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April 29, 2008

California Above U.S. Average for Health Insurance Cost Increases

The cost of health insurance premiums for coverage through private-sector jobs increased more than 10 times faster than employees' incomes from 2001 to 2005, according to a report released Tuesday by the Robert Wood Johnson Foundation, the Washington Post reports (Washington Post, 4/29).

In California, health insurance costs for the average family increased by about 34%, from $7,898 in 2001 to $10,551 in 2005, according to the study. During that period, salaries increased by about 9% on average for California workers.

California's jump in health insurance costs gives it the 12th-largest increase in the nation. The national average increase in health care costs was 30%, according to the study (Colliver, San Francisco Chronicle, 4/29).

Study Methodology

Researchers from the State Health Access Data Assistance Center at the University of Minnesota analyzed data from the U.S. Census Bureau and the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality to compile the report (Forster, St. Paul Pioneer Press, 4/28).

The information was released in conjunction with National Cover the Uninsured Week (Anstett, Detroit Free Press, 4/29).

National Findings

According to the report, monthly premiums for family coverage increased 34.6% from $1,921 in 2001 to $2,585 in 2005, while median family income rose 3.1% from $40,818 to $42,068 during the same period (Washington Post, 4/29).

The report also found that employees nationwide are paying a larger percentage of their insurance premiums -- 24.1% in 2005 compared with 23.2% in 2001 (Park, Arkansas Democrat-Gazette, 4/29).

According to the report, the number of people with private coverage dropped by about 6% nationally, while the number of private-sector employers who offered health insurance declined by 0.8% nationally (St. Paul Pioneer Press, 4/28). Premium increases contributed to 2.4 million fewer U.S. residents with private health coverage in 2005 than in 2001, according to the report (Krouse, Cox/Raleigh News & Observer, 4/29).

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Posted by healthinsurance at 04:16 PM | Comments (0)

April 24, 2008

Insurance reinstatement orders put health plans on edge

Last week’s move by state regulators, opening the door to restoring health insurance to thousands of customers who had their coverage cancelled by health plans, has the health care world waiting to see what will happen next.

The plans say they are still waiting for word from the Department of Managed Health Care about which 26 customers have been ordered to have their health care coverage restored. Thousands of other cases will be reviewed by an arbiter, selected by the department.Representatives from various health plans said they expect the broader review of these cancellations to be challenged in court. Though none would speak for attribution, they said they are waiting to see the details of the process established by the department before commenting on any potential legal action.

The department ordered the reinstatement of 26 patients who had their health coverage cancelled by Blue Cross, Blue Shield and Kaiser. More reinstatements may be ordered as the department winds up its investigation of HealthNet and PacifiCare.

Blue Shield and Kaiser said the department made the public announcement before revealing to the plans which patients were being reinstated. It was unclear whether the plans would fight those specific reinstatements.

“We are in the process of contacting them,” said DMHC spokeswoman Lynne Randolph. She said the DMHC had contacted the health insurance plans for information on cases, and would issue the formal reinstatement orders shortly. “We should have it wrapped up by the end of the week,’” she said.

DMHC Director Cindy Ehnes said her office would review cancellations between 2004 and 2008. “Every single rescission will be reviewed by this department,” Ehnes said, adding that patients would be compensated for their costs in the event the rescission was flawed. “For the first time, we are giving people a second chance to get that health coverage,” she said.

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Posted by healthinsurance at 02:38 PM | Comments (0)

April 22, 2008

California Health Insurers Must Reinstate Policies

Chalk one up for sickly patients. California regulators have ordered insurers there to reinstate the health insurance policies of 26 people who lost their coverage after the insurers claimed they had lied on their applications, according to news reports. The 26 cases represent the most egregious examples of insurers wrongly "rescinding" policies, typically for inadvertent errors. The person gets sick and starts making expensive claims, and the insurer cries "fraud!" The patient says "forgot!" or sometimes "say what?" For example, one woman I spoke with on this topic had answered "no" when asked if she'd been treated for cancer in the past 10 years. Later her policy was yanked because the insurer claimed that regular blood work she had to ensure her earlier cancer hadn't returned constituted cancer treatment.

