Well, According to DORA the Colorado Department of Regulatory Health Agencies, Division of Insurance, insurance is a way for people and insurance companies to “share the risk” of medical costs. People — whether healthy or sick — pay premiums into a pool of money, administered by an insurance company, so that there is money to pay for services when someone in the pool of insured people needs medical attention.
Insurance pays for claims made when customers see a provider, need treatment or tests. If the insurance company collects more premium than they make in payments and other administrative costs, then they make a profit. If they pay out more in claims than they have collected, they show a loss.
Writing in the Colorado Statesman on March 8, 2013, Miller Hudson has done the best work I have seen so far in explaining why we are in the fix we are in with the high cost of healthcare, what affect the Affordable Care Act is likely to have and what some ideas about how it might all become workable in the future. I highly recommend you invest a few minutes in reading this article.
Here, Courtesy of the Colorado Department of insurance, is their “Glossary and Definitions” for health insusrance. This information is provided by DORA so you can be familiar with some of the terms you may see in a health insurance policy. If you have questions, call the Division of Insurance for more information.
Certain products and services sold to consumers may appear to be health insurance but actually address very specific concerns. Be sure the product/service you are considering is health insurance, if that is what you want to buy.
- Does the word “insurance” appear in marketing materials?
- Does the health insurance carrier and/or the salesperson for the carrier appear in the Division of Insurance database as a licensed carrier and/or licensed insurance producer in Colorado?
An ”access fee” is a specific amount that a person covered under the policy must pay each time certain services are used or received. The access fee is not part of the deductible amount, and is not usually reimbursed by the health insurance carrier.
Catastrophic Health Insurance
Catastrophic health insurance is a type of health insurance that typically has very high deductibles. The coverage for a catastrophic policy does not kick in until you have paid your share of the deductible amount in the policy.
“High Deductible Health Plans (HDHPs)” are catastrophic health insurance policies created as a way to lower overall medical costs by providing a lower monthly premium in exchange for a higher annual health insurance deductible. With catastrophic health insurance plans, you pay for almost all medical care until you reach the annual deductible amount. If eligible, some people combine a high deductible health policy with a Health Savings Account (HSA). Read the policy carefully to understand what will be covered and how much your share of the costs will be if you need medical treatment.
After you have met the deductible for the covered period of time, your health policy may have a “co-insurance” that provides the patient will be responsible for a certain percentage of medical costs after the deductible has been met.
An individual health insurance policy may have a defined contestability period, so if the insured person becomes seriously ill during that time the health insurance carrier may check for any fraud or deception in the person’s application and medical history. This is intended to protect the carrier from individuals who may buy health insurance policies knowing they are in poor health and who may be misrepresenting themselves during the application process.
A “co-pay” is a fixed payment amount that is the responsibility of the patient. For example, a health policy may state that the patient must make a $25 co-pay for each doctor visit, and/or that the patient must pay $15 co-pay for each covered prescription medication that is purchased. (These amounts are examples, your policy may have different co-payment amounts.) The patient, or covered person, must make the required payment each time covered services are used. The amount of any required co-pays should be specified in the policy you select.
A deductible is a specific amount of money that you agree to pay before you receive any benefits for covered services from the health insurance carrier. Deductibles can vary, but if your policy has a $1,500 deductible, and you receive doctor’s care and medication that costs $1,200, you must pay for all of it. The carrier is not responsible for the amount of the covered service or medication you pay for up to the amount of deductible.
In addition to the monthly premium, or cost to be covered by insurance, you must also pay for all covered services until you reach the deductible amount. Generally, the higher the deductible is, the lower the monthly premium will be. If you agree to pay a $10,000 deductible, your premium would be lower, but if you are sick or injured, you will have to pay $10,000 worth of medicine and treatment before the carrier pays anything. (Check your policy to see what the options are.)
The entire deductible has to be met before your carrier will cover many of the services you could need, including hospital stays.
After you reach the deductible amount during a specific period of time, the carrier will begin reimbursing for covered medical services and treatment as specified in the policy. This may be at 100% co-insurance or could be another percentage, such as 50% of your medical treatment and services.
