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This is a compassionate view of American health care, ...
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This is a compassionate view of American health care, both from the perspective of the public recipients and the physicians who deliver it. It addresses the fundamental barriers to achieving cost effective and efficient health care from a psychological vantage, shedding light on human inclinations, foibles, and tendencies for group-think mentality. The book encompasses a review of the Affordable Care Act, from its inception to its passage. Finally, the author delivers thoughtful suggestions on how we can approach fixing our broken system. I found this book both comprehensive and moving.
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What seemed like a quick fluffy read turned out to be that and so much more. Hilarious take on the shallowness of the materialistic Dot-Commers. But great lessons of survival and even love. Well done.
~ Ingrid (from DesignDigitalSolutions.com - Jen would like that shameless plug!)
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eng_Latn
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Is ObamaCare really any better than Medicare?
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How is ObamaCare different from Medicare?
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What are the key similarities and differences between capitalism and socialism?
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eng_Latn
| 34,801 |
Apple’s two-step verification initially covered iTunes and the App Store .
It has now been extended to cover iCloud backups .
When two-step verification is enabled, users will now need to enter a code to access their account .
Apple has begun emailing customers informing them of the changes .
The update comes after hundreds of celebrity selfies were stolen from iCloud .
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True to its word, Apple has ramped up security on its iCloud service by including backups in its two-step verification process. When the security feature is enabled, users will now be sent a four-digit code to a trusted device that must be entered in addition to the iCloud account password when accessing the account online. Earlier this month, chief executive Tim Cook promised to strengthen security after hackers stole hundreds of celebrity selfies from the cloud service. Scroll down for video . The California-based tech giant’s two-step verification initially covered iTunes and App Store purchases, but has now been extended to cover iCloud backups. When two-step verification is enabled, users will now need to enter a code to access their account - however, the Find My Phone feature will remain open (pictured) The code isn't needed when a backup takes place, because the information is coming directly from a trusted device - it is only needed when users try to access their iCloud account from a web browser. Under the security measure, the majority of iCloud features remain locked until the user's identity has been verified. The only feature that is enabled without verification is the Find My Phone tool, which helps locate devices if they are lost or stolen. It is possible for users to enhance the security of their documents by turning off iCloud through Settings > iCloud on their device when they are not using it. They can also turn on two-step verification for their iCloud account. The tool prevents people accessing accounts - even if they have the password. To set up two-step verification, go to My Apple ID. Select Manage your Apple ID and sign in, then select Password and Security. Under Two-Step Verification, select Get Started and follow the onscreen instructions. When a user sets up two-step verification, they register one or more trusted devices. A trusted device is one that can receive four-digit verification codes using either SMS or Find My iPhone. Once enabled, any time a user signs in to manage their Apple ID at My Apple ID, or make an iTunes, App Store, or iBooks Store purchase from a new device, they'll need to verify their identity by entering both their password and a four-digit verification code. It is assumed that if a user doesn't have their trusted device, they can't receive the four-digit verification code. Two-step verification is an optional security feature, and settings are managed through the My Apple ID page. Two-step verification, also called two-factor authentication, requires a user to have two of . three things to access an account. This can include a password, . a separate four-digit one-time code, or a long access key given . to the user when they signed up for the service. When a user sets up two-step verification, they register one or more trusted devices. A trusted device is one that can receive four-digit verification codes using either SMS or Find My iPhone. Apple has begun emailing customers informing them of the changes, and more details are available from the official two-step verification support page. More than 100 celebrity iCloud account were hacked in August and photos, including nude selfies, were leaked online. At the start of the month, Mr Cook told the Wall Street Journal Apple will 'aggressively encourage . users to take stricter security measures', and the firm will also alert users if someone tries to access their files. These alerts will be sent using email and push notifications each time someone tries to change an account password, restore iCloud . data to a new device, or when a device logs into an account for . the first time. 'When I step back from this terrible scenario that happened and say what more could we have done, I think about the awareness piece,' Mr Cook said. 'I think we have a responsibility to ratchet that up. That's not really an engineering thing.' The code is sent to a registered, trusted device (pictured). If users no longer have access to a trusted device, they can use a recovery key to add a new one. This key is issued during the two-step verification setup process . The changes come following the recent celebrity photo scandal that saw hundreds of images stolen from Apple's iCloud service. Chief executive Tim Cook (pictured) recently said Apple will also start notifying users each time someone tries to access their account . Once enabled, any time a user signs in to manage their Apple ID at My Apple ID, or make an iTunes, App Store, or iBooks Store purchase from a new device and now access their iCloud account on a browser, they'll need to verify their identity by entering both their password and a four-digit verification code. 'We want to do everything we can do to protect our customers, because we are as outraged if not more so than they are,' continued Mr. Cook. The iCloud service lets users store photos and other . content, and access it from any Apple device. Scammers have been taking advantage of the celebrity hacking scandal to trick people into entering their Apple ID and password details into a fake login screen. Jennifer Lawrence (pictured) was among the 101 celebrities who had their photos stolen from iCloud. She is said to have posted more than 60 nude selfies to the online service . Security experts recently discovered emails and text messages that claim to be from Apple, warning users about unauthorised access to their accounts. The latest threat to people's accounts comes as both the FBI and Apple have said they are investigating the link. The so-called phishing emails are designed to trick people into offering up their details. Apple already offers a high-level of security on its iCloud account. iCloud secures data by encrypting it when it is sent over the web, storing it in an encrypted format when kept on server, and using secure tokens for authentication (explained above). This suggests the hackers were able to obtain the login credentials of the accounts, and pretend to be the user, in order to bypass this encryption . The service secures data by encrypting it when it is sent over the web, storing it in an encrypted format when kept on server, and using secure tokens for authentication. Tim Barajin, a technology analyst with Creative Strategies, told MailOnline: 'Security in the cloud is an issue generally - you have to completely trust Google, Apple, Samsung. 'Apple has some of the most powerful encryption tools out there - which is why they have almost a billion credit cards of file, and nobody had ever got hold of those.'
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Obamacare has survived a Supreme Court appeal, a government shutdown and ongoing challenges by opposing politicians. With few exceptions, every American must have health insurance by March 31 or pay a penalty fee. That's right: The marketplaces that are central to the Affordable Care Act -- also known as Obamacare -- launched on October 1, despite the shutdown showdown and the much-anticipated premiere of "The Walking Dead." The government has since reopened, and Obamacare is still the law. For most people, Obamacare won't make a direct impact. People who have health insurance through their employer, or through Medicare or Medicaid, can continue to get it that way. Obamacare coverage gap: The poor caught in between . But the more than 48 million Americans without health insurance have to enroll in one of the insurance marketplaces by December 15 in order to have their coverage start on January 1. The historic rollout has been overshadowed by technical issues and pessimistic predictions about how many people are really clamoring to sign up. Here are five things that have happened since the launch of Obamacare: . 1. Sign up on Healthcare.gov hasn't been easy . The launch of Obamacare was disappointing for many people who actually wanted to use the government website to enroll in health insurance. Technical problems with the federal website, HealthCare.gov, made signing up online difficult for some users. The high volume of traffic to the insurance exchange portal contributed to these problems. "I am the first to acknowledge that the website that was supposed to do this all in a seamless way has had way more glitches than I think are acceptable," President Obama told KCCI, a CNN affiliate in Des Moines, Iowa. A senior administration official told CNN that techs are working around the clock to get the site working better. But there also has been some confusion over user passwords. When CNN called the government help line, we were told passwords established in the first week of October were no longer valid and new passwords were needed to access the site; the Department of Health and Human Services told us that information was inaccurate. CNN's Elizabeth Cohen tried to enroll in Obamacare as an experiment. It took more than a week for her to create a login and password. When that finally worked, error messages plagued her efforts when she tried to log in. Almost two weeks went by before she succeeded in logging in and proceeding with an application. An insurance industry source told CNNMoney's Tami Luhby that insurers are receiving faulty information about new customers, including duplicate forms, and missing and garbled information. They are in discussion with regulators and the administration to address these issues. Next week, congressional oversight hearings will begin, where politicians will ask questions about why the rollout had so many problems. 2. State sites seemed to fare better . While 36 states are using Healthcare.gov as the gateway to sign up new insurance customers, 14 states and the District of Columbia are running their own sign-up sites. While HealthCare.gov has stumbled, many of these individual states are doing better. The Department of Health and Human Services says it won't release enrollment figures before November, but CNN has gotten a window on enrollment by canvassing the states running their own sign-up sites. As of Friday afternoon, at least 257,000 people had signed up for new insurance plans. More than half of those -- 134,000 -- are in New York state. Operations are also running relatively smoothly in Washington state and Kentucky, which each reported more than 45,000 new sign-ups. CNN reached its sign-up figures by combining what states report as "enrolled," and what they're calling "almost enrolled." The latter group has completed the process but has not yet made an initial payment. Also note: The numbers don't include those who have sought assistance or enrolled over the phone or via paper application, and not all the states responded to data requests. Not every state has had smooth sailing. Hawaii's marketplace didn't fully open until October 15, two weeks late. In California, the Los Angeles Times has reported repeated problems with the part of the website where people can check whether their doctors are part of a network. 3. Overall enrollment numbers are unclear . Department of Health and Human Services spokeswoman Joanne Peters said the administration has not set monthly enrollment targets. But this week the Associated Press reported it had obtained an internal September 5 memo that said Health and Human Services expected about 500,000 people to enroll in new plans this month. At the current pace, enrollment would nearly reach that figure in the 14 states and District of Columbia alone. Still, it's unclear how many people have actually obtained health insurance since October 1. CNN has created a map with the latest numbers for individual states that are releasing enrollment information. 4. The cost of care has become more clear . Before the insurance exchanges went live, it was unclear how much health care was going to cost consumers in each state. The Manhattan Institute has released an online map showing insurance premiums before and after Obamacare based on age and sex. The law's impact varies widely state to state. In Oregon, for example, rates for 40-year-old men have increased 24%. In Ohio, they have dropped 22%. The White House says that once tax credits are factored in, about 6 in 10 individuals will be able to find insurance for less than $100 a month. "In some states, insurance markets were already regulated to not allow insurers to discriminate against the sick. In those states, premiums will fall, like in New York, where premiums will fall by as much as 50%," said MIT economist Jonathan Gruber, who helped design the law. "In other states insurers were freely allowed to discriminate against the sick. In those states, by ending the discrimination, we're going to raise premiums in states like Wisconsin, or some of the Southern states." Overall, Gruber said, rates are going up for the young and healthy, and down for older people and people who are sick. Is Obamacare cheap or pricey? The verdicts are in . When you do choose a plan, you should be aware of what doctor choices you have under your coverage. To reduce premiums and other costs, many insurers have chosen to limit the selection of doctors in certain exchange plans. Large academic medical centers, which are often more expensive, are excluded from such plans. "The sticker price will be lower if the number of options are lower," Joe Mondy, a spokesman with Cigna, which is participating in five state exchanges, told CNNMoney. "The issue is how many options can you do without?" 5. The shutdown came and went -- without changing much . The government shutdown had no effect on users trying to sign up for Obamacare because money designated for the launch was approved in a previous session of Congress and didn't have to be approved again. Yet it was partly because of the Affordable Care Act that the shutdown continued so long in the first place. Republicans attacked the law on several fronts, demanding first that the government defund Obamacare, and then that it be delayed for a year. But when the government reopened, the GOP came away with just a small concession related to Obamacare: two additional reports from the Department of Health and Human Services. Republicans had wanted tighter income verification procedures for health insurance applicants. What they'll get is a report detailing the income checks the insurance exchanges will use, and a second report that reviews how effective the verification procedures are. The Republican party is still calling for an investigation into the HealthCare.gov website's problems. Opinion: Goodbye to the strategy Republicans knew was a fantasy .
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| 34,802 |
Last December, President Barack Obama said it does not make sense for the federal government to go after recreational drug users in Colorado and Washington State .
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By . James Nye . PUBLISHED: . 16:08 EST, 29 August 2013 . | . UPDATED: . 11:04 EST, 30 August 2013 . In a dramatic change in drug policy, the Obama administration said on Thursday that it won't sue to stop the states of Colorado and Washington from allowing recreational marijuana use as it issued a sweeping national policy statement that outlines its top priorities for pot enforcement. The action, welcomed by supporters of legalization, could set the stage for more states to legalize marijuana. Alaska is scheduled to vote on legalizing recreational use of marijuana next year, and a few other states plan similar votes in 2016. Under the policy, the top investigative priorities range from preventing the distribution of marijuana to minors to preventing sales revenue from going to criminal enterprises, gangs and cartels and preventing the diversion of marijuana outside of states where it is legal under state law. No Longer Under Threat: Cody Park exhales a cloud of marijuana smoke after taking a hit on a bong at the first day of Hempfest, Friday, Aug. 16, 2013, in Seattle . Other top-priority enforcement areas include stopping state-authorized marijuana activity from being used as a cover for trafficking other illegal drugs and preventing violence and the use of firearms in the cultivation and distribution of marijuana. The top areas also include preventing drugged driving, preventing growing marijuana on public land and preventing marijuana possession on federal property. The announcement follows last year's first-in-the-nation legalization of recreational marijuana use by the states of Colorado and Washington. In the aftermath of the moves by the two state, Attorney General Eric Holder launched a review of marijuana enforcement policy that included an examination of Colorado and Washington. The issue was whether the states should be blocked from operating marijuana markets on the grounds that actively regulating an illegal substance conflicts with federal drug law that bans it. Nearly a year after Washington state and Colorado voted to legalize . recreational marijuana, the Obama administration announced on Thursday . that it won't sue the states to comply with federal laws . Hempfest: Last December, President Barack Obama said it does not make sense for the federal government to go after recreational drug users in Washington and Colorado . The Obama administration also issued new guidelines for all U.S. attorneys on the dynamic issue of marijuana law . Last December, President Barack Obama said it does not make sense for the federal government to go after recreational drug users in a state that has legalized recreational use of small amounts of marijuana. Last week, the White House said that prosecution of drug traffickers remains an important priority. A Pew Research Center poll in March found that 60 percent of Americans think the federal government shouldn't enforce federal anti-marijuana laws in states where its use has been approved. Younger people, who tend to vote more Democratic, are especially prone to that view. But opponents are worried these moves will lead to more use by young people. Colorado and Washington were states that helped re-elect Obama. The Munchies: Seattle Police Department Detective Mark Jamieson (L), hand out bags of Doritos to festival goers during the Hempfest rally in downtown Seattle, Washington August 17th 2013 . Dan Riffle of the Marijuana Policy Project, the nation's largest marijuana policy organization, called the policy change "a major and historic step toward ending marijuana prohibition" and "a clear signal that states are free to determine their own policies." Kevin Sabet, the director of Project Smart Approaches to Marijuana, an anti-legalization group, predicted the new Justice Department policy will accelerate a national discussion about legalization because people will see its harms — including more drugged driving and higher high school dropout rates.
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Some 50 million Americans still lack health insurance. That will change for the greater majority when the Affordable Health Care Act, or Obamacare, as it's more commonly known, rolls out over the next couple of years. While the bulk of the law goes into place in 2014, you'll see a few changes this year. However, much of 2013 will be dedicated to health facilities and government offices getting ready for the larger changes coming down the road. On Thursday, the Department of Health and Human Services conditionally approved eight more states' plans to set up their own health insurance exchange programs. The conditional approvals mean a total of 19 states plus the District of Columbia have the initial thumbs-up on their plans. Two others, Arkansas and Delaware, have the go-ahead to run an exchange in partnership with the federal government. Decision day for states on health insurance marketplaces . States can decide to set up an exchange at any time, but the clock is ticking. States that plan to partner with the federal government need to do so by February 15. People not living in a state with an exchange have access to a federal program. All the exchanges are supposed to be up and running by October 1 of this year. In a conference call with reporters Thursday, Health and Human Services Secretary Kathleen Sebelius said she was encouraged by the progress states have made so far. "From the beginning, this process has been guided by our belief that states know their own needs better than anyone else," Sebelius said. "That's why we have worked so hard to give states the flexibility and resources to create and participate in marketplaces that work best for their citizens, and it's encouraging to see so many states moving forward to do just that." What these exchanges will do is give the uninsured a better chance to shop for insurance in a way that's supposed to take the mystery out of buying a plan. Think of it like an online travel site that pulls information from hundreds of companies, allowing customers to compare the costs of flights or hotels on one easy-to-read screen. Another advantage to the exchange may be a lower cost for health insurance, according to Jay Angoff. He is the former director of the Center for Consumer Information and Insurance Oversight at HHS, the office responsible for implementing Obamacare. "The key issue is not if the state or the fed runs the exchange," Angoff said. "The key is: Will it be a strong or weak exchange, and will it use the bargaining power that it has to standardize the benefit packages and establish a real competitive bidding process that can really drive down rates? "If the exchanges allow insurance companies to sell whatever they want, if (the state) doesn't negotiate or establish competitive bidding process, it's another case," he said. Obamacare to flesh-eating bacteria: Top 2012 health stories . Here are some other parts of Obamacare taking effect in 2013: . Preventative services . The federal government is sending more money to state Medicaid programs that offer preventative services for free or at little cost. Services include tests for high blood pressure, diabetes, and high cholesterol; many cancer screenings including colonoscopies and mammograms; counseling to help people lose weight, quit smoking or reduce alcohol use; routine vaccinations; flu and pneumonia shots; and others. Increased Medicaid payments . Doctors that take Medicaid patients get a pay raise. Starting January 1, Medicaid payments in every state were brought up to the same level Medicare pays doctors. Some experts say the Medicare rate is too low, but Medicaid paid even less. While it varies from state to state, primary care physicians see on average a 73% pay bump according to the Kaiser Family Foundation. A pilot program for bundling services . The law sets up a national pilot program that will encourage medical providers to coordinate patient care. Rather than have each service billed separately under Medicare, a flat rate would be paid for an episode of care. Justices won't block Obamacare's required emergency contraception coverage . Medicare tax increase . The wealthy face a 0.9% tax increase on the income they earn in excess of $200,000 (for couples filing jointly, it will hit those that make in excess of $250,000). This will help boost the Medicare trust fund. Medical device tax . A new 2.3% tax goes on the price of medical devices. This doesn't include hearing aids or corrective lenses, but does include devices like defibrillators, pacemakers, artificial joints and others. Medical deductions . Up until now, Americans got a tax deduction if all their total medical expenses added up to more than 7.5% of what they earn (minus deductions and exceptions). Those expenses now will have to add up to 10% or more for most tax filers. Cap on FSAs . Flexible Spending Accounts now have a cap. Up until now, employers set the limit on how much employees could set aside from their paychecks tax free to pay for medical expenses not covered by their insurance. The majority of companies set an FSA limit of around $5,000. The government is now limiting FSA's to $2,500. Health benefits spelled out . W-2 tax forms issued this year for wages paid in 2012 must now include a line on the form showing the benefit employees receive from their employer-sponsored health care. This is supposed to help you understand your benefits better and make health care spending more transparent.
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| 34,803 |
In a blog post on one of the year's quietest news days, the Centers for Medicare & Medicaid Services claimed 2.1 million sign-ups for Obamacare .
But an executive at a health insurance billing company says only half of enrollees have paid premiums in 17 states where his company has clients .
That would leave more than 1 million Americans possibly thinking they're insured on Jan. 1 – but having no medical coverage at all .
Many of them are expected to bring website printouts to doctor's offices instead of insurance cards, but it's unclear how physicians will react .
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By . David Martosko, U.s. Political Editor . PUBLISHED: . 13:52 EST, 31 December 2013 . | . UPDATED: . 14:11 EST, 31 December 2013 . More trouble ahead? HHS Secretary Kathleen Sebelius will likely face new questions after Jan. 1 about how many -- or how few -- Obamacare enrollees have made payments and are actually covered . The Department of Health and Human Services is in mid-victory-lap over its enrollment of an estimated 2.1 million Americans into Obamacare insurance plans, a figure claimed in a blog post Tuesday by the Centers for Medicare and Medicaid Services. But as many as half of those customers have yet to make a payment, a new report suggests. The Wall Street Journal interviewed Mark Waterstraat, the chief strategy officer at a firm that processes billings for insurers. He said that only about 50 per cent of enrollees in 17 states have paid their bills for the first month's premium. That statistic, if it were to hold true across the nation, indicates that more than 1 million Americans counted in the Obama administration's total aren't actually covered by medical insurance. Waterstraat's statistics cover more than 100 health insurance companies, which typically don't issue insurance cards or consider a new customer 'enrolled' until they receive payments. But the Obama administration has included in its public numbers everyone who has selected a plan – regardless of whether they have paid for it. Marilyn Tavenner, the administrator of the Centers for Medicare & Medicaid Services, wrote Tuesday on the agency's blog that '[t]he most recent data indicates that more than 2.1 million people nationwide have enrolled in a private health insurance plan through a new Health Insurance Marketplace since October 1.' That number would include enrollments from the District of Columbia and from 14 states that don't participate in the chronically troubled healthcare.gov website portal. But Waterstraat's statement suggests that half of them either incorrectly believe they are insured, haven't received a bill, or are still deciding whether to pay. Surge: As healthcare.gov's tech glitches were ironed out in December, more than 1 million new enrollees entered the system -- but how many of them have paid their bills? Think you're covered? Better have one of these: More than 1 million Americans may expect insurance coverage on Jan. 1 but haven't paid their premiums . 'We haven't written a check yet, because . no one has asked me for one,' Kelly Turner, a Fairfax, Virginia . homemaker, told MailOnline. 'This could be a disaster if I get hit by a . bus tomorrow, God forbid.' Health and Human Services Secretary Kathleen Sebelius blogged earlier on Tuesday that enrollees are largely on their own if they're not sure whether their sign-ups are complete. 'If . consumers have questions about their new private insurance coverage, . they can contact their insurance company directly,' wrote Sebelius. Few . appear to have taken that advice. The Wall Street Journal reported that . one health plan based in Temple, Texas only received first month's . premiums from 35 of its new customers. Some insurers expect customers to try to create their own proof of insurance. 'We anticipate that people will be using screen printouts' from . insurance exchange websites, the Journal heard from Donna Zimmerman, . vice president of government and community relations at HealthPartners, a . Minnesota insurer. Bad air out, good air in: Centers for Medicare & Medicaid Services chief operating officer Michelle Snyder (L) has stepped down as the Obamacare website saga nears its end; and CMS administrator Marilyn Tavenner (R) now claims 2.1 million people have enrolled overall . Big picture: President Obama's public opinion ratings are still suffering from his false promises that Americans could keep their health care plans; many of the new enrollees are those who lost coverage anyway . Sebelius counseled Americans Tuesday on her blog to 'get your insurance card or a temporary card with your new plan’s information.' 'If you don’t have your card yet, ask your insurance company to give you another way to confirm your coverage.' But for those Americans who haven't paid, that proof will be impossible to get. 'It's bad enough that the coverage is nearly twice as expensive as what my family had least year,' said Turner, the perplexed Virginian. 'But what good is the plan if I can't prove I've signed up?'
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(Mashable) -- Facebook profiles are like belly buttons: Everybody's got one. Perhaps that statement's still a bit of an exaggeration, but by the numbers, we (that is, Internet users around the globe) are becoming more obsessed with Facebook by the day. One out of every 13 Earthlings and three out of four Americans is on Facebook, and one out of 26 signs into Facebook on a daily basis. We could rattle off stats like until the cows come home, but instead, we'd like to show you this fascinating infographic from SocialHype and OnlineSchools.org. Here, in a visual nutshell, are some highlights about Facebook usage, 2010 trends, adoption numbers and a great deal more. Take a good look at this information (or click here for the full-size version), and in the comments, let us know what you think about our global fascination with Facebook. Is Facebook an amazing connective medium? A plague that preys on the easily addicted? A little bit of both, or something else entirely? © 2010 MASHABLE.com. All rights reserved.
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| 34,804 |
It is possible to drive a car when you want without owning it .
Many big cities, some colleges have companies offering car-share services .
Zipcar has U.S. fleet of 6,500 automobiles that service 300,000-plus users .
You pay membership fee, monthly fee -- but don't pay for gas or insurance .
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(AOL Autos) -- Letting someone else deal with the day to day expenses of maintaining an automobile (and just paying for what you use) seems to be a novel idea. Joining a "car share," such as the popular Zipcar car sharing service, is gaining in popularity as consumers look to other ways to save money. Car-sharing services let you avoid paying for gas and insurance, but there are fees and rules. By using a car share, you're not only shedding monthly car payments, taxes, insurance and upkeep, but you can let someone else worry about whether the old rattle trap will make it another year. You simply pay a fee and drive the car when you need it. By maximizing the utilization of a single automobile among many users, car sharing services claim they are helping to reduce pollution, too. Every single Zipcar removes about 15 personal cars from the road, the company says. Unclogging traffic and dialing back the amount of single-occupant vehicles burning fuel has a greening effect. Reducing expenses and saving the polar ice caps aren't the only reasons; there's as much justification for joining a car share as you can dream up, from impressing the client at a business meeting with a fancy car to going over the river and through the woods for family gatherings, all without actually owning a car (or paying for its gas or insurance). But is a car share for you? The concept seems best suited to metro areas, where car insurance rates and parking costs can be high. On the other hand, if you work out of your car, use it on a daily basis or live in a more rural or expansive suburban region, you might be better off keeping your current car. AOL Autos: Top 11 distracting things people do in their cars . "The ideal candidates for car sharing are consumers and businesses in cities where owning a car is costly, where there is good public transit, and where most amenities are within walking distance," Zipcar President and COO Mark Norman said. "In other words, where you don't really need to own a car. In addition, students are ideal car sharing members, given the high cost of ownership as well as the increasing limits on parking on campus." AOL Autos: Cheapest cars to own . Automobiles can be a huge hassle and expense if you only drive occasionally, so we've set out to look at what car sharing involves. AOL Autos: Pay as you drive insurance . How does it work? The biggest North American car share, Zipcar, aims to be convenient, easy, and technologically savvy. Far more streamlined than an old-school rental car, Zipcar makes getting the use of an automobile about as easy as making a withdrawal from an ATM. The concept of car sharing had its genesis in Europe and has spread to the North American market as interest in frugality and environmental consciousness has increased. AOL Autos: Twenty cars of the future . The first step to using Zipcar is signing up. As a member, you'll get a "Zipcard," which allows you to reserve a vehicle near you via the company's Web site or from a new iPhone application. Once you've reserved a car (or truck -- the beauty of car sharing services is that you can get a big car when you need it, not when you don't), a pretty neat technology unlocks the doors when you walk near your vehicle (we won't bore you with the details, but if you're wondering, it's called radio frequency identification). When it senses the card on you, the doors unlock, at which point, you're on your way. Cars are located all over metro areas (Zipcar gives you a map to the location of the car you've booked). While application approval is usually quick, it takes a few days to get the Zipcard mailed to you. If your city has a Zipcard office, you can pick up your card there. Where can you find car sharing? Car shares are springing up across the U.S., but you're likely to find them in major cities with a traffic problem. Zipcar is the largest service of its kind in the United States, maintaining a fleet of 6,500 automobiles that service 300,000-plus users. Twenty-eight states have at least one Zipcar outpost, and Zipcar has expanded its user base by 100 percent per year since 2004, so new service areas will spring up where demand supports it. Zipcar also operates in Canada, as well as London in the UK. The service is strongest on the coasts, with the Northeast being particularly thick with coverage, but even Des Moines, Iowa has Zipcars available. Zipcar claims that as consumers are moving toward more "access" models (such as buying music by the song for your MP3 player), cars could also move in this direction. "Car sharing has always represented great value for consumers by giving them the freedom of car ownership without the cost and hassles," Zipcar's Norman said. "Now more than ever, in an economic recession and with gas prices on the rise, people and businesses are turning to car sharing. In addition, in an era where people buy music by the song, driving a car by the hour makes a lot of sense." Municipalities often tout car sharing if a service is available. Check with your city to see if there are any plans to bring car sharing to your city. What are the costs? Since Zipcar is the most popular, we'll take a look at their fee structure for a sample of what car sharing might cost you. Rates vary by city, but on average a Zipcar account costs $75 to startup and there's an annual fee of $50 for an occasional driving plan. Additional drivers from the same household can be added to an account for $25 each. Insurance and fuel are covered -- each Zipcar has a gas card for fillup time. Overstay your reservation, and you'll get whacked for at least $50; late fees are $50 per hour with a $50 minimum. Reminders can be set up so users aren't caught off guard by poor time-management. Extra value plans wipe away the annual fee for a monthly commitment of at least $50. Ideal for heavy users, the rates are lower across the board. Businesses and Universities are also in Zipcar's crosshairs, and the Zipcar fleet could save many businesses money on company cars. AOL Autos: Rental car prices can change in a heartbeat . Zipcar touts its fleet as the most diverse of its kind with everything from Priuses to pickup trucks. There are premium nameplates in Zipcar's fleet that command higher prices -- the cars for the image-conscious versus plain-jane driver. Full-day rentals are $65, and a 7 a.m. to 7 p.m. business day runs $56. Cars come with a full tank of fuel, and you get 180 miles per day before you start paying by the mile. Other car sharing services . Zipcar isn't the only game in town, of course. Traditional car rental services offer one-way rentals, which Zipcar does not; this is something to consider depending on your travel plans. Hertz has jumped into the breech with its "Connect by Hertz" product, a veritable clone of Zipcar. Hertz only offers its service in five locations so far: New York City; Park Ridge, New Jersey; Ohio State University; Pepperdine University in California; and Washington D.C. UHaul has also tossed its hat into the ring with its UCarShare service, mostly based around specific college campuses in a small number of locations. UCarShare's rates are higher and terms more restrictive than Zipcar's. Regional players also abound, most based around a particular region. Bay area residents can use City Carshare, Chicago has I-GO, and there are small car sharing services in places like Denver, Philly, St. Louis, or Cleveland. Rates for these competitors vary from on par to more expensive. Terms of service may be different, some offering included miles, some charging for each mile -- it runs the gamut.
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By . David Martosko, U.s. Political Editor . PUBLISHED: . 01:30 EST, 1 November 2013 . | . UPDATED: . 17:05 EST, 1 November 2013 . Just six people successfully enrolled in health insurance plans through healthcare.gov during the first day of the Obamacare system's operation, according to Centers for Medicare and Medicaid Services meeting notes released Thursday night by a congressional committee. By the end of the second day, a total of 248 people nationwide had bought insurance policies through the federal government's online portal, whose disastrous launch has become the stuff of late-night TV jokes and a Saturday Night Live skit. The bombshell documents reflect summaries of 'war room' meetings held at least twice a day during the system's chaotic start by a technology working group inside the Center for Consumer Information & Insurance Oversight, a CMS division tasked with putting the website's plan into action. Turned over by a private Obamacare contractor at the request of the House Oversight and Government Reform Committee, . not by the Obama administration, the four pages paint a picture of a . multidisciplinary team trying to right a sinking ship, and collecting . statistics as it takes on water. SCROLL DOWN FOR VIDEO . We signed up how many? President Obama will have a new round of explaining to do, now that enrollment numbers have leaked out of a 'war room' set up to solve the healthcare.gov website's countless tech problems . On the morning following the first full day of the healthcare.gov website's operation, troubleshooters learned that just 6 people had successfully signed up for new health insurance plans . 'Six': Fox News host Megyn Kelly shows that she can count the Obamacare website¿s first-day success stories on two hands . The committee issued a subpoena for . similar documents from the Department of Health and Human Services after . the agency stalled for three weeks on requests from chairman Rep. Darrell Issa. Committee staff provided the documents to reporters on Thursday . evening while the White House was in the middle of a trick-or-treating . event for children of military families. The Obama administration has said publicly that 4.7 million unique website visitors came to healthcare.gov in its first 24 hours beginning at midnight on Tuesday, October 1. But war room meeting notes from the following morning showed that 'six enrollments have occurred so far with 5 different [insurance] issuers.' The lucky few chose insurance policies with BlueCross BlueShield North Carolina; BlueCross BlueShield Kansas City; the Ohio-headquartered CareSource; and Healthcare Service Corporation, a Chicago-based company that sells BlueCross BlueShield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, . By the afternoon of Oct. 2, war room meeting notes reflected 'approximately 100' successful enrollments. That number grew, modestly, to a total of 248 by day's end, according to notes from the morning meeting on Oct. 3. Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner refused to provide hard numbers to the House Ways and Means Committee on October 29, saying only that 'We'll have that information available until mid-November' Kiss of death: A website that wasn't adequately tested, and was built for a relatively small traffic load, had no chance on day one, and the enrollment figures are proof . Department of Health and Human Services spokeswoman Joanne Peters told the Fox News Channel on Thursday evening that the documents 'appear to be notes' and don't reflect official totals, which the agency has repeatedly said it plans to withhold until mid-November. 'We are focused on providing reliable and accurate information and we do not have that at this time. ... We have always anticipated that the pace of enrollment will increase throughout the enrollment period,' she said. Hedging his bets? On Oct. 21, Obama said 'the number of people who have visited the site has been overwhelming ... [and] thousands of people are signing up' The full open enrollment period for the Affordable Care Act will last for six months, ending March 31. By then, the administration hopes 7 million Americans will enroll in medical insurance plans through healthcare.gov and the similar websites run by 14 states and the District of Columbia. At that rate, the government needs to find about 38,500 new paid enrollees every day, on average. some of the state-run programs have faced their own challenges. Halfway through October, Delaware's exchange reported signing up just one person, Alaska had enrolled seven, and Wisconsin's total was less than 50. By October 18, Oregon conceded that it hadn't yet processed any applications for private insurance through its exchange. Sources inside HHS told MailOnline in mid-October that 52,000 people nationwide had completed applications for coverage by the end of the first week of October. That number likely included consumers whose applications weren't processed immediately, but also a much larger number who elected to sign up for Medicaid coverage instead of enrolling in plans they will pay for themselves. Those Medicaid enrollments will add only to the overall cost of the Affordable Care Act – unlike private insurance policies, whose premiums will subsidize the expense of medical care provided to others in the system. Pants on fire? 'We do not have any reliable data around enrollment,' insisted HHS Secretary Kathleen Sebelius on October 30 during a congressional hearing. 'The system isn't functioning, so we're not getting reliable data' House oversight committee chairman Rep. Darrell Issa, an anti-Obamacare partisan, released the documents on Thursday night, which his committee got from a private contractor doing work on the Obamacare website . Obama spoke to adoring throngs in Boston this week, including one fan whose 'I (heart) Obamacare' cast he gladly signed . Numbers from the war room meetings include only the successful sign-ups completed through healthcare.gov, not through any of the state-based insurance exchanges. They also, according to an HHS spokesperson who talked to CBS News, do not include applications from people who chose to fill out paper applications or register by telephone. But those other methods, along with assistance from 'navigator' program helpers, also rely on the website. Cal center operators and navigators enter consumers' information into the website in real-time, and a contractor enters handwritten information into the website days or weeks after ink hits paper. Given the tech woes that plagued healthcare.gov early on – and continue to knock it offline on a regular basis – it's unlikely anyone had significantly greater success. Medical insurance industry consultant Robert Laszewski told Fox News that 'the White House does not want insurance companies talking about what's going on here.' 'If four weeks ago the enrollment numbers were public,' he said, 'it would look very bad. I can tell you based upon the information that I continue to get, this trickle of enrollment ... for the first three days has really continued for the first month.' HealthCare-Gov.pdf .
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The NFL has for-profit business, but the league office is technically a trade association .
Therefore, it pays no taxes and owners can deduct the dues they pay .
Commissioner Roger Goodell makes as much as some of the highest paid CEOs .
Some in Washington are trying to change the law while others lobby against it .
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Did the National Football League make $10.5 billion in 2013, pay its chief executive Roger Goodell $44.2 million, yet pay no taxes to Uncle Sam? Well, yes and no. The National Football League pays taxes through its various money-making offshoots such as NFL Properties and NFL Ventures, but the league office in midtown Manhattan, which paid Goodell his very handsome salary, doesn't. The reason goes back to 1942 when the IRS ruled the NFL was a trade association for its now 32-member teams and therefore exempt from taxes as a nonprofit under section 501(c)6 of the tax code. Just to be safe, the NFL lobbied Washington in 1966 on the eve of its merger with the American Football League. Two powerful Louisiana politicians, Sen. Russell Long and Rep. Hale Boggs, wanted a football team in New Orleans. Then-NFL Commissioner Pete Rozelle wanted antitrust protection and confirmed tax-exempted status for the league office. The Saints were born in New Orleans and in exchange, Rozelle got his wish slipped into an unrelated federal bill on investments and depreciation. Sports attorney and expert on the NFL's tax exemption, Andy Delaney, told CNN, "Pete Rozelle was a forward-looking guy, I can't imagine what those two lines (of text), maybe three is worth today." Millions, it turns out, according to Sen. Tom Coburn, an Oklahoma Republican who wants the tax-exemption for professional sports teams gone. For all the professional sports leagues -- including the PGA Tour and NHL among others -- that use the loophole, "It amounts to like $10 million a year. $10 or 11 million a year. Probably $110 million over the next 10 years. But the point is why should they have that?" Coburn told CNN. Coburn has introduced the PRO Sports Act to strip the NFL and others of the decades-old exemption. What the NFL pays -- and doesn't -- in taxes . According to NFL spokesman Brian McCarthy, "every dollar of income that is earned in the National Football League -- from game tickets, television rights fees, jersey sales and national sponsorships -- is subject to tax. None of this income is shielded in a tax-exempt entity. Instead, the NFL's 32 clubs pay tax on all of these revenues." But that's not 100% true, Coburn said. "The individual owners and teams pay taxes. We're not going after them, but what they do is they can put all this confluence of money into the league office and do this as a nonprofit, which means they're not paying taxes like every other business that would be in a trade business like they are," Coburn said. The nonprofit NFL raked in more than $326 million from April 2012 to March 2013, almost of all of which came from "membership dues and assessments" or league fees paid by the member teams, according to a CNN analysis of IRS documents. Those dues are tax deductible for the teams as "business expenses" according to the IRS. Delaney thinks the NFL calling itself a nonprofit is too much. "I don't think anything they are doing is illegal, but it is not in the spirit of a nonprofit, nonprofits don't have directors with salaries north of 40 million," he said. "It's a business, and they should call it that." Goodell's salary, which comes from the NFL's nonprofit arm, rivals some of the top-paid CEOs in the corporate world. Goodell's compensation would rank in the top 20 for CEOs of U.S. public companies and above the leaders of Disney, Visa and Yahoo, according to a chart of total compensation compiled by the AFL-CIO. NFL's team in Washington . Redskins owner Dan Snyder may lead D.C.'s on-the-field franchise, but former Obama adviser Cynthia Hogan just recently became the new team captain of the NFL's real powerhouse squad: its lobbyists. According to a CNN analysis, the NFL employed 20 lobbyists in 2014 and spent more than $1 million in efforts to sway lawmakers. In a swanky building just blocks down Pennsylvania Avenue from the White House, the NFL employs six lobbyists, including four on its own payroll. The other two come from powerhouse law and lobbying firm Covington and Burling, which also employs former NFL Commissioner Paul Tagliabue. Tagliabue is not a registered lobbyist as of this writing, instead he "uses his experience as chief executive and board member of the National Football League, major businesses and nonprofits to advise clients on matters of organizational structure and governance, develop strategic risk mitigation approaches and assist in managing unfolding crises." Sheila Krumholz, executive director of the Center for Responsive Politics, which runs the transparency website Opensecrets.org, says the NFL's lobbying team is "all pro," and almost all are "former government employees, former Hill staffers. So they have good access by buying the help of people who know how to navigate Congress." Nineteen of the 20 worked for Congress, largely in the offices of House and Senate leaders, according to a CNN review of lobbying disclosures. The NFL even paid another influential lobby shop, Elmendorf | Ryan, to lobby against Coburn's bill, which thus far has been benched -- referred to the Senate Finance Committee with no action expected anytime soon. But that may be changing. Both Sen. Cory Booker, a New Jersey Democrat, and Sen. Maria Cantwell, a Washington Democrat, have introduced bills similar to Coburn's legislation. Booker wants the tax money to go to preventing domestic violence. Cantwell wants the NFL to scrap the Redskins moniker. If the NFL were to lose its tax exemption, there's precedence for it. Major League Baseball gave up its nonprofit status in 2007, and the National Basketball Association never had one.
