FRC Praises Florida Judge for Striking Down Entire Health Care Law

Family Research Council praised today's ruling by Federal Judge Roger Vinson of the U.S. District Court for the Northern District of Florida that strikes down the entire health care law that President Obama signed into law in 2010, including the individual mandate. The law mandates that individuals purchase health insurance, and also funds abortion with federal tax dollars.

Family Research Council's amicus brief, drafted by FRC's Special Counsel Ken Klukowski, argued that if the "individual mandate" is unconstitutional, then the entire law must be struck down.

Judge Vinson quoted Klukowski (pg. 32 and footnote 27 on pg. 64) in his opinion. Judge Vinson wrote that he borrowed "heavily"from FRC's amicus brief and said the brief "quite cogently and effectively sets forth the applicable standard and governing analysis of severability." FRC filed the only amicus brief focusing exclusively on how the individual mandate cannot be severed from the law.

Klukowski, who also serves as Director of FRC's Center for Religious Liberty, made the following comments:

"Today's ruling makes clear that as long as the mandate is in place, the entire law rests on an unconstitutional foundation. If the foundation crumbles, the whole law falls.

"We applaud Judge Vinson for striking down the entire law, recognizing that the individual mandate cannot be severed from the other 450 sections of the statute. The individual mandate is the essential heart of this legislation. We are grateful that Judge Vinson agreed with our argument that controlling Supreme Court precedents require striking down the entire law.

"No part of the Constitution empowers the federal government to command American citizens to spend their own personal money to purchase health insurance.

"We urge the Senate to follow the lead of the House of Representatives and move to repeal this unconstitutional law in its entirely, not merely to tinker with various provisions," Klukowski concluded.

Click here to read a DC Examiner opinion piece by FRC Special Counsel Ken Klukowski explaining why Obamacare's individual mandate cannot be severed to save the rest of the law. http://www.frc.org/op-eds/striking-down-individual-mandate-would-mean-ending-obamacare

Click here to read FRC's brief in the multi-state Florida lawsuit. http://www.frc.org/fl-hhs

Sebelius announces three million Medicare beneficiaries have received prescription drug cost relief under the Affordable Care Act

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced that three million Medicare beneficiaries nationwide have received prescription drug cost relief through the Affordable Care Act. To date, three million eligible beneficiaries who fell into the drug coverage gap known as the donut hole during 2010 have been mailed a one-time, tax-free $250 rebate check.

“For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent,” said Secretary Sebelius. “The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed.”

Eligible beneficiaries who fell into the coverage gap during 2010 are continuing to automatically receive rebate checks. These checks are only the first step in how the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting this year, eligible beneficiaries in the coverage gap will receive a 50-percent discount on covered brand name medications while in the donut hole. In addition, in 2011 Medicare will begin paying 7-percent of the price for generic drugs during the coverage gap.

Also today, Secretary Sebelius released a new video message on the new benefits the Affordable Care Act provides in 2011 for people on Medicare. You can watch the video message here.

The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor starting this year:

* As of January 1, 2011, Original Medicare no longer charges out-of-pocket costs for the “Welcome to Medicare” physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual wellness visit with a participating doctor, also at no cost.

* In addition to these annual wellness visits, most people with Medicare can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.

* Also this year, the Affordable Care Act will provide qualifying doctors and other health care professionals providing primary care to people on Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.

People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by contacting a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227) or visiting www.Medicare.gov.

Additionally, the Affordable Care Act makes Medicare stronger and more secure for all beneficiaries. These provisions under the new law increase benefits to beneficiaries and help to extend the life of the Medicare Trust Fund by 12 years.

* An analysis issued by the Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.

* The Affordable Care Act establishes a new Innovation Center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage. Innovations that are found to work can be rapidly expanded and applied more broadly—helping to transform the health care system into one that provides better care at lower cost.

· The Affordable Care Act contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. The law strengthens the screenings for health care providers who want to participate in Medicare, Medicaid, or CHIP, enables enforcement officials to see health care claims data from around the country in a searchable database, and strengthens the penalties for criminal wrongdoing. The reduction in waste, fraud, and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future. Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information or suspected fraud, waste, or abuse, or go to www.StopMedicareFraud.gov.

For more information on how the Affordable Care Act benefits seniors, visit www.HealthCare.gov.

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New report: 129 million Americans with a pre-existing condition could be denied coverage without new health reform law

Health and Human Services Secretary Kathleen Sebelius today released a new analysis showing that, without the Affordable Care Act, up to 129 million non-elderly Americans who have some type of pre-existing health condition, like heart disease, high blood pressure, arthritis or cancer, would be at risk of losing health insurance when they need it most, or be denied coverage altogether. Under the full range of policies in the Affordable Care Act to be enacted by 2014, Americans living with pre-existing conditions are free from discrimination and can get the health coverage they need, and families are free from the worry of having their insurance cancelled or capped when a family member gets sick, or going broke because of the medical costs of an accident or disease. Repealing the law would once again leave millions of Americans worrying about whether coverage will be there when they need it.

“The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our health care decisions,” said Secretary Sebelius. “The new law is already helping to free Americans from the fear that an insurer will drop, limit or cap their coverage when they need it most. And Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need.”

The analysis found that:

· Anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of pre-existing condition. Examples of what may be considered a pre-existing condition include:

· Heart disease

· Cancer

· Asthma

· High blood pressure

· Arthritis

· Older Americans between ages 55 and 64 are at particular risk; 48 to 86 percent of people in that age bracket live with a pre-existing condition.

· 15 to 30 percent of people under age 65 in perfectly good health today are likely to develop a pre-existing condition over the next eight years.

· Up to one in five Americans under age 65 with a pre-existing condition – 25 million individuals – is uninsured.

Prior to the Affordable Care Act, in the vast majority of states, insurance companies in the individual market could deny coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that 36 percent of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance for these reasons.

A number of protections are already in place thanks to the Affordable Care Act. Insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents’ coverage up to the age of 26 if they lack access to job-based insurance of their own, and insurers cannot deny coverage to children because of a pre-existing condition.

Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which provides private insurance to those locked out of the insurance market because of a preexisting condition. The PCIP program – which has already saved people’s lives by covering services like chemotherapy – serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a preexisting condition. There is a Pre-existing Condition Insurance Plan available in every state, and more information can be found at www.HealthCare.gov or by calling 1-866-717-5826.

