The U.S. Department of Health and Human Services (HHS) today announced a series of initiatives to work with states to save money and better coordinate care for the 9 million Americans enrolled in both Medicare and Medicaid. The new initiatives include better access to Medicare data and better coordination of health care between Medicare and Medicaid. The initiatives will be led by the new Federal Coordinated Health Care Office (the Medicare-Medicaid Coordination Office), which was created by the Affordable Care Act to help make the two programs work together more effectively to improve patient care and lower costs.
“Medicaid costs are largely driven by the complex medical needs of low-income seniors and people with disabilities who are eligible for both Medicare and Medicaid. We know that by working together, we can provide better, more coordinated care while lowering health care costs and saving money for states,” said Centers for Medicare & Medicaid Services (CMS) Administrator Donald M. Berwick, M.D. “Medicare and Medicaid spends $300 billion each year to care for people enrolled in both programs. Better coordinated care for this vulnerable population could yield savings and improve care and coverage in Medicaid.”
Currently, 60-percent of Medicare-Medicaid enrollees, “dual eligibles,” have multiple chronic conditions and 43-percent have at least one mental or cognitive impairment. While only 15-percent of Medicaid enrollees are also Medicare beneficiaries, Medicare-Medicaid enrollees represented 39-percent of Medicaid spending in 2007. Medicaid spent about $120 billion on this group – about twice as much as Medicaid spent on the 29 million children it covered. The Medicaid spending per Medicare-Medicaid enrollee was $15,459 in 2007, over six times higher than the comparable cost of a non-disabled adult Medicaid-only enrollee ($2,541).
The Medicare-Medicaid Coordination Office today launched the Alignment Initiative, an effort to more effectively integrate benefits under the two programs. Currently, low-income seniors and people with disabilities must navigate two separate programs: Medicare for coverage of basic acute health care services and drugs, and Medicaid for coverage of supplemental benefits such as long-term care supports and services. Medicaid also provides help with Medicare premiums and cost-sharing for those who need additional assistance.
A lack of alignment between the programs can lead to fragmented or episodic care for people with both Medicare and Medicaid coverage, which can reduce quality and raise costs. For example, Medicaid and Medicare have different coverage standards for those accessing durable medical equipment in the community. This can lead to fragmented care and coverage gaps that could result in patients losing access to the treatments and equipment that help them live at home or in the community. Even temporary coverage gaps can be disruptive if patients no longer have coverage for wheelchairs or other expensive medical care. The Medicare-Medicaid Coordination Office is seeking input and ideas about how to align in six areas: care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment, and appeals. Better alignment in these areas can reduce costs by improving health outcomes and making care coordination more efficient.
Today, HHS also announced a new process that provides faster state access to Medicare data to support care coordination. Access to Medicare data is an essential tool for states seeking to coordinate care, improve quality, and control costs for their highest cost beneficiaries. For example, a state that wants to expand its long term care and behavioral health care management program to serve low income seniors and people with disabilities needs data on their Medicare-covered hospital, physician, and prescription drug use. With Medicare data, states can identify high risk and high cost individuals, determine their primary health risks, and provide comprehensive individual client profiles to its care management contractor to tailor interventions.
“Navigating the two programs can be both complicated and burdensome for beneficiaries and their families and caregivers,” said Medicare-Medicaid Coordination Office Director Melanie Bella. “We are facilitating a national conversation on how to make these programs better serve the people that depend on them every day. We are working with states toward new levels of seamlessness so as to smooth the care journeys for these individuals.”
The first step in the Alignment Initiative is a notice for public comment that will be displayed in the Federal Register. The notice requests public input on priorities and key goals. Individuals wishing to submit comments have until July 11, 2011 to do so. For more information on the Alignment Initiative notice for comment, visit: www.ofr.gov/inspection.aspx. The Medicare-Medicaid Coordination Office will continue to engage with local stakeholders around the country on the Alignment Initiative through regional listening sessions.
The announcement of the new policy on state Medicare data for enrollees in Medicare and Medicaid will be published in a Center for Medicaid, CHIP and Survey & Certification (CMCS) Informational Bulletin today. The Bulletin is available at: www.cms.gov/CMCSBulletins/CMCSB/list.asp#TopOfPage.
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Wednesday, May 11, 2011
Tuesday, May 10, 2011
Most uninsured unable to pay hospital bills according to new HHS report
A new report released today by the U.S. Department of Health and Human Services (HHS) shows that few families without health insurance have the financial assets to pay potential hospital bills. 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.
“One of the most enduring myths in American health care is that people without health insurance can get care with little or no problem. Nothing could be farther from the truth,” said HHS Secretary Kathleen Sebelius. “The result is families going without care – or facing health care bills they can’t hope to pay. When the uninsured cannot afford the care they receive, that cost must be absorbed by other payers. This is why expanding access to affordable health insurance under the Affordable Care Act is so important.”
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.
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“One of the most enduring myths in American health care is that people without health insurance can get care with little or no problem. Nothing could be farther from the truth,” said HHS Secretary Kathleen Sebelius. “The result is families going without care – or facing health care bills they can’t hope to pay. When the uninsured cannot afford the care they receive, that cost must be absorbed by other payers. This is why expanding access to affordable health insurance under the Affordable Care Act is so important.”
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.
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Assisted Living Costs Rising Faster Nationally Than in Georgia, Finds Genworth's Annual Cost of Care Survey
/PRNewswire/ -- According to Genworth's 2011 Cost of Care Survey, assisted living cost inflation in Georgia is being outpaced by national cost increases. Overall, the cost of long term care services in Georgia is well below national levels.
The median hourly rate to receive care in the home, Americans' preferred long term care setting, is $17.50 an hour in Georgia for home health aide services and $19 per hour nationally. The cost for this type of care has increased 1.5 percent a year over the past six years in Georgia, and 1.4 percent nationally during this same period.
The cost for a private nursing home room in Georgia has risen 4.4 percent annually over the past six years, and in line with the national rate. The median annual rate in Georgia for a private nursing home room is $63,875 per year, less than the national rate of $77,745 per year.
Nationally, the median annual cost of long term care in an assisted living facility is $39,135, an increase of 6.0 percent annually over the past six years. In Georgia, the annual cost of assisted living care is $28,800 and costs have risen 0.7 percent per year over the same time period.
Click here for an interactive map of long term care costs in 15 regions across Georgia, as well as nationally.
Knowing Local Care Costs for Productive LTC Discussions
"Understanding local caregiving expenses is an essential first step for families faced with rising care costs," said Buck Stinson, president, U.S. Life Insurance Products at Genworth. "Genworth's Cost of Care Survey arms consumers with the knowledge to have informed conversations, whether they are speaking with a family member, a care provider or financial professional, about how they might realistically pay for care."
Now in its 8th year, Genworth's Cost of Care Survey not only provides Georgia residents with national and local long term care cost data, but also information on cost inflation over time. Armed with this information, consumers and their advisors can:
* Develop a comprehensive financial plan to cover anticipated future long term care costs
* Conduct an informed discussion with family members to address future long term care needs and preferences
* Negotiate more effectively with providers of long term care services
Negotiating With Care Providers: It Never Hurts to Ask
Some consumers may be surprised to learn that they have the power to negotiate with care providers to help contain costs. Care providers, particularly assisted living facilities and home care agencies, often face stiff competition in their local markets. Consumers should feel comfortable addressing the issue of costs, and the opportunity to lower them, when discussing care options with a provider of long term care services. Genworth's Cost of Care Survey provides localized cost data that empowers families to confidently discuss care costs and options with service providers.
Know What to Ask: Tips for Reducing Caregiving Costs
While nursing homes generally do not discount their rates because they are strongly influenced by the effect of Medicare/Medicaid on their overall business plans, assisted living facilities and home care providers are more apt to do so. Tips on where to start when negotiating with a long term care provider include:
* Know Local Costs: Genworth's Cost of Care Map provides the median cost of long term care across the U.S., including 15 regions in Georgia, to help consumers plan for the potential costs associated with the various types of long term care available in their preferred location and setting.
* Fee Waivers: Assisted living facilities often charge a one-time fee when a client first moves in. If the facility is in a competitive market, or has a surplus of vacant units, they may discount or waive this fee (or offer other discounts such as free rent for a period of time).
* Special Rates : Facilities will sometimes have a special rate if residents move in at the first of the month or during a time that is known to have higher vacancy rates.
* Vacancy Rates : Facilities may allow a resident to choose a more expensive room, at a lower price, if vacancies are currently high.
* Lower Hourly Rates: Home care agencies may lower their hourly rate if the services needed are easy to staff and long term, such as a weekday schedule that is predicted to last several months.
* Shop Around: If a home care agency's fees are at the high end of the local range, they may lower rates if they know the client is interviewing several agencies and cost is an important factor. Let care providers know if a lower rate has been quoted elsewhere for the same services.
* Premium Waivers: Agencies usually charge a premium for weekend services. For a client that also engages services for a significant amount of weekday hours, the agency may waive this premium.
* Ask for an Upgrade: Nursing homes generally do not discount their rates, however, certain extra amenities, or a private room upgrade, may be available under certain circumstances.
It is important to note that most of these price concessions are based on the availability of staff, or residential units, which is a factor that fluctuates often for some businesses. Contacting several providers before making a final decision offers the best chance of securing safe, appropriate services at a reasonable rate.
"While consumers should seek out quality and value when shopping for long term care, it is crucial that they have a financial plan in place to pay for long term care," said Stinson. "The cost of long term care remains one of the biggest risks to one's retirement security, especially with ever-increasing healthcare costs."
For consumers interested in learning more about the cost of care in their local market, Genworth offers an interactive map of long term care costs in 437 regions across all 50 states, including 15 regions in Georgia, at www.Genworth.com/CostofCare. The site offers a range of educational tools that help consumers compare costs across geographies, project future costs and share comparisons and calculations with family, friends or a financial professional.
Additional Resources:
* Genworth's "Let's Talk" campaign was developed to help families initiate conversations about long term care preferences, options, and strategies.
* Genworth Celebrates Caregivers Facebook Page: Caregivers can have their questions about caregiving challenges answered by a professional care advocate.
* An interactive Cost of Care press release containing downloadable content is available at:
http://multivu.prnewswire.com/mnr/genworthfinancial/49612.
About Genworth's 2011 Cost of Care Survey
Genworth's Cost of Care Survey, is the most comprehensive study of its kind, covering nearly 15,500 long term care providers nationwide. The survey includes 437 regions which cover all Metropolitan Statistical Areas defined for the 2010 U.S. census. Genworth annually surveys the cost of long term care across the U.S. to help Americans plan for the potential costs associated with the various types of care available in their preferred location and setting. CareScout®, part of the Genworth Financial family of companies, has conducted the survey since 2004. Located in Waltham, Massachusetts, CareScout has specialized in helping families find long term care providers nationwide since 1997. Genworth's 2011 Cost of Care Survey was conducted during January, February and March 2011.
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The median hourly rate to receive care in the home, Americans' preferred long term care setting, is $17.50 an hour in Georgia for home health aide services and $19 per hour nationally. The cost for this type of care has increased 1.5 percent a year over the past six years in Georgia, and 1.4 percent nationally during this same period.
The cost for a private nursing home room in Georgia has risen 4.4 percent annually over the past six years, and in line with the national rate. The median annual rate in Georgia for a private nursing home room is $63,875 per year, less than the national rate of $77,745 per year.
Nationally, the median annual cost of long term care in an assisted living facility is $39,135, an increase of 6.0 percent annually over the past six years. In Georgia, the annual cost of assisted living care is $28,800 and costs have risen 0.7 percent per year over the same time period.
