Story first appeared on the Los Angeles Times -
Though few patients realize it, many doctors receive thousands of dollars from pharmaceutical companies for each patient enrolled in an experimental drug trial. The medication might be the best thing for the patient's condition. The doctor's motives might be pure. But patients should be able to find out about such payments so they can discuss them with their doctors and decide for themselves whether the doctor's participation in an experiment might compromise his medical advice.
A provision of the 2010 healthcare reform law should bring new transparency about these and other corporate payments to physicians — including lavish dinners, gifts and industry-sponsored conventions that are more luxury vacations than medical conferences — by publishing the information in an online database. But the final regulations to implement the Physician Payment Sunshine Act were supposed to be published in October 2011; the database was supposed to go live later this year. Instead, the regulations are 15 months overdue.
As with the new food-safety act regulations — most of which were finally released in January, a full year past deadline — the sunshine rules have been drawn up by the appropriate agency but have been held up by the Office of Management and Budget. One theory for the delay, advanced by critics of the administration, is that President Obama wanted to avoid issuing regulations during election season, when the extent of government's reach was a contentious issue. That would be a poor excuse, if true. In any case, the election is over; at this point the delay smacks more of bureaucratic inefficiency than political expediency.
Most physicians put their patients' well-being first, but a study showed that doctors who receive food from a company are more likely to prescribe that company's products, even though they might not be doing it consciously.
The sunshine act isn't as strong as it should have been. Ideally, doctors would be the ones doing the divulging, making information about payments and gifts they have received readily available in their examining rooms. Not all patients will know about the online database or possess the savvy to use it. But the rules nonetheless are expected to influence behavior; public disclosure will make both physicians and drug companies more circumspect.
One question in the minds of consumer advocates is how much disclosure will reveal. For instance, if a company gives a doctor a large sum to lead a drug trial and that doctor spreads the money among other physicians who enroll patients, it's unclear whether those payments would be reported as coming from the drug company. The administration should release rules that fully reflect the spirit of the law, and it should do so soon.
Showing posts with label Healthcare Reform. Show all posts
Showing posts with label Healthcare Reform. Show all posts
04 February 2013
17 December 2012
Hospital Systems Branch Out as Insurers
originally appeared in The Wall Street Journal:
A increasing number of hospital systems are moving to start their own insurance plans, aiming to broaden their roles and prepare for the changes coming under the federal health-care overhaul.
Piedmont Healthcare and WellStar Health System, both in the Atlanta area, are set to announce a jointly owned insurance arm, with the goal of marketing coverage to employers and Medicare recipients in 2014. They also will consider selling coverage on a health exchange, one of the online insurance marketplaces required in each state by the health-overhaul law.
Piedmont and WellStar said their health plan would be built largely around their 10 hospitals and hundreds of affiliated doctors, and they will offer a competitive premium. We're broadening the reach of our delivery system, according to Piedmont's interim chief operating officer, who added that he expects the strategy to clearly have a positive impact on the quality of care.
In recent months, northern California's Sutter Health and New York's North Shore-Long Island Jewish Health System have said they would start selling health plans. A 2011 survey of 100 hospital leaders by health research firm Advisory Board Co. found that 20% of them intended to market an insurance plan. In 2010, around 10% of community hospitals owned, or were part of systems that owned, health plans, according to the American Hospital Association.
Typically, the new entrants will offer health-maintenance-organization-style plans that allow patients limited access to doctors and hospitals outside their network.
Some systems that have had limited insurance operations are expanding, including MedStar Health in the Baltimore-Washington area, which will add Medicare plans next year and is likely to have a plan on the Maryland health exchange, and Indiana University Health, which expects to start offering health plans to employers in 2013.
The moves reflect a broader blurring of the lines between those who provide health care and those who pay for it, as both sides increasingly aim to provide more efficient, seamless care. The hospital systems themselves are the product of a consolidation that brought together many hospitals and doctors.
Driving the trend is the mounting pressure to reduce costs, as well as the changes set to be unleashed by the health-care overhaul. In addition to adding coverage for millions of people, partly by expanding Medicaid, the federal-state health program for low-income Americans, the law will cut back on hospital payments by Medicare, the federal insurance program for the elderly. Some hospitals are starting their own plans for Medicaid recipients.
The hospitals expect to get a shrinking slice of reimbursements from the fees insurers and others pay for specific services. That payment system has been blamed for fueling rising health costs. Providers who depend solely on fee-for-service revenue will eventually have a slow death, according to the chief executive of North Shore-Long Island Jewish.
He said his hospital system intended to offer its own exchange plan, perhaps in 2014, the first year the health exchanges are supposed to be running. I want to go upstream as much as possible and take the premium dollar at the source, he said.
Because insurers pay claims for all doctor visits, lab tests and other care, they get a full view of their members. Hospital systems say they need direct access to that data, which they can get by offering their own plans, to manage patients better, avoiding duplication and detecting and treating problems early to head off pricey procedures later.
It's so much better for us to have, at least for a slice of our business, a total picture as to what's going on, according to a senior vice president at Sutter Health.
Still, most hospital systems have been stopping short of getting an insurance license, often taking more limited steps like striking reimbursement deals with insurers that reward them for providing more efficient care. Some are also forging partnerships with insurers that sometimes involve jointly selling a health plan built around the system.
Some hospital operators, including the University of Pittsburgh Medical Center and Intermountain Healthcare in Utah, long have had health plans. Others, including some health systems considering them now, have tried and failed with them in the past. The failures in part reflect the difficulties of reconciling conflicting interests: Hospitals typically make money when they fill their beds with patients, and health plans pay the bills for those admissions.
Another factor: Patients revolted against HMOs in the 1990s, when they were popular with employers, because they felt that HMOs limited their choices of providers and access to care.
The hospital systems may also create new fault lines as they compete against the other insurance companies that pay them, though their size and market power will make it tough for insurers to shut them out.
Aetna Inc.'s partnerships are lower cost, more flexible and more scalable for systems than building health plans from scratch, according to the chief executive of Aetna's Accountable Care Solutions business. Aetna's network includes providers who operate their own networks, but if a system became a significant competitor, competitive dynamics might push us…in a direction where we might not want to contract with them in a preferred state, or favor the system in Aetna's own plan designs.
Many of [the hospital systems] are also folks we do business with, according to Blue Shield of California's senior vice president for network management. There's a potential for that to be difficult.
Like insurers, which are building lower-cost narrow network plans for the exchanges, the hospital systems are betting that consumers will be willing to accept a smaller choice of health-care providers in return for the promise of smoothly integrated care and premiums that are likely to be lower. The hospital systems plan to build their coverage around their own networks, but may fill them out with other providers as well.
Hospital systems say their focus is on providing high-quality care, and they think that the better technology that helps them closely track patients will ensure they avoid some of the financial pitfalls of decades ago. Also, today there is financial urgency, according to the chief executive of Evolent Health, which is advising many hospital systems pursuing integrated operations, including Piedmont.
Piedmont and WellStar together have about 30% of the inpatient market share in the Atlanta area. Working together will spread out the fixed costs of starting a health plan, as well as offer greater reach in the combined network, according to the chief executive of WellStar.
A increasing number of hospital systems are moving to start their own insurance plans, aiming to broaden their roles and prepare for the changes coming under the federal health-care overhaul.
Piedmont Healthcare and WellStar Health System, both in the Atlanta area, are set to announce a jointly owned insurance arm, with the goal of marketing coverage to employers and Medicare recipients in 2014. They also will consider selling coverage on a health exchange, one of the online insurance marketplaces required in each state by the health-overhaul law.
Piedmont and WellStar said their health plan would be built largely around their 10 hospitals and hundreds of affiliated doctors, and they will offer a competitive premium. We're broadening the reach of our delivery system, according to Piedmont's interim chief operating officer, who added that he expects the strategy to clearly have a positive impact on the quality of care.
In recent months, northern California's Sutter Health and New York's North Shore-Long Island Jewish Health System have said they would start selling health plans. A 2011 survey of 100 hospital leaders by health research firm Advisory Board Co. found that 20% of them intended to market an insurance plan. In 2010, around 10% of community hospitals owned, or were part of systems that owned, health plans, according to the American Hospital Association.
Typically, the new entrants will offer health-maintenance-organization-style plans that allow patients limited access to doctors and hospitals outside their network.
Some systems that have had limited insurance operations are expanding, including MedStar Health in the Baltimore-Washington area, which will add Medicare plans next year and is likely to have a plan on the Maryland health exchange, and Indiana University Health, which expects to start offering health plans to employers in 2013.
The moves reflect a broader blurring of the lines between those who provide health care and those who pay for it, as both sides increasingly aim to provide more efficient, seamless care. The hospital systems themselves are the product of a consolidation that brought together many hospitals and doctors.
Driving the trend is the mounting pressure to reduce costs, as well as the changes set to be unleashed by the health-care overhaul. In addition to adding coverage for millions of people, partly by expanding Medicaid, the federal-state health program for low-income Americans, the law will cut back on hospital payments by Medicare, the federal insurance program for the elderly. Some hospitals are starting their own plans for Medicaid recipients.
The hospitals expect to get a shrinking slice of reimbursements from the fees insurers and others pay for specific services. That payment system has been blamed for fueling rising health costs. Providers who depend solely on fee-for-service revenue will eventually have a slow death, according to the chief executive of North Shore-Long Island Jewish.
He said his hospital system intended to offer its own exchange plan, perhaps in 2014, the first year the health exchanges are supposed to be running. I want to go upstream as much as possible and take the premium dollar at the source, he said.
Because insurers pay claims for all doctor visits, lab tests and other care, they get a full view of their members. Hospital systems say they need direct access to that data, which they can get by offering their own plans, to manage patients better, avoiding duplication and detecting and treating problems early to head off pricey procedures later.
It's so much better for us to have, at least for a slice of our business, a total picture as to what's going on, according to a senior vice president at Sutter Health.
Still, most hospital systems have been stopping short of getting an insurance license, often taking more limited steps like striking reimbursement deals with insurers that reward them for providing more efficient care. Some are also forging partnerships with insurers that sometimes involve jointly selling a health plan built around the system.
Some hospital operators, including the University of Pittsburgh Medical Center and Intermountain Healthcare in Utah, long have had health plans. Others, including some health systems considering them now, have tried and failed with them in the past. The failures in part reflect the difficulties of reconciling conflicting interests: Hospitals typically make money when they fill their beds with patients, and health plans pay the bills for those admissions.
Another factor: Patients revolted against HMOs in the 1990s, when they were popular with employers, because they felt that HMOs limited their choices of providers and access to care.
The hospital systems may also create new fault lines as they compete against the other insurance companies that pay them, though their size and market power will make it tough for insurers to shut them out.
Aetna Inc.'s partnerships are lower cost, more flexible and more scalable for systems than building health plans from scratch, according to the chief executive of Aetna's Accountable Care Solutions business. Aetna's network includes providers who operate their own networks, but if a system became a significant competitor, competitive dynamics might push us…in a direction where we might not want to contract with them in a preferred state, or favor the system in Aetna's own plan designs.
Many of [the hospital systems] are also folks we do business with, according to Blue Shield of California's senior vice president for network management. There's a potential for that to be difficult.
Like insurers, which are building lower-cost narrow network plans for the exchanges, the hospital systems are betting that consumers will be willing to accept a smaller choice of health-care providers in return for the promise of smoothly integrated care and premiums that are likely to be lower. The hospital systems plan to build their coverage around their own networks, but may fill them out with other providers as well.
Hospital systems say their focus is on providing high-quality care, and they think that the better technology that helps them closely track patients will ensure they avoid some of the financial pitfalls of decades ago. Also, today there is financial urgency, according to the chief executive of Evolent Health, which is advising many hospital systems pursuing integrated operations, including Piedmont.
Piedmont and WellStar together have about 30% of the inpatient market share in the Atlanta area. Working together will spread out the fixed costs of starting a health plan, as well as offer greater reach in the combined network, according to the chief executive of WellStar.
10 October 2011
Basic Health Benefits for Millions to be Designed by Feds
Story first appeared on the Associated Press.
The federal government is taking on a crucial new role in the nation's health care, designing a basic benefits package for millions of privately insured Americans. A framework for the Obama administration was released Thursday.
The report by independent experts from the Institute of Medicine lays out guidelines for deciding what to include in the new "essential benefits package," how to keep it affordable for small businesses and taxpayers, and also scientifically up to date.
About 68 million Americans, many of them currently insured, ultimately would be affected by the new benefits package. That's bigger than the number of seniors enrolled in Medicare.
The advisers recommended that the package be built on mid-tier health plans currently offered by small employers, expanded to include certain services such as mental health, and squeezed into a real-world budget.
They did not spell out a list of services to cover, but they did recommend that the government require evidence of cost effectiveness.
In this day and age, when we are talking about fiscal responsibility, it's a report that recognized that we have to take account of what we can afford while trying to make sure that people have adequate coverage.
Until now, designing benefits has been the job of insurers, employers and state officials. But the new health care law requires insurance companies to provide at least the federally approved package if they want to sell to small businesses, families and individuals through new state markets set to open in 2014.
Most existing workplace plans won't be required to adopt the federal model, but employers and consumer advocates alike predict it will become the nation's benchmark for health insurance over time.
With the nation divided over President Barack Obama's health care overhaul law, and Republicans condemning it as a government takeover, the administration reacted cautiously to the recommendations.
Health and Human Services officials would hold listening sessions around the country before any final decisions are made, which could take months. The IOM panel recommended an extensive effort to engage the public.
Before they put forward a proposal, it is critical that they hear from the American people. The law extends coverage to about 30 million uninsured people.
Actually, work on the benefits package is already well under way within the HHS department. On the outside, a huge lobbying campaign to shape the final package is about to take off.
Employer groups - particularly those representing low-wage industries - want to keep benefits fairly basic. Since the government is going to be subsidizing coverage for millions of people, a generous plan will drive up costs for taxpayers, they argue. But consumer and patient advocacy groups that helped pass the overhaul law want to make sure their priorities are included.
The health care law requires that essential benefits include outpatient, hospital, emergency, maternal, newborn and children's care, prescription drugs, mental health and substance abuse treatment, rehabilitation, labs, prevention and wellness. But Congress gave the administration lots of leeway to determine the specifics.
In its 300-page report, the Institute of Medicine panel stressed that the package has to be affordable if Obama's overhaul is going to stand the test of time.
The panel used the analogy of a shopper at the supermarket. One option is to fill up your cart with all the groceries you want, and find out the cost at the register.
The first option compares to what the government now does with Medicare and Medicaid - it pays all the bills. But the advisers said Obama's plan should be on a budget.
The panel proposed a tough financial test. Few small employer plans currently offer comprehensive mental health coverage, for example. As such services are added, the total cost of the package should stay within a realistic budget target to be set by the administration. That would help keep premiums affordable.
The panel's rough estimate put annual premiums for individual coverage under the plan at $5,500 to $7,000 in 2014, comparable to what employers pay now.
The federal government is taking on a crucial new role in the nation's health care, designing a basic benefits package for millions of privately insured Americans. A framework for the Obama administration was released Thursday.
The report by independent experts from the Institute of Medicine lays out guidelines for deciding what to include in the new "essential benefits package," how to keep it affordable for small businesses and taxpayers, and also scientifically up to date.
About 68 million Americans, many of them currently insured, ultimately would be affected by the new benefits package. That's bigger than the number of seniors enrolled in Medicare.
