Piggy bank

By David Urbaniak, Product Manager, Evolution1

With 2013 behind us, we can now look at what the year brought as related to the ever-changing world of defined contribution. Let’s first take a look at a couple key learnings and trends from 2013:

Proven Solutions – and Public Rollout – Aren’t Necessarily Easy – The experiences at both the federal and state marketplace levels illustrated the need to leverage proven partners and solutions. Investing in the right technology, services, and program management is essential. A marketplace will fail if you don’t focus on all three. This is equally true for private marketplaces. Marketplace processes were far from hassle-free, and the need for focusing on the consumer experience became painfully apparent. Marketplace consumer experiences are the tip of the icebergs in terms of the overall programs that sit underneath them, but the experience is the benchmark by how your marketplace will be judged and whether or not you will be successful.

Benefit Model Shift Gained Momentum, Plan Selection Evolved – Employers continued to move from a consumer-driven health care (CDHC) model to a defined contribution model, and all signs indicate that will continue in 2014. Just weeks ago, Target Corporation announced that it was moving its part-time employees to a defined contribution plan offering $500.

There are opportunities to provide value to the consumers impacted by this model change. Newer data, published by Aon, further illustrates the value of using a third-party administrator (TPA) as well as the need to offer CDHC accounts on the same platform as the defined contribution accounts.

The amount of employees who chose to enroll in a CDHC plan when given that choice in an exchange model tripled from 12 percent to 39 percent. This means that nearly 40 percent of employees will be looking for additional savings mechanisms – whether through a flexible spending account (FSA) or health savings account (HSA) – to help them budget and save for current and future out-of-pocket health care expenses. There is tremendous value to the employee (and savings to the employer!) when employees are given the opportunity to enroll in CDHC accounts through an exchange.

With 2014 underway, what change can we expect to see for defined contribution in the months ahead?

Continued and Accelerated Shift in Model – Employers will keep moving from traditional defined group benefit models to defined contribution models with consumer-directed health plans. That is, employers will fix the amount they are willing to contribute by giving each employee a defined contribution amount. Additionally they will provide employees with more insurance options to select through an exchange. Expect to see a deeper product extension beyond medical and ancillary plans and into gym memberships, pet insurance, organic food delivery services and more.

A recent study published by Accenture shows that by 2018 the number of employees expected to use a private marketplace to make their insurance plan decisions and purchases will surpass the number of individuals expected to use a public exchange by nearly 40 million consumers. That’s an incredible shift and one that is going to impact everyone involved in supporting and providing solutions related to employee benefits. Companies that provide solutions to employers today – whether directly or indirectly through brokers or health plans – need to seriously consider this shift and determine the role they want to play in this evolving ecosystem. Businesses that are positioned to provide defined contribution private exchange solutions or partner with another organization to do so will be in a great position to take advantage of new opportunities, and perhaps more importantly, protect their existing market share.

Continued – and Increasing – Employee Education and Communications – The ongoing fracturing of the group market will provide new opportunities for employees to potentially find benefits outside of their employer, but the process will continue to prove challenging for the foreseeable future until consumer understanding and more seamless solutions fill the void. The announcement by Target Corporation to move its part-time employees to a defined contribution model led to some confusion in both media perception and in responses from Target’s human resources team. It is crucial that benefit decision makers, HR staff, and employees understand the model.

There is a critical difference between dropping coverage altogether, and changing from group coverage to an individual defined contribution plan with opportunities to shop on a competitive marketplace. This distinction is important as more companies look to migrate from group to individual plans and ultimately the success these new benefit offerings have. Consumer engagement, along with clear and consistent communication are requirements for any defined contribution program. Employers can help facilitate this by providing:
An enrollment solution that is easy to use with decision support that meaningfully informs consumers as to what they can expect for their health care financial responsibility and how much they will need to save.
Education on insurance plan choices and self-service resources to help empower consumers to be in control of their health through personalized health insights and messaging, including utilizing the previous years’ consumer claim data.
A consumer experience that provides a holistic view of a consumer’s health care benefit financial picture with budgeting tools and payment solutions that address the consumer’s year-round needs of managing health care and related financial expenses.
Visibility during enrollment and throughout the year as related to employer funding/defined contribution amounts, price transparency for services and savings opportunities.

Continued Shift of Financial Responsibility to Employees – Regardless of the benefit model being supported – CDHC defined benefit programs, defined contribution programs, or even situations where employers are getting out of health insurance altogether – CDHC accounts that support employers to assist in funding their employee health care costs and provide employees with tax-advantaged ways to pay for their out-of-pocket health care expenses have a large role to play. The more financial responsibility employees are asked to take on, the more critical these accounts become.

Analytics – Analytics has been a trend topic for years; however, analytics for analytics’ sake does not provide value to downstream stakeholders. What does? The meaningful and applicable presentment of analytics to consumers and other stakeholders of the healthcare financial services ecosystem. We are coming (thankfully) into an age where we are not only aggregating the data, but also presenting it in ways that are meaningful, consumable and actionable. In the next six to 18 months, expect to see stronger integration between consumers’ health care financial benefit picture and their existing employee benefits such as their 401(k), tuition reimbursement, and more, presenting an even greater picture of an employee’s overall health, and wealth, picture. This is where we expect solutions to start to drive real behavioral change and reduce the upward trajectory of the healthcare cost trends in the U.S.

Increased Role and Need of Wellness Tools – As mentioned, the adoption of plans with additional consumer exposure as well as lower premium health plan designs are not the only things affecting cost; it extends to consumer tolerance to accept lower cost, narrow networks, and willingness to try new plans that are based on innovations in payment reform such as reference pricing models (see “The Sleeper in Health Care Payment Reform” by Uwe E. Reinhardt). Coupled with wellness incentives and greater transparency on provider costs, defined contribution offers promise for longer term favorable effects on the health care cost trend.

Cliché as it may be, the only thing we know for certain in 2014 is change. As Bill Gates said, “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction.” Be informed and take necessary action today rather than tomorrow.

David Urbaniak is a product manager at Evolution1. He can be reached at or 952-908-9096.

Popularity: 23% [?]

ACA Sparks Renewed Interest in CDHPs; FedEx Shifts to Account-Based Plans (2013)

Reprinted from HEALTH PLAN WEEK (c); Health Business Daily Story, Aug. 26, 2013

The trend toward consumer-directed health plans (CDHPs) got a major convert this month when package delivery giant FedEx Inc. said it would not only offer such plans, but actually switch its entire 400,000-some workforce to account-based insurance starting in 2014. Cigna Corp. and WellPoint, Inc.’s Anthem Blue Cross and Blue Shield will administer the new benefit.
Consultants and industry stakeholders didn’t blink at the news, considering that CDHPs have been around for more than a decade, but did stress that the reform law appears to be accelerating the speed at which large groups are moving away from more traditional coverage.
Tim Finnell, a certified health care reform specialist and president of Group Benefits LLC in Memphis, Tenn., says he sees a lot of large employers at least considering making a change. Finnell says FedEx, which is a bulwark in his hometown of Memphis, is being proactive by announcing its intentions now, well before open enrollment in the fall. “FedEx has always been innovative and ahead of the curve.…But this is part of a trend we are seeing shifting the cost to the claims side from the premium side,” he says. The consumer-directed plans, like the account-based program FedEx will roll out, puts members in a position to help themselves by making healthy choices, joining incentive-based preventive care programs and shopping for services.
FedEx spokesperson Scott Fiedler tells HPW that the reform law “is causing all employers to re-examine how they provide health care benefits to their employees. FedEx is no exception. Like many large employers, FedEx is self-insured and is working proactively to address rising coverage costs.”
CDHP Trend Gains Speed
Industry sources say the FedEx account-based plan likely will offer different levels of deductibles and will be tied to a health reimbursement arrangement (HRA). All prescriptions, preventive care programs and member primary care doctor visits to in-network providers will be covered outside of the annual deductible, with coinsurance instead being used in those instances. A $400 annual HRA contribution will offset the annual deductible for individual workers. Employees with children will have a $650 HRA contribution, while those with family coverage will have an $800 contribution.

“Consumer-Driven” Health Enrollment Reached 22 Million in 2010 ; 9.9 million in HSAs
The ranks of people enrolled in either a consumer-driven health plan (CDHP) or a high-deductible health plan (HDHP) reached 22 million in 2010, according to a report released today by the nonpartisan Employee Benefit Research Institute (EBRI). Participation in these account-based health care plans is low, but continues to grow, EBRI finds in its sixth annual Consumer Engagement in Health Care Survey. The EBRI report found that enrollment in CDHPs rose to 5 percent of the privately insured population (5.7 million people) in 2010, up from 4 percent in 2009. Enrollment in HDHPs increased to 14 percent of the privately insured population (17.2 million people) in 2010, up from 13 percent in 2009. “Findings From the 2010 EBRI/MGA Consumer Engagement in Health Care Survey” are published in the December 2010 EBRI Issue Brief, and are online at
Overall, 12.1 million adults ages 21–64 with private insurance, representing 9.5 percent of that market, were either in a CDHP or were in an HDHP that was eligible for an HSA but had not opened the account.
See EBRI Report, December 2010

Popularity: 39% [?]