In addition to the ban on discrimination against people with preexisting conditions, in 2014, individuals and small businesses will have access to new, high-quality insurance choices through competitive marketplaces called health insurance exchanges.

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New Study: Medicaid Pays Nursing Homes Less Than Minimum Wage

/PRNewswire/ -- A new study released today finds that Medicaid programs in states across the country underfunded nursing facility care by $5.6 billion in 2010, paying on average $7.17 per hour per patient, less than the nation's current minimum wage of $7.25 per hour. A lifeline for many elderly and disabled, Medicaid funds 64 percent of the care provided in America's skilled nursing facilities nationally.

"This report reveals a truth many would not believe – today's nursing facilities are paid less than the minimum wage," stated Mark Parkinson, President & CEO of the American Health Care Association (AHCA). "That must change if we ever hope to serve the needs of a Baby Boom generation that will only stress our care delivery system further."

Compiled by the research group Eljay -- a nationally-recognized expert in long term care -- the report identifies which states are most affected by the rising pressure on state Medicaid budgets, both in terms of highest aggregate Medicaid underfunding and highest per patient per day underfunding. States topping those lists are New York, Illinois, Massachusetts, Minnesota, New Jersey and Wisconsin.

Nursing home providers are often forced to rely on funding from other sources – primarily Medicare – to fill in the funding gaps resulting from inadequate Medicaid payments. With so many of the nation's governors facing difficult choices surrounding budget cuts, Parkinson cautioned at the danger of allowing an already squeezed Medicare system to prop up Medicaid payment rates.

"There is a vast gap between the actual cost of providing quality eldercare and what the Medicaid program truly finances," Parkinson stated. "As Baby Boomers begin to ponder their long term care needs in the future, it is simply unsustainable for Medicare to continue filling that financial gap. As current trends indicate, this problem will only grow worse in the coming years."

The following charts highlight the states with the largest aggregate Medicaid underfunding and largest per patient per day underfunding:

Largest aggregate Medicaid underfunding

1. New York - $1,396,494,595
2. Illinois - $378,779,709
3. Massachusetts - $310,871,237
4. New Jersey - $304,430,314
5. California - $288,599,289
6. Pennsylvania - $277,609,403
7. Ohio - $248,513,290
8. Wisconsin - $181,237,562
9. Minnesota - $151,611,752
10. Missouri - $137,412,649


Largest Medicaid per patient day underfunding:

1. New York - $47.95
2. New Hampshire - $31.25
3. Massachusetts - $31.22
4. New Jersey - $29.29
5. Washington - $28.18
6. Wisconsin - $26.54
7. Minnesota - $24.70
8. Wyoming - $23.67
9. Delaware - $22.86
10. Illinois - $21.95

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Long Term Care Pharmacy Alliance Concerned with Proposed CMS Rule; New Study Confirms LTCPA Position

/PRNewswire/ -- The Long Term Care Pharmacy Alliance (LTCPA) expressed concern with CMS's proposed rule on short-cycle dispensing within the long-term care (LTC) setting. In comments submitted to CMS Tuesday, LTCPA explained that any cost savings generated by implementing a short-cycle, 7-day fill dispensing regimen, would be overwhelmingly eliminated by additional dispensing fees resulting from the quadrupling the number of dispenses needed to move from 30-day to 7-day cycles.

A study conducted by Managed Solutions, LLC and released today supports this conclusion and finds that moving all Medicare Part D prescriptions to a 7-day fill would result in increased costs to Part D payers of over $800 million annually. Even moving more expensive brand products to a 7-day fill would still increase costs to Part D payers of $154 million annually.

"While LTCPA supports the goal of reducing waste, we also recognize the need to consider all costs associated with the proposed rule, so that unintended consequences do not result from the application of the rule. Given that it's the American taxpayer ultimately shouldering the burden of paying for this statute, it is critical that calculations such as those provided in our study be factored into the drafting of regulations," stated Bill Daniel, Executive Director for LTCPA.

The study derived its analysis from information received from eight LTC pharmacies. The findings estimated the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.

In addition to the increased cost to payers, other key findings included:

* "Wasteful dispensing" to nursing home residents covered by Medicare Part D, only amounts to approximately 2.9% of total dispensed value. Short cycling this percentage of waste would save only $125 million annually and cost over $900 million in additional dispensing fees. This is in stark contrast to the $712.5 million in annual savings estimated by the Congressional Budget Office in their scoring of the short-cycling provision.
* The tradeoff between reduced waste associated with unused medication and increased pharmacy operating costs due to more frequent medication dispensing only becomes favorable to the taxpayer for prescriptions with original dispensed value of over $400.


In its comments, LTCPA stated that CMS's approach on short-cycle dispensing is contrary to Congress' intent that Section 3310 of the Patient Protection and Affordable Care Act result in savings to Medicare Part D. "We believe that it was Congress' intent to decrease costs associated with unused medications for Part D residents in LTC facilities. Implementing short cycle dispensing for long term care patients with an average length of stay of 835 days who are primarily taking maintenance medications does not meet this financial goal. While we applaud CMS's initial proposal to short cycle traditionally more expensive brand products, we believe that this limitation isn't narrow enough. Our data clearly shows that there is a prescription value threshold of $400 that must be met in order to achieve any cost savings," continued Bill Daniel.

In the proposed regulations, CMS calls for data collection by Part D plans in order to study the efficiencies of various dispensing methodologies and to estimate the cost of unused drugs and possible savings. As CMS has identified their lack of data on unused Part D drugs in this population, LTCPA recommends that before drafting any final regulations CMS conduct a study to determine the causes, frequency and cost of unused medications and also consider alternatives to 7-day dispensing cycles.

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With Federal Support, States Hold Steady in Medicaid and CHIP Coverage Policies for Low-Income Children and Families Despite Recession

/PRNewswire/ -- Despite tight budgets, nearly all states maintained or made targeted expansions or improvements in their Medicaid and Children's Health Insurance Programs (CHIP) eligibility and enrollment rules in 2010, preserving the programs' ability to provide coverage to millions of low-income Americans who otherwise lack affordable options, according to a new survey released today by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU).

