« November 2007 | Main | February 2008 »

January 31, 2008

Labor Unions Against California Health Insurance Mandates

The "most vociferous opponents" of the California health care reform legislation, which the state Senate rejected on Monday, "were not fiscal conservatives but labor unions that launched a last-minute revolt against its most crucial feature: an individual mandate that would have forced everyone to buy coverage," Shikha Dalmia, a senior analyst at the Reason Foundation, writes in a Wall Street Journal opinion piece. Dalmia writes that "many California unions argued that a mandate would force uninsured, middle-income working families to divert money from more pressing needs toward coverage whose price and quality they cannot control."

She adds that the failure of the California legislation has "national political implications." According to Dalmia, although Democratic presidential candidate Sen. Hillary Rodham Clinton (N.Y.) has "denounced" rival Sen. Barack Obama (Ill.) for "refusing to include an individual mandate in his health care plan," he "seems to understand the perverse side effects of an individual mandate." Obama is "surely correct that part of the reason 45 million Americans are uninsured is not that no one is forcing them to buy it but that they can't afford it," Dalmia writes.

In addition, the recently implemented Massachusetts health insurance law, which served as the "inspiration" for both the California legislation and the Clinton proposal, "has inflated demand, which, combined with onerous regulations on insurance suppliers, has triggered premium increases of 12%" for 2008, according to Dalmia. She writes that Massachusetts "won't be able to fully shield those it subsidizes from the premium increases" and that "uninsured folks who don't qualify for government help really get pounded."

Live in California? Want cheap health insurance? click here for your free instant California health insurance quote!

Posted by healthinsurance at 04:09 PM | Comments (0)

Health Care Marketplace | California Regulators Issue $3.5M Fine

California health insurance regulators on Tuesday issued a $3.5 million fine against PacifiCare, a subsidiary of UnitedHealth Group.

The state Department of Managed Health Care issued the fine after a joint investigation with the state Department of Insurance found PacifiCare from July 1, 2005, through May 31, 2007, had more than 130,000 alleged claims processing violations. State regulators said that PacifiCare improperly denied 30% of claims reviewed during the investigation. In addition, they said that PacifiCare often delayed reimbursements to physicians and hospitals for more than 30 days.

Complaints against PacifiCare increased significantly in early 2006, when UnitedHealth acquired the company. The $9.2 billion acquisition increased UnitedHealth membership by about three million to 27 million. David Hansen, regional chief executive for UnitedHealth, on Monday in a meeting with the Los Angeles Times said that the company should have made fewer changes to PacifiCare at the time of the acquisition.

PacifiCare spokesperson Tyler Mason said that the company has taken "aggressive steps" to address the problems cited by state regulators. He added that PacifiCare has added 50 full-time employees to address claims processing issues. PacifiCare officials have not decided whether the company will pay the $3.5 million fine or pursue an appeal, Mason said.

State Might Issue $1.3B in Additional Fines
California Insurance Commissioner Steve Poizner on Tuesday said that the California insurance department might issue additional fines against PacifiCare for the alleged claims processing violations. Poizner said that fines for each alleged violation would range from $5,000 to $10,000.

According to the Wall Street Journal, additional fines could "theoretically add up to between $650 million and $1.3 billion," but "several analysts said additional fines would likely be far lower given the amounts traditionally levied in California." The state will issue the maximum fine only in the event that "authorities prove all the violations and show they were committed as part of a deliberate scheme."

More Audits
Poizner on Tuesday also said that the California insurance department will begin audits of the eight largest health insurers in the state to address alleged claims processing violations similar to those found at PacifiCare, the Union-Tribune reports. The eight health insurers include Aetna, Blue Shield of California, Cigna, HealthNet and WellPoint, among others. Representatives from WellPoint, which operates Blue Cross of California, and Blue Shield declined to comment on the audits.

Poizner said, "The actions today get at the very core of how our health care system operates. When a consumer gets sick, they expect their health insurance company to be there for them to pay legitimate claims to doctors and hospitals." He added, "I want to send a clear message to every health insurance company in California that I won't tolerate any company deploying a shoddy claims filing system"

Want cheap California health insurance? Click here for your FREE quote now!

Posted by healthinsurance at 08:19 AM | Comments (0)

January 30, 2008

California Health Care Reform Bill Rejected

A California Senate panel voted 10-1 late Monday, January 28, to reject comprehensive health care reform crafted by Republican Gov. Arnold Schwarzenegger and Democratic Assembly Speaker Fabian Núñez. The panel action came just over a month after the Assembly approved a compromise bill hammered out by Schwarzenegger and Núñez.