Click here for an interactive map of long term care costs in 15 regions across Georgia, as well as nationally.
Knowing Local Care Costs for Productive LTC Discussions
"Understanding local caregiving expenses is an essential first step for families faced with rising care costs," said Buck Stinson, president, U.S. Life Insurance Products at Genworth. "Genworth's Cost of Care Survey arms consumers with the knowledge to have informed conversations, whether they are speaking with a family member, a care provider or financial professional, about how they might realistically pay for care."
Now in its 8th year, Genworth's Cost of Care Survey not only provides Georgia residents with national and local long term care cost data, but also information on cost inflation over time. Armed with this information, consumers and their advisors can:
* Develop a comprehensive financial plan to cover anticipated future long term care costs
* Conduct an informed discussion with family members to address future long term care needs and preferences
* Negotiate more effectively with providers of long term care services
Negotiating With Care Providers: It Never Hurts to Ask
Some consumers may be surprised to learn that they have the power to negotiate with care providers to help contain costs. Care providers, particularly assisted living facilities and home care agencies, often face stiff competition in their local markets. Consumers should feel comfortable addressing the issue of costs, and the opportunity to lower them, when discussing care options with a provider of long term care services. Genworth's Cost of Care Survey provides localized cost data that empowers families to confidently discuss care costs and options with service providers.
Know What to Ask: Tips for Reducing Caregiving Costs
While nursing homes generally do not discount their rates because they are strongly influenced by the effect of Medicare/Medicaid on their overall business plans, assisted living facilities and home care providers are more apt to do so. Tips on where to start when negotiating with a long term care provider include:
* Know Local Costs: Genworth's Cost of Care Map provides the median cost of long term care across the U.S., including 15 regions in Georgia, to help consumers plan for the potential costs associated with the various types of long term care available in their preferred location and setting.
* Fee Waivers: Assisted living facilities often charge a one-time fee when a client first moves in. If the facility is in a competitive market, or has a surplus of vacant units, they may discount or waive this fee (or offer other discounts such as free rent for a period of time).
* Special Rates : Facilities will sometimes have a special rate if residents move in at the first of the month or during a time that is known to have higher vacancy rates.
* Vacancy Rates : Facilities may allow a resident to choose a more expensive room, at a lower price, if vacancies are currently high.
* Lower Hourly Rates: Home care agencies may lower their hourly rate if the services needed are easy to staff and long term, such as a weekday schedule that is predicted to last several months.
* Shop Around: If a home care agency's fees are at the high end of the local range, they may lower rates if they know the client is interviewing several agencies and cost is an important factor. Let care providers know if a lower rate has been quoted elsewhere for the same services.
* Premium Waivers: Agencies usually charge a premium for weekend services. For a client that also engages services for a significant amount of weekday hours, the agency may waive this premium.
* Ask for an Upgrade: Nursing homes generally do not discount their rates, however, certain extra amenities, or a private room upgrade, may be available under certain circumstances.
It is important to note that most of these price concessions are based on the availability of staff, or residential units, which is a factor that fluctuates often for some businesses. Contacting several providers before making a final decision offers the best chance of securing safe, appropriate services at a reasonable rate.
"While consumers should seek out quality and value when shopping for long term care, it is crucial that they have a financial plan in place to pay for long term care," said Stinson. "The cost of long term care remains one of the biggest risks to one's retirement security, especially with ever-increasing healthcare costs."
For consumers interested in learning more about the cost of care in their local market, Genworth offers an interactive map of long term care costs in 437 regions across all 50 states, including 15 regions in Georgia, at www.Genworth.com/CostofCare. The site offers a range of educational tools that help consumers compare costs across geographies, project future costs and share comparisons and calculations with family, friends or a financial professional.
Additional Resources:
* Genworth's "Let's Talk" campaign was developed to help families initiate conversations about long term care preferences, options, and strategies.
* Genworth Celebrates Caregivers Facebook Page: Caregivers can have their questions about caregiving challenges answered by a professional care advocate.
* An interactive Cost of Care press release containing downloadable content is available at:
http://multivu.prnewswire.com/mnr/genworthfinancial/49612.
About Genworth's 2011 Cost of Care Survey
Genworth's Cost of Care Survey, is the most comprehensive study of its kind, covering nearly 15,500 long term care providers nationwide. The survey includes 437 regions which cover all Metropolitan Statistical Areas defined for the 2010 U.S. census. Genworth annually surveys the cost of long term care across the U.S. to help Americans plan for the potential costs associated with the various types of care available in their preferred location and setting. CareScout®, part of the Genworth Financial family of companies, has conducted the survey since 2004. Located in Waltham, Massachusetts, CareScout has specialized in helping families find long term care providers nationwide since 1997. Genworth's 2011 Cost of Care Survey was conducted during January, February and March 2011.
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Thursday, May 05, 2011
Blue Cross and Blue Shield of Georgia Extends Grace Period on Premium Payments for Members Affected by Tornados
/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGa) today announced it is extending the grace period on premium payments to help members directly impacted by Georgia tornados on April 27 and 28. Extensive property damage, injuries and death are attributed to these storms.
A Governor's State of Emergency remains in effect, and a Presidential Disaster Declaration has been made for Bartow, Catoosa, Coweta, Dade, Floyd, Greene, Lamar, Meriwether, Monroe, Morgan, Pickens, Polk, Rabun, Spalding, Troup and Walker Counties. Additionally, the damage caused by the tornados and storms have had a significant impact on transportation throughout the state, including disruptions in mail service.
Mail delivery disruptions may have caused delays in BCBSGa receiving premium payments, and as a result, BCBSGa has extended the grace period on premium payments for Georgia members for payments due in April and May. Members impacted by the tornados that may receive a delinquency notice or cancellation notice need to contact BCBSGa to have the delinquency notice waived. Policies will not be cancelled for this timeframe if premium payments were delayed due to disruptions in mail service.
"This is a very tragic time for many Georgians and it is of the utmost importance that our members not experience additional hardships," said Morgan Kendrick, President, BCBSGa. "We are taking every precaution possible, including extending grace periods and shifting staff roles to assist in the processing of any premium payment backlogs."
If members have questions about their premium payment status due to mail disruptions caused by recent inclement weather conditions, they should call the customer service number on the back of their Member ID card, and if they do not have their card, they should call 1-866-417-7107.
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A Governor's State of Emergency remains in effect, and a Presidential Disaster Declaration has been made for Bartow, Catoosa, Coweta, Dade, Floyd, Greene, Lamar, Meriwether, Monroe, Morgan, Pickens, Polk, Rabun, Spalding, Troup and Walker Counties. Additionally, the damage caused by the tornados and storms have had a significant impact on transportation throughout the state, including disruptions in mail service.
Mail delivery disruptions may have caused delays in BCBSGa receiving premium payments, and as a result, BCBSGa has extended the grace period on premium payments for Georgia members for payments due in April and May. Members impacted by the tornados that may receive a delinquency notice or cancellation notice need to contact BCBSGa to have the delinquency notice waived. Policies will not be cancelled for this timeframe if premium payments were delayed due to disruptions in mail service.
"This is a very tragic time for many Georgians and it is of the utmost importance that our members not experience additional hardships," said Morgan Kendrick, President, BCBSGa. "We are taking every precaution possible, including extending grace periods and shifting staff roles to assist in the processing of any premium payment backlogs."
If members have questions about their premium payment status due to mail disruptions caused by recent inclement weather conditions, they should call the customer service number on the back of their Member ID card, and if they do not have their card, they should call 1-866-417-7107.
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Wednesday, March 16, 2011
Newly Released Study Shows Insurance Barriers Blocking Access to Healthcare
/PRNewswire/ -- Significant barriers to patient care implemented by the health insurance industry are difficult to navigate, have a negative impact on patient care and drive up the administrative costs of healthcare, according to a statewide survey of Georgia physician assistants. The survey, which was released today by the Georgia Association of Physician Assistants (GAPA), also indicated that most physician assistants (PAs) are proactively taking steps to help address the problems that plague the system, and feel there is a legislative role that can contribute to a solution.
According to the survey, a nearly universal 99 percent of PAs stated they have had to change the way they treat a patient as a result of restrictions imposed by an insurance company. An overwhelming majority, 94 percent, feels that health plans frequently or occasionally delay or deny diagnostic testing or prescription medications for their patients.
Not surprisingly, 93 percent of those surveyed stated they felt insurance requirements such as prior authorizations, pre-certifications, and step therapy protocols had some degree of a negative effect on their ability to treat patients.
"The lessons learned from this report are resounding, in that nearly all the physician assistants that responded to the survey cited major insurance hurdles they had to jump over before being able to provide the care they deemed appropriate for their patients," said Mary Vacala, ATC, PA-C, MSPAS, DFAAPA, and 2010-11 president of the Georgia Association of Physician Assistants. "Some cited several phone calls taking 45 minutes with an insurance company. Others noted that patients are forced to go without medication until the insurance company would approve the treatment already prescribed by the healthcare professional."
One-in-five respondents stated they or their staffs are required to interact with an insurance provider to obtain approval for a prescribed course of treatment or to determine the insurer criteria for prior authorization or step therapy protocols an alarming 150 times or more per month. Approximately one-in-five said the number was 61-100 and more than one-in-four stated the number of interactions as 21-60.
Understanding that each hour a provider spends on administrative tasks is an hour not spent evaluating patients, PAs are proactively taking steps such as utilizing newer technology to streamline the process. Currently, 64 percent of respondents have implemented Electronic Medical Records and 45 percent are using an e-prescription process on some level. At the same time, 90 percent of those surveyed agree that there should be enforceable legislation addressing restrictions that insurance companies place on health care providers.
"There are more than 2,000 physician assistants across the state of Georgia, and so many are using technology such as electronic medical records and e-prescribing, to promote better, more coordinated care," concluded Vacala. "As these technologies continue to be developed, the Georgia General Assembly should take steps requiring that patient formulary information be more transparent and that there be a uniform electronic process for obtaining medication approval. By taking simple steps, we will save significant time and resources while also having a healthier patient population in Georgia."
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According to the survey, a nearly universal 99 percent of PAs stated they have had to change the way they treat a patient as a result of restrictions imposed by an insurance company. An overwhelming majority, 94 percent, feels that health plans frequently or occasionally delay or deny diagnostic testing or prescription medications for their patients.
Not surprisingly, 93 percent of those surveyed stated they felt insurance requirements such as prior authorizations, pre-certifications, and step therapy protocols had some degree of a negative effect on their ability to treat patients.
"The lessons learned from this report are resounding, in that nearly all the physician assistants that responded to the survey cited major insurance hurdles they had to jump over before being able to provide the care they deemed appropriate for their patients," said Mary Vacala, ATC, PA-C, MSPAS, DFAAPA, and 2010-11 president of the Georgia Association of Physician Assistants. "Some cited several phone calls taking 45 minutes with an insurance company. Others noted that patients are forced to go without medication until the insurance company would approve the treatment already prescribed by the healthcare professional."
One-in-five respondents stated they or their staffs are required to interact with an insurance provider to obtain approval for a prescribed course of treatment or to determine the insurer criteria for prior authorization or step therapy protocols an alarming 150 times or more per month. Approximately one-in-five said the number was 61-100 and more than one-in-four stated the number of interactions as 21-60.
Understanding that each hour a provider spends on administrative tasks is an hour not spent evaluating patients, PAs are proactively taking steps such as utilizing newer technology to streamline the process. Currently, 64 percent of respondents have implemented Electronic Medical Records and 45 percent are using an e-prescription process on some level. At the same time, 90 percent of those surveyed agree that there should be enforceable legislation addressing restrictions that insurance companies place on health care providers.