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Editor's note: On CNN's "State of the Union," host and chief national correspondent John King goes outside the Beltway to report on the issues affecting communities across the country. The Cleveland Clinic is consistently among the country's best in quality ratings, and its costs are among the lowest. CLEVELAND, Ohio (CNN) -- As he walks the halls of the Cleveland Clinic, Dr. Steven Nissen makes the next generation of health care in America sound quite simple. "Everything that we do is done with the patient at the center of the picture, not the doctor at the center," Nissen says as he takes a visitor on a tour of the clinic's world-renowned cardiac center. The clinic is consistently among the country's best in quality ratings, and its costs are among the lowest -- which is why President Obama often cites the Cleveland Clinic as an example of how health care in America should be, and why Nissen and other leading doctors here are frequently consulted by lawmakers and administration officials pushing major reforms this year. Nissen says the clinic's organizational structure -- and its pay structure -- are what make it different. Go inside the Cleveland Clinic on State of the Union with John King, 9 a.m. ET, Sunday. The traditional model is for the nonsurgeons and surgeons to be organized in separate groups --- imagine a Department of Medicine and a Department of Surgery. The cardiologist works in the former, the cardiac surgeon in the latter. Add in a financial model where doctors are paid on a "fee-for-service" basis. "Everyone wants to do their procedure," is how Nissen explains the most frequent result. "One of the things we say in medicine is, to a man with a hammer, everything looks like a nail. "And so if you are a cardiologist you want to do your procedures, if you are a surgeon you want to do your procedures and frankly people sometimes end up getting multiple procedures when a single collaborative procedure would have actually solved the problem. One of the ways you facilitate collaboration is you take the issue of personal income out of the equation." At the Cleveland Clinic, Nissen and other doctors are paid a fixed salary. "I get the same check at the end of the month whether I do a thousand procedures or one," he said. "And so I'm not incentivized to do more than what is necessary to help the patient. We all get the same check, whether we do an operation or an angioplasty. So we have taken that issue of income out of the equation." As a result, Nissen says cardiologists and surgeons share notes and ideas -- and work together to give the patient the best care -- and to emphasize choices that help prevent major procedures and surgeries. The clinic staff tries to set an example: Yoga classes on the roof; exercise facilities; healthier choices in both the staff and public cafeteria; walking routes in the halls and on the grounds; a policy that forbids hiring smokers. So far, CEO Dr. Toby Cosgrove says the staff has lost a combined 75,000 pounds -- an emphasis on wellness that he says will without a doubt lower the hospital's own health care costs. "Seventy percent of the cost in health care is from chronic disease," Cosgrove told us in an interview at his Cleveland Clinic office. "And chronic diseases come from really three big things -- from obesity, from lack of exercise and from smoking. And it also results in 40 percent of the premature deaths in the United States. So we have to do something as a nation to begin to deal with all those." Cosgrove, like Nissen, is an enthusiastic proponent of major national health care reforms that bring coverage to the estimated 45 to 50 million Americans who lack health insurance and that put an emphasis on primary and preventive care. "We believe that the government ought to incentivize quality," Nissen said. "If you can do a better job and you can prove you are doing a better job, then you ought to be paid better. And if you are not doing a good job, then you ought to be paid less." Cosgrove, however, does sound some cautionary notes as the key committees in Congress set about the difficult business of writing legislation. Paying for reforms is a dicey political proposition, and mindful of campaign promises not to add to the tax burden on middle class families, Obama has insisted that a major chunk of the money needed to pay for reforms can be found in "cost savings" in the Medicare and Medicaid programs. Cosgrove said there is without a doubt ample waste in those programs. But he warns any savings need to be arrived at carefully. "If you begin to take money away, my concern is that you begin to drive quality down," he said. "The first thing that you will begin to see happening is a deferment in investment in infrastructure. A classic example of this is what happened to the national health system in England. I mean they didn't invest in their infrastructure for 50 years. And now a lot of hospitals in England are 100 years old and way behind." Again, Cosgrove is emphatic that there are substantial cost savings in federal health programs that can be achieved over time. But he says a rush to squeeze savings from federal programs could cause a shock to a fragile delivery system. "The concern right now is 50 percent of the hospitals in the United States are running in the red," he said. "So if you begin to look at reducing the amount of money coming into hospitals to look after patients, I think you are beginning to look at a failure of a group of hospitals." Cleveland Clinic is among the trailblazers in electronic record keeping and interaction with patients. Many leave the clinic with home devices to test heart rate, blood sugar levels and blood pressure that automatically use wireless transmission to send the results to a home computer and then on to the clinic. Doctors say the impact on the quality of care is nothing short of astounding -- a dangerous reading results in an urgent alert e-mail to the doctor and his staff, and that time is precious in altering approaches to, say, keep blood pressure under control and avoid escalation to a more serious -- and more expensive -- medical episode. Doctors say patients who know their physicians are getting frequent updates on their vital signs often are more likely to stick to their diet or take their medications properly. Obama's stimulus legislation included funding for an expansion of electronic record keeping, and he has held up the practice as a revolutionary way to improve quality and cut costs. In another cautionary note, Cosgrove, however, said over time he believes widespread electronic record keeping -- and sharing -- will lead to fewer duplicative tests and other cost savings, but that the jury is still out on that question. "What we've seen is our quality's gone up -- substantially," Cosgrove said. "What we haven't seen is our costs come down. It's like the difference between an abacus and a cash register. Clearly the cash register is better, gives you a better record. But it isn't cheaper."
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Prostitutes has been refused health cover before Affordable Care Act .
Nevada is the only state in America where prostitution is legal .
Brothels are tightly regulated and controlled .
New taxes to pay for Obamacare will hit brothel's owner .
Health scheme face criticism after glitches crashed website .
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By . Tom Gardner . PUBLISHED: . 08:55 EST, 2 December 2013 . | . UPDATED: . 10:07 EST, 2 December 2013 . President Obama's beleaguered health care programme has received a ringing endorsement - from Nevada's legal prostitutes. The controversial scheme - otherwise known as Obamacare - is accused of being too expensive by some critics and faced anger after crippling glitches on its website prevented many from signing up when it first launched. But the Patient Protection and Affordable Care Act has enabled the legal prostitutes to get health insurance cover for the first time. High price: Dennis Hof, owner of the Moonlight Bunny Ranch, center, says Obamacare is good for the legal prostitutes working in his brothel, but will cost him a fortune in extra tax . 'Having this profession, we aren't . exactly offered group health insurance... I'm excited,' Taylor Lee, who . works at Moonlight Bunny Ranch, told Nevada's news4. Ms Lee said she had repeatedly refused health cover prior to Barack Obama signing the statute. Nevada is the only state in America where, under certain strict circumstances, prostitution is legal. Risk: U.S. President Barack Obama has staked his political legacy on the Patient Protection and Affordable Care Act, otherwise known as Obamacare . But despite working within the tightly . controlled and regulated brothels, many of the women found they were . nonetheless shunned by health insurers, until now. Caressa . Kisses told news4: 'They equate us to illegal working girls who have very . high STD's and AIDS rates which we have none of the above. We're legal, . licensed prostitutes. She added: 'We're independent contractors. We have to get our own insurance but this is truly a blessing.' 'Blessing: Nevada's legal prostitutes say Obamacare, which extends health insurance to millions of Americans previously shunned by the health care industry, is a 'blessing' But to pay for the extension of health . insurance, the Affordable Care Act includes new taxes on high-earners, . the healthcare industry and large businesses - including the brothel's owner. Dennis . Hof claims the new healthcare system will cost him, as an owner of . seven separate brothels - all employing about 15 people each - a strip club, restaurants and a truck stop, across the state, a fortune. He told news4: 'I'm the sole stockholder but because I'm the owner for all these different businesses, they lump them together. 'What . am I going to do? I'm either going to have to spend a lot of money on . health insurance because the rates are going up or I'm going to have to . face severe penalties, so I'm really perplexed about all of this.' Criticism: Obama's Affordable Care Act has been slammed after the signup page on the HealthCare.gov kept crashing after it was launched . The Bunny Ranch, in Carson City, Nevada, is America's most famous brothel and featured on Oprah Winfrey's chat show. Working girl Brooke Taylor gave the crew a guided tour of the ranch where punters can legally pay for sex - including its on-site sexual health clinic. The blonde took the cameras inside the room where the 500 girls who are licensed to work at the ranch are tested for sexually transmitted diseases every week and HIV once a month. Obamacare has antagonised many Republicans and those on the Right because it is seen as too much state interference, extremely expensive and inefficient. While lower-income people could see lower costs because of government . subsidies, many in the middle class risk a rude awakenings when they . access the websites to discover they may have to pay significantly more. But many have welcomed the changes as the first time millions of Americans will have access to health care insurance.
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Editor's note: On CNN's "State of the Union," host and chief national correspondent John King goes outside the Beltway to report on the issues affecting communities across the country. The Cleveland Clinic is consistently among the country's best in quality ratings, and its costs are among the lowest. CLEVELAND, Ohio (CNN) -- As he walks the halls of the Cleveland Clinic, Dr. Steven Nissen makes the next generation of health care in America sound quite simple. "Everything that we do is done with the patient at the center of the picture, not the doctor at the center," Nissen says as he takes a visitor on a tour of the clinic's world-renowned cardiac center. The clinic is consistently among the country's best in quality ratings, and its costs are among the lowest -- which is why President Obama often cites the Cleveland Clinic as an example of how health care in America should be, and why Nissen and other leading doctors here are frequently consulted by lawmakers and administration officials pushing major reforms this year. Nissen says the clinic's organizational structure -- and its pay structure -- are what make it different. Go inside the Cleveland Clinic on State of the Union with John King, 9 a.m. ET, Sunday. The traditional model is for the nonsurgeons and surgeons to be organized in separate groups --- imagine a Department of Medicine and a Department of Surgery. The cardiologist works in the former, the cardiac surgeon in the latter. Add in a financial model where doctors are paid on a "fee-for-service" basis. "Everyone wants to do their procedure," is how Nissen explains the most frequent result. "One of the things we say in medicine is, to a man with a hammer, everything looks like a nail. "And so if you are a cardiologist you want to do your procedures, if you are a surgeon you want to do your procedures and frankly people sometimes end up getting multiple procedures when a single collaborative procedure would have actually solved the problem. One of the ways you facilitate collaboration is you take the issue of personal income out of the equation." At the Cleveland Clinic, Nissen and other doctors are paid a fixed salary. "I get the same check at the end of the month whether I do a thousand procedures or one," he said. "And so I'm not incentivized to do more than what is necessary to help the patient. We all get the same check, whether we do an operation or an angioplasty. So we have taken that issue of income out of the equation." As a result, Nissen says cardiologists and surgeons share notes and ideas -- and work together to give the patient the best care -- and to emphasize choices that help prevent major procedures and surgeries. The clinic staff tries to set an example: Yoga classes on the roof; exercise facilities; healthier choices in both the staff and public cafeteria; walking routes in the halls and on the grounds; a policy that forbids hiring smokers. So far, CEO Dr. Toby Cosgrove says the staff has lost a combined 75,000 pounds -- an emphasis on wellness that he says will without a doubt lower the hospital's own health care costs. "Seventy percent of the cost in health care is from chronic disease," Cosgrove told us in an interview at his Cleveland Clinic office. "And chronic diseases come from really three big things -- from obesity, from lack of exercise and from smoking. And it also results in 40 percent of the premature deaths in the United States. So we have to do something as a nation to begin to deal with all those." Cosgrove, like Nissen, is an enthusiastic proponent of major national health care reforms that bring coverage to the estimated 45 to 50 million Americans who lack health insurance and that put an emphasis on primary and preventive care. "We believe that the government ought to incentivize quality," Nissen said. "If you can do a better job and you can prove you are doing a better job, then you ought to be paid better. And if you are not doing a good job, then you ought to be paid less." Cosgrove, however, does sound some cautionary notes as the key committees in Congress set about the difficult business of writing legislation. Paying for reforms is a dicey political proposition, and mindful of campaign promises not to add to the tax burden on middle class families, Obama has insisted that a major chunk of the money needed to pay for reforms can be found in "cost savings" in the Medicare and Medicaid programs. Cosgrove said there is without a doubt ample waste in those programs. But he warns any savings need to be arrived at carefully. "If you begin to take money away, my concern is that you begin to drive quality down," he said. "The first thing that you will begin to see happening is a deferment in investment in infrastructure. A classic example of this is what happened to the national health system in England. I mean they didn't invest in their infrastructure for 50 years. And now a lot of hospitals in England are 100 years old and way behind." Again, Cosgrove is emphatic that there are substantial cost savings in federal health programs that can be achieved over time. But he says a rush to squeeze savings from federal programs could cause a shock to a fragile delivery system. "The concern right now is 50 percent of the hospitals in the United States are running in the red," he said. "So if you begin to look at reducing the amount of money coming into hospitals to look after patients, I think you are beginning to look at a failure of a group of hospitals." Cleveland Clinic is among the trailblazers in electronic record keeping and interaction with patients. Many leave the clinic with home devices to test heart rate, blood sugar levels and blood pressure that automatically use wireless transmission to send the results to a home computer and then on to the clinic. Doctors say the impact on the quality of care is nothing short of astounding -- a dangerous reading results in an urgent alert e-mail to the doctor and his staff, and that time is precious in altering approaches to, say, keep blood pressure under control and avoid escalation to a more serious -- and more expensive -- medical episode. Doctors say patients who know their physicians are getting frequent updates on their vital signs often are more likely to stick to their diet or take their medications properly. Obama's stimulus legislation included funding for an expansion of electronic record keeping, and he has held up the practice as a revolutionary way to improve quality and cut costs. In another cautionary note, Cosgrove, however, said over time he believes widespread electronic record keeping -- and sharing -- will lead to fewer duplicative tests and other cost savings, but that the jury is still out on that question. "What we've seen is our quality's gone up -- substantially," Cosgrove said. "What we haven't seen is our costs come down. It's like the difference between an abacus and a cash register. Clearly the cash register is better, gives you a better record. But it isn't cheaper."
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| 34,807 |
Groups express concerns about the Medicaid ruling .
The requirement to have health insurance by 2014 remains in place .
Insurance companies must cover people with pre-existing conditions .
Small business owners and medical groups disagree over the impacts of the law .
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The Supreme Court's decision Thursday to uphold the Affordable Care Act means that the predictions about how it will affect Americans remain in place. Obama: Supreme Court ruling on health care a victory for all Americans . The court did rule that a part of the law involving Medicaid must change. The law calls for an expansion of eligibility for Medicaid, which involves spending by the federal government and the states. The law threatens to remove existing Medicaid funding from states that don't participate in the expansion. The high court said the government must remove that threat. Several groups that follow the health care law closely said they were concerned about the high court's ruling on the Medicaid portion of the law. Read the court ruling (.PDF) Here are some highlights: . The uninsured . The decision leaves in place the so-called individual mandate -- the requirement on Americans to have or buy health insurance beginning in 2014 or face a penalty -- although many are exempt from that provision. In 2014, the penalty will be $285 per family or 1% of income, whichever is greater. By 2016, it goes up to $2,085 per family or 2.5% of income. Health care exchanges, which are designed to offer cheaper health care plans, remain in place as well. American Cancer Society CEO John Seffrin said his organization was looking at the ruling on Medicaid, and is "concerned that the decision may limit the expansion of quality coverage to some of our nation's most vulnerable citizens." The group Health Care for America Now, which spent tens of millions of dollars on ads supporting the health care plan, said it was "disappointed" and will work to make sure no states "choose to exclude the lowest-income uninsured adults from their Medicaid programs." Medicaid Health Plans of America, the trade group representing Medicaid health plans, praised the court "for keeping in place key elements of this historic legislation" and said it remains "committed to a strong partnership with the states and CMS (Centers for Medicare and Medicaid Services) to find a way to cover this population in need." Rep. Phil Gingrey, R-Georgia, a physician who staunchly opposed the health care law, told CNN he believes many who would have received Medicaid will now enter the health care exchanges, which offer subsidized plans. That, he argued, could cost taxpayers billions of dollars across the country. Breaking down the court's decision . The insured . Because the requirement remains for people to have or buy insurance, the revenue stream designed to help pay for the law remains in place. So insured Americans may be avoiding a spike in premiums that could have resulted if the high court had tossed out the individual mandate but left other requirements on insurers in place. Young adults . Millions of young adults up to age 26 who have gained health insurance due to the law will be able to keep it. The law requires insurers to cover the children of those they insure up to age 26. About 2.5 million young adults from age 19 to 25 obtained health coverage as a result of the Affordable Care Act, according to the U.S. Department of Health and Human Services. Two of the nation's largest insurers, United Healthcare and Humana, recently announced they would voluntarily maintain some aspects of health care reform, including coverage of adult dependents up to age 26, even if the law was scrapped. People with pre-existing conditions . Since the law remains in place, the requirement that insurers cover people with pre-existing medical conditions remains active. The law also established that children under the age of 19 could no longer have limited benefits or be denied benefits because they had a pre-existing condition. Starting in 2014, the law makes it illegal for any health insurance plan to use pre-existing conditions to exclude, limit or set unrealistic rates on coverage. It also established national high-risk pools that people with such conditions could join sooner to get health insurance. As of April, a total of only about 67,000 people were enrolled in federally-funded pools established by the health care law, according to the National Conference of State Legislatures. More than 13 million American non-elderly adults have been denied insurance specifically because of their medical conditions, according to the Commonwealth Fund. The Kaiser Family Foundation says 21% of people who apply for health insurance on their own get turned down, are charged a higher price, or offered a plan that excludes coverage for their pre-existing condition. Photos: Who is John Roberts? All taxpayers . No matter what the Supreme Court had decided, it would have been a mixed bag for all Americans when it comes to federal spending. There is heated dispute over what impact the health care law will have on the country over the long term. The federal government is set to spend more than $1 trillion over the next decade to subsidize coverage and expand eligibility for Medicaid. It is not immediately clear how the high court's ruling on the part of the law dealing with the expansion of Medicaid eligibility could affect spending. The nonpartisan Congressional Budget Office estimated that the law could reduce deficits modestly in the first 10 years and then much more significantly in the second decade. The CBO said a repeal of the mandate could reduce deficits by $282 billion over 10 years, because the government would be subsidizing insurance for fewer people. But the nation faces costs in various ways for having people who are uninsured. The Urban Institute's Health Policy Center estimated that without a mandate, 40 million Americans would remain uninsured. Meanwhile, the Flexible Spending Accounts that millions of Americans use to save money tax-free for medical expenses will be sliced under the law. FSAs often allow people to put aside up to $5,000 pre-tax; as of 2013, they were to face an annual limit of $2,500. Opinion: Are voters ready to move on? Small business owners . The rules and benefits small business owners face as a result of the health care law remain in place. As CNN has chronicled, the law brought a mix of both. The director of the National Federation of Independent Business is one of the plaintiffs who pushed the court to strike down the law. Meanwhile, a group called Small Business Majority fought to protect the law, saying its loss could be a nightmare. As of 2014, under the law, small firms with more than 50 full-time employees would have to provide coverage or face expensive fines. All Americans, in lesser known ways . The massive health care law requires doctors to report goodies they get from medical supply companies; demands more breastfeeding rooms; requires all chain restaurants to list calories under every menu item, and includes numerous other provisions, which now remain in place. Doctors and other health care providers . Health care providers have already begun making changes based on the 2010 law, and in preparation for what will go into effect in 2014. Those plans continue. In the short term, doctors avoid "chaos" that may have resulted from the law suddenly being dropped or changed, according to Bob Doherty, senior vice president of governmental affairs at the American College of Physicians, who wrote a blog post on the website kevinmd.com this spring. Medical groups have disagreed over the law. How the Supreme Court Justices voted . Opinion: A health care victory that's only a start . Ruling plays into campaign narrative for both sides .
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GULFPORT, Illinois (CNN) -- All roads in the town of Gulfport, Illinois, lead to nowhere. They all hit a dead end into Mississippi River floodwaters. Most businesses and homes in Gulfport, Illinois, are underwater. Only 28 residents had flood insurance. The small town in western Illinois was devastated Wednesday when two levees failed about 45 miles south. Tuesday, all that was visible were a few signs and rooftops. "It almost looked like a tidal wave coming across the land," recalls Rick Gerstel, a resident of Gulfport. "Almost like the end of the world is what it looks like." The water barreled through with such force, it knocked Gulfport's town hall off of its foundation, and the walls of some brick and mortar buildings collapsed. Most businesses and homes are underwater. But none of this was supposed to happen -- at least that is what residents believed. Gulfport was protected by a levee rated to withstand a 100-year flood. Although it wasn't designed to protect the town from a flood on the scale of last week's, it was enough protection that the Federal Emergency Management Agency did not require business or homeowners to purchase flood insurance. Only 28 of the town's 200 residents had federal flood insurance. The rest trusted that the levees would hold. Residents Rick and Gina Gerstel, who lost everything, say no one from their bank to the municipal or federal governments ever told them they were at risk and ought to buy flood insurance. Some residents said they felt misled about the risks of not having flood insurance. They said they thought the chances of a catastrophic flood were miscalculated. Watch: Flooded residents gambled and lost » . Sen. Chris Dodd, D-Connecticut, agrees. He supports legislation that would require anyone living in an area protected by a levee to have flood insurance. "I don't know how you define 'protected' or call that protected when you're telling people 'you don't have to have this; you don't need it' ... and you're watching families being devastated," Dodd said. "But the opportunity to get on their feet again is going to be very difficult for many families. And that's one of the major shortcomings in the flood insurance program." FEMA says its risk assessment of Gulfport was accurate, and the agency is spending $1 billion to upgrade outdated maps and re-evaluate flood dangers. "We do our best to advertise the availability of flood insurance and encourage people to purchase it," said Terry Reuss Fell, regional chief of FEMA's floodplain management. "We implement the laws that are given to us and the laws right now deal with the floodplains management within that 100-year floodplain and the insurance purchase requirements in that area also." The flooding could have been worse, according to officials, if the federal government had not purchased low-lying land after the historic floods in 1993, which caused $12 billion in damage. Since then, the government bought out more than 9,000 homeowners, turning much of the land into parks and undeveloped areas that can be allowed to flood with less risk. FEMA has moved or flood-proofed about 30,000 properties. But those changes are little consolation for the Gerstels and other uninsured residents who have lost everything and can't afford to rebuild. "Will you ever go back to that house?" CNN asked the Gerstels. "No, sir. I would not go back to the town," Rick Gerstel said. "I would never live there again."
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NEW: President Obama signs State Children's Health Insurance Program into law .
House approves the bill in vote that falls largely along party lines .
SCHIP passed the Senate last week .
SCHIP makes additional 4 million kids eligible for federally funded health insurance .
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WASHINGTON (CNN) -- President Barack Obama claimed the second major legislative victory of his young administration Wednesday, signing a bill to provide federally funded health care to an estimated 4 million children. President Obama says the SCHIP bill is a downpayment on his "commitment to cover every single American." The final version of the new law, which expands the State Children's Health Insurance Program (SCHIP) by roughly $35 billion over the next five years, passed a sharply polarized House of Representatives earlier in the day, with almost every Democrat voting in favor of the expansion and most Republicans opposing it. With the bill, Obama said at a White House ceremony, "We fulfill one of the highest responsibilities that we have -- to ensure the health and well-being of our nation's children." The president said the bill was a downpayment on his "commitment to cover every single American." The SCHIP expansion is Obama's second major legislative win in less than a week. The first was Thursday's approval of the Lilly Ledbetter Pay Equity Act, which makes it easier to sue employers for wage-based discrimination. Learn more about the SCHIP program » . The expansion is also a sign of the strength of Washington's new Democratic majority. Former President George W. Bush vetoed two similar health care bills in 2007, arguing that the legislation would encourage families to leave the private insurance market for the federally funded, state-run program. Before the bill's passage, SCHIP covered almost 7 million children whose parents earn too much to qualify for Medicaid -- the federal health insurance program for the poor -- but who can't afford private insurance. The new law boosts total SCHIP funding to approximately $60 billion. The expanded program will be financed with a 62-cent-per-pack increase in the federal tax on cigarettes. "This is a day worthy of celebration. There can be no greater cause ... than protecting the well-being of our nation's children," New Jersey Rep. Frank Pallone, the legislation's primary House author, said shortly before the bill's final passage on a 290-135 vote. Passing the health program's expansion is "morally the right thing to do by our children," said freshman Rep. Tom Perriello, D-Virginia. "At a time when the cost of health care is crushing America's families ... this is an important lifeline." Opponents of the legislation argued that, among other things, it will allow undocumented immigrants to illegally access taxpayer-financed health care, and is insufficiently funded. "This will go out of control just like all the other [entitlement] programs have, and our children will pay," Rep. Jack Linder, R-Georgia, warned during the House debate Wednesday. Rep. Steve King, R-Iowa, ripped the bill as a "foundation stone for socialized medicine in the United States," arguing that raising the income limit for SCHIP eligibility will serve as the basis for a massive expansion of government-run health care. The Senate passed the expansion Friday in a 66-32 vote. All those voting against the bill were Republicans, though nine Republicans voted in favor of the measure.
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Early learning programs may help children stave off obesity along with helping them do better in school, a new study suggests. Researchers from the University of Michigan looked at the BMIs of 19,023 children enrolled in Head Start - a federally-funded pre-school education service for low-income families. After a year, almost three-quarters of the 16per cent who were initially obese had a become a normal weight. Similar patterns were seen for overweight infants on the course. Early learning: Head Start programs have been shown to help poor children do better in school, but they may also help them fight obesity, a study suggests . This trend did not apply to children from Medicaid families and only slightly so with those from wealthier, privately insured families. Lead author Julie Lumeng says there a several factors of Head Start that could have a positive impact on a child's BMI. The quality of federally-regulated food provided may be higher than that in other child care facilities and pupils could have more opportunity for physical activity. Researchers say the potential benefits are important because obesity is so hard to treat and disproportionately affects low-income children. Dr. David Ludwig, a Harvard Medical School pediatrics professor and director of an obesity prevention center at Children's Hospital Boston, called the results 'encouraging'. Head Start is a federal pre-kindergarten program offered free in every state to low-income families. It often involves full-day preschool, focusing on school readiness, healthy eating and physical activity. Many programs provide children two daily meals, and give families health and nutrition advice. More than 1 million U.S. children participate. Nationwide, about eight per cent of preschoolers are obese, but the rate was mostly higher during the 2005-13 study. The recent piece of research was published online Monday in Pediatrics.
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A staggering 15,661 operations cancelled on day they were scheduled for .
Total, highest for nine years, is sign of increasing pressure on NHS trusts .
But Department of Health said these accounted for just 0.8% of operations .
New figures relate to elective operations between April and June this year .
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By . Tamara Cohen, Political Correspondent . Increase: The number of operations cancelled on the day they were due to go ahead has hit its highest total for nine years, according to official figures . The number of operations cancelled on the day they were due to go ahead has hit its highest total for nine years, according to official figures. In a sign of mounting pressure on many NHS trusts, it has emerged that between April and June 15,661 scheduled operations were cancelled at the last minute for non-medical reasons. That is the highest since the same three months in 2005 when 15,690 operations were cancelled on the day they were supposed to be carried out. But the Department of Health said the proportion of operations cancelled at the last minute is only 0.8 per cent, around the same as in previous years. It said the proportion has not changed because doctors carried out more than half a million more operations this year than in the same period eight years ago, driven by the ageing population and medical advances. Labour blames increases in the number of patients attending accident and emergency departments for the rise in cancelled operations. This spring the vast majority of patients affected had their operation rescheduled within a month, but 800 were left waiting longer. The data, published by NHS England, relates to elective operations – scheduled in advance – not emergency surgery. In the same quarter of 2006 the number of cancelled operations was only 12,548. In spring 2011, the year after the Coalition came to power, it was 12,780. NHS guidance states that common non-medical reasons for cancelling an operation include lack of ward beds available, the lack of an available surgeon, anaesthetist or theatre staff; an emergency case needing the theatre, equipment failure, or lack of a critical care bed. Last week figures from NHS England showed there are now 3.2million people on NHS waiting lists for operations, with some being forced to wait more than a year. The total is the highest since the target of treating 90 per cent of patients with 18 weeks was introduced six years ago. Concern: A spokesman for Health Secretary Jeremy Hunt (left) said it was important to reduce the waiting list for operations responsibly, while the Labour party's Andy Burnham (right) said hospitals are 'full to bursting' Ministers admit it may not be met again for months while the backlog is cleared. But a spokesman for Health Secretary Jeremy Hunt said it was important to reduce the waiting list responsibly – rather than try to meet the target by prioritising simple procedures rather than complex but life-changing operations which take longer. Labour health spokesman Andy Burnham said: ‘Not only are people waiting longer for operations, increasing numbers are facing the appalling anxiety and indignity of preparing for treatment only to be let down just hours before surgery. ‘Hospitals are full to bursting, with record numbers in A&E, and this is threatening to drag down the rest of the NHS.’ An NHS England spokesman said: ‘NHS England believes all cancellations should be avoided wherever possible. However, the level of cancellations remains low, in the context of the millions of operations performed in the NHS each year.’ A Department of Health spokesman said: ‘The number of operations cancelled in this quarter has remained steady at less than 1 per cent of all elective admissions, despite the fact that the NHS is responding to significantly increased demand by performing more than half a million more operations now than in the same period eight years ago.’
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(CNN) -- President Barack Obama needs to learn a simple lesson: Saying something doesn't make it true. Though the President has claimed victory touting 8 million "enrollments" under his health care law, Americans cannot and will not wipe their memories clear of the botched rollout and continual failings of Obamacare. Democrats have sustained their tactic of telling everyone the health care law is working, despite overwhelming evidence to the contrary. Perhaps if they say it enough, their reasoning goes, it will become true. Well, Obama can have his own opinions and he can even assert falsehoods as truth, but he can't conjure fact. A new Washington Post/ABC News poll lays the facts out bare. The President's approval rating has slipped to 41% -- the lowest of his presidency in Post/ABC News polls. And only 37% approve of the President's handling of Obamacare's implementation. Despite the 8 million enrollees vaunted by the administration, a mere 44% of Americans approve of the President's signature law. This negative view of Obamacare persists even upon the assumption, parroted by many in the media, that the 8 million enrollment figure is accurate. However, the administration refuses to tell the American people any details about that number. How many of those "enrollees" are insured, having paid their first month's premium? How many were previously uninsured? How many were forced off their former coverage that they liked? What will the quality of coverage be for those who actually receive coverage? These questions have been met with deaf ears and defensive posturing. "The debate over the repeal of the law is over," the President said. "This law is doing what it's supposed to do -- it's working." The President has confused reported high enrollment numbers with success, disregarding that while millions may be signed up under threat of penalty, Americans are not sold on the failed law. To provide Americans answers to the unanswered questions, the House passed in January the Exchange Information Disclosure Act, which would require transparency from the administration regarding the Obamacare insurance exchange. Yet U.S. Senate Majority Leader Harry Reid has blocked the bill in the Senate, unwilling to give the American people access to information they have a right to know. In an attempt to get the data directly from the source, the House Energy and Commerce Committee sent letters in March to every insurance provider participating in the federal exchange requesting enrollment data, including the number of individuals who have paid their first month's premium or were previously uninsured. The results finally came in. As of April 15, only 67% of individuals and families that selected a plan had paid their first month's premium, data provided to the committee by every provider in the Federally Facilitated Marketplace shows. Insurers informed the committee that, by the same date, only 2.45 million had paid their first month's premium for coverage obtained through the FFM. The purpose of Obamacare, if the President remembers, was to insure, not merely to sign up, and it seems the President's enrollment numbers far surpass the number of insured. Of those who have enrolled and paid their premiums, some surely liked their health insurance, were renewing their health insurance and were booted off their health insurance because of Obamacare regulations. This law is not a success. Even before the Energy and Commerce Committee released their findings, Americans still viewed Obamacare unfavorably. In Tuesday's Post/ABC News poll, 47% of Americans reported that the ACA has raised their health care costs and 60% blame Obamacare for increasing costs nationally. Americans -- faced with Obamacare's burdens and disappointed with the president's handling of the economy, foreign policy, and more -- want a Republican-controlled Congress to act as a check on the president's policies by 53 to 39%. The debate is far from over, Mr. President. Instead of taking responsibility for the failed health care law, Obama prefers to call major problems "glitches" and forced re-enrollment of millions who were previously insured "success." He has claimed victory with a number that includes millions who remain uninsured. The first step toward fixing a problem is admitting the problem exists. Instead of taking responsibility for the disaster they've created and the unnecessary hardships they've imposed on the American people, Obama and the Democrats are trying to rewrite the facts. Unfortunately for them, facts don't work that way. Join us on Facebook.com/CNNOpinion.
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Sebelius said in April: "Anyone under 400% of poverty will qualify for a tax subsidy"
CNN crunches the numbers, finds many low-income younger Americans will get no subsidy .
Officials now say that's because the cost of insurance is lower than initially expected .
Competition put premiums "so low that the premium is below the ceiling," says HHS spokeswoman .
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One of the basic tenets of Obamacare is that the government will help lower-income Americans -- anyone making less than about $45,900 a year -- pay for the health insurance everyone is now mandated to have. But a CNN analysis shows that in the largest city in nearly every state, many low-income younger Americans won't get any subsidy at all. Administration officials said the reason so many Americans won't receive a subsidy is that the cost of insurance is lower than the government initially expected. Subsidies are calculated using a complicated formula based on the cost of insurance premiums, which can vary drastically from state to state, and even county to county. That doesn't change the fact that in Chicago, a 27-year old will receive no subsidy to help offset premiums of more than $165 a month if he makes more than $27,400 a year. In Portland, Oregon, subsidies for individuals making just $28,725 a year phase out for those younger than 35 years old. The subsidies situation is adding another layer of complications and calculations to the already-complex picture of Obamacare. And Obama administration officials had promised that the threshold for government assistance would be higher. Subsidies are based on a formula set by law, applying to individuals with annual incomes of one to four times the poverty level -- or $11,490 to $45,960. A subsidy calculator . The percentage people have to pay for insurance increases on a sliding scale, with those making $11,490 paying no more than 2% of their income, and those making $45,960 paying no more than 9.5% unless they choose to select a more expensive plan. Back in April, Health and Human Services Secretary Kathleen Sebelius told a congressional subcommittee that any individual making under that $45,960 threshold -- or four times the poverty level of $11,490 for an individual -- would qualify for "an upfront tax subsidy." "Somebody who's making $25,500 would definitely qualify for a subsidy if he or she is purchasing coverage in the individual market," Sebelius added. Despite the secretary's assurance, a 25-year-old living in Nashville, Tennessee, making $25,500 will not qualify for a subsidy, for example. An administration official, presented with the data that many low-income Americans would not receive a subsidy, argued that lower premium costs meant the market was working. "In some instances, because of the competition that the marketplace creates, premiums have come in so low that the premium is below the ceiling in the law," said HHS spokeswoman Joanne Peters. "This means that, in some places, people will pay less than they would with a tax credit." Cancer survivor: Obamacare got me covered . To calculate premium subsidies, the government sets a maximum amount that low-income customers will have to pay for insurance as a percentage of their income. That cap is then subtracted from the cost of a mid-level insurance plan in the individual's region, and the difference is their subsidy. The insurance companies knock that amount off the price of premiums before the customer pays. But if the baseline plan is cheap enough, the formula is thrown off and the subsidy is zero. "The way the subsidy works is by capping the percent of your income that you'd have to spend on a silver premium," said Cynthia Cox, a policy analyst at the Kaiser Family Foundation, referring to the medium-level insurance plan the government uses as the baseline. "But if the premium before subsidies is already so low that it falls below your income cap, then you wouldn't qualify for a subsidy even if your income would otherwise qualify for one." This means that in places like Minneapolis, Minnesota, where premiums are especially low, a 40 year old making $28,725 a year would get no help from the government to purchase insurance. In that case, this individual would be earning just 250% of the federal poverty level, far below 400% where the subsidies are supposed to end. "While you don't qualify for subsidies your premiums are already lower," Cox pointed out. "So in this example, this person is only going to be paying $154 a month whereas the same person living somewhere else would be paying $193 a month after subsidies." Still, because of what government officials have been saying about who would get subsidies, many low-income consumers are counting on subsidies to lower their costs, no matter how small those costs may initially be. The actual age and income level where subsidies phase out differs depending on the cost of insurance, which are often lower in cities than in more rural areas. Opinion: Generation Y should opt for Obamacare . But no matter where a person lives, premiums increase based on a customer's age, meaning this problem will disproportionately affect younger customers. Two exceptions are in New York and Vermont, where state laws require insurance companies to charge younger customers the same as older customers. "There's a lot of interest in getting young people to enroll in coverage because that helps bring down the average cost," Cox said, but these younger, healthier consumers might stay out of the exchange it they "don't have subsidies to incentivize them to enroll." As incomes increase, the age cap gets even higher. Part of the reason for the sizable difference between the actual subsidy caps in certain cities and the intended cap under the law is that actual premiums came in below what the government and the Congressional Budget Office estimated. "The CBO projected premiums to be approximately 16% higher than they turned out to be," Cox said. Because Kaiser based its estimates on the CBO's, much of its projections turned out to be slightly off. The actual subsidy caps only became clear after October 1, when the foundation was able to compile the cost of the second-lowest silver plan from every coverage area in all 50 states and the District of Columbia. White House: Politics aren't pushing back start date of 2015 Obamacare enrollment .
