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Increasing The Medicare Eligibility Age: A Smaller Bargain

From Politico:


President Barack Obama and House Speaker John Boehner failed to strike a “grand bargain” on the nation’s deficit, but they may have pulled off another trick: revolutionizing the debate over Medicare.

When they both accepted the idea of increasing the Medicare eligibility age to 67, they gave a controversial idea more legitimacy and high-profile support than it’s ever gotten before.

The White House’s Fiscal Commission, led by Erskine Bowles and Alan Simpson, listed the idea of raising the eligibility age with the likes of such dramatic structural changes as the public option, block grants or an all-payer system. Alice Rivlin and former Sen. Pete Domenici didn’t even bring up the idea in their deficit report. And the top Democrats in both the House and Senate brushed aside the concept just last month.

But now the idea of raising the eligibility age has gotten the support of Obama and Boehner. While the age change is not expected to be part of the latest debt ceiling compromises, the idea is now likely to be a permanent fixture in the Medicare debate and, someday, to become a reality.

The idea has been loosely supported by Republicans in the past. Continue reading

CMS Report: Healthcare Reform To Increase Spending

Seniors listen to a round table discussion on the benefits of the Affordable  Care Act.

By BRETT NORMAN | 7/28/11 8:36 AM EDT

The Affordable Care Act will drive health care spending up slightly, to nearly a fifth of the country’s gross domestic product by 2020, while extending insurance coverage to 30 million more Americans, a new report from CMS projects.

But health care’s hefty share of the country’s economic output is reached through an average annual growth in medical spending of 5.8 percent over the next decade — just 0.1 percent more than would have been spent without the health reform law, the report claims.

CMS published its findings this morning in Health Affairs. The report also projects that once all the data are in, health spending in 2010 will have grown a historically low 3.9 percent — slightly lower than the previous record low growth of 4 percent in 2009.

That’s an aftershock of the recession, which cost millions of people their jobs and, consequently, their health insurance, slowing medical spending. Continue reading

Small Biz Skeptical of ACA, But Still To Offer Coverage

From The Hill:

By Sam Baker – 07/25/11 01:00 PM ET

House Republicans leapt on a new report Monday that suggests small businesses might scale back their healthcare benefits in the wake of the reform law.

The survey, released by the National Federation of Independent Business (NFIB), found that small businesses don’t have much faith in the new law’s power to control healthcare costs, but they don’t necessarily expect to quit offering coverage as a result.

According to NFIB, the number of small businesses offering health insurance isn’t likely to change much over the next year. Companies that don’t offer it aren’t likely to start, and companies that do aren’t likely to quit. Continue reading

PCIP Provides Bridge For Looming Healthcare Reform

From Forbes:

By DAVID A. LIEB –07.25.11, 10:21 AM EDT

JEFFERSON CITY, Mo. — One of the first prongs of President Barack Obama’s health care law has been in effect now for a year, and the result in Missouri is that about 500 additional people with chronic health problems now have insurance.

It is, by most accounts, an underwhelming result. Missouri’s experience is pretty typical of the national norm, which is causing even some supporters of the federal health care law to question how it is being implemented.

One of the less-publicized provisions of the 2010 law required a Pre-Existing Condition Insurance Plan in each state. Backed by $5 billion of federal subsidies, the health plans are intended to provide insurance at lower prices than typically available to people with health problems who have been uninsured for at least six months.

The new health insurance plans provide a bridge to 2014, when a new requirement kicks in prohibiting insurers from charging higher premiums to people based on their health status. That’s the same year that most people will be required to have health insurance or face tax penalties, and that people will be able to purchase coverage through new online health insurance markets called exchanges.

When Missouri began taking applications in July 2010 for its federally mandated Pre-existing Condition Insurance Plan, officials expected to cover about 3,000 people, said Vernita McMurtrey, executive director of the Missouri Health Insurance Pool. One year later, it has just one-sixth of that amount – about 500 enrollees.

Missouri is not unique.

“Enrollment is fairly low across all states,” said Jennifer Tolbert, director of state health policy at the nonpartisan Kaiser Family Foundation.

