Rate Increases for 2017 Medical Insurance Plans

There will be a significant rate increase for 2017 plans. The reasons given are the end of funding that was available in the first three years to offset rates, the rise in specialty medication and claims from those who enroll during Special Enrollment Periods.

In regard to the specialty medication, sometimes pharmaceutical companies are raising prices of medications when the need for a medication increases. Newer specialty medications can approach $100,000 per course of treatment and/or per year.

Below is the press release from Covered California on July 19, 2016

SACRAMENTO, Calif. — Covered California unveiled its rates for 2017 on Tuesday and announced that some health insurance plans will be expanding into new areas throughout the state to compete for consumers in California.

The statewide weighted average change will be 13.2 percent, up from approximately four percent in each of the last two years. However, most consumers will see a much smaller increase — or pay less next year — if they switch to another plan.

“Shopping is going to be more important this year than ever before,” Covered California Executive Director Peter V. Lee said. “Almost 80 percent of our consumers will either be able to pay less than they are paying now, or see their rates go up by no more than 5 percent, if they shop and buy the lowest-cost plan at their same benefit level. That’s the power of shopping.”

Lee said the opportunities to shop and save show that California has succeeded in building a competitive marketplace for health insurance, with rate increases that are still below trends in the individual market before the Affordable Care Act was passed.

“This is a new era of health care, where the consumer is in the driver’s seat with the power to look easily for a better deal, and where subsidies help absorb the impact of rate changes,” Lee said. “These options did not exist before the Affordable Care Act.”

Some consumers who choose to keep their plan will see a significant increase in their premium for 2017, while others will see a more modest increase, depending on where they live and what insurance plan they have. Consumers will begin receiving notices in October, when they will have an opportunity to review their new rates and change plans for their 2017 health coverage.

For many of those insured, the bulk of the premium increase will be absorbed by the subsidy paid by the government to help enrollees buy health insurance. Approximately 90 percent of Covered California enrollees get help to pay for their premiums. The average subsidy covers roughly 77 percent of the consumer’s monthly premium, and while premiums will rise, the subsidies will rise as well.

“Even though the average rate increase is larger this year than the last two years, the three-year average increase is 7 percent — substantially better than rate trends before the Affordable Care Act was enacted,” Lee said.

Lee said the average rate increase reflects the cost of medical care for consumers, not excessive profit.

“Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance,” Lee said. “So, while all plans are experiencing different cost pressures, we can be confident their rate increases are directly linked to health care costs, not administration or profit, which averaged 1.5 percent across our contracted plans.”

For consumers who get a tax credit to lower their costs — which is about 90 percent of those who sign up through Covered California — the amount they pay is impacted not only by the premium choice, but by changes in their tax credit. While the average rate increase is higher than past years, Covered California’s risk mix — the ratio of consumers who are healthy vs. sick — remains one of the best in the nation according to the Centers for Medicare and Medicaid Services (https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index.html).

Other reasons for rate increases include:
A one-year adjustment due to the end of a funding mechanism in the Affordable Care Act known as reinsurance, which was designed to moderate rate increases during the first three years when exchanges were being established. The American Academy of Actuaries estimates this will add between 4 percent and 7 percent to premiums for 2017.
Special enrollment by some consumers who may be enrolling in health insurance only after they become sick or need care, which seems to have had a significant impact on rates for two insurance plans.
The rising cost of health care, especially specialty drugs.
Pent-up demand for health care now being accessed by those who were locked out of the health care system before the Affordable Care Act was enacted.
Lee said Covered California is working to address some of these issues on multiple fronts. The exchange is aggressively marketing to attract healthy consumers year-round, and it is working to ensure special enrollment is available only to those who meet qualifying circumstances. It is also sampling the special enrollment population to better understand how to make any further improvements needed.

“We work hard to build a robust exchange that drives competition by attracting as many consumers as possible,” Lee said. “Now, consistent with the vision of the Affordable Care Act, we will redouble our efforts to make sure our consumers and potential consumers understand the importance of signing up during open enrollment and remaining covered throughout the year.”

Lee said Covered California’s 11 health insurers are competing across the state for its 1.4 million members.

“The sheer number of enrollees and their overall health means consumers in the individual market are benefiting from competition,” Lee said.

Below is the complete list of the companies selected for the 2017 exchange:
Anthem Blue Cross of California
Blue Shield of California
Chinese Community Health Plan
Health Net
Kaiser Permanente
L.A. Care Health Plan
Molina Healthcare
Oscar Health Plan of California
Sharp Health Plan
Valley Health Plan
Western Health Advantage
Rate details by pricing regions can be found in “Covered California’s Health Insurance Companies and Plan Rates for 2017,” posted online at:http://coveredca.com/news/pdfs/CoveredCA-2017-rate-booklet.pdf

The preliminary rates are subject to a 60-day public comment period and regulatory review by the California Department of Managed Health Care. In addition, the California Department of Insurance will review Health Net’s EPO.

Some insurance carriers will be increasing their coverage areas in 2017:
Oscar will be entering the market in San Francisco, Santa Clara and San Mateo counties.
Molina will expand into Orange County.
Kaiser will be available in Santa Cruz County.
With the expansion of its current carriers, almost all consumers (92.6 percent) will be able to choose from three or more carriers, and all will have at least two to select from.

In addition, more than 93 percent of hospitals in California will be available through at least one Covered California health insurance company in 2017, and 74 percent will be available in three or more plans.

Covered California also is improving its patient-centered benefit designs by increasing a consumer’s access to care by reducing the number of services that are subject to a consumer’s deductible.

Starting in 2017, consumers in Silver 70 plans will save as much as $55 on an urgent care visit and $10 on a primary care visit. In addition, consumers in Silver, Gold and Platinum plans will pay a flat copay for emergency room visits without having to satisfy a deductible, which could save them thousands of dollars.

These improvements build on features already in place that ensure most outpatient services in Silver, Gold and Platinum plans are not subject to a deductible, including primary care visits, specialist visits, lab tests, X-rays and imaging. In addition, some Enhanced Silver plans have little or no deductible and very low copays, such as $3 for an office visit. Even consumers in Covered California’s most affordable Bronze plans are allowed to see their doctor or a specialist three times before the visits are subject to the deductible.

In addition, the contract with health insurers for 2017 ensures consumers select or are provisionally assigned a primary care physician within 60 days of effectuation so they have an established source of care.

“Health care reform isn’t just about making insurance affordable, it’s about doing things to make it easier for consumers to get the right care at the right time,” Lee said.

In May, the Centers for Disease Control and Prevention announced that California’s uninsured rate had fallen to 8.1 percent at the end of 2015, down from 17 percent at the end of 2013, right before the Affordable Care Act began offering coverage.

“We can all be very proud of the extraordinary gains we have made in reducing California’s uninsured rate to a historic low,” Lee said.

About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

This article is from the Los Angeles Times date July 20, 2016

California Obamacare rates to jump

Premiums are set to go up an average of 13.2% next year. Rising medical costs are one reason, officials say.

BY MELODY PETERSEN AND NOAM N. LEVEY

Premiums for Californians’ Obamacare health coverage will rise an average of 13.2% next year — more than three times the increase of the last two years and a jump that is bound to stir debate in an election year.

The big increases come after two years in which California officials had boasted that the program helped insure hundreds of thousands people in the state while keeping costs moderately in check.

Premiums in the insurance program called Covered California rose just 4% in 2016 after rising 4.2% in 2015 — the first year that exchange officials negotiated with insurers. The program insures 1.4 million Californians.

On Tuesday, officials blamed next year’s premium hikes in the program on rising costs of medical care, including expensive specialty drugs and the end of a mechanism that held down rates for the first three years of Obamacare.

Two of the state’s biggest insurers — Blue Shield of California and Anthem Inc. — asked for the biggest hikes. Blue Shield’s premiums will jump an average of more than 19%, according to officials, and Anthem’s rates will rise more than 16%.

For consumers, the effect will depend on whether they get taxpayer-supported subsidies for their premiums and whether they are willing to switch to less-expensive plans that may come with higher co-pays and deductibles. Changing plans could also mean a new network of physicians, which could be disruptive to care for those with chronic conditions.

The rates vary significantly by region and insurer. Los Angeles and the rest of southwest Los Angeles County will see an average increase of almost 14%.

Blue Shield’s preferred provider organization rate in Los Angeles, chosen by 21% of those using the exchange, is increasing by an average of 19.5%. For a 40-year-old single person making $17,820 to $23,760, choosing a silver level plan, the monthly rate currently is $122, while the government pays Blue Shield $196. Next year that same person would pay $170, while the government would chip in $211 a month.

“We’re paying more for less,” said Jamie Court, president of Consumer Watchdog in Santa Monica. “Insurers are limiting access to doctors and hospitals while also demanding a higher price.”

Horacio Chavez, 34, of Boyle Heights said he made less than $25,000 last year as an education coordinator at a youth center. He currently pays a $100 premium for a Covered California plan that he uses for an annual checkup and a safety net in case of emergencies.

“I do want healthcare — I want the peace of mind that if anything happens to me that there’s some kind of coverage,” Chavez said. But “a 13% hike … that’s going to affect people.”

He said he’s already barely making ends meet trying to pay his rent, student loans from the University of Chicago, car payments and his health insurance premium.

“I’m already living check to check,” Chavez said.

Covered California officials defended the system Tuesday, saying that the competition among insurers offering coverage on the exchange was working to keep rates lower than they otherwise would be.

“California has a very competitive marketplace,” said Peter Lee, executive director of Covered California.

Obamacare has significantly reduced the number of uninsured Californians. Since the state’s health insurance exchange began offering coverage in 2014, the share of Californians without health insurance has fallen from 17% at the end of 2013 to 8.1% at the end of last year, according to officials.

Rates are expected to jump in other states too, although complete details won’t be available until later this year.

An analysis of 14 metro areas that have already announced their 2017 premiums found an average jump of 11%. The changes ranged from a decrease of 14% in Providence, R.I., to an increase of 26% in Portland, Ore., according to the analysis by the nonpartisan Kaiser Family Foundation.