Now California begins a case-by-case review of thousands of rescissions in the past four years, and it may be that these 26 are the tip of a fairly hefty iceberg. And consumer advocates say there's no reason to believe this issue is confined to California. They expect similar cases to begin emerging elsewhere.

These problems arise in the individual health insurance market, where people buy policies on their own. That market is much more loosely regulated than the group market—and often more problematic for patients—as I discussed a few months ago.

Right now, only about 5 percent of people buy insurance this way. But if Sen. John McCain has his way, many more would very likely start buying insurance on their own. The presumptive Republican nominee has proposed eliminating the tax break that employees currently get on their health insurance benefits and instead giving people a tax credit of $2,500 for individuals and $5,000 for families to put toward buying coverage. I also wrote today about the presidential candidates' healthcare reform proposals.

Many policy analysts see merits to the restructuring that McCain proposes, but they argue that without better regulation of the individual market, people who are older or sick won't be able to get affordable health coverage, or any coverage at all. They point to what's going on in California as an example of the kind of problems that can occur. "Look at the rescission mess in California," said health policy analyst Robert Laszewski, when I interviewed him for the election health reform piece. "The Democratic nominee will stand up and say, 'John McCain will throw you to the market wolves.' " McCain is expected to elaborate on his healthcare reform proposal at the end of April. Maybe at that time he'll offer details about how he plans to protect consumers from predatory insurance practices.

As for this rescission mess, I'd like to hear from people who've experienced problems similar to what's occurring in California. Is this just a left coast phenomenon, or is it happening elsewhere, too?

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Posted by healthinsurance at 02:38 PM | Comments (0)

April 17, 2008

Los Angeles Files Lawsuit Alleging Anthem Blue Cross Illegally Canceled Health Insurance Policies

Los Angeles City Attorney Rocky Delgadillo on Wednesday filed a lawsuit against Anthem Blue Cross alleging the insurer violated more than 25 state and federal laws and "sold people false promises of coverage and concealed a scheme to renege on policies for those diagnosed with serious and often expensive medical conditions," the Los Angeles Times reports. Delgadillo claims the insurer issued false promises of coverage and concealed a plan to rescind the health insurance policies for patients diagnosed with serious and costly medical conditions. The suit seeks restitution for patients left with medical bills and more than $1 billion in penalties.

The lawsuit claims that the company's coverage "is largely illusory." Delgadillo said Anthem "engaged in an egregious scheme not only to delay or deny the payment of thousands of legitimate medical claims but also to jeopardize the health of more than 6,000 customers by retroactively canceling their health insurance when they needed it most." He added, "Countless Californians who believe they have good health insurance actually have policies that aren't worth the paper they're printed on."

The charges cited by the suit include some allegedly illegal activities reported by a Times article highlighting the rescission of policies held by individuals with costly medical conditions. Jerry Flanagan, a patient advocate with Consumer Watchdog, said, "The complaint makes it very clear that a key part of the resolution will be to make sure everyone has coverage."

Cindy Ehnes, director of the state Department of Managed Care, on Thursday is expected to announce that rescinded policies of several individuals would be reinstated by health care plans and to describe a process by which other patients could have rescissions reviewed and reconsidered. State Insurance Commissioner Steve Poizner said he would examine the allegations and decide whether action is needed.

A spokesperson for Anthem's parent company, WellPoint, said the company "strongly disagrees with the allegations" and plans to defend itself. "Anthem has offered on several occasions to meet directly with the city attorney to provide further information on Anthem's rescission procedures," said Shannon Troughton of Wellpoint. "To date, the city attorney rejected each of these offers, and we are disappointed by his actions today because of our attempts to meet with him," she added.

