we have aetna and i don't have the same issues you are.
we have aetna and i don't have the same issues you are.
Have you switched to a CDHP?
self-insured just refers to the funding mechanism your company uses to pay for the coverage it provides its employees and their dependents. It is a financial structure and should be transparent to the employees. Meaning, it shouldn't matter about how your coverage is provided. Aetna administers the plan and pays claims and reviews care etc etc just like if it were fully insured through them. At least they are supposed to.
large percentage of costs caused by a small % of people -- this is sort of the point of insurance.. same is true with car insurance, fire insurance, etc. But that it is 'chronic conditions'.. that is where the focus is these days.
"managing our behavior to keep health care costs down" is the holy grail to some people, and i do think charging employees more for smoking, being overweight, drinking a lot, etc is the wave of the future. I think it is inevitable, really, as it fits in the puritanical ethic in american culture, and also because being fat and smoking and stuff do make people sick. This will lead to all sorts of privacy / individual rights issues that will be a lot of fun to sort out. How do you distinguish someone who is obese because of genetics vs obese due to poor habits? Can a company really refuse to employ smokers? refuse to employ drinkers? refuse to employ fat people? What about individuals who have a family history of cancer.. can you refuse to employ them? The common sense answer is that it might be ok to discriminate against someone based on what they can control, but not against things they can't like genetics, but how far can you take it?
I am skeptical about all that myself.. I don't care how pure and healthy our lifestyles, people are still gonna get sick from things and die. 100 years ago the leading causes of death were childbirth, dysentery, consumption, influenza and pneumonia. Today it's heart disease, cancer, etc. We can clear those up but then we'll be getting sick from something else which will require medical care which doesn't really exist yet and will cost a shitload of money.
We have a wellness program at my work. Basically premiums went up last year and to offset that we have those "Choose Well" program where we get $25 off our bi-weekly premium if we do a 'well-being assessment' (mini check up on-site) and fill out a survey. Pretty easy.
They also encourage walking by giving you a pedometer and you can upload your steps to a website and earn rewards and shit. I haven't really done it. I also was targeted for over-the-phone 'coaching' because I have bad cholesterol numbers, etc. It's annoying as shit though, and I'm not really participating.
our wellness program is not tied to our health insurance. i'm still afraid to answer some of the questions honestly. i think tom is right that this line of thinking is inevitable. i just wonder like tom, how far will it go? will snowboarders who break their arm not be hired? will bad drivers not be hired? i don't think it's right, but i don't know what other options exist for making people actually think about the health care they use, other than abolishing insurance altogether.
and i have "open access aetna select". i think our company did all the major hikes last year, so this year isn't bad at all.
"wellness program" implemented at ADP also. I did some of the coaching calls. Got a $100 gift card for doing 4 of them. BOOM!
Also, smokers get charged $25 more per pay period for health insurance and have to smoke OFF PROPERTY. This just means they take longer breaks than their normally long breaks and congregate on a sidewalk in between our building and the next business. It's like high school all over again.
THIS IS WHAT YOU ALL ASKED 4
i'm not a smoker and they haven't started charging for my extra fat, so i'm good (for now).
Keeping with the thread, this one dumb bitch in my old department whined, "I wonder if they're going to give us longer breaks now that we have to go off property to smoke" when that policy was announced. And there's this one girl who's been steadily ballooning over the past couple months who I just realized is pregnant who I've seen out there with the rest of them the last couple of days.
I didn't realize smokers' insurance costs were greater. My insurance is through captncrzy's company since their policy is better. No idea what the difference in cost is going to be but considering she didn't remark upon it, I'm figuring it was negligible.
Tom, Jan Brewer is accepting Medicaid expansion for Arizona.
Arizona Gov. Jan Brewer wastes no time pushing Medicaid expansion
Last Updated: 10 hours and 38 minutes ago
•By: Associated Press By: Associated Press
PHOENIX - Gov. Jan Brewer is wasting no time rallying support for her effort to expand Arizona's Medicaid plan, using a news conference at Maricopa Medical Center Wednesday to show she has backing from hospitals and the business community.
Hospitals are being asked to agree to a new bed tax to help pay the state's cost of adding about 300,000 low-income people to the plan, which Brewer said would bring billions of dollars in spending to the state health care industry.
The vast majority of the costs would initially be paid by the federal government under terms of President Barack Obama's health care reform law, the Affordable Care Act, with slightly smaller amounts to come in later years.
