Consumer Directed Healthcare

by Michelle Andrews

Health care reform is no laughing matter, but MIT economist Jonathan Gruber’s new comic book on the subject aims to communicate some pretty complicated policy details in a way that, if not exactly side-splitting, is at least engaging.

In Health Care Reform: What It Is, Why It’s Necessary, How It Works, Gruber steps into the pages of a comic book to guide readers through many of the major elements of the law, including the individual mandate to buy insurance, the health insurance exchanges where people will be able to buy coverage starting in 2014 and how the law tackles controlling health care costs.

He ought to know. Gruber helped develop the Massachusetts health overhaul law and advised the Obama administration on the federal version.

Gruber says he was eager to write a book on the federal law because he believes people don’t like the concept of the overhaul because they don’t understand what’s in it. He points to polling that shows the public endorsing individual aspects of the law.

But the decision to do this in a comic-book style was his publisher’s. “At first, I wasn’t enthusiastic,” Gruber says. “I didn’t think it would be that effective. But the publisher said they had done a graphic novel about the 9/11 report. My son likes graphic novels, he’s 17. He said it’s a great opportunity, it’s a great medium. When you’re on a plane and they want to teach you what to do in case of accident, they hand you a graphic. I think it was the right call.”

Although the book is chockablock with optimistic predictions about what will happen under the new law, the chapter on cost control takes a decidedly more cautious tone. Noting that it was politically impossible for the new law to include provisions that could be guaranteed to “bend the cost curve” and control health care costs, Gruber’s character says the law took the best ideas out there about what might work and wrote them all into the bill.

He’s referring, for example, to provisions under which pricey health insurance plans, often called Cadillac health plans, will begin to be taxed in 2018, and to comparative effectiveness research to evaluate whether expensive health care treatments are actually more effective than cheaper ones.

As the title of his book suggests, Gruber is clearly an advocate for the law. But, he says, “I wanted to be intellectually honest. I believe that cost control is too hard for us to know what to do right now.” He cites two hurdles that must be overcome related to cost control: scientific, meaning we don’t know what works, and political, meaning we can’t always predict what will fly.

“I want to explain to that set of voters and readers who are really critical of this bill because it doesn’t do enough on cost contol that that is really an unfair criticism,” says Gruber. “We’re not really at a place where we could address that problem.”

Popularity: 1% [?]

By Amanda McGrory

The newly launched IHT World LLC was created in an effort to counter the high costs of health care by offering custom packages for employer self-funded plans and using medical tourism and the Patient Protection and Affordable Care Act to help businesses cut their health care costs.

IHT World helps employees travel outside of the U.S. for nonemergency medical treatments where the quality of care is at least equal to that of the U.S. but the cost is much lower, the company says.

The combined medical costs, rehabilitation expenses, and travel fees for the patient and a travel companion are much less than the cost of the procedure in the United States, IHT World maintains. In the case of knee replacement surgery, for example, an employer could save approximately $15,000 on each procedure.

According to a PPACA provision, the premium rebate for a health insurance company should be at least 80 percent to 85 percent of premiums collected for health care treatment; however, if the insurance company does not meet the government mandate, the insured group could qualify for an yearly rebate from the insurance company. IHT World believes this could result in significant savings for both employees and employers.

“If American quality treatment is available, without the crushing prices, why wouldn’t you consider such a choice?” says IHT World President and Managing Director Pam Brammann. “When employers are presented with this new concept, especially businesses with employer self-funded plans, they are amazed that IHT World can significantly reduce their health care reimbursement costs without compromising quality.”

Popularity: 1% [?]

By PAULINE W. CHEN, M.D.
Pauline ChenLars Klove for The New York Times Dr. Pauline Chen

Within months of completing my training, I received the call that every doctor dreads.

“You’ve been named in a malpractice lawsuit,” said the hospital administrator on the other end of the line.

The family of a patient I had seen briefly a year before believed that a colleague’s decision not to operate hastened her demise. Now their lawyers, combing through the medical records, believed that a single sentence in my note brought that doctor’s decision into question. As a second or maybe even third opinion, I had written that the woman was a “possible candidate” for surgery.

The truth was that when I saw her she was a possible candidate, but only tenuously so. In fact, her health deteriorated so rapidly that by the time she finished seeing all the specialists and returned to her original surgeon, the chances of her surviving any treatment, no matter how heroic, were almost nil.

Though I knew all that, in the weeks after that telephone call I couldn’t help questioning myself, going over the case in my mind as soon as I woke up, then again and again late into the night. I froze with fear every time I was asked for my opinion on a diagnosis or treatment plan and became a master at evasion, littering my assessments and write-ups with words like “maybe,” “perhaps” and “will await further work-up.” And I wondered if my colleagues knew, if the blot on my record had already soaked through the fabric of my professional reputation.

In the end, the family dropped the case; I never met with any lawyers or went to court. But memories of the all-encompassing threat of a claim came flooding back when I read a recent study of how litigation affects doctors.

Medical malpractice lawsuits have existed in the United States for more than 150 years, though today, most medical errors are never pursued in court, and a large majority of claims never result in any kind of payment to patients. And even though the direct and indirect costs of such suits account for only 2.4 percent of total health care costs, that’s still $55 billion yearly. To say nothing of the even more important social costs, an issue addressed last month in The Journal of the American College of Surgeons.

Researchers surveyed more than 7,000 surgeons and found that nearly one in four were in the midst of litigation. Surgeons involved in a recent lawsuit were more likely to suffer from depression and burnout, including feelings of emotional exhaustion and detachment, a low sense of accomplishment and even thoughts of suicide.

“Malpractice is at the top of the list of major stressors for most physicians,” said Dr. Charles M. Balch, the lead author and a professor of surgery at the University of Texas Southwestern Medical Center in Dallas. “It’s right up there with financial distress, serious work-home conflicts and life-and-death circumstances.”

Other studies estimate that, depending on the specialty, anywhere from 75 percent to 99 percent of practicing doctors will over the course of a lifetime be threatened with a lawsuit. “We are not talking about some small subset of physicians who are vulnerable because they are weak,” said Dr. Tait D. Shanafelt, a co-author and associate professor of medicine at the Mayo Clinic in Rochester, Minn. “Malpractice affects a wide swath of our colleagues and their patients.”

Doctors who have been sued may end up practicing defensive medicine, ordering unnecessary tests and medications or refusing to treat patients with more complex illnesses altogether as a safeguard against future litigation. Those same doctors can also become burned out, which can lead to even more errors, and more malpractice claims.

“Burnout may be what reinforces the connections between malpractice, defensive medicine and poor-quality care,” said Amitabh Chandra, a professor of public policy at the Harvard Kennedy School of Government and an economist who has written extensively on medical malpractice.

The study authors propose that one way to disrupt the negative cycle is to improve communication between patients and doctors, so that patients are aware of the risks that can occur despite a doctor’s best efforts. Another important step is instituting programs that continue those conversations even after an error occurs. “We need supportive work environments and more programs that allow doctors and patients to resolve issues directly,” Dr. Balch said.

But change will require looking at malpractice reform in a new way, one that gives weight not just to the economic costs but to the ways reform might affect how patients and doctors interact.

“Ultimately we are dealing with doctors who are working under enormous pressures,” Dr. Chandra said. “For them, the emotional costs are colossal.”

Popularity: 1% [?]

I’m a first time mom, raising a child in the age of technology. I have the internet, thousands of health oriented websites, and medical blogs all at my fingertips. I read about each week of my pregnancy and tried to prepare as best as I could. Now that my daughter is here, there are so many more questions. Questions about feeding, what’s in her diaper, development and overall basic health. The questions just keep coming. I often wonder how my parents did it. Thank goodness for the information highway, right?

Well, I’m not so sure. Have we reached a point where access to health information has overcome commen sense?

While I believe that there are reputable sites that provide information on health conditions and treatments, I also believe that it’s information overload. There are many people self diagnosing and spreading misinformation.

I know I’ll continue to surf the web and make sure that what’s in my daughter’s diaper is the right color. Sorry I know, TMI!

But let me ask you this, next time your in the kitchen with someone who cuts their finger off, are you going to the ER or are you running to a computer or smart phone to find out what your next step is?

Popularity: 1% [?]

Nearly one-third of Americans believe overweight and obese individuals should be penalized for their unhealthy habits and more than half say smokers should pay more for their health insurance, according to a Thomson Reuters-NPR Health Poll.

About 31 percent of respondents say overweight or obese individuals should pay more for health insurance than individuals with a normal weight. About 11 percent even said they thought it was acceptable to deny employment to those heavier individuals.

But a much larger percentage (60 percent) believes smokers should pay the higher price. This view was more prevalent as respondents’ age, income, and level of education increased.

When asked about specific factors driving up health care costs, respondents pegged smoking (28.5 percent), obesity (27 percent) and stress (25 percent) as the top cost drivers. These factors beat out alcohol use (11 percent) and workplace safety (7.5 percent).

Overwhelmingly 85 percent believe that individuals with “healthful behaviors,” which included exercise, healthy eating and not using tobacco, should receive a discount on their health insurance premiums.

“Discounts for good behaviors are always more popular than surcharges for bad behaviors, but the science of behavioral economics teaches us that loss avoidance is three times more powerful than receiving a gain,” says Raymond Fabius, chief medical officer for the healthcare business of Thomson Reuters. “Before anyone rushes to create behavior-based plans, though, it’s important to look at the data. Our research shows that obesity is a much higher driver of health care costs than smoking.”

Thomson Reuters-NPR interviewed 3,012 participants from September 1-13, 2011. The margin of error is 1.8 percent.

Popularity: 1% [?]

Not sure I would say this is a solution to our healthcare problems! However, I am curious to see how well these kiosks will do.

ATLANTA, Ga., Oct. 21, 2011 /PRNewswire/ — SoloHealth®, a consumer-driven healthcare technology company, announced today it has closed $8.2 million in a round led by healthcare IT industry veteran and founder of HBOC, Walter Huff. SoloHealth has so far raised nearly $13 million, including an undisclosed amount from Coinstar, Inc., owner of Redbox DVD kiosks, as well as a $1.2 million grant from the National Institutes of Health. The news comes as SoloHealth prepares for a nationwide rollout in 2012 of its next-generation health and wellness kiosks, the SoloHealth Station™, with the goal of replacing many of the 25,000 out-dated blood pressure machines found today in retail locations nationwide.

“We are excited and energized to announce this additional round of funding as we enter into a pivotal and opportunistic time in our business with the planned nationwide rollout of our award-winning SoloHealth Station,” said Bart Foster, CEO & Founder of SoloHealth. “We’ve had a tremendously positive response from all the audiences that the SoloHealth Station touches – consumers, retailers, health and wellness marketers, and the healthcare industry. We are quite bullish on our future and our ability to contribute towards a healthier, more efficient American healthcare system.”

“The current state of our healthcare system, political environment, technological advancements, and consumer mindset makes it quite literally a perfect time for the introduction of the SoloHealth Station to capitalize on the emerging market,” said Huff. “I see tremendous opportunity for SoloHealth to become a perennial gateway and platform as consumer’s look to take charge of their health and work towards a healthier America overall.”

Currently in select U.S. test markets and retail locations, SoloHealth’s next-generation, comprehensive SoloHealth Station will screen vision, blood pressure, weight, and body mass index, and provide an overall health assessment free of charge. It also gives consumers access to a database of local doctors. The company plans to provide highly personalized and interactive healthcare opportunities for consumers, advertisers and retailers by placing kiosks in high-traffic retail locations and connecting them to SoloHealth’s multi-platform ecosystem across retail, online/digital, mobile and emerging platforms.

SoloHealth executives also announced growth statistics, noting it had tripled its Atlanta workforce since January, adding jobs in IT, Sales, Finance, Operations, and HR. The company also plans to hire approximately 50 additional staff during next 18 months including a CFO, Marketing Director and Ad Sales executives, effective immediately.

ABOUT SOLOHEALTH: Based in Atlanta, Ga., SoloHealth® is a leader in self-service consumer healthcare, utilizing technology to develop and deploy interactive health screening kiosks, as well as other platforms, in an effort to empower consumers about their health through awareness, education and action. The award-winning company’s first offering was the EyeSite Vision kiosk, currently located in select retail outlets and markets nationwide. In summer 2010, the company received a $1.2 M grant from the National Institute of Health (NIH), a division of the U.S. Department of Health and Human Services, to help enable innovation for self-service healthcare and prevention. In 2011, SoloHealth announced its next-generation kiosk, the SoloHealth Station, offering vision, blood pressure, weight, and body mass index; receive an overall health assessment; and access a database of local doctors. The company’s bilingual kiosks provide free health screenings and recommendations for follow-up care, which leads to prevention and lower health care costs. For more information, visit www.solohealth.com.

