Perks Ease Way in Health Plans for Lawmakers
By ROBERT PEAR
New York Times
November 19, 2013
WASHINGTON — Members of Congress like to boast that they will have the same health care enrollment experience as constituents struggling with the balky federal website, because the law they wrote forced lawmakers to get coverage from the new insurance exchanges.
That is true. As long as their constituents have access to “in-person support sessions” like the ones being conducted at the Capitol and congressional office buildings by the local exchange and four major insurers. Or can log on to a special Blue Cross and Blue Shield website for members of Congress and use a special toll-free telephone number — a “dedicated congressional health insurance plan assistance line.”
And then there is the fact that lawmakers have a larger menu of “gold plan” insurance choices than most of their constituents have back home.
While millions of Americans have been left to fend for themselves and go through the frustrating experience of trying to navigate the federal exchange, members of Congress and their aides have all sorts of assistance to help them sort through their options and enroll.
Lawmakers and the employees who work in their “official offices” will receive coverage next year through the small-business marketplace of the local insurance exchange, known as D.C. Health Link, which has staff members close at hand for guidance.
“D.C. Health Link set up shop right here in Congress,” said Eleanor Holmes Norton, the delegate to the House from the nation’s capital.
Insurers routinely offer “member services” to enrollees. But on Capitol Hill, the phrase has special meaning, indicating concierge-type services for members of Congress.
If lawmakers have questions about Aetna plan benefits and provider networks, they can call a special phone number that provides “member services for members of Congress and staff.”
On the website run by the Obama administration for 36 states, it is notoriously difficult to see the prices, deductibles and other details of health plans.
It is much easier for members of Congress and their aides to see and compare their options on websites run by the Senate, the House and the local exchange.
Lawmakers can select from 112 options offered in the “gold tier” of the District of Columbia exchange, far more than are available to most of their constituents.
Aetna is offering eight plan options to members of Congress, and Blue Cross and Blue Shield is offering 16. Eight are available from Kaiser Permanente, and 80 are on sale from the UnitedHealth Group.
Lawmakers and their aides are not eligible for tax credit subsidies, but the government pays up to 75 percent of their premiums, contributing a maximum of $5,114 a year for individual coverage and $11,378 for family coverage. The government contribution is based on the same formula used for most other federal employees.
In debates leading up to passage of the Affordable Care Act, members of both parties suggested that all Americans should have coverage as good as what Congress had. President Obama said in 2009 that people should be able to buy insurance in a marketplace, or exchange, “the same way that federal employees do, same way that members of Congress do.”
For decades, members of Congress have received coverage through the Federal Employees Health Benefits Program. They generally like their coverage, but — like millions of Americans facing the loss of their policies next year — they cannot keep it.
In the past, if lawmakers did nothing in the open enrollment period, their coverage would automatically continue. This year, by contrast, they must affirmatively pick a plan. Their coverage under the federal employee program will end on Dec. 31. If they do not choose a plan via D.C. Health Link by Dec. 9, they will lose the government contribution to their premiums and could lose their right to retiree health benefits as well.
In addition, lawmakers who go without insurance next year may, like other Americans, be subject to tax penalties.
Some congressional aides, especially older employees who face higher premiums, are unhappy about the changes. But some who carefully compare their options on the exchange find that they can save money.
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Jacqueline A. Thomas, a 26-year-old legislative correspondent for Representative Debbie Wasserman Schultz, Democrat of Florida, said she was able to reduce her monthly premium to $60, from $120, by switching to a Kaiser plan from a Blue Cross and Blue Shield plan.
“I’ll be paying half as much for comparable coverage,” she said.
The congressional work force is full of young, healthy people like Ms. Thomas, precisely the type of customer insurers want to attract.
Congressional aides naturally have a few complaints. Some are confused by the large number of options. When they sign up for a plan online, they get no confirmation, so they are apprehensive. In addition, the website for the local exchange does not display the government contribution for members of Congress and their aides.
It shows, for example, that a couple with one child may pay $1,300 a month for a plan, when, in fact, their share of the premium is only $352; the government pays $948. Local exchange officials said their website had not been set up to calculate premium contributions using the formula required for lawmakers and other federal employees.
One part of the new insurance program is veiled in secrecy. Lawmakers may allow some or all of their employees to keep their current insurance by declaring that they do not work in the “official office” of a member of Congress. Members do not have to disclose such decisions, though some have voluntarily done so.
Thus, for example, a spokesman for Representative Darrell Issa, Republican of California, said the congressman had decided that all of his staff members, including those who work in his personal office, could stay in the Federal Employees Health Benefits Program and would not have to go into an exchange.
By making it easier to compare the costs and benefits of different health plans, the exchange could make it e
asier for insurers to compete with Blue Cross and Blue Shield, which has long dominated the market on Capitol Hill.
For its part, Blue Cross and Blue Shield says it can best meet the needs of lawmakers and their aides because its national plans have a large network of providers, including nearly 90 percent of all doctors in the United States.
One perk is not in danger. Lawmakers can receive care from the attending physician to Congress, conveniently located in the Capitol, for an annual fee of $576. And they can get care at military hospitals.
Showing posts with label Health care reform. Show all posts
Showing posts with label Health care reform. Show all posts
Tuesday, November 26, 2013
Saturday, August 3, 2013
Health exchange releases new small business rates
"In San Diego County, four companies will offer SHOP plans: Sharp HealthCare, Health Net, Kaiser Permanente and Blue Shield."
Health exchange releases new small business rates
Says San Diego companies with fewer than 50 employees could save 12 percent
By Paul Sisson
Aug. 1, 2013
San Diego County small businesses will be able to save 12 percent on health insurance premiums for their employees if they buy coverage next year from the state’s newly created health exchange, officials announced Thursday.
Covered California, the state agency tasked with creating and running the new health insurance exchanges mandated by the Affordable Care Act of 2010, released selected rates for many California regions that it says are less expensive than those now available to businesses with 50 or fewer employees.
Federal health reform calls for each state to create a Small Business Health Options Program, often called SHOP, which will operate alongside a larger exchange tailored to individuals and families.
Both exchanges must be running by Oct. 1 to provide enough shopping time before Jan. 1, 2014, the date when most uninsured Americans must purchase coverage or pay a small penalty.
Small business rates are separated into 19 different geographical regions. In San Diego County, four companies will offer SHOP plans: Sharp HealthCare, Health Net, Kaiser Permanente and Blue Shield.
Covered California did not provide a full list of potential premiums for each company but instead compared prices for a single 40-year-old employee.
Sharp, the only local company offering its own plan in the health exchange for individuals and families, said in a statement that serving businesses made sense because the health system has “long been active in serving the small group market in San Diego.”
In San Diego County, the average of the three lowest premiums offered in the exchange was $290, a rate that the state claims is 12 percent less than an average of $324 for “comparable” small group plans sold this year.
Scott Hauge, president of Small Business California, a nonprofit advocacy group that lobbies in Sacramento on issues that affect small businesses, lauded the rates as a step toward controlling costs.
“It’s a good first step. It adds competition to the market, and any time you add competition, it’s a positive,” Hauge said.
But not everyone was so impressed. Bill Hammett, a San Diego area insurance broker, said there was no way to tell how the state selected a comparable plan to make its cost comparison. He said that, overall, there is just not much difference in costs between companies offering plans on the exchange and those operating in the open market.v “I have no ax to grind with the SHOP exchange, but I just don’t think it’s going to be the huge splash they were hoping for,” Hammett said.