Once you meet your deductible then you’re done for that calendar year or for the period specified in your policy. The following year, or next deductible period, you have to start satisfying the deductible all over again.
Disclosure (of medical history and status)
When applying for individual health coverage, you will be asked to “disclose” any existing medical conditions, existing medications and past medical history. You must answer the questions truthfully. If the health insurance carrier learns that you have not provided all requested information about your health status, the policy may be cancelled and your coverage denied.
Discount Health Plan
A “discount health plan” refers to a type of “buyers’ club” that specifically markets reduced-rate health care services. The Plan typically charges a membership fee in exchange for a list of health care professionals who will provide services at a discounted rate to members of the Plan. Plans may be marketed to consumers as a way to save money on various health services, such as medical, dental and vision care, as well as pharmacy and/or chiropractic services.
Be aware that state laws protecting consumers of insurance will not protect people who buy Discount Health Plans. For example, health insurance laws that guarantee access to providers, do not apply to these plans. Discount Health Plans do not qualify as “creditable health insurance coverage.” This means that if you drop your health insurance after purchasing a Discount Health Plan and later decide to purchase health insurance again, your new insurance may not — and probably will not — cover pre-existing conditions for a period of time.
The Division of Insurance provides a guide to understanding Discount Health Plans.
If you have been diagnosed or treated for a previous condition, illness, or injury, before you were insured, the health insurance carrier may not want to cover continuing treatment for that medical condition. The carrier does not want people to wait to purchase insurance coverage until they know they will need treatment. When a condition is already known to the consumer, the carrier may offer health insurance that covers other conditions that arise, but excludes treatment for anything that was pre-existing before the insurance was purchased. Naming specific illnesses, injuries or conditions that are “exclusions” on the policy means that the carrier will not pay for any treatment associated with them. Some individual health policies may allow coverage for the pre-existing condition after a certain time period (usually 12 months) has passed with continuous health insurance coverage.
An exclusion in your policy may also mean refer to anything the health insurance carrier will not cover, ranging from a type of drug to alternative treatments to a type of surgery. These exclusions can vary from policy to policy. A hospital stay may list a number of exclusions, sometimes anything “extra” that is not a medical necessity – from watching a rental television to using a hospital phone to deluxe meals – may not be covered. Cosmetic or elective surgery is often excluded, unless it is done in response to a medical condition. Dental treatment and vision needs are usually excluded unless treatment is required due to an accident or illness. If dental and or vision treatments are covered, it should be spelled out in your policy.
An exclusionary rider is a part of your policy that states when there are certain conditions or types of illnesses that will NOT be covered by your policy. The exclusionary rider eliminates coverage for any medical treatment associated with the medical condition or previously diagnosed illness specified on the rider.
Health Savings Account (HSA)
A Health Savings Account is a type of savings product that offers a different way for consumers to pay for their health care. HSAs are designed to encourage individuals to save money they may need for future health care expenses on a tax-free basis.
To be able to take advantage of HSAs, you must be covered by a qualified High Deductible Health Plan (HDHP). Because an HDHP generally costs less than what traditional health care coverage costs, the money saved on insurance can be put into the Health Savings Account.
People can sign up for Health Savings Accounts with banks, credit unions, and insurance companies, and sometimes their employers. The IRS has more information on the tax benefits and consequences of HSAs.
Limited Benefit Health Insurance Policies
“Limited benefit health insurance policies” can cost far less than traditional insurance, but cap what health insurance carriers will pay toward medical care. For example, the policy may pay $2,500 per person, per year, an amount that would be exhausted by a single trip to the emergency room. Some limited benefit health insurance policies have daily caps, such as paying a few hundred dollars a day toward hospital coverage. This differs from traditional health insurance, which generally covers most medical expenses in a given year, after deductibles and co-payments have been made.
Before purchasing a “limited benefit health insurance policy”, find out if you will be covered for hospital visits or routine doctor’s care and make sure you understand the all of the limits in the benefits provided.
Major Medical Health Insurance
Major Medical health insurance policies typically provide comprehensive coverage for hospital, doctor, x-ray and laboratory expenses.
