New health care bill fines Americans who refuse medical coverage
2/11/2010 6:21:59 AM
Key Senate Democrats unveiled last Thursday a health care revamp bill that imposes a fine of more than $1,000 for Americans who refuse to avail themselves of affordable health coverage. The bill aims to fulfill the top domestic priority of President Barack Obama. In a statement, Obama supported the legislation saying that it “reflects many of the principles I’ve laid out, such as reforms that will prohibit insurance companies from refusing coverage for people with pre-existing conditions and the concept of insurance exchanges where individuals can find affordable coverage if they lose their jobs, move or get sick."In the proposed health care system, it would be an obligation for citizens to be covered by health insurance as it is necessary for motorists to get auto insurance coverage now. The government would also subsidize health insurance for the poor and even for middle-class families. However, those who decline to apply for health care coverage would face penalties. As estimated by the Congressional Budget Office, the said penalties can raise $36 billion in 10 years. The penalty system is patterned after the method used in Massachusetts, which imposes an annual penalty of about $1,000 per individual who declines to get medical coverage. Federal legislation also dictates for the fines to be higher on families. Data from a survey by the Kaiser Family Foundation show that in 2008, employer-paid health care family plans averaged at $12,680 while individual plans were at $4,704. It is estimated that the cost of the revised federal health plan will be less than this.The penalties will be set at half the price of basic medical coverage. Called “shared responsibility payments,” the penalty aims to urge people to avail themselves of a health plan while they are still healthy and not wait until they get sick. Penalties shall be collected through the income tax system. Author: Warren Blumberg
Obama, Health Reform, and the Middle Class
2/11/2010 6:20:56 AM
WASHINGTON – From the very start, President Obama’s administration has been working hard to sell health care reform to the middle class as part of the solution to increasing medical costs, and not just as something costly for the benefit of the poor.But with the way legislation is being shaped by Congress, the most important issue yet to be addressed is whether the extent of the benefits for the middle class will be sufficient to gather their support.Back in the 1990s, President Bill Clinton’s health insurance regulations failed because of the “Harry and Louise” ads. The insurance industry used these ads to suggest that Clinton’s health plan was “a bad deal” for the middle class. Even though recent polls suggest some public discontent with the way Obama is handling the issue, the President is yet to go down the same road as Clinton.According to Len Nichols, New America Foundation’s health policy program director, the middle class’ decision will decide the fate of this year’s health care debates. "It will come down to Obama's portrayal of the benefits of the new world," and his solutions to the rising cost of insurance premiums. "All this is complicated. All this is hard to show.”Obama is selling a different payoff to Americans who are going to shoulder most of the bill that will cover the uninsured. Even though the portrayed payoff is generally appealing, quantifying it would be more difficult to do as compared to the subsidies needed to help cover the poor. The President wants the public to underwrite the cost of legislation and look forward to smaller premium increases in the future and guaranteed coverage. Author: Mark Kelsey
Obama continues push for Healthcare Reform in northern Virginia
2/11/2010 6:19:04 AM
President Obama will visit northern Virginia on Wednesday to hold another town-hall meeting as he continues to push for the overhaul of the country’s healthcare system. Those who want to participate in the event are encouraged by the White House to send questions and video responses online. People can visit the White House’s official Web site or connect through social networking sites like Facebook (http://facebook.com/Whitehouse) and Twitter (#WHHCQ). According to Sheryl Gay Stolberg of “The New York Times,” Obama’s administration has created a multi-pronged strategy to help the president promote his health plan to the public. The strategy aims to persuade government officials outside of Congress, like state governors, to help by acting as Obama’s emissaries. However, the strategy contains many potential risks, like funding problems, which will be tackled by lawmakers when they return to Capitol Hill next week from recess. “If Mr. Obama waits too long to exert his presidential muscle to forge consensus on Capitol Hill,” Ms. Stolberg warns, “his moment of opportunity could pass. He could also lose control of the final outcome if lawmakers cut backroom deals he dislikes, for example, by deciding to pay for the expansion by taxing employee health benefits, a move that worries Mr. Obama’s political advisers because it could cause the president to break a campaign promise.” According to senior adviser to the president, David Axelrod, the administration wants “as many people as possible” to take part in the nationwide discussion about the healthcare reform.Dan Balz and Shailagh Murray of the “Washington Post” analyze the administration’s plans. Just like healthcare, the energy and immigration bills will also face tough opposition in the Senate. Author: Avery Smith
Will Obama’s health insurance reform work?
2/11/2010 6:18:38 AM
Despite the strain of soaring costs, the government is continuing to head towards a huge health care overhaul, which, it is feared, will lead to sky-high costs for everyone. Americans are supportive of President Barrack Obama’s proposed health insurance reform plan yet many are worried about its impact.In a forum held last week at the White House, which was broadcasted live on the ABC television network, President Obama presented his health insurance reform plan to the public. Obama confidently answered questions on his proposed insurance reform, including questions relating to how people can keep their existing individual insurance plans.A fact check on the President’s speech and his answers to questions show that he is eager to pursue his reform but that he sometimes glosses over details in his explanation of how he plans to make the reform successful.The president campaigned for his health care plan and informed the audience that the costs of health care have increased three times faster than wages in the United States. Some studies, however, like the one prepared by Family USA, a group that is advocating for reforms in health care, reveal that heath care insurance costs have actually increased five times faster than wages in the US, as reported in October 2008.The president said, “If you are happy with your current [health care] insurance plan and happy with your doctor, we don’t want you to have to change.” However, some speculate that the president’s plan cannot change the fact that private companies have the freedom to choose the health care plans of their employees.Moreover, it has been found that Americans find it important for President Obama to offer a reform on health care without adding to the national deficit. But the price tag for this health care proposal is pegged to be between $1.3 and $1.6 trillion, which means it will clearly need more revenue for it not to add to the deficit. Author: Warren Blumberg
Health insurance in Guam will start covering ambulance fees
2/11/2010 6:18:16 AM
Most health insurance providers in Guam will start covering ambulance services as the Guam Fire Department starts to charge fees for the use of ambulances on July 1.According to Bri Hosei Habin, Health Care Management Division chief at Moylan's NetCare Life & Health Insurance program, various health insurance plans provide different levels of coverage for ambulance services. This means that a subscriber must pay ambulance fees or make a co-payment if he does not meet his health insurance deductible.Based on Public Law 29-02, the Guam Fire Department will charge $95 for non-emergency ambulance services and $195 per transport for emergency ambulance services.The bills for the services rendered will be mailed to health insurance providers while those uninsured will be charged directly, Edward Cruz, Fire Chief Aide, said during a press conference.Cruz said that beginning July 1, the Guam Fire Department will issue ambulance invoices and bill health insurance providers.Invoices for non-emergency purposes will cover the transport only while the fees for emergency services will include equipment and supplies used to provide medical care, such as a defibrillator, masks and oxygen, Cruz added.Cruz also said that the funds from the ambulance services will be utilized to train personnel and maintain medical equipment.Calvo's Select Care program health plan administrator, Frank Campillo, said that most ambulance services in the country’s mainland are offered by private companies. He further added that ambulance services are given by most health insurance companies in the island but that the Guam Fire Department did not charge for this before and will only start charging for them now. Author: Avery Smith
Hospitals and doctors on private health insurance
1/30/2010 3:00:00 PM
Insurance first gained popularity during the revolutionary era.
Eventually, people began to realize the importance of securing oneself from accidents
When availing of hospital services, people felt the burden of rising
medical bills. Consequently, the cost of training for medical practice became
more expensive along with medical equipment and technology. Hospitals needed to
augment the medical fees charged among patients. Moreover, doctors needed to
address demands on new therapeutic means and agents. Researches on effective
medicinal cure for acute illnesses added to the cost of maintaining a health
Soon enough, Texas' Baylor Hospital came up with an idea of spreading
of a patient's health expense over a connected group in 1929. The idea
gained approval from hospital administrators and doctors. The "Blue
Cross" health insurance program was supported primarily by teachers, and soon
became popular among three million Americans.
The effectiveness of the "Blue Cross" health insurance concept
had caught the attention of private insurance companies, which later on began
offering customized health care program with additional medical benefits and
The State saw the plight of some uninsured employees when faced with sudden
accidents or disasters. Since then, it has offered the option of tax exemption to
companies with a condition of providing customary health insurance plan among
The legislation of Medicare in 1960 offered medical insurance for senior
citizens and added new health care features for employees. The acceptance of
health insurance in the United States eased the cost for availing professional
medical services. Group health insurance plan has continued to provide
consolidated health assistance solutions.
Current U.S. President Barack Obama supports the national health insurance
exchange proposal, which highlights lower insurance premium dues and wider
standardized health care assistance.
Is health insurance reform necessary?
1/30/2010 3:00:00 PM
Lack of health insurance has been a countrywide problem in America,
causing the local, the state and the federal governments to respond. The number of uninsured individuals
will continue to grow unless the health insurance coverage undergoes a
change. To solve this, three
options for reform have to be taken into consideration.
First, there exists an option for employers to pay the health insurance
of workers. These employer
mandates are costly yet they can increase the number of insured
individuals. This scheme involves
the “pay or play” option. Employers
could “pay” the state to provide the necessary insurance to their employees or “play”
by paying for the insurance themselves.
Part time employees or smaller firms are not included according to the
legislation. This option, however,
can cause an employee’s status to shift from full time to part time.
Another option is to expand the Medicaid coverage for those who cannot
afford insurance plans. This
option, funded by the federal government, could increase employment and allow a
shift in employment status from part time to full time. One initiative from this option is the
State Children’s Health Insurance Program established by the Congress in 1997
that extends Medicaid to children in families who previously failed to qualify.
Tax credits, meanwhile, would allow individuals with low-income tax to
earn a federal tax credit. Under
this measure, a certain amount of money would be allotted for an individual or
a family. This may not be as
costly as the two previous provisions yet it is the least effective.
One has to weigh what these measures can offer to create that needed
change and give individuals better health plans. They may affect those uninsured, but they too can be costly
to the federal government.
State Policies on Health Insurance Plans
1/30/2010 3:00:00 PM
A growing number of Americans are
not covered by a basic health insurance program. This calls for immediate
action to address the basic health needs of 45.8 million citizens.
This reality prompted Democrats
and Republicans to legislate reforms on health care, requiring adjustments on
inexpensive health insurance plans. Many analysts across the country offered
suggestions such as the "single payer" program and the "pay or
Uninsured persons can benefit
from the proposed "single payer" program. Under this, the state will
pay or subsidize the insurance premium. On the other hand, employers may choose
the "pay or play" program. Employers may choose to provide customary
health insurance plan or pay bigger taxes instead. The tax will be used to
subsidize health care programs for the uninsured.
One of the arguments raised by
many employers is the high regulatory tax. Company owners candidly explained
the difficulty of recovering revenues since the recession began. Most companies
may struggle to provide medical insurance assistance.
The State places strict
regulations on health insurance policies. The State also places limitations on
the rating rules of health insurance providers. It also prohibits ungrounded
repudiation. The State health reform program also enforces restrictions on the
selection of medical providers.
Under the health insurance reform
act, premiums are given a limit. Insurance companies cannot increase dues in
excess of the stipulated rate. The law requires health insurance providers to
ensure the availability of medical facilities and the ease of benefit claims.
The State also obliges health insurance companies to provide discounted rates to
State attorney pushes for rejection of health plan cost increase
8/5/2009 5:34:15 AM
Connecticut state attorney
general Richard Blumenthal is pushing for the rejection of Connecticut insurance
companies’ request for a health care rate increase of 30% by October this year.
In response to Anthem
Blue Cross Blue Shield’s request for a rate increase of 22%–30%, Blumenthal
commented, “This request is legally or factually unjustified by anything this
company has submitted.”
In Anthem’s submitted
increase request, the premium for the $250-deductible Century Preferred PPO,
one of Anthem’s popular health plans, will increase by $62 monthly, from $264
Sarah Yeager, the
company’s director of corporate communications, said that increased claim costs
have exceeded the insurance premium enough for the company to demand for higher
A spokesperson of
Anthem Blue Cross Blue Shield also said that the finances and rates of the
company are regularly evaluated to ensure that the premium fees can cover claim
expenses and costs.
The company, which
filed its request on June 9, agreed to waive the 30-day deadline for the state
Insurance Department to continue its evaluation. Based on state law, the
changes in the company’s rates would have been automatically instated on Thursday
without the department’s implied disapproval. The changes in rates could affect
56,000 insured Connecticut residents. According to the Insurance Department’s
records, the population covered by the company comprises 4% of the 1.4 million
residents of Connecticut.
An increase of this
magnitude, Blumenthal said, is clearly against the statutory standard. “The current
economic condition and the October 1 implementation also make it necessary for
the state to reject this request.”
increases and the insurance companies’ compliance with regulations and laws
involving insurance business are regulated by the state Insurance Department.
Anthem urged to reconsider rate increase
8/5/2009 5:34:15 AM
Last Monday, Connecticut Senator
Christopher J. Dodd asked Anthem Blue Cross to review its proposed rate
increase. The proposal constitutes an increase of 23% on the average, while in
Connecticut the proposed rate increase is 32% for individual health insurance
Last Wednesday, Anthem
Blue Cross and Blue Shield asked the Connecticut Insurance Department to
approve the increases. Once approved, the majority of the 56,000 residents
below 65 years of age who bought health and medical insurance from Anthem will
The proposed increases
will not affect Anthem’s group and business health insurance policies. However,
some employers complained about recent premium increases.
In a letter addressed to
David R. Fusco, Anthem’s president in Connecticut, Senator Dodd stated that
Anthem’s proposed individual policy rate increase “runs counter to the goal of
providing all Americans with quality, affordable health care,” especially now
that the insurance industry is taking part in federal efforts to reform
America’s health care system.
Considering that 322,000
residents are uninsured, the senator said, "Should these new rates kick
in, there is no question that additional Connecticut families will join the
ranks of the uninsured."
Back in January, Dodd
started a “listening tour” to hear what constituents think about health care
reform. And according to the senator, Fusco was “kind enough” to attend the
In Monday’s letter, Dodd
requested that Fusco "reconsider the proposed rate increases in
Connecticut and instead join me once again in my efforts and those of the
Senate and the House to enact comprehensive health reform legislation this
In response, Anthem expressed its appreciation for
the senator’s concerns, but stated, “Our proposed rate increase is a reflection
of increasing health care costs." The company explained that some of its
policies will not be affected by the increase. However, those policies would
require buyers to shoulder more of the health expenses.
Americans doubt cancer coverage
8/5/2009 5:34:15 AM
released last Wednesday revealed that only a little less than half of the
American population believes that their health plans would cover their cancer
treatment costs in full, while around two-thirds have the false notion that
Medicare will not cover anything.
Out of the 1,000
adults who participated in the survey, 70% stated that they were “very
concerned” about shouldering cancer treatment costs if they ever had cancer,
while 59% fear putting their families in financial trouble.
Released by the
Community Oncology Alliance, the survey implies
that Americans are worried and at the same time misinformed about the country’s
health care system, as well as the modifications that might take place after
Congress and the White House finish working on the overhaul.
According to Dr.
Patrick Cobb, president of the Community Oncology
Alliance and a managing associate of Hematology-Oncology Centers of the
Northern Rockies in Billings, Montana, it is right for people
to fear the costs of cancer treatment since cancer is the second leading cause
of death in America.