Dana Howard, deputy director of media and public relations for Covered California, said prices are only one aspect of the SHOP exchange. He said the exchange is designed to allow small companies to act like their bigger competitors by allowing flexibility in the plan selected.
The SHOP exchange, he said, allows a company to “anchor” their coverage on a certain plan and allocate a set amount of money, say 50 percent, that they want to spend on an employee’s premium. But employees can decide on their own to go with a different insurance company offered on the exchange if they don’t like the one their employer selected. That ability [for employees] to move to different plans, Howard said, is usually an expensive option that most small companies can’t afford...
Health exchange releases new small business rates
Says San Diego companies with fewer than 50 employees could save 12 percent
By Paul Sisson
Aug. 1, 2013
San Diego County small businesses will be able to save 12 percent on health insurance premiums for their employees if they buy coverage next year from the state’s newly created health exchange, officials announced Thursday.
Covered California, the state agency tasked with creating and running the new health insurance exchanges mandated by the Affordable Care Act of 2010, released selected rates for many California regions that it says are less expensive than those now available to businesses with 50 or fewer employees.
Federal health reform calls for each state to create a Small Business Health Options Program, often called SHOP, which will operate alongside a larger exchange tailored to individuals and families.
Both exchanges must be running by Oct. 1 to provide enough shopping time before Jan. 1, 2014, the date when most uninsured Americans must purchase coverage or pay a small penalty.
Small business rates are separated into 19 different geographical regions. In San Diego County, four companies will offer SHOP plans: Sharp HealthCare, Health Net, Kaiser Permanente and Blue Shield.
Covered California did not provide a full list of potential premiums for each company but instead compared prices for a single 40-year-old employee.
Sharp, the only local company offering its own plan in the health exchange for individuals and families, said in a statement that serving businesses made sense because the health system has “long been active in serving the small group market in San Diego.”
In San Diego County, the average of the three lowest premiums offered in the exchange was $290, a rate that the state claims is 12 percent less than an average of $324 for “comparable” small group plans sold this year.
Scott Hauge, president of Small Business California, a nonprofit advocacy group that lobbies in Sacramento on issues that affect small businesses, lauded the rates as a step toward controlling costs.
“It’s a good first step. It adds competition to the market, and any time you add competition, it’s a positive,” Hauge said.
But not everyone was so impressed. Bill Hammett, a San Diego area insurance broker, said there was no way to tell how the state selected a comparable plan to make its cost comparison. He said that, overall, there is just not much difference in costs between companies offering plans on the exchange and those operating in the open market.v “I have no ax to grind with the SHOP exchange, but I just don’t think it’s going to be the huge splash they were hoping for,” Hammett said.
Dana Howard, deputy director of media and public relations for Covered California, said prices are only one aspect of the SHOP exchange. He said the exchange is designed to allow small companies to act like their bigger competitors by allowing flexibility in the plan selected.
The SHOP exchange, he said, allows a company to “anchor” their coverage on a certain plan and allocate a set amount of money, say 50 percent, that they want to spend on an employee’s premium. But employees can decide on their own to go with a different insurance company offered on the exchange if they don’t like the one their employer selected. That ability [for employees] to move to different plans, Howard said, is usually an expensive option that most small companies can’t afford...
Montana Experiment Brings NHS-Style Health Care to USA; Saves State Millions, Patients Delighted
"[D]ivision manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened."
Montana Experiment Brings NHS-Style Health Care to USA; Saves State Millions, Patients Delighted
by james321
Daily Kos
Jul 31, 2013
Former Montana Gov. Brian Schweitzer has pledged his support for single-payer health care in the past, but his recent efforts to bring zero-cost sharing primary and preventive care to Montana government employees and retirees may be doing something that most progressives would only dream could happen in America: bringing NHS-style, socialized medicine to Montana.
This is a big deal and -- while currently limited to state employees and retirees -- could be laying the groundwork for America's most socially-just health care system. NPR has the details:
A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.
A year later, the state says the clinic is already saving money.
Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.
"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.
That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.v Yup, nobody is forced to visit this publicly-financed clinic run by a private operator. If they wish, they can take their big-profit, private health insurance and head to any doctor they want, but folks are recognizing that this, err... public option, provides better care. And, when patients do make this choice, both the state and patients save money.
The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.
Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.
"Because there's no markup, our cost per visit is lower than in a private fee-for-service environment," Hill says.
Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.
Bottom line: a patient's visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it's free to patients, hundreds of people have come in who had not seen a doctor for at least two years.
Take a second and let the words above sink in real deep. There you have exactly why the UK, Canada, Australia, Italy, Costa Rica, Cuba and other first-world -- and third-world -- countries are able to secure better health care outcomes than the United States with dramatically lower health care spending. Imagine what -- let's call it the Montana model -- could do for our national debt. And, you know, even more importantly, the health of our people and the wellbeing of our medical professionals.
Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money.
Clinic operations director and physician's assistant Jimmie Barnwell says this model feels more rewarding to him.
"Having those barriers of time and money taken out of the way are a big part [of what gets] people to come into the clinic. But then, when they come into the clinic, they get a lot of face time with the nurses and the doctors," Barnwell says.v Again, common sense that's not too common in these United States -- with the exception of Montana -- at the moment. High-deductible garbage plans -- promoted by big wigs at Aetna and Cigna who want patients to have more 'skin in the game' -- lead patients to delay putting off that chest pain until it becomes a heart attack...and open-heart surgery. When doctors aren't dealing with private health insurer bureaucracy and any sort of medical billing, the entire resources of the practice go towards taking care of human beings. When doctors are salaried instead of operating with a fee-for-service model, they emphasize quality over quantity. This is how medicine works in the UK, Canada and many other countries where protecting the wealth of hospital and insurance company CEOs is not the primary goal of the health care system.
Even Republicans -- who, you know, are naturally predisposed to hate the idea of patients seeing doctors without cost-sharing -- have a tough time faulting the new clinics.
"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.
...
Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.v "They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.
Well, Mr. Republican, they're saving the state millions -- you just won't admit it, but at least you admit you love the socialized medicine.
What's most exciting about these clinics? More are on the way.
Montana recently opened a second state employee health clinic in Billings, the state's largest city. Others are in the works.
And best of all? Schweitzer went right around the backs of Republicans to set up these life- and money-saving clinics. That's bold, progressive leadership. Let's do our best to spread the news far and wide about how the "Montana model" is proving what much of the rest of the world already knows: the ideal primary health care system should be free at point of use.
Montana Experiment Brings NHS-Style Health Care to USA; Saves State Millions, Patients Delighted
by james321
Daily Kos
Jul 31, 2013
Former Montana Gov. Brian Schweitzer has pledged his support for single-payer health care in the past, but his recent efforts to bring zero-cost sharing primary and preventive care to Montana government employees and retirees may be doing something that most progressives would only dream could happen in America: bringing NHS-style, socialized medicine to Montana.
This is a big deal and -- while currently limited to state employees and retirees -- could be laying the groundwork for America's most socially-just health care system. NPR has the details:
A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.
A year later, the state says the clinic is already saving money.
Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.
"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.
That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.v Yup, nobody is forced to visit this publicly-financed clinic run by a private operator. If they wish, they can take their big-profit, private health insurance and head to any doctor they want, but folks are recognizing that this, err... public option, provides better care. And, when patients do make this choice, both the state and patients save money.
The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.
Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.
"Because there's no markup, our cost per visit is lower than in a private fee-for-service environment," Hill says.
Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.
Bottom line: a patient's visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it's free to patients, hundreds of people have come in who had not seen a doctor for at least two years.
Take a second and let the words above sink in real deep. There you have exactly why the UK, Canada, Australia, Italy, Costa Rica, Cuba and other first-world -- and third-world -- countries are able to secure better health care outcomes than the United States with dramatically lower health care spending. Imagine what -- let's call it the Montana model -- could do for our national debt. And, you know, even more importantly, the health of our people and the wellbeing of our medical professionals.
Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money.
Clinic operations director and physician's assistant Jimmie Barnwell says this model feels more rewarding to him.
"Having those barriers of time and money taken out of the way are a big part [of what gets] people to come into the clinic. But then, when they come into the clinic, they get a lot of face time with the nurses and the doctors," Barnwell says.v Again, common sense that's not too common in these United States -- with the exception of Montana -- at the moment. High-deductible garbage plans -- promoted by big wigs at Aetna and Cigna who want patients to have more 'skin in the game' -- lead patients to delay putting off that chest pain until it becomes a heart attack...and open-heart surgery. When doctors aren't dealing with private health insurer bureaucracy and any sort of medical billing, the entire resources of the practice go towards taking care of human beings. When doctors are salaried instead of operating with a fee-for-service model, they emphasize quality over quantity. This is how medicine works in the UK, Canada and many other countries where protecting the wealth of hospital and insurance company CEOs is not the primary goal of the health care system.
Even Republicans -- who, you know, are naturally predisposed to hate the idea of patients seeing doctors without cost-sharing -- have a tough time faulting the new clinics.
"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.
...
Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.v "They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.
Well, Mr. Republican, they're saving the state millions -- you just won't admit it, but at least you admit you love the socialized medicine.
What's most exciting about these clinics? More are on the way.
Montana recently opened a second state employee health clinic in Billings, the state's largest city. Others are in the works.
And best of all? Schweitzer went right around the backs of Republicans to set up these life- and money-saving clinics. That's bold, progressive leadership. Let's do our best to spread the news far and wide about how the "Montana model" is proving what much of the rest of the world already knows: the ideal primary health care system should be free at point of use.
Sunday, October 14, 2012
A Possibly Fatal Mistake
A Possibly Fatal Mistake
Daniel Stolle
By NICHOLAS D. KRISTOF
New York Times
October 12, 2012
MY wife and I attended my 30-year college reunion a couple of weekends ago, but the partying was bittersweet. My freshman roommate, Scott Androes, was in a Seattle hospital bed, a victim in part of a broken health care system. Strip away the sound and fury of campaign ads and rival spinmeisters, and what’s at stake in this presidential election is, in part, lives like Scott’s.
Scott and I were both Oregon farm boys, friends through the Future Farmers of America, when Harvard sent us thick envelopes. We were exhilarated but nervous, for neither of us had ever actually visited Harvard, and we asked to room together for moral support among all those city slickers.
We were the country bumpkins of Harvard Yard. Yet if we amused our classmates more than we intended, we had our private jokes as well. We let slip (falsely) that we kept deer rifles under our beds and smiled as our friends gave them a wide berth.
Scott was there when I limped back from the Worst Date in History (quite regularly), and he and I together worked our way onto the Crimson, the student newspaper. He had an omnivorous mind: Scott may be the only champion judge of dairy cattle who enjoyed quoting Thomas Macaulay, the 19th-century British historian. Scott topped off his erudition with a crackling wit to deflate pretentiousness (which, at Harvard, kept him busy).
By nature, Scott was even-keeled, prudent and cautious, and he always looked like the mild-mannered financial consultant that he became. He never lost his temper, never drove too fast, never got drunk, never smoked marijuana.
Well, not that I remember. I don’t want to discredit his youth.
Yet for all his innate prudence, Scott now, at age 52, is suffering from Stage 4 prostate cancer, in part because he didn’t have health insurance. President Obama’s health care reform came just a bit too late to help Scott, but it will protect others like him — unless Mitt Romney repeals it.
If you favor gutting “Obamacare,” please listen to Scott’s story. He is willing to recount his embarrassing tale in part so that readers can learn from it.
I’ll let Scott take over the narrative:
It all started in December 2003 when I quit my job as a pension consultant in a fit of midlife crisis. For the next year I did little besides read books I’d always wanted to read and play poker in the local card rooms.
I didn’t buy health insurance because I knew it would be really expensive in the individual policy market, because many of the people in this market are high risk. I would have bought insurance if there had been any kind of fair-risk pooling. In 2005 I started working seasonally for H&R Block doing tax returns.
As seasonal work it of course doesn’t provide health benefits, but then lots of full-time jobs don’t either. I knew I was taking a big risk without insurance, but I was foolish.
In 2011 I began having greater difficulty peeing. I didn’t go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision.
Early this year, I began seeing blood in my urine, and then I got scared. I Googled “blood in urine” and turned up several possible explanations. I remember sitting at my computer and thinking, “Well, I can afford the cost of an infection, but cancer would probably bust my bank and take everything in my I.R.A. So I’m just going to bet on this being an infection.”
I was extremely busy at work since it was peak tax season, so I figured I’d go after April 15. Then I developed a 102-degree fever and went to one of those urgent care clinics in a strip mall. (I didn’t have a regular physician and hadn’t been getting annual physicals.)
The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. That seemed to help, but by April 15 it seemed to be getting worse again. On May 3 I saw a urologist, and he drew blood for tests, but the results weren’t back yet that weekend when my health degenerated rapidly.
A friend took me to the Swedish Medical Center Emergency Room near my home. Doctors ran blood labs immediately. A normal P.S.A. test for prostate cancer is below 4, and mine was 1,100. They also did a CT scan, which turned up possible signs of cancerous bone lesions. Prostate cancer likes to spread to bones.
I also had a blood disorder called disseminated intravascular coagulation, which is sometimes brought on by prostate cancer. It basically causes you to destroy your own blood cells, and it’s abbreviated as D.I.C. Medical students joke that it stands for “death is close.”... •
Daniel Stolle
By NICHOLAS D. KRISTOF
New York Times
October 12, 2012
MY wife and I attended my 30-year college reunion a couple of weekends ago, but the partying was bittersweet. My freshman roommate, Scott Androes, was in a Seattle hospital bed, a victim in part of a broken health care system. Strip away the sound and fury of campaign ads and rival spinmeisters, and what’s at stake in this presidential election is, in part, lives like Scott’s.
Scott and I were both Oregon farm boys, friends through the Future Farmers of America, when Harvard sent us thick envelopes. We were exhilarated but nervous, for neither of us had ever actually visited Harvard, and we asked to room together for moral support among all those city slickers.
We were the country bumpkins of Harvard Yard. Yet if we amused our classmates more than we intended, we had our private jokes as well. We let slip (falsely) that we kept deer rifles under our beds and smiled as our friends gave them a wide berth.
Scott was there when I limped back from the Worst Date in History (quite regularly), and he and I together worked our way onto the Crimson, the student newspaper. He had an omnivorous mind: Scott may be the only champion judge of dairy cattle who enjoyed quoting Thomas Macaulay, the 19th-century British historian. Scott topped off his erudition with a crackling wit to deflate pretentiousness (which, at Harvard, kept him busy).
By nature, Scott was even-keeled, prudent and cautious, and he always looked like the mild-mannered financial consultant that he became. He never lost his temper, never drove too fast, never got drunk, never smoked marijuana.
Well, not that I remember. I don’t want to discredit his youth.
