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Insurance Issues, Principles & Solutions
[Welcome Industry Radar readers!]
I’m normally fairly circumspect when writing these blogs, but this time I may make an exception. I’m pissed. Blue Cross of California (shortly to be known as Anthem Blue Cross) just announced rates for their Small Business plan focal renewal. These will also be the base (aka "standard") rates for both new business and for renewals from May 1 forward. (Before all California readers panic, the focal renewal only applies to plans originally purchased prior to December 2003. Plans purchased after that won’t see these increases until their normal annual renewal. This also only applies to the Small Business plans, not individuals or groups with more 50 employees)
A bit of background…After years of incessant price increases, Blue Cross announced last November that the average January rates would decrease by roughly 5%. HSA policies would stay flat. Amazing. Finally a bit of stability in this slightly insane business. Needless to say, quite a few clients switched to Blue Cross.
Roll tape forward to now, roughly six months later. Average rate increase statewide: 15.4%. Average increase for HSA and HIA plans: 25.4%. Increase for their most popular plan, the Luminos 1500 HSA plan (and the one I'm on!)? A breathtaking 32%.
Thanks guys.
The increase for the Luminos 1500 wasn’t a surprise. The magnitude is. There's a good reason that it’s one of their most popular plans…it’s the best plan for the premium dollar, and with a low out-of-pocket maximum, it’s even a better deal if a serious medical condition is present. That was obvious to anybody who looked at the plan design. But if that was the case, why hold it at ZERO increase in January, and then go up 32% five months later????
What precisely changed? Is the actuarial department that out to lunch? Or are we looking at marketing games?
The same question applies (although not quite as bad) to their traditional PPO and HMO plans. To go from a 5% decrease to a 12% increase is disconcerting. A carrier should be able to forecast better than that. The typical excuses: The aging of the population causes increased utilization. There are increases in the cost of medical technology. Drug prices went up again. All are true. But we’re talking about a five month period here. And how did these last five months differ from the preceding period, where the rates were held stable and/or declined?
Stability and predictability is incredibly important. I have clients who switched to HSA plans that will now have their budgets completely blown….even after I advised to factor in a 12-15% annual increase in benefit expense. Goodwill generated by the rate decrease just vanished in a large cloud of oily smoke. I think I’m going home and work in the garden.

Significant goings-on up north. The Castonguay Report is released - see the Toronto Star.
Signficant because, at least in Quebec, the provincial health system is characterized as “overburdened,” “wheezing” and “near a crisis point” - because it can “no longer sustain the annual growth in health-care costs.”
Cheese, really? In Canada?
Significant also because the Castonguay Report recommends that Quebec adopt strategies that the evil American insurance companies use - - increase premiums (i.e., taxes) and reduce benefits (i.e., copays and deductibles). Predictably, unions fiercely oppose these strategies and meanwhile there is a shortage of doctors.
Sounds familiar. But in Canada??
The article notes that “The province currently spends about $24 billion annually on health care, or about 40 per cent of its budget.”
Well, now. The 2007 population of Quebec was about 7,720,000. Its $24 billion annual expenditure on health care is equivalent to $3,100 annually per capita. If U.S. federal health care spending were 40% of our budget, the U.S. would raise about $1.6 trillion anually to finance health care spending - - or around $5,400 per capita.
So the Canadian per capita number seems 43% less than the U.S. number. Is so large a difference the result of superior Canadian health care management? Maybe it is. But what if not?
What if, just maybe, this difference really measures how easily health care demand rises to meet the supply of money? What if, just maybe, it demonstrates that the American economy is able to supply substantially more health care per capita than Canada’s? And what if the difference mainly means Americans demand substantially more health care than Canadians? Might that explain, for example, the more immediate availability of hospital and specialty care in the U.S.? If the higher level of health care supply in the U.S. is bad, does that mean the higher level of health care demand is also bad? If so, who shall be punished for this?
A primary-care physician in New Hampshire recently had this to say:
“[Political candidates] talk about universal health insurance. But two of the greater issues would be cutting health-care costs and revitalizing primary care.”