tag:www.healthcareshopper.com,2013://2 2012-09-13T22:38:37Z Health Insurance, Health Care Policy, Primary Care, Health Care Reform, Prescription Drugs, Women's Health, Children's Health, Aging Movable Type Pro 4.38 tag:www.healthcareshopper.com,2012://2.1397 2012-09-13T22:51:20Z 2012-09-13T22:38:37Z

Assuming the Affordable Care Act (ACA) stays on track through the aftermath of the election, it will offer numerous new benefits, such as guaranteed coverage for all adults starting in 2014. Some companies may want to stop providing health coverage...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html Assuming the Affordable Care Act (ACA) stays on track through the aftermath of the election, it will offer numerous new benefits, such as guaranteed coverage for all adults starting in 2014. Some companies may want to stop providing health coverage and instead give workers money to buy their own. One of the more popular ideas being discussed is to give workers a lump sum, a voucher or defined contribution, and then let them use that money to buy their own individual health plan through the state health insurance exchange. One upshot is that workers could shop for plans that best suit their needs in terms of doctors and benefits, rather than relying on what their employers pick. They also get to take their policies with them if they leave their jobs. This model "gets a boost now", said David Lansky, chief executive of the *Pacific Business Group on Health*. The defined-contribution model is like a 401(k) plan in which employers put a fixed amount of tax-deferred dollars into employees' retirement accounts and leave it to the workers to manage the money. In the case of health benefits, employers gain more control over their spending and avoid the hassle of picking plans for their workforce. Small business employers should be eager for a new way of doing things as medical costs and insurance premiums keep climbing. Businesses with less than 50 employees have nothing to loose - no penalties or "taxes" - for not maintaining a group health plan. Some smaller firms, especially in technology, may want to keep benefits in-house to compete for the best talent. But companies in retail, hospitality and other service sectors with lots of lower-wage workers will be at the front of the line to sign-up for defined contribution plans. Larger companies tend to be fairly conservative are unlikely to give up their paternal healthcare role in the near term, but faced with escalating healthcare costs, some employers will look at unconventional options. *Extend Health*, a California-based company, has already helped 40 companies in the *Fortune 500* make this switch on retiree health plans, and it said many of those clients are interested in doing the same for current workers. *Aon Hewitt*, a major benefits consultant, is launching a private health exchange this fall aimed at employers with more than 5,000 workers. tag:www.healthcareshopper.com,2012://2.1391 2012-09-11T21:38:38Z 2012-09-13T19:48:17Z

With the Supreme Court decision finalized, federal and state agencies are rushing to create State Health Benefit Exchanges for individuals and possibly a SHOP Exchange for small-businesses by January 2014. State-Based Exchanges California and Maryland were early out of the...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html With the Supreme Court decision finalized, federal and state agencies are rushing to create [State Health Benefit Exchanges](http://www.healthcareshopper.com/health-insurance-exchange/index.htm) for individuals and possibly a SHOP Exchange for small-businesses by January 2014. **State-Based Exchanges** California and Maryland were early out of the gate and are well on their way to creating state based exchanges. Others moving forward with state-based exchanges include New York, Connecticut, Vermont, Massachusetts, D.C., West Virginia, Hawaii, Washington, Oregon, Nevada, Utah and Colorado. Some of these less-populous states will probably opt for a federal partnership. **Federally-Facilitated Exchanges** States that have opted not to create a state health benefit Exchange at all will most likely end up with a federally-facilitated Exchange. These states still can maintain some control their Exchanges, including primary responsibility for the plan management function. States do appear to have the option to use agents. Among the states that will probably have a federally-facilitated Exchange include: Texas, Florida, New Jersey, Michigan, South Carolina, Louisiana, Wisconsin, New Hampshire, Ohio, Maine, and Alaska. **Working On It** Illinois, Pennsylvania and Rhode Island have pending Exchange legislation that could result in state-run exchanges, but at this late date it is more likely they will ask for a federally-facilitated exchange, at least initially. **What About Funding?** Lurking in the wings HHS has yet to address how federally-facilitated Exchanges will be funded. The ACA does not include a way to fund this type of Exchange. More to follow...** tag:www.healthcareshopper.com,2012://2.1329 2012-08-15T23:09:21Z 2012-08-15T23:52:14Z