The federal healthcare-  .gov   exchange provides insurance under the Affordable Care Act in 38 states. California and a few other states operate their own exchanges.

Around the country, several insurers, including giant UnitedHealth, have stopped selling health plans on the exchanges, and a number of new nonprofit health insurance co-ops have gone out of business.

Those decisions have fueled charges from the law’s critics that Obamacare isn’t working.

Former Secretary of State Hillary Clinton, the presumptive Democratic presidential nominee, is pushing a number of specific steps to ease price pressure on consumers, including allowing Americans ages 55 to 64 to buy into Medicare.

Republican presidential nominee Donald Trump has argued the health law should be repealed.

The health law’s next enrollment period begins a week before election day.

The state and federal health insurance exchanges provide coverage to about 12 million people nationally, representing just a fraction of the nation’s total insurance market. The vast majority of Americans — more than 250 million people — are in health plans purchased through an employer or provided by a government plan such as Medicare or Medicaid.

But the exchanges are a pillar of the Affordable Care Act’s program for guaranteeing Americans’ insurance coverage. And monthly premiums have become a closely watched barometer of how the law is performing.

Covered California’s Lee told the House Ways and Means Committee on July 12 that 2017 would be “a transitional year” for Obamacare, with rates seeing “significant adjustments” across the nation.

He said one reason for the increase was the end of a program designed to keep rates down during the insurance exchange’s first three years. The program had assessed a fee on all health insurers and then redistributed those funds among carriers whose members had the highest medical expenses, Lee said.

Lee added that some insurers had also not charged enough in the first two years because they didn’t have full data on the medical costs or health status of those signing up. Now they’re adjusting to account for those higher costs.

Mia Campitelli, a Blue Shield spokeswoman, said Tuesday that the insurer’s average 19.9% premium increase was “driven by our members using more healthcare services than we expected,” as well as the phaseout of the federal mechanism that had kept rates down in the law’s early years.

Anthem spokesman Darrel Ng said: “Factors such as increased use of medical services and added costs of drugs and medical therapies put upward pressure on rates and underscore the additional work that needs to be done to moderate the growth in healthcare costs.”

The financial pain for most Californians getting insurance through the exchange will be muted because 90% get taxpayer assistance to cover the premiums.

Americans making less than four times the federal poverty level — about $47,000 for a single adult or $97,000 for a family of four — qualify for the assistance.

Nonetheless, Americans who make too much to qualify for subsidies are likely to feel the brunt of the higher premiums. That will probably increase pressure on the new president — Democrat or Republican — to review the exchanges in 2017 for ways to make health plans more affordable.

A year ago, Lee wrote an op-ed in The Times saying that Covered California’s power in negotiating with insurers was allowing Obamacare to work in the state.

“We now have the full picture in California, where we are proving that health insurance exchanges can keep prices in check,” he wrote.

Though the Affordable Care Act has improved care for millions of Americans — for example, insurance companies can no longer set lifetime limits on care or exclude anyone because of a preexisting condition — the 6-year-old law contains few controls on overall costs.

Spending on the country’s medical system averages more than $10,000 for every American, according to statistics released by the Obama administration this month, far higher than any other nation. melody.petersen

@ latimes.com   noam.levey@latimes.com   Times staff writer Soumya Karlamangla contributed to this report.

RICH PEDRONCELLI Associated Press

“CALIFORNIA has a very competitive marketplace,” said Peter Lee, executive director of Covered California. Above, Lee discusses the program last year.

Costs top healthcare concerns

This article from the Los Angeles Times, dated June 11, 2016 indicates that the cost of healthcare is a primary concern for our country. It also indicates that there is much confusion regarding Obamacare.

In my opinion the cost of healthcare will decrease significantly when physicians understand nutrition, exercise and psychological well being and will be able to effectively communicate this to patients. Everyone must be responsible for incorporating this in their lives.

USC DORNSIFE/LOS ANGELES TIMES POLL
Costs top healthcare concerns
A poll finds state residents more worried about rising prices than access.
BY DAVID LAUTER
WASHINGTON — Six years after President Obama signed the Affordable Care Act, the health reform law has gained acceptance from a majority of California voters, but the cost of getting healthcare remains a major concern, eclipsing worries about having insurance, according to a new USC Dornsife/Los Angeles Times poll.

The widespread worry about costs indicates a potential shift in the debate over healthcare, at least in this heavily Democratic state.

Nationally, the political debate has been stuck for most of the last six years on Republican efforts to block Obamacare, but that gridlock could lessen after the election.

In both parties, lawmakers increasingly have been hearing complaints from their constituents about the cost of care, and polls have found that prescription drug prices, surprise medical bills and other pocketbook issues concern voters more than the future of the health law.

Echoing that national trend, almost two-thirds of voters in the USC/Times survey say they worry “very much” about rising health costs, with only 10% saying that is not something they worry about.

Just slightly more than half say that lack of insurance is something they worry about a lot, and roughly three in 10 say they were not worried about it.

Latinos, however, were an exception, reporting equal levels of unease about cost and having insurance — three-quarters said they were very worried about each.

Cost concerns were most widespread among those in their 50s and early 60s. Indeed, that age group consistently showed the highest levels of anxiety on a series of healthcare concerns.

By contrast, those over age 65, most of whom are covered by Medicare, were the least likely to express worry about healthcare issues.

For a significant number of voters, the healthcare law itself takes blame for rising costs. Just over half of those surveyed said they believed that costs for average Americans have “gone up a lot” because of the law, compared with roughly one-third who said that the law had not caused that to happen.

As with many aspects of the healthcare debate, partisanship plays a big role in shaping beliefs about rising costs: Republicans by overwhelming margins blame the law, while Democrats were split closely on whether it’s responsible.

Most Americans have been forced to confront increased costs for health coverage for years — a trend that began long before the passage of the reform law.

Employers have continued to shift costs to their workers, mostly in the form of higher deductibles and co-payments. Although those higher costs may not have been caused by the new law, many blame it.

The law clearly has raised costs for one relatively small slice of Americans — mostly healthy, self-employed people with middle-class or higher incomes who were previously able to buy low-cost policies on the private market.

The new law requires those people to buy more comprehensive policies, which provide greater coverage, but at a higher price. Covering sicker customers who used to be denied insurance has also led insurers to raise some premiums.

Low- and middle-income Americans get subsidies under the law that lower their monthly premiums, but higher-income Americans do not.

More than three-quarters of California voters acknowledge the biggest effect the law has had — reducing the number of Americans who lack health coverage. By 77% to 15%, voters said that the law had achieved that goal.

Since the new law’s coverage expansion began in 2014, some 20 million previously uninsured Americans have gained coverage, and the share of American adults under age 65 who are uninsured has dropped from one in five to about one in eight, according to numerous private and government surveys.

But on that point, too, partisanship colors perceptions. Among Republicans, 28% in the current survey said that the new law had not led to more people having insurance. Among Republicans who identify with the tea party, 48% took that view, compared with 31% who said the law had reduced the number of uninsured.

The public’s view remains split on another of the law’s major accomplishments, as well — ending the ability of insurers to deny health coverage because of preexisting health conditions. The poll found 59% of voters saying that coverage could no longer be denied, while 21% said that had not happened.

On that question, the division did not appear primarily partisan. Instead, some of the groups whom the new law was designed to help most appeared least aware of one of its central elements.

Latinos, those younger than 30 and people with incomes under $30,000 were all less aware of the change regarding preexisting health conditions than whites and those who were older or more affluent. Among Latinos, for example, though 48% said the law had accomplished that goal, 30% said it had not.

That lack of awareness of one of the law’s main achievements marks a “messaging failure” by the law’s supporters, said Anna Greenberg, the Democratic pollster whose firm forms half of the bipartisan team that produced the survey for USC and The Times.

The White House and its allies have struggled at times to convey a message about the law, in part because for many Americans, it remains an abstraction.

Just over half of those surveyed said the law had no effect on themselves or their families. That’s by design: The law was written to cover the uninsured while minimizing the effect on people who get coverage through their jobs, as most working-age Americans do.

That has cost Obama politically. The views that most Americans have of the law have been shaped less by direct experience than by partisanship, according to Drew Altman, the president of the Kaiser Family Foundation, which has carefully tracked opinion about the health law.

Only about four in 10 of those who supported the law in the poll also said it had made their own families’ healthcare better.

Overall, 53% of the state’s voters favor the law, with 31% favoring it strongly. An additional 12% said they opposed it because it did not go far enough, while 27% said they opposed it because it went too far.

Those who said the law did not go far enough do not consistently back liberal views on how to replace it.

Only 40%, for example, supported a single-payer system — the sort of healthcare solution advocated by Sen. Bernie Sanders in his campaign for president.

By contrast, those who support the law backed the single-payer idea 69% to10%. Overall, just over half of the state’s voters supported it, with about one-quarter opposed.

The state’s voters divided evenly on the question of whether to repeal the law’s requirement that people have insurance.

Opinion on that question split along predictable partisan lines with one significant exception — Latinos, who generally back the law, also supported repeal of the mandate, by 57%-37%.

Most California voters have a positive view of their own healthcare and a somewhat positive view of healthcare in the state, the poll found. Seven in 10 rated their own healthcare as “excellent” or “good” while just under three in 10 called their care “fair” or “poor.”

Ratings were highest among those earning more than $100,000 a year and among those aged 65 and older, which reflects the generally positive view that Americans have of Medicare.

Asked about the state of healthcare in California, 44% called it excellent or good, while 34% said fair and 14% poor.

Ratings were gloomier about healthcare nationwide, with only 30% calling it either excellent or good, 39% fair and 25% poor.

The poll for the USC Dornsife College of Letters, Arts and Sciences and the Los Angeles Times was conducted jointly by the Democratic firm Greenberg Quinlan Rosner Research and the Republican firm American Viewpoint. It questioned 1,500 registered California voters from May 19-31. The margin of sampling error is 2.9 points in either direction for the full sample. david.lauter

@ latimes.com  .
DAVID BUTOW For The Times

 

Medicare for More

The following article from the Atlantic states that lowering of the Medicare age from 65 to a younger age might infuse needed money into the Medicare system. Additionally, rates for those who are younger and not Medicare eligible might benefit if older sicker people enroll in Medicare. All will depend on the healthcare needs of those who are shifted around.

