HFMA

Could be trouble for the Obama administration and Healhcare in general if the December 12 ruling by Federal Judge Hudson is upheld.  Whatever the decision, 2011 will prove to be a year of polemics and intense debates as healthcare will be at the top of the political agenda.

A federal district judge in Virginia ruled on December 12 that the individual mandate, a key provision of the Affordable Care Act, is unconstitutional. The action today marks the first time that any court in the country has ruled to invalidate any part of the legislation. However, according to Virginia Judge Henry E. Hudson, there should be no immediate effect on the ongoing rollout of the law.

In a 42-page opinion, Judge Hudson wrote that the law’s individual mandate to buy health insurance exceeds the regulatory authority granted to Congress under the Commerce Clause of the Constitution. The judge wrote that his survey of case law “yielded no reported decisions from any federal appellate courts extending the Commerce Clause or General Welfare Clause to encompass regulation of a person’s decision not to purchase a product, not withstanding its effect on interstate commerce or role in a global regulatory scheme.”

Obama administration officials said they are confident that the law eventually will be upheld and stressed that any actual impact on the law would be deferred for years. They noted that the insurance requirement does not even take effect until 2014, when the Supreme Court presumably will have ruled.

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Here are some interesting facts about who visits the ER from The New York Times. One interesting fact to take note of, people with private insurance visit the ER almost as much as people without insurance.

By RONI CARYN RABIN

Americans, insured and not, make ample use of hospital emergency rooms: One out of every five visited an E.R. at least once in 2007, the latest year for which the National Center for Health Statistics has data.

Among the uninsured, 7.4 percent made two or more visits to an E.R., but so did 5.1 percent of people with private insurance. Medicaid recipients were the heaviest users of E.R.’s, with 15.3 percent of them making two or more visits during the year.

Adults in fair or poor health were most likely to go to an E.R. More than a third of them visited an emergency room at least once during the year.

People younger than 65 who said the E.R. was their only health care facility were no more likely to have gone to an emergency room than others, and for those older than 65, there were more E.R. visits by people with a usual source of care than by those without one.

More than 25 percent of non-Hispanic blacks visited an E.R., compared with 20 percent of whites and about 18 percent of Hispanics. For people younger than 75, age made little difference.

In all age groups, about one in five people went to the E.R. But among those older than 75, one in four visited the E.R. at least once.

The uninsured were no more likely to make non-emergency visits to the E.R. than anyone else — about 10 percent of visits were for non-emergencies, whether the patients had private insurance, Medicaid coverage or no insurance.

Figuring out who visits emergency rooms, how often and for what reasons involves sorting out complex interactions among many factors — socioeconomic level, health status, age, health insurance, access to health care and others.

“Our job is to provide the best numbers to inform policy and practice,” said Amy B. Bernstein of the National Center for Health Statistics. “If people are concerned about the use of emergency rooms and how to make their use more efficient or effective, they should have accurate information about who is actually using them — and not who they think is using them.”

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Will the new healthcare reform act be beneficial to patients at the cost of being harmful to business? The jury is still out, but onething is for certain, costs will continue to rise in the immediate future.

The Daily – 07/22/10

By Beth Fitzgerald

As the new federal healthcare reform law is phased in through 2014, employers will face increased costs to comply with new regulations and reporting requirements, even as their health insurance premiums continue to rise.

That was the view from Scott Rappoport, CEO of Benefit Sources & Solutions, in

Bound Brook, who presented a workshop on the new law Thursday morning sponsored by the Somerset County Business Partnership. The session was held at Financial Resources Federal Credit Union’s Bridgewater office.

Rappoport reviewed key provisions of the law, starting with the “grandfathering” of healthplans that were in effect when the new law was adopted by Congress on March 23.  Many employers can keep their old plans – but the restrictions are such that, in most cases, it will be too costly to try and hang on to an old plan, he said. “I really believe that in two years, it will be so ridiculously expensive to maintain a grandfathered plan that it won’t make any sense,” he said.

One positive aspect of the law is that it spells out the “essential benefits” – including preventive care – health plans must provide, he said, which addresses a need to “focus on wellness and chronic disease management, and getting and staying well.”

In 2010,employers with fewer than 25 workers averaging salaries of $50,000 or less who pay 50 percent of their health insurance premiums can get a tax credit of 35 percent of the employer’s premium contributions. But Rappoport said in New Jersey, a high-wage state, many small employers won’t qualify.

Yet New Jersey Citizen Action, a consumer advocacy group, this week released a report by Washington, D.C. – based Families USA that estimated more than 100,000 New Jersey businesses could be eligible for the tax credit this year.

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Buyer beware! Most people don’t realize just how much out-of-pocket spending a healthplan may cost them until they become seriously ill or are hospitalized. The below article sheds light on the out-of-pocket expenses many consumers face and what they should be aware of when choosing a healthplan.

By WALECIA KONRAD

If you’re like most people, you may think they are the same. But while it is true both terms refer to the portion of medical bills you pay out-of-pocket, these two types of cost-sharing are quite different.

A co-pay is a fixed amount that you pay each time you see a doctor or fill a prescription, usually around $10 or $20. Co-insurance is the percentage of the cost of doctor visits, hospitalizations and prescription drugs that you must pay under your insurance policy.

Let’s say your policy calls for 80/20 co-insurance. After you meet your deductible, you must pay 20 percent of your medical bills; the insurance company is responsible for the remaining 80 percent.

Many plans demand both co-pays and co-insurance. Co-insurance is especially common when it comes to hospital stays. Of all workers covered by an employer-sponsored group health plan, 51 percent must pay co-insurance for hospital admissions, according to the 2009 Kaiser Family Foundation survey of employer health benefits. The average payment is 18 percent of the total. And 53 percent of covered workers pay co-insurance for outpatient hospital visits, with an average charge of 19 percent.

Co-insurance is common in the individual insurance market. And as companies head into this fall’s open enrollment season, many are considering a switch from co-pay to co-insurance as a way to increase employee cost-sharing and contain rising health benefit expenses, said Tom Billet, director for health and group benefits at the consulting firm Towers Watson.

Because of the confusion involving co-pay and co-insurance, many patients don’t realize just how much it may cost them until they become seriously ill or are hospitalized, said Lynn Quincy, a senior policy analyst at Consumers Union. “Ten or 20 percent may not sound like much, but 20 percent of a $100,000 surgery is a lot of money,” she said.

Co-insurance payments can add up quickly for seriously ill patients. It’s not unusual, for example, for a cancer patient to need $40,000 worth of medicine in a given year.

“Co-insurance on that could be as much as $14,000, and that’s just for the drugs. That’s not even counting going to the doctor or the hospital yet,” said Stephen Finan, senior director of policy at the American Cancer Society’s Cancer Action Network.

High co-insurance and other out-of-pocket costs, including insurance premiums, can sometimes discourage patients from receiving the treatment they need. One in three individuals under age 65 diagnosed with cancer has delayed needed health care in the last 12 months, according to a Cancer Action Network poll.

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