Tag Archives: Health Care Reform

Blocked Aetna-Humana Merger Reveals True Reason for Pullout from ACA

In an article yesterday in Business Insider, the recently blocked merger between Aetna and Humana is the reason given for Aetna’s sudden decision to leave the ACA exchanges.

Contradictory statements from Aetna in response to this decision, as to their ability to profit from the merger or not profiting from the exchanges, does not hide the fact that the bottom line is this:

The laws of Capitalism are incompatible with the goals of providing health care to everyone, even with all the fancy commercials and advertisements from the insurance companies that they are there for you.


They are not there for you, unless you are a top executive of the company, or a stockholder or shareholder, or investor. As the article states, this merger would have led to a consolidation of the health care industry to only three mega companies.

Do you want to wait until there is only one, a la the 1970’s movie, “Rollerball”, where corporations have dominated whole industries and replaced nations, or do you want to provide health care to all, no matter what their ability to pay, or if it makes a profit for some greedy bastards?

The choice is up to you.

Here is the link to the entire BI article:


Employees Unprepared for Increased Health Care Costs


While the duck is recovering from his injuries, Aflac has released a press release and a report on the state of readiness of American workers covered under employer-sponsored, consumer-driven health care plans, according to the Physicians for a National Health Plan “Quote-of-the-Day” newsletter.

The press release mentions a recent Aflac survey that reveals that employees are not prepared for increased costs, and may not want control of their options, and lack education about what is meant by “consumer-driven health care.”

The report finds that employees are not financially prepared, and that:

  • Only 24 percent of workers completely agree or strongly agree they will be financially prepared in the event of an unexpected emergency or serious illness.
  • Further, 46 percent of employees have less than $1,000 to be able to pay for out-of-pocket expenses associated with an unexpected serious illness or accident, and 25 percent of employees have less than $500.
  • Four-in-ten (40 percent) workers would have to borrow from their 401(k), friends and family to pay for out-of-pocket expenses associated with an unexpected serious illness or accident; 28 percent would have to use a credit card.

The report also states that:

  • Nearly three-quarters (72 percent) of the workforce have not heard of the phrase “consumer-driven health care;”
  • More than half (54 percent) of workers would prefer not to have greater control over their insurance options because they don’t have the time or knowledge to effectively manage it;
  • 62 percent of workers believe the medical costs they will be responsible for will increase, while only 23 percent are saving money for potential increases;
  • 75 percent of workers said they think their employer would educate them about changes to their health care coverage as a result of reform, but only 13 percent of employers said educating employees about health care reform was important to their organization.

Lastly, the report found that among consumers of health care plans:

  •  32 percent are not very/not at all knowledgeable about health savings accounts (HSA)
  • Three out of four (76 percent) are not very/not at all knowledgeable about federal and state health care exchanges
  • Almost half (49 percent) are not very/not at all knowledgeable about health reimbursement accounts
  • 25 percent are not very/not at all knowledgeable about flex spending accounts (FSA)

If American workers are unprepared financially to assume a greater portion of their health care spending, and if they are not aware of what “consumer-driven health care” is, nor are they interested in having control, what does this say about the state of the US healthcare system after January 1, 2014?

And more importantly, what does it mean for medical tourism, which is generally consumer-driven, and relies on patients to seek out medical tourism destinations as they would destinations for any other tourism?

For the workers’ compensation industry, this could mean cost-shifting from employer-sponsored health care plans for certain health care issues to workers’ compensation, which has happened from my personal knowledge of a subrogation company that recovers payments made by health care insurers, when the claim was actually covered under workers’ compensation. This would hasten the day medical tourism is implemented into workers’ compensation, so that employers and carriers can take advantage of the lower costs of medical care abroad.

While cost-shifting may happen, it is unlikely as most carriers would deny coverage for many claims that are routinely covered under health care, but would become financially unavailable to most employees because they are unprepared, or because their employer will want the employee to share the cost.

Whatever happens, medical tourism could see a sharp increase in business in the next few years.

Lower Work Comp Medical Costs under “Obamacare”?

The good folks at Business Insurance magazine, wrote a post last week about how the Affordable Care Act, “Obamacare” may actually lower workers’ comp medical costs.

The article, entitled,” “Obamacare” may cut work comp costs“, points to a Rand Corp study that concluded that the ACA may actually cut workers’ comp medical costs.

The author of the article quotes from the abstract of the study.

“Although it is widely recognized that health care reform has the potential to affect the volume and cost of medical care received through the workers’ compensation (WC) system, to date there is little empirical evidence of this effect,” the abstract says. “This study used the experience of Massachusetts, which implemented a health care reform package with several provisions similar to those in the Patient Protection and Affordable Care Act of 2010, to empirically estimate how health reform impacts WC hospital care. It was found that WC billing frequency for both emergency room visits and inpatient hospitalizations fell by 5 to 10 percent as a result of reform, but that billed charges and treatment volume were not measurably affected. These impacts were observable among patients with more costly injuries and persisted even after various approaches were used to account for the effects of the economic downturn that began at the end of 2007. While many outstanding questions about the impacts of health reform on WC remain, this early quantitative, empirical evidence suggests that reform may reduce medical costs borne by the WC system.”

If this is true, and there is a long way to go before there is definitive proof of this, it would mean that implementing medical tourism into workers’ compensation would be considerably more difficult to achieve. Yet, the study does suggest, as the abstract states, that billed charges did not change in Massachusetts.

One state out of fifty does not mean that costs in other states will do the same. Much of what people in the work comp industry have said about the ACA and its’ impact on work comp range from none at all, to complete federalization, so at this stage, it is too early to tell if there will be any cause for alarm among those wishing to implement medical tourism into workers’ comp.