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By . Francesca Chambers . Massachusetts is giving up on its health exchange website. State officials have decided that it would be cheaper to abandon the state's Health Connector website than it would to fix it, reports The Boston Globe. The state is now looking at other ways to sign up its uninsured residents for healthcare ahead of the next open enrollment period that begins November 15. Massachusetts' Health Connector site was . created by CGI Federal - the same company that created the glitchy . federal Obamacare sign-up site healthcare.gov. Massachusetts state officials have decided it would be cheaper to abandon the state's Health Connector website than it would to fix it . Much like its federal counterpart, mahealthconnector.org, has not worked properly since it went live in October 2013. Many Massachusetts residents were unable to sign up for health care online, and instead had to fill out paper applications. As a result of the hiccups with its website, Massachusetts asked the federal government in early February to exempt it from the nationwide March 31 deadline to sign up for qualifying health care plans. It asked that the Obama administration give it until September 30, and at the very least, until June 30. 'We spent a lot of money. Some of it may be federal, but it’s all . taxpayer money however it’s collected. We spent a lot of money for . something that doesn’t work,' state senator Richard Moore, a Democrat, told Mass Live at the time. 'It’s a wonder we . don’t have as series of mental health crises because of people’s . frustration.' The Bay State's Health Connector board was supposed to meet later this week to decide whether it would get rid of Massachusetts' health exchange entirely and feed residents into the federal exchange, the Boston Herald reported on Friday. However, the state official tasked with overseeing the site said on Monday that Massachusetts would pursue a 'dual track' approach to providing its uninsured residents with healthcare. The state will first look into purchasing a customized version of the state health insurance platform sold by health information and technology company hCentive. If it is not able to get its own exchange up and running quick enough, it will feed enrollees into the federal health exchange. 'I’ve said all along that no option on the table would be perfect, and the dual track certainly has its benefits and its challenges,' said health care Sarah Iselin, an insurance industry executive who was hired on a temporary basis by Democratic Governor Deval Patrick in February to fix the site. 'It does, however, solve for two realities: we need a reliable website to help people during the next open enrollment period, and we need to be in a position to achieve a fully integrated system in 2015,' Iselin, who is scheduled to return to her job at Blue Cross Blue Shield of Massachusetts this month, told The Boston Globe. On its website, hCentive boasts'reduced implimentation costs' and a 'shorter implimentation cycle' as part of its state exchange program. 'Our browser-based, user-configurable solutions are being adopted by different healthcare plans and organizations to enhance their processes and ensure compliance with healthcare reforms without significant cost or IT infrastructure,' the website says. It does not say on its site how much the program costs or what other states are using it. The Virginia-based company did not respond to MailOnline's request for comment. 'You can¿t help but admit it¿s a failure,' House Minority Leader Bradley Jones Jr., a Republican, said of Massachusetts' Health Connector website last week . Oregon became the first site to ditch it's health exchange and join healthcare.gov last month after spending $305 million to build and promote its Cover Oregon site. Massachusetts has spent at least $57 million on its site, Politico reports. The total amount of taxpayer money Massachusetts has spent on its failed health exchange site is not public. Members of the state's house passed legislation on Friday requiring Governor Patrick's office to disclose that information. It now awaits approval in the state senate. 'You can’t help but admit it’s a failure,' House Minority Leader Bradley Jones Jr., a Republican, said of the Health Connector website last week. 'It’s an abject failure that’s going to cost the taxpayers, whether it’s the commonwealth of Massachusetts or money from the feds or rate-payers, tens of millions of dollars that shoudn’t have happened.' The federal government spent $93.7 million on building Health Connector's botched sister site healthcare.gov. It is paying $121 million to fix it. Health Connector spokesman Jason Lefferts said he expected information on the cost of Massachusetts' site to be provided by the Patrick administration 'sooner than July.'
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The Washington, D.C court of appeals ruled that the law, as written, only allows insurance subsidies in states that have set up their own exchanges .
An appeals court in Richmond, Virginia ruled unanimously that people who purchased coverage through the federal exchanges are also eligible for subsides .
The cases could end up before the U.S. Supreme Court .
Affected states include some of the most populous: Ohio, Pennsylvania, Florida and Texas .
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The future of Obamacare was uncertain today after a federal court in Washington, D.C. struck down tax subsidies for Americans who bought insurance through federally-funded exchanges. Within hours the same policy was held up by another court, setting up a Supreme Court showdown. The cases revolve around four words in the Affordable Care Act, which says the tax credits are available to people who enroll through an exchange 'established by the state.' The rulings affect consumers who purchased their . coverage through the federal insurance marketplace - or exchange- that . serves 36 states. If the first ruling is upheld by the nation's high court, more than half of the 8 million Americans who purchased taxpayer-subsidized insurance under the law could see premium increases. Americans who are covered through the federal exchange will see no immediate changes to their policies, however, as the courts sort out the issue. 'In the meantime, to be clear, people getting premium tax credits should know that nothing has . changed. Tax credits remain available,' Department of Justice . spokeswoman Emily Pierce said in a statement after the first ruling. Scroll down for video . Another setback: A federal appeals court delivered a serious setback to President Barack Obama's health care law this morning, potentially derailing subsidies for many low- and middle-income people who have bought policies . In flux: Obamacare enrollees in the 36 states that initially or eventually used the federal healthcare marketplace as opposed to their own could face a steep rate increase now that a federal court has struck down a critical piece of Affordable Care Act legislation . Alabama Alaska ArizonaFloridaGeorgiaIdahoIndianaKansasLouisianaMaineMississippiMissouriMontanaNebraskaNew JerseyNew MexicoNorth CarolinaNorth DakotaOhioOklahomaPennsylvaniaSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaWisconsinWyoming . A three-judge panel in Washington, D.C. ruled 2-1 that the law, as written, only allows insurance subsidies in states that have set up their own exchanges. The majority opinion concluded that the law, as written, 'unambiguously' restricts subsides to consumers in exchanges established by a state. That would invalidate an Internal Revenue Service regulation that tried to sort out confusing wording in the law by concluding that Congress intended for consumers in all 50 states to have subsidized coverage. The subsidies, in the form of tax . credits, are available to people with annual incomes of up to 400 . percent of the federal poverty level, or $94,200 for a family of four. Causing further uncertainty is a decision by the 4th Circuit Court of Appeals in Richmond, Virginia, that was handed down this afternoon. That court said in a unanimous ruling that tax subsidies are indeed available people who bought their insurance through the federal exchanges. The seemingly arcane . issue is crucial to the success of the health law because most states . have been unable or unwilling to set up their own exchanges. The small business owners who challenged the law through the Washington, D.C. court say a literal reading of its language invalidates the IRS subsidy to people in the federal exchanges. The opponents say that people who would otherwise qualify for the tax credits should be denied that benefit if they buy insurance on a federally facilitated exchange. 'It is implausible to believe that Congress gave the IRS discretion to authorize $150 billion per year in federal spending, particularly when Congress had directly spoken to this issue,' the D.C. Appeals court challengers said in a court filing. 'Major economic decisions like these - indeed, any decisions granting tax credits - must be made unambiguously by Congress itself.' The Obama administration and congressional and state legislative supporters of the Affordable Care Act say the challengers are failing to consider the words of the statute in its entirety. 'It is pretty obvious what the congressional intent was here,' White House Press Secretary Josh Earnest said, which was for every qualified American to receive a subsidy 'regardless of whether it was state officials or federal officials running the marketplace.' Pierce said the D.C. ruling is 'at odds with the goal of the law.' 'We believe that this decision is incorrect, inconsistent with . Congressional intent,' the Justice Department official said. The Obama administration and congressional and state legislative supporters of the Affordable Care Act say the challengers to the law are failing to consider the words of the statute in its entirety . An appeals court filing by congressional and state legislative supporters of the Affordable Care Act, similarly argues that 'Congress did not provide that the tax credits would only be available to citizens whose states set up their own exchanges.' Congressional lawmakers and state legislators who are against the law hope that by limiting the subsidies to state exchanges, they can destabilize important aspects of the law, such as the individual mandate requiring most people to buy insurance. Andre . Davis, a Senior Circuit Court Judge serving on the Richmond court, explained the court's decision this way: . 'If I ask for pizza from Pizza Hut for lunch but clarify that I would . be fine with a pizza from Domino's, and I then specify that I want ham . and pepperoni on my pizza from Pizza Hut, my friend who returns from . Domino's with a ham and pepperoni pizza has still complied with a . literal construction of my lunch order.' Davis and his colleagues voted to uphold what the Obama administration says was the 'intent' of law - subsidies for all qualified Americans, regardless of whether they signed up for coverage through the state or federal exchanges. 'Today’s ruling highlights the ramifications of hastily passing legislation before fully knowing and understanding what it entails and how it will affect people,' House Republican Conference Chair Cathy McMorris Rogers said in a statement after the D.C. decision was handed down. 'For months, people all across this country have seen firsthand the flawed and ineffective implementation of Obamacare – in their skyrocketing premiums, lost coverage, limited access, and regulatory inefficiencies. 'And today’s decision is only further evidence of the legislation’s failure,' the GOP leader said.' It’s time to listen to the American people, enact real health care reforms, and start over. This law does not work.' Andre . Davis, a Senior Circuit Court Judge who wrote a concurring opinion on the Richmond court's decision, said he was not going to allow anti-Obamacare advocates to use the court to deny 'millions of Americans desperately-needed health insurance.' Davis admitted that the federal law was 'tortured' and it's construction was 'nonsensical' but it's 'manifest purpose, as revealed by the wholeness and coherence of its text and structure, could not be more clear.' In an attempt to explain the law in lay terms, Davis offered up an equally tortured pizza-based analogy. 'If I ask for pizza from Pizza Hut for lunch but clarify that I would . be fine with a pizza from Domino's, and I then specify that I want ham . and pepperoni on my pizza from Pizza Hut, my friend who returns from . Domino's with a ham and pepperoni pizza has still complied with a . literal construction of my lunch order,' he said. Judges on the D.C. case were Thomas Griffith, an appointee of President George W. Bush; A. Raymond Randolph, an appointee of Bush's father; and Harry Edwards, an appointee of President Jimmy Carter, who dissented. A lower court had ruled that the law's text, structure, purpose, and legislative history make 'clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges.' But the appeals court concluded the opposite - that the letter of the law 'unambiguously restricts' the law's subsidies to policies sold through exchanges established by the state. 'An Exchange established by the federal government cannot possibly be "an Exchange established by the State," ' Randolph wrote in a concurring opinion. 'To hold otherwise would be to engage in distortion, not interpretation. 'Only further legislation could accomplish the expansion the government seeks.' In a statement celebrating the D.C. court's decision, Sam Kazman, general counsel for the . Competitive Enterprise Institute, one of the organization's responsible for . funding the lawsuit said, 'The court’s decision puts an end to the power grab that the IRS rule represented. 'And more importantly it reaffirms the fact that we are a nation of laws enacted by Congress rather than rules issued by agenda-driven agencies,' Kazman added. 'Despite all the political calls for the country to 'get with the program and support Obamacare," it’s the Framers of the Constitution who have the last word.'
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Early learning programs may help children stave off obesity along with helping them do better in school, a new study suggests. Researchers from the University of Michigan looked at the BMIs of 19,023 children enrolled in Head Start - a federally-funded pre-school education service for low-income families. After a year, almost three-quarters of the 16per cent who were initially obese had a become a normal weight. Similar patterns were seen for overweight infants on the course. Early learning: Head Start programs have been shown to help poor children do better in school, but they may also help them fight obesity, a study suggests . This trend did not apply to children from Medicaid families and only slightly so with those from wealthier, privately insured families. Lead author Julie Lumeng says there a several factors of Head Start that could have a positive impact on a child's BMI. The quality of federally-regulated food provided may be higher than that in other child care facilities and pupils could have more opportunity for physical activity. Researchers say the potential benefits are important because obesity is so hard to treat and disproportionately affects low-income children. Dr. David Ludwig, a Harvard Medical School pediatrics professor and director of an obesity prevention center at Children's Hospital Boston, called the results 'encouraging'. Head Start is a federal pre-kindergarten program offered free in every state to low-income families. It often involves full-day preschool, focusing on school readiness, healthy eating and physical activity. Many programs provide children two daily meals, and give families health and nutrition advice. More than 1 million U.S. children participate. Nationwide, about eight per cent of preschoolers are obese, but the rate was mostly higher during the 2005-13 study. The recent piece of research was published online Monday in Pediatrics.
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Rep. Kevin McCarthy: Selling of Obamacare omits the reality that not everyone is paying .
Eight million "enrollees" doesn't equal 8 million paid customers, he says .
House Oversight Committee: Only 67% of enrollees had paid first month's premium .
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(CNN) -- President Barack Obama needs to learn a simple lesson: Saying something doesn't make it true. Though the President has claimed victory touting 8 million "enrollments" under his health care law, Americans cannot and will not wipe their memories clear of the botched rollout and continual failings of Obamacare. Democrats have sustained their tactic of telling everyone the health care law is working, despite overwhelming evidence to the contrary. Perhaps if they say it enough, their reasoning goes, it will become true. Well, Obama can have his own opinions and he can even assert falsehoods as truth, but he can't conjure fact. A new Washington Post/ABC News poll lays the facts out bare. The President's approval rating has slipped to 41% -- the lowest of his presidency in Post/ABC News polls. And only 37% approve of the President's handling of Obamacare's implementation. Despite the 8 million enrollees vaunted by the administration, a mere 44% of Americans approve of the President's signature law. This negative view of Obamacare persists even upon the assumption, parroted by many in the media, that the 8 million enrollment figure is accurate. However, the administration refuses to tell the American people any details about that number. How many of those "enrollees" are insured, having paid their first month's premium? How many were previously uninsured? How many were forced off their former coverage that they liked? What will the quality of coverage be for those who actually receive coverage? These questions have been met with deaf ears and defensive posturing. "The debate over the repeal of the law is over," the President said. "This law is doing what it's supposed to do -- it's working." The President has confused reported high enrollment numbers with success, disregarding that while millions may be signed up under threat of penalty, Americans are not sold on the failed law. To provide Americans answers to the unanswered questions, the House passed in January the Exchange Information Disclosure Act, which would require transparency from the administration regarding the Obamacare insurance exchange. Yet U.S. Senate Majority Leader Harry Reid has blocked the bill in the Senate, unwilling to give the American people access to information they have a right to know. In an attempt to get the data directly from the source, the House Energy and Commerce Committee sent letters in March to every insurance provider participating in the federal exchange requesting enrollment data, including the number of individuals who have paid their first month's premium or were previously uninsured. The results finally came in. As of April 15, only 67% of individuals and families that selected a plan had paid their first month's premium, data provided to the committee by every provider in the Federally Facilitated Marketplace shows. Insurers informed the committee that, by the same date, only 2.45 million had paid their first month's premium for coverage obtained through the FFM. The purpose of Obamacare, if the President remembers, was to insure, not merely to sign up, and it seems the President's enrollment numbers far surpass the number of insured. Of those who have enrolled and paid their premiums, some surely liked their health insurance, were renewing their health insurance and were booted off their health insurance because of Obamacare regulations. This law is not a success. Even before the Energy and Commerce Committee released their findings, Americans still viewed Obamacare unfavorably. In Tuesday's Post/ABC News poll, 47% of Americans reported that the ACA has raised their health care costs and 60% blame Obamacare for increasing costs nationally. Americans -- faced with Obamacare's burdens and disappointed with the president's handling of the economy, foreign policy, and more -- want a Republican-controlled Congress to act as a check on the president's policies by 53 to 39%. The debate is far from over, Mr. President. Instead of taking responsibility for the failed health care law, Obama prefers to call major problems "glitches" and forced re-enrollment of millions who were previously insured "success." He has claimed victory with a number that includes millions who remain uninsured. The first step toward fixing a problem is admitting the problem exists. Instead of taking responsibility for the disaster they've created and the unnecessary hardships they've imposed on the American people, Obama and the Democrats are trying to rewrite the facts. Unfortunately for them, facts don't work that way. Join us on Facebook.com/CNNOpinion.
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By . Matt Chorley, Mailonline Political Editor . PUBLISHED: . 05:03 EST, 18 December 2013 . | . UPDATED: . 20:58 EST, 18 December 2013 . More than 30 million people are in work for the first time in British history after a further fall in unemployment was revealed yesterday. David Cameron claimed that the Government’s economic plan ‘is working’ as unemployment fell by 99,000 in the three months to October, reducing the jobless rate from 7.6 per cent to 7.4 per cent, the lowest level since 2009. There were drops in almost every region outside the South – especially the West Midlands, the North West and the East. The unemployment rate fell to 0.74 per cent in the three months to October, down 0.3 percentage points on May to July . However, if the trend continues and . unemployment falls to 7 per cent, interest rates could be allowed to . rise by the Bank of England from their current record low of 0.5 per . cent. Millions of . homeowners would then see their monthly mortgage repayments start to . rise, although experts believe this is unlikely to happen before 2015. There are now 2.39 million out of work after the largest quarterly fall in more than a decade. The . number of people in work reached 30.09 million – an increase of 250,000 . over the quarter and of almost half a million compared with a year ago. There were 30.09 million people in employment aged 16 and over, up 250,000 from May to July 2013 and up 485,000 from a year earlier . For the first time 10 per cent of over-65s are still in work, the Office for National Statistics said . A record 1.1 million pensioners are still working into retirement years, official figures showed yesterday. With the employment rate jumping from 9.2 per cent a year ago to 10 per cent, this equates to another 109,000 OAP workers, according to the Office for National Statistics. Caroline Abrahams of Age UK said: ‘People are living longer, so many want to carry on working. However rock-bottom annuity rates combined with low interest rates on savings mean that others have no choice but to carry on working because they cannot afford to retire.’ Mr . Cameron said: ‘There should not be one ounce of complacency because we . have still got work to do to get our country back to work, and everyone . back in work means greater stability for them, greater ability to plan . for their future, greater help for their families. But the plan is working, let’s stick at it and get unemployment down even further.’ The . number unemployed for more than 12 months fell by 33,000 to 866,000, . the lowest rate for a year, while youth unemployment dipped by 19,000 to . 941,000. And the . number claiming Jobseeker’s Allowance fell by 36,700 in November to . 1.27 million, the thirteenth consecutive monthly reduction. The Prime Minister told the Commons 1.2 million more people were in work than when the Coalition came to power in 2010. But Labour leader Ed Miliband seized on figures showing a record 1.47 million were working part-time. ‘It’s . good our economy is creating more jobs, but the problem is too many of . them are part-time or low paid or insecure,’ he said. He . asked the Prime Minister: ‘Do you agree it is a matter of deep concern . that at the end of this year average wages are £364 lower than they were . a year ago and over £1,500 lower than they were at the general . election?’ Mr Cameron . replied: ‘I want to see more money in people’s pockets. The only way is . to keep on with our economic plan, keep cutting unemployment, keep taxes . down, cut the deficit so we keep interest rates down.’ The proportion of people working in the public sector has fallen to a new record, with most new jobs now in the private sector . This map shows the percentage of people in council areas claiming jobseekers allowance .
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Aviation fans are excited about the new, super-fast and stylish Gulfstream G650 .
Oprah, Ralph Lauren, Warren Buffett are said to be interested in the $65 million plane .
Businesses aim to make flying private more affordable .
Beyonce reportedly gave Jay-Z a Challenger 850 as a present .
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He's an 82-year-old "redneck hillbilly from west North Carolina" who's been scratching an itch to go fast his whole life. Finally, after decades of racing high-performance speed boats and winning world-class endurance car competitions, Preston Henn got his hands on the fastest executive jet on the planet: the G650. CNN caught up with Henn by cell phone between practice laps at Daytona International Speedway. "As long as the cars here don't crank up, we can talk!" he said. From then on, Henn -- Florida's flea market kingpin -- sounded like a giddy schoolboy as he told his story about how he put down a $1 million deposit in April 2012 to become the first person to buy a Gulfstream G650 -- "the hottest airplane out there" --- with its distinctive, sweeping, curving wings and its roomy, swanky interior. It made him "feel like a million dollars," he said gleefully. For a plane that costs $65 million, feeling like $1 million might seem like a disappointment. But you get the picture. The jet's top speed: 704 mph -- nearly the speed of sound -- makes it arguably the world's fastest civilian aircraft. "I was just amazed at how quick it took off," says Henn. "And then it just went ZOOM -- straight up. I just sat back and drank a glass of wine and enjoyed it." Henn knows speed. He's been around the track a time or two -- winning the checkered flag during the '80s at the 24 Hours of Daytona and the 12 Hours event at Florida's Sebring International Raceway. He doesn't compete anymore. But he still travels around the world to race his friends. A super-fast G650 that can fly 8,000 statute miles -- farther than just about any other executive class jet -- might save him a lot of time and hassles. Saving time and avoiding hassles are the main reasons the rich and famous want to fly private. Oprah Winfrey and Bill Gates reportedly each own a Bombardier Global Express. Tom Cruise is said to have a Gulfstream IV. Jackie Chan has an Embraer Legacy 650. And Jay-Z reportedly received a Bombardier Challenger 850 from his wife, Beyonce, as a Father's Day gift. But none of these planes can smoke the G650. Speed aside, it's got goodies like no other jet in its class. In the cockpit: an infrared night-vision system projects a pilot windshield display, increasing safety during landings. In the cabin: bigger 28-inch-tall windows and a ceiling height of 6-and-a-half feet. "if you fly from here to Tokyo, you have to fly with two crews," Henn explains. The G650 has "a complete crew quarters and restrooms and galley and everything they need. So it's a different breed of cat from what I'm used to." Speed flows through Henn's family bloodline, dating back to his boyhood in Western North Carolina. His father raced speed boats and cars when he wasn't running movie theaters. As an adult in 1963, Henn bought a drive-in theater of his own in Fort Lauderdale, Florida. During the next half-century, that drive-in grew into the Swap Shop -- an 88-acre flea market and cash cow. Of course, Henn's not the lone lover of the G650. Reportedly, the plane has caught Oprah's eye as well. Also said to be interested are Hollywood media mogul David Geffen, designer Ralph Lauren and financial wizard Warren Buffett. Keep in mind that "very few celebrities own their own jets," says Doug Giese of Embraer Executive Jets. Owning a plane is still expensive, even if you're rich. Giese says most celebs fly private by using brokers or buying memberships in fractional share programs. Brokers . New Hampshire-based PJS Private Jet Services Group brokers private jets -- hooking planes up with passengers for a one-time, up-front price. "Private aviation is becoming more commonplace because there are more programs now," says PJS CEO Greg Raiff, a 23-year top broker whose business includes several college and professional sports teams. "Thanks to the Internet, there are now 500 companies that can arrange something for you." Typically, an aircraft that can fly about 10 passengers round trip from New York City to Los Angeles could cost about $54,000. A smaller jet that seats about seven might cost $26,000 round trip from Philadelphia to Austin, Texas. Split the cost among the passengers, and it's comparable to the price of some luxury cruises -- and a possible option to celebrate an important life-event such as a golden anniversary or a retirement party. Fractional shares . Fractional share programs such as NetJet have been around for a while, offering travelers the less expensive option of buying shares of a jet instead of buying the whole thing. Share programs often come with "jet cards." Prepay tens of thousands of dollars onto your card in exchange for the convenience of dialing an 800 number and ordering a jet. "That was a real industry game-changer," says Raiff. "It made booking a jet as easy as ordering a pizza." One downside, says Raiff: You have to pay well in advance. Many jet cards start at a minimum of $100,000, but Delta Private Jets offers a more affordable $25,000 card. Give them at least 48 hours notice, and they'll get you a plane, says DPJ President Cyril Turner. One upside, says Turner: You're protected against rising prices. "People can lock in today's rate even if there are future increases," Turner says. "With the cost of Jet A fuel approaching $6 a gallon and a burn rate approaching -- depending on the plane type -- 200 gallons an hour, that gets pretty costly." Delta Private Jets charges about $5,000 per hour for jets seating up to eight people. Rates start at $9,800 per hour for jets seating up to 14 people. BlackJet offers an even more creative idea: "semi-private" flying, CNNMoney reports. BlackJet books business class planes from carriers such as JetSelect and sells the seats individually. A BlackJet seat on a Challenger 300 from New York to L.A. might cost around $3,500. CNNMoney: BlackJet offers private jet seats for less . Development of the G650 survived a crisis in 2011, when one of the jets crashed during a takeoff performance test in New Mexico, killing two Gulfstream pilots and two flight test engineers. Federal investigators blamed Gulfstream's testing process. During the investigation, Gulfstream temporarily shut down its G650 test planes. But 17 months later, the G650 received FAA certification. Now, Gulfstream has more than 200 customers waiting to get their hands on a G650. So far, only about a half dozen have been delivered to customers. As they roll out, plane spotters are on site, snapping photos and posting them online. "If you call Gulfstream and ask, 'When can I get a G650?' It's four or five years off," says Henn. Unfortunately for Henn, enjoying his G650 won't be an option for the time being. Ultimately, he says, he's a businessman, and the plane is an investment. He leased the jet back to Gulfstream so the company can use it as a demonstration model. "It's on its way to China," Henn says. "It's supposedly going to set a round-the-world record." There's a hint of disappointment in Henn's voice, above the sounds of revving engines at the Daytona track. "Sorry, it's time to get back to it," he explains. His Enzo Ferrari is beckoning. "I'm going to take my Enzo back out on the track, and then I'm finished for today," he says. "Then I'm going back to work."
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SACRAMENTO, California (CNN) -- Debbie Brown used to process medical and dental forms for a living before a debilitating illness forced her into early disability retirement and left her in a simple, no-frills wheelchair -- a rented wheelchair that has cost taxpayers about $1,200. CNN found a wheelchair similar to Debbie Brown's taxpayer-funded Medicare wheelchair for a fourth of the price. Brown says the public should be outraged about her wheelchair. Why? She says she could buy a comparable wheelchair on the Internet for $440 if she had the money. It sounded hard to believe that her rented, $1,200 taxpayer-funded wheelchair could be bought for $440, so CNN decided to check -- and instead found an even better deal. CNN went to the same company that charges Medicare for Brown's chair, Apria Healthcare, and bought it for $349 -- about a fourth of what taxpayers' have paid for Brown's rented wheelchair. That's why this slightly built woman, who lives modestly with her husband in Sacramento, California, believes her story and her wheelchair underscore the bigger problem of reforming health care in America. "Now you multiply that by how many people have a manual wheelchair, especially the baby boomers, it multiplies and multiplies and that money could be spent, even a hundred dollars out of that ... could give someone else the options that they need," Brown said. Reforming health care is at the top of the agenda in Washington. Everyone seems to agree this nation's health care costs and care availability are out of whack. Fixing it is another problem altogether. The Clintons failed. President Bush tried and got push-back as well. Now President Obama says he will do it because America can't put it off any longer. But he, too, is finding the way forward is not an easy path. Terms like "affordability," "single payer," "universal coverage," and an entire lexicon have become part of the health care buzz lingo. It is a complex issue with so many facets, so many lobbyists and so many special interests that one proposal seems to result in a competing proposal or proposals, or competing parties with concerns of their own. To illustrate how difficult it will be to overhaul America's health care, CNN decided to focus on one item in the nation's health care bill: a basic wheelchair. The wheelchair, in its own small way, CNN discovered, gives a glimpse of the contentious and complex debate swirling around health care reform. CNN interviewed Brown and her husband, Dennis Brown, at a community center in Sacramento. It is a place the couple visits frequently; it is free, offers programs, books, entertainment and features a park to stroll in. Debbie Brown sent an e-mail to CNN months ago, outraged over the continuing Medicare payments for a wheelchair that after four years of use is not in the best shape. It squeaks and is hard to navigate. Her ride in it is made more difficult because her husband, retired from the armed services, is also on disability and has trouble getting the wheelchair in and out of the car. On days he is not well, he sometimes has trouble pushing her. She showed CNN her bills and documented the fact that Medicare is still paying for the wheelchair after all these years. Medicare, with Brown's permission, confirmed the payments. Brown referred us to the Internet sites where comparable chairs -- and better ones than hers -- are listed for a fraction of the cost Medicare pays over time. The Browns have a limited income and say they cannot afford to buy one. That's when CNN decided to check Brown's story by buying one directly from Apria, based in Lake Forest, California. CNN paid cash for the chair after calling one of Apria's offices in an Atlanta, Georgia, suburb. Apria representatives told the CNN buyer that the chair Brown had is no longer made but offered the model that is being rented and sold as the replacement model for the one Brown still uses. When CNN asked Apria why it rented wheelchairs to the government for $1,200, but sold it to us for $349, the company said it was an "honest, unfortunate mistake." Lisa M. Getson, Apria executive vice president for government relations, said in a letter that CNN "should have been charged $949, in accordance with Apria's retail price...." "Since there's no comparable sale option in the Medicare system for such a wheelchair, our employee was confused by the sale request and charged the incorrect amount," Getson said. But the amount CNN paid is comparable to many other companies' prices on the Web. A quick check found two firms selling the Invacare Tracer SX5 for $289.00 and $249.00, including delivery. The manufacturer's suggested retail price is nearly $300 less than the corrected Apria price. Apria Healthcare said its costs are higher because of the stringent paperwork required by the government and because it provides 24-hour on-call service. Apria also points out that the cost of the wheelchair over the past four years has been less than 78 cents per day, a bargain because it allows the patient to remain at home. Wheelchairs are classified as durable medical equipment, along with such items as oxygen tanks and home infusion therapies. Apria is the nation's leading provider of home health care products and services, according to its Web site. The nation's $1 billion annual durable medical cost is only a fraction of Medicare's $444 billion budget last year, but one government officials believe it is time to rein in. That's where this story of the rented wheelchair gets caught between all the interests involved. Congress sets the rates Medicare pays and Congress determined that wheelchairs should be billed on a monthly rate for 13 months -- the renter has to pay 20 percent of the costs. After 13 months, a user can opt to own it -- if the user knows about the rule. Brown, who worked in claims processing for years, said no one ever told her the wheelchair that barely works for her now is hers if she wants it. Instead, now that her rental term has ended, she gets billed by Apria every six months for service. Medicare pays $63 and she pays $16. Jonathan Blum, one of Obama's picks to reform the Centers for Medicare and Medicaid Services, said it is simply wrong that a wheelchair an individual can buy for $349 has cost the government $1,200. He said the government has a plan to fix it: competitive bidding. "The good news is we have new authority right now to use competitive bidding to give the program much more flexibility," Blum said. But that's where the rubber -- or in this case, a wheelchair -- meets the road. Medicare has tried for years to get a bidding project off the ground. Last year, a bidding project was stopped after two weeks. The industry is flat-out against the government's proposed bidding project, contending it isn't competitive bidding at all. Opposing a bidding project is a well-funded lobbying industry, small- and durable-equipment businesses and special-interest groups who worry their ill clients won't be served if a bidding process as proposed by Medicare is put in place. So CNN loaded its wheelchair onto a Delta 757 to Washington and rolled it through the halls of Congress to find out why any representative -- not to mention 84 of them (the number who signed an April letter asking that competitive bidding be put on hold once again) would object to a plan that Medicare maintains will save taxpayer money. From Republican and Democrat alike, the answer was nearly identical as they sat for interviews next to CNN's $349 wheelchair. "Well, you know what? I am a big believer in competitive bidding," said Rep. Betty Sutton, a Democrat from Ohio, where Invacare, one of the biggest manufacturers of durable equipment, is based. "So at the outset I absolutely concur. But this program as it has unfolded, as it's been developed it really is a competitive bidding process that isn't competitive bidding." Rep. Marsha Blackburn, a Republican from Tennessee, agreed. "My hope is that as we look at health care reform that some of those that are working off of theory, if you will, and the federal system will slow down and we look at where the lessons learned should be and we will think long and hard before they move aboard a single-payer or mandated to restrict choice and restrict options for individuals," said Blackburn. The American Association for Homecare, which represents many in the durable-equipment industry, said the bidding program is anti-competitive. In a statement, the association said the bidding program would "sacrifice care for seniors and people with disabilities" as it "reduces patient access to and choice for medical equipment." The association said competitive bidding will "increase Medicare costs because it will lead to longer, more expensive hospital stays." But John Rother, the head of policy and strategy for the retiree advocacy group AARP, said what's really happening is business trying to protect profits -- in this case profits four times the cost of Brown's wheelchair rental. "It's an outrage," Rother said. "It's a ripping off of the taxpayer. It doesn't make any sense to have those kinds of expenses for products that could be bought for so much less." Medicare again plans to try to get its competitive bidding program started later this year in at least nine markets, although Blum said it is unlikely to go into effect until next year. As for Brown, her four-year-old wheelchair needs replacing. She's reluctantly applied through her doctor for a new one. CNN's Marcus Hooper contributed to this report.
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8 more states conditionally approved for health insurance exchange programs .
All the exchanges should be up and running by October 1 .
Changes in 2013 include preventative services, medical deductions and a cap on FSAs .
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Some 50 million Americans still lack health insurance. That will change for the greater majority when the Affordable Health Care Act, or Obamacare, as it's more commonly known, rolls out over the next couple of years. While the bulk of the law goes into place in 2014, you'll see a few changes this year. However, much of 2013 will be dedicated to health facilities and government offices getting ready for the larger changes coming down the road. On Thursday, the Department of Health and Human Services conditionally approved eight more states' plans to set up their own health insurance exchange programs. The conditional approvals mean a total of 19 states plus the District of Columbia have the initial thumbs-up on their plans. Two others, Arkansas and Delaware, have the go-ahead to run an exchange in partnership with the federal government. Decision day for states on health insurance marketplaces . States can decide to set up an exchange at any time, but the clock is ticking. States that plan to partner with the federal government need to do so by February 15. People not living in a state with an exchange have access to a federal program. All the exchanges are supposed to be up and running by October 1 of this year. In a conference call with reporters Thursday, Health and Human Services Secretary Kathleen Sebelius said she was encouraged by the progress states have made so far. "From the beginning, this process has been guided by our belief that states know their own needs better than anyone else," Sebelius said. "That's why we have worked so hard to give states the flexibility and resources to create and participate in marketplaces that work best for their citizens, and it's encouraging to see so many states moving forward to do just that." What these exchanges will do is give the uninsured a better chance to shop for insurance in a way that's supposed to take the mystery out of buying a plan. Think of it like an online travel site that pulls information from hundreds of companies, allowing customers to compare the costs of flights or hotels on one easy-to-read screen. Another advantage to the exchange may be a lower cost for health insurance, according to Jay Angoff. He is the former director of the Center for Consumer Information and Insurance Oversight at HHS, the office responsible for implementing Obamacare. "The key issue is not if the state or the fed runs the exchange," Angoff said. "The key is: Will it be a strong or weak exchange, and will it use the bargaining power that it has to standardize the benefit packages and establish a real competitive bidding process that can really drive down rates? "If the exchanges allow insurance companies to sell whatever they want, if (the state) doesn't negotiate or establish competitive bidding process, it's another case," he said. Obamacare to flesh-eating bacteria: Top 2012 health stories . Here are some other parts of Obamacare taking effect in 2013: . Preventative services . The federal government is sending more money to state Medicaid programs that offer preventative services for free or at little cost. Services include tests for high blood pressure, diabetes, and high cholesterol; many cancer screenings including colonoscopies and mammograms; counseling to help people lose weight, quit smoking or reduce alcohol use; routine vaccinations; flu and pneumonia shots; and others. Increased Medicaid payments . Doctors that take Medicaid patients get a pay raise. Starting January 1, Medicaid payments in every state were brought up to the same level Medicare pays doctors. Some experts say the Medicare rate is too low, but Medicaid paid even less. While it varies from state to state, primary care physicians see on average a 73% pay bump according to the Kaiser Family Foundation. A pilot program for bundling services . The law sets up a national pilot program that will encourage medical providers to coordinate patient care. Rather than have each service billed separately under Medicare, a flat rate would be paid for an episode of care. Justices won't block Obamacare's required emergency contraception coverage . Medicare tax increase . The wealthy face a 0.9% tax increase on the income they earn in excess of $200,000 (for couples filing jointly, it will hit those that make in excess of $250,000). This will help boost the Medicare trust fund. Medical device tax . A new 2.3% tax goes on the price of medical devices. This doesn't include hearing aids or corrective lenses, but does include devices like defibrillators, pacemakers, artificial joints and others. Medical deductions . Up until now, Americans got a tax deduction if all their total medical expenses added up to more than 7.5% of what they earn (minus deductions and exceptions). Those expenses now will have to add up to 10% or more for most tax filers. Cap on FSAs . Flexible Spending Accounts now have a cap. Up until now, employers set the limit on how much employees could set aside from their paychecks tax free to pay for medical expenses not covered by their insurance. The majority of companies set an FSA limit of around $5,000. The government is now limiting FSA's to $2,500. Health benefits spelled out . W-2 tax forms issued this year for wages paid in 2012 must now include a line on the form showing the benefit employees receive from their employer-sponsored health care. This is supposed to help you understand your benefits better and make health care spending more transparent.
