Study: Location Affects Health Care More Than Insurance
March 11, 2010 – The relative location of health services has a greater impact than health insurance status regarding people’s ability to obtain quality health care in the United States, according to a report to be published in April by the Center for Healthcare Research and Transformation.
Study results indicate low-income residents living in urban areas were more readily able to obtain health care services than all but the highest-income residents of suburban and rural areas. The study also found a significant percentage – about 17 percent – of those surveyed who have health insurance delayed obtaining necessary medical treatment due to the cost. About 40 percent of those without health insurance said they have delayed seeking medical treatment.
Survey results indicate location rather than health insurance is the primary reason people do not obtain necessary health care, according to officials for the Center for Healthcare Transformation and Research.
“Rather than a simple count of who has health insurance and who doesn’t, we wanted to get a clearer picture of the people behind the statistics,” said Marianne Udow-Philips, director of the Center for Healthcare Transformation and Research. “And we wanted to test the connection between health insurance and access to health care.”
Survey results indicate people living in small towns and rural areas have a much more difficult time accessing necessary health care due to the long distances needed to travel to the few health care facilities in the area, even when they have health insurance coverage provided through state and federal programs. But residents of larger urban centers who have no health insurance coverage typically have greater access to affordable health care clinics and other low-cost facilities located only a short distance away, according to researchers.
The study also indicates people without health insurance coverage generally consider their personal health to be on about the same level as those with health insurance coverage. Some 49 percent of those with health insurance coverage described their overall health as “excellent” or “very good.” About 47 percent of those without health insurance also described their personal health as “excellent” or “very good.”
Researchers from Michigan State University’s Institute for Public Policy and Social Research questioned 1,022 adults living in Michigan – the state with the nation’s highest unemployment rate and worst economy – in August 2009. The Center for Healthcare Research and Transformation is located on the University of Michigan campus and partners with the University of Michigan and Blue Cross and Blue Shield of Michigan to improve health care delivery.
COBRA Health Insurance Subsidy Extended through March
March 3, 2010 – A much-maligned halt in a federal health insurance subsidy for unemployed Americans was averted for a month after Senate Democrats yesterday cut a deal allowing passage of a federal spending measure.
President Barack Obama last night signed into law legislation temporarily extending the federal COBRA health insurance subsidy through March 31. Members of Congress are working on a longer extension through the end of the year, but the temporary extension was necessary after program expired Feb. 28.
The federal COBRA subsidy program helps workers who lost their jobs due to the recent economic downturn maintain their prior group health insurance coverage by paying about 65 percent of the premiums. The federal COBRA subsidy initially lasted 9 months, but with the United States facing its worst job market in decades, an estimated 7 million unemployed Americans would have begun losing their subsidy on Feb. 28. The latest extension was approved after Senate Democrats cut a deal allowing a floor vote on a funding measure for the temporary extension.
U.S. Senator Jim Bunning (R-Kentucky) last week used Senate Republicans’ renewed filibuster power to block a $10 billion spending bill providing funding to extend the COBRA health insurance subsidy program as well as the National Flood Insurance Program, federal unemployment benefits and federal highway projects, among others. Bunning objected to Democrats’ plans to add to the already record-level federal deficit, instead favoring using unallocated federal stimulus funding to fund the programs.
But Senate Democrats yesterday agreed to allow a floor vote on an amendment sponsored by Bunning requiring the $10 billion come from the unallocated portion of the $787 billion federal stimulus bill approved last year. The amendment was defeated, after which the Senate voted to approve the funding measure and sent it to President Barack Obama, who signed it into law last night.
The $787 billion federal stimulus package approved last year allocated funds to help unemployed Americans continue their health insurance benefits through the Consolidated Omnibus Budget Reconciliation Act of 1986 – popularly known as COBRA.
American families who recently lost their primary incomes due to unemployment have seen their average monthly health insurance benefits payments rise from about $389 per month while employed to $1,111 per month if choosing to continue them through COBRA, according to the non-profit Families USA organization. A monthly health insurance premium of $1,111 uses up about 83 percent of the average monthly unemployment take-home benefits of about $1,332, according to Families USA.
