More Americans oppose health-care law, but few want a total repeal

J Roberts

The nation still appears divided over the Affordable Care Act.  According to the below Washington Post article, a recent poll by ABC shows an even split over those in favor of the law and those who want a total repeal. What’s your position? We’d like to know.

Jon Cohen

The Washington Post

Republican claims that the new health-care law will hurt the country’s fragile economic recovery and inflate the deficit resonate with the public, according to a new Washington Post-ABC News poll. But few opponents of the law advocate an immediate, wholesale repeal of the legislation.

Overall, Americans’ views of the sweeping health-care overhaul, again under debate on Capitol Hill, remain firmly entrenched, with little change in stiff partisanship on the issue. Some 45 percent of those polled support the law, and 50 percent oppose it, numbers that exactly match their averages in Post-ABC polls going back to August 2009.

Three-quarters of Democrats support the new law, and 80 percent of Republicans oppose it; both are within a few points of their long-term averages. Independents tilt against the legislation, just as they have in most previous polls.

Republicans surveyed in the poll overwhelmingly see negative consequences if the law remains unchanged: 80 percent say it is likely to hurt the economy, 78 percent say it will increase the deficit, and 67 percent say it is apt to cost the country jobs. On each of these points, a majority of independents also take the pessimistic view.

On the economy generally and on jobs, most Democrats see long-term positive effects of the current law. But on the deficit, they divide down the middle, with 46 percent saying the law is more likely to increase the federal budget deficit and 46 percent saying it is more apt to decrease it.

Despite the relative popularity of the detractors’ arguments, there is still little consensus among opponents about the right approach to amending the legislation.

Those who do not support the law are split about evenly between advocating for its complete repeal (33 percent), a partial repeal (35 percent) and a wait-and-see approach (30 percent). Fully two-thirds of all Republicans say they want the law repealed, at least partly.

Recent polls on repeal yield very different answers depending on how the question is asked and how many answer categories respondents are offered. In every iteration of the question, a relatively split verdict on the law appears intact.

As reported Monday, for the first time in Post-ABC polling, congressional Republicans are now tied with President Obama on the question of whom the public trusts when it comes to dealing with health-care change. Overall, 43 percent of Americans approve of the way the president is handling the issue, matching a career low; 52 percent disapprove.

Another factor in the debate is that a quarter of those who oppose the health-care law say the legislation is faulty because it did not go far enough, not because it pushed change too far.

The poll was conducted by telephone Jan. 13 to 16, among a random national sample of 1,053 adults. The results from the full poll have a margin of sampling error of plus or minus 3.5 percentage points.

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Single Payer System Takes Center Stage in Vermont

J Roberts

Looks like single payer healthcare coverage is very much alive in Vermont.  Even though the national public outcry over a single payer system, deemed as socialized medicine, is very much real, Vermont is not the only state exploring and looking for alternatives to curtail the unsustainable rise in healthcare costs.   The article makes good points about those who have no insurance and those that are underinsured with only the basic minimum coverage.

Vermont Public Radio

While healthcare reform came under fire in many parts of the country, a single payer system is very much on the horizon in Vermont.

Vermont’s new governor-elect Peter Shumlin makes the case for a single payer system first and foremost as an economic issue based on the trajectory of  cost increases for the state, employers and individuals. Shumlin campaigned on a platform that calls for implementation of a single payer system, with benefits that follow the individual and are not a requirement of the employer. The system would reimburse based on outcomes rather than fee for service using technology for medical records and payment.  It would also eliminate private insurers and their administrative costs.

Earlier this year, Harvard Economics Professor William Hsiao, an expert on health care systems, was  commissioned by the Vermont legislature to develop implementation plans for healthcare system options including a single payer system. In a New York Times interview, Hsiao contends that “you can have universal coverage and good quality health care while still managing to control costs.  But you have to have a single-payer system to do it.”

Vermont would require a waiver from the federal government to implement a single payer program.  Shumlin is already lobbying President Obama about this waiver.  According to Shumlin, “the waivers is the easy part. The hard part is designing a single payer health care system that works and that delivers quality health care, gets insurers off our providers’ backs, has a reimbursement system that makes sense. … I believe if we design that system, we can sell it.”

There is solid evidence to back up Shumlin’s belief.  Exit polls tallied 59% of Vermont voters either backing national health care reform as-is (16%) or backing expansion of reform (43%).  And with the Vermont executive and legislative branches firmly controlled by one political party, there is the very real opportunity for a viable single payer system to be enacted.

