Posts Tagged ‘health insurance’

States to Determine Their Own ACA Coverage Levels

Wednesday, December 28th, 2011

The Obama administration averted a potentially vicious lobbying battle over the medical benefits insurers must cover under the Patient Protection and Affordable Care Act (ACA) when it handed the decision to the states.  The ruling gives states the power to set coverage levels for the policies uninsured people will purchase through exchanges, starting in 2014.  Business groups will make a case for a narrow set of benefits to save costs while consumer advocates want expanded coverage.  The decision shifts the issue to the states and away from the White House, and lets President Barack Obama say he’s giving governors and legislatures greater flexibility to confront rising medical costs and control changes the 2010 healthcare law is bringing to insurance markets.

“Obama has taken all the grief he can stand over healthcare,” said Erik Gordon, a business professor at the University of Michigan in Ann Arbor.  “He doesn’t want it to give the Republicans any more political ammunition.  He is passing the hot potato to the states.”

“This is significantly more state-flexible and friendly than many would have expected,” said Alan Weil, head of the National Academy for State Heath Policy. What’s to guarantee that the state’s choice of a benchmark plan will be affordable?” asked National Retail Federation Vice President Neil Trautwein.  If coverage is unaffordable today, this doesn’t change the equation.”

Ron Pollack, executive director of Families USA, said Department of Health and Human Services (HHS) would have to provide “strong oversight and enforcement” of the benefit standards as the states implement them.  “It will be important to ensure that adequate coverage across all 10 required benefit categories is provided — marking an improvement over many plans offered today,” he said.  Giving states greater flexibility to determine necessary benefits was perceived as an attempt to defuse criticism that the health reform law gives the federal government too much control over the healthcare system.  A longtime advocate for federal health reform, Pollack also expressed reservations.  “We understand the inclination to balance flexibility, comprehensiveness of coverage, and cost,” he said. “However, flexibility must yield to reliable, comprehensive coverage of benefits for consumers.  It is essential that HHS provide strong oversight and enforcement.”

Under the revised guidelines, state legislature must either set coverage levels in line with widely subscribed small- business plans in their communities, or tie them to benefits included in their state employees’ health plan, federal plans or the largest commercial managed-care plan in the state.  Generally, health plans for small businesses, state employees and federal workers “cover similar services,” including doctors’ visits, hospitalization and outpatient mental health, according to a study conducted by HHS.  Discrepancies arise in areas such as prescription drugs.  While they’re covered as a basic benefit by all government employee plans, only 84 percent of small business plans cover them.  Others require additional premiums.  Small business plans also rarely cover dental care, acupuncture, bariatric surgery and hearing aids, unless states require it.

According to Forbes magazine’s sba.com column, “At a first glance, this seems like it might be a step in the right direction for individuals and small business owners.  However, that is not necessarily the case.  It seems as though the new idea comes with a wide array of new problems.  First, while the new policy will give states flexibility, it imposes more benefit mandates.  The new policy lists 10 ‘essential health benefits’ that the state MUST provide.  Some of these essential benefits are prescription drugs, preventative care, doctor and hospital services, and maternity care.  The new policy allows the states to designate a state-wide ‘benchmark’ health insurance plan, setting the minimum standard of care.  All insurers would then have the ability to change their insurance plans as long as the coverage provided benefits of the same or greater value.  The new ‘more flexible’ plan still seems very rigid and regimented.  Additionally, the new plan would lead to higher-cost insurance premiums, not lower.

“Another long-standing issue with Obama’s idea is that individuals are not clear on what services and benefits are expected to be provided as a minimum.  Instead of clearing up this confusion and spelling out what exactly would be required, Obama has simply put that responsibility on the states – giving them the ‘flexibility’ to design their plans.

“While it may look like Obama is responding to his opponents’ remarks about his previous plan forcing health insurance standards on states, it seems as though this policy change still accomplishes his goals – just through a different means.  Obama can continue to shape and reshape his ideals; however it will be up to the Supreme Court to decide whether the government can require Americans to buy health insurance at all.”

AMA Reaffirms its Support for the Individual Mandate

Wednesday, July 6th, 2011

Despite strong opposition from some member doctors, the American Medical Association (AMA) supports a key element of the Patient Protection and Affordable Care Act (ACA) that requires Americans to buy health insurance.  By a 2 — 1 margin, the AMA’s policy-making House of Delegates voted to continue its support of the individual mandate, saying such responsibility for Americans who can afford to buy coverage was the best option to expand benefits to people who are currently uninsured.  The results of the vote were 326 in favor and 165 opposed.  Without an individual mandate, people will not purchase health insurance until they are sick; that would lead to a spike in premiums for all.

