Healthcare Blog

Latest "In The News" Posts

The Question Presidential Candidates Must Answer

The Affordable Care Act (ACA) seems to be a topic of discussion for Presidential candidates. Will the ACA still presidential candidatestay intact once the next President is elected into office? What changes will be made to the ACA? The biggest question stated by an article on Bloomberg View is, “How would they (Presidential Candidates) protect people with pre-existing conditions? Left to their own devices, after all, insurers have an incentive to charge higher premiums to potential customers who already have chronic health conditions – or not to offer them coverage at all.”

What the ACA has done well is to ban the refusal of coverage for individuals with pre-existing conditions. To protect the insurance providers the ACA has required ALL individuals and families to obtain coverage. This prevents those that are healthy from only enrolling in healthcare when something goes wrong, then dropping coverage once they are well again. Otherwise premium rates would skyrocket. It’s taking the good with the bad so that everybody is able to obtain coverage.

Several conservative plans offer a different option and still help people with pre-existing conditions as well as provide better options to healthy individuals. The proposal provides tax credits to help those who don’t have employer coverage, requires insurers to offer the same terms for sick and healthy as long as they are continually covered, and creates high-risk pools for anyone else. There are also ideas of rewarding those with continual coverage with protection from premium increases.

Many of the proposed options are trying to remove most of the federal spending and regulation. Bloomberg View states later in the article, “One could expect the need for the high-risk pools and the regulatory protections to diminish. They address problems that in large part result from the way federal and state policies have stunted the growth of the individual market.” All of the proposals on the table focus on allowing a more functional market to emerge. I’m looking forward to seeing the changes and how the ACA will develop with a new POTUS in office!

Read the full article on Bloomberg View HERE


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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , , ,

Healthcare Cost Keeps Rising

Healthcare cost continues to rise and the Affordable Care Act (ACA) isn’t exactly affordable at all. The inflation of healthcare is rising faster than the American economies natural inflation rate. What is making healthcare rise faster than everything else? There are many contributing factors and one of the major ones is supply and demand. The demand for healthcare didn’t happen organically, it happened over night. When the ACA was passed the entire United States population had demand, but the supply stayed the same. Sadly the healthcare provider market hasn’t expanded much in response to the demand.

There are some new health insurance carriers that are trying to hedge their way into the market, but the successful ones get bought out by the larger more established companies. The inflation for healthcare is not just attributed to supply and demand though, it is also the result of political decisions and increased regulations as well as the cost of prescriptions, medical devices, and hospital care, according to an article on Forbes. Some of these were already an issue to rising healthcare costs before the ACA was passed, so why did congress put a 2.3% tax on medical devices under the ACA’s law? Doesn’t make much sense when you are trying to keep healthcare cost “affordable.”

Here is a graph that we pulled from Forbes comparing the natural rate of inflation against the healthcare rate of inflation. Will healthcare increases outrun our incomes if more competition doesn’t halt the monopolized lack of supply for the ever increasing demand? What are your thoughts on healthcare costs?

healthcare cost
Read the full Forbes article HERE

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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , ,

Medicare Isn’t Sustainable

During a New Hampshire town meeting Jeb Bush was confronted by a senior citizen after a comment about entitlement reform. The women commented by saying, “My Medicare right now is wonderful and I paid into it for all these years. Why are you always attacking seniors?” Where Bush called it the entitlement system the woman rebutted that she had earned it.

I can see where the woman is coming from in the thought that she has paid into the system, and she has, but not nearly enough to contribute to the cost of her medical care. The level of funding is not adequate to support the current and future Medicare participants. It is expected that the Medicare fund will be insolvent by 2026 . According to Grace Marie Turner, “At best, she will have paid for less than half of the expected cost of her lifetime Medicare expenditures and possibly as little as 8%. Medicare is not sustainable as it is currently structured, and reform is indeed vital.” Take a look at this graph on the cost versus what is actually paid.