Many states will not be ready to establish their own state health insurance exchange program. Only, 15 states have passed legislation or issued executive orders to create exchanges. HHS is launching a series of regional meetings to encourage reluctant states...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html Many states will not be ready to establish their own [state health insurance exchange ](http://www.healthcareshopper.com/health-insurance-exchange/index.htm)program. Only, 15 states have passed legislation or issued executive orders to create exchanges. HHS is launching a series of regional meetings to encourage reluctant states to move forward. Time is running out for states to begin setting up the health insurance exchanges. Seven states have decided to allow the federal government to establish and run their exchanges and many of the remaining 28 states are waiting. Under the law, states will have to decide later this year wether or not they will create their own exchanges. The feds would have no trouble setting up and running the exchange infrastructure in multiple states, but they must get co-operation from the states to manage issues like selecting insurers and qualified health plans, determining eligibility and providing customer service and support. That cooperation may vary with state politics. In an effort to reduce the number of federal exchanges, the Obama administration has been flexible with states, allowing them to set their own benchmarks for essential health benefits and offering states the option of partnering with the federal government to share operations, tag:www.healthcareshopper.com,2012://2.1200 2012-07-19T21:09:14Z 2012-07-19T20:36:50Z

A Milliman study, published March 15, 2012, says the average annual health care costs for a family of four with an employer-sponsored PPO plan increased by 6.9% from 2011 to 2012, to $20,728. Employee Cost-Sharing Increases The study found that...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html A *Milliman* study, published March 15, 2012, says the average annual health care costs for a family of four with an employer-sponsored PPO plan increased by 6.9% from 2011 to 2012, to $20,728. **Employee Cost-Sharing Increases** The study found that employees will pay an average of 41%, or $8,584, of the total cost through premium contributions and out-of-pocket expenses, while employers will cover the remainder. **Slower Rate of Growth** According to **Milliman**, the 6.9% increase was the smallest annual growth rate recorded by the consulting firm in 12 years, but the $1,335 increase was the largest jump in dollars. Lorraine Mayne, a *Millima*n actuary, said the study "helps illustrate the challenge of controlling health care costs," noting that since "the total cost is already so high, even a slower rate of growth has a serious impact on family budgets" . tag:www.healthcareshopper.com,2012://2.1199 2012-07-18T20:47:16Z 2012-07-18T21:45:40Z

Today’s employer-sponsored health insurance market is dominated by defined benefit plans, under which employers determine a set of health insurance benefits that are provided for employees. These will gradually be replaced by defined contribution plans, under which employers pay a...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html Today's employer-sponsored health insurance market is dominated by defined benefit plans, under which employers determine a set of health insurance benefits that are provided for employees. These will gradually be replaced by defined contribution plans, under which employers pay a fixed amount, and employees use the money to buy or help pay for insurance they choose themselves. The fundamental driver of this shift is the effort by American businesses to reduce their exposure to healthcare costs. The natural next step will be for employers to strictly limit their health-insurance contributions to a set amount of money that workers could use to buy insurance. Companies will thus eliminate their exposure to unexpectedly high health-care costs. **Health Care Reform Accelerates the Shift** The Affordable Care Act (ACA), or Obamacare if you must, will accelerate the shift to defined contribution plans. Indeed, the legislation may have a larger impact on the type of health insurance plan that employers offer than on their decision about whether to drop healthcare benefits altogether. A survey by McKinsey & Co. has suggested the potential for huge declines in employer-based health insurance. Such estimates are highly uncertain, and what actually happens will probably depend on herd behavior. Employer surveys indicate that most companies will consider dropping their health plans only if other firms do. If most employers do retain their health plans, the state [Health Insurance Exchanges](http://www.healthcareshopper.com/health_insurance_exchange.htm) created under the new federal health-care law will make the basic idea of a defined-contribution health plan more prevalent, and thus speed its adoption. The regulations written to carry out the new law will determine how things play out. If defined contribution plans that are sufficiently generous count as employer-based coverage, as is generally expected, the trend toward such plans will probably accelerate. In any case, the bottom line is that a shift toward defined contribution plans seems likely. I'd be willing to bet that most large U.S. employer healthcare offerings in 2020 will be defined-contribution plans. tag:www.healthcareshopper.com,2012://2.1244 2012-07-11T22:37:24Z 2012-07-11T23:02:29Z

