Posts Tagged ‘Kaiser Family Foundation’
Tuesday, August 2nd, 2011
At a time when concern about federal deficits and the national debt are growing, few quarrel with the need to reform Medicare. The health insurance program for seniors and people with certain disabilities accounts for 15 percent of the federal budget – in third place behind Social Security and defense spending. That share is rising as healthcare costs continue to rise and more baby boomers retire, threatening the program’s long-term solvency.
Several of the most prominent solutions under discussion largely derive their savings by shifting a greater share of the cost onto beneficiaries. The plan sponsored by Representative Paul Ryan (R-WI) and passed by the House of Representatives would significantly cut Medicare spending by capping the government’s contribution to the program and transforming it into a system of “premium supports” given to seniors to help subsidize their purchase of private insurance plans, with seniors paying additional costs. This would double out-of-pocket spending by the average senior to $12,500 each year, according to Congressional Budget Office estimates.
The ability of a majority of seniors to shoulder that burden appears dubious. Just five percent of Medicare beneficiaries make $80,000 or more, a figure that includes any income from a spouse. For the 47 percent of seniors who are at or close to poverty, on average they are already spending nearly 25 percent of their budgets on healthcare, according to an analysis by the Kaiser Family Foundation.
“There’s this impression that there’s a great deal of wealth among the Medicare population, this image of wealthy seniors playing golf and enjoying their retirement years,” said Tricia Neuman, director of the Kaiser Family Foundation’s Medicare Policy Project.“But while some are lucky to do so, many are living on a fixed income, struggling to make ends meet…with really limited capacity to absorb rising costs.”
According to the Kaiser Family Foundation’s report, raising Medicare’s eligibility to 67 in 2014 would generate an estimated $5.7 billion in net savings to the federal government, but also result in an estimated net increase of $3.7 billion in out-of-pocket costs for 65- and 66-year-olds, and $4.5 billion in employer retiree healthcare costs. In addition, the study projects that the change would raise premiums by about three percent both for those who remain on Medicare and for those who obtain coverage through health reform’s new insurance exchanges. The study assumes both full implementation of the health reform law and the higher eligibility age in 2014 in order to estimate the full effect of both the law and the policy proposal. In the absence of the health reform law, raising Medicare’s age of eligibility would result in an increase in the uninsured, according to other studies, as many older Americans would have difficulty finding affordable coverage in the individual market in the absence of Medicare. With health reform, virtually all 65- and 66-year-olds would be expected to obtain alternative sources of coverage.”
Healthcare remains a major focus of budget talks on Capitol Hill,Senator Mark Kirk (R-IL) recently told the American College of Surgeons (ACS). Every group that relies on federal funding should expect a 10 to 20 percent drop in that funding. When Dr. L.D. Britt, president of the ACS, warned that such cuts could send some healthcare providers into a “tailspin,” Kirk responded that “the tailspin is the U.S. economy. There is a new audience at play,” Kirk said, referring to U.S. creditors. “The judgments they render, they are swift and severe.” Kirk is optimistic that a solution to the country’s debt-ceiling dilemma “will have a way of concluding itself one day before the August 2 deadline.”
Tags: American College of Surgeons, baby boomers, Congressional Budget Office, Defense spending, Deficits, healthcare costs, Healthcare insurance exchanges, healthcare reform, House of Representatives, Kaiser Family Foundation, Low-income senior citizens, Medicare, Medicare Policy Project, Private insurance plans, Representative Paul Ryan, Senator Mark Kirk, social security
Posted in Healthcare, Hospital Systems | No Comments »
Monday, August 1st, 2011
The Center for Medicare and Medicaid Services (CMS) has issued rules impacting the creation of co-ops, or private not-for-profit insurers created by Patient Protection and Affordable Care Act. The co-ops will receive funding via $3.8 billion in government loans. They will be run by consumers and will qualify for start-up loans if they have a high probability of becoming financially viable. CMS will determine viability based on evaluations of their legal, operational and business plans, according to Richard Popper, director of the Office of Insurance Programs at the CMS. Additionally, CMS will offer “solvency” loans to provide insurers with the legally and financially required reserves. The co-ops are intended as non-commercial alternatives for insurance consumers joining the health insurance exchanges that will begin in 2014. The rules will require that any co-ops’ profits to go to reducing their customers’ costs or improving their care. “That’s what really makes these plans different and why Congress chose to include these in the Affordable Care Act,” Popper said.
