Health-Insurance Exchanges Are Falling Behind Schedule
Here is an article published recently in the Wall Street Journal that cites areas of concern for those of us who support the Affordable Care Act.
By LOUISE RADNOFSKY and SARAH E. NEEDLEMAN
Government officials have missed several deadlines in setting up new health-insurance exchanges for small businesses and consumers—a key part of the federal health overhaul—and there is a risk they won’t be ready to open on time in October, Congress’s watchdog arm said.
The Government Accountability Office said federal and state health officials still have major work to complete, offering its most cautious comments to date about the Obama administration’s ability to bring the centerpiece of its signature law to fruition.
“Whether [the government’s] contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,” said the GAO in twin reports to be released Wednesday.
The 2010 Affordable Care Act created two exchanges, seeking to provide coverage for many Americans who now go without health insurance. President Barack Obama has said the exchanges will be ready on schedule in October, offering coverage to take effect Jan. 1, 2014, but he has cautioned that “glitches and bumps” are likely.
Around two million people are projected to receive insurance through the small business exchanges and seven million people will be enrolling in the individual insurance exchanges in 2014, according to the Congressional Budget Office.
The small-business exchanges in particular have had some early setbacks. The federal government said in April that contrary to initial plans, it wouldn’t allow workers in the first year to choose between a range of insurance options offered through employers. For the first year, companies will select one plan to offer to workers.
In some states, only one insurance carrier has expressed interest in the small-business exchange. In Washington state, officials have had to postpone the exchange altogether because they couldn’t find a carrier willing to offer small-business plans for all parts of the state.
Seventeen states are running their own small-business exchanges, with the federal Centers for Medicare and Medicaid Services carrying out the task on behalf of the remaining 33 states.
The GAO report on the small-business exchanges said officials still have big tasks to complete including reviewing plans that will be sold and training and certifying consumer aides who can help companies and individuals find plans.
It said that the 17 states running their own exchanges were late on an average of 44% of key activities that were originally scheduled to be completed by the end of March. “While interim deadlines missed thus far may not impact the establishment of exchanges, any additional missed deadlines closer to the start of enrollment could do so,” the report said.
The Obama administration has long said that it expects to be ready on Oct. 1. “We have already met key milestones and are on track to open the marketplace on time,” said Joanne Peters, a spokeswoman for the Department of Health and Human Services.
“This GAO report confirms our suspicions about the implementation of the health care law,” said Rep. Sam Graves (R., Mo.), chairman of the House Committee on Small Business. “With each passing day it appears the creation of the exchanges are very much in doubt.”
The administration has welcomed signs that the growth of health-care costs has tempered recently. Some economists believe that may be partly due to the new health law encouraging more cost-effective care. The Labor Department said Tuesday that its price index for medical care fell a seasonally adjusted 0.1% in May, the first monthly drop in almost four decades.
The administration and liberal groups are stepping up efforts to prepare people to enroll for coverage. For the economics of the exchanges to work, they must attract healthy people to balance the risk of those who have chronic diseases.
Enroll America, an administration-backed nonprofit group, opened its “Get Covered America” campaign Tuesday. “We are at a place where…78% of the uninsured aren’t even aware of what’s coming their way,” said Anne Filipic, the group’s president.
Republicans who oppose the health-care law are poised to highlight any glitches in the rollout, and many believe implementation of the law could be a key issue in 2014 elections.
Regulators in New Hampshire have said they received applications from only one carrier, Anthem Blue Cross and Blue Shield, a unit of WellPoint Inc., WLP +0.36% to sell small group plans or individual policies through the exchange next year.
Small-business owner Nancy Clark of North Conway, N.H., said she was disappointed more carriers didn’t apply because Anthem is already one of just two carriers that doctors in her area accept.
