California Individual And Group Health Insurance Plans

The Los Angeles Times - By Ricardo Alonso-Zaldivar, Times Staff WriterOct. 25: Frustration with the rising costs of health coverage surged sharply this year, helping to explain why many voters remain uneasy about the economy despite falling gasoline prices, low unemployment and a soaring stock market.The annual Health Confidence Survey, released today by the nonpartisan Employee Benefit Research Institute, found that more than half of those surveyed 52% were dissatisfied with health insurance costs, a sharp increase from 33% last year.About 6 in 10 said costs of their health plan such as premiums, deductibles and co-payments had gone up in the last year. Of those who said their costs had risen, more than half said they were saving less as a result. Retirement plans took a big hit, with 36% of those who reported higher costs over the last year saying they had reduced their contributions to 401(k) plans. Of that group, 28% said that because of health-related costs, they had trouble paying for such basic necessities as housing, heat and food."While people are employed, they don't feel particularly good about their situation, and that ends up influencing how they respond to questions about the economy," said Dallas L. Salisbury, president of the institute, a research group funded by employers, healthcare companies and labor unions.Earlier this month, an ABC News/Washington Post poll found that 45% of Americans viewed the economy as getting worse, whereas 17% saw improvement and 36% said conditions would remain the same. "Individuals are not seeing their real income go up because their employers are spending more on healthcare," Salisbury said. "And individuals themselves are spending more on healthcare."The institute's poll found that workers regard their employer-sponsored coverage as an ever more valuable benefit, even as many new jobs come with no coverage and employers cut back or drop existing plans. Overall, the proportion of employees covered by a company plan dropped from 81% in 2001 to 77% in 2005.Asked to choose between a $6,700 raise and employer-sponsored health insurance, 75% of those polled picked the health plan. Of those, 13% said no raise would be big enough to persuade them to give up their coverage. The average cost of employer-provided coverage was about $6,700 per worker in 2004. It has since gone up to more than $7,100.After annual increases in health insurance costs hit double-digit rates in 2001, employers responded by passing an increasing share of the burden on to workers in the form of higher deductibles and co-payments. Such measures have slowed cost increases for employers, although they are still running at about twice the rate of overall inflation."There is a continuing shift," Salisbury said. "Even some of the companies in the unionized sector have introduced cost-sharing for the first time ever. Employees who were paying nothing are now paying something, and those who were paying something are paying more."The telephone poll of 1,000 adults was the ninth such annual survey, and has a margin of error of plus or minus 3 percentage points. Separately, two studies published Tuesday offered mixed reviews for President Bush's main healthcare proposal. The White House is encouraging Americans to consider so-called consumer-directed plans, which feature low-cost insurance for major medical expenses with a tax-sheltered "health savings account" to cover the cost of routine care.A Rand Corp. report found that such plans could help cut spending and slow the rate of cost increases by reducing the use of medical services 4% to 15%. However, individuals may offset some of those savings by spending more out of their health savings accounts. The researchers said more study would be needed to determine whether the savings would be a one-time phenomenon or an enduring trend.The second paper, by the California HealthCare Foundation, raised concerns about how such plans would accommodate people with chronic illnesses, who account for a high proportion of all costs. It urged insurers to consider full coverage of certain medications, such as drugs used by diabetics to control blood sugar. That may help prevent patients with chronic conditions from cutting back on needed care and risking costly complications.About 3 million people are enrolled in consumer-directed plans, but the number is growing rapidly as large employers add this option to their benefits. The two studies were published on the Internet by the journal Health Affairs.

