Seasonal firefighters seek health care coverage

DENVER (AP) — They work the front lines of the nation's most explosive wildfires, navigating treacherous terrain, dense walls of smoke and tall curtains of flame. Yet thousands of the nation's seasonal firefighters have no health insurance for themselves or their families.

Many firefighters are now asking to buy into a federal government health plan, largely out of anger over a colleague who was left with a $70,000 hospital bill after his son was born prematurely.

Their request has been bolstered by more than 125,000 signatures gathered in an online petition during this year's historic fire season in the West and the ongoing national debate over health care.

"You pray you don't get sick," said firefighter John Lauer, a member of the Tatanka Hotshots crew based in Custer, S.D., who recently worked the massive High Park Fire in northern Colorado and started the petition.

The fire crews are heroes to those in the path of the flames. Politicians praise their bravery. Grateful residents buy them pizzas and send thank-you cards.

"That's what makes the job great," Lauer said. "But sometimes I wonder to myself. I wonder if people know we're uninsured."

Firefighters do get workers' compensation if they are hurt on the job, but that doesn't cover them in the offseason.

The National Interagency Fire Center in Boise, Idaho, which coordinates firefighting efforts nationwide, says 15,000 wildland firefighters are on the federal payroll this year. Of that number, some 8,000 are classified as temporary seasonal employees, who work on a season-to-season basis with no guarantee of a job the following year and no access to federal benefits.

Some seasonal firefighters say they put in a year's worth of hours in six months.

In two years, the Affordable Care Act, the new federal health care law, will allow seasonal firefighters the same opportunity to buy health insurance as other uninsured Americans. But firefighters want to be able choose among the plans offered by the federal government, like other federal employees, said Cory K. Bythrow, a spokesman for the National Federation of Federal Employees, a labor union.

Mark Davis, president of the Forest Service Council of the union, estimates it would cost the federal government $17.5 million a year to pay its share of premiums for seasonal firefighters working for the Forest Service, which employs about 70 percent of federal firefighters. The rest work for the Bureau of Land Management, the Bureau of Indian Affairs and other agencies.

The union is in talks with the Office of Personnel Management to try to extend health benefits to seasonal firefighters.

The agency declined to comment. Bythrow said he is optimistic a solution can be found.

Rep. Diana DeGette, D-Colo., said she will introduce a bill this week that would make the firefighters eligible for health benefits.

"When the issue was brought to her attention by John (Lauer), she realized how unfair this was," Juliet Johnson, DeGette's spokeswoman, said Monday.

Interior Secretary Ken Salazar, who visited Colorado on Monday, said no firefighters had raised the insurance issue with him, but he said he would look into it.

Forest Service spokeswoman Julie Anne Overton cited one health care plan that would cost a firefighter $185 a month for individual coverage and $430 month for a family. Permanent year-round federal firefighters are paid from $24,500 to $54,000 before overtime. Seasonal workers make less, Overton said.

The case that prompted Lauer and others to start their petition drive was the 2008 birth of Nathan Ochs' son. Ochs, then a temporary seasonal wildland firefighter, had no insurance.

His wife, Constance Van Kley, said the family couldn't find health insurance at any price — though the hospital did eventually forgive most of the $70,000 bill.

Ochs subsequently became a permanent seasonal federal firefighter and got government insurance. But the experience galvanized him and others to press the government to make health coverage available to all federal wildland firefighters.

"I feel that it's unfair and that it sends a message that the work isn't valued as it should be," said Ochs, who also worked in Colorado's blazes this year.

No one disputes the dangers of the job: lightning, falling trees, a dangerous landscape, as well as smoke and flames. Since 2003, 157 people have died battling wildfires in the U.S., according to the International Association of Wildland Fire. Injury statistics were unavailable.

Public support for Lauer's petition, posted at change.org, mushroomed during the High Park Fire near Fort Collins and the Waldo Canyon Fire in Colorado Springs. Together the two blazes damaged or destroyed more than 600 homes, killed three people and charred 162 square miles. Petition signers came from across the country.

"I'm insulted for them, and I'm insulted for our country," said Polly Tarpley, a resident of Poulsbo, Wash. Asked why she signed the petition, she quickly replied: "Oh, my god! That should be a pretty obvious question. These men and women work their tails off in extremely dangerous conditions."

"We should be more than willing to pay them health insurance," said Pam Shinkle, owner of Uncle Sam's Pancake House in Manitou Springs, a quaint mountain town that was briefly evacuated during the Waldo Canyon blaze. Dozens of firefighters helped to sustain business at Uncle Sam's while ash fell from the sky and flames roared just over a nearby hill.

"We love our firemen," Shinkle said. "They did a great job. They had a huge fire, and they got it out within two weeks, when they had been saying months."

Davis, of the federal employees union, argued that the cost to the government would be offset by reduced turnover. The attrition rate for temporary seasonal workers in the Forest Service is four times higher than that for permanent seasonal workers, said Davis, and he believes the lack of health insurance is a factor.

"You would save money in the long run by reduced training costs, reduced safety issues, accidents, that sort of thing," Davis said.

"These people put their lives on the line every day to protect our homes, our businesses, our entire communities," Bythrow said. "We believe that they shouldn't have to rely on luck. They shouldn't have to rely on the generosity of one hospital or one doctor."

___

Associated Press writers Ivan Moreno and P. Solomon Banda in Denver and Mead Gruver in Cheyenne, Wyo., contributed to this report.

View the original article here

Health care reform stands: How it impacts your coverage

The Supreme Court upheld health care reform Thursday, which includes a mandate that consumers have to buy coverage by 2014 or pay a penalty.

NEW YORK (CNNMoney) -- The Supreme Court's ruling Thursday to uphold health care reform has widespread implications for both insured and uninsured consumers.

Beginning in 2014, uninsured individuals must buy coverage -- either on their own, through an employer's plan or through a health insurance exchange -- or else pay a tax penalty. Meanwhile, insured consumers will continue to enjoy key mandates of the law, such as free preventive care and coverage of adult dependents up to age 26, but at the expense of higher out-of -pocket costs.

In the United States, more than half of the population -- or 160 million people -- gets health insurance directly through their employers, while 50 million people have no insurance, according to the government. Tens of millions more consumers either buy their own private insurance or are covered by government programs, such as Medicaid and Medicare.

Several key mandates of health reform have already gone into effect since the law passed in 2010. Here's a rundown of those provisions and new mandates rolling out over the next two years that will impact almost all of these consumers.

If you have insurance through your employer: Employees will continue to enjoy key benefits mandated by health reform that have already gone into effect.

"For consumers who are insured through their employers, this is good news," said Mike Thompson, principal with PwC's Global Human Resources Services.

Among the main provisions: Employers must provide coverage for adult dependents of workers up to age 26; health plans must cover certain preventive services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance; and insurers can't impose a maximum lifetime dollar limit on a customer's medical care.

In 2013, eight additional preventive care services for women, including HIV and HPV (Human Papillomavirus) screening, will be covered under health reform.

But some industry experts also said that employers who offer insurance will now be even more focused on controlling their health care costs, especially since the individual mandate is expected to add more people -- including more high-risk individuals -- to their plans.

This means employees could see further increases in premiums and deductibles.

Also starting in 2013, the health care law will limit employee contributions to flexible spending accounts to a maximum of $2,500 a year. Many employers have their own caps on FSA contributions and the cap for federal employees is $5,000.

"Come open enrollment, it's very important that employees pay careful attention to their benefits packages and take a good look at options and incentives that companies are offering them to lower their out-of-pocket costs," said Tracy Watts, senior health care consultant with benefits consulting firm Mercer.

If you buy your own insurance: About 15 million consumers in the United States buy health insurance directly from private insurers or work for businesses that do so.

Under health reform, insurers must also allow policyholders to add adult dependents up to age 26 to their plan. Also, beginning in 2014, insurers can't drop an individual if they become sick and they cannot refuse coverage for a pre-existing condition. Insurers also can't set annual or lifetime limits on the amount of care.

If you're uninsured: Come 2014, if you don't have health coverage, you will have to pay a penalty.