Anyone who is confused about the status of their state’s insurance exchange can take advantage of two excellent resources for clarification. One is a primer put out by the non-profit Kaiser Family Foundation which answers many basic questions about the online exchanges, where millions of individuals and small businesses will price and compare insurance plans starting in 2014, in clear-cut terms. Additionally, the Commonwealth Fund provides its own explanation of how the insurance exchanges will work.
“Co-ops will provide consumers with a wider range of choices, greater plan accountability and help ensure a more competitive insurance market,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight. This “announcement shows how the Affordable Care Act is bringing new choices and giving consumers a voice in insurance markets throughout the nation.”
The co-ops are structured to increase competition in the insurance market and provide additional options for people and small businesses looking for affordable health insurance. Their organization is similar to that of credit unions: profits are used to benefit members of the co-op, which can include reducing premiums, improving health benefits, improving the quality of care, expanding enrollment or taking other actions to contribute to stabilizing coverage.
“The co-op program also seeks to promote improved models of care. Existing health insurance cooperatives and other business cooperatives provide possible models for the successful development of Co-ops around the country,” noted the proposed rule. “One major barrier to continued development of this model has been the difficulty of obtaining adequate capitalization for start- up costs and state reserve requirements. The Co-op program is designed to help overcome this major barrier to new issuer formation by providing funding for these critical activities.”
Writing on Kaiser Health News, Christopher Weaver says that “The rules would steer a total of $3.8 billion in low-interest loans to groups such as The Evergreen Project in Baltimore, seeking to launch the so-called Consumer Oriented and Operated Plans. The health department hopes at least one ‘co-op’ will launch in each state and anticipates funding a total of 57 around the country. The strategy is that new health plans run by consumers – most board members would also have to be plan members — would find ways to improve care, rather than boost profits. The new plans, made possible by the seed money, would also compete with established insurers to drive prices down. The Evergreen Project, named after the coffee shop where its founders held initial meetings, is among a small cadre of groups that are laying the groundwork to launch these nonprofit insurers to care for families and individuals who will be required to buy coverage under the health law — but may be hard pressed to afford it.”
Dr. Peter Beilenson, one of the founders, said The Evergreen Project has already raised $315,000 in foundation grants and completed a 16-month feasibility study. The members are expecting a report from hired actuaries before applying for the loans to move forward. The key factor: Could the co-op actually cost less than other insurers? “We actually think we can bring it in” — meaning the plan’s premium prices — “under Aetna and Coventry,” Beilenson said.
Mike Leavitt, a former Secretary of Health and Human Services and governor of Utah said that governors need to take the lead in creating health insurance exchanges or the federal government will dictate how the exchanges should be run. “This is a profoundly important moment for states,” Leavitt said. “States need to lead. Too often, we have just deferred this to the federal government, and the federal government needs guidance (from the states) to do it.” Iowa Governor Terry Branstad said Iowans are “confused and, I think, very upset with what’s going on” with healthcare reform implementation. According to Branstad, consumers must take “ownership” of their health decisions and the costs.
Tags: Aetna, Center for Consumer Information and Insurance Oversight, Center for Medicare and Medicaid Services, Commonwealth Fund, Congress, Consumer Oriented and Operated Plans, Coventry, Department of Health and Human Services, Healthcare insurance exchanges, Kaiser Family Foundation, Mike Leavitt, Office of Insurance Programs, Patient Protection and Affordable Care Act, Private not-for-profit insurers, Terry Branstad, The Evergreen Project
Posted in Healthcare, Hospital Systems | No Comments »
Monday, June 27th, 2011
Seventy percent of Americans oppose cuts to Medicare and 57 percent are against cutting Medicaid, even when they are aware that the programs constitute an outsized weight in the federal deficit. Of the two wildly popular programs, Medicaid is the most vulnerable. 
