It is important to see Health Care Reform as simply an effort to consolidate the health industry into Wall Street size health systems that intend to go global. It has nothing to do with people being able to access care. What these pols are trying to do is limit the number of people able to access health care and to make those that do access it less likely to cost much. Sok, when you hear 'people with existing conditions will be covered by their health care insurance' the key here is who will have health insurance. These pols are making it impossible for anyone short of $100,000 annually to be able to afford health insurance with full care and those not able will be either on catastrophic or Medicaid.....both being reduced to public health checkups. Check your blood levels and coach you to stop drinking soda and eating fatty foods.....yes. Go to the hospital for disease.....no.
We know that health care costs are driven by fraud and waste.....almost a trillion dollars annually and that is conservative. Then you have all of the profit that should not be apart of a life and death business. If your incumbent went for Health Care for ALL in Maryland and not the private system being built now, which none in Maryland did as Johns Hopkins would not allow that, we would not be facing 2/3 of the American public not having health care beyond a public health checkup. Let these pols know this is not what you want by voting your incumbent out of office.
Employers hit by rising health costs look to high-deductible plans With open enrollment here, workers may have a new option
By Eileen Ambrose, The Baltimore Sun November 4, 2012
There's a good chance during open enrollment this fall that you will be offered a high-deductible insurance plan with a savings account — if you haven't already been nudged into one.
Increasingly, employers are offering this as a way to rein in their health insurance costs. The high deductible means lower premiums, benefits experts say. And employees — confronted with the prospect of potentially paying thousands of dollars before insurance kicks in — are less likely to run to the emergency room for minor problems, which also keeps costs down.
The plan frequently is paired with a health savings account, in which workers may set aside pre-tax money to cover the deductible and other medical costs. Employers sometimes chip in, too, to encourage participation.
This year, 19 percent of workers with insurance from an employer were enrolled in a high-deductible plan, more than double the percentage from just three years ago, according to the Kaiser Family Foundation. And these plans now have edged out HMOs as the second-most-popular option offered by U.S. employers, benefits consultant Aon Hewitt reports.
Studies suggest that these plans reduce health care costs — at least initially.
"They are seeing a savings. The question is why and if it's sustainable," said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute. "The jury is still out."
With employers seeing health care costs rise year after year, though, more are willing to try high-deductible plans. Some employers are beginning to make this their only choice.
M&T Bank, for example, is doing just that for next year, using its current insurance provider. The bank also will contribute to employees' health savings accounts on a sliding scale.
"Employees who make less get more of a contribution," spokesman Phil Hosmer said.
As with all plans now, preventive care is fully covered, so M&T workers don't have to pay any deductible for physicals or cancer screenings. In recent years, the bank also added wellness initiatives, such as cash incentives for workers and their families who take health assessments or undergo counseling sessions with a health coach.
"We feel by increasing the focus on employee health now, [we] can manage the cost of the growth of health care over time," Hosmer said.
High-deductible plans sprang up in the late 1990s, partly in response to the public revolt against health maintenance organizations, which were seen as limiting access to needed care, according to a report released last month by the Robert Wood Johnson Foundation.
Health savings accounts started to appear in 2004. Employees can contribute untaxed money into this account and use it later to pay deductibles and other medical expenses. About one-third of employers add money to workers' accounts, according to an Aon Hewitt survey.
For 2013, the most that can be contributed to a health savings account is $3,250 for an individual and $6,450 for those with family coverage.
Any money unused at the end of the year remains in the account, where it can earn interest or be invested. When employees leave the company, they can take the money with them.
(Health savings accounts are different from so-called flexible spending accounts, another popular option in which employees set aside money for health expenditures but the cash must be spent annually or it's forfeited.)
Under federal rules, plans paired with a health savings account must have a deductible next year of at least $1,250 for an individual and twice that for family coverage. Kaiser reported this year that the average deductible for a plan with a health savings account was $2,190 for an individual, and $4,068 for a family.