Relying on estimates from the Congressional Budget Office and a unit of the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services said last July that it believed between 200,000 and 400,000 people likely would enroll in the new health plans.

The actual number is but a fraction of that. Through May 31, a total of 24,712 people nationwide were enrolled in the pre-existing condition insurance plans.

Health care analysts and insurance executives cite several reasons for the lackluster response.

Chiefly, the health insurance premiums still are more expensive than many people can afford – or want – to pay.

Federal law prohibits the plans from charging more than the state’s standard individual health insurance premium for people of a similar age. That means chronically ill people can get insurance policies at the same cost as healthy people. But many chronically ill people who have gone without insurance for six months either are unemployed or in low-wage jobs, which makes it difficult for them to afford even the standard premiums.

Under Missouri’s plan, for example, a 50-year-old man who opts for a $1,000 deductible would pay a monthly premium of $544, McMurtrey said.

That would consume about half the paycheck of someone working 40 hours a week in a minimum wage job, without accounting for taxes, housing payments, food, utilities and gas for a car.

Missouri lowered its premiums by 25 percent, effective Feb. 1, in an attempt to make the plan more affordable. Program administrators currently are analyzing whether they can lower rates again, McMurtrey said.

Until now, “Missouri hasn’t been really creative in how to get the lowest prices,” said Thomas McAuliffe, a policy analyst at the Missouri Foundation for Health.

Not helping matters was the fact that many people – at least initially – found Missouri’s application for the program confusing, McAuliffe said.

Another factor holding down enrollment is the requirement to first go without insurance for a half year, Tolbert said.

“There are probably a lot of people – at least some people – who have existing insurance, but it’s fairly limited, who would likely benefit by enrolling in the better coverage,” she said. But “they’re simply not going to be willing to go bare, as we say, for six months to access the better coverage.”

Still another factor is the tendency of some people to avoid purchasing insurance until they know it’s needed, said Larry Case, executive vice president of the Missouri Association of Insurance Agents. Even though vehicle liability insurance is required by state law, about 14 percent of Missouri drivers lack it, Case said. Some people purchase car insurance only because it’s necessary to license their vehicle, then quit making payments, he said.

Similarly, Case said, people have little incentive to purchase health insurance under the pre-existing condition plan until they know they are headed to the hospital or have a major medical expense upcoming.

McMurtrey said many people who enroll in the plan immediately use their health coverage, in some cases have major operations such as heart bypass surgeries or organ transplants within two or three weeks.

Although some health care analysts said Missouri’s program has not been sufficiently publicized, McMurtrey said she has traveled the state to discuss it at hospitals, nursing homes, community centers, schools and with any group that can spread the information among those with chronic health problems.

“Even though the 500 itself is not a high number, we are serving needy Missourians,” she said. “Quite honestly, across the country, none of the states have the enrollment we thought we would.”

Panel Pushes For Free Insurer Provided Contraceptives

From The New York Times:

Editorial Board–July 20, 2011

In an encouraging development for women’s health, an advisory panel of leading experts has recommended that all insurers be required to offer contraceptives as well as other preventive services free of charge under the new health care law. The Obama administration seems inclined to follow the advice, which is even better news.

The recommendation by the National Academy of Sciences’ Institute of Medicine was based on a review of medical data on women’s health services requested by Kathleen Sebelius, the secretary of health and human services. The administration will use the report to help it identify services for women that all new health plans should cover without deductibles or co-payments. In addition to contraceptives, the panel’s proposed list includes sterilization procedures, annual preventive-care visits, counseling for domestic violence and testing for H.I.V. Continue reading

Vermont Moves Forward In Establishing Single Payer System

From The New England Journal of Medicine:

Anya Rader Wallack, Ph.D. | July 20, 2011

Governor Peter Shumlin of Vermont recently signed into law ambitious health care reform legislation that puts Vermont on course to implement a single-payer health care system. The law creates a Health Benefit Exchange, consistent with the federal Affordable Care Act, and anticipates using it as the administrative structure for a publicly funded program of health insurance coverage for all Vermonters. The Shumlin administration believes that a single-payer system offers the greatest promise for reducing administrative waste and hassle in our health care system, guaranteeing coverage to everyone in the state, and relieving employers of the increasingly crushing burden of health insurance costs.