The advisers recommended that the package be built on mid-tier health plans currently offered by small employers, expanded to include certain services such as mental health, and squeezed into a real-world budget.
They did not spell out a list of services to cover, but they did recommend that the government require evidence of cost effectiveness.
In this day and age, when we are talking about fiscal responsibility, it's a report that recognized that we have to take account of what we can afford while trying to make sure that people have adequate coverage.
Until now, designing benefits has been the job of insurers, employers and state officials. But the new health care law requires insurance companies to provide at least the federally approved package if they want to sell to small businesses, families and individuals through new state markets set to open in 2014.
Most existing workplace plans won't be required to adopt the federal model, but employers and consumer advocates alike predict it will become the nation's benchmark for health insurance over time.
With the nation divided over President Barack Obama's health care overhaul law, and Republicans condemning it as a government takeover, the administration reacted cautiously to the recommendations.
Health and Human Services officials would hold listening sessions around the country before any final decisions are made, which could take months. The IOM panel recommended an extensive effort to engage the public.
Before they put forward a proposal, it is critical that they hear from the American people. The law extends coverage to about 30 million uninsured people.
Actually, work on the benefits package is already well under way within the HHS department. On the outside, a huge lobbying campaign to shape the final package is about to take off.
Employer groups - particularly those representing low-wage industries - want to keep benefits fairly basic. Since the government is going to be subsidizing coverage for millions of people, a generous plan will drive up costs for taxpayers, they argue. But consumer and patient advocacy groups that helped pass the overhaul law want to make sure their priorities are included.
The health care law requires that essential benefits include outpatient, hospital, emergency, maternal, newborn and children's care, prescription drugs, mental health and substance abuse treatment, rehabilitation, labs, prevention and wellness. But Congress gave the administration lots of leeway to determine the specifics.
In its 300-page report, the Institute of Medicine panel stressed that the package has to be affordable if Obama's overhaul is going to stand the test of time.
The panel used the analogy of a shopper at the supermarket. One option is to fill up your cart with all the groceries you want, and find out the cost at the register.
The first option compares to what the government now does with Medicare and Medicaid - it pays all the bills. But the advisers said Obama's plan should be on a budget.
The panel proposed a tough financial test. Few small employer plans currently offer comprehensive mental health coverage, for example. As such services are added, the total cost of the package should stay within a realistic budget target to be set by the administration. That would help keep premiums affordable.
The panel's rough estimate put annual premiums for individual coverage under the plan at $5,500 to $7,000 in 2014, comparable to what employers pay now.
20 October 2010
W Virginia Hospitals brace for Costs of new Health Care Law
Bloomberg / BusinessWeek
West Virginia hospitals face uncertainty and hefty upfront spending as the federal health care overhaul begins to unfold, the head of their state association told lawmakers Monday.
Joseph Letnaunchyn, president of the hospital group, also warned of short-term drops in government reimbursement payments to hospitals, as scheduled under the new law. The chair of the state Health Care Authority, Sonia Chambers, echoed those concerns during the interim committee meeting Monday.
"It will be difficult for many West Virginia hospitals to sustain those reductions," said Chambers, whose agency regulates health care spending in the state.
But she and Letnaunchyn also sought to strike optimistic tones about the sweeping changes. Chambers cited its attempts to curb hospital readmissions forced by preventable infections. Letnaunchyn noted the more than 100,000 West Virginians who will eventually gain coverage, easing the hospitals' charity care costs.
"I contend that the glass is half-full rather than half-empty," Letnaunchyn told lawmakers. "We're just trying to tell you what the facts are from where we see them. We supported (health care reform) going in."
Those facts, he explained, include the price of required upgrades to health information technology systems. While the aim is long-term savings and improved patient care, some hospitals face devoting 35 to 40 percent of coming capital budgets to meeting that provision, Letnaunchyn said. Available federal funds will help, but only some, he said.
The impact of other provisions will depend on how officials write the rules that will carry them out, Letnaunchyn said. Awaiting those regulations, he said, creates a sense of uncertainty among hospitals that he likened to driving through fog.
Senate Minority Leader Mike Hall, R-Putnam, suggested that the overhaul will increase hospital costs by requiring them to hire additional staff to ensure they follow its many provisions.
"I'm speculating that it will cost millions and millions of dollars," Hall said.
Chambers said hospitals are already reporting information to regulators. But she noted that the overhaul could change. Among other factors, Republicans have vowed to seek the overhaul's repeal if they win control of Congress next month.
"I wouldn't be surprised if some of these provisions change year to year," Chambers said. "We're really going to have to wait and see."
29 September 2010
Health-care Overhaul Supports Research on Breast Cancer in Young Women
The Washington Post
Breast cancer is extremely rare in young women. But when it does happen, it can be serious, even deadly. A little-noticed section in the health-care overhaul aims to raise awareness among young women and their doctors about the risk of breast cancer between the ages of 15 and 44.
The law directs the Centers for Disease Control and Prevention to create education campaigns that will focus on breast cancer and young women, and encourage healthful habits that promote prevention and early detection of the disease.
The law also provides grants to groups that support young women with breast cancer. And it directs the National Institutes of Health to develop new screening tests and other methods to prevent breast cancer in young women and improve early detection. The law provides $9 million annually between 2010 and 2014 for these efforts.
Only about 10 percent of the roughly 250,000 women who receive diagnoses of breast cancer in a given year are younger than 45, according to the American Cancer Society . Family history, ethnicity and genetics can all increase a woman's risk.
When young women do get breast cancer, it tends to be more aggressive. The five-year survival rate for women given the diagnosis before age 40 is 83 percent, compared with 90 percent for other women, according to the American Cancer Society.
Advocates say younger women's lower survival rates also may be due in part to later diagnoses. With the likelihood of cancer remote, young women and their doctors sometimes take a wait-and-see approach when they discover a lump or other breast change.
When Robyn Haines found a lump under her arm last summer, she wasn't overly concerned, and she waited a few months before checking it out. The 28-year-old television newscaster eventually visited her gynecologist near her home in Cadillac, Mich., and her doctor said it was probably nothing but referred her for a mammogram and ultrasound, just to be safe. The results were inconclusive. The doctor then sent Haines to a general surgeon, who wasn't particularly concerned, either. But he said that if the lump was uncomfortable, he could remove it.
Haines decided to go ahead with that surgery and says she was "extremely shocked" to learn last October that she had an aggressive form of breast cancer. Haines underwent a bilateral mastectomy and chemotherapy, continuing her morning anchor duties in a wig after her hair, eyebrows and eyelashes fell out. She's still undergoing breast reconstruction.
Haines says some of her concerns are different than they would be if she were older. Fertility, for example, is a big unknown at this point. "I did what I could to preserve it, but it could be an issue down the road," says Haines, who received a series of shots during chemotherapy intended to minimize effects on her ovaries.
Experts agree that there are no easy solutions for screening women younger than 40. Given the low incidence of breast cancer in this group, widespread screening with mammograms wouldn't be cost-effective, and young women's breast tissue is often too dense to be effectively evaluated by a breast X-ray.
In the absence of cost-effective, high-tech tools, an advocacy group recommends that young women speak up quickly if they notice a change in their breasts. "Be familiar with the look, feel and shape of your breasts, so that if something develops you're aware of it," says Stacy Lewis, vice president of programming for the Young Survival Coalition. "If you see a change, go see a doctor, and if you're told that it's probably nothing, go to another provider."
Although encouraging young women to learn more about breast cancer may be good advice, some experts caution that knowledge isn't always power.
"It's all a balance," says H. Gilbert Welch, a professor and researcher at the Dartmouth Institute for Health Policy and Clinical Practice. "You want people to be aware without making them feel more vulnerable to disease than they are."
Experts say that the new law's most significant provisions relevant to breast cancer in younger women may be those that encourage further research.
Since screening women before age 40 isn't practical, identifying young women who are at risk becomes all the more important, says Dr. Therese Bevers, medical director of the cancer prevention center at the MD Anderson Cancer Center at the University of Texas in Houston. "We've got to have a way of picking out the right young women," she says. "Otherwise we'll miss cases."
The law directs the Centers for Disease Control and Prevention to create education campaigns that will focus on breast cancer and young women, and encourage healthful habits that promote prevention and early detection of the disease.
The law also provides grants to groups that support young women with breast cancer. And it directs the National Institutes of Health to develop new screening tests and other methods to prevent breast cancer in young women and improve early detection. The law provides $9 million annually between 2010 and 2014 for these efforts.
Only about 10 percent of the roughly 250,000 women who receive diagnoses of breast cancer in a given year are younger than 45, according to the American Cancer Society . Family history, ethnicity and genetics can all increase a woman's risk.
When young women do get breast cancer, it tends to be more aggressive. The five-year survival rate for women given the diagnosis before age 40 is 83 percent, compared with 90 percent for other women, according to the American Cancer Society.
Advocates say younger women's lower survival rates also may be due in part to later diagnoses. With the likelihood of cancer remote, young women and their doctors sometimes take a wait-and-see approach when they discover a lump or other breast change.
When Robyn Haines found a lump under her arm last summer, she wasn't overly concerned, and she waited a few months before checking it out. The 28-year-old television newscaster eventually visited her gynecologist near her home in Cadillac, Mich., and her doctor said it was probably nothing but referred her for a mammogram and ultrasound, just to be safe. The results were inconclusive. The doctor then sent Haines to a general surgeon, who wasn't particularly concerned, either. But he said that if the lump was uncomfortable, he could remove it.
Haines decided to go ahead with that surgery and says she was "extremely shocked" to learn last October that she had an aggressive form of breast cancer. Haines underwent a bilateral mastectomy and chemotherapy, continuing her morning anchor duties in a wig after her hair, eyebrows and eyelashes fell out. She's still undergoing breast reconstruction.
Haines says some of her concerns are different than they would be if she were older. Fertility, for example, is a big unknown at this point. "I did what I could to preserve it, but it could be an issue down the road," says Haines, who received a series of shots during chemotherapy intended to minimize effects on her ovaries.
Experts agree that there are no easy solutions for screening women younger than 40. Given the low incidence of breast cancer in this group, widespread screening with mammograms wouldn't be cost-effective, and young women's breast tissue is often too dense to be effectively evaluated by a breast X-ray.
In the absence of cost-effective, high-tech tools, an advocacy group recommends that young women speak up quickly if they notice a change in their breasts. "Be familiar with the look, feel and shape of your breasts, so that if something develops you're aware of it," says Stacy Lewis, vice president of programming for the Young Survival Coalition. "If you see a change, go see a doctor, and if you're told that it's probably nothing, go to another provider."
Although encouraging young women to learn more about breast cancer may be good advice, some experts caution that knowledge isn't always power.
"It's all a balance," says H. Gilbert Welch, a professor and researcher at the Dartmouth Institute for Health Policy and Clinical Practice. "You want people to be aware without making them feel more vulnerable to disease than they are."
Experts say that the new law's most significant provisions relevant to breast cancer in younger women may be those that encourage further research.
Since screening women before age 40 isn't practical, identifying young women who are at risk becomes all the more important, says Dr. Therese Bevers, medical director of the cancer prevention center at the MD Anderson Cancer Center at the University of Texas in Houston. "We've got to have a way of picking out the right young women," she says. "Otherwise we'll miss cases."
26 September 2010
Poll: Repeal? Many Wish Health Law Went Further
USA Today
President Obama's health care overhaul has divided the nation, and Republicans believe their call for repeal will help them win elections in November. But the picture's not that clear cut.
A new AP poll finds that Americans who think the law should have done more outnumber those who think the government should stay out of health care by 2-to-1.
"I was disappointed that it didn't provide universal coverage," said Bronwyn Bleakley, 35, a biology professor from Easton, Mass.
More than 30 million people would gain coverage in 2019 when the law is fully phased in, but another 20 million or so would remain uninsured. Bleakley, who was uninsured early in her career, views the overhaul as a work in progress.
The poll found that about four in 10 adults think the new law did not go far enough to change the health care system, regardless of whether they support the law, oppose it or remain neutral. On the other side, about one in five say they oppose the law because they think the federal government should not be involved in health care at all.
The AP poll was conducted by Stanford University with the Robert Wood Johnson Foundation. Overall, 30% favored the legislation, while 40% opposed it, and another 30% remained neutral.
Those numbers are no endorsement for Obama's plan, but the survey also found a deep-seated desire for change that could pose a problem for Republicans. Only 25% in the poll said minimal tinkering would suffice for the health care system.
Brian Braley, 49, a tech industry worker from Mesa, Ariz., wants Washington to keep its hands off. "I think it's a Trojan horse," Braley said of the health care law. "It's a communist, socialist scheme. All the other countries that have tried this, they're billions in debt, and they admit this doesn't work."
It may well satisfy people who share Braley's outlook if Republicans succeed in tearing out what they dismiss as "Obamacare" by the roots. But GOP leaders would still find themselves in a quandary.
Republicans "are going to have to contend with the 75% who want substantial changes in the system," said Stanford political science professor Jon Krosnick, who directed the university's participation.
"Republican legislators' passion to repeal the legislation is understandable if they are paying attention to members of their own party," Krosnick added. "But if they want to be responsive to all Americans, there are more Democrats and independents than there are Republicans."
The poll did find some agreement among people who think the law should do more and those who think government should get out.
Broad majorities of both the "get-outs" and "do-mores" said medical care, health insurance and prescription drugs cost too much. And most said the system should aim to increase the number of people with insurance and enable Americans to get the care they need, while improving quality.
The differences emerge when it comes to the means:
—Only 25% of the "get-outs" favor requiring health insurance companies to sell coverage to people regardless of pre-existing medical conditions, while 54% of the "do-mores" support it. The law requires insurers to cover children regardless of health problems starting this year, and that protection is extended to people of all ages in 2014.
—Among those who want a law that does more, 68% favor requiring medium to large companies to provide insurance to their workers or pay a fine; that stands at 28% among those who want the government out. The law does not require employers to offer coverage, but it hits companies that have 50 or more workers with a penalty if any full-time employee gets a government subsidy for health insurance.
—The "get-outs" overwhelmingly reject the health care law's requirement that most Americans carry health insurance starting in 2014. But the "do-mores" are split, with 34% favoring the mandate, 33% opposing it, and 32% neutral.
Tom Gergel, 45, of West Chester, Pa., said he supports the health care law because it moves toward coverage for all and does away with denial of coverage to people in poor health. But he doesn't think it's perfect.
"Is this program going to make it more expensive?" asked Gergel, who sells computer software for engineers. "The jury's still out versus where we are now. We have the best health care in the world for those who can afford to pay for it, but it doesn't work for everyone."
The survey was conducted Aug. 31 to Sept. 7, and involved interviews with 1,251 randomly chosen adults nationwide. It has a margin of sampling error of plus or minus 3.9 percentage points.
The survey was conducted by Knowledge Networks, which first chose people for the study using randomly generated telephone numbers and home addresses. Once people were selected to participate, they were interviewed online. Participants without Internet access were provided it for free.
Stanford University's participation in the project was made possible by a grant from the Robert Wood Johnson Foundation.
A new AP poll finds that Americans who think the law should have done more outnumber those who think the government should stay out of health care by 2-to-1.
"I was disappointed that it didn't provide universal coverage," said Bronwyn Bleakley, 35, a biology professor from Easton, Mass.
More than 30 million people would gain coverage in 2019 when the law is fully phased in, but another 20 million or so would remain uninsured. Bleakley, who was uninsured early in her career, views the overhaul as a work in progress.