Some plans will pick up the full cost of coverage once the deductible is met, while others require workers to pay a certain percentage of their medical bills until they hit a cap. Next year, the maximum out-of-pocket expense will be $6,250 for an individual and twice that for families.
(Some employers offer a health reimbursement arrangement instead, which follows different rules. The employer contributes money annually on behalf of workers, and the company keeps any balance left over once employees leave. Baltimore-based T. Rowe Price started offering HRAs this year with plans that have modest deductibles. The company kicks in up to $400 in the HRA and adds $50 to $150 extra for each healthy action workers and family members take, such as getting a physical.)
High-deductible plans often are called consumer-directed health plans, a name that implies patients will question their doctors on whether a test is really necessary or insist on generics over brand-name drugs.
The people are being told that non-profit co-ops will compete with these profit-driven insurers to bring down the cost of health care. No need for public health systems, we'll use the market to address the problem. So, here in Maryland we have yet another Harvard/Johns Hopkins doctor taking the lead in creating these co-ops all the while looking as if he is working for the people. These smart people know these entities won't do anything, but they are running as Democrats so have to look like they are working in the people's behalf. Think of Johns Hopkins as a non-profit. They may not give their profits to shareholders, but they do use profits for unlimited expansion which is exactly what these non-profit health insurance co--ops will do. Watch them expand across the country and expand globally all while never paying any taxes because they are non-profits.
THIS IS WHAT THESE NON-PROFIT HEALTH COOPERATIVES ARE ABOUT AND AGAIN IT IS BEING LED BY HOPKINS AND WALL STREET'S HARVARD GRADUATES.
Experts weigh in on nonprofit healthcare cooperatives
By Reuters Staff July 30, 2009
Reuters.com asked members of our expert panel on healthcare reform what role, if any, nonprofit cooperatives should play in healthcare reform policy? Here are their responses:
(Updated at 14:35 ET on July 30 to include Ted Okon’s view.)
Wendell Potter is the senior fellow on healthcare for the Center for Media and Democracy in Madison, Wisconsin. The views expressed are his own.
The idea of nonprofit cooperatives being able to compete effectively with the cartel of large for-profit insurers that dominate the market today is so naive one has to wonder if the legislative language proposing their creation was written by insurance company lobbyists.
The proposal, sadly, reflects a shocking lack of understanding in Congress of how the health insurance industry now operates in the United States. Over the past 15 years, seven for-profit health insurers have become so large that one of every three Americans is enrolled in a plan owned and operated by those seven insurers. The consolidation in the industry has also resulted in 94 percent of insurance markets in America being controlled by a handful of big insurers, often just one or two in many of the country’s biggest metropolitan areas. This means that other insurers cannot enter the market and expect to be competitive.
If large, profitable insurers cannot enter markets dominated by competitors, cooperatives, starting from scratch, wouldn’t have a remote chance of succeeding. Creating co-ops instead of a national public insurance option that actually could compete with the big insurers would be a gift to the industry.
Peter Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own.
Leading Democrats on the Senate Finance Committee have expressed cautious optimism that they’ll be able to attract bipartisan support for their reform effort by substituting “nonprofit health cooperatives” for the highly controversial public option. The federal government would provide states with the seed money — some $6 billion — to set up state-based or regional co-ops.
But don’t be fooled — a nonprofit health cooperative is little more than the public plan by another name. Both would be government-funded. Both could offer policies in multiple states, outside the purview of state insurance regulators. And both would sound the death knell of private insurance by tilting the playing field irrevocably in the government’s favor.
After all, not only would private insurers remain governed by unique and often burdensome regulations in each of the states. They’d also have to compete against government-funded co-ops that would have the implicit financial backing of the federal government — and thus could charge artificially low rates without risk of insolvency.
If they have any hope of preserving individual choice in health care, lawmakers should refuse to cooperate with these cooperatives.