Some of the biggest health insurers - Aetna and United Healthcare - recently had to to admit their utter incompetence at keeping a lid on healthcare costs. The are suing a network of surgical centers - Bay Area Medical &...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html Some of the biggest health insurers - Aetna and United Healthcare - recently had to to admit their utter incompetence at keeping a lid on healthcare costs. The are suing a network of surgical centers - Bay Area Medical & Surgical (BASM) - for $60 million for overcharging. That should be a concern to policyholders because it is the insurers' job to monitor medical claims and stamp it out if it's unnecessary or overpriced, or both. Judging from the Aetna and United lawsuits, those companies have finally gotten around to taking that task seriously, which is good. But it still leaves the question: What took them so long. The insurers don't have a good explanation for why they didn't catch this alleged fraud and put a stop to it long ago -- or why they paid what they now say were manifestly inflated claims. Among the claims cited in the lawsuits is an outpatient bunion operation for which a BASM clinic claimed $66,100. Aetna says the average payment to its in-network clinics for this operation is $3,677, but it paid BASM $52,880 on the claim anyway. United says BASM submitted a claim for $128,813 for a kidney stone operation in 2010. United blithely paid $97,051, even though its usual in-network payment was $6,851. Indeed, United says that's what happened. Its processing volume of 1 million claims a day is so burdensome that it's "not in a position to specifically investigate the veracity of each claim." BASM exploited that loophole, United argues. This is the part that should make you go, "Say what?" The whole point is that the industry supposedly has the expertise to identify and eliminate unnecessary healthcare and excessive billing. BASM and its physician partners aren't angels in this affair. The trend toward physicians owning shares in surgical clinics has raised the hackles of state and federal regulators for more than a decade. Numerous studies have shown that doctors with a direct financial interest in surgical or diagnostic facilities tend to overutilize those facilities by prescribing unnecessary surgeries or tests -- if you've invested in a CT scanner, after all, your incentive is to cover your nut by scheduling lots of CT scans. The unfortunate thing is that this is an aspect of rising healthcare costs that's least affected by the new reform act, which doesn't impose any direct control on private provider charges. That's going to be in the hands of the insurers. Judging from this affair, that's not reason for optimism. If the insurers continue to perform this badly, who will pay the price? As taxpayers and policyholders, you will tag:www.healthcareshopper.com,2012://2.1225 2012-06-25T18:36:31Z 2012-06-25T18:50:35Z

Our friends at ChamberofCommerce.com created this infographic to raise awareness of an issue important to us and millions of other small businesses. We are a small business ourselves and we serve small businesses. So, for us, it only made sense...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html ]]> tag:www.healthcareshopper.com,2012://2.1197 2012-06-11T20:08:07Z 2012-06-12T02:46:48Z

As health care consumers, we should be able to see what a service costs in advance of the treatment. We should have access to quality information scored by objective measures and an independent source who maintains the integrity of such...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html As health care consumers, we should be able to see what a service costs in advance of the treatment. We should have access to quality information scored by objective measures and an independent source who maintains the integrity of such information so we can weigh the cost with overall value. Just like everything else we buy. **The Big Secret** When providers and health plans negotiate contracts, they agree on discounted fees for a particular service. Providers bill one fee (higher) and accept a lower negotiated fee, writing off the contractual allowance. What is so frustrating is that there's considerable variation in cost for the same service between health insurance companies with no discernable difference in quality. Doubly frustrating s the fact that it's such a big secret. It seems that the payers and the providers all have a vested interest in hiding what the actual costs of services. **Demand Transparency** So what can consumers, all of us, do? Demand transparency and support consumerism, health and wellness. Encourage health insurers to start small by making the top 25 coded services visible to their members. Ask them to create tools and resources to help people become smarter, more informed healthcare shoppers. Can you imagine if we we had enough information to behave like consumers with our health care resources? A world where we could make decisions to avoid unnecessary care, tools that help us understand that expensive care is not necessarily care and that support us in making better choices where we have the ability. tag:www.healthcareshopper.com,2012://2.1192 2012-06-05T17:35:11Z 2012-06-05T18:19:20Z

