The debate over whether the new federally-funded high risk pool programs will allow funding for member’s elective abortions continues. The mandatory state high risk pools will be funded at least in part by the federal government and in some cases also federally administered, though many states have volunteered to administer the pools themselves and contribute the lion’s share of funding. The pools –referred to as “pre-existing condition insurance plans” – are meant to provide health insurance for residents with pre-existing conditions who would otherwise be ineligible for coverage. Last week, the Obama administration announced it would not permit funding to be used for elective abortions under the program. This angered pro-choice groups who argue the President is bending over backwards, compromising campaign promises to appease a few pro-life Democrats.

Will Obama Fund Abortions in High Risk Insurance Pools?

Pro-choice advocates further allege that the administration does not have the legal authority to determine whether funding can be used to pay for abortions, as the use of funds for such procedures in high risk pools was not mentioned in the language of the Affordable Care Act or the subsequent executive order. Pro-lifers and Republicans say that even if the high risk pools were not included in the language of the executive order which affirmed the Hyde Amendment, the principle of the deal which solidified pro-life Democrats’ last-minute votes should still apply. Essentially, the President promised Democrats the reform would neither expand nor contract abortion availability, and his office should keep that promise.

Abortion-rights groups respond that many states’ existing high risk pools currently cover abortions for good reason. Many of the women enrolled in high risk pools have chronic health problems like diabetes which can make pregnancy dangerous. Abortions must be available to these women as a backup plan if their birth control fails as a pregnancy could seriously threaten their health, or even their lives.

This morning, President Obama spoke to the press about the Gulf Oil Spill. The BP Oil Spill in the Gulf Coast has given us little predictability as to what the future holds for this catastrophic event.  This is the worst oil spill in US history; therefore raising many questions that have never been answered before.  With tar balls now showing up on the beaches in Galveston County Texas (some 400 miles away from the source of the spill) the consequences of this spill are very much unknown.  The health of the people in the Gulf Coast area is obviously an immediate concern.

Little research has been carried out on the long-term effects of oil spills on people’s health.  Those who are currently doing research on the potential health risks of oil presume that most of the health concerns will be short term.  However, they do fear potential long-term damage to the liver, lungs, and kidneys.  These short-term and long-term health concerns would be resultant of the oil fumes that workers are subject to while cleaning up the spill.  Other research has found that those working to clean up the oil may experience temporary DNA damage that the body will repair itself over time.

On a more positive note, physical contact with the oil does not pose many health threats.  The oil itself is potentially harmless. Although some people may experience a rash from skin contact with oil, this is only temporary skin irritation.  Health officials announce that you are not in notable danger if you touch or swallow small amounts of oil, but it is not advised to do so.

What consequences will the Gulf Oil Spill have for human health?

How we choose to manage the present circumstances of the BP Oil Spill can be controlled.  Hence, BP has organized clean-up crews in a particular manner.  Complaints have been recorded of an irrational amount of volunteers “standing around” at clean-up sights.  What they don’t realize is that this particular strategy has been arranged to prevent potential health risks to the volunteers.  The volunteers at the spill clean-up spill sites are working in near 100 degree temperatures.  Extended water breaks and shorter working periods reduces the potential of heat-related health risks, such as heatstroke and dehydration.  It also increases the clean-up efficiency of the volunteers

One health concern that has been deemed inevitable is the mental health of residents in the area of the BP Oil Spill.  Mental health issues are bound to arise because it has happened in every past oil spill.  Residents in the areas affected by the oil spill have higher rates of depression and other mental health issues as a result of the spill.  This ensues as a direct result of damages to the resident’s homes, beaches, and jobs.  People lose their jobs because tourism in the area decreases as a direct result of the damages to tourist attractions (especially beaches).  Also, those in the fishing industry lose their jobs because the oil contaminates many fish and people are more concerned with consuming fish.

