I’m a couple weeks behind on this, but I finally watched Jon Stewart’s January interview with HHS Secretary Kathleen Sebelius.  (part one, part two).  I like Jon Stewart.  I think he does a great job of pointing out inequality and voicing concerns for people who might otherwise not have much of a voice in the public arena.  And of course, he is quite skillful at making us laugh, regardless of how dry the actual topic at hand might be.

I enjoyed Jon’s interview with Secretary Sebelius.  They both made a lot of good points, and for people who aren’t aware of how the ACA will impact health insurance regulation, the interview is a quick, entertaining summary.  I couldn’t help but notice, however, that the entire interview focused almost entirely on health insurance.  There was a discussion about how the states are going to be allowed to define their own essential health benefits, and about how the health benefit exchanges will impact (or not) the way in which people get their health insurance (from an employer or in the individual market via the exchanges).  There was talk about the medical loss ratio (MLR) rules that require insurance carriers to spend at least 80 – 85 cents of every premium dollar on medical services (meaning only 15 – 20 cents can be spent on administrative costs).  They discussed pre-existing conditions and the fact that starting in 2014, health insurance companies won’t be allowed to exclude pre-existing conditions or deny coverage to people based on medical history.

What they didn’t talk about was healthcare.   My first concern is the fact that simply having health insurance is not a panacea.  It does not guarantee access to quality healthcare.  And more importantly, even if we could wave a wand and insure everyone in the country right now, we’d still be facing a very big problem:  spiraling healthcare costs.  It would be great if we could insure everyone and cap health insurance premiums at a universally affordable level, but it just doesn’t work like that.  Healthcare spending in the US nearly doubled in the first decade of this century.  Health insurance premiums go up because we keep spending more and more money on healthcare.  We’re taking more prescription drugs than ever (including children).  The percentage of Americans who are obese continues to climb, as do the associated healthcare costs.  Patients with health insurance tend to be insulated from the actual cost of their care, but they also tend to want the best and most convenient care available.  We love new technology, and the healthcare marketplace is filled with new technology, some of which is very expensive.

The reasons for our rapidly rising healthcare spending are complicated and numerous.  It’s not something that can be hammered out with a quick fix, especially if we’re focusing so much on health insurance.  As long as our healthcare costs keep going up, health insurance premiums have to keep rising as well.  If they don’t, the health insurers will not be taking in enough money to cover claims, and there’s no way that’s sustainable (regardless of whether the health insurance in question is public or private).

I get the point that Stewart and Sebelius were making.  They were addressing the aspects of the ACA that most directly impact people, since health insurance tends to be where most of us interact with healthcare costs.  And the interview did – very briefly – touch on healthcare costs when Stewart mentioned that one of the reasons wages have stagnated is because “healthcare costs keep going up.”  That is a key point, but they seemed to only be addressing it from the standpoint of health insurance premiums continuing to go up.  It’s true that the actual check the employer writes each month to cover healthcare is paid in the form of health insurance premiums.  But we have to address the root cause here, rather than just trying to figure out how to reign in premiums.

Steward did ask – in his usual joking manner – whether we all need to start exercising and eating better, which also touches briefly on the idea that a healthier nation would have lower healthcare costs.  But overall, nearly the entire interview focused on how the ACA will impact health insurance. While that makes for an interesting interview, it also presents the ACA (at least as far as pop culture is concerned) as health insurance reform rather than healthcare reform.  While there were definitely aspects of health insurance that needed reform, addressing health insurance as if it’s the crux of the issue is very much putting the cart before the horse.

No related posts.

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

My Wealth Builder hosted the 150th (!) Cavalcade of Risk this week – be sure to check out this collection of risk-related posts from around the internet.  I found this post by Glenn Cooke (guest posting on Boomer & Echo) particularly interesting, since it deals with topics that we often cover here at Colorado Health Insurance Insider… but from a Canadian perspective.

Glenn notes that although most people there have provincial health insurance policies, they often get additional coverage from their employers for things like prescriptions and dental care.  And he points out that all too often, people think that they’re “covered” just because they have a health insurance card in their hands – even though the coverage might have very low annual limits.  Of course that only becomes a problem when you have a catastrophic claim, which is of course when you need your health insurance the most.