Federal COBRA Health Insurance Subsidy to be Extended Through March
Feb. 26, 2010 – Favoring a publicity stunt over real action, federal lawmakers yesterday chose the easy route of yet again temporarily extending the federal COBRA health insurance subsidy program for unemployed workers and their families while they spent the majority of their time debating hotly contested federal health care reform measures that would not take effect for several years.
The federal COBRA subsidy program helps workers who lost their jobs due to the recent economic downturn maintain their prior group health insurance coverage without paying the full premium. The federal COBRA subsidy initially lasted 9 months, but with the United States facing its worst job market in decades, an estimated 7 million unemployed Americans began losing their federal COBRA subsidies on Dec. 1. Federal lawmakers temporarily extended the program in mid December, but they once again have become bogged down in health care reform debate – particularly in the wake of Republican Scott Brown’s recent victory in the Massachusetts U.S. Senate race to fill the vacancy left by the recent death of Ted Kennedy.
Having lost their filibuster-proof majority in the U.S. Senate, Democrats and President Barack Obama are exploring ways to implement changes to the $2.5 trillion a year health care industry in the United States. But while searching for ways to push through what Obama has cited as his “number one” domestic policy priority, federal lawmakers balked at making permanent changes to the COBRA subsidy program in favor of simply extending it through April 5.
The extension applies to unemployed Americans currently receiving the COBRA subsidy or who recently used up their 9-months’ of program eligibility. The $787 billion federal stimulus package approved last year allocated funds to help unemployed Americans continue their health insurance benefits through the Consolidated Omnibus Budget Reconciliation Act of 1986 – popularly known as COBRA. COBRA allows unemployed Americans to continue their group health insurance benefits for up to 18 months when they lose their jobs but requires them to pay the full premium – including any amounts their former employers paid to provide the health care benefits.
When federal officials approved the $787 billion federal stimulus package, they included a provision providing a federal subsidy to pay for 65 percent of health insurance benefits extended through COBRA, but the additional benefit would last only nine of the 18 months for which COBRA can last.
American families who recently lost their primary incomes due to unemployment have seen their average monthly health insurance benefits payments rise from about $389 per month while employed to $1,111 per month if choosing to continue them through COBRA, according to the non-profit Families USA organization. A monthly health insurance premium of $1,111 uses up about 83 percent of the average monthly unemployment take-home benefits of about $1,332, according to Families USA.
Congress to Tackle Measure Targeting Health Insurance Monopolies
Feb. 8, 2010 – Saying they want to increase competition and make health insurance more affordable, two Democratic lawmakers last week introduced legislation removing federal anti-trust exemptions from health insurance companies that likely will be debated this week.
Claiming the government-supported monopoly for health insurers results in higher health insurance premiums for consumers, U.S. Representatives Tom Perriello (D-Virginia) and Betsy Markey (D-Colorado) recently announced their intent to introduce a measure removing the federal anti-trust exemption enjoyed by health insurers and medical malpractice companies. The anti-trust exemption only makes it easier for health insurers to collude and establish higher premiums while facing little real competition, the lawmakers contend.
“The current health care system is crushing our families and businesses. Support for removing this unfair exemption cuts across party lines, and is a major piece of common ground that I’ve been working toward in our country’s health care debate,” Rep. Markey said in a news release. “This is about bringing sorely-needed competition back into an industry that has for too long wielded monopoly control over hard-working American families.”
The so-called Markey-Perriello bill would remove anti-trust exemptions the two freshman lawmakers claim enable executives at health insurance companies to set unreasonably high health insurance premiums, stake out market territories within individual states and rigging bidding on group health insurance contracts. The pair also claim some 400 mergers among health insurance companies during the past 14 years has concentrated about 95 percent of the nation’s health insurance markets in too few hands.
The proposed measure would repeal the 1945 McCarran-Ferguson Act, which allows states to regulate insurance companies unless federal lawmakers enact legislation specifically designed to regulate the nation’s insurance industry. House Speaker Nancy Pelosi (D-California) last week said the measure likely would be debated this week on the floor of the U.S. House of Representatives.
