Posts Tagged ‘Families USA’

ACOs Double in Size

Tuesday, July 17th, 2012

While the fate of Obama Care hung in the balance, the ACO became the voluntary dance that nobody wanted to show up to too early. Defined by the Centers for Medicare and Medicaid Services (CMS) as “an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it,” ACOs (Accountable Care Organizations) were promoted as a bigger, better model that allowed providers to get paid in a number of ways (capitation, fee-for-service, shared savings) in return for managing health at the population level across a broader swathe of the healthcare spectrum. But ACOs were tough, requiring greater accountability with providers having to report on 33 different performance measures to ensure they’re not skimping on care.  And then there was the little issue of whether reform would be repealed and make it all null and void. Well, a mere week and a half after John Roberts cast the tiebreaker to make the individual mandate — and essentially, Obama Care — a reality, the ACO program has doubled in size.  Eighty-nine participants joined 27 existing ACOs in the program. “The Medicare ACO program opened for business in January, and already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives,” acting CMS Administrator Marilyn Tavenner said in a statement.

According to the CMS, the selected ACO programs operate in a range of areas nationwide and nearly half are physician-led organizations that serve fewer than 10,000 beneficiaries, which indicates smaller organizations are interested in participating. Four hundred more organizations have already submitted a notice of intent to apply next month, according to the CMS. The application period is Aug. 1-Sept. 6, 2012 for organizations that want to participate in the Medicare shared-savings program starting in January 2013.

Now that reform has the imprimatur of the Supreme Court judges, the next court that the Administration will have to focus its efforts on is the court of provider and public opinion. According to a survey of 24,000 U.S. physicians by Medscape, WebMD’s flagship site for medical professionals, only about 3% of physicians participate with ACOs ; only another 5% say that they plan to become involved in the coming year.  52% percent of physicians believe that ACOs will cause a decline in income, while 12% say they will have little or no effect.  Overcoming that natural resistance to change may be the toughest part of putting the ACO in place.

Dying for Coverage

Tuesday, July 10th, 2012

More than 26,000 working-age adults die prematurely in the United States every year because they lack health insurance, according to a study published by Families USA.  The consumer advocacy group study, estimates that a record high of 26,100 people aged 25 to 64 died for lack of health coverage in 2010, up from 20,350 in 2005 and 18,000 in 2000.  That adds up to a rate of approximately 72 deaths per day, or three per hour.

The non-profit group based its report on data from the U.S. Census Bureau, the Centers for Disease Control and Prevention (CDC), and a 2002 Institute of Medicine (IOM) study that showed that Americans who lack insurance face a 25 percent higher risk of death than those with coverage.  The findings are in line with a study by the Urban Institute think tank that estimated 22,000 deaths nationwide in 2006.

“Lives are truly on the line,” said Ron Pollack, Executive Director of Families USA, who supports the Patient Protection and Affordable Care Act (ACA).  “If the Affordable Care Act moves forward and we expand coverage for tens of millions of people, the number of avoidable deaths due to being uninsured will decrease significantly.”  Pollack is not the only healthcare advocate to predict that the number of uninsured will continue to rise without reform as healthcare costs accelerate, employers cut benefits, and the social safety net unravels because of fiscal pressures.

The Affordable Care Act was passed by Congress to address an American tragedy and an American shame,” Pollack said.  “The fact remains that for the millions of Americans without health coverage, only the Affordable Care offers the promise of access to affordable coverage and to a longer and healthier life.”

According to the report, the reasons for being uninsured differ, but many without health insurance were denied coverage because of a pre-existing condition.  Others have been priced out of the market at a time when keeping their homes and feeding their families take priority over holding on to insurance in the face of rising premiums.  Some lost their benefits when employers stopped providing coverage.

Census Bureau data show that 50 million Americans lack healthcare coverage, and experts say that these people do without medical care, physician visits and preventive tests including cancer and blood pressure screenings.  “The uninsured get healthcare about half as often as insured Americans, on average,” said Dr. Arthur Kellermann, director of the think tank RAND Health and co-chairman of the committee that wrote the 2002 IOM study.  “There is an overwhelming body of evidence that they get less preventive care, less chronic disease care and poorer quality hospital in-patient care,” he said.