Kaiser Daily Health Policy Report -Oct. 24: Consumer-driven health plans can help employers reduce health care costs but might lead some patients to forgo necessary care to save money, according to a study by RAND, the Washington Post reports. For the study, published on Tuesday in Health Affairs, researchers examined dozens of previous studies on consumer-driven plans both with and without health savings accounts, which allow consumers to set aside money tax-free for medical expenses. Consumer-driven plans, which account for about 3% of the private health insurance market, have lower premiums than HMOs and PPOs but have higher deductibles typically $1,050 to $2,000 for an individual and $2,100 to $4,000 for families, compared with an average $220 deductible for traditional employer-sponsored plans. According to the RAND study, most employers offering consumer-driven plans save at least 10% on health care costs. Some employers save as much as 25%, although the study notes that some of the perceived savings could come from shifting costs to employees. Employees and dependents enrolled in consumer-driven plans without HSAs spend approximately 4% to 15% less on health care than those in traditional plans, while those in plans tied to HSAs spend about 2% to 7% less, the study found. Some of the savings are the result of plan members spending less money on unnecessary care, such as not going to the emergency department when it is not required. Other savings were the result of plan members forgoing necessary care, according to the study. The study also found that employees who switched to consumer-driven plans tend to have higher incomes and better health than those in traditional plans. This disparity was "modest" but "warrants monitoring," according to the study. In addition, the study found that there is a lack of useful and consistent information about the cost and quality of health care. The study recommends that the federal government establish standard quality assessment measures and remove legal barriers to pooling data from private insurers. CommentsLead author Melinda Beeuwkes Buntin, an economist at RAND, said, "The evidence is really mixed. There are some studies in which people are reporting that they don't fill a prescription or they don't get [a] follow-up that's recommended by a doctor. So those two things would be cause for concern." She added, "I don't think these plans can be a panacea" for rising health care costs, "but they could, if well-designed, be one part of the strategy for rationalizing our system of health insurance." Ron Pollack, executive director of Families USA, said consumer-driven plans discourage patients from getting necessary care, attract the healthiest individuals away from traditional insurance plans and favor wealthy individuals who receive the largest tax breaks from HSAs. Pollack said the plans will do little to reduce costs because 85% of U.S. health care spending is on catastrophic and end-of-life care, which are covered by the plans. "Every few years people are looking for a magic bullet to deal with costs," he said, adding, "And this bullet results in the shooting of a dud" (Lee, Washington Post, 10/24). Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

WASHINGTON, Oct. 23 (UPI) -- The director of U.S. anti-smoking organization said smokers and obese people need to pay considerably more for health insurance than others.

John Banzhaf, director of the Washington organization Action on the Smoking and Health said he's influence state governors to accept his plan in improvement their Medicaid programs.

Under the plan, obese people should pay a 10-percent increased health insurance premium, plus smokers usually paying an even higher percentage. Those who are obese and those who smoke need to pay nearly 30 percent more to obtain health insurance.

RINCON - Eliminating paperwork and then providing low cost health care would be to focus of a new doctor's office opening soon in the Effingham County.

This is a new concept of providing medical service on a cash basis to serve patients without insurance is the idea behind family practitioner Dr. Jack Heneisen's clinic.

A physician for more than 20 years, Heneisen said most fixed cost in today's health-care market involves administrative costs.

The San Diego Union-Tribune - Oct. 13: Medicare officials say it's time to modernize the health plan by providing America's seniors with more information and choice. But critics say information and choice are just euphemisms for confusion and higher cost.In many ways, the new Medicare initiatives reflect a shift within the private insurance market to more "consumer-driven" health care. In essence, patients pay part of their health care costs so they have more incentive to stay healthy and choose cost-effective care when they're sick.The prescription drug plan launched last year has been the most highly publicized of Medicare's efforts. But it's also pressuring hospitals to release more information on cost and quality. Later this year, the program will start covering more preventive tests, including an introductory physical designed to catch illnesses before they advance. And next year, Medicare will offer plans similar to health savings accounts, which allow enrollees to pay for some medical costs with tax-free dollars."A lot of people think, 'Consumer-driven health care, here's a check and a here's a phone book, go figure out what's best for you," said Dr. Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, the federal agency that oversees the programs. "That's not what this is."Still, many of the changes require more money and time from Medicare enrollees. Using quality and cost data requires Internet research. Plans with health savings accounts come with higher deductibles. And patients will have to chip in for the preventive tests, typically paying about 20 percent."Beneficiaries have always been responsible for a portion of their cost in Medicare, the problem was the benefits they had available didn't let them lower those costs," McClellan said.Traditional Medicare helped seniors pay for hospital and doctor costs when they got sick, but McClellan said the system's done little to help people stay well, catch problems early or manage illnesses with medication. "In 2006, that's not the way health care should work," McClellan said. Medicare has a big stake in patients managing their health.About 78 percent of Medicare beneficiaries have at least one chronic condition. Nearly two-thirds have two or more. Care for those patients soaks up 95 percent of Medicare's dollars each year. Medicare officials believe many of those dollars could be saved and patients could stay healthier if their illnesses were better managed.Part of the challenge is finding doctors and hospitals who perform the best care at the lowest cost. Earlier this year researchers at Dartmouth Medical School found Medicare could have saved about $40 billion nearly one-third of the total spent if all hospitals had followed the same highest-quality, lowest-cost practices.When Medicare started covering prescription costs last year, McClellan's theory was to let private firms compete for patients and let patients determine which company offered the best deal for them. At the time, many seniors complained they were overwhelmed by options and unable to wade through so much information.But a year later, about 90 percent of seniors have drug coverage through Medicare or a former employer. About 80 percent of them told the nonprofit Kaiser Family Foundation they're happy with their plan. And, average costs for the Medicare prescription plans, called Part D, will be lower than expected this year. "There's no question that the choice available for Part D was a big change," McClellan said. "There's also no doubt that because of competition we are getting the plan we want."McClellan said those same concepts of information and choice can help Medicare improve health care quality and patient satisfaction while reducing costs. "It's the only way we're going to keep Medicare sustainable for the future," McClellan said.Not everyone's convinced. "In my view, consumer-driven health care is quite poorly designed for this population," said Jonathan B. Oberlander, a health policy professor at the University of North Carolina-Chapel Hill. "You have to have a reality check about who the Medicare population is."The cost and quality information Medicare provides is limited and available only on the Internet. It examines how often physicians followed best practices for three common conditions and reports how much Medicare pays for 30 common procedures. The quality data is hospital-specific. The cost data is released by county.Oberlander and other health policy experts say many Medicare patients don't have access to the Internet or can't easily navigate it. Others struggle to understand the information."How are you going to expect someone who is sick to be a good consumer?" asked Stuart Guterman, senior program director for the Commonwealth Fund's Program on Medicare's Future.