As you can see the benefits received far outweigh what was “paid for” and as a common misconception of those currently receiving Medicare it’s a hard issue to reform. As time goes on with the cost of inflation the difference continues rise. This will be an issue that will have to be looked at in the upcoming Presidential term. Have you previously thought that Medicare is completely covered by what you have paid into over your working years? Do you agree that we need reform to the Medicare system?

Read the full article from Grace Marie Turner HERE


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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , ,

The ACA Boasts Fewer Uninsured

The Affordable Care Act (ACA) has boasted an increase in healthcare enrollment, which is to be expected as it’s Uninsuredmandatory. What do those numbers look like on paper though? In Colorado alone the uninsured have been cut by more than half over the past two years. The disheartening news is that the drop is due almost entirely to a surge in Medicaid enrollment, according to Biz Journals.

The Colorado Health Institute (CHI) and The Colorado Trust released its findings from the 2015 Colorado Health Access Survey and the increase in Medicaid enrollment was one of many things the survey revealed. Another is the way that Coloradans are buying health insurance. In a once employer-sponsored dominant healthcare market it showed 42,000 fewer workers receiving health insurance from businesses of 50 or fewer employees. This is a drop of 12% from the previous year. I’m not a betting woman, but I am betting this is due to the rising cost of employer-sponsored insurance and the fact that the ACA does not require companies that employee less than 50 to offer insurance. “That does not mean that fewer small-business employees are insured, however, as many of those workers have moved from group insurance plans to individual plans or to Medicaid, whose eligibility levels were expanded by the state in 2014”, said Michele Lueck, CHI president and CEO.

Ned Calonge, president and CEO of the Colorado Trust said, “The first big intent of the Affordable Care Act was to expand coverage. It’s achieved that. Those next pieces need the coverage piece to happen in order to work on that. We’re exactly where we need to be.” The numbers are there for individuals who are enrolled in healthcare, but now the number of under-insured individual’s needs to be looked at.

All in all the ACA has done well as its first goal was to insure Americans that were uninsured or under insured. What other areas of the ACA do you see that need to be fine-tuned?

Read the full article on Biz Journals HERE.

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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , , , ,

Pro or No Vaccine?

vaccinateThe battle continues from parents on Pro or No Vaccine. As the school year starts there are many children walking through the doors without their recommended vaccines due to medical, religious or philosophical reasons. Parents who are pro-vaccine believe that those that don’t vaccinate their children are putting their children at risk. Please inform me of something though, if their children are vaccinated they are no longer at risk, so why are they worried? It is the parents that don’t vaccinate their children that are putting each others children at risk and they all sit on the same side of the fence, so why the big issue?

The Centers for Disease Control and Prevention (CDC) suggests vaccination schedules for children and adults but there are no federal requirements. All states have their own policies to require children to be vaccinated, but parents are able to obtain exemptions. After a large outbreak of measles that originated at Disneyland in California those that don’t vaccinate have come under more ridicule. California and Vermont have now taken away the choice of parents to exempt their children for religious or philosophical reasons.

The possible excuse of not having or not being able to afford healthcare is eliminated as well due to the Affordable Care Act (ACA). Preventative care is typically covered at no cost to the individual and includes routine vaccinations against diseases. The CDC puts out a recommended vaccination list for all ages and can be found HERE. If it is an issue of healthcare coverage I urge you to look into health plans for your family to ensure that your family is protected if you desire to be.

If you are one that is anti-vaccination let me know, why do you choose not to vaccinate your child? If you do vaccinate your child please tell me, what are your thoughts on those that don’t and why you choose to vaccinate?


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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , , ,

1/3 The Healthcare Providers?

In a recent Washington Post article it was reported that, “Consumers who bought insurance on the health exchanges last year had access to one-third fewer doctors and hospitals, on average, than people with traditional employer-provided coverage” This is not necessarily a negative though as the smaller networks are typically negotiated contracts with the healthcare provider to offer lower costs which results in a lower premium price.

