The evolution of American health insurance services over the last few decades

evolution of American health insurance services

Overview: How health insurance has evolved for Americans in recent years.

evolution of American health insurance services evolution of American health insurance services

evolution of American health insurance services

From illness trends to the implementation of technology, changes in America health insurance services remain slow, complex, and constant much like the overall healthcare system.

Various healthcare proposals have been introduced over the years, but it’s the complexity of the healthcare industry in its entirety — environmental and technological factors — that remain the primary causes to changes in health insurance services in America.

  1. Increase in technology & cost of medical services

  2. Managed care & ability to select a doctor

  3. Extending Medicare coverage for prescription drugs
  4. How health care will change in the future (technology & more)

1. New technology; increased cost for health insurance

One primary change in American health insurance services is the increased cost for health insurance as a result of new technological treatments. Maybe back in the day, you could get away with surgery and a hospital stay without health insurance but now… not so much. (That goes without saying.)

This goes in tandem with the tremendous medical technology now available. If patients want to reap the benefits of these technologies, they must be willing to accept the ever-increasing medical costs that come with it.

2. Managed health care; limited doctor selection

As the cost for health insurance has risen there’s been a move toward managed health care. This move, in turn, has changed the health American insurance industry and services by creating limited flexibility for someone to choose a doctor.

Managed health care is a term that refers to health plans that involve selective contracting between insurers, health care providers, and employers to direct employees to a specified group of cost-effective health care providers.

This rapidly-changing revolution has affected everyone from physicians and hospitals to patients and insurance carriers.

Says Marc Maraccini, Vice President of Sales and Marketing at North Texas Healthcare Network: “Fifteen years ago, it used to be that a person had an insurance provider that covered almost anything with no questions asked. But this process made it difficult for employers to estimate how much they would pay for their employees’ health care. This is because a physician or hospital could charge almost any amount for a procedure or prescription.

A managed care plan has caused most people to receive coverage through their employer over the last decade. This practice saves money because unlike traditional plans, managed care plans contract directly with the health care providers to set payment for services.

Related article(s): The Evolution of Health Insurance

3. Medicare updated to include prescription drug coverage

In the early 2000s, one major change health insurance services saw was the update to Medicare to include prescription drug coverage. This idea  that was initially proposed by George W. Bush eventually turned into the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (sometimes called Medicare Part D). Enrollment was (and still is) voluntary, although millions of Americans use the program.

For a detailed timeline of the evolution of the American health care industry from Colonial Times (1700s) to now (21st Century), take a look at the related article below.

Related article(s): The History of Medicine and Organized Healthcare in America

4. Changes to expect for the future of health care services for Americans

As the baby boomer generation approaches retirement, thus qualifying for Medicare, healthcare spending by federal, state, and local governments is projected to increase.

Along with policy and technological changes, the people who provide healthcare are also changing. Providers are an important part of the healthcare system and any changes to their education, satisfaction, or demographics are likely to affect how patients receive care.

In the future, healthcare providers are more likely to focus their education on business than ever before. A large-scale analysis of Harvard Business School’s physician graduates indicates substantial growth in the number of physicians pursuing M.B.A. degrees in the last decade. This growth may result in more private practices and healthcare administrators.

Healthcare technology trends that focus heavily on patient empowerment will be on the rise (artificial intelligence, VR/AR, 3D-printing, robotics or nanotechnology). For example, the introduction of wearable biometric devices provide patients with information about their own health. Telemedicine apps allow patients to easily access care no matter where they live. These types of new technologies are focused on monitoring, research, and healthcare availability so patients will be able to take a more active role in their care.

With advances in digital healthcare technologies, healthcare workers have to embrace emerging healthcare technologies with an open mind in order to stay relevant in the coming years.

