INSPECTOR GENERAL SAYS MEDICARE PART "D" PAID $43.3 MILLION ON LESS THAN EFFECTIVE DRUGS IN 2006-2007
More from the Emeritus Newsroom- Without identifying those drugs which have been labeled as, "less than effective", an HHS Inspector General report on Medicare Part "D" drug payments shows $43.3 million was paid for such medications and raises the possibility of seeking restitution from those responsible. The report says,
"Of approximately $115 billion in gross drug costs included in Medicare Part D sponsors' prescription drug event (PDE) data for calendar years 2006 and 2007, CMS accepted PDE data totaling $43.3 million associated with less-than-effective drugs. Pursuant to Federal requirements, Medicare Part D should not have covered these drugs. Less-than-effective drugs are drugs that the Food and Drug Administration (FDA) approved before 1962 and that FDA subsequently found to be less than effective.
CMS's Drug Data Processing System subjects sponsors' PDE data to an edit designed to reject less-than-effective drugs. Although the edit identified and rejected the vast majority of PDE data associated with less-than-effective drugs, the edit did not identify and reject PDE data for some less-than-effective drugs because the Part D program used an incomplete list of less-than-effective drugs as the basis for the edit. There is no definitive list of less-than-effective drugs.
We recommended that CMS determine whether it can impose financial adjustments on sponsors that were paid for furnishing less-than-effective drugs and help ensure that drugs covered by Medicare Part D comply with Federal requirements by (1) collaborating with FDA to create and maintain a comprehensive list of less-than-effective drugs, (2) regularly disseminating this list to all sponsors, and (3) using this list to reject PDE data for less-than-effective drugs. CMS agreed with our first recommendation and partially disagreed with our second recommendation, stating that FDA should be responsible for maintaining and disseminating the list of less-than-effective drugs. We modified our second recommendation to reflect FDA's role in identifying less-than-effective drugs".
More from the Emeritus Newsroom- According to bids which have been submitted to the Center for Medicare and Medicaid Services, the average cost increase for Medicare Drug prescription plans, Part D, will be up $1 per month. The announcement from the CMS estimates that the average monthly premium beneficiaries will pay for standard Part D coverage will be $30 -- a $1 increase from the current year (2010) average premium of $29. CMS claims that premiums paid by Part D enrollees cover about 25 percent of the cost of basic Part D coverage. Enrollees with limited incomes may qualify for the low-income subsidy (LIS), or extra help, that typically covers some or all of the beneficiary’s premium, deductible, co payments and the cost of drugs in the coverage gap. Currently, more than 10 million beneficiaries are receiving LIS benefits. In 2011, the average value of the subsidy amount applied to the Part D benefit, premium and cost-sharing for those enrolled in the LIS program is estimated to be about $4,000. Under new Affordable Care Act provisions, fewer individuals who receive LIS benefits will need to move to a new plan to avoid paying a premium. “The Affordable Care Act helps reduce disruption for this vulnerable population, so only about 500,000 beneficiaries will be re-assigned to new plans, compared to about 800,000 who were moved last year,” Blum said. “And this year, we’ll be providing those beneficiaries who are moved into a new plan with more information than ever before about how these plan changes may affect them. For most people with Medicare, we expect the process to be seamless”. In addition to national average premiums for 2011, CMS announced the 2011 national average monthly bid, the base beneficiary premium, the regional low-income subsidy premium amounts for 2011; and the 2011 Medicare Advantage regional preferred provider organization benchmarks. General information about plan offerings will be released in September. The national and regional premium data can be found at: http://www.cms.gov/MedicareAdvtgSpecRateStats/RSD/list.asp.
FEDERAL TRADE COMMISSION BUSTS BOGUS HEALTH PLANS SOLD TO UNINSURED AND UNEMPLOYED AMERICANS / ALSO BUSTS INTERNET DOMAIN REGISTRATION SCAM
More from the Emeritus Newsroom- Investigators say sales personnel for various "medical discount plans" were marketing them as health insurance with high fees. The FTC filed three cases charging companies with deceptively marketing medical discount plans.
In one case, at the request of the FTC, a U.S. district court has ordered a temporary halt to the deceptive actions of Consumer Health Benefits Association, which targeted consumers who sought information on the Internet about major medical health insurance plans. CHBA telemarketers allegedly pitched consumers with a long list of false claims, including:
that they worked closely with major medical insurers;
that the discount plan was widely accepted by doctors, pharmacies, and other health care facilities;
that the plan would save consumers up to 85 percent on medical expenses;
that CHBA’s plan was accepted wherever Blue Cross Blue Shield was accepted; and
that consumers could use their medical discount card with any health care provider that accepts insurance.
Consumers paid between $29 and $280 in enrollment fees before they received written information about the plan. When they tried to use the plan with physicians CHBA claimed were “participating providers,” the providers said they did not accept the plan. One consumer who tried to use the plan to buy prescription medicine discovered the “discounted” price was higher than the price she had paid without the medical discount plan.
The FTC also charged that CHBA misrepresented its refund policies and that typically, consumers received refunds only after they threatened to complain to consumer protection agencies. The FTC seeks a permanent halt to the allegedly illegal activities and has asked the court to order the defendants to give up their ill-gotten gains.
Two other companies, Health Care One LLC and U.S. Benefits were also charged with selling discount plans as medical insurance.
The FTC also busted Canadian con artists involved with internet domain registration scams. According to the FTC, scores of small businesses, individuals and non-profits were instructed pay bogus bills, leading them to believe they would lose their web site addresses unless they paid. Settlement and default judgment orders signed by the court will bar the deceptive practices in the future.In June 2008, the FTC charged Toronto-based Internet Listing Service with sending fake invoices to small businesses and others, listing the existing domain name of the consumer’s Web site or a slight variation on the domain name, such as substituting “.org” for “.com.” The invoices appeared to come from the businesses’ existing domain name registrar and instructed them to pay for an annual “WEBSITE ADDRESS LISTING.” The invoices also claimed to include a search engine optimization service. Most consumers who received the “invoices” were led to believe that they had to pay them to maintain their registrations of domain names. Other consumers were induced to pay based on Internet Listing Service’s claims that its “Search Optimization” service would “direct mass traffic” to their sites and that their “proven search engine listing service” would result in “a substantial increase in traffic.”
The FTC’s complaint charged that most consumers who paid the defendants’ invoices did not receive any domain name registration services and that the “search optimization” service did not result in increased traffic to the consumers’ Web sites.
A federal district court judge in Chicago, Robert M. Dow, Jr., ordered a temporary halt to the deceptive claims and froze the defendants’ assets, pending trial. The settlement and default judgment orders announced today end that litigation. FTC press release on internet scam, click here.
WHITE HOUSE ORDERS INSURERS TO COVER PREVENTIVE TESTS WITH NO CO PAYS
More from the Emeritus Newsroom-In an effort to boost preventive care, the White House has released its rules under the new health reform law, mandating what services reaquired to be free to those in private health plans effective September 23d. According to the website www.healthcare.gov , some of the changes that have already taken place along with those still to come:
On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll out over four years and beyond, with most changes taking place by 2014. Others have already begun. Use this timeline to learn about what’s changing and when.
Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit. Learn more
Effective April 1, 2010
States will be able to receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents.
First checks mailed in June, 2010, and will continue monthly throughout 2010 as seniors hit the coverage gap
An estimated 4 million seniors will reach the gap in Medicare prescription drug coverage known as the “donut hole” this year. Each such senior will receive a $250 rebate.
Applications for employers to participate in the program available June 1, 2010. Learn more about the Early Retiree Reinsurance Program.
Too often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents.
National program established July 1, 2010
A Pre-Existing Condition Insurance Plan will provide new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state chooses not to do so, a plan will be established by the Department of Health and Human Services in that state. This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited. Learn more about the Pre-Existing Condition Insurance Plan.
Effective July 1, 2010
The law provides for an easy-to-use website where consumers can compare health insurance coverage options and pick the coverage that works for them.
Effective for health plan years beginning on or after September 23, 2010
Under the new law, young adults will be allowed to stay on their parent’s plan until they turn 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Some insurers began implementing this practice early. Check with your insurance company or employer to see if you qualify. Learn more about the young adults insurance policy.
Effective for health plan years beginning on or after September 23, 2010
Under the new law, young adults will be allowed to stay on their parent’s plan until they turn 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Some insurers began implementing this practice early. Check with your insurance company or employer to see if you qualify. Learn more about the young adults insurance policy.
Effective for health plan years beginning on or after September 23, 2010
In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately.
Effective for new plans beginning on or after September 23, 2010
The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.
Effective for health plan years beginning on or after September 23, 2010
Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.
Effective for health plan years beginning on or after September 23, 2010
Under the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans.
Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans
The new law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition.
Grants will be awarded beginning in 2010
The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases to be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium increases may not be able to participate in the new health insurance Exchanges in 2014.Turn pages on HealthCare.gov summary, click here.
07/15/2010
VETS GROUPS APPLAUD WHITE HOUSE DECISION TO LOOSEN REQUIREMENTS FOR VETERANS PTSD CLAIMS
More from the Emeritus Newsroom- In a statement from the Veterans of Foreign Wars (VFW), Thomas J. Tradewell Sr., the national commander of the 2.1 million-member group, and its Auxiliaries, called the VA secretary's decision to ease PTSD claims requirements a sea-change in the mindset of the VA. The group points out the VA decision follows numerous other decisions that increased the list of presumptions for diseases associated with Agent Orange exposure; increased services and programs for women veterans, veterans who reside in rural areas as well as the homeless; and reduced the size of the claims form from 23 to 10 pages. Tradewell said even the VA's outreach to patients possibly exposed to improperly sterilized equipment at a small number of its hospitals reflects the department's proactive, veterans' first attitude. A White House announcement of the decision explains the previous requirement for filing PTSD claims was "neither fair, nor sustainable". officials said it is especially true in the current wars in Iraq and Afghanistan where there are no static front lines and the combat zone is everywhere. The White House statement further stated,
"In reality, life in a combat zone is both complex and it affects each of us differently—as demonstrated by a number of scientific studies. Some who’ve been in the most terrible fighting can emerge relatively unscathed. Other non-combat troops, whose wartime experience came only in the form of a blaring air raid siren, can live for decades haunted by the sound and the threat it represented. The base where I was stationed was mortared—almost on a daily basis—enough that it gained the nickname “Moratoria.” My physical wounds make my combat experience clear, yet other troops on my base must prove they were at an actual explosion from one of those daily attacks. At VA, we’re now moving to treat all Veterans equally when it comes to filing a disability claim for PTSD". Press release from the White House, click here. Press release from the VFW, click here. 010
WELLPOINT SECURITY BREACH REVEALS PERSONAL AND FINANCIAL INFORMATION OF 470,000 PEOPLE
More from the Emeritus Newsroom- Its the third or fourth data breach by WellPoint or its subsidiaries in the last two years. The company admits the latest breach involves an estimated 470,000 people who are insured or were insured by the company. Roughly half, or 230,000 people involved in the breach, live in California and are insured by Anthem Blue Cross, a subsidiary. The company has come under fire over the last two years from California regulators for its data breaches as well as its rate increases and failure to pay claims of sick patients. State officials have not said, what action, if any, it will take in this most recent case. More from Associated Press, click here. 06/29/2010
OBAMA SIGNS MEDICARE DOCTORS PAY FIX /PACKAGE ONLY TEMPORARY AS BIGGER BATTLE LOOMS OVER PERMENENT SOLUTION
AMERICANS BUYING INDIVIDUAL HEALTH INSURANCE POLICIES FACE 20% PREMIUM INCREASES
More from the Emeritus Newsroom- The health insurance market for those buying individual policies for themselves and their immediate families are finding average increases this year of around 20%even with higher deductible policies. That's the latest finding from a survey conducted by the Kaiser Family Foundation. KFF says that in the vast majority of states, the non-group market is subject to substantially less regulation than group insurance, with insurers permitted to exclude people or impose rate surcharges based on pre-existing health conditions. Much will change under the new health reform law – including a requirement that insurers accept everyone regardless of health status, a prohibition on health status rating, and creation of purchasing Exchanges – but the major elements of the law do not take effect until 2014. The survey found that those ages 55-64 represented the largest share, 31% of the individual insurance market or those not in employer health plans. More than a quarter of those surveyed said they had insurance plans with deductibles of $5,000 or more. 06/21/2010
2.5 MILLION MORE WITHOUT HEALTH INSURANCE BETWEEN 2008 TO 2009
More from the Emeritus Newsroom- Early results from a study on the number of Americans without health insurance reveals a startling increase from 2008-2009. The Centers for Disease Control says that roughly 15% of the U-S population does not have health insurance coverage. The number of those uninsured between 2008-2009 rose about 2.5 million to 46.3 million people. One in five Americans have not been insured at some point during that period. Coverage of children in public insurance program grew by more than 3%, from 34.2% to 37.3%, most under Medicaid. The number of adults covered by private insurance plans dropped from 68.1% in 2008 to 65.8% in 2009, even with COBRA subsidies to help those laid off continue payment for their previous employers insurance plans. Direct link to National Health Insurance Survey, click here. 06/21/2010
UNEMPLOYMENT BENEFITS, COBRA HEALTH INSURANCE SUBSIDIES & MEDICAID PAYMENTS TO STATES UNRESOLVED
LATE FRIDAY VOTE IN SENATE PASSES BILL TO STOP MEDICARE DOCTOR PAY CUTS / STILL NEEDS HOUSE APPROVAL
More from the Emeritus Newsroom- The Senate, Friday night, passed a separate agreement from HB 4213 that prevents cuts in reimbursements for doctors Medicare fees for the next six months. The agreement was made to avoid doctors dropping out of the Medicare program. The House still must approve to finalized the deal, which is expected early next week. Without the agreement, doctors would face a 21% cut in reimbursements, but Senate leaders agreed to pay for it through anti-fraud and other Medicare billing changes for most other services, which Republicans demanded to avoid adding to the deficit. Still to be resolved is a permanent agreement for the doctors reimbursement issue, extended unemployment benefits, and subsidies for states increased costs associated with Medicaid which remain in HB 4213. 06/18/2010
OVER HALF OF STATES WILL PARTNER WITH H-H-S TO EXTEND HEALTH INSURANCE TO SICK PATIENTS
More from the Emeritus Newsroom- So far at least 28 states will be working with the Department of Health and Human services THIS YEAR to provide insurance for those who can't get it or afford it from the private insurance market. The Center for Medicare Advocacy today released a report on how the system will work and for how long. According to the group, about 60% of Americans receive their health insurance through an employer-sponsored group health insurance plan. Another 27% receive their health insurance through a government-sponsored program. The rest of the population, about 13%, must purchase insurance in the individual insurance market. Purchasing individual insurance is generally expensive, but not horribly difficult for people who have never been treated for a serious medical condition or for those without certain risk factors for diseases. For some individuals who have a pre-existing condition, however, it can be impossible to find an insurance company willing to offer them health insurance at any price. State high risk health insurance pools offer coverage to those who have been denied health insurance by insurance companies. The risk pool must pay at least 65% of the total costs of the benefits provided and the out-of-pocket limits can be no greater than those linked to amounts for high-deductible health plans with linked health savings accounts. Finally, the premiums must be established at a standard rate for a standard population and age rating cannot exceed a 4:1 ratio. Questions about how the 65% of total costs and out-of-pocket limits are calculated as well as the standard rate and standard population used for establishing the premiums may be addressed in future guidance. Full text of the Center for Medicare Advocacy report, click here. 05/13/2010
OBAMA OUTLINES NEW RULES FOR EARLY RETIREE HEALTH PLANS
More from the Emeritus Newsroom- The Business Roundtable meeting in Washington DC was the forum for President Obama's outline of new rules on health care coverage for early retirees. With the Affordable Health Care Act not taking full effect until 2014, many retirees, especially those who retire early, are not able to take advantage of employer health insurance plans since the number of large employers offering them for retirees has declined by more than 50% in the last 20 years. During his address to the Business Roundtable this morning, President Obama explained.
"Whenever I speak with leaders from the business community from all around the country, they all agree on one thing: rising health care costs are making it harder for workers and retirees to get the benefits they deserve. Increasingly, employers are being forced to choose between staying competitive and honoring the men and women who powered their businesses by providing their retirees with quality benefits.
Americans who retire before they turn 65 and are eligible for Medicare are particularly vulnerable. In 1988, 66 percent of large firms provided health care coverage to their retirees. 20 years later in 2008, the percent of firms offering coverage to retirees plummeted to 31 percent. The lack of coverage from their employer forces many retirees to pay exorbitant premiums or simply go without health insurance.
Fortunately for these Americans, the Affordable Care Act will provide immediate relief. The new law includes $5 billion in financial assistance for employer health plans that offer coverage to early retirees. This program is temporary and will help bridge the gap until 2014 when health insurance exchanges make it easier for all Americans to access affordable health coverage. B
"CBO and the Joint Committee on
Taxation (JCT) now estimate that, on balance, the direct spending and revenue effects of
enacting H.R. 3590 as passed by the Senate would yield a net reduction in federal deficits
of $118 billion over the 2010–2019 period. Approximately $65 billion of that reduction
would be on-budget; other effects related to Social Security revenues and spending as
well as spending by the U.S. Postal Service are classified as off-budget. In the estimate
that was provided on December 19, the estimated budgetary impact was a net reduction
in deficits of $132 billion, of which approximately $81 billion would be on-budget".
"Because the legislation would affect direct spending and revenues, pay-as-you-go
procedures would apply. The time periods used for pay-as-you-go calculations under the
new Statutory Pay-As-You-Go Act extend from fiscal year 2010 through fiscal years
2015 and 2020. Although CBO and JCT have not conducted a detailed analysis of the
legislation’s effects in 2020, enactment of the legislation would probably reduce the
budget deficit modestly in that year. Reflecting that assessment, CBO and JCT estimate
that enacting H.R. 3590 would reduce projected on-budget deficits both through 2015 and
through 2020".
HOUSE BUDGET COMMITTEE CLEARS HEALTH INSURANCE REFORM FOR TOUGH VOTE AHEAD
More from the Emeritus Newsroom - The House Budget Committee has made the first move to send health insurance reform on its way to a final showdown expected later this week in the House. The Budget Committee vote this morning was 21-16 in favor. Two Democrats on the committee, Rep. Chet Edwards (D) TX and Allen Boyd (D) FL, joined 14 Republicans to oppose the bill. Their votes were not a surprise since4 they voted against Democratic reform proposals last year. It now heads to the House Rules Committee where elements of the bill will be reviewed/rewritten Wednesday or Thursday. Click here for House Budget Committee version of bill. The Rules Committee's handling of the proposal will then determine how many votes will be needed before the actual final vote would be taken. House Speaker Nancy Pelosi said during her Friday news conference, that, "....once it passes the House it is the law of the land". For the most part, the health insurance reform proposal is the Senate version passed in December. 03/15/2010
OBAMA ASKS FOR "COURAGE" AT OHIO RALLY
More from the Emeritus Newsroom- Natoma Canfield was scheduled to introduce President Obama at his appearance today in Strongsville, Ohio, a Cleveland suburb. Her letter, written last December, was one of the letters President Obama reads everyday from Americans who write him, hoping he can make a difference in their seemingly hopeless situations. For Natoma, buying a health insurance policy on the individual market become impossible to afford. In January she dropped her policy. And just last week after collapsing and being taken to the emergency room, she was informed that she had leukemia. Now her family worries how she will be able to afford the treatment she will need. The President said he came to Ohio to talk about Natoma's story, which is another example of a broken health insurance system and the "courage" needed in congress to fix it. This is showdown week for those trying to fix the system with a proposal now before the House, which is headed for a final vote by the end of the week. Obama repeated his take on the health insurance debate as a choice of what America wants to be. Obama told the crowd,
" I want you to think about Natoma. When you hear people saying that this isn’t the “right time,” you think about what she’s going through. When you hear people talk about, well, what does this mean for the Democrats? What does this mean for the Republicans? I don’t know how the polls are doing. When you hear people more worried about the politics of it than what’s right and what’s wrong, I want you to think about Natoma and the millions of people all across this country who are looking for some help, and looking for some relief. That’s why we need health insurance reform right now". Video of President Obama's address click here. Transcript of Obama's address, click here.
03/15/2010
OBAMA DELAYS TRIP TO MAKE FINAL PUSH FOR HEALTH INSURANCE REFORM / PELOSI SAYS, ONCE IT'S PASSED BY HOUSE,"IT IS THE LAW OF THE LAND"
More from the Emeritus Newsroom - President Obama will delay his trip to Indonesia, Australia and other Pacific Rim countries until at least March 21st. White House Press Secretary Robert Gibbs today, during his press briefing, confirmed the trip schedule was changed. The President was scheduled to leave on the 18th and was to take his family to Indonesia where he spent part of his childhood. That has been changed now since Democratic leaders have asked him to stay as they battle opponents on capitol hill to get the health insurance reform measure passed. Also unfinished is long term unemployment benefits and COBRA subsidies which are packed inside the $140 billion jobs bill which was handed over to the House after passing the Senate earlier this week. During her press briefing this morning, House Speaker Nancy Pelosi confirmed she had been informed of the President's trip delay. Pelosi says reform is also waiting for the CBO report on the Senate version of the health insurance reform proposal which now has been changed in the house. Pelosi said the Congressional Budget Office report, (See story below) released yesterday on the Senate version was encouraging. Pelosi said the President's decision to delay the trip would help passage of health insurance reform, the speaker saying passage , "would not be possible without his leadership". She added, "We will take the time that we need to pass the legislation". Pelosi could not guarantee that it would be done in by March 21st, when the President is set to leave. The revised trip timetable set Obama's departure for March 21st and return to Washington on March 26th. Pelsi said the public option was not in the bill, "we improved what is in the the bill". And while the public option is NOT IN THE BILL, Pelosi said the insurance exchanges, which are set up to provide more choices for individual and small business policy holders, serves the same capacity of the public optio,n offering more competition in the insurance market. She still expresses the belief the actual public option would have produced more savings for consumers. Pelosi also confirmed an equity for states fix, that removed some deals cut with various tates to get more compensation for such things as Medicaid, thatn other states. Video of speaker Pelosi's news conference, click here. 03/12/2010
DEMOCRATS GET BOOST ON HEALTH INSURANCE REFORM FROM LATEST CONGRESSIONAL BUDGET OFFICE PROJECTIONS
More from the Emeritus Newsroom - House and Senate leaders were waiting weeks for the updated health insurance reform projections, out today from the Congressional Budget Office. In a letter from CBO Director Doug Elmendorf, the agency found:
"CBO and the Joint Committee on
Taxation (JCT) now estimate that, on balance, the direct spending and revenue effects of
enacting H.R. 3590 as passed by the Senate would yield a net reduction in federal deficits
of $118 billion over the 2010–2019 period. Approximately $65 billion of that reduction
would be on-budget; other effects related to Social Security revenues and spending as
well as spending by the U.S. Postal Service are classified as off-budget. In the estimate
that was provided on December 19, the estimated budgetary impact was a net reduction
in deficits of $132 billion, of which approximately $81 billion would be on-budget".
"Because the legislation would affect direct spending and revenues, pay-as-you-go
procedures would apply. The time periods used for pay-as-you-go calculations under the
new Statutory Pay-As-You-Go Act extend from fiscal year 2010 through fiscal years
2015 and 2020. Although CBO and JCT have not conducted a detailed analysis of the
legislation’s effects in 2020, enactment of the legislation would probably reduce the
budget deficit modestly in that year. Reflecting that assessment, CBO and JCT estimate
that enacting H.R. 3590 would reduce projected on-budget deficits both through 2015 and
through 2020".
OBAMA USES INVESTMENT FIRM INFO AS MORE AMMO FOR HEALTH INSURANCE REFORM / GOLDMAN SACHS EXPERT SAYS HEALTH INSURANCE COMPANIES WILL HAVE FEWER COMPETITORS, HIGHER PROFITS
More from the Emeritus Newsroom - White House Communications Director Dan Pfeiffer explained more of what has become a White House warning shot if health insurance reform is not enacted. Pfeiffer cites an analyst's characterization of the health insurance business. Goldman Sachs Global Investment Research, Steve Lewis, considered an expert on insurance company financial conditions, suggested that more employers, especially those with higher medical claims histories, would eventually be priced out of the market. according to the Goldman Sachs document,
"As a specific answer to that, we would say, price competition is down from year
ago. An overall theme that we would characterize this year, meaning, when I say this year,
the just completed January 1 renewals, and continuing up and through today. We feel this
is the most challenging environment for us and our clients in my 20 years in the business.
Not only is price competition down from year ago (when we had characterized last year's
price competition as being down from the prior year), but trend or (healthcare) inflation is
also up and appears to be rising. The incumbent carriers seem more willing than ever to
walk away from existing business resulting in some carrier changes.
And that's a significant adjustment from last year where we saw aggressive pricing on the
renewal front but not so much on the new business front. And then I'd say the other real
theme is we've seen some service levels that have gapped among few of the major players
which has further increased switching of carriers".
Pfeiffer also cited the Cowen and Company financial review of health insurer WellPoint, which also owns Anthem Blue Cross and Blue Shield. According to the Cowen document:
"We
maintain our favorable view of WLP shares given our expectation that the
pricing environment is improving in 2010, particularly in the individual and
small group segments of the market likely driving underlying commercial MLR
improvement. Of course, healthcare reform is a double-edged sword for WLP
shares. Should reform fail, WLP would be a primary beneficiary. However, its 2.2
million individual members do leave it somewhat exposed to the 80% individual
MLR floor contemplated in the Senate bill and Federal oversight of rating action
proposed by the President".
OBAMA STUMPS FOR PUBLIC PRESSURE ON CONGRESS TO PASS HEALTH INSURANCE REFORM
More from the Emeritus Newsroom- As is he were back on the campaign trail, a fired up President Obama got the reaction he was hoping for. Students at Arcadia University in suburban Philadelphia gave his call for health insurance reform a rousing endorsement as he laid out his goals for health care and eliminating the nations deficit through medical cost control. Obama told the audience, mainly young adults,
"The young people who are here, you’ve heard stories -- some of you guys still have health care while you’re in school, soill be on your parents’ plans, but some of the highest insurance rates are among young people. And it’s getting harder and harder to find a job that’s going to provide you with health care. And a lot of you right now feel like you’re invincible so you don’t worry about it. (Laughter.) But let me tell you, when you hit 48 -- (laughter) -- you start realizing, things start breaking down a little bit. (Laughter.)
And the insurance companies continue to ration health care based on who’s sick and who’s healthy; on who can pay and who can’t pay. That’s the status quo in America, and it is a status quo that is unsustainable for this country. We can’t have a system that works better for the insurance companies than it does for the American people. (Applause.) We need to give families and businesses more control over their own health insurance. And that’s why we need to pass health care reform -- not next year, not five years from now, not 10 years from now, but now. (Applause.)
