“In anticipation of the expected funding deficit for the 2023-2024 plan year, each TSHBP member school district will be required to make an additional contribution of $150 per month per participating employee starting May 1, 2024.” Sources tell us the TSHBP claim forecast was $70 million for 2023-2024 but now TSHBP projections indicate a total claim spend of $93.6 million, inclusive of run-out claims.   Last year’s TSHBP renewal warned member districts rates may not hold through the year. What will member districts do? We’ve been told they have until May 31, 2024 to decide. Seeking ..read more

“If a risk pool is profitable, the members get the advantage of reduced rates. But if the pool is unprofitable, the MEMBER DISTRICTS may be faced with assessments (additional contributions) regardless of what they tell you.“ “No insurance company or stock stands behind these pools except reinsurance above high retentions (deductibles). The managers and the agents bear no risk – only the members.” “Interlocal risk pools are not subject to oversight by Texas Department of Insurance or any other state department, and are not required to submit financial reports. Hence, some risk pools provide no ..read more

Reference Based Pricing (RBP) vendors should rejoice. They’ve been vindicated. But alas, one of the largest health care unions in the country does them one better. They support RBP pricing at 100% of Medicare, not 120, 140 or even 180% of Medicare. “Astronomical health care costs and lack of access continue to drive individuals, families, and businesses past their breaking point while insurance companies continue to soak-up billions of health care dollars as millions of children’s basic needs go unmet.” “Medicare has provided guaranteed health care for millions of seniors for more than 51 ye ..read more

By Ge Bai – Contributor – I am a professor of accounting and health policy at Johns Hopkins. Why Are Cash Prices Lower Than Health Insurance Negotiated Prices? Apr 21, 2024 Growing evidence demonstrates a counterintuitive phenomenon in healthcare: the cash price is often cheaper than insurance prices for the same service or product. Cash prices are unilaterally determined by a provider, while insurance prices are bilaterally negotiated between a provider and an insurance company. Don’t insurance companies presumably possess more bargaining power than individual patients? Our study found ..read more

The moment the employer signs such contracts, they are most likely already in violation of ERISA. In response to relentless increases in healthcare costs and broker despair, insurance carriers, MGAs, TPAs, and consultants are encouraging employers of all sizes to self-insure their health plans. For the right-fit employer, doing so can provide an opportunity to reduce costs, but agents and brokers should be aware that self-insurance isn’t a magic bullet. There are several reasons why these plans can be problematic for both employers and their employees. What Are the Fiduciary Risks of Self-Fun ..read more

Back in the 70’s Blue Cross of Texas sales reps were captive agents. Or were they? In 1973 the starting monthly salary of a Blue Cross of Texas sales representative was $840. That was before taxes. No commissions were paid. Straight salary. Damn good income, better than the starting salary of a public school teacher. Life was good, Vietnam was a fading memory. Independent insurance brokers were viewed as less than human, slithering creatures unworthy of representing the largest health insurance company in the world. Back in those days only college educated graduates were qualified to apply fo ..read more

How to get free, near free or almost free health insurance? How’s that possible? The Affordable Care Act, a government promulgated misnomer, gifts more people access to health insurance by lowering premium costs. How? By taxing middle class Americans and printing more money. In 2025 all Americans qualify for free, or near free or almost free health insurance: No Maximum Income Limit: Through the end of the 2025 coverage year, there is no maximum income limit for the premium tax credit. This means that even individuals and families with incomes above the federal poverty level can still re ..read more

TSHBP member school districts exiting the TSHBP health insurance program for Texas school districts must provide written notice of termination no later than 120 days before each renewal date. The Texas Schools Health Benefits Program Interlocal Agreement stipulates: “This Agreement may be terminated by either party on any successive renewal date by giving written notice no later than one hundred twenty (120) days before the renewal date or as provided by the Program Bylaws.“ What if a renewal offer is not made until 30, 60 or 90 days out and the district has not given notice of termination by ..read more

FOR IMMEDIATE RELEASE Willacy County Employee Health & Welfare Plan Adopts Wellness Initiative Raymondville, TX – April 15, 2024 – Willacy County is pleased to announce the launch of its latest initiative aimed at enhancing the health and wellness of its employees. The new program is designed to promote healthier lifestyles and improve overall well-being among county employees. Recognizing the importance of investing in the health and wellness of its workforce, Willacy County has partnered with primary care physicians, clinicians and wellness centers of excellence to develop a comprehensi ..read more

CMS Invites Hospitals To Raise Prices And Buy Physician Practices By Ge Bai – Contributor Mounting hospital bills, crushing medical debt, ballooning insurance premiums… While we are wrestling with these widespread healthcare affordability problems, it’s helpful to keep in mind that they are often caused by public policies. The most recent example is the financing scheme of Medicaid expansion in North Carolina. As in many other markets in the U.S., hospitals in North Carolina are highly consolidated and politically powerful. Medicaid expansion would not have become law in North Carolina w ..read more