Related article(s): How We Can Expect The Healthcare Industry to Change in The Future and 10 Ways Technology Is Changing Healthcare

Part II: COVID-19 Supplemental Sick Leave for California Employers (SB 95)

COVID-19 Supplemental Sick Leave

SB 95 Bill

Details of the recent SB 95 Bill that provides supplemental sick leave as a result of Covid-19

 In part I of this blog, we talked about the past Assembly Bill 1867, sick leave hours for the newest SB 95 bill, and eligibility. Today, we’ll be discussing the following points: 

  • How SB 95 interacts with other leave laws

  • Requirements, notices, and pay stubs

  • Compliance recommendations

SB 95 Interaction with Other Leave Laws

An employer may not require an employee to use other paid or unpaid time off before the employee uses SB 95 leave.

California Sick Leave – The Healthy Workplace Healthy Family Act

SB 95’s paid sick leave is in addition to any paid sick leave available pursuant to California’s sick leave law, known as the Healthy Workplace Healthy Family Act of 2014, established in Labor Code section 246.

Cal/OSHA Emergency Temporary Standards Required Paid Leave

Late last year, Cal/OSHA enacted Emergency Temporary Standards (ETS) that required employers, among other things, to prepare and implement a COVID-19 Prevention Program. Employers also had to provide “continued earnings” to employees who were excluded from the workplace because of work-related exposures or positive COVID-19 cases. SB 95 clarifies that employers may require an employee to exhaust supplemental paid sick leave under SB 95 before becoming eligible for “continue earnings” under the ETS.

If an employee took leave for an SB 95 qualifying reason after Jan. 1, 2021 pursuant to any federal, state, or local law, or employer-provided COVID-19 leave, it can be counted as leave provided under SB 95. The employer might be required to provide retroactive payment to the employee for the leave taken if it was unpaid or not paid at the level required by SB 95.

Retroactive Pay Requirement

SB 95 supplemental sick leave became retroactive to Jan. 1, 2021. The new law established these provisions for retroactive payments:

  • The employee took supplemental paid sick leave specific to COVID-19 on or after Jan. 1, 2021 (for example, a city-mandated leave for quarantine).

  • The leave was for one of the reasons covered by SB 95, as defined above.

  • The leave was either unpaid or paid at a lower rate than mandated by SB 95.

If all of these conditions are met and the employee requests retroactive pay either orally or in writing, the employer must comply. Once retroactive payments are made, employers may take credit for the leave hours previously provided.

Retroactive payments must be paid on or before the next full payroll period after the employee requests it. And employers might have to replenish the PTO, vacation, or other leave banks of employees who used them while on an SB 95 leave prior to its enactment.

Requirements and more

Notice Requirements

 Employers must provide employees with notice of the new law. The Labor Commissioner’s Office will release a model notice by the end of March. Employers may provide this notice electronically.

Pay Stub Requirements

  • The COVID-19 supplemental paid sick leave balances must be included on itemized wage statements.

  • The COVID-19 supplemental paid sick leave must be denoted separately from regular paid sick days. 

For employees that have part-time and variable schedules (making their leave entitlements variable), the new law specifies that the employer satisfy the wage statement obligation by doing an initial calculation of leave available and indicating “variable” next to it on the initial and subsequent wage statements. The calculation must be updated when leave is taken.

In-Home Health-Care Providers and Firefighters

A separate section in SB 95 outlines similar leave requirements for providers of in-home health care and supportive services firefighters.

Compliance Recommendations

 Employers are encouraged to take these steps to ensure compliance with the new law.

  • Educate and train human resources and payroll employees about the new supplemental paid sick leave requirements. Employers might want to include in the training the new law’s impact on Cal/OSHA’s emergency temporary standard (ETS) exclusion pay, as well as the requirement that the employer replenish vacation, sick leave, and PTO banks for leave taken since Jan. 1, 2021 for a covered reason.

  • Direct payroll employees to create or reinstate a separate COVID-19 supplemental paid sick leave designation on wage statements.

  • Watch for and post and/or electronically distribute the COVID-19 supplemental sick leave model notice the labor commissioner issues.

Be sure to check out part I of this blog to get all the details on the SB 95 bill.

