IN CALIFORNIA
Coverage Makes a Difference When It Comes to Surviving Cancer
Medi-Cal patients with breast, colon, and rectal cancer are more likely to be diagnosed at an advanced stage of disease and have lower five-year survival rates compared to those with other sources of health insurance, according to a survey by the UC Davis Health System. Medicare-Medi-Cal dual eligible patients are the least likely to get recommended treatment for breast and colon cancer.
VA patients have the longest intervals between diagnosis and treatment for breast, colon, rectal, lung, and prostate cancers, but their treatment outcomes compare favorably to patients with other types of health insurance, and they are generally more likely to get recommended treatment.
Researchers were not surprised that Medi-Cal and Medicare-Medi-Cal dual eligible, and uninsured patients were getting diagnosed at a later stage of cancer and had lower survival rates since adverse social factors affect these populations. But the lower quality of care cannot be as readily explained. In light of the rapid growth of Medi-Cal, the findings highlight the need to investigate the disparities in cancer care, according to the study. For more information, visit https://www.ucdmc.ucdavis.edu.
Californians Are Encouraged To Explore Mental Health Coverage
The California Assn. of Marriage and Family Therapists (CAMFT) urges Californians to investigate mental health coverage during open enrollment. Under California law, psychotherapy may be much more affordable than most people assume. The Affordable Care Act and the Mental Health Parity and Addiction Equity Act require insurers to provide behavioral health coverage to treat mental health disorders or substance abuse that is comparable to coverage for treatment of physical health with no annual limits. Despite robust access to affordable mental health care, many policyholders are not utilizing it to their full benefit. Often, the obstacle is a lack of information about the available options. The website, CounselingCalifornia.com, allows consumers to search for local therapists who accept clients with managed care plans.
Covered California Hires External Affairs Director
Covered California has named Kelly Green as director of external affairs. Green will lead Covered California’s legislative policy on health insurance and health care issues. She will advise executive director, Peter Lee and the Covered California Board of Directors on pending legislation and provide testimony on proposed bills when appropriate. Green comes to Covered California from the Assembly Health Committee, where she was a principal consultant, advising on policy issues covering commercial health insurance, Medi-Cal, and Medicare. Before that, she was a regulatory policy specialist for the California Nurses Assn. and deputy director for legislative and government affairs with the state Dept. of Health Care Services. Green graduated with a Bachelor of Arts degree in international relations from the University of California, Davis. Her annual is $150,000.
HEATLTHCARE
The ACA Has Not Inspired More Confidence in the U.S. Health Care System
Enactment of the Affordable Care Act (ACA) has had no effect on workers’ confidence in the health care system, according to recent research by the Employee Benefits Research Institute (EBRI). The report reveals the following:
- 47% are extremely or very confident that they can needed treatments today, but only 33% are confident that they can get needed treatments during the next 10 years, and just 26% are confident that they can get needed treatments once they are eligible for Medicare.
- 42% are confident that they have enough choices in providers, but only 30% are confident that they will have enough choices over the next 10 years, and 25% are confident that they will have enough choices once they are eligible for Medicare.
- 30% are confident that they can afford health care without financial hardship today, but this percentage decreases to 25% when they look out over the next 10 years, and 24% when they consider the Medicare years.
For more information, visit ebri.org.
Consumers Are Getting Hit With Unexpected Health Expenses
A survey by healthplans.com finds that almost one-third of consumers were surprised by out-of-pocket expenses two to three times this year. This reveals that many people don’t understand basic concepts about their health plans, like coinsurance and copays. Twenty-three percent said that health care services that they expected to be covered were not covered, which reveals that plan benefits are misunderstood or not adequately reviewed before people sign up. Forty-eight percent say that open enrollment brings them anxiety. When respondents were asked why they were not planning to enroll in a plan in 2016, the most popular answer is that it is too confusing. Only 11% knew when the first open enrollment deadline was for coverage starting January 1, 2016.
AMA Calls for Ban on Direct to Consumer Prescription Drugs Ads
The AMA is supporting a prescription-drug advertising ban. AMA board chair-elect Patrice Harris, M.D., M.A. said that direct-to-consumer advertising inflates demand for new and more expensive drugs even when these drugs are not appropriate. The AMA is also calling choice and competition in the pharmaceutical industry as well as greater transparency in prescription drug prices and costs.
The United States and New Zealand are the only countries that allow direct-to-consumer advertising of prescription drugs. In the past two years, advertisers have increased spending on prescription drug ads by 30% to $4.5 billion, according to Kantar Media.
The AMA wants federal regulators to limit pharmaceutical companies from manipulating patent protections and abusing regulatory exclusivity incentives in their efforts to reduce competition from generic manufacturers. Patent reform is a key area for encouraging greater market-based competition. Prices on generic and brand name prescription drugs experienced a 4.7% spike in 2015, according to the Altarum Institute Center for Sustainable Health Spending. The AMA will also monitor how pharmaceutical company mergers and acquisitions affect drug prices. For more information, visit ama-assn.org.
Health Care Costs Are A Major Problem for Small Business
Small businesses are facing huge health care cost increases while struggling to navigate the Affordable Care Act (ACA), according to a survey by the National Small Business Assn. (NSBA). “The smallest businesses are in worse shape than they were just one year ago,” said NSBA president and CEO Todd McCracken. Just 41% of firms with five or fewer employees offer health benefits, down from 46% one year ago.”
