Facts about Dirigo Health

The report below sites a number of the shortcomings of a well intended program. The Maine Heritage Policy Center, a conservative research and educational organization based in Portland, periodically publishes what it calls a “Dirigo Watch.” Recently, in its most recent edition, the center took aim at new and increased taxes enacted by the 123rd Legislature to fund Dirigo. The center cited 10 facts that, taken together, make a compelling case for the repeal of this costly failure: • DirigoChoice costs taxpayers $2,977 per enrollee per year just for the premium subsidy, excluding Dirigo Health Agency administrative costs. • As of April 2008, there were 12,637 individuals covered by DirigoChoice, less than 1 percent of the state’s population. • Only 31 percent of DirigoChoice enrollees — 3,917 — were previously uninsured for at least 12 months prior to enrollment. That is only 3.2 percent of the state’s uninsured population. • The marginal cost to state taxpayers is $9,603 to subsidize the coverage for one previously uninsured person through DirigoChoice. • Maine’s uninsured rate from 2003 to 2006, the latest year available, is virtually unchanged — 128,000 uninsured in 2003, 115,000 in 2004, 132,000 in 2005, 122,000 in 2006. • The Dirigo Health Agency’s administrative costs were $3.7 million in calendar year 2007. • Because of financial difficulties, DirigoChoice was closed to new enrollees on Sept. 1, 2007. • The 1.8 percent health care claims tax, which was included in the tax increase package approved by the Legislature, will cost individuals about $78 and families about $210 a year in higher health care premiums. • Without the $57 to $72 million tax increase, DirigoChoice enrollment is projected to drop by 4,000 individuals. Even with the tax increase, DirigoChoice enrollment still is projected to drop by 1,000 individuals. • The Dirigo Health experience has cost Maine taxpayers more than $100 million since 2005. Dirigo Health was supposed to make health insurance more affordable and provide coverage for most of Maine’s uninsured. In fact, it has done neither. As the Heritage Policy Center observes, “By its own measures, DirigoChoice will spend tens of millions more to cover fewer and fewer uninsured.”

Medical Cost Trends for 2009

Behind the numbers: Medical cost trends for 2009

http://www.theindustryradar.com/index.cfm?account=article&page=medical_trend_2009

HSA Market Report

Quarter 1- 2008

http://www.canopyfi.com/hsa_stat_report.pdf

Uninsured employee risk

LTCI: The largest uninsured employee risk What is the one employee benefit that employees ultimately need more over the course of their lifetimes than any other? With a 72 percent risk of needing long term care after age 65, the cost of long term care is the largest unfunded liability in America today. However, less than 10 percent of corporate America’s employees today own long term care insurance (LTCI). How is it possible that in 2008, more than 90 percent of U.S. corporations still don’t have a menu of voluntary LTCI coverage? Moreover, if no employer premium contributions are required, is there any reason for every corporation not to be offering voluntary long term care insurance? Most traditional employee benefit programs provide an effective balance of medical, dental, life and long term disability insurance coverage. Such benefit packages do an exceptional job of covering most areas of insurable risks that employees face during their working years. However, what exactly are considered the “working years” in 2008? Consider that back at the turn of the last century, the average American was expected to live to age 47. Today, men can be expected to live to approximately age 77, compared with age 83 for women. When a married couple reaches age 65 these days, one of them will likely live to age 90. Medical science is extending our lifetimes, creating a new insurable risk. That insurable risk should become the most important employee benefit: LTCI. Recent research into the cost of medical expenditures projected over our lifetime alerts us to an incredible “imbalance.” One study revealed that 80 percent of a lifetime of medical expenses can occur in the last two years of life. Consider that today, a typical employer and employee are together spending at least $400 to $500 per month for medical coverage. For a 45-year-old employee, that projects to at least $120,000 in total medical premiums paid — including medical inflation, which runs the total to more than $150,000. Yet, none of that $150,000 will go toward the medical bill after age 65. This illustration isn’t meant to discount the value of the protection that a $400 per month premium provides. Triple bypass surgery at age 50 needs to be insured. One medical catastrophe can quickly wipe out savings and another family home heading toward foreclosure. My objective is to give you a vision of the need for lifetime medical care coverage, not just to age 65. Regardless of the quality of our medical insurance during our working years, we better make sure we have adequate coverage during those last two years of life. However, what we used to define as the “working years” will necessitate more expansive employee benefits in years to come. Decades ago the traditional age for retirement was age 65. Those days appear to be gone forever. In many states today, seven out of 10 workers aged 65 years and older keep working because many simply can’t afford to retire at age 65; others discover their company sponsored benefits are too valuable to give up. Medicare, the federal governments’ medical insurance plan for today’s “senior” population, provides extensive benefits at an equitable cost. However, keep in mind that 94 percent of care after age 65 is “custodial” care and is not insured by Medicare. Even if it was skilled care (covered by Medicare), it’s never covered for more than 100 days. If those last few years of life are so medically and financially “hazardous,” how and when do we plan for it? At what point, or age, does an employee do their “later life” planning? Regrettably, the tendency is for our national workforce to do their long term care planning as part of the retirement planning process. However, since a diminishing number of retirees have adequate finances to actually retire on, the long term care planning process mostly never happens. From the employee’s perspective, the ever increasing long term care risk begins to reach the dangerous stage at just about retirement time. If the employee hasn’t purchased long term care insurance prior to this time, they’ll be facing several key issues simultaneously. By age 65, many retirees have already experienced ill health. At least 10 to 20 percent no longer qualify, as they’re medically uninsurable. Chances of qualifying for a good health discount are as low as 10 percent. Plus, the premium rates are increasing by 5 percent to 6 percent annually and, at the same time, health care costs are increasing by more than 5 percent each year. Every year of delay increases the cost another 10 percent to 11 percent to insure the very same risk. An employer can provide a most valuable service by simply calling attention to these issues. Employees automatically assume their employer has done their due diligence and employer-sponsored coverage has favorable discounted rates. Payroll deduction long term care insurance is the end result of the educational process for the employee population. Caution: Don’t expect that employees will be lined up waiting to apply for long term care insurance. My experience is that they won’t. Remember, e-mail communiqué’s, seminars, “lunch and learn” meetings and one-on-one meetings are all part of the necessary communication process. By Allan Checkoway Disability Services Group/ElderCare Publishing Inc

