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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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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Open Enrollment for 2011 Medicare prescription drug and health plans begins Nov. 15th

The Centers for Medicare & Medicaid Services (CMS) is encouraging all Medicare beneficiaries to take advantage of the annual Open Enrollment period to make sure they have the best coverage available to meet their health care needs in 2011.

The Medicare Open Enrollment Period this year begins on November 15th and runs through December 31st. During the Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meet their needs.

"The Affordable Care Act will make Medicare stronger and more sustainable. There will be new benefits available to nearly every person with Medicare starting in January 2011, including free annual wellness visits and free recommended preventive services like mammograms and colonoscopies. Seniors who fall into the donut hole in 2011 will be eligible for a 50 percent discount on brand-name prescription drugs. These new benefits make this year's Medicare Open Enrollment Period especially important," said HHS Secretary Kathleen Sebelius. "Every year, the Medicare Open Enrollment Period gives Medicare beneficiaries a chance to evaluate their current plans and see what other options might be out there that serve their needs, especially if their health status has changed. Those enrolled in Medicare can think of the Open Enrollment Period as a yearly coverage "check-up." It is important for people with Medicare to look closely at their plan, look at the options available to them, consider their health status, and find what works for them."

"There's never been a better time for Medicare beneficiaries to check out their Medicare coverage," said CMS Administrator Donald Berwick, M.D. "With better plan choices available for 2011, Medicare beneficiaries can think of Open Enrollment as their yearly coverage 'check-up'."

"During Open Enrollment, AoA's national network of community-based organizations will work with seniors, individuals with disabilities and their caregivers across the country to help them understand the new benefits available under the Affordable Care

Act," said Kathy Greenlee, Assistant Secretary for Aging. "In addition, we urge seniors to protect themselves from potential fraud and identity theft. We know there are people who use this time to scam seniors and rip off Medicare. Seniors should protect their Medicare number the same way they do their Social Security number or credit cards."


Resources for Medicare Beneficiaries
People with Medicare, their families and other trusted representatives can review and compare current plan coverage with new plan offerings, using many proven resources, including:

. Visiting www.medicare.gov, where they can get a personalized comparison of costs and coverage of the plans available in their area. The popular Medicare Plan Finder and Medicare Options Compare tools have been enhanced for an efficient review of plan choices. Multilingual Open Enrollment information and counseling is available.

. Calling 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about coverage options. TTY users should call 1-877-486-2048.

. Reviewing the 2011 Medicare &You handbook. It is also accessible at www.medicare gov and has been mailed to the homes of people with Medicare benefits.

. Getting one-on-one counseling assistance from the local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found:
o At http://www.medicare.gov/contacts/organization-search-criteria.aspx or
o On the back of the 2011 Medicare &You handbook or;
o By calling Medicare at 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048)
o Through a listing of national stand-alone prescription drug plans and state specific fact sheets can be found at: http://www.cms.hhs.gov/center/openenrollment.asp

Medicare beneficiaries who cannot meet the costs of prescription drugs may be eligible for additional resources. Based on eligibility for "extra help," some people Medicare will pay no more than $2.50 for each generic drug and no more than $6.30 for each name brand drug. The program, called Medicare's Limited Income Newly Eligible Transition (NET) Program, can also help pay for premiums and other out-of-pocket costs.

There is no cost to apply for this extra help. Medicare beneficiaries, family members, trusted counselors or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.

Protecting Against Fraud and Identity Theft

The new health care law also provides better tools to help fight waste, fraud and abuse to help protect Medicare. CMS offers tips to help beneficiaries protect themselves against fraud and identity theft during the Open Enrollment period. Medicare recommends thatpeople treat their Medicare number as they do their social security number and credit card information.

Beneficiaries should not give personal information to anyone arriving to their home uninvited or making unsolicited phone calls selling Medicare-related products or services. Beneficiaries who believe they are a victim of fraud or identity theft should contact 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048). More information is available at www.stopmedicarefraud.gov.

More information is available at www.healthcare.gov, a new web portal from the U.S. Department of Health and Human Services.

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Our Nation's Veterans Have Options for Health Care Coverage

/PRNewswire/ -- As the nation pauses to honor its veterans on Nov. 11 for their patriotism, love of country, and willingness to serve and sacrifice for the common good, Blue Cross and Blue Shield of Georgia (BCBSGA) wants our veterans to be taken care of, especially when it comes to their health. Those who have served their country through the United States military have several options surrounding their health care coverage.

Qualifying veterans receive care at VA facilities. Additionally, those 65 years old and older – and those with certain disabilities – may qualify for Medicare. "Many veterans don't know about their Medicare rights," said Krista Bowers, president of senior business at BCBSGA's parent company. "Most have earned access to the Medicare system, just as they've earned their VA benefits. They shouldn't lose the opportunity, especially since some of these benefits may be offered at an affordable or no cost."

"VA and Medicare offer different, yet valuable, benefits to veterans," stated Morgan Kendrick, President of BCBSGA.

Through the VA, eligible veterans have access to a full range of preventive outpatient and inpatient services as long as they stay within the VA health care system, which includes hospitals, clinics, nursing homes, pharmacies and doctors nationwide. VA co-payments and deductibles, including the costs of prescription drugs, are generally less than Medicare. Eligibility for benefits is based on a priority system. According to the United States Department of Veterans Affairs website, there are more than eight million people covered by the VA Health Care System.

Medicare has four parts – A, B, C and D. Part A covers inpatient services, including hospital, skilled nursing facility, home health and hospice care. Part B covers outpatient medical services, such as doctor visits, preventive care and durable medical equipment. Part C, also known as Medicare Advantage (MA), combines Parts A and B into one plan that is run by a private insurance company, like Blue Cross and Blue Shield of Georgia, rather than the government. These plans may also include Part D, which is drug coverage.

