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    Wednesday, February 01, 2006

    Details, Details: Those little blurbs about healthcare insurance reform in the State of the Union address are fleshed out here. Some key points:

    The President proposed to build on this success and expand HSAs by:

    * Giving Individuals That Purchase HSAs On Their Own The Same Tax Advantages As Those With Employer-Sponsored Insurance. The President proposes making premiums for HSA-compatible insurance policies deductible from income taxes when purchased by individuals outside of work. In addition, an income tax credit would offset payroll taxes paid on premiums paid for their HSA policies. This will level the playing field for those who currently do not have access to employer health care plans, including the self-employed, unemployed, and workers for companies that don’t offer health insurance. For Americans who are not working, especially early retirees, premiums for the purchase of non-group HSA plans would now be allowed tax-free from an HSA account.

    * Eliminating All Taxes On Out-Of-Pocket Spending Through HSAs. The President proposed allowing Americans with HSAs and their employers to make annual contributions to their accounts to cover all out-of-pocket costs under their HSA policy, not just their deductible as provided under current law. This will allow patients to cover all their out-of-pocket expenses tax-free through their HSA. The new proposal would also provide a credit for payroll taxes paid on HSA contributions made by individuals. The President's HSA proposals are projected to increase the number of Americans with HSAs from the currently projected 14 million to 21 million by 2010, a 50-percent rise.


    Guess that last one means you could blow your entire HSA on breast implants and no one would stop you.

    There's more. How about health insurance that you can keep when you change jobs?

    * Enabling Portable HSA Insurance Policies. Employers would have the ability to offer workers a Portable HSA insurance policy that the employees would own, control, and be able to take wherever they went. Their premiums would be tax-free and would not increase based on their health status at the time that they changed jobs, left the labor force, or moved. Employers could contribute to new employees' Portable HSA insurance policies – no matter where the policy was originally purchased. Employers would have the ability to decide whether or how much to contribute to these plans, but whatever they contributed would be tax-free.

    * The President Supports Permitting The Purchase Of Health Insurance Across State Lines. This would allow Americans to buy the best health insurance, based on their own circumstances, instead of being limited to only the policies available in their state. Allowing Americans to purchase health insurance policies issued in other states will provide much-needed choice and competition, while retaining the consumer protections of enforcement and licensing states currently provide.


    And then, there's the demand for transparency:

    Americans Should Be Able To Easily Obtain Understandable Information About The Price And Quality Of Health Care. The President urges medical providers and insurance companies to make information about prices and quality readily available to all Americans prior to the time of service or treatment.

    I support that. And the first step toward achieving that sort of transparency is to do throw out our current coding/billing system. Right now, if you call a doctor's office and ask how much a visit will cost, they can only give you an estimate. The amount billed will depend on how many things the doctor has to address and how hard he has to think about it. Suppose, for example, you have an ear infection. Usually, that would be a 99213 - the billing code for an intermediate level office visit. In my neck of the woods that would run around $60-65 out of pocket. BUT, if, while you are in the office you mention casually that you've been having chest pain whenever you walk a little too fast, well, that changes things. The visit will probably go up to a 99214 code, a detailed office visit, that involves more thinking and more risk for the doctor and costs around $75 to $80 in my neighborhood.

    It would be far better for everyone if we just billed by time, like lawyers.

    And finally, there are these two very interesting proposals to help the less fortunate:

    The President Proposes Providing $500 Million Per Year To Encourage States To Test Innovative Methods For Covering Chronically Ill Residents. Americans who are chronically ill and are not part of an employer or public pool must pay the full burden of their care through high premiums or, in some cases, go without insurance at all. Some states have established high-risk pools to insure chronically ill patients otherwise denied coverage, but there are also other innovative approaches that could provide better coverage at lower costs. The President proposes grants, awarded by the HHS Secretary, that would help cover chronically ill patients by helping up to 10 states build on their existing high-risk pools or test other innovative approaches such as risk-adjusted subsidies or plans designed to manage chronic illnesses such as diabetes.

    ...The President Proposes Expanding AHPs To Allow Civic, Community, And Religious Groups To Purchase Health Coverage For Their Members. This gives individuals and their families, including the most vulnerable Americans, the ability to pool together to buy health insurance outside of their workplace. Giving people more choices to buy insurance at group rates from organizations they already know and trust will help many Americans purchase quality, affordable, and portable health insurance.


    That last proposal is, perhaps, the most exciting. Why shouldn't we be able to pool our resources in the community for healthcare insurance? We have Catholic credit unions. Why not a Catholic health union? They probably wouldn't cover abortions and birth control, but that specific group of insureds wouldn't care, would they? And why not an American Baptist health union? or a Kiwanis health? You know, it might even improve participation in community organizations, to know you could get health insurance by virtue of membership.

    UPDATE: The Wall Street Journal offers some advice on choosing HSA's.
     

    posted by Sydney on 2/01/2006 08:31:00 PM 3 comments

    3 Comments:

    I understand your objection to billing with CPT codes. I think payers might have a problem with billing for time (and aren't CPT codes based on time and technology?) because of the potential for fraud. Of course if the patient is paying out of pocket, there is no problem. In fact, in a world of high deductibles, time-based billing might work better since it is easier to understand than codes.

    By Blogger cokaygne, at 8:07 AM  

    Hey, cool blog here. I'm blog surfing and came across yours...some good thoughts here.

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    By Blogger Rob, at 9:41 PM  

    Hi, cool blog. Is this your only one? I have a couple of my own. Keep up the blogging, enjoy.

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    By Anonymous group health insurance plans, at 2:08 AM  

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