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What does Single Payer health insurance mean and what is SB 562?

06-03-2017by Colleen King

Okay, I've been MIA as far as writing articles because things have been busy, including me getting married. But the prospect of SB 562 passing in our state has made me shake the dust off my writing.

SB 562 is proposing a 'single payer' system--this means the State of California would be paying the bills. NO more insurance companies, no more private insurance, individual or group health benefits. Or Medicare. Or MediCal. The current cost estimate is about $400 billiion a year, which is about double the entire State budget. Where is that going to come from? Well, part of it, according to the authors of the bill, would come from the existing funding from the Federal Government for Medicare and MediCal. Really? That's a stretch, as the Feds would have to sign off on that, so who knows. That would account for about $200 billion of the funding, the rest would need need to come from taxes.  Great.

There are many facets to this concept, so there will be more articles coming soon. Two terms that are interchanged, incorrectly, are 'single payer' and 'universal coverage.' They are not synonymous. Single payer means one entity writes the checks, universal coverage means everyone's covered, or able to be covered, but there could be more than one 'payer.' So in theory, with the Affordable (?) Care Act, we have universal coverage, everyone has access to coverage but not everyone buys it.  We still need to deal with affordability, which the ACA hasn't necessarily done.

SB 562 was passed in the Senate yesterday, now it goes to the Assembly. It's a flawed bill, another one of those 'pass it, then we can work out the details' kind of thing. Sound familiar? I watched some of the hearing yesterday, and support and opposition pretty much fell along party lines. But there were a couple of Dems who really pulled a fence straddler, in my opinion. They talked about the flaws in the bill, how incomplete it was and how 'ordinarily' they wouldn't vote for something like this but they like the general concept and there still needs to be a conversation on the subject. So this way, no matter what happens, feels like they can proclaim victory for their vote. Oh geez!

Of course then there is the little discussed hidden secret, that more Dems are against it than are willing to admit it. They are presuming Gov. Brown will veto it, that's their safety net. So they can appear to be for it, then be protected from the fall out if the Governor vetoes it. Keep in mind, this is the same State Legislature that had a bill a couple of years ago that would require all legislators to buy through Covered California, the health insurance exchange, and it didn't even make it out of committee, it crashed and burned before it could go for a vote. Talk about hypocrisy! Here's a link to an LA Times article yesterday about what this could mean for consumers. It's not completely unbiased of course, but we 'have to start the conversation.' Read article

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So, what happened a couple of weeks ago to President Trumps replacement health plan?

04-08-2017by Colleen King

Good question--One of the industry experts I heard speak on a conference call a couple of weeks ago said that anything around repeal is going to require 60 votes, and there are 2 chances of that happening--slim and none, and slim just left town. So the best we can hope for is amending, fixing, the existing law. Personally, I'd be okay with that, depending on what the fixes are.

Trump’s plan included serious cuts to Medicaid, aka MediCal in California. That’s a problem since about 30% of the state is on MediCal. There was some talk of revamping the premium rate structure, from a 3:1 to a 5:1 ratio—currently the highest rates cannot be more than 3 times the lowest which is part of what drives rates up for younger people, because health care costs for those of us for ‘a certain age’ are higher.

Plan designs need to be revised also—the Gold level and especially the Platinum level are for the most part are unsustainable, they cost a LOT to maintain. And not everyone wants all the bells and whistles included with the new designs.

So what happens to subsidies, plan designs, eligibility—time will tell. Hopefully calmer heads will prevail.

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Whats going to happen now that Trump is coming in?

12-02-2016by Colleen King

I have people ask me this everyday--Now that Trump has been elected President, what's going to happen to our health insurance? Is it going away, is it going to get more expensive, is it going to get less expensive? Are the subsidies going away, are we going to single payer?

Right now, nobody knows. The chant of 'repeal and replace' isn't entirely practical. This is going to take planning, it's not going to be something fixed, corrected or changed by Tweets. Rather than rehash a bunch of stuff, I ask that you check out this article which is an interview with Robert Laszewski, a highly respected expert, and what he thinks will, could or should happen. Read article.