The $2.6 trillion American healthcare system, which totals nearly 18 percent of the economy, is accessible to a majority of working-age Americans only through private health insurance.  But insurance costs – premiums, deductibles, co-pays and co-insurance – are unaffordable for many.

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the national trade association that represents the insurance industry said the rising cost of care must be addressed.  “Health plans have long supported reforms to give all Americans the peace of mind and financial security that healthcare coverage provides.  The nation must also address the soaring cost of medical care that is adding a financial burden on families and employers and threatening the long-term sustainability of our vital safety net programs.”

Families USA counters that the current delivery system is stacked against Americans who lack insurance.  They pay more for care because they lack the ability to negotiate discounted prices on physician and hospital charges like insurance companies can.

Writing in Forbes, Matthew Herper points out that “This estimate is 19 years old, and this number doesn’t tell us much that’s new about what is wrong with our healthcare system.  If anything, it emphasizes how our total lack of information about what works and what doesn’t is trapping us in an economic and social death spiral around health costs.  If anything, available data seem to point to this estimate being low.  The real story is that we care so little about how much insurance matters to people’s life spans that we haven’t really bothered to find out.  It’s possible that the number is actually higher.  A 2009 article in the American Journal of Public Health actually found a 40 percent increase in the risk of death for those who lack insurance.  The IOM notes this finding, and that using it would have substantially increased the 26,000 number.  So how many people do die from lack of health insurance?  The short answer is that we don’t know, because we don’t look.  We should have data collection systems in place to answer questions about how healthcare is performing.  This should translate into more transparency, so that voters and consumers can find out how well the system is doing.  Instead, we tend not to track data about the healthcare system, and to keep it completely siloed.  And then we wonder why the system doesn’t work.”

The Individual Mandate Passes: ObamaCare Survives Supreme Court

Monday, July 2nd, 2012

In one of the most significant rulings in recent memory (perhaps since the awarding of the Presidency to George W. Bush in 2000), the Supreme Court upheld President Obama‘s health care law  in a nuanced interpretation of Federal versus states’ rights. The historic 5-4 decision will affect the way 30 million uninsured Americans receive and pay for their personal medical care.   Chief Justice John Roberts cast the deciding vote (another surprise since most expected it to be Justice Kennedy if the law passed) and wrote the opinion. The key factor was classifying the penalty for not abiding by the individual mandate — the requirement that most Americans buy health insurance or pay a fine — as a tax and therefore constitutional. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness,” wrote Roberts. The court’s four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the outcome; Conservative Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas dissented.

The Obama Administration had taken a different approach in its argument, saying that Congress had the authority to pass the individual mandate as part of its power to regulate interstate commerce; the court struck this down, but preserved the mandate as within Congress’ constitutional taxing powers. As Roberts put it, a person who does not wish to carry health insurance is left with a “lawful choice to do or not do a certain act, so long as he is willing to pay a tax levied on that choice.”

The Republican-controlled House will vote July 11 for a full repeal of the health care law. It is a symbolic move that stands little chance of passage in the Democratic controlled Senate. Republican presidential candidate Mitt Romney and GOP congressional leaders have pledged to repeal the law if they take control of Congress and the White House in November elections. The decision may silence critics who have claimed that the Roberts Court has been one of the more partisan in recent memory, particularly with its decision in the 2010 Citizens United case which took the cap off independent political expenditures by corporations and unions. The ACA drew the Supreme Court into the election-year crossfire over the role of government and the concerns about deficit spending,

The court did find one part of the law unconstitutional, saying its expansion of the federal-state Medicaid program threatened states’ existing funding. According to the Wall Street Journal, “the court ruled that the federal government can’t put sanctions on states’ existing Medicaid funding if the states decline to go along with the Medicaid expansion.”

Some reactions:

House Budget Chairman Paul Ryan, R-Wis.: “It’s up to the American people in the next election and their representatives to determine the fate of this law.”

House Speaker John Boehner, R-Ohio: “The president’s health care law is hurting our economy by driving up health costs and making it harder for small businesses to hire. Today’s ruling underscores the urgency of repealing this harmful law in its entirety.”

Senate Minority Leader Mitch McConnell, Republican of Kentucky: “Today’s decision makes one thing clear: Congress must act to repeal this misguided law.”