The 10th annual KCMU 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices, this year conducted with the Georgetown University Center for Children and Families, found that coverage policies held steady or in some cases expanded, particularly for low-income children. However, eligibility for their parents and other low-income adults continued to lag behind. The stability of such programs during a recession that has produced sharp increases in unemployment and declines in state tax revenues arises in large part from the temporary federal fiscal relief for Medicaid provided by the American Recovery and Reinvestment Act of 2009 (ARRA).

That enhanced federal assistance, which will end in July, was tied to requirements for states to maintain Medicaid coverage policies. To help provide a base for the future Medicaid expansion, the health reform law also requires states to maintain public coverage for adults until broader health reform goes into effect in 2014 and until 2019 for children. However, in the coming year states continue to face significant budget pressures as demand for the programs remains high and state revenues continue to be depressed amidst the slow economic recovery.

"Millions of American families have turned to Medicaid and CHIP as incomes have declined after losing jobs and the health insurance that often goes with them," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. "Keeping these programs stable and strong has helped protect children and avoid an even larger increase in the nation's 50 million uninsured, and will be key to ensuring the success of health reform implementation over the next few years."

Coverage Policies Held Steady or Expanded in 2010, Especially For Children

The survey found that 49 states, including D.C., held steady or made targeted improvements in their Medicaid and CHIP eligibility rules and enrollment procedures. A total of 13 states expanded eligibility, largely for children, and 14 states made improvements in enrollment and renewal procedures to reduce burdens on families and streamline administrative processes.

Without the enhanced federal funding and maintenance-of-effort requirements in the ARRA and health reform laws, it is likely that more states would have made cutbacks in coverage to cope with budget pressures. Two states -- Arizona and New Jersey -- did make reductions that were not subject to the requirements in the laws.

Coverage for Low-Income Adults Continues to Lag Behind

The survey finds that as of January 1, 2011, 25 states, including D.C., cover children in families with incomes at least up to 250 percent of the federal poverty level ($45,775 for a family of three in 2010), continuing a decade of progress in covering children. However, coverage for their parents lags behind. The median Medicaid eligibility threshold for parents nationally remains at 64 percent of the federal poverty level, and 16 states limit eligibility for parents to those in families that earn below 50 percent of the federal poverty level ($9,155 for a family of three in 2010).

Until health reform passed, states could not cover adults without dependent children in Medicaid programs without a waiver. The new law ends the historic exclusion of these adults through a Medicaid eligibility expansion to a national floor of 133 percent of the federal poverty level ($24,352 for a family of three and $14,404 for an individual in 2010). Although the law won't take full effect until 2014, last year Connecticut and D.C. took advantage of the new option to begin covering these adults by moving into Medicaid low-income adults whom they had previously covered only with state and local dollars. Also, California received approval for a waiver to continue and expand county initiatives that cover low-income adults. A few other states, including Minnesota, also have pending plans to take advantage of the new option to provide Medicaid coverage to adults. Even with these efforts, as of January 1, only seven states (Arizona, Connecticut, Delaware, D.C., Hawaii, New York and Vermont) provided Medicaid or Medicaid-equivalent benefits to adults without dependent children.

In the absence of further expansions over the next couple of years, most uninsured, low-income adults will remain unable to qualify for Medicaid until health reform goes into effect in 2014.

States are Incorporating Technology into Their Programs, but Have More Work Ahead

The survey finds that states continue to adopt technology to modernize their programs. Many of these improvements have helped to reduce barriers to enrollment and renewal for families, while also streamlining administrative processes and achieving administrative efficiencies. For example, about half of the states (29) took advantage of a new option to rely on an electronic data match with the Social Security Administration to more efficiently and accurately verify citizenship status of applicants for Medicaid and CHIP. The survey also found states making progress in using electronic data matches to verify other aspects of eligibility.

Yet states still have a significant amount of work to do, the survey finds. The new health reform law calls upon states to implement an integrated, web-based, technology-driven enrollment process for Medicaid, CHIP, and coverage in the new health insurance Exchanges. While all states make their Medicaid application available online, only slightly more than half (29) allow for the application to be electronically submitted with an electronic signature and most of these still require families to submit paper documentation via mail or fax. In light of a rule proposed by the Administration at the end of 2010 to provide states with a 90% federal matching rate to prepare their Medicaid eligibility systems for health reform, new grant funding, and the likelihood of additional guidance and funding opportunities in the months ahead, more activity in this area is expected in the coming year.

Today's report, Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP, 2010-2011, and related materials from today's public briefing on the survey findings, are available online at: http://www.kff.org/medicaid/Medicaid-CHIP-Coverage-Recession-Health-Reform.cfm. In addition, an archived webcast of a public briefing will be available on the website after 4 p.m. ET today.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information and analysis on health issues.

The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, D.C. office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in health care and public policy.

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Shocking! 80 Million Swamp Medicare by 2030

Baby boomers skyrocket costs to $1 trillion/year by 2020

While the Obama administration very quietly backed off making end-of-life consultations party of the annual Medicare doctor-patient discussion, the coming swell of baby boomers leaves little doubt that Medicare will be able to continue operating unless government-paid health-care services are rationed, as the largest number of seniors ever to retire in America begins retiring this year.

"It's been a long, strange trip from Woodstock to the nursing home, but baby boomers are getting there - and soon," wrote Health Day reporter Amanda Gardner in Bloomberg Businessweek.

In 2011, the first round of baby boomers born in 1946 begins turning 65 and qualifying for Medicare, at a rate of approximately one every eight seconds.

In total, approximately 76 million baby boomers are expected to go on Medicare, with the result that Medicare will grow from 47 million today to 80 million in 2030, even factoring in death rates over that period, USA Today reported.

At the same time, health-care costs are expected to accelerate in coming years, with the result that Medicare is projected to cost nearly $1 trillion a year by 2020, an 80 percent increase over today.

Not enough doctors

According to Dr. Bruce Koeppen, founding dean of Quinnipiac University School of Medicine in Hamden, Conn., the problem is also that 40 percent of physicians themselves are approaching retirement and are becoming eligible for Medicare.

According to the American Geriatrics Society, there are now 7,029 board-certified geriatricians in the United States, or about one for every 2,699 Americans aged 75 or older, Gardner reported in her article. But that ratio is expected to drop to one geriatrician per 5,549 seniors by 2030.

Obamacare is also certain to produce a shortage among primary-care givers in health services as millions of Americans are instructed they have an entitlement "right" to government-paid medical care.