"There are more than 2,000 physician assistants across the state of Georgia, and so many are using technology such as electronic medical records and e-prescribing, to promote better, more coordinated care," concluded Vacala. "As these technologies continue to be developed, the Georgia General Assembly should take steps requiring that patient formulary information be more transparent and that there be a uniform electronic process for obtaining medication approval. By taking simple steps, we will save significant time and resources while also having a healthier patient population in Georgia."
-----
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Tuesday, March 01, 2011
States Urged to Pass and Defend Patient Protection Laws Requiring Insurers to Cover Costs of Colon Cancer Screening
/PRNewswire/ -- Passage of laws requiring insurance providers to cover the costs of colon cancer screenings has stalled over the past two years and advocates are bracing to protect existing legislation in states that currently guarantee access to these lifesaving tests, a coalition of public health associations and medical professional societies reported today. The progress made in passing state-mandated coverage of colon cancer screening tests according to accepted medical guidelines has come to a near halt as state legislatures reconsider their role in the wake of the passage of the federal Affordable Care Act.
Only one state, Hawaii, passed coverage legislation in 2010. Combined with Vermont's legislation passed in 2009, only two states have improved their grade in the past two years as reported by the annual Colorectal Cancer Legislation Report Card – the slowest improvement since the report card launched seven years ago.
"The facts are clear – in states with laws mandating coverage of colon cancer screening, more people get screened and more lives are saved," said Lisa Paulsen, CEO of the Entertainment Industry Foundation, the 501(c)(3) non-profit organization of which the National Colorectal Cancer Research Alliance is a part. "State legislatures need to move to ensure that everyone who needs colorectal cancer screening has access to it. We know that the prevention or early detection that can result from screening saves lives, and will save health care dollars for the states in the long run."
With the addition of Hawaii in 2010, 23 states and the District of Columbia now require insurance coverage of colonoscopies and other procedures that follow accepted medical guidelines, earning them the grade of "A." Ten other states require varying degrees of coverage, with scores of B, C or D, while 17 states score an "F" for failing to mandate any coverage of the cost of colon cancer screening.
As of September 23, 2010, all new health plans are required to cover colorectal screening tests as part of the Patient's Bill of Rights in the federal Affordable Care Act (ACA). The coverage rules follow guidelines established by the U.S. Preventive Services Task Force, which require that insurance companies cover some colorectal cancer screening tests for those ages 50-75. However, those guidelines still leave high-risk populations under 50 without coverage options. In addition, grandfathered plans (those existing health plans in which a person was enrolled on the date of enactment of ACA), are not required to cover the tests.
Starting in 2014, as part of the ACA, all plans participating in state exchange programs will be required to provide coverage based on a federally mandated "essential benefits" package. It is expected that the package will also follow the U.S. Preventive Services Task Force guidelines – potentially leaving high risk populations that fall outside the guidelines without coverage options.
In the 17 states that currently do not guarantee screening coverage, many people will continue to fall through the cracks unless patient protections are established. In addition, many of the states that currently have guaranteed coverage have benefits that go above and beyond the U.S. Preventive Services Task Force guidelines and advocates do not want to see any of those guarantees rolled back.
"We have made tremendous strides in moving states to take action to protect the health and lives of their citizens by ensuring that colorectal cancer screenings are covered for all who need them," said John R. Seffrin, PhD, CEO, American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society. "While the essential benefits package in the Affordable Care Act will go a long way in 2014 to guarantee coverage, the best way to ensure that everyone who needs screening tests have access to them is for states to continue to enact patient protections and maintain the strong laws they already have in place."
Colorectal cancer (also known as colon cancer) is the second-leading cause of cancer deaths for men and women combined in the United States. However, the disease can often be prevented entirely through the early identification and removal of pre-cancerous polyps. When colorectal cancer is diagnosed at an early stage, the five year survival rate is 90 percent. However, when it is not diagnosed until it has spread to distant organs, the five year survival rate is only 11 percent. In 2010, the American Cancer Society reported that the colorectal cancer death rate has continued to decline. Down approximately 3.9 percent per year in men from 2002 to 2006 and 3.4 percent per year in women from 2001 to 2006, colorectal cancers saw one of the largest declines in death rates of all leading cancers.
Research has shown that regular screening is crucial for all those over 50, as well as those under 50 at increased risk.
Despite widespread awareness about the importance of colon cancer screenings, insurance coverage is still a barrier to screening according to a 2009 survey undertaken by Harris Interactive on behalf of ACS CAN and the Entertainment Industry Foundation's National Colorectal Cancer Research Alliance (EIF's NCCRA).
In fact, 70 percent of all survey respondents, including two-in-three (62 percent) of those 50 and older, said that if they knew that their insurance covered the entire cost of colonoscopy, they would be somewhat to much more likely to have the procedure at age 50, or earlier if their doctor recommended.
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Only one state, Hawaii, passed coverage legislation in 2010. Combined with Vermont's legislation passed in 2009, only two states have improved their grade in the past two years as reported by the annual Colorectal Cancer Legislation Report Card – the slowest improvement since the report card launched seven years ago.
"The facts are clear – in states with laws mandating coverage of colon cancer screening, more people get screened and more lives are saved," said Lisa Paulsen, CEO of the Entertainment Industry Foundation, the 501(c)(3) non-profit organization of which the National Colorectal Cancer Research Alliance is a part. "State legislatures need to move to ensure that everyone who needs colorectal cancer screening has access to it. We know that the prevention or early detection that can result from screening saves lives, and will save health care dollars for the states in the long run."
With the addition of Hawaii in 2010, 23 states and the District of Columbia now require insurance coverage of colonoscopies and other procedures that follow accepted medical guidelines, earning them the grade of "A." Ten other states require varying degrees of coverage, with scores of B, C or D, while 17 states score an "F" for failing to mandate any coverage of the cost of colon cancer screening.
As of September 23, 2010, all new health plans are required to cover colorectal screening tests as part of the Patient's Bill of Rights in the federal Affordable Care Act (ACA). The coverage rules follow guidelines established by the U.S. Preventive Services Task Force, which require that insurance companies cover some colorectal cancer screening tests for those ages 50-75. However, those guidelines still leave high-risk populations under 50 without coverage options. In addition, grandfathered plans (those existing health plans in which a person was enrolled on the date of enactment of ACA), are not required to cover the tests.
Starting in 2014, as part of the ACA, all plans participating in state exchange programs will be required to provide coverage based on a federally mandated "essential benefits" package. It is expected that the package will also follow the U.S. Preventive Services Task Force guidelines – potentially leaving high risk populations that fall outside the guidelines without coverage options.
In the 17 states that currently do not guarantee screening coverage, many people will continue to fall through the cracks unless patient protections are established. In addition, many of the states that currently have guaranteed coverage have benefits that go above and beyond the U.S. Preventive Services Task Force guidelines and advocates do not want to see any of those guarantees rolled back.
"We have made tremendous strides in moving states to take action to protect the health and lives of their citizens by ensuring that colorectal cancer screenings are covered for all who need them," said John R. Seffrin, PhD, CEO, American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society. "While the essential benefits package in the Affordable Care Act will go a long way in 2014 to guarantee coverage, the best way to ensure that everyone who needs screening tests have access to them is for states to continue to enact patient protections and maintain the strong laws they already have in place."
Colorectal cancer (also known as colon cancer) is the second-leading cause of cancer deaths for men and women combined in the United States. However, the disease can often be prevented entirely through the early identification and removal of pre-cancerous polyps. When colorectal cancer is diagnosed at an early stage, the five year survival rate is 90 percent. However, when it is not diagnosed until it has spread to distant organs, the five year survival rate is only 11 percent. In 2010, the American Cancer Society reported that the colorectal cancer death rate has continued to decline. Down approximately 3.9 percent per year in men from 2002 to 2006 and 3.4 percent per year in women from 2001 to 2006, colorectal cancers saw one of the largest declines in death rates of all leading cancers.
Research has shown that regular screening is crucial for all those over 50, as well as those under 50 at increased risk.
Despite widespread awareness about the importance of colon cancer screenings, insurance coverage is still a barrier to screening according to a 2009 survey undertaken by Harris Interactive on behalf of ACS CAN and the Entertainment Industry Foundation's National Colorectal Cancer Research Alliance (EIF's NCCRA).
In fact, 70 percent of all survey respondents, including two-in-three (62 percent) of those 50 and older, said that if they knew that their insurance covered the entire cost of colonoscopy, they would be somewhat to much more likely to have the procedure at age 50, or earlier if their doctor recommended.
-----
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Thursday, February 10, 2011
New Rule Ensures Students Get Health Insurance Protections of the Affordable Care Act
A new proposed regulation announced today by the Department of Health and Human Services (HHS) would ensure students enrolled in health insurance coverage through their college or university benefit from critical consumer protections created by the Affordable Care Act. Students enrolled in college plans would have the freedom from worrying about losing their insurance, or having it capped unexpectedly if they are in an accident or become sick.
"Thanks to the Affordable Care Act, college students will have more control over their health care," said Secretary Sebelius. "This rule would ensure that these plans remain a viable, affordable option for students while guaranteeing that they are regulated consistently and offer transparent benefits to students."
Student health plans are often purchased when family coverage is not available, or is unaffordable. Approximately 1,500-2,000 institutions of higher education across the country offer some type of health coverage; however, what benefits are covered by these plans, as well as how they're regulated vary widely. The proposed regulation would ensure students enrolled in these plans benefit from important consumer protections created by the Affordable Care Act by clarifying that these plans will be defined as "individual health insurance coverage." Under the proposed rules, some of the new health insurance protections include:
* No Lifetime Limits on Coverage: Insurance companies would no longer be able to impose lifetime dollar limits on the amount they spend on health benefits in student health plans.
* No Arbitrary Rescissions of Insurance Coverage: Insurance companies can no longer drop coverage when student health plan enrollees get sick because of an unintentional mistake on an application.
* No Pre-Existing Condition Exclusions for Students Under Age 19: Insurance companies cannot deny or exclude coverage for students under age 19 because of a pre-existing condition.
Today, some student health plans, only offer limited benefits with low annual dollar limits on health care, or have limited networks of doctors, and other health care providers. For many students, these health plans are their only health insurance option.
The Affordable Care Act allows HHS to take steps to preserve market stability while ensuring student health plans remain affordable until all Americans have new coverage options through the state-based Exchanges that will be established in 2014. Under the proposed rule announced today, student health insurance plans would be allowed to have annual dollar limits on essential health benefits of no less than $100,000 for policy years beginning before September 23, 2012. Student health plans with policy years beginning after that date must fully comply with the Affordable Care Act's annual limit restrictions.
The proposed rules would also require insurance companies to clearly tell students enrolled in student health plans whether or not their plan meets the new requirements laid out under the Affordable Care Act-bringing transparency to this marketplace and enabling students to understand the value and quality of the coverage they have.
As a part of the new proposed rule, HHS also is requesting comments on how other Affordable Care Act protections might apply to student health plans, including the choice of medical provider and application of the new medical loss ratio rules.
To find the new proposed rule, visit www.ofr.gov/inspection.aspx. For a fact sheet on the new proposed rule, visit www.HealthCare.gov/news/factsheets/students02092011a.html . For more information about the new patient protections created under the Affordable Care Act, visit www.HealthCare.gov.
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"Thanks to the Affordable Care Act, college students will have more control over their health care," said Secretary Sebelius. "This rule would ensure that these plans remain a viable, affordable option for students while guaranteeing that they are regulated consistently and offer transparent benefits to students."
