In Part I, we discussed the first three major areas of HB and SB 5. In this post, we’ll explore the other two areas under consideration. To refresh your memory, these would be:
- Health care providers would be required to provide consumers advanced notice of health care services costs
- Proposes an analysis of a high-risk pool as a health insurance option for uninsured Ohioans, and further analysis of how to increase participation in small employer purchasing alliances.
The first item is interesting. According to my friend Bob in Hotlanta, this is being proposed in Georgia, as well: SB83 would “require hospitals and medical facilities to provide estimates of charges to patients.” I’m kinda ambivalent about this. On the one hand, when I walk into McDonald’s, there’s a sign that tells me how much that Big Mac is going to cost. So how come I can’t walk into my doc’s office and get the same thing?
Well, for one thing, everyone pays the same amount for a Big Mac; i.e. there’s no “Burger Network” or HMO. But based on contracts and negotiations, there may be a significant variation in what different patients pay, depending on with whom each is insured (just ask Anthem insured’s going to their Premier doc’s).
Finally, it’s interesting – and a little frustrating – that Ohio is one of the few states that do not currently have a high-risk pool for uninsured folks. Certainly the market is profitable enough to support this (such pools are generally funded by insurers writing business in a given state). So that’s a positive development.
I’m reserving judgment on the employer purchasing alliances. There’s an awful lot of misinformation out there about these. For one thing, they look a lot like MEWA’s to me. For another, I have often been struck by how many people buy into the “low group rate” mantra, without understanding that this is a classic oxymoron. Benefit for benefit, group plans are generally MORE expensive than individually issued plans. Why? Well first, because of the state mandated benefits built into such plans (see Part I below). Chief among these is maternity coverage, which is almost always excluded under individual plans. Finally, group insurance is guaranteed issue; that is, except for certain marketing restrictions (minimum size, participation, industry type), group carriers must issue plans to even sickly groups with high claims. Individual plans can exclude conditions, and even decline coverage.
This is definitely the “must-watch” legislation of the current session.
I agree with your point about "posted pricing" and the comparison to Mickey D, but I dont believe consumers are capable of making value-related decisions for medical care. We have an entire society of consumers, not just in health care, that seem to be price motivated. They have a Walmart mentality and want stuff that is cheap.
ReplyDeleteThere are several old jokes about using someone who is cheap for medical services, and at least one current TV commercial. I believe the company is in the financial services industry and is promoting a full service approach as contrasted with DIY financial planning. The opening scene shows a doctor in scrubs taking a call at a nurses station. All you see and hear is the docs side of the dialogue. Doc says something like "Have you sterilized the area? Good! Now make a 4 inch incision . . ."
Cut to the person on the other end of the line. You see a fellow sitting at the kitchen table with a knife in hand, ready to make an incision.
Point being, there are some things you just shouldn't be doing alone, surgery being one of them.
My point?
Consumers need help in making the right decisions, both in the purchase of insurance products and in helping them decide on the quality of care. In the movies you see people say "I don't care how much it costs, doc . . . just do what you can to save her."
Funny how seemingly mundane items like lab work is OK to price shop, but when a crisis happens money is no problem.
And your comment on MEWA's, HPA's and other "group" plans is on target. I have had several MEWA's as clients in the past, most of which were either Taft-Hartley plans or professional associations with a few staff leasing companies thrown in for good measure. Some of them were managed very well, but too many (of my non-clients) were not. Laws in most states (which actually have no legal jurisdiction over ERISA accounts) have all but eliminated most of the abusive trusts (MET's) & MEWA's. In their place are state (and federal) legislative benefits that have just made health care more expensive.
Lately, many of my clients are those who had coverage under an employer sponsored group plan, but found it prohibiitve to pay $800 per month for dependent coverage. Instead, they find they can get the coverage they need for something more affordable, like in the car payment range vs a mortgage payment.
Have I ranted enough?
Say goodnight, Gracie . . .