Health Insurance Reform

I agree with your first recommendation totally. But how would you keep the insurance companies from making the cost of this insurance so high that people with pre-existing conditions can't afford it?

Would you recommend cost caps?

Massachusetts adopted your number 1 reform and has many other mandated insurance regulations that other states don't have.  Consequently, insurance rates in Massachusetts are among the highest in the nation, making it unaffordable for many of it's citizens. Yet, the state now imposes fines for those who are not in compliance with what they deem "minimal coverage". Average monthly costs for insurance for a family is $1,200 to 1,600 per month with typically $1,000 to 3,000 in deductibles and $5,000 to $10,000 in co-insurance.  Plus tiered co-pays for dr. visits, prescriptions, emergency room, hospital stays, surgery and on and on and on.  It begs the question, just what do you get for your money?????

Many people in Mass. feel that the insurance co.'s have benefited the most from these regulations.  My husband feels we're slaves to insurance co.'s and their CEO's who make millions off us.  I personally know people who have insurance that's not in compliance with the minimum coverage because they can't afford it, and it's cheaper to just pay the fines.  In addition, the state is making it more and more difficult for competitive insurance companies to even offer less expensive coverage that doesn't meet the minimums.  I know that very soon the insurance I currently have will no longer be available to me, the company will have been run out of the state.  

SherriG I fear you're correct regarding the impact this is going to have on state budgets. Who will pay? Those of us in the middle, that's who.  We make too much to qualify for aid yet the costs are driving us into bankruptcy. Higher taxes, fines and surcharges are their only resource.  

Here's one small example:  just recently my insurance co. made a mistake and denied coverage on one of my chemo bills to the tune of $13,000.  When Mass General sent me the bill, they also sent a separate bill for a "surcharge" (tax!) that is collected on behalf of the state on any single procedure costing over $10,000.  This surcharge goes into a "pool" to fund the Massachusetts Health Care Safety Net.  I was so mad I could spit!  I appealed my insurance, won and now feel like giving them the famous Archie Bunker raspberry!

With national health care reform we can expect more of the same for sure!  Sorry if I rambled, this is such a strong issue.  I agree there needs to be reform but I don't have confidence that our politicians are making the right decisions on our behalf.

6.  Encourage healthy living education, and diet control.

7.  Encourage exercise.

Good luck with that. 

If, as some say, they don't want the government in control of healthcare, I sure as heck don't want the government trying to tell me what to eat and how much to exercise. Talk about personal freedoms. Those are about as personal as you can get.

Encourage? Ok, your doc does that now. Do we really need or want the gov doing it? I don't

Just my opinion.

Sherri G, you make a good point.  I could imagine some funny scenarios involving  Fitness audits and, well, just how much did you spend at Dunkin Donuts?  

Is anyone really hoping the "Food Pyramid" is as far as this is going?  Does anyone wonder if a government-sponsored health plan could charge a "Fat Tax"?  Does anyone doubt whether the government could mandate "fitness audits" and require people to demonstrate "healthy behaviors" as a condition of paying lower insurance premiums?

It's already happening: http://www.alseib.org/HealthInsurance/SEHIP/HealthWatch/WellnessWatch.aspx

The changes have attracted a lot of attention -- like this:  "Obese Alabama State Employees and Those with Other Risk Factors Could Pay More for Health Insurance Starting in 2011": http://www.al.com/news/birminghamnews/index.ssf?/base/news/121930653285600.xml&coll=2 

"Obese state employees and those who have high readings for blood pressure, cholesterol or glucose will have to pay more for health insurance starting in January 2011, unless they take steps to address those risks, under a plan adopted by a state board Wednesday.

Starting in Jaunary 2010, state employees will have to pay an extra $25 a month for health insurance unless they submit baseline readings for their weight, blood pressure, cholesterol and glucose.

Starting in 2011, they will have to pay the extra $25 a month unless a work site wellness screening shows their readings fall below certain thresholds or they consult with a doctor, participate in a wellness program or reduce their risk levels, perhaps by losing weight or lowering their blood pressure.

The changes will affect 37,555 active state agency employees covered by the State Employees' Insurance Board, which unanimously approved the changes."

Here's more: 

"Alabama to Link Premium Costs to Workers' Health":  http://www.cnn.com/2008/HEALTH/diet.fitness/09/19/alabama.obesity.insurance/index.html

"Alabama 'Obesity Penalty' Stirs Debate -- Plan Calls for State Employees to Pay More for Health Insurance if They Don't Lose Weight":   http://www.webmd.com/diet/news/20080825/alabama-obesity-penalty-stirs-debate

And, from FOX News, a more comprehensive view:  "Alabama Plans to Tax Fat Employees to Recoup Insurance Costs":  http://www.foxnews.com/story/0,2933,414861,00.html

State employees' health insurance premiums are pretty low in Alabama, so an extra $25 a month isn't a huge expense.  Just add it to the $25 you'd already be paying if you were a smoker.  (Technically, that's not a "tax" on smoking.  People who sign an affidavit testifying that they do not smoke get a $25 discount.)

The state insurance board insists these are not "penalties or "fines".  People are not being charged higher premiums because they have special risk factors or they're demonstrating unhealthy behaviors.  The board claims they're offering people incentives, to "encourage healthy living."

otter

Does anyone remember years ago when "health insurance" was only for in hospital items.  Women had babies IN the hospital and stayed several days, for example.   The patient paid the doctor with no insurance coverage, unless treatment was IN the hospital, such as surgery.   ER visits were paid in full by insurance.  It was called "hospitalization" insurance.   

Somewhere along the line, health insurance came to include eye exams, dental visits, and ALL doctor visits, with some co pays.   ER visits required co pay unless you were admitted to the hospital.   

I am not sure how it all got changed or when.  Maybe because I was "healthy" and did not require much more than an annual physical and I was "young"...    I also do not expect the insurance companies to change their way of doing business, since they have been adding more and more "clauses" and terminology to make it almost impossible for an average person to properly compare one policy from another.   I was duped into thinking I was covered for most medical tests and care needed, but I found out what I had only paid out (almost to the penny) what I had paid in up to that month of the year.   To clarify - I had an MRI for cervical disc disease - they paid very little after my required co pay.   Then I had a mammo - one that led to BC dx - and they paid NOTHING, because the cost of the MRI was over and above the amount of premiums I had paid in for the year.   I know, very confusing.  

The killer was that I still owe over $ 8000 for my first chemo treatment and scans, tests, biopsy, doctor visits - a year and a half after my first chemo.   And I had a "good" insurance plan.

Now I am faced with no insurance because the plan I have (HIGH premiums, but pays most of my costs) is being discontinued Feb 1.    I do not qualify for Medicare until 2011.    

Thanks for letting me rant and rave.  And I have too much in my IRA - goodness, I worked and saved and planned for retirement -- to qualify for any reduced coverage or assistance....    

Whatever bill passes, it is unlikely to see any changes till 2011-2013 or beyond. It just won't be soon enough for people who are in need.

Anne