Writing in the Washington Post about a report from the Kaiser Family Foundation about the health of Medicare and Medicaid, Ezra Klein says “It doesn’t matter whether Eric Cantor says he’s bargaining for the Ryan budget or not. The GOP cannot privatize and voucherize Medicare. They can’t even get close. It’s too easy an issue for Democrats, too dangerous an issue with seniors, and too slipshod a policy even for Michele Bachmann. The attack on Medicaid, however, is another story. That one might actually work. And if it does, it’ll actually be worse. ‘in-the-know political circles,’ says Chris Jennings, who ran President Bill Clinton’s healthcare reform efforts, ‘it’s just assumed Medicaid is going to be hit. No one is going to want to touch Medicare. Medicare is where the political juice is. But we’re going to need savings. So that leads to Medicaid.’ There are two reasons Medicaid is more vulnerable than Medicare. The first is who it serves. Medicaid goes to two groups of people: the poor and the disabled. Most of the program’s enrollees are kids from poor families, though most of the program’s money is spent on the small fraction of beneficiaries who are disabled and/or elderly. These groups have one thing in common: They’re politically powerless.”
It’s a little-known fact that Medicaid covers more people than Medicare. In 2010, according to the Department of Health and Human Services, Medicaid covered 53.9 million people, compared with Medicare’s 47.3 million. Additionally, Medicaid patients are also among society’s most vulnerable. “Kids (and) pregnant women are the vast majority,” according to Health and Human Services Secretary Kathleen Sebelius. “But then older seniors, many of whom are in nursing homes…and very disabled individuals” are also covered by Medicaid.
Although states and the federal government share the cost of Medicaid, what grates on some governors is the rules that come with the money. “Governors just want flexibility to run our states,” said Republican New Jersey Governor Chris Christie at the annual National Governors Association meeting in February. “We don’t want to pay 50 percent of the cost of Medicaid and have zero percent of the authority. And I don’t think that’s an unreasonable thing to be asking for.” Governor Haley Barbour of Mississippi agrees. “If I could get total flexibility, I would take a two percent cap in a heartbeat,” he said. Barbour’s preference is to receive a lump sum – what it gets now from the federal government, plus two percent to fund Medicaid.
Dr. Donald Berwick, administrator of the Center for Medicare and Medicaid Services, (CMS) said “There’s a right way to reform Medicare and a wrong way,” Berwick believes that the direction he is taking — modeled on his successful patient safety campaigns at the Institute for Healthcare Improvement – will bring about needed healthcare change. The Obama administration’s efforts to improve patient safety are more or less bipartisan. There is little cause to dispute CMS’ data: the agency spent $4.4 billion in 2009 caring for patients harmed in hospitals and an additional $26 billion on patients who were readmitted within 30 days. The Partnership for Patients, funded through the Patient Protection and Affordable Care Act (ACA), seeks to reduce preventable injuries by 40 percent and cut hospital readmissions by 20 percent in just two years. According to CMS, achieving the Partnership’s goals will result in 1.8 million fewer patient injuries, allow more than 1.6 million patients to recover complication-free and save up to $35 billion in health costs.
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius described contentious portions of the ACA as the inaugural steps toward entitlement reform. Sebelius criticized proposals to transform federal Medicaid funding into block grants for states. When some lawmakers asked her to speak about the Obama administration’s alternative proposal to rein in entitlement spending, Sebelius pointed to two provisions of the new law. The ACA created a new board of independent experts that will recommend Medicare payment cuts. Its recommendations will take effect automatically unless Congress blocks them — and proposes equivalent savings. According to Sebelius, the panel represents “a big step in terms of entitlement reform that actually doesn’t potentially cause harm to our seniors.” She also pointed to an HHS effort to create new methods of dealing with people who are eligible for both Medicare and Medicaid because those patients represent a lopsided share of the programs’ costs.
