HEALTH and WEIGHT LOSE SOLUTION

Archive for August, 2007

February 17, 2010

The Week in Health Reform–Federal Legislative Overview

House and Senate
Things were quiet last week in Washington due to the 30 plus inches of snow the area received.  On Feb. 9 House leaders announced that due to the heavy snow in the area they would suspend votes in the House for the remainder of the week. Congress will not be in session this week due to the President’s Day recess and will reconvene the week of Feb. 22.

As a result of the congressional schedule, the timeframe for a floor vote on the McCarran-Ferguson antitrust legislation will be pushed back until the week of Feb. 22 at the earliest.  Reports have stated that the antitrust bill is part of House Speaker Nancy Pelosi’s (D-CA) strategy of moving smaller pieces of health care legislation quickly to help build momentum for a comprehensive health care reform bill. The Speaker also continues to urge House Democrats to pass the Senate bill as long as it is accompanied by a separate “reconciliation” bill that would “fix” key provisions in the Senate bill (e.g., raising the threshold for the Cadillac tax and dropping the Nebraska Medicaid provisions) to satisfy some members of her caucus.

The Senate remained in session last week, despite the weather, although Majority Leader Harry Reid (D-NV) stated that the Senate would not conduct any votes.  On Feb. 11, Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released the highly anticipated “jobs bill” – The Hiring Incentives to Restore Employment (HIRE) Act.

Senators Baucus and Grassley issued a joint statement, emphasizing that this bill was drafted with bipartisan input.  They further stated:  “We also agree that, once properly reviewed, the package should be considered in a deliberate, but expeditious manner.  Any efforts to needlessly delay Senate completion of consideration of this package through partisan means will undermine our goal of timely action in the current economic climate.  Action on the expired provisions is long overdue.  Timely action on incentives for economic activity and job creation also is needed.”
Hours after details of the “HIRE” legislation were released, Majority Leader Reid publicly stated that he was scrapping the bill.  Reid told reporters that when the Senate returns from its recess on Feb. 22, “we will move to a smaller package than has been talked about in the press.”  Reid went on to state that some of the tax provisions included in the legislation – key to garnering Republican support for the deal – “confuse” the bill.  Reid went on to say that, “we don’t have a jobs bill. We have a jobs agenda.”

The draft “HIRE” legislation addresses a number of key health care issues:

* The bill extends, by three months, the eligibility period for premium subsidies for state continuation coverage and COBRA continuation coverage to include persons who are unemployed on or before May 31, 2010.  The bill also clarifies that these subsidies are available to persons who are involuntarily terminated from their jobs after previously losing their employer-sponsored coverage due to a reduction in hours.  The premium subsidies originally were enacted as part of the American Recovery and Reinvestment Act of 2009, also known as the “stimulus bill.”

* The bill provides for a seven-month Medicare physician payment fix (sometimes known as the “doc-fix”), maintaining physician payment rates at their current levels through Sept. 30, 2010.  Under current law, in the absence of congressional action, physicians are scheduled to face a steep rate reduction on March 1.

* The bill provides for a one-year extension of both Medicare Advantage Special Needs Plans (section 626) and Medicare Cost Plans (section 627).

* The bill includes numerous provisions addressing Medicare fee-for-service reimbursement issues.
White House Health Care Reform Summit
In a pre-Super Bowl interview on CBS, President Obama said that he would like to host a televised health care summit with Republican and Democratic congressional leaders on Feb. 25.  While specific details are not yet available, the summit represents the Obama Administration’s latest strategy to jumpstart the health care reform debate and seeks bipartisan cooperation following the loss of the Democrats’ supermajority in the Senate.  Republican leaders expressed interest in the summit, and House Republican Leader John Boehner (OH) issued a statement saying that, “The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access.”  In response, White House officials insisted that the President is not interested in starting from scratch on health reform.