According to Shumlin, “in Vermont, the cost of health care is estimated to increase by $1 billion from 2010 to 2012. For the average Vermont family of four that’s a $7,000 increase on top of the $32,000 that we now spend for health care coverage each year. Our rate of increase exceeds the national average. It is not sustainable. Health care costs are crippling our economy, hampering business growth, driving up property taxes, and bankrupting too many individuals. These costs must be brought under control. The only way to do this is for the state of Vermont to lead the nation in comprehensive health care reform.  47,000 Vermonters have no insurance. When these Vermonters become sick, they are faced with a choice—seek the care they need and risk bankruptcy, or avoid care and face debilitating health or even death. When they do choose to seek care, it is the insured that pay for it. This is an unacceptable choice in a civilized society. It also imposes ethical dilemmas on health care professionals trying to treat the uninsured. Unfortunately, this problem isn’t confined to the uninsured. Tens of thousands of Vermonters are underinsured. All too often Vermonters don’t get the care they need because of unaffordable deductibles, co-pays, and coinsurance.”

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Va. Judge Says Healthcare Reform Law Is Unconstitutional

J Roberts

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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HHS Issues Regs on Insurance Rate Increase Disclosure and Review

J Roberts

Read about the regulations concerning the new Affordable Care Act. Insurers will now have to justify any large or significant rate increases.


New proposed Affordable Care Act (ACA) regulations announced today by the U.S. Department of Health and Human Services (HHS) are intended to bring new transparency and scrutiny to proposed health insurance rate increases. These proposed rules allow HHS to work with states to require insurers to publicly disclose and justify unreasonable rate increases.

The ACA has already begun to help states strengthen or create rate review processes, HHS said. On August 16, HHS awarded $46 million to 45 states and the District of Columbia to help them improve their oversight of proposed health insurance rate increases. This is part of $250 million that the healthcare reform law makes available to states to take action against insurers


Today’s proposed regulations will build on these efforts by requiring insurers in all states to publicly justify any unreasonable rate increases beginning in 2011, as described in an HHS fact sheet. In 2011, proposed rate increases of 10 percent or higher will be publicly disclosed and thoroughly reviewed to determine if the rate increase is unreasonable. After 2011, state-specific thresholds would be set using data and trends that better reflect cost trends particular to each state. An insurance company’s justifications for unreasonable increases will be posted on HealthCare.gov and the insurance plan’s website.

Under the proposed regulation, states with effective rate review systems would conduct the reviews. If a state lacks the resources or authority to do thorough actuarial reviews, HHS would conduct them. Meanwhile, HHS will continue to make resources available to states to strengthen their rate review processes.

In 2014, the ACA empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance exchanges.


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Donuts, Diabetes and Dialysis — Doing More With Less

Doug

This week we’ve chosen to share some extracts from James Calver’s talk in the UK, “Doing More with Less” — improving care and lowering costs. His comments reflect new developments in US health care that address some of the challenges faced both sides of the Atlantic. Too many donuts (and not enough disease prevention) are driving extraordinary current and future costs of care.  New inexpensive monitoring tools and regimen adherence help diabetics and new developments in dialysis lower costs and improve patient care and experience.  He illustrates with two related debilitating diseases, diabetes and renal failure and, more often than not, the cause, avoidable lifestyle factors.

By James Calver   http://allexian.com/home

It is common knowledge that health care costs are increasing at a staggering rate in the US. Today, our health care expenses are nearly $3 trillion annually, 16% of GDP and projected to grow to 25% of GDP in the years ahead. The average family’s care costs $11,500 and this number has doubled in 5 years.

The increase in costs is driven by supply and demand factors. On the supply side, by 2020 we will have 40,000 fewer physicians. Medical technology costs outpace inflation nearly 5:1 and prescription drug spend on hypertension alone is $25 billion, a number that has doubled in ten years. On the demand side, 70% of our diseases are chronic and mostly lifestyle induced — too many donuts. Adding to the expanding waistline of health care expense is an aging population.

Several notable academics have written about the problem and the solution. Professor Clay Christensen from Harvard Business School; the originator of the term ‘disruptive technology’, writes in his new book. “…by transforming care delivery from integrated, centralized delivery points utilizing high cost interventions supported by highly skilled professionals to more disintegrated, de-centralized points leveraging lower cost interventions and supported by lower skilled professionals.” This means simply doing more with less in new, non-traditional ways and locations.

One of these new, non-traditional ways is more preventative care — 72% of chronic disease is preventable. Emergency room costs are some 80-100 times that of a wellness exam. Others include, personalized medicine tailored to the individuals needs and genome. Home care is cheaper and a better patient experience in many cases. New, lower cost treatments like Medco’s diabetic therapy management and education service. Levering inexpensive labor and technology can reduce costs dramatically.

(more…)

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Rivals Jockey for Roles in Insurance Exchanges

admin

The implementation of Health Care Exchanges has begun as part of the ramp up to the large changes in health care scheduled for 2014. The benefits of these websites will be selection and transparency of pricing for the individual and small business market. A couple of early sites are already available, including the one in New York City. This is a trend we will keep you updated on.

Wall Street Journal 11/16/2010 – By AVERY JOHNSON

 Health-technology companies are hoping that the new state insurance “exchanges” required by the federal health-care overhaul will offer them big new growth opportunities.

 EHealth Inc., an online insurance broker, has won two new government contracts for insurance websites, and has established a separate unit to go after a share of the exchange business. Benefitfocus Inc., which makes software designed for enrolling employees and others in health plans, says it is in talks with nearly 20 states to run their exchanges. Xerox Corp.’s ACS unit is circulating a white paper to states to make its case for integrating exchanges into Medicaid systems the company already runs.

 At stake is some $4 billion a year in revenue, according to an estimate by HealthConnect Systems, a tech company that aims to compete for the new business. The Department of Health and Human Services raised the stakes in September when it awarded roughly $1 million each to 48 states and Washington, D.C., to help build exchanges. Last month the agency announced it would award additional grants to help develop the necessary information-technology systems.

 Health-insurance exchanges are online marketplaces mandated by the law to promote competition and offer a way for the uninsured to find coverage. Many low-income consumers will be eligible for tax credits to help pay the premiums.

 The exchanges must be up and running by 2014, but many states hope to beat that deadline. Utah and Massachusetts have exchanges that predate the overhaul law, but the exchanges are in the early planning stages in most states. That means it may be months, or even years, before major contracts go up for bid.

 Setting up the exchanges may prove to be too complex for any one company. The 50 states could decide on as many different ways to run them.

 Companies say that some of the challenges they may face include working with insurers to get plan and price information. The exchanges will likely need to be able to verify consumers’ eligibility for federal tax credits and for Medicaid, the program for the poor, which will be expanded by the health law. They may also need safeguards to protect personal-health data and payment information, the companies say, and they will need consumer-friendly interfaces.

 Some of the potential competitors for the exchanges specialize in the consumer end of the business, while others are experienced in back-office functions, such as eligibility verification.

 EHealth, of Mountain View, Calif., operates ehealthinsurance.com, a site the company says is the largest online vendor of health insurance. It sells plans from major insurers in each state, much the way Amazon.com sells books or music.

 Last month, Florida picked EHealth and human-resources and benefits consultant Ceridian Corp. to set up Florida Health Choices, a website where small businesses can shop for coverage.

 HHS tapped EHealth this summer to collect pricing and benefits data for healthcare.gov, a federal site where consumers can compare, but not yet buy, individual health plans.

 EHealth recently established a separate government-services business focused on courting the states. “This could be a really, really good business,” says Gary Lauer, the company’s chief executive. “We are a tested solution that could work well for state governments.”

 EHealth faces some tensions in leaping into the business. For starters, the exchanges will be competing with its existing website. Mr. Lauer says the exchanges might lure consumers online, but not all of them will want to buy there. It isn’t clear how much customer support the state exchanges might have. EHealth said it offers round-the-clock support and expects to sell subsidized health plans to people who qualify.

 Insurance brokers like EHealth have little choice but to find new sources of revenue. Broker commissions are likely to be pinched by new rules which take effect next year, that require health plans to spend less on profits and overhead, including commissions. EHealth on its current system earns commissions averaging 10% to 11% on each sale —and more in the first year of a contract, says Mr. Lauer.

(more…)

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Federal health care site arrived July 1

J Roberts

Guess what became available July 1st 2010? A federal government website that gives consumers access to all the various health insurance plans. Eventually, the site will give consumers a list of all private and government health care plans for individuals and small businesses in their areas. Read on to understand the purpose and what consumers can expect to find on the site.

By Phil Galewitz, Kaiser Health News

Wish finding health insurance were as easy as shopping for an airline ticket?

A federal government website that starts July 1 takes a step in that direction. The site, for the first time, will give consumers a list of all private and government health care plans for individuals and small businesses in their areas.

