Posts Tagged ‘President Barack Obama’

GOP VP Candidate Paul Ryan Advocates “Medicare Premium Support”

Wednesday, September 5th, 2012

Now that Representative Paul Ryan (R-WI) has been selected by former Governor Mitt Romney (R-MA) as his vice presidential running mate, the debate is focusing on the Wisconsin representative’s plan to reform Medicare.  Known as Medicare Premium Support, it “refers to a system under which Medicare enrollees would pick from a menu of competing plans with a fixed government payment to help defray premium costs.  Enrollees would be on the hook for any charges above the government contribution.  But they could save money by selecting a plan with a premium below the federal subsidy.”

Ryan says that under his plan, the government’s contribution toward premiums will equal the cost of the second least expensive plan in any market — or traditional Medicare — whichever costs less.  Ryan believes that his plan is politically feasible because it doesn’t begin until 2022 with the result that it retains traditional Medicare for Americans who were 55 and older in 2011 — meaning that baby boomers are exempt from the changes.  Democrats who oppose the plan contend that Ryan’s Medicare overhaul would subject seniors to the vagaries of the private market, leaving them with little protection against rising premiums and negligible benefits.

So what is the difference between the Democratic and Republican cuts to Medicare?  The ACA stresses government control and central planning. The law creates a panel of 15 unelected government officials, called the Independent Payment Advisory Board (IPAB) to direct changes that will shrink spending by cutting physician and hospital reimbursement.  The Wyden-Ryan plan preserves the ACA’s targets for future Medicare spending, but uses competitive bidding.  Seniors would have the same benefits that they do now, and would have the option of choosing from several government-approved private insurance plans.

The Republican budget targets Medicare growth of GDP plus 0.5 percent, just as the 2013 Obama budget does. The difference lies in the fact that the GOP budget repeals the ACA, while maintaining that law’s Medicare cuts.  The Democratic budget leaves the ACA in place.

Writing in the Washington Post, Ezra Klein puts the difference in a nutshell:  “The difference between the two campaigns is not in how much they cut Medicare, but in how they cut Medicare.”

In an exclusive interview with Modern Healthcare magazine, Ryan says that “This is an idea whose time has come.  And it’s a bipartisan idea.  What Representative Ron Wyden (D-OR) and I tried to do was to plant the seeds of a bipartisan consensus.  We knew we weren’t going to pass it because of the politics.  We did this together to get the consensus-building started.”  Ryan believes that the plan’s chances for approval will greatly improve in 2013 — especially if the Romney/Ryan team wins the November 6 presidential election.  “I’m actually pretty optimistic,” he said, noting that the United States should reform healthcare on its own terms and “fix this on our terms” instead of borrowing European ideas.  “We believe there are far superior ways to get back to a patient-centered healthcare system, the nucleus of which is the patient and doctor — and not the government,” Ryan said.  “We believe consumer-driven, market-based reforms do more to alter the cost curve of healthcare inflation.”

If Ryan’s plan is enacted into law, people 55 and younger would see a change from one in which everyone gets the same set of government-paid benefits to one in which the government gives all senior citizens a fixed amount of money.  They could use this to purchase private insurance or pay a portion of the cost of enrolling in traditional Medicare.  Ryan has not said how much the premium support payment would be.  But he would limit the annual growth rate to no more than one-half percent more than the economy’s overall growth rate, even though healthcare costs are rising at a significantly faster pace.  Ryan’s plan would also raise the Medicare eligibility age to 67 from 65 by 2034.

Not so fast,” Democrats warn as partisans from both parties accuse the other side of throwing senior citizens under the bus.  “Make no mistake about it — these Republicans don’t believe in Medicare,” Obama campaign senior adviser David Axelrod said.  “They want to turn it into a voucher program.  And slowly, all the burden is going to shift to seniors themselves.  And that is not an answer to entitlement reform.”

Republicans counter that $716 billion in cuts to Medicare are already a part of the Patient Protection and Affordable Care Act (ACA).  An online video created by the Republican National Committee features Ryan saying that Democrats “have refused to make difficult decision because they are more worried about their next election than they are about the next generation.”  According to Ryan, “We won’t duck the tough issues; we will lead.”

Uwe Reinhardt, a healthcare economist at Princeton University disagrees, saying that rather than motivating insurers to control their costs, the Ryan plan will not benefit seniors.  “You’re essentially shoving these guys out on a boat, saying, ‘We’ll give you a push, but if the waves are rough, you’re on your own,” he said.  “It would really worry me if I were a middle-class American.”