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(CNN) -- Aiman Youssef can't catch a break with the weather. First, Superstorm Sandy leveled his home and devastated most of his neighborhood in the New York City borough of Staten Island. Now, an arctic blast that forecasters warn can have deadly consequences is gripping the region. A gas-powered heater and a tent was the only defense Youssef had late Thursday from the biting cold as he handed out jackets and sweaters at a makeshift supply depot he established to help his Midland Beach neighbors who, in some cases, are still struggling to get the power back on. "A lot of people have been coming so we give them jackets, we give them sweaters," he told CNN affiliate NY1. "Yeah, we are trying. We are trying our best to help them." But even as he helped his neighbors, he wondered how long he could keep the heater running at the tent where some of his neighbors were seeking shelter. Gas, he said, is expensive. Exposure to subfreezing temperatures has left at least three people dead in Wisconsin, Minnesota and Illinois, according to authorities. The National Weather Service forecasters urged caution early Friday as they warned "bitterly cold conditions" were expected to continue across much of the Midwest, Mid-Atlantic and Northeast into the weekend. Widespread light snow showers were expected across the upper Great Lakes region and across the Ohio Valley before moving later in the day across the eastern United States, according to the weather service. Forecasters at the National Weather Service predicted 1 to 4 inches of snow for areas in the Ohio Valley and Mid-Atlantic regions on Friday with the Carolinas and Tennessee Valley getting freezing rain beginning early in the morning. The snow was expected to move later in the day into the eastern United States. It was not good news in portions of New York and New Jersey, where homes destroyed by Superstorm Sandy in places such as Staten Island and Far Rockaway, Queens, lacked basic utilities needed to restore heat. With temperatures plummeting, warming centers were opened in New York, New Jersey, Pennsylvania and other areas, according to various emergency management officials. Schools shuttered, planes grounded . Dozens of school systems in Tennessee and some in northern Georgia said they would be closed. Schools in Raleigh, North Carolina, will close early, a spokesman with Wake County schools said. "We're going to make sure we put a plan in place so that the buses are rolling while it's still safe and the students are back home before weather becomes an issue," he told CNN affiliate WRAL. Road crews in North Carolina began salting major and secondary roads on Thursday in an attempt to avoid the possible repeat of a January 19, 2005, storm that stranded thousands, including 3,000 Wake University students on campus. Cindy Mease ended up sleeping on the floor of her office after a failed attempt to try to get home in that storm. "It was just a cluster. I mean, it was crazy out there," she told CNN affiliate WRAL in Raleigh. "(Cars would) hit a hill, and people would just start sliding back down." Travelers were already feeling the effects of the storm. A spokeswoman for Nashville International Airport said all inbound American Airlines flights for Thursday night and Friday morning were canceled. Though she had no official word from other carriers, Emily Richard said she anticipated they also would cancel flights. Caught in the snow . The snow in Pennsylvania played a role in the apprehension of suspected armed robbers, according to authorities. Investigators in Moon Township, just outside of Pittsburgh, tracked the footprints of three people and arrested them in connection with the robbery of a taxi driver at gunpoint after tracking their footprints in the fresh snow on Wednesday, police told CNN affiliate KDKA. The footprints in the fresh snow, according to police, led from the scene of the robbery to the front door of one of the suspects. CNN's Steve Almasy, Joe Sutton and Rachel Rodriguez contributed to this report.
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White House won't comment on payment statistics for Obamacare plans, relying on numbers of 'selected plans' as a proxy .
Centers for Medicare and Medicaid Services says its automated payment systems are not yet 'completed and fully tested'
Combined numbers from five states that publish those stats, including California and New York, indicate a 66 per cent payment rate .
If that percentage holds true nationwide, less than 2.2 million Americans are actually insured through Obamacare-created policies .
Deadline is Saturday for Americans who want coverage by March 1, but HHS warns about ill-timed tech outages on the deadline day .
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The White House and the Health & Human Services Department boasted Wednesday that 3.3 million Americans have signed up for private insurance coverage through marketplaces set up by the Affordable Care Act. But the administration still hasn't said a word about how many – or how few – of those signing up on the chronically ill healthcare.gov website have paid for their insurance, and are actually covered. A MailOnline analysis of publicly available totals from five states that run their own health insurance exchanges found that on average, just 66.5 per cent of enrollees in those states have paid premiums. If that proportion holds nationwide, the total number of Americans who are actually covered by private insurance because of Obamacare is less than 2.2 million. Bucking up the troops? President Obama has delivered speeches to groups of Obamacare enrollment advocates, but they haven't come through enough to breed widespread optimism about the Affordable Care Act . Political land mine: Chairman of the Council of Economic Advisers Jason Furman caught reporters' spears last week after a Congressional Budget Office report found that millions of jobs would be lost because of the president's health care law . At least five states provide such statistics on their own enrollees, showing that the numbers are, or ought to be, generally obtainable. A quarterly report published Wednesday by HHS announced that 'to date, 3.3 million persons have selected a Marketplace plan during the first four months of the initial open enrollment period, including 1.4 million in SBMs [state-based marketplaces] and 1.9 million in the FFM [federally facilitated marketplace].' But HHS conceded that its numbers 'include those who have paid a premium and those who have not yet paid a premium, regardless of when their coverage begins.' 'Enrollment is measured as those who selected a plan,' an HHS press release confirms. Similar disclaimers are offered some 20 times in the HHS report, both in its text and in accompanying graphs. The White House did not respond to a request for comment. Centers for Medicare and Medicaid Services spokesman Aaron Albright told MailOnline that his agency hasn't 'prioritized' reporting payment statistics, but plans to 'once our automated . payment systems are completed and fully tested.' At least five states, though, have already figured out how to do it. Press releases from health insurance exchanges in the states MailOnline sampled, including populous New York and California, show that 966,312 Americans have selected Obamacare plans there. Of those, 642,979 have paid for at least one month of insurance coverage. The state-by-state number are all over the map. Eighty-five per cent of Rhode Island's enrollees have paid first-month's premiums. That percentage was about 75 in California, 66 in Nevada, 59 in New York and a dismal 51.5 per cent in the state of Washington. No longer to blame: Obamacare's disastrous early months were blamed on a deeply flawed website, but failure at the March 31 finish line will fall squarely on the White House . Spin cycle: White House press secretary Jay Carney took a break Tuesday night from defending Obamacare, escorting his wife, ABC News reporter Claire Shipman, to the State Dinner in honor of French President Francois Hollande . The Obama administration said 25 per cent of the national enrollment total are Americans between the ages of 18 and 34, a far cry from the roughly 40 per cent economics say must enroll in order to avoid a 'death spiral' for Obamacare. The program's economics depend heavily on the presumption that a flood of younger, healthier people will contribute premium dollars in order to offset the cost of medical care for the old and sick. But with minimal fines – starting at just $95 this year – and widespread recognition that the IRS can only collect the penalty from Americans who are due an income tax refund, many young people are opting out. And early technical glitches and wholesale disasters plagued healthcare.gov as well as some of the state-based exchanges. Oregon's, for instance, is still not functional after a nearly five-month delay. Consumers have until Feb. 15 to select a plan if they want to be covered by March 1. But HHS quietly announced this week that on Saturday, the deadline day, a Social Security Administration computer system used to screen applicants for eligibility will be offline for long-planned annual maintenance.
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Washington (CNN) -- Feeding the hungry is the mission at Manna Food Center, a food bank in the suburbs of the nation's capital. This year, officials here are seeing more and more people who need their help. America's slow recovery from the worst economic crisis in decades has left families across the country struggling to put food on their tables, whether or not they have a job. With an unemployment rate stuck above 9 percent and millions of people working part-time jobs because they cannot find full-time positions, a record 45.8 million people -- one of every seven -- received food stamps from the government in May. Demand for this kind of federal help has risen in all 50 states. Manna helps people who get food stamps and thousands of others who do not qualify for them. The center says the number of people it serves has risen dramatically in recent years -- from 82,683 in fiscal year 2008 to 172,627 people in 2011. On a recent Friday morning, trucks arrived at the warehouse to drop off food the organization rescues from 40 area grocery stores, items that are reaching their sell-by dates but are still safe to eat. Volunteers worked to retrieve the deliveries from the loading docks, while others went from shelf to shelf filling boxes with goods or helping wheel them out to clients' cars. In the office, people began lining up around noon to receive the 70 pounds of fresh produce, canned goods and other items Manna hands out to each family every 30 days. Old and young. White, black and Hispanic. Some came alone; others brought their children or other family members. The economy is adding jobs, but not quickly enough to trickle down to the families the food bank serves. "Any growth that the economy is feeling, the folks here at Manna are not feeling that yet," said Natalie Corbin, Manna's development director, during an interview in the center's main warehouse in Gaithersburg, Maryland. "In fact, our numbers, from year to year have continued to trend upwards. So until we see a dramatic change in the economy, we're going to continue to see a dramatic increase in folks who are coming here. "We're expecting this winter to be the highest in history of Manna for folks needing food assistance." Even people who have jobs are having a hard time feeding their families. Eric Zevallos' mother had surgery a few months ago and is still recovering. Standing in line, he said his family was referred to Manna "because it's just me and my sister working, and right now it's kind of hard for both of us to provide for younger brothers that we have." "It's just a good program to help us out, get stable." The 25-year-old and his 18-year-old sister are working to feed themselves, their mother and their brothers, who are 9 and 16. "We've been rationing food and just scraping by," Zevallos said. It's not just local food banks that have seen an increase in demand. Feeding America, a national hunger-relief charity that helped feed 37 million people last year, says demand for food relief has risen 40 percent in the past four years. The organization has a network of 202 food banks that work with 61,000 agencies, including soup kitchens, churches and pantries, according to Eric Olsen, senior vice president of government relations. "Our food banks across the country will tell you stories of people who have been donors who now need food assistance, who have lost their jobs or suffered some other kind of health care trauma, for example, in the family where they just don't have enough to make ends meet," Olsen said. "People look at us as an emergency program, but more and more of our clients are coming to us on an ongoing basis. We are a regular part of how people get enough food to feed their families." Feeding America gets about 25 percent of its food from the federal government. Manna Food Center also gets government-subsidized food and relies on food drives, donations and state and federal emergency food grant programs. These organizations worry that the 12-member congressional committee established as part of the deal to raise the debt limit and tasked with recommending an additional $1.5 trillion in federal deficit-reduction measures over the next decade could target programs that provide government-subsidized food to these organizations or others that help the needy. That could increase demand at these food banks and strain their resources. "We really need both government and charity to make sure people in this country have enough to eat," Olsen said.
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Win a $1 million lotto jackpot? You would pay $450,000 to the IRS .
Anti-tax conservatives slam plan for lacking middle-class tax cuts .
GOP House majority makes serious consideration highly unlikely .
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By . David Martosko In Washington . PUBLISHED: . 12:20 EST, 29 April 2013 . | . UPDATED: . 12:24 EST, 29 April 2013 . Rep. Jan Schakowsky, a Democrat from Illinois, said she wants to raise the income tax rates paid by America's top earners to between 45 and 49 per cent, largely to justify more government spending. 'We need increased revenue,' she said in a statement, 'to eliminate the sequester, fund investments in education, public safety, and infrastructure and provide support for Americans striving to reach the middle class.' U.s. Democratic Congresswoman Jan Schakowsky wants top earners to pay more - a lot more - to the government at tax time, and justifies it with calls for revenue that would enable more spending . Billionaire Warren Buffett has said he would welcome a requirement to pay more in income tax. Obama has called for a 30 per cent 'Buffett Rule' tax plan. Schakowsky's would put rates far higher . Schakowsky said her Fairness in Taxation Act, introduced in the House of Representatives on Thursday, would put more money in the hands of the poor and the middle class. 'Our country faces an inequality crisis,' she insisted. America's top marginal tax rate sits at 39.6 per cent, a rate that's paid on income earned over $400,000 for single filers and above $450,000 for married earners who file tax returns jointly with their spouses. Schakowsky would add five new tax brackets, starting with a 45 per cent rate for income between $1 million and $10 million, and ending with 49 per cent for earnings after a taxpayer's first $1 billion in any tax year. That stratospheric top rate would only affect a handful of Americans, mostly those in the financial sector and many successful business entrepreneurs. Conservative push-back: Sen. Tom Coburn (L) isn't impressed with Jan Schakowsky's plan to hike tax rates for business leaders and entrepreneurs who earn more than $1 million, but the IRS would reap a windfall . While a Republican House majority makes it extremely unlikely that Schakowsky's bill would receive serious consideration - much less a vote - Senate Republicans also slammed the idea. 'Instead of raising rates on anyone we should lower rates for everyone by getting rid of special interest subsidies in the tax code, said John Hart, Communications Director for Senator Tom Coburn, an Oklahoma Republican. Hart also pointed out Schakowsky's legislation doesn't balance a tax increase on the rich with tax cuts for lower-income earners. Those Americans, he said, are already frozen out of the behind-the-scenes lobbying efforts mounted by large corporations, effectively freezing them out of any chance to see their taxes lowered. 'Tax earmarks for Hollywood movie producers, politically-connected "green" energy companies, and professional sports leagues are effective tax rate increases for lower income Americans who can't afford to hire lobbyists,' Hart told MailOnline. 'True tax reform will create shared prosperity rather than shared misery.' Grover Norquist, the anti-tax crusader . whose Americans For Tax Reform pressures lawmakers from both major . parties to pledge that they won't vote for tax increases while in . office, was angered by the idea of a new tax increase from the left side . of the aisle. Grover Norquist, a conservative tax activist and president of Americans for Tax Reform (R), has raised eyebrows with his endorsement of immigration reform laws but has remained steadfast on his signature issue: preventing tax increases . 'Congresswoman Schakowsky's collection of tax hikes - just four months after Obama's income and social security tax hikes - reminds us that Democrats' answer to all questions is "raise taxes,"' Norquist told MailOnline. 'And after that, "raise taxes, again." This never ends.' A senior Republican aide told MailOnline that the Democrats' 'incessant drumbeat to hike taxes' would ultimately 'kill off millions of jobs in this country, and that's really their biggest sin.' 'For all the Dems' talk about compassion,' he added, 'I just don't see it.' The aide spoke on condition of anonymity because he is not authorized to speak about pending legislation. Daniel Patrick Head, the press secretary for Wyoming Republican Sen Mike Enzi, also vented about Schakowsky's tax-increase plan. 'It's easy to say people should pay more in taxes when you aren’t the one that is paying them,' Head told MailOnline. 'The fiscal cliff plan provided hundreds of billions of dollars in tax increases earlier this year. Senator Enzi would like to see a focus on encouraging growth through simplifying the tax code, broadening the base, and lowering the rates instead of always trying to raise people’s taxes.' 'The government has to stop its borrowing and spending,' he added.' President Barack Obama has similarly called for higher tax rates on upper-income earners, insisting that they 'pay their fair share.' He has also called for continued year-on-year increases in federal government spending . In January President Obama's administration allowed a payroll tax holiday to expire, restoring older rates for Social Security and Medicare withholding and costing taxpayers an additional 2 per cent of their income up to $110,100. A White House spokesman did not respond to a request for comment about whether the president supports Schakowsky's plan to expand the tax base even more. Republicans in the House continue to project a united front on their leaders' goal of reforming the U.S. tax code. 'The (GOP) conference will unite around tax reform,' House Majority Whip Kevin McCarthy told The Washington Post on Saturday. 'The window is now.' Dave Camp, a Republican who chairs the powerful House Ways and Means Committee, added that conservatives want to scrap the entire tax code and start from scratch, with the goal of keeping just two income tax rates in place - with a 25 per cent ceiling. 'We're not going to take the current code and see what comes out,' Camp told the Post. 'We're going to take a blank piece of paper and see what goes back in.' Co-sponsors of Schakowsky's bill include Reps. John Conyers of Michigan, Donna Edwards of Maryland, Luis Gutierrez of Illinois, Barbara Lee of California, Betty McCollum of Minnesota and John Yarmuth of Kentucky. All are Democrats with liberal voting records.
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The Supreme Court's decision Thursday to uphold the Affordable Care Act means that the predictions about how it will affect Americans remain in place. Obama: Supreme Court ruling on health care a victory for all Americans . The court did rule that a part of the law involving Medicaid must change. The law calls for an expansion of eligibility for Medicaid, which involves spending by the federal government and the states. The law threatens to remove existing Medicaid funding from states that don't participate in the expansion. The high court said the government must remove that threat. Several groups that follow the health care law closely said they were concerned about the high court's ruling on the Medicaid portion of the law. Read the court ruling (.PDF) Here are some highlights: . The uninsured . The decision leaves in place the so-called individual mandate -- the requirement on Americans to have or buy health insurance beginning in 2014 or face a penalty -- although many are exempt from that provision. In 2014, the penalty will be $285 per family or 1% of income, whichever is greater. By 2016, it goes up to $2,085 per family or 2.5% of income. Health care exchanges, which are designed to offer cheaper health care plans, remain in place as well. American Cancer Society CEO John Seffrin said his organization was looking at the ruling on Medicaid, and is "concerned that the decision may limit the expansion of quality coverage to some of our nation's most vulnerable citizens." The group Health Care for America Now, which spent tens of millions of dollars on ads supporting the health care plan, said it was "disappointed" and will work to make sure no states "choose to exclude the lowest-income uninsured adults from their Medicaid programs." Medicaid Health Plans of America, the trade group representing Medicaid health plans, praised the court "for keeping in place key elements of this historic legislation" and said it remains "committed to a strong partnership with the states and CMS (Centers for Medicare and Medicaid Services) to find a way to cover this population in need." Rep. Phil Gingrey, R-Georgia, a physician who staunchly opposed the health care law, told CNN he believes many who would have received Medicaid will now enter the health care exchanges, which offer subsidized plans. That, he argued, could cost taxpayers billions of dollars across the country. Breaking down the court's decision . The insured . Because the requirement remains for people to have or buy insurance, the revenue stream designed to help pay for the law remains in place. So insured Americans may be avoiding a spike in premiums that could have resulted if the high court had tossed out the individual mandate but left other requirements on insurers in place. Young adults . Millions of young adults up to age 26 who have gained health insurance due to the law will be able to keep it. The law requires insurers to cover the children of those they insure up to age 26. About 2.5 million young adults from age 19 to 25 obtained health coverage as a result of the Affordable Care Act, according to the U.S. Department of Health and Human Services. Two of the nation's largest insurers, United Healthcare and Humana, recently announced they would voluntarily maintain some aspects of health care reform, including coverage of adult dependents up to age 26, even if the law was scrapped. People with pre-existing conditions . Since the law remains in place, the requirement that insurers cover people with pre-existing medical conditions remains active. The law also established that children under the age of 19 could no longer have limited benefits or be denied benefits because they had a pre-existing condition. Starting in 2014, the law makes it illegal for any health insurance plan to use pre-existing conditions to exclude, limit or set unrealistic rates on coverage. It also established national high-risk pools that people with such conditions could join sooner to get health insurance. As of April, a total of only about 67,000 people were enrolled in federally-funded pools established by the health care law, according to the National Conference of State Legislatures. More than 13 million American non-elderly adults have been denied insurance specifically because of their medical conditions, according to the Commonwealth Fund. The Kaiser Family Foundation says 21% of people who apply for health insurance on their own get turned down, are charged a higher price, or offered a plan that excludes coverage for their pre-existing condition. Photos: Who is John Roberts? All taxpayers . No matter what the Supreme Court had decided, it would have been a mixed bag for all Americans when it comes to federal spending. There is heated dispute over what impact the health care law will have on the country over the long term. The federal government is set to spend more than $1 trillion over the next decade to subsidize coverage and expand eligibility for Medicaid. It is not immediately clear how the high court's ruling on the part of the law dealing with the expansion of Medicaid eligibility could affect spending. The nonpartisan Congressional Budget Office estimated that the law could reduce deficits modestly in the first 10 years and then much more significantly in the second decade. The CBO said a repeal of the mandate could reduce deficits by $282 billion over 10 years, because the government would be subsidizing insurance for fewer people. But the nation faces costs in various ways for having people who are uninsured. The Urban Institute's Health Policy Center estimated that without a mandate, 40 million Americans would remain uninsured. Meanwhile, the Flexible Spending Accounts that millions of Americans use to save money tax-free for medical expenses will be sliced under the law. FSAs often allow people to put aside up to $5,000 pre-tax; as of 2013, they were to face an annual limit of $2,500. Opinion: Are voters ready to move on? Small business owners . The rules and benefits small business owners face as a result of the health care law remain in place. As CNN has chronicled, the law brought a mix of both. The director of the National Federation of Independent Business is one of the plaintiffs who pushed the court to strike down the law. Meanwhile, a group called Small Business Majority fought to protect the law, saying its loss could be a nightmare. As of 2014, under the law, small firms with more than 50 full-time employees would have to provide coverage or face expensive fines. All Americans, in lesser known ways . The massive health care law requires doctors to report goodies they get from medical supply companies; demands more breastfeeding rooms; requires all chain restaurants to list calories under every menu item, and includes numerous other provisions, which now remain in place. Doctors and other health care providers . Health care providers have already begun making changes based on the 2010 law, and in preparation for what will go into effect in 2014. Those plans continue. In the short term, doctors avoid "chaos" that may have resulted from the law suddenly being dropped or changed, according to Bob Doherty, senior vice president of governmental affairs at the American College of Physicians, who wrote a blog post on the website kevinmd.com this spring. Medical groups have disagreed over the law. How the Supreme Court Justices voted . Opinion: A health care victory that's only a start . Ruling plays into campaign narrative for both sides .
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Most economists aren't worried about the dip and see it as a temporary contraction because of the harsh weather .
Healthcare spending shrank 0.2percent as Obamacare of implemented .
Experts predict 3percent growth for the second-half of the year .
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By . Associated Press . and Daily Mail Reporter . Americans went into hibernation during the bitter polar vortex winter this year - and the U.S. economy slumbered along with them, dropping a stunning 2.9percent in the first quarter of 2014. The sharp drop from January through March is the biggest dip since the Great Recession shaved 5.4percent off the Gross Domestic Product five years ago. It is one of the biggest contractions outside of a recession is recent history. Economists believe most of the contraction was the result of a short-lived slowdown in spending due to an abnormally long and and harsh winter that disrupted shipping, shut down factories and kept consumers away from shopping malls and auto dealerships. The first-quarter contraction reported Wednesday by the Commerce Department was even more severe than the 1 percent annual decline it had estimated a month ago. Besides the harsh winter, much of the downward revision reflected a drop in health care spending. Another factor was a bigger trade deficit than initially estimated. Drop: The economy shrank by a stunning 2.9percent in January through March of this year - thanks largely to a terrible winter . Most analysts also foresee the economy expanding at a healthy rate of around 3 percent in the second half of this year. Reports on consumer spending, manufacturing and business investment have shown a solid rebound this spring. Orders for big-ticket manufactured goods excluding military hardware and for core capital goods, a proxy for business investment, rose strongly in May, a report Wednesday showed. 'We have ample evidence that the first quarter was just a temporary setback for the economy, and we are climbing out of the hole in the current quarter,' said Stuart Hoffman, chief economist at PNC Financial. Last quarter's 2.9 percent annual decline in economic activity, as measured by the gross domestic product, followed a 2.6 percent gain in the fourth quarter. It was the weakest showing since the economy shrank at a 5.4 percent annual rate in the first quarter of 2009 in the midst of the Great Recession. Most of the downward revision from the government's previous estimate of a 1 percent annual decline reflected a change in the estimate of spending on health care. The government had previously estimated a strong gain in this category reflecting implantation of provisions of the Affordable Care Act. But data derived from an actual survey showed the government's estimate was far too optimistic. Health care spending, instead of rising at a 1 percent rate, had fallen in the first quarter at a 0.2 percent rate. A long, nasty winter kept many shopper home, shut down factories and derailed deliveries in the first quarter of 2014 . Analysts say solid hiring, growth in manufacturing and surging auto sales are contributing to a stronger economy. A stumbling housing recovery has been a concern. But even there, recent data on home sales and construction have been encouraging. 'The larger contraction in GDP in the first quarter is not a sign that the US is suffering from a fundamental slowdown,' said Paul Dales, senior U.S. economist at Capital Economics. If economists are correct that annual growth will reach around 3 percent in the second half of the year, it would be a sharp improvement from the 2 percent annual pace of the first five years of this subpar economic recovery. 'We should have a much better second half this year and a much better 2015 than 2014,' said Mark Zandi, chief economist at Moody's Analytics. Zandi said he's forecasting growth of 3.5 percent to 4 percent in 2015. If he's correct, that would be the strongest year since the economy grew 3.8 percent in 2004. 'In past recoveries, we have always gotten a year of very strong growth,' Zandi said. 'I think we will get that in 2015,' helped by a long-awaited improvement in wage growth. Of course, the optimistic projections could prove too rosy. Analysts see risks to their forecasts, primarily the possibility that tensions in the Middle East could cause oil prices to surge given the deteriorating crisis in Iraq. Surging energy prices have preceded earlier economic slowdowns, including the most recent recession.
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Editor's note: Ted Epperly, M.D., a family physician in Boise, Idaho, is president of the American Academy of Family Physicians, which represents more than 93,000 physicians and medical students nationwide. He spent 21 years in the U.S. Army, including service as a family physician, chief of a Mobile Army Surgical Hospital emergency room during Desert Storm and Desert Shield, and deputy commander of an Army medical center. Ted Epperly says recruiting more primary care doctors would improve access to quality health care. (CNN) -- Clayton Christensen, Jason Hwang and Vineeta Vijayaraghavan are right about one thing in their CNN commentary titled "We don't need more doctors." America's health care system is broken. It requires significant reform if patients are to have access to convenient, affordable and -- most importantly -- high-quality care that results in good outcomes. But they have missed a central point. We need more primary care physicians now and we will need even more in the future as the baby boom generation ages. If Americans are to see meaningful health care reform, they must have a primary care doctor to whom they can turn for everyday problems: annual physicals and preventive care, diagnosis and treatment for common illness, and diagnosis and treatment of complex, chronic conditions, referral to subspecialists, and coordination of care provided by a team of professionals. Our current system has a serious and growing shortage of these primary care physicians. Today, only 30 percent of physicians provide primary care and 70 percent subspecialize in a single organ system or disease. We need a system in which patients get the right kind of care at the right time in the right place by the right type of provider. They need health services that provide not just convenient hours for minor health problems, but also medical expertise that ensures consistent, ongoing care; accurate diagnoses of symptoms; coordination with pharmacists, other specialists and allied health professionals such as physical therapists; consistent follow-up; and convenience. All at an affordable cost. Several health reform proposals set forth by President Obama and Congress would move federal policy in that direction. How? They incorporate convenience, efficiency, continuity of care and access to a system that relies on the patient-centered medical home -- a concept in which physicians coordinate care with a team of health professionals, offer evening and weekend office hours, and use electronic communication with patients and members of the health care team. But this concept won't be fulfilled unless we have health reform that increases the number of primary care physicians. Right now, America has a current and worsening shortage of primary medical care. Christensen, Hwang and Vijayaraghavan contend that increasing the number of physicians also leads to "greater intensity of care, but not better health outcomes." But their argument leaves out a major caveat. Although a greater number of subspecialists does increase the intensity, number and cost of services, research by Barbara Starfield at the Johns Hopkins University Bloomberg School of Public Health consistently demonstrates the opposite occurs in communities with more primary care physicians, particularly family physicians. Starfield concludes that an increase of one primary care physician per 10,000 population resulted in a reduction of 34.6 deaths per 100,000 population at the state level. Katherine Baicker, professor of health economics at Harvard School of Public Health, and Amitabh Chandra at the Harvard Kennedy School of Government confirm these findings. Their research shows that increasing the number of primary care physicians results in a significant increase in the quality of health care and a reduction of cost to patients. However, increasing the number of subspecialists was associated with higher costs and poorer quality. At issue, then, is not the total number of physicians, but the number of family physicians and their primary care colleagues. Demographics, an aging population and resulting increased demand for services will require a significant increase in the number of these physicians. Given the long-term process required to train primary care physicians, we will continue to struggle with a shortage of primary care physicians, and that shortage will affect patients' access to care. Family physicians now are working to fill some of those gaps, according to a 2008 survey by the American Academy of Family Physicians. The survey found 42 percent of respondents offer extended office hours and 29 percent provide open access or same-day scheduling. Moreover, 36 percent offer Web-based health information, 32 percent (up from 10 percent two years ago) prescribe medications by e-mail, and 21 percent (up from 18 percent two years ago) offer e-mail interactions. In short, despite the financial disincentives and other barriers in the current system, family physicians are working to meet patients' needs for convenience and access. They are improving this convenience and access with the help of nurses and nurse practitioners, who are excellent sources of care when patients have a known set of conditions and diagnoses that are amenable to treatment protocols. Likewise, walk-in clinics can fill the access gap when patients have an acute problem that requires a treatment that can be spelled out by an accepted protocol. However, even these clinics rely on an adequate number of primary care physicians. Most walk-in clinic staff realize that convenience should not trump quality or continuity, and most will refer patients to a primary care physician for follow-up and ongoing care. Again, without an adequate number of primary care physicians, these patients will have only partial access to the care they need. Family physicians and other primary care providers are part of the solution, not part of the problem. It is important at this critical time of restructuring the health care system to understand clearly what we are trying to accomplish. What we are building is a high-quality, accessible health care system that increases patient satisfaction and health care outcomes while we decrease cost and ethnic disparities. This is what a primary-care based health system will deliver. This is why President Obama and Congress aim to rebuild the U.S. health care system around primary care. This is why we need more primary care physicians. The opinions expressed in this commentary are solely those of Dr. Ted Epperly.
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Centers for Medicare and Medicaid Services, same agency that runs Healthcare.gov, flunks test .
Government Accountability Office found it's virtually impossible for consumers to get accurate, reliable information .
Biggest lapse is in showing taxpayers what out-of-pocket costs will be for various services including nursing and hospice care, surgeries and MRIs .
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With many seniors facing high medical bills, a congressional investigation has found that federal government websites meant to give Medicare patients basic consumer tools instead fail to provide adequate information on out-of-pocket costs, and even quality of care. The nonpartisan Government Accountability Office found that Medicare lacks clear procedures for getting useful information to consumers. The report, obtained by The Associated Press before its public release, finds 'critical weaknesses' in five consumer-information websites run by the Centers for Medicare and Medicaid Services that seek to inform how well hospitals, nursing homes, physicians and other Medicare providers are doing. The GAO said a confusing layout, data gaps and lack of customized information make it virtually impossible for consumers to get the information they need and won't be fixed anytime soon, even as the federal government plans new websites on the quality of hospice, inpatient rehabilitation and long-term care. It is the latest report to detail problems in the government's health care websites. Ready? Set? Good luck: Medicare beneficiaries are often left to fend for themselves because government websites confuse the elderly and fail to provide reliable information about health care choices . Tough milestones: Medicare covers portions of everything from hip surgeries to hospice care, and most American seniors are getting precious little help sorting it out . The Obama administration has already grappled with the technology meltdown experienced last year by Healthcare.gov as well as glitches in the Sept. 30 rollout of data on payments doctors receive from drug companies. 'The GAO report reveals that there is a need to empower patients with better information on health care price and quality,' said Sen. Pat Toomey of Pennsylvania, home to the nation's fourth-largest share of residents 65 and older, at roughly 1 in 7. Only Florida, West Virginia and Maine have higher percentages of seniors. 'Armed with the facts, it will be possible for consumers to obtain high quality care and drive down costs,' he said. The GAO cautioned that due to a lack of clear policies or performance measures, CMS will likely continue to have 'limited effectiveness in conveying relevant and understandable information on cost and quality to consumers.' It cited a growing need for the information due to rising health care costs. Jim Esquea, an assistant secretary at the Health and Human Services Department, concurred with the recommendations. He wrote that CMS, an agency of HHS, was planning to expand its star ratings, already in use on its 'Nursing Home Compare' website. He also said HHS was committed to providing detail on estimated out-of-pocket costs 'to the extent feasible' and had developed many internal procedures, although GAO said it had found no evidence that was the case. In the study, GAO compared data on CMS' websites with that of third-party vendors providing similar information on gallbladder surgery, magnetic resonance imaging, or MRIs, of the lower back and maternity care. They also examined documents and interviewed company and government officials and experts on best practices. In all, the audit found wide variation in charges for the same medical procedures in the same geographic area regardless of quality – information it said was not readily available on the CMS sites. Esquea said there were challenges in providing cost information. In addition, the CMS sites often lacked critical data on quality of care, such as patient-reported outcomes on common procedures such as a colonoscopy, according to the report. Consumer Reports toaster ratings for life-and-death decisions: The government boils down nursing homes' critical performance metrics to 'star' ratings like those given to small appliances . Nursing home or warehouse? What will it cost after coverage pays its share? Government websites that are supposed to help consumers make difficult end-of-life choices often fall far short of expectations . In interviews with the GAO, CMS officials said they plan to add patient-reported outcomes on a number of medical procedures. The investigators cited a likelihood of continuing problems despite the government's 2011 pledge under the Affordable Care Act to provide consumers complete and understandable information. While CMS has said it will make improvements, GAO pointed to limitations due in part to resistance from medical providers. In recent months, the American Medical Association has opposed Medicare's release of billing records for 880,000 physicians, citing the danger of data being reported inaccurately or taken out of context; much of that information was eventually released. 'People deserve to know information on the cost and quality of the health care services they need,' said New Hampshire Democratic Sen. Jeanne Shaheen, one of the lawmakers who requested the report. 'The new GAO study makes important recommendations on how to better empower consumers, and I look forward to working with this bipartisan group of senators to establish more transparency.
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By . Daily Mail Reporter . PUBLISHED: . 19:15 EST, 7 March 2014 . | . UPDATED: . 19:16 EST, 7 March 2014 . The new competition watchdog is to investigate the banks’ failure to lend to small businesses. It will be the first major probe undertaken by the Competition and Markets Authority, which takes over from the Competition Commission and the Office of Fair Trading next month. It marks a victory for the Daily Mail’s ‘Make the Banks Lend’ campaign launched in July 2010 to highlight the plight of small firms, which need money to grow. The Competition and Markets Authority will look into banks' failure to lend to small businesses (library image) The OFT began a review of small business lending last year, amid concerns that healthy firms were being starved of credit. Banking industry insiders confirmed yesterday that it had found sufficient evidence of wrongdoing to recommend a full-scale inquiry by the CMA. The investigation will pile more pressure on the High Street giants. About £42billion of cheap money has been made available in lending schemes over the past 18 months but although households have benefited from cheap mortgages, lending to small firms continues to fall. Between April 1 and December 31 last year, firms made repayments that totalled £1.32billion more than they received in loans.
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Mara Schiavocampo called a helpline and was left on hold for 20 minutes before giving up .
Sites for at least 25 of the 36 exchanges open today posted errors as the marketplaces opened at 8am Eastern .
Officials blamed high traffic volume - New York's exchange alone got two million visits just two hours after opening .
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MSNBC anchor Mara Schiavocampo had a rocky experience trying to sign up for Obamacare as the insurance marketplaces opened up to a rocky start Tuesday. The long anticipated rollout came despite the government shutdown and the snags are expected to contribute to a slow start to enrollment and give increased ammo to Obama's Republican foes. At least 25 of the 36 federally-run, state-specific marketplace sites posted error messages soon after open enrollment began at 8am, so Schiavocampo was far from alone. Waiting: Mara Schiavocampo ran into difficulties as she tried to sign up for the newly launched health-care exchanges. She gave up trying to sign up for a plan after 15 minutes online and about 20 minutes on the phone . Schiavocampo described her experience in real time as she created an account at HealthCare.gov. She created a username and password and at first the process was typical. 'Pretty much like it would be for any other website,' she said. After she created her account, Schiavocampo moved on to step two in the process, where she entered her and her family's information. It was at step three, when the anchor would have chosen from among Obamacare plans, when she hit a snag. Glitches: Heavy Internet traffic and system problems plagued the launch of the new health insurance exchanges Tuesday morning . 'I keep getting this error page,' she said, 'It won't let me progress.' After two phone calls and a combined 35 minutes trying to enroll in Obamacare, Schiavocampo gave up. 'If I were signing up for myself, this is where my patience would be exhausted,' she said. The website was showing signs of trouble handling the volume of consumers on October 1, the first day of the . six-month open enrollment period. Federal officials are aware of the website problems and say they are working to address it as quickly as possible. U.S. Health and Human Services spokeswoman Joanne Peters . says officials "have built a dynamic system and are prepared to make adjustments . as needed and improve the consumer experience." The site for Maryland, which is running its own exchange, . displays a message saying 'We open at 12:00 noon on October 1st.' Other callers to the federal call center where consumers can get . help by telephone have reported long wait times. The federal government also announced delays for small business and Spanish-language signups. System down: Screenshot of the HHS website for the Obamacare exchanges . The biggest expansion of society's . safety net since Medicare is now in the hands of consumers, and most of . their concerns don't revolve around ideology and policy details. People want to know if they can afford . the premiums, if the coverage will be solid, where the bureaucratic . pitfalls are and if new federal and state websites will really demystify . shopping for health insurance. Full answers may take months. Open for business: Obamacare's online insurance marketplace, pictured, went live at midnight. You can find it at www.healthcare.gov/marketplace . People who don't have access to job-based health insurance can start shopping right away for subsidized private policies. Or they can wait to sign up as late as December 15 and still get coverage by January 1. Consumers also could run into problems getting their right subsidy amounts. People with complicated tax returns and extended families living under the same roof could find they need personal assistance to work out the issues. Referrals to state Medicaid programs might go smoothly in some states, not so well in others. 'As this unveils, it is going to be very clear that everything can't be done on a computer,' Christine Ferguson, director of Rhode Island's marketplace, said in an interview prior to the launch. 'But by Day 60 to 120, and the year after that, it's going to get a lot more user-friendly and effective.' Message: Obama recorded a video message for U.S. military personnel in which he avoided blaming the GOP, saying only that 'Congress has not fulfilled its responsibility' Eventually, at least half the nation's nearly 50 million uninsured people are expected to get coverage through the Affordable Care Act, either through subsidized private plans sold in the new markets or an expanded version of Medicaid in states accepting it for low-income adults. Immigrants in the country illegally will be the largest group remaining uninsured. People who do have access to employer-based plans will also see changes. Starting January 1, virtually all Americans will have a legal obligation to carry health insurance or face fines. Passing up the company medical plan in exchange for a bigger paycheck may no longer be an option. But employees who lose their jobs, entrepreneurs starting their own businesses and people in between school and work could have an easier time getting coverage. Also as of January 1, a pre-existing medical condition will no longer be a barrier to getting health insurance. A partial government shutdown, driven by Republican opponents of increasing the federal role in health care, will not stop what they call 'Obamacare.' Core provisions and benefits are shielded from annual budget battles. If other government services are shut down, the health care overhaul can largely keep going - much like Social Security and Medicare. 'Shutdown or no shutdown we're ready to go,' Health and Human Services Secretary Kathleen Sebelius said Monday. Federally operated markets in 36 states open at 8 a.m. Eastern time. The remaining states are running their own markets. Shutdown: John Boehner, pictured, and President Obama squared off in a proverbial sparring match that ended up in a government shutdown on Monday night . Polls show the country remains divided over the law, with opponents outnumbering supporters. Nonetheless, a Kaiser Family Foundation survey released over the weekend found 56 percent of Americans disapproved cutting off funding to expand coverage for the uninsured, as congressional Republicans have done. The poll also found people in a fog about what the law means for them. Nearly three-fourths of the uninsured were unaware of the new insurance markets opening to serve them. In states not expanding Medicaid, millions of uninsured people below the federal poverty level will likely be shut out of coverage. That's the case in Texas and Florida - both of which have large uninsured populations - and in many, but not all, Republican-led states. It's because under the law, people below the poverty line - an individual making $11,490, a family of four $23,550 - can only get the new coverage through expanded Medicaid. And the Supreme Court gave states the right to opt out. The other arm of 'Obamacare's' coverage expansion - subsidized private insurance through the new markets - is mainly geared to uninsured people in the middle class. The administration is hoping to sign up 7 million the first year. Young, healthy adults are prime customers, since they'll help offset the cost of caring for sicker people sure to sign up once insurers can no longer reject them. Kevin Maass of Fairfax, Virginia, has been uninsured for more than a year, since he turned 26 and could no longer stay on his parents' insurance. He's got a background in statistics that he hopes to apply to criminology, but he's been working temporary jobs while looking for permanent employment in law enforcement. 'Not having health insurance has made me a little bit more cautious,' said Maass. 'I like to snowboard, but it's given me second thoughts. Heaven forbid I should break my wrist or my arm.' Maass thinks he might be able to afford $100 to $200 a month for insurance. Early indications are that he'll find plenty of options. However, plans with the lowest premiums will have high deductibles and copayments, which means sizable out-of-pocket costs if he gets sick or has an accident. Nonetheless, Maass says he's definitely planning to check out the health insurance market. 'My parents have been pushing for me to get health insurance,' he said. 'I might as well at least get something rather than pay (a fine) to not have anything.'
