| August 1, 2013
An Obamacare scorecard: Part 2 - The hits, misses, and mixed reviews
By Trudy LiebermanIn Part 1 we examined what parts of the original law have been implemented, what parts are on hold, and what parts are gone. In this, Part 2, we assess the law as it stands so far--its hits and its misses, as well as the parts that get mixed reviews. :::::::: Reprinted with the permission of the Columbia Journalism Review |
Read Part 1 ( An Obamacare scorecard : What's gone, what's on hold, and what's still in place) here
Politico recently summed up the president's recent sales pitch for Obamacare this way: "Make the big sell by talking small." And indeed, in a mid-July address, the president tried to assure Americans that all was going according plan, Politico reported , by painting "an optimistic picture of how Obamacare is putting money back into the pockets of consumers who will soon see new competition drive down insurance rates." While the president has been focusing on some early small victories--like the rebates some people are getting due to a provision in the law--at its core the Affordable Care Act is about insurance.
When it passed, it was about giving some 30 million of the 50 million people uninsured at the time, in 2010, a chance to get insurance--for some, to buy it with help from subsidies from the federal government, and for some others, getting it through Medicaid, via an extension of the existing federal/state program for the poor. A secondary goal was to get rid of some of the worst practices in the so-called individual market, which prevented sick people from obtaining coverage and well people from affording it. There was also talk that the law would slow down the rise in the cost of US medical care, though it arguably did not contain teeth strong enough to make that happen. Forces that could actually raise healthcare costs--like consolidation in the insurance and hospital markets--would have continued with or without Obamacare. It is within this context that the Affordable Care Act to date must be scored. In Part 1 we examined what parts of the original law have been implemented, what parts are on hold, and what parts are gone. In this, Part 2, we assess the law as it stands so far--its hits and its misses, as well as the parts that get mixed reviews.
THE HITS
Coverage for young adults. According to the 2012 Biennial Health Insurance Survey, from 2010 to 2012 about 3.4 million young adults up to age 26 gained coverage under their parents' insurance policies, thanks to Obamacare. While some states and some employers already permitted young adult coverage, this popular provision has helped many young people who are starting their working lives.
No lifetime limits on insurance coverage. Anyone who has experienced a catastrophic illness or accident and found that their insurance stopped paying the bills because the costs exceeded the policy limits knows how important this provision can be. While most people never reach those limits, they could mean financial ruin to those who did. Now, insurance companies can no longer impose lifetime dollar limits on coverage, a provision the White House says has already affected 105 million Americans with individual or group coverage. Annual limits, too, will be entirely phased out by 2014. Insurers, however, are still allowed to limit the number of physician visits or treatments. Whether a policy comes with such limits will be a factor of the premium and the cost sharing a policyholder will pay . But the overall dollar limits for healthcare benefits--a factor when serious illness or accidents occur--will be a thing of the past.
Prescription drug savings for seniors.Early on, the government sent a $250 rebate check to Medicare beneficiaries who had high drug expenses--those who in 2010 had reached the so-called "donut hole," where the Medicare prescription drug law, passed in 2003, provides no benefits. The Affordable Care Act closed the donut hole gap, thanks to a deal the administration made with the drug companies. The companies helped fund some coverage for brand name drugs needed by consumers whose expenses were high enough to reach the coverage gap. That, of course, gave them entrée to new customers for those drugs. In 2011, the White House says, seniors saved, on average, $604 per person.
Preventive care benefits. The law requires most health plans to cover core preventive services recommended by the US Preventive Services Task Force--with no cost sharing on the part of the patient. These include such services as immunizations and blood pressure screenings. Other services are aimed at women , such as well-woman visits and gestational diabetes screening, are also covered without cost sharing.
Obamacare also called on Medicare to pay for one wellness exam each year for beneficiaries. (The exam is not a full-fledged physical; it's basically a visit to assess someone's health risks. Patients fill out a short health risk assessment, and the doctor may measure blood pressure and body mass or discuss strategies for improvement). The exam is free for seniors if their doctors have agreed to accept Medicare's payment in full (most do). Doctors may do other tests and provide other services like vaccinations. Some may be covered under Medicare's preventive benefits, but others may not be. The wellness exam has been underused. In 2012 only about 12 percent--about 3.1 million seniors and disabled people--enrolled in traditional Medicare (not Medicare Advantage plans) got their wellness visit.
THE MISSES
High-risk pools.