The poll found that about four in 10 adults think the new law did not go far enough to change the health care system, regardless of whether they support the law, oppose it or remain neutral. On the other side, about one in five say they oppose the law because they think the federal government should not be involved in health care at all.
The AP poll was conducted by Stanford University with the Robert Wood Johnson Foundation. Overall, 30% favored the legislation, while 40% opposed it, and another 30% remained neutral.
Those numbers are no endorsement for Obama's plan, but the survey also found a deep-seated desire for change that could pose a problem for Republicans. Only 25% in the poll said minimal tinkering would suffice for the health care system.
Brian Braley, 49, a tech industry worker from Mesa, Ariz., wants Washington to keep its hands off. "I think it's a Trojan horse," Braley said of the health care law. "It's a communist, socialist scheme. All the other countries that have tried this, they're billions in debt, and they admit this doesn't work."
It may well satisfy people who share Braley's outlook if Republicans succeed in tearing out what they dismiss as "Obamacare" by the roots. But GOP leaders would still find themselves in a quandary.
Republicans "are going to have to contend with the 75% who want substantial changes in the system," said Stanford political science professor Jon Krosnick, who directed the university's participation.
"Republican legislators' passion to repeal the legislation is understandable if they are paying attention to members of their own party," Krosnick added. "But if they want to be responsive to all Americans, there are more Democrats and independents than there are Republicans."
The poll did find some agreement among people who think the law should do more and those who think government should get out.
Broad majorities of both the "get-outs" and "do-mores" said medical care, health insurance and prescription drugs cost too much. And most said the system should aim to increase the number of people with insurance and enable Americans to get the care they need, while improving quality.
The differences emerge when it comes to the means:
—Only 25% of the "get-outs" favor requiring health insurance companies to sell coverage to people regardless of pre-existing medical conditions, while 54% of the "do-mores" support it. The law requires insurers to cover children regardless of health problems starting this year, and that protection is extended to people of all ages in 2014.
—Among those who want a law that does more, 68% favor requiring medium to large companies to provide insurance to their workers or pay a fine; that stands at 28% among those who want the government out. The law does not require employers to offer coverage, but it hits companies that have 50 or more workers with a penalty if any full-time employee gets a government subsidy for health insurance.
—The "get-outs" overwhelmingly reject the health care law's requirement that most Americans carry health insurance starting in 2014. But the "do-mores" are split, with 34% favoring the mandate, 33% opposing it, and 32% neutral.
Tom Gergel, 45, of West Chester, Pa., said he supports the health care law because it moves toward coverage for all and does away with denial of coverage to people in poor health. But he doesn't think it's perfect.
"Is this program going to make it more expensive?" asked Gergel, who sells computer software for engineers. "The jury's still out versus where we are now. We have the best health care in the world for those who can afford to pay for it, but it doesn't work for everyone."
The survey was conducted Aug. 31 to Sept. 7, and involved interviews with 1,251 randomly chosen adults nationwide. It has a margin of sampling error of plus or minus 3.9 percentage points.
The survey was conducted by Knowledge Networks, which first chose people for the study using randomly generated telephone numbers and home addresses. Once people were selected to participate, they were interviewed online. Participants without Internet access were provided it for free.
Stanford University's participation in the project was made possible by a grant from the Robert Wood Johnson Foundation.
11 September 2010
Health Insurers Plan Hikes
The Wall Street Journal
Rate Increases Are Blamed on Health-Care Overhaul; White House Questions Logic
Health insurers say they plan to raise premiums for some Americans as a direct result of the health overhaul in coming weeks, complicating Democrats' efforts to trumpet their signature achievement before the midterm elections.
Aetna Inc., some BlueCross BlueShield plans and other smaller carriers have asked for premium increases of between 1% and 9% to pay for extra benefits required under the law, according to filings with state regulators.
These and other insurers say Congress's landmark refashioning of U.S. health coverage, which passed in March after a brutal fight, is causing them to pass on more costs to consumers than Democrats predicted.
The rate increases largely apply to policies for individuals and small businesses and don't include people covered by a big employer or Medicare.
About 9% of Americans buy coverage through the individual market, according to the Census Bureau, and roughly one-fifth of people who get coverage through their employer work at companies with 50 or fewer employees, according to the Kaiser Family Foundation. People in both groups are likely to feel the effects of the proposed increases, even as they see new benefits under the law, such as the elimination of lifetime and certain annual coverage caps.
Many carriers also are seeking additional rate increases that they say they need to cover rising medical costs. As a result, some consumers could face total premium increases of more than 20%.
While the increases apply mostly to the new policies insurers write after Oct. 1, consumers could be subject to the higher rates if they modify their existing plans and cause them to lose grandfathered status.
The rate increases are a dose of troubling news for Democrats just weeks before an election in which they are at risk of losing their majority in the House and possibly the Senate.
In addition to pledging that the law would restrain increases in Americans' insurance premiums, Democrats front-loaded the legislation with early provisions they hoped would boost public support. Those include letting children stay on their parents' insurance policies until age 26, eliminating co-payments for preventive care and barring insurers from denying policies to children with pre-existing conditions, plus the elimination of the coverage caps.
Weeks before the election, insurance companies began telling state regulators it is those very provisions that are forcing them to increase their rates.
Aetna, one of the nation's largest health insurers, said the extra benefits forced it to seek rate increases for new individual plans of 5.4% to 7.4% in California and 5.5% to 6.8% in Nevada after Sept. 23. Similar steps are planned across the country, according to Aetna.
Regence BlueCross BlueShield of Oregon said the cost of providing additional benefits under the health law will account on average for 3.4 percentage points of a 17.1% premium rise for a small-employer health plan. It asked regulators last month to approve the increase.
In Wisconsin and North Carolina, Celtic Insurance Co. says half of the 18% increase it is seeking comes from complying with health-law mandates.
The White House says insurers are using the law as an excuse to raise rates and predicts that state regulators will block some of the large increases.
"I would have real deep concerns that the kinds of rate increases that you're quoting... are justified," said Nancy-Ann DeParle, the White House's top health official. She said that for insurers, raising rates was "already their modus operandi before the bill" passed. "We believe consumers will see through this," she said.
Previously the administration had calculated that the batch of changes taking effect this fall would raise premiums no more than 1% to 2%, on average.
After Regence mailed a letter notifying plan administrators of its intention to raise group insurance rates in Washington state, the White House contacted company officials and accused them of inaccurately justifying the increase. Kerry Barnett, executive vice president for Regence BlueShield, said the insurer is changing the letter to more precisely explain the causes of the increase.
The industry contends its increases are justified. "Anytime you add a benefit, there are increased costs," said Karen Ignagni, president of America's Health Insurance Plans, the industry's lobbying group.
Massachusetts, which enacted universal insurance coverage several years ago, also has seen steadily rising insurance premiums since then. Proponents of that plan attribute the hikes there to an overall increase in medical costs, while insurers cite it as a cautionary example of what can happen when new mandates to improve benefits aren't coupled with a strong enough provision to force healthy people to buy coverage.
Republicans, who have sought voter support by opposing the health law, say premium increases could help in November's congressional races. "People are finding out what's in [the law], they don't like it, and I think it's going to play a big factor in this election," said Iowa Sen. Charles Grassley, the top Republican on the Senate Finance Committee.
About half of all states have the power to deny rate increases. Ms. DeParle pointed out that the law awards states $250 million to bolster their scrutiny of insurance-rate proposals, saying that will eventually curb premiums for people.
"In Kansas, I don't have a lot of authority to deny a rate increase, if it is justified," said Kansas Insurance Commissioner Sandy Praeger. She recently approved a 4% increase by Mennonite Mutual Aid Association to pay for the new provisions in the health law.
The process of reviewing rate increases varies by state. For instance, Ms. Praeger said she can deny only rate increases that are unreasonable or discriminatory.
Some regulators say not all insurers have adequately justified their increases. "A lot of it is guesswork for companies," said Tom Abel, supervisor at the Colorado Division of Insurance. "I was anticipating the carriers to be more uniform."
Regence BlueCross BlueShield of Oregon, which estimates its increase covers 57,000 members, said its goal is to "anticipate the financial needs of our members as accurately as possible and to collect just enough premiums to cover costs," said a spokeswoman. Other insurers offered similar explanations or declined to discuss their increases.
A small number of insurers have submitted plans to lower rates and cite the new mandates in the legislation as the reason. HMO Colorado, a Blue Cross Blue Shield plan owned by WellPoint Inc., submitted a letter to state regulators saying small group rates would fall 1.8% starting Oct. 1 because of changes from the law.
Democrats had hoped to sell the bill in the fall elections. But in recent weeks, some Democrats who voted for the bill have shied away from advertising that fact, while the handful of House Democrats who cast "no" votes see it as a potential boost to their re-election bids.
"I think it's a question of short term versus long term," said North Carolina Insurance Commissioner Wayne Goodwin, a Democrat up for re-election in 2012. "Thankfully we're seeing people get more coverage and protections than they've ever had before. But until we see the medical-cost inflation affected, you're likely to see rate increases as long as they are not excessive and in violation of the law."
Health insurers say they plan to raise premiums for some Americans as a direct result of the health overhaul in coming weeks, complicating Democrats' efforts to trumpet their signature achievement before the midterm elections.
Aetna Inc., some BlueCross BlueShield plans and other smaller carriers have asked for premium increases of between 1% and 9% to pay for extra benefits required under the law, according to filings with state regulators.
These and other insurers say Congress's landmark refashioning of U.S. health coverage, which passed in March after a brutal fight, is causing them to pass on more costs to consumers than Democrats predicted.
The rate increases largely apply to policies for individuals and small businesses and don't include people covered by a big employer or Medicare.
About 9% of Americans buy coverage through the individual market, according to the Census Bureau, and roughly one-fifth of people who get coverage through their employer work at companies with 50 or fewer employees, according to the Kaiser Family Foundation. People in both groups are likely to feel the effects of the proposed increases, even as they see new benefits under the law, such as the elimination of lifetime and certain annual coverage caps.
Many carriers also are seeking additional rate increases that they say they need to cover rising medical costs. As a result, some consumers could face total premium increases of more than 20%.
While the increases apply mostly to the new policies insurers write after Oct. 1, consumers could be subject to the higher rates if they modify their existing plans and cause them to lose grandfathered status.
The rate increases are a dose of troubling news for Democrats just weeks before an election in which they are at risk of losing their majority in the House and possibly the Senate.
In addition to pledging that the law would restrain increases in Americans' insurance premiums, Democrats front-loaded the legislation with early provisions they hoped would boost public support. Those include letting children stay on their parents' insurance policies until age 26, eliminating co-payments for preventive care and barring insurers from denying policies to children with pre-existing conditions, plus the elimination of the coverage caps.
Weeks before the election, insurance companies began telling state regulators it is those very provisions that are forcing them to increase their rates.
Aetna, one of the nation's largest health insurers, said the extra benefits forced it to seek rate increases for new individual plans of 5.4% to 7.4% in California and 5.5% to 6.8% in Nevada after Sept. 23. Similar steps are planned across the country, according to Aetna.
Regence BlueCross BlueShield of Oregon said the cost of providing additional benefits under the health law will account on average for 3.4 percentage points of a 17.1% premium rise for a small-employer health plan. It asked regulators last month to approve the increase.
In Wisconsin and North Carolina, Celtic Insurance Co. says half of the 18% increase it is seeking comes from complying with health-law mandates.
The White House says insurers are using the law as an excuse to raise rates and predicts that state regulators will block some of the large increases.
"I would have real deep concerns that the kinds of rate increases that you're quoting... are justified," said Nancy-Ann DeParle, the White House's top health official. She said that for insurers, raising rates was "already their modus operandi before the bill" passed. "We believe consumers will see through this," she said.
Previously the administration had calculated that the batch of changes taking effect this fall would raise premiums no more than 1% to 2%, on average.
After Regence mailed a letter notifying plan administrators of its intention to raise group insurance rates in Washington state, the White House contacted company officials and accused them of inaccurately justifying the increase. Kerry Barnett, executive vice president for Regence BlueShield, said the insurer is changing the letter to more precisely explain the causes of the increase.
The industry contends its increases are justified. "Anytime you add a benefit, there are increased costs," said Karen Ignagni, president of America's Health Insurance Plans, the industry's lobbying group.
Massachusetts, which enacted universal insurance coverage several years ago, also has seen steadily rising insurance premiums since then. Proponents of that plan attribute the hikes there to an overall increase in medical costs, while insurers cite it as a cautionary example of what can happen when new mandates to improve benefits aren't coupled with a strong enough provision to force healthy people to buy coverage.
Republicans, who have sought voter support by opposing the health law, say premium increases could help in November's congressional races. "People are finding out what's in [the law], they don't like it, and I think it's going to play a big factor in this election," said Iowa Sen. Charles Grassley, the top Republican on the Senate Finance Committee.
About half of all states have the power to deny rate increases. Ms. DeParle pointed out that the law awards states $250 million to bolster their scrutiny of insurance-rate proposals, saying that will eventually curb premiums for people.
"In Kansas, I don't have a lot of authority to deny a rate increase, if it is justified," said Kansas Insurance Commissioner Sandy Praeger. She recently approved a 4% increase by Mennonite Mutual Aid Association to pay for the new provisions in the health law.
The process of reviewing rate increases varies by state. For instance, Ms. Praeger said she can deny only rate increases that are unreasonable or discriminatory.
Some regulators say not all insurers have adequately justified their increases. "A lot of it is guesswork for companies," said Tom Abel, supervisor at the Colorado Division of Insurance. "I was anticipating the carriers to be more uniform."
Regence BlueCross BlueShield of Oregon, which estimates its increase covers 57,000 members, said its goal is to "anticipate the financial needs of our members as accurately as possible and to collect just enough premiums to cover costs," said a spokeswoman. Other insurers offered similar explanations or declined to discuss their increases.
A small number of insurers have submitted plans to lower rates and cite the new mandates in the legislation as the reason. HMO Colorado, a Blue Cross Blue Shield plan owned by WellPoint Inc., submitted a letter to state regulators saying small group rates would fall 1.8% starting Oct. 1 because of changes from the law.
Democrats had hoped to sell the bill in the fall elections. But in recent weeks, some Democrats who voted for the bill have shied away from advertising that fact, while the handful of House Democrats who cast "no" votes see it as a potential boost to their re-election bids.
"I think it's a question of short term versus long term," said North Carolina Insurance Commissioner Wayne Goodwin, a Democrat up for re-election in 2012. "Thankfully we're seeing people get more coverage and protections than they've ever had before. But until we see the medical-cost inflation affected, you're likely to see rate increases as long as they are not excessive and in violation of the law."
12 August 2010
For Many still in the Dark, Groups shed Light on Health Care Law
USA Today
True or false: The new health care law will cut Medicare benefits for seniors. It will slash Medicare payments to doctors. It will ration health care.
In three polls conducted last month, large percentages of Americans answered "true" to each statement. All three are false.
Six weeks before the nation's health care delivery system begins a huge transformation, confusion reigns. For example: The debunked idea raised by opponents during congressional debate that "death panels" could make end-of-life decisions is seen as real by nearly half of those surveyed.
Many key parts of the new law, signed by President Obama in March, take effect in several stages beginning next month and continuing through 2015. Because it's so complex, consumer advocates worry that people won't take advantage of its benefits, so they have embarked on a nationwide education campaign.
