Employer Rules for PPACA Grandfathered Health Care Plans

Rules for Employers with Grandfather Exceptions for the Health Care Mandates

The Patient Protection and Affordable Care Act mandates that employers with health care programs meet certain requirements for employee participation, coverage limits, and treatment of pre-existing conditions upon enrollment. Having just spent the past few days studying the grandfather provisions for the health care reform implementation in 2014, this article is meant to provide a bit of illumination to any confused employers or their staff. Generally grandfathered group health care programs will have a calendar year or a fiscal year plan renewal date. Since this is the time when changes are introduced each year, if a plan has a June anniversary date, it would have had to apply for grandfather status by the June 2011 anniversary. Hence the first anniversary of a grandfathered plan is likely to have occurred by now and this is the time when a plan administrator may be required to show the plan meets the PPACA requirements.

What is NOT Affected by the Grandfather Provision

Provisions which are unaffected by the grandfather provision are lifetime benefit limits and the rescission rules. Rescission rules allow insurance companies to retroactively cancel insurance contracts due to fraud. Individual insurance contracts can have benefit limitations, which can be maintained in the contracts after January 1, 2014. Insurance companies must now meet certain standards in order to cancel a contract retroactively; specifically they must show the individual insured intentionally defrauded the insurance company at the time of the application.

Grandfathering Election-Opting Out of the Mandates

In order to opt out of the insurance mandates, employers can elect to have their current health care plan arrangement remain in force until January 1, 2014, when all plans must comply with the PPACA requirements.  However, the grandfather rules are murky and this article highlights some of the sticking points. The main reasons employers may choose to keep their current plans in force and wait out the health care reform implementation are to save money, avoid some of the mandates, and aversion to change.  Unfortunately once an employer elects to grandfather an existing health care program, there are strict rules which must be followed, subject to reporting, and audited by the government.  Let’s examine what these requirements are: disclosure and documentation, phase-in levels for lifetime benefit limits, measuring benefit parity, assessing increases in employee copayments, and calculating employee cost sharing increases.

Disclosure and Documentation

Presently under the ERISA rules, employers who have health & welfare plans are required to provide employees with a Summary Plan Description of plan benefits, identification of the plan administrator, and other pertinent contact information. The PPACA expands on these mandates by requiring documentation of the Patient Protection Provisions such as disclosure of patient rights for emergency room parity, parity between in-network and out-of-network cost sharing for certain services, and the ability to self designate a personal provider for pediatrics or OBGYN without a referral. The insurance company who has the contract will incorporate these mandates into the annual Summary Plan Description as it does for all other state and federal requirements.

Calculating Benefit Parity for Your Plan

To establish benefit parity there are three methods to assess appropriate levels of plan benefits for non-network services including; contract payment at in-network levels, payment at Medicare levels, and payment at out-of-network benefit levels.  The rule states that whichever method provides the highest benefit payment for the insured is the deciding factor for compliance. There are several ways an employer sponsored medical plan can meet this mandate, including having the same benefit level, such as 80% for all essential services. Grandfathered plans do not have to comply with this provision until 2014.

Phase-In of Lifetime Benefit Limits

Since September 23, 2010 all new insurance plans must offer an unlimited lifetime benefit for essential medical insurance services. Essential services include hospitalization and non-elective doctor’s services among other things. There is a phase-in provision for existing plans, which must comply with this schedule for contract limitations for essential benefits:

October 23, 2011-$750,000

October 23, 2012-$1,250,000

October 23, 2013-$2,000,000

Special Enrollee Provision

If you are one of the unfortunate thousands of people who have maxed out on their insurance contract benefits, you may now enroll on the group insurance plan via the Health Insurance Portability and Accountability (HIPAA) rules. Also the group insurance rules do apply to an individual plan if it was obtained when a group insurance plan was cancelled. The HIPAA rules stipulate that the individual must have 18 months of creditable coverage from the group plan in order to be eligible. HIPAA also stipulates the insurance company may only look-back six months to determine a pre-existing condition and the exclusion period cannot exceed 12 months for those conditions. And finally, in order to secure the provision, the individual must not have had a break-in-coverage longer than 63 days. The previous employer (if this is the case) must notify the newly eligible special enrollee with a 30 day window for re-enrollment on the group medical plan. Anyone who has maxed out of the prior contract benefits must be notified of this right to re-enroll.

