What are the major stories?
• Rate hikes
• Electronic Health Records and “meaningful use”
• High-risk pool: is it enough?
• Public sentiment: Bleak.
Rate hikes are on. They’re off. Oh no wait,
they’re back on again.
Anthem and Aetna brought feelings of mistrust and anger to a boil as
they first threatened customers with massive rate hikes, rescinded,
then returned with same bad news. Add to that the embarrassment
of mathematical errors as the initial cause of the rate hikes and a
sea of news reports about bloated health insurance CEO salaries
and medical claims processing errors.
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Fe y e uly
http://consumerist.com/2010/06/1-out-of-5-medical-claims-processed-incorrectly-says-ama.html http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/02/11/BU2F15I06K.DTL&tsp=1 http://bscindustryupdates.blogspot.com/search/label/Anthem%20Blue%20Cross
Measure of transparency puts
customer in control
“The state Department of Insurance has begun alerting customers by e-mail whenever health insurance providers submit planned rate hikes to
the agency.” The hope is that the program will provide more transparency to the escalating premiums. "We want as many people as possible
scouring these rate filings to ensure they are mistake-free," Insurance Commissioner Steve Poizner said in a statement.
Electronic health records & “Meaningful use”
Last year a law was adopted as a part of the economic stimulus to encourage the use of health information technology and
electronic health records by hospitals and doctors. In order to qualify, hospitals must meet “meaningful use” criteria to get a
piece of the $17.2 billion pie set aside for EHR adoption under the new law.
However, many hospitals don’t think they will get a piece of the funding to implement EHR use. According to a
PricewaterhouseCoopers LLP report, there is a lack of clarity on the criteria to get funding, “a shortage of skilled IT
workers, unpreparedness of external vendors and lack of networking capabilities and bandwidth to handle massive data
flow associated with EHR implementation.” - ITChannelPlanet
Add to that the worries over data privacy and
security that come with electronic records.
Sink or swim?
Will the high-risk insurance pool plan work?
Resources Some are opting out
• The government is providing California $760 million to create the high-risk
pool for those with pre-existing conditions. That gives the state a budget of
“well over the $200 million a year. Beneficiaries will pay premiums, too, but
no more than 35 percent of the cost of benefits. The money is expected to
cover almost 25,000 people a year, though estimates suggest there are
more than 200,000 Californians unable to get insurance because of pre-
existing conditions.” -Sacramento Business Journal
• An Anthem spokesperson said the
company declined to participate in the federally
supported high-risk pool because the program is
"temporary in nature (pools would operate until 2014)
and ... would require significant changes to our
existing systems in order to implement."
• Many worry that the funds could be exhausted by
A bleak outlook
• People are feeling disappointed with their president and with his policies
including reform. Morale is slowly sinking and the media is serving up a
plate-full of negative outlook on our economic future.
• 48% said they were “in favor” of the reform as of June, 41% unfavorable
and 10% undecided. Across political party lines, people are generally in
agreement about the reform. But many see politicians as pushing reform
only for votes and not for the good of citizens.
• Anthem’s rate hike squabble has only generated greater distrust of
insurance companies and fed the general sentiment that they make too
“Public Opinion on Health Care Issues,” by The Henry J. Kaiser Family Foundation, June 2010