According to the Dallas Morning News, North Texas 3-Share Plan wants to help uninsured employees in Dallas County by providing a relatively inexpensive and subsidized health care option.  The plan launched its first initiative, TexHealth Dallas County, last week in Irving.  The organization is led by Don Spies, who was formerly a Dallas County director of health initiatives.  “We want to focus on preventive care,” Spies said. “There are so many who will forgo care until something gets worse,” and then costs can quickly escalate.

Living without a Texas health insurance plan is particularly troublesome for Texans who work for companies with fewer than 50 employees because more than 60 percent of small businesses do not offer health insurance.  In a multi-share plan like the North Texas 3-Share Plan, the cost burden is partially lifted from the employer without being placed directly on the employee, as a public fund also contributes to create a more affordable Texas health insurance plan. According to the Dallas Morning News:

The 2010 cost is $260 per employee per month, with the employer paying half, the employee liable for $50 and the subsidy paying the remaining $80…The program will be available to small businesses that have not offered group health insurance in the past 12 months. Employees are eligible if they have a pre-tax income of $16 an hour or less, which is about 300 percent of the Federal Poverty Level.

This dramatic cut in health care costs for employees comes at a fortuitous time, as federal health care reform is leading many companies to drop their Texas health insurance plans in order to save money.  If multi-share plans take off and see early success, they may play a big role in providing low-cost Texas health insurance to employees and small businesses affected by such reforms.

According to the Dallas Morning News:

The 1 percent trim to provider fees that starts Sept. 1 sounds modest. But doctors, insurance industry officials and health care experts widely see it as the first of many hits coming to doctors’ wallets as Texas’ fiscal woes deepen.  State leaders’ instructions for agencies to identify additional 10 percent budget cuts in the next two-year budget cycle mean more fee cuts may come next summer.

Industry experts believe that further budget reductions could drive doctors from the state and result in more patients seeking emergency room care.  This would be an inauspicious beginning to federal health care reform, which, starting in 2014 will create huge new demands for care by putting more poor adults and children on Medicaid.  This bit of legislation is conservatively estimated to add 1.5 million Texans to Medicaid by 2015.  The number currently stands at about three million.

Expanding the rolls of Medicaid while reducing doctor reimbursements simply won’t work, as fewer doctors will accept these patients.  At the same time, health care reform will expand Texas health insurance rosters in general without expanding the amount of medical professionals to service the newly insured.

Medicaid is a great resource for people who can’t afford traditional Texas health insurance plans, but without the necessary medical network to support these patients, expansion may overburden our already weakened state.

We find that emergency room costs will increase for two reasons: 1) about half the newly insured will enroll in Medicaid, and Medicaid patients seek emergency room care more often than the uninsured, and 2) while the newly insured will try to increase their consumption of care, the absence of any program to create more providers will force patients to turn to emergency rooms as the outlet for increased demand.

The recently enacted reforms will eventually add more than 30 million people to health insurance rosters, but no measures are being taken to expand the amount of doctors, nurses and medical support staff.  Naturally, this will lead to a severe imbalance in the demand for health care and the available supply.  Since it will be difficult for newly insured patients to see overworked doctors, emergency rooms will be the only place they can receive care.  Another consideration is that approximately half of the newly insured are expected to enroll in Medicaid.  Since many private practitioners do not accept Medicaid patients, the patients will again be forced to seek care at emergency rooms.

So rather than decrease our nation’s dependence on costly emergency room care, health reform legislation is likely to have the opposite effect.  The NCPA projects that “insuring between 32 million and 34 million additional people will generate between 848,000 and 901,000 additional emergency room visits every year.”  This is just another example of the negative impact ObamaCare may have on our already-overburdened health care system and economy.

According to the Dallas Morning News, Kathleen Sebelius, U.S. Health and Human Services secretary, said in a letter to state insurance commissioners:

“Unfortunately, scam artists and criminals may be using the passage of these historic reforms as an opportunity to confuse and defraud the public…Media accounts indicate that fraudsters have gone door to door selling phony insurance policies,” she wrote. “Some have attempted to make dishonest profits by urging consumers to obtain coverage in a nonexistent ‘limited enrollment’ period that they falsely claim was made possible by the new legislation.”

Since these fake Texas health insurance plans are not backed by financial reserves, the insurers in question likely have no ability or desire to pay claims.  Consumers swindled by these scams may be left without insurance in a time of need.  To protect yourself from fraudulent insurance schemes, regulators have warned people to be wary of anyone claiming to be with the federal government and trying to sell you insurance.  Texas health insurance policies are sold and issued by companies, not government officials.  And be alert to sophisticated sales pitches. The Morning News notes that in some states, fraudulent sales representatives are attempting to sell a bogus product called an “ObamaCare Insurance Policy.”

