On Health and Money
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Marriage, in Sickness and for Health Insurance
Continue reading… 9 CommentsAfter 12 years of unwedded bliss, two friends of mine recently got married. The reason: Her job offers health insurance benefits to married couples but not unhitched cohabiting ones. Now it turns out these two may have been at the leading edge of a trend. According to a new poll, 7 percent of respondents said they or someone they lived with decided to get married in the last year in order either to have access to health insurance benefits or to give their new spouse access.
And they say romance is dead. At a time when the typical family health plan costs upwards of $12,000 a year, sharing a group policy number is more than a token way to say "I love you." It's a hefty commitment, giving new meaning to "in sickness and in health."
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Wealth Lowers Stroke Risk, No Surprise
Continue reading… 1 CommentMoney can't buy you love or happiness, but it may protect you from having a stroke. That's the takeaway from a new study in the journal Stroke, released today. Researchers found that the least wealthy were three times more likely to have a stroke between ages 50 and 64 compared with those who were in the top 75th to 89th percentile in wealth (the very wealthiest outliers were excluded). Once people hit 65, however, all bets were off, and wealth no longer afforded them protection.
The study examined the effect of education, income (annual earnings), and wealth (all housing and financial assets) on nearly 20,000 participants in the ongoing University of Michigan Health and Retirement Study. It's the first study to find that wealth predicts stroke incidence independently of income and education, according to Mauricio Avendano, a research fellow in public health at the Erasmus Medical Center in Rotterdam and coauthor of the study, in a press release announcing the findings.
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Find Medicare Part D Confusing? You're Not Alone
Continue reading… 13 CommentsAs anyone who's ever tried to decipher the Part D Medicare drug benefit knows, user friendly it's not. Seniors typically have dozens of plans to choose from, all with different moving parts—deductibles, copayments, coinsurance, covered drugs—not to mention that mother of all confounders, the so-called doughnut hole into which seniors fall after they've accrued a few thousand in drug costs. Until they reach a certain threshold and catastrophic coverage kicks in, they're responsible for paying the full freight.
Now the Journal of the American Medical Association has released a pair of studies that examine seniors' understanding of their costs under Part D, and how those costs affect "adherence" to their prescription drug regimens. One study found that—surprise!—60 percent of a random sample of seniors enrolled in a plan through Kaiser Permanente didn't know that it had a doughnut hole. Just over a third of these seniors reported that drug costs had affected their behavior, causing them to switch to a cheaper drug or not fill a prescription, for example. The other JAMA study found that seniors were less likely to report problems sticking to their drug regimens because of costs after the Medicare drug benefit began in 2006. But the sickest patients didn't see the same improvement.
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California Health Insurers Must Reinstate Policies
Continue reading… 26 CommentsChalk one up for sickly patients. California regulators have ordered insurers there to reinstate the health insurance policies of 26 people who lost their coverage after the insurers claimed they had lied on their applications, according to news reports. The 26 cases represent the most egregious examples of insurers wrongly "rescinding" policies, typically for inadvertent errors. The person gets sick and starts making expensive claims, and the insurer cries "fraud!" The patient says "forgot!" or sometimes "say what?" For example, one woman I spoke with on this topic had answered "no" when asked if she'd been treated for cancer in the past 10 years. Later her policy was yanked because the insurer claimed that regular blood work she had to ensure her earlier cancer hadn't returned constituted cancer treatment.
Now California begins a case-by-case review of thousands of rescissions in the past four years, and it may be that these 26 are the tip of a fairly hefty iceberg. And consumer advocates say there's no reason to believe this issue is confined to California. They expect similar cases to begin emerging elsewhere.
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High-Deductible Health Plans: for Many, Too Costly
Continue reading… 6 CommentsIf there can be such a thing as buzz in health policy circles, for the past few years "consumer-driven healthcare" has been hot, hot, hot. Although only a little more than 1 in 10 adults is enrolled in one of these types of plans so far, it's the current big idea that everyone's focused on to reduce the number of uninsured and bring healthcare costs down.
Fundamentally, the idea is that if consumers have a bigger financial stake in their own healthcare—meaning they pay more for it, basically, because their plans have higher deductibles—this will lead them to make more fiscally prudent decisions and save the system money. (You know, you'll cut back on all those frivolous doctor visits that you schedule "for fun" because you like the gowns.) Since these high-deductible health plans have lower premiums than traditional plans, the thinking goes, coverage will become more affordable, and we'll make a dent in the 47 million people who are currently uninsured.
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Worries About Healthcare Credit Scores
Continue reading… 4 CommentsYou arrive at the hospital for a medical procedure. But instead of checking you in, the person at the front desk says, "Sorry, your healthcare credit score is too low. No healthcare for you!" That's the alarming specter raised by recent reports of the scoring systems hospitals and other providers use to figure out whether patients have the resources to pay and are likely to do so.
Could it happen? Consumer advocates say they've never heard of people being turned away because of their score, and hospitals are adamant that it would never occur. But consumers may still worry, and who can blame them? Regular credit scores are used to approve a car loan or a mortgage. If a bad score can get you turned down in those instances, why not for healthcare?
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Dying Too Young for Lack of Coverage
Continue reading… 4 CommentsIf we want to measure how well our healthcare system is working, tracking premature death is arguably the ultimate yardstick. Now a new study spells out, state by state, how many people died in 2006 because they didn't have health insurance. In California, for instance, more than eight working-age people died each day because they lacked coverage, a total of 3,100 for the year. The death toll from lack of insurance was 390 in Arkansas. And so on.
The concept isn't new, but seeing the numbers spelled out for your own state literally brings it home. In 2002, the Institute of Medicine found that adults without insurance were 25 percent more likely to die before their time than those with private insurance. It estimated that 18,000 adults died in 2000 for this reason. The Urban Institute later updated that figure to 22,000 for 2006. Families USA, a nonprofit health advocacy group, has now broken down the figures for 25- to 64-year-olds in every state and the District of Columbia. The group's report, "Dying for Coverage," was released today.
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Wal-Mart Rethinks Its Move on Deborah Shank
Continue reading… 36 CommentsWal-Mart bought itself a passel of bad publicity recently when it tried to recover its medical costs for a former shelf stocker who suffered brain damage in a car crash and then received a $1 million settlement. "Greedy and heartless" was how many described the company's actions. Now, Wal-Mart has said it won't, after all, go after the reported $470,000. That must be a great relief for the family of former employee Deborah Shank, who will need special medical care for the rest of her life.
As for Wal-Mart, which has been trying to reform its reputation as a healthcare Scrooge by improving employee healthcare benefits, you've got to wonder what exactly the company was thinking when it inflicted this PR wound on itself. But setting that aside, consumers should be aware that this isn't just a meanie tactic that the company dreamed up on its own. Companies and health plans have been going after accident settlements for years, and they're getting more aggressive about it as healthcare costs rise. Instead of taking aim at Wal-Mart alone, critics should widen their scope—and eyeball their own healthcare plan documents in the process. Because chances are that what happened to this family could happen to any of us.