Even today, many physicians in private practice do not take Medicare patients because it's not profitable to do so.

This situation is certain to become even worse if Obamacare results in the 2011 cuts to Medicare that are called for in the legislation.

Medicare faces trillions of dollars in unfunded obligations

WND has also reported that the true negative net worth of the federal government was $70.7 trillion in 2009, largely because of unfunded obligations in Social Security, Medicare and Medicaid.

In other words, the total U.S. obligations, including Social Security and Medicare benefits to be paid in the future, have effectively placed the U.S. government in bankruptcy, even before we take into consideration any future and continuing social welfare obligations that may be embedded within the Obama administration's planned massive overhaul of health care.

Under cash accounting, the government makes no provisions for the future Social Security and Medicare benefits in the year in which those benefits accrue.

The approximately 76 million U.S. children born between 1945 and 1964 represent some 28 percent of the U.S. population.

"Simply said, holding revenues constant, required Medicare, Medicaid and Social Security spending and the related deficit financing costs will far exceed the Government's ability to pay," the Citizens' Guide to the 2007 Financial Report of the United States Government concluded.

The Congressional Budget Office notes that in 2010, 21 percent of federal spending went to Medicare and Medicaid, with the expectation that 31 percent of the federal budget will be spent on the two programs by 2020, as reported by CBS MoneyWatch.com.

The problem is that there is no end in sight

The CBO also estimates that spending on Medicare and Medicaid will grow from 7 percent of U.S. gross domestic product in 2020 to 12 percent in 2050.

Even with Medicare, retirees will need substantial personal financial resources to cover medical-care costs.

The Employee Benefit Research Institute has estimated that to have a 90 percent chance of having enough savings to cover health costs in retirement, a man would need $211,000 in personal savings that can be applied to cover health costs and a woman would need $242,000, if no former employer were available to subsidize private health insurance to supplement Medicare in retirement.


By Dr. Jerome Corsi
(c) 2010 RedAlert.WND.com


Reprinted with permission.

ABOUT THE AUTHOR: Jerome R. Corsi received a Ph.D. from Harvard University in political science in 1972. He is the author of the #1 New York Times bestselling books THE OBAMA NATION: LEFTIST POLITICS AND THE CULT OF PERSONALITY and the co-author of UNFIT FOR COMMAND: SWIFT BOAT VETERANS SPEAK OUT AGAINST JOHN KERRY. He is also the author of AMERICA FOR SALE, THE LATE GREAT U.S.A., and WHY ISRAEL CAN'T WAIT. Currently, Dr. Corsi is a Senior Managing Director in the Financial Services Group at Gilford Securities as well as a senior staff writer for WorldNetDaily.com.

ABOUT GILFORD SECURITIES: Gilford Securities, founded in 1979, is a full-service boutique investment firm headquartered in New York City providing an array of financial services to institutional and retail clients. From investment banking and equity research to retirement planning and wealth management services, our financial experts are prepared to accommodate the needs of investors. For more information about Gilford Securities please visit, Click Here: http://www.gilfordsecurities.com/financial-services-group.php

The views, opinions, positions or strategies expressed by the authors and those providing comments are theirs alone, and do not necessarily reflect Gilford Securities Incorporated's views, opinions, positions or strategies. Gilford Securities Incorporated makes no representations as to accuracy, completeness, currentness, suitability, or validity of any information expressed herein and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use.

ABOUT RED ALERT: Jerome Corsi's RED ALERT is your weekly, global financial strategies newsletter. Designed to be your guide to economic trends in the best of times and the worst of times, it is edited by New York Times best-selling author Jerome Corsi, Senior Managing Director of the Financial Services Group at Gilford Securities as well as a WND senior staff writer and columnist. For 25 years, Corsi worked with banks throughout the U.S. and the world developing financial services marketing companies to assist banks in establishing broker/dealers and insurance subsidiaries to provide financial planning products and services to their retail customers. Corsi developed three third-party financial services marketing firms that reached annual gross sales levels of $1 billion in annuities and equal volume in mutual funds. Corsi received his Ph.D. in political science from Harvard University in 1972.

New Affordable Care Act rules shed light on high health insurance rate hikes

New proposed Affordable Care Act regulations announced today by the U.S. Department of Health and Human Services (HHS) will bring new transparency and scrutiny to proposed health insurance rate increases. These proposed rules allow HHS to work with states to require insurers to publicly disclose and justify unreasonable rate increases.

“Year after year, insurance company profits soar, while Americans pay more for less health care coverage,” said Secretary Sebelius. “The Affordable Care Act is bringing unprecedented transparency and oversight to insurance premiums to help reign in the kind of excessive and unreasonable rate increases that have made insurance unaffordable for so many families.”

Health insurance premiums have risen rapidly over the past decade, straining pocketbooks for American families and businesses. Since 1999, average premiums for family coverage have risen 131 percent.

The Affordable Care Act has already begun to help states strengthen or create rate review processes. On August 16, HHS awarded $46 million to 45 states and the District of Columbia to help them improve their oversight of proposed health insurance rate increases. This is part of $250 million that the health reform law makes available to states to take action against insurers seeking unreasonable rate hikes.

Today’s proposed regulations will build on these efforts by requiring insurers in all states to publicly justify any unreasonable rate increases beginning in 2011. In 2011, proposed rate increases of 10 percent or higher will be publicly disclosed and thoroughly reviewed to determine if the rate increase is unreasonable. After 2011, state-specific thresholds would be set using data and trends that better reflect cost trends particular to each state. Insurance company’s justifications for unreasonable increases will be posted on HealthCare.gov and the insurance plan’s website.

“The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified,” said Jay Angoff, director of HHS’ Office of Consumer Information and Insurance Oversight.

Under the proposed regulation, states with effective rate review systems would conduct the reviews. If a state lacks the resources or authority to do thorough actuarial reviews, HHS would conduct them. Meanwhile, HHS will continue to make resources available to states to strengthen their rate review processes.

In 2014, the Affordable Care Act empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance exchanges.