Popularity: 1% [?]

As the end of the year approaches, some people start to comtemplate making New Year’s resolutions. Diet, exercise, pick up a new hobby or maybe try to save more money. Well, now would be a good time to consider your HSA contribution limits as part of your savings plan.

Individuals enrolled in a High Deductible Health plan can increase their contribution limit. For individual plans, the HSA contribution limit is $3,100. For family plans, the HSA contribution limit is $6,250.

For 2012, a qualifying high deductible health plan that can be paired with an HSA is one with an annual deductible of at least $1,200 for individual coverage and $2,400 for family coverage, the same qualifications required in 2011. The qualifying health plans can’t have annual out-of-pocket expenses (besides premiums) for 2012 in excess of $6,050 for individual coverage and $12,100 for family coverage.

This new HSA contribution limits are effective for calendar year 2012.

Popularity: 1% [?]

Every three years, the Department of Health and Human Services updates its strategic plan, which describes its work to address complex, multifaceted, and ever-evolving health and human service issues. An agency strategic plan is one of three main elements required by the Government Performance and Results Act (GPRA) of 1993 (Public Law 103-62). An agency’s strategic plan defines its missions, goals, and the means by which it will measure its progress in addressing specific national problems, needs, or challenges related to its mission over the course of at least five years.

For the period FY 2010—2015, HHS has 5 goals:

Goal 1: Transform Health Care

Goal 2: Advance Scientific Knowledge and Innovation

Goal 3: Advance the Health, Safety, and Well-Being of the American People

Goal 4: Increase Efficiency, Transparency, and Accountability of HHS Programs

Goal 5: Strengthen the Nation’s Health and Human Services Infrastructure and Workforce

HHS will seek to drive down costs, put more money in the hands of the American people, and ensure all Americans receive the health care services they need and deserve. These actions will increase transparency, eliminate waste, and put Americans back in charge of their health care.

To read more on each of the goals, you can visit:
http://www.hhs.gov/secretary/about/priorities/priorities.html

Popularity: 1% [?]

Regardless of where you fall on the political spectrum, you have to admit that these are historical times.

As more patients come into a health system already under stress, they encounter higher premiums. Higher premiums are tough to swallow especially when unemployment rates are hovering around 9 percent (10-12% some states) and the economy is unpredictable. The Obama administration recently channeled $109 million in an attempt to fight against “unreasonable” increases. The grant comes on the heels of a provision in the health care law affecting rate review. The provision requires health insurers who want to increase their rates by 10 percent or more in the individual and small group market to justify the increases in writing.

Whatever the reason for increases in medical costs, one thing remains certain – we cannot continue down the same road. So whether or not you are in favor of or against the health care reform bill, do you think you have ideas that could help solve the world’s health care issue?

Please share your thoughts and stories.

Popularity: 1% [?]

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer – Tue May 17, 3:04 am ET
WASHINGTON – A disease standoff may be brewing: How can Alzheimer’s research receive more scarce dollars without cutting from areas like heart disease or cancer?

In one of the stark realities of the budget crisis, scientists’ chances of winning research dollars from the National Institutes of Health for any condition have dipped to a new low.

“We are clearly not able to support a lot of great science that we would like to support,” NIH Director Dr. Francis Collins told senators last week. This year, for every six grant applications that NIH receives, “five of them are going to go begging.”

That’s down from nearly 1 in 3 grants funded a decade ago, and 1 in 5 last year. And it comes before the looming fight over how much more to cut in overall government spending for next year, and where to make those cuts.

Already, a new report says one of the biggest losers is aging research, despite a rapidly graying population that promises a worsening epidemic of dementia, among other illnesses.

“Nobody wants to say Alzheimer’s is worse than diabetes or heart disease or cancer,” says Dr. Sam Gandy, a prominent neuroscientist at New York’s Mount Sinai School of Medicine.

But “part of the problem now with all the pressure to cut the budget … is that for Alzheimer’s to get more, something else has to lose,” adds Gandy. His own lab is scrambling for funds to study a potential dementia drug after losing out on an NIH aging grant.

The NIH pays for much of the nation’s leading biomedical research. Republicans and Democrats alike have long been staunch supporters. But the agency’s nearly $31 billion budget offers an example of the hard choices facing lawmakers, especially if they’re to meet House calls for a drastic scale-back of overall government spending.

Consider aging issues.

The NIH spends about $469 million on Alzheimer’s research, says a new report from the Alzheimer’s Foundation of America that criticizes overall aging research as “a minuscule and declining investment.”

About 5.4 million Americans now have Alzheimer’s disease, and studies suggest health and nursing home expenditures for it cost more than $170 billion a year, much of it paid by Medicare and Medicaid.

NIH’s Collins told a Senate appropriations subcommittee that there’s a “very frightening cost curve.” In 2050, when more than 13 million Americans are projected to have Alzheimer’s, the bill is expected to reach a staggering $1 trillion. But he said that cost could be halved merely by finding a way to delay people getting Alzheimer’s by five years.

Monday, Republican presidential contender Newt Gingrich jumped into the debate, saying that over the next four decades Alzheimer’s could cost the government a total of $20 trillion. He suggested selling U.S. bonds to raise money for research rather than have the disease compete each year for a share of the federal budget.

“We are grotesquely underfunded,” Gingrich said of health research dollars.

The Alzheimer’s Foundation report goes beyond dementia, finding that the National Institute on Aging receives 3.6 cents for every dollar Congress sends to the NIH. Cancer and heart disease get nearly three to four times as much. Despite the tough economic times, the foundation has joined with other groups lobbying for an extra $300 million for the aging institute’s overall work next year, to boost its budget to $1.4 billion.

Competition for today’s dollars is fierce, with applications up 60 percent at the aging division alone since 2003. Aging chief Dr. Richard Hodes says last year, his institute couldn’t pay for about half of what were ranked as the most outstanding applications for research projects. Still, he hopes to fund more scientists this year by limiting the number who get especially large grants.

What’s the squeeze? Congress doubled the NIH’s budget in the early 2000s, an investment that helped speed the genetic revolution and thus a host of new projects that scientists are clamoring to try. But in more recent years, economists say NIH’s budget hasn’t kept pace with medical inflation, and this year Congress cut overall NIH funding by 1 percent, less than expected after a protracted battle.

The Obama administration has sought nearly $32 billion for next year, and prospects for avoiding a cut instead are far from clear. Sen. Tom Harkin, D-Iowa, who chairs the subcommittee that oversees the issue, warns that under some early-circulating House plans to curb health spending, “severe reductions to NIH research would be unavoidable. That doesn’t make sense.”

Sen. Jerry Moran, R-Kan., pushed Collins to make the case that investments in medical research really can pay off.

Collins’ response: Four decades of NIH-led research revealed how arteries get clogged and spurred development of cholesterol-fighting statin drugs, helping lead to a 60 percent drop in heart-disease deaths. Averaged out, that research cost about $3.70 per person per year, “the cost of a latte, and not even a grande latte,” Collins told lawmakers.

___

EDITOR’S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington. Associated Press writer Philip Elliott contributed to this report.

Popularity: 1% [?]

By Insure.com
Last updated Jul 6, 2010

Medicare is a health insurance program for people age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). According to the federal Centers for Medicare & Medicaid Services (CMS), Medicare serves about 40 million beneficiaries.

The large majority of Medicare beneficiaries have original Medicare. This is the traditional fee-for-service arrangement, which means you can go to any health care provider who accepts Medicare. You must pay a deductible, and then Medicare pays its share of the costs and you pay your share.

Medicare & You

You can call the Medicare Choices Helpline at (800) 633-4227 and ask for a Medicare handbook.

This toll-free number is staffed by English- and Spanish-speaking customer service representatives from 8 a.m. to 4:30 p.m.

Hearing-impaired individuals using a telephone device for the deaf can call (877) 486-2048.

You can also view the handbook on Medicare’s official Web Site.

How does Medicare work?

Original Medicare, also called traditional Medicare and Medicare fee-for-service (FFS), is the most widely used and best understood choice through which Medicare beneficiaries receive their health care. Health care providers are paid based on the services they provide.

In general, your choices are less restricted with traditional Medicare than with other Medicare choices. For example, you can go to any doctor, hospital, or other health care provider who accepts Medicare. But your costs are likely to be higher than with other choices because you may also need to buy Medicare supplement (Medigap) insurance. Medigap policies can help defray some of the costs not covered by traditional Medicare.

Who pays for Medicare?

Medicare is financed by federal taxes and administered by the CMMS. Beneficiaries also have “out-of-pocket” costs: They must pay Medicare premiums, deductibles and co-payments, and Medigap premiums if they choose to purchase this supplemental insurance. Beneficiaries must also pay for their own routine physicals, custodial care, most dental care, dentures, routine foot care and hearing aids.

Who is eligible for Medicare?

To be eligible, you or your spouse must have worked for at least 10 years in Medicare-covered employment, be age 65 or older, and be a citizen or permanent resident of the United States. A younger person with a disability or with chronic kidney disease also might qualify for Medicare.

Are there income limits or medical requirements?

There are no income limits for Medicare. There are medical requirements for the delivery of services, because an individual must have a medical need for those services.

How do I enroll in Medicare?

Some people are enrolled in Medicare automatically. Enrollment is automatic if you are not yet age 65 and you already are receiving Social Security or Railroad Retirement benefits. If you are disabled, you will be automatically enrolled in both Part A and Part B of Medicare beginning with your 25th month of disability.

Most people have to enroll in Medicare. The enrollment period begins three months before you turn age 65 (or right away if you require regular dialysis or a kidney transplant) and continues for seven months. Applying early can help you avoid a possible delay in the start of your Part B coverage. If you have questions about Medicare eligibility or enrollment, call Social Security’s toll-free number, (800) 772-1213, weekdays from 7:00 a.m. to 7:00 p.m., EST. You may also enroll online by visiting www.socialsecurity.gov.

To apply for Medicare, contact any Social Security Administration office. (If you or your spouse worked for the railroad, contact the Railroad Retirement Board.) If you don’t enroll during these 10 months, you’ll have to wait until the three months beginning on Jan. 1, and your Part B coverage won’t start until July.

What happens if I wait to enroll?

Don’t put off signing up for Medicare. If you wait 12 or more months to enroll, your premiums are likely to be higher. However, you have some options if you have group health insurance based on your own or your spouse’s (or a family member’s) current employment.

Even if you continue to work after your 65th birthday, you should sign up for Part A of Medicare. Part A might help pay some of the health care costs not covered by your employer plan.

Part B is a different story, however. It might not be a good idea to sign up for Medicare Part B if you have health insurance through your employer. You would be required to pay the monthly Part B premium, and your Part B benefits could be of limited value when the employer plan is the primary payer of your medical bills. However, under some circumstances you will have to pay an extra 10 percent per year penalty for not immediately signing up for Part B.

What is a Medicare HMO?

Medicare health maintenance organizations (HMOs), where available, provide all Medicare-covered services under Parts A and B and may provide additional benefits — such as prescription drug coverage — that are not offered with traditional Medicare. However, Medicare HMOs are not widely available in some regions of the country.

What is a Medicare private fee-for-service (PFFS) plan?

PFFS plans are Medicare plans offered by private health insurers and are hybrids of Medicare HMOs and traditional Medicare fee-for-service plans. There is no provider network, which could be particularly important to beneficiaries who live in rural areas that historically have lacked private Medicare insurance options.

Can I join more than one plan?

No, you can’t join more than one Medicare health plan at the same time.

What if I want to leave a Medicare HMO or PFFS plan?

You must take care when you change how you receive Medicare services. This is particularly true when you leave a managed care plan, whether voluntarily or involuntarily. Because Medigap insurance is not needed when you’re in a managed care plan, beneficiaries returning to traditional Medicare have certain rights to buy Medigap insurance.

Where can I get help when changing plans?

You should contact your State Health Insurance Assistance Program (SHIP) for help.