Obamacare intended these as a stopgap measure for sick people who needed insurance but have been shut out of the individual market because they had preexisting conditions, until the part of the law forbidding that takes effect. While several states had offered high-risk pools for years with little success, the health reform law pumped some $5 billion into such pools to encourage sick people to join. Advocates feared that wouldn't be enough. Medicare's chief actuarypredicted in the spring of 2010 that 375,000 people would sign up by the end of that year. Instead enrollment has been disappointing. Sky-high premiums and deductibles have deterred a lot of would-be customers. Only 220,000 people are currently in them, and states are phasing them out in anticipation of the new exchanges.
Small business tax credit. The idea here was to encourage small businesses to offer insurance to their workers by refunding a percentage of a firm's health insurance expenses between 2010 and 2013. This has n ot been a spectacular success . The Government Accountability Office found that the credit was too small to persuade business owners to spend the time and money calculating the credit to cover their workers. It was estimated that between 1.4 and 4 million companies would be eligible for the credit. In mid 2012 the Government Accountability Office reported only 170,300 firms had claimed a credit in 2010. The White House said that in 2011, the number had jumped to about 360,00O, still way short of the estimates.
MIXED REVIEWS
Medicare Advantage plans. The president came to office vowing to cut the government's overpayments to Medicare Advantage plans, which are a private insurance alternative to receiving Medicare benefits, and which have been getting more money from Medicare for services than traditional government-run Medicare pays for the same benefits. And indeed the Affordable Care Act called for some $200 billion in cuts to these plans . For years the Medicare Payment Advisory Commission reported that the government was overpaying sellers of Medicare Advantage plans, and that those overpayments were shortening the life of the Medicare Hospital Trust Fund. But administration actions over the past few years have raised questions about how serious the president is about cutting overpayments.
First came a Medicare decision that restored money to Medicare Advantage plans. The rationale was to encourage better care. Plans that earned at least three stars on a five-star scale for improving care received a bonus. Three star or average plans could get a bonus payment of three percent of what the government normally paid them to provide benefits to seniors. Then this year, as CJR noted , Medicare Advantage plans were scheduled for a reimbursement cut of 2.3 percent as part of an annual review process. But a lobbying campaign by the industry aimed at the public and Beltway pols instead resulted in a 3.3 percent increase--worth billions to insurers.
Insurance rebates. One provision of the ACA calls for insurance companies to pay out at least 80 percent of the premiums collected in benefits to policyholders. The idea here was to limit what they could spend on administrative costs and retain as profits. The administration says on August 1 that about 8.5 million people will get rebates averaging $100 because their insurance carriers did not spend enough on medical care. This year's rebates total about $500 million, compared with $1.1 billion last year, and the administration says the so-called 80/20 rule has forced companies to be more efficient and lower their premiums.
Why the mixed review? While an extra hundred bucks or so is certainly welcome news for those who get it, long-range questions remain. Insurance experts say it's not hard for the big companies to meet the new 80/20 rule. For small companies, which the administration is counting on to offer competition and lower prices of insurance throughout the system the 80/20 rule may be difficult to comply with. Time will tell.
Cracking down on fraud. On its website, the government touts the "new tools and resources provided by the Affordable Care Act" that have enabled healthcare fraud and prevention efforts to recover $4.1 billion in 2011 and $10.7 billion over the last three years. The Center for Public Integrity tells a different tale, going forward. In a piecepublished earlier this month, the Center reported:
Citing massive budget and staff cuts, federal officials are set to scale back or drop a host of investigations into Medicare and Medicaid fraud and abuse even though cracking down on government waste and cutting health care costs have been top priorities for the Obama administration.
It turns out, the Center said, the Office of the Inspector General for the Department of Health and Human Services will lose some 400 employees--auditors, investigators, evaluators--who kept an eye out for Medicare and Medicaid fraud. The agency blamed "expiring funding streams," and the sequester didn't help.
Accountable Care Organizations.Obamacare supporters eager to see lower medical costs as a result of the Affordable Care Act are pinning some of their hopes on accountable care organizations or ACOs--groups of healthcare providers who come together to provide coordinated care that eliminates duplication and theoretically poor care. Obamacare financially encourages them. A year and half ago, the government selected 32 ACOs as pioneers to test the theory that by giving patients better care, the costs would come down. A piece by Kaiser Health News in mid-July tells us that the results so far are mixed at best.
The so-called pioneers managed a gross savings of about $87 million, but only 13 saved enough money to share the savings with Medicare, which was the point of the exercise. Two plans actually owed Medicare money. Nine plans are leaving the three-year program before it ends; most are joining other arrangements that carry less risk. Medicare head Marilyn Tavenner said that "successful Pioneer ACOs have reduced costs for Medicare and improved quality of care for their patients." But Chas Roades, chief research officer at the Advisory Board Company , a health technology and research consulting firm, said, "Going forward, I think we should temper our expectations about how much money we're actually going to save through ACOs."
