Georgia Health Insurance 411

Archive for November, 2009

Dr. Kleaveland offers his views on health care reform. It is not a pretty sight, but we face off in a battle of dueling public letters.

You can read his complete dissertation by using the link, but here are some lowlights.

Consumer protection in the health industry is addressed as follows:

No denial for pre-existing conditions or gender.

Guaranteed coverage to all individuals and employers and automatic renewal of coverage.

Prohibits premium variance except for reasons of area or family enrollment and sets limits on higher premiums based on age.

Prohibits cancelling of health insurance coverage except for convincing evidence of fraud.

Pious platitudes but this demonstrates how little the good doctor actually knows about the current system. Every state has provisions that allow access to health insurance on a guaranteed issue basis. Every one. Yet this fact is ignored over and over.

Setting premium limits sounds great but as has been demonstrated over and over in states that have attempted to over-regulate health insurance, the result is less competition and significantly higher premiums for almost everyone.

All states have laws that prohibit the cancellation of health insurance except for reason of fraud or non-payment of premium.

Skipping around a bit, we find the following.

Lists required covered services, including hospitalization, prescription drugs, mental health services, preventive services, maternity care, and children’s dental, vision and hearing services.

Payments for primary care services would be increased

These are admirable, but costly. But let’s look at the doctors arguments as to why “health care reform” is needed.

Medical insurance premiums have more than doubled in the past 10 years.

OK, and why is that?

Health insurance premiums are driven by the underlying cost of medical care and the benefits they are required to cover. Most of the things Dr. Kleaveland proposes are built in to the House and Senate proposals. None of the provisions will serve to lower health insurance premiums, so what is really accomplished?

Requiring health insurance companies to take on more risk (banning medical underwriting), covering more items (dental, vision, mental health parity) and compressing the premium spread will result in massive premium increases if this form of health “care” reform passes.

Look at it this way. If Washington required auto insurance carriers to cover tires, brakes and oil changes as well as all routine maintenance and repairs, would auto insurance rates come down under this kind of reform? If you paid little or nothing for maintenance and repairs, but rather used your auto insurance plan to cover these costs, do you think the underlying cost of auto repair would decrease?

If you answered “yes” you are clearly out of touch with reality.

If you answered “no” then you are beginning to understand why health care reform will do nothing to lower health insurance premiums and make coverage more affordable.

Cost of health care have risen to 16 percent of the Gross Domestic Product (GDP) and is predicted to rise to 20 percent of GDP by 2018. No country can survive or compete in the global market if they spend 20 percent of their GDP on health care.

Unless and until the cost of health care is addressed, health care reform will not do a thing to stop this type of inflationary pressure.  None of the proposals in Congress, and none of the items in Dr. Kleaveland’s letter will slow down or control the cost of health care.

The more time the House and Senate bills spend in the light of day, the more insidious they become. Pages 264 – 265 tell us that Indians whose income is below 300% of the FPL will receive free health care.

My wife has some Cherokee in her ancestry if you go back far enough. Suppose she can qualify?

Page 443 of the bill substitutes “legal residents” with the language “those lawfully residing in the United States.”

What is that all about?

Page 369 of the bill protects workers from retribution if they complain that their employer is not providing health insurance benefits.

If you are an Indian does that mean your employer doesn’t have to provide coverage?

Isn’t this fun?

Nathalie Blanchard is on medical leave after being diagnosed with major depression. She is collecting monthly sick leave benefits from Manulife. This was not a problem until she decided to take a trip and post some pics on Facebook.

When Blanchard called Manulife, the company said that “I’m available to work, because of Facebook,” she told CBC News this week.

She said her insurance agent described several pictures Blanchard posted on the popular social networking site, including ones showing her having a good time at a Chippendales bar show, at her birthday party and on a sun holiday — evidence that she is no longer depressed, Manulife said.

When my wife is depressed, a trip to Chippendales always cheers her up. Apparently Manulife views it differently.