Student health plans are often purchased when family coverage is not available, or is unaffordable. Approximately 1,500-2,000 institutions of higher education across the country offer some type of health coverage; however, what benefits are covered by these plans, as well as how they're regulated vary widely. The proposed regulation would ensure students enrolled in these plans benefit from important consumer protections created by the Affordable Care Act by clarifying that these plans will be defined as "individual health insurance coverage." Under the proposed rules, some of the new health insurance protections include:
* No Lifetime Limits on Coverage: Insurance companies would no longer be able to impose lifetime dollar limits on the amount they spend on health benefits in student health plans.
* No Arbitrary Rescissions of Insurance Coverage: Insurance companies can no longer drop coverage when student health plan enrollees get sick because of an unintentional mistake on an application.
* No Pre-Existing Condition Exclusions for Students Under Age 19: Insurance companies cannot deny or exclude coverage for students under age 19 because of a pre-existing condition.
Today, some student health plans, only offer limited benefits with low annual dollar limits on health care, or have limited networks of doctors, and other health care providers. For many students, these health plans are their only health insurance option.
The Affordable Care Act allows HHS to take steps to preserve market stability while ensuring student health plans remain affordable until all Americans have new coverage options through the state-based Exchanges that will be established in 2014. Under the proposed rule announced today, student health insurance plans would be allowed to have annual dollar limits on essential health benefits of no less than $100,000 for policy years beginning before September 23, 2012. Student health plans with policy years beginning after that date must fully comply with the Affordable Care Act's annual limit restrictions.
The proposed rules would also require insurance companies to clearly tell students enrolled in student health plans whether or not their plan meets the new requirements laid out under the Affordable Care Act-bringing transparency to this marketplace and enabling students to understand the value and quality of the coverage they have.
As a part of the new proposed rule, HHS also is requesting comments on how other Affordable Care Act protections might apply to student health plans, including the choice of medical provider and application of the new medical loss ratio rules.
To find the new proposed rule, visit www.ofr.gov/inspection.aspx. For a fact sheet on the new proposed rule, visit www.HealthCare.gov/news/factsheets/students02092011a.html . For more information about the new patient protections created under the Affordable Care Act, visit www.HealthCare.gov.
-----
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Georgia Seniors Get Very Low-Cost Medicare Supplement Insurance Policy
(BUSINESS WIRE)--A new low-cost Medicare Supplement insurance policy is now approved for sale to seniors in Georgia. The Georgia Office of Insurance and Safety Fire Commission has approved a very low-cost Medicare Supplement insurance plan for seniors and Georgia is among the first states in the nation to allow this supplemental insurance plan to be offered to its citizens. The availability of this low-cost supplemental plan for Georgia seniors was announced today by State Mutual Insurance Company of Rome, GA.
“We have eliminated a substantial cost element in this process”
State Mutual President and CEO, Dee Yancey III, said that Georgia residents of Medicare age now have access to one of the lowest cost Medicare supplement insurance plans available anywhere in the nation. Yancey said that State Mutual Insurance Company will allow Medicare-age consumers to apply for the supplemental Medicare insurance policy online, without having to talk with an insurance agent. “They can go online (www.statemutualinsurance.com) to fill out a confidential application and only buy the coverage they determine for themselves that best supplements their Medicare,” he said. “They can go forward secure in the knowledge that no one is going to try to sell them anything,” he said.
State Mutual was founded in 1936 and is licensed in 41 states and the District of Columbia. Yancey said that by using the Internet and allowing consumers to fill out their own applications online, the company has been able to substantially reduce its costs and the price it charges to consumers. “Consumers can also call the company for assistance in filling out applications,” he said.
A quick random comparison of Medicare supplement policies available in a number of states shows that the State Mutual policy is generally the lowest cost in most categories, and in some cases, costing less than half the price of the most expensive policies for the same coverage.
The online program allows an interested customer to review and select a policy, see a price quote, submit an application, receive confirmation of coverage and receive his or her policy in a few minutes of online time. Most policies will be issued within a working day, rather than the customary one- to two-month wait for underwriting review and processing. The customer can also download his or her policy and store it for review at any time. Consumers who wish to speak to a customer service representative, either to obtain information or to apply for a policy, can do so by calling 1-855-764-4000.
Yancey said that the low-cost of the State Mutual Insurance Company policy is achieved by empowering the customer to go online for most, if not all, of the information and application phase of obtaining Medicare supplement insurance. “We have eliminated a substantial cost element in this process,” he said. “This benefits the consumer who can obtain a superior insurance policy from an established company very quickly and inexpensively,” he said.
-----
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“We have eliminated a substantial cost element in this process”
State Mutual President and CEO, Dee Yancey III, said that Georgia residents of Medicare age now have access to one of the lowest cost Medicare supplement insurance plans available anywhere in the nation. Yancey said that State Mutual Insurance Company will allow Medicare-age consumers to apply for the supplemental Medicare insurance policy online, without having to talk with an insurance agent. “They can go online (www.statemutualinsurance.com) to fill out a confidential application and only buy the coverage they determine for themselves that best supplements their Medicare,” he said. “They can go forward secure in the knowledge that no one is going to try to sell them anything,” he said.
State Mutual was founded in 1936 and is licensed in 41 states and the District of Columbia. Yancey said that by using the Internet and allowing consumers to fill out their own applications online, the company has been able to substantially reduce its costs and the price it charges to consumers. “Consumers can also call the company for assistance in filling out applications,” he said.
A quick random comparison of Medicare supplement policies available in a number of states shows that the State Mutual policy is generally the lowest cost in most categories, and in some cases, costing less than half the price of the most expensive policies for the same coverage.
The online program allows an interested customer to review and select a policy, see a price quote, submit an application, receive confirmation of coverage and receive his or her policy in a few minutes of online time. Most policies will be issued within a working day, rather than the customary one- to two-month wait for underwriting review and processing. The customer can also download his or her policy and store it for review at any time. Consumers who wish to speak to a customer service representative, either to obtain information or to apply for a policy, can do so by calling 1-855-764-4000.
Yancey said that the low-cost of the State Mutual Insurance Company policy is achieved by empowering the customer to go online for most, if not all, of the information and application phase of obtaining Medicare supplement insurance. “We have eliminated a substantial cost element in this process,” he said. “This benefits the consumer who can obtain a superior insurance policy from an established company very quickly and inexpensively,” he said.
-----
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Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
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Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
Friday, February 04, 2011
Two Year Anniversary of Children's Health Insurance Law Sees Millions of Newly Insured Children, Families
Two years after President Obama signed the Children's Health Insurance Program Reauthorization Act (CHIPRA), HHS Secretary Kathleen Sebelius today announced that more than two million more children were served by Medicaid or the Children's Health Insurance Program (CHIP) at some point over the past year.
Together, the two programs serve more than 42 million children who would otherwise not have access to regular medical care. CHIPRA was signed into law on February 4, 2009.
"The increase in the number of children served by these two vital programs is especially significant in the face of the recent economic downturn states are experiencing," said Secretary Sebelius. "Even in times of hardship states have demonstrated their commitment to the health of children by continuing efforts to identify and enroll them in coverage."
To continue to advance coverage for children, Secretary Sebelius today also announced $40 million in new grants to states, community-based organizations, school systems and others to support their outreach and enrollment activities. The grants will help states further modernize and streamline their administrative systems, as well as create and implement school-based outreach strategies and approaches for identifying children who have historically been hard to reach.
Today's grant announcement builds on $206 million in enrollment bonuses earned by 15 states last year that increased enrollment above specific target levels. The bonus funds help states cover the cost of enrolling additional children in Medicaid.
"As we mark the second anniversary of one of President Obama's first actions as President, we can be confident that CHIPRA has proven to be a tremendous success," said Sebelius. "Now we must build on our accomplishments. Today, I am again calling on leaders across the country - from federal, state and local officials to private sector leaders - to join our effort to insure more children. We all have a stake in America's children and together, we will ensure millions more children get the care they need."
States were able to increase enrollment in the two programs in part because of boosts in federal support provided by the American Recovery and Reinvestment Act (ARRA). ARRA temporarily increased federal matching funds for state Medicaid programs during the recession.
While Medicaid and CHIP have helped bring the rate of uninsured children to the lowest level in more than two decades, an estimated five million uninsured children are thought to be eligible for one of these programs, yet not covered.
The Secretary's Challenge: Connecting Kids to Coverage, launched last year, will continue support efforts to reach more children by providing leaders with critical information and support as they work to insure more children in their communities and by closely monitoring progress.
"States' continued progress toward enrolling all eligible children in coverage is a significant step in cushioning the recession's impact on access to health insurance," said Cindy Mann, director of the Center for Medicaid CHIP, and Survey & Certification within the Centers for Medicare & Medicaid Services (CMS). "As families lose employment or have their hours cut back they may lose the health coverage benefit that came with that job. If not for these two programs, millions more children would go without critical health care services."
In its second annual report on CHIP and Medicaid enrollment, CMS notes that:
. More than 2 million children gained Medicaid or CHIP coverage during federal fiscal year 2010 (October 1, 2009 - September 30, 2010). In total, Medicaid and CHIP served more than 42 million children last year. This steady increase in enrollment is evidence of the important role that Medicaid and CHIP play for children, especially during economic downturns. The uninsured rate for children continues to decline at a time with the rate for adults is climbing. The increase in children's enrollment demonstrates that Medicaid and CHIP are serving the purpose for which they were created - providing high quality health coverage for lower-income families.
. Thirteen states implemented eligibility expansions in 2010 and many others simplified their enrollment and renewal procedures. Forty-six states and the District of Columbia now cover children with incomes up to 200 percent of the federal poverty level (FPL) in Medicaid and CHIP; with 24 of those states and the District of Columbia covering children with incomes up to 250 percent of the FPL. Twenty-one states now offer coverage to lawfully residing immigrant children and/or pregnant women, enabling states to receive federal funding for this coverage.
. CHIPRA Performance Bonuses have encouraged states to adopt and augment simplification measures in Medicaid and CHIP. Fifteen states qualified for a total of $206 million in performance bonuses for FY 2010; this is a significant increase over 2009 where 10 states received bonuses totaling $75 million. These bonuses provide additional federal financial support each year to states that successfully boost enrollment above target levels among previously eligible but uninsured children in Medicaid. To qualify, a state not only has to enroll more children, but must also have implemented program features that are designed to promote enrollment of eligible children.
. States are increasing their use of technology to facilitate children's enrollment and retention. Nearly two-thirds of states (32) have an on-line application that can be submitted electronically; 29 states allow electronic signatures on those applications. Six states have received approval to enroll children through the "Express Lane Eligibility" option created by CHIPRA. Express lane eligibility allows states to use data gathered for other programs such as housing assistance or food stamps to determine Medicaid or CHIP eligibility. And 33 states are utilizing the CHIPRA data matching process provided by the Social Security Administration to confirm U.S. citizenship for children.
. Outreach and enrollment grants have advanced coverage and led to public-private partnerships throughout the country to enroll more children. Sixty-eight grantees across 41 States and the District of Columbia are working diligently to facilitate children's enrollment in health coverage.
-----
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Together, the two programs serve more than 42 million children who would otherwise not have access to regular medical care. CHIPRA was signed into law on February 4, 2009.
"The increase in the number of children served by these two vital programs is especially significant in the face of the recent economic downturn states are experiencing," said Secretary Sebelius. "Even in times of hardship states have demonstrated their commitment to the health of children by continuing efforts to identify and enroll them in coverage."
To continue to advance coverage for children, Secretary Sebelius today also announced $40 million in new grants to states, community-based organizations, school systems and others to support their outreach and enrollment activities. The grants will help states further modernize and streamline their administrative systems, as well as create and implement school-based outreach strategies and approaches for identifying children who have historically been hard to reach.