Vermont’s plan would include many features common to single-payer systems around the world: a global budget for health care expenditures, guaranteed coverage that is not linked to employment, and a single system of provider payments and administrative rules. The health care delivery system would remain privately owned, however, and the state could contract with a private insurer to perform some functions required of the single payer. It is not yet clear how far the state can go toward establishing a complete single-payer system. Our administration is exploring the potential relationship between the single payer and federal programs such as Medicare and TriCare (the military’s health plan) and determining how self-insured employer plans will fit into the Vermont system. Other elements yet to be worked out include the specific sources of public financing and detailed specifications for covered benefits. We intend to develop these facets of the plan during the next 2 years and will request federal permission to have the single payer fully operational by 2017. Continue reading

Inefficiencies Of “One Size Fits All” Health Care Reform

From Market Watch:


Press Release–July 21, 2011, 2:00 p.m. EDT

ORANGE, Calif., Jul 21, 2011 (BUSINESS WIRE) — A panel of industry experts has advised states on alternative strategies to comply with federal health reform focusing on each state’s “unique demographic, business and cultural characteristics.” The discussion was part of a podcast conducted by CHOICE Administrators Exchange Services; ACS, A Xerox Company; and Benefitfocus. The three companies are working together to deliver health insurance exchange solutions to states throughout the country. The podcast was an outgrowth of a white paper — “State-Based Health Reform: A 7-Step Strategy” — issued last month by CHOICE Administrators.

Panelists included Kevin Counihan, president of CHOICE Administrators Exchange Services and author of the white paper; Ron Goldstein, president and CEO of CHOICE Administrators, which manages the country’s longest-standing, state-approved exchange — CaliforniaChoice; Kevin Walsh, vice president of healthcare eligibility and exchange services at ACS, a Xerox Company; and John Emge, government programs manager at Benefitfocus, which helped launch the Maryland Virtual Compare Portal. Continue reading

An Uncertain Future For Medicare and Medicaid

From Politico:

The Obama administration could be faced with obligations to spend cash it  doesn’t have.

By J. LESTER FEDER| 7/21/11 10:47 PM EDT

A default scenario is so unthinkable that not too many people have thought about what happens to Medicare and Medicaid if a deal isn’t reached.

One longtime Washington health hand said he had not contemplated the overall picture of what happens after Aug. 2 without a deal because, “I think it’s unlikely, but it’s also kind of [too] horrible” to think about.

But people are getting nervous enough that it’s time to give the issue real thought, said Julius Hobson, former congressional affairs director for the American Medical Association.

“I think up until last week people were buying into that usual, conventional wisdom that they’d get that grand deal, and now they’re being disabused of that notion,” he said.

So what does happen? Does Medicare keep making payments? If Social Security checks continue to go out, will Medicare premiums be withheld? Will states get their Medicaid dollars? Continue reading

Free Health Care Blitz

From WLTX:

There’s a free health care blitz by SC Mission coming to Columbia in August. Lauren Talarico reports. Follow link for video.

State Health Exchanges Leaning Toward Insurers

From The Huffington Post:

Wendell Potter–7/14/11 12:29 PM ET

The insurance industry made it abundantly clear this week that it is in the driver’s seat–in both Washington and state capitals — of one of the most important vehicles created by Congress to reform the U.S. health care system.

The Affordable Care Act requires the states to create new marketplaces — “exchanges” — where individuals and small businesses can shop for health insurance. In the 15 months since the law took effect, insurers have lobbied the Obama administration relentlessly to give states the broadest possible latitude in setting up their exchanges. And those insurance companies have been equally relentless at the state level in making sure governors and legislators follow their orders in determining how the exchanges will be operated.

When Health and Human Services Secretary Kathleen Sebelius announced the proposed federal rules governing the exchanges on Monday, insurance executives must have been doing high fives all over the country.

Insurers had several main objectives. First, they did not want the feds to require states to negotiate with health plans on price and benefit design. And they did not want plans that failed to meet certain criteria to be excluded from the exchanges. Insurers did want the states to feel free to appoint people with ties to the industry to run the exchanges. Continue reading