"People are still afraid that there are death panels ... or that Medicare is going to go away," says Cheryl Matheis of AARP, the nation's largest seniors organization. "We have an obligation to get the information out there. Historically, people don't use services as much as the services are available to them, because they're just not aware."
That's true of most of the nation's safety-net programs, including Medicaid, welfare and food stamps. In the case of the health care law, a number of provisions kicking in this year must be claimed. Among them:
•Young adults. If they lack coverage, they can stay on their parents' plans up until they turn 26.
•Tax credits. As many as 4 million small businesses are eligible for tax credits of up to 35% of their health insurance costs.
•Preventive services. Consumers can obtain tests such as mammograms and colonoscopies without having to pay a share of the cost.
•High-risk coverage. People with pre-existing conditions or who are uninsured at least six months can get this coverage through a state or federal high-risk pool.
Despite outreach from the federal and state governments, insurers, businesses and consumer groups, however, it's up to individuals to seek the available care, coverage or tax credits.
"It's going to take some time for people to understand how the law benefits them," says Stephanie Cutter, assistant to the president for special projects. "It's critical that there is extensive outreach with consumers, the business community and the insurance industry if we want to ensure the maximum benefits of the law."
The need for outreach became apparent in recent weeks following the release of three polls:
The National Council on Aging posed 12 questions about the law to 636 seniors and found that fewer than 17% of them knew half the answers. For instance, only one in three knew that Medicare will offer free annual wellness exams.
"I was surprised by the magnitude of confusion and how much work we have to get the facts out," says Howard Bedlin, the council's vice president for public policy and advocacy.
The Kaiser Family Foundation, a non-profit research organization, and Harris Interactive market research firm found similar confusion among both seniors and the general population.
More than four in 10 people in the Kaiser poll wrongly believe the law included a government panel to make end-of-life decisions for Medicare patients. More than one-third in the Harris Poll said it included a government plan to compete with private insurers, something that was scuttled during congressional debate.
"The level of ignorance and misinformation is sort of astounding," says Humphrey Taylor, chairman of the Harris Poll. "It seems people are still reacting to the rhetoric, not the substance of what is in the bill, because they don't actually know what is or is not in the actual legislation."
As the Department of Health and Human Services issues the regulations needed to implement the law, it's trying to get the facts out through its website, healthcare.gov. The Centers for Medicare and Medicaid Services is helping, most recently with a cable TV ad featuring Andy Griffith.
Insurance companies, many of which opposed the law, also are trying to spread the word online. Blue Cross Blue Shield of North Carolina offers an interactive timeline. Aetna has questions and answers for seven topics.
"There's going to be a lot of information out there," says Karen Ignagni, president of America's Health Insurance Plans, the industry trade group.
The calendar gives advocates of the law time to spread the word — something Families USA, a health care consumers group, is doing with regional forums that feature state and federal officials.
Kathleen Stoll, the group's director of health policy, helped organize the most recent forum in Philadelphia last week and was struck by what the 150 participants knew — and didn't know.
"They're sort of hearing there's something bad," she says, "but they're not hearing any of the good stuff."
In three polls conducted last month, large percentages of Americans answered "true" to each statement. All three are false.
Six weeks before the nation's health care delivery system begins a huge transformation, confusion reigns. For example: The debunked idea raised by opponents during congressional debate that "death panels" could make end-of-life decisions is seen as real by nearly half of those surveyed.
Many key parts of the new law, signed by President Obama in March, take effect in several stages beginning next month and continuing through 2015. Because it's so complex, consumer advocates worry that people won't take advantage of its benefits, so they have embarked on a nationwide education campaign.
"People are still afraid that there are death panels ... or that Medicare is going to go away," says Cheryl Matheis of AARP, the nation's largest seniors organization. "We have an obligation to get the information out there. Historically, people don't use services as much as the services are available to them, because they're just not aware."
That's true of most of the nation's safety-net programs, including Medicaid, welfare and food stamps. In the case of the health care law, a number of provisions kicking in this year must be claimed. Among them:
•Young adults. If they lack coverage, they can stay on their parents' plans up until they turn 26.
•Tax credits. As many as 4 million small businesses are eligible for tax credits of up to 35% of their health insurance costs.
•Preventive services. Consumers can obtain tests such as mammograms and colonoscopies without having to pay a share of the cost.
•High-risk coverage. People with pre-existing conditions or who are uninsured at least six months can get this coverage through a state or federal high-risk pool.
Despite outreach from the federal and state governments, insurers, businesses and consumer groups, however, it's up to individuals to seek the available care, coverage or tax credits.
"It's going to take some time for people to understand how the law benefits them," says Stephanie Cutter, assistant to the president for special projects. "It's critical that there is extensive outreach with consumers, the business community and the insurance industry if we want to ensure the maximum benefits of the law."
The need for outreach became apparent in recent weeks following the release of three polls:
The National Council on Aging posed 12 questions about the law to 636 seniors and found that fewer than 17% of them knew half the answers. For instance, only one in three knew that Medicare will offer free annual wellness exams.
"I was surprised by the magnitude of confusion and how much work we have to get the facts out," says Howard Bedlin, the council's vice president for public policy and advocacy.
The Kaiser Family Foundation, a non-profit research organization, and Harris Interactive market research firm found similar confusion among both seniors and the general population.
More than four in 10 people in the Kaiser poll wrongly believe the law included a government panel to make end-of-life decisions for Medicare patients. More than one-third in the Harris Poll said it included a government plan to compete with private insurers, something that was scuttled during congressional debate.
"The level of ignorance and misinformation is sort of astounding," says Humphrey Taylor, chairman of the Harris Poll. "It seems people are still reacting to the rhetoric, not the substance of what is in the bill, because they don't actually know what is or is not in the actual legislation."
As the Department of Health and Human Services issues the regulations needed to implement the law, it's trying to get the facts out through its website, healthcare.gov. The Centers for Medicare and Medicaid Services is helping, most recently with a cable TV ad featuring Andy Griffith.
Insurance companies, many of which opposed the law, also are trying to spread the word online. Blue Cross Blue Shield of North Carolina offers an interactive timeline. Aetna has questions and answers for seven topics.
"There's going to be a lot of information out there," says Karen Ignagni, president of America's Health Insurance Plans, the industry trade group.
The calendar gives advocates of the law time to spread the word — something Families USA, a health care consumers group, is doing with regional forums that feature state and federal officials.
Kathleen Stoll, the group's director of health policy, helped organize the most recent forum in Philadelphia last week and was struck by what the 150 participants knew — and didn't know.
"They're sort of hearing there's something bad," she says, "but they're not hearing any of the good stuff."
11 August 2010
Missouri Voters Oppose Mandatory Health Insurance
The Wall Street Journal
Voters in Missouri overwhelmingly opposed requiring people to buy health insurance, in a largely symbolic slap at the Obama administration's health overhaul.
The referendum was the first chance for voters to express a view on the overhaul, although turnout in the state was low and Republican voters significantly outnumbered Democrats.
With all precincts reporting, 71% of voters supported Proposition C, establishing a state law that says Missouri cannot compel people to pay a penalty or fine if they fail to carry health coverage. Twenty-nine percent voted against the proposition.
The state law runs counter to the federal health law President Barack Obama signed in March, which calls on most Americans to carry coverage or pay a fine.
Some state attorneys general have challenged the insurance mandate as unconstitutional. Defenders of the law say the mandate falls within Congress's power to regulate interstate commerce and levy taxes.
The Missouri vote is likely to have little immediate practical effect because the mandate doesn't take effect until 2014. If federal courts uphold the federal law as constitutional, it would take precedence over any state law that contradicts it.
Supporters of the state law said Congress was overreaching by requiring people to buy coverage, and they called the proposition a chance to stand up for states' rights.
Opponents included the Missouri Hospital Association, which said that if the mandate isn't enforced some who can afford insurance will get a free ride and pass the costs on to those who are insured. The association spent about $400,000 on direct mail in connection with Proposition C, according to its filings.
A June Wall Street Journal/NBC News poll found that 44% think Mr. Obama's health-care plan is a bad idea, while 40% called it a good idea.
The referendum was the first chance for voters to express a view on the overhaul, although turnout in the state was low and Republican voters significantly outnumbered Democrats.
With all precincts reporting, 71% of voters supported Proposition C, establishing a state law that says Missouri cannot compel people to pay a penalty or fine if they fail to carry health coverage. Twenty-nine percent voted against the proposition.
The state law runs counter to the federal health law President Barack Obama signed in March, which calls on most Americans to carry coverage or pay a fine.
Some state attorneys general have challenged the insurance mandate as unconstitutional. Defenders of the law say the mandate falls within Congress's power to regulate interstate commerce and levy taxes.
The Missouri vote is likely to have little immediate practical effect because the mandate doesn't take effect until 2014. If federal courts uphold the federal law as constitutional, it would take precedence over any state law that contradicts it.
Supporters of the state law said Congress was overreaching by requiring people to buy coverage, and they called the proposition a chance to stand up for states' rights.
Opponents included the Missouri Hospital Association, which said that if the mandate isn't enforced some who can afford insurance will get a free ride and pass the costs on to those who are insured. The association spent about $400,000 on direct mail in connection with Proposition C, according to its filings.
A June Wall Street Journal/NBC News poll found that 44% think Mr. Obama's health-care plan is a bad idea, while 40% called it a good idea.
04 August 2010
Massachusetts: Small Businesses Applaud new Health Care Measure
Boston Globe
Small-business leaders say new legislation aimed at controlling their health care costs brings them a giant step closer to leveling the playing field in Massachusetts’ David-and-Goliath-like health insurance system.
Business leaders, insurers, health care providers, and advocates yesterday were still scouring the 63-page document passed late Saturday as lawmakers raced to wrap up their legislative session for the year. The legislation, which awaits the governor’s signature, would allow some small businesses to band together to negotiate cheaper insurance rates, a move small-business leaders have long lobbied for. They say they lack the clout of larger businesses to bargain for more affordable insurance for themselves and their employees. If signed by the governor, the measure would become law immediately.
The measure, a compromise between different bills passed earlier by the House and Senate, would also beef up the authority of the state insurance commissioner to reject insurance rate increases based on excessive administrative costs or surplus margins. Specifically, rates could be rejected if the insurers’ administrative expenses increase more than the rate of medical inflation in New England, or if insurers spend less than 90 cents of every premium dollar on health care.
Jon Hurst, president of the Retailers Association of Massachusetts, which led the group-buying initiative, called the legislation the most important reform for small businesses in 20 years.
“What we were pushing for all along was equal rights,’’ Hurst said, “and we essentially got what we were looking for.’’
Health advocates and others had strongly opposed letting small businesses create cooperatives. They said the groups would cherry-pick the youngest and healthiest workers, and that would drive up costs for thousands of other small-business employees not allowed in the co-ops.
But the legislation contains provisions to safeguard against that. For one, it gives the insurance commissioner sweeping oversight. The legislation allows for the creation of up to six group-buying cooperatives with a total of 85,000 members — which is only one-tenth of the entire small-group market — and requires the insurance commissioner to file a progress report on the co-ops with lawmakers in two years.
The legislation also aims to close a loophole that allowed consumers to buy insurance shortly before a pricey medical procedure, then drop it after, a practice that insurers said drove up costs for everyone else. The new rules will phase in an annual enrollment period, but includes exceptions for people facing life changes, such as loss of workplace insurance or the birth of a child.
Additionally, the new rules contain a provision aimed at driving down rates charged by hospitals. It would prohibit contracts between insurers and hospitals that create monopolies for some health care providers. Regulators and the state attorney general have said such practices have created soaring health care provider rates that drive up costs, but rate regulation proposals have not fared well.
Senator Mark C. Montigny, a New Bedford Democrat who chaired the committee that hammered out the compromise, said the anticompetitive push is a “really hard-hitting first step,’’ but said much more is needed to control rates.
“It’s a cannonball shot into the bow of the insurance industry and the major hospitals, saying you are all fighting and pointing fingers, but ultimately the consumer is losing and you are all benefiting from the status quo,’’ Montigny said.
Statements from the Massachusetts Hospital Association and from Blue Cross Blue Shield of Massachusetts, the state’s largest private insurer, applauded the lawmakers for passing legislation that brings some rate relief to small businesses. But both groups declined to directly address the anticompetitive contracting concerns.
Hospitals dodged a requirement, contained in a version of the bill previously passed by the Senate, that would have required hospitals doing well financially to make one-time contributions, totaling $100 million, to a fund to reduce costs for small businesses. Instead, the final measure makes such payments voluntary.
Business leaders, insurers, health care providers, and advocates yesterday were still scouring the 63-page document passed late Saturday as lawmakers raced to wrap up their legislative session for the year. The legislation, which awaits the governor’s signature, would allow some small businesses to band together to negotiate cheaper insurance rates, a move small-business leaders have long lobbied for. They say they lack the clout of larger businesses to bargain for more affordable insurance for themselves and their employees. If signed by the governor, the measure would become law immediately.
The measure, a compromise between different bills passed earlier by the House and Senate, would also beef up the authority of the state insurance commissioner to reject insurance rate increases based on excessive administrative costs or surplus margins. Specifically, rates could be rejected if the insurers’ administrative expenses increase more than the rate of medical inflation in New England, or if insurers spend less than 90 cents of every premium dollar on health care.
Jon Hurst, president of the Retailers Association of Massachusetts, which led the group-buying initiative, called the legislation the most important reform for small businesses in 20 years.
“What we were pushing for all along was equal rights,’’ Hurst said, “and we essentially got what we were looking for.’’
Health advocates and others had strongly opposed letting small businesses create cooperatives. They said the groups would cherry-pick the youngest and healthiest workers, and that would drive up costs for thousands of other small-business employees not allowed in the co-ops.
But the legislation contains provisions to safeguard against that. For one, it gives the insurance commissioner sweeping oversight. The legislation allows for the creation of up to six group-buying cooperatives with a total of 85,000 members — which is only one-tenth of the entire small-group market — and requires the insurance commissioner to file a progress report on the co-ops with lawmakers in two years.
The legislation also aims to close a loophole that allowed consumers to buy insurance shortly before a pricey medical procedure, then drop it after, a practice that insurers said drove up costs for everyone else. The new rules will phase in an annual enrollment period, but includes exceptions for people facing life changes, such as loss of workplace insurance or the birth of a child.
Additionally, the new rules contain a provision aimed at driving down rates charged by hospitals. It would prohibit contracts between insurers and hospitals that create monopolies for some health care providers. Regulators and the state attorney general have said such practices have created soaring health care provider rates that drive up costs, but rate regulation proposals have not fared well.
Senator Mark C. Montigny, a New Bedford Democrat who chaired the committee that hammered out the compromise, said the anticompetitive push is a “really hard-hitting first step,’’ but said much more is needed to control rates.
“It’s a cannonball shot into the bow of the insurance industry and the major hospitals, saying you are all fighting and pointing fingers, but ultimately the consumer is losing and you are all benefiting from the status quo,’’ Montigny said.
Statements from the Massachusetts Hospital Association and from Blue Cross Blue Shield of Massachusetts, the state’s largest private insurer, applauded the lawmakers for passing legislation that brings some rate relief to small businesses. But both groups declined to directly address the anticompetitive contracting concerns.
Hospitals dodged a requirement, contained in a version of the bill previously passed by the Senate, that would have required hospitals doing well financially to make one-time contributions, totaling $100 million, to a fund to reduce costs for small businesses. Instead, the final measure makes such payments voluntary.
