/PRNewswire/ -- The following is released by Lockton:
Human resource and benefits managers--and perhaps a lot of CEOs and CFOs--who in recent weeks had begun thinking seriously about the impact of federal health reform on their profitability, workforce structure and health plan viability, may have awoken Nov. 3 asking, "What now?"
What now, indeed. As Republican candidates in federal, state and local races swept into office in historic numbers, promising a change in the course of government, attention has centered on the impact of the election results and on the future of the federal health reform law.
The answer is: Don't expect much in the way of change. At least not yet.
Repeal is Not an Option...For Now
There was a never a chance that Republican mid-term victories, under the most optimistic of projections, would or could unravel the health reform law. Even had Republicans managed to capture control of the Senate in addition to their reclamation of the House, the health reform law was in no danger of repeal. Any attempt by Congress to do that would be vetoed by President Obama, and the Republicans lack the 67 Senate votes necessary to override a Presidential veto. Any serious attempt at repeal must await the results of the 2012 elections. Repeal will require the complete reversal of 2008: Republican control of the White House and both chambers of Congress.
If the GOP cannot now outright behead the law, can they strangle it by denying it funding? To be sure, the funding issue is the law's weak underbelly. The law requires federal funding of more than 100 key components of the bill, most notably grants to states to establish insurance exchanges by 2014, and of course the $500 billion necessary to provide subsidies toward individuals' purchases of insurance in the exchanges. Federal taxpayers are also picking up, for the first several years, all or nearly all of the additional Medicaid expenses associated with the expansion of Medicaid eligibility.
Risky Business
But holding up the federal budget - threatening the shutdown of the government - is risky business. Many voters are weary of partisanship and are looking for Congress to make something good happen. Republicans must remember that according to a number of exit polls, voters identified the economy as their main concern, by a wide margin (about 62% of voters picked the economy as their primary issue; only 18% cited the health reform law). The American electorate wants results.
The new makeup of the Congress doesn't bode well in that regard. Among the many Democrats swept out of the House are a significant number of self-styled moderates, known as "Blue Dogs." This purging of Democratic moderates means we'll now have in the Congress, particularly on the Democratic side of the aisle, a caucus whose center of gravity is a fair bit farther left than before. Throw in a Republican majority infused with new blood drawn from the mid- to far-right, and you have all the makings of political gridlock.
What's in Store?
So what will happen, then? Our best guess, for the short term, is that Republicans in the House will pass a symbolic bill repealing the health reform law, a bill that will go nowhere in the Senate. Again, here the Republicans must be prudent. Voters, particularly those in the all-important political center, are likely to have little tolerance for symbolic gestures while the nation's economy festers. For the same reason, if Republicans allow themselves to become bogged down over fringe issues, they will have misread the lessons of the election results.
Some nibbling around the soft edges of the health reform bill is likely. The business community is rightly aghast at the new Form 1099 reporting requirement appended to the law. The requirement compels businesses to issue a Form 1099 to every vendor - from copy repairmen to bartenders - to whom the company pays $600 or more during a year. House Republicans will move swiftly to repeal that provision, and will likely attract enough Senate Democrats - spooked by the election bloodletting - to get it done.
There is talk of attempting to do even more, perhaps repealing the "Individual Mandate" (the provision that compels nearly all Americans to have minimum health coverage by 2014 or face a modest penalty) or the "Free Rider Surcharge"(the penalty employers will pay beginning in 2014 if they fail to offer affordable coverage to full-time employees who instead obtain subsidized coverage in the insurance exchanges).
Such actions, like the health reform bill itself, may have unintended consequences. The health reform law requires insurers to issue policies to all applicants, without pre-existing condition restrictions. That works only if the nation gets everyone in the risk pool. Otherwise, people will simply wait to buy insurance until they get sick. Removing the individual mandate without relieving carriers of the obligation to issue a policy to all applicants, without restrictions, makes it even more difficult for private insurance companies to survive.
Business has many reasons to oppose the Free Rider Surcharge. But if the insurance exchange concept survives until 2014, and employers find then that their employees have another, taxpayer-subsidized option for health coverage available, and no surcharge binding the employers to their existing group health plans, a great many more employers may simply terminate their group coverage. That will improve employers' bottom lines (although many employees will fare worse in the exchanges), but not the nation's.
The Congressional Budget Office, when estimating the first decade's cost of the bill at $1 trillion, assumed only about 4-5 million Americans (net) who have group insurance today will lose it by 2019, as a result of the health reform law. A recent study suggests that the cost of federal subsidies in the insurance exchanges rises about $300 billion for every additional six million Americans who seek exchange-based coverage. If the 4-5 million estimate balloons to 40-50 million, the first decade's cost of the program leaps to $2.5 - $3 trillion, a number that is simply not sustainable.
Stay the Course
So we shall see. Experienced political pundits say that prognostications based on mid-term election results are almost always wrong. In other words, we should not read too much into the results, although there is still much to make of them. Our advice to employers who are beginning to assess the impact of health reform and chart a course to address the issues it poses, is to "stay the course." There is still much to do, and health reform isn't going anywhere, at least not for a while.
-----
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Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Thursday, November 04, 2010
Tuesday, October 05, 2010
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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"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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Wednesday, August 25, 2010
Health Reform Costs, Benefits Explained in NCPA Consumer's Guide
/PRNewswire/ -- The first detailed and objective consumer's guide on the impact of the Patient Protection and Affordable Care Act has just been released by the National Center for Policy Analysis (NCPA), titled "What Does Health Care Reform Mean To You? A Detailed Analysis"
"The guide does not ignore the benefits of the Affordable Care Act, but it also does not deny the costs," said NCPA President, CEO and Kellye Wright Fellow John C. Goodman. "This is the first unbiased summary of health care reform costs and benefits, and it's a unique resource."
"The consumer's guide answers questions about the coming changes and costs in Medicare, Medicaid, health insurance, employer coverage, and income tax returns," added Goodman.
Guide: http://www.ncpa.org/pdfs/What-Does-Health-Reform-Mean-for-You-A-Detailed-Analy sis.pdf
The research analyzes the costs, benefits and drawbacks of health reform changes, including:
-- Health insurance requirements and fines for individuals and employers
-- Expanded health coverage for up to 34 million people
-- Projected shortages of doctors, nurses and hospitals
-- Free health plan preventative services
-- New coverage protections for patients with pre-existing conditions
-- Reporting family income totals to your employer
-- Benefit and spending cuts for the elderly and disabled on Medicare
-- New taxes on private health insurance, drugs, medical devices
-- Insurance subsidies and changes in coverage options
To educate patients, doctors and all those affected by the new health care law, the NCPA has also produced a shorter version of the guide in a summary pamphlet, also titled "What Does Health Care Reform Mean To You?" The pamphlet is a succinct and unbiased overview of the Affordable Care Act changes, in layman's terms, to help consumers understand what to expect from health care reform.
The National Center for Policy Analysis (NCPA) is a nonprofit, nonpartisan public policy research organization, established in 1983. The NCPA's goal is to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector. Topics include reforms in health care; Medicare and Social Security;
retirement; taxes; small business policy; and energy and environmental regulation.
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"The guide does not ignore the benefits of the Affordable Care Act, but it also does not deny the costs," said NCPA President, CEO and Kellye Wright Fellow John C. Goodman. "This is the first unbiased summary of health care reform costs and benefits, and it's a unique resource."
"The consumer's guide answers questions about the coming changes and costs in Medicare, Medicaid, health insurance, employer coverage, and income tax returns," added Goodman.
Guide: http://www.ncpa.org/pdfs/What-Does-Health-Reform-Mean-for-You-A-Detailed-Analy sis.pdf
The research analyzes the costs, benefits and drawbacks of health reform changes, including:
-- Health insurance requirements and fines for individuals and employers
-- Expanded health coverage for up to 34 million people
-- Projected shortages of doctors, nurses and hospitals
-- Free health plan preventative services
-- New coverage protections for patients with pre-existing conditions
-- Reporting family income totals to your employer
-- Benefit and spending cuts for the elderly and disabled on Medicare
-- New taxes on private health insurance, drugs, medical devices
-- Insurance subsidies and changes in coverage options
To educate patients, doctors and all those affected by the new health care law, the NCPA has also produced a shorter version of the guide in a summary pamphlet, also titled "What Does Health Care Reform Mean To You?" The pamphlet is a succinct and unbiased overview of the Affordable Care Act changes, in layman's terms, to help consumers understand what to expect from health care reform.
The National Center for Policy Analysis (NCPA) is a nonprofit, nonpartisan public policy research organization, established in 1983. The NCPA's goal is to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector. Topics include reforms in health care; Medicare and Social Security;
retirement; taxes; small business policy; and energy and environmental regulation.
-----
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Unemployed See COBRA Costs Increase in 2010, While Current Workers Brace for More Health Care Cost Shifting in 2011, Says Aon Consulting
/PRNewswire/ -- As the national unemployment rate continues to hover around 10 percent, health care costs for those jobless Americans have seen a year-over-year increase, according to Aon Consulting, the global benefits and human capital consulting business of Aon Corporation (NYSE:AON) .
Aon Consulting surveyed 1,079 employers nationwide in its 2010 Benefits Survey, and found an increase in monthly COBRA* contributions for terminated employees. Specifically, the average monthly cost for employee-only HMO coverage for a terminated worker is $429 this year, compared to $399 for the same coverage in 2009. For employee plus family, the former employee is paying $1,251 a month this year, compared to $1,171 per month last year. As for PPO coverage, the average monthly cost for employee only is $449 in 2010, compared to $439 in 2009, and for employee plus family, the cost tops out at a monthly average of $1,310 this year, versus $1,275 last year. (Click on the following link to see charts on a detailed year-over-year comparison: http://aon.mediaroom.com/index.php?s=43&item=1998)
"The increased frequency and duration of COBRA use is creating a significant strain on the program, leading to higher costs," said John Zern, executive vice president and Health & Benefits Practice director with Aon Consulting. "Those who are unemployed, and facing uncertainty about employment prospects and future COBRA availability, are utilizing the program more than we've traditionally seen to treat a variety of conditions prior to potentially losing coverage. This coupled with the high unemployment rate, is placing the COBRA program in a unique and unprecedented position."
As for current employees, they can expect to shoulder more of the expense related to health coverage in 2011, according to this survey. In fact, 65 percent of employers plan to increase cost sharing next year for things such as deductibles, co-pays and out-of-pocket maximums. What's more, 57 percent of companies say they will ask employees to contribute more for the overall cost of health care in 2011. The amount of cost sharing implemented by employers varies. On plan design (e.g., deductibles, co-pays and out-of-pocket maximums), 46 percent of employers are shifting costs to employees equal to the overall renewal increase, while an additional 46 percent are shifting costs to workers that are less than the overall renewal increase. For overall health plan cost, 40 percent of employers say the additional worker contributions will be equal to the 2011 renewal increase, and 49 percent indicate that workers will be asked to pay less than next year's renewal increase.
"We believe the new health reform law will increase health care costs by 2 percent to 4 percent during the next three years," said Tom Lerche, senior vice president with Aon Consulting. "In addition, we expect to see new costs related to excise taxes and potential cost shifting from reductions in Medicare reimbursement to providers, which will be on top of existing long-term medical trend inflation. These factors will lead many employers to consider increased employee contributions for health coverage, as well as plan design cost sharing."
To learn more about Aon Consulting's 2010 Benefits Survey, please visit www.aon.com/2010survey.
* COBRA - refers to the Consolidated Budget Reconciliation Act of 1985, and includes provisions for members of company health plans who have lost their coverage due to a "qualifying event" to continue coverage at the employee's expense for a period of time.