When it comes to
health insurance comparisons, only a small number of private insurance plans
provide full coverage for cancer treatment. These plans could have premiums of
$5,000 or more.
explained, "Monthly out-of-pocket costs for cancer care and treatment, not
covered by private insurance plans or Medicare, can easily run to $1,000 or
more. For many cancer patients, the costs of
diagnostic imaging, surgery and expensive cancer medications, especially in the
first few months of treatment, can add up to well beyond $2,500 per
As part of the
proposed health care reform, President Obama has begun to push for a
government-managed insurance option that will be offered along with the
traditional private and employer-sponsored insurance.
Granholm doubts Dillon’s bold health care reform proposal
8/5/2009 5:34:15 AM
state employees have already dropped their health benefits, Gov. Jennifer
Granholm said today while giving a cold shoulder to House Speaker Andy Dillon’s
plan to pool some 400,000 public employees covered by individual health plans
to help the state save money.
week, Dillon, D-Redford Township, claimed this bold health care reform will
help the state save as much as $900 million per year. Dillon further said this plan would provide insurance for retirees
and local employees who would be covered by a single health plan that would
provide extensive health plan options for individuals, depending on the
premiums they can afford.
the money. I do not know where the savings come from,” Granholm told the
reporters. She further said she had not seen the details of Dillon’s
proposal. “I haven’t seen the
legislation and I have a million questions about it,” she added.
proposal evidently does not work for Granholm. She said it will never resolve
the state’s financial problems. She doubted that bigger pools of workers will
help the state save money, noting that the state currently has 55,000 employees
that belong to big insurance pools.
further added that she believe that Dillon was wrong to say that state
employees pay less for health insurance and receive better benefits than those
in private sectors. Granholm then cited last year’s House Fiscal Agency report
that reveals that state employees have lower wages and receive fewer benefits
than private sector employees.
prepared statement, Dillon replied to Granholm, saying, “Change is never
easy—there will always be countless reasons not to change. But one thing is
clear: business as usual isn’t working.”
suggested lowering government expenses to prevent layoffs, and decreasing
college scholarships. “We need leaders like Governor Grandholm, Senate Majority
Leader Mike Bishop and others to work together in the days ahead so we can turn
Michigan around,” Dillon said.
Vaccines and the battle for U.S. health reform
8/5/2009 5:34:15 AM
According to health officials and doctors,
adult vaccinations and the issues surrounding them are some of the numerous
problems that haunt legislators as Congress continues to work on the health
In a survey released by health officials, only
a small number of adults are aware that they can avail themselves of vaccines
against meningitis, tetanus, whooping cough, pneumonia, and shingles.
Experts however believe that demand and
awareness are just tiny bits of the whole problem. According to Dr. William
Schaffner from Vanderbilt University in Tennessee and the National Foundation
for Infectious Diseases, the health care system is a hindrance to vaccination.
Not all medical insurance and health plans provided by companies cover
vaccinations, doctors are paid only minimally for administering them, and nobody
can ensure the availability of vaccines.
In a news conference, Schaffner said, "They
system is cumbersome almost to the point of not being able to get the
Schaffner, along with vaccine experts, is
hoping for Congress to tackle vaccination issues in the health care reform
legislation. He said, "More than $10 billion a year is spent in direct
medical costs and indirect costs" to treat pneumonia, meningitis and
influenza. “These diseases can be prevented through vaccination.”
A survey of 22,000 U.S. adults released by Dr.
Anne Schuchat of the U.S. Centers for Disease Control and Prevention indicates
that most adults in the U.S. don’t get the necessary vaccines.
Dr. Anne Schuchat further stated in the news
conference that, "About half of adults had received a tetanus shot within
the past 10 years." People should get tetanus vaccines every 10 years.
25 million are underinsured
8/5/2009 5:34:15 AM
week, President Barack Obama will be in North Carolina and Virginia to promote
health care reform. During the recess next month, the president will be keeping
Congress under pressure. The fact that 47 million people are uninsured in
America is only one of the arguments that support health care reform. Another
argument, which many people are unaware of, is the fact that 25 million people
in the U.S. are underinsured.
Stewardson wakes up very early in the morning and goes to work at the 602 union
located in Washington, D.C. He’s home before noon as he needs to prepare lunch
for Linda, his wife who is a cancer survivor.
just going to have to take medicine for the rest of my life," Linda said.
summer, she was diagnosed with a tumor in her brain; she is currently in
remission. Now, the financial health of her family is at stake, as their group
health insurance only paid $150,000 for the treatment. Their savings were
demolished by the cost of the treatments, both for the cancer itself and for
the side effects.
like she fell out a cancer tree and hit every branch on the way down," said
family is around $100,000 in debt.
the Senate, Sen. Chris Dodd is working to make health choices affordable. He is
supporting the government’s insurance plan that would eliminate caps on health
underinsured are a critical group," said Dodd. "In some cases, fifty-three
percent don't know they're underinsured. So they either have huge co-pay if a
problem happens or the deductibles are so high they might as well not have
union only offered him one plan. After this reached its cap, they were left
uninsured. Every day, John calls Medicare and his union to ask for additional
coverage. So far, John has had no luck.
Disagreements continue about the progress of the health reform bill
8/5/2009 5:34:15 AM
is nearly over and everybody is still having disagreements about the real
progress of the health care reform legislation. According to Speaker Nancy
Pelosi and White House officials on Sunday, legislation is progressing, however, their fiscally conservative allies are still less optimistic and
the Republicans continue to oppose it.
CNN’s “State of the Union,” Pelosi said, “When I take this bill to the floor,
it will win. We will move forward, it will happen.”
Dakota senator and budget committee chairman Kent Conrad expressed his opinion that
a bill that only carries votes from Democrats is impossible and undesirable.
“Look, there are not the votes for Democrats to do this just on our side of the
aisle,” he said on ABC’s “This Week.”
minority leader Mitch McConnell also stated on CNN’s “State of the Union” that,
“The only thing bipartisan about the measures so far is the opposition to
White House originally wanted the legislation to be completed before Congress
takes a break in August. Robert Gibbs, spokesman for the White House tried to
be positive about the missed deadline: “We are enthusiastic about the progress
that’s been made. We think we’re on the road to getting
comprehensive health care reform by this fall.”
also stated that even though committees from the House and Senate are
considering different versions, 80% of the contents of a final version have
already been agreed upon.
a statement on CBS’s “Face the Nation,” Obama’s senior advisor, David Axelrod,
similarly described the progress of the bill. “Now, we are at that final twenty
percent. We are trying to work through those details.”
care reform has been at the top of Obama’s plans since he assumed the presidency.
He wants every American citizen to have medical insurance as well as other
Alternative Treatments and Insurance
8/5/2009 5:34:15 AM
The growing demands of the
public are continuing to push the insurance industry into providing wider
coverage. More and more people are willing to spend on health and medical
insurance policies. In addition, as far as expanding coverage is concerned,
insurance companies are starting to consider alternative treatments and
As a consumer, you want to
get the most out of your insurance plan. If you’re planning to apply for
coverage, you must first understand the issues related to health plans and
Back in 2006, 18 major
Health Maintenance Organizations (HMOs) and insurance providers, including
Medicare, Prudential, Aetna, and Kaiser Permanente, participated in a survey,
which listed 14 companies that covered 11 out of 34 alternative treatments.
Massage therapy, chiropractic treatments, and acupuncture are some of the most
common alternative treatments covered by insurance. However, coverage is
limited to discounts and fewer sessions.
The health care systems of
the West emphasize the use of drugs for treating mental illness. But with
concerns about the use of drugs like tricyclics or SSRIs (selective serotonin
reuptake inhibitors), alternative medicines like St. John’s wort could be an
option. Scientists from the Center for Complementary Medicine in Munich
discovered and concluded that the herbal extract of St. John’s wort may be far
more effective than any antidepressant.
If you want to avail
yourself of these alternative treatments and medications, you must first find
out a few basic facts about your insurance policy. The first thing you might
want to know is whether the insurance plan provides coverage for alternative
treatments and medications, and, if it does, to what extent.
Before getting treatment,
you might also want to ask a particular practitioner whether he or she accepts
health insurance and if there are additional costs involved. This basic
information will help you choose the best insurance for your money.
Basic information about HIPAA
8/5/2009 5:34:15 AM
The Health Insurance
Portability and Accountability Act (HIPAA) was enacted by Congress in 1996 to
provide privacy and health coverage for patients. The recording and electronic
exchange of health information prompted the need to secure the privacy of
patients. Prior to the enactment of HIPAA, there was a scarcity of laws to
protect the privacy of patients when their health and medical files were stored
in computers instead of the traditional paper charts.
HIPAA has two main titles:
Title I and Title II. Title I deals with individual health insurance and group
or business health insurance. It works to ensure the availability of insurance
for every citizen. Title II, on the other hand, provides a list of rules and
penalties regarding the national health care system. It is well-known for the
"Administrative Simplification" guidelines.
The rules were drafted by
the Department of Health and Human Services. They are meant to ensure the
security and efficiency of electronic health data during exchanges throughout
the country’s health care system.
HIPAA helps provide
insurance coverage to as many people as possible. However, there are limits to
what it can do. HIPAA cannot coerce employers to pay or offer insurance
coverage for their employees. And because of that, it cannot guarantee coverage
for everyone in the workforce. It also cannot force employers to provide their
employees with the same health insurance coverage and benefits that were
provided by their previous employers.
Even though HIPAA assists
in the availability of insurance to everybody, it cannot regulate how insurance
companies charge group or business health insurance coverage. It also cannot
force business health plans to provide specific benefits.
HIPAA has been helping
Americans for almost 12 years now. People should understand the basic
provisions and limitations of the Act to be able to maximize the benefits they
Basics of Indemnity Health Insurance Policies
8/5/2009 5:34:15 AM
Unlike Preferred Provider
Organization (PPO) and Health Maintenance Organization (HMO) health plans, many
indemnity policies provide the insured with an option to choose their preferred
doctors and hospitals when needing health care services. Sometimes, this type
of insurance is more expensive than PPO and HMO provided plans, but the payoff
means more options for the insured.
Some important points to
consider when choosing an indemnity policy for a health plan is the deductible,
which refers to the amount of money one has to pay before the health coverage
is provided. Moreover, some insurance plans require a co-payment, a portion of
the remaining fees one has to pay after paying the deductible. For example, if the
eligible fees are $1,000 and the deductible is $200, then what’s left is $800.
The co-payment is a percentage of what is left from the eligible charges. If
the insurance company requires a co-payment of 20%, then the co-payment of
$1,000 eligible charges with a $200 deductible would be $160.
In addition, many
indemnity health plans do not cover preventative health care services. These
services, including annual check-up exams and other doctor visits, are health
services that may prevent diseases or illnesses.
Unlike other types of
health insurance, the good thing about indemnity health insurance policies is
that most of these policies provide the insured with the freedom to use the
services of his or her chosen doctor. Some policies also allow the insured to
go to his or her preferred hospital.
Indemnity health insurance
policies also vary in terms of benefits, depending on the rate, the insurance
provider, etc. Some insurers offer indemnity plans covering more benefits, but
charge high premiums, while some offer the same coverage but with high
deductibles. The challenge is to get affordable insurance that covers what type
of health care one really needs.
Benefit Waiting Periods
8/5/2009 5:34:15 AM
In the health insurance
industry a benefit waiting period refers to the time before health insurance
coverage commences. There are different kinds of waiting periods with
corresponding rules for how they work within the framework of certain kinds of
health insurance plans. In general, some of the typical waiting periods are
employer waiting periods and affiliation periods.
The employer waiting
period is the most common type of waiting period. This is applicable to
business group plans. Newly hired employees must wait for a certain period
before becoming eligible for health insurance coverage. The waiting period,
which is usually three months, is enforced by employers to prevent new
employees from filing large claims and then leaving the company quickly.
Employer waiting periods have fewer restrictions. However, it is better to have
a “back-up” health care plan since the new benefits are not yet in effect.
The employer waiting
period runs concurrently with a pre-existing condition exclusion period. They
both begin on the same date. It means that employees are spared from a longer
Meanwhile, an affiliation
period is set by a Health Maintenance Organization. With specific guidelines,
this waiting period usually lasts less than two months. But for late enrollees,
the affiliation period could stretch up to three months.
Affiliation periods are
regulated by HIPAA or Health Insurance Portability and Accountability Act.
While waiting for coverage to commence, you don’t need to pay premiums since
HMOs are not providing the benefits yet. One of the benefits of enrolling in an
HMO plan that imposes an affiliation period is the absence of pre-existing
condition exclusions. HMOs can’t deny coverage for pre-existing conditions.
Benefit waiting periods act
as gaps in your insurance coverage. By understanding how they work, you will be
able to decide whether you need an additional health plans as a backup.
Can immigrants get health insurance?
8/5/2009 5:34:15 AM
Around 51% of the
immigrants in the United States are not enrolled in any health insurance plan.
Getting health care coverage may be particularly difficult for an immigrant,
considering that many immigrants are not working at companies that offer
group/business health insurance.
There are only a few
options for insurance coverage for immigrants. Usually, immigrants are not
eligible for federal insurance like Medicaid. Although Medicaid provides
subsidies to people with low income, poor immigrants are still not qualified to
receive public benefits like Medicaid because of the Personal Responsibility
and Work Opportunity Reconciliation Act (PROWRA). Immigrants may only avail
themselves of a subsidy after five years of residence in the U.S. Undocumented
non-citizens are not eligible for Medicaid.
Similarly, although there
are many subsidized health programs for children in the U.S., like State
Children’s Health Insurance Program (SCHIP), the children of immigrants who
have not been in the U.S. for at least five years are restricted from receiving
health care assistance due to PROWRA. They may still be ineligible for an
extended period due to economic requirements. Moreover, unrecorded non-citizens
do not qualify for SCHIP.
The easiest way for
immigrants to get access to health coverage is through private individual
health plans. The cost of this type of insurance is, however, higher than many
other health plans.
Nonetheless, in a nation
where health care costs are soaring at a very alarming rate, it is a necessity
for every U.S. resident, whether an immigrant or one who was born in the U.S.,
to purchase an insurance plan that greatly lessens the burden of medical costs.
Coverage for Alternative Therapy
8/5/2009 5:34:15 AM
Different types of
alternative medicine, also known as CAM (Complementary and Alternative
Medicine), are becoming more popular with people living in the U.S. All
health-related practices and therapies that are not considered as traditional
medicine are classified as CAM. Examples of CAM include treatments such as
energy healing, acupuncture, biologic therapies, body and mind mediations,
massage and chiropractic therapies, and spiritual healing and prayer.
According to the Center
for Disease Control, in 2004, around 36% of the people living in the United
States had undergone alternative therapy. Nowadays, a lot of people think that
combining CAM therapies with traditional medicine provides better possibilities
for healing. The term “alternative” is used to refer to therapies that are used
in place of traditional medicine therapies. On the other hand, the term
“complementary” is used to refer to therapies that are used together with
traditional medicine therapies.
Insurance for alternative
therapy is now being offered by a number of insurance companies in the United
States. CAM therapies such as massage therapy, chiropractic care, and
acupuncture are covered by this type of insurance. Many job-based group health
insurance plans cover this option as an answer to the requests of employees.
