The report, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices and Quality, looked at spending and quality measures in Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K. and the U.S. Spending in the U.S. approached $8,000 per person in 2009, while others spent anywhere from one-third to two-thirds as much. Quality indicators show that the U.S. has better than average cancer survival rates, average heart-attack and stroke mortality rates, and the worst rates for asthma and diabetes related preventable deaths and amputations.

Using a linear regression model to predict healthcare spending based on national income, the study found that the U.S. would spend $4,849 per capita or 11% of GDP, far less than the $7,960 and 17.4% spent in 2009. If the U.S. were to spend the same share of GDP on healthcare as the Netherlands (the next highest GDP spender), the U.S. would have saved $750 billion in 2009, and $1.25 trillion if it had spent the same amount as Japan (the lowest spender).

The study looked at contributing factors to higher spending in the U.S. and debunked several myths, such as an aging population, higher incomes and smoking rates. Among the 13 countries studied, the U.S. population was far younger, with 13% older than 65 compared to the OECD median of 16%, and Japan at 22.7%. The study also found the U.S. smoking rate (16% of adults) to be far below the OECD average (21.5%) and the second lowest after Sweden (14.3%). Finally, the highest-income country in the study was Norway, and its spending on GDP was $5,352 per capita and 9.6% of GDP (nearly eight percentage points lower than the U.S.).

The study next looked at what contributing factors may lead to higher spending without greater outcomes. Obesity rates indicate that one-third of the U.S. is obese, while New Zealand is the next highest at 26.5%, followed by Australia at 24.6%. Obesity costs accounted for 10% of all medical spending in 2008. The U.S. also has more access to expensive medical technology leading to higher hospital visits, with the U.S. average of $18,000 per discharge compared to less than $10,000 in Sweden, Australia, New Zealand, France and Germany. Finally, the more complex and less regulated fee system in the U.S. (aka, no price controls) leads to higher prices, with prices for 30 of the most commonly prescribed drugs one-third higher than in Canada and Germany and twice the prices in Australia, France, Netherlands, New Zealand and the U.K.

The study concluded that the U.S. could learn lessons from Japan’s fee-for-service system that allows unrestricted access to specialists and hospitals. Through transparency and price regulations, Japan’s prices are capped for procedures, whereas the U.S. has widespread variation and a lack of transparency, and that an all-payer system (also utilized in Maryland) could reduce these costs

In order to get affordable health insurance in Santa Monica and Cailfornia we need a more transparent health care system. The consumer needs to know what each health care procedure cost, only with that he has the ability to question the system and starts to control his health care cost, and with that health insurancepremium can be controlled in Santa Monica.

Did you ever think the day would come when you would receive money back from your health insurance carrier?  By August, insurance companies will be required to issue consumer rebates if they were not in compliance with the Medical Loss Ratio (MLR)  part of the Affordable Care Act (ACA)  in 2011. Insurers offering health plans to individuals and small businesses must spend at least 80 percent of their premium income on health care claims and quality improvement activities; the other 20 percent or less can be used on administrative expenses such as marketing, products, earned profits for investors and commissions for agents. The MLR is higher for larger groups (85:15 percent).
According to the Kaiser Family Foundation, based on the preliminary estimates from insurers, rebates would total $ 1.3 billion this year , including $ 426 million in the individual market, $ 377 million in the small group market, and $ 531 million in the large group market.

In the individual market the average rebate is estimated at $ 127 per person per year. The average rebates vary substantially from state to state, and within states, by insurers. States like Hawaii, Maine and the District of Columbia will not have any rebates, whereas states such as Alaska ( $305 ), Maryland ($294), and Pennsylvania ( $243) are among the largest per-person rebate states.  For the small group market the average rebate is estimated at $ 76 per person per year, and in the large group market the average rebate is estimated at $ 14 per enrollee on an annualized basis. Unfortunately,  the exact data for California is not available, as the HMO’s are not required to report to the National Association of Insurance Commissioners ( NAIC).