28 July 2010
Health Law Augurs Transfer of Funds from Old to Young
The Wall Street Journal
Mark Baumann, a 44-year-old uninsured diabetic, sees in the Obama administration's health-care law a future with stable coverage to pay for his insulin shots and blood tests. Currently unable to meet costs such as Anthem health insurance quotes, he will rely on reform measures to meet his medical needs.
That's likely to come indirectly at the expense of his mother's generous health-care plan.
Humana Inc., Mary Baumann's insurer, intends to pare her "Medicare Advantage" plan to make up for the smaller government payments it will soon receive as a result of the new law, leaving her with higher costs or fewer services. On the table are beefed-up co-payments and premiums, as well as the loss of perks such as her free membership at a health club.
Across the country, dozens of private insurers that run similar Medicare plans are preparing to pare dental, vision and certain prescription-drug coverage starting next year, according to consultants who have helped them assemble annual bids.
Although some planned cuts might not materialize given Congress's history of tabling unpopular measures, the law represents the tip of a broader change. Most Americans know the overhaul is designed to cover the uninsured, a decades-long goal of Democrats. But it also represents a change in how the government spreads its social safety net underneath Americans. Already, it's creating tensions that are a harbinger of debates to come.
Since the creation of Social Security and Medicare, younger workers have funded programs for the elderly. It's a compact in which workers paid for retirees with the understanding that they'd be looked after by the generation behind them.
The health overhaul diverges by tapping a program for the elderly to help provide insurance to 32 million Americans of younger generations. Nearly half the funding for the law is supposed to come from paying lower fees to hospitals, insurers and other health-care providers that participate in Medicare, the federal insurance program for Americans age 65 and older, as well as younger disabled people.
The 44 million Americans on Medicare won't see changes to their guaranteed benefits under the law. But of those, 11.3 million on Medicare Advantage plans, a public-private hybrid of the type used by Ms. Baumann, who is 79, are likely to begin seeing extra benefits go away as soon as next year. Medicare Advantage cuts are slated to pay for 15% of the health-care law's tab.
The trims mark the leading edge of a spending shift that could broaden as lawmakers grapple with a deficit expected to hit $1.47 trillion this year. Left unchanged, Medicare and Social Security will consume half of all federal spending by 2035, up from about one third today, according to the Congressional Budget Office.
A White House-sponsored commission that is examining ways to reduce the budget deficit is considering how to tackle Social Security, too. Even AARP, the seniors group, recently embraced the prospect, noting that to keep Social Security viable, Congress "needs to make some small adjustments." AARP supported the health-care overhaul.
Prominent lawmakers in both parties have suggested restrictions on future Social Security benefits, such as a higher retirement age for younger workers and financial means testing to determine who gets benefits.
"We badly need to, over time and very gradually, reallocate resources from the elderly to younger families and their children," said Isabel Sawhill, senior fellow at the liberal-leaning Brookings Institution.
The White House says the health law doesn't take from seniors to help younger generations, but instead eliminates overpayments to private companies, particularly insurers that run Medicare plans like Ms. Baumann's. By lowering payments to health providers, the new law extends the life of Medicare's trust fund by 12 years, according to an actuarial report from Medicare's umbrella agency.
"I'm sure that some of those additional benefits have been nice," Nancy-Ann DeParle, who runs the White House's Office of Health Reform, says of Medicare Advantage plans. "But I think what we have to look at here is what's fair and what's important for the strength of the Medicare program long term."
Stuart Butler, a vice president at the conservative Heritage Foundation, says the White House is misrepresenting the benefits that accrue from Medicare payment cuts. "It uses it to create a new entitlement for a separate group of people rather than strengthening" the program, he says. Moreover, such cuts alone don't pay for the law.
The law will spend $938 billion over a decade, mostly to expand coverage to lower-income Americans. To finance that, there will be $455 billion coming from cuts in government payments to health-care providers that serve patients on Medicare and two other federal programs. The hardest hit—to the tune of $136 billion—will be private insurance companies that run Medicare Advantage plans.
Most of the rest will be funded by new levies, including taxes on health-care companies, a higher Medicare payroll tax for wealthy Americans and a tax on high-value insurance plans. Critics of the law say its total cost is likely higher than advertised.
Some older Americans are irate, including some of Ms. Baumann's gym-mates. One has joined the tea-party movement, in part to protest the cuts. Democrats are worried about the political pressure from seniors, who vote in large numbers, especially in midterm elections, and represent a political force that is disproportionate to their numbers.
The party has played up the perks for seniors included in the law. Among other things, it closes a gap in Medicare prescription-drug coverage and makes preventive services free for enrollees.
Ms. Baumann has few medical needs except two daily blood-pressure medications and dental work, but she is torn about the changes. She credits the gym membership with helping her overcome her husband's death in 1994. She couldn't afford it on her fixed annual income of $17,000 and has voiced that concern at meetings of Humana's local consumer advisory board, of which she is a member.
"I think there's other cuts we could make besides our age group," she says. But she wants her son to get insured.
The Congressional Budget Office says on average, Medicare Advantage enrollees will get $68 less a month in benefits by 2019 because of the law. The payment cuts to Medicare Advantage begin in 2012.
John Gorman, a consultant who helped insurers prepare bids, says his clients are planning to raise non-essential emergency room co-pays to $500 from $200. They're pushing enrollees toward generic drugs and charging more for optometrist visits.
Ms. Baumann and her late husband, Donald, raised six children around New Orleans. Donald Baumann worked as a switchman for the phone company and earned $40,000 a year when he retired in 1982. Ms. Baumann stayed home to raise their children and later sold cosmetics at an Estee Lauder counter.
Donald Baumann's health plan from BlueCross BlueShield of Louisiana kept their costs low. When their youngest child, Mark, was diagnosed with Type 1 diabetes at 16, the insurance covered his two-week hospital stay.
After college, Mark Baumann bounced between jobs in Chicago selling hotel rooms to corporate groups. The hotels offered patchy insurance. In 2008, shortly after Mr. Baumann moved back to Louisiana to be closer to his family, he lost his $44,000-a-year sales job at a New Orleans Best Western.
"I thought I'd be employed within a month," Mr. Baumann said one afternoon as he sat on his mother's couch petting his Chihuahua, Peanut. He didn't worry about housing since he lived in his mother's one-story home, perched eight feet above ground to protect against flooding from nearby Lake Pontchartrain. He limited discretionary spending to splurges such as $150 in plants for their garden.
Mr. Baumann began stretching the time between daily blood sugar tests to make his supply of testing strips, which cost $1.20 each, last longer. He skipped three annual blood tests. Last summer, he went to a low-cost clinic and accepted three vials of free insulin that had been partially consumed. In the fall, an intense side pain landed him in the emergency room, resulting in an $8,000 bill. The facility waived it after he wrote a letter saying he couldn't pay.
Cobra, the federal insurance program for people between jobs, was too costly. Louisiana turned him down for Medicaid, saying he didn't qualify because his unemployment benefits—$3,096 over three months—put him over the income limit.
Under the health law, that will change by 2014. If Mr. Baumann is earning under $43,320 a year then, he'd qualify for a health insurance tax credit. If unemployed, he has a better chance than now of qualifying for Medicaid, the federal-state insurance program for the poor.
Mr. Baumann's unemployment benefits recently lapsed, and he's now leaning on $200 a month of food stamps. He got a break last month, when his local health clinic told him he qualified for the state's low-income care program, which paid for a CT scan and other tests to diagnose bouts of fainting. The program will defray his medical costs until he finds a job, but still leaves him without insurance.
Ms. Baumann has one of the best government insurance deals the country offers. Since 2003, she has been enrolled in a Humana Gold Plus HMO. The plan is part of an experiment Congress started decades ago to make Michigan Medicare plans more efficient by paying private insurers to administer coverage. In rural areas, private insurers didn't rush into the market, prompting Congress in 2003 to raise the rate it paid.
The government now pays private insurers an average of 9% more to operate the plans than it costs to run traditional Medicare, according to the Medicare Payment Advisory Commission. Insurers must spend most of that overpayment on enrollees.
As a result, Ms. Baumann's plan covers her "Silver Sneakers" gym membership, worth $54 a month, at Franco's health club and spa. The plan includes $10 a month worth of sunscreen, vitamins, laxatives and other products. She pays no premium beyond what seniors pay for traditional Medicare.
Humana, which administers Medicare Advantage plans to 1.75 million seniors, is trying to pare 15% of its overall costs, in part to offset lower expected government payments.
"There's no question that either premiums go up or either benefits go down over the long term," said Michael B. McCallister, Humana's president and CEO. "Everything is on the table."
Word of cuts has Ms. Baumann's gym mates in a huff.
"With the president being younger, my biggest concern is that we don't mean anything," said Sandy Reed, a 61-year-old who has a Medicare Advantage plan because she qualifies as disabled. "We're disposable."
One recent morning, Ms. Baumann and her son drove her 1999 Lexus SUV 35 miles to the Louisiana State University Bogalusa Medical Center. It sells insulin for at least 50% less than a traditional pharmacy. Ms. Baumann lent her son $100 to buy it.
He ducked his head into the pharmacy window, underneath a burned-out light bulb, and a woman handed him a paper bag with 100 syringes and three vials of insulin for $83.
Back in the car, he lamented his finances. "Maybe I shouldn't have bought all those plants," he said.
The next morning, Ms. Baumann walked past the waterfall in the lobby of her health club. She brought Mr. Baumann as a guest so he could lift weights. The facility has two pools, waterslides, a Starbucks counter and a grill which sells quesadillas and avocado mint smoothies.
After Ms. Baumann's "Dancin' to the Oldies" class, some of the women fretted that the free memberships they get through Humana could go away.
"Most of these older people don't like change," Ms. Baumann said. "But they have to get used to it. There will be change."
That's likely to come indirectly at the expense of his mother's generous health-care plan.
Humana Inc., Mary Baumann's insurer, intends to pare her "Medicare Advantage" plan to make up for the smaller government payments it will soon receive as a result of the new law, leaving her with higher costs or fewer services. On the table are beefed-up co-payments and premiums, as well as the loss of perks such as her free membership at a health club.
Across the country, dozens of private insurers that run similar Medicare plans are preparing to pare dental, vision and certain prescription-drug coverage starting next year, according to consultants who have helped them assemble annual bids.
Although some planned cuts might not materialize given Congress's history of tabling unpopular measures, the law represents the tip of a broader change. Most Americans know the overhaul is designed to cover the uninsured, a decades-long goal of Democrats. But it also represents a change in how the government spreads its social safety net underneath Americans. Already, it's creating tensions that are a harbinger of debates to come.
Since the creation of Social Security and Medicare, younger workers have funded programs for the elderly. It's a compact in which workers paid for retirees with the understanding that they'd be looked after by the generation behind them.
The health overhaul diverges by tapping a program for the elderly to help provide insurance to 32 million Americans of younger generations. Nearly half the funding for the law is supposed to come from paying lower fees to hospitals, insurers and other health-care providers that participate in Medicare, the federal insurance program for Americans age 65 and older, as well as younger disabled people.
The 44 million Americans on Medicare won't see changes to their guaranteed benefits under the law. But of those, 11.3 million on Medicare Advantage plans, a public-private hybrid of the type used by Ms. Baumann, who is 79, are likely to begin seeing extra benefits go away as soon as next year. Medicare Advantage cuts are slated to pay for 15% of the health-care law's tab.
The trims mark the leading edge of a spending shift that could broaden as lawmakers grapple with a deficit expected to hit $1.47 trillion this year. Left unchanged, Medicare and Social Security will consume half of all federal spending by 2035, up from about one third today, according to the Congressional Budget Office.
A White House-sponsored commission that is examining ways to reduce the budget deficit is considering how to tackle Social Security, too. Even AARP, the seniors group, recently embraced the prospect, noting that to keep Social Security viable, Congress "needs to make some small adjustments." AARP supported the health-care overhaul.
Prominent lawmakers in both parties have suggested restrictions on future Social Security benefits, such as a higher retirement age for younger workers and financial means testing to determine who gets benefits.
"We badly need to, over time and very gradually, reallocate resources from the elderly to younger families and their children," said Isabel Sawhill, senior fellow at the liberal-leaning Brookings Institution.
The White House says the health law doesn't take from seniors to help younger generations, but instead eliminates overpayments to private companies, particularly insurers that run Medicare plans like Ms. Baumann's. By lowering payments to health providers, the new law extends the life of Medicare's trust fund by 12 years, according to an actuarial report from Medicare's umbrella agency.
"I'm sure that some of those additional benefits have been nice," Nancy-Ann DeParle, who runs the White House's Office of Health Reform, says of Medicare Advantage plans. "But I think what we have to look at here is what's fair and what's important for the strength of the Medicare program long term."
Stuart Butler, a vice president at the conservative Heritage Foundation, says the White House is misrepresenting the benefits that accrue from Medicare payment cuts. "It uses it to create a new entitlement for a separate group of people rather than strengthening" the program, he says. Moreover, such cuts alone don't pay for the law.
The law will spend $938 billion over a decade, mostly to expand coverage to lower-income Americans. To finance that, there will be $455 billion coming from cuts in government payments to health-care providers that serve patients on Medicare and two other federal programs. The hardest hit—to the tune of $136 billion—will be private insurance companies that run Medicare Advantage plans.
Most of the rest will be funded by new levies, including taxes on health-care companies, a higher Medicare payroll tax for wealthy Americans and a tax on high-value insurance plans. Critics of the law say its total cost is likely higher than advertised.
Some older Americans are irate, including some of Ms. Baumann's gym-mates. One has joined the tea-party movement, in part to protest the cuts. Democrats are worried about the political pressure from seniors, who vote in large numbers, especially in midterm elections, and represent a political force that is disproportionate to their numbers.
The party has played up the perks for seniors included in the law. Among other things, it closes a gap in Medicare prescription-drug coverage and makes preventive services free for enrollees.
Ms. Baumann has few medical needs except two daily blood-pressure medications and dental work, but she is torn about the changes. She credits the gym membership with helping her overcome her husband's death in 1994. She couldn't afford it on her fixed annual income of $17,000 and has voiced that concern at meetings of Humana's local consumer advisory board, of which she is a member.
"I think there's other cuts we could make besides our age group," she says. But she wants her son to get insured.
The Congressional Budget Office says on average, Medicare Advantage enrollees will get $68 less a month in benefits by 2019 because of the law. The payment cuts to Medicare Advantage begin in 2012.
John Gorman, a consultant who helped insurers prepare bids, says his clients are planning to raise non-essential emergency room co-pays to $500 from $200. They're pushing enrollees toward generic drugs and charging more for optometrist visits.
Ms. Baumann and her late husband, Donald, raised six children around New Orleans. Donald Baumann worked as a switchman for the phone company and earned $40,000 a year when he retired in 1982. Ms. Baumann stayed home to raise their children and later sold cosmetics at an Estee Lauder counter.
Donald Baumann's health plan from BlueCross BlueShield of Louisiana kept their costs low. When their youngest child, Mark, was diagnosed with Type 1 diabetes at 16, the insurance covered his two-week hospital stay.
After college, Mark Baumann bounced between jobs in Chicago selling hotel rooms to corporate groups. The hotels offered patchy insurance. In 2008, shortly after Mr. Baumann moved back to Louisiana to be closer to his family, he lost his $44,000-a-year sales job at a New Orleans Best Western.
