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Tuesday, July 15, 2008Massachusetts Health Plan-The Good and Bad
In April of 2006, the Massachusetts legislature approved a bill that requires all residents to purchase health insurance by July 1 of last year or face legal penalties. Massachusetts is the first state to attempt to remedy the problem of incomplete medical coverage through the mentality of treating patients the same way as cars.
July 1st, 2008 marked the one-year anniversary of the deadline for most Massachusetts residents to carry health coverage. Since the program began a year ago, the percentage of uninsured adults has dropped by nearly half--originally at 13%, the uninsured percentage is now 7%, according to studies cited by the state.
Yes, this is a huge and extremely positive improvement. However, it does not come with no setbacks. Currently, the Massachusetts experiment still faces a huge challenge — costs. Why is this?
Most of the newly insured under the plan are lower income residents of Massachusetts who qualify for either low or no-cost coverage through the state. However, there were more uninsured in such a bracket than the state anticipated. Both of these factors contributed to the cost of the program for the first year, $625 million, which was way over the anticipated estimates of $472 million.
State figures indicated that monthly premiums for those who qualify for the program went up on average 9.4% going into the second year of the program. For those higher income residents buying coverage without a state subsidy, the average premium rose 5.1%.
So as the presidential candidates outline their own health proposals, is Massachusetts' health plan an paradigm worthy of copying or is it an example to avoid?
Posted By: Blog Master @ 3:33:31 PMTop
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Friday, July 11, 2008Health Insurance and Recent College Grads
With around 13 million of the uninsured population in the United States being young people ages 19-29, insurance companies are currently trying to reach out to college students and recent college graduates through new marketing techniques. Most of these young people have the mentality that because they are healthy now, they will remain that way. Studies have shown that approximately one-third of all college grads become uninsured the year after graduation.
Many insurance companies drop dependents from their parents' policies once they reach a specific birthday. This date usually ranges from age 22 to 25, or simply when the dependent is no longer a full-time student.
The problem is that, although these people may be healthy now, it might take a serious medical condition to remind them of their need for health coverage. Yet, by this time, it may be too late. The important detail about health insurance is to alread have it when medical conditions arise.
What these young people don't realize is that now is the time they are most likely to be approved for a comprehensive plan with low premium rates. In short, the age bracket most likely to neglect health insurance has the best chance at gaining affordable health insurance.
In addition to those who simply disregard the need to be insured, the other end of the spectrum includes those who opt to pay a pricey monthly fee in order to keep the same doctor and remain on their parents' plan through a program called COBRA. While COBRA's major benefit is that it includes coverage for all preexisting conditions, this means its monthly premium is even higher than other options. Many young people select COBRA as a temporary option while they search for work.
However, there are alternatives to COBRA for short-term health insurance. The best option for healthy individuals who are looking for coverage while applying to jobs is to either enroll in a short term plan, which can be found through Health Plan One, or a regular plan which can be terminated at any point. The point is that no matter what type of plan these individuals are looking to enroll in, their premium rates are going to be lower and more affordable than if they obtained insurance after something happened.
Posted By: Blog Master @ 3:27:02 PMTop
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Wednesday, July 09, 2008Recent Medicare Cuts
Hot topic in the Senate recently has been the new Medicare cuts and pending bill which addresses this issue. Lawmakers face the tough decisions each year of how to pay doctors through the federal health insurance program. Just prior to the Fourth of July, the House passed a bill to prevent the Medicare pay cut by a vote of 355 to 59. This took effect on July 1, 2008.
This decision however is being questioned and many a speaking out in regards to it. Over the holiday weekend, advertisements on the radio and television by the America Medical Association, made claims about the Republican Party and how they have been protecting powerful insurance companies at the expense of Medicare patient’s access to doctors. These advertisements were targeted at 10 different Republican senators, seven of which are running in the election this fall.
President Bush and most members of the Republican Party oppose the bill because they believe that it would be funding a raise in doctor’s fees. It would raise these fees by reducing federal payments to insurance companies that offer private Medicare Advantage plans as a substitute to the traditional Medicare program. Insurance companies as well as the White House think that the bill will hurt beneficiaries who rely on these private Medicare plans.