CAM therapies are used by
an increasing number of people in the U.S. As a result, CAM is now one of the
health care industry’s fastest-developing segments. However, many insurance
companies still think twice about providing coverage for CAM, in spite of
increasing public demand.
It is important to take
into account that for some states, this kind of insurance coverage is not
considered as an insurance product.
Diabetes and Health Insurance
8/5/2009 5:34:15 AM
Diabetes is the medical
condition wherein a person has a very high level of blood sugar. It is
necessary and normal to have sufficient sugar in one’s blood; however, too much
sugar in one’s blood can be dangerous and can lead to diabetes. Gestational
diabetes, Type 2, and Type 1 are two of the types of diabetes.
Almost 21 million
Americans, adults and children alike, struggle with diabetes. Many of these 21
million Americans do not have health insurance. Thus, they have significantly
limited options for treatment and they are at great risk in case of illness.
People who have diabetes but do not have medical insurance should know the
risks of remaining uninsured.
Not only is diabetes
itself harmful, but it can also lead to other illnesses. These include kidney
failure, heart disease, blindness, stroke, and amputation of the lower limbs.
For diabetics, visits to
the doctor, medication, and other medical treatments are the benefits of having
health insurance. These are necessary in order to control a person’s diabetes
as well as other medical issues that will arise from it. Diabetes is usually an
illness that lasts a lifetime. Health care for diabetics is ongoing and the
best solution for financing one’s medical expenses is getting health insurance.
When selecting a health
insurance plan that will answer your needs, it is important to look at a number
of things. For one, find a policy that will cover all the necessary treatments
for diabetes. Also, make sure that the policy will cover treatments for the
medical conditions that are linked to diabetes. Finally, make sure that your
health insurance plan will cover a substantial amount of the costs of your
Federal Statutes and Job-based Coverage
8/5/2009 5:34:15 AM
Many types of insurance,
including individual health insurance, life insurance, and casualty and
property insurance are regulated by the state. However, it is the federal
government that regulates job-based group health insurances. In the U.S.,
people who receive health insurance from their employers enjoy the same
protection and rights. A number of federal statutes were issued to establish
The Employee Retirement
Income Security Act, more popularly known as ERISA, was enacted by Congress in
1974. All the types of benefits enjoyed by employees are regulated by the act.
Not only does it regulate job-based group health insurance plans but it also
regulates retirement plans and pensions.
With the act, all
employees who have health insurance plans as part of their job benefits have a
right to information about their health plans. Information on the health plan
must be offered to the employees by the administrator of the health plan. This
information includes financial information, rules of the plan, and the
management and operation of the plan.
In 1985, the Consolidated
Omnibus Budget Reconciliation Act (COBRA) was enacted. It required employers
who had more then 20 employees to offer a continuation of the coverage to their
employees who need to leave their health plans because of certain reasons.
The employer must offer
this continuation to the employee (including the employee’s dependents) when
one of these qualifying events occurs to the employee: reduction of working
hours, death, legal separation or divorce, termination of employment, becoming
eligible for Medicare, and when an employee’s dependent child loses
Health Insurance Exchange: Solution to Health Care Crisis?
8/5/2009 5:34:15 AM
The U.S. health-plan
market is run by a complex system of federal state laws and regulations that
are already out of date and therefore counterproductive. One of these laws is
the federal tax code. People receive unlimited tax breaks when purchasing
health plans, if they get their coverage through their employers. Outside the
workplace, Americans pay for health insurance with after-tax dollars. The
solution to this inefficient system is a statewide insurance exchange, which
offers individuals and families the chance to obtain the health insurance of
their choice without losing tax benefits.
By law many health
insurance tax benefits are only available to those who are subsidized by their
employers or are in an employer-based system. Purchasing health plans outside
this system often entails not only inflexible government mandates and high
administrative costs, but also state and federal tax breaks. Losing these tax
breaks can mean an addition of 40 to 50 percent to the total cost of the
purchased health care plan, compared to the cost of obtaining it with an
The solution to this
problem is a single health insurance market, which should be designed to work
well for everyone, not just for employees working for large companies.
A health insurance market
exchange should be designed to work as a market for every type of insurance
plan, including health maintenance organizations, health savings accounts, traditional
health insurance plans and other options that might present themselves in
response to people's demands
In principle a health
insurance exchange should work like a stock exchange, which functions as a
single market for all sorts of stocks and which regulates the costs of selling,
purchasing and trading stocks.
HEALTH INSURANCE STATISTICS: SOME IMPORTANT FACTS
8/5/2009 5:34:15 AM
purposes of this article, four types of health insurance have been
identified. A high deductible
heath plan is private insurance with lower monthly or annual premiums than
other types of insurance, but consumers pay greater out of pocket expenses for
care. A consumer-directed health
plan, also known as a health savings account, combines a high deductible plan
with a special, tax-free account that can be used to pay for medical
expenses. Private insurance is a
plan provided by an employer, a trade union, or purchased directly by the
customer and includes managed care plans like HMOs, but does not include
military insurance. Public health
insurance includes state or federally funded programs like Medicare, Medicaid,
and State Children’s Health Insurance Plans (SCHIP).
A 2007 US
Census Bureau survey reported that both the percentage and actual number of
uninsured people decreased slightly between 2006 and 2007. Despite this promising trend, the number
of people who receive health insurance through public programs increased during
that same period, from 80 million in 2006 to 83 million in 2007. This could be due to any number of
factors including turnover in the workforce as baby boomers retire or the
current economic recession and subsequent job loss.
under the age of 65, 43 million are uninsured. This represents slightly less than16 percent of the
population. In this same age
group, more than 67 percent of people who have health coverage own policies
issued by private insurance companies.
Of this 67 percent with private health insurance, 17 percent are
enrolled in a high deductible health plan. Five percent of people with private medical insurance are
enrolled in consumer-directed health plans. Those enrolled in individual health insurance plans are more
likely to have a plan with a high deductible than those who have group health
insurance through an employer or trade union. Citizenship has a significant impact on access to medical insurance,
as foreign-born residents of the US are about two and a half times more likely
to be uninsured than those born here.
increased awareness of and access to state health plans for children, only
about nine percent of children under the age of 18 are uninsured. More than 60 percent of children are
covered by private health insurance, while nearly 33 percent are covered under
a public health plan backed by state or federal government. Economic status clearly plays a role in
a child’s access to health insurance, as children living at or below the
poverty level are more likely than other children to go without medical
insurance, either through a private or public plan.
factors also affect the population at large. Income level has been shown to directly correlate to rates
of medical coverage. About 25
percent of citizens with annual income of less than $25,000 do not have any
health insurance, while the more affluent are likely to have at least some kind
of health coverage. The plan
quality and percentage of the population increases in relation to income
Health Insurance: What it Means
8/5/2009 5:34:15 AM
Health insurance is a guarantee
that whenever a person contracts a disease or suffers an accident he/she won’t
have to pay the full payment for his/her medical expenses. Health insurance
aids people in protecting themselves against costly or unexpected medical
expenses. The mechanics of health insurance is that a person pays for an
insurance policy that states what kinds of accidents or diseases the insurance
company is willing to cover. If the person agrees to the coverage of the policy
then the insurance company and the person have a binding contract. These can be
purchased through private insurance companies or government-funded insurance
programs. It can be acquired individually or by a group. Both ways aim to
provide the individual with a less costly means of getting medical treatment.
Health insurance companies determine the kind of
coverage a person or group might need. They determine this by looking at the
age of the person, the kind of lifestyle he/she has, the kind of work they do,
and the current state or physical health they are in. After going through these
processes the health insurance company will determine how much the person would
have to pay for his/her first premium.
The health insurance policy has several factors:
Premium: This is how much the insured (or if the individual is insured
under his/her company, the employer will pay for this) would have to pay
to acquire medical coverage. Deductible: This is how much the insured must pay from his/her account before
the health insurer pays its share. For example, a policy-holder might have
to pay a $500 deductible per year, before any of their health care is
covered by the health insurer. It may take several doctor's visits or
prescription refills before the insured person reaches the deductible and
the insurance company starts to pay for care. Co-payment: This is the amount that the insured person must pay for from his
own pocket before the insurance company pays for the patient’s visit to
his doctor. Co-insurance: This requires the insured to pay a certain percentage of the total
payment, which is agreed beforehand in the health insurance policy. Exclusions: This explains that not all treatments or services are covered by
the policy. The insured person must also pay the full cost of non-covered
services. Coverage limits: In some health insurance policies the health insurance company
will only pay up to a certain amount. In case of extra charges, the
insured person would be required to pay for that from his own pocket. In
addition, some insurance company plans have lifetime or annual coverage
maximums. If the insured reaches this limit he/she would have to pay for
the rest of the expenses from his/her own pocket.
HOT TOPIC: HEALTH INSURANCE REFORM
8/5/2009 5:34:15 AM
Americans are totally uninsured, while millions more struggle to fit
ever-increasing health insurance premiums or the high out-of-pocket cost of
covering gaps in their policies into budgets that are already stretched to the
limit. It is clear that most
Americans are ready for a change. The only question is: “What kind of healthcare reform makes
the most sense?”
system of medical insurance in America has several glaring problems. The freedom of choice that makes
American business so unique—supply and demand, consumer-driven competition,
etc.—is virtually non-existent in the health insurance industry. The tax incentives for employers who
offer medical coverage to their workers, along with federal and state insurance
regulations that make policies the property of these employers, limit the free
market system. Patients are taken
almost completely out of the equation and are usually forced to settle for the
coverage their employer has chosen for them. Furthermore, because policies are owned by employers,
employees must leave their insurance when they leave their job. This eliminates portability of coverage
and, in some cases, continuity of care.
Finally, moral and religious objections of patients who participate in
group plans are overlooked. Group
premiums are combined to pay for a wide range of services for all members. This can include things like abortion,
birth control, and stem cell treatments.
If an employee objects to a procedure on a moral or religious basis,
they are powerless to redirect their premium payments away from those services
because their employer controls which insurance policy they are offered and
what types of coverage those plans include. The employee’s only choice is to reject coverage altogether,
which is never an attractive option.
who support health insurance reform tend to favor a single-payer, government
sponsored system similar to those in many European countries. These plans would provide universal
coverage to all Americans, regardless of employment or income status. Contributions would be combined into a
single fund that would be used to pay healthcare providers for all services
largely oppose the liberal model, believing a single payer system will actually
raise healthcare costs for all Americans.
Some conservatives propose a federal tax credit that would extend to
individuals who purchase their own insurance the same tax breaks enjoyed by
employers who offer group coverage to their workers. Others advocate a plan that would allow people to keep the
same medical coverage no matter where they work, and to take a plan from job to
job. Another faction supports
allowing individuals to purchase health plans from states other than their own
which reform model they champion, the ultimate goal of activists is to bring
true freedom of choice to health insurance and open a free market system in the
industry. This would make coverage
more affordable for millions of people and would expand a patient’s control
over his or her personal healthcare.
Insurance companies would be forced to offer more competitive rates,
premiums, benefits, and coverage options; thus opening access to essential
health insurance for a multitude of uninsured Americans.
Liberals Insist on Strong Public Health Insurance Plan
8/5/2009 5:34:15 AM
Several democrats are voting against the
health care reform legislation if it does not have an insurance program
commandeered by the government.
They also opposed a health plan of Rep. Henry Waxman, D-California and
four moderate Democrats, which entailed offering small businesses and
individuals a health insurance plan as another option to private insurance, but
they intend to negotiate the health care providers’ rates.
The Democrats, who opposed the plan of Waxman et al., want the public to
be able to pay the same rates that they pay to Medicare, which is lower
compared to private insurers.
A letter sent to House Speaker Nancy Pelosi, Waxman et al. had this to
say about higher reimbursement rates than Medicare rates, “would ensure higher
costs for the public plan, and would do nothing to achieve the goal of ‘keeping
insurance companies honest,’ and their rates down,” The chairmen of two other
committees with jurisdiction over health care reform also received the same
The letter also opposed the reduction in insurance subsidies for
middle-income Americans, which was in the compromise bill.
“We simply cannot vote for such a proposal,” the letter read.
Outside the Capitol on a Thursday afternoon Rep. Lynn Woolsey, D-Calif.
spoke at a press conference saying that most of the signers support a
single-payer health care system, i.e. Medicare for everyone. They have settled
for something that still falls short of what they are really expecting; they
are no longer willing to compromise more than that,” Woolsey said.
Sounds of the protesters were heard on the Capitol grounds shouting,
“Single-payer now.” The protesters held their rally near the press conference.
Rep. Raul Grijalva, D-Ariz., told the Obama administration and the House
leadership before that they believed in their vision of the health care reform
because of the solid public insurance plan included there.
While the press conference was in motion, Waxman’s committee worked on
the legislation. A health care reform bill has already been passed by two other
House committees, which includes a public plan that the liberal Democrats would
like more. Some of the people on Waxman’s committee and several others balked
at this provision, which pressured Waxman to broker another deal just to get
enough votes to pass the legislation. Waxman’s committee is expected to vote on
this bill on Friday.
House leaders will have a difficult task managing the Democrats’
dissension, when Congress comes back from its August break. The bill has two
versions that the Congress has to mould into one, and one of the two groups of
Democrats (Blue Dogs and Liberal) are going to be disappointed with the final
Insurance companies and several business groups do not approve of the
public plan. They argue that the charge on private users is higher compared to
Medicare because Medicare pays below-market rates for their services. If the
government makes a public plan based on the rates of Medicare the problem would
only worsen, which will cause premiums to increase for those businesses that
are covered by private insurers.
Some people are afraid that this might force private insurers out of the
market, which will leave the pubic plan as the people’s only choice.
But Rep. Nydia Velazquez, D-N.Y., stated that a public plan might just
be the thing to nudge private insurers to lower their rates and try to compete.
MAKING SENSE OF HEALTH MAINTENANCE ORGANIZATIONS
8/5/2009 5:34:15 AM
Organizations (HMOs) are a form of managed healthcare insurance. Customers belong to a larger group of
plan participants and pay fixed monthly fees in order to receive care. Providers receive a fixed,
pre-negotiated fee from the insurance company in exchange for their
services. Most HMOs only cover
services provided by a limited network of doctors and facilities.
employers and government agencies use HMOs to offer health insurance for
employees. The overall goal of the
HMO is to keep medical costs low for all members. Insurers accomplish this by contracting with specific
doctors, dentists, clinics, hospitals, and other providers, and insuring large
groups of patients. This allows
the company to negotiate for lower prices based on volume participation. HMOs also lower premiums by identifying
and eliminating certain procedures and treatments they deem medically
As with any
health plan, there are advantages and disadvantages associated with HMOs.
The cost of
a monthly HMO premium is relatively inexpensive when compared to other types of
health insurance. Premiums are
fixed and co-payments are usually the only required out-of-pocket expense for
patients; some HMOs do not charge co-pays at all. Most HMOs require patients to designate a primary care
physician who acts as a single point of contact for all other care. While some see this aspect of HMOs as a
disadvantage, others find it comforting to know that their care is being
managed by a single provider who has access to their complete medical records
and healthcare history.
primary care physician can be problematic, however, as patients may have to
switch doctors and thus interrupt continuity of care. Patients typically have less control over their own care and
may have to wait to receive treatment if they need specialized care. If a patient wishes to see a specialist,
she must first make an appointment with her primary care physician. If the primary doctor deems the
specialized service medically necessary, he will submit a referral to the
HMO. The HMO either approves or
rejects the proposal and, if the referral is approved, only then is the patient
free to make an appointment with the specialist. If the referral is denied, the patient must then choose to
forego the treatment or will have to pay the total cost of services out of
pocket. Another disadvantage of
HMOs is that they typically limit coverage in an effort to cut costs, focusing
on treating conditions as they arise rather than on preventative care and
considering purchasing an HMO plan, think about your particular needs. Do you have a condition which requires
specialized care? Might you need
this kind of treatment in the future?
