Health Insurance Info for Colorado

news & commentary on health insurance and benefits

Consumer Protection??!

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This isn’t “consumer protection”: it’s state-mandated equal sharing of misery:

There will be virtually NO short-term medical plans available in Colorado after this regulation goes into effect, I predict. Since when did “consumer protection” extent to The State simply demanding that all things must be one size/shape/form, eliminating any chance of the consumer being able to make his own decision for his or her own needs, supplanted by the “we know what’s best for you” overregulation that actually causes more harm than good? Elections have consequences: Big Brother won, and guess who loses.

Oh, and to be clear: the intent of this regulation is a thumb in the eye to the Trump Administration, and its attempts to bring market forces to work, to expand choices, and provide relief for people who simply want to buy something that might work more effectively for them, even if it *gasp* isn’t a lock-step, over-priced, ACA clone that many can’t afford. Egads! We can’t have that, can we?

Government: we know what’s best, so shut the hell up.

ColoradoCare raises its ugly head.. again!

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Many years ago (ancient history for many, since it was in the last century) a certain Colorado Governor demanded the reform of Colorado’s health insurance regulations, or he’d bring a “single payor system” down on our heads. it was to be called, if memory serves, ColoradoCares. Reform happened, so it went away. But you know, the relentless need to have a government-run health care system never goes away with Democrats.

Well, its back, and it’s even worse. Here’s a quote: ” a “risky and untested state-run health insurance system.” State-run, as in, the state of Colorado, and financed with a whopping big tax increase, larger than the size of the entire Colorado budget. It will replace Obamacare. And no, that would not be the kind of replacement I’d be in favor of!

If you love Obamacare, you’ll love this – until you don’t.

Read the full story here.




NEWSFLASH: Colorado Health OP

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The Colorado Division of Insurance moved swiftly to remove Colorado HealthOP from the list of approved insurers in Colorado and through the Connect 4 Health Colorado Marketplace Exchange. See the news release here.

O-Care Premium Spikes Coming

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One of the most frequently cited ways that insurers used to reduce costs for the new ACA compliant plans was to engineer new provider networks, primarily HMOs, with lower fee-for-service reimbursements, referred to as  per-member-per-month arrangements. These networks were reviewed at the state level for adequacy. In fact, the new networks were substantially smaller, as many physicians opted out of them due to reduced reimbursement rates or capitation necessitated by the new rules carriers must operate under due to Obamacare.

The federal government decided that this won’t be acceptable for 2015.  In a draft letter from the Centers for Medicare & Medicaid Services (CMS), insurers will be required to include 30% of “essential community providers” (ESPs) in their network.

ESPs serve primarily “underserved” populations, including community health centers, HIV/AIDS clinics, family planning clinics and children’s hospitals. From Insurance Business: “In order to assure this is the case, CMS plans to establish its own process for certifying adequate provider networks, cutting out the role of state regulators.” See the full story here.

CMS, in 2013, stated that, for 2014, they would “rely on state analyses and recommendations when the state has the authority and means to assess issuer network adequacy.” See the full text of the earlier guidance here. For 2015, with CMS expanding the ESP requirement,this will likely increase premiums further, due to an increase in network providers mandated by CMS.

Other changes that will have a cost effect on premiums include changes to stand-alone dental plans, and a new requirement to pay for a 30-day supply of any new drug that a new customer had been taking—even if the drug would not have ordinarily been covered.  For the complete 2015 guidance, go here.

Insurers are rightfully concerned about the new requirements, with America’s Health Insurance Plans (AHIP) already expressing its disapproval in comments filed on the proposed changes. Insurers have just weeks to present their changes, with some deadlines beginning in April of 2014.

Canada: Back To The Future?

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A recent study shows that Canadians are facing the longest waiting times for medically necessary care in almost two decades.

With all the talk about how bad Obamacare will be, with its standardized benefit structures, centralized command and control, and over-arching subsidy program that will drive as many as 80 million Americans into Medicaid (yes, you read that right, it’s in the bill!) one should remember why so many Canadians have come south of the border to access care: they can’t get any, which is something we are going to be facing in the not-too-distant future, as anyone who’s ever studied socialized, government run or controlled, capitated health care delivery systems knows all too well. Remember: in the Orwellian future of American health care, you are no longer the customer – you are a unit.

ITEM: In a report from late last year, the Fraser Institute, Canada’s leading public policy think-tank, said this:

  • “Canadians are being forced to wait almost four-and-a-half months, on average, to receive surgical care, prolonging the pain and suffering patients and their families are forced to endure.”

And this:

  • “Despite significant increases in government health spending, Canadians are still waiting too long to access medically necessary treatment.”

Amazingly, Canadians put with waiting times between referral by a general practitioner or PCP and consultation with a specialist of between 7 1/2 weeks to almost 10 weeks, depending on where they live. Obviously, Canucks are way more patient than anyone in my family.