The nation’s new health care law requires the site (www.healthcare.gov). Initially, it will provide just basic facts, such as the names of companies, health plans and Web links. Beginning in October, it will list detailed cost and benefits information. Consumer groups and insurers already are clashing over exactly what information should be displayed.

“What we are trying to do is create some order in the marketplace,” says Karen Pollitz, a top official at the new Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services. She acknowledges the site won’t be the Expedia of health care any time soon: “This ain’t like buying a plane ticket; it is much more complicated.”

For example, unlike the popular travel sites where people can immediately buy an airline ticket, consumers will have to contact insurers directly to sign up.

Insurers including United Healthcare and Aetna say HHS is going too far in planning to list certain data, such as the percent of claims that health plans deny, the rate at which they cancel policies after customers get sick and the number of times patients appeal coverage decisions. They say the data would mislead potential customers.

“Let’s do what the legislation sets out and not overcomplicate, which will lead to consumer confusion and higher costs,” says Aetna spokesman Mohit Ghose.

Consumer groups such as AARP and Families USA counter the data are vital in helping people pick a plan.

The site can “be the great equalizer so consumers can have equal access to information and be on the same playing field as insurance companies,” says Elisabeth Benjamin, co-founder of Health Care for All New York, a consumer health care coalition. “The government needs to make the information as open as possible.”

The site aims to help consumers navigate the insurance market. The main part of the health overhaul law takes effect in 2014, when there’s a major expansion of insurance coverage and the creation of new state-based health insurance exchanges, which are marketplaces to make it easier for individuals and small businesses to buy insurance. These exchanges will have their own websites.

“It is a very important first step to give consumers the information they need … so insurers are competing on quality of care and customer service,” says AARP lobbyist Paul Cotton.

HHS has said that in October, when it will begin listing premiums for insurance plans, it will use what Pollitz calls “sticker prices.” Actual rates could be significantly higher based on an individual’s health status. Until 2014, insurers are allowed to charge sicker people more, and to deny applications altogether.

UnitedHealthcare is concerned that consumers could misinterpret even those base prices. The company wants the site to list average prices.

Meanwhile, consumer advocates such as Benjamin say consumers should be able to get exact prices from insurers on the site. That could require patients to submit detailed medical histories — at least until 2014.

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NEW REPORT: How Will The Affordable Care Act Affect 15 Million Uninsured Young Adults?

J Roberts

Here’s some good news! According to a recent report from The Commonwealth Fund, the majority of young adults uninsured in America could gain health insurance coverage by 2014.  Looks like the Patient Protection Affordable Care Act may make some significant difference regarding the uninsured.

New York, NY, October 8, 2010—Young adults continue to represent one of the largest groups of Americans without health insurance, with nearly 15 million people aged 19-29 uninsured in 2009—an increase of more than 1 million over 2008, according to a Commonwealth Fund report released today. However, the Affordable Care Act (ACA) is poised to make a significant difference for this population, as up to 12.1 million could gain subsidized insurance once all of the law’s provisions go into effect in 2014.

The report, Realizing Health Reform’s Potential: Young Adults and the Affordable Care Act of 2010, by Commonwealth Fund researchers Sara Collins and Jennifer Nicholson, is an update of a May 2010 report, with new numbers reflecting the latest data on the number of uninsured Americans released by the U.S. Census Bureau last month.

According to the report, by 2014, when most of the bill’s provisions will have taken effect, up to 7.2 million uninsured young adults will gain coverage through Medicaid expansions and up to 4.9 million will gain subsidized private coverage through new insurance exchanges. About 1 million uninsured young adults up to age 26 are projected to join their parents’ policies beginning in 2010. The report estimates that 1.8 million uninsured young adults are not legal residents and will not be eligible for federally subsidized health insurance under the new law.

The authors conclude that, “when fully implemented, the ACA will allow young adults of all income levels to undergo a new rite of passage: establishing necessary ties with the health care system, without fear of accumulating medical debt, as they pursue their educational and career goals.”

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What’s Happening To Your Health Plan?

J Roberts

It’s open enrollment season regarding health plans and 2011 benefits. While no one is sure how the Patient Protection Affordable Care Act will play out, one thing is for certain – the immediate impact is a rise in annual premiums for most employers. This translates to a larger share in health-care costs for employees. Who is on your side to manage health care billing issues?

By AVERY JOHNSON

It’s open-enrollment season, the annual rite of fall when health-care costs hit home for most people.

