Health Care Reform Seattle

Health Care Reform Seattle Information & updates on health care reform. Ken Williams ChFC CLTC CLU CHRS
425-539-2016
[email protected]
www.kenwilliamschfc.com

Information on how to buy subsidized health insurance. Updates on changes to the law and how they affect you. Posting opinions and controversies surrounding the law. Summaries of benefits and rules under the law.

08/23/2023

States ranked by average annual family health insurance premium.

Jakob Emerson

The figures listed only reflect employee contributions to their total annual premium and not their employer's contribution. The national employee contribution on average for family premiums was $6,492 per year. To see the states where employers pay the highest annual premiums per employee, click here.

States ranked by average family insurance premium per year:

Florida: $7,734

North Carolina: $7,643

Delaware: $7,593

Texas: $7,579

Georgia: $7,529

Mississippi: $7,416

Idaho: $7,219

Arizona: $7,202

Maryland: $7,121

Pennsylvania: $7,110

Virginia: $7,081

South Carolina: $6,963

Colorado: $6,903

New Hampshire: $6,877

Nebraska: $6,857

Alaska: $6,807

California: $6,755

Vermont: $6,736

Tennessee: $6,693

South Dakota: $6,604

Iowa: $6,559

Kentucky: $6,554

Maine: $6,546

West Virginia: $6,532

North Dakota: $6,359

Alabama: $6,300

Connecticut: $6,299

Rhode Island: $6,290

Louisiana: $6,252

New Mexico: $6,250

Wyoming: $6,235

District of Columbia: $6,234

New Jersey: $6,212

Indiana: $6,105

Arkansas: $6,099

Oregon: $6,071

Montana: $5,960

Utah: $5,922

Missouri: $5,894

Minnesota: $5,878

Massachusetts: $5,875

New York: $5,693

Illinois: $5,653

Nevada: $5,649

Kansas: $5,638

Wisconsin: $5,637

Oklahoma: $5,514

Ohio: $5,336

Michigan: $5,195

Washington: $5,125

Hawaii: $4,931

08/15/2023

Insurers won't cover new Alzheimer's treatment for some customers.

AP News
Some private insurers are balking at paying for the first drug fully approved to slow mental decline in Alzheimer's patients. Insurers selling coverage in North Carolina, Pennsylvania and New York, among other states, told The Associated Press they won't cover Leqembi with insurance offered on the individual market and through employers because they still see the $26,000-a-year drug as experimental.

07/25/2023

The Rise Of The $2 Million Health Insurance Claim.

Mehb Khoja

American healthcare spending is at an all-time high, reaching $4.3 trillion in 2021, or just under $13,000 per capita. But a per-capita measurement is misleading in an industry where a small portion of the population is responsible for the majority of the costs. In fact, a 2019 report from the Employee Benefit Research Institute found that from 2013-2017, 20% of the population accounted for 84% of total healthcare costs.

This small, but costly, group is often referred to as “high-cost claimants,” which the American Health Policy Institute defines as an individual whose claims exceed $50,000 or more annually.

Often these high-cost claims are the result of a chronic or complex condition that requires exorbitant and/or ongoing care, such as preterm/premature births, cancer treatments and lifelong conditions such as heart disease and blood disorders. More recently, they include patients with Covid-19 complications, and those utilizing new (and very expensive) therapies, such as cellular and gene therapy.

As a large claims underwriter and reinsurer, I’ve seen my fair share of high-cost claims that impact the companies I have worked for and the clients we serve. Twenty years ago, a $2 million claim would have been shared industrywide as a once-in-a-lifetime learning opportunity. Ten years ago (pre-Affordable Care Act), a $2 million claim would have been an anomaly. Last year, BCS Financial’s Large Claims Solutions business paid six claims of over $2 million (ground-up allowed charges) across a nearly $450 million portfolio of stop loss and reinsurance.

Those claims ranged from a Covid patient with complications, to a pre-term birth with several associated health issues, to an adult hemophilia patient, among others. One billed claim for lengthy in-patient treatment was for $12.9 million by itself.

The moral of the story: Big claims are getting bigger (and more frequent, too).

07/20/2023

3 reasons medical costs are rising, according to payers.
Rylee Wilson

In the individual market, some payers have requested premium increases to keep up with anticipated rising costs in 2024.

Here are three factors behind the trend, according to payers:

More outpatient procedures: Older adults are seeking surgeries and other care delayed during the COVID-19 pandemic, payers have said. UnitedHealthcare executives told investors outpatient costs are rising among the Medicare Advantage population, especially for cardiac and orthopedic procedures. In a June 16 SEC filing, Humana warned of a similar trend, with emergency care, outpatient procedures and dental services contributing to rising costs.

More people are seeking behavioral healthcare: UnitedHealthcare executives told investors more people are using behavioral health services. The trend is happening across all populations, the company said. In June, Centene CEO Sarah London said behavioral health is one of the areas where care costs are rising fastest.

Demand for weight loss drugs: Expensive weight loss drugs like Ozempic are contributing to rising costs, several payers said. BCBS of Massachusetts told the Boston Globe it expects spending on weight loss drugs to triple in 2023 compared to last year. BCBS of Michigan said increasing demand for the drugs is one the factors driving proposed premium increases in the individual insurance market.

07/14/2023

How the 'Amazon effect' is changing what people expect from their health insurer.