Tags: Block grants, Center for Medicare and Medicaid Services, Department of Health and Human Services, Disabled, Dr Donald Berwick, Ezra Klein, Governor Chris Christie, Institute for Healthcare Improvement, Kaiser Family Foundation, Kathleen Sebelius, Medicaid, Medicare, National Governors Association, Obama administration, Partnership for Patients, Patient Protection and Affordable Care Act, poor, President Bill Clinton, Representative Eric Cantor, Representative Michele Bachmann, Representative Paul Ryan, senior citizens
Posted in Healthcare, Hospital Systems | No Comments »
Monday, April 11th, 2011
A Congressional proposal to reform Medicare will transfer a significant share of the cost to the nation’s senior citizens – a constituency that is known for high voter turnout in elections. The Congressional Budget Office (CBO) added fodder for critics, concluding that the majority of future retirees would pay considerably more for healthcare under the “Path to Prosperity” approach — which turns Medicare into a voucher-like plan for Americans who are currently 54 and younger. Representative Paul Ryan
(R-WI), who introduced the plan, said “We don’t want to turn the safety net into a hammock that lulls people to lives of complacencies and dependencies, into a permanent condition where they never get on their feet.” Instead of coverage for a set of prescribed benefits, Americans in their mid-50s and younger would receive a federal payment to purchase private insurance from a choice of government-regulated plans. If the proposal becomes law, beginning in 2022, Americans would have a vastly different experience when they became eligible for Medicare. The age for eligibility would rise from 65 to 67, according to the CBO.
Ryan’s proposal slashes $1.4 trillion from Medicaid over the next decade. He proposes to cut $630 billion off the budget by more or less repealing the Patient Protection and Affordable Care Act’s provisions that extend coverage to include anyone living on less than 133 percent of the poverty rate — just under $30,000 for a family of four. Additionally, Ryan’s plan eliminates subsidies for private insurance premiums for those just above the poverty line. According to CBO estimates, nearly 17 million people without insurance would have been covered by the Medicaid expansion.
Representative Chris Van Hollen (D-MD), the ranking Budget Committee Democrat, said Republicans are protecting tax breaks for corporations and the wealthy to the detriment of the middle class and the poor. “It doesn’t reform Medicare, it deforms and dismantles it,” Van Hollen said. As for Medicaid, Ryan’s proposal “rips apart the safety net” for poor and older people. “A typical beneficiary would spend more for healthcare under the proposal,” according to the CBO analysis. “Although the uncertainty in future federal spending on healthcare would decrease under the proposal, that uncertainty would be transferred to future beneficiaries,” the CBO analysis said. “If the volume, complexity, and costs of medical services turned out to be greater than expected, future beneficiaries would pay higher premiums and cost-sharing amount than are currently projected.”
Ryan’s budget resolution would improve the nation’s overall fiscal health, cutting projected deficits in President Obama‘s budget and moving the federal government towards a surplus by 2040, according to the non-partisan CBO. Ryan believes that the cuts are necessary to save the programs. “This is not a budget. This is a cause,” he said. “The social safety net is fraying at the seams.” Chip Kahn, president of the Federation of American Hospitals, said that Ryan’s proposal would “result in the loss of health coverage for millions of low-income Americans, reduce critical benefits for others, and make it more difficult for hospitals, clinicians and other healthcare providers to deliver the care so many need.” Other critics maintain that Ryan’s approach will shift the higher costs to individuals, much as the change from defined-benefit pensions to 401(k) plans has increased retirement risk. Senior citizens, the disabled and the poor likely will pay more for healthcare, even as Washington pays less. Additionally, Ryan’s plan would permanently extend George W. Bush’s tax cuts.
“The idealized notion that older consumers would be making these annual choices may have some merit as an idea, but it doesn’t seem to be taking place in practice,” said Patricia Neuman, director of the Medicare Policy Project at the non-partisan Kaiser Family Foundation. Picking the right health plan could become even more critical if premiums outpace federal subsidies. In 2010, 50 percent of the nation’s Medicare recipients reported incomes of less than $21,000 a year, according to a Kaiser Family Foundation analysis.
