Medicaid is big issue for states and small businesses
How to reform Medicaid and pay for it is a big issue for hospitals, small businesses and other small employers as well as for the states’ governors and legislatures. Click on the headline of this story to see several articles and other Medicare and Medicaid information resources. Today, a lot of the cost is being shifted by state and federal legislators to buyers of private health insurance, and it appears more cost shifting is on the way.
Foundations fund research on health care, insurance, financing
The Robert Wood Johnson Foundation is a major source of scholarly research related to how small business owners provide health insurance to their employees. The foundation’s major emphasis is on funding programs designed to increase access to health services, reduce the number of uninsured and improving insurance coverage of kids and families. The foundation’s home page is here.
Insurance underwriting keeps small businesses from providing health insurance
Small businesses can learn from health insurance errors by Fortune 1000
Fortune magazine’s current issue (Mar. 3, 2003, p. 105) reports that workers’ health care costs will soar 24% this year as companies shift cost increases to their employees. The real lessons small businesses should be learning from corporate America is what they should not do with health and pension benefits, because taking benefits back is really tough. Indeed, the Fortune article warns that a lot of big, unionized companies will be taking strikes over health benefit issues for many years. The major lessons are:
Employees of small businesses less likely to have health insurance
Only 36.2% of workers in small businesses with less than 10 workers have health insurance, and 47.65 of those in firms with 10 to 24 workers have health insurance. Federal and local government employees are the most likely to have health insurance coverage through their employers, according to the lastest report from the Medical Expenditure Panel Survey, 2000, by the Agency for Healthcare Research and Quality.
Would these Medicare reforms cut small businesses’ health insurance costs?
Robert E. Moffit, Ph.D., comes up with some rather creative ideas for Medicare reform in this commentary, which appeared in the Feb. 20 issue of The Wall Street Journal. “At a certain date, Congress should allow new retirees who are 65 or older one of two options: enrolling in the conventional Medicare program or taking their private health plan with them into retirement, with a government contribution to offset its cost,” Moffit writes. Question is, what would happen to the medical rating of small businesses’ private health plans if their risk pools became riskier as their retirees aged? Moffit would protect retirees from cost escalation with government subsidies, which supposely would be less expensive for the government than traditional Medicare. But, health policy makers would want to know what would happen to the premiums of small employers and large self-insured employers.
Why medical rating makes no sense for small businesses
Although the Colorado House narrowlly defeated HB03-1013 (32 no, 31 yes), Sen. Mark Hillman (R), plans to push his bill that would alow the sale of stripped down health insurance plans that are medically underwritten, SB 03-162, to a vote next Wednesday.
The problem is that there is little, if anything, the legislature can do during this session to help small businesses control health care costs, and any of the bills in the hopper this year will do more harm than good. But legislators feel they’ve “got to do something.” They don’t have to do something that will hurt small businesses and consumers, and that is the direction they are going. The philosophical and economic issues under debate include:
No fault auto insurance bill looks like a close call
Colorado’s General Assembly is close to deciding on reforming the state’s no fault auto insurance laws, which expire July 1, 2003. Chiropractors, massage therapists and other alternative providers who make money serving auto accident victims at the expense of auto insurers oppose HB03-1225. The bill would allow reasonable use of the services of alternative providers, but not the abuse of the sytem that the current law allows. Most (but not all) auto insurers and health insurers and business groups support the bill as the best possible compromise. Trial lawyers oppose the bill because they think the current system is working, and, financially, it’s working for them. The Denver Business Journal’s report is the best overview of the debate that I’ve seen so far. If 1225 doesn’t pass, Colorado will return to a tort system, which will throw many more auto accident cases into the courts and will drive up the cost of both auto and health insurance.
Colorado House preserves modified community rating for small business health insurance
Colorado’s General Assembly yesterday acted on two health insurance bills important to small businesses. First and most important, the House defeated HB03-1013, which would have replaced modified community rating with flexible and risk rating. Second, Debbie Stafford’s bill to prevent small businesses from gaming the system, 1294, was advanced, according to this report in the Denver Post. The Post reported:
“A bill designed to make it more difficult for small businesses to “game the system” by jumping in and out of the health insurance market passed the House Business Affairs and Labor committee Tuesday.
“Supporters of House Bill 1294, sponsored by Aurora Republican Debbie Stafford, said some small companies leave the small-group health insurance market - which is required to cover all employees - in favor of cheaper but more restrictive plans when their employees are healthy.” See the full story at the Denver Post.
Colorado nursing homes hit by budget cuts
Nursing homes in Colorado, many of which are small businesses and not-for-profit organizations, are being hit by General Assembly budget cutting like everyone else, reports the Colorado Springs Gazette.
Colorado General Assembly updates
Colorado wants to stop marketing access for children
The Colorado government wants to “stop promoting the Child Health Plan Plus, or CHP+, intended for the children of the working poor,” according to the Coloradan. This would increase costs for Medicaid and hospitals when kids don’t get early medical care and wind up in expensive emergency departments. It’s another effort to shift to small businesses the cost of providing health care.
Medical errors occur outside hospitals, too
Medical errors are as likely to occur outside a hospital as in one, according to a Harvard study reported on by by Sandra Boodman in today’s Washington Post. I’ve had major quibbles with the Institute of Medicine study on hospital medical errors, as have authors who have published in the Journal of the American Medical Assn. and elsewhere. Click on the “articles” link in the first (left) column of our home page to see my article.
Medicare use varies by as much as 30%; quality not affected
Spending on Medicare patients in their last six months of life, normally the most expensive in terms of health care, varies by as much as 30% without any significant benefit to patients who received more intensive services, according to this Reuters
report. The results in the Annals of Internal Medicine are summarize below. Also see my questions:
Appeals court grants patients rights to sue HMOs
Patients denied care can sue health maintenance organizations (HMOs) in the North East, an appeals court ruled last week, according to Robert Pear in The New York Times. This is another blow to the efforts of managed care organizations (MCOs) to help small businesses and other employers control health insurance and health care costs. But it also makes sense for patients who have had little or no recourse against insurance companies whose medical directors and case managers tried to ration appropriate care in an effort to control their medical loss ratios. A patients bill of rights hasn’t made it through Congress and it may never be enacted, but what conservatives might call an “activist court” has righted some of the problems with the current system. This won’t put MCOs out business, but it will continue the trend toward indemnity managed care organizations.