Although the ACA has nixxed lifetime benefit maximums on health insurance policies here in the US, significantly increased annual maximum thresholds, and designated several categories of “essential benefits” that must be covered at specified levels, HHS has granted plenty of waivers for employers who are offering “mini-med” policies to their workers.  These policies are far from being a safety net in the event of a catastrophic illness or injury, and often only cover a few thousand dollars in benefits per year.  They remind me a lot of the type of policies Glenn is describing.

Glenn’s article also addresses dental insurance, and the fact that the coverage provided in most cases is really just allowing you to pay for your dental care (plus a bit of a markup) on a monthly basis rather than all at once when you go for a cleaning or to have routine dental work done.  This is the case with most individual and small group dental plans here in Colorado too.  Most of them have relatively low annual benefit maximums.  Need a cleaning and a filling?  That’s probably going to be covered.  Need an implant?  You’re probably going to be on the hook for a good amount of money out of pocket.  If your employer is offering dental insurance at no cost (or a very low cost) to you, it’s wise to take it, since the employer is subsidizing a lot of your dental expenses that way.  But if you have to buy it on your own, you might be better off just saving the money yourself and budgeting for your dental needs.  If you end up having a large dental expense, it’s likely that dental insurance won’t cover much of it anyway.

Related posts:

1. Some Mini-Med Policies Are Better Than Others
2. The Logical Insurance Salesman Has Skinny Kids
3. Mini-Med Plans Don’t Really Help Workers

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

Anyone who pays for their own individual health insurance policy knows that premiums go up every year.  And nearly everyone who gets their health insurance from an employer-sponsored plan is aware that costs increase in some form nearly every year (via higher copays and deductibles, a switch to an HSA-qualified high deductible plan, or an increase in the premiums that are payroll deducted).  Some employers manage to shoulder the brunt of the health insurance premium hikes from one year to the next, which means that employees with group health insurance probably aren’t as aware of the rapidly-rising healthcare costs as their self-employed counterparts (or, increasingly, people who aren’t self employed but have to find health insurance in the individual market because their employers can no longer afford to offer group coverage).  But no matter how you get your health insurance, you’re likely aware that premiums are a lot higher than they were five or ten years ago.  And of course, that’s a direct result of healthcare costs that are much higher than they were five or ten years ago.

This RAND Corporation infographic paints a pretty clear picture of how healthcare costs have increased over the past decade (specifically, the data refers to 1999 – 2009).  Healthcare spending nearly doubled in that time frame, from $1.3 trillion to $2.5 trillion, but the second graphic shows how our complicated method of paying for healthcare makes it harder for the average family to see how their own healthcare costs have been impacted.  The last graphic in the series shows what the average family could have done with the extra $2880 they would have had in 2009 if healthcare costs had grown during the 2000′s at the same rate they did in the 1990′s (GDP + 1%).  Given how cash-strapped a lot of families have been for the past few years, I’m sure an extra three grand could have made a big difference.

In case you missed this post from Maggie Mahar about current trends in healthcare spending, it’s a worthwhile read.  Her conclusion is that it’s just too soon to tell whether we’ve started to really get healthcare spending under control.  Let’s hope so.  Otherwise, the infographic another decade from now will be a sad picture indeed.

Related posts:

1. Obesity As A Factor In Healthcare Spending
2. High Deductible Plans And Reduced Spending
3. Spending Caps Will Help Individual Families But Won’t Reduce Overall Costs

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

Anthem Blue Cross Blue Shield released details last week of a new program in Colorado that will increase pay for primary-care physicians who serve as a medical home for their patients.  The patient-centered medical home pilot program will hopefully decrease overall spending on healthcare while also resulting in better patient health – and it should also increase pay for primary care physicians.  That last part will be welcome news for people who have lamented how few new doctors are entering the primary care field, and those who notice the fact that primary care physicians are adept at focusing on lower-cost interventions for health conditions.  Boosting their pay – if done on a broad scale rather than just through pilot programs in isolated areas – should help to attract more medical students to primary care.  And more primary care doctors should result in more low-tech (but effective), low-cost treatment plans – particularly with regards to preventive medicine (ie, more focus on keeping patients healthy, rather than fixing problems after they occur).

Of course, that’s all in an ideal world.  How it works in reality remains to be seen.  As with any changes in healthcare structure, people have all sorts of opposing viewpoints.   Some – on both sides of the debate – are quite logical (of course, plenty are just knee jerk reactions that may or may not make sense – check out the comments on this Denver Post forum topic regarding the new Anthem primary care pilot program).