-----
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Aon Consulting surveyed 1,079 employers nationwide in its 2010 Benefits Survey, and found an increase in monthly COBRA* contributions for terminated employees. Specifically, the average monthly cost for employee-only HMO coverage for a terminated worker is $429 this year, compared to $399 for the same coverage in 2009. For employee plus family, the former employee is paying $1,251 a month this year, compared to $1,171 per month last year. As for PPO coverage, the average monthly cost for employee only is $449 in 2010, compared to $439 in 2009, and for employee plus family, the cost tops out at a monthly average of $1,310 this year, versus $1,275 last year. (Click on the following link to see charts on a detailed year-over-year comparison: http://aon.mediaroom.com/index.php?s=43&item=1998)
"The increased frequency and duration of COBRA use is creating a significant strain on the program, leading to higher costs," said John Zern, executive vice president and Health & Benefits Practice director with Aon Consulting. "Those who are unemployed, and facing uncertainty about employment prospects and future COBRA availability, are utilizing the program more than we've traditionally seen to treat a variety of conditions prior to potentially losing coverage. This coupled with the high unemployment rate, is placing the COBRA program in a unique and unprecedented position."
As for current employees, they can expect to shoulder more of the expense related to health coverage in 2011, according to this survey. In fact, 65 percent of employers plan to increase cost sharing next year for things such as deductibles, co-pays and out-of-pocket maximums. What's more, 57 percent of companies say they will ask employees to contribute more for the overall cost of health care in 2011. The amount of cost sharing implemented by employers varies. On plan design (e.g., deductibles, co-pays and out-of-pocket maximums), 46 percent of employers are shifting costs to employees equal to the overall renewal increase, while an additional 46 percent are shifting costs to workers that are less than the overall renewal increase. For overall health plan cost, 40 percent of employers say the additional worker contributions will be equal to the 2011 renewal increase, and 49 percent indicate that workers will be asked to pay less than next year's renewal increase.
"We believe the new health reform law will increase health care costs by 2 percent to 4 percent during the next three years," said Tom Lerche, senior vice president with Aon Consulting. "In addition, we expect to see new costs related to excise taxes and potential cost shifting from reductions in Medicare reimbursement to providers, which will be on top of existing long-term medical trend inflation. These factors will lead many employers to consider increased employee contributions for health coverage, as well as plan design cost sharing."
To learn more about Aon Consulting's 2010 Benefits Survey, please visit www.aon.com/2010survey.
* COBRA - refers to the Consolidated Budget Reconciliation Act of 1985, and includes provisions for members of company health plans who have lost their coverage due to a "qualifying event" to continue coverage at the employee's expense for a period of time.
-----
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Thursday, August 05, 2010
How Local Governments Are Addressing Retiree Health Care Funding
/PRNewswire/ -- A new issue brief from the Center for State and Local Government Excellence finds that the economy has slowed the ability of local governments to address long-term funding of their retiree health care obligations.
The brief follows up on a 2009 survey in which 206 local governments indicated they were likely to adopt a long-term strategy to strengthen their retiree health care funding, including:
-- establishing a Section 115 trust (governmental); medical subaccount
[401(h)]; or Voluntary Employee Beneficiary Association (VEBA) trust
[501(c)(9)];
-- issuing OPEB bonds;
-- increasing the years of service for vesting for RHC;
-- increasing the age at which RHC is available;
-- terminating retiree health care for all new hires.
Since then, the economy, insufficient revenues, and competing budget priorities have posed the greatest impediment to their plans.
The new brief finds that many jurisdictions are making sweeping changes in their retiree health care plans:
-- 36 percent have increased or plan to increase the years of service
required to vest.
-- 11 percent have increased the retirement age.
-- 39 percent have eliminated or plan to eliminate retiree health
benefits for new hires.
-----
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The brief follows up on a 2009 survey in which 206 local governments indicated they were likely to adopt a long-term strategy to strengthen their retiree health care funding, including:
-- establishing a Section 115 trust (governmental); medical subaccount
[401(h)]; or Voluntary Employee Beneficiary Association (VEBA) trust
[501(c)(9)];
-- issuing OPEB bonds;
-- increasing the years of service for vesting for RHC;
-- increasing the age at which RHC is available;
-- terminating retiree health care for all new hires.
Since then, the economy, insufficient revenues, and competing budget priorities have posed the greatest impediment to their plans.
The new brief finds that many jurisdictions are making sweeping changes in their retiree health care plans:
-- 36 percent have increased or plan to increase the years of service
required to vest.
-- 11 percent have increased the retirement age.
-- 39 percent have eliminated or plan to eliminate retiree health
benefits for new hires.
-----
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www.georgiafrontpage.com
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Wednesday, August 04, 2010
Medical Tourism Association Releases Healthcare Reform White Paper
(PR.com)-- The Medical Tourism Association has released an educational White Paper on Healthcare Reform, detailing what positive and negative effects healthcare reform is expected to have on both inbound, outbound and domestic medical tourism. Healthcare Reform passed into law in March 2010 and has both immediate implications and those to go into full effect in 2014. Many expect the reform will continue to raise healthcare and health insurance costs in the United States. As healthcare costs and health insurance costs rise in the United States this will push American patients to choose to travel domestically for medical tourism, a new term coined towards the provision of more affordable healthcare services within the US, or to leave the United States to travel abroad for medical care.
As stated by Devon Herrick of National Center for Policy Analysis, USA, “The recent Health Reform legislation contains virtually nothing to encourage patients and providers to control costs. By contrast, medical tourism represents global competition in health care, where providers compete on price and quality. Medical tourism is our best opportunity to encourage competition within the health care industry.”
The Healthcare Reform white paper is meant to give guidance and understanding on how the different aspects of healthcare reform will interact with medical tourism. The Medical Tourism White Paper can be read in the Healthcare Reform Updates section of the Medical Tourism Congress website. http://medicaltourismcongress.com/en/healthcare-reform-updates.html
“We have released this white paper in order to provide insight into healthcare reform and its different provisions, projecting how it may affect medical tourism. Many people around the world do not understand the lengthy healthcare reform document passed in the US and mistakenly think that it provides more affordable healthcare to Americans and that it will lower healthcare costs. Costs will likely go up under healthcare reform and this was reaffirmed in the recent medical tourism survey the MTA conducted with almost 100 insurance companies and employers, where almost 100% of respondents found that they believe costs will rise,” said Jonathan Edelheit, CEO of the Medical Tourism Association.
The healthcare reform and medical tourism white paper will be available at the MTA’s annual conference, The World Medical Tourism & Global Healthcare Congress, which will have a large focus on Healthcare Reform this year in Los Angeles, California from September 22-24th. The conference will focus on how healthcare reform affects employers, insurers, insurance agents, healthcare providers and patients and will peel back the onion of the thousands of pages of healthcare reform bill to look at how different aspects of health care reform will really work. www.medicaltourismcongress.com
The Medical Tourism Association also conducted a survey of over one hundred US insurance companies and US employers on the effect medical tourism will have upon them. The survey, “Healthcare Reform Survey Among Industry Stakeholders Discovers Similar Concerns,” July, 2010, shows a sample of the future growth potential of the medical tourism industry. 71 percent of insurance companies and employers felt healthcare reform was extremely positive for the medical tourism industry and more Americans would travel overseas under the new law. Employers and insurance companies know that healthcare reform will increase costs and medical tourism is one of the few ways to lower those costs. http://medicaltourismmag.com/article/healthcare-reform-survey.html
The Medical Tourism Association (Medical Travel Association), also known as the Global Healthcare Association, at http://www.MedicalTourismAssociation.com is the first international non-profit association comprised of the top international hospitals, healthcare providers, medical travel facilitators, insurance companies, and other affiliated companies and members with the common goal of promoting the highest level of quality of healthcare to patients in a global environment. Our Association promotes the interests of its healthcare provider and medical tourism facilitators members. The Medical Tourism Association has three mission-driven tenets: Education, Communication and Transparency.
-----
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As stated by Devon Herrick of National Center for Policy Analysis, USA, “The recent Health Reform legislation contains virtually nothing to encourage patients and providers to control costs. By contrast, medical tourism represents global competition in health care, where providers compete on price and quality. Medical tourism is our best opportunity to encourage competition within the health care industry.”
The Healthcare Reform white paper is meant to give guidance and understanding on how the different aspects of healthcare reform will interact with medical tourism. The Medical Tourism White Paper can be read in the Healthcare Reform Updates section of the Medical Tourism Congress website. http://medicaltourismcongress.com/en/healthcare-reform-updates.html
“We have released this white paper in order to provide insight into healthcare reform and its different provisions, projecting how it may affect medical tourism. Many people around the world do not understand the lengthy healthcare reform document passed in the US and mistakenly think that it provides more affordable healthcare to Americans and that it will lower healthcare costs. Costs will likely go up under healthcare reform and this was reaffirmed in the recent medical tourism survey the MTA conducted with almost 100 insurance companies and employers, where almost 100% of respondents found that they believe costs will rise,” said Jonathan Edelheit, CEO of the Medical Tourism Association.
The healthcare reform and medical tourism white paper will be available at the MTA’s annual conference, The World Medical Tourism & Global Healthcare Congress, which will have a large focus on Healthcare Reform this year in Los Angeles, California from September 22-24th. The conference will focus on how healthcare reform affects employers, insurers, insurance agents, healthcare providers and patients and will peel back the onion of the thousands of pages of healthcare reform bill to look at how different aspects of health care reform will really work. www.medicaltourismcongress.com
The Medical Tourism Association also conducted a survey of over one hundred US insurance companies and US employers on the effect medical tourism will have upon them. The survey, “Healthcare Reform Survey Among Industry Stakeholders Discovers Similar Concerns,” July, 2010, shows a sample of the future growth potential of the medical tourism industry. 71 percent of insurance companies and employers felt healthcare reform was extremely positive for the medical tourism industry and more Americans would travel overseas under the new law. Employers and insurance companies know that healthcare reform will increase costs and medical tourism is one of the few ways to lower those costs. http://medicaltourismmag.com/article/healthcare-reform-survey.html
The Medical Tourism Association (Medical Travel Association), also known as the Global Healthcare Association, at http://www.MedicalTourismAssociation.com is the first international non-profit association comprised of the top international hospitals, healthcare providers, medical travel facilitators, insurance companies, and other affiliated companies and members with the common goal of promoting the highest level of quality of healthcare to patients in a global environment. Our Association promotes the interests of its healthcare provider and medical tourism facilitators members. The Medical Tourism Association has three mission-driven tenets: Education, Communication and Transparency.
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Friday, July 23, 2010
Six Key Tips for Caregivers Navigating the System on Behalf of Their Parents, Grandparents and Others
/PRNewswire/ -- According to the National Alliance for Caregiving, more than 65 million people in the United States serve as informal caregivers, typically for family members, which equates to more than one out of every four people serving as unpaid caregivers.
A caregiver is someone who provides assistance to another person who is ill, disabled or needs help with daily activities. It's a role that can be physically and emotionally draining. The health care system doesn't make it any easier. Fortunately, there are a few tips caregivers can follow to better manage their loved one's health care, particularly when it comes to people with Medicare, according to Krista Bowers, senior vice president of senior products at Blue Cross and Blue Shield of Georgia's parent company.
"At Blue Cross and Blue Shield of Georgia (BCBSGA), we hear regularly from caregivers who are learning how to navigate the system on behalf of their parents, grandparents and others," said Monye Connolly, President, BCBSGA. "There are some themes that are common among them."
Gathering Information
The first step in helping to manage care for a loved one is gathering as much information as possible about their health and health benefits. Some items caregivers might want to gather include the following:
-- Medicare card (if eligible)
-- Health plan membership card
-- A list of doctors, including specialists
-- A list of medicines and dosages
-- Information about the person's medical conditions both treated and
untreated.
This is basically creating a "personal health record." A loved one might be reluctant to share this information at first. Experts recommend that caregivers remain patient. They can explain that the information is needed to advocate on their behalf with their doctors, hospitals and insurance companies.
Getting Permission
Most people have heard of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is an important law for protecting patient privacy. However, it can be an obstacle for caregivers.
"People are sometimes surprised to learn that companies like Blue Cross and Blue Shield of Georgia cannot readily disclose a person's health information, even to their own spouse or child," said Connolly. "That's why it's so critical for caregivers to file the proper paperwork with their loved one's health benefits provider."
