Archive for February, 2012

The California Department of Insurance issued the following news release:

Insurance Commissioner Dave Jones today announced that Donald Martin Steffensen, 73, of Midvale, Utah was sentenced on January 27 for violating Penal Code Section 368 (d) Financial Elder Abuse and Penal Code 487 Grand Theft, along with Penal Code 186.11 (a) (sentence enhancement for Fraud and Embezzlement). Steffensen entered a plea of No Contest in Madera County Superior Court.

He was sentenced to time served after more than 700 days in jail, and placed on three years’ probation following his release. He was also ordered to pay more than $352,000 in restitution as well as court costs. continue

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Mercury News reporter Lisa Krieger’s compelling, poignant tale Sunday of her father’s final 10 days of life and the extraordinary hospital costs they entailed should be required reading for all. For doctors. For hospital administrators. For health care policy makers, both elected and professional. And, although it is painful, for every one of us with aging parents or friends — or with a creeping sense of our own inescapable mortality.

Krieger puts it best: “My father’s story — the final days of a frail, 88-year-old with advancing dementia at the end of a long and rewarding life — poses a modern dilemma: Just because it’s possible to prolong a life, should we?” continue

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Consumers struggle to understand and use health insurance. These health insurance difficulties take a toll on consumers’ health and financial well-being, and have cost implications for health plans and the nation.

This project aims to develop a precise language for describing what is difficult for consumers about health insurance. By developing a “common language” — in the form of a widely-accepted health insurance literacy measure–we can bring precision to research efforts and policy discussions.

For more information, click here (http://www.consumersunion.org/pub/core_health_care/018348.html).

Hard hit by one of the worst recessions in nearly a century, hundreds of thousands of Californians lost insurance coverage across the state as employers shed jobs and the health plans that came with those jobs, according to a new report from the UCLA Center for Health Policy Research. Among the most alarming trends resulting from the so-called Great Recession: a significant jump in California’s already high rate of residents with medical debt. In 2009, 2.6 million non-elderly Californians had some kind of medical debt — an increase of 400,000 since 2007, the new “State of Health Insurance in California” report shows.

The report, published every two years with grant funding from The California Endowment and The California Wellness Foundation, uses the latest data from the California Health Interview Survey (CHIS) to paint a comprehensive picture of health insurance trends, access and coverage status for California’s more than 37 million residents. The report found that medical debt was highest among those uninsured all of the year (of whom 18.4 percent had debt) and among those uninsured for part of the year (23.2 percent). But even 9.1 percent of those with employment-based coverage reported some kind of medical debt.

“No Californian should have to take on debt to pay medical bills or go without access to health care just because they lost their job,” said Shana Alex Lavarreda, lead author of the report and director of health insurance studies a the UCLA Center for Health Policy Research. “As this recession has so clearly shown us, linking health care to a volatile job market puts us all at risk.”

Yet the report also discusses the potential positive implications of health care reform on California’s uninsured population. “This data clearly indicates the need for successful implementation of the Affordable Care Act,” said Dr. Robert K. Ross, CEO and president of The California Endowment. “The rate of uninsured Americans increases annually, and the burden that presents to our health care system is economically unsustainable. Health care reform will ensure that many millions of Californians need not fear a potential health catastrophe just because of an economic downturn.”

Among the report’s findings: Californians living on ‘thin margin’ About half of those with medical debt reported the amount to be below $2,000. “It’s an indication that people are living on a very thin margin if they don’t have even $2,000 in savings to put towards medical debt,” Lavarreda noted. Medi-Cal under stress

Among enrollees in Medi-Cal, the program that is intended to provide comprehensive care for low-income residents, 18.2 percent had medical debt, a level comparable to the uninsured (18.4 percent). “This suggests that the program may not be providing everything its enrollees need, either because certain services are not included in coverage or there are increasingly fewer doctors that accept Medi-Cal patients,” said Lavarreda. Increasing reliance on high-deductible coverage More than 50 percent of Californians with individually purchased insurance participate in high-deductible health plans. Of these, only 8.8 percent purchase these risky plans with a health savings account that might protect them from financial hardship. Recession’s toll

In 2007, 61.8 percent of the uninsured were in families with a full-time worker. In 2009, only 46.3 percent of the uninsured were in families with a full-time worker. The proportion of the uninsured living in poor families (families with incomes below 100 percent of the federal poverty level) climbed from 29.0 percent in 2007 to 33.1 percent in 2009, the highest level in a decade. Lack of insurance equals lack of care

Uninsured children and adults were significantly more likely to report not seeing a health care provider in the past year (41.8 percent of children and 49.9 percent of adults) than children and adults with employment-based insurance (8.3 percent and 13.4 percent, respectively).