Looking ahead.The next stage of Obamacare is the one that we should watch most carefully, as exchanges set up by the law start selling insurance policies to the unininsured and granting subsidies help people pay for them--the heart of the Affordable Care Act. If people get better insurance for the buck, and decide they can afford the coverage rather than pay the tax penalty, and sign up in droves--that's a huge hit. But it's a complicated machine to start up and operate, and reporters need to watch closely. There are bound to be misses and mixed results. Whether they will undermine the success of the law is a big unknown. Neither the Democrats, the Republicans, or the press has a crystal ball.
THE HITS
THE MISSES
High-risk pools.
Obamacare intended these as a stopgap measure for sick people who needed insurance but have been shut out of the individual market because they had preexisting conditions, until the part of the law forbidding that takes effect. While several states had offered high-risk pools for years with little success, the health reform law pumped some $5 billion into such pools to encourage sick people to join. Advocates feared that wouldn't be enough. Medicare's chief actuarypredicted in the spring of 2010 that 375,000 people would sign up by the end of that year. Instead enrollment has been disappointing. Sky-high premiums and deductibles have deterred a lot of would-be customers. Only 220,000 people are currently in them, and states are phasing them out in anticipation of the new exchanges.
Why the mixed review? While an extra hundred bucks or so is certainly welcome news for those who get it, long-range questions remain. Insurance experts say it's not hard for the big companies to meet the new 80/20 rule. For small companies, which the administration is counting on to offer competition and lower prices of insurance throughout the system the 80/20 rule may be difficult to comply with. Time will tell.
Accountable Care Organizations.Obamacare supporters eager to see lower medical costs as a result of the Affordable Care Act are pinning some of their hopes on accountable care organizations or ACOs--groups of healthcare providers who come together to provide coordinated care that eliminates duplication and theoretically poor care. Obamacare financially encourages them. A year and half ago, the government selected 32 ACOs as pioneers to test the theory that by giving patients better care, the costs would come down. A piece by Kaiser Health News in mid-July tells us that the results so far are mixed at best.
Looking ahead.The next stage of Obamacare is the one that we should watch most carefully, as exchanges set up by the law start selling insurance policies to the unininsured and granting subsidies help people pay for them--the heart of the Affordable Care Act. If people get better insurance for the buck, and decide they can afford the coverage rather than pay the tax penalty, and sign up in droves--that's a huge hit. But it's a complicated machine to start up and operate, and reporters need to watch closely. There are bound to be misses and mixed results. Whether they will undermine the success of the law is a big unknown. Neither the Democrats, the Republicans, or the press has a crystal ball.
Health insurance rates call for higher bills in rural Maine regions
Posted:TodayUpdated: 7:37 AM
Proposed plans under new coverage exchanges include one annual differential of $1,000.
By Joe Lawlor jlawlor@pressherald.com
Staff Writer
Staff Writer
An Aroostook County resident who buys a health care plan on the new federal insurance exchange could pay $1,000 more per year in premiums than a Portland resident for exactly the same coverage, according to information released Wednesday by the Maine Bureau of Insurance.
The rates released Wednesday must still be approved by the federal Centers for Medicare & Medicaid Services. And customers with incomes between 100 percent and 400 percent of the federal poverty level will be eligible for subsidies to help with the cost.
How much consumers pay will not only depend on how comprehensive a plan they choose, but also their age, whether they use tobacco and where they live.
http://www.pressherald.com/news/health-rates-call-for-higher-bills-in-rural-regions_2013-08-01.html
Examples offer prices, benefits of new Maine health plans
Posted:TodayUpdated: 12:56 AM
Some deductibles would be high, but subsidies would reduce costs for Mainers with lower incomes.
A 25-year-old single person living in Portland and earning $25,000 would pay about $150 per month – after a federal subsidy – to buy one of the plans on Maine's new health care exchange, according to one insurance provider.
A 50-year-old single smoker living in Lewiston and earning the same annual salary would pay $369 per month after the subsidy for the same plan.
In both cases, the policy holders would have to spend $5,000 of their own money for most health services before the insurance carrier starts covering the costs.
A full-scale analysis of newly released insurance rates available through Maine's exchange is not yet possible because information about the plans being offered is incomplete. However, one insurer -- Maine Community Health Options co-op -- released a few examples of plan costs and benefits to the Press Herald on Thursday, offering a first glimpse of the costs and coverage.
Regulators approve Maine health plans under Obamacare, but impact remains unclear
Posted July 31, 2013, at 7:24 p.m.
AUGUSTA, Maine — The state’s insurance bureau met a deadline Wednesday to report on how much some Maine consumers and businesses will pay for health coverage under the Affordable Care Act, often called Obamacare, but the impact of the new federal health law remains unclear.