If you have questions about Medicare, or if you are interested in changing the way you receive Medicare-funded health care services, contact your local SHIP office. Special rules and consumer protections sometimes apply when you change health plans. Additionally, if you or your spouse have health insurance through a former employer or union, contact your benefits representative before you make any new plan choices. Otherwise, you could lose future options or benefits.

Financial help and benefits
There are several programs available to help low-income Medicare beneficiaries pay for some of their Medicare out-of-pocket expenses. For each of these programs the income requirements vary.

What programs can help you if your income is low and you can’t afford the premiums, deductibles or Medigap?

The Qualified Medicare Beneficiary (QMB) Program pays for your Medicare premiums, deductibles, and coinsurance.

The Specified Low Income Medicare Beneficiary (SLMB) Program pays for your Medicare Part B premium.

The Qualified Individual 1 (QI-1) Program pays for your Medicare Part B premium.

The Qualified Individual 2 (QI-2) Program pays a small portion of your Medicare Part B premium. Individuals who may be qualified for any of these programs can apply at their local Medicaid offices.

Popularity: 1% [?]

Medigap insurance: Filling in Medicare’s gaps
By Insure.com

Last updated Nov. 5, 2010

When you qualify for Medicare, policy choices abound. Will you be choosing Original Medicare or a Medicare Advantage Plan? Will you need Part D prescription coverage?

If you enroll in Original Medicare, Part A pays for care in a hospital or skilled nursing facility, as well as for home health and hospice care. Medicare Part B pays for treatment by physicians, outpatient hospital care, durable medical equipment and other medical services. But Medicare does not pay every medical charge or service. Depending on your health situation, you could be open to a variety of out-of-pocket medical expenses.

The federal government has authorized 10 standardized Medigap policies.

Enter Medicare supplement insurance — also known as Medigap policies — to plug the gaps left in Original Medicare. (Those with Medicare Advantage Plans are not eligible for Medigap policies.) Medigap policies are private insurance policies that cover Medicare coinsurance, co-payments and deductibles that you’d otherwise have to pay yourself. Some Medigap policies also pay for costs not covered by Original Medicare.

The 10 letters of Medigap
The federal government has authorized 10 standardized Medigap policies: Plans A through N. Depending on where you live, all 10 of these standard policies — or only a few — may be offered. If an insurance company wants to sell Medigap policies, it must sell at least Plan A. However, if an insurance company sells any other type of policy, aside from Plan A, it must also offer Plans C or F.

To purchase a Medigap policy that’s right for your situation, you need to review the choices annually to make sure your Medigap plan still fits your needs. Plan A offers a very basic supplement to Medicare coverage. Plan F offers much more coverage but is also more expensive. Plans K and L offer payment of 50 or 75 percent on certain co-payments, coinsurance and deductibles. Don’t confuse the Medigap policy designations with Medicare Parts A and B.

Each plan letter’s coverage is the same from insurance company to insurance company. For example, no matter which company is selling the policy, Plan C will contain the same coverage. (However, insurers in Massachusetts, Minnesota and Wisconsin are permitted to sell somewhat different combinations of benefits.

Medigap policies will generally pay most or all of the Medicare coinsurance amounts and Medicare’s deductibles. Certain plans will also pay for emergency medical care in a foreign country. (See chart below.) No plan will cover prescription drugs; for that you need to sign on with a Medicare prescription plan.

Also, your Medigap plan will not cover your spouse; you’ll each need your own policy.

Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses or private-duty nursing.

If you’re interested in a Medigap policy, strike while the iron is hot! Your Medigap open enrollment period begins on the first day of the month in which you are age 65 or older and enrolled in Medicare Part B, and it lasts for six months. During this time, an insurance company can’t refuse to sell you any Medigap policy it sells, can’t make you wait for coverage to start (except possibly for coverage of pre-existing conditions), and can’t charge you more for a Medigap policy because of your health problems. (Medicare will still cover your pre-existing condition but you’ll have to pay your own out-of-pocket costs.)

There’s still another Medigap option. Medicare SELECT, sold in some states, can be any of the standardized Medigap Plans A through L except that you must use specific hospitals and, in some cases, specific doctors to get your full insurance benefits (except in an emergency). The advantage is that Medicare SELECT policies generally cost less than other Medigap policies. However, if you have a Medicare SELECT policy but don’t use hospitals or doctors on the list for non-emergency services, you will have to pay some or all of what Medicare doesn’t pay. Medicare will still pay its share of approved charges no matter which hospital or doctor you choose.

For all the details about Medigap plans and enrollment, see the latest “Choosing a Medigap Policy” handbook at www.medicare.gov.

http://www.insure.com/articles/healthinsurance/medigap.html

Popularity: 1% [?]

6 questions to help your parent choose a Medigap insurance plan
By Rosanna Jordan, Insure.com
Last updated Nov. 7, 2010

You want to know that your parents are eating well and paying their bills on time. You should also know whether they are choosing appropriate health insurance. Relying solely on Medicare to pay health care bills could put your parents in a deep financial hole. Medicare supplement policies, known as Medigap plans, are available from private health insurance companies and provide coverage for expenses that your parents would otherwise have to pay out of pocket.

Navigating the Medigap road requires asking the right questions. Below are starting points for helping a parent evaluate the need for a Medigap plan.

Does my parent need Medicare supplement insurance?
According to the Kaiser Family Foundation (KFF), approximately 20 percent of the 47 million Medicare beneficiaries have purchased a Medigap plan. If your parents selected original Medicare, they should consider buying a Medigap plan.

For example, in 2010 Medicare Part A coverage has a $1,100 deductible that covers the first 60 days of a hospital stay. Beyond the initial 60 days, Medicare beneficiaries are responsible for a coinsurance amount of $275 per day for hospital stays between 61 and 90 days. Without a Medigap plan in place, a prolonged hospital stay could send seniors on a downward financial spiral.

To begin, evaluate your parent’s current health needs by writing down the health care services he’s received in the past 12 months. Include visits to the family doctor, annual checkups, preventive care and any visits to a specialist.

In addition to current health care needs, consider future needs. For instance, if one of your parents has made frequent visits to a specialist for arthritis or osteoporosis in the past few months, those visits may increase over the next year.

Which Medigap plan would fit my parent?
Consult a Medigap benefits grid that outlines the available benefits options. There are 10 Medigap plans that are differentiated by letters A through N. The plans are standardized, so benefits don’t vary among the same “letter” plan.

With your list of health care services in hand, highlight the ones your parent might use.

If your parent is relatively healthy and needs only basic benefits, he might select Medigap Plan A. But if international travel is a major part of his retirement, foreign travel emergency coverage may be important and he should select a Medicare supplement insurance plan that includes that benefit.

When should my parent enroll in a Medigap plan?
If one of your parents wants to buy a Medigap plan, she should buy one during her open enrollment period, which is a period of six months beginning on the first day of the month in which she is 65 and enrolled in Medicare Part B.

While your parent can buy a Medigap policy any time, open enrollment is the ideal time to enroll because the Medigap company cannot refuse to sell your parent a policy that it offers, it cannot charge your parent more due to their health and it can’t make her wait for coverage to start (although it may require a waiting period for coverage of pre-existing conditions).

Open enrollment (Nov. 15 – Dec. 31) for Medicare Advantage plans and Medicare Part D coverage is a good time to evaluate a parent’s existing and future health insurance needs.

Which company should my parent buy from?
Contact your state health insurance assistance program (SHIP) or the department of insurance in your state to find out which companies are licensed to sell Medigap plans in your state.

How much will my parent pay for a Medigap policy?
Medigap premiums are determined using a number of factors, including geographical rating and – depending on when you buy one — medical underwriting. Some health insurance companies will offer discounts to people who are married or non-smokers.

Ask which rating system the company uses to determine premiums. There are three rating systems:

Community-rated: Premiums won’t rise with age but they might rise due to factors like inflation.
Issue-age rated: Premiums are lower for people who buy at a younger age and the price doesn’t rise with age, but it could rise due to other factors.
Attained-age rated: Premiums go up as you get older and may also rise due to other factors.

What should I watch out for?
The National Association of Insurance Commissioners (NAIC) warns that it is illegal for anyone to pressure your elderly parent to purchase a Medigap plan. You should also be wary of anyone from a private health insurance company who claims to work for Medicare or who says that a Medigap policy is “approved” or “recommended” by Medicare.

http://www.insure.com/articles/healthinsurance/medigap-questions.html

Popularity: 1% [?]

Getting your masters in nursing to change the health care system. New health care laws have started to take affect and people around the country are wondering how their health care will be affected. Nurses are the first line of help in our health care system and we need them to be the best that they can be. All across the country, hospitals need more nurses and we need to supply them to ensure that we have the health care system we deserve. Research the best schools to get a nursing degree and do it today!

Popularity: 1% [?]

Download image PwC’s Private Company Trendsetter Barometer tracks the business issues and standard industry practices of leading privately held US businesses. It incorporates the views of 224 CEOs/CFOs: 125 from companies in the product sector and 99 in the service sector, averaging $256.7 million in enterprise revenue/sales, and including large, $300 million-plus private companies.

NEW YORK, Oct. 14 /PRNewswire-USNewswire/ — As private company CEOs review the provisions of the federal Patient Protection and Affordable Care Act (the “Act”), nearly half (47%) of executives surveyed for PwC’s Private Company Trendsetter Barometer say the Act may have a notable financial impact on their business. However, nearly one-third (31%) of respondents believe it’s “too soon to tell” how the Act’s provisions will impact their companies. Twenty percent don’t anticipate a notable financial impact; 2% were unreported. Companies that don’t anticipate a notable financial impact are forecasting above-average revenue growth, compared with the other companies surveyed.

(Logo: http://www.newscom.com/cgi-bin/prnh/20100917/NY66894LOGO )

(Logo: http://photos.prnewswire.com/prnh/20100917/NY66894LOGO )

Although the majority of Trendsetter CEOs (70%) have begun reviewing their healthcare benefit plans in light of the Act, 55% have not yet determined what changes need to be made to their companies’ plans. Only 15% have started to take action.

“In helping our clients assess the effect that healthcare reform will have on their organizations, we’ve been looking at their overall healthcare benefit packages to evaluate whether they’re in compliance with the Act, as well as considering strategies for managing the expected increase in healthcare costs,” says Ken Esch, a partner in PwC’s Private Company Services practice. “In light of current economic conditions, it’s imperative that companies begin assessing their healthcare plans and cost-containment strategies soon rather than later.”

Overall Impact Unclear

When asked which of the Act’s provisions were likely to have a moderate or significant overall impact on their company (including an impact on costs, benefits, strategy, operations, systems, employee recruitment, wellness programs, etc.), Trendsetter CEOs’ responses varied a good deal. “Although we’re seeing CEOs begin to review their options and healthcare strategy, on the whole they’re uncertain about how significant an impact the provisions will have on their organization,” says Esch.

This is evident, for instance, in the Trendsetter CEOs’ response to the Act’s tax provisions. Although a fair number of private companies expect the tax provisions (starting in 2013) to have a moderate to significant effect on their business (31 percent say this about the Medicare tax increase and 26 percent about the net investment income tax), the overall response to those provisions was mixed.

“This is an interesting time for Trendsetter CEOs, when you consider they’ll be implementing new healthcare requirements in tandem with increasing tax rates,” says Esch. “It’s possible this could create a cash flow issue as CEOs look to continue reinvesting in their business. Every company is different, of course, but we’re seeing clients consider accelerating income or deferring deductions now at the lower tax rate, which should provide a permanent tax benefit when rates go up.”

Popularity: 1% [?]

By Madison Park, CNN

Spurred by Apple co-founder and transplant recipient Steve Jobs, the bill has gained support from major politicos, including California Gov. Arnold Schwarzenegger, and is expected to land on his desk this summer.

Meanwhile, on the East Coast, a far more sweeping transplant bill would make every person an organ donor who doesn’t opt out. This would create an organ donation system in New York similar to the ones used in several European countries, but the measure is already facing opposition.

The two states have vastly different bills, but their intents are the same.

With more than 100,000 U.S. patients waiting for organ transplants, better methods of encouraging organ donations are needed, supporters say.

California

This bill creates a living donor registry for kidneys. Read the bill (enter SB 1395)

Patients who need kidney transplants often have friends or family members who are willing to donate their organs. But sometimes, these organs do not match.

Registries have been set up on the Web or by transplant centers where kidney patients and their donors seek to swap organ matches.