HHS Sets November 16 Deadline for Healthcare Marketplace Details

Wednesday, July 11th, 2012

States must give detailed information to the federal government by November 16 – just 10 days after the 2012 presidential election – on how they intend to run their online insurance marketplaces, according to Kaiser Health News.  States that miss the deadline — or can’t operate their own marketplaces – will have it done for them by the federal government, starting in January 2014.

The marketplaces, which are mandated by the Patient Protection and Affordable Care Act (ACA), are designed to increase competition among insurers and make coverage more affordable.  States can opt to run the exchanges, perform limited services, or yield control to the federal government.  The Department of Health & Human Services (HHS) “will seek to harmonize…policies with existing state programs and laws wherever possible.”  Although the guidance does not state whether there will be a governing board overseeing the federal exchanges, it does say the federally-overseen marketplaces will accept any insurer that meets the basic requirements.  Consumer groups, such as the American Cancer Society Cancer Action Network, wanted the federal government to be more selective, in hopes that it would make insurers compete more on pricing and quality measures.

Steve Larsen, the federal official overseeing the federal exchange creation, said the initial approach will be an open marketplace, although in the future, other options may be explored.  States that operate their own exchanges are free to choose whichever model they prefer.  While many states are moving forward – 34 have received federal grants to fund planning efforts – others are moving slowly or not at all.  Six states — Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington – recently received additional grants totaling more than $181 million.

Officials in some state say they are holding back pending the Supreme Court’s decision on the constitutionality of the ACA.  The court could uphold the entire law, strike it down entirely or eliminate some parts of it.  Other state lawmakers have said they want to hold off on creating marketplaces until after the November election.  Larsen reiterated the government’s stance that the court will uphold the law and that President Obama will be re-elected, noting that “states should turn their attention to moving forward.”

The ACA requires states to establish exchanges that offer federally subsidized health coverage to an estimated 16 million people who currently lack healthcare insurance.  The exchanges let consumers purchase their insurance from an easily readable menu of competing plans, at premiums set on a sliding scale according to the buyer’s income.

“What this shows is that states are making real progress in delivering quality, affordable health coverage to their residents and they want to be up and running by January 2014,” said Kathleen Sebelius, HHS Secretary.  She said that 34 states — including some that want the ACA overturned — and the District of Columbia have accepted federal grant money to help establish the insurance exchanges.  Approximately 15 states have moved to establish exchanges, either through legislation or executive order.

HHS also released guidelines for helping states that might not be able to offer full exchange services by 2014 and for establishing federal exchanges in states that refuse to participate.  According to officials, the administration will partner with state governments in two realms: certifying health insurance providers for the exchanges and helping consumers apply for coverage and enroll in the chosen plan.

Karen Ignani, President of America’s Health Insurance Plans, is taking a wait-and-see attitude According to Ignani, “Exchanges work best when they are true marketplaces that maximize choice and competition so that individuals, families, and small businesses can purchase plans that are right for them.  States are in the best position to establish exchanges because they have the experience and local-market knowledge to meet the consumers’ needs.  If a state chooses not to establish its own exchange, any exchange that is implemented should seek to preserve consumer choice and avoid regulatory duplication that will add complexity and increase costs for consumers.  We appreciate that the Department has prioritized minimizing administrative burdens, encouraging choice, and preserving the states’ traditional role of regulating health insurance as these exchanges are developed.  Allowing all health plans that meet new quality and performance standards to offer coverage in an exchange will help ensure competition and preserve consumer choice.  Moreover, we agree that exchanges should be developed with input from all stakeholders to ensure they are able to provide individuals, families, and small businesses with the most accurate and up-to-date information about all of their coverage options.”

6.6 MillionYoung Americans Now Have Healthcare, Thanks to the ACA

Tuesday, June 26th, 2012

More than 6.6 million young adults aged 26 and younger were enrolled in their parents’ insurance plans last year because of the Patient Protection and Affordable Care Act (ACA), the largest single-year increase in medical coverage for the age group.  The section of the law that allows young people to remain on parental plans helped boost coverage during tough economic times, said Sara Collins, vice president for affordable health insurance at the Commonwealth Fund.

The benefit for young adults is one of the most popular parts of the ACA as young adults face a labor market that makes it difficult to find a job with healthcare coverage.  Unemployment among 16- to 24-year-olds is 16.1 percent, almost double the 8.2 percent rate for the nation as a whole.  “The economy is absolutely a factor in both the large number of adults who are without health insurance and likely the number coming onto their parents’ policies,” Collins said.  The ACA “came at a really good time for young adults, in terms of the poor job market.”  Adding young adults to their parents’ coverage was one of the first provisions of the law enacted.  Approximately 71 percent of Americans polled by the Kaiser Family Foundation said they viewed that provision favorably.  The ACA in its entirety is less popular, with an approval rate of 37 percent, and an unfavorable view by 44 percent of those surveyed in May, according to Kaiser’s monthly tracking poll.

