Posts Tagged ‘healthcare reform’
Monday, August 30th, 2010
The state of Illinois has created the Illinois Pre-Existing Condition Insurance Plan (IPXP) for individuals with pre-existing conditions who lack medical insurance. Enrollment will be on a first-come, first-served basis and is funded by premiums and the federal government, which is giving the state $196 million to operate the program until 2014. The funding is expected to cover between 4,000 and 6,000 people - nowhere near the 1.7 million Illinoisans who currently lack healthcare insurance.
“This program is not a silver bullet that will solve all health insurance problems in Illinois,” said Michael McRaith, director of the Illinois Department of Insurance. Illinois is one of approximately 30 states establishing similar “high-risk pools” under the healthcare reform legislation passed in the spring. Congress has set aside $5 billion to fund the pools, although this is not enough money to cover existing needs. As many as 400,000 people nationally are expected to enroll in their state programs.
To qualify for IPXP, a person must be uninsured for six months, have a pre-existing condition, be a United States citizen or a legal resident, and be unable to get insurance from another source. There is a $2,000 deductible and dependents are not covered. Premiums will vary, but a Chicagoan who is 25 and doesn’t smoke will pay $149 a month. The older the patient, the higher will be the premium.
Tags: Congress, healthcare reform, high-risk pools, Illinois, Michael McRaith
Posted in Economics, General, Healthcare, Hospital Systems | No Comments »
Wednesday, August 25th, 2010
With little fanfare, the Obama administration has released $250 million to establish “new access points,” locations designed specifically to house primary-care services in underserved neighborhoods. The facilities are intended to mirror community health centers. Created by the new healthcare reform law, the grants will be awarded by the Health Resources and Services Administration.
Kathleen Sebelius, Secretary of Health and Human Services, said “These funds reflect the administration’s steadfast commitment to improving and expanding access to vital primary healthcare services. From our cities to our smallest towns, each health center has an important role to play, ensuring access to services in its community.”
Organizations eligible for the funding include public and non-profit groups, including tribal and faith-based community organizations. All must meet health center funding requirements.
Tags: community health centers, Department of Health and Human Services, faith-based organizations, Health Resources, healthcare reform, Kathleen Sebelius, Obama administration, primary healthcare, tribal organizations
Posted in Healthcare, Healthcare Village | No Comments »
Thursday, August 19th, 2010
The Department of Health and Human Services has made available an application that employers must fill out so claims incurred by members of early retiree healthcare plans can receive reimbursement. The Early Retiree Reinsurance Program lets the government pay employers for part of healthcare claims made by retirees who are 55 or over but not yet covered by Medicare. The plan covers eligible dependents, no matter their age. Once a participant in an early retiree plan has $15,000 in healthcare claims for one year, the government will pay plan sponsors for 80 percent of the claims or $90,000.
Congress appropriated $5 billion for the program as part of the healthcare reform law. It is seen as a way to encourage employers to continue their early retiree healthcare plans until 2014 when many key provisions of the new law take effect. In the future, part of the coverage will be provided by state pools where lower-income individuals can use federal health insurance premium subsidies to buy coverage.
“Until Americans have access to affordable insurance plans through health insurance exchanges in 2014, this program will make it easier for retirees and their families to maintain employment-based coverage,” according to Kathleen Sebelius, Department of Health and Human Services Secretary.
Tags: Congress, Department of Health and Human Services, healthcare reform, Kathleen Sebelius
Posted in Healthcare, Hospital Systems | No Comments »
Monday, August 16th, 2010
The healthcare reform bill is expected to save Medicare $7.8 billion through 2011 and $418 billion over the next decade, according to a report released by the Centers for Medicare and Medicaid Services (CMS). Kathleen Sebelius, Health and Human Services Secretary, said “Because we began making changes right away, the savings from Medicare add up fast.”
The CMS report focuses largely on the measures that will change how healthcare is delivered and paid, which are at the heart of the historic legislation passed by Congress in spring. Some of the programs are designed to cut the number of hospital re-admissions, find new ways to reimburse hospitals and physicians, and target fraud and abuse. The last is expected to save Medicare billions.
Sebelius believes that Medicare will lead the private sector in reforming how healthcare is delivered. Jonathan Blum, deputy administrator of CMS, said “I think when you look at the history of hospital and provider payments, when large payers like the Medicare program place continued financial pressure, hospitals become more productive.”