Hillary Clinton’s new proposal to expand coverage for middle-aged adults provides a glimpse at how she would make Obamacare her own.

VANN R. NEWKIRK II

MAY 23, 2016

What’s the next step for Obamacare? Much of the 2016 presidential race functions as a referendum on just what to do with the the six-year-old Affordable Care Act. Despite some mixed returns on costs and the stability of insurance markets, the health-reform law has brought the uninsured rate to its lowest point in American history. Reflecting that mixed legacy, most Americans now favor modifications to the ACA over continuing to implement it as it is or repealing it.

LATEST FROM POLITICS
That puts most Americans on the opposite side of whatever Donald Trump’s health care plan might be. But both Hillary Clinton and Bernie Sanders have plans to modify and expand Obamacare. Sanders’s plan of “Medicare for All,” a radical overhaul of the current system based on a single-payer system, has received most of the attention. Clinton’s more modest proposals to expand tax credits and allow undocumented immigrants access to health-insurance marketplaces have garnered less press. But recently, Clinton has made waves with a new idea to allow people over 50 or 55—the specifics have not yet been announced—to purchase Medicare plans.  At present, only those over 65 and a select few of their dependents are eligible for Medicare. This “Medicare for More” concept is a significant addition to the Clinton health plan, but what does it mean for the future of Obamacare?

A new report from Avalere extrapolates what it might mean for the future of 50-somethings. There are about 13 million people between the ages of 50 and 65 who are either uninsured or have purchased private insurance on the Obamacare marketplaces. This population represents most people in the age range without affordable employer- or group-insurance coverage and who don’t qualify for Medicaid. Assuming that this is the population that would be eligible for Clinton’s Medicare for More, Avalere reports that it is “unclear” if Medicare would automatically be a good deal for them.

With no knowledge of premiums or subsidies yet, a Medicare buy-in might just be too costly for those uninsured adults above 50 who have low incomes but are ineligible for Medicaid because of state rules. For those in private plans, Medicare has a distinct number of cost disadvantages, including a 20 percent cost-sharing requirement, no lifetime cap on out-of-pocket expenditures, and drug benefits that are generally less generous. Also, it is unclear if people under 65 could qualify for the Medicare Advantage plans that help fill in gaps in coverage. Sicker elderly adults regularly run up against the limits of Medicare, and it is hard to envision cases in which Medicare would make more financial sense for near-elderly adults with serious chronic illnesses than medium-cost marketplace plans.

Medicare for More is a step away from Clinton’s position as a defender of President Obama’s legacy and towards her central policy identity as an architect of American health policy.

But Medicare has always been a good deal for those who don’t use many health-care services, and it might beat out low-cost marketplace plans for healthy adults between 50 and 65 with few health problems. Medicare provides access to one of the broadest networks of physicians, providers, and benefits possible, and consumers value continuity. A buy-in at 50 could allow people to remain on the same insurance coverage with the same providers for the rest of their lives. Also, while Medicare has not been shown to have a serious effect on health trajectories for uninsured adults who become enrollees at age 65, at age 50 it might provide services early enough to change outcomes. Medicare also provides protection against medical debts, and if premiums could be made affordable to uninsured adults over 50, it could have serious value as health issues mount with age.

Medicare for More might have more value to the Medicare program than to any individual beneficiary. People between 50 and 65 are healthier than those over 65, and many of the costs that penalize high utilization can be seen as offsets for having to cover the most expensive population in the country. Even for Medicare, which has broad power to affect prices and policy, covering services, visits, drugs, surgery, and hospital stays costs money, and as patients near costly end-of-life holding patterns, the cost curve skyrockets. Adding healthier, younger people to the risk pool might bring down the per-person costs of the program. If the subsidies are equivalent to marketplace subsidies, premiums and savings from the over-50 crowd could actually cut back net costs for the Medicare albatross. Removing more middle-aged adults from marketplace risk pools might actually make insurance cheaper for young adults as well.

The results of a Medicare buy-in for potential beneficiaries and the program will likely depend on specifics as detailed by the Clinton campaign, but its rhetorical value is much more readily assessed. Allowing private purchase of one of America’s two big public-insurance programs is an addition to Obamacare’s willingness to blur the lines between public and private insurance, risk, and public-health responsibility. The proposal gives Clinton ammunition both against Sanders in the primary and, should she win, Trump in the general.

But above all, Medicare for More is a step away from Clinton’s position as a defender of President Obama’s legacy and towards her central policy identity as an architect of American health policy. Obamacare could very well be a platform for Clinton to achieve some of the goals that remain unfulfilled from the 1993 health plan that she spearheaded. Combined with some recent support from Clinton for the idea of a public option, a Medicare buy-in can be seen as a very Clinton-esque way of using the market to provide universal care. The free market solution to coverage, along with the major expansion of Medicare as a coverage pathway for non-elderly adults, is reminiscent of the ‘93 plan, and the population that it impacts is massive. Medicare for More would also cement Obamacare as the foundational law of all of American health policy, and establish a regime of incrementalism not unlike the coverage shifts seen in the decades between Medicare and Obamacare. The proposal might open the door for other shifts, such as allowing even younger people or government employees Medicare buy-ins.

For those further to Clinton’s left, however, Medicare for More might close the door for hopes of more radical overhauls while the figurative iron is still hot and while the ACA is still a hotly debated law. Sanders’s plan rests on frustrations about the compromising nature of the Affordable Care Act, which whittled down some of the more ambitious coverage plans in favor of  a market-based solution that still leaves millions uninsured. The current Obama-Clinton doctrine of health-care views zero uninsurance as a lofty and likely unreachable goal more than a first-order cause. Much of Sanders’s momentum with Medicare for All comes from the fact that the liberal benchmark––a universal public option supported by high, progressive taxes––has still not been reached. Clinton’s incrementalism would in all likelihood reset the clock on that dream.

Medicare for More isn’t Sanders’s Medicare for All, and it certainly isn’t what many Sanders supporters are looking for, but it is a step for Clinton and would be a significant addition to the massive impact of Obamacare. If Clinton does wind up in the White House, it could be the beginning of a piecemeal process to bring the ACA closer and closer to its originally intended ideal of universal coverage, as Obamacare is a perfect platform for incremental increases in coverage. Now, it is another sign that the work of providing coverage and making the health care system more affordable and better is not yet done.

Eliminating Confusing Health Plans

It has been my experience as an insurance broker that some insurance companies have far too many plan designs which are very confusing for the consumer. Hopefully changes will be adopted to make the process of choosing a plan more consumer friendly.
Below is a partial excerpt from Covered California’s Daily News, dated March 9, 2016 which discusses the issue.
________________________________________
New Analysis Urges Shift to Patient-Centered Benefit Designs to Cut Costs and Help Consumers Get Care
Posted: 09 Mar 2016 02:52 PM PST
Lessons Learned in California Can Help Avert a Collision Between Conflicting Reform Initiatives

SACRAMENTO, Calif. — A new analysis urges state-based marketplaces, the employer-sponsored insurance market and health insurance plans to take action and move toward plan benefit designs that put consumers first, and remove existing barriers to getting needed health care.
In an article written in the New England Journal of Medicine by Dr. Elliott Fisher, Director of The Dartmouth Institute for Health Policy and Clinical Practice, and Covered California Executive Director Peter V. Lee, both stress the importance of patient-centered benefit designs to reach the next level of health care reform.

“Health plans, states and employers should take to heart the lesson that offering a lot of different designs does not serve consumers well,” Fisher said. “Too many health plans, in exchanges and the employer sector, offer confusing benefit designs with out-of-pocket costs that prevent people from seeing their doctor.”

Lee said Covered California has a model that has worked for its consumers since the agency opened its doors in 2014.

“Covered California has led the way in the fight for consumers by shaping benefit designs that help consumers make apples-to-apples comparisons and to get the health care they need,” Lee said. “A good patient-centered benefit design is critical to making sure consumers get the right care at the right time.”

Fisher and Lee noted that the current health care system seeks to improve care and cut costs through provider-focused and consumer-focused reform initiatives that directly conflict with one another.
For example, provider-focused initiatives encourage physicians, hospitals and other providers to coordinate and improve care to lower costs. However, the consumer-focused approach discourages people from seeing their provider because of increased cost-sharing.

Studies show the proportion of Americans with employer-sponsored coverage involving deductibles of more than $1,000 has increased from 10 percent to 46 percent since 2006, with many plans requiring people to fully meet their deductible before receiving any coverage for primary care. A 2015 National Bureau of Economic Research study showed the adoption of a high-deductible health plan in a relatively high-income population led to a 10 percent reduction in the use of preventative services and an 18 percent drop in physician visits, with the greatest reductions occurring in the sickest patients.

“We want consumers to be able to see their doctor when necessary, so their health care needs can be met in the most effective and efficient way possible,” Fisher said.

The authors cite California’s approach as an example of how it might be possible to avoid this collision between provider- and consumer-focused efforts. Covered California, the state’s insurance exchange, requires plans to adopt patient-centered benefit designs that allow consumers at every metal tier (cost-sharing split between insurer and enrollee) to visit their primary care physician without the cost being subject to a deductible. “When a consumer is able to get the right care at the right time, it cuts down health care costs for everyone,” Lee said.

The Centers for Medicare and Medicaid Services recently announced it would allow health insurance companies to offer patient-centered benefit designs on the federal exchange.
“This is a good step for consumers,” Lee said. “However, more needs to be done if we are going to reach the next level in health care reform.”

The article, “Toward Lower Costs and Better Care – Averting a Collision between Consumer- and Provider-Focused Reforms,” is available atwww.nejm.org/doi/full/10.1056/NEJMp1514921.

About The Dartmouth Institute
Since 1988, The Dartmouth Institute for Health Policy and Clinical Practice has been working to find solutions to some of the most challenging problems in health care delivery. Our goal is to help create an affordable, high-performing health system for everyone.

About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the governor and the Legislature.

