Medicare to Cover More Mental Health Costs
By JUDITH GRAHAM
For decades, older adults with depression, anxiety and other psychological conditions have received unequal treatment under Medicare. The program paid a smaller share of the bill for therapy from psychiatrists, psychologists or clinical social workers than it did for medical services. And Medicare imposed strict lifetime limits on stays in psychiatric hospitals, although no such limits applied to medical care received in inpatient facilities.
There was never a good rationale for this disparity, and in 2008 Congress passed the Medicare Improvements for Patients and Providers Act. The law required Medicare to begin covering a larger share of the cost of outpatient mental health services in 2010 and to phase in additional increases over time.
On Jan. 1, that process will be complete, and for the first time since Medicare’s creation seniors who seek psychological therapy will be responsible for 20 percent of the bill while Medicare will pay 80 percent, the same percentage it covers for most medical services. (Payment kicks in once someone exhausts an annual deductible — $147 next year.)
In 2008, Medicare covered 50 percent of the cost of psychological treatment. Last year, it covered 65 percent.
The Medicare change follows new regulations issued last month by the administration for the Mental Health Parity and Addiction Equity Act, which expanded the principle of equal treatment for psychological illnesses to all forms health insurance. But that law does not apply to Medicare.
“Hopefully, older adults who previously were unable to afford to see a therapist will now be more likely to do so,” said Andrea Callow, a policy lawyer with the Center for Medicare Advocacy.
But parity under Medicare remains incomplete, and hurdles still stand in the way of older adults receiving services. A 190-day lifetime limit on inpatient services at psychiatric hospitals is the most notable example. There is no similar cap on any other inpatient medical services provided through Medicare.
“It’s just an arbitrary cap that targets people with serious mental illnesses who need care,” Ms. Callow said.
Placing Odds on Your Health (and Its Cost)
By ANNA BERNASEK
What is the chance that you will rack up big health care bills in 2014?
For the typical American adult under 65 who does not have health insurance, the total of all health care bills would be $2,700. That’s according to calculations by Milliman, an actuarial firm.
The obvious problem is that you can’t know in advance if your costs for the year will be typical. If you are unfortunate enough to have a costly medical problem, you could end up with far higher bills. Milliman calculated that 5 percent of the population will incur bills, absent insurance, exceeding $47,300.
Milliman estimated what patients will be billed without insurance, not what is paid to providers. According to Milliman, uninsured patients, who don’t have the benefit of insurance negotiators, are billed about 30 percent more than insured patients. The Affordable Care Act requires individuals to purchase insurance, but at what coverage level? If half of Americans without insurance will be billed less than $2,700, as Milliman projects, a healthy person, might do better under a plan with lower premiums but with high deductibles. (They can generally run as high as $5,000 for an individual and $10,000 for a couple.)
Of course, Milliman doesn’t know whether you are likely to become sick and to be among the top 5 percent or even the top 20 percent (who are billed more than $13,300). When choosing insurance, consumers need to consider their personal situations — and their stomach for risk.
Seeing the positive changes brought by the federal health law
Despite a troubled rollout, as many as 20 million people have gained access to coverage. But GOP lawmakers have blocked wider access to Medicaid, and House Republicans' hostility is making it impossible to fix flaws.
Michael Hiltzik
5:00 AM PST, December 29, 2013
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This was the year that millions of Americans learned that health insurance is complicated. The landscape they discovered is ugly.
Paying a premium doesn't mean your costs are over. Lower premiums mean higher deductibles, higher fees at the doctor's office, higher prescription costs. You may have to pay more to see a certain doctor or go to a certain hospital.
After New Year's Day 2014, the discoveries will keep coming, when many of the newly insured use their policies for the first time. They may wonder, Why am I getting a bill? And, Why is it still so high?
And many may blame this curious, largely mythical beast called Obamacare, even though these features have been baked into the American healthcare system for years, even decades.
What they will be discovering is that the American way of health coverage is close to the worst and costliest in the developed world. The Affordable Care Act puts a dent in both those features, but doesn't eliminate them. During 2014, the country will finally start coming to grips with what to do about the features of American healthcare that haven't been measurably improved by the new law. And at the same time, the process of fixing the act's existing flaws will begin — or rather, continue.
"It's important that people realize this is a multi-year process," says Timothy S. Jost, a healthcare expert at Washington and Lee University. "I feel we're bottoming out this year in terms of the disruption of change." The hard work, he says, still lies ahead.