The criticisms that make the most sense are the ones that warn that doctors might avoid performing indicated tests or referring patients to specialists for needed care, specifically so that they could get the bonus money from Anthem for keeping costs in check.  One would hope that this problem would be countered by qualitative, objective measures of the quality of care that patients are receiving, and – most importantly – the overall patient outcomes in the program.  Dr. Elizabeth Kraft, Anthem Blue Cross Blue Shield’s medical director in Colorado, says that

“By better supporting physicians in managing all aspects of patient health, we are confident that our members will receive higher quality health care and experience more optimal health outcomes.  Thanks to this program, primary care physicians will have some of the necessary resources, along with the financial incentive, to begin maximizing the potential of primary care to help our members live healthier lives, while responsibly reducing costs.”

I like everything about this, as long as we’re truly able to objectively measure the program’s success in terms of “higher quality health care”, “more optimal health outcomes” and “[living] healthier lives”.  Five years from now, will be we see that the patients who have been part of this medical home program have a lower incidence of illnesses that we know are either caused or exacerbated by lifestyle and/or lack of compliance with medical recommendations?

I can obviously see how this structure can result in lower costs, and I particularly like the fact that it will be paying primary care doctors  for “non-visit” services that are not currently reimbursed (the example given in the press release is “preparing care plans for patients with multiple and complex conditions” but I can see how this could be extended to other areas of care and could help to move away from the current ten minute visit + diagnosis + prescription scenario that is so common).  But particular care will need to be taken to make sure that the end result is truly healthier patients, as well as lower healthcare costs.

A measure of patient satisfaction could also be beneficial here.  This is a tough one though, as patients might tend to have less of a focus on the overall picture (outcome + cost) and more focus on the factors that directly and immediately impact them, such as outcome and convenience.  Cost is a factor for patients, but since most of us have health insurance, we tend to be largely insulated from the immediate costs of our healthcare.  We get the annual rate increase notification or a letter from our employer saying that our deductible and copays are going up, but most patients probably don’t consider how their own healthcare usage directly impacts the overall “big picture” of healthcare spending (and thus the resulting health insurance premium hikes).  But in general, a program that results in an overall improvement in patient health and lower costs should also end up with satisfied patients.  Things like more face-time with their primary care doctor (who is being compensated for keeping the patient healthy, not just fixing problems once they occur) ought to improve patients’ overall perception of the care they are receiving.

All told, this seems like a good step for Anthem to take.  Well managed, with a strong focus on patient outcomes in addition to cost savings, it will hopefully end up being beneficial for doctors, patients and payers.

Related posts:

1. Medical Home Pilot Program
2. A New Transparency Tool From Anthem Blue Cross Blue Shield
3. Anthem Blue Cross Blue Shield Product Enhancements

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

Welcome to the Health Wonk Review.  We’re honored to be hosting, and were thoroughly impressed by the quality of the articles that were submitted for this edition.  A good number of them addressed the politics of healthcare reform and/or the Republican primary race.  So I thought it would be fitting to organize this edition of the Health Wonk Review as an election.  All of the candidates are well qualified and knowledgeable about healthcare, from many different angles.  And they all write quite convincingly.  Some take polar opposite positions, while others lean more toward the center.  I’ll summarize each candidate’s platform, and you can get all the details by clicking on the names.  Once you’re finished, cast your vote for your favorite in the comments.  Be warned, however – you will have a hard time choosing!

Ladies and gentlemen, here are your candidates for Wonkiest Health Wonk 2012:

Anthony Wright‘s camp is taking issue with Rep. Dave Camp’s position that the ACA is the reason for the decrease in the percentage of employers who offer health insurance benefits and the increase in premiums (both trends that were well established long before the ACA was crafted, and as Anthony points out, most of the provisions of the ACA haven’t been implemented yet).  Rep. Camp quoted Wright on his website, and mis-used the words to support his position that the ACA is to blame for the current problems.  Anthony is – quite understandably – unimpressed.

Joe Paduda‘s platform is all about taking aim at Mitt Romney’s enjoyment of firing people – and insurance companies.  Although it sounds nice (and very “free-market-y”) to say that if you don’t like your health insurance company you can just fire them, that isn’t usually the case.  Joe explains how most people have limited options (if any at all) when it comes to their health insurance, particularly if they have any health conditions.  Firing ones health insurance carrier isn’t really a possibility for most of the population.  Joe’s common sense approach should win over a lot of voters.