The bureau released hundreds of pages of documents filed by two insurance carriers that plan to offer policies on Maine’s health insurance exchange, an online marketplace where consumers and small businesses will be able to shop this fall under the Affordable Care Act. Wednesday was the deadline for regulators in Maine and other states to approve insurance rates for the exchanges and report to the federal government.
In submitting the documents, the Maine Bureau of Insurance reported to the U.S. Department of Health and Human Services that the plans complied with health insurance regulations and appear to meet federal requirements to be sold on the exchange. The federal department will render the final decision.
The two carriers selling policies on Maine’s exchange are Anthem and the nonprofit Maine Community Health Options, which is new to Maine’s insurance marketplace. Consumers can begin enrolling in October, with the plans taking effect Jan. 1, 2014.
Maine’s submission to the feds was expected to shed light on how much consumers and small businesses will pay for insurance through the exchange and what benefits the plans will include. The trove of documents included a framework for how the insurers will set rates, but not a summary or side-by-side comparison of the plans, making it difficult to determine what consumers actually will pay, said Joe Ditre, executive director of the Augusta-based Consumers for Affordable Health Care.
“This gobbledegook is absolutely infuriating,” he said. “They’ve got to do a much better job of putting this into a format and form that the average consumer can understand.”
The documents detail how factors will raise or lower consumers’ premiums from a base amount — including their age, where they live and whether they smoke — but fail to include a needed breakdown of how much consumers can expect to pay for each product, he said.
“You’ve got to do all this complicated factoring in order to figure this out,” Ditre said. “That’s not the way to do it.”
Even when clear information about pricing becomes available, consumers will have to determine whether they’re eligible for federal subsidies that could lower their premiums, he said.
Elsewhere in the country, regulators have used the release of exchange plan pricing as a political opportunity, declaring their support or disdain for Obamacare. Ohio, New York, California and other states have seen fierce public debate about their numbers, with liberal and conservative analysts heralding both dropping rates and skyrocketing prices based on the information.
Some states have produced side-by-side comparisons and issued press releases about whether health insurance rates were increasing or decreasing under Obamacare. But comparing health insurance plans is inherently difficult, as many consumers and employers are well aware — and was so even before the reform law’s up-ending of the health insurance market — given the variety in consumers’ circumstances and types of plans and benefits.
David Clough, Maine’s director for the National Federation of Independent Business, had a chance to scan the hundreds of pages of filings the state released on Wednesday.
“My eyes are going in circles and my head is kind of swimming,” he said.
The basics of Maine’s health insurance exchange
Posted July 31, 2013, at 10:22 p.m.
What is a health insurance exchange?
An online marketplace where consumers and small businesses can shop for health insurance under the Affordable Care Act. The goal of the exchanges is to make health insurance more comprehensive and affordable.
Some states will operate their own exchanges, while Maine and 26 other states have opted to have them run by the federal government.
The exchanges will allow consumers to compare and purchase insurance from private carriers. Government-sponsored insurance, such as Medicaid and Medicare, will be offered next year much as it is now.
Four basic types of plans will be available: Platinum plans will pay 90 percent of the cost of covered medical services, on average, with consumers picking up the other 10 percent; gold plans will pay 80 percent; silver plans 70 percent; and bronze plans 60 percent. Premiums will vary, with platinum plans generally costing more than bronze plans.
Consumers can use the exchange to determine if they’re eligible for Medicaid and the Children’s Health Insurance Program.
Almost everyone who can afford health coverage must have it by 2014 or pay a penalty. In states that have declined to expand Medicaid under the law, including Maine, people who earn less than 133 percent of the federal poverty level ($15,282 for an individual, $31,322 for a family of four) will be exempted from the penalty.
When can I shop on Maine’s exchange?
Enrollment in the plans begins in October, with the plans taking effect Jan. 1, 2014. Consumers and small-business owners will be able to sign up online or through a toll-free phone hot line.
Which carriers will offer plans on Maine’s exchange?
Two health insurers have applied to sell policies on Maine’s exchange, Anthem Blue Cross and Blue Shield and the nonprofit Maine Community Health Options, a new player in Maine’s insurance market that will be governed by policyholders.
Who can shop on the exchange?
For the most part, people who have health insurance through their employer and those covered by public insurance — Medicaid, Medicare, and military and veterans’ coverage — won’t be shopping for insurance on the exchanges. That’s most of Maine’s insured population.
About 5 percent to 8 percent of Maine’s population is expected to shop for insurance on the exchange, according to the Maine Bureau of Insurance.
Individuals — those lacking insurance and people who already buy their own insurance rather than get coverage through an employer — and small businesses with 50 or fewer full-time equivalent employees will be eligible. Small companies of that size aren’t required to offer health insurance to workers, but larger companies will be penalized if they don’t,starting in 2015.
