Federal health care legislation could add hundreds of millions of dollars in costs to Georgia’s state budget, but advocates and opponents differ greatly on whether the state can afford it. As the health care debate has raged in Washington, the issue of the cost to states has become a fire-hot topic. The single greatest cost to states is expected to be the vast expansion of Medicaid coverage for poor people.In Georgia, the state Department of Community Health has estimated the additional state costs would start at $100 million to $200 million a year when the program begins in about 2013, and increase over a half-dozen years to upwards of $500 million a year.DCH’s estimate is Georgia’s only official state analysis. A separate review by a federal nonprofit group called Federal Funds Information for States said the bill approved last week by the U.S. Senate would cost Georgia about $145 million a year from 2017 to 2019.It is unclear why these numbers differ from the state’s estimates.State officials acknowledge that their analysis is far from final, as the Senate bill changed after the analysis was done. Differing House and Senate bills have passed, and the two houses must now forge a compromise.A spokesman for Gov. Sonny Perdue said the estimates remain in the ballpark.“The state would be looking at hundreds of millions of dollars per year,” said Perdue spokesman Bert Brantley.Republicans, including Perdue, say the state cannot afford these added costs at a time of severe budget belt-tightening. The 2010 Legislature, convening next month, is expected to have to cut hundreds of millions of dollars from the state budget.“This bill places an unsustainable burden on the backs of Georgia’s taxpayers, and will lead to either higher state taxes or massive cuts to basic state services in years to come,” Perdue said of the Senate bill.Some medical groups also worry that the measures would drive up costs to hospitals and doctors, as well as people’s individual insurance coverage.Democrats reject the idea that health reform would place a heavy burden on the state, its hospitals or its people.“We’re not going to do anything to put the state in bankruptcy,” said U.S. Rep. John Lewis, an Atlanta Democrat.“When you count the costs and look at the benefits, it’s going to make things better not just for the state of Georgia but for all of America,” Lewis said.Under the final legislation, Medicaid enrollment could spike in Georgia. Medicaid is a national program, funded by the federal and state governments, which pays for medical care for many who can’t afford it.Georgia does not generally provide Medicaid to single adults with no children, and has a tougher eligibility threshold for parents to obtain Medicaid than many other states, said Timothy Sweeney, a senior health care analyst for the Georgia Budget and Policy Institute.Both of those areas could change under the health care overhaul, said Sweeney, who wrote an opinion piece favoring the initiative in The Atlanta Journal-Constitution on Tuesday.Both the House and Senate bills would expand Medicaid eligibility so that it would be available for a family of four earning roughly 150 percent of the federal poverty level.Georgia’s thresholds vary from about 55 percent of the federal poverty level for working parents to 100 percent or more for children, Sweeney said.Georgia’s analysis of the House bill said the state’s Medicaid enrollment could increase by 77 percent, with an estimated increase of 756,000 people. Georgia has about 1.7 million uninsured people.Many of the remaining uninsured could qualify for planned government subsidies to help them afford private insurance. Some others may be illegal immigrants who would not be eligible for subsidies or Medicaid, Sweeney said.Both the House and Senate bills provide full federal funding in the first few years for those who are newly eligible for Medicaid, and afterward provide up to 90 percent of the costs. The costs would then rise significantly, according to the state analysis.Under the House proposal, the expansion would cost the state about $93 million in 2013, the first year of the program, according to the state analysis.Even though the federal government would pay for the newly eligible people, the state believes that the push to sign up people for Medicaid would draw many people who are already eligible but had not signed up.In addition, the state is estimating that the increased Medicaid enrollment will require more staffing and other administrative costs, to the tune of about $35 million in 2013.Still, advocates say it is a great deal for Georgia.“This is a big benefit for a state like Georgia,” in that many people with no health coverage would become eligible for Medicaid, said Sweeney.Sweeney said $128 million is a small percentage of a state budget that is about $17 billion a year, which makes the proposal “a bargain for Georgia. It’s a small price to the state, considering all the federal dollars coming in to help people get health insurance.”Kelly McCutchen, president of Georgia Public Policy Foundation, a conservative group, disagrees.“Ten percent of a very big number is still a very big number,” he said. “It’s money the state doesn’t have right now.”
Archive for the ‘Uninsured Hospital Bills’ Category
Health bill to hit Georgia budget
Sunday, February 28th, 2010Oklahoma insurance commissioner Kim Holland says health bill is flawed
Friday, February 26th, 2010State Insurance Commissioner Kim Holland has several concerns about the health care bill being debated by the Senate and doesn’t think it would contain costs or induce a significant number of the uninsured to purchase coverage, according to a letter the Democratic commissioner wrote Sen. Tom Coburn.Holland was critical of a key part of Senate Democrats’ health care legislation — a government-run health care plan that would compete with private plans. As currently written, the Senate bill would allow states to opt out of the so-called public option, and Holland said Oklahoma likely would not participate.First, she said, if the reimbursement rates for doctors and hospitals were low, as they are in the Medicaid and Medicare programs, there would be more cost-shifting to private plans.Moreover, she said she shares the concerns of many opponents of a public option — that it would potentially allow the federal government “to assert an unfair advantage that would adversely affect our insurance markets and further stress our health care delivery system.”The Senate today began its second week of debate on its health care bill, which Democratic leaders hope to pass by Christmas. A fight is expected early this week on an amendment to prevent public money from being used for abortion services, either in a public option or from private plans if public subsidies are involved.The Senate bill would require individuals to purchase health insurance, and Holland lauded that goal. But she said the penalties in the Senate bill for those who don’t buy insurance aren’t high enough to force compliance.”The penalty is $95 the first year, increasing to $750 in year three,” Holland wrote. “This penalty is inadequate to induce a large-scale take up of health coverage among Oklahoma’s uninsured. Even with generous premium credits, the absence of a strong non-compliance penalty will not encourage the desired and necessary take-up among the young and healthy to offset the greater risk and cost of the older and unhealthier.”She said the Oklahoma Health Care Authority has estimated there are nearly 600,000 uninsured working Oklahomans and nearly half are between the ages of 19 and 32.”There is no indication that most of those uninsured would voluntarily enroll in any health benefit plan,” she wrote Coburn.If only older people with health conditions have an inducement to buy coverage, she said, the Senate bill won’t lead to lower premiums for coverage.”Data shows that the number one driver in health insurance premium costs are increased medical costs and utilization. As you know, on average, between $0.80 and $0.90 of every premium dollar for a comprehensive health plan is spent directly on benefits to policyholders,” Holland wrote.”Of concern to us are reports from the (Congressional Budget Office) and others that the Senate reform plan will reduce premium costs. In actuality, we believe premium costs will rise substantially if adverse selection is allowed to occur and if the cost of medical care is not addressed. While the generous premium subsidies contemplated by the bill will indeed reduce an individual’s expense in financing their health care needs (a strategy we agree is necessary to ensure affordability), health insurance premiums will not be lower.”Coburn, an Oklahoma Republican who opposes the Senate bill, called Holland’s letter “a fairly strong indictment from somebody who cares about the people of Oklahoma and what is going to happen in health care.”
