AI
Wednesday, May 16, 2012 7:11:01 AM
Global push to guarantee health coverage leaves U.S. behind
China, Mexico and other countries far less affluent are working to provide medical insurance for all citizens. It's viewed as an economic investment.
By Noam N. Levey, Washington Bureau
May 12, 2012, 5:00 a.m.
WASHINGTON — Even as Americans debate whether to scrap President Obama's healthcare law and its promise of guaranteed health coverage, many far less affluent nations are moving in the opposite direction — to provide medical insurance to all citizens.
China, after years of underfunding healthcare, is on track to complete a three-year, $124-billion initiative projected to cover more than 90% of the nation's residents.
Mexico, which a decade ago covered less than half its population, just completed an eight-year drive for universal coverage that has dramatically expanded Mexicans' access to life-saving treatments for diseases such as leukemia and breast cancer.
In Thailand, where the gross domestic product per person is a fifth of America's, just 1% of the population lacks health insurance. And in sub-Saharan Africa, Rwanda and Ghana — two of the world's poorest nations — are working to create networks of insurance plans to cover their citizens.
"This is truly a global movement," said Dr. Julio Frenk, a former health minister in Mexico and dean of the Harvard School of Public Health. "As countries advance, they are realizing that creating universal healthcare systems is a necessity for long-term economic development."
Many countries are still struggling to improve the quality of their medical care. And making healthcare affordable remains a challenge for most countries, as it does for the U.S., where about 15% of the population lacks coverage.
But the international drive to provide healthcare for everyone is increasingly leaving America behind.
"We are really an outlier," said David De Ferranti, a former World Bank vice president who heads the Results for Development Institute, an international nonprofit based in Washington.
That stands in stark contrast to America's historic leadership in education, he said. Long before most European countries, the United States ensured access to public schooling. Today, the U.S. is alone among the world's richest nations in not providing healthcare coverage to all citizens.
Although the new U.S. health law is scheduled to do that in 2014, former Massachusetts Gov. Mitt Romney, the presumptive Republican presidential nominee, has promised to repeal it. Romney's alternative does not include any provision to guarantee coverage.
Two decades ago, many former communist countries in Eastern Europe and elsewhere dismantled their universal healthcare systems amid a drive to set up free-market economies.
But popular demand for insurance protection has fueled an effort in nearly all of these countries to rebuild their systems. Similar pressure is coming from the citizens of fast-growing nations in Asia and Latin America, where rising living standards have raised expectations for better services.
Some countries have set up public systems like those in Great Britain or Canada. But many others are relying on a mix of government and commercial insurance, as in the U.S.
"People are demanding responses from their governments," said Cristian Baeza, health director of the World Bank. Indeed, in countries such as India, politicians have learned that one of the surest ways to secure votes is to promise better access to healthcare.
In Chile, where free-market reforms eroded the country's universal health system in the 1980s, a socialist candidate won the presidency in 2000 for the first time in nearly 30 years on a promise to renew guaranteed healthcare.
The Thai system, set up a decade ago, has survived years of political upheaval and a military coup. "No party dares touch it," said Dr. Suwit Wibulpolprasert, a senior advisor to the Ministry of Public Health.
Many political leaders around the world also have concluded that creating a system of universal healthcare is crucial to remaining competitive globally and sustaining economic growth.
Chinese leaders were concerned their citizens were saving excessively because there was no system to protect them if they got seriously ill, said Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University. The high savings rate was restraining domestic demand for consumer items, making the economy overly dependent on selling goods abroad.
In Mexico, political leaders were alarmed to see that poor families were often forced to pull a child out of school or to give up productive assets such as livestock or equipment to pay medical bills, said Frenk, the former health minister.
Before embarking on its healthcare push, the Mexican government found that 4 million people every year were being driven into bankruptcy by illness. "That was a huge drag on the economy," Frenk said.
Today, Mexico's new government insurance plan — known as Seguro Popular — covers more than 50 million people, filling the gap left by the traditional health insurance system funded by payroll taxes.
Such steps don't eliminate all financial strain on households. Indeed, in many poor nations that are expanding healthcare coverage, such as Vietnam and the Philippines, people still must pay most of their own medical bills, a sign of skimpy coverage.
Governments, too, feel the strain.Colombia'suniversal healthcare system, set up in 1993, has cost more than twice what was expected, said Ramiro Guerrero, a former vice minister of health.
Even so, there is growing evidence that universal coverage is protecting millions worldwide from financial ruin.
In Rwanda, researchers found that citizens who had joined one of the nation's health plans were nearly 75% less likely to be hit with a catastrophic healthcare bill that threatened to bankrupt them.
And while the impact of broader coverage on overall health is still unclear, there are some signs that citizens of countries that are committed to guaranteeing health coverage are getting more treatment for serious illnesses.
In Mexico, the 30-month survival rate for children with cancer has more than doubled since the creation of the Seguro Popular program in 2003. In Ghana, visits to clinics and hospitals have doubled since the West African country passed a universal health law in 2003, said Nathaniel Otoo, general counsel for the National Health Insurance Authority of Ghana.
The universal system has also become a foundation for improving the quality of medical care in many countries such as China, where the government is now pushing a major overhaul in the way physicians are trained.
"That is the next challenge," said Dr. Jeanette Vega, a former vice minister of health in Chile who is now managing director of the New York-based Rockefeller Foundation.
noam.levey@latimes.com
Copyright © 2012, Los Angeles Times
http://www.latimes.com/news/nationworld/nation/la-na-global-health-reform-20120512,0,4695600.story [ http://www.latimes.com/news/nationworld/nation/la-na-global-health-reform-20120512,0,4197779,full.story ] [with comments]
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Affordable Care Act working even before it fully kicks in
By Susan Lynch | Guest columnist
May 10, 2012
I am a nurse practitioner. One of my roles is to provide free primary care at the Good Samaritan free clinic in DeLand. My work at the clinic has brought me face to face with the reality of people who cannot obtain health insurance because of costs or pre-existing conditions.
Many primary-care providers will not take patients who do not have insurance because of liability issues. Over the past few years, I have witnessed the team at Good Samaritan take on the hardest cases, save many lives and comfort those who have only a short time left to live. Through all the ups and downs, one consistent thing I have noted is that the Affordable Care Act, even in its first two years, is working for many patients and millions of Floridians.
Despite the valiant and well-meaning role of our best practitioners, our country's medical system has undoubtedly been in sore need of major overhaul and reform. Health care was simply becoming too expensive and fragmented. Before the Affordable Care Act, one of the toughest challenges I had to deal with was watching my patients struggle with medical bills and worrying about their coverage.
The health-care law will help reduce Florida's growing uninsured population and address the challenges that families across the state face in finding affordable health insurance and maintaining the coverage they do have. It also offers more affordable options for small businesses to purchase health insurance for their employees.
Since the Affordable Care Act became law on March 23, 2010, Florida's seniors, women, youth and those with pre-existing conditions are getting better health care and saving money on their health-care costs. And when the law is fully implemented in 2014, all Floridians will benefit.
Consider these numbers as further evidence of how the new law is helping. During the past two years, the U.S. Department of Health and Human Services has monitored and tracked the health-care law's benefits for Americans and Floridians. According to HHS data:
More than 238,000 of Florida's seniors have saved nearly $140 million in brand-name prescription-drug costs — an average savings of more than $500 per senior.
An estimated 2.5 million Floridians have received at least one new necessary preventive health-care service with no co-pay because, under the law, more private health-insurance providers are required to cover preventive services without a cost-sharing requirement. These important services include immunizations, cholesterol and blood pressure screenings, PSA tests and mammograms.
Two and a half million adults under age 26, including more than 150,000 in Florida, have health coverage because the health-care law allows young adults to stay on their parents' health insurance plan until age 26. In this group are my own two children who, after graduating from college in this terrible economy, experienced a long period of unemployment. Thankfully, my husband's insurance covered them.
Starting in 2014, more elements of the law will kick in. Insurance companies will have more accountability. Private insurers will focus on wellness instead of transactions, and will be accountable to keeping their members healthy. Insurance companies will no longer be allowed to impose annual dollar limits on most benefits, can't deny coverage to adults with pre-existing conditions, and will have to include benefits for pregnancy and newborn care with new policies.
The new exchange marketplace will begin operations, allowing individuals and families to purchase affordable policies, and very low income people will qualify for Medicaid.
Beyond these substantial direct benefits of the health-care law, we all have also benefited indirectly from the new law. For example, funding through the health-care law has helped law enforcement to crack down on waste, fraud and abuse in the Medicare system and recover billions of tax dollars.
Copyright © 2012, Orlando Sentinel
http://articles.orlandosentinel.com/2012-05-10/opinion/os-ed-affordable-care-act-051012-20120509_1_health-insurance-health-care-law-affordable-care-act [with comments]
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Obama administration cracking down on health care fraud
By Kathleen Sebelius and Eric Holder
Updated 08:31 p.m., Friday, May 11, 2012
We are proud to say that last week Houston was part of the largest-ever coordinated law enforcement takedown of defendants charged with committing fraud against Medicare and Medicaid. Medicare Fraud Strike Force teams in Houston and six other cities, operated in partnership by the Department of Health and Human Services and the Department of Justice, charged 107 people for allegedly submitting fraudulent claims to Medicare worth about $450 million.
Here in Houston, nine individuals were charged with fraud schemes involving a total of $16.4 million in false billings for home health care and ambulance services. According to court documents, the owners and operators of four different ambulance companies allegedly billed Medicare for ambulance rides that were medically unnecessary.
Since 2009, the Obama administration has more than quadrupled the number of Medicare Strike Force teams operating in fraud hot spots around the country. And the president's 2010 health care law, the Affordable Care Act, has put more boots on the ground and established tougher sentences for those who commit fraud. More than 500 law enforcement agents participated in the May 2 operation.
The health care law and other recent legislation have also enhanced our ability to put in place cutting-edge technology that makes it possible to identify and respond to fraud faster. In the past, government was often two or three steps behind the perpetrators, too often showing up after the criminals had already skipped town.
The Affordable Care Act and other recent legislation give us new data-analysis tools to look at trends across claims data, instead of monitoring each claim individually.
Using a technology similar to what credit card companies use to identify and stop suspicious payments before they go out, we are using new authorities under the health care law to suspend payments when there are credible allegations of fraud, until an investigation is complete. The Centers for Medicare and Medicaid Services has stopped payment or taken other administrative actions on 52 provider organizations connected to the May 2 arrests until we have investigated them fully. Now those looking to rip off Medicare aren't getting a head start.
The health care law also gives us the authority to put in place new safeguards to keep bad actors out of Medicare and Medicaid in the first place. For example, we've established a tougher screening process for the enrollment of providers in the areas where fraud is most likely to occur, such as for home-health visits or durable medical equipment, like wheelchairs.
In short, we have made it harder to submit a fraudulent Medicare claim. And criminals who do are more likely to get caught: The number of defendants in all criminal health care fraud cases increased by more than 75 percent during the Obama administration, from 797 in 2008 to 1,430 last year - and if convicted, criminals face longer jail sentences due to new sentencing guidelines.
This fight against fraud is a key part of this administration's historic effort to strengthen Medicare for the future. According to the Medicare actuaries, the Affordable Care Act - including some of its key anti-fraud provisions - has extended the life of the Medicare Trust Fund by eight years, to 2024.
We are committed to continuing to strengthen Medicare and Medicaid and getting the criminals out of our health care system so that we can ensure that our seniors and other vulnerable citizens in Houston and across the nation will have access to the high-quality, affordable health care that they need and deserve.
Sebelius is secretary of the U.S. Department of Health and Human Services and Holder is the U.S. attorney general.
http://www.chron.com/opinion/outlook/article/Obama-administration-cracking-down-on-health-care-3552754.php [with comments]
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Insurers Face $1 Trillion Revenue at Stake in Health Law
Health-care law supporters and opponents gather outside the Supreme Court during the first week of arguments.
Photographer: Rich Clement/Bloomberg
By Alex Wayne - May 14, 2012 1:00 PM CT
Health insurers will gain $1 trillion in new revenue over the next eight years under the 2010 health- care law, assuming it’s upheld by the Supreme Court, according to a Bloomberg Government study.
The amount is equal to about one-half percent of the nation’s estimated gross domestic product from 2013 to 2020, and insurers led by UnitedHealth Group Inc. (UNH) would keep about $174 billion -- $22 billion a year -- for profit and administrative costs. The money comes from U.S. subsidies to people purchasing insurance beginning in 2014 and an expansion of Medicaid, the government’s health program for the poor.
The Supreme Court is weighing whether the law’s requirement that most Americans carry health insurance is constitutional. If it isn’t, the court will decide how much of the law to strike down. Should the law survive the court’s review and Republican efforts at repeal, it is projected to expand insurance to 32 million Americans who lack it by 2016.
“It’s a confirmation of, one, how much money we’re spending as a nation on health care; and two, how much is riding on this court case and the Supreme Court’s decision,” Matt Barry, a Bloomberg Government health analyst and the study’s author, said in a phone interview. “You’re talking an amount of money here that can affect the economy, not just an industry.”
About 9 percent of the insurance industry’s total revenue from 2013 to 2020 hinges on whether the health law stands, according to the study.
State Exchanges
Starting in 2014, states are required to open new insurance marketplaces called “exchanges” that will sell subsidized policies to people who don’t get coverage through their jobs. People who earn wages close to the poverty level, about $23,000 for a family of four in 2012, will be made eligible for Medicaid.
Barry’s study calculates that subsidizing private insurance premiums will cost taxpayers $557 billion through 2020, while the Medicaid expansion will cost the federal government $669 billion. The two provisions account for 98 percent of new spending in the law, the report said.
About 58 percent of that spending would pass through insurers. They would get another $322 million from consumers’ share of premiums.
Under the health law, insurers must spend at least 80 percent of their premium revenue on medical care, so most of the $1 trillion will flow to hospitals, doctors and other health providers.
‘Good for Consumers’
“This is a law that’s good for consumers and good for business, and there are a trillion reasons why it’s good for the insurance industry,” said Ethan Rome, executive director of Health Care for America Now!, an advocacy group that supports the health law and is critical of insurers.
The insurance industry, through its Washington trade group, America’s Health Insurance Plans, provided about $86 million to the U.S. Chamber of Commerce in 2009 to help fund a lobby and advertising campaign against the law. A spokesman for AHIP, Robert Zirkelbach, declined to comment on the Bloomberg Government study.
Mitt Romney, the presumptive Republican nominee for president, has said he will seek to repeal the health law if he’s elected in November.
To contact the reporter on this story: Alex Wayne in Washington at awayne3@bloomberg.net
To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net
©2012 BLOOMBERG L.P.
http://www.bloomberg.com/news/2012-05-14/insurers-face-1-trillion-revenue-at-stake-in-health-law.html [with comments]
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Congress may get tough medicine from health bill
By Chris Mondics
INQUIRER STAFF WRITER
May 14, 2012
No matter how the case turns out, one group of Americans is assured of getting quality health insurance when the Supreme Court rules on President Obama’s Affordable Care Act in June: members of the court itself.
The Supreme Court, which is expected to issue its decision in June, gets its health insurance through the same plan available to members of Congress and other federal employees — and though benefits have been trimmed in recent years, it remains among the best.
In one little-known feature of the law, however, members of Congress would have to leave the generous federal plan and obtain their coverage through online insurance exchanges, or markets, if the law is upheld. The law mandates the establishment of exchanges in each of the states as a means for consumers to shop for health coverage, comparing costs and features of competing plans.
“It is more of a gesture to show that members of Congress are willing to experience what ordinary Americans are willing to accept,” said Mark Pauly, professor of health care management at Wharton, referring to the requirement that Congress exit the federal employee health plan.
The federal government spends some $50 billion a year to provide health care coverage to eight million federal workers, retirees and their independents under the Federal Employee Health Benefits Plan. Expanding it to include nonfederal workers has been touted as a way to fix the nation’s twin health care ills of spiraling costs and growing numbers of uninsured. A total of 225 health insurers and health maintenance organizations participate.
“The actuarial value of these plans is very good,” said Walt Francis, an economist and program analyst who writes the Consumers’ Checkbook guide to federal health care coverage, a website that compares costs for federal employees in every region of the country. “In years past, it [the federal health care plan] was arguably inferior on average to large employer plans. But those have been cutting back and now the two are very comparable on average.”
The fact that members of the Supreme Court have health insurance should come as no surprise, nor does it have any legal bearing on the complex issues before the court. The case, brought by 26 Republican attorneys general and the National Federation of Independent Business against the Obama administration, hinges on whether the federal government has the power to require individual citizens to obtain health insurance or pay a penalty to the IRS, as part of a larger plan to extend coverage to millions of uninsured Americans.
But the controversial law illustrates the political and policy complexities that face lawmakers and executive branch officials trying to extend coverage to the uninsured. Jurists also face difficult choices sorting through the competing arguments.
“They are pretty decent plans,” said Pauly, of the federal health insurance plan. Pauly asserts one reason federal health plans offer relatively generous benefits, and stack up well against those in the private sector is that federal workers on average are paid less than private sector employees; the difference is made up in benefits.
Depending on the type of plan, out-of-pocket costs for federal employees in the Washington area, which would include members of the Supreme Court, range from $2,410 to as much as $7,930 for a family of four, including deductibles and co-payments. The Checkbook website estimates that a basic Blue Cross plan would cost the typical family of federal workers about $4,300 a year, including deductibles of $25 for visits to the doctor and hospitalizations with $150 a day deductibles.
The coverage typically resembles plans provided to private sector workers, and with good reason. Participants in the federal plan include some of the nation’s largest private insurers, Aetna, Blue Cross and Kaiser Permanente, among others, who also contract with large private employers.
Under the basic Blue Cross option, there is no overall deductible. But, the plan imposes penalties on patients who fail to abide by its cost-cutting strategies such as obtaining advance approval for a hospital admission. Failure to get such an approval, for example, could result in a $500 charge. And if a patient chooses a hospital outside of the insurer’s network, the patient risks paying the entire cost of the hospitalization out of pocket.
Because the federal health insurance plan has been successful in holding down costs, it also has been touted by liberals and conservatives as a potential vehicle for providing coverage to the nation’s uninsured, now totaling around 50 million. When he ran for president in 2004, Sen. John Kerry (D., Mass.) proposed opening the program to uninsured Americans who could not afford to purchase coverage on their own but earned too much to qualify for Medicaid, the government-financed health care program for the poor.
The federal employees health insurance plan, which served as a model for the exchanges, would not be impacted if the Affordable Care Act is upheld. The only change would be the requirement that members of Congress exit the plan and obtain coverage from the exchanges. The exact details of how members will purchase insurance, and from which exchanges, have yet to be worked out.
But Joseph Antos, a health care policy analyst at the American Enterprise Institute, a conservative think tank based in Washington, said that language was inserted by Republicans to make a point.
“The reason that provision was adopted was purely political,” Antos said. “It was purely for Republicans to say to Democrats that if you like this so much, you should live with it too.”
Contact Chris Mondics at 215 854 5957 or cmondics@phillynews.com
© Copyright 2012 Philadelphia Media Network Inc.
http://articles.philly.com/2012-05-14/business/31690169_1_federal-health-health-insurance-mark-pauly
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China, Mexico and other countries far less affluent are working to provide medical insurance for all citizens. It's viewed as an economic investment.
By Noam N. Levey, Washington Bureau
May 12, 2012, 5:00 a.m.
WASHINGTON — Even as Americans debate whether to scrap President Obama's healthcare law and its promise of guaranteed health coverage, many far less affluent nations are moving in the opposite direction — to provide medical insurance to all citizens.
China, after years of underfunding healthcare, is on track to complete a three-year, $124-billion initiative projected to cover more than 90% of the nation's residents.
Mexico, which a decade ago covered less than half its population, just completed an eight-year drive for universal coverage that has dramatically expanded Mexicans' access to life-saving treatments for diseases such as leukemia and breast cancer.
In Thailand, where the gross domestic product per person is a fifth of America's, just 1% of the population lacks health insurance. And in sub-Saharan Africa, Rwanda and Ghana — two of the world's poorest nations — are working to create networks of insurance plans to cover their citizens.
"This is truly a global movement," said Dr. Julio Frenk, a former health minister in Mexico and dean of the Harvard School of Public Health. "As countries advance, they are realizing that creating universal healthcare systems is a necessity for long-term economic development."
Many countries are still struggling to improve the quality of their medical care. And making healthcare affordable remains a challenge for most countries, as it does for the U.S., where about 15% of the population lacks coverage.
But the international drive to provide healthcare for everyone is increasingly leaving America behind.
"We are really an outlier," said David De Ferranti, a former World Bank vice president who heads the Results for Development Institute, an international nonprofit based in Washington.
That stands in stark contrast to America's historic leadership in education, he said. Long before most European countries, the United States ensured access to public schooling. Today, the U.S. is alone among the world's richest nations in not providing healthcare coverage to all citizens.
Although the new U.S. health law is scheduled to do that in 2014, former Massachusetts Gov. Mitt Romney, the presumptive Republican presidential nominee, has promised to repeal it. Romney's alternative does not include any provision to guarantee coverage.
Two decades ago, many former communist countries in Eastern Europe and elsewhere dismantled their universal healthcare systems amid a drive to set up free-market economies.
But popular demand for insurance protection has fueled an effort in nearly all of these countries to rebuild their systems. Similar pressure is coming from the citizens of fast-growing nations in Asia and Latin America, where rising living standards have raised expectations for better services.
Some countries have set up public systems like those in Great Britain or Canada. But many others are relying on a mix of government and commercial insurance, as in the U.S.
"People are demanding responses from their governments," said Cristian Baeza, health director of the World Bank. Indeed, in countries such as India, politicians have learned that one of the surest ways to secure votes is to promise better access to healthcare.
In Chile, where free-market reforms eroded the country's universal health system in the 1980s, a socialist candidate won the presidency in 2000 for the first time in nearly 30 years on a promise to renew guaranteed healthcare.
The Thai system, set up a decade ago, has survived years of political upheaval and a military coup. "No party dares touch it," said Dr. Suwit Wibulpolprasert, a senior advisor to the Ministry of Public Health.
Many political leaders around the world also have concluded that creating a system of universal healthcare is crucial to remaining competitive globally and sustaining economic growth.
Chinese leaders were concerned their citizens were saving excessively because there was no system to protect them if they got seriously ill, said Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University. The high savings rate was restraining domestic demand for consumer items, making the economy overly dependent on selling goods abroad.
In Mexico, political leaders were alarmed to see that poor families were often forced to pull a child out of school or to give up productive assets such as livestock or equipment to pay medical bills, said Frenk, the former health minister.
Before embarking on its healthcare push, the Mexican government found that 4 million people every year were being driven into bankruptcy by illness. "That was a huge drag on the economy," Frenk said.
Today, Mexico's new government insurance plan — known as Seguro Popular — covers more than 50 million people, filling the gap left by the traditional health insurance system funded by payroll taxes.
Such steps don't eliminate all financial strain on households. Indeed, in many poor nations that are expanding healthcare coverage, such as Vietnam and the Philippines, people still must pay most of their own medical bills, a sign of skimpy coverage.
Governments, too, feel the strain.Colombia'suniversal healthcare system, set up in 1993, has cost more than twice what was expected, said Ramiro Guerrero, a former vice minister of health.
Even so, there is growing evidence that universal coverage is protecting millions worldwide from financial ruin.
In Rwanda, researchers found that citizens who had joined one of the nation's health plans were nearly 75% less likely to be hit with a catastrophic healthcare bill that threatened to bankrupt them.
And while the impact of broader coverage on overall health is still unclear, there are some signs that citizens of countries that are committed to guaranteeing health coverage are getting more treatment for serious illnesses.
In Mexico, the 30-month survival rate for children with cancer has more than doubled since the creation of the Seguro Popular program in 2003. In Ghana, visits to clinics and hospitals have doubled since the West African country passed a universal health law in 2003, said Nathaniel Otoo, general counsel for the National Health Insurance Authority of Ghana.
The universal system has also become a foundation for improving the quality of medical care in many countries such as China, where the government is now pushing a major overhaul in the way physicians are trained.
"That is the next challenge," said Dr. Jeanette Vega, a former vice minister of health in Chile who is now managing director of the New York-based Rockefeller Foundation.
noam.levey@latimes.com
Copyright © 2012, Los Angeles Times
http://www.latimes.com/news/nationworld/nation/la-na-global-health-reform-20120512,0,4695600.story [ http://www.latimes.com/news/nationworld/nation/la-na-global-health-reform-20120512,0,4197779,full.story ] [with comments]
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Affordable Care Act working even before it fully kicks in
By Susan Lynch | Guest columnist
May 10, 2012
I am a nurse practitioner. One of my roles is to provide free primary care at the Good Samaritan free clinic in DeLand. My work at the clinic has brought me face to face with the reality of people who cannot obtain health insurance because of costs or pre-existing conditions.
Many primary-care providers will not take patients who do not have insurance because of liability issues. Over the past few years, I have witnessed the team at Good Samaritan take on the hardest cases, save many lives and comfort those who have only a short time left to live. Through all the ups and downs, one consistent thing I have noted is that the Affordable Care Act, even in its first two years, is working for many patients and millions of Floridians.
Despite the valiant and well-meaning role of our best practitioners, our country's medical system has undoubtedly been in sore need of major overhaul and reform. Health care was simply becoming too expensive and fragmented. Before the Affordable Care Act, one of the toughest challenges I had to deal with was watching my patients struggle with medical bills and worrying about their coverage.
The health-care law will help reduce Florida's growing uninsured population and address the challenges that families across the state face in finding affordable health insurance and maintaining the coverage they do have. It also offers more affordable options for small businesses to purchase health insurance for their employees.
Since the Affordable Care Act became law on March 23, 2010, Florida's seniors, women, youth and those with pre-existing conditions are getting better health care and saving money on their health-care costs. And when the law is fully implemented in 2014, all Floridians will benefit.
Consider these numbers as further evidence of how the new law is helping. During the past two years, the U.S. Department of Health and Human Services has monitored and tracked the health-care law's benefits for Americans and Floridians. According to HHS data:
More than 238,000 of Florida's seniors have saved nearly $140 million in brand-name prescription-drug costs — an average savings of more than $500 per senior.
An estimated 2.5 million Floridians have received at least one new necessary preventive health-care service with no co-pay because, under the law, more private health-insurance providers are required to cover preventive services without a cost-sharing requirement. These important services include immunizations, cholesterol and blood pressure screenings, PSA tests and mammograms.
Two and a half million adults under age 26, including more than 150,000 in Florida, have health coverage because the health-care law allows young adults to stay on their parents' health insurance plan until age 26. In this group are my own two children who, after graduating from college in this terrible economy, experienced a long period of unemployment. Thankfully, my husband's insurance covered them.
Starting in 2014, more elements of the law will kick in. Insurance companies will have more accountability. Private insurers will focus on wellness instead of transactions, and will be accountable to keeping their members healthy. Insurance companies will no longer be allowed to impose annual dollar limits on most benefits, can't deny coverage to adults with pre-existing conditions, and will have to include benefits for pregnancy and newborn care with new policies.
The new exchange marketplace will begin operations, allowing individuals and families to purchase affordable policies, and very low income people will qualify for Medicaid.
Beyond these substantial direct benefits of the health-care law, we all have also benefited indirectly from the new law. For example, funding through the health-care law has helped law enforcement to crack down on waste, fraud and abuse in the Medicare system and recover billions of tax dollars.
Copyright © 2012, Orlando Sentinel
http://articles.orlandosentinel.com/2012-05-10/opinion/os-ed-affordable-care-act-051012-20120509_1_health-insurance-health-care-law-affordable-care-act [with comments]
===
Obama administration cracking down on health care fraud
By Kathleen Sebelius and Eric Holder
Updated 08:31 p.m., Friday, May 11, 2012
We are proud to say that last week Houston was part of the largest-ever coordinated law enforcement takedown of defendants charged with committing fraud against Medicare and Medicaid. Medicare Fraud Strike Force teams in Houston and six other cities, operated in partnership by the Department of Health and Human Services and the Department of Justice, charged 107 people for allegedly submitting fraudulent claims to Medicare worth about $450 million.
Here in Houston, nine individuals were charged with fraud schemes involving a total of $16.4 million in false billings for home health care and ambulance services. According to court documents, the owners and operators of four different ambulance companies allegedly billed Medicare for ambulance rides that were medically unnecessary.
Since 2009, the Obama administration has more than quadrupled the number of Medicare Strike Force teams operating in fraud hot spots around the country. And the president's 2010 health care law, the Affordable Care Act, has put more boots on the ground and established tougher sentences for those who commit fraud. More than 500 law enforcement agents participated in the May 2 operation.
The health care law and other recent legislation have also enhanced our ability to put in place cutting-edge technology that makes it possible to identify and respond to fraud faster. In the past, government was often two or three steps behind the perpetrators, too often showing up after the criminals had already skipped town.
The Affordable Care Act and other recent legislation give us new data-analysis tools to look at trends across claims data, instead of monitoring each claim individually.
Using a technology similar to what credit card companies use to identify and stop suspicious payments before they go out, we are using new authorities under the health care law to suspend payments when there are credible allegations of fraud, until an investigation is complete. The Centers for Medicare and Medicaid Services has stopped payment or taken other administrative actions on 52 provider organizations connected to the May 2 arrests until we have investigated them fully. Now those looking to rip off Medicare aren't getting a head start.
The health care law also gives us the authority to put in place new safeguards to keep bad actors out of Medicare and Medicaid in the first place. For example, we've established a tougher screening process for the enrollment of providers in the areas where fraud is most likely to occur, such as for home-health visits or durable medical equipment, like wheelchairs.
In short, we have made it harder to submit a fraudulent Medicare claim. And criminals who do are more likely to get caught: The number of defendants in all criminal health care fraud cases increased by more than 75 percent during the Obama administration, from 797 in 2008 to 1,430 last year - and if convicted, criminals face longer jail sentences due to new sentencing guidelines.
This fight against fraud is a key part of this administration's historic effort to strengthen Medicare for the future. According to the Medicare actuaries, the Affordable Care Act - including some of its key anti-fraud provisions - has extended the life of the Medicare Trust Fund by eight years, to 2024.
We are committed to continuing to strengthen Medicare and Medicaid and getting the criminals out of our health care system so that we can ensure that our seniors and other vulnerable citizens in Houston and across the nation will have access to the high-quality, affordable health care that they need and deserve.
Sebelius is secretary of the U.S. Department of Health and Human Services and Holder is the U.S. attorney general.
http://www.chron.com/opinion/outlook/article/Obama-administration-cracking-down-on-health-care-3552754.php [with comments]
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Insurers Face $1 Trillion Revenue at Stake in Health Law
Health-care law supporters and opponents gather outside the Supreme Court during the first week of arguments.
Photographer: Rich Clement/Bloomberg
By Alex Wayne - May 14, 2012 1:00 PM CT
Health insurers will gain $1 trillion in new revenue over the next eight years under the 2010 health- care law, assuming it’s upheld by the Supreme Court, according to a Bloomberg Government study.
The amount is equal to about one-half percent of the nation’s estimated gross domestic product from 2013 to 2020, and insurers led by UnitedHealth Group Inc. (UNH) would keep about $174 billion -- $22 billion a year -- for profit and administrative costs. The money comes from U.S. subsidies to people purchasing insurance beginning in 2014 and an expansion of Medicaid, the government’s health program for the poor.
The Supreme Court is weighing whether the law’s requirement that most Americans carry health insurance is constitutional. If it isn’t, the court will decide how much of the law to strike down. Should the law survive the court’s review and Republican efforts at repeal, it is projected to expand insurance to 32 million Americans who lack it by 2016.
“It’s a confirmation of, one, how much money we’re spending as a nation on health care; and two, how much is riding on this court case and the Supreme Court’s decision,” Matt Barry, a Bloomberg Government health analyst and the study’s author, said in a phone interview. “You’re talking an amount of money here that can affect the economy, not just an industry.”
About 9 percent of the insurance industry’s total revenue from 2013 to 2020 hinges on whether the health law stands, according to the study.
State Exchanges
Starting in 2014, states are required to open new insurance marketplaces called “exchanges” that will sell subsidized policies to people who don’t get coverage through their jobs. People who earn wages close to the poverty level, about $23,000 for a family of four in 2012, will be made eligible for Medicaid.
Barry’s study calculates that subsidizing private insurance premiums will cost taxpayers $557 billion through 2020, while the Medicaid expansion will cost the federal government $669 billion. The two provisions account for 98 percent of new spending in the law, the report said.
About 58 percent of that spending would pass through insurers. They would get another $322 million from consumers’ share of premiums.
Under the health law, insurers must spend at least 80 percent of their premium revenue on medical care, so most of the $1 trillion will flow to hospitals, doctors and other health providers.
‘Good for Consumers’
“This is a law that’s good for consumers and good for business, and there are a trillion reasons why it’s good for the insurance industry,” said Ethan Rome, executive director of Health Care for America Now!, an advocacy group that supports the health law and is critical of insurers.
The insurance industry, through its Washington trade group, America’s Health Insurance Plans, provided about $86 million to the U.S. Chamber of Commerce in 2009 to help fund a lobby and advertising campaign against the law. A spokesman for AHIP, Robert Zirkelbach, declined to comment on the Bloomberg Government study.
Mitt Romney, the presumptive Republican nominee for president, has said he will seek to repeal the health law if he’s elected in November.
To contact the reporter on this story: Alex Wayne in Washington at awayne3@bloomberg.net
To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net
©2012 BLOOMBERG L.P.
http://www.bloomberg.com/news/2012-05-14/insurers-face-1-trillion-revenue-at-stake-in-health-law.html [with comments]
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Congress may get tough medicine from health bill
By Chris Mondics
INQUIRER STAFF WRITER
May 14, 2012
No matter how the case turns out, one group of Americans is assured of getting quality health insurance when the Supreme Court rules on President Obama’s Affordable Care Act in June: members of the court itself.
The Supreme Court, which is expected to issue its decision in June, gets its health insurance through the same plan available to members of Congress and other federal employees — and though benefits have been trimmed in recent years, it remains among the best.
In one little-known feature of the law, however, members of Congress would have to leave the generous federal plan and obtain their coverage through online insurance exchanges, or markets, if the law is upheld. The law mandates the establishment of exchanges in each of the states as a means for consumers to shop for health coverage, comparing costs and features of competing plans.
“It is more of a gesture to show that members of Congress are willing to experience what ordinary Americans are willing to accept,” said Mark Pauly, professor of health care management at Wharton, referring to the requirement that Congress exit the federal employee health plan.
The federal government spends some $50 billion a year to provide health care coverage to eight million federal workers, retirees and their independents under the Federal Employee Health Benefits Plan. Expanding it to include nonfederal workers has been touted as a way to fix the nation’s twin health care ills of spiraling costs and growing numbers of uninsured. A total of 225 health insurers and health maintenance organizations participate.
“The actuarial value of these plans is very good,” said Walt Francis, an economist and program analyst who writes the Consumers’ Checkbook guide to federal health care coverage, a website that compares costs for federal employees in every region of the country. “In years past, it [the federal health care plan] was arguably inferior on average to large employer plans. But those have been cutting back and now the two are very comparable on average.”
The fact that members of the Supreme Court have health insurance should come as no surprise, nor does it have any legal bearing on the complex issues before the court. The case, brought by 26 Republican attorneys general and the National Federation of Independent Business against the Obama administration, hinges on whether the federal government has the power to require individual citizens to obtain health insurance or pay a penalty to the IRS, as part of a larger plan to extend coverage to millions of uninsured Americans.
But the controversial law illustrates the political and policy complexities that face lawmakers and executive branch officials trying to extend coverage to the uninsured. Jurists also face difficult choices sorting through the competing arguments.
“They are pretty decent plans,” said Pauly, of the federal health insurance plan. Pauly asserts one reason federal health plans offer relatively generous benefits, and stack up well against those in the private sector is that federal workers on average are paid less than private sector employees; the difference is made up in benefits.
Depending on the type of plan, out-of-pocket costs for federal employees in the Washington area, which would include members of the Supreme Court, range from $2,410 to as much as $7,930 for a family of four, including deductibles and co-payments. The Checkbook website estimates that a basic Blue Cross plan would cost the typical family of federal workers about $4,300 a year, including deductibles of $25 for visits to the doctor and hospitalizations with $150 a day deductibles.
The coverage typically resembles plans provided to private sector workers, and with good reason. Participants in the federal plan include some of the nation’s largest private insurers, Aetna, Blue Cross and Kaiser Permanente, among others, who also contract with large private employers.
Under the basic Blue Cross option, there is no overall deductible. But, the plan imposes penalties on patients who fail to abide by its cost-cutting strategies such as obtaining advance approval for a hospital admission. Failure to get such an approval, for example, could result in a $500 charge. And if a patient chooses a hospital outside of the insurer’s network, the patient risks paying the entire cost of the hospitalization out of pocket.
Because the federal health insurance plan has been successful in holding down costs, it also has been touted by liberals and conservatives as a potential vehicle for providing coverage to the nation’s uninsured, now totaling around 50 million. When he ran for president in 2004, Sen. John Kerry (D., Mass.) proposed opening the program to uninsured Americans who could not afford to purchase coverage on their own but earned too much to qualify for Medicaid, the government-financed health care program for the poor.
The federal employees health insurance plan, which served as a model for the exchanges, would not be impacted if the Affordable Care Act is upheld. The only change would be the requirement that members of Congress exit the plan and obtain coverage from the exchanges. The exact details of how members will purchase insurance, and from which exchanges, have yet to be worked out.
But Joseph Antos, a health care policy analyst at the American Enterprise Institute, a conservative think tank based in Washington, said that language was inserted by Republicans to make a point.
“The reason that provision was adopted was purely political,” Antos said. “It was purely for Republicans to say to Democrats that if you like this so much, you should live with it too.”
Contact Chris Mondics at 215 854 5957 or cmondics@phillynews.com
© Copyright 2012 Philadelphia Media Network Inc.
http://articles.philly.com/2012-05-14/business/31690169_1_federal-health-health-insurance-mark-pauly
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