Yet for all his innate prudence, Scott now, at age 52, is suffering from Stage 4 prostate cancer, in part because he didn’t have health insurance. President Obama’s health care reform came just a bit too late to help Scott, but it will protect others like him — unless Mitt Romney repeals it.
If you favor gutting “Obamacare,” please listen to Scott’s story. He is willing to recount his embarrassing tale in part so that readers can learn from it.
I’ll let Scott take over the narrative:
It all started in December 2003 when I quit my job as a pension consultant in a fit of midlife crisis. For the next year I did little besides read books I’d always wanted to read and play poker in the local card rooms.
I didn’t buy health insurance because I knew it would be really expensive in the individual policy market, because many of the people in this market are high risk. I would have bought insurance if there had been any kind of fair-risk pooling. In 2005 I started working seasonally for H&R Block doing tax returns.
As seasonal work it of course doesn’t provide health benefits, but then lots of full-time jobs don’t either. I knew I was taking a big risk without insurance, but I was foolish.
In 2011 I began having greater difficulty peeing. I didn’t go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision.
Early this year, I began seeing blood in my urine, and then I got scared. I Googled “blood in urine” and turned up several possible explanations. I remember sitting at my computer and thinking, “Well, I can afford the cost of an infection, but cancer would probably bust my bank and take everything in my I.R.A. So I’m just going to bet on this being an infection.”
I was extremely busy at work since it was peak tax season, so I figured I’d go after April 15. Then I developed a 102-degree fever and went to one of those urgent care clinics in a strip mall. (I didn’t have a regular physician and hadn’t been getting annual physicals.)
The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. That seemed to help, but by April 15 it seemed to be getting worse again. On May 3 I saw a urologist, and he drew blood for tests, but the results weren’t back yet that weekend when my health degenerated rapidly.
A friend took me to the Swedish Medical Center Emergency Room near my home. Doctors ran blood labs immediately. A normal P.S.A. test for prostate cancer is below 4, and mine was 1,100. They also did a CT scan, which turned up possible signs of cancerous bone lesions. Prostate cancer likes to spread to bones.
I also had a blood disorder called disseminated intravascular coagulation, which is sometimes brought on by prostate cancer. It basically causes you to destroy your own blood cells, and it’s abbreviated as D.I.C. Medical students joke that it stands for “death is close.”... •
Thursday, June 28, 2012
Supreme Court upholds Obama’s health-care law
Supreme Court upholds Obama’s health-care law
By Robert Barnes
June 28, 2012
Washington Post
Chief Justice John G. Roberts Jr. on Thursday joined the liberal wing of the Supreme Court to save the heart of President Obama’s landmark health-care law, agreeing that the requirement for nearly all Americans to secure health insurance is permissible under Congress’s taxing authority.
Even as it upheld that central component of the Patient Protection and Affordable Care Act, however, the court modified another key provision of the law, ruling that the federal government cannot withdraw existing Medicaid funding from states that decide not to participate in a broad expansion of Medicaid eligibility.
The court’s historic compromise, which will affect the health-care choices of millions of Americans, amounts to a major victory for the White House less than five months before the November elections, although the Medicaid decision sets new limits on the power of the national government.
President Obama welcomed the ruling, which he called “a victory for people all over this country whose lives will be more secure.” He said the decision would allow the health-care law to offer millions of currently uninsured Americans “an array of quality, affordable health-insurance plans to choose from” starting in 2014.
“Today the Supreme Court also upheld the principle that people who can afford health insurance should take the responsibility to buy health insurance,” Obama said in televised speech at the White House. He said he knew that this individual mandate “wouldn’t be politically popular” and that the debate over the law “has been divisive.” But he said the law was “good for the country” and “good for the American people.”
“The highest court in the land has now spoken,” Obama said. “We will continue to implement this law. And we’ll work together to improve on it where we can. But what we won’t do, what the country can’t afford to do, is refight the political battles of two years ago or go back to the way things were. With today’s announcement, it’s time for us to move forward.”
Illustrating the divided nature of the ruling, Justice Anthony M. Kennedy, representing the court’s most consistent conservatives, read a scathing dissent, while Justice Ruth Bader Ginsburg, representing the liberals, issued a separate opinion supporting Roberts but differing with him on key aspects of the case...
By Robert Barnes
June 28, 2012
Washington Post
Chief Justice John G. Roberts Jr. on Thursday joined the liberal wing of the Supreme Court to save the heart of President Obama’s landmark health-care law, agreeing that the requirement for nearly all Americans to secure health insurance is permissible under Congress’s taxing authority.
Even as it upheld that central component of the Patient Protection and Affordable Care Act, however, the court modified another key provision of the law, ruling that the federal government cannot withdraw existing Medicaid funding from states that decide not to participate in a broad expansion of Medicaid eligibility.
The court’s historic compromise, which will affect the health-care choices of millions of Americans, amounts to a major victory for the White House less than five months before the November elections, although the Medicaid decision sets new limits on the power of the national government.
President Obama welcomed the ruling, which he called “a victory for people all over this country whose lives will be more secure.” He said the decision would allow the health-care law to offer millions of currently uninsured Americans “an array of quality, affordable health-insurance plans to choose from” starting in 2014.
“Today the Supreme Court also upheld the principle that people who can afford health insurance should take the responsibility to buy health insurance,” Obama said in televised speech at the White House. He said he knew that this individual mandate “wouldn’t be politically popular” and that the debate over the law “has been divisive.” But he said the law was “good for the country” and “good for the American people.”
“The highest court in the land has now spoken,” Obama said. “We will continue to implement this law. And we’ll work together to improve on it where we can. But what we won’t do, what the country can’t afford to do, is refight the political battles of two years ago or go back to the way things were. With today’s announcement, it’s time for us to move forward.”
Illustrating the divided nature of the ruling, Justice Anthony M. Kennedy, representing the court’s most consistent conservatives, read a scathing dissent, while Justice Ruth Bader Ginsburg, representing the liberals, issued a separate opinion supporting Roberts but differing with him on key aspects of the case...
Sunday, April 29, 2012
Obama healthcare reforms lead to $1.3 billion in insurance rebates
Obama healthcare reforms lead to $1.3 billion in insurance rebates
By Noam N. Levey
April 26, 2012
U.S. consumers and businesses will receive an estimated $1.3 billion in rebates from insurance companies this year, according to a new study quantifying a key early benefit of the healthcare law that President Obama signed in 2010.
That will translate into anywhere from a few dollars to more than $150 for some 15 million consumers nationwide, the new report by the nonprofit Kaiser Family Foundation found.
Obama’s healthcare law requires insurers to spend a minimum portion of customers’ premiums on medical care, a provision championed by consumer groups concerned that companies were hiking premiums to pay for executive salaries, shareholder dividends and other expenses unrelated to their customers’ care.
Starting last year, if insurers did not meet these targets – known as medical loss ratios – they had to pay rebates this year to people enrolled in their plans.
The Kaiser study, which analyzed rate documents filed with state regulators nationwide, found 486 health plans nationwide that will be required to pay rebates, with the largest number in the so-called individual market serving people who do not get health coverage through work.
Nearly a third of all consumers in this market, which is widely seen as the most trouble-plagued in the country, will be eligible for a rebate.
Approximately a quarter of consumers in the small group insurance market and less than a fifth of consumers in the large group market qualified for rebates.