This week Democratic and Republican congressional leaders also met with President Obama at the White House to discuss the jobs bill, health reform, energy, trade and other legislative priorities.

Following the meeting, the President spoke with reporters and he made the following comments about health reform:  “I’m going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals.  What I will not do, what I don’t think makes sense and I don’t think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there’s a lot of posturing.  Let’s get the relevant parties together; let’s put the best ideas on the table.  My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don’t get every single thing that I want.

JANUARY 22, 2010

This Week in Health Care Reform

After months of public debate and private negotiations, health care reform discussions stalled following Tuesday’s Senate vote in Massachusetts. The Democratic Senate lost its 60th vote supermajority when Republican Scott Brown was elected to the United States Senate in the Massachusetts special election.

Health Care Reform Negotiations Post-Massachusetts Special Election

Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat’s 60th vote in the Senate opens up the legislation to a Republican filibuster – something the Democrats have managed to avoid thus far in the debate.

House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.

On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama’s desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called “reconciliation,” which only requires 51 votes in the Senate.

Other remaining options:

1.
House and Senate Democrats could also quickly complete the merging of the two bills and vote on the combined package before Mr. Brown is sworn in.
2.
Democratic leaders could attempt to re-engage Sen. Olympia Snowe (R-ME), the only Republican who voted for the Senate Finance Committee’s bill passed in October. Democrats would need to allow her to amend the bill so that she could support its passage and give Democrats the needed 60th vote; or,
3. House and Senate Democrats could essentially start over in their respective chambers and propose scaled-back versions of the bill under “reconciliation” procedures or regular order. Reconciliation procedures would greatly limit the scope of the legislation to issues only related to raising or spending federal funds; therefore, many provisions, such as creating new insurance exchanges and an individual mandate, might be excluded.

President Obama seemed to indicate that he favors having House and Senate lawmakers start over again and produce a scaled-back bill. In addition, more moderate Senate Democrats – hesitant to push through such a huge partisan bill in light of the Massachusetts election – urged leaders to slow down.
Sen. Jim Webb (D-VA) has called on Senate leaders to suspend voting on health care reform until Mr. Brown is sworn into office. President Obama and Senate Majority Leader Harry Reid (D-NV) have iterated this same message. Further, Sen. Joe Lieberman (D-CT) called for a bipartisan effort as the best way to achieve health care reform legislation.

Health Care Reform Negotiations Prior to Massachusetts Special Election

Senators Urge Guarantee of Government Savings: In a letter sent last Thursday to Sen. Reid, five Democratic Senators asked for the inclusion of a “fail-safe mechanism” in the final bill. This mechanism would give Congress “the tools to keep costs under control should the current savings estimates fail to materialize.”

Both the Senate and House versions of the bill rely heavily on reductions in government spending, particularly around Medicare, to help pay for reform. Republicans and some nonpartisan analysts believe the government will not follow through on these spending reductions, which will lead to soaring costs.

President Obama Pushes for Less Protection for Biologic Drugs: Last Thursday President Obama pushed for a change in the health care reform legislation that would reduce the number of years that biologic drugs were patent protected from generic competition, previously set at 12 years. White House officials and Rep. Henry Waxman (D-CA) were negotiating for 10 years protection or less.

Members of the news media speculated that the move to reduce biologic drug protections could be a leverage point for President Obama to pressure the drug industry to increase contributions to pay for health care reform. In fact, the Wall Street Journal reported that Congressional Democrats had already asked drug companies to contribute an additional $10 billion or more, over and above the $80 billion which the industry agreed to early on in the reform negotiations.

President Obama Strikes Deal with Unions: Last week Democratic negotiators struck a deal with union officials and conceded to union demands to scale back a tax on high-end insurance plans. The deal would exempt union workers from having to pay the tax until 2018, five years after the tax would apply to other workers. While the deal would help gain union support for the bill, it would also reduce the amount of tax revenue generated by about 40 percent, to $90 billion. As such, Democratic leaders would need to find other sources of revenue to make up the difference.