Dr. Steffie Woolhandler and Dr. David Himmelstein are both associate professors of medicine at Harvard Medical School and primary care doctors at Cambridge Hospital. They co-founded Physicians for a National Health Program. The views expressed are their own.
The proposed cooperatives would add nothing useful to the healthcare landscape. Stripped of the resources that government would bring to the table, they would be under-resourced competitors sure to be swamped by powerful private insurers. The cooperatives under discussion in Washington would be small scale insurers, whose small enrollment would guarantee high administrative costs because the costs of computers, claims processing offices, utilization reviewers etc. would be spread over a small number of patients. And they would lack the resources to effectively compete by marketing to attract healthy, profitable patients and avoid the sick, unprofitable ones.
Ted A. Okon is executive director of Community Oncology Alliance. The views expressed are his own.
Local and regional nonprofit health insurance cooperatives have been offered as a solution to the near monopoly power of private insurance companies. Unfortunately, history and market economics stand against cooperatives as an effective solution. First, we forget that we have already been down the road of having nonprofit entities control the healthcare market and have failed. Second, our country does not run by having nonprofit entities produce effective, cost-efficient products. Nonprofits are effective as advocates for causes but not as producers of products. The cost and expertise needed to create a cooperative that could compete with well-entrenched competitors would be prohibitive.
A better solution to the problem is a nonprofit entity running a tight insurance exchange that lists all insurance products and options in an easy-to-understand and transparent manner. Concurrently, local and regional markets need to be investigated to break monopolies where they exist and allow more competition by lowering barriers to entry
I have not read one professional critique that says these organizations will do anything to address public access. We are a heavily Democratic state so why do we not have a public health system? This is a wealth state driven by corporate profit and your incumbent serves that 1% of Maryland's population. Below you see a longtime Baltimore Health Commissioner. Baltimore has the worst in the country stats on health care, especially for the poor and this man led the city's health programs. What he does is public health. He works to make sure communicable disease is contained.....third world health like you see in Africa or Asia. This is the system being established in Maryland where all people not affording health insurance will be monitored for health stats but get little after-care.
Will your family fall into the category of $100,000 or higher IN THE NEAR FUTURE OR EVER HIGHER IN THE MEDIUM TERM that can afford to keep private health insurance? Peter Beilenson will be sure to protect the 10% from your health maladies.
IS HEALTH CARE FOR ALL MARYLAND SHOUTING LOUDLY ABOUT THIS? IF NOT, THEY ARE NOT WORKING FOR YOU AND ME!
Think Big… Move fast
The Magazine of Johns Hopkins School of Public Health
As Baltimore’s long-tenured health commissioner, Peter Beilenson daily confronts some of the nation’s most entrenched big-city health problems. He does it with political savvy, a flair for statistics, and one foot on the accelerator.
By Dale Keiger
Photos by David Colwell and Howard Korn
On a Tuesday morning in Baltimore in late June, Peter Beilenson is digging into some numbers. Baltimore has just had a bad weekend, with eight homicides. But none involved juveniles, to the relief of the dozen people assembled with Beilenson around a conference table. According to a bar graph projected on an overhead screen, since the first of the year 10 Baltimore kids have died by homicide. That’s 10 too many, but it’s a 33 percent reduction compared to this point last year, which is the kind of number this group is after.
“Peter has a towering intellect so he immediately understands a problem... Then he has the courage to take action.” —Stephen Teret, director of the School’s Center for Law and the Public’s Health
They meet weekly as part of a city health department data review called KidStat. Beilenson, MPH ’90, is the Baltimore City health commissioner. He’s held the job for the past 11 years, a long tenure for a big-city health commissioner. And the job gets more challenging all the time. Commissioners like Beilenson must deal with all the old problems—restaurant sanitation, vermin control, epidemics of sexually transmitted diseases, drug addiction—and new urban nightmares like bioterrorism, SARS, and “dirty bombs.” For more than a decade, Baltimore’s health problems have been Beilenson’s headache, and he’s responded by thinking big and moving fast.