Gary Schwitzer‘s campaign is focused on calling out half-truths and shoddy journalism.  He cites an example of an ABC News segment that purports to be a journalistic look at a new “lifesaving” technology.  But it might just be blatant self-promotion on the part of the doctor being interviewed.  And even worse, it might convince countless viewers that they need the same high-tech test (along with several others that are mentioned in the story), despite the far less flashy stories about the comparative effectiveness data that indicate that the tests in question aren’t really useful for low-risk individuals.  And that leads to over-utilization of healthcare.  Which leads to increased healthcare spending.  Which leads to higher health insurance premiums.  Which leads to more people being uninsured.  It’s not a good cycle.  Kudos to Gary for digging in on this story.

Maggie Mahar‘s campaign is all about healthcare spending.  This has been a hot topic for the last several years, and people have been able to make the numbers say pretty much anything they want (lies, damned lies, and statistics?).  Maggie – in her usual thorough style – delves a little deeper into the fact that healthcare spending rose much more slowly over the past couple years than usual.  At first glance, that’s cause for celebration.  But we may see a spike in healthcare spending after the recession ends and/or people regain lost health insurance coverage.  Whether that spike will put us back to pre-recession levels remains to be seen.

David Williams is running on the idea that the much-hyped nursing shortage might be exaggerated.  We’ve all heard that there is a shortage of nurses all across the country that is predicted to grow rapidly over the next couple of decades as our baby boomer population ages.  But David points out that the economy doesn’t work that way.  As demand grows, so does supply.  And he notes that it’s possible that the stories of nursing shortages might be started (or at least spread around) by people with a vested interest in turning out more nurses.  Hard to argue with that logic.

Jaan Sidorov‘s campaign is centered around the increase in physician-to-physician referrals over the past decade (which is not at all surprising as far as he’s concerned).  The study that Jaan references cites two possible reasons for the increase:  increasingly complex healthcare (thus the need for more physicians to weigh in on a patient’s care) and a need to offload some work onto other care providers.  Dr. Sidorov also notes a couple of additional explanations:  the shift from HMO to PPO-style care, and an increase in consumerism on the patient’s part.  He’s done his research and it makes sense… is it enough to get your vote?

Roy Poses is running on a platform of transparency and openness – it’s time to talk about the elephants in the room.  Roy writes about a recent survey of the chairs of medicine and surgery at US medical schools which asked various questions about problems at the schools that nobody was willing to discuss.  The survey found that the majority of the respondents felt that there were indeed “elephants in the room” at their medical schools (although most of them felt that they were not themselves responsible for the lack of discussion).  But interestingly enough, the article about the things that we cannot mention didn’t specifically address what those things are.  We cannot mention what we cannot mention.  I always like candidates who tell it like it is and are willing to openly discuss the elephant in the room.

Jon Coppelman is running his campaign on the effectiveness of government safety programs for the workplace.  He focuses on CAL/OSHA and whether or not it has been effective in terms of improving workplace safety.  The answers are a bit murky.  As with most government programs, paperwork and official compliance is only half the battle; you have to also have company management that is focused on workplace safety and making it a priority on a daily basis.  And government programs often start with lofty ideals and goals only to find that implementation is more of a challenge than expected.

Jason Shafrin‘s campaign takes a closer look at President Obama’s recent State of the Union address, and specifically examines the aspects of it that focused on healthcare.  His take is that healthcare wasn’t really a focus during this most recent address – especially when compared with the State of the Union address in 2010 – and the President didn’t mention anything new this year.  Jason notes that if a Republican wins the election this year, the State of the Union address next year will likely have far more talk about healthcare, since repealing or significantly changing the ACA seems to be a top priority for a lot of Republican politicians.

John Goodman is running on the notion that it makes a lot more sense to tackle healthcare costs with a market-driven supply side strategy rather than continuing to implement government run, demand-side controls.  He paints a rather dismal picture of how demand-side buyers of care (including government and private enterprises) have failed repeatedly to control costs, while some supply-side programs have done an excellent job of providing high quality care while also controlling costs.  Being from Colorado, I have to throw Grand Junction into this debate.  I think the three-decade long collaboration between Rocky Mountain Health Plans and the physicians in the Grand Junction area is a good example of supply and demand working together to create a good model that is definitely working well.  But as John notes, you can’t just copy what works in one place and expect it to work everywhere – it’s not that simple.

