KHN: Kaiser Health News

You’ve heard all the campaigns and statistics: Smoking Kills. It’s the leading cause of preventable death in the U.S. And it’s expensive.

The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses. That’s why the federal Affordable Care Act permits insurers to charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. ”In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

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Corrected at 6:00 p.m. to reflect that 11 insurers, rather than 17 have submitted policies to sell in the state’s new online health insurance marketplace.  The larger number includes those proposing to sell both inside and outside the online marketplace.

Colorado became the latest state Wednesday to post proposed health insurance plans for its new online marketplace, which is slated to begin enrolling people in coverage Oct. 1.

What stands out is the number of plans being proposed.  A total of 11 insurers are seeking approval to market about 250 health plans to individuals and small groups  in the state’s online marketplace under the federal health care overhaul.

While Colorado regulators said they are encouraged by the number of carriers who want to participate—hoping competition will help keep down premium costs—it worries agents.

“I would say that number has to come down or people are going to be overwhelmed by the choices they have,” said Marie DeWolf, who runs an insurance agency in Greeley, Colo. (more…)

Maybe competition among health insurance plans can lead to lower rates.

As soon as Oregon this week became the fourth state to publicly list health insurers’ proposed 2014 rates for individual and small group coverage, two plans moved to cut their suggested prices, the Oregonian reported Friday. Providence Health Plan and Family Care Health Plans sought to lower their rates when they noticed they were out of whack compared to competitors — five months before the health law’s new online marketplaces even open for enrollment.

What is also clear from the filings is that there’s little sign in Oregon of the major premium hikes that the industry has been warning about for months.

“I don’t see sticker shock in the rates,” said Jim Perucca, executive vice president of Independent Insurance Agents and Brokers of Oregon.

Other states that have made insurers’ filings public show a range of proposed premium changes: In Maryland, CareFirst Blue Cross Blue Shield, the state’s dominant insurer, requested a 25 percent average rate increase for its 2014 individual-market plans.  Vermont  and Rhode Island officials said the insurers’ proposed rates were close to today’s prices.

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An advertisement for Colorado's health insurance marketplace

With less than five months until Colorado’s new online health insurance marketplace opens for business this fall, officials are concerned that few state residents have heard of it.

This week, it became the first state to launch a public awareness campaign with television, print, radio and billboard ads that will cost $2 million and run two months.  The TV ad shows a woman at her kitchen table scrolling through health plan information on the Connect for Health Colorado website. The voice over says the website lets people shop and buy a health plan online.

“When health care companies compete, there is only one winner: you,” says the voice over, as the woman jumps up and down as if celebrating a sports victory. The 30-second ad makes no mention that the new website is a result of the 2010 federal health law known to most Americans as Obamacare.

The Colorado marketplace, like others, will open for enrollment Oct. 1, selling coverage that will take effect next January. Colorado is one of 17 states approved by the Obama administration to operate its own online marketplace. Other states are relying in part or in whole on federally run marketplaces.

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The only real surprise about Colorado’s bill to expand Medicaid, now that it’s been approved by both legislative chambers, is that it won a vote from a Republican legislator.

Sen. Larry Crowder from the San Luis Valley said he couldn’t vote against the bill when hospitals in his district are strained to the breaking point caring for the uninsured. Colorado hospitals strongly support the expansion, saying it will replace many of their unpaid bills with new Medicaid payments.

Both chambers of Colorado’s legislature passed bills late last week to expand Medicaid as called for in the Affordable Care Act. The next step is the state Senate is expected to approve amendments to the House version of the bill on Tuesday and send it to the desk of Gov. John Hickenlooper, a Democrat, who has said he will sign it.

“I have no choice but to support this,” said Crowder, whose rural district includes several of the state’s poorest counties.

“I was opposed to Obamacare,” he said, but added that four of the seven hospitals in his district are in “serious financial trouble” and he felt obligated to vote for the bill because it will give uninsured patients a way to pay their bills.