Public Opinion

Exit Poll Indicates Health Care Reform as Hot Button Issue: As the ballot polls closed on Tuesday night’s Massachusetts Senate election, an exit poll conducted by Frabrizio, McLaughlin & Associates indicated that 52 percent of voters said that they oppose the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing this legislation. In addition, 48 percent said that health care was the single issue driving their vote.

Polls Show Discontent: The latest Wall Street Journal/NBC News poll indicated that almost half of Americans believe the health care reform bill in Congress is a bad idea (46 percent). This figure is up dramatically from April when only 26 percent believed the plan was a bad idea. Further, just 33 percent say the plan is a good idea. Nearly half of those surveyed (48 percent) believe that passing the current legislation would be a “step backward.”

In addition, a new Quinnipiac University poll showed that public support for health care reform continues to decline. Thirty-four percent mostly approve, while 54 percent mostly disapprove. At the end of December, 53 percent of Americans mostly approved, while 36 mostly disapproved.

Looking Ahead

Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill. President Obama had hoped to see a final bill prior to his State of the Union address, which has been scheduled for January 27; however, it appears this goal is likely out of reach.

joining several states across the nation, Republicans in the Pennsylvania House held a rally Jan. 27 to introduce a pair of bills aimed at opposing possible federal health mandates.

House Bill 2053, dubbed the Health Care Freedom Act, was introduced by Rep. Matt Baker (R-Bradford/Tioga) and would preserve individual rights to not take part in a government-run health care program, citing preservation of the patient-doctor relationship.

Whether a public option will be a part of a single piece of Congressional health reform legislation is still up for debate, but many think the endeavor will fail due to lack of support.

In a statement, Baker said that health insurance controlled by the government, “means that we will have less freedom to make the health care choices that are best for us and our families.

“My legislation will protect our right to pay directly for medical service and prohibit any individual from being penalized for not purchasing federally sanctioned health insurance,” said Baker, Republican chairman of the House Health and Human Service Committee.  “A government requirement to purchase health insurance is ineffective, costly and arguably an unconstitutional infringement upon states’ rights.”

Rep. Curt Schroder (R-Chester County) also introduced House Bill 2179, a joint resolution proposing an amendment to the state’s constitution protecting a citizen’s right to chose their own health care and purchase coverage from the company of their choosing.

The bill also rejects any law that would “penalize a person, employer or health care provider for declining to participate in a health care system.”
Schroder said his bill “recognizes the importance of health care” while also protecting Pennsylvania residents “from a massive government intrusion.

“By amending our state constitution, as proposed in House Bill 2179, we get the hand of the federal government out of our pockets and ensure the right of all Pennsylvanians to make their own health care decisions,” he said.

At the rally, Rep. Stan Saylor (R-York) said that state governments “have a deep understanding of the health care problems their residents face.

“Any health care legislation coming from the federal government should recognize that states can craft innovative, effective solutions to their own health care problems without intervention from Washington,” he said.

Both bills are before the House Insurance Committee and are part of the House Republican Policy Committee’s Health Care Task Force.

An Iowa health care provider is one of 85 community health centers nationwide to receive a significant monetary boost from the American Recovery and Reinvestment Act, President Barack Obama announced Wednesday.

“… Funding for construction, technology and a medical home demonstration project won’t just save more money, and create more jobs, they’ll give more people the peace of mind of knowing that health care will be there for them and their families when they need it. Ultimately, that’s what health reform is really all about,” Obama said.

Primary Health Care Inc. of Des Moines is slated to receive more than $2.6 million. The nonprofit organization maintains dental and medical clinics in Des Moines as well as a community access pharmacy, HIV services and outreach project. It also operates a medical and dental clinic in Marshalltown.

Although the clinics provide services to patients who have insurance, they specifically cater to those who are uninsured or underinsured. According to their Web site, Primary Health Care Inc. strives “to find and successfully treat medical condition before they become serious enough to require hospitalization or emergency treatment.”

It has also developed several specialized programs.

The Outreach Program specifically targets populations that often fall through the cracks in existing health care.

Health Care for the Homeless is a federally funded program that serves individual, families, street youth and homeless children in a non-traditional clinic setting. A federally-funded program called Enhancement provides mental health and substance abuse care for homeless clients.

The organization has also developed a four-point program for maternal child health that consists of a combination of state and federally-funded programs to provide service to pregnant women, newly expanding families and newborns up to age 6. Their Families in Transition program, which is funded through U.S. Housing and Urban Development, serves both prenatal or parenting families up to a child’s 15th birthday, and allows case workers to link homeless individuals to medical and mental health services as well as affordable and safe living environments.

Clinics that participate in the Outreach Program are located in six different sites throughout Des Moines, placing them within the areas of the community that are experiencing the most need.

To qualify for funding, the health facility had to be a federally-qualified community health center. Grants of $508.5 million were provided through the Facility Investment Program to address pressing health center facility needs. Also, as much as $88 million was made available to help Health Center Controlled Networks improve operational effectiveness and clinical quality in health centers by providing management, financial, technology and clinical support services.

The new Recovery Act funds are the latest in a series of grants awarded to community health centers, which deliver preventive and primary care services nationally at more than 7,500 service delivery sites around the country to patients regardless of their ability to pay.  Across the country health centers serve more than 17 million patients, about 40 percent of whom have no health insurance.

As the members of the class of 2010 prepare to flip their tassels to the left in May, there’s more than just studying to cross off of their to-do lists. While stressing over where to live and finding a job, many young adults do not address the issue of health insurance.

Reality will set in for some graduates when their parents’ plan or student insurance coverage expires, if it hasn’t already. Whether these current students are busy studying sociology or calculus, they need to make time to read up on their health insurance options before they suddenly find themselves uninsured.

“Thirty percent of people ages 19 through 29 are uninsured,” said Steve Trattner, president of Cinergy Health, in his article “Congratulations on Your College Graduation – Now Get Health Insurance.”

“Instead of being smart about the frailty of life, this age group tends to believe they’re invincible or simply do not recognize the necessity of health insurance, especially as we confront seemingly ever-rising health care costs,” Trattner continues in the article.

CNN Senior Medical Correspondent Elizabeth Cohen agrees with Trattner’s viewpoint in her article, “What’s a Recent College Graduate to do about Health Insurance?” Cohen acknowledges that some students are trying to find health insurance, but “others, dubbed the ‘young invincibles’ think they don’t need it since they’re young and healthy.” Cohen makes the point that all it takes is “a car accident, a cancer diagnosis” to put a 20-something college grad in “real trouble.”

To save themselves the pain and hassle of acquiring medical debt on top of already-looming college loan debt, students should check out their options now.
Insurance laws vary by state. As of Jan. 1, 2009, Connecticut law states that “Every individual health insurance policy providing coverage of the type specified in [certain] subdivisions… shall provide that coverage of a child shall terminate no earlier than the policy anniversary date on or after whichever of the following occurs first, the date on which the child: Marries; ceases to be a resident of the state; becomes covered under a group health plan through the dependent’s own employment; or attains the age of twenty-six.” This law does not apply to all insurance plans.

In “What’s a Recent College Graduate to do about Health Insurance?” Cohen suggests looking into the Consolidated Omnibus Budget Reconciliation Act (COBRA). According to the U.S. Department of Labor Web site, COBRA “gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances.”

COBRA is not a free option. The Web site explains that “Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost of the plan.”

