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4A Daily News – Tuesday, June 4, 2013 Pastimes & Arts entertainment Parsing premiums for health care exchanges By Ezra Klein The Washington Post Imagine you went to Best Buy and found a great deal on a plasma television set. I want to be clear: You didn't find a great television set. This one is actually a bit crummy. The picture is fuzzy. Consumer Reports says it breaks down a lot and it's expensive to fix. But it's really cheap. The price tag reads $109. When you take it to the counter the saleswoman tells you that the set will actually cost you $199. And count yourself lucky, she confides in a conspiratorial whisper. There are customers whom Best Buy won't sell it to at any price. You ask her which customers those are. The ones who need the TV most, she replies. So here's the question: Does that television really cost $109? Best Buy, of course, would never do this to you. If they say you can buy a television set for $109, you can buy it for $109. Plus, they're handsome, their customer service is great and I hope they advertise in The Washington Post forevermore, amen. But this is actually how the individual health insurance market works. And understanding why is crucial to understanding a lot of what you're going to read about health reform in the next year. Last week, California released early information on the rates insurers intend to charge on the new insurance marketplaces — known as "exchanges" — that the state is setting up under Obamacare. They were far lower than anyone expected. Where analysts had anticipated average premiums of $400 to $500, insurers were actually charging $200 to $300. "This is a home run for consumers in every region of California," crowed Peter Lee, director of the state's exchanges. The Affordable Care Act's critics saw it differently. Avik Roy, a conservative health writer at Forbes, said Lee was being "misleading" and that "Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent." Obamacare, he said, would Nutrition labels may be coming to alcoholic drinks Mary Clare Jalonick Associated Press trigger "rate shock," the jolt people feel when they see the higher rates. That doesn't sound like a home run at all. Who's right? In typical columnist fashion, I'm not going to tell you just yet. But stick with me, and you'll be able to parse the next year of confused and confusing Obamacare arguments with ease. Here's the first thing to know: We're talking about a small fraction of the American healthcare system. This isn't about people on Medicare or Medicaid or employer-based insurance. It's about people joining Obamacare's insurance exchanges. That's people who buy insurance on their own now as well as some of the uninsured. In 2014, 7 million people, or 2.5 percent of the country, is expected to buy insurance through the exchanges. By 2023, that will rise to 24 million, or eight percent. So we're talking about a small portion of the market. Worse, we're talking about that small portion of the market all wrong. Roy got his 146 percent at eHealthInsurance.com, by running a search for insurance plans in California and comparing the cost of the cheapest plans to the cost of the plans offered in the exchanges. If only it was that easy. I ran the same search Roy did. I looked for insurance in Irvine, Calif. — my home town. The average monthly premiums of the five cheapest plans is $114. So I took the middle plan. HealthNet's IFP PPO Value 4500. It's got RANDAL S. ELLOWAY DDS IMPLANT DENTISTRY 2426 SO. MAIN ST., RED BLUFF 530-527-6777 FACT SHEET ON DENTAL IMPLANTS DENTAL IMPLANTS: * are the most advanced tooth replacement system ever devised *help preserve jawbone to prevent the appearance of premature aging *look and function like natural teeth *are placed/restored in the doctor's office with minimal discomfort *improves comfort, appearance, speech * have a 95% success rate * allow you to eat the foods you love and talk, laugh and smile with confidence * represent a conservative treatment option-adjacent teeth are left untouched * never develop decay * can provide great stability for lower denture * can completely eliminate the need for a denture * can help people of any age * give patients a third set of teeth that are natural looking and very long-lasting Ask yourself the following questions: Are you missing one or more of your natural teeth? Do you have a complete or partial denture that is no longer completely comfortable? Have you ever been embarrassed by a denture or a bridge? If you answered "yes" to one or more of these questions, call us today at (530) 527-6777 to schedule an evaluation appointment. We would be pleased to evaluate your oral health and discuss treatment options with you. a $4,500 deductible, a $2,500 deductible for brand-name medications, huge co-pays and a little "bestseller" icon next to it. It's only $109 — if they'll sell it to you for that price. That's the catch, and it's a big one. Click to buy the plan and eventually you'll have to answer pages and pages of questions about your health history. Ever had cancer? How about an ulcer? How about a headache? Do you feel sad when it rains? When it doesn't rain? Is there a history of cardiovascular disease in your family? Have you ever known anyone who had the flu? The actual cost of the plan will depend on how you answer those questions. According to HealthCare.gov, 14 percent of people who try to buy that plan are turned away outright. Another 12 percent are told they'll have to pay more than $109. So a quarter of the people who try to buy this insurance product for $109 a month are told they can't. Those are the people who need insurance most — they are sick, or were sick, or are likely to get sick. Comparing the preunderwriting price of this plan to those in Obamacare's exchanges is ridiculous. The plans in Obamacare's exchanges have to include those people. They can't turn anyone away or jack up rates because of a history of arthritis or heart disease. They also have to offer insurance that meets a certain minimum standard. Under Obamacare, for instance, the out-ofpocket limit for someone making 100 to 200 percent of the poverty line is $1,983. Under the Value 4500, you could spend up to $9,500 before the outof-pocket limit kicked in. Obamacare also has subsidies for people making up to four times the poverty line. The poor pay next to nothing. The rich pay full freight. "We as a society have never really said here's what reasonable insurance is," says Larry Levitt, director of the Kaiser Family Foundation. "It's just been anything goes. For the first time they're setting a minimum about what reasonable insurance should be." They're also setting a minimum about who should be able to get it and at what cost. Now it really