In Maine, that’s an estimated 257,000 people.
But how many of those people actually buy their coverage on the exchange is a guessing game. The final number could be a fraction of those who are eligible.
Consumers will have other options, as insurance companies can sell policies on the exchange, outside the exchange or both. Maine Community Health Options plans to sell individual, family and small-business policies both on and off Maine’s exchange. Anthem will sell its small group policies on and off the exchange.
Some of the 33,500 Mainers who buy their own insurance (about 4 percent of the population) may opt to purchase plans off the exchange directly from health insurers. Roughly a third now buy their insurance from companies other than Anthem, primarily Mega Life and Health Insurance Co., and may stick with that coverage. Mega still will sell plans in Maine, but not on the exchange.
Similarly, some of the 91,000 people who have coverage through a small business could continue getting coverage from several insurers that plan to stay in Maine’s market but not sell policies on the exchange.
Another group eligible to shop on the exchange, Maine’s 133,000 uninsured (about 10 percent of the population), are more likely to do so. But they could choose to remain without coverage and pay a penalty, become eligible for Medicaid, or find a way to afford an off-exchange plan.
People who accept health insurance through an employer or a family member’s employer can’t shop for insurance on the exchanges, except in limited cases. Or they can turn down the coverage (and lose any contribution from their employer) and shop on an exchange. They won’t be eligible for any help paying their premiums, though, unless the employer’s coverage isn’t considered affordable and comprehensive under federal standards.
Here’s where it gets even more complicated: If the premium offered by the employer costs more than 9.5 percent of a person’s annual household income — for individual, not family coverage — or if the employer’s plan pays less than 60 percent of the cost of covered benefits, then the employee can drop employer coverage and shop on an exchange, and may be eligible for a tax credit.
People with public health insurance, including Medicaid, Medicare, and veteran’s coverage, won’t really be affected by the exchanges. Roughly 500,000 of Maine’s 1.3 million people are covered by public health insurance.
What kind of financial help will be available to pay for health insurance?
By logging on to the exchanges, consumers can learn if they’re eligible for two types of financial help to pay for health coverage, depending on income and family size.
Some people can get a tax credit to lower the amount of their monthly premium. Individuals and families with incomes of up to 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013) may be eligible.
There’s also a new option to lower out-of-pocket costs, including deductibles, co-payments and co-insurance. The “cost-sharing subsidy” is available to those with incomes of up to 250 percent of the poverty level ($28,725 for an individual and $58,875 for a family of four in 2013).
The less income a family has, the larger the subsidy.
For small businesses, some with fewer than 25 employees may qualify for a tax credit of up to 35 percent of premium costs in 2013 and up to 50 percent in 2014.
What benefits will the plans include?
All plans are required to offer a comprehensive set of health benefits including doctor visits, preventive care, maternity care, hospital treatment, mental health and substance abuse treatment, and prescriptions.
Plans can’t deny coverage to people with pre-existing conditions or charge them more. Maine beat federal health reform to the punch on that requirement. It has placed limits on insurers denying coverage to people with many pre-existing conditions since the early 1990s, which the Affordable Care Act outlaws starting in 2014. Nationally, this will lead to higher premiums for healthy people compared with before the law and lower premiums for the sick.
Next year, the Affordable Care Act also prohibits insurers from setting a dollar limit on how much they spend for a core group of benefits over a policyholder’s lifetime.
For information about health insurance exchanges, visit www.healthcare.go
Aetna's Profits Rise After Managed Care Plan Purchase - Kaiser Health News
The insurer's second quarter earnings increased 17 percent as it reaped enrollment and revenue gains from its acquisition of the managed health care company Coventry Health Care Inc.
The Associated Press/Washington Post: Health Insurer Aetna's 2nd-Quarter Profit Rises 17 Percent, Helped by Coventry Acquisition
Aetna Inc.’s second-quarter earnings jumped 17 percent, and the health insurer raised its 2013 forecast as it reaped revenue and enrollment gains from its acquisition of fellow insurer Coventry Health Care. The Hartford, Conn., company said Tuesday that it earned $536 million, or $1.49 per share, in the three months that ended June 30. That's up from $457.6 million, or $1.32 per share, a year ago (7/30).
