Tag Archives: Health Plans

Americans Are Skipping Health Insurance

Bloomberg on Monday published an article by John Tozzi that reported that some Americans are taking a risk and skipping health insurance because of the cost.

In the article, “Why Some Americans Are Risking It and Skipping Health Insurance”, Bloomberg interviews three families; the Buchanans of Marion, North Carolina, the Owenses of Harahan, Louisiana, and the Bobbies in a suburb of Phoenix, Arizona.

The Buchanans decided that paying $1,800 a month was too much for health insurance and decided to go without it for the first time in their lives.

Doubling insurance premiums convinced the Owenses to do so as well, and Mimi Owens said that, “We’re not poor people but we can’t afford health insurance.”

Saving money to pay for their nine-year-old daughter Sophia, who was born with five heart defects, forced the Bobbies to go uninsured for themselves and their son Joey.

These three families are but a small part of the dozen other families Bloomberg is following to understand the trade-offs when a dollar spent on health insurance cannot be spent on something else. Some are comfortable financially, others are just scrapping by.

According to Tozzi, the share of Americans without insurance is near historic lows, the current administration is rolling back parts of the ACA. At the same time, Tozzi reports, the cost for many people to buy a plan is higher than ever.

In the case of the Buchanans, wife Dianna, 51, survived a bout with cancer 15 years ago, her husband, Keith has high blood pressure and takes testosterone. Both make more than $127,000 a year from an IT business and her job as a physical therapy assistant. They have additional income from properties they own.

However, their premium last year was $1,691, triple their mortgage payment, and was going up to $1,813 this year. A deductible of $5,000 per-person meant that having and using coverage would cost more than $30,000.

What made the Buchanans take this step was when Blue Cross and Blue Shield of North Carolina and the major hospital system in Asheville, could not reach an agreement, putting the hospital out of network. Keith Buchanan said, “It was just two greed monsters fighting over money.” He also said, “They’re both doing well, and the patients are the ones that come up short.”

The Buchanans are now members of a local doctors’ practice, for which they pay $198 a month. They also signed up for a Christian group that pools members’ money to help pay for medical costs. For this membership, it costs the Buchanans $450 a month, and includes a $150 surcharge based on their blood pressure and weight.

After dropping their coverage with Blue Cross and Blue Shield, Keith injured his knee, went to an urgent care center and was charged $511 for the visit and an X-ray. “If we can control our health-care costs for a couple of years, the difference that makes on our household income is phenomenal,” Keith said.

There is evidence, Tozzi writes, that having insurance is a good thing. People with insurance spend less out of pocket, are less likely to go bankrupt, see the doctor more often, get more preventive care, are less depressed and have told researchers they feel healthier.

Yet, some 27.5 million Americans under age 65 were uninsured in 2016 (myself included), about 10 percent of the population, according to the Kaiser Family Foundation.

The most common reason cited by KFF was that the cost was too high. A Gallup poll suggested that despite declining for years, the percentage of adults without coverage has increased slightly since the end of 2016.

However, other data, Tozzi writes, showed no significant change.

The following chart outlines the household income and health insurance status of people under 65 who qualify for government help with having insurance.

For the Bobbie family, the current administration’s proposal to make it easier for Americans to buy cheaper health plans could open options for the rest of the Bobbie family, but with over $1 million in medical costs for Sophia, these less-expensive choices would lack some of the protection created by the ACA that allowed her to get coverage.

The tax scam that became law in December will lift the ACA’s requirement that every American have coverage or pay a fine.

Some states are trying out the new rules, offering plans that don’t adhere to ACA requirements. This is the case in Idaho where the state’s Blue Cross insurer attempted to offer a so-called “Freedom Plan” that had annual limits on care and questionnaires that would allow them to charge higher premiums to sick people or those likely to become sick.

The current administration judged reluctantly that this plan violated ACA rules.

The Owenses decided to do something like what the Buchanans did. They tried a Christian health-sharing ministry for a few months, but joined a direct-primary care group, which Mimi Owens called, “the best care we’ve ever had.”

