Archive for May, 2011
Thursday, May 26th, 2011 | Uncategorized | Comments Off
The Patient Protection and Affordable Care Act (PPACA) establishes four levels of coverage based on the concept of “actuarial value,” which represents the share of health care expenses the plan covers for a typical group of enrollees. As plans increase in actuarial value – bronze, silver, gold, and platinum – they would cover a greater share of enrollees’ medical expenses overall, though the details could vary across plans.
The levels of coverage provided for in the PPACA are central to the coverage people will get and how they will ultimately perceive the effects of the health reform law. But an actuarial value is not as intuitive for people as specific deductibles and other out-of-pocket costs. Additionally, estimates of deductibles and other coverage features were not released by the Congressional Budget Office during the legislative debate.
Because projections of deductibles are subject to variation in estimating techniques and databases used, to present the most likely range of out-of-pocket costs, the Foundation commissioned separate analyses from three different actuarial consulting firms to present a range of potential estimates.
The study is part of the new Kaiser Initiative on Health Reform and Private Insurance, which will inform federal and state policymakers as they implement the PPACA and examine the implications of changes in the private insurance market under the health reform law.
Tuesday, May 17th, 2011 | Uncategorized | Comments Off
On May 11, following a two-day mark-up, the House Energy and Commerce Committee passed H.R. 5, a medical liability reform bill, by a vote of 30-20. The legislation will cap non-economic damages in malpractice cases at $250,000 and set other restrictions on lawsuits against doctors.
The bill still needs to be heard by the Judiciary Committee and then, if approved by that panel, would need to be voted on by the full House, which may occur as soon as Memorial Day.
President Obama has said that he is open to working with the GOP on tort reform, but he isn’t a fan of the damages cap in H.R. 5, and Senate leadership has made it clear that the bill will not advance there. The Congressional Budget Office said the Energy and Commerce bill would save the federal government roughly $54 million over 10 years.
Friday, May 13th, 2011 | Uncategorized | Comments Off
Support for repeal of the national health care law has rebounded after falling below 50% for the first time since it was passed by Congress in March of last year.
The latest Rasmussen Reports national telephone survey shows that 57% of Likely U.S. Voters now at least somewhat favor repeal of the law. Thirty-six percent (36%) oppose repeal. The new findings include 44% who Strongly Favor repeal of the measure and 26% who are Strongly Opposed. (To see survey question wording, click here.)
Rasmussen Reports has tracked support for repeal every week since the bill became law. Prior to last week, support for repeal has ranged from a low of 50% to a high of 63%. Last week, for the first time ever, support for repeal fell below 50%.
Eighty-seven percent (87%) of Republicans and 56% of voters not affiliated with either major party favor repeal. Sixty percent (60%) of Democrats oppose it.
Fifty percent (50%) of all voters believe the health care law will be bad for the country. Thirty-two percent (32%) hold the opposite view and believe the law will be good for the nation. Four percent (4%) say it will have no impact and 13% aren’t sure.
Seventy-seven percent (77%) of all voters who have health insurance rate their coverage as good or excellent. Just four percent (4%) feel their coverage is poor. These figures have shown little change since the debate over the president’s health care proposal began. In the summer of 2009, a Wall Street Journal article noted that the most significant obstacle facing the president’s plan was that most voters were happy with their coverage.
(Want a free daily e-mail update? If it’s in the news, it’s in our polls). Rasmussen Reports updates are also available on Twitter or Facebook.
The survey of 1,000 Likely Voters was conducted on May 7, 2011 by Rasmussen Reports. The margin of sampling error is +/- 3 percentage points with a 95% level of confidence. Field work for all Rasmussen Reports surveys is conducted by Pulse Opinion Research, LLC. See methodology.
Voters with health insurance remain closely divided over the potential impact of the health care law on their coverage. Forty-one percent (41%) say the law makes it at least somewhat likely that they will have to change insurance, with 22% who say it’s Very Likely. But 45% think a forced change of coverage is unlikely, including 17% who say it is Not At All Likely. Fourteen percent (14%) are not sure.
Belief that the new law will force a change in insurance coverage has ranged from 34% to 51% in surveys since the bill became law.
The majority (55%) of Republicans think the law is likely to force them to change their health insurance. Most Democrats (57%) and a plurality (47%) of unaffiliated voters don’t believe that to be the case.
Most voters still believe free market competition rather than more government regulation is the better way to reduce the cost of health care in America.