Caregivers can access a loved one's health information in a number of ways. One way is with a "durable power of attorney," which can be established with the assistance of an attorney. Another way is with an "Authorization to Disclose Personal Health Information," which is available from a health benefits company. With the disclosure form, the member can authorize someone else to see their health care information, while specifying just how much information that person can see. Beneficiaries also can designate someone to participate on their behalf in Medicare appeals and grievances by filling out an "Appointment of Representative" form.
These forms are returned to the health benefits company where they are kept on file. When they are on file, designees can serve as the member's representative on health benefits, including determinations, exceptions, and appeals and grievances. Anybody can serve as a designee, including a family member or friend. However, the member can revoke these designations, in writing, whenever they see fit.
Enrolling in a Chronic Disease Program
Some Medicare beneficiaries suffer from chronic diseases, such as cancer, stroke, multiple sclerosis, dementia, diabetes, end stage renal disease or Alzheimer's disease. In fact, according to the Centers for Disease Control and Prevention, eight out of 10 Americans age 65 or older are living with some chronic illness. Those enrolled in a Medicare plan may have access to free programs to help them manage their diseases. Many times, these programs are administered by nurses or other licensed personnel. The goal is to help prevent acute episodes through better disease management. Many plans even follow-up with members after their hospitalization.
"These programs are above and beyond those offered by Original Medicare," Bowers explained. "It's important for caregivers to know about them and encourage their loved ones to participate. They may want to get a copy of a member's explanation of coverage from their insurer to find out what's available."
Knowing Your Rights
Once the disclosure/authorization paperwork has been filed, caregivers can speak to a customer care agent on a beneficiary's behalf as well as access the beneficiary's information online, including claims history, provider network and drug formularies.
If a beneficiary ever disagrees with any Medicare decision, including a denial, they have the right to appeal it. For more information about appeals, visit http://www.medicare.gov/ to get a free copy of "Your Rights and Protections."
Investigating 'Extra Help'
As a caregiver, it's also important to know about "extra help" that is available to low-income people with a Medicare prescription drug plan through the Social Security office. This "extra help" includes assistance with monthly prescription drug premiums, annual deductibles and prescription copayments. For information about eligibility for this program, go to www.socialsecurity.gov/extrahelp.
Even if your loved one doesn't qualify for extra help from Social Security, there are a myriad of other resources that might be available to them at the state and community levels. The Web site www.benefitscheckuprx.org has compiled information about these resources in one convenient online location. The site, which counts Blue Cross and Blue Shield of Georgia among its sponsors, tracks more than 1,550 benefit programs throughout all 50 states and the District of Columbia. It has identified more than $7.6 billion in benefits for those in need since being launched in 2001.
Caring for Yourself
The final tip for caregivers, and perhaps the most important, is for them to take care of themselves, including getting enough sleep, going for a walk, taking an occasional day off and maintaining a sense of humor. After all, caregivers can't possibly take care of anyone else until they first take care of themselves.
According to the Alzheimer's Association, research shows that caregivers face an increased risk of developing depression. It's natural to grieve about a loved one's disease. However, if sadness persists to the extent that it prevents decision making, interrupts daily living, and discourages participation in normal activities, then it may be time to get some help. Primary care physicians may offer help, including referrals to other resources. Caregivers with access to Employee Assistance Programs (EAP) can find them useful.
"Caregivers need to know that there's no shame in asking for help," said Connolly.
For more information about care giving and Medicare, including helpful forms, please visit www.medicare.gov/caregivers.
-----
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A caregiver is someone who provides assistance to another person who is ill, disabled or needs help with daily activities. It's a role that can be physically and emotionally draining. The health care system doesn't make it any easier. Fortunately, there are a few tips caregivers can follow to better manage their loved one's health care, particularly when it comes to people with Medicare, according to Krista Bowers, senior vice president of senior products at Blue Cross and Blue Shield of Georgia's parent company.
"At Blue Cross and Blue Shield of Georgia (BCBSGA), we hear regularly from caregivers who are learning how to navigate the system on behalf of their parents, grandparents and others," said Monye Connolly, President, BCBSGA. "There are some themes that are common among them."
Gathering Information
The first step in helping to manage care for a loved one is gathering as much information as possible about their health and health benefits. Some items caregivers might want to gather include the following:
-- Medicare card (if eligible)
-- Health plan membership card
-- A list of doctors, including specialists
-- A list of medicines and dosages
-- Information about the person's medical conditions both treated and
untreated.
This is basically creating a "personal health record." A loved one might be reluctant to share this information at first. Experts recommend that caregivers remain patient. They can explain that the information is needed to advocate on their behalf with their doctors, hospitals and insurance companies.
Getting Permission
Most people have heard of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is an important law for protecting patient privacy. However, it can be an obstacle for caregivers.
"People are sometimes surprised to learn that companies like Blue Cross and Blue Shield of Georgia cannot readily disclose a person's health information, even to their own spouse or child," said Connolly. "That's why it's so critical for caregivers to file the proper paperwork with their loved one's health benefits provider."
Caregivers can access a loved one's health information in a number of ways. One way is with a "durable power of attorney," which can be established with the assistance of an attorney. Another way is with an "Authorization to Disclose Personal Health Information," which is available from a health benefits company. With the disclosure form, the member can authorize someone else to see their health care information, while specifying just how much information that person can see. Beneficiaries also can designate someone to participate on their behalf in Medicare appeals and grievances by filling out an "Appointment of Representative" form.
These forms are returned to the health benefits company where they are kept on file. When they are on file, designees can serve as the member's representative on health benefits, including determinations, exceptions, and appeals and grievances. Anybody can serve as a designee, including a family member or friend. However, the member can revoke these designations, in writing, whenever they see fit.
Enrolling in a Chronic Disease Program
Some Medicare beneficiaries suffer from chronic diseases, such as cancer, stroke, multiple sclerosis, dementia, diabetes, end stage renal disease or Alzheimer's disease. In fact, according to the Centers for Disease Control and Prevention, eight out of 10 Americans age 65 or older are living with some chronic illness. Those enrolled in a Medicare plan may have access to free programs to help them manage their diseases. Many times, these programs are administered by nurses or other licensed personnel. The goal is to help prevent acute episodes through better disease management. Many plans even follow-up with members after their hospitalization.
"These programs are above and beyond those offered by Original Medicare," Bowers explained. "It's important for caregivers to know about them and encourage their loved ones to participate. They may want to get a copy of a member's explanation of coverage from their insurer to find out what's available."
Knowing Your Rights
Once the disclosure/authorization paperwork has been filed, caregivers can speak to a customer care agent on a beneficiary's behalf as well as access the beneficiary's information online, including claims history, provider network and drug formularies.
If a beneficiary ever disagrees with any Medicare decision, including a denial, they have the right to appeal it. For more information about appeals, visit http://www.medicare.gov/ to get a free copy of "Your Rights and Protections."
Investigating 'Extra Help'
As a caregiver, it's also important to know about "extra help" that is available to low-income people with a Medicare prescription drug plan through the Social Security office. This "extra help" includes assistance with monthly prescription drug premiums, annual deductibles and prescription copayments. For information about eligibility for this program, go to www.socialsecurity.gov/extrahelp.
Even if your loved one doesn't qualify for extra help from Social Security, there are a myriad of other resources that might be available to them at the state and community levels. The Web site www.benefitscheckuprx.org has compiled information about these resources in one convenient online location. The site, which counts Blue Cross and Blue Shield of Georgia among its sponsors, tracks more than 1,550 benefit programs throughout all 50 states and the District of Columbia. It has identified more than $7.6 billion in benefits for those in need since being launched in 2001.
Caring for Yourself
The final tip for caregivers, and perhaps the most important, is for them to take care of themselves, including getting enough sleep, going for a walk, taking an occasional day off and maintaining a sense of humor. After all, caregivers can't possibly take care of anyone else until they first take care of themselves.
According to the Alzheimer's Association, research shows that caregivers face an increased risk of developing depression. It's natural to grieve about a loved one's disease. However, if sadness persists to the extent that it prevents decision making, interrupts daily living, and discourages participation in normal activities, then it may be time to get some help. Primary care physicians may offer help, including referrals to other resources. Caregivers with access to Employee Assistance Programs (EAP) can find them useful.
"Caregivers need to know that there's no shame in asking for help," said Connolly.
For more information about care giving and Medicare, including helpful forms, please visit www.medicare.gov/caregivers.
-----
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Tuesday, July 13, 2010
Enactment of New FSA Restriction Will Pose Problems for Consumers, Retailers and Benefit Providers
/PRNewswire/ -- A provision of health care reform could blindside consumers and create an administrative nightmare for providers and retailers as its January 1, 2011 implementation date draws closer. Without intervention, the Patient Protection and Affordable Health Care Act, passed earlier this year, will require consumers to obtain a physician's "prescription" in order to use their pre-tax flexible spending accounts (FSAs) to pay for over-the-counter (OTC) medicines other than insulin. Rep. Earl Pomeroy (D-ND) and industry groups have called for clarification of the new regulations to give providers and retailers an opportunity to educate consumers and develop compliance procedures.
In a letter to U.S. Treasury Secretary Timothy Geithner, Rep. Pomeroy encouraged the Treasury "...to work with consumers and stakeholders to address certain compliance issues in advance of the mandated implementation date." Without clarifying the policy, "...consumers are left confused and frustrated and benefit administrators and retail merchants will be left with increased processing and consumer service costs," wrote Rep. Pomeroy.
An industry group responsible for establishing standards for electronic payment processing for health spending accounts, such as those used to identify eligible OTC purchases, argues additional guidance is needed to clarify how the new regulations will work in practice before it can be implemented. The law currently states that only "prescribed" OTC drugs are eligible for reimbursement; however, it does not specify whether a prescription is required or if a letter of medical necessity will suffice.
"Without clarification on the type of permission needed for FSA reimbursement for OTC drugs, consumers, retailers and third party administrators will be confused and unlikely to fully comply with the new regulations by the start of the new year. Meanwhile, we're likely to see doctor's offices overwhelmed with patients seeking prescriptions to use their spending accounts for Claritin, Zyrtec and other OTC items," said Jody Dietel, president and chair of the Special Interest Group for Inventory Information Approval System Standard (SIGIS). "A delay in implementation will provide time for all parties to be better educated on the issue and prepared to comply with the new rules."
Both Rep. Pomeroy and SIGIS warn that forcing retailers to quickly change their distribution practices for a January 1, 2011 start date will be difficult given the current electronic systems structure, which, in turn, will lead to processing errors, consumer frustration and major challenges for FSA administrators.
"This restriction will hurt millions of consumers who rely on their FSAs to manage their out of pocket health care costs and pay for necessary over-the-counter therapies," noted Joe Jackson, CEO of WageWorks Inc., a benefits company based in San Mateo, California. "If Congress is intent on putting this provision into effect, they should at least push back the deadline so that consumers and especially retailers are ready for the transition."
Currently, consumers may contribute money to their FSAs to cover out-of-pocket medical expenses not covered by insurance, including co-pays and over-the-counter items such as asthma and allergy supplies, aspirin and flu medications.
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In a letter to U.S. Treasury Secretary Timothy Geithner, Rep. Pomeroy encouraged the Treasury "...to work with consumers and stakeholders to address certain compliance issues in advance of the mandated implementation date." Without clarifying the policy, "...consumers are left confused and frustrated and benefit administrators and retail merchants will be left with increased processing and consumer service costs," wrote Rep. Pomeroy.
An industry group responsible for establishing standards for electronic payment processing for health spending accounts, such as those used to identify eligible OTC purchases, argues additional guidance is needed to clarify how the new regulations will work in practice before it can be implemented. The law currently states that only "prescribed" OTC drugs are eligible for reimbursement; however, it does not specify whether a prescription is required or if a letter of medical necessity will suffice.
"Without clarification on the type of permission needed for FSA reimbursement for OTC drugs, consumers, retailers and third party administrators will be confused and unlikely to fully comply with the new regulations by the start of the new year. Meanwhile, we're likely to see doctor's offices overwhelmed with patients seeking prescriptions to use their spending accounts for Claritin, Zyrtec and other OTC items," said Jody Dietel, president and chair of the Special Interest Group for Inventory Information Approval System Standard (SIGIS). "A delay in implementation will provide time for all parties to be better educated on the issue and prepared to comply with the new rules."
