Friday, September 25, 2009

NY State Extends Cobra to 36 Months & Dependent eligibility to age 29

The State of New York recently enacted two laws that will dramatically impact insured employee benefit plans, and the group health insurance industry as a whole, in the Empire State. The first law effectively extends the maximum length of federal COBRA and state-mandated continuation coverage to three years, while the second law allows certain children to continue coverage under their parents’ employer-based group health plans through age 29. Full text

Thursday, September 24, 2009

“The budget should be balanced, the treasury should be refilled, public debt should be reduced, the arrogance of officialdom should be tempered and controlled, assistance to foreign lands should be curtailed lest Rome become bankrupt, the mobs should be forced to work and not depend on government for subsistence.”

- Marcus Tullus Cicero (106-43 B.C.)

Friday, September 18, 2009

Competing to be The Biggest Loser;Got EAP?

Ever spend any time on itunes looking at random app's? I admit I do. I look at the free ones because I'm cheap. Anyhow I run across one called FML and its very popular. I click and look at it to find;

If you’ve never been the website FMyLife, it’s kind of like Twitter for losers who just can’t get a break… people post very short anecdotes about how F’d their lives are, always ending with the abbreviated mantra “FML”, and then the rest of the world votes on whether the person’s life is truly F’d or if they got what they deserved. Here are a few:

There is something sad about a culture that competes to demonstrate how terrible their life is, not too mention how shallow is the individual who lifts himself by tearing down another in the comments section of a website or blog? But we have all seen such individuals. The web has coarsened our national rhetoric. Just another reminder why you need to communicate the access to your EAP.

Thursday, September 17, 2009

What's Wrong With This Photo Op?

I have to be home by 5:30 pm these days to take my son to football practice. Passing by the tv on ABC during the national news last night and I see the image of Senator Baucus at the podium. Alone. Charlie Gibson is wondering why the plan has no bi-partisan support from republicans since Baucus has met all the Presidents objectives. Gibson never notices the podium void of any Democratic supporters. Nor does he notice Harry Reid being quoted the bill wont work for Nevada due to the oppressive burden it places on States after the Medicaid Mandates remain long after the funding dries up which I wrote about last month.
Meanwhile, The President is slated for a full Ginsburg on the Sunday talk shows followed by Letterman on Monday for a full hour. Making dogfood is just not a pretty sight.

Wednesday, September 16, 2009

Centralizing Healthcare

“The proletariat will use its political supremacy to wrest, by degree, all capital from the bourgeoisie, to centralize all instruments of production in the hands of the state… Of course, in the beginning, this cannot be effected except by means of despotic inroads on the rights of property”

— Karl Marx

Another Aspect Of Baucus Plan

Responsibility for Employers – The Mark would not require employers to offer health insurance. However, effective January 1, 2013, all employers with more than 50 employees who do not offer coverage will have to reimburse the government for each full-time employee (defined as those working 30 or more hours a week) receiving a health care affordability tax credit in the exchange equal to 100 percent of the average exchange subsidy up to a cap of $400 per total number of employees whether they are receiving a tax credit or not.

As a general matter, if an employee is offered employer-provided health insurance coverage, the individual would be ineligible for a health care affordability tax credit for health insurance purchased through a state exchange. An employee who is offered coverage that does not have an actuarial value of at least 65 percent or who is offered unaffordable coverage by their employer, however, can be eligible for the tax credit. Unaffordable is defined as 13 percent of the employee’s income. A Medicaid-eligible individual can always choose to leave the employer’s coverage and enroll in Medicaid. In this circumstance, the employer is not required to pay a fee.

Your  government has deemed spending 12.99% of your before tax income on health care premiums is affordable and you do not qualify for a health care affordability tax credit.

How's that change working out for you now?

America’s Health Future Act; Don't Drink The Kool-Aid

Senator Baucus has released his long awaited Health Care legislation.The full text of the America’s Health Future Act is available here

Let me call your attention to just one aspect of the proposed bill from Senator Baucus's press release.

Americans who like their health insurance and want to keep it can do so.