"I thought I'd be employed within a month," Mr. Baumann said one afternoon as he sat on his mother's couch petting his Chihuahua, Peanut. He didn't worry about housing since he lived in his mother's one-story home, perched eight feet above ground to protect against flooding from nearby Lake Pontchartrain. He limited discretionary spending to splurges such as $150 in plants for their garden.
Mr. Baumann began stretching the time between daily blood sugar tests to make his supply of testing strips, which cost $1.20 each, last longer. He skipped three annual blood tests. Last summer, he went to a low-cost clinic and accepted three vials of free insulin that had been partially consumed. In the fall, an intense side pain landed him in the emergency room, resulting in an $8,000 bill. The facility waived it after he wrote a letter saying he couldn't pay.
Cobra, the federal insurance program for people between jobs, was too costly. Louisiana turned him down for Medicaid, saying he didn't qualify because his unemployment benefits—$3,096 over three months—put him over the income limit.
Under the health law, that will change by 2014. If Mr. Baumann is earning under $43,320 a year then, he'd qualify for a health insurance tax credit. If unemployed, he has a better chance than now of qualifying for Medicaid, the federal-state insurance program for the poor.
Mr. Baumann's unemployment benefits recently lapsed, and he's now leaning on $200 a month of food stamps. He got a break last month, when his local health clinic told him he qualified for the state's low-income care program, which paid for a CT scan and other tests to diagnose bouts of fainting. The program will defray his medical costs until he finds a job, but still leaves him without insurance.
Ms. Baumann has one of the best government insurance deals the country offers. Since 2003, she has been enrolled in a Humana Gold Plus HMO. The plan is part of an experiment Congress started decades ago to make Michigan Medicare plans more efficient by paying private insurers to administer coverage. In rural areas, private insurers didn't rush into the market, prompting Congress in 2003 to raise the rate it paid.
The government now pays private insurers an average of 9% more to operate the plans than it costs to run traditional Medicare, according to the Medicare Payment Advisory Commission. Insurers must spend most of that overpayment on enrollees.
As a result, Ms. Baumann's plan covers her "Silver Sneakers" gym membership, worth $54 a month, at Franco's health club and spa. The plan includes $10 a month worth of sunscreen, vitamins, laxatives and other products. She pays no premium beyond what seniors pay for traditional Medicare.
Humana, which administers Medicare Advantage plans to 1.75 million seniors, is trying to pare 15% of its overall costs, in part to offset lower expected government payments.
"There's no question that either premiums go up or either benefits go down over the long term," said Michael B. McCallister, Humana's president and CEO. "Everything is on the table."
Word of cuts has Ms. Baumann's gym mates in a huff.
"With the president being younger, my biggest concern is that we don't mean anything," said Sandy Reed, a 61-year-old who has a Medicare Advantage plan because she qualifies as disabled. "We're disposable."
One recent morning, Ms. Baumann and her son drove her 1999 Lexus SUV 35 miles to the Louisiana State University Bogalusa Medical Center. It sells insulin for at least 50% less than a traditional pharmacy. Ms. Baumann lent her son $100 to buy it.
He ducked his head into the pharmacy window, underneath a burned-out light bulb, and a woman handed him a paper bag with 100 syringes and three vials of insulin for $83.
Back in the car, he lamented his finances. "Maybe I shouldn't have bought all those plants," he said.
The next morning, Ms. Baumann walked past the waterfall in the lobby of her health club. She brought Mr. Baumann as a guest so he could lift weights. The facility has two pools, waterslides, a Starbucks counter and a grill which sells quesadillas and avocado mint smoothies.
After Ms. Baumann's "Dancin' to the Oldies" class, some of the women fretted that the free memberships they get through Humana could go away.
"Most of these older people don't like change," Ms. Baumann said. "But they have to get used to it. There will be change."
17 June 2010
AP-GfK Poll: More Republican Voters Supporting Health Care Reform
Associated Press
The vital signs are improving for President Barack Obama's health care plan.
The latest Associated Press-GfK poll on Obama's top domestic achievement finds support for the new overhaul has risen to its highest point since the survey started asking people about it in September — six months before it became law.
The results now: 45 percent in favor, 42 percent opposed. That's a significant shift in public sentiment considering that opposition hit 50 percent after Obama signed the health plan into law in late March and that in May, supporters were outnumbered 39 percent to 46 percent.
"I thought when people began to realize what was in the health care package that they would see it's a good, solid program and that would dispel some of the misinformation," said Brigham Young University English professor Claudia Harris, 72, of Orem, Utah.
Electrical contractor Kerry Eisley of Moscow, Pa., said he thinks people are starting to get nuts-and-bolts information on how the law affects them.
"If we can insure more people across the United States and get the cost of health care down, I think that's a better thing," said Eisley, 43, a Republican who supports the plan, which passed without the vote of any GOP lawmaker.
The poll found support increased since May among men (from 36 percent to 46 percent), people in their prime working years (from 35 percent to 49 percent among 30-49 year-olds) and Republicans (from 8 percent to 17 percent.) The uptick among Republicans comes even as party leaders are calling for the law's repeal.
The changes coincide with a concerted effort by the Obama administration, congressional Democrats and their allies to sell the immediate benefits of the law.
Among the selling points: coverage for young adults on their parents' plan until they turn 26; a $250 rebate check for older people with high prescription costs; tax credits for some small businesses that cover their employees; and federal money to train more primary care doctors and nurses.
"They are clearly making progress in convincing more Americans that this bill is the right way to go," said Robert Blendon, a Harvard University public health school professor who tracks opinion trends on health care.
Despite the gains, the prognosis for Obama and the Democrats is guarded.
"In my view, they can claim victory if it gets a majority," Blendon added. "The country is so polarized, it just might not make it."
The $1 trillion, 10-year health care remake puts the nation on a path to coverage for all. Starting in 2014, everyone in the U.S. will be required to carry health insurance. The government will provide tax credits to help middle-class people not covered at work buy a policy through new competitive health insurance markets. Medicaid will be expanded to help low-income people. The plan is paid for through a combination of Medicare cuts and tax increases.
One complication for the president is that older people remain opposed to the law. Just last week, Obama answered questions at a televised town hall meeting in a senior center, but his assurances seem to be having little effect. The poll found that 56 percent of people 65 and older don't like the new law.
"I don't know if it's sustainable, and that's got us worried," said Audrey Guillot, 69, whose family owns a general store in Pierre Part, La. "How much can we borrow? How long before other countries start calling in our debts? Medicare is about to go broke — when do you address that? How many bridges to nowhere can we build?"
The poll found that 51 percent trust Democrats to do a better job of handling health care, an issue that more than three-fourths rate as personally important to them. By comparison, 38 percent said they trusted Republicans.
Daniel Lowery, 23, a shipper at a Lowe's distribution center in Ohio, said he thinks Democrats "are headed in the right direction, for the most part." But he complained they haven't clearly explained how the complex law works.
"I think people would be more for it if they actually explained what they're giving us, because I barely know, and I watch news every day," said Lowery, who lives in Fostoria, south of Toledo.
The AP-GfK Poll involved landline and cell phone interviews with 1,044 randomly chosen adults and was conducted by GfK Roper Public Affairs & Corporate Communications from June 9-14. It has a margin of sampling error of plus or minus 4.3 percentage points.
The latest Associated Press-GfK poll on Obama's top domestic achievement finds support for the new overhaul has risen to its highest point since the survey started asking people about it in September — six months before it became law.
The results now: 45 percent in favor, 42 percent opposed. That's a significant shift in public sentiment considering that opposition hit 50 percent after Obama signed the health plan into law in late March and that in May, supporters were outnumbered 39 percent to 46 percent.
"I thought when people began to realize what was in the health care package that they would see it's a good, solid program and that would dispel some of the misinformation," said Brigham Young University English professor Claudia Harris, 72, of Orem, Utah.
Electrical contractor Kerry Eisley of Moscow, Pa., said he thinks people are starting to get nuts-and-bolts information on how the law affects them.
"If we can insure more people across the United States and get the cost of health care down, I think that's a better thing," said Eisley, 43, a Republican who supports the plan, which passed without the vote of any GOP lawmaker.
The poll found support increased since May among men (from 36 percent to 46 percent), people in their prime working years (from 35 percent to 49 percent among 30-49 year-olds) and Republicans (from 8 percent to 17 percent.) The uptick among Republicans comes even as party leaders are calling for the law's repeal.
The changes coincide with a concerted effort by the Obama administration, congressional Democrats and their allies to sell the immediate benefits of the law.
Among the selling points: coverage for young adults on their parents' plan until they turn 26; a $250 rebate check for older people with high prescription costs; tax credits for some small businesses that cover their employees; and federal money to train more primary care doctors and nurses.
"They are clearly making progress in convincing more Americans that this bill is the right way to go," said Robert Blendon, a Harvard University public health school professor who tracks opinion trends on health care.
Despite the gains, the prognosis for Obama and the Democrats is guarded.
"In my view, they can claim victory if it gets a majority," Blendon added. "The country is so polarized, it just might not make it."
The $1 trillion, 10-year health care remake puts the nation on a path to coverage for all. Starting in 2014, everyone in the U.S. will be required to carry health insurance. The government will provide tax credits to help middle-class people not covered at work buy a policy through new competitive health insurance markets. Medicaid will be expanded to help low-income people. The plan is paid for through a combination of Medicare cuts and tax increases.
One complication for the president is that older people remain opposed to the law. Just last week, Obama answered questions at a televised town hall meeting in a senior center, but his assurances seem to be having little effect. The poll found that 56 percent of people 65 and older don't like the new law.
"I don't know if it's sustainable, and that's got us worried," said Audrey Guillot, 69, whose family owns a general store in Pierre Part, La. "How much can we borrow? How long before other countries start calling in our debts? Medicare is about to go broke — when do you address that? How many bridges to nowhere can we build?"
The poll found that 51 percent trust Democrats to do a better job of handling health care, an issue that more than three-fourths rate as personally important to them. By comparison, 38 percent said they trusted Republicans.
Daniel Lowery, 23, a shipper at a Lowe's distribution center in Ohio, said he thinks Democrats "are headed in the right direction, for the most part." But he complained they haven't clearly explained how the complex law works.
"I think people would be more for it if they actually explained what they're giving us, because I barely know, and I watch news every day," said Lowery, who lives in Fostoria, south of Toledo.
The AP-GfK Poll involved landline and cell phone interviews with 1,044 randomly chosen adults and was conducted by GfK Roper Public Affairs & Corporate Communications from June 9-14. It has a margin of sampling error of plus or minus 4.3 percentage points.
07 June 2010
Americans may give Health Care Law a Chance
Associated Press
WASHINGTON — Toss it or fix it?
Anxious backers of President Barack Obama's health care overhaul law are starting to see a flicker of hope.
While polls show Americans remain sharply divided over the Democrats' landmark legislation, they aren't clamoring for its repeal.
Instead, the public seems willing to listen to candidates who would give the overhaul a chance and fix or improve it as needed. That's the signal from some surveys and a congressional race in a bellwether Pennsylvania district.
It's a pragmatic, somewhat counterintuitive outlook.
That could be a break for Democrats in the fall elections, since Republicans are campaigning hard for repeal of the health care law.
"Though most Americans still do not favor the law, they tend to be leaning toward candidates who would give it a chance and make some changes, rather than those who would repeal it and start over again," said Robert Blendon, a Harvard public health school professor who follows opinion trends on health care.
The law seeks to expand access to coverage by setting up competitive insurance markets and providing tax credits for many who can't afford premiums now. Most Americans will have to carry health insurance, and insurers will be barred from turning away people in poor health.
Those core provisions don't take effect until 2014, but tinkering has already begun.
Regulation writers at the Health and Human Services Department are filling in blanks that lawmakers left on critical consumer issues, such as guaranteed coverage for children with health problems. A House Democrat has introduced legislation to let federal employees keep young adult dependents on the government health plan this year, instead of making them wait until January.
Americans' nuanced outlook is reflected in some recent polls. For example, an NBC News/Wall Street Journal survey found the public tilting against the law 44-38, with 36 percent saying the quality of their health care would get worse, and only 17 percent believing it would improve. Not exactly a vote of confidence.
But when asked if they would be more likely to vote for a congressional candidate willing to give the law a chance to work and make changes as needed, or one who would repeal it entirely and start over, respondents picked the one who would give it a chance by 55-42.
Political independents favored giving the law a chance 57-40 in the poll, taken in early May.
The closest thing to a real life test of such findings may have been the hotly contested election to fill the seat of the late Rep. John Murtha, a powerful Democrat who had long represented his conservative, economically struggling district near Pittsburgh.
Mark Critz, a former Murtha aide who ran as the Democratic candidate, said he would have voted against the health care bill, but also opposed its repeal.
"The health care bill is the law," Critz said during the campaign. "Let's look at it. Let's fix the things that we can. Let's improve it where we can." Critz's comments were incorporated into a hard-hitting ad by his Republican opponent. But Critz won the May 18 special election.
"The repeal message is falling flat," said Maryland Rep. Chris Van Hollen, chairman of the Democratic Congressional Campaign Committee. "People want to work to implement the law and make changes as necessary, they don't want to go back and re-debate and re-litigate this whole issue."
Virginia Rep. Eric Cantor, the No. 2 House Republican, disagreed, saying "the health care issue was not determinative" in the Pennsylvania race, and "repeal and replace" remains an effective message for his party.
"When we go out into the district I represent, this health care bill is very unpopular," Cantor said. "It will raise costs. Businesses are scared they won't be able to provide benefits anymore. Moms are scared they won't be able to find a doctor for their children."
Still, Republicans face doubts about their own health care promises. An Associated Press-GfK poll in May found that 47-39 percent, Americans trust Democrats to do a better job of handling the issue. The trust gap persists despite the lack of popular support for the health care law. Indeed, respondents in the AP poll also said they opposed it by 46-39 percent.
None of this means Democrats are confident. Poll numbers on the new law are still too negative. Its complexity makes it hard to craft simple messages that sell the benefits.
"To date, the opposition has been more successful in defining (the law) than we have been," said Democratic pollster Celinda Lake. "The plan needs very careful and aggressive selling. There have been some efforts, but I think those efforts need to be quadrupled."
Anxious backers of President Barack Obama's health care overhaul law are starting to see a flicker of hope.
While polls show Americans remain sharply divided over the Democrats' landmark legislation, they aren't clamoring for its repeal.
Instead, the public seems willing to listen to candidates who would give the overhaul a chance and fix or improve it as needed. That's the signal from some surveys and a congressional race in a bellwether Pennsylvania district.
It's a pragmatic, somewhat counterintuitive outlook.
That could be a break for Democrats in the fall elections, since Republicans are campaigning hard for repeal of the health care law.
"Though most Americans still do not favor the law, they tend to be leaning toward candidates who would give it a chance and make some changes, rather than those who would repeal it and start over again," said Robert Blendon, a Harvard public health school professor who follows opinion trends on health care.
The law seeks to expand access to coverage by setting up competitive insurance markets and providing tax credits for many who can't afford premiums now. Most Americans will have to carry health insurance, and insurers will be barred from turning away people in poor health.
Those core provisions don't take effect until 2014, but tinkering has already begun.
Regulation writers at the Health and Human Services Department are filling in blanks that lawmakers left on critical consumer issues, such as guaranteed coverage for children with health problems. A House Democrat has introduced legislation to let federal employees keep young adult dependents on the government health plan this year, instead of making them wait until January.