Markey and Perriello contend the anti-trust exemption for health insurance companies has resulted in health insurance premiums more than doubling over the prior decade, but critics say otherwise. A study conducted last year by the nonpartisan Congressional Budget Office suggests repealing the McCarran-Ferguson Act would have no discernable outcome and might result in higher insurance premiums rather than lowering them.
Some state insurance regulators say placing federal officials in control of insurance regulation would siphon away funds from already cash-strapped state general funds. Other critics suggest removing anti-trust exemptions simply would play into the hands of the nation’s largest health insurance companies, which aren’t as reliant upon other insurers for health-related information necessary to establish suitable health insurance premiums. The net effect would be to drive out smaller health insurance companies and create an even greater monopoly among the nation’s largest health insurance companies, some critics contend.
Regardless its outcome, leading Democrats on Capitol Hill are anxious to at least appear to be moving forward with national health care reform President Obama previously stated was his “number one” domestic priority but whose efforts were derailed by Republican Scott Brown’s recent upset victory over early favorite Martha Coakley in Massachusetts’ special election to fill the U.S. Senate seat vacated upon the recent demise of the late Edward Kennedy.
Obama Angles for Health Reform Votes; Medicare Expansion Likely Out
Dec. 15, 2009 – A proposed expansion of the federal Medicare health program likely will be nixed as President Barack Obama and U.S. Senate Democrats struggle to find the 60 votes needed to pass national health care reform legislation being debated.
The President today held a closed-door meeting with Senate Democrats to try to work out a compromise in order to get the President’s top domestic priority approved during a time when public opinion polls show his approval ratings continue to fall. The latest Rasmussen Reports poll indicated more people surveyed, 53 percent, disapprove the job done so far by President Obama versus 44 percent indicating their approval.
Already divided over the possible creation of a public health care plan, Senate Democrats were divided on a proposed expansion of the federal Medicare program. Some Senators last week proposed lowering the eligibility age from 65 to 55 for people choosing to “buy in” early to participate in the federal health care program for the elderly.
Senator Joe Lieberman, an independent from Connecticut and former running mate of Democratic Presidential nominee John Kerry in 2004, is among Senators whose vote is needed to approve any health care reform measures. But Lieberman has threatened to filibuster any measures creating a public health plan or expanding Medicare.
Without Lieberman, Senate Democrats do not have the votes necessary to pass legislation or end a filibuster. Other Senators, such as Democrat Ben Nelson of Nebraska, also have threatened to vote against health care reform. Nelson earlier introduced an amendment restricting federal funding of abortion procedures. The Senate defeated the amendment on a 55-45 vote and placed Nelson in a position of opposing a measure President Obama and most Democrat lawmakers badly want passed.
President Obama today said there is general agreement on health care reform, but Democrats apparently have not secured the 60 votes necessary to advance a health care reform measure. After joining other Democratic U.S. Senators in meeting with the President today, Sen. Dick Durbin (D–Illinois), said expanding Medicare likely would not emerge as part of Senate’s health care reform efforts.
Although Medicare expansion likely is out, several Senators have said a public health insurance plan administered by the government likely would be part of Senate reform efforts. The proposed plan would utilize private health insurance companies operating on a non-profit basis and regulated by the federal Office of Personnel Management, which administers the health insurance plans for Congress and federal employees.
Republicans remain united in their opposition to the proposals, citing some $500 billion in proposed cuts to Medicare funding, $400 billion in new taxes and increased health insurance premiums for American families among reasons for their opposition. Senate Democrats are trying to get their version of health care reform passed by the end of the year.
Reports: Medicare Expansion In, Abortion Restrictions Out
Dec. 9, 2009 – The U.S. Senate likely will make expanding Medicare eligibility part of its health care reform package but not a controversial measure restricting abortions, and several news outlets are reporting a public health care option is dead, although some say otherwise.
The U.S. Senate yesterday voted 55-45 to defeat an amendment restricting how public funds could be used when subsidizing health insurance plans providing coverage for abortion services. Soon after, a group of ten Senate Democrats met in a closed session in Senate Majority Leader Harry Reid’s office and hammered out a tentative deal essentially scrapping the public health care option in favor of expanding Medicare eligibility and create a national, non-profit insurance exchange overseen by the federal Office of Personnel Management, ABC News reported today.