Most people, including veterans, don't pay a premium for Part A. In most cases, these costs have been covered by payroll taxes. In contrast, Part B generally requires a monthly payment. Some companies offer Medicare Advantage plans (Part C) that cover everything included in Parts A and B, and more, including preventative services, at no additional cost. These are known as "zero premium plans." Some of these plans could also include dental, vision and hearing coverage. Other plans provide the same services, but require a monthly premium.

Enrollment processes and eligibility differ for VA and Medicare. Veterans can choose to participate in one program or the other or both. Enrollment in a Medicare plan does not affect an individual's VA eligibility.

On its website the VA recommends veterans not decline Medicare based solely on their VA coverage. The VA says there is no guarantee funds will continue to be appropriated for medical care for all enrollment priority groups. This could leave some veterans, especially those enrolled in one of the lower priority groups, with no access to care. For this reason, having a secondary source of coverage, like Medicare, may be in a veteran's best interest, the VA says.

Additionally, people who decline Medicare Part B when they are first eligible to receive it face substantial financial penalties if they decide to enroll later. The initial enrollment period typically occurs in the three months before the person's 65th birthday, their birthday month and the three subsequent months. There is no similar penalty for veterans who delay Part D enrollment because the VA's drug coverage is deemed equal to or better than Medicare.

Other benefits of Medicare for veterans include having access to doctors, hospitals and pharmacies outside the VA network and potentially having a larger list of covered drugs. Wider access could be important in case of an emergency or if a veteran needs a second opinion or specialized care.

There are additional benefits to having a Medicare Advantage plan. These advantages vary by insurer, but may include some or all of the following:

* Limits to total out-of-pocket costs
* Fitness programs, such as free gym memberships
* Preventive dental and vision care
* Programs that help people with chronic diseases, such as diabetes and asthma.
* Discounts on non-covered health-related products
* Chiropractic and podiatry services


It's important to remember that Medicare cannot generally pay for the same service paid for by the Department of Veterans Affairs (VA). Similarly, the VA generally cannot pay for the same service paid for by Medicare

"Obviously, this can get very complicated," said Kendrick. "There are many things for veterans to consider when selecting health care, including premiums, copayments and access. At Blue Cross and Blue Shield of Georgia we provide health benefits to many veterans and are happy to answer their questions to help them understand their options. After all, they deserve the absolute best health care coverage they can get."

For more information about veterans and Medicare, visit the Department of Veterans Affairs Web site at http://www4.va.gov/healtheligibility/ and click on " Medicare Information for Veterans ."

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How health care reform affects your Medicare enrollment

(ARA) - Health care legislation passed earlier this year may make Medicare annual enrollment season particularly challenging for the millions of baby boomers aging into Medicare and for seniors already enrolled who are considering different coverage for 2011. Annual enrollment runs from Nov. 15 to Dec. 31, allowing people to select their Medicare coverage for 2011.

"Choosing a Medicare plan can be overwhelming in any year," says Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor, a Medicare plan selection service for people with disabilities and those 65 and older. "However, this year there are not only the usual changes, such as premium and coverage changes, you also need to understand how the Patient Protection and Affordable Care Act may affect your 2011 Medicare coverage."

According to Muralidharan, the most important ways the new health care legislation will affect Medicare beneficiaries for 2011 include:

* Prescription drug costs should be lower in the "doughnut hole." For 2011, Medicare beneficiaries will receive a 50 percent discount for the cost of brand-name prescription drugs and a 7 percent discount for generic drugs they are taking while in the prescription drug doughnut hole.

* Medicare Part B (medical insurance) will fully cover preventive care. Beginning in 2011, Medicare beneficiaries will no longer have to pay deductibles or co-pays for preventive services that fall under U.S. Preventive Service Task Force guidelines, such as an annual wellness exam.

* More beneficiaries may have higher costs for Medicare Part B and Part D (prescription drug) coverage. The Part B income threshold freezes at the 2010 levels through 2019. As a result, individuals with modified adjusted gross income (income) exceeding $85,000 and married couples with income exceeding $170,000 will have to pay higher premiums. Because this will not adjust with inflation, it's likely more people over time will be subject to higher premiums. In addition, the law reduces the Medicare Part D premium subsidy for individuals with incomes above these levels.

* Opportunities to change coverage after the annual enrollment period will be more limited. Historically, an open enrollment period ran from Jan. 1 through March 31, immediately after annual enrollment ended. During open enrollment, people were able to switch from their existing Medicare plans to similar Medicare coverage, choosing from "like to like" options.

Now, open enrollment has been replaced with a shorter annual disenrollment period, which runs from Jan. 1 through Feb. 14. During this period, the only change that can be made is to disenroll from a Medicare Advantage plan in order to enroll in traditional Medicare and join a Medicare Part D plan. Other selections will not be available to consumers.

"It's easy to get confused over the various Medicare enrollment periods," Muralidharan says. "However, it's now more important than ever to look at annual enrollment as your main opportunity to choose your coverage."

Reasons to review your medicare coverage

Changes brought on by health care reform are just one reason people should evaluate their Medicare coverage. Each year, individuals with Medicare should consider different health care coverage if they experience any of the following:

* Your health situation has changed in the past year.

* Your provider situation has changed (for example, you hospital or physician left your plan).

* Your coverage has changed (for example, certain drugs, procedures or conditions are no longer covered).

* Your plan premiums and/or co-payments have increased.

* You have moved to a new location.

* Your current plan no longer will be available.

Additionally, people now turning 65 and becoming Medicare-eligible for the first time should carefully review their options - and make certain they follow the enrollment guidelines. Failing to do so can trigger costly penalties and may mean certain coverage is unavailable in the future.