Mandated Health Benefit
Mandated health benefits are benefits that are required to be covered by law. There are both federal and state mandated benefits. In Colorado (as in many states), the mandated health benefits may not apply to all types of health insurance policies or plans offered in the state. Some mandated health benefits are required of group health plans, but not of individual policies. If you have previously been covered by a group health plan, and are now shopping for individual health insurance, check carefully to see what the new policy covers. Many people assume that individual policies will have the same health mandates, and they may not. Covering some of these health mandates is optional for individual health policies.
There are some mandated benefits that are required by federal law, and there are some that are required by state law. Colorado statutes may mandate some benefits for certain types of insurance (benefits that must be covered by group plans, for example), that are not mandated for all types of insurance (such as individual coverage.)
If you have experienced an illness or disability for which you have been diagnosed, treated or advised, that is considered a “pre-existing condition.” When you apply for an individual health insurance policy, you will be asked to describe any pre-existing conditions or previous treatment. The health insurance carrier may decide to offer you health coverage with an “exclusion” for the specific condition, even if you are not currently experiencing problems. This means the carrier will not cover any medical treatment for the excluded condition. Failing to mention a pre-existing condition for which you have previously sought medical advice is a reason for the carrier to rescind or cancel your policy at a later date. It is always advisable to provide a full and complete medical history.
The amount paid to the health insurance carrier each month to purchase health coverage. The premium is paid by the policyholder on an individual policy. On employer group plans, the cost of the premium amount can be shared by the employee and the employer.
Reasonable and Customary Charges (also called “Usual, Customary and Reasonable” or UCR)
The cost associated with a health care service that is consistent with the going rate for identical or similar services within a particular geographic area.
Reimbursement for out-of-network providers is often set at a percentage of the “usual, customary and reasonable” charge, which may differ from what the provider actually charges for a service.
When an insurer disallows a portion of a charge as being in excess of the Usual and Customary allowance, it means only that the charge is in excess of the standard the company used to determine Usual and Customary, or UCR. Providers are free to charge whatever fee for service they choose. Your insurance coverage is designed to provide benefits up to the plan’s Usual and Customary percentile and is priced accordingly.
Your policy should contain a definition of Reasonable and Customary (or UCR) and explain how claims will be paid. If you disagree with the amount paid or if you believe a claim was denied improperly, there is a step-by-step process by which consumers may appeal the decision.
If you have questions or complaints about your insurance, please contact the Colorado Division of Insurance for assistance.
As is now the case with Social Security, we older folks will continue to depend on younger people to pay more to maintain our standard of living. Now the younger generations will be subsidizing our health insurance. See the article below published February 22, 2013.
By David Morgan
WASHINGTON (Reuters) – The Obama administration on Friday finalized new consumer safeguards for health insurance that impose tighter restrictions on what insurers can charge older customers, despite industry warnings that the young may be forced to pay more as a result.
The Department of Health and Human Services rejected an industry request to phase in a reform prohibiting insurers from charging older beneficiaries premiums more than three times higher than those available to younger adults.
The so-called 3:1 ratio, due to take effect in 2014 in the individual and small-group markets, is a cornerstone of consumer safeguards enshrined in the 2010 Patient Protection and Affordable Care Act. The law also bars insurers from policies that discriminate on the basis of gender and pre-existing conditions.
Health insurers, which often charge adults over age 50 far higher rates, had asked HHS to start out with a 5:1 ratio in 2014 and move gradually to the tighter 3:1 ratio over a number of years, saying too abrupt a change would cause rates for younger beneficiaries to skyrocket.
“The new restrictions on age rating will result in an overnight increase in health care costs for people in their 20s, 30s, and early 40s,” said Karen Ignagni, president of America’s Health Insurance Plans, an insurance trade association.
She and other industry executives have warned that higher costs could encourage young adults to forego coverage and thus deny the industry the younger, healthier customers that were supposed to keep costs down as the health insurance market implements President Barack Obama’s reform law.