Limits on Increasing the Deductible or Co-payments for Grandfathered Medical Insurance Plans

If your firm has elected to grandfather its health insurance plan, the ability to increase the plan deductible between 2010 and 2014 is limited to the CPI or Consumer Price Index plus 5% per year.  Co-payment increases are limited to a $5 increase per contract year.  And finally, a decrease in a benefit, such as the emergency room benefit of more than 5% may disqualify the plan. Anything larger than any of these thresholds is likely to trigger a disqualification of the grandfathered exception.

Pre-Existing Condition Waiver Rules

All plans must comply as of January 1, 2014 with removal of any pre-existing condition clause for enrollees. However, for children, this restriction was removed as of September 23, 2010.

Transitional Rules for Cost Sharing

The Accountable Care Act allows the employer to elect to change the non-fixed cost sharing arrangement in the medical plan without losing its grandfathering status. Changes made after March 23, 2010 and adopted by June 14, 2010 are OK until the next plan year. The formula for calculating the acceptable zone for a fixed-amount cost sharing scenario is as follows:

1.        Determine the CPI based index ($387.14 in 2010)

2.       Add the CPI factor to this base

3.       Convert to a percentage increase

4.       Determine the net allowable increase

5.       Generally a maximum of 15% is an allowable increase

The easiest way for an employer to avoid this hassle is simply to change its group insurance plan from a fixed amount cost sharing formula to a percentage cost sharing formula. In the years when I was in the benefits brokerage business, all of my clients had a percentage co-payment arrangement anyway. The government probably had to come up with this formula for certain industries, a necessary complication I suppose.

Rules to Avoid Disqualification of a Grandfathered Medical Insurance Program

The rules are fairly straight forward here including:

1.       Benefits may not be reduced below allowable levels

2.       Essential benefits may not be eliminated

3.       Increases in co-payments may not be increased beyond the stated level

4.       Employer contributions to the medical plan may not be reduced beyond the allowable level

5.       Annual benefit limits must comply with the phase-in schedule

6.       Documentation of plan benefits must comply with the new rules

7.       Evasion of compliance or overtly attempting to usurp the standards is not allowed

For What it’s Worth-Professional Education for Insurance Agents

I spent about three days studying a college level course on the Accountable Care Insurance Mandate Requirements in order to become familiar enough with the rules to pass a Washington State approved continuing education course exam for renewal of my insurance license. Though I no longer sell insurance, I do keep my license current to competently critique the field. I was actually surprised by the rigor of the course material, but it should be noted that insurance agents can choose to sit in seminars where no testing is required to meet the continuing education edicts or they can opt for less challenging material.  Washington State requires 24 hours of continuing education to renew a life and health (disability) insurance license every two years. Not all states require this much rigor, but most states have some education requirement in order for the agent to renew his or her license. And the good news is, for all of those who hate federal edicts; these requirements are determined by each state, with an elected insurance commissioner. The only exception to this is for those representatives who sell Medicare supplement contracts, who must undergo even more rigorous education and marketing oversight, which are nationally mandated. The latter is also a good thing, as the elderly are vulnerable and the Medicare program is paid for with our tax dollars, so oversight is warranted.

This is the healthpolicymaven signing off, license in hand.

This article may be reprinted with the permission of Roberta E. Winter, MHA, MPA.

Supreme Court Reprieve for U.S. Health Care Reform

Despite the best efforts of health care reform detractors, the Supreme Court looks to have upheld the insurance mandate provisions as well as much of the rest of the edicts. A closer look at the impact on the Medicaid equalization will come after July 5th, when I return from holiday.
Bon Voyage!
healthpolicymaven