"The choices you make about your Medicare coverage can have a significant effect on your health care and your finances," says Muralidharan. "If you are uncertain about which Medicare plans are available to you, or which would best meet your needs, seek help before enrolling." More information on Medicare plan selection assistance is available at Medicare.Allsup.com or (888) 271-1173.


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NAIC: Few Aware That Additional Health Care Reform Provisions Take Effect This Month

/PRNewswire/ -- Earlier this year, Congress passed sweeping reforms designed to revamp the health care system and increase access to care for many Americans. Yet, according to a new survey by the National Association of Insurance Commissioners (NAIC), many consumers are confused about the provisions and unsure of timing for actual implementation.

When asked to choose from four dates for which the first health care reform provisions officially take effect, only 14 percent correctly identified Sept. 23, 2010.

"Our survey findings are a clear indicator that most Americans are not aware of how soon some of the early health care changes may impact them," said NAIC President and West Virginia Insurance Commissioner Jane L. Cline. "It's essential for consumers to understand what to expect and when to consult their state insurance departments for more information."

When asked about specific reform provisions that take effect Sept. 23, most respondents correctly identified provisions concerning children. Specifically, 72 percent knew that children with pre-existing conditions may not be excluded from coverage and 70 percent understood that individuals up to age 26 may be covered under their parents' insurance.

However, half of the respondents were under the impression that employers with fewer than 50 employees will have to offer coverage to employees, and 47 percent incorrectly thought that all health insurance plans must cover approved preventive care and checkups without co-payment.

In reality, employers with fewer than 50 employees are not required by the new law to provide health insurance to staff, and all co-payments for preventive care and checkups are not eliminated. However, those qualifying for Medicare will receive new preventive care benefits that will include annual visits free of co-payments, but this is not mandated for all health insurance plans.

"The results show that while most consumers are well attuned to provisions specifically affecting their children's health care, they do not grasp the overall reform framework," said Cline. "It's promising to see this, but we feel it necessary for consumers to fully understand the changes and get informed about what to expect."

To keep up with the complex health reform process that includes multiple implementation phases in the coming years, the NAIC urges consumers to contact their state insurance department with questions. Go to http://map.naic.org/ to find your state contact information.

In addition, the NAIC website has a special section dedicated to health care reform questions and resources. Visit http://www.naic.org/index_health_reform_section.htm to learn more.

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Many Americans Still Confused About New Healthcare Reform Law and its Provisions

/PRNewswire/ -- Not sure what's in--and not in--the new healthcare legislation signed into law by President Barack Obama in March? You're not alone. More than 2,100 adults were given a list of 18 reform items and asked to identify what's included and what's not included in the law. Only four items were correctly identified by the majority of those polled.

Most (58 percent) know that the reform package will prohibit insurers from denying coverage to people because they are already sick; 55 percent know the law permits children to stay on their parents' insurance plan until age 26; and 52 percent realize that people who don't have insurance will be subject to financial penalties. Additionally, half are aware that employers with more than 50 employees will have to offer their workers affordable insurance.

These are some of the major findings of today's HealthDay/Harris Poll, conducted between July 15 to 19, 2010 among 2,104 adults (aged 18 and over).

Among other findings: 82 percent think the bill will result in rationing of health care or that it might (it won't); 79 percent don't know or aren't sure if drug companies will pay an annual fee, (they will); 73 percent don't know the law establishes a new tax on the sale of medical devices; 66 percent don't know or aren't sure if the legislation will result in insurance exchanges where people can shop for insurance, (it will); and 63 percent either aren't sure or don't know if the new law will increase the number of people eligible for Medicaid, (it will).

"The problem for the (Obama) administration is healthcare reform is fiendishly complicated because the healthcare system is fiendishly complicated, and it is not politically feasible to tear up the system and build it again," said Humphrey Taylor, chairman of the Harris Poll, Harris Interactive's long-running public opinion poll. "Instead you have to build on the system that you have. When you try to build on a fiendishly complicated system, you have fiendishly complicated reforms."

Another cause of the confusion is due to the long and heated political debate that surrounded the bill before it was passed, Taylor said.

"The level of ignorance and misinformation is sort of astounding," he said. "It seems people are still reacting to the rhetoric, not the substance of what is in the bill, because they don't actually know what is or is not in the actual legislation."

For more information, click here to read the full report and methodology. HealthDay's news report is available here. Full data on the poll and its methodology are available at Harris Interactive.

TABLE 1
            KNOWLEDGE OF ITEMS THAT ARE INCLUDED IN REFORM BILL (PPACA)
  "Please indicate if you believe each of the following is included (or
  will result from) or is not included (or will not result from) the
  health care reform bill that was signed by President Obama in March
  of this year.  If you don't know, please do not guess but
  check "Not sure."
  Base: All adults

                                                        Is Not
                                        Is Included/   Included/
                                        Will Result    Will Not
                                            From     Result From  Not
                                                                  Sure
  Not allowing insurers to deny
   coverage to people                 %           58            9      34
  because they are sick
  Allowing children to stay on their
   parents' insurance until           %           55            9      35
  they are 26 years old
  Financial penalties for all
   individuals who do not have or     %           52            9      39
  do not buy insurance
  All employers with more than 50
   employees must offer               %           50            9      41
  their employees affordable
   insurance
  Tax credits for small business to
   provide insurance to               %           43           14      43
  their employees
  Increasing the number of people who
   are eligible for                   %           37           13      50
  Medicaid
  Insurance exchanges where people
   can shop for                       %           35           14      52
  insurance
  A new tax on the sale of medical
   devices                            %           27           13      60
  An annual fee to be paid by drug
   companies                          %           21           14      65


  Note: Percentages may not add up exactly to 100% due to rounding.