Blanchard said that on her doctor’s advice, she tried to have fun, including nights out at her local bar with friends and short getaways to sun destinations, as a way to forget her problems.

She also doesn’t understand how Manulife accessed her photos because her Facebook profile is locked and only people she approves can look at what she posts.

Apparently Canadian insurance companies can be as dastardly as U.S. based ones.

Her lawyer Tom Lavin said Manulife’s investigation was inappropriate.

“I don’t think for judging a mental state that Facebook is a very good tool,” he said, adding that he has requested another psychiatric evaluation for Blanchard.

Well of course not.

If Facebook can diagnose psych issues then why do we need real docs? Paging Dr. Facebook . . .

The folks at The Heritage Foundation have nailed it in today’s Morning Bell. This should be required reading of anyone, ESPECIALLY those who will be called to vote on the legislation.

Excerpt . . .

Last Saturday night Speaker Nancy Pelosi (D-CA) forced through a vote on her 2,032 page health care bill only a few days after releasing it to the public. Now Senate Majority Leader Harry Reid (D-NV) is poised for another Saturday night cram down, forcing a Senate cloture vote mere days before his 2,074 page bill was given to Senators. Yet again, Congress will be forced to vote on a bill that none of them have actually read. More importantly, as we pour through the details, it becomes obvious that none of them even believe the plan will do what the bill says.

Kills Jobs: All told, the Reid Bill raises taxes by $370.2 billion over the next ten years with many of those taxes starting to be collected this year while unemployment is at 10.2% and rising. Worse, the bill includes a job killing employer mandate which taxes companies for hiring people. Specifically, companies with more than 50 employees that do not offer a health plan approved by federal bureaucrats will be forced to pay a $750 per employee job tax.

Hurts Small Businesses: The Reid Bill acknowledges it is terrible public policy for small businesses and tries to address this problem by including a “small business tax credit” to minimize the impact of the job killing employer mandates and regulation-caused rises in private health insurance premiums. But the tax credit only lasts two years and largely excludes small business owners, small businesses with high-average payrolls, and firms with 25 or more workers. After all exclusions, essentially the only eligible firms are those firms with 10 or fewer workers as well as those with low-income workers—the least likely to offer coverage even with a significant price reduction.

For the rest of the story, click the link above to Heritage.

This is truly another example of a stupid government trick.

Having trouble deciding on a Medicare Prescription Drug Plan? You are not alone. CVS can help.

They have a calculator to help you find the right plan. Enter your medications and the calculator compares different plans and shows potential savings.

They even have a short quiz that rewards you with a $5 off coupon.

When it is your money Congress is spending, there is no limit. Care to guess how much Sen. Mary Landrieu want’s for a yes vote for health insurance reform?

Try $100 million.

On page 432 of the Reid bill, there is a section increasing federal Medicaid subsidies for “certain states recovering from a major disaster.”

The section spends two pages defining which “states” would qualify, saying, among other things, that it would be states that “during the preceding 7 fiscal years” have been declared a “major disaster area.”

I am told the section applies to exactly one state: Louisiana, the home of moderate Democrat Mary Landrieu, who has been playing hard to get on the health care bill.

In other words, the bill spends two pages describing would could be written with a single world: Louisiana. (This may also help explain why the bill is long.)

No kidding.

This falls under the category of saving or creating a health insurance reform bill.

Change you can believe in.

Aetna health insurance plans are some of the best available in Georgia, but some of them are lacking in coverage.  I tell folks that, when looking at a health insurance policy, look at what it does NOT cover before deciding if it is right for you or not.

“I’m a health care provider and I don’t think I will get sick, so I don’t need comprehensive health insurance that includes prescription drug coverage.”

That was the line used to justify this woman’s position during a phone interview.

She called me looking for dental insurance. Something most people don’t need.

She has an Aetna PPO Value 10,000 plan. Not a bad plan . . . until you get sick.

Non-preferred brand name drugs are not covered. That includes most cancer drugs.