Today's grant announcement builds on $206 million in enrollment bonuses earned by 15 states last year that increased enrollment above specific target levels. The bonus funds help states cover the cost of enrolling additional children in Medicaid.
"As we mark the second anniversary of one of President Obama's first actions as President, we can be confident that CHIPRA has proven to be a tremendous success," said Sebelius. "Now we must build on our accomplishments. Today, I am again calling on leaders across the country - from federal, state and local officials to private sector leaders - to join our effort to insure more children. We all have a stake in America's children and together, we will ensure millions more children get the care they need."
States were able to increase enrollment in the two programs in part because of boosts in federal support provided by the American Recovery and Reinvestment Act (ARRA). ARRA temporarily increased federal matching funds for state Medicaid programs during the recession.
While Medicaid and CHIP have helped bring the rate of uninsured children to the lowest level in more than two decades, an estimated five million uninsured children are thought to be eligible for one of these programs, yet not covered.
The Secretary's Challenge: Connecting Kids to Coverage, launched last year, will continue support efforts to reach more children by providing leaders with critical information and support as they work to insure more children in their communities and by closely monitoring progress.
"States' continued progress toward enrolling all eligible children in coverage is a significant step in cushioning the recession's impact on access to health insurance," said Cindy Mann, director of the Center for Medicaid CHIP, and Survey & Certification within the Centers for Medicare & Medicaid Services (CMS). "As families lose employment or have their hours cut back they may lose the health coverage benefit that came with that job. If not for these two programs, millions more children would go without critical health care services."
In its second annual report on CHIP and Medicaid enrollment, CMS notes that:
. More than 2 million children gained Medicaid or CHIP coverage during federal fiscal year 2010 (October 1, 2009 - September 30, 2010). In total, Medicaid and CHIP served more than 42 million children last year. This steady increase in enrollment is evidence of the important role that Medicaid and CHIP play for children, especially during economic downturns. The uninsured rate for children continues to decline at a time with the rate for adults is climbing. The increase in children's enrollment demonstrates that Medicaid and CHIP are serving the purpose for which they were created - providing high quality health coverage for lower-income families.
. Thirteen states implemented eligibility expansions in 2010 and many others simplified their enrollment and renewal procedures. Forty-six states and the District of Columbia now cover children with incomes up to 200 percent of the federal poverty level (FPL) in Medicaid and CHIP; with 24 of those states and the District of Columbia covering children with incomes up to 250 percent of the FPL. Twenty-one states now offer coverage to lawfully residing immigrant children and/or pregnant women, enabling states to receive federal funding for this coverage.
. CHIPRA Performance Bonuses have encouraged states to adopt and augment simplification measures in Medicaid and CHIP. Fifteen states qualified for a total of $206 million in performance bonuses for FY 2010; this is a significant increase over 2009 where 10 states received bonuses totaling $75 million. These bonuses provide additional federal financial support each year to states that successfully boost enrollment above target levels among previously eligible but uninsured children in Medicaid. To qualify, a state not only has to enroll more children, but must also have implemented program features that are designed to promote enrollment of eligible children.
. States are increasing their use of technology to facilitate children's enrollment and retention. Nearly two-thirds of states (32) have an on-line application that can be submitted electronically; 29 states allow electronic signatures on those applications. Six states have received approval to enroll children through the "Express Lane Eligibility" option created by CHIPRA. Express lane eligibility allows states to use data gathered for other programs such as housing assistance or food stamps to determine Medicaid or CHIP eligibility. And 33 states are utilizing the CHIPRA data matching process provided by the Social Security Administration to confirm U.S. citizenship for children.
. Outreach and enrollment grants have advanced coverage and led to public-private partnerships throughout the country to enroll more children. Sixty-eight grantees across 41 States and the District of Columbia are working diligently to facilitate children's enrollment in health coverage.
-----
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Monday, January 31, 2011
FRC Praises Florida Judge for Striking Down Entire Health Care Law
Family Research Council praised today's ruling by Federal Judge Roger Vinson of the U.S. District Court for the Northern District of Florida that strikes down the entire health care law that President Obama signed into law in 2010, including the individual mandate. The law mandates that individuals purchase health insurance, and also funds abortion with federal tax dollars.
Family Research Council's amicus brief, drafted by FRC's Special Counsel Ken Klukowski, argued that if the "individual mandate" is unconstitutional, then the entire law must be struck down.
Judge Vinson quoted Klukowski (pg. 32 and footnote 27 on pg. 64) in his opinion. Judge Vinson wrote that he borrowed "heavily"from FRC's amicus brief and said the brief "quite cogently and effectively sets forth the applicable standard and governing analysis of severability." FRC filed the only amicus brief focusing exclusively on how the individual mandate cannot be severed from the law.
Klukowski, who also serves as Director of FRC's Center for Religious Liberty, made the following comments:
"Today's ruling makes clear that as long as the mandate is in place, the entire law rests on an unconstitutional foundation. If the foundation crumbles, the whole law falls.
"We applaud Judge Vinson for striking down the entire law, recognizing that the individual mandate cannot be severed from the other 450 sections of the statute. The individual mandate is the essential heart of this legislation. We are grateful that Judge Vinson agreed with our argument that controlling Supreme Court precedents require striking down the entire law.
"No part of the Constitution empowers the federal government to command American citizens to spend their own personal money to purchase health insurance.
"We urge the Senate to follow the lead of the House of Representatives and move to repeal this unconstitutional law in its entirely, not merely to tinker with various provisions," Klukowski concluded.
Click here to read a DC Examiner opinion piece by FRC Special Counsel Ken Klukowski explaining why Obamacare's individual mandate cannot be severed to save the rest of the law. http://www.frc.org/op-eds/striking-down-individual-mandate-would-mean-ending-obamacare
Click here to read FRC's brief in the multi-state Florida lawsuit. http://www.frc.org/fl-hhs
Family Research Council's amicus brief, drafted by FRC's Special Counsel Ken Klukowski, argued that if the "individual mandate" is unconstitutional, then the entire law must be struck down.
Judge Vinson quoted Klukowski (pg. 32 and footnote 27 on pg. 64) in his opinion. Judge Vinson wrote that he borrowed "heavily"from FRC's amicus brief and said the brief "quite cogently and effectively sets forth the applicable standard and governing analysis of severability." FRC filed the only amicus brief focusing exclusively on how the individual mandate cannot be severed from the law.
Klukowski, who also serves as Director of FRC's Center for Religious Liberty, made the following comments:
"Today's ruling makes clear that as long as the mandate is in place, the entire law rests on an unconstitutional foundation. If the foundation crumbles, the whole law falls.
"We applaud Judge Vinson for striking down the entire law, recognizing that the individual mandate cannot be severed from the other 450 sections of the statute. The individual mandate is the essential heart of this legislation. We are grateful that Judge Vinson agreed with our argument that controlling Supreme Court precedents require striking down the entire law.
"No part of the Constitution empowers the federal government to command American citizens to spend their own personal money to purchase health insurance.
"We urge the Senate to follow the lead of the House of Representatives and move to repeal this unconstitutional law in its entirely, not merely to tinker with various provisions," Klukowski concluded.
Click here to read a DC Examiner opinion piece by FRC Special Counsel Ken Klukowski explaining why Obamacare's individual mandate cannot be severed to save the rest of the law. http://www.frc.org/op-eds/striking-down-individual-mandate-would-mean-ending-obamacare
Click here to read FRC's brief in the multi-state Florida lawsuit. http://www.frc.org/fl-hhs
Friday, January 21, 2011
Sebelius announces three million Medicare beneficiaries have received prescription drug cost relief under the Affordable Care Act
U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced that three million Medicare beneficiaries nationwide have received prescription drug cost relief through the Affordable Care Act. To date, three million eligible beneficiaries who fell into the drug coverage gap known as the donut hole during 2010 have been mailed a one-time, tax-free $250 rebate check.
“For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent,” said Secretary Sebelius. “The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed.”
Eligible beneficiaries who fell into the coverage gap during 2010 are continuing to automatically receive rebate checks. These checks are only the first step in how the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting this year, eligible beneficiaries in the coverage gap will receive a 50-percent discount on covered brand name medications while in the donut hole. In addition, in 2011 Medicare will begin paying 7-percent of the price for generic drugs during the coverage gap.
Also today, Secretary Sebelius released a new video message on the new benefits the Affordable Care Act provides in 2011 for people on Medicare. You can watch the video message here.
The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor starting this year:
* As of January 1, 2011, Original Medicare no longer charges out-of-pocket costs for the “Welcome to Medicare” physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual wellness visit with a participating doctor, also at no cost.
* In addition to these annual wellness visits, most people with Medicare can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.
* Also this year, the Affordable Care Act will provide qualifying doctors and other health care professionals providing primary care to people on Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.
People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by contacting a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227) or visiting www.Medicare.gov.
Additionally, the Affordable Care Act makes Medicare stronger and more secure for all beneficiaries. These provisions under the new law increase benefits to beneficiaries and help to extend the life of the Medicare Trust Fund by 12 years.
* An analysis issued by the Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have 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 in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.
* The Affordable Care Act establishes a new Innovation Center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage. Innovations that are found to work can be rapidly expanded and applied more broadly—helping to transform the health care system into one that provides better care at lower cost.
· The Affordable Care Act contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. The law strengthens the screenings for health care providers who want to participate in Medicare, Medicaid, or CHIP, enables enforcement officials to see health care claims data from around the country in a searchable database, and strengthens the penalties for criminal wrongdoing. The reduction in waste, fraud, and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future. Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information or suspected fraud, waste, or abuse, or go to www.StopMedicareFraud.gov.
For more information on how the Affordable Care Act benefits seniors, visit www.HealthCare.gov.
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“For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent,” said Secretary Sebelius. “The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed.”
Eligible beneficiaries who fell into the coverage gap during 2010 are continuing to automatically receive rebate checks. These checks are only the first step in how the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting this year, eligible beneficiaries in the coverage gap will receive a 50-percent discount on covered brand name medications while in the donut hole. In addition, in 2011 Medicare will begin paying 7-percent of the price for generic drugs during the coverage gap.
Also today, Secretary Sebelius released a new video message on the new benefits the Affordable Care Act provides in 2011 for people on Medicare. You can watch the video message here.
The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor starting this year:
* As of January 1, 2011, Original Medicare no longer charges out-of-pocket costs for the “Welcome to Medicare” physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual wellness visit with a participating doctor, also at no cost.
* In addition to these annual wellness visits, most people with Medicare can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.
* Also this year, the Affordable Care Act will provide qualifying doctors and other health care professionals providing primary care to people on Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.
People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by contacting a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227) or visiting www.Medicare.gov.
Additionally, the Affordable Care Act makes Medicare stronger and more secure for all beneficiaries. These provisions under the new law increase benefits to beneficiaries and help to extend the life of the Medicare Trust Fund by 12 years.
* An analysis issued by the Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have 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 in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.
* The Affordable Care Act establishes a new Innovation Center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage. Innovations that are found to work can be rapidly expanded and applied more broadly—helping to transform the health care system into one that provides better care at lower cost.
· The Affordable Care Act contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. The law strengthens the screenings for health care providers who want to participate in Medicare, Medicaid, or CHIP, enables enforcement officials to see health care claims data from around the country in a searchable database, and strengthens the penalties for criminal wrongdoing. The reduction in waste, fraud, and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future. Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information or suspected fraud, waste, or abuse, or go to www.StopMedicareFraud.gov.
For more information on how the Affordable Care Act benefits seniors, visit www.HealthCare.gov.