UCLA News - Oct. 12: UCLA Health System and Blue Shield of California announced today a successful conclusion to contract negotiations resulting in a new agreement that allows Blue Shield of California members and their families to continue receiving medical services from UCLA's hospitals. Blue Shield of California members can now continue to fully access medical care at both UCLA Medical Center and Santa Monica-UCLA Medical Center."We are pleased to have reached an agreement that adequately reimburses UCLA's hospitals for the high quality, complex medical care our hospitals provide to our Blue Shield members," said Dr. David L. Callender, CEO, UCLA Hospital System. "UCLA Healthcare remains committed to providing exemplary health care to our Blue Shield patients."Previously, contract negotiations stalled when the UCLA Health System could not accept the terms offered by Blue Shield of California for renewal of its contractual relationship that spanned two decades and the contract between the two parties terminated, as of July 12, 2006.UCLA Medical Center ranks as one of the top five American hospitals and the best hospital in the Western United States for the 17th consecutive year, according to a U.S. News & World Report survey that reviewed patient outcomes data, reputation among physicians and other care-related factors. UCLA Medical Center is the only Southern California hospital to earn a spot on the magazine's "honor roll" rankings during the 17 years U.S. News has conducted the survey. The honor roll recognizes hospitals that demonstrate excellence across many specialties.

