Local residents, officials sound off about health insurance bill

Auburn doctor says patients need to think twice about expensive medicines, tests
By: Bridget Jones, Journal Staff Writer
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A proposed bill has local officials and residents speaking out about insurance rates and government control. Assembly Bill 52 was approved by the California Assembly and was being reviewed by the Senate Health Committee as of Thursday. The bill, written by Assemblyman Mike Feuer (D-Los Angeles), states that health care service plans or health insurers that issue individual or group contracts or policies have to file rate applications for proposed rates or rate changes with the Department of Insurance and Department of Managed Health Care on or after Jan. 1, 2012. The departments would then be able to reject any rate or rate changes found to be “excessive, inadequate or unfairly discriminatory.” Other parts of the bill include that rate applications would have to require certain information. The departments could also deny, change or modify any proposed rates or rate changes. The departments could review rates that went into effect Jan. 1, 2011 through Jan. 1, 2012 and refunds for policy holders could be ordered if necessary. Placer County hadn’t taken an official position on the bill as of Thursday. Supervisor Jim Holmes said although he hadn’t read the full text of the bill, he could see the bill possibly being a positive thing. “On the face of it … it sounds like it might be worth pursuing,” Holmes said. “Health insurance costs are sky rocketing. I know personally because we don’t get any health care insurance from the county, the supervisors don’t. There are probably some people opposed to that because now there is government interference in the free market, but a lot of families can’t afford that health insurance.” Dr. Mark Vaughan, of Auburn Medical Group on Professional Drive, said talk of high insurance rates is common in his office. “I’m always hearing about rates going up higher,” Vaughan said. “I’m experiencing it myself, rates going up higher, having to move to different plans.” Vaughan said AB 52 is not a good way to try to solve the healthcare problem in California, because insurance companies need to be able to charge certain amounts in order to deliver the care coverage that is asked of them. “What you typically see in the legislation is they write a bill that on the surface sounds good, but when you actually look into it and see what the impact is going to be on the state, it’s not going to solve the problem of affordable healthcare,” Vaughan said. “The problem needs to be solved another way. I think that we need to make some hard decisions about some things that just cost too much and aren’t essential.” Vaughan said insurance rates tend to go up as more expensive items are expected to be covered, including certain medications and diagnostic tests. Vaughan said an example is the comparison between the drugs Warfarin and Pradaxa. The two medications are anticoagulants and help prevent heart attack or stroke. Warfarin requires close monitoring and patients have to have monthly blood draws. Pradaxa does not require the tests. Vaughan said he has patients who have been on Warfarin for years and are doing fine. The cost of Warfarin is $10-$20, depending on the dose, for a 30 day supply. Pradaxa costs $12,000 a year, or about $1,000 a month. “There’s an example right there, that one single medicine $12,000 a year, that’s all that patient’s premium plus some other people’s, not paying for anything else in health care,” Vaughan said. “Pradaxa, $12,000 a year for a drug that does the job of a $10 a month drug, I wouldn’t give that to my own kid. So why do we think insurance companies should give that to somebody?” Vaughan said patients should also stop and think before getting expensive tests that won’t change their treatments. “People will ask for a particular test, and that test will cost $1,000 every time it’s done,” he said. “So, I ask them, ‘What are we going to do with the results? If it’s not going to make a difference in treatment why are we going to do it?’” Meadow Vista resident Jeff Maloney said he used to sell Blue Cross Insurance, and even as an agent the company raised his rates from $330 to $670 a month in a matter of a couple months. Maloney said health care is a battle of keeping both doctors and insurance companies happy and making money while providing patients with the care they need. Maloney said he thinks insurance companies capriciously raise rates without good reason, and regulation is good, but only when those politicians who are bringing it can be trusted and are not writing the legislation for ulterior reasons. “Am I in favor of regulation?” Maloney asked. “Sure. But it comes down to trust in that regulation. It is a complex problem. I don’t think any single bill is going to solve it.” Auburn resident Rosalie Wohlfromm said she thinks there is a good reason for AB 52. “I think if the insurance companies … weren’t so greedy, this bill wouldn’t have to come across,” Wohlfromm said. “I really don’t like regulations, I really, really don’t. But I think if the government doesn’t do something, who will? And that’s all we have got now. I remember when years ago they weren’t as greedy, they had a little bit of heart and now it seems like, ‘I want mine, the hell with you.’” Dayle Edgerton, a registered nurse and First Five Placer commission chair, said health care can be a big problem for some families, because they have other necessary costs, like paying their mortgages. “The current economic condition of our region and state has a significant impact on the ability to access medical services,” Edgerton said. “Some families must choose between providing other family essential needs such as housing, food or transportation, even with a dedicated medical insurance plan. The family may not have enough money to cover a co-pay. In these tough economic times some families are simply doing without medical care that is not of an emergency nature.” Reach Bridget Jones at ------------------------------------------------------ What does Placer County offer to those who need medical care? Placer County offers two programs to residents who don’t have private health insurance, according to Cheryl Davis, director of the Human Services Division of Placer County Health and Human Services. “One is the Medi-CAL program, which is California’s name for the federal Medicaid program, and that is for families with children and disabled single individuals, disabled or elderly,” Davis said. “The county operates what we call the Medical Care Services Program, and that’s for single individuals without children or couples without children.” The programs do have requirements and residents who are interested can get more information at Davis said Human Services also works closely with Sutter, Kaiser and U.C. Davis hospitals to try to help with costs when patients just can’t afford them and need care. Davis said the programs have seen a lot more enrollees than in the past. “We have had more emotionally distraught folks into our offices in the past few years than I have ever seen, and a lot of it is, ‘I never thought I would be here,’” she said. “And they do everything they can to avoid coming here, sell their homes, sell their cars … we have been their last resort. It’s been very tough times for folks.”