will work like Best Buy where the price on the tag is the price everyone actually pays. Some people will find the new rules make insurance more expensive. That's in part because their health insurance was artificially cheap. It used to turn away sick people. It also won't allow for as much discrimination based on age or gender. The flip side of that, of course, is that some people will suddenly find their health insurance is much cheaper, or they will find that, for the first time, they're not turned away when they try to buy health insurance. Rate shock goes both ways. Community Clip? e-mail: clerk@redbluffdailynews.com or Fax: 527-9251 Type 2 Speed Training Instructed by Troy Lalaguna Collegiate Track and Field Athlete and Certified Strength and Conditioning Specialist. "I have been developing athletes of Northern California for the last 10 years through my Type 2 Speed Training and Sports Fusion Camps." My Type 2 Speed Training Camps have taken hundreds of athletes to the next level of competition. I use multiple methods to increase speed, power and agility. These methods include: Dynamic Warm Up, Bio-mechanical Analysis, Plyometrics, Sprint Drills, Agility, and Reaction Drills, Core Strengthening Exercises, and various Coordination Activities. This camp not only improves speed, it also improves movement efficiency for greater coordination and agility. This camp will make you run faster, jump higher, and become a better mover. When: Tuesday & Thursday 4-5PM June 18th-July 11th Where: Tehama Family Fitness Center Instructed by: Troy Lalaguna CSCS Cost: $100 must be paid in full prior to class Limited to 20 Athletes 528-8656 Tehama Family Fitness Center 2498 South Main St, Red Bluff • 528-8656 www.tehamafamilyfitness.com WASHINGTON — Alcoholic beverages soon could have nutritional labels like those on food packaging, but only if the producers want to put them there. The Treasury Department, which regulates alcohol, said this past week that beer, wine and spirits companies can use labels that include serving size, servings per container, calories, carbohydrates, protein and fat per serving. Such package labels have never before been approved. The labels are voluntary, so it will be up to beverage companies to decide whether to use them on their products. The decision is a temporary, first step while the Alcohol and Tobacco Trade and Tax Bureau, or TTB, continues to consider final rules on alcohol labels. Rules proposed in 2007 would have made labels mandatory, but the agency never made the rules final. The labeling regulation, issued May 28, comes after a decade of lobbying by hard liquor companies and consumer groups, with clearly different goals. The liquor companies want to advertise low calories and low carbohydrates in their products. Consumer groups want alcoholic drinks to have the same transparency as packaged foods, which are required to be labeled. "This is actually bringing alcoholic beverages into the modern era," says Guy Smith, an executive vice president at Diageo, the world's largest distiller and maker of such wellknown brands as Johnnie Walker, Smirnoff, Jose Cuervo and Tanqueray. Diageo asked the bureau in 2003 to allow the company to add that information to its products as low-carbohydrate diets were gaining in popularity. Almost 10 years later, Smith said he expects Diageo gradually to put the new labels on all of its products, which include a small number of beer and wine companies. "It's something consumers have come to expect," Smith said. "In time, it's going to be, why isn't it there?" Not all alcohol companies are expected to use labels. Among those that may take a pass are beer companies, which don't want consumers counting calories, and winemakers, which don't want to ruin the sleek look of their bottles. The Wine Institute, which represents more than a thousand California wineries, said in a statement that it supports the ruling but "experience suggests that such information is not a key factor in consumer purchase decisions about wine." Spokeswoman Gladys Horiuchi said the group knows of no wine companies that plan to use the new labels. The beer industry praised the agency for acknowledging that labels should take into account variations in the concentration of alcohol content in different products. The industry has opposed the idea of defining serving size by fluid ounces of pure alcohol — or as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor — on the grounds that you may get more than 1.5 ounces of liquor in a cocktail depending on what else is in the drink and the accuracy of the bartender. The ruling would allow the labels to declare alcohol content as a percentage of alcohol by volume, the approach favored by the beer industry. "We applaud the TTB's conclusion that rules be based on how drinks are actually served and consumed," said Joe McClain, president of the Beer Institute. McClain said the beer industry is pleased that the ruling provides "substantial flexibility" in terms of the format and placement of the disclosure on packaging. It is unclear whether beer companies will actually use the labels, however. Consumer advocates criticized the regulation. "It doesn't reflect any concern about public health," said Michael Jacobson, director of the Center for Science in the Public Interest. He said the rules are too close to what the alcohol companies had sought. Consumer advocates have said that listing alcohol content should be mandatory so consumers know how much they are drinking. Jacobson and others also support having calorie counts on labels, but they said the labels should not include nutrients that make the alcohol seem more like a food. "Including fat and carbohydrates on a label could imply that an alcoholic beverage is positively healthful, especially when the drink's alcohol content isn't prominently labeled," Jacobson said. Current labeling law is complicated. Wines containing 14 percent or more alcohol by volume must list alcohol content. Wines that are 7 percent to 14 percent alcohol by volume may list alcohol content or put "light" or "table" wine on the label. "Light" beers must list calorie and carbohydrate content only. Liquor must list alcohol content by volume and may also list proof, a measure of alcoholic strength. Wine, beer and liquor manufacturers don't have to list ingredients but must list substances people might be sensitive to, such as sulfites, certain food colorings and aspartame. Tom Hogue of the TTB said the aim of the ruling is to make sure alcohol labeling is more consistent. "The idea here is we are trying to make it easy for the industry to communicate this with consumers if they want to do so, and if their consumers want them to do it," he said. 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