Healthcare Compromise – The Uninsured and Problems Facing Healthcare
Thursday, February 25th, 2010Although there is room for improvement in our health care system, our current path will not solve the underlying problems. We need reform but we don’t need the confluence of bureaucracy and regulations currently under construction.
First let’s examine some facts: It seems everyone agrees there are around 47-48 Million uninsured. Of that total the White House includes 9.7 million foreigners, (Many of those illegal). And, according to the same Census report, 8.3 million uninsured people earn between $50,000 and $74,999 per year, and 8.74 million make more than $75,000 a year. That’s roughly 17 million people who ought to be able to “afford” some health insurance, (they make substantially more than the median household income of $46,326). Furthermore, a 2003 Blue Cross/Blue Shield association study estimated that about 14 million of the uninsured were eligible for Medicaid and/or SCHIP and would be signed up automatically if they went to the hospital. Technically these people have health insurance.
All-in that leaves 6.26 million Americans who are truly without health insurance. Hmmm, Should we spend 1 trillion dollars and completely alters the health care delivery, payment, and responsibility to satisfy 2% of the entire U.S. population? Along the way should we cut physician and hospital reimbursement for care? Does anyone believe cutting compensation will improve care? That’s what is proposed.
Examining the uninsured population a little further we see that 45% of the uninsured are “temporary”. It’s unclear which of the above categories they fall into. However, statistics show that these 20 million “uninsured” are without insurance for an average of only 4 months. Sure “temporarily uninsured” is dangerous. Many go longer than 4 months, and if care is required during the temporary period it can cause significant financial damage to families as well as the institution obligated to provide medical care. This point needs to be addressed. However, the current solution doesn’t specifically address this problem.
Lastly, the issue of “quality of care” in the U.S. verses other countries. Anyone who doesn’t inherently suspect that health technology and techniques in the U.S. is not one of the best in the world is delusional. This propaganda is distorted misinformation from a study performed by the World Health Organization (WHO). The report is not an analysis of care (The U.S. ranks #1 in outcomes for 14 of 16 cancer treatments) but more an analysis of social contributions towards healthcare. Since my goal is facts and solutions I will sum up the report for the otherwise misinformed. The WHO report has several major factors that contribute to country rankings. One major factor is: Individual Financial Contributions to healthcare. The scoring method is biased towards countries with higher levels of social (government) contributions. The result is a penalty effect on those countries with lower government expenditure. The scoring system further penalizes the U.S. for higher homicide and motor vehicle deaths which have nothing to do with healthcare delivery. The bottom line is it would be nearly impossible for a country like the U.S. with a “free-market” health system to score high in the overall ranking. Bottom line, the U.S. is #1 in healthcare not so high in government financial intrusion.
Now that we have some facts let’s examine where there may be some legitimate concerns, and address some specific areas for improvement. The unintended consequences of the proposed solution will be enormous. To rush into a social experiment of this magnitude without every reasonable outcome fully vetted and addressed is reckless.
The problems:
Rapidly rising cost, A growing burden on individuals, families, and employers to maintain premium payments, the inability of those with health issues to get health insurance, the temporary uninsured, and the 6.2 million that may require some legitimate support and safety net.
For the benefit of society we need some way to manage this group (33M) for the greater good of society as a whole. However, the reality is that there are options available today that would resolve a big chuck of these obstacles. What we need is reasonable fine tuning to maintain relevance to the modern economic environment – Not the 1950’s environment. For one, there are high deductible health saving accounts which have not been embraced by individuals. Millions of uninsured could afford these premiums ($75-100/month for average 40 year old) yet they opt for nothing. This is just irresponsible on the part of many and it affects us all when these people (earning over 50K/year) become ill, and transfer their burden to society.
Another significant factor driving up cost is the fragmented system of regulation on our current health insurance market. Simplifying this system, providing new health technology, modernized regulatory and oversight, and standardized infrastructure including claims forms etc. would drive out significant overhead, create synergies, improve productivity, increase competition, and further drive out waste and unnecessary spending. This is the only area where we should ever see government involvement in a capitalistic society. Creating infrastructure and a platform on which capitalism can thrive. (i.e. interstate transportation system)
Next: The burden associated with the uninsured entering a hospital/emergency room. Hospitals account for these services under the indigent care expense line in there budget and make up the loss by overcharging the insured.
The final factor is addressing the reality of the “truly uninsured”. The burden (financial or otherwise) regardless of whether they are temporary, illegal, foreign, or have sufficient income – they must be dealt with. A real solution does not ignore reality nor should it jeopardize 250 million people to fix the problems of 6 million.
Solutions:
The following concepts will specifically impact the major issues facing the U.S. health delivery system. I have defined these major categories as: 1) Cost control 2) Minimize provider loss, 3) Reduce Insurance premiums 4) Provide catastrophic coverage for every American 5) Create an environment of affordable, manageable health delivery 5) Minimal added cost. What follows is a 21st century, free market based, U.S. world leadership solution. They are the foundation of a real solution, a place I believe many of us can agree.
