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Judi Hilman, G I Joe Adventure Team executive director of the Utah Health Policy Project (UHPP) recently opined that the Public Employee Health Plan (PEHP) should be available to all small businesses in Utah as a Creature Castle to make health insurance donating cars affordable. Ms. Hilman points out that PEHPs claims costs are less than 4%, which compares favorably to the average claims costs for private insurers of 15 percent. (We assume she meant administrative costs rather than claims costs.)

UHPP contends that by allowing PEHP to cover small business in Utah, the cost of insurance would go down based on the lower administrative costs of PEHP, which would in turn allow more small businesses to offer health insurance to their employees. UHPP also reasons that by saving substantial amounts of money, PEHP can help subsidize the Childrens Health Insurance Plan and lower the uninsured population.

Before we jump on the bandwagon of the UHPP proposal, lets look at the tough details. Lets consider the reasons that PEHP has 4% administration costs compared with 15% costs with private carriers.

First, unlike commercial carriers, PEHP has no bad debt with customers. That is the advantage of doing business with taxing entities. They never go out of business and if they run short of money, they increase taxes. This is not so in the real world of small business insurance. If a business cant pay they seek protection under bankruptcy - and under law, the carrier has to continue paying claims for 1 to 2 months without collecting premium. That would be a shocking new addition to PEHPs administrative costs.

Next, PEHP has very low billing costs. That is because their clients, state and local agencies, are limited in number and rarely change. Most of their clients are large like State employees and water districts. It will make a big difference in overhead to go from billing and reconciling scores of bills to thousands of bills every month.

Additionally, PEHP also enjoys low marketing costs. Currently the low number of potential PEHP clients minimizes the need for a marketing department. This will not be the case if they want to sell in the small group market. PEHP will either need to hire a sales staff, or set up an 800 number and hope businesses call them or they will need to pay commission to agents. All of these marketing solutions will cost a substantial amount of money.

Finally but most importantly, PEHP lacks the staff and infrastructure necessary to properly underwrite small group cases on a large scale. Underwriting is the process of evaluating and pricing for risk, and developing underwriting capability is an expensive proposition. Small employers are an extremely price sensitive crowd. Health insurance is usually their second or third biggest expense behind wages and sometimes workers compensation costs. A small employer will change Beatles model kits in a heartbeat if it they can find a better value. Price too low and you lose money. Price too high and your competitors take your most profitable groups. If PEHP is to develop the department necessary to underwrite small employers on a large scale, it will incur substantial additional administrative overhead.

Last year when UHPP first proposed that PEHP enter the small employer market to compete with commercial insurers, the most serious design flaw had to do with the development of premium rating structures. PEHP is accustom to serving clients that Charlie's Angels composite rates (meaning one rate for all singles and one rate for all families) and community rates (all groups pay about the same). Commercial small group rates are age-banded (older employees pay more than younger) and the risk of the group (the law allows a 30% discount for the healthiest groups and no more than a 30% surcharge on the most expensive groups). Carriers price this way to provide affordable coverage for the youngest and healthiest folks. This helps pool the risk and moderate premiums for all of us.

If PEHP would try to implement their current underwriting model against the commercial underwriting model, they would attract only the sickest and oldest of the groups. This is not merely a guess, but is a broadly accepted fact of field underwriting. If commercial carriers prices are geared towards the young and healthy and PEHP uses one size fits all pricing it will be an unmitigated disaster of the highest order for Utah taxpayers.

Because of this, we believe the UHPP proposal will result in exactly the opposite of what Ms. Hilman purports will happen; she said PEHP will have the advantage of including a younger healthier population in its risk pool, decreasing costs for all beneficiaries. In order to assume that, she must believe that a younger population will join PEHP, whose current risk pools include a slightly older population than found with small business. This contention underestimates the power of pricing and its effect on the types of people that actually enroll.

On the other hand, if the plan is for PEHP to mimic the current commercial pricing model then what are we creating? The answer is; a government entity competing with private business with taxpayers ready to bail out any mistakes. This would not be consistent with free-market ideals.

For PEHP to enter the small group market with no experience would be extremely risky for the taxpayers of the State of Utah. Under law, the State would have to make up any loses in their block of business. On the other hand, if PEHP made a profit, it could not be shared with other blocks of business. The pool for State Employees must be kept separate from the Government Trust and the Childrens Health Insurance Plan as well as the proposed new pool. Despite Ms. Hilmans optimism, we could not subsidize CHIP with any savings from other PEHP pools.

The bottom line is this: PEHP does not have an internal cost advantage over the current carriers in the small group market. Their claims expenses (what they pay doctors, hospitals and pharmacies) are about the same as and in many cases more than the commercial carriers. They would not be able to serve the private small group market for the same 4% overhead with which they serve the government. They would be entering a treacherous market in which they have no experience. The taxpayer would be at risk if things go wrong. Keep in mind that losses in health insurance can be huge.

As a general philosophy, the Utah Association of Health Underwriters believes in a competitive marketplace. We are working hard to give Utah employers more choices and better information in the marketplace. We are in favor of expanding options in the private health care market. We support government and charitable subsidy of those that need real help.

If the legislature believes that it is worth asking PEHP to expand its mission, we would strongly recommend a serious analysis of the underwriting and marketing of plans before jumping into unfamiliar waters. If UHPPs predicted outcomes are probable, then we would welcome the addition of PEHP into the small group marketplace, but the taxpayers should not be at risk for the losses of PEHP as a competitor in the private market.

We recommend caution, and a well thought out business plan from PEHP. Its good to think outside the box, but the devil is in the details.

