Health insurance costs come under political fire

| 01/03/2017 | 47 Comments

(CNS): The problems people in the Cayman Islands are facing with health insurance were at the centre of debates in the LA last week when the opposition leader presented a private member’s motion to tackle some of the challenges the uninsured face and the premier steered through some amendments to the law. The government accepted parts of a motion brought by McKeeva Bush that will see the ex-wives of seamen get access to CINICO cover and is considering premium assistance for people on low incomes who are struggling to meet high healthcare costs.

The opposition leader dropped some heavy hints that the matter is likely to become part of the forthcoming election campaign and he said he was considering some ideas about the entire regime and the need for change. Falling short of admitting it might be time to consider a single pay system, he made it clear that he did not think it was socialism to try to help the people.

“We are going to have to come to grips with health insurance,” he said, adding that he believed in free enterprise and did not want to “hamstring business” but even if the parliament was labeled as socialist, there had to be a better way. He said it was all right for those in the private sector earning $20,000 a month to criticise social welfare, as they can afford their health insurance, but the government had to help its own people who were struggling.

Bush acknowledged that the economy was improving but he said there was still a problem with the “trickle-down effect” as not everyone was benefitting from the economic growth. He also raised concerns that the law was not being properly enforced and that people were being dropped by insurance firms when they should not be.

He also said that the $167 per month basic premium for the SHIC plan fell far short when it came to the benefits people get and the premiums were often higher for retired people who are on fixed incomes and really struggling. He pointed to average earners with a monthly income of around $4,000 paying a premium of over $1,200 per month to cover a family of four. Bush also spoke about people losing their jobs where they have existing conditions that are driving premiums so high employers can’t cover the employees and are forced to let them go or be in breach of the law.

Those who are self-employed were also struggling, Bush said, adding that growing numbers of people face real difficulties trying to get mandatory health insurance when insurance companies are pushing up premiums.

Bush suggested CINICO could provide the necessary cover for everyone who was struggling because of existing conditions. He said that the government health insurance company should be “racked up” and given the tools it needed to help more people.

He raised concerns about those who have retired who only get three months of insurance from their former employers after they leave a lifetime of work. They are then left looking for private sector cover at a time when they are getting older and likely to have existing health concerns and so are either being turned down or offered premiums that are far too high. In the end, government picks up the tab for people who are not properly insured when they turn up in the emergency room and can’t pay.

Premier Alden McLaughlin, who is the health minister, acknowledged the myriad problems and said there were concerns about people who are not considered indigent in every other sense of meeting their monthly needs but struggle with health insurance, especially if they have a health issue “as it is very expensive”. He said government had agreed that the costs to cover the ex-wives of seamen via CINICO would be relatively small, so the government would move on that. He also said there should be some form of assistance from government to help people cover the cost of monthly premiums

A point raised by several MLAs was the fact that the pool of people was very small but there are around nine private health insurers selling policies. This plus rising healthcare costs were pushing premiums beyond the reach of many people, the politicians believed, and it was clear that some form of top-up was needed. CINICO already covers more than 40% of local population, including members of the civil service, the indigent, those that are uninsurable and retired seamen and veterans.

Finance Minister Marco Archer said he believed the government would have to find a new solution to the current health insurance regime but he agreed with an interim measure of subsidising premiums for people on low or fixed incomes.

Ezzard Miller (North Side) said government needed to take a much more holistic review of the health insurance regime but it could at least start with a modern efficient verification system to get real-time clearance and payment at the point of treatment. He said providers should have electronic clearance  to say who has what and help avoid the major problem with insurance companies who always want to “deny, deny, deny and delay, delay, delay”.

Poll: How should the next government to tackle health insurance?