Business Wire - Oct. 12: San Mateo, Calif. - New data released today by WageWorks is more evidence that employees are missing out on the advantages of consumer driven healthcare, and employers may be partly to blame. The data reveals that a lack of guidance may be contributing to low adoption of consumer driven healthcare accounts, and shows that even among employees who do sign up for the accounts, many are not using them correctly and are missing out on significant savings.Conducted on behalf of WageWorks(R), provider of consumer-driven, tax-advantaged health care spending and savings accounts to more than 1,000 employers, the national survey of 1,105 adult employed Americans identified some areas of concern, especially regarding Health Savings Accounts (HSAs).-- Among employees with access to high deductible health plans (HDHPs), only half (51 percent) receive information from their employer on how an HSA and HDHP work together. Similarly, only half (51%) report that their employer offers them access to an HSA.-- Only four in ten (41%) employees with access to HDHPs are provided with a list of banks they can visit to obtain an HSA."It is important for employers to offer thorough information on why employees should enroll in an HSA along with their HDHP. If employees neglect to do so they could be missing out on significant savings and are not reaping the full benefits of their HDHP," says Jon Kessler, chairman and chief executive officer of WageWorks. "Luckily, the upcoming benefits open enrollment season provides a new opportunity for employers to offer more hands on guidance, and employees get more engaged in their healthcare decisions and get it right in the coming year," he continues.The problems are not limited to HSAs and HDHPs. The survey also found that 35 percent of employees who have access to a flexible spending account (FSA), HSA, or major medical coverage say that none of these benefits had been thoroughly explained to them by their employer. This relates to earlier findings from an April 2006 study of 1,044 individuals conducted by StrategyOne which revealed poor choices and lack of awareness with regard to all types of consumer driven accounts, including FSAs. For example:-- 57 percent of Americans are likely to set aside money for out of pocket expenses, but only 1 in 5 have an FSA, indicating a lack of knowledge about the benefits of an FSA and a possible shortfall in educational guidance.-- 36 percent of individuals with an FSA said that they did not allocate the correct amount to their FSA or didn't know whether they allocated the right amount.-- A majority of individuals (61 percent) have more difficulty budgeting and planning for health care expenses than for other types of expenses, indicating the need for additional help with the planning process. Top-ranked desired resources from employers were: clear information to help choose health care benefits (33%), better information about costs and savings of health benefits (28%), hands-on help from health and financial experts (15%), and tools for health care expense management (12%)."Along with other industry data in the market today, these survey findings are yet another sign that simply offering consumer driven benefits is not enough to solve the problem of rising healthcare costs," Kessler continues. "If employers decide to use consumer driven benefits as part of their overall strategy to reduce costs and recruit and retain top talent, they also need to make sure employees are getting the tools, education and guidance they need, and are using the tools effectively in order to make good decisions. Otherwise, adoption and savings rates for both the employer and employee will suffer."

PR Newswire - Oct. 11: Nashville, Tenn., - How futuristic is it to believe that one swipe of a debit card would reveal your identity, your health record, and your health plan coverage and eligibility information? Not as far off as you think.According to HealthLeaders-InterStudy, a leading provider of managed care and healthcare market intelligence, insurers and payment processors are building technology systems to link banks, payors, providers and consumers. The ultimate goal is a smart debit card that will carry all the information needed to make a healthcare purchasing transaction transparent, efficient and seamless."With an estimated 6 million Americans participating in consumer-driven healthcare, the need is growing for a consumer 'smart' card," states Chris Lewis, HealthLeaders-InterStudy research analyst. "However, achieving widespread use within providers' offices will pose the most direct challenge."The majority of health accounts do have debit cards tied to flexible spending accounts and health reimbursement arrangements, which are set up and controlled by employers to pay for employees' qualified medical expenses.Industry observers say the more recent adoption of health savings accounts, which are tied to high-deductible health insurance plans, will further propel debit card use. However, most systems do not feature instant processing and approval of a health insurance claim and without that "real-time claims adjudication" feature, most health purchases cannot be as simple as a department-store purchase.A few large insurers are making progress. Humana Inc. has launched a successful real-time claims adjudication system in six medical practice sites so that physicians' offices can be paid in a matter of seconds. This four-month pilot project enabled the clinic staff at MacGregor Medical Center in San Antonio, Texas, to get a claim back from the insurer so the bill could be presented to the patient on the spot.UnitedHealth Group is unveiling an integrated ID and debit card that will store members' identification, eligibility status, and health records. Using a card reader connected to the provider's computer via a standard USB port, the provider can then call up the patient's information on the UnitedHealthCareOnline provider portal. This system would enable a claim to be submitted, and within 10 seconds the provider would know the reimbursement and how much the patient would owe.There are several factors that would further complicate instant pricing and payment. Many physician practices commonly deal with 15 or more payors with varying product lines. For multi-coded services, prices and payment rules vary widely among insurers. With a thousand or so practice management software programs currently in use around the country, it will be difficult to design a card "smart" enough to work.

Proposed changes in the Broome County's health insurance system can now bring up to $5 million in savings to the taxpayers over the next four years.

Health insurance costs for about 3,400 county employees and the retirees during 2007 will cost more than $36 million, Fiala said when presenting her 2007 budget proposal. Health care tops Medicaid as the county's only-largest expense and eats up about 11 percent of her $328 million expenditure proposal.

One in every five California residents are without health insurance, according to a study released today by UCLA's Center for Health Policy Research.

The statistic comes even as more researchers are now finding marginal improvements in the job-based health insurance for adults and public health program enrollment for children. In all, the study approximates about 6.5 million residents, statewide, lack health insurance.