The law imposes a financial penalty on most adults who fail to obtain coverage by January 1, 2014. But industry officials have complained that the fine may be too small to alter behavior, particularly if costs rise sharply.
“This increases the likelihood that younger, healthier people forgo purchasing insurance until they are sick or injured. When this happens, costs go up for everyone, young and old,” Ignagni said.
AHIP said people in their 20s and 30s could see insurance premiums jump 29 percent and 19 percent, respectively, while adults aged 50 to 64 receive reductions of between 5 percent and 8 percent.
The administration said in the 145-page regulation that its hands were tied by the healthcare law.
“We do not have the legal authority to permit any rating factors in the final rule other than those explicitly permitted (by the law),” HHS said. “Further, we do not have the legal authority to provide for a phase-in.”
U.S. officials contend that any pressure for higher rates would be mitigated by greater competition and federal subsidies that will be available for working families in the form of premium tax credits.
Consumer groups including AARP, the powerful lobbying group for older Americans, welcomed the decision.
“Implementing a limited use of age rating immediately thwarts what would have been a negative and disproportionate effect on Americans aged 50 To 64,” said AARP Executive Vice President Nancy LeaMond.
The Affordable Care Act, nicknamed “Obamacare,” is expected to provide health coverage for an estimated 38 million people after 2014. Most are expected to obtain subsidized private insurance via new online state healthcare marketplaces that are scheduled to start enrolling beneficiaries on October 1.
The administration is also working with half of the 50 U.S. states to extend the Medicaid program for the poor to cover adults living near the federal poverty level.
Aside from age, the law still allows insurers to vary premiums based on tobacco use, family size and geography. Other forms of discrimination based on gender, past insurance claims, occupation or the size of a small employer will not be permitted from 2014.
(Additional reporting by Caroline Humer; Editing by Ros Krasny and Dan Grebler)
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Below is an article published February 8, 2013 in the Northern Colorado Business Review by Molly Armbrister that attemps to answer this question.
With the opening day of the Colorado Health Benefits Exchange just months away, the big question is: will it be ready?
Thousands of state residents are expected to rush in to enroll, but a lot remains to be done in the next few months including overcoming IT issues, hiring personnel and approvals of insurers wanting to take part.
Officials with the exchange say they’ll be ready, but concerns have been raised about the enormous undertaking the exchange has become, both in terms of manpower and financial resources; more than $62 million in grants already have been dedicated to setting up the exchange.
Compared to many other states, Colorado’s exchange is far ahead. Only 18 states have taken steps toward setting up their own exchanges, which are mandated under the Patient Protection and Affordable Care Act.
Colorado was among the first six states to get federal approval for its exchange. The basic idea behind the exchanges is to create a more organized and competitive market for buying health insurance.
Exchanges will offer a choice of health plans. Not all will qualify, but those who purchase insurance via an exchange will be eligible for government subsidies.
The Colorado Health Benefits Exchange, or COHBE, is planning on opening enrollment when it begins operations on Oct. 1, the date mandated by the federal government for the exchanges to open. COHBE is planning on enrolling between 75,000 and 150,000 individuals within the first six months. Within two to three years, that number is expected to increase to 250,000, according to Jim Sugden, Small Business Health Options Program exchange manager for the COHBE.
The exchange is in the process of staffing up to deal with the volume, and plans on eventually having 50 to 60 customer-service employees, in addition to 25 or so to handle administrative and IT tasks. Along with hiring, the exchange is “moving methodically” through the rest of the tasks that lie between now and Oct. 1. “We do have the capacity to be ready, but there are a lot of different things to do,” Sugden said.
One of the biggest tasks is making sure the carriers that will be involved with the exchange get their plans approved by the Division of Insurance in time. The exchange is working with carriers to help them make it through the approval process. Carriers must comply with various regulations, as well as make sure that their plans are priced properly, Sugden said. The carriers will be able to submit their plans to the DOI beginning in March, with a deadline of May 1, according to Tom Abel, supervisor of the Rates and Forms section of the DOI. Regulators will have a deadline of July 31 to review the plans.
