With the Supreme Court justices sounding like they might strike the mandate down, this is a question I've been getting a lot lately.I have pointed to New Jersey as a real life example of what can happen when insurance reforms take place but there is no incentive for consumers to buy it until the day they need it.In 1992, New Jersey passed health insurance reform that required insurance carriers
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If the Supreme Court Overturns the Individual Mandate
First, trying to predict how the Court will rule is at best just speculation. I know what Justice Kennedy said both today and yesterday and it certainly doesn’t look good for the Obama administration and upholding at least the mandate.But I will remind everyone, based upon oral arguments, most Court watchers expected a ruling in favor of the biotech industry on a recent case involving health care
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The 300 Page MLR Rules—About as Valuable as Taking Your Shoes Off at the Airport
This whole medical loss ratio (MLR) provision in the new health care law is a fool’s errand. When it comes to controlling health care costs it is about as productive as taking your shoes off at the airport is valuable at improving air travel security.Without a doubt, the new health care law does far too little toward making health care costs affordable. And, marginal health insurance carriers
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The Senate Finance Insurance Reform Rules Have to Be Fixed in Spite of the Gang That Can’t Shoot Straight
Last week the health insurance trade association (AHIP) released a report it sponsored, and was authored by PricewaterhouseCoopers (PwC), that claimed the Senate Finance bill would be problematic for the insurance markets only leading to much higher costs.As I posted last week, my own analysis of the Finance bill gives me big concerns about what it would do to health insurance costs and the
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What’s Next? Follow the Money
With the passage of the Senate Finance bill the health care effort now moves to a critical stage with the Senate Majority Leader and the House Speaker now clearly in charge.The more important effort will be Reid’s. Pelosi’s final product will be more predictable (very liberal) but Reid’s will have to be more practical. Every inch Reid moves away from the more moderate Baucus bill will cause
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The Senate Finance “Cadillac” Health Insurance Excise Tax Collects Almost Five Times More Revenue in 2019 Than It Does in 2013
Critics of the Pricewaterhouse Coopers (PWC) report on the Senate Finance bill have been making the argument that the analysts are not giving credit for the changes in behavior the bill would create. In short, the notion that, for example, insurers would pass on billions in taxes on high cost health plans to customers is flawed because the Baucus bill would provide the incentive to lower the cost
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The Senate Finance Health Bill Has No Clothes
Readers of this blog know that I have lots of concerns for the Senate Finance health bill primarily because it does not so much represent health care reform as just an expensive entitlement expansion.Readers also know the insurance lobby--AHIP--is not one of my favorite organizations.But I will tell you the report by Pricewaterhouse Coopers (PwC) commissioned by the AHIP and released this morning
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The Democratic Health Care Bills Could Be A Disaster for the Insurance Pool
With Baucus gutting his fine for not having health insurance there would be no reason for people to buy it. In 2013, for example, there would be no fine for not having insurance. By 2014 the penalty would be $200 per adult and it would rise to $400 in 2015, $600 in 2016, and $750 by 2017. Coupled with the expectation middle class families would have to pay $6,000 to $10,000 a year for insurance
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The Health Reform Bills Would Be Great For the Business Of Health Care
Have you noticed how none of the big health care business special interests is running any negative health care reform ads? Why should they when each is poised to gain billions of dollars from it?As President Barack Obama has said many times, any health care bill that costs about $1 trillion would be paid for, roughly half and half, with savings in the health care system and new revenues (taxes).
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Will Eliminating Medical Underwriting and Merging the Small Group and Individual Market Into a New Insurance Exchange Work? Lessons From Massachusetts
Creating a universal system of health insurance is everyone’s objective. But even if we pass an expensive health care bill in 2009 we won’t achieve it. We just don’t have enough money to cover everyone. Maybe, in the most expensive proposals, we would make it possible for 90% to be covered. In others, far less.The problem is that without an absolutely seamless system there will still be people
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Little Ado About Nothing—Part Deux
Last November, the insurance industry offered to do away with pre-existing conditions limitations. This week the health insurance trade associations have also offered to phase-out the practice of varying premiums based on health status in the individual market.From their letter to Congress this week:Specifically, by enacting an effective, enforceable requirement that all Americans assume
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AHP Announces a Health Care Reform Initiative and Tells All of the Other Stakeholders What They Ought to Do
I'd like to propose a new health care reform rule.You can't announce health care reform proposals unless Part 1 of your plan first tells us just what it is your side is going to sacrifice for the effort.I don't know about you, but I am getting tired of one vested interest after another in the health care system telling the others what it is they have to do to fix the system. Everyone has to
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Watch the Wyden-Bennett "Healthy Americans Act"--It Could Be the Place Health Care Reform Compromise Takes Place in 2009
Health care reform will be hard to do after the November election. I've even called it a long-shot.Polls clearly show the voters split evenly between the Democratic and Republican approach to health care reform. I can't tell you who will win the presidency but I am willing to make the bold statement that it will be a close election and neither very different approach to health care reform will
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Haley Barbour or Hillary Clinton?
Here's a test.Who just proposed the following, Hillary Clinton or Haley Barbour:A government authorized health insurance purchasing exchange program for the purpose of marketing health insuranceRun as a not-for-profit clearing house from which consumers could purchase health insuranceTarget the uninsuredAvailable to workers in small businessesDesigned to reduce the overhead costs of small group
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California Insurers Lose a Big Court Case In the Health Insurance Policy Rescission Controversy
Here's one for a Harvard Business School case study: A few months before voters in the state are going to decide the future of your industry get into a losing battle about retroactively canceling sick peoples' health insurance policies.A unanimous California Appeals Court decision has decided that California health insurers have a responsibility to check the accuracy of applications for health
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The Shadegg Bill––A “Health-Insurance Solution” That Is a Waste of Time
Merrill Mathews, writing on yesterday’s Wall Street Journal op-ed page, asks why Representative John Shadegg’s (R-AZ) “Health Care Choice Act” isn’t a “no-brainer” for the Congress to pass.Shadegg’s proposal would enable consumers to buy a health insurance policy in any state thereby bypassing the states with the most costly benefit mandates. At the top of his costly mandate list are state “
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California Policy Cancellation Scandal Heats Up As Republican Candidates Propose Health Reform Based On An Individual Health Insurance System
All of the leading Republican candidates for president favor health reform based on the individual health insurance model instead of the more common employer-based system.Apparently, a number of health insurance companies would like to derail those Republican health reform plans by scaring the heck out of consumers and voters picking the year before the election to hold a policy cancellation
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Report: "Health Insurer Tied Bonuses to Dropping Sick Policyholders"
It's hard to imagine a worse headline for the health insurance industry just as we are heading into what will be a fundamental debate over who should run our health care system.It is even harder to imagine a dumber thing for the insurance industry to do than continue to argue and litigate the notion that an insurer can cancel--or rescind--an insurance policy for a misstatement of fact on an
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Aetna to Provide Managed Care Services to the British National Health Service--Say What?
Aetna has been approved by the British National Health Service (NHS) as one of the suppliers who can provide local Primary Care Trust (PCT) managers "a wide range of support, ranging from specific tasks such as designing medical management programs, also known as demand management, to comprehensive contracting and procurement of services."Where's Michael Moore? He needs to do an addendum to "
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People Who Say Insurance Regulation Creates More Uninsured Are Missing the Forest for the Trees
The health insurance trade association, AHIP, just released a new study on the impact of state health insurance reforms on the market and argues that the "unintended consequences" of these reforms hasn't been good.Here is an excerpt from their release:“This report offers important lessons. It demonstrates that insurance reforms without universal access drives up health care costs for consumers
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