It's crucial that Americans don't allow the disruptions to obscure the positive changes already wrought by the Affordable Care Act, including access to insurance for as many as 20 million people previously locked out of the system by high costs and medical conditions.
Last month, Harold Pollack of the University of Chicago tried to tote up the number of people with a stake in the success of healthcare reform, using statistics from the U.S. Centers for Disease Control and Prevention. He counted 1.8 million uninsureds who had received a cancer diagnosis, 2.8 million suffering from diabetes, another million or more diagnoses with stroke, emphysema, heart disease or another serious chronic condition.
Throw in an additional 4.6 million with asthma or other pulmonary condition or liver and thyroid disease, and you've got 10.3 million uninsured Americans with "significant physical health issues." Prior to Obamacare, a huge percentage of these people, perhaps almost all of them, would have been unable to find affordable coverage at all. Now none of them can be excluded or socked with inflated premiums.
That's a population that easily swamps the number of those who are made worse off by the act. That latter figure, moreover, has been systematically overstated, due in part to confusion by customers and lazy news reporting.
http://www.latimes.com/business/la-fi-hiltzik-20131224,0,3488407,print.column
Goodbye, Dirigo Health: What Maine’s program accomplished over 10 years
Posted Dec. 27, 2013, at 1:07 p.m.
As full implementation of the Affordable Care Act unfolds, it’s hard not to reflect upon Maine’s experiences with health reform.
Certainly Maine’s Dirigo Health reform is a microcosm in this sea of change, but a full decade after its enactment the similarities are striking. Both reforms created subsidized, private health insurance, negotiated by an independent entity; both expanded Medicaid and included strategies to improve quality and lower cost; and both met with strong, well-organized conservative opposition.
States have long experimented with health reform, and in 2003 Maine led the next wave, enacting Dirigo Health Reform. A campaign promise in John Baldacci’s race for governor, it became law his first year in office, after considerable work and compromise that won strong bipartisan support but only by changing the underpinnings of the program.
Always controversial, Dirigo survived numerous assaults. Gov. Paul LePage campaigned to end the program, but instead the program continued and accepted new enrollees, albeit with reduced funding.
And, just as Baldacci’s bipartisan advisory group recommended, Dirigo will sunset on Dec. 31, 2014, as enrollees transition to the ACA’s health exchange.
A quick review of Dirigo’s accomplishments:
• Covered 40,498 people and 994 businesses with affordable commercial insurance and annually funded MaineCare coverage for about 6,500 low-income parents.
• Established an independent agency, like Massachusetts and the ACA that followed, that negotiated with insurers and bargained on behalf of members for more affordable and quality products.
• Brought new competition to the market. The nonprofit Harvard Pilgrim Health Plan, routinely ranked best health plan by the National Committee for Quality Assurance, became the Dirigo insurance carrier.
• Responded to the market, helping low-wage, part-time workers buy their companies’ insurance. Unlike Massachusetts or the ACA, Dirigo subsidized workers in small businesses, not just individuals and families.
• Covered preventive services with no co-pays required, a provision now part of the ACA.
• Bucked national trends by reducing the number of uninsured in Maine, despite the deepest recession since the Great Depression, when employer-sponsored health insurance was waning. In 2003, America’s Health Rankings listed Maine 18th among the states lacking health insurance; in 2011, Maine was sixth best in the country.
• Linked access to health coverage with efforts to limit costs and spur quality. Dirigo established voluntary targets that limited hospital costs to a 3 percent growth rate; created a state health plan to guide decisions about the health system; and launched the Maine Quality Forum, advocating for high-quality health care and helping consumers make informed health care choices. The ACA establishes a new Patient Centered Outcomes Research Center to improve quality of care nationally.
Medicaid expansion through private insurance? Not if we want lower health spending
Posted Dec. 27, 2013, at 1:17 p.m.
As the Legislature returns to Augusta this winter, some might suggest an arrangement under which Maine uses federal funds meant to expand Medicaid to instead purchase private insurance for low-income residents.
It’s an approach that’s proved more politically palatable to Republicans across the country than a direct Medicaid expansion. Arkansas, with a Democratic governor and Republican legislature, blazed the trail for the arrangement, securing the federal government’s approval to try it out. In Iowa, Republican Gov. Terry Branstad has followed suit. A number of other Republican governors are also interested. Maine Gov. Paul LePage is paying attention to those developments while he remains opposed to an expansion, his spokeswoman has said.
But is expanding coverage by having the state pay for private insurance for some of its poorest residents a good idea?