The Wall Street Journal: Aetna Earnings: Membership Keeps Growing
In May, Aetna acquired the managed-health-care company Coventry Health Care Inc. to bolster its presence in government-financed health care. The cash and stock deal, worth $5.7 billion when announced in August, added about 3.7 million medical members and 1.5 million Medicare Part D members. While Aetna's revenue has improved over the past year, its profit came under pressure as consumers started to return to former health-care usage patterns amid an improving U.S. economy (Warner, 7/30).
http://www.kaiserhealthnews.org/Daily-Reports/2013/July/31/marketplace-aetna.aspx
July 31, 2013
WASHINGTON – To mark the 48th anniversary of Medicare, congressional lawmakers and consumer advocates today called for Medicare to be expanded to provide health insurance to all Americans and highlighted a new study showing that a Medicare-for-all, or single-payer, system would save enough money to cover all of the 44 to 50 million uninsured Americans.
Participants in a rally outside the U.S. Capitol included U.S. Rep. John Conyers (D-Mich.), U.S. Sen. Bernie Sanders (I-Vt.), other members of the Congressional Progressive Caucus and representatives from Public Citizen, Physicians for a National Health Program, Labor Campaign for Single Payer Healthcare, Kentuckians for Single Payer Healthcare, Health Care Now! and All Unions Committee for Single Payer Health Care–HR 676. The event was preceded by a congressional briefing about the cost savings of a Medicare-for-all system and followed by lobby visits.
Although the Affordable Care Act (ACA) is designed to ensure that many more Americans are covered by the time the plan is fully implemented, a single-payer system would achieve far greater savings than the ACA, which maintains the role of the costly and wasteful private insurance industry. It also would be less complicated to put into place because it is already in place for Americans over 65 in the form of Medicare.
"The solution to our nation's health care crisis isn't cutting Medicare," said Robert Weissman, president of Public Citizen. "It's strengthening Medicare and expanding it to cover everyone. A Medicare-for-all, single payer system will ensure that every American is covered as a matter of right, and will save hundreds of billions of dollars by eliminating costs imposed by the wasteful private insurance industry."
The new study, done by Gerald Friedman, professor of economics at the University of Massachusetts Amherst and released today by Physicians for a National Health Program, shows that upgrading the nation's Medicare program and expanding it to cover people of all ages would yield more than a half-trillion dollars in efficiency savings in its first year of operation, enough to pay for high-quality, comprehensive health benefits for all residents of the United States at a lower cost to most individuals, families and businesses.
http://www.pnhp.org/print/news/2013/july/to-mark-medicare-anniversary-lawmakers-and-advocates-rally-for-expansion-of-program-t
The Associated Press/Washington Post: Health Insurer Aetna's 2nd-Quarter Profit Rises 17 Percent, Helped by Coventry Acquisition
Aetna Inc.’s second-quarter earnings jumped 17 percent, and the health insurer raised its 2013 forecast as it reaped revenue and enrollment gains from its acquisition of fellow insurer Coventry Health Care. The Hartford, Conn., company said Tuesday that it earned $536 million, or $1.49 per share, in the three months that ended June 30. That's up from $457.6 million, or $1.32 per share, a year ago (7/30).
The Wall Street Journal: Aetna Earnings: Membership Keeps Growing
In May, Aetna acquired the managed-health-care company Coventry Health Care Inc. to bolster its presence in government-financed health care. The cash and stock deal, worth $5.7 billion when announced in August, added about 3.7 million medical members and 1.5 million Medicare Part D members. While Aetna's revenue has improved over the past year, its profit came under pressure as consumers started to return to former health-care usage patterns amid an improving U.S. economy (Warner, 7/30).
http://www.kaiserhealthnews.org/Daily-Reports/2013/July/31/marketplace-aetna.aspx
Alternative Treatments Could See Wide Acceptance Thanks to Obamacare
By: Kaiser Health News and Ankita Rao
Jane Guiltinan said the husbands are usually the stubborn ones.
When her regular patients, often married women, bring their spouses to the Bastyr Center for Natural Health to try her approach to care, the men are often skeptical of the treatment plan -- a mix of herbal remedies, lifestyle changes and sometimes, conventional medicine.
After 31 years of practice, Guiltinan, a naturopathic physician, said it is not uncommon for health providers without the usual nurse or doctor background to confront patients' doubts. "I think it's a matter of education and cultural change," she said.
As for the husbands -- they often come around, Guiltinan said, but only after they see that her treatments solve their problems.
To mark Medicare anniversary, lawmakers and advocates rally for expansion of program to include every American
U.S. Rep. John Conyers, U.S. Sen. Bernie Sanders, others push for single-payer health care system
By Public Citizen (news release)July 31, 2013
WASHINGTON – To mark the 48th anniversary of Medicare, congressional lawmakers and consumer advocates today called for Medicare to be expanded to provide health insurance to all Americans and highlighted a new study showing that a Medicare-for-all, or single-payer, system would save enough money to cover all of the 44 to 50 million uninsured Americans.
