Posts Tagged ‘Preventive healthcare’

Health Insurer OKs Reform No Matter What the Supreme Court Does

Monday, June 18th, 2012

Even if the Supreme Court declares the Patient Protection and Affordable Care Act (ACA) unconstitutional, UnitedHealth, the nation’s largest health insurer will still cover certain types of preventive care. The extensions will apply primarily to its customers who have individual policies or small-group health insurance through their employer, a minority of its 35 million total members.  The ACA, whose goal is to provide coverage for millions of uninsured people, started unfolding in 2010 after health insurers fought to block its passage.  Challenges to the law from states and other groups opposed to it wound their way to the Supreme Court.  Bob Laszewski, a consultant and former insurance executive, UnitedHealth’s move a “very smart business decision.”  The provisions are relatively inexpensive and are already factored into the coverage price.  If insurers cut these benefits, customers probably will expect a corresponding premium drop, he noted.  “It would probably be more trouble to roll these things back than go ahead with them,” Laszewski said.  “It just makes common sense to leave these things in there and not take these benefits away since they’re already priced in.”  Laszewski expects other insurers and large employers to take a similar approach.

The provisions UnitedHealth will maintain include providing coverage for dependents up to age 26 under their parents’ plan.  The company will still offer certain preventive healthcare services without requiring a co-payment.  These include yearly check-ups, screening for high-blood pressure and diabetes, and immunizations.  Additionally, UnitedHealth will continue to forgo lifetime dollar coverage limits on policies.  “The protections we are voluntarily extending are good for people’s health, promote broader access to quality care and contribute to helping control rising healthcare costs,” UnitedHealth Chief Executive Officer Stephen Hemsley said.  “These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue.”

The ACA is the largest overhaul of the $2.6 trillion American healthcare system in nearly a half century.  It is designed to ultimately expand coverage to more than 30 million uninsured Americans, by setting up insurance exchanges and opening Medicaid for low-income Americans.

According to estimates, the ACA let approximately 6.6 million young adults remain on their parents’ health insurance plans last year, according to a report from The Commonwealth Fund. If the law is declared unconstitutional, Republican lawmakers may reinstate the extension of young adults dependent coverage.  Other provisions that UnitedHealth plans to maintain include providing easily understandable ways for members to appeal coverage claim decisions; and eliminating rescissions, which are considered to be retroactive policy cancellations, except in the case of fraud.  DeAnn Friedholm, director for health reform at the Consumers Union, called UnitedHealth’s actions “a positive step” and said she hopes other companies follow suit should the law be struck down.

Ronald Pollack, executive director of the consumer advocacy group Families USA and a supporter of the law, applauded UnitedHealth’s move.  “It would make a huge difference for a great number of people who would otherwise be left out in the cold in terms of getting coverage,” he said. “And hopefully, given UnitedHealthcare’s market share, this would have tremendous influence on other companies.”  Even if other large insurers follow suit, Pollack said, it would hardly make up for the loss of other provisions in the law that are set to take effect in 2014 — including subsidies to help low-income Americans buy insurance and bans against discriminating against adults with preexisting conditions.

Writing for CBS News, Stephanie Condon says that UnitedHealth’s decision “Could also alter the political fallout from the high court’s decision.  Should the Supreme Court reject President Barack Obama’s law, he could point to UnitedHealthcare’s announcement to validate his policy agenda.”

The Associated Press’ Ricardo Alonso-Zaldivar points out that dismantling the ACA could be messy.  “It sounds like a silver lining.  Even if the Supreme Court overturns President Barack Obama’s healthcare law, employers can keep offering popular coverage for the young adult children of their workers.  But here’s the catch: The parents’ taxes would go up.  That’s only one of the messy potential ripple effects when the Supreme Court delivers its verdict on the Affordable Care Act this month.  The law affects most major components of the U.S. healthcare system in its effort to extend coverage to millions of uninsured people.  Because the legislation is so complicated, an orderly unwinding would prove difficult if it were overturned entirely or in part.  Better Medicare prescription benefits, currently saving hundreds of dollars for older people with high drug costs, would be suspended.  Partially overturning the law could leave hospitals, insurers and other service providers on the hook for tax increases and spending cuts without the law’s promise of paying more to offset losses.”

Uninsured Americans Uncertain About Healthcare Reform

Wednesday, September 14th, 2011

Americans have agreed to disagree about the efficacy of the Patient Protection and Affordable Care Act (ACA). According to Kaiser Family Foundation President and CEO Drew Altman, Americans agree about this one thing: “It really does help the uninsured; 32 million uninsured people will get coverage.”  The foundation’s recent tracking poll found that only about 50 percent of uninsured people have any idea that help is on the way.  Fewer than one-third (31 percent) think the ACA means they will be able to purchase health insurance.