1) A system that insures displaced worker for up to one year. Most individuals look at COBRA through the lens of unemployment and conclude that it’s unaffordable. Of course they do; they’re unemployed. Employers should be required to provide some minimum level of health insurance for 12 months after unemployment. After year 1 the displaced employee could choose to buy the minimum coverage in that employer group for an unlimited time frame. Result, they are able to stay in that group as long as premiums are paid, no preexisting condition discrimination, and this specifically addresses the problem of the uninsured and uninsurable.
The minimum standard coverage would include 2 parts: First, some preventative and basic health care. i.e. 2 doctors visits annually plus some diagnostic coverage benefit. I would limit this coverage to $500 per recipient or family member. This would keep people going to doctors and minimize future catastrophic needs. Also it gives the unemployed or those doing other work access to a group health plan. Anyone who has at least one job in life would have coverage as long as someone paid a reasonable premium. The second part of the minimum requirement would be catastrophic coverage over $100,000 to the $250,000 threshold. Individuals could have the option to purchase “gap” coverage to fill in between $500 and $100,000 if they choose. Once employed again the individual would be transitioned to the new employer group and responsibility transferred. (This would only apply to groups over some predetermined level i.e. 50 members)
2) We need a National health Insurance Regulatory Agency so insurers who provide policies over several states could meet ONE regulatory requirement recognized by all states. I would make this requirement significant in areas of financial capitalization, loss reserve, as well as other necessary standards. It should be tougher than any state so that there is no “systematic risk” in the event of one national provider failure. Essentially, it should be tough enough to almost eliminate the possibility of failure. This would create an environment in which national plans would emerge strengthening competition and reduce insurance cost. Large insurance plans would not have to contend with 50 regulators, and regional providers that can do better on a local level would remain and drive out cost on a regional level. An insurance “exchange” as is currently being discussed would be a sufficient alternative but I don’t believe it will work. It is irrational to allow New Yorkers to buy insurance in Georgia or Indiana. Those plans are priced for those geographic areas and insurers will just impose higher premiums in zip codes they don’t want business. In addition how will an insurer be regulated in NY that may be based in Tennessee? It seems like it adds more – not less – bureaucracy, but I am open to suggestions.
3) Minimize provider loss: The burden of the uninsured on hospitals, and other providers. This is one of the major issues driving up the cost for the insured. I would impose an off budget, segregated, “Lock box” type trust fund that could not be borrowed from EVER. A small tax on wages would provide for catastrophic coverage over a $250,000 threshold for every American. Since this would be a separate tax on income (over federal poverty level) it would bring every worker into the system including those wage earners with sufficient income to afford some coverage but skate by without. These individuals currently add cost by increasing risk, utilizing ER services for care, and those who have insurance pay higher prices and premiums.
As these individuals are brought into the system they can still opt out of other coverage but the high burden they place on the system is reduced and their newly captured tax pays for their catastrophic coverage. At least they have coverage above 250,000. Hospitals are relieved of the burden of losses above the 250k. The catastrophic burden is mitigated and shared by every Americans and more importantly foreign workers, and those irresponsible Americans earning sufficient wages but not contributing to the system.
Important: Those currently insured are rewarded when the artificial inflation of services is reigned in and provider loses are mitigated. This will result in some reductions in health insurance premiums, offsetting at least some portion of the tax paid. Additional premium reductions would occur since most insurance policies cover up to 2 million, 5 million, or even unlimited benefit limits. Those who currently have health insurance would see further premium reductions as the liability above 250K is transferred from insurance companies to the trust fund (could be phased in once the trust fund is in place). The total tax to those already insured would be offset – in time – by the savings. But I’m not banking on 100% return, but the added costs will be borne predominately by those who can afford the coverage in the first place but choose to ignore the need.
Results: relaxed underwriting standards, (insurer would be more willing to accept some riskier applicants since exposure is limited). This expands the availability of reasonably priced health insurance for those with preexisting conditions and/or elevated risk profiles. This further addresses the uninsured however many would eventually become tied to some group plan. (above)
4) “Cost control”: (The ugly and anti-free market dilemma) – The government could create a reimbursement rate for services provided above the catastrophic amount controlling expenditures at the high end. This would be applied to high cost treatment and procedures only. An area where we could realistically apply responsibility over a group of multiple providers (Physicians, hospitals, and pharmaceutical providers) for the package treatment and healthcare of one. (Although not entirely necassary.) The plan could include BONUSES for quality of care, outcomes, and other health performance criteria that many advocate.
I would allow providers and hospitals to balance bill (up to 15%) and opt out of the catastrophic coverage system altogether (not likely since they would be exposed to loses when any uninsured presented in their emergency room and they were mandated to provide service) ALL group and individual “comprehensive” plans would have to include excess charges. However “Gap” plans available to individuals (one that paid up to the 250K cat coverage) would not. These “Gap” plans would only be available as HSA accounts and would include a minimum ($50/month) HSA contribution. The trade off here is the HSA contribution would belong to the specific individual but could only ever be used for healthcare. This is the trade off for purchasing individual coverage without the “excess” coverage feature. Theoretically the HSA owner would be saving for catastrophic expenses that went into the “excess” dimension. The insured would have the option to purchase these hybrid HSA plans or purchase plans that included the additional excess coverage. Result: Under The new reform the 20 something’s obligated into the system could accumulate (with HAS’s) 10′s of thousands of dollars in their 20′s and 30′s which could be used later in life as health care needs become more likely. Later in life it could be used for individual or family healthcare and eventually it could be applied toward LTC premiums after age 55. That would solve ANOTHER problem facing the U.S. healthcare system.
As many have stated when individuals use there own accounts they spend more wisely. Having ownership of a health plan from the age of 18 or 21 keeps individuals involved. Ultimately we’ll create an environment were everyone pays something, everyone gets something and everyone has some level of affordable healthcare insurance. No government intrusion necessary.
Some additional Details: Similar to our current environment HMO’s and other insurers would still negotiate reimbursement of excess charges above the 250K catastrophic limit. The plan provider would manage and make payments to providers but would be reimbursed at the scheduled rates from the healthcare trust. Further we need to also reform HSA account use and expand premium tax deductions to individuals. The employer provided version requires users to spend down these accounts each year. This is Dumb. We need to allow employer based MSA’s to accumulate over years.
