Suddenly Health Insurance Reform Is Not Affordable

Armen Hareyan's picture
Baucus and Health Insurance

As the lawmakers are focusing on health care reform the biggest obstacle to the reform seems to be not as much the public health insurance program, but rather who will pay for the health care reform? How to recover the cost of providing affordable health insurance.

Up to this date the American public knew that health insurance is not affordable for an estimated 46 million americans. Now we hear that health care reform is very costly and everyone is asking who or how to pay for an affordable health insurance reform.

Senator Max Baucus, a key player in the health care reform debate says to Bloomberg that things are moving forward bu there that there are no guarantees. "It's not ready until it's ready. It's more ready now, but it's not ready yet."


Today, the latest solution to get a movement in the House on the health insurance reform is to get a surtax on high income Americans. It would apply to individuals with adjusted gross income of more than $200,000 and couples over $250,000. It is estimated that this type of surtax will effect 2.4 percent of U.S. taxpayers. It will raise nearly $375 billion dollars in the next ten years, which will be used for making the cost of health care reform more affordable.

Let's see where the pain for paying the health insurance reform will be felt the most.

Connecticut, the hedge fund capital of the world, or what it used to be has the largest percentage of of taxpayers who will be heat by a surtax, is coming in at 4.7 percent. Next in line is the nation's capital D.C with 4.4 percent. Massachusetts and New Jersey each come with 4.00 percent. As for New York, it's mere 3.1 percent according to Bloomberg.

The current system while able to provide quick and quality health care is not working for millions of people. It is estimated that 46 to 50 million people in America are without health insurance coverage. These are families, children and individuals who cannot go out and buy health insurance on their own. Their salaries are a low making health care coverage even less affordable.

Written by Armen Hareyan



[title] Utah health insurance reform vs. federal health care reform. in-depth analysis. [summary] Utah health insurance reform affects all of Utah from residents to carriers alike. Select Health, Regence Blue Cross Blue Shield, Altius and Humana form a Utah state insurance portal to share risk under watchful government eye. gives an in-depth analysis of state health reform efforts vs. federal health care reform. [Body-longer version] Insurance reform + medical provider reform = health care reform, right? Utah health insurance reform has been center focus for the state, UAHU and private insurance carriers over the past 24 months. Mike Oliphant (UAHU board webmaster) runs a small Utah based health insurance website as well as Mike’s viewpoint provides a unique analysis which comes from being a “fly on the wall” observer in countless state session and insurance meetings. “Utah has been thrust into a state insurance reform pressure cooker which isn’t necessarily negative where I am an insurer, insured and patient”. Several interesting changes took place with H.B. 188 passage earlier this year which seems all too familiar to the ongoing federal health care reform attempt under Obama’s administration. The spirit of the bill allows private Utah market place remedies. It essentially guarantees a Utah health insurance carrier a "no loss" or "no gain" premise over competing carriers that operate within the “Utah Insurance Exchange portal”. On the surface it would seem unattractive to a carrier’s consideration (voluntary at this point). But you have to understand the carriers’ goal is to cover their administration fees and maintain a 3% profit. The Utah health insurance reform model claims this can be accomplished now by legislation and the watchful eye of the state’s risk adjuster board. The medical claim risks are essentially shared equally among the participating carriers. Therefore, the carriers can focus on administration efficiencies more so than competition over a fluctuating market share. Insurance carriers such as SelectHealth have efficiencies and risk management experience polished by long tested actuarial tables with health statistics and claim trends. Is it a bad idea to share that experience with a national carrier such as Humana? Would it surprise anyone to know that maternity NICU and anti-depressants represent the highest utilization in health insurance costs for medical and pharmacy in Utah? Compare this to Texas which suffers from abnormally high levels of diabetes and liver disease per capita. The other half of the “health care reform equation” is medical provider and billing practices. The state claims this is on the agenda. It is popular belief among Utah legislators that reform stops with the insurance carrier. However, how can the insurance carrier continue to bear the risk and re-distribution of health insurance premiums back out the door in claims without provider billing reform? Add to this obstacle a continuing shrinkage of the insured populace. Obama’s administration proposes mandatory participation in a health insurance policy by employers of all sizes, self employed and unemployed populace. The logic being to shore up the unhealthy with healthy premium. When analyzing the Massachusetts’s system, you actually pay a penalty if you have no proof of coverage. The benefit level and health insurance price is nowhere close when you compare Utah health insurance quotes through or dental insurance quotes at Utah premium is easily half. This insight comes from a Utah health insurance agent whom often interacts with employers and residents looking for affordable coverage, making sure claims are paid correctly, implementation and explanation of the many policy procedures and putting a complex SelectHealth insurance language in understandable terms. Yet legislators claim agents to be of no value all in the name to save 3-4 off of Utah health% With the latest announcement of hospitals agreeing to contribute $155 billion, where are the costs going to be shifted for this donation? In Utah, studies conducted by revealed that cost shifting already exists in the ER. There is apparent lack of legislators in Utah and on the federal level proposing TORT REFORM. It is factual that a majority of US senators and representatives are lawyers. To push liability insurance premiums down that absorb as much as 15% in expenses with most medical providers is significant. Take 15% off total medical expenditures in US and you will see savings in the trillions. If we go down the path of nationalized health care reforms, will we at some point be forced to address usage and ration? Will we have to define when to refuse further care for patients receiving critical illness treatments, intensive care unit, disease management, neonatal intensive-care unit for? SelectHealth documents that the single most expensive bills are NICU for newborns and seniors in acute / intensive care / pre-hospice. Without TORT REFORM, medical provider costs will never drop. Liability insurance costs are approaching nearly half of the operating expenses for specialty care physicians, units and facilities. Humana health plans state that their costs of medical liability and defensive medicine accounts for nearly 10 cents out of every premium dollar collected. Compare that to Humana’s reported pharmaceutical claims of 15 cents out of every premium dollar collected. Or better yet, 21 cents out of every premium dollar collected is paid back to physicians for physician treatments.