In 2014, Congress gets Obamacare. Here’s how they’ll pay for it.

By Ezra Klein – Washington Post

Starting in 2014, members of Congress and their staffs will have to get their health insurance through Obamacare’s insurance marketplaces. But according to a regulation that the Obama administration’s Office of Personnel Management plans to announce on Friday and release next week, the federal government can continue to contribute toward the cost of their health plans.

The regulation comes after months of worry on Capitol Hill. The Affordable Care Act includes a provision, first proposed by Sen. Chuck Grassley (R-Iowa), forcing members of Congress and their staffs to buy insurance through Obamacare. But it didn’t provide a clear mechanism for them to do so.

The insurance marketplaces are built for individuals, not employers, and there was concern that the federal government could not continue paying its traditional share of congressional health plans. That would mean the entire cost would fall to members of Congress and their staffs, many of whom would likely flee the institution.

The Obama administration’s compromise is to permit the federal government to contribute toward employee insurance on the exchanges, but to render those employees ineligible for any tax credits or subsidies.

“Members of Congress and their staff must go into the exchange,” said an administration official. “No ands, ifs, or buts. They will not be eligible in any way for subsidies or tax credits. But they don’t lose their current employer contribution.”

Congress is the only large employer that has to enter the exchanges or is even allowed to do so. Some on Capitol Hill have asked why the White House staff doesn’t follow suit.

“We have no legal authority to do that,” the official said. “But we would support legislation that would apply the same standard to the President and the White House staff and the cabinet members. We believe the insurance exchanges are a very good deal, a very good benefit, and we’re happy to be in them.”

Popularity: 2% [?]

Charting the Unknown Water of HSA’s in the Health Insurance Exchanges

By Reed Erickson, VP of Compliance & Risk Management

Most benefits professionals agree that the health insurance exchanges have the potential to create real change in the health care industry. But the high degree of unknowns related to the long-term implementation of the state-run and federal exchanges is dampening the excitement for many people and creating a wait-and-see attitude among employers and industry professionals.

What we know, and what we don’t know
Health insurance exchanges, as laid out in the Affordable Care Act (ACA), are new for 2014, which means there is a tremendous amount of work being undertaken by states and health insurers to develop the infrastructure to support this type of purchasing system. And what worries many critics as well as supporters is because there is little history for the exchange system the industry has no baseline for predicting what kind of results will be realized.

The majority of the discussion related to health insurance exchanges has centered around the health plan design and pricing. And while little has been publicly said about health savings accounts (HSAs), we do know that the exchanges will feature HSA-compatible health plans.

The HSA is a valuable complement to the high-deductible health plan (HDHP), because it allows and encourages individual consumers to set aside money for future health care needs, and it can provide a short-term buffer for medical emergencies.

This is important, because it’s anticipated that health care costs will at least initially increase once the exchanges go into effect. A report from the Society of Actuaries predicts that insurance companies will pay 32 percent more in claims costs once the exchanges go into effect. The upside of this is that millions of people will have access to health coverage who previously were uninsured.

Although the health insurance exchanges will initially roll out without HSA selection as an option, some experts predict that employers and individuals will continue to choose the HDHP option because it will be less expensive to start, and it can be coupled with an HSA for added savings potential.

Consider the recent study from TowersWatson and the National Business Group on Health, which states that 66 percent of large companies (with 1,000 or more employees) offered at least one account-based health plan option in 2012. That number is expected to increased to 80 percent in 2014.

Account-based health plans are expected to see growth within the exchanges because HSA plans have been proven to slow the growth in health care spending. For example, a 2012 study from the Rand Corporation, a policy research institute, found that families with consumer-directed health coverage like HSA plans spent an average of 21 percent less on health care the first year after switching from traditional coverage. Consequently if half of those with employer-sponsored coverage were in account-based plans, it’s estimated that health care costs would fall by $57 billion.

Educating consumers about HSA compatible health plans
While the popularity of HSAs has soared in recent years – in 2012, 11.6 million people owned HSAs nationwide, according to the Employee Benefit Research Institute many consumers who are new to purchasing health insurance will have to overcome a learning curve before they realize the potential value of the HSA as a health care savings tool. That will call for a concerted and ongoing education effort.

The responsibility for educating individuals about their option to open an HSA and how this could benefit them will fall soundly on the shoulders of health plans and HSA administrators, since there will initially be no direct visibility on the exchanges. Here’s what individuals will need to know in the short term:

* The basics of how the HSA works
* How much the individual can contribute
* Contributions to the HSA reduce tax liability
* How to get money from the account to pay for expenses
* What the HSA can be used for (eligible expenses)
* Tax-free withdrawals for eligible expenses
* Where to go for more information about HSA rules
* How to open an HSA and how to find an HSA administrator
* What kind of service and support to expect from an HSA administrator

Establishing transparency for long-term success
To be successful in the long term, individuals should be able to shop for an HSA when they choose a qualified, high-deductible health plan from within the exchanges.

Once the initial rollout of the health insurance exchanges is complete, it will be essential for those HSA choices to be transparent within the framework of the exchanges. This will allow one-stop shopping for an entire health package. Just as with the health plan, the HSA selection needs to provide visibility into the available HSAs, their costs, their benefits, and educational tools that enable consumers to make the best choice possible.

Available HSAs Consumers should be able to see a list of companies that offer HSAs and compare the HSA plans offered by each company.
Costs Individuals should be able to clearly see what, if any, monthly administrative fee they will pay for their HSA. In addition, they should be able to see a detailed list of extra fees that some HSA providers charge, such as account opening and closing fees, non-sufficient funds fees, and debit card swipe fees.
Benefits It will be important to spell out the financial benefits of the HSA to the consumer. From understanding the tax advantages of the account (reducing taxable income and paying no tax penalty on withdrawals for qualified expenses now or in retirement), earning interest on account balances, the long-term savings potential of the HSA, and the potential to invest unused HSA dollars into a variety of stocks, bonds and mutual funds, will help individuals make informed decisions.
Educational tools Individuals should be able to connect to information and tools, such as online cost calculators, that help them understand how the HSA saves them money and contributes to long-term savings, in addition to instructional videos and tips on how to use the account.
For individuals who choose a qualified high-deductible health plan, embedding these features into the health exchange infrastructure will deliver the best experience possible, because it will enable them to choose a health plan that best fits their health care needs and budget, while building a foundation for a financially sound and healthy future.

Popularity: 3% [?]

Obamacare 2013: Battle over Obamacare continues on law’s third anniversary

By: CNN Wire

Some see 2013 shaping up as 2012 all over again — at least on the issue of health care.

The dispute over President Barack Obama’s signature health reform law, which he signed three years ago on Saturday, is back on. Democrats say the law will expand access to health care and rein in the rising costs of healthcare. Republicans say the law is bad news for the health care system and the economy.

Obama was flying home on Saturday from his trip to Israel and Jordan, but noted the anniversary with a statement saying the law reflected “the principle that in the wealthiest nation on Earth, no one should go broke just because they get sick.”

“Already, millions of seniors are saving $600 a year on their prescription drugs,” he said, touting what he described as the law’s successes. “Millions of young people have been able to stay on their family’s health plan until age 26. Preventive care, like mammograms for women and wellness visits for seniors, is covered free of charge. Most importantly, for the sake of our fiscal future, the growth of health care costs is beginning to slow.”

Republican opposition

But Republicans don’t see successes. House Speaker John Boehner said Saturday Democrats passed the law with a “host of promises that are proving more empty by the day.”

“Instead of keeping the coverage they have, an estimated 7 million Americans are at risk of losing their health insurance, including millions of low-income and minority seniors enrolled in Medicare Advantage,” Boehner said.

“Far from ‘bending the cost curve,’ Obamacare’s projected price tag has nearly doubled. Health insurance premiums have spiked and are expected to climb even further when the law takes full effect next year. The millions of jobs Democrats promised are nowhere to be found, and businesses large and small are already pointing to the impact of Obamacare as the reason for ‘planned layoffs and a reluctance to hire more staff,’” he said.

Both chambers held votes this week on a repeal of the law.

Senate Republicans united behind an amendment to the Senate budget resolution which would repeal the health reform law. It failed in the Democratic-held body 55-45 while the overall budget proposal passed early Saturday morning.

The left-leaning group Center for American Progress says Senate Republicans proposed at least seven amendments to that resolution to either partially or fully roll back the law.

The main amendment for repeal was proposed by Sen. Ted Cruz, a freshman Republican from Texas. He told CNN on Friday that if it goes into effect “it could very well cause a recession.”

“I intend to keep trying to repeal Obamacare and to fight for pro-growth policies every single day,” he said. “The economy is not growing, and implementing Obamacare now raises a real possibility that we will push this economy into a recession.”

