Is this the end of health insurers?
By Sarah Kliff,
In 2012, MedStar Health, like many large employers, struggled to keep up with rapidly rising health-care costs. For three years, the company held down premiums for its 19,000 employees by absorbing the increases itself.
Most employers would have had no choice but to raise premiums — in this case, by about $550 for a family — and cope with frustrated employees. MedStar, one of the Washington area’s largest health systems, saw another option.
It would launch its own health insurance plan, offering it first to its employees. Patients would be limited to MedStar-affiliated providers, and as a result, pay lower premiums. In time, MedStar could compete with the Aetnas and Blue Crosses of the world, offering insurance to the public.
“By putting in the new health plan, we had the ability to give them an option that actually allowed savings,” said Eric Wagner, a MedStar vice president. “People who enrolled in MedStar Select got a lower premium than they had the year before.”
All of a sudden, the health system did not just send out insurance claims — it also received them. This was, for the health industry, revolutionary. Insurance plans and hospitals are typically at loggerheads. They squabble over claims that the hospitals submit and insurers sometimes deny.
“They make their money by not paying for health care to be delivered,” Wagner said of health insurers. “We make our money by delivering care. There’s always been a natural tension.”
For years, hospitals have accepted that tension as a cost of doing business. Insurers have decades of experience in the complex work of setting premiums, which requires anticipating how much care patients will need in the coming year.
Now, a growing number of large hospital systems are betting that, with a little help, they can do that just as well — or even better.
“These organizations believe that they’re really good, can capitalize on their brand and get people to enroll in it,” said Paul B. Ginsburg, president of the Center for Studying Health System Change. “They see a different way to capture these gains.”
Seeing health insurance companies as the middlemen, these hospitals are only too eager to squeeze them out.
Democrats Shrug Off Delays and Affirm Support for Health Law
By ROBERT PEAR
WASHINGTON — Congressional Democrats said Wednesday that they expected to see more delays and snags in President Obama’s efforts to carry out the new health care law, but they affirmed their strong support for the overarching goal of expanded coverage.
The comments came in a hearing of a House Ways and Means subcommittee held to investigate the president’s decision last week to delay until 2015 a major provision of the law. It requires employers with more than 50 full-time workers to offer health coverage to them.
Administration officials, invited to explain Mr. Obama’s abrupt shift in policy, said they were not ready to testify before the panel. So the task of defending the law fell to House Democrats, who were not consulted or told in advance of the delay, announced in a blog post on a Treasury Web site on the evening of July 2.
Representative Mike Thompson, Democrat of California, said: “I don’t like the delay any more than anybody else. But I would suggest that it’s better to do the delay and get this right than not to do the delay and get it wrong.”
“We had people who were one layoff away from having no insurance at all, one sickness away from having no coverage at all,” Mr. Thompson said. “That is devastating to everybody, including the business community.”
Kathleen Sebelius, the secretary of health and human services, and other federal officials had repeatedly assured Congress that the administration was on schedule in carrying out the complex law.
But Representative Peter Roskam, Republican of Illinois, said, “The administration for years has been pumping sunshine.”
Mr. Roskam said the Treasury official who disclosed the delay in the blog post was essentially whispering, “It’s not working; oops, this is a mess.”
The delay suggests that the structure of the law is “fundamentally flawed,” Mr. Roskam said.
Doctors Badmouthing Other Doctors
By PAULINE W. CHEN, M.D.
A physician friend known for her conscientious work recently disclosed that a year ago she was named in a malpractice lawsuit. The revelation rattled me not only because there were no discernible errors in the care she provided, but also because I couldn’t believe who had provoked the patient to hire a lawyer.
It was another doctor.
“I’m shocked that nothing was done sooner,” the other doctor had said when the patient went for a second opinion. “You could have died.”
The patient later decided to sue.
Like many who heard the story, I was quick to criticize the other physician. Throughout training and regularly at work, we are reminded of the importance of professionalism and respect. Shifting blame, doctors are taught, demoralizes other clinicians, undermines patient trust and compromises patient outcomes.
Surely, I thought, the doctor who had trashed our colleague was out of line, his comments aberrant. But it didn’t take long for me to recall instances when friends and I had been equally critical about other doctors’ work. And while I wanted to remember those indiscretions as private, limited to a few colleagues at most, I wasn’t entirely sure.
