Health
care
legislation
is an
important
concern
in the
California
health
insurance
market.
It
affects
both the
cost of
health
insurance
and
coverage
options
significantly.
A recent
study
shows
that 20%
of the
recent
increases
in
health
insurance
premium
is a
result
of
legislation
(primarily
State).
California
is
probably
the most
regulated
State in
the U.S.
when it
comes to
health
care and
health
insurance.
Let's
look at
the some
of the
major
bills
passed,
upcoming
bills,
and
future
trends.
AB 8 (Núñez): "Health Care Coverage"
As of 6/28/07: Assembly Speaker Fabian Núñez’s (D-Los Angeles) health reform proposal (AB 8) aims to significantly expand affordable health coverage for Californians. The legislation now contains significant provisions from SB 48 (Perata). The bill establishes a "pay or play" system and requires employees of firms that “pay” to enroll in the newly created California Cooperative Health Insurance Purchasing Program (Cal-CHIPP) to receive coverage. The proposal expands eligibility for public health insurance programs for children and parents. The proposal also aims to improve access to coverage on the individual insurance market by standardizing medical underwriting, clarifying eligibility for the high-risk pool, and facilitating comparison shopping.The proposal would be financed through employer and employee contributions and new federal matching dollars associated with public program expansion. The proposal includes specific elements to help control health care costs.
Our take on this bill?? This is the big one that currently makes headlines. It partially follows in the footsteps of Massachusetts. There are pro's and con's to every system. Ultimately, the only thing that will reduce costs is if people collectively take better care of themselves (HSA's
address
this
with an
individual
financial
incentive...typically
the only
thing
that
works)
or if
care is
rationed.
For
example,
in
Canada,
if you
want an
MRI, you
go on a
waiting
list
which
typically
runs 6
months.
There
are more
MRI's in
Minneapolis-St
Paul
than all
of
Canada.
The
question
with our
current
system
is
whether
we can
(or are
willing
to)
afford
this
access
to care.
The
interesting
thing is
that
people
who are
strongly
in favor
of
Single
Payer
typically
despise
HMO's.
What
they
don't
realize
is that
they are
one in
the
same.
The
reason
Single
Payer
plans
ration
care is
because
they are
fixed
dollar.
You have
an
allotted
budget
for
health
care for
the
year.
You
divvy up
that
budget
($25,000
million
for
MRI's,
$1
billion
for
hospital,
etc).
Let's
say in
our
example,
the $25m
of MRI's
affords
10
million
MRI's.
That's
the
number...no
more.
They
ration
care
based on
that.
HMO's
are also
fixed
dollar
plans.
Each
doctor
is given
a
certain
amount
per
enrollee
and
he/she
(or the
medical
group)
works
within
that
budget.
Our
system
increases
the
premium
based on
the
claims
but
there is
no
rationing
of care
(although
some
management
on
behalf
of
carriers).
If a
person
medically
needs 6 MRI's in
a year
(say to
watch
the
advance
or
status
of
cancer),
then
that's
what
they
get.
Ultimately,
there's
no free
ride in
the
universe.
You
either
must
reduce
medical
costs or
ration
care in
any
system.
France
has
double
the tax
and
unemployed
we have.
Something
has to
give in
either
system
and most
likely,
the best
approach
is in
the
middle. If California were to pass a law that is guaranteed issue (can qualify regardless of health) and mandates coverage, premium costs will likely go up 50% or more. This has been the history in any State that attempted such a thing. The other issue that is specific to California is that they're are many un-insured (millions) who are not in the system. How do you mandate coverage for these individuals if they do not fall in the tax for DMV system? The issue of people using hospitals as last resort will not be fixed. There will likely be a piecemeal progression towards part private market and more government based programs. |
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Mental
Health
Parity
Mental
health
parity
essentially
states
that
mental
health
benefits
should
match
medical
bills.
California
is one
of the
first
States
to pass
such a
bill and
the US
will
likely
follow
suit on
a
Federal
Level.
This
bill has
greatly
expanded
coverage
for
important
conditions
and has
also
significantly
increased
insurance
premiums.
The
brand-name
medication
coverage
for
depression,
anxiety,
and
other
qualified
conditions
alone is
a
significant
factor
due to
the high
cost and
prevalence
of these
drugs.
Let's
take a
quick
look at
the
rough
sketches
of this
bill:
Health & Safety Code 1374.72; Insurance Code
10144.5. Effective for contracts issued,
amended, or renewed on or after 7/1/00. Does
not apply to Medi-Cal HMOs.