The fight to repeal the law has fared better in the Republican-controlled House. Budget Chairman Paul Ryan included a repeal in his budget that passed the GOP-controlled body on Tuesday.

But that’s where the progress stops. Even if the Senate were to do the unlikely and pass a repeal of Obamacare, the president would veto it. It appears unlikely that Republicans could muster the two-thirds majority in both chambers needed to overturn a presidential veto.

“The House Republicans have voted more than 30 times to repeal Obamacare,” White House press secretary Jay Carney told reporters last week. “That seems at some point to be time not well spent.”

Law was challenged in 2012

The Supreme Court heard challenges to the law last year and upheld it by a 5-4 vote. The high court found constitutional the law’s key individual mandate provision, which requires most Americans to obtain health insurance or face a tax penalty.

The four conservative-leaning justices who dissented argued the majority — the four liberal-leaning justices and Chief Justice John Roberts, who was appointed by President George W. Bush — was rewriting the law to consider the individual mandate a tax.

That decision also paved the way for the full law to take effect next year.

It also came amid the 2012 election year politics, as the two parties were wrangling for control over the White House and Capitol Hill.

Obamacare, Romneycare and Obamaneycare

The health care law was heavily debated on the campaign trail between Obama and Republican presidential nominee Mitt Romney, who drew cheers at his campaign rallies with the promise to repeal the law. Ryan was then his vice presidential candidate and also pledged to abolish Obamacare.

The term Obamacare itself was initially seen as a derogatory term. Rep. Debbie Wasserman Schultz, D-Florida, protested Republican use of the word on the House floor in 2011, saying, “It [is] a violation of the House rule wherein members are not permitted to make disparaging references to the president of the United States.”

But the president eventually embraced the term, saying on the campaign trail that yes, as the moniker implied, he did care, and that was why he proposed the health law.

On his own road to the White House, Romney faced challenges from within his own party on the health care issue.

When governor of Massachusetts, he signed a 2006 health care law which included an individual mandate. He wasn’t helped by the Obama administration, which said it drew from the Massachusetts law in crafting its own plan. The candidate defended “Romneycare” as a state-level solution for his state’s issues, arguing states should design their own health care systems because a one-size, nationwide solution would not fit all.

Poll: Opinions mixed

The most recent CNN/ORC poll showed Americans are as split as Washington over the law. The January survey shows that 51% favor most or all of the proposals, while 44% oppose most or all elements of the law. Those numbers are reversed from 2011, when only 45% were in favor and 51% opposed.

A Bloomberg poll conducted in February found 55% thought health care costs would become worse in the next 12 months. Only 22% said health care costs would get better, and 21% expected costs to remain about the same.

The law remains unpopular in Republican circles, giving those who vocally oppose it an audience in the GOP.

“Ted Cruz is putting down some markers,” Republican strategist and CNN contributor David Frum said Friday on CNN’s “The Situation Room.”

“There is a struggle to define who is going to be the next leader of the Republican Party, and a lot of people who have emerged early are people who have one strike or another against them,” he said. “Rand Paul, they’re too exotic. Another case is they may not have the force of character, but Ted Cruz has the toughness and brains, and he represents an important fundraising state. He is putting down his marker to be at least a Senate leader, maybe more.”

Much of the law takes effect next year

There are, however, a few Republican leaders supporting portions — but only portions — of the law taking effect.

At least eight Republican governors have said they support an expansion of Medicaid, the health coverage program for the poor, which is included in the health reform law. The Supreme Court ruled the federal government could not compel the states to accept this portion of the law.

Some have said they only support the expansion for three years, when the federal government funds the entire cost. After that, the federal government will fund 90% and the states 10% of the program.

Governors who have accepted the program include New Jersey’s Chris Christie and New Mexico’s Susana Martinez, both of whom are thought by some as potential White House contenders.

Arizona’s Jan Brewer, Michigan’s Rick Snyder, Nevada’s Brian Sandoval, North Dakota’s Jack Dalrymple and Ohio’s John Kasich have also voiced support for the program.

Gov. Rick Scott of Florida said he would accept it, but his state legislature voted not to.

The Medicaid expansion is one of several health care changes set to take effect next year, including the law’s most high-profile elements, including the ban on dropping patients with pre-existing conditions, ban on annual benefit limits and the health insurance exchanges. About half of the states have said they will conduct their own exchanges; exchanges in the other states will be run by the federal government.

Federal agencies are already deep into the complicated rule-making process which will stand behind the actual law.

Senate Minority Leader Mitch McConnell, a Kentucky Republican, wheeled out this week a hand truck stacked with documents that towered over him.

“You know nothing sums up all the excesses of the Obama Administration like Obamacare,” he said. “For example, these are the first regulations: 20,000 pages, 7 feet tall, and they’re just getting started. Everything they promised about Obamacare isn’t coming true.”

And as people around the country start to navigate the law, expect the arguments for and against the law from both sides of the aisle to continue.

Popularity: 2% [?]

Stakeholders have mixed reviews on proposed meaningful use requirements

By Diana Manos, Senior Editor
Created 01/04/2010

Physicians and privacy advocates aren’t pleased with the newly proposed “meaningful use” requirements with which providers will likely have to comply to gain bonuses under the American Recovery and Reinvestment Act of 2009.

The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology proposed the rules on Dec. 30, and will take comments for 60 days before issuing a final rule.

The Medical Group Management Association said the requirements “are overly complex” and that medical groups will confront significant challenges trying to meet them.

“The Medicare and Medicaid incentive programs must be designed to facilitate the rapid deployment of health information technology,” said MGMA President and CEO William F. Jessee, MD. “Overly burdensome requirements and needlessly complex administration will only discourage physician participation in the program and the implementation of (electronic health records).”

Jessee encouraged the administration to simplify the meaningful use criteria and qualifying procedures.

According to the MGMA, the rules will create “significant barriers” for physicians trying to achieve meaningful use of EHR data, including:

* Unreasonable threshholds for some meaningful use criteria, including computerized prescription order entry, electronic claim submission and electronic insurance eligibility verification;
* Potentially difficult meaningful use attestation after the first year; and
* A requirement that physician offices provide patients and others with electronic copies of medical records.

“We were pleased to see that the CMS and ONC rules include some flexibility, especially in the areas of escalating stages of meaningful userequirements, straightforward first year attestation and reasonable 90-day reporting windows,” Jessee said. “However, we firmly believe that the government should make additional changes to achieve widespread adoption by professionals in all types of clinical settings.”

Privacy advocates are also displeased with the rule. Deborah C. Peel, MD, founder and chairwoman of Patient Privacy Rights, said the rule “does not contain the single most important criteria American patients and consumers demand to trust electronic health systems: control over personal health information.”

Comments submitted by the bipartisan Coalition for Patient Privacy, representing millions of Americans, were not considered, Peel said.

The rule “guarantees that the stimulus billions will be wasted to purchase obsolete, unethical EHR ‘clunkers’ instead of EHRs with privacy-enhancing technologies that put patients in control of their sensitive health records, from prescriptions to DNA,” Peel said.

Not everyone was displeased with the rules. Justin Barnes, chairman of the Electronic Health Record Association, said the basic EHR incentive funding for Medicare and Medicaid pathways, along with much of the specific clinical EHR meaningful use criteria, hasn’t really changed from preliminary requirements published earlier in 2009.

John Halamka, chairman of the Healthcare Information Technology Standards Panel (HITSP) and Chief Information Officer of the Beth Israel Deaconess Medical Center, called the rule “well done.”

“The recommendations are consistent with the work of thousands of experts over the past decade,” he said. “They do not include all the detailed recommendations from HITSP or implementation profile writers such as IHE but they do include all the highly mature constructs that are deployable in 2011 without over burdening the industry.”

“There is much more to applaud than criticize,” added H. Stephen Lieber, president and CEO of the Healthcare Information and Management Systems Society. “We now have clarity of what technology functions constitute a qualified electronic health record, we now have a multi-year road map of future expectations, and we have certainty about many of the standards necessary to support practitioners’ ability to improve patient care.”

Popularity: 4% [?]

Open Enrollment Season Is Here: eHealthInsurance Releases Top Seven Consumer Health Insurance Tips


As the cost of employer-sponsored health insurance continues to rise and the final provisions of the Affordable Care Act loom on the horizon, eHealthInsurance, America’s first and largest private health insurance exchange, released its top consumer tips for this year’s open enrollment season.

Open enrollment is the time of year when workers receiving health insurance and other benefits from their employers are asked to make personal coverage selections for the coming year. For many employers and employees, open enrollment for the 2013 calendar-year benefit period will occur between October and December 2012.

Increased Health Insurance Costs for 2013

According to a survey sponsored by the National Business Group on Health, employers estimate their health insurance costs will increase an additional 7 percent in 2013. As a result, some employers may stop providing employees with health insurance coverage, while others may pass on cost increases to employees in the form of higher premiums, deductibles, or coinsurance. Both employers and employees may be forced to look for creative health insurance solutions to maintain their coverage at a price they can afford. Some employees may even turn to the individually-purchased health insurance market.