Having a state registry would “take it from a process that has been spontaneous and driven by the Web into a more organized fashion, that allows transplant centers to feel a greater degree of security and confidence,” said Dr. Bryan Becker, the president of the National Kidney Foundation, which supports the California bill.

The registry might increase the number of transplants, he added. About one-third of U.S. kidney transplants come from living donors.

Jobs, the CEO of Apple, was a major player in bringing the bill to the forefront, said Schwarzenegger, in a March 19 press conference.

“He’s a wealthy man,” Schwarzenegger said at the news conference. “That helped him get a transplant. But he doesn’t want that — that only wealthy people can get a transplant.”

A pancreatic cancer survivor, Jobs received a liver transplant at Methodist University Hospital Transplant Institute in Memphis, Tennessee, last year.

Livers are scarce, as only about one-third of the people on the national transplant waiting list receive one. Jobs’ transplant stirred controversy about whether celebrity and wealth gained him an advantage.

“He wants every human being — if you have no money at all or you’re the richest person in the world — everyone ought to have the right to get a transplant,” Schwarzenegger said. “This is why he has talked to my wife; he has talked to me to put the pressure on us to get this bill going so there’s enough organs available for all the potential recipients.”

Jobs spoke at the conference and noted that more than 400 Californians died waiting for a liver transplant.

“Last year, I received a liver transplant. I was very fortunate because many others died waiting to receive one while I received one…” he said. “I was almost one of the ones who died waiting for a liver in California last year.”

The bill is expected to be at the governor’s desk by July or August.

Also under the proposal, residents would be asked whether they would like to become organ donors when they receive or renew their driver’s licenses or identification cards. If they leave the box unmarked, a clerk will verbally ask the question.

New York

A New York assemblyman whose daughter’s life was saved by two kidney transplants said he wants more organ donations. One of Assemblyman Richard Brodksy’s most controversial ideas: Make everyone an organ donor unless the individual opts out.

This is also known as “presumed consent” — a marked departure from what’s done in the United States. Several European countries, such as Spain, France, and the Netherlands operate on this concept. Brodsky said this would save more lives.

“We can trust the decency of the American people,” Brodsky said. “But the government needs to come up with a program that lets people express that decency. That’s what’s missing — a connection between the fundamental goodness of the American people and a system that is not producing the organs that save lives.” Read Brodsky’s bill here

Every year, 500 New Yorkers die waiting for an organ transplant, he said.

Another one of Brodsky’s bills would prevent relatives from overriding organ donation decisions made by the deceased.

He became inspired by his 18-year-old daughter, Willie Brodsky, who had transplants because of an autoimmune disease.

While sympathizing with Brodsky’s perspective, Tarris Rosell, a chairman at the Center for Practical Bioethics in Kansas City, Kansas, said presumed consent infringes on individual’s rights.

“The saving of life is a deep, American value, but in this sort of situation, such as presumed consent, it goes up against other American values, like right to privacy, even property rights, which begins with our bodies and a deeply inscribed individualism,” he said.

Some religious and cultural beliefs value the integrity of the body and oppose organ donations, he added.

United Network for Organ Sharing, a nonprofit organization that administers the nation’s organ matching and placement process, does not support presumed consent, because of “inadequate safeguards for protecting the individual autonomy of prospective donors.”

These recent proposals in New York and California do not mean that public opinion toward organ donations is changing, said Sheldon Kurtz, a law professor at the University of Iowa who has drafted organ donation legislation.

“You can’t assume because bills are pending that public opinions have changed,” he said.

Popularity: 2% [?]

By Parija Kavilanz, senior writer
CNNMoney.com

NEW YORK (CNNMoney.com) — The new health law puts the nation’s hospitals on strict notice.

Either they improve the safety and quality of care for patients or the government will hit them where it hurts the most — their revenue.

The legislation contains dozens of provisions, including fining hospitals, to reduce medical errors, hospital-borne infections and costly preventable readmissions.

Those three issues alone drain billions of dollars annually from the health care system.

Industry watchers and consumer advocates say the measures were sorely needed and will go a long way to protect patients and enhance efficiency in the system.

But for hospitals, the new law could present a tough challenge.

Preventable readmissions: These cost the health care system about $25 billion every year, according to consulting firm PricewaterhouseCoopers.

To tackle the problem, beginning in 2012, the Department of Health and Human Services (HHS) will publish each hospital’s readmission track record.

Experts say high readmission rates — when patients return within 30 days of discharge — indicate hospitals aren’t adequately addressing patient issues or they’re discharging them prematurely.

In 2012, Medicare will stop paying hospitals for preventable readmissions tied to health conditions such as heart failure or pneumonia. In 2014, HHS will expand that policy to cover four additional health conditions.

Medical harm: The second penalty for hospitals is tied to hospital-acquired conditions stemming from medical errors or infections.

Here, the government has set a carrot-or-stick approach.

For instance, the government currently gives hospitals an incentive payment for simply reporting their performance on things like patient satisfaction and care quality tied to treatment of conditions such as heart failure, pneumonia and hospital-borne infections.

That’s changing.

Under the legislation, hospitals won’t be paid for just reporting their performance, but beginning in 2012, will be paid commensurate to their score. Higher scoring hospitals will receive higher payment and vice versa.

In 2015, HHS will also start reporting each hospital’s record for medical errors and infections pertaining to Medicare patients.

About 15 million instances of injury or harm as a result of a medical treatment occur every year in the United States, according to non-profit group the Institute for Health Care Improvement.

These include more than than 30,000 people who die annually from catheter-related blood stream infections, according to consumer advocacy group Consumers Union’s Safe Patient Project.

In 2015, Medicare will reduce its payments by 1% to hospitals with the highest rate of medical errors and infections. The government will also no longer pay hospitals for treatment when a Medicaid patient is harmed during a hospital stay.

Doctors: A tough job just got tougher
A medium-sized general hospital could lose upward of $1 million a year from these penalties at a time when all providers are struggling to keep up with escalating health care costs.

“That’s real money,” said Brad Bowman, director with PricewaterhouseCoopers’ health care advisory practice.

On top of that, Bowman warned of an even bigger risk to hospitals — a tainted reputation.

“Think about a town with three or four hospitals,” said Bowman. “Once the local press has access to hospitals’ detailed quality and performance scores, consider the impact a story about a poor-performing hospital can have on its business.”

It will be many times more than the dollars lost to penalties, he said. “Guess what? People will now say ‘Don’t take me to hospital D but to hospital A.’”

For its part, hospitals’ main trade group, the American Hospital Association (AHA), said it is supportive of some provisions but concerned about others.

“The penalties are intended to send a strong message from Congress that they want hospitals to be efficient and keep patients safe,” said Nancy Foster, AHA’s vice president of quality and patient safety. “That’s exactly what our members are working hard to do.”

Regarding readmissions, Foster said the government has to be “strategic” about how to bring down what it labels “preventive” readmissions.

“You don’t want a fear of penalties preventing hospitals from readmitting people who may need to come back soon after they were released,” Foster said, adding that many times, patients’ economic status prevents them from properly following post-hospital care and thus landing them back in a hospital.

“We’re eagerly awaiting regulations that improve these provisions to make sure these types of cases are thought about,” she said.

If regulations aren’t sensitive to people’s social issues, she warned that the measures could frequently punish hospitals that cater to the disadvantaged population.

Michael Young, CEO of Atlanta-based Grady Memorial, one of the largest public hospitals in the nation, said Foster makes a valid point.

As many as 95% of Grady’s patients are in the low income bracket and 40% of those don’t have insurance, which forced the hospital to provide $300 million in “free care” last year.

“When these patients can’t pay for things like home nurse care and readmissions go up, it’s the hospital that’s getting blamed under these measures,” he said.

“The legislation is a step in the right direction but the penalties are a legitimate concern,” Young said. “For public hospitals, the next five years will be a tremendous challenge.”

A victory for consumers
From a consumer perspective, PWC’s Bowman said the law is a big win.

“Up until this point, consumers have had so little information on health care providers,” he said. “You can get more information easily on a company’s stock in India than on a hospital down the street.”

The law, he said, cracks this door open so that consumers can make more informed choices about providers.

Lisa McGiffert with Consumers Union Safe Patient Project, agreed. “These measures put us on a path to improving care because when you change their payment structure, the behavior in hospitals improves.”

And even though most of these measures affect public insurance payments, McGiffert is hopeful of a knock-on effect on private insurance payments as well.

“As Medicare goes, typically so do other private insurers,” she said. “Medicare by virtue of being the largest insurance program in the country is considered the trendsetter for insurers and providers.”

Popularity: 2% [?]

Business Insurance

By Jerry Geisel

Under the provision, employees would have to meet two conditions to be entitled to the employer-funded vouchers: their family income could not exceed 400% of the federal poverty level; and the premium contributions their employers require them to make must be between 8% and 9.8% of their income. Some experts believe the 9.8% figure was a drafting error and will be changed later in a technical corrections bill to 9.5%.

If those conditions are met, those employees would be entitled to receive a voucher from their employers, and the value of the voucher would not be tied to the plan in which the employee was actually enrolled.

Instead, the voucher’s value would be equal to what the employer would pay if the employee were enrolled in whichever of its plans offered the largest premium contribution by the employer. Experts say it isn’t clear whether “largest” refers to the percentage of the premium paid by the employer or the dollar amount of the contribution.

Then, the employee could use the voucher to purchase health insurance coverage from a state health insurance exchange. The exchanges are authorized under the reform law and are supposed to be set up by 2014.

If the cost of a policy purchased by an employee through the exchange is less than the value of the voucher, the employee could pocket the difference in cash, which would be considered income and taxed.

The voucher feature could prove costly to employers, especially those that have a heavy concentration of low-wage employees—such as retailers—and require employees to make hefty employee premium contributions, relative to their incomes.

And depending on how the legislative language is interpreted in subsequent regulations, it also could prove costly to employers that offer employees a choice of health care plans ranging from relatively low-cost to very expensive plans.

Experts say the provision is almost certain to result in adverse selection, inflating employer costs.

For example, a young, low-paid employee working for a company with a high concentration of older, less healthy and expensive-to-insure employees likely would receive a voucher whose value would be much higher than the cost of buying coverage in an exchange, especially if the employee purchased a lower-cost high-deductible plan. Under the reform law, exchanges can base premiums on the age of policyholders.

As a result, employees remaining with the employer’s plan would be the most costly to insure, pushing up the employer’s insurance premiums.

“We are talking about something that could be very costly to employers,” said Chantel Sheaks, a principal with Buck Consultants L.L.C. in Washington.

“As I read it, any employer that offers comprehensive benefits and has low-wage employees could be impacted,” said Helen Darling, president of the National Business Group on Health in Washington.

Despite the potential financial impact of the provision, few employers have focused on the voucher provision, noted Jennifer Henrikson, a legal consultant with Hewitt Associates Inc. in Lincolnshire, Ill.

The likely reason for that, Ms. Henrikson said, is that employers now have to concentrate on reform-related issues that are more pressing. The voucher provision does not go into effect until 2014, while numerous others, such as elimination of lifetime dollar limits, go into effect beginning in 2011.

The intent of the provision isn’t clear, experts say. A much broader version of the provision was backed by Sen. Ron Wyden, D-Ore., who has sponsored a proposal in which employers no longer would offer coverage to their employees, but instead would give them cash that they would use to purchase health care coverage on their own.

Many issues involving the provision itself are not clear. “There is a lot of complexity here that has to be figured out,” said Sandi Hunt, a principal in the San Francisco office of PricewaterhouseCoopers L.L.P.

For example, the provision says the voucher contribution would be equal to the amount the employer would have paid if the employee had been “covered under the plan with respect to which the employer pays the largest portion of the cost of the plan.”

That legislative language is about as “clear as mud,” Ms. Henrikson said. For example, it isn’t clear whether the largest portion of the premium refers to the percentage of the premium paid by employers or the actual dollar amount employers pay, though experts say it likely is the latter.

If the latter interpretation is adopted through regulation, the provision could have a costly impact on employers that give employees a choice between lower-cost plans, such as consumer-driven health care plans and much more costly plans, such as traditional preferred provider organizations.

Take the case of a young employee enrolled in a high-deductible plan with a premium of $10,000, of which the employer paid $7,000. The employer also offered a more traditional PPO plan costing $15,000, of which the employer paid $10,000.