A peek inside the 2021 healthcare reform plan

Healthcare Reform

Health insurance in coloradoTaking a look at the nation’s healthcare agenda for 2021 

New healthcare plans are underway as we inch into completing the first quarter of 2021. An executive order was recently signed that will direct the federal government to open a special enrollment period from February 15 to May 15 for Affordable Care Act (ACA) exchanges that serve 36 states.

 According to Forbes, this measure is designed to boost coverage for people who are uninsured. The goal of the upcoming healthcare agenda is to improve people’s access to health insurance.

 The key pillars of the 2021 healthcare agenda include:

  • Fortifying the ACA, which includes augmenting the law with a public option;

  • Expanding ACA for lower-income Americans in non-Medicaid expansion states;

  • Introducing legislation on Medicare for More;

  • Revitalizing public health.

 More details about efforts to support the ACA can be found here.

Why the ACA is still significant to us, and why it’s still under attack today.

On March 23, 2010, the Affordable Care Act was signed into law, allowing over 100 million people to not have to worry that an insurance company will deny coverage or charge higher premiums just because they have a pre-existing condition – whether cancer or diabetes or heart disease or a mental health challenge.

 While over the last decade, the Affordable Care Act has been under relentless attack for various reasons, efforts are being made to protect the Affordable Care Act from these continued attacks in the following ways:

  • Fortifying the ACA, which includes augmenting the law with a public option.

 Instead of starting from scratch and getting rid of private insurance, the plan is to build on the Affordable Care Act by giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate

  • Expanding ACA for lower-income Americans in non-Medicaid expansion states.

 The prospect that health protections could extend to millions of uninsured Americans is being raised. As the Covid-19 pandemic saps state budgets and strains safety nets, the opportunity arises. The goal is to break the Medicaid deadlock in the 12 states that have rejected federal funding made available by the Affordable Care Act.

 While this is not an overnight procedure, there are significant opportunities for the remaining states to embrace the Medicaid expansion.

 Key to these potential compromises will likely be federal sign off on conservative versions of Medicaid expansion, such as limits on who qualifies for the program or more federal funding.

 Read more about the efforts that are being made to expand Medicaid here.

  • Introducing legislation on Medicare for More.

 Unlike the Medicare for All approach that would abolish private health insurance and provide universal access to all Americans, regardless of age, Medicare for More builds incrementally on the existing framework of both Medicare and the Affordable Care Act (ACA), and aims to close current gaps in access to healthcare insurance.

 This version of Medicare for More is narrower, as it would permit people aged 60 to 64 to enroll in Medicare. Premium and cost-sharing subsidies would be offered to lower-income beneficiaries. As a result, approximately 20 million more Americans would be eligible for Medicare. Enrolling in Medicare would be voluntary. Employers would be prohibited from dropping newly Medicare-eligible persons from their plans.

 There is an increased likelihood for a pragmatic approach that combines Medicare for More, introduction of a public option, and reinforcement of the Affordable Care Act (ACA).

Learn more about the Medicare approach here.

  • Revitalizing public health.

 In January, the National Strategy for the COVID-19 Response and Pandemic Preparedness was released. The plan builds on the previously announced vaccine distribution plan and the American Rescue Plan, and is organized across seven goals, namely, efforts to get the pandemic under control so Americans can inch into a safer future moving forward.

 Some of those goals are listed below:

  1. Mount a safe, effective, and comprehensive vaccination campaign;

  2. Mitigate spread through expanding masking, testing, treatments, data, healthcare workforce, and clear public health standards;

  3. Safely reopen schools, businesses, and travel while protecting workers;

 For a more comprehensive list on the plan to revitalize public health, read here.

7 Important Women’s Health Screenings You Should Prioritize

Women's Health Screenings

Maintaining one’s good health takes commitment to a few critical habits.

While you may be well aware of the benefits of eating nutritious foods, getting regular exercise, and making time for rest, be sure not to overlook regular visits to your doctor as well. With routine screenings and checkups, you can detect problems early on to receive proper treatment. In this article, we’ll discuss seven critical health screenings that women should prioritize for the benefit of their good health.

