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Re Post from Tom Murphy, AP Business Writer at Yahoo Finance

Several health insurers say they will stop selling new child-only individual insurance policies as they face a health care reform provision that will prevent them from excluding children with potentially costly pre-existing conditions.

An insurance industry representative said the decision affects a relatively small population and is being made to keep costs down for all policyholders. But a Georgetown University researcher said some middle-class children could be left vulnerable by the ensuing lack of coverage options.

Several provisions of the health care overhaul went into effect Thursday, six months after it was signed into law.

One of those could help parents who have struggled to find coverage for children with expensive medical conditions. Under the provision, insurers will not be able to exclude children from coverage because of a pre-existing health condition. This means they will no longer be able to deny coverage or agree to cover the child except for services related to certain conditions.

However WellPoint Inc., UnitedHealth Group Inc., Aetna Inc., Cigna Corp. and Humana Inc. — the five largest publicly traded health insurers based on enrollment — all have said recently they will stop selling child-only individual policies, although those children can still get coverage through a family plan in the individual market.

Individual insurance is coverage that is not offered through an employer and includes both single and family coverage.

Parents who buy single plans for their children under age 18 paid an average of $1,350 in annual premiums last year, according to a survey by the industry trade group America’s Health Insurance Plans. But that cost can vary depending on where the children live and how healthy they are.

Aetna said in a statement it made the decision to stop selling to new members “to protect our current members from significant price increases,” but it will continue to administer the policies it already has.

Cost is a big concern, according to Robert Zirkelbach, a spokesman for the industry trade group America’s Health Insurance Plans.

The provision in the new law tries to allay that by allowing insurers to sign up children only during a fixed annual enrollment period. That is designed to discourage parents from waiting until their child gets sick before they buy coverage.

But Zirkelbach noted there’s no set time of the year for all insurers to hold open enrollment like there is for Medicare Advantage plans. That means parents can still wait until their child becomes ill and then shop around for an insurer that happens to be holding open enrollment. Those customers then will generate more in medical claims than they contribute in premiums, and that could ultimate raise the cost of insurance for everyone else.

“The goal here is to make coverage as affordable as possible for all policyholders,” he said.

Zirkelbach called the child-only portion of individual insurance business a niche market. AHIP estimates that child-only single coverage makes up about 6 percent of all policies in the individual insurance market. Estimates for how many children currently have this coverage vary.

About 16.7 million people have individual insurance coverage in the United States, according to the Employee Benefit Research Institute.

The decision by insurers to stop selling new child-only policies could hurt children from middle-class families that don’t have employer-based coverage but have incomes too high to qualify for public assistance like Medicaid, said Jocelyn Guyer, a senior researcher with the Georgetown University Center for Children and Families.

“I think the number of children affected is very small, but the issue is some of them are particularly vulnerable,” she said.

By 2014, insurers will be required to cover everyone, under the new law, and most Americans will have to buy insurance.

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The Departments of Health and Human Services (HHS), Labor, and Treasury issued  final regulations requiring new health plans to cover certain preventive services without any cost-sharing requirements when delivered by network providers. Cost-sharing includes out-of-pocket costs like deductibles, co-payments and co-insurance. Employers should note that these required preventive services do not apply to grandfathered plans.

Preventive Services to Be Covered without Cost-Sharing
HHS reports that under the new rules, depending on age and plan type, individuals may have easier access to the following preventive services:

  • Blood pressure, diabetes, and cholesterol tests
  • Cancer screenings, including mammograms and colonoscopies
  • Flu and pneumonia shots
  • Routine vaccines ranging from routine childhood immunizations to periodic tetanus shots for adults, including diseases such as measles, polio, or meningitis
  • Counseling from health care providers on such topics as quitting smoking, losing weight, eating better, treating depression, and reducing alcohol use
  • Counseling, screening and vaccines for healthy pregnancies
  • Regular well-baby and well-child visits, from birth to age 21

For more on preventive services under the Affordable Care Act, go to visit http://www.healthcare.gov/law/provisions/rebate/index.html You can also view a list of covered services for adults, women (including pregnancy) and children by visiting http://www.healthcare.gov/law/about/provisions/services/lists.html

This blog is sited from http://blog.ascentis.com

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The statistics are well known to physicians, pharmacists, hospital administrators, and many patients: preventable medical errors kill and seriously injure hundreds of thousands of Americans every year! It would be the sixth leading cause of death in the U.S.  