The full  impact of the ruling politically remains to be seen. The Wall Street Journal reflected the uncertainty: “The court’s decision, while a relief to Democrats, could further energize voters who dislike the law to back Republicans in November. And it forces the Obama administration to continue defending the unpopular insurance mandate, which the court has now made clear is legally equivalent to a tax on those who refuse to carry health insurance. On the other hand, the court’s blessing could itself shape public opinion of the law, particularly among independents and undecided voters who view the justices as relatively free of the partisan agendas of the government’s elected branches. Polls consistently show that the public places greater confidence in the Supreme Court than either Congress or the presidency, although the justices’ approval ratings have slipped somewhat over the past year.”

Health Insurer OKs Reform No Matter What the Supreme Court Does

Monday, June 18th, 2012

Even if the Supreme Court declares the Patient Protection and Affordable Care Act (ACA) unconstitutional, UnitedHealth, the nation’s largest health insurer will still cover certain types of preventive care. The extensions will apply primarily to its customers who have individual policies or small-group health insurance through their employer, a minority of its 35 million total members.  The ACA, whose goal is to provide coverage for millions of uninsured people, started unfolding in 2010 after health insurers fought to block its passage.  Challenges to the law from states and other groups opposed to it wound their way to the Supreme Court.  Bob Laszewski, a consultant and former insurance executive, UnitedHealth’s move a “very smart business decision.”  The provisions are relatively inexpensive and are already factored into the coverage price.  If insurers cut these benefits, customers probably will expect a corresponding premium drop, he noted.  “It would probably be more trouble to roll these things back than go ahead with them,” Laszewski said.  “It just makes common sense to leave these things in there and not take these benefits away since they’re already priced in.”  Laszewski expects other insurers and large employers to take a similar approach.

The provisions UnitedHealth will maintain include providing coverage for dependents up to age 26 under their parents’ plan.  The company will still offer certain preventive healthcare services without requiring a co-payment.  These include yearly check-ups, screening for high-blood pressure and diabetes, and immunizations.  Additionally, UnitedHealth will continue to forgo lifetime dollar coverage limits on policies.  “The protections we are voluntarily extending are good for people’s health, promote broader access to quality care and contribute to helping control rising healthcare costs,” UnitedHealth Chief Executive Officer Stephen Hemsley said.  “These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue.”

The ACA is the largest overhaul of the $2.6 trillion American healthcare system in nearly a half century.  It is designed to ultimately expand coverage to more than 30 million uninsured Americans, by setting up insurance exchanges and opening Medicaid for low-income Americans.

According to estimates, the ACA let approximately 6.6 million young adults remain on their parents’ health insurance plans last year, according to a report from The Commonwealth Fund. If the law is declared unconstitutional, Republican lawmakers may reinstate the extension of young adults dependent coverage.  Other provisions that UnitedHealth plans to maintain include providing easily understandable ways for members to appeal coverage claim decisions; and eliminating rescissions, which are considered to be retroactive policy cancellations, except in the case of fraud.  DeAnn Friedholm, director for health reform at the Consumers Union, called UnitedHealth’s actions “a positive step” and said she hopes other companies follow suit should the law be struck down.

Ronald Pollack, executive director of the consumer advocacy group Families USA and a supporter of the law, applauded UnitedHealth’s move.  “It would make a huge difference for a great number of people who would otherwise be left out in the cold in terms of getting coverage,” he said. “And hopefully, given UnitedHealthcare’s market share, this would have tremendous influence on other companies.”  Even if other large insurers follow suit, Pollack said, it would hardly make up for the loss of other provisions in the law that are set to take effect in 2014 — including subsidies to help low-income Americans buy insurance and bans against discriminating against adults with preexisting conditions.

Writing for CBS News, Stephanie Condon says that UnitedHealth’s decision “Could also alter the political fallout from the high court’s decision.  Should the Supreme Court reject President Barack Obama’s law, he could point to UnitedHealthcare’s announcement to validate his policy agenda.”

