Amendment to Release Religious Organizations From Contraceptive Mandate

The Senate is expected to vote on an amendment tomorrow that will keep religious employers from having to follow government mandates regarding contraception. This move was expected for a couple of weeks, and appears to finally be at hand.

Stay tuned for more.

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Health insurance California
There are a lot of health insurance options in California, so take the time to investigate your options. Visit a website to get quotes from all the major carriers, compare them, and then apply.

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Dental Insurance Versus Dental Discount Plans

Which is the better option if you need dental services because of tooth pain? Neither option will probably allow you to see your regular dentist, because dentist's primarily take PPO plans, and PPO plans have waiting periods. So you'll have to choose an HMO dental insurance plan or a discount plan. Both HMO and discount will seem to be identical to most people because they ultimately offer you a savings off the regular prices a dentist charges.

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Improving Cardiovascular Health

Palomar Pomerado Health will be holding a free education program to help people improve their cardiovascular health. The program will teach attendees about risk factors and making lifestyle changes. The program is presented by Dr. Charles Hardison and will be held at the Pomerado Outpatient Pavilion Education Classroom
15611 Pomerado Road, Poway, CA 92064

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Anthem Blue Cross Announces Rate Adjustments May 1st, 2012

Blue Cross of California today announced that rates on individual and family health insurance plans will be adjusted starting on May 1st, 2012. Notices to plan members should go out during March. How much the increases are we don't know yet.

Stay tuned for more.

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Health Insurance Companies Moving To New Payment Scheme

Several major health insurance companies, Aetna, United HealthGroup, and WellPoint, will begin paying selected primary care physicians higher fees for improved patient care in an effort to reduce long-term health care costs. Consumers will be the winner of this new payment scheme by fewer hospital visits and improved health.

Stay tuned for more.

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Although "Doc Fix" Bandaid In Place, No Long-Term Solution In Sight

Legislators went home for the President's Day weekend with a patch in place to prevent Medicare doctors from getting hit with a 27.4% pay cut. However, that bandaid will only last until December 31, 2012. What will they do then?

This problem started back in 1997 as part of a deficit reduction plan that used a formula to set Medicare physician payment rates. A few years later it became obvious that the formula was not going to work, and the yearly "Doc Fix" struggle began. A simple fix is difficult because the total cost to correct the problem is $316 billion over the next decade and nobody can agree on where that money is going to come from.

Physicians are also guilty of being part of the problem because they are paid for each test or service they provide, rather than for the health of the patient. This drives medical costs up. So a fundamental change in the overall structure of the health care system is needed.

Stay tuned for more.

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Maternity Health Insurance in California: At the Crossroads

Maternity health insurance will be changing in California starting on July 1st, 2012. On that date all health insurance plans in California will be required to provide maternity care. The insurance companies have yet to publicly state how they will approach this, but a few rumblings have been heard.

Blue Cross is rumored to simply add the maternity care to all existing plans, while changing the name of the new maternity plans, and grandfathering all existing plans that currently do not have maternity care. Blue Shield is rumored to be working on an entirely new portfolio of health plans.

Aetna is a company that may have the most interesting response to the maternity care mandate, because none of their plans currently offer maternity care. Will they add this to existing plans, will they create new plans, or will they exit the California individual health insurance marketplace?

Stay tuned for more.

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Medicare Payment Fix To Cost Smokers, Obese, and Poor

The new legislation to fix the yearly Medicare doctor payment hole was passed by Congress and the House, and will be signed by President Obama this week. The legislation is not without costs however. To pay for the increased payments to doctors that treat Medicare patients, the administration will take money from a fund to help prevent smoking and obesity, and reduce payments to hospitals that treat large numbers of poor people.

What was that last one? Cut money going to hospitals that treat poor people? Won't that make it worse for those hospitals and the patients they treat?

I guess it decided that poor people don't vote as much, so the government will protect Medicare for the seniors that vote, and stick it to the poor people. Wow! That's government at it's finest!

Stay tuned for more.

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Hospital Use of Electronic Medical Records Soars

Over 35% of all hospitals now use electronic records to better manage the care of patients according the Health and Human Services department. This is up from 16% in 2009, and is driven by incentive payments from Medicare and Medicaid.

"Health IT is the foundation for a truly 21st century health system where we pay for the right care, not just more care," said Sebelius.

The emphasis on electronic medical records will help in the early detection of disease outbreaks and enable the measurement of effective treatments across all providers that use the new medical IT system.

Stay tuned for more.

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Optometrist's Rise Up Against Health Care Reform

Health Care Reform appears to have overlooked the optometrist that takes care of your eyes. The insurance exchanges, that are to be the health insurance hub of the post 2014 health care reform economy, have no provision to include information about vision insurance plans. This worries optometrists.

Vision plans are the norm in the employer benefits marketplace, and these plans enable employees to get eye care and vision correction through glasses and contacts. Optometrists worry that with no connection to the exchanges, their industry will be left on the sidelines, and their patients will suffer as a result.