INSURERS SPUR A DROP IN C-SECTION BIRTHS

Will a drop in C-Sections decrease insurance rates?

I have personally know someone whose C-Section was performed for the convenience of the doctor.

Below is an article from the Los Angeles Times dated March 8, 2016.

Low-risk surgeries in state hospitals fell from 27.3% in 2013 to 26.1% in 2014 amid pressure to cut costs.
BY SOUMYA KARLAMANGLA AND RYAN MENEZES
At hospitals across California, administrators are pushing doctors to perform fewer caesarean deliveries, hiring birth coaches and asking pregnant women to stay in labor longer.
For years, medical experts have said that C-sections were being done too often, yet the rates kept climbing.
In 2014, however, delivery hospitals in California reduced the number of C-sections performed by more than 1,000 compared with 2013, according to a Times analysis of new data.
What’s changed recently, some experts say, is the nature of the healthcare system, which focuses increasingly on eliminating unnecessary expenses.
In the era of the Affordable Care Act and its emphasis on low-cost medical care, C-sections — which cost more than vaginal deliveries — have become a sticking point for hospitals and a target for the people paying the bills.
Childbirth is the most common reason for hospitalization in the U.S., said Katy Kozhimannil, a health policy professor at the University of Minnesota, so when insurers and self-insured employers “look at where their costs are going, you start to see caesarean delivery rises to the top.”
Hospitals not only face direct pressure from insurers to curb C-sections, but they’re also concerned that a high rate could affect business. As more data on medical facilities is available to patients, hospitals don’t want to fall to the bottom of the pack and lose patients who see higher C-section rates as unfavorable.
Dr. Allyson Brooks, an obstetrician and chief quality officer at Hoag Memorial Hospital Presbyterian in Newport Beach, remembers that a few years ago the hospital was under fire from its insurer because of a higher-than-average C-section rate.
In California, maternal care plus a vaginal delivery cost commercial insurers $15,259 on average, while maternal care plus a C-section cost $21,307, according to a report commissioned by the Center for Healthcare Quality and Payment Reform, a nonpartisan research center.
Over the last two decades, many U.S. doctors began opting for C-sections in part out of convenience, because the procedure is often much quicker than waiting for a woman to deliver vaginally, experts say.
Some patients chose to have C-sections — a trend made famous by celebrities in the 2000s and labeled “too posh to push.”
Though generally safe, C-sections are still invasive surgeries, with a longer recovery time than vaginal deliveries.
And once a woman has one C-section, she has a 90% chance of delivering her next babies by C-section.
The World Health Organization says the ideal C-section rate is around 15%, but in the U.S. it reached 32.9% in 2009.
The rates were influenced by factors such as the culture of a hospital and type of community it serves. Three years ago, Brooks recalled seeing posts on social media by Orange County residents such as, “If you want to have a vaginal delivery go to a different hospital, if you want to have a C-section go to Hoag.”
Brooks said that though most obstetricians agree C-section rates are too high, it can be difficult to get them to consider doing fewer.
They worry that trying to bring down rates will harm women. C-sections can be necessary if the umbilical cord is dangerously tied around a baby’s neck or a woman’s uterus is at risk of rupturing.
So she began calculating a low-risk, or NTSV, C-section rate for her hospital. It includes only women considered the least likely to need C-sections — first-time mothers, having a single baby around their due date, and carrying a baby positioned head down.
The U.S. surgeon general has called for reducing the low-risk C-section rate to 23.9% by 2020.
Hoag began requiring that doctors show clear medical reasons to induce labor in women, and also started calculating and sharing each doctor’s low-risk C-section rate.
At Hoag, the low-risk C-section rate dropped from 31% in 2013 to 26% in 2014, one of the biggest declines in the state.
And it wasn’t just Hoag. From 2013 to 2014, the rate of C-sections among low-risk moms in California dropped from 27.3% to 26.1%, a reduction of 1,219 procedures statewide, according to data released last month by the California Hospital Assessment and Reporting Task Force and analyzed by The Times.
The analysis also found that the percentage of California’s 244 delivery hospitals that met the surgeon general’s goal jumped from 32% to 42% between the two years.
Hoag negotiated with its insurer to be paid an equal rate for C-sections and vaginal deliveries so it wouldn’t lose money when rates dropped.
But other hospitals that have reduced their C-sections rates have faced financial consequences.
The six Providence Health & Services hospitals in Southern California took a revenue hit from doing fewer C-sections, said Regional Chief Medical Officer Michael Bernstein. They also spent money to hire obstetricians to staff the labor and delivery wards in shifts, so doctors wouldn’t feel rushed and opt for C-sections because they’re quicker procedures.
Bernstein said he thinks the change is better for patients and could be good for the hospital group in the long run.
Increasingly, under changes set into place by the Affordable Care Act, hospitals aren’t paid per treatment, but based on the quality of the care. Hospital leaders say C-section rates could become one of the metrics used in such calculations.
But Dr. Aaron Caughey, chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University School of Medicine, said there’s no single low-risk C-section rate that all hospitals should aim for, and that rates will vary from hospital to hospital because of differences in the patient population.
“I would hate it if Medicaid said, ‘Every hospital whose rate is above the median, we’re not going to pay you a chunk of money.’ That is a bad approach because then people squeeze it down without attention to what’s best for patients,” Caughey said.
Even if hospitals aren’t being officially penalized for high C-section rates, administrators are worried about the financial effect of losing patients who want a vaginal birth.
Deliveries aren’t big moneymakers for hospitals, but once a hospital treats a mother, it’s likely to care for the rest of her family in the years to come.
Some mothers say that they felt as if their physicians rushed into C-sections, and they don’t want to repeat the experience.
When Anastasia Stone, 32, was pregnant with her first child, her doctor told her she needed to be medically induced to begin labor, which resulted in a C-section. “I was a typical first-time mom,” she said.
Stone, who lived in Santa Cruz at the time, said she later came to believe she could’ve had a vaginal delivery instead of a C-section if her physician had waited.
When she was pregnant with her second child, Stone went looking for a doctor who would try for a vaginal birth.
Dr. William Gilbert, regional medical director for women’s services at Sutter Health in the Sacramento region, said Sutter Davis Hospital has drawn such women from around the area because it had the lowest C-section rate in the state in 2014 — 12%.
The hospital uses nurse midwives, who deliver most of the babies, and reserves obstetricians for backup. Birth is treated as a natural process instead of a “health condition” that always requires medical intervention, said Carolyn Campos, nursing manager of the hospital’s birthing center.
Gilbert thinks that as more data on specific rates of procedures or treatments is available, patients will increasingly turn to that information when choosing where to seek care.
In 2014, low-risk C-section rates ranged from 12% to 70% at California hospitals.
Six years ago at Sutter Medical Center, Sacramento, Gilbert began encouraging physicians to allow longer labor in women, and began posting each physician’s low-risk C-section rate in the doctors’ lounge.
From 2010 to 2014, the hospital’s low-risk C-section rate dropped from 31% to 27%.
Gilbert thinks that most of the success came from publishing the doctor’s rates internally.
“Doctors don’t want to be the highest rate,” he said. soumya.karlamangla
@latimes.com
Twitter:
@skarlamangla ryan.menezes
@latimes.com
Twitter:
@ryanvmenezes

MARK BOSTER Los Angeles Times
LOW-RISK C-section rates at Hoag Memorial Hospital Presbyterian, where Dr. Allyson Brooks is chief quality officer, fell from 31% in 213 to 26% in 2014.

Anthem Blue Cross Rebates

Anthem Blue Cross will not be issuing rebates for the 2014 insurance year.

Anthem Blue Cross files report on MLR rebates for California: No rebates

August 4, 2015

The Affordable Care Act (ACA or health care reform law) requires health plans to meet a minimum medical loss ratio (MLR), which varies according to market. Health insurance issuers must meet a minimum MLR of 85% in the fully insured large group market and 80% in the fully insured small group and individual markets. (States that received waivers to have a lower threshold for the individual market are required to meet that percentage, not the 80% in the ACA.)* The health care reform law also requires health plans to file an MLR report each year with the Department of Health and Human Services (HHS).

On July 31, we filed the required MLR report with HHS for the 2014 calendar year.

We met the required loss ratio for all lines of business in 2014 for our Anthem Blue Cross Life and Health Insurance Company products under the California Department of Insurance (CDI) and our Blue Cross of California products under the Department of Managed Health Care (DMHC). As a reminder, medical loss ratio requirements do not apply in the ASO market and short-term medical insurance is excluded from rebates.

View this fact sheet for more details and FAQs. For all other health care reform needs, please visitwww.makinghealthcarereformwork.com.

*NoteThere are no waivers in effect for the 2014 year. However, the MLR calculation uses a 3 year average. Therefore, the waiver impacts the 2014 rebates being paid in 2015.