In 2014, the fee is capped at $285 per family, or 1% of income, whichever is greater. By 2016, it will jump sharply to $2,085 per family, or 2.5% of income, whichever is greater. Individuals will pay penalties of $95 in 2014 that will climb to $625 in 2016.

The law mandates that states set up health insurance exchanges -- an online marketplace where consumers can buy subsidized health plans -- by 2014. These exchanges are geared towards making health insurance affordable to underinsured and uninsured individuals.

Subsidies are determined by individuals' income levels. Uninsured consumers with incomes between 139% and 400% of poverty will be eligible for tax credits to offset the cost of buying coverage through exchanges.

According to the Congressional Budget Office, the average subsidy per enrollee in the exchange will be $4,780 in 2014, rising to $5,780 in 2018.

If you work for a small business: By 2014, companies with 50 or more full-time employees must start providing health insurance or face penalties.

For most small businesses, that means a new way to shop for less expensive health insurance on the exchanges where they can buy plans for their workers.

But Sandy Ageloff, an analyst with Towers Watson, a leading benefits consulting firm for Fortune 1000 companies, expects several businesses could still opt out of providing health care coverage and instead send workers to exchanges.

"For these businesses who buy insurance coverage directly from private insurers, they often have higher premiums," said Ageloff.

"So they may find it more cost effective. despite the penalties, to eliminate their company insurance benefits and send workers to exchanges," she said.

Mercer's Watts said health insurance exchanges are a welcome provision for early retirees as well.

"There are many individuals who want to retire early but don't because they don't want to lose their health insurance," she said. "These exchanges will allow them to retire and still be able to buy affordable health insurance."

If you're insured through Medicare or Medicaid: For Medicare beneficiaries, health reform mandates that the Part D donut hole -- the gap in drug coverage during which beneficiaries have to pay the cost of prescriptions entirely out of pocket -- will be phased out by 2020.

The government said Medicare recipients have saved $3.7 billion on drug costs as a result of provisions which went into effect after health reform passed in 2010. To help afford their prescriptions, those who have fallen into the donut hole have received a one-time tax rebate and discounts on name-brand and generic drugs.

Those who currently receive Medicaid won't be impacted much by health care reform. It's less certain after Thursday's ruling, however, whether all states will expand the program come 2014.

Initially, health care reform mandated that states expand Medicaid coverage or lose federal funding for the program. The new Medicaid guidelines were to expand coverage to anyone under 65 whose income was up to 133% of the federal poverty level by 2014.

On Thursday, the Supreme Court struck down that provision, saying it should be up to the states to decide whether or not they want to expand the program, without any threat of losing federal funding.

"This is the one piece that impacts some individuals," said Ageloff. "If a state decides not to expand the program, some individuals now may not be able to get Medicaid coverage."

More on health care reform:

What health reform could cost

20-somethings celebrate: 'I can pay my rent'

Exchanges: Health insurance models of the future

Health reform: What companies need to know 

First Published: June 28, 2012: 4:41 PM ET

View the original article here

Health care reform: How it impacts your insurance coverage

The Supreme Court's ruling Thursday to uphold health care reform has widespread implications for both insured and uninsured consumers.

Beginning in 2014, uninsured individuals must buy coverage -- either on their own, through an employer's plan or through a health insurance exchange -- or else pay a tax penalty. Meanwhile, insured consumers will continue to enjoy key mandates of the law, such as free preventive care and coverage of adult dependents up to age 26, but at the expense of higher out-of -pocket costs.

In the United States, more than half of the population -- or 160 million people -- gets health insurance directly through their employers, while 50 million people have no insurance, according to the government. Tens of millions more consumers either buy their own private insurance or are covered by government programs, such as Medicaid and Medicare.

Several key mandates of health reform have already gone into effect since the law passed in 2010. Here's a rundown of those provisions and new mandates rolling out over the next two years that will impact almost all of these consumers.

If you have insurance through your employer: Employees will continue to enjoy key benefits mandated by health reform that have already gone into effect.

"For consumers who are insured through their employers, this is good news," said Mike Thompson, principal with PwC's Global Human Resources Services.

Among the main provisions: Employers must provide coverage for adult dependents of workers up to age 26; health plans must cover certain preventive services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance; and insurers can't impose a maximum lifetime dollar limit on a customer's medical care.

In 2013, eight additional preventive care services for women, including HIV and HPV (Human Papillomavirus) screening, will be covered under health reform.

Related: Justices say insurance mandate is a tax

But some industry experts also said that employers who offer insurance will now be even more focused on controlling their health care costs, especially since the individual mandate is expected to add more people -- including more high-risk individuals -- to their plans.

This means employees could see further increases in premiums and deductibles.

Also starting in 2013, the health care law will limit employee contributions to flexible spending accounts to a maximum of $2,500 a year. Many employers have their own caps on FSA contributions and the cap for federal employees is $5,000.

"Come open enrollment, it's very important that employees pay careful attention to their benefits packages and take a good look at options and incentives that companies are offering them to lower their out-of-pocket costs," said Tracy Watts, senior health care consultant with benefits consulting firm Mercer.

If you buy your own insurance: About 15 million consumers in the United States buy health insurance directly from private insurers or work for businesses that do so.

Under health reform, insurers must also allow policyholders to add adult dependents up to age 26 to their plan. Also, beginning in 2014, insurers can't drop an individual if they become sick and they cannot refuse coverage for a pre-existing condition. Insurers also can't set annual or lifetime limits on the amount of care.

If you're uninsured: Come 2014, if you don't have health coverage, you will have to pay a penalty.

In 2014, the fee is capped at $285 per family, or 1% of income, whichever is greater. By 2016, it will jump sharply to $2,085 per family, or 2.5% of income, whichever is greater. Individuals will pay penalties of $95 in 2014 that will climb to $625 in 2016.

The law mandates that states set up health insurance exchanges -- an online marketplace where consumers can buy subsidized health plans -- by 2014. These exchanges are geared towards making health insurance affordable to underinsured and uninsured individuals.

Related: 20-somethings celebrate: 'I can pay my rent'

Subsidies are determined by individuals' income levels. Uninsured consumers with incomes between 139% and 400% of poverty will be eligible for tax credits to offset the cost of buying coverage through exchanges.

According to the Congressional Budget Office, the average subsidy per enrollee in the exchange will be $4,780 in 2014, rising to $5,780 in 2018.

If you work for a small business: By 2014, companies with 50 or more full-time employees must start providing health insurance or face penalties.

For most small businesses, that means a new way to shop for less expensive health insurance on the exchanges where they can buy plans for their workers.

But Sandy Ageloff, an analyst with Towers Watson, a leading benefits consulting firm for Fortune 1000 companies, expects several businesses could still opt out of providing health care coverage and instead send workers to exchanges.

"For these businesses who buy insurance coverage directly from private insurers, they often have higher premiums," said Ageloff.

"So they may find it more cost effective. despite the penalties, to eliminate their company insurance benefits and send workers to exchanges," she said.

Related: What small businesses need to know

Mercer's Watts said health insurance exchanges are a welcome provision for early retirees as well.

"There are many individuals who want to retire early but don't because they don't want to lose their health insurance," she said. "These exchanges will allow them to retire and still be able to buy affordable health insurance."

If you're insured through Medicare or Medicaid: For Medicare beneficiaries, health reform mandates that the Part D donut hole -- the gap in drug coverage during which beneficiaries have to pay the cost of prescriptions entirely out of pocket -- will be phased out by 2020.

The government said Medicare recipients have saved $3.7 billion on drug costs as a result of provisions which went into effect after health reform passed in 2010. To help afford their prescriptions, those who have fallen into the donut hole have received a one-time tax rebate and discounts on name-brand and generic drugs.

Those who currently receive Medicaid won't be impacted much by health care reform. It's less certain after Thursday's ruling, however, whether all states will expand the program come 2014.

Initially, health care reform mandated that states expand Medicaid coverage or lose federal funding for the program. The new Medicaid guidelines were to expand coverage to anyone under 65 whose income was up to 133% of the federal poverty level by 2014.

On Thursday, the Supreme Court struck down that provision, saying it should be up to the states to decide whether or not they want to expand the program, without any threat of losing federal funding.