Both Rep. Pomeroy and SIGIS warn that forcing retailers to quickly change their distribution practices for a January 1, 2011 start date will be difficult given the current electronic systems structure, which, in turn, will lead to processing errors, consumer frustration and major challenges for FSA administrators.
"This restriction will hurt millions of consumers who rely on their FSAs to manage their out of pocket health care costs and pay for necessary over-the-counter therapies," noted Joe Jackson, CEO of WageWorks Inc., a benefits company based in San Mateo, California. "If Congress is intent on putting this provision into effect, they should at least push back the deadline so that consumers and especially retailers are ready for the transition."
Currently, consumers may contribute money to their FSAs to cover out-of-pocket medical expenses not covered by insurance, including co-pays and over-the-counter items such as asthma and allergy supplies, aspirin and flu medications.
-----
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Wednesday, May 26, 2010
Blue Cross and Blue Shield of Georgia Announces It Will Unilaterally Implement Key Provisions of the 'Breast Cancer Patient Protection Act'
/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGA) announced today it will unilaterally implement key provisions of the Breast Cancer Patient Protection Act introduced by U.S. Representative Rosa DeLauro. These new provisions include more transparent benefit language including clear explanations of benefits to members with breast cancer, and the provisions standardize minimum recovery times in the hospital for women recovering from mastectomy.
The adoption of these provisions builds on BCBSGA's existing leadership in breast cancer treatment. While variability exists within clinical guidelines and state regulations, the vast majority of BCBSGA's members already receive the standard of care indicated in the legislation. However, BCBSGA believes that applying this universal minimum standard will both benefit our members, as well as encourage others in the industry to follow and adopt this standard. Beginning July 1, 2010, BCBSGA will standardize clinical guidelines for women recovering from mastectomy, and will continue to offer a voluntary 48-hour minimum in-hospital stay.
"Women recovering from breast cancer surgery, in consultation with their physicians, will decide whether hospitalization for 48 hours is required," said Robert McCormack, Medical Director, BCBSGA. "We are committed to making medical coverage decisions for women with breast cancer that are in accord with the latest scientific evidence and clinical research. It's important for us and our members that BCBSGA continues to lead in this area," he added.
"We continue to work with the American Cancer Society and academic thought leaders to gain real-world knowledge of breast cancer treatments that will shape improvements in care for women diagnosed and living with breast cancer, or who are in remission," said McCormack. "Our goal is to ensure that our members receive optimal care."
BCBSGA also champions effective member communication and transparency regarding breast cancer diagnosis and treatment options. More than 3,000 nurses and clinical associates work with members daily, to encourage detection of breast cancer at its earliest stages and to ensure that members are receiving the best breast cancer treatments available. Toward that end, BCBSGA is taking steps to provide more straight-forward explanations of benefits so that members more clearly understand their treatment options.
"BCBSGA works diligently to ensure that all of our members are getting best practice care," said Monye Connolly, President, BCBSGA. "We are especially proud of our record in improving care for women with breast cancer and believe these added measures will increase the quality of care that our members receive."
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The adoption of these provisions builds on BCBSGA's existing leadership in breast cancer treatment. While variability exists within clinical guidelines and state regulations, the vast majority of BCBSGA's members already receive the standard of care indicated in the legislation. However, BCBSGA believes that applying this universal minimum standard will both benefit our members, as well as encourage others in the industry to follow and adopt this standard. Beginning July 1, 2010, BCBSGA will standardize clinical guidelines for women recovering from mastectomy, and will continue to offer a voluntary 48-hour minimum in-hospital stay.
"Women recovering from breast cancer surgery, in consultation with their physicians, will decide whether hospitalization for 48 hours is required," said Robert McCormack, Medical Director, BCBSGA. "We are committed to making medical coverage decisions for women with breast cancer that are in accord with the latest scientific evidence and clinical research. It's important for us and our members that BCBSGA continues to lead in this area," he added.
"We continue to work with the American Cancer Society and academic thought leaders to gain real-world knowledge of breast cancer treatments that will shape improvements in care for women diagnosed and living with breast cancer, or who are in remission," said McCormack. "Our goal is to ensure that our members receive optimal care."
BCBSGA also champions effective member communication and transparency regarding breast cancer diagnosis and treatment options. More than 3,000 nurses and clinical associates work with members daily, to encourage detection of breast cancer at its earliest stages and to ensure that members are receiving the best breast cancer treatments available. Toward that end, BCBSGA is taking steps to provide more straight-forward explanations of benefits so that members more clearly understand their treatment options.
"BCBSGA works diligently to ensure that all of our members are getting best practice care," said Monye Connolly, President, BCBSGA. "We are especially proud of our record in improving care for women with breast cancer and believe these added measures will increase the quality of care that our members receive."
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Monday, December 21, 2009
Blue Cross and Blue Shield of Georgia Statement on For-Profit Health Insurance Tax Amendment
On December 19, Senator Reid released his Manager's amendment to the health care reform legislation currently being discussed in the U.S. Senate. One provision in the amendment involved the $6.7 billion annual tax that will be levied on the health insurance industry. As the Congressional Budget Office has stated, this tax will get passed on to consumers through higher premiums. In his amendment, Senator Reid put forth that non-profit health insurance companies will be exempt from this tax -- in essence leaving for-profit plans, and their members, to shoulder the entire tax burden.
What does this mean to the nearly 91 percent (5,285,472) of Georgians that have health insurance provided by for-profit companies?
It means Georgia's share of the $6.7 billion tax will increase. It will directly impact Georgia's insured population and will cause premium amounts to increase even more under this legislation. Because a greater percentage of Georgians are insured by for-profit companies (91 percent) than the national average (55 percent), Georgia taxpayers will subsidize states like Michigan, which has a very low enrollment in for-profit health insurers (23 percent).
Any proposal to tax only for-profit health plans will further exacerbate the un-level playing field for not-for-profit plans, without improving access to health benefits coverage or enhanced health services. While some plans are not-for-profit, that does not mean they are not "profitable." Insurers are required to generate a "net income" in order to help ensure they can pay future claims by members. Not-for-profit simply reflects a tax status under the Internal Revenue Service Code. In many states, the net income on a per-member, per-month (PMPM) basis for not-for-profit health plans is actually higher than that of the for-profit health plans.
Over time, un-equal taxation will lead to the erosion and potential insolvency of for-profit plans, as a progressively smaller share of the overall market would bear the burden of sustaining the entire amount of the tax. Ultimately the government would receive no revenue from the tax when there are no for-profit entities remaining subject to the tax.
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What does this mean to the nearly 91 percent (5,285,472) of Georgians that have health insurance provided by for-profit companies?
It means Georgia's share of the $6.7 billion tax will increase. It will directly impact Georgia's insured population and will cause premium amounts to increase even more under this legislation. Because a greater percentage of Georgians are insured by for-profit companies (91 percent) than the national average (55 percent), Georgia taxpayers will subsidize states like Michigan, which has a very low enrollment in for-profit health insurers (23 percent).
Any proposal to tax only for-profit health plans will further exacerbate the un-level playing field for not-for-profit plans, without improving access to health benefits coverage or enhanced health services. While some plans are not-for-profit, that does not mean they are not "profitable." Insurers are required to generate a "net income" in order to help ensure they can pay future claims by members. Not-for-profit simply reflects a tax status under the Internal Revenue Service Code. In many states, the net income on a per-member, per-month (PMPM) basis for not-for-profit health plans is actually higher than that of the for-profit health plans.
Over time, un-equal taxation will lead to the erosion and potential insolvency of for-profit plans, as a progressively smaller share of the overall market would bear the burden of sustaining the entire amount of the tax. Ultimately the government would receive no revenue from the tax when there are no for-profit entities remaining subject to the tax.
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Sunday, December 20, 2009
AHIP Statement On Senate Health Care Reform Legislation
/PRNewswire/ -- Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP), released the following statement today on the Senate health care reform legislation:
"The debate before us today is not whether insurance market reforms are needed. In fact, health plans proposed and support a complete overhaul of insurance market rules and new consumer protections to ensure all Americans have guaranteed access to affordable, portable coverage. The critical policy questions are whether the current legislation can bend the cost curve and result in a sustainable system. While the bill makes important improvements in access and takes steps towards cost-containment, it lacks accountability to ensure that costs are brought under control. Moreover, this bill includes provisions that will increase costs for families and small businesses and disrupt the quality coverage on which millions of Americans rely today."
Barriers to affordability:
-- A new $70 billion premium tax that will increase the cost of health
care coverage for millions of Americans and fall primarily on small
businesses and those who purchase coverage in the individual market.
-- More cost shifting to patients with private coverage as providers are
forced to make up for hundreds of billions in reduced Medicare
payments.
-- New market and rating rules that will increase premiums for
individuals and small businesses with coverage today.
Disruptions for current policyholders:
-- New regulatory requirements and benefit mandates that go into effect
beginning next year - before access provisions go into effect - that
will cause major disruption for millions who have already enrolled in
their plan for next year.
-- A new federal plan that would preclude many high-quality plans from
participating and increase complexity in the exchanges.
-- Arbitrary caps on administrative costs that will undermine essential
health care services, such as disease management and care coordination
programs, investments in health information technology, programs to
root out fraud and abuse in the health care system, and new
administrative simplification requirements.
-- Major cuts in Medicare Advantage benefits beginning next year that
will ultimately result in millions of seniors losing their current
coverage.
"These issues need to be resolved if the country is to make health care coverage more affordable and put the system on a sustainable path. Health plans will continue to work to solve the problems that have been identified."
-----
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"The debate before us today is not whether insurance market reforms are needed. In fact, health plans proposed and support a complete overhaul of insurance market rules and new consumer protections to ensure all Americans have guaranteed access to affordable, portable coverage. The critical policy questions are whether the current legislation can bend the cost curve and result in a sustainable system. While the bill makes important improvements in access and takes steps towards cost-containment, it lacks accountability to ensure that costs are brought under control. Moreover, this bill includes provisions that will increase costs for families and small businesses and disrupt the quality coverage on which millions of Americans rely today."
Barriers to affordability:
-- A new $70 billion premium tax that will increase the cost of health
care coverage for millions of Americans and fall primarily on small
businesses and those who purchase coverage in the individual market.
-- More cost shifting to patients with private coverage as providers are
forced to make up for hundreds of billions in reduced Medicare
payments.
-- New market and rating rules that will increase premiums for
individuals and small businesses with coverage today.
Disruptions for current policyholders:
-- New regulatory requirements and benefit mandates that go into effect
beginning next year - before access provisions go into effect - that
will cause major disruption for millions who have already enrolled in
their plan for next year.
-- A new federal plan that would preclude many high-quality plans from
participating and increase complexity in the exchanges.
-- Arbitrary caps on administrative costs that will undermine essential
health care services, such as disease management and care coordination
programs, investments in health information technology, programs to
root out fraud and abuse in the health care system, and new
administrative simplification requirements.
-- Major cuts in Medicare Advantage benefits beginning next year that
will ultimately result in millions of seniors losing their current
coverage.
"These issues need to be resolved if the country is to make health care coverage more affordable and put the system on a sustainable path. Health plans will continue to work to solve the problems that have been identified."
-----
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Friday, December 04, 2009
Medicare Open Enrollment Begins: Now Is The Time To Review Your Plan
(NAPSI)-You may know that new Medicare prescription drug and health plan choices are offered each year. Medicare's Open Enrollment Period runs through December 31.
Open Enrollment is your chance to review your current plan-including your Original Medicare coverage-compare it with your other options and make sure you're getting the best available coverage for your health care needs.
Your current health plan may have changed its cost or coverage for 2010, or maybe you'd like a plan with a lower deductible.
If you've had any changes in your health, it's particularly important for you to double-check your coverage during Open Enrollment so you can make sure that any new treatments or drugs are covered by your plan.
Since coverage varies by plan, know what's important for you. For example, make a list of the drugs you take so you can make sure they're covered by the plans you're considering.