The Impact of Health Reform on Open Enrollment this Year

This year’s open enrollment period will be the last one before implementation of the final consumer-focused provisions of the Affordable Care Act (ACA) in January 2014. While the “individual mandate” and the guarantee of access to individually-purchased coverage will not take effect until Jan. 1, 2014, health reform is nonetheless having an impact on this year’s open enrollment period:

*During open enrollment this year, employees will be provided with new federally-mandated “Summary of Benefits and Coverage” forms for each health plan offered by their employers. The intent of these forms is to provide consumers with standardized, easy-to-understand descriptions of how their benefits work and what their out-of-pocket costs would be in various medical scenarios.

*Employees should also note that the maximum amount of pre-tax dollars that can be saved for medical expenses in an employer-sponsored flexible spending account (FSA) is being lowered to $2,500 in 20132.
With the above in mind, eHealthInsurance has prepared the following tips to help consumers with employer-sponsored health insurance navigate their choices during this year’s open enrollment season:

Top Seven Health Insurance Tips for Open Enrollment Season
1. Pay attention to what you — and your employer — are paying: A 2011 survey sponsored by eHealthInsurance and conducted by Kelton Research found that fewer than half (47 percent) of employees could confidently say how much was taken from their own wages to pay for their health insurance premiums. Fewer than one-in-five (18 percent) could say how much their employers contributed toward their total premiums. Pay attention to your premium contributions and look out for increases in these costs compared to last year. In order to gauge the full cost of your employer health insurance plan, find out how much your employer pays toward premiums both for yourself and your dependents. Remember that if you are laid off and enroll in COBRA in 2013, you’ll likely be required to pay the combined total of what is currently paid by both yourself and your employer in order to maintain your coverage.

2. Review ALL your options: Start reviewing every plan available from your employer as soon as you receive your open enrollment packet. Look carefully through each “Summary of Benefits and Coverage” form you receive in order to understand what your costs may be for medical care rendered under each plan. For good measure, check your options in the individually-purchased health insurance market too. Health care reform has strengthened the benefits offered under most individually-purchased health insurance plans. While many group plans may still provide more robust coverage and will cover pre-existing medical conditions, individually-purchased plans may offer a stronger alternative than they did a couple years ago — especially for persons who can no longer afford employer-based coverage.

3. Shop smarter: If possible, enroll in a plan that only covers the services you need most. Doing so may allow you to save money on your monthly premium. A plan that covers chiropractic care, for example, may not be important to you. Or, if you don’t care about brand-name drugs, see if your employer offers a plan covering only generic drugs instead. Choosing a high deductible plan may be smart for some because it typically reduces your monthly premiums, but be prepared to pay the amount of the deductible in the coming year if serious health care needs arise.

4. Carefully review coverage options for adult children. Since 2010, the Affordable Care Act has allowed adult children to retain coverage under a parent’s health insurance policy until age 26. This is a valuable coverage option for many young adults, but keep in mind some important caveats. If your adult children live in another state, for example, they may not have access to in-network health care providers, severely restricting their level of coverage. Make sure you know how your adult child’s coverage will work and help him or her to find the best coverage option available, even if it means helping them purchase individual health insurance.

5. Consider an HSA rather than an FSA: Many employers offer a high-deductible health plan option with a health savings account (HSA). Some may even contribute to your HSA for you. Depending upon your level of health care utilization, this may be a savings opportunity because money may be deposited into your HSA on a pre-tax basis and used to pay for unexpected health expenses not covered by your health plan, including deductibles and copayments. If you like your employer-sponsored flexible spending account (FSA) but are frustrated by the new restrictions on contributions in 2013 (limited to $2,500), consider enrolling in an HSA-eligible plan and opening a health savings account. As with FSAs, money can be saved in an HSA on a pre-tax or tax-deductible basis to pay for qualified medical care. Unlike FSAs, the money in your HSA is yours to keep and funds can roll over and grow year-after-year until retirement. The contribution limit for HSAs in 2013 is $3,250 for individual coverage, or $6,450 for family coverage.

6. Mix and match, if appropriate: Depending on your own and your family members’ health and how much your employer contributes toward dependent coverage, it may be less expensive for certain family members to be insured on a separate, individually-purchased health plan. Work with a licensed agent like to get free quotes, and do the math on separate policies. Remember, it is still possible to be declined coverage for an individually-purchased health insurance plan based on an applicant’s medical history — so don’t cancel or disenroll from any existing line of coverage until you have been approved for a new one.

7. Look for fresh innovations in the market, like shrinking deductibles: If you can no longer afford employer-based health insurance, or if your employer plan doesn’t meet your needs, look for new options in the individually-purchased health insurance market. Insurance companies in some states are offering incentives to encourage you to avoid over-utilizing your coverage. For example, some may substantially reduce your deductible next year if you don’t meet your full deductible this year; others may incentivize healthy habits by sending you gift cards and other rewards for positive health outcomes. The Affordable Care Act also has strengthened individually-purchased coverage by doing away with most lifetime coverage limits and ensuring that members will have no out-of-pocket costs for many preventive care and women’s and reproductive health services. Some states are also mandating stronger coverage in the individual market. For example, in California, maternity coverage is now standard on all health insurance plans.

Popularity: 3% [?]

5 Things to Know about Healthcare Post-Debate

(CNN) — During the first presidential debate Wednesday night, the candidates talked a lot about how they would lower the cost of your medical care.

Heavy on data and large numbers, the debate may not have been the easiest to follow for Americans interested in the subject.

Ken Thorpe, an Emory University economist who specializes in health care costs, may have been one of the few excited by all these numbers.

“It was about as substantive a debate as I think we’ve ever seen,” Thorpe said. “The problem is, even after this debate, I don’t think people truly understand the similarities and the differences in what these candidates are proposing for health care.”

Here are five things you should know about what the candidates said about health care in last night’s debate:

1. You do pay more for health insurance, but Obama’s policy isn’t totally to blame.

The first mention of health care came about six minutes into the debate. Discussing how “middle-income Americans have been buried” financially under the president’s policies, Republican challenger Mitt Romney said health care costs have gone up by $2,500 a family.

Each year, health care costs have gone up during Obama’s administration — that is true. But experts say the increases have not been due to policy, but because of the rising cost of health care. The figure Romney used is not quite right.

The Kaiser Family Foundation, which conducts an annual survey of health care costs, found that since 2008 the average family premium has gone up about $1,698. For context, that is the total cost that you and your employer pay — it’s not $1,698 out of your pocket. In fact, the report said the increase you personally pay was not “statistically significant.”

Rising health care costs are a significant problem, though. The same survey found that the average premiums for family coverage have increased a whopping 113% since 2001. That means the trend started long before President Barack Obama took office.

2. Medicaid and Medicare fraud is a huge problem and more needs to be done.

Obama’s first specific reference to health care described how the administration pursued medical fraud in Medicare and Medicaid “more aggressively than ever before,” which saved the system tens of billions of dollars.

Medicare and Medicaid fraud is what one expert called “one of the most profitable crimes in America.” It costs taxpayers billions of dollars annually — $60 to $90 billion a year, based on government estimates. That’s money that could be better spent on taking care of actual health care costs.

Historically, it was up to states to police this problem, but the fraud grew too big for them to handle. A Republican-backed bill called the Deficit Reduction Act of 2005 created the Medicaid Integrity Program, which gives the federal government the ability to oversee and support states’ anti-fraud efforts.

The Obama administration launched several key programs to protect against fraud. They have saved taxpayers billions; however, a Government Accountability Office investigation concluded that while progress has been made under Obama, more could be done.

In a report this June, in fact, it found at least one of the major programs — an audit conducted by the government — costs taxpayers $102 million, but only found $20 million in excess payments.

“They have certainly been increasing their work in this area,” Thorpe said. “A certain kind of focus definitely did help eliminate some of this fraud.”

3. Sending Medicaid back to the states would save the federal government money, but cost states more and adversely impact those using the benefits.

Obama criticized Romney’s idea of sending Medicaid back to the states. He argued that this would mean a “30% cut in the primary program (for) seniors who are in nursing homes, for kids who are with disabilities.”

The plan GOP vice-presidential candidate Paul Ryan, as the head of the House Budget Committee, suggested in April — which Romney adopted as his own — would cut $1.4 trillion in Medicaid in the next 10 years. It would accomplish this by converting the program into a block grant that would in large part shift costs to the states, which Romney argued would give states more flexibility to do what they deem best to help their Medicaid population.

The nonpartisan Congressional Budget Office conducted an analysis of the proposal, which found that it would save the federal government a significant amount. Medicaid costs would be 49% lower by 2030 than current spending under Ryan’s plan. That’s because the block grant spending caps the cost and makes fewer adjustments.

The CBO concluded that while the federal government would save money, the states would “face significant challenges in achieving sufficient cost savings.”