The three American families are by no means not alone in having to decide whether to have insurance or to take the risk and forgo paying huge premiums to save money or to use it for another family member with more pressing medical issues.

Two of these families are not low-income, as they both earn over $100,000 a year and could afford to buy health coverage if it was affordable. But the reality is that premiums have risen and will continue to rise and will price them out of the market.

Except for the Bobbies, no one in the other two families have serious medical issues that are exceedingly expensive, and they have found lower cost alternatives, but for many other families in the U.S., that may not be an option.

The only real solution is universal health care. Then the Buchanans, Owenses, and Bobbies of America will not have to worry about how they are going to pay for medical bills if some serious medical condition arises. We can and should be better than this.

Copper, or Cop Out?

The recent bipartisan health care bill, posted here, is an attempt to save the cost-sharing reimbursements that the Orangutan ended last week, and that the White House (the adult day care center) has not endorsed.

This is what Health Care.gov says about these copper plans, with commentary from Don McCanne of Physicians for a National Health Plan.

ACA Catastrophic Plans
Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself.
Deductibles — the amount you have to pay yourself for most services before the plan starts to pay anything — are very high. For 2017, the deductible for all Catastrophic plans is $7,150.
According to Dr. McCanne, the bill will extend CSR’s for two years in exchange for concessions from Sen. Patty Murray.
One of those concessions, Dr. McCanne says is  to allow anyone to purchase on the exchange the catastrophic plans that are currently available only to individuals under 30 or those who qualify for certain hardship exemptions. These plans are sometimes referred to as copper plans, indicating that they have an actuarial value below the other metal tier plans (bronze, silver, gold, and platinum).
The appeal of these plans, he adds, is that their premiums are very low, but that is because their actuarial value is only 50 percent – they cover an average of about half of health care costs.
For 2017, the deductible for these plans is $7,150.
He believes that the concept that we can take beneficial policies and detrimental policies and combine them to come up with a reasonable compromise is a fallacy. Bad policies are bad policies, and they cannot be neutralized by political accommodations.
His solution is a national health plan.
Otherwise, it is either copper or a cop-out.

Fallout of the End of ACA Subsidies

Joe Paduda today gave a very succinct and clear-minded assessment of the fallout of the ending of the ACA subsidies, also known as Cost-Sharing Reimbursement (CSR) payments.

Here is Joe’s article.

It makes perfect sense that what the Orange man said yesterday will do more damage to health care than his false and misleading pronouncements of the past year that the ACA is failing and doing harm.

It is you, sir, who are doing harm. To the poor, to minorities like those in Puerto Rico despite your morning mea culpa, to African-Americans and Latinos,  to women, to international agreements and organizations,  and to our credibility with our allies and adversaries.


Medical Tourism and Workers’ Comp: What’s Good for the Goose is Good for the Gander

Happy New Year everyone!

For my first post of the year, I want to re-post an article published yesterday by my fellow medical tourism blogger, Maria Maldonado of Trip4Care.

Maria has written an excellent article outlining the benefits of medical tourism for an employer’s health plan, so naturally the same can be said for workers’ comp, especially with regard to self-insured or even opt-out employers.

Here is Maria’s article in its entirety:

Medical Tourism: A Component of Your Health Insurance Plan?

Given that medical tourism is an option chosen by many to get procedures not typically covered by insurance, it may come as a surprise that medical tourism is also something that is growing in popularity as an additional health insurance benefit—especially for self-insured companies. Let’s take a look at the reasons behind this trend.

Why Employers and Health Insurers Are Opting to Add Medical Tourism to their Health Plans

There are actually quite a lot of reasons why employers and health insurers alike are opting to add medical tourism benefits to their health plans. Let’s take a look at some of these:

