Health Insurers Raise Some Rates by Double Digits
By REED ABELSON
Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.
Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.
In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.
In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.
The proposed increases compare with about 4 percent for families with employer-based policies.
Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.
The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.
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Baby boomers with no place to call home
Shelters are seeing a surge in older men with age-related illnesses, a trend that could have implications for how we shape public policy.
He’s 55 years old, the average age of the men in the room. They’re allowed inside the shelter a half-hour early, so they can avoid the long lines in sub-freezing temperatures, and they sleep on cots rather than the standard floor mats.
Jones, who first became homeless five years ago after a bank foreclosed on his Belfast farm, suffers from degenerative disc disease and mental health problems that emerged after he lost the farm. He says he’s seeing more and more people in the shelter who, like him, also struggle with health issues.
“It’s the older folks,” he says. “The older generation is growing.”
The demographics at the shelter – increasing numbers of older men with physical and mental health problems – are indicative of a national trend that has implications for public policy, according to Dennis Culhane, a professor of social welfare policy at the University of Pennsylvania who has done extensive research on the demographics of the nation’s homeless population.
The chronic homeless are aging, he says, but the data does not exactly mirror the overall aging of the nation. Rather, there is one group – men born between 1954 and 1966, the baby boomer generation – who are nearly twice as likely to stay in a homeless shelter than any other age group.
This group was first identified in the 1990 Census, when they were around age 30. They appeared again in the 2000 Census, when they were around age 40, and again in 2010, when they were around age 50. In each decade, that generation of men had the highest risk of experiencing homelessness.
The shelter staff has noticed the trend as well. While the shelter has always seen a significant number of older male clients over the years, a much larger percentage now are also experiencing acute physical and psychological problems, problems that often come with age, says shelter director Josh O’Brien.
In 2002, men between the ages of 47 and 59 stayed at the shelter an average of 31 nights. In 2012, men in the same age group stayed an average of 53 nights.
They are staying longer because the economy has worsened, budgets for programs aimed at helping the poor have been cut, and many of the men have debilitating health problems that are exacerbated by life on the street, O’Brien says.
“It’s a deadly combination for the men we serve,” he says.
Some of the men who come to the shelter are being discharged directly from hospitals. In the five-month period between June 1 and Nov. 30, 2012, a total of 142 people at the Oxford Street Shelter reported having been discharged from hospitals, including Maine Medical Center and Mercy Hospital in Portland, and Spring Harbor, a psychiatric hospital in Westbrook.
The shelter’s medical dorm didn’t exist a year and a half ago, but is now full. To keep up with demand, O’Brien last week went to Scarborough to buy five more cots at Cabela’s, a hunting supply store. The shelter now has 39 cots set aside for people who are too sick to sleep on floor mats.
Culhane says many of the chronic homeless are young baby boomers who came of age during the back-to-back recessions in the late 1970s and early 1980s. Older baby boomers had taken the best, highest-paying jobs, and housing supply was tightening, he says.
Unable to find work, some of the homeless got involved in the growing underground drug market, in particular crack cocaine. Many ended up in prison, where they became estranged from their families, he says. Others would spend the rest of their lives cycling between unemployment and occasional stints in menial, low-paying jobs.
The combination of substance abuse, loss of family support and economic displacement became defining factors that affected those men the rest of their lives. The impact, Culhane says, has implications both for their own lives and for society.
Turns out there IS a doctor in the House
Well, three, actually, and another in the state Senate. Together with other medical professionals, they make up a powerful bloc as Maine confronts its health care future.
As a family physician practicing in Skowhegan for more than 30 years, Dr. Ann Dorney knows all too well the mounting challenges of providing health care in Maine.
“I know more than I want to know about opiate addiction in central Maine,” Dorney said in a recent telephone interview from her home in Norridgewock.
Dorney will count on first-hand experience as she assumes a new role as state representative of House District 86 in the 126th Maine Legislature, at a time when health-care reform and social service issues dominate the political landscape and public discourse.
Dorney, a Democrat, is one of four medical doctors who will serve this session – the highest number since six physicians served in 1933 and the same number as in 1935, according to records culled by librarians at the Maine State Law and Legislative Reference Library.
The doctors are leading an effort to build a health policy caucus of legislators who want to develop bipartisan solutions to health care issues. They are among 14 legislators who work in health-care or social-service fields, a group that includes two emergency medical technicians, a pediatric nurse practitioner, a social worker, a family therapist, a dental hygienist and a pharmacist.
House Speaker Mark Eves, D-North Berwick, a family therapist, believes legislators with professional experience will bring additional clout to simmering debates related to the federal Affordable Care Act and health-care reform in general.
The issues are complex and range from increasing demand for social services and mental health care, to the possibility of expanding Medicaid coverage provided through MaineCare. Eves compared the potential influence of health-care and social-service professionals to that of business owners on economic development and farmers on agricultural concerns.
“There are big things happening in health care and social services today, and these are individuals who care about their communities,” Eves said. “They understand how the system works and know what can be improved.”
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Individual mandate in healthcare was year's top consumer story
In a split decision, the Supreme Court this year upheld the individual mandate, the cornerstone of President Obama's healthcare reform law.
David Lazarus
December 30, 2012
This was the year of the healthcare mandate. No other consumer story of 2012 comes close.
In a split decision, with Chief Justice John G. Roberts Jr. casting the deciding vote, the U.S. Supreme Court upheld the cornerstone of President Obama's healthcare reform law, the most sweeping overhaul of our dysfunctional medical system in decades.
The so-called individual mandate requires that most people have health insurance. It's the trade-off for the insurance industry's agreement to stop denying coverage to people with preexisting conditions and to stop charging higher rates if you get sick.
It's also the trade-off for insurers to remove limits on how much treatment they'll cover annually or over your lifetime.
"It's a huge deal," said Lee Goldberg, vice president of health policy for the National Academy of Social Insurance, a Washington think tank. "Without the mandate, you're much more likely to have spiraling healthcare costs and an unsustainable market for coverage."
Critics of the mandate, and there are plenty of them, say it represents a government takeover of healthcare, a socializing of medicine. The government, they say, can't make you buy something you don't want.
But that's not how the mandate works. No one's forcing you to buy insurance. No one's forcing you to be covered.
However, there will be a tax penalty if you decide that you want to take your chances. And there's a very good reason for this: Taking your chances is foolish.
Unless you're Superman, you're going to need healthcare at some point in your life. That's just a fact.
The Hoax of Entitlement Reform
It has become accepted economic wisdom, uttered with deadpan certainty by policy pundits and budget scolds on both sides of the aisle, that the only way to get control over America’s looming deficits is to “reform entitlements.”
But the accepted wisdom is wrong.
Start with the statistics Republicans trot out at the slightest provocation — federal budget data showing a huge spike in direct payments to individuals since the start of 2009, shooting up by almost $600 billion, a 32 percent increase.
And Census data showing 49 percent of Americans living in homes where at least one person is collecting a federal benefit – food stamps, unemployment insurance, worker’s compensation, or subsidized housing — up from 44 percent in 2008.
But these expenditures aren’t driving the federal budget deficit in future years. They’re temporary. The reason for the spike is Americans got clobbered in 2008 with the worst economic catastrophe since the Great Depression. They and their families have needed whatever helping hands they could get.
If anything, America’s safety nets have been too small and shot through with holes. That’s why the number and percentage of Americans in poverty has increased dramatically, including 22 percent of our children.
What about Social Security and Medicare (along with Medicare’s poor step-child, Medicaid)?
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