Those two misperceptions are unmistakably connected.  Among those who currently lack insurance, 41 percent incorrectly think the law has no provisions to help people with modest means buy health insurance coverage; (seven percent said they didn’t know); and 37 percent believe the law doesn’t include an expansion of the Medicaid program to low-income, able-bodied adults; and (16 percent were unsure). 

The logical conclusion, Altman says, is an apparent “communications failure” on the part of the law’s supporters to explain how the ACA will actually work.  “What’s going on here is people who are uninsured are busy just trying to make it through the week, paycheck to paycheck,” he said.  “They’re listening to a confusing political debate.”  But the bottom line, Altman says, is that the healthcare overhaul will eventually start to become clearer in 2014, “when there are benefits out there, real coverage out there that people can look at — and can get.”  That’s when people without insurance will really be able to decide whether they can afford insurance or they like the law or it helps them.  “Until then,” Altman says, “it’s just a political debate.” 

Writing in The Hill, Sam Baker says that “Only 29 percent knew that the law eliminates cost-sharing for some preventive services, and half said the law did not provide that benefit.  The poll was conducted just two weeks after the Health and Human Services Department (HHS) announced that it would require plans to waive cost-sharing for contraception and other women’s health services.  And strong majorities approved of that decision, despite not being aware that the healthcare law includes preventive benefits.  Eliminating cost-sharing for birth control garnered 66 percent support in the Kaiser poll.  Although support was higher among younger respondents than their older counterparts, partisanship was the sharpest fault line.  Fewer than half of Republican respondents approved of HHS’s decision, compared with 64 percent of independents and 82 percent of Democrats.” 

On the Politico website, Jennifer Haberkorn writes that “The coverage expansion isn’t due to go into effect until 2014, but Altman says people are unlikely to be truly aware of the benefits until up to two years later.  The figures reflect the struggle supporters of the law will have in getting the word out to consumers who can benefit from it.   President Barack Obama and congressional Democrats focused much of their ‘pitch’ for the health law on the benefits for the uninsured.  They frequently cited the Congressional Budget Office estimate that the law would insure 32 million Americans.  But since the law’s passage, some have criticized that pitch, insisting that they should have focused instead on the benefits for the middle class and those who already have coverage.  Altman said the figures do not reflect a communications failure.  He says busy people — particularly those struggling to afford insurance now — will only understand the law when it becomes tangible for them.  The law’s least popular provision — the requirement that nearly all Americans have to buy insurance — remains one of its most recognizable.  About 65 percent of Americans know about the provision, the poll found.” 

At the beginning of 2011, any Republican suggestion of “repeal” was nearly always followed by “Obamacare”.  Since then, the debate has drifted into the background, morphing into a new regulatory repeal push.  A memo outlining the strategy, issued by House Majority Leader Eric Cantor (R-VA), includes a single paragraph on a grandfathering rule for health insurance plans that will become a target in the winter.   While Republicans are moving away from a health repeal agenda, Democrats appear to be having a hard time explaining what exactly the ACA will do for Americans.

Despite their best efforts, both political parties see their bases moving away from them on health reform.  The number of Republicans who have a favorable opinion has gone up by nine points, while Democratic approval ratings fell by 10 points.  Independent voters held on to their original opinions, with nearly the same number favoring the ACA was as when it was passed.  Both parties are running up against the same two challenges here. First, the health reform law is really complicated.  Other than “repeal and replace,” the ACA doesn’t lend itself easily to slogans that explain how it works.  This hurdle has been especially thorny for Democrats, who have seen low support for the ACA, despite the fact its individual provisions are polling extremely well.  

Tim Hoff of the Albany Times-Union believes that “Offering health insurance at reasonable prices is a key component of making the reform law cost-effective and able to reach millions of uninsured people.  The logic of getting private insurance companies to participate in state health insurance exchanges and offer good coverage at those reasonable prices predicates itself on having a balanced ‘risk pool’ of individuals in the marketplace — who must purchase health insurance.  Through a mix of healthy and sick purchasers, some who overuse their insurance and some who underuse, private insurers can be assured of not losing money (and thus exiting the market) by signing up only high-risk individuals.

“Without a mandate, many healthy uninsured people, as they tend to do, will continue to roll the dice and go uninsured.  This is even truer for the increasing number of Americans who are out of work or who work for employers who do not provide insurance, but earn too much to qualify for Medicaid.  For them, paying for health insurance is lower on the priority list.  That is, until they get sick,” Hoff said.

