The state's top HMO regulator said Monday that health plans should be necessary to get outside review before dropping a policyholder, a theatrical step up in oversight that probably would face stiff challenges from the industry.
Cindy Ehnes, director of the Department of Managed Health Care, said she hadn't yet residential details on how such a requirement would work. But she said any outside input possibly by the department or some independent panel could significantly enhance policyholder's safeguard against the loss of coverage. "It is clear to me that we have to have some independent oversight," Ehnes said. Her call for outside appraisal came after a public meeting she called in Los Angeles to hear from consumers, health plans and providers on what her organization could do to limit the controversial practice of insurers to cancel health coverage after policyholders have submitted claims for care.
Joann Visconto was allowing for buying life insurance that was obtainable through the bank where she works. But the policy had a premium that could rise every year, and it wasn't moveable, so she would lose coverage if she changed jobs. So Visconto, who is over 40, called an agent and bought a certain level-premium policy for a similar price. "When you go with a broker," says the Burlington, N.J., resident, "you can inform him this is what I want, and he is going to get it."
When benefits are offered for sale in the workplace, employees often suppose the products have been independently vetted by their company's officials and are improved or cheaper than those in the marketplace. That isn't always the case, though, and consumer advocates and financial advisers say employees should shop approximately before buying a number of the benefits offered at work. Critics of limited-benefit medical plans say an individual could be insured, but still risk disastrous hospital bills. Health-insurance experts say employees should opt for the plans only if reasonable comprehensive group coverage isn't available from a spouse, parent or other source.
Employees soon will be routinely enrolled in a new medical insurance plan if their own health plan goes out of business or can't purpose because of a disaster, under new rules that take effect Feb. 16.
At present, employees must switch to a new plan if their plan is discontinued by the Office of Personnel Management. If they don't, they mislay their coverage. OPM is to revise the rules so employees are transferred to the nationwide Blue Cross and Blue Shield Association standard plan if their health plan is discontinued and they don't control to another plan on their own.
OPM also is increasing the circumstances under which it can discontinue a plan to include situations in which a plan is not capable to provide services, either permanently or temporarily, because of a disaster. OPM presently can discontinue plans when they go bankrupt or there is a risk that the plan won't be able to meet its financial obligations. In a Jan. 17 Federal Register notice has announce the new rules, OPM said the changes are warranted in light of the damage caused by Hurricane Katrina and the information that it may be impossible to locate enrollees to inform them of the need to change health plans.
The California Medical Assn. is combining patients and hospitals in taking the state's largest insurer to task for what they believe amounts to the company inappropriately abrogating patient’s individual health coverage and then skipping out on the bills for sanctioned medical care.
Physicians are asking to join a class-action lawsuit that the state's hospitals filed in opposition to Blue Cross of California last October, not long after patients filed a separate class-action suit in May 2006.The medical community and patients blame Blue Cross of digging for supposed misstatements or omissions on patient’s policy applications after they have been decided coverage, and then retroactively cancelling patient’s benefits to avoid paying steep claims.
The lawsuits rely on California law that prohibits insurers from repealing health coverage unless patients falsely misrepresent their medical history. State insurance regulations also prohibit health plans from denying payment for medical treatment given in good faith after it was approved.
"The whole health care system depends on doctors and hospitals and patients being capable to rely on the representations of health plans as to patients' coverage, and people make decisions what to do based on those representations," said Catherine I. Hanson, CMA vice president and universal counsel. "It's absolutely ineffectual to be forced to continuously wonder whether the authorization is meaningful or not."
A proposal announced last week by California Gov. Arnold Schwarzenegger that would require all state inhabitants to obtain health insurance "could punctual others to follow suit," although the plan could have a number of "downsides," the Wall Street Journal reports. According to the San Jose Mercury News, the suggestion is "refocusing attention on an issue that every state must deal with the economic burden of the uninsured and that Congress has largely ducked." Chuck Todd, editor in chief of Hotline, said, "California does set an instance. I would not be astonished if 30 states end up copying what California does on health coverage if it's successful."
Leif Wellington Haase, a health policy specialist at the Century Foundation, said that the proposal also will allow Democratic presidential candidates to raise the issue of universal health insurance "without the stigma of socialized medicine." However, the proposal has received some censure over concerns about "multiple moving parts and controversial fees," the Mercury News reports. New York Times columnist Paul Krugman has printed that the proposal has "serious flaws," and David Henderson, a research fellow at the Hoover Institution, has said that the plan would lead to "more regulation, more government expenses and more taxes". In addition, the proposal expected will face opposition from physicians, hospitals, health insurers, employers and labor groups. California Gov.Arnold Schwarzenegger has planned a $12 billion health care package that he says should be the model for the rest of the country. Forcing people to buy health insurance will not resolve the problem of the uninsured, make America healthier or reduce the amount of money we spend on health care. Such schemes will increase taxes, kill jobs and obliterate private health care markets. They are also the next rational step on the path to single-payer health care.