Mike Sarafolean, CEO of Orion Corp. of Minnesota, said he had a limited number of insurance choices to offer his 70 workers: “I had to buy a plan that would make sense and fit for most people. Now they make...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html Mike Sarafolean, CEO of *Orion Corp.* of Minnesota, said he had a limited number of insurance choices to offer his 70 workers: "I had to buy a plan that would make sense and fit for most people. Now they make choices that fit for them." For the past few years, his company faced "double-digit premium increases every renewal." A little more than a year ago, Orion received a 40 percent renewal increase, prompting him to move to Minneapolis-based *Bloom Health*, which set up private exchanges in Michigan, Minneapolis and Indiana. **Defined Contribution Model** Now, his company makes a defined contributions ranging $125 a month for younger workers to $350 for older ones to special health reimbursement accounts (HRA), which workers then use to buy an insurance policy. By making the change to a flat contribution and a private exchange, the company is saving 10 percent over its previous year's cost of insurance, he says. Many of his workers also spend less, he says. This "defined contribution" model in health care compares the to one that gained speed in the early 1990s - employers abandoning pensions in favor of offering workers 401(k) plans for retirement savings. But just as 401(k) plans transferred the risk of market downturns to workers, the flat-payment model would shift risk to workers if rapidly rising health costs outpace increases in employer contributions. **Rejection For Preexisting Health Conditions** Unlike most of the private exchanges, the *Bloom Health* model, which serves about 25,000 people, sends workers to buy their own policies on the individual market, rather than through a group health policy. However, insurers selling individual policies in most states can reject applicants with medical problems, a practice that will end in 2014 under rules in the health care law. Bloom CEO Abir Sen says his company offers its services only in states where rejected applicants can qualify for special state-run, high-risk insurance programs, which generally cost at least 25 percent more. Gabrielle Smith, a 16-year employee of Orion who has an auto-immune disease, worried that under Bloom she would be unable to get insurance "or it would be so in excess of what I could afford." Smith, 48, did get coverage - through Minnesota's high-risk pool - and she now pays $45 a month for her premium on top of her employers contribution. "I haven't heard anyone who is unhappy with the current insurance because it was all individualized," says Smith. "Some of the younger employees with no medical conditions (found low-cost plans that) don't require any money out of their paychecks." **Other Private Exchange Models** Other private exchanges, including Buffalo-N.Y.-based *Liazon*, which serves about 25,000 employees in 23 states, and the new *Aon Hewitt* model send workers to group policies, which cannot reject applicants with health problems. The exchanges vary in other ways, too: While *Bloom* and *Aon Hewitt* offer a variety of insurers, for example, *Liazon* contracts primarily with one main health insurer in each region.. It's unclear how the advent of state-based exchanges will affect programs such as Bloom, Liazon and Aon Hewitt, or whether there will still be a demand for their services by small businesses. tag:www.healthcareshopper.com,2012://2.1196 2012-05-30T19:52:30Z 2012-05-30T18:35:27Z