The plan would lower the minimum age for Medicare program eligibility from 65 to 55 years of age in 2011, according to ABC News. And citizens would be allowed to purchase private health insurance plans offered through the national health insurance exchange. Senators also agreed to require insurers to spend 90 percent of insurance premium dollars on health care and reduce administrative costs, the Associated Press reported.
Although several news outlets are reporting a public health insurance option is dead, Reid said that isn’t true. The yet-to-be-revealed compromise plan “includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices,” Reid said in a statement.
The Senate debate is scheduled to last until Dec. 18, but several Capitol Hill pundits anticipate eroding public support could push the debate into next year. Gallup recently released results of its national telephone survey of 1,017 adults conducted Nov. 20-22, and a plurality indicated they would “advise” their respective representatives in Congress to vote against a health care reform measure while 44 percent indicated they would advise voting for reform.
Even fewer want federal lawmakers to take action this year. Only 35 percent of those surveyed said they favor voting on health care reform this year while 42 percent said they prefer Capitol Hill lawmakers take more time before enacting major legislation that won’t take effect for several years.
Gallup’s polling results corroborate similar recent findings by Rasmussen Reports, which last week reported some 56 percent of those polled oppose federal health care reform efforts while only 38 percent indicated support. The support of federal efforts hadn’t dipped below 41 percent in prior weekly polling, according to Rasmussen Reports.
A recent Rasmussen survey also indicates most people don’t think reform efforts will help. Some 54 percent of those polled said the Senate and House bills would harm and not help health care, and 60 percent said the federal legislation likely would increase costs for everyone. Only 16 percent of those polled believe Congressional reform efforts will lower costs.
Federal COBRA Health Insurance Subsidy Expiring
Dec. 1, 2009 – The first of an estimated 7 million Americans utilizing a recent federal subsidy program to pay for health insurance while unemployed begin losing their taxpayer-provided funding as the temporary program expires starting today.
The $787 billion federal stimulus package approved earlier this year allocated funds to help unemployed Americans continue their health insurance benefits through the Consolidated Omnibus Budget Reconciliation Act of 1986 – popularly known as COBRA. COBRA allows unemployed Americans to continue their group health insurance benefits for up to 18 months when they lose their jobs but requires them to pay the full premium – including any amounts their former employers paid to provide the health care benefits.
When federal officials approved the $787 billion federal stimulus package, they included a provision providing a federal subsidy to pay for 65 percent of health insurance benefits extended through COBRA, but the additional benefit would last only nine of the 18 months for which COBRA can last.
American families recently losing their primary incomes due to unemployment see their average monthly health insurance benefits payments rise from about $389 per month while employed to $1,111 per month if choosing to continue them through COBRA, according to the non-profit Families USA organization. A monthly health insurance premium of $1,111 uses up about 83 percent of the average monthly unemployment take-home benefits of about $1,332, according to Families USA.
The federal subsidy program began in March with Americans being eligible if they qualify for federal COBRA benefits continuation and were laid off or lost their jobs between Sept.1, 2008, and Dec. 31 of this year. Individuals cannot have annual incomes exceeding $145,000 while families are allowed to up to $290,000 in income to receive the additional benefit. People eligible for federal Medicare benefits or another group health insurance plan do not qualify for the COBRA subsidy.
U.S. citizens with adjusted gross incomes of between $125,000 and $145,000 for individuals and $250,000 to $290,000 for spouses filing joint income tax returns must repay a portion of the additional benefit when filing their annual income taxes. Individuals earning less than $125,000 in adjusted gross income and families less than $250,000 are not required to repay any of the benefit.
The Congressional Budget Office estimated a total of 7 million Americans would participate in the program when enrollment began in March. And starting today, those enrolled in March will begin losing their subsidy as the 9-month period expires. Federal lawmakers are considering extending the program.
Senate Health Care Debate Begins; Polls Show Support Slipping
Nov. 30, 2009 – Members of the U.S. Senate today began the opening jabs of a contentious debate on national health care reform as yet another major public opinion poll shows declining support for federal lawmakers’ efforts to reform the nation’s $2.5 trillion-a-year health care industry.