Patient Safety = Lower Health Care Costs

Concerned about patient safety and recognizing the potential savings of reducing hospital-based medical errors, Medicare identified a number of “reasonably preventable” conditions you could get during a hospital stay. These hospital-acquired conditions or problems would not be reimbursed and the hospital could not bill you if you were affected.  

These rules went into effect in 2008 before the passage of the Affordable Care Act. Not unexpectedly, several large private health insurance companies, including Aetna and the Blue Cross/ Blue Shield Association among others, implemented similar policies not to pay hospitals and physicians for care related to medical complications that should not typically occur during a hospitalization. 

The goal of these policies is to save lives and save money by having hospitals implement new procedures to prevent errors.

As part of health reform, the federal government will provide $75 million annually to improve quality and safety measures. But, Will It Work?

With a strong emphasis on quality improvement and a clear “carrot and stick” approach to hospital reimbursement, it is likely that hospital care will change for the better over the long term. However, with all of the other changes in the health system expected from health reform, the demands (both financial and the increased numbers of patients needing services) on hospitals and physicians – especially Primary Care Physicians – are likely to be significant, if not chaotic.

It remains to be seen if we can improve quality and reduce cost while providing insurance coverage to millions of additional Americans.

This article is condensed and originally written by ,  at About.com Guide   


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I just pulled up some lyrics from a song called Count My Blessings from Nas & Damian Marley.  I will just focus on the part that is related to health insurance.  For those of you who don’t know Damian Marley, he is the son of the legendary Bob Marley.  His lyrics are as follows:

-I’ve got love and assurance
-I’ve got new heath insurance
-I’ve got strength and endurance
-So I count my blessings

The lyrics have a lot of things that Damian Marley is thankful for, but he does include health insurance as one of his blessings. 

For those of us with health insurance, I think we can relate that we are thankful for our health insurance coverage.  It lifts a burden off of us.  Those with out insurance or with out the proper kind of health insurance are still burdened with their “what ifs”.  Health insurance can be low cost and having health insurance is better than not having it.  Please don’t wait until last minute to take care of your health.


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Broken Pledge: An early draft of regulations written for the health care overhaul estimates that more than half of U.S. workers will see their medical insurance change. Funny, that’s not the promise we remember.

Late last week, reports surfaced that an 83-page White House document had been leaked from the White House. If the rules included in this draft are promulgated, the health plans of 51% of workers will be subject to change within three years.

In the new system, companies that modify employee coverage after Jan. 1, 2014, will lose their “grandfather” status and be forced to comply with ObamaCare rules. This means they will have no choice but to buy plans that will cost more because the law says they must include expanded coverage.

Changes in plans that would cause a company to lose its grandfather status can be as modest as a small shift in the co-payment amount or in the employees’ contribution to the coverage. By merely asking workers to share a bit more of the burden, companies will have to buy new plans.

Many Americans are likely to find the added coverage of the new plans unnecessary for their needs and the extra costs taxing to household budgets. How many who liked their plans will have new ones forced on them by a bureaucracy that’s not equipped to make decisions for people it doesn’t know?

According to the midrange estimate cited in the White House document, small businesses will be hit hardest. Two-thirds of them “will relinquish their grandfathered status by the end of 2013″ while 45% of large employer plans will be affected.

“In the worst-case scenario,” reported IBD’s Sean Higgins and David Hogberg on Monday, “69% of employers — 80% of smaller firms — would lose that status, exposing them to far more provisions under the new health law.”