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60 Participants in Fulton County Retirement Plan Take Advantage of MassMutual's LifeBridge(SM) Free Life Insurance Program

/PRNewswire/ -- As part of MassMutual's LifeBridge(SM) Free Life Insurance Program, 11,500 individuals across the country have received $575 million in free life insurance, including employees of Fulton County, Georgia. To date, the program has provided 60 participants in the Fulton County Defined Contribution 401(a) Plan each with a $50,000 free term life insurance policy, totaling $3 million in free coverage from MassMutual.

Under the program, MassMutual pays all insurance premiums for a $50,000 10-year term life insurance policy. If an insured parent or legal guardian dies during the term of the policy, $50,000 will be put in trust to pay the educational expenses of his or her children. The program is available to all parents between the ages of 19 and 42 who meet the criteria of the program. Individuals need not participate in a retirement plan administered by MassMutual or be a client of MassMutual's to apply.

"MassMutual offers this great program, not just to its retirement plan clients, but to any working parent in the country who qualifies. Our MassMutual retirement plan relationship manager made us aware of this program and we're thrilled that so many of our employees have been able to take advantage of it," says Tammy Goebeler, Investment Officer of Fulton County. "As a parent, you want the best education possible for your children. This program can give a parent peace of mind in the event that something unexpected happens. Our hope is that other working parents in our community will explore the LifeBridge Program and take advantage of this great program as well," says Goebeler.

"We're pleased that so many Fulton County employees were able to take advantage of this great program," says Elaine Sarsynski, executive vice president of MassMutual's Retirement Services Division and chairman and CEO of MassMutual International LLC. "By offering group meetings for its employees, Fulton County has helped raise awareness of this valuable free life insurance program among its retirement plan participants. We encourage every MassMutual retirement plan sponsor to inform their employees about the availability of the LifeBridge program," she adds.

MassMutual also offers a convenient onsite application event for large groups. For more information about the LifeBridge Free Life Insurance Program, please call (800) 272-2216 or visit www.massmutual.com/lifebridge. Existing MassMutual Retirement Services clients interested in learning more about the program can also request information from their MassMutual relationship manager.

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State-Run Property Insurers Lose Customers but Gain Risk

/PRNewswire/ -- Florida and Louisiana have reduced the number of high-risk policyholders covered by their state-run property insurers of last resort since 2008 while still leaving non-coastal property owners vulnerable to paying for these same insurers' potential coastal losses, according to the Insurance Information Institute's (I.I.I.) recently updated Residual Market Property Plans: From Markets of Last Resort to Markets of First Choice.

Florida Citizens Property Insurance Corporation, the largest property insurer of last resort in the U.S., provides insurance to residential and commercial property owners unable to purchase coverage in the standard market. Yet Florida Citizens saw the number of its total policies in force drop to 1.2 million at year-end 2009, down 14 percent from 1.4 million at year-end 2008. Meanwhile, Louisiana Citizens Property Insurance Corporation, the fourth largest state-run property insurer of last resort in the U.S. in terms of total policies in force behind Texas and Massachusetts, has seen an even more dramatic reduction in its total policy count. Louisiana Citizens had about 165,000 policies in force in June 2008, a figure that dropped to 127,000 policies as of June 2010, a reduction of around 40 percent.

"However, this year's report by the Insurance Information Institute, like the reports of the last two years, records the ongoing growth in the exposure base of the residual market property insurers along with the still-precarious financial condition of some plans. This growth comes despite a collapse in the housing sector that has brought development in many catastrophe-prone areas to a near standstill," write the report's co-authors, Dr. Robert Hartwig, president of the I.I.I. and an economist, and Claire Wilkinson, vice president of Global Issues at the I.I.I.

The I.I.I. estimates that, even as the number of policyholders in Florida, Louisiana and the 32 other Fair Access to Insurance Requirements (FAIR) Plans for which data are available dropped to 2.47 million from 2.62 million between 2008 and 2009, their cumulative exposure to loss grew to $614.9 billion in 2009 from $612.7 billion in 2008. The nation's FAIR plans account for by far the majority of policies and exposure in the U.S. overall residual property market. But when the FAIR Plan exposures are added to those incurred by Beach and Windstorm Plans, such as those in place in states such as Alabama and Mississippi, the U.S. residual market exposure to loss grows to $703 billion (2009) from $696 billion, according to the Property Insurance Plans Service Office (PIPSO).

"As long as [these] plans continue to grow, state finances will remain under threat and ultimately taxpayers, many of whom live nowhere near the coast, will continue to face the prospect of increased assessments in the years ahead," Dr. Hartwig and Ms. Wilkinson state.

Since state property insurers of last resort often charge premium rates that do not reflect the risk they are incurring on the policyholder's behalf, the claims paying capacity of FAIR, Beach or Windstorm Plans is relatively limited, and often exhausted quickly in the event of a severe storm. Should this occur, a number of capital-raising options are available to state-run property insurers. The two main options—levying assessments on all policyholders and issuing bonds that must be paid back by all state taxpayers—often result in higher costs for all of the state's policyholders, no matter where they live, as these costs are passed along in the form of premium surcharges or higher taxes. Every homeowners insurer doing business in a particular state is generally a member of a state-run residual market program, just as auto insurers join forces to spread the risks involved in covering problematic drivers through assigned risk programs.

"Increasingly plans are being bailed out by a diversion of tax revenues," the I.I.I. report states, pointing to the fact that in 2008, after Hurricane Ike struck the Texas coastline, $230 million of the $430 million in assessments incurred by the Texas Windstorm Insurance Association's (TWIA) member insurers were subject to premium tax credits. TWIA is the state's insurer of last resort for wind and hail coverage in 14 coastal Texas counties and parts of Harris County.

The report also notes that Mississippi enacted legislation in 2007 to allow a one-time diversion of $80 million in federal and state funds to the Mississippi Windstorm Underwriting Association (MWUA), one of the state's two residual market plans, to boost the MWUA's reserves for windstorm damage claims and protect MWUA policyholders against rate increases.

The I.I.I. report also offers a detailed analysis of the residual market plans in North Carolina and South Carolina, as well as the states cited previously, a list which includes Florida, Louisiana, Massachusetts, Texas, Alabama and Mississippi. Policymakers and other interested parties seeking an update on the pending federal pieces of legislation on the issue of natural catastrophe risk should consult the I.I.I. report's Appendix, which can be found on the final two pages of the 51-page document.

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New Affordable Care Act rules give consumers better value for insurance premiums

New regulations issued November 22 by the Department of Health and Human Services (HHS) require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. This regulation, known as the “medical loss ratio” provision of the Affordable Care Act, will make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money.

