Posts Tagged ‘private insurance’

States Want Feds to Move Faster on ACA Rules

Tuesday, February 21st, 2012

Although the Patient Protection and Affordable Care Act’s (ACA) major provisions don’t go into effect until 2014, states and insurers must be prepared to enroll some 32 million Americans who currently lack insurance coverage into Medicaid or private insurance programs.  According to Kaiser Health News, the fly in the ointment is that to successfully unveil their individual programs in just two years, the states must make important crucial decisions and take actions this year.

It will be difficult for many states to meet fast-approaching deadlines, and some may not make it, said Brett Graham, managing director at Leavitt Partners, a consulting firm.  Two years is surprisingly brief and many states need information from the federal government detailing the various insurance exchange options and precisely which benefits must be included in health plans.  Complicating the situation is the fact that states are competing for a limited pool of information technology vendors to give them the help they need.  “It’s a pressure cooker,” said Graham. States are “in a position where they have to act with imperfect information.”

Next New Year’s Day, the Department of Health and Human Services (HHS) will certify which states are ready to run their own exchanges.  To earn certification, a state must put in place laws to fund the exchanges’ continuing operations.  While the federal government is providing financial help up front for the creation of exchanges, states will assume the cost once they are underway.  HHS can issue a conditional certification for those states that are making progress but need more time.

Only 14 states and the District of Columbia have made significant legislative progress toward creating exchanges, according to a Robert Wood Johnson Foundation report prepared by the Urban Institute. The study’s authors reach the conclusion that because of the ACA, the percentage of the population that is uninsured will decline in all 50 states and Washington, D.C.

While some states are aggressively moving forward, “at the other end are states that say, ‘no way, no how, we’re not doing it.’  Montana, Texas, Louisiana, Florida, they are not going to build it and they’re playing a game of chicken,” said Graham.  “They’re waiting for the Supreme Court,” hoping it will declare the ACA unconstitutional in June.

The majority of states cannot make up their minds about whether to build their own exchanges and or participate in the proposed federal model. It’s ironic that some states that are participating in the Supreme Court challenge have taken action: Colorado, Washington and Nevada have set up exchanges.

According to the Robert Wood Johnson/Urban Institute report, “Without action by these states, their populations will still benefit from health reform through the expansion of Medicaid/CHIP, but will have to rely on the federal government to create exchanges, as called for under the ACA.  This creation will be dependent on adequate federal resources and political support.”

According to the Robert Wood Johnson Foundation and the Urban Institute, 15 states have made “little or no progress” implementing insurance exchanges where individuals and small businesses can buy private insurance.  The states that haven’t started working on creating exchanges are among the states with the most residents eligible for federal subsidies to help buy insurance.  According to the analysis, the federal government has the ability to establish and run a substitute in any state that does not establish its own exchange.

Creating a full or partial federal exchange also could be a problem, although some healthcare analysts are unsure whether it will be any easier for the federal government.  It faces the same brief timeline as the states.  While Obama administration officials say they have the money to fund exchanges, many healthcare analysts aren’t so certain.  Most state legislatures will adjourn for the year by March or April — before the Supreme Court hands down its ruling — according to the National Conference of State Legislatures.  Special sessions after the ruling would be virtually impossible in an election year.

ER Visits on the Rise, Thanks to Quick Treatment

Monday, October 24th, 2011

Visits to hospital emergency rooms soared to an all-time high of 136 million in 2009, according to new estimates provided by the Centers for Disease Control and Prevention (CDC).  This represents an approximately 10 percent increase from the 2008 statistic of 123.8 million.  The CDC study is one of three examinations of ER use being released at the American College of Emergency Physicians meeting.  

According to the CDC, patients under the age of 15 accounted for 21 percent of ER visits in 2009; patients between 15 and 24 made up 15 percent; patients between 25 and 44 accounted for 28 percent; patients between 45 and 64, 21 percent; and patients 65 and older, 15 percent.  Breaking visits down by gender, the CDC noted that women visited the ER at a rate of 48 visits per 100, while men had a rate of 42.   

The expected sources of payments for ER visits were private insurance, 39 percent; Medicaid or State Children’s Health Insurance Program, 29 percent; Medicare, 17 percent; other and unknown, five percent each.  Nineteen percent of ER visitors reported that they had no insurance.  The most typical reasons for visiting the ER were stomach and abdominal pain, 9.6 million; fever, 7.4 million; chest pain, 7.2 million; cough, 4.7 million; headache, four million; and shortness of breath and back symptoms, 3.7 million each.  