Brewer said expanding coverage under the state's version of Medicaid, the Arizona Health Care Cost Containment System, would cut uncompensated care that is currently absorbed by hospitals but ultimately passed on to consumers.
She estimates that costs an average Arizona family $2,000 a year in higher insurance premiums.
Leaders of the state's Chamber of Commerce community argued that cutting the number of uninsured in the state will lower insurance costs for businesses.
Brewer made the surprise announcement that she would expand the state's plan in a speech to the Legislature on Monday.
The governor has ardently opposed the federal health care plan and remains uneasy about the federal government playing such a large role in health care, but said the part that expands coverage to citizens who earn up to 138 percent of the federal poverty line is the right thing to do.
"The decision faced by Arizona leaders today is not one of whether the Affordable Care Act should exist. It's the law of the land," she said. "Our decision is whether we will take the action that most benefits Arizona's families and businesses."
States have an option of not signing onto the Medicaid expansions that are part of the Affordable Care Act.
Brewer also will have to convince the Legislature, whose Republican leaders are leery of the proposal.
"We're not going to just push it out the door," House Speaker Andy Tobin said Wednesday. "She's the executive and she has her plan. But a lot of members have great concern about how this actually rolls out and how it affects the budget."
Brewer plans to pay the state's share -- $154 million in the 2015 budget year -- by assessing hospitals using the bed tax. The idea is that hospitals that now have millions in uncompensated care will pay the tax and receive much more than that in insurance payments by treating the newly insured. Federal payments that year are estimated at $1.6 billion, or $1.9 billion if childless adults who lost coverage following recent state rule changes are reinstated, according to Brewer's office.
Some hospitals that serve fewer indigent patients have objected to such taxes in the past, but Brewer said she had an unspecified plan to get their backing.
"We understand that there are some hospitals that are not serving that population," Brewer said. "That doesn't mean that they're not on board with what we are doing in regard to the Affordable Care Act."
Read more: http://www.abc15.com/dpp/news/state/...#ixzz2IFKphZKb
Hopefully New Mexico, Nevada, and (especially) Arizona give Utah's governor the cover he needs to come out for this. Medicaid expansion would be one of the best things imaginable for my clients (and more importantly for the working poor they are trying to serve, but who are currently on the economic fringe of qualifying for services).
Today was the deadline for the states to decide if they would set up their own exchanges under the Affordable Care Act. Here's a map that shows where each state is, both on the decision to set up the exchanges, and on the decision to accept Medicaid expansion:
I'm surprised Oregon is light blue in that map. I thought they were firmly in the Medicaid Expansion camp.
Also, I am the point now where I will be surprised if the federal exchanges are actually fully operational by 10/1/13. Wouldn't shock me to see a bill in Congress (or an executive order?) delaying everything 6 months. HHS has a shitload of stuff on their plate right now.
Tom, you do some crap in health insurance. What would your advice be to someone self-employed who needs coverage? Where are the good places to look for individual plans and what to be careful of? How has Obamacare actually affected things for people like us? Or does your job have absolutely nothing to do with any of this stuff?
My job has everything to do with that stuff. My job right now is to predict how people like you are going to behave (wrt buying or not buying health insurance) come 2014 and what that's going to do to the market.
If you need health insurance right away, a place like essurance.com is as good as any I suppose.
If you are willing to wait for 2014, you can look for health insurance on the "exchange", which basically will be a website with standardized comparisons so it's easier to shop. You may also be eligible for premium subsidies depending on your income. And insurance companies won't be able to deny you coverage because of your health status or your history of abusing narcotics. However, come 2014, health insurance will likely be more expensive than it is now (30% more?) so another strategy to consider is buying it now (if you can pass their underwriting tests) (how good a liar are you?) (very good, I imagine) at the lower rates and then be "grandfathered" come 2014 so those lower rates are (sort of) locked in.
also come 2014 the age variation in premium rates will be compressed so that young guys subsidize old guys. another factor.
... k, I understood some of that. Yes I am very good at lying. What's a "premium subsidy?" I mean, obviously I know what those words mean individually, but how would I qualify for one and what would it mean to my bottom line?
Tom, would you put me on under your insurance? C'mon bro.
This is the template for the national plan.
Welcome to the Massachusetts Connector.
Take it out for a test drive and remember to buckle-up.
Medicaid Access Increases Use of Care, Study Finds
By ANNIE LOWREY
WASHINGTON — Come January, millions of low-income adults will gain health insurance coverage through Medicaid in one of the farthest-reaching provisions of the Obama health care law. How will that change their finances, spending habits, use of available medical services and — most important — their health?