Take a few minutes to read this, it will give you some insight, and hopefully calm the concerns that it's all going away the day Trump takes office.


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Okay, it is the day after--now what?

11-10-2016by Colleen King

In a word, NOTHING.  It's November 9th, day after THE election. Sun came up, most birds were still singing, but as far as health insurance and the god awful rates we're looking at for 2017, nothing will change right now.

First of all, Trump doesn't take office until January. When he does I hope he will have been spending a lot of time on building teams to look at many areas, especially health care and how to fix the Unaffordable Care Act. In case he or any of his team catch my blog, I have some opinions of what could help. And no, I don't have the stats to back how much could be saved, or insurance costs could be cut--this is just gut instinct:

  • Modify the 'actuarial values' structure--this is where the law says a Platinum plan has to cover 90% of your costs, Gold covers 80%, Silver covers 70% and Bronze covers 60%. This needs to be modified, especially the Gold and Platinum levels, because these structure are unsustainable. Gold and Platinum plans usually have no deductible. Great, but that makes these plans really expensive.
  • We used to have plans that would offer generic drug coverage only. Government said that wasn't good enough. But what if that's all you wanted, and you were willing to chance it? Shouldn't that be your choice? That would help.
  • Maternity coverage is required on all plans. And to the guys that say 'they' don't need it, 1. you're usually involved when a woman gets pregnant, and 2. I have coverage for prostate exams I don't need. I would like to see it permissible to have a few plans without Maternity coverage, but require carriers to have it on the majority of their plans, like 75-80%--that spreads the cost out, otherwise plans with maternity are ridiculously expensive.
  • Revamp the exchanges--how did they expect to add a whole NEW bureaucratic layer in health insurance administration and bring the cost of insurance down? Shrink the exchange concept down to where they help administer/answer questions about that kind of eligibility. Agents at least in California have been involved in the majority of insurance plan sales on Covered CA. Maybe expand their ability to answer questions about the MediCal side, since it's 'hands off' for them once one is eligible for MediCal and the case goes to the 'Local County Office'--yikes!

That's it for now. I'm sure there's more, like oh, cost containment in the pharmaceutical industry? I'm done....for now....

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But I have a PPO--what do you mean I have a PCP now?

11-02-2016by Colleen King

One of the main reasons people tend to like PPOs, unless they've had a good HMO experience, is the freedom to choose which doctors they go to. You can see someone contracted with your health plan, or not. If they aren't contracted, you pay more of the cost. And there is no 'discounted,' contracted rate to help contain your costs.

So when Covered CA came out this year and dictated that even if you have a PPO you will be assigned to a primary care provider (PCP) agents were very alarmed, because we knew the phone would start ringing. No, you still have a PPO, you just have a PCP to go with it. Here are the points, good, bad or indifferent, that you need to know about this new thing for 2017:

  • You will automatically be assigned to a PCP. Maybe it's someone you know, maybe not. The carriers are saying they may review claim info to try to assign you to someone that you've been using.
  • You don't have to use that doctor EVER--the theory is, maybe there will be a higher utilization of preventive services if a member has someone to go to, since a lot of people don't have a regular doctor. If you want to change your assigned PCP, just like with an HMO, you can at any time.
  • You can still go to anyone you want, you don't need a referral for a specialist--BIG difference from an HMO PCP.
  • This doctor supposedly is NOT being paid to be your PCP. With HMOs your PCP is paid 'capitation'--$X amount per member, per month, whether they see you or not. So the new PPO PCP, they will be compensated like they are now, when they see a patient.

So, is this going to make a difference, will it increase the use of preventive services? Dunno. Is it going to improve the quality of care? Maybe. Are patients and doctors going to like this? Remains to be seen. Just another change in our health care system that supposedly wasn't going to change once the ACA hit. So stay tuned....

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