While the Senate debate is scheduled to last until Dec. 18, several Capitol Hill pundits anticipate eroding public support could push the debate into next year. Gallup today released results of its national telephone survey of 1,017 adults conducted Nov. 20-22, and a plurality indicated they would “advise” their respective representatives in Congress to vote against a health care reform measure while 44 percent indicated they would advise voting for reform.
Even fewer want federal lawmakers to take action this year. Only 35 percent of those surveyed said they favor voting on health care reform this year while 42 percent said they prefer Capitol Hill lawmakers take more time before enacting major legislation that won’t take effect for several years.
Gallup’s polling results corroborate similar recent findings by Rasmussen Reports, which last week reported some 56 percent of those polled oppose federal health care reform efforts while only 38 percent indicated support. The support of federal efforts hadn’t dipped below 41 percent in prior weekly polling, according to Rasmussen Reports.
The recent Rasmussen survey also indicates most people don’t think reform efforts will help. Some 54 percent of those polled said the Senate and House bills would harm and not help health care, and 60 percent said the federal legislation likely would increase costs for everyone. Only 16 percent of those polled believe Congressional reform efforts will lower costs.
The Senate’s proposal requires all American citizens purchase health insurance and creates regional insurance exchanges where individuals can shop for health insurance coverage tailored to more specific needs. People earning too little to afford health insurance would receive federal subsidies to purchase coverage.
The Senate bill also creates a federal health insurance option in which state legislatures would choose to participate and prevent health insurance companies from refusing coverage to individuals with pre-existing health problems. Some 17 new taxes have been proposed to pay for the estimated $849 billion cost of initiating the Senate plan over a 10-year period.
While Senate Democrats needed 60 votes to advance the measure to a floor debate, independent Senator Joe Lieberman of Connecticut – who sits with the Democratic Caucus – has said he would oppose the Senate version even though he voted to allow the floor debate.
Lieberman, who was Democrat John Kerry’s running mate during the 2004 presidential election, opposes a public option as provided in the Senate bill and earlier announced he would filibuster the measure unless amended to remove the public plan proposed by Senate Majority Leader Harry Reid (D-Nevada). Lieberman says a public option would drive up costs for people with health insurance. Reid contends states would have the option of whether or not to participate in the proposed federal health care option.
Study: Medicare Patients, Uninsured More Likely to Die from Trauma
Nov. 17, 2009 – A recent study conducted by Harvard University researchers indicates Medicare patients stand a 56 percent greater chance of dying from traumatic injuries and the uninsured an 80 percent greater chance than their counterparts with traditional health insurance coverage.
Focusing on people suffering “unintentional injuries,” Harvard University researchers found auto accidents the number-one cause of unintentional injuries. Information on 2.7 million trauma patients was obtained from the National Trauma Data Bank for the years 2002 through 2006. Researchers then compared patients based on their age, race, sex, how they were injured and to what extent. Results then were compared based on the reported insurance status of patients.
“Unintentional injuries” rank among top 10 causes of death for every age group in the United States and is the top cause of death for Americans under age 44, according to the U.S. Centers for Disease Control and Prevention. The most common unintentional injuries are caused by vehicular accidents.
Results showed Medicare patients were 56 percent more likely to die from traumatic injuries than their counterparts, and people without health insurance coverage of any kind were 80 percent more likely to die after suffering traumatic injuries than those with health insurance coverage.
While significant differences seem to arise based on whether or not a patient had health insurance coverage, researchers acknowledge no direct correlation can be made between insurance status and survivability. In most cases, injury severity was the deciding factor.
Researchers speculated the severity of trauma rather than access to care was the primary reason people were more likely to die than others. Among young adults, gunshot wounds as well as auto accidents ranked among the top causes of traumatic injury. Because young adults are more likely to have no health insurance than older adults and they on average suffer much more life-threatening injuries, the severity of injuries suffered rather than access to health insurance is the main reason youth die more often from traumatic injuries, according to the Harvard University research team.