The Associated Press’ Ricardo Alonso-Zaldivar points out that dismantling the ACA could be messy.  “It sounds like a silver lining.  Even if the Supreme Court overturns President Barack Obama’s healthcare law, employers can keep offering popular coverage for the young adult children of their workers.  But here’s the catch: The parents’ taxes would go up.  That’s only one of the messy potential ripple effects when the Supreme Court delivers its verdict on the Affordable Care Act this month.  The law affects most major components of the U.S. healthcare system in its effort to extend coverage to millions of uninsured people.  Because the legislation is so complicated, an orderly unwinding would prove difficult if it were overturned entirely or in part.  Better Medicare prescription benefits, currently saving hundreds of dollars for older people with high drug costs, would be suspended.  Partially overturning the law could leave hospitals, insurers and other service providers on the hook for tax increases and spending cuts without the law’s promise of paying more to offset losses.”

26 Percent of Americans Had No Healthcare Coverage in 2011

Monday, May 7th, 2012

A Commonwealth Fund survey found that 26 percent of adults surveyed had no health insurance at some point in 2011.  The reasons typically were losing a job, changing jobs or becoming ineligible for Medicaid.  Fully 69 percent of respondents lacked coverage for one year or longer, while more than 50 percent had no insurance for two years or longer.  Low- and moderate-income individuals were most likely to experience a long gap in healthcare coverage.

The online survey is based on responses from a random sample of 2,134 adults aged 19 to 64.  Among respondents who had a gap in coverage, 41 percent lost their employer-sponsored insurance because of changing jobs, losing their job, working part-time, because they could no longer afford to pay their share of the premium, or because their employer stopped offering health insurance.  Another 18 percent who had qualified for Medicaid lost coverage because they made too much money or neglected to re-enroll in the program when they were supposed to.

After losing insurance, finding coverage was difficult if not impossible. Approximately one-third who lost their insurance and tried to find new coverage within the past three years were turned down, charged a higher price, or were denied because of a pre-existing condition.  Nearly 50 percent of those who lost their employer-sponsored coverage said they never bought a new insurance plan, typically because it was too expensive.

“For people who lose employer-sponsored coverage, the individual market is often the only alternative, but it is a confusing and largely unaffordable option,” Commonwealth Fund vice president Sara Collins, lead author of the survey, said.  “As a result, people are going a year, two years, or more without healthcare coverage, and as a result going without needed care.”

The holes in health insurance were a primary force in President Barack Obama’s push for the Patient Protection and Affordable Care Act (ACA). According to the survey, people without health insurance often skip necessary medical care and do not get crucial preventive services such as cancer screenings.  Over all, nearly 75 percent of women aged 40 to 64 with health insurance had a mammogram in the previous two years.  In contrast, only 28 percent of women in that age group who did not have insurance for a year or more received a mammogram.

The Commonwealth Fund’s report proves that the ACA is helping to bridge coverage gaps for young adults because of the new provision for dependent coverage that allows young adults up to age 26 to join or stay on their parents’ health insurance plan.  Nearly half (46 percent) of young adults said they had stayed on or joined a parent’s insurance policy in the last year, and about a quarter (23 percent) of parents with children under age 26 reported that they had an adult child stay on or enroll in their health plan.  Young adults in higher-income families were more likely to have been helped by the new option than those in lower-income households.  This is likely because adults in higher-income households are more likely to have health insurance with dependent coverage.  Almost two-thirds (63 percent) of working adults knew about the provision.

Writing on the Huffington Post, Jeffrey Young says that “Nearly 50 million Americans had no health insurance in 2010, according to the latest census data.  Healthcare costs, which have risen tenfold since 1980, are putting an increasing burden on families, employers, and government programs.  Costs also are driving up the ranks of the uninsured and leading fewer companies to offer health benefits to their workers.  From 2001 to 2011, the percentage of companies offering health benefits dropped from 68 percent to 60 percent, the Henry J. Kaiser Family Foundation reported.  More than two-thirds of those who lost health insurance in 2011 cited losing their job or getting a new job without health benefits as the main reason they were uninsured, according to the Commonwealth Fund survey.  Among these people, 45 percent said that they were discouraged from buying health insurance on their own because of the high cost.  Sixty-two percent of the uninsured responded that finding a new health plan was ‘very difficult or impossible,’ the Commonwealth Fund said.

At the same time, many Americans don’t know exactly what the ACA contains.  According to the survey, awareness of the health law’s provisions vary significantly depending on income.  Fifty-four percent of respondents who had incomes below 250 percent of the federal poverty level were unaware of the under-26 provision, compared to just 25 percent at or above that line.  For the high-risk pools, the totals were 63 percent and 39 percent, respectively.