“The AMA’s policy supporting individual responsibility has bipartisan roots, helps Americans get the care they need when they need it and ends cost shifting from those who are uninsured to those who are insured,” said AMA president Dr. Cecil Wilson, a Winter Park, FL. internist.  “Important insurance market reforms, such as an end to denials based on pre-existing conditions, are only possible by having broad participation in the health insurance market.  The AMA reviewed alternatives and concluded that any approach to covering the uninsured that is in line with AMA policy cannot be fully successful in covering the uninsured without individual responsibility for health insurance,” Wilson noted.

After the civil, one-hour individual mandate debate,  Wilson said an “overwhelming” majority of physicians voted to continue the position the association has maintained 2006.  Some delegates raised the issue because the constitutionality of that portion of healthcare reform legislation is being challenged.  “Our concern is that if we are not able to have a requirement that people have an individual responsibility to purchase insurance, we’re not aware of another solution, except something that would say that the government would make a requirement and tax the individuals for that,” Wilson said.  “From our perspective, the concern would be raised that would take us down a path toward a government run system.”

Wilson criticized people who can afford health insurance but refuse to purchase it, “who then arrive in the emergency room having fallen off of their motorcycle – and they did not wear a helmet – and they end up with major life-threatening injuries, the treatment for which very few people could afford.  And the result of that is that all of pay for that, private as well as taxpayers.”  Those are the people who cause those who have health coverage to pay premiums that are “$1,000 a year more than they otherwise would be.”  The reaffirmation vote stipulates that for individuals and families who cannot afford health coverage, there would be government tax subsidies or credits inversely proportional to income.  When asked if the AMA might file an amicus brief to support the Obama administration’s fight to block challenges, Wilson said that is unlikely.

According to Wilson, the delegates’ vote emphasized that “We cannot walk away from the fact that some 32 million more Americans would be able to have insurance and who do not have it now, and that as a result of not having insurance, would live sicker and die sooner.”

Several physicians strongly opposed the mandate,  referring to constitutionality challenges, freedom issues, and the opposition of physicians and numerous medical organizations.  The AMA admits to having lost 12,000 members since 2009, many because of their endorsement of ACA.  “The AMA has turned 180 degrees since the 1950s, when it held that ‘the voluntary way is the American way,'” said Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS).  “Now it has adopted the ‘progressive’ left-wing stance of calling for compulsory purchase of government-prescribed insurance.”  People will no longer be able to choose how to pay their medical bills.  Many might opt for the most affordable way: self-payment of most bills, with low-cost, high-deductible insurance for the rare catastrophe.  “But that choice would deprive the government’s favored plans of some fat premiums,” Dr. Orient said.

With 250,000 of the nation’s physicians comprising its membership,  the influential AMA has historically been opposed to a bigger government role in healthcare.  Physicians who oppose the ACA attempted to convince colleagues that the AMA should change its position.  Some delegates have blamed the Association’s support of the individual mandate for a loss of membership in the AMA in their states.  “I believe that each state, working with the population it has and the specific problems it has, can craft a solution that works better for that state than perhaps the one next door,” said Michael Greene, M.D., a delegate with the Medical Association of Georgia.  Dr. Greene, a family physician, supported the amendment.

Healthcare Reform – 3; Opponents – 2

Wednesday, March 16th, 2011

The score on legal challenges to the Affordable Care and Patient Protection Act is now 3 – 2 – with the Obama administration and healthcare reform in the lead. Nor surprisingly, the three judges who have voted to uphold the law are Democratic appointees, while those who struck down the law are Republican appointees.

The law survived a challenge in federal court in Washington, D.C., the third win in a series of lawsuits attempting to overturn the legislation. U.S. District Judge Gladys Kessler threw out a lawsuit brought in June by five individuals who claimed the requirement that people obtain minimum insurance coverage starting in 2014 is unconstitutional.  Judge Kessler said Congress was acting “within the bounds” of its constitutional Commerce Clause power when it imposed the insurance requirement.  “The individual decision to forgo health insurance, when considered in the aggregate, leads to substantially higher insurance premiums for those other individuals who do obtain coverage,” Kessler wrote.  “Thus, the aggregate effect on interstate commerce of the decisions of individuals to forgo insurance is very substantial.”