Among older Americans receiving treatment through Medicare, the higher mortality rate due to traumatic injuries likely stems from a greater likelihood of suffering from long-term, more debilitating illnesses and injuries, according to researchers.
While death rates from traumatic events among younger and older Americans without health insurance coverage are more readily explained, researchers suggest middle-age Americans without health insurance coverage tend to suffer more than their insured counterparts and die more often due to delays in obtaining medical care, lapses in treatments and other causes.
The federal Emergency Medical Treatment and Active Labor Act of 1986 ensures people seeking treatment at hospital emergency rooms are treated regardless of whether or not they have health insurance coverage. But when uninsured individuals suffer a traumatic injury, they often have complicating conditions that increases odds of dying from a traumatic injury, several medical professionals contend.
Poll: Potential Health Care Reform Costs Making Voters Wary
Nov. 16, 2009 – By a narrow margin, the percentage of Americans recently polled who support current health care plans being assessed in Congress is less than those opposed to health care reform efforts with potential cost generally being the tipping point.
Some 43 percent of those participating in a recent Associated Press poll indicated they oppose current health care reform efforts while 41 percent indicated support. Some 15 percent of respondents indicated no preference.
Factoring in an about 3 percent error margin, poll results indicate no statistically significant difference between those supporting and those opposed. But lawmakers at-risk of losing their seats in the 2010 elections won’t be emboldened by such results clearly indicating no strong amount of support or a “mandate” for federal health care reform efforts.
A month ago, the Associated Press poll showed an equal 40-40 split among those supporting and those opposing health care reform plans. The slight shift toward pessimism suggests current Congressional efforts do not resonate well among poll participants, and potential cost is their primary concern.
Current legislative proposals would prevent health insurance companies from refusing to insure people due to pre-existing medical conditions, and some 82 percent of those polled in October by the Pew Research Center support requiring health insurers cover people with pre-existing medical conditions.
But when informed their health insurance premiums likely would rise to cover the added costs of providing health insurance coverage to people with pre-existing medical conditions, support for current health care reform proposals declined sharply, with only 43 percent of those participating in the Associated Press poll saying they still would support reform efforts while 31 percent said they would oppose them due to the higher cost.
Adding to potential health insurance costs increases is a legislative proposal limiting the amount health insurers can charge the elderly for coverage. Instead, health insurers would have to increase rates charged to a group already comprising a large percentage of the uninsured – healthy people in their 20s.
Current measures in the U.S. House and Senate also require all Americans purchase health insurance coverage or obtain it through an employer or government program. Low-income people and families with mid-level incomes would have access to state and federal subsidies to help pay for health care, if approved and signed into law, which also would increase health care costs for most of the more than 80 percent of U.S. citizens with health insurance coverage, according to the Associated Press.
Stanford University researchers conducted the telephone poll of 1,502 adults from Oct. 29 to Nov. 8 and has a margin of error of 2.5 percent.
CBO: Tort Reform Could Save $41 Billion in Federal Health Care Costs
Oct. 20, 2009 – A recent federal study suggests taxpayers could save $41 billion over 10 years if lawmakers placed limits on medical malpractice lawsuits tied to federal health care programs.
The nonpartisan Congressional Budget Office study runs counter to a prior report issued from the same organization last year suggesting potential savings would be much less. The report issued last year suggested the only savings from tort reform would be limited to lower premiums paid by doctors for malpractice insurance without encouraging them to improve care delivery.
Federal officials revised their estimate after further studying the matter.
“Recent research has provided additional evidence that lowering the cost of medical malpractice tends to reduce the use of health care services,” said Douglas Elmendorf, director of the Congressional Budget Office, in a letter to members of Congress.
When combined with a potential $13 billion in additional tax revenues, tort reform could net $54 billion over 10 years, according to the Congressional Budget Office report. Some federal lawmakers are attempting to place liability limits on medical malpractice suits in any proposed federal health care reform. And Elmendorf suggested the fear of malpractice lawsuits causes most doctors to perform more work than necessary on most patients, leading to higher health care costs, according to an Oct. 12 Associated Press report.