President Barack Obama’s $1 trillion, 10-year plan to overhaul the healthcare system was passed by Congress in 2010 without a single Republican vote.  Parts of the law were then challenged as unconstitutional by 26 states.  The Supreme Court is slated to rule on those objections, a decision that could overturn the law.  The head of a caucus of 21 Republican lawmakers with medical backgrounds said that no matter the outcome, he will try to preserve the coverage for young adults and for people with pre-existing medical conditions.  Representative Phil Gingrey (R-GA), an obstetrician-gynecologist, believe that the young-adult provision is “a good policy.”

Despite this, the Commonwealth Fund report found that almost 40 percent of young adults between the ages of 19 and 29 did not have health insurance in 2011.  Another finding is that more than 36 percent of young adults had medical bill problems or were in the process of paying off medical debt.  Of those young Americans, 43 percent were experiencing serious financial troubles; 32 percent had trouble making their student loans or tuition payments; 31 percent deferred education or career plans, and 28 percent couldn’t afford food, heat or rent because of medical bills.

Because of the high cost of healthcare, young Americans are not having prescriptions filled, skipping recommended tests or treatments, avoiding doctor visits and failing to get specialist care when they need it.  And, according to doctors. young adults don’t listen to medical advice once they hear how much treatment costs.

Dr. Jeffrey Hausfeld is well aware of the debt problem.  As co-owner for FMS Solutions, a collection agency that specializes in medical debt, Hausfeld has seen a 50 percent increase in the amount of debt held by young adults over the last several years.  He cited “the tremendous cost shift” to patients caused by high-deductible insurance plans, co-payments and co-insurance, said Hausfeld, an ear, nose and throat doctor who no longer practices.  “Getting sick isn’t something that a healthy 26-year-old expected to have to pay for.  They didn’t budget for it,” Hausfeld said.  “Now they’re sitting with a $10,000 hospital bill and they don’t know what to do.”

“While the Affordable Care Act has already provided a new source of coverage for millions of young adults at risk of being uninsured, more help is needed for those left behind,” Collins, said.  “The law’s major insurance provisions slated for 2014, including expanded Medicaid and subsidized private plans through state insurance exchanges, will provide nearly all young adults across the income spectrum with affordable and comprehensive health plans.”

Commonwealth Fund President Karen Davis said that the survey is a hopeful indicator at a time when millions of Americans have trouble getting access to needed healthcare.  “The new report…shows that implementation of the law has already begun to make a difference for young adults, their families and other Americans,” she said.  Allowing young adults, the majority of whom are healthy, to remain on their parents’ health plans is not as expensive as expanding coverage to populations with higher medical costs, although independent analyses estimate the expansion could boost premiums one percent to two percent.

Young Americans who had no healthcare coverage faced the greatest risk: 51 percent with a gap in coverage had a medical bill problem or medical debt.  The costs could be substantial.  One-quarter of young adults paying off medical debt owed $4,000 or more; 15 percent reported $8,000 or more in debt.  Among those who were paying off debt, 31 percent owed $4,000 or more; 21 percent had $8,000 or more; and 11 percent had $10,000 or more.

“There’s no question that young people have cut back on high-value screenings, doctor visits and therapies,” Dr. Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design, said.  “You twist your knee playing soccer and you go to get an MRI.  But if the doctor says you have to pay 50 percent of the cost, you’re going to be less likely to go through with it,” he said.

Health Insurer OKs Reform No Matter What the Supreme Court Does

Monday, June 18th, 2012

Even if the Supreme Court declares the Patient Protection and Affordable Care Act (ACA) unconstitutional, UnitedHealth, the nation’s largest health insurer will still cover certain types of preventive care. The extensions will apply primarily to its customers who have individual policies or small-group health insurance through their employer, a minority of its 35 million total members.  The ACA, whose goal is to provide coverage for millions of uninsured people, started unfolding in 2010 after health insurers fought to block its passage.  Challenges to the law from states and other groups opposed to it wound their way to the Supreme Court.  Bob Laszewski, a consultant and former insurance executive, UnitedHealth’s move a “very smart business decision.”  The provisions are relatively inexpensive and are already factored into the coverage price.  If insurers cut these benefits, customers probably will expect a corresponding premium drop, he noted.  “It would probably be more trouble to roll these things back than go ahead with them,” Laszewski said.  “It just makes common sense to leave these things in there and not take these benefits away since they’re already priced in.”  Laszewski expects other insurers and large employers to take a similar approach.

