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.

The survey, the first Commonwealth Fund Tracking Survey of U.S. Adults, found that the lack of health insurance coverage, as well as income, had a significant effect on access to care, such as receipt of recommended preventive screenings. Just 10 percent of low-income uninsured adults age 50 and over had received the recommended screening for colon cancer, compared with 50 percent of those in the same income range who had health insurance, and 56 percent of higher-income adults. Only about one-third (32%) of low-income uninsured women ages 40 to 64 had received a mammogram, compared with two-thirds (66%) of low-income women with health insurance, and three-fourths (74%) of higher-income women.

“People with low and moderate incomes run the highest risk of lacking job-based health insurance, are least able to afford health insurance on their own, and are the most at risk of not being able to afford care in the absence of coverage,” said Commonwealth Fund Vice President Sara Collins, lead author of the report. “Consequently, problems getting needed care in the United States are disproportionately concentrated among low- and moderate-income families.”

Having health insurance also meant the difference between having a regular source of care and not having one. Low- and moderate-income adults in the survey who were without health insurance were less likely to report that they had a regular doctor or place to go for their health care needs than low- and moderate-income insured adults.

Compared to insured low- and moderate-income adults, those without insurance in the same income range reported going to the emergency room for non-emergency reasons at higher rates. Low- and moderate-income adults without health insurance were more likely than low- and moderate-income insured adults to go to the emergency room because they needed a prescription (50 % vs. 35 %), because they did not have a regular doctor (41% vs. 16%), or because other options were unaffordable (40% vs. 20%).

Designed to paint a picture of how low- and moderate-income families are faring when it comes to health care and health insurance, the new report, The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System, by Commonwealth Fund researchers Sara Collins, Ruth Robertson, Tracy Garber, and Michelle Doty, is the first in a series that The Commonwealth Fund will release over the next several years titled Tracking Trends in Health System Performance. Subsequent surveys will revisit the same adults surveyed initially in order to track their experiences as the Affordable Care Act is implemented. The Commonwealth Fund is undertaking additional tracking surveys that will focus on young adults ages 19-29, and adults ages 50-70, which will be released later in 2012.

According to the new report, while adults are often uninsured in low- and moderate-income families, programs such as Medicaid and the Children’s Health Insurance Program (CHIP) step in to fill a crucial gap by insuring children in 63 percent of low-income families and 38 percent of moderate-income families. However, 31 percent of low-income families and 20 percent of moderate–income families still reported some or all of their children were uninsured, compared to only 12 percent of higher-income families.

The study’s authors find that the Affordable Care Act is positioned to narrow, if not entirely eliminate, the profound income inequities that currently exist in the U.S. health care system. Specifically:

The Affordable Care Act has already expanded health insurance to 2.5 million 19-to-25 year-olds, banned lifetime limits on health insurance coverage, created pre-existing condition insurance plans providing health insurance options to those who were often uninsurable, and required insurers to cover preventive care without requiring co-payments.

But the major provisions of the law to be implemented in 2014 will have the biggest effect on narrowing the income divide, through expanded Medicaid coverage; new health insurance exchanges offering comprehensive coverage and premium tax credits to make coverage affordable; and new rules that will prevent insurers from denying coverage or charging people more based on pre-existing conditions or gender.

“The struggles that those in the bottom third of the income distribution face in getting the health care they need are untenable,” said Commonwealth Fund President Karen Davis. “It is encouraging that the safety net created by Medicaid and CHIP is working to insure millions of children in low- and moderate-income families, but if parents can’t get needed health care, their family’s health and financial well-being remains at risk. By making health insurance affordable for all Americans, the Affordable Care Act aims to ensure that families at all income levels will have access to needed health care and greater financial security.”

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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.

But members of the auto insurance community have been lashing out in response to the report, saying that placing more regulation on insurers would decrease competition in the marketplace, which could in turn actually end driving costs up for consumers.

“The most effective way to lower the price of auto insurance is reduce the costs of underlying factors” like the cost of health care and abuse of the system, said Robert Hartwig, president of the Insurance Information Institute (III). “Changing rating factors that have been shown to accurately project future losses will only distort prices and result in good drivers subsidizing riskier ones.”

The Property Casualty Insurers Association of America (PCI) responded in an official statement with equal tenacity.

“The CFA has the flawed impression that overregulation will keep insurance rates down,” said Paul Blume, the senior vice president of state government relations for the PCI. “Ultimately, overly restrictive laws and regulations have been shown time and again to reduce consumer choice and inhibit market innovations.”