In an opinion piece in the Seattle Post-Intelligencer, the “Monday Morning Economist” Stephen Herrington writes “The tax cut proposal is not getting the attention it deserves. If it shapes up to be anything like was described in Ryan’s Road Map, it will create massive dislocations and disruptions in the economy. Ryan’s plan was/is to cut the top tax bracket from 35 percent to 25 percent with the promise/expectation that this would not impact revenues. In a departure from the standard ‘trickle down’ excuse for tax cuts, Ryan meant/means to offset the admitted loss in revenues by eliminating all manner of deductions. The deductions in our current tax code, such as medical, mortgage and state income tax expense are there for a purpose. Eliminating them will introduce wild distortions in markets and effectively push the tax cuts for the rich onto the other 98 percent of us. Elimination of the medical expense deduction will intensify the impact of the Medicare/Medicaid part of the plan. It is as if Ryan thinks the magic of the free market can absorb any shock in real time. No more mortgage deduction? No problem, I just won’t buy a house at all until the lack of the mortgage deduction causes prices to fall by half.”
Tags: 401 (k) plans, Congress, Congressional Budget Office, Defined benefit pensions, Federal budget, Federation of American Hospitals, George W Bush, healthcare providers, House Budget Committee, Kaiser Family Foundation, Low-income Americans, Medicaid, Medicare, Medicare Policy Project, mortgages, Patient Protection and Affordable Care Act, President Barack Obama, Privatization, Representative Chris Van Hollen, Representative Paul Ryan, Ryan’s Road Map, Seattle Post-Intelligencer, senior citizens, Social safety net, Stephen Herrington, Tax bracket, tax cuts, vouchers, “The Path to Prosperity”
Posted in Healthcare, Hospital Systems | No Comments »
Wednesday, March 30th, 2011
As the Patient Protection and Affordable Care Act (ACA) celebrates its first birthday, the future of the law is still unclear, but its effects have been enormous. The debate over the law likely created the “tea party” movement. Last November, Republicans took control of the House of Representatives and strengthened their numbers in the Senate. Potential contenders for the 2012 Republican presidential nomination need only say one word, “Obamacare,” to get a negative reaction from a crowd. President Obama at times himself has struggled to ensure that his first term isn’t defined solely by this legislation.
Public opinion over the ACA remains divided, despite the efforts of Democrats to showcase how it will provide healthcare insurance to millions of uninsured Americans. Additionally, most Americans remain confused about what the healthcare overhaul actually accomplishes. Republicans considering a 2012 presidential race for the most part stand united in their opposition to the legislation. Former Minnesota Governor Tim Pawlenty is using his opposition to the law to gain a national following. “If courts do not do so first, as president, I would support the immediate repeal of Obamacare and replace it with market-based healthcare reforms,” Pawlenty said. Former Massachusetts Governor Mitt Romney is in a different position because he supported a similar law during his tenure.
Representative Steve King (R-IA), the Iowa Congressman who is in the vanguard to repeal the ACA, says that “America will never become the nation it can be if were saddled with Obamacare“, “I have a deep conviction that this is unconstitutional, that this is unsustainable, and I have a duty. And that doesn’t mean I sit back and wait for the Supreme Court to save America from itself. It’s my job to step up and lead.”
Taking a difference stance, Carmela Coyle, president and chief executive of the Maryland Hospital Association, said her group strongly supports the reform law and will work to assure that the effort translates into better and cost-effective care. “We support healthcare reform because hospitals see every day what happens when patients don’t have the healthcare coverage they need and can’t get their care at the right time and in the right setting. Expanding coverage was necessary, and it was right. We must ensure that the health coverage now guaranteed to many Marylanders is meaningful coverage.”
What’s the future of the Affordable Care Act? House Republicans, who say the law gives the federal government too much control and doesn’t cut costs, passed a repeal bill after they became the majority in January. Full repeal is unlikely unless Republicans successfully take control of the Senate and the presidency in the 2012 presidential elections. The current Democratic-led Senate will not vote to repeal and President Obama would certainly veto a repeal bill. Democrats argue the law’s reforms will slow the growth of healthcare costs while improving care and reducing the ranks of the uninsured. Republican efforts to withhold funds to block the law’s implementation will be DOA in the Senate. That leaves Republicans the option of picking apart the law regulation by regulation, a strategy that could prove more successful.