“This report provides yet more evidence of the need for change of our current system of health care and also of the devastating effect California’s budget crisis has had on the programs that support our state’s most vulnerable residents,” said Diana M. Bonta, president and CEO of The California Wellness Foundation. The authors noted that the estimated number of uninsured Californians may have grown since 2009 (when the data was collected), as the federal subsidy that enabled many laid-off workers to retain their employer-provided health insurance through COBRA has since expired. Read the report, “The State of Health Insurance in California: Findings from the 2009 California Health Interview Survey.” T

he California Wellness Foundation’s mission is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention. The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians. The California Health Interview Survey (CHIS) is the nation’s largest state health survey and one of the largest health surveys in the United States. The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health-related information on Californians.

A federal appeals court delivered on Wednesday its opinion that Allstate should pay for an uninsured motorist claim in which a driver swerved to avoid a box lying in the road that was presumed to have fallen off the back of an unidentified driver’s car.

The opinion from the 3rd U.S. Circuit Court of Appeals stated that since the injuries ultimately stemmed from the use of the unidentified motor vehicle that had been carrying the box, it should be covered under the claimant’s uninsured motorist policy.

The case has its beginnings in October 2008, when Larry Squires swerved to avoid a two-foot square cardboard box lying in the middle of a Pennsylvania highway and ended up getting injured as a result.

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Prudential Insurance Co. has entered into a $17 million settlement with seven states to help conclude an investigation into how the company uses the Social Security Administration’s Death Master File to find life insurance policyholders who have died.

The settlement is the latest chapter in the company’s effort to show regulators that it is working to implement systems designed to improve how it uses the Death Master File. Last month, the company settled with about 20 states and agreed to apply new standards to how it uses the file for policies dating back to 1992.

This new settlement, which was reached with insurance departments in seven states, will require the company to apply new standards to policies going forward. The states that have signed on include California, Florida, Illinois, New Hampshire, North Dakota, Pennsylvania and New Jersey.

For the agreement to become effective, a total of at least 20 states need to sign All states have until March 31 to sign the agreement to become eligible to receive the distribution of the settlement payment. continue

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New Commonwealth Fund Survey Finds Profound Income Divide in Health Insurance and Access to Health Care; Health Reform Could Nearly Eliminate Gaps When Fully Implemented in 2014

Adults in low- and moderate-income families are more likely to be uninsured, to lack a regular source of health care, and to struggle to get the health care they need compared to those in higher-income families, according to a new Commonwealth Fund survey. The survey found that 57 percent of people in low-income families–those earning less than $29,726 for a family of four (133 percent of poverty)–were uninsured for some time in the past year, and 35 percent had been uninsured for two years or more. More than one-third (36%) of adults in moderate-income families–those earning between $29,726 and $55,875 for a family of four (133 to 249 percent of poverty)–were uninsured during the year, and 18 percent had been uninsured for two years or more.

In contrast, just 12 percent of adults in families with incomes at or above $89,400 for a family of four (400 percent of poverty) were uninsured during the year, and only 3 percent were uninsured for two years or more. continue

By JOHN HANNA, Associated Press

Kansas Gov. Sam Brownback’s efforts to overhaul Medicaid hit a rough spot Thursday after the state’s largest health insurance company decided not to bid on a contract to help manage the program, leaving some lawmakers and advocates increasingly uneasy.

Officials with Blue Cross and Blue Shield of Kansas Inc. said submitting a bid for a state contract would require the company to make dramatic business changes in less than a year. Brownback’s administration plans to issue three contracts this year for the state’s $2.9 billion program, which provides health coverage to poor families and disabled and elderly Kansans. The contracts would start Jan. 1, 2013.

