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| EMERITUS NEWS INSURANCEWILL TRADITIONAL HEALTH INSURANCE COMPANIES DISAPPEAR BY 2020?VETERAN GETS $400,000 SETTLEMENT IN 60 YEAR BATTLE FOR DISABILITY BENEFITSMore in this article from the New York Times, click here - National Association for Veterans Advocates website, click here. 01/27/2012 RISE IN FEDERAL HEALTH CARE SPENDING LOWEST IN 50 YEARSMore from the Emeritus Newsroom-The ultimate summary of federal spending on health care cites real progress in 2009 and 2010 to hold down costs. Prepared by the Center for Medicare Services, the compilation of the "National Health Expenditures" grade card offers hope. Rather than growing at a rate almost double that of the rest of the economy, the report says federal spending on health care rose 3.8% in 2009 and 3.9% in 2010. The slower rate of spending increases also resulted in health care costs, as percentage of the gross domestic product, remained at 17.9%. True, the recession did slow growth in health spending in 2009 and 2010 as consumers remained cautious about their spending—in part because of losses in private health insurance coverage, lower median household income, and future financial uncertainty. Slower growth in spending for hospital care and physician and clinical services, along with record low growth in spending for prescription drugs, reflected slower growth in the use of these goods and services. From a payer perspective, according to the report, continued slow growth in private health insurance and out-of-pocket spending (which grew just 2.4 percent and 1.8 percent, respectively) and decelerations in Medicare and Medicaid spending growth (which slowed to 5.0 percent and 7.2 percent, respectively) contributed to overall low growth in 2010. Although medical goods and services are generally viewed as necessities, the latest recession had a dramatic effect on their utilization. On average, between 2007 and 2009, growth in the use and intensity of health care goods and services contributed 1.4 percentage points to the annual growth in personal health care spending (5.0 percent). This was much lower than its average contribution of 3.3 percentage points between 2000 and 2006, when personal health care spending grew 7.6 percent, on average. Full text of National Health Expenditures report from HealthAffairs.org, click here. 01/09/2012 MASSACHUSETTS SUPREME COURT ORDERS IMMIGRANTS COVERAGE ON STATE HEALTH PLANMore from the Emeritus Newsroom- Saying that restrictions against immigrants preventing them from being insured by "Commonwealth Care" health plans, the Massachusetts Supreme Court has ordered the state pick up the estimated 150+ million tab to insure the estimated 38,000 LEGAL immigrants who must wait five years to be eligible. the state has it's own subsidized plans for those with no coverage and separate plans for the poor, who cannot afford insurance. A group called, Health Law Advocates, had taken the state to court over immigrants exclusion from the plans. Saying the immigrants paid taxes, were eligible for military service, and were entitled to equal protection, under the law. The Massachusetts Supreme Court agreed and ordered the state to include them. In a statement after the ruling, Health Law Advocates of Boston said their victory in the case will immediately help tens of thousands of low-income Massachusetts legal immigrants, who were eliminated from access to Commonwealth Care because they had not been in the U-S for five years. the group claims that Massachusetts’ historic health reform law passed in 2006 allowed legal immigrants who met eligibility requirements to obtain health insurance through the Commonwealth Care program.
Wendy Parmet, a Northeastern University School of Law professor who argued the case on behalf of the immigrants said “Our constitution prohibits the government from trying to solve its financial problems on the backs of a vulnerable class of people.” Full text of actual Massachusetts Supreme Court ruling, click here. Statement from Health Law Advocates, click here. 01/06/2012 PROBE OF MONEY TRAIL BETWEEN GINGRICH AND HEALTH CARE LOBBY REVEALS CONTRADICTIONSMore in this article from the Washington Post, click here- Also see MSNBC video below of segment from Politics Nation with Al Sharpton - 11/18/2011 Visit msnbc.com for breaking news, world news, and news about the economy CONSUMER WATCHDOG SAYS INSURANCE COMPANIES TRYING BACK DOOR METHOD TO PROTECT PROFITSMore from the Emeritus Newsroom- California based advocacy group Consumer Watchdog claims it and other consumer groups are demanding state insurance commissioners reject a proposal to increase health insurance industry sales commissions and profits at the expense of individuals struggling to pay for insurance. Consumer Watchdog called on state insurance regulators to allow the public to participate in a closed conference call scheduled for Tuesday to consider the insurance industry-sponsored resolution.The resolution would remove broker pay from the medical loss ratio rule of the federal health reform law and cost consumers nationwide an estimated $1.1 billion in premium rebates. It would render meaningless the requirement that companies spend 80% to 85% of health premiums on actual health care, not overhead, salaries and profit, said Consumer Watchdog. “Health insurers are going after the only rule in health reform that could force them to cut wasteful bureaucracy and excessive profits. Exempting sales commissions from this key consumer protection would free health insurers from the rule, leaving brokers to demand higher pay and insurance companies to increase premiums at will,” said Carmen Balber, Washington Director for Consumer Watchdog. “Insurance commissioners considering this blatantly political move should remember that their responsibility is to protect citizens, not insurance industry profits.” Florida Insurance Commissioner Kevin McCarty, who works for Gov. Rick Scott, an avowed opponent of federal health insurance reform, is leading the charge to gain support for the industry proposal. The resolution, intended to revive legislation that is stalled in Congress, asks the Department of Health and Human Services to remove insurance sales commissions from industry administrative costs for purposes of calculating the medical loss ratio. It also suggests that HHS amend the rule to count much of the sales commission as “health care” instead of an overhead expense. Backers assert that health reforms will drive brokers and agents out of business and leave consumers without “professional advisers” in choosing and dealing with insurance companies. However, all credible data says otherwise, said Consumer Watchdog. For instance: A recent study by an industry lobby and trade group--the Independent Insurance Agents and Brokers of America--found that “organic [customer base] growth improved, albeit modestly, and profitability held constant across most of the study’s six [broker and agent] revenue groups.” The study credited more efficient business operations—exactly what the health reform legislation sought—for much of the recovery from an industry slump that began in 2006, long before federal health reform was even debated, said Consumer Watchdog. See the IIABA report. Such evidence indicates that the medical loss ratio rule is beginning to work, said Consumer Watchdog, and that insurance agents and brokers are holding their own--even improving profits in some cases. But these moves toward greater efficiency will be over before the first rebate check is issued if the NAIC embraces the insurance and broker industry demands, said Consumer Watchdog. State insurance regulators backing consumer rights and opposing the broker resolution include: California, Connecticut, Minnesota, New York, Oregon and Washington. State regulators that have publicly endorsed a version of the broker resolution include: Florida, Alabama, Arkansas, Georgia, Idaho, Kentucky, Louisiana, Indiana, Mississippi, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, South Carolina, Tennessee and Wisconsin. A 2010 analysis by Consumer Watchdog found that more than half the state insurance commissioners had ties to the insurance industry, including commissioners that are former insurance executives and commissioners that have taken a combined $1 million in political contributions from insurers. The national lobbying groups for health insurance agents and brokers uniformly opposed federal health reform. See the analysis. Full text of Consumer Watchdog announcement, click here. 11/14/2011 D-C APPEALS COURT SIDES WITH OBAMA ON HEALTH INSURANCE REFORM LAWMore from Associated Press, click here- Link to PDF download of Appeals Court decision, click here-11/08/2011 TRICARE PATIENTS TO GET CREDIT MONITORING AFTER DEFENSE DEPARTMENT COMPUTER HACKINGMore from the Emeritus Newsroom- The Department of Defense announced today that the TRICARE® Management Activity (TMA) has directed Science Applications International Corp. (SAIC) to provide one year of credit monitoring and restoration services to patients who express concern about their credit as a result of a data breach that occurred in Texas and was reported to TMA on Sept. 14, 2011. Approximately 4.9 million patients treated at military hospitals and clinics during the last 20 years may have been affected by the breach. Potentially affected patients are being notified by letter. "These additional proactive security measures exceed the industry standard to protect against the risk of identity theft," said Brig. Gen. W. Bryan Gamble, TMA deputy director. "We take very seriously our responsibility to offer patients peace of mind that their credit and quality of life will be unaffected by this breach." Immediately upon learning of the recent SAIC data breach TRICARE posted information about the data breach on their website at https://www.tricare.mil to inform their beneficiaries. There is no evidence any of the data has actually been accessed by a third party, and analysis shows the chance any data was actually compromised is low.Proactive measures are being taken to ensure potentially affected patients are kept informed and protected. The data involved in the breach may contain names, Social Security numbers, addresses and phone numbers, and some personal health data such as clinical notes, laboratory tests and prescriptions. There is no financial data, such as credit card or bank account information, on the information that was taken. Concerned individuals may contact the SAIC Incident Response Call Center, Monday through Friday, 9 a.m. to 6 p.m. Eastern time at 855-366-0140 (toll free) for U.S. callers and 952-556-8312 (collect) internationally. Full text of Defense Department statement, click here. 11/04/2011 MEDICARE PREMIUMS AND DEDUCTIBLES FOR 2012 LESS THAN EXPECTEDMore from the Emeritus Newsroom- Officials of health and Human Services have announced the amounts of Medicare premiums and deductibles for 2012. According to HHS, Medicare Part A premiums will be increasing by just $1 per month, and the deductible will increase by just $24. For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, and some home health care, about 99 percent of Medicare beneficiaries do not pay a premium since they or their spouses have at least 40 quarters of Medicare-covered employment. The standard Medicare Part B monthly premium will be $99.90 in 2012, a $15.50 decrease over the 2011 premium of $115.40. However, most Medicare beneficiaries were held harmless in 2011 and paid $96.40 per month. The 2012 premium represents a $3.50 increase for them. Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. The estimate for the average 2012 Part D premium for basic coverage is $30. This is slightly lower than the actual average for 2011 of $30.76. The estimate for the average 2012 Part D premium for supplemental coverage is $8. The estimate for the average 2012 total Part D premium is $38. On average, Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011, and plans project enrollment to increase by 10 percent. Of people with Medicare, 99.7 percent continue to enjoy access to a Medicare Advantage plan, and benefits remain consistent with those offered in 2011. The premiums for long term care and the income related ajustments were also set. Click here for the full text of HHS announcement. 10/31/2011 FAMILY PREMIUMS FOR EMPLOYER HEALTH INSURANCE COVERAGE UP 9%More from the Emeritus Newsroom- According to a Kaiser Health News survey, premiums for family coverage rose 9 percent this year, to an average of $15,073 a year. The employee share of that was $4,129. For employer-provided individual coverage, premiums rose 8 percent, with workers typically picking up $921 of the average $5,429 annual tab. The price increases come as employees prepare to select their benefits for 2012. According to Kaiser Health News, premiums, deductibles and cost sharing continue to rise, sometimes even more steeply than in previous years. More employers are also moving to high-deductible plans that shift increasing expenses onto their employees, requiring them to pay more before benefits kick in. And companies are making it pricier to insure spouses and children. More in this article from Kaiser Health News, click here. 10/25/2011 OBAMA ADMINISTRATION GIVES UP ON "CLASS" INSURANCE FOR LONG TERM / NURSING HOME CAREMore from the Emeritus Newsroom- Health and Human Services Secretary Kathleen Sebelius admitted today that the Obama administration is giving up on part of the health reform act, called "CLASS". The program was designed to fund long term or nursing home care. However, intensive review of the plan by government actuaries reveals it will not work. The plan had been a magnet for criticism from Republicans, but an actuarial review from HHS auditors claims the rest of the reform plan will be able to stand on its own without "CLASS". The HHS report says, "While the designated CLASS Plan is operational, solvency or legal problems may prevent the CLASS Program from continuing to implement the p lan. The Secretary might determine that the CLASS plan could no longer be reasonably expected to remain solvent, even if she were to make statutorily authorized changes to the plan, or a court might conclude that the designated CLASS Benefit Plan violates the CLASS Act. In those circumstances, there is substantial uncertainty about both what the Secretary would have authority to do and what a court would require. If such a circumstance occurred, there is a risk that the CLASS program would have to be entirely shut down, rather than simply closed to future enrollment, and then-existing enrollees or eligible beneficiaries would have no opportunity to receive the anticipated benefits, although it is possible—though by no means guaranteed—that they may be able to recoup some portion of their paid premiums". The authors of the HHS report conclude, "....there is substantial uncertainty about what would follow if solvency or legal problems prevented the CLASS program, once operational, from continuing to implement the plan. We cannot with any confidence predict that the CLASS program would be able to honor its commitments to individuals who had already enrolled or entered beneficiary status in the program, or avoid leaving them worse off, or that such individuals would be able to recoup their paid premiums". Full SCRBD text of HHS report, click here. 10/14/2011 INSURANCE COMPANIES BATTLE PUBLIC RELEASE OF DOCUMENTS SUPPORTING RATE INCREASESMore from the New York Times, click here- 10/12/2011 PENTAGON CLAIMS TRICARE PATIENT MEDICAL RECORDS HACKED BY DATA THIEVES / LATEST IN STRING OF DEFENSE DEPARTMENT BREACHESBy Donna Miles WASHINGTON, Oct. 7, 2011 – The TRICARE Management Activity is reviewing its data protection policies and procedures in the wake of a data breach involving personal health information of an estimated 4.9 million military clinic and hospital patients. The breach potentially affects patients who received care or filled pharmacy prescriptions in San Antonio-area military treatment facilities from 1992 through Sept. 7, 2011, TRICARE spokesman Austin Camacho reported. Other beneficiaries who received care elsewhere, but whose laboratory workups were processed in San Antonio military treatment facilities, also could be affected, he said. The exact circumstances of the loss are part of TRICARE’s investigation, he said. Those results are expected to be published as soon as possible. The tapes may include Social Security numbers, addresses and phone numbers, as well as personal health data such as clinical notes, laboratory tests and prescriptions, he said. No financial data such as credit card or bank account information is included. Despite the information involved, TRICARE officials estimate the risk of harm to patients to be relatively low. “Reading the tapes takes special machinery. Moreover, it takes a highly skilled individual to interpret the data on the tapes,” Camacho said. “Since we do not believe the tapes were taken with malicious intent, we believe the risk to beneficiaries is low.” As TRICARE officials investigate the incident, they plan to notify everyone whose personal information may have been involved in the breach, Camacho said. TRICARE and SAIC are working together to come up with that list of names, but because of the number of people potentially affected and the need to review multiple databases, Camacho said, individual notifications could take four to six weeks. In the meantime, TRICARE officials encourage people who suspect they were affected by this incident to take steps outlined on the Federal Trade Commission website to protect their personal information. They also can monitor their credit and place a free fraud alert on their credit for 90 days using the FTC website. Concerned patients may contact the SAIC Incident Response Call Center at no charge, Monday through Friday from 9 a.m. to 6 p.m. Eastern time. Stateside, patients may call toll-free to 855-366-0140. Overseas, patients can make collect calls to 952-556-8312. Pentagon Channel Video of story below. 10/11/2011
170,000 MEDICARE PATIENTS SUSPECTED PAIN KILLER DRUG FRAUD / GAO SAYSMore from the Emeritus Newsroom- The Government Accountability Office (GAO) says there is a rising toll of those addicted and those attempting to profit from abusive prescription filling practices in the Medicare Part "D" program. During testimony before a congressional committee today, Gregory D. Kutz Director, Forensic Audits and Special Investigations, GAO said, "...analysis found that about 170,000 Medicare beneficiaries received prescriptions from five or more medical practitioners for the 12 classes of frequently abused controlled substances and 2 classes of frequently abused non controlled substances in calendar year 2008. This represented about 1.8 percent of the Medicare Part D beneficiaries who received prescriptions for these 14 classes of drugs during the same calendar year. These individuals incurred approximately $148 million in prescription drug costs for these drugs, much of which is paid by the Medicare program. We also found the following: (1) Most of these 170,000 Medicare beneficiaries who were prescribed prescriptions from five or more practitioners were eligible for Medicare Part D benefits based on a disability. Specifically, approximately 120,000 Medicare beneficiaries (about 71 percent) were eligible for Medicare Part D benefits based on a disability. (2) Of these 170,000 beneficiaries, approximately 122,000 beneficiaries (72 percent) received a Medicare Low-Income Cost-Sharing (LICS) subsidy". The GAO obtained additional information on 10 of the Medicare Part D beneficiaries that showed indications of doctor shopping. In each of the 10 cases, they found evidence that the beneficiary was acquiring highly abused drugs through doctor shopping. Also, physicians were not aware that their patients were receiving drugs prescribed by other prescribers. According to the Drug Enforcement Administration, the definition of doctor shopping specifies an individual receiving more of a drug than intended by any single physician. In several examples physicians stated that they would not have prescribed the drugs if they were aware that the patient was receiving the same class of drugs from other sources. GAO says more scrutiny of prescription claims data will help the drug plans identify individuals who are likely obtaining excessive amounts of highly abused drugs or potentially seeking such drugs from multiple medical practitioners. The complication comes as federal law does not authorize Part D plans to restrict the access of these individuals, leaving little recourse for preventing known doctor shoppers from obtaining hydrocodone, oxycodone, and other highly abused drugs. GAO suggests the Administrator of CMS should review our findings, evaluate and consider additional steps, such as a restricted recipient program for Medicare Part D that would limit identified doctor shoppers to one prescriber, one pharmacy, or both for receiving prescriptions. GAO says Medicare and Medicaid supervision through the Centers for Medicare and Medicaid Services, should consider sharing information on identified doctor shoppers among the Part D drug plan sponsors so that those beneficiaries cannot circumvent the program by switching prescription drug plans. Full text of GAO summary and link to full report, click here. 10/04/2011 OBAMA APPEALS TO SUPREME COURT TO RULE ON REQUIREMENT FOR HEALTH INSURANCE IN REFORM ACTMore from the Emeritus Newsroom- The Obama administration today asked the U-S Supreme Court to take up the mandatory insurance requirement embedded in the health insurance reform laws. At issue is a case brought by the State of Florida, which contested the federal government's right to require all Americans have health insurance from the private sector or subsidized coverage from the government or face a tax penalty. This despite the fact that most states use the same requirement to obtain a driver's license, states argue they can legally do that, while the federal government cannot, as written in the reform laws. The appeal arises from a decision from the Eleventh Circuit Court of Appeals in Atlanta, which ruled in favor of the State of Florida, that the mandatory provision for insurance, was unconstitutional. In the appeal filing to the U-S Supreme Court, attorneys for the Department of Health and Human Services claim, "The minimum coverage provision is squarely within Congress’s power to regulate interstate commerce, lay and collect taxes, and enact legislation that is necessary and proper to effectuate its enumerated powers.The court of appeals’ contrary decision is fundamentally flawed and denies Congress the broad deference it is due in enacting laws to address the Nation’s most pressing economic problems and set tax policy. The importance of the decision below—which strikes down “central piece of a comprehensive economic regulatory scheme enacted by Congress,” App. 189a (Marcus, J.,dissenting), on a ground that has no basis in the Constitution’s text or this Court’s precedents—is manifest. Moreover, the court of appeals’ conclusion that the mini-mum coverage provision lies outside Congress’s commerce authority directly conflicts with a recent decision of the Sixth Circuit (Cincinnati)" (page23). The Sixth Circuit Court of Appeals, had rejected challenges to the mandatory insurance provision. A win for the Obama administration. A ruling on the appeal could come next June during the height of the presidential campaign, however, in view of various provisions of the new health insurance laws, which take effect next year through 2014, the court could expedite a hearing and a decision. Full text of actual Supreme Court filing from HHS, click here. 09/29/2011 HEALTH INSURANCE PREMIUMS UP BY 9% / PARTIALLY DUE TO INCREASING COVERAGE FROM REFORM ACTMore from the Emeritus Newsroom- A survey of employers by the Kaiser Family foundation has found small companies especially hard hit by premium increases for their health insurance. According to Kaiser, annual premiums for employer-sponsored family health coverage increased to $15,073 this year, up 9 percent from last year. On average, workers pay $4,129 and employers pay $10,944 toward those annual premiums. Other findings from the study include:
Full text of 2011 Employer Health Benefits Survey, click here. 09/28/2011 MORE 18-26 YEAR OLDS GETTING HEALTH INSURANCE DUE TO REFORM ACTMore from the Emeritus Newsroom- Different surveys show different results. Regardless of the true number, the health insurance reforms passed over the last two years have helped those, ages 18-26, get health insurance coverage. A survey from the Census Bureau shows more than 500,000, in that age group, were able to get coverage, mostly by being attached to a parent or guardian's plan, mandated by the reform laws. Also, according to a Center for Disease Control survey, released earlier this month, among adults aged 19–25, the percentage uninsured at the time of interview decreased from 33.9% (10 million) in 2010 to 30.4% (9.1 million) in the first 3 months of 2011. And in a Gallop survey, released today, fewer young adults in the U.S. reported lacking health insurance coverage in each of the three quarters since the new healthcare law in September 2010 began allowing young adults to stay on their parents' plans up to age 26. About one in four (24.2%) 18- to 25-year-olds reported being uninsured in the second quarter of this year, down from 28% in the third quarter of 2010, and nearly the lowest Gallup has measured at any point since it began tracking health insurance coverage rates in 2008. Text of Census Bureau survey (page 83 chart ), click here. Text of CDC survey, click here. Text of Gallop survey, click here. 09/21/2011 OBAMA / LAWMAKERS EYE CUTS TO ARMED FORCES MEDICAL AND BENEFIT PLANSMore in this article from the New York Times, click here- 09/19/2011 ARMED FORCES ACCUSE WALGREENS OF FEAR CAMPAIGN ON PRECRIPTION DRUG BENEFIT TALKSBy Donna Miles WASHINGTON, Sept. 15, 2011 - A dispute between Walgreens and a TRICARE contractor will not stop beneficiaries from getting their prescriptions filled, despite a Walgreen's ad campaign to the contrary, a TRICARE official said today. Don't let that advertising, letter and Internet outreach campaign scare you, Navy Rear Adm. Christine Hunter, deputy director of the TRICARE Management Agency, said. Even if contract renewal negotiations fall through and Walgreens drops out of TRICARE's retail pharmacy network on Jan. 1, beneficiaries still will have plenty of other options for getting their prescriptions filled. Hunter called the dispute between Walgreens and Express Scripts, Inc., the contractor for TRICARE's retail pharmacy and pharmacy home delivery programs "a business matter" between the two companies. A similar impasse between the two companies in 2008 ultimately was resolved by mid-November, about six weeks before the new contract was to take effect, she noted. Walgreens is a big player in the TRICARE pharmacy network, with about 7,000 participating outlets that Hunter said have filled prescriptions for one in 10 TRICARE beneficiaries at one time or another. Concerned about a campaign that has alarmed some TRICARE beneficiaries, Hunter offered assurance today that regardless of how this year's negotiations go, patients will always have access to the medications they need. "If Walgreens does drop out or fail to renew their relationship with ESI so they are not included in the network, patients will still have 56,000 other pharmacies to obtain their medications at retail," she said. "We have a very, very broad network" that, for the vast Meanwhile, Hunter emphasized other options TRICARE beneficiaries can use to get their medications: a TRICARE military treatment facility or the increasingly popular mail- order and home-delivery plans. Hunter is a big proponent of the mail-order and home-delivery program, helping boost participation by 9.9 percent this year alone as retail pharmacy use grew by just 1.6 percent. Delivering medications directly to the beneficiary's home assures an uninterrupted supply of medication, she said, while saving money for beneficiaries as well as the Defense Department. "I would recommend that this is a great time to consider TRICARE [Pharmacy] Home Delivery for chronic medications," Hunter said. But with more than three months left on Walgreen's current contract with ESI, she emphasized, "There is no emergency, and there is time for people to understand and consider their options." Those who elect to stay with the retail pharmacy option but are concerned that Walgreens could drop out of the TRICARE pharmacy network also have the option of moving their prescriptions to another pharmacy in the TRICARE network now. "We are not taking a position about whether patients should move their prescriptions," Hunter said. "We are allowing this issue to play itself out, but those who want to can do so, and that will absolutely be honored." Because all prescription information is centralized, the only thing patients need to do to move their prescriptions is to take their medication bottle or tube to another pharmacy. "They don't need another prescription or visit to a doctor," Hunter said. Beneficiaries also can elect to use pharmacies not included in the TRICARE network. However, Hunter offered a reminder that these users will receive only partial reimbursement for their out-of-pocket costs and could have to file their own insurance claim, where network pharmacies do that automatically. "Our focus is on ensuring patients have access to the care they need," including reliable access to their prescription medications, she said. "Our goal is to be sure people have the information they need so that they get their medications in a timely fashion." From Emeritus News- In a statement on a special webpage, Walgreens explained, "We offered to lower our current rates with Express Scripts for prescriptions filled on behalf of TRICARE beneficiaries. In fact, under our proposal, the payment rates for TRICARE would have been lower than under Walgreens commercial rates. In addition, Walgreens offered to separate its contract with Express Scripts for TRICARE beneficiaries from all commercial business with Express Scripts so that we would be in a position to continue providing services for all active and retired military personnel. We do not wish for military beneficiaries to be “in the middle” of this issue". Walgrees special website on Tricare talks, click here. 09/15/2011 RULES SET FOR NEW HEALTH INSURANCE PLANS TO OFFER PREVENTIVE CARE FOR WOMEN NO ADDITIONAL COSTMore from the Emeritus Newsroom- Historic new guidelines that will ensure women receive preventive health services at no additional cost were announced today by the U.S. Department of Health and Human Services (HHS). Developed by the independent Institute of Medicine, the new guidelines require new health insurance plans to cover women’s preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment, co-insurance or a deductible. “The Affordable Care Act helps stop health problems before they start,” said HHS Secretary Kathleen Sebelius. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need.” Before health reform, too many Americans didn’t get the preventive health care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs. Often because of cost, Americans used preventive services at about half the recommended rate. Last summer, HHS released new insurance market rules under the Affordable Care Act requiring all new private health plans to cover several evidence-based preventive services like mammograms, colonoscopies, blood pressure checks, and childhood immunizations without charging a copayment, deductible or coinsurance. The Affordable Care Act also made recommended preventive services free for people on Medicare. Today’s announcement builds on that progress by making sure women have access to a full range of recommended preventive services without cost sharing, including:
New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012. The rules governing coverage of preventive services which allow plans to use reasonable medical management to help define the nature of the covered service apply to women’s preventive services. Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use. The administration also released an amendment to the prevention regulation that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services. This regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception. HHS welcomes comment on this policy. Previously, preventive services for women had been recommended one-by-one or as part of guidelines targeted at men as well. As such, the HHS directed the independent Institute of Medicine to, for the first time ever, conduct a scientific review and provide recommendations on specific preventive measures that meet women’s unique health needs and help keep women healthy. HHS’ Health Resources and Services Administration (HRSA) used the IOM report issued July 19, when developing the guidelines that are being issued today. The IOM’s report relied on independent physicians, nurses, scientists, and other experts to make these determinations based on scientific evidence. For more information on the HHS guidelines for expanding women’s preventive services, please visit: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. The guidelines can be found at: www.hrsa.gov/womensguidelines/. Full text of HHS statement, click here. 08/01/2011 LIKE IT OR NOT, THE FEDERAL GOVERNMENT WILL BE PAYING HALF OF ALL HEALTH CARE COSTS BY 2020More from the Emeritus Newsroom- With financial projections increasingly pointing to the federal government paying a larger share of America's medical bills, it is difficult to understand why there is so much opposition to a single payer health care system such as Canada's. More statistics released today by the Centers for Medicare and Medicaid Services show the federal government will be paying half of all medical care by the year 2020, even with private insurance companies still doing business. The information comes from an article in "Health Affairs", a publication of Project Hope. The article state, in 2010, US health spending is estimated to have grown at a historic low of 3.9 percent, due in part to the effects of the recently ended recession. In 2014, national health spending growth is expected to reach 8.3 percent when major coverage expansions from the Affordable Care Act of 2010 begin. The expanded Medicaid and private insurance coverage are expected to increase demand for health care significantly, particularly for prescription drugs and physician and clinical services. Robust growth in Medicare enrollment, expanded Medicaid coverage, and premium and cost-sharing subsidies for exchange plans are projected to increase the federal government share of health spending, IN THOSE PROGRAMS, from 27 percent in 2009 to 31 percent by 2020. HOWEVER, by 2020, governments' total health care spending for ALL PROGRAMS, COUNTING THOSE IN NEW HEALTH REFORM LAWS, "... is projected to be 49 percent of national health spending, up from 47 percent in 2014, reaching a total of $2.3 trillion; it is expected that the federal government will pay almost two-thirds of this amount. During this period, projected increases in the government’s share of health care financing is largely associated with the robust projected Medicare enrollment growth, the Medicaid expansion, and federal costs associated with the exchange premium and cost-sharing subsidies (but offset somewhat by the lower Medicare expenditures resulting from Affordable Care Act provisions). As the government share of spending rises, the projected share for private businesses declines (from 20 percent in 2014 to 18 percent by 2020), and the share for households remains at 26 percent", according to the report. The report also shows, while total health care costs as Gross Domestic Product will rise, the increase will be more controlled, from the current 17.6% to 20% of GDP, from 2010-2020, even with 23 million more consumers added to the rolls of the insured through health care reform. Full text of report from"Health Affairs", click here. Direct link to "Health Affairs" home page (Great Site!), click here. 07/28/2011 10 STATES GET FEDERAL REVIEW OF HEALTH INSURANCE RATE INCREASESMore in this article from the New York Times, click here- 07/26/2011 PHARMACY BENEFITS GIANTS MEDCO AND EXPRESS SCRIPTS PLAN MERGERMore from the Emeritus Newsroom- Prescription benefit companies Medco and Express Scripts today announced Express Scripts, Inc. (NASDAQ: ESRX) and Medco Health Solutions, Inc. (NYSE: MHS) today announced that they have entered into a definitive merger agreement. Under the agreement, Medco shareholders will receive $71.36 per share in cash and stock, or $29.1 billion, based on yesterday's closing price. Medco shareholders will receive $28.80 in cash and 0.81 shares for each Medco share they own upon closing of the transaction. The agreement has been unanimously approved by the boards of directors of both companies. Both companies will be operated by Express Scripts Holdings. The joint press release from both companies says the merger will combine the expertise of two complementary pharmacy benefit managers (PBMs) to accelerate efforts to lower the cost of prescription drugs and improve the quality of care for Americans. "The cost and quality of healthcare is a great concern to all Americans; this is the right deal at the right time for the right reasons," said George Paz, chairman and CEO of Express Scripts. "Companies like ours have a responsibility to provide the leadership and resources required to drive out waste in healthcare and provide the best care in the world. The merger with Medco will accelerate our efforts to create greater efficiencies in the healthcare system and better protect American families from the rising costs of prescription medicine while improving health outcomes. "This continues Express Scripts' commitment to strong growth, both organically and through strategic mergers and acquisitions. The opportunity with Medco represents an attractive strategic combination which will provide the opportunity to move forward with a wide array of tools and resources to accomplish our goals." David Snow, chairman and CEO of Medco, commented: "Our organizations represent two great success stories in American business. We have each been successful in creating shareholder value because we are both passionate about driving value to our customers through service, innovation and a focus on cost and quality. We have a shared desire to improve the way healthcare is delivered in this country and I believe this creates a strong best-of-breed foundation, culturally, for a very successful merger. "We continue to have great confidence in moving forward as a stand-alone business, however, the incremental benefits of combining with Express Scripts are both logical and compelling." Full text of joint statement on Medco, Express Scripts merger, click here. 07/21/2011 GOVERNMENT ACCOUNTABILITY OFFICE URGES STEPPED UP ENFORECEMENT ON MEDICAID AND MEDICARE FRAUDMore from the Emeritus Newsroom- The Government Accountability Office today presented an erratic picture of federal efforts to catch those who defraud Medicare and Medicaid and made recommendations for improvements. The GAO report was introduced during a hearing today before the House Sub-Committes on Oversight and Health. As an example, the GAO report stated, a CMS contractor identified overpayments in excess of $9 million after interviewing physicians who had referred beneficiaries with high home health costs. The physicians indicated that their signatures had been forged or that they had not realized the amount of care they had authorized. We recommended that CMS require that physicians receive a statement of services beneficiaries received based on the physicians’ certification, but to date, the agency has not taken action. The GAO recommends: 1. Strengthening provider enrollment process and standards. Checking
the background of providers at the time they apply to become Medicare
providers is a crucial step to reduce the risk of enrolling providers intent on
defrauding or abusing the program. In particular, GAO has recommended
stricter scrutiny of providers identified as particularly vulnerable to
improper payments to ensure they are legitimate businesses. 2. Improving pre-payment review of claims. Pre-payment reviews of claims are essential to helping ensure that Medicare pays correctly the first time. GAO has recommended that CMS further enhance its ability to identify improper claims through additional automated pre-payment claim review before they are paid. 3. Focusing post-payment claims review on most vulnerable areas. Post payment
reviews are critical to identifying payment errors and recouping
overpayments. GAO has recommended that CMS better target claims for
post payment review on the most vulnerable areas. 4. Improving oversight of contractors. Because Medicare is administered by contractors, overseeing their activities to address fraud, waste, and abuse is critical. GAO found that CMS’s oversight of prescription drug plan sponsors’ compliance programs has been limited. However, partly in response to GAO’s recommendation, CMS oversight of these programs is expanding. 5. Developing a robust process for addressing identified vulnerabilities. Having mechanisms in place to resolve vulnerabilities that lead to improper payment is vital to program management, but CMS has not developed a robust process to specifically address these. GAO has recommended that CMS establish an adequate process to ensure prompt resolution of identified improper payment vulnerabilities. Full PDF download of GAO report, click here. 07/12/2011 RESEARCH PROVES INSURANCE IMPROVES MEDICAL OUTCOMES FOR THE POOR / CUTS LONGTERM COSTSMore from the Emeritus Newsroom- A 2008 lottery by the state of Oregon to determine which low income adult residents would qualify for Medicaid, provided the ideal sampling pool for research. The concept was to see what result access to insurance would have on medical care and outcomes for those who were selected in the lottery. The results were published today by MIT and the National Bureau of Economic Research, both based in Cambridge, Massachusetts. According to a press release from MIT, the research shows that Medicaid recipients are far more likely to receive health care than the uninsured. Citizens with Medicaid are 30 percent more likely to have a hospital stay, 35 percent more likely to have an outpatient visit to a doctor, and 15 percent more likely to take prescription drugs, compared to similar low-income citizens not enrolled in the program. MIT press release on study, click here. Website purchase page for report from NBER, click here. 07/07/2011 OBAMA ADMINISTRATION LOWERS PAYMENTS FOR "HIGH RISK" PATIENT HEALTH INSURANCEMore from the Emeritus Newsroom- Depending on the state, "high risk" patients who cannot get or afford health insurance on the open market, will pay less than aniticipated on most government run alternative health insurance policies. Effective July 1st, the Department of Health and Human Services began changing rate and filing requirements to simplify applications for those plans. According to HHS, premiums for the Federally-administered Pre-Existing Condition Insurance Plan (PCIP) will drop as much as 40 percent in 18 States, and eligibility standards will be eased in 23 States and the District of Columbia to ensure more Americans with pre-existing conditions have access to affordable health insurance. The Pre-Existing Condition Insurance Plan was created under the Affordable Care Act and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma. “The Pre-Existing Condition Insurance Plan changes lives, and in many cases, literally saves lives,” said HHS Secretary Kathleen Sebelius. “These changes will decrease costs and help insure more Americans". In 23 States and the District of Columbia, the PCIP program is Federally-administered. The remaining States operate their own PCIP programs using Federal funds provided by the Affordable Care Act. Under the changes announced today, PCIP premiums will drop as much as 40 percent in 18 States where the Federally administered PCIP operates. These premium decreases help bring PCIP premiums closer to the rates in each State’s individual insurance market; in the six States where PCIP premiums were already well-aligned with State premiums, premiums will remain the same. The changes announced today will make enrolling in the Federally-administered PCIP in 23 States and the District of Columbia easier. Starting July 1, 2011, people applying for coverage can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness. Applicants will no longer have to wait on an insurance company to send them a denial letter. This option became available to children under age 19 in February, and this pathway is being extended to all applicants regardless of age. Applicants will still need to meet other eligibility criteria, including that they are U.S. citizens or residing in the U.S. legally and that they have been without health coverage for six months.HHS also sent letters today to the 27 States running their own programs to inform them of the opportunity to modify their current PCIP premiums. Beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. This step will help reach those who are eligible but un-enrolled. Several States have experimented with such payments with good success. This is a part of continuing HHS outreach efforts with States, insurers, providers, and agents and brokers to reach more eligible people and let them know that coverage is available. HHS is also working with insurers to notify people about the PCIP option in their State when their application for health insurance is denied.Congress created the temporary PCIP program as part of the Affordable Care Act to help uninsured Americans with a variety of medical conditions get affordable coverage rather than be locked out of the system by insurance companies. In 2014 and beyond, insurers will be prohibited from denying coverage to anyone with a pre-existing condition and new competitive marketplaces called Health Insurance Exchanges will give people the opportunity to shop for the policy that best suits their needs. Millions of Americans also will receive tax credits to help cut the cost. Enrollment in PCIP programs has begun to grow rapidly, according to HHS. In the period between November 2010 and March 2011, enrollment in all programs rose 129 percent to more than 18,000 Americans enrolled in PCIP. Full text of HHS statement, click here. Special HHS website for PCIP programs, click here. 07/05/2011 APPEALS COURT UPHOLDS MANDATORY COVERAGE PROVISION OF HEALTH INSURANCE REFORMMore from the Emeritus Newsroom- Health insurance reform legislation which passed in the first two years of the Obama presidency, has scored a victory in a federal appeals court. The case, referred to as, "Thomas More Law Center, et al. v. Barack Hussein Obama, President of the United States", challenged the the mandatory coverage requirement as being unconstitutional. The Thomas More Law Center had filed an an appeal of a lower court ruling, with the 6th Circuit Court of Appeals in Cincinnati. The appeals court wrote in its decision, "For now, whatever else may be said about plaintiffs’ activity/inactivity theory of