Although the “excess” billing option creates an environment of complexity to this solution it allows some sensible variations in pricing and regional cost variations. At the same time it does not create a system that encourage providers to “excess bill” and individuals to avoid the coverage. The result may be some high end clinics, hospitals and providers, but this is no different to the free-market environment present in the current hospital and provider system. Some providers will always be better than others. Experience and expertise will naturally accumulate in “pools” this is Nature at work and a working plan will have to accomidate the laws of nature.
In a later phase I MIGHT require all insurers to cover all applicants at a maximum of 2x the base rate. Or create some sort of national high risk pool and assign applicant to plans bases on plan size and other factors. This would make health care coverage attainable to those remaining high risk individuals. I would only consider this after several years and the impact of phase one of the health care reforms I have proposed is evaluated. Another option is a “High risk” reimbursement for those who have been denied coverage from 2 of more insurance providers. They would pay 2x the base rate from a provider of their choice and the government would kick in the balance necessary for the provider to take in the previously denied applicant. (Details on this portion world need to be worked out)
Many readers might retort that I overlooked items such as Malpractice Insurance and caps on lawsuits. I trust you I did not. Certainly there are additional issues that need addressing but healthcare reform should not be confused with other reform. We must find common ground and that sometimes means shrinking the ground to be covered. (pay attention Washington)
Before we continue on any such reform we should keep a few simple principles at the top of any government reform package including healthcare:
1) Do no harm2) Improve the system for everyone. Society should provide a safety net, but it should be simple and just – No excessive burden on any class.3) Minimize government involvement (infrastructure, regulatory platforms, and technology platforms are the role of government – Not biased competition, or industry takover) If you don’t understand the hidden costs of government involvement - Read this next.4) Find Common Ground – Horse trading is not working in Politics. Effective legislation can only be accomplished when we find areas of agreement and commit to legislation directed to specific areas on which there is agreement.
Responsible government means specifically defining problems, outlining solutions, and analyzing reasonable outcomes. There needs to be sufficient time for review before instituting reform. 30-60 days seems rational time for debate and analysis. Anything less is irresponsible. Our Constitution was not completely ratified for 9 months and it took 3 months before the first state put its signature on the plan. The current rush into new programs is our current governments attempt to cloak what is happening from the public. It is a disgrace, and the absence of these principles is destroying our great country. We need to return to the place our founders created. (1 – large – page I might add)
Code Red: Texas In Crisis Over Number Of Uninsured
Tuesday, February 23rd, 2010The American populace has been sufficiently bombarded by information on the “health insurance crisis,” the “healthcare crisis,” the “community crisis.” Despite living in a country where everyone is supposedly entitled to equal access, another horrifying and dismal piece of information seems to be released almost everyday on the declining state of healthcare for the uninsured and underinsured,
The uninsured die more often, receive less preventative care, less therapeutic care, and are diagnosed at more advanced stages of disease than the insured. One-third of those who went without insurance did not receive a recommended test or treatment due to cost in 2004, three to four times the rate of the insured. Texas is the hardest hit, with 25% of its population currently uninsured, in some areas more like 33%. What we have to ask now, knowing we have a major problem on our hands, is what all this actually means for those who lack individual health insurance.
It means that hospitals, clinics, and emergency rooms are shutting down across the country, including in major cities like Dallas and Houston, due to lack of funding, in part because of covering the costs of treating uninsured who had nowhere else to go. It means you may not have an emergency room in your community next year.
The number of doctors no longer accepting Medicaid “the government’s free insurance program for the low-income” is climbing, and the number of those accepted to the program is decreasing, due to a 2006 Congressional approval of $46.1 billion in budget cuts to the program over the next ten years. That means those foregoing needed medical attention, including those in Texas, because they simply can’t afford it, is also on the rise. The extent of this situation is difficult to even estimate, because those who don’t have insurance are less likely to get checked, and those who don’t at least attempt to receive care don’t make it into most of the studies. That means if, like so many, you are uninsured, this could be you.
According to the U.S. Census Bureau, 46 million, or 15.7% of the population, went without health insurance in 2004. Almost one-third of the non-elderly went without in 2002-2003 – 43% for Texas – and millions more were considered underinsured in the same years.
Texas has the highest percentage of uninsured adults, working adults, and children, only a portion of whom are actually in poverty. According to the Institute of Medicine, a large percentage of the uninsured are working individuals who can sustain themselves, but who cannot afford health coverage due to rising costs; premiums alone have increased an average of 15% over the last five years nationally, and employee spending for healthcare increased by 143% between 2000 and 2005.
It’s difficult, particularly for young people, to conceptualize the consequences of not having individual health insurance until a catastrophe, even a small one, hits.
“Yeah, it’s horrible,” grumbles David*, a construction worker who has worked in Arizona, Texas, and New Mexico. “There’s always work in the Southwest because the weather is so great, but most of the time I can’t do it anymore because of this,” he says, aggravated, pointing at his midsection. “It’s not the worst thing that could have happened to me, but it’s definitely one of the more damaging to my career.”
David, 29, suffered a hernia four months ago, a condition that is usually not life-threatening, but inhibits a person from performing certain activities, including heavy lifting. With no individual health insurance of his own, the only way it will be treated properly is if he can somehow pay for the expensive surgery himself. “Medicaid won’t cover me because my average income is too high, workers’ comp won’t cover me because it didn’t happen on the job, and the hospitals won’t cover me because it’s not a life-threatening situation. I don’t have my own insurance because the premiums are too high. So what am I supposed to do? Construction is the only skill I have.”
What this translates into, practically, is that David now has to choose between the lesser of two evils. He risks serious injury by taking assignments requiring heavy lifting – almost all construction jobs – but not working means he can’t pay the bills. As a high school graduate who went directly into construction, he has little experience outside of the field, and no other skilled trades. “It’s either this or fast food.”
Texas, with the highest rate of uninsured and some of the strictest guidelines to qualify for Medicaid, is a prime example of how difficult receiving adequate healthcare is without coverage. While Medicaid and the State Children’s Health Insurance Program is largely the state’s responsibility for those who actually make the cut, care for medically indigent patients is the county’s responsibility, and funding across the state varies widely. Some counties only provide for those without any, or with extremely low, incomes – which means that cities like Dallas, Houston, San Antonio, and Austin are absorbing the cost of patients coming in from other parts of the state. But Texas cities have their own problems; 28% of Houston residents, for instance, are uninsured themselves.