The provisions UnitedHealth will maintain include providing coverage for dependents up to age 26 under their parents’ plan.  The company will still offer certain preventive healthcare services without requiring a co-payment.  These include yearly check-ups, screening for high-blood pressure and diabetes, and immunizations.  Additionally, UnitedHealth will continue to forgo lifetime dollar coverage limits on policies.  “The protections we are voluntarily extending are good for people’s health, promote broader access to quality care and contribute to helping control rising healthcare costs,” UnitedHealth Chief Executive Officer Stephen Hemsley said.  “These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue.”

The ACA is the largest overhaul of the $2.6 trillion American healthcare system in nearly a half century.  It is designed to ultimately expand coverage to more than 30 million uninsured Americans, by setting up insurance exchanges and opening Medicaid for low-income Americans.

According to estimates, the ACA let approximately 6.6 million young adults remain on their parents’ health insurance plans last year, according to a report from The Commonwealth Fund. If the law is declared unconstitutional, Republican lawmakers may reinstate the extension of young adults dependent coverage.  Other provisions that UnitedHealth plans to maintain include providing easily understandable ways for members to appeal coverage claim decisions; and eliminating rescissions, which are considered to be retroactive policy cancellations, except in the case of fraud.  DeAnn Friedholm, director for health reform at the Consumers Union, called UnitedHealth’s actions “a positive step” and said she hopes other companies follow suit should the law be struck down.

Ronald Pollack, executive director of the consumer advocacy group Families USA and a supporter of the law, applauded UnitedHealth’s move.  “It would make a huge difference for a great number of people who would otherwise be left out in the cold in terms of getting coverage,” he said. “And hopefully, given UnitedHealthcare’s market share, this would have tremendous influence on other companies.”  Even if other large insurers follow suit, Pollack said, it would hardly make up for the loss of other provisions in the law that are set to take effect in 2014 — including subsidies to help low-income Americans buy insurance and bans against discriminating against adults with preexisting conditions.

Writing for CBS News, Stephanie Condon says that UnitedHealth’s decision “Could also alter the political fallout from the high court’s decision.  Should the Supreme Court reject President Barack Obama’s law, he could point to UnitedHealthcare’s announcement to validate his policy agenda.”

The Associated Press’ Ricardo Alonso-Zaldivar points out that dismantling the ACA could be messy.  “It sounds like a silver lining.  Even if the Supreme Court overturns President Barack Obama’s healthcare law, employers can keep offering popular coverage for the young adult children of their workers.  But here’s the catch: The parents’ taxes would go up.  That’s only one of the messy potential ripple effects when the Supreme Court delivers its verdict on the Affordable Care Act this month.  The law affects most major components of the U.S. healthcare system in its effort to extend coverage to millions of uninsured people.  Because the legislation is so complicated, an orderly unwinding would prove difficult if it were overturned entirely or in part.  Better Medicare prescription benefits, currently saving hundreds of dollars for older people with high drug costs, would be suspended.  Partially overturning the law could leave hospitals, insurers and other service providers on the hook for tax increases and spending cuts without the law’s promise of paying more to offset losses.”

Federal Government Bets $2 Billion on Oregon Medicaid Program

Thursday, June 14th, 2012

Oregon Governor John Kitzhaber, a former emergency room physician, has convinced the Center for Medicare and Medicaid Services (CMS) that he can significantly improve Medicaid treatment and do it cheaper by altering the way the sickest people in his state get healthcare.  If Kitzhaber’s experiment works, it could have repercussions for the entire nation.  According to Kaiser Health News, Oregon’s major cities — Portland, Salem and Eugene — will have their own umbrella groups for treating the Medicaid population, in effect, a “coordinated care organization.” (CCOs)  Under these umbrellas will be a majority of the heavy hitters in the health sector including hospitals, doctors, mental health providers and dentists.

Kitzhaber wants to switch Oregon’s 600,000 Medicaid patients into CCOs, which will accept a flat fee for delivering each patient’s care while remaining within that budget, with bonuses for quality metrics.  If patient care costs more than the flat fee, healthcare providers must eat the difference.

Kitzhaber’s idea is that healthcare businesses will stop competing for patients and instead link to each other electronically so that it’s easier for providers to share information.  Patients can see whichever provider they need to get maximal care.  The sickest people will have a $20-an-hour outreach worker to assist them in navigating the system and avoiding pricey hospitalizations.  Each outreach worker will manage a caseload of approximately 30 patients – with the goal of saving Medicaid hundreds of thousands of dollars.