Now, since we took this issue on a year ago, there have been plenty of folks in Washington who’ve said that the politics is just too hard. They’ve warned us we may not win. They’ve argued now is not the time for reform. It’s going to hurt your poll numbers. How is it going to affect Democrats in November? Don’t do it now.
My question to them is: When is the right time? (Applause.) If not now, when? If not us, who?"
Obama explained that opponents don't care if the country is in good times or bad, it's never the time for reform. For the people that need coverage, according to the President, the time is now.
"Natoma Canfield -- self-employed cancer survivoetween now and then, this program will provide premium relief for employers, making it easier to give their retirees high-quality, affordable medical coverage".
Following up on Obama's announcement, the Department of Health and Human Services released its interim final rule with comment period (IFC) to implement the Early Retiree
Reinsurance Program. The summary states,
The Early Retiree Reinsurance Program provides reimbursement to participating
sponsors (employers) for a portion of the costs of providing health coverage to early retirees (and eligible
spouses, surviving spouses, and dependents of such retirees). The program becomes effective June 1, 2010. For claims incurred before June 1, 2010, the
amount of such employer claims up to $15,000 count toward the cost threshold and the cost limit. The
amount of employer claims incurred before June 1, 2010 that exceed $15,000 are not eligible for
reimbursement and do not count toward the cost limit. reimbursement “shall be used to lower costs for the
plan. Such payments may be used to reduce premium costs for an entity” receiving a
reimbursement or to reduce premium contre funding for health insurance reform as well as student loan reform. The health insurance reform portion of the bill increasing tax credits for the middle class, investing in community health centers, and strengthening efforts to fight waste and fraud. The other portion of the bill reforms the student loan system in the U-S. During the signing ceremony at Northern Virginia Community College, President Obama told students the legislation will generate nearly $68 billion in savings over the next 11 years by finally putting an end to bank subsidies to act as middlemen for student loans. Some of the savings, according to the President, will be used to reinvest in community colleges, 800,000 more Pell grants, increasing the per student Pell grant to almost $6,000, and limiting to ten per cent, the percentage of your income that will be used at any one time to repay your student loans. the proposal also includes forgiveness for some of the loans if the student selects some of the target job categories after graduation, such as enlisting in the armed forces, or being a teacher or a nurse in under served and poor areas. Text of President's speech, click here. Text of review of the new law from Brian Levine of the Middle Class Task Force, click here. 03/30/2010
INSURANCE LOBBYING GROUP SAYS COMPANIES WILL COMPLY WITH COVERAGE REQUIREMENTS FOR CHILDREN
More from the Emeritus Newsroom- A major health insurance lobbying group says companies they representi have every intention of obeying the new law regarding coverage of children. After suggestions earlier in the week by some health insurance reform opponents that insurance companies may not comply, Karen Ignani, represnting America's Health Insurance Plans, says her group will comply with rules to cover children with pre-existing conditions. Health and Human Services Secretary Kathleen Sebelius issued a warning to insurers that the administration would enforce the law and would not tolerate actions by any insurer to exclude children with pre-existing conditions. The law also allows parents to cover their children, under the age of 26, as dependents on their family plan. Full text of Ignani press release from AHIP, click here. 03/30/2010
BOTH HOUSES PASS THE HOUSE BUDGET RECONCILIATION BILL WITH HEALTH INSURANCE REFORM AND STUDENT LOAN REFORM
More from the Emeritus Newsroom- BOTH HOUSES OF CONGRESS HAVE NOW APPROVED THE D BUDGET RECONCILIATION BILL THAT CONTAINED THE FUNDING FOR HEALTH INSURANCE REFORM AND THE STUDENT LOAN REFORM PROPOSAL CONTAINING MORE MONEY FOR STUDENTS AND COLLEGES. THE HOUSE VOTE TONIGHT WAS 220-207. Earlier, the Senate approved the bill. The vote was 56-43. A challenge earlier in the week from Senator Judd Gregg (R) NH was rejected by the Senate Parliamentarian, however, other objections from Republicans on language of the bill will now force the House to approve the changes in the Senate version, just passed. So far the changes, according to Senate Democratic leaders are "relatively minor", seeming confident the House will also approve. Despite the complications and protests, congressional leaders are now hoping to get the rest of the reform package to President Obama next week. RECORD OF HOUSE VOTE, CLICK HERE. RECORD OF SENATE VOTE CLICK HERE. 03/25/2010
SENATE DEMOCRATS NEWS CONFERENCE FOLLOWING HOUSE AND SENATE VOTES TO PASS RECONCILIATION-MARCH 25 2010
WHITE HOUSE, DEMOCRATS DELIVER ON EXECUTIVE ORDER BANNING FEDERAL FUNDING FOR ABORTIONS
PRESIDENT OBAMA SIGNS SENATE VERSION OF HEALTH INSURANCE REFORM / THE IMMEDIATE CHANGES / REPUBLICANS LOSE PARLIAMENTARY CHALLENGE
More from the Emeritus Newsroom- With those who have fought against insurance companies and those who fought in congress, President Obama signed the Senate version of the health insurance reform bill. The bill immediately forces an end to canceling patients who are sick, bans denial of insurance due to pre-existing conditions, tax breaks for employers who offer health insurance to their workers. Some of the other provisions of the bill take effect in stages, such as penalties for not getting insurance. Those penalties start in 2014. Individuals will be given subsidies to get insurance if they cannot afford it. It they don't attempt to secure insurance through their employers, on their own, or through subsidies, they would pay a penalty. Businesses would also pay a penalty of $2,000. Some state attorneys general, 14 of them, are suing the government claiming the federal government cannot mandate forced coverage, saying they mandate encroaches on states rights. They claim that violates the tenth amendment of the constitution. The U-S Supreme Court has most often sides with the federal government for such programs, transportation being among them. The federal government usually claims, in such cases, that it does have rights to regulate commerce. THE FEDERAL GOVERNMENT HAS BEEN SUCCESSFULL IN PREVIOUS LANDMARK CASES, MOST NOTABLY IN DESEGREGATION CASES, THAT THERE IS CONTITUTIONAL LAW AND SUPREME COURT RULING PRECENDENT FOR SUPREMACY OF FEDERAL LAW WHEN IN CONFLICT WITH STATE LAW. Though the case involving health insurance reform has not yet come before the Supreme Court, justices, regardless of their political beliefs are reluctant to reverse previous Supreme Court rulings.
Still to be resolved is the Senate vote on the House reconciliation version, which the House also approved with the Senate version on Sunday night and was signed this morning by President Obama. Senate Republicans have challenged the House version saying it violates Senate rules. But, the Senate Parliamentarian has ruled against that Republican challenge, leaving the GOP to introduce endless amendments as one of the few avenues left to derail Senate passage of the House reconciliation bill.
OBAMA TO SIGN PART OF HEALTH INSURANCE REFORM TUESDAY / SENATE TO TAKE UP HOUSE BUDGET RECONCILIATION VERSION
More from the Emeritus Newsroom - President Obama is scheduled to sign the Senate version of the health insurance reform proposals Tuesday, with the House budget reconciliation version passed last night by the House, to be voted on later this week by the Senate. The reconciliation bill is currently being reviewed by the Senate Parliamentarian as to how it will proceed through that chamber. At stake is whether the reconciliation bill might be thrown out over a Republican challenge that the reconciliation bill is out of order due to its impact on Social Security. If the ruling effectively tosses out the House reconciliation bill, health insurance reform would then revert to the Senate version, which was opposed by Republicans and some Democrats. With President Obama scheduled to sign the Senate version tomorrow, the Senate version will become law regardless whether the changes in the reconciliation bill survive. The move carries some risk for reform opponents since most found the Senate version more objectionable than the reconciliation designed to fix it. Senate leaders have indicated a vote could come on Thursday, if the Parliamentarian rules against the challenge. 03/22/2010
PROPOSED CHANGES IN THE FINAL HEALTH INSURANCE REFORM RECONCILIATION BILL
CBO: REFORM WOULD COST 940 BILLION & CUT DEFICIT BY 138 BILLION OVER NEXT TEN YEARS
More from the Emeritus Newsroom- The release today of a Congressional Budget Office analysis on health insurance reform has set off an intense effort by both sides to prevail. HR 4872, their revised reform reconciliation proposal was also released by the Democrats today (See direct link at bottom). The Democrats proposal would cover 95% of the country's population by expanding Medicaid for those in lower income brackets and cutting the Medicare Advantage subsidies for insurance companies by $500 million. The CBO report released today finds that the Democrats proposal would cost $940 billion dollars the first ten years, cutting$138 billion from the deficit over the same period.In a letter to Democratic leaders, Director Doug Elmendorf explained the reform plan would produce even greater savings, up to $1.2 trillion, from 2020-2029.
"Our analysis indicates that H.R. 3590, as passed
by the Senate, would reduce federal budget deficits over the ensuing decade relative to
those projected under current law—with a total effect during that decade that is in a broad
range between one-quarter percent and one-half percent of gross domestic product
(GDP). The imprecision of that calculation reflects the even greater degree of
uncertainty that attends to it, me of you may stcompared with CBO’s 10-year budget estimates".
SOURCES: DEMOCRATS NOW HAVE THE VOTES TO PASS HEALTH INSURANCE REFORM
More from the Emeritus Newsroom -The announcement today by liberal Ohio Rep. Dennis Kucinich (D), that he will now vote for the health insurance reform proposal in the House, is just one of several shifts expected by members of congress who were either undecided, or had voted against the proposal before. Kucinich was among the block of members wanting a public option, which was taken out of the bill in the Senate and is now before the House with insurance "exchanges" to make coverage more affordable for individuals and small business. Kucinich announced this morning that, while he is not happy with some elements of the reform proposal in the House, he believes it is the country's best chance to get started on a path to controlling costs and getting insurance to the millions of uninsured. Sources report that several members who publicly are saying they are undecided, are now leaning toward voting for the proposal in a final vote which is expected on Sunday. Bloomberg News is also reporting today that the Democrats now have the votes to move the bill. In the CBO projections on the Senate proposal, released last week, CBO Director Doug Elmendorf wrote,
r from Ohio -- she wrote us a letter. Last year her insurance company charged her over $6,000 in premiums; paid about $900 worth of care. Now they’ve decided to jack up her rates 40 percent next year. So she’s had to drop her insurance, even though it may cost her the house that her parents built. Natoma knows it’s time for reform".
CONSUMER WATCHDOG SUES ANTHEM BLUE CROSS OVER HEALTH INSURANCE RATE INCREASES
More from the Emeritus Newsroom - Consumer Watchdog, a California based consumer legal advocacy group, has filed a class action lawsuit against Anthem Blue Cross and Blue Shield, for what the group called, "Enormous rate hikes to force patients into lower-benefit and higher-deductible health coverage in violation of state law". The suit is based on Anthem's proposed rate increases on certain individual policies and some of the policies it no longer wants to carry. Consumer Watchdog claims California law requires that health insurers that close a policy either offer consumers new comparable coverage, or minimize premium increases on the now-closed policies. The lawsuit accuses Anthem of systematically increasing the premiums patients to push them into lower benefit coverage—often with high deductibles and dramatically scaled back coverage. Full text of the Consumer Watchdog press release, copy click here. Full text of the actual lawsuit filed by Consumer Watchdog. 03/05/2010
WHITE HOUSE SETS DEADLINE OF MARCH 18 TO PASS HEALTH INSURANCE REFORM
More from the Emeritus Newsroom - White House Press Secretary Robert Gibbs today narrowed down the time frame for passing health insurance reform in congress. Gibbs explained the President wants to sign the bill by March 18, just before he leaves on an international trip to Australia and other Pacific rim countries. House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid both believe the differences between the two houses have a better chance of being resolved since reconciliation rules will be used to pass reformby simple majorities in both chambers. 03/04/2010
PRESIDENT OBAMA TO ANNOUNCE SUPPORT FOR RECONCILIATION / REPUBLICANS OFFER NO SUPPORT IN EXCHANGE FOR OBAMA'S CONSIDERATION OF GOP PROPOSALS/ SENATE DEMOCRATS SAY REFORM NOW IN MOTION IN THE HOUSE
More for the Emeritus Newsroom- Senate Democrats are preparing to move their version of the health insurance reform package through the House, then through the Senate, requiring only simple majorities instead of 60 votes. The move comes as President Obama has endorsed the use of "Reconciliation", requiring only simple majorities to pass health insurance reform. Obama announced today during a White House news conference that,
"... every idea has been put on the table and everything about health care has been said. Now is the time to make a decision. While both sides agree the current system is not working....The proposal I have put forward, holds insurance companies more accountable. You can keep your plan, you can keep your doctor. My proposal would end the worst practices of insurance companies. Give uninsured and business owners the same health insurance as members of congress. And if you still can't afford insurance, we will offer you tax credits. It's the middle class that gets squeezed and that is who we have to help. We are going to eliminate taxpayers subsidies to insurance companies (Medicare Advantage). We do this while protecting Medicare benefits.Or proposal is paid for...and brings down the deficit. It incorporates the best ideas from Democrats and Republicans. Despite all that we agree on, most Republicans just have a fundamental disagreement. Unless everyone has access to affordable coverage, you can't limit the amount families have to pay out of their own pockets. Health reform only works if you take care of all these problems at once. I don't see how another year of negotiations would help. And insurance companies continue to raise premiums. The American people and the US economy just can't wait that long. It deserves the same up or down vote that was used for welfare reform and the Bush tax cuts. I urge every American who wants this reform to make their voice heard. This has been a long and wrenching debate. I will leave it to others to sift through the politics. This is about middle class families who will have health insurance for the very first time in their lives. It's about the kind of country that we want to be. I ask congress to finish its work and I look forward to signing this into law". Full text of the president's speech, click here.
Republicans rebuffed Obama's pledge to consider four Republican proposals as part of the reform package, in exchange for support during votes. Obama let it be known last week, during a summit with Republicans, that he was not going to do incremental steps to reform, which most Republicans support. 03/03/2010
OBAMA SAYS HE'LL CONSIDER FOUR REPUBLICAN HEALTH INSURANCE REFORM PROPOSALS
More from the Emeritus Newsroom - As a result of last week's summit between Republican and Democratic leaders on health insurance reform, President Obama signaled today he is open to four Republican proposals. In a statement released today by the White House. Obama says,
"No matter how we move forward, there are at least four policy priorities identified by Republican Members at the meeting that I am exploring. I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit:
Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.
My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.
At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.
Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.
There are provisions that were added to the legislation that shouldn’t have been. That’s why my proposal does not include the Medicare Advantage provision, mentioned by Senator McCain at the meeting, which provided transitional extra benefits for Florida and other states. My proposal eliminates those payments, gradually reducing Medicare Advantage payments across the country relative to fee-for service Medicare in an equitable fashion..."
The Medicare Advantage plans have been a target of the Obama administration since the program subsidizes coverage with private companies at a cost higher than that of basic Medicare coverage. Democrats claim as much as $500 billion dollars a year is wasted on the program in order to assure profits of insurance companies since they cannot run the program at the same administrative cost as the government. Republicans bills the cuts as cuts to Medicare. Full text of Obama statement, click here. 03/02/2010
CENTER FOR RETIREMENT RESEARCH SAYS UNLESS THERE IS REFORM, SENIORS CAN EXPECT TO PAY AT LEAST $260,000 IN MEDICAL COSTS TILL DEATH
More from the Emeritus Newsroom - A consortium of university experts making up The Center for Retirement Research at Boston College has released results of a study on health care costs for those age 65 and older. The findings reveal,
"We estimate
that a typical household age 65 has a 5‐percent risk of the present value of its
lifetime health care costs exceeding $311,000, or $570,000 including the cost of
long‐term care. We find that relatively little resolution of uncertainty occurs with
age, even for those who remain free of chronic disease".
The study, released today, also limited the effect of those elderly on Medicaid. Researchers determined that while the health care expenditures of most households are constrained by their
available resources, the indigent receive free health care through Medicaid. When
estimating econometric models of health care expenditure, we exclude Medicaid eligible
households and include an indicator variable for those with less than zero
financial assets to avoid underestimating the risk faced by the remainder of the
population. The study also reviews expenses of less expensive home based care. it cites a Prudential (2008) report that in 2008, the
annual cost of a nursing home was about $71,000 for a semi‐private room and
$79,000 for a private room. Alternatively, employing a home health aide for four hours a day, five days a week at $22,000 a year.
IN A VERY INTERESTING SIDE NOTE, MANY EDUCATOR HEALTH INSURANCE GROUPS ARE OFTEN PRIVATELY CONSIDERED BY INSURANCE COMPANIES TO BE MORE EXPENSIVE, AND THEIR VIEW POINT GETS SOME TRACTION IN THIS STUDY, WHICH FOUND,
"Controlling for
health status, those with more education spent significantly and substantially more
on health care. All of the diseases were associated with increased health care
spending, but first onset was not associated with further increases. The
institutionalized also spent more on health care, inclusive of the cost of nursing
home care".
A typical couple age 65 can expect to
incur health care costs of $260,000 in present‐value terms over their lifetimes,
including the cost of long‐term care and Medicare, Medigap, and retiree health
insurance premiums, assuming their financial resources permit. But this couple
faces a 5‐percent chance that it will spend more than $570,000. At age 65,
remaining life expectancy for men and women born in 1944 is 17 and 21 years,
respectively. By age 85, it has more than halved, to six and seven years,
respectively. But health care cost risk decreases much less than proportionately,
and a typical couple age 85 still faces a 5 percent chance that the present value of its
remaining lifetime health care costs will exceed $477,000.
HEALTH INSURANCE REFORM SUMMIT REVEALS DETERMINATION ON BOTH SIDES TO STAY THE COURSE / DEMOCRATS APPEAR LIKELY TO MOVE FOR SIMPLE MAJORITY TO PASS REFORM
More from the Emeritus Newsroom- After more than six hours debating health insurance reform....one point remained clear. Neither the Democrats nor Republicans have changed their views from last December, when the Senate passed their version of a health insurance reform proposal. Democrats seem determined to pass reform with special risk pools to help small business with subsidies for low income policy holders, prohibiting rejections due to pre-existing conditions and cancellations due to illness. While Republican agree on limiting rejections by insurance companies, they continue to stand by their determination to preserve the Medicare Advantage subsidies to private insurance companies which Democrats want to use to bring more coverage to the uninsured. Republicans say the plan is too expensive, Democrats say it is critical to pass it now to prevent medical costs from consuming the federal budget. Sources tell Emeritus News that Democrats are likely to move toward "reconciliation rules" that make it possible to pass reform with simple majorities instead of 60 votes. Since the likelihood of any Republicans voting for the Senate bill are remote, Republicans may still use parliamentary tactics to delay the bill, demand consideration of amendments and full reading of reform provisions. Senate Majority Leader Mitch McConnell (R) KY, told reporters after the meeting he did not consider it a waste of time, but felt the President was set in his position. More in the story from the Washington Post, click here. Brief article from Congressional Quarterly, click here. Also note an interesting article about reconciliation rules from Stuart Rothenberg in Congressional Quarterly, click here. Video of the summit will be available here soon. 02/25/2010
HHS REPORT: MEDICARE ADVANTAGE PREMIUMS UP AVERAGE 32%
More from the Emeritus Newsroom- HHS Secretary Kathleen Sebelius says seniors who remained enrolled in their Medicare Advantage plans between 2009 and 2010 have experienced rapidly increasing premiums, at 32 percent on average, with a steeper 78 percent average increase for enrollees in private fee-for-service plans. The Medicare Advantage plans are subsidized by the federal government in order to give Medicare beneficiaries a choice of private sector plans beyond the standard basic government plan. Sebelius says:
"...while seniors are suffering, insurance companies are doing better than ever. Humana earned $452.3 million in the fourth quarter of 2009 from its Medicare Advantage plans, compared with $267.3 million a year earlier, a 70 percent increase. At the same time, these companies are being vastly overpaid by the federal government, making huge profits and sticking seniors with higher bills".
A report released by HHS shows, in California, beneficiaries recently received letters from Anthem Blue Cross announcing their rates would go up as high as 39 percent. Elsewhere, in the last year alone, large insurers have requested premium increases of 56 percent in Michigan, 24 percent in Connecticut, 23 percent in Maine, 20 percent in Oregon and 16 percent in Rhode Island.
Sebelius says cost cutting through reform could provide 250,000 to 400,000 new jobs a year.
HHS SECRETARY SEBELIUS BLASTS ANTHEM BCBS AND WELLPOINT FOR 39% HEALTH INSURANCE PREMIUM INCREASES / WELLPOINT ANNOUNCES DELAY
More from the Emeritus Newsroom - In a letter to Leslie Margolin,President, Anthem Blue Cross, HHS Secretary Kathleen Sebelius criticized the company for their proposed 39% premium increase on some health insurance policies. Sebelius called on the California company to publicly justify its decision . In her letter, Sebelius notes that the parent company of Anthem Blue Cross, WellPoint Incorporated earned $2.7 billion in the last quarter of 2009.
“As we continue the health insurance reform debate in Washington, this announcement reminds us that too many Americans can be left with unaffordable insurance each time the rates or rules change in the private market,” Sebelius added. “It’s clear that we need health insurance reform that will give American families the secure, affordable coverage they need.”
Sebelius says the largest price increases are on individual policies. She has asked the company to publicly reveal the percent of individual market premiums that is used for medical care versus the percent that is used for administrative costs. Sebelius added, "Policy holders in the individual market deserve to know if their premium increases would be invested in better medical care or insurance company overhead costs like salaries, profits, and advertising. I am aware that the State of California is investigating this matter, and urge Anthem Blue Cross to cooperate fully. In the meantime, I will be closely monitoring the situation".
HHS ORDERS EQUAL PAYMENT FOR MENTAL HEALTH EXPENSES
More from the Emeritus Newsroom - The Departments of Health and Human Services, Labor and the Treasury today jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders.“The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care,” said Secretary Sebelius. “I applaud the long-standing and bipartisan effort that made these important new protections possible.”“Today’s rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services,” said U.S. Secretary of Labor Hilda L. Solis. “The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That’s not just sound policy, it’s the right thing to do.”“Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment,” said Deputy Treasury Secretary Neal Wolin. “These rules expand on existing protections to ensure that people don't face unnecessary barriers to the treatment they need.”The new rules prohibit group health insurance plans—typically offered by employers—from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996 which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits. The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits. For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits—they must be calculated as one limit. MHPAEA applies to employers with 50 or more workers whose group health plan chooses to offer mental health or substance use disorder benefits. The new rules are effective for plan years beginning on or after July 1, 2010.Full Text of HHS press release, copy click here. 02/01/2010
LONG TERM CARE PROVISION STILL ALIVE IN HEALTH INSURANCE REFORM PLANS
DEMOCRATS PLAN BANS INSURANCE COMPANIES LIFETIME POLICY CAPS BUT LEAVES POTENTIAL FOR DUMPING SICK PATIENTS
More from the Emeritus Newsroom - In what is an example of what TV journalism needs more of, CNN reporter Brianna Keilar uncovered a weakness in the Senate Democrats plan to ban insurance company lifetime benefit caps. Insurance companies use those caps to limit payments for patients with expensive long term or catastrophic illnesses and other medical issues. Language in the current version of the bill allows no lifetime caps, but does have language stating, "reasonable annual caps", which essentially would give private insurers wiggle room to get an annual cap instead of a lifetime cap. Iowa Senator Tom Harkin (D), admitted that the "reasonable" alternative to the lifetime cap ban had not yet been worked out, but that some "determination" was yet to be make by the Department of Health and Human Services. Supporters of the Senate Democratic plan says the reform package, even if it becomes law, will be a work in progress. They argue the foundation must be laid for reform, even if there are some aspects that don't completely solve all the problems. But, sources at the White House have told Democratic Senate leaders they will not go along with the language as it. And some groups such as the American Cancer Society have also objected to insertion of the "annual reasonable cost", wording. . CNN story on lifetime caps, copy click here. 12/10/2009
CONGRESSIONAL BUDGET OFFICE REVIEWS MALPRACTICE, FINANCIAL AND CONSUMER REFORM PROPOSALS / ALL WOULD SAVE MONEY
More from the Emeritus Newsroom- One of the biggest issues which, so far, is not included in health insurance reform, is that of malpractice claims and insurance. The Congressional Budget Office today released a study showing that tort reform would lower costs
for health care both directly, by reducing medical malpractice costs, and
indirectly, by reducing the use of health care services through changes in the
practice patterns of providers; the agency estimated that enacting a package of
proposals outlined in that letter would reduce federal budget deficits by about
$54 billion during the 2010–2019 period. In the letter to Senator Hatch, CBO noted that imposing limits on
suits for damages resulting from negligent health care might have a negative
impact on health outcomes but concluded that the evidence is less clear about the
effects of tort reform on health outcomes than it is about the effects on health care
costs. The CBO report was important since there have been increasing calls to also address malpractice reform as part of an overhaul of health insurance reform. But, Democrats see the malpractice issue as being addressed after problems with health care access and payment, and procedure cost containment are addressed first. Republicans have used the issue as further leverage to delay Senate legislation on health insurance reform unless it also includes malpractice reform with it. Text of the CBO report on malpractice (Tort) reform, copy click here.
JUST LAST WEEK THE CBO ISSUED A REPORT ON ADVERTISING BY DRUG COMPANIES TO PROMOTE NEW OR PATENT PROTECTED MEDICATIONS. The CBO report, while offering justifications for some pharmaceutical industry promotions did raise concern about some aspects of the promotions, including a drug makers position as a
monopolist, " whose product has no
competition can turn a profit on an advertising-induced
increase in demand because a monopolist can set the
drug’s price above what it costs to satisfy that increased
demand. In addition, companies that produce drugs with
few or no competitors run little risk that advertising for
those drugs will spur demand for competing products.
That circumstance is particularly important for DTC
advertising because, at most, an advertisement might
motivate an individual to contact his or her doctor and
ask to be prescribed the advertised drug. The physician
would have to assess the patient’s condition and then
judge the advertised and requested drug to be the most
effective course of treatment. The greater the number of
other medications available, the greater the possibility that
the prescriber will choose a treatment other than the drug
the patient saw advertised. Some research suggests that
DTC advertising encourages individuals to visit their doctors
and increases sales for the advertised drug’s class—but
not necessarily for the advertised drug itself.
Detailing expenditures do not exhibit the same relationship
between average spending and the number of competitors
in a drug class. Even when there are several alternative
treatments available, drug manufacturers have an
incentive to spend on detailing to help doctors differentiate
their drugs from those of their competitors. In a visit
to a physician, a drug company’s sales representative can
remind the doctor of the company’s products, provide
samples that the physician can distribute to patients, and
compare the benefits and risks of the company’s drugs
with those of competing treatments.CBO report on drug marketing and promotions, copy click here.