Reducing State Liability Minimums

Support of efforts to cut state liability minimums–the minimum amount of coverage that policies issued in a particular state must provide–is about the only thing that the CFA and PCI seem to have in common.

The CFA believes that keeping liability minimums at 25/50/25–which would provide $75,000 in total liability coverage–or below might help lower costs slightly and make them more affordable to LMI households.

The authors also posit that these lower limits might entice uninsured drivers to get coverage and end up bringing costs down for all drivers.

Industry groups like the III, however, have noted that many state-mandated minimums may be too low to protect all of a person’s assets in a serious accident. And those with low minimums who do cause a serious accident could have to pay for the remaining damages out of pocket and be driven into debt.

Expanding Low-Income Programs

The report’s authors laud states like California and New Jersey for coming up with programs to help residents get coverage for cheap if they meet certain eligibility requirements related to income levels and driving history.

“When such plans exist,” the authors argue, “it is easier to morally justify rigorous enforcement of mandatory liability laws.”

But they go on to say that access to these programs are limited and need to be expanded.

“California’s program provides only liability protection and has even fewer [than 20,000] participants even though millions of drivers are uninsured,” they write.

The III’s Hartwig responded to the issue by noting the low enrollment in the California program and saying it indicates that the private market is already meeting consumers’ needs.

Tightening Regulation

While the CFA report acknowledges the fact that state regulatory departments do not allow insurers to take income level into account when setting rates, the authors say that factors like occupation, geographic location, education level and credit history are serving as proxies for income.

But industry groups say that these factors help indicate a policyholder’s level of risk, not income, and that they simply help insurers price risks more accurately.

The CFA also says regulators need to investigate whether rating factors discriminate against certain groups–even though a handful of state regulatory departments and the Federal Trade Commission have already done this for credit scoring–investigate claim settlements to see if they favor higher-income drivers and look into insurers’ charging more money for less coverage.

“Only state regulators can take the lead in mitigating these problems,” the authors conclude.

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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.

CEO Michael Fraizer described 2011 as a year of “repositioning,” moving the company through an “uncertain environment” and improving focus by shedding some business units and streamlining expenses.

The fourth-quarter earnings were driven by gains in U.S. life insurance, and crimped by a loss in U.S. mortgage insurance as the housing crisis continues to roil the nation.

Shares were up more than 7 percent in extended trading following the report, gaining 58 cents to $8.62. (c) 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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The U.S. insurance industry added 1,100 jobs in January — a mere 0.05% increase from the previous month, according to the latest employment report released by the U.S. Bureau of Labor Statistics.

On a year-to-year basis, the industry, which currently sits at roughly 2.2 million jobs, is about 1,000 jobs ahead of where it stood in January 2011.

The figures released by BLS also included adjusted employment numbers for December that showed the industry added 2,700 jobs between November and December. That figure is down from the increase of 3,300 BLS had previously reported

Nationally, the country added 243,000 jobs in January, causing the unemployment rate to dip to 8.3%. BLS reported job growth was widespread in the private sector, with large employment gains in professional and business services, leisure and hospitality, and manufacturing. Government employment changed little over the month.

Total insurance industry payrolls are reported each month on a seasonally adjusted basis, along with the current month’s nonfarm payrolls. Separately, data by industry segment — broken out by various insurance carrier and noncarrier categories — are available only on an unadjusted basis for the prior month.

The job growth the industry saw in December primarily affected health (+0.1% to 430,900 jobs); property/casualty (+1.5% to 526,800 jobs); title insurance (+2% to 71,500 jobs); reinsurance (+2.3% to 27,300 jobs); agents/brokers (+0.2% to 646,600 jobs); and third-party administration of funds (+1.5% to 136,500 jobs). Life insurance (-2.3% to 343,800 jobs) and claims adjusting (-2.4% to 49,500 jobs) both saw their employment figures drop off slightly.

In terms of wages, all sectors except for title insurance saw upticks in their weekly wages on a year-to-year basis.

Life insurance weekly wages increased 4.8% to $1067.19; health 4.2% to $1037.19; property/casualty 4.1% to $1085.06; agents/brokers 5.4% to $839.08; claims adjusting 5.11% to $967.57; and third-party administration of claims 3.7% to $815.69. Reinsurance again saw the most dramatic increase in weekly wages, jumping 37.4% to 1315.55%.

Marking a double-digit decline, title insurance saw its average weekly wages fall 15.9% to $793.51.