It’s graduation time. Do you know where your health insurance is? Depending on your health plan, it might be gone. For many American students still covered under a parent’s insurance, health coverage ends upon graduation; they will be left to navigate the increasingly expensive and complicated world of health insurance as they struggle to find jobs.
Luckily for some, since 1994, 30 states have passed laws extending the age at which young adults are allowed to be dropped from their parent’s plan. In Massachusetts, insurance companies must cover children for two years after they lose dependent status or until age 26, whichever comes first. In New Jersey, a dependent may stay on his parent’s plan until 31 as long as he is unmarried. Connecticut, New York and Maryland, among others, all have similar laws that extend coverage, while California and Washington, D.C. have no such laws. Obama’s health care plan would guarantee that children remain eligible for their parent’s plan until age 26.
Despite these laws, young adults aged 18 to 25 are the most likely age group to be uninsured. According to the U.S. Census Bureau, in 2008, 28 percent of Americans aged 18 to 24 lacked health insurance. Given that only 11 percent of children under 18 lacked health coverage in 2004, this is a precipitous decline for those children who now fall into the 18 to 24 age group. The likelihood of being uninsured decreases with age over 25, and in total, 15 percent of Americans were uninsured in 2008.
The Independent talked to a number of seniors and recent graduates about their attitudes toward their health insurance decisions. On the whole, most seemed more interested in finding a job than in finding health coverage.

What You Should Know About Health Plans

In general, large monthly premiums mean small deductibles and small monthly premiums mean large deductibles.
A monthly premium is the amount of money you pay per month for your coverage. A deductible is the amount of money that you must pay out of your own pocket before the health insurance company will begin to pay for any health care costs. For example, if you have a the BlueChoice HSA plan from Blue Cross Blue Shield, your deductible is $2700 per year. In a given year, you will have to pay $2700 of your own money on medical expenses before Blue Cross will start to help you out. So, logically, if you are responsible for paying a large deductible, then you won’t be responsible for a high monthly fee, and vice-versa.

Your out-of-pocket expenses in one year will not exceed a set amount.
One of the most important aspects of health insurance is that even if you have a catastrophic year of medical problems, you will hopefully not go bankrupt. Let’s say you have been hospitalized and have already paid enough to cover your deductible. The BlueChoice plan says that once you have paid the deductible, hospitalization will only cost you $600 per day while Blue Cross pays the rest. However, you will not have to pay more than $5,250.

Some plans require that you pay coinsurance once you have reached your deductible.
Health insurance companies can specify a percentage of health expenses that you must pay until you have reached your out-of-pocket maximum.

When you visit the doctor or get a prescription, you usually only have to pay a co-pay and the insurance company will pick up the rest.
A co-pay is the fixed amount of money that your health insurance company charges for doctors’ visits or prescription medication. Co-pays for visits to specialists cost more than those to a primary care doctor, and co-pays for generic drugs are lower than for brand-name ones. If you have the BlueChoice plan, preventative care, like annual check-ups to your primary care doctor or OB/GYN are totally free, but if you choose to see a doctor for any other reason, you must pay the full cost of the visit until you have paid your deductible. After that, you only pay your co-pay.

You can save money, tax-free, for health care.
Health Savings Accounts (HSAs), created in 2003, operate just like savings accounts for health care expenses. If you have a plan with a large deductible, it will most likely offer you an HSA. You can deposit money into the account, before taxes, and it will accrue tax-free interest. You can withdraw the money to pay for a long and comprehensive list of “qualified” health care expenses. If you withdraw the money for any unqualified expenses you are subject to a ten percent fee.

The type of plan you have will determine your doctor “network.” Visits to doctors outside of your network may not be covered by your plan.
A Health Maintenance Organization (HMO) plan has the most restrictive rules but it is usually are the cheapest option. You are required to have a primary care physician who will see you for most of your appointments and refer you to specialists if need be. Your plan will only cover visits with doctors who have specifically made an agreement with your HMO-your network. Another choice is a Preferred Provider Organization (PPO) plan, which does not require that you have a primary care doctor and offers a much larger network of approved doctors. You can also choose to see a doctor outside of the network, but this will cost you more.