick up the burden. (Let's remember, the uninsured get it worst, getting charged more than others and facing collections and bankruptcy. But there are costs that are borne in the overall system.)

In some states, they actually have an explicit fee on insurance to help fund the safety-net hospitals and providers that care for the uninsured. So employers and purchasers are able to directly see, on their bill, how much they are paying for a broken health system that leaves people uninsured.

The New America Foundation, in its analysis defending its work, actually pointed out Hoover didn't question the notion of a "hidden tax," just its size. And the New America Foundation makes a credible case that it is bigger than what Hoover estimates.

The thing that rankled me most about the Walters column was the notion that reducing the "hidden tax" was "the most appealing premise" of health care reform. Let's put aside the millions of uninsured who would get coverage, and no longer live sicker, die younger, and be one emergency away from financial ruin. Let's put aside the community, economic, and public health benefits.

It seems to me that there are other reasons why an *insured* person would want a change in our health system:

* SECURITY: Even insured people recognize that they are one job change, one divorce, or other life event, from being uninsured. Reforms could provide more security that they keep the coverage they have now (through an employer or a universal system), are more likely to have coverage at their next job, are more likely to have a safety net if they fall upon hard time, and are more likely to have coverage even if they get sick.

* AFFORDABILITY: Aside from efforts to simply shift the burden of costs onto consumers, most of the ideas to contain costs in the health care system work better when more people are in the system. Whether its information technology, or prevention, or bulk purchasing, or better planning (not to mention fair financing), the cost savings work best in a universal system, rather than our current a fragmented system where it is hard to implement these efforts. For those who are insured, we can best slow the growth in health care costs better if we deal with the uninsured issue as well.

There's no disagreement that there's a cost to the status quo. But let's recognize the other benefits of reform as well.

Labels: Affordability, CostContainment, Employers, IndividualMandate, InTheNews, Research, Sacramento, Schwarzenegger, YearOfReform

posted by Anthony Wright | Permalink | 3:56 PM

In opposing reforms to prevent them from denying Californians coverage, Blue Cross is bringing up the energy crisis, but the analogy might backfire.

Newspapers and even this blog have already chronicled BlueCross' bad behavior in the marketplace, and their overall opposition to any health care reform.

Now they have launched a $2 million-plus ad campaign, under the name "Coalition for Responsible Healthcare Reform." (The LA Times' Political Muscle covers it here.) Blue Cross should be ashamed, spending millions to retain their ability to deny coverage to Californians.

The ads say "Remember how the rash enery deregulation of the energy market in California spawned power outages and soaring rates? Let's not go there again."

But if the energy crisis is the analogy, then Blue Cross is Enron, taking advantage of an unregulated California market and leading to a blackout of coverage for millions. But even the now-disgraced Enron never had the gall to run ads arguing that they should be allowed to continue to manipulate the market.

Because there are so few rules on insurers now, Californians are concerned now they are one job change or life event away from facing a blackout of coverage. We have over 6 million Californians in a coverage blackout. Frankly, we have tolerated deregulation for too long: new and fair rules would increase the security that Californians have now with their coverage, so they are not denied because of their health status.

BlueCross' ad campaign may backfire with the public. They won't believe BlueCross, and they will make it clear to Californians what we can win with health reform.

DOING A FACT CHECK: I think Californians know better than to believe Blue Cross and their misleading statements, especially the absurd notion that buying health coverage as an individual is affordable now. Their ad won't persuade most Californians that individual insurance is affordable now, from a 50-year old woman in the Bay Area, to anybody that takes a handful of prescriptions a year.

Blue Cross' price comparisons matches apples and oranges. It's different products, different people, and different states:
* The list price in many states does not include the significant mark up for age or those who have even minor health issues.
* The states with "guaranteed issue" are Northeast states which started with higher costs of living and higher insurance costs generally.
* Finally, you can't compare a product that actually covers you when you are sick, to one that will not.

We'll have more later in the day.

Labels: Affordability, BlueCross, InTheNews, OtherBlogs, OtherStates, YearOfReform

posted by Anthony Wright | Permalink | 11:01 AM

HEALTH ACCESS UPDATE
Tuesday, May 15, 2007

NEW NUMBERS FOR NUNEZ AND PERATA PLANS ON HEALTH REFORM

* Democratic legislative leaders release financial specifics on health care proposals
* Proposals would cover over two-thirds of uninsured; provide more security for workers
* Momentum for reform prospects, affordability for consumers and employers highlighted

New on the Health Access WeBlog: Theresa Mary Johnson, RIP

Over two-thirds of uninsured Californians would have health coverage under newly fleshed out proposals released by both Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata Tuesday.

The new numbers show how each lawmaker’s health expansion plan would be paid for and provide more specifics on how coverage would be provided. Under the notion of "shared responsibility," the proposals would set a minimum contribution for employers at 7.5 percent of wages (for both full- and part-time workers) toward worker health care; would create a statewide purchasing pool as a new option for employers to cover their workers; would expand public programs; would take advantage of federal tax breaks and matching funds; and would place new rules on insurers and reform the insurance market.

This is the first time that the legislative leaders have released the new figures since they both introduced their health coverage proposals in December, which were both aimed at increasing health coverage amo

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Dressing up the Individual (Market)

Monday, June 09, 2008

The timing could not have been better...

Friday, May 09, 2008

Beyond HillaryCare

Friday, March 28, 2008

A BIG, unfortunate and expensive illustration for health reform

Monday, December 03, 2007

Strange bedfellows

Saturday, December 01, 2007

Not just a word, but a challenge

Wednesday, November 28, 2007

Willing, but Unable....

Tuesday, November 27, 2007

Poor Credit. Bad Credit.

Tuesday, October 23, 2007

Scraping by

Wednesday, October 17, 2007

Governor introduces health reform language....

Tuesday, October 09, 2007

Humanely affordable

Monday, October 08, 2007

If a tree falls in a forest...

Tuesday, September 25, 2007

Creeping Costs....

Tuesday, September 18, 2007

"When is something less than nothing?''

Friday, August 10, 2007

Testing the Tensile Strength of our finances

Monday, July 09, 2007

Don't take it from us -- here's what others say....

Friday, June 29, 2007

This is NOT from Publisher's Clearinghouse..

Thursday, June 28, 2007

Women and Health and the Glass Ceiling

Wednesday, June 27, 2007

Contest!

Friday, June 01, 2007

Real stories...

Wednesday, May 30, 2007

The "hidden" reasons for reform...

Tuesday, May 29, 2007

"Unintended consequences" of BlueCross' ad campaign

Thursday, May 24, 2007

The money's on the table

Tuesday, May 15, 2007