According to CMS estimates, changed to the Medicare Advantage programs and the ways in which the agency will reimburse providers will save $145 billion and $205 billion over the next decade respectively. The report also highlighted several changes that affect care delivery. As an example, actions to improve quality and simplify care are expected to save more than $15 billion.
Tags: Centers for Medicare and Medicaid Services, Congress, Department of Health and Human Services, healthcare reform, Jonathan Blum, Kathleen Seblius, Medicare, Medicare Advantage, reimbursements
Posted in Healthcare, Hospital Systems | No Comments »
Wednesday, August 11th, 2010
Senate Republicans want to fast-track an amendment that repeals a portion of the new healthcare reform law. Whether or not they will be able to accomplish this is another question.
Senator Mike Johanns (R-NE) has proposed legislation to rescind a provision in the new law that requires businesses to report purchases of $600 or more to the Internal Revenue Service (IRS). Business lobbyists such as the U.S. Chamber of Commerce and the National Federation of Independent Business (NFIB) both support the legislation. Republicans want to attach the repeal provision to a broader bill intended to help small businesses. According to the Chamber and the NFIB, the provision places a burdensome obligation on the nation’s 40 million small businesses. Under this provision of the healthcare reform bill, businesses are required to file an IRS 1099 form for non-credit card purchases totaling $600 or more. Johanns says that rule is “overly burdensome.”
To make up for the $17 billion that the provision would raise, Johanns has proposed reducing the individual mandate threshold and defer $16 billion in funding for wellness programs. Senator John Cornyn (R-TX) and other Republicans have introduced legislation that would kill the Independent Payment Advisory Board that the healthcare reform law created. Democratic Senators who wrote the legislation counter that the board is needed to reduce consistently increasing healthcare costs.
Tags: Democrats, healthcare reform, IRS, John Cornyn, Lobbyists, Mike Johanns, Republicans, US Chamber of Commerce
Posted in Healthcare, Healthcare Village, Wellness Centers | No Comments »
Tuesday, July 20th, 2010
The Department of Health and Human Services (HHS) has launched a new website to help Americans better understand and explore the options open to them as healthcare reform legislation takes effect. The website was mandated in the healthcare reform bill passed in March; in October, there will be a tool that lets people compare pricing for various insurance plans.
Insurance companies aren’t entirely happy with some of the content on the new HHS website. The industry’s lobbyist, America’s Health Insurance Plans (AHIP) told HHS that they were not comfortable about the insurance plan information that might be detailed on the website. One of the sore spots was the government’s request for data on how many claims are denied by healthcare plans. According to Robert Zirkelbach, an AHIP spokesman, “Providing information about claims denials without providing proper context does not begin to tell the whole story.” Zirkelbach said that claims are often denied because of duplicates or submitting a claim to the incorrect health plan.
HHS Secretary Kathleen Sebelius, writing on the White House blog, said “The site makes a system that thrived on complication and confusion easier to understand. This kind of transparency helps create informed consumers, which increases competition, reduces prices and improves quality.” The website’s two-minute video explains the law and its provisions, while a tab on the home page provides in-depth information on the law. HealthCare.gov even has its own Twitter account.
Tags: America's Health Insurance Plans, Department of Health and Human Services, healthcare reform, HealthCare.gov, Kathleen Seblius, Twitter, White House blog
Posted in Healthcare, Hospital Systems | No Comments »
Monday, July 19th, 2010
Healthcare coverage for uninsured Americans with pre-existing conditions won’t come cheaply. Premiums in the new “high-risk” pool could average $300 to $600 a month in certain states, according to a new government website. The Department of Health and Human Services says that the premiums could range from $140 to as much as $900 a month.
According to Richard Popper, deputy director of the Office of Consumer Information and Insurance Oversight, “There are going to be meaningful premiums that are going to be required to stay in this plan…in the hundreds of dollars.” HealthCare.gov estimates show that monthly premiums for a 50-year-old Floridian would be $552 to $675; for a New Yorker, the average cost would be $400 to $600; $491 to $600 for a Texan; and only $283 for a Pennsylvanian. Coverage under the Pre-Existing Condition Insurance Plan begins on August 1.