THE CBO SAYS ITS FINDINGS SHOW THE FINANCIAL REFORM AND CONSUMER PROTECTION ACT OF 2009, AS PROPOSED IN THE HOUSE, WOULD NOT ADD TO THE DEFICIT. IN FACT, THE CBO says it would bring increased revenues of $3.1 billion over the 2010-2019 period and would
reduce direct spending by $4.2 billion over that 10-year period. Text of the CBO report on the reform and consumer bill, copy click here. 12/10/2009
NELSON-HATCH AMENDMENT TO RESTRICT FEDERAL PAYMENTS FOR ABORTION DEFEATED IN SENATE / DEMOCRATS CUT DEAL TO MODIFY PUBLIC OPTION
More from the Emeritus Newsroom - As the U-S Senate debates its way through their health insurance reform proposal, an amendment to prevent federal funding for abortions was defeated 54-45 Tuesday. According to opponents, including the American Civil Liberties Union, the amendment would have denied women abortion rights, and goes beyond legal means to limit those who receive any federal health care subsidy from purchasing an insurance plan on the exchange that covers abortion care even if the premium is largely paid for with private dollars. Supporters claim that any federal dollars spent on health care should be reserved for costs associated with preserving life. The Stupak amendment was passed in the House last month as part of that chambers health insurance reform bill, which was then submitted to the Senate. DEMOCRATIC LEADERS ALSO ANNOUNCED THAT A MODIFIED VERSION OF A PUBLIC OPTION PLAN HAS BEEN AGREED TO THAT WOULD ALLOW THOSE 55 AND OVER TO JOIN MEDICARE. Senate Majority Leader Harry Reid would not release details of the proposal until he had a chance to talk it over with the rest of the Senate Democrats. reid did not rule out the possibility that a public option might be added once the Senate's reform proposal moved to the floor for a final vote. 12/09/2009
UPROAR OVER MEDICARE HOME CARE CUTS CENTERS AROUND WASTE AND OVERPAYMENT TO PROVIDERS
More from the Emeritus Newsroom- The protest over proposed cuts in Medicare home health care as part of the new Senate version of the health insurance reform plan, has gained endorsements from two key groups. Both AARP and the National Association for Home Care and Hospice have endorsed the proposal saying that the cuts amount to saving overpayments and wasted per client costs to get more services to more people. The endorsements came during a flurry of publicity over the weekend, with Republicans condemning Democrats for the cuts. Supporters of the idea say those opposed are really opposed to cutting fees for home service contractors in order to spread services to more people. Democrats were able to get the proposal approved on Saturday even with several Democrats defecting over their opposition to the cuts. Democratic leaders were able to fend off some of the criticisms with the AARP and NAHCH endorsements. More in this article from Associated Press. 12/06/2009
HEALTH REFORM OPPONENTS CONTINUE STALL IN SENATE /AARP OBJECTS TO DELAYS AND MCCAIN AMENDMENT
More from the Emeritus Newsroom - "Don't give up on us". That, from California Senator Barbara Boxer in response to accusations Democrats are caving on support of a public option. Boxer made the statement tonight during a raucous conversation with Progressive talk show host Ed Schultz on MSNBC. Boxer repeated the oft said statement from Democratic leaders that health care reform will happen despite Republican efforts to slow the progress of the Senate proposal. Boxer admitted there were diverse opinions in the Democratic party, but stressed that they got the 60 votes needed to advance the debate in the Senate, overcoming any filibuster attempts by Republicans. Some of the frustration, voiced by Schultz and others, is that Delaware Senator Tom Carper (D) is trying to come up with language that would soften the public option. Republicans meanwhile, have come up with an amendment, sponsored by Sen. John McCain (R) AZ, that would keep Medicare Advantage plans alive, as wellibutions, co-payments, deductibles, co-insurance, or
other out-of-pocket costs for plan participants. We encourage sponsors to use their
reimbursement under the program for both of the following purposes: (1) To reduce the
sponsor’s health benefit premiums or health benefit costs, and (2) To reduce health benefit
32
premium contributions, co-payments, deductibles, coinsurance, or other out-of-pocket costs, or
any combination of these costs, for plan participants. We expect that sponsors will continue to
provide at least the same level of contribution to support the applicable plan, as it did before this
program. For example, for a sponsor that pays a premium to an insurer, if the premium
increases, program funds may be used to pay the sponsor’s share of the premium increase from
year to year, which reduces the sponsor’s premium costs. Full text of HHS summary of new rules, click here. 05/04/2010
ANTHEM BLUE CROSS/BLUE SHIELD CANCELS 39% PROPOSED RATE INCREASE / PROPOSAL WAS TARGET OF CRITICISM FOR OBAMA ADMINISTRATION
More from the Emeritus Newsroom-Anthem Blue Cross/Blue Shield announced today it was withdrawing its proposed maximum 39% increase on individual policy holders. The company today admitted that it made mistakes in calculating its proposed rate structure and will come up with a new proposal. The California Department of Insurance claims it found, "numerous and substantial errors", in the rate increase request submitted by Anthem. Full text of Anthem press release click here. California Department of Insurance press release, click here. 04/29/2010
HEALTH INSURER DENIES IT CANCELED FEMALE POLICY HOLDERS DUE TO BREAST CANCER
More from the Emeritus Newsroom- WellPoint says a story from Reuters that the company cancels female policy holders with breast cancer, is misleading and inaccurate. The Reuters article explains the cases of several women whose insurance was canceled after WellPoint learned they had breast cancer. The Reuters reports states;
"They had no idea that WellPoint was using a computer algorithm that automatically targeted them and every other policyholder recently diagnosed with breast cancer. The software triggered an immediate fraud investigation, as the company searched for some pretext to drop their policies, according to government regulators and investigators". Reuters also reports that WellPoint has been found, in government probes, to be one of the worst offenders involving the practice of rescission.
. WellPoint responded that today's Reuters story that the company employs a targeted rescission policy for members with breast cancer is inaccurate and grossly misleading. The story incorrectly reports that WellPoint singles out women with breast cancer for aggressive investigation with the intent of canceling their insurance. This is simply wrong. In fact, WellPoint works to prevent breast cancer, to detect it early, and to get our members into treatment. We also work to ensure that all of our members are getting best practice care for breast cancer. Full text of Reuters story, click here. . Full text of : WellPoint's Reuters Response, click here. 04/22/2010
MORE BELT TIGHTENING PREDICTED AT SOME MEDICAL CENTERS AND HOSPITALS AS MEDICARE AND MEDICAID REIMBURSEMENTS ARE CUT DUE TO OVERPAYMENTS
More from the Emeritus Newsroom - In a complicated formula that includes reduced compensation for services due to past overpayments, the Centers for Medicare and Medicaid Services announced their payment schedules today. The CMS says under legislation passed in 2007, CMS is required to recoup the entire amount of FY 2008 and 2009 excess spending from changes in hospital coding practices by FY 2012. CMS estimates that payments to general acute care hospitals under the proposed rule for operating expenses in FY 2011 will decline by 0.1 percent, or $142 million, compared with FY 2010, and taking into account all factors that would affect spending. This is being done, according to the agency, to recoup one-half of the estimated excess spending in FY 2008 and 2009 aggregate payments, due to changes in hospital coding practices that did not reflect increases in patients severity of illness (overcharging). Long Term Care Facilities will be doing better in 2011, due to the fact their coding practices did not lead to the problems recorded at other health care facilities. The proposed rule would apply to approximately 3,500 acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), and approximately 420 long-term care hospitals paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS), beginning with discharges occurring on or after October 1, 2010. Proposed payment rates are based on the most recently available data and may be revised in the final rule to reflect more current data. Full text of CMS press release, click here. 04/19/2010
CONSUMER WATCHDOG SAYS SENATE REPORT SHOWS INSURANCE COMPANIES ALREADY MOVING TO HIDE ADMINISTRATIVE COSTS IN MEDICAL CARE
More from the Emeritus Newsroom - The group, Consumer Watchdog, citing a report to the U-S Senate, says insurance companies are already working to hide some of their administrative costs as medical care. A filing to the Senate Commerce Committee from the Office of Oversight and Investigations, shows the 2009 medical loss ratio results continue to reveal a large disparity between patient medical spending in the large group market, and spending in the individual and small group markets.
Investigators say that because the largest for-profit companies were reluctant to voluntarily share their medical loss information broken out in a way that would be helpful for consumers, the Committee began collecting this information from 2008 “Accident & Health Policy Experience Exhibit” forms that the companies filed with the National Association of Insurance Commissioners (NAIC).
Office of Oversight and Investigations claims the analysis found the largest for-profit health insurers spend a lower percentage of their customers’ premium dollars on patient care than other health insurers. The analysis also found that in the individual and small group markets, health insurers spend a significantly smaller portion of each premium dollar on medical care than they do in the large group market. For example, UnitedHealth told its investors that the company’s overall 2008 medical loss ratio was 82%.4 But the NAIC filings revealed that the company’s medical loss ratio was 71% in the individual market, 79% in the small group market, and 84% in the large group market.
According to their own data, last year the largest insurers used about 15 cents out of every large group premium dollar for administrative costs and profits, while more than 26 cents out of every premium dollar went to administrative costs and profits in the individual market. Advocates at Consumer Watchdog point out that the health reform law enacted last month requires that insurers spend at least 80% of customers’ premiums on medical care in the individual insurance market, and 85% in the employer/group market.
“Health insurers keep proving that they will sniff for every loophole and play every game to keep profits high without becoming more efficient or helping control overall medical costs,” said Jerry Flanagan, health care policy director of Consumer Watchdog. “The Obama Administration must act swiftly to put an end to this insurer gaming. Consumers will accept no excuses for failure by the White House or Congress to strongly defend newly won consumer protections and ward off an onslaught of well-funded lobbyists". Full text of Office of Oversight and Investigations report, click here. Consumer Watchdog press release, click here. 04/19/2010
NEW YORK ATTORNEY GENERAL SAYS STUDENT HEALTH INSURANCE PLANS ARE CASH COWS FOR INSURANCE COMPANIES
More from the Emeritus Newsroom- Students are paying in much more than they are receiving in medical services. New York Attorney General Andrew Cuomo has subpoenaed ten of the largest insurers of students and five insurance brokers, agents, and consultants as part of the investigation.
In a letter sent to more than 300 colleges, universities, professional schools, and trade schools, Cuomo cautioned schools to review their sponsored student health insurance plans and alter potential problems that add gratuitous expenses and put students at risk. The Attorney General’s letter was sent to schools across New York and to certain out-of-state institutions attended by New York residents.
Many colleges and universities require students to purchase a school-endorsed, private health insurance plan unless students prove that they have comparable insurance coverage. The Attorney General’s investigation revealed that many of the school-endorsed plans have extremely low coverage limits, excessive costs for the coverage provided, and inconsistencies with federal protections recently signed into law.
“Many of the sponsored health care plans looked at during our investigation leave students at risk while providing massive profits for insurance companies,” said Attorney General Cuomo. “It is important for students to have adequate health care coverage to protect themselves during times of illness or injury, but a bad health insurance plan can have catastrophic and long-lasting effects on a young person’s life. By being informed of the problematic practices that currently exist in the industry, schools can negotiate for better health plans, and students and their families can be better equipped to select the coverage that is best for them.”
The school-sponsored student health insurance industry generates over $1 billion of revenue per year. Approximately 1,000,000 college students obtain their health insurance through school-sponsored plans nationwide. With these plans, students pay annual premiums for individual coverage that can be as low as under $100 or as high as over $2,500. Over two-thirds of private colleges and universities and almost one-quarter of public colleges and universities require that their students either purchase the school-sponsored plan or have their own “comparable” health insurance.
Cuomo says the health insurance reform law which allows parents to carry children on their health insurance policies up to age 26 should replace student plans. That part of the reform law takes effect in September.
The investigation revealed that in addition to providing limited coverage, many school-sponsored plans are unnecessarily costly. In many cases the amount of claims paid out by the insurance company is only a fraction of the premiums students pay, resulting in excessive profits for the insurance companies.
The investigation also exposed troubling conflicted relationships between agents and health insurers involving undisclosed contracts that created incentives for the agents to work against the best interests of students and to persuade schools to take and maintain overly costly plans.
More from the Emeritus Newsroom- Health insurance reform has brought out the bad actors already. According to Health and Human Services Secretary Kathleen Sebelius, scam artists have wasted no time trying con people into buying flu cures or bogus and unnecessary policies. In a letter to all state attorneys general, Sebelius asks them to be diligent in prosecuting scam artists. In her letter, Sebelius points out,
"Media accounts indicate that fraudsters have
gone door to door selling phony insurance policies. Some have attempted to make dishonest
profits by urging consumers to obtain coverage in a non-existent “limited enrollment” period that
they falsely claim was made possible by the new legislation.
These types of scams are unacceptable and threaten Americans across the country. Sadly, they
are not new. For example, during the height of the H1N1 flu outbreak, some attempted to market
phony flu treatments. We are determined to stop dishonest individuals who are working to
defraud the American people, no matter what their pretense.
At the Department of Health and Human Services, I have notified our aging networks about
these scams and put our Senior Medicare Patrol teams on alert. In addition to their existing
responsibilities, our Health Care Fraud Prevention & Enforcement Action Teams (HEAT) will
vigorously monitor and crack down on new forms of fraud and abuse.
Now, we are counting on law enforcement officials in states across the country to crack down on
those who seek to defraud consumers. While there are new insurance options in the near future –
a new high-risk pool program for those blocked out of insurance due to a pre-existing condition
and new insurance protections that begin in September – consumers should beware policies that
are time limited, offer limited benefits, or advertise themselves as necessitated by health
insurance reform. I urge you to vigorously monitor and prosecute any individuals who attempt
to operate or profit from dishonest scams that take advantage of the new law. And I hope you
will act quickly to make investigating and prosecuting these cases one of your top priorities". Full text of Sebelius letter, click here. 04/06/2010
OBAMA SIGNS HOUSE BUDGET RECONCILIATION BILL / INCLUDES HEALTH INSURANCE REFORM AND STUDENT LOAN REFORM WITH MORE PELL GRANTS
More from the Emeritus Newsroom- After singing the Senate version of health insurance reform last Tuesday, President Obama today signed the House budget reconciliation version. The reconciliation version contains much of th as the subsidies for insurance companies for those plans, which effectively would take about 500 billion in savings used by Democrats to fund their reform plan. But, Republicans have stalled action for consideration on McCain's amendment. More on the Senate rancor in this article from the Washington Post. Meanwhile, the AARP today issued a press release saying, "AARP today sent a letter to senators in opposition to Sen. John McCain’s amendment to recommit the Patient Protection and Affordable Care Act. The Association noted that, while the bill must be improved to make health care and prescription drugs more affordable, the McCain amendment ignores the need to strengthen Medicare" Full Text of AARP press release, cop click here.12/02/2009
CBO CONFIRMS HEALTH REFORM PLAN WILL HAVE LITTLE EFFECT ON HEALTH INSURANCE PREMIUMS
More from the Emeritus Newsroom - Analysis of the Congressional Budget Office, released today, finds the Patient Protection and Affordable Care Act now being considered in the Senate, would have have li9ttle adverse impact on employer sponsored health plans, would make insurance more affordable for small groups and through subsidies make individual coverage much more affordable.
The largest effects would be seen in the nongroup market, which would grow in size under the proposal but would still account for only 17 percent of the overall insurance market in 2016. The effects on premiums would be much smaller in the small group and large group markets, which would make up 13 percent and 70 percent of the total insurance market, respectively.
CBO and JCT estimate that the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law. About half of those enrollees would receive government subsidies that would reduce their costs well below the premiums that would be charged for such policies under current law.
That difference in unsubsidized premiums is the net effect of three changes:
• Average premiums would be 27 percent to 30 percent higher because a greater amount of coverage would be obtained. In particular, the average insurance policy in this market would cover a substantially larger share of enrollees’ costs for health care (on average) and a slightly wider range of benefits. Those expansions would reflect both the minimum level of coverage (and related requirements) specified in the proposal and people’s decisions to purchase more extensive coverage in response to the structure of subsidies.
• Average premiums would be 7 percent to 10 percent lower because of a net reduction in costs that insurers incurred to deliver the same amount of insurance coverage to the same group of enrollees. Most of that net reduction would stem from the changes in the rules governing the nongroup market.
• Average premiums would be 7 percent to 10 percent lower because of a shift in the types of people obtaining coverage. Most of that change would stem from an influx of enrollees with below-average spending for health care, who would purchase coverage because of the new subsidies to be provided and the individual mandate to be imposed.3
Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.4
Those figures indicate what enrollees would pay, on average, not accounting for the new federal subsidies.
The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium, CBO and JCT The weighted average of the differences in those amounts equals the change of 10 percent to 13 percent in the average premium per person summarized above, but the percentage increase in the average premium per policy for family policies is larger and that for single policies is smaller because the average number of people covered per family policy is estimated to increase under the proposal. The effects on the premiums paid by some individuals and families could vary significantly from the average effects on premiums.
The legislation would have much smaller effects on premiums for employment-based coverage, which would account for about five-sixths of the total health insurance market. In the small group market, which is defined in this analysis as consisting of employers with 50 or fewer workers, CBO and JCT estimate that the change in the average premium per person resulting from the legislation could range from an increase of 1 percent to a reduction of 2 percent in 2016 (relative to current law).Under the proposal, the subsidy levels in each market would be tied to the premium of the second cheapest plan providing the “silver” level of coverage (that is, paying 70 percent of enrollees’ covered health care costs, on average). CBO and JCT have estimated that, in 2016, the average premium nationwide for those “reference plans” would be about $5,200 for single coverage and about $14,100 for family coverage. The difference between those figures and the average nongroup premiums under the proposal that are cited above ($5,800 and $15,200, respectively) reflects the expectation that many people would opt for a plan that was more expensive than the reference plan, to obtain either a higher amount of coverage or other valued features (such as a broader network of providers or less tightly managed benefits). Employment-Based Coverage
6 In the large group market, which is defined here as consisting of employers with more than 50 workers, the legislation would yield an average premium per person that is zero to 3 percent lower in 2016.
U-S SENATE APPROVES HEALTH INSURANCE REFORM PACKAGE DEBATE
More from the Emeritus Newsroom- By a vote of 60-39, the U-S Senate tonight approved "Cloture" to bring the Senate version of the health insurance reform bill to the floor for debate. All Democratic members and two independents accounted for the 60 votes needed to avoid a delay. This means debate will start after the Thanksgiving holiday and with the goal of a vote by December 15th, if not sooner. 11/21/2009
U-S SENATE SETS MAJOR HEALTH REFORM VOTE
More from the Emeritus Newsroom- Senate Democratic leaders have set Saturday, November 21st, at 8pm, for a major procedural vote to move a health insurance reform proposal to the floor for debate and a final vote. The Senate version of the bill passed in the house, will need all 60 Democratic Senators voting in favor of "Cloture" to prevent Republican delay of the bill. The details of the Senate bill are available in the story below along with the Congressional Budget Office cost review. 11/20/2009
SENATE DEMOCRATS LATEST HEALTH INSURANCE REFORM PROPOSAL / CBO ESTIMATE SAYS PLAN COSTS $849 MILLION / REDUCES DEFICIT $127 BILLION / COVERS 94% OF POPULATION /HAS PUBLIC OPTION
More from the Emeritus Newsroom - Senate Democratic leaders tonight announced they have a ten year plan that, according to the Congressional Budget Office, will cover 94% of the population, cost 51 billion dollars less than the 900 billion dollar ceiling set by President Obama and cut $127 billion from the deficit. Called, The Patient Protection and Affordable Care Act, it contains a higher medicare tax would be charged those making more than $250,000 a year. The public option gives states authority to opt out. Democrats are hoping to take a procedural vote on the bill Friday or Saturday, before it advance to the floor for more debate and a final vote. If the measure is approved in the Senate, it then heads to a joint house-senate conference to settle differences. CBO estimate, copy click here. Text of Senate Democrats bill, copy click here. 11/18/2009
CHIEF FINANCIAL FORECASTER FOR CENTERS FOR MEDICARE AND MEDICAID SERVICES ISSUES SOBERING REPORT ON HEALTH INSURANCE REFORM IMPACT ON SENIORS AND THE POOR
More from the Emeritus Newsroom- The Chief Actuary for the Centers for Medicare and Medicaid Services today released his report showing, what he calls, cause a major reduction in benefits for senior citizens and could force more hospitals and doctors to reject the government health plans. The report from Richard Foster at CMS was requested by congressional Republicans on the Ways and Means Committee, some of whom he blamed last year for telling him not to release his cost estimates for the medicare prescription drug plan supported by then President Bush. In his projection released today, Foster claims the package passed by the House last weekend would may prompt some hospitals and nursing homes to stop accepting Medicare and Medicaid. His report did not appear tonight on the CMS web site but has appeared in various published reports However, Democratic House leaders today also pointed out that the report projects health care spending would increase one per cent over a ten year period, supporting their claim that the reform plan actually does control costs. Full text of report from Richard S. Foster, click here. 11/14/2009
OPEN ENROLLMENT FOR MEDICARE BEGINS
More from the Emeritus Newsroom- With Medicare open enrollment in two days there is a lot at stake this time around. Medicare Advantage plans will be trying to put their best forward as they campaign against proposed elimination o9f the plans as part of reform. And the Centers for Medicare and Medicaid Services are under the gun this year to improve enrollment and supervision of that enrollment. Last year, the Inspector General found both enrollment and supervision inadequate under the former Bush administration. Officials say the net impact from changes brought by last year's enrollment problems will be cut the number of different versions of plans, which often led to confusion and misleading sale tactics relating to chronic or catastrophic conditions. Patients often complained of hidden or confusing co-pay combinations and higher percentages for name brand drugs.The agency also says, as part of CMS’ oversight efforts of the Medicare Advantage and Prescription Drug plans, sponsoring organizations are being asked to conduct audits on the data provided to CMS about the operation of their plans. These new audits will be in addition to the current CMS financial and program compliance audits. The existing Program compliance audits will be strengthened by becoming more targeted, data-driven and risk-based. They will focus on high-risk areas that have the greatest potential for beneficiary harm, such as enrollment operations, appeals and grievances, and marketing. CMS press release from March 2009 regarding Medicare enrollment problems and resulting changes, copy click here. CMS press release from Nov. 12 2009 for enrollment. 11/13/2009
WHY AGE RATING OF HEALTH INSURANCE POLICIES WILL CONTINUE WITH REFORM
/ OPPONENTS CLAIM DISCRIMINATION
HEALTH INSURANCE REFORM SUPPORTERS WIN CLOSE SATURDAY NIGHT VOTE / AMENDMENT ADDED TO RESTRICT FEDERAL FUNDING FOR ABORTIONS
More from the Emeritus Newsroom- After approving an amendment from Rep. Bart Stupak (D) MI to restrict federal payment for abortions, the US House voted 220-215 to approve the House version of the health insurance reform bill (HR 3962). It will now be up to the Senate approve a version which will then be submitted to a conference committee to settle differences between the two chambers. A total of 39 Democrats joined Republicans to vote no. Most were from district which trend Republican. One Republican unexpectedly broke ranks to join majority Democrats. Rep. Anh “Joseph” Cao (R) from Louisiana's second district, which includes much of New Orleans and suburban areas, was the only Republican to vote for the proposal. During a news conference held after the vote, Speaker Nancy Pelosi said President Obama called and congratulated them for their victory. Pelosi said she was proud of members of congress who bravely took a stand for the American people. Democratic Majority Leader Rep. Steny Hoyer said, "The American people won today". He addled, "This about making sure every American has access to quality care". Rep. James Clyburn (D) SC said the vote, "Bodes well for the American People". Text of HR 3962, copy click here. Thomas summary of HR 3962, copy click here. Primer on Senate and House health insurance reform bills, copy click here. A MUST READ!!!!11/07/2009
HEALTH INSURANCE REFORM SUPPORTERS READY HOUSE BILL FOR WEEKEND VOTE / DEMS BATTLE FOR VOTES
More from the Emeritus Newsroom- A late Friday night meeting of the House Rules Committee restlessly and exhaustively wrestled with amendments to the Democrats health insurance reform proposal. Earlier in the day, house Democratic leaders were doing their best to get a weekend vote on their health insurance reform proposal. At last word, House Democratic Majority Leader Steny Hoyer was trying to line up at least 218 votes they would need to pass the proposal. Although Democrats have already indicated they will vote against it, Democratic leaders remain confident they will get their proposal approved either this weekend, or Tuesday at the latest. Not a single Republican indicated any willingness to vote for the proposal. At last report, President Obama planned to meet with house Democrats Saturday morning, but that could change depending on a possible vote. Speaker Nancy Pelosi has indicated the possibility of a Sunday vote. The proposal is that announced last week on the steps of the Capitol by speaker Nancy Pelosi and other supporters. Text of HR 3962, copy click here. Thomas summary of HR 3962, copy click here. Primer on Senate and House health insurance reform bills, copy click here. A MUST READ!!!!11/06/2009
AARP ANNOUNCES ENDORSEMENT OF HOUSE DEMOCRAT HEALTH INSURANCE REFORM PLAN
More from the Emeritus Newsroom- The Board of Directors of the American Association of Retired Persons has decided to endorse the House versions of the Affordable Health Care for America Act (H.R. 3962/H.R. 3961) . The House version of the Act is scheduled to be voted on Saturday in the House. The AARP says the House proposals that would improve health care for older Americans and their families. They include: Protecting and strengthening Medicare for today’s seniors and future generations of retirees. Ensuring seniors can see the doctor of their choice or find a doctor if they need one by improving Medicare’s payments to doctors. Lowering drug costs for seniors by closing the Medicare Part D "doughnut hole." Taking steps to reduce waste, fraud, abuse and inefficiency in the Medicare program. Requiring Medicare and insurance companies to provide for important preventive services like screenings for diabetes, cancer and osteoporosis free of charge for those who don’t have coverage. Preventing insurers from denying affordable coverage to anyone because of their age or health. Limiting how much your insurance company can make you pay out-of-pocket. Providing affordable health insurance options for those who don’t have insurance or can’t afford it. Providing benefits to help seniors and people with disabilities live in their own homes and communities. 11/05/2009
CONGRESSIONAL BUDGET OFFICE STUDY OF GOP HEALTH PLAN SHOWS IT WOULD HELP ONLY 3 MILLION UNINSURED
More from the Emeritus Newsroom- In a review of the health reform proposal submitted by Republicans the Congressional Budget Office has concluded :
"By 2019, CBO and JCT estimate, the number of non elderly people without health
insurance would be reduced by about 3 million relative to current law, leaving about
52 million non elderly residents uninsured. The share of legal non elderly residents
with insurance coverage in 2019 would be about 83 percent, roughly in line with the
current share. CBO and JCT estimate that enacting the amendment’s insurance
coverage provisions would increase deficits by $8 billion over the 2010–2019
period.
Some of the major points of the Republican proposal include:
Regulatory reforms in the small group and nongroup markets, including
establishing AHPs and individual membership associations, and allowing
states to establish interstate compacts with a unified regulatory structure;
A State Innovations grant program to provide federal payments to states that
achieve specified reductions in the number of uninsured individuals or in the
premiums for small group or individually purchased policies; 1
Federal funding for states to use for high-risk pools in the individual
insurance market and reinsurance programs in the small group market; and
Changes to health savings accounts (HSAs) to allow funds in them to be
used to pay premiums under certain circumstances, to make net contributions
to HSAs eligible for the saver’s credit, and to provide a 60-day grace period
for medical expenses incurred prior to the establishment of an HSA.