Women’s Health Screenings

Seven health screenings to prioritize:

  1. Blood pressure screening. According to the American Heart Association, the ideal blood pressure measuring is 120/80 or below. So, if you maintain this healthy blood pressure, it is recommended that you have it checked at least once every two years, beginning at the age of 20. However, if you are at a higher risk of hypertension, you are 40 or older, African American, or suffer from a chronic condition like obesity, then an annual screening is encouraged.
  2. Cholesterol check. A cholesterol check is an assessment of your risk for heart disease or stroke. It is recommended that adults older than 20 to have this measured at least once every five years. However, if you pose a higher risk for these conditions, be sure to ask your doctor about the frequency at which you should have this checked.
  3. Pap smears. This critical exam takes cells from your cervix to check for cervical cancer. It is recommended that women get a pap smear exam every three years after the age of 21. And after 30 years of age, you can get this done just once every five years if it’s combined with a screening for HPV– an STD that can lead to cervical cancer.
  4. Mammograms. These take an x-ray image of the breast to screen for cancer. And while these are exceptionally important, there is debate over the frequency at which a woman should undergo a mammogram. That’s because while the risk for breast cancer increases with age, false positives are common with frequent screenings. However, the most recent guidelines suggest women begin at 50 years old to have a mammogram screening every two years. If you have a family history of breast cancer, though, talk to your physician about more frequent screenings.
  5. Bone density screenings. Women are especially prone to suffering from osteoporosis. And so, they should receive a bone density test at age 65. If you display risk factors, including fractures and low body weight, then you might consider getting screened earlier. The frequency of tests should be determined by your doctor, depending on your bone density and risk factors.
  6. Blood glucose test. After age 45, women should receive a blood glucose test every three years. This checks for diabetes and prediabetes. You might consider getting these tests done at an earlier age if you are at a particular risk for these diseases. If you are obese, have a family history of diabetes, or are a race or ethnicity that is at higher risk, you may need to have more concern for your blood glucose level. Speak with your doctor to help you plan.
  7. Skin examination. No matter your age, the American Cancer Society recommends that women should examine their skin every month at home. Each month, be sure to check for moles or changes to existing moles. These could be early signs of skin cancer. If you have a family history of skin cancer or you are at an increased risk, it may be necessary to talk with a dermatologist about routine office visits.

We at Bernardini and Donovan aim to help you and your family members stay healthy. That’s why we encourage your routine doctor’s visits and physical exams. These will help you stay healthy and promptly get the medical attention you require. And in the instance that you need more than routine checkups, make sure that you’re adequately insured. Reach out today for assistance with your health insurance needs.

Catching Up On Your Preventative Care

health insurance

When we get sick in the winter, as much as we don’t like it, it’s the season that we expect to get sick. With the cold weather and more dreary environment, a scratchy throat or runny nose seems to come with the territory. But when Summer hits, that is not the time to get sick! Is there anything worse that feeling unwell on your summer vacation? Or is it going to be a beach with a stuffed up nose? One of the things that your healthcare provides for you is preventative care.

PREVENTIVE CARE

There is no charge involved, and it does exactly what it says it does. It keeps you from getting sick. And while Summer doesn’t always make us think about going to the doctor, it is a great time to make sure that you are healthy. But what exactly is involved? Preventative care includes the following

  • Immunizations and vaccines

    If you read our last blog on the measles, you probably have a good idea of how effective vaccines can be for your health. Many standard immunizations such as the TdAp (tetanus, diphtheria, pertussis) or the MMR (measles, mumps, rubella) are all standard immunizations. Your doctor can help you know if you should need them at all or if it is time for a booster.

  • Wellness check-ups

    Essentially, these check-ups are to make sure that you are healthy. Sometimes they are also called a yearly physical. It can help your doctor know how to better care for you when you are sick. They can measure your weight, height, blood sugar levels, blood pressure, and cholesterol so that when you come back the following year, they can see if you’ve had any significant changes and can address them better.

  • Screenings for cholesterol, cancer, diabetes, depression, and obesity

    Health professionals realize that these issues are some of the most likely to affect our society. So to ensure that a person does not neglect to get the help that they need, these screening are part of their preventative care.