Preferred brand drugs are covered but only up to $5,000 per year. Someone who is ill can run through that amount in a few months.

The plan also has a $1,000,000 annual limit on all benefits.

But back to the health care provider.

“I can always change my plan if needed because of portability laws.”

Really?

Portability only applies to group health insurance plans. She has an individual health insurance plan.

“As long as I don’t have a break in coverage they have to cover my pre-existing conditions.”

True . . . assuming they will even accept you. Of course if you are really sick, needing a medication that runs $5,000 per month what are your chances of them taking you on as a policyholder?

“I’m not planning on getting sick.”

I decided it was time to end this call. Probably should have asked if she worked in Washington. That is the kind of argument I would expect to hear out of those folks.

Georgia Insurance Shop is proud to represent Aetna and many other fine health insurance companies.

Obamacare promises to cover the uninsured, but not all, only 36 million . . . eventually. The Senate version of health insurance reform carries a price tag of $894 billion over 10 years.

But even that figure is in question since the CBO has not completed their final tally. The $894 billion is . . . just an estimate.

Still, that is the only figure available at this time.

So $894 billion over 10 years is $89 billion per year.

To cover 36 million who currently have no health insurance.

That works out to $2 million per uninsured per year.

Sorry, but this isn’t working for me.

Smaller cars, bigger health insurance premiums, Poppa Washington.

Health care stimulus is coming and I can hardly wait. The folks who gave us Cash for Clunkers, the program that ran out of money in two weeks, are showing us how well health care reform will work.

The folks in Washington are so proud of what the stimulus plan is doing to save or create jobs, they even give us a website where we can watch every detail of where our tax dollars are being spent. The folks at Recovery.gov have given us this information to bolster our confidence in how well they manage our money, and will (I am certain) do just as well when they take over health care.

Your Congressmen spent $3,582,587 in the 86th Congressional district of Florida to save or create 5 jobs.

I have two questions.

How does Florida qualify for 86 districts when California, a much larger and more populous state have only 54? The answer is, they don’t have 86 districts so where did the money go?

The other question is, how do I get one of those jobs? If all the jobs pay equally that means I could earn $716,517. Not bad for a job in a non-existent part of Florida.

Here in Georgia they spent $2,200,000 to create one job in district 00.

We don’t have a district 00 but I still would like to apply for that job.

By the time you read this the site will probably be sanitized.

We can only hope that health care stimulus will be just as promising with physicians receiving $250,000 to perform bunion removal and hospitals getting billions to make them smell less medicinal.

For some, open enrollment is going on as employees scramble to make elections for the coming year. I consulted with a client today on their options.

The family has been covered under a family major medical plan but his wife has recently returned to work and has been offered a benefit package. The health plan is good and very inexpensive for her after factoring in the employer contribution.

Like most employer plans, the heavy cost is shifted to the employee that has a family looking for coverage. After reviewing the benefits of their current plan vs. the one through the employer and weighing the cost of both plans the husband decided to keep what he has now.

The husband and children will remain on the current plan, the wife will choose the employer plan.

We then looked at other benefits such as life insurance, dental and vision. The dental and vision plans both have nominal premiums (due to heavy employer subsidy) and were essentially a no-brainer.

He dismissed the life insurance but I encouraged him to look at it further. Like many plans, the employee will receive life insurance at no charge that is a multiple of salary.

Free is good.

They also have a dependent life insurance plan that allows the wife to buy $50,000 of life insurance on her husband. Since this is open enrollment he can pick up the insurance without evidence of insurability.

This last item is a key in the decision process.

My client has cancer.

He has been battling cancer for 2 years. He applied for SSDI (Social Security Disability Insurance) in January and was approved in three weeks.

No one is approved that quickly.

If he were to apply for life insurance in the open market he would be denied. I strongly encouraged him to pick up as much life insurance as he can get under the employer plan.

After I explained the way the plan will work, that he will not be required to answer health questions or submit to a physical exam, he agreed that purchasing life insurance through the employer was a good idea.