Md. co-op gets fed loan, will compete against private health insurers
By Kelley L. Allen Posted: October 30, 2012 Insurance and Financial Advisor
Evergreen Health Cooperative Inc. has received a $65 million federal loan to operate a non-profit insurance co-op in Maryland to fulfill a mandate of the Patient Protection and Affordable Care Act.
Peter L. Beilenson
The loan is through the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services, which are tasked with establishing the Consumer Operated and Oriented Plan (CO-OP) Program. The program is designed to create non-profit health insurance issuers that offer “competitive health plans in the individual and small-group markets” in each state, according to CMMS.
Evergreen will offer insurance through the state’s new health insurance exchange, Maryland Health Connection, when it opens for business in October 2013. Coverage starts on Jan. 1, 2014.
The co-op, which is being touted as being “consumer-owned,” also will sell insurance outside of the exchange and will compete against private insurers.
People in the low- to medium- income brackets who earn too much to qualify for Medicaid but not enough to afford private insurance are the main target for the cooperative.
Dr. Peter Beilenson, founder of Evergreen and the former Howard County health officer who resigned his post upon approval of the loan, said the goal of the co-op is to make health care more available and affordable for working families. The plan also will be available to Marylanders who have insurance but are seeking new insurance options.
According to Beilenson, Evergreen presents “a promising model not seen before in Maryland.”
A second group, whose main sponsor is MedChi, the Maryland State Medical Society, plans to submit an application to fund a second co-op insurance company in Maryland. That co-op would offer insurance to people living on the Eastern Shore and in Delaware
As the article below points out, Blue Cross started with a mission of public health insurer. It became regional, then national, and now works the same as private insurers. These public co-ops will be the same if taken state by state and not start as a national public option. Whereas Blue Cross took decades to become just another corporate entity, these current non-profit health co-ops will grow with the speed of Wall Street banks.
IF WE DO NOT SHOUT LOUDLY AND STRONGLY FOR A NATIONAL PUBLIC OPTION OR UNIVERSAL CARE, 2/3 OF ALL PEOPLE AND ALL POOR, SICK, AND ELDERLY WILL HAVE PUBLIC HEALTH LEVEL CARE WITHIN A DECADE OR SO!
VOTE YOUR INCUMBENT OUT OF OFFICE!!!!
Public Plan or Cooperative: Does it make a Difference?
Tuesday, November 6, 2012 New York Times
Are Cooperatives a Reasonable Alternative?
First, a word about history. We have tried cooperatives before. During the 1930s and 1940s, the heyday of the cooperative movement in the United States, the Farm Security Administration encouraged the development of health cooperatives. At one point, 600,000 mainly low-income rural Americans belonged to health cooperatives. The movement failed. The cooperatives were small and undercapitalized. Physicians opposed the cooperative movement and boycotted cooperatives. When the FSA removed support in 1947, the movement collapsed. Only the Group Health Cooperative of Puget Sound survived. Over time, moreover, even Group Health, though nominally a cooperative, has become indistinguishable from commercial insurers–it underwrites based on health status, pays high executive salaries, and accumulates large surpluses rather than lower its rates.
The Blue Cross/Blue Shield movement, which also began in the 1930s, shared some of the characteristics of cooperatives. Although the Blue Cross plans were initiated and long-dominated by the hospitals and the Blue Shield plans by physicians, they did have a goal of community service. The plans were established under special state legislation independent from commercial plans. They were non-profit and, in many states, exempt from premium taxes. They were exempt from reserve requirements in some states because they were service-benefit rather than indemnity plans and because the hospitals and physicians stood behind the plans. They were exempt from federal income tax until the 1980s. In turn, they initially offered community-rated plans and offered services to the community, such as health fairs. In some states their premiums were regulated and they were generally regarded as the insurer of last resort for the individual market.