Physicians attributed the sharp increase to both greater demand for services and improvements that allow ERs to treat patients faster.   “With the economy, people have lost their coverage and, given the fact the emergency department is the safety net, they come to us,” said Dr. Jay Kaplan, an emergency physician at Marin General Hospital who serves on the board of the emergency physicians’ organization.  The physicians contend that it is counterproductive to discourage patients from going to the ER to save money in healthcare costs because they say it doesn’t.  “We’re efficient.  We take care of acute patients and that’s what we do well,” said Dr. Paul Kivela, managing partner of Napa Valley Emergency Medical Group, and a board member of the American College of Emergency Physicians.  

According to Dr. Michael Gerardi, an ACEP board member, he and his colleagues want comprehensive medical liability reform that includes indemnification based on recognized guidelines, caps on non-economic damages and medical courts where providers are judged by medical peers.  “In America, we sue far too often for bad outcomes and not deviations from standard of care,” Gerardi said.  “The overall anxiety of patients and the lack of acceptance that bad outcomes happen are driving costs.”  Because ERs are safety-net providers, they have become increasingly overcrowded.  One factor is the passage in 1986 of the Emergency Medical Treatment and Labor Act, which requires hospitals to provide people with emergency services, despite their inability to pay.  

It has been estimated that 13.7 percent of all emergency room visits could be treated in retail medical clinics, which are typically based in pharmacies or grocery stores.  These facilities are equipped to treat a limited number of minor conditions, such as throat infections or urinary tract infections.  An additional 13.4 percent of emergency room visits could be handled by urgent-care clinics — an independent medical facility that can handle a broader scope of problems, such as minor fractures and more serious injuries.  Urgent-care clinics typically are open on evenings and weekends, fulfilling the need for patients with occurring before or after typical physician office hours.

Is the GOP Alone In Wanting to Repeal Healthcare Reform?

Monday, December 6th, 2010

Even though Republicans will control the House of Representatives and have a larger presence in the Senate come January, they still are likely to hit some formidable roadblocks in their attempt to repeal the Affordable Care and Patient Protection Act. Those roadblocks are such lobbying giants as the American Medical Association (AMA), the American Hospital Association (AHA) and the Pharmaceutical Research and Manufacturers of America (PRMA).  The groups are on board with the new healthcare reform law because they will gain an estimated 30 million (or more) new paying customers in the next few years.  The reform law is expected to increase payments to physicians and hospitals who have felt squeezed in recent years.  Additionally, analysts believe the new law is a major force for job creation in the healthcare sector.

“These guys were onboard for a reason,” said David Dranove, a professor of health enterprise management at Northwestern University’s Kellogg School of Management.  “Very few employers will drop private health insurance, and you will expand private insurance to 15 million people.  If this legislation stands, we are not likely to see new reforms for a generation.”

Primary-care physicians, who are likely to benefit significantly from the healthcare reform law, will see their reimbursements from government insurance programs rise – although many believe the reform law is only the beginning.  According to Dr. Cecil Wilson, AMA president, “While the 111th Congress made important improvements to our nation’s healthcare system, more work needs to be done.”  Hospitals – which have been hard hit by patients unable to pay their medical bills because of unemployment – will be in better financial shape once more Americans get health insurance subsidies in 2014.

Pharmaceutical companies, which were among reform’s earliest supporters, oppose repeal, even though analysts say it will cost them $100 billion in government rebates.  The upside is that the industry will obtain new customers who were previously uninsured and unable to afford the latest brand-name medications.  Even the much-maligned insurance companies – who will have more than 15 million new customers – oppose repeal.

ER Usage Study Shows Interesting Results

Tuesday, August 24th, 2010

Twenty percent of Americans visited a hospital emergency room in 2007, the most recent year for which the National Center for Health Statistics has data.  That includes approximately 7.4 percent of the uninsured who visited the ER multiple times, as did 5.1 percent of people with private insurance.  The most frequent ER visitors were Medicaid patients, with 15.3 percent reporting two or more visits in 2007.  A total of 116.8 million ER visits were made that year.

One third of adults in fair or poor health visited the ER at least once during the year and are the patients most likely to use that facility.  Patients over 65 reported more ER visits and described it as their customary source of healthcare.  Approximately 25 percent of individuals aged 75 and older visited the ER at least once in 2007.

The big surprise?  Contrary to conventional wisdom, the uninsured were not more likely to make non-emergency visits to the ER than other groups.  Approximately 10 percent fall into the non-emergency category whether the patient had private insurance, Medicaid coverage or no insurance.  Determining who visits the ER, the frequency and for what reasons requires examining complicated interactions among multiple factors – socioeconomic level, overall health, age, health insurance, access to healthcare and others.

“Our job is to provide the best numbers to inform policy and practice,” said Amy B. Bernstein of the National Center for Health Statistics.  “If people are concerned about the use of emergency rooms and how to make their use more efficient or effective, they should have accurate information about who is actually using them – and not who they think is using them.”