And the problem is not just with healthcare, but with all the aspects of personal life and the economy that poor health can affect. Poor health, for a notable example, negatively impacts educational status, which, in turn, negatively impacts health. The problem is so urgent in Texas that a Task Force of ten of the state’s academic institutions was created to address the crisis. The Task Force concluded – among other things – that, “in the absence of vigorous initiatives” to correct the situation, hospitals and emergency rooms will continue to close, the state’s economic power will decrease, and both state and county budgets will spin into crises.
So what does this Code Red for Texas mean exactly? It means that if you’re uninsured, you have less access to care, lower quality of care when you get it, and a higher chance of the care you get being too little, too late. It means that if you’re unfortunate enough to contract cancer while uninsured, you are statistically more likely to get diagnosed at a later stage of disease, more likely to receive less therapeutic (i.e., effective) care, and, sadly, more likely to die. It means that if you’re uninsured and diagnosed with HIV, or diabetes, or high blood pressure, you will probably suffer a similar fate.
Texas’ Code Red also means that, under the current conditions of the economy and healthcare system, you’re statistically more likely to survive, or suffer less severe consequences of a disease, if you invest in health insurance. While the country, of course, needs to fight the dysfunction that created this terrible situation, you had best protect yourself. It could literally be a matter of survival.
What Happens When the Uninsured Go to the Emergency Room?
Monday, February 22nd, 2010The U.S. Census Bureau reports that an increasing number of people are now unable to afford medical insurance. Some 47 million people do not have medical insurance. When they begin to fall sick, there is nothing that can be done if money is short. When it comes to a choice between food on the table and treatment, most people decide to eat. They hope they will get better. When health does not improve, there is no improvement in the choice to be made. If treatment remains unaffordable, they have to wait until their sickness worsens to the point it can be considered an emergency. At this point, people decide to go to the emergency room at their local hospital. Federal law is very clear. Hospitals are under a positive legal obligation to treat everyone who walks in through the door. It does not matter whether the emergency is real, in the sense of a traffic accident inflicting unexpected injury, or to some extent manufactured, where the condition only becomes an emergency because of a deliberate delay. People must be given treatment. The difficulty is that most of the uninsured cannot afford to pay their bills. The hospitals can and do issue invoices for the treatment given and drugs supplied. This is also a part of the law. People have a responsibility to pay for their treatment. But hospitals are realistic about their chances of collecting. Continued pursuit for payment usually results in bankruptcy and the creditors only get a few cents in the dollar. So, hospitals make a rational decision. They spread all the unpaid bills among all those who can pay. In other words, whether you are paying out of your own pocket or you are relying on your own health insurance to pay for your treatment, a percentage of every hospital’s bill is a provision against bad debts from the uninsured. The irony is that everyone who is insured is also insuring all the uninsured for their emergency room visits. If you have been wondering why your own health insurance premiums have been going up so sharply of late, it’s because there is a wave of uninsured people going to the emergency rooms around the country. The health insurers are having to pay more and this additional cost gets passed on in the premiums. Is it going to get any better? No. It’s actually going to get worse. Ever more people are finding health insurance unaffordable. Even with sites like this which allow people to find the cheapest insurance around, many still find the premiums too much. That does not mean you should give up. Using this site will get you offers. Then it’s up to you to negotiate directly with the insurer or its agents to get the best actual premium for the cover. It’s not worth the risk of being uninsured. If at all possible, get some cover.
Health-care bill passed 60-39 could mirror Canadian style rationing system
Saturday, February 20th, 2010The health-care bill, which is President Obama’s top domestic priority, would extend insurance to about 30 million people who now lack it, expand the reach of Medicaid for the poor, and impose new rules on health insurance companies. It would cost about $871 billion over 10 years, but raise more than that in new taxes and fees and cuts in Medicare. Democrats win the vote 60-39 over Republican objections.With the economy struggling to break the chains of a job-destroying recession. Under Obama-care, Americans will be forced to buy government-approved health insurance and anyone earning a middle class wage will have to pay for it out of their own pocket. Federal subsidies will only be provided for people who are not offered coverage by their employer and earn below the 400 percent poverty level. Families whose employers drop their plan will be forced to buy it on their own – at a cost of over $15,000 dollars a year. “The Senate health care bill gives employers two powerful incentives to stop offering health insurance coverage to their workers,” writes Terry Jeffrey“First, if an employer does offer coverage, its lower-wage workers will lose the federal insurance subsidy they would otherwise get.Secondly, if an employer does not offer coverage, the $750-per-worker fine it faces will be far less than the premiums it would pay if it did offer coverage.”Families struggling in this deep recession who earn a combined total greater than $88,200 and don’t have their health care covered by their employer will be hit with a mandatory annual fee of about $15,000 according to the Congressional Budget Office’s analysis of the final Senate health-care bill.There is nothing voluntary about Obama’s health-care mandate:The Senate has dismissed concerns over the individual insurance mandate and the tax penalty imposed on those who don’t meet that requirement. If you refuse to pay the penalty or you refuse to provide any information on your health-care status on your tax return, you will face the prospect of being audited by the Internal Revenue Service. This is supposedly a “voluntary mandate” and the IRS can’t do anything against you if you refuse to pay the penalty. They claim that because page 340 (A) and (B) of the bill waives criminal prosecution of taxpayers and says that no liens or levies can be filed on the taxpayer’s property. That claim is wrong.Congressional Budget Office’s (CBO) itself made clear that the financing of health-care reform is based in substantial part on generating $167 billion in “penalty payments” from individual taxpayers and employers.The IRS, which is known for its habit of disregarding court decisions that disagree with its interpretations of the law, may use audits and the ability to find problems in a taxpayer’s finances in areas totally unrelated to the health care mandate to force compliance with the mandate and coerce payment of the tax penalty imposed by Reid’s bill. according to The Heritage Foundation, The very idea of using the taxing powers of the state to force compliance with this law is one that should shock the conscience of everyone, even those who support “reforming” our health care system.Obama’s answer to the question posed by George Stephanopoulosin an interview, “Under this mandate, the government is forcing people to spend money [to buy insurance], fining you if you don’t. How is that not a tax?’’