This article applies to:

  • California
  • Small Group, Large Group, and Individual (under 65)

Background The Affordable Care Act (ACA or health care reform law) requires health insurers to report medical loss ratios (MLR). MLR is the percentage of premiums that insurers spend on medical care (including claims and activities that improve health care quality). Health insurance issuers must meet a minimum MLR of 85% in the fully insured large group market and 80% in the fully insured small group and individual markets. (States that received waivers to have a lower threshold for the individual market are required to meet the percentage as described in the waivers.)* *Note: There are no waivers in effect for the 2014 year. However, the MLR calculation uses a 3 year average. Therefore, the waiver impacts the 2014 rebates being paid in 2015. As required by the health care reform law, we filed the MLR report with the Department of Health and Human Services (HHS) by July 31 for the prior calendar year. If rebate checks are due for the prior calendar year, they will be received by September 30. Questions and answers Q. Who is eligible for a rebate?* A. Any fully insured individual or group who had an active health insurance policy during the prior calendar year is eligible for a rebate, including individuals or groups who ended their coverage or started their coverage at any point during the prior plan year. However, not everyone gets a rebate. Q. Are rebate amounts a matter of public record? A. The total amount we must pay in rebates becomes public information after we file an MLR report with the HHS. Because we have already filed a report for the prior year, that information is now public. Please note that the rebate amounts paid to each employer or individual are not made public. Q. How did you determine how much the rebate checks would be for? A. Check amounts were calculated based on the rules from the government. In general, we took the amount we paid in medical care and quality programs and divided that by the amount of money we earned in premiums minus state and local taxes. That number was then distributed proportionately to all people in the specific product line in a state. Based on the rules set by the federal government, we calculated the rebate amount for groups or members. For specifics on these rules, please visit http://www.healthcare.gov. Q. My client recently got their rebate check and said that when they calculated the rebate themselves it was different than the amount on their check. Why is the check amount different from what my client calculated if they used the MLR percentage that was given on their notice? A. The MLR percentage that was provided on notices does not include state and federal tax adjustments. According to the MLR rebate calculation formula provided by HHS, a certain percentage is deducted for taxes from the original MLR percentage, which impacts the final check amount customers received. Individual example: In the individual market we are required to meet 80% of premium spent on medical costs and quality programs. If we only reached 77.8%, or 2.2% less than what was required, we would rebate 2.2% minus .09% in state and federal taxes. So the final rebate percentage would be 2.11%. Group example: In the large group market we are required to meet 85% of premium spent on medical costs and quality programs. If we ended up spending 84.1%, or .9% less than what was required, we would rebate .9% minus .04% in state and federal taxes. So the final rebate percentage would be .86%. Q. Can you provide the exact calculations you used so I can walk my client(s) through their exact rebate amount? A. Unfortunately no. The calculations are extremely complicated. However, the data that was reported to the federal government and the amount received is accurate based on the formula provided by HHS of what is required to meet the medical loss ratio requirement. Q. In what situation would a group receive two rebate checks? A. As stated by HHS, if the employer group has both HMO and PPO products it is possible that they will receive two rebate checks if we did not meet the minimum MLR requirement for both plans. Rebate checks are being issued at the subgroup level which could also result in multiple checks. Finally, some of our products are underwritten by two different legal entities. This could result in multiple checks being issued. Q. What information are we making available to members? A. Under the law, notices will only go out to fully-insured members and employer groups that will be getting a rebate. Also, our member portals will have a comprehensive questions and answers document that members and others can access. *Only health plans regulated by the Department of Managed Health (DMHC) are eligible for rebates in the state California. This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

My Clients Evaluate My Agency- Thank You!

Names of my clients have been removed for privacy.

Health insurance concerns can be difficult to navigate at times. Whenever I call Dennis he has always created time to patiently explain all aspects of my insurance plan. He collects all the information and addresses the pros and cons to answer my specific questions which I truly appreciate! He is wonderful to work with and I highly recommend him!

I have had the pleasure of working with The Dennis L. David Insurance Agency since 1997. Mr. David is consistently prompt, professional and thorough. He always provides me with the most up-to-date information available in the industry. No matter how tough the challenge, he works through it until he finds a reasonable solution to fit my insurance needs. Over the years, I have referred him to friends and family. He has provided them with the same level of care and attention. I truly appreciate and highly recommend the services of The Dennis L. David insurance agency.

Buying health insurance isn’t exactly the most exciting thing in the world but Dennis provides great service and makes the process as painless as possible. With a new child getting good insurance was a must. Dennis helped us figure out which insurer had our doctors in their network as well as the preferred hospitals we noted. Once we chose the paperwork was easy and he took care of the rest.

Dennis David is thorough, reliable, and provides great service. My family has been with him for over 10 years and he has never failed us.

I have known Dennis David for many years and he is the most professional and honest insurance agent. I highly recommend his services for all of your insurance needs.

We are so appreciative for the experience and professionalism of Dennis. He always helps us with our health insurance questions and help us choose the right insurance for our company. We are very pleased with the services Dennis provides our company. Our company has had many changes and he has been there to make sure everything is submitted and changed for us.

I have had a great experience with Dennis. He always gets back to you in a timely fashion he knows what he’s doing he recommends what is best for you. I would never use anyone else.

Dennis David has been my insurance agent for over 25 years. I’ve relied on him to do the research and work to best serve my personal needs — and he’s never let me down. He answers my calls or emails promptly and no question is too little to ask him. He’s honest, compassionate, patient, knowledgable, straight-forward. I give him the highest recommendation.

I have known Dennis both professionally and personally for over 30 years. When it comes to my health insurance needs, he has always had my best interests in mind. He is honest and direct and caring and conscientious. I might not always say it, but I appreciate how he has kept me informed to an ever changing health care environment. As a CPA, I have never hesitated to refer my clients to him. I know he will give my clients the same personalized service that I give my clients. My clients thank me for referring Dennis and were glad he was able to help them through some very difficult situations. Even if he was unable to help my clients, he has always been available for consulting and assisting in making a decision. Whether the situation was dealing with the “normal” day to day health care needs or something more complicated like medicare, he has always been aware of and has the knowledge of the various plans in the market place. Dennis also sells business insurance and long-term care insurance. I would expect that he gives nothing less than his utmost professionalism to these sales and services as well. I never hesitate to refer Dennis. He will always be available to assist his clients in what ever manner is necessary. The client comes first..

I was recommended to speak to Dennis by my general doctor. He has been incredibly helpful in finding me the best insurance policies for my specific needs. He’s easy to reach, extremely knowledgeable, and honest. I expect to work with him for many years to come!

Dennis David is everything you would want in an insurance agent. He is knowledgeable, efficient, honest, and caring. He has worked with us through some very demanding insurance needs. Mr. David met with all of our employees individually and identified their personal budget and issues with which they could benefit the most. He took the time to research and present comprehensive plans to the administration and employees. In the end, everyone felt satisfied and had obtained the coverage which was best for them , within the appropriate budget. For me personally, he helped us find an insurance that would cover our daughter’s medication needs. I was so impressed with the attention he paid to us so that we could have a positive outcome. I have recommended him to family and friends. I highly recommend this agency to everyone.

I have been working with Dennis for the last 14 years! He is incredibly knowledgeable, patient and helpful. He always calls me right back when I leave a message, takes time to answer all of my questions, and never makes me feel rushed to make a decision. I have recommended him to other people and would highly recommend him if you are looking for someone to help you thru all the craziness of health insurance.

Dennis is extremely knowledgeable, patient and straightforward. Most importantly, he really seems to care about his clients. He has been incredibly helpful to us in navigating through the otherwise completely anxiety provoking labyrinth of selecting insurance. In fact, he seems to care more about providing a service than making a sale. I recommend him as highly as possible

Dennis is a great listener, does what is helpful to me and my friends whom I have sent to him, and in general is a fantastic resource in this space of insurance. He knows the business, what needs to be considered and guides me through it with patience and caring. Thank you Dennis!

I’ve gone through several rounds of health insurance reviews with Dennis David for our family plan and am so appreciative of how thorough he is! He is incredibly patient and explains all of the small details, and there are many these days! I would highly recommend Dennis to anyone who would like to better understand all healthcare options in this rapidly changing insurance environment.

Dennis could not have been more helpful when we spoke on the phone regarding my need for medical insurance. He was patient and explained everything very clearly, answering all my questions thoroughly and patiently. He even offered advice above and beyond what I asked him and it was very much appreciated. Highly recommend him.

Dennis David has helped me navigate through the complex, changing web of health insurance plans for many, many years. His dedicated support and patience goes far beyond the call of duty and I can always count on David for wise and excellent advice. He sincerely cares about his clients and works tirelessly to come up with the very best health insurance plan to suit their needs. I can’t recommend him highly enough.

The Dennis David Insurance Agency came highly recommended through a good friend of mine several years ago. He and his wife have relied on Dennis David for years for their insurance needs. Dennis has a gift for simplifying what could potentially be a complex process for his clients. His follow-up is timely, clear and concise. Dennis David’s Agency provides outstanding service with an integrity and excellence I know I can count on!

Dennis David has handled my family’s insurance needs for over 20 years. He is knowledgeable, thorough, and absolutely trustworthy. I consider myself very lucky to have him in my corner.

We have been Mr. David’s customer for several years now. Dennis has been very responsive and attentive to our practices needs. He initially reviewed our small business insurance coverage and found some holes in our coverage and was able to provide us the right coverage at a lower price than what we were paying. He subsequently has been monitoring our practice insurance policies and has made the appropriate changes as needed. Dennis is extremely knowledgeable, his follow-up, advice and expertise is above standard and I would definitely recommend him.

..to answer all of my questions and help me to navigate on the huge ‘ocean’ of heath insurance options, specifications, etc. He is extremely knowledgeable and looks out for MY best interest. I can’t say enough about what a gem he is!

Dennis has worked with my family and me for thirty years through various changes in our health insurance needs beginning when we were a young family and going through our going on Medicare. In all cases he was reliable, available, professional, and caring of our needs, whether or not his recommendations resulted in a premium for him. There were times when he recommended products where he was not in a position to make a fee because he felt the product was best for us. I always knew I could count on on him for insurance advice, and I have referred him many friends and family. He gets my highest rating.

We have found Dennis David to be an excellent broker and extremely helpful and knowledgeable. We have always referred him to our friends and clients and always with total satisfaction! A very honest and trustworthy individual.

Dennis is an excellent insurance agent. He helped us navigate all the changes that we faced during implementation of the Affordable Care Act and found the best medical and dental insurance policies for our family. He is honest, professional, well connected in the industry, and has a sophisticated understanding of its complexities. He has the ability to present complicated choices in more simple form and can answer all the tough questions facing consumers. Our family is very grateful for his guidance!

i have been with dennis for many years and he always responds quickly to any questions i have. i would highly recommend him to take care of any insurance issues you may have.

We’ve been working with Dennis for many years and he has guided us through the labyrinth of health insurance plans for ourselves and our employees. He explains things in understandable terms, is incredibly patient, reliable and we feel he always has our best interest in mind. We can’t recommend Dennis’s services highly enough.

We always know when we have any and all questions about our insurance that Dennis David is always there to help us with the best choices and decisions for our family. So nice to know Dennis is always there for us.

I have been a client for over 20 years and there has not been a time when I asked a question that Dennis has not been helpful. Dennis makes you feel that you are his most important client. He is very knowledgeable about the insurance industries.