I empathize with them, but I also know that standard health insurance plans allow patients to see an Ophthalmologist to have their eyes checked and get vision prescriptions. Seeing an Ophthalmologist typically costs more than seeing an Optometrist, so from a cost control standpoint it's not ideal.

Stay tuned for more.

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The 3 Pillars Of Health Care Reform

True health care reform has to be based upon 3 core parts of the health care system. The 3 pillars are healthy lifestyle reform, health care delivery/treatment reform, and health care payment reform. Each is vital to the success of any changes.

Life style reform is something that each of us controls. Our diets, our activity levels, and willingness to use preventive screenings. Health care delivery reform involves the coordination of our medical information and treatment strategies so that we eliminate duplicate and un-needed tests, while ensuring that our full medical records are available to all medical professionals when needed. Health Care payment reform involves changing the way medical services are paid for, such that necessary "wellness" and "sickness" prevention drive the delivery of monies, instead of the amount of treatments and tests.

Stay tuned for more.

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Blue Shield of California To Provide Credits

Blue Shield of California subscribers in Department of Managed Health Care (DMHC) plans will get a one-time credit of 62% applied to their April coverage bill. The credit is the result of an agreement Blue Shield made with the DMHC to help reduce the costs for DMHC subscribers.

Stay tuned for more.

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Final Guidelines For New Health Insurance Plan Benefit Descriptions Published

The Federal Health and Human Services department issued the final guidelines that large employers and health insurance companies must use to describe the benefits provided in health plans. The deadline to have the new documents complete is Sept 2012.

Beginning in September, the new plan descriptions will provide a 6 page summary of the plan information, such as co-pays and deductibles, along with estimated out-of-pocket costs for delivering a baby, and caring for Type 2 diabetes.

This new information should make it easier for consumers to select plans that will result in lower costs for their health care, by standardizing the information that each plan provides. Thereby making apple to apple comparisons a little easier.

Stay tuned for more.

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Medicare Needs Doctors To Serve Patients

The "Doctor Fix" that is being worked on in Congress is just the tip of the iceberg of what is starting to happen in the Medicare industry. More and more physicians are realizing that serving America's older patients is a money losing practice, and they are not taking any new Medicare patients. This will leave an increasing number of new seniors without adequate healthcare, as the physicians left in the Medicare program will have increasingly larger patient loads, and therefore less time spent with each senior.

Congress is taking a very short-sighted view of this problem, and scrambling to put a small bandaid on the issue for this year. Hoping to just pass the problem on to the future. Well the future is here now, because the number of people reaching 65 is expected to climb dramatically for the next 20 years. Welcome to hell Congressman...

Stay tuned for more.

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Congress Still Trying To Fix Medicare Doctor Payment Hole

Congress is wrapping up new legislation that aims to extend the payroll tax cut and unemployment insurance, and they attached a provision to protect payments to Medicare physicians to the bill. The hope is that enough legislators will overlook the "Doctor Fix" and vote only on the payroll tax and unemployment insurance parts of the package. House Republicans indicated that they intend to split the "Doctor Fix" portion from the rest of the bill, but said that it was too early to know how it would play out.

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How Does Mental Health & Addiction Treatment End Up In Health Care Reform?

The federal government has empowered each state to define their own set of health care standards that all insurance plans within that state must meet by 2014. This provides flexibility to the states to define the minimum benefits of plans offered in each state, but almost guarantees that each state will be different than the others. These differences will prevent insurance plans from being able to serve multiple states and will shrink the pool of people in each plan. This also leaves mental health and addiction treatment in the hands of bureaucrats.

Making the treatment of mental health and addiction part of the minimum benefits for all plans will provide relief to millions of untreated individuals. By providing care within the health insurance policies, the needed therapies can lessen the emergency room visits and help to transition these sufferers into productive citizens again. Let's make sure they are not forgotten.

Stay tuned for more.

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Revised Birth Control Plan Won't Affect California

The revised plan to make health insurance companies provide free birth control to employees of religious organizations won't change anything in California. California already requires all health insurance plans that provide prescription benefits to include contraceptive services for free.

Stay tuned for more.

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Obama Health Care Rules Back Down From Catholics

The Obama administration yesterday changed a new health care rule that would require all religious organizations to provide free contraceptive coverage for their employees, even if it went against the religious beliefs of the organization. The change now stipulates that the insurance companies have to provide free contraceptive care to employees of religious organizations, rather than the organization itself.

This maneuver helped to soften the fallout from the previous rule, which religious groups were vehemently against. The only push back over the new rule was from the insurance industry, which worried that they would not be allowed to factor this new benefit into their prices for plans. The price effect should be small, but the primary concern of the insurance industry was the precedent this new rule would set, and worries that this would lead to new "unfunded" benefits by regulators.

Stay tuned for more.

