Ideas of Federal Panel on Long-Term Care Don’t Include Costs
By JUDITH GRAHAM
The federal Commission on Long-Term Care on Friday issued more than two dozen recommendations meant to bolster services for older Americans and people with disabilities, but stopped short of endorsing a new public or private program to help families pay for home health care, custodial care, assisted living or nursing home services.
“We’re disappointed,” said James Firman, president of the National Council on Aging. “They kind of ducked the most important issue.”
The commission was established by Congress last January after the demise of the Class Act, a voluntary long-term care insurance program originally part of the Affordable Care Act. It was given limited resources, an ambitious agenda and a very tight timetable: the first meeting was held in June, three months before the deadline for issuing a report.
Many experts judged it a “semi-serious, halfhearted effort on behalf of the Congress,” Mr. Firman said.
Yet how to pay for the rising costs of long-term care is a pressing problem. Public programs and families spent $317 billion on long-term care services — nursing homes, home health aides and so forth — in 2011, according to the Congressional Research Service. AARP estimates the yearly value of unpaid care provided by 42 million caregivers at $450 billion.
Yet how to pay for the rising costs of long-term care is a pressing problem. Public programs and families spent $317 billion on long-term care services — nursing homes, home health aides and so forth — in 2011, according to the Congressional Research Service. AARP estimates the yearly value of unpaid care provided by 42 million caregivers at $450 billion.
More than 12 million Americans rely on long-term care services, and the number is expected to expand sharply as baby boomers age. Only impoverished older Americans and people with disabilities receive funding for long-term care through state Medicaid programs. Medicare does not ordinarily pay for long-term care.
The commission was tasked with developing recommendations for addressing this need. The report announced on Friday was passed by the commission by a 9-to-6 vote.
Among other measures, it endorsed the delivery of more long-term care services in community settings, rather than institutions; integrating long-term care more closely with medical care; improving standards for home-care workers; and creating a standardized assessment of the need for services. But the members could not agree on a way to finance expanded long-term care coverage.
In a letter to President Obama and Congressional leaders released Friday, six commissioners emphasized their conviction that “the commission’s recommendations should not increase the existing budgetary commitment to health care faced by both state and federal governments.”
Separately, five commissioners issued a statement strongly supporting a more robust publicly financed long-term care program.
Teenagers Are Getting More Exercise and Vegetables
By ANAHAD O'CONNOR
Teenagers are exercising more, consuming less sugar and eating more fruits and vegetables, a trend that may be contributing to a leveling off of obesity rates, a new study shows.
The findings suggest that aggressive anti-obesity messages aimed at children may be starting to make a difference, albeit a small one. The study was published in the journal Pediatrics on Monday.
Still, most teenagers were falling short of federal recommendations, which call for children to get at least an hour of physical activity daily, a central message of Michelle Obama’s signature “Let’s Move” campaign. The new data showed that most children engaged in an hour of exercise fewer than five days a week and spent more than two hours a day watching television, chatting online and playing video games.
The numbers also revealed something of an age and racial divide. Younger children had the highest levels of physical activity and fruit and vegetable consumption. But as children got older, the frequency of eating junk foods and engaging in sedentary behaviors crept up, along with average body mass index, a crude measure of obesity.
Black and Hispanic adolescents lagged behind whites on almost every measure of progress, even after the researchers tried to take into account the influence of socioeconomic factors.
“In some ways you can interpret what we found positively by saying we’re beginning to bend the curve, and hopefully we’ll start seeing a downward trend in obesity,” said Dr. Ronald J. Iannotti, a study author and chair of the department of exercise and health sciences at the University of Massachusetts Boston. “But there’s large room for improvement.”
The study, published in the journal Pediatrics on Monday, analyzed data from a national survey of tens of thousands of schoolchildren in grades 6 through 10, which was carried out once every four years from roughly 2001 to 2010.
Childhood obesity rates, which have more than doubled since 1980, rose slightly between 2001 and 2006, then leveled off by 2010, at roughly 13 percent. The proportion of those who were overweight also plateaued at around 17 percent.
Obesity tends to follow children into adulthood, raising the risk of heart disease and cancer as well as Type 2 diabetes, a disease that has also risen sharply among childre
As healthcare law rolls out, its effects will depend on your state
People living in states that back the Affordable Care Act will get substantial help unavailable to those in states that are fighting it. The law kicks in next month.