Insurer filings to the National Association of Insurance Commissioners (NAIC) are a standardized source of information on health plan premiums and expenditures in the aggregate at the state level. The data - compiled by Mark Farrah Associates - shows how...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html National Association of Insurance Commissioners (NAIC) are a standardized source of information on health plan premiums and expenditures in the aggregate at the state level. The data - compiled by Mark Farrah Associates - shows how average premiums in the individual insurance market varied across the country for 2010. Nationwide, the average monthly premium per person in the individual market in 2010 was $215, but the state-by-state range was substantial. Vermont and Massachusetts both had average per member per month premiums over $400 per month. The average premium revenues in Rhode Island, New York, and New Jersey were also relatively high, ranging from about $344 to $364 per month. Alabama ($136), California1 ($157), Arkansas ($163), Idaho ($167), and Delaware ($169) had the lowest average monthly premiums in the country. (Note that these figures represent average premium revenue per member per month. This represents an average across adults and children, so will be lower than a typical premium charged to a single adult.) Why the Variation? There are a variety of reasons why premiums might vary, including: the cost of living, health care costs, state demographics (e.g., the age distribution of the population), plans' effectiveness at controlling costs, the benefits offered by plans, and the patient cost-sharing required. Though premiums are lower in some states, the people enrolled in these plans may have to pay higher deductibles or copayments that offset the savings in premiums. Thus, the map above does not take into account the relative protection offered by the plans. Also, states that have instituted reforms in their insurance markets to make coverage more accessible - such as Massachusetts, Vermont, New York, and New Jersey - may have higher average premiums because people with pre-existing health conditions are able to enroll. Conversely, states that permit medical underwriting may have average premiums that are low because the risk pools include a healthier than average population. Health Care Reform Will Narrow the Variation Among States Starting in 2014, the health reform law (ACA) will require insurers to cover a standard essential benefit package in all states and to use defined tiers of cost-sharing. The minimum cost-sharing tier will require that all newly-purchased insurance in the non-group market have an actuarial value of at least 60%, meaning that the plan pays for at least 60% of the cost of covered benefits in the aggregate for a typical population. In addition, tax credits will be available to make coverage more affordable for people with incomes up to 400% of the poverty level ($43,560 for a single individual and $89,400 for a family of four in 2011 dollars). These changes should all help to narrow the variation in the insurance people buy in different areas of the country. But, a wide range of insurance policies will still be available (ranging from Bronze coverage at an actuarial value of 60% to Platinum coverage at an actuarial value of 90%), so patterns of purchase may still vary substantially across the country. The health reform law will also require all insurers in the individual (non-group) market to accept everyone regardless of health status and prohibit premium surcharges for people with pre-existing health conditions. These rules should narrow the variation in how much people pay for insurance in different parts of the country, but premiums will likely continue to vary considerably due to differences in the cost of living in general and health care, in particular.]]> tag:www.healthcareshopper.com,2012://2.1193 2012-05-24T19:42:51Z 2012-10-23T14:59:10Z

Private and State Exchanges Being competitive in the new health reform environment will require a new view of customers. Jeffrey Troutman, Executive Vice President of PNC Healthcare, a division of PNC Bank, N.A., sees a fundamental shift: “The industry is...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Private and State Exchanges** Being competitive in the new health reform environment will require a new view of customers. Jeffrey Troutman, Executive Vice President of PNC Healthcare, a division of PNC Bank, N.A., sees a fundamental shift: "The industry is moving from wholesale to retail, and the need to make every interaction simple and user-friendly will drive much of the success for health insurers," he said. The direct-to-consumer sales process changes the customer mix insurers are used to. Small employers will also be joining the exchange, making up nearly 4 million of the total exchange membership of 2014. **Affordability More Important than Ever** Of those currently uninsured, 76% say they can't afford it. Affordability is expected to change for this population in 2014 when the government takes two steps: establishes a national floor for Medicaid eligibility and provides government [premium subsidies](http://www.cahba.com/health-care-reform/health-insurance-subsidy.htm) for middle-income Americans. Previously, states set their own standards for Medicaid eligibility; some states were stingy so as to limit spending, and others were generous. But in 2014, Americans whose incomes fall below 138% of Federal Poverty Level (FPL) will qualify for Medicaid. Americans with incomes of 138% to 400% of FPL will be eligible for premium subsidies to buy private insurance in the exchanges. Incidentally, 400% FPL for a family of four is about $90,000. **Customized Products Needed** With this shift toward a retail focus, it will be more important than ever for insurers to know who their customers are so they can meet their needs and build lasting relationships. Their preferences vary based on their backgrounds, demographics, and genders. consumers who are younger and healthier are more open to purchasing health insurance from nontraditional sources, such as a retail store. This is also the group that is less likely to consider price as most important. Younger consumers, consumers with higher incomes, consumers in very good health are the most familiar with the individual mandate. Most consumers would be loyal to a health insurance company that offers incentives for healthy behaviors--except for the young and those in the poorest health. Younger consumers (aged 18 to 34 years) are three times as likely as consumers over 45 to be willing to give up their choice of doctor for a lower insurance costs. tag:www.healthcareshopper.com,2012://2.1191 2012-05-24T17:04:21Z 2012-05-24T17:24:35Z