"This is the one piece that impacts some individuals," said Ageloff. "If a state decides not to expand the program, some individuals now may not be able to get Medicaid coverage."

More on health care reform:

What health reform could cost 20-somethings celebrate: 'I can pay my rent'

Exchanges: Health insurance models of the future Health reform: What companies need to know

View this article on CNNMoney

More From CNNMoney.com

View the original article here

Court weighs making health coverage a fact of life

WASHINGTON (AP) — Death, taxes and now health insurance? Having a medical plan or else paying a fine is about to become another certainty of American life, unless the Supreme Court says no.

People are split over the wisdom of President Barack Obama's health care overhaul, but they are nearly united against its requirement that everybody have insurance. The mandate is intensely unpopular even though more than 8 in 10 people in the United States already are covered by workplace plans or government programs such as Medicare. When the insurance obligation kicks in, not even two years from now, most people won't need to worry or buy anything new.

Nonetheless, Americans don't like being told how to spend their money, not even if it would help solve the problem of the nation's more than 50 million uninsured.

Can the government really tell us what to buy?

Federal judges have come down on both sides of the question, leaving it to the Supreme Court to sort out. The justices are allotting an unusually long period, six hours over three days, beginning March 26, to hear arguments challenging the law's constitutionality.

Their ruling, expected in June, is shaping up as a historic moment in the century-long quest by reformers to provide affordable health care for all.

Many critics and supporters alike see the insurance requirement as the linchpin of Obama's health care law: Take away the mandate and the wheels fall off.

Politically it was a wobbly construction from the start. It seems half of Washington has flip-flopped over mandating insurance.

One critic dismissed the idea this way: "If things were that easy, I could mandate everybody to buy a house and that would solve the problem of homelessness." That was Obama as a presidential candidate, who was against health insurance mandates before he was for them.

Once elected, Obama decided a mandate could work as part of a plan that helps keep premiums down and assists those who can't afford them.

To hear Republicans rail against this attack on personal freedom, you'd never know the idea came from them.

Its model was a Massachusetts law signed in 2006 by Mitt Romney, now the front-runner of the Republican presidential race, when he was governor. Another GOP hopeful, former House Speaker Newt Gingrich, supported a mandate on individuals as an alternative to President Bill Clinton's health care proposal, which put the burden on employers.

All four GOP presidential candidates now promise to repeal the Affordable Care Act, which they call "Obamacare." Former Pennsylvania Sen. Rick Santorum calls it "the death knell for freedom."

So much for compromise.

Obama and congressional Democrats pushed the mandate through in 2010, without Republican support, in hopes of creating a fair system that ensures everyone, rich or poor, young or old, can get the health care they need. Other economically advanced countries have done it.

Doing nothing is more expensive than most people realize.

Congress found that when the uninsured go to clinics and emergency rooms, the care they can't pay for costs nearly $75 billion a year. Much of that cost is passed along and ends up adding $1,000 a year to the average family's insurance premium.

The overhaul is neither the liberal dream of a single government program supported by taxes and covering everyone nor the conservative vision of stripping away federal rules and putting free enterprise in charge.

The Obama plan relies on private companies plus lots of regulation to make sure they provide basic benefits, keep premiums reasonable, and cover the sick as well as the healthy. That's where the mandate comes in. If insurers must cover everyone, even those with existing medical conditions, healthy people have little incentive to sign up before they get sick.

Insurance companies argue that if only the sick sign up, insurers will go broke. So the law says everybody must have insurance for themselves and their children, or pay a penalty.

Also, because everyone needs health care sometime, if everyone purchases insurance, the price per person can be lower, with the cost of care spread out over many people.

After all, the government requires workers to pay Social Security and Medicare taxes, whether they want the benefits or not.

One argument for the insurance mandate is that the fines are just federal taxes by another name. Another is that it falls under the government's constitutional power to regulate commerce that crosses state borders.

State governments, of course, tell people to buy lots of things, including auto insurance or motorcycle helmets.

"You can always move to another state," said Tom O'Connor, a consultant in Fairfax, Va., who thinks the health care law overreaches. "It's a little more difficult to move to another country."

Many agree.

In an Associated Press-GfK poll, 85 percent said the U.S. government should not have the power to require people to buy health insurance. When the question is worded without the specific reference to federal power, acceptance of the mandate grows a bit, but 6 in 10 are still against it.

Even among those who generally support the health care overhaul, one-third said they are against the insurance mandate.

There's also a significant minority who sees mandates as a cop-out and prefer a government program that covers everyone, Medicare for all.

It's clear that many people do not understand what the law would do or how it would affect them.

Jan Gonzales, an out-of-work bookkeeper in Pablo, Mont., calls fining people for going without insurance "the most ridiculous, asinine thing you ever heard of."

"If I can't put food on the table for my children, how can I pay for health care coverage?" asks Gonzales, who's been without insurance for seven years. "What moron came up with that idea?"

Of course, she might qualify for the law's exemptions for those too poor to pay and for assistance for low-income people, as well as many in the middle class.

There also are some religious exemptions. .

Estimates vary widely of how many uninsured people will get insurance once it's required in January 2014.

About 4 million people would pay a penalty to the Internal Revenue Service for being uninsured in 2016, the Congressional Budget Office estimates.

By 2016, the fine reaches $695 per uninsured adult or 2.5 percent of family income, up to $12,500 per year. The IRS is in charge of the penalties but can't prosecute violators or place liens against them. Its only enforcement option may be withholding money from refunds.

That leaves insurance companies, who stand to gain lots of new customers, worried that people instead will shrug off the weak mandate.

Meanwhile, the state-federal Medicaid program will expand to cover more low-income people, and that's another issue before the Supreme Court, because many states say they cannot afford the extra cost.

___

Online:

Health care law: http://www.healthcare.gov

Supreme Court: http://www.supremecourt.gov/docket/PPAACA.aspx

___

Associated Press writer Stacy A. Anderson contributed to this report.

View the original article here

Health care coverage for pre-existing conditions

If you have a pre-existing condition, you may think it will keep you from getting affordable health insurance.

But health insurers don't make money by denying applicants. Instead, they may offer what is known as a condition-specific deductible, or CSD, that can provide the health care coverage you need at a price you can afford.

A CSD is an annual deduction that is completely separate from your medical and/or prescription drug deductible and applies only to treatment and medication for a single health condition. Once you reach your condition-specific deductible, your health insurance plan will typically pay covered expenses related to that condition at 100 percent for the rest of the year.

Vincent Blair, a veteran health insurance broker based in Webster Groves, Mo., says that prior to the introduction of CSDs several years ago, insurance companies had three ways of dealing with consumers with health conditions. They could decline them outright, exclude the specific condition with an exclusion rider, or "rate up," meaning they would charge more for the policy.

"You have some companies that say we don't put exclusions on any conditions. Well, that sounds good, but they decline quicker. Or they'll include the condition but charge you more money, typically on things like blood pressure or cholesterol," says Blair. "But they can't rate up an arthritic hip because there's no premium they can charge to cover a $40,000 hip replacement, so they exclude it."

In a worst-case scenario, the consumer would bear the full burden of treatment costs for their condition without the benefit of the insurer's network-discounted rates.

Assurant Health, a health insurer based in Milwaukee, then introduced the CSD, a consumer-friendly alternative to the exclusion rider that allows the insured to take advantage of discounts with network providers.

"It was a softer version of the pre-existing condition exclusion," says Michael Morrisey, professor at the University of Alabama at Birmingham's School of Public Health. "What happens is you pay whatever the insurer has negotiated with that doctor out of pocket rather than through the insurance until you hit the deductible, then the insurance takes over."

Under a condition-specific deductible offered by Humana, consumers with health conditions may qualify for in-network deductible amounts of $2,500, $5,000 or $7,500; out-of-network deductibles double to $5,000, $10,000 or $15,000.

While it's comforting to know the maximum amount you'll face out of pocket for your condition in the coming year, Blair says it's the access to the insurer's re-priced rates that really sell a CSD.

