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
Monday, January 31, 2011
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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