A right-wing group called the American Center for Law and Justice (ACLJ) is appealing Judge Kessler’s ruling.  The group maintains that it is unconstitutional for the law to require that each person purchase insurance; they perceive it as a move towards adopting socialized medicine.  According to the appeal, the group wants to spare Americans “all of the horrors you have heard coming out of Canada (and) Europe, where it is a bureaucrat who decides — not your doctor — what care you have.”  According to Edward White, an attorney with the ACLJ, “That does not mean that Congress cannot fix the healthcare problem we have in this country.  It’s just the way they’re going about it now by requiring people to act and buy a product and using its Commerce Clause power to an extent that is beyond what Congress has ever done in the 200 some odd years of this country.”

Judge Kessler could not disagree more strongly: “To put it less analytically, and less charitably, those who choose — and Plaintiffs have made such a deliberate choice — not to purchase health insurance will benefit greatly when they become ill, as they surely will, from the free healthcare which must be provided by emergency rooms and hospitals to the sick and dying who show up on their doorstep,” she said.  “In short, those who choose not to purchase health insurance will ultimately get a ‘free ride’ on the backs of those Americans who have made responsible choices to provide for the illness we all must face at some point in our lives.”

Nearly one year after President Obama signed the healthcare reform bill, more than half of the states have challenged the legislation in the courts. In comments filed in a Florida federal court, representatives of the 26 states that successfully challenged the healthcare reform law asked the judge to halt the healthcare law’s implementation, according to The Hill. The comments are a response to the Obama administration’s request that U.S. District Judge Roger Vinson explain his January 31 ruling that the healthcare reform law is unconstitutional.  Of five federal court rulings on the reform law so far, Judge Vinson’s is the only one that strikes down the entire law.

Additionally, Florida and Alaska have declared the reform law effectively dead unless an appellate court reverses the decision.  Court comments by the 26 states – which were backed by the National Federation of Independent Business — said the Obama administration should have requested a stay, pending appeal, rather than request a clarification.  “If the Government was not prepared to comply with the Court’s judgment, the proper and respectful course would have been to seek an immediate stay, not an untimely and unorthodox motion to clarify,” the plaintiffs wrote.

Uninsured Americans Total 9.4 Percent of the Population in 2009

Wednesday, October 6th, 2010

The number of Americans with no health insurance climbed in 2009, along with a rising poverty rate.As Congress debated healthcare reform, the number of Americans who lack healthcare insurance climbed approximately 9.4 percent to 50.7 million people in 2009.  According to U.S. Census Bureau statistics, 16.7 percent of Americans have no healthcare insurance compared with 15.4 percent — or 46.3 million people — the previous year.

During the same time period, the poverty rate in the United States rose to 14.3 percent, the highest level since 1994. The 2008 rate was just 13.2 percent.  This means that 44 million Americans – one in seven people – are living in poverty, an increase of four million over the previous year.  Children were especially hard hit, with one in five under the age 18 living in poverty, according to the Census Bureau.

“This is the highest number of uninsured since 1987, the first year that comparable uninsured data was collected,” said David Johnson, chief of the Census Bureau’s Household Economic Statistics Division.  The report includes conclusions from the 2010 Current Population Survey Annual Social and Economic Supplement.

Census Bureau statistics reveal that the number of Americans covered by private health insurance fell from 201 million to 194.5 million in 2009 compared with the previous year.  Employment-based health insurance fell from 176.3 million covered to 169.7 million.  Meanwhile, Americans with government health insurance rose to 93.2 million from 87.4 million.

Some Healthcare Insurers Refuse to Sell Child-Only Policies

Monday, October 4th, 2010

Insurers who refuse to sell child-only policies are creating a political firestorm.  Some of the nation’s largest insurers are in open rebellion against a provision contained in the new healthcare reform law that is already in effect.  The shot across the White House’s bow is a decision by several insurers to stop selling child-only policies instead of complying with the law that blocks them from turning away kids with pre-existing conditions.  Anthem Blue Cross, Aetna, Inc., and others are refusing to sell the policies in states such as California, Illinois, Florida and Connecticut – even though the law requires that insurers cover children under 19 even if they have a history of illness.  Approximately 500,000 children nationally are impacted by this action.

The insurers claim that the new requirement will result in unforeseen costs related to covering eligible children.  The scenario they envision is that parents might buy policies for their children only after they get sick, creating a surplus of kids who suddenly need insurance coverage.  The decision by some of the big insurers to abandon this niche marketplace means that just a few firms will be forced to share what could be an enormous financial burden.  The good news is that relatively few child-only policies are sold.