For its part, the DOI is holding meetings with carriers to make sure that filings are complete so that the process will be as efficient as possible, Abel said. The division will look at protections for consumers, rates and compliance with regulations in the plans. Between eight and 10 carriers have expressed interest in the exchange, Sugden said.
The exchange, meanwhile, is also assembling training curricula for its “navigators,” consumer advocates and other volunteers who will be responsible for helping people find the appropriate coverage on the exchange. Local insurance brokers will also be able to receive training, Sugden said. The COHBE is working with subcontractors that specialize in formulating finance-related training programs. Navigators and brokers must be well versed in the exchange and the plans offered through it. Health insurance has always been a confusing product for consumers, and with the added complication of government subsidies, matters only get trickier.
One of the other big challenges is establishing the technical backbone that will be needed to support the exchange.
While face-to-face and telephone assistance will be available to customers who need it, the exchange will function primarily online, in a manner that has been compared to finding airline and hotel tickets on websites like Expedia.com. Putting together such a system is no small task. To finance the effort, the state was given a $43.5 million grant from the federal Health and Human Services Department in September to provide the “resources to meet deadline for certification, testing and deployment of systems and operations,” according to the award language.
Coming up with the proper IT systems is one of the big concerns for Colorado Sen. Kevin Lundberg of Berthoud, who sits on the Senate Committee for Health and Human Services. Similar to the task of establishing any “significant IT system,” Lundberg said that he worries about the exchange’s ability to interface with Medicaid, anticipating that the system may experience problems similar to the Colorado Benefits Management System. CBMS is the state’s computerized benefits management system that has been plagued with issues for years. The system is used for other benefits, like food stamps, as well as medical aid. The system went online in September 2004 and immediately began experiencing difficulties; CBMS is still working out bugs today.
On the other hand, technology has made significant advances in the nearly 10 years since CBMS launched, and the state likely learned more than a few lessons from that experience. “The exchange could possibly be ready in time,” Lundberg said, “but I do have concerns.” The overall expense of the setting up the exchange is another concern of Lundberg’s. The $43.5 million grant is just the most recent chunk of money given to Colorado to set up the exchange. In February 2012, just under $18 million was awarded to the exchange to hire more staff and to begin forming the online infrastructure. Before that, $1.2 million was awarded for startup costs. In total, that is $62.6 million in grants so far.
Lundberg, a Republican, has his doubts about the long-term financial viability of the exchange model, and the Affordable Care Act in general. “The implementation of Obamacare may or may not be successful,” he said. “I do not expect it to be a long-term solution.” Advocates, of course, think otherwise.
The following articale was written by David Pittman, Washington Correspondent, MedPage Today and published February 05, 2013
WASHINGTON — Separate surveys released this week give dramatically different outlooks for two groups of people under the Affordable Care Act (ACA): the young, healthy worker and the part-time worker.
Premiums for a healthy, nonsmoking, 27-year-old in a “bronze” — or relatively inexpensive — small-group or individual policy would increase on average by 169% in five markets in 2014, a survey of major health insurers by the conservative American Action Forum (AAF) found.
Meanwhile, premiums for an unhealthy, 55-year-old smoker in a more generous gold-rated policy would decrease by 22%, on average, in those same five markets in 2014.
“The results surveyed above indicate that there will be massive sticker shock to the relatively young and healthy in both the small group and individual markets,” the AAF report said. Those increases essentially subsidize the ACA mandated coverage of sicker individuals and limits on variations in premiums between groups of insured such as men and women, the report noted.
ACA mandates coming in 2014 include the mandate for individuals to purchase insurance; minimal coverage requirements for insurers; coverage of pre-existing conditions for adults; limits on premium variation based on age, gender, health status, or group size; new fees and taxes; and other new rules.
The AAF sought to understand how these changes would play out in different markets. It sent a survey to an unspecified number of major insurers and asked them to forecast the ACA’s impact on small-group and individual plans in six cities.
Results showed premiums would increase for young, healthy individuals by an average of 190% in Milwaukee and 157% in Phoenix — the city with the lowest increase for the group.