Arkansas Gov. Mike Beebe is out to prove it is. In applying for federal approval for the Medicaid expansion alternative, Arkansas said it would seek to prove those who receive private insurance rather than Medicaid will have access to more care providers than their Medicaid counterparts, will use the emergency room less and will “churn” in and out of health plans less frequently as their incomes and eligibility for services change. The idea is they would be able to stick with a private plan even if they no longer qualified for Medicaid.
In addition, Arkansas said it would get those results at a comparable cost to traditional Medicaid.
We’re eager for the results on those first three points, and we think there’s a good chance Arkansas will be proved right. On the last point, cost, we have our doubts.
There’s a reason people with low incomes don’t enroll in private insurance: They can’t afford it. Indeed, it might be unwise to read too deeply into early Obamacare enrollment numbers, but just 41 percent of those who qualified by the end of November to enroll in private insurance through the law’s exchanges had incomes low enough to receive federal subsidies meant to defray the cost. To qualify for those subsidies, someone has to make between 100 percent and 400 percent of the federal poverty level — between $26,951 and $78,120 for a three-person family.
The new participants in Arkansas’ alternative Medicaid model won’t have to pay monthly premiums, but many of them will ultimately be responsible for cost sharing — including deductibles and copayments. Even with the Affordable Care Act’s annual caps on the amount someone can spend out of pocket on medical expenses, a three-member family participating in Arkansas’ Medicaid expansion making less than $27,000 could still end up paying more than $4,200 out of pocket on medical expenses. That’s nearly 16 percent of annual income for a family that’s unlikely to have much money to spare.
Commentary: New day in health care dawns Jan. 1
Millions of Americans, in Maine and nationwide, are learning what a bargain quality health coverage can be under the Affordable Care Act.
By Kathleen Sebelius
Kathleen Sebelius is secretary of the U.S. Department of Health and Human Services.
This Wednesday, Jan. 1, will mark a new day in health care for millions of families and individuals throughout Maine.
Starting Wednesday, it will be against the law for insurance companies to deny you coverage or charge you more because of a pre-existing medical condition like diabetes, high blood pressure or asthma. And they will no longer be able to drop you from coverage just because you get sick or get into an accident.
What’s more, insurance companies will no longer impose an annual cap on your health benefits. They won’t be able to deny you coverage simply because you made a mistake on your paperwork. Most plans must cover preventive services like cholesterol and cancer screenings, at no out-of-pocket cost. And being a woman will no longer be a pre-existing condition.
It’s all thanks to the health care law: the Affordable Care Act.
If you do not have health insurance through your job, you have an opportunity to obtain quality, affordable coverage through HealthCare.gov. In fact, you may even qualify for financial assistance to help lower the cost of your premiums.
The Health Insurance Marketplace has brought choice and competition to Maine that were previously unavailable: In the Portland area, you can choose from 17 qualified health plans.
As millions of Americans learn about their new options, they’re finding just how affordable health coverage can be under the new law. A family of four in Portland earning $50,000 per year can obtain affordable coverage for as little as $103 per month (with premium tax credits).
Nationwide, six in 10 uninsured Americans can obtain coverage for as little as $100 a month or less.
And make no mistake: The plans offered on the marketplace are actual, honest-to-goodness health insurance. By law, they must cover a set of essential benefits, including visits with doctors, prescription medications, hospital stays, ambulatory care, maternity and newborn care and preventive services.
You still have three more months to enroll in affordable coverage – the deadline is March 31.
If you want your health insurance to begin Feb. 1, you’ll need to sign up by Jan. 15.
'Sticker shock' over Obamacare bolsters single-payer argument
New reporting by AP underscores systemic problems with healthcare system based on for-profit insurance model
By Jon QueallyCommon Dreams, Dec. 23, 2013
As the political uproar surrounding the Affordable Care Act has played out over recent months, one single fact remains: the private insurance model—on which the law widely known as Obamacare is based—is more complicated, more expensive, and provides less coverage than a simple, "everybody in/nobody out," single-payer model that almost every other advanced country in the world enjoys.
And even within the debate about whether or not Obamacare is a "step forward" or a "step back" for healthcare delivery in the U.S., what's become increasingly clear—as was predicted by progressive critics of the Obamacare model—is that though portions of the law undoubtedly improve the kinds of coverage that some people receive, others are still excluded from the system entirely and among those who are now purchasing insurance for the first time in their lives many will face "sticker shock" at the high premiums or out-sized deductibles.
