Increasing Health Care Costs


have been an issue for a LONG time.  See our main page for the most current information, namely after Health Care Reform – ObamaCare.

This is historical information.

Paying More Getting Less (2008) Joel A Harrison 

Organ Transplants Joel A Harrison – East County San Diego Magazine 1.2009

Kaiser’s Premium Rates – Employer Backlash – LA Times  7.24.2013

SB 746 – I’d link to the State of CA, but their site is down today.    I don’t understand why we need this law, considering the  Medical Loss Ratio  MLR mandate of 80%  in Health Care Reform.  If you have a thought, please post it in comments, including a URL if you state any facts.

The part that concerns me is that Kaiser is the “model” of preventive care, “case management,” etc.  If their rates are going up…   How will Health Care Reforms mandate of Preventative Care and Case Management work?

Wellpoint – Anthem Blue Cross have higher earnings – costs are down  LA Times 7.25.2013

Millman Study 4.2013 on Health  Reform and Premiums pdf (click on bookmark icon)

Anthem Blue Cross 4.2013 MORE detailed explanation of why Medical costs are rising. 7 Pages pdf

Full Report

Inpatient Prospective Payment System (IPPS) Provider Level Charges and Medicare Payments for the Top 100 Diagnosis-Related Groups (DRG)

Cedar’s doesn’t really charge as much as the report shows – LA Times 5.2013

CMS just release study on pricing

Medicare Supplement Increases Blue Cross Flyer 11.2010

Medical Cost Trend: 2013 (PWC)

Los Angeles Times – Steve Lopez
$5K Emergency Room for Stomach Ache!

Recent News and Insurance Company Bulletins

New York Times 1.5.2013
Premiums still increasing despite Medical Loss Ratio (MLR) & Rate Regulation

12.13.2012 LA Times
Blue Shield Rate Hike 12%


New legislation.  use our search engine
Proposed government mandates–such as the

reform, and
health care tax changes–will continue to drive health care costs up.

AB 88
Small Group Reform
Costs of Infertility Treatment
 cal health

CHFC Articles

In the private insurance market, cost containment is largely left to market forces. Insurers compete with one another for customers partly on the basis of price. When the insurers are managed care plans, they have some influence on medical costs through their contractual relationships with participating providers, who may agree to fee constraints because of their desire to be included in the plan’s provider networks and to have access to that source of business. Health plans often also implement various utilization controls to limit service use.

Price competition among providers is less intense, since most consumers of health care are covered by insurance and are thus relatively insensitive to provider prices. However, various forms of patient cost-sharing are designed to give consumers incentives to avoid excess utilization and to choose less expensive medical alternatives.

The public-sector buyers achieve cost control primarily through administered prices for providers. The state sets the fees it will pay Medi-Cal providers and health plans participating in either Medi-Cal or Healthy Families, and has other features in place to control utilization.

Although there is no consensus about what proportion of our resources should be devoted to medical care, many believe the present system does not adequately contain costs. Health expenditures have risen more rapidly than wages and represent an increasing proportion of total spending.

20 percent of Californians remain Uninsured More than half of California’s uninsured children are eligible for public health insurance

Cost Containment


Study of 10 health plans in CA and how they actually perform – Georgetown University
my medical
I haven’t figured out who sponsors them or where they get their data from

Video Samples of Accidents covered by medical insurance

Video’s of Surgeries NIH

NIH Health Topics

Blue Cross Statement on Employers rising costs

Agency for Health Care Research & Quality

Health reform is high on the political agenda in California, and things are moving fast. Cal Health  was created to help keep Californians up-to-date on the major proposals, analyses, hearings, and news. We also provide resources to help explain the issues and a discussion forum where you can share your ideas.