                                     TABLE 2
            BELIEF THAT ITEMS NOT IN REFORM BILL (PPACA) ARE INCLUDED
  "Please indicate if you believe each of the following is included (or
  will result from) or is not included (or will not result from) the
  health care reform bill that was signed by President Obama in March
  of this year.  If you don't know, please do not guess but
  check "Not sure."
  Base: All adults

                                                       Is Not
                                       Is Included/   Included/
                                       Will Result    Will Not
                                           From     Result From  Not
                                                                 Sure
  An increase in the federal
   government's budget deficit       %           45           13      42
  Higher income taxes for the middle
   class                             %           37           22      41
  All Americans will have health
   insurance                         %           36           29      35
  New ways to ration health care     %           36           18      46
  A new government run health plan
   to compete with                   %           36           22      43
  private insurance plans
  A cut in Medicare benefits         %           33           21      45
  Higher tax deductions from
   workers' pay                      %           33           16      50
  Panels to decide what care very
   sick, older people                %           30           26      44
  should receive
  Illegal aliens will have health
   insurance                         %           28           27      45

Note: Percentages may not add up exactly to 100% due to rounding.


Methodology

This survey was conducted online within the United States July 15 to 19, 2010 among 2,104 adults (aged 18 and over). Figures for age, sex, race/ethnicity, education, region and household income were weighted where necessary to bring them into line with their actual proportions in the population. Propensity score weighting was also used to adjust for respondents' propensity to be online.

All sample surveys and polls, whether or not they use probability sampling, are subject to multiple sources of error which are most often not possible to quantify or estimate, including sampling error, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments. Therefore, Harris Interactive avoids the words "margin of error" as they are misleading. All that can be calculated are different possible sampling errors with different probabilities for pure, unweighted, random samples with 100% response rates. These are only theoretical because no published polls come close to this ideal.

Respondents for this survey were selected from among those who have agreed to participate in Harris Interactive surveys. The data have been weighted to reflect the composition of the adult population. Because the sample is based on those who agreed to participate in the Harris Interactive panel, no estimates of theoretical sampling error can be calculated.

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Oxendine: Flood Insurance Program Resumes Issuing Policies

Insurance Commissioner John W. Oxendine said the National Flood Insurance Program has been reauthorized by Congress, and flood policies are again available through your homeowners insurance agent or company.

Flood coverage is federally backed by the NFIP. The National Flood Insurance Extension Act extends the NFIP through September 30 of this year, and is retroactive back to June 1, 2010. The program had been inactive since May 31.

Oxendine said a flood policy can be a valuable addition to standard homeowners coverage.
“Purchasing flood insurance is an important consideration for Georgia consumers, even if you think a flood is unlikely in your area,” Oxendine said. “Twenty-five percent of flood claims occur in areas considered medium or low-risk for floods.”

Oxendine said flood insurance is available for up to $250,000 for damage to your home. A standard flood policy will cover the basic structure as well as the furnace, water heater, air conditioner, floor surfaces (carpeting and tile) and debris clean up.

You can buy NFIP flood insurance directly from your property and casualty insurance agent or insurance company, if your community participates in the NFIP. Your insurance agent or insurance company can confirm whether flood insurance is available to you and what it would cost. You can buy flood insurance for your home or business regardless of whether the property is in or out of a floodplain, as long as the property is located in a participating community.

It is very important to plan ahead; a flood insurance policy will not go into effect until 30 days after you buy the policy. You can obtain more information about flood insurance at http://www.floodsmart.gov.

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Deloitte Survey: Majority of Insured Consumers Satisfied With Current Health Plan -- But Concerned About Changes Health Care Reform Act May Bring

/PRNewswire/ -- Of the 82 percent of consumers surveyed who consider themselves "well" or "adequately" insured, nearly all (96 percent) are somewhat or very satisfied with their health plans overall, according to a new Deloitte poll. (www.deloitte.com/us/consumerhealthpulse) Many are concerned the new health reform law will bring about significant changes to their current coverage. Of those enrolled in employer-sponsored health plans, 61 percent believe their employer will reduce benefits for dependents and retirees and 32 percent think employers will probably pay the penalty and discontinue health coverage for employees altogether.

"Anxiety about current and future health insurance coverage will continue to be a major issue for American consumers as health care reform is implemented nationally," stated Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions. "For example, our research shows that consumers who are covered through Medicare are more highly satisfied with their health care services than those in employer-sponsored plans."

Among survey respondents who consider themselves "very knowledgeable" about the Patient Protection and Affordable Care Act, many also indicated concerns over the impact of health reform on access to quality health care. They believe that some hospitals and medical practices will close (72 percent) and that their employers may drop their coverage (51 percent).

The cost of care is also an issue for the majority of consumers. Survey respondents anticipate increases in taxes (76 percent), health insurance costs, including premiums and out-of pocket expenses (65 percent), hospitals and physicians services (66 percent), and the cost of medications (54 percent) as reform is implemented.

Age is a major factor contributing to opinions about health care reform. In general, younger adults are more positive about health reform than older consumers. According to the survey, more than half (51 percent) of 18-34 year-olds believe that the reform bill will reduce health care costs in the long term, compared to respondents 45-54 years old (23 percent), 55-64 years old (36 percent), and 65 years old and above (30 percent).

"Younger consumers are beginning to embrace a new norm for health care," said Keckley. "Those in the younger age groups, (18-44 years old), are increasingly aware that the health care reform process has many moving parts and that they may find themselves entering into a new pact with employers."