Voters continue to believe tax cuts and decreases in government spending will benefit the nation’s economy. But most also still think government spending will go up under the Obama administration.
Senate Republicans are calling for side-by-side votes on President Obama’s 2012 budget proposal and the House-approved debt reduction plan by Republican Congressman Paul Ryan. While opposition to Ryan’s proposal is increasing, even more voters are saying no to the president’s.
Thursday, May 12th, 2011 | Uncategorized | Comments Off
Associated Press
May 12, 2011
President Barack Obama’s main idea for getting quality health care at less cost was in jeopardy Wednesday after key medical providers called his administration’s initial blueprint so complex it’s unworkable.
Just over a month ago, top officials released long-awaited draft regulations for “accountable care organizations,” networks of doctors and hospitals that would collaborate to keep Medicare patients healthier and share in the savings with taxpayers. Obama’s health care overhaul law envisioned quickly setting up hundreds of such networks around the county to lead a bottom-up reform of America’s bloated health care system.
But in an unusual rebuke, an umbrella group representing premier organizations such as the Mayo Clinic wrote the administration Wednesday saying that more than 90 percent of its members would not participate, because the rules as written are so onerous it would be nearly impossible for them to succeed.
“It’s not just a simple tweak, it’s a significant change that needs to be made,” said Donald Fisher, president of the American Medical Group Association, which represents nearly 400 large medical groups around the country providing care for roughly 1 in 3 Americans. Its members, including the Cleveland Clinic, Intermountain Healthcare in Utah, and Geisinger Health System in Pennsylvania, had been seen as the vanguard for accountable care.
The medical groups say they are worried they will be left holding the bag for losses, that the government has designed things so there is no easy way to tell which patients are part of the program, and that there’s no reliable way to adjust for patients who are sicker and require closer follow-up and more expensive treatments.
The deadline for public comments on the proposed regulations is still weeks away, but Fisher said “we needed to get their attention early on, so (the administration) could be thinking about how major changes are needed to make these regulations viable.”
Medicare spokesman Brian Cook said the agency is doing extensive outreach to explain and take feedback on the regulations and hat “we will carefully consider this input.”
“We are confident that providers’ decisions on whether to participate in the program will be made on the basis of the final rule, which will reflect the feedback we receive,” added Cook.
Many in the health care industry were silent partners backing Obama’s overhaul law, but disappointment over the accountable care rules has put a chill into the relationship. During the congressional debate, Obama extolled Mayo and Geisinger, holding them up as a model of what he wanted to achieve for the nation. Industry criticism of his administration’s proposal has been building up for weeks in online forums.
“This has all the hallmarks of a party that nobody comes to, unless there is a serious rethinking,” said former Medicare administrator Gail Wilensky, who ran the agency under President George H.W. Bush.
Wilensky said the idea of coordinating care isn’t the problem, but “it sounds like (the administration) really overshot the mark.”
The regulations are “overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive,” the medical group association said in its letter. One of the major problems seems to be that medical groups have little experience in managing insurance risk, and the administration blueprint rapidly exposes them to potential financial losses.
Without major changes, “we fear that very few providers will enroll … and that (Medicare) and the provider community will miss the best opportunity to inject value and accountability into the delivery system.”
Private insurers are also experimenting with versions of the accountable care idea, but successful adoption by Medicare is seen as the key to spreading it across the country. The Obama administration had estimated as much as $960 million in savings from the first three years of the program, and bigger amounts thereafter.
Fisher, the medical association head, said he does not think the administration will easily back off its approach, because on paper it saves the government money.
Wednesday, May 11th, 2011 | Uncategorized | Comments Off
By David G. Savage, Washington BureauMay 11, 2011
Reporting from Richmond, Va.—
The Obama administration received a friendly hearing for its defense of the new national healthcare law from three judges of the U.S. 4th Circuit Court of Appeals, all of whom were Democratic appointees.
By their comments and questions Tuesday, the judges signaled they were likely to uphold provisions in the law that require virtually all Americans to have health insurance by 2014 or pay a penalty.
In December, a federal district judge here became the first to strike down the new healthcare law as unconstitutional. The hearing Tuesday was the first before a federal appeals court.
Regardless of how they rule, the appellate judges are not likely to have the final word. Two other federal appeals courts are to hear arguments on the same issue in the next month, and the Supreme Court is almost certain to consider the constitutionality of the healthcare law in the year ahead.
At issue is whether Congress has the power to regulate the national health insurance market by requiring all those who can afford insurance to pay for coverage.
