http://www.nytimes.com/2013/05/11/us/politics/obama-to-makes-new-pitch-on-health-care-law.html?ref=us

Speaking just for Kentuckians, I’m really skeptical that we’re going to see a decrease in premiums.  Just taking into account what the new policies are going to have to cover, that in and of itself will cause an increase in premiums.  For instance, maternity.  All policies (even men) will have maternity coverage. Right now, that costs about $100/mo more than a policy that doesn’t cover it.

The second factor that’s going to cause premiums to rise is the guaranteed issue aspect of the law.  When underwriting is taken away from the insurance companies, healthy individuals are going to be penalized even more than they are today because insurance companies can’t offset the amount on the older and/or sicker population.  So the older individuals more than likely have their premiums staying roughly the same, it’s the younger generation that’s going to see an increase.  The same young people that the President is targeting to enroll in this law.

I will give the President this, the individuals and families that receive a subsidy, may see a decrease in what they pay.  However, I think the insurance will still cost more.

We’re going to just have to wait and see in October when the premiums are made public just how much it will cost.

So, the process is when I see something, I send it to our National Association, and I ask them to put something together, or I work with them, but usually Kathryn at NAHU always gives me something great.

This morning I submitted the below editorial to the Courier-Journal.  I’ve had good luck in the past getting in, so let’s hope we get another one!

Dear Editor,

A recent article reported that hospitals across the country are charging “wildly varying amounts for common major medical care” (“Costs for same medical procedures vary widely at Louisville hospitals,” May 9). Even the director of the Center for Medicare and Medicaid Services, Jonathan Blum, questions the validity of the practice.

The healthcare law’s efforts to improve access to insurance are admirable, but the problem isn’t limited to the cost of health insurance. If we continue to ignore this “cost shifting” in hospitals as well as other pricing issues with pharmaceutical companies, healthcare equipment providers, medical malpractice suites and other causational factors, coverage will remain unaffordable. Addressing the system’s cost drivers is crucial to preventing that unfortunate outcome.

M. Zachary Zinser

Media Relations Co-Chair

Greater Louisville Association of Health Underwriters

http://www.courier-journal.com/article/20130509/PRIME07/305090046

Figures from the 2012 U.S. Census Bureau tells us that 308,000 Kentuckians will now be eligible for this coverage.  The next step is for these newly eligible citizens is to enroll.  The National Association of Health Underwriters (NAHU) have always touted that many uninsured citizens could obtain coverage if they were to sign up for it.  Some citizens don’t even know that they’re eligible for “free” coverage.  Hopefully this will change.

Another point to keep in mind with this expansion is that hopefully Employer Based premiums will be lowered because these premiums have a “tax” included that helps offset the bills for the uninsured.  Hopefully that will be removed.

Let’s also hope that these newly enrolled citizens will start using their insurance.  One problem that uninsured people encounter is that they wait to get their healthcare.  By waiting, they’re more likely to seek service in the Emergency Room, which is the most costly place to seek service.  Now that they have Medicaid, hopefully they will seek preventive care and stay out of the Emergency Room.  Opponents have said this will flood doctor’s offices.  I guess we’ll have to wait and see.

The last point I’d like to cover is what kind of impact will this have on Employers.  Under this Expansion, a single person making up to $15,856 annually, will be eligible for Medicaid.  This is just a tick above the minimum wage level (assuming a 40 hour work week).  Something that I’d like to know is how many Kentuckians with full-time employment (under the new law that’s over 30 hours per week) would qualify for Medicaid.  These newly eligible citizens maybe considered a  ”Qualified Waivers” to an Employer Sponsored Plan.  A Qualified Waiver is someone that has coverage elsewhere under another insurance plan.  An example would be someone today being covered under their spouse’s plan.  The employer doesn’t have to cover that spouse, and the employer isn’t harmed in their participation percentage with their health insurance company because the employee is covered under a spouse’s plan.  I know, it’s confusing.  The point is (and I’m still waiting for insurance companies to verify this, although today this is accurate) that these newly Medicaid eligible recipients will now be considered a qualified waiver in an employer sponsored plan.  How many new Medicaid recipients make this amount of money and work 30+ hours for one employer?

In all seriousness, this is something that we’ve been talking to our clients about since 2003.  This is a huge problem that I’ve believed in for the last ten years.  Hopefully with this new published information, this will start us in the right direction in getting pricing out in public.  The medical industry is the only industry in the USA where you have no idea what something costs.  When you ask someone at the hospital/doctor’s office, you get a bewildered look, as in why are you asking, or how would I know?  It’s insane.  We as a society should have been demanding this time of open information for the last twenty years, it took the government to pass a over-reaching law to finally get this type of information.

Now, I could ramble on for the next twenty minutes about this, but I’m trying to keep it at a minimum.  I would like to know why hospitals charge what they charge.  Why does heart failure cost $10,000 at Baptist Hospital, but $16,000 at Norton’s?  What does that extra $6,000 get me?  Am I more likely to survive at Norton’s, or is it simply better food at Norton’s?

Here’s a link to the article:

http://www.courier-journal.com/article/20130508/BETTERLIFE05/305080118

Remember, especially for those with Health Savings Accounts, ask for a cost before having anything done to you.  You can do the same thing for prescriptions, call around to a few places before making a purchase.

Let me know if you have any specific questions.

http://www.sba.gov/healthcare

This doesn’t take the place of your CPA, this should be used for informational purposes only.

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