Kaine Signs Insurance Co-Op Bill

Gov. Timothy M. Kaine has signed House Bill 761, legislation that will allow small businesses — those under 50 employees — to form health-insurance buying cooperatives. States a press release issued by the Governor’s office:

The legislation is consistent with other federal and state statutes related to small group market issues. It allows businesses to have flexibility in how they form purchasing pools, either by establishing one person or entity to be responsible for collection and payment of premiums, or by allowing each company to take responsibility for its own policy. The savings potential of this health insurance pooling depends on the size, composition and administration of the pool.

Gov. Kaine has pushed for legislation like this for a long time, and anything that makes it easier for small businesses to provide medical insurance for their employees is a positive step. I’m skeptical, however, that this measure, by itself, will have a big impact on the healthcare marketplace because, as I read the bill summary, it does nothing to exempt these insurance pools from mandated insurance coverage.

In Virginia insurance plans are required to include every conceivable health care profession and medical procedure, making it impossible for businesses to offer affordable, bare-bones insurance coverage. If you’re a contractor or shop owner, you don’t have the luxury of offering a stripped down Jeep Cherokee to your employees — you can only offer the model with leather seats, tinted windows, racing strips, surround-sound speakers and the rest of the luxury package. Not everyone can afford it.

HB 761 is a part of the solution to Virginia’s health care crisis — but only part.

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10 responses to “Kaine Signs Insurance Co-Op Bill”

  1. Anonymous Avatar

    Screening for breast cancer = Racing stripes.

    Harry Landers

  2. Ray Hyde Avatar
    Ray Hyde

    This is great news. I think I’ll try to start a co-op for farmers. If it turns out as you predict, I will complain bitterly.

    Anything is better than what we have now. Incremental improvement is better than a strategic stalemate while waiting for the perfect solution.

  3. Anonymous Avatar

    Screening for breast cancer = wheels

    The most common cancer in women, and you don’t want to cover the test that can find it in time?

    I’d be dead if it wasn’t for mammograms. If you don’t think that affects how I vote, and how my friends and family vote, you’re out of your mind.

    Multiply me by the approximately 25% of all women who will eventually develop breast cancer, and their families, and their friends. I’m a Republican, but I’ll bail on the party in a heartbeat if they try to pull this sort of stunt.

    This sort of ridiculous exclusion is why I STRONGLY oppose relaxing the rules for mandated coverage.

    I worked in the insurance industry and I’ve seen the costs of adding various coverages. You are buying into an industry line of BS that is not backed up by the actual numbers. Many of these “costly additional coverages” are literally – not figuratively – pennies per month.

    If you know a group sales guy over at Anthem, ASK for the underwriting numbers of how much it would cost to add x, y, and z. You’ll be amazed at how cheap it is.

    The expensive items are low deductibles, low copayments, and prescription drug coverage – not mandated coverage for mammograms or other specific, high need procedures. Oddy enough, stop losses and unlimited coverage (no max $) are not expensive, because it’s rare to hit them.

    Stripping out mandated coverages doesn’t materially save $ – but it does cost lives.

    Talk to an underwriter or an actuary. This is garbage, and life threatening garbage at that.

  4. Jim Bacon Avatar
    Jim Bacon

    Anonymous 7:12, If mammograms are worthwhile, which they most assuredly are, and they cost “only pennies per month,” then they’ll be included in most medical plans, regardless of whether there’s a mandate or not. But how about chiropractors? And optometrists? Are you willing to defend every single mandate? Is it really an “all or nothing” issue with you?

  5. Anonymous Avatar

    Being worthwhile and cheap does not guarantee coverage. Been there, saw that.

    When you are talking about life and death, or living a reasonably whole life versus being maimed – which you are with most of the mandates – requiring coverage is reasonable.

    Who would argue against coverage of mammograms, PSA antigen tests, PAP smears, diabetes, childhood immunizations, dependent children, or obstetrical care? Or coverage of a cheaper hospice so you can die in dignity instead of in intensive care, at LESS expense than otherwise?

    But if these weren’t mandated, there WOULD be groups excluding them. That’s why they became mandates in the first place.

    If you look at the mandates, they are mostly things that everyone will agree on. The ones that aren’t an automatic “of course” are worth looking at for WHY.

    Optometrists are cheaper than ophthalmologists. For most routine visits, they do basically the same exams – screening for vision and checking for glaucoma and other problems. Why wouldn’t you cover the same service, at a lower price, from an optometrist?
    That is, if I understand it, why it was approved as a mandate.

    I believe the approval for chiropractors was similar – back surgery, expensive and risky, was covered – chiropractors, cheaper and less risky, were not.

    Both, if I understand it correctly , were approved b/c they were cost-effective, doubtless initiated after lobbying by optometrists and chiropractors, who want a piece of the pie. But if they are alternate cost-effective coverage, it’s cheaper with them in than out. One can then argue it on principle – but not on cost.