If you already have a doctor you trust, will you have to find a new
one? Would a change in physician
interrupt your care? Finally,
research the HMO’s reputation in your area and figure out if the cost of the
plan is reasonable for the level of care you will receive as a member.
MAKING THE MOST OF YOUR HEALTH INSURANCE: HOW TO CHOOSE THE RIGHT DOCTOR
8/5/2009 5:34:15 AM
primary care doctor or a specialist can be a daunting task, but it is an
undoubtedly important decision and worth taking the time to do the proper way.
check with your insurance carrier for a list of approved providers. If your plan restricts you to seeing
certain medical professionals, you’ll want to know this ahead of time. This will help you narrow your focus to
only those doctors in your plan’s approved network and will save you the
out-of-pocket expense of treating with a non-network provider.
have a solid list of leads from your insurance company, ask around for
recommendations. Talk to neighbors,
friends and co-workers; see if they have any experience with or knowledge of
any of the physicians on your list.
Next, do a
background check. This is easy to
do online and you can get important information about a doctor’s educational
history, records, licenses, board certifications, and even any disciplinary
action or lawsuits brought by patients.
Your state medical licensing board is a good place to start. You can also consult the Administrators
in Medicine database or the American Medical Association’s Physician Select
why you need a doctor. Do you have
any family history of serious illness or medical conditions? Do you or a dependent family member
require specialized care for an ongoing health concern? Are you seeking homeopathic or
alternative medicine? What
personal factors would make you most comfortable—is a doctor’s age, gender,
primary language, or years in practice important to you?
have chosen a doctor or two, schedule an interview appointment. This is the best way to get a feel for
a doctor’s personality. Judge a
potential candidate on the factors that are important to you. Did the doctor
answer your questions? Listen to
your concerns? Take his or her
time in the interview to make sure you were satisfied?
questions you might want to consider:
How far is the doctor’s office from where you live or work? Which hospital does the doctor
use? Where would you go to have
lab tests or x-rays done? Is the
doctor accepting new patients and, if so, how long will you have to wait to get
an appointment? What is the office
staff like? How would you get help
if you needed to speak to someone after hours? How does the doctor handle referrals? Will the office staff take care of
insurance paperwork for you or will you have to file claims and seek
reimbursement on your own? How
many other doctors are in the practice, and will you be able to see your own
doctor every time you visit?
conduct a careful search and educate yourself not only about potential
healthcare providers, but also about the details of your insurance plan, you’ll
find that choosing a quality physician is much less intimidating than it may
have seemed at first.
MINDING THE STORE: HEALTH INSURANCE REGULATION
8/5/2009 5:34:15 AM
states have regulated private insurance companies since the late 19th
century. State regulation is meant
to make insurance affordable to more people to make sure insurance companies
are financially viable, to protect consumers against fraud, and to ensure
customers receive the benefits they have been promised.
states remain the primary regulators of insurance companies and the products
they sell, federal standards are set for employer-sponsored medical plans and
all states must work within this larger framework imposed by the federal
policies vary widely from state to state and each state in the US has a unique
set of standards that insurers selling policies there must adhere to. However, there are some common
guidelines that all states impose; most of these involve claims activity. Insurers are always required to be
financially secure enough to pay for claims made against policies. All states require prompt payment of
claims benefits and fair claims practices. Aspects of health insurance that vary by state include
access, rating, and coverage.
for-profit organizations, insurance companies—like any other business—seek to
maximize profits while minimizing loss.
Some states regulate this activity with guaranteed-issue laws, which
prohibit insurers from denying group coverage to individual applicants based on
health history or current medical conditions. Some states extend this right to individuals, as well. Guaranteed renewability laws are
another way to combat unfair practices.
Several states have laws that prevent insurers from cancelling group
coverage based on claims or sudden diagnosis of a serious illness. In these states, all group and
individual plans must be renewed annually once issued so long as the company
continues to sell policies in that state.
To stop unfair market practices, some states mandate that insurance
companies must promote all of their coverage options to businesses regardless
of employees’ health or previous claims history. Several states also require companies to guarantee access to
insurance for special populations.
These polices are usually meant to protect infants, disabled children,
and disabled adults who have been covered under a parent or guardian’s policy
since childhood. A few states have
continuation laws, which force small businesses to offer COBRA insurance to
former employees whether or not those companies are subject to the federal
practices in some states prohibit or restrict the ability of insurers to charge
higher premiums based on a patient’s current health status, claims history, or
any future risk for illness or injury.
covered benefits legislation often have a wide range of standards governing the
types of medical services and procedures that insurance companies are required
to include in polices sold in the state.
These are sometimes called “mandated benefits.”
has an insurance department charged with overseeing all policy issuers
marketing products in the state, performing audits, implementing corrective
measures, taking legal action when necessary, and educating the public about
companies operating in the state.
Your state’s department is an excellent source of information about
healthcare coverage regulations in your particular location.
‘Cadillac’ coverage tax prompts questions
8/5/2009 5:34:15 AM
Health care debate full of distortions
8/5/2009 5:34:15 AM
Cutting employee health care could lead to millions in savings
8/5/2009 5:34:15 AM
Kids in Oregon Will Have Health Insurance Coverage
8/5/2009 5:34:15 AM
Pickets at Democrats\' Health Care Events Ignite Political Power Struggle
8/5/2009 5:34:15 AM
The health care
debate last Wednesday reached its boiling point with the appearance of
badgering protesters, the same protesters who had plagued several other
Democratic town-hall forums prior to the debate. Democrat party leaders
labelled the critics as ‘angry mobs’ trying to ‘destroy President Obama’ while the
Republicans accused the Democrats of rejecting public opposition to their
A few Democrats
encountered jeers, taunts and even an effigy, as the House members went home
for the August recess. Video footages of protests, intended to drown out the
health plan debate that were to be the focus in an otherwise relatively quiet
news week were seen on television and online.
As the political
power struggle is getting stronger due to the current situation, each side is
questioning whether the pickets being held at gatherings in different locations
have been arranged by conservative groups or were ignited by the common people
who just wanted to voice their own discontentment and displeasure.
opted to marginalize the complaints as a fringe movement, prompting House
Minority Leader John A. Boehner (R-Ohio) to respond Wednesday, "Democrats
are in denial. Instead of acknowledging the widespread anger millions of
Americans are feeling this summer toward Democrat-controlled Washington,
Washington Democrats are trying to dismiss it as a fabrication."
Some political figures attempted to find a
middle ground in the midst of the vicious partisanship.
"We have to
be careful we don't just jump to the conclusion and label every bit of
opposition above a certain decibel level as organized and contrived," Senator
Robert P. Casey, Jr. (D-Pa.) said Wednesday.
This week, Robert
Gibbs, the White House spokesman stated that the opposition contains voices
that are genuine.
Lawmakers mocked by Arkansas crowd because of Obama’s health plan
8/5/2009 5:34:15 AM
US chief executive reaffirms his vow not to impose tax hike on middle class
8/5/2009 5:34:15 AM
Obama uses unemployment rate to press health care system overhaul
8/5/2009 5:34:15 AM
Recess in August would help Democrats with the health bill, says Durbin
8/5/2009 5:34:15 AM
Serious illness can ruin even those with insurance
8/5/2009 5:34:15 AM
When Glenda Krull and Mark
Moody couldn’t afford their mortgage and health insurance payments any longer,
they knew what they had to do. The couple sold their home.
Four year ago, Moody, 60
years old, underwent a liver transplant; it is possible that he will need
another one. Every month, Moody pays $1,345 for the best policy he can afford
from Premera Blue Cross.
Moody is desperate to keep
the policy despite the consequences. The expensive premiums of his individual
health insurance forced his wife Glenda to have her coverage downgraded, the
couple’s retirement savings were slashed, and they were forced to move to a
house half the size of their original home.
A good insurance policy
doesn’t guarantee Americans who have serious illnesses that they will receive
the care they require and that they will not go broke.
According to a study by
researchers from Ohio University and Harvard University, in 2007, about
two-thirds of all of the personal bankruptcies that were filed throughout the
US were related to medical bills, illnesses or income loss. Of those who filed
for bankruptcy, 78% had individual health insurance during the time they got
Economist Sara Collins
said, “It’s not just the uninsured. It’s people who have insurance that doesn’t
protect them [who are increasing the need for reform].” Collins is also a
vice-president of the Commonwealth Fund, a New York-based foundation for
private health care.
For Moody, when health
insurance coverage goes beyond the reach of people like him and his wife, it
shows that the health care system of the country has gone gravely awry.
Health Insurance Statistics and Health Costs
8/5/2009 5:34:15 AM
One reason that health insurance is the top priority of many politicians
is because 47 million people are not enrolled in health plans, while the
government spent $2.3 trillion on health care last year.
In 2006, according to the Census Bureau, 59.7% of the population had
employer-provided health insurance, 27% availed themselves of government health
plans like Medicaid and Medicare, and 15.8% did not have any health insurance
These statistics are broken down by economic status and race. People who
have higher incomes are more likely to access health care through private
health plans while most of those in the low-income bracket had the cheaper
health plans funded by the government.
In 2008, the cost of health insurance increased by 6.1%. This increase
has also caused 0.3% of employers to drop their workers’ health insurance. The
number of Americans with government-subsidized health insurance also went down
For a family of four, the average cost of insurance is between $12,000
and $15,000 per year. While that is already expensive for those with low
incomes, not enrolling in any health insurance is usually even more expensive.
Depending on the state, the average cost of an emergency-room visit alone
is between $560 and $1,250, while cancer treatment averages $33,248 and a
colonoscopy averages $2,000. The hospital costs of labor and delivery also
vary, ranging from $7,000 to $14,000.
Moreover, health insurance without maternity coverage can quickly put
any woman into debt, as the average OB visit costs $90. In addition, ultrasound
and laboratory work cost an average of $300 and $200, respectively. Naturally,
complicated pregnancy costs even more, which is why health insurance with
maternity coverage is so important.
High-Risk Health Insurance Plans
8/5/2009 5:34:15 AM
Although the majority of Americans avail themselves of subsidized health
care coverage through their employers (group/business health insurance), some
people who do not have access to this kind of insurance just purchase their own
independently (individual health insurance). However, the challenge is when the
person has what is called a “high risk” medical condition, like cancer, central
nervous system issues, cardiovascular conditions and other diseases that
require frequent and costly treatments. Aside from treatment costs, these
conditions also often last longer and can result in complications that become
another responsibility of the insurance company. Since the law allows insurers
to reject the applications of individuals with serious pre-existing health
issues, most insurance companies do.
The most common health care option for “high risk” individuals is
high-risk health insurance. High-risk health insurance provides almost the same
coverage options as those offered by individual health insurance. Both
typically are comprehensive and have diverse options. In many states, a
Preferred Provider Organization (PPO) plan is one of the most popular types of
high-risk insurance plans. Health Maintenance Organization plans are also
available in many areas.
Today, individual states provide this type of health plan through
high-risk insurance pools. The coverage is funded by the state but the insured
has to pay a premium, which is often quite expensive, to the state insurance
High-risk insurance provides broad health coverage and even pays for
prescription drugs. Mental health and maternity are also often covered by
high-risk insurance. The main disadvantage of purchasing high-risk insurance,
however, is costly premiums which are determined by the insured’s pre-existing
health conditions, location, and age.
High Risk Pools Overview
8/5/2009 5:34:15 AM
In most states, the majority of insurance companies deny people with
pre-existing health conditions health insurance coverage. Some people get
medical insurance either through their employer or as a dependent on someone
else’s health insurance plan.
Currently, 31 states run high risk pools, which are designed to help
those who cannot get health coverage due to pre-existing health conditions. In
many states, the health coverage offered by high risk pools is similar to what
individual health insurance offers. Most pools provide comprehensive medical
plans covering extensive disease-specific benefits. Many high risk pools also
include disease management programs for people with chronic diseases.
Typically, enrollees are provided with an option of choosing a PPO, HMO or
Like other insurance options, high risk pool coverage has limitations in
terms of benefits. This type of insurance also requires higher deductibles,
co-payments, and out-of-pocket costs. In most states, high risk pool coverage
usually imposes a so-called ‘pre-existing condition exclusion’ period of up to
12 months. Only after this period has ended will the insurance company start
paying insurance claims.
High risk pool insurance is usually more costly than regular individual
health insurance. Enrollees in high risk pools usually pay 150% to 200% more in
premiums than the standard rate charged by insurance providers for individual
insurance policies. This is mainly because the people enrolled in this type of
coverage have illnesses that require frequent and expensive treatments.
Although costly, this can be the best option for those who are unable to
purchase an individual policy because of existing health problems. Generally,
the health care cost of being uninsured will be a lot greater than the cost of
high risk pool premiums.
Insurance Limits and Exclusions
8/5/2009 5:34:15 AM
8/5/2009 5:34:15 AM
Several states in the U.S., particularly Massachusetts, are working on
enacting or have enacted laws that require the residents of the state to get
individual health insurance. Usually called insurance mandates, these laws are
passed in an attempt to reform the U.S. health care system.
Expanding a state’s risk pool is the concept behind these insurance
mandates. The result of this would be reduced costs for all the state’s
Risk pools work based on the idea that a state has low-risk and healthy
residents who will counterbalance the high expenses brought about by the pool’s
high-risk and less healthy members. When low-risk and healthy individuals are
insured, the members of the pool will then assume a larger part of the expenses
of the pool’s high-risk members.
There are instances when the members of the pool start to find it very
hard to pay for their premiums. This is usually called a “death spiral” by the
insurance industry. To lessen the probability of a “death spiral” occurring,
insurance mandates are issued so that everyone will be forced to purchase
insurance, thus diversifying the members of the risk pool and lowering
There are some problems with insurance mandates. For one, there will be
low-risk and healthy individuals who would prefer not to buy insurance as they
are hardly ever sick. The state would then need to create penalties for those
who fail to comply with the mandate. Another problem is that there are some
people who cannot afford health insurance. The state must then work on
subsidizing or lowering insurance premiums.
Hybrid Long Term Health Insurance Policies
8/5/2009 5:34:15 AM
Until today, people had
very few long-term, health care insurance options. Most commonly, people would
have traditional policies, which offered a certain amount of health benefits.
But, the traditional, long-term health care policies weren’t really enough and,
with the soaring health care costs, self-ensuring is also a risky move.
Depending on family may also be an alternative, but it is still not a viable
While the traditional
long-term-care health plans were a great help for some, many still wanted
guaranteed benefits in the event that the health plan was never used. Thus, the
insurance industry came up with traditional health plans that had a “return of
premium” rider. With this type of policy, the health insurance company, over a
period of time, would return part of the premiums to the owner of the policy if
the health benefits were never used.