The Constitution gives Congress broad authority “to regulate commerce” and to “make all laws which shall be necessary and proper” to carry out that power. Citing those provisions, the administration’s lawyers argued that requiring everyone to pay for insurance is necessary if insurers are required to accept all buyers.
Otherwise, said Acting Solicitor Gen. Neal Katyal, people could wait and “buy insurance on the way to the hospital.”
Judge Andre Davis, an Obama appointee from Maryland, seemed to agree. Congress has the “practical power” to make the regulation work. And it is a “slam dunk” to say it is necessary for everyone to participate, he said.
Judge James Wynn Jr., another Obama appointee, said Congress saw the issue as a matter of personal responsibility. “Citizens use healthcare. Someone has to pay for it,” he said.
Under the rules of the 4th Circuit, judges are picked to sit on particular cases by “a computer program designed to achieve total random selection,” the court said. The third member of the panel, Judge Diana Motz of Maryland, is a President Clinton appointee.
The judges heard two cases. One was brought by Virginia Atty. Gen. Ken Cuccinelli, a Republican, who said he was acting on behalf of Virginians who did not want to buy health insurance. But his lawyer struggled to explain how the state had the legal standing to challenge the healthcare mandate, which applies to individuals.
“We have sovereign standing,” said Duncan Getchell Jr., the state’s solicitor general. “That gives us a ticket into federal court.”
All three judges made skeptical comments and strongly hinted they would toss out Virginia’s suit.
The second case was brought by Liberty University, a Christian school founded by the Rev. Jerry Falwell, and its plaintiffs include individuals who object to the healthcare law. Even Katyal agreed these plaintiffs had standing to sue.
But Liberty lawyer Mathew Staver did not fare much better. He argued that his clients were “inactive bystanders,” not participants in interstate commerce. Therefore, they are beyond the reach of federal regulation, he argued.
The three judges said Congress had made the reasonable assumption that virtually everyone would need healthcare sometime in life. And very few can afford the cost of a catastrophic accident, they said.
Katyal said hospitals and taxpayers had to pay about $43 billion a year to cover the medical expenses of people who have no insurance. That adds $1,000 a year to an average family’s healthcare costs, he said.
Copyright © 2011, Los Angeles Times
Wednesday, May 11th, 2011 | Uncategorized | Comments Off
Your auto policy may include six coverages. Each coverage is priced separately.
1. Bodily Injury Liability
This coverage applies to injuries that you, the designated driver or policyholder, cause to someone else. You and family members listed on the policy are also covered when driving someone else’s car with their permission.
It’s very important to have enough liability insurance, because if you are involved in a serious accident, you may be sued for a large sum of money. Definitely consider buying more than the state-required minimum to protect assets such as your home and savings.
2. Medical Payments or Personal Injury Protection (PIP)
This coverage pays for the treatment of injuries to the driver and passengers of the policyholder’s car. At its broadest, PIP can cover medical payments, lost wages and the cost of replacing services normally performed by someone injured in an auto accident. It may also cover funeral costs.
3. Property Damage Liability
This coverage pays for damage you (or someone driving the car with your permission) may cause to someone else’s property. Usually, this means damage to someone else’s car, but it also includes damage to lamp posts, telephone poles, fences, buildings or other structures your car hit.
4. Collision
This coverage pays for damage to your car resulting from a collision with another car, object or as a result of flipping over. It also covers damage caused by potholes. Collision coverage is generally sold with a deductible of $250 to $1,000—the higher your deductible, the lower your premium. Even if you are at fault for the accident, your collision coverage will reimburse you for the costs of repairing your car, minus the deductible. If you’re not at fault, your insurance company may try to recover the amount they paid you from the other driver’s insurance company. If they are successful, you’ll also be reimbursed for the deductible.
5. Comprehensive
This coverage reimburses you for loss due to theft or damage caused by something other than a collision with another car or object, such as fire, falling objects, missiles, explosion, earthquake, windstorm, hail, flood, vandalism, riot, or contact with animals such as birds or deer.
Comprehensive insurance is usually sold with a $100 to $300 deductible, though you may want to opt for a higher deductible as a way of lowering your premium.
Comprehensive insurance will also reimburse you if your windshield is cracked or shattered. Some companies offer glass coverage with or without a deductible.
6. Uninsured and Underinsured Motorist Coverage
This coverage will reimburse you, a member of your family, or a designated driver if one of you is hit by an uninsured or hit-and-run driver.