“I was hoping more [insurance] providers would step up to the table,” said Ms. Clark, whose firm, advertising agency Glen Group Inc., has 10 employees and has offered benefits to full-time staff since 1997 to attract and retain talented workers. “I had these rose-colored glasses on, thinking that doctors in our area would then accept more insurance plans, truly giving everyone a choice.”
Ms. Clark said she also worried that without more carriers in the exchange, the cost of a group health plan wouldn’t stabilize or go down as she had anticipated. She said her premiums have increased every year by double digits despite her work force’s good health.
Some Democratic members of Congress also are beginning to express concerns about particular aspects of the law relating to employers. Sen. Joe Donnelly of Indiana, who voted for the law as a member of the House, on Wednesday is expected to become the first Democrat who backed the law to support changing a requirement that larger firms must provide coverage to employees working 30 hours a week or more, his staff said.
Joe Trauger, vice president of human resources policy for the National Association of Manufacturers in Washington, D.C., said the trade group’s 12,000 members are “deeply concerned” about the lack of information available about the state exchanges. “It comes up in every meeting I’m in,” he said.
Backers of the law say that over time, competition between carriers and new restrictions barring insurers from setting small group premiums based on members’ medical history will keep costs in check for business owners and enable them to keep offering coverage.
Michael Brey, president of Brey Corp., a toy retailer in Laurel, Md., that does business as Hobby Works, said he was looking forward to being able to shop for a small-group plan from a variety of carriers through his state’s exchange. Currently he can choose from just three carriers. “I have some degree of confidence that it will be a good move for us,” he said.
Mr. Brey also said he expected to get a better deal through the exchanges. He covered 100% of the cost of premiums for his staff when he bought the business in 1992, but he said he can only afford to contribute 50% now, and only for full-time employees.
—Jennifer Corbett Dooren contributed to this article.
Write to Louise Radnofsky at email@example.com and Sarah E. Needleman at firstname.lastname@example.org
- Published in Affordable Care Act, Colorado State Initiatives, Federal Law Changes and Mandates, Individual Health Insurance
Subsidies Cost Calculator for Colorado Individual and Families Health Insurance
Beginning in 2014, many individuals and families will be eligible to receive subsidized coverage through Connect for Health Colorado if they are not eligible for Medicare, Medicaid or the Children’s Health Insurance Program and are not offered affordable coverage through their employer.
Here is Connect for Health Colorado’s Cost Calculator for Individuals and Families.
Notes: This calculator shows expected spending for families and individuals eligible to purchase coverage in the Exchange under the Affordable Care Act. Under the law, maximum contributions to premiums will be based on modified adjusted gross income, while estimates in this calculator are based on the annual income entered by the user. Actual premiums in the Exchange are not yet known. The premiums in this calculator reflect national estimates from the Congressional Budget Office for silver plans, adjusted for premium inflation and age rating.
Miller Hudson Explains What You Need to Know About Healthcare Costs
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.
- Published in Affordable Care Act, Colorado State Initiatives
New Database to Help Coloradans Shop for Best Priced and Effective Medical Procedures
In my opinion, the single most important factor in the ever increasing cost of medical care is clients’ inability to obtain competitive pricing for medical treatments and their lack of knowledge/confidence in choosing the best option. Is the knee MRI offered by one provider for $297 really as good as the same test offered by someone else at $1261?
According to an article published November 2, 2012 in the Denver Post, the new Colorado All Payer Claims Database will shine a harsh spotlight on health price differences that can not be justified.
Organizers claim the database will be Colorado’s most accurate reflection ever of costs actually paid by consumers, insurance companies and government plans. Many other listings have focused on “charges” — the retail prices for health care rarely paid by large insurers or the very poor.
By late next year, another leap in data will allow consumers and analysts to compare actual costs for various services on a hospital-by-hospital or doctor-by-doctor level, with the provider named and open to questioning.
Cost experts estimate $750 billion, or about 25 percent, of U.S. health care spending is unnecessary and driven by waste, misuse or overuse. That waste won’t be cut until consumers can shop accurately for health care, and providers can see how others deliver care more efficiently, database promoters said.
By late 2013 or early 2014, consumers should be able to use an interface showing, for example, their share of cost and the insurer’s share for a colonoscopy at specific hospitals within a 20-mile radius. A side-by-side column would also show a quality rating for each facility, taking into account factors like how many post-surgery infections occurred at that hospital.
I believe that if this new database can live up to these projections, it will have a huge impact on lowering medical cost.
- Published in Colorado State Initiatives
Autism- What is Covered by Health Insurance in Colorado?
Broadly speaking, the Colorado Autism Insurance reform Law(C.R.S. 10-16-104), which went into effect July 1, 2010, applies to all children under the age of 19.
Plans must provide at least $34,000 of coverage per year for applied behavior analysis from birth to age nine. Plans must provide at least $12,000 of coverage per year for applied behavior analysis a child nine years of age or older until the child is 19.
- Published in Colorado State Initiatives, Individual Health Insurance
Essential Health Benefits-What Do You Want vs. What Are You Willing To Pay?
The Affordable Care Act requires Americans have access to quality, affordable health insurance. To achieve this goal, the law requires health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer a comprehensive package of items and services, known as “essential health benefits.” Essential health benefits must include items and services within at least the following 10 categories:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management, and
- Pediatric services, including oral and vision care
The challenge now facing the Colorado Department of Insurance is what additional, if any, benefits they will require the new policies to contain. Each state is empowered to devise their own list.
Here is a partial run down of additional requirements being consider in other states and of course, each benefit has a very active advacacy group pushing for inclusion:
Acupuncture (now a requirement in California)
Pre-vacation visits to travel clinics (whatever this is, apparently it will be required in Colorado)
Bariatric Surgery (stomach reduction)
Each of these services is, of course, very dear to a segment of the population. The question before the Department of Insurance is “is it reasonable to require all health insurance policy holders to pay higher premiums for these benefits, when they may or may not be “”essential””?
Here is an excellent article written by the Washington Post on this subject.
Colorado Continuation/Conversion is a state law that assures an employee who leaves a company with less than 20 full time employees and has been covered by the firm’s health insurance plan for 6 continuous months, a continuation of their health insurance coverage for up to 18 months, except in cases of “gross misconduct.” For an employee leaving a Colorado based company with more than 20 employees, the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) applies.
The ex-employee will be responsible for the full premium (the combination of that which the employer and the employee were previously paying) plus a small administrative cost.
Within 10 days of termination, the employer must sent written notice to the employee of the right to continue. The employee then has an “Election Period” of 30 days from termination to notify the employer of acceptance.
If after this period the employee decides they do not want to accept Continuation coverage, they owe nothing. However, if they do decide they want to accept the coverage, they will owe premium back to their last day of employment.
One concern with smaller companies is that if the firm goes out of business and/or cancels their health insurance plan, this whole option disappears for the ex-employee.
Colorado Continuation/Conversion is a form of “group health insurance” and generally cannot exclude coverage for pre-existing conditions. However, because of this, the premiums are much higher than a relatively healthy person or family could obtain with an individual policy.
If you would like to know more about your options, please give me a call at 303-541-9533.
- Published in Colorado State Initiatives, Individual Health Insurance, Misc
How is my Newborn Covered by My Health Insurance in Colorado?
Under Colorado law, your child will automatically be covered by your (father or mother) insurance plan for the first 31 days of life, without notification or payment of premium.
If you do notify your plan of the child’s birth within the first 31 days, he or she will automatically be added to the plan going forward. As no new underwriting is required, this law is to assure coverage in the case that the child is born with problems.
Of course, you will be charged extra premium in the same manner you would for any new dependent.
Want to know more about it? Please give me a call at 303-541-9533
- Published in Colorado State Initiatives, Individual Health Insurance, Misc