In the meantime, implementation is underway. “As we look forward with implementation of the health reform law, the states really become the focus now,” said Jennifer Tolbert, a principal policy analyst at the Kaiser Family Foundation. “When thinking about the coverage expansions in particular because it is going to be up to the states to implement the expansion of the Medicaid program for lower-income individuals and to create the new health-insurance exchanges that will provide access to private insurance for moderate and middle income individuals.”
Tags: Health insurance exchanges, healthcare insurance, healthcare reform law, House of Representatives, Kaiser Family Foundation, Lower-income individuals, Maryland Hospital Association, Medicaid, Mitt Romney, Obamacare, Patient Protection and Affordable Care Act, President Barack Obama, Public opinion, repeal, Republicans, Senate, Supreme Court, Tea Party, Tin Pawlenty, uninsured Americans
Posted in Healthcare, Hospital Systems | No Comments »
Wednesday, March 9th, 2011
Defying the odds – and facing President Barack Obama’s veto pen – the Republican-controlled House of Representatives voted to repeal the Patient Protection and Affordable Care Act (ACA); a move that was DOA in the Senate.
Despite considerable evidence to the contrary, approximately 50 percent of Americans are convinced that the healthcare law has been successfully repealed. A poll by the Kaiser Family Foundation found widespread public confusion about the law, with 22 percent of Americans incorrectly believing it has been repealed and another 26 percent unsure or unwilling to say. Even after extensive media coverage of the repeal effort, only 52 percent of Americans accurately responded that the healthcare law remained intact. According to the Kaiser Family Foundation, “There remains no consensus about whether to keep, expand, replace or repeal the law. Forty-eight percent are opposed to the law, while 43 percent favor it. Sixty-one percent of those polled oppose Congress cutting off funding of the law in order to block it, as many Republican lawmakers are considering.”
The Republican-sponsored repeal bill, curiously named the “Repealing the Job-Killing Health Care Law Act,” passed 245 – 189 with assistance from three Democrats. Majority Leader Harry Reid (D-NV) has refused to bring repeal to the Senate floor for a vote. President Obama has vowed to veto any repeal effort. Republicans have not introduced an alternative bill, although Speaker of the House John Boehner (R-OH) said Republicans will ask congressional committees to make “common-sense reforms” to expand coverage and cut costs, but told reporters no “artificial deadlines” were needed.
“As has been true since early in the debate, individual provisions of the new law are more popular than the law itself, complicating the debate over repeal,” the study notes. “So while the public in general is divided over whether to keep or repeal the legislation, if they could pick and choose, the large majority (roughly eight in 10 Americans) would keep the provisions providing tax credits to small businesses, and upward of seven in 10 would keep the provisions that close the Medicare doughnut hole, provide coverage subsidies to those of low and moderate income, institute the new voluntary long-term care insurance program known as the CLASS Act, and prohibit insurance companies from denying coverage based on pre-existing conditions.”
According to a USA TODAY/Gallup Poll, 32 percent of Americans would like to see the law repealed; 13 percent want to see the bill left as it stands. The poll found that 29 percent of Americans want to see minor changes and that 24 percent want major changes. Representative Ben Chandler, (D-KY), who voted against the law last year, said he voted against repeal because he thinks the law’s “bad” parts should be repealed piece by piece. “I will not vote to repeal parts of the law that protect central Kentuckians by preventing insurance companies from dropping people if they get sick, ending lifetime caps on coverage and eliminating pre-existing condition exclusions,” Chandler said.
Implementation of the law is continuing as planned, according to Health and Human Services Secretary Kathleen Sebelius. “I want the people who are benefiting from the Affordable Care Act — including families, seniors and small business owners — to know that this vote does not change the law and that this department will continue to work every day to implement this vital law.”