In Wednesday night’s debate, Romney spelled out how he would adjust spending behind these block grants. “I would like to take the Medicaid dollars that go to states and say to a state, ‘You’re going to get what you got last year, plus inflation, plus 1%, and then you’re going to manage your care for your poor in the way you think best,’ ” he said.

That formula doesn’t account for rising health care costs (remember the cost of health insurance has gone up 113% since 2001), nor does it account for the aging population. With “baby boomers” getting older, there will be 63 million more people over 60 by the time 2030 comes around, according to U.S. Census projections.

Health care costs would go up significantly to accommodate this 20% increase in the number of people over 60 who will need more health care. Nor does Romney’s formula account for economic downturns where more people would qualify for the Medicaid program, like the current government formula — which would leave the states in a much more uncertain position.

The CBO analysis concludes about these block grants that these proposed cuts would “likely force states to scale back their Medicaid programs considerably.” Since poor people, seniors, and people with disabilities make up the majority of those who receive Medicaid, “they’d be hit the hardest.”

4. Romney’s accusation that Obama cut Medicare by $716 billion is misleading.

In the debate, Romney said 10 times that Obama was paying for his health care package by taking the money from Medicare recipients’ pockets, cutting $716 billion out of the program.

“To balance the additional cost of Obamacare is, in my opinion, a mistake,” Romney said. In his closing statement, he promised to restore that amount.

Dozens of bipartisan fact-checkers say that number, often repeated by the Romney/Ryan campaign, is misleading.

Where does it come from? It’s the figure mentioned in a letter from the Congressional Budget Office sent to House Speaker John Boehner in July. Boehner had asked for an analysis from the CBO if Congress could repeal Obamacare, something Romney said he would do if elected. “Spending for Medicare would increase by an estimated $716 billion” over the next decade, the analysis said.

That means Medicare would cost the government more. Obama’s health legislation does not mean people will see cuts to their benefits. Hospitals and health care providers will, but that’s what they agreed to in exchange for the Affordable Care Act’s mandate that people have health insurance. If more people have health insurance, hospitals will have to care for fewer of the uninsured. Uninsured patients cost significantly more to care for than patients who are insured.

It is unclear what impact the cuts would have on the Medicare program. Romney argues providers will accept fewer Medicaid patients. In the debate he said, “Some 15% of hospitals and nursing homes say they won’t take any more Medicare patients under that scenario (Obamacare).”

Medicare’s own independent actuary, which it uses to analyze changes in the program, has warned that these planned cuts to pay providers’ bills will force some doctors to stop accepting Medicare patients.

5. The Cleveland and Mayo Clinics do it better.

The candidates agreed during the debate that more needs to be done to control the cost of health care.

Obama praised the Cleveland Clinic as a model for new ways of controlling the cost of care. “They actually provide great care cheaper than average,” he said. “And the reason they do is because they do some smart things.”

One approach he highlighted was the collaborative approach of the clinic’s doctors. Instead of each doctor ordering a different test, they meet and decide as a team how to approach the patient’s problem. This prevents duplication. The team of doctors also provides preventive care.

Obama has held the clinic up as a model throughout his time in office. He visited it in 2009. It is a top-ranked teaching hospital that attracts patients from around the world. An analysis done by the Dartmouth Atlas of Health Care found that the Cleveland Clinic did treat Medicare patients for tens of thousands of dollars less than many other medical centers.

One of the big differences between the Cleveland Clinic and other hospitals is that it and other multi-specialty clinics like the Mayo Clinic in Minnesota employ their own doctors and can create these teams. In most traditional hospitals, doctors are independent private practitioners who are left to making their own choices.

Because Cleveland Clinic’s doctors are paid fixed salaries, there is less incentive to do unnecessary tests or procedures compared to a doctor who works on a fee-for-service basis.

As of right now, Medicare acts a lot like those traditional hospitals do, Thorpe said. “If you take the typical patient who is chronically ill, they will be overweight or obese, they suffer from bad cholesterol, hypertension, asthma and diabetes — that means they take 10 to 15 medications and there is no team-based care,” he said.

“Going to separate doctors with their own plans is expensive. These integrated group plans work well and the ongoing preventive care they provide — working with doctors, nutritionists, nurses, nurse practitioners and the rest — ultimately save on costs.”

Popularity: 21% [?]

Daniels: Health Savings Accounts incentivize citizens

By: Gov. Mitch Daniels

The central contention of a book I recently wrote is that our liberty depends on the personal responsibility and accountability of individual citizens. Unfortunately, many, especially those setting national policy today believe that Americans are too intimidated, gullible or dim-witted to make wise, informed decisions about the important issues affecting their lives, and need their benevolent betters in government to do it for them.

My experience in public life leads me to the opposite conclusion. I have seen that our citizens, properly informed of the facts, are fully capable of governing themselves.

There is no better example of this than healthcare. In this area of policy Indiana has pursued a path that respects the right of all our people to make their own healthcare choices, and trusts their ability to do so. In the process, we have restored the true concept of insurance and returned to it a measure of consumerism that presses for quality and cost control in every other economic sector.

Shortly after taking office I added Health Savings Accounts, personal accounts from which to pay medical expenses, to our state’s menu of healthcare plans, which featured the usual fee-for-service plans. HSAs challenge purchasers to think more carefully about services, which are no longer “free,” incentivizing citizens to look at heath care with a consumerist eye.

Despite resistance from the defenders of the third-party payment system and the proponents of a government-run, single-payer healthcare system, the HSAs have been an unqualified success. In 2006, the first year of availability for Indiana state employees, they were selected by only four percent of us. But over the next few years, this option grew in popularity: by 2012, more than 90 percent of state workers had signed up.

Real consumerism kicked in

Along the way real consumerism kicked in. Patients began avoiding emergency rooms for non-emergencies, and using generic drugs and preventative care at higher rates than their counterparts in traditional plans. Ultimately, the HSAs saved both the state and the employees money. Outside analysis showed double-digit reductions in the state’s costs compared to traditional health coverage. Meanwhile, employee premiums were much lower and HSA holders had accumulated savings in the amount of $54 million.

In addition to lowering costs for taxpayers and state employees, HSAs have also helped us bring the peace of mind that comes with health insurance to many low-income Hoosiers. The Healthy Indiana Plan (HIP), which we enacted in 2007, created personal accounts managed by participants and funded through a combination of modest premiums and state contributions. The accounts, which total $1100 per person per year, offer “healthcare you can control, at a price you can afford,” and have presented our state with a partial solution to the problem of the chronically uninsured.

Today nearly 50,000 Hoosiers are enrolled in the plan. When surveyed, over 99 percent indicated that they would re-enroll in the HIP. Members have lower non-emergency ER use versus the traditional Medicaid population, and higher generic drug use than a comparable commercial population. Unfortunately, despite this success, HIP’s continued federal authorization is in doubt, a consequence of the current administration’s preference for the traditional Medicaid program.

The crisis in American healthcare is the result of a system built for overconsumption and overspending. Most Americans are, in essence, using someone else’s credit card to cover medical expenses. But when it’s your money and not someone else’s, you will always be more judicious about spending it. As Indiana’s two programs show, by encouraging citizens to be more thoughtful about healthcare decisions, HSAs can bring skyrocketing healthcare costs back toward earth and provide affordable coverage for those lacking insurance.

Unfortunately, these virtues were ignored during President Obama’s recent healthcare overhaul. The idea of a form of insurance controlled by individual citizens, rather than a panel of experts, is anathema to the “reformers.” In fact, ObamaCare, with its avalanche of hastily written (and not yet written) regulations, not only limits the use of HSAs, but also purposely discourages insurance companies from offering them.

This is all too typical of our national policy, which refuses to trust Americans with decision making power over not only healthcare, but a range of other important issues ranging from education to consumer finances. As I wrote in “Keeping the Republic: Saving America by Trusting Americans,” this is the fundamental question facing our country. What type of people will we be? Objects of therapy, or creatures of dignity? Wards of the state, or a free people born to liberty?

Influenced by my experiences in Indiana, I’m betting on the latter.

Popularity: 15% [?]

John Roberts Saves Obamacare

By Walter Shapiro

In his White House memoir, “Courage and Consequence,” Karl Rove recalls being the lone non-lawyer among the group of George W. Bush aides who initially interviewed John Roberts for the Supreme Court in 2005. Rove asked Roberts to go back in history to name the justice whom he most revered. Roberts’ answer, Robert Jackson, intrigued and reassured Rove. When appointed in 1941, Jackson was serving as Franklin Roosevelt’s attorney general and had been expected to be a pro-New Deal rubber-stamp on the court. But, as Rove put it, Jackson “instead demonstrated a fidelity to the Constitution that Roberts admired.”

Thursday, in a jaw-dropping turnabout worthy of Justice Jackson, Roberts provided the swing vote in a 5-to-4 decision that upheld the constitutionality of almost all of Obamacare, the president’s signature legislative achievement. While an army of armchair court watchers expected Justice Anthony Kennedy to determine the fate of the Affordable Care Act (a recent Time cover called him “The Decider”), it was Roberts who took his fidelity to the Constitution in an ideologically surprising direction. Kennedy voted with three other conservative justices to overturn the health insurance mandate at the heart of the law.