Are the bureaucrats writing these regulations unfamiliar with the promise President Obama made repeatedly last year: “If you like your health care plan, you can keep your health care plan”?

Did they know that Linda Douglass, the White House fixer who said it was her job to “keep track of all the disinformation out there about health insurance reform,” assured the public that Obama was sincere when he said that? The answer to both is an emphatic yes.

So why write regulations that break a presidential promise? Because that promise was never meant to be kept. Like all the misrepresentations about cost, it was meant to mislead the public and generate support for, or at least blunt opposition to, a government takeover of the health care sector.

Article Posted from Investors.com

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Documents obtained by Fortune and published on CNN show that AT&T and other major companies — including Verizon, Deere and Caterpillar — considered eliminating their employee benefits program and simply paying a fine to the government for those they employed without insurance. The fine for AT&T would have amounted to $2,000 per employee, costing the company a grand total of $600 million a year. Maintaining benefits, meanwhile, will cost the firm some $4.6 billion.

Democrats apparently canceled hearings into the companies practices when they received the documents and learned that such hearings might expose a major flaw in their health insurance overhaul: namely that companies might pay a fine rather than provide benefits for employees because the fine would be dramatically cheaper. They’ve had the documents for roughly a month, Fortune magazine said.

Verizon commissioned a study examining the effects of various healthcare bills under consideration on their bottom line. The study, prepared by a consulting firm, asserted, “Even though the proposed assessments [on companies that do not provide health care] are material, they are modest when compared to the average cost of health care.”

To avoid added costs, the study said, “employers may consider exiting the health care market and send employees to the Exchanges.”

Caterpillar and AT&T examined what they believed would be an increase in insurance costs as major drug manufacturers, insurers and medical device makers shifted costs from new taxes they were going to pay onto health insurance clients.

“Caterpillar and AT&T actually spell out the cost differences: Caterpillar did its estimate in November, when the most likely legislation would have imposed an 8% payroll tax on companies that do not provide coverage,” CNN’s Shawn Tully wrote late Wednesday. “Even with that immense penalty, Caterpillar stated that it could shave $25 million a year, or almost 10% from its bill. Now, because the $2,000 is far lower than 8%, it could reduce its bill by over 70%, by Fortune’s estimate.”

On the flip side, health insurance companies have argued the penalties for not carrying insurance are too small. They posit that some Americans will decide to pay a fine rather than carry insurance because the fine is cheaper, and they figure they can buy insurance when they get sick (since insurers will be banned from denying coverage based on pre-existing conditions).

None of the companies have confirmed they are actively considering dropping benefits for employees. Many businesses see health and other benefits as important factors in helping them hire and retain talented workers.

But the costs to the US government if they did would be enormous — another reason why Democrats may have canceled hearings on the matter.

“By Fortune’s reckoning, each person who’s dropped would cost the government an average of around $2,100 after deducting the extra taxes collected on their additional pay,” Tully wrote. “So if 50% of people covered by company plans get dumped, federal health care costs will rise by $160 billion a year in 2016, in addition to the $93 billion in subsidies already forecast by the” Congressional Budget Office.

This article is posted by By John Byrne.

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Canada’s dysfunctional universal health care system is coming to America courtesy of the democratic-controlled Congress and the Obama administration.  Canada’s governments are desperately scrambling to find ways to cut costs. Canada backs away from the socialistic system that is bankrupting it.

“A few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery, Reuters reports. “It’s likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036.”

The provinces that administer the Canadian healthcare system are not on the level of health care in America today.

Quebec only starting thinking about acquiring medical evacuation helicopters for human beings after the tragic death last year of actress Natasha Richardson, who suffered a traumatic brain injury while skiing at Mont Tremblant resort.

There’s got to be some change to the status quo whether it happens in three years or 10 years. We can’t continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services. At some stage we’re going to hit a breaking point. Said Derek Burleton, a senior economist at Toronto-Dominion Bank

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And here we go…aren’t those people that thought this would be “FREE”, going to be surprised.