“George,’’ chided Obama, “the fact that you looked up Merriam’s Dictionary . . . indicates to me that you’re stretching a little bit right now.’’Merriam-Webster’s definition of “tax’’ – “a charge, usually of money, imposed by authority on persons or property for public purposes.’’One place to look to see what the universal coverage would do is the state of Massachusetts, about 200,000 state taxpayers remained uninsured in the beginning year of 2008, it hasn’t made insurance more affordable, Massachusetts has the highest health insurance premiums in the nation. It rose by 7.4 percent in 2007, 8-12 percent in 2008 and will expect to rise 9 percent this year who knows what 2010 will bring, according to Jeff Jacoby who’s article entitled Mandatory insurance: Yes, it’s a tax, addresses the promise Obama’s made not to raise taxes on any American family earning less than $230,000 a year, contradicts that by supporting legislation that would force every American to carry health insurance or pay a hefty penalty to the IRS.Some of the taxes that will be imposed on the public under the new health-care bill that has people taken back with concern: according to H.R. 3590 Patient Protection and Affordable Care Act.Section 1501 – Requirement to maintain minimum essential coverage – Individuals will be required to maintain health insurance. Those that do not will be assessed an annual tax penalty of $750. The tax penalty is scheduled to escalate in subsequent years. Consequently, Massachusetts residents that do not maintain health insurance will be assessed a tax at both the state and federal level.Section 9001 – Excise tax on high cost employer-sponsored health coverage – This provision levies an excise tax of 40 percent for any health coverage plan that is costs over $8,500 per year for single coverage and $23,000 per year for family coverage. Since this was protested vigorously by unions and public employees, the Senate caved and granted a massive concession. The tax is not levied on the individual receiving the tax free benefit, but is levied on the insurance company or plan administrators that provide the employee the benefit. How absurd is that?Section 9008 – Imposition of annual fee on branded prescription pharmaceutical manufacturers and importers – This piece of the legislation imposes a $2.3 billion excise tax on the pharmaceutical industry. The tax is allocated across the industry and is based on market share, not on income. This tax starts immediately and is non-deductible for the corporation being taxed. These companies will still be required to pay their federal income taxes.Section 9009 – Imposition of annual fee on medical device manufacturers and importers – This section imposes a $2 billion excise tax on the medical device industry. The fee is allocated across the industry based on market share, not on income. This tax starts immediately and is non-deductible for the corporation being taxed.Section 9010 – Imposition of annual fee on health insurance providers – Another excise tax. This one is assessed on the health insurance industry in the amount of $6.7 billion taxed out and is also based on market share. How can the imposition of $11 billion in excise taxes (section 9008, 9009 and 9010) on the health care industry reduce costs to consumers? Does anyone else suspect these companies will have to pass these costs over to consumers?Section 9013 – Modification of itemized deduction for medical expenses – For those incurring significant medical costs, your ability to deduct these expenses will be decreased. This legislation increases the adjusted gross income threshold for claiming an itemized deduction from 7.5 percent to 10 percent.Section 9015 – Additional hospital insurance tax on high-income taxpayers – This increases the Medicare tax on wages by 0.50 percent on individuals making in excess of $200,000 and married couples making over $250,000. This will be effective starting January 1, 2013. (As a side note, individual income taxes are already scheduled to increase in 2011, with the highest rate already increasing by 4.6 percent. This will be in addition to the tax increase as outlined here in Section 9015.)”Average premiums per policy in the non-group market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal,” according to the Congressional Budget Office’s (CBO).
Even if health bill passes soon, wait for reforms could be long
Thursday, February 18th, 2010The White House has a message for Americans suffering under today’s health insurance system: “Help is on the way.” But not as fast as you might think.Measured against the promises President Obama and congressional Democrats have made about health-care reform, the bill the Senate begins debating this week could be setting Americans up for disappointment: Some of the main reforms would not take place for several years, and even when they do, some observers say, the bill does too little to make sure they would be enforced.Until 2014, insurance companies could continue to deny coverage or charge higher premiums based on people’s medical history. Another highly touted reform — banning annual and lifetime limits on coverage — would take effect in 2010, but it would permit significant exceptions. Even with those rules in place, “there’s no power to really hold the insurance companies accountable,” said consumer advocate Betty Ahrens, executive director of the Iowa Citizen Action Network. “It’s toothless.”Jim Manley, a spokesman for Senate Majority Leader Harry M. Reid (D-Nev.), said the bill was a compromise. “This is not the legislation we would have written in a perfect world, but Senator Reid believes that this bill has the best chance possible to get the 60 votes necessary to overcome a Republican filibuster,” Manley said.The delay in implementing some key reforms contrasts with the urgency of Obama’s call for action.Although some changes might take years to implement, Obama said in July, “We shouldn’t have to wait a long time to make sure that people don’t lose their insurance because of a preexisting condition.”Delaying relief until 2014 means that Obama could face reelection — and Congress be transformed by two elections — before voters begin feeling the legislation’s full effect.It would also reduce the cost of the bill during the 10-year budget window measured by the Congressional Budget Office.Deferred until 2014 would be a federal mandate that everyone buy insurance, subsidies to help people with lower incomes pay for it, and the creation of marketplaces called exchanges, in which individuals and small businesses could comparison-shop for health plans.The bill would offer interim relief for some people with preexisting conditions by creating a temporary insurance plan just for them, but only people who have been uninsured for six months could join. White House health reform czar Nancy-Ann DeParle said the president was moving as quickly as possible. She said that the insurance industry cannot be forced to accept people irrespective of preexisting conditions until everyone is required to have insurance, and that the administration does not want such a requirement until the exchanges are up and running. A close reading of the bill reveals other surprises, like the section titled “No lifetime or annual limits,” which is intended to protect people from huge out-of-pocket expenses.Where annual benefits are concerned, the Senate bill bans only “unreasonable” limits. What that means is not spelled out; a Senate aide said the Treasury Department would set the standard.In addition, the bill says that certain health plans could continue to use annual