The Deloitte survey also identified that consumers with employer-sponsored coverage seem to be the most skeptical and expect to experience negative impacts from the implementation of reform. This segment of survey respondents agree with the following:

-- The cost of the health reform act will be higher than expected (82
percent), which is significantly different from those who are
individually insured (68 percent).
-- The health reform act will not reduce health care costs in the
long-term (58 percent), which is significantly different from the
uninsured (43 percent).
-- Employers will pass the increased cost of health benefits through to
their employees (80 percent).


"Our research indicates that health insurance plans and employers may need to collaborate more than ever to help ease the anxiety of plan participants and employees as new health reform measures are implemented," said John T. Bigalke, vice chairman and Deloitte's health sciences and government industry leader.

Additional key findings from the survey include:

-- Eighty-four percent of all consumers surveyed have health insurance.
-- More than half (56 percent) of those surveyed believe that incentives
for doctors and hospitals to use electronic medical records will be
effective or very effective at improving the overall performance of
the health care system.
-- Cutting the rate of growth of Medicare costs will be only somewhat or
not effective at improving the overall performance of the health care
system according to 60 percent of those surveyed.
-- Sixty-nine percent of those surveyed believe the issue is not whether
an organization is for-profit or not-for-profit -- it's what they do
that matters.
-- Sixty-one percent of respondents agree that a mix of for-profit and
not-for-profit organizations stimulates positive competition and
innovation.

Methodology:


This survey was conducted via telephone interviews within the United States by Harris Interactive on behalf of the Deloitte Center for Health Solutions from May 21-24, 2010 among 1,019 adults ages 18 years old and above. Results were weighted to reflect the U.S. adult population. The survey results have a sampling error of +/- 3 percentage points at the 95% confidence level.

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Momentum Building on Sebelius' Challenge to Insurers to Ban Rescission Before Law Takes Effect in September

More insurers are heeding Secretary Sebelius' call to voluntarily implement key provisions of the Affordable Care Act before the law requires them to do so.

Today, UnitedHealthcare announced they will join with other insurers and stop using rescissions - the practice of dropping patients' health coverage. This announcement follows a letter that Secretary Sebelius sent to the nation's largest insurer, WellPoint, after seeing reports that they were targeting women with breast cancer with the goal of canceling their coverage. WellPoint announced yesterday they would stop the practice, and Secretary Sebelius urged other insurers to do the same.

"The days when insurers can drop coverage when patients get sick are coming to an end but insurers don't need to wait to do the right thing," said Secretary Sebelius. "Americans need to be secure in knowing that their health coverage will be there when they need it most. That is why we are working hard to get the benefits of the Affordable Care Act to families everywhere as quickly as possible."

The Affordable Care Act will ban rescissions, except in cases of intentional misrepresentation of fact or fraud, beginning September 23, but Secretary Sebelius continues to urge insurers not to wait until the fall to do the right thing.

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HHS Secretary Kathleen Sebelius on WellPoint's Decision to Ban Rescissions in Advance of the Affordable Care Act's Requirement

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released the following statement today on WellPoint's announcement that it intends to end the practice of rescinding patients' coverage in advance of the Affordable Care Act's requirement that insurers stop this practice starting this fall. WellPoint's announcement comes after Secretary Sebelius sent a letter on April 22 urging the company to immediately stop the practice of rescinding coverage for patients who become ill.

The Affordable Care Act will specifically prohibit insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact.


STATEMENT OF SECRETARY SEBELIUS

"Last week, when I heard reports of one insurer - WellPoint - targeting breast cancer victims for rescission of their policies, I challenged the company and the rest of the insurance industry to do what they have done with other key insurance reforms in the bill and not wait until September to do the right thing.

The last thing someone who is really sick needs to hear is that they are being dropped by their insurer because they got sick and tried to use the policy they purchased.

I was encouraged to learn today that WellPoint has announced it will act to stop rescissions and no longer engage in this practice as of the end of this week. I urge other insurers to also accelerate the Affordable Care Act's deadline for ending this practice and stop rescinding patients' policies immediately."

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HHS Secretary Kathleen Sebelius on Growing List of Insurers That Will Provide Coverage for Young Adults under Age 26

I welcome the Blue Cross Blue Shield plans, Kaiser Permanente, and Humana to the growing list of insurers who are offering to continue health insurance for young adults graduating from college or aging out of their parents’ plan.  This initiative, complementing the permanent policy in the Affordable Care Act, will enable young people to retain insurance coverage at an important moment as they begin their adult lives and launch their careers.

Many young adults under the age of 26 have traditionally had a difficult time getting access to – and affording – health coverage.  The Affordable Care Act, and the voluntary actions of insurers to eliminate the coverage gap for young adults on their parents plans, will give greater health security to millions of American families.

Insuring younger Americans is a top priority for the Administration and we will continue working to expand the opportunity for children and young adults to have access to quality, affordable care.

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States Get Bonuses for Boosting Enrollment in Children's Health Coverage‏

HHS Secretary Kathleen Sebelius today announced the award of more than $72 million to nine states for making significant progress in enrolling children in health coverage through Medicaid and improving access to children's coverage through Medicaid and the state children's health insurance program.

Funding for the "performance bonuses" was included in the Children's Health Insurance Program Reauthorization (CHIPRA) law. CHIPRA also set performance goals that states must meet to qualify for a bonus.

"Today, we're happy to reward states that have taken important steps to help insure more children and made a real difference in the lives of families across the country," said Secretary Sebelius. "These awards will provide crucial support and help states continue to serve children and families."

States receiving funds today include: Alaska, Alabama, Illinois, Louisiana, Michigan, New Jersey, New Mexico, Oregon, and Washington. (See below for a complete list of state awards.) Awards vary by state according to a formula set out in CHIPRA but total $72.6 million this fiscal year.