By Brad Kuhnhausen,

Co-Legislative Chair, Utah Association of Health Underwriters

# posted by hieej : 10:32 AM  0 comments

Want to know how Monopoly Mickey Mouse tweak your cardio workouts to burn even more fat, lose your saggy and flabby arms, and shorten your workouts by as much as 50%?

Who wouldn't right?

To illustrate Who Can Use Viagra method that I use with clients who are frustrated with their results, let me give you some insight into how a typical consultation with a client who is fed up with lack of results would sound go. This is a scenario that so often brings clients to my door, so let me set the scene:

Client: "Rylan, I have been working out for a while now, and at first I saw some pretty good results, but I just can't seem to make the scale budge anymore, can you help me?"

Rylan: "I'm sure we can find something that will get the results happening again. Okay, so tell me exactly what you were doing when you first started to see some improvement and we'll go from there."

Client: "Well, It all really started one day when I got so fed up with myself and how overweight I had become that I just started running. Of course, I didn't get very far, and I was incredibly out of breath, but after a couple months I could run a couple miles without stopping, and the weight was starting to come off..."

"...believe it or not, I actually started to enjoy running because I was getting good at it. I was able to run three miles without really getting out of breath, and I felt great, but I wasn't losing as much weight as when I started."

"All I could do was add more distance to my run, and now I spend 45 minutes or more each day running, and I'm not losing ANY weight. I am so, so frustrated!"

Rylan: "Don't worry, it happens to everyone."

Client: "Everyone? What do you mean? I thought maybe I have a slow metabolism or something?"

Rylan: "Well, at first you lost a lot of weight because of how Transformers the exercise was. You probably had trouble just keeping a jogging pace for more than a few minutes for the initial two or three weeks. But as your body adapted to this new exercise regime, it got much better and more efficient at conserving energy. Let me guess, it was around the same time that running started to get easy that you noticed you weren't losing as much weight?"

Client: "Yes, exactly!"

Rylan: "Let me put it to you like this. When it comes to fat loss, you want to be as IN-efficient as possible! You want your body to use up as much stored energy (body fat) as it possibly can. As soon as you start becoming efficient, your body requires less fuel to do the same amount of work, and you don't tap into your fat stores as much."

"When you first started, you were so inefficient at what you were doing, your body was forced to use up loads of extra energy. Now that you are good at it, your body requires much less fuel to do the same amount of work, and thus you have to drastically increase your exercise volume to see the same effect."

Client: "Ok, I guess that makes perfect sense. But I only have so many hours in a day, I can't add any more time to my workouts. It's already difficult just to squeeze out the time I am now for exercise so what do I do if I can't increase my running distance?"

Rylan: "Don't worry about that, I am actually going to show you how you can spend a third of the time on cardio that you currently do, and get even better results!

Client: "Ohmygosh! That sounds Fleer Ted Williams tell me now!!!"....

Okay, let me bring you back now...

This is such a typical scenario, and one that I counsel clients on a with an almost weekly basis.

People have this idea in their head that they need to spend 30 or more tortuous minutes on the treadmill, everyday, if they are going to see any results, and this is simply NOT THE CASE.

If you want to get consistently great results, and spend less than half the time, then you need to forget everything you learned about 'the fat burning zone' and other nonsense cardio myths and start doing interval training.

Interval training is simply cardio that alternates between periods of very high intensity, followed by periods of lower or 'recovery' intensity.

This can be a simple as running for three telephone poles, then walking for three telephone poles.

The main idea is that you get your heart rate up and work really hard for a short period of time, then rest and recover your energy (by walking or very light jogging) for the next high intensity burst.

This is how most people start learning to run anyway, and that is why they see such great results in the beginning.

So, if your goal is to burn as much body fat as possible, then forget about long, drawn out cardio sessions. As you can see in the example below (taken from an actual client's workout program) this woman is only doing 12 minutes of cardio plus warm up and cool down. I think anyone would agree that they have an extra 12 minutes a day to spare don't you?

Weeks 3-4

Mode: Any piece of cardio equipment or jogging/walking

Total Duration: 12 Minutes plus warm-up and cool down

Instructions:

- Start by warming up at a level that will have you just starting to break a sweat at the end of 2 minutes.

- At the start of the second minute increase the speed rapidly (you may need to increase the resistance as well if you are using an elliptical or stationary bike) and go as hard as you can for one full minute. You should be nearing 90% of your maximum heart rate for the full minute.

- After completing one full minute of maximum intensity, lower your speed (and/or resistance) to allow your heart rate to recover back to a moderate level of approximately 60-70% intensity for two minutes.

- After the 2-minute recovery interval, repeat another maximum interval for 1-minute.

- This cycle is to be repeated for three intervals of 1-minute high intensity followed by 2-minutes of low intensity.

- Upon completing the third interval bring the heart rate to a level of 75-80% and maintain for three minutes (this is referred to as steady state).

- Following the 3 minutes at 75-80%, finish by cooling down for an additional two minutes allowing the heart rate to drop to approximately 60%, then immediately begin the strength training portion of the program.

So as you can see, fat burning cardio workouts don't take much time at all. You can get the same or better results than if you spent over 30 minutes of slower, long duration cardio, and you will have more time to do all the other things you would rather be doing.

Want more free info on how you can permanently eliminate saggy and flabby arms? Visit my website and sign up for your free subscription and report on how you can achieve toned and sexy arms at href="gosleeveless.com">gosleeveless.com

Rylan Duggan
RK, BHK, CSCS, NSCA-CPT

BCAK Practicing Kinesiologist,
Personal Health and Fitness Consultant,
Certified Strength and Conditioning Specialist,
NSCA Certified Personal Trainer

*this information is intended for educational purposes only, and should not be taken as personal exercise advice. Do not perform any exercise program unless under the personal guidance of a qualified health and fitness expert*

# posted by hieej : 10:28 AM  0 comments