Health Care Reform Articles - August 26, 2012

Unhealthy Competition
Paul Ryans Plans to Reduce Health Care Costs by Using Competition Wont Work
by Peter Orzag

https://dl.dropbox.com/u/77156032/Unhealthy%20competition%20-%20Honolulu%20Star%20Advertiser-22%20Aug%202012%20-%20Page%20%2312.pdf

Controlling Health Care Costs in Massachusetts With a Global Spending Target FREE ONLINE FIRST

Robert Steinbrook, MD

[+] Author Affiliations

JAMA. Published online August 22, 2012. doi:10.1001/2012.jama.11322

http://jama.jamanetwork.com/article.aspx?articleid=1352960

A Glitch in Health Care Reform

Confusing language in the health care reform law has raised the possibility that millions of Americans living on modest incomes may be unable to afford their employers’ family policies and yet fail to qualify for government subsidies to buy their own insurance. This is a bizarre development that undercuts the basic goal of health care reform — to expand the number of insured people and make their coverage affordable.

The people left in the lurch would be those who had lower incomes but were not poor enough to qualify for Medicaid. They would either have to pay more than they could afford for an employer’s family plan or go without health insurance. The problem arises because the reform law quite properly tries to keep people from dropping affordable employment-based coverage and turning to taxpayer-subsidized coverage on new insurance exchanges, starting in 2014. Only those with coverage deemed “unaffordable” by the health care act would be allowed to receive subsidies.

As Robert Pear reported in The Times recently, the law considers a worker’s share of the insurance premium unaffordable when it exceeds 9.5 percent of the worker’s household income. But that calculation is based on individual coverage for the worker alone, not family coverage, which is much more expensive. That is how the wording of the law has been interpreted by the Internal Revenue Service and the Congressional Joint Committee on Taxation.

http://www.nytimes.com/2012/08/26/opinion/sunday/a-glitch-in-health-care-reform.html?_r=1&pagewanted=print

Choosing the “Best” Plan in a Health Insurance Exchange: Actuarial Value Tells Only Part of the Story
Ryan LoRe, Jon R. GabeL, RoLand Mcdevitt, and MichaeL SLoveR
ABSTRACT: In the health insurance exchanges that will come online in 2014, consumers will be able to compare health plans with respect to actuarial value, or the percentage of health care costs that a plan would pay for a standard population. This analysis illustrates the out-of-pocket costs that might result from plans with various plan designs and actuarial values. We find that average out-of-pocket expense declines as actuarial values rise, but two plans with similar actuarial values can produce very different outcomes for a given person. The overall affordability of a plan also will be influenced by age rating, income- related premium subsidies, and out-of-pocket subsidies. Actuarial value is a useful starting point for selecting a plan, but it does not pinpoint which plan will produce the best overall value for a particular person.
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Aug/1626_Lore_choosing_best_plan_HIE_actuarial_ib_v2.pdf

Cuba squeezed by health care costs

1:00 AM 

Cuba's health sector has had millions of dollars in budget cuts and tens of thousands of layoffs.

The Associated Press

HAVANA - Cuba's system of free medical care, long considered a birthright by its citizens and trumpeted as one of the communist government's great successes, is not immune to cutbacks under Raul Castro's drive for efficiency.
http://www.pressherald.com/news/nationworld/cuba-squeezed-by-health-care-costs_2012-08-26.html

Pen Bay Medical Center working to cut down high readmission rates after Medicare penalty

By Stephen Betts, BDN Staff

Posted Aug. 25, 2012, at 11:27 a.m.

ROCKPORT, Maine — The new head of Pen Bay Healthcare said steps have been taken to address the high rate of patients who are readmitted to Pen Bay Medical Center after being treated there.

Pen Bay is one of 10 hospitals in Maine being penalized by Medicare for the high rate of readmissions. The Rockport hospital’s penalty is the highest in the state in terms of percentage of payments being withheld by the federally funded health care program.

The monetary penalty for Pen Bay will be $77,590 in 2012-2013, less than one-tenth of 1 percent of revenues received by the hospital.

Medicare is imposing penalties of up to 1 percent starting Oct. 1 for hospitals with greater than acceptable rates for patients who are admitted to the hospital within 30 days of being discharged. The penalty increases to a maximum of 2 percent in October 2013 and up to 3 percent in October 2014.

Wade Johnson, the president and chief executive officer of Pen Bay Healthcare, said Thursday that reducing the readmission rate is one of the priorities. Johnson was hired in February to oversee the health care system that includes Pen Bay Medical Center in Rockport, Quarry Hill retirement village in Camden, the Knox Center for Long Term Care in Rockland, Kno-Wal-Lin Home Health Care, and the majority of physician offices in the area.

“There’s no question that Pen Bay sticks out,” Johnson said of the readmission rates.

http://bangordailynews.com/2012/08/25/health/pen-bay-medical-center-working-to-cut-down-high-readmission-rates-after-medicare-penalty/print/