Health Insurance Info for Colorado

news & commentary on health insurance and benefits

Obamacare News: It Isn’t Pretty

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This has been an interesting month, as HHS continues its assault on the health insurance industry, religious freedom, and the hollowing out of the promise made during the passage of Obamacare not to impose abortion on the majority of citizens who oppose federal funding for abortion, not to mention abortion-on-demand. And, lastly, The Congressional Budget Office (CBO) finally tells us that, lo and behold, Republicans were right when they tried to point out, to a deaf and dumb press, that the Administration was cooking the books in it’s original cost estimates for Obamacare, and that the estimates were in fact, inaccurate. Garbage in, garbage out, as always. (And then there is this ludicrous piece, written in Forbes, of all places, that tries to make the point that the new estimates aren’t in fact an increase, and…well, I’ll let you read it and figure out exactly where the writer is missing the boat.)

But most interesting of all, I think, is the orchestrated PR campaign being coordinated by the White House for the oral arguments on the constitutionality of Obamacare before the Supreme Court. The Center for American Progress, Families USA, Health Care for America Now, and Protect Your Care are among the groups (“partner organizations”) mentioned in a leaked strategy memo, all of them left-wing advocacy groups, at least one of which is an open supporter of single-payor health care. The PR campaign, on the second anniversary of Obamacare, targets the “core constituencies” of women, young adults, and others who benefit from Obamacare. See the full story here, and the memo here.

  • An excerpt: “”Remind people that the law is already benefiting millions of Americans by providing health care coverage, reducing costs and providing access to healthcare coverage. This message will include the ideas that these are benefits that politicans/the Court art (sic) are trying to take away from average Americans.”
  • And: “Frame the Supreme Court oral arguments in terms of real people and real benefits that would be lost if the law were overturned. While lawyers will be talking about the individual responsibility piece of the law and the legal precedence, organizations on the ground should continue to focus on these more tangible results of the law.”

In other developments, HHS finalized the rules governing “health insurance exchanges” which, in the opinion of many, are a defacto takeover of state-regulated health insurance, since the exchanges, and the regulations which govern them, inevitably lead to a decrease in state sovereignty and a strengthening of federal control, via a “one size fits all” regulatory approach which, contrary to the HHS press release, will not reduce rates, since it’s only mechanism, pooling, has limited ability to fix rising premiums. Let me put it another way: if pooling was all it took to reduce health insurance premiums, then larger employers, so the story goes, have an advantage over individual and small groups because they can negotiate lower rates. Assuming this is true, then working for the largest employer in Colorado – the state government – would automatically give you lower rates. But this is false: Colorado state employees have very high rates for insurance coverage, $444.46/mo. for an employee on a PPO plan, and more than $461/mo. for a single employee on a Kaiser HMO plan. This is higher, actually, much higher, than competing plans on a small group basis that I place with employers, and substantially more expensive than individual plans (which aren’t guaranteed issue). See the rates and benefits here. Lastly, they aren’t even great plans. So much for “pooling” being the antidote to continued federal messin’ in the delivery of health care: it isn’t so. And the exchanges won’t be any cheaper.

Lastly, the federal government, as it often does, purposely misses the point when it comes to the actual mechanisms in place for large employers to manage their health care costs, namely, self-insurance. While pooling has an effect on the overall premiums charged, ultimately it is the way the contract is written, managed, and back-stopped with stop-loss coverage that makes all the difference. As with the contraceptive controversy, federal regulators at all levels show an appalling lack of interest and expertise in how insurance markets, or for that matter,  insurance risk pooling, really work, probably because they aren’t advocates for real insurance mechanisms, preferring their ivory tower academic approach of vilifying “evil insurance companies” and advancing their sacred, pet solutions embracing centralized control and redistribution rather than free-market approaches.

“The Founding Fathers knew a government can’t control the economy without controlling people. And they knew when a government sets out to do that, it must use force and coercion to achieve its purpose. So we have come to a time for choosing.” – Ronald Reagan

Health reform at-a-glance: small group/large group

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The new health care reform law established, for the first time, federal definitions of “small employer” and “large employer” for health insurance markets. Prior to the passage of this legislation, states defined these markets for themselves.

Here are the new rules:

  • From now until 2016, states can define the size of small employer groups as either 50 and fewer employees, or 100 and fewer.

Colorado has defined “small employer” for group insurance purposes as 50 or fewer, and there doesn’t seem to be any rush to change this with the passage of federal law, for now.

Beginning in 2016, the new definitions will apply – businesses with, on average, 1-100 employees in the preceding calendar year will be “small employers”. “Large employers” will be those who had, on average, 101 or more employees in the preceding calendar year (and at least one employee on the first day of the plan year).

For employers who are used to calculating COBRA continuation eligibility, the full-time calculation accounts for both full-time and part-time employees, using the same general formula (part-time employees counted as fractions).

TIP: Full-time seasonal employees who worker fewer than 120 days during the year are excluded.

There are inconsistencies in the application of these new federal definitions that will need to be ironed out, assuming the entire health reform act isn’t amended, repealed and replaced, or successfully challenged in court.

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