commerce power, they have not shown that the individual mandate exceeds that power
in all of its applications. Congress may apply the mandate in at least four settings: (1) to
individuals who already have purchased insurance voluntarily and who want to maintain
coverage, but who will be required to obtain more insurance in order to comply with the
minimum-essential-coverage requirement; (2) to individuals who voluntarily obtained
coverage but do not wish to be forced (at some indeterminate point in the future) to
maintain it; (3) to individuals who live in States that already require them to obtain
insurance and who may have to obtain more coverage to comply with the mandate or
abide by other requirements of the Affordable Care Act; and (4) to individuals under 30,
no matter where they live and no matter whether they have purchased health care before,
who may satisfy the law by obtaining only catastrophic-care coverage. The valid
application of the law to these groups of people suffices to uphold the law against this In a partial dissent against the majority opinion, which also partially agreed with, United States District Judge James L. Graham (Southern District of Ohio) wrote, "Section 1501 of the Patient Protection and Affordable Care Act of Actual PDF text of decision, click here. Audio of 6th Circuit opening statements, click here. MP3 Audio of argument on the merits of case, click here. 07/01/2011 STUDY: VETS DISABILITY CLAIM BACKLOG WORSE / LABELED BY CRITICS AS "RESEARCH FRAUD"More from the Emeritus Newsroom- A survey , released this month, conducted by the Transactional Research Action Clearing House, refutes reports from federal officials that progress is being made on the backlog of claims from the nation's veterans. According to TRAC, based at Syracuse University, more than 728,000 Americans are waiting for an appeal hearing on their Social Security disability benefits claims that have been initially denied. This shows a 5 percent increase in pending cases over the last year.Wait times for appeals cases peaked in 2008 at 514 days. The Social Security administration has stated that its goal is to reduce the average wait time for appeals from 367 days, where the SSA claim the backlog presently stands, to 270 days by 2013. The TRAC reports provides fodder for those suspicious of SSA backlog estimates. According to TRAC, in addition to documenting the recent overall surge in the number of pending matters, TRAC's analysis also found sharp variations in the growth and decline in backlogs depending on where the claimants live. In the last 12 months, for example, the change in state-by-state pending case backlogs varied from an increase of 86 percent in Nevada to a decline of 25 percent in Connecticut. The reasons why some states were up and others were down sometimes were hard to discern, with Iowa experiencing a 23.5 percent increase, while next door in Nebraska the backlog dropped by 14.8 percent. Table 1 shows the 10 states with the largest backlog growth and the 10 states with the largest declines over the last 12 months. Details for every state can be obtained from the interactive "app" accompanying this report. SSA today stated the, " (TRAC) “analysis” of our hearing backlog reduction efforts is sloppy and irresponsible. It focuses on the wrong measures, ignores the tremendous progress we have made in addressing the disability hearing backlog, and reaches the incorrect conclusion that we are “faltering.” What matters most to someone waiting for a decision is how quickly we decide their case, not how many other people are waiting for a hearing. We have made significant progress in reducing that time. In August 2008, the average wait time for a decision peaked at 532 days. In May 2011, the average processing time for a hearing decision was less than a year at 354 days -- the lowest monthly figure since October 2003. The agency’s published benchmark for processing hearing cases is 270 days, and we established it in consultation with Congress and the disability advocacy community. In 2008, nearly half of the people waiting for a decision waited more than 270 days. As of May 2011, only 29 percent of pending hearings were over 270 days. TRAC misrepresents the facts by failing to note this standard and the data that relate to it". Full text of TRAC report, click here. SSA response to TRAC report, click here. 06/20/2011 EXTRA FED PAYMENTS ENDING AS MEDICAID FACES FINANCIAL TRAIN WRECK / STATES PUSH FOR MOREMore from the Emeritus Newsroom- The warnings have long come from the hardest hit states, where unemployment and the uninsured have consumed billions in state and federal assistance. The so far, "Boiling under the must deal with now" crisis level, will advance to the "We're in over our heads" level, starting next month, as extra federal dollars that were part of the American Recovery & Reinvestment Act of 2009 (ARRA), as a federal match for state paid Medicaid claims . It runs out at the end of this month. At least half the states around the country will be boosting patient co-pays and/or cutting payments to providers. The amounts, in many states, have not even been decided , as their legislatures try to get a better handle on Medicaid budgets. As a bargaining chip, The National Association of Medicaid Directors is pushing the Obama Administration to compensate the states for state payments made on SSI benefits, which should have been processed under federal SSI disability payments instead. In a letter to HHS Secretary Kathleen Sebelius, Andy Allison,
Executive Director,
Kansas Health Policy Authority and
President of NAMD, along with the NAMD Vice President,
Darin J. Gordon "As you know, for nearly 40 years, the Social Security Administration (SSA) erroneously enrolled hundreds of thousands of people in the program for Supplemental Security Income for the Aged, Blind, and Disabled (SSI), when they should have been enrolled in the Social Security Disability Insurance (SSDI) program. This error resulted in states making payments under their Medicaid program that legally should have been paid for by Medicare. The error has been acknowledged by SSA, and over the past ten years the agency has implemented the SDW project to correct the error and restore the cash benefits that were wrongfully withheld from those who qualified for them. Next month's expiration of the extra federal aid for Medicaid will reduce the fed portion to 57% from the current 67%. It remains to be seen how congress will eventually deal with this issue, as most of the oxygen on Capitol Hill has been invested in the current showdown over the federal debt ceiling. NAMD letter to Sec. Sebelius, click here. 06/15/2011 AIR AMBULANCE BILL MAY MAKE YOU WISH YOU DIED ON THE WAY TO THE HOSPITAL / INSURANCE MAY PAY NOTHINGMore in this article from Kaiser Health News, click here- 06/15/2011 FOR PROFIT MEDICAID MANAGED CARE PLANS HAVE HIGHER ADMINISTRATIVE COSTSMore in this article from Kaiser Health News, click here- 06/15/2011 GAO SAYS DISABILITY OVERPAYMENTS EXCEED $1.4 BILLIONMore from the Emeritus Newsroom- The Social Security Administration says the exact total of overpaid disability benefits is unknown, however, it estimates that Disability Insurance overpayments detected by SSA increased from about $860 million in fiscal year 2001 to about $1.4 billion in fiscal year 2010. The problem is detailed in a Government Accountability Office review, released today. According to the GAO report, overpayments include those paid to recipients who have returned to work or who are no longer eligible due to medical improvement. SSA estimates about 72 percent of all projected DI overpayments were work related during fiscal years 2005 through 2009. While the agency collected, or recovered, $839 million in overpayments in fiscal year 2010, monies still owed by beneficiaries grew by $225 million that same year, and total DI overpayment debt reached $5.4 billion. SSA does not have agency-wide performance goals for debt collection, for example, the percent of outstanding debt collected annually. And while SSA does have a policy for full repayment within three years, 19 of the 60 continuing disability review (work CDR) cases we reviewed had repayment plans exceeding three years. SSA officials told lengthy repayment plans are often the result of an individual's limited income, but SSA does not review or approve repayment plans which exceed agency policy. During the course of our review, we also found a limitation in SSA's Recovery of Overpayments, Accounting and Reporting (ROAR) system. Used to track overpayments and collections, ROAR does not reflect debt due SSA past year 2049 so the total balance due the program is unknown, and likely larger than the agency is reporting. SSA officials acknowledged this issue, but are unable to determine the extent of the problem at this time. They told us they have a work group which will recommend action to correct the problem. But until this issue is addressed, SSA officials told us the agency can only track and report on overpayments scheduled to be repaid through 2049. Full text of GAO summary click here. Full GAO report, click here. 06/14/2011 ATLANTA FEDERAL APPEALS COURT JUDGES SUGGEST POSSIBLE DEFEAT FOR FED HEALTH REFORM LAWMore in this article from the LA Times, click here- 06/08/2011 STUDY FINDS MEDICARE PAYMENTS TO DOCTORS AND MEDICAL CENTERS "DEEPLY FLAWED"More from the Emeritus Newsroom- A commission approved by the Obama Administration last year has blasted compensation formulas used to determine payments to doctors and medical centers. Released today by the National Academy of Sciences, the commission claims the fact that 40% of hospitals are granted exceptions to get higher payments from Medicare, is proof that the formulas for determining payments are not working. The report cites the total financial picture at stake for the Medicare program being more than $500 billion dollars for 2010 alone, based on Congressional Budget Office estimates. Other major highlights of the report: Federal law requires geographic adjustments to be budget neutral, meaning any increase in the amount paid to one hospital or practitioner must be offset by a decrease to others. Salaries and benefits make up one of the largest costs of providing care. The Medicare program should use health sector data from the Bureau of Labor Statistics (BLS) to develop its indexes for calculating wage adjustments for hospitals and private practice health professionals, the report says. BLS data are a more accurate, independent, and appropriate source than the hospital cost reports, physician surveys, census data, and other information currently used, the committee said. Congress will have to revise a section of the Social Security Act to enable this change. Medicare should take into account median wage data for all types of workers in private practice settings and hospitals to calculate payments, the report adds. Currently, regional wage differences are based on data for registered nurses, licensed practical nurses, health technicians, and administrative staff only, which does not reflect the full work force in many practices or hospitals. Medicare also adjusts payments according to which labor market a hospital or practitioner operates in and competes for workers. Because hospitals and health professionals in a given area tend to function within the same local market, there is no reason for the program to use one set of 441 markets to determine hospital payments and a different set of 89 markets for practitioner adjustments, the report says. Instead, the program should employ the metropolitan statistical areas (MSAs) developed by the Office of Management and Budget for both. MSAs reflect information on where people live and work and decisions made by employers and employees that define labor markets' boundaries, the report notes. Full text of press release from the National Academy of Sciences, click here. Link to complete PDF of report, click here. 06/02/2011 OBAMA ADMINISTRATION INTRODUCES COVERAGE FOR THOSE WITHOUT HEALTH INSURANCE DUE TO PRE-EXISTING CONDITIONSMore from the LA Times, click here- 06/01/2011 MEDICARE TO RATE HOSPITALS ON SPENDING PER PATIENTMore from the New York Times, click here- 05/31/2011 UNINSURED PATIENTS GETTING FARTHER BEHIND PAYING MEDICAL BILLSMore from the Emeritus Newsroom- The Department of Health and Human Services claims few families without health insurance have the financial assets to pay potential hospital bills. According to a report the agency released today, on average, uninsured families can only afford to pay in full for approximately 12-percent of hospital stays they may experience – and even higher income uninsured families are unable to pay for most potential hospital stays. Hospital stays for which the uninsured cannot pay in full account for 95-percent of the total amount hospitals bill the uninsured. Other studies have estimated that the bills for all types of health care that the uninsured cannot pay – the uncompensated cost of care – is up to $73 billion a year, a significant portion of which is shifted into higher costs for Americans with insurance and their employers. Approximately 50 million Americans are uninsured. The report found that most uninsured people have virtually no savings. In fact, the median financial assets for all uninsured families are just $20. Even among higher income families, assets are low. Half of families with income at 400-percent of the Federal Poverty Level (FPL), or $89,400 a year for a family of four in 2011, have financial assets below $4,100.Every year, nearly 2 million uninsured Americans are hospitalized. With 58-percent of these hospital stays resulting in bills of more than $10,000, most uninsured people are unable to afford potential hospital bills. Even the top 10-percent of uninsured families with the most assets are estimated to be able to pay the full bill for only half of potential hospital stays. Uninsured families can, on average, afford to pay the full bills for only about 12-percent of the hospital stays they might experience, bills that account for just 5-percent of the total amount hospitals bill them. “Health insurance is critical in helping protect families from unexpected hospital costs,” said Sherry Glied, HHS assistant secretary for planning and evaluation. “This report shows that even higher income uninsured families are struggling to meet the high costs of health care. No family should bear the burden of being one illness or accident away from bankruptcy.” The high cost of hospitalization means that lacking health insurance poses a greater risk of financial catastrophe than lacking car insurance or homeowner’s insurance. Although people are 50-percent more likely to have car accident than to be hospitalized in a given year, the average bill for a hospital visit is over two and a half times higher than the average loss for a car accident. And, while the bill for a single hospitalization is about the same as the average loss from a house fire, a person is ten times more likely to be hospitalized than to experience a house fire. The report can be found at aspe.hhs.gov/health/reports/2011/ValueofInsurance/rb.shtml. 05/10/2011 FLORIDA LEGISLATURE REFORMS MEDICAID INTO HMO / NEEDS GOVERNOR'S SIGNATUREMore in this article from the St. Petersburg Times, click here- More in this article from the New York Times, click here. 05/07/2011 AMERICAN THERAPEUTIC AND MEDLINK MANAGEMENT GROUP PLEAD GUILTY TO $200 MILLION MEDICARE BILLING SCAM IN MIAMIMore from the Emeritus Newsroom- Two prominent Miami, Florida health care firms have agreed to a settlement in the government's case against them for fraudulent medicare claims. According to the U-S Justice Department, ATC and Medlink are each charged with conspiracy to commit health care fraud in a superseding indictment unsealed on Feb. 15, 2011. ATC is also charged in the superseding indictment with health care fraud and conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. “ATC and Medlink, and their owners, have now pleaded guilty to perpetrating a massive $200 million Medicare fraud scheme in South Florida,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division. “The fraud scheme was staggering in scope, and those who concocted the scheme exhibited a complete disregard for the elderly, infirm and disabled victims who were used to commit it. Today’s guilty pleas mark an important step forward in our effort to hold accountable everyone -- and every entity -- involved in the scheme, and to recover the maximum amount possible on behalf of American taxpayers.” “The defendants altered patient files, diagnoses and medication types and levels to make it appear that patients being treated qualified for PHP treatments,” said U.S. Attorney Wifredo Ferrer for the Southern District of Florida. “This was done so that the defendants could fraudulently bill Medicare for more than $200 million in medically unnecessary services. We are pleased to have put these unscrupulous operators out of business.” “No matter what the scheme or how elaborately it was disguised, personal and corporate greed by these two corporations and their owners defrauded taxpayers of millions of dollars,” said Special Agent in Charge John V. Gillies of the FBI’s Miami Field Office. “Ultimately, health care fraud robs from the elderly and disabled.” “ATC and Medlink shared a common business model: the systematic defrauding of American taxpayers. Now these companies are out of business and they’ll pay for their crimes.” said Daniel R. Levinson, HHS Inspector General. “Investigators from my office will continue to keep the heat on health care criminals whose victims are the most vulnerable in society.” Full text of Justice Department press release, click here. 05/04/2011 FEW TAKERS OF FREE SERVICES FOR MEDICARE PATIENTS / FEW AWARE OF SOME REFORM CHANGESMore from the Washington Post, click here- 04/26/2011 AIG INSURANCE SUBSIDIARY TO PAY $760,000 SETTLEMENT IN ILLEGAL INSURANCE POLICY SCAMMore from the Emeritus Newsroom- Massachusetts Attorney General Martha Coakley announced today that the United States Life Insurance Company in the City of New York (U.S. Life), a subsidiary of AIG, will pay full restitution and payments to the Commonwealth for selling and marketing illegal health insurance products to Massachusetts consumers. These products did not cover mandated benefits as required by Massachusetts law. Under the terms of the settlement, U.S. Life must pay $760,000 with $500,000 set aside to refund premiums and pay claims to consumers for mandated services and $260,000 to be paid to the Commonwealth. “When Massachusetts consumers buy health insurance, they should be able to feel confident that the coverage complies fully with Massachusetts law,” Attorney General Coakley said. “Our office will continue to monitor the marketing and payment practices of health insurers issuing coverage for Massachusetts residents to make sure that consumers are not misled and are not denied benefits to which they are legally entitled.” According to the Attorney General’s complaint filed with the consent judgment in Suffolk Superior Court, U.S. Life sold health insurance policies in Massachusetts that were not authorized for sale. The complaint also alleges that U.S. Life did not cover health services required by Massachusetts law. The mandated services at issue include mental health, maternity health care, infertility care, “pap” test screening, mammography, and preventive care for children up to age six. By marketing health insurance that was not authorized for sale and by denying mandated benefits to Massachusetts residents, U.S. Life violated the state’s Consumer Protection Act. Under the terms of the consent judgment, U.S. Life will set aside $500,000 as a minimum amount for consumer relief to pay Massachusetts residents who were sold these illegal plans. The consent judgment requires U.S. Life to send letters to consumers entitled to relief. The terms of the agreement require U.S. Life to refund premiums paid by Massachusetts residents who purchased unauthorized health insurance coverage less any claims paid under it. The consent judgment also requires U.S. Life to pay for mandated services previously denied to Massachusetts residents who were covered under certain health insurance policies. After affected consumers have been compensated, any remaining portion of the $500,000 will be paid to the Commonwealth. The terms of the consent judgment also require U.S. Life to pay $260,000 to the Commonwealth. As part of the consent judgment U.S. Life did not admit any liability and cooperated in the resolution of this matter. Consumers concerned about illegal health insurance practices in the Commonwealth are urged to call the Attorney General’s Health Care Hotline at (888) 830-6277. Consumers who wish to purchase health insurance can find a number of available options at www.mahealthconnector.org. Guidance on how to choose a health plan is also available on the Attorney General’s website. U-S Life may face additional legal problems in other states over the same issue. 04/25/2011 VIRGINIA LEGISLATURE PASSES BAN ON ABORTION CLAIMS PAYMENTS FROM STATE INSURANCE EXCHANGEMore from the Emeritus Newsroom- An anti abortion provision attached to Virginia health care law would prohibit insurers from paying for abortion services, as part of the new health care exchange, with the exceptions of rape, incest, and to save the life of the mother. There was no exception involving a fetus with deformities or difficulties preventing their survival after birth. The legislation was pushed by Governor Bob McDonnell, who will sign the bill, since it has been approved in both houses. The health exchanges are part of the health care reform laws passed by congress in 2009 and 2010, whereas states set up insurance exchanges for those seeking small group and individual policies that would be difficult or not available for purchase on the open insurance market. Opponents of the bill say it limits what private insurers can offer, which has no bearing on the 1977 Hyde Amendment, that prohibits federal funding for abortions. Estimates by insurance advocacy groups say at least 75 percent of insurance policies have coverage for abortion related claims. More from NARAP Pro-Choice Virginia, click here. Virginia Legislature record of bill, click here. 04/07/2011 REPUBLICAN HOUSE MEDICARE PROPOSAL BLASTED BY CENTERS FOR MEDICARE AND MEDICAID SERVICESMore from the Emeritus Newsroom- A Medicare reform plan announced today by Republican House leaders was immediately blasted by officials of the Centers for Medicare and Medicaid Services. In a statement released this morning the CMS wrote, The budget released today by the House of Representatives includes proposals that pretend to address issues that affect Main Street Americans. Once again we're hearing proposals to "reform" Medicare. These plans are not about reform or deficit reduction. They are about a long held desire to do away with Medicare, shifting costs to American families who are already struggling. Newt Gingrich told us in the 1990s that he might not be able to eliminate Medicare, but that he would watch it wither on the vine. This time, some of the proposals actually do eliminate Medicare, replacing it with vouchers to purchase private insurance. The proposals are reckless and extreme. As with Medicare Advantage and Medicare Part D, these proposals will cost beneficiaries and taxpayers more than the traditional Medicare program. With a capped annual voucher to purchase insurance, Medicare beneficiaries will pay more out-of-pocket, get less coverage, and have less access to health care. Sounds like rationing to us.