I had to wonder: are we all capable of talking like that in front of patients?
The answer, according to a recent study in The Annals of Internal Medicine, is an unqualified and disturbing, “Yes.”
Over the last decade, few issues have garnered as much interest among health care experts as disrespectful behavior among doctors. While sociologists have devoted careers to researching the topic, it wasn’t until the 1990s that the medical profession itself began to take serious note.
Spurred on by the increasing complexity of medicine, concerns about safety and patient satisfaction and an ever-growing urgency to contain costs, the Institute of Medicine convened a national panel of health care experts to discuss “the chasm” between what could be and what was actually being done for patients. In 2002, they published an ambitious report that called for a “sweeping redesign of the entire health system.” Realizing that vision, said the panel, would require, among other changes, better collaboration and cooperation among physicians and the creation of a “culture of respect.”
How Faith Can Affect Therapy
By ASHLEY TAYLOR
Can belief in God predict how someone responds to mental health treatment? A recent study suggests it might.
Researchers at McLean Hospital in Belmont, Mass., enrolled 159 men and women in a cognitive behavioral therapy program that involved, on average, 10 daylong sessions of group therapy, individual counseling and, in some cases, medications. About 60 percent of the participants were being treated for depression, while others had bipolar disorder, anxiety or other diagnoses.
All were asked to rate their spirituality by answering a single question: “To what extent do you believe in God?”
The results, published in The Journal of Affective Disorders, revealed that about 80 percent of participants reported some belief in God. Strength of belief was unrelated to the severity of initial symptoms. Over all, those who rated their spiritual belief as most important to them appeared to be less depressed after treatment than those with little or no belief. They also appeared less likely to engage in self-harming behaviors.
“Patients who had higher levels of belief in God demonstrated more effects of treatment,” said the study’s lead author, David H. Rosmarin, a psychologist at McLean Hospital and director of the Center for Anxiety in New York. “They seemed to get more bang for their buck, so to speak.”
One possible reason for this, he said, is that “patients who had more faith in God also had more faith in treatment. They were more likely to believe that the treatment would help them, and they were more likely to see it as credible and real.”
Of the 56 people who expressed the strongest belief in God, 27 also had very high expectations for the treatment, while nine had very low expectations. In contrast, of the 30 patients who said they had no belief in God or a higher power, only two had high expectations for the treatment.
“It’s one of the first studies I’ve read that actually looks at perhaps a mechanism” for “why we see some correlation between the strength of religious commitment or the strength of spiritual commitment and better outcomes,” said Dr. Marilyn Baetz, a psychiatrist at the University of Saskatchewan who studies the effects of religion and spirituality on mental health. An earlier yearlong study by Dr. Baetz and her colleagues found that people with panic disorder who rated religion as “very important” to them responded better to cognitive behavioral therapy, showing less stress and anxiety, than those who rated religion as less important.
Republicans’ Obamacare search-and-destroy mission
By Dana Milbank,
Watching House Republicans’ latest complaint about Obamacare brings to mind the joke Woody Allen used to open “Annie Hall,” about two elderly women at a Catskills resort.
“Boy, the food at this place is really terrible,” says one.
“Yeah, I know,” says the other. “And such small portions.”
Last week, the administration announced it was delaying by a year the implementation of one of Obamacare’s provisions, the requirement that large employers provide health insurance. You’d think the opposition party, which has spent four years denouncing the health-care reforms, would be delighted by the reprieve. But on Wednesday, Republicans on the House Ways and Means Committee held a hearing to condemn the administration — for incomplete enforcement of the law they hate.
“This committee intends to get an explanation,” proclaimed Rep. Kevin Brady (R-Tex.), chairman of the subcommittee holding the hearing. “This committee has serious questions about how and why this alarming decision was made and the effect that delaying this key provision will have on other provisions of the law.”
It was kind of the chairman to show such thoughtful concern for a law he wants repealed. And if Brady saw the delay as “alarming,” others were apoplectic. “Boy, I’ll tell you,” Rep. Sam Johnson (R-Tex.) said, beginning his remarks. “I hate to see a dictatorship come into this country, but it sure looks like that’s what’s happening with health care.”
“We see this as definitely something that leans toward socialism,” proclaimed Rep. Devin Nunes (R-Calif.).