If you are in Original Medicare and don't have prescription drug coverage, you can join a Medicare drug plan during Open Enrollment.
Medicare has several ways to get you the help you need to find a plan that works for you.
• Visit www.medicare.gov, where you can get a personalized comparison of the costs and coverage of the plans available in your area.
• Call 1-800-MEDICARE (1-800-633-4227) to find out more about your coverage options. TTY users should call 1-877-486-2048. Medicare customer service representatives are available 24 hours a day, seven days a week with multiple language options and resources for people with disabilities.
• Watch your mailbox for the 2010 "Medicare & You" handbook. The handbook is mailed to all Medicare households each fall and includes a listing of all plans in your area. This handbook is also conveniently available online at www.medicare.gov.
• Meet one on one with a trained expert for personalized assistance. Call 1-800-MEDICARE or visit www.medicare.gov to find a Medicare specialist in your area. Select "Find Helpful Phone Numbers and Websites."
Important Medicare Enrollment Dates:
Dec. 31: Open Enrollment ends. Last day to join or change your Medicare drug plan.
Jan. 1: Your new plan coverage begins.
This message is brought to you by the U.S. Department of Health & Human Services.
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Open Enrollment is your chance to review your current plan-including your Original Medicare coverage-compare it with your other options and make sure you're getting the best available coverage for your health care needs.
Your current health plan may have changed its cost or coverage for 2010, or maybe you'd like a plan with a lower deductible.
If you've had any changes in your health, it's particularly important for you to double-check your coverage during Open Enrollment so you can make sure that any new treatments or drugs are covered by your plan.
Since coverage varies by plan, know what's important for you. For example, make a list of the drugs you take so you can make sure they're covered by the plans you're considering.
If you are in Original Medicare and don't have prescription drug coverage, you can join a Medicare drug plan during Open Enrollment.
Medicare has several ways to get you the help you need to find a plan that works for you.
• Visit www.medicare.gov, where you can get a personalized comparison of the costs and coverage of the plans available in your area.
• Call 1-800-MEDICARE (1-800-633-4227) to find out more about your coverage options. TTY users should call 1-877-486-2048. Medicare customer service representatives are available 24 hours a day, seven days a week with multiple language options and resources for people with disabilities.
• Watch your mailbox for the 2010 "Medicare & You" handbook. The handbook is mailed to all Medicare households each fall and includes a listing of all plans in your area. This handbook is also conveniently available online at www.medicare.gov.
• Meet one on one with a trained expert for personalized assistance. Call 1-800-MEDICARE or visit www.medicare.gov to find a Medicare specialist in your area. Select "Find Helpful Phone Numbers and Websites."
Important Medicare Enrollment Dates:
Dec. 31: Open Enrollment ends. Last day to join or change your Medicare drug plan.
Jan. 1: Your new plan coverage begins.
This message is brought to you by the U.S. Department of Health & Human Services.
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Thursday, December 03, 2009
Sebelius Statement on Benefits of Health Insurance Reform for Businesses
HHS Secretary Kathleen Sebelius today highlighted the benefits of health insurance reform for businesses and released a new fact sheet regarding a recent analysis from the Congressional Budget Office.
"Businesses across the country are struggling under the weight of high health care costs," Secretary Sebelius said. "Health insurance reform will help lift this burden, help businesses prosper, and ensure workers have the affordable, quality health care they need."
A fact sheet regarding the analysis is included below.
Fact Sheet: New CBO Analysis Confirms Benefits of Health Insurance Reform for Businesses
American businesses know the health care status quo is unacceptable. Since 2000, premiums have more than doubled, a rate three times faster than the growth in wages. Between 2000 and 2009, the percentage of firms offering coverage fell from 69 to 60, with much of that drop occurring in the past year alone. Small businesses in particular struggle under the current health care system. For firms employing less than 10 workers, the erosion in coverage is striking -- from 57 percent offering coverage in 2000 to 46 percent offering coverage in 2009. If we do nothing, over the next ten years, health care costs for large businesses are projected to reach $28,530 per employee, a 116 percent increase from 2009.
A new analysis by the Congressional Budget Office (CBO) affirms that businesses' health insurance costs will be lower under health insurance reform -- even though the analysis does not take into account the full range of policies that will benefit businesses.
Health Insurance Premiums for Businesses According to CBO. In a November 30 letter to Senator Evan Bayh, CBO assesses the impact of the Patient Protection and Affordability Act on premiums for the individual, small-group, and large group markets. In 2016, CBO estimates that 159 million or 83 percent of privately insured people will be insured through employers.
Premiums for small business will go down. Small businesses are likely to see premiums drop by 1 to 4 percent under the proposal due to lower prices. These lower prices come from:
-- Lower administrative overhead. Right now, each small business
has to consult with a broker or hire someone to collate plan
information, assist employees with decisions, and handle issues as they
arise. Under reform, in the exchange, there will be people whose job it
is to provide plan information and facilitate enrollment. The exchange
centralizes what is otherwise a process that is extremely duplicative,
streamlining administrative costs and lowering premiums.
-- Greater competition. CBO attributes savings to "providing a
centralized marketplace in which consumers could compare the premiums of
relatively standardized insurance products." This includes competitive
pressure from a public health insurance option.
-- Administrative simplification. Physicians spend on average about
140 hours and $68,000 a year just dealing with health insurance
bureaucracy. By simplifying and standardizing paperwork and
computerizing medical records, doctors will be able to focus on caring
for their patients instead of dealing with bureaucracy. CBO estimates
nearly $20 billion in Federal savings over 10 years, with additional
savings accruing to businesses and families.
Up to 3 percent premium savings as the risk pool for employer-based coverage improves. Today, businesses have seen their premiums skyrocket every year, with many facing double digit percentage increases in their premiums. Health insurance reform will stop this trend.
With nearly 30 million additional Americans gaining health insurance, the purchasing pool for businesses will expand and, largely, improve. Big businesses will save from 0 to 3 percent on premiums due to the changing risk pool while small businesses could save 1 percent on
premiums.
Better options for small businesses. Small businesses would gain access to the health insurance exchanges and new benefit options and tax credits under reform.
-- 3.6 million small businesses could qualify for a tax credit to
help pay their premiums.[vii] An estimated 12 percent of people insured
through small businesses will qualify for tax credits that lower
premiums by 8 to 11 percent. This translates into $620 to $860 for
individuals and $1,540 to $2,120 for families assuming that the coverage
is comparable to what they get today.
-- Today, small businesses often have coverage that has high
deductibles and gap-ridden benefits. The legislation offers such
businesses better options that CBO assumes businesses will take. Such
better coverage has premiums that are 0 to 3 percent higher than the
average plans today, but will save money for employees by ensuring they
are not forced to pay high out-of-pocket costs for services not covered
by their current insurance.
-- In the current health insurance system, small businesses may see
premiums skyrocket if just one or two workers fall ill and accumulate
high medical costs. Health insurance reform will prevent insurance
discrimination based on health status, meaning that small businesses
will no longer be unfairly penalized if a worker falls ill.
9 to 12 percent premium savings for high-premium plans under current law. By assessing high-cost plans, the excise tax encourages businesses and individuals to streamline coverage, leading to lower premiums over time.
-- CBO estimates that the 19 percent of people in employer-coverage
in high-cost plans today will pay 9 to 12 percent less under reform.
This translates to premium savings of at least $835 for single and
$2,070 family policies.
-- This could yield increases in workers wages, by around $70
billion in 2019.
Nearly $10 billion in savings for small businesses.
-- Under current law, CBO estimates premiums to be $7,800 for
single policies and $19,300 for families in the small group market.
-- Small businesses that opt for comparable coverage under reform
could save up to $390 for single policies and $965 for family policies.
Assuming all 25 million people insured through small business save at
least $390 (more for families), this will yield nearly $10 billion in
savings in 2016 alone.
-- Additional savings will accrue to low-wage, small businesses
that newly offer coverage in the exchange. CBO estimates that roughly
12 percent of people in the small group market would get the credit
which would reduce premiums by about 10 percent in 2016. Multiplying
this by the population and average premiums in the report, this suggests
that about one and a half million people would save roughly $780 per
person on premiums in 2016.
-- Even those that CBO estimates will "buy-up" will save, paying
$100 less per family for coverage that is more protective.
At least $13.4 billion in savings for large businesses.
-- Under current law, CBO estimates premiums to be $7,400 for
single policies and $20,300 for families in the large group market.
-- CBO estimates that, under reform, large business premiums will
drop by $100 per single policy and $200 per family policy. With 134
million people enrolled in such coverage, this translates into at least
$13.4 billion in savings in 2016 alone.
Businesses can keep what they have.
-- CBO affirms that any proposed benefit mandates would not affect
the small or large group markets: "The requirement would have relatively
little effect on premiums in the small group market, however, because
most policies sold in that market already cover those services and would
continue to cover them under current law."
-- CBO also affirms the effectiveness of the grandfather policy:
"Further, small group policies that are maintained continuously would be
grandfathered under the proposal."
-- In the large group market, CBO affirms that "[Benefit]
requirements would have no significant effect on premiums in the large
group market."
No cost-shifting to the employer-based insurance market.
-- CBO states: "... CBO's assessment is that the legislation would
have minimal effects on private-sector premiums via cost shifting."
Additional Policies To Benefit Businesses. CBO does not include in its analysis several additional policies in the Patient Protection and Affordable Care Act that would benefit businesses.
Reinsurance for businesses that cover early retiree plans.
-- The proportion of employers that offer retiree coverage has been
declining precipitously over time, from 66 percent in 1988 to 29 percent
in 2009.
-- The proposal would provide a time-limited, Federal reinsurance
program to cover some of the cost of covering early retirees. This
translates to savings of up to $1,200 off the premium of every family
plan offered by that company.
Policies to slow health care cost growth.
-- Insurance oversight: In recent years, several states' insurance
commissioners have rejected unjustifiably high premium increases in the
small group and individual insurance markets. Health insurance reform
will allow insurance commissioners to continue to play this important
role and require transparency and oversight of premium increases.
-- Delivery system reform. Health insurance reform will invest in
care innovations such as accountable care organizations, make healthcare
providers more accountable and efficient through value-based purchasing,
and improve quality and patient safety, including reducing preventable
readmissions. A recent report by the Business Roundtable found that if
many of the delivery system reforms were adopted by the private sector,
large businesses could save $3,000 per employee by 2019.
-- Lowers expensive drug costs. Biologic drugs are some of the most
expensive drugs on the market, and yet there is no streamlined avenue to
get generics on the market to provide lower-cost alternatives. Reform
will create an expedited process to make generic biologic drugs
available, significantly lowering drug costs.
Immediate benefits. While the CBO report provides savings estimates for 2016, several of the policies discussed above would take effect immediately, including early retiree reinsurance, administrative simplification, small business tax credits, and increased oversight of the insurance industry.
Benefits to Businesses Beyond Lower Costs. CBO focused exclusively on health insurance premiums which are critical to businesses. There would be other benefits of health reform for businesses as well.
Improved workplace productivity.
-- The Institute of Medicine found that lost productivity due to
untreated illness among uninsured workers cost businesses between $75
billion and $150 billion per year. Expanding coverage to the uninsured
will create a more productive workforce.
-- Current job-lock (inability to leave current employment if it
will result in loss of health insurance) has been demonstrated to hurt
the economy through reduced productivity, and prevents an employee from
taking a job with potentially higher wages. By ending limitations on
coverage based on pre-existing conditions and expanding portable
coverage options through the health insurance exchange, reform will
increase the flexibility and productivity of the workforce.
New jobs.
-- Bringing down the cost of healthcare will enable investments in
business and job creation. The President's Council of Economic Advisers
(CEA) estimated that if the annual growth rate of health spending slows
by 1.5 percentage point, new jobs could rise by 500,000.
-- The health insurance exchange will expand options for coverage,
making small businesses a more attractive place for people to work, and
encouraging people to start up businesses of their own.
-- Health insurance reform could save 80,000 jobs in the small
business sector by 2019 and increase take-home pay by almost $30
billion.