Members of both parties agree that they want to change the formula for Medicare and the growth rate for spending on doctors. Under the current formula, doctors could still face cuts of more than 5 percent a year from 2010 to 2012. This new bill only offers a short term solution.
Doctors around the country have begun to re-evaluate their involvement in Medicare. For example, Dr. David Richardson from Los Angeles closed his practice to all of his patients except those emergency patients and those patients in need of surgery. Doctors realized that leaving their offices opened makes them lose money. Other doctors have started to not accept Medicare patients until further notice.
Posted By: Blog Master @ 11:56:38 AMTop
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Wednesday, July 02, 2008National Health Insurance
Currently, National Health Insurance is a pressing issue in America. Creating the proper plan to most efficiently run the health insurance system is crucial. Most prominently, many pressures are being put on the health insurance system. These pressures include; deficit reduction, millions of voters lacking health insurance coverage, rising prices, problems with practices, retirement policies, coverage and who receives it, and long-term insurance.
The ultimate decision has been made that only a true national health plan based on universal access and shared financial responsibility will result in sufficient system change. As opposed to how health insurance problems were dealt within the past, comprehensive proposals are being drafted by the business community. In addition, many primary care physicians have joined together to fight for one national health insurance model. Even the New England Journal of Medicine has showed support for a national health insurance plan.
The National Health Insurance debate will focus on new topics. These topics include concern for the quality and appropriateness of health care and how this quality should be measured. Also, how to inform the public is a priority. Lastly, the debate will address how quality of the product should relate to price. All of the proposals made have a few common factors. They all believe that access must be attained and that patient responsibility must encourage use of protective services.
All of the proposals seem well and good, but it’s a matter of these plans actually going in effect that is difficult. There are so many things that need to be taken into consideration before even trying to make these proposals a reality. These include tax status of health insurance benefits, hospital budgeting systems, and physician payment reforms. Employers would need to participate more in aiding employees in paying for coverage. Long term care plans and public hospital systems would need to be implemented as well.
Posted By: Blog Master @ 12:59:04 PMTop
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Thursday, June 26, 2008Employee Health Benefits
Wanda Glenn, the supervisor for Sears in Ohio recently went to court to discuss her benefits as an employee. Eight years ago she suffered from heart disease and took a leave of absence, providing the store with proof from her doctors as to why she was absent. Sears offers their employees long-term disability insurance as a benefit but the plan administrator, MetLife, said that Wanda’s situation did not apply for this benefit. Wanda sued Sears but while in court they ruled against her because she was unable to prove that Sears acted in an unprincipled way. Shortly after the trial, the Appellate Court for the Sixth Circuit ruled in Wanda’s favor because they said argued that MetLife had acted under a conflict of interests. Ultimately the Appellate Court’s decision was affirmed by the Supreme Court and Wanda was able to receive her benefits.
Here is where conflict arose. Previously, employees who felt that they were being deprived of proper health care benefits from their employers did not have much luck in court. The only way they could ever have the potential to come close to winning the case was if they could provide the judge with proof that their employer behaved in an impulsive, unprincipled way. Apparently this conflict has been going on ever since Congress passed an employee benefits law in 1974. This law required that the officials who made decisions regarding employee benefits to act solely in the interest of the workers. This law’s consequences were not as planned because Congress did not take into consideration that those who make the decision on the benefits are usually hired by the company that pays for the benefits, and therefore share the employer’s interest in keeping costs low.
A decision for how to address this conflict the future was made in 1989. The court decided that when district courts reviewed benefits disputes, they should review all the facts again, and this is called a de novo review. In addition, this decision said that employees could sometimes win by showing that those who make decisions about employee benefits had acted under a conflict of interest.