Unfortunately you will not be able to keep your own health insurance if you like it. You see with this bill existing health insurance will be grandfathered. That means the insurance companies will not have any new customers in those plans after 1/1/2013. How many companies would stick with a product when by law they could not offer the product to new customers? Would you? If I told a customer this at best I would be guilty of an error of ommision--the failure to mention a material fact--and at worst I would be lying. The only plans insurers can sell after 1/1/2013 are those whose rates and benefits conform with an as yet uncreated health exchange whose edicts on rate setting will be enforcable or the grandfathered plans that have no growth prospects. But have no fear the government will be using the internet to make it easier for you to buy coverage they have defined through their newly created exchange.If you like and find it and the 1-800-medicare a bastion of information staffed by knowledgable call center personell who are unfailingly polite and extrardinarily helpful you are in luck.They should have trotted out the Guinness Guys for the Press conference. Brilliant! Politicans who missed the hundreds of thousands of Americans protesting on 912 in DC must think the average American has stupid painted across their forehead. Read for yourself from the press release.
Individual Market Reforms – The Mark would require insurance companies to issue coverage to all individuals regardless of health status; insurers would no longer be allowed to limit coverage based on pre-existing conditions. Limited variation in premium rates would be permitted for tobacco use, age, and family composition. Variation in rating would be allowed between geographic areas, but would not differ within a geographic area.

Small Group Market Reforms – Rating rules for the individual market would also apply to the small group market, as defined by states. This would include groups of one to 50 employees, but could include companies with up to 100 employees, depending on current state law.

Health Insurance Exchanges – The Mark would make purchasing health insurance coverage easier and more understandable by using the Internet to present consumers with available plans. The Mark would create state-based web portals, or “exchanges” that would direct consumers purchasing plans on the individual market to every health coverage option available in their zip code. The exchanges would offer standardized health insurance enrollment applications, a standard format companies would use to present their insurance plans, and standardized marketing materials. The exchanges would have a call center for customer support. The exchanges would also enable users to determine whether they are eligible for health care affordability tax credits or public programs and would enable consumers without access to the Internet to enroll through the mail or in person in a variety of locations.

Small Group Purchasing Through SHOP Exchanges − Under the Chairman’s Mark, small businesses would have access to state-based Small Business Health Options Program (SHOP) exchanges. These exchanges – like the individual market exchanges – would be web portals that make comparing and purchasing health care coverage easier for small businesses.

Transitioning to a Reformed Insurance Market – Once the insurance market reforms take effect, people who want to keep the insurance they have today can do so. Plans would be allowed to continue to offer the coverage they offer today and this coverage would be grandfathered. These grandfathered plans would only be available to those people who are enrolled today or, in the case of a small employer, to new employees and their dependents. People who qualify for the health care affordability tax credits in the reformed market would not be able to use the credits to purchase grandfathered plans. Tax credits would be offered only to purchase plans created in the reformed market that meet the new benefit standards.


Transitioning for Rating Requirements − Federal rating rules for the individual market (other than for grandfathered plans) would take effect by January 1, 2013. Federal rating rules for the small group market would be phased in over a period of up to five years, as determined by each state, with approval from the Secretary of HHS

Tuesday, September 15, 2009

The American Risk Pool & Heart Disease

Excellent summary of the challenges our nation faces in bending the health care cost curve down.

Fewer and fewer Americans are at low risk for cardiovascular disease, according to an important and frightening new report on long term trends from the National Health and Nutrition Examination Surveys (NHANES) of adults 25-74 years of age.

In the most recent survey (1999-2004) only about 8% of US adults had a low risk profile, despite favorable trends in reducing smoking and cutting cholesterol. The overall increase in risk was due to the increased prevalence of diabetes, obesity, and hypertension, said the CDC’s Earl Ford, and his colleagues, in their report in Circulation.
Of major concern, the long term trend observed by the study was troubling. Following the early 1970s, when very few people had low risk factor profiles, progress appeared to be made, as the survey found substantial increases in the proportion of people with low risk profiles in the late 1980s and early 1990s. But then the hopeful trend reversed in the mid 1990s, apparently in accord with the increase in obesity and diabetes
Low risk was defined as;
•not currently smoking

•total cholesterol <200 mg/dL and not using cholesterol-lowering drugs

•blood pressure <120/80 mm Hg and not using antihypertensive drugs

•BMI <25 kg/m²

•no previous diagnosis of diabetese

Prescription Drug Non-compliance

WSJ Health Blog has an interesting piece up on just how prevalent non compliance for prescription medicines is today that will be of interest to those benchmarking pharmaceutical compliance. This is a coachable moment for wellness advocates as 1/3 of americans do not adhere to their prescription routine.