“Our country faces what may be an extended economic slump, a severe and perhaps more permanent absence of good jobs, rapid downsizing of the middle class and continued abdication by employers from offering benefits such as health insurance.  Yet, we leave it to lawyers and politicians to engage in armchair debates about what might or might not be ‘constitutional’ instead of supporting our government to do something beneficial that furthers the nation’s long-term health and prosperity.  Insuring every citizen is beneficial for our country.  It would do as much for our long-term future as a just, democratic society as any jobs program or debt reduction strategy would.  We are an increasingly sicker, unequal and less productive country in part because of the declining health and well-being of our citizenry, especially our poorer citizens,” according to Hoff.

 “How do we think we can fix the problem of the uninsured without requiring people to carry health insurance?  In our broken, polarized political system that is devoid of bold ideas, this health reform law and its insurance mandate were the best we could do to get health insurance to more people.  Asking almost everyone — citizens and legal residents — to have health insurance is fair, and subsidizing the poor’s ability to do it sensible.  At some point, everyone uses the health care system.  When the uninsured do, they cost us a lot more than those who are insured.  But the insurance mandate issue also speaks to how those of us with good health insurance often think selfishly about the role of healthcare in our own lives.”

High-Deductible Health Plans Equal Less Healthcare

Tuesday, May 3rd, 2011

Americans who have high-deductible health plans tend to not get necessary medical treatments whether they are low-income people with chronic health problems or healthier or higher-income people, according to a study by RAND, a non-profit research group, and Towers Watson, a consulting firm.  The researchers analyzed healthcare claims data from 59 large companies, examining first-year experiences with high-deductible plans comprised of more than 800,000 families nationally between 2003 and 2007.

Medical spending declined among all families with high-deductible and consumer-driven health plans, compared with those in traditional plans, according to the study published by the journal Forum for Health Economics & Policy. Families who live where the median income is 200 percent less than the federal poverty level, and those with one of the five most costly chronic conditions — cancer, diabetes and heart disease — spent approximately the same on healthcare than families with high-deductible plans.  The families all had at least one member working full time in a job that included health benefits, the researchers noted.

“One important issue is whether high-deductible health plans will leave low-income and chronically ill patients with inadequate access to healthcare,” Amelia Haviland, the study’s lead author and a RAND statistician, said.  “The evidence suggests that non-vulnerable families, low-income families and high-risk families are equally affected under high-deductible plans.  We discovered that costs go down dramatically during the first year people are enrolled in high-deductible health plans, as long as the deductible is at least $1,000 per person.  “But we also found concerning reductions in use of preventive care. This suggests people are cutting both necessary and unnecessary care.”

The researchers determined that deductibles of at least $1,000 per person led to an average of a 14 percent decrease in spending when compared with families who had lower deductibles.  The RAND study notes that “The drop in preventive care happened even though the high-deductible plans in the study waived a need to pay a deductible when receiving such care.  This suggests that enrollees in high-deductible plans either did not understand this part of their policy or some other factor discouraged them from getting preventive care.”

According to the RAND study, “High-deductible and consumer-directed health plans have been gaining favor as one way to help control health care costs.  By 2009, about 20 percent of Americans with employer-sponsored health coverage were enrolled in such plans.  A 2010 survey found that more than 54 percent of large employers offered at least one high-deductible health plan to their employees.  Healthcare reform is expected to further encourage enrollment in high-deductible health plans as such plans are expected to be a key offering in the insurance exchanges being set up in many states to help the uninsured find health coverage.”

As families cut their medical spending, they eliminated some forms beneficial care, the researchers found.  Although childhood vaccination rates rose in families who had traditional health plans, they fell among families in high-deductible health plans.  Mammograms, cervical cancer screening and colorectal cancer screening also declined among those with high-deductible health plans.

Writing on Kaiser Health News, Jonathan Cohn, Senior Editor of The New Republic, says “Conservatives think traditional health insurance provides too much financial protection from medical expenses.  They also think that the Affordable Care Act will make this situation worse.  That’s one reason they want to repeal it.  The problem, according to the conservatives, is that insurance dulls the average person’s consumer instincts.  When medical care is cheap or free, people don’t bother to shop around for the best prices — and they don’t think twice before seeing the doctor.  In other words, they end up with too much care at too high a price.  Insurance and government programs spread that cost around, so that eventually all of us end up paying more in the form of higher premiums or taxes over which we have little individual control.  The solution, as this argument goes, is to redesign insurance so that it forces people to pay more out-of-pocket expenses.  And, within reason, it’s not a bad idea.  Most economists, even those on the left, would agree that excessive coverage leads to higher health care spending.”