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New Health Care Tax Will Raise Premiums For Everyone

A new report by the actuarial firm Millman Inc. says that the new tax on health insurers' premium revenues will be passed on the consumers, and will cause problems with state Medicaid programs. The premium tax was intended to help pay for coverage of the 32 million uninsured Americans, and will be paid by all insurance companies, but under federal law the state and federal governments have to pay the tab for their Medicaid programs.

So let's see, there's a new tax on health insurance that we will have to pay because the insurance companies will pass the tax on to us in increased premiums, AND, the tax that is paid on the Medicaid program expenses (which we already pay through our income taxes) will also have to be paid by the state and federal government revenues (aka our taxes). Hmm....Sounds like we get hit with the full cost of the "health care tax". Who's bright idea was that! Oh yeah...our government. Brilliant!

The insurance industry trade group (AHIP) said that they believe consumers should be exempt from this tax that increases health care coverage costs. I agree.

Stay tuned for more.

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The Feds Slap California's Hand Over Medi-Cal Copays

Governor Brown's plan to charge low-income patients for medical care they receive through the Medi-Cal program were rejected by Federal health officials. The copays were part of Governor Brown's budget balancing on it was hoped that the state would save $296 Million by having poor people make co-payments for medical services.

Legislative advocates applauded the Federal health officials, and warned that imposing copays on poor people would worsen the problem by making them avoid the health care system entirely, until an emergency occurred.

Stay tuned for more details.

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Pregnant Without Insurance : A 3 Step Plan

If you are pregnant and have no insurance, or your insurance plan does not offer maternity coverage, here is a simple 3 step plan to get the coverage you need.

1. Call your Medi-Cal office to determine if you qualify for the California Medicaid program.
2. Call the Aid for Infants and Mothers (AIM) program office to see if you qualify for this program.
3. If 1 and 2 don't work, the talk to a health insurance broker about the Pre-Existing Condition Insurance Plan (PCIP California). This plan will cover you if you are already pregnant, but you must have been uninsured for 6 months. There are a few limited benefit plans that can tide you over if you don't immediately meet the 6 month criteria. Call us for more details.

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ObamaCare Stubs Toe On Catholics

The new change in the Health Care Reform package, that removes the exemption religious organizations had with respect to providing birth control as part of their employee health insurance plans, has angered many in the small Democratic block that helped pass the health care reform bill. Previously church organizations were allowed to exclude any benefits that were against the religious beliefs of the organization, but the new rules do away with that exemption.

Many religious schools, non-profits, and hospitals will now have to provide health services that go against their beliefs. This has caused many to indicate they may decide to drop health care plans for their employees instead of following the new rules.

Oh what a fickle web we weave when first we practice to deceive. Oh well, stay tuned to see what happens next.

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Congressional Republicans Working New Health Care Reform Package

Congressional republicans have not given up on getting Obama's Affordable Care Act repealed or at least rendered in operative. Republicans have started working on a new version of health care reform to replace the ACA, which they feel is very flawed. The details of the new Republican plan are not worked out yet, but word has it that medical liability reform and allowing health insurance companies to sell policies across state borders are part of outline the Republicans are working on.

Stay tuned for more details.

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New Single Payer Health Plan For California?

The California Senate is working on a revamped version of a single payer health plan for all Californians. The estimated cost of the plan is $210 billion, more than 2 times the size of the entire state budget for 2011. This sounds like a program that is busted before it even starts because there is NO WAY to pay for the cost of the plan.

However, cost and not having the money has never slowed down the California government in the past, so why should now be any different. Even though the state is struggling with ongoing budget deficits, state Senators think they can find twice as much as they currently have for just a single program. Good Luck with that!

Stay tuned for more.

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Health Insurance And "The Law Of Large Numbers"

Insurance companies know that a small percentage of people will get cancer each year. What they don't know is who will get it. The law of large numbers says that an insurance company can accurately control their risk by insuring as large a pool of people as possible. The larger the pool is, the better their prediction will be regarding how many people in the pool will have any specific health issue, so the better they can predict their expenses and keep costs lower.

This is the reason why the health insurance mandate is needed. By spreading the risk of expensive health problems across a larger number of people, the cost for each person is kept lower.

Stay tuned for more.

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Majority of Americans Don't Like Health Care Mandate

In a new Kaiser Health Tracking Poll, a majority of the participants did not like the mandate which would require everyone to have health insurance.  The poll showed that 67% did not want the mandate, and 54% want the Supreme Court to strike down that provision of the Affordable Care Act.

What this tells me is that the industry needs to better explain the reason why the mandate is the only way to prevent health care costs from spiraling out of control when health care reform kicks takes effect in 2014.  Americans don't seem to understand the "law of numbers" concept that rules all insurance products like home insurance, liability insurance, and of course, health insurance.

Stay tuned for more details.

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Anthem Blue Cross of California Announces HIPPA Rate Adjustment

Anthem Blue Cross of California announced that effect April 1st, 2012 they would adjust the pricing for their Individual HIPAA and Conversion plans.  These rate adjustments are done once each year.  Members affected by the adjustments will be notified by mail.

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