Offer rates dropped among all small firms too; 65% of small firms offer health insurance, down from 70% one year ago. One in five said that premium increase exceeded 20% during their most recent renewal. While cost is the number one driver of whether a small business will offer health insurance, complexity and administrative burden cannot be underestimated since the overwhelming majority of small business owners handle their firm’s health benefits. Just nine percent of small-business owners plan to purchase health insurance through the Small Employer Health Options Program (SHOP) exchange or an individual exchange, down from 14% last year. The average small business owner spends as much as 13 hours a month on ACA compliance. For more information, visit nsba.biz or follow us at @NSBAAdvocate.
The Majority of Uninsured Americans Have a Chronic Condition
Sixty-two percent of Americans have been diagnosed with a chronic health condition, according to a survey commissioned by the Transamerica Center for Health Studies. The most common conditions are being overweight, having high blood pressure, and having high cholesterol. The study finds the following:
- 82% of Americans say they can afford routine health expenses compared to 41% of the uninsured. However, 41% report an increase in premium costs over the past one to two years.
- 71% say they can afford a $100 monthly premium.
- 66% say they can’t afford a premium of $300 or more per month.
- Since the implementation of the Affordable Care Act, the number of uninsured Americans has dropped from 21% in 2013 to 11% in 2015.
- 82% of Americans are very or somewhat satisfied with the healthcare system, compared to 73% in November 2013.
- The most common reason cited among for not getting health coverage is low awareness of the ACA insurance mandate (26%). Eighteen percent do not know how to apply, and 21% are willing to pay the tax penalty for not having health insurance.
- 30% of Americans say the ACA directly affected their health coverage; those who did tended to report a positive effect.
- 48% have no strong opinion of the ACA.
- White Americans (67%) are most likely to are diagnosed with a chronic health condition.
- African Americans have the highest rates of high blood pressure and Type 2 Diabetes (24% and 10%, respectively).
- At 41%, Asian Americans are the least likely to have a chronic health condition.
For more information, please visit: bit.ly/1MO3OJv.
EVENTS
Medicare Webinar
The Medicare Rights Center is presenting a free webinar, “Benefits that Help You Afford Medicare Costs,” on Tuesday, December 15 at 12:00 a.m. PST. The one-hour web presentation will cover the following:
- The roles of federal, state, and local governments in administering benefits.
- An overview of extra help for Medicare drug costs.
- Types of Medicare savings programs (MSPs) and benefits.
- What to know about MSP enrollment and recertification.
- Case examples illustrating how each program works.
For more information, visit facebook.com/medicarerights.
NEW PRODUCTS
Telehealth
Arizona-based HealthiestYou announced a $30 million growth investment from Frontier Capital. The company will use the investment for more aggressive sales and marketing efforts, technology enhancements, and leadership to increase its share of the large and rapidly growing telehealth market. Over 4,000 employer groups provide the HealthiestYou service to their employees. HealthiestYou’s web-based and mobile technology application enables users to manage their healthcare needs 24/7, within the framework of their employer-provided benefits and with the most cost-effective options. For more information, visit healthiestyou.com.
Health Plan Shopping
Rally Connect is a new online portal that enables people to shop for health care. It links individual health plan data with pricing information based on the contracted rate between the insurer and the care provider. It instantly calculates what will be covered and what the consumer will pay. It includes what services are eligible to be covered through their Health Savings Account (HSA). For more information, visit RallyHealth.com.
Critical Illness
Aflac launched its “Group Critical Illness Advantage” plan. It includes three new value-added services: health advocacy, Medical Bill Saver, and telemedicine. The plan offers more covered conditions and benefits, and has no pre-existing conditions limitation, no maximum issue age, no reduction in benefits at age 70, and no 30-day waiting period. The plan also includes a waiver-of-premium benefit and additional and reoccurrence benefits payable with six months between diagnosis dates. Plus, all coverage is HSA-compatible. The benefit amount increases at each anniversary with no change in premium or additional underwriting. For more information, visit aflacgroupinsurance.com.
Financial Wellness Tools
MassMutual has acquired the assets of Viability Advisory Group. Viability helps companies evaluate the financial costs of employees being unprepared for retirement and the loss of productivity that comes from employees’ lack of financial security. The Viability suite of tools will be offered to MassMutual retirement plans and worksite insurance clients strictly through financial advisors. The program calculates the hard-dollar cost of inappropriate or under-utilization of retirement savings and other employee benefit programs. “No other insurance or financial services firm will be able to match our new capabilities,” said Elaine Sarsynski, executive vice president of MassMutual Retirement Services and Worksite Insurance. For more information, call 800-874-2502, option 4.
Individual Dental
MetLife introduced “TakeAlong Dental.” The portable individual dental plan will be available in the first quarter of 2016. With this product, businesses of all sizes can expand coverage to more employees, such as part-time or retired workers. Unlike many individual dental offerings that only feature a percentage discount card or provide very limited coverage and networks, TakeAlong Dental will provide covered services similar to group plans, including the same network of pre-screened providers, online access, and claims handling. For more information, visit metlife.com/brokers/benefit-products/group-employee/index.html.
Download Management Services
IVANS new Exchange 2016 provides carriers and MGAs with a single location to manage agency download services and measure download adoption against industry average benchmarks. It gives carriers and MGAs a comprehensive view of their download activity by individual agency and individual lines of business. For more information, visit exchange.ivansinsurance.com.