The rebates of the Medical Loss Ratio, although not very large, are among the more tangible effects of the Affordable Care Act to be felt by consumers. One other effect  of the ACA is free preventive care, which many consumers are taking advantage of.
The presence of a Medical Loss Ratio and the rebate requirements have provided an incentive for insurers to seek lower premium increases. This indirectly has produced more savings for consumers and businesses alike. The new rate review procedures, in which states and the federal government review rate increases exceeding 10 %, also encourage insurers to moderate their premium increase requests. All major California insurance carriers showed premium increases under 10 % statewide. Anthem adjusted its rates from the original proposal of 10.4 % to 8.2%;  Blue Shield’s increases averaged 9.7 % and Aetna’s averaged 8 % .  While the MLR is helping consumers and businesses get greater value for their premium dollars, these rate controls still are not the solution to limiting the ever-increasing health care costs, which continue to drive the increasing health insurance premiums.

Furthermore, especially in California where the unemployment rate is still 11 percent, and the annual family income  mostly was stagnant over recent years, even a “so called low 8 percent health insurance increase” is a fundamental hardship for California’s families.

Barbara Schmalz ,  owner of Solid Health Insurance Services, will assist you in finding  affordable health insurance in Santa Monica that fits your health needs and also your financial budget for your family and business.

CMS released the findings ahead of highly anticipated reports Monday from the Medicare and Social Security trustees, which said last year that the healthcare law had extended Medicare’s solvency.

The biggest Medicare savings come from cuts to doctors, hospitals and other healthcare providers, as well as private insurance companies. Together, those two categories of cuts save Medicare more than $150 billion, according to the CMS report.

CMS said the policies in the healthcare law also have the potential to produce more significant long-term savings, in part by shifting the healthcare system to pay more for quality than quantity of treatments.

The healthcare law is also saving seniors money, CMS said — about $59 billion by 2016, and more than $200 billion through 2021.

The law gradually closes the “doughnut hole” in which seniors have to pay for all of their prescription drugs, and it makes certain preventive services available without a co-pay.

“In the short term, both taxpayers and beneficiaries will save billions thanks to the health care law,” acting CMS Administrator Marilyn Tavenner said in a statement. “Over the long run, the Affordable Care Act will allow us to invest in new models of providing care that will save money and deliver higher quality in health care.

Controlling the cost of health care is the best way to guarantee affordable health insurance in Brentwood.

“Comparison shopping for medical procedures can involve a web of billing codes and arcane terminology, despite efforts in California to simplify things.

Californians are still struggling to get straight answers about the cost of common medical procedures despite state efforts aimed at lifting the veil on medical pricing.

As consumers shoulder a larger share of their healthcare costs, the ability to comparison shop is key to keeping that care affordable. Medical costs borne by U.S. employees have more than doubled since 2002 to more than $8,000 a year, while the median household income has dropped 4%.

Under a state law that took effect in 2006, hospitals must publish their average charges for the most common procedures on a state website. But relatively few take the extra step of listing prices on their own websites, where people are more likely to be looking for pricing information, according to healthcare experts.

David Dranitzke, 40, of San Francisco, recalled his frustration when he tried to get prices on a battery of blood tests for his 15-month-old daughter from three different hospitals and lab companies.

He gave up after spending more than 10 hours calling, waiting on hold and faxing information, all the while having to decipher arcane medical terminology and billing codes.

“It’s more difficult to get a price on blood work than remodeling your kitchen,” said Dranitzke, a visual-effects producer. “At some point you just throw in the towel.”

Dranitzke, who was unaware of the state website, ended up paying more than $700 out of pocket under his insurance plan for his daughter’s tests.

To see what consumers were up against, The Times contacted 10 California hospitals and asked for the cost of a routine gallbladder surgery for someone with a high-deductible insurance policy.

Seven of the hospitals offered at least partial estimates, but the quoted prices ranged widely — from $1,200 an hour for the operating room to a $8,687 facility fee. None included the cost of the doctors, although California Pacific Medical Center in San Francisco did say that the total cost for hospital services, including a room, drugs and other supplies, could be $37,217.

One hospital, Desert Regional Medical Center, didn’t return calls. Contacted later, spokesman Richard Ramhoff apologized and said Desert Regional “strives to make sure everyone with a question about rates gets an answer.” Another hospital said it would take 10 business days to get an estimate, and another required detailed insurance information before discussing prices.

