The Health Shopper

Modeled after a similar program in Ohio, Florida's Governor Charlie Crist has announced that the state will offer a free prescription drug discount card for individuals who earn less than 300 percent of the poverty level and have no drug coverage or are above the age of 60. Under the program, the state will negotiate discounts with pharmacies and drug manufacturers and state officials expect the program will offer discounts of up to 30 percent off of retails prices, although some discounts may fall short of the discounts offered at major chain stores.

Having or not having health insurance can affect more than just your financial health. A study released today from the American Cancer Society finds that people diagnosed with cancer are much more likely to die if they don’t have insurance than if they do. The reason: They’re more unlikely to get screened early. By the time they are finally screened, it’s often already too late.

"If you are uninsured, and you are diagnosed with cancer, you have a 60 percent greater chance of dying from cancer than if you were insured and diagnosed with cancer," Dr. Otis Brawley, chief medical officer at the cancer society, told Health Day News. "There is not a cohort of insured and a cohort of uninsured cancer patients that have the same five-year survival. It's always the uninsured who do worse."

Some interesting statistics from the study:

• 38.1 percent of uninsured women aged 40 to 64 had a mammogram since 2005
• 74.5 percent of insured women have had them (same age group)
• 20 percent to 30 percent of uninsured women will be diagnosed with late-stage breast cancer (same age group)
• Only 10 percent to 15 percent of insured women will be diagnosed with late-stage breast cancer (same age group)

On the heels of news that Medicare will stop reimbursing for medical errors, The New York Times notes a study in the Journal of the American Medical Association finding that Medicare pays hospitals more money for patients who get infected in hospitals than for patients who make it in and out of the hospital without complications.

The study focused on urinary tract infections, which affect 1 million people at a cost of $400 million annually. And given the financial incentives in place, it's easy to see why those numbers are so high: One Colorado Hospital cited in the study, for example, received a 63 percent increase in reimbursement for heart attack patients who had complicated infections over the repayment for a heart attack patient who recovered without complications.

Of course, as the study's authors note, doctors and health care workers don't set out to make people sick just to earn a buck. And certainly, some errors can't be prevented. At the same time, as the New York Times quotes the study's authors as saying, "When properly designed, financial incentives should provide rewards for desired clinical outcomes, not hospital-acquired harms.''

America's Health Insurance Plans released a series of reform proposals to improve the individual insurance market. The proposal advocates that states create "Guaranteed Access Plans"-which would function similarly to high risk insurance pools-and in exchange, insurers would agree to cover anyone whose expected annual health costs do not exceed twice the state average. The proposal, which can be read in full here, would also require insurers to offer better coverage for pre-existing conditions and limit the ability of insurers to rescind policies.

An Indiana pilot program will offer low-income insurance that couples higher-deductible coverage with a subsidized savings account in place of a traditional Medicaid plan. Specifically, the program will provide participants with income-adjusted subsidies to a Personal Wellness and Responsibility account to cover expenses up to an $1,100 deductible, at which point the state insurance plan will cover remaining costs. In addition to providing major coverage, Indiana will also make an income-adjusted contribution to the Personal Wellness account, and individual expenses will be capped at 5 percent of gross income.

Blue Shield is the latest California insurer to come under fire for illegally cancelling individual policies. State Insurance Commissioner Steve Poizner  is seeking to levy a $12.6 million fine against the insurer for delaying claims processing in more than a thousand cases, causing more than 200 people to lose their insurance. 

The crux of the matter, according to the Los Angeles Times, seems to be Blue Shield's policy of taking applications "at face value" because of the cost of underwriting, and then returning to investigate expensive claims of policy holders, which ultimately leaves very sick people who thought they had insurance both ill and in debt.

Merrill Matthews has an interesting column in today's Wall Street Journal arguing for Congress to pass the Health Care Choice Act, which would allow individuals to shop around for policies in all 50 states, rather than just their own. Matthews notes that opponents of the bill oppose the measure on the grounds that prohibiting residents from purchasing out-of-state plans "would limit the ability of states to protect their residents." Which is clearly ridiculous. For example, Matthews points out that the cost of family policies in New Jersey is nearly triple the cost of a similar policy in New Jersey due to more stringent regulations, and that allowing a middle income New Jersey family to buy the Pennsylvania policy could bring costs down and make insurance more affordable and accessible.

Hospital care is expensive, but it's particularly pricey for uninsured patients who pay "list prices" for care, which can be several times higher than what an insurer pays for treatment. After being overcharged for emergency care, a couple of uninsured patients in California have filed a lawsuit that is aimed at getting hospitals to charge uninsured patients similar prices to what insurers pay to make hospital care a bit more affordable for the uninsured. In effect, the suit argues that charging list prices is effectively price gouging.

List prices are wildly inflated numbers that hospitals use as a starting point for negotiations with insurers. As the San Jose Mercury News puts it, list prices "bear little relation to the actual cost of the care provided and are far higher than what insured patients are asked to pay."

The suit, if successful, would alter billing practices in more than fifty California hospitals.

Louisiana is exploring the possibility of shifting some state funding away from charity care toward vouchers for adults to purchase health insurance in the private market. Proponents of the reform are touting the plan as a free market alternative to charity care that will allow uninsured adults with incomes below 200 percent of the poverty line to have more choice of physicians and hospitals and the ability to get non-emergency care outside of the hospital. The proposal could also make care more accessible. Historically, uninsured Louisiana residents have had to obtain medical care through state charity hospitals, but many of the hospitals have been unable to reopen since Hurricane Katrina.

Other states, such as New Mexico, have begun to explore individual mandate plans modeled after Massachusetts. According to recent estimates, nearly 300,000 previously uninsured Massachusetts residents have signed up for health coverage, which is somewhere between half and three quarters of the previously uninsured population in the state.

A California appellate court has ruled that consumers with individual health policies can file class action suits against insurance companies who wait to review applications and then revoke coverage after a policyholder becomes sick. The appeals court also held that if an insurer fails to properly attach a copy of the policy to an individual's application, it loses the right to rescind a policy retroactively, regardless of the accuracy of the initial application.

Consumer advocates are hailing the ruling as an important protection for individual policyholders. For example, Dr. Richard Frankenstein, president of the California Medical Assn., told the Los Angeles Times that "Hopefully, the courts are showing that they understand the importance of fairness to people who have tried their best to meet their obligation to have their healthcare paid for."