"In Debate on Health, It's Coverage vs. Cost"

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Joy125

Posted Tuesday, October 06, 2009 3:21 AM

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FROM NEW YORK TIMES

In Debate on Health, It’s Coverage vs. Cost

By ROBERT PEAR
Published: October 5, 2009

TO READ COMPLETE ARTICLE SEE:

http://www.nytimes.com/2009/10/06/health/policy/06health.html

EXCERPTS:

" . . . The Senate Finance Committee had been scheduled to meet Tuesday to finish work on a sweeping health care bill that it put together over the last two weeks. But it postponed the session while it waits for a cost estimate from the Congressional Budget Office.

Under the committee’s bill, there would be four levels of benefits — bronze, silver, gold and platinum — and all insurers would be required to offer, at a minimum, coverage in the silver and gold categories.

Most employer-sponsored health plans already meet the proposed federal standards. But insurers and actuaries say that one-third to one-half of policies bought by individuals and families fall short. About 17 million people buy insurance on their own, in this individual market. . .

. . . In comparing the overall benefit levels of different health plans, federal officials often use a yardstick known as actuarial value. This statistic measures the share of health care spending for a given population that is covered by a plan. Consumers pay the remainder, in deductibles, co-payments and other charges.

The four levels of coverage allowed by the Finance Committee have actuarial values ranging from 65 percent for the bronze plan to 90 percent for the platinum plan.

The Senate health committee prescribes three levels of coverage, with actuarial values from 76 percent to 93 percent.

The House bill also calls for three levels of coverage — basic, enhanced and premium — with values from 70 percent to 95 percent.

By contrast, the Congressional Budget Office says, the actuarial value of policies bought in the individual insurance market now averages 55 percent to 60 percent.

For insurance plans provided by employers, it said, the average value is 80 percent to 85 percent. And according to the Congressional Research Service, the value is slightly higher, 87 percent, for the standard Blue Cross and Blue Shield plan available to federal employees, including members of Congress. . .

. . .While higher-value plans may provide greater protection for many people, they may also cost more.

But Senator Debbie Stabenow, Democrat of Michigan, said the whole point was to improve the protection of consumers.

“The more we lower the actuarial value, the more the individual or the family will have to shoulder the costs of their plan,” Ms. Stabenow said. . . . Senator Olympia J. Snowe, Republican of Maine, said she shared that concern.

. . . The chairman of the Finance Committee, Senator Max Baucus, Democrat of Montana, said he was trying to “strike a balance between affordability and proper coverage.”

If the government does not set minimum coverage levels, he said, insurers will continue to offer low-value policies that leave consumers exposed to exorbitant costs and the risk of bankruptcy.

__________________________________________________

Lift up your hand, oh God. Do not forget the helpless. Psalm 10:12

http://www.physiciansforpeace.org/

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Grandpavan

Posted Tuesday, October 06, 2009 1:50 PM

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Last Login: Today @ 4:13 PM
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In a quick look all this says to me is that you get no more than what you pay for. In the private market most people look for the cheapest insurance so they get a policy with lower actuarial value. To get more actuarial value they have to pay higher premiums and people don't do this. The policy says what coverage you get so this is chosen by the buyer. God bless.

Age 82, diagnosed RA 12/2001, married since 1952, 4 sons no daughters, 4 grandsons 1 granddaughter. Doing well on Methotrexate and Remicade.

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