Sharon Long‘s camp is calling foul over Senator Santorum’s erroneous claims regarding health reform during the last Republican debate.  The specific focus is on Mass. health reform and how the state’s healthcare system has fared over the past six years (hint:  it’s nowhere near as bad as Senator Santorum would have people believe), and Sharon points out the progress the state has made as well as areas that still need work.  Although the details are state-specific, many of the general ideas can give us a rough road map for how the rest of the country might be faring a few years down the line, once the ACA is fully implemented.

Bob Vineyard‘s platform is focused on the health insurance exchanges that are slated to being operationg in 2014.  He’s not impressed, and the point he makes is a very good one.  Health insurance agents play a vital role in consumers’ understanding of the policies they purchase.  Agents also tend to be the ones to answer most of the clients’ initial questions when they’re comparing policies and a lot of insureds call their agent first when they have a question after the policy is in place.  Bob notes that the high risk health insurance pools created by the ACA were supposed to cover 4 million people in the first two years.  Nearly 1.5 years in, 30,000 people have signed up and many states (including Colorado) are rapidly running out of money for the program.  The exchanges are expected to be all online, guided by “navigators” who may not be as knowledgeable as licensed agents, and are supposed to be the conduit to health insurance for 200 million people.  It might not go as smoothly as lawmakers were hoping.

Jared Rhoads‘ campaign is centered on the individual mandate in the ACA (and specifically, the similar version that Mass. enacted several years ago).  He notes that not everyone fits into the “insured” or “free-loader” categories.  There’s a third category of people who self-insure and/or want to purchase high deductible, catastrophic-only health insurance (which might not be considered “good enough” under the ACA).  Jared’s point is that the individual mandate implies that the people in that third category are free-loaders who should be forced into purchasing health insurance, and he calls foul.  Given the divisive nature of the individual mandate, Jared is sure to win over plenty of voters.

Neil Versel‘s campaign is calling out the left and the right – Kathleen Sebelius and Newt Gingrich – on healthcare reform.  He points out that Gingrich has aligned himself with the far right idea of repealing the ACA and has been distancing himself from his work over the past decade that pushed for health IT reform and technology-enhanced improvements in our healthcare system.  Neil also notes that Sebelius and the Obama Administration have been focusing a bit too much on the health insurance aspects of the ACA and seem to have forgotten that health insurance is not the same thing as healthcare.  Simply having health insurance does not guarantee access to care, affordability of care, or that the care one will receive will be of the highest possible quality.  Neil’s position ought to win him quite a bit of favor from a lot of center-minded folks.

Brad Wright‘s platform is one that will appeal to a lot of people, regardless of their political affiliation.  He’s proposing that we do a better job of scrutinizing the community benefits provided by non-profit hospitals.  Non-profit hospitals are exempt from federal taxes, but that’s in exchange for providing benefits to their communities – things like uncompensated care and job creation.  However, there’s not a lot of accountability around the whole process, and the waters get a bit murky when we try to differentiate the business practices of the for-profit and non-profit hospitals.

Fiona Gathright is running a campaign on the merits of “just do it” instead of “just talk about it”.  When it comes to wellness benefits provided by employers, it appears that tangible incentives like gym memberships (or even just breaks in the workday that encourage movement and activity) are valued by employees and are also more beneficial than online resources to encourage employees to incorporate healthy habits into their lives.  We all know what we need to do to be healthy.  Fiona’s campaign slogan might be “less talk, more action.”

There you have it.  16 excellent candidates.  Lots of different viewpoints -all very well explained and defended.  Enjoy the reading, and don’t forget to cast your vote for your favorite candidate.

Jason Shafrin at Healthcare Economist has the next Health Wonk Review

Related posts:

1. Health Wonk Review – The Election Is Over Edition
2. Health Wonk Review
3. Health Wonk Review at Health Care Policy and Marketplace Review

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

The provision in the ACA that allows young adults to remain on their parents’ health insurance policies until the age of 26 has been one of the more popular aspects of the health reform law.  It has increased the percentage of young adults with health insurance coverage and helps to make sure that recent graduates can remain insured even if they accept an entry-level job that doesn’t offer health insurance benefits.

The provision has received a lot of press coverage over the past couple years, and I would say that it’s widely understood.  But this article from The Colorado Health Foundation’s Sandy Graham illustrates a lesser-known loophole in the law:  The ACA was added to HIPAA, so plans that aren’t impacted by HIPAA are also not impacted by the ACA.  Retiree-only plans fall into this category.