Thank you for being so patient and explaining everything to me so thoroughly! I was so overwhelmed and you made it all so clear!

Dennis took so much time with me and my family to find the right Insurance plan for us. We have switched plans many times for various reasons and he was always so knowledgeable, patient, creative and helpful. He listened and understood our unique needs and came up with many choices for us and went through the pros and cons of each option. He knows the business so well and really has such a gentle way of dealing with people that it made it so easy to reach out and ask questions. I have recommended him to many of my friends and feel confident that anyone who works with him will be extremely satisfied.

I would have been lost without Dennis David’s help. He made sure I found a reliable health insurance provider. Strongly recommend!

I can’t say enough great things about Dennis and his expertise. He has a plethora of knowledge in this industry and with the most complicated and confusing changes within the health insurance world, it’s nice to know he keeps up with this information. I always feel reassured when I deal with him and I know he places my family and I in the best plans in a customized fashion. We are blessed to know him and call him our insurance agent! He knows his stuff so you don’t have to! That makes my life easier for me, and I’m deeply grateful.

Dennis is a true professional. I highly recommend using Dennis. He is easily accessible and very knowledgable. He helped guide us into the right health insurance for my entire family and helped me get a refund from another insurance company that owed us money. Thanks again Dennis!

I have been with Dennis for years. His service is second to none. I always get well informed and detailed information on how to make the best decisions for insurance that is cost effective for the coverage I need. He is available when I have questions and gives updates about changes in insurance programs. Nice to have an agent that keeps me current. I highly recommend Dennis.

Dennis David has helped me enroll employees in health insurance plans, has walked me through Affordable Care, and just recently held my (electronic) hand as I waded through the medicare system and enrolled in supplementary insurance. He is thoughtful, he makes sure I understand what I’m doing, he keeps me updated on changes. I absolutely trust him and I would — and have — recommend him to my friends.

Dennis advised us of our options and carefully explained the pros and cons of the different choices. We have excellent personal health insurance coverage and have been able to maintain the same policy for years. We were so pleased that we asked him to find insurance for my company. He looks at different options and price compares for us every year. We made the right decision in choosing Dennis!

Dennis is amazing! He is very knowledgeable and always up to date on the healthcare industry. He’s helped me in so many ways. I always check with him, first, before I make any decision on health insurance!

I have known Dennis for over 30 years, we met while colleagues in an Insurance Firm, and have remained steadfast friends ever since. Dennis’s work ethics have never changed, honest, truthful, responsible and accountable. He takes care of his clients, understanding their needs, always offering guidance with such kindness, which in today’s marketplace, is not easy to find. When my time came for a Long Term Health Policy, Dennis gave me options, explaining the differences in coverages and costs. A financial planner recently took a look at my policy and was so impressed with its detail, thank you Dennis. When time came for retirement and entering the Medicare world, Dennis was so very thorough in every aspect of all the Plans. I felt very taken care of and secure, thank you Dennis The insurance world is very lucky to have Dennis David with his expertise and caring ways, he will not disappoint.

Dennis David has been my insurance agent for many years. He is very helpful and knows his stuff. He is always well prepared when it comes time for me to make insurance decisions and he offers me different choices, so I can make informed decisions. I highly recommend Denis David for all insurance needs.

I found my experience with Mr. David to be an example of true expertise. He was patient and really listened to my concerns and got right to the heart of what I needed for my family. His efficient communication really assisted me in trusting the whole insurance process and made it simple not complicated. All of my questions were answered swiftly and I knew that I was in good hands, thank you again!

I have used Dennis David’s services for over 20 years and been extraordinarily satisfied with EVERYTHING! Not once has he disappointed me or not been able to help me with questions or issues. I have recommended him to all of my friends, most of them self-employed over this time period and they are all still with him. Dennis is not only proficient in his profession but he is really kind and compassionate. There is nothing at all that I have been reticent to tell him.

Dennis is very attentive and knowledgable. We have done business with him for many years and he always gets back to us in a timely and efficient manner. I am very happy we found someone we can trust and work with!

 

I had the great good fortune of working with Mr. David, just this past year. During the most confusing and high pressure time the Affordable Care Act proposed. He not only was he exceedingly professional, knowledgeable he made the process smooth and very comprehensible for a novice like me. With his guidance I feel confident that I choose the best health care plan for my budget and my needs. I have used it twice now with no surprises. I would highly recommend Mr. David’s services to anyone; businesses and individuals a like, he is very approachable, quick to respond and has many avenues of access one of which is his website.

I have bought insurance from Dennis – Health, Life and Liability – over 20 years. Insurance can be complex and Dennis is always able to explain what is important and he is able to help me make the right decision. I value his advice and look forward to continuing to do business with the Dennis David Agency

We are using Dennis for closee to 20 years. We admire his knowledge, and his devvotion to his customers. Dnnis is always there when you need him, is esponsee time is fantastic. His proffeesionlism is a 10.

Dennis is the most professional and knowledgable insurance broker I have ever known. He makes it a point to stay informed with the latest changes in the industry that effects me. He is exceptional in staying in good contact with me. His very high ethical standards are apparent at all times.

I have been very happy dealing with insurance companies because I have Dennis David to help me. I have had an awesome experience with Dennis L. David insurance company. Every time there is an issue or a billing error, they instantly attend to it and take care of it for me. I would recommend this company to everybody.

I have worked with Dennis for many years and as an Insurance Broker his knowledge and service is second to none! He provides his clients with competitive products to meet all of their insurance needs. For Dennis, helping clients is his priority!

I have worked with Dennis David for over 15 years. He always takes care of me and my needs. Now he also takes care of members of my family. Dennis has been especially wonderful during the changes in our healthcare system. I mean, who can figure it out? I am grateful to have him to explain it all. I am well taken care of.

I have worked with a number of insurance agents through the years, but without a doubt, this agency has been by far the best. Dennis David, in particular, is exceptional in his knowledge and expertise, and when he doesn’t know the answer, he researches it and in a timely manner reconnects with you. There is a true conscientiousness and concern for the client. As for me, with the dramatic and sweeping changes that occurred in health insurance, I felt very unclear as to what direction I should take. He was able to significantly help me sort through the morass of choices, and help land an insurance plan that was the best fit for me. I very much appreciated his guidance and I learned later that his suggestions were offered irrespective of the commission he could potentially receive. I highly recommend this agency.

Health insurance concerns can be difficult to navigate at times. Whenever I call Dennis he has always created time to patiently explain all aspects of my insurance plan. He collects all the information and addresses the pros and cons to answer my specific questions which I truly appreciate! He is wonderful to work with and I highly recommend him!

I have known Dennis David for many years and he is the most professional and honest insurance agent. I highly recommend his services for all of your insurance needs.

“Dennis has worked with my family for years. He’s consistent and reliable along with being very nice and easy to work with! Insurance can be complicated and costly, it’s of so much value have someone like Dennis on your side during the process. I would recommend him time and time again! I’m grateful to have him on my team. I always feel like my needs are met and that I’ve accomplished what I wanted after our phone meetings. He’s also great on email which is a plus for me!”

– Lucy F.
“Dennis is very knowledgeable, friendly and helpful when it comes to sorting through the confusing world of insurance. I highly recommendation Dennis.”
Hi Dennis, I wanted to let you know that of May 1, 2016  I need to cancel our insurance with Anthem Blue Cross. I would like to thank you again for all your help at a time we had no idea what we were going to do. You walked us through every option and helped us make the best choice and decision for our family. I don’t know what we would have done with out you. Thank you again for always being there to help with our many questions.
Thank you so much Dennis for your dedication in helping us.

Insurance premiums spark new front in Obamacare war

In this the second year of implementation of the Affordable Care Act, premiums have not stabilized but it is probably an unreasonable expectation of the giant upheaval in a the health insurance system. The coming years will be the litmus test, hopefully the trend of large rate increases will turn around.

Below is an article from the Washington Examiner, date July 6, 2015.

Republicans target big increases as evidence that healthcare law isn’t working

Insurance premiums have quickly become a new front in the Obamacare fight, with opponents pouncing on big increases and supporters and experts countering the increases won’t be so bad.

The fight started last month when insurers were required to disclose estimated 2016 rates of 10 percent or more for Obamacare customers. Some figures grabbed headlines, especially with certain insurers calling for 50 to 70 percent increases.

The premium spikes vary by state and insurer. For instance, some plans in Florida are actually proposing reduced premiums, but 13 plans want rate increases of 10 percent or more, including Time Insurance Co.’s 63 percent hike.

Republicans say the higher rates are evidence that the law is hurting Americans and not lowering healthcare costs.

“The whole point of Obamacare was to make health care more affordable. But premiums aren’t going down; they’re going up — way up,” said Rep. Paul Ryan, R-Wis., chairman of the House Ways and Means Committee, in a recent hearing.

“The model we’re on in the Affordable Care Act is not sustainable,” said Rep. Mike Kelly, R-Pa., at the same hearing.

This is the first time since Obamacare’s passage that insurers can look at a full year’s worth of claims data and calculate premiums, Rep. Pete Roskam, R-Ill., said at the hearing. He added that the premium spikes are not growing pains.

“The law created a number of temporary programs to pay out billions in taxpayer funds during the first few years to lower costs seen by individuals and to protect big insurance companies against financial losses,” he said. “But those programs are beginning to phase out, and as the government is slowly taking off the training wheels, Obamacare is looking pretty wobbly.”

Supporters counter that any increases aren’t finalized and will have a modest impact overall.

“We have just the bad news,” said Kathy Hempstead, who directs coverage issues for the Robert Wood Johnson Foundation.

One analysis found that Obamacare customers as a whole may only see a modest increase.

The research firm Avalere looked at proposed rate filings in seven states and the District of Columbia. The average premiums for silver plans, the second cheapest option and a popular choice for Obamacare enrollees, will increase nearly 6 percent, Avalere said.

Avalere also noted that the low-cost silver plan options are likely to be smaller than the silver plan as a whole. Premiums for the lowest- and second-lowest silver plans in the seven states and D.C. will increase on average 4.5 percent and 1 percent.