Participants in a rally outside the U.S. Capitol included U.S. Rep. John Conyers (D-Mich.), U.S. Sen. Bernie Sanders (I-Vt.), other members of the Congressional Progressive Caucus and representatives from Public Citizen, Physicians for a National Health Program, Labor Campaign for Single Payer Healthcare, Kentuckians for Single Payer Healthcare, Health Care Now! and All Unions Committee for Single Payer Health Care–HR 676. The event was preceded by a congressional briefing about the cost savings of a Medicare-for-all system and followed by lobby visits.
Although the Affordable Care Act (ACA) is designed to ensure that many more Americans are covered by the time the plan is fully implemented, a single-payer system would achieve far greater savings than the ACA, which maintains the role of the costly and wasteful private insurance industry. It also would be less complicated to put into place because it is already in place for Americans over 65 in the form of Medicare.
"The solution to our nation's health care crisis isn't cutting Medicare," said Robert Weissman, president of Public Citizen. "It's strengthening Medicare and expanding it to cover everyone. A Medicare-for-all, single payer system will ensure that every American is covered as a matter of right, and will save hundreds of billions of dollars by eliminating costs imposed by the wasteful private insurance industry."
The new study, done by Gerald Friedman, professor of economics at the University of Massachusetts Amherst and released today by Physicians for a National Health Program, shows that upgrading the nation's Medicare program and expanding it to cover people of all ages would yield more than a half-trillion dollars in efficiency savings in its first year of operation, enough to pay for high-quality, comprehensive health benefits for all residents of the United States at a lower cost to most individuals, families and businesses.
http://www.pnhp.org/print/news/2013/july/to-mark-medicare-anniversary-lawmakers-and-advocates-rally-for-expansion-of-program-t
House Republicans just itching for a shutdown
Posted Aug. 01, 2013, at 2:16 p.m.
House Republicans, in their final days at work before taking a five-week vacation, have come out with a new agenda: “Stop Government Abuse.”
A more candid slogan might be: “Stop Government.”
This is traditionally one of the busiest weeks of the year, when the House rushes to complete the dozen annual spending bills so that the Senate can pass them before the new fiscal year begins Oct. 1. But there is no hurry this time. Instead of taking the lead on spending bills as the House traditionally does, lawmakers are instead proceeding with bills such as one “guaranteeing a citizen’s right to record conversations with federal regulators.”
That legal protection for recording devices might be a fine idea. But the real “government abuse” is what the House itself is doing: Only four of the 12 appropriations bills have cleared the chamber as of this writing. And because the House plans to be in session just nine days in September, that guarantees that government finances won’t be in order in time for the new fiscal year.
House Republicans aren’t even trying to get the job done — which would seem to confirm the suspicion that they are precipitating a crisis.
The budget and appropriations processes have been a mess in recent years under both parties’ control, and there was no expectation this year would be different. But this time the slow walk serves conservatives’ singular purpose of undermining Obamacare. Because the appropriations won’t be completed by Oct. 1, Congress will have to pass a temporary extension, or “continuing resolution.” This kitchen-sink measure gives House Republicans the power to shut down the federal government if President Barack Obama doesn’t agree to their demands — particularly the repeal of health care reform.
On Monday, leaders of influential conservative groups such as the Club for Growth, Heritage Action, Family Research Council, FreedomWorks and Americans for Tax Reform sent a letter to House leaders begging for a donnybrook. “The best and last chance for House Republicans to stand up and thwart this law before its new entitlements kick in is during the upcoming funding debate,” they wrote, “and the House should live up to the moment and pass a bill funding the government but denying any funding for Obamacare.”
Newcomer Sen. Ted Cruz, R-Tex., who is pushing for a shutdown showdown, spelled it out on Andrea Tantaros’ radio show: “We need 41 Republicans in the Senate or 218 Republicans in the House, to stand together, to join me” in saying that “we will not vote for a single continuing resolution that funds even a penny of Obamacare.” Cruz has since taunted “scared” Republicans who oppose his idea and dismissed as “cocktail chatter” the notion that a government shutdown would be a bad move for Republicans.
Happily, a number of Senate Republicans have called that idea daft. But it’s a different matter in the House, where the obsession with rolling back Obamacare takes on yet another form Friday with a vote on a bill blocking the Internal Revenue Service from implementing the health care law. In that sense, the lack of urgency with which the House is handling the spending bills makes perfect sense: It gives Republicans another swing at Obamacare. So what if economic chaos is a side effect?
Posted Aug. 01, 2013, at 12:15 p.m.
NEW YORK — Patients going to a hospital for surgery care about many things, from how kind the nurses are to how good the food is, but Consumers Union figures what they care about most is whether they stay in the hospital longer than they should and whether they come out alive.