Americans' nuanced outlook is reflected in some recent polls. For example, an NBC News/Wall Street Journal survey found the public tilting against the law 44-38, with 36 percent saying the quality of their health care would get worse, and only 17 percent believing it would improve. Not exactly a vote of confidence.
But when asked if they would be more likely to vote for a congressional candidate willing to give the law a chance to work and make changes as needed, or one who would repeal it entirely and start over, respondents picked the one who would give it a chance by 55-42.
Political independents favored giving the law a chance 57-40 in the poll, taken in early May.
The closest thing to a real life test of such findings may have been the hotly contested election to fill the seat of the late Rep. John Murtha, a powerful Democrat who had long represented his conservative, economically struggling district near Pittsburgh.
Mark Critz, a former Murtha aide who ran as the Democratic candidate, said he would have voted against the health care bill, but also opposed its repeal.
"The health care bill is the law," Critz said during the campaign. "Let's look at it. Let's fix the things that we can. Let's improve it where we can." Critz's comments were incorporated into a hard-hitting ad by his Republican opponent. But Critz won the May 18 special election.
"The repeal message is falling flat," said Maryland Rep. Chris Van Hollen, chairman of the Democratic Congressional Campaign Committee. "People want to work to implement the law and make changes as necessary, they don't want to go back and re-debate and re-litigate this whole issue."
Virginia Rep. Eric Cantor, the No. 2 House Republican, disagreed, saying "the health care issue was not determinative" in the Pennsylvania race, and "repeal and replace" remains an effective message for his party.
"When we go out into the district I represent, this health care bill is very unpopular," Cantor said. "It will raise costs. Businesses are scared they won't be able to provide benefits anymore. Moms are scared they won't be able to find a doctor for their children."
Still, Republicans face doubts about their own health care promises. An Associated Press-GfK poll in May found that 47-39 percent, Americans trust Democrats to do a better job of handling the issue. The trust gap persists despite the lack of popular support for the health care law. Indeed, respondents in the AP poll also said they opposed it by 46-39 percent.
None of this means Democrats are confident. Poll numbers on the new law are still too negative. Its complexity makes it hard to craft simple messages that sell the benefits.
"To date, the opposition has been more successful in defining (the law) than we have been," said Democratic pollster Celinda Lake. "The plan needs very careful and aggressive selling. There have been some efforts, but I think those efforts need to be quadrupled."
31 May 2010
What to do about Health Insurance if you are Jobless
Forbes
Obama's health care reforms are making it easier for young adults to secure coverage.
If you've caught recent TV news about Washington's health care overhaul, you've probably heard talk about a mysterious thing called the COBRA. You may have even wondered, half-jokingly, "What does health care reform have to do with the terrorist group from G.I. Joe?"
The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, brought a variety of changes to federal law during the Reagan era, but the one for which it's become most famous was a requirement that large employers allow former employees to stay on the company's health plan temporarily (a year and a half is the norm) after they leave.
COBRA wound up helping unemployed college grads because the law also covered dependents of employees participating in a company health plan. Full-time college students have typically been allowed an exemption to remain on working parents' health insurance even though they're legally adults; if you're out of school and don't have a job, you're going to have to make another arrangement. The good news is, COBRA provides you with a temporary solution. And the Democratic majority in Congress keeps pushing legislation designed to strengthen the program.
The bad news is, your family has to cover the entire cost to get you COBRA coverage--you won't receive the financial contribution from a parent's employer that you may have received when you qualified for normal coverage. Luckily for you, the recently passed national health care overhaul, known as ObamaCare, addresses the high number of young adults struggling to find a long-term health coverage solution. And if you're a grad without a job, you may be able to take advantage of the new changes immediately.
One reform under ObamaCare allows children to remain on their parents' health insurance plans until age 26. The law will force a lot of plans to be more generous in offering coveage to young-adult children than they were previously. Technically, the new extension affects insurance plans that go through their annual renewal process after late-September, but many plans are already agreeing to put in place the new age limit before the change is officially mandated.
Government websites, like the U.S. Department of Labor, are posting lists of insurers that are implementing the age-limit increase ahead of schedule.
"Even if your insurer is included on the list, you have to call up and make sure it applies to you, because a lot of employer plans are self-funded, so different rules might apply,' cautions Cheryl Fish-Parham, deputy director of health policy at the nonprofit advocacy group Families USA.
If you don't have a parent's workplace health plan to rely on, you may be eligible for a government insurance program. A few states, including Connecticut and Massachusetts, have been expanding Medicaid (federally funded insurance historically reserved for the poor and disabled) so that the well-educated but out of work are more likely to be covered. In addition, each state has its own insurance program for low-income residents. Families USA's website has an interactive map where you can find state-by-state information on public health care options.
Whatever you do, try to avoid an interruption in health insurance coverage. If you experience a serious medical problem while uninsured, you'll be saddled with debt that could take you years to dig out from under. Also, when you apply for insurance after being uninsured, your new insurance company is bound to refuse to pay for medical bills related to a preexisting condition.
"If you have a gap in coverage, unfortunately you might find your pre-existing condition is excluded [by your new insurer] for a period of time," Fish-Parham warns. "Even if it's just a broken bone, they'll say, 'We won't cover it.'"
The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, brought a variety of changes to federal law during the Reagan era, but the one for which it's become most famous was a requirement that large employers allow former employees to stay on the company's health plan temporarily (a year and a half is the norm) after they leave.
COBRA wound up helping unemployed college grads because the law also covered dependents of employees participating in a company health plan. Full-time college students have typically been allowed an exemption to remain on working parents' health insurance even though they're legally adults; if you're out of school and don't have a job, you're going to have to make another arrangement. The good news is, COBRA provides you with a temporary solution. And the Democratic majority in Congress keeps pushing legislation designed to strengthen the program.
The bad news is, your family has to cover the entire cost to get you COBRA coverage--you won't receive the financial contribution from a parent's employer that you may have received when you qualified for normal coverage. Luckily for you, the recently passed national health care overhaul, known as ObamaCare, addresses the high number of young adults struggling to find a long-term health coverage solution. And if you're a grad without a job, you may be able to take advantage of the new changes immediately.
One reform under ObamaCare allows children to remain on their parents' health insurance plans until age 26. The law will force a lot of plans to be more generous in offering coveage to young-adult children than they were previously. Technically, the new extension affects insurance plans that go through their annual renewal process after late-September, but many plans are already agreeing to put in place the new age limit before the change is officially mandated.
Government websites, like the U.S. Department of Labor, are posting lists of insurers that are implementing the age-limit increase ahead of schedule.
"Even if your insurer is included on the list, you have to call up and make sure it applies to you, because a lot of employer plans are self-funded, so different rules might apply,' cautions Cheryl Fish-Parham, deputy director of health policy at the nonprofit advocacy group Families USA.
If you don't have a parent's workplace health plan to rely on, you may be eligible for a government insurance program. A few states, including Connecticut and Massachusetts, have been expanding Medicaid (federally funded insurance historically reserved for the poor and disabled) so that the well-educated but out of work are more likely to be covered. In addition, each state has its own insurance program for low-income residents. Families USA's website has an interactive map where you can find state-by-state information on public health care options.
Whatever you do, try to avoid an interruption in health insurance coverage. If you experience a serious medical problem while uninsured, you'll be saddled with debt that could take you years to dig out from under. Also, when you apply for insurance after being uninsured, your new insurance company is bound to refuse to pay for medical bills related to a preexisting condition.
"If you have a gap in coverage, unfortunately you might find your pre-existing condition is excluded [by your new insurer] for a period of time," Fish-Parham warns. "Even if it's just a broken bone, they'll say, 'We won't cover it.'"
Federal Health Care Reform begins to Shape Consumer Options
Mercury News
SANTA CRUZ - Drew Miller, who works out of a small office on Pacific Avenue, has been helping local residents get health insurance for 30 years.
This year, he's had to advise people of some changes.
Though reforms in the much-hyped federal health care legislation won't unfold fully until the end of the decade, young adults, small businesses and Medicare recipients can benefit as soon as this summer, and already people are shopping for better care.
"Most clients are asking about this. It concerns them," said Miller of Drew Miller Insurance Services.
The changes arriving this year, which Miller and other brokers have begun telling clients about, allow people 26 years old and younger to get insurance on their parents' plans; owners of small businesses to qualify for a tax credit if they provide insurance to employees; and Medicare recipients to get a $250 rebate when they pay expenses in the so-called "doughnut hole," the range where federal coverage lapses.
"Most of the significant changes are still years off, but there are changes (now)," Miller said.
A county report released last week, the most detailed yet on how the federal legislation will play out locally, anticipates that 34,000 of the county's currently 44,000 uninsured will be covered by 2018. The gains will begin this year, the report confirms.
Most notable is the provision, effective in September, that permits children to remain on their parents' health insurance plan until age 26. The change provides new options for an unspecified number of young adults, including those attending UC Santa Cruz and Cabrillo College.
"As you know, kids launch a little later these days," said Rama Khalsa, director of the county Health Services Agency and chief author of the recent county report. "And yes, people get sick in their 20s."
Beyond extending family plans to older children, insurance companies this year will be prohibited from setting annual and lifetime limits on coverage as well as excluding coverage for children with pre-existing conditions.
Adults with pre-existing conditions who are denied coverage may qualify for a yet-to-be-established "high-risk" insurance pool offered by the state. Otherwise, they'll have to wait for the creation of the proposed health care exchanges in 2014, when people will be able to competitively shop on a public marketplace for insurance.
The county report suggests as many as 17,600 local residents, driven by the pending requirement that everyone be insured, will opt for coverage on the exchanges. Federal subsidies will assist poor residents who choose this option.
The other major boon for uninsured county residents, according to the report, will also come in 2014 with the expansion of Medi-Cal, the jointly-run state and federal insurance program. Thousands are expected to be newly enrolled in the program locally.
According to Alan McKay, executive director of the Central Coast Alliance for Health, county residents are already benefiting from a directive by the federal government that prohibits states from reducing eligibility for insurance programs until federal plans are in place.
As the most immediate reforms unravel, state Assemblyman Bill Monning, D-Carmel, who was recently appointed chair of the Assembly Health Committee, has begun working out details of how the coming initiatives will take shape.
Among them are making sure enough medical facilities are in place to accommodate the surge in health care. The committee is eyeing a number of work force development programs, from new training options to low-coast loans for medical students.
"If you boost the number of Californians who are going to be eligible for coverage and seeking California health insurance quotes, there's going to be necessary growth in providers," Monning said.
This year, he's had to advise people of some changes.
Though reforms in the much-hyped federal health care legislation won't unfold fully until the end of the decade, young adults, small businesses and Medicare recipients can benefit as soon as this summer, and already people are shopping for better care.
"Most clients are asking about this. It concerns them," said Miller of Drew Miller Insurance Services.
The changes arriving this year, which Miller and other brokers have begun telling clients about, allow people 26 years old and younger to get insurance on their parents' plans; owners of small businesses to qualify for a tax credit if they provide insurance to employees; and Medicare recipients to get a $250 rebate when they pay expenses in the so-called "doughnut hole," the range where federal coverage lapses.
"Most of the significant changes are still years off, but there are changes (now)," Miller said.
A county report released last week, the most detailed yet on how the federal legislation will play out locally, anticipates that 34,000 of the county's currently 44,000 uninsured will be covered by 2018. The gains will begin this year, the report confirms.
Most notable is the provision, effective in September, that permits children to remain on their parents' health insurance plan until age 26. The change provides new options for an unspecified number of young adults, including those attending UC Santa Cruz and Cabrillo College.
"As you know, kids launch a little later these days," said Rama Khalsa, director of the county Health Services Agency and chief author of the recent county report. "And yes, people get sick in their 20s."
Beyond extending family plans to older children, insurance companies this year will be prohibited from setting annual and lifetime limits on coverage as well as excluding coverage for children with pre-existing conditions.
Adults with pre-existing conditions who are denied coverage may qualify for a yet-to-be-established "high-risk" insurance pool offered by the state. Otherwise, they'll have to wait for the creation of the proposed health care exchanges in 2014, when people will be able to competitively shop on a public marketplace for insurance.
The county report suggests as many as 17,600 local residents, driven by the pending requirement that everyone be insured, will opt for coverage on the exchanges. Federal subsidies will assist poor residents who choose this option.
The other major boon for uninsured county residents, according to the report, will also come in 2014 with the expansion of Medi-Cal, the jointly-run state and federal insurance program. Thousands are expected to be newly enrolled in the program locally.
According to Alan McKay, executive director of the Central Coast Alliance for Health, county residents are already benefiting from a directive by the federal government that prohibits states from reducing eligibility for insurance programs until federal plans are in place.
As the most immediate reforms unravel, state Assemblyman Bill Monning, D-Carmel, who was recently appointed chair of the Assembly Health Committee, has begun working out details of how the coming initiatives will take shape.
Among them are making sure enough medical facilities are in place to accommodate the surge in health care. The committee is eyeing a number of work force development programs, from new training options to low-coast loans for medical students.
"If you boost the number of Californians who are going to be eligible for coverage and seeking California health insurance quotes, there's going to be necessary growth in providers," Monning said.
20 May 2010
$35M for Dartmouth Health Care Delivery Center
Associated Press
Dartmouth College is getting $35 million to open a center it hopes will help the nation take the next big steps in health care reform: improving quality while lowering costs.
The historic health care overhaul legislation President Barack Obama signed in March will give millions of Americans access to health care, but "the real rocket science in health care right now is in the delivery," said Dartmouth President Jim Yong Kim, who has been promoting the idea of a national institute on health care delivery since arriving at Dartmouth last July.
Now, he has a $35 million commitment from an anonymous donor to establish the Dartmouth Center for Health Care Delivery Science, which will bring together experts in everything from medicine and management to sociology and systems engineering to figure out what is working in successful health care systems such as Minnesota's Mayo Clinic. They'll then teach practitioners, who can return home and make changes immediately, Kim said.
"We're not just doing the research and presenting it for people to either accept or not accept," he said.
The center also will be home to a new master's degree in health care delivery science, which will begin enrolling students in July 2011.
"The science of health care delivery is being practiced by many wonderful scholars throughout the country, but most colleges and universities have not made it a major focus," Kim said. "A lot of medical schools teach health policy, but they don't really teach the complexities of what it takes to actually build effective, functioning, health care systems, clinics or hospitals."
Kim, the first Asian-American to lead an Ivy League school, is a former director of the World Health Organization's HIV/AIDS department. He helped found Partners in Health to support health programs in poor communities worldwide. Kim came to Dartmouth from Harvard Medical School, where he was chairman of the Department of Global Health and Social Medicine.
He said he hopes Dartmouth's new center will be a clarion call to other colleges and universities.
"We're talking about an industry that's growing so quickly, and we're really worried that without improving quality, we're just going to have increased costs," he said. "So I think there's a tremendous urgency to tackling health care delivery, and I firmly believe that American institutions of higher education have a central role in tackling that problem."
Kim described the anonymous donor as a consumer who recognizes the health care system is in trouble. He expects the initial seed money will be enough to set the center up to attract government and private funding. And though he agrees with goals of Obama's health care legislation, Kim emphasized that the new center "is not about cheerleading" for the administration.
He pointed out that Sen. Judd Gregg, R-N.H., has long supported the research done by Dartmouth's Institute for Health Policy and has been involved in the planning for the new center, along with Sen. Jeanne Shaheen and Gov. John Lynch, both Democrats.