and lifetime limits. As Timothy Stoltzfus Jost, a law professor at Washington and Lee University, interprets it, those potentially exempt from the ban include companies that self-insure, meaning they pay employee health benefits out of their own coffers, and businesses with more than 100 employees. Further, the prohibition on lifetime and annual limits applies only to limits “on the dollar value of benefits.”In the past, health plans have gotten around restrictions measured in dollars. In 1996, Congress passed a law that said employers could not set lower dollar limits on mental health coverage than on medical and surgical coverage. Many employers responded by adopting tighter limits on the number of mental health outpatient visits or hospital days, according to testimony the Government Accountability Office gave in 2000. Congress finally closed that loophole in 2008.In this bill, the Senate majority leader avoided an absolute ban on annual limits because that could drive up premiums, said a Reid aide who was not authorized to speak publicly on the matter. While a low annual dollar limit might be unreasonable, an annual limit of three attempts at in vitro fertilization might be reasonable, the aide said.What’s more, enforcement of the bill’s new federal insurance rules would generally be the responsibility of state regulators. With some exceptions, the federal government would step in to police private insurers only if it determined a state was not doing the job.”Unless an administration is in place in 2014 that is deeply committed to pushing recalcitrant states aside and taking direct action, it is likely that the reforms may never be implemented adequately throughout the country,” Jost wrote in a recent blog post.The government has used a similar “federal fallback” model to enforce other landmark health-care legislation, and a congressional committee found that insurance abuses festered.At issue is the practice known as rescission, in which insurers revoke policies after policyholders become severely ill or injured. To avoid paying big medical bills, insurers search policyholders’ original applications for grounds to cancel the policies, such as failure to disclose preexisting conditions.A 1996 federal law called HIPAA, the Health Insurance Portability and Accountability Act, prohibited rescissions unless consumers defrauded the insurer or deliberately misrepresented their medical condition. But the federal agency responsible “has done nothing to enforce those rights or to ensure that states do so,” Rep. Henry A. Waxman (D-Calif.) said in a hearing last year.An official testifying for the agency, Abby L. Block, confirmed that it had taken no enforcement action. She said her hands were tied unless it appeared that a state was not “substantially enforcing” the federal requirements.Despite the HIPAA standard, most states have allowed rescissions even if policyholders’ misrepresentations were accidental, the staff of the House Energy and Commerce Committee reported this year.Now, Congress is trying to do something about it again. The Senate bill reaffirms that insurers cannot rescind coverage unless the policyholder made a fraudulent or intentional misrepresentation.If the bill is passed, that reform would take effect in 2010.
AMA, AARP back House health care bill
Wednesday, February 17th, 2010The push to overhaul health care received a major boost Thursday as the American Medical Association and AARP endorsed legislation drafted by top House Democrats.The AARP, the nation’s largest organization of older Americans, is a nonpartisan group that advocates for people 50 and older. The AMA, historically an opponent of health care reform, is considered one the nation’s most influential doctors’ advocacy groups.”I want to thank both organizations again for their support, and I urge Congress to listen to AARP, listen to the AMA and pass this reform for hundreds of millions of Americans who will benefit from it,” President Obama said at the White House.The backing of those two groups comes as House Speaker Nancy Pelosi, D-California, oversees final changes to the $1.1 trillion health care bill. The measure likely will come to a final vote Saturday.A 42-page manager’s amendment on the health care legislation posted Tuesday night made mostly technical changes in the nearly 2,000-page bill compiled from three Democratic proposals passed by three House committees.By making the changes public Tuesday, House Democratic leaders could open floor debate on the bill Friday, while fulfilling their pledge to allow 72 hours of review before bringing the measure to the full chamber.Pelosi insisted Thursday she will have the 218 votes necessary to pass the bill. Meanwhile, President Obama is set to huddle Friday with congressional Democrats on Capitol Hill to review the legislation.In a statement, AARP CEO Barry Rand said, “We started this debate more than two years ago with the twin goals of making coverage affordable to our younger members and protecting Medicare for seniors.”We can say with confidence that [the House bill] meets those goals with improved benefits for people in Medicare and needed health insurance market reforms to help ensure every American can purchase affordable health coverage.”The AMA’s president, Dr. J. James Rohack, told reporters Thursday that the legislation is “not a perfect representation of our views” but is close enough to warrant his group’s support and keep the reform process moving forward.Rohack said the bill needs to be accompanied by legislation reversing scheduled Medicare reimbursement payment reductions to physicians.Responding to the AMA endorsement, Obama said the doctors’ group is “supporting reform because [its members have] seen firsthand what’s broken about our health care system,” Obama said.”They would not be supporting it if they really believed that it would lead to government bureaucrats making decisions that are best left to doctors.”Meanwhile, House Republicans on Thursday continued to signal their opposition to the measure. GOP leaders held a rally on Capitol Hill along with “Tea Party” movement protesters and other activists to warn that the House legislation would translate into a full-blown government takeover of the health care system.Rep. Michele Bachmann, R-Minnesota, told CNN’s “American Morning” on Thursday that Democrats had forgotten the lessons of August’s town hall meetings when angry conservatives severely criticized health care legislation.”I think what we’re going to see is the town hall coming to Washington, D.C., just to remind members of Congress [that] we’re the ones we would like you to pay attention to, not lobbyists. And we don’t want the government to own our health care,” Bachmann said.Speaking at Thursday’s opposition rally, actor John Ratzenberger, who played Cliff on the sitcom “Cheers,” slammed the Democratic bill as a form of socialism.”These are Woodstock Democrats,” Ratzenberger said. “We have to remember where their philosophy comes. It doesn’t come from America. It comes from overseas. It comes from socialism. And socialism is a philosophy of failure.”House Democrats have rejected an alternative $60 billion Republican plan as inadequate for meeting the goals of expanding health coverage to most of the nation’s 46 million uninsured while bringing down costs and ending controversial industry practices such as denying coverage for pre-existing conditions.Pelosi’s bill would extend insurance coverage to 36 million uncovered Americans and guarantee that 96 percent of Americans have coverage, according to the Democratic leadership.The claim is based on an analysis by the nonpartisan Congressional Budget Office.Among other things, the bill would subsidize insurance for poorer Americans and create health insurance exchanges