Constitutional law seminars and unlicensed political psychologists will spend years speculating about Roberts’ motivations in joining the liberal bloc in probably the most important Supreme Court decision since Bush v. Gore in 2000. While we may wait decades to know for certain, it does seem plausible that Roberts may have been partly triggered by a desire to prevent the court from being seen as overtly political. Polls showing public respect for the Supreme Court at a quarter-century low reflect the growing view that the justices pursue partisan agendas.

One of the most important passages in Roberts’ majority decision was the chief justice’s assertion: “We do not consider whether the act embodied sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenge provisions.”

In short, if you want a national referendum on the health-care law, then the proper arena is the 2012 campaign—and not the inner sanctums of the Supreme Court.

The majority opinion in the health care case points up the inadequacy of the political clichés used in the heat of an election year to describe the Supreme Court. Phrases like “strict constructionist” and “not making law from the bench” do not clarify complex Supreme Court opinions like Thursday’s ruling. Romney’s campaign website declares, “As president, Mitt will nominate judges in the mold of Chief Justice Roberts and Justices Scalia, Thomas and Alito.” There’s only one problem with this formulation: Roberts went in one direction and Scalia, Thomas and Alito went in the opposite on the constitutionality of the health care bill.

Obama’s own ability at prophecy is limited, as well. In 2005, the former constitutional law professor declared in a Senate address that he was opposing Roberts’ nomination to the Supreme Court because “I ultimately have to give more weight to his deeds and overarching political philosophy … than to the assuring words he provided me in our meeting.”

While Obama has sharply disagreed with major decisions of the Roberts Court (particularly the anything-goes Citizen United ruling on campaign finance), it is tempting to wonder if the president now feels that he misjudged the man who saved his legislative legacy.

It is almost part of the job description of a president that he will make, at least, one blunder when picking Supreme Court justices. Harry Truman called one of his nominees, Tom Clark, a “damn fool from Texas.” When George H.W. Bush tapped New Hampshire jurist David Souter in 1990, the president never expected that he would be reinforcing the court’s liberal wing. Now it is Roberts who has refused to stay in his pre-determined ideological cubbyhole.

With four current justices over the age of 70, it is likely that whoever is elected president this November will get an opportunity to put his stamp on the Supreme Court. But the potential for Lucy-and-the-football surprises endures. About the only ways a president can achieve some measure of certainty about the court are either to nominate fire-breathing ideologues like Antonin Scalia or political cronies like Abe Fortas, who kept open a back channel to Lyndon Johnson during his brief tenure as a justice. But even the Scalia precedent no longer works, because anyone with a sharply articulated judicial philosophy probably could not make it through today’s hyper-partisan Senate.

As for the health care law, its major provisions remain on schedule to take effect in 2014. Even a President Romney may it difficult to reverse history, as he would have to face down a filibuster threat by Senate Democrats to get a repeal bill through Congress. (There are, however, administrative gambits that Romney could use to eviscerate Obamacare if Congress proves balky.) That’s why the Supreme Court seemed like such a beguiling short cut for conservatives who loathe Obamacare.

It’s also why back in 2005 Karl Rove may have badly misinterpreted John Roberts’ stated intention to be an independent jurist like Robert Jackson.

Walter Shapiro’s Yahoo! News column examines what we know about the character and personalities of the 2012 candidates. Shapiro, who is covering his ninth presidential campaign, is also a special correspondent for the New Republic.

Popularity: 71% [?]

Obama’s health care aid to small firms disappoints

By Ricardo Alonso-Zaldivar
May 30, 2012

WASHINGTON (AP) It seemed like a good idea at the time.

But a health insurance tax credit for small businesses, part of President Barack Obama’s health care law that gets strong support in public opinion polls, has turned out to be a disappointment.

Time-consuming to apply for and lacking enough financial reward to make it attractive, the credit was claimed by only 170,300 businesses out of a pool of as many as 4 million potentially eligible companies in 2010.

That’s put the Obama administration in the awkward position of asking Congress to help fix the problems by allowing more businesses to qualify and making it simpler to apply.

But Republicans who run the House say they want to repeal what they call “Obamacare,” not change it.

“They completely missed the target on this thing,” Rep. Sam Graves, R-Mo., said of the tax credit. “I don’t think expanding it is going to make any difference whatsoever.” Graves chairs the House Small Business Committee.

It doesn’t help the administration’s plea that the biggest small-business lobbying group is a lead plaintiff asking the Supreme Court to overturn the Affordable Care Act. The National Federation of Independent Business isn’t likely to spend much time tinkering with the tax credit or promoting it to members.

Small businesses represent the crumbling edge of the nation’s system of employer-based health care. Only about 30 percent of companies with fewer than 10 workers offer health coverage, and they often pay more for insurance than large businesses. The credit, which once had support in principle from lawmakers of both parties, was supposed to help businesses already providing coverage afford the premiums. And maybe it would even entice some to start.

“We agree it is not a panacea for all costs,” said John Arensmeyer, founder of Small Business Majority, an advocacy group that supports the health care law and disagrees with the much larger independent business federation. The problem is all the negative publicity around the health care law has discouraged business owners from applying for the credit, he says.

“There has been more heat than light shone on this,” Arensmeyer said. “There is no reason why small businesses shouldn’t be taking advantage of this credit.” About 770,000 workers were covered by the businesses claiming the credit in 2010.

However, a recent report by Congress’ nonpartisan Government Accountability Office identified several issues with the credit itself.

To begin with, the GAO said, the tax credit is structured so its biggest benefits go to very small companies paying low wages. About 4 out of 5 such businesses don’t offer coverage, and the tax credit is not sufficient to encourage them to start doing so.

“Small employers do not likely view the credit as a big enough incentive to begin offering health insurance,” the report said.

The average credit claimed in 2010 was about $2,700, although some companies qualified for much more.

Many small firms did not qualify because they paid fairly decent wages. The GAO report quoted an unidentified tax preparer who explained that “people get excited that they’re eligible and then they do the calculations and it’s like the bottom just falls out of it and it’s not really there.” It’s almost a bait and switch.

Complexity has been another obstacle. IRS Form 8941, which employers must complete to claim the credit, has 25 lines and seven worksheets, the GAO said. Some tax preparers told the agency it took clients from two to eight hours to pull together supporting information and tax professionals another three to five hours to calculate the credit.

Trying to help, the IRS identified “three simple steps” employers needed to follow, but the GAO found “the three steps become 15 calculations, 11 of which are based on seven worksheets, some of which request multiple columns of information.”

Arensmeyer said claiming the credit will be simpler once it becomes standard in tax-preparation software.

As it stands now, the credit is only temporary, expiring in 2016. That’s another reason Congress appears unlikely to adopt the administration’s proposed fixes, which would cost an estimated $14 billion that has to be offset with cuts elsewhere.

If the health care law withstands Supreme Court scrutiny, more employers could start claiming the credit. Otherwise, it may just go down as a missed opportunity, for policymakers and small-business owners alike.

Popularity: 1% [?]

Your insurance company may owe you $127

NEW YORK (CNNMoney) — Thanks to a provision in the health care reform law, millions of consumers will be receiving rebates from their insurers this summer.

By Aug. 1, insurers that failed to meet one of the early guidelines of the Affordable Care Act are going to issue rebates averaging $127 to certain policyholders, according to estimates from the Kaiser Family Foundation.

Last year, the Affordable Care Act started requiring health insurers to spend a certain percentage of the premium payments they receive toward patient care, such as doctor’s visits and hospital stays, and quality improvement activities, including discounted gym memberships or wellness brochures, instead of things like administrative and marketing costs.

Under the law, large employer-sponsored plans must spend 85% of a policyholders’ premiums this way, while insurance companies that cover individuals and small businesses have to spend at least 80%. If an insurer fails to meet that threshold, they must issue a refund.
What health care reform is (and isn’t) doing now

Based on insurers’ recent filings to the National Association of Insurance Commissioners, those rebates will total $1.3 billion altogether this year, according to Kaiser.

A large share of this money, or $426 million, will go to consumers who bought their own insurance through one of 215 plans. Nationwide, these consumers — roughly 3.4 million people — will each receive an average rebate of $127, Kaiser said in its report.

Most likely, they will receive a check in the mail, although the rebate could be issued as a discount on future premiums. Actual amounts will vary by insurer, by state and the extent to which the insurer fell below the threshold, Kaiser said.

In some states, like Alaska and Maryland, the average rebate is estimated to be near $300, while in New Mexico and Maine, the average rebate will be just $1 (not even enough for the insurer to issue a check).

Those insured through a private employer or a state or local government plan could see nothing at all. Those rebates will mostly go to the group policy holder, although the money could be passed on to employees who contributed a portion of their paycheck to their premium last year.

Kaiser calculated the averages based on insurers’ early estimates. Actual rebates will be based on the reports the insurance companies submit to the federal government later this summer, Kaiser said.