"Everyone in California must have health insurance," Schwarzenegger confirmed. This is already true for automobile insurance, yet up to 25% of the state's inhabitants leave home without it. In Massachusetts, only four in 10 of those suitable for the totally free Commonwealth Care have signed up. Premiums for the subsidized plans are set as high as 6% of the insured's income, prompting talk of not enforcing the individual permission.
Schemes based on individual mandates will need new and extreme regulation of the private insurance market. Under California's plan, insurers won't be capable to turn down anyone based on health status or age, a policy that causes premiums to skyrocket. In 1993, premiums jumped 500% when New Jersey passed a related regulation.
Americans are extremely conflicted when it comes to health care. We think the eminence of the system is poor, yet we praise our individual care. We support universal coverage, but not if it entails any limitations or costs more. Arnold and company better hope that these sentiments don't relate to California, because the move to universal coverage not only costs more, but will only come from mandates and will appear with plenty of restrictions.
Awaiting the outcome of a lawsuit, the New Jersey Superior Court has ruled Vanguard Anesthesia Associates must stop demanding money from customers of Horizon Blue Cross and Blue Shield of New Jersey through a apply called "balance billing." The ruling came after a 90-minute trial Tuesday in Morristown before Superior Court Judge Catherine M. Langlois.
In a lawsuit filed by Horizon, Vanguard is accused of inappropriate direct billing of Horizon's insurance subscribers and threatening subscribers' credit for nonpayment of debts. Many of the pretentious subscribers received medical services at the Kennedy Surgical Center in Washington Township, and at South Jersey Hospital in Vineland and Elmer. Since last fall, Horizon received a predictable 2,000 complaints from subscribers about the billing and threats. The company filed for court act on Dec. 14, 2006.
"It couldn't have gone better for us," said Dan Emmer, spokesman for Horizon, referring to the court's decision on Tuesday. He called the court's injunction and other instructions for Vanguard to restore money to Horizon customers "an extraordinary move." Vanguard claims it is permitted to an additional $4.3 million from 8,000 Horizon subscribers for anesthesia services from Jan. 1, 2004 through April 30, 2006.
"Balance billing" occurs when a health-care supplier charges patients the difference between the amount paid by an insurance company and the actual cost of the medicinal service. Horizon says its accord with Vanguard prohibits balance billing. While proceedings are still pending, Horizon subscribers can stop worrying about demands for more money from Vanguard, Emmer said.
Horizon Blue Cross Blue Shield of New Jersey, headquartered in Newark, is New Jersey's largest health insurer, providing treatment to more than 3.2 million people. It is an autonomous licensee of the Blue Cross Blue Shield Association.
In our affluent society, where having enough is rarely a problem, the natural human want for more is becoming an irrepressible impulse. More comfort, more security, more health, wealth and happiness.
If the problem were only greediness, it would be bad enough. But joined with increasing reliance on government, which many people view as an unrestricted bucket of money, simple greed morphs into greed on steroids. There are built-in safeguard to overspending your own finances, like going hungry or going broke. But these days excessiveness other people's money is less and less restrained.
California Legislative Analyst Elizabeth G. Hill projects a $5.5 billion working budget shortfall for 2007-2008. Even the state's $3.1 billion keep won't fill that hole. One might think anticipating such terrible conditions would prompt restraint in Sacramento's halls of spending. One it seems that would be wrong.
Such attitudes are fed by a rising sense of entitlement. Is there no esoteric, astronomically luxurious medical procedure beyond the public's appetite? Need eyeglasses? Need a new kidney? Need a heart transplant? The typical response seems to be, "If I want it, I'm entitled to it." But do you desire to pay for it? Not on your life. That's someone else's responsibility.
Gov. Arnold Schwarzenegger will reveal Monday his plan for feeding Californians' health care appetite, and we think it won't be a lean diet. The governor already has promised about this. More insurance coverage for more people, even it seems, if insurance companies and employers must be enforced to provide it against their own economic benefits. Such government mandated costs are simply taxes by another name. And taxes are the means of impressive one man's will on another man's pocketbook.