to make it easier for small groups and individuals to purchase coverage. It also would cap annual out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.Pelosi’s office has said the bill would cut the federal deficit by roughly $30 billion over the next decade. The measure is financed through a combination of a tax surcharge on wealthy Americans and spending constraints in Medicare and Medicaid.Specifically, individuals with annual incomes more than $500,000 — as well as families earning more than $1 million — would face a 5.4 percent income tax surcharge. Growth in Medicare expenditures would be cut by 1.3 percent annually.The House bill also includes a government-run public option. Under the House plan, health care providers would be allowed to negotiate reimbursement rates with the federal government. Pelosi and other liberal Democrats had argued for a more “robust” public option that would tie reimbursement rates for providers and hospitals to Medicare rates plus a 5 percent increase. Several Democrats representing rural areas, however, killed the proposal after complaining that doctors and hospitals in their districts would be shortchanged under such a formula.One thorny issue yet to be resolved among House Democrats is the bill’s final language on abortion. Rep. Bart Stupak, D-Michigan, has been pushing leaders to add stronger language prohibiting the use of federal money to pay for abortions under the health care overhaul.Stupak has vowed that if he isn’t allowed a vote on the issue, a group of 40 anti-abortion Democrats will work to block the bill from getting to the House floor.The House bill differs from legislation the Senate is considering in a number of critical ways. Senate Majority Leader Harry Reid, D-Nevada, also favors a public option but would allow individual states to opt out of the plan.An $829 billion bill recently passed by the Senate Finance Committee does not include a tax surcharge on the wealthy but would impose a new tax on high-end health care policies, which critics have dubbed “Cadillac” plans. A large number of House Democrats are opposed to taxing those policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.Individuals under the $829 billion Finance Committee plan would be required to purchase health insurance coverage or face a fine of up to $750. The House bill imposes a more stringent fine of up to 2.5 percent of an individual’s income. Both versions include a hardship exemption for poorer Americans.The Finance Committee bill would require large companies to contribute to the health care costs of lower income workers if those workers received a government subsidy for insurance. The House legislation would require larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.Democratic leaders in both chambers agree on establishing nonprofit health care cooperatives and stripping insurance companies of an anti-trust exemption that has been in place since the end of World War II.Reid refused Tuesday to predict when the chamber would pass a health care bill, possibly signaling difficulty in generating support from his entire Democratic caucus.Part of the holdup is that Reid is waiting for the Congressional Budget Office to finish its cost analysis of his legislation. The report was expected this week but likely won’t be ready until at least next week, several Democratic senators said.Some Senate moderates also have expressed concern over the public option included in Reid’s plan.
Medical Tourism: Quality Affordable Medical Care For The Uninsured
Monday, February 15th, 2010Most businesses acknowledge that there is nothing better than a personal testimonial from a satisfied client to boost their business. At the rate, those businesses specializing in medical tourism are receiving those rave reviews today; it is enough to inspire envy with a capital ‘E’ among other industry leaders.
Without health insurance, the average household is one major medical bill away from bankruptcy, a possibility facing nearly 45 million adults in the United States today. Medical tourism representatives say they hear stories every day about the impact their business is making on the quality of people’s lives both medically and financially, short and long term.
One company, Med Journeys, shared the letter below from the *son of a client for this article. The patient, rejected by the healthcare system in the U.S. decided that that the option to use medical tourism was his only alternative:
“My dad was one of the millions that lost his insurance last year and was facing a life in a wheelchair because he could not afford double knee replacement surgery. When a friend pointed him in the direction of your company, he was tired, in considerable pain, and more than a bit anxious over the thought of traveling to another country for surgery.
Understandably cautious, Dad went to great lengths to research the procedures as well as your company. He was pleased to find out that each journey is arranged through a respected, knowledgeable and trustworthy agent. He was even more pleased to find that each agent had established relationships with the most respected medical facilities in the world.
In the end, what made the entire trip possible was the amount of care and thought that went into the entire process, as well as the cost. Passport assistance, round trip airfares, all medical expenses including x-rays, anesthesia, surgery, pre & post op treatment, physical therapy, doctors, medications, hospital stay with one companion, and recovery at a beautiful guest house complete with meals was completely covered in one inclusive price!
From the moment my parent’s plane touched down, they were taken care of in a manner that allowed them to focus on my Dad’s health and well-being. Mom and Dad were met at the airport and taken to the hospital without any fuss or confusion. On the day of my Dad’s surgery, my mother was able to relax on a beautiful hospital balcony in New Delhi. One of the world’s finest orthopedic surgeons performed the surgery itself. This doctor has performed over 3500 joint replacement surgeries in his long career.
My parents returned home completely satisfied with their experience. Dad has repeatedly stated that because of your company he had complete confidence in, and indeed, experienced care in India far superior to any care he received recently in the states. He was also happy the way my Mom was treated and even encouraged to relax and sightsee while he was receiving therapy.
I am of course as delighted as my parents are. Dad still cannot get over the price of the surgery. His double knee replacement surgeries cost my Dad only 17% of the cost he would have incurred in the United States!
I would like to convey our thanks on behalf of our entire family. You have given us back our Dad.” – R. L. (2009 – Reprinted with permission – Med Journeys)
Medical tourism is fast becoming a viable, alternative solution to the rising health care crisis facing the United States. Medical tourism advocates work continually to improve knowledge of the process and remove the myths surrounding the practice of medicine in foreign countries. In 2008 alone, an estimated 1.5 million people underwent surgery in exotic locations such as Thailand, Brazil, India, Costa Rica, Malaysia, and Singapore. Moreover, all the surgery performed is done at world-class hospitals by teams of surgeons and doctors educated at Princeton, Harvard, and Johns Hopkins.
Today’s economic climate requires every individual to begin to think outside the box when it comes to getting quality affordable medical care. With the help of medical tourism, even those in desperate straits, may now think outside of the country when it comes to having their medical needs met and solutions to their healthcare problems resolved.