Health Care & Public Policy Books Worth Reading

Having served as a health care and public policy book reviewer for the independent New York Journal of Books, I thought I would share some of the "good reads," with you as NYJB is closing its site.
My latest review, "Breasts, A Natural and Unnatural History," by Florence Williams is featured on the banner page for the site. It is a historical, scientific, and anthropological review of breasts, sociologically, scientifically, and as a bell weather for toxins in our society. Florence Williams will be in Seattle this month reading from her book.
http://www.nyjournalofbooks.com/review/breasts-natural-and-unnatural-history
The best book I have read about the long term problems in United States health care delivery and what the 2010 reforms may mean is "The Battle Over Health Care, What Obama's Reforms Mean," by Rosemary Gibson and Janardan Prasad Singh. Singh is an economist with the World Bank and Gibson is formerly with the Robert Wood Johnson Foundation, so the book is a nonpartisan review.
 http://www.nyjournalofbooks.com/review/battle-over-health-care-what-obama%E2%80%99s-reform-means-america%E2%80%99s-future
Another health care book I highly recommend was written by, Jonathan Wolff, Director of Philosophy, Justice, and Health at University College in London, is "The Human Right To Health," an Amnesty International Global Ethics Series, which explores global health and some of the perversions that happen because of self interest and misguided efforts of public/nonprofit entities.
 http://www.nyjournalofbooks.com/review/human-right-health-amnesty-international-global-ethics-series
Health Professionals and Trust: The Cure for Health Care Law and Policy, by Mark Henaghan, a New Zealand Professor shines the light on how government rules and their administration can interfere with patient safety, among other health care conundrums.
 http://www.nyjournalofbooks.com/review/health-professionals-and-trust-cure-health-care-law-and-policy
El Narco, by Ion Grillo lays bare the morass of the U.S. financed war-on-drugs and is one heck-of-a-ride. Grillo traveled throughout North America, Central America, and South America to research this book.
http://www.nyjournalofbooks.com/review/el-narco-inside-mexico%E2%80%99s-criminal-insurgency
And finally, Robert Pelton's, "Licensed to Kill, Hired Guns in the War on Terror," exposes how war and insurgency is financed globally and is highly profitable to a select few.
 http://www.nyjournalofbooks.com/review/licensed-kill-hired-guns-war-terror
Here is a nod to these thought provoking writers in a time of national attention deficit.
Thanks for reading my column and more importantly, thanks for reading books. To those of us who don't want to surrender our humanity to the "Snookies" of the world this is the healthpolicymaven encouraging you to buy books which raise our consciousness, not dull it

Why We Don't Want To Get Rid of Medicare-Our Best Tool for Health Care Reform

Why We Don’t Want To Get Rid of Medicare-Our Best Tool for Health Care Reform

The pressure is on for federal budget slashing and of course social programs (not defense) are top-of-the-list for cost reductions, including the malignant call for block granting the Medicare program. Having previously analyzed the Bush Administration’s Deficit Reduction Act of 2005, including the odious federal government, “claw back provision” for reducing federal contributions for state Medicaid programs, this article reviews some potential impacts of a block grant or per capita allowance for Medicare participants. Parallels are drawn between the Medicaid changes and what may happen to Medicare if it is schlepped to the states. Finally, Medicare’s impact on overall health care policy making in the United States is analyzed.

Would Block Granting Medicare Look like the Medicaid 1115 Waiver Plans?

As of 2005, half the states already had approved Medicaid 1115 plans including: Alabama, Arizona, Arkansas, California, Colorado, The District of Columbia, Florida, Georgia, Idaho, Illinois, Maine, Massachusetts, Michigan, Missouri, New Jersey, New Mexico, New York, Oregon, Puerto Rico, South Carolina, Tennessee, Texas, Utah, and Washington. Oregon is famous for its health care plan which assesses a clinical and cost/benefit value for treatments covered by its subsidized public health care program. Most of the other states with Medicare 1115 Plans have eliminated benefits under the programs or drastically cut enrollment for poor residents. By example, Missouri eliminated 500,000 people from its Medicaid program. Many of the states with Section 1115 waivers used the provision to charge co-payments and premiums to certain Medicaid eligible constituents.

Impact on Drug Costs-Zip

In addition to cutting back on benefits, one of the trends for state implementation of Medicaid 1115 Waiver Programs is to pass more of the prescription drug costs to their plan participants. This does nothing to contain costs and merely makes low-income people pay more for their medicines. Medicare is also doing this with its drug program, by allowing pharmaceutical companies to charge retail market prices (the highest-in-the-world) for drugs while offering “discounts” to Medicare participants. It doesn’t take a rocket scientist to figure out that the pharmaceutical companies just raise their prices to include the “discounts” to the Medicare set.