More Than Half Of Individual Health Plans Offer Coverage That Falls Short Of What Can Be Sold Through Exchanges As Of 2014 A paper published in Health Affairs today, uses data supplied by health insurance companies to determine the financial...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html More Than Half Of Individual Health Plans Offer Coverage That Falls Short Of What Can Be Sold Through Exchanges As Of 2014 A paper published in Health Affairs today, uses data supplied by health insurance companies to determine the financial protection they provided in 2010 in the individual and small- and large-group markets, and then compares that protection against the new 2014 standards. The Affordable Care Act (ACA) creates state-based health insurance exchanges (HIX) that will begin acting as a marketplace for health insurance plans and consumers in 2014. More than half of Americans who had individual insurance in 2010 were enrolled in plans that would not qualify as providing essential coverage under ACA rules for the exchanges in 2014. These people were enrolled in plans with an actuarial value below 60 percent, which means that the plans covered less than that proportion of the enrollees' health expenses. Many of today's individual health plans are below the "bronze" level, the lowest level of plan that can be sold through exchanges. In contrast, most group plans in 2010 had an actuarial benefit of 80-89 percent and would qualify as highly rated "gold" plans in the exchanges. To sell to ten million new buyers on the exchanges, insurers will need to redesign benefit packages. Combined with a ban on medical underwriting, the individual insurance market in a post-health reform world will sharply contrast with the market of past decades. **Key Findings** - The average actuarial value of group plans in 2010 was 83 percent, compared with an average of 60 percent for individual plans. - Most people (65%) enrolled in group plans were in either the gold or platinum tier; about 28 percent were in the silver tier and 6 percent were in the bronze tier. Fewer than 1 percent were in plans with an actuarial value of less than 60 percent--dubbed "tin" plans by the authors. - In the individual market, 51 percent of enrollment was in tin plans. Another third of enrollees were in bronze plans, 14 percent were in silver plans, and 2 percent were in gold plans. In the individual market, there were no platinum plans. - Average out-of-pocket spending per household in the group plans was $1,765. In the individual plans, average household out-of-pocket spending was $4,127. The highest spenders in tin-tier individual insurance plans--including very sick people who incur huge medical bills--had more than $27,000 in annual out-of-pocket spending. ]]> tag:www.healthcareshopper.com,2011://2.1010 2011-12-06T18:14:06Z 2011-12-06T20:49:22Z