Tags: "Repealing The Job-Killing Health Care Law Act", CLASS Act, Democrats, Department of Health and Human Services, Healthcare law, House of Representatives, Kaiser Family Foundation, Kaiser Health News, Kathleen Sebelius, Medicare doughnut hole, Patient Protection and Affordable Care Act, pre-existing conditions, President Barack Obama, repeal, Representative Ben Chandler, Representative John Boehner, Republicans, Senate, Senator Harry Reid, Speaker of the House, USA TODAY/Gallup Poll, Veto
Posted in Healthcare, Hospital Systems | No Comments »
Friday, December 17th, 2010
The State of Arizona – facing soaring enrollments and shrinking revenues – has eliminated Medicaid coverage for some transplants of the heart, liver, lungs, pancreas and bone marrow. Because these treatments are usually considered to be life saving, the consequences for Medicaid patients in Arizona requiring transplantation are grim. The cut, which impacts approximately 100 Arizonans, is a clear demonstration of the fiscal pressure that states are facing.
“It’s a real sign of the times,” said Alan Weil, executive director of the National Academy for State Health Policy. “And I think this is a precursor to a much larger number of states having this discussion.” These policy implications are all the more striking, given the partisan framing of the healthcare debate. Republican arguments against the Patient Protection and Affordable Care Act frequently focus on the specter of healthcare rationing and even the so-called death panels. Democrats counter with the argument that – because 50 million Americans currently lack coverage – healthcare is already being rationed.
Diane Rowland, director of the Kaiser Commission on Medicaid and the Uninsured, said that Arizona’s move “is a classic example of making decisions based not on medical need but based on a budget. It results, potentially, in denial of care to individuals in a life-or-death situation.” Dr. Robert Gaston, president-elect of the American Society of Transplantation, agrees, noting that “It seems inappropriate that life-saving care has the potential to be withheld based solely on budgetary issues and the bureaucratic determination of relative benefits.”
Earlier this year, Arizona became the only state to almost eliminate its Children’s Health Insurance Program, which would have impacted 47,000 children from lower-income families. State legislators reversed this decision before the effective date, but only after concluding that the state might lose billions of dollars in matching money from the federal government
Tags: American Society of Transplantation, Arizona, Centers for Medicare and Medicaid Services, Children’s Health Insurance Program, death panels, Economic downturn, Governor Jan Brewer, Healthcare rationing, Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, Medicaid, Medicaid cuts, National Academy for State Health Policy, Organ transplantation, Patient Protection and Affordable Care Act
Posted in Healthcare, Hospital Systems | No Comments »
Wednesday, December 1st, 2010
A recent investigation by the House of Representatives’ Committee on Energy and Commerce has found that many individual health insurance policies do not cover maternity care. The news is no surprise for women who are covered by these policies and experienced a rude awakening when they became pregnant. The four largest for-profit health insurers – Aetna, Humana, UnitedHealth Group and WellPoint – don’t cover normal deliveries for their members who have individual policies. The committee’s report confirms a 2009 report by the National Women’s Law Center (NWLC) that scrutinized 3,600 individual policies and determined that just 13 percent provide maternity coverage. For women with these policies, it gets even worse should they become pregnant. At that point, if they apply for coverage in the individual market, insurers typically determine that pregnancy is a pre-existing medical condition and deny coverage on that basis. Maternity riders are offered on some policies, but they are extremely expensive, provide very limited coverage and might take as long as a year to become effective, according to the NWLC. The average cost of maternity care – nine months of prenatal care, three months of post-partum care and a delivery without complications – averaged $10,652 in 2007, a March of Dimes study reported. The Pregnancy Discrimination Act of 1978 exempts companies with less than 15 employees and individual policies from providing maternity coverage, although some states maintain stricter requirements. This year, 12 states mandate maternity coverage in the individual insurance market and 17 in the small-group market, according to statehealthfacts.org, a project of the Kaiser Family Foundation. Thanks to the Patient Protection and Affordable Care Act, this coverage gap will cease to exist in 2014.
