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Obama’s Ohio Health Care Myths – Separating Fact From Fiction

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Health care reform is one of the Ohio’s most contentious issues. President Obama wants government-sponsored health care, hoping costs will reduce. Insurers and doctors are concerned that patients will have fewer choices under Obama’s plan. Drug companies fear that quality of our health care will reduce. Consumers don’t want to be forced to buy plans they don’t want, and especially don’t want to see substantial rate increases.

Sometimes it’s hard to determine the difference between myth and fact. One common myth is that Ohio consumers overwhelmingly want to see the current health care system changed. But that’s not true since recent polls indicate roughly half of the state residents, and the US population, want to maintain the current system. While the current way is not perfect, perhaps it should be tweaked instead of overhauled.

For example, HSAs are very popular and most employer-provided plans are partially-paid by the business owners. Major medical plans help healthy persons reduce their cost of coverage while high-risk pools provide a guaranteed option for persons with major medical issues.

Liz Peek wrote a very interesting article about Obama’s five “Health Care Myths.” I don’t necessarily agree with all of her assertions, but there are some very valid points she raises. If you’re concerned about Ohio health care, you’ll be interested in reading this article.

You can read the article in its entirety here.

UPDATE: December 2012  I guess she was right!

Is Universal Health Reform Good For Ohio?

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True Ohio health care reform centers on the four “pillars” of patients’ rights. Choice, competition, accountability and personal responsibility. A patient must have the right to choose their own doctor, and must protect a consumer’s right to choose the health insurance that best fits their needs and budget.

“Conservatives For Patients Rights” (CPR) recently reviewed 16 plans that have been discussed, written about or offered up as legislation. Which plans are too costly? Which plans promote competition within the healthcare industry? These policies were designed to give customers benefits that they are likely to use every day.

UPDATE: January 2013. The article we were referencing no longer assists so we removed the link. Many of those 16 plan descriptions are available today. Of course, the prices may be different than they were in 2009, but the point of the article was to be able to shop around for policies that allow you to take care of most of your concerns. For example, if you have plenty of liquid assets and are comfortable with $25,000 of out of pocket risk, you should be able to take it. However, most consumers would rather pay more and reduce their potential risk.

We’re not sure you’ll receive that type of choice when Exchanges are ready in 2014. Later this year, we will get a better idea of some of the best selections. And re Universal health care…technically it’s not here yet, although many folks believe it is inevitable. We will find out in a few years, when “The Affordable Care Act” has some time under its belt.

UPDATE: October 2018. The number of carriers offering Marketplace plans continues to reduce in the Buckeye State. Although Oscar, in its second year of participation, is expanding its service areas, Anthem, Aetna, Humana, and UnitedHealthcare have not returned yet. Short-term plans are becoming popular again, although pre-existing conditions are not covered.

National Health Care…Who’s Going To Pay For It?

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A national health care system may allow individuals to avoid paying for their health insurance. But the cost of health care will not reduce. In fact, it may actually increase. I’m not a big advocate of government-sponsored health care. I believe a combination of increased utilization of HSA accounts (found on this page), mandated (required) health care for everyone, increased tax credits and mandatory preventative visits will solve our problems.

James F. Pontuso, Charles Patterson Professor of Government & Foreign Affairs at Hampden-Sydney College, offers some very astute views…

The reason health care costs have risen is not because of waste, neglect, incompetence, or greed, but rather because medical care has become so much better.


Proponents of national health care insist that there will be reductions in administrative health-care costs. It is true that there are savings because of economies of scale, but has anyone ever seen a big government program administered efficiently?  Big government programs are almost always more expensive than expected exactly because bigness breeds inefficiency. A national health-care system in the U.S. may create the largest bureaucracy in the history of the world.


We could also reduce health care by capping the compensation for doctors, nurses, and other health care professionals. But we have to wonder whether the nursing shortage in the U.S. would get worse if nurses’ pay were lowered. As for my cardiologist, she loves medicine and she might have pursued her career even if it took her longer to pay off her debts. I know she is talented enough to succeed in most any profession she entered. Like most people who are really good at what they do, she wants to be compensated for all her hard work, dedication, long hours, and expert skill – such, after all, is the American dream.