Consumer advocates are advising the uninsured who have health problems to sign up quickly - despite the cost - because they cannot be turned down for coverage. The high-risk pool is a temporary solution for at-risk individuals who cannot get healthcare insurance because of a medical condition. The pool will be available until 2014 when healthcare reform takes full effect. At that point, insurance companies will not be allowed to turn down people in poor health. Low- and middle-income individuals will receive subsidized coverage.
Tags: Department of Health and Human Services, healthcare reform, HealthCare.gov, high-risk pools, insurance premiums, pre-existing conditions, President Barack Obama, primary medicine, private insurance
Posted in Healthcare, Healthcare Village, Hospital Systems, Wellness Centers | No Comments »
Thursday, July 15th, 2010
A suburban Chicago teenager had her healthcare coverage rescinded when her parents’ insurance company learned that she had been diagnosed with an overbite at age eight. An orthodontist and braces cured the overbite, but the insurer cancelled the girl’s coverage by claiming it was a pre-existing condition. The girl’s parents fought back and - thanks to strong support from Illinois insurance regulators - the coverage has now been reinstated.
Thanks to healthcare reform legislation, this practice - known as rescission - will no longer be allowed as of late September except in cases where fraud is involved. Illinois has one of the nation’s highest rescission rates with 12.9 for every 1,000 policies written. The girl’s father, an attorney employed at a small firm, buys individual coverage for his family. Insurance regulators say that rescission is most common in these circumstances. People who are covered by company-sponsored programs rarely face rescission. According to the girl’s father, “We didn’t try to hide anything. Our orthodontist told us her mandibular hypoplasia was routine, and it was nothing the insurance company even asked us about on our application. From our perspective, they didn’t even ask for the names of any of our children’s dentists or orthodontists.”
“There’s now a defined legal standard for when a rescission is appropriate,” said Michael McRaith, Illinois Insurance Director. “In Illinois, our law was ambiguous, vague and left wide latitude and discretion with the insurance industry.” The insurance industry defends rescissions as a necessary business practice when people misrepresented or lied about their medical histories on their applications. Rescissions affect approximately seven percent of the population with private insurance who purchase individual policies. Robert Zirkelbach, spokesman for America’s Health Insurance Plans, a lobbying group, said “Rescissions are very rare. They are only used as a last resort.”
Congressional Democrats take another view. “It was viewed by Congress as the tip of the spear,” said Representative Jan Schakowsky (D-IL). “It typifies the practices of the insurance industry to maximize their profits that were so clearly anti-consumer and harmful to people who were counting on their health insurance at the moment they needed it the most.”
Tags: Congressional Democrats, healthcare reform, Jan Schakowsky, National Association of Insurance Commissioners, pre-existing conditions, pre-existing medical conditions
Posted in Economics, General, Healthcare, Hospital Systems, Physician Recruitment, Wellness Centers | No Comments »
Wednesday, July 7th, 2010
Although between 5.8 and seven million Americans may qualify for healthcare coverage through the temporary high-risk pool program created as part of healthcare reform, the $5 billion set aside for use between now and 2014 may cover only 200,000 patients annually.
The high-risk pool, created by the 2010 Patient Protection and Affordable Care Act, provides subsidized coverage to uninsured individuals with pre-existing medical conditions. One portion of the law provides income-based subsidies so healthcare coverage is more affordable and accessible. Because most of the provisions do not become effective until January of 2014, however, the limited funding means available dollars will have to be stretched as far as possible, said Paul B. Ginsburg, Ph.D., NICHR director of research. The National Institute for Health Care Reform (NIHCR) has identified key policy considerations in its Health Coverage for the High-Risk Uninsured: Policy Options for Design of the Temporary High-Risk Pool policy analysis.
According to Kaiser Health News, many people with medical conditions may be unable to obtain coverage. “That fear — along with partisan considerations — prompted officials in 20 states to decline to establish their own federally financed pools, opting to leave the task to Washington. Officials in those states, predominantly Republicans, worry that they would face intense pressure to pick up the burden if the money runs out.”
Tags: healthcare reform, high-risk pools, Kaiser Health News, Patient Protection and Affordable Care Act, Republicans
Posted in Healthcare, Hospital Systems | No Comments »
A prime example of why access to quality healthcare needs to be expanded is an ambitious effort to hold an enormous, free medical event in Chicago. 