Monday’s vote’s also canceled a companion ballot initiative that would have provided the funding for the reforms, including employer health care coverage spending requirements and an increase in the cigarette tax and fees paid by hospitals to support increases in provider reimbursement from the state’s Medicaid program.

Provisions in the compromise bill—aimed at bringing health insurance coverage to most of the state’s nearly 7 million uninsured—would require most state residents to obtain health insurance, while the state would subsidize premiums for lower-income state residents.

Employers would have to spend a specific percentage of payroll on health care for employees or pay into a pool that would be created to provide coverage for the uninsured.

The cost of the reforms was projected at more than $14 billion, roughly the size of the deficit the state faces this year. Before Monday’s vote on the bill, Núñez challenged the committee to come up with a better reform measure.

“I would challenge the members of the Senate to come up with a plan that’s doable, and that can withstand the same type of scrutiny [the proposal] was put through in this committee, the same kind of analysis by the Legislative Analyst, that is going to respond to the needs of those poor families who have absolutely no health care today,” Núñez said in testimony at the panel hearing Monday.

Meanwhile, Gov. Schwarzenegger is evaluating his next move, according to a spokeswoman.

“The fact that the Senate missed a golden opportunity to pass health care reform doesn’t change the governor’s commitment to fixing California’s health care system,” the spokeswoman said. “Keep in mind that in Massachusetts, it took Gov. Romney three years to push the concept of individual responsibility across the finish line.”

Need cheap health insurance? Californians click here for your free quote now!

Posted by healthinsurance at 11:54 AM | Comments (0)

January 23, 2008

California health care in critical condition

Sen. Sheila Kuehl (D-Santa Monica) stopped by the Los Angeles Times this week to discuss health care reform. Kuehl will hold a hearing today on the Nunez-Perata health care bill, which is supported by Gov. Schwarzenegger. The Assembly has already passed the bill. If Senate also approves it, an initiative providing funding for the new system will be put on an upcoming ballot for voter approval. Kuehl spoke about her skepticism of the bill and support for a single-payer system.

Sheila Kuehl: The bill has an individual mandate; every Californian would be required to buy health insurance. The minimum creditable coverage would be established by the Medical Risk Management Insurance Board, fondly known as MRMIB... MRMIB exists today. They essentially are tasked currently with finding insurance for un-insurable people. They have a waiting list that would go around this building, because they can't find sufficient insurance. But that's their job.

Eryn Brown: When I was reading over this a few months ago it seemed as if they didn't have jurisdiction over all the plans, that it was only some. So if they're determining minimum coverage would that be for all people in California or just for people in certain pools?

Sheila Kuehl: That's a good question. They are not allowed to say that employers have to buy certain plans. However, you would not satisfy the mandate unless you bought a plan that was the minimum creditable coverage. I think what they're trying to do — I mean, this give Rube Goldberg a new name for simplicity. It's much more complicated than any Rube Goldbergian machine that used to appear in this paper many many years ago. So they might offer plans that don't meet the minimum creditable coverage, but if you bought them you wouldn't have satisfied your mandate. So it's quite confusing.

Eryn Brown: "They" would be the insurance industry?

Sheila Kuehl: Correct. The thought being that young men who won't get pregnant and think they're going to live forever don't want to buy all these things because policies are mandated to cover pregnancy; they're mandated to cover diabetes, etc. Minimum creditable coverage would include all of those mandates in the state. Theoretically no policy can be offered in the state now that doesn't include all those items. So you would be required to buy an insurance policy. Employers would be required to spend a certain percentage of their payroll on insurance. And there are a certain number of things they can deduct from their percentage if they contribute to the employees' health, things like gym memberships. That is a real loophole, in my opinion... What we found when we studied workers comp in California is that some employers categorized some employees as independent contractors. Independent contractors don't count toward your payroll. It potentially is a way that employers could reduce their burden, by increasing the number of employees they categorize as independent contractors. Some of that happened with workers comp, but this is a big bite for employers. They might say, "I can't do this. You're an independent contractor now."

Click here for your free California health insurance quote now!

Posted by healthinsurance at 10:01 PM | Comments (0)

January 22, 2008

State's health care overhaul could cost taxpayers billions

The proposed overhaul of California's health care system could cost taxpayers billions of dollars in unanticipated expenses within five years of being launched, according to a review released tonight by the Legislature's nonpartisan analyst.

