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Health care insurance companies seem to be having a field day profits-wise, as many Americans choose to postpone, or forgo, medical care.
According to a feature on The New York Times, the United Health Group (UHG), among the nation’s largest health insurance providers, revealed to analysts that there has been a drop in insured hospital stays. Another insurer, Cigna, also indicated decreased levels of medical use. Despite this, however, insurance companies are still pushing for increases in their premiums, citing the fact that they need protection from increases in the price of health care, as well as a potential increase in demand once people have more money to spend on health care.
Doctors shared that people nowadays have become more budget-conscious. Dr. Jim King, a family practice physician in rural Tennessee, shared: “I am noticing my patients with insurance are more interested in costs… Gas prices are going up, food prices are going up. They are deciding to put some of their health care off .” As an example, the feature mentioned that some patients may choose not to drive 50 miles to see a specialist due to the cost of gas.
Some people find that even if they have insurance, they still do not have enough cash to shell out for the necessary co-payments. Significant co-payments have also triggered a shift among patients for generic medicines, as opposed to brand name drugs.
Scrimping on health care costs at this time might also mean that patients are being tempted to forgo such tests as colonoscopies or mammograms, as some plans may still call for patients to spend up to $500 for these procedures.
A provision in the health care reform law, which called for the filing of a 1099 tax form for purchases over $600, has been repealed by the Senate. The provision had been drafted to prevent tax fraud, as well as to raise funds for health care reform.
The Senate voted 87 to 12 in favor of the repeal, according to a report on CNN. Since the House has already given its approval for the bill, it is now slated to go directly to President Barack Obama. The President has not yet revealed whether he is inclined to sign the repeal, although sources from both the Republican and Democrat parties have indicated that the President might sign the legislation.
The provision did not sit well with businesses, who pointed out that it was too burdensome for them.
According to an aide of Sen. Mike Johanns of Nebraska, the senator’s efforts towards having the provision repealed were geared towards reducing the workload on businesses. Senate Republican Leader Mitch McConnell, on the other hand, commented that he hoped that the vote would be the first of “many successful repeal votes related to the disastrous health spending bill Democrats passed last year.”
After the legislation was passed, White House Press Secretary gave a statement that indicated that the administration was “open to working with Republicans and Democrats to improve the health reform law. Carney added further: “We are pleased Congress has acted to correct a flaw that placed an unnecessary bookkeeping burden on small businesses… And the administration remains eager to work with anyone with ideas about how we can make health care better or more affordable for all Americans.”
Among government workers in the United States, military retirees enjoy arguably the best lifetime health benefits. The premiums are a mere fraction of those in other government sectors as well as those in the private sector, the deductibles are low and co-pays are limited.
While costs of health care in the private sector have increased between 5 to 10 percent per year since 1995, premiums for TRICARE, the health care program for those serving military service members, retirees and their families, have not changed in 16 years. However, with TRICARE costs projected to hit $65 billion in 5 years, Pentagon says it needs to charge higher fees.
The proposal, which is part of the 2012 defense budget request, would raise premiums for more than 500,000 retirees by $2.50 per month for individuals and $5 per month for families. It would also raise annual enrollment fees from $230 to $260 for individuals and from $460 to $520 a year for families.
Pentagon’s plans to raise health care fees for working-age retirees have been met by varied reactions. Although some experts believe that even with the proposed fee hikes, the military’s health program is still so much more affordable compared to private sector health plans, the proposal’s opponents insist that lifetime health care was part of an agreement made with retired service members for risking their lives on the battlefield.
The Patient Protection and Affordable Care Act will increase Medicare benefits, adding benefits like a free annual checkup and other free preventive care services. However, a survey on 460 seniors aged 65 and older conducted by Extend Health revealed that 70% believe the new law will reduce their Medicare benefits.
The survey also revealed the following:
* 72% expect reductions in their choice of Medicare Advantage or Medigap insurance plans
* 64% expect reductions in their choice of Part D prescription drug plans
* 87% expect increases in the cost of their Medicare insurance premiums
* 84% expect increases in their prescription drug premiums
* 82% expect increases in their out-of-pocket prescription drug expenses
Extend Health, Inc. operates the nation’s largest private Medicare exchange. The survey, which is the last of of four surveys conducted between December 2009 and December 2010 to track seniors’ confidence in Medicare, was conducted from December 10-17, 2010.