I think this is really a defining moment for health care in the State of Oregon and, I think that if we’re successful, probably for healthcare beyond our borders,” Kitzhaber said.  The plan is supported by both Republicans and Democrats, with the state’s leaders putting their political reputations on the line for this deal.  The legislature passed its entire budget in the belief that the federal government was going to fund the program.  Unions and businesses in Oregon also support the program.  Malia Wasson, the president of US Bank in Oregon, celebrated the news.  “Governor, I know that you’re not prone to being overly demonstrative,” she said.  “But would you indulge me with a high five?”

Naturally, there are skeptics.  State Representative Jim Weidner voted against the Medicaid bill.  “It doesn’t really drive down the cost of healthcare.  It’s just shifting costs into different spots,” Weidner said.  He believes that the program ultimately will cost the state money.  Kitzhaber disagrees, noting that the coordinated care organization will be paid with a lump sum to manage Medicaid patients.

Under Oregon’s present system, hospitals and doctors don’t have a financial incentive to make people better.  To the contrary, if a patient keeps coming back, the provider keeps getting paid.  Under the new system, the faster a patient recovers, the coordinated care organization can keep more money.  Kitzhaber believes that over the next five years, Oregon will be able to save Medicaid every cent of the $2 billion the state’s been promised.

“We estimated that if every state Medicaid program in the country were to adopt this model, the net savings would be about $1.5 trillion dollars over 10 years,” Kitzhaber said.  Congress is looking at $1.2 trillion in cuts over the next 10 years after the super committee failed to come up with budget cuts.  Despite the fact that Oregon is pleased with itself, the federal government has said that if the state doesn’t show cuts to Medicaid spending by two percent next year, the new money could dry up.

Oregon is the only state to attempt to rethink Medicaid backed by federal tax dollars, said Dr. Roger Stark, a physician and healthcare policy analyst with the Washington Policy Center.  “The Oregon program is based on an HMO model which ties into quality controls to hold costs down.  But Oregon is broke, and they didn’t have the seed money to start the program because like all the states, they’re broke.  Oregon really stood on its head, and the CMS gave in.  Oregon’s program lines up with President Barack Obama’s law, and they probably sold it to the administration as a sort of pilot program,” Stark said.

According to Stark, the CCO approach resembles the HMO model, which was reviled by doctors and patients.  “The physicians hated it because they couldn’t control treatment decisions and had to focus on cutting costs, and the patients hated it because they couldn’t get complete treatment — they had no trouble seeing a primary care physician, but it was extremely difficult seeing a specialist,” Stark said, noting that rationing is inevitable under this approach.  “Oregon told CMS they could save money, which is pie in the sky.  Instead, there will be some form of rationing because they’re dealing with a fixed amount of money.  The rationing will be subtle and insidious.  Say you’re 60 years old and need a hip or knee replacement; they will tell that patient, ‘Oh, you don’t need that operation.’  Or they will tell him, ‘Take these pills, not those,’” Stark said.

Handicapping the ACA’s Fate

Wednesday, June 13th, 2012

As the nation anticipates the Supreme Court decision on the future of the Patient Protection and Affordable Care Act (ACA),  pointed questioning by justices has supporters and opponents facing the possibility that the law could be declared unconstitutional.  That would eliminate — along with the contentious mandate that people purchase health insurance — popular provisions such as letting young adults stay on their parents’ plans until age 26, making prescription drugs more affordable for seniors, and requiring insurers to cover those with pre-existing medical conditions.

Even if the court keeps most of the law intact and strikes down the individual mandate, many healthcare advocates, insurers, and legislators believe that these consumer protections will be meaningless.  “There are a series of provisions of the law which have already been enacted which have proven to be fairly popular,’’ said Andrew Dreyfus, president and CEO of Blue Cross Blue Shield of Massachusetts.  “The question nationally is will there be bipartisan consensus to maintain those provisions even if the Supreme Court overturns some aspects of the law or the whole law?’’

Congress has been disinclined to talk about contingency plans, or the possibility of compromise.  There is agreement  that nothing will be done before November’s presidential election.  “Repeal and replace is a good slogan, but what kind of replacement are we talking about?’’ asked Gail Wilensky, a healthcare economist who administered Medicare and Medicaid under George H.W. Bush.  “Is it a replacement that will substantially extend coverage for people who have been uninsured?  At the moment it’s a little hard to see that happening.’’

“It’s a standard rule of politics that people value losses more than hypothetical gains,’’ said John McDonough, director of Harvard University’s Center for Public Health Leadership and who helped the Senate write the ACA.  “If the court were to strike down significant parts of the law that are already in place, there could quite possibly be a potent public reaction against what is being taken away from people.’’