In that example, the employee would be entitled to a $10,000 voucher, funded by the employer. If the employee then found coverage in the exchange, perhaps similar to the high-deductible plan in which he was enrolled, for $8,500, he could purchase the coverage and then have $1,500 in additional cash. But his employer’s health insurance cost would be $1,500 higher.

Popularity: 8% [?]

American Chronicle
Michael Jordan – April 09, 2010

Any time of year can be the right time to consider setting up a Health Savings Account (HSA). If you need a new way to reduce taxes while you put money away, an HSA may be just the thing for you.

Insurance Information

These high-deductible health insurance plans coupled with IRA-style savings accounts are really pretty easy to understand, offer a number of benefits and are becoming more popular.

What is an HSA? HSAs were developed to maximize your savings on health insurance while providing a valuable tax break. The two parts of an HSA program are an eligible, high-deductible health plan and a tax-advantaged savings account. For an individual, an HSA-eligible health insurance plan must have an annual deductible of at least $1,050 for individuals and $2,100 for families.

Insurance Tips

The second part of an HSA program is an IRA-style savings account that allows you to reduce your taxable income by building savings. You can deposit funds up to the total of your health plan’s deductible into the HSA each year. So, within certain regulatory limits, the higher your health plan’s deductible, the more you can tuck away tax-free.

How does the Tax Savings work? If you make $40,000 a year and you put $2,000 in your HSA, you’ll only pay taxes on $38,000. Like an IRA, the HSA is meant to encourage you to save for retirement. Funds placed into your HSA can be invested and the balance will roll over each year into retirement.

You can use your HSA funds to cover medical expenses such as over-the-counter drugs, eyeglasses, co-payments and any medical costs incurred before your annual deductible is met.

Popularity: 2% [?]

You can ask the IRS for more time to file your tax return.  However that won’t extend the deadline for funding an individual retirement account or a health savings account for last year.  There’s a firm deadline of April 15th, 2010, for making a contribution to your 2009 traditional IRA, your 2009 Roth IRA, or your 2009 health savings account.

Tax deductions for HSA contributions are limited to maximum dollar amounts set per year:

Report your tax-deductible HSA contributions on IRS Form 8889, with the total contributions also reported on Form 1040.  Insurance companies report your HSA contributions to the IRS using Form 5498-SA.

If you would like more information, please contact NEOS Consumer Driven Healthcare at 877-636-7472 or by visiting our website at www.NEOSCDH.com

Popularity: 2% [?]

By LAURAN NEERGAARD, AP Medical Writer

WASHINGTON – Better beat the crowd and find a doctor.

Primary care physicians already are in short supply in parts of the country, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.

The new law goes beyond offering coverage to the uninsured, with steps to improve the quality of care for the average person and help keep us well instead of today’s seek-care-after-you’re-sick culture. To benefit, you’ll need a regular health provider.

Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.

A growing movement to change how primary care is practiced may do more to help with the influx. Instead of the traditional 10-minutes-with-the-doc-style office, a “medical home” would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most.

“A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months,” says Dr. Sam Jones of Fairfax Family Practice Centers, a large Virginia group of 10 primary care offices outside the nation’s capital that is morphing into this medical home model.

“We think it’s the right thing to do. We were going to do this regardless of what happens with health care reform,” adds Jones. His office, in affiliation with Virginia Commonwealth University, also provides hands-on residency training to beginning doctors in this kind of care.

Only 30 percent of U.S. doctors practice primary care. The government says 65 million people live in areas designated as having a shortage of primary care physicians, places already in need of more than 16,600 additional providers to fill the gaps. Among other steps, the new law provides a 10 percent bonus from Medicare for primary care doctors serving in those areas.

Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last fall reported just over half of internists and 40 percent of family and general practitioners weren’t accepting new patients, an increase in recent years as the state implemented nearly universal coverage.

Nationally, the big surge for primary care won’t start until 2014, when the bulk of the 32 million uninsured starts coming online.

Sooner will come some catch-up demand, as group health plans and Medicare end co-payments for important preventive care measures such as colon cancer screenings or cholesterol checks. Even the insured increasingly put off such steps as the economy worsened, meaning doctors may see a blip in diagnoses as those people return, says Dr. Lori Heim, president of the American Academy of Family Physicians.

That’s one of the first steps in the new law’s emphasis on wellness care over sickness care, with policies that encourage trying programs like the “patient-centered medical home” that Jones’ practice is putting in place in suburban Virginia.

It’s not easy to switch from the reactive — “George, it’s your first visit to check your diabetes in two years!” — to the proactive approach of getting George in on time.

First Jones’ practice adopted an electronic medical record, to keep patients’ information up to date and help them coordinate necessary specialist visits while decreasing redundancies.

Then came a patient registry so the team can start tracking who needs what testing or follow-up and make sure patients get it on time.

Rolling out next is a custom Web-based service named My Preventive Care that lets the practice’s patients link to their electronic medical record, answer some lifestyle and risk questions, and receive an individually tailored list of wellness steps to consider.

Say Don’s cholesterol test, scheduled after his yearly checkup, came back borderline high. That new lab result will show up, with discussion of diet, exercise and medication options to lower it in light of his other risk factors. He might try some on his own, or call up the doctor — who also gets an electronic copy — for a more in-depth discussion.

“It prevents things from falling through the cracks,” says Dr. Alex Krist, a Fairfax Family Practice physician and VCU associate professor who designed and tested the computer program with a $1.2 million federal grant. In a small study of test-users, preventive services such as cancer screenings and cholesterol checks increased between 3 percent and 12 percent.

Pilot tests of medical homes, through the American Academy of Family Physicians and Medicare, are under way around the country. Initial results suggest they can improve quality, but it’s not clear if they save money.

Primary care can’t do it alone. Broader changes are needed to decrease the financial incentives that spur too much specialist-driven care, says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

“What we need is not just a medical home, but a medical neighborhood.”

Popularity: 2% [?]

Having staked the success of his presidency on the longstanding Democratic dream of universal health care, President Obama finally achieved victory on Sunday night, bringing an end to a yearlong partisan struggle. “This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction,” Obama said shortly after the historic vote. “This is what change looks like.” With Democrats chanting the signature line of the Obama presidential campaign – “Yes we can!” – the House voted 219-212 to send a sweeping overhaul of the nation’s health care system to be signed into law. “We tonight will make history for our country and progress for the American people,” Speaker Nancy Pelosi declared shortly before the vote. “Today we have the opportunity to complete the great unfinished business of our country.”

The Democrats passed the bill without a single Republican vote – and with the knowledge that it may well have ended the political careers of some who voted for it at a time when the public remains deeply divided over the entire endeavor. “If we pass this bill, there will be no turning back,” warned minority leader John Boehner. “It will be the last straw for the American people.”

Suspense about the outcome continued until the final hours of the debate. Passage appeared to be assured only after Michigan Congressman Bart Stupak announced in the late afternoon that he and a group of antiabortion Democrats, who had pushed for more restrictive language in the original House bill, had been satisfied that the Senate version would not allow the use of federal funds to pay for the procedure. That only came after President Obama promised to sign an executive order reaffirming that the bill would maintain a “consistency with longstanding restrictions on the use of federal funds for abortion.” In reality, that executive order was more a symbolic move than an actual concession; the bill’s supporters have insisted all along that it does nothing to change the current federal policy, known as the Hyde Amendment, which has been in effect since 1976.

The second bill passed by the House late Sunday will make adjustments to the legislation, such as lowering the impact of an excise tax on high-value insurance plans and stripping out some sweetheart deals like the now infamous cornhusker kickback, using a process known as budget reconciliation. Such changes would be filibuster-proof in the Senate, though that process could still drag on a while if Republicans choose to draw it out with objections and amendments. Even so, it will be an anticlimax to Sunday’s historic House vote, which will send the underlying Senate bill to President Obama’s desk for signature.

As the House debated throughout the day, hundreds of protesters from the Tea Party movement rallied on the Capitol lawn, chanting, “Kill the bill.” It was a dead-serious message, but on a glorious spring day, when cherry blossoms were just beginning to appear on the trees, the atmosphere felt more like a carnival – especially compared to the day before, when some protesters had hurled racial epithets at a few African-American members of the House. The crowd was stoked by regular appearances that lawmakers made on a balcony overlooking the protesters. “It’s interesting how many faces they recognize,” said Republican Congressman Steve King of Iowa. Republicans flashed handwritten signs with the word No on them, sending the crowd into rapture.

Democrats also got into the act. Sheila Jackson-Lee, a liberal Democrat from Texas, said she went down among the protesters saying, “God bless America. We’re glad you’re here.” She also flashed two fingers in a mischievous V for victory. The response? “Someone flipped a third finger,” she said.

On the other end of Pennsylvania Avenue, the President and his team were waiting and working the phones to make sure the final votes were nailed down. There was also the distraction of March Madness to pass the hours. One aide said of Obama: “He’s in the West Wing, getting updates, dropping in on staff, and like the rest of America, examining the rubble of his bracket.” At one point during the afternoon, the Commander in Chief ordered his health care czar, Nancy-Ann DeParle, to take a break and go out for a run.

With passage of the legislation, Obama has achieved the signature domestic goal of his presidency, and the most sweeping piece of social legislation since the 1960s Great Society initiatives that saw the passage of Medicare and Medicaid. Universal coverage is a goal that has eluded Presidents going at least as far back as Teddy Roosevelt, and Obama’s bill comes as close to that target as anyone has. The bill would provide health coverage to an estimated 32 million additional Americans, meaning 95% of those who are legally in this country would have health insurance, up from 83% today.

The bill also promises to rein in health costs by reorienting the practice of medicine, making it more efficient, with health care providers rewarded on how well they treat their patients, rather than how much care they give them. Whether it actually achieves that latter ambition, however, is far more uncertain.

In the early years, most Americans will see only minor changes in the health care system. It will almost immediately end some insurance-company practices, such as denying coverage to children with pre-existing conditions. And dependent children under the age of 26 would be allowed to remain on their parents’ policies if they cannot get health insurance elsewhere. Adults with pre-existing conditions would also be able to buy coverage through expanded high-risk pools.

Beginning in 2014, more far-reaching measures will begin to take effect. States would be required to set up new “exchanges,” or insurance marketplaces, that would offer a variety of health care plans for small businesses and individuals who do not get coverage from their employers. Government subsidies would be available to those earning up to 400% of poverty. Employers with 50 or more workers who do not offer coverage would be fined, and for the first time, most people would be required to obtain health coverage – either at work, or by purchasing it on their own – or pay a penalty.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40% levy on certain high-priced insurance policies.

But while the bill is headed toward becoming law, the fighting over it isn’t going away anytime soon. Republicans have already issued notice that they plan to campaign in this fall’s midterm elections on a pledge to repeal it. There will be constitutional challenges. And in dozens of states, legislatures are considering measures that would attempt to exempt their citizens from some of its provisions, including the requirement that individuals purchase insurance.

By KAREN TUMULTY / WASHINGTON Karen Tumulty / Washington

Popularity: 3% [?]

Sources Say ‘Dramatic’ Developments in Late Negotiations but Vote Count Unclear
By JAKE TAPPER
WASHINGTON, March 12, 2010—

Speaking volumes about how Democrats lack the votes to pass health care overhaul legislation, President Obama has decided to delay next week’s trip to Indonesia and Australia.

The president was due to leave Thursday, which is the deadline that the White House gave Congress to finish negotiations and pass a bill.

But the White House has confirmed that Obama will leave three days later on Sunday, March 21, and without his wife and daughters as originally planned.

White House officials and congressional Democratic sources expressed confidence that the compromise House-Senate legislation will ultimately pass, but as of now, House Speaker Nancy Pelosi, D-Calif., does not have the votes.

“We’ll take whatever time is required forus to pass the legislation,” Pelosi told reporters today.

She needs 216 votes — a majority of the House’s 431 members — to pass the Senate bill and changes to it. Anti-abortion Democrats, led by Rep. Bart Stupak, D- Mich., have said they will not support the Senate bill because it has less restrictive language on abortion than the House bill.

Democratic congressional leaders had asked the president to delay his trip until after the health care overhaul vote so he could make a personal appeal to House Democrats to vote for legislation that has consumed so much of his presidency.

“I’m delighted the President will be here for the passage of the bill. It’s going to be historic,” Pelosi said.

Meanwhile, Senate Majority Leader Harry Reid, a key figure in the ongoing negotiations, is facing a personal health care crisis of his own.

