COOPS, EXCHANGES DON’T WORK A look at Massachusetts. GET THE FACTS BEHIND THE NEWS Trudy Lieberman, a contributing editor to the Columbia Journalism Review, has done a stellar job of reporting on the Massachusetts initiative
She found that the Connector( MA exchange) had failed to create affordable insurance OPTIONS for the people in Massachusetts. Using a hypothetical family from Pittsfield in western Mass, Lieberman went shopping on the Connector website. She found that coverage for a 44-year-old couple with an income of $66,150, slightly over the eligibility limit for a state insurance subsidy, “All but three of the fourteen Connector policies cost at least $1,000 a month, or $12,000 a year—eighteen percent of their income.” The cheapest policy, at $820 a month, was no bargain. Yet according to the state’s own guidelines, a Pittsfield family with kids could only afford $364 in monthly premiums. Others point out that Mass has about 93% coverage at high cost. Costs have not been contained.
Like many ideas a health insurance exchange looks better on paper than in practice. When Massachusetts launched its health reform experiment in 2006, it relied heavily on Heritage Foundation policy prescriptions. Under then-Governor Mitt Romney, Massachusetts created a voluntary insurance exchange similar to the one Obama often promotes. Massachusetts outlines some basic requirements for plans that participate but it doesn’t set rates or reimbursement levels. And far from revolutionizing health care, the exchange—known in Massachusetts as the Connector—is demonstrating the limitations of relying solely on the market to solve the nation’s health care woes and rein in skyrocketing medical costs.
Prices vary by age. Lieberman found that if she changed the age of her Pittsfield family, the premiums jumped significantly. Lieberman reports that it’s not just consumers who are complaining. Insurance companies have failed to get the promised deluge of new customers, who’ve been deterred by the high prices.
In the reform bills currently pending in Congress, Democrats have modified the Connector model by introducing a public plan that would compete in the exchange to help keep costs down.
In WA State, which has one of the two regulated Co-Ops in the nation, Group Health Rates for me and my husband and daughter, which would include prescriptions, would be$614 a month or more, up to over $800 a month for a $500 deductible. At the $614/mo rate the deductible for the family would be $4,500.year. There is a 30% co- insurance after deductible, so I would be responsible for anything after the insurance paid 70%, plus the Rxs are paid at 30%-50% only. I would have to pay the balance. For my husband's asthma medication, which is non-generic, that would be over $100/month, every month, on top of the costs above. This plan does not include dental. I could get catastrophic coverage for a lot less for the family, but there would be no Rx coverage and really high deductibles.
Wednesday, September 30, 2009
Monday, September 21, 2009
A Public Option that works!
Should there be a “public option” that competes with private insurance?
Answers might be found in San Francisco, where ambitious health care legislation went into effect early last year. San Francisco and Massachusetts now offer the only near-universal health care programs in the United States.
The early results are in. Today, almost all residents in the city have affordable access to a comprehensive health care delivery system through the Healthy San Francisco program. Covered services include the use of a so-called “medical home” that coordinates care at approved clinics and hospitals within San Francisco, with both public and private facilities. Although not formally insurance, the program is tantamount to a public option of comprehensive health insurance, with the caveat that services are covered only in the city of San Francisco. Enrollees with incomes under 300 percent of the federal poverty level have heavily subsidized access, and those with higher incomes may buy into the public program at rates substantially lower than what they would pay for an individual policy in the private-insurance market.
To pay for this, San Francisco put into effect an employer-health-spending requirement, akin to the “pay or play” employer insurance mandates being considered in Congress. Businesses with 100 or more employees must spend $1.85 an hour toward health care for each employee. Businesses with 20 to 99 employees pay $1.23 an hour, and businesses with 19 or fewer employees are exempt. These are much higher spending levels than mandated in Massachusetts, and more stringent than any of the plans currently under consideration in Congress. Businesses can meet the requirement by paying for private insurance, by paying into medical-reimbursement accounts or by paying into the city’s Healthy San Francisco public option.
There has been great demand for this plan. Thus far, around 45,000 adults have enrolled, compared to an estimated 60,000 who were previously uninsured. Among covered businesses, roughly 20 percent have chosen to use the city’s public option for at least some of their employees. But interestingly, in a recent survey of the city’s businesses, very few (less than 5 percent) of the employers who chose the public option are thinking about dropping existing (private market) insurance coverage. The public option has been used largely to cover previously uninsured workers and to supplement private-coverage options.
Through our experience working on health-care-reform efforts in California and Washington (one of us worked for President George W. Bush’s Council of Economic Advisers), we have seen how concern over employer costs can be a sticking point in the health care debate, even in the absence of persuasive evidence that increased costs would seriously harm businesses. San Francisco’s example should put some of those fears to rest. Many businesses there had to raise their health spending substantially to meet the new requirements, but so far the plan has not hurt jobs.