In an interview with Kaiser Health News, Jon Kingsdale, Executive Director of the Commonwealth Health Insurance Connector Authority, who is working to implement the ACA said “We’re working with about a dozen states, and they fall, I’d say, into three camps: One, working very, very hard with a real strong vision of what they want to set up, to implement by October 1, 2013 – which is less than 18 months away.  Others that are planning – they’re preparing.  They’re waiting to see, in fact, if it’s implemented after the Supreme Court decision, which is expected to be announced in June – and/or the election in November.  And then there are states, frankly, we are not working with that are pretty much waiting to see this go away.”

Kingsdale believes that the entire law will not be thrown out by the Supreme Court.  “I think their striking down the entire law is much less probable than striking down the mandate,” he said.  “I’ve begun to talk to people in insurance companies and states and vendor organizations about what happens if the entire law is struck down, and I am struck by the lack of anticipation of what that would mean.  People are aware that there are huge problems. There are many things that have been implemented already, in terms of insurance coverage and Medicare payment policies and accountable care organizations, the authorization of which would be undercut.”

David Axelrod, chief campaign strategist to President Barack Obama, is denying reports that the White House may revisit healthcare in his second term.  “Our hope and our expectation is that the Supreme Court will affirm the healthcare law,” Axelrod said.  “Now is not the time to speculate on that.  We believe that the law is constitutional.  The Affordable Care Act is also really important to the health and well-being of the American people,” Axelrod said. “It is already helping people all over this country, and has improved the position of people relative to their insurance companies, and the kind of policies they are getting and the return they are getting for the premiums they are paying.”

Rest of the World Beats the U.S. on Healthcare Reform

Tuesday, May 22nd, 2012

As Americans debate whether the Patient Protection and Affordable Care Act (ACA) and its promise of guaranteed healthcare coverage should be overturned, a surprising number of less affluent nations are moving to provide medical insurance to all citizens.  Many political leaders globally have concluded that creating a system of universal healthcare is essential to remaining competitive and supporting economic growth.

After years of underfunding healthcare, China is completing a three-year, $124 billion initiative that will cover more than 90 percent of its population.  Mexico, which 10 years ago covered less than 50 percent of its population, just completed an eight-year drive for universal coverage that has noticeably expanded access to lifesaving treatments for diseases.  In Thailand, where the GDP per person is 20 percent of America’s, just one percent of the population doesn’t have health insurance.  Rwanda and Ghana — among the world’s poorest nations — are creating networks of insurance plans to cover their citizens.

“This is truly a global movement,” said Dr. Julio Frenk, a former health minister in Mexico and dean of the Harvard School of Public Health.  “As countries advance, they are realizing that creating universal health-care systems is a necessity for long-term economic development.”  Many countries are still struggling to improve the quality of their medical care.  And making health care affordable remains a challenge for most countries, as it does for the U.S., where about 15 percent of the population lacks coverage.

Today, the United States is the only one of the world’s richest nations that does not provide healthcare coverage for all citizens.  The Supreme Court is expected to hand down a ruling on a legal challenge to the ACA in June.

Some countries established public systems similar to those in Great Britain and Canada.  Others rely on a mix of government and commercial insurance, similarly to the ACA.  The Thai system, set up a decade ago, has survived years of political upheaval and a military coup.  “No party dares touch it,” said Dr. Suit Wibulpolprasert, a senior adviser to the Ministry of Public Health.

We are really an outlier,” said David de Ferranti, a former World Bank vice president who heads the Results for Development Institute, an international non-profit organization based in Washington.  That stands in sharp contrast to the United States’ leadership in education, he said.  Long before most European nations, the United States assured access to public schooling.

People are demanding responses from their governments,”  said Cristian Baeza, the World Bank’s director for health, nutrition and population.  In countries such as India, political leaders know that one of the surest ways to get votes is to promise better access to healthcare.

National Alzheimer’s Plan Launched

Monday, May 21st, 2012

President Barack Obama has thrown down the gauntlet in announcing the first National Alzheimer’s Plan, which sets a deadline of 2025 to find ways to effectively treat — or at least delay — the mind-destroying disease.  The Obama administration is laying out numerous steps the government and private partners can take over the coming years to fight what is poised to become a defining disease of the rapidly aging population.  Families and caregivers with a family member suffering from Alzheimer’s can visit a new website for information about dementia and where to get help in their own communities.

The National Institutes of Health (NIH) is funding new studies of possible therapies, including a form of insulin that is shot into the nose.  “These actions are the cornerstones of an historic effort to fight Alzheimer’s disease,” Health and Human Services Secretary Kathleen Sebelius said.