“This really highlights how impossible it is for consumers right now with high-deductible plans to effectively shop for care,” said Ateev Mehrotra, a policy analyst for Santa Monica-based Rand Corp. and an assistant professor at the University of Pittsburgh School of Medicine.

Mehrotra’s Rand study in 2009 produced similar results in California. Only 28% of the state’s hospitals responded to a request for an estimate from a fictional uninsured patient and less than 3% offered detailed price quotes including hospital and physician fees.

The California Hospital Assn. says consumers should work with their doctors and insurance companies to figure out estimated costs because each patient’s medical situation is unique.

“An auto shop can give an estimate for a brake job, but people are not cars,” said Jan Emerson-Shea, vice president of external affairs at the California Hospital Assn. “It’s very difficult to get a random call from someone saying, ‘I need gallbladder surgery, so tell me what it costs.’ “

Yet some hospitals do make it easier. On its website, Huntington Memorial Hospital in Pasadena allows people to select several common procedures and get an instant price quote, including an estimate of the patient’s share after plugging in their deductible and coinsurance. But even those numbers exclude the thousands of dollars that physicians, anesthesiologists and other specialists would tack on for most surgeries.

“We are working diligently to make publicly available both cost and quality information,” said Stephen A. Ralph, Huntington Memorial’s chief executive. “The need for pricing transparency in healthcare services has taken on increasing importance for citizens.”

People tend to turn first to medical providers when hunting for prices. In a recent California HealthCare Foundation survey of 1,528 consumers, 26% said they had looked for information on the cost of a medical procedure in advance. Thirty-nine percent of those surveyed said they contacted a healthcare provider, 30% looked online and 8% turned to their insurance company, according to the foundation.

Policymakers and economists have said for years that one way to help slow the rising cost of healthcare was for consumers to have more of their own money at stake.

A report issued earlier this year by the market research division of Thomson Reuters estimated that $36 billion could be saved annually if the 108 million Americans with employer coverage did some comparison shopping on more than 300 common medical procedures.

In 2006, California was among the first states nationwide to require hospitals to publish average charges for some of the most common procedures. The state Office of Statewide Health Planning and Development lists this information for specific hospitals online.

The trouble is that no one actually pays these billed charges, not even the uninsured. Insured patients would be responsible for a reduced price negotiated by their insurer, and the discount would vary based on the company. David Byrnes, a spokesman for the state planning office, said his agency doesn’t have the authority to request additional hospital data beyond the billed charges.

Dario Frommer, former state Assembly majority leader and a lawyer in Los Angeles, sponsored the bill requiring hospitals to disclose more cost information. At the time, he expected it to help consumers shop for the best hospital prices and not be shocked afterward by huge medical bills. “There may be some bad apples, but my experience is hospitals are trying to conform with the law and make information available,” Frommer said.

Insurers have tried to come to the aid of patients by rolling out new online tools allowing members to get a range of prices among network providers. Other sites such as fairhealth.org and healthcarebluebook.com offer consumers average prices by ZIP Code for many common services and tips on managing out-of-pocket costs.

Nonprofit Blue Shield of California launched a new “treatment cost estimator” on its website last month, accessible to its members with preferred-provider plans. It shows, for instance, that a shoulder arthroscopy at three specific hospitals in Northern California varies in price from $7,523 to $11,534 at the company’s negotiated rates; a hip replacement ranged from $18,306 to $45,766 at three Los Angeles-area hospitals.

However, the detailed data with specific names of hospitals or clinics can’t be shared with the general public under the terms of most contracts between insurers and medical providers. California Insurance Commissioner Dave Jones said he would like more consumers to have access to that pricing information. “Consumers don’t really know the health-cost consequences of their decisions,” Jones said, “and they have more of their money at stake.”

Some California lawmakers say hospitals can do more. State Sen. Ted Lieu (D-Torrance) has filed a bill that would require hospitals to disclose all potential charges, including all physician and lab fees, in certain cases. The legislation is scheduled for a second Senate hearing later this month.

“The burden should be on the hospital, not the patient, to figure this out,” Lieu said. “Patients should have the right information so they can choose to go forward or not.”