The percentage of adults who received health insurance through their employers has increased to 56.2 percent during 2005, up from 55.1 percent in 2003. The authors credit the state's current firm labor market for this increase, but note that this figure is actually behind the 2001 level of 57 percent. The study predicts that this development is unlikely to continue given the unsteadiness of employment-based insurance in the face of growing costs.

Plans by the Uganda government to introduce a National Health Insurance Scheme through the back door would terribly backfire if the existing public does not take part in initial discussions about the project.

The scheme, expected to come into effect by July 2007, would also require an 8 per cent contribution shared equally between employers and the employees. While the scheme might be well intended, its consequences are far reaching. It is important for government to do a methodical due industry first by getting other stakeholders' input.

The new Massachusetts health insurance law "contains a little-known excuse: The mandate insurance that all residents have coverage by next summer does not include children," the Boston Globe reports. The law requires residents ages 18 or older to obtain health insurance by July 1, 2007, or be penalized on their income taxes.

Officials with the administration of Gov. Mitt Romney (R) said it was a mistake, which the exclusion was not addressed sooner, and the state Executive Office of Health and Human Services has asked the Legislature to make "technical corrections" to the law that will expand the mandate to contain children and also to make other changes. Leaders in the state Legislature "said they are willing to study the issue soon, but [added] that forcing parents to insure their children might be unenforceable and unnecessary, because most parents willingly insure their children when they buy coverage for themselves," the Globe reports.

BestWire Services - Sept. 27: Monthly premiums for a family of four enrolled in a small company's group-health plan averaged $814 a month in early 2006, according to a new survey of the small-group market by the country's largest health insurance lobbying group, a survey the group said was the largest of its kind. The survey, commissioned and released by Washington-based America's Health Insurance Plans, involved more than 656,000 small-group plans, defined as those with 50 or fewer workers, encompassing more than 7.2 million covered people. Among those small plans, premiums tended to be more expensive for smaller groups those with 10 or fewer employees which accounted for 83% of the group plans surveyed. Monthly premiums for those plans averaged $864 for a family of four; for a group with 11 to 25 employees, a similar plan cost $785 a month; and for a group with 26 to 50 employees, premiums were $752 a month. For single coverage, the AHIP survey found that the average premium for small-group coverage was $311 a month for all small groups. For groups with fewer than 10 workers, single coverage was $330 a month; for groups with 11 to 25 employees, $299 a month; and for groups with 26 to 50 workers, the cost was $287 a month, on average. It's unclear, however, what policy implications the survey results hold. AHIP said the survey also was the first of its kind, meaning there are no direct comparisons with prior years or with other data examining the small-group market. AHIP said its survey showed that small-group premiums in 2006 were slightly lower than those reported in a 2005 study by the Kaiser Family Foundation, but those studies aren't directly comparable; the KFF survey involved all firms with three or more employees, rather than small groups with 50 or fewer workers, and the study didn't say whether the plans examined were comparable.When asked what public policy changes the survey data suggested, AHIP's president and chief executive officer, Karen Ignagni, said there were none. However, she said, "people will be surprised to see what is going on in the small group market." Ignagni also said policy-makers should give insurers greater flexibility, which would lead to more affordable group plans; she said removing state coverage mandates would help provide that flexibility. AHIP also said its study looked only at what insurers were charging for small-group coverage, and so did not examine what proportions of those premiums were borne by employers and workers. The survey queried 21 insurance companies that are members of AHIP, collecting data about enrollment during January 2006, said Jeff Lemieux of AHIP's Center for Policy and Research.