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Category: Health, Health Insurance, Local News

Comments (47)

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  1. Anonymous says:

    I did health insurance for donkey years in the States, and the one thing I said when mandatory health care came in here in the 90s, was that prices would soar. Why? Because physicians and facilities would no longer be collecting from the customer (i.e. the patient). The customer is very sensitive to their pocket book, if a third party is paying they would not give a snot. And, rampant overcoding would become the norm without punitive oversight. Why? Because end users do not care if it costs more if they do not think they are paying for it. There is no oversight for coding, so a child with the sniffles is a level 4 here. Stupid is as stupid does.

  2. Anonymous says:

    Insurance should be the same for everyone, in benefits and premium .Gov’t should get rid of the companies that over charge a set rate by Gov’t. I have paid one year $485 next year $ 675 next year $800??? WTH, finally ranting to a friend he said I can fix that for you. Now I pay under $200 a month for SHIC. SO YES they are ripping us all off. Elected officials should have stopped this years ago.

  3. Ol buddy says:

    What annoys me most is medical providers who don’t accept your insurance and make you pay upfront and then you claim from your insurer.
    That has to stop. Elected officials please change the law to make it mandatory for medical providers to accept insurance cards.
    What if I always pay my insurance premiums but need treatment but don’t have the cash to pay up front? That defeats the purpose of having insurance!

  4. Anonymous says:

    its a simple solution..deduct a $25 “social” cost on anyone earning $400 CI a week or more. this covers all health costs for the retired old folk.

    • Anonymous says:

      That is just silly. You are not addressing any of the issues that have caused the rise in premiums, and instead shifting responsibility to others.

  5. Anonymous says:

    I could not imagine working in the insurance industry. I would not be able to live with myself for selling empty promises so that hard-working people satisfy burdensome laws imposed upon them by politicians and money people who are complicit in this fraudulent “business” sector.
    You know who you are.

  6. Anonymous says:

    It need to allow international health insurance in Cayman….population in Cayman is too small to run any Health insurance companies….International health do offer better coverage than Cayman.. I have tried to have world travel cover…here cost US$400 for 2 weeks while I found one insurance oversea cost US90 for 6 months which I pay oversea even they know I live in Cayman.

  7. Veritas says:

    Does Mr Bush not recognise the significant irony when he comments that those in the private sector “earning $20,000 a month can well afford their health insurance”.He himself with his double dipping must be in the same income bracket, yet he pays a big ZERO for his gold plated health insurance.He needs to address the issue of having civil servants (including all the MLA’s) paying for their health cover like everyone else, then Government could allocate a lot more funds to assist with the health care of the poor and elderly.

    • Anonymous says:

      No. You’d only have a lot more working people falling in to the ‘working poor’ category because of the cost of their health insurance relative to the value of their pay cheque. And you’d have to renegotiate all those civil service contracts that currently include health-in-lieu-of-cash. Because what you are proposing is an across the boar pay cut of hundreds of dollars a month. Which will be reflected in an across the board personal spending cut f hundreds of dollars a month. (Except in spending on health care, which will continue to go up.) – You may be mad at the cost of your health care but call for the Government/country to address that problem, not to make everyone poorer just so you’ll feel better with more company down in the crab bucket.

      • Anonymous says:

        You miss the point 11.40. You cannot have two systems in a small island. You wonder why people start counting CS benefits? One system for all. CS is mostly ( but by no means all) social welfare anyway, and many have second jobs or private business income anyway. Away your myths.

      • Anonymous says:

        With the poorer civil servants, yes. And measures can be put in place to deal with that . However, many high level civil servants make upwards of 60K per year. They are even making into the 100s of thousands. Why are we (the Caymanian residents) footing the bill for them?

  8. Anonymous says:

    A rip off for years. Bobo-the-clown MLA’s passing laws that allowed Health Insurers to siphon thousands of dollars from your hard earn salary in return for peanuts in Health Insurance coverage; while they themselves never had to pay a single penny.

    Now that the electioneering has begun, they all want to pretend like they are coming to the rescue, to save of us all from the very laws they themselves passed in the first place. Scoundrels, the lot of them.