The National Alzheimer’s Plan comes as leading scientists and researchers are meeting at the NIH to debate what research needs to be prioritize to meet that 2025 deadline.  According to the researchers, the time is right to begin testing potential therapies before people have full-blown Alzheimer’s symptoms, when it may be too late to help.  “There’s a sense of optimism” as a result of some new discoveries, Dr. Francis Collins, director of the National Institutes of Health, said.  But, “we need to figure out exactly where is the best window of opportunity” to battle Alzheimer’s.  Collins noted that cardiologists don’t test cholesterol-reducing drugs on people who have advanced heart failure.

The research is being funded by grants of $16 million and $7.9 million respectively. Experts predict that unless more effective drugs are developed, the number of Americans with Alzheimer’s will double by 2050 and related healthcare costs could soar to more than $1 trillion.  Alzheimer’s affects approximately 5.1 million Americans today; current treatments address symptoms, but do not prevent the disease or halt its progression.

The 2025 goal was the subject of a long debate in the advisory council tasked with helping to write the national plan.  “We had people saying it was overly ambitious and we had people who said it wasn’t ambitious enough,” said Don Moulds, principal deputy assistant secretary for planning and evaluation at HHS.  According to Moulds, some were concerned that an earlier goal might skew research funding into treatments that might be easy hits, but not game-changing treatments.  The 2025 target was deemed to be the earliest date when an effective treatment could be found.  “It’s a huge initiative and a very ambitious step in the right direction,” Moulds said.

Researchers leading the largest clinical study ever done on Alzheimer’s disease have run into an unexpected hurdle.  With nearly 500 patients undergoing MRI scans, PET scans and even spinal taps, researchers hope to invent the first ever test to find Alzheimer’s before a patient loses any memory — or even knows there’s a problem.  “We may be able to screen and begin treatment even before any symptoms begin,” said Dr. Raymond Turner of Georgetown University Hospital, which is one of 57 centers participating in the study.

“The problem is finding volunteers to join the studies,” Turner said.  “Patients.”  The study of 750 patients is 250 patients short.  Nationally, the deficit is in the thousands, with virtually every clinical trial related to Alzheimer’s short of volunteers.  Alzheimer’s itself is part of the problem.  Patients who don’t know that they have the disease don’t know to volunteer, and patients with mild memory loss are often reluctant to participate.  The lead researcher of the imaging trial, Dr. Michael Weiner, says one answer is to recruit physicians who treat Alzheimer’s patients.  “We definitely could do a better job trying to get physicians to refer patients to our project,” Weiner said.  “The slower our trial goes, the slower the rate of progress.”

Eric J. Hall, president and CEO of the Alzheimer’s Foundation of America (AFA), “This day has been a long time coming. The release of the ‘National Plan To Address Alzheimer’s Disease’ reflects the growing impetus among the public and policymakers to act on a disease that has been in the shadows for far too long.  We commend President Obama, HHS Secretary Kathleen Sebelius and Congress for uniquely recognizing and responding to the implications of the Alzheimer’s Disease epidemic.  Recognition is essential for action, and their courage has forged enormous opportunity.

As Many As 112 Million May Have Pre-existing Conditions

Wednesday, May 16th, 2012

Between 36 million and 112 million Americans have pre-existing conditions, according to the Government Accountability Office (GAO).  Previously insurers have been able to deny coverage to sick people or offer policies that don’t cover their pre-existing conditions.  The Patient Protection and Affordable Care Act (ACA) prohibits insurers from charging higher prices to people with pre-existing conditions.

Americans with pre-existing conditions represent between 20 and 66 percent of the adult population, with a midpoint estimate of 32 percent.  The differences among the estimates can be attributed to the number and type of conditions included in the different lists of pre-existing conditions.

The GAO compared several recent studies that tried to determine how many adults have pre-existing conditions,  based on the prevalence of certain common conditions.  Hypertension, mental health disorders and diabetes are the most common ailments that lead insurers to deny coverage, GAO said.  The report doesn’t say how many of those people are presently uninsured, but the insurance industry said that number could be relatively low.  Most people have insurance through an employer that is available irrespective of pre-existing conditions, according to America’s Health Insurance Plans (AHIP).  The trade association stressed that requiring plans to cover everyone is closely linked to the individual mandate, which the Supreme Court could strike down this summer.  There is widespread agreement that the two policies must go hand-in-hand — the Obama administration told the Supreme Court that if it strikes down the mandate, it should also toss out the politically popular requirement to cover people with pre-existing conditions.

Adults with pre-existing conditions spend $1,504 to $4,844 more annually on healthcare, and the majority — 88 to 89 percent — live in parts of the country “without insurance protections similar to the Affordable Care Act provisions, which will become effective in 2014.”

