Costs that Affect You

Should smokers pay more for health insurance?

The issue was one of several that California lawmakers considered this week as they sent Gov. Jerry Brown bills that carry out the federal health care overhaul by 2014.

Health organizations successfully won provisions that prohibit insurers from charging tobacco users higher premiums on the individual market.

WASHINGTON – At least 90% of more than $200 million in “questionable billing” issues found at Medicare outpatient community mental health centers occurred in states with little or no oversight, according to a federal report to be released today [August 21, 2012].

“This creates a vulnerability whereby dishonest individuals have an opportunity to establish (the centers) and improperly bill Medicare,” according to the report from Medicare’s inspector general.

A pregnant woman in San Mateo could take a limo to Fresno for her hospital delivery and still save money, a new study on California hospital prices suggests.

The typical patient in the San Mateo area was charged nearly $48,000 for a Cesarean birth in 2010 while the average charge in Fresno was less than $13,000, according to a report published Thursday by the California Public Interest Research Group’s Education Fund, a nonprofit consumer advocacy organization.

Democratic lawmakers portrayed a shift of 880,000 children from Healthy Families to Medi-Cal as a way to help bridge the state’s $15.7 billion deficit, but opponents say there is good reason to think the change could actually cost the state more money.

Gov. Jerry Brown’s administration is counting on $13 million in general fund savings in 2012-13 because only a partial shift will occur in the fiscal year – and only in the second half of the year. At full implementation, the state would save $73 million in 2014-15.

SAN DIEGO — As part of President Obama’s 2013 budget, the Department of Defense proposed raising annual enrollment fees and prescription drug cost-sharing for TRICARE, the health care program for active military members, retirees their families and survivors.

The proposed additional fees amount to a $13 billion shift from the Pentagon to TRICARE beneficiaries over a period of five years.

TRICARE serves 9.6 million eligible active and retired military personnel and their families. Approximately 650,000 of those beneficiaries are based in California. More than 300,000 live in the San Diego region.

Some California health insurers are proposing to raise small-business rates more than 10% next month, drawing scrutiny from state regulators.

Aetna Inc., which drew the ire of state insurance officials for a rate hike earlier this year, wants to increase premiums 10% on average, and as high as 24% for some employers. Anthem Blue Cross, the state’s largest for-profit insurer and a unit of WellPoint Inc., has proposed boosting rates 13%. Blue Shield of California is looking to charge some small employers up to 6% more.

Kaiser Permanente must provide medically necessary physical, occupational and speech therapy to members denied treatment since January 2009 — and reimburse those who paid for the services themselves — according to a settlement with state managed-care regulators.

Announced Friday [May 25, 2012, the settlement gives Kaiser 60 days to contact members who have filed complaints about denial of this kind of care since that date. The California Department of Managed Health Care received about 100 complaints, but there may be more members eligible for treatment and payment, state officials said.

The Department of Agriculture released a report last week comparing the costs of healthy versus unhealthy foods, estimating the cost of more than 4,000 food items by price per 1) calorie, 2) edible gram (weight), and 3) portion size. Under the latter two comparisons, healthy foods were less expensive than unhealthy foods. As one example, carrots and bananas were less expensive under the portion size standard than ice cream and French fries, while grains such as oatmeal and rice were the least expensive food category across the board.

A new study could pose a challenge to the basic premise of President Barack Obama’s approach to controlling health costs — that spending will come down if doctors don’t give patients as much unnecessary medical care.

The study from the Health Care Cost Institute found that costs rose 3.3 percent in 2010 even though people actually used fewer services in many categories. Spending grew not because there were a lot of unnecessary procedures and treatments but rather because the services themselves got more expensive.