The insurance industry has
designed health insurance described as “linked or hybrid” policies. These
health plans provide the benefits offered by an annuity or life insurance
agreement and the traditional, long-term care insurance plans. With this type
of policy, the insured is guaranteed that if he or she remains healthy and does
not use the health care, the benefits can be used by his or her beneficiaries.
Some hybrid insurance policies do not have a “premium rider”. Instead, a part
of the internal return is used in paying for the long-term care benefits. The
cost of the long-term care benefits is based on the amount of coverage chosen
upon the purchase of the term. Usually, the insurers of some hybrid health
plans provide a payout of 200% or 300% of the aggregate insurance value up to
three years after the value of the annuity account is depleted.
Democrats pursue new health plan
7/28/2009 2:16:13 PM
President Barack Obama and other Democrats in Congress are pursuing a new health insurance plan. According to nonpartisan budget experts, this health plan would work with private insurance companies without forcing them to shut their doors.
Good news for Democratic ears, the Congressional Budget Office’s estimate comes as officials pushed for progress on the health care reform before the recess in August.
Democrats had a meeting on Monday afternoon with their allies in the House, and, according to House Speaker Nancy Pelosi, a floor vote may still be pushed through in the coming days. Meanwhile, negotiations between a small number of Republican and Democratic lawmakers resumed in order to find a compromise.
Democratic dissension has slowed the progress of legislative work from the President’s strict timetable.
Two weeks ago, Budget Office Director Douglas Elmendorf infuriated congressional Democrats and the White House with his statement in Congress about the House bill’s inability to control health care costs due to lack of mechanisms.
In order to disprove allegations that their proposal would make way for a federal takeover of the commercial and private health insurance industry, Democrats are now backing a suggestion from the budget office for a government insurance option that will not harm private insurance companies.
Given the unclear projections about how an actual reformed health care system would work, the controversy has yet to have an end in sight.
Poll results show that Americans favor a public coverage option as a component of the health care system reform. However, both employer groups and the insurance industry fear that a government-run insurance option will destroy private insurers.
Disagreements continue about the progress of the health reform bil
7/28/2009 2:12:57 PM
July is nearly over and everybody is still having disagreements about the real progress of the health care reform legislation. According to Speaker Nancy Pelosi and White House officials on Sunday, legislation is progressing, however, their fiscally conservative allies are still less optimistic and the Republicans continue to oppose it.
On CNN’s “State of the Union,” Pelosi said, “When I take this bill to the floor, it will win. We will move forward, it will happen.”
North Dakota senator and budget committee chairman Kent Conrad expressed his opinion that a bill that only carries votes from Democrats is impossible and undesirable. “Look, there are not the votes for Democrats to do this just on our side of the aisle,” he said on ABC’s “This Week.”
Senate minority leader Mitch McConnell also stated on CNN’s “State of the Union” that, “The only thing bipartisan about the measures so far is the opposition to them.”
The White House originally wanted the legislation to be completed before Congress takes a break in August. Robert Gibbs, spokesman for the White House tried to be positive about the missed deadline: “We are enthusiastic about the progress that’s been made. We think we’re on the road to getting comprehensive health care reform by this fall.”
He also stated that even though committees from the House and Senate are considering different versions, 80% of the contents of a final version have already been agreed upon.
In a statement on CBS’s “Face the Nation,” Obama’s senior advisor, David Axelrod, similarly described the progress of the bill. “Now, we are at that final twenty percent. We are trying to work through those details.”
Health care reform has been at the top of Obama’s plans since he assumed the presidency. He wants every American citizen to have medical insurance as well as other health plans.
Obama travels the country to rally support for health care reform
7/28/2009 1:19:30 PM
President Barack Obama currently travels the country to promote health care reform. Obama brought his campaign for the
health care revamp to a public forum on Thursday near the Midwestern city of Cleveland, Ohio.
With the increasing number of Americans getting skeptical about his overhaul plan on the American health care system, and with the growing costs of health plans, the president has become more
determined to gain support for his health care reform campaign.
“We can rescue our economy,” Obama said. “We can rebuild it stronger than before. We can achieve quality, affordable health care for every single American. That is what we are called upon to do. That is what we will do, with your help, Ohio.”
The president seeks major and bold changes in the nation’s medical care system that costs $2.4 trillion. The United States is the major industrialized nation that does not have a comprehensive health care system.
The president emphasized that changing the nation’s health care system can no longer wait. “We spend one of every six of our dollars on health care in America, and that is on track to double in the next three decades,” said the president.
But the Congress’ top Democratic lawmakers have left their plans to meet Obama’s deadline for voting on his reform. Senate
Majority Leader Harry Reid said senators will not vote on Obama’s plan before their recess in August, as the president had wanted. Reid said more work is still necessary to come up with the right plan.
Obama stressed that there is a sense of urgency about the issue, saying “I have no problem, if I think people are really working
through all these issues in making sure that we get it right. But I do not want a delay just because of politics.”
Obama prepared to “knock heads” for health care reform, says Robert Reich
7/28/2009 1:16:19 PM
Robert Reich, the labor secretary during the Clinton administration, spoke to healthcare executives on Thursday in San Francisco. Reich said that Obama must “start knocking heads” on the health reform issue if he wants a bill from Congress by this fall.
He also said that the president has learned from Bill Clinton’s mistakes. Unlike Clinton’s reform proposals in the 1990s, Obama did not send Congress a bill that he knew would not be passed at all.
Reich also said that Obama should have begun working on the issue two weeks in advance. Obama is now at risk of Congress adjourning and leaving the bill unsettled. With this, the opponents of the package will have time to plan their attacks. Reich was the speaker at the Leadership Summit that was sponsored by the American Hospital Association and Health Forum.
Even so, Reich said that “you will see an Obama bill.” He added that “Obama will play his cards” when a Senate and House joint committee works on the legislation. Reich is now a professor at the University of California, Berkeley. He is a regular commentator on political policy and economic issues.
Reich also said that the president will be adamant in adding standards to the insurance of medical malpractice. He also said that Obama as well as Obama’s allies are now more interested with HMO-style pre-paid health care and the accountable care provided by integrated systems such as the Cleveland Clinic or the Mayo Clinic. Obama and his allies are becoming aware that offering coverage to those who are uninsured is only a piece of the health reform puzzle.
Connecticut sees advance in universal health care
7/28/2009 12:01:08 PM
Lawmakers in Connecticut are moving forward with their plans to establish universal health care, as there has been no federal legislation on the issue. This move follows Massachusetts’ pioneering law.
Currently, President Barack Obama’s administration and the Democrats in Congress are struggling to rally support for a plan to provide health care for a large number of Americans. Connecticut is part of a small minority of states that are planning to create universal health care independently. The state is aiming to improve the system that has caused more than 40 million Americans to be left
On Monday, Republican Connecticut governor Jodi Rell’s veto was overridden by the state legislature, which is controlled by Democrats. A board composed of nine members will be created to develop a system for universal health care in the state. On January 1, 2011, this board will be giving lawmakers recommendations for the health care plan. Called SustiNet, the plan will cover almost all of the 3.5 million residents of Connecticut, including the 350,000 residents of the state who do not have coverage.
In 2006, Massachusetts enacted a law that made health coverage compulsory. It was the first state to do so in the U.S., and it brought health coverage within the reach of people who cannot afford it by providing subsidies and by reforming the industry. Maine and Vermont are also in the process of advancing their health care reforms.
Connecticut will be building a system around a health insurance pool that includes employees of the state and Medicaid participants. The pool would eventually be expanded to include private employers and residents who require individual health insurance.
Obama: U.S. health care system revamp cannot be delayed
7/28/2009 11:43:57 AM
President Barack Obama continues to push for the overhaul of the U.S. health care system. He says that this matter cannot be
delayed because it would affect “the stability of our entire economy.”
In Obama’s weekly Internet and radio address, he urged the Representatives from the two parties to work on laws that will
decrease costs and regulate the “unwarranted giveaways to [health] insurance companies in Medicare and Medicaid,” while keeping the Americans’ health care options intact.
Obama added, “This is what the debate in Congress is all about: Whether we’ll keep talking and tinkering and letting this problem fester as more families and businesses go under, and more
Americans lose their coverage, or whether we’ll seize this opportunity.”
Obama is ramping up this health insurance reform campaign, as he is set to hold two legislation events for the press this week. He
will gather the Representatives to the White House for deliberations, and will hold a primetime press conference on July 22. The House and Senate are hard set to meet Obama’s August deadline, as he urges them to act on legislation before the coming congressional recess.
According to Obama’s recent statements, he will deny support on legislation that would add to the deficit.
“I don’t believe that government can or should run health care,” Obama remarked. “But I also don’t think insurance companies
should have free rein to do as they please.”
Obama wants a final bill in about two months time, by October. Certain members of both parties criticize Obama’s action timetable for this health care overhaul campaign as “too ambitious.”
Jon Kyl, Arizona Senator, commented in the Republican weekly address on radio: “Something this important needs to be done
right, rather than done quickly.”
Obama's Strategies to Amend America's Health Care System
7/28/2009 11:37:58 AM
A considerable amount of the American family’s budget is spent on medical insurance. The USA government alone allocates over $2.2 trillion yearly or $8,000 per person on health plans to ensure healthy workers and a productive economy. It is projected that the
amount the government spends on the health care system will increase to more than $4 trillion by 2017 if no program for the reform of the system is enacted.
President Obama has initiated ways to modernize the system of health care in America. The Recovery Act of 2009 includes a provision for the citizens who have recently lost their jobs, which will provide a tax credit that will continue their health insurance
contribution through COBRA. He also signed a law that supports health plan coverage for children through the Children’s Health Insurance Program (CHIP). The president has also pushed for the computerization of health records in the United States in five years in order to make the system more efficient and more accurate. The government will save much money if the paper-based records, which
are time-consuming and expensive, are replaced with a computer system that will deliver speedy results with minimal or no errors.
The government also seeks to uplift the research and development of the current health system. The Recovery Act has also allocated $1.1 billion for comparative research that details data on the effectiveness of a medical treatment or procedure. This will aid the doctors in proper diagnosis and treatment of their patients. Programs on wellness will also be promoted in the country because almost one-third of illnesses are attributed to poor lifestyle choices. This will reduce the risks of acquiring diseases, such as hypertension, cardiovascular ailments, and cancer.
Would $1 trillion be enough?
7/28/2009 11:32:52 AM
The White House and the Democrats in Congress who are working hard on the health care bills to beat President Obama’s deadline, are trying to keep legislation costs to $1 trillion for 10 years. But would that be enough?
There is no doubt that $1 trillion would cover a lot of uninsured people. However, it will not be enough to meet the goals that the advocates initially wanted. Congress is currently working on proposals that include a $1.042 trillion bill that will be presented by Democratic leaders in the House on Tuesday. The proposals intend to provide subsidies to a smaller number of moderate-income families. They will also prevent most workers from abandoning the health plans provided by their employers.
According to the Congressional Budget Office, the estimated number of uninsured people will go down to 15-20 million after 10 years. As of now, around 50 million people are uninsured.
Last Monday, Senate GOP leader Mitch McConnell stated that "One of the major concerns that Americans have about health care reform is the price tag. Every proposal we've seen would cost a fortune by any standard."
In defense of the health care reform, President Obama says that the overhaul is a crucial investment toward fixing the nation’s dysfunctional health care system. Straightening the rough edges of the current health care system would prevent financial problems in the future.
Lawmakers are still trying to figure out how to finance the overhaul. According to Obama, fixing the health care system will not increase the country’s financial deficit, and to offset such a deficit there will be a need to either raise taxes or cut national spending.
Democrats reveal health care overhaul plans
7/28/2009 11:25:13 AM
House democrats unveiled an extensive plan for a bold reform of the nation’s health care system. Contained in the 1,018-page bill are provisions on regulating the health insurance market, formation of a new health insurance option run by the government, and other steps for implementing universal health coverage.
The bill sets out initiatives for reducing health care costs, which are expected to rise to $2.5 trillion this year. In addition, the cost of the legislation, which is estimated at $1 trillion, will be offset with a new tax to be imposed on wealthy Americans.
The proposal, which is considered one of the most liberal in revamping the system, was criticized by Republicans and 30 leading business groups, although many of these also showed support for some aspects.
If implemented, employers will either provide medical insurance to their workers or pay the government a fee based on their payroll. Small businesses with an income below $250,000 will be exempt from paying the fees. Also included in the plan are regulations prohibiting insurance companies from denying Americans with pre-existing medical conditions. This is to ensure more affordable options for everyone.
All low income Americans will also become eligible for Medicaid, and private insurance companies will be offering a standard universal benefit package designed by the government.
The Congressional Budget Office (CBO) estimates that 97% of Americans, including legal immigrants, will have health coverage by 2019. Furthermore, the CBO estimates that nearly 162 million people
will have continued employer-provided insurance and 30 million people will avail themselves of health coverage through the new health insurance exchange. Nine million of those who would avail themselves of the new exchange are expected to choose the new health program run by the government.
Will health care reform really cut costs?
7/13/2009 1:33:42 PM
Despite the continuing support for President Obama’s health care reform, some of the major players in the debate are beginning to worry about the overhaul’s success. They fear it won’t be sufficient to solve the problem of runaway medical costs.
Some even believe that the deals the White House made with drug makers and hospitals to keep the negotiations alive could make the problem worse.
On Monday, there will be a closed-door meeting between labor leaders and Obama. They will discuss aggressive measures to keep health care costs from escalating. Terry O’Sullivan, head of the Laborers' International Union of North America, expressed his support of the plan to have everyone covered by medical insurance, and at the same time his concerns about the reform.
"We are certainly for expansion of coverage. We think every American ought to have health insurance. But if that doesn't come with making sure there is real prevention, if we're not talking about really controlling healthcare costs, this is going to be a train wreck."
On the other hand, business groups are urging the current administration and its allies in Congress to tackle the cost issues by making changes to the way doctors, hospitals and providers are paid.
According to Steve Wojcik, the National Business Group on Health’s vice-president for public policy, “Going into health reform, there was a lot of talk from the president on how controlling costs had to be on a par with expanding coverage. The priority on controlling costs seems to have fallen by the wayside."
Consistent survey results point to the public’s biggest health care concern: rising cost of medical bills and health plan premiums. At the core of his campaign for health care reform, Obama insists that his health care reform will provide relief.
U.S. government provides $40M in children’s health care grants
7/13/2009 11:44:00 AM
U.S. Health and Human Services Secretary Kathleen Sebelius disclosed Monday that local and government organizations could now avail themselves of outreach grants to enroll more children in health care insurance plans.
The outreach program aims to cover 4 million children who do not have health care plans and keep 7 million children insured under the Children’s Insurance Programs and Medicaid. Sebelius said that the project prioritizes residents of “historically under-served” or rural areas.
“These grants arrived just in time, when we need them the most,” Sebelius added, referring to recent news on the country’s unemployment rate, which has reached 9.5%. Sebelius also stressed that when the unemployment rate is high, the rate of uninsured individuals also rises. This is because the majority of Americans are enrolled in group health insurance plans, which are employer-provided health plans. “When parents lose their jobs, they and their children also lose health coverage,” Sebelius added.
The grants, made through the Children\'s Health Insurance Program Reauthorization Act signed by President Barack Obama and which was released in February, will be initially funded by the federal government. The outreach program will last until 2013 and will be providing a total of $100 million worth of grants.