-----
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Tuesday, January 18, 2011
New report: 129 million Americans with a pre-existing condition could be denied coverage without new health reform law
Health and Human Services Secretary Kathleen Sebelius today released a new analysis showing that, without the Affordable Care Act, up to 129 million non-elderly Americans who have some type of pre-existing health condition, like heart disease, high blood pressure, arthritis or cancer, would be at risk of losing health insurance when they need it most, or be denied coverage altogether. Under the full range of policies in the Affordable Care Act to be enacted by 2014, Americans living with pre-existing conditions are free from discrimination and can get the health coverage they need, and families are free from the worry of having their insurance cancelled or capped when a family member gets sick, or going broke because of the medical costs of an accident or disease. Repealing the law would once again leave millions of Americans worrying about whether coverage will be there when they need it.
“The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our health care decisions,” said Secretary Sebelius. “The new law is already helping to free Americans from the fear that an insurer will drop, limit or cap their coverage when they need it most. And Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need.”
The analysis found that:
· Anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of pre-existing condition. Examples of what may be considered a pre-existing condition include:
· Heart disease
· Cancer
· Asthma
· High blood pressure
· Arthritis
· Older Americans between ages 55 and 64 are at particular risk; 48 to 86 percent of people in that age bracket live with a pre-existing condition.
· 15 to 30 percent of people under age 65 in perfectly good health today are likely to develop a pre-existing condition over the next eight years.
· Up to one in five Americans under age 65 with a pre-existing condition – 25 million individuals – is uninsured.
Prior to the Affordable Care Act, in the vast majority of states, insurance companies in the individual market could deny coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that 36 percent of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance for these reasons.
A number of protections are already in place thanks to the Affordable Care Act. Insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents’ coverage up to the age of 26 if they lack access to job-based insurance of their own, and insurers cannot deny coverage to children because of a pre-existing condition.
Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which provides private insurance to those locked out of the insurance market because of a preexisting condition. The PCIP program – which has already saved people’s lives by covering services like chemotherapy – serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a preexisting condition. There is a Pre-existing Condition Insurance Plan available in every state, and more information can be found at www.HealthCare.gov or by calling 1-866-717-5826.
In addition to the ban on discrimination against people with preexisting conditions, in 2014, individuals and small businesses will have access to new, high-quality insurance choices through competitive marketplaces called health insurance exchanges.
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“The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our health care decisions,” said Secretary Sebelius. “The new law is already helping to free Americans from the fear that an insurer will drop, limit or cap their coverage when they need it most. And Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need.”
The analysis found that:
· Anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of pre-existing condition. Examples of what may be considered a pre-existing condition include:
· Heart disease
· Cancer
· Asthma
· High blood pressure
· Arthritis
· Older Americans between ages 55 and 64 are at particular risk; 48 to 86 percent of people in that age bracket live with a pre-existing condition.
· 15 to 30 percent of people under age 65 in perfectly good health today are likely to develop a pre-existing condition over the next eight years.
· Up to one in five Americans under age 65 with a pre-existing condition – 25 million individuals – is uninsured.
Prior to the Affordable Care Act, in the vast majority of states, insurance companies in the individual market could deny coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that 36 percent of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance for these reasons.
A number of protections are already in place thanks to the Affordable Care Act. Insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents’ coverage up to the age of 26 if they lack access to job-based insurance of their own, and insurers cannot deny coverage to children because of a pre-existing condition.
Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which provides private insurance to those locked out of the insurance market because of a preexisting condition. The PCIP program – which has already saved people’s lives by covering services like chemotherapy – serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a preexisting condition. There is a Pre-existing Condition Insurance Plan available in every state, and more information can be found at www.HealthCare.gov or by calling 1-866-717-5826.
In addition to the ban on discrimination against people with preexisting conditions, in 2014, individuals and small businesses will have access to new, high-quality insurance choices through competitive marketplaces called health insurance exchanges.
-----
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Wednesday, January 12, 2011
New Study: Medicaid Pays Nursing Homes Less Than Minimum Wage
/PRNewswire/ -- A new study released today finds that Medicaid programs in states across the country underfunded nursing facility care by $5.6 billion in 2010, paying on average $7.17 per hour per patient, less than the nation's current minimum wage of $7.25 per hour. A lifeline for many elderly and disabled, Medicaid funds 64 percent of the care provided in America's skilled nursing facilities nationally.
"This report reveals a truth many would not believe – today's nursing facilities are paid less than the minimum wage," stated Mark Parkinson, President & CEO of the American Health Care Association (AHCA). "That must change if we ever hope to serve the needs of a Baby Boom generation that will only stress our care delivery system further."
Compiled by the research group Eljay -- a nationally-recognized expert in long term care -- the report identifies which states are most affected by the rising pressure on state Medicaid budgets, both in terms of highest aggregate Medicaid underfunding and highest per patient per day underfunding. States topping those lists are New York, Illinois, Massachusetts, Minnesota, New Jersey and Wisconsin.
Nursing home providers are often forced to rely on funding from other sources – primarily Medicare – to fill in the funding gaps resulting from inadequate Medicaid payments. With so many of the nation's governors facing difficult choices surrounding budget cuts, Parkinson cautioned at the danger of allowing an already squeezed Medicare system to prop up Medicaid payment rates.
"There is a vast gap between the actual cost of providing quality eldercare and what the Medicaid program truly finances," Parkinson stated. "As Baby Boomers begin to ponder their long term care needs in the future, it is simply unsustainable for Medicare to continue filling that financial gap. As current trends indicate, this problem will only grow worse in the coming years."
The following charts highlight the states with the largest aggregate Medicaid underfunding and largest per patient per day underfunding:
Largest aggregate Medicaid underfunding
1. New York - $1,396,494,595
2. Illinois - $378,779,709
3. Massachusetts - $310,871,237
4. New Jersey - $304,430,314
5. California - $288,599,289
6. Pennsylvania - $277,609,403
7. Ohio - $248,513,290
8. Wisconsin - $181,237,562
9. Minnesota - $151,611,752
10. Missouri - $137,412,649
Largest Medicaid per patient day underfunding:
1. New York - $47.95
2. New Hampshire - $31.25
3. Massachusetts - $31.22
4. New Jersey - $29.29
5. Washington - $28.18
6. Wisconsin - $26.54
7. Minnesota - $24.70
8. Wyoming - $23.67
9. Delaware - $22.86
10. Illinois - $21.95
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"This report reveals a truth many would not believe – today's nursing facilities are paid less than the minimum wage," stated Mark Parkinson, President & CEO of the American Health Care Association (AHCA). "That must change if we ever hope to serve the needs of a Baby Boom generation that will only stress our care delivery system further."
Compiled by the research group Eljay -- a nationally-recognized expert in long term care -- the report identifies which states are most affected by the rising pressure on state Medicaid budgets, both in terms of highest aggregate Medicaid underfunding and highest per patient per day underfunding. States topping those lists are New York, Illinois, Massachusetts, Minnesota, New Jersey and Wisconsin.
Nursing home providers are often forced to rely on funding from other sources – primarily Medicare – to fill in the funding gaps resulting from inadequate Medicaid payments. With so many of the nation's governors facing difficult choices surrounding budget cuts, Parkinson cautioned at the danger of allowing an already squeezed Medicare system to prop up Medicaid payment rates.
"There is a vast gap between the actual cost of providing quality eldercare and what the Medicaid program truly finances," Parkinson stated. "As Baby Boomers begin to ponder their long term care needs in the future, it is simply unsustainable for Medicare to continue filling that financial gap. As current trends indicate, this problem will only grow worse in the coming years."
The following charts highlight the states with the largest aggregate Medicaid underfunding and largest per patient per day underfunding:
Largest aggregate Medicaid underfunding
1. New York - $1,396,494,595
2. Illinois - $378,779,709
3. Massachusetts - $310,871,237
4. New Jersey - $304,430,314
5. California - $288,599,289
6. Pennsylvania - $277,609,403
7. Ohio - $248,513,290
8. Wisconsin - $181,237,562
9. Minnesota - $151,611,752
10. Missouri - $137,412,649
Largest Medicaid per patient day underfunding:
1. New York - $47.95
2. New Hampshire - $31.25
3. Massachusetts - $31.22
4. New Jersey - $29.29
5. Washington - $28.18
6. Wisconsin - $26.54
7. Minnesota - $24.70
8. Wyoming - $23.67
9. Delaware - $22.86
10. Illinois - $21.95
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Long Term Care Pharmacy Alliance Concerned with Proposed CMS Rule; New Study Confirms LTCPA Position
/PRNewswire/ -- The Long Term Care Pharmacy Alliance (LTCPA) expressed concern with CMS's proposed rule on short-cycle dispensing within the long-term care (LTC) setting. In comments submitted to CMS Tuesday, LTCPA explained that any cost savings generated by implementing a short-cycle, 7-day fill dispensing regimen, would be overwhelmingly eliminated by additional dispensing fees resulting from the quadrupling the number of dispenses needed to move from 30-day to 7-day cycles.
A study conducted by Managed Solutions, LLC and released today supports this conclusion and finds that moving all Medicare Part D prescriptions to a 7-day fill would result in increased costs to Part D payers of over $800 million annually. Even moving more expensive brand products to a 7-day fill would still increase costs to Part D payers of $154 million annually.
"While LTCPA supports the goal of reducing waste, we also recognize the need to consider all costs associated with the proposed rule, so that unintended consequences do not result from the application of the rule. Given that it's the American taxpayer ultimately shouldering the burden of paying for this statute, it is critical that calculations such as those provided in our study be factored into the drafting of regulations," stated Bill Daniel, Executive Director for LTCPA.
The study derived its analysis from information received from eight LTC pharmacies. The findings estimated the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.
In addition to the increased cost to payers, other key findings included:
* "Wasteful dispensing" to nursing home residents covered by Medicare Part D, only amounts to approximately 2.9% of total dispensed value. Short cycling this percentage of waste would save only $125 million annually and cost over $900 million in additional dispensing fees. This is in stark contrast to the $712.5 million in annual savings estimated by the Congressional Budget Office in their scoring of the short-cycling provision.
* The tradeoff between reduced waste associated with unused medication and increased pharmacy operating costs due to more frequent medication dispensing only becomes favorable to the taxpayer for prescriptions with original dispensed value of over $400.
In its comments, LTCPA stated that CMS's approach on short-cycle dispensing is contrary to Congress' intent that Section 3310 of the Patient Protection and Affordable Care Act result in savings to Medicare Part D. "We believe that it was Congress' intent to decrease costs associated with unused medications for Part D residents in LTC facilities. Implementing short cycle dispensing for long term care patients with an average length of stay of 835 days who are primarily taking maintenance medications does not meet this financial goal. While we applaud CMS's initial proposal to short cycle traditionally more expensive brand products, we believe that this limitation isn't narrow enough. Our data clearly shows that there is a prescription value threshold of $400 that must be met in order to achieve any cost savings," continued Bill Daniel.
In the proposed regulations, CMS calls for data collection by Part D plans in order to study the efficiencies of various dispensing methodologies and to estimate the cost of unused drugs and possible savings. As CMS has identified their lack of data on unused Part D drugs in this population, LTCPA recommends that before drafting any final regulations CMS conduct a study to determine the causes, frequency and cost of unused medications and also consider alternatives to 7-day dispensing cycles.
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A study conducted by Managed Solutions, LLC and released today supports this conclusion and finds that moving all Medicare Part D prescriptions to a 7-day fill would result in increased costs to Part D payers of over $800 million annually. Even moving more expensive brand products to a 7-day fill would still increase costs to Part D payers of $154 million annually.