The study also found wide variation in states, with insurers selling individual health plans in some states such as Alaska, Maryland and Pennsylvania required to provide average rebates of around $300. In Hawaii and Maine, by contrast, no insurers in the individual market will have to provide rebates.
Data was not available for California because HMOs in the state are not subject to the same reporting requirements...
Wednesday, January 4, 2012
Bad news: if your doctor won't stand up for you to your insurance company, you're in trouble
New Year, New Deals? Breaking Down Health Plan, Doctor Alliances
by Dan Diamond
California Healthline Contributing Editor
January 04, 2012
The Washington Post's annual In/Out List doesn't crossover much with "Road to Reform." (Possibly for good reason; the latest edition says "wonks" are officially out this year.)
But this column is nothing if not occasionally gimmicky. So here's a one-time, two-line trend-spotting bonus for 2012:
Out: Physicians and insurance companies as mortal enemies.
In: Health insurers and physicians ... as partners.
Regular California Healthline readers know that several big payer-doctor deals were struck in 2011, disproportionately in the Golden State. UnitedHealth's Optum division acquired a handful of physician groups, most notably 2,300-member Irvine-based Monarch HealthCare. Other health plans teamed up with independent practice associations to launch accountable care organizations.
Are these deals an industry blip or the beginning of a boom?
Check back at year-end. For now, it's too soon to know.
The high-profile deals are garnering plenty of buzz, however. And given the rumblings, many other doctor groups and plans are scrambling to evaluate whether similar partnerships make sense.
Changes Afoot for Everyone
It's old news that industry players are taking on new roles.
Hospitals in 2011 ramped up the pace of physician acquisition, seeking to integrate care and gain reimbursement. More employers added responsibilities for their employees' wellness, hoping to cut costs.
But the physician and insurer deals are particularly striking because of the sectors' oft-contentious relationship. If doctors and health insurance plans aren't fighting over reimbursement, they're battling over paperwork or even public scorecards. Outside of Kaiser Permanente, many efforts at vertically integrated systems with insurers running doctor groups have largely failed.
Even the CEO of Monarch HealthCare is surprised by his own partnership with UnitedHealth.
"Not 10 years ago I would not have thought of something like this," Bart Asner told Modern Healthcare's Rebecca Vesely. But when seeking a partner, "[UnitedHealth] showed up on our doorstep."
What's Driving the New Partnerships
UnitedHealth's pursuit of Monarch -- and by extension, other plans looking to partner with physicians -- isn't a shock.
Given ongoing industry efforts to coordinate care, lock up primary care providers and cut costs, physician groups have many suitors.
But Vesely concludes that the reasons for physicians to team up with health plans, rather than merge with other doctors' groups or join a hospital, are less cut-and-dry.
One driver may be that national plans have much more financial wherewithal to meet the sales price for large groups, as well as their strategic ambitions. UnitedHealth projected profits of more than $5 billion in 2011. The average hospital clears about one-1000th of that per year.
Alternately, IPAs and health plans may be pushed together as dance partners while hospitals bulk up. The growing "dominance" of hospital-led health systems means that physician groups are losing market power and the ability to recruit new doctors, health care consultant Penny Stroud told American Medical News late last year, making plan ownership more appealing.
California at the Epicenter
These drivers can all be seen in the unlikely Monarch-UnitedHealth deal, which Vesely neatly breaks down in Modern Healthcare.
What UnitedHealth gains: Access to physicians for its members and better positioning in a new market of integrated care delivery.
What Monarch gains: Deep pockets to invest in electronic health records, clinical programs and its growth strategy.
A good share of these new physician-payer deals are unfolding in California.
That's partly because the state's long history with managed care offers fertile ground for such partnerships. The entrenched HMOs, large multidisciplinary physician groups and concentrated market have set up an ideal laboratory for attempting this kind of coordination.
CMS' efforts to reward integrated care also are pushing California's strong IPAs to the forefront. No state had more organizations named as Pioneer ACOs last month than the Golden State's six, which includes Monarch.
Reaction and Reassessment
Modern Healthcare calls the new deals a "marriage of convenience" -- and there's certainly little romance and a lot of number-crunching to the proceedings.
Monarch also leaves behind a pair of jilted ex-partners.
Blue Shield of California will end its contract with Monarch in May, citing the IPA's new relationship with UnitedHealth. Anthem Blue Cross has pulled out of the physician group's planned ACO pilot.
That ACO effort may become an early litmus test for the UnitedHealth-Monarch relationship. Other payers are watching how smaller-scale initiatives, like regional insurers' efforts to acquire physician clinics, are unfolding.
If the partnerships prove successful, expect a flurry of activity across 2012 as more payers and physicians make sure they're dealt in -- and not left out.
Here's what else to watch as the new year begins.
In the States
CMS on Dec. 20, 2011, approved a new three-year, $26.75 billion Medicaid waiver for Massachusetts that allows its 2006 health insurance law to continue and provides hospitals with incentives to offer quality-focused and cost-efficient care. The waiver will expire in June 2014 (Baker, "Healthwatch," The Hill, 12/20/11). The waiver is vital to the state law's primary goal of ensuring that most residents have health insurance (Conaboy, "White Coat Notes," Boston Globe, 12/20/11).
Texas Democrats in a recent letter urged HHS Secretary Kathleen Sebelius to reject the state's request for a waiver from the medical-loss ratio regulations under the federal health reform law (Pecquet, "Healthwatch," The Hill, 12/22/11).
The advocacy group Progress VA recently filed a petition seeking to pressure state lawmakers to disassociate with the American Legislative Exchange Council, a conservative, pro-business group that authored the state's lawsuit against the federal health care reform law (Pecquet, "Healthwatch," The Hill, 12/28/11).
Challenges to Reform
After more than a year of vowing to "repeal and replace" the federal health reform law, Republicans still have not developed a plan to substitute for it. Republican presidential candidates have proposed new tax credits and allowing residents to purchase health insurance over state lines as an alternative to the reform law. However, some conservative experts said the ideas might not work as intended and even if they did, they would be only the beginning of a true replacement for the Affordable Care Act (Fahrenhold, Washington Post, 12/24/11). In related news, a Kaiser Family Foundation survey shows that among opponents of the current reform law, most want the ACA repealed, but not replaced (Kliff, "WonkBlog," Washington Post, 12/26/11).
Inside the Industry
Health insurers in 2012 will start paying the federal government a $1 fee for each insured person to go toward funding the Patient-Centered Outcomes Research Institute, which aims to determine which medications, medical procedures, tests and treatments work best. While the Treasury Department said the fee would not likely be collected this year, insurers will still owe the federal government the amount. The fee rises to $2 per insured person in 2013 and rises with inflation each year thereafter (Alonso-Zaldivar, AP/Washington Times, 12/27/11).
CMS on Tuesday announced the names of 73 health care experts who will participate in its Innovation Advisors Program, which will support individuals who seek to pilot and refine innovative payment and delivery models. After an orientation phase, advisers will work with the CMS Innovation Center -- established through the health reform law -- to pilot health care delivery models in their local communities and create partnerships that can foster and disseminate successful ideas. Each adviser's organization will receive up to $20,000 to support his or her activities during their participation (CMS release, 1/3). The Innovation Advisors Program will select up to 200 participants within its first year. The agency is expected to reopen applications in Spring 2012 and select remaining advisors by June (CMS fact sheet, 1/3)...
by Dan Diamond
California Healthline Contributing Editor
January 04, 2012
The Washington Post's annual In/Out List doesn't crossover much with "Road to Reform." (Possibly for good reason; the latest edition says "wonks" are officially out this year.)