Reid’s wife and daughter are recovering from a car accident Thursday that left the women hospitalized in serious condition.

Democrats Await CBO Score to Move Ahead
DemocSen. Reid’s wife, Landra, 69, suffered a broken nose, back and neck. Daughter Lana Reid Barringer, 48, has a neck injury and facial lacerations. Both are “conscious, can feel their extremities, and according to doctors, their injuries are nonlife threatening,” a Reid spokesman said.

The incident put Democrats’ intense legislative negotiations temporarily on hold Thursday as Reid rushed to the hospital to be by their sides. But Reid soon after returned to the Capitol; one sign that negotiations among House and Senate Democrats have become make-or-break.

“If Nancy Pelosi had the votes, they’d have already voted on this,” conservative commentator Laura Ingraham said on “Good Morning America” today. “Obviously, the president, he’s put it all on the line here. It’s not going to be good for Democrats, no matter what they do.”

But Democrats insisted they have the will and the votes to pass a bill soon.

“We’re in the home stretch,” Democratic strategist Donna Brazille told ABC News’ George Stephanopoulos. “There’s no question the Democrats will round up the votes.”

The White House had set a deadline for the House to pass the Senate bill by March 18, when the president was originally scheduled to leave for an overseas trip to Indonesia and Australia.

The White House has since backed off its deadline.

“Our hope is to get this done as soon as possible,” White House press secretary Robert Gibbs said Thursday. “If it … takes a couple extra days after a year, it takes a couple of extra days.”

One reason for the delay is the eagerly anticipated Congressional Budget Office score on how much the health care bill now before the House will cost. Its release is expected any day.

The Congressional Budget Office issued an updated cost estimate of the health care bill that passed the Senate Dec. 24, but that estimate didn’t include the changes being negotiated with the White House. The updated estimate was up slightly, from $871 billion to $875 billion over 10 years. And the total deficit reduction went from $132 billion to $118 billion.

‘Full Speed Ahead’ for Reid Despite Personal Matter
After congressional Democrats broke from their meeting Thursday night, White House chief of staff Rahm Emanuel told reporters, “It was a very good meeting. A lot of decisions were made. We’re getting towards the end.”

Sources described “dramatic” developments in the closed-door meetings in the past 24 hours.

As for whether Reid’s personal situation will affect the process ahead, many people close to the senator say that’s unlikely.

“This won’t slow him down, although he may have to spend quite a bit of time with his wife here in the next few days,” Sen. Mark Pryor, D-Ark., said “It’s going to be a full speed ahead for him for sure.”

The House budget committee may begin writing the “fixes” to the Senate bill Monday.

ABC News’ Devin Dwyer contributed to this report.

Popularity: 2% [?]

By Tom De Luca
Wed Mar 3, 1:14 pm ET
 
New York – The debate over healthcare reform should have been about doctors, patients, insurance and drug companies, and coverage. Instead, much of the attention has been focused on a preexisting condition.

A filibuster allows a senator to delay or defeat legislation through endless talk – or merely the threat of it. That gives the minority breathtaking power to cause gridlock and discredit the majority by stopping it from pursuing the program it was elected on. That is exactly what 41 Senate Republicans are doing to 59 Democrats right now.

The filibuster has become so potent a political weapon that President Obama is reportedly approving the use of the controversial “reconciliation” process to pass healthcare reform. Under this method, Democrats could turn the reform bill into law with a simple majority of senators instead of the 60 now needed to end a filibuster. Critics are calling reconciliation an “abuse of power,” “undemocratic,” and “the nuclear option.” The real undemocratic abuse of power, however, is the present way in which the filibuster is used.

While the use of a simple majority through reconciliation to pass legislation would restore constitutional sanity to the Senate, it does not go far enough. The Senate should rewrite the filibuster rule entirely. Full and thorough debate should be preserved, but the unconstitutional practice of requiring supermajorities to pass important legislation must be ended. 

Many of us first learned about the filibuster in “Mr. Smith Goes to Washington.”

In that classic film, the filibuster is our quintessential American hero Sen. Jefferson Smith’s last hope of stopping corruption and symbolically saving the American republic.

In the real world of American politics today, however, the filibuster has become the weapon of choice to thwart a democratically elected majority on important legislation. Once rare, it’s now used routinely. Filibusters used to be hard work. Senators had to actually stand and talk in the Senate 24/7 until they literally dropped. Now they merely need to threaten a filibuster to stop legislation from ever coming to a vote.

This usurpation is more than an unheroic partisan power grab. It is an unconstitutional change in which the entire Senate – and both parties – are complicitous.

The Framers were explicit about those rare cases, such as constitutional amendments, in which supermajorities are required. They fashioned a document that assumed the majority rule principle for legislation, and based important arguments for the constitution’s ratification on that assumption.

In “The Federalist No. 10,” James Madison defended the newly proposed constitution on the grounds that it created the kind of republic that could prevent factions from undermining liberty. He was most worried by the abusive potential of a majority faction and prescribed, not supermajority rule, but a large and strong republic supplemented by federalism and separation of powers.

Minority factions could be more easily handled, he believed, by simply applying the “republican principle” of majority rule, enabling “the majority to defeat [the minority’s] sinister views by regular vote.”

The filibuster also upends the Great Compromise of 1787 that gave us a bicameral legislature. Small-population states wanted congressional representation based on state equality, while large-population states wanted to base it on the number of inhabitants in a state (or the amount of taxes it contributed).

The deal was to have both: a Senate and a House of Representatives. In granting an extraconstitutional veto to a minority faction of senators, the filibuster increases their (and their states’) power relative to that of other senators (and states). It also upsets the balance of power with the House and its members. The filibuster undermines the state equality and proportionality principles at the same time.Â

Debates over when “extraordinary majorities” would be required were part of the horse-trading that led to final agreement on the constitution. Southern states, for example, depended on agricultural exports and some wanted a legislative supermajority to be required for passage of laws that affected navigation, something the New England shipping states opposed. They traded this demand away for a 20-year guarantee of continuance of the slave trade and a ban on export taxes. Because sectional and state interests played an important role in these deals and compromises, it is inconceivable that the back door would have been left open for supermajorities to sneak in.

Article I, Section 5 offers filibuster-defenders one slim reed to grasp: that “Each House may determine the rules of its proceedings.” However, it also says that each senator shall have “one vote” and that “a majority of each [House] shall constitute a quorum to do business.” The filibuster both deviates from the equality of power idea intrinsic to the “one vote” principle, and changes the meaning of the words “to do business” – unless they were intended by the Founders to mean “do nothing but talk.”

The filibuster “rule” is in reality not a rule at all. It is a structural change to the meaning of the Constitution itself, something even a unanimous Senate is not empowered to do. Its defenders should ask themselves this question: If the filibuster “rule” were written into the constitution’s draft, would the constitution have been ratified? Without a new round of debates and compromises, the answer is no.

As the president of the Senate, Vice President Joe Biden should rule unconstitutional any use of the filibuster to block major legislation. As a political matter, such a move would be highly controversial, but as a constitutional matter, it merely restores the Framers’ intent regarding using majority votes to move legislation in each house of congress – something conservatives should support. After all, the status quo distorts the Constitution. And it robs the vice president of the only real power he has: to cast the tiebreaking vote when the Senate is “equally divided,” an impossibility if the meaningful vote is the one that requires 60 senators to end debate.

If Mr. Biden takes this step and gets attacked, it would be a perfect time to treat his Senate colleagues to a filibuster of his own, by reading to them, in its entirety, “The Federalist No. 51,” which explains how to avoid excessive concentration of power: “Ambition must be made to counteract ambition,” Madison wrote. “The interest of the man must be connected with the constitutional rights of the place.” In protecting his own power from Senate usurpation, Biden would also be fulfilling Madison’s constitutional plan. Mr. Smith would be very proud. But not as proud as Madison.

Tom De Luca, a professor of political science at Fordham University, is coauthor of “Liars! Cheaters! Evildoers! Demonization and the End of Civil Debate in American Politics.”

Popularity: 2% [?]

By RICARDO ALONSO-ZALDIVAR and JENNIFER LOVEN, Associated Press Writers Ricardo Alonso-zaldivar And Jennifer Loven, Associated Press Writers

WASHINGTON – With tempers flaring, President Barack Obama and congressional Republicans clashed in an extraordinary live-on-TV summit Thursday over the right prescription for the nation’s broken health care system, talking of agreement but holding to long-entrenched positions that leave them far apart.

“We have a very difficult gap to bridge here,” said Rep. Eric Cantor, the No. 2 House Republican. “We just can’t afford this. That’s the ultimate problem.”

With Cantor sitting in front of a giant stack of nearly 2,400 pages representing the Democrats’ Senate-passed bill, Obama said cost is a legitimate question, but he took Cantor and other Republicans to task for using political shorthand and props “that prevent us from having a conversation.”

And so it went, hour after hour at Blair House, just across Pennsylvania Avenue from the White House — a marathon policy debate available from start to finish to a divided public.

The more than six-hour back-and-forth was essentially a condensed, one-day version of the entire past year of debate over the nation’s health care crisis, with all its heat, complexity and detail, and a crash course in the partisan divide, in which Democrats seek the kind of broad remake that has eluded leaders for half a century and Republicans favor much more modest changes. With Democrats in control of the White House and Congress, they were left with the critical decision about where to go next.

Obama and his Democratic allies argued at Thursday’s meeting that a broad overhaul is imperative for the nation’s future economic vitality. The president cast health care as “one of the biggest drags on our economy,” tying his top domestic priority to an issue that’s even more pressing to many Americans.

“This is the last chance, as far as I’m concerned,” Rep. Louise Slaughter, D-N.Y.

Obama lamented partisan bickering that has resulted in a stalemate over legislation to extend coverage to more than 30 million people who are now uninsured. “Politics I think ended up trumping practical common sense,” he said.

And yet, even as he pleaded for cooperation — “actually a discussion, and not just us trading talking points” — he insisted on a number of Democratic points and acknowledged agreement may not be possible. “I don’t know that those gaps can be bridged,” Obama said.

With hardened positions well staked out before the meeting, the president and his Democratic allies prepared to move on alone — a gamble with political risks no matter how they do that.

One option — preferred by the White House and progressives in the Democratic caucus — is to try to pass a comprehensive plan without GOP support, by using controversial Senate budget reconciliation rules that would disallow filibusters. GOP Sen. Lamar Alexander asked Democrats to swear off a jam-it-through approach, while Senate Majority Leader Harry Reid, D-Nev., defended it. Obama weighed in with gentle chiding, asking both sides to focus on substance and worry about process later — a plea he made repeatedly throughout the day with little success.

A USA Today/Gallup survey released Thursday found Americans tilt 49-42 against Democrats forging ahead by themselves without any GOP support. Opposition was even stronger to the idea of Senate Democrats using the special budget rules, with 52 percent opposed and 39 percent in favor.

A second alternative for Obama and his party is going smaller, with a modest bill that would merely smooth some of the rough edges from the current system. A month after the Massachusetts election that cost Democrats their Senate supermajority and threw the health legislation in doubt, the White House has developed its own slimmed-down health care proposal so the president will know what the impact would be if he chooses that route, according to a Democratic official familiar with the discussions. That official could not provide details, but Democrats have looked at approaches including expanding Medicaid and allowing children to stay on their parents’ health plans until around age 26.

Obama himself hinted at a Democrats-only strategy. When asked by reporters as he walked to the summit site if he had a Plan B, he responded: “I’ve always got plans.”

Many lawmakers and Obama stressed areas of agreement, including items such as allowing parents to keep young adult children on their health plans into their 20s, cutting fraud and waste and ensuring that sick people aren’t dropped by insurance companies. But such items occupy the edges of reform.

Indeed, any skepticism about reaching broad consensus was vindicated as soon as the first Republican spoke — in opposition to the mammoth bills that have passed the House and Senate. Alexander, of Tennessee, said Congress and the administration should start over and take small steps, including medical malpractice reform, high-risk insurance pools, a way to allow Americans to shop out of state for lower-cost plans and an expansion of health savings accounts.

“We believe we have a better idea,” Alexander said. “Our views represent the views of a great number of American people.”

Disagreements were not always expressed diplomatically.

Alexander challenged Obama’s claim that insurance premiums would fall under the Democratic legislation. “You’re wrong,” he said. Responded Obama: “I’m pretty certain I’m not wrong.”