Business Wire - Oct. 2: Hartford, Conn. - Aetna announced today the results of the broadest study to date of consumer-directed plans a review of four years of data to determine the impact of consumer-directed health plans on 1.6 million Aetna members. This includes members in an Aetna HealthFund(R) consumer-directed plan, as well as employees within the same employer groups who have chosen other benefits options. The study finds that, five years after the launch of Aetna HealthFund, consumer-directed plans consistently result in lower medical costs, maintained or improved levels of chronic and preventive care, and increased usage of generic medications and consumer tools and information."We're very pleased to see many positive developments among employer groups who offer an Aetna HealthFund product. Most notably, we find lower medical costs and maintained or improved chronic and preventive care," said Aetna Chairman, CEO and President Ronald A. Williams. "The financial results achieved by full replacement plans are particularly significant - equating to a savings of $1 million per 1,000 members over a three-year period while still maintaining quality care."Among the key study findings: -- Full replacement plans see the most significant savings from Aetna HealthFund. Health Reimbursement Arrangement (HRA) plans effective in January of 2003 experienced an average medical cost trend of 1 percent over three years, meaning that medical costs for these plans increased only 3 percent between 2002 and 2005. -- Employers who offered Aetna HealthFund as an option are seeing savings across all products offered. Those who offered an HRA option plan effective in January of 2003 experienced an average medical cost trend of 6.7 percent over a three-year period. -- Both Aetna HealthFund HRA and Health Savings Account (HSA) members with chronic conditions maintained or improved the level of care they received prior to joining the plan, including a 6 percent higher usage of inhaled steroids among asthmatics when compared to a similar population.-- Preventive care was also maintained or improved. For example, first-year HSA members received cervical cancer screenings at a 13.8 percent higher rate than PPO members. -- Generic drug utilization for HRA members was 4.5 percent higher than PPO members.The study is a unique snapshot of how offering a consumer-directed plan as an option impacts all employees in a group, regardless of which plan they choose. The 1.6 million members studied include 134,000 HRA members from 99 employers, 18,000 HSA members from 27 employers, and 1.45 million Aetna members from those same employer groups who have chosen other benefits offerings. These members were compared to a population of 1.4 million Aetna PPO members comprised of all large employer groups. Four years of data was studied for HRA members, two years of data was studied for HSA members, and three years of data was studied for the comparison population."Aetna is committed to studying the impact of our consumer-directed plans. We want to gauge the performance of the plans we offer to our customers so that we can consistently enhance and improve our offerings. In addition, we are working to expand the body of knowledge around these relatively new products to increase understanding and adoption of consumer-directed plans," said Williams. This is Aetna's third annual study of its HRA members and its first review of HSA members. It focused on answering several key questions - including who is choosing the plan, and the impact of the plan on cost of care and consumer behavior. Other notable findings included: -- HSA members are saving money in their fund, with more than half (52 percent) rolling over their entire fund in 2005; approximately half (49 percent) of HRA members rolled over some or all of their fund in 2005. -- Aetna HealthFund members accessed online tools more than twice as often as members of other plans, based on the experiences of five large employer groups. -- The average age and family size of Aetna HealthFund members (31.6 average age, 2.2 average family size) is very similar to other employees included in the study (33.4 average age, 2.3 average family size). Aetna launched its first-generation Aetna HealthFund HRA product in September 2001 and its Aetna HealthFund HSA product in December of 2003. Since its inception, the Aetna HealthFund family of products has expanded to include a wide variety of fund and account options meeting the unique needs of employers of all sizes and individuals. Aetna HealthFund leverages Aetna's unique resources, including one of the largest networks of physicians, dentists, hospitals, pharmacies and health professionals; its extensive experience in claims payment and administration of innovative health benefits; and the company's powerful online resources and self-service tools.

AP Online - Sept. 27: Washington - The quality of the health care provided to millions of Americans improved last year across several dozen categories, including increased immunization rates among insured children.The improvements are seen through the reporting of data that the White House and Congress want more of from health-care providers. They're contained in a report being issued Wednesday by the National Committee for Quality Assurance, which accredits and certifies insurers.The association tracks dozens of care measurements, submitted by many of the nation's insurance plans. The long-term tracking of the measurements helps improve the quality of care, according to the report.For patients in private insurance plans, there was improvement in 35 of 42 measurements, including such categories as cervical cancer screening, colorectal cancer screening and the controlling of high blood pressure in hypertension patients.Categories that showed a decrease in the quality of care included breast cancer screenings. The percentage of women in commercial insurance plans, ages 50-69, who got a breast cancer screening in the past two years dropped to 72 percent from 73.4 percent. Similar drops were seen in insurance plans covering Medicare and Medicaid patients.The gains also include increased numbers of children with private health insurance getting all their recommended immunizations, with the rate reaching 77.7 percent, up from 72.5 percent. Also, more smokers enrolled in Medicare received advice about kicking the habit.From year to year, many of the changes are small often just a percentage point or two. But the differences come into clearer focus over a 10-year period, officials said.For example, the committee said that more than 96 percent of patients who suffered heart attacks last year were given drugs to lower their blood pressure and slow the heart rate, which helps prevent a second attack. A decade ago, about 62 percent of patients suffering heart attacks were given such medicines.One in four Americans are enrolled in health plans that collect and report data on the quality of care. However, more than 100 million Americans are enrolled in plans that report no objective quality data, the report said."This past decade has demonstrated the benefits of measurement, reporting and accountability, but three out of four people don't enjoy those benefits today," said Margaret E. O'Kane, the president of the National Committee for Quality Assurance. "It's time to ask, 'Why not?'"The committee noted that one important exception to a pattern of improvement was the quality of care for Americans with mental health problems. Patients in insurance plans who are hospitalized for mental illness are only marginally more likely to get appropriate follow-up care than they were when the insurers began collecting quality data in 1998.