-----
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"Businesses across the country are struggling under the weight of high health care costs," Secretary Sebelius said. "Health insurance reform will help lift this burden, help businesses prosper, and ensure workers have the affordable, quality health care they need."
A fact sheet regarding the analysis is included below.
Fact Sheet: New CBO Analysis Confirms Benefits of Health Insurance Reform for Businesses
American businesses know the health care status quo is unacceptable. Since 2000, premiums have more than doubled, a rate three times faster than the growth in wages. Between 2000 and 2009, the percentage of firms offering coverage fell from 69 to 60, with much of that drop occurring in the past year alone. Small businesses in particular struggle under the current health care system. For firms employing less than 10 workers, the erosion in coverage is striking -- from 57 percent offering coverage in 2000 to 46 percent offering coverage in 2009. If we do nothing, over the next ten years, health care costs for large businesses are projected to reach $28,530 per employee, a 116 percent increase from 2009.
A new analysis by the Congressional Budget Office (CBO) affirms that businesses' health insurance costs will be lower under health insurance reform -- even though the analysis does not take into account the full range of policies that will benefit businesses.
Health Insurance Premiums for Businesses According to CBO. In a November 30 letter to Senator Evan Bayh, CBO assesses the impact of the Patient Protection and Affordability Act on premiums for the individual, small-group, and large group markets. In 2016, CBO estimates that 159 million or 83 percent of privately insured people will be insured through employers.
Premiums for small business will go down. Small businesses are likely to see premiums drop by 1 to 4 percent under the proposal due to lower prices. These lower prices come from:
-- Lower administrative overhead. Right now, each small business
has to consult with a broker or hire someone to collate plan
information, assist employees with decisions, and handle issues as they
arise. Under reform, in the exchange, there will be people whose job it
is to provide plan information and facilitate enrollment. The exchange
centralizes what is otherwise a process that is extremely duplicative,
streamlining administrative costs and lowering premiums.
-- Greater competition. CBO attributes savings to "providing a
centralized marketplace in which consumers could compare the premiums of
relatively standardized insurance products." This includes competitive
pressure from a public health insurance option.
-- Administrative simplification. Physicians spend on average about
140 hours and $68,000 a year just dealing with health insurance
bureaucracy. By simplifying and standardizing paperwork and
computerizing medical records, doctors will be able to focus on caring
for their patients instead of dealing with bureaucracy. CBO estimates
nearly $20 billion in Federal savings over 10 years, with additional
savings accruing to businesses and families.
Up to 3 percent premium savings as the risk pool for employer-based coverage improves. Today, businesses have seen their premiums skyrocket every year, with many facing double digit percentage increases in their premiums. Health insurance reform will stop this trend.
With nearly 30 million additional Americans gaining health insurance, the purchasing pool for businesses will expand and, largely, improve. Big businesses will save from 0 to 3 percent on premiums due to the changing risk pool while small businesses could save 1 percent on
premiums.
Better options for small businesses. Small businesses would gain access to the health insurance exchanges and new benefit options and tax credits under reform.
-- 3.6 million small businesses could qualify for a tax credit to
help pay their premiums.[vii] An estimated 12 percent of people insured
through small businesses will qualify for tax credits that lower
premiums by 8 to 11 percent. This translates into $620 to $860 for
individuals and $1,540 to $2,120 for families assuming that the coverage
is comparable to what they get today.
-- Today, small businesses often have coverage that has high
deductibles and gap-ridden benefits. The legislation offers such
businesses better options that CBO assumes businesses will take. Such
better coverage has premiums that are 0 to 3 percent higher than the
average plans today, but will save money for employees by ensuring they
are not forced to pay high out-of-pocket costs for services not covered
by their current insurance.
-- In the current health insurance system, small businesses may see
premiums skyrocket if just one or two workers fall ill and accumulate
high medical costs. Health insurance reform will prevent insurance
discrimination based on health status, meaning that small businesses
will no longer be unfairly penalized if a worker falls ill.
9 to 12 percent premium savings for high-premium plans under current law. By assessing high-cost plans, the excise tax encourages businesses and individuals to streamline coverage, leading to lower premiums over time.
-- CBO estimates that the 19 percent of people in employer-coverage
in high-cost plans today will pay 9 to 12 percent less under reform.
This translates to premium savings of at least $835 for single and
$2,070 family policies.
-- This could yield increases in workers wages, by around $70
billion in 2019.
Nearly $10 billion in savings for small businesses.
-- Under current law, CBO estimates premiums to be $7,800 for
single policies and $19,300 for families in the small group market.
-- Small businesses that opt for comparable coverage under reform
could save up to $390 for single policies and $965 for family policies.
Assuming all 25 million people insured through small business save at
least $390 (more for families), this will yield nearly $10 billion in
savings in 2016 alone.
-- Additional savings will accrue to low-wage, small businesses
that newly offer coverage in the exchange. CBO estimates that roughly
12 percent of people in the small group market would get the credit
which would reduce premiums by about 10 percent in 2016. Multiplying
this by the population and average premiums in the report, this suggests
that about one and a half million people would save roughly $780 per
person on premiums in 2016.
-- Even those that CBO estimates will "buy-up" will save, paying
$100 less per family for coverage that is more protective.
At least $13.4 billion in savings for large businesses.
-- Under current law, CBO estimates premiums to be $7,400 for
single policies and $20,300 for families in the large group market.
-- CBO estimates that, under reform, large business premiums will
drop by $100 per single policy and $200 per family policy. With 134
million people enrolled in such coverage, this translates into at least
$13.4 billion in savings in 2016 alone.
Businesses can keep what they have.
-- CBO affirms that any proposed benefit mandates would not affect
the small or large group markets: "The requirement would have relatively
little effect on premiums in the small group market, however, because
most policies sold in that market already cover those services and would
continue to cover them under current law."
-- CBO also affirms the effectiveness of the grandfather policy:
"Further, small group policies that are maintained continuously would be
grandfathered under the proposal."
-- In the large group market, CBO affirms that "[Benefit]
requirements would have no significant effect on premiums in the large
group market."
No cost-shifting to the employer-based insurance market.
-- CBO states: "... CBO's assessment is that the legislation would
have minimal effects on private-sector premiums via cost shifting."
Additional Policies To Benefit Businesses. CBO does not include in its analysis several additional policies in the Patient Protection and Affordable Care Act that would benefit businesses.
Reinsurance for businesses that cover early retiree plans.
-- The proportion of employers that offer retiree coverage has been
declining precipitously over time, from 66 percent in 1988 to 29 percent
in 2009.
-- The proposal would provide a time-limited, Federal reinsurance
program to cover some of the cost of covering early retirees. This
translates to savings of up to $1,200 off the premium of every family
plan offered by that company.
Policies to slow health care cost growth.
-- Insurance oversight: In recent years, several states' insurance
commissioners have rejected unjustifiably high premium increases in the
small group and individual insurance markets. Health insurance reform
will allow insurance commissioners to continue to play this important
role and require transparency and oversight of premium increases.
-- Delivery system reform. Health insurance reform will invest in
care innovations such as accountable care organizations, make healthcare
providers more accountable and efficient through value-based purchasing,
and improve quality and patient safety, including reducing preventable
readmissions. A recent report by the Business Roundtable found that if
many of the delivery system reforms were adopted by the private sector,
large businesses could save $3,000 per employee by 2019.
-- Lowers expensive drug costs. Biologic drugs are some of the most
expensive drugs on the market, and yet there is no streamlined avenue to
get generics on the market to provide lower-cost alternatives. Reform
will create an expedited process to make generic biologic drugs
available, significantly lowering drug costs.
Immediate benefits. While the CBO report provides savings estimates for 2016, several of the policies discussed above would take effect immediately, including early retiree reinsurance, administrative simplification, small business tax credits, and increased oversight of the insurance industry.
Benefits to Businesses Beyond Lower Costs. CBO focused exclusively on health insurance premiums which are critical to businesses. There would be other benefits of health reform for businesses as well.
Improved workplace productivity.
-- The Institute of Medicine found that lost productivity due to
untreated illness among uninsured workers cost businesses between $75
billion and $150 billion per year. Expanding coverage to the uninsured
will create a more productive workforce.
-- Current job-lock (inability to leave current employment if it
will result in loss of health insurance) has been demonstrated to hurt
the economy through reduced productivity, and prevents an employee from
taking a job with potentially higher wages. By ending limitations on
coverage based on pre-existing conditions and expanding portable
coverage options through the health insurance exchange, reform will
increase the flexibility and productivity of the workforce.
New jobs.
-- Bringing down the cost of healthcare will enable investments in
business and job creation. The President's Council of Economic Advisers
(CEA) estimated that if the annual growth rate of health spending slows
by 1.5 percentage point, new jobs could rise by 500,000.
-- The health insurance exchange will expand options for coverage,
making small businesses a more attractive place for people to work, and
encouraging people to start up businesses of their own.
-- Health insurance reform could save 80,000 jobs in the small
business sector by 2019 and increase take-home pay by almost $30
billion.
-----
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Thursday, November 05, 2009
AARP Endorses Affordable Health Care for America Act
/PRNewswire/ -- Today AARP announced its endorsement of the Affordable Health Care for America Act (H.R. 3962) and the accompanying Medicare Physician Payment Reform Act (H.R. 3961). The Association's support follows nearly two years of work with lawmakers on both sides of the aisle to craft a health care reform plan that meets the needs of AARP's nearly 40 million members and all older Americans. Among those needs are reforms that strictly curb insurance companies' discrimination against older Americans and Medicare improvements that strengthen benefits while protecting the program for future generations.
"We started this debate more than two years ago with the twin goals of making coverage affordable to our younger members and protecting Medicare for seniors," said Jim Wordelman, State Director for AARP in Idaho. "We've read the Affordable Health Care for America Act and we can say with confidence that it meets those goals with improved benefits for people in Medicare and needed health insurance market reforms to help ensure every American can purchase affordable health coverage."
Today's endorsement marks the first time in this legislative battle that AARP has put its full weight behind a comprehensive health care reform package. In the coming days, AARP will be educating its members about the health care reform package through its publications, paid advertising and more than five million calls and e-mails to its grassroots activists.
The Affordable Health Care for America Act and the Medicare Physician Payment Reform Act contain critical components AARP has been fighting for on behalf of its members and all older Americans to improve health care for them and their families. They include:
-- Protecting and strengthening Medicare for today's seniors and future
generations of retirees;
-- Ensuring seniors can see the doctor of their choice or find a doctor
if they need one by improving Medicare's payments to doctors;
-- Lowering drug costs for seniors by closing the Medicare Part D
"doughnut hole" and allowing Medicare to negotiate with drug makers
for lower drug prices;
-- Taking steps to reduce waste, fraud, abuse and inefficiency in the
Medicare program;
-- Requiring Medicare and insurance companies to provide for important
preventive services like screenings for diabetes, cancer and
osteoporosis free of charge;
-- Stopping insurance companies from denying you affordable coverage
because of your age;
-- Preventing insurance companies from denying you coverage if you have a
pre-existing condition or dropping your coverage if you get sick;
-- Limiting how much your insurance company can make you pay
out-of-pocket;
-- Providing affordable health insurance options for those who don't have
insurance; and
-- Providing benefits to help seniors and people with disabilities live
in their own homes and communities by establishing the Community
Living Assistance Services and Supports (CLASS) program.
Wordelman added: "We cannot continue to let insurers price older Americans out of the market, just as we cannot stand idle while millions of seniors are forced to choose between their groceries and their prescriptions. AARP is proud to endorse the Affordable Health Care for America Act and the Medicare Physician Payment Reform Act, and we urge members of the House to pass this critical package in the coming days to help fix our broken health care system."
-----
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"We started this debate more than two years ago with the twin goals of making coverage affordable to our younger members and protecting Medicare for seniors," said Jim Wordelman, State Director for AARP in Idaho. "We've read the Affordable Health Care for America Act and we can say with confidence that it meets those goals with improved benefits for people in Medicare and needed health insurance market reforms to help ensure every American can purchase affordable health coverage."
Today's endorsement marks the first time in this legislative battle that AARP has put its full weight behind a comprehensive health care reform package. In the coming days, AARP will be educating its members about the health care reform package through its publications, paid advertising and more than five million calls and e-mails to its grassroots activists.