REPORT PROJECTS NUMBER OF UNINSURED UNDER AGE 65 WILL BE OVER 50 MILLION NEXT YEAR
More from the Emeritus Newsroom- The Economic Policy Institute released a report this morning showing a sharp decrease in the number of health care plans being offered by employers, which is swelling the ranks of the uninsured. The EPI says the number of people on government sponsored health plans increased by 3.4 million people as the number of those on employer sponsored plans dropped by 1.8 million. States with the largest decreases, North Carolina, South Carolina, Michigan, Tennessee and Missouri. EPI press release and link to report, copy click here. 10/27/2009
SENATE MAJORITY LEADER REID PROPOSES HEATH INSURANCE REFORM "OPT OUT" PUBLIC PLAN FOR STATES
More from the Emeritus Newsroom- Senate Majority Leader Harry Reid today formally proposed an "Opt Out" public plan, which gives states the option, not to offer a public plan. Reid says the public wants a public plan as an alternative to private health insurance. Reid claims his proposal was being sent today to the Congressional Budget Office for a cost analysis. Republicans have opposed the public option saying it would force private insurers out of the market and increase the nation's debt. Arizona Republican Senator John Kyl today accused Democrats of trying to hide the real cost of the plan. That cuts to Medicare would take place. Democrats have wanted to cut the Medicare Advantage plans which are subsidized at a higher rate than basic medicare plans to help cover administrative costs of private insurers. However, private insurers often include extras on their plans such as health club memberships as an incentive to Medicare beneficiaries to sign up for their plans. Video of Sen. Harry Reid proposing his plan at a news conference, copy click here. Video of Republican leaders response, click here. 10/26/2009
BASIC MEDICARE PREMIUMS UP 15% / BASIC COST WILL BE $110.15 / HHS SEC. SELEBELIUS SAYS HEALTH INSURANCE REFORM IS URGENTTO PREVENT MEDICARE INCREASES
More from the Emeritus Newsroom-The Centers for Medicare and Medicaid Services has announced basic Medicare premiums will increase 15% next year, costing $110.15. However, the announcement from CMS also claims that most Medicare beneficiaries will not see a Part B monthly premium increase as a result of a “hold harmless” provision in the current law. This allows for 73 percent of beneficiaries to be protected from an increase raising the 2010 Part B monthly premiums from $96.40 to $110.50. The Administration continues to urge Congressional action that would protect all beneficiaries from higher Part B premiums and eliminate the inequity of a high premium for the remaining 27 percent of beneficiaries. An article in the New York Times quoted HHS Secretary Kathleen Sebelius urging the Senate to approve a bill already approved in the house, in order to avoid the Medicare increases. Medicare premium announcement including income tables from CMS, copy click here. Medicare.gov premium and co-insurance rates page, copy click here. 10/19/2009
RIGHTS TO SUE INSURERS FOR DENIED MEDICAL TREATMENT REMAINS UNSETTLED IN REFORM DISCUSSIONS
SENATE FINANCE COMMITTEE APPROVES HEALTH INSURANCE REFORM PLAN 14-9 / SEN. OLYMPIA SNOWE (R) ME. VOTES YES, JOINING DEMOCRATS TO GET BILL OUT OF COMMITTEE / PUBLIC OPTION SUPPORTERS STILL OPTIMISTIC SOME FORM WILL EMERGE IN FINAL BILL
More from the Emeritus Newsroom - The Senate Finance Committee has passed, by a vote of 14-9, the committee's health insurance reform proposal. Senator Olympia Snowe (R) was the only Republican to vote for the proposal. Before the vote, questions largely centered around Congressional Budget Office and Joint Committee on Taxation projections. Emeritus. Senate Finance Committee proposal, copy click here. Video of Sen. Olympia Snowe speech before vote, click here. Video of Sen. Max Baucus and committee vote, click here. 10/13/2009
PRIVATE INSURER GROUP SAYS SENATE PLAN WOULD INCREASE COSTS / DEMOCRATS FIRE BACK
More from the Emeritus Newsroom- With statistics from the accounting firm of Price Waterhouse Coopers, the group representing smaller health insurance companies, America's Health Insurance Plans, has begun its attack on the Senate Finance Committee reform proposal. The group claims the reforms as proposed would increase the cost of private health insurance plans beyond the increases already expected under current law through 2016. The AHIP funded report claims :
The cost of the average family policy is approximately $12,300 today and will rise to:
* $15,500 in 2013 under current law and to $17,200 if these provisions are implemented.
* $18,400 in 2016 under current law and to $21,300 if these provisions are implemented.
* $21,900 in 2019 under current law and to $25,900 if these provisions are implemented.
Additionally, the AHIP report claims between 2010 and 2019 the cumulative increases in the cost of a typical family policy under this reform proposal will be approximately $20,700 more than it would be under the current system.
Democrats on the Senate Finance Committee were on the counter attack today, claiming that the report was bought and paid for by the same insurance businesses that have made more profits over the last seven years while the number of uninsured Americans has increased. Scott Mulhauser, a spokesman for Democrats on the Senate Finance Committee, said in a statement today that insurance companies, "have been gouging too many consumers for too long as they stand in the way of reform yet again. Now that health care reform grows ever closer, these health insurers are breaking out the same, tired playbook of deception to prevent millions of Americans from getting the affordable accessible care they need". Democrats also say last week's CBO report offers proof why the AHIP report is inaccurate. The White House also attacked the AHIP report, saying , "This is a self-serving analysis from the insurance industry, one of the major opponents of health insurance reform. Even the company hired to produce the report has issued a statement saying they produced a skewed report that analyzes only part of the bill because that is what the insurance industry paid them to do".
SENATE FINANCE COMMITTEE TO VOTE TUESDAY ON HEALTH REFORM PACKAGE
More from the Emeritus Newsroom- Senate Majority Leader Harry Reid announced today that the Senate Finance Committee will vote on that chamber's version of the health Insurance reform proposal. He also did not rule out the possibility of inserting a public option in the bill before it goes to the full Senate for a vote. The Senate Finance Committee proposal does not offer a public option but does offer co-operative insurance exchanges for those who cannot find or afford coverage in the private insurance market. Also today, House Speaker nancy Pelosi announced the Congressional Budget Office would be evaluating House proposals, which do include public government run options. Pelosi's announcement comes as there are increasing expectations that a final bill from both chambers will include the public option. Although Democrats may not have the 60 Senate votes to prevent a filibuster by Republicans to stop it, they may use procedural rules to allow passage by a simple majority. 10/08/2009
MOTHERS IN SINGLE PARENT FAMILIES MAKE UP MOST OF BANKRUPTCIES DUE TO MEDICAL BILLS / NEW REPORT SHOWS UNEMPLOYED FEMALE HEADS OF HOUSEHOLDS UP 40% / TREND BRINGS 276,000 MORE UNINSURED CHILDREN
More from the Emeritus Newsroom- A report released today
by the Joint Economic Committee of Congress brings a stark picture of declining fortunes for American female heads of households. The report claims an estimated 64 million women lack adequate health insurance. Women are more vulnerable to high health care costs than men. Several factors explain why. First, women’s health needs differ from men’s, so women are obliged to interact more regularly with the health care system – regardless of whether they have adequate insurance coverage or not. Second, women are more likely to be economically vulnerable and therefore face devastating consequences when faced with a mounting pile of medical bills. Findings show the number of unemployed female heads of household has increased 40 percent over the past twelve months. For many of these women, the loss of a job means not only a disappearing paycheck, but also the disappearance of employer-sponsored health insurance coverage for their families, resulting in 276,000 more children losing their insurance coverage. The report also claims:
Over one-quarter (26 percent) of all young women (ages 19-24) do not have health insurance coverage. The weak job market has hit young workers particularly hard, with the unemployment rate amongst young women at 15.5 percent in September 2009, substantially higher than the national unemployment rate of 9.8 per-cent.
39 percent of all low-income women lack health insurance coverage. Because of wide variability in state Medicaid eligibility rules, millions of American women fall through the safety net every day. The devastating impact of the recession on state budgets has forced some states to further tighten Medicaid eligibility rules at precisely the time when need is growing fastest.
Women are more likely than men to de-pete their savings accounts in order to pay medical bills. One-third of under-insured women deplete their savings to pay medical bills, as compared to a quarter of under-insured men. The disparity is comparable amongst the uninsured (34 percent of uninsured women as compared to 29 percent of uninsured men).
CBO GIVES LIFT TO SENATE FINANCE COMMITTEE HEALTH REFORM PROPOSAL / FORECASTS REDUCTION OF BUDGET DEFICIT
More from the Emeritus Newsroom- A deficit reduction of at least $81 billion over ten years. that's the latest budget effect from the health reform proposal now in the Senate Finance Committee. The Congressional Budget Office estimates were released this afternoon as committee members prepare to vote on the proposal to get it out of committee and onto the floor of the Senate. The CBO projections found the health reform bill in the Se ante Finance Committee would:
"....result in a net reduction in federal budget deficits of
$81 billion over the 2010–2019 period (see Table 1). The estimate includes
a projected net cost of $518 billion over 10 years for the proposed
expansions in insurance coverage. That net cost itself reflects a gross total
of $829 billion in credits and subsidies provided through the exchanges,
increased net outlays for Medicaid and the Children’s Health Insurance
Program (CHIP), and tax credits for small employers; those costs are partly
offset by $201 billion in revenues from the excise tax on high-premium
insurance plans and $110 billion in net savings from other sources. The net
cost of the coverage expansions would be more than offset by the
combination of other spending changes that CBO estimates would save
$404 billion over the 10 years and other provisions that JCT and CBO
estimate would increase federal revenues by $196 billion over the same
period.1 In subsequent years, the collective effect of those provisions would
probably be continued reductions in federal budget deficits. Those
estimates are all subject to substantial uncertainty.
"Starting in July
2013, the proposal would establish a requirement for such residents to
obtain insurance and would in many cases impose a financial penalty on
people who did not do so. The proposal also would establish new insurance
exchanges and would subsidize the purchase of health insurance through
those exchanges for individuals and families with income between
100 percent and 400 percent of the federal poverty level (FPL)."
SEN. BAUCUS: HEALTH REFORM BILL WILL BE OUT OF FINANCE COMMITTEE BY NEXT FRIDAY OCTOBER 9TH / DEMOCRATIC LEADERS WANT TO GET BILL TO PRESIDENT BY OCTOBER 20TH / UNEMPLOYMENT EXTENSION BILL NEXT IN LINE
More form the Emeritus Newsroom- Senate Finance Committee Chairman Max Baucus today announced his committee will get a report back next week from the Congressional Budget Office on the cost of the committee's proposal for health insurance reform. Baucus today revealed a few details about the bill releasing a statement claiming:
This bill will lower taxes for more than 42 million Americans and reduce the federal deficit.
This bill will protect Medicare benefits for seniors.
This bill will significantly expand health coverage.
By building on our employer‐based system, the majority of Americans can keep what they have today, if
they like it.
And this bill will help the most vulnerable in our society get the care they need, not just the care they
can afford.
Tonight, we can all be proud. We are offering a fiscally‐responsible bill that takes good ideas from both
sides of the aisle.
I have never felt more proud because, tonight, we take another step toward putting this country on a
path to a healthy future.
Baucus hopes to have the bill out of his committee by next Friday. PART OF THE REASON FOR THIS IS THE COMMITTEE'S DETERMINATION TO DO SOMTHING ABOUT EXTENDED JOBLESS BENEFITS FOR THE LONG TERM UNEMPLOYED. About a half million jobless Americans lost their benefits as of the end of September with a million more set to lose them by the end of this month. Recent projections along with Friday's dour report from the Labor Department are motivating senators to come up with some proposal to handle and extended jobless downturn, now that the monthly string of job losses is the worst since the Great Depression. Sources in the Senate Finance Committee have told Emeritus News the unemployment extension is why Chairman Baucus wants to get the health reform bill out of committee sooner to take on the extended benefits issue.
CENTERS FOR MEDICARE AND MEDICAID SERVICES GIVES $6.3 TO STATE BASED MEDICARE HEALTH INSURANCE COUNSELING PROGRAMS / COUNSELS SENIORS ABOUT INSURANCE CHOICES AND PROBLEMS
More from the Emeritus Newsroom- The Centers for Medicare & Medicaid Services (CMS) today announced that an additional $6.3 million has been distributed to State Health Insurance Assistance Programs (SHIPs) to help beneficiaries get more information about their Medicare health and prescription drug plan choices. These final disbursements for 2009 – part of $49.6 million in total grants to States for their SHIP operations – fund programs that use community-based networks to provide Medicare beneficiaries with local, personalized assistance on a wide variety of Medicare and health insurance topics.
“We know beneficiaries want personalized assistance as they make decisions about their health care options,” said Jonathan Blum, acting director of the Center for Drug and Health Plan Choices and director of the Center for Medicare Management. “In addition to 1-800-MEDICARE operations and its customer service representatives, SHIPs are one of the most important resources available to Medicare beneficiaries.”
In grant year 2008, SHIPs reached approximately 5.2 million beneficiaries, caregivers and advocates. The SHIPs reported that they are addressing more complex cases as well as trying to meet the needs of diverse populations.
CALIFORNIA REGULATORS TAKE OVER GOLDEN STATE MUTUAL LIFE INSURANCE COMPANY / HAS 80,000 CUSTOMERS IN U-S
More from the Emeritus Newsroom- California insurance regulators have taken over the Golden State Mutual Life Insurance Company as the L.A. based company continues to lose hundreds of thousands of dollars each month. The company has been a tradition among African American families for more than 80 years, but as with other troubled insurance companies, was expected to become insolvent by the end of the year, according to regulators. The California Insurance Commissioner Steve Poizner today announced, "For some time my department has been concerned with Golden State Mutual's continued operating losses and repeatedly warned the company that continuing to sell assets to cover losses was hazardous to its policyholders and would eventually lead to conservation. Unfortunately, that day has now come. For the protection of its policyholders, the company has been seized to prevent continuing financial deterioration". The company's primary business is the sale of individual term and whole life products, with annuity riders attached on a participating basis through a number of general agents. In order to ensure that insurance policies are secure, state Law requires that companies like Golden State Mutual have more than $5 million in capital and surplus. At the end of June, Golden State Mutual reported capital and surplus of $1.65 million. During the 3rd quarter Golden State Mutual will report losses of approximately $600,000. The company has experienced significant net operating losses in every year for the past five years. Including losses through August 31, 2008, the company's losses total $6.1 million. Insurance Department press release, copy click here. 09/30/2009
STATES FACE POTENTIAL ECONOMIC CATASTROPHE AS UNEMPLOYED AMERICANS FLOOD MEDICAID ROLLS / FINDINGS FROM KAISER FAMILY FOUNDATION REPORT
More from the Emeritus Newsroom- Unless there is health insurance reform in the U-S, states face massive budget shortfalls just to keep up with insuring the rising number of poor and unemployed. A report released today by the Commission on Medicaid and the Uninsured at the Kaiser Family Foundation says the Medicaid enrollment rate in the past fiscal year grew by 5.4%. That was the largest increase in six years and above the 3.6% increase that was forecast by state Medicaid directors across the country. The report also shows that total Medicaid spending growth averaged 7.9 percent in FY 2009, the highest rate in five years, well above the 5.8 percent projected growth. For FY 2010, states estimate Medicaid enrollment will grow by 6.6 percent over FY 2009 levels. The survey finds that, based on initial legislative appropriations, Medicaid spending across states is expected to grow by an average of at least 6.3 percent in fiscal 2010. But officials in three-fourths of the states are concerned that those appropriations will not be enough, leading to more budget shortfalls and more pressures to trim services and spending. Kaiser Family Foundation report on Medicaid Spending, copy click here.
09/30.2009
SENATE FINANCE COMMITTEE VOTES DOWN TWO PUBLIC OPTION PROPOSALS
More from the Emeritus Newsroom- The Senate Finance Committee today voted against two public option proposals, but public option supporters say there is still a chance to pass it before the full House and Senate. The Finance Committee hearing and votes on the two proposals mirrored earlier debates on the issue, with Republicans claiming a public option would wipe out the private sector insurance business, and Democrats saying the public option is the only way to reign in prices. The first public option amendment was offered by West Virginia Senator John Rockefeller (D), which was turned down 15-8 with the second public option proposal from Senator Charles Schumer (D) NY, which garnered a 10-13 defeat. Still, the plan from committee chairman, Montana Senator Max Baucus (D) remains with a public co-operative as an alternative to private insurance companies, for individuals and small businesses. Schumer and Rockefeller have vowed to continue their fight for a public option as the Senate works toward a final bill. C-SPAN page with video replays of hearings, click here. 09/29/2009
FEDS WARN HUMANA NOT TO USE CUSTOMER DATABASE TO CAMPAIGN AGAINST INSURANCE COMPANY CUTS / CAUSES UPROAR DURING HEARINGS ON SUBSIDY CUTS TO INSURANCE COMPANIES / VOTE ON SENATE COMMITTEE PROPOSAL COULD BE DELAYED TWO MORE WEEKS
More from the Emeritus Newsroom- Republicans accused the Obama administration today of stepping on insurance companies first amendment rights by ordering Humana not to use Medicare customer bases to get customers to opposed subsidy cuts to insurance companies. the situation boiled over today during a hearing held by the Senate Finance Committee. The notification to insurance companies came from the Center for Medicare and Medicaid Services. Chairman Max Baucus, who has been trying to win over various factions through compromise proposals became angry with Republicans accusations, saying "I have deep respect for the First Amendment," he said. "We're talking about a special category here.... We’re talking about the communication that these plans have with their membership. These plans have personal information that no one else has". At issue is cutting 113 billion dollars in government subsidies for the Medicare Advantage program. cutting those subsidies and other programs, which the Obama administration considers waste, is the centerpiece for paying down health reform costs over the next ten years. Because Congressional Budget Office estimates may take two weeks to finish, a vote on the proposal may not come for three weeks to a month. 09/23/2009
PRESIDENT OBAMA RESTATES HIS GOAL FOR PUBLIC OPTION / ALSO EXTENDS WILLINGNESS TO COMPROMISE
More from the Emeritus Newsroom- At times, responding to a Republican chorus of boos, President Obama called the stories of death squads and other distortions, "Lies". Tonight the President again laid claim to a goal of having a public option to compete with private insurance companies. But, Obama sought to quell fears from those with health insurance coverage, saying that reform would take nothing away from them. As for those without insurance, the President says, his reform proposal,
" creates a new insurance exchange -- a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It's how everyone in this Congress gets affordable insurance. And it's time to give every American the same opportunity that we give ourselves".
Obama expressed support for a proposal put forth by Republican Senator John McCain (R)-AZ, which would create a special insurance pool for individuals and small businesses that can't afford insurance.
The President also mentioned his determination to promote more competition among insurance companies.
"My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. (Applause.) Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates".
CONGRESSIONAL BUDGET OFFICE PROJECTS SENIORS MEDICARE PART "D" PREMIUMS WOULD INCREASE BUT THEIR DRUG COSTS WOULD FALL
More from the Emeritus Newsroom- Paring its way through scoring the effects of reform on Medicare, the Congressional Budget Office has released projections of Medicare part "D" premiums and actual drug costs for seniors from 2010-2019. Congressional Budget Office (CBO) has estimated the change in Medicare Part D premiums that would result from certain provisions contained in title I in division B of H.R. 3200, America’s Affordable Health Choices Act of 2009, as introduced on July 14, 2009. According to CBO’s estimates, enacting those changes would lead to an average increase in premiums for Part D beneficiaries of about 5 percent in 2011, rising to about 20 percent in 2019. However, beneficiaries’ spending on prescription drugs apart from those premiums would fall, on average, as would their overall prescription drug spending (including both premiums and cost sharing). As with CBO’s other estimates related to this bill, the following analysis remains preliminary and does not reflect any modifications or amendments made after July 14. CBO Medicare, Part "D" projections, PDF copy click here. 08/29/2009
HHS REPORT SHOWS REFORM CRITICAL TO KEEPING MEDICARE INTACT
More from the Emeritus Newsroom- A new report, called, "America’s Seniors and Health Insurance Reform: Protecting Coverage and Strengthening Medicare" was released today by the Department of Health and Human Services. The report highlights the problems with the status quo that leave seniors paying escalating costs for their health care while outlining how health insurance reform will strengthen Medicare and protect coverage for seniors. The report is available at www.HealthReform.gov. HHS Secretary kathleen Sebelius says,
“Senior citizens have seen their premiums and out-of-pocket drug costs rise and without reform, many seniors on Medicare could lose access to the doctor they know and trust,” Secretary Sebelius said. “Health insurance reform will protect the coverage seniors depend on, improve the quality of care and help make Medicare strong.”
The report highlights current problems in the status quo and the solutions health insurance reform will provide, including:
Overpayments to Private Plans: A typical older couple in traditional Medicare will pay almost $90 next year on average to subsidize private insurance companies who are not providing their health benefits. Health insurance reform will eliminate these overpayments.
High Prescription Drug Prices: Health insurance reform will cut the drug costs that seniors have to bear in the “doughnut hole” by 50 percent.
Imminent Doctors’ Payment Cut will Limit Access: Because of a flawed system for paying physicians, Medicare is scheduled to reduce its fees next year by 21 percent next year. According to a recent survey by the American Medical Association, if Medicare payments are cut by even half that amount, or 10 percent, 60 percent of physicians report that they will reduce the number of new Medicare patients they will treat, and 40 percent will reduce the number of established Medicare patients they treat. Health insurance reform will stop this cut and ensure seniors can continue to see the doctor they know and trust.
Preventing Medicare from Going Bankrupt: The Medicare Hospital Insurance Trust Fund is projected to be exhausted in eight years, sometime during 2017. Health insurance reform will reduce overpayments to private plans and clamp down on fraud and abuse to bring down premiums for all seniors and extend the life of the Medicare trust fund by five years.
“The status quo is unsustainable and unacceptable for seniors,” added Sebelius. “Health insurance reform will ensure our seniors have the quality, affordable coverage they deserve.”
08/27/2009
STATE LEGISLATIVE LEADERS APPEAR READY TO CHANGE LAW ALLOWING GOVERNOR TO NAME SUCCESSOR TO SEN. TED KENNEDY / COULD PROVIDE CRITICAL VOTE ON HEALTH CARE
WHITE HOUSE SAYS HEALTH REFORM GOAL STILL INCLUDES PUBLIC OPTION / HHS SECRETARY SEBELIUS HAD INDICATED WHITE HOUSE WOULD CONSIDER INSURANCE CO-OPS INSTEAD
More from the Emeritus News- White House Spokesman Robert Gibbs today denied that the administration was giving up on the "Public Option" for insuring the uninsured. Gibbs, during this morning's briefing with reporters, said,
"...the administration's position is unchanged; that we have a goal of fostering choice and competition in a private health insurance market. The President prefers the public option as a way of doing that. If others have ideas, we're open to those ideas and willing to listen to those details. That's what the President has said for months. Coincidentally that's what the Secretary of Health and Human Services has said for months. It's what I've said for months. I think the suggestion somehow that anything that was said Saturday or Sunday as being new administration policy is just not something that I would agree with".
Gibbs press briefing transcript, copy click here. The White House statement was prompted by statements from Senate and House members, as well as HHS Secretary Kathleen Sebelius. See story below. 08/18/2009
SOME DEMOCRATS SAY INSURANCE CO-OPS HAVE BETTER CHANCE THAN PUBLIC OPTION
More from the Emeritus Newsroom- Democratic leaders admit they don't have the votes to get a public option health plan alternative through congress. But, the offering of a co-operative to offer health insurance to those uninsured and offer competition to other private plans appears to have the best chance. During an appearance on Fox News Sunday, North Dakota Democratic Senator Kent Conrad explained that cooperatives would also force private insurers to improve service and hold down premiums. Conrad has been a consistent supporter of the co-operative concept, claiming the public option had no chance of getting out of the Senate without a filibuster by opposing Republicans. HHS Secretary Kathleen Sebelius, in an appearance today on CNN, said the Obama administration was willing to accept reform without a public option. 08/16/2009
LOW INCOME MEDICARE PATIENTS MAY HAVE TO SWITCH DRUG PLANS DUE TO PART "D" PREMIUM INCREASES NEXT YEAR
More from the Emeritus Newsroom- Medicare Part "D" premiums for next year were announced today by the Centers for Medicare and Medicaid Services. The agency says,
"Based on the bids submitted by Part D plans, CMS estimates that the average monthly premium that beneficiaries will pay for standard Part D coverage in 2010 will be $30, an increase of $2 over the 2009 average premium of $28. Premiums and benefits for Medicare Advantage plans and more details about the Part D plans will be announced in September, as well as the list of plans that are not renewing their contracts with Medicare for 2010. Some beneficiaries who receive the low-income subsidy to pay for their premiums will need to move to a new plan to ensure that they can remain in a zero-premium plan in 2010 because the plan’s premium will be higher than the 2010 subsidy amount. CMS, working with its partners, will notify all individuals in this situation to make sure they are aware of their options."
INSURANCE COMPANIES FIRE BACK AT DOCTORS OVER HIGH FEES
More from the Emeritus Newsroom- In another salvo aimed at doctors fees an insurance trade group has taken aim at out of network doctor fees. Health insurance companies establish provider networks with established fees for each procedure. Some doctors complain the in-network fees are too low, and refuse to join those provider networks. But, the insurance group, America's Health Insurance Plans, decided to release a survey, with individual state breakdowns of out of network fees, as evidence of of doctors "exorbitance". Their report shows:
"Some out‐of‐network providers are charging exorbitant prices – several hundred or even
over a thousand percent of the Medicare reimbursement for the same service in the same
area. Recent examples: $4,500 for an office visit when Medicare would have paid $134;
$14,400 for removal of a gallbladder when Medicare would have paid $656; and $40,000 for
a total hip replacement when Medicare would have paid $1,558.
Consumers who are charged exorbitant fees by out‐of‐network providers incur additional
costs because the protection against balance billing generally does not extend to services
provided out‐of‐network. This detracts from the ability of health plans to offer affordable
access to out‐of‐network providers for those consumers who want the advantages of a
network, but also maintain the option to go out‐of‐network if they choose."
REPORT SHOWS EXTENT OF THOSE UNINSURED DUE TO PRE-EXISTING CONDITIONS OR CANCELLATIONS
More from the Emeritus Newsroom- The web site Healthreform.gov has released a report showing how extensive the problems of cancellation and rejection are in the individual policy holder insurance market. This is the part of the market where individuals shop for health insurance for themselves and/or their family members. The report points to two surveys:
A recent national survey estimated that 12.6 million non-elderly adults5 – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years.6
and a second survey:
In another survey, one in 10 people with cancer said they could not obtain health coverage, and six percent said they lost their coverage, because of being diagnosed with the disease.7
It is still legal in nine states for insurers to reject applicants who are survivors of domestic violence, citing the history of domestic violence as a pre-existing condition.8
Even when offering coverage, insurers can exclude whole categories of illnesses related to a pre-existing condition. For example, someone with a pre-existing condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage.9
The report claims that in 45 states across the country, insurance companies can discriminate against people based on their pre-existing conditions when they try to purchase health insurance directly from insurance companies in the individual insurance market.4 Insurers can deny them coverage, charge higher premiums, and/or refuse to cover that particular medical condition.