Unfortunately, scam artists will always attempt to make a buck at the expense of confused consumers, so do what you can to protect your health and keep your finances secure.  If you have questions about health care reform, or need to obtain insurance, work with a licensed Texas health insurance broker, or contact a reputable, well-known health insurance carrier in your state.

Health savings accounts are the fastest growing health insurance option in the country, swelling in number from one million accounts in 2005 to nearly 10 million today.  Their appeal is obvious.  Paired with a high deductible health plan, a Texas HSA allows consumers to save money tax-free for use toward medical expenses, giving consumers greater control over their health care spending and more flexibility to pursue the treatment options they prefer.  But recent legislation may be the death knell for these consumer-friendly health insurance plans.  According to The Heritage Foundation:

On January 1, 2011, insurers will be required to maintain an 80 percent medical loss ratio (MLR) in the individual market.  This means that 80 percent of revenue from premiums must be spent on medical claims, not on administrative costs or profits.  The National Association of Insurance Commissioners recently held a teleconference on the MLR’s impact, as several insurers begin to consider exiting the individual market in certain states where meeting the new MLR requirement would be not be viable…According to Dowling and Partners, an insurance research firm, major players such as Aetna, Assurant, Mega Life, and United Health are likely to bail out of the individual market in at least some states.  As a result, 1 to 2 million Americans could lose their current coverage.

So much for promises.  ObamaCare will so severely restrict health carriers’ operations that many won’t be able to offer individual plans, like HSAs.  In fact, some carriers may fold entirely.  The Heritage Foundation notes that nHealth, a Richmond, Virginia insurance provider specializing in high deductible plans and HSAs, “recently announced it will close its doors due to the combination of stringent new regulations and future uncertainty—both the product of the new health care law…and many other insurers are expected to follow suit due to new regulations created by Obamacare, especially its federally-imposed medical loss ratio.”

So contrary to presidential promises, you can’t always keep the health insurance you like, especially when your favorite provider ceases to exist.

Under the new laws, many employers can save money by dropping the Texas health insurance plans they provide to their employees.  Rather than subsidize comprehensive group plans, employers can encourage their workers to find their own health insurance through the government-run exchanges.  This will result in fines for companies with more than 50 employees, but the fines are expected to be significantly smaller than the cost of keeping a workforce insured.

The Dallas Morning News reports that, “in the case of Dallas-based AT&T Inc., the move could mean saving billions of dollars per year.”  AT&T paid about $2.4 billion last year in health insurance costs for its 283,000 workers.  If the company were to push all those workers onto government subsidized exchanges, it would only have to pay an annual penalty of $600 million. Those are some serious savings for the company, which employs more than 14,000 workers in the Dallas area alone.

And the ramifications of the new health care law may become a big issue for taxpayers as well.  According to calculations by Fortune magazine, “if half of all people covered by company plans get bumped to the exchanges, it would raise the price tag of the new law by $160 billion a year.”  So adding insult to injury, it’s likely that we’ll have to pay a premium for losing our preferred Texas health insurance plan.

So why do recent reports from the United Health Foundation find that one in four Texans is living without Texas health insurance?  This number is the highest in the nation, placing Texas dead last in percentage of insured residents.  Reasons why people forgo insurance include:

High costs – The number one reason people cite for living without Texas health insurance is the cost.  However, high deductible health plans can be quite affordable.  A high deductible plan features a low monthly premium, and individuals pay out of pocket until their high deductible is met.  This plan isn’t for everyone, but it can be a very low cost option for healthy individuals, and it provides coverage in case of a major medical emergency.

Employers don’t offer health insurance – The high price of insurance impacts more than just individuals; employers feel the crunch as well, and many have responded by dropping their employees’ health plans.  If this happens to you, consider an individual Texas health insurance plan, which is a far better option than living without health insurance.

Unemployed – Since the majority of health insurance plans are still tied to jobs, the unemployed often lose their Texas health insurance the day they lose their job.  However, an individual health insurance plan is always an option, and COBRA may also be a possibility.  With COBRA, you may be eligible to continue your health insurance for up to 18 months after you lose your job.

People choose to go without insurance – Millions of Texas workers simply choose to live without Texas health insurance.  Forgoing health insurance can save some money, but it’s a big risk that can have severe consequences should a serious illness or accident result in an operation or lengthy hospital stay.

