Fixing Healthcare: Trying to Stay Ahead of the Flames

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PPACA established the PCIP (Pre-Existing Condition Insurance Plan), which provided transitional relief for people with a pre-existing condition who have been without coverage for at least six months, until the exchanges are established. When PCIP started, 23 states, in part concerned that the program would run out of cash, defaulted to a federally-run program.  And in February, PCIP did just that—ran out of money, potentially leaving some of America’s sickest and most vulnerable population without [...] Read more »

This Skeptic Is Still Hopeful about Healthcare Reform

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As I write these blog entries, I often ask myself, “Am I one of those negative people? Do I always see the downside?”  For more than a year I have been writing with a cautionary, skeptical tone about whether the Obama Administration has bit off more than it can chew with federal healthcare reform. I really don’t want to seem negative and clearly have come around to agree with the essence of the law. All Americans [...] Read more »

Multimillion Court Awards Threaten Healthcare Affordability

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In a potential watershed case for the health insurance industry, a Nevada jury awarded $24 million in compensatory damages and $500 million in punitive damages to three plaintiffs in a case stemming from a hepatitis C outbreak. In the case against affiliates of UnitedHealth Group, two plaintiffs claimed they became infected when their gastroenterologist used unsafe injection practices for an endoscopy; one plaintiff was a spouse. In medical malpractice cases, plaintiffs can generally only recover damages from [...] Read more »

The Insurance Exchange: If You Build It, Will They Come?

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Recently the President and his head of HHS met with insurance industry executives to reaffirm the commitment to the insurance exchanges. The exchanges, a significant part of the ACA legislation, are intended to help individuals and small businesses more easily procure less-costly healthcare. Like many pieces of the ACA, exchanges are off to a rocky start. Many states have opted not to establish a state-based SHOP and Individual exchange. As a result, the federal government, in those states, will operate federally facilitated options. While the Individual exchange so [...] Read more »

Delays, More Delays and Bureaucracy

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So. . .they did it again. Tuesday HHS announced that the Federally-Facilitated and Partnership exchanges or marketplaces (the Small Business Health Options Program or SHOP exchanges) that will operate in 33 states will not be fully functional until 1/1/2015.  Employers in these states purchasing coverage through the exchange will only be able to offer one plan with one carrier to their employees, rather than the multiple-plan, multiple-carrier marketplace that was anticipated.  The 17 states running [...] Read more »