    • Anonymous says:

      There is absolutely no doubt that the Health Insurance Law was written for the benefit of the insurance companies and not the patient. Somebody mentioned to me the other day that the law allows health insurance companies to raise your premiums by 400% at any time without reproach. If someone knows this to be false, please post.

      • Caymanian says:

        Pension laws are the same. All these mandatory things are done not for us but the companies who provide it. Look at the new pension law it is designed with the pension providers in mind.

      • SSM345 says:

        Every single year you have to renew your insurance and the fee’s goes up by 20-25%, yet the benefits remain the same. Same with everything else in this country, from food to gas, always going up and we all are just meant to suck it up and move along. Its f**king disgusting and these persons days are coming.

  9. 345 says:

    Let’s see if any of the political parties or independents (your chance to redeem yourself Gilbert) will run with this issue.

    Probably too risky to be labeled a “socialist”, which is almost as bad as being LGBT or atheist. So, short answer, no.

  10. Anonymous says:

    The whole system is bonkers and needs scrapping, to be replaced with a mixed private/state program where the costs are real (can you explain why in certain parts of Europe the costs of getting some serious work done are less than 10% of the cost here? In fact normally less than the cost of our deductibles here?). Those that can afford it pay extra for immediate service, those who cannot still get good treatment for free, paid for in part by those that can afford it. Control of costs and quality is the key.

  11. Anonymous says:

    Is somebody, anybody, in the LA going to lay some blame at the feet of the insurance companies who have raised premiums over 400% over the last 10-year, while — and please take note of this fact — the sums reimbursed to doctors over the same period have remained EXACTLY the same? The insurance companies are making out like bandits. And, those of your with Cayman First who want to know where your inflated premiums are going to, take a look at the massive property being built by them on Shedden Road: that’s where.

    • Anonymous says:

      Exactly! They increased my premium by CI$185.00 more per month due to a US$6,000.00 claim for when I gave birth to my daughter. This was a normal claim as the max they cover for child delivery is US$6K (including doctor/hospital stay etc.) and I had no complications or anything either. This is after being with them for yearsssss and having very small claims here and there. Needless to say, I have since switched providers but they are all the same crooks if you ask me.

      • Anonymous says:

        Pregnancy is a pre-existing condition.

        • Anonymous says:

          Only in West Bay 2.41

        • Anonymous says:

          Pregnancy is not a pre-existing condition. Insurers don’t like it because they know the likely costs but it’s not a bar to getting insurance whilst you’re pregnant.

          • Anonymous says:

            Looks like it got treated as a pre-existing condition for the lady who had had a successful pregnancy. Better up her premium (though yes they didn’t drop her coverage) because she might get pregnant again. = pregnancy is a pre-existing condition.

    • Veritas says:

      11.13am – you have got it wrong. Doctors and all medical providers get paid in full. If their charges exceed the legislated health fees schedule (unchanged in the last 10 years), then the insured pays the difference to their doctor. For example a doctor’s charge is $500 but the schedule only allows $400 for his procedure, then the insurance company pays the doctor $320 ($400 less the insured’s 20% co-pay) and the insured has to pay the doctor $180 which makes his co-payment effectively 36%. It’s not the doctor who suffers, but the insured. As for the insurance companies they are paying claims limited to the fees charged 10 years ago, yet they have increased their premiums significantly over the same period.So, the victim is the insured, the villain is the insurance company.

  12. Anonymous says:

    Seamen benefits should only apply to those who went to sea prior to 1975 as after that time it was a choice, not a necessity, to go to sea. The numbers involved should be dropping steadily. If the wives were involved back then they should be included. I do not see why a young woman who marries an elderly seaman in recent times should qualify.
    If a date is not placed on this “benefit” where does it stop?