Sandy’s daughter ended up getting an individual health insurance policy for $143/month.  But individual health insurance in Colorado is medically underwritten (and will be for almost two more years until the guaranteed-issue provision of the ACA begins in 2014), which means that she had to be relatively healthy in order to qualify for coverage and/or avoid an underwriting rate increase.  The benefit of the ACA rule that allows young adults to remain on their parents’ plan is that there is no need for additional underwriting – the coverage is continuous, regardless of any new medical issues that might have arisen since the plan was originally purchased.  This can be very useful for young adults with pre-existing conditions who haven’t yet secured a job that provides guaranteed issue group health insurance coverage.

I don’t know what percentage of the population is covered by retiree-only health plans, but it seems that group might be more likely than others to have children who are young adults.  I’m sure Sandy and her husband aren’t the only parents to have found out that the ACA doesn’t apply to their retiree-only health plan.

While we’re talking about The Colorado Health Foundation, the most recent issue of their quarterly magazine – Health Elevations – includes an article about our blog.  We’re thrilled and honored to be featured!

Related posts:

1. Retiree Health Insurance Benefits Based On Age Makes Sense
2. Health Insurance Options For Young Adults
3. Grand Rounds And A Defense Of Tiered Health Insurance Plans

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

The Notwithstanding Blog hosted the Cavalcade of Risk this week in the most interesting fashion I’ve ever seen.  Check it out.   And be sure to grab a pencil and paper because it’s a quiz!  Since I’ve been writing about health insurance for quite a while and I’m familiar with a lot of the topics that usually appear in the COR, I took the quiz without reading the entries, just for fun (I got six right and two wrong). Our regular readers will probably have fun taking the quiz too, especially since most of the entries in this edition of the COR are related to healthcare and/or health insurance.

Jaan Sidorov’s article about health insurance exchanges is really good (and I had to read it to figure out the correct answer to the question for his post – it was one of the two I missed).  He notes that it’s a bit illogical that so many of us are willing to spend hours comparison shopping for a new TV, but feel put out if we have to spend much time at all comparison shopping for health insurance.  And he laments the fact that health insurance exchanges are in their very early days but already are being dismissed by some as too complicated for the average consumer to figure out.

Related posts:

1. Cavalcade of Risk – Colorado Nature Edition
2. Cavalcade of Risk #26
3. Cavalcade Of Risk – The New Year Edition

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

Dr Val Jones has done an excellent job with a four-part Grand Rounds this week, which was published on the USA Today site.  My favorite is Part Four, as it focused on one of my favorite subjects – healthcare costs.  This post from Common Sense Family Doctor is especially good, particularly if you’re a fan of consumer directed health insurance plans and HSA-qualified policies.  The author and his wife are both family practice doctors and have delivered hundreds of babies.  And they diligently tried to find out how much it would cost them to have their own baby in the months leading up to the birth.  But in the end, they just had to make an educated guess about how much money they would need to set aside to cover their 20% coinsurance, because nobody at the hospital could tell them how much it was going to cost, even assuming there were no complications.

We had an HSA qualified health insurance policy for our family for years, until we switched to a less expensive “Core Share” policy from Anthem Blue Cross Blue Shield last fall (still a high deductible plan, but not HSA qualified).  We’ve written about how difficult it can be to really shop around and be a “consumer” when it comes to healthcare.  And how even when you think you’ve dotted all your i’s and crossed all your t’s and asked all the right questions, you can still end up with unexpected charges.

I’m still a fan of consumer directed health plans, high deductibles, and HSAs.  I think that they can be useful tools to help people keep their health insurance premiums as low as possible and also (if an HSA is involved) set aside pre-tax money to cover potential future medical bills.  But they are not a panacea.  They are probably not a good solution for anyone who has a chronic illness that needs ongoing, expensive care.  They don’t work so well for people with very little money who would struggle to cover the relatively high out-of-pocket costs and would not likely be able to fund an HSA.  And no matter how great the actual consumer directed health plans are, the fact remains that transparency with regards to healthcare costs is still quite elusive.  For some procedures, it can be relatively easy to get a set figure up front in terms of how much it’s going to cost.  But much of the time that number can be difficult or impossible to pin down.  Obviously, complications can arise in any medical situation (and the resulting increase in costs would make earlier estimates irrelevant).  But even without factoring in complications, “shopping around” for healthcare is often an exercise in futility.  In order to make consumer directed health plans more effective, there is much work to be done with regards to cost transparency.

