http://www.youtube.com/watch?v=bLJxmJZXgNI

Admitted felon and still licensed insurance agent “Half Guilty” A.C. Olivarez, after having his sentencing postponed two or three times since August 2008, is now scheduled to be sentenced in McAllen, Texas on May 15 at 9:30 am.  See related stories on this blog.

Editor’s Note: Bribery of public officials to gain insurance contracts is a crime. To continue to act as a licensed insurance agent after pleading guilty to a felony seems improbable. The Wheels of Justice turn ever so slowly.

WASHINGTON (Reuters) – Support grew on Friday for insurance industry demands that all Americans be required to obtain coverage as part of a planned healthcare system overhaul, with a senior Senate Democrat and a coalition of business and consumer groups promoting the idea.

 Senate Finance Committee Chairman Max Baucus, a Democrat who is helping write healthcare legislation, said an insurance requirement, or mandate, would help the market function better and reduce premium costs for everyone.

 Baucus argued that the cost of medical care for people with no insurance is being shifted to those with insurance, forcing costs higher.

Editor’s Note:  Insuring everyone will not lower health care costs.

A $175,000 heart surgery in the United States goes for about $10,000 in India. What is up with that? Indian doctors practicing in the United States charge more than if they were in India?  Seems logical that one should consider going to India for surgery to save money. In fact, an employer would do well to encourage it. If employee Jones needs heart surgery, why not offer him the option of traveling to India with his wife, free of charge, pay 100% of all expenses, including medical expenses, and hand employee Jones a check for $20,000.

http://www.cnn.com/2009/HEALTH/03/27/india.medical.travel/index.html?eref=rss_topstories

Next Tuesday a Senate hearing will be held to highlight medical out-of-network issues. The issues include the contention that insurance companies are low-balling out-of-network reimbursement and leaving the consumer to pay more than they should.

Editor’s Note: It is frustrating to watch Congress delve into areas they have no business delving into. They should let free market forces reign. This is another example of why PPO networks drive costs up, not down and have become nothing more than a smokescreen to allow providers to inflate their fees. The only thing that a PPO guarantees is the promise of no balance-billing. But, we have found a solution to the balance billing issue which defuses the fear mongering tactics used by medical providers, insurance companies and PPO network salesmen.

Rep. Howard Berman (D-Calif) added funding to allow Providence Health & Services to purchase a $200,000  tattoo-removing laser to expand their ten year-old program that removes gang-sign tattoos. The program, run out of North Hollywood, has removed tattoos from 12,000 former gang members, helping them get jobs with employers who otherwise would not hire them. Berman spokesman says the program actually makes the streets safer for all Southern California residents. “When former gang members with these tattoos go walking around, they become targets of drive-bys and other shootings” he said.

Editor’s Note: This article appeared in the March 9, 2009 issue of Modern Healthcare magazine. Appropriately, the beneficiaries of the plan are residents of California.

New survey discloses the best and the worst insurance companies – 2009payorsurveyfactsheet1

A stop loss carrier sent this to us this morning which bears worth watching:

HB 1578 has been introduced in the Texas Legislature.  The Bill would affect stop loss and reinsurance policies.  Under the Bill reinsurance would be prohibited and stop loss insurance required to cover a self-funded plan.  All stop loss policies must be approved by the Commissioner.  An individual stop loss policy must have a deductible between $5000 and $100,000 or it will not be approved. 

hb01578i

Editor’s Note: This is another example of government interferance in private enterprise. It appears that the State of Texas wants to become an insurer and will prohibit the private sector from reinsuring medical stop loss policies. Specific stop loss limit of $100,000 will significantly increase costs for larger self-funded groups that currently have their specific level at $250,000 or higher.  And, for those groups, it would not be actuarial sound to limit their exposure to $100,000.

Health care reform has taken center stage this week and we expect headline news on this in the coming days. Yet, no one really knows what changes are to be proposed or what specific directions a national health care plan will take.

Our predictions include a two payer system; a government run system that will compete with private health care companies such as Aetna and Cigna. This arrangement will be problematic since a government run plan can mandate costs while a private health care company can only negotiate costs.  Our second prediction is all health care costs will be taxable income to plan beneficiaries. Our third prediction is that the government will mandate expense ceilings for private health care plans as well as mandated target loss ratios. This will diminish the role, and the need for, independent insurance agents and brokers as well as damper financial interests of private payers such as United HealthCare, Aetna and their respective share holders. In time, the private sector health care payers will fade away and a one payer natiional health plan will become reality.

A Texas public school district could join the TRS ActiveCare Plan, essentially maintain the same level of benefits, and save the taxpayers over $16,000,000.  Current annual cost of the district’s self-funded health insurance exceeds $42,000,000. When you add in claim run-off liability, that figure jumps to over $50,000,000. Yet by joining the TRS ActiveCare Plan this district’s cost would below $30,000,000 annually.