The Obama administration immediately denounced the action.  White House Press Secretary Robert Gibbs told reporters “It’s obviously very unfortunate that insurance companies continue to make decisions on the backs of children and families that need their help.”

The stakes are especially high in California.  Legislation awaiting Governor Arnold Schwarzenegger’s approval would ban companies that refuse to sell child-only policies from selling insurance in the profitable individual market for five years.  Assemblyman Mike Feuer (D-Los Angeles), who wrote the bill, said “At a time when we are launching a national approach to ensure that all children have access to healthcare, Anthem’s actions represent a step backwards.  By threatening to drop child-only policies in California, the company jeopardizes the health of families and children.  I call on Anthem to reconsider its plan.”

Republicans “A Pledge to America” Vows to Repeal the Affordable Care Act

Sunday, October 3rd, 2010

House Republicans want to repeal the Affordable Care Act.Republicans are threatening to repeal the Patient Protection and Affordable Care Act as part of their “A Pledge to America” proposal.  On the six-month anniversary of healthcare reform’s enactment, House Republicans issued their “Pledge” , which proposes overturning the law and replacing it with “real reforms” focusing on medical liability reforms to control “junk lawsuits” and defensive medicine.  Other elements of the “Pledge” would expand health saving accounts; ban taxpayer funding of abortion; allow people to buy insurance across state lines; assure access for patients with pre-existing conditions by expanding state high-risk pools and reinsurance programs; as well as cutting the cost of coverage.

According to Stephanie Cutter, assistant to the president for special projects, “The (Republicans’) agenda claims to protect people with pre-existing conditions, but it repeals the new law’s ban on discriminating against uninsured Americans, including children who have a pre-existing condition.  It will mean that seniors will pay more for their prescription drugs, and their new free preventive Medicare benefits will be cut.”

Ron Pollack, executive director of Families USA, noted that the GOP proposal “will raise taxes by more than $40 billion on up to four million small businesses that provide health benefits to their employees…and will result in premium increases by eliminating the billions of dollars in cost-saving measures.”

Democratic lawmakers assailed the “Pledge” as recycled ideas that will only intensify the nation’s problems.  “Republicans want to return to the same failed economic policies that hurt millions of Americans and threatened our economy,” said Nadeam Elshami, a spokesman for Speaker of the House Nancy Pelosi (D-CA).  Even if Republicans vote to repeal the Affordable Care Act, President Barack Obama still has the power to veto their legislation.  It’s likely that he would use his veto power to protect one of his major legislative achievements.

Healthcare Consumption Shows Systemic Waste

Monday, September 27th, 2010

More than half of America’s 354 million annual acute-care visits – for fevers, stomach aches or coughs – typically take place in a hospital emergency room rather than in a primary-care physician’s office. This statistic was revealed in a study of systemic waste published in the journal Health Affairs. According to the study’s authors, their findings underscore a valid question about the healthcare reform law – how can a system that is already overwhelmed provide care to an additional 32 million newly insured patients?

The study, led by Dr. Stephen R. Pitts, an associate professor of emergency medicine at Emory University, examined acute-care visit records from 2001 to 2004 and found that 28 percent were to the emergency room.  This was particularly true for weekend and after-hours visits.  More than 50 percent of acute-care visits by patients who lacked health insurance were to emergency rooms, which are required by federal law to threat anyone with a serious condition.  This places a heavy financial burden on hospitals, which are compelled to provide basic care in what is admittedly an expensive environment.  Often, there is little or no follow-up to determine progress or secure follow-up care.

“More and more patients regard the emergency room as an acceptable or even proper place to go when they get sick,” according to Dr. Pitts.  “And the reality is that the E.R. is frequently the only option.  Too often, patients can’t get the care they need, when they need it, from their family doctor.”  The Affordable Care and Patient Protection Act is anticipated to boost primary care by increasing reimbursements for physicians, attracting students to the field with incentives; expanding community health facilities; and encouraging accountable-care organizations and medical homes.  “If history is any guide, things might not go as planned,” Dr. Pitts wrote.  “If primary care lags behind rising demand, patients will seek care elsewhere.”

Left and Right Give Thumbs Down to Health Insurance Mandate

Thursday, January 14th, 2010

The left, right and insurance industry are unhappy with the healthcare insurance mandate.  There’s one element of healthcare reform legislation on which many liberals and conservatives agree – the mandate.  Both the Senate and House versions of the healthcare reform bill contain a mandate requiring that all Americans be insured – whether it is through their job, the government or the private market.

