Health care decision: The Supremes 'keep us hangin' on'

US Supreme Court At this moment there are hundreds of Washington, D.C., reporters, lobbyists and pundits with their feet in the starting blocks waiting for the signal to race up the marble steps of the U.S. Supreme Court and hear the decision on health care. Will the Patient Protection and Affordable Care Act, aka "Obamacare," survive intact? Will the judges throw it out? Or -- the third option -- will the Supreme Court chew it up and spit out pieces like the individual mandate, which requires everyone to get health care? So far, the nine justices have succeeded at one thing: agreeing to a "mum's the word" policy. The Supreme Court chambers, like the Federal Reserve, seem to be more leak-proof than the White House, where President Obama is fighting for his political life amid enough leaks to resurrect the Watergate plumbers. I don't have the answer. But like everyone else -- Republicans, Democrats, health insurers, consumer advocates and the media -- I'm willing to hazard a guess. Likely split I believe that whatever the decision, it will be messy. Our judges are seldom like Solomon, who refused to cut the baby in half. It seems to me that the four-to-four, conservative-liberal split… (continue reading......)

Corruption comes to town: Insurance and the mayor

money2 My sleepy New Jersey suburb was recently rocked with scandal when our highly respected and popular mayor was accused of extorting bribes from a health insurance broker. For me, that's bad news. But what's worse is that this could happen in your hometown. Yes, I know all about the Garden (of Corruption) State: home of the Sopranos, leaking landfills and the infamous New Jersey Turnpike. But my township, and our mayor, had a good reputation. Our garbage is collected and our taxes are no worse than any other New Jersey jurisdiction, so our mayor was re-elected by a 2-to-1 majority. Then things went awry. First, The Citizens Campaign public interest group started to question why our school board's insurance broker had been working without a contract since 2009. Then the FBI showed up and littered our township government and school board with subpoenas. Finally, our mayor was charged by the Offices of the United States Attorneys with soliciting $12,400 from said insurance broker, allegedly "to pay his taxes." Pay to play Insurance brokers arrange for businesses, townships and school boards to buy health insurance and workers' compensation for their employees, property/casualty insurance to protect against fires and slip-and-falls, and auto… (continue reading......)

Cracking the health care code

code When my wife fell on the ice two winters ago, her wrist didn't look as nature intended. She went to her doctor, who advised her to go to the X-ray department in the building. With her wrist still crooked months later, she got a second X-ray from her usual imaging facility so that the orthopedist could compare the two. The health insurer sent the explanation of benefits (EOB) for each X-ray, which showed how much it cost. Big difference. The EOB for the initial X-ray was $1,200, while the EOB for the second one was $100. Why was the original billed at Cadillac cost? Her doctor's office is in a building owned by a corporation which also owns area hospitals. When she asked about the difference in price, they told her that the first X-ray was performed at a hospital and therefore billed at a hospital rate. My wife said that seemed strange, since the so-called hospital had no emergency room, no beds for patient admission and wasn't listed on the state's insurance website under its directory of hospitals. The outcome: the corporation offered a refund of $1,100 -- the difference in price between the two X-rays. Co-pay or not… (continue reading......)

Will your employer offer health insurance in 2014?

mcdonalds These days, many companies in America are having battles in the boardroom, insurance brokers and company officials tell me. On one side of the table sits the chief financial officer (CFO), who would like nothing better than to drop the company health plan in 2014 and send employees to the newly formed health insurance exchanges. On the other side of the table sits the human resources manager, who argues that health insurance is so vital for hiring and retaining talented workers that it can't be eliminated. Imagine the headline or sound bite that says "IBM (or any other major company) ends employee health care plans." That's a public relations nightmare, according to the H.R. manager. Doing the math The CFO's argument is compelling when you do the math. The average company's health care plan costs about $10,000 per employee. In contrast, dropping the plan means having to pay a $2,000 penalty in accordance with the 2010 Patient Protection and Affordable Care Act. But dropping coverage and paying the penalty translates to roughly an $8,000 savings per employee, and about 40 percent savings to the company compared to what it now pays. The House Ways and Means Committee is now a… (continue reading......)

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