OBAMA ADMINISTRATION UNLEASHES MORE ATTACKS ON MISINFORMATION / STARTS NEW WEBSITE JUST TO HANDLE THE RUMORS
More from the Emeritus Newsroom - With the mission of a truth squad sent out to quash the rising tide of misinformation, the Obama administration has created the web site, 'Reality Check". The web site features numerous videos from those seeking to set the record straight about various messages being circulated by opponents. Opponents claims that health reform could cause senior citizens to be euthanized and the government to take over all health care, has forced an acceleration from supporters. The new Obama administration web site features facts on the latest proposals, and answers to some of the most frequent questions most often distorted by opponents.
MEDICARE GROUP SAYS INSURANCE COMPANIES STILL USING FRAUDULENT TACTICS TO SELL "MEDICARE ADVANTAGE" PLANS / WANT NEW LAWS TO TIGHTEN LOOPHOLES FOR INSURERS
More from the Emeritus Newsroom - The Center for Medicare Advocacy says insurers are still using aggressive and fraudulent tactics to enroll the elderly in Medicare Advantage plans. The group feels insurers are doing this, knowing that federal law allows them to take lawsuits into more favorable federal court reviews and out of state courts and more stringent consumer protection laws. The group also claims that some elderly without the capabilities to understand their choices are being encouraged by insurers to sign up without the knowledge of their legal representatives. The group says some federal courts are also moving these case back to state court. They cite:Ackermann v. United Healthcare Service, Inc.[6]
In Ackermann, plaintiffs claimed that a home health agency employee stole Mr. Ackermann's personal information and enrolled him in a Medicare Advantage plan, thereby taking him out of the traditional Medicare program against his will. The Ackermanns brought suit in state court and the defendants tried to have the case removed to federal district court. The federal district court recently remanded the case to state court, citing a lack of jurisdiction. The court stated, "[the] plaintiffs' state law claims…are neither completely preempted by, nor 'inextricably intertwined' with claims under the Medicare Act…."
SENATE AND HOUSE MOVE CLOSER TO AGREEMENTS / OBAMA SETS DOWN IN NORTH CAROLINA AND VIRGINIA TO PUSH CONGRESS FOR AGREEMENT
More from the Emeritus Newsroom - Democratic leaders say progress continues to be made on creating a less costly health care reform bill. Blue Dog Democrats in the House say that chamber has come up with an agreement to bring the cost in line with that expected in the Senate.....$900 million. The House version also calls for employer mandated coverage with exceptions for those below $500,000 a year in payroll. Expansion of Medicaid. Public plans that would establish separate pay rates than Medicare and Medicaid. And state risk pools offering coverage for individuals and small businesses. During a in Town Hall meeting this morning in Raleigh, North Carolina, President Obama thanked members of the House Energy and Commerce Committee and the Blue Dog Democrats for working out a deal to advance reform. President Obama's text at town meeting, copy click here. 07/29/2009
OBAMA TELLS AARP TOWN HALL THAT REFORM CRITICAL TO CLOSING 'DOUGHNUT HOLE" AND PROVIDING DRUGS TO ELDERLY
More from the Emeritus Newsroom- During a webcast town hall meeting at the AARP headquarters in Washington D.C., President Obama underscored the need to support reform to close the so called, "Doughnut Hole" in Medicare Part "D". The "Doughnut Hole" is the uncovered portion of the Medicare Prescription plan where enrollees must shoulder the cost of their medications. Obama says the reform must also come with government authority to negotiate prices of drugs, which was not included in the original legislation when Part "D" was established. Obama says the fact that the pharmaceutical industry has offered to cut $80 billion in drug costs, would pay for half of the cost of closing the "Doughnut Hole" . And the President said he is convinced more could be saved. The AARP town hall was webcast live on both the AARP website and the White House Livestream website. Click here for White House text transcript. Click here for AARP replay of the the video. 07/28/2009
HEALTH REFORM UPDATE: LATEST CBO REPORT SHOWS PUBLIC PLAN WOULD NOT FORCE OUT PRIVATE INSURANCE / CBO ALSO DOUBTS OBAMA PLAN WOULD SAVE MONEY / OBAMA SUPPORTERS SAY PROPOSAL NOT YET FINISHED / HOUSE STILL TRYING PASS THEIR VERSION
More from the Emeritus Newsroom - Republican house leaders say possibly 68 conservative and moderate Democrats may bolt to their side to keep health care reform from happening. Democratic leaders say all Democrats in the house want reform and that, once the various versions are agreed to, it will pass in the house. And Speaker Nancy Pelosi today did not rule out the house may have a plan before their adjournment on the 31st. The Senate is set to adjourn on August 7th. Meanwhile, over the weekend, the Congressional Budget Office released yet another report on the Obama administrations proposal for health care reform. The CBO's latest report, released on Saturday, gave both sides something to use in the Current debate. The CBO says the public option portion of reform would not force out the private insurance sector, a complaint often registered by Republicans as the reason for their opposition. But, the CBO, once again, said there is still no solid proposal to cut health care costs, which is the foundation for Obama's claim that reform will be deficit neutral. CBO's latest report, copy click here. As part of a damage control move, Former CBO Director, now Director of the White House Office on Management and Budget, Peter Orszag, challenged the CBO projection models that nothing would be saved, saying that, "In providing a quantitative estimate of long-term effects without any analytical basis for doing so, CBO seems to have overstepped". OMB Orszag statement, copy click here. 07/27/2009
U-S SENATE DELAYS VOTE ON HEALTH REFORM TILL FALL
More from the Emeritus Newsroom- The August 7th deadline that President Obama had set for the passage of a health reform bill apparently will not be met. Senate Majority Leader Harry Reid confirmed today that because of negotiations in the Senate Finance Committee, any bill that emerges will have to wait until Congress returns from their summer break. Such is not the case in the House so far as house leaders refuse to says whether health reform will be approved by the house deadline of July 31st. Even though the senate was to adjourn the week following, Democratic leaders say that is still not enough time, given ongoing negotiations in the Finance Committee and reconciliation of any bill that would come from the house by July 31st. 07/23/2009
OBAMA FIGHTS BACK AGAINST CONGRESSIONAL BUDGET OFFICE PROJECTIONS / / REPUBLICAN MOUNT ATTACK BUT MENTION NO PLAN OF THEIR OWN AS ALTERNATIVE
More from the Emeritus Newsroom - President Obama this morning sharpened his attack against opponents who say his plan will grow the deficit and hurt the quality of health care. The President, speaking at Childrens National Hospital in Washington DC. , told media and others gathered in a hospital lobby, that "...over the past decade, premiums have doubled in America; out-of-pocket costs have shot up by a third; deductibles have continued to climb. And yet, even as America's families have been battered by spiraling health care costs, health insurance companies and their executives have reaped windfall profits from a broken system". The Obama administration took a hit from the Congressional Budget Office on Friday, when CBO Director Doug Elmendorf said the plans now being considered in congress would add to the deficit and not do enough to cut costs in a bloated service quantity reward system. Obama repeated his demand that the final plan, when approved by congress, will be DEFICIT NEUTRAL, and should not impede progress toward reform. Obama statement, copy click here. See video of most of the President's speech, click here. Republican National Chairman Michael Steele today assailed the Obama health care reform proposals as a dangerous experiment with the economy. Steele said, Obama is rushing this experiment through Congress so fast, so soon, that we haven't had a moment to think if it would work, or worse, to think about the consequences to our nation, our economy and our families if it doesn't work". Chairman Steele speech text, copy click here.
07/20/2009
ROBERT WOOD JOHNSON FOUNDATION SURVEY FINDS MORE AMERICANS WORRIED ABOUT LOSING THEIR HEALTH INSURANCE
More from the Emeritus Newsroom - The American public seems increasingly uneasy about their health care future, although more seem positive about the current health care. The advocacy group's June survey also found that minorities and individuals with lower incomes report a lower confidence level in health care. White, non-Hispanic respondents had a confidence level of 105.9, while non-white respondents had an overall confidence level of 86.9. People with incomes in the bottom third of those surveyed had a confidence level of 87.5, compared to a confidence level of 118.0 for those in the top third of incomes. But, there is a stark reversal, even among those in upper income levels on the future of their health care.
Americans believe health reform is an important part of addressing the nation’s economic crisis. More than 8 in 10 people (84.7%) believe that it is important for President Obama to reform the health care system as a step in solving the nation’s economic woes.
People are worried about being able to afford future care. More than four in 10 of all Americans (43.3%) are worried that they will not be able to pay for their future health care needs in the event of a serious illness. Additionally, nearly four in 10 (39.8%) are worried that they will not be able to afford all of the routine health care services they need (39.8%).
Americans are afraid of losing their insurance in the coming year. Nearly one in four currently insured adults (23.3%) fear losing their health insurance at some point in the next 12 months.
Americans are having trouble paying their medical bills. One in four people (25.8%) report having had trouble paying medical bills during the past year.
People are worried that medical bills will lead to bankruptcy. Nearly a quarter (22.9%) report being worried that they will go bankrupt from not being able to pay their medical bills.
NOT ENOUGH SAVINGS IN REFORM PLANS: CONGRESSIONAL BUDGET OFFICE HEAD CLAIMS FED WOULD BE SPENDING MORE FOR HEALTH CARE
More from the Emeritus Newsroom - Congress will have to do more to cut the increase of health care costs. A more detailed estimate by Doug Elmendorf, Director of the Congressional Budget Office, found plans from both the House and the Senate, in their current form will not do enough to curb the increase in federal spending or that in the private sector in order to avoid budget meltdowns. Although previous estimates by the CBO the plans estimated costs of the plans, the debate is expanding around projected cost savings and cost cutting needed to keep the plans budget neutral...or saving as much as is spent. Elmendorf told the Senate Budget Committee, that he saw no way the current proposals could bring down the "long term cost curve". Text of Elmendorf's testimony, copy click here. Video of the hearing, click here. 07/16/2009
SENATE COMMITTEE PASSES HEALTH REFORM MEASURE
More from the Emeritus Newsroom- The Senate Education, Labor and Pensions Committee has passed its version of the Affordable health Choices Act. A synopsis of the bill claims the legislation: This section creates a new national insurance program to help adults who have or develop
functional impairments to remain independent, employed and stay a part of their communities. Financed
through voluntary payroll deductions (with opt-out enrollment similar to Medicare Part B), this program
will remove barriers to independence and choice (e.g., housing modifications, assistive technologies,
personal assistance services, transportation) by providing a cash benefit to individuals unable to perform
two or more functional activities of daily living. The large risk pool created will make added coverage
more affordable and reduce incentives for people with severe impairments to spend down to Medicaid. The Congressional Budget Office estimates the bill to cost less than $615 billion over 10 years. Committee statements and full synopsis of Affordable Health Choices Act, click here. 07/15/2009
DEMOCRATIC LEADERS ANNOUNCE HOUSE VERSION OF HEALTH REFORM / USES HIGHER TAXES ON RICH / REQUIRES EMPLOYERS TO INSURE OR PAY PENALTY
More from the Emeritus Newsroom- House Speaker Nancy Pelosi and the Chairmen of three house committees today announced an agreement called, "America's Affordable Health Choices Act". Pelosi calls the proposal, “... a starting point and a path to success. To lower costs to consumers and businesses; to give greater choice to Americans, including keeping your doctor or plan if you like them; better quality of care putting doctors, not insurance companies, back in charge; and to provide stability and peace of mind that you cannot be denied care or coverage for a pre-existing condition.” Among the provisions:
A Health Insurance Exchange. The new Health Insurance Exchange creates a transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers.
A public health insurance option. One of the many choices of health insurance within the health insurance Exchange is a public health insurance option. It will be a new choice in many areas of our country dominated by just one or two private insurers today. The public option will operate on a level playing field. It will be subject to the same market reforms and consumer protections as other private plans in the Exchange and it will be self-sustaining – financed only by its premiums.
Guaranteed coverage and insurance market reforms. Insurance companies will no longer be able to engage in discriminatory practices that enable them to refuse to sell or renew policies today due to an individual’s health status.
Essential benefits. A new independent Advisory Committee with practicing providers and other health care experts, chaired by the Surgeon General, will recommend a benefit package based on standards set in the law.This new essential benefit package will serve as the basic benefit package for coverage in the Exchange and over time will become the minimum quality standard for
employer plans. The basic package will include preventive services with no cost-sharing, mental health services, oral health and vision for children, and caps the amount of money a person or family spends on covered services in a year.
Starting in 2011, a family making $500,000 would have to pay $1,500 in additional income tax to help subsidize coverage for the uninsured. A family making $1 million would have to pay $9,000.
Employers who do not provide health insurance to workers would generally have to pay a fee or penalty to the government. The fee would be equal to 8 percent of wages for an employer with an annual payroll of more than $400,000.
The surtax would apply to any adjusted gross income exceeding $280,000 a year for an individual and $350,000 for a couple filing a joint return. The tax rates would range from 1 percent to 5.4 percent.
The Congressional Budget Office preliminary review of the proposal suggests all but 16-17 million people would not be insured by the plan, with half of that number being illegal immigrants. This means that about 94 per cent of the population would have either a public or private health insurance plan...higher than the 81% estimated in a previous proposal from the Senate.
NATIONWIDE INSURANCE SETTLES LAWSUIT FROM POLICYHOLDERS CHEATED OUT OF DAMAGE CLAIMS
More from the Emeritus Newsroom- Attorneys General in states throughout the country have announced a proposed settlement in a class action lawsuit in Arkansas against Nationwide Insurance. Thousands of homeowners may be eligible for payments as part of the settlement between Nationwide Mutual Insurance Co. and affiliated companies and homeowner policyholders who claimed they were underpaid on structural damage claims since 1996. The lawsuit claims that Nationwide underpaid policyholders by not taking into account general contractors' overhead and profit when it paid certain claims involving damage to a building or other structures. Homeowners who submitted claims from 1996 through March 20, 2009, or who received a payment during that period, may be affected. These Nationwide companies are involved: Nationwide Mutual Insurance Company, Nationwide Mutual Fire Insurance Company, AMCO Insurance Company, Allied Property and Casualty Insurance Company, Depositors Insurance Company, National Casualty Company, Nationwide Insurance Company of America, Nationwide Affinity Insurance Company of America, Nationwide Property and Casualty Insurance Company, Nationwide Lloyds, Nationwide Insurance Company of Florida, Nationwide Indemnity Company, Scottsdale Indemnity Company, Scottsdale Surplus Lines Insurance Company, and Scottsdale Insurance Company.
For details on the issues, who is eligible, and how to file a claim, consumers should:
* Visit this Web site created by the courts and lawyers for both sides: www.alexanderclassactionsettlement.com
* Call the court-appointed settlement administrator's office at 1-888-287-1333.
Nationwide maintains that it properly resolved and settled homeowner's claims but agreed to settle the suit to avoid the cost and distractions of prolonged litigation. An Arkansas circuit court will hold a July 27 hearing on whether to approve the settlement.
07/07/2009
LATEST CBO REVIEW OF FULL HEALTH REFORM PROPOSAL CUTS COSTS/ IMPROVES WORKABILITY
More from the Emeritus Newsroom- The latest report from the Congressional Budget Office suggest that that health care reform (HELP) is now within reach. This differs from the more ominous report on the partial proposal submitted being discussed by the Senate Committee on Health Education Labor and Pensions Committee. The CBO review of the full proposal is a stark contrast to the earlier CBO review.
In the opinion of New York Times columnist Paul Krugman:
"The HELP plan achieves near-universal coverage through a combination of regulation and subsidies. Insurance companies would be required to offer the same coverage to everyone, regardless of medical history; on the other side, everyone except the poor and near-poor would be obliged to buy insurance, with the aid of subsidies that would limit premiums as a share of income.
Employers would also have to chip in, with all firms employing more than 25 people required to offer their workers insurance or pay a penalty. By the way, the absence of such an “employer mandate” was the big problem with the earlier, incomplete version of the plan.
And those who prefer not to buy insurance from the private sector would be able to choose a public plan instead. This would, among other things, bring some real competition to the health insurance market, which is currently a collection of local monopolies and cartels.
The budget office says that all this would cost $597 billion over the next decade. But that doesn't’t include the cost of insuring the poor and near-poor, whom HELP suggests covering via an expansion of Medicaid (which is outside the committee’s jurisdiction). Add in the cost of this expansion, and we’re probably looking at between $1 trillion and $1.3 trillion.
There are a number of ways to look at this number, but maybe the best is to point out that it’s less than 4 percent of the $33 trillion the U.S. government predicts we’ll spend on health care over the next decade. And that in turn means that much of the expense can be offset with straightforward cost-saving measures, like ending Medicare overpayments to private health insurers and reining in spending on medical procedures with no demonstrated health benefits.
So fundamental health reform — reform that would eliminate the insecurity about health coverage that looms so large for many Americans — is now within reach. "
Although the CBO stated in their report that their analysis does not represent a formal or complete
cost estimate for the draft legislation. This estimate reflects the major
provisions of the legislation but CBO has not yet completed an analysis of
all of its effects. Specifically, the agency has not yet estimated the
administrative costs to the federal government of implementing the
specified policies or the costs of establishing and operating the new
insurance exchanges, nor has it taken into account all of the proposal’s
likely effects on spending for other federal programs or their potential
effects on revenues from corporate taxes. But, significant is the fact the CBO estimated cost of this draft of the legislation to be roughly $400 billion
less over 10 years than the cost CBO estimated for an earlier version of the
proposal (in CBO’s letter dated June 15, 2009). Click here for the Krugman article in the New York Times. Click here for the new CBO report on HELP from July 2 as PDF file.
07/06/2009
NEW BILL INTRODUCED TO KEEP WATCH ON NATION'S INSURANCE COMPANIES
More from the Emeritus Newsroom- Rep. Paul E. Kanjorski, (D-Pa), is back with another proposal to establish a national office that would to keep watch over national and international activities of American insurance companies. Kanjorski had a similar bill in the house last year, which was dropped by House Speaker Nancy Pelosi in the schedule crush of last year's financial crisis. House sources also believe the bill has a better chance of passing with the new more Democratically controlled congress. The bill, HR 2609, would establish a so called, "Office of Insurance Information" in the Treasury Department, that would be involved with insurance regulation. Critics of current insurance regulations say the void in federal oversight contributed to some of the problems that allowed insurers such as A-I-G, to become involved in investments schemes that led to the near failure of the company last year. The Office of Insurance information would also include advisory groups of consumer advocates. 06/16/2009
CBO RELEASES PRELIMINARY ESTIMATE ON HEALTH CARE REFORM / FINAL ANALYSIS YET TO COME / GIVES WORKERS WITH UNAFFORDABLE PLANS ACCESS TO PUBLIC PLAN WITH THOSE UNINSURED
More from the Emeritus Newsroom- In a letter to Senator Edward Kennedy, who chairs the Senate Committee on Health, Education, Labor and Pensions, The Congressional Budget Office has crunched the preliminary numbers on some of the basic health care reform proposals in the Affordable Health Choices Act. The CBO says it and the Joint Committee on Taxation have determined that enacting the proposal would result in a net
increase in federal budget deficits of about $1.0 trillion over the 2010–2019
period. Once the proposal was fully implemented with a public plan option, about 39 million
individuals would obtain coverage through the new insurance exchanges.
At the same time, the number of people who had coverage through an
employer would decline by about 15 million (or roughly 10 percent), and
coverage from other sources would fall by about 8 million, so the net
decrease in the number of people uninsured would be about 16 million. The number of uninsured is complicated by those lacking legal immigration documentation. The CBO says that those figures do not represent a formal or complete cost estimate for the draft legislation. Complete CBO analysis statement, copy click here. 06/15/2009
MEDPAC COMMISSION SAYS EXPANDING MEDICARE IS NOT THE ANSWER FOR HEALTH CARE REFORM
More from the Emeritus Newsroom- MedPAC, a commission set up to study medicare reforms and how to cut medical expenditures, says simply expanding Medicare to all Americans would not save money. The commission feel that reform must include medicare and reform medical care and the way medical claims are paid. “To achieve better care coordination and efficiency, Medicare must change the way it pays health care
providers,” said Glenn Hackbarth, chair of the Commission. “Current incentives reward volume instead
of value and costly care instead of efficient, effective care. When providers don’t work together, quality
suffers and costs increase—which benefits neither the patient nor the Medicare program.” President Obama has often referred to the Medicare Advantage program being a subsidy for the insurance companies. The Commission, it its report released today says, MedPAC reports on different approaches to reforming
Medicare Advantage payment. Under the current system, in 2009 Medicare is paying about $12
billion more for the beneficiaries enrolled in MA plans than it would have spent if they were in
FFS Medicare. The report discusses options that encourage efficient plans and reward quality. MedPAC Report, copy click here. 06/15/2009
MEDICAL BILLS CAUSING MORE BANKRUPTCIES / NEW SURVEY SHOWS BANKRUPTCIES INCREASING AMONG THOSE WITH HEALTH INSURANCE
More from the Emeritus Newsroom- A new study from Harvard University researchers found that medical bills and related issues were major factors in 62% of all bankruptcies filed in 2007. This number was an increase over a similar survey back in 2001, which showed medical bills were a major factor in 55% of bankruptcies. The Harvard study also shows that about 78% of bankruptcy filers due to medical expenses were insured. The full report will be published in the August issue of the American Journal of Medicine. 06/04/2009
SENATE SPECIAL COMMITTEE ON AGING TO HOLD HEARING ON LONG TERM CARE INSURANCE PROBLEMS
More from the Emeritus Newsroom- A hearing on long term care and insurance to cover it will be held tomorrow, June 3d in a 2 pm hearing held by the Senate Special Committee on Aging. The problem has been aggravated by complaints over insurance companies delayed claims processing, questions about the financial fitness of some companies to be able to pay when their customers need the coverage, and regulatory enforcement over such policies. Consumer Reports magazine says it reviewed 47 policies. That long-term-care insurance is too risky and too expensive for most who need it. CR also says, you must keep paying to keep it in force. If premiums rise, you may have to drop the coverage, possibly losing everything that you’ve paid. The policy’s benefits may cover only a portion of the total expense. Many policies are packed with catches that can keep you from collecting. Finally, there’s no guarantee that long-term-care insurers, some of which have weak balance sheets, will be around 20, 30, or 40 years from now when you need them to pay. Consumer Reports article, copy click here. 06/02/2009
CRITICS SAY CONGRESS-HEALTH CARE INDUSTRY EXCLUDING SINGLE PAYER DEBATE
SIX PEOPLE CHARGED IN CALIFORNIA HOSPICE CARE INSURANCE SCAM
More from the Emeritus Newsroom- California Attorney General Jerry Brown has filed charges against six people, who Brown claims, paid healthy seniors to be admitted to a hospice for the terminally ill and then billed state and federal health care programs for "phantom procedures" never performed. Brown says the six defendants - including a mother and her two children - were physicians and staff at "We Care" hospice in Sherman Oaks. One defendant was arrested today. Another four will surrender to authorities later this month. One remains at large. Brown's Office and the U.S. Department of Health and Human Services launched a joint investigation in 2008 after an audit found that a suspiciously large number of patients admitted to We Care were in good health and the mortality rate was low for a hospice. The scheme netted $9 million in fraudulent billings to Medicare and Medicaid. California Attorney General's press release, copy click here. Tomorrow, a Senate Special Committee on Aging hearing entitled, "Catch Me if You Can: Solutions to STOP Medicare and Medicaid Fraud from Hurting Seniors and Taxpayers", Ranking Member Mel Martinez, (R-FL) will chair a hearing entitled: "Catch Me If You Can: Solutions To STOP Medicare and Medicaid Fraud From Hurting Seniors And Taxpayers", starting at 2:00 pm. in Hart 216.