Over time, however, the Blues lost their focus on community service and began to look more and more like their competitors. THINK ABOUT CHASE BREXTON IN BALTIMORE..... They abandoned community rating (which, realistically, they could not maintain when faced with competition from experience-rated commercial plans) and began to impose underwriting and cost-sharing requirements indistinguishable from the private plans. Although providers lost control of the Blue plans, the plans never took a leadership role in bargaining aggressively with providers, despite their market dominance in many states. Many of the largest Blue plans became for-profit, and those that remain non-profit are largely indistinguishable from commercial insurers. Although the national Blue Cross/Blue Shield association offers some coordination services to local plans, it has not resisted the move of Blue plans away from a community-service toward a for-profit orientation. Lacking a national focus on public service, state and regional plans have become indistinguishable from their commercial competitors.
Blue plans are not the only non-profit insurers that survive. Many church and fraternal organizations have their own non-profit plans. Although these plans often try to serve their communities, they usually have a small presence and little bargaining power in most communities in which they operate; tend to insure individuals and small groups, the most costly market; are often the victims of adverse selection; usually underwrite much like commercial plans; and tend to offer low value, high cost-sharing policies. They are not a model on which to build national reform. Mutual insurers are also in theory owned by their members. They also, however, are indistinguishable from for-profit insurers in most states.
What can we learn from this history? First, health care cooperatives are, in fact, an American response to health care reform. Cooperatives and non-profit insurers were there before for-profit commercial insurers entered the health insurance business, and we could try to revive the idea again.
But why would state or locally-run cooperatives be any more successful now than they were when we tried them before?
First, it is hard to imagine how they would get underway. Capitalization and critical size were problems before and would likely be problems again. Senator Conrad’s recent draft suggests that members of the coops would elect their boards, and that the coops would then obtain state licensure as mutual insurers, meeting state standards for solvency and reinsurance (with the help of federal seed money). But there is a chicken and egg problem here. Until the coops had members they could not have a board. Until they had a board, how would they meet licensure requirements? The state coops, moreover, would, under Conrad’s, proposal be supervised by a national board, but the national board would be elected by the state coops. Again, the state coops would presumably not be able to get underway until the national board provided policy guidance, but the national board could not get underway until the state coops were formed to elect it. None of this makes sense.
Second, there is every reason to believe that small, state run coops would fail like their predecessors did in the 1930s and 1940s. Unless they reached the critical mass necessary to bargain effectively with providers, to accumulate reserves, and to compete with national private insurance plans, they would be doomed to failure. Even if they managed to succeed here and there, they would contribute nothing to a national effort to control costs, drive value, and make affordable care accessible.
Third, if state-run coops in fact, against all odds, became large, successful competitors for insurance business, what would keep them from following the course of the Blue and mutual plans before them? Without strong Congressional direction and a unifying national leadership, what could keep them focused on cost control, quality improvement, transparency, and service rather than simply becoming indistinguishable from their commercial competitors? How would they drive the delivery system change we need?
Fourth, how does setting up cooperatives on a state-by-state basis drive national health care reform? Each state currently can set up cooperatives if it wishes to, but none have done so. Why would states suddenly embrace this concept? And what assurance do we have that they would pursue anything like a common strategy? To approach this issue on a state-by-state basis is simply to surrender on national health care reform. A federal fallback plan to be implemented in the future is also unlikely to work. HIPAA contained a federal fallback plan for states that failed to implement reforms in the individual market, but it was poorly implemented and eventually abandoned. To revert to a state-by-state approach is to surrender on national health care reform
Below you see the article by the health insurance industry in Maryland that basically details why Maryland will continue with private health systems and not go public. This is 2010 and O'Malley and Maryland pols have shouted for public health systems in the media, but Maryland never skipped a beat in using the private system already in place. There was never any intent to do differently as Hopkins was speaking through media that private systems would be best. Note the reason given for not pursuing public system was the billion dollar cost at a time of fiscal stress. Maryland loses a few billion of health revenue every year to fraud.