LCRCC- Week 16

LCRCC- Week 16 Legislative Report

http://www.vermont.org/pdf/week%2016%20may%202.pdf

BCBS- Week 16

LEGISLATIVE REPORT For the Week Ending April 25, 2008 Legislative leaders are pressing for adjournment by the end of this week by urging committees to complete their work quickly and work out conference committee agreements with their colleagues in the other chamber. Saturday, May 3rd is the target adjournment date barring any hitches that could send the session spilling into another week.

http://www.bcbsvt.com/pages/news/2008WeekSixteen.htm

New Mandates & More Studies

Toward Evidence Based Health Care Reform- Volume 3, # 9

http://www.vtreform.com/d/volume3/20080317_More_Mandates_More_Studies.pdf

Off the Charts

Hospital admissions and lengths of stay vary widely in Vermont, and a new report asks why By Ken Picard [02.06.08] - 314 reads

http://www.7dvt.com/2008/charts#

Pharmacy Benefits for HSA Plan

Improving service for our customers is a priority for BCBSVT, and we focus our resources where we can make positive change for employer groups and members. Our most recent improvement: High-deductible health plans now recognize and calculate prescription drug purchases against our members’ annual HSA deductibles. Members who have satisfied their annual deductibles will no longer have to pay at the pharmacy and seek reimbursement from Blue Cross and Blue Shield of Vermont. The pharmacy will automatically bill the Plan after the annual deductible limit is met. Prescription claims may take up to five days to be updated in our systems, and pharmacies will continue to charge members until their deductibles are fully met. For example, if a member has $500 remaining in their deductible and the prescription costs $750, the pharmacy will charge the member $750 and the Plan will reimburse $250 to the member. After that claim is processed, all subsequent pharmacy claims will be billed to the Plan. The deductible calculation applies to all BCBSVT HSA Blue and TVHP HSA BlueCare high-deductible plans and is effective January 1, 2008. If you have any questions about high-deductible health plans, please call our Sales & Service department at (800) 255-4550, options 1, 1 and then 3. Blue Cross and Blue Shield of Vermont | 445 Industrial Lane | Berlin, Vermont

Green Mountain Care

Green Mountain Care is a family of low-cost and free health coverage programs for uninsured Vermonters. Offered by the state of Vermont and its partners, Green Mountain Care programs provide coverage for health services such as doctor visits, emergency care, prescription medicines, and more. Programs offer no or low co-payments and premiums to keep out-of-pocket costs reasonable.

http://greenmountaincare.org

Walmart $4 Prescription List

As part of our commitment to lowering healthcare costs, Wal-Mart offers over 360 prescription drugs at only $4 per 30-day supply.* In only its first year, this program has already saved our customers over $610 million.

http://www.walmart.com/catalog/catalog.gsp?cat=546834&fromPageCatId=5431

Northern Benefits Honored

Northern Benefits honored with 2007 Vermont Small Business of the Year Award

http://www.burlingtonfreepress.com/apps/pbcs.dll/article?AID=/20071114/BUSINESS/711140312/1003&theme