Side effects of Medicaid 1115 Waiver Programs

Deferring Health Care

One of the provisions that Medicaid 1115 Opt-Out Plans can make, is to transfer more plan costs to the poor who are enrolled on these plans, however, that may mean people avoid medical care. This is a conundrum, though Medicaid enrollees have health insurance, they may not have enough money to contribute to the co-payment requirement. The Journal of Health Affairs published an analysis of the Utah State Medicaid program which showed that cost sharing up to 10% did have a negative impact on the indigent patient’s ability to obtain health care (AKA they deferred treatment).[1]. 

Clinician Access

Patients enrolled on Medicaid plans have insurance, but may not have a primary care clinician who will see them. Merely having insurance does not mean there are clinicians willing to accept those patients.  Medicaid has notoriously been viewed as paying poorly for medical services, although some states have taken steps to alleviate that road block to care. This problem of access to clinical care, especially for wellness or primary care is also rampant for Medicare participants. If they don’t have private insurance, it is very difficult for a Medicare patient to find a clinician who will accept them into their patient mix. This phenomenon is reflective of the poor reimbursement CMS provides for its primary care clinicians.

Another one of the methods that states have used 1115-Waiver provisions to change their Medicaid plans is to offer private insurance coverage, but this is hardly more cost effective, since the administration costs are three times as high as what the Centers for Medicare and Medicaid (CMS) charge, with no cost containment. This could however increase access to doctors who are willing to treat Medicaid patients.

Medicare as the Policymaker for Health Care Treatment and Payment

CMS, which administers health care for Medicare and Medicaid, is by far the largest health care program in the United States. Administrative cost for CMS run about 6%, as opposed to 18% for the private insurance sector. In addition to administering health care programs for the elderly and the poor, two constituents whom the private insurance sector has historically had little interest in insuring, CMS also finances demonstration projects with clinics throughout the country to figure out how to improve health care. An example of such a project is the Advanced Primary Care Demonstration Initiative[2], which is looking at patient-clinician engagement to improve health outcomes and pay clinicians for coordinating well patient care. There are also similar projects for the Accountable Care mandates, which reward clinics that produce better clinical results than those who are more marginal. These efforts are possible with a large enough patient population and an integrated patient tracking system, which coincidentally, is representative of a national health care program.

Fraud Detection-The Government Has the Bigger Stick

Medicare is the number one detector of fraudulent billing for health services in the country and it is essential that this bully pulpit be preserved. In The Battle Over Health Care[3], big pharmacy is now cited as the number one defrauder of the government and hence the United States people, even ahead of the perennial defense industry. Do any of us really trust the drug companies to police themselves, or for that matter any of the medical suppliers? In a fragmented Medicare system fraud detection would be more difficult not less.

Patient Safety-Do You Want to Leave it up to the Private Sector?

 In Rosemary Gibson’s and Janardan Prasad Singh’s brilliant, The Battle Over Health Care, numerous frightening examples abound of drug company, medical device supplier, and hospitals actually harming patients. Perhaps most egregious are the methods some of these companies (most of the abusers are for-profits) use to avoid accountability when they harm patients. A bright spot on this tarnished map is the University of Michigan Health Systems, which has a protocol mandating that its clinicians/facilities which harm patients; take responsibility, offer transparent information on what occurred, offer a settlement to the patient/family(without litigation), apologize, and provider free ongoing health care.[4] It is this type of candor which would go a long way toward improving patient safety in American health care. Imagine clinicians and hospital administrators who fess up rather than lawyer-up.

Conclusion

Though Medicare certainly has its detractors and is not lithe when it comes to adopting changes, it is more economical than any private sector health insurance program, and it covers  high-risk populations like the elderly and those with end-stage renal disease. Medicare drives policy changes throughout the entire United States health care system by determining how it will pay for services. This is ultimately the way the country can start to reduce its health care costs, by negotiating with drug companies, eliminating fraud, and equally important, unnecessary procedures. Because Medicare changes also impact private sector insurance companies, it is an essential component of health reforms and well as other national health care initiatives. CMS, which administers both Medicare and Medicaid, provides the nationwide health care partnership to test and deploy health care program changes. Through this surveillance process we can learn what works for the disparate U.S. health care system and attempt to lower costs and improve not only primary health care, but also preventive care. Too much of the U.S. health care dollar is spent on late-stage disease treatment versus patient health maintenance. If we hope to be competitive in a world economy, we must bring the per capita cost of our health care in line with the rest of the world and turning it over to the private sector foxes is not the answer.