CEO of Extend Health Bryce Williams said “These survey results are a reminder of the complexity of our health care system. When you couple that with media coverage and points of view from individuals and organizations with their own political agendas, it can make it virtually impossible for smart, well-educated people to separate fact from fiction. To reform health care, we need to end the confusion and instead empower consumers to make informed choices.”
On December 2, 2010, the Department of Health and Human Services launched a 10-year plan called “Healthy People 2020”. The initiative includes the new goals and objectives for health promotion and disease prevention of the United States for the next ten years.
HHS Secretary Kathleen Sebelius said: “The launch of Healthy People 2020 comes at a critical time… our challenge and opportunity is to avoid preventable diseases from occurring in the first place.”
The press release for the program shares the following statistics: 7 out of 10 Americans succumb to such chronic diseases as heart disease, cancer, and diabetes. Of the annual national health spending of the United States, 75 percent goes to costs that can be associated with these chronic diseases. These diseases are, however, caused by risk factors that are largely preventable.
Howard K. Koh, M.D., M.P.H., Assistant Secretary for Health, shared: “Too many people are not reaching their full potential for health because of preventable conditions… Healthy People is the nation’s road map and compass for better health, providing our society a vision for improving both the quantity and quality of life for all Americans.”
The Healthy People initiative is based on the feedback of key stakeholders, including public health and prevention experts; federal, state, and local government officials, and a consortium of more than 2,000 organizations. In addition, it also took into consideration input from the general public.
The new initiative now includes the following topic areas, among others: adolescent health, blood disorders and blood safety, genomics, healthcare-associated infections, and lesbian, gay, bisexual and transgender health.
Health care insurance providers offer a wide variety of coverage plans, and among them is one called the “mini-med plan”. This type of plan offers very limited coverage for doctor, hospital and medicine bills. There are many workers in the United States for whom the only type of health care coverage offered is the mini-med plan, a plan which offers very limited benefits.
The thing is, there are companies who are not as up-front as they ought to be when they sell these mini-med plans, so much so that consumers could not help but be caught painfully unaware when their coverage suddenly runs out. These companies sometimes beat around the bush and confuse consumers with bureaucratic language that only they can understand.
This is being remedied, however, by a new guidance issued by the Department of Health and Human Services (HHS). Moving forward, health insurers that offer these “mini-med” plans are required to notify consumers, in plain language, of the fact that their plans offer “extremely limited benefits.” In addition, the HHS has also placed a restriction on the sale of new mini-med plans.
Kathleen Sebelius, Secretary of the Department of Health and Human Services, gave the following statement as part of a press release on the HHS website: “The Affordable Care Act is giving consumers more control over their health care by providing them with information about their health insurance options… Now, we’re taking an unprecedented step to ensure consumers are informed when they purchase policies that offer limited coverage.”
The health care reform law has been met with a lot of debates and criticisms since the time it was conceived. Many have been questioning whether it could really improve America’s health care system and how long its effects can be felt. What some people might not know is that in the years to come, the health care reform law can bring so much more into the treatments that American patients receive.
A provision has been included in the law which will allow the creation of a research institute that will try to find the cure to diseases that have long plagued not only Americans, but the whole human race. The law will set aside $500 million for the new non-profit organization which will be like a “Patient-Centered Outcome Research Institute” that will act as the country’s guiding force for comparative effectiveness research. It works by comparing different measures to cure health problems to be able to find the most effective way to cure or prevent diseases.
The objective of the whole idea is to be able to save money by finding the best cure at the most reasonable expense for patients. It is also believed that comparative research will determine whether cheaper priced medicine or drugs, medical devices, and even surgical techniques can still be as good as their expensive counterparts.
The other argument is that this centralized organization might be a cause for rationing of care – particularly those pricey treatments. To prevent this in the future, the law has added that new developments and findings from the center will become mandates for treatment of diseases. They cannot be used as reasons to deny coverage for specific treatments.