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(CNN) -- Vehicles began streaming across the San Francisco-Oakland Bay Bridge early Tuesday -- a day ahead of schedule -- after the completion of repairs to a crack in the structure's east span. Commuters make the trek across the San Francisco-Oakland Bay Bridge after it reopened Tuesday. Commuters began driving over the bridge around 6:40 a.m. PT (9:40 a.m. ET), shortly after Randy Iwasaki, director of the California Department of Transportation, announced the reopening at a news conference. "The bridge has been inspected, and it is safer than when we closed it on Friday," Iwasaki said. Over the weekend, crews began repairing a "significant crack" that was found on the east span of the bridge during a planned closure for another project. The target time for reopening had been early Wednesday, but crews worked nonstop overnight to repair the eyebar beam, Iwasaki said. He thanked motorists for being patient. "I know it's been trying. I received a few e-mail notes," the official said. Iwasaki said some closures or detours near the bridge would remain in place a while longer, including those along northbound and southbound Interstate 880. About 280,000 vehicles cross the landmark bridge every day, according to the department. The Bay Bridge was closed last week as part of a seismic retrofitting project that required cutting out and replacing a double-deck portion of the east span. Watch as the bridge needed big repairs » . A 50-foot section of the bridge collapsed in 1989 during the Loma Prieta earthquake, prompting efforts to make it quake tolerant.
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Obama administration sent 800,000 HealthCare.gov customers wrong tax information .
About 50,000 taxpayers who already filed may have to resubmit their returns .
Errors were found in new tax forms called 1095-As, which are like W-2 for health care .
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Nearly a million Americans may have to wait longer to get their tax refunds this year thanks to a clerical error linked to ObamaCare. The Obama administration revealed today it sent about 800,000 HealthCare.gov customers the wrong tax information, and officials are asking those consumers to delay filing their 2014 taxes. Another 50,000 or so who already filed may have to resubmit their returns. The tax mistake is a self-inflicted injury that comes on the heels of what President Barack Obama had touted as a successful enrollment season, with about 11.4million people signed up. Oops! About 800,000 HealthCare.gov customers got the wrong tax information from the government, and officials are asking those affected to delay filing their 2014 returns . Glitch: Errors have been discovered in new tax forms called 1095-As, which are like W-2 for health care . California, which is running its own insurance market, on Thursday announced a similar problem affecting about 100,000 people in that state. Federal officials also announced Friday a special sign-up extension for uninsured people facing the health care law's tax penalties for the first time this year. Several million households could benefit from that grace period, which had been sought by Democratic lawmakers in Congress. Uninsured people who go to file their taxes and learn they're facing a penalty will have between March 15 and April 30 to sign up for subsidized coverage through HealthCare.gov. The fines for being uninsured are going up in 2015. The tax error highlights the complicated links between Obama's health care law and taxes, connections that consumers will experience for the first time this year. The law subsidizes private health insurance for people who don't have access to job-based coverage. By delivering those subsidies through the income tax system, the White House and the law's supporters were able to tout the health care overhaul as a tax cut. But it also introduced new wrinkles to an already-complicated tax system. The errors disclosed Friday are in new forms that HealthCare.gov sent to millions of consumers receiving coverage through the federal insurance market that serves most states. It's that time again: Obama administration officials are asking the 800,000 consumers affected by the error to delay filing their 2014 taxes . Those forms, called 1095-As, are like a W-2 for health care. They provided a month-by-month accounting of the subsidies consumers received to help pay their premiums. That information is then used to make sure everybody got the right amount, not too much, or too little. Andy Slavitt, a top administration official overseeing federal health insurance programs, said the administration is still investigating the root cause of the problem. Slavitt said it had to do with erroneous calculations of a 'benchmark' premium that is used to help determine the amount of subsidies that individuals receive. It's unclear how the error would affect consumers, Slavitt said. He said it's a mix of people who would have gotten too much assistance with their premiums, or too little. Slavitt said the administration started notifying the affected consumers today. He urged them to wait to file their taxes until they receive corrected forms. An estimated 50,000 who have already filed will receive special instructions from the Treasury Department, he said. 'We're not doing any victory laps,' HealthCare.gov CEO Kevin Counihan told reporters.
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By . Helen Collis . PUBLISHED: . 12:48 EST, 8 August 2013 . | . UPDATED: . 04:05 EST, 9 August 2013 . A researcher in Germany has discovered a major glitch in Xerox copier machines which have shown to substitute the wrong numbers when scanning documents. After scanning a blueprint document from an architect, David Kriesel, a computer science researcher at the University of Bonn in Germany, thought the firm was pulling his leg when they accused him of altering some figures. But sure enough, on three occasions, the number six had been replaced with an eight. Changing numbers: David Kriesel noticed that in some of the numbers he scanned in with a '66' sequence (pictured on the left) they had changed to '86' (pictured on the right) Technical error: Again, the numbers which feature a 6 on the original document (left) have been changed to an 8 (pictured right). The table shows that 54,60 (left) turns into 54,80 (right) and 65,40 (left) becomes 85,40 (right) Outrage: When Mr Kriesel noticed the error and the company explained, he took to Twitter to spread his concern . He told ABC News: I thought they were kidding. But I tried it myself.. and the numbers changed (after being scanned).' Alarmed, Mr Kriesel contacted the U.S. firm, but found no one knew anything about it. In response, the company's principle engineer posted a five paragraph blog on its website explaining the situation and how to avoid it. Frances Tse said the issue had been detected in certain machines when scan- quality and resolution settings were altered; when files were compressed, and the quality reduced. Each page is scanned as a number of small patches, and the machine replaced each patch with one that best fits from a library of symbols. However, when the file quality is reduced, there is a subsequent 'tradeoff' in accuracy, Mr Tse said. He wrote on his blog: 'The Xerox design utilizes the recognized industry standard JBIG2 compressor which creates extremely small file sizes with good image quality, but with inherent tradeoffs under low resolution and quality settings.' He explains that for 'data integrity purposes', the company recommends using the factory default settings for scanning, with quality level set to 'higher'. 'In cases where lower quality/higher compression is desired for smaller file sizes, we provide the following message to our customers next to the quality settings within the device web user interface: “The normal quality option produces small file sizes by using advanced compression techniques. Image quality is generally acceptable, however, text quality degradation and character substitution errors may occur with some originals.",' he said . Coverage: Mr Krisesl said he thinks the glitch should get some airtime on a late night satirical programme . Numerous Xerox machines are affected by the glitch, including this ColorQube a 87XX / 89XX model . The potential implications of the Xerox scanning glitch could be very serious, especially if they affect construction documents or medical developments, customers point out (stock image of an office) Mr Tse's blog, titled 'Always Listening To Our Customers: Clarification On Scanning Issue' has not been well received however, by those who fear the potential fallback from this issue could be colossal. S. Basinger questioned what will happen when people find engineering documents are released for construction with numbers switched by Xerox’s machines, or medical documents have used with switched figures. 'A lame response like this suggests that some of the ignorance of the consequences may be willful and that your senior leadership is hoping that this will somehow go away,' the comment continues. 'Heaven forbid as time continues to tick away and you delay a proper recall that people die as a result of your inaction.' Others criticise the company for failing to explicitly say which machines are affected, another points out that the warning message did not show up on his machine when he followed the instructions. When one client called the customer services for advice, he found no one knew what he was talking about. In response, Mr Tse later added some extra details in answer to his blog comments. He pointed out that the product families affected were numerous: ColorQube 87XX / 89XX, ColorQube 92XX / 93XX, WorkCentre 57XX, WorkCentre 76XX, WorkCentre 58XX, WorkCentre 77XX, WorkCentre 5030/5050, WorkCentre 6400, WorkCentre 78XX, WorkCentre 51XX, WorkCentre 7220/7225, WorkCentrePro 2XX / BookMark 40/55, WorkCentre 56XX and WorkCentre 75XX . He also drew attention to the fact that unless default settings had not been changed, the problem would not arise. He said the company was taking the issue very seriously. He said from people's feedback 'we will look for ways to help our customers better manage their scanning application needs'. German researcher Mr Krisesl, who has spoken to both Mr Tse and Xerox's vice president Rick Dastin, is still concerned about the consequences. He told ABC News: 'This problem is dangerous. If something is compressed with JBIG2 and I claim it's incorrect, you can't prove me wrong.'
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Most Who Enrolled in Michigan’s Medicaid Expansion Already Either Work or Can’t Work, Study Shows
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Newswise — ANN ARBOR, MI – Nearly half of the people who enrolled in Medicaid after it expanded in Michigan have jobs, a new study finds. Another 11 percent can’t work, likely due to serious physical or mental health conditions.
About 1 in 4 enrollees are out of work but also are much more likely to be in poor health, according to the findings published in JAMA Internal Medicine by a team from the University of Michigan Institute for Healthcare Policy and Innovation.
The findings, from a detailed survey of more than 4,000 people enrolled in Michigan’s program for more than a year, may inform discussions of potential work requirements for the poor and near-poor Americans who qualify for expanded Medicaid in the 31 states and the District of Columbia that offer it, and other states that are considering expansion.
Several of those states have submitted proposals to require Medicaid expansion enrollees to work at least part time, actively seek work or volunteer, or risk losing Medicaid coverage.
Several others are considering doing so, and the current federal administration has signaled a willingness to approve the waivers states need to enact such requirements. Some states have started voluntary work-referral programs for enrollees.
“The question raised by these data for states is - is it worth the cost to screen and track enrollees when only a small minority isn’t working who are potentially able to work,” says Renuka Tipirneni, M.D., M.Sc., lead author of the new study and a clinical lecturer in general internal medicine at U-M.
“Even if they don’t meet federal disability criteria, our survey shows many of these individuals face significant health challenges,” she adds. “It’s also important to consider that dropping them from coverage for failure to fulfill a work requirement could seriously impact their ability to receive care for chronic physical and mental health conditions that can worsen without treatment.”
The new study is the first published report about work-related information obtained directly from enrollees in Medicaid expansion states, rather than administrative data or survey estimates.
It’s also the first peer-reviewed study from IHPI’s formal evaluation of Michigan’s expansion, called the Healthy Michigan Plan. The evaluation, funded by IHPI’s contract with the Michigan Department of Health and Human Services, is required under a federal waiver that allowed the state to customize its Medicaid expansion when it launched in April 2014.
Tipirneni and her colleagues, including senior author and IHPI director John Z. Ayanian, M.D., M.P.P, and Susan D. Goold, M.D., M.H.S.A., M.A., compiled the report based on telephone surveys carried out in 2016 in a representative sample of Healthy Michigan Plan participants.
In all:
8 percent of respondents said they were employed or self-employed full or part time -- though their incomes were all below 133 percent of the federal poverty level, about $15,800 for an individual and $32,300 for a family of four.
6 percent were out of work, in a state that in 2016 was around the national average for unemployment after a decade and a half of above-average unemployment. Of these, one-third said they were in fair or poor health – compared with 19 percent of those who said they were employed. Two thirds of those out of work said they had a chronic physical illness, and 35 percent said they had been diagnosed with a mental illness. One-quarter of those out of work said they had a physical or mental impairment that interfered with their ability to function at least half the days in the last month.
3 percent said they were unable to work. Of these, 73.4 percent reported being in fair or poor health.
5 percent said they were retired
2 percent said they were students
5 percent said they were homemakers
Although the U-M team did not ask about respondents’ roles as caregivers for other household members and how that may limit their ability to work, they included these questions in the 2017 survey they just completed.
Respondents who had a mental health condition that limited their ability to function were twice as likely to say they were out of work than those without. Other factors that were associated with individuals’ being significantly more likely to say they were not working were being in their 50s or early 60s, being male, or being in fair or poor health overall.
Tipirneni notes that survey respondents who said they were employed or self-employed may have enrolled in the Healthy Michigan Plan because many low-wage and part-time jobs do not offer health insurance. Employers are not required to offer health insurance if they have less than 50 workers, nor do they have to offer it to any employees who work 30 hours or less a week, under the Affordable Care Act.
Those with incomes under the federal poverty level also cannot get financial help to purchase their own coverage through a health insurance exchange such as HealthCare.gov, no matter whether their state expanded Medicaid or not.
“Medicaid expansion was designed to cover those who have a gap in their coverage, or jobs that don’t offer insurance but don’t pay enough to allow someone to afford individual coverage,” Tipirneni says. “States considering work requirements should evaluate their potential impact on individuals, and the potential return on expenditures required for enforcement.”
Reference: JAMA Internal Medicine, DOI:10.1001/jamainternmed.2017.7055
http://jama.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2017.7055
SEE ORIGINAL STUDY
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Maharashtra CM Devendra Fadnavis. (Express photo) Maharashtra CM Devendra Fadnavis. (Express photo)
SEVENTY-ONE years after they fled West Pakistan following Partition and made refugee camps across Maharashtra their home, relief is finally around the corner for descendants of Sindhi migrants. The state Cabinet on Tuesday converted the land tenures of all such lands from leasehold to freehold properties, clearing decks for the redevelopment of these colonies.
About 30 lakh Sindhi migrants had settled in 31 refugee camps across the state post Partition. Five such settlements, collectively occupying 280 acres, were erected in Mumbai. These include camps in Mulund and Sion Koliwada — spread over 100 acres each — being the largest. Around 60 acres is occupied by the Sindhi camp in Chembur and 10 acres each by the Thakkar Bappa Colony (also in Chembur), and the Wadia Trust Estate Refugee Camp in Kurla. A total of 5,000 families reside in these settlements, sources said.
While the state government has been overseeing the maintenance of these settlements since 1971, officials said that the low-rise settlements had outlived their age, and several of these buildings were now in derelict condition, making their redevelopment necessary.
Most of the 25 buildings in the Sion Koliwada refugee camp, for instance, have been tagged dangerous and unfit to live in. The Mumbai municipality had even threatened to pull down these buildings down last week, offering occupants alternative temporary shelters at Mahul near Chembur.
When their redevelopment plans were discussed, the government realised that it would first need to alter the tenure of such lands, which continue to vest in the Union government
Sources said the process for the land tenure conversion was first initiated in the state in 2006, but the benefit had so far been extended to settlements in the districts of Dhule and Jalgoan. On Tuesday, the Cabinet extended the same conversion model to such colonies in all the remaining districts too.
For Mumbai, officials said plans to redevelop the five colonies on the lines of the incentive redevelopment model employed for the reconstruction of the Bombay Development Department (BDD) chawls in central Mumbai is already afloat.
Once the tenure is formally mutated on land records, the plan is to move a proposal before the state Cabinet for appointment of Maharashtra Housing and Area Development Authority (MHADA) — which is also redeveloping the chawls — as the nodal agency for the urban renewal of these settlements.
The state’s housing department has directed officials to conduct a land survey and submit a report on the area, the number of occupants and the irregularities. The conversion of land tenures would also allow the original migrants to sell their apartments or plots, added officials.
“When they came here from west Pakistan, they had left behind their land holdings. The land allocated to them were always meant to be freehold properties, but for some reason, they were mutated as leased properties at that time. It is only fair that the land be freed from the clutches of the government,” an official said.
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'Safety net' clinics uneven in delivery of help to quit smoking
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(Reuters Health) - Health clinics where low-income people in the U.S. obtain medical care don't always offer help with quitting smoking - and availability of that assistance may vary by patients' ethnicity and insurance, a recent study suggests.
So-called safety net clinics exist to reduce barriers to healthcare. Patients at these clinics have higher-than-average rates of smoking, so it's particularly important to address these disparities, said Dr. Steffani Bailey, a family medicine researcher at Oregon Health & Science University School of Medicine in Portland.
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"We need to ensure that all patients, particularly in these settings, are getting access to the assistance that they need to help them to quit smoking," she said in an email.
Bailey and her team examined electronic health record data from 136,314 smokers at 143 clinics in 12 states between 2014 and 2016. The researchers analyzed the type of smoking cessation assistance these patients received - whether it was no assistance, counseling only, medication only or counseling and medication together.
They also looked at whether age, gender, race, income level, insurance status and the presence of medical and psychiatric conditions influenced who received cessation help.
The odds of getting both counseling and medication - which is considered best practice - were lower among patients of all ethnicities combined than they were among non-Hispanic whites, the researchers found.
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Patients with Medicaid, the government insurance for low-income recipients, had 17 percent higher odds of receiving counseling and medication compared with commercially-insured patients, but uninsured people had the lowest odds, the study team reports in the American Journal of Public Health.
With few exceptions, the study found, women, older people and those with co-existing medical conditions were the most likely to receive assistance with quitting smoking.
While other studies have used electronic health record data, Bailey said, hers is the first to examine predictors of smoking cessation assistance from such a large sample. The study was limited by the fact that researchers do not know the reasons for some patients not receiving smoking cessation medication. They also didn't have data on patients who purchased nicotine replacement therapy over the counter.
Bailey said her team plans to interview patients and providers and observe clinic visits to better understand why smoking is, or is not, being addressed in these visits.
Dr. Andy Tan, an assistant professor at the Harvard University T.H. Chan School of Public Health in Boston who wasn't involved in the study, said researchers' access to electronic health records provides previously unavailable data on service delivery for a large number of patients.
"This is important because this will accelerate the identification of gaps in delivery of smoking cessation among subgroups of patients who smoke, to target training, patient education, and system change that ultimately eliminates disparities in providing this service," he said in an email.
The U.S. Public Health Service Clinical Practice Guideline recommends that clinicians offer brief smoking cessation interventions at nearly all encounters, Bailey said.
They recommend the "5 A's model" (Ask about smoking, Advise to quit smoking, Assess willingness/readiness to quit smoking, Assist patient in quitting smoking, and Arrange follow-up). The clinician should discuss medication with the patient and should offer it unless there is a reason, such as pregnancy, that it should not be prescribed, Bailey said.
Offering medication and behavioral counseling together is considered the most effective way to help people quit smoking, said Dr. Kristine Browning of The Ohio State University College of Nursing and The Ohio State University Wexner Medical Center-James Cancer Hospital in Columbus, who wasn't involved in the study.
"To continue to close the disparity gaps that exist in healthcare, it is essential that behavioral researchers and healthcare providers continue to illuminate healthcare disparities where they exist, and work toward multifactorial solutions to eliminate disparity and improve patient outcomes." she said in an email. "All patients deserve that highest evidenced-based treatment."
SOURCE: https://bit.ly/2u0nry7 American Journal of Public Health, online June 21, 2018.
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SCORES of people have turned out in a show of solidarity against aged care staff cuts.
The rally, held outside Blue Care's Pioneer aged care facility on Barolin St this morning, included nurses, personal carers, family members and residents.
Queensland Nurses and Midwife Union member and former Blue Care nurse of 43 years Cheryl Dorron spoke at the rally, saying enough was enough.
"Over the years we have witnessed at insidious and systematic move by providers, aided and abetted by government, to remove nursing from the provision of aged care," she said.
Blue Care recently announced it would slash 11 full-time equivalent positions from its three Bundaberg facilities, but later told the NewsMail that number would be dropped to nine.
Darryl Hampson, whose mother stays with Blue Care, at the rally. Crystal Jones
"It's a no-win situation for the residents with a further loss of quality care,the relatives who can have no confidence that care is being given in a timely manner and the staff who through no fault of their own don't have the numbers nor skills to provide that care at the time it is needed" Ms Dorron said.
"We need providers to be held accountable for how they spend government funding, we need nurse to resident ratios or funding specifically dedicated to nursing care."
An online petition calling on Blue Care to halt cuts to nursing staff has already gained 1456 online signatures and more on hard copy.
The petition can be found at: http://bit.ly/2uU1SkJ.
More to come
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Medicare launches revamp for heart attacks, hip fractures
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WASHINGTON (AP) — Heart attacks and broken hips cause much suffering and worry as people grow older. This year, Medicare wants to start changing how it pays for treatment of these life-threatening conditions, to promote quality and contain costs. Beneficiaries and family members may notice a new approach.
Hospitals and doctors in dozens of communities selected for large-scale experiments on this front are already gearing up. The goal is to test the notion that better coordination among clinicians, hospitals, and rehab centers can head off complications, prevent avoidable hospital re-admissions and help patients achieve more stable and enduring recoveries. If results back that up, Medicare can adopt the changes nationwide.
The cardiac and hip fracture experiments are the latest development in a big push under the Obama administration to reinvent Medicare, steering the program away from paying piecemeal for services, regardless of quality and cost. It’s unclear whether Donald Trump as president will continue the pace of change, slow down or even hit pause.
Trump’s Health and Human Services nominee, orthopedic-surgeon-turned-congressman Tom Price, has expressed general concern that the doctor-patient relationship could be harmed by Medicare payment changes seeking to contain costs. And the Medicare division that designed the experiments — the Center for Medicare & Medicaid Innovation — is itself under threat of being abolished because it was created by President Barack Obama’s 2010 health care law.
Some outside groups, including AARP, worry that Medicare may be moving too fast and that focusing on cost containment could lead to beneficiaries being shortchanged on rehab care.
Innovation center director Patrick Conway, who also serves as Medicare’s chief medical officer, is plowing ahead nonetheless. “Delivery system reform and paying for better care are bipartisan issues,” Conway said. And quality ranks ahead of cost savings in evaluating any results, he added.
The cardiac and hip fracture experiments focus on traditional Medicare, which remains the choice of nearly 7 in 10 out of Medicare’s 57 million beneficiaries. The cardiac experiment involves both heart bypass and heart attack patients. The trials join similar ongoing tests involving surgery for hip and knee replacement, as well as care for cancer patients undergoing chemotherapy.
In the experiments, doctors, hospitals, and rehab centers get paid the regular Medicare rates. But hospitals are given responsibility for overall quality and cost, measured against benchmarks set by Medicare. If the hospital meets or exceeds the goals, it earns a financial bonus, which can be shared with other service providers. If the hospital falls short, it may have to pay the government money.
“Now your doctor and hospital are working together to make sure they are well coordinated,” said Conway.
Under the old system, if a patient was discharged from the hospital after a heart attack, “they might hand you a piece of paper that said please follow up with your primary care doctor,” Conway continued. “In this model, the hospital is going to have a strong incentive to make sure you follow up.”
Overall, about 168,000 Medicare beneficiaries are treated for heart attacks in a given year, while 48,000 undergo heart bypass surgery for clogged arteries and 109,000 have surgery for broken hips.
Around the country, hospitals in 98 metro areas will be involved in the cardiac experiment. The hip surgery experiment involves 67 areas that are also part of Medicare’s ongoing test with hip and knee replacements.
Areas in the cardiac test include Boston, as well as Akron, Ohio; Charleston, South Carolina; Fort Collins, Colorado; Utica, New York; and Yuma, Arizona. A smaller group of communities will be involved in a related experiment that pays hospitals for coordinating rehab care for heart patients. Although the benefits of cardiac rehab are widely recognized, only a small share of patients receives it.
The hip fracture test includes the Miami, New York, and Los Angeles metro areas, as well as Austin, Texas; Bismarck, North Dakota; Flint, Michigan, and New Orleans.
Hospitals are not happy with the changes, though doctors have generally been supportive. A big concern for hospitals is that Medicare requires mandatory participation by all the facilities in areas selected for these tests. But Conway says that’s likely to lead to even better results. The idea is that hospitals will watch each other’s performance closely, and the ones that have room to improve will try to catch the high achievers.
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Online:
Metro areas involved in Medicare’s experiments — http://tinyurl.com/jzfyo5l
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The NDP is committing to adding more than 900 surgeries in an effort to cut down wait times. Today’s Global News Hour at 6 Health Matters is brought to you by Pharmasave.
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2 big insurance breakups on Valentine's Day
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It was a rough day for the already-roiled U.S. health insurance market: One giant merger was abandoned, another is threatened by infighting, and a major insurer announced it will stop selling coverage on public exchanges in 11 states.
Both merger deals had already been rejected by federal regulators and judges, but the companies were considering appeals to those decisions. Now they both appear to be off.
Aetna said it was abandoning its planned $34 billion purchase of Medicare Advantage provider Humana early Tuesday. Then, later in the day, Cigna said it is suing Anthem to kill a $48 billion acquisition bid.
FILE - In this Tuesday, Aug. 19, 2014, file photo, a pedestrian walks past a sign for Aetna Inc., at the company headquarters in Hartford, Conn. Aetna and Humana are calling off a $34 billion deal to combine the two major health insurers after a federal judge, citing antitrust concerns, shot down the deal. (AP Photo/Jessica Hill, File)
The deals were conceived as a way to help the insurers increase their enrollment and cut down on expenses in part so they could improve their performances on the Affordable Care Act's public insurance exchanges. Big insurers have been hit with substantial losses from the exchanges, even though they represent a relatively small part of their overall business. Many have already cut back their offerings, and that has slashed customer choices in markets around the country.
The collapse of one deal and the uncertain future of the other could hurt shoppers on the exchanges next year by leaving them with even fewer options and potentially higher prices. Humana told investors late Tuesday that it was abandoning it exchanges in all 11 of its states as of the beginning of next year.
Humana, based in Louisville, Kentucky, was the only insurer on exchanges in 16 Tennessee counties, according to data compiled at the start of the 2017 open enrollment period by the Associated Press and health care consulting firm Avalere. That means customers in those counties may have no way to buy coverage with help from government tax credits next year unless another insurer decides to enter those markets.
Every exchange in the U.S. had at least one insurer selling coverage on it for 2017, according to Larry Levitt of the nonprofit Kaiser Family Foundation, which studies health care issues.
Morningstar insurance analyst Vishnu Lekraj said it's possible all the four insurers involved in the deals could leave the exchanges.
Aetna Chairman and CEO Mark Bertolini raised that possibility months ago. He said that if his company's planned, was blocked, "we believe it is very likely that we would need to leave the public exchange business entirely," according to court documents filed in that case.
Aetna, based in Hartford, Connecticut, says it lost $450 million last year on ACA-compliant coverage, while the company booked an overall profit of $2.27 billion. Its loss on ACA-compliant business was $100 million more than it expected.
Bertolini said recently that his company would announce by April 1 whether it will remain in any of its exchanges. "We're looking at everything," he said.
Government and industry officials have said President Donald Trump's administration and congressional Republicans are weighing measures to stabilize the wobbly exchanges. Insurers have been pushing them to act soon.
"The clock is definitely ticking for the Trump administration to provide some clarity around what the rules will be," Levitt said.
In suing to end its tie-up, Cigna, based in Bloomfield, Connecticut, said it wants more than $13 billion in damages from its onetime-companion Anthem, the Blue Cross-Blue Shield insurer, which is based in Indianapolis.
Cigna says it is seeking a $1.85 billion termination fee from Anthem and billions more in damages for what it says were Anthem's breaches of the merger agreement.
The insurer says the damages include the amount Cigna shareholders would have received if the merger had not failed. It noted that Anthem assumed full responsibility for litigation strategy and getting the necessary regulatory approvals, suggesting that it was Anthem's responsibility to push the deal through.
"Cigna fulfilled all of its contractual obligations and fully cooperated with Anthem throughout the approval process," the insurer said in a statement.
An Anthem spokeswoman says Cigna has no right to end the deal, and it remains committed to closing the transaction. The insurer had just filed on Monday paperwork to appeal the federal court ruling.
Anthem and Aetna put their acquisition bids together in 2015 and touted them as a way to grow enrollment and reap savings that they would then pass on to consumers.
The deal would have given Aetna the opportunity to significantly expand its presence in Medicare Advantage coverage, which involves privately run versions of the federal Medicare program for people who are over 65 or disabled.
But the Department of Justice had sued last summer to stop the deals, due to concerns about how they may affect prices and consumer choices. Federal judges then rejected the acquisitions in separate rulings filed earlier this year.
The deals would have combined four of the nations' five largest insurers. UnitedHealth Group is the largest.
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AP Data Journalist Meghan Hoyer contributed to this report from Washington, D.C.
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This time of year, whether you are looking for something elegant or kitchy, meaningful or clever, sincere or ironic, there is an option out there for you. And depending on how you feel about the glut of mass-produced, cardboard ways to let partners, friends, and family know just how much you love them each Feb. 14, you might want to thank - or blame - the city of Worcester.
Start the conversation, or Read more at WGBH.
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Trump Guts Requirement That Employer Health Plans Pay For Birth Control
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The Trump administration is rolling back the Obama-era requirement that employer-provided health insurance policies cover birth control methods at no cost to women.
According to senior officials with the Department of Health and Human Services, the goal of the new rule is to allow any company or nonprofit group to exclude the coverage for contraception if it has a religious or moral objection.
"This provides an exemption and it's a limited one," said Roger Severino, director of the HHS Office of Civil Rights. "We should have space for organizations to live out their religious identity and not face discrimination."
He said he expects most companies will continue to provide coverage for birth control and that the changes will only affect a tiny percentage of U.S. women. The new rules are being published Friday in the Federal Register and go into effect immediately.
But some health policy analysts say the new rule creates a huge opening that lets any employer claim an exemption, leaving their female workers to pay the full cost of any birth control out of pocket.
"It is a huge loophole for any employer that does not want to provide birth control coverage to their employees," says Dania Palanker, a professor at Georgetown's Center on Health Insurance Reform.
The change fulfills a promise Trump made in May to the Catholic religious order The Little Sisters of the Poor in a ceremony in the White House Rose Garden. The nuns had sued the Obama administration over the birth control requirement.
The Affordable Care Act requires employer-provided health insurance policies to include coverage for preventive health care. After the law passed, HHS used its regulatory authority to specify what has to be included in those preventive services, and birth control, including "all Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity."
But the policy was controversial from the start.
Several companies and religious groups sued, saying the rule infringed on their religious freedom.
The Obama administration created an exemption for churches, and allowed other "religious employers" to opt out by notifying the government. When they did so, the administration would arrange with their insurance companies to provide the coverage directly, without the employers' involvement.
But the Little Sisters of the Poor weren't happy with that workaround and sued.
The group's case, and a second one involving private businesses including the Hobby Lobby chain of craft stores, went to the Supreme Court.
The court ruled in favor of Hobby Lobby in 2014, saying privately held companies could object on religious grounds. And then, last year, the court issued a split ruling in the Little Sisters case, saying the government shouldn't fine the nuns, but also ordering the two sides to work out an arrangement that accommodates their religious beliefs.
Before a deal was reached, Donald Trump became president.
At the Rose Garden ceremony in May, he told the Little Sisters of the Poor that he planned to change the rules. "You're long ordeal will soon be over," he promised.
Under the new rule, women who work for Hobby Lobby or the religious group may no longer have access to birth control coverage through the Obama-era workaround. A Hobby Lobby spokesman said the company would have no comment on Friday, and the Little Sisters of the Poor didn't respond to NPR's emails seeking comment.
Hobby Lobby's founder and CEO David Green told reporters in 2013, "Our family is now being forced to choose between following the laws of the land that we love or maintaining the religious beliefs that have made our business successful and have supported our family and thousands of our employees and their families."
HHS officials said they don't expect many companies to seek waivers. They said the group seeking waivers will likely be limited to those approximately 200 companies and nonprofits that have already sued.
But Palanker says the impact could be a lot bigger. There are a lot of large private companies, she says, whose owners may hold strong religious beliefs but did not want the publicity and expense of suing the federal government.
Hobby Lobby has 32,000 employees.
"A lot of women will retain birth control coverage," Palanker says, "but there will be a lot of women who will lose that coverage."
That means they'll find themselves paying out of pocket. A one-month's supply of birth control pills can cost anywhere from $4 to $55 or more, according to GoodRX.com.
Longer-acting contraception, like an IUD, can cost more than $1,000, says Sarah Lipton-Lubet, a vice-president of the National Partnership for Women and Families. She says the new rule is a tool for discrimination against women.
"Women shouldn't be denied access to basic health care based on their employers' religious beliefs," she says. "We all have the right to our religious beliefs. But the way that this rule treats religion is really an excuse to discriminate."
HHS officials say they also plan more stringent enforcement of a provision in the Affordable Care Act that prohibits federal subsidies from being used for insurance policies that cover abortion. The agency will issue guidelines for insurers today on how they have to charge women who want abortion coverage at least $12 a year more for such a policy, and they have to keep that money in a separate fund to be used only to pay for abortions.
The Trump administration's rule is likely to face its own legal challenges from groups that favor contraception.
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Scott Pruitt increasingly looks the worst of the worst out of the appalling cabinet of President Trump, quite aside from his race to become the single most corrupt cabinet member in the entire history ofthe US. The latter is trivial compared to his policy change after policy change that will increase pollution in the environment and end up killing people, to be blunt about it. But now the Environmental Economics blog reports that since June 7 Pruitt’s EPA has been planning to distort benefit-cost in a way to make it less likely to support environmental policy enforcement (sorry not able to make link to site work).
In particular they are planning to eliminate counting “co-benefits” of policies. Only what a policy is specifically directed at can be counted. So, if one looks at coal burning and wishes to limit particulate emissions, then one cannot count co-benefits such as reducing SO2 and mercury emission. This is simply outrageous and makes no sense whatsoever. But indeed, Scott Pruitt may be the worst cabinet member in US history, and Trump seems to be in no hurry to remove him, indeed, defends him.
Barkley Rosser
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Tory MP carries out survey of 118 NHS Trusts to reveal shocking statistic .
3,600 foreigners running up debts to the NHS of £1,000 or more every year .
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Health tourists taking advantage of free treatment on the NHS have cost the taxpayer £40million, it has been revealed. Due to the lax system of checks carried out by GPs and British hospitals, many foreigners are able to undergo often lengthy and expensive treatment then simply leave the country without paying. Conservative MP Chris Skidmore carried out a study of 118 health trusts which has revealed that up to 3,600 foreigners run up debts to the NHS of £1,000 or more each year. Burden: Health tourists receiving treatment on the NHS and leaving without paying have cost British taxpayers £40million . Mr Skidmore is now calling on the government to introduce new laws to clamp down on patients from overseas who cheat the system. He said: 'NHS services are paid for by British taxpayers, who work hard and are proud of the health service that successive generations have built. 'Opening this up internationally, free of charge, is not fair on those who actually pay for it.' Mr Skidmore wants all non-emergency hospital patients to provide passports or proof of residence before they receive treatment. And he believes GPs need to carry out far more effective checks before they refer patients for treatment. Under his proposals, non-UK residents would also be charged a flat fee for seeing a GP. He added: 'GPs are often the first point of contact with the NHS for individuals, and as such provide a gate keeping function. 'At present anyone can register with a GP, and it is not obligatory for the practice to check whether or not an individual is entitled to free hospital care. 'It is therefore entirely possible for a patient eligible for charges to be referred to a hospital for treatment, and not pay a penny, due to the necessary information not being transmitted.' Mr Skidmore used Freedom of Information requests, to ask every NHS Trust in the country how much they were owed by foreign nationals and how much of that had been written off. Of the 118 trusts responded Guy's and St Thomas' NHS Foundation Trust were owed the most with more than £8million renmaining unpaid. The next two were Barts and London NHS Trust, who were owed around £3 million and Imperial College Healthcare NHS Trust who were owed roughly £2.7million. Earlier this week BBC's Panorama programme revealed some health tourists are paying bribes of up to £1,000 to get onto GP surgery lists so they can claim free treatment. Reform: Conservative MP Chris Skidmore believes GPs need to carry out effective checks before they refer patients for treatment . Their investigation uncovered a thriving black market in which NHS staff are illegally accepting cash. Once registered with a practice, patients are being seen by GPs and then referred for hospital treatment worth tens of thousands of pounds. The investigation found one manager at a . surgery in the West Midlands was offering to register an entire family . from India for £5,000. Research: Conservative MP Chris Skidmore carried out a study of 118 NHS trusts . He also took £800 from a female undercover reporter posing as a health tourist to put her on the practice’s list. The reporter claimed to be an Indian patient suffering from the back condition sciatica, which wouldn’t merit free treatment as it isn’t deemed urgent. But she was subsequently referred to hospital for an MRI scan that would have cost the NHS £800 – the same as the cost of her place on the list. The unidentified manager told her it was ‘good business’ as she had already got her money back with the cost of the scan – and would be likely to benefit from more expensive treatment. The manager said: ‘Just with the scan you’ve made your money.’ The investigation also discovered that ‘fixers’ – who aren’t employed by the NHS – are putting overseas patients on GP lists in exchange for cash. These individuals are likely to have close ties with managers or doctors within the surgery who agree to register the patients. Mr Skidmore said: ‘This is nothing short of abuse of precious NHS resources. It’s highly irresponsible of somebody to be making money out of patients who are vulnerable. ‘The law is clear: if you’re not eligible for free treatment then you should be paying for it.’ Only patients who have lived in the UK for the past year can get free hospital treatment. But NHS staff will treat anyone whose condition is deemed life-threatening or urgent, including women giving birth. Treatment at hospital A&E units and walk in clinics is also free for all. GPs have discretion about whether or not to charge patients who are not on their lists depending on how urgent they assess the patient’s condition to be. But GP surgeries are not legally obliged to register overseas patients. In fact many don’t, as they worry that if the patients are later referred to hospital, they won’t pay for the treatment. Although hospital staff are meant to check patients have been living in the UK for at least a year before treating them – unless they are urgent – many don’t bother. So once patients are on GP lists, they can potentially be given thousands of pounds of hospital treatment without ever having to pay. For EU residents, their home country will cover the cost of treatment in the UK through the European health insurance card scheme. In addition, the Health Service will not charge for treating certain infectious diseases such as tuberculosis and HIV to prevent them spreading. Health Minister Anna Soubry said: 'The NHS is not there to serve the health needs of the world and we will not tolerate abuse of the system, but it does have a duty to help anyone whose life or long-term health is at immediate risk without demanding a credit card up front. 'Last year we began a wholesale review of the current system to address concerns about access, cut down abuse and consider how best to ensure those who should pay do so.'