05/05/2009
HEALTH INSURERS REPORT JOB LOSSES LEADING TO MORE UNINSURED THAN EXPECTED
INJURED CONTRACTORS IN IRAQ SAY THEIR PRIVATE INSURANCE PLANS ADD INSULT TO INJURY
More from the Emeritus Newsroom- An investigation by ABC News, the Los Angeles Times, and ProPublica found that the government supervised private insurance plans, many of them from A-I-G, have been slow to pay claims and help with artificial limbs and other treatments. A sheriff's deputy from South Carolina, Tim Newman, was reported to have fought for a year to get a prosthetic leg, after being wounded by a roadside bomb. According to the report, congressional investigators found that of the 1.5 billion spent by the government to cover private contractors in the war zone, $600 million of it went to corporate profits. More from ProPublica. ABC video of story. 04/18/2009
INSPECTOR GENERAL AT H-H-S FINDING IMPROPER BILLING OF STATE MEDICAID FOR VETERANS CARE
More from the Emeritus Newsroom- The Office of Inspector General for Health and Human Services says it has found at least $1.3 million dollars in improper billing as it continues its probe of provider claims. The IG's office says found that Medicaid programs in 8 of 11 selected States spent a total of $1.3 million in potential improper payments. The improper payments stem from services for veterans who are, so called, "dual eligible", for VA benefits and for Medicaid. However, some benefits have been billed to both, or billed to Medicaid, when they should have been billed to the VA. The services involved are largely from outside laboratory or ancillary providers. Inspector General Office HHS press release, copy click here. 04/15/2009
HOUSTON'S METHODIST HOSPITAL TO REPAY $9.99 MILLION TO MEDICARE FOR OVERCHARGES
More from the Emeritus Newsroom- The U-S Justice Department has announced that Methodist Hospital in Houston has agreed to pay the United States $9.99 million to settle allegations that it defrauded the federal Medicare program, the Justice Department announced today.The settlement resolves allegations that Methodist improperly increased charges to Medicare patients in order to obtain enhanced reimbursement from Medicare. In addition to its standard payment system, Medicare pays supplemental reimbursement, called outlier payments, to hospitals in cases where the cost of care is unusually high. Congress enacted the supplemental outlier payment system to ensure that hospitals possess the incentive to treat inpatients whose care requires unusually high costs.The government alleged that, between January 2001 and August 2003, Methodist improperly inflated charges for inpatient and outpatient care to make its costs for providing such care appear greater than they actually were, and thereby obtain outlier payments from Medicare that it was not entitled to receive. Office of Inspector General HHS press release, copy click here. 04/13/2009
PHYSICIANS FOR A NATIONAL HEALTH PROGRAM CALLS FOR SINGLE PAYER PUBLIC PLAN
More from the Emeritus Newsroom- Physicians for a National Health Care Plan have made no secret in the past about their preference for a national single payer plan. Now, with some type of reform a certainty, the group says it is time to end private health insurance plans. That the nation spends twice as much per capita as other industrialized nations and fares poorly against those nations on categories of life expectancy, infant mortality, and immunization rates. The group claims that, private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars. Physicians for a National Health Care Plan press release, copy click here. 04/09/2009
STUDY SAYS PUBLIC HEALTH INSURANCE PLAN COULD PUT PRIVATE PLANS OUT OF BUSINESS / PUBLIC PLAN YET TO BE PRESENTED
More from the Emeritus Newsroom- The Fall Church, VA. consulting firm, The Lewin Group, which last year studied the various candidates health plan proposals, has now come out with a study on the effect of a public plan to insure those who are uninsured. However, if that plan were available to everyone, it would probably be to the detriment of private plans. The study claims that If the public plan is opened to all employers as once proposed by former Senators Clinton and Edwards, at Medicare payment levels we estimate that about 131.2 million people would enroll in the public plan. The number of people with private health insurance would decline by 119.1 million people. This would be a two-thirds reduction in the number of people with private coverage (currently 170 million people). Here again, if the higher private payer levels are used, enrollment in private insurance would decline by only 12.5 million people. As for limiting access to the public plan, the study reveals, if as the President proposed, eligibility is limited to only small employers, individuals and the self-employed, public plan enrollment would reach 42.9 million people. The number of people with private coverage would fall by 32.0 million people. If private payer reimbursement levels are used by the public plan, enrollment would be lower, with only 10.4 million people switching to the public plan from private insurance. Lewin Study press release, copy click here. Lewin Study full report, copy click here. 04/07/2009
CENTERS FOR MEDICARE AND MEDICAID SERVICE SPENDS 36 MILLION TO HELP SENIORS WITH HEALTH INSURANCE ISSUES
More from the Emeritus Newsroom- the Centers for medicare and Medicaid Services has announced it is sending out nearly $36 million in funding to the 54 State Health Insurance Assistance Programs (SHIPs) to help people with Medicare get more information about their health care choices. The $35.8 million in funding is the first installment of federal grant funds provided to SHIPs by the Centers for Medicare & Medicaid Services (CMS) for the grant year beginning April 1, 2009, and ending March 31, 2010. An additional $1.5 million in performance-based funding will be awarded in September 2009. SHIPs are state-based programs that use community-based networks to provide Medicare beneficiaries with local, personalized assistance on a wide variety of Medicare and health insurance topics. CMS press release copy, click here. 04/03/2009
NEW RESTRICTIONS PLACED ON PRIVATE MEDICARE PLANS
More from the Emeritus Newsroom- The Centers for Medicare and Medicaid Services today announced rule changes to private Medicare plans in order to make them more consistent and transparent. The CMS is still on the hook for their weak monitoring of the Medicare sign up and supervision of private Medicare plans, which, last year, the Inspector General found inadequate under the former Bush administration. Officials says the net impact will be cut the number of different versions of plans, which often led to confusion and misleading sale tactics relating to chronic or catastrophic conditions. Patients often complained of hidden or confusing co-pay combinations and higher percentages for name brand drugs.The agency also says, As part of CMS’ oversight efforts of the Medicare Advantage and Prescription Drug plans, sponsoring organizations are being asked to conduct audits on the data provided to CMS about the operation of their plans. These new audits will be in addition to the current CMS financial and program compliance audits. The existing Program compliance audits will be strengthened by becoming more targeted, data-driven and risk-based. They will focus on high-risk areas that have the greatest potential for beneficiary harm, such as enrollment operations, appeals and grievances, and marketing. CMS press release, copy click here. 03/30/2009
THREE VETERANS BENEFITS BILLS ADVANCE FROM HOUSE COMMITTEE
More from the Emeritus Newsroom- the House Veterans Affairs Committee has unanimously approved three bills to provide cost of living adjustments, a homeless veterans reintegration program, and VA payments for non-VA emergency services.
H.R. 1377 (as amended), To expand veteran eligibility for reimbursement by the Secretary of Veterans Affairs for emergency treatment furnished in a non-Department facility, and for other purposes; (Filner D-CA-51). This bill would expand veteran eligibility to require the VA to pay for emergency treatment for a non-service connected condition if a third party is not responsible for paying for the full cost of care. The bill clarifies that the VA only pay the difference between the amounts paid by the third party and the VA allowable amount, and is not responsible for co payments the veteran owes to the third party.
H.R. 1171 (as amended), Homeless Veterans Reintegration Program Reauthorization Act of 2009; (Boozman R-AR).
This bill would reauthorize the Homeless Veterans Reintegration Program for fiscal years 2010 through 2014. The bill was amended to authorize an additional $10 million to provide dedicated services for homeless women veterans and homeless veterans with children. Grants would be made available to provide job training, counseling, placement services, and child care services to expedite the reintegration of veterans into the labor force.
H.R. 1513, Veterans’ Compensation Cost-of-Living Adjustment Act of 2009; (Kirkpatrick D-AZ).
This bill would direct the Secretary of Veterans Affairs to increase the rates of basic compensation for disabled veterans and the rates of dependency and indemnity compensation to their survivors and dependents, along with other benefits, in order to keep pace with the rising cost-of-living. The adjustment would become effective December 1, 2009, and would be equal to that provided on an annual basis to Social Security recipients.
GAO RELEASES SEVERAL MAJOR REPORTS ON SMALL PRIVATE HEALTH INSURANCE PLANS, CONFLICTS OF INTEREST IN PENSION PLANS AND SOLVING DISABILITY BACKLOGS AT SOCIAL SECURITY
More from the Emeritus Newsroom- The Government Accountability Office released several reports today. In their study of the small group health insurance market and shares of the market The GAO found that Blue Cross and Blue Shield plans collectively have increased their market share in 38 states reporting this information in 2008 to about 51 percent of the health insurance market, compared to the 44 percent reported in 2005 and the 34 percent reported in 2002 for the 34 states supplying information in each of these years. Twenty-four of the 29 states providing information in both 2002 and 2008 saw increases in the market share of the top carrier that ranged from about 2 to 39 percentage points. In most states the top carrier was increasingly tilting toward the BCBS plans. The median market share of all the BCBS carriers in the 38 states supplying this information was about 51 percent, with a range of less than 5 percent in Vermont and Wisconsin and more than 90 percent in Alabama and North Dakota. ANOTHER REPORT FOUND THAT GAO's ANALYSIS OF STATISTICAL DATA FOUND A STATISTICAL BETWEEN PENSION PLANS WITH WEAK DISCLOSURE RULES AND LOWER INVESTMENT RETURNS. Pension consultants registered as investment advisers, who adequately disclosed their conflicts of interest and those who did not, detected lower annual rates of return for those ongoing plans associated with consultants that had failed to disclose significant conflicts of interest. These lower rates generally ranged from a statistically significant 1.2 to 1.3 percentage points over the 2000 to 2004 period. Problems may occur when pension consultants or other companies providing services to a plan also receive compensation from other service providers. Without disclosing these arrangements, service providers may be steering plan sponsors toward investment products or services that may not be in the best interest of participants. THE GAO QUANTIFIED WHAT HAS BEEN KNOWN IN RECENT YEARS...THAT THE SOCIAL SECURITY ADMINISTRATION IS LOSING ITS BATTLE WITH A BACKLOG THAT CONTINUES TO GROW. The GAO report shows SSA has experienced a growing backlog of disability claims and deteriorating customer service at field offices. SSA's total backlog of disability claims doubled from 1997, reaching 576,000 in 2006, which has resulted in claimants waiting longer for final decisions. The backlog was particularly acute at the hearings level. SSA also experienced declines in field office service delivery, with average customer wait times in field offices increasing by 40 percent from 2002 to 2006, and over 3 million customers waiting more than 1 hour to be served in 2008. To address overall workloads and maintain customer service, SSA has shifted workloads to less busy offices and deferred workloads it deemed lower priority. However, deferring certain workloads, such as continuing eligibility reviews, can result in beneficiaries receiving payments who no longer qualify. In response to a recent GAO recommendation, SSA agreed to develop a single service delivery plan to help it better manage future service delivery challenges. However, it remains unclear how SSA will address current and future challenges given its current service delivery infrastructure and resource constraints. GAO reports page, click here. 03/24/2009
HEALTH INSURANCE COMPANIES SEE WRITING ON THE WALL / OFFER TO BACK AWAY FROM CHARGING MORE FOR SICK POLICY HOLDERS
More from the Emeritus Newsroom- With health insurance companies keenly aware of the disdain much of the public holds for them, their executives announced a big change in their position yesterday. Americas Health Insurers, a group representing private insurers, today proposed to eliminate premiums determined by the health history of their policy holders. This has been one of the big issues that has torpedoed insurers in the court of public opinion and has put more pressure on private health insurers to change its current practice of selling experience rated policies, both on the individual and group levels. Experience ratings determine the price of a policy by the claims history of a particular employer group or the health and claims history of an individual policy holder. Letter sent to U-S Senate committee leaders from Health Insurers offering modification of experience rated policies, copy click here. 03/24/2009
STUDY: NUMBER OF UNINSURED WORKERS INCREASES TO 1 IN 5
More from the Emeritus Newsroom- With health insurance increases outpacing workers income 8 to 1, the Robert Wood John Foundation study says the number of uninsured workers has increased. Nationwide, nearly 9 million more Americans are uninsured from 1994-2007. Six million more working people are uninsured in the United States during the 13 year study period. According to Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation, “Further inaction means that costs rise, businesses struggle, and workers go without. As high as the numbers of uninsured people seem to be, they don’t even reflect the current crisis with millions of Americans losing their jobs, which puts their insurance status in jeopardy. And the more people who become uninsured, the harder it is on our health care system.” Robert Wood Johnson Foundation study, press release copy click here. 03/24/2009
REPUBLICANS GEAR UP FOR BATTLE AGAINST GOVERNMENT RUN HEALTH INSURANCE OPTION TO COVER UNINSURED
More from the Emeritus Newsroom- Sen. Charles Grassley says the biggest issues facing health care reform is whether the government should create a government run health care plan that would compete with the private health insurance system. Proponents of such a plan generally favor a single payer government run health care plan to replace the current system of private insurers. However, some members of congress favor a government run plan to cover the uninsured, who are not already covered by employer health plans, or who have problems obtaining insurance. Grassley says the government run health care option is a make or break issue for both sides. Republicans generally oppose a government run system that would compete in any way with a private health care system. They believe that the government would have an unfair competitive advantage. Democrats generally favor a government run plan to cover the uninsured who are not attractive to the private health insurance market. But, some Democrats favor a complete government single payer takeover. Sen. Grassley video from the Kaiser Family Foundation , click here. 03/19/2009
TWO REPORTS PROJECT RISING UNINSURED: SPENDING ON HEALTH CARE TO DROP/RECESSION AND UNINSURED AMONG REASONS
More from the Emeritus Newsroom- Two reports, one released by a government agency, the other by the Robert Wood Johnson Foundation, show more Americans will lose their health insurance as the economy weakens, and fewer employers offering coverage. The Robert Wood Johnson Foundation report, prepared by the U.S. Institute of Medicine, states that between 1999 and 2008, the average annual employee premium contribution for family coverage rose from $1,543 to $3,354. This problem will put more pressure on Medicaid and public health plans, which some states have had to cut in recent months, even with aid from the recently passed stimulus act. Another report, released by the Centers for Medicare and Medicaid projects spending on health care to decrease this year, when compared with 2008. The decrease comes not for lack of need. According to the report released by CMS, private health spending growth, which includes growth in private health insurance spending and out of pocket payments, is projected to decelerate from 5.8 percent in 2007 to 5.3 percent in 2008. It is then projected to reach a 15-year low of 3.9 percent by 2009, driven by expected slower income growth and a decline in the number of people covered by private health insurance. By contrast, over a ten year period, through 2018, average annual spending growth by public payers (7.2 percent) is expected to outpace that of private payers (5.3 percent). As a result, the public share of total health care spending is expected to rise from 46.2 percent in 2007 to over 50 percent by 2016, and then reach 51.3 percent by 2018. Then, with all public and private spending, the figure over the period 2008-2018, average annual health spending growth (6.2 percent) is anticipated to outpace average annual growth in the overall economy (4.1 percent). By 2018, national health spending is expected to reach $4.4 trillion and comprise just over one-fifth (20.3 percent) of GDP. U-S Institute of Medicine report from the Robert Wood Johnson Foundation, copy click here. CMS report copy, click here. 02/25/2009
JUDGE ALLOWS GM SPINOFF DELPHI TO CUT HEALTH CARE BENEFITS TO SALARIED RETIREES/GIVES RETIREES RIGHT TO RESPOND
More from the Emeritus Newsroom-Associated Press is reporting that a New York bankruptcy has approved Delphi's request to stop paying for health care and insurance benefits for its retired salaried workers. Judge Robert Drain on Tuesday provisionally approved the auto supplier's request to cut off the benefits effective April 1. But he says the 15,000 affected retirees can form a committee to investigate if they have the right to negotiate with the company. The committee will present its findings at a March 11 hearing.Troy, Mich.-based Delphi Corp. has been operating under Chapter 11 bankruptcy protection since 2005. It says it needs to cut off the benefits as part of its restructuring.But attorneys for the retirees say the company is obligated to negotiate with the retirees before it cuts off their benefits.More than 1,600 retirees sent letters to the judge begging him to deny Delphi's motion. Delphi bankruptcy update web page with court decisions, click here. Judge Robert Drain's decision web page, click here. 02/24/2009
FEDERAL MEDICAID BAILOUT DOLLARS TO BE RELEASED WEDNESDAY
More from the Emeritus Newsroom- States, coming under increasing pressure to meet bulging Medicaid enrollments, will be receiving federal help this week. President Obama, this morning, during a White House luncheon for the National Governors Association revealed that $15 billion in stimulus package dollars will be released Wednesday for state Medicaid programs. This money is expected to help an estimated 20 million Americans keep coverage which states may have been forced to cut. Obama also told the Governors he intends to cut the federal budget deficit by the time his first term ends. He explained that goal can, in part, be accomplished by reforming the nation's health care system. Text of President's statement on Medicaid assistance, click here. 02/23/2009
NEW YORK GOVERNOR PATERSON PROPOSES SOLUTION FOR UNINSURED YOUNG ADULTS
More from the Emeritus Newsroom- Parents would be able to use their insurance to cover children up to age 29, under a proposal from New York Governor David Paterson. The move comes as young adults in the workforce make up the largest share of the population either insured or underinsured. Currently, many insurance policies limit family to coverage for children up to the age of 18 or while they are still in school or college. His request comes amid rising concerns of providing insurance coverage for dependent children who are among those added to the ranks of the unemployed. A report issued by COMMUNITY CATALYST provides information on the extent of the problem and how it can be solved. The report suggests that state laws be relaxed to allow extensions of dependents age to eligible under their parents policies. In New York, the Governor's Office estimates this would cover about 80,000 of 775,000 uninsured young adults. Community Catalyst Report on Uninsured Young Adults, click here. Outstanding New York Times article on the problem, click here. 02/18/2009
HEATHNET & ANTHEM BLUE CROSS AGREE TO SETTLEMENTS AFTER DUMPING HEALTH INSURANCE CUSTOMERS WITH BIG CLAIMS
More from the Emeritus Newsroom- Two major settlements reported with insurance companies operating in California, accused of canceling sick policy holders with big claims. Anthem Blue Cross was accused by the state insurance department of canceling more than 1,770 policy holders with big claims. The agreement calls for Anthem to reinstate those policy holders and pay their claims. Anthem also must pay a $1 million fine. In the HealthNet case, the company agrees to pay each canceled policy holder up to $218,000. But, the HealthNet canceled policy holders have the option of refusing the settlement and filing their own lawsuit. It was only last year Anthem agreed to pay a $10 million fine for canceling more than 2,300 HMO policy holders with significant claims histories. The HealthNet class action lawsuit was filed by Los Angeles City Attorney Rocky Delgadillo, on behalf of the victims. HealthNet paid over $10 million in fines and a total of $40 million to settle related lawsuits which included paying medical claims of the victims before and after their policies were canceled. LA Times story on HealthNet, click here. LA Times story on Anthem, click here. 02/12/2009
GM RETIREES UNDER 65 ON MEDICARE TO BE BUMPED FROM COMPANY HEALTH BENEFITS
More from the Emeritus Newsroom- Details of the General Motors restructuring continue to leak to the news media. The automaker is expected to hand in it's report to congress next week, on how it plans to prove itself as a "going concern" in the future. The report is mandated as part of the requirements from the TARP bailout fund. The company has already announced more job cuts and buyouts. Today published reports say GM has a plan to drop retirees under the age of 65, who are on medicare, from the company health insurance program. The move somewhat similar to a request from GM 's former subsidiary Delphi, which last week, asked a bankruptcy court to approve dropping health insurance benefits for 15,000 salaried management retirees. Delphi, which has been in bankruptcy since 2005, informed the court it could save 70 million dollars a year by eliminating the benefit. Bankruptcy judges have traditionally upheld retiree and employee benefits as it relates to health insurance. In some cases, the fed's Pension Benefits Guarantee Corporation has pursued companies for failure to pay the benefit. Also, attorneys for retirees are given the opportunity to oppose such a request. So GM's proposal will likely draw sharp criticism as retirees and federal regulators may argue the company's request to do so may violate contracts and federal employment and pension laws. There is also consistent opposition from federal and state lawmakers and officials who fear these types of cuts will only put more financial pressure on local health care providers with a population more prone to illness. 02/11/2009
OPTIONS FOR HEALTH INSURANCE WHEN YOU LOSE YOUR JOB
More from the Emeritus Newsroom- TV, radio and newspaper ads are pushing to attract buyers of health insurance to cover workers who have lost their jobs and employer coverage. There are an incredible number of policies out there with confusing formulas to attract buyers, but their claims record to prove their worth ream ins cloudy. A new report from Families USA provides information as to how to compare policies and what to watch out for. Among the concerns: What benefits are covered? If I face an unexpected serious illness such as cancer, will
this policy adequately protect me? What prescription drugs are covered by the plan? Is there a formulary? Is there an annual or lifetime cap—either in dollars or number of visits—on the benefits I
receive from my plan? Families USA Health Insurance Report, click here. 02/09/2009
CALIFORNIA BC-BS ORDERED TO PAY CANCELLED SICK POLICYHOLDERS
More from the Emeritus Newsroom-The California Department of Insurance (CDI) has reached an agreement with Blue Shield of California Life & Health Insurance Company to offer new health insurance to 678 consumers whose policies were rescinded between January 1, 2004 and May 31, 2008, reimburse them for out-of-pocket medical expenses and implement significant changes in its underwriting and claims practices. In exchange the Department of Insurance will drop 12.6 million dollars in fines. The practices were the focus of a series of articles by the Los Angeles Times. The California Department of Insurance then followed with an investigation of their own. The LA Times is also reporting that in September, State Insurance Commissioner Steve Poizner announced a similar settlement with Health Net Inc. of Woodland Hills, which agreed to offer new coverage to 926 people and pay $3.6 million in penalties.
Neither Blue Shield nor Health Net admitted wrongdoing.
The state Department of Managed Health Care, which supervises health maintenance organization coverage, struck similar deals last year with Anthem Blue Cross, Blue Shield and other major insurers. Cases involving other insurers are pending. Click here to get the complete press release from the California Department of Insurance. Click here to get article from the Los Angeles Times.
01/07/2009
CENTERS FOR MEDICARE AND MEDICAID ANNOUNCE MEDICAID CHANGES/BENCHMARK OPTIONS FOR COVERAGE
More from the Emeritus Newsroom-Rule changes giving states unprecedented flexibility in designing their own Medicaid programs, including adjusting their benefit package, have been announced by CMS. The agency says, "Under the regulation, states can now offer their beneficiaries health care that has the same value as plans that are being offered to other populations in the state, through alternative benefit packages called, “benchmark plans". Benchmark plans are models states can use in designing new programs. These benchmark plans are similar to the flexibility provided to states under the State Children’s Health Insurance Program (SCHIP). Benchmark coverage includes:The standard Blue Cross/Blue Shield preferred provider option service benefit plan under the Federal Employees Health Benefit Plan;State employee coverage; coverage that is offered by the largest commercial health maintenance organization in the state; or Coverage that the Secretary of Health and Human Services approves". Click here to get the complete CMS press release. Several advocacy groups contacted by Emeritus News today reserved comment on the proposal until next week, needing more time for review.
12/03/2008
INSPECTOR GENERAL REPORT SAYS FED WINS 1.8 BILLION DOLLARS IN JUDGEMENTS AND SETTLEMENTS IN MEDICARE AND MEDICAID FRAUD CASES
More from the Emeritus Newsroom- The Office of Inspector General from Health and Human Services reports the federal government won or negotiated settlements that earned 1.8 billion dollars from prosecuting Medicare and Medicaid fraud cases. In addition, HHS was able to get over 185 million dollars in recoveries for overpayments and other enforcement actions. One case involved Bristol-Myers Squibb Company (BMS) and its generic division, Apothecon, which paid the United States $328 million to resolve a broad array of allegations involving illegal drug pricing and marketing activities. According to the Inspector General, BMS and Apothecon agreed to pay an additional $187 million to State governments based on the same allegations. The civil settlement resolves allegations that (1) BMS and Apothecon set and maintained inflated prices knowing that federal health care programs used these prices for reimbursement, and then marketed the “spread”– the difference between the reported price used by Medicare to set reimbursement rates and the price charged to customers – to induce sales by increasing providers’ profits. Click here to get the complete HHS Inspector General report. 12/02/2008
MAJOR ANNOUNCEMENT BY HEALTH INSURORS/ PROPOSE COVERAGE FOR EVERYONE, ELIMATE PRE-EXISTING CONDITIONS AND REQUIRE EVERYONE TO HAVE COVERAGE
More from the Emeritus Newsroom- In a major policy turn for American health insurance companies, the trade group which represents them presented a plan today to cover everyone. The significance of the announcement is that the industry is willing to eliminate pre-existing conditions and would cover everyone. But, everyone would be required to have coverage. In their announcement today America's Health Insurance Plans President and CEO Karen Ignagni, said, “No one should fall through the cracks of our health care system. Universal coverage is within reach and can be achieved by building on the current system.” Click here to get a copy of the America's Health Plans proposal. The group also realizes the political realities of a more Democratically controlled incoming congress and perhaps the most liberal president ever elected in President-Elect Barack Obama. THE FOLLOWING IS AN EDITORS COMMENTARY...The coverage requirement has long been a roadblock in the debate over health care reform, as competitive bidding for employer health insurance plans intensified over the last 20 years. Plans for self insured employers were especially dependent on keeping younger and healthier employees in the "experience rated" group, thereby keeping the premiums as low as possible. "Experience rated" policies are more advantageous for companies, providing companies with some control over the costs of their plans based on the collective age of their employees and the companies claims histories or experience. Employers often prefer this as opposed to a "community", or broad based rated premium health plans determined by the expense of a general population risk pool insured by the company. However, employers are also more vulnerable in "experience rated" plans should some employees, regardless of age, contract chronic or catastrophic health conditions. This has fueled additional pressures on companies to buy out more experienced and older workers with higher health care costs. It also has lead to lawsuits where employees have been fired, then later sue, on the basis they were fired because of their impact on the company health plan. Another, seldom covered aspect of self insured employer plans, is that companies are aware of the conditions and expenses of their employees, since they pay for and have record of, the actual claims expenses, which are administered and processed by insurance companies. 11/19/2008
AARP DOES PROBE OF ITS HEALTH INSURANCE MARKETING/RESPONSE TO SEN. GRASSLEY'S CHARGE MARKETING IS MISLEADING
More from the Emeritus Newsroom- AARP has appointed the former Vermont Insurance Commissioner, Elizabeth Rowe Costle, to probe the marketing of its Medical Advantage Health Insurance plan from United Health Care. The plans came under fire from Senator Charles Grassley (R)-IA. Grassley says the marketing for the plan is misleading. Grassley's inquiry was prompted by the experience of a cancer patient treated at
M.D. Anderson Cancer Center in Houston, who was forced to produce tens of thousands in
payments up front before she would be treated. Lisa Kelly’s health policy was an AARP limited
benefit policy. Grassley said his review of the health policy led to the conclusion that the
marketing materials are misleading and would cause an average person to believe he or she is
buying real insurance when the coverage is not insurance. AARP and United have suspended sales of the policies. Click here to get Sen. Grassley's statement. 11/19/2008
TEXAS HAS LARGEST PERCENTAGE OF UNINSURED CHILDREN, SAYS FAMILIES U-S-A
More from the Emeritus Newsroom- Using data from the US Bureau of the Census, Families U-S-A has researched each state detailing the ranks of uninsured children and their families. Their report, released today, shows that 20,5%, or slightly more than one in five children (1.4 million), are uninsured. The group found Texas’s uninsured children come from working families. In Texas, the vast majority of uninsured children (89.5 percent) come from families where at least one parent works, and nearly three-quarters of uninsured children—or 73.9 percent—live in households where at least one family member works full-time, year-round. Click here to get the complete Families U-S-A press release. 10/30/2008
WOMEN'S ADVOCACY GROUP SAYS INSURANCE COMPANIES DISCRIMINATE AGAINST WOMEN
More from the Emeritus Newsroom- A survey by the National Women's Law Center claims insurance companies discriminate against women. Their survey found that on the individual insurance market, those policies purchased directly from a company, not an employer group plan, The Center found that insurers
who practice gender rating charged 25-year-old women anywhere from 6% to 45% more
than 25-year-old men; charged 40-year-old women from 4% to 48% more than 40-year-old
men; and charged 55 year-old women premiums that ranged from 22% less to 37% more than
55-year-old men. The huge variations in premiums charged to women and men for identical
health plans highlight the arbitrariness of gender rating, and the financial impact of gender rating
is compounded when insurers also charge more for age and health status when setting insurance
premiums.