    Most of these mandates are pretty much deal breakers, though. Eliminating them would be pretty ghastly.

  6. Jim Bacon Avatar
    Jim Bacon

    Anonymous 10:09, Sure, you can make a case for any individual mandate. But the bottom line is this: Add all the mandates together and you get a pretty expensive insurance package. What you eliminate from the marketplace is a bare-bones insurance policy that, say, covers primary care, catastrophic expenses and negotiated (thus cheaper) rates with providers — which is better than having no insurance at all.

    I understand that you feel passionate about a procedure that saved your life. But how many lives would be saved if affordable insurance were made available to hundreds of thousands of Virginians who have no coverage at all?

    In the quest of the “perfect”, you would eliminate the “pretty good” for those who can’t afford anything else.

  7. Anonymous Avatar

    Nope. That’s why I’m calling you on it. If you add in all of the Virginia mandates, you get what most people would consider normal basic medical coverage.

    The entire mandated benefit list includes coverage of:
    Dependent children
    Mental health and substance abuse
    Biologically based mental illness
    Newborn children
    Rape and incest
    Postpartum obstetrical expenses
    Pap smears
    Reconstructive breat surgery
    Early intervention
    PSA antigens
    Clinical trials for cancer
    Minimum stay for hysterectomy
    Hospice Care
    Colorectal cancer screening
    Childhood immunizations
    Infant hearing screening
    Hospitalization and anesthesia for oral surgery
    Lymphedema (a disabling side effect of cancer surgery)
    Doctor includes dentist (does not mandate dental coverage, which is optional)

    There are also mandated offers (which I’m not 100% sure of the definition, but appear at first glance to be things that insurance companies must offer but you don’t have to buy, such as conversion COBRA coverage), and mandated providers, which do not necessarily expand benefits – typically they say that if coverage is available, you must pay this class of providers.

    What’s mandated is not the expensive stuff. What’s mandated IS primary care and basic coverage – not bells and whistles.

    The only expensive thing in there is coverage for mental illness and substance abuse, and for biologically based mental disease. The rest are either primary care, essential medical care, or specific coverage for things that are CHEAPER than the more commonly offered alternative – mandates that save money, rather than cost it.

    If you take those coverages out, you have coverage that is worthless to many, many people, and that will cost a lot of lives. What good is it to have insurance coverage that does not cover basic, primary care needs?

    That’s no better than no coverage at all – actually worse, because you paid for nothing.

    What costs a lot are not coverage of basic medical expenses and common-sense things. What costs a lot are low co-payments and low or no deductibles. Talk to an underwriter or an actuary. If you want to lower your medical expenses, raise your co-payments and deductibles.

    The groups pushing against these mandates are not benign impartial observers. They’re special interest groups looking for a scapegoat for rising insurance costs. You need to dig a little deeper and ask some questions.

    I’ll fight anyone tooth and nail for these coverages – and so will a LOT of other people. Removing these mandates makes our health care situation much worse, not better.

  8. Jim Bacon Avatar
    Jim Bacon

    Anonymous, who are the “special interest groups looking for a scapegoat” for rising insurance costs?

  9. Anonymous Avatar

    The insurance industry. The “it’s mandates, the sky is falling” papers I’ve seen are written by groups with warm fuzzy names and a “we’re a group of small and large insurance companies” description under their “about us.” Or written by folks who accepted their info uncritically w/o digging.

    I’m fine with limiting mandates to simple, basic things – not bells and whistles. I am so NOT FINE it’s not funny about removing mandates for those basic primary and rehabilitative care items – because the millisecond you remove them, some idiot with preconceptions will foist off insurance w/o them on innocent people.

    They are mandates precisely because they were not universally available. Being able to die in a hospice, instead of a hospital, may save money and be common sense – but that doesn’t mean it would be an option for most people if it wasn’t mandated.

    Excluding lymphedema coverage saves a very little money. Untreated lymphedema results in a limb that’s swollen, prone to infections/cellulitis, and with long term tissue changes – a lifetime of misery. Any cancer victim that lost a lymph node is prone to it, most notably breast cancer victims, but a melanoma survivor w/it in a leg was in the Richmond T-D not too long ago.

    Insurance is supposed to protect you against the odds, not be a crap shoot of “is it covered or isn’t it covered” where your life and functionality are dependent on whim.

    Raising co-pays and deductibles, while keeping a stop loss, allows you to cut the cost of insurance significantly. THAT’s where you get your basic coverage, fairly spread around normal medical care. Not saying “we won’t cover diabetes, we won’t cover cancer, we won’t cover infectious disease.”

    If you don’t cover that stuff, what in the world is the POINT of having insurance? It’s then an expensive lie.

    You should also consider separately things like hospice that actually SAVE money b/c of their mandates.

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