Spike Dolomite Ward is the founder and executive director of Arts in Education Aid Council, a nonprofit organization that is restoring the arts to public schools in the San Fernando Valley. www.aieac.org I want to apologize to President Obama. But...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html Spike Dolomite Ward is the founder and executive director of Arts in Education Aid Council, a nonprofit organization that is restoring the arts to public schools in the San Fernando Valley. www.aieac.org **I want to apologize to President Obama. But first, some background.** I found out three weeks ago I have cancer. I'm 49 years old, have been married for almost 20 years and have two kids. My husband has his own small computer business, and I run a small nonprofit in the San Fernando Valley. I am also an artist. Money is tight, and we don't spend it frivolously. We're just ordinary, middle-class people, making an honest living, raising great kids and participating in our community, the kids' schools and church. We're good people, and we work hard. But we haven't been able to afford health insurance for more than two years. And now I have third-stage breast cancer and am facing months of expensive treatment. To understand how such a thing could happen to a family like ours, I need to take you back nine years to when my husband got laid off from the entertainment company where he'd worked for 10 years. Until then, we had been insured through his work, with a first-rate plan. After he got laid off, we got to keep that health insurance for 18 months through COBRA, by paying $1,300 a month, which was a huge burden on an unemployed father and his family. By the time the COBRA ran out, my husband had decided to go into business for himself, so we had to purchase our own insurance. That was fine for a while. Every year his business grew. But insurance premiums were steadily rising too. More than once, we switched carriers for a lower rate, only to have them raise rates significantly after a few months. With the recession, both of our businesses took a huge hit -- my husband's income was cut in half, and the foundations that had supported my small nonprofit were going through their own tough times. We had to start using a home equity line of credit to pay for our health insurance premiums (which by that point cost as much as our monthly mortgage). When the bank capped our home equity line, we were forced to cash in my husband's IRA. The time finally came when we had to make a choice between paying our mortgage or paying for health insurance. We chose to keep our house. We made a nerve-racking gamble, and we lost. Not having insurance amplifies cancer stress. After the diagnosis, instead of focusing all of my energy on getting well, I was panicked about how we were going to pay for everything. I felt guilty and embarrassed about not being insured. When I went to the diagnostic center to pick up my first reports, I was sent to the financial department, where a woman sat me down to talk about resources for "cash patients" (a polite way of saying "uninsured"). "I'm not a deadbeat," I blurted out. "I'm a good person. I have two kids and a house!" The clerk was sympathetic, telling me how even though she worked in the healthcare field, she could barely afford insurance herself. Although there have been a few people who judged us harshly, most people have been understanding about how this could happen to us. That's given me the courage to "out" myself and my family in hopes that it will educate people who are still lucky enough to have health insurance and view people like my family as irresponsible. We're not. What I want people to understand is that, if this could happen to us, it could happen to anybody. If you are fortunate enough to still be employed and have insurance through your employers, you may feel insulated from the sufferings of people like me right now. But things can change abruptly. If you still have a good job with insurance, that doesn't mean that you're better than me, more deserving than me or smarter than me. It just means that you are luckier. And access to healthcare shouldn't depend on luck. Fortunately for me, I've been saved by the federal government's [Pre-existing Condition Insurance Plan](http://www.healthcareshopper.com/health-reform/pcip.htm), something I had never heard of before needing it. It's part of President Obama's healthcare plan, one of the things that has already kicked in, and it guarantees access to insurance for U.S. citizens with preexisting conditions who have been uninsured for at least six months. The application was short, the premiums are affordable, and I have found the people who work in the administration office to be quite compassionate (nothing like the people I have dealt with over the years at other insurance companies.) It's not perfect, of course, and it still leaves many people in need out in the cold. But it's a start, and for me it's been a lifesaver -- perhaps literally. Which brings me to my apology. I was pretty mad at Obama before I learned about this new insurance plan. I had changed my registration from Democrat to Independent, and I had blacked out the top of the "h" on my Obama bumper sticker, so that it read, "Got nope" instead of "got hope." I felt like he had let down the struggling middle class. My son and I had campaigned for him, but since he took office, we felt he had let us down. So this is my public apology. I'm sorry I didn't do enough of my own research to find out what promises the president has made good on. I'm sorry I didn't realize that he really has stood up for me and my family, and for so many others like us. I'm getting a new bumper sticker to cover the one that says "Got nope." It will say "ObamaCares." *Reprinted from the OP/ED Section of the LA Times on 12/6/2011*]]> tag:www.healthcareshopper.com,2011://2.941 2011-04-27T22:43:55Z 2012-10-23T15:00:37Z

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...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html health insurance exchange, which states must establish by 2014. Exchanges will provide information about competing insurance companies and their plans' benefits and costs.]]> tag:www.healthcareshopper.com,2011://2.940 2011-04-25T22:17:27Z 2011-04-27T22:31:47Z

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...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html 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.