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New York (CNN) -- If President Obama had been forthright last week at the health care summit, he would have opened the meeting by stating: "If you have health coverage, under our reform bills you are going to pay more and get less. If you are one of the 45 million elderly or disabled people on Medicare, you are going to get less. There is no such thing as free medical care. Somebody has to pay! And in the end it is you." Those are the facts! And as Senate Majority Leader Harry Reid stated to the Republicans : "...you're entitled to your opinion, but not your own facts." However, the facts, as the president has found out, are not exactly a compelling message to persuade a reluctant Congress and public to overhaul nearly one-fifth of the nation's economy. Adding 31 million people (45 million now don't have coverage) to the health care system will cost the taxpayers trillions over time. Many of that uninsured group can't afford health insurance, and if this legislation passes, the government will create an entitlement program to subsidize them. In the end, like the entitlement programs that have gone before them, they will far exceed any cost estimates on the table today. Just to remind you, Mr. President and members of Congress, the taxpayers have a right to know the full fiscal consequences of this legislation. The United States is spending this year nearly $2.5 trillion on health care. That is 17.3 percent of the U.S. economy and it's rising at a rapid rate. We spent $134 billion more in the past year than in the year before. To put $2.5 trillion into perspective, that is more money than the federal government received in taxes and revenues this year. The problem is nobody knows (and especially the Congress) what a trillion dollars really means. A trillion is a million million. Still means nothing to most of us. If you spent a million dollars a day since the birth of Jesus Christ, it wouldn't even equal a trillion. If you stacked up a trillion dollars in dollar bills, it would reach 68,000 miles into the sky, about a third of the way from the Earth to the moon. Those numbers are too big for any of us. Somebody has to pay for the most expensive health care in the world. Many experts would argue it is also the very best health coverage in the world. Health care today is paid for by three entities. The government (federal, state and local) pays more than 50 percent of the costs. That is us, the taxpayers. The insurance companies pay about one-third of the costs. That again is us. We pay the premiums and the insurance company pools the risk, and distributes our monies back for the medical services. They obviously add an overhead cost as does any business, but it's still our money being paid out. The third payer is again us. Out-of-pocket reimbursements or additional fees come directly out of our pocket and paycheck. Health care has changed as dramatically as anything in our society in the last half century. First, we are living longer. In 2007, American men could expect to live 3.5 years longer and women 1.6 years longer than in 1990. We are long past the days when you walked into a doctor's office and the doctor -- armed only with a stethoscope, blood pressure monitor and a thermometer -- listened to our symptoms and made a diagnosis. Maybe in a rare case an X-ray was called for. We paid our bill and went to the drugstore and got our prescription. There were no MRI's, no heart diagnostic tests, no CT scans or any of the wonder drugs that have extended our lives and in many cases made the quality better. It's not that people aren't seeing doctors. In the last several years, more than 1.2 billion annual visits to a physician's office have taken place, averaging more than three a year per person. Certainly, some efforts must be made to provide some insurance reform -- but that also means malpractice insurance reform. Some massive efforts need to be made to curb Medicare and insurance fraud. And efforts must be made to create more competition among insurance companies across state lines. The president's attempt to add some of the better suggestions from the Republicans addressing these issues is not going to add any support from that side of the aisle. They are minor changes that are positive but don't tackle the fundamental cost issues or address the new entitlements and mandates that Republicans object to most. Reducing costs in most cases means reducing services. Who doesn't want an MRI for their child injured in a car wreck? Who doesn't want tests done on a spouse or parent who has chest or abdominal pain? But if Reid and Pelosi shove this legislation through Congress against public opinion, they and their party will pay a price. Yet the price Democrats will pay at the polls in November won't be nearly as big a price as our kids and grandkids will pay when the bill comes through years hence. If you're going to have reform, make the system better. Take your time and do it right. The opinions expressed in this commentary are solely those of Ed Rollins.
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HIC: Insurers need to make profit
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(CNS): Mervin Connolly, who heads up both the Department of Health Regulatory Services and the Health Insurance Commission (HIC) has told the Public Accounts Committee that health insurance companies need to make a profit. After several days of PAC meetings examining the auditor general’s latest damning report, where members heard the details of the many failings of the healthcare system in Cayman, Connolly defended the private sector profit motive. But he did raise concerns about some of the shortcomings.
As the committee reconvened Monday, PAC Chair Ezzard Miller pointed out that the biggest complaint about the health system is insurance.
Connolly said the funding of healthcare in Cayman was “complex” but he defended the insurers’ right to make a profit and that premiums must not be outstripped by claims. He suggested that the firms employ “initiatives to ensure they remain in the black”.
Connolly said the commission’s main concern is where an insured person “has a plan of benefits that meets an episode of illness but claims are denied with little justification”. That’s when the regulator will pursue the insurer, he explained, but repeated his position that the health insurance companies should be allowed to make money.
Connolly claimed that his department regularly monitored the sector and problems were emerging regarding late payment to physicians, which doctors say makes it very difficult. Most healthcare providers accept that they can manage with the current fee regime but when insurance companies seek to delay or deny claims, the physicians start to lose out.
He said doctors were complaining about pre-clearance or certification, which is seeing some insurance companies fail to pay up and doctors believe they are trying to use this to deny legitimate claims. This is leading to non-medical personnel from the insurance firms quizzing a doctor about whether a course of treatment was needed or not.
Connolly said if the local market cannot sort this out, then the commission may need to introduce regulation.
But the health regulator said he believed the local system would be improved with the introduction of a verification system so that all healthcare providers can verify the cover of patients, but he hinted at the recent issues with that. Although he did not mention it, Connolly was referring to the CarePay scandal and subsequent criminal trial, in which the former chair of the Health Services Authority, Canover Watson, was found guilty of corruption in connection with a verification system that he introduced at the hospital.
After almost twenty years sitting on the backbench of the Legislative Assembly and having served in two governments, Captain Eugene Ebanks, one of the committee members, said the local health insurance companies were acting like a cartel. He queried why private insurance companies were allowed to drop insured clients the second they reached retirement. Ebanks said he did “not know how it got this far for so long without anything being done”, but he said he was now going to make every effort to make a change.
Connolly said that to ensure people could be covered past retirement they would have to create a scheme where people paid even more when they were younger to cover themselves in old age.
But Miller said that should not be allowed to happen because the whole principle of group insurance was that the younger fitter people who are paying in and not using their own cover fund the needs of the elderly. He pointed out that this was the problem with the profit motive, as the only goal of the private health insurers was to increase it. Connolly said that he would back any initiative that could deal with this problem.
But the HIC boss denied that CINICO and the tax payers were picking up the tab for the elderly and uninsurable so the private sector firms could make even more profit.
Even though CINICO has some 15,000 clients, he said it was a perception, not a reality, that they were all the uninsurable. CINICO is not the largest insurer, he noted, as one of the private sector companies covers almost 20,000 people.
However, he gave no figures to indicate that the private sector was covering the elderly or people with existing conditions. He said a law has been passed to prevent insurers from removing from the older or more vulnerable customers.
But there was no comment on how that was being monitored or enforced or how much insurance for vulnerable people costs.
See proceedings below.
Category: Government oversight, Health, Health Insurance, Politics
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April 3 Heidrick & Struggles International Inc :
* Heidrick & Struggles announces CEO Tracy Wolstencroft to take medical leave of absence
* Heidrick & Struggles International Inc - executive vice president Krishnan Rajagopalan appointed acting CEO
* Heidrick & Struggles International Inc - will take a three-month leave of absence for treatment of a benign lung condition Source text for Eikon: Further company coverage:
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The Perplexing Psychology Of Saving For Health Care
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Spending your own money on health care might mean that you'll be more frugal with it. That's the theory behind health savings accounts, a decades-old GOP concept that's sparking renewed interest on Capitol Hill as Republican lawmakers look for ways to replace the Affordable Care Act.
HSAs are like personal savings accounts — with a difference. As with a retirement account, money put into an HSA can be invested, and any growth in the fund accumulates tax-free. Withdrawals can be made at any time, and they are tax-free, too — but the money can only be used to pay for certain medical expenses, such as health insurance deductibles, or for copays for hospital care or a visit to the doctor.
Currently, HSAs are only available to people who have high-deductible health plans, meaning they usually pay a few thousand dollars for medical care each year before their insurance kicks in to pay its share. While HSA participation is growing, only about 20 million people out of the 176 million who have health insurance participate in these savings accounts, according to a 2015 report by the Association of Health Insurance Plans.
Why don't more people who are eligible for HSAs have them? For one thing, not everyone has money to contribute upfront. But psychologists and behavioral economists point out that even many people who have the extra cash on hand confront big psychological barriers to saving.
"How we think and feel is directly tied to our ability to make 'good' financial decisions," says Alycia DeGraff, a board member and secretary of the Financial Therapy Association. DeGraff says when faced with financial decisions about the future, many people simply get stressed-out.
"These stressors can become so overwhelming that ... we can become debilitated and ignore the situation all together," she says. "Or we can practice any kind of defense mechanism — entitlement, suppression, overcompensation, isolation, etc. — to try and deal with [it]."
This may explain, at least in part, why middle-class Americans are pretty bad at saving money in general. Only about half of us have money in any sort of retirement account. And those of us who are parents have only saved, on average, enough to pay for about one year at an in-state college for our kids.
Saving money is hard. It means setting aside what we want now for something we think we'll want or need later. And we live in a culture that offers a lot of pretty, shiny, things to buy RIGHT NOW.
Plus, we all pretend we won't get old or sick.
"People are predictably irrational," says Dr. Mitesh Patel, especially when it comes to money. He's a behavioral economist, physician and assistant professor at the University of Pennsylvania's Perelman School of Medicine.
But many of us really hate to lose money, Patel says, which is what makes the concept of HSAs is so appealing.
For example he and his colleagues published a study last year in the Annals of Internal Medicine on what motivates people to lose weight, and found that the way a financial incentive was framed made all the difference.
The researchers observed three groups of people for 13 weeks. They told one group to walk 7,000 steps a day. About 30 percent of the group did so. Meanwhile, people assigned to the second group were told they'd be paid $1.40 every day they walked 7,000 steps. About 35 percent of the second group did so.
Here's the kicker: Each person in the third group was paid $42 upfront and was docked $1.40 each time they failed to meet their goal. Forty-five percent of that group met the assigned goal, Patel says. People hate to lose money.
Another way to encourage more saving might be to make HSAs operate more like the 401(k)s that required people who didn't want to participate to actively opt out of the plan — rather than requiring people who want to contribute to opt in. "This creates a path of least resistance," Patel says.
Of course, setting up and overseeing such a plan would likely cost the government some money, he notes.
People with HSAs do use less health care than those without such plans, a recent study from the Employee Benefits Research Institute suggests. But it's unclear whether they actually improve their health. Prescription drug costs went down for people enrolled in HSAs in the EBRI study, but emergency room visits went up — particularly for lower-income families.
Then there's the issue of figuring out how much you, as an individual or a family, would need to save for health care — it's not easy to find out the average price for a medical test or procedure in your town, let alone how much that price varies from doctor to doctor or hospital to hospital.
"If you want to save for a house, you can pretty much figure out the math," Patel says. "But if you go to a doctor, they don't give you a menu for prices."
To really increase their health savings — or any savings — we'd all need to change our mindset, says Degraff, the financial therapist.
"People would have to first take a dose of reality and get real about their future selves," she says. Naturally, we thing our future selves will be "better, healthier, more financially secure," she adds. But, for many of us, health and income eventually decline with age. We need to save more now for later.
HSAs can be useful, Degraff notes, but only for those who have enough cash to pay their day-to-day expenses — plus a little left over.
"A lot of people don't even have a regular emergency fund savings," DeGraff says, "especially those that are already struggling to pay for health insurance."
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Cash-strapped American cities are increasingly asking their residents to pay higher amounts for mundane services as they struggle to pay for mounting pension obligations, cover costly infrastructure improvements and replace revenue depleted by the last recession. Bills are rising for everything from parking tickets and 911 calls to sewer service and trash pickup.
Click the above audio player to hear the full story.
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Long-term care insurance: Proceed with caution
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The issue: When people live past 65, there is a high probability that they will need some form of long-term care.
The background: A major problem for many insurance companies in the long-term care industry is that they are not profitable or are losing money. People are living much longer now than when many of the long-term care, or LTC, policies were sold. Many of the assumptions actuaries used proved to be erroneous.
For example, it was commonly assumed that 5 percent of policyholders would allow their policies to lapse annually. In fact, only about 1 percent of policyholders have done so.
Another assumption was that insurance companies would be able to invest their capital at a 7.5 percent return. Interest rates, however, have remained below historical levels, and returns in 2017 were approximately 4.6 percent, according to A.M. Best, an insurance industry research, ratings and analysis firm.
Premium alert: Many insurance companies offering LTC policies have either gone out of business or discontinued selling the policies. Most of the companies that remain in the business have taken steps to increase premiums for both existing policyholders and new customers.
Insurance companies cannot arbitrarily raise premiums for existing customers without the approval of the state insurance department. When premium increases have been granted, they have more than doubled. For those who had the foresight to buy these policies many years ago, it seems very unfair.
The majority of policyholders expected that their premiums would remain fixed. Unfortunately, I am not aware of any insurance company that guaranteed premiums would not increase.
Policyholders who have seen their premiums raised significantly are faced with three unpleasant options: pay more, allow their policies to lapse or accept less coverage. This seems unfair because when they bought the policies, they were under the impression that premiums would be stable.
With most other policies, such as term life insurance or standard whole life policies, the premiums are fixed. Now facing substantial premium increases, policyholders are understandably very upset with their insurance companies.
Crunch time: Another factor that makes the situation worse is that many of these policyholders have already retired and have few or no options to increase their income to be able to afford premium increases.
Insurance companies can go to their state insurance departments and try to obtain approval for premium increases. If the insurance department refuses to approve the increases, the insurance company — facing large losses — may have to liquidate.
When an insurance company is forced to liquidate, the policyholder generally loses some coverage. There is no guarantee, when a company does liquidate, that policyholders will receive the coverage they initially contracted for.
The bottom line: Anybody considering buying a standard LTC policy should understand that there is no guarantee that these premiums will be fixed. Prospective policyholders should determine the past history of the company regarding approved premium increases.
They should also review the financial rating of the insurance company, specifically their A.M. Best rating. Only consider companies with top ratings.
Another consideration is how long the company has been offering these policies. Currently, only about a dozen companies still offer LTC policies.
My best advice: I suggest you only consider companies that have been in this business many years, have an excellent financial rating and have not increased their rates or have only increased premiums minimally.
Resource: AARP has an extensive primer on “Understanding Long-Term Care Insurance” here.
Elliot Raphaelson writes for Tribune Content Agency. Contact him at [email protected].
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Twitter: @sdeditgirl
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Six bills have been prefiled in the South Carolina House of Representatives in an effort to protect ratepayers following the collapse of the V.C. Summer nuclear project earlier this year.
The prefiled bills, known as the Utility Ratepayer Protection Package, come as legislators continue to hold hearings in the wake of the project's ending.
The various bills take aim at reforming the state's Public Safety Commission and the Office of Regulatory Staff, creating a new oversight committee, forcing SCANA to issue refunds on the project, halting rate payments by SCE&G that were used to pay for the project, and reforming Santee Cooper.
These bills are will be reviewed by the House Judiciary Committee, according to House Speaker Jay Lucas, due to the pending lawsuits targeting the project's collapse.
“Chairman Peter McCoy and the other 19 members of the House Utility Ratepayer Protection Committee worked tirelessly for three months to carefully craft this package of bills and I commend each of them for their efforts. The House Judiciary Committee should begin debating all six pieces of legislation as soon as possible and ahead of the January session to ensure ratepayers receive the protections they deserve," Lucas said in a statement.
Copyright 2017 WIS. All rights reserved.
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Ever get a surprise medical bill? You're definitely not alone
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A new poll found that more than 400,000 New Jersey families received large and unexpected medical bills over the course of a year.
Joel Cantor, director of the Rutgers Center for State Health Policy, which conducted the poll, says families in the survey said the nasty surprises came from outside and inside their health provider networks.
"For a low-income family, that could be $100. For a high income family, it might take a thousand dollar bill to be considered large," he said.
The prevalence of large and unexpected bills rose to around 1 in 5 among groups such as lower income families, those with less than a high school education, Asian, Hispanic and black residents and people who reported being in poor health.
A proposed law in the state Legislature would require health care providers to disclose when out-of-network providers serve a patient. Following a years-long debate, the Legislature in April passed the "Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act. Gov. Phil Murphy is expected to sign it.
"Our poll suggests that while this new bill in New Jersey will address a big part of the problem, there are other parts of the problem that it will not reach. Surprise medical bills occur, even for people without insurance," Cantor said.
He says if he had to summarize the poll's finding in one word, it would be "complexity."
"This poll really just shows how complex our health care delivery and financing system is today, and the burden really on patients as well as providers and insurers to try to improve information so that people know what to expect."
Joe Cutter is the afternoon news anchor on New Jersey 101.5
Also on New Jersey 101.5:
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Listen To The Story Marketplace Embed Code
Cash-strapped American cities are increasingly asking their residents to pay higher amounts for mundane services as they struggle to pay for mounting pension obligations, cover costly infrastructure improvements and replace revenue depleted by the last recession. Bills are rising for everything from parking tickets and 911 calls to sewer service and trash pickup.
Click the above audio player to hear the full story.
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Judge’s ruling slows plans for Medicaid work requirement
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WASHINGTON (AP) — The Trump administration’s drive to wean poor people from government benefits by making them work has been slowed by a federal judge framing a fundamental question: Are poverty programs meant to show tough love or to help the needy?
U.S. District Judge James E. Boasberg in Washington last week halted Kentucky’s first-in-the-nation experiment with Medicaid work requirements, ruling that the Trump administration glossed over potential coverage losses. He sent the state’s plan back to federal authorities for a harder look.
The debate goes well beyond Medicaid, the federal-state health program for low-income and disabled people.
This spring, President Donald Trump signed an executive order directing cabinet agencies to add or strengthen work requirements for programs including subsidized housing, food stamps and cash welfare. The government’s biggest assistance program for low-income people — the Earned Income Tax Credit — is already designed to supplement earnings from work.
Boasberg found that “medical assistance” is by law a “central objective” of Medicaid. While work requirements might be allowable if that’s what a state wants, “there may be limits to how much (coverage) loss is too much,” he wrote.
Kentucky’s Republican Gov. Matt Bevin wanted to impose work requirements on some 428,000 state residents who got Medicaid under the Affordable Care Act’s expansion. Optional for states, the expansion passed under former President Barack Obama covers about 12 million people nationally, mainly adults.
Kentucky expanded Medicaid under a Democratic governor. Bevin argues that the cost is unsustainable for his state, even with Washington paying at least 90 percent of the bill, because many more people signed up than initially expected. The state estimated that work requirements would save money, reducing the Medicaid rolls by about 95,000 people over five years.
That number got the judge’s attention.
Boasberg ruled that the federal Health and Human Services department didn’t dig deeply enough into the potential coverage losses. The department “paid no attention to that deprivation,” he wrote, and “this oversight is glaring,” amounting to rubber-stamping the state’s request.
Although state and federal officials contend that many people leaving Medicaid would find private coverage, Boasberg said there was no hard analysis, no “bottom-line estimate.”
The ruling seemed to catch the Trump administration unprepared.
Seema Verma, head of the Centers for Medicare and Medicaid Services, called it “disappointing.” The administration may appeal, or it may re-run its evaluation of the Kentucky plan to meet the judge’s concerns. Medicaid work requirements in a few other states are unaffected.
However, the ruling may make it much harder to approve work requirements in states that have not expanded Medicaid. In such states, Medicaid recipients would face a high risk of losing health care because even paltry earnings could make them ineligible for continued coverage.
Verma said the administration won’t be deterred from nudging the poor to go to work.
“We will continue to support innovative, state-driven policies that are designed to advance the objectives of the Medicaid program by improving health outcomes for thousands of low-income Americans,” she said in a statement. Work improves health, the administration argues.
The nonpartisan Kaiser Family Foundation estimates that about 60 percent of adults with Medicaid are already working, and among those not working, most either have health problems, are taking care of home or family or are students.
Advocates for low-income people say they feel like a corner has been turned, even if the issue is far from settled.
“What’s particularly significant is that the judge basically said you have to look at the purpose of Medicaid, which is to provide coverage,” said Judy Solomon of the nonprofit Center on Budget and Policy Priorities. Work requirements “were outside the core objectives of the Medicaid program, and he basically said you can’t ignore the core objectives.”
Others point out that the judge stopped short of deciding the merits of the case, focusing instead on problems with the process that HHS followed in approving Kentucky’s request.
Matt Salo, executive director of the nonpartisan National Association of Medicaid Directors, said work requirements may serve the purposes of Medicaid in some states, particularly if that helps convince conservative lawmakers to expand coverage to more uninsured people.
“There’s a broader issue at play here about maintaining political support and the sustainability of the program,” said Salo. “Does the inability to do a work requirement lead to a scenario where Kentucky is going to get rid of the entire expansion?”
So far that hasn’t happened, but Bevin did cut Medicaid dental and vision coverage in response to the judge’s ruling.
The case is Stewart vs. Azar.
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In mounting a major randomized trial of alcohol's health effects, NIH officials reached out to the beverage industry for funding, the New York Times found.
And another big NIH trial, dubbed ISCHEMIA, is also stirring controversy after leaders instituted a late change to the primary endpoint, writes Larry Husten at Cardiobrief.
What if your state ordered you to screen pregnant women for depression and you had nowhere to send them? (Kaiser Health News)
Hematopoietic stem cell transplant for relapsing-remitting multiple sclerosis found effective in a 100-patient trial. (The Telegraph)
How many drinks did Americans consume during binges in 2015? The CDC now has an estimate.
Another study examines drinking of a different sort: coffee consumption is on the rise. (Reuters)
Essential oils may have an unwanted effect in preteen boys. (BBC)
The FDA is warning again about unapproved erectile dysfunction products.
Three physicians honored with Gold Medals by the Society of Interventional Radiology. (PR Newswire) Find more coverage of SIR's annual meeting from MedPage Today here.
Also getting MedPage Today's gavel-to-gavel treatment is The Endocrine Society's annual meeting, underway through tomorrow.
Medicare will allow coverage of certain "next-generation" genetic sequencing tests for cancer patients, giving additional discretion to local contractors -- which pleased the College of American Pathologists.
Huge student loan debt -- what to do? James Dahle, MD, walks two young professionals through the problem. (Kevin MD)
Morning Break is a daily guide to what's new and interesting on the Web for healthcare professionals, powered by the MedPage Today community. Got a tip? Send it to us: [email protected].
2018-03-19T08:45:00-0400
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Nearly half of Americans will develop pre-existing cardiovascular disease conditions, analysis shows
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A new study projects that by 2035, cardiovascular disease, the most costly and prevalent killer, if left unchecked, will place a crushing economic and health burden on the nation's financial and health care systems. The study was conducted by RTI International for the American Heart Association.
According to the study, in the next two decades, the number of Americans with cardiovascular disease will rise to 131.2 million -- 45 percent of the total U.S. population -- with costs expected to reach $1.1 trillion.
"Mostly driven by the aging of the population, the prevalence and costs of cardiovascular disease are expected to increase significantly in the next 20 years with total costs reaching over a $1.1 trillion by 2035," said Olga Khavjou, economist in RTI's public health economics program and lead author of the study.
The new projections are an update of those made by the association in 2011 that estimated around 100 million Americans would suffer from cardiovascular disease by 2030. Unfortunately, that prediction came true in 2015 -- almost 15 years sooner than anticipated. That same year, the death rate from heart disease rose by 1 percent for the first time since 1969. This latest study projects that by 2035, there will be:
123.2 million Americans with high blood pressure
24 million coronary heart disease patients
11.2 million suffering from stroke
7.2 million Americans with atrial fibrillation
Some other key findings:
By age 45, your cardiovascular disease risk is 50 percent, at 65 it jumps to 80 percent
Black Americans will have the highest rates of cardiovascular disease by 2035, followed by Hispanics
Men will suffer from cardiovascular disease at a greater rate than women between now and 2035
RTI researchers conducted the analysis and developed the methodology for generating these projections.
In addition to the staggering human toll it takes on Americans' lives and health, cardiovascular disease wreaks havoc on our economy. Currently, cardiovascular disease is the costliest disease in our nation, with a price tag of $555 billion in 2016. Yet, today's study suggests that the economic burden of cardiovascular disease will only get worse. By 2035, costs will be in the trillions. Specifically, the total cardiovascular disease costs across all conditions are projected to more than triple among those age 80+ and more than double among those ages 65-79.
The report breaks out the total cost into direct and indirect costs. Direct medical costs related to cardiovascular disease will continue to rise, with costs expected to triple over the next 20 years for Hispanics, more than double among Blacks and be higher for women than men. In addition, expenses associated with cardiovascular disease are expected to surpass medical cost estimates for other chronic diseases, such as diabetes and Alzheimer's. Indirect costs due to cardiovascular disease, or the costs related to lost productivity in the workplace and at home, are projected to be the highest for individuals age 45-64. On average, an employee with cardiovascular disease costs his or her employer nearly 60 hours and over $1,100 more in lost productivity per year than an employee without cardiovascular disease. While white Americans face the highest indirect costs, the report stresses that Hispanics are expected to experience the largest relative increase in costs due to cardiovascular disease over the next 20 years.
To address the escalating burden highlighted in this report, the association recommends the following specific changes in federal policies:
Increased funding for heart and stroke research by the National Institutes of Health
Enhanced focus on prevention to improve and preserve population health from birth to old age
Preservation and expansion of access to high-quality affordable health care
Even though heart disease and stroke account for 23 percent and 4 percent of all deaths respectively, the NIH invests a meager 4 percent of its budget on heart disease research, a mere 1 percent on stroke research and only 2 percent on other cardiovascular disease research. The association believes robust NIH-funded research is our best hope to turn these projections around.
As the report notes, stroke and heart failure account for the most spending in the Medicare fee-for-service program. This scenario reflects how our health care system rewards efforts that treat disease rather than those that prevent them. Prevention programs under the Affordable Care Act have enabled insured patients to obtain blood pressure and cholesterol screenings, smoking cessation services, behavioral counseling for obesity, as well as improved access to primary care and medications needed to help manage their diseases and reduce their risks. Retaining this emphasis on prevention and investments in it will be key to reducing health care costs moving forward.
Finally, protections for patients with pre-existing conditions are vitally important for Americans who have or will develop cardiovascular disease. It is estimated that more than 50 percent of adults under age 65 have conditions that would have precluded them from health insurance coverage under the pre-existing condition and medical underwriting rules that existed in most states before the Affordable Care Act. The association urges Congress to maintain the ban on pre-existing condition exclusions as they consider changes to the ACA. These protections will continue to be critical for Americans with heart disease or stroke now and in future years.
"While we have made tremendous progress in fighting cardiovascular disease, recently reported death rates and these projections reinforce that now is not the time to relax," said American Heart Association President Steven Houser, Ph.D., FAHA.. "We must continue to be vigilant, because if these projections become reality, a serious health and economic crisis is on the horizon. The association welcomes the opportunity to work with Congress and the new administration to find ways to wipe out the burden of cardiovascular disease and build an improved culture of health in our country."
Find the report online at: http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_491543.pdf
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Even if the Affordable Care Act is repealed or significantly changed by Congress and President Donald Trump, the more than 9,900 employees of the City and County of Denver enrolled in one of the three city-offered health insurance plans should not be greatly affected. Heather Britton, manager of benefits and wellness in the city’s Office […]
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Is Globalization a Double-Edged Sword in Healthcare?
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LAGUNA NIGUEL, Calif.—The world is flat, make that flatter, compared to just a couple of decades ago. That has both positive and negative implications when it comes to managing disease and care on a global level.
This was the conclusion of a panel discussion Monday afternoon at Fortune‘s Brainstorm Health conference, which takes place over the course of two days this week here in Laguna Niguel, Calif. (You can follow along on the livestream here.) During the session, a trio of experts discussed the opportunities and challenges of a more globalized world, including cross-border clinical trials, the spread of disease and emerging pathogens and managing supply chains.
“On the supply chain side, it [already] is quite global,” said George Barrett, executive chairman of Cardinal Health. “Even if you think of yourself as a domestic company, it’s very likely you’re dependent on something from around the world.” (In the case of Cardinal Health, its supply of isotopes is being produced in the Netherlands and other regions, for example.)
When it comes to conducting clinical trials on a cross-border level, though, it is still early days and there are many hurdles.
“It’s very complicated to provide therapy that is uniform, to have a clinical trial that can be adopted across the globe,” says Joe Almeida, the chairman, president and CEO of Baxter International. “It takes a while to design trials that satisfy different countries.” (Almeida also noted that, while in the United States, there has been progress in getting clinical trials through, the opposite has been true in some other countries.)
Not surprisingly, the spread of diseases (not to mention unhealthy lifestyles that lead to diseases) on a global level is much easier than coordinating care, managing supply chains and clinical trials and rolling out treatments. Why? Pathogens don’t know borders or regulatory restrictions. And there are plenty of economic incentives for expanding fast food chains and other lifestyle-altering franchises to other geographic regions.
“We are the heaviest and most obese country in the world,” said Michael Milken, chairman of the Milken Institute. “We’re now exporting this enormous burden. The changing of the food chain around the world has dramatically changed the onset of diseases.”
For more coverage of Fortune’s Brainstorm Health conference, click here.
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Hospitals may soon have to post their standard prices for patients online, under a proposed rule unveiled Tuesday by the Trump administration.
Also, the administration is seeking comments on how to stop so-called surprise billing — when patients are charged after unknowingly being seen by out-of-network providers — and how to give patients better information about the out-of-pocket costs they will face.
And officials are ramping up pressure on hospitals to give patients better access to their medical records electronically or face a penalty.
The proposed rule is the Centers for Medicare & Medicaid Services’ latest effort to give patients more information about the cost of health care and about their own medical history. The guidance applies mainly to Medicare patients and providers, but officials expect it will influence practices across the nation’s health care system. It would take effect in 2019.
Related: Trump wants to make it easier for you to access your medical records
The initiative builds on the Obama administration’s efforts to increase transparency. Hospitals are already required to provide either a list of their standard charges or their policies for allowing the public to view the prices. Trump officials want hospitals to post this information on the Internet and make it available in a way that third-party app developers can access.
The administration is also pressing providers to increase the sharing of information among hospitals so patients could see all their records, regardless of where they go for care. Currently, a hospital often gives patients access to their data through its own online portal.
“Our administration is serious about ensuring that when a patient leaves a hospital, they are able to get their medical information electronically,” said Seema Verma, the agency’s administrator.
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UnitedHealth Group's 1Q Earnings Beat Estimates
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UnitedHealth Group, the largest U.S. health insurer, reported a 9.4 percent rise in quarterly revenue, driven by strength in its pharmacy benefit management business.
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The company, which sells employer-based insurance as well as Medicare and Medicaid, said net earnings attributable rose to $2.17 billion, or $2.23 per share, in the first quarter ended March 31, from $1.61 billion or $1.67 per share, a year earlier.
Revenue rose to $48.72 billion from $44.53 billion.
UnitedHealth’s results come a month after legislation to overhaul the U.S. healthcare system was pulled by Republican leaders due to a shortage of votes.
The Republicans’ failure to repeal Obamacare, at least for now, means it remains federal law. President Donald Trump and Republicans have promised to repeal and replace the law.
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(Reporting by Ankur Banerjee in Bengaluru; Editing by Shounak Dasgupta)
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Aug 14 (Reuters) - Unicharm Corp
* Says it has received the approval to extend the deadline of submitting the Q2 report for fiscal year ending December 2017 to Sept. 14, instead of Aug. 14
Source text in Japanese:goo.gl/XpKnCK
Further company coverage: (Beijing Headline News)
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GOP Health Care Law Could Cost Nearly 1 Million Jobs, Report Finds
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The American Health Care Act, the GOP’s answer to Obamacare, could end up costing the U.S. economy close to 1 million jobs, researchers predicted Wednesday.
The bill, if passed as written by the House of Representatives, would start out boosting jobs and increasing economic output because it would cut taxes, the team at George Washington and The Commonwealth Fund found.
But that would change fast, the experts forecast.
“The AHCA would initially cause a brief spurt of economic growth from tax cuts, which primarily help those with high incomes,” said Leighton Ku, director of the Center for Health Policy Research at the Milken Institute School of Public Health at GW, who led the study team.
“However, cuts in funding for Medicaid and health subsidies then begin to deepen, triggering sharp job losses and broad disruption of state economies in the following years,” Ku added.
“Within a decade, almost a million fewer people would have jobs. The downturn would hit the health care sector and states that expanded Medicaid the hardest.”
Related: Here's What the AHCA Would Do
Health care has added an average 22,000 jobs a month so far in 2017, compared to an average monthly gain of 32,000 in 2016,” the Bureau of Labor Statistics said in its May statement. That adds up to 329,000 jobs over the past year.
Changes in total and health care employment due to the American Health Care Act, 2018 to 2026 George Washington University analysis
The more people who have health insurance, the more health care they seek.
The nonpartisan Congressional Budget Office projected last month that the AHCA would lead to 23 million people losing or opting out of health insurance by 2026 and would cut federal spending on health care by $1.1 trillion.
“Our estimates are based on changes in federal funding gained or lost to states, consumers, and businesses,” Wednesday's report reads.
“The AHCA significantly reduces federal funding for Medicaid. It lowers federal match funding for the 31 states and District of Columbia that expanded Medicaid, encouraging them to discontinue their expansions.”
The Center for Medicare and Medicaid Services, part of the U.S. Health and Human Services Department, has a much lower projection for how many people would lose or drop insurance. The CMS actuary calculates that 13 million fewer people would be covered in 2026 under the AHCA.
Related: Will Obamacare Repeal Cost Millions of Jobs?
Health care jobs are an enormous part of the U.S. economy — making for 18 percent of the total Gross Domestic Product or GDP. Hospitals, clinics, doctors and health care services are major sources of jobs, too.
The Senate is working on its own version of the AHCA and it would have to be reconciled with the House version. There’s been little information out of the Senate about what changes are planned for its version, which is being written entirely by the Republican majority.
Conservatives want to reduce federal spending to lower the deficit. Ku and colleagues note that will hit jobs on the state level.
“Federal health funds are used to purchase health care. Then, fiscal effects ripple out through the rest of the economy, creating employment and other economic growth. This phenomenon is called the multiplier effect,” the report reads.
“Health funds directly pay hospitals, doctors’ offices, and other providers; this is the direct effect of federal funding. These facilities use revenue to pay their employees and buy goods and services, such as rent or equipment; this is the indirect effect of the initial spending.”
Related: U.S. Health Spending Grew Especially Fast Last Year
When people spend less money, jobs can be lost.
That would happen in 2018 in 17 states, the report predicted.
By 2026 the 10 biggest losers would be:
New York (86,000 jobs lost)
Pennsylvania (85,000)
Florida (83,000)
Michigan (51,000)
Illinois (46,000)
New Jersey (42,000)
Ohio (42,000)
North Carolina (41,000)
California (32,000)
Tennessee (28,000)
“The Affordable Care Act enabled the U.S. to make substantial gains in health insurance coverage and led to nationwide improvements in health care access and affordability for millions of people,” said Commonwealth’s Sara Collins.
“The deep coverage losses projected under the American Health Care Act would be damaging both to the health of Americans and the state economies in which they work.”
The same team at Commonwealth and GW made similar predictions in January.
Either way, health care spending is likely to grow. CMS projected last February that health care spending will grow by an average of 5.6 percent a year over the next decade. The CMS report released Wednesday projects that health spending would account for 19.9 percent of GDP in 2026.
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Rep. Lois Capps, D-Santa Barbara, on Wednesday spoke out against the Offshore Energy and Jobs Act (House Resolution 2231), which will be considered on the House floor later this week.
The bill dramatically expands offshore drilling nationwide, and mandates immediate oil and gas lease sales off the coasts of Santa Barbara and Ventura counties.
Capps spoke on the House floor Wednesday in opposition to the bill, and sent a letter to the Natural Resources Committee earlier this month opposing the legislation. Similar legislation has been considered on the House floor every year since 2011, but has never advanced in the Senate.