For more discussion on this health care article, feel free to comment below. This article was written by Roberta E. Winter, the healthpolicymaven, and may be reprinted with her permission. Feel free however to share it voraciously with your friends and family.

Also, for those who want to read more of The Battle Over Health Care go to the New York Journal of Books for my review, by following this link: http://www.nyjournalofbooks.com/review/battle-over-health-care-what-obama%E2%80%99s-reform-means-america%E2%80%99s-future

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[1] http://content.healthaffairs.org/content/25/2/532.full

Samantha Artiga, David Rosseau, Barbara Lyons, Stephen Smith, and Daniel Gaylin, Can States Stretch the Medicaid Dollar Without Passing the Buck? Lessons from Utah, Health Aff., March 26, 2006, vol. 25, no. 2. p. 532-540

[2] http://healthreform.gov/newsroom/factsheet/medicalhomes.html

[3] Rosemary Gibson and Janardan Prasad Singh, The Battle Over Health Care, chapter 2, page 24

[4] Rosemary Gibson and Janardan Prasad Singh, The Battle Over Health Care, chapter 13, page 163

State by State Analysis of Health Insurance Exchange Adoption

State By State Analysis of Public Health Service Act Requirements for Employers in the United States

The Public Health Service Act of 2010 requires most employers in the United States to provide group medical insurance for their employees. Employers who choose not to comply with this law will be fined, as authorized in Section 490-H of the Internal Revenue Code. Employers with fifty or more employees are required to offer health insurance to their employees who work, on average, thirty or more hours a week. And the insurance plan must meet certain affordability standards, the employer must pay part of the cost and the plan has to meet certain eligibility requirements for enrollment equity. The global purpose of this act is to increase the proportion of people who have access to health care in the United States.  Evidence of the ability to pay for medical treatment through insurance thus contributes to this goal. The data source for the fifty-state-analysis, came from the National Conference of State Legislatures web site.[1] Also my book, Unraveling U.S. Health Care includes 50-state surveys for health care legislation as well.

Health Insurance Exchanges

Small employers are slated to enroll in regional insurance exchanges by 2014. Large employers may elect to enroll in the exchanges by 2017. The latter is the most intriguing, because initially it is thought that large employers will not choose the insurance exchanges. However, based on my experience as a former insurance broker here are some reasons why employers may ultimately choose insurance exchanges.

1.      1. The insurance exchanges will have federal compliance components built into the design and employers will not have to worry about being fined if they go through that process.

2.      2.  Employers can finance and have their employees enroll in insurance exchange health plans and avoid group health insurance administration hassles by having their employees make individual elections.

3.    3.    The insurance industry will see a shrinking of health care providers over time, especially in some states, so the insurance exchanges will become markets of choice.

4.      4.  Insurance exchanges are slated to include strict criteria for administrative transparency and target levels for allocation of insurance premium contributions to actually pay health care claims(AKA consumers like this)

5.      5.  Applying the law of large numbers, a large association of employers can expect some purchasing power and stability. In any case this is what the insurance industry has been saying for decades.

6.     6.   The insurance exchanges are designed not to discriminate and once again, consumers like that.

States Which Have Authorized Health Insurance Exchanges

Despite the tumultuous cries of calamity about the insurance exchanges, nearly half of the states have already adopted laws to implement them including: Alabama, Arkansas, California, Colorado, Connecticut, District of Columbia, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Nevada, Oregon, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

States Which Have Pending Legislation to Authorize Health Insurance Exchanges

Alaska is working to establish its own insurance exchange. The Georgia governor signed an executive order to authorize a Health Insurance Exchange. Mississippi has a state high risk pool for insurance and it is authorized to serve as a Health Insurance Exchange provider. North Dakota plans to create its own Health Insurance Exchange by 2013, otherwise the federal government will implement one. The Rhode Island governor signed an executive order to create a Health Insurance Exchange on September 19, 2011. The Texas Office of Insurance and the Office of Health & Human Services have partnered together to create its own Health Insurance Exchange. Vermont is working on creating its own state-wide single payer health plan. There are other states with pending legislation, but they were not cited because programs were not yet specified.

States Which Have Outlawed Health Insurance Exchanges

New Hampshire SB 148 became law on July 14, 2011 and it prohibits Health Insurance Exchanges.

