Building A Customer-Oriented Health Insurance Exchange
http://thedianerehmshow.org/shows/2012-12-04/building-customer-oriented-health-insurance-exchange
In the shadow of negotiations over the so-called fiscal cliff, another deadline looms in Washington. States have until December fourteenth to decide whether they intend to create state-based health insurance markets. If states choose not to build their own or partner with others, then the federal government will step in. As states rush to create exchanges by 2014, they’re considering how best to develop health care comparison tools. Individuals and small businesses need ways to plan for unexpected expenses, find out which plans include their provider, and compare service quality. Diane and her guests talk about building customer-friendly health insurance exchanges.
Guests
Robert Krughoff
founder and president of Center for the Study of Services and Consumers' CHECKBOOK.
Julie Appleby
senior correspondent, Kaiser Health News.
Sonya Schwartz
program director, National Academy for State Health Policy.
William Custer
director of Center for Health Services Research at the J. Mack Robinson College of Business, Georgia State University.
Glen Shor
executive director, Massachusetts Commonwealth Health Connector.
Comments
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My situation demonstrates why the Massachusetts Health Connector program is unfair.
I'm a 50 yo male , fit and in good health.
My employer offers insurance but only pays $100 a month toward the premium.
My share of the premium is over $400.
This is over 20% of my gross income, I work 32 hours per week.
I cannot afford this.
The Mass Connector offers affordable premiums but rejected my application twice because "employer offers insurance"
So how is it fair that I can't get in the program and at the same time subsidize others through my tax dollars ?
Customer-oriented? ROFL!
Customer-oriented with stockholders waiting for dividends! ROFLMAO!
This is at least as funny as affordable healthcare. Ain't gonna happen.
"Customer-Oriented"
Makes me think we are buying TVs. Once we take the word "Cutsomer" out of the thinking, and start using the word "Human" then we can get this figured out. Whats the point in having the greatest when you cannot afford it. Money is the only thing anybody really cares about in this country. I for one am tired of being thought of as money for these people. Just go to the single payer system and be done with it!
"Just go to the single payer system and be done with it!"
And then money won't matter?
This is, of course, the logical step for the USA to take, but it seemed to have been "off the table" before it was even "on the table". I guess that the private insurance industry - I use that word advisedly - has more lobbyists than the Pope has priests, so there could not even be a discussion of it.
I write from Canada, where each province in the country has its own single-payer system, each mandated by a federal law on the subject and partially supported through federal tax dollars which go down to the provincial governments. There are NO user fees, no co-pays, no lifetime limits on care, no pre-existing condition rules. And everyone in the country is automatically a member of the system just by being registered.
I'm a Mass resident, 43, healthy - never use health care expect for regular checkups. I'm a contract/temp worker actively seeking full-time work. I pay $500 per month, my partner pays $500. My Harvard Pilgrim has a hefty premium. I had bloodwork done and was charged $340 (plus the $500) for last month. How is this affordable? It's not. Each month it is a choice between rent, food, gas and healthcare. Unless you are poor, you get health care for free or if you are rich, you don't think about it.
What about the rest of us?
HMO's are a rook and everyone knows it.
See Sunday, Dec 2 Wash Post, page B5. Vet Affairs health system as model. By Dr. Yogesh Khanal.
I live I n NC. I have worked 32 years in healthcare, the last fifteen in health information technology and population management.
I am now disabled on SSDI from complication from diabetes over the last 45 years…
I am 56 years old, have never qualified for Medicaid and now find myself with a $2300 per month income. My cost sharing is $500 per month for insulin pump and other technologies paid through my spouses insurance.
We are very concerned and spend much time working in our community trying to assist othe4r with similar circumstances.
Considering my experience in both private and public sectors managing large clinical integration projects we are concerned about timing.
Our state and many others have lagged in making a decision: hoping for repeal of the law in my judgment.
