The Health Insurance Coach

This week's landslide success for Barack Obama as the democratic presidential hopeful in South Carolina also brought to light the importance of affordable health insurance to the public today.

As it's reported at the Kaiser Daily Health Policy Report, exit polls found that an estimated 25% of Americans cited health care as their number one most important issue for upcoming elections.

Everyone knows that the current health care system isn't working, but the real divisions arise in terms of how to make affordable health insurance available to all. Clinton and Edwards favor a universal health care system, while Obama does not. Republican candidates tend to favor tax breaks for those who purchase coverage, while some, like McCain, urge for shifts in the insurance market that would make prices more competitive.

Regardless of who wins the primaries, or even the presidency, everyone is hoping for more affordable health insurance in the future. Especially the 47 million uninsured Americans, and the millions of under-insured who are one illness or accident away from financial disaster, and medical debt.

A study published in the January 24 edition of The New England Journal of Medicine finds that important breast cancer prevention steps, including mammograms, are less likely to occur when women are expected to produce a co pay for their health insurance coverage plan.

As it's quoted at MSN Health, a co-pay as small as $10 can stand in the way of a woman getting a potentially lifesaving mammography.

Co pays have grown more prevalent and more expensive in recent years, as insurance agencies seek to get consumers to consider cost before getting health-care services. The hope is that it will force consumers to rethink unnecessary procedures and medications, saving health insurance coverage costs.

But unfortunately, breast cancer prevention is one place where we don't need women to skip procedures and treatments. For the cost of the co pay, even as little as $10, that woman might be saving her own life.

But for many women, co pays are higher than $10, and exams may seem unnecessary or too expensive. And for women who don't have health insurance coverage at all, breast cancer prevention is far out of their reach.

What ought to happen is that every woman should be offered a mammogram free with their insurance, and every woman ought to have that insurance to begin with. In the mean time, women who are searching for affordable coverage need to keep in mind that they need a plan that covers mammograms, and that they need to have those mammograms every year after age 40.

According to the San Jose Mercury News, California Governor Arnold Schwarzenegger's ambitious and almost universal California health insurance plan will now move to the Senate, where it will face an extended hearing this week and the likelihood of a close vote in the Health Committee.

Schwarzenegger's plan has been surrounded by controversy since its debut. Small business owners have been protesting that the legislation would require employers to spend too much to fund the required percentage of their payrolls on health coverage for their workers.

Citizens who couldn't obtain California health insurance through jobs or a government program would be required to buy insurance on their own, which would be subsidized in part by fees on hospitals and an increase in cigarette taxes.

It's not clear whether or not the plan will pass. California is deep in debt, with a $14 billion dollar deficit predicted in the next 18 months. It's one thing to want universal California health insurance for all, but as one representative put it, "It's rather difficult for me to vote for a health care plan that's going to cost $14 billion at the same time I'm looking at cutting $14 billion."

Pennsylvania Gov. Ed Rendell (D) has said he will not approve medical malpractice subsidies for physicians until state lawmakers agree to fund the Cover All Pennsylvanians program, his medical coverage plan designed to offer Pennsylvania health insurance to more state citizens who cannot afford it.

Kaiser Daily Health Reports that Rendell is refusing to approve the funding designed to lower medical malpractice suits in his state, a move which could cost doctors "hundreds to tens of thousands of dollars more for medical malpractice insurance."

If, however, legislature approves the funding for his Pennsylvania health insurance plan Rendell has proposed extending the subsidies for medical malpractice insurance for 10 years.

Rendell, who is clearly playing hardball, has received a lot of criticism over this. State Sen. Don White (R) said Rendell is "holding doctors and hospitals hostage" while he tries to force the Legislature to approve funding for the plan.

The balance Rendell needs to strike is one between funding Pennsylvania health insurance for its most needy citizens, and doing so without draining state taxes. Whether he can pull it off will soon be seen, but in the mean time Pennsylvanians should continue shopping online for the best coverage they can afford. It could be quite awhile before the Cover All Pennsylvanians program can make it out of legislature with a decent budget.

The Department of Labor's Employee Benefits Security Administration last month issued rules that "[i]n effect" will "close a legal loophole that could have allowed employers to make health insurance more expensive for unhealthy workers than for their colleagues," according to Kaiser Daily Health.

And this again raises a question that has been circulating quite a bit in the last year: should healthier people have greater access to affordable health insurance?

In California, Governor Schwarzenegger has suggested that those people who meet certain health oriented bench marks should pay less for medical coverage, in the form of vouchers that could be applied for maintaining a healthy weight, having low cholesterol, not smoking, keeping low blood pressure, etc.

The idea is that unhealthy people boost overall medical coverage costs, which are in turn filtered down to everyone who must find coverage. In essence, the idea is that those who cost less deserve more affordable health insurance.

But detractors argue that this is illegal, and promotes discrimination in the workplace. It could also make it impossible for those with pre-existing conditions to find affordable health insurance to treat them, something that could mean the difference between their life and death.

In this case the Department of Labor handled the situation for us, closing a loophole that would have stigmatized those with a condition. But the fact still remains that affordable coverage is very difficult to find these days, no matter what your health condition might be.

According to the latest report by Kaiser Daily Health, California isn't the only state struggling to balance their budget with a desire to expand family health insurance to those who need it most.