Legislative Analyst Elizabeth Hill, warning that Gov. Arnold Schwarzenegger and other proponents of the legislation may have under-estimated the cost of providing care to millions of uninsured Californians, said that hundreds of millions of dollars in federal support is also uncertain as is the number of people who may need state support.

The report comes on the eve of a critical hearing about the bill before the state Senate's health committee, set for Wednesday.

The overhaul legislation, AB 1X was approved by the state Assembly in December, but senators have been skeptical of its cost and workability. The warnings from Hill may provoke even more concerns.

"If it doesn't pass my committee, if we don't approve it - the governor will be out there saying that the state Senate killed health care reform," said Sen. Sheila Kuehl, D-Santa Monica, chair of the health committee and a critic of the proposal.

"But the headline should be that the senate refused to put out a bad health care bill," she said.

The $14 billion overhaul proposal would mandate virtually all Californians to have insurance. Employers would be required to cover their workers or pay into a state pool for purchasing insurance at a cost between 1 percent and 6.5 percent of company payroll.

There would be a fee on hospitals and a $1.75 tax on a pack of cigarettes to help pay for coverage of an estimated 6.8 million Californians who lack insurance.

The fees and taxes would go before voters in November, if approved in the Legislature.

Steve Maviglio, spokesman for Assembly Speaker Fabian Núñez, D-Los Angeles and author of the health care bill, called the analysis "thorough" but said the speaker and legislative analyst disagree on some aspects.

Californians, click here for your free health insurance quote. Click now for the best deals!

Posted by healthinsurance at 10:19 PM | Comments (0)

January 20, 2008

Governor's health care bill faces long hearing, close vote

SACRAMENTO—Gov. Arnold Schwarzenegger's $14 billion health care expansion bill moves to the Senate, where it will face an extended hearing this week and the likelihood of a close vote in the Health Committee.

"This is not a slam dunk," said Sen. Leland Yee, a San Francisco Democrat who could end up being the swing vote on the measure.

The bill passed the Assembly in December, but the Senate put off consideration to give the Legislature's budget analyst, Elizabeth Hill, time to report on the bill's costs.

The Health Committee will take it up Wednesday with a hearing that the chairwoman, Sen. Sheila Kuehl predicts will stretch from midmorning into the evening.

The panel will hear from Hill, take a look at health care experiments in other states, examine the bill piece by piece and take testimony from supporters, opponents and those on the fence looking for amendments.

"There are going to be a lot of witnesses," said Kuehl, D-Santa Monica.

The legislation would require employers to spend a certain percentage of their payrolls on health coverage for their workers, either by buying policies themselves or paying into a state health insurance pool.

Most Californians who couldn't obtain coverage through jobs or a government program would be required to buy insurance on their own.

The plan would be funded through employer contributions, fees on hospitals and an increase in cigarette taxes, in addition to premiums paid by consumers. Administration officials also are counting on getting additional federal funding to expand health care programs for the poor.

Supporters say the proposal would provide coverage for most of the 5.1 million Californians who lack health insurance and force insurers to take all customers instead of denying coverage because of pre-existing conditions.

"This is fundamental reform...," said Assembly Speaker Fabian Nunez, D-Los Angeles, who negotiated the legislation with Schwarzenegger and is carrying the bill.

Californians, click here for your free health insurance quote today!

Posted by healthinsurance at 08:25 PM | Comments (0)

January 19, 2008

Insider Tips for Californians to Lower Health Insurance Premiums

Pick PPO

If you are covered by an HMO policy, immediately change your coverage to a PPO plan.

In California, HMO plans are substantially more expensive than PPO plans. With an HMO plan you may or may not have a deductible, but you will still make co-payments for office visits and other preventive services. With a PPO plan you, not the HMO, can select your doctor. I recommend changing to a PPO plan to save an average of 40 to 80 percent.

Increase Your Deductible

The cost of medical services in California has made your deductible nothing more than a down payment on your real financial exposure - your annual maximum out of pocket cost or expense. As an example, if you or a family member were to go to the hospital as an outpatient for a series of medical tests, the cost would range from $15,000 to $25,000, even though you were classified as an outpatient. In this example, no matter the size of your deductible, you would pay the annual out of pocket cost maximum, making the size of the deductible financially meaningless. I recommend that you increase your low deductible policy to one with a deductible at or near your annual maximum out of pocket cost, and save from 60 to 80 percent.