Full CMS statement, click here. 04/05/2011 REPUBLICAN PROPOSAL TO REFORM MEDICARE PARTIALLY WRITTEN BY FORMER CLINTON OMB DIRECTORMore on the Republican proposal from California Healthline, click here- National Review article on plan co-written by former Clinton Office of Management and Budget Director, Alice Rivlin, click here. 04/05/2011 MEDICARE BENEFITS WILL COVER PROSTATE CANCER DRUGMore from the Emeritus Newsroom- The Centers for Medicare and Medicaid Services today announced Medicare patients WILL have access to the prostate cancer treatment drug Provenge, which costs more than $90,000. Since being approved by the FDA in April, controversy about the effectiveness of the drug and the price tag kept access in doubt for Medicare patients. But the CMS today stated that it considered use of the drug for its approved purpose, "reasonable and necessary for that indication under 1862(a)(1)(A) of the Social Security Act (the Act)". Full text of CMS statement, click here. 03/30/2011 MARICOPA COUNTY AZ. WORKERS QUESTION NICOTINE TESTS TO GET HEALTH INSURANCE DISCOUNT / ALSO QUESTION USE OF INFORMATION FOR TESTS AND SCREENINGSMore from the Emeritus Newsroom- Maricopa County, Arizona workers say confusing and conflicting information has left more questions than answers, regarding saliva tests needed to get a non smokers discount on their health plan. In an e-mail to workers last month (see copy below) , employees were told they had to submit to a cheek swab test to qualify for the discount. Local media reports claim county officials decided to take the action after only ten percent of the workers, in the health plan, claimed to be smokers, an exceptionally low percentage, in view of what county officials believe to be the case. The Arizona ACLU has also raised questions about privacy and constitutional issues. Irregularities as to application of the rules, involving dependents of covered workers and their use of tobacco, as well as the use of information gained through the saliva and screening tests, are prompting more questions from workers, who believe they are not being told the whole story. The e-mail sent workers states, "This year, in order to receive the non-tobacco user incentive, you must complete a saliva test that detects the use of nicotine. lf you pass the test and if all your covered dependents have not used tobacco products for the past six months, you will qualify to save up to $480 annually ($20 savings per pay period) as an incentive for being tobacco free. "Tobacco user" means the occasional or regular use of a tobacco product including, but not limited to: cigarettes, cigars, pipes, snuff ,chewing tobacco and any other products containing tobacco. lf you provide inaccurate information regarding covered dependents in order to receive the incentive for which you are not eligible, you may be subject to disciplinary action up to and including termination. Please note the saliva test applies only to you and not to your dependents". Questions remain over verification of dependents, who may use tobacco products, but will not be tested, the testing effect from passive smoke on non smoking workers, confidentiality of testing and screenings. County officials claim the test results and screenings will be confidential, but workers question how confidentiality could be guaranteed if a worker is rejected from eligibility for the discount, in which the payroll department is notified to change the amount for insurance premium deductions, or confidentiality in the event the worker wants to challenge their results. Full text of e-mail to county workers, click here. Also a MUST READ story and video from the Arizona Republic, click here. 03/17/2011 INSURANCE COMPANIES SAY NEW INSURANCE LAWS NOT THE BIG REASON FOR PRICE INCREASESMore in this article from the New York Times, click here- 03/06/2011 ILLINOIS BLUE CROSS BLUE SHIELD AGREES TO PAY $25 MILLION FOR MEDICAID CLAIMS FRAUDMore from the Emeritus Newsroom- Federal and state prosecutors have reached agreement with Illinois Blue cross and Blue Shield to repay the Illinois Medicaid system at least $25 million for claims it should have paid instead of Medicaid. According to Illinois Attorney General Lisa Madigan, the agreement settles allegations the company denied coverage of nursing care needed for sick children and other fragile patients and fraudulently shifted the cost of this expensive care to the state and federal Medicaid program. The settlement reached by Madigan and U.S. Attorney Patrick Fitzgerald resolves their investigation into Blue Cross Blue Shield, a division of Health Care Service Corporation, denying patient claims for in-home, skilled nursing care for complex medical needs. The Attorney General and Fitzgerald alleged BCBS denied patient claims based on internal, undisclosed guidelines that were more restrictive than the language provided to patients in plan policy materials. As the result of the denials, the cost of the care that should have been covered was shifted to the state and federal Medicaid program, costing it nearly $12 million. “Blue Cross Blue Shield’s inappropriate denial of legitimate claims placed an undue burden on the state’s finances,” Attorney General Madigan said. “My office is committed to holding health care insurers accountable on behalf of the people of Illinois for this type of deception and fraud.” Madigan and Fitzgerald also alleged instances where BCBS fraudulently contended patients weren’t covered for this care during claims review processes sought after patient denials. Under the agreement, BCBS will pay $14.25 million to Illinois and $9.5 million to the U.S. Treasury to help fund and reimburse Medicaid programs. The company will also pay $1.25 million that will go to Illinois consumers who were denied by BCBS but did not receive Medicaid coverage. Full text of Attorney General Madigan statement, click here. 02/24/2011 U-S HOUSE APPROVES CUTOFF OF FUNDS FOR AFFORDABLE HEALTH CARE ACT / SENATE LIKELY TO STOP ITMore from the Emeritus Newsroom- The U-S House today approved with holding of funds for the Affordable Care Act, passed last year. In a mostly partly line vote, 239-187, Republicans succeeded in pushing HR 1 through a largely symbolic move, fulfilling a promise they made during their election campaigns last November, when they won control of the House. Because HR 1 also involves a critical defense appropriations bill, the Senate is still controlled by Democrats, is likely to act only on the defense portion of the, with the portions blocking funding for the Affordable Care Act to most of the bill from the House is unlikely to get anywhere. Thomas summary of HR1, click here. 02/18/2011 MEDICARE DRUG PLAN ENROLLMENT EXTENDED TO END OF THE MONTH DUE TO CONFUSION OVER PROVIDERSMore from the Emeritus Newsroom- Because of confusion over which providers were still or out of drug plan enrollment for Medicare, those who have not selected a drug plan for the current year will be able to do so by the end of the month. Those who don't make a selection by the end of the month will be without drug coverage until the 2012 selection goes into effect. A letter was sent out to recipients informing them of the change. Full text of CMS letter to recipients, click here. 02/18/2011 FACEBOOK PAGE LEADS TO LOSS OF DISABILITY BENEFITSMore in this article from the LA Times, click here- 01/25/2011 INSURANCE COMPANIES MAKING HUNDREDS OF MILLIONS ON FEDERAL MEDICARE PREPAYMENTSMore from the Emeritus Newsroom- The federal government could be losing out on more than $700 million in savings and earnings on money that is prepaid insurance companies for the Medicare Advantage program. A report from the Inspector General's Office at the Department of Health and Human Services shows the Medicare Part A and Part B trust funds (which finance the Medicare Advantage program) could have earned approximately $450 million of interest income in calendar year (CY) 2007. Alternatively, if Federal requirements had been established to require MA (Medicare Advantage) organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income, the Medicare program could have saved an estimated $376 million that the 457 MA organizations that were included in our sampling frame earned in CY 2007. In order to resolve the issue, the IG's office suggests that CMS (Centers for Medicare and Medicaid) evaluate these audit results and either (1) pursue legislation to adjust the timing of Medicare's prepayments to MA organizations to account for the time that these organizations invest Medicare funds before paying providers for medical services or (2) develop and implement regulations that require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income. CMS did not concur with our recommendation. Full text of IG's summary and report, click here. 01/21/2011 STATE OF NEW YORK AGREES TO REPAY $207.6 MILLION FOR FEDERAL MEDICAID REIMBURSEMENTS ON REHAB SERVICES / FEDS CLAIM STATE DIDN'T HONOR REQUIREMENTSMore from the Emeritus Newsroom- State of New York officials have agreed to refund the federal Medicaid program $207.6 million dollars submitted by community residence rehabilitation providers during calendar years 2004 through 2007. the HHS Inspector General's Office says that 100 claims in a random sample, 31 claims complied with Federal and State requirements, but 69 claims did not. These claims lacked (1) a physician's reauthorization for rehabilitation services based on a review of the recipient's service plan or case record, (2) a physician's initial authorization that included a face-to-face assessment of the recipient, (3) a rehabilitation service at least 15 minutes in duration, (4) a physician's authorization specifying the maximum duration of services needed by the recipient, (5) at least four different reimbursable rehabilitative services provided to the beneficiary for a monthly claim, and/or (6) a service plan reviewed and signed by a qualified mental health staff person. New York State elected to include coverage of rehabilitation services provided to recipients residing in community residences (group homes and apartments) in its Medicaid program. Full text of GAO report, click here. 01/21/2011 HOUSE APPROVES REPEAL OF HEALTH REFORM / DEFEAT EXPECTED IN SENATEMore from the Emeritus Newsroom- Republicans in the House approved a repeal of the Affordable Care Act. The vote was considered symbolic since it has little chance of passing the Senate and no chance being signed by President Obama. One of the biggest argument against repeal has been a CBO study showing repeal would add $230 billion to the federal deficit over the next ten years. Some insurance executives, already vested in the laws now on the books, oppose repeal since Republicans, so far have offered no proposals to cover more people with more people paying into the insurance market to pay for it. For example, in November, Cigna CEO, David Ordain, said during a Reuters Health Summit in New York City,"I don't think it's in our society's best interest to expend energy in repealing the law". However, Cordani said there is room to do more to further contain the United States' spiraling healthcare costs, such as expanding more consumer-directed options like health savings accounts and improving the nation's payment system. 01/20/2011 MEDICARE PATIENTS MAY PAY MORE FOR HOME HEALTH VISITSMore in this article from the Associated Press- 01/15/2011 CONGRESSIONAL BUDGET OFFICE SAYS REPEAL OF HEALTH CARE REFORM ADDS $230+ BILLION TO DEFICITMore from the Emeritus Newsroom- The Congressional Budget Office today restated their projections that the health care reform legislation passed by congress last year and signed by the President, will save more than $230 billion from 2012 to 2020. The CBO response to Speaker John Boehner's request for a review, was released today. CBO Director Doug Elmendorf told Boehner, "The Congressional Budget Office (CBO) has reviewed H.R. 2, the Repealing the Job-Killing Health Care Law Act, as introduced on January 5, 2011. That bill would repeal the Patient Protection and Affordable Care Act (PPACA, Public Law 111-148) and the provisions of the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) that are related to health care. Both of those laws were enacted in March 2010. Elomendorf says, "...over the 2012–2021 period, the effect of H.R. 2 on federal deficits as a result of changes in direct spending and revenues is likely to be an increase in the vicinity of $230 billion, plus or minus the effects of technical and economic changes to CBO’s and JCT’s projections for that period". CBO report and letter to Speaker Boehner, click here. 01/06/2011 BLUE SHIELD OF CALIFORNIA BACK WITH 59% RATE INCREASE REQUEST FOR INDIVIDUAL POLICY HOLDERSMore in this article from the LA Times, click here- CBS Evening News You Tube story below. 01/06/2011
HHS INSPECTOR GENERAL SAYS MORE SKILLED NURSING FACILITIES SUBMITTING QUESTIONABLE CLAIMSMore from the Emeritus Newsroom- Higher cost therapies in skilled nursing facilities have always faced scrutiny from insurers and government agencies. A report released by the inspector General at HHS claims that for-profit skilled nursing facilities have a higher rate of filing for more expensive higher cost therapies than those operated by non profit and government agencies. The IG's report says SNFs (skilled nursing facilities) increasingly billed Medicare for higher paying RUGs from 2006 to 2008, even though beneficiary characteristics remained largely unchanged. Specifically, the IG found large increases in RUGs (resource utilization groups) for ultra high therapy, with payments to SNFs for ultra high therapy increasing by nearly 90 percent from 2006 to 2008, rising from $5.7 billion to $10.7 billion. In addition, RUGs for high levels of assistance with daily activities increased. The probe also revealed that for-profit SNFs were far more likely than nonprofit or government SNFs to bill for higher paying RUGs, and we found that a number of SNFs had questionable billing in 2008. Taken together, according to the IG report, these findings raise concerns about the potentially inappropriate use of higher paying RUGs, particularly those for ultra high therapy. As for remedies, the IG report stated: "We recommend that CMS: (1) monitor overall payments to SNFs and adjust rates, if necessary; (2) change the current method for determining how much therapy is needed to ensure appropriate payments; (3) strengthen monitoring of SNFs that are billing for higher paying RUGs; and (4) follow up on the SNFs identified as having questionable billing. CMS concurred with three of the four recommendations. It did not concur with the recommendation to change the current method for determining how much therapy is needed, but stated that it is committed to pursuing additional improvements to the SNF payment system". Full text of Inspector General report, click here. 01/04/2011 MEDICARE RECIPIENTS LIFETIME MEDICARE PAYMENTS AVERAGE LESS THAN A THIRD OF BENEFITS PAIDMore in this article from NPR, click here- 01/03/2011 OBAMA ADMINISTRATION FORCES HEALTH INSURERS TO GET PERMISSION FOR RATE INCREASES OVER 10%More from the Emeritus Newsroom- As part of a plan to keep watch on premium rate increases from health insurance companies, the Affordable Care Act gives states $250 million to help pay for rate reviews to protect consumers and stop unreasonable premium increases. The Obama administration claims that 46 states and the District of Columbia are already using the money to do just that. According to Obama administration officials, the money will help states enforce restrictions imposed by the Affordable Care Act which requires insurers to publicly justify any unreasonable premium increases. Under the new rules, if an insurance company proposes to raise rates by 10% or more, they must publicly disclose on their own, as well as HHS’ web site the justification for the increase. The appropriate state insurance commissioner or, if a State does not have an effective rate review process, HHS, will then review the insurance company’s justification to determine whether or not the increase is justified. In some states like, Washington and Maine, all new insurance premium rates, regardless of whether they are below 10% need to be approved by the state insurance commissioner’s office ahead of time, and will continue to be reviewed moving forward. Health and Human Services Secretary Kathleen Sebelius has recorded a new White House White Board video (below) to explain just how this new rule works, and how rate review helps states review and crack down on unjustified premium hikes and protect consumers.12/22/2010
FEDERAL COURT JUDGE IN VA. RULES HEALTH REFORM LAW MANDATING INSURANCE PURCHASE UNCONSTITUTIONALMore from the Emeritus Newsroom- A federal judge in Richmond, Virginia, has ruled against the mandatory health insurance purchase requirement in the new health care reform act. In his decision, Judge Henry Hudson said the law overstepped boundaries for regulating interstate commerce. Hudson added, in his decision, that striking, what he considers, the unconstitutional section, may have additional impact, which may advance to higher courts. Hudson questions whether the rest of the new reform law sections will be able to stand on their own, without the mandatory purchase section. Today's ruling by Hudson will not have an immediate effect, since the mandatory purchase requirement does not take effect till 2014. But, it sets in motion more legal arguments, which likely will end at the U-S Supreme Court. Hudson's ruling is the first federal court victory for health reform opponents, since two other federal court decisions have dismissed earlier challenges. Full text of Judge Hudson's decision, click here. 12/13/2010 CHIEF OF MEDICARE AND MEDICAID SAYS SAVINGS THROUGH HEALTH REFORM WILL PRESERVE SYSTEMMore from the Emeritus Newsroom- His recess appointment not going down with Republicans on the Senate Finance Committee, Medicare and Medicaid Services Director, Dr. Donald Berwick defended health care reform as a stabilizing force for both programs. In testimony to the Senate Finance Committee yesterday, Berwick testified, "To date, 1.8 million seniors and people with disabilities who have incurred high prescription drug costs have received immediate help through a tax-free $250 rebate check to help reimburse them for out-of-pocket costs in the Part D prescription drug coverage gap known as the ―donut hole.‖ In addition, every year, people with Medicare Part D will pay less for their prescription drug costs in the coverage gap. Beginning in 2011, eligible Medicare beneficiaries will get a 50 percent discount on brand name prescription drugs in the coverage gap. By 2020, we will have closed the donut hole". Berwick added, "These important changes put Medicare on a path toward long-term sustainability and produce savings for the taxpayers by prolonging the life of the Medicare Hospital Insurance Trust Fund for an additional 12 years to 2029. These important changes will also benefit people with Medicare by keeping their premiums and cost sharing low. New authorities in the Affordable Care Act offer additional front-end protections to keep those who commit fraud out of Federal health care programs, as well as new tools for deterring wasteful and fiscally abusive practices, promptly identifying and addressing fraudulent payment issues, and ensuring the integrity of the Medicare and Medicaid programs". Full text of Berwick statement, click here. Senate Finance Committee hearing page with video, click here. 11/18/2010 MONTANA GOVERNOR PUSHES CHEAP CANADIAN DRUG PLAN APPROVAL FROM THE FEDSMore in this article from the Washington Post, click here - 11/17/2010 REGENCE BLUE CROSS FORCED TO GIVE 1,000 WOMEN $148,000 EACH FOR DENYING PAYMENT FOR I-U-D REMOVALMore in this article from the Seattle Times, click here - 11/16/2010 CDC SAYS 59 MILLION NOW WITHOUT HEALTH INSURANCE IN THE U-S / CIGNA C-E-O OPPOSES REPEAL OF HEALTH INSURANCE REFORMMore from the Emeritus Newsroom- The ranks of those without health insurance in the U-S continues upward due to job losses and price increases. The latest statistics were released by the Centers for Disease Control which claims more than 59 million Americans had no health insurance for at least part of 2010, an increase of 4 million from the previous year. "As private insurance coverage fell, the safety net protected children, but did not adequately protect adults,", said Thomas Frieden, Director, Centers for Disease Control. As more the health insurance reform legislation is taking effect, the man expecting to be House Speaker with the incoming Republican controlled House, Rep. John Boehner (D) OH, has said he believes Republicans were elected in order to repeal sweeping health reforms passed last year that were in part aimed at finding coverage for the uninsured. One of the ways Republicans say they plan on addressing healthcare reforms is by de funding the reform's initiatives. Regardless, many predict political gridlock during the next two year in implementing health reforms. HOWEVER, YESTERDAY THE CHIEF EXECUTIVE OFFICER OF INSURANCE GIANT CIGNA, SAYS HE OPPOSES REPEAL OF HEALTH INSURANCE REFORM. Cigna CEO, David Cordani, said Tuesday, during a Reuters Health Summit in New York City,"I don't think it's in our society's best interest to expend energy in repealing the law". However, Cordani said there is room to do more to further contain the United States' spiraling healthcare costs, such as expanding more consumer-directed options like health savings accounts and improving the nation's payment system. More from Senate Democrats on CDC announcement, click here. Full text of Reuters report on Cigna CEO Cordani, click here. CDCtranscript of news conference, click here. 11/10/2010 U-S SUPREME COURT REJECTS PRELIMINARY MOTION TO BLOCK HEALTH REFORM LAWSMore from the Emeritus Newsroom- An attempt by foes of health reform laws to get a preliminary boost from the U-S Supreme Court has failed. In a unanimous ruling announced today (Re: case #10-369) , the court turned down a preliminary injunction request from Steve Baldwin, a conservative activist who is suing the Department of Health and Human Services and Secretary Kathleen Sebelius, in order to block the Patient Protection and Affordable Care Act. Full text of lower court decision, rejecting motion for preliminary injunction, click here. 11/08/2010 HEALTH REFORM EFFECTS ON EMPLOYER HEALTH PLANS STILL UNSETTLED / TREND FOR HIGHER CO-PAYS AND DEDUCTIBLES CONTINUESMore in this article from the Washington Post, click here - 11/08/2010 REPUBLICANS VOW TO DEFEAT PRESIDENT OBAMA AND REPEAL HEALTH REFORMMore from the Emeritus Newsroom- Republicans in the House and Senate have vowed to repeal health reform enacted by the current congress and signed by President Obama. Some of its provisions have already taken effect, with more taking effect January 1st, before the new congress is convened. Republican leaders are wasting no time campaigning against the new law and President Obama, showing more defiant signals of 'bi-partisan be damned" ultimatums, they intend to pursue with control of the House. During a speech Thursday at the Heritage Foundation, Senate Minority Leader, Sen. Mitch McConnell, (R) KY, said the only way to change the course of Washington was to get Republican control of the Senate and defeat President Obama. See must see video story below from Voice of America.