Regardless of your reason for living without health insurance, there is a way around it for the majority of Texans.  High deductible plans offer low monthly costs, and maintaining just this minimum level of coverage can result in serious savings should a catastrophic event occur.  Plus, recent legislation will make it easier for people with preexisting conditions to obtain health insurance.  Texas health insurance is an investment that may seem unduly expensive or unnecessary to some, but it’s an investment that will protect your wellbeing—and your wallet—for years to come.

If applying for a new Texas health insurance policy, people with preexisting conditions may have to wait several months, or even years, before the policy will provide coverage for the condition.  The waiting period is typically shorter for people enrolling in a group Texas health insurance plan than for people enrolling in an individual Texas health insurance plan.  And if you do obtain coverage, insurance companies may choose to cover you for everything but medical claims related to your preexisting condition.  Of course, recent health care legislation will change these exclusionary practices.

Beginning June 21, 2010, a national high risk pool will be established to cover people with preexisting conditions.  American citizens and legal immigrants who have been uninsured for at least six months and have preexisting conditions will be eligible to enroll in this pool and receive subsidies to help them afford the premiums.

Further legislation stipulates that starting September 23, 2010, health insurance companies will be prohibited from excluding children with preexisting conditions from being covered by their family policy.  The process takes far longer for adults, however, as insurance companies can continue to exclude adults with preexisting conditions until January 1, 2014, at which point the high risk pool will be eradicated.

Since the majority of changes don’t go into effect until 2014, it’s important to do what you can to remain covered.  To get all the facts and details about how insurance companies will treat your preexisting condition, try contacting a Texas health insurance broker or potential carrier to discuss your particular situation.

Foster’s report details the costs, savings and coverage impacts expected as a result of health care reform.  The findings, which refute the Administration’s claims regarding improvements in care, cost savings and coverage, are not startling to most independent health care economists, but it’s surprising and refreshing that this 38 page report comes from a respected agency within the federal government.

John Goodman of the National Center for Policy Analysis provides some key summaries taken directly from the Actuary’s report:

Health care costs will increase, not decrease
National health expenditures will increase from 17 percent of GDP now to 21 percent under the new law and will be higher than without the legislation. Net federal spending on health care will also increase.

Expect health care shortages
Because of the increased demand for health care, “supply constraints might initially interfere with providing the services desired by the additional 34 million insured persons.”

14 million employees will lose their employer coverage
Under the new laws, many employers can save money by dropping their sponsored plans.  Employees of small firms are especially at risk.

A Medicaid insurance card is not a guarantee of care
An estimated 18 million people will be added to Medicaid, but because there is no corresponding increase in the supply of caregivers, “it is reasonable to expect that a significant portion of the increased demand for Medicaid would be difficult to meet, particularly over the first few years.”

Higher taxes will lead to higher premiums
The new taxes on medical devices, prescription drugs, and insurance plans “would generally be passed on through to health consumers in the form of higher drug and device prices and higher insurance premiums.”

The promise to those with pre-existing conditions is unfunded
“By 2011 and 2012 the initial $5 billion in federal funding [for those with pre-existing conditions] would be exhausted, resulting in substantial premium increases to sustain the program.”

That’s just a taste of what we can expect from ObamaCare, a massive piece of legislation that 58% of Americans want repealed.  It will be interesting to see the impacts felt by our country as these reforms roll out over the next few years.  Millions of Americans will experience cost and tax increases, and millions more will notice a reduction in the quality of their health care, so do what you can to prepare yourself and your family.

Unfortunately, new healthcare legislation will enact changes that will water down these helpful health plans.  Starting on January 1, 2011, people with health savings accounts can no longer use their HSA funds to pay for over-the-counter medicines.  Purchasing medications like pain relievers, cold remedies and cough syrup can really add up, especially for large families, but the new law dictates that such expenses must be paid out of pocket.

Another change looming in 2011 is that the penalty for withdrawing money from an HSA for non-medical expenses doubles from 10 percent to 20 percent.  So if one mistakenly spends HSA money on an unapproved item, like over-the-counter medication, for example, he’ll be penalized at double the current rate.

Regardless of these changes, health savings accounts are still a very attractive option to many individuals, especially now that the government has mandated that all people purchase health insurance.  Because of this, there will be many new entrants to the health insurance market, including millions of “young and invincible” consumers who previously chose to go without insurance to save money.  It’s likely that such people will want to keep their costs down and will opt for a high deductible health plan with a low monthly premium.  Choosing a high deductible plan will make more people eligible for HSAs, and therefore increase the amount of people enrolling in health savings accounts.

That could be a good thing for both the individuals and the tax-paying public.  When consumers are the key decision makers over how their money is spent, incentives will be aligned throughout the health care system to create better value.