In the first effort of its kind, the nonprofit publisher of Consumer Reports magazine released ratings of 2,463 U.S. hospitals in all 50 states on Wednesday, based on the quality of surgical care. The group used two measures: the percentage of Medicare patients who died in the hospital during or after their surgery, and the percentage who stayed in the hospital longer than expected based on standards of care for their condition. Both are indicators of complications and overall quality of care, said Dr John Santa, medical director of Consumer Reports Health.
Among Maine hospitals, the data included ratings for Eastern Maine Medical Center and St. Joseph Hospital in Bangor, St. Mary’s Regional Medical Center and Central Maine Medical Center in Lewiston, Maine Medical Center in Portland and MaineGeneral Medical Center’s Waterville campus. Other hospitals had insufficient data for ratings.
St. Mary’s placed highest, with an overall safety score of 67 and high marks for its low incidences of bloodstream infections compared to the national average. The hospital scored poorly for the number of patients who in surveys said doctors always explained new drugs. CMMC in Lewiston trailed St. Mary’s at 61 points. MaineGeneral in Waterville came in third with a score of 58.
In Bangor, St. Joseph bested EMMC 55-52. Both got low marks for drug information, and EMMC got poor scores for bloodstream infections and avoiding readmittance, which is based on the chance of heart attack, heart failure or pneumonia patients being readmitted to the hospital within 30 days of being discharged.
Maine Medical Center in Portland came in last with 47 points, getting low marks in bloodstream infections and drug information.
The ratings will surely ignite debate, especially since many nationally renowned hospitals earned only mediocre ratings. The Cleveland Clinic, some Mayo Clinic hospitals in Minnesota, and Johns Hopkins Hospital in Baltimore, for instance, rated no better than midway between “better” and “worse” on the CU scale, worse than many small hospitals. Because CU had only limited access to data, the ratings also underline the difficulty patients have finding objective information on the quality of care at a given facility.
Aetna and Maine health organizations’ experimental approach aims to improve care, lower costs
Posted Aug. 01, 2013, at 2:43 p.m.
Insurer Aetna announced Thursday that it has partnered with five Maine health organizations in an effort to reward providers financially for keeping patients healthy and happy.
Aetna will form “accountable care organizations” with MaineGeneral Health of Augusta and Portland’s Mercy Health System of Maine, InterMed, P.A., MaineHealth and Martin’s Point Health Care, the insurer announced in a press release. Accountable care organizations, a cornerstone of the federal Affordable Care Act, are alliances of doctors and hospitals tasked with better coordinating patients’ care.
The experimental approach rewards health providers with financial incentives for keeping patients healthy rather than steering them toward more visits and procedures. If providers reduce costs while providing high-quality care for a certain population of patients, they can share in the savings with the health insurer. Likewise, if they fail to cut costs or miss certain quality targets, hospitals may get pinched financially.
Aetna, which administers the health plan for Maine state employees, said the new arrangements will benefit state workers and all of the company’s customers in Maine who visit the health systems or their affiliated providers for care.
Under each of the five new accountable care agreements, the providers will become part of a health care network and receive information about patients’ medical care and medications. Aetna expects that to lead to better coordination of care that will help reduce duplicate testing and appointments and simplify the health care experience for patients.
 | |
Hill gets Obamacare fix
| |
| Lawmakers and staff can breathe easy — their health care tab is not going to soar next year. The Office of Personnel Management, under heavy pressure from Capitol Hill, will issue a ruling that says the government can continue to make a contribution to the health care premiums of members of Congress and their aides, according to several Hill sources. A White House official confirmed the deal and said the proposed regulations will be issued next week. (PHOTOS: 25 unforgettable Obamacare quotes) Just Wednesday, POLITICO reported that President Barack Obama told Democratic senators that he was personally involved in finding a solution. The problem was rooted in the original text of the Affordable Care Act. Sen. Chuck Grassley (R-Iowa) inserted a provision which said members of Congress and their aides must be covered by plans “created” by the law or “offered through an exchange.” Until now, OPM had not said if the Federal Employee Health Benefits Program could contribute premium payments toward plans on the exchange. If payments stopped, lawmakers and aides would have faced thousands of dollars in additional premium payments each year. Under the old system, the government contributed nearly 75 percent of premium payments. Obama’s involvement in solving this impasse was unusual, to say the least. But it came after serious griping from both sides of the aisle about the potential of a “brain drain.” The fear, as told by sources in both parties, was that aides would head for more lucrative jobs, spooked by the potential for spiking health premiums. http://dyn.politico.com/printstory.cfm?uuid=5A754D54-0FCE-4974-9155-C283E89AF9E3 |
No comments:
Post a Comment