Healthcare Providers
An analysis by Avalere Health said, “Compared with traditional employer coverage, exchange plans had networks with 42 percent fewer cancer and cardiac specialists; 32 percent fewer mental health and primary-care doctors, and 24 percent fewer hospitals.” As stated above the negotiated contracts between healthcare providers and insurance carriers helps control cost. There are plans on the healthcare exchange that provide broader networks, but you are paying for that network in higher premium.

The real issue is not that the network is small, but whether a doctor stays on the network for the entire calendar year. At Design Health we have seen instances where an individual signs up for their health plan in January and their doctor is in network, but by March the doctor has ended their contract and is no longer participating in that network. Unfortunately a consumer is locked into their health plan for the calendar year, unless there is a qualifying event, whereas the healthcare provider can jump ship.

Often times consumers are informed of the network access their health plan provides and understand that there are both in and out of network providers. When the consumer is informed they go to great lengths to make sure their provider is in-network so they do not end up with a full out of pocket payment for services. Although, for those not informed they believe they can go to any doctor because they have insurance. In this instance it doesn’t matter if the network is narrow or broad, if a consumer doesn’t do their research they run the risk of paying much higher prices.

Are you a consumer that understands your healthcare network? When you enrolled in healthcare did you make sure that your doctors were included in the health plan you chose?

Read the full article from the Washington Post HERE


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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , ,

Less Than A Month Away For A January 1st Enrollment Date

There is less than a month left for a January 1st start date so don’t miss out on the December 15th enrollment deadline. If you are someone that understands health insurance plans backwards and forwards then you are way ahead of the game, but many Americans do not understand the other language that is “health insurance.” I encourage you to reach out to a broker that is well versed on the language and let the help you understand.

Once you enroll in a health plan during Open Enrollment for 2016 you are locked into that plan for the entire calendar year unless you have a qualifying even like a birth, marriage, or major move. open enrollmentOpen Enrollment goes through January 31st this year.  The important deadlines and dates to remember are:

November 1st, 2015: First day to enroll in a health plan for a January 1st, 2016 start date.

December 15th, 2015: Last day to enroll in a health plan for a January 1st, 2016 start date.

January 1st, 2016: First day of coverage for those that enrolled in health plans from November 1st, 2015-December 15th, 2015

January 15th, 2016: Last day to enroll in a health plan for a February 1st, 2016 start date.

January 16th-January 31st: Enrollment days for a March 1st, 2016 start date.

January 31st: The last day to enroll in a health plan for 2016 without a qualifying event.

Check the website HERE for all dates, deadlines, and news for Health Plans.

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Posted by Lauren Yeager in All Posts, Did You Know?, Health Insurance, In The News and tagged , , , ,

Opposing View for Insurance Premium Rates

USA TodayIt’s not often that an article written asks itself to be pitted against somebody with an opposing view, but that is exactly what USA Today did when they asked The Galen Institute to write their view on next years insurance premium rates. USA Today’s camp states that premium increase will be at a minimum and that for Obamacare critics there is never any good news, and that critics think “Obamacare is a ready to-implode disaster.” The article goes on to quote several rate requests submitted for 2016, and says that any large rate hikes are due to miscalculated rates from 2015 and the need to “regroup.” Read the full USA Today article HERE

The Galen Institute writes their opposing view with early quotes of, “President Obama is jawboning regulators to Galenlower rates, but that can only go so far when plans face multi-million dollar gaps between premium income and claims payments” and ” To offset the cost of the Affordable Care Act’s many new mandated benefits, the most popularly priced plans have ultra-limited networks plus high out-of-pocket costs and deductibles” This goes to show that things are not always as they seem. USA Today is quoting on smoke and mirrors rather than what is behind the facade.