Underinsured motorist coverage comes into play when an at-fault driver has insufficient insurance to pay for your total loss. This coverage will also protect you if you are hit as a pedestrian.
Are you fully protected? Contact us today to make sure.
Tuesday, May 10th, 2011 | Uncategorized | Comments Off
By Ros Krasny
May 10, 2011
(Reuters) BOSTON | Mon May 9, 2011 12:10am EDT – Almost everyone in Massachusetts has health insurance under a state mandate, but many doctors do not accept the subsidized insurance programs available to low-income residents, a new study shows.
Residents in some areas also face long waits in getting doctors’ appointments, or find that overstretched primary care practices are not taking on new patients.
“Insurance coverage doesn’t equal access to care,” said Alice Coombs, president of the Massachusetts Medical Society and an emergency room physician,
Massachusetts’ health care program was introduced five years ago by then-governor Mitt Romney, a Republican now expected to run for president in 2012 after falling short in 2008.
The state’s program is often regarded as a model for President Barack Obama’s 2010 health care reforms. Conservatives have criticized Romney for his support of the state’s plan, although he has said it was designed for Massachusetts and would not work as a national plan.
The medical society on Monday issued its annual Physician Workforce survey, which was conducted in February and March. More than 23,000 doctors and students are members of MMS, which publishes the New England Journal of Medicine.
Coombs said that despite its problems, Massachusetts has done “an incredible job” with health care. Issues such as a shortage of doctors in poorer communities are not unique to the state, she noted.
“It’s a success in terms of the number of patients who have seen a doctor in the past few years, but the physician workforce has been strained,” Coombs said.
Massachusetts, like much of the nation, has a severe shortage of doctors in primary care — internists and family physicians — because those fields are less lucrative.
“We need more doctors in primary care. There’s no getting around that fact,” said Coombs.
Many primary care doctors do not accept MassHealth, the state’s version of Medicaid, and even less accept Commonwealth Care and Commonwealth Choice, programs for low- and moderate-income residents.
More than half of primary care practices are not taking new patients, especially patients for whose treatment they will be paid at a much lower level than for those carrying private health insurance.
Long wait times are common — almost seven weeks, on average, for a non-emergency appointment for internal medicine. The average wait time for pediatricians was 24 days, the MMS study showed.
New patient wait times in Massachusetts jumped from 2006 to 2007 after the initial implementation of the state health care reform law and have remained high. As a result, the rate of emergency room visits to receive care also has stayed high.
More lucrative specialist practices — gastroenterology, cardiology, obstetrics/gynecology and orthopedics — were in most instances taking new patients, although long wait times were still seen, MMS said.
“There really is a maldistribution of medical workforce resources,” said Coombs.
Tuesday, May 10th, 2011 | Uncategorized | Comments Off
Associated Press
May 10, 2011
President Barack Obama’s health care overhaul will get its first oral arguments in federal appeals court Tuesday when a three-judge panel hears two Virginia cases — one that upheld the law and another that struck down its key provision.
Nine lawsuits challenging the law are pending on appeal, but the Virginia cases before the 4th U.S. Circuit Court of Appeals are the first to reach the oral argument stage. Thirteen cases have been dismissed with no appeal filed, and nine are pending in district courts, according to federal officials.
In the most prominent of the two Virginia cases, U.S. District Judge Henry E. Hudson struck down the health care law’s key provision: a requirement that individuals buy health insurance or pay a penalty starting in 2014. Thirty-one lawsuits challenging the law have been filed nationally, and Hudson — a 2002 appointee of President George W. Bush — was the first judge to strike down any of its provisions. Hudson left the rest of the law intact.
“An individual’s personal decision to purchase — or decline to purchase — health insurance from a private provider is beyond the historical reach of the Commerce Clause,” Hudson wrote in the Dec. 13 opinion, which the U.S. Justice Department promptly appealed.
U.S. District Judge Norman K. Moon in Lynchburg reached the opposite conclusion in a lawsuit filed by Liberty University, the conservative Christian school founded by the Rev. Jerry Falwell. Two weeks before Hudson’s ruling, the 1997 appointee of President Bill Clinton ruled that the mandate is a proper exercise of congressional authority under the Commerce Clause.
Court officials expect a packed house for the back-to-back hearings. Courtroom doors will be opened two hours early, and a closed-circuit television feed of the proceedings will be shown in a second courtroom. Also, for the first time, the court will make an audio recording of the hearings available on its website later in the day.