"If you had an exclusion rider on your knee, that's an uncovered expense and doesn't get negotiated. So along comes Assurant and says, 'We'll cover you and put a $15,000 deductible on your knee.' Why this is so genius is, they already know that if you have a torn meniscus, the bill is not going to go past $15,000, so they're going to be out nothing, and you get the negotiated rate!"

How much is that discount worth? It so happens that Blair had knee surgery recently.

"The bill was $15,000, but after it was run through my insurance, it came to $3,200," he says. "With a CSD, you just give them your card because you do have insurance; it's not an exclusion, and they don't rate you up."

A Humana example uses a customer with psoriasis whose condition requires light therapy at a doctor's office and a prescription cream. If his condition was excluded from coverage, he'd pay $6,000 out of pocket -- with a CSD of $2,500, he'd save $3,500.

Not surprisingly, condition-specific deductibles are not available for every health condition; insurers need to know what the fixed costs of a condition might be in order to price the deductible accordingly. But they are available for some medications for controllable conditions such as asthma.

"There's a list; they know what they can do CSDs on and what they can't," says Blair. "If somebody had, say, two herniated discs in their back and it was bad, the company probably wouldn't put a CSD on it because you just don't know where that back surgery is going to go. They'll exclude that. You're not going to get a CSD on high blood pressure or diabetes either. Diabetes is pretty much a decline everywhere you go."

While a CSD could save you thousands in out-of-pocket expenses each year for an excluded health condition today, they're likely to disappear from the health insurance landscape entirely by 2014, when a provision in the Affordable Care Act prohibiting all health discrimination based on pre-existing conditions takes effect.

"Can an Assurant- or Humana-type condition-specific deductible survive in 2014? The answer is, probably not," says Deborah Chollet, a senior fellow at Mathematica Policy Research in Washington, D.C., who is helping states set up the new reform-mandated health exchanges. "The reason is, group plans are not able to discriminate between individuals based on their health status. In general, it will be very hard for these products to survive in the market because they go hand-in-glove with medical underwriting, and there will not be medical underwriting by 2014."

Chollet says that's all good news for Americans with health conditions.

"At least they will get much better coverage for their premium dollar, if not also get a reduction in premium," she says.

More From Bankrate.com

View the original article here

Court weighs making health coverage a fact of life

WASHINGTON (AP) — Death, taxes and now health insurance? Having a medical plan or else paying a fine is about to become another certainty of American life, unless the Supreme Court says no.

People are split over the wisdom of President Barack Obama's health care overhaul, but they are nearly united against its requirement that everybody have insurance. The mandate is intensely unpopular even though more than 8 in 10 people in the United States already are covered by workplace plans or government programs such as Medicare. When the insurance obligation kicks in, not even two years from now, most people won't need to worry or buy anything new.

Nonetheless, Americans don't like being told how to spend their money, not even if it would help solve the problem of the nation's more than 50 million uninsured.

Can the government really tell us what to buy?

Federal judges have come down on both sides of the question, leaving it to the Supreme Court to sort out. The justices are allotting an unusually long period, six hours over three days, beginning March 26, to hear arguments challenging the law's constitutionality.

Their ruling, expected in June, is shaping up as a historic moment in the century-long quest by reformers to provide affordable health care for all.

Many critics and supporters alike see the insurance requirement as the linchpin of Obama's health care law: Take away the mandate and the wheels fall off.

Politically it was a wobbly construction from the start. It seems half of Washington has flip-flopped over mandating insurance.

One critic dismissed the idea this way: "If things were that easy, I could mandate everybody to buy a house and that would solve the problem of homelessness." That was Obama as a presidential candidate, who was against health insurance mandates before he was for them.

Once elected, Obama decided a mandate could work as part of a plan that helps keep premiums down and assists those who can't afford them.

To hear Republicans rail against this attack on personal freedom, you'd never know the idea came from them.

Its model was a Massachusetts law signed in 2006 by Mitt Romney, now the front-runner of the Republican presidential race, when he was governor. Another GOP hopeful, former House Speaker Newt Gingrich, supported a mandate on individuals as an alternative to President Bill Clinton's health care proposal, which put the burden on employers.

All four GOP presidential candidates now promise to repeal the Affordable Care Act, which they call "Obamacare." Former Pennsylvania Sen. Rick Santorum calls it "the death knell for freedom."

So much for compromise.

Obama and congressional Democrats pushed the mandate through in 2010, without Republican support, in hopes of creating a fair system that ensures everyone, rich or poor, young or old, can get the health care they need. Other economically advanced countries have done it.

Doing nothing is more expensive than most people realize.

Congress found that when the uninsured go to clinics and emergency rooms, the care they can't pay for costs nearly $75 billion a year. Much of that cost is passed along and ends up adding $1,000 a year to the average family's insurance premium.

The overhaul is neither the liberal dream of a single government program supported by taxes and covering everyone nor the conservative vision of stripping away federal rules and putting free enterprise in charge.

The Obama plan relies on private companies plus lots of regulation to make sure they provide basic benefits, keep premiums reasonable, and cover the sick as well as the healthy. That's where the mandate comes in. If insurers must cover everyone, even those with existing medical conditions, healthy people have little incentive to sign up before they get sick.

Insurance companies argue that if only the sick sign up, insurers will go broke. So the law says everybody must have insurance for themselves and their children, or pay a penalty.

Also, because everyone needs health care sometime, if everyone purchases insurance, the price per person can be lower, with the cost of care spread out over many people.

After all, the government requires workers to pay Social Security and Medicare taxes, whether they want the benefits or not.

One argument for the insurance mandate is that the fines are just federal taxes by another name. Another is that it falls under the government's constitutional power to regulate commerce that crosses state borders.

State governments, of course, tell people to buy lots of things, including auto insurance or motorcycle helmets.

"You can always move to another state," said Tom O'Connor, a consultant in Fairfax, Va., who thinks the health care law overreaches. "It's a little more difficult to move to another country."

Many agree.

In an Associated Press-GfK poll, 85 percent said the U.S. government should not have the power to require people to buy health insurance. When the question is worded without the specific reference to federal power, acceptance of the mandate grows a bit, but 6 in 10 are still against it.

Even among those who generally support the health care overhaul, one-third said they are against the insurance mandate.

There's also a significant minority who sees mandates as a cop-out and prefer a government program that covers everyone, Medicare for all.

It's clear that many people do not understand what the law would do or how it would affect them.

Jan Gonzales, an out-of-work bookkeeper in Pablo, Mont., calls fining people for going without insurance "the most ridiculous, asinine thing you ever heard of."

"If I can't put food on the table for my children, how can I pay for health care coverage?" asks Gonzales, who's been without insurance for seven years. "What moron came up with that idea?"

Of course, she might qualify for the law's exemptions for those too poor to pay and for assistance for low-income people, as well as many in the middle class.

There also are some religious exemptions. .

Estimates vary widely of how many uninsured people will get insurance once it's required in January 2014.

About 4 million people would pay a penalty to the Internal Revenue Service for being uninsured in 2016, the Congressional Budget Office estimates.

By 2016, the fine reaches $695 per uninsured adult or 2.5 percent of family income, up to $12,500 per year. The IRS is in charge of the penalties but can't prosecute violators or place liens against them. Its only enforcement option may be withholding money from refunds.

That leaves insurance companies, who stand to gain lots of new customers, worried that people instead will shrug off the weak mandate.

Meanwhile, the state-federal Medicaid program will expand to cover more low-income people, and that's another issue before the Supreme Court, because many states say they cannot afford the extra cost.

___

Online:

Health care law: http://www.healthcare.gov

Supreme Court: http://www.supremecourt.gov/docket/PPAACA.aspx

___

Associated Press writer Stacy A. Anderson contributed to this report.

View the original article here

Health Insurance for Babies -- eHealthInsurance Describes Coverage Options for New Parents

MOUNTAIN VIEW, CA--(Marketwire -03/15/12)- Today eHealthInsurance (NASDAQ: EHTH - News), the leading online source of health insurance for individuals, families and small businesses, described different health insurance options that new or expecting parents should consider for coverage of newborns.