11/05/2010 HHS COST PROJECTIONS SHOW MEDICARE RECIPIENTS COULD SAVE 12,300 OVER 10 YEARSMore from the Emeritus Newsroom- Traditional Medicare plan recipients are in line to save between $3,500 to 12,300 over ten years, according to the latest estimates from the Department of Health and Human Services. Those with disabilities and higher prescription costs are more likely to see the maximum savings.The analysis, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), shows that the Affordable Care Act helps lower costs for those on Medicare by slowing the growth of cost-sharing in Medicare. Closing the Part D coverage gap known as the “donut hole” will produce the greatest cost savings. Already, more than 1.8 million seniors and people with disabilities who have reached the donut hole in 2010 received a one-time $250 rebate check, and checks will continue to be distributed to those who enter the donut hole this year. Next year, people in the donut hole will receive 50 percent discounts on covered brand name Part D prescription drugs. Also starting next year, seniors and people with disabilities on Medicare will have access to a number of recommended preventive services and annual wellness visits at no additional cost. Although all seniors and people with disabilities in Medicare are likely to see savings, the savings will be greatest for those with costly medical conditions or high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary with spending in the donut hole, estimated savings increase from $553 in 2011 to $2,217 in 2020. “The savings that seniors and people with disabilities on Medicare are seeing are due to critical improvements the Affordable Care Act makes to Medicare,” said Assistant Secretary for Planning and Evaluation, Sherry Glied. “Reducing waste, fraud and abuse, improving the quality of care beneficiaries receive, and making the program more efficient all contribute to lower cost increases across the system.” Full text of the HHS press release, click here - 11/04/2010 UCLA HEALTH STUDY FINDS HIGH DEDUCTABLE INSURANCE POLICIES FORCE SICK TO PUT OFF/NOT SEEK MEDICAL CAREMore from the Emeritus Newsroom- A study shows 3 million of 32 million Californians have high deduct able insurance plans because they can't afford premiums of plans with lower deductibles. The UCLA Health Policy Research Center found a co-relation between those not seeking care when they should, having insurance plans with higher deductibles. High deduct able plans are considered those with $1,000 deductibles for individuals and $2,000 for families. In addition, those in higher deduct able plans were more likely not to have medical savings accounts to help offset out of pocket costs. UCLA Health Policy Research Center press release, click here. 10/28/2010 NO COST OF LIVING RAISE FOR SOCIAL SECURITY MEANS NO RAISE FOR MEDICARE PART 'B' PREMIUMS FOR MOST SENIORSMore from the Emeritus Newsroom- It's called the, "Hold Harmless Provision" and it likely will prevent most seniors on Social Security from having to pay increases in Medicare part 'B' premiums. The Center for Medicare Advocacy says the hold harmless provision in the Social Security Act disallows an increase in the Medicare Part 'B' premium for qualifying Social Security recipients if their COLA is not large enough to cover the increase in the Part B premium. Although the Centers for Medicare & Medicaid Services (CMS) has not yet announced the Part B premium for 2011, the principles of hold harmless will apply regardless of the amount. According to the Center's news release issued today, to be protected by the hold harmless provision, a beneficiary must:
Because of the hold harmless provision, most Social Security recipients will not see an increase in their Part B premiums in 2011. Those seniors who WILL face an increase in the Medicare Part 'B' premium are:
Beneficiaries new to Medicare in 2011, even if they received Social Security benefits in November and December, will not have had Medicare premiums deducted from their checks in both December 2010 and January 2011. Because they were not paying Part B premiums for the last two months of 2010, they will not have experienced a decrease in benefits in 2011 that is due to the increase in the Part B premium. Next, beneficiaries who, because their incomes exceed a threshold set in the law, are required to pay a higher, income-related Part B premium are explicitly excluded from the hold harmless provision. Third, the roughly seventeen percent of Medicare Part B beneficiaries who are dually eligibles for Medicare and Medicaid and whose Part B premiums are paid by the state, usually through one of the Medicare Savings Programs (MSPs) are not subject to the hold harmless provision. Dual eligibles are not protected by the hold harmless clause because their Part B premiums are not deducted from their Social Security checks. Dual eligibles are not directly affected, however, as the increased premium will be paid by their state Medicaid program. Full text of Centers for Medicare Advocacy press release, click here. 10/21/2010 L-A CITY ATTORNEYS : WELLPOINT CONTINUED CANCELING BREAST CANCER PATIENTS AFTER BEING TOLD TO STOPMore from the Emeritus Newsroom- Los Angeles City Attorneys have filed suit against health insurance giant WellPoint, claiming the company continued to drop policies of breast cancer patients after the company claimed it had stopped. WellPoint has come under increasing pressure for the last two years from local, state and federal investigators for canceling sick patients, most notably, those with catastrophic illnesses. According to Los angeles city Attorneys, WellPoint continued the practice beyond dates when the company claimed it had corrected the problems. The City Attorney’s civil enforcement action against WellPoint was filed in April 2008 stating
that, from 2002 to 2008, WellPoint’s California subsidiaries unlawfully rescinded the health
care coverage of approximately 6,000 of their members. WellPoint sold approximately 1.8 As of this posting, WellPoint has not responded publicly to the latest allegations. Full text of Los Angeles City Attorney press release, click here. 10/16/2010 LATEST TREND FROM SCAMMERS: TELL SENIORS THEY WILL LOSE THEIR MEDICARE UNLESS THEY GIVE UP PERSONAL FINANCIAL INFORMATIONMore in this article from the Chicago Tribune, click here 10/15/2010 HEALTH CARE REFORM ACT PASSES FIRST COURT TESTMore in this article from the New York Times, click here- 10/07/201 REIMBURSEMENTS FOR OVER THE COUNTER DRUGS FACE LIMITS ON FLEX ACCOUNTSMore from the Emeritus Newsroom- Most often cited "Q and A" on what expenses will still be allowed on Flex accounts when new federal rules go into effect January 1, 2011 : Over-the-counter medicines without a prescription? No. Medical co-pays and deductibles? Yes. Medical supplies without a prescription? Yes. OTC medications without a prescription purchased in 2010 but not reimbursed until 2011? Yes. OTC medications without a prescription purchased in 2011 during my 2010 FSA's "grace period"? No. More in this article from the Chicago Tribune, click here 10/03/2010 LOSS OF JOB, HEALTH INSURANCE FORCES 3.7 MILLION INTO MEDICAID / STATES FACE MEDICAID FUNDING CRISIS IN 2011More from the Emeritus Newsroom- The latest annual survey by the Kaiser Family Foundation found an 8.2 per cent increase in the number of people forced into Medicaid in 2009, the last resort insurer for the poor. In terms of numbers, that means an increase of 3.7 million people. KFF says the increase amounts to the highest rate of growth in eight years and well above their original projections of 6.3 percent growth. Medicaid directors attributed the unexpected jump to higher-than-expected increases in eligible families due to the recession, which pushed the national unemployment rate above 10 percent and even higher rates in some states. the KFF report also details why this represents a financial make or break issue for states, whose additional federal Medicaid assistance will run out next year, without action from congress. PATIENTS "BILL OF RIGHTS" TAKES EFFECT / SOME INSURANCE COMPANIES END CHILD ONLY POLICIES / AVERAGE PRICE OF MEDICARE ADVANTAGE PLANS GOING DOWNMore from the Emeritus Newsroom- The "Patients Bill of Rights", another part of the "Affordable Care Act" into effect today. As stated by the White House today, The Patient’s Bill of Rights includes: Bans discrimination against kids with pre-existing conditions. Allows young adults to remain on their parents’ plan until their 26th birthday. Prohibits insurance companies from cutting off your coverage when you’re sick if you made a mistake on your application. Prohibits insurance companies from putting a lifetime limit on the amount of coverage you may receive, and restricts the use of annual limits until they are banned completely in 2014. And if you join a new plan: You have the right to choose your own doctor in your insurer network. Your insurer is banned from charging more for emergency services obtained outside of their network. You will be guaranteed the right to appeal insurance company decisions to an independent third party. You will receive recommended preventive care with no out-of-pocket cost. Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered, and insurance companies will be prohibited from charging deductibles, co-payments or co-insurance. Citing as examples of progress, due to health insurance reform, Blue Cross Blue Shield North Carolina announced on Monday that, thanks to the Affordable Care Act, 215,000 customers will receive refunds totaling $155.8 million. Tuesday brought more good news when the Department of Health and Human Services announced that, on average, premiums for seniors enrolled in Medicare Advantage would go down, while enrollment in the program is expected to increase. THE CHANGES HAVE ALSO PROMPTED SOME HEALTH INSURANCE COMPANIES TO END CHILD ONLY POLICIES. WellPoint, Anthem, Cigna, CoventryOne and other insurance companies have said they are ending their, "Child Only" individual health insurance policies because of the fear that parents will only buy them when their children are sick, then cancel them when they are well. LA Times article, click here. Recent government estimates show that only 55% of children in the U-S are covered by private insurance plans, with 64% of adults covered by private insurance plans. Medicaid is the largest single insurer of children in the U-S. The rate of children insured under public plans has been increasing over the last four years, due to parents unemployment, high costs of family coverage and small employers dropping health plans. The White House also announced a new website today with information about changes due the "Affordable Care Act". Click here for White House health care reform page. WHITE HOUSE VIDEO OF PRESIDENT OBAMA PHONE CALL TO CANCER PATIENT NOW INSURED THROUGH HEALTH CARE REFORM ACT
09/23/2010 CALIFORNIA HEALTH INSURER FIGHTS $9.9 BILLION FINEMore from the Emeritus Newsroom- California state insurance regulators claim PacifiCare, now owned by United Health group, violated state law more than a million times from 2006-2008 and should be fine more than $9.9 billion dollars, perhaps the largest such fine against a health insurer in U-S history. The company is accused of losing customer claims, repeatedly botching payouts to patients and doctors and other providers and doing little if anything to fix the problems. Attorneys for the California Insurance Commissioner say it was all a campaign rooted in corporate greed to cut costs by any means possible, legal or illegal. United Health and PacifiCare deny the accusations, saying the errors were mainly clerical and did not result in any major problems. The companies did admit that many of the problems stemmed from the company's failure to properly notify patients and providers of their rights to appeal claims payment decisions in 2007. PDF copy of original complaint against PacifiCare, click here. 09/07/2010 INSPECTOR GENERAL SAYS MEDICARE PART "D" PAID $43.3 MILLION ON LESS THAN EFFECTIVE DRUGS IN 2006-2007More from the Emeritus Newsroom- Without identifying those drugs which have been labeled as, "less than effective", an HHS Inspector General report on Medicare Part "D" drug payments shows $43.3 million was paid for such medications and raises the possibility of seeking restitution from those responsible. The report says, "Of approximately $115 billion in gross drug costs included in Medicare Part D sponsors' prescription drug event (PDE) data for calendar years 2006 and 2007, CMS accepted PDE data totaling $43.3 million associated with less-than-effective drugs. Pursuant to Federal requirements, Medicare Part D should not have covered these drugs. Less-than-effective drugs are drugs that the Food and Drug Administration (FDA) approved before 1962 and that FDA subsequently found to be less than effective. CMS's Drug Data Processing System subjects sponsors' PDE data to an edit designed to reject less-than-effective drugs. Although the edit identified and rejected the vast majority of PDE data associated with less-than-effective drugs, the edit did not identify and reject PDE data for some less-than-effective drugs because the Part D program used an incomplete list of less-than-effective drugs as the basis for the edit. There is no definitive list of less-than-effective drugs. We recommended that CMS determine whether it can impose financial adjustments on sponsors that were paid for furnishing less-than-effective drugs and help ensure that drugs covered by Medicare Part D comply with Federal requirements by (1) collaborating with FDA to create and maintain a comprehensive list of less-than-effective drugs, (2) regularly disseminating this list to all sponsors, and (3) using this list to reject PDE data for less-than-effective drugs. CMS agreed with our first recommendation and partially disagreed with our second recommendation, stating that FDA should be responsible for maintaining and disseminating the list of less-than-effective drugs. We modified our second recommendation to reflect FDA's role in identifying less-than-effective drugs". Full text of HHS Inspector General report, click here. 08/23/2010 MEDICARE DRUG PLANS UP $1@ MONTHMore from the Emeritus Newsroom- According to bids which have been submitted to the Center for Medicare and Medicaid Services, the average cost increase for Medicare Drug prescription plans, Part D, will be up $1 per month. The announcement from the CMS estimates that the average monthly premium beneficiaries will pay for standard Part D coverage will be $30 -- a $1 increase from the current year (2010) average premium of $29. CMS claims that premiums paid by Part D enrollees cover about 25 percent of the cost of basic Part D coverage. Enrollees with limited incomes may qualify for the low-income subsidy (LIS), or extra help, that typically covers some or all of the beneficiary’s premium, deductible, co payments and the cost of drugs in the coverage gap. Currently, more than 10 million beneficiaries are receiving LIS benefits. In 2011, the average value of the subsidy amount applied to the Part D benefit, premium and cost-sharing for those enrolled in the LIS program is estimated to be about $4,000. Under new Affordable Care Act provisions, fewer individuals who receive LIS benefits will need to move to a new plan to avoid paying a premium. “The Affordable Care Act helps reduce disruption for this vulnerable population, so only about 500,000 beneficiaries will be re-assigned to new plans, compared to about 800,000 who were moved last year,” Blum said. “And this year, we’ll be providing those beneficiaries who are moved into a new plan with more information than ever before about how these plan changes may affect them. For most people with Medicare, we expect the process to be seamless”. In addition to national average premiums for 2011, CMS announced the 2011 national average monthly bid, the base beneficiary premium, the regional low-income subsidy premium amounts for 2011; and the 2011 Medicare Advantage regional preferred provider organization benchmarks. General information about plan offerings will be released in September. The national and regional premium data can be found at: http://www.cms.gov/MedicareAdvtgSpecRateStats/RSD/list.asp. Full text of CMS press release, click here. 08/19/2010 FEDERAL TRADE COMMISSION BUSTS BOGUS HEALTH PLANS SOLD TO UNINSURED AND UNEMPLOYED AMERICANS / ALSO BUSTS INTERNET DOMAIN REGISTRATION SCAMMore from the Emeritus Newsroom- Investigators say sales personnel for various "medical discount plans" were marketing them as health insurance with high fees. The FTC filed three cases charging companies with deceptively marketing medical discount plans. In one case, at the request of the FTC, a U.S. district court has ordered a temporary halt to the deceptive actions of Consumer Health Benefits Association, which targeted consumers who sought information on the Internet about major medical health insurance plans. CHBA telemarketers allegedly pitched consumers with a long list of false claims, including:
Consumers paid between $29 and $280 in enrollment fees before they received written information about the plan. When they tried to use the plan with physicians CHBA claimed were “participating providers,” the providers said they did not accept the plan. One consumer who tried to use the plan to buy prescription medicine discovered the “discounted” price was higher than the price she had paid without the medical discount plan. The FTC also charged that CHBA misrepresented its refund policies and that typically, consumers received refunds only after they threatened to complain to consumer protection agencies. The FTC seeks a permanent halt to the allegedly illegal activities and has asked the court to order the defendants to give up their ill-gotten gains. Two other companies, Health Care One LLC and U.S. Benefits were also charged with selling discount plans as medical insurance. The FTC also busted Canadian con artists involved with internet domain registration scams. According to the FTC, scores of small businesses, individuals and non-profits were instructed pay bogus bills, leading them to believe they would lose their web site addresses unless they paid. Settlement and default judgment orders signed by the court will bar the deceptive practices in the future.In June 2008, the FTC charged Toronto-based Internet Listing Service with sending fake invoices to small businesses and others, listing the existing domain name of the consumer’s Web site or a slight variation on the domain name, such as substituting “.org” for “.com.” The invoices appeared to come from the businesses’ existing domain name registrar and instructed them to pay for an annual “WEBSITE ADDRESS LISTING.” The invoices also claimed to include a search engine optimization service. Most consumers who received the “invoices” were led to believe that they had to pay them to maintain their registrations of domain names. Other consumers were induced to pay based on Internet Listing Service’s claims that its “Search Optimization” service would “direct mass traffic” to their sites and that their “proven search engine listing service” would result in “a substantial increase in traffic.” A federal district court judge in Chicago, Robert M. Dow, Jr., ordered a temporary halt to the deceptive claims and froze the defendants’ assets, pending trial. The settlement and default judgment orders announced today end that litigation. FTC press release on internet scam, click here. FTC press release, copy click here. video sample of bogus TV ad. 08/11/2010 WHITE HOUSE ORDERS INSURERS TO COVER PREVENTIVE TESTS WITH NO CO PAYSMore from the Emeritus Newsroom-In an effort to boost preventive care, the White House has released its rules under the new health reform law, mandating what services reaquired to be free to those in private health plans effective September 23d. According to the website www.healthcare.gov , some of the changes that have already taken place along with those still to come: On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll out over four years and beyond, with most changes taking place by 2014. Others have already begun. Use this timeline to learn about what’s changing and when. Changes to note: Effective Jan. 1, 2010 Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit. Learn more Effective April 1, 2010 States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents. First checks mailed in June, 2010, and will continue monthly throughout 2010 as seniors hit the coverage gap An estimated 4 million seniors will reach the gap in Medicare prescription drug coverage known as the “donut hole” this year. Each such senior will receive a $250 rebate. Applications for employers to participate in the program available June 1, 2010. Learn more about the Early Retiree Reinsurance Program. Too often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents. National program established July 1, 2010 A Pre-Existing Condition Insurance Plan will provide new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state chooses not to do so, a plan will be established by the Department of Health and Human Services in that state. This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited. Learn more about the Pre-Existing Condition Insurance Plan. Effective July 1, 2010 The law provides for an easy-to-use website where consumers can compare health insurance coverage options and pick the coverage that works for them. Effective for health plan years beginning on or after September 23, 2010 Under the new law, young adults will be allowed to stay on their parent’s plan until they turn 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Some insurers began implementing this practice early. Check with your insurance company or employer to see if you qualify. Learn more about the young adults insurance policy. Effective for health plan years beginning on or after September 23, 2010 Under the new law, young adults will be allowed to stay on their parent’s plan until they turn 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Some insurers began implementing this practice early. Check with your insurance company or employer to see if you qualify. Learn more about the young adults insurance policy. Effective for health plan years beginning on or after September 23, 2010 In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for new plans beginning on or after September 23, 2010 The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process. Effective for health plan years beginning on or after September 23, 2010 Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Effective for health plan years beginning on or after September 23, 2010 Under the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans. Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans The new law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition. Grants will be awarded beginning in 2010 The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases to be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium increases may not be able to participate in the new health insurance Exchanges in 2014. Turn pages on HealthCare.gov summary, click here. 07/15/2010