But this column is nothing if not occasionally gimmicky. So here's a one-time, two-line trend-spotting bonus for 2012:
Out: Physicians and insurance companies as mortal enemies.
In: Health insurers and physicians ... as partners.
Regular California Healthline readers know that several big payer-doctor deals were struck in 2011, disproportionately in the Golden State. UnitedHealth's Optum division acquired a handful of physician groups, most notably 2,300-member Irvine-based Monarch HealthCare. Other health plans teamed up with independent practice associations to launch accountable care organizations.
Are these deals an industry blip or the beginning of a boom?
Check back at year-end. For now, it's too soon to know.
The high-profile deals are garnering plenty of buzz, however. And given the rumblings, many other doctor groups and plans are scrambling to evaluate whether similar partnerships make sense.
Changes Afoot for Everyone
It's old news that industry players are taking on new roles.
Hospitals in 2011 ramped up the pace of physician acquisition, seeking to integrate care and gain reimbursement. More employers added responsibilities for their employees' wellness, hoping to cut costs.
But the physician and insurer deals are particularly striking because of the sectors' oft-contentious relationship. If doctors and health insurance plans aren't fighting over reimbursement, they're battling over paperwork or even public scorecards. Outside of Kaiser Permanente, many efforts at vertically integrated systems with insurers running doctor groups have largely failed.
Even the CEO of Monarch HealthCare is surprised by his own partnership with UnitedHealth.
"Not 10 years ago I would not have thought of something like this," Bart Asner told Modern Healthcare's Rebecca Vesely. But when seeking a partner, "[UnitedHealth] showed up on our doorstep."
What's Driving the New Partnerships
UnitedHealth's pursuit of Monarch -- and by extension, other plans looking to partner with physicians -- isn't a shock.
Given ongoing industry efforts to coordinate care, lock up primary care providers and cut costs, physician groups have many suitors.
But Vesely concludes that the reasons for physicians to team up with health plans, rather than merge with other doctors' groups or join a hospital, are less cut-and-dry.
One driver may be that national plans have much more financial wherewithal to meet the sales price for large groups, as well as their strategic ambitions. UnitedHealth projected profits of more than $5 billion in 2011. The average hospital clears about one-1000th of that per year.
Alternately, IPAs and health plans may be pushed together as dance partners while hospitals bulk up. The growing "dominance" of hospital-led health systems means that physician groups are losing market power and the ability to recruit new doctors, health care consultant Penny Stroud told American Medical News late last year, making plan ownership more appealing.
California at the Epicenter
These drivers can all be seen in the unlikely Monarch-UnitedHealth deal, which Vesely neatly breaks down in Modern Healthcare.
What UnitedHealth gains: Access to physicians for its members and better positioning in a new market of integrated care delivery.
What Monarch gains: Deep pockets to invest in electronic health records, clinical programs and its growth strategy.
A good share of these new physician-payer deals are unfolding in California.
That's partly because the state's long history with managed care offers fertile ground for such partnerships. The entrenched HMOs, large multidisciplinary physician groups and concentrated market have set up an ideal laboratory for attempting this kind of coordination.
CMS' efforts to reward integrated care also are pushing California's strong IPAs to the forefront. No state had more organizations named as Pioneer ACOs last month than the Golden State's six, which includes Monarch.
Reaction and Reassessment
Modern Healthcare calls the new deals a "marriage of convenience" -- and there's certainly little romance and a lot of number-crunching to the proceedings.
Monarch also leaves behind a pair of jilted ex-partners.
Blue Shield of California will end its contract with Monarch in May, citing the IPA's new relationship with UnitedHealth. Anthem Blue Cross has pulled out of the physician group's planned ACO pilot.
That ACO effort may become an early litmus test for the UnitedHealth-Monarch relationship. Other payers are watching how smaller-scale initiatives, like regional insurers' efforts to acquire physician clinics, are unfolding.
If the partnerships prove successful, expect a flurry of activity across 2012 as more payers and physicians make sure they're dealt in -- and not left out.
Here's what else to watch as the new year begins.
In the States
CMS on Dec. 20, 2011, approved a new three-year, $26.75 billion Medicaid waiver for Massachusetts that allows its 2006 health insurance law to continue and provides hospitals with incentives to offer quality-focused and cost-efficient care. The waiver will expire in June 2014 (Baker, "Healthwatch," The Hill, 12/20/11). The waiver is vital to the state law's primary goal of ensuring that most residents have health insurance (Conaboy, "White Coat Notes," Boston Globe, 12/20/11).
Texas Democrats in a recent letter urged HHS Secretary Kathleen Sebelius to reject the state's request for a waiver from the medical-loss ratio regulations under the federal health reform law (Pecquet, "Healthwatch," The Hill, 12/22/11).
The advocacy group Progress VA recently filed a petition seeking to pressure state lawmakers to disassociate with the American Legislative Exchange Council, a conservative, pro-business group that authored the state's lawsuit against the federal health care reform law (Pecquet, "Healthwatch," The Hill, 12/28/11).
Challenges to Reform
After more than a year of vowing to "repeal and replace" the federal health reform law, Republicans still have not developed a plan to substitute for it. Republican presidential candidates have proposed new tax credits and allowing residents to purchase health insurance over state lines as an alternative to the reform law. However, some conservative experts said the ideas might not work as intended and even if they did, they would be only the beginning of a true replacement for the Affordable Care Act (Fahrenhold, Washington Post, 12/24/11). In related news, a Kaiser Family Foundation survey shows that among opponents of the current reform law, most want the ACA repealed, but not replaced (Kliff, "WonkBlog," Washington Post, 12/26/11).
Inside the Industry
Health insurers in 2012 will start paying the federal government a $1 fee for each insured person to go toward funding the Patient-Centered Outcomes Research Institute, which aims to determine which medications, medical procedures, tests and treatments work best. While the Treasury Department said the fee would not likely be collected this year, insurers will still owe the federal government the amount. The fee rises to $2 per insured person in 2013 and rises with inflation each year thereafter (Alonso-Zaldivar, AP/Washington Times, 12/27/11).
CMS on Tuesday announced the names of 73 health care experts who will participate in its Innovation Advisors Program, which will support individuals who seek to pilot and refine innovative payment and delivery models. After an orientation phase, advisers will work with the CMS Innovation Center -- established through the health reform law -- to pilot health care delivery models in their local communities and create partnerships that can foster and disseminate successful ideas. Each adviser's organization will receive up to $20,000 to support his or her activities during their participation (CMS release, 1/3). The Innovation Advisors Program will select up to 200 participants within its first year. The agency is expected to reopen applications in Spring 2012 and select remaining advisors by June (CMS fact sheet, 1/3)...
Sunday, October 23, 2011
Employers to continue raising rates, shifting cost to workers
About 31 percent of workers are in so-called high deductible plans this year, up from 10 percent in 2006, according to a Kaiser Family Foundation survey. Such policies are sometimes accompanied by a tax-sheltered savings account that can be used for health expenses.
Employers to continue raising rates, shifting cost to workers
Jim Gallagher
STLtoday.com
October 23, 2011
As open enrollment for health insurance approaches, employees can expect the same-old same-old — paying more for less coverage.
The real cost of health insurance will rise an average of 7.1 percent nationally for 2012, based on early results from a Mercer survey of employers.
That's actually an improvement. Costs have been spiking annually at 9 percent for about five years, said Mercer, the big human resources company.