It gets worse:

-I pity the poor fool who needs orthopedic surgery: average wait is more than 39 weeks (more than 9 months).

-And, this is a stunner: if you need neurosurgery, like, on your brain (!) be prepared to pray a lot: you’ll wait 38.3 weeks.

No wonder Canada has introduced “market reforms” that finally allow some people to buy private health insurance. Too bad we’ve taken the wrong path and will have to learn the hard way what Canada and Britain have already learned.


Health Care Reform: It’s Repealed!

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As reported everywhere, the Affordable Care Act has been repealed in the U.S. House of Representatives by a bipartisan vote (well, three Democrats, anyway). For details, go here, here, and especially, here.

What does this mean for Colorado? Not much, for the present, but stay tuned. While Senate Republicans insist that the repeal will be taken up in their chamber, Harry Reid’s words to the contrary notwithstanding, a more interesting showdown is approaching with regards the Court challenge mounted by 26 (and counting!) states’ Attorney General’s, of which Colorado is one. Ultimately the issue of Obamacare, as it’s now universally known, will be decided my nine Supreme Court Justices’, with Justice Kennedy almost certainly being the swing voter. As to the severability issue (the Affordable Care Act was passed without this protective clause) we’ll have to wait and see. While it would be easy to say that striking down any part of the Act would render the entire Act null and void, it isn’t that simple – and without the individual mandate, the Court could still say that what remains is still law. That would create a bottomless pit of debt, since the individual mandate is the financing mechanism in place for the entire program (which is why this is such a growth opportunity for the IRS – who else has the expertise to manage such a burden on the taxpayer?).

For the record, all of the Colorado Democrats in the House chamber voted against repeal, while all of the Republicans voted for repeal.

Follow-up: medical-loss-ratios

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To recap, interim regulations concerning the new minimum-loss-ratios (MLRs) were recently released for public comment.

OVERVIEW: Beginning in 2011, health insurers must spend at least 80%, or 85% for the large group (more than 100 employees) market, of premiums for medical care claim expenses and “health-care quality improvement”. Otherwise, they will be penalized – beginning in 2012, they will be required to provide rebates to their customers.

The National Association of Insurance Commissioners (NAIC) was entrusted with writing and creating the definitions and formula for calculating MLRs. The Department of Health and Human Services (HHS) reserved the authority to make final decisions about these regulations, based on the NAIC recommendations.

As previously mentioned in a prior post, HHS went along with the NAIC on their recommendations, for the most part. A review of the interim regulations shows that:

  1. insurers are allowed to deduct state and federal taxes from premiums used to calculate MLRs.
  2. agent/broker commissions, rather than being treated as pass-through expenses, will be treated as administrative expenses. (More on this in a moment)
  3. anti-fraud programs are counted as admin expenses, rather than as quality improvements, as many in the health insurance industry had hoped.
  4. MLRs, rather than being judged collectively, are required to be accounted for separately in every state.

Regarding so-called “mini-med” policies, of the kind that have elicited so much press recently concerning waivers from the new regulations on coverage, these plans will have at least another year to gather data before falling under the requirement. Mini-med plans are used in many service industries, in place of traditional health insurance policies, primarily due to costs. [Senator Rockefeller, D-WV, is holding a hearing Dec. 1 on whether limited-benefit “mini-med” plans should even be classified as health plans, which is certainly a shot-across-the-bow in the battle to have these  so-called “mini-med” plans removed from the market, forcing employers to provide much more expensive policies for all full and part-time employees – a jobs killer, for sure!]

States may apply to have the MLR standard adjusted or modified if the requirement would result in the destabilization of their individual health insurance market; some states have already said they will apply for such adjustments.

The agent/broker issue: Many in the industry are puzzled about why compensation, in the form of commissions, were treated as administrative expenses. It’s been argued that commissions aren’t premium income, but are a service charge or fee that is tacked on to the total premium and relayed to the agent as a pass-through expense. NAIC side-stepped this issue on first examination, but the truth is many people are concerned that, without insurance agents and brokers, state agencies would be overwhelmed with questions about how to purchase coverage, what kind of coverage, and so on. HHS, along with the NAIC, is participating in a working group, studying the agent-broker issue further, because of the concern that the market could be destabilized without properly trained and experienced professional agents and brokers helping consumers make informed choices. Developing…

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  • Published: Dec 2nd, 2010
  • Category: insurance news
  • Comments: Comments Off on Colorado Insurance Commish stepping down December 1st

Colorado Insurance Commish stepping down December 1st

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In a press release dated November 29th, Barbara Kelley, head of the Department of Regulatory Agencies, State of Colorado, announced the departure of Marcy Morrison as Colorado Insurance Commissioner.

Effective December 1st, 2010, Morrison will be replaced on an interim basis by John Postolowski, who is currently the Deputy Commissioner of finance and administration at the DOI.

Postolowski has been described as a “veteran” state employee. He will serve in this capacity until Governor-Elect Hickenlooper appoints a permanent replacement.

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