The Affordable Health Care for America Act and the Medicare Physician Payment Reform Act contain critical components AARP has been fighting for on behalf of its members and all older Americans to improve health care for them and their families. They include:
-- Protecting and strengthening Medicare for today's seniors and future
generations of retirees;
-- Ensuring seniors can see the doctor of their choice or find a doctor
if they need one by improving Medicare's payments to doctors;
-- Lowering drug costs for seniors by closing the Medicare Part D
"doughnut hole" and allowing Medicare to negotiate with drug makers
for lower drug prices;
-- Taking steps to reduce waste, fraud, abuse and inefficiency in the
Medicare program;
-- Requiring Medicare and insurance companies to provide for important
preventive services like screenings for diabetes, cancer and
osteoporosis free of charge;
-- Stopping insurance companies from denying you affordable coverage
because of your age;
-- Preventing insurance companies from denying you coverage if you have a
pre-existing condition or dropping your coverage if you get sick;
-- Limiting how much your insurance company can make you pay
out-of-pocket;
-- Providing affordable health insurance options for those who don't have
insurance; and
-- Providing benefits to help seniors and people with disabilities live
in their own homes and communities by establishing the Community
Living Assistance Services and Supports (CLASS) program.
Wordelman added: "We cannot continue to let insurers price older Americans out of the market, just as we cannot stand idle while millions of seniors are forced to choose between their groceries and their prescriptions. AARP is proud to endorse the Affordable Health Care for America Act and the Medicare Physician Payment Reform Act, and we urge members of the House to pass this critical package in the coming days to help fix our broken health care system."
-----
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Wednesday, October 28, 2009
Selecting Medicare Coverage: Four Considerations to Help Seniors Choose
/PRNewswire/ -- Open enrollment, the six-week period during which seniors can select healthcare coverage for 2010, begins Nov. 15. Health plans have begun sharing their costs and coverage, but making a choice can be a daunting task. Here are four considerations to help Medicare-eligible seniors select which Medicare coverage best meets their individual needs:
1. Understand the A, B, C and Ds of Medicare. There are four primary parts
to Medicare. Parts A and B cover hospital and medical expenses,
respectively. Parts C and D provide benefit and prescription drug
coverage through health insurance companies that are approved by
Medicare. Medicare Advantage plans include all of the coverage offered
by Parts A and B and can include prescription drug coverage under Part
D.
2. Compare costs. Premiums can range for $0 to hundreds of dollars per
month, depending upon the type of organization (nonprofit or
for-profit) and the type of coverage. Total plan costs include
premiums, co-payments and deductibles for everything from preventive
care to hospitalization.
3. Compare benefits and doctors. Does the plan have a large network of
doctors and specialists for you to choose from? Is your doctor and
preferred hospital in that network? Does the plan cover your
prescription medications?
4. Compare quality. Call the customer service number for the plans you're
considering. Does a live person answer the phone? Are they friendly,
helpful and knowledgeable? Does the plan offer value-added programs
that help you maintain or improve your health and independence? Does
the plan offer services to help your loved ones take care of you if
needed? Will the plan coordinate your care between doctors and
specialists?
Selecting Medicare coverage is an important decision, especially since Medicare rules indicate that members must maintain the coverage they've chosen for an entire year. Seniors currently enrolled in Medicare Advantage plans will soon receive letters from their health plans explaining any changes in coverage for 2010. "We recommend that people read this letter thoroughly to avoid any surprises in the coming year," said Tom Lescault, president of SCAN Health Plan Arizona. "Changes in government funding has forced many health plans to reduce benefits or increase costs. People need to make sure they are able to make informed decisions during open enrollment."
As part of an ongoing commitment to improving the lives of seniors, SCAN Health Plan Arizona is an exclusive sponsor of "Healthy Tips for Successful Aging" with ABC 15. Each week, the station airs 30-second health tips provided by SCAN. The health plan also is the exclusive studio sponsor for KOY radio and co-hosts "Senior Focus," a broadcast dedicated to senior-related issues.
-----
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www.artsacrossgeorgia.com
Arts Across Georgia
1. Understand the A, B, C and Ds of Medicare. There are four primary parts
to Medicare. Parts A and B cover hospital and medical expenses,
respectively. Parts C and D provide benefit and prescription drug
coverage through health insurance companies that are approved by
Medicare. Medicare Advantage plans include all of the coverage offered
by Parts A and B and can include prescription drug coverage under Part
D.
2. Compare costs. Premiums can range for $0 to hundreds of dollars per
month, depending upon the type of organization (nonprofit or
for-profit) and the type of coverage. Total plan costs include
premiums, co-payments and deductibles for everything from preventive
care to hospitalization.
3. Compare benefits and doctors. Does the plan have a large network of
doctors and specialists for you to choose from? Is your doctor and
preferred hospital in that network? Does the plan cover your
prescription medications?
4. Compare quality. Call the customer service number for the plans you're
considering. Does a live person answer the phone? Are they friendly,
helpful and knowledgeable? Does the plan offer value-added programs
that help you maintain or improve your health and independence? Does
the plan offer services to help your loved ones take care of you if
needed? Will the plan coordinate your care between doctors and
specialists?
Selecting Medicare coverage is an important decision, especially since Medicare rules indicate that members must maintain the coverage they've chosen for an entire year. Seniors currently enrolled in Medicare Advantage plans will soon receive letters from their health plans explaining any changes in coverage for 2010. "We recommend that people read this letter thoroughly to avoid any surprises in the coming year," said Tom Lescault, president of SCAN Health Plan Arizona. "Changes in government funding has forced many health plans to reduce benefits or increase costs. People need to make sure they are able to make informed decisions during open enrollment."
As part of an ongoing commitment to improving the lives of seniors, SCAN Health Plan Arizona is an exclusive sponsor of "Healthy Tips for Successful Aging" with ABC 15. Each week, the station airs 30-second health tips provided by SCAN. The health plan also is the exclusive studio sponsor for KOY radio and co-hosts "Senior Focus," a broadcast dedicated to senior-related issues.
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Arts Across Georgia
Friday, October 23, 2009
Sebelius Releases New Report on Benefits of Health Insurance Reform for Women with Breast Cancer
As Americans mark breast cancer awareness month, Secretary of Health and Human Services Kathleen Sebelius today released a new report, Health Insurance Reform and Breast Cancer: Making the Health Care System Work for Women. The report details how health insurance reform will help women diagnosed with breast cancer and is available now at www.HealthReform.gov.
"Thousands of women and their families are impacted by breast cancer," Secretary Sebelius said. "We are fighting for health reform that will help improve treatment for women with breast cancer and doing all we can to encourage women to take the simple steps that can help prevent this disease."
The new report highlights the problems in the health care status quo that significantly impact women who are diagnosed with breast cancer or are breast cancer survivors. The report notes:
* Breast cancer is the second leading type of cancer among women.
The disease will affect one in eight American women during their
lifetime, with treatment costs totaling $7 Billion in 2007.
* Breast cancer patients with employer-based insurance had total
out-of-pocket costs averaging $6,250 in 2007, higher than out-of-pocket
spending for patients with asthma, diabetes, chronic obstructive
pulmonary disease (COPD), or high blood pressure.
* Breast cancer patients, even when in remission, are unlikely to
find meaningful insurance coverage in the individual insurance market. A
full 11 percent of individuals with any cancer said they could not
obtain health coverage in the individual insurance market.
"Today, breast cancer patients incur thousands of dollars in debt, and breast cancer survivors struggle to get the affordable care they need," Sebelius added. "Health insurance reform will bring costs down, make care more affordable and prevent insurance companies from discriminating against breast cancer survivors."
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"Thousands of women and their families are impacted by breast cancer," Secretary Sebelius said. "We are fighting for health reform that will help improve treatment for women with breast cancer and doing all we can to encourage women to take the simple steps that can help prevent this disease."
The new report highlights the problems in the health care status quo that significantly impact women who are diagnosed with breast cancer or are breast cancer survivors. The report notes:
* Breast cancer is the second leading type of cancer among women.
The disease will affect one in eight American women during their
lifetime, with treatment costs totaling $7 Billion in 2007.
* Breast cancer patients with employer-based insurance had total
out-of-pocket costs averaging $6,250 in 2007, higher than out-of-pocket
spending for patients with asthma, diabetes, chronic obstructive
pulmonary disease (COPD), or high blood pressure.
* Breast cancer patients, even when in remission, are unlikely to
find meaningful insurance coverage in the individual insurance market. A
full 11 percent of individuals with any cancer said they could not
obtain health coverage in the individual insurance market.
"Today, breast cancer patients incur thousands of dollars in debt, and breast cancer survivors struggle to get the affordable care they need," Sebelius added. "Health insurance reform will bring costs down, make care more affordable and prevent insurance companies from discriminating against breast cancer survivors."
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Tuesday, October 20, 2009
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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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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Wednesday, September 23, 2009
Blue Cross and Blue Shield of Georgia Launches Zagat Health Survey Tool
/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGA) today announced the launch of the Zagat Health Survey tool, an online survey tool that will allow its members to share their physician experiences with other members throughout the state.
"Zagat is widely known and trusted for its ability to help people share and learn from other consumer experiences. By working with them we are able to create a trusted resource for our members that will actively engage them in sharing and using that information," said Monye Connolly, president of BCBSGA. "We are committed to providing our members with useful information to better help them navigate the health care system. Making information available, such as the patient experience information contained in the Zagat Health Survey, along with other quality and cost transparency information, is part of that commitment."
The Zagat Survey enables BCBSGA to address an unmet need for peer-to-peer interaction among health care consumers. The Zagat Health Survey tool provides a vehicle for members to review physicians based on a set of distinct criteria, creating a trusted resource to support informed member decision-making. The criteria are solely designed to reflect a consumer's experience with a physician and not to reflect the quality of care received. This tool not only helps members, but is also designed to assist doctors in understanding members' experiences.
The online survey tool allows consumers to review their doctor visits based on:
-- Trust - Confidence in the physician's approach
-- Communication - Physician's bedside manner, responsiveness and rapport
-- Availability - Convenience for making appointments and physician's
punctuality
-- Environment - Condition of the office, staff helpfulness, atmosphere
and amenities
Members are also asked whether they would recommend their doctor to others. The survey also features a comments section, allowing members to explain their ratings.
The online entry will display physician contact information, ratings on a 30-point scale for each of the four categories, and the percentage of members who recommend that physician. The most recent comments will be displayed first, and members will have the option to rate the usefulness of comments and report suspicious comments. BCBSGA members can complete the Zagat Health Survey by logging on to the secure member portal on the BCBSGA Web site.
"For physicians the Zagat survey tool can provide valuable, objective feedback on how their patients feel about them and their practice, information that often remains unknown," said Dr. Robert McCormack, medical director for BCBSGA. "For consumers, the survey can provide information to help them select a physician who is most likely aligned with their personal style and who will meet their health care needs. All-in-all, it is a viable mechanism that could very well change the way health care is measured and delivered throughout Georgia."
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"Zagat is widely known and trusted for its ability to help people share and learn from other consumer experiences. By working with them we are able to create a trusted resource for our members that will actively engage them in sharing and using that information," said Monye Connolly, president of BCBSGA. "We are committed to providing our members with useful information to better help them navigate the health care system. Making information available, such as the patient experience information contained in the Zagat Health Survey, along with other quality and cost transparency information, is part of that commitment."
The Zagat Survey enables BCBSGA to address an unmet need for peer-to-peer interaction among health care consumers. The Zagat Health Survey tool provides a vehicle for members to review physicians based on a set of distinct criteria, creating a trusted resource to support informed member decision-making. The criteria are solely designed to reflect a consumer's experience with a physician and not to reflect the quality of care received. This tool not only helps members, but is also designed to assist doctors in understanding members' experiences.