"While LTCPA supports the goal of reducing waste, we also recognize the need to consider all costs associated with the proposed rule, so that unintended consequences do not result from the application of the rule. Given that it's the American taxpayer ultimately shouldering the burden of paying for this statute, it is critical that calculations such as those provided in our study be factored into the drafting of regulations," stated Bill Daniel, Executive Director for LTCPA.
The study derived its analysis from information received from eight LTC pharmacies. The findings estimated the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.
In addition to the increased cost to payers, other key findings included:
* "Wasteful dispensing" to nursing home residents covered by Medicare Part D, only amounts to approximately 2.9% of total dispensed value. Short cycling this percentage of waste would save only $125 million annually and cost over $900 million in additional dispensing fees. This is in stark contrast to the $712.5 million in annual savings estimated by the Congressional Budget Office in their scoring of the short-cycling provision.
* The tradeoff between reduced waste associated with unused medication and increased pharmacy operating costs due to more frequent medication dispensing only becomes favorable to the taxpayer for prescriptions with original dispensed value of over $400.
In its comments, LTCPA stated that CMS's approach on short-cycle dispensing is contrary to Congress' intent that Section 3310 of the Patient Protection and Affordable Care Act result in savings to Medicare Part D. "We believe that it was Congress' intent to decrease costs associated with unused medications for Part D residents in LTC facilities. Implementing short cycle dispensing for long term care patients with an average length of stay of 835 days who are primarily taking maintenance medications does not meet this financial goal. While we applaud CMS's initial proposal to short cycle traditionally more expensive brand products, we believe that this limitation isn't narrow enough. Our data clearly shows that there is a prescription value threshold of $400 that must be met in order to achieve any cost savings," continued Bill Daniel.
In the proposed regulations, CMS calls for data collection by Part D plans in order to study the efficiencies of various dispensing methodologies and to estimate the cost of unused drugs and possible savings. As CMS has identified their lack of data on unused Part D drugs in this population, LTCPA recommends that before drafting any final regulations CMS conduct a study to determine the causes, frequency and cost of unused medications and also consider alternatives to 7-day dispensing cycles.
-----
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Tuesday, January 11, 2011
With Federal Support, States Hold Steady in Medicaid and CHIP Coverage Policies for Low-Income Children and Families Despite Recession
/PRNewswire/ -- Despite tight budgets, nearly all states maintained or made targeted expansions or improvements in their Medicaid and Children's Health Insurance Programs (CHIP) eligibility and enrollment rules in 2010, preserving the programs' ability to provide coverage to millions of low-income Americans who otherwise lack affordable options, according to a new survey released today by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU).
The 10th annual KCMU 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices, this year conducted with the Georgetown University Center for Children and Families, found that coverage policies held steady or in some cases expanded, particularly for low-income children. However, eligibility for their parents and other low-income adults continued to lag behind. The stability of such programs during a recession that has produced sharp increases in unemployment and declines in state tax revenues arises in large part from the temporary federal fiscal relief for Medicaid provided by the American Recovery and Reinvestment Act of 2009 (ARRA).
That enhanced federal assistance, which will end in July, was tied to requirements for states to maintain Medicaid coverage policies. To help provide a base for the future Medicaid expansion, the health reform law also requires states to maintain public coverage for adults until broader health reform goes into effect in 2014 and until 2019 for children. However, in the coming year states continue to face significant budget pressures as demand for the programs remains high and state revenues continue to be depressed amidst the slow economic recovery.
"Millions of American families have turned to Medicaid and CHIP as incomes have declined after losing jobs and the health insurance that often goes with them," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. "Keeping these programs stable and strong has helped protect children and avoid an even larger increase in the nation's 50 million uninsured, and will be key to ensuring the success of health reform implementation over the next few years."
Coverage Policies Held Steady or Expanded in 2010, Especially For Children
The survey found that 49 states, including D.C., held steady or made targeted improvements in their Medicaid and CHIP eligibility rules and enrollment procedures. A total of 13 states expanded eligibility, largely for children, and 14 states made improvements in enrollment and renewal procedures to reduce burdens on families and streamline administrative processes.
Without the enhanced federal funding and maintenance-of-effort requirements in the ARRA and health reform laws, it is likely that more states would have made cutbacks in coverage to cope with budget pressures. Two states -- Arizona and New Jersey -- did make reductions that were not subject to the requirements in the laws.
Coverage for Low-Income Adults Continues to Lag Behind
The survey finds that as of January 1, 2011, 25 states, including D.C., cover children in families with incomes at least up to 250 percent of the federal poverty level ($45,775 for a family of three in 2010), continuing a decade of progress in covering children. However, coverage for their parents lags behind. The median Medicaid eligibility threshold for parents nationally remains at 64 percent of the federal poverty level, and 16 states limit eligibility for parents to those in families that earn below 50 percent of the federal poverty level ($9,155 for a family of three in 2010).
Until health reform passed, states could not cover adults without dependent children in Medicaid programs without a waiver. The new law ends the historic exclusion of these adults through a Medicaid eligibility expansion to a national floor of 133 percent of the federal poverty level ($24,352 for a family of three and $14,404 for an individual in 2010). Although the law won't take full effect until 2014, last year Connecticut and D.C. took advantage of the new option to begin covering these adults by moving into Medicaid low-income adults whom they had previously covered only with state and local dollars. Also, California received approval for a waiver to continue and expand county initiatives that cover low-income adults. A few other states, including Minnesota, also have pending plans to take advantage of the new option to provide Medicaid coverage to adults. Even with these efforts, as of January 1, only seven states (Arizona, Connecticut, Delaware, D.C., Hawaii, New York and Vermont) provided Medicaid or Medicaid-equivalent benefits to adults without dependent children.
In the absence of further expansions over the next couple of years, most uninsured, low-income adults will remain unable to qualify for Medicaid until health reform goes into effect in 2014.
States are Incorporating Technology into Their Programs, but Have More Work Ahead
The survey finds that states continue to adopt technology to modernize their programs. Many of these improvements have helped to reduce barriers to enrollment and renewal for families, while also streamlining administrative processes and achieving administrative efficiencies. For example, about half of the states (29) took advantage of a new option to rely on an electronic data match with the Social Security Administration to more efficiently and accurately verify citizenship status of applicants for Medicaid and CHIP. The survey also found states making progress in using electronic data matches to verify other aspects of eligibility.
Yet states still have a significant amount of work to do, the survey finds. The new health reform law calls upon states to implement an integrated, web-based, technology-driven enrollment process for Medicaid, CHIP, and coverage in the new health insurance Exchanges. While all states make their Medicaid application available online, only slightly more than half (29) allow for the application to be electronically submitted with an electronic signature and most of these still require families to submit paper documentation via mail or fax. In light of a rule proposed by the Administration at the end of 2010 to provide states with a 90% federal matching rate to prepare their Medicaid eligibility systems for health reform, new grant funding, and the likelihood of additional guidance and funding opportunities in the months ahead, more activity in this area is expected in the coming year.
Today's report, Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP, 2010-2011, and related materials from today's public briefing on the survey findings, are available online at: http://www.kff.org/medicaid/Medicaid-CHIP-Coverage-Recession-Health-Reform.cfm. In addition, an archived webcast of a public briefing will be available on the website after 4 p.m. ET today.
The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information and analysis on health issues.
The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, D.C. office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in health care and public policy.
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The 10th annual KCMU 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices, this year conducted with the Georgetown University Center for Children and Families, found that coverage policies held steady or in some cases expanded, particularly for low-income children. However, eligibility for their parents and other low-income adults continued to lag behind. The stability of such programs during a recession that has produced sharp increases in unemployment and declines in state tax revenues arises in large part from the temporary federal fiscal relief for Medicaid provided by the American Recovery and Reinvestment Act of 2009 (ARRA).
That enhanced federal assistance, which will end in July, was tied to requirements for states to maintain Medicaid coverage policies. To help provide a base for the future Medicaid expansion, the health reform law also requires states to maintain public coverage for adults until broader health reform goes into effect in 2014 and until 2019 for children. However, in the coming year states continue to face significant budget pressures as demand for the programs remains high and state revenues continue to be depressed amidst the slow economic recovery.
"Millions of American families have turned to Medicaid and CHIP as incomes have declined after losing jobs and the health insurance that often goes with them," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. "Keeping these programs stable and strong has helped protect children and avoid an even larger increase in the nation's 50 million uninsured, and will be key to ensuring the success of health reform implementation over the next few years."
Coverage Policies Held Steady or Expanded in 2010, Especially For Children
The survey found that 49 states, including D.C., held steady or made targeted improvements in their Medicaid and CHIP eligibility rules and enrollment procedures. A total of 13 states expanded eligibility, largely for children, and 14 states made improvements in enrollment and renewal procedures to reduce burdens on families and streamline administrative processes.
Without the enhanced federal funding and maintenance-of-effort requirements in the ARRA and health reform laws, it is likely that more states would have made cutbacks in coverage to cope with budget pressures. Two states -- Arizona and New Jersey -- did make reductions that were not subject to the requirements in the laws.
Coverage for Low-Income Adults Continues to Lag Behind
The survey finds that as of January 1, 2011, 25 states, including D.C., cover children in families with incomes at least up to 250 percent of the federal poverty level ($45,775 for a family of three in 2010), continuing a decade of progress in covering children. However, coverage for their parents lags behind. The median Medicaid eligibility threshold for parents nationally remains at 64 percent of the federal poverty level, and 16 states limit eligibility for parents to those in families that earn below 50 percent of the federal poverty level ($9,155 for a family of three in 2010).
Until health reform passed, states could not cover adults without dependent children in Medicaid programs without a waiver. The new law ends the historic exclusion of these adults through a Medicaid eligibility expansion to a national floor of 133 percent of the federal poverty level ($24,352 for a family of three and $14,404 for an individual in 2010). Although the law won't take full effect until 2014, last year Connecticut and D.C. took advantage of the new option to begin covering these adults by moving into Medicaid low-income adults whom they had previously covered only with state and local dollars. Also, California received approval for a waiver to continue and expand county initiatives that cover low-income adults. A few other states, including Minnesota, also have pending plans to take advantage of the new option to provide Medicaid coverage to adults. Even with these efforts, as of January 1, only seven states (Arizona, Connecticut, Delaware, D.C., Hawaii, New York and Vermont) provided Medicaid or Medicaid-equivalent benefits to adults without dependent children.
In the absence of further expansions over the next couple of years, most uninsured, low-income adults will remain unable to qualify for Medicaid until health reform goes into effect in 2014.
States are Incorporating Technology into Their Programs, but Have More Work Ahead
The survey finds that states continue to adopt technology to modernize their programs. Many of these improvements have helped to reduce barriers to enrollment and renewal for families, while also streamlining administrative processes and achieving administrative efficiencies. For example, about half of the states (29) took advantage of a new option to rely on an electronic data match with the Social Security Administration to more efficiently and accurately verify citizenship status of applicants for Medicaid and CHIP. The survey also found states making progress in using electronic data matches to verify other aspects of eligibility.
Yet states still have a significant amount of work to do, the survey finds. The new health reform law calls upon states to implement an integrated, web-based, technology-driven enrollment process for Medicaid, CHIP, and coverage in the new health insurance Exchanges. While all states make their Medicaid application available online, only slightly more than half (29) allow for the application to be electronically submitted with an electronic signature and most of these still require families to submit paper documentation via mail or fax. In light of a rule proposed by the Administration at the end of 2010 to provide states with a 90% federal matching rate to prepare their Medicaid eligibility systems for health reform, new grant funding, and the likelihood of additional guidance and funding opportunities in the months ahead, more activity in this area is expected in the coming year.