Separate Family Policies into Individual Policies

By separating policies into individual plans you will be able to customize your overall insurance coverage to reflect your specific needs. As an example, men between the ages of 18 to 35 usually do not go to the doctor as often as women in the same years; therefore, an annual physical would probably be sufficient. In addition, young children visit the doctor more frequently than their parents and may need a plan with more complete well baby office and other benefits. By separating family policies into individual policies, you may be able save 20-50 percent.

Select a High Deductible Health Savings Account (HSA) Qualified Plan

The requirements in 2008 for an HSA qualified health insurance policy are that the minimum deductible is $1,100 for an individual, and $2,200 for a family. The annual maximum out-of-pocket cost is $5,600 individual, and $11,200 for a family. With this type of insurance coverage you pay for all of your medical expenses, with the exception of your annual physical and annual OB/GYN exam, up to the amount of your deductible. The real benefit to you is that once you achieve your annual deductible/maximum out of pocket costs, all future medical expenses will be paid by the insurance company. Doing this can save you up to 35 or even 50 percent.

Want your free health insurance quote? live in the great state of California? Good, now click here. It's that easy!

Posted by healthinsurance at 08:35 PM | Comments (0)

January 17, 2008

Kids’ health plan in California saves big bucks

A new study found that providing health insurance to children through the local Children’s Health Initiatives saves California taxpayers in nine counties $7 million a year by preventing more than 1,000 unnecessary hospitalizations.

The study comes at an advantageous time for supporters of universal children’s health insurance, who fear momentum for guaranteeing coverage to all children may be waning in light of a $14 billion state budget shortfall and fading enthusiasm for comprehensive statewide health reform.

“It’s exactly the thing we need,” said Kena Burke, director of the San Luis Obispo County Children’s Health Initiative. “It demonstrates that when you put your dollars in the beginning, the kids stay healthier.”

Children’s Health Initiatives in 25 counties, including San Luis Obispo, boost enrollment in public programs, Healthy Families and Medi-Cal, in addition to offering their own insurance, Healthy Kids.

Healthy Kids is for children in families who don’t qualify for state and federal programs because their families earn too much or because of their immigration status.

The study released Monday by the Center for Community Health Studies at USC’s Keck School of Medicine compared preventable childhood hospitalizations in nine counties before and after the implementation of the Children’s Health Initiatives.

The study was funded by The California Endowment and First 5 Association of California.

Live in California, and want to save big bucks? Click here now, for your free health insurance quote!

Posted by healthinsurance at 06:40 PM | Comments (0)

January 16, 2008

California court rules against insurer over policy cancellations

A California appeals court ruling may bode well for physicians and patients in their fight against alleged illegal policy cancellations by health insurance companies.

A three-judge panel of the 2nd District Court of Appeal unanimously ruled that the practice of reviewing individuals' applications after they have submitted claims and then pulling the coverage based on alleged errors "is flatly prohibited" under state insurance laws. The Dec. 4, 2007, decision gave the green light to a patient's class-action lawsuit alleging that Blue Shield of California tried to dodge claims by looking for supposed misstatements or omissions on patients' policy forms after approving treatment.

The ruling comes amid heavy scrutiny of various health plans' cancellation practices by state insurance regulators. Also, physicians and hospitals have turned to the courts.

The California Medical Assn., along with a group of hospitals, is suing Blue Cross of California to block alleged similar tactics. Blue Cross declined to comment on the case.

Physicians and lawyers involved in the issue say the recent decision signals that the courts are paying attention and are willing to hold insurers accountable.

"This is a good sign for patients and doctors," said CMA spokeswoman Karen Nikos. "The court has spoken and said that taking insurance away from patients is wrong, and we look forward to seeing [the Blue Shield] case go forward with this sentiment."

Not only are patients left uncovered when insurers pull policies, but doctors also are left uncompensated for authorized care they had provided in good faith, Nikos said. "It's a complete breakdown of the physician-patient relationship when patients have their insurance wrongfully taken away."

Blue Shield spokesman David Seldin called the appeals court ruling a "narrow" one and just one step in the litigation process. The company asked the court to reconsider its decision, and the 2nd District on Jan. 3 granted its request. No hearing date has been scheduled.

Live in California? Click here for your free health insurance quote today!

Posted by healthinsurance at 07:56 PM | Comments (0)