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Posted by healthinsurance at 11:53 AM | Comments (0)

April 11, 2008

Two health-care rescission bills make way through Assembly

The battle over how and when health plans can cancel a patient's insurance policy returned to the Capitol this week as two key pieces of legislation cleared the Assembly Health Committee.

At issue are the rules health insurance companies must abide by before they cancel a patient's health care coverage.

"In the five years that we have records, there have been about 700 rescission per year," says Hector De La Torre, D-South Gate, author of one of the bills passed out of Health Committee this week. "This bill would make it so those rescissions would have to be reviewed by a third party before they can happen."

Under current practice, health plans have the authority to unilaterally rescind a policyholder's insurance if they find there has been a "willful misrepresentation" of the patient's medical history on their initial health care application. De La Torre's bill would force health plans to seek approval from a third-party arbiter before an enrollee's health insurance policy can be revoked.

A number of high-profile cases in recent years have found that health insurance plans have improperly revoked policies from insurance holders for accidental omissions on their health insurance applications.

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Posted by healthinsurance at 05:43 PM | Comments (0)

April 08, 2008

Report links deaths in California to lack of insurance

A report by a national health advocacy group says at least eight Californians die every day because they lack health insurance or have insufficient coverage.

The study, conducted by Families USA, says an estimated 3,100 adults died in California in 2006 because they lacked health insurance, could not afford care or received substandard or late care because of a lack of insurance.

The report follows a three-year study by the National Institute of Medicine that linked roughly 18,000 deaths annually to a lack of insurance in the U.S.

Families USA, based in Washington, D.C., says its report is the first to link deaths to a lack of health insurance on the state level.

The group says the uninsured are less likely to have regular physician visits and more likely to put off the medical care they need. They also receive less health care once they are in hospitals and often cannot afford prescription medication to control chronic illnesses.

Californians, click here for your free California health insurance quote now!

Posted by healthinsurance at 04:32 PM | Comments (0)

April 03, 2008

Many Asian Americans in Sacramento County lack health insurance

Even while her stomach was killing her, Melelea Tausinga remained the heart and soul of Sacramento's Tongan community.

She counseled troubled teens, was the water mom for Tongan rugby teams and danced everything from Tongan classics to her favorite, "The Electric Slide."

But Tausinga never went to a doctor because she didn't know where to go and felt she couldn't afford it anyway, her husband said.

Tausinga, who died Oct. 25 of stomach cancer at age 51, was among tens of thousands of Pacific Islanders, Korean Americans and Southeast Asians without health insurance.

These ethnic groups "are doing much worse than other subgroups in terms of health insurance and access to health care," according to a study of Asian Americans released Tuesday by the Kaiser Family Foundation and the Asian & Pacific Islander American Health Forum.

Korean Americans, Native Hawaiians and Pacific Islanders are less likely to be insured than other Asian American groups such as Japanese or Asian Indians and twice as likely to be uninsured as whites, according to an analysis of national health data from 2004-2006.

The disparity is particularly acute in California, home to a third of the nation's Asian Americans and Pacific Islanders, said Cara James, the foundation's senior policy analyst for race and ethnicity.

"People who do not have health insurance delay much needed medical care, are more likely to forgo care because of costs, and when they do finally show up for care the conditions they have are often far more severe," James said. "They are more likely to show up with late stage cancer."

That's what happened to Tausinga, said her husband, Tevita Tausinga, who won't shave his beard or change his black clothes until his wife has been gone a year.

"She was almost everywhere, and she always followed the kids, who came by the hundreds to see her before she died," he said.

Melelea Tausinga, mother of four and grandmother of seven, not only gave herself to her community, she worked for more than 10 years as motel maid, then as teaching assistant at Susan B. Anthony Elementary, where her granddaughters attend. Neither job provided health insurance.

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Posted by healthinsurance at 01:32 PM | Comments (0)