Today's report, Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP, 2010-2011, and related materials from today's public briefing on the survey findings, are available online at: http://www.kff.org/medicaid/Medicaid-CHIP-Coverage-Recession-Health-Reform.cfm. In addition, an archived webcast of a public briefing will be available on the website after 4 p.m. ET today.
The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information and analysis on health issues.
The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, D.C. office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in health care and public policy.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
Shocking! 80 Million Swamp Medicare by 2030
Baby boomers skyrocket costs to $1 trillion/year by 2020
While the Obama administration very quietly backed off making end-of-life consultations party of the annual Medicare doctor-patient discussion, the coming swell of baby boomers leaves little doubt that Medicare will be able to continue operating unless government-paid health-care services are rationed, as the largest number of seniors ever to retire in America begins retiring this year.
"It's been a long, strange trip from Woodstock to the nursing home, but baby boomers are getting there - and soon," wrote Health Day reporter Amanda Gardner in Bloomberg Businessweek.
In 2011, the first round of baby boomers born in 1946 begins turning 65 and qualifying for Medicare, at a rate of approximately one every eight seconds.
In total, approximately 76 million baby boomers are expected to go on Medicare, with the result that Medicare will grow from 47 million today to 80 million in 2030, even factoring in death rates over that period, USA Today reported.
At the same time, health-care costs are expected to accelerate in coming years, with the result that Medicare is projected to cost nearly $1 trillion a year by 2020, an 80 percent increase over today.
Not enough doctors
According to Dr. Bruce Koeppen, founding dean of Quinnipiac University School of Medicine in Hamden, Conn., the problem is also that 40 percent of physicians themselves are approaching retirement and are becoming eligible for Medicare.
According to the American Geriatrics Society, there are now 7,029 board-certified geriatricians in the United States, or about one for every 2,699 Americans aged 75 or older, Gardner reported in her article. But that ratio is expected to drop to one geriatrician per 5,549 seniors by 2030.
Obamacare is also certain to produce a shortage among primary-care givers in health services as millions of Americans are instructed they have an entitlement "right" to government-paid medical care.
Even today, many physicians in private practice do not take Medicare patients because it's not profitable to do so.
This situation is certain to become even worse if Obamacare results in the 2011 cuts to Medicare that are called for in the legislation.
Medicare faces trillions of dollars in unfunded obligations
WND has also reported that the true negative net worth of the federal government was $70.7 trillion in 2009, largely because of unfunded obligations in Social Security, Medicare and Medicaid.
In other words, the total U.S. obligations, including Social Security and Medicare benefits to be paid in the future, have effectively placed the U.S. government in bankruptcy, even before we take into consideration any future and continuing social welfare obligations that may be embedded within the Obama administration's planned massive overhaul of health care.
Under cash accounting, the government makes no provisions for the future Social Security and Medicare benefits in the year in which those benefits accrue.
The approximately 76 million U.S. children born between 1945 and 1964 represent some 28 percent of the U.S. population.
"Simply said, holding revenues constant, required Medicare, Medicaid and Social Security spending and the related deficit financing costs will far exceed the Government's ability to pay," the Citizens' Guide to the 2007 Financial Report of the United States Government concluded.
The Congressional Budget Office notes that in 2010, 21 percent of federal spending went to Medicare and Medicaid, with the expectation that 31 percent of the federal budget will be spent on the two programs by 2020, as reported by CBS MoneyWatch.com.
The problem is that there is no end in sight
The CBO also estimates that spending on Medicare and Medicaid will grow from 7 percent of U.S. gross domestic product in 2020 to 12 percent in 2050.
Even with Medicare, retirees will need substantial personal financial resources to cover medical-care costs.
The Employee Benefit Research Institute has estimated that to have a 90 percent chance of having enough savings to cover health costs in retirement, a man would need $211,000 in personal savings that can be applied to cover health costs and a woman would need $242,000, if no former employer were available to subsidize private health insurance to supplement Medicare in retirement.
By Dr. Jerome Corsi
(c) 2010 RedAlert.WND.com
Reprinted with permission.
ABOUT THE AUTHOR: Jerome R. Corsi received a Ph.D. from Harvard University in political science in 1972. He is the author of the #1 New York Times bestselling books THE OBAMA NATION: LEFTIST POLITICS AND THE CULT OF PERSONALITY and the co-author of UNFIT FOR COMMAND: SWIFT BOAT VETERANS SPEAK OUT AGAINST JOHN KERRY. He is also the author of AMERICA FOR SALE, THE LATE GREAT U.S.A., and WHY ISRAEL CAN'T WAIT. Currently, Dr. Corsi is a Senior Managing Director in the Financial Services Group at Gilford Securities as well as a senior staff writer for WorldNetDaily.com.
ABOUT GILFORD SECURITIES: Gilford Securities, founded in 1979, is a full-service boutique investment firm headquartered in New York City providing an array of financial services to institutional and retail clients. From investment banking and equity research to retirement planning and wealth management services, our financial experts are prepared to accommodate the needs of investors. For more information about Gilford Securities please visit, Click Here: http://www.gilfordsecurities.com/financial-services-group.php
The views, opinions, positions or strategies expressed by the authors and those providing comments are theirs alone, and do not necessarily reflect Gilford Securities Incorporated's views, opinions, positions or strategies. Gilford Securities Incorporated makes no representations as to accuracy, completeness, currentness, suitability, or validity of any information expressed herein and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use.
ABOUT RED ALERT: Jerome Corsi's RED ALERT is your weekly, global financial strategies newsletter. Designed to be your guide to economic trends in the best of times and the worst of times, it is edited by New York Times best-selling author Jerome Corsi, Senior Managing Director of the Financial Services Group at Gilford Securities as well as a WND senior staff writer and columnist. For 25 years, Corsi worked with banks throughout the U.S. and the world developing financial services marketing companies to assist banks in establishing broker/dealers and insurance subsidiaries to provide financial planning products and services to their retail customers. Corsi developed three third-party financial services marketing firms that reached annual gross sales levels of $1 billion in annuities and equal volume in mutual funds. Corsi received his Ph.D. in political science from Harvard University in 1972.
While the Obama administration very quietly backed off making end-of-life consultations party of the annual Medicare doctor-patient discussion, the coming swell of baby boomers leaves little doubt that Medicare will be able to continue operating unless government-paid health-care services are rationed, as the largest number of seniors ever to retire in America begins retiring this year.
"It's been a long, strange trip from Woodstock to the nursing home, but baby boomers are getting there - and soon," wrote Health Day reporter Amanda Gardner in Bloomberg Businessweek.
In 2011, the first round of baby boomers born in 1946 begins turning 65 and qualifying for Medicare, at a rate of approximately one every eight seconds.
In total, approximately 76 million baby boomers are expected to go on Medicare, with the result that Medicare will grow from 47 million today to 80 million in 2030, even factoring in death rates over that period, USA Today reported.
At the same time, health-care costs are expected to accelerate in coming years, with the result that Medicare is projected to cost nearly $1 trillion a year by 2020, an 80 percent increase over today.
Not enough doctors
According to Dr. Bruce Koeppen, founding dean of Quinnipiac University School of Medicine in Hamden, Conn., the problem is also that 40 percent of physicians themselves are approaching retirement and are becoming eligible for Medicare.
According to the American Geriatrics Society, there are now 7,029 board-certified geriatricians in the United States, or about one for every 2,699 Americans aged 75 or older, Gardner reported in her article. But that ratio is expected to drop to one geriatrician per 5,549 seniors by 2030.
Obamacare is also certain to produce a shortage among primary-care givers in health services as millions of Americans are instructed they have an entitlement "right" to government-paid medical care.
Even today, many physicians in private practice do not take Medicare patients because it's not profitable to do so.
This situation is certain to become even worse if Obamacare results in the 2011 cuts to Medicare that are called for in the legislation.
Medicare faces trillions of dollars in unfunded obligations
WND has also reported that the true negative net worth of the federal government was $70.7 trillion in 2009, largely because of unfunded obligations in Social Security, Medicare and Medicaid.
In other words, the total U.S. obligations, including Social Security and Medicare benefits to be paid in the future, have effectively placed the U.S. government in bankruptcy, even before we take into consideration any future and continuing social welfare obligations that may be embedded within the Obama administration's planned massive overhaul of health care.
Under cash accounting, the government makes no provisions for the future Social Security and Medicare benefits in the year in which those benefits accrue.
The approximately 76 million U.S. children born between 1945 and 1964 represent some 28 percent of the U.S. population.
"Simply said, holding revenues constant, required Medicare, Medicaid and Social Security spending and the related deficit financing costs will far exceed the Government's ability to pay," the Citizens' Guide to the 2007 Financial Report of the United States Government concluded.
The Congressional Budget Office notes that in 2010, 21 percent of federal spending went to Medicare and Medicaid, with the expectation that 31 percent of the federal budget will be spent on the two programs by 2020, as reported by CBS MoneyWatch.com.
The problem is that there is no end in sight
The CBO also estimates that spending on Medicare and Medicaid will grow from 7 percent of U.S. gross domestic product in 2020 to 12 percent in 2050.
Even with Medicare, retirees will need substantial personal financial resources to cover medical-care costs.
The Employee Benefit Research Institute has estimated that to have a 90 percent chance of having enough savings to cover health costs in retirement, a man would need $211,000 in personal savings that can be applied to cover health costs and a woman would need $242,000, if no former employer were available to subsidize private health insurance to supplement Medicare in retirement.
By Dr. Jerome Corsi
(c) 2010 RedAlert.WND.com
Reprinted with permission.
ABOUT THE AUTHOR: Jerome R. Corsi received a Ph.D. from Harvard University in political science in 1972. He is the author of the #1 New York Times bestselling books THE OBAMA NATION: LEFTIST POLITICS AND THE CULT OF PERSONALITY and the co-author of UNFIT FOR COMMAND: SWIFT BOAT VETERANS SPEAK OUT AGAINST JOHN KERRY. He is also the author of AMERICA FOR SALE, THE LATE GREAT U.S.A., and WHY ISRAEL CAN'T WAIT. Currently, Dr. Corsi is a Senior Managing Director in the Financial Services Group at Gilford Securities as well as a senior staff writer for WorldNetDaily.com.
ABOUT GILFORD SECURITIES: Gilford Securities, founded in 1979, is a full-service boutique investment firm headquartered in New York City providing an array of financial services to institutional and retail clients. From investment banking and equity research to retirement planning and wealth management services, our financial experts are prepared to accommodate the needs of investors. For more information about Gilford Securities please visit, Click Here: http://www.gilfordsecurities.com/financial-services-group.php
The views, opinions, positions or strategies expressed by the authors and those providing comments are theirs alone, and do not necessarily reflect Gilford Securities Incorporated's views, opinions, positions or strategies. Gilford Securities Incorporated makes no representations as to accuracy, completeness, currentness, suitability, or validity of any information expressed herein and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use.
ABOUT RED ALERT: Jerome Corsi's RED ALERT is your weekly, global financial strategies newsletter. Designed to be your guide to economic trends in the best of times and the worst of times, it is edited by New York Times best-selling author Jerome Corsi, Senior Managing Director of the Financial Services Group at Gilford Securities as well as a WND senior staff writer and columnist. For 25 years, Corsi worked with banks throughout the U.S. and the world developing financial services marketing companies to assist banks in establishing broker/dealers and insurance subsidiaries to provide financial planning products and services to their retail customers. Corsi developed three third-party financial services marketing firms that reached annual gross sales levels of $1 billion in annuities and equal volume in mutual funds. Corsi received his Ph.D. in political science from Harvard University in 1972.
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