WHEN, the big factor for us is WHEN… can we expect changes to affordability through exchanges.
I am welcome in Israel as a Jewish man. We have considered moving there. Imagine considering this move and its risk to our safety just to live somewhere with a workable health system for persons with chronic disease.
Jeffrey Harris
The goal is to make everything as complicated as possible. That way, we can never figure out what we have.
Simply put, on $8 per hour on a job, you won't get much insurance. Most likely, you won't get any. Regardless of who the company is, you still have to pay for it.
Obfuscation Forever!
53 yro unemployed teacher in MA on unemployment...was told I make 300x the amount to be eligible for MassHealth!
exploring Medical Security, but it considers income for the past 6 months...
as a teacher I made $80K...now making $30K on unemployment, which is great but not enough to pay $700+/month for Cobra...
any suggestions from your panelists?
(love the show! keeping me company as I search for work!)
The guests with you today could help us clarify:
Why the old safety net was not affordable
How the new system will expand coverage for people like me.
55 yo male, not Medicaid eligible with chronic disease and modest income 4X FPL
The guests with you today could help us clarify:
Why the old safety net was not affordable
How the new system will expand coverage for people like me.
55 yo male, not Medicaid eligible with chronic disease and modest income 4X FPL
How do I know the options offered in my state? Is there a website for Pennsylvania that I can look later on, and see my options?
"Choice" is a faux choice. Uniformity and test flying each aircraft, etc., makes for safety, timeliness, ability to access proper help. We don't need the 'ways' of some 'entities.
With vision (brainstem) probs, and multi others, w/o insurance, there is an exhaustion factor. Speaking problem. But when I am on all cylinders, I notice that even the 'providers', even of 'social services' etc., can only remember so much, even if they are being responsive to one's queries. And I always get notification that they need one more thing at the zero hour, so don't get medicaid, or food stamps. No one could humanly respond at 100 percent and with copilot. This is the 'way' of some states, and is designed in by not so 'friendly' to the 47%. We can all be considered 'incompetent' or of 'diminished' capacity with some of their designed in tactics. Contact at last moment, at time of day, where even highly skilled computer skills, and contact, already hits the Friday, or end of month deadline that all companies operate with. This is NOT FRIENDLY, and one CAN'T CALL FOR HELP.
Diane, how could the gentleman from GA say they don't know what the user experience will be? It's already been done in states like MA. And the coordination between state and federal agencies is only a matter of DOING it, like these other states have. It's not impossible and sounds like these Republican-leaning states are only dragging their feet.
Why does everyone assume that being uninsured means you are poor. I have a slight case of MS, take no medications, but since I have a pre existing condition can only qualify for very expensive insurance. I have been uninsured for over 10 years now, pay my way to get regular check-ups because, although not rich, have enough money. My fear, phobia, is that in the next months before I qualify for Medicare in June, something will happen to me that will take all of the money that my husband and I have saved for our retirement. Just saying that makes my heart rate increase!
Why does everyone assume that being uninsured means you are poor. I have a slight case of MS, take no medications, but since I have a pre existing condition can only qualify for very expensive insurance. I have been uninsured for over 10 years now, pay my way to get regular check-ups because, although not rich, have enough money. My fear, phobia, is that in the next months before I qualify for Medicare in June, something will happen to me that will take all of the money that my husband and I have saved for our retirement. Just saying that makes my heart rate increase!
Is there a plan to create a National Portal to select insurance?
Will it integrate with existing clinical systems e.g. eHR and pHR
The consumer experience is a hassle NOW due to data entry and exchange issues.
Is the Office of the National Coordinator for HIT involved with the technical design?
I am amazed that none of your guests mentioned to the caller from Texas that there is a federal program for which he is eligible. My husband was just enrolled in it.
He has stents in his heart and was refused coverage by Blue Cross Blue Shield in NC. The only stipulation for coverage is that he must have a letter stating that he had been denighed coverage by an insurance company and that he not had coverage for 6 months or longer. My husband had both and he was enrolled. This program was instituted in 2010.