High-Risk Pool Healthcare Has Hefty Premiums

Monday, July 19th, 2010

“High-risk pool” healthcare coverage comes at a steep price.  Healthcare coverage for uninsured Americans with pre-existing conditions won’t come cheaply. Premiums in the new “high-risk” pool could average $300 to $600 a month in certain states, according to a new government website.   The Department of Health and Human Services says that the premiums could range from $140 to as much as $900 a month.

According to Richard Popper, deputy director of the Office of Consumer Information and Insurance Oversight, “There are going to be meaningful premiums that are going to be required to stay in this plan…in the hundreds of dollars.”  HealthCare.gov estimates show that monthly premiums for a 50-year-old Floridian would be $552 to $675; for a New Yorker, the average cost would be $400 to $600; $491 to $600 for a Texan; and only $283 for a Pennsylvanian.  Coverage under the Pre-Existing Condition Insurance Plan begins on August 1.

Consumer advocates are advising the uninsured who have health problems to sign up quickly – despite the cost – because they cannot be turned down for coverage.  The high-risk pool is a temporary solution for at-risk individuals who cannot get healthcare insurance because of a medical condition.  The pool will be available until 2014 when healthcare reform takes full effect.  At that point, insurance companies will not be allowed to turn down people in poor health.  Low- and middle-income individuals will receive subsidized coverage.

Bigger Incomes for Specialty Nurses Drive Physicians Away From Primary Practice

Monday, June 21st, 2010

Specialist nurses have bigger paychecks than physicians.  At a time when primary-care physicians are in short supply, many hospitals are offering bigger paychecks and incentives to specialist nurses such as certified nurse anesthetists (CRNAs), nurses who administer anesthesia to patients during surgical procedures.  A study conducted by Merritt Hawkins & Associates, a physician recruiting firm, found that primary-care physicians were offered an average base salary of $173,000 last year compared with the $189,000 average for CRNAs.

“It’s the fourth year in a row that CRNAs were recruited at a higher pay than a family doctor,” said Kurt Mosley, a staffing expert with Merritt Hawkins.  As the number of surgeries has grown in recent years, creating demand for anesthesiologists and anesthetists, CRNA salaries have trended higher.  Mosley notes that the income disparity is not going to encourage medical students to pick primary practice, at a time when the nation is facing a shortage of approximately 60,000 physicians in that specialty.

“The demand for primary-care doctors will increase twofold when health reform happens and millions of more Americans have access to healthcare,” Mosley said.  “Who is going to triage these patients?  It’s not the neurologist or the pulmonologist.  It has to be the primary-care doctor.”

The American Association of Nurse Anesthetists (AANA) argues that its members are receiving the compensation they deserve.  “From our perspective, we are fairly compensated for the level of responsibility that we shoulder,” said Lisa Thiemann, the AANA’s senior director of professional services and a CRNA for 14 years.  “We are at the head of the patient’s bed.  We deliver anesthesia and we keep the patient safe.  Once nurses and physicians arrive at anesthesia training, we use the same textbooks and the same cases.  We all deliver anesthesia the same way.”

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.”

Medicare: The Free Market Option

Tuesday, September 8th, 2009

Medicare gives patients more choice, and a greater range of free-market options than does private insurance.  While Medicare has had its financial challenges, it is an example of a government-run program that gives patients choice.  Sometimes, private insurers refuse to include physicians in their plans; Medicare does not exclude physicians.

The insurance companies insist the idea of healthcare reform to include a public option – such as Medicare – but it’s important to look at the facts that includes a government-run plan.  According to a recent article in Mother Jones magazine, “Survey results demonstrate that Medicare beneficiaries are less likely than those with private coverage to High healthcare cost, advanced healthcare directivereport negative experiences with their insurance plans – including having expensive medical bills for non-covered services, being charged a lot more than insurance would pay, and physicians not taking their insurance.”

According to a study by the Commonwealth Fund, 37 percent of Medicare patients are completely satisfied with their coverage and report few problems accessing and paying for healthcare.  Only 20 percent of people with employer provided plans reported the same level of satisfaction.

One argument often used against the public health plan option is the following: I want to choose my own doctor, and I don’t want a government bureaucrat making that decision.  That’s wrong.  Under private healthcare plans, your only choice is to pick a doctor who has negotiated costs with your insurance company.  Doctors unwilling to negotiate are excluded.

In seeing the way the healthcare debate has been framed, perhaps the administration would have been better off describing the proposed reform as the extension of Medicare to the entire population.

A public health plan option will not introduce a bureaucracy into healthcare; that bureaucracy already exists.