“We need to do more,” said Kathleen Stoll, director of health policy for Families USA, a group that supports the health law.  She described how “it takes a while for programs like these to break through.”  People with pre-existing conditions are a specific challenge, because individual states run the high-risk pools with differing levels of publicity.

“The current system of health insurance in the United States has gaping holes, the effects of which have become increasingly pronounced during a weak economy,” Commonwealth Fund President Karen Davis concluded.  “The Affordable Care Act is beginning to close those gaps, so that people who are already struggling can maintain health care coverage that will provide for their families’ health and help ensure their financial security.”

States to Determine Their Own ACA Coverage Levels

Wednesday, December 28th, 2011

The Obama administration averted a potentially vicious lobbying battle over the medical benefits insurers must cover under the Patient Protection and Affordable Care Act (ACA) when it handed the decision to the states.  The ruling gives states the power to set coverage levels for the policies uninsured people will purchase through exchanges, starting in 2014.  Business groups will make a case for a narrow set of benefits to save costs while consumer advocates want expanded coverage.  The decision shifts the issue to the states and away from the White House, and lets President Barack Obama say he’s giving governors and legislatures greater flexibility to confront rising medical costs and control changes the 2010 healthcare law is bringing to insurance markets.

“Obama has taken all the grief he can stand over healthcare,” said Erik Gordon, a business professor at the University of Michigan in Ann Arbor.  “He doesn’t want it to give the Republicans any more political ammunition.  He is passing the hot potato to the states.”

“This is significantly more state-flexible and friendly than many would have expected,” said Alan Weil, head of the National Academy for State Heath Policy. What’s to guarantee that the state’s choice of a benchmark plan will be affordable?” asked National Retail Federation Vice President Neil Trautwein.  If coverage is unaffordable today, this doesn’t change the equation.”

Ron Pollack, executive director of Families USA, said Department of Health and Human Services (HHS) would have to provide “strong oversight and enforcement” of the benefit standards as the states implement them.  “It will be important to ensure that adequate coverage across all 10 required benefit categories is provided — marking an improvement over many plans offered today,” he said.  Giving states greater flexibility to determine necessary benefits was perceived as an attempt to defuse criticism that the health reform law gives the federal government too much control over the healthcare system.  A longtime advocate for federal health reform, Pollack also expressed reservations.  “We understand the inclination to balance flexibility, comprehensiveness of coverage, and cost,” he said. “However, flexibility must yield to reliable, comprehensive coverage of benefits for consumers.  It is essential that HHS provide strong oversight and enforcement.”

Under the revised guidelines, state legislature must either set coverage levels in line with widely subscribed small- business plans in their communities, or tie them to benefits included in their state employees’ health plan, federal plans or the largest commercial managed-care plan in the state.  Generally, health plans for small businesses, state employees and federal workers “cover similar services,” including doctors’ visits, hospitalization and outpatient mental health, according to a study conducted by HHS.  Discrepancies arise in areas such as prescription drugs.  While they’re covered as a basic benefit by all government employee plans, only 84 percent of small business plans cover them.  Others require additional premiums.  Small business plans also rarely cover dental care, acupuncture, bariatric surgery and hearing aids, unless states require it.

According to Forbes magazine’s sba.com column, “At a first glance, this seems like it might be a step in the right direction for individuals and small business owners.  However, that is not necessarily the case.  It seems as though the new idea comes with a wide array of new problems.  First, while the new policy will give states flexibility, it imposes more benefit mandates.  The new policy lists 10 ‘essential health benefits’ that the state MUST provide.  Some of these essential benefits are prescription drugs, preventative care, doctor and hospital services, and maternity care.  The new policy allows the states to designate a state-wide ‘benchmark’ health insurance plan, setting the minimum standard of care.  All insurers would then have the ability to change their insurance plans as long as the coverage provided benefits of the same or greater value.  The new ‘more flexible’ plan still seems very rigid and regimented.  Additionally, the new plan would lead to higher-cost insurance premiums, not lower.

“Another long-standing issue with Obama’s idea is that individuals are not clear on what services and benefits are expected to be provided as a minimum.  Instead of clearing up this confusion and spelling out what exactly would be required, Obama has simply put that responsibility on the states – giving them the ‘flexibility’ to design their plans.