From the right, there’s criticism from Michael Cannon, a health policy analyst at the libertarian Cato Institute, who says “The federal government does not have the power to force you to purchase a private product.”  From the left, Jim Dean, chairman of Democracy for America, notes that “We’d like to see the individual mandate stripped.  It was fair given the presence of a government entity that could provide competition and control the cost.  It’s not fair if people are required to buy insurance from the same insurance industry that caused this problem.”

The reasoning behind the mandate reflects the basic concept that underlies all insurance.  A large pool of people pays fairly small premiums to create a fund large enough to take care of people who need help.  The idea that people of all ages participate is of particular importance in healthcare, because costly medical conditions are found primarily in Americans who are middle-aged or older.  When younger and healthier people don’t have insurance, the others pay higher premiums.

The insurance industry has a totally different reason for disliking the mandate – they think it’s too mild.  Robert Zirkelbach, spokesman for America’s Health Insurance Plans, believes that “We think there’s more that (the bill) needs to do.  There’s still a strong incentive for people to wait until they are sick to purchase insurance.”  Zirkelbach is referring to one of the legislation’s hallmark features – the requirement that insurers treat those with pre-existing conditions the same as all other patients and bans denying coverage.

Tom Harkin Taking Up Ted Kennedy’s Healthcare Reform Torch

Wednesday, October 14th, 2009

Harkin on KennedySenator Tom Harkin (D-IA), the liberal who succeeded Senator Ted Kennedy as chairman of the Senate Health Committee, is predicting that Congress will pass healthcare reform with a public option before year’s end.

Harkin, who recognizes that there is opposition to the Health Committee’s bill, believes his fellow Democrats will join with President Barack Obama to pass a wide-ranging healthcare reform bill that the late Kennedy described as “the cause of my life.”

President Obama is championing an insurance marketplace where people who lack employer-provided healthcare can purchase coverage.  This exchange would encompass private insurance companies and a public option to create competition aimed at driving down high premium prices.  The majority of Republicans and some conservative Blue Dog Democrats oppose the public option, claiming it would have an unfair competitive advantage by offering lower prices.  They reason that this would drive private insurers out of the market.

Because of Senate procedural rules, Democrats need 60 votes to avoid a Republican filibuster to delay the legislation.  With Massachusetts Governor Deval Patrick’s appointment of Paul Kirk to fill Ted Kennedy’s Senate seat until next January’s special election, the Democrats now have that bullet-proof majority – assuming Harkin can bring the Blue Dogs into line.

“I’m convinced we’re going to have a healthcare reform bill on the president’s desk before we go home for Christmas,” Harkin said.  “And there will be some form of public option.  There’s a lot of support for it.  We’re not going to accept defeat.”

Where Is the Republicans’ Healthcare Reform Plan?

Tuesday, October 13th, 2009

Amidst all the commotion at town hall meetings and attacks on President Barack Obama’s healthcare reform guidelines, the question arises:  where is the Republican Party’s plan?  The answer is that Republican Congressional leaders chose not to draft a bill encapsulating their own vision.

US-CONGRESS-HEALTH CARE REFORMSome Republicans are challenging this “party of no” moniker.  Louisiana Governor Bobby Jindal, who has 2012 presidential aspirations, said it’s time for the GOP “to pivot and say, in addition to emphasizing what we oppose, here are our proposals” for healthcare reform.  Responding to Jindal, Senator Richard Durbin (D-IL) sees an opportunity to counter Republican attacks on Obama’s proposals, noting that “The Grand Old Party’s coffers are empty when it comes to healthcare reform.”

A “Republican Solutions Handbook” created by the House Republican Conference possibly has the most comprehensive summary of GOP healthcare proposals.  The single-page document offers plans to limit medical malpractice lawsuits and dedicate more resources to stopping “waste, fraud and abuse” in Medicare and Medicaid.  Proposed tax cuts would go to workers without employer-provided health plans and to low-income people to help them buy private insurance.

Representative Roy Blunt (R-MO) has been of two minds on the issue.  On June 17, he said “I guarantee you, we will bring you a bill that costs far less, far less than the Democrats’ and will provide better results for the American people.”  A month later, Blunt wrote on his blog: “Our bill is never going to get to the floor, so why confuse the focus?  We clearly have principles; we could have the language, but why start diverting attention from this really bad piece of work they’ve got to whatever we’re offering right now.”