President Obama was called a dictator and a socialist for passing Obamacare. Now he’s a dictator and a socialist for postponing it? “The irony of objecting to the delay of a program you’ve been trying to stop is no doubt lost on this room,” observed Rep. Jim McDermott (Wash.), the ranking Democrat on the subcommittee.
Tax break can help with health coverage, but there’s a catch
Posted July 11, 2013, at 9 a.m.
There are two kinds of financial help for people planning to enroll in the online health insurance marketplaces that will open this fall. One could put people at risk of having to pay some of the money back, while the other won’t.
That’s one big difference between tax credits and subsidies, both of which are intended to help people with lower incomes pay for health insurance through the new health care law.
People with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for individuals in 2013) may be eligible for tax credits to reduce the cost of their monthly health insurance premiums.
In addition, people with incomes between 100 and 250 percent of the poverty level ($11,490 to $28,725) may qualify for cost-sharing subsidies that will bring down their deductibles, copayments and coinsurance. The subsidies also reduce the maximum amount they can be required to pay out of pocket annually for medical care.
Instead of waiting until tax time to claim the credit for the premiums on their return, people can apply to get it in advance, based on their estimated income for 2014. In that case, the state health exchange, or marketplace, will estimate the tax credit and send it directly to the insurer.
But there’s a catch. When April 15 rolls around, the Internal Revenue Service will reconcile the amount of the advance payments sent to the insurer with the taxpayer’s actual income. If a person’s income is higher than the estimate, the taxpayer will have to repay the difference.
But there’s some good news, too. If a person’s income is lower than estimated, the taxpayer will get a credit.
People who qualify for the cost-sharing subsidies won’t face the same financial risk. The federal subsidies, which reduce consumers’ out-of-pocket costs, will be paid directly to insurers. They could cover thousands of dollars of costs, depending on a person’s health care usage.
But with the subsidies, if a person’s income changes during the year, he or she won’t be responsible for any extra costs.
“It’s not a reconcilable tax credit, so consumers aren’t on the hook if their income changes,” says Christine Monahan, a senior health policy analyst at Georgetown Health Policy Institute’s Center on Health Insurance Reforms.
So check out both options for cheaper premiums, but be well aware of the differences.
Role reversal: Republicans dispense Obamacare advice
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| Republican lawmakers have spent the past three years blasting Obamacare, but now they have a new role: helping people sign up for it. It’s a role reversal that puts party politics at odds with constituent service. Even Obamacare’s most strident opponents say that if people call their offices looking for help when enrollment starts in October, they’ll direct their staff to assist. “We always provide people with the best information that’s available to us. We always try to cut red tape,” said Rep. Steve King of Iowa, perhaps the House’s most vocal Obamacare critic. If someone asks for assistance, “we’re not going to shut people out of information. We’re not going to make their life more difficult. Obamacare’s bad enough to have to live under.” (Also on POLITICO: CBC to launch Obamacare tour) Obamacare is at a turning point. For three years it’s been an abstraction. But enrollment starts in October, and come January, millions of Americans will be covered. And members of Congress expect the phones to start ringing with confused constituents. Republicans are anticipating even more questions now that the White House has delayed enforcement of the employer mandate for one year, which may make a confused public even more confused. “It’s going to be hard to answer questions with the kind of uncertainty that these delays create. That’s why it would be better if you had a permanent delay,” said Sen. John Thune (R-S.D.), who added that his office will help constituents the best it can back home — while he joins a reinvigorated Republican drive in Washington to halt it. (Also on POLITICO: Blue Cross, Walgreens explain ACA) GOP lawmakers won’t go out and sell Obamacare. But they’ll answer questions. To prepare, Republican congressional staffers have been participating in calls and meetings hosted by Obama administration officials to inform them about the basics of the law, such as how enrollment will work, who will be eligible and how to sign up. The events have been open to Democrats, as well. Republican lawmakers have not had the regular sessions the Democrats have had with administration officials on how to roll out the law most effectively. Nor have they requested help with public education events from organizations like AARP, which did a lot of bipartisan outreach when Medicare drug coverage began, said David Certner, the legislative policy director of AARP. http://dyn.politico.com/printstory.cfm?uuid=6B41A14E-7221-4844-ACBF-75A4CC0910ED |
With the growing cost of health insurance the companies are starting to get hefty premiums from customers so this is why the costumers choose other insurance policies over a health insurance policy.
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William Martin
PPI Claims Made Simple