While working to clean up the most disastrous Oil Spill in US history, all those involved with the Spill must take precaution.  With so much unknown about the potential health threat of oil, research could potentially find that it is toxic.  It is best to take safety measures.  The oil itself contains organic compounds, which can be carcinogenic.  Those working with oil or around oil fumes have a high risk of exposure to these carcinogens in the oil, such as benzene.

Decided in 1973, the Roe v. Wade case forbade states from establishing laws that banned abortion.  It gave women the right to have an abortion in any US state up until their third trimester.  The ruling of this case has led to an ongoing abortion debate throughout the nation.  Anthony Kennedy, a Justice of the Supreme Court, is known for having a “swing vote” in many Supreme Court decisions.  However, people fear that a Republican President may choose to replace Kennedy.  Kennedy’s vote has always been important in the abortion cases.  If he were replaced, there is fear that Roe v. Wade may be overturned. This would allow states to enact laws against abortion at any point in the pregnancy if they so desire.

Supreme Court Nomination May Overturn on Roe v. Wade

If Roe v. Wade was overturned, the likelihood that we would see any variation in the amount of abortions in the US would be slim.  More problems may arise than would be solved in the event that Roe v. Wade was overturned.  If it was, there are about 20-25 states that would immediately enact laws against abortion.  This would make it more difficult for females to find a doctor offering abortion services.  However, it would not stop them from having abortions.  Females will either go to the states offering abortion services or find other means that are less safe and healthy than finding an available doctor.  Overturning Roe v. Wade would theoretically eliminate 170 doctors providing abortion services, which is less than 10% of all services available in the US.

Overturning Roe v. Wade will pose serious health and financial burdens.  As mentioned before, females will take more risky measures to have an abortion.  Those who decide to keep their baby are immediately faced with the high hospital costs and medical costs associated with having a baby.  Consequently, more women may consider taking contraceptives to prevent pregnancy in the first place.  However, this too can be expensive because many health insurance plans do not cover contraceptives.  If they do offer coverage, there is often a high out-of-pocket charge for the contraceptive prescription.  Also, there are very few health insurance companies that offer abortion coverage (most are private insurance companies).  It is likely that these health insurance companies will establish much higher costs in the states that would choose to allow abortion after overturning Roe v. Wade.

The replacement of Anthony Kennedy is not an immediate concern, but it is a possibility in the near future.  Kennedy’s retirement should not be in question because he is not likely to retire soon.  The only imminent threat to his position would be a Republican president, who may choose to replace Kennedy with a candidate who opposes abortion.  This decision, however, would have many repercussions and may not solve any abortion issues.

Obama administration officials and some Senate Democrats are optimistic that the federal subsidy of COBRA benefits passed by the economic stimulus bill will be extended by inserting  a provision to this effect into the “extenders” package of jobless benefits working its way through the Senate this week. This bill is co-sponsored by Senators Bob Casey Jr. (D-PA) and Sherrod Brown (D-OH). As discussed in my last post here, it is estimated that over 2 million families who would have lost their employer-sponsored health insurance as the result of a lay-off took advantage of the COBRA subsidy. Instead of losing their coverage, COBRA has allowed them to keep their previous employer’s health insurance and the federal government’s subsidy has paid for 65% of the total cost of maintaining that coverage. This subsidy was a huge help for families who otherwise would have had to assume 100% of the total cost of premiums (including the portion their employer used to pay) to maintain their coverage under COBRA.

COBRA Subsidy Running Out for the Unemployed

As of June 1, 2010, the 15-month COBRA subsidy has expired for those who took advantage of it when it first became available in February 2009. The National Employment Law Project estimates that more than 144,000 households each month will be dropped from the subsidy as these families hit their 15-month mark. Many families whose COBRA subsidy has not yet expired hope the Senate will pass this extension of the COBRA subsidy beyond the 15 month mark so that they can continue paying just 35% of the total cost of their previous employer’s insurance premiums and keep their old coverage. Here are five reasons why I don’t think an extension of this subsidy will make it into the final jobless benefits package which should come to a vote this week:

1)      Centrist House Democrats rejected a similar proposal to extend COBRA subsidies in May 2010 because of concerns about continuing to run-up the national deficit.