  You really need to read this……starts next year

This is part of the new Health Care Bill.

Go to www: thomas.gov ; enter HR3590 in the search
Box and look for summaries. 

Starting in 2011 (next year folks) your W 2 tax form sent by your employer
Will be increased to show the value of what ever health insurance you are
Given by the company. It does not matter if that’s a private concern or
Governmental body of some sort. If you’re retired ? So what; your gross
will go up by the amount of insurance you get.

  You will be required to pay taxes on a large sum of money that you have
Never seen.

Take your tax form you just finished and see what $15,000 or $20,000
Additional gross does to your tax debt. That’s what you’ll pay next year.
For many it also puts you into a new higher bracket so it’s even worse.

This is how the government is going to buy insurance for 15 % that don’t
Have insurance and it’s only part of the tax increases.

Not believing this I researched the summaries and here’s what I’m reading:

On page 25 of 29 :

9001 , as modified by sec. 10901)
Sec.9002.  “requires employers to include in the W-2 form of each employee
The aggregate cost of applicable employer sponsored group health coverage
That is excludable from the employees gross income.”

Joan Pryde is the senior tax editor for the Kiplinger letters. Go to
Kiplingers and read about 13 tax changes that could affect you. Number 3 is
What I just told you about.

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On Thursday April 29th 2010, Los Angeles-based Anthem withdrew plans their plans for the increase. (I’m sure that  those Anthem members will be thrilled for joy)

Appearenlty Anthem rationalization for raising premiums was based on flawed data.

The decision also came one day after Anthem’s parent, Wellpoint, Inc. of Indianapolis, announced its first-quarter profit soared by 51 percent.

“The current application that was withdrawn today (Thursday) was just flawed,” Poizner said. He added that it contained mathematical errors and in some instances double counting of data. (Lovely)

Neither Poizner nor Anthem officials said just how big the insurance giant’s next proposed increase would be. (Can’t wait to see that)

“You can count on this,” he said. “A 25 percent average rate increase up to a maximum of 39 percent rate increase, that’s not going to happen in California.”

U.S. Secretary of Health and Human Services Kathleen Sebelius praised Anthem’s decision to withdraw the rate hike.

“Today’s announcement is good news for the more than 800,000 Californians who could have been hit with massive rate increases and gives them some much-needed temporary relief,” Sebelius said.

WellPoint operates Blue Cross Blue Shield plans in 14 states. Anthem Blue Cross is the trade name of Blue Cross of California. (Ah yes… capitalizm at its finest)

Anthem said policyholders will be notified at least 30 days before they go into effect and current rates will remain unchanged until then and Poizner said state insurance officials will review the change to make sure it adheres to all state statutes. (We the people, by the people….humm)

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Today in Los Angeles more than 5,600 people are expected to show up for a free seven-day medical and dental clinic at the Los Angeles Sports Arena, starting today.

Organizers handed out 5,599 wristbands Sunday to people — some of whom waited in line overnight — for a shot at getting free medical, dental and vision care. The number of people lining up for the free clinic was overwhelming. Organizers agreed to accept additional patients when they realized people were still lined up outside the Sport Arena when they stopped handing out wristbands Sunday.

The clinic hopes to treat up to 1,200 patients each day. Many of its other clinics are held in rural areas or undeveloped countries.

In August 2009, a free eight-day clinic at the Forum in Inglewood and treated more than 6,000 people, but others were turned away.

This free clinic is comprised of volunteer health care professionals, will set up 40 medical exam rooms, 100 dental chairs and 30 eye exam stations and will provide full medical examinations, including mammograms, PAP smears, chest x-rays, diabetes screening, blood pressure screening, dental examinations including cleanings, extractions, fillings, restorative procedures and root canals, prescription eye glass fittings and cataract surgery.

Attendees will not be required to show proof of income or insurance. About a third of Los Angeles County residents have no health insurance. If you need to get insurance please call us at 818-887-8780 to get a free quote and not have to wait for free healthcare.

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