Preventative care can help you in the long run because tests, screenings, and immunizations like these can catch life-altering health issues early while they are most receptive to care. Call your doctor today to make an appointment with them to receive this preventative care that comes with your health insurance.

Summer Sun Skin: 5 Ways to Protect Your Skin This Summer

family health insurance

Summer brings so many good things for us! Time off from school, family vacations, beach trips, warm weather and lots and lots of sunshine! But while you are partaking in soaking up these rays, it is essential to think about how to protect your skin. Your skin can go through some severe damage during this season. So here are fives ways to protect your skin this summer!

  • Drink Water

    When the temperatures rise your body sweats and lose hydration. On top of that, your skin is made up of 64% water. So when you are not drinking enough water, it can show! It can also lead to headaches and itchy patches on your skin. So it is essential that you are keeping your body well hydrated with eight glasses of water a day.

  • Sun protection is key

    One of the most significant issues with too much sun exposure is skin cancer, and one of the easiest ways to avoid this is to wear sunscreen. Anything over SPF 30 will block out about 97% of the UV rays. You will want to make sure that you are covering any part of your skin that will be in the sun and then reapply every two hours. If you are swimming or sweating you may want to apply more often. But sunscreen is not the only way to protect yourself from the sun. You can also cover up with clothing. Light long sleeves and pants and a wide-brimmed hat can do wonders to keep you from getting sunburned. You may also want to seek out shade. Some choose to carry an umbrella with them for a little extra protection against the sun.

  • Exfoliate

    During the summer months, your skin experiences a lot and needs to be exfoliated. Between sweat, sunscreen, and other elements, your skin can be easily clogged and can lead to acne and breakouts. Regular exfoliation and washing allows your pores to breath and makes for happier skin.

  • Feed your skin

    The saying you are what you eat holds some weight here. Your skin reacts to what you are eating, and if you are not feeding yourself good, nutritious foods, your skin is one of the first telltale signs. But eating foods that vary in all the colors of the rainbow can help your skin can help protect your skin from outside elements while also giving you a healthy glow.

  • Quit Smoking

    Smoking has many adverse side effects, but on top of those havoc-wreaking consequences, it also hurts your complexion.
    There are plenty of reasons other than your skin health to give cigarettes the boot—like an increased risk of lung cancer—but all those packs also wreak havoc on your complexion. Smoking causes the small elastic fibers and collagen in your skin to be damaged and over a period that leads to wrinkles in your skin. Smoking makes you age much faster than the average person would. So this summer, put down your tobacco use for good.

    We hope that this list has given you a few helpful tips and tricks to keep your skin happy this summer. We know that it is easy to be excited for beach days and warm vacation spots, but taking care of your skin today will have lasting benefits for the rest of your life.

There are plenty of reasons other than your skin health to give cigarettes the boot—like an increased risk of lung cancer—but all those packs also wreak havoc on your complexion. Smoking causes the small elastic fibers and collagen in your skin to be damaged and over a period that leads to wrinkles in your skin. Smoking makes you age much faster than the average person would. So this summer, put down your tobacco use for good.

family health insurance

We hope that this list has given you a few helpful tips and tricks to keep your skin happy this summer. We know that it is easy to be excited for beach days and warm vacation spots, but taking care of your skin today will have lasting benefits for the rest of your life.

The Mighty Mind: Suffering From Mental Health Awareness Month

suffering from mental health

The Mighty Mind: Suffering From Mental Health Awareness Month

We talk a lot about our physical health, but you may not know that May is Mental Health Awareness Month. As a society, we spend a lot of time dedicated to our health. This comes in the form of education, access to doctor care, sharing about eating for health or promoting physical exercise. But what has not always been prevalent is talking about Mental Health. In fact, speaking about mental health and receiving care for mental health held a stigma for a long time and in specific communities still does. It is critical to raise awareness so that these individuals can receive the care that they so desperately need.