Although state approve of this rating differential, the National Women's Law Center says that with more women forced into the individual policy market, they face the possibility of not being able to afford coverage or being rejected. Click here to get a copy of the report. 10/30/2008
SOCIAL SECURITY TO SPEED UP PROCESSING OF DISABILITY CLAIMS FOR THOSE WITH CANCER AND RARE DISEASES
More from the Emeritus Newsroom- Streamlining the disability benefits application process so that benefits are quickly provided to those who need them most. that's the concept behind the SSA's new Compassionate Allowances designation. SSA says it's the second piece of the agency’s two-track, fast-track system for certain disability claims. When combined with the agency’s Quick Disability Determination process, and once fully implemented, this two-track system could result in six to nine percent of disability claims, the cases for as much as a quarter million people, being decided in an average of six to eight days. Click here to see the entire SSA press release. 10/27/2008
CONGRESSMAN CALLS FOR CLOSER MONITORING ON MEDICARE ENROLLMENTS AS INSURANCE INDUSTRY BOOSTS COMMISSIONS
More from the Emeritus Newsroom - California Congressman Pete Stark sent a letter to the Centers for Medicare and Medicaid Services urging them to restrict Medicare Advantage plan commissions during the upcoming enrollment. The enrollment period begins November 15th. Rep. Stark is concerned that increased commissions being paid agents and brokers selling Medicare Advantage plans creates, "churning". Churning is an industry term, which means an agent or broker, convinces a Medicare Advantage plan policy holder to switch companies from year to year. A staffer in Stark'sWashington office told Emeritus News today that those who convince policy holders to churn, or switch companies, are paid much higher commissions. The staffer says commissions from some companies with Medicare Advantage plans have doubled or nearly tripled. Stark is also concerned that some beneficiaries are often misled or confused about what they have purchased. CMS has promised closer monitoring of insurance companies during the enrollment period. Most of the reported abuses have come during the sale of so called, "Fee for service plans". A report released this summer by the Office of Inspector General at HHS detailed inadequate supervision by CMS during last year's enrollment period. Beneficiaries can also choose the standard Medicare plan instead of choosing an Advantage plan. Click here to get a copy of Rep. Stark's letter. 10/23/2008
JOURNAL OF THE AMERICAN MEDICAL ASSN. STUDY: UNINSURED PATIENTS NOT TO BLAME FOR OVERCROWDED HOSPITAL EMERGENCY ROOMS
More from the Emeritus Newsroom- Media accounts from scores of hospital emergency rooms have long led the public to believe that the uninsured are forcing emergency rooms to the breaking point. Now a study, released in the Journal of the American Medical Association, challenges that by offering statistics showing a more complicated picture. The study points out that 17% of Americans are uninsured. According to the study, the percentage of uninsured that go to the emergency rooms is between 10-15 %. This suggests the uninsured are actually under represented in emergency rooms. The most common groups getting emergency room care are those in public health plans such as Medicare and Medicaid. Elderly patients with chronic conditions and disabled patients with Medicaid are often forced to emergency rooms when their doctors are not available. Medicaid patients, in some case, have problems finding a primary care physician who will accept Medicaid.
10/22/2008
GROWING NUMBER OF UNINSURED CHILDREN WITH INSURED PARENTS/RACE AND THE UNINSURED PAYING THE ULTIMATE PRICE
More from the Emeritus Newsroom- A report released today by the Journal of the American Medical Association details the widening disparity between uninsured children and their insured parents. Those whose parents had public coverage were less likely to be uninsured than were those whose parents reported private health insurance. These predictors remained significant in full-year analyses. Similar patterns of vulnerability were also found among a subset of uninsured children with privately covered parents. Click here to get the complete JAMA press release.Also, a report released today in the Archives of Surgery, argues that race and being uninsured translated to higher mortality rates. The survey claims that Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes, but insurance status appears to have the stronger association with mortality after trauma. Click here to get complete press release from the Archives of Surgery Article. Alzheimer's rates among Latinos is the focus of a story from the New York Times, which points to studies that suggest they have more risk factors. Click here to get the New York Time story on Latinos and Alzheimer's. The American Journal of Preventive Medicine found that the U.S. suicide rate rose to 11 per 100,000 people in 2005, from 10.5 per 100,000 in 1999, an increase of just under 5%. Of particular interest, was the increase of suicides among those age 40-64, The rate for that age group rose to 15.6 per 100,000 in 2005, from 13.5 per 100,000 in 1999.Click here to get a pdf of the article from American Journal of Preventive Medicine. Click here to be connected to the American Journal of Preventive Medicine Home Page. And finally, families of autistic children often buckle under the stress of raising a child who is autistic, and the financial stress of treatment for the disorder. More states are mandating that insurance companies offer benefits to help pay for it. An article in Newsweek from AP Reporter Carla Johnson is a wonderful update on the issue. Click here to get the complete Newsweek article.10/21/2008
WHY EMPLOYER BASED PRIVATE HEALTH INSURANCE IS IMPLODING
CENTERS FOR MEDICARE AND MEDICAID RELEASE MEDICARE PLAN COMPARISONS FOR MEDICAL AND PRESCRIPTIONS
More from the Emeritus Newsroom- With Medicare benefits selection underway the CMS has released a comparison and explanation of both medical and prescription plans. The agency is getting a closer look from the Inspector General's office for not properly supervising Medicare marketing plans last year. Click here to get the comparison and explanation page from the Centers for Medicare and Medicaid Services. Also, an evaluation from Avalere shows fewer Part "D" options for those who are low income. Click here to get the Avalere report. Avalere is a consulting firm for healthcare technology companies, federal government agencies, and major medical foundations. 10/09/2008
MAJOR COURT DEFEAT FOR EMPLOYERS NOT WANTING TO PAY GOVERNMENT HEALTH PROGRAMS FOR UNINSURED EMPLOYEES
More from the Emeritus Newsroom -The National Senior Citizens Law Center says the the Ninth Circuit U.S. Court of Appeals on September 30 upheld the San Francisco Health Care Security Ordinance, rejecting arguments by businesses and the Department of Labor that the law was preempted by the Employee Retirement Income Security Act of 1974 (ERISA). The significance, according to the NSCLC, it stops a general campaign by employers to cut off individual remedies for denial of employee health benefits and at the same time block states from enacting reforms to expand health coverage – all on the basis of unstated congressional intentions in ERISA. Trade associations representing employers, backed by the U.S. Chamber of Commerce and the Bush Administration, filed suit late last year to stop the San Francisco ordinance from going into effect. The local law requires that medium and large businesses make minimum expenditures for employee health care, either in the form of benefits directly to employees, or through payments to the city’s own health care program. It also imposes penalties for failure to make such expenditures, for failure to keep and allow access to records, or for reducing a company’s workforce to avoid the requirement. Click here to get the complete NSCLC press release. Click here to get copy of actual decision. 09/30/2008
STUDY: MORE PEOPLE MOVING TO MEDICAID
More from the Emeritus Newsroom- Medicaid spending by states increased nationwide by 5.3% in fiscal year 2008 and enrollment increased by 2.1% largely because of the continuing economic downturn. That's the conclusion of the annual study by the Kaiser Family Foundation, from interviews with the Medicaid directors of all 50 states between July 1, 2007, and June 30, 2008. The findings show that in FY 2009, Medicaid enrollment is projected to increase by 3.5% and state spending is projected to increase by 5.8%. MDMC members will be able to continue to see their current Primary Care Provider until December 31, 2008.The costs of the new plan for MDMC enrollees will be the same as they were paying under their MDMC plan until December 31, 2008. After December 31, 2008, enrollees will receive services from providers in Humana’s network and Humana cost sharing will apply. Humana will be working with MDMC providers about possibly joining the Humana network if they don’t already belong. . Click here to get the complete Kaiser Family Foundation press release and pdf file of complete report. 09/30/2008
CHANGES FOR 16,000 MEDICARE PATIENTS IN FLORIDA
More from the Emeritus Newsroom - The Centers for Medicare and Medicaid Services today announced they were cutting their contract in Florida with MD Medicare Choice (MDMC), a Florida health plan providing services to more than 16,000 Medicare beneficiaries. The company is a Medicare Advantage plan provider in 23 Florida counties (Alachua, Brevard, Broward, Charlotte, Miami-Dade, Duval, Escambia, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, and Volusia. All of those currently in the MD Medicare Choice plan will be enrolled in a health plan with similar health care and prescription drug benefits administered by Humana, effective tomorrow, October 1, 2008. Members also have a special enrollment period if they wish to choose another plan before the end of 2008. Click here to get a complete copy of the CMS press release. 09/30/2008
REPORT: FEDERAL EMPLOYEES FACE 7%+ HEALTH INSURANCE PREMIUM INCREASES
More from the Emeritus Newsroom -Estimates are the average government worker faces a more than seven per cent increase in insurance premiums. According to the Office of Personnel Management, enrollees with self-only coverage will pay, on average, $4.83 more each pay period (about $125 per year) next year. Family coverage will cost an average $11.12 more per pay period. FEHB enrollees pay - on average - 30 percent of the total cost of a plan's premium, while the government pays 70 percent. Click here to get the OPM press release. Click here to get thePDF files with specific HMO and FFS rates. This year's Open Season begins November 10 and runs through December 8, 2008, giving employees the opportunity to change or add to their portfolio of health- and family-care insurance products. Click here to get Washington Post story. 09/26/2008
EMPLOYER HEALTH INSURANCE SURVEY SHOWS PREIUMS UP 5% WITH HIGHER DEDUCTIBLES
More from the Emeritus News- A survey just released today by the Kaiser Family Foundation shows that employer health plans are keeping premium increases to single digits by increasing employee copays and deductibles. The survey found that premiums for employer-sponsored health insurance rose to $12,680 annually for family coverage this year – with employees on average paying $3,354 out of their paychecks to cover their share of the cost – and the scope of that coverage has changed, with many more workers now enrolled in high-deductible plans. This finding is significant because high deduct able plans represent a bigger shift to employees than a mere trend of standard policies with gradually rising deductibles. High deductible policies, depending on their coverage limits, may not pay the first dollar for coverage until a family has reached $1,500 in medical expenses, some of them as high as $3,000. The Survey also shows a growing number with general plan deductibles of at least $1,000 – 18 percent of all covered workers in 2008, up from 12 percent last year. This is partly, but not entirely, driven by growth in consumer-directed plans such as those that qualify for a tax-preferred Health Savings Account. Preferred Provider Organizations continue to dominate the employer market, covering 58 percent of covered workers. Health Maintenance Organizations cover 20 percent of workers, with 12 percent in Point-of-Service plans, 8 percent in consumer-directed plans, and 2 percent in conventional indemnity plans. Click here to get a copy of the Kaiser Family Foundation press release. 09/24/2008
VA EXPANDS BENEFITS FOR VETERANS WITH LOU GEHRIG'S DISEASE AND TRAUMATIC BRAIN INJURIES
More from the Emeritus Newsroom - The Department of Veterans Affairs has finally accepted what many veterans advocates have been saying for years. That veterans are more likely to contract Lou Gehrig's disease (ALS-Amyotropic Lateral Sclerosis), and that traumatic brain injuries, TBI , should be examined for possible full disability. The VA has announced that "ALS will become a presumptively compensable illness for all veterans with 90 days or more of continuously active service in the military". This means veterans with ALS qualify for full service disability pensions and assistance. A disability rating for a traumatic brain injury would be determined by evaluating physical, emotional and cognitive behavior, with ratings based on the cumulative result of the evaluations. Physical problems could include pain, hearing loss and speech problems. Cognitive behavior would include decision making, judgment and social interaction.The new interim final regulation involving ALS and TBI applies to all applications for benefits for those suffering from ALS as well as those will traumatic brain injuries, received by VA on or after September 23, 2008, or that are pending before VA, the United States Court of Appeals for Veterans Claims, or the United States Court of Appeals for the Federal Circuit on that date.“Veterans are developing ALS in rates higher than the general population, and it was appropriate to take action,” Secretary of Veterans Affairs Dr. James B. Peake said. The VA says, Secretary Peake based his decision primarily on a November 2006 report by the National Academy of Sciences’ Institute of Medicine (IOM) on the association between active-duty service and ALS. ALS, is a neuromuscular disease that affects about 20,000 to 30,000 people of all races and ethnicities in the United States, is often relentlessly progressive, and is almost always fatal. Click here to get a copy of the VA press release. Click here to get a copy of the S. Karger Geneva Study 2008, a more recent review of the issue. 09/24/2008
STUDY: MEDICARE PROVIDES LESS THAN AVERAGE EMPLOYER HEALTH PLANS
More from the Emeritus Newsroom - Hewitt Associates and the Kaiser Family Foundation have released results of a study that shows, even with its new drug benefit, Medicare on average provides less generous benefits to seniors than they would receive under a typical large-employer health plan or the most popular plan available to federal employees. The study compares the traditional fee-for-service Medicare benefit package, including the drug benefit, with a typical large employer PPO plan and with the Blue Cross/Blue Shield standard national PPO plan available to federal workers under the Federal Employees Health Benefits Plan, which covers about half of all federal workers. Click here to get a complete copy of the Kaiser Family Foundation Report. 09/23/2008
MEDICAID RECIPIENTS SUE TO GET COMMUNITY BASED CARE AND GET OUT OF NURSING HOMES
SENATE VETERANS AFFAIRS COMMITTEE MEMBERS JOIN TO SPONSOR NEW BILL FOR ADVANCE FUNDING OF VETERANS HEALTH CARE
More from the Emeritus Newsroom- As a way to boost standing of veterans health care in the federal budget, Senate Veterans Affairs Committee Chairman Daniel Akaka wants the Veterans Health Administration funded at least a year in advance. Akaka and several other Senators who have sponsored an advance funding bill, complain congressional passage of VA budgets are too often delayed and incomplete. In a joint statement the group says, "Advance funding has been used to fund programs such as Section 8 housing vouchers, and the Low Income Heating Energy Assistance Program (LIHEAP). Under the proposed legislation, veterans' health care would go through the same process as these entities, thus securing timely funding without making VA health care an entitlement. The advance funding bill would also increase transparency in the VA funding process, by requiring an annual GAO audit and public report on VA's funding forecasts. Click here to get the group's complete statement. Click here to get individual statement from Chairman Akaka. 09/19/2008
INSPECTOR GENERAL REPORT SLAMS INSURANCE COMPANY MARKETING DURING LAST MEDICARE ENROLLMENT PERIOD. CENTERS FOR MEDICARE AND MEDICAID RESPOND.
More from the Emeritus Newsroom - It was conspicuously NOT mentioned in a press release about tighter rules on Medicare marketing materials from The Centers for Medicare and Medicaid. When the Centers announced new rules to protect the public against against Medicare plan marketing materials that don't meet requirements, they didn't mentioned why they are now going this. They forgot to mention an inspector general report stating the agency failed to supervise marketing materials from the companies, 85% of which violated one rule or another of the Centers own guidelines. The Inspector General report stated, "Eighty-five percent of marketing materials failed to meet at least one element of CMS’s guidelines. These elements reflected the array of requirements in the guidelines, which ranged from details about PDP benefits and rules to requirements for font size for footnotes. In addition to problems with marketing materials that stem from model documents, 79 percent of advertisements with pharmacy cobranding failed to include a required statement that other pharmacies are also available. Forty-two percent of pharmacy directories did not describe
the process for a beneficiary to obtain a prescription if mail order service is delayed, as required. Seventeen percent of comprehensive formularies, which are organized by therapeutic class, failed to include an alphabetical index of drugs, as required, potentially hindering beneficiaries’ ability to find information about their drugs". Click here to get Centers for Medicare and Medicaid response. Click here to get complete Inspector General Report. Meanwhile, the Kaiser Family Foundation released a study that shows companies promote Medicare Advantage plans most often. In fact, the study claims, the ads for Medicare Advantage plans (which provide all Medicare benefits and often additional benefits) were estimated to cost more than twice as much than for stand-alone drug plan ads. Click here to get the Kaiser Family Foundation report. 09/16/2008
FULL TIME WORKING POOR MINORITIES, MORE LIKELY TO BE UNINSURED
HEALTH NET AGREES TO PAY 25 MILLION DOLLARS TO SETTLE HEALTH INSURANCE COMPLAINTS IN CALIFORNIA FROM SICK PEOPLE THEY CANCELED.
More from the Emeritus Newsroom - A series of Los Angeles Times news articles, complaints from customers and and investigations by the California Department of Insurance, has culminated in an agreement with HealthNet of Woodland Hills. The company was accused of dropping hundreds of policyholders who got sick, including those who were in group purchased and administrated health plans. Perhaps one of the best known policy cancellations, was a hairdresser, whose policy was canceled when she began chemotherapy for breast cancer. It remains unclear just how this will impact pending lawsuits against HealthNet which have been filed by dropped or unhappy policyholders. According to the agreement, HeathNet has agreed to pay 25 million dollars in claims, premiums, and penalties. Click here to get press release from the California Insurance Commissioner. 09/12/2008
CENTERS FOR MEDICARE AND MEDICAID SERVICES DENIES REPORT THAT PARENTS OF CHILDREN IN S-CHIP PROGRAM WILL LOSE INSURANCE
More from the Emeritus Newsroom - The Centers for Medicare and Medicaid Services is denying a published report that Minnesota parents insured by the S-CHIP childrens health insurance program would be dropped. A spokesperson for CMS told Emeritus News today that negotiations are continuing to move the parents into an appropriate Medicaid program. The Bush administration has opposed parents being insured by S-CHIP programs, claiming it should be limited to children. Minnesota and perhaps six other states had received waivers in the past to insure parents of children in the S-CHIP program. CMS claims Minnesota was given an extension until September 24th to provide more time for moving the parents into another program. A spokesperson for Minnesota Medicaid confirmed to Emeritus News that the state was in negotiations with CMS about the issue, but would not elaborate on sticking points in the negotiations. 09/11/2008
MEDICARE OVERPAYS MILLIONS FOR DRUGS TO DUE FAILURE TO KEEP UP WITH GENERIC PRICING
More from the Emeritus Newsroom - A report from the Inspector General's Office reveals that failure to keep up with generic drug price inputting on the agency's computers, has prompted an overpayment of at least 6.5 million dollars for one drug, in one month alone. And the OIG's office suspects the tally will go higher as a deeper examination of other drugs is completed. The OIG's report states that, in March 2008, the Medicare payment amount for the drug "irinotecan" was more than double the OIG-calculated average manufacturer sales price. The Medicare payment amount for irinotecan ($126.31) exceeded the OIG-calculated average manufacturer sales price ($51.59) by 145 percent in March 2008. Lower priced generic versions accounted for the vast majority (86 percent) of irinotecan sales in March 2008. The average manufacturer sales price for generic irinotecan was $40.66; the average manufacturer sales price for the brand-name product was nearly three times greater.
Further, we estimate that had the Medicare payment amount for irinotecan been based on the average manufacturer sales price in March 2008, Medicare expenditures for this drug would have been reduced by $6.5 million in that month alone. Click here to get the complete IOG report. 08/28/2008
THE MISLEADING HEADLINES OF THE CENSUS REPORT ON HEALTH INSURANCE COVERAGE
More from the Emeritus Newsroom - What the Census Bureau wanted to show, in their abnormally high trumpeted news conference yesterday, was that more Americans had health insurance and that the ranks of the uninsured had decreased during the year 2007. What was discussed only in passing was that the number of those insured by employer plans has stagnated, and has probably dropped with this years layoffs of thousands of workers. The ranks of those under private health insurance plans had dropped. It was also worth noting that the major share of those not insured, children, dropped only because of the success of enrolling families in special government sponsored health insurance plans. In an analysis of the report by the Kaiser Family Foundation these issues stood out. Not that there were more people insured, as often headlined, across the country, but that,
The proportion of people with private coverage dropped to 67.5% from 67.9%;
The proportion of people with employer-sponsored coverage fell to 59.3% in 2007 from 59.7% in 2006, although the number of people with employer-based insurance was not statistically different from 2006 (Girion, Los Angeles Times, 8/27);
The proportion of people with any type of public coverage grew to 27.8% from 27.0% in 2006;
Uninsurance rates differed by race, with 32.1% of Hispanics uninsured in 2007, down from 34.1% in 2006, remaining the group with the highest percentage of uninsured. Uninsurance rates for blacks decreased from 20.5% to 19.5% during the period. The rate for whites declined from 10.8% to 10.4%, and the rate for Asian-Americans was up from 15.5% in 2006 to 16.8% in 2007 (New York Times graphic, 8/27);
Massachusetts ranked first overall among states in the proportion of residents with health coverage, with 92.1% covered (Smith, Boston Globe, 8/27); and
Texas ranked last among states with 24.4% of residents having no health coverage (Urbina, New York Times, 8/27).
Overall the number of people enrolled in government-sponsored health programs increased to 83 million in 2007 from 80.3 million in 2006. The number of people enrolled in Medicaid increased from 38.3 million to 39.6 million in 2007 (Los Angeles Times, 8/27). An additional one million U.S. residents enrolled in Medicare last year, and the federal government's military health care programs covered 400,000 more people in 2007 than in 2006 (Dougherty/Zhang, Wall Street Journal, 8/27).
Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Foundation's Commission on Medicaid and the Uninsured, said, "In 2007, at least 26 states made efforts to expand coverage, but as the economy has turned downward so have state efforts." She added that insurance premiums have been rising faster than wages and inflation, causing many people to seek coverage through government-sponsored programs. The report also indicates that, after adjusting for inflation, the median income of working-age households was $2,010 lower than its 2000 level and that the 2006-2007 change was not statistically significant (New York Times, 8/27). 08/27/2008
ADVOCACY GROUP ISSUES CAUTION WHEN MOVING TO "INDIVIDUAL" POLICY HEALTH INSURANCE MARKET
More from the Emeritus Newsroom- A leading advocacy group, Families U-S-A, has released a report questioning the feasibility of switching to an individually priced health insurance market where individuals and their families shop for a health insurance policy. The report , called , "Empty Promise:
Searching for Health Insurance in an Unfair Market" was written by Claire McAndrew. It questions, "If health insurance companies are allowed to drastically vary their prices based on applicants’
health or refuse to sell policies to some applicants altogether, even tax credits that appear
generous are not a viable solution for helping consumers obtain quality, affordable coverage". There has been more discussion about moving away from employer based health insurance plans. Proponents of such plans propose individuals shopping for their own insurance, while other reformers say heath insurance policies should be government financed through taxes charged everyone, and those insured by those plans would enroll as part of a government program that is "community rated" or determined by the expenses of the entire program, rather than "experience rated" according to an individual or their families claims, or health experience. Click here to get the complete report. 08/26/2008
MEDICAID FRAUD PROBE: WELLCARE TO PAY $35.2 MILLION DOLLARS
More from the Emeritus Newsroom - With an investigation and penalty determination yet to be finished, health care provider, WellCare of Tampa, Florida, has filed an agreement with the Securities and Exchange Commission, (Dated August 18th,2008) reportedly reached with federal and state officials regarding repayment of Medicaid behavioral services which were considered by investigators to be over billing. The agreement states that WellCare and its subsidiaries will pay the money to cover overpayments between the years 2002-2006. The company also states this does not include any fines or other levies against the company which are yet to be decided. The future of the company also remains clouded. In a filing on August 15, 2008, the company, in its forward statement, claims that the investigations into their activities may lead to sanctions against them in Florida and other states, which may prevent them from doing business in those states. WellCare does business in Florida as WellCare, Healthease and Harmony Health. In Illinois, they are under the banner of Harmony Health and WellCare. They do business as WellCare in New York, Arizona, New Jersey, Texas, Ohio, Louisiana, Georgia, and Connecticut. They also operate their own prescription service called WellCare Prescription Insurance. Click here to be taken to link connecting to the August 18th and August 15th filings. 08/19/2008
MEDICARE WITHDRAWALS ON S-S CHECKS "A MESS"
More from the Emeritus Newsroom - Montana Senator Max Baucus of the Senate Finance Committee calls it, "A mess". A General Accounting Office (G-A-O) review of the issue states, there were numerous reports of beneficiaries not having the correct Parts C and D premiums withheld. Also, about 231,000 beneficiaries had their premiums refunded erroneously because they were mistakenly identified as having paid excess premiums. In addition, the G-A-O report, which was actually written in July and only released yesterday, found that The Social Security Administration in 2006 rejected 44.5% of Medicare's requests for premium deductions. Click here to get get a copy of the G-A-O report. 08/14/2008
ROBERT WOOD JOHNSON FOUNDATION RELEASES NEW SURVEY SHOWING CHILDREN FROM UNINSURED FAMILIES FORGO ADEQUATE HEALTH CARE
More from the Emeritus Newsroom - In a survey of patients conducted by the University of Minnesota, the Robert Wood Johnson Foundation says the finding show medicaid and SHIP and other programs for insuring children fill a critical need. The survey shows that one third of children. The report that more than one in three chronically ill children nationwide is enrolled in one of these programs and has consistent access to needed care because of them. The point of the survey's release was not only to prove the need for the programs, but also call attention to families finding out if they qualify for such programs. As part of the foundation's annual, "Cover the Uninsured Back-to-School Campaign". Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation states, “Hard-working parents need these programs, and their children benefit greatly because of them. Making sure kids have insurance helps safeguard the health of our children and ultimately the strength of our nation". Click here to get a complete copy of the Robert Wood Johnson Foundation press release. 08/14/2008
NEW MEDICARE PART "D" COST PROJECTIONS
More from the Emeritus Newsroom - Based on the bids submitted by Part D plans, the centers for Medicare and Medicaid Services estimates that the average monthly premium that beneficiaries will pay for standard Part D coverage in 2009 will be $28. This is about 37 percent lower than originally projected ( $44.12) when the benefit was established in 2003. Low income beneficiaries will be entitled to additional price breaks and assistance. Click here for details from the Centers press release. 08/14/2008
EMPLOYER HEALTH INSURANCE CONSULTANT PREDICTS ANOTHER DOUBLE DIGIT RISE FOR HEALTH INSURANCE OVER NEXT YEAR, LESS FOR RETIREES
More from the Emeritus Newsroom - Health care costs are expected to increase on average 10.6 percent in the next 12 months, according to Aon Consulting Worldwide, a Chicago based employer insurance consultant. But, company officials point out that the projection represents the lowest trend rate increases since the study began in 2001, and are slightly lower than one year ago, when HMO cost increases were 10.9 percent, 10.8 percent for POS plans, 11.2 percent for PPOs and 10.7 percent for CDH plans. In addition, health care rate increases for retirees over the age of 65 are projected to be 7.3 percent for Medicare Supplement plans and 7.7 percent for Medicare Advantage plans, down from 11.2 percent and 9.2 percent, respectively, one year ago. Click here to get complete press release from Aon Consulting. 08/12/2008
IMMIGRANTS INCREASINGLY UNINSURED
More from the Emeritus Newsroom -Native born Americans still make up the majority of people in this country who are uninsured, however, the number of immigrants that are uninsured has exploded. According to a survey from the Employee Benefit
Research Institute,
about 55 percent of the increase in the U.S. uninsured
population over a 12-year period ending in 2006, is due to the immigrant population. The non partisan group reports that in 1994 immigrants accounted for 18.8 percent of the U.S.