“Thanks to the Affordable Care Act, millions of Americans will get better value for their health insurance premium dollar,” said HHS Secretary Kathleen Sebelius. “These new rules are an important step to hold insurance companies accountable and increase value for consumers.”

Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. Thanks to the Affordable Care Act, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs, starting in 2011. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.

In 2011, the new rules will protect up to 74.8 million insured Americans and estimates indicate that up to 9 million Americans could be eligible for rebates starting in 2012 worth up to $1.4 billion. Average rebates per person could total $164 in the individual market. Important details regarding the new regulation are included below.

The medical loss ratio regulation outlines disclosure and reporting requirements, how insurance companies will calculate their medical loss ratio and provide rebates, and how adjustments could be made to the medical loss ratio standard to guard against market destabilization.

Beginning in 2011, the law requires that insurance companies publicly report how they spend premium dollars, providing meaningful information to consumers. Also beginning in 2011, insurers are required to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities. Insurance companies that are not meeting the medical loss ratio standard will be required to provide rebates to their consumers. Insurers will be required to make the first round of rebates to consumers in 2012.

“These rules were carefully developed through a transparent and fair process with significant input from the public, the States, and other key stakeholders,” said Jay Angoff, director of the Office of Consumer Information and Insurance Oversight at HHS. “As we build a bridge to 2014, when better, more affordable options are available to consumers, these rules will help make health insurance fairer for consumers now.”

The Affordable Care Act required the National Association of Insurance Commissioners (NAIC) to develop uniform definitions and methodologies for calculating insurance companies’ medical loss ratios. Insurance commissioners in every State have a responsibility to protect the interests of the general public, policyholders, and enrollees within their respective States. Today’s regulation certifies and adopts the recommendations submitted to the Secretary of HHS on October 27, 2010 by the NAIC. It also incorporates recommendations from a letter sent to the Secretary by the NAIC on October 13, 2010.

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Misleading Postcards Are Not From Medicare

The Department of Human Services urges older adults to be on the alert for misleading post cards titled “Important: Projected Medicare Changes.” The cards are sent on behalf of insurance salespeople and are not endorsed by Medicare.

“Private insurance companies request signatures, ages, and other details on these post cards and then use the information to make sales calls and visits to people’s homes,” said Dr. James J. Bulot, Director of the Georgia Department of Human Services (DHS) Division of Aging Services. “If consumers have questions about Medicare changes, they should contact the GeorgiaCares network.”

The GeorgiaCares State Health Insurance Assistance Program (SHIP) offers individuals free, one-on-one help provided by trained local counselors. The program is managed statewide by the DHS Division of Aging Services and Georgia’s 12 Area Agencies on Aging. To contact GeorgiaCares, call 1-800-669-8387 toll-free or visit www.MyGeorgiaCares.org.

Callers may request personalized information about Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, the resolution of billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.

The GeorgiaCares team is ready to answer questions now about open enrollment for Medicare Part C (prescription drug coverage) and Part D (Medicare Advantage plans). Enrollment began November 15th, and recipients will have until December 31, 2010, to make their choices. After this period, beneficiaries may make limited changes during the annual Disenrollment Period of January 1 - February 14th of each year. Beneficiaries who do not want to make a change can remain in their plan from 2010.

GeorgiaCares SHIP counselors will answer hotline calls from individuals and provide community education sessions for any group throughout the state to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.

GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.

For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).
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Many Important Health Insurance Choices Must Be Made Now in Georgia

PRNewswire/ -- For employees who work for companies that offer health insurance benefits through late November/early December, this is usually the time when important health plan decisions must be made for the upcoming year - 2011. Interestingly, studies show consumers typically spend more time researching car and computer purchases than they do when selecting a health insurance plan. These studies also indicate that most people spend an hour or less reviewing their insurance plan options and often default to the plan they had the previous year.

With health care reform changes in the mix, the comprehensive long-term impact is still uncertain. Nevertheless, employees must make educated and well-thought-out decisions for their 2011 benefits now, using the information that is currently available to them. Equally important, employers must do everything they can to provide their employees with the information necessary to make an informed decision. And, since open enrollment season is upon us, this is the best time to share tips to help employees navigate through the choices they must make.

Many of Georgia's companies offer more than one health insurance plan option, which typically have different costs to the employees, both in the amount deducted from their paychecks and the total cost of the coverage for deductibles, co-pays and co-insurance during the course of the year. In addition, many employers are offering base coverage plans and then offer a 'buy up' plan option where employees can purchase additional coverage not covered by the employer.

"It's a mistake not to review your health plan options each year and carefully weigh which plan will be the best fit for you and your family," said Morgan Kendrick, President, Blue Cross and Blue Shield of Georgia (BCBSGa) who noted that often consumers choose the plan that has the least impact on their paycheck when that option may not be the best choice overall.

Plans with higher monthly premiums and lower co-pays and deductibles might be best for those who anticipate using a lot of health care services throughout the course of the year. On the other hand, young and healthy employees without kids might save more with a plan that features low premiums and a high deductible.

We encourage employers to provide their employees with the tools and resources needed to help them make informed decisions about their health care coverage. Below are a few things employers can do to make this process easier:

1. Encourage Healthy Behaviors. Research shows that approximately 85 percent of ill health comes from poor health choices. Therefore, open enrollment provides a great opportunity for the promotion of health and wellness programs and incentives, including smoking cessation or weight management courses, gym subsidies, etc. Not only will this help contain company costs long-term, it also helps employees feel and perform better.
2. Hold open enrollment meetings. If possible, make them mandatory, but make them fun and interactive. Bring in an account manager from your insurance carrier or have an onsite benefits manager/HR representative explain the various health care options and answer questions on-the-spot.
3. Avoid acronyms when communicating with employees. Use simple terms and definitions, and communicate early and often. An Institute of Medicine report showed that nearly half of all U.S. adults have difficulty understanding healthcare benefits information. As a result, the materials go unread and plan selections are made haphazardly.
4. Help Familiarize Employees with Consumer-Driven Health Plans (CDHPs). CDHPs continue to gain popularity because they help employers and employees control health care costs. CDHPs provide you with health account options to help you pay for the costs of health care such as Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs). Companies that are the most successful in introducing and migrating to CDHPs take time to explain these plans to employees up front, which usually results in higher adoption rates.