Companies are responding by cutting benefits, urging employees into lower-cost plans and charging employees a bigger share of premiums. Only 39 percent of companies will not shift costs to employees next year, according to the survey.
Usually starting in November, open enrollment allows workers to choose from a menu of plans offered by their employer. As cost rise, many employees are moving into plans with deductibles of at least $1,000 for single coverage, and higher for families. About 31 percent of workers are in so-called high deductible plans this year, up from 10 percent in 2006, according to a Kaiser Family Foundation survey. Such policies are sometimes accompanied by a tax-sheltered savings account that can be used for health expenses.
Cost-shifting maneuvers are helping companies hold their own cost increase down to an average of 5.4 percent, according to Mercer...
Employer Health Plans Often Omit Part-Timer Workers
Kaiser Health News.org
Oct 23, 2011
Several news outlets this weekend covered work-based insurance issues, including reaction to the Wal-Mart announcement that it would be cutting back coverage for new part-timers and what workers in a number of places should expect as their bosses roll out policies for the coming year.
The Washington Post: Health-Care Coverage Still Eludes Some Part-Time Workers
The news came as a shock: Wal-Mart, the nation’s largest private employer, would not offer health benefits to new part-time employees, the company said Friday. But perhaps it shouldn’t have been so surprising, since the retailer was among a minority of U.S. businesses. Only 16 percent of employers offer health insurance to part-timers, according to the Kaiser Family Foundation’s most recent Employer Health Benefits Survey. The number increases to 42 percent among large employers. ... The health-care law that Congress passed last year is unlikely to change that. While part-time workers will have access to new, subsidized coverage on the individual market, the Obama administration’s signature legislative achievement provides little incentive for employers to cover workers who are not full-time staff (Kliff, 10/22)...
Employers to continue raising rates, shifting cost to workers
Jim Gallagher
STLtoday.com
October 23, 2011
As open enrollment for health insurance approaches, employees can expect the same-old same-old — paying more for less coverage.
The real cost of health insurance will rise an average of 7.1 percent nationally for 2012, based on early results from a Mercer survey of employers.
That's actually an improvement. Costs have been spiking annually at 9 percent for about five years, said Mercer, the big human resources company.
Companies are responding by cutting benefits, urging employees into lower-cost plans and charging employees a bigger share of premiums. Only 39 percent of companies will not shift costs to employees next year, according to the survey.
Usually starting in November, open enrollment allows workers to choose from a menu of plans offered by their employer. As cost rise, many employees are moving into plans with deductibles of at least $1,000 for single coverage, and higher for families. About 31 percent of workers are in so-called high deductible plans this year, up from 10 percent in 2006, according to a Kaiser Family Foundation survey. Such policies are sometimes accompanied by a tax-sheltered savings account that can be used for health expenses.
Cost-shifting maneuvers are helping companies hold their own cost increase down to an average of 5.4 percent, according to Mercer...
Employer Health Plans Often Omit Part-Timer Workers
Kaiser Health News.org
Oct 23, 2011
Several news outlets this weekend covered work-based insurance issues, including reaction to the Wal-Mart announcement that it would be cutting back coverage for new part-timers and what workers in a number of places should expect as their bosses roll out policies for the coming year.
The Washington Post: Health-Care Coverage Still Eludes Some Part-Time Workers
The news came as a shock: Wal-Mart, the nation’s largest private employer, would not offer health benefits to new part-time employees, the company said Friday. But perhaps it shouldn’t have been so surprising, since the retailer was among a minority of U.S. businesses. Only 16 percent of employers offer health insurance to part-timers, according to the Kaiser Family Foundation’s most recent Employer Health Benefits Survey. The number increases to 42 percent among large employers. ... The health-care law that Congress passed last year is unlikely to change that. While part-time workers will have access to new, subsidized coverage on the individual market, the Obama administration’s signature legislative achievement provides little incentive for employers to cover workers who are not full-time staff (Kliff, 10/22)...
Friday, August 12, 2011
Appeals court strikes down health overhaul requirement that most Americans must buy insurance
The way I see it, Americans shouldn't have to die or be physically damaged simply because they don't have healthcare. Also, they shouldn't end up financially devastated by illness or injury.
This means we all have to chip in to provide health care for all. Having everyone buy health insurance is one way of doing this. But if this isn't possible, then the only solution I can see is a single-payer system.
Appeals court strikes down health overhaul requirement that most Americans must buy insurance
By Associated Press
August 12, 2011
ATLANTA — A federal appeals court panel on Friday struck down the requirement in President Barack Obama’s health care overhaul package that virtually all Americans must carry health insurance or face penalties.
The divided three-judge panel of the 11th Circuit Court of Appeals struck down the so-called individual mandate, siding with 26 states that had sued to block the law. But the panel didn’t go as far as a lower court that had invalidated the entire overhaul as unconstitutional...
This means we all have to chip in to provide health care for all. Having everyone buy health insurance is one way of doing this. But if this isn't possible, then the only solution I can see is a single-payer system.
Appeals court strikes down health overhaul requirement that most Americans must buy insurance
By Associated Press
August 12, 2011
ATLANTA — A federal appeals court panel on Friday struck down the requirement in President Barack Obama’s health care overhaul package that virtually all Americans must carry health insurance or face penalties.
The divided three-judge panel of the 11th Circuit Court of Appeals struck down the so-called individual mandate, siding with 26 states that had sued to block the law. But the panel didn’t go as far as a lower court that had invalidated the entire overhaul as unconstitutional...
Saturday, April 16, 2011
A long way to go on health reform
A long way to go on health reform
By Umang Malhotra
San Diego Union-Tribune
April 15, 2011
The American health care system has been leaking like an old car for decades. Congress, in the search for a universal solution, is using a piecemeal or duct tape approach to stop the leaks. Our lawmakers bemoan the expense, while using the most cost-ineffective solution.
The system is undeniably broken. By reputable measurements, America ranks first in obesity, 27th in life expectancy, 37th in infant mortality and 54th in access to health care (tied with Fiji). CIA World Factbook figures are even worse. Despite the U.S. spending twice what the next affluent country spends per person, all international comparisons show that America lies near the bottom on health care. According to AARP data, it also lags far behind other countries in long-term care for seniors. Nearly 50 million people in the U.S. are uninsured; millions are underinsured, and more than half the personal bankruptcies – over 1 million a year – are caused by medical bills, something unheard of elsewhere.
America is the only affluent nation unable to provide universal health care for its residents – astonishing for the richest country in the world.
The reason is a money-driven system – riddled with interest groups selfishly fighting to protect their own constituencies. With the cost of health care rising at more than twice the rate of inflation, it is already a huge problem for businesses and governments. If it continues, it will be disastrous.
The health care bill signed by President Barack Obama is neither universal nor is it likely to ever be cost-effective. It is nearly 2,700 pages, and with the addition of all the enabling regulations, becomes a minefield open to interpretations in the hands of insurance companies and lawyers – a bureaucratic nightmare. The cost of premiums and payments from your pockets will keep on rising.
Sadly, many legislators turn the issue into an ideological controversy, rather than a search for common good. They bury their heads in a sand of partisanship, power and hypocrisy; accepting government health care plans for their families while denying the same to the rest of the population.
Other issues, uniquely American, are lobbying by insurance and drug companies, and the involvement of vast armies of lawyers. The same drug costs much more in America than in other countries, while frivolous malpractice lawsuits escalate the costly practice of defensive medicine...