As of December 2008, there was no indication that San Francisco’s employment grew more slowly after the enactment of the employer-spending requirement than did employment in surrounding areas in San Mateo and Alameda counties. If anything, employment trends were slightly better in San Francisco. This is true whether you consider overall employment or employment in sectors most affected by the employer mandate, like retail businesses and restaurants.
So how have employers adjusted to the higher costs, if not by cutting jobs? More than 25 percent of restaurants, for example, have instituted a “surcharge” — about 4 percent of the bill for most establishments — to pay for the additional costs. Local service businesses can add this surcharge (or raise prices) without risking their competitive position, since their competitors will be required to take similar measures. Furthermore, some of the costs may be passed on to employees in the form of smaller pay raises, which could help ward off the possibility of job losses. Over the longer term, if more widespread coverage allows people to choose jobs based on their skills and not out of fear of losing health insurance from one specific employer, increased productivity will help pay for some of the costs of the mandate.
The San Francisco experiment has demonstrated that requiring a shared-responsibility model — in which employers pay to help achieve universal coverage — has not led to the kind of job losses many fear. The public option has also passed the market test, while not crowding out private options. The positive changes in San Francisco provide a glimpse of what the future might look like if Washington passes substantial health reform this year.
William H. Dow, who was a senior economist for President George W. Bush’s Council of Economic Advisers
Answers might be found in San Francisco, where ambitious health care legislation went into effect early last year. San Francisco and Massachusetts now offer the only near-universal health care programs in the United States.
The early results are in. Today, almost all residents in the city have affordable access to a comprehensive health care delivery system through the Healthy San Francisco program. Covered services include the use of a so-called “medical home” that coordinates care at approved clinics and hospitals within San Francisco, with both public and private facilities. Although not formally insurance, the program is tantamount to a public option of comprehensive health insurance, with the caveat that services are covered only in the city of San Francisco. Enrollees with incomes under 300 percent of the federal poverty level have heavily subsidized access, and those with higher incomes may buy into the public program at rates substantially lower than what they would pay for an individual policy in the private-insurance market.
To pay for this, San Francisco put into effect an employer-health-spending requirement, akin to the “pay or play” employer insurance mandates being considered in Congress. Businesses with 100 or more employees must spend $1.85 an hour toward health care for each employee. Businesses with 20 to 99 employees pay $1.23 an hour, and businesses with 19 or fewer employees are exempt. These are much higher spending levels than mandated in Massachusetts, and more stringent than any of the plans currently under consideration in Congress. Businesses can meet the requirement by paying for private insurance, by paying into medical-reimbursement accounts or by paying into the city’s Healthy San Francisco public option.
There has been great demand for this plan. Thus far, around 45,000 adults have enrolled, compared to an estimated 60,000 who were previously uninsured. Among covered businesses, roughly 20 percent have chosen to use the city’s public option for at least some of their employees. But interestingly, in a recent survey of the city’s businesses, very few (less than 5 percent) of the employers who chose the public option are thinking about dropping existing (private market) insurance coverage. The public option has been used largely to cover previously uninsured workers and to supplement private-coverage options.
Through our experience working on health-care-reform efforts in California and Washington (one of us worked for President George W. Bush’s Council of Economic Advisers), we have seen how concern over employer costs can be a sticking point in the health care debate, even in the absence of persuasive evidence that increased costs would seriously harm businesses. San Francisco’s example should put some of those fears to rest. Many businesses there had to raise their health spending substantially to meet the new requirements, but so far the plan has not hurt jobs.
As of December 2008, there was no indication that San Francisco’s employment grew more slowly after the enactment of the employer-spending requirement than did employment in surrounding areas in San Mateo and Alameda counties. If anything, employment trends were slightly better in San Francisco. This is true whether you consider overall employment or employment in sectors most affected by the employer mandate, like retail businesses and restaurants.
So how have employers adjusted to the higher costs, if not by cutting jobs? More than 25 percent of restaurants, for example, have instituted a “surcharge” — about 4 percent of the bill for most establishments — to pay for the additional costs. Local service businesses can add this surcharge (or raise prices) without risking their competitive position, since their competitors will be required to take similar measures. Furthermore, some of the costs may be passed on to employees in the form of smaller pay raises, which could help ward off the possibility of job losses. Over the longer term, if more widespread coverage allows people to choose jobs based on their skills and not out of fear of losing health insurance from one specific employer, increased productivity will help pay for some of the costs of the mandate.
The San Francisco experiment has demonstrated that requiring a shared-responsibility model — in which employers pay to help achieve universal coverage — has not led to the kind of job losses many fear. The public option has also passed the market test, while not crowding out private options. The positive changes in San Francisco provide a glimpse of what the future might look like if Washington passes substantial health reform this year.