Here are some items employees should keep in mind when choosing a health insurance plan:

1. Do your homework and take advantage of the tools offered to you. If your company holds open enrollment meetings, attend at least one and be prepared with questions. Take the information home and review the details in a more relaxed environment. Make sure to follow up with your company benefits advisor if you have additional questions – that's what the benefits advisor is there for.
2. Understand and learn what basic health insurance terms mean. Use online tools provided by your current health plan or other tools such as www.wikipedia.org as a reference. For example, make sure you can answer the following:
-What is the difference between co-payment and co-insurance?
-What does deductible mean and how could it impact your out-of-pocket costs?
-What does it mean to seek "out-of-network" services?
3. Examine your family's past health care spending. An excellent way to determine a good plan fit for 2010 is to understand what health care services your family used in 2010 and take into consideration what expenses may occur in the coming year—like having a child or if you will have to deal with a chronic health condition like diabetes.
4. Before continuing on your current plan, read the details. What you signed up for last year may have changed. Have the co-pays and deductibles increased? Often employers will adjust these levels as a result of the increasing cost of health care services. Pay attention to the details in order to avoid surprises down the line.
5. Verify in advance that your physician and hospital are part of the network for the plan you are choosing. This is especially important if the insurance company is changing or if you are switching to a different health plan.
6. Take advantage of your HSA, HRA or Flexible Spending Account (FSA) if appropriate. Make sure you understand the difference between an HSA, HIA, HRA and an FSA, as well as any changes in access to these funds, for example, FSA accounts have new prescription requirements surrounding over-the-counter medications.


"In the past, consumers may have quickly looked over their benefit options and made a selection without seriously considering the comprehensive financial impact it could have on them and their family," said Kendrick. "But this year, with the additional economic pressures consumers are facing and new health care reform mandates, it makes sense to really study all plan options in order to make the best choice to meet their needs."

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Good News for National Diabetes Month: People with Type 1 Diabetes Have Better Life Insurance, Long Term Care Insurance Options

(BUSINESS WIRE)--During National Diabetes Month, there is good news about insurance options for people living with type 1 diabetes. “Many people who in the past have been declined life insurance and long-term care insurance (LTC) solely on the basis of their type 1 diabetes diagnosis are now seeing some of the barriers come down,” said Danny Mensh, president of Mensh Insurance “Under certain circumstances, several major carriers are now willing to underwrite and issue both long-term care insurance and term life insurance policies.”

In the past, insurance carriers did not know how to price the risk on life insurance and long-term care insurance for people with type 1 diabetes and automatically declined their applications. However, within the last 24 to 36 months, the insurance industry has become more lenient on this chronic condition. “Due to improved medications, advancements in the manner in which they are distributed and more precise blood sugar level monitoring, underwriters are increasingly more comfortable with the longer life prospects and health maintenance of those with stable histories of type 1 diabetes,” Mensh said.

Some of the basic underwriting criteria for issuing policies to a person with type 1 diabetes include:

* Controlled A1c < 8
* < 60 units of insulin
* Controlled height and weight
* Average fasting blood sugar < 200
* Blood pressure, 140/90
* No transient ischemic attacks (TIAs) within past five years
* No smoking within last two years
* No cardiac complications or retinopathy associated with eye impairments
* No chronic steroid usage

“Many people with type 1 diabetes are very stable and can easily demonstrate via medical records that they should qualify for approval from major insurance carriers,” Mensh said. “It has been exciting to open up the options for future financial planning to people with this chronic condition.”

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

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

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

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

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

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

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


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

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

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

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

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

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

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

Protecting Against Fraud and Identity Theft

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

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

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

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Humana to Offer Savings and Broad Choice with 2011 Medicare Plans

(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) will offer a wide variety of Medicare Advantage (MA) and Prescription Drug Plans (PDP) to people with Medicare in 2011, including the new Humana Walmart-Preferred Rx Plan (PDP) that offers the nation’s lowest monthly premium in all 50 states and Washington, D.C.

Humana will offer people with Medicare choices that include MA plans with more benefits than Original Medicare, an affordable monthly premium, an extensive list of doctors in many areas, and predictable costs that are easy to budget.

The Annual Election Period when Medicare beneficiaries will select their Medicare coverage for 2011 runs from Nov. 15 through Dec. 31, 2010. In recent years, people with Medicare were allowed to change plans during the first three months of the year. Beginning in 2011, the January-to-March enrollment period has been eliminated.

“At a time when people are still coping with the impact of our challenging economy, especially senior citizens and disabled people living on a fixed income, it is critical to have medical and prescription-drug coverage that’s affordable,” said Tom Liston, senior vice president, senior products, and the leader of Humana’s Medicare organization. “Humana continues to offer a variety of choices across the country enabling Medicare beneficiaries to select a plan that meets their needs while receiving comprehensive benefits and value people have come to expect from Humana.”

Medicare Advantage Plans

Humana’s MA plans can help people get more out of their health care dollar. Most Humana MA plans:

* Offer additional benefits beyond Original Medicare
* Have copayments offering predictable costs that are easy to budget no matter which health care services are used
* Come with worldwide coverage for emergency care

With drug coverage, health-and-wellness offerings and disease-management programs also available with MA coverage, Humana MA plans remain an excellent value in 2011. Plans, benefits and premiums vary by state and county. Plans include local and regional PPO plans, as well as HMO and Private Fee-For-Service plans. Humana is committed to informing its members of the various benefits and savings options that are available to them for 2011. All Humana MA plans have annual out-of-pocket maximums in 2011, protecting beneficiaries against catastrophic costs.

Benefits with most Humana MA plans include:

* Care coordination and disease-management programs
* Affordable deductibles
* Affordable copayments
* 24-hour nurse hotline
* SmartSummary Rx benefits statement (available to both MA and PDP members)
* No-cost preventive services
* No-cost diabetic-monitoring supplies, including test strips, lancets and glucometers

Well-Being Benefits for Members

Humana is dedicated to supporting its Medicare members on their lifelong pursuit of well-being. As evidence of this commitment, most Humana MA members enjoy access to programs that encourage healthy behaviors such as gym memberships through SilverSneakers or Silver & Fit, and the WellDine Food Program, which delivers meals following a hospitalization. Over the long-term, these programs aid members in achieving a greater quality of life.