  • The employer saves money. This is especially true for employers who opt to “self-insure” (i.e. the employer acts as an insurer, and pays the employee medical expenses rather than providing a separate insurance plan).
    • Since many procedures can be completed internationally for a fraction of the cost of the same procedure at home (even including the cost of travel), this is one of the biggest drivers behind the trend, for both self-insured organizations and other insurers.
  • The employees get more options. Giving employees additional benefits like this can be used as a recruiting tool, helping organizations to secure talent.
  • The employees have the choice to travel– possibly at no personal cost – for some treatments, and may be able to take a vacation at the same time. The option for coupling international travel with a medical treatment can be a major benefit for some employees.
  • Technology makes this process easier than in the past. With the wealth of information available at the click of a button today, it’s easier than ever to research the procedures that are available internationally and gain trust. Additionally, there are companies like Trip4Care that can facilitate all aspects of a medical tourism trip, making administration simple for the organization.
  • Employees do not sacrifice health outcomes. Naturally, companies who opt to take this route should take care to ensure to partner with companies offering the highest standard of care. In this way, everyone benefits and costs are kept low.
  • Keeping employer costs low also benefits the employee in the form of low premiums. It stands to reason that if costs are kept low throughout the group, there will be less rationale for premium price hikes. Another win-win.
  • Keeping costs low benefits, the employee through lower shared expenses too. Whether the healthcare plan’s coinsurance is 20%, 30%, or more, it all adds up. Keeping total expenses down for the patient is beneficial for everyone. Besides the obvious cost savings, this can reduce the stress involved for employees who have to seek medical care—reducing the financial burden can relieve some of the anxiety.
  • From an employer cost-savings standpoint, another option is to pass along the travel portion of the cost to the employee. This saves the company money while still keeping costs down overall. (Obviously this is lesser of a benefit for the employee, but the employee will often still come out ahead in terms of total expenditures as compared to having the procedure at home.)
  • Adding medical tourism coverage could make providing dental care more affordable. Dental procedures are a perfect example of a procedure that can often be sought internationally for less money than at home; employers offering dental coverage can take advantage of that.
  • Treatment wait times may be shorter. In cases where an employee may be subject to a lengthy wait list for a treatment at home, medical tourism options may give the flexibility to avoid that wait list and get treatment faster. This is yet another benefit for employees and employers alike.

Self-insured companies have the flexibility to do this right away. While this trend may take some time to take hold, it’s always great news to hear that more options will be available to more patients—allowing individuals to have more choices in their healthcare.

It has been pointed out in the past that doing this for either health care or workers’ comp is too complex and too costly; but as I have said many times before, we went to the moon more than once, and that was infinitely more complex and more dangerous than sending employees to another country for medical care.

I have defended my idea in the following posts:

The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible and is not a Pipe Dream

Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation

“We’re No. 1!”, NOT! — Why the US Health Care System is Not the Best in the World and Why Implementing Medical Tourism into Workers’ Comp Could Improve Outcomes

Why Medical Tourism for Workers’ Comp is an idea whose time has come

Tell Me Again Why Medical Tourism in Workers’ Comp is a Bad Idea?

Nothing is Impossible

Paralysis by Analysis: Or the Only Thing We Have to Fear Is, Fear Itself

So when people tell me this idea is ridiculous and a non-starter, or that I have no credibility, or some other lame excuse why it won’t be considered, I go back to the points made in these seven articles above, and many others I have written that says it is possible. It’s just our lack of vision that makes it so.

The only things preventing it are the complexities of the health care or workers’ comp systems that are harming the systems, making them more expensive than they should be, people defending the status quo so that entrenched interests continue to game their respective systems to the detriment of the patient bases they service, and to those who would like to change them for the better.

We have seen this in our tax code, our politics, and many other facets of life. But it does not have to be that way. We can make things much simpler, but it requires employers, carriers and others to do so. Saying it can’t be done or it is too expensive only makes things worse.

We went to the moon; no one ever said it was too expensive to go, too complex to go, too dangerous to go. We went, and we went many times, but in the end, the naysayers and right-wing penny-pinchers who were really diverting that money into the pockets of the wealthy, shut down our space program, so that now we have to hitch rides on Russian rockets.

That’s what we get for saying it is too complex. That’s why the supercollider is in Europe and not in Texas. We have given up and given in. The world is changing, globalizing. Let’s not blow that too.

In other words, what’s good for the health care goose, should be good for the workers’ comp gander.

Here’s is the link to Maria’s article: