Another Glitch May Impair Access Under New Health Insurance Law

Your benefits under health insurance reform can vary depending on where you live.

This clearly is representative of the failure to connect the dots before penning the law, and establishes the failure of the policy writers and planners engaged in this process.

Perhaps the taxpayers should be repaid for the extensive waste of money and resources in the fiasco that does little but line the pockets of Big Insurance.

Clearly this will raise costs and limit benefits.  It also suggests a bigger push toward privatization.

Some States Are Lacking in Health Law Authority

By ROBERT PEAR and KEVIN SACK, New York Times

WASHINGTON — Faced with the need to review insurance rates and enforce a panoply of new rights granted to consumers, states are scrambling to make sure they have the necessary legal authority to carry out the responsibilities being placed on them by President Obama’s health care law.
Insurance commissioners in about half the states say they do not have clear authority to enforce consumer protection standards that take effect next month.
Federal and state officials are searching for ways to plug the gap. Otherwise, they say, the ability of consumers to secure the benefits of the new law could vary widely, depending on where they live.
Meanwhile, state governments that have for years allowed insurers to set premiums virtually at will are gearing up to establish procedures to review rate increases.
Under the new federal standards, insurers generally must offer coverage to children under 19 and must allow adult children up to age 26 to stay on their parents’ policies. Insurers cannot charge co-payments for preventive services or impose a lifetime limit on benefits; must allow consumers to appeal a denial of benefits; and cannot rescind coverage, except in cases of fraud or intentional misrepresentation.
States have the primary role in enforcing many of the new standards. If a state fails to enforce a standard, the federal government will step in to do so — as it did in several states after passage of a health insurance law in 1996.
The federal government recently surveyed states to assess their enforcement capabilities, and the results suggest a patchwork of protections.
California, Florida, Hawaii, Michigan, Nebraska, Oklahoma, Virginia and Wyoming, among other states, said they did not have authority to enforce federal law.
Some state regulators said they would ask state legislators to expand their authority by putting the federal standards into state law next year. Others said they would rely on their powers of persuasion, the good will of insurers or general state laws that ban unfair or deceptive trade practices.
By contrast, Maryland passed a bill in April that explicitly authorizes its insurance commissioner to enforce consumer protections in the new federal law. Similar bills were signed in June by Gov. Bev Perdue of North Carolina and in July by Gov. John Lynch of New Hampshire.
Kathleen Sebelius, the secretary of health and human services, said she realized that “some states may lack the full authority they might need or desire to fully enforce” the new market rules.
The administration said its general approach was to have “states take a lead role in providing consumer protections, with federal enforcement only as a fallback measure.”
Sara Rosenbaum, a professor of health law and policy at George Washington University, said this was an awkward arrangement. “The new law creates detailed federal standards for insurance, but does not give consumers a right to sue if insurers don’t live up to their obligations,” Ms. Rosenbaum said.
Kim Holland, the Oklahoma insurance commissioner, said, “We will have to seek explicit authority from our State Legislature to make sure we can adequately enforce all the new provisions of federal law.”
Ken Ross, the Michigan insurance commissioner, said, “I fully expect insurers to comply,” even though his office “does not currently have clear authority to enforce the consumer protections enacted in federal law.”
Arizona said it was unlikely to pass legislation authorizing any state agency to enforce federal insurance standards, in view of its participation in a lawsuit challenging the federal law. Moreover, it said, Gov. Jan Brewer has “instituted an indefinite rule-making moratorium, so we have no plans to adopt rules related to enforcement” of the law.
Some states hope to secure compliance by using their power to review insurance policy forms and contracts.
In a recent bulletin, the Texas Insurance Department encouraged insurers to file amendments to standard policy forms that would bring them into compliance with federal law. John Greeley, a spokesman for the department, emphasized the word “encouraged.”
“We don’t have authority right now to require it,” Mr. Greeley said.
Florida said that if insurers did not voluntarily revise their contracts, the state “has no legal authority to force them to do so.”
The Nebraska Insurance Department said it did not have “specific authority to order compliance with federal law in the face of a refusal to comply.”
Wyoming said it did not have the authority, under its insurance code or its Unfair Trade Practices Act, to enforce federal law even if it received consumer complaints.
New Jersey, New York and Ohio said they believed they had the power to enforce federal standards.
Gov. David A. Paterson of New York said his state would require insurers to rewrite their contracts to include the new consumer protections. State officials have developed model language. In addition, Mr. Paterson said, the Legislature will consider amending state insurance laws so they “meet or exceed” federal requirements.
Within days, the Obama administration is expected to announce up to $51 million in grants to states to help them perform one of their new duties: reviewing “unreasonable increases in premiums.”
Thirteen states currently have no authority to review proposed health premium increases for most forms of coverage, according to the National Association of Insurance Commissioners. About a dozen have limited power to review increases after they take effect, while half the states require some form of state approval.
With insurers proposing heavy rate increases this year, possibly in anticipation of tougher regulation, several states have exerted their rate review authority with new vigor.
Sandy Praeger, the Kansas insurance commissioner and chairwoman of the health committee for the National Association of Insurance Commissioners, said states were eager to toughen their procedures to ward off federal interest in obtaining that authority. “The pressure is on us to prove that what we do is effective, and for states that don’t have the authority to get it done,” Ms. Praeger said. Many states will require legislation to change their rate review systems, she said.
States are also waiting for the federal Department of Health and Human Services to define unreasonable rate increases.
“That’s the big question,” Ms. Praeger said. “Unreasonable is a rather nebulous term.”

Paging Doctor Nurse

In the mid 1970s I held the position of critical care coordinator in a large urban hospital that also included a burn center.

At that time I had just completed advanced education at Columbia College of Physicians and Surgeons that put me in the role of being the only nurse diagnostician in the hospital and the only NP.

My friend and colleague who was the Emergency Care Coordinator had a joke she liked to pay when she needed my help in the ER. The page was "Doctor Nurse".

At that time the big push for NPs was to help with lack of doctors and time constraints facing them that was not as restrictive for nurses. We educated patients, worked independently, provided excellent care, and this was about 35 years ago.

As an old friend, now a psychiatrist at Harvard used to like to say (a la Baba Ram Dass), "Well, here we are."

CHICAGO – A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."
For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the care overhaul is putting more money into nurse-managed clinics.
Those newly insured patients will be looking for doctors and may find nurses instead.
The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.
Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.
"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."
On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.
Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.
The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning.
States regulate nurse practitioners and laws vary on what they are permitted to do:
• In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.
• In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.
• In Montana, nurse practitioners don't need a doctor involved with their practice in any way.
• Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.
• In some states, nurse practitioners with a doctorate in nursing practice can't use the title "Dr." Most states allow it.
The AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?
The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing.
Many with the title use it with pride.
"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.
What's the evidence on the quality of care given by nurse practitioners?
The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.
"The argument that patients' health is put in jeopardy by nurse practitioners? There's no evidence to support that," said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.
Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.
The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.
The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.
"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."
In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee.
One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn't prescribe a powerful enough medication and the doctor couldn't be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn't be reached in the middle of the night, nurses told The Associated Press.
Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.
That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said.
But it hasn't helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.
The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable.
"We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners," said Dr. Mario Motta, president of the state medical society.
The new U.S. health care law expands the role of nurses with:
• $50 million to nurse-managed health clinics that offer primary care to low-income patients.
• $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.
• 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.
• A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.
The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.
"We know we need to get to 100 percent for everybody. This is a crack in the door," said Michelle Artz of ANA. "We're hopeful this sets the tone."
In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners.
She believes patients get real advantages by letting her manage their care. Nurse practitioners' uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.
Joseline Nunez, 26, is a patient of Cockrell's and happy with her care.
"I feel that we get more time with the nurse practitioner," Nunez said. "The doctor always seems to be rushing off somewhere."
By CARLA K. JOHNSON, AP Medical Writer, April 13, 2010

___
On the Net:
American Nurses Association, http://www.nursingworld.org/
American Medical Association, http://www.ama-assn.org/

More Problems with Health Insurance Reform

Experience with Publicly Funded Private Health Insurance -

If you think this will just apply to those who speak English as a second language, don't overlook the great probability that Big Insurance will pull this trick on you, even if you are outside the legal immigrant groups.

To the Editor:

On October 31, 2009, Massachusetts involuntarily transferred about 30,000 legal immigrants (mostly “green card” holders) from Commonwealth Care, the state-subsidized insurance program, to a new private insurance plan. CeltiCare, a subsidiary of the out-of-state, for-profit insurer Centene, agreed to take over their care for only $1,300 per person, one third of the state's previous cost1 and well below the average cost of adequate care nationally.23 CeltiCare excluded several hospitals (and their affiliated community health centers) that have traditionally provided safety-net care for immigrants, including Boston Medical Center and Cambridge Health Alliance (CHA), where we work.

We used internal hospital data to determine the characteristics of patients who were transferred to CeltiCare and who had formerly received their primary care at CHA. A total of 1325 patients who had visited a primary care provider at CHA during the past year were moved to CeltiCare. Of these patients, 73% speak a primary language other than English, including Portuguese (24%), Spanish (20%), and Haitian Creole (9%); 19% have hypertension, and 10% have diabetes mellitus. A psychiatric disorder has been diagnosed in at least 9%.

We then evaluated the adequacy of the provider network for these patients. During the second and third months after the switch to CeltiCare, we searched CeltiCare's Web site4 for primary care providers within 5 miles of CHA's ZIP Code. The search returned 326 providers, of whom 217 were nonduplicate adult generalists. Of these providers, 25% could not be reached at the telephone number provided. Of those available by telephone, only 37% were actually accepting new CeltiCare patients, and the average wait for an appointment was 33 days. In all, only 60 providers were accepting new CeltiCare patients, and only 38 could provide service for even one of the three major linguistic minorities.

Given these findings, we believe that patients who were switched from Commonwealth Care to CeltiCare had inadequate access to primary care 3 months into this new program. We fear that such “rationing by inconvenience”5 shuts patients out of care to the detriment of their health but to the benefit of CeltiCare's bottom line. Policymakers, in Massachusetts and nationally, should reassess the role of profit-driven insurers in the provision of safety-net care.

Ruth Hertzman-Miller M.D., M.P.H.
Malgorzata Dawiskiba M.D.
Cassie Frank M.D.
Cambridge Health Alliance, Cambridge, MA
rhertzman-miller@challiance.org

http://www.nejm.org/doi/full/10.1056/NEJMc1005451

It must be a day for graphics at Natural Health News

"Neo" Health Care
By Rocky Vega, The Daily Reckoning

08/05/10 Alexandria, Virgina — This week, over 70 percent of Missourians voted for Prop C — to exempt the state from the federal insurance mandate — and, by extension, against President Obama’s health care plan. Three more states — Arizona, Florida, and Oklahoma — also have votes on deck with the hope of a possibly-binding opt out of the mandate.

From STLtoday’s coverage, via The Daily Bail’s post on the landslide vote:

“Missouri voters on Tuesday overwhelmingly rejected a federal mandate to purchase health insurance, rebuking President Barack Obama’s administration and giving Republicans their first political victory…

“‘The citizens of the Show-Me State don’t want Washington involved in their health care decisions,’ said Sen. Jane Cunningham, R-Chesterfield, one of the sponsors of the legislation [...] With most of the vote counted, Proposition C was winning by a ratio of nearly 3 to 1.”

Health Insurance Reform and how it works (sic), a flow chart from Congress

More on Health Insurance Reform

UPDATE: 3 August - Health Insurance Reform, how it plays out

Covering New Ground in Health System Shift

http://www.nytimes.com/2010/08/03/health/policy/03insurance.html

Medicare Reform Means Some Seniors Face Benefit Cuts

See full article from DailyFinance: http://www.dailyfinance.com/story/medicare-reform-means-some-seniors-face-benefit-cuts/19578216/?icid=main|main|dl1|link3|http%3A%2F%2Fwww.dailyfinance.com%2Fstory%2Fmedicare-reform-means-some-seniors-face-benefit-cuts%2F19578216%2F&icid=sphere_copyright

UPDATE: 2 August - Judge Gives Virginia OK to Press On With Health Care Lawsuit Against Feds

U.S. District Court Judge Henry Hudson is allowing a health care

suit filed by the state of Virginia against the U.S. government to proceed, saying no court has ever ruled on whether it's constitutional to require Americans to purchase a product.

The state of Virginia can continue its lawsuit to stop the nation's new health care law from taking effect, a federal judge ruled Monday. 

U.S. District Court Judge Henry Hudson said he is allowing the suit against the U.S. government to proceed, saying no court has ever ruled on whether it's constitutional to require Americans to purchase a product. 

"While this case raises a host of complex constitutional issues, all seem to distill to the single question of whether or not Congress has the power to regulate -- and tax -- a citizen's decision not to participate in interstate commerce," Hudson wrote in a 32-page decision. Complete article

HEALTHCARE:  Impact on Access to Care, Costs

Lobbyists gear up for November

Health-policy experts across the political spectrum are wary of Obamacare’s promises to increase access to health care and lower costs.

Use 'search' to locate more than 36 related Natural Health News posts on this topic

The libertarian Cato Institute’s Michael Tanner notes President Obama recently told MSNBC’s Chuck Todd that the law “not only makes sure everybody has access to coverage but is reducing costs.”  Tanner refutes those claims: 

• “The bill doesn’t come close to giving ‘everybody’ access to coverage. According to the Congressional Budget Office, 10 years from now there will still be at least 21 million uninsured Americans. That’s an improvement over today, but it’s a far cry from the universal coverage that Obama once promised. And nearly half of the newly covered aren’t getting access to true health insurance but are being added to the Medicaid program, with all of its attendant problems of access and quality.”
  
• “Even further from reality is the president’s continued insistence that the new law is ‘reducing costs.’ In fact, the administration’s own chief health-care actuary reports that the law will actually raise US health-care spending by $311 billion over 10 years. This failure to control costs means that the law will add significantly to the already crushing burden of government spending, taxes and debt.”
  
• “Anyone who thinks that their insurance premiums will be going down in the foreseeable future is going to be disappointed. The law does nothing to restrain the growth in insurance costs. In fact, the Congressional Budget Office says that premiums will double over the next six years, roughly the same rate of increase as would have occurred without health-care reform.”

Meanwhile, Dr. Steffie Woolhandler, a professor of medicine at Harvard Medical School and cofounder of Physicians for a National Health Program (PNHP), told the SocialistWorker.org that the health-reform bill was actually written by the insurance industry and doesn’t address underlying problems:

• “The big problem with the bill is that so much money and power is being handed to the private health insurance industry, which is the cause of the problem in the first place.… If you look at the [political] donations, plenty of insurance industry money did go to the Democrats. An insurance industry vice president, Elizabeth Fowler, actually came to work for Sen. Max Baucus, the head of the Senate Finance Committee, and was the author of the Baucus Framework for the legislation.”
  
• “Under the new ‘exchanges’ set up under the law for the uninsured to go to buy insurance, people will have to spend up to 9.5 percent of their income for policies that cover only 70 percent of health care costs. So you would still be in a situation of having insurance that was so skimpy that you would have difficulty getting care when you needed it. As you know, Massachusetts has the prototype of this reform. If you go on the Internet to look at our insurance exchange, it’s called the Massachusetts Connector. For someone in their mid-50s, the cheapest policy available that would meet the mandate for someone who is paying the full rate—which is anyone who makes more than $33,000 in income a year—costs more than $5,000 per year in premiums. Then, if you get sick, there’s a $2,000 deductible—so you have to take another $2,000 out of your pocket before the insurance kicks in. And then, for the next $15,000 in health spending, you’re responsible for 20 percent of everything—$3,000. So it’s extremely expensive if you get sick and have to use it once you buy it.”
  
• “That means that many people will still lack access to care—because they won’t be able to afford to use their insurance policy, even if they own it.”

 Sources:

• “Obamacare’s Broken Promises,” by Michael D. Tanner, Cato Institute, July 20, 2010:http://www.cato.org/pub_display.php?pub_id=11993
• “This Cure Leaves the Disease Untreated,” Interview with Dr. Steffie Woolhandler, SocialistWorker.org, March 29, 2010: http://socialistworker.org/2010/03/29/cure-doesnt-treat-the-disease

Another No Suprise News Piece: Doctors too lazy to properly diagnose

HealthierTalk is a website that publishes some of the articles I write that are not posted on Natural Health News.  This note is from their editor and it is certainly worth sharing with NHN readers.

To me, it is certainly no surprise because I hear this from so many people and see it with my clients. It is one of the key reasons when over a decade ago we created our sleuthing service.

Read related article

As we are moving into unchartered territory under health insurance reform, it is best to be well advised, and aware!

What would you say if I told you that your doctor was going to put you on heavy-duty anti-depressants...but not because you are depressed...simple because he was just too lazy to read? It sounds crazy right? Unfortunately--as a new study about to be published in the Journal of Clinical Psychiatry reveals--it's quite common.

Turns out that an astounding 75% of general practice docs...and an additional 25% of psychiatrists...are choosing to ignore their own guidelines when diagnosing major depressive disorder (MDD).

Those guidelines, set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), exist to give doctors the guidance they need and to protect us from being misdiagnosed and improperly treated. But, of course, they only can work if doctors follow them.

When a group of doctors were asked how often they are using the DSM-IV when diagnosing depression, the majority of them answered the multiple-choice question with "less than half of the time."

The author of the study, psychiatrist Dr. Mark Zimmerman, offered up the whiz-bang theory that doctors may not be using the DSM-IV criteria because it's very long and some may not be able to recall all of it.

Umm...excuse me?! He's got to be kidding. The results of the study would have been ridiculous enough on their own. But Dr. Zimmerman's observations send this one right past ridiculous straight to shocking.

Let's see if I can break this one down:

1. The criteria for diagnosing a person with a serious illness are just too long for doctors to recall.
2. And apparently it is too much trouble for them to actually pull them out and read through them when they can't remember them.
3. So, instead, my doctor embracing his laziness, chooses to throw caution to the wind, ignore the guidelines, and pronounces me "seriously depressed."
4. Out comes the prescription pad and, next thing I know, I am doped up on some serious medication(s) to treat my illness. Only problem is, I wasn't even depressed to begin with.

Zimmerman went on to helpfully suggest that perhaps we should shorten up the definition of MDD to assist the docs...who are blatantly ignoring the guidelines...to get their diagnoses right.

I suppose just expecting doctors to do their job would be too much to ask?

If you'd like to see what's in the DSM-IV you can take a look at it here. Better yet, you might want to be sure your doctor has the link.

Federal Panel Limits Preventive Care

How an Obscure Federal Panel Limits Preventive Care

This time is isn't Big Insurance limiting your access to health care, its Big GOV!

By requiring that insurers cover certain screening tests and other kinds of preventive services, the Affordable Care Act has thrust an obscure federal advisory panel into the spotlight. The U.S. Preventive Services Task Force(USPSTF), which has been around for a quarter of a century, grades preventive services by their clinical value, and the reform law requires that all services with a grade of “A” or “B” be covered. But what Congress didn’t reckon with in adopting this mandate is the conservatism of the USPSTF, which includes primary care doctors but not specialists.

Read Complete Story: 
http://industry.bnet.com/healthcare/10003056/healthcare-reform-how-an-obscure-federal-panel-limits-preventive-care/

Greed, Health Costs win over Better Care

Amidst the concern for profit ant about any cost, this fellow shows a degree of integrity missing from the daily scene for decades

A mathematical David stuns a healthcare Goliath

July 15, 2010| By Duke Helfand, Los Angeles Times

A respected actuary working from his rural Riverside County home — and for a time from a hospital bed — uncovers the errors that led Anthem Blue Cross to cancel rate increases of up to 39%.

Finally someone else has some good comments regarding the REAL issues in insurance reform - price-fixing for profit is a long standing tradition

Buried deep in the 2,000 pages of health reform legislation is yet another attempt to slam a cap on health insurance rates: States may, if they wish, bar insurance companies that raise premiums by an “unreasonable” amount from participating in the state insurance exchanges that will begin operating in 2014. Federal regulations have yet to be written, but I suspect that the end result will be a state-by-state rerun of the current drama that’s playing out in Massachusetts. And in the end, the effort to impose price controls by government fiat will fail miserably.

Read complete article - Greed from Insurers Won't Control Costs

Medicare Rationing begins in 2011

Several examples from NHN posts re: insurance "reform"

Natural Health News: Health Insurance Update on Current Issues

Jul 08, 2010

If you believe this is just a fluke with or without health insurance reform, be prepared for more. Blue Shield of California is accused of overcharging for safety-net insurance. A Los Angeles woman says in a lawsuit that the health plan ...

Update: Facts on the Health Insurance Reform Bill

Mar 26, 2010

About the health reform bill http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill/ http://static1.firedoglake.com/1/files/2010/03/mythfactshcr-2.pdf. This information is provided by Creating Health ...

Why Insurance Reform Doesn't Get You Better Health

Jan 04, 2010

Senator Lieberman who is holding positive movement on insurance reform in limbo may have reason to be concerned, especially where women's health is concerned. It seems as if the controversy over Hadassah Lieberman, the Senator's wife, ...

Married? Pay More Under Health Insurance Reform

Jan 11, 2010

The disparity comes about in part because subsidies for purchasing health insurance under the plan from congressional Democrats are pegged to federal poverty guidelines. That has the effect of limiting subsidies for married couples with ...

Does this really close the doughnut hole?

AARP was really pulling for this crazy health insurance bill to pass because they have a vested interest in United Health Care's Medicare supplement insurance.  And in case you were not aware, United is in part owned by one of the Big PhRMA firm poised to make big bucks on the recently passed bill,

What the real facts are that the doughnut hole is not closed, it is only reduced in diameter.

Prescription Drugs:

Proponents of the health care bill have been touting how it aims to close the "doughnut hole" in prescription drug coverage. What that means is that older Americans who hit the cap on their Medicare prescription drug benefits will be given a rebate, starting this year. Once they spend $2,830, older Americans will receive a $250 rebate. Starting in 2011, older Americans who go past the allotted amount will be given a 50 percent discount on prescription drugs. The bill aims to close the "doughnut hole" completely by 2020, but older Americans will still have to pay for 25 percent of their drugs.

SOURCE

More from Kiplinger -

Health Care Reform: What It Means for Retirees

Changes to Medicare and to the individual insurance market will affect retirees. Here are key details that you need to know.
By Susan B. Garland, March 24, 2010

President Obama has signed the landmark health-care overhaul legislation into law, and the Senate is taking up a bill with proposed changes. Here are key provisions that could affect you.
Medicare. The Part D prescription-drug doughnut hole will be gradually reduced by 2020. Seniors who reach the doughnut hole in 2010 will receive a $250 rebate. Starting in 2011, drug companies will be required to provide a 50% discount on brand-name drugs bought in the coverage gap. The federal subsidy for Part D premiums will be reduced for higher-income beneficiaries. Cost sharing for preventive-care services is eliminated.
A new advisory board would submit recommendations to Congress to reduce the rate of growth in Medicare spending. The board is not allowed to submit proposals that would ration care or change benefits.
More Medicare beneficiaries could be snared by the Part B premium surcharge for high-income seniors. The law freezes the income thresholds for income-related Part B premiums from 2011 to 2019.
Medicare Advantage plans. Studies have found that Advantage plans cost the government 14% more on average than traditional Medicare. To get costs more in line with traditional Medicare, the new law freezes federal payments to private Medicare Advantage plans at 2010 levels. These plans will be required to spend at least 85% of their revenues on patient care. Plans that prove they provide high-quality efficient care will get rebates from the government.
New taxes. The law would raise the Medicare payroll tax by an additional 0.9% (to 2.35%, from the current 1.45%) on earned income above $200,000 for individuals and $250,000 for joint filers. It would also impose a Medicare tax of 3.8% on investment income, such as dividends and interest, for individuals with adjusted gross income above $200,000 and joint filers with AGI above $250,000. These taxes will go into effect in 2013. Distributions from pensions, IRAs, 401(k)s and other qualified retirement plans will be exempt. Self-employed people will have to pay the additional tax.
Medical tax deductions. Beginning in the 2013 tax year, the threshold for the itemized medical deduction rises to 10% of AGI, from the current 7.5%. Individuals age 65 and older, and their spouses, would be exempt for the tax years 2013 through 2016.
Early retirees and self-employed. For most workers who receive employer-sponsored coverage, the new law is not likely to have much impact. But the law provides a number of protections for those who need to buy insurance in the individual market. Six months after enactment, health insurers cannot place lifetime limits on the value of coverage or revoke existing coverage. Starting in 2014, insurers must accept all applicants, including anyone with preexisting medical conditions.
Until then, individuals with preexisting conditions who have been uninsured for more than six months will be eligible to enroll in a national high-risk pool and receive subsidized premiums. Cost sharing will be capped at $5,950 for individuals and $11,900 for families. This could be especially helpful to early retirees in Arizona and Nevada, which do not have state high-risk pools. It could also help Floridians, because Florida's is not open to new enrollees.
Exchanges and coverage subsidies. Nearly everyone would be required to buy coverage, or pay a penalty. Early retirees, the self-employed and others without insurance would be able to purchase coverage through state-based exchanges. Tax credits would be available to individuals and families with income between 133% and 400% of the poverty level (that's $19,378 to $58,280 for a couple).
Private insurance companies could sell policies through the exchanges. Buyers would choose among four benefit categories.
Retiree health plans. If you are 55 or older and receive retiree health benefits from your employer, you could benefit from a government reinsurance program. The program will reimburse employers or insurers for 80% of retiree claims between $15,000 and $90,000. Payments from the reinsurance program will be used to lower the costs for enrollees in the employer plan. The program will end on January 1, 2014. It will not reimburse costs for retirees who are eligible for Medicare.
Long-term care. In 2011, workers can enroll in a national insurance program to cover non-medical services in case of disability. After a five-year vesting period, the Community Living Assistance Services and Supports program will provide individuals who become disabled with a benefit of about $50 a day. The program will be financed with voluntary payroll deductions.
For more authoritative guidance on retirement investing, slashing taxes and getting the best health care, click here for a FREE sample issue of Kiplinger’s Retirement Report.

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http://www.kiplinger.com/features/archives/krr-health-care-reform-what-it-means-for-retirees.html

The Medicare donut hole: Now you're covered, now you're not

ScienceDaily (2010-03-25) -- If you're older, a woman, and suffering from either dementia or diabetes, you are the most likely to be exposed to unsubsidized medication costs in the US. This is known as the coverage gap for enrollees of Medicare Part D. According to a new study, these clinically vulnerable groups should be counseled on how to best manage costs through either drug substitution or discontinuation of specific, non-essential medications. ... > read full article

Health Bill Still Too Cozy with Big PhRMA

Obama has already given away a big pHat prize to PhRMA on the very disguised and very limited cut in the "doughnut hole" of the Medicare D plan. I'd like to know just when all these crooks in DC are going to do something for the people.

I also think it is rather strange that representatives are 'elected' yet are treated as employees rather than as independent contractors. This about this one because as elected independent contractors there are NO benefits.

Dems tap drug maker millions for PhRMA-friendly bill
Read complete article

Health-Insurance Caps to Fail

Once again collusion in Big Insurance raises an ugly head -

Trying to rein in health spending by limiting on insurance rates is like trying to hold down the lid on a pot of boiling water. Aside from the fact that insurance costs partly reflect ever-increasing medical costs over which insurers have little control, the legal justification for saying “no more” has never been clear. This has become apparent in Massachusetts, where an administrative court has ruled against a state-imposed insurance cap, and in California, where insurers have retreated temporarily from big rate hikes but are expected to return with new demands. Complete story

While cost control is often helpful, restraining trade and reducing income for health professionals is against sound economics.

Health Insurance Rewards More for Procedures Than Real Care

Are you wondering why Congress blocked Medicare reimbursements?

I thought this was quite a good report on the current state of health care.  The problem as I see it is that this mentality has been the mainstay of Medicare and Big Insurance since the "managed care" movement moved in with gusto in the 80s.

I just hop my readers will take heed and realize this is what you are up against in regard to REAL health care reform.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

Complete article:
http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html

Health Lobby Fights Against Progress with $$$

If you aren't aware that the health insurance reform bills aren't being bought, here's an update on how the battle is moving from Congress payoffs to the state level -

" Insurance companies, hospitals and other health care interests have been positioning themselves in statehouses around the country to influence the outcome of the proposed health care overhaul. Around the 2008 election, the groups that provide health care contributed about $102 million to state political campaigns across the country, surpassing the $89 million the same donors spent at the federal level, according to the institute. " Health Lobby Takes Fight to the States