Popularity: 2% [?]

Supreme Court appears willing to let most of health care law stand

Washington (CNN) — The heart of the health care law championed by President Barack Obama may be in judicial trouble, but the Supreme Court appeared very inclined Wednesday to keep the rest of the sweeping reform legislation intact.

On the final day of its marathon public debate over the 2010 Affordable Care Act, the justices tackled what would happen if they ruled against the constitutionality of the individual mandate, the key funding mechanism of the law.

At issue Wednesday morning was whether the entire law’s 450 or so provisions would have to be scrapped if the individual mandate were found unconstitutional.

A separate session is scheduled for Wednesday afternoon on whether states would be “coerced” by the federal government to expand their share of Medicaid costs and administration by the risk of losing that funding if they refuse.

Even though the health care law’s “individual mandate”– requiring most Americans to have health insurance beginning in 2014 or face a financial penalty– appeared to be on shaky legal ground, few on the court seemed eager to take the drastic step and invalidate the rest of the landmark legislation.

“There are so many things in the act,” said Justice Ruth Bader Ginsburg, including many provisions not directly related to market reforms such as Native American health care. “Why make Congress redo that? Who should we stop and start from scratch?”

Added Justice Elena Kagan. “Half a loaf is better than no loaf,” meaning some provisions would survive.

And the court appeared in no mood to pick and choose.

“You want us to go through 2,700 pages” of the law, asked Justice Antonin Scalia. “Is this not totally unrealistic … to go through one by one and decide each one?”

Justice Anthony Kennedy said he was reluctant to take on this “awesome exercise of judicial power,” at the expense of congressional discretion.

Supreme Court, health care and one little girl

This week’s hearings are among the most politically charged and closely watched in years, with dueling protests and news conferences outside the court building every day on what is likely to be a central issue of the November presidential election.

With the legal survival of the individual mandate in constitutional jeopardy, the question of “severability” — whether the rest of the law can stand if one part is invalidated — has become more important.

All of this may be moot. If the court decides the mandate is constitutional — even in a narrowly tailored way — they will not even bother to take up the severability question presented Wednesday.

In the morning arguments, the clearly divided court expressed concern over whether Congress would have passed the broad reform package without the key funding mechanism — the mandate– firmly in place. However, several of the justices seemed ready to let lawmakers eventually sort out the specific funding questions with or without the mandate.

After the end of six hours of arguments spread over three days, the nine-member bench will retreat from the public spotlight and get to the real task before them.

They will likely gather as a group in a closed-door conference over the next few days and actually decide on the four health care appeals. Going one-by-one in order of seniority, they will all be thinking of the number five — which is how many votes it will take to achieve a majority.

Two families, two viewpoints on health care reform

Once the tallies are sorted out, opinions will be assigned to individuals to craft over the next three months. What the court says in these written opinions — how it interprets the Constitution — will be far more important than what they said in the oral arguments this week.

The rulings may be in essence how legislators, individual Americans and history will judge these justices.

Wednesday’s cases gave the administration another chance to regain the rhetorical offensive and defend the entire law’s validity. Many legal observers concluded the Obama administration’s solicitor general, Donald Verrilli Jr., did little to boost the individual mandate’s constitutionality in two hours of intense arguments Tuesday.

The questioning of Verrilli’s performance was so widespread that the White House issued a statement Wednesday defending him.

“Mr. Verrilli is an extraordinarily talented advocate who possesses a sharp mind, keen judgment, and unquestionable integrity,” said the statement by White House Counsel Kathryn Ruemmler. “He ably and skillfully represented the United States before the Supreme Court yesterday, and we have every confidence that he will continue to do so.”

Wednesday’s first argument dealt with severability, but most court watchers think of it as the “domino effect” issue — if the individual mandate section is ruled unconstitutional, must the entire law collapse as well?

A federal judge in Florida had so ruled in February 2011, saying: “Because the individual mandate is unconstitutional and not severable, the entire act must be declared void.”

However, a federal appeals court subsequently overruled on the severability question while upholding the individual mandate’s unconstitutionality.

Opponents of the law say the individual mandate is crucial to its overall impact, since it is the main funding mechanism for the expansion of a range of other programs. This might be the one question on which the justices will ultimately agree in favor of the government.

The high court and election-year blockbusters

Then comes the Medicaid “coercion” question, which can be seen as the” national policy implications” issue.

Separate lawsuits by 28 Republican-led states say the new law’s significant expansion of the social safety net unconstitutionally “coerces” state governments.

Medicaid is administered by the states with a combination of federal and state money. It currently required coverage only for poor children and their parents or caretakers, adults with disabilities and poor individuals 65 or older. The “coercion” issue was surprisingly added to the health care debate by the Supreme Court justices.

Both sides of the issue agree that what the high court decides on Medicaid could have broad implications for the regulatory ability of the federal government to set long-term national policy goals in areas such as the environment, education and the workplace.

Some states have long complained their autonomy is being eroded by creeping federal intervention on spending matters.

Article 1 of the Constitution gives Congress the power to “lay and collect … taxes to pay the debts and provide for the common defense and general welfare of the United States” and to “regulate commerce … among the several states.”

Such authority has long been broadly interpreted, including when imposing conditions on recipients, be they individuals or states. No federal court has ever ruled states have been unlawfully coerced when they accept conditions or strings attached to federal funds. The Supreme Court in 1987 affirmed that congressional discretion.

Starting in 2014, the health care law’s Medicaid changes would make millions of additional Americans eligible for benefits by raising the income cap for qualification. That would include all adults up to 133% of the federal poverty line.

The tricky point is that states are not forced to agree to the law’s incremental Medicaid increases, spread out over six years. The states could instead abandon their participation in the program, but they say that would be a financial, social and political catastrophe — one which they cannot realistically accept.

Supporters of the health care law say the Medicaid issue involves political motivations rather than real policy concerns.

“These arguments aren’t based on Medicaid’s health outcomes among children or seniors,” Dr. L. Toni Lewis, the health care chair of the Service Employers International Union, said at a news conference Wednesday. “They aren’t based on testimony from those who have received services from Medicaid. They aren’t even based on data that shows how well Medicaid controls costs compared to private insurance. That’s because the challenge to Medicaid in the Supreme Court isn’t based on what’s good for our health. It’s just based on politics and posturing.”

Through this issue, the long-standing fight over “federalism” and the leverage the national government wields over states might soon reach epic levels with a high court decision either strengthening or limiting congressional authority on this and potentially a host of other regulatory areas.

The cases argued Wednesday were National Federation of Business v. Sebelius (11-393) and Florida v. Department of Health and Human Services (11-400).

Popularity: 2% [?]

MetLife Study Finds That Despite Economy Nine out of Ten Employers Don’t Plan Reduction of Benefits

Gen Y and Gen X Employees Taking Great Interest in Workplace Benefits

The economy is causing employees — particularly younger generations — to turn with greater interest to employers for help with establishing financial security. Nearly half (49%) of all employees surveyed say that because of the economy they are counting on employers’ benefits programs to help with their financial protection needs, and that percentage climbs to 55% for Gen X workers and 66% for Gen Y. The majority of surveyed employers (60%) feel economic conditions are creating additional opportunities to leverage workplace benefits programs to achieve their objectives, and only about 10%, regardless of company size, say they plan to reduce benefits, according to MetLife’s 10th Annual Study of Employee Benefits Trends released today. A copy of the study is available at .

Among the employers that see additional opportunities to leverage their benefits programs, 91% feel strongly that benefits can be used to retain employees, 86% say that benefits can greatly increase employee productivity, and 80% feel that benefits can greatly help attract employees — all key objectives.

“The workplace has changed rather dramatically over the last decade since MetLife began doing its annual Study of Employee Benefits Trends. Ten years ago, many Baby Boomers were planning to retire at age 65, Gen Y workers were just entering the workplace, and communication vehicles like Facebook and Twitter didn’t exist. However, employers’ top benefits objectives have remained consistent, and the study highlights ways employers can evolve their strategies to cost-effectively attract and retain a talented and productive workforce,” says Anthony J. Nugent, executive vice president, MetLife.

Generational Expectations and Preferences

Surprisingly, the study found that younger workers are more risk averse than older workers when it comes to their investments: 81% of Gen Y employees say they want guarantees that offer stable but somewhat lower returns compared to 76% of surveyed Baby Boomers. Perhaps fueling this conservative approach among the youngest workers is planning a retirement without Social Security benefits. Just 16% of employees believe that Social Security benefits will be available for Gen Y workers when they retire as they are for today’s eligible retirees, and just 24% of employees believe these benefits will be available for Gen X. Having enough money in retirement is a growing concern for younger workers. For instance, in 2003 one-third (33%) of employees ages 21 to 30 were very concerned about running out of money in retirement. Now more than half (52%) of that age group are very concerned.