As new reporting by The Associated Press highlights:
"As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplace and making what seems like a logical choice: They're picking the cheapest one.
"Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they're on the hook for most of the initial cost.
"The prospect of sticker shock after Jan. 1, when those who sign up for policies now can begin getting coverage, is seen as a looming problem for a new national system that has been plagued by trouble since the new marketplaces went online in the states in October."
What the AP goes on to describe is how the economic hardships that most middle- and low-income Americans experience on a daily basis compel them to choose insurance policies with the lowest monthly premium, but don't realize that the huge deductibles attached to those plans mean that they may have huge medical bills to pay before their coverage kicks in.
http://www.pnhp.org/print/news/2013/december/sticker-shock-over-obamacare-bolsters-single-payer-argument
Simple solution — single payer
By Rochelle Dworet, M.D.
Health Policy Solutions (Denver, Colo.), Dec. 23, 2013
So the Affordable Care Act is finally being implemented, even online. Our state has its own exchange, which seems to run better than the national model. The people in the states that implemented their own exchanges are all busy heaping accolades on each other. However, the real question is, “Where is the single-payer solution that would save hundreds of millions of dollars and lives?”
Our fiscally prudent cohorts should want a system of private care or whatever the provider fancies with a low overhead to administer, and one that covers everyone — namely single payer. After all, let’s remember that Medicare was implemented within six months of passage using one’s Social Security number and all the relevant information documented on index cards. No fancy computer system was required with exorbitant expenditures to make it work. Now seniors love their Medicare, as witnessed by the signs, “Government, hands off my Medicare.”
Unfortunately, the big PR firms, lobbyists and corporate giants that control the medical empire make way too much in salaries and bonuses to care about what is good for people.
We recently mourned the loss of one of the greatest civil and human rights activists ever, Nelson Mandela. Yet, we forget that the United Nations decreed that health care is a human right. We, as a civil society, have an obligation to all our brothers and sisters to afford them health care regardless of financial means.
But no, as Steven Brill pointed out in “The Bitter Pill,” his Time Magazine article last March, hospitals and clinics charge as much as they can get away with based on some medical fiction called the “Chargemaster,” a system more suited to a Star Wars movie than to humanity. Is it any wonder that we are the only developed nation with a 62 percent bankruptcy rate due to medical debt, and two-thirds of those people had insurance!
As a physician, I know that medicine does not fit a business model. Each time a patient enters into a discussion and examination for care, she breaks the mold of another algorithm and diagnostic code. Providers need to use their skills to fullest capacity and be compensated fairly whether they are in primary care or a narrower specialty. It is a team approach that creates success at wellness.
Health Policy Solutions (Denver, Colo.), Dec. 23, 2013
So the Affordable Care Act is finally being implemented, even online. Our state has its own exchange, which seems to run better than the national model. The people in the states that implemented their own exchanges are all busy heaping accolades on each other. However, the real question is, “Where is the single-payer solution that would save hundreds of millions of dollars and lives?”
Our fiscally prudent cohorts should want a system of private care or whatever the provider fancies with a low overhead to administer, and one that covers everyone — namely single payer. After all, let’s remember that Medicare was implemented within six months of passage using one’s Social Security number and all the relevant information documented on index cards. No fancy computer system was required with exorbitant expenditures to make it work. Now seniors love their Medicare, as witnessed by the signs, “Government, hands off my Medicare.”
Unfortunately, the big PR firms, lobbyists and corporate giants that control the medical empire make way too much in salaries and bonuses to care about what is good for people.
We recently mourned the loss of one of the greatest civil and human rights activists ever, Nelson Mandela. Yet, we forget that the United Nations decreed that health care is a human right. We, as a civil society, have an obligation to all our brothers and sisters to afford them health care regardless of financial means.
But no, as Steven Brill pointed out in “The Bitter Pill,” his Time Magazine article last March, hospitals and clinics charge as much as they can get away with based on some medical fiction called the “Chargemaster,” a system more suited to a Star Wars movie than to humanity. Is it any wonder that we are the only developed nation with a 62 percent bankruptcy rate due to medical debt, and two-thirds of those people had insurance!
As a physician, I know that medicine does not fit a business model. Each time a patient enters into a discussion and examination for care, she breaks the mold of another algorithm and diagnostic code. Providers need to use their skills to fullest capacity and be compensated fairly whether they are in primary care or a narrower specialty. It is a team approach that creates success at wellness.
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