GAO’s analysis found that nearly 33.2 million adults age 19-64 years old, or about 18 percent, reported hypertension in 2009.  People with hypertension reported average annual expenditures of $650, but expenditures reached $61,540.  Mental health disorders and diabetes were the second and third most commonly reported conditions.  Cancer was the condition with the highest average annual treatment expenditures — approximately $9,000.

Little-Known ACA Proviso Stirs Controversy

Wednesday, May 9th, 2012

There’s a largely unseen battle raging among consumer advocates, physician groups and some Democrats in Congress over a key benefit in the Patient Protection and Affordable Care Act (ACA) — tax credits that will help millions of people purchase insurance.

According to Kaiser Health News, “At issue is a section of the law that outlines when low- and moderate-income employees can opt out of their employer’s coverage and instead get federal subsidies to buy insurance through new state-based marketplaces, called exchanges.  The debate over who qualifies for subsidies has been overshadowed by more-polarizing issues such as the government’s authority to require most people to buy insurance.  But if the Supreme Court upholds the law — or even most of the law — the way the tax-credit dispute is resolved will help determine how many people can get subsidized coverage.  A proposed Treasury Department rule says workers and their families cannot qualify for those subsidies unless their employer’s plan is unaffordable because it exceeds 9.5 percent of their household income.”

Consumer advocates are steadfast in their opposition to the rule because it bases affordability on how much an employee might pay for individual coverage, rather than on the cost of covering their entire family.  As a result, many workers won’t be able to afford family coverage, yet their spouses and children will be ineligible to get help to buy insurance.  Approximately 3.9 million dependents might be impacted, according to one estimate.

“The proposed rule excludes people Congress intended to cover,” said Bruce Lesley, president of First Focus Campaign for Children, who sent a letter to Treasury signed by more than 100 advocacy groups, including the American Academy of Family Physicians, the Children’s Defense Fund, the March of Dimes and the National Council of La Raza.  The letter asks President Barack Obama and congressional leaders to take “administrative action or legislation” to spell out what Congress intended.

Treasury officials are drafting final rules, which are expected to be released soon.  “We are working with consumers, businesses and all interested parties to ensure women and families get the affordable care they need,” Treasury Department spokeswoman Sabrina Siddiqui said.

Supporters of the proposed rule, primarily employer groups and insurance brokers, say it is in keeping with the wording in the ACA that defines affordability in terms of the cost of “self-only coverage.”  Critics, including the National Partnership for Women and Families, say it allows for basing the affordability standard on the cost of family coverage. The group notes that Treasury officials plan to use the cost of a family plan as a basis for exempting some people from penalties for not buying insurance.  “It’s unlikely that Congress intended affordability to be determined one way” for penalty fines and another for subsidies, according to the groups.

Several Democratic lawmakers who played key roles in writing and passing the law say the proposed rule is not what Congress intended.  “The notion that Congress wrote the law in a manner that would exclude many families from access to more affordable coverage…is simply incongruent,” according to Representative Sander M. Levin (D-MI), the ranking Democrat on the Ways and Means Committee, and Representative Henry A. Waxman (D-CA), the ranking Democrat on the Energy and Commerce Committee.

Employers and taxpayers have a lot at stake in the way this rule is interpreted. For every worker who forgoes “unaffordable” job-based coverage in favor of subsidized insurance, the employer pays either a $3,000 per subsidized-worker penalty or $2,000 per employee.  The government’s stake will be less if more workers retain job-based coverage and fewer people seek subsidies.  At the same time, tax credits are the main way the law is expected to help low- and middle-income Americans buy insurance if they don’t have access affordable employer-based coverage.  By 2019, for example, the Congressional Budget Office (CBO) estimated that the government will spend $70 billion in tax credits to help 18 million people buy coverage through the exchanges.

Workers paid an average of $921 for an individual health insurance policy last year. That equals 18 percent of the total cost of the plan, according to an annual survey by the nonpartisan Kaiser Family Foundation and the Health Research & Educational Trust.  An employee’s share of a family plan averaged $4,129, or 28 percent of the total cost.

Based on those figures, a worker earning $40,000 will be ineligible to get subsidies because the $921 is less than 9.5 percent of income, even though the cost of the family plan exceeds that cap. In that scenario, the worker’s dependents will be ineligible to receive subsidies.  The policy is certain to impact women, who are 2.5 times as likely as men to be insured as a dependent, the hardest, according to the National Partnership.

“It will force more people into not having an affordable option,” said Dana Cope, executive director with the State Employees Association of North Carolina.  According to Cope, family coverage costs increased the ranks of the uninsured in North Carolina, where the state subsidizes employee coverage, but does not contribute toward family insurance.  “State employees…who earn on average $41,000…cannot afford to cover their dependents,” Cope said.