Kansas has asked the federal government, which helps finance Medicaid, to waive some of its rules so that the contracts can cover the disabled and elderly and include financial incentives for improving services while controlling costs. Critics worry Brownback’s administration is moving too quickly.

Brownback’s efforts to overhaul Medicaid represent the first time the state has attempted to cover the disabled and the elderly, including those in nursing homes, with a managed-care program.

“It’s crystal clear now that it’s going to be for-profit, out-of-state, multinational, probably publicly traded, Wall Street companies,” said Rocky Nichols, executive director of the Disability Rights Center of Kansas, adding that fellow advocates worry about “placing profits” between Medicaid recipients and services.

Brownback spokeswoman Sherriene Jones-Sontag declined to comment about the Blue Cross decision, because the bidding process isn’t complete. Companies had until Tuesday to submit technical details for their proposals but still have until Feb. 22 to complete their bids, and the administration is not releasing a list of firms still seeking a contract.

Blue Cross was among 15 companies represented at a mandatory conference for potential bidders in December. Others included large, multistate firms such as Coventry Health Care Inc., based in Bethesda, Md.; United Healthcare, based in Minnetonka, Minn., and WellPoint Inc., with its headquarters in Indianapolis.

Administration officials have said the overhaul will lead to better coordination of services for high-need Medicaid participants and will eliminate duplication. The plan calls for participants to be able to choose from three statewide contractors.

 State medical programs provide services for an average of 380,000 people a month, and the bulk already receive state health coverage through private contractors. By bringing the disabled and elderly into a managed-care system, the state would add Kansans who need relatively expensive long-term services.

Blue Cross, based in Topeka, is owned by policyholders and paid about $2 billion in health claims in 2010. It provides coverage for about 656,000 Kansans and handles claims and services for another 223,000 with coverage from outside the state. Spokeswoman Mary Beth Chambers said the contracts would require Blue Cross to do things it doesn’t do now as a traditional health insurer, such as helping families decide whether elderly members should go into a nursing home and managing that care.

“We just felt it wasn’t responsible for us to commit to changing our business model that much,” she said. `We certainly have no intent _ and would be disappointed _ if people read our decision as criticizing the governor’s proposals.”

But Sen. Dick Kelsey, a Goddard Republican who argues that the GOP administration should delay the contracts, said Blue Cross’ decision showed that a major player wanted to put together a proposal but, “They concluded it can’t be done.”

“It’s a huge statement, and I don’t know how it can be ignored,” he said.

Senate Public Health and Welfare Committee Chairwoman Vicki Schmidt, a Topeka Republican, wants to set up a committee to monitor the overhaul. Rep. Jim Ward, a Wichita Democrat, has introduced a bill to require annual, independent audits of Medicaid. He noted the administration promises the overhaul won’t kick participants out of Medicaid, reduce their benefits or cut payments to health care providers.

“We want an independent third party to look over the shoulder of these insurance companies and make sure they keep those promises,” he said.

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A new report released this week by the Consumer Federation of America (CFA) says that premiums have become an undue economic burden on low- and moderate-income (LMI) Americans and that state regulators should do all they can to reduce costs for this group.

“What is undeniable is that high auto insurance costs for LMI households either impose a substantial financial burden or greatly limit economic opportunity, especially access to jobs,” said the report’s authors, who are a former Texas regulator and the executive director of insurance at the CFA.

The CFA report makes three major recommendations to help right the situation: move to slice state-mandated minimum liability limits, create special programs for low-income Americans to get cheaper coverage and eliminate elements of the pricing process that hurt LMI households.

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Shares of Genworth Financial Inc. shot up in after-hours trading Thursday, after the insurance company swung to a quarterly profit and beat analysts’ estimates.

Genworth said fourth-quarter net income was $107 million, compared to a loss of $161 million in the same period a year ago.

On a per-share basis, earnings were 22 cents compared with a loss of 33 cents a year ago. Analysts had been expecting 19 cents a share in the latest quarter, according to FactSet.

The company was also profitable for the full year, with net income of $122 million. But that was down from $142 million in 2010. continue

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