As with much in the complicated health care debate, both sides had a point. The Congressional Budget Office says average premiums for people buying insurance individually would be 10 to 13 percent higher in 2016 under the Senate legislation, as Alexander said. But the policies would cover more medical services, and around half of people could get government subsidies to defray the extra costs.

Obama and his 2008 GOP opponent for the presidency, Sen. John McCain of Arizona, had a barbed exchange. McCain complained at length about what he said was a backdoor process to produce the original bills that resulted in favors for special interests and carve-outs for certain states.

“We’re not campaigning anymore. The election’s over,” responded a clearly irritated Obama.

“I’m reminded of that every day,” McCain shot back, adding that “the American people care about what we did and how we did it.”

Said Obama: “We can have a debate about process or we can have a debate about how we’re actually going to help the American people at this point. And I think that’s — the latter debate is the one that they care about a little bit more.”

Generally, polls show Americans want solutions to the problems of high medical costs, eroding access to coverage and uneven quality. But they are split over the Democrats’ sweeping legislation, with its $1 trillion, 10-year price tag and many complex provisions, including some that wouldn’t take effect for eight years.

The Democratic bills would require most Americans to get health insurance, while providing subsidies for many in the form of a new tax credit. The Democrats would set up a competitive insurance market for small businesses and people buying coverage on their own. Democrats also would make a host of other changes, which include addressing a coverage gap in the Medicare prescription benefit and setting up a new long-term-care insurance program. Their plan would be paid for through a mix of Medicare cuts and tax increases.

“Not only are lawmakers polarized, the parties’ constituencies are far apart,” said Robert Blendon, a Harvard University professor who follows public opinion trends on health care. “The president is going to use it as a launching pad for what will be the last effort to get a big bill passed. He will say that he tried to get a bipartisan compromise and it wasn’t possible.”

The Blair House setting wasn’t grand, or even particularly comfortable. About 40 senators, representatives and administration officials were crowded shoulder-to-shoulder around a hollow square table, perched for the six-hour marathon on wooden chairs with thin cushions. Coffee breaks were ruled out, so the only pause in the action came during lunch.

C-SPAN carried complete coverage, while news operations from cable networks to public broadcasting were making it the focus of their day.

Leaving the site during a lunch break, Obama was asked by waiting reporters if he thought the debate was engendering a lot of interest across the country.

“I don’t know if it’s interesting watching it on TV,” he responded.

___

Associated Press writers Erica Werner, Ben Feller and Natasha Metzler contributed to this story.

Popularity: 3% [?]

By Bernadine Healy, MD

Salvage efforts are underway for the president’s health reform package, put into a stall by the recent surprise election of Republican Sen. Scott Brown in Massachusetts, which disrupted the one-vote margin that would have passed the legislation last month. On the one hand, President Obama seems conciliatory; a proposed televised summit in late February would allow key members from both sides of the aisle to hear from those who have different ideas. On the other, he does not seem willing to scrap the health reform bills that were a year in the making and would radically restructure both the financing and delivery of healthcare. Last week, Secretary of Health and Human Services Kathleen Sebelius delivered the message that the administration would not budge from its comprehensive approach to lowering costs and covering the uninsured, since the “pieces of the puzzle are too closely tied to one another.”

She has a point there. The Obama­care puzzle, a centrally driven plan that requires at least a trillion dollars to succeed, counts on a combination of taxation, fines, penalties, and cost savings; a reallocation of major resources within the current health system; and a willingness among doctors and patients to accede to substantial new government controls. Regardless of how workable the administration’s grand design appears to be on paper—about 4,000 pages of paper—it will fail if all of these big puzzle pieces are not in place. Most obviously, are the needed resources there for the tapping? There are at least two giant reasons that I think the puzzle is now imploding on its own, and neither has anything to do with political partisanship. And no televised show of hand-holding will make one whit of difference.

The first fatal flaw: leaning on Medicare. Obamacare counts heavily on its ability to drain off money from Medicare—which, by the administration’s own accounting, is slated to go into bankruptcy in seven years even as it is. It seems like a heavy dose of voodoo eco­nomics to expect that this program, with its ranks just starting a big swell because of aging baby boomers, has the capacity, no less the will, to cough up half a trillion dollars to pay for half of the cost of health reform. Much has been made of the savings to be found in ending fraud and abuse, but success there would in no way be sufficient to prevent a hike in Medicare payroll taxes on working Americans (who would not be pleased), higher Medicare premiums for beneficiaries, and a big bite out of the medical care our elders now receive.

Health reform proposes to save lots of government money by keeping seriously and chronically ill old folks from being readmitted to the hospital too frequently, a major source of Medicare expenditure. Sounds good, but it is easier said than done, both medically and ethically. Political pundits who would have you think that a hospital admission should cure the disease and that a readmission is a sign of doctor or hospital failure know little about the nature of the formidable degenerative diseases that affect the hearts and lungs, bones and brains, and immune systems of the elderly. Patients who can be tuned up with a few days in the hospital and return home better, even if it’s more than once, are not candidates for hospice. Where else are they to turn? Washington is threatening to cut reimbursement to the doctors and hospitals with higher readmission rates, or label them as poor performers, without analyzing the circumstances. It won’t work.

Another source of money is slated to come from ending Medicare Advantage, a popular but costlier option that covers 10 million elderly in privately managed healthcare organizations that provide pharmaceuticals and impose small or no copayments. Though the savings here are sure to be realized, they come at the risk of citi­zen discontent. Especially so when some elders, namely Floridians, are exempt. Who was the hero who saved Advantage for the 1 million elderly in the Sunshine State? It was their own Sen. Bill Nelson, who made that loophole the price for his health reform “Aye” vote.

The second seed of destruction: counting on Medicaid. The current plan to cover half of the uninsured by putting them into Medicaid has special appeal to federal budgeteers, since the states would be forced to kick in as much as 50 percent of the expense. But Medicaid is already literally bankrupting many states, which unlike the federal government have no way to print money. This new unfunded federal requirement would inevitably mean higher state income taxes that, yes, would hit the middle class despite the president’s promise otherwise.

On this point, give a tip of the hat to the other Nelson, the unrelated Sen. Ben Nelson of Nebraska, who got the bill passed even as he struck a special—and a bit tacky—deal to protect his state. Stridently opposed to the health bill up until the 11th hour, Nelson finally traded his 60th and winning vote in return for a promise that the feds would pay for Nebraska’s portion of Medicaid costs related to health reform in perpetuity. This did not sit well with other governors. Indeed, in his January State of the State address, California’s Gov. Arnold Schwarzenegger went ballistic about reform that would dump huge costs on states already struggling to pay their bills. Once a supporter, he called health reform a “trough of bribes, deals, and loopholes” and challenged the state’s congressional delegation “to fight for the same sweetheart deal Senator Nelson of Nebraska got for the Cornhusker State.”

If the federal government were to make the Nebraska deal with every state, reform would add billions more to the federal deficit, and the president by his own promise would have to veto the bill. But if the “I’ll vote for the law as long as I don’t have to follow it” approach is what carries health reform to his desk, he should by his own conscience consider using his veto pen.

Clearly, fixing the Obamacare mess will take time, if it’s possible at all. But one bipartisan effort that’s worth tackling and is doable right away is targeted insurance regulation. Let’s begin creating a health reform puzzle with this key piece: a system with no denials of access; no cherry-picking of the healthy over the sick; and, rather than one-size-fits-all coverage, an open market where people can search anywhere across the country to find the best policy at the best price for their own needs. Such change would cause insurers to compete to win the trust of, and lower the premiums for, their “covered lives” in order to keep their business. That would be real change.

Popularity: 5% [?]

Health Insurers Post Record Profits

Insurance Firms Rake in Profits as They Cut Patients, Advocacy Group Says

By EMILY WALKER
MedPage Today Staff Writer
Feb. 12, 2010—

In the midst of a deep economic recession, America’s health insurance companies increased their profits by 56 percent in 2009, a year that saw 2.7 million people lose their private coverage.

The nation’s five largest for-profit insurers closed 2009 with a combined profit of $12.2 billion, according to a report by the advocacy group Health Care for American Now (HCAN).

“The outsized earnings are a vivid reminder that without comprehensive national health care reform, the gatekeepers of our broken health insurance system always will put the short-term interests of Wall Street before the needs of millions of patients and a national economy plagued by joblessness,” the report said.

A spokesman for the nation’s health insurers said their profits are reasonable and represent only a small part overall increase in health insurance costs.

The HCAN report attributed this year’s profits largely to insurers’ dropping coverage of 2.7 million people, who then moved onto public insurance plans such as Medicaid.

Under questioning from reporters, Richard Kirsch, national campaign manager for HCAN, conceded that insurance companies don’t bear all the blame for eliminating people from their rolls. He said the recession induced many employers to cut back on benefits, including health plans. Also, many who were laid off lost their insurance coverage and were forced to enroll in Medicaid.

Even so, insurance companies have also offloaded their most expensive patients by cancelling their policies and raising premiums drastically, Kirsch asserted in a Thursday press call.

Among the report’s findings on specific insurance companies:

 - Wellpoint increased profits 91 percent from 2008 while it chopped 3.9 percent of its total enrollment.

 - United Health’s profit increased 28 percent from 2008, while enrollment dropped by 3.4 percent.

 - Cigna’s profit increased 346 percent and enrollment dropped 5.5 percent.

 - Humana’s profit increased by 61 percent while enrollment decreased by 1.7 percent.

 - Aetna was the only company with a drop in profit and a gain in enrollment. The company’s profit declined by 8 percent from 2008, and enrollment grew by 7 percent.

Lawmakers and critics who took part in the HCAN call said they were disgusted by the notion of insurance companies profiting while unemployment rates soar and more than 40 million people lack health insurance.

“How did they accomplish this feat in the midst of a sharp economic downturn that reduced wealth across the board?” asked Rep. Rosa DeLauro (D-Conn.). “Easy. They delayed payments to doctors, hospitals, patients. They raised premiums, increased co-pays and deductibles.”

California’s largest insurer, Blue Cross, announced last week that it will raise premiums 30 percent to 39 percent for many of its 800,000 customers.

“Without reform, we’re going to continue to see double-digit rate increases,” Kirsch said. “Without requiring that everyone’s covered, without regulating insurance companies, and without subsidies for people to make it more affordable, the data this year will continue unabated,” Kirsch said.

The health care bills being considered in Congress would impose regulations on insurance companies, prohibiting them from denying insurance or cancelling policies based on a pre-existing health condition. Both bills would also require insurance companies to spend money from premiums on health care, not on administrative costs.

Insurance companies agreed to the deal because of a provision that would require most Americans to buy health insurance, which would increase their customer base.

Some say the health care reform movement stalled with the election of Republican Scott Brown to Sen. Edward Kennedy’s old Massachusetts Senate seat, and President Barack Obama is holding a televised health care summit on Feb. 25 in hopes of bringing Republicans and Democrats together on some kind of agreement.

A spokesman for the insurance industry said health insurance profits “are well below other industries in the health care sector.”

“For every dollar spent on health care in America, less than one penny goes towards health plan profits,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans (AHIP). He argued that in 2009, it was spending on hospitals, physicians and prescription drugs that “continued to soar.”

Indeed, a recent report by the Centers for Medicare and Medicaid Service (CMS) found that health spending grew 5.7 percent, reaching $2.5 trillion in 2009, even though the overall economy declined by 1 percent. The report pointed to increased spending on hospitals, doctors, and medications as major drivers in the rising cost of health care.

Copyright © 2010 ABC News Internet Ventures

Popularity: 5% [?]

By Bernadine Healy M.D.,

Posted: February 2, 2010

In his State of the Union address, President Obama vowed not to “walk away” from healthcare reform, though he was clearly chastened by the upset in Massachusetts that had swept Republican Scott Brown into the Senate, depriving Obama, at the 11th hour, of a signed bill before the speech. The legislation barely made it through each chamber, and the 60-vote victory on Christmas Eve in the Senate came without a vote to spare. The president did not reveal how he would move forward, but his rescue options are sorely limited. Still, whatever path he chooses, the walk provides a totally unexpected opportunity for the country: the chance to go back and make changes that would not have been possible before Massachusetts voters weighed in.