William H. Dow, who was a senior economist for President George W. Bush’s Council of Economic Advisers
Thursday, September 17, 2009
Does a Public Option Insurance Plan
DOES A SINGLE-PAYER HEALTHCARE PLAN MERIT
YOUR CONSIDERATION?
Would a single-payer(public option) Healthcare Plan similar to Medicare make sense for every one in the US? Remember MEDICARE is the best liked, most efficient, and least costly health plan we have.
Ms. Olive Johnson of Vancouver, Canada recently sent a letter to the Chicago Tribune entitled, “Gov’t-funded care”.
“I am writing from Canada because of my interest in the current debate about healthcare in the US. I think Americans would want to know how other countries handle healthcare coverage.
These are the facts about health care coverage in Canada.
1)Gov’t-funded health care is available to everyone. People are free to choose the doctor they want.
2)Individuals pay a modest amount for government-funded health-care(approximately $50 per month), which covers all of their doctor visits, hospital procedures(including surgeries) and laboratory tests.
3)Drugs for those over 65 are paid for, in part or in full, by the Gov’t. The amount paid is dependent on one’s income.
4)People younger than 65 may have their drugs paid for by their employers. Otherwise they can pay into a private insurance scheme to cover the cost of their drugs.
5)Contrary to rumors about long waiting lists in Canada most people are able to see a doctor without delay. The exception to this in rural areas where there are too few doctors. Medical specialists may also have waiting lists.
I can assure you that in Canada gov’t-funded health care is very popular. ALMOSTS ALL OF THOSE WHO DENIGRATE OUR PUBLIC HEALTH-CARE SYSTEM ARE INDIVIDUALS WHO STAND TO PROFIT FROM ITS DEMISE. I URGE AMERICANS NOT TO BE FOOLED INTO ACCEPTING PRIVATE, FOR PROFIT HEALTH CARE, WHICH IS BOTH MORE EXPENSIVE AND LESS EFFICIENT THAN GOV’T-FUNDED CARE.
YOUR CONSIDERATION?
Would a single-payer(public option) Healthcare Plan similar to Medicare make sense for every one in the US? Remember MEDICARE is the best liked, most efficient, and least costly health plan we have.
Ms. Olive Johnson of Vancouver, Canada recently sent a letter to the Chicago Tribune entitled, “Gov’t-funded care”.
“I am writing from Canada because of my interest in the current debate about healthcare in the US. I think Americans would want to know how other countries handle healthcare coverage.
These are the facts about health care coverage in Canada.
1)Gov’t-funded health care is available to everyone. People are free to choose the doctor they want.
2)Individuals pay a modest amount for government-funded health-care(approximately $50 per month), which covers all of their doctor visits, hospital procedures(including surgeries) and laboratory tests.
3)Drugs for those over 65 are paid for, in part or in full, by the Gov’t. The amount paid is dependent on one’s income.
4)People younger than 65 may have their drugs paid for by their employers. Otherwise they can pay into a private insurance scheme to cover the cost of their drugs.
5)Contrary to rumors about long waiting lists in Canada most people are able to see a doctor without delay. The exception to this in rural areas where there are too few doctors. Medical specialists may also have waiting lists.
I can assure you that in Canada gov’t-funded health care is very popular. ALMOSTS ALL OF THOSE WHO DENIGRATE OUR PUBLIC HEALTH-CARE SYSTEM ARE INDIVIDUALS WHO STAND TO PROFIT FROM ITS DEMISE. I URGE AMERICANS NOT TO BE FOOLED INTO ACCEPTING PRIVATE, FOR PROFIT HEALTH CARE, WHICH IS BOTH MORE EXPENSIVE AND LESS EFFICIENT THAN GOV’T-FUNDED CARE.
Sunday, September 13, 2009
The Public option would SAVE $224 to $400 billion
GET THE FACTS BEHIND THE NEWS A look at insurance state by state shows that in most states one or two companies have about 80% of the healthcare insurance business. Pres Obrama mentioned that in Alabama one company has 90% of the business. In Maine Sen Snow's state Wellpoint has 71% of the insurance healthcare business etc.
We need a public option to give insurance buyers more choice and provide a low cost option FOR PEOPLE OF LIMITED MEANS.
The URBAN INSTITUTE Public Policy Institute estimated that a public option would save the taxpayers $224 to 400 Billion over a period of 10 years by lowering the the cost of proposed subsidies for the uninsured. More later
We need a public option to give insurance buyers more choice and provide a low cost option FOR PEOPLE OF LIMITED MEANS.
The URBAN INSTITUTE Public Policy Institute estimated that a public option would save the taxpayers $224 to 400 Billion over a period of 10 years by lowering the the cost of proposed subsidies for the uninsured. More later
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