Buy Health Insurance at the Mall

You can buy clothes, shoes and towels in the stores at most shopping malls and you also can pick up some health insurance. Highmark Blue Cross Blue Shield is opening its eighth Highmark direct retail store in Pennsylvania. It also joins dozens of other stores operated by other health insurance companies across the country in Maryland, South Carolina, Florida, Colorado and other states.

Added Value for Shoppers

Inside the stores, customers can do their own research on plans as well as talk to an agent. The store will have an area where consumers can check their height, weight and blood pressure, as well as undergo other self-administered health assessments. The store also will have a classroom, which will offer sessions on quitting smoking and other wellness topics.

More Individual Health Insurance Buyers

Most people have health insurance provided through their employer and have limited choices about how they are covered. But for several reasons health insurers say the day may be coming when you shop for insurance, just as you do for other products. The percentage of American workers insured by their employers is declining. The share of Americans under age 65 who are covered by group health plans declined for the ninth year in a row in 2009, falling from 68 percent in 2000 to 59 percent in 2009. Others have lost insurance because of layoffs in the lagging economy. But by 2014, most U.S. residents will be required to have health coverage, or pay a penalty tax, because of health care reform.

State Health Insurance Exchanges Coming

The state also is gearing up for changes. Consumers will be able to shop for plans via a health insurance exchange, which states must establish by 2014. Exchanges will provide information about competing insurance companies and their plans’ benefits and costs.

Aon Hewitt Inc. is developing a health insurance exchange that would enable employers with least 1,000 employees to offer their workers an array of plans provided by participating insurers. By using the exchange, employers would be relieved of the time and expense of choosing health insurers and administering their plans, while employees would have a broader choice of health plans, explained Ken Sperling, global health and benefits practice leader in Aon Hewitt’s Norwalk, Conn., office. “Employers wouldn’t have to worry about bids or plan administration,” Mr. Sperling notes. Instead, the employer’s only role would be deciding how much of the premium it would pay for each option.

Several Options

Insurers would offer identical plans with five different levels of benefits, including three high-deductible plans that could be linked with health savings accounts and another whose benefit coverage would resemble that of a traditional PPO plan. Premiums initially would be set on an employer-by-employer basis. Mr. Sperling said the program is geared toward employers with at least 1,000 employees, adding, though, that Aon Hewitt has received interest in the exchange concept from employers of various sizes and industries. For insurers, the exchange concept offers the potential of tapping a much larger market.

Earlier Program

The exchange, which Lincolnshire, Ill.-based Aon Hewitt hopes to launch in 2012, would be an extension of a retiree medical exchange program it now administers and through which about 50 insurers offer coverage to 2.4 million retirees and dependents. The average participant has access to 32 medical plan and 23 prescription drug plan choices, an Aon Hewitt spokesman said.

Medically vulnerable individuals enrolled in high-deductible health plans are not at a greater risk for cutting back on necessary health services than non-vulnerable enrollees in high-deductible plans, according to a new study by RAND Corporation,

For the study, researchers analyzed data on more than 360,000 U.S. families enrolled in high-deductible health plans through 59 large employers between 2003 and 2007.
In particular, researchers examined how high-deductible plans affected families living in low-income areas and families that had a member with a serious chronic condition.

Key Findings

Some health advocates have expressed concern that high-deductible plans could spur low-income families and people with chronic illnesses to forgo necessary medical care.
However, Amelia Haviland -- lead author of the study and a statistician at RAND -- said researchers "did not find greater cutbacks for medically vulnerable families."

The study found that some high-deductible plan enrollees with chronic illnesses were more likely to obtain certain preventive services than low-income and non-vulnerable enrollees.

Researchers noted that policyholders of all income levels tended to use recommended preventive services less frequently after switching to a high-deductible plan. In addition, the study found that the size of the deductible affected spending on health services among non-vulnerable families. According to Haviland, medically vulnerable families reduced spending on prescription drugs only when deductibles were at least $1,000 per person.

Implications

Haviland said the study "suggests that non-vulnerable families, low-income families and high-risk families are equally affected under high-deductible plans." Researchers noted that the findings could become more pertinent over the next few years because the state health insurance exchanges mandated under the federal health reform law could start offering high-deductible health plans in 2014.