The Sacramento Bee - Sept. 28: If you're pregnant or suffer from asthma, your HMO is doing a good job taking care of you. On the other hand, California's major health maintenance organizations fare poorly when it comes to treating your youngster's throat infection or helping you quit smoking. These were some of the conclusions reached in an annual report card released Wednesday by the state Office of the Patient Advocate."Variations in quality can be dramatic. It's important for consumers to be actively involved and knowledgeable about their care," said Ed Mendoza, deputy director of the Patient Advocate's Office. Overall, the 12 million Californians who belong to the state's nine largest health plans have seen a slight improvement in the service and care they have received in the past year, according to the patient advocate's HMO report card for 2006.This year, HMOs earned high marks for heart, asthma and maternity care as well as performing cholesterol checks for diabetes patients. Health plans, though, fell short on treating children and making sure they receive the shots they need, screening for sexually transmitted infections and long-term follow-up and treatment of depressed patients."Over the last number of years, we really haven't held them (HMOs) accountable," said Cindy Ehnes, director of the state Department of Managed Health Care. "Letting the plans know where they stand is important." The Office of the Patient Advocate, which offers information about consumer rights to HMO members, publishes the annual HMO rankings to push health plans to raise standards.The analysis is compiled from reports HMOs file with the National Committee on Quality Assurance, which evaluates health plans for companies and groups that offer medical coverage to their employees. HMO members and physician groups also are surveyed.Kaiser Permanente Northern California, Kaiser Permanente Southern California, Health Net of California Inc. and PacifiCare of California ranked the highest in meeting national standards for care.Both Kaiser groups and Sacramento-based regional health plan Western Health Advantage received the top marks for customer satisfaction. On the other end, Aetna Health of California Inc. and CIGNA HMO earned poor grades for customer service."There is room for improvement. It's something that we take very seriously," said Rachelle Cunningham, a spokeswoman for Aetna. "We have implemented over the past couple of years initiatives to improve customer satisfaction."Those changes include giving company claims representatives more authority to resolve issues and an improved online system. The report card gives consumers a tool to check out HMOs on key medical issues such as heart disease and cancer. It is released on the eve of the fall open enrollment period when employers allow workers to switch health plans. HMO officials say it is one measuring stick for their performance."We use this as a tool to try to improve our operation. We do value their ratings," said Garry Maisel, chief executive of Western Health Advantage.Dr. John Zweifler, medical consultant to the state office, said HMOs improved significantly in the past year with programs to control high blood pressure, to screen for the sexually transmitted disease chlamydia and to perform eye exams for diabetes patients.But health plans lost ground in screening for breast cancer, offering advice to quit smoking, treating children for throat and upper respiratory infections and following up for mental health conditions after patients leave the hospital."California HMOs have struggled with using antibiotics appropriately," Zweifler said about treating children with throat infections. "We're concerned about antibiotic resistance developing. California, compared to the rest of the country, has significant room for improvement."Bobby Pena, a spokesman for the California Association of Health Plans, said he was surprised with the low score on children's care."That is one area that health plans focus very strongly on," Pena said. Health plans have been working with medical providers on the antibiotics issue. "We are dependent on the physicians to come up to speed on that."

By July 2007, all residents South Vermont must have some form of state-approved health insurance or should face tax penalties.

The state will not create a health insurance program. It is relying on private insurers to develop plans that would also meet its criteria.

A new state authority, the Commonwealth Health Insurance Connector, would vet health plans and to decide whether they are adequate and affordable.

The Connector would set rates for publicly subsidized health plans.

Residents making less than $9,804 a year would receive free health insurance.

Those making between $9,804 and $29,412 a year would pay between $18 a month and $106 a month for insurance, then depending on income.


The state would even subsidize the rest of the premiums.

Those already receiving adequate health insurance through work or through government programs like Medicare should to change their plans.