Blue Cross Provider Quality Finder Links

America’s Health Insurance Plans – merged with Health Insurance Institute of America

State Health

Blue Cross letter to Employers

Tips for Better Health - Avoid Medical Procedures





Just when I was so thankful that the Grandfathered Plans (if you like your plan, you can keep it) were great for 2014 and beyond.  The plans allowed many of our clients to stay out of the 1.1.2014 Covered CA SNAFU fiasco of no ID cards or invoices, narrow networks, glitch ridden websites and rollover to Metal Level Plans.     I just found out from a prospect and the LA Times that there is a rate increase (why?) of up to 25%.   With almost daily bulletins and changes, a lot of my new information is from the LA Times rather than Insurance Company bulletins.  Now the Times requires registration and/or a subscription, as if the barrage of advertising on their website isn’t enough.

If you want to look at new Obama Care coverage, check our ONLINE instant quote engine.  If you think you might qualify for tax credits – premium subsides, send us your  household income and we will do the calculation for you.  Click here for an explanation, including a video explanation.

According to the LA Times, the CA Department of Insurance must review the rate regulation (our new website)  filing.   Here’s the ACTUAL filing around 500 pages, on the CA DOI website.  It’s quite possible that you might get a rate decrease!  If you have any comments, the DOI has a spot for that on their filing page.  You may also post them on our Premium Increases web page.

Please email or call us for further information.  We have NO call holding wait times.   If we are in the middle of something, send an email or leave a message.  We will respond within 2 working hours.



Exchange Enrollees – Covered CA? Sicker than on employer group plans

Kaiser only company to cut rates for 2015

Average rate increase for all exchanges

Average rate increase for 2015

More details


Exchange Rates might increase in 2015

Trans Union survey shows more than 1/2 of consumers surprised by amount of medical bills


Covered CA rates for 2015 to be released Thursday. No increases expected?

Anthem predicts 10% or less premium increase for 2015

Last week, Anthem and other insurers filed their proposed rates for 2015 with Covered California

The final rates are expected to be disclosed publicly in late July when health insurers submit them to state regulators for review

“These narrow networks are making a huge difference on affordability,” Morgan said. “People value price above all else…. These narrow networks are really here to stay.”

Hunkered down in conference rooms, insurance actuaries are parsing prescriptions, doctor visits and hospital stays for clues about how expensive these new patients may be. By May, insurance companies must file next year’s rates with California’s state-run exchange so negotiations can begin.

“I probably neglected my health the last few years because of the expense,” Davidson said. “Now I’m going to have every test known to man.”

She plans to undergo lab tests for her diabetes, a mammogram, a bone density scan and a colonoscopy — everything she put off while she went without comprehensive insurance.

claims information is usually a better guide to future costs than a customer’s age, sex and other demographic data.

Rate Increases for 2015 – Insurance Mandatory Filings coming up soon

Insurers’ short turnaround time, coupled with regulatory uncertainties, has led some industry officials and outside experts to predict that double-digit rate hikes could be in the works. That would be bad news for consumers, the administration and Democrats running for election in November. The fear is that if premiums rise significantly, fewer healthy but uninsured Americans will sign up in 2015, leading to more rate hikes. Still, many observers say the exchange market would survive rate increases because the law’s re-insurance and risk-adjustment mechanisms protect plans with higher-than-expected costs.

“There will undoubtedly be remarkable price increases,” WellPoint CEO Joseph Swedish said. He added that the prospect of double-digit hikes “appears as if it’s likely,” but he was uncertain about specific numbers. His company—the biggest commercial insurer in the exchanges, with 500,000 members as of the end of January—will study the demographics and medical utilization of its new members to figure that out

three-year phase-out of re-insurance and risk-corridor protections established under the ACA, said Hans Leida, a consulting actuary with Milliman. The phase-out of re-insurance would contribute about 6% to 12% in rate increases alone, spread out over the next few years. The risk-corridor program built in some certainty for insurers on the exchanges by limiting both potential gains and losses.


Here’s an attorney’s thought on why Rx have increased so much. Prescription Benefit Managers? I really wish she had citations for your statements.

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