A separate analysis from the nonpartisan Kaiser Family Foundation found that in 11 major cities the cost of a regular silver plan would be on average 4.4 percent higher in 2016 than this year.

Premiums must be finalized by October. That way customers facing a high premium can choose a different plan during the next open enrollment this fall.

Another reason why the rates could change is states need to conduct reviews themselves.

Obamacare requires states to report on any premium increase trends and recommend whether certain plans should be excluded from the exchanges, according to the National Conference on State Legislatures.

In 2011, the federal government started to work with states to strengthen or alter their rate review programs. If a state doesn’t have the resources to conduct the required review, the Department of Health and Human Services will do it, the National Conference on State Legislatures said.

“The carriers really have to be able to explain their rates, and that is part of the point of the whole medical loss-ratio regulations,” Hempstead said.

The medical loss ratio is another new regulation installed under Obamacare. It requires insurers to devote 85 percent of the cost of a premium on medical care and the other 15 percent on administrative costs.

The ratio ensures that insurers don’t devote too much of their costs to overhead.

Amid the rhetoric over the premium increases are certain trends that could affect the insurance market as a whole.

Many Blue Cross Blue Shield insurers kept premiums in marketplaces comparatively low with small increases from year to year, but that varies considerably across the country, according to a study of trends for market place plans done by the foundation and the left-leaning think tank Urban Institute.

The report looked at the cheapest silver plans in 30 states. Some insurance companies were reluctant to enter the Obamacare marketplaces in 2014 and when they did the plans were more expensive.

However, the report projects insurers will lower premiums to keep prices low to attract enough customers buying insurance through the Obamacare marketplaces.

But for opponents of Obamacare, the proposed increases represent a long-standing criticism about the law’s ability to battle healthcare costs, which was levied even before the exchanges opened in 2014.

Marriage Equality Means Changes for Health Insurance
Last Friday’s Supreme Court decision overturning state bans on same-sex marriage will have implications for the employer-based benefits system. The 5-4 decision in Obergefell v. Hodges determined that marriage, regardless of sexual orientation, is a fundamental right under the Constitution’s Equal Protection Clause and states do not have a right to deny marriage to same-sex unions. Prior to the decision, same-sex marriage had been legalized in 37 states.

We know that this ruling evokes strong feels among many on both sides of the argument but, for NAHU and health insurance agents and brokers, the most important thing about the ruling is that now there will be standardization across the country for how employers treat employees for spousal benefits. Previously, employers had to navigate a messy patchwork of laws across states to determine whether benefits would need to be extended to same-sex spouses. Last week’s ruling, effective immediately, will help to clear up some of the confusion for employers uncertain of whether they legally need to offer coverage to same-sex spouses. It will also help to clear up confusing plan administration for some domestic partnership couples who could now become legal spouses.

Kaiser Family Foundation survey last year found that while nearly all employers offered coverage to spouses, only half allowed same-sex partners to claim insurance benefits if they weren’t legally married. The ruling may lead to some employers dropping coverage for domestic partnerships and instead only offering to legally wed spouses. Prior to the ruling, Verizon, Delta and IBM, among other companies, had rescinded coverage to domestic partners who lived in states with legal same-sex marriage.

The ruling will be applied differently for fully insured plans and self-insured plans. Any fully insured plan will be required to extend coverage to spouses regardless if they are same-sex. However, self-insured plans have more discretion, as there is no legal requirement that a self-insured plan include a same-sex spouse. Companies with religious objections to extending benefits to same-sex spouses could theoretically self-insure to avoid offering coverage, but legal scholars warn that companies may open themselves up to discrimination lawsuits in the future should they decide not to offer benefits to same-sex spouses. A patchwork of different state laws relating to non-discrimination of benefits may further complicate this.

The Supreme Court ruling will also force changes for Medicaid and the health insurance marketplaces. The 2013 ruling that struck down the Defense of Marriage Act led CMS to encourage states to recognize same-sex marriages performed in another state when the state the couple resides does not recognize same-sex marriage, leading to a gray area in how benefits would be applied. The ruling last week will require all states’ Medicaid programs to recognize all legally wed spouses. The ruling will also impact same-sex households applying for tax credits on the exchanges, where they may previously have been treated as individuals but can now apply as a married couple.

http://dennisdavidhealthplans.com/377/

Centene to Combine with Health Net in Transaction Valued at Approximately $6.8 Billion

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Investor Relations – News Release

The article below has been copied from the St. Louis and Los Angeles Business Wire Dated July 2, 2015

Centene to Combine with Health Net in Transaction Valued at Approximately $6.8 Billion

Creates Leading Platform for Government-Sponsored Programs and One of the Largest Medicaid Managed Care Organizations in the Country

Broadens Presence to Build Scale and Drive Diversification

Transaction Expected to be Significantly Accretive to Centene’s EPS in the First Year Following Close

Estimated to Achieve up to Approximately $150 Million in Annual Synergies by the Second Year Following Close

Companies to Host Conference Call at 8:30 AM ET

ST. LOUIS & LOS ANGELES–(BUSINESS WIRE)–Jul. 2, 2015– Centene Corporation (NYSE: CNC) and Health Net, Inc. (NYSE: HNT) announced that the Boards of Directors of both companies have unanimously approved a definitive agreement under which Centene will acquire all of the shares of Health Net in a cash and stock transaction valued at approximately $6.8 billion, including the assumption of approximately $500 million of debt.

The combination of Centene and Health Net would create a leading diversified multi-national healthcare enterprise with more than ten million members across the country and estimated 2015 pro forma premium and service revenues of approximately $37 billion. Centene is expected to continue to deliver attractive growth by offering a more comprehensive and scalable portfolio of innovative solutions focusing on uninsured and under-insured individuals, including participation in Medicare Advantage, TRICARE, and Veterans Affairs programs. The companies believe that the addition of Health Net’s high-qualityMedicare platform to Centene’s Medicaid programs provides an opportunity for additional growth across the combined company’s markets. Health Net’s demonstrated commitment to risk-based provider arrangements is reflective of the market shift from volume to value and is anticipated to enhance Centene’s leading position in high quality, low cost access to government-sponsored programs. With increased scale and diversification, Centene expects to deploy its full portfolio of specialty services and provide an integrated offering that benefits its members, providers and other stakeholders.

Under the terms of the agreement, Health Net shareholders would receive 0.622 shares of Centene common stock and $28.25 in cash for each share ofHealth Net common stock. Based on Centene’s closing stock price on July 1, 2015, the implied consideration of $78.57 per share represents a premium of approximately 21% over Health Net’s closing stock price on July 1, 2015, and of approximately 26% on June 1, 2015. Upon completion of the transaction,Centene shareholders would own approximately 71% of the combined entity, with Health Net shareholders owning approximately 29%. The transaction is expected to be significantly accretive to Centene’s diluted earnings per share in the first year following closing.

“We are pleased to have reached this agreement with Health Net, which we believe will create value for both Centene and Health Net shareholders and will enhance our ability to serve our members and work with our providers and government partners,” said Michael F. Neidorff, Centene’s Chairman, President and Chief Executive Officer. “Over the past five years, Centene has achieved record performance and today’s announcement is a significant next step in our strategy to increase scale and drive geographic and product diversification. This transaction ensures that we extend our competitive position as one of the largest plans covering government-sponsored programs in the country. Health Net’s presence in California and other key western states is complementary to our offerings, allowing us to bring additional innovative solutions to the healthcare market. With Health Net, we see opportunities to leverage our local approach more broadly to enhance our members’ access to higher quality healthcare services on a cost-effective basis and ensure measurable quality outcomes.”

Mr. Neidorff continued, “We have tremendous respect for Health Net’s management team and employees, and for all that they have accomplished. Given our scalable model and record of successfully integrating acquisitions, we expect to achieve a smooth transition. Together, we will build on both companies’ shared commitment to working with providers and key community stakeholders to achieve better results for members and drive shareholder value.”

Jay Gellert, Health Net’s President and Chief Executive Officer, said, “Centene has an impressive record of serving populations that have been traditionally underserved in a high-quality and consumer-centered manner. Our successes complement Centene very well and will lead to better offerings in line with new consumer and payer demands. After closing, we will be a leading provider of managed health care services very much aligned with the future. We expect thatHealth Net associates will play a critical role in the future of the combined company.”

Strategic and Financial Benefits of the Transaction

  • Addition of Incremental Scale: The addition of Health Net’s complementary network is expected to strengthen Centene’s presence in the California Medicaid program, which is the country’s largest with more than 12 million individuals. The transaction will provide Centene with access to California’s dual demonstration program and expansion in other Medicaid and Medicare programs in the Western United States, including Arizona, Oregon andWashington. The combined company expects to have approximately six million Medicaid members, making it one of the largest Medicaid managed care organizations in the country. The combined company anticipates driving profitable growth by leveraging Centene’s local approach that provides members access to high quality and culturally sensitive health care services.
  • Increased Product Diversity Provides Ability to Create a More Comprehensive Portfolio: This transaction would extend Centene’s offerings in government programs including Medicare, TRICARE, and U.S. Department of Veterans Affairs. The combined company would be positioned to provide its members access to more solutions, with opportunities for integrated specialty services across the entire enterprise. In particular, the combined company believes that Health Net’s high quality Medicare platform, including its presence in Medicare Advantage, has the potential to be applied across the combined business thereby enhancing the growth strategy. Centene also believes there are opportunities to scale Health Net’s programs that reach underserved communities and extend its business lines for this constituency. Both companies have demonstrated success focusing on the subsidized portion of the Health Insurance Marketplace. The companies believe that by focusing on these government programs, the combined company will enhance its innovative provider relationships that enable it to deliver affordable, accessible healthcare.
  • Strong Financial Profile and Significant Earnings Accretion: Combined, Centene and Health Net are estimated to have 2015 pro forma annual premium and service revenues of approximately $37 billion. The transaction is expected to generate diluted earnings per share accretion of 10% and adjusted diluted earnings per share accretion of 20% in the first year following closing.
  • Significant Synergy Opportunities: The combined company is estimated to achieve approximately $150 million of annual cost synergies by the second year following close with 50% achieved after year one following close. Synergies will come from areas including efficiencies in core G&A, integration of a range of specialty services and leveraging capabilities in IT systems and process management.

