A Sign of Things to Come for States’ Lawsuit Against Health Care Reform?

As you may have heard, there are 20 states filing a lawsuit against the federal government to get the health care reform bill overturned.  A judge will hear arguments in September on the motion to dismiss and set a tentative schedule that would move the case into the late fall. 

However, there was a recent ruling out in California regarding San Francisco’s universal health care law.  If you’re not aware, the San Francisco Board of Supervisors passed a law in 2006 that went into effect Jan. 1 2008 requiring businesses with 20 or more employees to either provide a certain amount of health care for their workers or pay a set amount into a city health care pool for every hour that uncovered employees worked.  Businesses that chose not to provide health care had to pay $1.31 (or more) for every hour worked by an uninsured employee. 

Well, the Supreme Court refused to hear a challenge on the suit that the Ninth U.S. Circuit Court of Appeals  had rejected in 2008.  That effectively handed the city a victory and allows the law to stand. This case can probably be used as a predictor for the states’ lawsuit against the health care reform bill.

And what has the impact of the San Francisco law been in the two and a half years it has been in effect?  You be the judge:

  • Emergency room visits at SF General Hospital down 27%
  • 53,000 of the formerly uninsured 60,000 adults in the city are now covered by Healthy San Francisco (the city run plan)
  • Employer penalties have risen from $1.17/hr in 2008 to $1.31/hr in 2010.
  • Most restaurants have been forced to raise menu prices or add a 3-4% service fee to each bill

5% of Patients Account for 49% of Health Care Spending

THAT is an amazing fact.  For more mind-blowing numbers about health care and health care reform, please check out this Deloitte produced video. 

The Country with the BEST Health Care in the World!

Best health care system in the worldThe Commonwealth Fund surveyed doctors and patients in 7 Western countries.  The overall winner??   The Netherlands.  Three Cheers for the Red, White and Blue!!!

Wait…I thought the US had the best health care system in the world?   Well, not according to this survey.  In fact, we came in 7th.  That’s out of 7.  The only category we didn’t come in dead last was “Quality of Care”.  We finished 6th there.

What’s really interesting to me is that the Netherlands does NOT have a government run health system.  More surprisingly, they achieve universal coverage with an insurance mandate much like the one the US recently passed.  AND the Netherlands does it for HALF the cost of the US.  We spend $7,290 per person while the Netherlands spends $3,837.

Perhaps when it comes to health care, Americans should think about going Dutch.

Health Care Reform Enters Day 90

Ninety Day AnniversaryToday marked the “90 day anniversary” for the health care reform law known as the Patient Protection and Affordable Care Act.  The administration and the department of Health and Human Services marked the celebration(?) by issuing a Patients’ Bill of Rights.  For the most part, this is just a restatement of some of the provisions of the law that are taking place this year.  There was one paragraph that did catch my eye.
  • Getting the Most from Your Premium Dollars. Beginning in January, the Affordable Care Act requires individual and small group insurers to spend at least 80% and large group insurers to spend at least 85% of your premium dollars on direct medical care and efforts to improve the quality of care you receive – and rebate you the difference if they fall short. This will limit spending on overhead and salaries and bonuses paid to insurance company executives and provide new transparency into how your dollars are spent. Insurers will be required to publicly disclose their rates on a new national consumer website – HealthCare.gov.
  • The piece I found interesting was that the insurers will have to disclose their loss ratio numbers on a national website for the whole world to see.  Now, as of this writing, HealthCare.gov is not currently up and running.   I will be keeping an eye on it and let you know when its up and what type of information will be found there.

    No Health Insurance? Don’t Shoot Yourself!

    Here is a story about a woman in Michigan with arm pain, who is unemployed and without insurance, who decided to shoot herself to get the care she needed.

    A couple of comments.

    First, it sounds as if she went to the emergency room looking for someone to treat her shoulder.  The following information would have been good to share with her (and probably a good idea to share this with your employees): ER personnel are there for life threatening emergencies such as car accidents, heart attacks and the like. DO NOT go to the emergency room if you have pain in your shoulder, a headache or some such. She would have been better off going to a local general practitioner, sharing her predicament with him and asking for a discount or payment plan. 

    Second, if she is very lucky the state will prosecute her and send her to jail. Then, she will get free healthcare in the prison and maybe the prison doctor will be able to help her with the shoulder pain.  <—— (sarcasm)   =)

    Is Your Insurance Company Paying Your Health Claims Correctly?

    insurers processing claims incorrectly 20% of the timeThe AMA came out with a report yesterday that said that one in five medical claims is processed incorrectly.  The AMA claims that over $770 million in doctors’ administrative costs could be saved if the health insurance industry improves claim processing by one percent! Keep in mind, this amount doesn’t include the out of pocket money that patients could save if the claim is processed correctly. 

    The report looked at seven of the largest health insurance companies for timeliness and accuracy of payment.  Here are the accuracy results of the insurers that operate in Illinois:

    • Aetna                             81.23%
    • Cigna                             84.51%
    • HCSC (Blue Cross)    87.83%
    • Humana                        82.92%
    • United Healthcare      85.99%

    This report drives home how important it is for everyone to check their Explanation of Benefits.  Explanation of Benefits (EOBs) are usually sent via mail and can be checked on-line at most insurer’s websites.  They will explain the amount that was charged, the discount that was applied, the amount the insurance company paid and the patient’s responsibility of charges.  Your broker should help you with any claims issues you may have.

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