By Noam N. Levey
4:37 PM PDT, September 6, 2013
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WASHINGTON — Colorado residents shopping for health insurance next year will be able to compare health plans using a star system that ranks insurance companies on quality.
In Oregon and Maryland, consumers will save as much as 30% on some plans after state regulators forced insurers to lower 2014 premiums. Californians will get extra help selecting a health plan next year from a small army of community workers paid in part by foundations and the state.
As President Obama's healthcare law rolls out next month, even supporters acknowledge there will be problems. But Americans who live in states backing the Affordable Care Act will receive substantial protections and assistance unavailable to residents in states still fighting the 2010 law. That could mean confusion and higher insurance premiums for millions of consumers in states resisting the law.
Leaders in these resistant states have not set up consumer hot lines. Several state insurance regulators are refusing to make sure health plans offer new protections required by the law, such as guaranteed coverage for people who are ill. In response to the law, Florida suspended its authority to review how much insurance companies charge consumers.
"I would certainly rather be in a state that is trying than in one that is not," said Alan Weil, executive director of the National Academy for State Heath Policy. "There are going to be some big differences."
The Affordable Care Act was supposed to smooth out disparities in insurance coverage and healthcare quality between states, providing all Americans with a basic level of protection.
The law will still make some benefits available everywhere. Starting next year, all insurance plans will be prohibited from rejecting consumers who are sick. Plans cannot put annual or lifetime limits on what they cover. For the first time, all plans will have to provide a standardized set of health benefits.
And millions of low- and moderate-income Americans will qualify for government subsidies to help them buy health insurance if they cannot get coverage through their employers.
The new law will not make health coverage available to all Americans, however.
Mammograms, colonoscopies, contraception, oh my! Free preventive health care under the ACA
Posted Sept. 16, 2013, at 5:33 a.m.
Most of us visit the doctor only when we’re sick or injured. We break an ankle, get walloped with the flu, and finally dial up our physician or nurse practitioner to tell them where it hurts.
The Affordable Care Act seeks to change that. While the health reform law can’t quell your fear of needles or force your stubborn husband to schedule a physical, it’s nudging you to think about your health even when you feel well, by appealing to you where it counts. Your wallet.
Since 2010, the law has required most private health plans to cover a range of preventive care services to adults and children with no “cost-sharing.” In plain English, that means at no cost to you. Blood pressure and cholesterol tests, colonoscopies, vaccines and other services must be provided without charging you a co-pay or co-insurance, even if you haven’t met your yearly deductible.
Also included are additional preventive services for women, such as breast cancer screenings and all contraceptive methods approved by the U.S. Food and Drug Administration. You may recall the outcry earlier this year over the birth control inclusion, and months of protest by religious groups and others who argued that the act forced them to violate religious tenets against contraception. In February, the White House offered a compromise that exempts nonprofit, religious employers that object to that requirement.
The U.S. Department of Health and Human Services recently touted that in 2011 and 2012, 301,000 Mainers with private health insurance gained preventive service coverage with no cost-sharing through the act.
Consumers are less likely to get preventive care when they have to fork over a payment, explains Mitchell Stein, policy director at Consumers for Affordable Health Care, an Augusta advocacy group.
“Study after study has shown that the presence of a co-pay or co-insurance impedes [the use] of services,” he said.
In other words, make it free, and we’re more likely to wince our way through a less-than-pleasant colonoscopy or mammogram.
Another goal of the preventive care requirement is to open the door to a new type of relationship between health practitioners and their patients, one that’s less about periodic complaints and more about overall wellness, said Wendy Wolf, president and CEO of the Maine Health Access Foundation.
“By eliminating cost-sharing for preventive benefits, we’re trying to encourage people to have earlier testing so that we can catch significant illnesses earlier in the course and intervene before they become more costly,” she said.
The preventive care requirement applies to private health plans purchased both on and off the new health insurance marketplaces, where small businesses and consumers can shop for coverage come Oct. 1. So if you’re in the “individual market,” meaning you buy your own plan and will shop on the marketplace, you’ll benefit. The requirement also applies to employer plans, so if you have coverage through work, preventive services are probably free.
Free preventive care services list
Posted Sept. 16, 2013, at 5:28 a.m.