“While it may look like Obama is responding to his opponents’ remarks about his previous plan forcing health insurance standards on states, it seems as though this policy change still accomplishes his goals – just through a different means.  Obama can continue to shape and reshape his ideals; however it will be up to the Supreme Court to decide whether the government can require Americans to buy health insurance at all.”

Will Cuts in Healthcare Save the Federal Budget?

Tuesday, December 6th, 2011

Healthcare budget and policy experts are waiting for Washington to eventually face the difficult task of finding even more savings to cut the deficit.  They anticipate that health spending — which makes up more than 20 percent of the federal budget — will be targeted.  Some healthcare leaders are already planning to redirect a debate they’re expecting in 2013.  They hope to prevent spending from being shifted from one part of the system to another.  Jack Lewin, chief executive of the American College of Cardiology, said that proposals to address the basic causes of high healthcare costs have mostly been ignored in Washington.

“We talk about them all the time, but there’s nothing that we’re doing in any of these proposals to get that done,” Lewin said.  “What we would like to get on the table that’s not there is a paradigm shift in thinking about how you control costs.”  According to Thomas Scully, a former Medicare administrator under President George W. Bush and now a senior counsel at Alston & Bird, an Atlanta-based law firm, “There’s going to be a Round Two (of cuts), but after the election, because of the economic pressures exerted by the national debt.”

Proposals include reducing payments to providers; asking beneficiaries to pay more for coverage; and raising the Medicare eligibility age.  The healthcare interests that might take another hit in 2013 want to start planning now.  Several key healthcare leaders – the majority of whom have been through other cost-cutting campaigns — say efforts to reduce spending too often transfer costs from the federal budget and individuals, insurers, doctors and hospitals.

These worries have caused “people from dramatically different quarters to start thinking about what to do to get their hands around this” and redirect the conversation, said Karen Ignagni, president of America’s Health Insurance Plans.  “I’ve been talking to a range of stakeholders about how to work together…to urge policymakers to look at what’s already out there now and build on it.”

The Patient Protection and Affordable Care Act (ACA) is one element of this debate.  Administration officials and other supporters of the law say it will help drive down costs through initiatives designed to promote primary care, emphasize on preventive medicine, study treatments to evaluate their effectiveness and rate hospitals and other providers on quality.  Other healthcare authorities counter that the law will not strongly impact costs because its reforms are small and will mature incrementally.

Additionally, the law saves money by cutting Medicare payments to hospitals and other providers; it also places some unwelcome standards on health plans.  For example, insurers cannot reject people with pre-existing conditions, must justify rate increases of 10 percent or more, and send rebates to consumers if they don’t spend a minimum of 80 percent of premiums on healthcare.

Writing in the Washington Post, Drew Altman and Larry Levitt – both with the Kaiser Family Foundation — note that “Healthcare costs are driving people into poverty.  Indeed, if the burden of healthcare expenses were not taken into account, then 10 million fewer people would have been classified as poor.  One of the biggest jumps in poverty under the new method is among people with private health insurance.  We tend to think of such people, most of whom get coverage through their jobs, as being better equipped to handle the cost of getting sick.  But even those who are insured are increasingly vulnerable to high healthcare costs, in no small part because, as costs keep rising, employers have shifted more of the burden onto workers.  The share of employees with an insurance deductible of $1,000 or more for single coverage has tripled in the past five years.  The trend is especially strong among small businesses, where half of workers faced a deductible of at least $1,000 in 2011.  For those on the edge of poverty, a big medical bill could send you over it — even if you have insurance.  The effect of healthcare costs is particularly acute for the elderly, with the proportion of seniors living in poverty increasing from nine percent under the official census measure to 16 percent under the alternative measure.  An astounding 49 percent of seniors are living at or below twice the poverty level, a threshold at which people are still considered low-income (up from 35 percent under the official method).

“It’s up to us to get really serious with the agenda so that, when the time comes after the election, we are prepared to offer serious proposals that deal with costs and that do not impair the quality of care,” said Ron Pollack, executive director of the consumer group Families USA.

