Posts Tagged ‘insurance’

In an effort to curb healthcare spending, some insurance companies have tried to increase copays for outpatient visits in an effort to decrease the overall rate of visits to the doctor’s office. However, a new study from Brown University published in the Jan. 28 issue of the New England Journal of Medicine is showing that this strategy has some unintended consequences. After looking at some Medicare managed care plans that implemented such copay hikes between 2001 to 2006, the researchers noted an increase in hospital usage. Although these plans had 19.8 fewer annual outpatient visits per enrollee, they consequently had 2.2 additional hospital admissions and 13.4 more inpatient days per 100 enrollees. And as we all know being hospitalized is PRICEY. The authors estimate that by increasing outpatient copays in the short term Medicare plans might save $7,150 per 100 enrollees, but inpatient spending would swell by $24,000 per 100 enrollees in the year after the co-payment increase, thus not really saving any money at all. [via Medline Plus]

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The big news in U.S. health care came early Monday morning (1 am to be exact) as a 60-Senator majority  agreed upon their plan for health care reform. The Senate bill would make health insurance mandatory for almost all citizens of the union, covering nearly 30 million currently uninsured Americans. But, if there is any indication as to whether this most recent bill favors the American individual or the private, for-profit insurance companies all one needs to do is to look towards the ticker. Shares of major U.S. health insurance companies rose Monday, including Aetna, Cigna, Humana, United Health and Wellpoint – all hitting 52-week highs. According to Businessweek, “Investors have been worried for months that a public option would provide unfair competition to private insurers in part because it would receive government financial backing and could set reimbursement at artificially low levels.” But, worry no more since the lobbying efforts of these companies continue to pay off as lawmakers continue to pass bills that put our money into the pockets of insurers rather than spending the majority of it on caring for our health. [via Businessweek]

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As you may know, the latest news in the US health care reform debate is whether private for-profit insurance companies can honestly and competently offer comprehensive health insurance at prices which every American can afford. Senators are working on a proposed bill which will give a federal agency, the Office of Personnel Management, the power to negotiate with insurance companies to offer national health plans similar to those offered to members of Congress. If these plans do not meet criteria set forth to make coverage affordable for all, it would trigger the government to offer a “public option” which will compete with private insurers. But many, including lawmakers, do not support such reform which would replace the public option with a purely private approach. However, if acceptable, affordable and comprehensive coverage existed, does it matter who administers it? Perhaps not, provided that certain measures were in place. Other capitalist countries like Japan, Germany, and Switzerland all mandate that each citizen have health insurance, be it through private insurers, community-based plans, etc. The catch is that insurers cannot make a profit on basic health care or deny anyone based on preexisting conditions. If the government is able to successfully negotiate with insurance companies and also offer some public assistance to pay for premiums, then perhaps this proposal can be a capitalist compromise that will bring forth some much needed social change.

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A Canadian woman recently lost her health disability insurance benefits over photos of her found on Facebook. Due to a diagnosis of major depression, Nathalie Blanchard was on sick leave from her job at IBM. However, her payments stopped this fall after her insurance agent apparently found several pictures of her in which she appeared to be having fun – at a Chippendales bar show, at her birthday party and on a getaway vacation. However, having depression doesn’t mean you are depressed all the time. Depressed individuals can have fleeting moments of joy, only to return back to their feelings of sadness afterwords. In her own defense, Ms. Blanchard states it was her physician’s advice to try and interject some fun into her life. She is currently working with her lawyer to regain her benefits. [via Yahoo! News]

Visit our Guide To Major Depression.

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The Genetic Information Nondiscrimination Act (GINA) is a federal law that protects Americans from being treated unfairly due to differences in their DNA which may affect their health. The parts of the law pertaining to employers took effect Saturday November 21, 2009. The act prohibits employers from requesting genetic testing or using an employee’s genetic background when making decisions about hiring, firing or promotions. It also protects Americans from being forced by their employers to undergo genetic testing. In addition, it makes it illegal for health insurance companies and group plans to use a customer’s genetic information – such as a family history of a certain disease – to deny coverage or to set premiums and deductibles. [via Health Day]

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A new law, which took effect last Friday, is allowing U.S. college students to take up to one year away from school for medical reasons while remaining on their family’s health insurance plan. “Michelle’s Law” is named after college student Michelle Morse who decided to remain a full time student, against the recommendation of her doctors, while undergoing chemotherapy for colon cancer because she could not afford to be dropped from her parents’ health insurance policy. Previously, students between the ages of 19-24 could continue their health coverage under their parent’s policy as long as they remained as a full-time student (12 credits). If they became too ill to continue as a full time student they would either lose their insurance or could continue their coverage under the C.O.B.R.A. portion of the parent’s policy for an additional premium. By law C.O.B.R.A. can be as much as 102% of the premium for up to 36 months; many families cannot afford this expense.  Michelle Morse was an aspiring teacher who died six months after she graduated from college at the age of 22. [via Businessweek]

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San Francisco is the first city in the US to offer a health plan for its uninsured citizens. The plan, called “Healthy San Francisco,”  was launched two years ago and has received high marks in independent studies. Currently, three-quarters of San Francisco’s uninsured adults have enrolled in the program which guarantees access to medical services. “Healthy San Francisco is not insurance,” and doesn’t function outside of the city limits. But ”any uninsured adult who lives in San Francisco and earns up to 500% of the federal poverty level annually is eligible. … Patients must pick a medical home out of a network of more than 30 public and private clinics, physician groups and hospitals within the city limits. The idea is that patients get consistent care and the system avoids duplicating services. … Preventative services, care for illness and chronic conditions, hospital stays and prescriptions are all covered.” The funding for the program comes from public funds as well as an employer mandate. Restaurants and businesses may also contribute to the fund by way of an additional “fee” added to their patron’s bills. [Los Angeles Times via Kaiser Health News]

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According to an analysis released by The Commonwealth Fund this week, private insurance premiums for employer-sponsored coverage will rise by 94% by the year 2020. This is on top of the 119% increase that has already occurred between 1999-2008. These premium increases were greater than four times the rise in family incomes during the same period, even prior to the current recession. And these are only the premiums alone, not including out-of-pocket costs – deductibles, co-pays, and miscellaneous fees – which have also risen. This is why medical bills have become the number one cause in 62% of bankruptcies. Yet, instead of reining in cost and saving us money, private insurance companies will continue to increase their premiums. Regardless of how we end up dealing with our current health care situation, any genuine reform must counter the rising cost of health insurance premiums. [via The Commonwealth Fund]

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A Congressional staff briefing on the state of health care in the US will take place on Tuesday March 24. The briefing will include the release of a new report, Primary Care Access: An Essential Building Block of Health Reform, which will reveal that nearly 60 million Americans are currently without a regular source of preventitive and primary health care. This is attributable to many factors, including economic instability, as well as the worsening shortage of primary care physicians and a growing scarcity of providers willing to treat the uninsured or publicly insured.

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The BT Test, or Biomarker Translation Test, is a blood test marketed by Provista Life Sciences for the early detection of breast cancer. The test can detect breast cancer-related proteins in the blood and, in conjunction with mammograms, can sometimes assist physicians in detecting breast cancer in women who have a high risk of breast cancer, or those with dense breast tissue that can make mammography difficult. Provista announced this week that it will file private insurance claims on behalf of women who take the test, in addition to covering the remainder of the cost not covered by insurance.  Those who do not want to submit an insurance claim can get the test done for $295.

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