We were told about the program by the independent insurance broker that sells Blue Cross Blue Shield.
We need universal coverage. The system is rigged and there are too many people profiting off of health insurance companies. I recently found out that if you are on Medicare and would like to purchase a supplemental Medi Gap Plan you can still be disqualified or charged a huge premium for a pre existing condition. This will not go away for 2014. A little fact gone unnoticed by many regarding the Affordable Care Act. Medicare is considered your Primary insurance, therefore a supplemental can still underwrite their conditions. Has anyone been on the Medicare site? Holy Crap is it confusing and I am a 40 year old woman who knows how to navigate the Internet. Thank God I am here for my Mother because if I wasn't she would be prey for insurance peddlers. There are many jobs being created in this industry by sticking it to the average citizen, including seniors by purposely making it so confusing and deceptive. If we really would take a good look at what we are getting for our money we should all revolt. Unfortunately that is not the case because you don't realize how much you need good coverage until "you know What hits the fan". And nobody likes to think about it.
I work for a senior center in Illinois, and have been trained by my state as a SHIP counselor--Senior Health Insurance Program. At every training session we are updated on the Affordable Care Act, and there is every indication that we will be trained to help anyone using the exchanges. Unfortunately, our local Medicaid office has closed, due to state budget cuts, and I don't see how the expansion of Medicaid and the exchanges are going to be very effective without a human infrastructure. I'm all for the exchanges, as nothing is worse than helping a person new to Medicare get set up and telling their younger spouse we can't help them until they turn 65.
The biggest driver of health cost is liability insurance for doctors. No cost reduction in health care will be accomplished until something is done about doctor and medical device suits by our lawyer leaders in the executive and legislative branches.\
Every time I listen to a discussion about health care in this country it becomes more obvious that everyone is dancing around, or trying to appease, those who will not relinquish their hold on this "for-profit model". Children think they can have their cake AND eat it, too...Where are the adults? I watched first hand as my 57 yr. old mother died of cancer while arguing with the insurance company.
These talk shows offer nothing but procrastination..blah, blah, blah...while many people suffer in this callous system.
-Indianapolis
Pardon my ignorance - I haven't heard the show yet or read the above comments - but aren't these "exchanges" pretty much just a medical-insurance version of Priceline or Kayak?
Maybe some of these states could contract with an outfit like Kayak to set them up. I'm only half-joking.
Hi Diane,
I love your show!
My wife and I retired from teaching 4 years ago.
We had wonderful, affordable health care while we taught.
Soon as we retired, we realized that the state health
care plan for retirees is much more expensive.
Now we can hardly afford our insurance.
My wife's family is from France. My father and mother-in-law
yearly traveled back and forth from France for over 23 years.
They raved about France's health care, and how simple the
health care system is. My wife and I have had to make use of French
hospitals while traveling, and have nothing but high praise for their
system.
We are utterly appalled by the US health care system. We are appalled
by how many people are uninsured. We are also appalled by it's
complexity and lack human concern for US citizens.
Diane, please have a show on good countries for US retirees to migrate to.
We are sick of US politics. We are sick of the US government's inability to fix important
problems. AND We are sick of rich and greedy politicians. There must be a few places
in this world that accepts new residents and has a good state run health
care system. There are often articles on yahoo. com on good countries to retire to, I
would love to hear some experts talk about migrating on the Diane Rehm show.
(We are thrilled about one thing though, Mitt Romney is not our president! Things could
be so much worse!)