uninsured population, while by 2006 they accounted for 26.6 percent of the uninsured population. During the same period,
native-born Americans dropped as a percentage of the uninsured, from 81.2 percent in 1994 to 73.4 percent in 2006. Click here to see the entire press release (PDF file ) from EBRI. 08/06/2008
UPSTATE NEW YORK SENIORS GET REVENGE IN HEALTH INSURANCE SCAM
More from the Emeritus Newsroom- It was a busy day for New York Attorney General Andrew Cuomo. Yet another action was taken by his office regarding scams and investments that took advantage of senior citizens. A probe of an upstate health insurance scam determined that, "Dozens of senior citizens across state were duped into spending thousands of dollars for overlapping policies – while Auburn broker collected commissions. The scam was widespread with complained coming from Rochester, Syracuse, Ithaca, Binghamton and Buffalo". Cuomo says that, as part of a court order, Auburn, New York, insurance broker Thomas Piccirillo will pay $500,000 in restitution to seniors he defrauded, $100,000 in penalties, plus an additional $10,000 penalty to the state for targeting senior citizens. Piccirillo is also now barred from selling any home-care policies unless he posts a $500,000 bond. Consumers who believe they were defrauded by Piccirillo are urged to contact the Attorney General’s Buffalo Office at 716-853-8404 by September 15, 2008 in order to be possibly eligible for restitution. Click here to see NY AG's entire press release. 07/24/2008
LONG TERM CARE INSURANCE COMPLAINTS-SALES PRACTICES LEAD TO G-A-O REPORT AND CONGRESSIONAL HEARING
More from the Emeritus Newsroom- The release of a G-A-O report on the eve of today's hearing on the issue by the House Energy and Commerce Subcommittee on Oversight and Investigations, gave context to what is increasingly a gray area of insurance regulation in need of action. The G-A-O report states, "GAO found that rate increases for LTCI policies fluctuate widely from state to state and plan to plan. For example, one company cited in the report repeatedly raised premiums, resulting in a cumulative increase of more than 70 percent since 1991, while another company has raised premiums only once since 1975. According to the report, rate stability standards, which are designed to protect consumers against sharp premium increases, have now been adopted by more than half of all states. However, because many states have not yet adopted these standards, a vast number of consumers are still left unprotected. Additionally, because the rate standards are so new, state regulators are unsure of how successful they will be in moderating future premium increases". Click here for a copy of the complete G-A-O report. Click here to House Energy and Commerce Subcommittee on Oversight and Investigations hearing link. 07/24/2008
UNITED HEALTH CARE TAKES EARNINGS DIVE AFTER COURT SETTLEMENT
More from the Emeritus Newsroom- Even with a payout of over 912 million dollars to settle a lawsuit with CalPers pension fund and other stakeholders over stock options, United Health Care still earned 337 million dollars for the 2Q. That compares with 1.2 billion dollars in same quarter earnings a year ago. Click here for United Health Care press release. 07/22/2008
HERITAGE FOUNDATION REPORT FINDS FLAWS IN CHILDRENS HEALTH INSURANCE PROGRAM
More from the Emeritus Newsroom- In a report released today by the Heritage Foundation, the purpose of the SCHIP program for childrens' health insurance comes under question. The report questions the motive for expanding to program beyond purposes for which it was intended. The writer of the report, Dennis Smith, outlined concerns over current proposals in congress to extend the program. Smith says there needs to be debate over, "The expansion of coverage to higher income children and adults, as well as non citizens. The "crowd out" of private insurance and unnecessary tax increases and budget gimmicks". Smith explains that, "Expanding SCHIP would extinguish the potential of tax credits and deprive private insurance—including employer coverage—of the oxygen of healthy lives and resources needed to sustain insurance pools". Click here for entire report from Heritage Foundation. 07/16/2008
CONGRESS OVERRIDES PRESIDENT BUSH VETO OF MEDICARE PAYMENTS BILL
More from the Emeritus Newsroom- As promised, President Bush today vetoed the Medicare payments bill, but both the house and senate overrode his veto in short order later in the day. Only 41 Republicans stood with the President in the house and in the senate the override was approved by a 70-26 vote. The medicare payments bill prevents what would have been a ten percent payment cut to doctors while cutting reimbursements to insurance companies in the Medicare Advantage program. Bush called the bill 'irresponsible" and said that it offered no long term recognition and solutions for the financial issues faced by Medicare. Bush has also felt that the bill was too generous to medical equipment suppliers. Both houses had passed the bill by veto proof margins before it was sent to the President. Supporters feared that if it didn't pass it could lead to a massive back up of claims as doctors offices sort out different payment schedules before and after July 1st, when the cuts to doctors were to take effect. They also feared that many of the doctors now in the regular medicare plan would have pulled out. It was one of the worst legislative defeats for Bush during his presidency. 07/15/2008
More from the Emeritus Newsroom- In an article entitled, "The Supreme Court Strands Beneficiaries of Retirement and Health Benefit Plans", two attorneys for the National Senior Citizens Law Center claim the recent refusal by the U-S Supreme Court to review a case, where a family was denied death benefits due to the actions of an employer, amounts to ignoring illegal practices. The family's attorney claimed the employer led the employee to believe he had death benefit coverage, when he did not. This despite repeated doubts and questions from the employee about his status. Click here to read complete article by Harper Jean Tobin and Simon Lazarus, attorneys with the National Senior Citizens Law Center. 07/08/2008
SHOWDOWN OVER DOCTORS MEDICARE PAY
More from the Emeritus Newsroom- (Update HR 6331 was passed by Congress 7/15/2008 to override President Bush veto. Bill now becomes law. ) The battle over HR 6331. At issue is preventing proposed physician fee cuts by cutting Medicare payments to private insurance companies in the Medicare Advantage program. The insurance industry is fighting the cuts. At stake is not only keeping physicians in the Medicare system, but also an avalanche of paperwork delays that could bog down claims processing . CLICK ON EMERITUS NEWS CUBE BELOW to hear interview with Maria Freese,Director of Government Relations and Policy for the National Committee to Preserve Social Security and Medicare. The interview is seven minutes long and is a comprehensive look at the issue as of 7/3/2008 before the bill became law. 07/03/2008
WHICH U-S CITIES ARE SAFEST FOR DRIVING
More from the Emeritus Newsroom- Allstate Insurance gathered all it's claim data and came up with the safest driving towns. Ever been to Sioux Falls, South Dakota? Well, Allstate says the likely hood of you having an accident there is probably the least of any of their rated cities. The company says Sioux Fall residents have an accident, on average every 14.6 years. Which should translate to lower insurance rates. See the Allstate press release for all the details. 07/03/2008
UNITED HEALTH CARE TO PAY 912 MILLION DOLLAR SETTLEMENT
From the Emeritus Newsroom- United Health Care has agreed to pay a total 912 million dollars to settle a lawsuit filed against the company for stock options practices. According to the company, the suit was filed by California Public Employees’ Retirement System (CalPERS) and plaintiff class representative Alaska Plumbing and Pipefitting Industry Pension Trust, on behalf of themselves and members of the class, to settle the federal securities class action lawsuit arising from the consolidated amended complaint filed on December 8, 2006, in the U.S. District Court in Minnesota. CALPERS, in a statement released today, said CalPERS and several other investors sued the company after news reports focusing on the practice of allowing executives to set their stock purchase dates when share values were low, then selling them later when they were high. In September 2006, CalPERS was named lead plaintiff in the lawsuit. United Health Care admits no wrongdoing in the settlement. See company statement See CalPERS statement 07/02/2008
CALIFORNIA INSURANCE LAWS BRING RATE CUT
More from the Emeritus Newsroom- The California Insurance Commissioner Steve Poizner today announced Fireman's Fund home insurance policy holders will be getting a 17.9% reduction in insurance premiums.
Poizner's statement says, "Under the rate reductions announced today, homeowners will save an average of $505 per year, per policy. Fireman's Fund is the 9th largest homeowners insurer in California, with 58,740 policyholders. San Francisco County Fireman's Fund customers will enjoy a total of $1.7 million in savings. Los Angeles policyholders will save a total of $5.3 million. The new rates will take effect on August 1, 2008 and apply to renewing policyholders and new customers. Click here for the entire press release. The refunds are mandated according to California's Proposition 103 insurance law, which was passed to prevent insurance companies from charging unjustified rates . 07/01/2008
More from the Emeritus Newsroom- It's hardly a romance novel, but it is a 'just the facts ma'am" look at the complexities of qualifying for and troubleshooting Medicare. The Center for Medicare Advocacy pushing the book, which was written by some of the groups most noted experts on the subject. See group's book page.
EMERITUS NEWS INSURANCE
ANALYSIS OF CHANGES IN MEDICARE AND MEDICARE ADVANTAGE PLANS WITH THE PATIENT PROTECTION AND AFFORDABILITY CARE ACT OF 2010- FROM THE CENTER FOR MEDICARE ADVOCACY
PRESIDENT OBAMA PROVIDES UPDATE ON HEALTH INSURANCE REFORM TALKS WITH REPUBLICANS
More from the Emeritus Newsroom- President Obama, in a surprise appearance during the daily White House briefing, details reasons for hope and more reasons for action now as health insurance reform reached another roadblock, with the election of Republican Scott Brown to the Senate seat formerly held by the late Sen. Edward Kennedy. Obama explained there was a good and frank discussion
of the issues. I am confident .Obama said the two sides also discussed the job package, which also includes an extension of jobless benefits. Although the house version contains the benefits, the original Senate version did not and is expected to before it is passed. both sides have until February 19th to pass an extension without causing a benefits interruption for those who depend on unemployment compensation and extension of COBRA subsidies to help with health insurance payments. Obama said that unless health insurance reform takes place it will be the largest business and job killer. He also criticized Senate Republicans for putting a hold on various nominees and threatened to install those nominees during a recess, similar to what President George W. Bush had done when Democrats were blocking several appointments. Obama says whatever is passed must meet his core goals including , controlling costs, controlling deficits, insurance company abuses and affordability. Obama says he willing to accept not getting everything he wants, but will not tolerate another year of wrangling over reform and he said, bipartisanship cannot be that he agrees to everything they want. The President feels the public has become so tired of the rancor over the issue it has affected their willingness to understand actual proposals that are being discussed. Full text of the President's remarks during news conference, click here. 02/10/2010
HOUSE SPEAKER PELOSI SAYS SENATE VERSION OF HEALTH INSURANCE REFORM WILL NOT PASS IN THE HOUSE
More from the Emeritus Newsroom - House Speaker Nancy Pelosi says there are not enough votes in the House to pass the Senate version of the health insurance reform bill. Pelosi made the statement today during a meeting with other members of the caucus.And later, in a speech before the U-S Conference of Mayors, Pelosi said that health insurance reform will move ahead and be passed. Both Pelosi and Senate Majority Leader Harry Reid said they would work together to come up with a compromise, but so far there have been no proposals revealed. President Obama said during an interview on ABC that he was willing to consider starting over for a more pared down version of the bill and adding fewer of the uninsured. But, the President said his goal remains comprehensive health insurance reform. 01/21/2010
MORE YOUNG PEOPLE WITHOUT HEALTH INSURANCE DUE TO HIGH UNEMPLOYMENT
More from the Emeritus Newsroom - The Commonwealth Fund today released their latest survey on the problems young workers and their families face with health insurance. The survey shows finds almost half are without insurance at some time during the year. As they hit milestones like high school or college graduation, they face loss of coverage as they are dropped from parents' plans or public insurance programs. In the current economic climate, young adults are less likely to find jobs, and when they do, are frequently offered positions that come without benefits. Provisions in the health reform bills could help young adults by expanding Medicaid eligibility, creating a health insurance exchange with premium subsidies, and requiring insurers and employers to allow young adults to remain on parents' plans up to age 26 or 27. These provisions could help young adults obtain and keep affordable, comprehensive coverage through transitions from school to work and from job to job. In 2009, 45 percent of young adults ages 19 to 29, or an estimated 20.5 million people, were without health insurance for some time during the past year (Exhibit 1). Nearly three of 10 (28%) were uninsured at the time of the survey, and an additional 17 percent reported they had health insurance, but had gone without coverage for some time during the last 12 months.
The majority of young adults with gaps in insurance are members of low-income families. Four of five (79%) uninsured young adults had household incomes of less than $40,000: 55 percent had incomes of less than $20,000 and an additional 24 percent had incomes between $20,000 and $39,999 (Exhibit 2). Among young adults in households with incomes under $20,000, more than half (53%) were uninsured at some time during the past year, more than three times the rate for young adults from higher-income households (i.e., incomes of $60,000 or more) (Exhibit 3). Racial and ethnic minorities were more likely to be uninsured during the year, with 54 percent of blacks and 58 percent of Hispanics reporting a time without insurance, compared with 39 percent of white young adults. PDF download of Commonwealth Fund Report, copy click here. 01/19/2010
NEGOTIATIONS OVER HEALTH INSURANCE REFORM CHANGE TAXES FOR MOST EXPENSIVE PLANS
REPUBLICAN ATTORNEYS GENERAL THREATEN LAWSUIT OVER MEDICAID PAYMENT DEAL GIVEN OKLHAOMA TO GET REFORM AGREEMENT
More from the Emeritus Newsroom - In an effort spearheaded by Republican Attorneys General from 13 states, Democratic Congressional leaders in Washington are being threatened with a potential lawsuit over the deal to give $100 million extra Medicaid dollars to Oklahoma in order to get the vote of that state's Democratic Sen. Ben Nelson. South Carolina's two U-S Senators, Republicans Lindsey Graham and Jim DeMint asked the South Carolina Attorney General, Henry McMaster, to examine constitutional challenges to the deal which allowed Democratic congressional leaders to pass a health insurance reform proposal December 24th. The vote was 60-39, enough to avoid a Republican delay on the package. AG Mc Master, with support of the other attorneys general, then issued a letter late Wednesday to Democratic congressional leaders saying,
"As chief legal officers of our states we are contemplating a legal challenge to this provision and we ask you to take action to render this challenge unnecessary by striking that provision,"
DEMOCRATS PASS HEALTH INSURANCE REFORM / REPUBLICANS VOW REVENGE IN 2010 ELECTIONS
More from the Emeritus Newsroom- Senate Democrats have passed their version of the health insurance reform bill. The early morning vote saw all 60 Democrats voting to approve and 39 Republicans opposed. Kentucky Senator Jim Bunning (R) did not vote. The Senate proposal will likely be changed somewhat in the merger with the House proposal. One big issue is how the public option. The Senate approved public option is actually a pool run by private insurance companies, while the House version is largely operated by the federal government. Both the Senate and House versions require Americans to have insurance, offer subsidies for purchasing insurance, prevent companies from turning down patients with pre-existing conditions, canceling policies on those with chronic or catastrophic illnesses, and provides a bill of rights for hospital and nursing home patients. The plan is partially paid for through increased Medicare taxes on higher income earners and those with high end insurance plans. Premiums are likely to increase initially as insurance companies will no longer be able to cancel and discriminate against sick patients. However, supporters of the legislation feel this will eventually stabilize health care financing so as that more patients will have insurance, therefore, hold the price of services, which have increased to compensate for the those who can't pay. More in this article from the Washington Post, click here. More in this article from the New York Times, click here. Full Text of the CBO report, copy click here. CBO's report showing health insurance reform would not force out private companies, copy click here. FULL PDF TEXT DOWNLOAD OF SENATE HEALTH INSURANCE REFORM BILL, CLICK HERE. 12/24/2009
TRACING THE MONEY TO THE HEALTH INSURANCE REFORM VOTE
AMERICAN MEDICAL ASSOCIATION ENDORSES AMENDED SENATE HEALTH INSURANCE REFORM PROPOSAL
More from the Emeritus Newsroom- In a news conference this morning with Senate Democratic leaders, the President of the American Medical Association gave the group's endorsement to the amended Senate proposal, which passed its first procedural vote early this morning 60-40. AMA President-elect Cecil B. Wilson, M.D., said the proposal "advances" many of the groups "priority issues".
“The AMA communicated closely with the Senate about items it supported and items of concern in the prior version of the Senate bill,” said Dr. Wilson. “We are pleased that the manager’s amendment addresses several issues of concern to AMA. It increases payments to primary care physicians and general surgeons in undeserved areas while no longer cutting payments to other physicians. It eliminates the tax on physician services for cosmetic surgery and drops the proposed physician enrollment fee for Medicare.”
Democratic leaders face a huge task merging the bill with one passed in the house, then passing it once again in the Senate for a vote that could come Christmas eve. Full Text of AMA endorsement, copy click here. 12/21/2009
SENATE PASSES HEALTH INSURANCE REFORM PROCEDURAL VOTE 60-40 / FIRST OF SEVERAL CRITICAL HEALTH INSURANCE REFORM VOTES / CBO CORRECTS DEFICIT SAVINGS ESTIMATE AFTER 2019 / LINK TO CBO LETTER / DEAL CUT WITH SEN. BEN NELSON TO PASS HEALTH INSURANCE REFORM / SENATE REPUBLICANS SAY THEY WILL DELAY VOTE ON HEALTH INSURANCE REFORM AS LONG AS POSSIBLE / SENATE PASSES MILITARY FUNDING / SOURCES SAY REPUBLICAN LEADERS ADMIT DEMS MAY GET UPPER HAND
More from the Emeritus Newsroom- SENATE DEMOCRATS PREVAILED 60-40, ON A CRITICAL PROCEEDURAL VOTE AT 1 AM MONDAY MORNING TO MOVE THEIR VERSION OF THE HEALTH INSURANCE REFORM MEASURE FORWARD FOR SEVERAL MORE VOTES. THE FINAL VOTE COULD COME CHRISTMAS EVE. ALL 58 DEMOCRATS AND TWO INDEPENDENTS VOTED FOR THE REFORM MEASURE. ALL 40 REPUBLICANS VOTED AGAINST IT. ALSO, THERE WAS MORE from the Congressional Budget Office over the weekend, in reference to potential savings from the health insurance reform package now in the Senate. A letter from CBO Director Douglas Elmendorf says the new estimates will have no effect on the estimates between 2010 to 2019. HOWEVER, THE LETTER DOES LOWER ESTIMATES ON SPENDING GROWTH BETWEEN 2020-2029. In his letter to Senate Majority Leader Harry Reid, Elmendorf says:
"With this corrected reading, savings from changes to the Medicare program (along with other changes to direct spending that are not associated directly with expanded insurance coverage) would increase at a rate that is between 10 percent and 15 percent per year during the 2020–2029 period, compared with a growth rate of nearly 15 percent reported in the initial estimate. The long-run budgetary effects of the other broad categories of the legislation are unchanged from the initial estimate. All told, CBO expects that the legislation, if enacted, would reduce federal budget deficits over the decade after 2019
relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of GDP". Full text of Elmendorf letter, copy click here.
Democratic leaders on Saturday said they had reached a deal Friday night with Sen. Ben Nelson (D) NE, to get his vote on the health insurance reform proposal now before the Senate. This after Democrats were able to pass a military spending bill in the Senate, 88-10 . The 626-billion dollar measure includes nearly 130-billion for the ongoing wars in Afghanistan and Iraq. Since the bill has already passed in the house, it now goes to President Obama for his signature. According to a report in the Washington post, click here for full article:
"Under the new abortion provisions, states can opt out of allowing plans to cover abortion in the insurance exchanges the bill would set up. The exchanges are designed to serve individuals who lack coverage through their jobs, with most receiving federal subsidies to buy insurance. Enrollees in plans that cover abortion procedures would pay with separate checks -- one for abortion, one for any other health-care services. This was an effort to comport with the 32-year prohibition against federal funding for abortions, but the Nelson compromise is a softening of the House language, which was written by Rep. Bart Stupak (D) MI.
12/20/2009
Sen. Nelson's vote was critical for the Democrats to get the 60th vote to avoid a promised Republican filibuster to delay the plan, which now appears headed for a vote on Thursday. In their quest to delay voting on the heath insurance reform measure, Republicans found themselves in an unenviable position of trying to delay a vote on military funding....something they have accused Democrats of doing in the past. Democrats were able to overcome a Republican filibuster on a procedural vote of 63-33 to move the military spending bill to a vote on Saturday.
This means Democratic leaders will move to finish a health insurance reform measure next week. Reports had focused on Sen. Ben Nelson (D) NE, and his demand that language in the bill strictly prevent federal payment for abortions, however, there are other issues in the Senate Democratic Caucus that are providing backroom drama. In an interview Thursday with a radio station in Lincoln, Nebraska, Sen. Nelson said, “I can’t tell you that they couldn’t come up with something that would be satisfactory on abortion between now and then and solve all the other issues that I’ve raised to them, but I don’t see how”, The implication was that Nelson saw little chance of him changing his mind and little hope of an improved deal.
This had raised the possibility the issue will not be settled until lawmakers get back from their Christmas break. Senators from more liberal leaning states are rebelling over the lack of a public option and any language that would prevent ANY federal payment for abortion, including to save the life of the mother, or in cases of rape or incest. Senate leaders and White House officials have claimed confidence in being able to come up with a deal to satisfy those concerns. Several congressional sources, not wanting to be identified, have told Emeritus News, that even Republican leaders have now privately admitted Democratic leaders are very close to , "getting what they want or a variation of it".
The sources also say that because of the continued problems with long term unemployment and the increasing costs of continuing insurance coverage for the jobless, Democrats may even get as many as three Republican votes, giving cover for Democratic Senators in tough re-election fights next year, in more conservative states. Sen. Ben Nelson interview with radio station KLIN, click here. 12/18/2009
BATTLE FLARES OVER ATTEMPTED DELAYS IN SENATE VOTE ON HEALTH INSURANCE REFORM
SENATE DEFEATS BILL THAT ALLOWED IMPORTATION OF CHEAPER DRUGS FROM CANADA AND WESTERN EUROPE
More from the Emeritus Newsroom - By a vote of 51-48, nine short of 60 needed for passage, the Senate today failed to approve a bill from Senators Byron Dorgan (D) ND and John McCain (R) AZ to allow importation of cheaper prescription drugs from Canada and Europe. Even supporters of health reform and the Food and Drug Administration felt the importation raised serious questions about quality control and trade. The pharmaceutical industry was opposed as was President Obama, who shares similar concerns and feels price controls on pharmaceuticals should be a regulatory and national policy issues not be left to market forces of international trade. Supporters feel the pharmaceutical industry is forcing Americans to pay the lion share of costs to develop and produce medications. AS FOR THE HEALTH INSURANCE REFORM NEGOTIATIONS, OKLAHOMA SENATOR BEN NELSON SIAD IN A RADIO INTERVIEW WITH A LINCOLN NEBRASKA RADIO STATION “I can’t tell you that they couldn’t come up with something that would be satisfactory on abortion between now and then and solve all the other issues that I’ve raised to them, but I don’t see how” . THE 12/15/2009
OBAMA MEETS WITH DEMOCRATS IN FINAL PUSH FOR HEALTH INSURANCE REFORM AGREEMENT / FORMER DEMOCRATIC NATIONAL COMMITTEE CHAIRMAN HOWARD DEAN SAYS SCRAP SENATE PLAN, START OVER
More from the Emeritus Newsroom- Senate Democrats were told by President Obama today, during a meeting at the White House, they should not let individual issues stop the overall benefit of health insurance reform. Also attending the meeting was independent Senator Joe Lieberman, CT, who, over the weekend had indicated he would oppose extending Medicare to those ages 55-64, although he had earlier stated his support for such an idea in a video interview with CONNPOST.COM. After the meeting today with the President, Lieberman is now saying he will support the extension. Sen. Ben Cardin (D) MD agrees with President Obama's statement that a deal for health insurance reform is close. Sen. Judd Gregg (R) NH, is among Republicans opposed to the Senate plan. He says it expands the role of government, cuts medicare benefits and will add to the country's financial problems. Gregg also pointed out the dour assessment from the Center for Medicare and Medicaid Services, Chief Actuary, Richard Foster. Critics of Foster's assessment claim it is ironic Republicans are using Foster's report when they ignored his criticisms of the Republican supported Medicare drug plan passed while former President Bush was still in office. Full text of report from Richard S. Foster, click here. Supporters say the CBO analysis it will improve coverage for most Americans, cut the deficit, and add more people to the roles of insured who are now without. Full Text of the CBO report, copy click here. CBO's report showing health insurance reform would not force out private companies, copy click here. ALSO TODAY, DURING A PUBLIC RADIO INTERVIEW IN VERMONT, FORMER DEMCORATIC NATIONAL COMMITTEE CHARIMAN, HOWARD DEAN CALLED FOR THE SENATE PLAN TO BE SCRAPPED AND START OVER. A story from the Commondreams.org website, claimsDean sees removal of the Medicare buy-in made the bill not worth supporting, and urged Dem leaders to start over with the process of reconciliation in the interview, which is set to air at 5:50 PM Eastern today on Vermont Public Radio.
“This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”
DEMOCRATS VOW TO HAVE HEALTH REFORM DONE BY CHRISTMAS / LIEBERMAN THREATENED TO HOLD UP REFORM OVER MEDICARE EXTENSION / NOW SAYS HE'S ENCOURAGED / OBAMA TO MEET WITH DEMOCRATIC CAUCUS ON TUESDAY / VIDEOS & PDF DOWNLOAD OF SENATE HEALTH INSURANCE REFORM BILL
More from the Emeritus Newsroom- Following a critical meeting with the Senate Democratic Caucus, Democratic leaders admitted negotiations are continuing to finish a health insurance reform proposal before Christmas. Senate Majority Leader Harry Reid said during a news conference after the meeting Democrats, "are not going to let the American people down" . Also, The entire Senate Democratic caucus has been invited to the White House on Tuesday afternoon for a group meeting with President Obama on health care reform efforts. All this, after several days of wrangling behind the scenes over Senator Joe Lieberman's about face on his earlier support of an extension of Medicare for those ages 55-64. Supporters of the Medicare extension proposal were furious with Lieberman's comments over the weekend, that he could not support reform with extension of medicare, after previously expressing his support for such an idea three months ago in a video interview on CONNPOST.COM . Lieberman can be heard in the interview supporting such a proposal, but then reversed course over the weekend, to the surprise of Democratic leaders who were not aware of his reversal on the issue despite meeting with him earlier last week. Consumer advocates were quick to pounce on the Lieberman reversal , claiming that insurance interests from the senator's home state had convinced him to back out, over concerns it would be a move toward a public option to challenge insurance companies. After the Demcratic Caucus Monday night, Senator Lieberman said he was "encouraged " by the direction the neogotiations were headed. In a report from the Connecticut Post Monday night, Erika Masonhall, Lieberman's spokeswoman, said his comments were made before full reporting was completed on U.S. Sen. Max Baucus' bill, which contained extensive health insurance reforms, "including a more narrow age rating for pricing health insurance premiums and extensive affordability credits that would benefit this specific group of individuals"."Any inclusion of a Medicare buy-in for that same age group would be duplicative of what is already in the bill, would put the government on the hook for billions of additional dollars, and would potentially threaten the solvency of Medicare". But consumer advocates were saying privately that Lieberman's claim of duplicity between private and Medicare coverage for the 55-64 age group was disingenuous, since private insurers covered the age group to begin with, at the time of his September 2 2009 interview with CONNPOST.COM. Sen. Lieberman, after tonight's meeting with Democratic leaders said he Recent problems over a reported, "Near Agreement", repeatedly surfaced over the past week, as conservative Democrats voiced concerns about the" principle " of a public option as more evidence from the Congressional Budget Office was showing reform would save money and not add to the deficit.Though the CBO has yet to rate a Medicare buy in option for those age 55-64, Senate Democatic leaders say there would not be any major decision announced on negotiations until the after CBO report on the medicare extension. FULL PDF TEXT DOWNLOAD OF SENATE HEALTH INSURANCE REFORM BILL, CLICK HERE. Video of Senate Democratic leaders after Democratic Caucus December 14 2009.
12/14/2009
DEMOCRATS PLAN MONDAY NIGHT HUDDLE OVER NEXT REFORM MOVE
