S&S Benefits.....Opinion, Hearsay & News Review

A retired Alabama chiropractor is suing 45 Blue Cross plans nationwide. The suit alleges that BCBS license agreements not to sell in each other's markets violates federal anti-trust laws and limits competition in those markets. He claims the BCBS Association rules have driven up insurance costs and reduced payments to doctors and hospitals, especially in places like Alabama where the Blues have a 90% market share. From our perspective,  he appears to have a point.

Several health insurers are asking HHS to not include fraud prevention costs as part of the Medical Loss Ratio (MLR rules). HHS announced an initiative to share claims data among insurers to fight fraud, so the insurance industry responded  by requesting this change. No word on the HHS response.

Health Savings Accounts are estimated to have grown to more than $14.1 billion in assets over 7.1 million accounts according to a recent survey. That's an average of $1,986 per account. The data came from the top 50 HSA providers surveyed in July 2012. That is a 12% increase in the number of accounts from last year and a 21% increase in assets from last year. HSA account holders have retained about 30% of their contributions in 2012, up from 24% in calendar year 2011.

The 4th annual report  for the Generic Pharmaceutical Association found the use of generic drugs has reduced U.S health care costs by more than one trillion dollars in the last decade and $193 billion in the last year alone. Last year, nearly 80% of the  4 billion in prescriptions dispensed were generic drugs and those drugs accounted for just 27 % of Rx spending. Where both brand and generic drugs were available for the same diagnosis, consumers opted for generics 94% of the time.

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Aetna has announced it will buy Coventry Health Care for $7.3 billion. The acquisition is primarily to expand Aetna's Medicare and Medicaid business by Coventry's membership of 4 million medical members and 1.5 million Medicare Part D members. The deal is expected to close in mid-2013, further limiting competition in the health care insurance market.

How the game is played with the big boys: After Rush Health System in Chicago refused Aetna's request for a 30% cut in reimbursement rates for Aetna patients, Aetna cancelled its provider contracts with Rush, effective last January 1st. Aetna also covered Rush System employees. Now Rush has dropped Aetna from administering their self-funded plan and chosen Cigna to administer the program for their approximate 17,000 workers.

The Council for Disability Awareness released its latest survey. Forty-three percent of participating insurance companies reported increased claim incidence from 2010 to 2011. Only 19% reported a lower claim incidence. 2011 was the first year since 2008 where the number of private corporations offering LTD increased. The total number of disabled workers receiving Social Security  disability payments has continued to increase. Does anyone blame current economic conditions for this?

The Social Security Administration paid a record $120 billion to disabled workers in 2011, up 4% from 2010. Over 2.5 million workers in the 20-49 age group were receiving SSDI payments, out of a record 8.6 million total workers (5% of the U.S. workforce!) who were receiving SSDI benefits. The average monthly benefit was $1,111.

Wellpoint's CEO- Angela Braly has resigned. Stock in the company rose.

After President Obama declared in June that 800,000 young undocumented immigrants could remain and work in the United States, HHS has quietly issued a rule last week that blocks these undocumented immigrants from taking advantage of the health reform law. The workers will not be able to join pre-existing conditions plans or the coming exchanges. There seems to be some irony in this position, since the administration clearly wants them to vote.