You can quote premium rate increases, but you have to look at what those rate increases are covering. A rate increase today of 6% is like a 10% rate increase pre-ACA. The rates might not look like they are increasing that much, but when you look at the broad picture of insurance plans and premiums before ACA vs. current pricing, the increase is much larger than even Grace Marie Turner of the Galen Institute wrote about. Read The Galen Institute’s opposing view HERE

What were your healthcare premium costs like before the ACA compared to what they are now? What is the percentage of your increase over the years?

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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , , ,

More Co-Ops Go Flop

Co-OpLast week a webinar was given by several well informed professionals on the Affordable Care Act and the topic at hand, co-op shut downs. We are 8 down and counting stated Scott Harrington, Wharton School at UPenn Professor of Health Care Management, echoing the sentiments of the other panelists. After several more health co-ops have shut their doors just before the opening of the 2016 enrollment period one can’t help but say who is next. Many of the cooperatives seemed to fail before they even started, but with the prospect of true governmental help they could have survived.

As stated during the webinar, “In the real world businesses that lose money don’t stay open.” Unfortunately there is a bigger picture for this “lose money” statement. Lets take a look at Colorado Health Op for example. Their projections and financial model was set to pay back their loans of 73 million. Although, they also stood on the governments promise to provide their risk corridor funds. When it came time for the government to hold up their end of the law and provide the funds requested by Colorado Health Op, among several other cooperatives and smaller insurance companies, they only provided 12% of the 100% of funds provided.

How can our government do that you might ask, when it is written into the law? They can’t, but they did with the stipulation that the full 100% would be paidco-ops in time, just not this year in full. Convenient that the Department of Insurance (DOI) shut the doors to Colorado Health Op for failing to have enough funds in reserve due to the government defaulting on their promise and now the government is released from their obligation. Keep in mind it will also cost $40 million to close Colorado Health Op’s doors according to Chuck Holum, Colorado Health Op Board President.

Tom Miller made a point during the webinar of saying, “(co-ops) resemble a family in financial trouble, taking out additional credit cards to pay their daily bills.” Well Mr. Miller those extra credit cards don’t have to be taken out if the government would have held true to their original “credit card” terms of use! This is an experiment gone bad where tax payers are the ones suffering. There’s 2.3 billion put into this floundering project. Who will pay it back? The American people will end up taking the obligation upon themselves without consent, and it shouldn’t be our burden to carry.

Now we sit and wait to see the next episode of Survivor, staring the remaining cooperatives in 2016. It will be an interesting year, but here’s to hoping the remaining survive and we have seen the last of the closures. Sadly this will probably be false hopes.

Watch the recorded webinar HERE

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Posted by Lauren Yeager in All Posts, Health Insurance, In The News and tagged , , , ,

Common Misconceptions with Defined Contribution

QuestionThere are common misconceptions with defined contribution plans as to their legality and how to set them up to comply with regulations. One of the common questions comes from understanding that the employer is not directly paying for an employee’s individual health insurance. When a company sets up a defined contribution plan it must be compliant with IRS, ERISA, HIPPA, and ACA guidelines. We typically recommend using an administrator when setting up these plans. So why do you need to set up a formal plan to be in compliance versus giving the employee funds directly?

To maintain compliance employers aren’t involved in the employee’s decision to choose their individual health policy, the employer does not directly pay for the insurance premium, and the employer is not involved in any communication between the individual and the insurance company. When following the above guidelines it allows the employer to contribute to an individual health insurance plan maintaining compliance with federal law.

In a defined contribution plan employers are able to give employees different contributions based on their class or position within the company. This class can be based on job categories, geographic location, part-time or full-time status, etc. A class must treat all employees equally, to avoid discrimination. These classes are defined by the employer in an ERISA plan document before the defined contribution plan is put into place.

We have found Zane Benefits is one of the best at administering defined contribution plans. Zane offers a FAQ sheet on their website HERE. For more common misconceptions and answers visit their website. What are some of your biggest questions when it comes to Defined Contribution?


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Posted by Lauren Yeager in All Posts, Did You Know?, Health Insurance, In The News, Small Business and tagged , , , ,