(c) 2012 A.M. Best Company, Inc.

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Car thefts in Michigan declined by more than 9 percent between 2009 and 2010, according to data recently released by the Michigan Auto Theft Prevention Authority (ATPA).

The total number of cars stolen in the state dropped from about 29,650 to 26,875 during that period.

While the 9 percent year-to-year drop is impressive, the data also show that thefts actually dropped a whopping 50 percent between 2000 and 2010.

The state saw double or near double-digit decreases every year since 2007.

The ATPA attributed the decline to the 110 workers in the state who are funded with anti-theft grants from the ATPA, which was first established in 1986. At that time, Michigan was the state with the highest volume of car thefts in the country, with more than 72,000 vehicles stolen that year.

In 2010, the state had the 6th-highest volume and the 10th-highest theft rate.

Since then, there have been huge advances in antitheft technology–like automatic disabling devices and GPS tracking–that have significantly reduced the theft rate.

According to the ATPA, 6 of the 10 most-stolen vehicles in Michigan in 2010 were Dodge Ram pickups that were manufactured between 1997 and 2003.

The other vehicles on the top-10 list were Ford and Chevrolet pickups.

The largest share of thefts took place in Detroit, which accounted for 47 percent of the statewide total.

The ATPA is funded by a $1-per-vehicle assessment that’s paid by insurance companies and the returns on investments of those funds. Those funds then go to produce grants that help law enforcement agencies combat the theft problem. The Authority reported that it issued more than $6 million in grants between October 2010 and September 2011.

The ATPA says those grants resulted in $27.5 million worth of vehicles and equipment being recovered and more than 2,280 arrests being made.

In addition to law enforcement agencies, grants are issued to county prosecutors as well as nonprofits that provide VIN-etching services to residents. According to the ATPA’s latest report, etched vehicles are 29 percent less likely to be stolen when compared with non-etched cars.

Possible Insurance Implications of Lower Theft Rates

While Michiganders aren’t likely to see an immediate price cut while searching for the cheapest auto insurance in Michigan following the latest ATPA report, significant long-term drops in theft could help drivers get cheaper comprehensive coverage, which is the only type that provides protection after a car’s stolen.

When insurers have to pay fewer claims on a certain type of coverage, they generally lower the price.

However, insurers usually look at the local level, not statewide, and at the types of cars that are being stolen.

If there are drops in thefts in a policyholder’s area, or if they get a new car that has a better history with thefts or is equipped with effective antitheft devices, they could expect a drop in rates. But theft reductions at the statewide level likely won’t have any immediate effect on prices.

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American workers will be better able to access annuities and address their lifetime retirement security needs under a series of steps taken today by the U.S. Treasury and Labor Departments, said the American Council of Life Insurers (ACLI).

Treasury’s actions will make it easier for workers participating in employer-sponsored retirement plans to use a portion of their savings to acquire an annuity that offers guaranteed income for life. Treasury would eliminate some of the burdens that discouraged retirement plans from offering annuity options to participants.

“Treasury has advanced a major plan to address our nation’s retirement income crisis. Millions of American workers are not prepared for the challenge of managing assets through a lengthy retirement. They face a real risk of outliving their assets, possibly facing economic hardship at one of the most vulnerable stages of their lives. Helping today’s workers achieve lifetime retirement income can help avert a crisis in the years ahead, when much of the baby boom generation will leave the workforce,” said ACLI President and CEO Dirk Kempthorne.

Today’s actions follow a Treasury-Labor Department “Request for Information” published in 2010 on ways to encourage lifetime retirement income options.

ACLI’s response focused on the unnecessary administrative burdens faced by retirement plans that want to offer annuity options to participants.

“Treasury wisely recognized the need to help people secure a stream of income they could not outlive. We are gratified that Treasury responded to many of our suggestions. Our common goal should be to help assure the financial security of American workers throughout their retirement years,” Kempthorne said.

Also, the Labor Department today issued a final rule that will enhance disclosure of the benefits offered and the fees charged by retirement plan service providers.

Under the DOL rule, employers will receive information from service providers under uniform rules for describing the costs and benefits of plan products and services. The rule takes effect July 1.

“Life insurance companies provide outstanding service and excellent value to retirement plans. We hope the new rule will help employers recognize the benefits life insurers can offer plans,” he said.