The appeals court in Richmond will hear the Liberty case at 9:30 a.m., then the lawsuit filed by Virginia Attorney General Kenneth T. Cuccinelli. The hearings are scheduled to last 40 minutes each, and rulings are expected in a few weeks.
Cuccinelli said Monday his team spent about an hour and a half practicing on the eve of the arguments. They had the advantage, he said, because they will get to hear the Liberty case and then will go last in their case, so they will know what the judges’ questions are.
“It’s probably the most important case any of the lawyers on the matter will ever work on in their lives, and we all recognize that’s what it is,” he said. “But it is straight legal argument. We’ve done the work and we’re ready to go.”
Neither side will know which three justices from the 14-member bench will hear the cases before Tuesday morning.
“Regardless of whether the Fourth Circuit panel hearing the case is composed of liberal judges like Diana Motz or conservatives like J. Harvie Wilkinson III, the result should be the same: the ACA is constitutional,” said Elizabeth Wydra, chief counsel for the Constitutional Accountability Center, which filed brief in the case defending the constitutionality of the health care overhaul.
Cuccinelli said if he is not successful, he will appeal directly to the U.S. Supreme Court.
“We’d like a good hearing and a good opinion, obviously, out of the 4th Circuit, but at the same time this is all just in the course of doing business and we don’t want to get overwrought about it even as important as it is,” he said.
Cuccinelli asked the Supreme Court to take up his case without waiting for an appeals court review, but his petition — which the Justice Department opposed — was rejected. The case could still reach the Supreme Court in time for a decision by early summer 2012.
Cuccinelli said he was confident, but acknowledged that the case was unprecedented and anything could happen.
“If I had to bet on one side or the other, I’d bet on us,” Cuccinelli said. “But I wouldn’t bet everything.”
Monday, May 2nd, 2011 | Uncategorized | Comments Off
The federal debt and deficit also are top of mind for members of Congress as the nation nears its statutory debt limit. Treasury Secretary Timothy Geithner has said that the nation will hit the debt limit by May 16 but that Treasury can take steps to avoid a default until July 8. These talks could have health care implications, as many of the deficit-limiting proposals and spending cuts being discussed involve government-related and PPACA health care spending programs. Republicans are pressing for limits on federal spending in exchange for raising the debt ceiling, and House Majority Leader Eric Cantor (R-VA) has suggested that Republicans might extend debate on the measure well beyond May 16.
The so-called “Gang of Six,” a bipartisan group of senators working on deficit reduction plans, is widely expected to release its proposal in the near future. The proposal will be based on recommendations from the National Commission on Fiscal Responsibility and Reform, which were released in December 2010 and included significant health care changes, including the possibility of eliminating the federal income tax exclusion for employer-based health coverage, as well as eliminating the PPACA CLASS Act provisions that would create a new federal long-term care program. Members of the so-called Gang of Six are Sens. Mark Warner (D-VA), Saxby Chambliss (R-GA), Kent Conrad (D-ND), Dick Durbin (D-IL), Tom Coburn (R-OK) and Mike Crapo (R-ID).
In addition to the Gang of Six talk, on May 5 Vice President Biden will convene a bipartisan group of members of Congress for the first in a series of negotiations on deficit reduction. President Obama called for the group in an April 13 speech on deficit reduction. Members of the group are:
- Senate Finance Committee Chairman Max Baucus (D-MT)
- Senate Appropriations Committee Chairman Daniel Inouye (D-HI)
- Senate Minority Whip Jon Kyl (R-AZ)
- House Majority Leader Eric Cantor (R-VA)
- Assistant Democratic Leader Rep. James Clyburn (D-SC)
- House Budget Committee Ranking Member Chris Van Hollen (D-MD)
Monday, May 2nd, 2011 | Uncategorized | Comments Off
AHIP HI-WIRE
Douglas Schulz
May 02, 2011
Roughly one-quarter of large companies in the U.S. have an on-site clinic and the number of such clinics is expected to grow by at least 15% per year over the next 5 years.
In many ways, on-site clinics are an example of the use of preventative services to improve long-term health and thus reduce the use of more intensive and expensive medical services in the future.
Two new stories from today show that an awareness of that potential savings is a common driving force for the growth of on-site clinics.
“A Culture of Health” published today in Human Resource Executive Online discusses how the Mayo Clinic, Anderson Corp., and Union Pacific Railroad Corp. are using on-site clinics to keep their employees healthy.
“Creating a healthier workplace” published today in the Appleton (Wisconsin) Post-Crescent explores several local businesses that have engaged various flavors of on-site clinics.
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