Posted By: Blog Master @ 2:43:28 PM
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Wednesday, June 25, 2008Electronic Health Records
Recently the government has administered a survey in regards to the use of electronic patient health records. An overwhelming number of those surveyed stated that electronic health records have aided in improving the quality of care, reducing errors and controlling costs. Ironically, less than one in five of America’s doctors are taking advantage of these electronic health records. The reason for this small number is primarily economic.
Hospitals and large practice have already adopted this system but small practices have struggled. Small practices lack the financial incentive to invest in these computerized records. Making the change to electronic health records is costly. Personal computers must be updated, new software must be bought, and a new technical staff must be hired in order for the change to effectively take place. All of these costs could add up to more than $20,000. On top of the cost, doctors would not have as much time to see patients. This would really bring their costs up because patient visits are the way they obtain incomes. These doctors are not satisfied with the electronic health care product options because they complain that the products are more geared and designed for hospitals. On the other hand, Hospitals gain much from this conversion. They can save money as a result of a reduced amount of paper handling, fewer administration expenses, and lesser amounts of lab tests.
To help these struggling doctors, the government created a $150 million Medicare project that presents doctors with incentives to move from paper to electronic patient health records. This project will help up to 1,200 small practices in 12 different cities and states so that they can make the conversion successfully without the burden of the high costs.
Encouragingly, about 80-90 percent of those who are currently using electronic health records say that they enhanced the quality of medical choices, helped in avoiding medication errors, and improved the delivery of preventative care. In the near future advances for the system will be put forth. For example, Microsoft and Google may begin creating services that offer consumer-controlled personal health records over the Web.
Posted By: Blog Master @ 1:59:17 PMTop
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Tuesday, June 24, 2008Bernanke's Take on Health Care
Strengthening the health care system’s performance is the biggest challenge facing the country at the moment according to Federal Reserve Chairman Ben Bernanke. Because of medical breakthroughs, technology has allowed for better treatments which in turn produce longer, healthier lives. Right now, all of those considered to be part of the baby boomers era are aging. This, together with the fast growing health care costs, is resulting in a constant increase in government and personal budgets. This increase will continue to create struggles that will become more and more taxing unless changes are made.
Economists are unable to predict how the Federal Reserve will handle the interest rate issues. Some say they will be held at two percent while others say the Fed will raise its rates. Still others say the Fed will keep rates steady throughout the year. Raising the rates would prevent a large inflation outbreak. This fact creates a very hard position for the Federal Reserve policy makers to be in. By helping America’s economy, the Reserve is allowing inflation to take off. On the other hand if the Reserve does not aid the economy, it will continue to fail. It is a lose, lose situation. The decisions are difficult because weighing which loss is less will not be easy. Bernanke suggests that due to the importance of the results of these very difficult decisions, Congress and the White House should be the decision-makers.
Bernanke’s only advice comes in three parts. First, improving access to health care for the estimated 47 million American’s that do not have health insurance coverage is a must. Second, improving the quality of the health care system is needed. Lastly, costs must be controlled. Never once did Bernanke say any of these three would be easy tasks, but efforts must be made to at least try to change the system as we know it today.
Posted By: Blog Master @ 2:06:56 PMTop
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Monday, June 23, 2008Changing the Health Care System
During June 2008 the Senate Finance Committee held a bipartisan conference in attempt to review the basics and lay the groundwork for what leaders of both the Republican and Democratic parties expect will be a major drive for health care legislation in 2009. The chairman of the Federal Reserve, Ben Bernanke, addressed Congress by voicing that until lawmakers repair the health care system, health spending would continue to rise definitely.
Max Baucus, the Democratic Senator of Montana who is heading the health care reforming committee wants a federal health board to be created. This board’s main project would be to aid Congress in making technical policy decisions. Bernanke responded to Baucus’ idea by suggesting that Congress create an independent health care panel. This panel would be able to take their ideas to Congress who would approve or reject any proposals made by the health care panel. Bernanke also suggested Congress could create a commission to set health policy. Either the panel or commission would have to be very clearly guided by Congress because the topic of health care is nothing to be belittled seeing as health care accounts are a huge part of America’s economy.
