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% [?]

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% [?]

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% [?]

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% [?]

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% [?]

Nearly Half of Private Company CEOs Believe Healthcare Reform May Have a Notable Financial Impact on Their Business

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

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

(Logo: )

(Logo: )

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

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

Overall Impact Unclear

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

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

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

Popularity: 2% [?]

California, New York mull changes to organ donor laws

By Madison Park, CNN

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

New York

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

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

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

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

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

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

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

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

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

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

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

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

Popularity: 2% [?]

Health care voucher provision may inflate employer costs

Business Insurance

By Jerry Geisel

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Popularity: 35% [?]

Investing For Retirement While Saving For Health

American Chronicle
Michael Jordan – April 09, 2010

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

Insurance Information

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

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

Insurance Tips

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

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

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

Popularity: 1% [?]

Health overhaul likely to strain doctor shortage


WASHINGTON – Better beat the crowd and find a doctor.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Popularity: 2% [?]

Obama, Republicans clash at heated health summit

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Disagreements were not always expressed diplomatically.

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Popularity: 2% [?]

Health Reform: Let’s Work on Drug Costs and Premiums

Pills & billsBy Bernadine Healy M.D.,

Posted: February 2, 2010

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

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

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

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

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

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

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

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

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

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

Popularity: 2% [?]

Health Care Overhaul’s Uncertain, Super-Majority-Free Future

Experts Disagree Over Legislation’s Fate

ABC News Medical Unit
Jan. 21, 2010—

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

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

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

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

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

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

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

But others disagree.

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

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

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

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

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

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

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

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

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

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

Other ideas for a bill passage have been floated.

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

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

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

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

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

His representative clarified afterward.

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

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

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

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

Popularity: 1% [?]