To put a dollar amount on that, the average current monthly premium in Chicago, Phoenix, Atlanta, Austin, and Milwaukee is $2,047 for young, healthy workers in a small-group plan. The AAF survey found it will jump to around $5,124 in 2014 with the ACA changes.
However, premiums would drop 32% for older, less healthy individuals in Austin, Texas, the largest drop for the surveyed cities, and by 15% in Milwaukee, the smallest drop for a city.
Premiums for older, less healthy workers in a small-group plan in those same five cities would drop from $14,534 today to $10,706 next year, the AAF survey found.
Both groups of enrollees would be helped economically in some cases by federal tax credits available for those making between 100% and 400% of the federal poverty level, if they purchased insurance through a health insurance exchange.
“By eliminating or constraining these ‘rating factors’ that result in the variation in today’s market, the ACA in 2014 increases the premium for the young and healthier and lowers the premium for the older and sicker,” the AAF survey said. “The same would be true if there were a law reforming automobile insurance.”
The AAF survey didn’t specify which health insurers participated in its survey but did say it wouldn’t have published results without at least four respondents for each city. Albany, N.Y., was the only city it asked about whose results weren’t published.
On Monday — the same morning the AAF released its survey — Health and Human Services Secretary Kathleen Sebelius said the government must reach out to young people currently uninsured who may not know they can gain federal assistance to buy coverage through a health insurance exchange or marketplace. Young people are particularly tough to reach, she noted.
“If we’re going to fulfill the full promise of the Affordable Care Act and insure millions of Americans, we need to reach these people,” Sebelius said Monday.
Todd Hixon wrote the following thought provoking article for the 1/29/2013 edition of Forbes online.
The Health Insurance Company Is Your Friend
I’m serious about this, not just trolling for comments. Health insurers have developed a negative image, in many ways justified. But, the game is changing, and in the next period they will be more allies than enemies for both consumers and plan sponsors.
Why? The next decade will be about bringing U.S. health care costs back to earth. Healthcare expenditure is the main driver of U.S. budget deficits in the long run (more). It is imperative to dramatically slow the growth of healthcare cost, or the U.S. is Greece. And, healthcare spending in the U.S. is about twice as large, as a percent of GDP, versus other advanced countries, and results are not better in general. There are a number of reasons, however, the biggest drivers are over-utilization of advanced medical care, and the high earnings of the providers of that care (more).
The next era in healthcare is going to be the battle of the payers versus the providers. Health insurers are firmly on the side of the payers, and the payers need their help.
Providers have been preparing for this battle for years. In the 1990s the payers used “managed care” to squeeze lower charges from providers. Managed care enabled payers to channel customers to preferred providers and thus enhanced their bargaining power. This dynamic succeeded in “bending the cost curve” (= slowing the rate of cost growth) for most of the 1990s (see chart at right).
US Healthcare Expenditure in Constant 2010 Dollars: $/capita (blue) and Annual Growth Rate (red).
But, the strategy ran out of steam, in large measure because providers learned to fight back: they consolidated to create market power at the regional level. Early on this took the form of hospital mergers, like the merger of Massachusetts General Hospital and Brigham and Women’s that created Partners Healthcare in Boston, the leading (some say “dominant”) provider. Then hospitals began hiring primary care doctors and buying primary care practices, the referral sources for most advanced care. Today, 40%-50% of primary care doctors work for hospitals. This raises revenues two ways: hospitals can often charge more for the same service than independent doctors, and they gain control over referrals for hospital services (more).
Continue reading Will the Affordable Care Act Really be Able to Drive Costs Down?
Any time your health carrier denies benefits for covered services that you and your health care provider feel are medically necessary or have medical evidence proving that the services aren’t subject to a contractual exclusion, you have the right to challenge that decision. The decision to deny benefits is known as an “adverse determination”.
The State of Colorado Department of Insurance publishes a brochure as a guide to the rights you have when your health carrier says “no”. It contains summary information about standard and expedited utilization review, emergency services, “peer-to-peer conversations”, first level reviews, voluntary second level reviews, expedited reviews, and independent external reviews. Colorado law requires all health carriers subject to the state insurance laws to follow the same procedures.