Obviously costs are always an issue, especially when it comes to health care. Changing the system to help those applying for coverage is important. Bernanke says that ultimately health insurance prices will decline, but not in the near future; therefore, all that can be done to improve the system should be done as soon as possible.
Both Democrats and Republicans have their own ideas when it comes to how health care should be taken care of. Both contribute positive ideas as to how to change the system. Democrats say if the system will be fixed, it must cover everyone while Republicans say that markets, choices, and private alternatives must be offered. In conclusion, every American should be insured, but the choice of private health plans competing in the market alongside government programs should be made available.
Being that health care is the number one economic issue in America, it is only fitting that the government develop a plan where American’s can pay less for higher quality. Hopefully exactly that will happen in the near future.
Posted By: Blog Master @ 3:53:13 PMTop
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Friday, June 20, 2008Co-Payments on the Rise
Finding the right health insurance plans that work for each specific situation is a challenge. Luckily, there are easy ways to become informed on each individual and group plans offered that each applicant can choose from. Some plans have higher monthly premiums and therefore have lower co-pays. On the contrary, what has been seen more frequently is lower premiums matched with higher co-pays.
Some health insurance companies have begun using a new system to price extremely expensive drugs. Instead of asking their patients to pay a fixed co-pay rate for each prescription no matter what the drug’s actual cost is, health insurance companies having their patients pay a certain percentage of the drug’s actual cost.
For example, Copaxone, the prescription medication used to treat someone with multiple sclerosis, previously required only a $20-$30 co-pay while on certain health insurance plans. Recently, some plans have changed their pricing system and each time the drug is purchased a $325 payment must be made because that is 20-30% of the drugs actual price. Along with Copaxone there are many other drugs that have reformed to this system. These drugs are considered Tier 4 drugs and now about ten percent of health insurance plans have Tier 4 drug categories. Unfortunately for those who are insured, private insurers can change their health insurance coverage plans to include these Tier 4 drugs without even notifying their current customers. Medicare is required to inform their patients if this change takes place, but it some cases this important information can get thrown away with junk mail or just simply be overlooked. In this case, the customer who was used to paying $20 for a prescription will be in for a surprise when he or she goes to purchase the new Tier 4 drug.
Insurers argue that this new pricing system will keep monthly premiums lower. So it really comes down to which plan will best fit each individual situation. What is best for one person’s life style might not be best for another’s. The main goal is keep costs low for those who are suffering from illnesses.
Posted By: Blog Master @ 11:48:36 AM
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Thursday, June 19, 2008Massachusetts's New Plan
Within the past year Massachusetts has been eagerly trying to create a new plan for health insurance coverage in attempt to try to save its residents from large expenses. The plan which is to provide universal health coverage is going well so far but the upcoming year is where the plan’s status will really be accessed. This new plan requires its residents to do two things. First, they must take on health insurance and if they do not they will suffer tax penalties. Secondly, the plan requires employers to offer coverage to all of their workers and if they do not do so, they must make other payments to compensate for lack of coverage offered.
Massachusetts has held premium increases to 5 percent and also changed the individual market so that everyone can take advantage of less expensive group rates. Within the plan’s early stages, an estimated 350,000 of Massachusetts’s uninsured were covered. Massachusetts hopes to expand these numbers in the upcoming year, when higher penalties for those who do not get coverage will be administered.
With every good idea there are flaws or problems that may occur. Critics are saying that Massachusetts cannot call this plan universal because 350,000 people covered does not qualify the plan to be considered “universal.” Adding to the concerns is the fact that residents may change coverage to gain the benefits from the subsidized coverage and also businesses might fire employees who are part of the state program because they feel it is costing the company more money. Also, many newly insured have found it difficult to find a primary care physician and the amount of lower-income residents who used the emergency rooms for nonemergency situations is rising.
Most negative is that costs have risen faster than expected. In order to keep this plan around, Massachusetts must really strive to keep the costs low and under control by finding new sources of income and also strive to gain as much support for the plan as they can .
Posted By: Blog Master @ 6:27:55 PM
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