To get the most qualified applicants, Cindy Mann, director of the Center for Medicaid and State Operations, advised using innovative methods, such as technology-driven or even localized and community-based initiatives. “We should think of ways that can really help us reach all qualified children in order for them to enroll with less red tape,” Mann said.
Local governments, community-based or non-profit organizations, schools, and religious groups are welcome to apply. Eligible candidates may submit their applications at grants.gov until early August.
Key Senate Democrats cut cost of medical insurance bill
7/13/2009 11:39:13 AM
Key Senate Democrats presented a modified health care bill, calling for private insurance companies to compete with insurance options offered by the government.
In a letter, Senators Edward Kennedy and Christopher Dodd said their improved bill dramatically decreases the costs of the earlier incomplete proposal. The two senators stressed that the Congressional Budget Office’s estimate of the proposal’s cost is now down to $611.4 billion over 10 years from $1 trillion.
In a press conference, Senator Dodd said the revised plan is closer to the “historic health care reform.” This bill, he added, offers the public options on a health plan that is run by “what functions best for Americans, not by what makes enormous profits.”
The revised bill also calls for a $750 annual fee for each full-time worker and $375 for each part-time worker at large companies not subsidizing health coverage for their employees. Small companies with only 20 employees would be exempt from penalties. It is estimated that the fee would raise $52 billion in 10 years. This would be used to subsidize those who cannot afford to pay for medical insurance. The government’s budget would be coming from higher taxes and trimmed Medicaid and Medicare spending.
The two senators also emphasized that the legislation aims to reduce the number of employers who want to drop their workers’ health coverage next year due to high health care costs.
The bill also urges private insurance companies to provide medical coverage to any applicant at a lower cost, especially to those with pre-existing medical conditions. The revised proposal is also projected to advance President Barack Obama’s proposal that aims to cover an estimated 47 million people who lack health coverage.
New health care bill fines Americans who refuse medical coverage
7/13/2009 11:31:38 AM
Key Senate Democrats unveiled last Thursday a health care revamp bill that imposes a fine of more than $1,000 for Americans who refuse to avail themselves of affordable health coverage. The bill aims to fulfill the top domestic priority of President Barack Obama.
In a statement, Obama supported the legislation saying that it “reflects many of the principles I’ve laid out, such as reforms that will prohibit insurance companies from refusing coverage for people with pre-existing conditions and the concept of insurance exchanges where individuals can find affordable coverage if they lose their jobs, move or get sick."
In the proposed health care system, it would be an obligation for citizens to be covered by health insurance as it is necessary for motorists to get auto insurance coverage now. The government would also subsidize health insurance for the poor and even for middle-class families. However, those who decline to apply for health care coverage would face penalties.
As estimated by the Congressional Budget Office, the said penalties can raise $36 billion in 10 years. The penalty system is patterned after the method used in Massachusetts, which imposes an annual penalty of about $1,000 per individual who declines to get medical coverage. Federal legislation also dictates for the fines to be higher on families.
Data from a survey by the Kaiser Family Foundation show that in 2008, employer-paid health care family plans averaged at $12,680 while individual plans were at $4,704. It is estimated that the cost of the revised federal health plan will be less than this.
The penalties will be set at half the price of basic medical coverage. Called “shared responsibility payments,” the penalty aims to urge people to avail themselves of a health plan while they are still healthy and not wait until they get sick. Penalties shall be collected through the income tax system.
Democratic senators propose government-run insurance option, cheaper cost for health care bill
7/13/2009 11:28:16 AM
Key Democratic senators are pushing for a government-managed insurance policy to provide alternatives that will compete with private health plans. This proposal, which aims to help President Obama’s health care reform, will also require large companies that do not provide insurance to their employees to pay an annual fee of $750 per worker.
Democratic Senators Edward M. Kennedy of Massachusetts and Christopher Dodd of Connecticut said that the modified proposal would be cheaper compared to its previous version. The revised proposal aims to cover up to 97 percent of the American population.
Two weeks ago, the Congressional Budget Office estimated the cost of the previous proposal at $1 trillion over 10 years. The revised proposal on the other hand will cost around $611.4 billion. This modification on the actual cost of the proposal also “virtually eliminates” the earlier prediction that many companies would be forced to drop health insurance coverage for their employees.
On Wednesday, the two senators wrote to the members of the Senate Health, Education, Labor and Pensions Committee in anticipation of the return from vacation of lawmakers to the Capitol.
As early as next week, the Health Committee could finish its version of the bill. A party-line vote is virtually guaranteed because of the proposed government-run health insurance alternative.
On the other end, the Senate Finance Committee is working separately towards a companion measure that aims to achieve a bipartisan concession.
At the end of the month, the three House committees working on the legislation are expected to arrive at a vote that is sure to include the proposed insurance option from the government.
Obama is pressing for Congress to pass legislation within the year.
Obama, Health Reform, and the Middle Class
7/13/2009 11:25:42 AM
WASHINGTON – From the very start, President Obama’s administration has been working hard to sell health care reform to the middle class as part of the solution to increasing medical costs, and not just as something costly for the benefit of the poor.
But with the way legislation is being shaped by Congress, the most important issue yet to be addressed is whether the extent of the benefits for the middle class will be sufficient to gather their support.
Back in the 1990s, President Bill Clinton’s health insurance regulations failed because of the “Harry and Louise” ads. The insurance industry used these ads to suggest that Clinton’s health plan was “a bad deal” for the middle class. Even though recent polls suggest some public discontent with the way Obama is handling the issue, the President is yet to go down the same road as Clinton.
According to Len Nichols, New America Foundation’s health policy program director, the middle class’ decision will decide the fate of this year’s health care debates. "It will come down to Obama's portrayal of the benefits of the new world," and his solutions to the rising cost of insurance premiums." All this is complicated. All this is hard to show.”
Obama is selling a different payoff to Americans who are going to shoulder most of the bill that will cover the uninsured. Even though the portrayed payoff is generally appealing, quantifying it would be more difficult to do as compared to the subsidies needed to help cover the poor. The President wants the public to underwrite the cost of legislation and look forward to smaller premium increases in the future and guaranteed coverage.
Obama continues push for Healthcare Reform in northern Virginia
7/13/2009 11:15:54 AM
President Obama will visit northern Virginia on Wednesday to hold another town-hall meeting as he continues to push for the overhaul of the country’s healthcare system.
Those who want to participate in the event are encouraged by the White House to send questions and video responses online. People can visit the White House’s official Web site or connect through social networking sites like Facebook (http://facebook.com/Whitehouse) and Twitter (#WHHCQ).
According to Sheryl Gay Stolberg of “The New York Times,” Obama’s administration has created a multi-pronged strategy to help the president promote his health plan to the public. The strategy aims to persuade government officials outside of Congress, like state governors, to help by acting as Obama’s emissaries. However, the strategy contains many potential risks, like funding problems, which will be tackled by lawmakers when they return to Capitol Hill next week from recess.
“If Mr. Obama waits too long to exert his presidential muscle to forge consensus on Capitol Hill,” Ms. Stolberg warns, “his moment of opportunity could pass. He could also lose control of the final outcome if lawmakers cut backroom deals he dislikes, for example, by deciding to pay for the expansion by taxing employee health benefits, a move that worries Mr. Obama’s political advisers because it could cause the president to break a campaign promise.”
According to senior adviser to the president, David Axelrod, the administration wants “as many people as possible” to take part in the nationwide discussion about the healthcare reform.
Dan Balz and Shailagh Murray of the “Washington Post” analyze the administration’s plans. Just like healthcare, the energy and immigration bills will also face tough opposition in the Senate.
Government shoulders 65% of insurance premiums for those who lost their jobs
7/13/2009 11:08:55 AM
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), the federal economic recovery plan offers a subsidy for employees who wish to continue their health insurance after job loss. As long as they are qualified for a new health insurance plan, the subsidy will pay 65% of their insurance premium for nine months.
COBRA offers continuing group/business health insurance for workers who lost their jobs. Signed into law in February 2009, this new subsidy covers involuntary job loss between September 1, 2008 and December 31, 2009, and applies to those who were terminated for any cause as long as it was not because of gross misconduct, as set in the IRS guidelines. Workers cut in large layoffs may also avail themselves of the subsidy.
In a notice, the IRS explains, “If the company would have terminated the employee’s services and the employee had knowledge that he/she would be terminated, the retirement is involuntary.”
Moreover, although COBRA mostly covers offices with at least 20 workers, smaller companies or groups that are under state mini-Cobra plans may also avail themselves of the subsidy. If the employee worked in a company that pays for COBRA premiums, he/she is only required to pay 35% of the total health plan for up to nine months.
nce qualified, a laid-off employee can use the Health Coverage Tax Credit, which shoulders 80% of health premiums for retirees that receive financial support from Pension Benefit Corporation. This also covers workers who lost their jobs due to technical modernization or deferral trade policies.
Workers who do not qualify for the subsidy are those who have a gross income of more than $125,000 a year or $250,000 for joint filers.
Will Obama’s health insurance reform work?
7/13/2009 10:55:59 AM
Despite the strain of soaring costs, the government is continuing to head towards a huge health care overhaul, which, it is feared, will lead to sky-high costs for everyone. Americans are supportive of President Barrack Obama’s proposed health insurance reform plan yet many are worried about its impact.
In a forum held last week at the White House, which was broadcasted live on the ABC television network, President Obama presented his health insurance reform plan to the public. Obama confidently answered questions on his proposed insurance reform, including questions relating to how people can keep their existing individual insurance plans.
A fact check on the President’s speech and his answers to questions show that he is eager to pursue his reform but that he sometimes glosses over details in his explanation of how he plans to make the reform successful.
The president campaigned for his health care plan and informed the audience that the costs of health care have increased three times faster than wages in the United States. Some studies, however, like the one prepared by Family USA, a group that is advocating for reforms in health care, reveal that heath care insurance costs have actually increased five times faster than wages in the US, as reported in October 2008.
The president said, “If you are happy with your current [health care] insurance plan and happy with your doctor, we don’t want you to have to change.” However, some speculate that the president’s plan cannot change the fact that private companies have the freedom to choose the health care plans of their employees.
Moreover, it has been found that Americans find it important for President Obama to offer a reform on health care without adding to the national deficit. But the price tag for this health care proposal is pegged to be between $1.3 and $1.6 trillion, which means it will clearly need more revenue for it not to add to the deficit.
Health Care and the 2008 Presidential Elections: A Window of Opportunity
3/14/2007 8:54:00 PM
With the 2006 elections behind us and the 2008 Presidential elections rapidly approaching, there is a clear window of opportunity to translate and innovate the myriad health care reform models proposed over the years into meaningful, life-saving actions as Presidential candidates put forth their policies and voters go to the polls. Windows of opportunity come rarely, and one is now opening wide with the new Congress in 2007 and the upcoming Presidential elections in 2008.
The next President will confront major health policy decisions that will affect the lives of almost all Americans.
Senator: Sweeping health reform possible
3/14/2007 7:59:00 PM
Senator: Sweeping health reform possible
WASHINGTON, March 14 (UPI) -- While the mode in Washington is to focus on incremental change, Sen. Ron Wyden, D-Ore., is pushing comprehensive healthcare reform.
"Healthcare is so complex that to fix it, you have to put pieces together," Wyden told United Press International Wednesday.
"A piece here and a piece there won't do it."
In policy circles, the conventional wisdom has become that only healthcare reforms modeled after Massachusetts' plan, which builds on existing private insurance and public programs, are politically viable.
Wyden's plan, however, involves much more sweeping changes.
Cook: Hillary Clinton - playing her game
3/14/2007 7:36:00 PM
NASHUA, N.H. - New York Sen. Hillary Rodham Clinton used her speech to the New Hampshire Democratic Party's "100 Club" Saturday night to preview what aides say will closely resemble her presidential campaign stump speech.
Punctuated with a "you are invisible" refrain, Clinton charged that "President Bush and the Washington Republicans" have chosen to ignore group after group, including struggling single parents, small-business owners, Hurricane Katrina victims, first responders and wounded soldiers returning from combat.
Democracy Now News Story
3/14/2007 7:11:00 PM
Attorney General Alberto Gonzales has acknowledged mistakes in the firing of eight US attorneys but is refusing calls to step down. This comes as the House Judiciary Committee has released a series of emails and documents showing the White House initiated the process that led to the dismissals. The decisions were made in part on whether the prosecutors "exhibited loyalty to the president and attorney general." On Capitol Hill, Democratic lawmakers say they want to question White House adviser Karl Rove and former White House counsel Harriet Miers.
3/14/2007 5:00:00 PM
Health and disability insurance providers must offer a policy that expressly excludes coverage for abortion not necessary to preserve the woman's life or to terminate pregnancies resulting from rape or incest. 18 Pa. Cons. Stat. Ann. 3215(e) (Enacted 1982; Last Amended 1988).
in these pages
3/14/2007 2:45:00 PM
Tort reform is back in the news again. Last year, doctors and insurance companies declared a malpractice "crisis" here in Florida. The solution was deemed to be a cap on payments to plaintiffs (and their attorneys), but that has already been declared unconstitutional by the Florida Supreme Court once before. A new bill to reinstitute caps failed in the Legislature spawning a Constitutional Amendment petition drive.
The Amendment ultimately proposed (Amendment 3) limited the percentage of awards that an attorney could receive, similar to the case of California's MICRA statute.
3/14/2007 12:55:00 PM
The Board of Directors of the American Society of Addiction Medicine (ASAM) has appointed a Medical Specialty Action Group (MSAG) to develop a knowledge base and make recommendations regarding the recognition of Addiction Medicine as a physician specialty by the American Board of Medical Specialties (ABMS). The MSAG held its inaugural meeting December 1-2 at the Hazelden Foundation, Center City, MN.
High Deductible Health Plans Linked To Fewer Emergency Room Visits
3/14/2007 12:56:00 AM
Patients who switched to high-deductible health plans went to the emergency department 10 percent less than patients who remained in traditional plans, according to a new study by the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care). The study, published in the March 14 Journal of the American Medical Association, shows that most of this reduction was for less severe conditions like colds, nausea, and headaches. The authors followed members for approximately one year after the switch to the high-deductible plan.
Post-Katrina health care lags in N.O.
3/14/2007 12:06:00 AM
WASHINGTON -; Eighteen months after Hurricane Katrina, the healthcare system in New Orleans remains in such disarray that patients with heart disease and cancer are getting inadequate care, local medical authorities told Congress on Tuesday. By one estimate, they said, the number of deaths may have increased by more than 40% from pre-Katrina figures.
The federal government has pumped in millions of dollars in aid, but hospitals and clinics that care for the poor -; already strained before the storm -; have not recovered.
Secular Student Alliance | Mobilizing Students for a New Enlightenment
3/13/2007 7:00:00 PM
As Legal Coordinator, this individual supports the operation of the Appignani Humanist Legal Center of the American Humanist Association, providing paralegal like support of the work of our pro-bono legal team. As Grassroots Coordinator, this individual fills a supportive role to local Humanist groups across the country. Salary is dependant on skills and experience and the AHA offers good benefits, including health insurance and a 403(b) retirement savings plan. The American Humanist Association is an equal opportunity employer. Expected start date is on, or about June 1.