It is important to note that a failure to authorize an insurance exchange is not the same as a ban and no other state had banned the exchange as of the end of 2011. Further, nearly all states have accepted money to implement the exchanges, some as much as fifty million dollars, so unless they are planning on giving the money back, they will also be creating their own exchanges.

Exceptions to the Rule

First of all, any employer who wishes to self insurance under the ERISA rules can exempt itself from all of these 2010 insurance plan design requirements. What this basically means is contracting with a third party administrator to pay claims and buying reinsurance through a broker.

Secondarily, the law seeks to provide financial subsidies for small employers who heretofore have had difficulty affording health insurance. This will mean more customers for the profitable insurance industry, which will now benefit by federal government subsidies for customers who are mandated to buy their product.

Thirdly, and perhaps most lucratively, employers who are enrolled or will enroll in “Professional Association Plans” or multiple employer trusts will be able to meet the requirements of the law.  These large employer plans are underwritten and managed by insurance brokerage firms. This is how the large brokerage firms deal with the small business sector; they fit them into their multiple employer association plans.

Though many insurance agents have been whining about the Public Health Services Act, the mandate for this act was promulgated by the insurance industry as a means to avoid obsolescence. Though the national insurance requirement will prove very lucrative for the industry, this does not necessarily mean it will benefit American health care purchasers to the same degree.

This article was written by Roberta E. Winter, MHA, MPA, the healthpolicymaven and may be reprinted with her permission.

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[1] http://www.ncsl.org/issues-research/health/state-actions-to-implement-the-health-benefit-exch.aspx

How Medical Insurance Impacts Access to Health Care in the United States

Without Insurance Access to Health Care is Limited in the United States
Why the Insurance Model Was Chosen for Increasing Health Care Access
One of the things I learned while a student at the School of Public Health and Community Medicine was that people who lacked health insurance also lacked reliable health care. Let us review some of the national data in this regard. In my fifty-state analysis I reviewed the following components for individual health care measures: evidence of employer based health insurance, the state uninsured population, infant mortality and other clinical outcomes. Listed below are the top performers for the criteria, as well as the laggards.

States with the Highest Levels of Health Insurance, Public or Private
Using the latest Kaiser Family Foundation Insurance Survey , the 2010 results show the number one state for health insurance coverage is Massachusetts, with 95% reporting health insurance plans. Massachusetts has been the model for the national insurance exchanges because its state mandate has achieved near universal coverage and is self supporting. Other states deserving honorable mention for securing health insurance for 90% of their residents include: Hawaii, Vermont, and Wisconsin.

States with the Lowest Levels of Health Insurance, Public or Private
Women ages 19-64
In the same survey, the worst state for provision of medical insurance either public or private was Texas, with only 70% of its women reporting medical insurance coverage. The national average for insured women was 80% at the time of the survey. Florida reported that 74% of its adult women had medical coverage. A host of states reported only 75% of their adult female populations had medical insurance including: Arkansas, Mississippi, Nevada, and New Mexico.
Men ages 19-64
The national average for men with medical insurance was 76% by 2010. For Texas men only 65% had medical insurance. Other low fliers for men with medical insurance were: Georgia (71%), New Mexico (67%), and Florida (69%).
Children <18
Across the nation only 50% of our children had health insurance provided through their parent’s place of work. Though 90% of the nation’s children have medical insurance now, 36% of that figure is provided by public programs like Medicaid. For the children’s health survey, Texas also posted an equally poor level of insured children, the lowest in the nation, with 17% of the state’s children lacking medical insurance. This is despite the federally subsidized Children’s Health Insurance Program, so is Texas failing to enroll its children or are their parents making too much money to qualify?
Other states with high levels of an uninsured children included Florida (16%), Nevada (16%), and Arizona (15%). You would think Nevada could come up with something creative like a gambling tax to subsidize health insurance for its residents. Why do some of these states have so many more children without health insurance?
Cost of Deferred Health Care
Since the United States has chosen to finance its health care through a public and private system, the lack of payment for services for the uninsured gets allocated to hospitals and insurance plans. The federal insurance mandate is an attempt to stave the high costs for hospitals and communities from serving the uninsured population. Those states with higher levels of uninsured individuals mean that more health care is either delayed or delivered in emergency settings. Additionally, uninsured patients are not receiving preventive or basic health care. States that are laissez faire place a disproportionate burden on their hospitals to serve uninsured patients and this impacts the overall health care safety net.
Clinical Outcomes
If evidence of insurance is a factor in securing better health care, let’s see what the clinical data shows for these states. Infant mortality is an indication of prenatal and postnatal care and here are the infant deaths per 1,000 babies for the states with high levels of insurance, versus the low levels. These infant mortality rates are drawn from the 2009 Kaiser Foundation Survey. Infant mortality is just one measure of childhood health, but in adherence to brevity I am not going to list the other metrics I used in my full scorecard evaluation.
Infant Mortality
Best in class for both percentage of the population covered for insurance (95%) and the lowest infant mortality rate in the nation at 4.9 deaths is Massachusetts. Way to go mother Mass! This makes their prenatal and postnatal care equal to most of Europe, which is a high standard. And here is how the other well-insured states ranked for infant mortality per 1,000 babies: Hawaii-6.1 deaths, Vermont-5.6, and Wisconsin-6.3. Now let us compare this metric to the states which reported the lowest levels of children with health insurance and here are the infant deaths per 1,000: Texas-6.3, Florida- 7.2, Nevada-6.2, and Arizona-6.6. When you compare the average infant mortality of the states with higher insurance levels to those without, there is a difference of nearly one life per 1,000 babies, which is significant. Also, in case you don’t know, the United States infant mortality rate on average is 47th in the world, behind all of Europe and most of the developed world. And if you don’t already feel bad enough, some countries, including Singapore boast an infant mortality rate which is one third of the U.S. average at 2.31 deaths per 1,000 babies.