To receive these performance bonuses, states had to meet two types of performance goals set forth in the CHIPRA statute. States had to qualify by adopting at least five of eight listed program features-like providing 12 months of continuous eligibility, using a joint application for both Medicaid and the Children's Health Insurance Program (CHIP) and streamlining eligibility renewal processes-that are known to encourage enrollment and retention of eligible children. States also had to document significant increases in Medicaid enrollment among children over the course of the year.

Performance bonuses are not the only federal incentive for states to maintain and expand their Medicaid programs. A short-term boost in Medicaid reimbursement rates authorized by the American Recovery and Reinvestment Act (ARRA) also provided relief to states with suffering economies, enabling them to extend care to eligible children.

"In the midst of the worst economic downturn since the Great Depression, decisive action in ARRA and CHIPRA, along with focused state activity, helped ensure that children got the health care they need," said Cindy Mann, director of the Center for Medicaid and State Operations within the Center for Medicare and Medicaid Services (CMS). "We are pleased to see the success these states have achieved as well as the actions to enroll eligible children taken by other states that we expect may qualify for the bonus next year."

Today's announcement closely follows the release of a study by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured which also credited ARRA and CHIPRA with enabling States to expand access to care for low-income, uninsured children. In a 50-state survey, the Commission concluded that 26 states expanded and/or simplified their Medicaid and CHIP programs in 2009. A copy of the complete report can be found at http://www.kff.org.

State award amounts today are:
Alabama $39.1 million
Alaska $789,000
Illinois $9.1 million
Louisiana $1.5 million
Michigan $3.7 million
New Jersey $4.2 million
New Mexico $5.1 million
Oregon $1.6 million
Washington $7.5 million

Total: $72.6 million

CMS today also released a letter to state health officials providing more detailed guidance on the criteria for qualifying for a bonus payment for 2009 and in future years. That letter will be available on the CMS web site at www.cms.hhs.gov/CHIPRA and also on the Insure Kids Now website at www.insurekidsnow.gov

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NORD Calls for Immediate End to Lifetime Insurance Caps

/PRNewswire/ -- The National Organization for Rare Disorders (NORD) today called upon Congress to put an immediate end to lifetime and annual health insurance caps. In a full-page ad in The Politico, a newspaper distributed widely on Capitol Hill, NORD said the current Senate health reform bill includes loopholes that would allow caps to continue for most Americans, contrary to what many people believe.

"NORD supports health care reform and welcomes the promises made by President Obama and Congress to eliminate lifetime and annual caps," said NORD President Peter L. Saltonstall. "However, under the current version of the Senate bill, caps would continue for several years for many people and would never be eliminated for others."

Private insurers often set lifetime or annual caps on the amount of health care coverage an individual may have. For Americans with chronic diseases, rare disorders, or major medical crises, this can lead to financial crisis or bankruptcy when insurance benefits are exhausted.

The health care reform debate has focused a spotlight on this problem. President Obama promised this fall that the caps would be eliminated under health reform, noting that insurance companies would "no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime." Originally, the Senate health reform debate also advocated eliminating the caps.

However, the current version of the Senate bill provides for "grandfathering" existing insurance plans so that existing plans would be subject to annual lifetime caps indefinitely. The bill also allows self-insured plans to impose annual or lifetime caps indefinitely, which means that many people with employer-provided insurance would still be subject to caps. Even when the bill would require eliminating caps, it would not require doing so for several years.

Earlier this fall, NORD sent a letter to all members of Congress and President Obama outlining four measures that it considers essential to any health reform plan: prohibiting discrimination based on pre-existing conditions; protecting patients against catastrophic out-of-pocket costs and lifetime or annual caps; prohibiting insurers from canceling policies as a result of medical diagnoses; and including tax credits and other direct financing support to assure that all Americans can afford coverage.

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Humana Will Cover H1N1 Vaccine for Members

(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) today announced that the company will cover the administration cost of the H1N1 (swine flu) vaccine for all fully insured members including those members who have a benefit plan that excludes immunization coverage. All co-payment, coinsurance and deductibles will be waived for the administration of the H1N1 vaccination regardless of the preventative-services benefit currently provided in these members’ plans.

“The safety and well-being of our health plan members, country, communities and associates is of utmost concern to Humana,” said Lisa Weaver, M.D., Humana segment vice president, clinical strategies. “Our initial focus is to encourage the CDC-identified priority groups to get vaccinated.”

Humana is taking this step to support its members’ ability to get the vaccination. The company will continue to monitor and respond to guidance from the Centers for Disease Control and Prevention. For the most up-to-date H1N1 information, log on to their website: www.cdc.gov/h1n1flu/. To reach the CDC by phone call 800-CDC-INFO (800-232-4636) or email: cdcinfo@cdc.gov.

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Sebelius, Mills Release New Report Insurance at Risk: Small Business Employees Risk Losing Coverage

Secretary of Health and Human Services Kathleen Sebelius and Small Business Administration Administrator Karen Mills today released a new report, Insurance at Risk: Small Business Employees Risk Losing Coverage. The report examines the health care status quo that has left
employees at risk of losing their insurance and underscores the financial difficulties small businesses face when providing health insurance to their employees. The complete report is available now at www.HealthReform.gov.

"More Americans who work for a small business have lost their health insurance coverage, and those who still have coverage have seen their costs go up," said Secretary Sebelius. "Health insurance reform will drive costs down and make it easier for small business owners to give
their employees the quality coverage they need."

"The cost of health insurance is the number one concern of small business owners. On average, small businesses pay 18 percent more than big businesses for the same health insurance policy. This has left small business owners in an untenable situation, having to choose between their employees, who are often like family to them, and the bottom line," Administrator Mills said. "Health care reform will provide small business owners with greater access to the affordable, quality coverage they want and need for themselves and their employees."