3/13/2007 6:23:00 PM
Wed, 29 Nov 2006 13:16:00 +00002006-11-29T08:16:52.026-05:00Founder's Quotehttp://firstname.lastname@example.org (Liberally Conservative)http://www.blogger.com/feeds/7784011/posts/full/116473247099082850
Tue, 28 Nov 2006 20:08:00 +00002006-11-28T15:10:36.703-05:00Liberals for Hugo Chavez and Citgo
A Look Into the LTC-linked Annuity Market
3/13/2007 5:13:00 PM
March 13, 2007
SOURCE: InsuranceNewsNet, Inc.
The passage of the Pension Protection Act (PPA) has injected new life into the languishing stand-alone long-term care (LTC) insurance market by paving the way for a new breed of products known as the Annuity/Insurance-LTC Combos.
A major benefit of PPA is the tax-free funding for LTC benefits bundled as riders with these life insurance and annuity products. Prior to Bush';s reform bill, this funding was subject to taxes. But in 2010, the premiums for all new and in-force life insurance and annuity LTC combo policies will no longer be taxable.
NCD Authorizing Statute
3/13/2007 5:11:00 PM
SEC. 400. (a)(1)(A) There is established within the
Federal Government a National Council on Disability (hereinafter
in this title referred to as the "National Council"),
which shall be composed of fifteen members appointed by the President,
by and with the advice and consent of the Senate.
(B) The President shall select members of the National
Council after soliciting recommendations from representatives of--
(i) organizations representing a broad range of individuals
with disabilities; and
(ii) organizations interested in individuals with
The Next Health Care Battle
3/13/2007 6:00:00 AM
At a time when the nation is pondering how to provide medical coverage to some
47 million uninsured Americans, it is logical and right to start with the country's
nine million uninsured children. The Bush administration, unfortunately, is
going in exactly the opposite direction.
In a shortsighted effort to save money and promote its free-market philosophy,
it has proposed reducing the federal contribution to a highly successful children's
health insurance program operated by the states.
Source of the Problem: Third-Party Payment
3/13/2007 1:17:00 AM
In 1960, consumers paid about 47 percent of overall health care costs out of pocket.
The proportion had fallen by almost half to 23 percent by 1980.
In 2004, consumers paid only 13 cents out of their own pockets every time they spent a dollar on health care.
The Market for Physician Services. On the average, every time American patients spend a dollar on physician services, they pay only 10 cents out of their own pockets. Millions of people do not even spend that much.
:: Necco - The Power of Family ::
3/5/2007 11:11:00 AM
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
Your health information is private. NECCO understands that the information it
collects about you and your health is personal. NECCO is required by law to
maintain the privacy of protected health information and to provide individuals
with notice of its legal duties and privacy practices with respect to protected
Necco is required to abide by the terms of the notice currently in effect.
Australia needs a better system for health care evaluation
3/4/2007 7:25:00 PM
There are privacy concerns surrounding the use of individual patients' data;
The analysis and interpretation of linked datasets pose considerable challenges; for example, with common adverse events such as heart attacks or stroke, any associations found must be analysed in relation to other known risk factors, details of which may not be available or may not be accurately reported in the linked data; and
There will be costs involved in establishing a national capacity for data linkage.
St. Louis Commerce Magazine
3/4/2007 12:34:00 PM
While the proportion of families with dual-income earners has
increased over the past few decades, the share of employers
offering health insurance continues to decline, putting pressure
on the employers that continue to offer health-insurance benefits.
Employers providing health insurance to their employees' working
spouses are assuming additional costs of more than $46 billion
nationally and $891 million in Missouri in 2006, according to
a report by the Missouri Foundation for Health.
Your chance to help shape a new NHS
3/3/2007 1:52:00 PM
Have your say
There are two National Health Services in Britain. First, there is the one we encounter in our own lives. This NHS is shedding staff while digesting vast sums of money. Its computer systems don't work, its junior doctors go jobless because of bureaucratic errors, its staff are demoralised, its patients grumpy.
In this actual NHS, wards are so filthy that hospitals risk becoming, as in the Middle Ages, places where we go to die. Some are lucky enough to be sent abroad for treatment; others pay twice so as to buy their way out.
International Franchise Association Speech
3/2/2007 10:37:00 PM
Good morning! Thank you for inviting me to your convention.
I'm pleased to be here to share some thoughts with you about the state of our economy. And I'd also like to discuss several challenges that impact our workforce and how we can work together to help workers thrive in the 21st century economy.
Today, our economy is one of the fastest growing and most robust among large industrialized nations, with GDP growth over 3 percent in 2006. The national unemployment rate remains a low 4.6 percent. That's more than a full percentage point lower than the 5.7 percent unemployment rate of the 1990s.
The Rise Of Economic Populism
3/2/2007 10:03:00 PM
There is no denying the mood to which Hacker, Stern, and Dobbs - to say nothing of the leaders of the Democratic party - are responding. Americans are more worried about their economic well-being, and the uncertainties we face are daunting. Many defined-contribution programs like 401(k)'s will indeed fall short when retirement arrives. And even at its healthiest, the economy will not be able to outgrow the budgetary challenge posed by Social Security. This problem, in turn, will be made worse by the expansive prescription-drug plan pushed through by President Bush and the Republican Congress.
Uninsured Children Admitted to Hospitals Are Twice as Likely To Die as Insured Children, According to Families USA Study
3/2/2007 8:57:00 PM
Daily Health Policy Report
Coverage & Access | Uninsured Children Admitted to Hospitals Are Twice as Likely To Die as Insured Children, According to Families USA Study
[Mar 02, 2007]
Children who lack health insurance are twice as likely to die from their injuries after being hospitalized as children who are insured, according to a new report released by Families USA, USA Today reports. For the report, researchers led by J. Mick Tilford of the University of Arkansas for Medical Sciences analyzed government data from 2000 and 2003.
3/2/2007 6:55:00 PM
The debate over Gov. Eliot Spitzer's proposed health care budget cuts heated up last week as Spitzer responded to a statewide campaign launched by The Healthcare Education Project, a joint initiative between United Workers East/1199 and the Greater New York Hospital Association, with his own television advertisement being aired statewide.
Spitzer's 30-second television spot, paid for by Spitzer 2010, features crying babies and addresses the same issues he discussed in his Jan. 31 budget address.
State Farm Announces $1.25 Billion Mutual Auto Policyholder Dividend
3/2/2007 6:41:00 PM
Bloomington, Illinois, March 1, 2007 - State Farm Mutual Automobile Insurance Company, the largest insurer of autos in the nation, announced today it will pay $1.25 billion in dividends to its mutual auto insurance policyholders in 46 states, the District of Columbia and the Canadian province of New Brunswick.
The record-breaking payment of dividends, approved by the State Farm Mutual board of directors, eclipses the previous high of just over $1 billion in June, 2000.
The better-than-expected auto results combined with a $4.
California Health Insurance Agency Announces Fast and Easy Quoting Website for Individuals of All Ages
3/2/2007 3:47:00 PM
Sacramento, CA (PRWEB) March 2, 2007 -- McClerkin Insurance Services, based in California, has announced today that it will now be offering instant, free health insurance quotes for California residents through their new quoting system at mcclerkinins.com.
We believe in utilizing every way possible to give California residents the tools they need to acquire health insurance. This site seems to be the perfect tool. It's very easy to use, extremely fast and doesn't require personal information
"We believe in utilizing every way possible to give California residents the tools they need to acquire health insurance.
Central Valley Business Times
3/2/2007 2:21:00 PM
According to Union Bank of California Senior Economist Keitaro Matsuda, when the labor market is tight, employers start to offer more generous compensation packages. Even though less than half (47.7 percent) of the survey respondents offer healthcare coverage, a tight labor market seems to be forcing employers to absorb some of the rising cost of this benefit.
The survey also highlights optimism on the part of California's small business owners, the bank says.
Sixty-seven percent of survey respondents expect profits to be higher in 2007 than in 2006.
Customer Education: Knowledge Is The Path To Healthy HSAs
3/2/2007 1:42:00 PM
A couple of years into the consumer-directed healthcare era, and it's clear that the President, Congress and most banks like instruments such as health savings accounts a great deal-enough that HSAs were as highly touted in the State of the Union Address as the man who threw himself under a subway train to save a passenger from getting hit.
But what's less clear is consumer knowledge of the product, particularly when it comes to fees and costs, a knowledge gap that could hinder adoption.
AG Says Health Benefits Paid By Public Authorities Illegal
3/2/2007 10:43:00 AM
ALBANYA legal opinion issued Wednesday by Attorney General Andrew Cuomo has concluded that the New York State Housing Finance Agency and state Mortgage Agency had no legal authority to pay health insurance premiums for board members. Such payments were illegal compensation and contracts for post-retirement benefit payments are null and void, Cuomo opined.
The agencies had requested an opinion on the legality of those contracts.
HFA and SONYMA have been paying health insurance premiums of board members since 1998.
Smart Cards in U.S. Healthcare: Benefits for Patients, Providers and Payers
3/2/2007 10:40:00 AM
The healthcare market is poised to move from a paper world to an electronic one. In an era of managed care, specialized medicine, thin financial margins, identity fraud, difficult insurance claims, and government demand for secure, portable, and confidential patient information, the competitiveness of healthcare providers may depend on effective use of information technology (IT). However, increased computerization, reliance on databases, and movement of sensitive patient information require strict controls to safeguard the security and confidentiality of healthcare records.
October 2003--TSA Celebrates the Senate Passage of Genetic Nondiscrimination Legislation
3/2/2007 10:36:00 AM
(TSA), a membership
driven, non-profit organization dedicated to serving all people with
Tourette Syndrome (TS), hails the vote in the United States Senate
approving comprehensive legislation to ban genetic discrimination in
health insurance and employment.
almost a decade, TSA has been vigorously advocating for this
Judit Ungar, TSA President. "Our
members, and all those with inherited conditions, will benefit
enormously in terms of discrimination in both healthcare coverage and
TSA Testifies for Mental Health Parity
3/2/2007 10:34:00 AM
November 16, Tourette Syndrome Association (TSA) Board Member, Sandra Hollis,
whose son, Zak has Tourette Syndrome, testified before the Medicaid Commission
about the financial disparities that exist between the coverage for mental
illness and physical illness and requested the inclusion of Mental Health Parity
in the Commission's report regarding long-term recommendations for Medicaid.
For historical reasons
TS has been classified as a mental health disorder in the reference lists used
by health maintenance organizations and health insurers.
Deckert's school health insurance plan awaits a good grade
3/2/2007 5:10:00 AM
Oregon State Sen. Ryan Deckert liked his bill for a statewide school employee health insurance pool a lot more before people started taking sides on it.
Five years ago when the Beaverton Democrat first introduced the idea, he said it wasn';t as politicized as it is today.
The concept was simple and not entirely new. Pool all of the school districts in the state together into one insurance pool, appoint experts and those knowledgeable in insurance rates to an Oregon Educators Benefit Board that would leverage the sheer size of the pool and get better rates on insurance plans.
National Network of Local Groups to Monitor Health
3/2/2007 2:11:00 AM
"This plan is about giving consumers good
information to make decisions about their health care, and giving
providers information to help them improve care," Leavitt said. "It's
also about hard work and trust. At the local level, providers and
purchasers can meet eye-to-eye and achieve the trust that must underlie
a system of improvement based on more open information."
Under the plan, HHS would select qualified regional
collaboratives to be chartered as Value Exchanges.
Fujitsu To Implement PalmSecure™ Biometric Authentication Device At The City Of Angels Medical Center
3/1/2007 5:12:00 PM
Fujitsu To Implement PalmSecure™ Biometric Authentication Device At The City Of Angels Medical Center
Award-winning PalmSecure Sensor to Help Streamline Healthcare Administrative Processes and Safeguard Unauthorized Access to the Protected Health Records
Sunnyvale, CA, February 26, 2007 -; Fujitsu Computer Products of America, Inc., one of the world's leading suppliers of innovative computer products including hard disk drives, peripherals and biometric security solutions, today announced that City of Angels Medical Center has utilized the Fujitsu PalmSecure biometric authentication device in their Urgent Care department.
Affordable Health Insurance > Medicare Recipients Warned to Resist Aggressive Marketing
3/1/2007 10:45:00 AM
Insurance Commissioner Jim Long urged Medicare recipients- particularly senior citizens- and their families to be aware that some health insurance companies are employing aggressive marketing tactics to sell Medicare Advantage products which may mislead consumers. According to the Department's respected Seniors' Health Insurance Information Program (SHIIP), many Medicare beneficiaries are receiving bad financial advice leading them to make decisions which are not in their best interest.
Medicare Advantage plans include HMO, PPO, Medicare Medical Savings Accounts and Private- Fee-for-Service products.
Symptoms of an unsustainable system
3/1/2007 1:07:00 AM
Symptoms of an unsustainable system
By Jacob Weisberg
Published: February 28 2007 18:35 | Last updated: February 28 2007 18:35
America's healthcare system runs the gamut from capitalist to socialist, pausing at various points along the way. At the free-market extreme are the 10m people who buy private insurance without a subsidy and the 48m who have none at all. At the collectivised end are 5m military veterans who see government doctors in government hospitals, the 32m covered by Medicare (retirees) and 37m on Medicaid (the poor).
Kaiser Daily Health Policy Report Highlights News Of US State Actions Related To Launch Of Medicare Drug Benefit
1/14/2006 6:52:00 PM
Several US states recently took steps to ensure that Medicare beneficiaries -- including dual eligibles, whose prescription drug coverage was switched from Medicaid to Medicare on Jan. 1 -- are receiving needed medications under the new Medicare prescription drug benefit. Summaries appear below.
Massachusetts: The state on Monday instructed pharmacists to fill prescriptions under the new Medicare benefit and bill the state for beneficiaries whose eligibility could not be verified, the Boston Globe reports. The plan, which costs the state between $1.
HSAs Can Help the Uninsured, Study Says
1/6/2006 6:56:00 PM
The study found a health care tax credit would lower the number of uninsured by 10 percent. Coauthor Feldman's baseline for the number of uninsured excluded those who had access to some form of coverage, including full-time college students, people enrolled in public health programs, and those who had the option to be covered though a spouse's policy. That brought the baseline number of uninsured to 27 million people. Under the president's health care tax credit, Feldman says in the report, 2.9 million people would gain coverage.
Over 1 million sign up for new Medicare Rx plan
12/23/2005 3:06:00 PM
More than 1 million people voluntarily signed up for the new Medicare prescription drug benefit in the first four weeks it was offered, government officials said Thursday.
Another 20 million were automatically enrolled in the program, so only half of the 42 million Americans eligible for the new coverage have signed up.
Government officials said the numbers reflected "a strong start" to the Part D prescription drug program, which starts Jan. 1 for those signed up by Dec. 31.
International Medical Insurance
11/29/2005 1:21:00 PM
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SCIENCE&HEALTH: Future of Medicare remains uncertain
11/29/2005 1:11:00 AM
SCIENCE&HEALTH: Future of Medicare remains uncertain
Program faces need for reform as baby boomers approach retirement
By Sarah FisherIncreasing Social Security costs and a decreasing population that is subsidizing the program make its future availability for younger generations - such as today's college students - uncertain. There are a number of challenges facing the program now that could threaten Medicare's future viability for today's young people.In 2006, there will be a 4.1 percent increase in monthly Social Security payments to beneficiaries, which is the largest such increase since the 5.4 percent increase in 1991.