Health plans
must provide coverage for the diagnosis and
medically necessary treatment of severe
mental illness in any person or serious
emotional disturbance of a child. The health
plan may provide the required services
through a separate or specialized health
care service plan.
The benefits
must include:
-
outpatient services;
-
inpatient hospital
services;
-
partial hospital
services;
-
prescription drugs, if the plan covers
prescription drugs.
Benefits that
must be applied equally to all benefits
under the health plan contract include:
Severe mental
illness includes:
-
schizophrenia;
-
schizoaffective
disorder;
-
bipolar disorder
(manic-depressive illness);
-
major depressive
disorders;
-
panic disorders;
-
obsessive-compulsive
disorder;
-
pervasive
developmental disorder or autism;
-
anorexia nervosa;
-
bulimia
nervosa.
Serious emotional disturbance
of a child is defined as a child who:
(1) has
one or more mental disorders identified
in the DSM, other than a primary
substance abuse disorder or
developmental disorder, that results in
behavior inappropriate to the child's
age according to expected developmental
norms, AND
(2) meets
the criteria specified in Welfare &
Institutions code 5600.3 (a)(2) -- as a
result of the mental disorder, ONE of
the following occurs:
(A) The child
has substantial impairment in at
least two of the following areas:
self-care, school functioning,
family relationships, or ability to
function in the community; AND
either of the following occur:
(i) the
child is at risk of removal from
home or has already been removed
from the home, or
(ii) the mental disorder and
impairments have been present
for more than six months or are
likely to continue for more than
one year without treatment, OR
(B) The
child displays one of the following:
psychotic features, risk of suicide or
risk of violence due to a mental
disorder, OR
(C) The child meets
special education eligibility
requirements (is an "individual with
exceptional needs" identified by an
individualized education program team as
a child with a disability, and the
child's impairment requires instruction,
services, or both, which cannot be
provided with modification of the
regular school program).
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CAL-GLBA
Privacy
California
expanded the
privacy
requirements
at the
Federal
level
enacted
effective
March 24,
2003.
This bill
has created
another
level of
documentation
and
procedure
above and
beyond the
new Federal
guidelines.
Calhealth.net
and
Goodacre
Insurance
Services
fully comply
with Cal-GLBA
and you can
find more
information
on our
Privacy
statement. |
SCHIPS
Plan
|
The
State
Children's
Health
Insurance
Program
(SCHIP)
began
in
1997.
Also
know
as
Title
XXI,
SCHIP
was
part
of
the
federal
Balanced
Budget
Act
of
1997.
SCHIP
provides
a
capped
amount
of
funds
to
states
on a
matching
basis
for
federal
fiscal
years
(FY)
1008
through
2007
to
provide
coverage
to
low-income
uninsured
children.
SCHIP
represents
the
most
comprehensive
federal
effort
to
ensure
health
insurance
coverage
of
children
since
the
creation
of
Medicaid.
Since
the
states
have
several
options
as
to
how
they
can
develop
programs
to
provide
coverage
to
the
children
in
their
states,
different
parts
of
the
country
have
been
more
successful
than
others
in
reaching
out
to
low-income
kids.
SCHIP
will
expire
on
September
30,
2007
unless
it
is
reauthorized
by
Congress.
The
program
enjoys
wide
bipartisan
support
but
there
are
differences
of
opinion
regarding
the
reauthorization.
Some
members
of
Congress
would
like
to
expand
the
program.
Among
the
policy
changes
under
consideration
include
formally
allowing
adults
into
the
program,
changing
the
program
from
a
block
grant
to
an
entitlement
and
raising
the
eligibility
criteria.
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HSA
or
Health
Savings
Accounts
Health
Savings
Accounts
are
tax-advantaged
personal
savings
accounts
used
in
conjunction
with
a
qualified
high-deductible
health
plan
(HDHPs)
to
help
pay
for
unreimbursed
medical
expenses.
Contributions
to
HSAs
may
be
received
from
employers,
individuals
or
any
combination
of
both.
Employer
contributions
are
excludable
from
income
and
individual
contributions
are
deductible,
regardless
of
whether
or
not
a
taxpayer
itemizes
deductions.
Annual
contributions
are
limited
to a
statuary
level
and
out-of-pocket
maximums
are
limited,
but
individuals
age
55
and
over
with
accounts
can
make
additional
contributions.
HSAs
are
portable
and
funds
carry
over
to
subsequent
years.
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