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Read more: http://www.californiahealthline.org/articles/2011/4/19/highdeductibles-not-triggering-atrisk-enrollees-to-forgo-care.aspx#ixzz1JzNpHYL1

Massachusetts became the first state to move toward universal health insurance five years ago. Now, the state is debating how to replace the fee-for-service medical system. Mass Governor Deval L. Patrick (D) is trying to push the health care system here into a new era of cost control. He is proposing a new way of paying for care that would give lump payments to teams of doctors responsible for almost all the care of a group of patients, with bonuses for saving money and dispensing high-caliber services that keep people healthy.

“We did access first,” said state Senate President Therese Murray (D). “Now we have to figure out how we afford that.”

In 2006 created a health insurance exchange, a requirement that most residents carry coverage and subsidies to help them pay for it — central elements now in the federal Affordable Care Act (ACA). As a result, 98 percent of the residents here are now insured, but the first round of health care changes devoted far less attention to medical costs.

Leaders from the state’s insurance and hospital industries, medical society, legislature and governor’s staff served on a special state commission assigned to diagnose the cause of soaring medical spending.

Fee-for-service medicine “is a primary contributor to escalating costs and pervasive problems of uneven quality,” the commission unanimously concluded in 2009.

In 2009 Blue Cross Blue Shield of Massachusetts it began a new payment system called Alternative Quality Contracts. The arrangement is a version of the accountable care organizations that the federal government also is trying to encourage in Medicare. They pay teams of doctors or hospitals a lump sum or what is called a “global budget” for the patients assigned to them. If a team can provide care for less, it keeps some of the savings, assuming it also meets enough of 64 measures of quality that Blue Cross has defined. Today, about one-third of the primary care doctors in Blue Cross’s network are taking part. A half-million HMO patients have been put in them — but not told by the insurer.

At Partners HealthCare, the famous Boston-based medical system that dominates health care locally, Massachusetts General Hospital has been conducting a Medicare experiment in which nurses are assigned to coordinate care for about 2,500 older patients with multiple ailments. The experiment, which began five years ago, so far has reduced hospital re-admissions by one-fifth and cut medical spending by 7 percent.

President Obama signed legislation Thursday, April 14 repealing the expanded 1099 reporting requirements in the health care reform law and Small Business Jobs Act. The widely unpopular rules would have required businesses to report any purchases of goods or services of more than $600 a year from another vendor to the IRS on a Form 1099-MISC.

President Obama supported repealing this provision and with a bipartisan effort, lawmakers removed a requirement that would have been an undue barrier to small business growth. The many benefits of the health reform law for small businesses remain in place. These tools are already helping small business owners find more affordable and accessible coverage for themselves and their employees.

House Ways and Means Committee Chairman Dave Camp, R-Mich., praised the repeal. “After nearly a year-long battle to repeal the onerous 1099 provisions enacted by Democrats, I am pleased the President has now signed their repeal into law,” he said. “On the eve of Tax Day, small businesses can finally breathe a huge sigh of relief that one of the many burdens the Democrats’ health care law would have placed on them has been repealed. Instead, small businesses can focus more of their energies and resources on creating jobs, not filling out yet another form for the IRS.”

Narrow Network HMOs

Thousands of employers in California and across the U.S. are eliminating costly physicians and hospitals from their health care provider networks in an effort to reduce health care costs. Since the recession started in 2008, more than 10,000 California employers and public agencies have opted for so-called “narrow network” HMOs. Such health plans offer fewer choices in health care providers but can reduce an employer’s spending on insurance premiums by nearly 25% in some cases.

Small Business Favorites

Insurers and employers say the narrow networks are growing fastest among small businesses. However, some larger entities — such as CalPERS and the University of California — also are offering narrow network plans from Blue Shield of California and Health Net.

Health Advocates Push Back

Consumer advocates and health care experts warn that cutting physicians and hospitals from health plan networks might harm patients, particularly those who depend on specific health care providers for the treatment of life-threatening or chronic conditions. They added that HMO enrollees seeking care from out-of-network health care providers typically are responsible for the entire cost of their treatment.

Insurers’ Position

Health insurers contend that they take health care quality into account when designing the smaller provider networks. They also argue that narrow network HMOs do not dramatically reduce enrollees’ choices, noting that the networks often include many of the same health care providers listed in the broader HMO networks.