2)      Last week, the non-partisan Congressional Budget Office evaluated the Senate’s trimmed down version of the proposal which is in currently in the works. Extending the COBRA subsidy again is estimated at $4.1 billion, which is much higher than supporters had anticipated.

3)      Congress already extended the subsidy once in November 2009, allowing COBRA beneficiaries to continue receiving the 65% subsidy of their total premium cost for a maximum of 15 months. The original subsidy as passed in the American Recovery and Reinvestment Act of 2009 was set to expire after 9 months.

4)      There are few other areas of the bill from which co-sponsors Sens. Bob Casey Jr. (D-PA) and Sherrod Brown (D-OH) can pull funds for the subsidy. The subsidy extension is only part of a package of provisions the Senators are trying to attach to the must-pass legislation. Their whole package has a total cost estimated at nearly $7 billion. Other parts of their provisions would extend unemployment benefits and make changes in dozens of federal programs, and these are not areas from which the senators could easily justify cutting funding in order to make room for another COBRA subsidy extension.

5)      A similar proposal to extend the COBRA subsidy was dropped from the House-passed bill. Additionally, Senate Democratic leaders omitted it from their version when the bill was originally drawn up.

Unfortunately, it seems that given the strained economy and need for budget-consciousness in Washington families who have relied on the federal subsidy to keep their coverage under COBRA will have to reevaluate their options.

According to Hartford Business online, the Connecticut State Government is debating on passing a bill which will mandate expanded coverage for more than six medical conditions. Such mandates would add approximately 3% to total premiums, according to insurance experts.

The six medical condition mandates for the new proposal include: ostomy-related supplies, prosthetic devices, hearing aids for children and wigs for patients who experience hair loss due to medical conditions. These mandates would cover what is typically paid for out of pocket, therefore increasing premium costs.

Thousands of families who took advantage of the federal government subsidy for extending their former employer’s health insurance coverage through COBRA have had to rethink their options in the past few weeks. On June 1, 2010 the federal government’s subsidy of COBRA health plan extensions expired. COBRA is a federal program which allows workers who have been laid off to continue the health insurance benefits their families received through their job after their employment has been terminated. With employer-sponsored coverage, companies contribute a given portion of the cost of their workers’ health insurance premiums and workers pay the rest. When a worker is laid off, COBRA gives that individual the option to remain on the same insurance plan as long as they agree to pay the total cost of monthly premiums themselves. Unfortunately, the full burden of such premiums is often too onerous for unemployed individuals to bear, especially in economic times such as these. That’s why as part of last year’s economic stimulus package, the federal government offered to subsidize the cost of extending one’s old coverage through COBRA at 65%. This subsidy was available beginning March 1, 2009 and offered 15 months of subsidized coverage to those who took advantage of the extension.

According to a study by the Treasury Department up to 1/3 of eligible unemployed workers signed up for the program. Last Tuesday, this benefit expired leaving thousands of families who took advantage of the opportunity to extend their health plan feeling they can no longer afford to continue this coverage without the help of the subsidy.  One exception to the June 1, 2010 expiration date remains for those who did not become unemployed until more recently. Those families who accepted the COBRA subsidized extension after March 1, 2009 but before December 31, 2009 are able to continue COBRA until September 30, 2010 when the subsidy expires completely. These families will be dropped off COBRA on a rolling basis based on when they signed up.

Though Congress has extended the COBRA subsidies four times since February 2009, the most recent proposed subsidy extension failed due to worries on the part of legislators about the federal budget deficit. Some states are offering additional COBRA extensions (called “mini-COBRA” laws) to supplement federal COBRA to extend benefits up to 36 months but again, the cost of these premiums tend to be much higher than those for plans available on the individual market.