The online survey tool allows consumers to review their doctor visits based on:
-- Trust - Confidence in the physician's approach
-- Communication - Physician's bedside manner, responsiveness and rapport
-- Availability - Convenience for making appointments and physician's
punctuality
-- Environment - Condition of the office, staff helpfulness, atmosphere
and amenities
Members are also asked whether they would recommend their doctor to others. The survey also features a comments section, allowing members to explain their ratings.
The online entry will display physician contact information, ratings on a 30-point scale for each of the four categories, and the percentage of members who recommend that physician. The most recent comments will be displayed first, and members will have the option to rate the usefulness of comments and report suspicious comments. BCBSGA members can complete the Zagat Health Survey by logging on to the secure member portal on the BCBSGA Web site.
"For physicians the Zagat survey tool can provide valuable, objective feedback on how their patients feel about them and their practice, information that often remains unknown," said Dr. Robert McCormack, medical director for BCBSGA. "For consumers, the survey can provide information to help them select a physician who is most likely aligned with their personal style and who will meet their health care needs. All-in-all, it is a viable mechanism that could very well change the way health care is measured and delivered throughout Georgia."
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Analysis Shows Narrow Age Rating Would Raise Premiums by Nearly 50 Percent, Causing Many Young and Healthy to Forgo Coverage
/PRNewswire/ -- Allowing age adjustments more restrictive than 5 to 1 would cause dramatic premium spikes for the young and healthy in the individual insurance market, making coverage unaffordable for many according to a new analysis.
The Blue Cross and Blue Shield Association (BCBSA) released today new data, prepared by Oliver Wyman's Actuarial and Health and Life Sciences practice, showing that a 2 to 1 age rating ratio would increase premiums for the youngest and healthiest Americans in the individual market in many states by nearly 50 percent in the first year, relative to a 5 to 1 age rating ratio.
Currently 42 states permit health plans to vary premiums based on age by 5 to 1 or more -- the primary benefit being that premiums are kept affordable for younger individuals to encourage broad participation. If more restrictive age ratings are implemented, younger people would opt out of purchasing coverage. Oliver Wyman estimates that, over a five year period, more than 1 million younger members would leave the market, resulting in a 10 percent premium increase overall for individuals in some parts of the country.
"An affordable, sustainable insurance market requires broad participation across all age groups to maintain more affordable premiums. As this analysis shows, overly restrictive age rating regulations would hurt a large portion of those with individual coverage -- making coverage less affordable and undermining the key goals of healthcare reform," said Scott P. Serota, president and CEO of BCBSA. "To ensure the long-term sustainability of healthcare reform, we must strike the right balance on age rating to avoid disproportionately burdening one segment of the population over another. For this reason, we support a 5 to 1 age rating similar to what the vast majority of states permit today."
The Oliver Wyman analysis also finds that restricting age rating ratios to 3 to 1 would increase premiums in many states by as much as 30 percent for younger people, relative to a 5 to 1 ratio.
"Younger individuals are much more sensitive to the costs of health insurance compared to older individuals. The bottom line is that if premiums are too high, young and healthy individuals simply will not purchase insurance and their needed cross-subsidies for older, sicker people will be lost, increasing the cost of healthcare for everyone," Serota said.
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The Blue Cross and Blue Shield Association (BCBSA) released today new data, prepared by Oliver Wyman's Actuarial and Health and Life Sciences practice, showing that a 2 to 1 age rating ratio would increase premiums for the youngest and healthiest Americans in the individual market in many states by nearly 50 percent in the first year, relative to a 5 to 1 age rating ratio.
Currently 42 states permit health plans to vary premiums based on age by 5 to 1 or more -- the primary benefit being that premiums are kept affordable for younger individuals to encourage broad participation. If more restrictive age ratings are implemented, younger people would opt out of purchasing coverage. Oliver Wyman estimates that, over a five year period, more than 1 million younger members would leave the market, resulting in a 10 percent premium increase overall for individuals in some parts of the country.
"An affordable, sustainable insurance market requires broad participation across all age groups to maintain more affordable premiums. As this analysis shows, overly restrictive age rating regulations would hurt a large portion of those with individual coverage -- making coverage less affordable and undermining the key goals of healthcare reform," said Scott P. Serota, president and CEO of BCBSA. "To ensure the long-term sustainability of healthcare reform, we must strike the right balance on age rating to avoid disproportionately burdening one segment of the population over another. For this reason, we support a 5 to 1 age rating similar to what the vast majority of states permit today."
The Oliver Wyman analysis also finds that restricting age rating ratios to 3 to 1 would increase premiums in many states by as much as 30 percent for younger people, relative to a 5 to 1 ratio.
"Younger individuals are much more sensitive to the costs of health insurance compared to older individuals. The bottom line is that if premiums are too high, young and healthy individuals simply will not purchase insurance and their needed cross-subsidies for older, sicker people will be lost, increasing the cost of healthcare for everyone," Serota said.
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Vice President Biden, Secretary Sebelius Issue New Report on Seniors and Health Insurance Reform
Vice President Joe Biden and Health and Human Services (HHS) Secretary Kathleen Sebelius today hosted a town hall meeting with seniors in Silver Spring, Md., and released a new report,
Health Insurance Reform and Medicare: Making Medicare Stronger for America's Seniors. The report, authored by HHS, outlines how health insurance reform will help seniors and answers key questions about President Obama's health insurance reform plan. The complete report is
available now at www.HealthReform.gov.
"We will protect seniors -- not burden them with out of pocket costs," said Vice President Biden. "The bottom line is, seniors will be better off under what we are proposing, and not a dollar from the Medicare trust fund will be used to pay for health insurance reform."
"Under health insurance reform, seniors will get better care and their health care costs will go down," said Secretary Sebelius. "Reform will strengthen Medicare, cut drug costs, and help ensure all seniors get the high-quality, affordable care they deserve."
The report highlights several problems in the current health care system and health insurance reform solutions such as:
* Preserving and strengthening Medicare.
According to the Medicare Trustees 2009 report, the Medicare Part A
Trust Fund will be exhausted by 2017. Health insurance reform will
extend the life of the Medicare Trust Fund by an additional four to five
years -- and delivery system reforms included in health insurance reform
have the potential to keep the Trust Fund solvent even longer into the
future. Health insurance reform will also reduce overpayments to private
plans and will clamp down on fraud and abuse to strengthen Medicare for
all seniors. Coupled with improvements in the quality of care, expansion
of the health care workforce, and reductions in out-of-pocket costs,
health insurance reform will ensure that Medicare will continue to
provide the high-quality, affordable coverage that America's seniors
deserve and expect.
* Cutting high prescription drug costs.
Prescription drug costs represent a significant expense for seniors.
While Medicare added a prescription drug benefit, this benefit includes
a coverage gap commonly called the "donut hole." In 2007, over 8 million
seniors hit the "donut hole." For those who are not low-income or have
not purchased other coverage, average drug costs in this coverage gap
are $340 per month, or $4,080 per year. Health insurance reform will
close the coverage gap in Medicare Part D over time, so seniors do not
have to worry about losing coverage for their drug costs. While the
closure of the coverage gap is phased in, health insurance reform will
also provide seniors with a discount of 50 percent on their brand name
medication costs in the coverage gap, saving thousands of dollars for
some seniors.
* Making preventive services free.
Many seniors do not receive recommended preventive and primary care,
leading to less effective and more expensive treatments. For example, 20
percent of women aged 50 and over did not receive a mammogram in the
past two years, and 38 percent of adults aged 50 and over have never had
a colonoscopy or sigmoidoscopy. Seniors in Medicare must pay 20 percent
of the cost of many preventive services on their own. For a colonoscopy
that costs $700, this means that a senior must pay $140 -- a price that
can be prohibitively expensive. Under health insurance reform, a senior
would not pay anything for a screening colonoscopy or other preventive
services. Reform will eliminate any deductibles, copayments, or other
cost-sharing for obtaining preventive services, making them affordable
and accessible.
* Ending overpayments to private insurance companies that cost all
Medicare beneficiaries.
The federal government pays private insurance companies on average 14
percent more for providing coverage to Medicare Advantage beneficiaries
than it would pay for the same beneficiary in the traditional Medicare
program. There is no evidence that this extra payment leads to better
quality for Medicare beneficiaries, and all Medicare beneficiaries pay
the price of these excessive overpayments through higher premiums --
even the 78 percent of seniors who are not enrolled in a Medicare
Advantage plan. A typical couple in traditional Medicare will pay on
average nearly $90 next year to subsidize private insurance companies
that do not provide their Medicare benefits. Health insurance reform
will eliminate excessive government subsidies to Medicare Advantage
plans, which could save the federal government, taxpayers, and Medicare
beneficiaries well over $100 billion over the next 10 years.
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Health Insurance Reform and Medicare: Making Medicare Stronger for America's Seniors. The report, authored by HHS, outlines how health insurance reform will help seniors and answers key questions about President Obama's health insurance reform plan. The complete report is
available now at www.HealthReform.gov.
"We will protect seniors -- not burden them with out of pocket costs," said Vice President Biden. "The bottom line is, seniors will be better off under what we are proposing, and not a dollar from the Medicare trust fund will be used to pay for health insurance reform."
"Under health insurance reform, seniors will get better care and their health care costs will go down," said Secretary Sebelius. "Reform will strengthen Medicare, cut drug costs, and help ensure all seniors get the high-quality, affordable care they deserve."
The report highlights several problems in the current health care system and health insurance reform solutions such as:
* Preserving and strengthening Medicare.
According to the Medicare Trustees 2009 report, the Medicare Part A
Trust Fund will be exhausted by 2017. Health insurance reform will
extend the life of the Medicare Trust Fund by an additional four to five
years -- and delivery system reforms included in health insurance reform
have the potential to keep the Trust Fund solvent even longer into the
future. Health insurance reform will also reduce overpayments to private
plans and will clamp down on fraud and abuse to strengthen Medicare for
all seniors. Coupled with improvements in the quality of care, expansion
of the health care workforce, and reductions in out-of-pocket costs,
health insurance reform will ensure that Medicare will continue to
provide the high-quality, affordable coverage that America's seniors
deserve and expect.
* Cutting high prescription drug costs.
Prescription drug costs represent a significant expense for seniors.
While Medicare added a prescription drug benefit, this benefit includes
a coverage gap commonly called the "donut hole." In 2007, over 8 million
seniors hit the "donut hole." For those who are not low-income or have
not purchased other coverage, average drug costs in this coverage gap
are $340 per month, or $4,080 per year. Health insurance reform will
close the coverage gap in Medicare Part D over time, so seniors do not
have to worry about losing coverage for their drug costs. While the
closure of the coverage gap is phased in, health insurance reform will
also provide seniors with a discount of 50 percent on their brand name
medication costs in the coverage gap, saving thousands of dollars for
some seniors.
* Making preventive services free.
Many seniors do not receive recommended preventive and primary care,
leading to less effective and more expensive treatments. For example, 20
percent of women aged 50 and over did not receive a mammogram in the
past two years, and 38 percent of adults aged 50 and over have never had
a colonoscopy or sigmoidoscopy. Seniors in Medicare must pay 20 percent
of the cost of many preventive services on their own. For a colonoscopy
that costs $700, this means that a senior must pay $140 -- a price that
can be prohibitively expensive. Under health insurance reform, a senior
would not pay anything for a screening colonoscopy or other preventive
services. Reform will eliminate any deductibles, copayments, or other
cost-sharing for obtaining preventive services, making them affordable
and accessible.
* Ending overpayments to private insurance companies that cost all
Medicare beneficiaries.
The federal government pays private insurance companies on average 14
percent more for providing coverage to Medicare Advantage beneficiaries
than it would pay for the same beneficiary in the traditional Medicare
program. There is no evidence that this extra payment leads to better
quality for Medicare beneficiaries, and all Medicare beneficiaries pay
the price of these excessive overpayments through higher premiums --
even the 78 percent of seniors who are not enrolled in a Medicare
Advantage plan. A typical couple in traditional Medicare will pay on
average nearly $90 next year to subsidize private insurance companies
that do not provide their Medicare benefits. Health insurance reform
will eliminate excessive government subsidies to Medicare Advantage
plans, which could save the federal government, taxpayers, and Medicare
beneficiaries well over $100 billion over the next 10 years.
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