Many new and expecting parents today express uncertainty or confusion about the health insurance options available for their new babies. This is especially true of the large number of new parents without employer-sponsored health insurance.

The 2010 Affordable Care Act (ACA) allows adult children to stay on a parent's health insurance policy until age 26 but grandchildren are not eligible for coverage under the same policy. The ACA also prevents insurers from declining coverage for children under age 19 based solely on the presence of pre-existing medical conditions. However, child-only individual health insurance policies are not readily available in many states.

The coverage scenarios and tips described below are provided to help consumers better understand coverage options for newborns. eHealthInsurance recommends that consumers contact their employers or work with a licensed health insurance agent like eHealthInsurance to better understand their personal choices.

Health Insurance Options for Newborn Children

Enrolling a newborn under a parent's employer-sponsored plan. If you or your child's other parent are currently covered under an employer-sponsored health insurance plan, this is often your baby's best coverage option. Employer-based plans tend to provide robust benefits that may include preventive checkups, well-baby visits and immunizations -- often at no or little out-of-pocket cost. A few considerations:

The child may be covered under either parent's employer plan (or both), even if the parents aren't married Adding a dependent may substantially increase the amount the employee is required to contribute from his or her paycheck towards the monthly premium You don't need to wait for the employer's open enrollment period to add a newborn to your plan but must typically enroll the baby within a specific time-frame, typically thirty days after birth If you miss the enrollment window, you may want to consider a short-term plan to temporarily cover the baby; keep in mind, however, that while short-term plans can provide protection in case of serious illness or injury, they often don't cover preventive care or regular checkups Contact your Human Resources department or benefits administrator before your child is born to make sure that you understand how the enrollment process works and how much additional money will be withheld from your paycheck for dependent coverage

Enrolling a newborn under a parent's individually-purchased plan. Individually-purchased health insurance plans may provide coverage for individuals or for families. The 2010 Affordable Care Act strengthened these plans by doing away with lifetime coverage limits for basic covered services and making certain preventive care services available at no out-of-pocket cost. According to eHealth, Inc's 2011 Cost and Benefits Report, the average monthly premium paid for a family of two or more in 2011 was $414 per month* Nearly nine in ten (88.8%) of the plans surveyed in the report included well-baby coverage.

If you already have an individually-purchased policy, contact your licensed agent or insurer to learn how to add a dependent and how much your monthly premiums may increase as a result Be sure to add your newborn as a dependent within the "qualifying event" period, typically thirty days following birth When applying or re-applying for individual or family coverage it is possible for adults age 19 and over to be declined coverage due to pre-existing medical conditions; such a decline may result in the decline of the application as a whole, including for the coverage of dependents

Enrolling a newborn in a child-only individual plan. "Child-only" plans are individual health insurance policies made available to children age 18 and under with no parent or guardian listed on the same policy. The 2010 health reform law prevents insurers from declining applications for children based solely on pre-existing medical conditions. However, child-only policies are not available in many states, and states where child-only policies are available may limit enrollment to designated open enrollment periods or only with the occurrence of a "qualifying event."

Find out if child-only plans are available in your state by contacting your state department of insurance or a licensed agent Review eHealthInsurance's recently published chart describing the availability of child-only plans across the country Birth may be considered a qualifying event and enrollment may be allowed within a specific period of time after birth in states where child-only health insurance plans are available In states where child-only plans are not available you may still be able to apply for an individually-purchased family plan with yourself as the policyholder and your child as a dependent, but remember that the application may be declined due to your own pre-existing medical conditions

Enrolling a newborn in a state-sponsored health insurance program. If no other options are open to you and you can't afford coverage on your own, you may qualify for government assistance. Depending on your income, you and/or the baby may qualify for Medicaid. In some states there may be other programs available specifically for uninsured infants and children.

Contact your state department of insurance or the non-profit Foundation for Health Coverage Education (coverageforall.org) to learn more If you face an enrollment delay with a government program, consider a short-term plan to temporarily cover the baby; keep in mind, however, that while short-term plans can provide protection in case of serious illness or injury, they often don't cover preventive care and regular checkups

NOTES:

*Based on a survey of over 100,000 family plans purchased through eHealthInsurance.com and with coverage in effect as of February 2011. Read the 2011 Cost and Benefits Report.

Additional Consumer Resources:

About eHealth

eHealth, Inc. (NASDAQ: EHTH - News) is the parent company of eHealthInsurance, the nation's leading online source of health insurance for individuals, families and small businesses. Through the company's website, www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation's leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through the company's eHealthTechnology solution (www.eHealthTechnology.com), eHealth is also a leading provider of health insurance exchange technology. eHealthTechnology's exchange platform provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides powerful online and pharmacy-based tools to help seniors navigate Medicare health insurance options, choose the right plan and enroll in select plans online through its wholly-owned subsidiary, PlanPrescriber.com (www.planprescriber.com) and through its Medicare website www.eHealthMedicare.com.

For more health insurance news and information, visit the eHealthInsurance consumer blog: Get Smart - Get Covered.

View the original article here

Health Insurance for Babies -- eHealthInsurance Describes Coverage Options for New Parents

MOUNTAIN VIEW, CA--(Marketwire -03/15/12)- Today eHealthInsurance (NASDAQ: EHTH - News), the leading online source of health insurance for individuals, families and small businesses, described different health insurance options that new or expecting parents should consider for coverage of newborns.

Many new and expecting parents today express uncertainty or confusion about the health insurance options available for their new babies. This is especially true of the large number of new parents without employer-sponsored health insurance.

The 2010 Affordable Care Act (ACA) allows adult children to stay on a parent's health insurance policy until age 26 but grandchildren are not eligible for coverage under the same policy. The ACA also prevents insurers from declining coverage for children under age 19 based solely on the presence of pre-existing medical conditions. However, child-only individual health insurance policies are not readily available in many states.

The coverage scenarios and tips described below are provided to help consumers better understand coverage options for newborns. eHealthInsurance recommends that consumers contact their employers or work with a licensed health insurance agent like eHealthInsurance to better understand their personal choices.

Health Insurance Options for Newborn Children

Enrolling a newborn under a parent's employer-sponsored plan. If you or your child's other parent are currently covered under an employer-sponsored health insurance plan, this is often your baby's best coverage option. Employer-based plans tend to provide robust benefits that may include preventive checkups, well-baby visits and immunizations -- often at no or little out-of-pocket cost. A few considerations:

The child may be covered under either parent's employer plan (or both), even if the parents aren't married Adding a dependent may substantially increase the amount the employee is required to contribute from his or her paycheck towards the monthly premium You don't need to wait for the employer's open enrollment period to add a newborn to your plan but must typically enroll the baby within a specific time-frame, typically thirty days after birth If you miss the enrollment window, you may want to consider a short-term plan to temporarily cover the baby; keep in mind, however, that while short-term plans can provide protection in case of serious illness or injury, they often don't cover preventive care or regular checkups Contact your Human Resources department or benefits administrator before your child is born to make sure that you understand how the enrollment process works and how much additional money will be withheld from your paycheck for dependent coverage

Enrolling a newborn under a parent's individually-purchased plan. Individually-purchased health insurance plans may provide coverage for individuals or for families. The 2010 Affordable Care Act strengthened these plans by doing away with lifetime coverage limits for basic covered services and making certain preventive care services available at no out-of-pocket cost. According to eHealth, Inc's 2011 Cost and Benefits Report, the average monthly premium paid for a family of two or more in 2011 was $414 per month* Nearly nine in ten (88.8%) of the plans surveyed in the report included well-baby coverage.

If you already have an individually-purchased policy, contact your licensed agent or insurer to learn how to add a dependent and how much your monthly premiums may increase as a result Be sure to add your newborn as a dependent within the "qualifying event" period, typically thirty days following birth When applying or re-applying for individual or family coverage it is possible for adults age 19 and over to be declined coverage due to pre-existing medical conditions; such a decline may result in the decline of the application as a whole, including for the coverage of dependents

Enrolling a newborn in a child-only individual plan. "Child-only" plans are individual health insurance policies made available to children age 18 and under with no parent or guardian listed on the same policy. The 2010 health reform law prevents insurers from declining applications for children based solely on pre-existing medical conditions. However, child-only policies are not available in many states, and states where child-only policies are available may limit enrollment to designated open enrollment periods or only with the occurrence of a "qualifying event."