Monday, September 14, 2009

If you misrepresent this plan We will call you out

What is the deductible?
What is the out of pocket maximum?
Who is in the network?
What is the co-pay, if there is one?
What are the coinsurance levels?
What does the plan cover?
What is excluded?
What does it cost?
Does my HSA go away?
What coverage is available for prescription drugs?

"While there are some difficult issues to be worked out...If you misrepresent this plan We will call you out"

How could someone possibly misrepresent the plan? There is no plan. There is only the expectation a newly created government bureaucracy free from any political pressure will create an insurance exchange that will define a plan options that will reduce out of pocket costs for all Americans while expanding coverage to the uninsured allowing everyone to retain coverage they like, with the doctor they like, without rationing, while preserving Medicare and not adding a penny to the deficit  while simultaneously bending the cost curve down on Medicare spending. Call me a skeptic, hell call me out Mr President but just how you propose to do these things would interest many Americans. Do tell. Americans who ask the questions above deserve answers and by the way it coarsens the national debate when David Axlerod goes on television and suggests they are wrong for asking the basic questions anyone purchasing healthcare would ask. If you are going to sell health care reform you need to have answers for basic questions about costs and benefits or else your're just asking Americans to trust you and congress to get it right. We trust you, Nancy Pelosi & Harry Reid like the Shamwow salesman on cable TVwho you increasingly resemble except that shamwow guy at least covers costs and benefits. The shamwow guy does not pretend to be anything but a salesman, a charlatan and a snakeoil salesman. You could learn from him.

Friday, September 11, 2009

911 Remember

Today we mark the eighth anniversary of 9-11.
The following two videos are 'moving' to say the least. They are must views by all, lest we forget that horrific day in our history and those who are sacrificing to ensure America never has to experience that again.

NEVER forget and ALWAYS remember there are evil people who want to harm us and our nation - some of which are right here on our soil.
And, do not let this Day be remade into a day of 'national service' by those in government who do not appreciate nor understand the greatness of our nation, the wisdom of our Founders or the cost of freedom.
September 11 is, and must remain a day of rememberance, reflection, thanks, prayer, honor, and a reminder of our vulnerabilty.
May God bless our great nation.


Friday, September 4, 2009

Teddy Roosevelt on Reform

Teddy Roosevelt was a giant in the progressive era. As our nation debates health care reform and the President addresses congress next week I am struck by the prescience of TR articulating his famous man in the arena speech in one of the lesser known passages. My own belief is that it offers great insight into the outcry President Obama faces as evidenced by his rapidly dropping poll numbers. The comparison between two Presidents is striking.

The citizen must have high ideals, and yet he must be able to achieve them in practical fashion. No permanent good comes from aspirations so lofty that they have grown fantastic and have become impossible and indeed undesirable to realize. The impractical visionary is far less often the guide and precursor than he is the embittered foe of the real reformer, of the man who, with stumblings and shortcoming, yet does in some shape, in practical fashion, give effect to the hopes and desires of those who strive for better things. Woe to the empty phrase-maker, to the empty idealist, who, instead of making ready the ground for the man of action, turns against him when he appears and hampers him when he does work! Moreover, the preacher of ideals must remember how sorry and contemptible is the figure which he will cut, how great the damage that he will do, if he does not himself, in his own life, strive measurably to realize the ideals that he preaches for others. Let him remember also that the worth of the ideal must be largely determined by the success with which it can in practice be realized. We should abhor the so-called "practical" men whose practicality assumes the shape of that peculiar baseness which finds its expression in disbelief in morality and decency, in disregard of high standards of living and conduct. Such a creature is the worst enemy of the body of politic. But only less desirable as a citizen is his nominal opponent and real ally, the man of fantastic vision who makes the impossible better forever the enemy of the possible good.