Information about the steps taken today can be found at:

Treasury Release http://www.treasury.gov/press-center/press-releases/Pages/tg1407.aspx

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Car insurance provider Allstate saw profits jump 340 percent between the third and fourth quarters of 2011, a development that’s being largely attributed to the absence of the types of natural disasters in the fourth quarter that wreaked havoc in the third.

The amount of catastrophic losses suffered by the company plummeted 94 percent between the third and fourth quarters, dropping from $1.08 billion down to $66 million. Insurance companies generally consider catastrophic losses to be events that cause $25 million or more in insured losses.

Allstate’s fourth quarter profits were $724 million, which is up considerably from the $165 million in third-quarter profits and the $296 million in profits the company reaped in the fourth quarter of 2010.

But the catastrophic weather events still took their toll on the year-end numbers.

Between 2010 and 2011, yearly profits for the insurer dropped 15 percent, to $788 million.

That reverses the trend seen between 2009 and 2010, when the company saw an increase in yearly profits of 8.7 percent.

Allstate remains one of the top rated auto insurance companies in the country. As of March 2011, it had the second-largest share of the private passenger coverage market with nearly $17 billion in premiums written–a 10.2 percent market share.

State Farm is the only car insurer with a larger share of the market.

While the industry saw gargantuan losses from tornadoes in the Midwest, storms on the East Coast and wind storms on the West Coast last year, many experts say the industry is on the road to recovery.

To read the experiences of current and former Allstate policyholders, readers can find user-submitted Allstate auto insurance reviews online.

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A federal appeals court has ruled  the damages from a van fire that burned down a house under construction should not be covered by a Virginia auto insurance policy covering the van because the van was not being used “as a vehicle” when the fire erupted.

According to court documents, the case originally began in 2008, when John Robins was performing construction work on Steven and Cathy Ivey’s house in Virginia.

Robins had been working on the house for several weeks and was using his Ford Econoline van basically as a storage shed for tools and equipment, powering his equipment with a battery charger and electric splitter that he kept in the van.

He had his van parked there for about a month, driving to and from the house in a separate vehicle.

Robins left the work site for the weekend on Friday, August 15. On Sunday, a fire started in the van that spread to the house and caused nearly $293,000 in damages.

A handful of fire investigators all concluded that the fire had started as the result of “malfunction of equipment kept in the rear of the van, most likely an electrical problem with an extension cord or battery charger,” according to court documents.

After the fire, the company insuring the house paid the Iveys for the fire damage and sought reimbursement from Robins, saying that the incident was a result of his negligence.

Robins then sought coverage from State Farm, the provider of his Virginia car insurance policy, and Nationwide, the provider of his commercial general liability policy.

Each of the companies said the other should cover the damages.

Nationwide said that it should not have to pay the claim because it excluded coverage that was the result of Robins’s use of a vehicle. And State Farm said that it should not have to pay the claim because Robins was not technically using the vehicle at the time of the accident.

The 4th U.S. Court of Appeals found in favor of State Farm. The court noted that Virginia law says for a car insurer to cover the damages caused by a vehicle in an accident, it must be used “as a vehicle.”

The court wrote in its opinion that Robins was using the vehicle as a storage shed, not as a vehicle, and therefore fell out of the jurisdiction of an auto insurance policy.

The court reversed the district court’s ruling that State Farm pay for the damages, and the case was sent back to the district court for further proceedings.

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State Farm announced on Friday that it will be bumping up Delaware auto insurance rates by an average of 1.9 percent starting on Feb. 27.

The second-largest car insurer in the First State said the overall changes for individual policyholders will depend on the discounts they qualify for, the coverages they carry and a number of other factors.

Liability and personal injury protection (PIP) premiums look to be increased across the board, while “the cost of the collision and comprehensive coverages will go up for some and down for others,” according to a release from the company.

The latest data from the National Association of Insurance Commissioners showed that the average size of PIP and property damage liability claims filed by Delaware policyholders increased between 2006 and 2008. During that period, the size of the average PIP claim rose 10 percent, while the size of the average property damage liability claim rose about 4.5 percent.

In the announcement regarding the upcoming increase, the automobile insurance company said that it would be raising rates “to ensure it can fulfill the promises it has made to its customers.”

According to the most recent data made available by Delaware regulators, State Farm has a 22 percent share of the state’s car coverage market.

The only company with a larger share is Nationwide.

Other Recent State Farm Premium Updates

State Farm has announced a handful of statewide premium increases and decreases in recent months. Among them are the following:

To research how State Farm performs when handling claims, consumers can read user-submitted State Farm auto insurance reviews online.

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