New results from a landmark study, released on Wednesday in The New England Journal of Medicine, go a long way toward answering those questions. The study, called the Oregon Health Study, compares thousands of low-income people in Oregon who received access to Medicaid with an identical population that did not.
It found that those who gained Medicaid coverage spent more on health care, making more visits to doctors and trips to the hospital. But the study suggests that Medicaid coverage did not make those adults much healthier, at least within the two-year time frame of the research, judging by their blood pressure, blood sugar and other measures. It did, however, substantially reduce the incidence of depression, and it made them vastly more financially secure.
“There was this view that Medicaid coverage would not do much for the low-income uninsured, either because they had access to charity care or because Medicaid is not good insurance,” said Amy Finkelstein of the Massachusetts Institute of Technology. “This rejects that notion entirely.” Her work on the Oregon study contributed to her receipt last year of the John Bates Clark Medal, a laurel for younger economists considered second only to the Nobel Memorial Prize in Economic Science for those in the profession.
Currently about 50 million Americans, nearly all them poor, receive health care coverage under Medicaid, a federal program administered by the states. But most states do not provide Medicaid coverage to adults without disabilities or dependent children, no matter how poor they are.
Health economists anticipate that new enrollees to the Medicaid program will swell the country’s health spending costs by hundreds of billions of dollars over time. In 2014, at least 18 states and the District of Columbia will provide coverage to all adults with incomes below 133 percent of the federal poverty line. That currently would translate to coverage for all individuals with incomes below about $15,000 and for households of four people receiving less than about $31,000.
Many more states might join in the expansion in the coming months or years. The Affordable Care Act, President Obama’s health care law, has the federal government pay for a large majority of the increased Medicaid costs in perpetuity, making the financial burden on states much smaller.
The unique Oregon study came about when the state found itself with enough money to provide additional Medicaid coverage to about 10,000 low-income adults. Many times that number qualified.
Rather than deny coverage to all Oregonians, the state established a lottery, to distribute coverage randomly. That gave economists and other social scientists a once-in-a-lifetime chance to perform a randomized control experiment — the gold standard in medical and scientific research, but a rarity in much of social science — isolating the effect that coverage had on health and broader well-being.
An earlier round of results from the Oregon Health Study analyzed assessments of health and well-being reported by study participants, as well as data from hospitals and credit agencies. This second major set of results stems from biometric data collected at in-person visits with participants. A huge team of researchers collected blood samples, blood pressure readings and weight measurements from thousands of Oregonians; about half of them had won access to Medicaid in a lottery and half had not.
The researchers found that Medicaid coverage did not significantly affect the prevalence or diagnosis of hypertension or high cholesterol, or the use of drugs used to treat those conditions. It significantly increased the probability that a person would receive a diagnosis of diabetes and be treated, though it did not reduce blood sugar levels noticeably.
Where Medicaid seemed to have the strongest measured impact was on depression. Getting Medicaid coverage reduced the probability of a positive screening by more than 30 percent.
“The authors are almost tilting the spin on the story to be a little more pessimistic than I would have been,” said John Holahan of the Urban Institute, responding to the new findings.
“There are some positive effects on health,” he said, calling the effect on depression “especially strong.”
Confirming previous findings released by the researchers, the new round of results found that adults covered by Medicaid increased their use of a broad number of health services, like mammograms and cholesterol tests. That increased their medical spending by about 35 percent, compared to adults who did not win Medicaid coverage in the lottery.
Some researchers had theorized that getting Medicaid coverage would lead to a spike in use of medical services by low-income adults. Once covered, they might visit the doctor, have conditions checked out and treated, then stop using medical services as much.
But the second set of results from the Oregon study shows that is not the case. There is no spike in use of health services, nor is there any decline later on. Rather, use of the health system increased, and that increase persisted between the first year and the second year of the study.
“They go to the doctor more often, they visit the hospital more often, they use more prescription drugs, they are more likely to use preventive care,” said Katherine Baicker, a Harvard professor, co-author of the study and former economic adviser to President George W. Bush. “There is no evidence of a spike of utilization from pent-up demand.”
The right wing has gone absolutely nuts over this report. I think they've drawn the wrong conclusions, but it's still amazing to watch them rush to trumpet literally anything that might suggest giving poor people access to affordable health care is a bad idea.
I'm sorry, but I call anything that helps significantly with depression as a success.