Megan Lane, Director of legislative Services atColorado Health Institute, wrote the following blog giving us an update on issues facing Colorado Lawmakers in the new year.
The 2013 legislative session is off and running, and here at the Colorado Health Institute, we are happy to be back in action at the Capitol, helping policymakers to make informed decisions on important health care policy issues.
Legislators are sure to face a multitude of complex and controversial issues this session – everything from gun control and civil unions to child welfare reform and marijuana regulation. Yet health care is also likely to be a big topic.
At the outset of every legislative session, CHI does its best to predict the major health policy trends that will emerge. Here are our thoughts for 2013:
•Medicaid Expansion: Likely to be the biggest – and possibly the most controversial – health care policy issue. Colorado must decide whether to expand Medicaid eligibility to 133 percent of federal poverty level in conjunction with the Affordable Care Act (ACA). Governor Hickenlooper announced last week his intention to expand Medicaid, and several Democratic lawmakers have voiced their enthusiastic support of that plan. Yet when the Department of Health Care Policy and Financing presented to the joint House and Senate health committees yesterday, several Republicans expressed concerns about the long-term financing. (Hickenlooper has stated that he can fund the expansion without using any General Fund dollars through cost savings efforts within the program.) Meanwhile, Sen. David Balmer, R-Centennial, introduced a bill that would prohibit using K-12 funding to fund any portion of Medicaid expansion (although these monies have not yet been proposed as a funding source). Although it is still uncertain exactly what role the legislature will play in deciding whether to expand Medicaid eligibility, it is clear that this will be a major topic of discussion.
•Federal Health Care Reform Implementation: As the Affordable Care Act moves forward, many of the nuts and bolts of implementing the federal law will be left to the states. Within Colorado, some believe that our state insurance laws will need to be reconciled with the new federal requirements of the ACA. (For example, eliminating the lifetime coverage limit.) We expect the Division of Insurance to bring legislation that would “harmonize” current state insurance statutes with the new mandates of the ACA, enabling Colorado to maintain regulatory oversight of insurance plans when the ACA is fully implemented.
•Behavioral and Oral Health: Governor Hickenlooper has several proposals to expand mental and oral health services, many of which would require legislative action. The governor proposes adding a capped dental benefit for adults covered by Medicaid, as well as expanded Medicaid coverage for substance abuse disorders. He outlined a far-reaching plan to expand mental health services, proposing to update the state’s commitment statutes, which could lower the threshold for committing a patient involuntarily. We expect to see several bills on oral and mental health this session.
Other health care legislation to watch for: A bill establishing a health care co-op within Colorado, a bill eliminating the three-month waiting period for the Child Health Plan Plus (CHP+) program and a universal vaccine purchase bill to let the state purchase vaccines in bulk and distribute them to individual providers.
We’ll be tracking all the important health care bills closely throughout the session, and we will provide you with regular updates on the latest health care policies being debated at the Capitol. It promises to be an exciting session!
Below please find reprinted an interestiong article published in on-line in Businessweek by John Tozzi on January 11, 2013
The 69 percent of American adults who are overweight or obese and the 19 percent of us who smoke pay more for health insurance because of the risks associated. People with a body mass index of 30 or higher, considered obese, pay on average 22 percent more to buy health insurance in the individual market, according to data (PDF) released this week by eHealthInsurance.com, based on more than 200,000 policies sold through the online brokerage for 2012.
Tobacco users pay an extra 14 percent, though women who smoke pay even more: an extra $44 a month on average, or 22 percent more than nonsmokers.
This kind of price variation is most salient for people buying medical policies on their own or for small companies, because large employers have big risk pools. In a big enough company, the fitness buffs balance out the smokers. The good news for individuals and small businesses: 2013 is the last year insurance companies can charge people more for those extra pounds. The Affordable Care Act’s insurance market reforms taking effect in 2014 limit the factors underwriters can consider. Premiums can reflect the policy holder’s age, family size, geographic region, and smoking status. Insurers will still be allowed to charge as much as 50 percent more for lighting up.