Companies typically allow employees to elect their benefit packages once a year. Making this season especially tricky: the health-care overhaul, which is leading to confusion—and sticker shock—for many employers and workers alike.

For the first time in years, your benefits could well be getting more lavish—but they could cost more, too.

Companies are scrambling to comply with early provisions of the Patient Protection and Affordable Care Act, such as a requirement that plans cover dependent children up to the age of 26. Many employees will be able to count on their companies paying all their bills for preventative care, and plans must eliminate lifetime limits on coverage.

But some companies, citing the new mandates, say costs are rising too fast: In a survey of more than 1,000 employers, Mercer, a human-resources consulting firm, found that corporate health-care costs would rise by 10% next year if firms made no changes to their plans. Many are finding that they have little choice but to switch a greater share of costs to employees.

Last year, when the outcome of the health-care overhaul was still uncertain, some employers held off on making any significant alterations in their plans. That is one of the reasons the number of changes this year is so great, says Tom Richards, senior vice president for U.S. products at health insurer Cigna Corp. (more…)

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Health Insurers Plan Hikes

J Roberts

Expect more premium increases and greater out-of-pocket expenses beginning October 1st as insurers begin to roll out their plans to employers for January 1.

Health insurers say they plan to raise premiums for some Americans as a direct result of the health overhaul in coming weeks, complicating Democrats’ efforts to trumpet their signature achievement before the midterm elections.

Aetna Inc., some BlueCross BlueShield plans and other smaller carriers have asked for premium increases of between 1% and 9% to pay for extra benefits required under the law, according to filings with state regulators.

These and other insurers say Congress’s landmark refashioning of U.S. health coverage, which passed in March after a brutal fight, is causing them to pass on more costs to consumers than Democrats predicted.

Insurers say the law mandates free preventive care that raises premiums.

The rate increases largely apply to policies for individuals and small businesses and don’t include people covered by a big employer or Medicare.

About 9% of Americans buy coverage through the individual market, according to the Census Bureau, and roughly one-fifth of people who get coverage through their employer work at companies with 50 or fewer employees, according to the Kaiser Family Foundation. People in both groups are likely to feel the effects of the proposed increases, even as they see new benefits under the law, such as the elimination of lifetime and certain annual coverage caps.

Many carriers also are seeking additional rate increases that they say they need to cover rising medical costs. As a result, some consumers could face total premium increases of more than 20%.

While the increases apply mostly to the new policies insurers write after Oct. 1, consumers could be subject to the higher rates if they modify their existing plans and cause them to lose grandfathered status.

The rate increases are a dose of troubling news for Democrats just weeks before an election in which they are at risk of losing their majority in the House and possibly the Senate.

In an interview with WSJ’s Alan Murray, Aetna Chairman and CEO Ronald Williams says that a side effect of the health-care reform bill is that costs will increase. He also criticizes leaders in Washington for the demagoguery of his industry that persisted during the health-care debate.

In addition to pledging that the law would restrain increases in Americans’ insurance premiums, Democrats front-loaded the legislation with early provisions they hoped would boost public support. Those include letting children stay on their parents’ insurance policies until age 26, eliminating co-payments for preventive care and barring insurers from denying policies to children with pre-existing conditions, plus the elimination of the coverage caps.

Weeks before the election, insurance companies began telling state regulators it is those very provisions that are forcing them to increase their rates.

Aetna, one of the nation’s largest health insurers, said the extra benefits forced it to seek rate increases for new individual plans of 5.4% to 7.4% in California and 5.5% to 6.8% in Nevada after Sept. 23. Similar steps are planned across the country, according to Aetna.

Regence BlueCross BlueShield of Oregon said the cost of providing additional benefits under the health law will account on average for 3.4 percentage points of a 17.1% premium rise for a small-employer health plan. It asked regulators last month to approve the increase.

In Wisconsin and North Carolina, Celtic Insurance Co. says half of the 18% increase it is seeking comes from complying with health-law mandates.

The White House says insurers are using the law as an excuse to raise rates and predicts that state regulators will block some of the large increases.

“I would have real deep concerns that the kinds of rate increases that you’re quoting… are justified,” said Nancy-Ann DeParle, the White House’s top health official. She said that for insurers, raising rates was “already their modus operandi before the bill” passed. “We believe consumers will see through this,” she said.

Previously the administration had calculated that the batch of changes taking effect this fall would raise premiums no more than 1% to 2%, on average.

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