Both the California Medical Assn., which represents physicians, and the state hospital trade group have concerns about the legislation. For one, they say, hospitals shouldn’t be responsible for supplying physician charges because doctors are independent contractors and can’t be employed by hospitals under state law.

The physicians’ group calls the legislation an “unworkable solution” and says insurance companies are in a better position to assist members with questions about out-of-pocket costs. “We have to ask whether we want physicians focusing on paperwork or treating patients,” said Molly Weedn, spokeswoman for the California Medical Assn.

In January, Anthem Blue Cross rolled out a service in Ventura, Orange and San Diego counties in which it calls members who are referred for an MRI, CT scan or other imaging test and informs them of the lowest-cost option in their area. Anthem said it started the service because the cost for these scans can vary from $350 at outpatient centers to more than $2,000 at hospitals with little difference in quality.

Dranitzke sought help from Anthem, his insurer, but representatives there only advised him whether a service was covered or not by his plan.

He decided to call around for the best prices. His family of four has a $3,500 deductible, and his out-of-pocket costs can reach nearly $12,000.

Healthcare policy experts say that such price-shopping could be a brake on rising healthcare costs, by forcing medical providers to be competitive. But as Dranitzke found, it’s not like shopping for the best deal on a set of tires.

“If I could have saved 10% off the cost, that would have been a big chunk of change,” he said. “But it’s nearly impossible to figure this out.”

We need to demand, as they have done in Europe, a more transparent medical system. With the information technology we have, it should be possible to have all the procedure cost for common medical procedures on the hospital’s website. The consumer than can comparison shop and discuss with his physician, which procedures and/or hospital the best choice is for him. Affordable health insurance in Santa Monica, demands transparent procedure codes, which are understandable to the consumer and insurance, so that we can all together reduce the ever rising health care cost.

About 21% of the population of the State of California, nearly 7 million people, are uninsured.  Consequently, California is paying close attention to last week’s Supreme Court hearing concerning the Affordable Care Act.  The remarks of the conservative Supreme Court justices raise the concern  that it is very  possible the court will strike the individual mandate to purchase health coverage.  Such a ruling could throw out the entire Affordable Care Act  as unconstitutional.  If the federal law is struck down how will the California insurance commissioner handle health care reform in California?

California’s Insurance Commissioner, Dave Jones, has stated  that he “would work with other state leaders to make sure that California continues to move ahead. We require everyone to have auto insurance in California, and the world hasn’t stopped spinning on its axis. All this political tumult generated by the far right is really ignoring the reality in California and elsewhere”.

Consumer advocates in California also support Jones’ position, as they feel that the current status is untenable for people with and without insurance. The average California family pays an additional $1400 in premiums annually to cover the costs of the uninsured.  In the event that the federal Affordable Care Act is struck down, California would require a two-thirds majority vote in the State’s Assembly and Senate to mandate Californians to buy health insurance.  That task failed in 2008 under then-Governor  Arnold Schwarzenegger.

The health insurance industry warns that if a guaranteed issue policy is mandated, premiums will rise substantially unless everyone in California participates.  And if premium increase furthe, even more Californians would drop their health insurance coverage.

One of the biggest risks is that a ruling from the Supreme Court that strikes down the health reform act could  significantly cut off federal money and reduce the expansion of Medi-Cal, California’s program for the poor and disabled, as well as reduce subsidies for families purchasing private coverage.   Under the current federal law, California could receive up to $ 55 billion in federal funds for Medi-Cal expansion for the years 2014-2019, and a similar amount to help subsidize people who are now uninsured.  According to the Kaiser Commission, it is estimated that 2 million people would be added to Medi-Cal and 2.2 million Californians could be eligible for subsidies toward the purchase of private coverage.

Since the Obama health care law in 2010 has been signed, many significant changes in California have already taken place; examples of these are free preventive health screening, guaranteed issue for children under age 19, and effective July 2012, mandatory maternity coverage on all CA plans.  Furthermore, the mandate that the health insurance companies spend at least 80 % of their funds for medical care on individual policies will still stay intact, even if the federal law is struck down.  California will continue to build the California Health Benefit Exchange for 2014, using about  $40 million in federal funds to set up and market the various plans to consumers.