Cheap Health Insurance
11/22/2005 11:54:00 AM
The cost of healthcare seems to be rising every day, and the
only way for many people to afford taking care of themselves is
through a health insurance plan. Still, finding cheap health
insurance that will not break your budget and will still allow
for you to get the medical care you need can be a challenge. Yet
knowing how to look for cheap health insurance that will provide
what you need can make sure that you are able to access your
Cheap health insurance is there to make sure you and your
family can obtain medical care in a way that is affordable.
11/18/2005 11:39:00 PM
Practice innovations would place a high premium on patients' time and convenience to ensure an overall positive experience. A medical home practice might, for instance, use open scheduling as well as Web-based patient-directed scheduling software to minimize "wait" time and maximize face-to-face time between the patient and physician. E-mail and telephone consultations might be available outside regular office hours to reduce the need for patients to come into the office for non-urgent care.
Home practices would make arrangements with teams of additional health professionals to provide services outside the practice's expertise.
A Plan to Make Health Insurance Affordable
11/18/2005 8:24:00 AM
Article Posted: 11/16/2005 8:00:18 AM
A Plan to Make Health Insurance Affordable by Nebraska Senator Ben Nelson
In my travels through Nebraska one of the main complaints I hear from citizens is that the cost of health insurance is going through the roof. It's true. If we don't do something to help small businesses cope with the costs of health care, soon we will have an entire workforce without health insurance coverage.
The figures are staggering even in Nebraska where there are at least 30 thousand small businesses and only 31 percent offer health benefits.
Most Undocumented Immigrants Going Without Health
11/10/2005 9:55:00 PM
Most Undocumented Immigrants Going Without Health Insurance
They account for a third of the growth in the uninsured in the U.S.
THURSDAY, Nov. 10 (HealthDay News) -- Of all U.S. residents, undocumented immigrants
remain the most likely to be without heath insurance, a new study finds.
The study, by the nonprofit Rand Corp., also found that undocumented immigrants account
for up to a third of the increase over the past two decades in the number of people in the United
States who don't have health insurance.
Tips on Choosing a Health Plan
11/10/2005 4:43:00 PM
While Sutter Health is not a health plan, we offer a network of physicians and hospitals that provide care paid for by insurers. You'll want to make certain when you choose a health plan that you select one that gives you access to the routine and specialized services available through Sutter Health. We've prepared this guide to help you understand the different types of insurance and the coverage available.
Choosing a Health Plan - A Simple Guide to Health Insurance
You're not the only one who doesn't know the difference between an HMO, PPO and Point of Service (POS) plan.
10/17/2005 4:03:00 AM
After four years of double-digit rate hikes, average health care insurance premiums rose less than 10 percent in 2005. And they're expected to rise less than 10 percent again in 2006, according to several national surveys.
But excuse employers if they don't get excited about the trend. They are still faced with having to pay much higher prices or trimming benefits--or both.
Health care insurance premiums this year increased 9.2 percent, a 2-percent drop in the average increase from the year before, according to a report recently released by Kaiser Family Foundation.
Help stop healthcare fraud
10/4/2005 2:42:00 PM
Healthcare fraud costs Americans
between $30 billion and $180 billion annually. That’s alarming
information that angers most of us as consumers.
According to the Government Accounting
Office and large anti-fraud organizations such as the National
Health Anti-Fraud Association, that dollar amount is between 2
percent and 10 percent of annual health expenditures in the United
AHRQ Launches New "Effective Health Care Progrom" to Compare Medical Treatments and Help Put Proven Treatments into Practice, USA
10/3/2005 12:01:00 PM
HHS' Agency for Healthcare Research and Quality today launched its new Effective Health Care Program to help clinicians and patients determine which drugs and other medical treatments work best for certain health conditions. Thirteen new research centers, as well as an innovative center for communicating findings, were named as part of the three-part program.
"There is more we must learn about what really works most effectively and safely for our patients, especially for some of the most widespread and costly health conditions," said HHS Secretary Mike Leavitt.
LEARN MORE ABOUT
9/30/2005 1:50:00 AM
Based on their experience, more Americans understand that our national health care system desperately needs an overhaul. In public opinion polls, health care now ranks as one of the top three public concerns, eclipsing terrorism. By an 84-12 margin in one recent poll, Americans think there should be more money spent on health care instead of federal tax cuts. Our nation has the most advanced medical technology in the world as well as the highest rate of any industrialized nation of citizens with no insurance. Currently, this includes nearly one in six Americans, with more added every year.
The Daily News Online
9/19/2005 8:57:00 AM
A few companies, mostly very small ones, will probably drop employee health insurance altogether, a process that is steadily eroding coverage over time. According to the Kaiser Family Foundation, which conducted one of the surveys, the percentage of employers offering health insurance has slid from 69 percent to 60 since 2000.
But for most workers, the employer response has been simply to require workers to pay more, and the other survey, by Mercer Human Resource Consulting, indicates many are looking hard for ways to do that.
An Introduction to Insurance
9/17/2005 7:23:00 PM
The options for purchasing Insurance are plentiful with choices ranging from choosing the Insurance Company, searching for an agent, deciding on the deductible, amount of coverage, beneficiaries and dependent coverage. Once you have a child the offers start pouring in on insuring your new arrival. Does the child need a policy or can he or she be added to an existing policy?
For couples planning on marrying they need to decide which Employer offers the best coverage. When you merge your belongings into one household as cohabitants the need for a renter's policy, if one is not already in place, becomes an issue.
Commentary: HSAs Gaining Popularity, Can Be Better
9/13/2005 10:56:00 PM
Proponents of Health Savings Accounts (HSAs) predicted they would revolutionize the health marketplace. Now, less than two years after becoming law, more than a million people own HSAs. That's twice as many as in September 2004, according to a study released in May by the trade group America's Health Insurance Plans.
By most accounts, HSAs are having an enormously beneficial effect on the design of health insurance in this country. Instead of an employer or insurer paying medical bills, more than one million people are managing some of their own health care dollars.
Even the insured can buckle under health care costs
9/12/2005 3:48:00 PM
Medical progress has helped Americans live longer, but the exploding cost of those breakthroughs has polarized the nation: More than one in four Americans are faltering under the burden of health costs, while almost half — those lucky enough to be healthy or wealthy — are untouched.
The rest are a mix of those who say they worry about whether they will be able to pay routine medical bills in the future and those who have already started cutting corners — skipping treatments or not taking prescriptions — because of the costs.
Infertility Insurance Laws
8/30/2005 5:00:00 PM
The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy;
The patient has not reached the maximum number of allowed egg retrievals and the patient is 45 years of age or younger.
The procedures are performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
The law allows religious organizations to request an exclusion of this coverage if it is contrary to the religious employer's bona fide religious tenets.
Advance Directives For Medical Care
8/25/2005 7:06:00 AM
You can decide in advance what medical treatment you want to receive if you become physically or mentally unable to communicate your wishes. As an adult in a hospital, skilled nursing facility, or other health care setting, you have the right to (a) keep your personal and medical records private, (b) know what kind of medical treatment you will receive and (c) tell people ahead of time what type of treatment you want, or don't want, in case you lose the ability to speak for yourself. You can do this by preparing an Advance Directive.
What is an Advance Directive?
Saving for a healthy day: New accounts force choices
8/25/2005 6:40:00 AM
You can use them to buy over-the-counter drugs, massage therapy, Lasik eye surgery and other treatments insurers usually deny.
Or you can sock the tax-free money away in the stock market. Or both.
They are the increasingly common "health savings accounts." Some say they're the future of American health insurance.
Importantly, the accounts come free of use-it-or-lose-it rules, unlike their predecessors, which were known as "medical savings accounts." Even if you leave your job, the money is yours to keep so long as you use it for health care.
Prescription for Change
7/29/2005 7:24:00 PM
Although they are relatively new, consumer-directed health plans have already driven structural change in the health insurance industry. The early results on costs, utilization, and satisfaction are decidedly upbeat. As the potential for a broader, more comprehensive framework becomes more evident, HSAs are garnering more serious interest from traditional financial-services firms. Virtually all of the major insurance players have now joined the CDHP fray, and the pure-play entrants continue to grow and innovate.
Choosing and Using a Health Plan
6/30/2005 2:11:00 PM
Your Health Plan Affects Many ThingsWhat Are Your Choices?How to Make Decisions Based on QualityRate Your Health Plan Choices
Today there are more health plans to choose from than ever before. Not everyone has a choice. But if you do, this section can help you choose the plan that offers the best quality for you and your family.
The quality of health plans varies widely. In 1997, a study published by the National Committee for Quality Assurance (NCQA) showed differences in the ways managed care organizations provide access to care, keep people healthy, treat illness, deliver high-quality service, and satisfy patients.
Giving employees more control may ease fears about health benefits - 2005-06-20
6/20/2005 10:22:00 PM
According to Towers Perrin, an international consulting firm with offices in San Francisco, 52 percent of employees working at medium and large companies nationwide feel negatively about their health care coverage and many worry that their plans fail to provide adequate financial protection, cover needed services or deliver enough value for the cost.
The survey, which involved more than 1,400 employees, also found that 60 percent of employees feel negatively about the health care experience itself and base important medical decisions on fear and insecurity.
Medicare Officials Insisting on Wider Choices in Drug Benefits - New York Times
6/14/2005 8:42:00 PM
WASHINGTON, June 14 - As companies devise insurance policies for the new Medicare drug program, federal officials are pressing them to offer a surprisingly generous array of prescription drug choices, according to industry executives.
As a result, experts say, the Medicare drug benefit, which begins in January, is shaping up to give beneficiaries access to a larger number and a wider variety of prescription drugs than are now available to many workers and retirees with private employer-sponsored health insurance.
Medicare will rely on private health plans to deliver drug benefits to the elderly and the disabled.
Blue Cross Blue Shield of Massachusetts
5/30/2005 10:09:00 PM
The partnership -- between two of the state's largest health care players -- wants a bill passed this year and plans to spend its money over three years to help ensure the entrenchment of its agenda. To get there, they are actively developing data, launching a print advertising campaign, advertising via underwriting on public radio station WBUR and on May 16 launched a Web site (MassachusettsHealthReform.org) to help push their agenda.
"This is the year we can make progress on three important issues," said Tom Glynn, chief operating officer of Partners, which includes hospital giants Massachusetts General and Brigham & Women's.
Plastic: Coalition Presses Congress For Universal Health Care
5/28/2005 7:56:00 PM
Ok, well I'm no expert. So, I guess my question is, why is our healthcare so expensive?
I'm not an expert either, but I try. Its a very good question and not a particularly easy one, but first is admninistative costs with our hodge podge system and I will take key quotes from Paul Krugman since he did a recent series. Essentially our system sets up institutionalized infighting in which a lot of money is spent passing the buck and a lot more than say on medical malpractice. Sometimes it can be a lot more cost effective to have everyone covered than a crazy quilt where a good chunk gets left out:
Finally, the U.S.
Get ready for more HIPPA rules
5/16/2005 4:12:00 PM
Just when you thought you had “licked”
HIPAA and its privacy rules, another HIPAA deadline lurks —
the deadline for implementing the HIPAA Security Rule.
Unlike previous HIPAA regulations, the Security
Rule has received relatively little publicity. Not only are many
healthcare providers not yet compliant with the requirements of
the rule, but many doctors are not even aware of the very existence
of the legislation — not to mention the rapidly approaching
April 20, 2005, deadline.
Legal Advocacy at the ADA
5/7/2005 11:42:00 AM
Because much of the discrimination that people with diabetes experience is the result of decision-makers’ ignorance of diabetes and current methods of diabetes management, we begin by trying to educate in order to prevent discrimination or stop ongoing discrimination. For example, in response to the barriers that children with diabetes face at school, ADA proposed developing nation-wide materials on care of students with diabetes that would have the imprimatur of the organizations and agencies respected by school personnel and education officials.
Sophos email security aids patient confidentiality
5/4/2005 12:40:00 PM
Lynnfield, MA - Sophos, a world leader in network security, continues to help organizations protect against malicious threats, enforce policies and achieve overall compliance with the Health Insurance Portability and Accountability Act (HIPAA), legislation that mandates patient confidentiality. Healthcare organizations that have selected Sophos include Byram Healthcare Centers, Poudre Valley Health System, Rothman Institute and Virginia Mason Medical Center.
Florida legislation that would ensure that abortion businesses in the state
5/3/2005 3:05:00 AM
FL (LifeNews.com) -- Florida legislation that would ensure that
abortion businesses in the state meet the same health and safety requirements
as any legitimate surgical center is advancing through the state legislature.
Meanwhile, a parental notification measure is also finding success.
Women's Health and Safety Act is expected to receive a vote in the Florida
state House on Thursday and hearings in a state Senate committee are
bills in other states have been successful in closing abortion facilities
that put women's health at risk.
HIPAA Deadline Passes, SMBs Fall Short
4/27/2005 3:32:00 PM
The deadline to complete the security requirement segment of the Health Insurance Portability and Accountability Act (HIPAA) passed today without much fanfare, and many SMBs affected by the new law failed to meet the deadline. However, the law is structured in such a way that it could be sometime before anyone knows who has complied with the government regulations.
"Considering everything that is involved with compliance, there are a lot of factors as to why some companies may not have completed it," Earl Crane, a senior consultant with Foundstone Professional Services, said.
Employers' attorney criticizes cuts in workers' comp benefits
4/25/2005 8:03:00 PM
SACRAMENTO – In a surprising critique, a former president of an attorneys' group that represents employers and insurers says benefits for disabled workers have been slashed to "socially unacceptable" levels under Gov. Arnold Schwarzenegger.
Clifford D. Sweet III, in an April 21 memorandum to the "workers' compensation community," said the Legislature should move quickly to fix the problem.
"From the perspective of a workers' compensation defense attorney, the reduction in permanent disability indemnity payments is socially and politically unacceptable for all parties, including employers," Sweet said.
4/13/2005 12:06:00 AM
Despite the widespread belief that Wal-Mart offers no health benefits, the company says it is, at most, one percentage point away from the bill's requirement that the largest employers spend at least 8 percent of their payrolls on health insurance. About 80 percent of Wal-Mart's hourly employees are eligible for coverage and about half choose to take it -- not ideal, but fairly typical for the retail trade.
In truth, this was a purely symbolic effort driven by the desire of Democratic politicians to demonstrate solidarity with union workers who see Wal-Mart as a threat to wages and benefits that have risen to uncompetitive levels.
California Agents Battle New Disclosure Proposal
4/9/2005 1:28:00 AM
Agent groups are mounting fierce opposition to legislation in California that they contend would require burdensome and needless disclosures to clients.
Senate Bill 938-authored by Sen. Joseph Dunn, D-Garden Grove-would require agents and brokers to disclose all of their commissions and fees to consumers and also to obtain multiple quotes and explain them to buyers in detail.
The bill would also give the insurance commissioner authority to regulate broker fees to ensure they are commensurate with the services provided and that customers are charged similar fees for similar service.
National Underwriter News Story
4/9/2005 1:20:00 AM
Will Congress mark the 60th anniversary of granting states the right to oversee insurer market conduct by taking that authority back? Not if state insurance regulators have anything to say about it.
To preserve their individual autonomy, insurance commissioners have worked together with state legislators to cobble together a new model market conduct oversight system. However, it remains to be seen whether they will prevail against members of Congress who believe federal action is required to shore up the patchwork means devised over the years to protect consumers.