Becker's Payer Issues

Healthcare is complicated — but members want their experiences with health insurance to be as easy as shopping on Amazon, executives told Becker's. John Bennett, MD, president and CEO of Capital District Physicians Health Plan, told Becker's today's consumers are looking for things "instantaneously."

06/29/2023

Extreme heat will cost the US $1 billion in health care costs — this summer alone.

Grist

Extreme heat — summertime temperatures and humidity that exceed the historical average — is being made more frequent and intense by climate change. In the first two weeks of June, a late-spring hot spell prompted schools in the Northeast, Mid-Atlantic, and Great Lakes areas to close or send students home early. A heat wave broke temperature records in Puerto Rico — the heat index, a measure of how temperatures feel to the human body, reached 125 degrees Fahrenheit on parts of the island. And extreme heat spurred deadly storms and power outages for hundreds of thousands of customers from Texas to Louisiana.

All that heat is bad for human health and leads to a rise in hospitalizations for cardiovascular, kidney, and respiratory diseases, particularly among the urban poor, who often lack access to air conditioning and green spaces. Those hospitalizations will come with a hefty price tag. A new report from the public policy research group Center for American Progress estimates extreme heat will create $1 billion in health care-related costs in the United States this summer. The analysis, provided exclusively to Grist, projects that excessive heat will spur nearly 235,000 emergency department visits and more than 56,000 hospital admissions for conditions related to increased body temperature across the country this summer.

06/27/2023

Report: Amazon pauses 50-state virtual care service expansion.

mHealth Intelligence

Amazon is holding off on a 50-state expansion of its virtual care clinic after receiving a letter from lawmakers expressing concern over its data privacy practices, according to a report from Politico.

05/26/2023

The big changes coming to HSAs in 2024.

Becca Stanek

Health savings accounts, or HSAs, are already a great way to set aside money for medical costs, and they're about to get even better. The IRS recently announced that for 2024 it is making what The Wall Street Journal described as "the largest ever increase to the amount Americans can set aside in health savings accounts each year."

HSA contribution limits will increase significantly in 2024, meaning that Americans with access to an HSA will be able to sock away a lot more money in their account. For 2024, the maximum HSA contribution will jump to $8,300 for a family and $4,150 for an individual. Plus, participants who are age 55 and older can save an additional $1,000 per year.

The 2023 limits were $7,750 for a family and $3,850 for an individual, meaning the 2024 increases are jumps of around 7% and 8%, respectively. Typically, "HSA caps are boosted each year by only about 1.5%, or $100 to $200, if at all," USA Today reported. The IRS said it's making these larger-than-usual increases in an effort to keep up with high inflation.

05/18/2023

Federal appeals court grants stay in ACA preventive care ruling.

Fierce Healthcare
A federal appeals court has issued a stay on a lower court ruling that struck down free preventive care under the Affordable Care Act. The Fifth Circuit Court ruled Monday in favor of an administrative stay while it reviews the case. Texas Judge Reed O'Connor ruled in March that the federal government could not enforce preventive care mandates under the ACA, which require payers to cover a slew of services at no cost.

05/11/2023

White House looks to move past COVID emergency.
BY NATHANIEL WEIXEL AND BRETT SAMUELS

White House COVID-19 Response Coordinator Ashish Jha speaks during the daily briefing at the White House in Washington, Thursday, Dec. 15, 2022. (AP Photo/Susan Walsh)
The White House is signaling that it wants to close the book on the COVID-19 pandemic once the public health emergency expires Thursday.

But even as the administration and the public look to move on, experts say the virus won’t go away. Hundreds of people still die every day from COVID-19, and more are being hospitalized. The current situation is precarious and could backslide in the fall.

The administration also faces a challenge in filling leadership roles across key health positions, including the National Institutes of Health, the National Institute of Allergy and Infectious Diseases, the Centers for Disease Control and Prevention (CDC), and a new White House pandemic response office.

CDC Director Rochelle Walensky said she will step down effective June 30, and her replacement likely will be the last person a president can appoint to the job without Senate confirmation.

The government funding bill passed at the end of last year will make the CDC director subject to confirmation, but not until Jan. 20, 2025.

Walensky assumed the position in the midst of the greatest threat to the health of Americans in decades, and the pandemic defined much of her tenure.

She faced criticism from Democratic and Republican lawmakers over the agency’s muddled communication and guidance, but forged ahead and last year announced a major organizational overhaul to streamline the agency and make it more accountable.

Walensky’s announcement came just days before the administration is set to end the three-year-old COVID-19 public health emergency. When that declaration expires on Thursday, so too will a number of pandemic flexibilities and administration powers.

05/10/2023

Survey: With judge's ruling, some employers may cut off no-cost preventive care.

Fierce Healthcare

Some employers have already followed the advice in a ruling by a federal district court judge in Texas that struck down mandates for no-cost preventive care in the Affordable Care Act and have stopped paying for certain services.

05/01/2023

Millions of kids could lose health coverage as states purge Medicaid rolls.

Pew Charitable Trusts

Millions of parents who take their children to the doctor this year will hear devastating news: "Your Medicaid coverage has been canceled." That's because all 50 states are undertaking the biggest reshuffling of health insurance coverage since the Affordable Care Act took effect in 2010. But instead of adding insurance options for people with low incomes, this new effort will be taking away coverage — with no promise of a replacement.

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