“The so-called Offshore Energy and Jobs Act is nothing more than another old idea that will not become law,” Capps said. “We’ve voted on a form of this legislation in each of the last three years, but it has gone absolutely nowhere every time. Instead of working on new, more sustainable energy ideas, the Majority is yet again wasting time on another misguided, destructive and unnecessary offshore drilling bill. I’m also particularly dismayed that the bill explicitly targets the Central Coast for expanded drilling, despite the fact that local residents have repeatedly made it clear that they don’t want it.”
Capps, a member of the House Committee on Energy and Commerce, will offer an amendment to strike the section of the legislation which mandates the new drilling off the Central Coast. She also proposed an amendment to prohibit new leases on any federal lands adjacent to a coastal state which has a moratorium on offshore oil, gas and mining activities. The Majority did not allow this amendment to be considered on the House floor.
Earlier this week, Capps also reintroduced the California Ocean and Coastal Protection Act (H.R. 2486), which would permanently ban new exploration and drilling for oil and gas off California’s coast.
— Ashley Schapitl is press secretary for Rep. Lois Capps, D-Santa Barbara.
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Trends In Healthcare Insurance Market Outlook-Ken Research
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Market Research Report for Health Care states that Change in lifestyles and luxuries come with the cost and in corporate driven career world, this cost is health. One of the most controversial and debatable topic of the world is healthcare policies and practices. Health insurance is a type of coverage that pays for insured person’s medical and surgical expenses which saves them from huge financial loss. It has been observed that Health Insurance has grown immensely over a decade. Insurance act 1938 even holds a separate special amendment for health insurance different from life and non-life insurance. The most basic and important principle of insurance is UTMOST GOOD FAITH which states that insurer and insured must possess full faith on each other and should disclose all relevant information related to insurance prior to the agreement.
Increase in office hours and unhealthy food intake has made health prime concern for all age groups as it leads to health complications ranging from obesity to cardiac attack. Therefore health insurance has become the basic need of the hour to be away from such unexpected attacks and extravagant expenses attached to it. Older citizens are more prone to chronological illness and diabetes. There are few things to be kept in mind while buying Health insurance for better services:
Market Research: Thorough market research is prerequisite to get best health insurance plan that would fulfill all the requirements of insured.
Coverage Option: In every health insurance there is provision of what would be covered and what not. Therefore beforehand information is beneficial while choosing plan.
Enlisted Specialist: There is a list of specialist enlisted by insurance company, one must always keep them in consideration and ensure there is an alternate medical specialist listed.
Terms and Condition: It’s very important to read all the terms and condition and check all the medical test mentioned to be taken before the insurance plan is signed.
Insured must not hesitate to contact insurer in case of any doubt to avoid any scope of miscommunication and misunderstanding after the agreement is duly signed.
Over the years uninsured citizen rate has decreased in developing and developed countries providing great competitive opportunities to health insurers. Raising option of awareness and altering them to give the best alternative to cater patient needs. According to Health Care Industry Research Report Developing countries like India by 2020 would see a great increase in healthcare industries and thus IRDAI has formed same rules and regulation for government and private health insurance company to ensure safety of client. Government insurance providers are open for negotiation and offer services at discounted rates still people are more inclined towards private sector insurance provider as they have benefit of restoration and offers full coverage on medical expenses. In developed countries such as The United States of America humana, profit insurance provider organization has a great market share than any private provider or AARP. In Europe EHIC is the market leader. The common objective of every health insurance company whether government or private comes down to providing cost- effective and satisfying services to their client.
To know more, click on the link below:
https://www.kenresearch.com/healthcare/general-healthcare/SC-91-64.html
Related Report:
https://www.kenresearch.com/metal-mining-and-chemicals/chemicals/europe-anti-counterfeit-packaging-for-healthcare-industry-situation-and-prospects-research-report/145399-101.html
Contact Us:
Ken Research
Ankur Gupta, Head Marketing & Communications
[email protected]
+91-9015378249
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Feb 2 (Reuters) - Heritage Insurance Holdings Inc:
* HERITAGE INSURANCE HOLDINGS, INC. APPOINTS KIRK H. LUSK CHIEF FINANCIAL OFFICER
* HERITAGE INSURANCE - UNTIL APRIL 28, 2018, MR. LUSK WILL SERVE AS CO-CFO WITH STEVEN MARTINDALE, CO‘S CURRENT CFO
* HERITAGE INSURANCE HOLDINGS INC - STEVEN MARTINDALE HAS AGREED TO REMAIN INVOLVED WITH COMPANY AND HAS BEEN APPOINTED TO COMPANY‘S BOARD OF DIRECTORS Source text for Eikon: Further company coverage:
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Sen. Mike Lee: Americans Don’t Want Obamacare Bailouts
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The Republican Congress that was elected to repeal Obamacare is now considering bailing it out. It shouldn’t.
Earlier this month, America’s Health Insurance Plans, the lobbying arm of the health insurance industry, sent a letter to the Republican leadership demanding billions of dollars in new subsidies for Obamacare insurance policies.
The letter did not mention that health insurance companies are already enjoying record high profits without additional taxpayer subsidies.
Unfortunately, the congressional leadership appears committed to giving the insurance companies what they want. The omnibus spending bill set to be released Monday will likely contain a provision that would send Obamacare insurers $10 billion in “reinsurance” payments a year for three years — 2019, 2020, and 2021.
Instead of repealing the Obamacare regulations that have caused premiums to more than double since 2013, Republicans are set to buy off insurance companies to hide the true cost of rising premiums.
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While advocates for these insurance subsidies argue that these payments will reduce premiums, it’s essential to understand that they do not reduce premiums in real terms.
There’s no real decrease in costs. They hide part of the premium by shifting it to taxpayers. That’s a bailout.
Don’t think for a second that this would be a one-time $30 billion price tag. Why would a future Congress allow a $10 billion annual bailout to end on a cliff in 2022? Insurers’ lobbyists will be back in 2022 leveraging their control over premiums for the spigot to continue.
What congressional leadership would be agreeing to by including reinsurance bailout funds in this omnibus is a $10 billion annual corporate bailout in perpetuity.
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On top of being bad policy, these reinsurance payments will fund abortion unless the Hyde Amendment — a pro-life protection preventing taxpayer funding of abortion coverage — is specifically applied.
Pro-life groups were clear in 2017 that unless the Hyde Amendment is included, any member voting for the reinsurance payments would “not only be voting to sustain what many have called the largest expansion of abortion since Roe v. Wade, but would also be voting to directly appropriate taxpayer dollars for insurance that includes abortion.”
Thus far, none of the bailout proposals have included the Hyde Amendment.
Congressional leadership needs to listen to the voters who sent them to Washington to end Obamacare. In a recent poll, 61 percent of Americans opposed Congress paying health insurance companies to temporarily lower premiums.
RELATED: Johnny Kampis: Trump Should Slow Down Infrastructure Plan
What Americans need is real relief from the Obamacare regulations that are already raising the cost of health care. We need to allow the states to run their own health insurance markets again.
Bailing out Obamacare’s fundamental failures only puts the real goal further out of reach.
Mike Lee is the junior Republican senator from Utah. A version of this Op-Ed appeared on The Daily Signal website under the headline “Americans Don’t Want Obamacare Bailouts.”
The views expressed in this opinion article are solely those of their author and are not necessarily either shared or endorsed by the owners of this website.
What do you think? Scroll down to comment below.
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SUNBURY – It was another economically productive month in the U.S., sparking reaction from around the Valley. U.S. employers added 200,000 jobs in January and wages rose at the fastest pace in more than eight years. Bob Garrett, President/CEO of the Greater Susquehanna Valley Chamber of Commerce joined WKOK’s On The Mark.
He also noted the rising wage growth, “As the job market tightens up, as folks get into those better jobs, those more knowledge-based jobs, we should be seeing more wage growth, and sure it enough now it’s happening.”
Garrett also says the recently passed GOP tax bill brings an immediate tax burden down on your paycheck, “Everybody should be seeing an increase; and particularly in corporate taxes. Remember we have the highest corporate taxes in the industrial world here in the United States. The fact that those are coming down, that just means that companies have more money to invest in workers, in technology, in equipment, to all those sort of things that make us competitive.”
You can hear more reaction from Garrett at WKOK.com.
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Bipartisan legislation could bring more competition to rural Western Slope health care markets
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It's an issue that's been studied to death, but the problem seems very clear: Health insurance premiums on the individual marketplace on Colorado's Western Slope are insanely high and part of a trifecta of economic forces crippling small businesses and entrepreneurs.
Coupled with the high cost of living and tight housing market, health insurance rates for everyone who doesn't get their insurance through their employers — more than 50 percent of people statewide — are prohibitively high.
"What people are coming to realize on both sides of the aisle down here (at the State Legislature) is that this health insurance cost is never going to go away, so it's about time we start looking at the fundamental problems and not be so partisan about it," said Democrat Dylan Roberts, who represents Eagle and Routt counties.
Roberts is a prime House sponsor — along with Rep. Marc Catlin, R-Montrose — of HB-1384, a bipartisan bill that passed out of the House Health, Insurance & Environment Committee by an 8-5 vote on Tuesday, April 17, and to the House Appropriations Committee, which voted 8-5 on Monday, April 23, to send it along to the House floor.
“We have some of the best care in the world; we just don’t have access to it.”Chris RomerVail Valley Partnership Recommended Stories For You
On the Senate side, the bill is sponsored by Kerry Donovan, D-Vail, and Don Coram, R-Montrose.
There are currently 14 counties in Colorado, including Roberts' original home of Routt County (he now lives in Eagle), that have just one health insurance company available on Connect for Health Colorado, the state's individual-market health-insurance exchange. Eagle County has two companies available on the state exchange: Anthem and Kaiser.
If it passes both the House and Senate and is signed into law by Gov. John Hickenlooper, HB-1384 directs both the state Department of Health Care Policy and Financing and the Division of Insurance to come up with three different health insurance plans using the state's existing health care infrastructure in an effort to create more competition in those underserved counties.
The three plans need to be submitted to the legislature by February of next year, which would give lawmakers the rest of the next legislative session (ending in May 2019) to pick a plan and run a bill that would then finally begin lowering rates by generating more competition.
Plan Options
One of the plans the bill requires a proposal for is an option to allow Coloradans to purchase a health insurance plan through the state's Medicaid department. It's hoped a so-called "public option" in Colorado would create competition and drive down rates for private plans.
Right now in Eagle County, insurance brokers say a family of five pays about $2,800 a month for an Anthem plan or $2,000 a month for a Kaiser plan on the individual market — much less if they can keep their income below certain levels and qualify for Advanced Premium Tax Credits under the Affordable Care Act. But those income levels are very low for a expensive place such as Vail.
"Congress could help stabilize these insurance costs, but that's unlikely to happen anytime soon," Roberts said. "Many middle-class families must choose between paying for health insurance and paying for housing, child care or college tuition. This bill will set forth detailed options for how we can bring badly needed competition to the market."
The second plan his bill requires the two state departments to study is a public-private partnership plan modeled after the federal Children's Health Insurance Program, or CHIP.
And the third option the bill studies is what Roberts dubs a regional or community-based co-op plan that would allow small companies to band together to negotiate a group plan with a private insurance company. Sponsored by a chamber or business association, the group would then have the increased buying power of a much larger company such as Vail Resorts.
"This model works in other places like Wyoming and Missouri, and we're trying to see if we can duplicate it in Colorado," said Chris Romer, of the Vail Valley Partnership. "But there are a lot more rules in Colorado that make it harder, and at the federal level, they're trying to make it easier and we as a state are pushing back on it. That doesn't make a lot of sense."
ALL SOLUTIONS NEED TO BE EXPLORED
Romer said he's talked to Colorado's Interim Insurance Commissioner Michael Conway, who last month wrote a letter to the U.S. Department of Labor opposing rule changes that would make "multiple-employer welfare groups" easier to set up. Conway's concern is the plans would allow for coverage exemptions that pull healthy people out of other plans.
Romer said all possible solutions need to be explored aggressively to bring down health insurance costs on the Western Slope.
"In an environment with an already high cost of living and with employee retention challenges increasingly reliant on entrepreneurs, health care and housing are two issues that are the straws that break the camel's back in terms of being able to truly grow and scale an entrepreneurial business here," Romer said. "We have some of the best care in the world; we just don't have access to it."
Roberts said the $360,000 price tag for the bill is what generated the five "no" votes in committee, but that's the cost of the two state departments hiring accountants and the economists to do the actuarial analysis of the three plans. And he points out the current budget has the money to come up with a legislative solution for one of the Western Slope's most intractable problems.
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The Pennsylvania Insurance Department wants opioid addicts and their families to be better informed about the range of insurance coverage options for substance abuse treatment.
The state agency has released a brochure titled, “Substance Use Disorder and Your Insurance Coverage,” which outlines coverage options under the Affordable Care Act, employer-provided health insurance, and government programs such as Medicaid and Medicare.
The brochure outlines how the source of health care coverage determines what treatment coverage options a person has, or whether the treatment is covered at all.
Although the information was already online, the agency first made the brochure available on Aug. 3 at a meeting on the opioid crisis held by the Diocese of Greensburg at Our Lady of Grace Parish in Greensburg.
“We chose to release the information at the Diocese of Greensburg meeting in order to provide an additional resource to people who may be looking for help for themselves or a loved one,” said department spokeswoman Ali Fogarty.
The brochure notes that insurance plans that have Substance Abuse Disorder coverage must offer the same level of benefits as they do for medical or surgical treatment – a concept known as parity.
Services that are subject to parity rules and must be covered at the same level as medical or surgical benefits include: the number of outpatient visits; out-of-pocket costs, such as co-pays, deductibles and co-insurance; prior authorization requirements; the provider network for out-of-network services; and the criteria used to determine medical necessity.
Dave Buono, consumer liaison for the Insurance Department, will give a presentation on insurance coverage at 7 p.m. Wednesday at St. Thomas More University Parish in Indiana – the last of seven Summer Diocesan Drug Education and Prayer Service Evenings with Bishop Edward C. Malesic.
The brochure can be found on the Pennsylvania Insurance Department website .
Stephen Huba is a Tribune-Review staff writer. Reach him at 724-850-1280, [email protected] or via Twitter @shuba_trib.
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| 34,839 |
Health insurance reform passes lower house
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People under 30 could be the biggest winners from the Turnbull government's push to make private health insurance more affordable.
The package, which passed parliament's lower house on Thursday, will allow insurers to offer young people a two per cent discount on their premiums every year up to a maximum of 10 per cent.
The changes will allow some people to increase their excess in exchange for lower premiums - up to $750 for singles and $1500 for families.
People with hospital insurance that does not offer full cover for mental health treatment will be able to upgrade their cover and access mental health services without a waiting period on a once-off basis.
Insurers will be able to offer travel and accommodation benefits for people in regional and rural areas that need to travel for treatment.
Health insurance policies will be categorised into gold, silver and bronze.
Health Minister Greg Hunt said the package would address concerns about affordability and complexity.
"This government continues to take pressure off private health insurance premiums with the introduction of these reforms delivering the lowest annual premium change in almost two decades," Mr Hunt told parliament on Thursday.
Labor's health spokeswoman Catherine King outlined her party's plans to cap premium increases at two per cent a year.
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11:06
Cooper on HB2: 'Today, the legislature had the chance to do the right thing for NC and they failed'
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| 34,840 |
Lawmakers: safeguard health insurance for young adults
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The dependent child coverage provision should remain intact regardless of any new health laws.
Since the Patient Protection and Affordable Care Act was signed into law in 2010, I have been able to live with the comfort of knowing I was protected — I would be able to stay on my parents’ health insurance plan until I turn 26 as part of the dependent child coverage provision.
The ACA, also known as “Obamacare,” is not universal coverage, but it subsidizes the cost of insurance for those who cannot afford it. It also mandates that people buy insurance, or else pay a fine. The law has had its fair share of controversy, as conservatives claim coercing Americans to buy insurance is unjust.
But one of the most popular aspects of the ACA, regardless of party affiliation, is the dependent child coverage provision, which allows young adults like myself to stay on their parents’ plans until they’re 26 years old. According to a December poll conducted by the Pew Research Center, 85 percent of Americans, including 82 percent of Republicans, have a favorable opinion of this mandate.
It has been a comfort knowing that despite any potential financial crises I might experience as a student, or as a recent graduate, I wouldn’t have to worry about having health insurance.
But with the swearing-in of a new president and some new members of Congress insistent on repealing the ACA, it feels like that comfort isn’t so secure — despite the fact that recent polls have shown the ACA has higher approval ratings than ever.
The dependent child coverage provision both eases the burden on people during a financially stressful period of their lives, and makes for a healthier, more insured population. This is a law that specifically helps college-aged adults, and Republican and Democratic legislators alike should make it a priority to preserve this provision, whether it remains in the ACA or a different, future health care plan.
“It was offered because of the changing nature of the workforce, and the probability that a 22- or 23-year-old person graduating from college might not be presented with a full-time job that had benefits,” said professor Robin Kolodny, the political science department chair.
Jed Cainglet, a freshman computer science major, is currently insured through his parents, and he said he supports the dependent child coverage provision.
“It’s extremely helpful for students who, after graduation, are still looking for a job,” Cainglet said. “It gives us time to prepare to get our own insurance.”
This is what makes the provision so valuable: people who formerly fell through the cracks, too old for their parents’ plan but too young to buy their own, can now more easily be insured.
Megan Lehman, a freshman biology major, is currently insured through her parents.
“Right now, I work to pay for school,” she said. “I’m planning on going to more school after this. I don’t think I would be able to afford [health insurance].”
In 2008, when the ACA was being drafted, adults ages 18 to 25 had the highest uninsured rate of any age group in the country at 27.6 percent. By 2016, the rate had fallen to 14.8 percent.
This sizable dent in the uninsured population should be proof enough that this provision is worth keeping. But despite the added benefits for young people, many Republicans have been insistent on repealing and replacing the ACA, citing rising premiums and a lack of competition between insurance providers.
This potentially puts those covered by the dependent child coverage provision at risk, as the future of the ACA is called into question. It’s not clear what a new health care plan would mean for young adults or if there would be a gap in coverage as a new plan is instituted.
Health insurance can be expensive and confusing — especially for financially insecure young adults. If the ACA is repealed, and young people need to find a different way to be insured, many will likely forgo insurance altogether.
“The annual screening for things like your cholesterol and blood pressure will be lost,” Kolodny said. “If someone was going to develop a problem that was going to turn into something more significant, you’ve given up the opportunity to catch it in a visit.”
The provision doesn’t exclusively help a largely uninsured population receive health care. Catherine Maclean, an economics professor, said it also has positive effects on the health care market.
“The dependent coverage mandate brings young people into the market,” Maclean said. “Those people are on average healthier, have lower health care expenditures, and are less likely to get sick.”
The health insurance market is complex and unpredictable. But on all counts, the dependent child coverage provision is valuable to citizens and insurers alike.
Even if the future of the ACA comes into question by Republican lawmakers, the dependent child coverage provision should remain safeguarded for the sake of young people.
Luke Mottola can be reached at [email protected].
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Credit up to $1,000 for those paying 10% of income on student loans.
Minnesota Senator Jeremy Miller (R-Winona) has introduced a bill that he believes will help a group that is often overlooked in the college-affordability discussion.
Senate File 941 is a tax credit of up to $1,000 for those individuals paying at least 10 percent of their income in student loan debt.
"I think it's important to look at ways to help offset the debt that students or graduates have already accumulated," Miller told WIZM.
Since both houses are Republican controlled, Miller believes the legislation should pass as part of a larger tax bill.
"I do believe that there is support for this type of proposal and I'm hoping we can get it passed this year," Miller said. "It doesn't solve the issue of student debt but it's a step in the right direction."
Miller sees the discussion on college students is focuses on affordability but those saddled with debt are often forgotten.
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| 34,841 |
Tax Plan Targets Affordable Care Acts Individual Mandate
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Consumer advocates warn that tax breaks that primarily benefit corporations and the top one percent of earners could lead to cuts to Medicare and Medicaid. (Getty Images)
DENVER – As Republicans work to bridge divides between the House and Senate versions of their new tax legislation, consumer advocates are warning that the measure could have significant health consequences.
By removing the Affordable Care Act's mandate for all people to buy health insurance, the GOP hopes to keep deficits low enough to pass the law with a simple majority vote.
Adam Fox, director of strategic engagement for the Colorado Consumer Health Initiative, says that won't help working families in Colorado or anyone struggling to pay for coverage in the individual marketplace.
"It will end up leaving 13 million more Americans uninsured, and that includes an estimated 235,000 Coloradans," he warns. "On top of that, it will increase insurance premiums by double digits every year."
Fox says that without the mandate, younger and healthier people could choose to not buy insurance, and that would leave more older and sicker people in risk pools, which would drive up costs. He says Coloradans who already face rising premiums on the individual marketplace could see those costs increase by an additional ten percent each year.
Supporters of the move claim middle-income families will see losses in health subsidies offset by additional tax cuts.
Fox notes that while tax cuts for corporations will be permanent, cuts for the middle class are set to be phased out. He's also concerned that the GOP's proposal to increase the federal deficit by $1.4 trillion will result in cuts to social programs that middle-class and struggling families rely on.
"In the GOP budget, we know that they ask for $1 trillion in cuts to Medicaid and another $400 billion in cuts to Medicare," he says.
GOP leaders have promised that tax cuts will boost the economy and pay for themselves. A conference committee is currently working to create a unified version of bills already passed in both the U.S. House and Senate.
Fox says Coloradans have about a week to contact their representatives and weigh in on the proposal.
Eric Galatas, Public News Service - CO
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March 19 (Reuters) - SA’s Competition Tribunal:
* CONDITIONS FOR NETCARE, AKESO DEAL INCLUDE: NETCARE SHALL MAINTAIN BASE TARIFF CURRENTLY IMPLEMENTED AT AKESO FACILITIES
* CONDITIONS FOR NETCARE, AKESO DEAL INCLUDE: NETCARE WILL HONOUR AKESO’S EXISTING CONTRACTUAL AGREEMENTS
* CONDITIONAL APPROVAL TERMS NETCARE TO NOT ALTER TARIFF CLASSIFICATIONS AT AKESO FACILITIES FOR EXISTING TREATMENT MODALITIES
* CONDITIONS FOR NETCARE, AKESO DEAL INCLUDE NETCARE WILL DISPOSE OF RAND HOSPITAL AND BELL STREET HOSPITAL Further company coverage:
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| 34,842 |
New York Plans To Force Uber To Add Tipping Option
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For $25 -Also,has a chat bot now. Message it for stories and more. Check out the new SourceForge HTML5 Internet speed test!
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A new poll found that more than 400,000 New Jersey families received large and unexpected medical bills over the course of a year.
Joel Cantor, director of the Rutgers Center for State Health Policy, which conducted the poll, says families in the survey said the nasty surprises came from outside and inside their health provider networks.
"For a low-income family, that could be $100. For a high income family, it might take a thousand dollar bill to be considered large," he said.
The prevalence of large and unexpected bills rose to around 1 in 5 among groups such as lower income families, those with less than a high school education, Asian, Hispanic and black residents and people who reported being in poor health.
A proposed law in the state Legislature would require health care providers to disclose when out-of-network providers serve a patient. Following a years-long debate, the Legislature in April passed the "Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act. Gov. Phil Murphy is expected to sign it.
"Our poll suggests that while this new bill in New Jersey will address a big part of the problem, there are other parts of the problem that it will not reach. Surprise medical bills occur, even for people without insurance," Cantor said.
He says if he had to summarize the poll's finding in one word, it would be "complexity."
"This poll really just shows how complex our health care delivery and financing system is today, and the burden really on patients as well as providers and insurers to try to improve information so that people know what to expect."
Joe Cutter is the afternoon news anchor on New Jersey 101.5
Also on New Jersey 101.5:
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kor_Hang
| 34,843 |
No Fault Law- Pre-existing condition aggravated by automobile accident may trigger no-fault liability
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WASHINGTON (AP) — Medicare will require hospitals to post their standard prices online and make electronic medical records more readily available to patients, officials said Tuesday.
The program is also starting a comprehensive review of how it will pay for costly new forms of immunotherapy to battle cancer.
Seema Verma, head of the Centers for Medicare and Medicaid Services, said the new requirement for online prices reflects the Trump administration's ongoing efforts to encourage patients to become better-educated decision makers in their own care.
"We are just beginning on price transparency," said Verma. "We know that hospitals have this information and we're asking them to post what they have online."
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Hospitals are required to disclose prices publicly, but the latest change would put that information online in machine-readable format that can be easily processed by computers. It may still prove to be confusing to consumers, since standard rates are like list prices and don't reflect what insurers and government programs pay.
Patients concerned about their potential out-of-pocket costs from a hospitalization would still be advised to consult with their insurer. Most insurance plans nowadays have an annual limit on how much patients must pay in copays and deductibles — although traditional Medicare does not.
Likewise, many health care providers already make computerized records available to patients, but starting in 2021 Medicare would base part of a hospital's payments on how good a job they do.
Using electronic medical records remains a cumbersome task, and the Trump administration has invited technology companies to design secure apps that would let patients access their records from all their providers instead of having to go to different portals.
Verma also announced Medicare is starting a comprehensive review of how it will pay for a costly new form of immunotherapy called CAR-T. It's gene therapy that turbocharges a patient's own immune system cells to attack cancer.
Immune system T cells are filtered from the patient's own blood and reprogrammed to target and kill cancer cells that had managed to evade them. Hundreds of millions of copies of the revved-up cells are then returned to the patient's blood to take on the cancer.
Though only a couple of such treatments have been approved for blood cancers, the cost can exceed $370,000 per patient.
"It's a new area for the agency," said Verma. "We haven't seen drugs priced at this level and we're having to think about our strategy."
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eng_Latn
| 34,844 |
Tax Deadline Still Means Health Insurance Questions
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Federal income taxes are due April 18 and, likely for several million people, so is a fine for failing to get health insurance.
Despite a lengthy debate, Congress has not yet acted on a bill to repeal portions of the Affordable Care Act. That means the law and almost all of its regulations remain in force, for now.
It's not too early to think about managing your taxes and minimizing the hit to income. Jon Sweeney / NBC News
For the majority of tax filers, who had insurance through an employer or government program for 2016, all they have to do is check the box on Form 1040 that says they were covered for a full year. That's it.
Under a decision by the Trump administration, however, leaving that box blank will not get your tax return kicked back to you. The IRS under President Barack Obama also did not reject returns with the box left blank last year or the year before, but it had announced it would step up enforcement of what's known as the "individual mandate" for tax year 2016. That plan was canceled under Trump's executive order calling on federal agencies to "minimize the burden" of the health law.
Related: Six Things You May Not Know Could Go With Obamacare Repeal
Still, those who lacked insurance for more than three consecutive months, or who bought individual insurance and got federal help paying the premiums, need to do a little more work.
Those with no insurance or a lengthy gap may be required to pay what the federal government calls a "shared responsibility payment." It's a fine for not having coverage, on the theory that even those without insurance will eventually use the health care system at a cost they can't afford and someone else will have to pay that bill.
Many people without insurance, however, qualify for one of several dozen "exemptions" from the fine. Nearly 13 million tax filers claimed an exemption for 2015 taxes, according to the IRS. The most common were for people whose income was so low (less than $10,350 for an individual) that they are not required to file a tax return, Americans who lived abroad for most of the year and people for whom the cheapest available insurance was still unaffordable (costing more than 8 percent of their household income).
Related: Should You Even Sign Up for Obamacare?
The fine for 2016 taxes is the greater of $695 per adult or 2.5 percent of household income. Fines for uncovered children are half the amount for adults. Fines are pro-rated by the number of months you or a family member was uninsured.
The maximum fine is $2,676; that is the national average cost of a "bronze" level insurance plan available on the health exchanges. But most people do not pay anywhere near that much. Last year, said the IRS, an estimated 6.5 million tax filers paid a fine that averaged $470.
Related: Seven Ways Trump Could Make Obamacare 'Explode'
If you bought your own insurance from the federal or a state health insurance exchange and you got a federal tax credit to help pay for that coverage, you also have to take a step before you can file your taxes.
People who got those tax credits must fill out a form that "reconciles" the amount of subsidies they received based on their income estimates with the amount they were entitled to according to their actual income reported to the IRS.
In 2016, 5.3 million taxpayers had to pay the government because they got too much in tax credits, compared with 2.4 million who got additional money back. But among those who underestimated their incomes and had to pay back some of those tax credits, 62 percent still received a net refund on their taxes.
This story was contributed by Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation and a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
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BY FRANK CAMPILLO
The Republican-led Senate just passed a bill to reform America’s corporate and individual taxes on a split and mainly partisan 51 to 49 votes. All 48 Democrats voted “no” and Republican Sen. Robert P. Corker of Tennessee joined them on the vote. Republicans are now closer to sending the legislation to President Donald Trump’s desk with the House voting soon to formally set up a conference committee that will finalize the final version of a compromised tax bill. The House had already passed its tax reform legislation earlier in November.
Although . . .
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Apple reportedly in talks with Aetna to bring the Apple Watch to millions of customers
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Apple and Aetna have held several secret meetings to discuss offering the Apple Watch to Aetna’s 23 million customers, according to CNBC.
These meetings, held on Thursday and Friday of last week in Southern California, reportedly involved top executives from both companies, including Myoung Cha, who is in charge of Apple’s special health projects, and hospital chief medical information officers from across the country.
Aetna could roll out the plan as early as next year, according to a CNBC source.
This is not the first time Apple has joined up with the health insurance company. Aetna already offers the Apple Watch to its 50,000 employees. Aetna also announced last September it would be offering the Apple Watch to select large employers and these talks could be an extension of that announcement.
Aetna now reportedly has ambitions to offer it to a wider field — adding large swaths of new health data to pull from and giving the health insurance company insight into the activities of its customers.
The deal also would be beneficial to Apple, which heavily promotes the Apple Watch for health and fitness and briefly became the top wearable vendor this year, beating out Fitbit before Xiaomi took the top spot in Q2.
Apple also has been secretly hiring biomedical engineers and beefing up work on sensors for tracking blood sugar levels and detection of other diseases, which would come in handy for any health insurer wanting data-driven insights into its customer base.
Of course, whether customers will be willing to give up that information in exchange for the Apple Watch remains to be seen.
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Eleven health insurers filed 88 health plans for Washington state’s individual market yesterday, and all 39 counties will be covered in 2019.
Once again, Premera Blue Cross is the only insurer for Grays Harbor residents on the exchange, while Pacific County will be down to only Premera as Lifewise Health Plan of Washington is no longer listed as an option.
In a release, the Office of Insurance Commissioner(OIC) Mike Kreidler released a list of the proposed rate changes for plans throughout the state.
Proposed 2019 individual health insurers by county
These proposed rate changes are targeted for release on June 4.
“We can all breathe a sigh of relief knowing consumers in every county who need coverage will have access to a health plan in 2019,” said Insurance Commissioner Mike Kreidler. “Obviously, how much premiums may change and any increases to out-of-pocket costs are still key concerns, but I’m grateful that we can assure people that coverage is available, regardless of where they live.”
Last year, Grays Harbor and Klickitat Counties initially had no option for individual health insurance, although negotiations from Kreidler encouraged Premera Blue Cross to cover Grays Harbor and Bridgespan and Molina to cover Klickitat.
In addition to Grays Harbor, Kreidler says that Premera has made assurances to offer coverage should any county be without an individual health insurer for 2019.
About 300,000 people in Washington buy their own individual health insurance coverage.
Kreidler’s office will review all proposed health plans and their proposed rate changes over the next several months with decisions coming in the fall.
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Ballooning bills: More U.S. hospitals pushing patients to pay before care
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FILE PHOTO: An emergency sign points to the entrance to Scripps Memorial Hospital in La Jolla, California, U.S. March 23, 2017. REUTERS/Mike Blake/File Photo
Last year, the Henry County Health Center in Iowa started providing patients with a cost estimate along with pre-surgery medical advice.
The 25-bed rural hospital in the southwest corner of the state implemented the protocol because of mounting unpaid bills from insured patients, a group that had previously not raised red flags.
Henry County is one of hundreds of U.S. hospitals trying to cope with an unexpected consequence of the Affordable Care Act of 2010, known as Obamacare: millions more Americans have health insurance, but it requires them to spend thousands of dollars before their insurer kicks in a dime.
Since U.S. hospitals do not want to end up footing the bill, they are now experimenting with pre-payment strategies for patients, with a growing number requiring payment before scheduled care and offering no interest loans, according to interviews with more than two dozen hospitals, doctors, patients, lenders and healthcare experts.
“Most patients are appreciative that we’re telling them up front,” said David Muhs, chief financial officer for the Henry County hospital, which provides a discount for early payment. The discussion leads some patients to skip care, others to delay it or use a no interest loans available through the hospital, he said.
The ACA extended insurance to 20 million Americans, which initially helped hospitals begin to shrink debt from uninsured patients who could not pay their medical bills. But more and more, people in Obamacare plans or in employer-based health plans are choosing insurance that features low monthly payments. The trade-off is high out of pocket costs when they need care. (For a graphic, click tmsnrt.rs/2oCzePS)
If President Donald Trump dismantles Obamacare as promised, these plans won't disappear. Republicans also believe high-deductible plans curb spending, and Americans faced with medical costs that rise faster than inflation and wages will look for premiums they can afford.
The trend is expected to accelerate this year because unpaid bills are creating massive bad debt for even the most prestigious medical centers. U.S. hospitals had nearly $36 billion in uncompensated care costs in 2015, according to the industry’s largest trade group, a figure that is largely made up of unpaid patient bills.
The largest publicly-traded hospital chain, HCA Holdings Inc, reported in the fourth quarter of 2016 that its ratio of bad debt to gross revenues of more than $11 billion was 7.5 percent.
One of the first to test this new payment strategy was Novant Health, headquartered in North Carolina with 14 medical centers and hundreds of outpatient and physician facilities. It saw patient debt increase when more local employers started adopting high deductible plans, including one that made its executives pay $10,000 in out-of-pocket expenses.
“To remain financially stable, we had to do something,” said April York, senior director of patient finance at Novant, whose patient default rate dropped to 12 percent from 32 percent after it started offering no interest loans through ClearBalance.
“Patients needed longer to pay. They needed a variety of options,” she said.
IMPACT ON PATIENTS
These prepayment strategies are being rolled out by hospitals across the country because the financial equation has changed so much for patients – even the insured ones.
Almost half of Americans – 45 percent - polled by the Kaiser Family Foundation said they would have difficulty paying an unexpected $500 medical bill. The average deductible this year for the least expensive of the widely used Obamacare health plans is $6,000 for an individual - an 18 percent spike since 2014 - and more than double that for a family, according to government data.
Jessica Curtis, a senior advisor at Community Catalyst, a consumer advocacy group in Boston, said the impact on patients stretches beyond personal finance.
“They delay procedures, they don’t follow advice on prescription drugs, and when they see care, they usually are for more expensive procedures because they’ve waited,” she said
Brian Sanderson, managing principal of Crowe Horwath's healthcare services group, said communicating with patients and providing longer repayment options is a good strategy since hospital margins have shrunk, thanks to growing unpaid medical bills from consumers.
“A well informed patient is more likely to meet their obligations,” he said. “It’s just good patient relations and it helps to minimize bad debt.”
Hospitals are doing what they can to retain patients while helping them pay medical bills that could run thousands of dollars. Many are expanding charity eligibility, and hiring companies like ClearBalance, AccessOne and Commerce Bank to provide loans to patients no matter what their credit. Most carry no interest rate for the patient, and could be extended far longer than the few months that hospitals once required before sending a bill to collections.
“People are more likely to pay a bank than a hospital,” said Mark Huebner, director of Health Services Financing at Commerce Bank, which offers its line of credit at more than 200 hospitals.
“People are aware that banks will come after them. Banks do collect on debt, and hospitals generally have been more relaxed,” he said.
Wake Forest Baptist Medical Center in North Carolina had seen its bad debt creep up in recent years as more patients saw out of pocket expenses soar, with some deductibles reaching $15,000.
“We’ve seen that many patients are unaware of the increases in their deductibles,” said CFO Chad Eckes. Wake Forest now asks for payment before non-emergency services are provided but also offers zero interest, longer repayment options.
“It’s a challenging position,” he said. “It’s a discussion no one wants to be in, and none of us enjoy.”
(Editing by Caroline Humer and Edward Tobin)
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GRAND RAPIDS, Mich. – A local medical supply company has informed its patients of a potential cyber breach.
Airway Oxygen, Inc. sent letters to customers this week notifying them of the potential breach. The letter says an “unidentified criminal” had gained access to the company’s infrastructure and had installed ransomware, a type of malware designed to keep the user from getting to their data. The company says they were learned of the breach on April 18.
The company says that there is no indication that health information of customers was accessed, but they are recommending customers to watch for fraud and to place fraud alerts with a consumer reporting company like Equifax, TransUnion, or Experian.
The company says they are taking steps to secure their internal systems against further intrusions and they have reported the incident to the FBI.
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Kentucky Cuts Benefits for 460,000 on Medicaid
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As many as 460,000 Medicaid beneficiaries in Kentucky have had their dental and vision coverage cut by Republican Gov. Matt Bevin's administration.
The move was announced on the weekend and came after Bevin's Medicaid overhaul plan was blocked Friday by a federal judge, the Associated Press reported.
Officials in Bevin's administration blamed the cuts on the judge's ruling, saying it removed a "legal mechanism" to pay for Medicaid dental and vision coverage for hundreds of thousands of people, and left too little time to reverse planning for the state's Medicaid overhaul.
Officials also said they were working to reinstate the dental and vision benefits, the AP reported.
The cuts were condemned by Democrats and others.
The Bevin administration's "short-sighted" actions are already causing confusion and hardship, according to Democratic state Rep. Joni Jenkins, the AP reported.
"We have folks that are showing up for dental appointments that they made months ago and neither they nor the providers are really certain what the rules are," she said. "And that's just unacceptable for government to be operating this way."
Jenkins also warned that the cuts could increase drug addiction in Kentucky, the AP reported.
"We know that untreated dental pain is a huge gateway to addiction to painkillers," Jenkins said.
The cuts were "totally uncalled for" and could lead to another court challenge, according to Sheila Schuster, an advocate for the disabled and people without health insurance, the AP reported.
"The real question is: Are they within their legal authority to suspend benefits that are part of this program and are part of the essential health benefits without any due notice and without any hearings?" Schuster said. "I think that's a question to be resolved in the courts."