Californians are clamoring not for less, not even for the position quo. They want more. Does that sound a spot like greed? The choice facing state lawmakers and the governor in the coming year is whether to continue feeding a greedy appetite with highly satiable resources. The fact that those resources belong to others critically compounds the problem. In this period of unquenchable appetites, we may be in the minority, but we call on the governor to impress some badly needed restraints.
Workers in California would be permitted to pay their health premiums with pre-tax dollars under a proposal Gov. Arnold Schwarzenegger released yesterday.
The idea, part of a broader health improvement plan the governor plans to unveil Monday, is designed to lure more employees to buy insurance by manufacture it more affordable. The governor wants to make health insurance available to the estimated 6.5 million Californians who lack coverage for all or part of the year.
Schwarzenegger said the suggestion would save employees as much as 40 percent on their health insurance costs because money they spend on premiums wouldn't be taxed. Employers would also save, paying less in federal payroll taxes, an assistant to the governor said. Schwarzenegger also proposed requiring health insurers to recommend incentives for healthy living. For example, people who sign up for gym memberships or weight loss programs might have their insurance rates lower.
The proposal to force employers to offer so called Section 125 plans and reference to an Internal Revenue Service code. It should carry a big price tag at a time when the state faces a $5.5 billion budget deficit. The governor said the accounts could save populace $900 million annually in state income taxes, although he expects that the loss to state coffers will be less than that because the state frequently ends up paying for health care for the uninsured. The governor has not said how he would give for the program. SCAN Health Plan newly announced that the UCLA Health System, which includes UCLA Medical Center, Santa Monica-UCLA Medical Center and the UCLA Medical Group, has attached the health plan's provider network, efficient immediately. As a result, SCAN members now have admittance to more than 100 UCLA primary care physicians in Santa Monica, Brentwood, Culver City, Malibu, Manhattan Beach, Pacific Palisades and West Los Angeles as well as at the nationally famous medical centers in Westwood and Santa Monica.
UCLA Medical Group is mainly composed of faculty physicians of the David Geffen School of Medicine at UCLA. For the second year in a row, the medical group has been recognized as one of California's top performing physician organizations by the Integrated Healthcare Association. UCLA Medical Center is rated among America's top five hospitals and has been rated the top hospital in the western United States for 17 successive years by U.S. News & World Report.
"The UCLA Health System is excited to partner with SCAN to provide another option for seniors in our community," said Dr. Samuel Skootsky, medical director of the UCLA Medical Group. We look forward to caring for these patients in our physician offices throughout the Westside and at our hospitals in Westwood and Santa Monica.
SCAN is one of California's fastest-growing senior-focused health plans, at present serving more than 90,000 Medicare-eligible individuals in Los Angeles, Orange, Riverside, San Bernardino,Ventura and Kern counties. Successful January 1, 2007, SCAN will begin serving members in San Diego County through a partnership with Scripps Health. In adding up, the plan was recently awarded a three-year agreement by the Arizona Health Care Cost Containment System to provide long-term care services in Maricopa County.
Gov. Arnold Schwarzenegger will include plenty of time to think about California's pressing health-care needs before he releases a reform plan this month. Of course, as governor, he has no doubt has access to the best insurance plans the state lavish on its employees. And as a millionaire many times over, he can get care above and beyond what any plan has to offer.
Even for Californians with good jobs, health-care access doesn't approach cheap. With premiums increasing at double-digit rates as well as escalating deductibles and shrinking benefits packages just staying healthy is becoming an increasingly unaffordable challenge. For millions of Californians without coverage, the situation is yet worse.
For many, an accident like the one that befell the governor in Idaho last month would result in innumerable, agonizing hours waiting in an emergency room, followed by a sharp bill that would either bankrupt the patient or effect in yet higher rates for those of us who are insured. Schwarzenegger understands this, which is why he has promised to build health-care reform the centerpiece of his 2007 agenda. And we can expect that the spirit of cooperation that captured Sacramento this past fall will maintain, resulting in real progress headed for increasing health-care access for all.
First is that the health care discuss will touch on some politically sensitive areas such as taxes, immigration, regulations and personal responsibility issues that clash up against some of the ideological pet causes of the political parties. Whether the politicians will mind more about improving health care or their blessed cows remains to be seen.
Over the next few months, Schwarzenegger is going to face the intimidating challenge of molding whatever plan he propose so that it not only works, but also can endure the Sacramento political process and not alienate too many of his key followers. But then, essential work never is. And Schwarzenegger, who is at the compassion of the doctors who are caring for him, must know as well as anyone how important a performing medical system is. |
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