Organization and Management

Upon closing of the transaction, Mr. Neidorff will lead the combined company as Chairman, President and Chief Executive Officer. Mr. Gellert will assist to achieve a smooth transition. The combined company will be headquartered in St. Louis, Mo, the location of Centene’s current headquarters, with operations throughout the country.

Financing and Approvals

Centene intends to fund the cash portion of the acquisition through a combination of existing cash on hand and debt financing. The transaction is not contingent upon financing, with Wells Fargo, N.A. providing $2.7 billion of financing commitment.

The transaction is expected to close by early 2016. It is subject to approval by Centene and Health Net shareholders, the expiration or termination of the applicable waiting periods under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, approvals by relevant state insurance and healthcare regulators and other customary closing conditions.

Advisors

Allen & Company LLC and Evercore are serving as financial advisors to Centene, with Skadden, Arps, Slate, Meagher & Flom LLP serving as legal counsel. J.P. Morgan Securities Inc. LLC is serving as financial advisor to Health Net with Morgan, Lewis & Bockius LLP serving as legal counsel.

Conference Call

Centene and Health Net will host a conference call today, July 2, 2015, at 8:30 a.m. (Eastern Time) and will simultaneously broadcast it live over the Internet. The conference call can be accessed by dialing (866) 610-1072(866) 610-1072 FREE (domestic) or (973) 935-2840(973) 935-2840 (international). An investor presentation, to be reviewed during the conference call, can be accessed via each company’s investor relations website at www.centene.com/investors orwww.healthnet.com/InvestorRelations. A telephonic replay of the conference call will be available immediately after the call and can be accessed by dialing (800) 585-8367(800) 585-8367 FREE, or for international callers, (404) 537-3406(404) 537-3406. The passcode for the live call and the replay is 77042984. The archive of the call replay will be available until July 16, 2015. The live webcast and archived replay can be accessed on both companies’ investor relations websites. The online archive of the webcast will be available until July 2 of 2016.

About Centene

Centene Corporation, a Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government-sponsored healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs and Medicare (Special Needs Plans). The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.

About Health Net

Health Net, Inc. (NYSE:HNT) is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net provides and administers health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as “Part D”), Medicaid, dual eligible, U.S. Department of Defense, including TRICARE, and U.S. Department of Veterans Affairsprograms. Health Net also offers behavioral health, substance abuse and employee assistance programs, and managed health care products related to prescription drugs.

For more information on Health Net, Inc., please visit Health Net’s website at www.healthnet.com.

Forward Looking Statements

This press release contains certain forward-looking statements with respect to the financial condition, results of operations and business of Centene, Health Net and the combined businesses of Centene and Health Net and certain plans and objectives of Centene and Health Net with respect thereto, including the expected benefits of the proposed merger. These forward-looking statements can be identified by the fact that they do not relate only to historical or current facts. Forward-looking statements often use words such as “anticipate,” “target,” “expect,” “estimate,” “intend,” “plan,” “goal,” “believe,” “hope,” “aim,” “continue,” “will,” “may,” “would,” “could” or “should” or other words of similar meaning or the negative thereof. There are several factors which could cause actual plans and results to differ materially from those expressed or implied in forward-looking statements. Such factors include, but are not limited to, the expected closing date of the transaction; the possibility that the expected synergies and value creation from the proposed merger will not be realized, or will not be realized within the expected time period; the risk that the businesses will not be integrated successfully; disruption from the merger making it more difficult to maintain business and operational relationships; the risk that unexpected costs will be incurred; changes in economic conditions, political conditions, changes in federal or state laws or regulations, including the Patient Protection and Affordable Care Act and the Health Care Education Affordability Reconciliation Act and any regulations enacted thereunder, provider and state contract changes, the outcome of pending legal or regulatory proceedings, reduction in provider payments by governmental payors, the expiration of Centene’s or Health Net’s Medicare or Medicaid managed care contracts by federal or state governments and tax matters; the possibility that the merger does not close, including, but not limited to, due to the failure to satisfy the closing conditions, including the receipt of approval of both Centene’s stockholders and Health Net’s stockholders; the risk that financing for the transaction may not be available on favorable terms; and risks and uncertainties discussed in the reports that Centene and Health Net have filed with the Securities and Exchange Commission (the “SEC”). These forward-looking statements reflect Centene’s and Health Net’s current views with respect to future events and are based on numerous assumptions and assessments made by Centene and Health Net in light of their experience and perception of historical trends, current conditions, business strategies, operating environments, future developments and other factors they believe appropriate. By their nature, forward-looking statements involve known and unknown risks and uncertainties because they relate to events and depend on circumstances that will occur in the future. The factors described in the context of such forward-looking statements in this announcement could cause Centene’s and Health Net’s plans with respect to the proposed merger, actual results, performance or achievements, industry results and developments to differ materially from those expressed in or implied by such forward-looking statements. Although it is believed that the expectations reflected in such forward-looking statements are reasonable, no assurance can be given that such expectations will prove to have been correct and persons reading this announcement are therefore cautioned not to place undue reliance on these forward-looking statements which speak only as of the date of this announcement. Neither Centene nor Health Net assumes any obligation to update the information contained in this announcement (whether as a result of new information, future events or otherwise), except as required by applicable law. A further list and description of risks and uncertainties can be found in Centene’s Annual Report on Form 10-K for the fiscal year endedDecember 31, 2014 and in its reports on Form 10-Q and Form 8-K as well as in Health Net’s Annual Report on Form 10-K for the fiscal year ended December 31, 2014 and in its reports on Form 10-Q and Form 8-K.

Additional Information and Where to Find It

The proposed merger transaction involving Centene and Health Net will be submitted to the respective stockholders of Centene and Health Net for their consideration. In connection with the proposed merger, Centene will prepare a registration statement on Form S-4 that will include a joint proxy statement/prospectus for the stockholders of Centene and Health Net to be filed with the SEC, and each will mail the joint proxy statement/prospectus to their respective stockholders and file other documents regarding the proposed transaction with the SEC. Centene and Health Net urge investors and stockholders to read the joint proxy statement/prospectus when it becomes available, as well as other documents filed with the SEC, because they will contain important information. Investors and security holders will be able to receive the registration statement containing the joint proxy statement/prospectus and other documents free of charge at the SEC’s web site, http://www.sec.gov. These documents can also be obtained (when they are available) free of charge from Centene upon written request to the Investor Relations Department, Centene Plaza 7700 Forsyth Blvd. St. Louis, MO63105, (314) 725-4477 or from Centene’s website, http://www.centene.com/investors/, or from Health Net upon written request to the Investor Relations Department, Health Net, Inc. 21650 Oxnard Street Woodland Hills, CA 91367, (800) 291-6911(800) 291-6911 FREE, or from Health Net’s website,www.healthnet.com/InvestorRelations.

Participants in Solicitation

Centene, Health Net and their respective directors and executive officers and other members of management and employees may be deemed to be participants in the solicitation of proxies from the respective stockholders of Centene and Health Net in favor of the merger. Information regarding the persons who may, under the rules of the SEC, be deemed participants in the solicitation of the respective stockholders of Centene and Health Net in connection with the proposed merger will be set forth in the joint proxy statement/prospectus when it is filed with the SEC. You can find information about Centene’s executive officers and directors in its definitive proxy statement for its 2015 Annual Meeting of Stockholders, which was filed with the SEC onMarch 16, 2015. You can find information about Health Net’s executive officers and directors in its definitive proxy statement for its 2015 Annual Meeting of Stockholders, which was filed with the SEC on March 26, 2015. You can obtain free copies of these documents from Centene and Health Net using the contact information above.

No Offer or Solicitation

This communication shall not constitute an offer to sell or the solicitation of an offer to sell or the solicitation of an offer to buy any securities, nor shall there be any sale of securities in any jurisdiction in which such offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such jurisdiction. No offer of securities shall be made except by means of a prospectus meeting the requirements of Section 10 of the Securities Act of 1933, as amended, and otherwise in accordance with applicable law.

 

View source version on businesswire.com: http://www.businesswire.com/news/home/20150702005239/en/

Source: Health Net, Inc.

For Centene
Investors
Edmund Kroll, 212-759-0382212-759-0382
or
Media
Marcela Manjarrez-Williams, 314-505-6502314-505-6502
or
For Health Net
Investors
Peter O’Neill, 818-676-8692818-676-8692
or
Media
Brad Kieffer, 818-676-6833818-676-6833

 

 

“Safe Harbor” Statement under the Private Securities Litigation Reform Act of 1995: Statements in this press release regarding Health Net, Inc.’s business which are not historical facts are “forward-looking statements” that involve risks and uncertainties. For a discussion of such risks and uncertainties, which could cause actual results to differ from those contained in the forward-looking statements, see “Risk Factors” in the Company’s Annual Report or Form 10-K for the most recently ended fiscal year.

 

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The Dennis L. David Insurance Agency | Long Term Care Insurance, Los Angeles Medical Insurance, Anthem Blue Cross Healthcare Insurance, Whole & Term Life Insurance Policies, Cigna, Disability Insurance, Blue Shield of CA, Group Health Plans, Aetna, Group Medical Insurance, Skilled Nursing Insurance, Medicare Supplement Insurance, Medicare Part D Prescription Drug Plans, In-Home Care, Disabled Work Insurance, Disability Benefits, Culver City Health & Life Insurance, Family & Individual Health Insurance, Health Care Reform & Affordable Care Act Assistance, Obamacare, Covered CA Health Insurance, Health Plans, Kaiser Insurance, Genworth Life, John Hancock Life, Culver City Long Term Care & Disability, Employee Benefits, Beverly Hills, Hollywood, West Hollywood, Santa Monica, Pacific Palisades, Marina Del Rey, West Los Angeles, Los Angeles, El Segundo, Sherman Oaks, Encino, Los Angeles, Manhattan Beach, Los Angeles County CA, California

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