California Association of Health Underwriters Health Proposal

Following is a summary of the health plan proposed by the California Association of Health Underwriters from their website:

CAHU’s Healthy Solutions for California
Executive Summary
May 17, 2007

All Californians deserve a health care system that delivers both world-class care and financial security. They deserve a system that is accessible, affordable and fair. Californians deserve a system that boosts the state’s economy, attracts new businesses and strengthens existing enterprises. Californians also deserve a system that is realistic. We can only do so much as a single state; but what we can do, we should do.

The California Association of Health Underwriters (CAHU) is the state’s largest association for health insurance agents, brokers and other professionals. We occupy a unique place in the health care coverage system, working to connect Californians with their best possible coverage from health insurance providers. We see firsthand what’s working and what’s not. We educate consumers on their health care coverage choices, help them select the most appropriate plans for their specific needs and serve as their advocate if problems arise.

Requirements of Reform
As the Governor and State lawmakers move forward in efforts to reform California’s health care system, CAHU is putting forward its “Healthy Solutions” package of reforms and principles that we strongly believe should be used as guidelines for any and all proposed reform packages. Below are the core principles CAHU has identified in an effort to define the terms for a truly comprehensive health care reform effort.

 We believe any reform package must ensure that all Californians have basic health care coverage.
 We believe reform must bankrupt neither families nor the state.
 We believe reform must provide the state’s diverse population with equally diverse health care choices.
 We believe reform must promote ongoing and long-term innovation and experimentation that enable the state’s health care system to adapt over time to the evolving needs of its citizens.
 We believe reform must address and constrain skyrocketing medical care costs.
 We believe reform must provide consumers access to meaningful information and expert advice and counseling from licensed professionals.

The CAHU Healthy Solutions Plan:
Following the principles described above, CAHU has identified a number of specific elements of a comprehensive package of health care reforms, including:

1. Access for All
 Enroll the one million Californians who, while currently eligible for state programs such as MediCal and Healthy Families, fail to participate in them, reducing the state’s uninsured by nearly 15 percent
 Once 85 percent of those eligible to enroll in existing state programs have done so, as the state’s finances permit, these programs should be expanded to reach children up to 300 percent of the Federal Poverty Level and single adults up to 100 percent of the Federal Poverty Level
 Subsidies should be provided to Californians below 250 percent of the Federal Poverty Level enabling them to buy basic coverage in the private marketplace. As state finances permit, subsidies should be offered to individuals up to 400 percent of the Federal Poverty Level (FPL) on a sliding scale (e.g., 90 percent of the cost of basic coverage for those below 150 percent of the FPL to 10 percent for those between 351 and 400 percent of the FPL)
 All Californians, regardless of income, should be required to have at least basic health care coverage

John Pack
Low Cost Health Insurance

SICKO

Having recently watched the Michael Moore documentary, Sicko, I wanted to share some thoughts and opinions about the movie and the U.S. healthcare system in general. Overall, I felt that Moore did a really good job of bringing some major issues to the forefront, albeit in a sensationalistic portrayal. However, it is the job of a good documentary to assure that the viewer perceives and understands the importance of the issues being portrayed, and to this end, Moore's work is outstanding. He also injects humor into the equation and comes up with an end product which definitely accomplishes its purpose and entertains the viewer. However, the biggest failure of Sicko is the inability to provide a workable alternative to the current state of healthcare in this country, and Moore's examples of "a better way" leave much to the imagination and do not even come close to convincing one that the systems portrayed would actually work.

As a relative newcomer to the health insurance industry, I have personally observed many flaws in the current system such as a client who had coverage rescinded due to an issue in her medical record which was unknown to her at the time she completed an application, clients who had claims held up for 90 to 120 days while insurance companies investigated whether a claim was due to a pre-existing medical condition, and overcharges on services due to errors in the negotiated rates between a carrier and service provider. I also have observed human error in incorrect explanations of benefits being communicated to members and in the billing process. There is no question that much improvement needs to take place administratively within the private sector of healthcare.

In today's market, I feel that the most important issues are providing coverage for as many people as possible and making sure that people understand the coverage they possess. Many times one insurance company will decline or rate up a prospect while another will accept the prospect given the same information. The inconsistencies in the medical underwriting of policies are much too widespread as are the number of declines based on insignificant medical issues. Furthermore, the lack of uniform disclosure of the basic coverages provided by health plans is alarming. Many people are sold plans with information on important plan features omitted. Some health insurance carriers actually tell their sales people that it is a terminatable offense if they leave anything in writing with a client without taking an application. In all too many cases, the consumer doesn't know the correct questions to ask, and the broker or company in the quest to make the sale fails to cover key exclusions or deficiencies of the plan.

What this all adds up to is a healthcare system that needs a lot of work. However, in this writer's opinion, most of the entities proposing solutions including Mr. Moore, the politicians, and the insurance companies have their own agendas. In a perfect world, these groups would work together to improve and enhance the current system of healthcare. However, in reality, this quest becomes very political in nature with the various factions competing against each other.

I personally don't believe that a purely universal healthcare system is the answer, but as long as the major players in the industry are participants in our capitalistic, profit oriented society, there will be too many reasons to bypass the real issues at hand in the quest for the almighty dollar. I think all any of us can do is to stay on top of the issues and make our voices heard in support of what we believe in. For this, I have to thank Michael Moore for his efforts.

John Pack
Low Cost Health Insurance

Transforming Healthcare in America

Aetna is at the forefront of the national debate on health care in America. To help their constituents – brokers, plan sponsors and members – learn more about what Aetna is doing to help transform the health care system in our country, they recently created a new website called “Transforming Health Care In America.” The website contains key messages on the subject of health care reform as well as links to news and announcements of initiatives that demonstrate how Aetna is working to help improve health care access and the overall health care experience for all Americans. Please visit their site for more information.

Transforming Healthcare in America

John Pack
Low Cost Health Insurance