Continue reading “The Mighty Mind: Suffering From Mental Health Awareness Month”

Here We Go Again: The Healthcare Debate Flip-Flop

Healthcare Debate

Here we go again: The Healthcare Debate Flip-Flop

When it comes to healthcare in the news, we should be used to an ever-changing message. So we guess there should be no surprise as Donald Trump picks up the healthcare debate once again and flip flops on his answers.

From the beginning of his political trajectory, our current president has had a lot to say about the Affordable Care Act. He made promises throughout his campaign that it would be abolished. Then when the Republicans came up with a replacement health care plan of their own, they lacked the unification needed to get it passed through the Senate. Healthcare was a big talking point in the 2018 elections, and many believe that the democratic majority win in the house was due to the health care initiatives. Continue reading “Here We Go Again: The Healthcare Debate Flip-Flop”

Breast Cancer Awareness Month

breast cancer check-up

Breast Cancer Awareness Month

October is Breast Cancer Awareness Month! And out of all of the monthly awareness programs, this one might be one of the most well known in this area. Redlands has held an annual Believe Walk that runs throughout Downtown Redlands that many citizens have participated in. “The purpose of the Stater Bros. Charities & Inland Women Fighting Cancer Believe Walk is to raise critical funds that support cancer-fighting organizations in this region. Through the generosity of sponsors and donors; the Believe Walk will directly impact lives, by providing funds to improve cancer care and support services for cancer patients and their families in the Inland Empire communities of Southern California.”

The Believe Walk will take place on Sunday, October 7th and will start at 8 am! If you are interested in participating, volunteering or donating, please feel free to visit their website at – believeinlandempire.com

Breast Cancer Check-Up

The purpose of this month is to spread awareness of how early detection of breast cancer can save lives. This early awareness can be achieved through self-inspection as well as mammograms. A mammogram is a type of x-ray that allows the tissue in the breast to be examined for any form of cancer that could be there. It is recommended that women over the age of 40 on an annual basis. A mammogram has the potential to show changes in the breast two years before those changes should occur. And equally important is the self-examination which can take place at any time and should be done on a regular basis on women regardless of their age. It is through regular self-examination that many cases of breast cancer are found. Being aware of your own body and any changes that it may be going through is vital to tracking your health. Please be especially aware if anyone in your family has been diagnosed with breast cancer and be checking yourself on a monthly basis.

If you are in need of insurance to cover your annual breast cancer check-up, please speak to us. We can help you find health insurance that fits your needs and your price point. We hope to help everyone find health insurance that they love especially as open enrollment is soon to open.

Healthcare In the News – August Edition

Healthcare in the News

Healthcare In the News – August Edition

In the past month, we have seen some seriously dramatic news stories about our nation’s health care laws. Usually, dramas of that sort are kept to cable television, but maybe art does imitate life, especially as we watched the news coverage of the US Senate. If you have been living under a rock or just don’t enjoy listening to the news, let us give you a quick fly over.

In May, the House voted to pass the ACHA which had a series of changes to our current Affordable Care Act. The Senate then decided to write their bill however they delayed the voting until they could work out their details within the Republican party. It failed to pass. Then a series of votes continued to try and repeal and possibly replace Obamacare. None of those passed either. The Republican party needed every representative to vote yes, and with some dramatic conversations between party members, the numbers didn’t rally.

When Senate Majority Leader Mitch McConnell was asked about the future of healthcare reform, he stated that they had suffered a setback and that the future was “murky.” This murkiness has started talks with Democrats about single payer healthcare. If you are unclear about what single payer healthcare is, you can read about it on our previous blogs: www.bdhealthinsurance.com/single-payer-healthcare and how it doesn’t work here: www.bdhealthinsurance.com/single-payer-healthcare-cons-part-one and here: www.bdhealthinsurance.com/single-payer-healthcare-cons. Representative John Conyer (D- Mich) has already introduced his single payer bill called Medicare for All. He already has the support of about half of the House Democrats behind his bill. Senator Bernie Sanders says he will propose his bill shortly. It will probably look very similar to the plan he posted on his website last year, and we heard him speak about on the campaign trail. We will have to wait and see how this unfolds in the next few months.