Entries for May 2008

Is having some sort of health insurance—even spotty coverage—better than having no protection at all? That's the conventional wisdom behind initiatives like the bill signed last week by Florida Gov. Charlie Crist that allows insurers to sell inexpensive health insurance policies with limited benefits to uninsured Floridians. The new law is the latest example of a nationwide trend toward offering "limited benefit" or "bare bones" plans that often cover some everyday medical expenses like visits to the doctor and prescription medications but may come up seriously short if a policyholder gets seriously ill.

The governor acknowledges that the new Florida plans won't offer "Cadillac coverage." But for $150 a month or less, he says, they'll include some coverage for preventive services, drugs, surgery, screenings, and durable medical equipment, among other things. And how is that possible, you're wondering. Some plans won't provide catastrophic coverage that would pick up the tab for major medical expenses like cancer treatment or heart surgery, for example, nor will they necessarily cover all of the benefits available through comprehensive plans, like podiatry or certain transplants. There could be dollar limits or other restrictions as well.

Making sure kids have good healthcare is something everybody agrees is important, but a new report shows that some states do a much better job than others of making good on that intention. Aiming to cover more of the roughly 9 million children who lack insurance, both Democratic presidential candidates have called for universal coverage for children. Without a stronger commitment at the federal level, it's hard to imagine how we're ever going to address the inequities highlighted by the report so that kids can count on getting the care they need no matter where they live.

Organized as a score card, the Commonwealth Fund report examined how states perform on 13 different indicators in five categories: access to care, quality of care, cost, potential to lead healthy and productive lives, and equity in the quality of care provided regardless of race, income, or insurance status. It ranked states within each category and then assigned states a final overall ranking.

There's no way to know how many travelers returning home from abroad tuck a few blister packs of prescription pills into their bags. Souvenirs of a visit to a local pharmacy, many drugs are often available without a prescription for just pennies a pill. And even if prescriptions are ostensibly required, travelers often find that local druggists are willing to bend the rules. Taking a chance is tempting. A 90-day supply of 20-milligram Lipitor tablets can be had for just $190 in Canada compared with $336 here, for example. With high drug costs eating into people's budgets at home, the siren call of a cut-rate diuretic or anti-inflammatory may be hard to resist.

But—and you knew this was coming—buying drugs overseas can be risky, especially in developing countries where drug counterfeiting may be common and manufacturing and storage practices may be suspect. And even if you're in a European country and get a prescription from a doctor there, you need to be careful: Dosages and drug names may be different from what you're familiar with in the United States. If you're thinking of buying prescription drugs overseas for any reason, keep these pointers in mind:

Today, President Bush signed a long-awaited bill that bars insurers and employers from discriminating against people based on genetic test results. If you've hesitated to get a genetic test for fear you'd be fired or turned down for health insurance, passage of the Genetic Information Nondiscrimination Act means you can breathe easier. (My colleague, Bernadine Healy, recently wrote about GINA and privacy concerns related to genomic medicine.) But just because you're curious about whether Uncle Joe's colon cancer runs in the family doesn't mean your insurer will pay for a test. There are more than 1,200 genetic tests on the market, and some of them cost thousands of dollars. Unless a test meets certain standards and it's pretty clear that you'll benefit from taking it, your insurer may well decide not to pay.

Coverage rules vary, but in general here are some of the considerations that may determine whether a genetic test is covered by insurance.

And now for something completely different: a tax code change that actually makes life easier for people, in this case husbands and wives who run small businesses together and want financial protection if they become disabled.

Of course, everyone faces this risk. It gets higher the older we get as brittle bones, heart disease, and all the rest make unwelcome inroads into our otherwise able-bodied, never-miss-a-day-of-work selves. A 20-year-old worker has a 30 percent chance of becoming disabled before retirement, according to the Social Security Administration. "To the extent that husbands and wives go into business together, and if they stay in business together, there's a very good chance someone will become disabled," says Andrew Imparato, president and CEO of the American Association for People with Disabilities.

Imagine this: a healthcare system that provides coverage for nearly everyone and lowers insurance costs for individuals and small businesses by 30 percent. Sound too good to be true? It may well be. But let's take a look at it anyway. The new plan, developed by the Commonwealth Fund and published today in the journal Health Affairs, is similar in many particulars to the proposals put forward by the Democratic presidential candidates. But unlike the candidates' plans, this one offers specifics about costs to individuals and businesses. The numbers can certainly be disputed—that 30 percent cost savings seems awfully optimistic—but given our regular diet of lofty but not always satisfying campaign rhetoric, this provides food for thought.

Like the Democrats' plans, the Commonwealth Fund proposal would create a new national "connector" through which small businesses and individuals could buy insurance, either a souped-up "Medicare Extra" plan through the federal government or private insurance. Everyone would be required to have coverage, but insurers couldn't turn anyone away or charge people an arm and a leg because they're sick. The program would expand Medicaid and SCHIP coverage for low-income adults and children to all those earning less than 150 percent of the poverty level (about $15,000) and provide tax credits for everyone to make premiums more affordable. Employers would be required to either provide health insurance or contribute to a pool to help pay for coverage.

You'd expect to find a concierge medical practice in Palm Beach, Fla. These high-touch, personalized practices that give patients 24/7 access to doctors who keep close tabs on their care generally cost a few thousand dollars a year. That's more than many people who are already struggling just to cover their healthcare premiums and copayments can afford.

So I was surprised to learn of a Florida concierge practice that's offering its 24-karat care free to a select group of 25 people with incomes at 200 percent of the poverty level or less ($42,400 for a family of four). It's all happening under the auspices of the Palm Beach County Medical Society's Project Access, which provides nonemergency medical care to hundreds of residents in this mostly rural county, people who don't show up in the society pages and aren't well to do.

They may have grown 35 percent in the past year, but the fact is that health savings account (HSA) plans—which are high-deductible health plans that can be linked to tax-advantaged health savings accounts—are still pretty thin on the ground. In 2007, the number of Americans covered by these plans grew to 6.1 million, up from 4.5 million the year before, according to a new survey by America's Health Insurance Plans, a trade group. With total private insurance coverage topping 170 million, however, that's small potatoes indeed.

In case you haven't come across them, these plans (also sometimes described as consumer-driven health plans, though that phrase can also refer to other plans) must have a deductible of at least $2,200 for families and $1,100 for individuals in 2008, among other criteria. An HSA that links to the plan allows people to accumulate money tax free to pay for medical expenses.