VETS GROUPS APPLAUD WHITE HOUSE DECISION TO LOOSEN REQUIREMENTS FOR VETERANS PTSD CLAIMSMore from the Emeritus Newsroom- In a statement from the Veterans of Foreign Wars (VFW), Thomas J. Tradewell Sr., the national commander of the 2.1 million-member group, and its Auxiliaries, called the VA secretary's decision to ease PTSD claims requirements a sea-change in the mindset of the VA. The group points out the VA decision follows numerous other decisions that increased the list of presumptions for diseases associated with Agent Orange exposure; increased services and programs for women veterans, veterans who reside in rural areas as well as the homeless; and reduced the size of the claims form from 23 to 10 pages. Tradewell said even the VA's outreach to patients possibly exposed to improperly sterilized equipment at a small number of its hospitals reflects the department's proactive, veterans' first attitude. A White House announcement of the decision explains the previous requirement for filing PTSD claims was "neither fair, nor sustainable". officials said it is especially true in the current wars in Iraq and Afghanistan where there are no static front lines and the combat zone is everywhere. The White House statement further stated, "In reality, life in a combat zone is both complex and it affects each of us differently—as demonstrated by a number of scientific studies. Some who’ve been in the most terrible fighting can emerge relatively unscathed. Other non-combat troops, whose wartime experience came only in the form of a blaring air raid siren, can live for decades haunted by the sound and the threat it represented. The base where I was stationed was mortared—almost on a daily basis—enough that it gained the nickname “Moratoria.” My physical wounds make my combat experience clear, yet other troops on my base must prove they were at an actual explosion from one of those daily attacks. At VA, we’re now moving to treat all Veterans equally when it comes to filing a disability claim for PTSD". Press release from the White House, click here. Press release from the VFW, click here. 010 WELLPOINT SECURITY BREACH REVEALS PERSONAL AND FINANCIAL INFORMATION OF 470,000 PEOPLEMore from the Emeritus Newsroom- Its the third or fourth data breach by WellPoint or its subsidiaries in the last two years. The company admits the latest breach involves an estimated 470,000 people who are insured or were insured by the company. Roughly half, or 230,000 people involved in the breach, live in California and are insured by Anthem Blue Cross, a subsidiary. The company has come under fire over the last two years from California regulators for its data breaches as well as its rate increases and failure to pay claims of sick patients. State officials have not said, what action, if any, it will take in this most recent case. More from Associated Press, click here. 06/29/2010 OBAMA SIGNS MEDICARE DOCTORS PAY FIX /PACKAGE ONLY TEMPORARY AS BIGGER BATTLE LOOMS OVER PERMENENT SOLUTIONMore from Kaiser Health News, click here- 06/25/2010 STARTING JULY 1ST, HIGH RISK POOLS WILL TAKE UNINSURED WITH HEALTH PROBLEMSMore from the New York Times, click here- Additional information in this letter from the Congressional Budget Office to Senator Mike Enzi, click here. 06/25/2010 AMERICANS BUYING INDIVIDUAL HEALTH INSURANCE POLICIES FACE 20% PREMIUM INCREASESMore from the Emeritus Newsroom- The health insurance market for those buying individual policies for themselves and their immediate families are finding average increases this year of around 20%even with higher deductible policies. That's the latest finding from a survey conducted by the Kaiser Family Foundation. KFF says that in the vast majority of states, the non-group market is subject to substantially less regulation than group insurance, with insurers permitted to exclude people or impose rate surcharges based on pre-existing health conditions. Much will change under the new health reform law – including a requirement that insurers accept everyone regardless of health status, a prohibition on health status rating, and creation of purchasing Exchanges – but the major elements of the law do not take effect until 2014. The survey found that those ages 55-64 represented the largest share, 31% of the individual insurance market or those not in employer health plans. More than a quarter of those surveyed said they had insurance plans with deductibles of $5,000 or more. 06/21/2010 2.5 MILLION MORE WITHOUT HEALTH INSURANCE BETWEEN 2008 TO 2009More from the Emeritus Newsroom- Early results from a study on the number of Americans without health insurance reveals a startling increase from 2008-2009. The Centers for Disease Control says that roughly 15% of the U-S population does not have health insurance coverage. The number of those uninsured between 2008-2009 rose about 2.5 million to 46.3 million people. One in five Americans have not been insured at some point during that period. Coverage of children in public insurance program grew by more than 3%, from 34.2% to 37.3%, most under Medicaid. The number of adults covered by private insurance plans dropped from 68.1% in 2008 to 65.8% in 2009, even with COBRA subsidies to help those laid off continue payment for their previous employers insurance plans. Direct link to National Health Insurance Survey, click here. 06/21/2010 UNEMPLOYMENT BENEFITS, COBRA HEALTH INSURANCE SUBSIDIES & MEDICAID PAYMENTS TO STATES UNRESOLVEDMore in this article from Kaiser Health News, click here- 06/21/2010 LATE FRIDAY VOTE IN SENATE PASSES BILL TO STOP MEDICARE DOCTOR PAY CUTS / STILL NEEDS HOUSE APPROVALMore from the Emeritus Newsroom- The Senate, Friday night, passed a separate agreement from HB 4213 that prevents cuts in reimbursements for doctors Medicare fees for the next six months. The agreement was made to avoid doctors dropping out of the Medicare program. The House still must approve to finalized the deal, which is expected early next week. Without the agreement, doctors would face a 21% cut in reimbursements, but Senate leaders agreed to pay for it through anti-fraud and other Medicare billing changes for most other services, which Republicans demanded to avoid adding to the deficit. Still to be resolved is a permanent agreement for the doctors reimbursement issue, extended unemployment benefits, and subsidies for states increased costs associated with Medicaid which remain in HB 4213. 06/18/2010 CRITICS CHALLENGE MEDICARE ADVANTAGE PLANS RATINGSMore from Kaiser Health News, click here- 06/18/2010 OVER HALF OF STATES WILL PARTNER WITH H-H-S TO EXTEND HEALTH INSURANCE TO SICK PATIENTSMore from the Emeritus Newsroom- So far at least 28 states will be working with the Department of Health and Human services THIS YEAR to provide insurance for those who can't get it or afford it from the private insurance market. The Center for Medicare Advocacy today released a report on how the system will work and for how long. According to the group, about 60% of Americans receive their health insurance through an employer-sponsored group health insurance plan. Another 27% receive their health insurance through a government-sponsored program. The rest of the population, about 13%, must purchase insurance in the individual insurance market. Purchasing individual insurance is generally expensive, but not horribly difficult for people who have never been treated for a serious medical condition or for those without certain risk factors for diseases. For some individuals who have a pre-existing condition, however, it can be impossible to find an insurance company willing to offer them health insurance at any price. State high risk health insurance pools offer coverage to those who have been denied health insurance by insurance companies. The risk pool must pay at least 65% of the total costs of the benefits provided and the out-of-pocket limits can be no greater than those linked to amounts for high-deductible health plans with linked health savings accounts. Finally, the premiums must be established at a standard rate for a standard population and age rating cannot exceed a 4:1 ratio. Questions about how the 65% of total costs and out-of-pocket limits are calculated as well as the standard rate and standard population used for establishing the premiums may be addressed in future guidance. Full text of the Center for Medicare Advocacy report, click here. 05/13/2010 OBAMA OUTLINES NEW RULES FOR EARLY RETIREE HEALTH PLANSMore from the Emeritus Newsroom- The Business Roundtable meeting in Washington DC was the forum for President Obama's outline of new rules on health care coverage for early retirees. With the Affordable Health Care Act not taking full effect until 2014, many retirees, especially those who retire early, are not able to take advantage of employer health insurance plans since the number of large employers offering them for retirees has declined by more than 50% in the last 20 years. During his address to the Business Roundtable this morning, President Obama explained. "Whenever I speak with leaders from the business community from all around the country, they all agree on one thing: rising health care costs are making it harder for workers and retirees to get the benefits they deserve. Increasingly, employers are being forced to choose between staying competitive and honoring the men and women who powered their businesses by providing their retirees with quality benefits. Americans who retire before they turn 65 and are eligible for Medicare are particularly vulnerable. In 1988, 66 percent of large firms provided health care coverage to their retirees. 20 years later in 2008, the percent of firms offering coverage to retirees plummeted to 31 percent. The lack of coverage from their employer forces many retirees to pay exorbitant premiums or simply go without health insurance. Fortunately for these Americans, the Affordable Care Act will provide immediate relief. The new law includes $5 billion in financial assistance for employer health plans that offer coverage to early retirees. This program is temporary and will help bridge the gap until 2014 when health insurance exchanges make it easier for all Americans to access affordable health coverage. B"CBO and the Joint Committee on Taxation (JCT) now estimate that, on balance, the direct spending and revenue effects of enacting H.R. 3590 as passed by the Senate would yield a net reduction in federal deficits of $118 billion over the 2010–2019 period. Approximately $65 billion of that reduction would be on-budget; other effects related to Social Security revenues and spending as well as spending by the U.S. Postal Service are classified as off-budget. In the estimate that was provided on December 19, the estimated budgetary impact was a net reduction in deficits of $132 billion, of which approximately $81 billion would be on-budget". "Because the legislation would affect direct spending and revenues, pay-as-you-go Full text of CBO letter to Senate Majority Leader Harry Reid, click here. 03/17/2010 JUST HOW MUCH WILL AMERICANS SAVE THROUGH HEALTH INSURANCE REFORM?More from the Associated Press, click here. - 03/17/2010 HOUSE BUDGET COMMITTEE CLEARS HEALTH INSURANCE REFORM FOR TOUGH VOTE AHEADMore from the Emeritus Newsroom - The House Budget Committee has made the first move to send health insurance reform on its way to a final showdown expected later this week in the House. The Budget Committee vote this morning was 21-16 in favor. Two Democrats on the committee, Rep. Chet Edwards (D) TX and Allen Boyd (D) FL, joined 14 Republicans to oppose the bill. Their votes were not a surprise since4 they voted against Democratic reform proposals last year. It now heads to the House Rules Committee where elements of the bill will be reviewed/rewritten Wednesday or Thursday. Click here for House Budget Committee version of bill. The Rules Committee's handling of the proposal will then determine how many votes will be needed before the actual final vote would be taken. House Speaker Nancy Pelosi said during her Friday news conference, that, "....once it passes the House it is the law of the land". For the most part, the health insurance reform proposal is the Senate version passed in December. 03/15/2010 OBAMA ASKS FOR "COURAGE" AT OHIO RALLYMore from the Emeritus Newsroom- Natoma Canfield was scheduled to introduce President Obama at his appearance today in Strongsville, Ohio, a Cleveland suburb. Her letter, written last December, was one of the letters President Obama reads everyday from Americans who write him, hoping he can make a difference in their seemingly hopeless situations. For Natoma, buying a health insurance policy on the individual market become impossible to afford. In January she dropped her policy. And just last week after collapsing and being taken to the emergency room, she was informed that she had leukemia. Now her family worries how she will be able to afford the treatment she will need. The President said he came to Ohio to talk about Natoma's story, which is another example of a broken health insurance system and the "courage" needed in congress to fix it. This is showdown week for those trying to fix the system with a proposal now before the House, which is headed for a final vote by the end of the week. Obama repeated his take on the health insurance debate as a choice of what America wants to be. Obama told the crowd, " I want you to think about Natoma. When you hear people saying that this isn’t the “right time,” you think about what she’s going through. When you hear people talk about, well, what does this mean for the Democrats? What does this mean for the Republicans? I don’t know how the polls are doing. When you hear people more worried about the politics of it than what’s right and what’s wrong, I want you to think about Natoma and the millions of people all across this country who are looking for some help, and looking for some relief. That’s why we need health insurance reform right now". Video of President Obama's address click here. Transcript of Obama's address, click here. 03/15/2010 OBAMA DELAYS TRIP TO MAKE FINAL PUSH FOR HEALTH INSURANCE REFORM / PELOSI SAYS, ONCE IT'S PASSED BY HOUSE,"IT IS THE LAW OF THE LAND"More from the Emeritus Newsroom - President Obama will delay his trip to Indonesia, Australia and other Pacific Rim countries until at least March 21st. White House Press Secretary Robert Gibbs today, during his press briefing, confirmed the trip schedule was changed. The President was scheduled to leave on the 18th and was to take his family to Indonesia where he spent part of his childhood. That has been changed now since Democratic leaders have asked him to stay as they battle opponents on capitol hill to get the health insurance reform measure passed. Also unfinished is long term unemployment benefits and COBRA subsidies which are packed inside the $140 billion jobs bill which was handed over to the House after passing the Senate earlier this week. During her press briefing this morning, House Speaker Nancy Pelosi confirmed she had been informed of the President's trip delay. Pelosi says reform is also waiting for the CBO report on the Senate version of the health insurance reform proposal which now has been changed in the house. Pelosi said the Congressional Budget Office report, (See story below) released yesterday on the Senate version was encouraging. Pelosi said the President's decision to delay the trip would help passage of health insurance reform, the speaker saying passage , "would not be possible without his leadership". She added, "We will take the time that we need to pass the legislation". Pelosi could not guarantee that it would be done in by March 21st, when the President is set to leave. The revised trip timetable set Obama's departure for March 21st and return to Washington on March 26th. Pelsi said the public option was not in the bill, "we improved what is in the the bill". And while the public option is NOT IN THE BILL, Pelosi said the insurance exchanges, which are set up to provide more choices for individual and small business policy holders, serves the same capacity of the public optio,n offering more competition in the insurance market. She still expresses the belief the actual public option would have produced more savings for consumers. Pelosi also confirmed an equity for states fix, that removed some deals cut with various tates to get more compensation for such things as Medicaid, thatn other states. Video of speaker Pelosi's news conference, click here. 03/12/2010 DEMOCRATS GET BOOST ON HEALTH INSURANCE REFORM FROM LATEST CONGRESSIONAL BUDGET OFFICE PROJECTIONSMore from the Emeritus Newsroom - House and Senate leaders were waiting weeks for the updated health insurance reform projections, out today from the Congressional Budget Office. In a letter from CBO Director Doug Elmendorf, the agency found: "CBO and the Joint Committee on Taxation (JCT) now estimate that, on balance, the direct spending and revenue effects of enacting H.R. 3590 as passed by the Senate would yield a net reduction in federal deficits of $118 billion over the 2010–2019 period. Approximately $65 billion of that reduction would be on-budget; other effects related to Social Security revenues and spending as well as spending by the U.S. Postal Service are classified as off-budget. In the estimate that was provided on December 19, the estimated budgetary impact was a net reduction in deficits of $132 billion, of which approximately $81 billion would be on-budget". "Because the legislation would affect direct spending and revenues, pay-as-you-go Full text of CBO letter to Senate Majority Leader Harry Reid, click here. 03/11/2010 OBAMA USES INVESTMENT FIRM INFO AS MORE AMMO FOR HEALTH INSURANCE REFORM / GOLDMAN SACHS EXPERT SAYS HEALTH INSURANCE COMPANIES WILL HAVE FEWER COMPETITORS, HIGHER PROFITSMore from the Emeritus Newsroom - White House Communications Director Dan Pfeiffer explained more of what has become a White House warning shot if health insurance reform is not enacted. Pfeiffer cites an analyst's characterization of the health insurance business. Goldman Sachs Global Investment Research, Steve Lewis, considered an expert on insurance company financial conditions, suggested that more employers, especially those with higher medical claims histories, would eventually be priced out of the market. according to the Goldman Sachs document, "As a specific answer to that, we would say, price competition is down from year Pfeiffer also cited the Cowen and Company financial review of health insurer WellPoint, which also owns Anthem Blue Cross and Blue Shield. According to the Cowen document: "We
maintain our favorable view of WLP shares given our expectation that the Full text of Lewis statement in this PDF download of Goldman Sachs document, click here. Also see Cowen and Company analysis of health insurer WellPoint, click here. 03/08/2010 OBAMA STUMPS FOR PUBLIC PRESSURE ON CONGRESS TO PASS HEALTH INSURANCE REFORMMore from the Emeritus Newsroom- As is he were back on the campaign trail, a fired up President Obama got the reaction he was hoping for. Students at Arcadia University in suburban Philadelphia gave his call for health insurance reform a rousing endorsement as he laid out his goals for health care and eliminating the nations deficit through medical cost control. Obama told the audience, mainly young adults, "The young people who are here, you’ve heard stories -- some of you guys still have health care while you’re in school, soill be on your parents’ plans, but some of the highest insurance rates are among young people. And it’s getting harder and harder to find a job that’s going to provide you with health care. And a lot of you right now feel like you’re invincible so you don’t worry about it. (Laughter.) But let me tell you, when you hit 48 -- (laughter) -- you start realizing, things start breaking down a little bit. (Laughter.) And the insurance companies continue to ration health care based on who’s sick and who’s healthy; on who can pay and who can’t pay. That’s the status quo in America, and it is a status quo that is unsustainable for this country. We can’t have a system that works better for the insurance companies than it does for the American people. (Applause.) We need to give families and businesses more control over their own health insurance. And that’s why we need to pass health care reform -- not next year, not five years from now, not 10 years from now, but now. (Applause.) Now, since we took this issue on a year ago, there have been plenty of folks in Washington who’ve said that the politics is just too hard. They’ve warned us we may not win. They’ve argued now is not the time for reform. It’s going to hurt your poll numbers. How is it going to affect Democrats in November? Don’t do it now. My question to them is: When is the right time? (Applause.) If not now, when? If not us, who?" Obama explained that opponents don't care if the country is in good times or bad, it's never the time for reform. For the people that need coverage, according to the President, the time is now. "Natoma Canfield -- self-employed cancer survivoetween now and then, this program will provide premium relief for employers, making it easier to give their retirees high-quality, affordable medical coverage". Following up on Obama's announcement, the Department of Health and Human Services released its interim final rule with comment period (IFC) to implement the Early Retiree Reinsurance Program. The summary states, The Early Retiree Reinsurance Program provides reimbursement to participating INSURANCE LOBBYING GROUP SAYS COMPANIES WILL COMPLY WITH COVERAGE REQUIREMENTS FOR CHILDRENMore from the Emeritus Newsroom- A major health insurance lobbying group says companies they representi have every intention of obeying the new law regarding coverage of children. After suggestions earlier in the week by some health insurance reform opponents that insurance companies may not comply, Karen Ignani, represnting America's Health Insurance Plans, says her group will comply with rules to cover children with pre-existing conditions. Health and Human Services Secretary Kathleen Sebelius issued a warning to insurers that the administration would enforce the law and would not tolerate actions by any insurer to exclude children with pre-existing conditions. The law also allows parents to cover their children, under the age of 26, as dependents on their family plan. Full text of Ignani press release from AHIP, click here. 03/30/2010 BOTH HOUSES PASS THE HOUSE BUDGET RECONCILIATION BILL WITH HEALTH INSURANCE REFORM AND STUDENT LOAN REFORMMore from the Emeritus Newsroom- BOTH HOUSES OF CONGRESS HAVE NOW APPROVED THE D BUDGET RECONCILIATION BILL THAT CONTAINED THE FUNDING FOR HEALTH INSURANCE REFORM AND THE STUDENT LOAN REFORM PROPOSAL CONTAINING MORE MONEY FOR STUDENTS AND COLLEGES. THE HOUSE VOTE TONIGHT WAS 220-207. Earlier, the Senate approved the bill. The vote was 56-43. A challenge earlier in the week from Senator Judd Gregg (R) NH was rejected by the Senate Parliamentarian, however, other objections from Republicans on language of the bill will now force the House to approve the changes in the Senate version, just passed. So far the changes, according to Senate Democratic leaders are "relatively minor", seeming confident the House will also approve. Despite the complications and protests, congressional leaders are now hoping to get the rest of the reform package to President Obama next week. RECORD OF HOUSE VOTE, CLICK HERE. RECORD OF SENATE VOTE CLICK HERE. 03/25/2010 SENATE DEMOCRATS NEWS CONFERENCE FOLLOWING HOUSE AND SENATE VOTES TO PASS RECONCILIATION-MARCH 25 2010