Related posts:

1. Comparing US Healthcare Costs With Other Countries
2. Capping Profits And Admin Costs Across The Healthcare Industry
3. Surprising Effect Of More PCPs On Healthcare Costs

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

In 2010, soon after the ACA was signed into law, Colorado’s Attorney General joined with AGs from several other states to bring a lawsuit against the federal government, challenging the legality of the individual mandate portion of the law.  A total of 26 states eventually joined in the lawsuit, although even within those states there is plenty of controversy surrounding the individual mandate and the ACA in general.  The legal battle will reach the Supreme Court later this year.

But now Colorado’s House of Representatives has voted to initiate an amendment to the US Constitution that would repeal the ACA.  In order to be successful, state-initiated amendments have to be passed by at least two thirds of the states.  So 33 other states would have to pass a resolution similar to what Colorado has done.  Given the fact that only 26 states joined in the lawsuit to challenge the legality of the individual mandate (the cornerstone of the “unconstitutional” argument) it seems extremely unlikely that two thirds of the states will pass measures calling for a state-initiated amendment that would repeal the ACA.

Although the Republican-led Colorado House passed the measure, Democratic lawmakers were not impressed.  They chided the Republicans for wasting time and money on a resolution that isn’t going to end up going anywhere (presumably because of the extremely slim chances of having two thirds of the states pass a similar measure).

Given the fact that the legality of the ACA is going to come before the Supreme Court this year, I agree that the new Colorado resolution seems like a waste of legislative time.  The Supreme Court will tell us whether or not the federal government has the right to make health insurance mandatory, and the states that are taking the opposing position on the matter have already joined in a lawsuit to express their position.  Hopefully Colorado’s lawmakers will work together from both sides of the aisle and move on to other issues that are facing the state.

Related posts:

1. Colorado HB1389 Passes House And Senate
2. Colorado House Bill 1355 Passes Senate
3. Colorado House Bill 1025 Would Repeal Health Care Affordability Act

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.

Our friend Julie Ferguson of Workers’ Comp Insider hosted the Health Wonk Review today, with a “look to the future” edition full of predictions and thoughts about the future of healthcare.  It’s a great edition – be sure to check it out.

One of my favorite articles in the HWR comes from Joe Colucci writing at The New Health Dialogue.  Joe discusses the upcoming Supreme Court case regarding the Affordable Care Act.  Last summer, I wrote about my hope that the court will hand down a decision – regardless of which way they decide – sooner rather than later.  I think that in order to move forward with healthcare reform and plan for the future, we need certainty one way or the other in terms of the legality of the rules that govern the whole process.

Joe’s take on the court battle is that the Supreme Court is unlikely to go against the majority of the lower courts that have ruled in favor of the constitutionality of the individual mandate.  And he’s got lots of other well-thought-out opinions on the subject – his post is a must read if you’re interested in the legality of the ACA.

Personally, I’m with Joe on this one.  I believe that opting to go without health insurance is in fact opting to self-insure, since the likelihood of people needing no medical care at all is slim.  For people who can truly afford to self-insure, there might be an argument to be made in terms of their right to do so (Rush Limbaugh?  Maybe.  The rest of us who don’t earn $33 million per year?  Not so much).  But for the majority of the population, being uninsured means that potential healthcare bills – especially the big ones – will be paid by the rest of the population via higher healthcare costs and increased health insurance premiums.  There’s no realistic way for hospitals to recoup costs from uninsured patients who have no ability to pay, especially if the bills are significant.  And it might be well within the boundaries of the law to require people to not pass that risk off onto other people.

I also believe that if the individual mandate is found to be unconstitutional, the ACA will need to be significantly revamped.  The mandate is such a fundamental part of the whole picture, especially if we want to keep the provision that would make all individual policies guaranteed issue starting in 2014.

Time will tell.  It will definitely be interesting to watch the continuing legal battles surrounding the ACA.  I wouldn’t have predicted that our Denver Broncos would make it to the second round of the playoffs this year, so I should probably refrain from predictions in general.  But I’m excited to see how it all plays out, one way or the other.

Related posts:

1. Thoughts On Direct-Pay PCPs
2. Thoughts On The Postponed Medicare Payment Cuts
3. Even More Thoughts On Pregnancy Coverage

Visit for further reading: Colorado Health Insurance Insider - Research and discussion of the Colorado health insurance industry and the healthcare crisis in America.