Kids With Pre-Existing Conditions May Get Insurance Coverage Before September 23

Thursday, June 24th, 2010

Starting in September, the approximately five million Americans under the age of 19 who have pre-existing medical conditions cannot be denied health insurance coverage. The healthcare reform law also gives these patients expanded physician choices because many previously had to rely on government programs such as Medicaid.  Children account for approximately nine percent of the 57.2 million Americans under the age of 65 who have pre-existing conditions.

Although Congress wanted to implement this section of the bill immediately instead of waiting until September 23, some private insurers are showing signs of stepping up to the plate and providing coverage as soon as the Obama administration issues regulations on final implementation.  According to Illinois Insurance Director Michael McRaith, “It would not surprise me if insurers would undertake this earlier.”

Although there were some concerns that insurers might try to deny coverage to children with pre-existing conditions or set rates too high, Secretary of Health and Human Services Kathleen Sebelius sent a letter to Karen Ignani, CEO of America’s Health Insurance Plans directing the trade organization to comply with the new law.  “To ensure there is no ambiguity on this point, I am preparing to issue regulations in the weeks ahead ensuring that the term ‘pre-existing condition exclusion’ applies to both a child’s access to a plan or to his or her benefits once he or she is in the plan,” Sebelius wrote.

“This is a confidence builder in what healthcare reform does,” said Ron Pollack, executive director of Families USA, a consumer health advocacy group that backed expanding healthcare coverage.  “It’s a popular group to reach out to…and it’s not going to have as big of an impact on costs as, say, somebody between the ages of 56 and 64 who has multiple chronic conditions.”

Got Healthcare Reform Questions? Click These Links for Answers

Monday, April 26th, 2010

Click these links to learn more about healthcare reform.  Confused about what healthcare reform means to you?  Following is a handy guide to links that clarify the new rules and have timelines detailing when the various elements will kick in.

The Kaiser Family Foundation summarizes what healthcare reform means under Its “New & Noteworthy” section.  Click on the “summary of the law” for an outline and on the “timeline”.

Families USA, a non-profit advocate for healthcare consumers has a “Health Reform Central” that provides a full rundown of the changes.

This website has a “Health Care Reform” button that links to an easy-to-read timeline.  Be aware that the site belongs to an insurance broker.

This is the Obama administration’s explanation of how healthcare reform will work.

Consumer Reports presents useful information at the “Health-care reform” button towards the bottom of the home page.

Although this website is used primarily by house buyers looking for low mortgage rates, it presents a good summary of healthcare costs.  Type “reform” into the search box, then click on the “What’s in it for you” button.

The March’s website summarizes important new provisions impacting women and children.  Access it by clicking on “In the news.”

The Medicare Rights Center reviews important new provisions impacting senior citizens.  Click on the box that says “learn more about health reform and Medicare.”

The Department of Health and Human services is planning to launch a website on healthcare reform that will include links to insurance options that it considers to be affordable on a state-by-state basis.

Lack of Healthcare Insurance = More Deaths

Wednesday, March 10th, 2010

Failure to pass healthcare reform legislation could result in 275,000 premature deaths over the next decade.  The real cost of failure to pass healthcare reform legislation could mean that 275,000 Americans nationwide will die unnecessarily over the next 10 years – simply because they lack insurance.  According to a new study by Families USA, “This is only the tip of the iceberg, and the most severe consequence, which is death,” said Kathleen Stoll, director of health policy at Families USA.

The states with the largest populations were found to be the ones where the majority of projected premature deaths would occur.  The top states are California (34,600 early deaths); Texas (31,700); Florida (25,400); and New York (13,900).  Families USA estimates that 68 adults under the age of 65 die every day because they lack healthcare insurance coverage.  Unless a significant change occurs, that figure will climb to 84 by 2019.

Research exploring the connection between a lack of health insurance and an increased risk of death has found that the uninsured are more likely to avoid screenings and preventive care.  As a result, their medical problems tend to be diagnosed later when they are advanced and difficult to treat.  “The bottom line is that if you don’t get a disease picked up early and you don’t get necessary treatment, you’re more likely to die,” said Stan Dorn, a senior fellow at the Urban Institute and author of an earlier study of premature deaths.

Healthcare experts warn that the Families USA’s study’s premature death estimate errs on the side of caution, although the report calculated that a lack of insurance increases mortality rates by 25 percent.  More recent research found that people who do not have healthcare research are 40 percent more likely to die early.