Find out if child-only plans are available in your state by contacting your state department of insurance or a licensed agent Review eHealthInsurance's recently published chart describing the availability of child-only plans across the country Birth may be considered a qualifying event and enrollment may be allowed within a specific period of time after birth in states where child-only health insurance plans are available In states where child-only plans are not available you may still be able to apply for an individually-purchased family plan with yourself as the policyholder and your child as a dependent, but remember that the application may be declined due to your own pre-existing medical conditions

Enrolling a newborn in a state-sponsored health insurance program. If no other options are open to you and you can't afford coverage on your own, you may qualify for government assistance. Depending on your income, you and/or the baby may qualify for Medicaid. In some states there may be other programs available specifically for uninsured infants and children.

Contact your state department of insurance or the non-profit Foundation for Health Coverage Education (coverageforall.org) to learn more If you face an enrollment delay with a government program, consider a short-term plan to temporarily cover the baby; keep in mind, however, that while short-term plans can provide protection in case of serious illness or injury, they often don't cover preventive care and regular checkups

NOTES:

*Based on a survey of over 100,000 family plans purchased through eHealthInsurance.com and with coverage in effect as of February 2011. Read the 2011 Cost and Benefits Report.

Additional Consumer Resources:

About eHealth

eHealth, Inc. (NASDAQ: EHTH - News) is the parent company of eHealthInsurance, the nation's leading online source of health insurance for individuals, families and small businesses. Through the company's website, www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation's leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through the company's eHealthTechnology solution (www.eHealthTechnology.com), eHealth is also a leading provider of health insurance exchange technology. eHealthTechnology's exchange platform provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides powerful online and pharmacy-based tools to help seniors navigate Medicare health insurance options, choose the right plan and enroll in select plans online through its wholly-owned subsidiary, PlanPrescriber.com (www.planprescriber.com) and through its Medicare website www.eHealthMedicare.com.

For more health insurance news and information, visit the eHealthInsurance consumer blog: Get Smart - Get Covered.

View the original article here

Could employers dumping health insurance coverage decrease the deficit?

???initialComments:true! pubdate:03/15/2012 16:47 EDT! commentPeriod:14! commentEndDate:3/29/12 4:47 EDT! currentDate:3/15/12 8:0 EDT! allowComments:true! displayComments:true!Posted by Sarah Kliff at 04:47 PM ET, 03/15/2012 TheWashingtonPost

In the debate over health reform, there’s a lot of crystal ball-gazing over whether employees will continue to offer health insurance, or send their employees to the new health insurance marketplaces where many could purchase subsidized coverage. One concern is that if lots of employers do this, the health reform law’s price tag would skyrocket as more Americans have the federal government footing part of their insurance bill.

Avik Roy notices something interesting in a new CBO report out today, which comes to a different conclusion: Employer-dumping into the exchange could actually reduce the deficit, rather than increase it. That scenario would only play out, however, if employers compensated for dropped coverage by upping their employees’ salaries.

You can see this in this chart, under the Scenario 3, where the CBO modeled a high level of employer dumping:

If employers drop14 million, currently-insured workers into the exchange, the CBO projects that the federal deficit would actually decrease by $13 billion, since those workers could no longer use the current tax deduction for employer-sponsored insurance. Here’s how the CBO explains it:

In this scenario, those extra costs would be almost entirely offset by higher tax revenues stemming from an increase in taxable wages and salaries that would occur as firms reduced their nontaxed payments for employment-based health insurance. That increase in revenues would amount to $351 billion. In addition, revenues from penalties collected from uninsured individuals and especially employers who do not provide minimum health benefits would be higher in this scenario than in the baseline.

The government would have to spend $372 billion for workers who received their coverage through the exchanges, Medicaid and CHIP. But it would also net more in revenue, from newly-taxable income from fees imposed on employers who drop coverage (generally $2,000 per employee). Do the math, and the federal government ends up with $13 billion in deficit reduction.

There is, however, one big caveat to this analysis: It assumes that when employers drop coverage, the money previously spent on insurance will get tacked onto a worker’s paycheck. “So, for example, if your boss is paying you $50,000 a year, and spending $20,000 a year on your health insurance, under the ACA, he’ll drop your health coverage and give you $70,000 in wages,” writes Roy.

If employers cut coverage without a corresponding pay bump, the government wouldn’t see the increase in tax revenue—and that could leave the government in the red.

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Blog Contributors

Ezra Klein is the editor of Wonkblog and a columnist at the Washington Post, as well as a contributor to MSNBC and Bloomberg. His work focuses on domestic and economic policymaking, as well as the political system that’s constantly screwing it up. He really likes graphs, and is on Twitter, Google+ and Facebook. E-mail him here.

Suzy Khimm covers the budget, economic policy, and financial regulatory reform. Before coming to Washington, she was based in Brazil and Southeast Asia, where she wrote for the Economist, Slate, and the Wall Street Journal Asia. Follow her on Twitter here, and email her here.

Sarah Kliff covers health policy, focusing on Medicare, Medicaid and the health reform law. She tries to fit in some reproductive health and education policy coverage, too, alongside an occasional hockey reference. Her work has appeared in Newsweek, Politico, and the BBC. She is on Twitter and Facebook.

Brad Plumer is a reporter focusing on energy and environmental issues. He was previously an associate editor at The New Republic. Follow him on Twitter. Email him here.

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Christine Harper 

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Ezra Klein 

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Steven Mufson 

David S. Hilzenrath 

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Sarah Kliff 

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View the original article here

Health reform coverage cost falls slightly

The Congressional Budget Office now estimates that the health reform law will reduce the number of uninsured by 30 million by 2016.

NEW YORK (CNNMoney) -- The cost and promised savings of health reform tied lawmakers in knots two years ago. The issues are no less complicated or uncertain today.

On Tuesday, the Congressional Budget Office released new estimates on the cost of subsidizing insurance coverage for millions of Americans.

The bottom line: The government's overall tab is expected to fall slightly over a decade. It is now projected to spend $1.083 trillion between 2012 and 2021. Last year, CBO's estimate was $1.131 trillion.

A key goal of the Affordable Care Act, passed in 2010, is to guarantee coverage for everyone regardless of health status and create affordable insurance options for low- and middle-income Americans.

To achieve that end, the law expands eligibility rules for Medicaid and subsidizes the cost of health insurance for low- and middle-income families buying policies on newly created insurance exchanges, which will open in 2014.

The CBO now expects more people to be eligible for Medicaid and the Children's Health Insurance Program, increasing the government's costs by $168 billion compared to last year's estimates. The reason: higher unemployment projections and lower income expectations.

At the same time, that increased outlay is offset by a reduction in projected costs for various tax credits and the government's share of premiums.

It is also offset by higher-than-expected taxable compensation and penalties, both of which will add to government revenue.

Specifically, the CBO expects up to 5 million more workers will lose their employer-based insurance, and in exchange their employers will pay them more instead. That additional pay will be taxable, whereas an employer contribution to pay for a worker's health insurance is treated as tax-free compensation.

Plus, the CBO expects more penalties to be paid by employers that don't provide adequate financial support for their workers' health coverage.

Despite this increased estimate of people who will no longer have work-based coverage, the CBO still expects the number of workers with employer-sponsored plans to grow, just more slowly than it might have without the health reform law.

Today, an estimated 154 million workers get their health insurance at the office. By 2022, the CBO projects 161 million will.

Overall, the agency expects the health reform law to reduce the total number of uninsured by 30 million in 2016. As a result, it projects that 93% of non-elderly, legal U.S. residents will have health coverage, up from 82% today.

The CBO -- the official budget scorekeeper on Capitol Hill -- has not revised its cost estimate for the full health reform law, which includes many provisions beyond coverage subsidies. Last year, it determined that the Affordable Care Act as a whole would reduce deficits by $210 billion between 2012 and 2021.