The report notes:

* Employees of small businesses are 50 percent more likely to lose
coverage as workers at large businesses. Half of workers in small firms
that do not offer health benefits remain uninsured.
* Premiums for employer-based health insurance have more than
doubled since 2000, rising three times faster than wages. As a result,
fewer small businesses provide coverage for their employees. In 2000, 57
percent of firms employing less than 10 workers provided coverage. In
2009, only 46 percent of similar-sized firms provided coverage.
* In one national survey, nearly three-quarters of small
businesses that did not offer benefits cited high premiums as the
reason, and on average small businesses pay up to 18 percent more than
large firms for the same health insurance policy. This is due in part to
high broker fees (which can be up to 10 percent of premiums) and health
plan administrative costs that are three to four times those in the
large group market.

Health insurance reform will stabilize health insurance coverage for Americans who work for small businesses. Health insurance reform will provide small businesses with tax credits to help them provide health insurance for their employees. This will make health care more affordable for small businesses and their workers, solidifying and strengthening employer-based coverage for years to come.

Health insurance reform will also create a health insurance exchange so Americans without access to affordable insurance on the job can compare prices and health plans and decide which quality affordable option is right for them. The exchange will also significantly reduce
administrative costs for small businesses by enabling them to easily and simply compare the prices, benefits, and performance of health plans.

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Blue Cross and Blue Shield of Georgia to Provide First Dollar Coverage of H1N1 Vaccine for All Members

/PRNewswire/ -- Each year, influenza causes illness, hospitalizations and deaths, and severely strains the health care delivery system. This year, seasonal flu is complicated by the emergence and rapid spread of the H1N1 virus. In an effort to ensure that individuals and their families can take the appropriate actions to help protect themselves against the H1N1 virus, Blue Cross and Blue Shield of Georgia (BCBSGA) will cover the administration of the H1N1 vaccine without co-pay or deductible for all of its members. BCBSGA is also are encouraging self-insured employers to cover the cost of the vaccination for their employees.

"At BCBSGA, our priority is to ensure that our actions and communications support public health," said Dr. Bob McCormack, BCBSGA medical director. "Our goal is to keep our members as healthy as possible. We are committed to working with the CDC and HHS on an information campaign to ensure that members and the public are vaccinated to prevent H1N1, and if they develop H1N1 flu, they are treated effectively and appropriately."

Since a significant proportion of the vaccine is likely to be administered through non-traditional providers such as pharmacies, retail clinics and public health clinics, BCBSGA is currently working to complete agreements with these providers to increase access to the H1N1 vaccine. In addition, the antiviral medications Tamiflu and Relenza will move to an economical tier in plan formularies.

The CDC has recommended that certain populations receive the 2009 H1N1 vaccine when it becomes available. Initial prioritization includes pregnant women, people who live with or care for children younger than six months of age, children and young adults from 6 months to 24 years old, and people from 25 through 64 years old if they have chronic medical conditions that increase their risk of complications from influenza infection.

The CDC also recommends people take common-sense steps like washing your hands frequently; covering your mouth with your arm when you cough and sneeze; and staying home when you are sick to help protect others from the flu.

"The U.S. health care system has a responsibility to achieve maximal vaccination and effective treatment of H1N1 flu and its emerging risks, and we are eager to do our part to be sure that populations at high risk are immunized against this virus," said Monye Connolly, president, BCBSGA.

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Senate Finance Committee Plan Goes Far To Achieve Reform But New Taxes Raise Affordability Concerns

/PRNewswire/ -- Scott P. Serota, president and chief executive officer of the Blue Cross and Blue Shield Association (BCBSA), issued the following statement regarding the chairman's mark released yesterday by Chairman Max Baucus (D-MT) and members of the Senate Finance Committee:

"We strongly support healthcare reforms that expand coverage to everyone, improve quality, and rein in costs. This chairman's mark achieves many of these goals.

"The mark addresses many necessary insurance reforms, the foundation of which is a proposal advocated by BCBSA to guarantee coverage to everyone, regardless of pre-existing conditions. We commend Chairman Baucus for including in his mark a personal responsibility requirement to obtain and maintain coverage -- the linchpin to making insurance reforms work.

"We also support the mark's age rating provision which allows discounts to young people to encourage them to purchase coverage. Age rating provisions in other bills would preclude these discounts and would result in major premium increases to young people causing many to forgo coverage. Making insurance affordable for young people, who account for as much as 40 percent of those without insurance, is critical to reducing the number of uninsured and will help to lower the cost of health insurance for everyone, including older Americans.

"We strongly support the goal of making coverage affordable. However, we are greatly concerned that burdensome new taxes and fees aimed at insurers and other healthcare industry stakeholders would severely undermine the reforms that the chairman's mark aims to achieve. These unprecedented new taxes would make coverage much less affordable for individuals, their families, and employers.

"We look forward to continuing a vigorous and productive discussion with the Senate Finance Committee. This is a once-in-a-generation opportunity to achieve meaningful and sustainable change in our healthcare system, and BCBSA will continue to advocate for reforms that expand access to everyone, improve quality, and rein in costs."

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BCBSGA Announces Decision to Cover H1N1 Vaccine Administration

/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGA) announced today that it will offer coverage for the administration of the H1N1 (swine flu) vaccine when it becomes commercially available to the general public. The vaccine administration will be covered for members whose benefit plans provide coverage for vaccines.

BCBSGA will also continue coverage of seasonal flu vaccine administration for those whose health plans offer vaccine coverage. The U.S. Centers for Disease Control and Prevention has stated that the H1N1 vaccine is not intended to replace the seasonal flu vaccine. Seasonal flu and H1N1 vaccines may be administered on the same day, according to the CDC.