WHITE HOUSE, DEMOCRATS DELIVER ON EXECUTIVE ORDER BANNING FEDERAL FUNDING FOR ABORTIONSMore from the Emeritus Newsroom- Upholding a portion of an implied agreement between anti-abortion Democrats and President Obama, the President today reaffirmed a ban on federal funding for abortions. Democratic congressional leaders says the bank is already law in the U-S, but anti abortion Democrats wanted a clear cut ban through law and executive order, for their support of the health insurance reform legislation which passed both the Senate and the House. For reasons unexplained, the main online entry for the President's order was stated in Spanish only as of this posting. English version attachment to the Spanish version, click here.03/24/2010 PRESIDENT OBAMA SIGNS SENATE VERSION OF HEALTH INSURANCE REFORM / THE IMMEDIATE CHANGES / REPUBLICANS LOSE PARLIAMENTARY CHALLENGEMore from the Emeritus Newsroom- With those who have fought against insurance companies and those who fought in congress, President Obama signed the Senate version of the health insurance reform bill. The bill immediately forces an end to canceling patients who are sick, bans denial of insurance due to pre-existing conditions, tax breaks for employers who offer health insurance to their workers. Some of the other provisions of the bill take effect in stages, such as penalties for not getting insurance. Those penalties start in 2014. Individuals will be given subsidies to get insurance if they cannot afford it. It they don't attempt to secure insurance through their employers, on their own, or through subsidies, they would pay a penalty. Businesses would also pay a penalty of $2,000. Some state attorneys general, 14 of them, are suing the government claiming the federal government cannot mandate forced coverage, saying they mandate encroaches on states rights. They claim that violates the tenth amendment of the constitution. The U-S Supreme Court has most often sides with the federal government for such programs, transportation being among them. The federal government usually claims, in such cases, that it does have rights to regulate commerce. THE FEDERAL GOVERNMENT HAS BEEN SUCCESSFULL IN PREVIOUS LANDMARK CASES, MOST NOTABLY IN DESEGREGATION CASES, THAT THERE IS CONTITUTIONAL LAW AND SUPREME COURT RULING PRECENDENT FOR SUPREMACY OF FEDERAL LAW WHEN IN CONFLICT WITH STATE LAW. Though the case involving health insurance reform has not yet come before the Supreme Court, justices, regardless of their political beliefs are reluctant to reverse previous Supreme Court rulings. Still to be resolved is the Senate vote on the House reconciliation version, which the House also approved with the Senate version on Sunday night and was signed this morning by President Obama. Senate Republicans have challenged the House version saying it violates Senate rules. But, the Senate Parliamentarian has ruled against that Republican challenge, leaving the GOP to introduce endless amendments as one of the few avenues left to derail Senate passage of the House reconciliation bill. TRANSCRIPT OF OBAMA SPEECH AT SIGNING, CLICK HERE WHAT DOES THE NEW HEALTH REFORM LAW MEAN FOR YOU, CLICK HERE WHAT IMMEDIATE CHANGES TAKE EFFECT WITH HEALTH INSURANCE REFORM, FROM KAISER HEALTH NEWS, CLICK HERE WHAT HEALTH INSURANCE REFORM LAW MEANS FOR PRESCRIPTIONS, CLICK HERE. DETAILS OF THE SIGNING CEREMONY, CLICK HERE. 03/23/2010 OBAMA TO SIGN PART OF HEALTH INSURANCE REFORM TUESDAY / SENATE TO TAKE UP HOUSE BUDGET RECONCILIATION VERSIONMore from the Emeritus Newsroom - President Obama is scheduled to sign the Senate version of the health insurance reform proposals Tuesday, with the House budget reconciliation version passed last night by the House, to be voted on later this week by the Senate. The reconciliation bill is currently being reviewed by the Senate Parliamentarian as to how it will proceed through that chamber. At stake is whether the reconciliation bill might be thrown out over a Republican challenge that the reconciliation bill is out of order due to its impact on Social Security. If the ruling effectively tosses out the House reconciliation bill, health insurance reform would then revert to the Senate version, which was opposed by Republicans and some Democrats. With President Obama scheduled to sign the Senate version tomorrow, the Senate version will become law regardless whether the changes in the reconciliation bill survive. The move carries some risk for reform opponents since most found the Senate version more objectionable than the reconciliation designed to fix it. Senate leaders have indicated a vote could come on Thursday, if the Parliamentarian rules against the challenge. 03/22/2010 PROPOSED CHANGES IN THE FINAL HEALTH INSURANCE REFORM RECONCILIATION BILLMore from this article in the New York Times, click here- Washington Post has story on the unpredictability of CBO forecasts on a complicated issues, click here. 03/19/2010 CBO: REFORM WOULD COST 940 BILLION & CUT DEFICIT BY 138 BILLION OVER NEXT TEN YEARSMore from the Emeritus Newsroom- The release today of a Congressional Budget Office analysis on health insurance reform has set off an intense effort by both sides to prevail. HR 4872, their revised reform reconciliation proposal was also released by the Democrats today (See direct link at bottom). The Democrats proposal would cover 95% of the country's population by expanding Medicaid for those in lower income brackets and cutting the Medicare Advantage subsidies for insurance companies by $500 million. The CBO report released today finds that the Democrats proposal would cost $940 billion dollars the first ten years, cutting$138 billion from the deficit over the same period.In a letter to Democratic leaders, Director Doug Elmendorf explained the reform plan would produce even greater savings, up to $1.2 trillion, from 2020-2029. "Our analysis indicates that H.R. 3590, as passed Summary and details of HR 4872, released today, click here. CBO report and letter from Director Doug Elmendorf, click here. Washington Post story on reform proposal release, click here. 03/18/2010 SOURCES: DEMOCRATS NOW HAVE THE VOTES TO PASS HEALTH INSURANCE REFORMMore from the Emeritus Newsroom -The announcement today by liberal Ohio Rep. Dennis Kucinich (D), that he will now vote for the health insurance reform proposal in the House, is just one of several shifts expected by members of congress who were either undecided, or had voted against the proposal before. Kucinich was among the block of members wanting a public option, which was taken out of the bill in the Senate and is now before the House with insurance "exchanges" to make coverage more affordable for individuals and small business. Kucinich announced this morning that, while he is not happy with some elements of the reform proposal in the House, he believes it is the country's best chance to get started on a path to controlling costs and getting insurance to the millions of uninsured. Sources report that several members who publicly are saying they are undecided, are now leaning toward voting for the proposal in a final vote which is expected on Sunday. Bloomberg News is also reporting today that the Democrats now have the votes to move the bill. In the CBO projections on the Senate proposal, released last week, CBO Director Doug Elmendorf wrote, r from Ohio -- she wrote us a letter. Last year her insurance company charged her over $6,000 in premiums; paid about $900 worth of care. Now they’ve decided to jack up her rates 40 percent next year. So she’s had to drop her insurance, even though it may cost her the house that her parents built. Natoma knows it’s time for reform".Full text of Obama's speech at Arcadia University, Glenside, Pennsylvania, click here-03/08/2010 CONSUMER WATCHDOG SUES ANTHEM BLUE CROSS OVER HEALTH INSURANCE RATE INCREASESMore from the Emeritus Newsroom - Consumer Watchdog, a California based consumer legal advocacy group, has filed a class action lawsuit against Anthem Blue Cross and Blue Shield, for what the group called, "Enormous rate hikes to force patients into lower-benefit and higher-deductible health coverage in violation of state law". The suit is based on Anthem's proposed rate increases on certain individual policies and some of the policies it no longer wants to carry. Consumer Watchdog claims California law requires that health insurers that close a policy either offer consumers new comparable coverage, or minimize premium increases on the now-closed policies. The lawsuit accuses Anthem of systematically increasing the premiums patients to push them into lower benefit coverage—often with high deductibles and dramatically scaled back coverage. Full text of the Consumer Watchdog press release, copy click here. Full text of the actual lawsuit filed by Consumer Watchdog. 03/05/2010 WHITE HOUSE SETS DEADLINE OF MARCH 18 TO PASS HEALTH INSURANCE REFORMMore from the Emeritus Newsroom - White House Press Secretary Robert Gibbs today narrowed down the time frame for passing health insurance reform in congress. Gibbs explained the President wants to sign the bill by March 18, just before he leaves on an international trip to Australia and other Pacific rim countries. House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid both believe the differences between the two houses have a better chance of being resolved since reconciliation rules will be used to pass reformby simple majorities in both chambers. 03/04/2010 PRESIDENT OBAMA TO ANNOUNCE SUPPORT FOR RECONCILIATION / REPUBLICANS OFFER NO SUPPORT IN EXCHANGE FOR OBAMA'S CONSIDERATION OF GOP PROPOSALS/ SENATE DEMOCRATS SAY REFORM NOW IN MOTION IN THE HOUSEMore for the Emeritus Newsroom- Senate Democrats are preparing to move their version of the health insurance reform package through the House, then through the Senate, requiring only simple majorities instead of 60 votes. The move comes as President Obama has endorsed the use of "Reconciliation", requiring only simple majorities to pass health insurance reform. Obama announced today during a White House news conference that, "... every idea has been put on the table and everything about health care has been said. Now is the time to make a decision. While both sides agree the current system is not working....The proposal I have put forward, holds insurance companies more accountable. You can keep your plan, you can keep your doctor. My proposal would end the worst practices of insurance companies. Give uninsured and business owners the same health insurance as members of congress. And if you still can't afford insurance, we will offer you tax credits. It's the middle class that gets squeezed and that is who we have to help. We are going to eliminate taxpayers subsidies to insurance companies (Medicare Advantage). We do this while protecting Medicare benefits.Or proposal is paid for...and brings down the deficit. It incorporates the best ideas from Democrats and Republicans. Despite all that we agree on, most Republicans just have a fundamental disagreement. Unless everyone has access to affordable coverage, you can't limit the amount families have to pay out of their own pockets. Health reform only works if you take care of all these problems at once. I don't see how another year of negotiations would help. And insurance companies continue to raise premiums. The American people and the US economy just can't wait that long. It deserves the same up or down vote that was used for welfare reform and the Bush tax cuts. I urge every American who wants this reform to make their voice heard. This has been a long and wrenching debate. I will leave it to others to sift through the politics. This is about middle class families who will have health insurance for the very first time in their lives. It's about the kind of country that we want to be. I ask congress to finish its work and I look forward to signing this into law". Full text of the president's speech, click here. Republicans rebuffed Obama's pledge to consider four Republican proposals as part of the reform package, in exchange for support during votes. Obama let it be known last week, during a summit with Republicans, that he was not going to do incremental steps to reform, which most Republicans support. 03/03/2010 OBAMA SAYS HE'LL CONSIDER FOUR REPUBLICAN HEALTH INSURANCE REFORM PROPOSALSMore from the Emeritus Newsroom - As a result of last week's summit between Republican and Democratic leaders on health insurance reform, President Obama signaled today he is open to four Republican proposals. In a statement released today by the White House. Obama says, "No matter how we move forward, there are at least four policy priorities identified by Republican Members at the meeting that I am exploring. I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit:
There are provisions that were added to the legislation that shouldn’t have been. That’s why my proposal does not include the Medicare Advantage provision, mentioned by Senator McCain at the meeting, which provided transitional extra benefits for Florida and other states. My proposal eliminates those payments, gradually reducing Medicare Advantage payments across the country relative to fee-for service Medicare in an equitable fashion..." The Medicare Advantage plans have been a target of the Obama administration since the program subsidizes coverage with private companies at a cost higher than that of basic Medicare coverage. Democrats claim as much as $500 billion dollars a year is wasted on the program in order to assure profits of insurance companies since they cannot run the program at the same administrative cost as the government. Republicans bills the cuts as cuts to Medicare. Full text of Obama statement, click here. 03/02/2010 CENTER FOR RETIREMENT RESEARCH SAYS UNLESS THERE IS REFORM, SENIORS CAN EXPECT TO PAY AT LEAST $260,000 IN MEDICAL COSTS TILL DEATHMore from the Emeritus Newsroom - A consortium of university experts making up The Center for Retirement Research at Boston College has released results of a study on health care costs for those age 65 and older. The findings reveal, "We estimate
that a typical household age 65 has a 5‐percent risk of the present value of its The study, released today, also limited the effect of those elderly on Medicaid. Researchers determined that while the health care expenditures of most households are constrained by their IN A VERY INTERESTING SIDE NOTE, MANY EDUCATOR HEALTH INSURANCE GROUPS ARE OFTEN PRIVATELY CONSIDERED BY INSURANCE COMPANIES TO BE MORE EXPENSIVE, AND THEIR VIEW POINT GETS SOME TRACTION IN THIS STUDY, WHICH FOUND, "Controlling for
health status, those with more education spent significantly and substantially more A typical couple age 65 can expect to
incur health care costs of $260,000 in present‐value terms over their lifetimes,
including the cost of long‐term care and Medicare, Medigap, and retiree health Full text of study, click here. 03/02/2010 HEALTH INSURANCE REFORM SUMMIT REVEALS DETERMINATION ON BOTH SIDES TO STAY THE COURSE / DEMOCRATS APPEAR LIKELY TO MOVE FOR SIMPLE MAJORITY TO PASS REFORMMore from the Emeritus Newsroom- After more than six hours debating health insurance reform....one point remained clear. Neither the Democrats nor Republicans have changed their views from last December, when the Senate passed their version of a health insurance reform proposal. Democrats seem determined to pass reform with special risk pools to help small business with subsidies for low income policy holders, prohibiting rejections due to pre-existing conditions and cancellations due to illness. While Republican agree on limiting rejections by insurance companies, they continue to stand by their determination to preserve the Medicare Advantage subsidies to private insurance companies which Democrats want to use to bring more coverage to the uninsured. Republicans say the plan is too expensive, Democrats say it is critical to pass it now to prevent medical costs from consuming the federal budget. Sources tell Emeritus News that Democrats are likely to move toward "reconciliation rules" that make it possible to pass reform with simple majorities instead of 60 votes. Since the likelihood of any Republicans voting for the Senate bill are remote, Republicans may still use parliamentary tactics to delay the bill, demand consideration of amendments and full reading of reform provisions. Senate Majority Leader Mitch McConnell (R) KY, told reporters after the meeting he did not consider it a waste of time, but felt the President was set in his position. More in the story from the Washington Post, click here. Brief article from Congressional Quarterly, click here. Also note an interesting article about reconciliation rules from Stuart Rothenberg in Congressional Quarterly, click here. Video of the summit will be available here soon. 02/25/2010 HHS REPORT: MEDICARE ADVANTAGE PREMIUMS UP AVERAGE 32%More from the Emeritus Newsroom- HHS Secretary Kathleen Sebelius says seniors who remained enrolled in their Medicare Advantage plans between 2009 and 2010 have experienced rapidly increasing premiums, at 32 percent on average, with a steeper 78 percent average increase for enrollees in private fee-for-service plans. The Medicare Advantage plans are subsidized by the federal government in order to give Medicare beneficiaries a choice of private sector plans beyond the standard basic government plan. Sebelius says: "...while seniors are suffering, insurance companies are doing better than ever. Humana earned $452.3 million in the fourth quarter of 2009 from its Medicare Advantage plans, compared with $267.3 million a year earlier, a 70 percent increase. At the same time, these companies are being vastly overpaid by the federal government, making huge profits and sticking seniors with higher bills". A report released by HHS shows, in California, beneficiaries recently received letters from Anthem Blue Cross announcing their rates would go up as high as 39 percent. Elsewhere, in the last year alone, large insurers have requested premium increases of 56 percent in Michigan, 24 percent in Connecticut, 23 percent in Maine, 20 percent in Oregon and 16 percent in Rhode Island. Sebelius says cost cutting through reform could provide 250,000 to 400,000 new jobs a year. Full text of Secretary Sebelius press release, copy click here. Full text of HHS report, copy click here. 02/19/2010 HHS SECRETARY SEBELIUS BLASTS ANTHEM BCBS AND WELLPOINT FOR 39% HEALTH INSURANCE PREMIUM INCREASES / WELLPOINT ANNOUNCES DELAYMore from the Emeritus Newsroom - In a letter to Leslie Margolin,President, Anthem Blue Cross, HHS Secretary Kathleen Sebelius criticized the company for their proposed 39% premium increase on some health insurance policies. Sebelius called on the California company to publicly justify its decision . In her letter, Sebelius notes that the parent company of Anthem Blue Cross, WellPoint Incorporated earned $2.7 billion in the last quarter of 2009. “As we continue the health insurance reform debate in Washington, this announcement reminds us that too many Americans can be left with unaffordable insurance each time the rates or rules change in the private market,” Sebelius added. “It’s clear that we need health insurance reform that will give American families the secure, affordable coverage they need.” Sebelius says the largest price increases are on individual policies. She has asked the company to publicly reveal the percent of individual market premiums that is used for medical care versus the percent that is used for administrative costs. Sebelius added, "Policy holders in the individual market deserve to know if their premium increases would be invested in better medical care or insurance company overhead costs like salaries, profits, and advertising. I am aware that the State of California is investigating this matter, and urge Anthem Blue Cross to cooperate fully. In the meantime, I will be closely monitoring the situation". Full text of HHS Secretary Sebelius' letter, copy click here. WELLPOINT ANNOUNCES DELAY, STORY FROM NEW YORK TIMES, COPY CLICK HERE. 02/10/2010 HHS ORDERS EQUAL PAYMENT FOR MENTAL HEALTH EXPENSESMore from the Emeritus Newsroom - The Departments of Health and Human Services, Labor and the Treasury today jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders.“The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care,” said Secretary Sebelius. “I applaud the long-standing and bipartisan effort that made these important new protections possible.”“Today’s rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services,” said U.S. Secretary of Labor Hilda L. Solis. “The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That’s not just sound policy, it’s the right thing to do.”“Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment,” said Deputy Treasury Secretary Neal Wolin. “These rules expand on existing protections to ensure that people don't face unnecessary barriers to the treatment they need.”The new rules prohibit group health insurance plans—typically offered by employers—from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996 which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits. The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits. For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits—they must be calculated as one limit. MHPAEA applies to employers with 50 or more workers whose group health plan chooses to offer mental health or substance use disorder benefits. The new rules are effective for plan years beginning on or after July 1, 2010. Full Text of HHS press release, copy click here. 02/01/2010 LONG TERM CARE PROVISION STILL ALIVE IN HEALTH INSURANCE REFORM PLANSMore from this article in the New York Times, click here- 12/15/2009 DEMOCRATS PLAN BANS INSURANCE COMPANIES LIFETIME POLICY CAPS BUT LEAVES POTENTIAL FOR DUMPING SICK PATIENTSMore from the Emeritus Newsroom - In what is an example of what TV journalism needs more of, CNN reporter Brianna Keilar uncovered a weakness in the Senate Democrats plan to ban insurance company lifetime benefit caps. Insurance companies use those caps to limit payments for patients with expensive long term or catastrophic illnesses and other medical issues. Language in the current version of the bill allows no lifetime caps, but does have language stating, "reasonable annual caps", which essentially would give private insurers wiggle room to get an annual cap instead of a lifetime cap. Iowa Senator Tom Harkin (D), admitted that the "reasonable" alternative to the lifetime cap ban had not yet been worked out, but that some "determination" was yet to be make by the Department of Health and Human Services. Supporters of the Senate Democratic plan says the reform package, even if it becomes law, will be a work in progress. They argue the foundation must be laid for reform, even if there are some aspects that don't completely solve all the problems. But, sources at the White House have told Democratic Senate leaders they will not go along with the language as it. And some groups such as the American Cancer Society have also objected to insertion of the "annual reasonable cost", wording. . CNN story on lifetime caps, copy click here. 12/10/2009 CONGRESSIONAL BUDGET OFFICE REVIEWS MALPRACTICE, FINANCIAL AND CONSUMER REFORM PROPOSALS / ALL WOULD SAVE MONEYMore from the Emeritus Newsroom- One of the biggest issues which, so far, is not included in health insurance reform, is that of malpractice claims and insurance. The Congressional Budget Office today released a study showing that tort reform would lower costs
for health care both directly, by reducing medical malpractice costs, and
indirectly, by reducing the use of health care services through changes in the
practice patterns of providers; the agency estimated that enacting a package of JUST LAST WEEK THE CBO ISSUED A REPORT ON ADVERTISING BY DRUG COMPANIES TO PROMOTE NEW OR PATENT PROTECTED MEDICATIONS. The CBO report, while offering justifications for some pharmaceutical industry promotions did raise concern about some aspects of the promotions, including a drug makers position as a