The CBO's estimates come just two weeks before the Supreme Court will hear arguments in a landmark case brought by 26 states and the National Federation of Independent Business, which contend certain provisions in the law are unconstitutional. 

View the original article here

Health reform coverage cost falls slightly

The Congressional Budget Office now estimates that the health reform law will reduce the number of uninsured by 30 million by 2016.

NEW YORK (CNNMoney) -- The cost and promised savings of health reform tied lawmakers in knots two years ago. The issues are no less complicated or uncertain today.

On Tuesday, the Congressional Budget Office released new estimates on the cost of subsidizing insurance coverage for millions of Americans.

The bottom line: The government's overall tab is expected to fall slightly over a decade. It is now projected to spend $1.083 trillion between 2012 and 2021. Last year, CBO's estimate was $1.131 trillion.

A key goal of the Affordable Care Act, passed in 2010, is to guarantee coverage for everyone regardless of health status and create affordable insurance options for low- and middle-income Americans.

To achieve that end, the law expands eligibility rules for Medicaid and subsidizes the cost of health insurance for low- and middle-income families buying policies on newly created insurance exchanges, which will open in 2014.

The CBO now expects more people to be eligible for Medicaid and the Children's Health Insurance Program, increasing the government's costs by $168 billion compared to last year's estimates. The reason: higher unemployment projections and lower income expectations.

At the same time, that increased outlay is offset by a reduction in projected costs for various tax credits and the government's share of premiums.

It is also offset by higher-than-expected taxable compensation and penalties, both of which will add to government revenue.

Specifically, the CBO expects up to 5 million more workers will lose their employer-based insurance, and in exchange their employers will pay them more instead. That additional pay will be taxable, whereas an employer contribution to pay for a worker's health insurance is treated as tax-free compensation.

Plus, the CBO expects more penalties to be paid by employers that don't provide adequate financial support for their workers' health coverage.

Despite this increased estimate of people who will no longer have work-based coverage, the CBO still expects the number of workers with employer-sponsored plans to grow, just more slowly than it might have without the health reform law.

Today, an estimated 154 million workers get their health insurance at the office. By 2022, the CBO projects 161 million will.

Overall, the agency expects the health reform law to reduce the total number of uninsured by 30 million in 2016. As a result, it projects that 93% of non-elderly, legal U.S. residents will have health coverage, up from 82% today.

The CBO -- the official budget scorekeeper on Capitol Hill -- has not revised its cost estimate for the full health reform law, which includes many provisions beyond coverage subsidies. Last year, it determined that the Affordable Care Act as a whole would reduce deficits by $210 billion between 2012 and 2021.

The CBO's estimates come just two weeks before the Supreme Court will hear arguments in a landmark case brought by 26 states and the National Federation of Independent Business, which contend certain provisions in the law are unconstitutional. 

View the original article here

Health reform coverage cost falls slightly

The Congressional Budget Office now estimates that the health reform law will reduce the number of uninsured by 30 million by 2016.

NEW YORK (CNNMoney) -- The cost and promised savings of health reform tied lawmakers in knots two years ago. The issues are no less complicated or uncertain today.

On Tuesday, the Congressional Budget Office released new estimates on the cost of subsidizing insurance coverage for millions of Americans.

The bottom line: The government's overall tab is expected to fall slightly over a decade. It is now projected to spend $1.083 trillion between 2012 and 2021. Last year, CBO's estimate was $1.131 trillion.

A key goal of the Affordable Care Act, passed in 2010, is to guarantee coverage for everyone regardless of health status and create affordable insurance options for low- and middle-income Americans.

To achieve that end, the law expands eligibility rules for Medicaid and subsidizes the cost of health insurance for low- and middle-income families buying policies on newly created insurance exchanges, which will open in 2014.

The CBO now expects more people to be eligible for Medicaid and the Children's Health Insurance Program, increasing the government's costs by $168 billion compared to last year's estimates. The reason: higher unemployment projections and lower income expectations.

At the same time, that increased outlay is offset by a reduction in projected costs for various tax credits and the government's share of premiums.

It is also offset by higher-than-expected taxable compensation and penalties, both of which will add to government revenue.

Specifically, the CBO expects up to 5 million more workers will lose their employer-based insurance, and in exchange their employers will pay them more instead. That additional pay will be taxable, whereas an employer contribution to pay for a worker's health insurance is treated as tax-free compensation.

Plus, the CBO expects more penalties to be paid by employers that don't provide adequate financial support for their workers' health coverage.

Despite this increased estimate of people who will no longer have work-based coverage, the CBO still expects the number of workers with employer-sponsored plans to grow, just more slowly than it might have without the health reform law.

Today, an estimated 154 million workers get their health insurance at the office. By 2022, the CBO projects 161 million will.

Overall, the agency expects the health reform law to reduce the total number of uninsured by 30 million in 2016. As a result, it projects that 93% of non-elderly, legal U.S. residents will have health coverage, up from 82% today.

The CBO -- the official budget scorekeeper on Capitol Hill -- has not revised its cost estimate for the full health reform law, which includes many provisions beyond coverage subsidies. Last year, it determined that the Affordable Care Act as a whole would reduce deficits by $210 billion between 2012 and 2021.

The CBO's estimates come just two weeks before the Supreme Court will hear arguments in a landmark case brought by 26 states and the National Federation of Independent Business, which contend certain provisions in the law are unconstitutional. 

View the original article here

Health reform coverage cost falls slightly

The Congressional Budget Office now estimates that the health reform law will reduce the number of uninsured by 30 million by 2016.

NEW YORK (CNNMoney) -- The cost and promised savings of health reform tied lawmakers in knots two years ago. The issues are no less complicated or uncertain today.

On Tuesday, the Congressional Budget Office released new estimates on the cost of subsidizing insurance coverage for millions of Americans.

The bottom line: The government's overall tab is expected to fall slightly over a decade. It is now projected to spend $1.083 trillion between 2012 and 2021. Last year, CBO's estimate was $1.131 trillion.

A key goal of the Affordable Care Act, passed in 2010, is to guarantee coverage for everyone regardless of health status and create affordable insurance options for low- and middle-income Americans.

To achieve that end, the law expands eligibility rules for Medicaid and subsidizes the cost of health insurance for low- and middle-income families buying policies on newly created insurance exchanges, which will open in 2014.

The CBO now expects more people to be eligible for Medicaid and the Children's Health Insurance Program, increasing the government's costs by $168 billion compared to last year's estimates. The reason: higher unemployment projections and lower income expectations.

At the same time, that increased outlay is offset by a reduction in projected costs for various tax credits and the government's share of premiums.

It is also offset by higher-than-expected taxable compensation and penalties, both of which will add to government revenue.

Specifically, the CBO expects up to 5 million more workers will lose their employer-based insurance, and in exchange their employers will pay them more instead. That additional pay will be taxable, whereas an employer contribution to pay for a worker's health insurance is treated as tax-free compensation.

Plus, the CBO expects more penalties to be paid by employers that don't provide adequate financial support for their workers' health coverage.

Despite this increased estimate of people who will no longer have work-based coverage, the CBO still expects the number of workers with employer-sponsored plans to grow, just more slowly than it might have without the health reform law.

Today, an estimated 154 million workers get their health insurance at the office. By 2022, the CBO projects 161 million will.

Overall, the agency expects the health reform law to reduce the total number of uninsured by 30 million in 2016. As a result, it projects that 93% of non-elderly, legal U.S. residents will have health coverage, up from 82% today.

The CBO -- the official budget scorekeeper on Capitol Hill -- has not revised its cost estimate for the full health reform law, which includes many provisions beyond coverage subsidies. Last year, it determined that the Affordable Care Act as a whole would reduce deficits by $210 billion between 2012 and 2021.

The CBO's estimates come just two weeks before the Supreme Court will hear arguments in a landmark case brought by 26 states and the National Federation of Independent Business, which contend certain provisions in the law are unconstitutional. 

View the original article here

Family Health Insurance Expert Frank Saltzburg Exposes Secrets of Obtaining Best Health Coverage at Most Affordable ...