Prescription Drug Plans

In all 50 states, Washington, D.C. and Puerto Rico, Humana offers stand-alone PDPs, meaning they’re separate from Medicare medical coverage. Stand-alone PDPs enable people with Medicare to add drug coverage to their Original Medicare coverage.

New this year is the Humana Walmart-Preferred Rx Plan, which features a monthly premium of just $14.80, making it the lowest-premium plan available in all 50 states and Washington D.C. Copayments start at just $2 for preferred generic prescriptions filled at any Walmart, Sam’s Club or Neighborhood Market pharmacy. Copayments of $0 are available for many generic drugs filled via Humana’s home-delivery (mail-order) pharmacy, RightSource. Humana and Walmart estimate that the new co-branded plan will save members an average of more than $450 a year.

People with Medicare who prefer first-dollar coverage (no annual deductible) for preferred generics and a broader network of pharmacies should consider Humana’s Enhanced PDP Plan. With more than 62,000 pharmacies in Humana’s national pharmacy network, and $0 copayments for many generic drugs when using mail-order, this plan typically appeals to people who want that additional coverage.

Also New in 2011

In addition to the new Humana Walmart-Preferred Rx Plan (PDP), Humana is offering new MA plan options in multiple markets across the U.S. Here’s an overview of the various plan options Humana is offering for 2011:

* HMO plans in 27 states and Puerto Rico
* Local PPO plans in 39 states and Puerto Rico
* Regional PPO plans in 23 states (in 14 Medicare Advantage regions)
* Full−network Private Fee-for-Service (PFFS) plans in 34 states. All services are available in and out of network, taking full advantage of any Humana contracted discounts when the member uses in-network providers.
* Partial-network PFFS plans (networked for ancillary services only) in 28 states
* Non-network PFFS plans in 2 states
* PDP offerings approved for 2011 are statewide in 50 states, the District of Columbia and Puerto Rico and include the new nationwide PDP co-branded with Walmart.

For more information about Humana’s 2010 Medicare offerings, visit www.humana-medicare.com or call toll free 1-800-611-1481. TTY users call 1-877-833-4486.

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New report shows Affordable Care Act savings of $3,500 for Medicare beneficiaries

A new analysis issued today (November 4) by the U.S. Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher - as much as $12,300 over the next 10 years - for seniors and people with disabilities who have high prescription drug costs.

"The Affordable Care Act makes Medicare stronger and reduces the burden of health care costs on some of our most vulnerable citizens," said Secretary Kathleen Sebelius. "The law improves benefits for seniors and people with beneficiaries who rely on Medicare and ensures that Medicare will be there for current and future generations by extending the life of the Medicare Trust Fund. These benefits and savings are only possible with the continued implementation of the Affordable Care Act."

The analysis, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), shows that the Affordable Care Act helps lower costs for those on Medicare by slowing the growth of cost-sharing in Medicare. Closing the Part D coverage gap known as the "donut hole" will produce the greatest cost savings. Already, more than 1.8 million seniors and people with disabilities who have reached the donut hole in 2010 received a one-time $250 rebate check, and checks will continue to be distributed to those who enter the donut hole this year. Next year, people in the donut hole will receive 50 percent discounts on covered brand name Part D prescription drugs. Also starting next year, seniors and people with disabilities on Medicare will have access to a number of recommended preventive services and annual wellness visits at no additional cost.

Although all seniors and people with disabilities in Medicare are likely to see savings, the savings will be greatest for those with costly medical conditions or high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary with spending in the donut hole, estimated savings increase from $553 in 2011 to $2,217 in 2020.

"The savings that seniors and people with disabilities on Medicare are seeing are due to critical improvements the Affordable Care Act makes to Medicare," said Assistant Secretary for Planning and Evaluation, Sherry Glied. "Reducing waste, fraud and abuse, improving the quality of care beneficiaries receive, and making the program more efficient all contribute to lower cost increases across the system."

The full analysis is available at http://www.healthcare.gov/center/reports/affordablecareact.html.

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What Now, for Health Reform?

/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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Our Nation's Veterans Have Options for Health Care Coverage

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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Open Enrollment Goes Virtual: Blue Cross and Blue Shield of Georgia Launches Virtual Open Enrollment Center, Allowing Companies to More Easily Engage Employees

/PRNewswire/ -- For medium and large organizations, providing employees with complete, comprehensive and consistent information during open enrollment can be challenging. To help businesses reach and engage their employees more easily, Blue Cross and Blue Shield of Georgia (BCBSGA) has launched a Virtual Open Enrollment center, an easy to use, easy to understand interactive 3-D environment, which can be found at: http://tinyurl.com/23hkhqg.

"The virtual enrollment center is another way that Blue Cross and Blue Shield of Georgia is delivering the best value to our customers and the members we serve," said Morgan Kendrick, President, BCBSGA. "Many businesses tell us they want to improve their systems to more effectively and efficiently communicate important benefit information to their employees. The BCBSGA virtual open enrollment center, designed with input from businesses, was created to meet this need. Ultimately, we believe this will help individuals make the best benefit choices to fit their unique circumstances."

With the virtual enrollment center, employees can access benefits information at their convenience in a single intuitive and interactive location. Upon entering the site, a user will see a 3-D design with their company's logo and a video spokesperson delivering personalized messages. The center has scrolling marquees providing up to date messaging. The user can easily find enrollment information through simple key word searches. In addition, the virtual enrollment center has a content library, housing enrollment materials, documents that can be downloaded, and web links to additional information such as health plan details, provider lists, prescription information and other available health programs.

This is also a valuable resource for human resource departments as they can easily maintain and publish content. The virtual enrollment center gives them the ability to efficiently reach all employees, increase visibility within the organization, track the number of visitors and monitor the usage.

"BCBSGA's virtual open enrollment center has been a great resource for our business and our employees," said Hazel Davis, manager, health and welfare plans for Albemarle Corporation. "We began using this new system last week and already our employee engagement has increased, and the employee feedback has been overwhelmingly positive. Our employees are able to access the center at their convenience, helping them to more effectively select the best benefits for themselves and their families. We have been looking for a way to increase employee engagement and Blue Cross and Blue Shield of Georgia's virtual open enrollment center has been a perfect solution."

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