I have recently been attending seminars with the leading insurance carriers talking about affordable health insurance in Santa Monica.  Many executives believe that the health care reform act in California will stay, even if it is federally struck down.  And no one is stopping any preparations in California for 2014.

The Supreme Court is reviewing the Health care Reform act., this can have a significant effect of affordable health insurance for us in California and the Rest of the USA.

As I am unqualified to report on the legal issues of the Supreme Court  and the health care reform issues  I wanted to share this important article in Bloomberg, By Greg Stohr
- “March 26, 2012: The U.S. Supreme Court opened today its historic review of President Barack Obamas health-care law, three days of arguments that might result in the presidents premier legislative achievement being found unconstitutional in the middle of his re-election campaign. The court will determine the fate of a measure designed to extend insurance to about 32 million people and revamp an industry that accounts for 18 percent of the U.S. economy. The six hours of planned debate that began this morning is the most on a case in 44 years. The core dispute — the laws upcoming mandate that uninsured people purchase coverage –comes on the second day. First, the justices today hear arguments on a seemingly arcane question: Does the penalty for failing to get insurance amount to a tax? There is at least some doubt about it, Justice Antonin Scalia told attorney Robert Long, who argued that the court should not decide the case. I find it hard to think this is clear. A 145-year-old law, the Anti-Injunction Act, says courts can’t rule on the legality of federal taxes until they are imposed. For the no-insurance penalty in the 2010 health care law, which takes effect in stages, that comes in 2015. The justices may decide it’s too soon to rule on the health law’s constitutionality. 1867 Law It’s the sleeper issue of the health-care case, said Adam Winkler, a constitutional law professor at the University of California at Los Angeles School of Law. The great constitutional controversy over Obamacare could end with a whimper rather than a bang. The 90-minute debate on the 1867 law will serve as a prelude for the court’s arguments tomorrow over the marquee issue: whether the Constitution lets government require Americans to either get insurance or pay the penalty. The mandate is a primary tool the government uses to expand insurance coverage. The question for the court is whether it falls within the scope of Congress constitutional authority to regulate interstate commerce. On the third day of arguments, the justices will hear debate about what should happen to the rest of the law if the insurance requirement is voided. The court also will take up whether the law, by expanding the Medicaid program, unconstitutionally coerces the states into spending more on health care for the poor. Political Decision Expected The case marks the first time the high court has considered striking down a president’s signature legislative achievement in the midst of his re-election campaign. Republican candidates, including former Massachusetts Governor Mitt Romney, are campaigning against the measure, saying it should be repealed. A Bloomberg National Poll earlier this month found that three-quarters of Americans say the Supreme Court will be influenced by politics when it rules, probably in June, less than five months before the presidential election. The sentiment crosses party lines and is especially held by independents, 80 percent of whom said the court will not base its ruling solely on legal merits. More Republicans than Democrats, by 74 percent to 67 percent, said politics will play a role.

It will be interesting to see how the supreme court will rule. I believe that the health care reform has some very positive sides, like free preventive care and in order for it to work efficiently  everyone needs to be insured. Only this will help to get a control on health care cost and be able to offer affordable health insurance  in California.

Serencsa Settlement Movement Option

Reference your letter with important information about Serencsa options.

Call your Anthem agent – 310-909-6135.

Call our customer service team, Monday through Friday from 8:30am to 7:00 pm PST at 1-866-636-8991.

Changing your Individual policy could cause a loss of “grandfathered” status. Policies with “grandfathered” status are not subject to all of the mandates required by federal health care reform. Moving to a new Individual policy could cause a loss of “grandfathered” status. But, in some cases, if you choose to move to a new Individual plan/policy that includes a deductible increase only, you may be able to keep your “grandfathered” status. Please see your Policy to verify you have a “grandfathered” policy or contact your Anthem agent or our Customer Service team for further information.

You may not be able to move back to your existing policy. If you switch to another plan/policy, you may not be able to switch back in the future.