Recently we have had many families losing their COBRA coverage visit our website to look into other, less expensive health insurance options offered on the individual and family health insurance market through us at Health Plan One. With individual and family plans, consumers are able to tailor their coverage so they only pay for the benefits which meet their specific needs. If you’re interested in doing your homework on the individual and family plans available to you, call one of our licensed agents at (877) 567-5267 for an expert, personalized consultation. Other public options for individuals with major preexisting conditions dropping their COBRA exist in most states, as do so-called “HIPAA-eligible” plans. Visit your state’s informational page at healthplanone.com to learn more about the publicly funded programs available in your area which benefit groups like pregnant women, children, and low-income families.

Finally a health insurance company competently defends themselves from egregious claims against it. HHS (Health and Human Services) Secretary Sebelius and Reuters accuse WellPoint of specifically targeting women with breast cancer to drop their policies. For the counterclaim by WellPoint, please see link.

WellPoint goes on to say that when people fraudulently fill out applications it’s their duty to review those applications. They have a very thorough and professional process, and exercise a high level of due diligence on those review cases. And in fact the charge of dropping policies is not even what the case is about; it’s about rescinding policies where there is fraud involved.  What Sebelius does not understand is that for a health insurer to detect fraud is protecting the policy holders of the company. If someone has a $50,000 claim for an illness, in the end it would not be the insurance company that would pay for that claim. Ultimately it is the other policy holders who pay.

It’s only fitting that Angela Braly, the CEO of WellPoint, makes a very strong response to Sebelius. It was in fact Braly that allowed the California subsidiary to put through rate increases of up to 39% that gave the congress and Obama administration the renewed fuel to pass health reform that was believed to be all but dead in February. Better late than never?

Cuts may be ahead for TennCare, Tennessee’s Medicaid program, according to the Wall Street Journal Health Blog. In attempts to offset the cuts to TennCare, Tennessee hospitals may ask to pay higher taxes on hospital revenues, though the rate right now is unclear. The WSJ blog forsees cuts at the federal levl, if Medicaid cuts on the state level persist.

The hospital tax, according to Tennnesean.com, expired in 1994, when TennCare was created. Though these cuts would save the state approximately $380 million, they would really be costing Tennessee as much as three times more in federal aid. Hospitals have estimated around $526 million in state and federal funding this year and according to Craig Becker, the president of the Tennessee Hospital Association, some state services and hospitals will disappear, which is why the new tax is being proposed.

Tennessee is not the only state facing Medicaid costs. According to the Virginian-Pilot, rising health care costs and a growth in the number of Medicaid patients have increased the government’s obligation to pay over $750 million within the past two years. New Hampshire and Wisconsin as well may see state-level Medicaid cuts, according to a post in KaiserHealthnews.org.

Debicella vs. Himes and Lamont

On Monday night I had the pleasure of attending the health care debate between congressman Jim Himes, Ned Lamont, and State Senator Dan Debicella. The participants offered up a comprehensive review of Democratic and Republican talking points that are worth a quick analysis. We’ll start with the Democratic talking points:

1. We have a moral obligation to cover all those without insurance.

I think many Americans agree with that statement. And we actually do cover all Americans today because no one can get turned away in an emergency room. A related question to ask is: why don’t these Americans have insurance? In many states, like Connecticut – and in Massachusetts prior to healthcare reform – almost half of the uninsured individuals are, in fact, eligible for Medicaid. They may not sign up because the state makes it difficult to enroll or the individual does not take the time to enroll. It seems like one prescription for our health care problem is: let’s get people enrolled in a program we have today.

The next big batch of uninsured Americans is illegal aliens. This is one of the toughest issues in healthcare reform – what do we do with the 10-15 million illegal aliens in the United States that do not have health insurance. I wish I had a prescription but unfortunately there is no easy answer on this one. The next batch of the uninsured are “risk takers.” Unfortunately, the risk takers are risking the taxpayers’ money and the money of those who are insured, not their own. If they get really sick we treat them anyway! A prescription for this problem is, in fact, a mandate. Finally, the rest of the uninsured population is people who are too sick to qualify for health insurance. Those people need financial assistance.

2. We need more competition (more insurance companies). Therefore, we need a public option.

Interesting point but completely irrelevant in Connecticut. In Connecticut’s individual insurance market we have Cigna, Aetna, Connecticare, Anthem Blue Cross, Time Assurant, Celtic, Golden Rule, and a few other no-names. Clearly, lack of competition is not a problem. So I’m not sure why Himes raised this talking point.

3. Insurance companies are bad.

Congressman Himes skewered the insurance companies; referring to their “pernicious” practices of rescinding policies after issuing them. In reality, this practice of “rescission” is rare. At Health Plan One, we have sold thousands and thousands of policies and have never had one client’s policy rescinded. Rescission occurs in the event of fraud perpetrated on the insurance company and its policyholders. For example, if an insurance applicant has cancer and intentionally misrepresents his/her condition, an insurance company may face hundreds of thousands of dollars of liability and has one of two choices: rescind the policy, due to fraud or take those losses and charge all their honest customers. Pretty easy choice for the policyholders and insurance company. Not sure who Mr. Himes thinks should pay for insurance fraud?

4. Medicare represents a $40 trillion unfunded liability.

Wow! Kudos to Congressman Himes for bringing this up. He got off the talkpoint memo. The insolvency of Medicare and $40 trillion unfunded liability is our ultimate problem and everything else we’re doing is working on the margins. Unfortunately, after announcing this financial bomb, the Congressman had no solutions other than to cut Medicare Advantage which is a cut to seniors’ benefits, but sounds like cuts to the insurers which is more politically palatable. He offers no clear solutions for a big problem.

5. Eliminate preexisting conditions.

Good idea. Who’s going to pay for it? You can’t have a functioning insurance market with no preexisting conditions unless you mandate that everyone gets in the insurance pool. For proof, go to the New York insurance department where they implemented no pre-existing conditions. Every insurer in the state has moved out and prices are 10 times what they are in Connecticut or Pennsylvania. The weak $750 mandate will not be sufficient to obligate people to buy health insurance.

Republican talking points:

Senator Debicella started out strong with the salient point that escalating costs are the key problem. Then, on to Republican talk points:

1. Tort Reform

The cornerstone of any Republican plan is tort reform. Certainly a good idea and should be part of any plan. Reduce physician costs and mitigate wasteful defensive medicine.

2. Electronic medical records (also a Democratic talking point)

EMRs are a good idea and cost a lot of money, but they might save a lot of money in the future.

3. Buying insurance across state lines.

Great idea if you live in NY, RI, VT, and a whole bunch of states that have blown up their individual insurance market. You have to fire a lot of state regulators, though, so Dems hate this idea.

4. Introducing high deductible plans.

This is a great point. Higher deductible plans have lower premiums and introduce the concept of cost-sharing to the consumer. For example, at Health Plan One, we carry many high quality, high deductible plans that are great options, especially for younger consumers who are healthy. Reducing health care costs must include patient cost-sharing and innovation on health benefit designs. Current congressional bills prohibit this.

5. Wellness (also a Democratic talk point)

Who could argue with wellness? Wellness is a great idea but you’ve got to have a plan to implement it. Close McDonald’s?

Prospective governor talk points:

Mr. Lamont made it very clear he will run for governor. He pointed out that Connecticut has not created a lot of jobs over the last 20 years and believes that the high cost of health care is part of the problem. We’ve heard a lot about the problems which were largely accurate but the prescription is unclear.

A fun event but, unfortunately, Congressman Himes could not adequately defend the House or Senate health care bills that he wants to pass.

Score one for Debicella – start again!

Interesting article in the New York Times today poses the above question, with comments from guest writers as well as readers. Despite the differences in opinion, everyone seems to agree on one thing – we need to start from scratch.