monopolist, " whose product has no THE CBO SAYS ITS FINDINGS SHOW THE FINANCIAL REFORM AND CONSUMER PROTECTION ACT OF 2009, AS PROPOSED IN THE HOUSE, WOULD NOT ADD TO THE DEFICIT. IN FACT, THE CBO says it would bring increased revenues of $3.1 billion over the 2010-2019 period and would NELSON-HATCH AMENDMENT TO RESTRICT FEDERAL PAYMENTS FOR ABORTION DEFEATED IN SENATE / DEMOCRATS CUT DEAL TO MODIFY PUBLIC OPTIONMore from the Emeritus Newsroom - As the U-S Senate debates its way through their health insurance reform proposal, an amendment to prevent federal funding for abortions was defeated 54-45 Tuesday. According to opponents, including the American Civil Liberties Union, the amendment would have denied women abortion rights, and goes beyond legal means to limit those who receive any federal health care subsidy from purchasing an insurance plan on the exchange that covers abortion care even if the premium is largely paid for with private dollars. Supporters claim that any federal dollars spent on health care should be reserved for costs associated with preserving life. The Stupak amendment was passed in the House last month as part of that chambers health insurance reform bill, which was then submitted to the Senate. DEMOCRATIC LEADERS ALSO ANNOUNCED THAT A MODIFIED VERSION OF A PUBLIC OPTION PLAN HAS BEEN AGREED TO THAT WOULD ALLOW THOSE 55 AND OVER TO JOIN MEDICARE. Senate Majority Leader Harry Reid would not release details of the proposal until he had a chance to talk it over with the rest of the Senate Democrats. reid did not rule out the possibility that a public option might be added once the Senate's reform proposal moved to the floor for a final vote. 12/09/2009 UPROAR OVER MEDICARE HOME CARE CUTS CENTERS AROUND WASTE AND OVERPAYMENT TO PROVIDERSMore from the Emeritus Newsroom- The protest over proposed cuts in Medicare home health care as part of the new Senate version of the health insurance reform plan, has gained endorsements from two key groups. Both AARP and the National Association for Home Care and Hospice have endorsed the proposal saying that the cuts amount to saving overpayments and wasted per client costs to get more services to more people. The endorsements came during a flurry of publicity over the weekend, with Republicans condemning Democrats for the cuts. Supporters of the idea say those opposed are really opposed to cutting fees for home service contractors in order to spread services to more people. Democrats were able to get the proposal approved on Saturday even with several Democrats defecting over their opposition to the cuts. Democratic leaders were able to fend off some of the criticisms with the AARP and NAHCH endorsements. More in this article from Associated Press. 12/06/2009 HEALTH REFORM OPPONENTS CONTINUE STALL IN SENATE /AARP OBJECTS TO DELAYS AND MCCAIN AMENDMENTMore from the Emeritus Newsroom - "Don't give up on us". That, from California Senator Barbara Boxer in response to accusations Democrats are caving on support of a public option. Boxer made the statement tonight during a raucous conversation with Progressive talk show host Ed Schultz on MSNBC. Boxer repeated the oft said statement from Democratic leaders that health care reform will happen despite Republican efforts to slow the progress of the Senate proposal. Boxer admitted there were diverse opinions in the Democratic party, but stressed that they got the 60 votes needed to advance the debate in the Senate, overcoming any filibuster attempts by Republicans. Some of the frustration, voiced by Schultz and others, is that Delaware Senator Tom Carper (D) is trying to come up with language that would soften the public option. Republicans meanwhile, have come up with an amendment, sponsored by Sen. John McCain (R) AZ, that would keep Medicare Advantage plans alive, as wellibutions, co-payments, deductibles, co-insurance, or
other out-of-pocket costs for plan participants. We encourage sponsors to use their
reimbursement under the program for both of the following purposes: (1) To reduce the
sponsor’s health benefit premiums or health benefit costs, and (2) To reduce health benefit ANTHEM BLUE CROSS/BLUE SHIELD CANCELS 39% PROPOSED RATE INCREASE / PROPOSAL WAS TARGET OF CRITICISM FOR OBAMA ADMINISTRATIONMore from the Emeritus Newsroom-Anthem Blue Cross/Blue Shield announced today it was withdrawing its proposed maximum 39% increase on individual policy holders. The company today admitted that it made mistakes in calculating its proposed rate structure and will come up with a new proposal. The California Department of Insurance claims it found, "numerous and substantial errors", in the rate increase request submitted by Anthem. Full text of Anthem press release click here. California Department of Insurance press release, click here. 04/29/2010 HEALTH INSURER DENIES IT CANCELED FEMALE POLICY HOLDERS DUE TO BREAST CANCERMore from the Emeritus Newsroom- WellPoint says a story from Reuters that the company cancels female policy holders with breast cancer, is misleading and inaccurate. The Reuters article explains the cases of several women whose insurance was canceled after WellPoint learned they had breast cancer. The Reuters reports states; "They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators". Reuters also reports that WellPoint has been found, in government probes, to be one of the worst offenders involving the practice of rescission. . WellPoint responded that today's Reuters story that the company employs a targeted rescission policy for members with breast cancer is inaccurate and grossly misleading. The story incorrectly reports that WellPoint singles out women with breast cancer for aggressive investigation with the intent of canceling their insurance. This is simply wrong. In fact, WellPoint works to prevent breast cancer, to detect it early, and to get our members into treatment. We also work to ensure that all of our members are getting best practice care for breast cancer. Full text of Reuters story, click here. . Full text of : WellPoint's Reuters Response, click here. 04/22/2010 MORE BELT TIGHTENING PREDICTED AT SOME MEDICAL CENTERS AND HOSPITALS AS MEDICARE AND MEDICAID REIMBURSEMENTS ARE CUT DUE TO OVERPAYMENTSMore from the Emeritus Newsroom - In a complicated formula that includes reduced compensation for services due to past overpayments, the Centers for Medicare and Medicaid Services announced their payment schedules today. The CMS says under legislation passed in 2007, CMS is required to recoup the entire amount of FY 2008 and 2009 excess spending from changes in hospital coding practices by FY 2012. CMS estimates that payments to general acute care hospitals under the proposed rule for operating expenses in FY 2011 will decline by 0.1 percent, or $142 million, compared with FY 2010, and taking into account all factors that would affect spending. This is being done, according to the agency, to recoup one-half of the estimated excess spending in FY 2008 and 2009 aggregate payments, due to changes in hospital coding practices that did not reflect increases in patients severity of illness (overcharging). Long Term Care Facilities will be doing better in 2011, due to the fact their coding practices did not lead to the problems recorded at other health care facilities. The proposed rule would apply to approximately 3,500 acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), and approximately 420 long-term care hospitals paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS), beginning with discharges occurring on or after October 1, 2010. Proposed payment rates are based on the most recently available data and may be revised in the final rule to reflect more current data. Full text of CMS press release, click here. 04/19/2010 CONSUMER WATCHDOG SAYS SENATE REPORT SHOWS INSURANCE COMPANIES ALREADY MOVING TO HIDE ADMINISTRATIVE COSTS IN MEDICAL CAREMore from the Emeritus Newsroom - The group, Consumer Watchdog, citing a report to the U-S Senate, says insurance companies are already working to hide some of their administrative costs as medical care. A filing to the Senate Commerce Committee from the Office of Oversight and Investigations, shows the 2009 medical loss ratio results continue to reveal a large disparity between patient medical spending in the large group market, and spending in the individual and small group markets. Investigators say that because the largest for-profit companies were reluctant to voluntarily share their medical loss information broken out in a way that would be helpful for consumers, the Committee began collecting this information from 2008 “Accident & Health Policy Experience Exhibit” forms that the companies filed with the National Association of Insurance Commissioners (NAIC). Office of Oversight and Investigations claims the analysis found the largest for-profit health insurers spend a lower percentage of their customers’ premium dollars on patient care than other health insurers. The analysis also found that in the individual and small group markets, health insurers spend a significantly smaller portion of each premium dollar on medical care than they do in the large group market. For example, UnitedHealth told its investors that the company’s overall 2008 medical loss ratio was 82%.4 But the NAIC filings revealed that the company’s medical loss ratio was 71% in the individual market, 79% in the small group market, and 84% in the large group market. According to their own data, last year the largest insurers used about 15 cents out of every large group premium dollar for administrative costs and profits, while more than 26 cents out of every premium dollar went to administrative costs and profits in the individual market. Advocates at Consumer Watchdog point out that the health reform law enacted last month requires that insurers spend at least 80% of customers’ premiums on medical care in the individual insurance market, and 85% in the employer/group market. “Health insurers keep proving that they will sniff for every loophole and play every game to keep profits high without becoming more efficient or helping control overall medical costs,” said Jerry Flanagan, health care policy director of Consumer Watchdog. “The Obama Administration must act swiftly to put an end to this insurer gaming. Consumers will accept no excuses for failure by the White House or Congress to strongly defend newly won consumer protections and ward off an onslaught of well-funded lobbyists". Full text of Office of Oversight and Investigations report, click here. Consumer Watchdog press release, click here. 04/19/2010 NEW YORK ATTORNEY GENERAL SAYS STUDENT HEALTH INSURANCE PLANS ARE CASH COWS FOR INSURANCE COMPANIESMore from the Emeritus Newsroom- Students are paying in much more than they are receiving in medical services. New York Attorney General Andrew Cuomo has subpoenaed ten of the largest insurers of students and five insurance brokers, agents, and consultants as part of the investigation. In a letter sent to more than 300 colleges, universities, professional schools, and trade schools, Cuomo cautioned schools to review their sponsored student health insurance plans and alter potential problems that add gratuitous expenses and put students at risk. The Attorney General’s letter was sent to schools across New York and to certain out-of-state institutions attended by New York residents. Many colleges and universities require students to purchase a school-endorsed, private health insurance plan unless students prove that they have comparable insurance coverage. The Attorney General’s investigation revealed that many of the school-endorsed plans have extremely low coverage limits, excessive costs for the coverage provided, and inconsistencies with federal protections recently signed into law. “Many of the sponsored health care plans looked at during our investigation leave students at risk while providing massive profits for insurance companies,” said Attorney General Cuomo. “It is important for students to have adequate health care coverage to protect themselves during times of illness or injury, but a bad health insurance plan can have catastrophic and long-lasting effects on a young person’s life. By being informed of the problematic practices that currently exist in the industry, schools can negotiate for better health plans, and students and their families can be better equipped to select the coverage that is best for them.” The school-sponsored student health insurance industry generates over $1 billion of revenue per year. Approximately 1,000,000 college students obtain their health insurance through school-sponsored plans nationwide. With these plans, students pay annual premiums for individual coverage that can be as low as under $100 or as high as over $2,500. Over two-thirds of private colleges and universities and almost one-quarter of public colleges and universities require that their students either purchase the school-sponsored plan or have their own “comparable” health insurance. Cuomo says the health insurance reform law which allows parents to carry children on their health insurance policies up to age 26 should replace student plans. That part of the reform law takes effect in September. The investigation revealed that in addition to providing limited coverage, many school-sponsored plans are unnecessarily costly. In many cases the amount of claims paid out by the insurance company is only a fraction of the premiums students pay, resulting in excessive profits for the insurance companies. The investigation also exposed troubling conflicted relationships between agents and health insurers involving undisclosed contracts that created incentives for the agents to work against the best interests of students and to persuade schools to take and maintain overly costly plans. Full text of Cuomo press release, click here. 04/08/2010 HHS ISSUES WARNING ON SCAM HEALTH INSURANCE PLANSMore from the Emeritus Newsroom- Health insurance reform has brought out the bad actors already. According to Health and Human Services Secretary Kathleen Sebelius, scam artists have wasted no time trying con people into buying flu cures or bogus and unnecessary policies. In a letter to all state attorneys general, Sebelius asks them to be diligent in prosecuting scam artists. In her letter, Sebelius points out, "Media accounts indicate that fraudsters have
gone door to door selling phony insurance policies. Some have attempted to make dishonest
profits by urging consumers to obtain coverage in a non-existent “limited enrollment” period that
they falsely claim was made possible by the new legislation. OBAMA SIGNS HOUSE BUDGET RECONCILIATION BILL / INCLUDES HEALTH INSURANCE REFORM AND STUDENT LOAN REFORM WITH MORE PELL GRANTSMore from the Emeritus Newsroom- After singing the Senate version of health insurance reform last Tuesday, President Obama today signed the House budget reconciliation version. The reconciliation version contains much of th as the subsidies for insurance companies for those plans, which effectively would take about 500 billion in savings used by Democrats to fund their reform plan. But, Republicans have stalled action for consideration on McCain's amendment. More on the Senate rancor in this article from the Washington Post. Meanwhile, the AARP today issued a press release saying, "AARP today sent a letter to senators in opposition to Sen. John McCain’s amendment to recommit the Patient Protection and Affordable Care Act. The Association noted that, while the bill must be improved to make health care and prescription drugs more affordable, the McCain amendment ignores the need to strengthen Medicare" Full Text of AARP press release, cop click here.12/02/2009 CBO CONFIRMS HEALTH REFORM PLAN WILL HAVE LITTLE EFFECT ON HEALTH INSURANCE PREMIUMSMore from the Emeritus Newsroom - Analysis of the Congressional Budget Office, released today, finds the Patient Protection and Affordable Care Act now being considered in the Senate, would have have li9ttle adverse impact on employer sponsored health plans, would make insurance more affordable for small groups and through subsidies make individual coverage much more affordable. The largest effects would be seen in the nongroup market, which would grow in size under the proposal but would still account for only 17 percent of the overall insurance market in 2016. The effects on premiums would be much smaller in the small group and large group markets, which would make up 13 percent and 70 percent of the total insurance market, respectively. CBO and JCT estimate that the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law. About half of those enrollees would receive government subsidies that would reduce their costs well below the premiums that would be charged for such policies under current law. That difference in unsubsidized premiums is the net effect of three changes: • Average premiums would be 7 percent to 10 percent lower because of a net reduction in costs that insurers incurred to deliver the same amount of insurance coverage to the same group of enrollees. Most of that net reduction would stem from the changes in the rules governing the nongroup market. • Average premiums would be 7 percent to 10 percent lower because of a shift in the types of people obtaining coverage. Most of that change would stem from an influx of enrollees with below-average spending for health care, who would purchase coverage because of the new subsidies to be provided and the individual mandate to be imposed.3 Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.4 Those figures indicate what enrollees would pay, on average, not accounting for the new federal subsidies. The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium, CBO and JCT The weighted average of the differences in those amounts equals the change of 10 percent to 13 percent in the average premium per person summarized above, but the percentage increase in the average premium per policy for family policies is larger and that for single policies is smaller because the average number of people covered per family policy is estimated to increase under the proposal. The effects on the premiums paid by some individuals and families could vary significantly from the average effects on premiums. The legislation would have much smaller effects on premiums for employment-based coverage, which would account for about five-sixths of the total health insurance market. In the small group market, which is defined in this analysis as consisting of employers with 50 or fewer workers, CBO and JCT estimate that the change in the average premium per person resulting from the legislation could range from an increase of 1 percent to a reduction of 2 percent in 2016 (relative to current law).Under the proposal, the subsidy levels in each market would be tied to the premium of the second cheapest plan providing the “silver” level of coverage (that is, paying 70 percent of enrollees’ covered health care costs, on average). CBO and JCT have estimated that, in 2016, the average premium nationwide for those “reference plans” would be about $5,200 for single coverage and about $14,100 for family coverage. The difference between those figures and the average nongroup premiums under the proposal that are cited above ($5,800 and $15,200, respectively) reflects the expectation that many people would opt for a plan that was more expensive than the reference plan, to obtain either a higher amount of coverage or other valued features (such as a broader network of providers or less tightly managed benefits). Employment-Based Coverage 6 In the large group market, which is defined here as consisting of employers with more than 50 workers, the legislation would yield an average premium per person that is zero to 3 percent lower in 2016. Full Text of the CBO report, copy click here. 11/20/2009 U-S SENATE APPROVES HEALTH INSURANCE REFORM PACKAGE DEBATEMore from the Emeritus Newsroom- By a vote of 60-39, the U-S Senate tonight approved "Cloture" to bring the Senate version of the health insurance reform bill to the floor for debate. All Democratic members and two independents accounted for the 60 votes needed to avoid a delay. This means debate will start after the Thanksgiving holiday and with the goal of a vote by December 15th, if not sooner. 11/21/2009 U-S SENATE SETS MAJOR HEALTH REFORM VOTEMore from the Emeritus Newsroom- Senate Democratic leaders have set Saturday, November 21st, at 8pm, for a major procedural vote to move a health insurance reform proposal to the floor for debate and a final vote. The Senate version of the bill passed in the house, will need all 60 Democratic Senators voting in favor of "Cloture" to prevent Republican delay of the bill. The details of the Senate bill are available in the story below along with the Congressional Budget Office cost review. 11/20/2009 SENATE DEMOCRATS LATEST HEALTH INSURANCE REFORM PROPOSAL / CBO ESTIMATE SAYS PLAN COSTS $849 MILLION / REDUCES DEFICIT $127 BILLION / COVERS 94% OF POPULATION /HAS PUBLIC OPTIONMore from the Emeritus Newsroom - Senate Democratic leaders tonight announced they have a ten year plan that, according to the Congressional Budget Office, will cover 94% of the population, cost 51 billion dollars less than the 900 billion dollar ceiling set by President Obama and cut $127 billion from the deficit. Called, The Patient Protection and Affordable Care Act, it contains a higher medicare tax would be charged those making more than $250,000 a year. The public option gives states authority to opt out. Democrats are hoping to take a procedural vote on the bill Friday or Saturday, before it advance to the floor for more debate and a final vote. If the measure is approved in the Senate, it then heads to a joint house-senate conference to settle differences. CBO estimate, copy click here. Text of Senate Democrats bill, copy click here. 11/18/2009 CHIEF FINANCIAL FORECASTER FOR CENTERS FOR MEDICARE AND MEDICAID SERVICES ISSUES SOBERING REPORT ON HEALTH INSURANCE REFORM IMPACT ON SENIORS AND THE POORMore from the Emeritus Newsroom- The Chief Actuary for the Centers for Medicare and Medicaid Services today released his report showing, what he calls, cause a major reduction in benefits for senior citizens and could force more hospitals and doctors to reject the government health plans. The report from Richard Foster at CMS was requested by congressional Republicans on the Ways and Means Committee, some of whom he blamed last year for telling him not to release his cost estimates for the medicare prescription drug plan supported by then President Bush. In his projection released today, Foster claims the package passed by the House last weekend would may prompt some hospitals and nursing homes to stop accepting Medicare and Medicaid. His report did not appear tonight on the CMS web site but has appeared in various published reports However, Democratic House leaders today also pointed out that the report projects health care spending would increase one per cent over a ten year period, supporting their claim that the reform plan actually does control costs. Full text of report from Richard S. Foster, click here. 11/14/2009 OPEN ENROLLMENT FOR MEDICARE BEGINSMore from the Emeritus Newsroom- With Medicare open enrollment in two days there is a lot at stake this time around. Medicare Advantage plans will be trying to put their best forward as they campaign against proposed elimination o9f the plans as part of reform. And the Centers for Medicare and Medicaid Services are under the gun this year to improve enrollment and supervision of that enrollment. Last year, the Inspector General found both enrollment and supervision inadequate under the former Bush administration. Officials say the net impact from changes brought by last year's enrollment problems will be cut the number of different versions of plans, which often led to confusion and misleading sale tactics relating to chronic or catastrophic conditions. Patients often complained of hidden or confusing co-pay combinations and higher percentages for name brand drugs.The agency also says, as part of CMS’ oversight efforts of the Medicare Advantage and Prescription Drug plans, sponsoring organizations are being asked to conduct audits on the data provided to CMS about the operation of their plans. These new audits will be in addition to the current CMS financial and program compliance audits. The existing Program compliance audits will be strengthened by becoming more targeted, data-driven and risk-based. They will focus on high-risk areas that have the greatest potential for beneficiary harm, such as enrollment operations, appeals and grievances, and marketing. CMS press release from March 2009 regarding Medicare enrollment problems and resulting changes, copy click here. CMS press release from Nov. 12 2009 for enrollment. 11/13/2009 WHY AGE RATING OF HEALTH INSURANCE POLICIES WILL CONTINUE WITH REFORM
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