Apparently, at least 13 states face large budget deficits for the next fiscal year, and about 12 others face serious financial problems, leading Governors to "come up with creative - some say risky - budget gimmicks to find new sources of cash" to pay for health care and other programs.

California is a prime example, where Governor Schwarzenegger has suggested a 10% reduction in funds for all state programs at the same time that he has struggled to get a statewide health coverage plan ready for legislation. In each case, it's state funded family health insurance for adults and children who can't afford expensive premiums that has contributed to the financial trouble.

Those who are arguing for a federal medical coverage plan see this situation as proof that so long as states must fend for themselves, family health insurance will fall through the cracks.

Hopefully, state and federal legislation will find a means of protecting those who need it most. In the mean time, those who need good medical coverage should shop around aggressively online, since shopping around is more likely to produce a more affordable health insurance plan.

Last week's news in our insurance woes took the American health care situation global. According to Reuters, the U.S. ranked worst of all wealthy nations when it came to treating preventable illnesses. Why? We need greater access for all citizens to affordable health insurance.

The article states that "France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations."

If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year. What's stopping us? We need more affordable health insurance, and we need a health care system dedicated to preventing sickness, not just treating it.

After all, pharmaceutical companies don't spend billions on medications to keep you from getting sick, they want to treat you when you need their product to stay alive.

The top two in the list of healthy nations - France and Japan - offer a universal health care plan to all citizens, a move that has been hotly debated by upcoming presidential hopefuls.

But here, even a system that offers more affordable health insurance rates to most people could make a significant impact in the prevention of disease. Studies prove that those people who are insured live longer, healthier lives. This is mainly due to yearly checkups and access to doctors who can offer the right kind of advice to patients on the wrong track.

There are 47 million uninsured in America, and making insurance more available to them could easily put the U.S. at the top when it comes to taking care of sick or injured citizens.

Forbes.com asked this week whether health insurance companies like Cigna are really to blame in cases like that of Nataline Sarkisyan, the 17-year-old girl who died recently in Los Angeles because she needed a liver transplant.

What the article fails to do is discuss the real issue here, which involves taking a long, critical look at our health care system as a whole.

Health insurance companies like Cigna are the target of much frustration these days. There are millions of uninsured and under-insured Americans who are turned away by insurance providers for everything from previous conditions to a simple lack of money.

In Nataline's case, her parents allege that she was denied the funding for the transplant by Cigna, and as a result she died. The article at Forbes addresses whether or not the hospital is really to blame.

But health insurance companies and hospitals are only one piece of the giant puzzle known as the American health care system. Whether it's rising costs, use of medications, a large number of sick and unhealthy people, or simple greed, it's not just one factor that contributes to sad cases like that of Nataline.

What we need is an entirely new or at least significantly remodeled health care system for everyone. Until that happens, lawsuits against health insurance companies or hospitals or doctors won't really make things different for the next person who needs care and cannot afford it.

Do we all need health insurance? Yes. Do we need to make healthy lifestyle decisions and see our doctor every year? Yes. This is why it's important to have medical coverage in the first place.

Now we just need to make it affordable, available, and of good quality for all American citizens.

Just last week the AARP filed a petition to the U.S. Supreme Court to review whether the Equal Employment Opportunity Commission had the authority to issue a regulation that allows employers to legally eliminate or reduce medical insurance coverage for retirees when they reach age 65 and become eligible for Medicare, while retaining benefits for retirees under age 65.

The regulation in question allowed employers to change health benefits packages based on age alone, an act that has been ruled discriminatory in the past.

As it's reported for Kaiser Daily Health Policy, the petition claims that the regulation in question offers nothing more than a "misguided approach" that threatens the medical insurance coverage of "approximately 10 million older Americans."

Furthermore, this would allow employers to back out of health care commitments made to long term employees, forcing them to fall back on Medicare supplemental insurance to fill in the gaps associated with Medicare.

As expensive as medical insurance coverage has become it's clear that employers, who often can't afford to cover their employees any more, are passing the fees on to those who can afford them the least.

For those seniors who do need more health insurance, it's a good idea to shop around online for the most competitive rates possible. Medicare can be very helpful for some things, but in many cases, it needs a little help to cover all the bases.

While it's been common sense news for years now, two independent studies released by Harvard Medical School and the American Cancer Society this month have proven that those people who don't have, or can't afford, medical insurance coverage are far more likely to die of disease than those who do have it.

As it's reported at the Kaiser Daily Health Policy Report, "uninsured people suffer significantly worse outcomes from cardiovascular disease, diabetes and cancer than those who have coverage." And with cardiovascular disease, diabetes, and cancer topping the list when it comes to the diseases that kill Americans, not having medical insurance coverage could be downright dangerous.

But what should be done for those who can't afford insurance? After all, health insurance premiums have grown three times faster than the rate of inflation for the last 15 years. Employers can no longer afford to offer medical insurance coverage to many employees, let alone their families. And, for an average family to pay for family health insurance all year long, they're looking at losing 1/3 of their yearly income.

Now it's time for the other common sense news to make it big: everyone needs access to some kind of health insurance in this country.

In the mean time, those searching for insurance should remember to look for a plan that offers yearly checkups, and to attend those checkups like clockwork. Regular visits to the doctor have been proven to reduce the incidences of disease drastically, saving lives and minimizing the dangers of medical debt at the same time.