By Umang Malhotra
San Diego Union-Tribune
April 15, 2011
The American health care system has been leaking like an old car for decades. Congress, in the search for a universal solution, is using a piecemeal or duct tape approach to stop the leaks. Our lawmakers bemoan the expense, while using the most cost-ineffective solution.
The system is undeniably broken. By reputable measurements, America ranks first in obesity, 27th in life expectancy, 37th in infant mortality and 54th in access to health care (tied with Fiji). CIA World Factbook figures are even worse. Despite the U.S. spending twice what the next affluent country spends per person, all international comparisons show that America lies near the bottom on health care. According to AARP data, it also lags far behind other countries in long-term care for seniors. Nearly 50 million people in the U.S. are uninsured; millions are underinsured, and more than half the personal bankruptcies – over 1 million a year – are caused by medical bills, something unheard of elsewhere.
America is the only affluent nation unable to provide universal health care for its residents – astonishing for the richest country in the world.
The reason is a money-driven system – riddled with interest groups selfishly fighting to protect their own constituencies. With the cost of health care rising at more than twice the rate of inflation, it is already a huge problem for businesses and governments. If it continues, it will be disastrous.
The health care bill signed by President Barack Obama is neither universal nor is it likely to ever be cost-effective. It is nearly 2,700 pages, and with the addition of all the enabling regulations, becomes a minefield open to interpretations in the hands of insurance companies and lawyers – a bureaucratic nightmare. The cost of premiums and payments from your pockets will keep on rising.
Sadly, many legislators turn the issue into an ideological controversy, rather than a search for common good. They bury their heads in a sand of partisanship, power and hypocrisy; accepting government health care plans for their families while denying the same to the rest of the population.
Other issues, uniquely American, are lobbying by insurance and drug companies, and the involvement of vast armies of lawyers. The same drug costs much more in America than in other countries, while frivolous malpractice lawsuits escalate the costly practice of defensive medicine...
Monday, January 24, 2011
Health-care law: Arizona tries new approach to get by federal Medicaid rules
Health-care law: Arizona tries new approach to get by federal Medicaid rules
By N.C. Aizenman
Washington Post
January 23, 2011
Republican efforts to repeal or limit the reach of the new health-care law took a new direction last week when Arizona lawmakers approved a novel and controversial attempt to cut Medicaid for 280,000 of the state's poor.
The bill, requested and signed by Gov. Jan Brewer (R), empowers her to make a formal request, most likely this week, for a federal waiver to avoid complying with provisions of the law that prohibit states from tightening their eligibility requirements for Medicaid.
Twenty-nine Republican governors, including Brewer, have signed a letter calling on President Obama and congressional leaders to remove the provision from the law.
But Arizona is the first state to, in effect, play chicken with the Obama administration by directly requesting a reprieve and daring Health and Human Services Secretary Kathleen Sebelius to refuse.
The move is widely regarded as a long shot. While a spokesman said the White House had no comment on Arizona's request, administration officials have shown scant interest when asked about the idea in the past.
Still, Arizona's move reflects two pressing realities: Many states face large budget shortfalls because of continuing economic difficulties, and Republican governors point to Medicaid cuts as one of the most logical ways to balance those budgets...
By N.C. Aizenman
Washington Post
January 23, 2011
Republican efforts to repeal or limit the reach of the new health-care law took a new direction last week when Arizona lawmakers approved a novel and controversial attempt to cut Medicaid for 280,000 of the state's poor.
The bill, requested and signed by Gov. Jan Brewer (R), empowers her to make a formal request, most likely this week, for a federal waiver to avoid complying with provisions of the law that prohibit states from tightening their eligibility requirements for Medicaid.
Twenty-nine Republican governors, including Brewer, have signed a letter calling on President Obama and congressional leaders to remove the provision from the law.
But Arizona is the first state to, in effect, play chicken with the Obama administration by directly requesting a reprieve and daring Health and Human Services Secretary Kathleen Sebelius to refuse.
The move is widely regarded as a long shot. While a spokesman said the White House had no comment on Arizona's request, administration officials have shown scant interest when asked about the idea in the past.
Still, Arizona's move reflects two pressing realities: Many states face large budget shortfalls because of continuing economic difficulties, and Republican governors point to Medicaid cuts as one of the most logical ways to balance those budgets...
Wednesday, May 26, 2010
Study: Health care reform a good deal for California, other states
Study: Health care reform a good deal for California, other states
MercuryNews.com
By Mike Zapler
05/26/2010
WASHINGTON — A new report estimates that the national heath care reform law will allow California and other states to significantly pare the ranks of the uninsured at a relatively small cost, as the federal government picks up the lion's share of additional costs of expanding coverage.
In a joint study released Wednesday, the Kaiser Family Foundation and Urban Institute examined the cost to states of expanding Medicaid, one of the main vehicles in the reform law to cover the uninsured. The law will expand the federal health care program for the poor (known as Medi-Cal in California), to those earning up to 133 percent of the federal poverty line, or $14,400 for an individual. Medi-Cal rules vary, but generally it covers families who make up to 106 percent of the poverty level...
MercuryNews.com
By Mike Zapler
05/26/2010
WASHINGTON — A new report estimates that the national heath care reform law will allow California and other states to significantly pare the ranks of the uninsured at a relatively small cost, as the federal government picks up the lion's share of additional costs of expanding coverage.
In a joint study released Wednesday, the Kaiser Family Foundation and Urban Institute examined the cost to states of expanding Medicaid, one of the main vehicles in the reform law to cover the uninsured. The law will expand the federal health care program for the poor (known as Medi-Cal in California), to those earning up to 133 percent of the federal poverty line, or $14,400 for an individual. Medi-Cal rules vary, but generally it covers families who make up to 106 percent of the poverty level...
Monday, May 11, 2009
Group wants to cut $2 trillion from US health care costs over 10 years
Interested parties are discussing "legislation that would direct Medicare to reward health-care providers who get better outcomes for patients using less costly procedures."
MAY 11, 2009
Industry Officials Dismiss Concerns About Health Costs Plan
By Patrick Yoest
DOW JONES NEWSWIRES
A team of health-care industry groups that announced a $2 trillion cost-saving initiative Monday expressed little worry about the effect of cuts on their bottom lines, saying that skepticism about the plan is unwarranted.
The groups, which represent health insurers, hospitals, doctors and other health workers, met with President Obama on Monday to discuss their initiative. They have sketched out a 10-year plan to slow the growth of health costs by $2 trillion by drawing down the rate of cost increases in the sector by 1.5% each year...
Meetings among the groups - which also include the American Medical Association, PhRMA and the Service Employees International Union (SEIU) - intensified in recent weeks, with the SEIU taking a lead role. The groups recently have taken to meeting on Saturdays, they said...
MAY 11, 2009
Industry Officials Dismiss Concerns About Health Costs Plan
By Patrick Yoest
DOW JONES NEWSWIRES
A team of health-care industry groups that announced a $2 trillion cost-saving initiative Monday expressed little worry about the effect of cuts on their bottom lines, saying that skepticism about the plan is unwarranted.
The groups, which represent health insurers, hospitals, doctors and other health workers, met with President Obama on Monday to discuss their initiative. They have sketched out a 10-year plan to slow the growth of health costs by $2 trillion by drawing down the rate of cost increases in the sector by 1.5% each year...
Meetings among the groups - which also include the American Medical Association, PhRMA and the Service Employees International Union (SEIU) - intensified in recent weeks, with the SEIU taking a lead role. The groups recently have taken to meeting on Saturdays, they said...
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