Tags: Aetna, America’s Health Insurance Plans, For-profit insurers, House Committee on Energy and Commerce, House of Representatives, Humana, Individual insurance policies, Kaiser Family Foundation, March of Dimes, Maternity coverage, National Women’s Law Center, Patient Protection and Affordable Care Act, Pregnancy, Pregnancy Discrimination Act of 1978, UnitedHealth Group, Wellpoint
Posted in Healthcare, Hospital Systems | No Comments »
Wednesday, July 21st, 2010
Healthy San Francisco, the innovative program that provides affordable healthcare services to an estimated 53,000 uninsured, was given the green light when the Supreme Court turned down a business group’s challenge. The Supreme Court decision “is a victory for the 53,0000 San Franciscans who have healthcare today through our groundbreaking universal healthcare program,” said Mayor Gavin Newsom, who spearheaded the program. “The high court’s decision…ensures we can continue providing healthcare coverage to thousands who otherwise would go without.”
Healthy San Francisco won unanimous approval from the city’s Board of Supervisors in 2006 and went into effect on January 1, 2008. The law requires businesses with 20 or more workers to provide a certain degree of healthcare coverage for their employees. Alternatively, they can pay a fixed amount into a city healthcare pool for every hour the uninsured employee works. The Golden Gate Restaurant Association sued to overturn the law, claiming that the city could not legally force businesses to provide health benefits to its workers or participate in the city pool. The Ninth U.S. Circuit Court of Appeals rejected that argument, as did the Supreme Court.
Healthy San Francisco provides a safety net to the city’s adults who have lacked healthcare insurance for 90 days. It provides access to a network of hospitals and public and private clinics that provide low- or no-cost-care. Tangerine Brigham, the program’s director, notes that “So far, about 1,100 employers have selected Healthy San Francisco as their option.” Because participants are given a personal physician, expensive ER visits to San Francisco General Hospital fell 27 percent in the first years of the program. A 2009 study by the Kaiser Family Foundation determined that 94 percent of participants were satisfied with Healthy San Francisco.
Tags: Board of Supervisors, Healthy San Francisco, Kaiser Family Foundation, medical home, San Francisco, United States Supreme Court
Posted in Economics, Healthcare, Hospital Systems, Wellness Centers | No Comments »
Thursday, May 27th, 2010
As healthcare reform is ushered in over the next few years, Medicaid will play a leading role in bringing coverage to as many as 20 million Americans who don’t have the resources to buy insurance on their own. “Medicaid is finally living up to its role of serving as the healthcare safety net for poor and lower-income individuals and families,” said Jennifer Tolbert, principal policy analyst with the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.
Healthy adults under the age of 65 will qualify for Medicaid starting in 2014 if they earn $14,404 in current dollars for a single person or $29,326 for a family of four. That adds up to 133 percent of the federal poverty level. Most asset requirements will be abolished, so people who lose their jobs can get health coverage even if they own a home or have money saved for retirement. Bringing as many as 20 million people into the Medicaid system is a herculean task, even though four years have been set aside to make the changes necessary to make enrollment easier. Many Americans don’t even know that they will be eligible, and it is the states’ responsibility to inform them.
“We’re pretty busy, I can tell you that,” said Ann Kohler, director of health services with the American Public Human Services Association, which administers the National Association of State Medicaid Directors. “Many of my members opposed the bill and still do, frankly. But it is the law, and we’re working hard to get it implemented.” The most frequently cited obstacles include the fact that many doctors refuse to accept Medicaid payments because it doesn’t reimburse as much as private plans or Medicare. Additionally, filing claims involves significant paperwork and lengthy payment delays.
The federal government is sweetening the pot for physicians by increasing Medicaid payments for primary care to Medicare levels in 2013 and 2014. That may not be enough, though. Physicians prefer to avoid Medicaid patients because they tend to be sicker than insured patients, miss appointments and do not cooperate with treatment plans.
Tags: American Public Human Services Association, healthcare reform, Kaiser Family Foundation, Medicaid, Medicare, National Association of State Medicaid Directors, Robert Wood Johnson Foundation, uninsured Americans
Posted in Healthcare, Hospital Systems | No Comments »
