Posts Tagged ‘Families USA’

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.”

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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.

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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.”

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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.

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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.

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