As proposed, the non-profit institute will be under a 19-member board of directors which will all be appointed by the US Comptroller General. The center will run six months from the time it was approved.
Residents of California whose pre-existing conditions have resulted in previous denials of health care coverage, or the quotation of higher insurance premium rates, may now seek coverage through the California Pre-Existing Condition Insurance Plan (PCIP), according to a feature on CivSourceonline.com.
The implementation of PCIP was assigned by the state of California to the Managed Risk Medical Insurance Board (MRMIB). The MRMIB now serves as administrator of the public-private partnership that will manage PCIP.
The Federal Temporary High Risk Health Insurance Fund, created earlier this year, as well as insurance premiums, will be the source of funding for PCIP. The Federal Temporary High Risk Health Insurance Fund currently has $761 million funds available.
California residents who do not have health care coverage over the past six months after being denied coverage due to pre-existing conditions, or who have been quoted insurance premium rates that are higher than the preferred provider premium rates of the high risk pool of the state, are eligible for coverage. PCIP is now open for enrollment, with health care coverage immediately available for those who qualify. Through the PCIP, an estimated 23,000 Californians will be assured of health care insurance coverage.
The feature quoted California Governor Arnold Schwarzenegger, who said: “Operating the high-risk insurance plan is a win-win for our state because we can maximize federal funds while providing more affordable coverage to individuals who desperately need health insurance.” Since early this year, the governor has expressed a strong desire to implement federal health care reform in California, and since the passage of the law, his administration has worked towards being able to implement key initiatives before 2014.
The Affordable Care Act has been finally passed by Congress and signed by President Obama last March, 2010. It becomes the new health law which includes the provision of insurance for those with pre-existing conditions. This is certainly a welcome note for those who have been previously denied coverage by private insurance firms due to pre-existing conditions.
The Pre-Existing Condition Insurance Plan will be made available to you provided that you meet the following criteria: you have been denied insurance for at least six months, you have a pre-existing condition or denied coverage due to your pre-existing condition, and a US citizen or one who is legally residing in the United States. If you do satisfy all of the above mentioned conditions, then you will be able to have access to affordable health care insurance thru the Exchange marketplace. You will not be disqualified even if you have a pre-existing condition.
Each state may have different laws with regards to this new provision. The program in each state will be either run using the resources available under the Affordable Care Act or by the coverage of the Department of Health and Human Services. In some states, the Health Department with the aid of the U.S. Office of Personnel Management and the Department of Agriculture’s National Finance Center will be responsible for the new provision; in other areas, the state government handles it. The enforcement of the Pre-Existing Condition Insurance Plan may therefore vary from one state to another.
Despite variations in the implementation of the new provision, three things should remain wherever you may be: (1) no higher charges due to your pre-existing condition; (2) eligibility won’t be based on income; and (3) it will cover all health benefits including hospital care, prescription medicines and specialty care even for the treatment of the pre-existing condition.
A lot has been said about the health care reform, from the time that it was first laid on the table to the time that it was passed into law. Most of the things said about it consisted of what the Democrats, and the Republicans, thought about it, which resulted in a chaotic it’s-good-no-it’s-bad affair. It is certainly not surprising that many people find health care reform confusing and have difficulty understanding what it is about.
In order to help clear the air, the Howard H. Baker Center for Public Policy at the University of Tennessee, Knoxville, is hosting a panel discussion on health care reform. The Baker Center is a non-partisan organization that focuses on “better understanding of government,” as well as a “greater appreciation for the importance of public service.” Its efforts are towards education, research and public programs.
Carole R. Myers, assistant professor in the College of Nursing at UT Knoxville and fellow for health policy at the Baker Center, and Beth Uselton, the lead organizer for the Tennessee Health Care Campaign, will serve as panelists at the event.
Myers shared the following with The Daily Beacon, a student newspaper at UT: “The goal of Beth Uselton, who is my partner for the presentation, and I is to do three things: provide factual, non-partisan information about key provisions of the health reform law that passed earlier this year, describe the impact of the law of key constituencies and respond to questions from attendees at the forum.”
The discussion will be held on Tuesday, August 31, from 6:30 p.m. to 8:30 p.m. in the Baker Center Toyota Auditorium.