The decision to cover the H1N1 vaccine administration is based on formal recommendations announced this week by the CDC's Advisory Committee on Immunization Practices. ACIP recommended initial prioritization for those administering the vaccine for five key populations, including:

-- pregnant women,
-- people who live with or care for children younger than six months of
age,
-- health care and emergency services personnel,
-- children and young adults from 6 months old to 24 years old, and
-- people from 25 through 64 years old if they have chronic medical
conditions that increase their risk of complications from influenza
infection.

ACIP also provided guidance regarding high risk groups to be targeted in the event of a significant shortage of vaccine as well as recommendations for the rest of the general population if the supply of vaccine exceeds the needs of the target groups.

BCBSGA's immunization policy decisions are based on recommendations issued by ACIP and other nationally recognized organizations. ACIP is composed of 15 experts in fields associated with immunization who provide advice and guidance to the U.S. Department of Health and Human Services and CDC on the most effective means to prevent vaccine-preventable diseases.

Vaccine administration is covered for members whose benefit plans provide coverage for vaccines. Policyholders should confirm their specific benefits by calling the toll-free telephone number listed on their insurance card.

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The Amputee Coalition of America and Nearly 200 Amputees and Patient Advocates Go to Washington

(BUSINESS WIRE)--On Tuesday, March 10, the Amputee Coalition of America had nearly 200 amputees and patient advocates from 34 states in Washington, D.C., to urge members of Congress to support fair insurance coverage for artificial arms and legs. Their message was simple: Arms and legs are not a luxury!

These citizen lobbyists made this trip to tell lawmakers that they need their own “bailout.” Many of them have nightmarish stories of fighting with insurance companies to try to get the prosthetic devices they need to work and live.

“Insurance companies are unrealistically limiting reimbursement of prosthetic arms and legs or summarily electing not to cover them at all,” said Kendra Calhoun, Amputee Coalition president and CEO. “We intend to turn this tide, and this event is a great example of the grassroots support we have from across the country. Arms and legs are not luxury items. Mobility is a serious issue for amputees who want to keep their jobs, take care of their families, and live healthy, active lives.”

Jeffrey Cain, MD, is a bilateral lower-limb amputee and a member of the Amputee Coalition’s Board of Directors and Medical Advisory Committee. Dr. Cain is an excellent example of how prosthetic devices can help amputees function in their daily lives and contribute to society rather than become dependent on it.

“Being able to have prosthetic devices means that I can take care of my patients and teach medical students,” said Dr. Cain.

Unfortunately, working people with employer-provided health insurance plans are often the ones with the biggest problems, Dr. Cain noted. “Because employer-provided insurance plans are increasingly introducing unreasonable limits and caps, if you have a job in America – if you are a hardworking member of society – you can’t afford a leg to stand on. It’s gotten that bad.”

In fact, some insurance companies are providing coverage for only one prosthesis per lifetime or eliminating coverage completely.

“Even for older adults, it is absurd to expect them to use only one prosthesis in their lifetime,” Calhoun said. “No one would expect a person to wear a single pair of shoes their entire life, and prosthetic devices should be no different.”

These types of insurance company practices pose especially grave challenges for families of children with limb loss.

Rick Castro, of Connecticut, took two of his children to the event because he wanted to try to get better prosthetic coverage for all families, including his own. Castro’s 4-year-old daughter Jennifer was born missing part of her arm below the elbow, and Castro is well aware that, as she grows, she’ll need several highly expensive prosthetic devices.

“When people find out that their insurance company doesn’t provide fair coverage for prosthetic devices, what do they do?” asked Dr. Cain. “They mortgage their homes, raid their children’s college fund, go into debt, turn to government programs for assistance, or are forced to have bake sales to try to pay for these medically necessary and often very expensive devices. That’s pretty sad, especially when they’ve paid their insurance premiums for years for this very purpose.”

David Ross, of New York City, lost part of his right hand and his right leg above the knee after he was mugged and thrown in front of a subway in 1997. He’s seen what happens when amputees have to settle for devices that are not really what they need because of the limitations in their insurance policies, and that’s what brought him to Capitol Hill.

“It’s so unfair that prosthetics are not covered by health insurance plans to the same degree that other conditions are,” Ross said. “It’s a shame that a lot of my fellow amputees who have already had to get over a traumatic accident or being born without a limb have to fight for something that should already be included in their insurance policy.”

Robert D. Doty, Jr., MD, who lost his left arm as a result of a car falling on him, has had problems with his insurance company not understanding – or not acknowledging – his prosthetic needs.

“My carrier did not want to cover a body-powered prosthesis after covering a myoelectric prosthesis,” Doty said. “The company said that one prosthesis is as good as another and that they can do the same thing, which is not true. I can’t do anything around water, liquids, chemicals or heavy machinery or do any heaving lifting with my myoelectric prosthesis without damaging it. It’s great for doing fine, precise work, but if I’m going to be doing heavy lifting or working around water or liquids, a body-powered prosthesis is better. I really need both.”

As these nearly 200 citizen lobbyists hustled from office to office, they made it clear that they want change. In a single day, they made more than 60 Senate visits and more than 100 House visits. In addition, 26 organizations, including disability rights groups and O&P [orthotic and prosthetic] professional organizations, have now signed on with the Amputee Coalition of America to help move this legislation forward.

“We are thrilled with the results of the day,” said Morgan Sheets, the Amputee Coalition’s national advocacy director. “We are already hearing from House and Senate members who are interested in co-sponsoring our bills and supporting our efforts for fair coverage of artificial arms and legs. The turnout exceeded our expectations, and the great enthusiasm of the participants has certainly encouraged us to continue this important fight for fairness.”

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