The cost of national health care will be high either because good health care is expensive or because inexpensive health care will not be good. This is the issue which we face.

 UPDATE February 2013- Maybe the answer is finally known. We all pay! With health insurance rates expected to substantially rise when Exchanges are the law of the land (2014), it becomes very clear that perhaps the system isn’t working as well as anticipated.

Is Your Doctor An Ohio Network Provider?

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If you currently have an Ohio health insurance policy, then you probably pay a “copay” on your office visit coverage.  The “copay” is the dollar amount you must pay for your visit to the doctor. Normally, copays range from $15-$40. Sometimes they’re as much as $50. And if you have a deductible that applies, you pay almost the entire amount.

If your doctor does not participate in your plan, your out-of-pocket expense will be higher. A lot higher. That’s because your insurer (probably Anthem, UnitedHealthOne or Medical Mutual) will not (and can not) contractually force the provider to charge a lower rate. And that difference can be substantial.

Verify Your Provider

So what can you do? Perhaps your best course of action is to ensure that when you are treated for a sickness or an illness, you have previously verified that your doctor (or Urgent Care facility) is considered “in-network.” It will likely mean the difference of paying about $30 vs. perhaps paying more than $100. A specialist visit will result in greater savings. An unexpected emergency room visit could be extremely expensive if you go outside of your plan.

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Perhaps the biggest price difference are ER or hospital bills. If you do not use a network provider, the difference in your actual bill could easily be thousands of dollars (or more). If you are scheduling a surgery, there should be ample time to determine the status of the hospital. You can also call them directly or easily view online a provider list from your carrier. It’s common that you can use out-of-state facilities, as long as network-verification occurs before treatment.

What About An Emergency?

If your treatment is an emergency and life-threatening, typically it will not matter where you are treated. It will be considered an “in-network” expense. For example, if you live in Toledo, and are vacationing in Florida, let’s assume you suddenly have an appendicitis attack. Of course, your vacation is ruined, but that’s a minor point!

If/when you are rushed by ambulance to the hospital, naturally, you don’t have time to research where you are going to be taken and what providers the facility accepts. You’re probably going to have your surgery at the closest hospital or trauma center. And that’s precisely the proper procedure.

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It Pays To Stay In-Network

Your entire stay, including, surgery, room and board, anesthesia, doctors visits and consultations etc…should be classified as a network visit by your health insurer in Ohio. As a result, regardless whether you have a high-deductible plan or a PPO with little or no deductible, you should not be subject to a higher cost for going “outside” of the provider network. You can also verify this procedure with your carrier.

The type of coverage you have, whether it is a group, individual, catastrophic or comprehensive, will still cost you less when you utilize your provider list. If you have an HSA for 2013 or later, the same set of rules apply.

Size Matters!

Yes, the size of the insurer will often have a direct correlation on the number of providers you will have access to. For example, as you might expect, Anthem and UnitedHealthcare have the largest number of physician, specialist and hospital options in the state. Medical Mutual and Aetna aren’t far behind and Humana still maintains many participants. Kaiser and Summa Health are regional carriers and focus more on the Northern portion of the state.


Delphi, Retirees Reach Agreement On Health Care And Benefits

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Ohio white-collar retirees from  Delphi Corp. could be getting some help with their health care costs after a tentative agreement was reached between the bankrupt company and a committee representing those retirees. The settlement must be approved by Delphi’s creditors and the bankruptcy court.

The company will contribute $8.75 million into a separate fund that will be established to subsidize medical costs for salaried retirees.

The fund also covers the cost of creating a Voluntary Employees’ Benefit Association (VERA), a system that covers health care insurance costs with tax-free funds. A national health care program will be selected to manage the fund.

Delphi estimates that it will cost the typical retiree between $300 and $660 per month to maintain coverage, while family coverage could cost as much as $1,800 per month. Dental coverage would cost between $45 and $125 extra, depending on whether individual or family coverage is requested.

Earlier this year, a U.S. Bankruptcy judge allowed Delphi to abruptly terminate health care and life insurance benefits for its current and future salaried employees.

We offer professional local advice to Delphi employees. All major companies are researched to find high quality Ohio health care at the guaranteed lowest available cost.