Many health plans are required to cover certain preventive care services to adults at no cost under the Affordable Care Act, such as mammograms and colonoscopies. All health plans sold through the health insurance marketplaces — where small businesses and consumers can shop for coverage come Oct. 1 — and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance:
1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
4. Blood pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal cancer screening (colonoscopies) for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. HIV screening for everyone ages 15 to 65, and other ages at increased risk
11. Immunization for adults — doses, recommended ages, and recommended populations vary:
12. Obesity screening and counseling for all adults
13. Sexually Transmitted Infection prevention counseling for adults at higher risk
14. Syphilis screening for all adults at higher risk
15. Tobacco use screening for all adults and cessation interventions for tobacco users
Preventive health services for women
Most health plans must cover additional preventive health services for women. All marketplace health plans and many other plans must cover the following list of preventive services for women without charging a copayment or coinsurance:
1. Anemia screening on a routine basis for pregnant women
2. Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
3. Breast cancer mammography screenings every 1 to 2 years for women over 40
4. Breast cancer chemoprevention counseling for women at higher risk
5. Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
6. Cervical cancer screening for sexually active women
7. Chlamydia infection screening for younger women and other women at higher risk
8. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling; must be prescribed by a health-care provider for women of reproductive age (not including drugs that induce abortion). This does not apply to health plans sponsored by certain exempt “religious employers.” Plans are not required to cover all brands of birth control.
9. Domestic and interpersonal violence screening and counseling for all women
10. Folic acid supplements for women who may become pregnant
11. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
12. Gonorrhea screening for all women at higher risk
13. Hepatitis B screening for pregnant women at their first prenatal visit
14. HIV screening and counseling for sexually active women
15. Human Papillomavirus (HPV) DNA Test every 3 years for women with normal urine test results who are 30 or older
16. Osteoporosis screening for women over age 60 depending on risk factors
17. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
18. Sexually transmitted infections counseling for sexually active women
19. Syphilis screening for all pregnant women or other women at increased risk
20. Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
21. Urinary tract or other infection screening for pregnant women
22. Well-woman visits to get recommended services for women under 65
Source: HealthCare.gov
The required preventive benefits include services found to be effective by the U.S. Preventive Services Task Force ; immunizations endorsed by the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices; pediatric services recommend by U.S. Health Resources and Services Administration ’s Bright Futures for Children program.
Little-known facts about the Affordable Care Act
Posted Sept. 16, 2013, at 5:29 a.m.
So, let’s say you’re pregnant. (Fellas, bear with me here.)
You’re thinking you’d like to breastfeed your new bundle of joy. You’re sure. Pretty sure. But how to work and nurse?
Under the Affordable Care Act, you’ll get some help figuring that out. (Plus a free breast pump for just that purpose.)
If you’re not pregnant and don’t want to be, insurance companies will pay for your birth control under the ACA. If you have little ones, you’ll have access to dental and vision care for them.
Haven’t heard about all that? You aren’t alone.
A lot of attention has been paid to the big parts of the ACA — the fact that large businesses will have to provide health insurance to workers, that almost all Americans will have to have health insurance or pay a penalty, and that the federal government will help some people pay for insurance. But the ACA is 900-plus pages long, with regulations that take up thousands of pages more.
It’s easy to miss things.
Things like these.
Breast pumps for all!
All ACA-compliant health insurance plans must provide breastfeeding support, counseling and equipment. Help may be provided before the baby’s born; it must be provided for the duration of breastfeeding.
That doesn’t mean your insurance company has to hand over a new, $1,000 hospital-grade breast pump. Pumps can be manual or electric, used and rented or new and yours to keep. That depends on your insurance plan.
Also dependent on your plan: Whether your doctor must sign off on it. Some insurance companies require preauthorization. Talk to your doctor or insurance company to find out more.
But let’s say your doctor’s on board, your insurance company has handed over the Cadillac of breast pumps (or maybe the Ford of breast pumps) and little Juniper is happily taking a bottle with Daddy, at Grandma’s or in day care.
How are you supposed to find time for all this pumping while you work? The ACA also requires many employers to provide reasonable break time — and a private location other than a bathroom — for pumping.
There are exceptions. For example, companies with fewer than 50 employees don’t have to comply if they prove such a break would impose an “undue hardship” on them. And the company doesn’t have to pay you for the time unless you’re pumping during a break that would be paid for other employees.
But if your employer fits the requirement, these accommodations must be made for as long as you are breastfeeding, for up to a year after the baby’s birth.
Birth control
http://bangordailynews.com/2013/09/16/health/little-known-facts-about-the-affordable-care-act/print/
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