Health Insurance

Lots of health reform activity recently in states. Here's some help in catching up:

Connecticut. The state legislature has approved a Democratic bill permitting municipalities, nonprofits, and small businesses to join the state employee health insurance pool. Unclear whether Gov. Jodi Rell will support it. Some leading Republicans object to a "government-run" health system, while Democrats and labor backers say the greater buying power of the pool will save municipalities money. Not a comprehensive solution but we'll be interested in watching how this plays out.

Alabama. We posted a few weeks ago about Birmingham's plan to cover children—which we confess was a pleasant surprise to us given the state's history, poverty, and health status. Now we see the state has a new $3 million, five-year grant for the University of Alabama's initiative to reduce health disparities among older blacks.

Throughout the primary season we have heard two things consistently from voters: they are worried about the economy and concerned about affording health care. Today, New America's own Len Nichols and Sarah Axeen analyzed one linkage between these two domestic priorities: the impact of rising health care costs on global competitiveness and U.S. jobs.

Just about everybody who writes about health care has weighed in on the relative scarcity of primary care docs (including geriatricians) and the relative abundance of extremely well-paid specialists. Now the Wall Street Journal reports that we are even running low on certain specialists—the ones that don't make as much money.

The Journal story focuses (no pun intended) on neuro-ophthalmologists who treat complex, baffling visual disorders connected to the brain. They spend a lot of time testing, examining and talking to each patient. But our payment system doesn't reward time-consuming low-tech procedures. High-volume and high-tech is the way to go to maximize income. A neuro-opthalmologist has more training than a general ophthalmologist, but he makes about a third less money.

"Many in health-policy circles have focused on how the current health-care payment system is helping create shortages among primary-care doctors, internists and others on the front lines of medicine. But often lost is how the system is endangering some of the country's most highly trained specialties as well," the article continues, citing endocrinologists, rheumatologists, and pulmonologists.

Fifty-five percent of insured people don’t understand the “critical details” of their health policies, a new survey tells us. We ask ourselves: who are the 45 percent who do understand them?

We worry about this because we have begun a national dialogue this year about health care reform. And it’s really easy to scare off the public if they don’t understand what they’ve got today, let alone what they will or won’t have under the various reforms being proposed.

Bloomberg reports on a J.D. Power & Associates survey that found that 55 percent did not understand their insurance including prescription benefits, how to find the right doctor and appeal-coverage denials. Additionally, consumers ranked health plans lower in customer satisfaction than hospitals and pharmacies.

No, your eyes aren't deceiving you. We CAN guarantee all Americans quality health coverage and improve our delivery system without breaking the bank, according a report released today by the Congressional Budget Office (CBO).

Today's letter signed by CBO Director, Peter Orszag, and Joint Committee on Taxation Chief of Staff, Edward Kleinbard, says the bipartisan Healthy Americans Act would be budget-neutral in its first year and would get better after that. CBO analysts also predict that the HAA, sponsored by Senators Ron Wyden (D-OR), Bob Bennett (R-UT), and 12 others, would actually, "become more than self-financing and thereby would reduce future budget deficits or increase future surpluses," over time.

Stay tuned for more information from the press conference...

Forget pheromones. A new poll from the Kaiser Family Foundation found that seven percent of adults reported that in the past year they or someone in their household decided to get married in order to get health insurance from a spouse. (We don't even want to think about what their bridal gift registry looks like.)

The Kaiser poll had lots of somber news as health care costs are taking their toll on American families (including the middle class) during the economic downturn. Twenty-eight percent report that they or their families have had a serious problem paying for health care, behind paying for gas (44 percent) and about tied with getting a good-paying job or raise in pay (29 percent). Smaller shares report serious problems paying their rent or mortgage (19 percent), dealing with credit card or other personal debt (18 percent), paying for food (18 percent) or losing money in the stock market (16 percent). That 28 percent figure was true as well for middle class families, making between $30,000 and $75,000.

"Many people view health and the economy as separate issues, but the cost of health care is a significant pocketbook issue for many families and paying for health care has become a key dimension of the public's economic concerns," Kaiser Family Foundation President and CEO Drew Altman said.

Speaking of Cover the Uninsured Week—now a word from its sponsors...

Family premiums have risen 10 times faster than income in recent years—30 percent versus 3 percent—, according to a new analysis of government data from 2001 to 2005 released by the Robert Wood Johnson Foundation.

The study by University of Minnesota researchers shows that workers aren't paying a bigger share of the premiums if insurance is offered on the job, but the dollar amount increased a lot. (This particular study didn't look at cost-sharing, higher deductibles, co-pays etc, just the cost of the insurance policy itself.)

Nationally, the average cost of family coverage increased nearly $2,500, from $8,281 in 2001 to $10,728 in 2005. Workers paid about a fourth of that cost, but while that proportion held steady, the dollar amount increased $664, from $1,921 in 2001 to $2,585 in 2005. Meanwhile, the median income of people who hold family health insurance policies increased just $1,250 during the same period, from $40,818 in 2001 to $42,068 in 2005.

The very first day we started this blog, in March, we wrote about the mandate war between Hillary Clinton and Barack Obama, and how it was obscuring their many areas of agreement on health care. With the two Democratic candidates again beating each other up about health policy it's worth checking out Jacob Hacker's piece on The New York Times web site today (it's also available on NewAmerica.net). Hacker, a Yale political scientist and New America fellow, urges the two candidates to cool it because their health care rhetoric is only confusing voters. Hacker writes:

"So what's the main story: (1) a basic Democratic consensus about what should be done, or (2) a widening policy divide fueled by presidential ambitions? The answer is (1), but unfortunately, the reality of (2) is increasingly upstaging this welcome development. And, unfortunately, this unnecessary and self-defeating conflict could ultimately derail efforts at reform, confusing and turning off the very voters Democrats need to woo."

Apparently, a lot of Californians shared our disappointment when the state's health reform efforts fell apart earlier this year. A new Field Health Policy Survey shows that Californians are none too confident about the future of health care in their state after lawmakers killed Gov. Arnold Schwarzenegger's plan to cover all Californians in January.

The survey, commissioned by the California Wellness Foundation, found that voters are even more worried now (quite possibly because as the economy worsens, people get more nervous about health costs and job-related insurance). For instance, 59 percent are "very concerned" about not being able to pay all of the costs for a major illness or surgery, up from 48 percent in late 2006. Other findings:

In 1994, he was one of the masterminds of the infamous Harry and Louise ad campaign that helped kill the Clinton health care initiative. Now Chip Kahn is trying to prepare the ground for comprehensive national reform after the 2008 elections. No more baby steps and incremental reform. Kahn wants to cover everyone. Economically, he says, we have no choice.

Kahn, currently the president of the Federation of American Hospitals, has been around Washington long enough to know that big change doesn't come easily, and that no matter how inclusive the message from whoever occupies the White House next year, partisanship is not going to dissipate like the morning dew. Far from it, he told us the other day in a friendly if not always 100 percent encouraging conversation that included words like "bludgeoning" to describe the national legislative process.

But if the political parties are as deeply, or more deeply, divided than in the early 1990s, some of the interest groups that were once metaphorically clawing each other's eyes out about health have found common ground. That's powerful, Kahn said. And it's different.

"I've been involved in some pretty strange bedfellow alliances in my time. But this is one of the strangest," said Kahn, who has been a Republican heavy-weight player on Capitol Hill and a top trade official for both insurers and hospitals.