    • Anonymous says:

      Excellent post

      • Anonymous says:

        A lot of men and their wives that are Johnnies come lately, say they are Seamen ,they was not Caymanian when or they went to sea,(some never went to sea) are getting the benefits, they never sent a red cent into these Islands, if they went to sea at all. Even preachers and some men that just came to live in these Islands a few years ago is getting the benefits, that should stop, also some Caymanian that never went to sea at all and some only went for a few weeks or months its getting it, and the old Seamen young wives they all should be also stopped, If these Caymanians need help then social services should help them, they should not load up the Seamen benefits.if the politicians have a pair,they will stop all of this, .

        • Veritas says:

          Caymanians should take a few cruises on the Carnival ships, then they can claim seamen’s benefits to pay for them.

    • Anonymous says:

      And there are some retired seamen who are wealthy and should not benefit from Cinico.

    • Anonymous says:

      Because it will get Mac some votes and possibly some attention from those “ex-wives” while the country has to pick up the tab.

    • Anonymous says:

      10:05 the rules says only Seamen that went to sea before 1985 can get the benefits and had to be Caymanian with their wives living in the Caymanian Islands during their 3 years or sea time. But Nobody checks on this properly, that is the problem.

      • Anonymous says:

        Obviously not the reality as there are many wives that are recently married receiving benefits. Plus the wives that married long after the husband stopped being a seaman and those same seamen had regular jobs.

  13. Anonymous says:

    Make CINICO a top class non profit organisation for all and put these insurance companies that decide if you live or die out of business

    • Anonymous says:

      This would entail HSA getting rid of all their current staff. I’m convinced 90% of their doctors scraped through medical school.

  14. Anonymous says:

    Allow people to source their cover overseas from reputable global firms, and watch the costs come down!

    • Anonymous says:

      This would close down too many companies on island and would never happen but we can all dream…..

    • Anonymous says:

      I agree, there are many excellent options for far superior coverage at lower prices. Our insurance cover SHIC was designed to benefit government’s bottom line not the consumer’s. Mandatory hemodialysis coverage? Not RX? We should be able to choose the coverage that meets our needs, not theirs.

  15. Nunya says:

    As an individual who has a “preexisting” condition as the insurance companies like to call it. I can attest to many years of feeling imprisoned by the system as it was originally designed.
    I feel that insurance companies have taken advantage of the law and from day one they knew they had people by the balls because the law required that everyone be insured. As the article states people only have a handful of insurance companies to choose from. Then the insurers write the policies by group/company and risk in spread across that company (e.g. a company that has 60 employees), so if someone has a major illness the premium goes up for that company. I would think it would make more sense to spread that risk across the entire insured population i.e all people insured with that company on the island (e.g. 1060 or whatever).
    It’s a type of socialised system I guess so I don’t know if that is practical – but what I do know is that what they have now ain’t working for the either party because it’s a cyclical effect. People feel they they are paying high rates for their insurance so they need to use it more and go to the doctor for a hangnail – the more they use it the more the rates go up…

  16. Anonymous says:

    We have a fire department and police department for all, so why not a health care system for all. The idea of forcing me to buy health insurance from a private company who is guaranteed a profit and who makes no guarantee on the quality of health care is actually unconstitutional. Their business model is not only a violation of my constitutional rights it actually feels immoral and offends my christian values.

    We should never trust a for profit private insurance companies to make life and death decisions solely based on someones wealth and such companies should be illegal. If everyone pays the same amount that we are paying now to private insurance companies into a government owned health care system, we would have a more universal quality of care and better control over the rate of increase of the costs. I hope someone seeking a seat in this election embraces a higher morality supported by the math.

    Say yes to a single payer system and a moral compass that supports a universal quality of health care and win my vote.

  17. Anonymous says:

    It is much worst than people think the situation is, people are paying $267.00 for a schic policy and in some cases your benefit is $40..00. That is why most people are now going to the Hospital Emergency center because it is cheaper than going to a private Doctor and please don’t be late in paying your monthly premium because you will get cut off and in most cases never reinstated.

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