We must change these politicians if we are to change this direction! Don't believe they are working towards insuring all because they are doing the opposite!
Md. workgroup, brokers disagree on setup of health insurance exchanges
By Bob GrahamPosted: November 22, 2010 Insurance and Financial Advisor
Maryland’s federally mandated health insurance exchange should be a public, government-run agency with a board tasked with overseeing its operations, according to a state task force.
That determination from members of the Maryland Exchange and Insurance Markets Workgroup, including co-chairman Beth Sammis, Maryland’s insurance commissioner, does not square with the health insurance agents’ vision for the exchanges.
In two studies prepared for health insurance agents and third-party administrators, as well as in comments over the last year, health insurance agents and brokers in Maryland have consistently called for the state to expand the role of the private health insurance delivery system, not create a new public delivery mechanism.
For health insurance agents and brokers, a public system could signal the end of their role in selling health insurance products.
But the workgroup, part of Gov. Martin O’Malley’s Maryland Health Care Reform Coordinating Council, says a public system should be established. That public system should facilitate sales of individual and small-group insurance policies, something the state’s three third-party administrators, or TPAs, already handle.
Health insurance exchanges must be set up in all states by January 2014, as part of the sweeping federal health reform law passed in March. In Maryland, O’Malley appointed the council to address all of the implications of federal health reform, and the exchange and insurance markets workgroup is one of the subcommittees involved in looking ahead.
Three TPAs – BenefitMall, Group Benefit Services and Kelly & Associates Insurance Group – already facilitate the shopping and administration of health insurance in the state, having spent, according to their chief executives, millions in infrastructure costs, including technology, to support the health care delivery system. All three pledged earlier this year a commitment to IFAwebnews.com that they would do what is necessary to handle the needs of the state health exchange.
Anirban Basu, an economist and CEO of the Sage Policy Group in Baltimore, Md., suggested two days before the workgroup’s report was issued that the existing TPA system is “capable” and doing “the same as the exchanges” during a presentation to the Baltimore and Greater Washington chapters of the National Association of Health Underwriters.
“If you don’t take advantage of the TPAs,” Basu said, “then the calls will come to the government. You will have to explain.”
Basu, who is investigating the economic impact of health insurance agents and their work on the state’s budget, said at least 1 million calls about insurance plans and millions more emails are transmitted each year to the TPAs regarding health insurance.
“Many in the legislature want to build health exchanges from scratch,” Basu said. “But when you have a $1.6 billion [state budget] deficit, you don’t have that luxury.”
Earlier this year, the health insurance industry commissioned the two studies looking at the role TPAs could play in health exchanges in Maryland.
Maryland’s existing system, which connects health insurance companies to consumers through general agencies and insurance brokers, “has evolved into a unique sales structure that centralizes administrative processes for small groups and achieves many of the functions of an exchange in the private market,” according to the report released by Avalere Health, a Washington, D.C.-based advisory services company. The study was funded by BenefitMall, a Dallas, Texas-based general agency and third-party administrator operating in Maryland.
The second report, prepared for the Maryland Association of Health Underwriters and the Maryland chapter of NAIFA, also argued for the role of TPAs. The report says Maryland’s private-sector system, the result of 1993 small-group insurance reform, is more efficient public-policy approach to marketing and selling health insurance in the state.
“With regard to the establishment of an insurance exchange, the capabilities of the intermediaries reviewed in this report revealed that Maryland is well-positioned to leverage the existing private sector infrastructure rather than expend scarce public resources to establish a new public entity to help organize and structure the market, enhance transparency, improve competition and subsidize the purchase of commercial [health] insurance,” the NAIFA-MAHU report said.
The workgroup’s recommendation went to the full council, which could, but isn’t likely to, alter the recommendation.