Insurance Blog

Insurance can be expensive but it's worth it. A report by the New York-based Commonwealth Fund estimated that 84 million adults in the US have inadequate health care coverage. Families are foregoing care because they cannot afford it, even with the implementation of the AffordableCare Act in January 2014. The under-insured and uninsured will just be transferred to an inferior plan with huge out-of-pocket costs.

The federal health law that will take effect next year is expected to raise insurance premiums, especially for people who purchase their own insurance, expert said.

The law will mandate that plans increase their minimum benefits, and it will ban insurers from weeding out people already diagnosed with illnesses.

Health and Human Services Secretary Kathleen Sebelius said to reporters that "Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law."


Her remarks come weeks before insurers are expected to begin releasing rates for plans that will start on Jan. 1, 2014, when key provisions of the health law kick in.

Some insurers have already begun signaling that they could dramatically increase prices for people buying policies in the individual market to compensate for restrictions on how they treat consumers, as well as new fees and requirements that they provide bigger benefits packages, reported by The Wall Street Journal last week.

The Society of Actuaries also issued a warning that the cost of medical claims in the new individual-insurance market could rise by an average of 32% per person over the first few years the law is in place.

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A 3-month old baby boy in Nebraska was separated from his parents for 100 days because their insurance company refuses to pay for their baby to be moved.

The baby is in Presbyterian St. Luke’s Hospital in Denver, while his parents live in Lincoln, Nebraska, and have been forced to commute to see their son every other weekend.

Julius James Frack was born on December 30, 2012 weighing one pound, six ounces and was only 12 inches long.

Jennifer and David Frack weren't expecting the baby to arrive soon but had complication with her pregnancy while visiting family in Sydney, Nebraska, after Christmas.

Doctocs in Sydney said that the mom needed needed specialized care and arranged for her to be flown to Presbyterian St. Luke’s Hospital in Denver. Because Julius was so small, he was rushed to the hospital’s NICU.   

The mom healed in a few weeks and was allowed to go home but the baby was too fragile for long drive. Howerver, the parents need to go back to work. And since December, the parents has been spending too much money to drive back and forth from Lincoln to Denver every other weekend.

Fracks asked to have Julius moved since the commute is too much. Doctors told the parents that the baby needs to be transferred by helicopter and doctors at Presbyterian St. Luke’s Hospital helped them fill out paperwork but their insurance company denied the request.

The Fracks’ insurance company, Blue Cross and Blue Shield of Nebraska, released a statement that said, “In general, when our nurses and physician reviewers look at cases such as this, the decision to cover a service is based on whether a ‘medical necessity’ exists,” said Dr. David Filipi, Chief Medical Director, Blue Cross and Blue Shield of Nebrask

source: http://kdvr.com/2013/04/14/parents-separated-from-baby-for-100-days-over-insurance-decision/#ooid=9kOHB5YTqKX8XQn55UgtnqXYpYBIbLXu

The Wall Street Journal reports that a number of companies would rather pay government's penalty to break the law and it will be cheaper for them than following it.

Under the Obamacare provision that goes into effect next year, employers with 50 or more full-time workers will be required to provide coverage for employees who work an average of 30 or more hours a week in a given month. An alternative to that mandate is for business owners to pay a $2,000 penalty for each full-time worker over a 30-employee threshold.

Rick Levi owns Consolidated Management based in Des Moines, Iowa that runs cafeterias at schools, offices and jails in 10 states. The law would require him to offer insurance to all of his 102 full-time employees starting in January. Assuming all of them take the coverage, Mr. Levi says the cost of premiums could exceed $500,000 per year if every employee takes the insurance plan. The penalty will cost him around $144,000.

"I've never made a profit in any year of the company that has surpassed that amount," says Mr. Levi, 62 years old. "I don't make enough money."

He says it makes more sense to drop insurance entirely and pay a penalty of about $144,000.

The Obama administration and Republican officials in several states are exploring ways to redirect federal money intended to expand Medicaid, the main public insurance program for the poor, and use it instead to buy private health insurance for Medicaid recipients. The approach could have important benefits for beneficiaries and for the future of health care reform. But the idea also carries big risks. Federal officials will need to enforce strict conditions before agreeing to any redirection of Medicaid dollars that were originally intended to enlarge the Medicaid rolls.

The Supreme Court ruled last year that the states could decide whether they want to expand their Medicaid programs to cover more of the uninsured; they can’t be required to do so, as the health reform law intended.

The law provides hugely attractive financial incentives for states to add more people. The federal government will pay 100 percent of the cost of caring for newly eligible enrollees for the first three years, tapering to 90 percent in later years. Even so, some state officials, mostly Republicans, are proposing that the very generous federal financing for expansion be used instead to pay the premiums of poor people on new electronic health care exchanges, created by the reform law, where people can shop for subsidized private insurance.

Private insurance obtained on the exchanges could help poor beneficiaries in several ways. They would be less vulnerable to disruptions every time their incomes fluctuated above or below the boundary line that determines whether they are poor enough to qualify for Medicaid, where they would see one array of doctors, or slightly better off and eligible for subsidized insurance on the exchanges, where they might see a completely different group of doctors. Providers would be paid the same amount whether treating a Medicaid recipient or a privately insured patient, potentially creating a wider network of doctors for Medicaid patients. And some poor residents of states resistant to expansion, who would otherwise be frozen out by a glitch in the reform law, could gain coverage through the exchanges.

But the main benefit would be political in that it could engage Republicans in the whole health reform effort, make it easier to carry out the law and reduce the appetite among Congressional Republicans to gut the law.

There are at least two big caveats. The switch would be likely to increase costs for the federal government, and ultimately state governments, because private insurance is almost always more costly than Medicaid. That could force a cutback in the number of people covered because the money won’t go as far. There is also a risk that poor people will end up with fewer benefits and higher cost-sharing on the exchanges despite regulations that should prohibit that.

Federal officials must be vigilant in ensuring that recipients on the exchanges receive the same services and same cost-sharing limits that they would under an expanded Medicaid program. State officials who don’t want to play by those rules would be better off using the generous federal dollars as originally intended — to expand their Medicaid programs to cover many more of their uninsured residents.

nytimes.com