“Despite continuing to contribute towards Social Security, approximately four out of five younger workers believe the amount of money they can expect to receive from Social Security will be significantly reduced relative to today’s recipients. Gen Y and Gen X recognize that they will be shouldering more of the responsibility for their long-term security but are looking to employers for help even if they have to pay for some of these benefits themselves,” says Dr. Ronald S. Leopold, vice president, MetLife.

The study found that 62% of surveyed Gen Y and Gen X employees are willing to bear more of the cost of their benefits rather than lose them. More than half, 57%, are interested in a wider array of voluntary benefits offered by their employer, as compared to 43% of Baby Boomers. The study also found that employers recognize this interest as 62% of employers agree that in the next five years employee-paid benefits will become a more important strategy than they are today.

Retirement Readiness: A Growing Issue

The study illustrates that the past several years have eroded retirement savings, and the percentage of employees who have fallen behind schedule in their progress towards retirement savings has increased from 45% in 2004 to 50% in 2011. More than one-third of surveyed Baby Boomers (35%) say that as a result of economic conditions they plan to postpone their retirement.

Workplace financial programs can help with retirement planning. The study found that only 39% of employees overall feel very confident in their ability to make the right financial decisions for themselves and their families, and 72% express interest in having various financial education programs made available in the workplace. The study also found that attending these programs can make a difference: 58% of people who attended a financial education program feel very confident in their decision making contrasted to 43% of people who had a program available to them but did not attend.

Loyalty Gap Widens

The study found that employee loyalty continues to wane. The percentage of employees who feel a very strong sense of loyalty towards their employer is at only 42% — a seven-year low. One in three people would like to work for a different employer in 2012, but that number climbs to one in two for Gen Y employees. Not too surprisingly, people who say they hope to be working elsewhere are nearly three times as likely to admit to a decrease in the quality of their work. Conversely, the percentage of employers who feel a very strong sense of loyalty towards their employees has grown to 59% in 2011 — a seven-year high.

More than half of surveyed employees (58%) say benefits are an important retention driver — and this is highest among Gen Y (63%) and Gen X (62%) workers. The study highlights a correlation between benefits satisfaction and loyalty. For instance, 61% of employees who are very satisfied with their benefits say they feel a very strong sense of loyalty to their employer compared to 24% of employees who are very dissatisfied with benefits.

While employers seemed to understand how items like salary and wages, advancement opportunities and company culture influence employees’ feelings of loyalty, they continue to underestimate the power of leveraging their benefits programs. For example, while 66% of surveyed employees say that health benefits are an important driver of their loyalty, only 57% of employers believed so. The divide widens when it comes to retirement and non-medical benefits. For instance, 59% of employees said retirement benefits are very important for influencing their feeling of loyalty toward their employer, but only 42% of employers realized this, and 51% of employees said the same for non-medical benefits like dental, disability, and life insurance, while only 32% of employers thought so.


The 10th Annual MetLife Study of Employee Benefits Trends was conducted during September and October of 2011 and consisted of two distinct studies fielded by GfK Custom Research North America. The employer survey comprised 1,519 interviews with benefits decision-makers at companies with staff sizes of at least two employees. The employee sample comprised 1,412 interviews with full-time employees age 21 and over, at companies with a minimum of two employees.

GFK Custom Research North America

GfK Custom Research North America is part of the GfK Group, one of the world’s largest and most prestigious market research organizations, operating in more than 100 countries. Headquartered in New York City, with 10 offices in the U.S., GfK Custom Research North America provides full-service market research and consulting services in the areas of Customer Loyalty, Product Development, Brand & Communications, Channels, Thought Leadership, Innovation, and Public Affairs.

About MetLife

Metropolitan Life Insurance Company (MetLife) is a subsidiary of MetLife, Inc. /quotes/zigman/252112/quotes/nls/met MET -0.28% , a leading global provider of insurance, annuities and employee benefit programs, serving 90 million customers in over 50 countries. Through its subsidiaries and affiliates, MetLife holds leading market positions in the United States, Japan, Latin America, Asia Pacific, Europe and the Middle East. For more information, visit .

SOURCE: MetLife, Inc.

Popularity: 2% [?]

Primary Care 2025

Forecasts by numerous health care experts strongly suggest that primary care is likely to be very different from what we experience today. While the recent health care reform legislation is driving change from a policy level, developments in technology, disease knowledge, health care financing, care protocols and modalities, and other areas are transforming the field of primary care. As these changes unfold, it will be essential for policy-makers, public health officials, health care providers, and others to understand the alternative paths that 21st century primary care could take.

IAF has developed Primary Care 2025: A Scenario Exploration, a set of scenarios describing the alternative futures of primary care in the U.S. in the year 2025. These scenarios consider the nation’s economic challenges, political polarization, and opportunities afforded by disruptive technological advances and new delivery systems. The report includes implications and recommendations based on the scenarios, developed at a National Workshop of leaders. The scenarios help organizations, associations, and communities to gain greater understanding of the challenges facing primary care as well as the options we may have in the years to come.

This project is supported by a grant from the Kresge Foundation as part of the foundation’s mission to improve the delivery and financing of health care in the United States. Policy-makers can use the scenarios to help them anticipate changes that affect policy and legislation. Health care providers can use the scenarios as a basis for strategic thinking and to help ensure that they are working toward their preferred future of primary care.

Popularity: 2% [?]

Budget 2013: Private Health Insurance Programs

By Allison Bell

The Centers for Medicare & Medicaid Services (CMS) could see big changes in private health insurance programs spending in federal fiscal year 2013.

The budget for one major private health insurance program could fall more than 98% as spending on others soars.

The Obama administration talks about CMS private programs funding in the 2013 U.S. Department of Health and Human Services (HHS) budget proposal.

Fiscal year 2013 starts Oct. 1.

The private health insurance programs budget pays for CMS to set up and run programs created by the Patient Protection and Affordable Care Act of 2010 (PPACA).

CMS is not the only HHS agency implementing PPACA, and HHS is not the only federal department implementing PPACA.

HHS has a separate health insurance reform implementation fund. The budget there increased to $411 million this year, from $208 million in 2011. The budget could fall back to $344 million in the coming year.

The Employee Benefits Services Administration, an arm of the U.S. Labor Department, talks about its PPACA projects in its 2013 budget proposal.

The Internal Revenue Service, an arm of the U.S. Treasury Department that would be responsible for enforcing PPACA tax subsidy and penalty provisions, mentions PPACA only briefly in its budget outline.

CMS is the HHS agency that has budget line items for the biggest, best-known PPACA efforts.

Overall private programs spending could drop 13%, to $4.1 billion.

The Early Retiree Reinsurance Program (ERRP) – a PPACA program that’s been subsidizing health benefits for some early retirees – would get only $28 million, down from $2 billion. CMS officials recently announced that ERRP will be closing two years early because early retiree health plan sponsors used up the funding.

Spending on construction of the new PPACA health insurance distribution exchanges would increase 20%, to $1.1 billion. PPACA calls for the exchanges to start selling health insurance to individuals and small groups in 2014.

The CMS budget also includes big increases for the Consumer Operated and Oriented Plan (CO-OP) program and the Pre-Existing Condition Insurance Plan (PCIP) program.

The CO-OP program is supposed to provide seed loans that groups can use to start nonprofit, member-owned health insurers. CO-OP funding could jump to $803 million, from $93 million this year.

The PCIP program has been providing health coverage for uninsured people with health problems who are unable to buy ordinary commercial health insurance.

Starting in 2014, PPACA is supposed to require all health insurers to sell coverage on a guaranteed-issue, mostly community-rated basis, with no extra charges for people with health problems. Congress put the PCIP program in PPACA to give people who already had health problems some relief while they were waiting for 2014.

PCIP enrollment has been much lower than PPACA drafters had predicted but the medical expenses of the people who have signed up for coverage have been much higher than expected. Some states have warned that their federal PCIP money is running out.

The 2013 CMS budget proposal would increase PCIP funding 31%, to $2.1 billion.

Popularity: 2% [?]

To Understand Health Overhaul, Try A Comic Book

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: 18% [?]

IHT World enters market to counter costs of self-funded plans

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: 2% [?]

When the Doctor Faces a Lawsuit

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: 4% [?]

Knowledge is Power?

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: 2% [?]

POLL: Should Unhealthy Habits Be Penalized?

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: 5% [?]

SoloHealth’s Self-Service Health Kiosk

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 Stationâ„¢, 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

Popularity: 4% [?]

2012 HSA Contribution Limits

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: 4% [?]

HHS Strategy

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:

Popularity: 1% [?]

Health Care Reform – What Would YOU do?

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: 3% [?]

How to square budget cuts, need for aging research

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: 2% [?]

Understanding Medicare

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

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: 8% [?]

Medigap insurance: Filling in Medicare’s gaps

Medigap insurance: Filling in Medicare’s gaps

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

Popularity: 6% [?]

6 questions to help your parent choose a Medigap insurance plan

6 questions to help your parent choose a Medigap insurance plan
By Rosanna Jordan,
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.

Popularity: 2% [?]

Masters in Nursing

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: 2% [?]