PHOENIX, March 13, 2012 /PRNewswire/ -- Health insurance costs are creating struggles for many individuals, families, and small business owners today. Within many companies, from small to large, the cost of supplying employees health insurance coverage has become so expensive they are now passing on a significant portion of the expense to employees.

People always ask, "How much does health insurance cost?" and "How can I save money on health insurance?" he said.

"There are several strategies that will allow millions of families to acquire excellent, affordable comprehensive health coverage. Unfortunately, unless the soon-to-be insured does their homework with a state-licensed insurance professional, they will be unaware of these simple solutions for themselves, their families, or small businesses," said Saltzburg, whose company, Healthcare Solutions Team, LLC (arizonahealthcarereformexpert.com), custom-designs affordable health care plans in 44 states based on medical history, medical provider access, and budget.

The four secrets of obtaining the best affordable health coverage are:

Always use a professional, state-licensed broker or agent. They are trained and educated to be aware of the best plans in the current market. It does NOT cost you any more to use a broker as major medical rates are already approved by your State Insurance Commissioner.Don't use an online quote engine as your final answer - it is only a starting point.Be aware of telemarketing call center representatives who do not have a state-issued health insurance license.Utilize the "bundle" concept to give you better coverage at an affordable price with less out-of-pocket financial exposure.

"To further add to the confusion and frustration for families and businesses looking for affordable health care, there has been a huge influx of online insurance quote engines. The problem here is these quote engines assume you are in perfect physical and mental health. You'll be in for quite a shock. The price you were quoted online is not your final cost as your policy has been 'rated up' which could result in prices that are 20% - 200% higher," he stated.

"One other major challenge to getting the best medical insurance coverage is the increase in 'telemarketing call centers' that, in most cases, are not state-licensed to represent valid Major Medical coverage. They typically offer "guaranteed issue" or "group membership" plans, which are severely limited to defined maximum coverages, usually at 31 days per calendar year in the hospital. If the policy does not state 'unlimited' coverage, you are not getting the proper coverage. This type of coverage is geared toward people who were previously denied health insurance, or may have a pre-existing condition that currently is considered uninsurable. If the cost of this plan appears to be very low, there is a reason. You are not getting a true Major Medical plan," Saltzburg said.

Millions of families and business searching for affordable health care coverage are very concerned about their deductible. Gone are the days when the deductible may have been $500 - $1,500, even under a large company group plan. The average deductible today is estimated at $5,000.

"We design our plans strategically so that the deductible is no longer a major issue. According to industry analysts, about 8 out of 10 hospitalizations (80%) occur due to accidents. Up to 18% of hospitalizations happen due to critical illnesses such as heart attacks, cancer, stroke, kidney failure, severe burns, loss of limbs, blindness, deafness, coma, and advanced Alzheimer's disease," he stated.

"We 'bundle' our plans to include accidental coverage to pay up to the deductible amount. Plus, we offer critical illness coverage to also offset the deductible. The critical illness coverage offers the ability to have a lump sum payout to allow the insured to have an extra $5,000 up to $100,000 living expense money. So while they are recuperating from their critical illness, they won't worry about paying daily living bills. Bundling allows the insured to have a higher deductible, a lower premium, and an even more comprehensive plan," he said.

About Frank Saltzburg

With more than 20 years of financial services, health, health care reform, sales, and management experience, Frank helps clients obtain the health care coverage that best solves their needs. His expertise includes custom-designing affordable health care plans for individuals, families, and small business owners. He is part of Healthcare Solutions Team, LLC and is licensed in AZ, PA, FL, TX, MO, NV, and MN. He is a speaker on the current Health Care Reform Act as it relates to individuals, families, and small business owners.

For information, please go to http://www.arizonahealthcarereformexpert.com.

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Health reform law provides coverage for nearly 50,000 Americans with pre-existing conditions

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Six Mistakes to Avoid When Choosing Health-Care Coverage

Photo courtesy of Amy Forrest.

What could pediatrician appointments possibly have to do with Joe Merrick's business as an online precious metals dealer? When it comes to health insurance, the answer is everything. The 13 full-time employees of Merrick's Dallas-based Provident Metals have 30 children, all under the age of 15, with four babies born in 2011 alone. That means potentially high medical bills for everything from childbirth to vaccinations, which Merrick had to factor into his health-insurance decisions.

Like many small-business owners, Merrick, 34, had no experience with group coverage. "We had no idea how to even start looking for health insurance," says Merrick. But with some outside help he gradually learned how to navigate the health insurance system – and you can, too.

Here are six common mistakes to avoid when choosing your company's health-care coverage:

1. Don't go it alone. Whether it's insurance brokers or your state insurance department, reach out to experts for help. When Merrick began looking into his options, he didn't realize he could use a broker until he stumbled on an ad for eHealthInsurance.com, an online health-insurance brokerage. The broker presented 20 options and helped narrow his selection based on the demographics and needs of his employees. "It's a lot less daunting with someone in your corner," Merrick says.

Your state insurance department is also a good resource, providing details about such possible small-business benefits as health-insurance tax credits and joint purchasing arrangements with other companies that can reduce costs.

Related: Small Business Health Care Stuck on Hold

2. Don't assume one size fits all. When Merrick was settling on an insurance plan, he quickly realized a generic package wouldn't work for his employees who range in age from their early 20s to late 50s. To accommodate such a broad age span, Anthony Lopez, a small-business specialist at Mountain View, Calif.-based eHealthInsurance Services Inc., recommends providing employees with two or three plan options.

After consulting with his broker, Merrick decided to offer a health savings account that sets aside a percentage of tax-free employee wages toward healthcare and two group plans, including a less comprehensive one with a higher deductible and lower premium costs. "We have some single guys here and their premium is much lower," Merrick says. His company pays 80 percent of premium costs up to $650 a month.

Related: Four Ways to Cut Small Employer Health-Care Costs

3. Don't overlook employee opinions. Remember to include employees in discussions about insurance coverage both to understand their needs and to encourage them to take responsibility for their health-care spending, says Devon Herrick, health economist at the National Center for Policy Analysis, a Dallas-based public policy research organization.

"Educate them that this is not just free money. It's part of [their] pay." It also helps to talk with workers about adopting healthier habits and making smart choices, such as using generic rather than brand name drugs.

4. Don't scrimp on benefits. It's tempting to save money by forgoing benefits like dental and vision, but such extra coverage can be valuable in competing for talent. While dental care and chiropractic services aren't part of his company's health plan, Merrick reimburses each employee $200 a year per family member for dental care and covers the cost of a first-time chiropractic appointment and half the cost of subsequent visits.

"We need to have things those big companies have," says Merrick, who also offers gym membership reimbursement. "We are competing against them as much as we are with smaller companies."

5. Don't limit yourself to traditional plans. Sometimes a standard group insurance plan isn't the right--or only--choice. When Merrick realized a group dental plan would be far too costly, he asked local dentists if they would offer discounts to employees who pay with cash or checks. Merrick succeeded in negotiating discounts of as much as 40 percent for basic services like cleanings and X-rays at two dental offices, and he worked out a similar deal with a local chiropractor.

In some cases, offering a group plan isn't even an option. Mary Harrell-Paul, 51, founder of Crown Chauffeured Transportation, a Des Plaines, Ill.-based car service, wanted to provide health insurance, but not enough employees were interested to meet the minimum participation rate required for a group plan. Paul took an alternative approach, allowing the two employees in her 12-person company who want coverage to purchase their own insurance and reimbursing 90 percent of the cost.

Related: How 'Working Spouse' Rules Can Save a Company Money and Headaches

6. Don't neglect to reevaluate the coverage. With medical costs continuing to rise and the fate of the health-care reform law still uncertain, policies and plans will be changing rapidly. It's critical to stay on top of the latest developments, says Sandy Praeger, chairwoman of the Health Insurance and Managed Care Committee of the National Association of Insurance Commissioners. She also advises companies to track changes in the composition of their workforce that might warrant adjustments to insurance plans.

At least twice a year, Merrick asks his insurance broker to reevaluate his coverage and costs. As a result, he has changed insurance companies twice in four years to save money. "If you are not rerating yourself at least twice a year," he says, "you are really doing a disservice to your company."

This article originally posted on Entrepreneur.com

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