But among many arguments, patient advocacy groups and lobbyists for trial lawyers say placing liability limits on medical malpractice lawsuits could cause some victims to recoup less than they will be forced to pay over a lifetime of ongoing medical care. Others wouldn’t be compensated properly for their pain and suffering. Proponents of liability limits suggest patients would benefit rather than be harmed.
“Cutting medical liability costs would help preserve patients’ access to care,” Sen. Charles Grassley (R-Iowa), a member of the Senate Finance Committee, was quoted in the Associated Press report. “The more federal health care programs spend on unnecessary tests, the less money is available for necessary patient care.
The Senate Finance Committee recently approved a health care measure encouraging states to find ways to resolve medical malpractice cases rather than battling in court. The highly publicized “Baucus Bill” is one of several federal health care reform proposals and now goes before the entire U.S. Senate for consideration. Another Senate bill also has been approved by the Health Care Committee and awaits approval. The measures are part of federal efforts to reform the U.S. health care system.
Making Health Insurance More Affordable for Individuals
Oct. 15, 2009 – Group health insurance plans generally are more cost-effective and accepting of individuals with pre-existing medical conditions, but most people with no health insurance coverage don’t realize they can qualify for group health insurance benefits in a number of ways other than through job providers.
The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires insurers to cover people with pre-existing medical conditions if previously covered by a group health insurance plan within a predetermined period of time – usually about 6 months. But even with no prior health insurance coverage, individuals obtaining group health insurance coverage can have their conditions covered after a standard waiting period of between 12 and 18 months.
While HIPAA offers protection for individuals with group health insurance – where about 60 percent of Americans obtain health insurance coverage, it only applies to group health insurance and not individual health insurance plans. People who are self-employed, work part-time or are unemployed typically don’t have group health insurance benefits. And the Kaiser Family Foundation indicates about 21 percent of people applying for individual health insurance are refused coverage, charged higher premiums or provided a plan excluding their pre-existing medical conditions.
But what many don’t realize is in a dozen states an individual can qualify as a “group” to obtain health insurance, and in all other states any two or more individuals can form a “group” and obtain more affordable and effective group health insurance.
As federal lawmakers grapple with various national health care reform proposals, health insurers have said a meaningful federal mandate requiring all Americans to purchase health insurance coverage would be enough to enable insurers to provide health coverage at lower costs and cover people with pre-existing medical conditions.
But the measures recently approved by two U.S. Senate committees propose a maximum annual tax of $750 charged to individuals incapable of proving they have health insurance coverage while requiring health insurance providers to cover people with pre-existing conditions. Health insurers say the potential penalty is too low and would only result in fewer people purchasing health insurance while increasing costs for those whose premiums ultimately would be increased to offset the additional cost of covering people with pre-existing conditions.
Colorado, Connecticut, Delaware, Florida, Hawaii, Maine, Massachusetts, Mississippi, New Hampshire, North Carolina, Rhode Island and Vermont are states allowing individuals to form “groups of one” for the purpose of purchasing group health insurance plans, according to the Kaiser Family Foundation. All other states and the District of Columbia require at least two individuals to qualify for group health insurance coverage. States allowing groups of one have varying regulations defining the types of coverages available to them.
As the nation’s unemployment rate has risen, more people have lost their employer-provided group health insurance benefits but have the option of continuing them for a period of time through the federal COBRA law, but they are responsible for all premium costs, including what their former employers’ paid to provide group insurance for an individual and his or her family. Often times, the COBRA costs are too high for people drawing unemployment, forcing them to drop their health insurance coverage.
If an individual loses health insurance coverage, he or she can apply for coverage with another health insurer within 63 days of losing group benefits and still be covered for pre-existing conditions with no waiting period. And every state has a designated “insurer of last resort,” which must accept individuals if they apply within 63 days of losing their prior health insurance coverage. The “Catch 22” is that in some states, there are no limits on the amount of premiums charged and deductibles can be very high.
Many professional organizations also offer group health insurance plans for their members, who often are self-employed.
Regardless their situation, for people lacking health insurance coverage, waiting for meaningful and effective federal health care reform could take years. But taking some initiative could result in immediate savings while ensuring their families’ health care will be covered.