As we listen to the harping about Americans not having a right to basic health care, bear in mind that the United States has the highest percentage of children living in poverty in the industrialized world, at nearly one fourth (24%) of our child population. You have to ask yourself, what do our nation’s children have a right to in this wealthy country?

For more information on 50-state performance metrics come to the Northwest Women’s Show on March 2nd to hear excerpts from my book, Unraveling U.S. Health Care.

This article was written by Robert E. Winter, MHA, MPA and may be reprinted with her permission, but feel free to share it virally.

Congressional Wrangling Over Proposed Insurance Exchanges Takes A Nasty Turn

Wrangling Over Proposed Insurance Exchanges and Standard Health Care Benefits Takes a Nasty Turn

Barely recovering from the last congressional gaffe about redefining the rape of a woman in a transparent attempt to get out from under the federal Hyde Amendment criteria for Medicaid payments, the “powers-that-be” have made another mind blowing error in public engagement. In a nutshell and yes, I do mean all of these puns, here is the latest blunder by the Republicans controlling the house.

In a public hearing for testimony on the federal health insurance exchanges and standardized benefits for primary health care, which includes birth control options as benign as birth control pills, no women were allowed to testify at the hearing. It certainly is curious that those who are actually capable of pregnancy are excluded from the hearing. This refusal was despite vigorous opposition by female congresswomen. I actually listened to the hearing in order to believe it. And the woman they refused to allow to testify about the insurance exchange’s proposed standardized women’s health care was a college student. Yah, that is just what we want to discourage in this country, a woman with an education using prudence in reproductive matters.

And if that isn’t enough to befuddle a rational thinker, the reason the committee chairman gave for denying any woman the right to speak was because the meeting was about voting and safe guarding conscience in decision making. Interesting, I wasn’t aware that women lacked conscience, especially when you look at the violent crime statistics. But then again I guess these boys have turned their eyes away from those statistics. One wonders if they also were party to the move to redefine rape of an unconscious woman as a noncriminal event. If this is a matter of conscience, one wonders about theirs.

We are constantly assailed with Republican blather about fighting against big government, yet they seek to prevent birth control services from being covered on private insurance plans. As I have previously reported, several states already have enacted laws which prevent even private insurance plans from covering birth control services. Here are the members of this hall of shame: Kentucky, Missouri, Oklahoma, Idaho, and North Dakota. According to a 2003 Kaiser Foundation survey on contraceptive care, 87% of private employers provided coverage for birth control services, including abortion. So despite the anti-big-government talks, this smacks of big brother to me, or is it daddy?

For more straight talk on health care attend the Northwest Women’s Show on March 2nd, as the healthpolicymaven™ will present findings from her book, Unraveling U.S. Healthcare with my conscience intact.