I'm so angry with my insurance company. I had extensive nerve damage that has left me with a permanent foot drop. I have to wear an afo brace or I will trip over my own foot, and possibly twist my ankle and break my foot just like I did 3 days before my back surgery. I know I'm blessed, because I am able to walk rather well with my brace. However, I feel that had my insurance co approved my doctors 1st or 2nd requests for a MRI of my back, I wouldn't need this brace. I am 46 reasonably fit and active woman. No more high heels...no more dressy boots...no more flip flops...no rubber boots...etc... I'm tired of paying so much for insurance that is constantly telling my doctors what meds or procedures they'll agree to provide. By the time my MRI was approved I had 2 disc that had pushed half into my spinal cord. My neuralogical back surgeon saw my MRI and fit me in for surgery the next day. To add insult to injury, I have a max $2,000 out of pocket per individual, but have had more than $4,500 out of pocket. Fine print...The insurance only pays 80% on pt and none of that money goes toward the out of pocket max. We're paying our insurance company $12,000 annually and I feel like they've failed us. We need some drastic changes. Do we really need health insurance companies? Couldn't that money be better used elsewhere?
@den niel
Meaning no disrespect. If you think things are so good in France, then your search for another country to live in is over and that's where you should go - and don't let the door hit you on the back side. You will also be priveleged to pay their tax rates - unless you can get the top percentage payers to pay them for you, as you would, no doubt, like to have them do here.
The U.S. health care system, once the best in the world, is in a race to the mediocre. Numerous posters here are crying for government-run, centrally-run health care. They pretend that the quality of care will be what it is today, once expanded by 30 or 40M more people. You think insurance companies are hard to deal with? Just wait until the voice on the other end of that phone is a government bureaucrat.
These people do not want everyone to have good care - they just want everyone to have the same care - and if they and the President get their way that is where we will end up.
My sister lives in Massachusetts and is a healthy 53 year old she has seen her premiums soar to $700. a month with their most reasonable HMO plan. She is okay with being in an HMO because there are so many doctors and hospitals in Boston where she lives and supports health reform but is finding it hard to survive financially with the rising premiums in the state since healthcare reform was enacted. She has always purchased her own insurance. The question is whether these excessive rate hikes will happen all over the country. I also have always purchased my own insurance as a freelancer.
Fran in Lamy, New Mexico
I hope this is one of many, many programs you will do on health care....from many different perspectives, Diane. It will be a great contribution to at least 98, 97, 96, 95% of the citizens of the U.S.
As you can tell from the many immediate comments, the word 'affordable' healthcare is a fraud perpetrate by those few people who have enough income to afford $400-$1000/mo. on healthcare.
To quote one of your guest, responding to the unemployed caller who was paying $845+/mo. "at least he can get SOME coverage...he's not DENIED coverage". (Forgive me for yelling.) The absurdity of that response show how economically out of touch are the people doing the planning for "affordable" healthcare.
Either you provide single payer healthcare for everyone, or you decide the value of human life on how much money a person has.
The US has the best health care in the world.
Anybody get tired of hearing that canard? They always leave out the last phrase...."IF you can afford it." The now deceased Shah of Iran vame to the US for cancer treatment. The ultrawealthy (those one percenters) still get great care. Some of those just below the top one percent can afford special "surgery vacations" to places like Thailand for high end procedures unavailable elsewhere. Desperate types like Andy Garcia go to the Phillipines or Mexico for peach pit cancer treatments.......and learn that there is bogus treatment available just about anyplace.
Those in the real health industry know that PROFITS are now tops in the minds of insurers and some corporate facility provider chains.......even the physicians they employ (gobbled up in proprietary "networks") are chained to profit making quotas and forced to perform an avalanche of fee for service procedures that generate huge income for the chains......forced admits to hospitals to keep beds at 100% occupancy regardless of cost to the patients. Did anybody see the 60 Minutes expose recently? Former "big blues" switched from mutual companies to the massive all profit machines they now are.
At least the exchanges will allow the public to see online and compare price for coverage in the light of day. Employers will be able to better analyze waht the competition has available.........in 2014.
Medicare can be a model and testing platform as cost containment is exercised there focusing on outcomes vs outliers, NOT fee for service.