Over four committee hearings, Republican lawmakers were the only ones to speak against the bill. No individuals or groups testified that it should not be passed. Proponents, on the other hand, were numerous and vocal. In testimony, advocates for the poor praised the expansion plan, saying it will finally extend coverage to adults without dependent children and tens of thousands of working Coloradans who make too little to afford private health policies.

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Protesters clashed Tuesday outside the Jackson Women’s Health Organization, the only abortion clinic in Mississippi, which won a victory in federal court that allows the facility to continue to operate, at least for now.

The legal victory for the clinic came Monday when U.S. District Judge Daniel Jordan III temporarily blocked a state law that requires all the doctors at the facility to have admitting privileges at a local hospital. The judge is preventing the law from taking effect until a legal challenge against it is settled.

Outside the clinic in the state capital of Jackson, abortion rights supporters in yellow “clinic escort” vests  helped women into the facility as anti-abortion protesters called to the patients begging them not to have the procedure.

The ruling is a big letdown for anti-abortion protestors like Cal Zastrow who wants to see the clinic closed. He compared abortions to the deaths caused by Monday’s attack at the Boston Marathon.

“I am very disheartened that some people feel they need to murder children with bombs and ball bearings and also with surgical abortion,” Zastrow said. “That is disheartening to me. That some people dehumanize other people and commit acts of terrorism on them.”

Supporters of the clinic played music and tried to shield the women from the shouts of the protesters.

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Last week Vermont became the first state to provide a glimpse of how expensive individual health insurance might be under the Affordable Care Act. Proposed rates there, while of questionable relevance to the rest of the country because of the state’s unusual insurance market, showed little change from current prices and reassured health law supporters fearing headlines about “sticker shock.”

But rate disclosure elsewhere may take a while. In many states the deadlines for filing proposed plans aren’t until late May. And some states with early deadlines have no plans to publish results as quickly. Vermont insurers had to file paperwork by March 25, and the state disclosed results on April 1.

“The state of Vermont is very intent on transparency,” said Dale Schaft, spokeswoman for the Vermont Department of Financial Regulation.

In New York, proposed rates from insurers are due Friday, April 12. But under state law, new insurance filings are not made public until they are approved by state regulators, which is anticipated in July, said a spokesman for the state health department.

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The cost of doing business may be lower in areas where there’s a “culture of health.”  And that’s put Colorado, which has the lowest adult obesity rate in the nation, on the map for companies looking to relocate or expand.

Kelly Brough is proud of this.  She runs the Denver Metro Chamber of Commerce, and she’s creative about luring businesses to relocate in Colorado.  For instance, she runs a “Colorado loves California” campaign.

“We do it on Valentine’s Day,” she says.  “The CEOs actually do get valentines from us. And it’s been a real creative, cool way to say to companies, ‘We know you’re out there, and we think you may be interested.’”

Brough says if Colorado can catch a corporate executive’s eye, she’s got the numbers to hook them. And she’s talking about more than just the typical tax breaks and labor costs.

“Our obesity rate being the lowest in the nation ranked extremely high for the companies we recently attracted,” she said at a luncheon for Denver health leaders.

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What if there were a way for even small employers to escape some Affordable Care Act rules blamed for driving up costs? Some see self-insurance for medical care, which is exempt from the law’s taxes, benefit rules and price restrictions taking effect next year, as just such an opportunity.

Self-insured firms finance most worker health costs and buy “stop-loss” reinsurance to cover especially high claims. Self-insurance has typically been the realm of large employers. But Kaiser Health News has reported brisk interest by small companies exploring self coverage. Stop-loss coverage that kicks in as low as $10,000 or $20,000 per worker makes self-insurance an option for firms with as few as 20 or 30 on staff, brokers say. Yet advocates of the law worry that more small firms with young, healthy employees will self-insure next year, exploiting what some see as an ACA loophole and leaving small-group insurance pools with sicker members and higher costs.

Regulators have little information about what’s going on, says a new study from the Robert Wood Johnson Foundation and the Urban Institute. If self-insurance takes off among small companies, the information gap could make states slow to react to keep their small-group markets viable.

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