There are really only two paths forward, and both will take time. In the faster (and perhaps too clever) way, the House would pass the Senate bill untouched and send it to the president, bypassing the need for a final Senate vote that includes Brown. Secret negotiations are underway at both ends of Pennsylvania Avenue to modify the 2,700-page Senate monster to the House’s liking—but any changes can be voted on only after the president signs the bill into law. The post-facto recasting would use a political gimmick, a process called reconciliation, that applies to budget issues and requires a simple majority vote (51 percent) rather than the supermajority (60 percent) often needed to pass controversial legislation in the Senate. If the House balks at this feat of legislative engineering, Congress will have to take a deep breath, step back, and fashion a more bipartisan bill.

Both scenarios mean that healthcare reform could still be made far more respectful of patients’ individual choices and their pocketbooks—not just the federal purse. Let me suggest two big-ticket areas that badly need attention: prescription drug costs and insurance premiums. Both must be affordable, or a central goal of reform—ready healthcare for all—will never be achieved.

Pharmaceuticals: In the United States, medicines in exactly the same doses commonly run three to four times, and in some cases 10 times, prices in other places on the planet with drug-safety and approval systems like our own. The issue became hot in 2003, when older folks were caught boarding buses to Canada to buy their drugs at huge discounts. Rather than being cheered on by Uncle Sam for saving healthcare dollars, the renegades were threatened with confiscation of their “illegal” purchases. The federal government refused to relax the Food and Drug Administration’s rules against citizens’ importing drugs, even those obtained from perfectly legitimate pharmacies. And the consumers’ revolt was vigorously opposed—surprise, surprise—by the drug companies, which lobbied heavily to continue to soak American taxpayers under the guise of safety. A bill to allow such drug imports, cosponsored by none other than Barack Obama when he was in the Senate, was roundly defeated.

 Shortly after he was inaugurated, Obama vowed to bring down the cost of drugs by making it possible for Americans to fill prescriptions outside the country. It did not take long, however, for the special interests to entice him to cave. In a stunning surprise, given his legislative record and earlier promises, Obama made a backroom deal with the pharmaceutical lobby. Big Pharma would support Obamacare and even contribute $80 billion to the healthcare reform effort. The president would quash efforts in support of the citizen revolt.

Then, in mid-December, in one of the few bipartisan moves related to health reform, a majority of senators voted to amend the bill to allow Americans to buy drugs from Canada, Europe, Australia, New Zealand, and Japan. How could they not do so? The Congressional Budget Office had just estimated that the amendment would save the government almost $20 billion, and Democratic Sen. Byron Dorgan of North Dakota, who sponsored the bill, said it would lower patients’ costs by $80 billion. The amendment did not get the 60 votes necessary to be added to the health reform bill, but a reconciliation strategy that needs only 51 votes, or a new bill fashioned from scratch, could and should get the gray panthers a win after all. Health reformers ought to place value on healthy competition, which, if allowed to flourish, can lower costs to individuals as well as to the U.S. Treasury.

Insurance reform: In the same spirit of allowing competition and consumer choice to thrive, the way health insurance is sold should be addressed. The current system bears no resemblance to an open market where people can shop for the best policy for themselves and their families at the best price, as they can, say, for car insurance. Now, patients have little leverage. Those with health risks can be rejected out of hand, existing coverage can be canceled, and claims can be denied for little or no reason. Outlawing such abuses is the one part of the current healthcare reform legislation that has strong bipartisan support. And this is an imperative that cannot be walked away from.

But even then, a nagging problem remains: People don’t feel insurers are working for them, although the companies manage lots of their money and weigh in on their health. This could get worse, since a keystone of health reform—the individual mandate—would force people to buy coverage restricted to that sold through either a government-run exchange or an employer. Only the federal government would define the “essential” coverage every American must have and would set up the rules of the exchange.

Instead, to preserve patient choice while trimming cost, we need multiple nationwide exchanges, public and private, that will foster competition among insurers, expand choices, and lower prices by helping patients to be smart consumers. Rather than being forced to buy a one-size-fits-all, comprehensive, government-approved policy, for example, most young people could get insurance for thousands of dollars less by choosing a scaled-back, high-deductible cata­strophic plan that brings access to discounted ­prices for preventive and primary care.

Face it: Since most of the uninsured fall into the relatively healthy under-40 group, the current bills will force tens of millions of Americans to overpay for coverage, a juicy deal for insurers but not for anyone else. A bonus to allowing high-deductible plans is that they force people to think about the cost of their care and, much as those elders did when they boarded buses to cross the border to get cheaper drugs, to search for ways to save. We cannot ignore the power of the people to make their own wise decisions. Let’s give them an incentive to do so, and we’ll develop a generation of prudent healthcare consumers. 

Popularity: 2% [?]

Experts Disagree Over Legislation’s Fate

By JOSEPH BROWNSTEIN
ABC News Medical Unit
Jan. 21, 2010—

With Republican Scott Brown’s victory in Massachusetts on Tuesday, Republicans in the Senate captured a seat long held by Democrats, and, perhaps more importantly, the possible 41st vote necessary to filibuster any new health care bill.

But while the future of a health care overhaul remains unclear, experts are divided as to how to read the tea leaves in public opinion on the issue following a vote from a state that already has universal health care. Brown, then a state senator, voted in favor of the measure when the Massachusetts legislature passed it in 2006.

Brown has vowed to halt the current version of health care reform, passed by the Senate on Dec. 24, saying he did not think the current plan was a good one for the country — or Massachusetts.

“We already have 98 percent of our people insured here,” Brown said Wednesday afternoon, repeating one of his campaign themes. “We know what we need to do to fix it. But to have the one-size-fits-all plan that is being pushed nationally — it doesn’t work.”

Experts were split on whether health care overhaul could continue forward at this point.

“President Obama’s already unpopular health plan didn’t lose just one vote in the Senate. It lost maybe a handful of votes in the Senate and perhaps a dozen or more in the House,” said Michael Cannon, director of health policy studies at the Cato Institute.

“Antipathy toward the Obama plan was the number one reason for Brown’s victory, and that has vulnerable Democrats in Congress running scared,” he said. “They are now far more likely to vote against the Obama plan, particularly since the elections in New Jersey and Massachusetts show that Obama can’t help them on the campaign trail.”

But others disagree.

“Health reform is not doomed. It just depends who does it,” said Uwe Reinhardt, a professor of economics and public affairs at Princeton University. “The task will always be much, much more difficult for Democrats, because they are suspected of plotting government hegemony just breathing. It is much simpler for Republicans to do the same thing.”
State of Opposition
To be sure, nationwide numbers have shown the public to be divided on the issue, with a slight majority opposed to the measure.

But it remains unclear how those numbers translate to Massachusetts, traditionally one of the most Democratic-leaning states in the union, but one that has some unusual circumstances when it comes to health care overhaul.

During his campaign, Brown said the health-care bill passed by the Senate would force Massachusetts to subsidize care in other states.

“It is a good point that Massachusetts residents didn’t ‘need’ national reform,” said David Dranove, a professor of health industry management at the Kellogg School of Management at Northwestern University. “But they must have been furious about having to pay for healthcare in Nebraska and Louisiana on top of paying for their own healthcare.”

He also noted that Massachusetts voters “could see that the national reform effort was a badly compromised version of their own reforms,” noting that Democrats in Congress struck some deals that he feels voters found unpalatable.

But some also noted the fact that Massachusetts has had some level of health care reform may be a sign that voters did not cast their votes based on that issue — and perhaps politicians shouldn’t interpret it to mean that.

“I do find it ironic that many people outside of Massachusetts are interpreting this vote as a message that those living in the state oppose health care reform, when a very similar system is very popular inside that state,” said Dr. Aaron Carroll, director of the center for health policy and professionalism research at the Indiana University School of Medicine. “If they were truly opposed, you should have seen at least one campaign running on a platform of scrapping their system. None did.”
Second Life Or Dead On Arrival?
While some may see health care overhaul as a lost opportunity, others see the vote as a setback that can be overcome.

Reinhardt noted that in the past, Republican administrations have pushed bills through Congress that brought price controls set by the federal government. Under Ronald Reagan the target was the hospital sector, and under George H.W. Bush it was doctors.

“Both times it went without a huge public outcry. But now imagine if a Democratic president — e.g., Bill Clinton or Obama — had done the same thing. He would swiftly be denounced as trying to impose Soviet-style pricing on American hospitals which, in effect Reagan’s [pricing systems] were,” he said.

“Moral of the story: There is a double standard here,” Reinhardt said. “Perhaps only Republicans can get health reform done, because only they can get away with doing even Soviet-style policies.”

Other ideas for a bill passage have been floated.

Some proponents of health reform have held out hope of persuading Maine Sen. Olympia Snowe, a Republican, to vote for a bill, and others wanted to speed through health care reform before Brown was seated, although Obama has nixed that idea.

“Here is one thing I know, and I just want to make sure this is off the table,” he told ABC News’ George Stephanopoulos on Wednesday. “The senate certainly shouldn’t try to jam anything through until Scott Brown is seated. People in Massachusetts spoke. He’s got to be part of that process.”

Leadership Unclear
Even Democrats in the Senate do not appear to have a clear plan for how to proceed right now.

In response to a question from ABC News correspondent Jonathan Karl about whether he was committed to finishing the health care bill and confident he could pass it on to the president, Senate Majority Leader Harry Reid replied, “I am confident that health care is an issue in this country. We are going to do everything we can to alleviate the pain and suffering of people who cannot afford health care and who want to maintain what they have.”

He then noted that the House had until Dec. 24, 2010 to pass the bill the Senate had passed at the end of last year and send it to the President.

His representative clarified afterward.

“We are still committed to getting health care done,” Reid spokesman Jim Manley said.

But Brown himself has given some hints that even if the current incarnation of health care reform is not something he will vote for, it does not mean he will oppose any proposal.

“I think it’s important for everyone to get some kind of health care,” he said Wednesday. “It’s just a question of whether we’re going to raise taxes, cut a trillion from Medicare, we’re going affect veterans’ care — I think we can do it better.”

ABC News’ Political Unit in Washington contributed reporting. The ABC News Medical Unit is based in Needham, Mass.

Popularity: 2% [?]

From Dana Bash and Ed Henry, CNN

(CNN) — Faced with the once-unthinkable prospect of losing the Massachusetts Senate race, Democratic officials on Capitol Hill are quietly talking about options for passing health care reform without that critical 60th Senate vote.

Top White House aides insist they are not engaging in any talk of contingency plans, because they believe Democrat Martha Coakley will beat Republican Scott Brown in Tuesday’s crucial Senate battle.

“We are not having any discussions like that,” White House spokesman Bill Burton told CNN. “We believe she is going to win.”

Asked about potential contingency plans as Air Force One returned to the Washington area after President Obama’s Sunday campaign rally for Coakley in Boston, White House Press Secretary Robert Gibbs insisted to reporters the plan is to still pass health care reform with 60 votes. “We think Coakley will win this race,” Gibbs said.

But Democratic sources on Capitol Hill say “what-if” discussions are taking place about how they could proceed with health care if Coakley is defeated, and they privately admit none of their alternatives is very good. According to senior Democratic congressional officials, here are options under discussion:

Pass health care reform before Scott Brown is seated.

But multiple Democratic sources say this is unlikely. Even if House and Senate Democrats could reach a deal to meld their bills and pass them in the next couple of weeks — a big if — there would be a huge outcry from not only Republicans, but also an increasingly distrustful public.

For that reason, one senior Democratic source says some Democratic lawmakers who voted yes last time have already warned they would vote no if health care is voted on in advance of any swearing in of Brown.

The House passes the Senate health care bill.

Democratic sources also call this extremely unlikely, because House Speaker Nancy Pelosi likely wouldn’t have the votes to pass it. Many House Democrats have major differences with several provisions in the Senate bill, especially the way the Senate structured a tax on high-cost insurance plans.

Revisit the idea of trying to push health care through the Senate with only 51 votes, a simple majority.

But to do that, Democrats would have to use a process known as reconciliation, which presents technical and procedural issues that would delay the process for a long time, and Democrats are eager to put the health care debate behind them and move onto economic issues such as job creation as soon as possible this election year.

Try once again to get moderate Maine Republican Olympia Snowe’s vote. They could try for a compromise health reform plan with the independent-minded Republican, but multiple Democratic sources say they believe that is unlikely now.

Their health care overhaul dies.

Although some Democrats are not ruling out this possibility, numerous top Democrats say not passing a health care bill for the president to sign is unthinkable after he put so much political capital into passing a reform bill, and congressional Democrats spent much of last year working on it.

Popularity: 2% [?]