One idea they've discussed is using the center to make New Hampshire a model for innovative health care delivery.
"There's a lot of talk in Washington right now about setting up pilot programs," Kim said. "I think a really, really exciting possibility though would be to set up a pilot state to take on an entire state with multiple health care systems in it."
While a single health care system, such as a hospital, can perform well because of centralized control, "the challenge of performing well across an entire state is a different kind of challenge, and one we'd love to take on," he said.
The historic health care overhaul legislation President Barack Obama signed in March will give millions of Americans access to health care, but "the real rocket science in health care right now is in the delivery," said Dartmouth President Jim Yong Kim, who has been promoting the idea of a national institute on health care delivery since arriving at Dartmouth last July.
Now, he has a $35 million commitment from an anonymous donor to establish the Dartmouth Center for Health Care Delivery Science, which will bring together experts in everything from medicine and management to sociology and systems engineering to figure out what is working in successful health care systems such as Minnesota's Mayo Clinic. They'll then teach practitioners, who can return home and make changes immediately, Kim said.
"We're not just doing the research and presenting it for people to either accept or not accept," he said.
The center also will be home to a new master's degree in health care delivery science, which will begin enrolling students in July 2011.
"The science of health care delivery is being practiced by many wonderful scholars throughout the country, but most colleges and universities have not made it a major focus," Kim said. "A lot of medical schools teach health policy, but they don't really teach the complexities of what it takes to actually build effective, functioning, health care systems, clinics or hospitals."
Kim, the first Asian-American to lead an Ivy League school, is a former director of the World Health Organization's HIV/AIDS department. He helped found Partners in Health to support health programs in poor communities worldwide. Kim came to Dartmouth from Harvard Medical School, where he was chairman of the Department of Global Health and Social Medicine.
He said he hopes Dartmouth's new center will be a clarion call to other colleges and universities.
"We're talking about an industry that's growing so quickly, and we're really worried that without improving quality, we're just going to have increased costs," he said. "So I think there's a tremendous urgency to tackling health care delivery, and I firmly believe that American institutions of higher education have a central role in tackling that problem."
Kim described the anonymous donor as a consumer who recognizes the health care system is in trouble. He expects the initial seed money will be enough to set the center up to attract government and private funding. And though he agrees with goals of Obama's health care legislation, Kim emphasized that the new center "is not about cheerleading" for the administration.
He pointed out that Sen. Judd Gregg, R-N.H., has long supported the research done by Dartmouth's Institute for Health Policy and has been involved in the planning for the new center, along with Sen. Jeanne Shaheen and Gov. John Lynch, both Democrats.
One idea they've discussed is using the center to make New Hampshire a model for innovative health care delivery.
"There's a lot of talk in Washington right now about setting up pilot programs," Kim said. "I think a really, really exciting possibility though would be to set up a pilot state to take on an entire state with multiple health care systems in it."
While a single health care system, such as a hospital, can perform well because of centralized control, "the challenge of performing well across an entire state is a different kind of challenge, and one we'd love to take on," he said.
18 May 2010
Health Reform's Next Test
The Washington Post
Jim Yong Kim
Health insurance reform is now law, giving millions of Americans access to the full resources of our health-care system for the first time. The question becomes: How can we ensure that they -- and all of us -- receive value-based and high-quality care?
It is well known that U.S. health-care costs, as a share of our economy, are the highest in the world but that compared to other industrialized countries, our results are the worst. The Dartmouth Atlas has documented the enormous waste in our system and shown that spending more money and performing more medical procedures do not equal better outcomes for patients.
Americans deserve health care that is coordinated across physicians and health systems, and that is effective, appropriate and safe. As a nation, we have a moral and a fiscal responsibility to ensure that all patients receive value for health services. While the achievement of health insurance reform was historic, it is time to focus on the next step: improving quality while bending the unsustainable cost curve significantly.
We are physicians and researchers; one of us is now a college president, and the other head of a leading academic medical center. We share a history of work in medicine, science, policy reform and education. We also share the view that throughout history, our most difficult problems have found scientific solutions.
We propose the rapid expansion of a new field to tackle the twin problems of how to provide high-quality health care while lowering costs: health-care delivery science.
This new field will work with the recognition that truly reforming health care requires more than the efforts of one entity. We cannot blame government or insurers or physicians for the complex and multilayered problem. No single group or entity created the puzzle that is our health-care system; it is not reasonable to expect one group to solve it.
What will lead to improvements is a multidisciplinary approach that brings the best minds to focus on the problem. Experts in management, systems thinking and engineering, sociology, anthropology, environmental science, economics, medicine, health policy and other fields must join together to apply a laser focus to fixing the delivery system.
Why? Consider the moving pieces of a patient-health system encounter. A patient comes into the emergency room. Immediately, judgments are made about how sick she is and what treatments she needs. There is no universal medical record for that patient, so the provider has no idea about her medical history, medication use or preexisting conditions. Incomplete information is relayed through layers of nurses, physicians, specialists and the shifts of personnel who replace them. In the absence of real-time information, tests are ordered and treatment decisions made. Perhaps after an overnight stay, barring complications from drug interactions or perhaps an unrecognized underlying condition, she is discharged, with no further transfer of information to a provider and, more important, no follow-up to see whether the treatment was effective. The symptoms were treated; the patient was not.
The best insurance in the world will not fix this problem. We need a whole new cadre of people committed to applying their expertise to the challenge of health-care delivery.
We have begun building that cadre at Dartmouth with the establishment of a Center for Health Care Delivery Science. But it is our hope that many more institutions will work together to generate the needed evidence on health-care delivery solutions, to disseminate that knowledge and to train the current and future professionals who will put solutions into practice. We envision a network of centers across the country that will marry research and implementation from the start -- finding and testing delivery solutions with practitioners and patients on the front lines.
The recent health legislation establishes an implicit covenant with the American people. The spirit of this covenant goes far beyond insurance. In exchange for new public and private investment in the health system, Americans expect access to effective, high-quality care within a financially sustainable system. With a robust science of health-care delivery, this goal can be achieved.
Jim Yong Kim is president of Dartmouth College. James N. Weinstein is president of the Dartmouth-Hitchcock Clinic.
It is well known that U.S. health-care costs, as a share of our economy, are the highest in the world but that compared to other industrialized countries, our results are the worst. The Dartmouth Atlas has documented the enormous waste in our system and shown that spending more money and performing more medical procedures do not equal better outcomes for patients.
Americans deserve health care that is coordinated across physicians and health systems, and that is effective, appropriate and safe. As a nation, we have a moral and a fiscal responsibility to ensure that all patients receive value for health services. While the achievement of health insurance reform was historic, it is time to focus on the next step: improving quality while bending the unsustainable cost curve significantly.
We are physicians and researchers; one of us is now a college president, and the other head of a leading academic medical center. We share a history of work in medicine, science, policy reform and education. We also share the view that throughout history, our most difficult problems have found scientific solutions.
We propose the rapid expansion of a new field to tackle the twin problems of how to provide high-quality health care while lowering costs: health-care delivery science.
This new field will work with the recognition that truly reforming health care requires more than the efforts of one entity. We cannot blame government or insurers or physicians for the complex and multilayered problem. No single group or entity created the puzzle that is our health-care system; it is not reasonable to expect one group to solve it.
What will lead to improvements is a multidisciplinary approach that brings the best minds to focus on the problem. Experts in management, systems thinking and engineering, sociology, anthropology, environmental science, economics, medicine, health policy and other fields must join together to apply a laser focus to fixing the delivery system.
Why? Consider the moving pieces of a patient-health system encounter. A patient comes into the emergency room. Immediately, judgments are made about how sick she is and what treatments she needs. There is no universal medical record for that patient, so the provider has no idea about her medical history, medication use or preexisting conditions. Incomplete information is relayed through layers of nurses, physicians, specialists and the shifts of personnel who replace them. In the absence of real-time information, tests are ordered and treatment decisions made. Perhaps after an overnight stay, barring complications from drug interactions or perhaps an unrecognized underlying condition, she is discharged, with no further transfer of information to a provider and, more important, no follow-up to see whether the treatment was effective. The symptoms were treated; the patient was not.
The best insurance in the world will not fix this problem. We need a whole new cadre of people committed to applying their expertise to the challenge of health-care delivery.
We have begun building that cadre at Dartmouth with the establishment of a Center for Health Care Delivery Science. But it is our hope that many more institutions will work together to generate the needed evidence on health-care delivery solutions, to disseminate that knowledge and to train the current and future professionals who will put solutions into practice. We envision a network of centers across the country that will marry research and implementation from the start -- finding and testing delivery solutions with practitioners and patients on the front lines.
The recent health legislation establishes an implicit covenant with the American people. The spirit of this covenant goes far beyond insurance. In exchange for new public and private investment in the health system, Americans expect access to effective, high-quality care within a financially sustainable system. With a robust science of health-care delivery, this goal can be achieved.
Jim Yong Kim is president of Dartmouth College. James N. Weinstein is president of the Dartmouth-Hitchcock Clinic.
27 April 2010
Next in Health Care War: Applying the Law
USA Today
Uma Kotagal, left, a senior vice president for Cincinnati Children's Hospital Medical Center, walks the hall with health Secretary Kathleen Sebelius.
WASHINGTON — The debate in Congress over President Obama's health care law is done. The battle over how to carry out the law is just getting started.
Dozens of special-interest groups that helped shape the 10-year, $938 billion health care measure over the past year — from insurance companies to patient advocates — are gearing up for a second wave of lobbying as the Obama administration prepares to implement the law.
The U.S. Chamber of Commerce, which opposed the measure in Congress, is fighting to protect businesses that might be required to provide insurance, for instance. Drugmakers who supported the bill are monitoring how much they may have to discount prices.
Watchdog groups say patients can get lost in the lobbying blitz. "Industry dominates this process even more than they dominate the legislative process," said Robert Weissman, with Public Citizen. "It's more of an inside game."
Congress gave sweeping power to federal agencies, especially the Department of Health and Human Services, to fill in gaps lawmakers left in the 906-page legislation — an effort that will take years. The law refers more than 1,000 times to Cabinet secretaries who will make decisions on how to carry out the law.
For example, the law requires health insurance companies to spend 80% of premiums on medical claims, as opposed to administrative costs, by 2011. But it directs the health department to decide whether gray-area expenses, such as health-and-wellness programs offered by insurers, count as care or overhead.
Karen Ignagni, president of the industry group America's Health Insurance Plans, said her staff is "already geared up" and is providing data and suggestions on that and other issues to the department. But, she said, agencies implementing the law will weigh many arguments before making a decision.
"I don't think regulators are influenced by the classic sense of lobbying," she said. "There's a level playing field."
Unlike the legislative process, much of the battle over regulations takes place behind the scenes, Weissman said. The public may comment on proposed decisions, but many groups try to gain access to decision-makers early on, he said.
The health department declined to discuss industry attempts to influence implementation, but Secretary Kathleen Sebelius said in a statement that the department is "working closely with states, insurers, providers and other partners … we want to hear from everyone."
Other looming battles over the new law include:
• The health department must create high-risk insurance plans to provide temporary coverage for people with pre-existing conditions. Private insurers are watching to make sure those plans don't affect their bottom line, said Mark Pauly, a University of Pennsylvania health economist.
• Firms with more than 50 full-time employees would face fines in 2014 if they don't provide health insurance to workers. The Treasury Department must determine who qualifies as a full-time employee, a decision that will affect businesses on the edge of the 50-worker threshold. "We really have to make our case early," said Randel Johnson with the Chamber of Commerce.
• Health department officials must develop a review process to judge dozens of pilot programs created in the law — and decide whether they should be expanded. The National Partnership for Women & Families, a patient-advocacy group, wants the process to take quality of care into account. "It can't just be about saving money," the group's president, Debra Ness, said. "We also want to make sure they deliver better care."
Health care interests spent heavily on lobbyists as the legislation worked its way through Congress. In all, health industries spent $652 million in 2009, up 14% from 2008, according to the non-partisan CQ Moneyline.
Last year, the Obama administration passed a sweeping series of rules requiring federal agencies to disclose contacts their officials had with lobbyists about the economic stimulus. Similar rules do not exist for the health care law.
"We all want to … meet with folks to describe some of the issues and concerns we think need to be navigated," said Ron Pollack of Families USA, which supports the law. "I have no doubt that industry and others are going to be doing the same thing."
Dozens of special-interest groups that helped shape the 10-year, $938 billion health care measure over the past year — from insurance companies to patient advocates — are gearing up for a second wave of lobbying as the Obama administration prepares to implement the law.
The U.S. Chamber of Commerce, which opposed the measure in Congress, is fighting to protect businesses that might be required to provide insurance, for instance. Drugmakers who supported the bill are monitoring how much they may have to discount prices.
Watchdog groups say patients can get lost in the lobbying blitz. "Industry dominates this process even more than they dominate the legislative process," said Robert Weissman, with Public Citizen. "It's more of an inside game."
Congress gave sweeping power to federal agencies, especially the Department of Health and Human Services, to fill in gaps lawmakers left in the 906-page legislation — an effort that will take years. The law refers more than 1,000 times to Cabinet secretaries who will make decisions on how to carry out the law.
For example, the law requires health insurance companies to spend 80% of premiums on medical claims, as opposed to administrative costs, by 2011. But it directs the health department to decide whether gray-area expenses, such as health-and-wellness programs offered by insurers, count as care or overhead.
Karen Ignagni, president of the industry group America's Health Insurance Plans, said her staff is "already geared up" and is providing data and suggestions on that and other issues to the department. But, she said, agencies implementing the law will weigh many arguments before making a decision.
"I don't think regulators are influenced by the classic sense of lobbying," she said. "There's a level playing field."
Unlike the legislative process, much of the battle over regulations takes place behind the scenes, Weissman said. The public may comment on proposed decisions, but many groups try to gain access to decision-makers early on, he said.
The health department declined to discuss industry attempts to influence implementation, but Secretary Kathleen Sebelius said in a statement that the department is "working closely with states, insurers, providers and other partners … we want to hear from everyone."
Other looming battles over the new law include:
• The health department must create high-risk insurance plans to provide temporary coverage for people with pre-existing conditions. Private insurers are watching to make sure those plans don't affect their bottom line, said Mark Pauly, a University of Pennsylvania health economist.
• Firms with more than 50 full-time employees would face fines in 2014 if they don't provide health insurance to workers. The Treasury Department must determine who qualifies as a full-time employee, a decision that will affect businesses on the edge of the 50-worker threshold. "We really have to make our case early," said Randel Johnson with the Chamber of Commerce.
• Health department officials must develop a review process to judge dozens of pilot programs created in the law — and decide whether they should be expanded. The National Partnership for Women & Families, a patient-advocacy group, wants the process to take quality of care into account. "It can't just be about saving money," the group's president, Debra Ness, said. "We also want to make sure they deliver better care."
Health care interests spent heavily on lobbyists as the legislation worked its way through Congress. In all, health industries spent $652 million in 2009, up 14% from 2008, according to the non-partisan CQ Moneyline.
Last year, the Obama administration passed a sweeping series of rules requiring federal agencies to disclose contacts their officials had with lobbyists about the economic stimulus. Similar rules do not exist for the health care law.
"We all want to … meet with folks to describe some of the issues and concerns we think need to be navigated," said Ron Pollack of Families USA, which supports the law. "I have no doubt that industry and others are going to be doing the same thing."
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