Your rate for a new Individual policy may be higher. Changing policies doesn’t guarantee your rates will be lower – now or in the future. Rates quoted on anthem.com may not account for specific rating factors applicable to you and should not be relied on as a promise or guarantee of a specific rate. To determine the premium for any plan/policy you’re considering, call us at 1-866-636-8991, Monday through Friday from 8:30 a.m. to 7:00 p.m. PST, or talk with your Anthem agent.

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Let us assist you to find an affordable health plan with Anthem and other carriers in Santa Monica , and please take advantage of the free medical underwriting in April and May.

The final rule addresses standards for state-operated Exchanges, health insurer standards for Exchange participation and Qualified Health Plans (QHP), and standards that employers must meet to participate in the small business (SHOP) Exchanges. It should be noted that the ruling allows agents and brokers to enroll people into plans under state Exchanges, and it also allows companies to enroll people through privately run websites.

Standards for Establishing and Operating an Exchange
The final rule outlines standards in developing an Exchange that remain unchanged from the prior proposed regulations. Each state can structure its Exchange in its own way, such as a non-profit entity established by the state, an independent public agency, or as part of an existing state agency. A state may decide to operate in partnership with other states (regional Exchange) or with multiple Exchanges that cover distinct areas within the state.

Any Exchange must be approved by HHS no later than January 1, 2013; however, the final rule allows for conditional approval for states that are advanced in preparation but cannot demonstrate complete readiness.

Health Plan Standards
To sell a health plan on an Exchange, insurers and HMOs must be certified as a Qualified Health Plan (QHP) by meeting minimum standards defined in the Patient Protection and Affordable Care Act (PPACA). Exchanges have the power to establish additional standards for health plans offered in their respective marketplace, such as structuring QHP choices and setting timeframes in the health plan accreditation process. Exchanges are allowed to set network adequacy standards to help ensure consumers have timely access to health care professionals.

Eligibility and Enrollment Standards
Exchanges must establish an integrated enrollment system to facilitate determination of eligibility and successful enrollment in the health coverage that best fits the needs of eligible applicants. The rule provides for:

• A single application for all available programs
• Coordination with other state programs such as Medicaid and Children’s Health Insurance Plan (CHIP)
• Easy notification process for life events and annual eligibility redetermination
• Use of existing electronic data sources to reduce paperwork for consumers
• New options for interacting with Medicaid agencies when making eligibility determinations that facilitate the administration of premium tax credits

The Exchanges are expected to have toll-free call centers and updated websites to help educate consumers so they may make informed choices about the coverage available on the Exchange and to facilitate consumer enrollment.

Navigators
Exchanges are required to set up a Navigator process to assist consumers. Navigators may provide consumer outreach, education and assistance with the application process. States are directed to choose at least two Navigator organizations (one of which must be a community or consumer-focused non-profit organization).

Employer Participation on Small Business Health Options Program (SHOP)
The rule sets standards for small employer participation in the SHOP Exchanges, including requirements for employees hired outside of the initial and annual open enrollment period.

Comment Period
While this is considered a final rule, there are several provisions within the final rule that are considered interim final rules subject to a 45-day comment period ending May 9, 2012.

The news that agents  and brokers  can assist Individuals and small companies with the Health Care Exchanges are welcome news, as otherwise our livelihood  would be destroyed. The most important thing is that we will find a way to offer more affordable health insurance  in Santa Monica, so that we reduced the amount of uninsured, who burden the health system.

Many prospects who have called me in the recent week got the advise from Anthem not to switch out of their  grandfathered plan. What a bad advise, why would you not switch into  the health care reform plans ? The premium might be lower, but more important you will receive free preventive care, such a free mammogram, papsmear and colonoscopy , which all old grandfathered plan do not offer. Anthem’s position is clear, they do not want to loose all the healthy people out of the grandfathered plan, as otherwise these plan will even get more expensive, as only people with illnesses remain in the old grandfathered plan.

On top of it Anthem send out the premium notices to the policy holder although the rates are not confirmed, and we have to wait until Friday what the final premium will be for May , and if it makes sense to switch into other plans. What a mismanagement, why upsetting policyholders without knowing the facts.

Let me help you to find affordable health insurance in Brentwood by comparing all the insurance carrier. Unfortunately company loyalty is not paid with better premium.