The court ruling against Kentucky's plan to overhaul its Medicaid program was also a setback for the Trump administration, which has encouraged states to impose work requirements on Medicaid beneficiaries and make other changes to the program, the AP reported.
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Kathy Swan (Source: www.house.mo.gov)
Kathy Swan (Source: www.house.mo.gov)
How did the Governor's legal troubles affect the state legislature, and how will it change the Missouri GOP moving forward. Kathy Swan talked with KFVS today about the last few months and what's next. Swan said she felt the legislature was not affected and says the number of bills they passed is proof. This past session they passed 149 bills. That's up near double from the previous session where they only made it through 76. But as far as the GOP's future goes, it's too e...
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Provides an extra $45billion for military and domestic programs for 2014 .
Afghanistan war chest to be boosted by further $85.2bn under new plans .
But health fund will be cut by $1billion to prevent spending on Obamacare .
Measures aim to ward off second crisis after 16-day shutdown in October .
Democrat Senator: 'Bill simply cannot reflect the wants of only one party'
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By . Simon Tomlinson . Congress has unveiled a $1.1 trillion spending bill that aims to prevent another government shutdown which boosts funding slightly for military and domestic programs - but not for 'Obamacare' health reforms. With a deadline looming at midnight tomorrow for new spending authority, lawmakers will still need a three-day stop-gap funding extension to ensure enough time for passage of the spending bill this week. The measure eases across-the-board spending cuts by providing an extra $45 billion for military and domestic discretionary programs for fiscal 2014, to a total of $1.012 trillion. It also provides an additional $85.2 billion for Afghanistan war funding that is typically handled off-budget. 'Can't please everyone': Senate Appropriations Committee Chair Barbara Mikulski (center) said a new $1.1trillion spending bill unveiled by Congress yesterday could not reflect the wants of just one party . The spending measure fills in the details of a budget agreement passed in December in the aftermath of a 16-day shutdown of many government agencies in October. The shutdown was prompted largely by disputes over funding for 'Obamacare' health insurance reforms. Although many programs will get a slight increase over 2013 levels and avoid steep cuts previously slated for this year, the proposed bill does not provide any increase for implementation of the Affordable Care Act, President Barack Obama's signature healthcare reform law. According to a House Republican summary, a public health fund will be reduced by $1 billion to prevent Health and Human Services Secretary Kathleen Sebelius from 'raiding' these funds to spend on Obamacare insurance exchanges. Boost: The bill provides an extra $85.2 billion for Afghanistan war funding that is typically handled off-budget . The chairs of the Senate and House of Representatives Appropriations Committees said in a joint statement that the deal will eliminate the economic instability caused by Congress' recent funding battles. 'As with any compromise, not everyone will like everything in this bill, but in this divided government a critical bill such as this simply cannot reflect the wants of only one party,' Democratic Senator Barbara Mikulski of Maryland and Republican Representative Harold Rogers of Kentucky said in a statement. White House Budget Director Sylvia Mathews Burwell said the measure will help fund critical investments in education and infrastructure. 'This legislation adheres to the funding levels in the budget agreement enacted in December, unwinds some of the damaging cuts caused by sequestration,' she said in a statement. The military avoids about $22 billion in the across-the-board cuts, with total non-war spending of about $520.5 billion under the bill, while agencies focused on domestic programs will get $491.8 billion, representing an increase of about $22 billion over sequester levels. Blow: The proposed bill does not provide any increase in funding for implementation of the Affordable Care Act, President Barack Obama's signature healthcare reform law . But some controversial budget items took a hit. The . spending measure provides no funds for high-speed rail projects, and it . again denied a funding transfer needed to pay for critical reforms to . the International Monetary Fund. But both Republicans and Democrats touted a provision in the bill that reverses planned military pension cuts for disabled veterans, a controversial part of the December budget deal that helped pay for about $6 billion in new spending. Military retirees of working age were to see smaller cost-of-living increases in their pensions starting in 2015, but it was later discovered that the change was inadvertently applied to disabled veterans and survivors of deceased veterans as well. While the spending bill will reverse the cuts for disabled veterans and survivors, many Republicans in Congress still want to cancel the cuts for all retired military service members. Negotiations on the measure bogged down as lawmakers attempted to attach policy provisions on issues ranging from restricting abortions to curtailing regulation of carbon emissions. Many of these were successfully fought off, including new abortion provisions, Mikulski told reporters. Democratic aides said the bill includes no new provisions prohibiting regulations on greenhouse gas emissions, nor forestry and stream management. They also prevented new gun-rights language from inclusion. But Republicans did get a policy provision into the measure that prohibits funding of the Obama administration's 'light bulb standard,' which prohibits the manufacture of incandescent light bulbs in favor of newer technologies that reduce energy consumption. Passage of the measure would leave just one more significant fiscal policy hurdle during the current fiscal year which ends on September 30 - an increase in the federal debt limit. This will likely be needed by March or April to avoid a default on the Treasury's debt and the resulting market turmoil.
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Critique: Wolf Blitzer said government should delay Obamacare until website is fixed . Wolf Blitzer has hit out at the White House over the launch of Obamacare saying the health insurance marketplace is not ready for the programme. The CNN anchor urged the government to listen to advice from the Republican party and hold off on the health insurance scheme until the website providing the care cover plans work properly. Since the launch on October 1, the state website Healthcare.gov has experienced problems which has resulted in thousands left unable to sign up for affordable health cover. ‘If they weren’t fully ready, they should accept the advice that a lot of Republicans are giving them. 'Delay it another year, get it ready, and make sure it works,” Blitzer said on CNN yesterday. ‘They know how to do it, but if they didn’t get it ready on time, then maybe fix the problem and make sure people don’t have to worry about it,’ he added. Despite efforts by thee Health and Human Service Department to fix HealthCare.gov and other associated websites glitches have frustrated millions of consumers unable to complete their applications. The website problems gave Republicans reason to hit back at the Affordable Care Act, known better under the name given to it by the opposition – ‘Obamacare’. 'Americans have seen once again that Obamacare is not ready for prime time,' Rep. Eric Cantor of Virginia, the No. 2 House Republican, said in a statement on Friday. 'A dysfunctional website is the least of that law's problems,' he added. The government made an attempt to turn the online issues into positive coverage, blaming the glitches on high demands. 'Americans are excited to look at their options for health coverage, with record demand in the first days of the marketplaces,' said the release announcing the planned fixes. The statement was headlined: 'Health Insurance Marketplace Open for Business - Week One Success.' Problems: Ms Hill says the 'terminate' button on the Health Insurance Marketplace did not work . Confused: Technology experts and government officials are stumped about the reasons for the computer glitches plaguing the Obama administration's launch of new health insurance exchanges . The . state-level markets were designed to be the gateway to health insurance . for people who don't have access to coverage on the job. Middle-class . consumers will be able to buy government-subsidized private plans, . while the poor and near-poor will be steered to Medicaid in states . agreeing to expand the program. Glitch in the plan: The launch of the Affordable Care Act's health insurance marketplace has not been a smooth ride for Obama . Federal . and state websites experienced problems this week. Some states, . including Maryland, have also announced they are scheduling repairs. The . federal site, which serves 36 states, drew millions of users, an . indication of strong consumer interest. Yet many people were unable to . get on the site. They encountered a screen that told them to wait, and . they did, sometimes for hours. Refreshing the screen only sent them to . the back of the line. Quite a . few got hung up trying to create security questions to protect their . accounts. The drop-down menus providing the questions would not . populate. As a result, . consumers could not advance through the application process and learn if . they were eligible for a tax credit to help pay premiums, much less . pick a plan. Some who did make it through were timed out because they took too long comparing plans. To . add insult to injury, the first days of Obamacare saw a lukewarm . interest in signing up for cover. California, the ultimate blue state . whose federal lawmakers voted overwhelmingly in support of Obamacare, . turned less than 1 per cent of its Web visits into 'Covered California' participants on Tuesday. Connecticut . saw a similarly low rate of interest with 28,000 visitors, and took 167 . applications for health insurance, indicating just 0.59 per cent of . Connecticut residents who sought information about their state's . Obamacare program on Monday decided to become part of it.
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What would Donald Trump replace Obamacare with?
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What should Donald Trump propose as an alternative to Obamacare?
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If the ACA is repealed, what options would I have if my insurance carrier denies coverage based on my pre-existing condition?
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What is reinsurance?
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What is reinsurance? How is it useful, and what are the limits?
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What do we think about religion?
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Despite Health Law, Uninsured Rely On Prevention Care Patchwork
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The federal health law gave a huge boost to insurance coverage for preventive care, mandating that nearly all health plans provide cancer screenings, checkups and, more controversially, contraceptives to people without an extra charge. But those requirements won't help the 30 million or so people who are expected to remain uninsured despite the law. They will still lean on a patchwork of prevention services whose federal and state funding are anything but certain. Among those who could still be without insurance are low-income people in states that aren't adopting the health law's expansion of Medicaid, immigrants in the country illegally and those here legally but not yet eligible for Medicaid. Poor preventive care coverage hits women particularly hard. Women's reproductive care needs are greater than those of men, requiring regular visits for exams and contraceptives. Women's health advocates say many women who want to ensure that their visits to health care clinics for birth control and other reproductive health services remain confidential frequently choose not to use insurance, even if they have it. "The Affordable Care Act is wonderful in expanding coverage to millions of women, but it's very difficult to obtain confidential services if you're a dependent on anyone else's policy," says Kinsey Hasstedt at the Guttmacher Institute. There are programs available that help uninsured and low-income people get the preventive care they need, but advocates worry that funding, which is always precarious, will be further cut because of the misperception that starting next year everyone will have insurance that covers preventive care. The health law requires that health plans provide preventive services recommended by the U.S. Preventive Services Task Force without any out-of-pocket cost to patients. The only exception is for grandfathered plans. For example, the Centers for Disease Control and Prevention runs two cancer screening programs for uninsured and underinsured people with incomes up to 250 percent of the federal poverty level ($28,725 in 2013). The National Breast and Cervical Cancer Early Detection Program provides screening in all states and the District of Columbia. The Colorectal Cancer Control Program is smaller, operating in half the states. A 2012 analysis published by researchers at George Washington University and the Lewin Group estimated that if every state expanded Medicaid under the federal law, 1.7 million low-income uninsured women would still be eligible for that breast cancer screening in 2014 and 4.5 million women would be eligible for cervical cancer screening. An additional 1.6 million men and women would be eligible for the colorectal cancer screening program, says Leighton Ku, a professor of health policy who co-authored the study. Patient advocates are working to ensure the screening programs aren't cut back. "We don't want to take steps backwards," says Citseko Staples Miller, senior specialist for state and local campaigns at the American Cancer Society's Cancer Action Network.
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Back in 2006, when many municipalities across the country took Arizona's lead passing stringent laws against illegal immigrants, the Dallas suburb of Farmers Branch became a kind of poster boy. With much controversy, the city passed legislation that among other things barred anyone from renting property to undocumented immigrants. Yesterday, after more than six years and a legal battle that cost the city of 29,000 residents at least $6 million, the 5th Circuit Court of Appeals in New Orleans ruled the ordinance was unconstitutional because it infringed upon federal government duties. NPR member station KERA reports: "The ordinance would have required all renters to obtain licenses before renting. City inspectors would've been able to check an immigrant's status and deny licenses to any undocumented workers. Landlords who rented to immigrants without permits would have faced fines or removal of their renters' licenses. "Other towns have fought to put in place similar laws with mixed success. A federal appeals court ruled against a renter's ordinance in Hazleton, Pa., but a different court ruled in favor of another ordinance in Fremont, Neb." The latest ruling, reports The Dallas Morning News, relies heavily on a Supreme Court decision declaring parts of Arizona's immigration laws unconstitutional. The paper reports: "Judges also found fault with the city's plan to fine or revoke the renters' licenses of landlords who leased to immigrants without permits. "'The ordinance not only criminalizes occupancy of a rented apartment or single-family residence, but puts local officials in the impermissible position of arresting and detaining persons based on their immigration status without federal direction and supervision,' the court said." The city said it would review its options. This was the city's second appeal.
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Listener: Hit By A Car, Helped By Negotiated Care Rates
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Matthew Kime, a freelance photographer and Web designer in Brooklyn, bought health insurance coverage through a freelancers collective. Kime writes from WNYC land: I consider myself someone young and healthy so I didn't see a point in buying the expensive plans that most people are used to. I did a lot math. To come out ahead, I'd have to go to the doctor about once a month. In a given year, I'm unlikely to go to the doctor at all. The plan itself is very simple. Under $10k, nothing is covered. I consider to be bankruptcy protection rather than healthcare. However, I do get the negotiated rate for services and that's where things get weird. Eventually I did make use of the plan. About a year ago I was hit by a car while riding my bike. Thankfully I walked away from the accident. Read More >> One concerned and very generous bystander called an ambulance which I refused to get into despite everyone's advice. I knew it would be a really expensive ride to the hospital and while I was very shaken, I felt fine. I literally couldn't find anything wrong with myself and if not for a bent wheel, I would have continued my ride home. Strangely, the EMTs can't do anything but haul you back to the hospital if you're conscious. If there was anything to check for at that point they were either unable or restricted from checking. More generally, this is a decision I don't think anyone with "real" insurance would have made. A few days later I did go and see a doctor as my ankle had become swollen and bruised. The doctor thought it was likely broken and recommended me to a specialist to get xrays to confirm. The xrays proved I was fine and my ugly ankle was nothing to worry about. Services rendered -- Two doctor visits and one xray. A few months later I got a statement from the insurance company regarding my first doctor's visit. It itemized the expenses, listed the amount the office charges and the negotiated rate. I have no idea what to do with this thing. It doesn't even provide an address to send payment. Then I get a statement from the doctor's office saying I owe the full amount. I don't remember how I figured out how to reconcile the bills but this is how it goes -- you send payment to the doctor for the amount itemized by your insurance company. Doctor says, You owe $300. I say, Here is $120, my insurance company says that's how much I owe. Do we do business in that manner anywhere else in the country? If so, I'm unfamiliar with it. And that's if things go properly. But they almost never do. About nine months later I get a statement from the specialist saying that I owe x amount and that I'm 9 months late. I call my insurance company to see if they have my statement. As it turns out, the specialists didn't fill out the paperwork properly and the insurance company had been waiting for them to correct it. In particular, they needed a statement saying this wasn't a pre-existing condition. I don't know what can be less pre-existing than getting hit by a car but something must have gotten distorted in the game of telephone. A couple months later I get the complete paperwork. It's taken the doctor nearly a year to get paid. And how much money did the negotiated rate save me? About 20 percent. That's not bad, but I saved more than 50 percent for the first doctor's visit and a visit to an allergist brought it closer to 70 percent.
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In the mid-1980's a woman who didn't consider herself a feminist was asked to solve perhaps the biggest problem women face. How she and a small group of people seized on that rare moment and fought back in the hopes that something could finally be done. If you would like to read more on the topic, here's a list: No Visible Bruises by Rachel Louise Snyder Equal: Women Reshape American Law by Fred Strebeigh Know My Name by Chanel Miller We love to hear from our listeners! Tweet at us @throughlineNPR, send us an email, or leave us a voicemail at (872) 588-8805.
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Why Is The Medical Device Tax Taking Center Stage?
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Moderate Republican lawmakers say they have found a way to end the government shutdown — a proposal they say President Obama will agree to. The bill would fund the government for another year, while also taking aim at the Affordable Care Act by repealing the medical device tax that helps pay for health care reform. Noam Levey, national health care reporter for the Los Angeles Times, tells Here & Now that most of the major medical device manufacturers are in states where Democrats are in power. “Democrats have joined Republicans to support efforts to repeal this tax,” he says. Guest
Noam Levey, national health care reporter for the Los Angeles Times. He tweets @NoamLevey.
JEREMY HOBSON, HOST: Well, yesterday, we heard on the show from a moderate Republican congressman who said that the key to reopening the government could be repealing the medical device tax that helps pay for the Affordable Care Act. So what would that mean for medical device makers and for the health care law? Joining us with answers is L.A. Times national health care reporter Noam Levey, welcome. NOAM LEVEY: Thank you. HOBSON: Well, first of all, just tell us what the medical device tax is. LEVEY: So, starting this year, medical device makers - who make everything from surgical gloves to CT scans - will be subject to a 2.3 percent tax on sales. And it's important to understand that this tax is not on consumer products like Band-Aids or eyeglasses, for example, but for - or even wheelchairs - but for these products that usually are used by hospitals, by medical offices, critical to the delivery of health care. And... HOBSON: And we're talking about what kinds of things, then? LEVEY: It's basic things like gauze and surgical gloves that are used in hospitals. It's very complex, artificial valves, for example, in hearts, scanners, other very complex diagnostic equipment that, you know, is integral to the delivery of health care in this country. HOBSON: And this is just a 2.3 percent tax on these devices. LEVEY: Correct. HOBSON: So what's the big deal? LEVEY: Well, like any industry, device makers don't particularly like the fact that their products are being taxed, and they have claimed that if this tax goes into effect, it will cause them to lose jobs, to ship manufacturing overseas, and will otherwise hurt, you know, what is a $100 billion industry in this country, and one that has generated quite a lot of innovation over the years. HOBSON: And you've been reporting on this. How much of that is just bluster, and how much of it is real, that this would have a big impact on their bottom line? LEVEY: Well, it appears that a lot of it is bluster. The important thing to understand about the way the tax is structured is that it's on sales in this country. So we don't anticipate that hospitals are going to stop buying surgical gloves, for example, or that they're going to stop buying CAT scanners. And even if manufacturing is moved overseas, those products would still be subject to a tax when they come into the United States. So there's some question about whether or not the impact on the industry will be as large as the industry claims. Now, it is important to note, of course, that anytime the government imposes a tax on a business sector, any business sector, most businesses pass along those costs to consumers in one way or another. So the argument could be made, I think, that if you're trying to control overall health care spending, if you impose a new tax, that's probably not going to contribute to that broader effort. HOBSON: And we should note that this is all a big part of raising money to pay for other parts of the Affordable Care Act. This medical device tax was projected to raise $30 billion in the next decade. LEVEY: That's right, and when the Affordable Care Act was written, three-and-half, four years ago, the authors of the law - including the Obama administration - were looking for ways to ensure that the law didn't increase the deficit. And so they imposed some new taxes in the law, and they also sought contributions from various sectors of the health care industry, the thinking being that if the federal government was going to pay to provide health insurance to tens of millions of currently uninsured Americans, that would essentially deliver a lot of new paying customers to hospitals, to drug makers, to insurance companies and to device makers. HOBSON: So tell us about the opposition, because it's not just from one side of the aisle. This is coming from both Republicans and Democrats, some of them in states with big medical device makers, so maybe a lot of money at stake for them. But tell us about the opposition. LEVEY: Well, this is a little bit of a Washington story. I mean, nobody who - none of the industries that were hit with these taxes and contributions were particularly happy about them, so you could ask: Why is it the device makers, of all of the stakeholders here, how do they get the ear of Congress
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In China, a U.S. factory executive is being held captive in his office by his own workers. He's Chip Starnes, a co-owner of the Florida-based Specialty Medical Supplies. It hasn't been a violent takeover. In fact, Starnes has been able to get a few words out to the press.
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Battle Continues Over Abortion In High-Risk Insurance Pools
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The battle over whether the new federally-funded program to help people with pre-existing health conditions will pay for abortions just won't go away. Last week, the Obama administration said it would not allow funding for elective abortions in the new program, which it's calling "Pre-existing condition insurance plans," despite claims to the contrary by anti-abortion groups. That set off a backlash by abortion-rights groups, who claim the administration is knuckling under to a few anti-abortion Democrats. Read More As of now, both sides are still unhappy. The conservative website CNS News reported Friday that Maryland would provide federally-funded abortion coverage in its high-risk pool -- a charge Maryland officials were quick to deny. But its abortion-rights advocates who are feeling particularly angered by this latest Administration action. On the one hand, they question whether the administration even has the legal authority to impose the ban, since the high-risk pools were not mentioned in the abortion-restricting language in either the bill or the executive order the President issued in exchange for winning the final votes of abortion-opposing Democrats. But even if it does, wrote Jessica Arons of the Center for American Progress on the Reproductive Health Reality Check blog, there's a simple question of fairness -- the final deal on the health law was that it was supposed to neither expand nor contract abortion availability. "Abortion opponents who participated in the bargaining did not raise concerns about high risk pools or other specific potential sources of federal funding, and they should be able to live with the deal they made," Arons wrote. And there's a reason many states currently cover abortion in their existing high risk pools, wrote Douglas Laube of Physicians for Reproductive Choice and Health: "Many women entering the high risk pools have underlying medical problems, like cancer and diabetes, that make pregnancy risky. They must have abortion available as a backup if their birth control fails, or if a planned pregnancy unexpectedly threatens their health, as happened to me when a kidney transplant patient experienced dangerously high blood pressure in her third month of pregnancy." As with all things abortion-related, this is not a battle likely to end any time soon. Check out my conversation with Robert Siegel on All Things Considered tonight. ROBERT SIEGEL, host: The Obama administration is finding itself on the defensive with a usually reliable ally: abortion rights groups. They are furious that the administration is banning abortion coverage in a new program that's part of the health insurance overhaul law. The program is meant to provide coverage with pre-existing health conditions. NPR's Julie Rovner joins us now to explain what's going on. Hiya. JULIE ROVNER: Hiya. SIEGEL: And tell us about the new program. These are the high-risk pools. ROVNER: That's right. Basically, they're for people who have health problems that make it otherwise impossible for them to get health insurance. In fact, in order to get insurance through this program, you have to prove that you've been denied coverage by another health insurer and that you've been uninsured for at least six months. Now, this is a temporary program. It will end in 2014, when these new health insurance exchanges begin. There is $5 billion in federal funding to either help states run their own programs or have the federal government run these high-risk pools. SIEGEL: Now, take us back to passage of the overhaul in March. I thought there was a promise made that federal abortion funding would be banned as part of the new law. ROVNER: Well, yes and no, and that's what this current fight is about. If you remember, in order to get the health bill passed, Democrats needed the votes of members of their party who both support and oppose abortion, which was no mean feat. In the end, President Obama promised to issue an executive order barring federal abortion funding. But the executive order only extends to the new health insurance exchanges, which as I just said don't start until 2014, and to community health centers. SIEGEL: So you're saying that there's a loophole for these high-risk pools. ROVNER: Well abortion rights groups are saying there's a loophole for these high-risk pools, and they're saying that that's not insignificant. They point out that women with cancer or diabetes or MS or whatever else makes them eligible for the high-risk pools in the first place are also more likely to have high-risk pregnancies that could result in the medical need for an abortion, which is why many existing state high-risk pools actually offer abortion as a covered service now. SIEGEL: And what does the Obama administration say? ROVNER: Well, so far they're saying they're following the rules of the health plans for federal workers, which also ban abortion except in cases of rape, incest or when the life of the woman would be endangered
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Just as quickly as Democrats in the legislature rolled out their new plan for health care reform, influential business groups called it dead on arrival. The state Chamber of Commerce and others said that too much of the cost of insuring millions more Californians would still be strapped on the backs of employers. But, some consumer groups appear ready to drop their opposition to a controversial issue: forcing everyone to have insurance.
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Presidential Candidates Weigh In on Health Care
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Health care has emerged as one of the most significant domestic issues facing the presidential candidates this year. In a July Gallup Poll, only the situation in Iraq was cited as a more pressing problem. Nearly 60 percent of those surveyed said their health care costs had risen in the past year. A separate survey by NBC and the Wall Street Journal found that worries over health care were contributing to an overall gloominess about the U.S. economy. And older voters in the early-balloting states of Iowa, South Carolina, Florida, Nevada and New Hampshire tell AARP that candidates' positions on health care will be important to deciding their votes. Major candidates from both parties have been offering up proposals to control the cost of health care and provide better coverage for millions of uninsured Americans. Nearly all of the candidates agree that quality could be improved and money saved through greater use of information technology, best medical practices, and consumer information that allows patients to shop around. Here's a sampling of their other proposals: Republicans Rudolph Giuliani --Deregulate insurance market to encourage lower-priced policies. Where state mandates limit affordable options, Giuliani would allow the purchase of insurance across state lines. --Change tax law to put insurance purchased by individuals on the same footing as employer plans, for payments up to $15,000. --Health insurance tax credit to help low-income people buy insurance. Mitt Romney --Deregulate insurance market to encourage lower-priced policies. --Change tax law to put insurance purchased by individuals on the same footing as employer plans. --Federal subsidies for those who can't afford full-priced insurance (but who make too much money to qualify for Medicaid). This is similar to the plan Romney helped institute as governor of Massachusetts. But it lacks two elements of the Massachusetts plan: a requirement for larger employers to provide health insurance or contribute to a state system; and a requirement for individuals to obtain health insurance. John McCain --Has not outlined a health care proposal. Democrats Hillary Clinton --Require all individuals to have coverage. Tax credits would be provided to ensure that no one pays more for insurance than a set percentage of their income. --Provide new choices of public and private health plans. The public plan will be similar to Medicare. Private plans would be similar to those offered to federal workers and members of Congress. --Require large employers to either cover their workers or else contribute to the costs of those coverage costs. Tax credits would be provided to encourage small businesses (those with fewer than 25 workers) to provide health insurance, but they would not be required to do so. Tax credits would also be provided to large employers with high retiree health care costs. The estimated $110 billion annual cost would be financed by a variety of mechanisms, including repealing some of President Bush's tax cuts for those earning more than $250,000. It would also be offset through savings from better management of chronic health conditions and streamlined administration of the health care system. John Edwards --Employers must provide insurance for workers or pay into government system. --Change tax law to put insurance purchased by individuals on same footing as employer-provided coverage. Edwards would go farther than Romney by offering a refundable tax credit to those who don't owe income tax. --Create nonprofit regional purchasing pools to offer a variety of insurance plans to businesses and indivduals. At least one plan would be a government plan, based on Medicare. Over time, this might evolve into a single-payer system, if that's popular. --Expand Medicaid to cover more people, using additional federal funds. --New requirements on insurers to prevent them from denying coverage on the basis of age, pre-existing conditions, etc. --After these other steps are complete, require everyone to buy insurance. Dennis Kucinich --National, nonprofit, single-payer health care. Barack Obama --Allow individuals and small businesses to buy into national plan in the same manner that federal employees do. --Provide subsidies to those who can't affored premiums but who earn too much to qualify for Medicaid. --Create a National Health Insurance Exchange to provide individuals with more options. Participating private insurers would have to offer plans as good as or better than national plan. --Expand Medicaid and SCHIP to cover more people. --Require employers to help cover their workers, or pay into national plan. --Retain flexibility for states that want to continue with their own health care experiments.
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Editor's note: Live special coverage for this event has ended. Seven Democratic candidates took the stage Thursday night to participate in the sixth and final primary debate of the year, hosted by PBS NewsHour and Politico. NPR hosted live audio coverage of the debate online and on many public radio stations. Read NPR's live online analysis here. Due to narrowed qualification standards, only seven candidates appeared onstage: Vice President Joe Biden; Vermont Sen. Bernie Sanders; Massachusetts Sen. Elizabeth Warren; Minnesota Sen. Amy Klobuchar; South Bend, Ind., Mayor Pete Buttigieg; businessman Tom Steyer; and entrepreneur Andrew Yang. For a post-debate recap, subscribe to the NPR Politics Podcast.
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Should We Pity The Insurance Companies?
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By now we've all heard about the money being wasted in our health insurance system. You'd think it would be in the insurance companies' interest to get rid of the needless spending. If they could do that, then they could charge lower premiums and attract more patients. Lately at Planet Money, we've been asking why that hasn't happened. One answer is the insurance folks give us is that hospitals have been joining forces -- agreeing on protocols for treatment and presenting a united front. Insurance companies say that when they try to get hospitals to eliminate unnecessary tests or perform more efficiently or charge less for certain services, the hospitals just say no and there isn't much the insurers can do. The insurance companies have some backing for their complaint. A study from 2004 by the Center for Studying Health System Change concurs that hospitals now often have the upper hand in these battles. One particular fight was referred to as a "sumo-wrestling match." The group's report from 2001 found showdowns erupting, with hosptials and health care providers willing to play chicken during negotiations. Read More >> Throughout the years of debate over health care, hospitals have often taken the position that they know what is best for patients and don't want insurance companies dictating care. From their perspective, it's the insurance companies who are the bullies. An excellent map from the Associated Press shows that often one insurance company does dominate a local market. And if you missed Steve Inskeep's interview on Morning Edition with Wellpoint CEO Angela Braly, it's worth a listen. Wellpoint is the country's largest insurance company as measured by the number of people covered.
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Good morning. Former Federal Reserve chair Alan Greenspan tells the BBC that a global economic crisis "will happen again". Greenspan says people in prosperous times can't stop themselves from believing that leaner time are inevitable. The Wall Street Journal finds the overhaul of financial regulation is faltering, a year after the Lehman Brothers collapse. Surprising words from the Financial Times, which reports that Goldman Sachs CEO Lloyd Blankfein has attacked some investment banking products for lacking "social utility" -- or as the FT paraphrases it, for being "socially useless." Banks expect to haul in $27 million on overdraft fees this year from checks and debit cards. The New York Times reports that 2.8 million households are carrying interest-only mortgages that will soon become a lot more expensive. The loans looked like a great deal when home values were rising. Now, not so much. As NPR's Chris Arnold reports, the threat of foreclosures remains a big, big problem for banks.
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In New Hampshire, Skating For The Visually Impaired
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After a late-winter thaw, temperatures are dropping again in the Northeast. In Portsmouth, New Hampshire, it will stay below freezing for much of the weekend. And that will give a group of people who live with blindness one last chance to do something many of us take for granted. Jason Moon (@jasonmoonNHPR) from Here & Now contributor New Hampshire Public Radio explains.
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Massachusetts Gov. Mitt Romney signed legislation Wednesday that would make his state the first in the nation to require every resident to have health insurance, just as drivers must have automobile coverage.
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What Happens To Obamacare If Individual Mandate Disappears?
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Republicans' tax overhaul gets rid of the tax penalty for people who fail to maintain insurance coverage. If it becomes law, what happens to the deficit and the number of uninsured?
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Justice Department files notice that it agrees with a federal judge's ruling that the ACA should be thrown out. The administration had previously said it wanted only parts of the law invalidated.
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Health Differences May Explain Medicare Spending Variation
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The idea that uneven Medicare health care spending around the country is caused by wasteful practices and overtreatment — a concept that has influenced portions of the federal health law — took another hit in a study published Tuesday. The analysis concludes that differing levels of health of people around the country explain between 75 percent and 85 percent of cost variations in Medicare. "People really are sicker in some parts of the country," said Dr. Patrick Romano, one of the authors. That's a sour assessment for those hoping to wring large savings from the health care system by making it more efficient. Some, such as Peter Orszag, President Barack Obama's former budget director, assert that geographic variations in spending could mean that nearly a third of Medicare spending may be unnecessary. Their views were based on wide differences in spending, which in 2011 ranged from an average of $14,085 per Medicare beneficiary in Miami to $5,563 per beneficiary in Honolulu. The latest look at spending differences comes as an Institute of Medicine panel prepares a report on whether Congress should pay less to hospitals and doctors in areas where there is heavy use of medical services, and more in regions where spending is lower. That report is due out this summer, but an interim report indicated that the panel was opposed to the idea, though it said there is much unexplained geographic variation between regions. Medicare is already moving ahead with efforts to rein in high-spending hospitals and doctors, albeit not on a regional basis. As directed by the health law, the government in October 2014 intends to start penalizing hospitals whose patients cost Medicare the most. Medicare is also authorizing so-called accountable care organizations, partially inspired by Dartmouth's research, to create financial incentives for physicians to avoid extra tests and treatments. The new paper is one of the sharpest attacks yet on the work of the Dartmouth Institute for Health Policy & Clinical Practice, whose three decades of research have popularized the theory that unexplained differences in spending among regions are the result of some physicians being more aggressive in diagnosis and treatment, in large part because it enriches them. The theory, popularized by a 2009 New Yorker article on high spending in McAllen, Texas, has divided health policy experts. "The trouble with Dartmouth is they were trying to spin a simple story from a world which is far more complex and far more nuanced," said James Reschovsky, the lead author on the paper published in the journal Medical Care Research and Review. Dartmouth economist Jonathan Skinner called the critical study "fatally flawed" in an email. He noted that the Institute of Medicine's preliminary report stated: "Although a non-trivial amount of geographic variation can be explained by specific demographic and, potentially, health status variables, a substantial amount of variation remains unexplained."
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Remember that panoramic shot of all those health care lobbyists in the Senate hearing room? Well NPR's Dollar Politics team is now digging around in the latest lobbying disclosure reports. They've tallied up how much money the brand-name pharmaceutical industry spent in three critical months of the health care debate -- April, May, and June. The total? A whopping $40 million. And that's just one side of one part of the debate. Here's a cool graphic breaking down the money among the 45 different DC lobbying shops PhRMA hired in those months. And here's the main story, on tonight's All Things Considered
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Mass. Leads Nation with State-Wide Health Plan
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Massachusetts Gov. Mitt Romney signed legislation Wednesday that would make his state the first in the nation to require every resident to have health insurance, just as drivers must have automobile coverage.
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On Sept. 23, insurance companies will no longer be allowed to place a lifetime limit on the benefits they pay out. For the vast majority of people with health insurance, the caps have been nothing to worry about. But lifting the limits is one of several changes taking place next week as a result of the new health care overhaul law.
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Mandatory Health Insurance May Hit Middle Class
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All the health care bills circulating through Congress, including one unveiled Wednesday — require people to carry health insurance. The bills also include some government subsidies to help them pay for it. The latest bill, however, provides less generous subsidies, which could make it harder for middle-class families to afford the mandatory insurance.
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Republicans' tax overhaul gets rid of the tax penalty for people who fail to maintain insurance coverage. If it becomes law, what happens to the deficit and the number of uninsured?
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Mayo Clinic: America's Model?
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The Mayo Clinic keeps popping up as a model for how Americans should get their care. There's hardly a better brand-name around, but could the Mayo approach, melding lower-than-average cost and better-than-average quality, really work everywhere? NPR's Linda Wertheimer asks Mayo Clinic President and CEO Denis Cortese on Tuesday's Morning Edition. Yes, he says, the Mayo model "is transportable--with difficulty." The key ingredient is instilling a culture among physicians that puts the needs of patients first, he says. We thought the Hippocratic Oath was supposed to cover that, but evidently even the modernized version used in many med schools isn't up to the task. Read More >> Wertheimer zeroes in on one of Mayo's secrets--putting doctors on salary. Doesn't that hurt recruiting? Pay at Mayo is "competitive," despite the salary approach, Cortese says, and turnover is low. When it comes to the patient's experience, taking a doctor's pocketbook out of the care equation makes a big difference. Paying doctors by the procedure, or for treating sicker people can create conflicts, Cortese says. "If they end up doing less, keeping people healthier or keeping them at home, they may actually make no money," he explains. Cortese argues for payments to providers of health care based on the value they provide--not the number of procedure they perform. If Medicare paid providers of good value care a little more--enough to give them a 2% profit margin--practices like Mayo's "would grown indefinitely," he says. For another view, check out the Washington Post's deep Mayo dive over the weekend. One skeptic, Richard Cooper, a U Penn professor of medicine, tells the Post, "It's not [Mayo's] model. It's their patients and money. If you have the money, you can attract good staff, good doctors, good nurses."
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NPR's Mary Louise Kelly speaks with Gabrielle Mayer, who is graduating from medical school early to help the coronavirus-positive patients coming into Bellevue Hospital in New York City.
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Recession Hits States' Mental Health Budgets
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The shooting of Rep. Gabrielle Giffords in Tucson led to fresh scrutiny of gaps in the nation's mental health system. With the spotlight fading some, the National Alliance on Mental Illness, an advocacy group, took a look what's been happening to mental health spending at the state level. The group found that states cut $1.8 billion, or about 8 percent, from their total mental health budgets from 2009 to 2011. The cuts are compromising an already frayed system, according to NAMI's report out today. And the reductions come as demand for community-based services is actually going up in most states, according to the National Association of State Mental Health Program Directors. Continue Reading Since 2010, states have cut or plan to cut 3,930 state psychiatric beds, which represents more than 8 percent of capacity, according to NASMHPD Research Institute data. And NAMI executive director Michael Fitzpatrick says the latest cuts — affecting emergency and long-term hospital treatment, mental health case workers and crisis teams — stand to make things much worse. "People end up involved in the criminal justice system, living in homeless shelters and going to the emergency room," he said. Thirty-two states and the District of Columbia have cut their mental health budgets since 2009. The budget ax in Kentucky was the most severe, cutting 47.5 percent of the budget. Alaska was second at 35 percent. Health services haven't fared as badly as some other budget items. "States are making budget cuts across the board, and few areas are exempt," says Stacey Mazer, senior staff associate at The National Association of State Budget Officers. "If anything, due to the financial aid from the Recovery Act funds, education and Medicaid tend to be areas that are cut last after" other government functions, such as administrative services, accounting and parks. But Kevin Martone, president of NASMHPD, says that "because mental health services have traditionally been paid for out of state general revenues, the impact of the downturn in the economy has been more devastating on these services than to other safety net services for general healthcare." State general funds, which are administered by state mental health authorities, represent 40 percent of total state support for mental health services. Medicaid, the joint federal-state health insurance program for low income people, makes up another 46 percent. Martone adds that while "other safety net health providers such as community health centers received infusions of federal stimulus dollars that mental health did not receive while the demand for services increased." And Medicaid services are due to be on the chopping block as well in many states. Medicaid received a temporary increase in federal funding from the stimulus package, which has helped to fill a growing hole in many state budgets. But that extra funding is set to expire on June 30. Mental health budgets are particularly vulnerable in the next budget cycle, because many of the services are technically "optional" benefits under federal Medicaid rules and can therefore be cut.
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Americans have launched a surge of DIY projects during the pandemic, transforming their homes and yards — and causing shortages of treated lumber and other supplies.
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That Surgery Might Cost You A Lot Less In Another Town
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Need knee replacement surgery? It may be worthwhile to head for Tucson. That's because the average price for a knee replacement in the Arizona city is $21,976, about $38,000 less than it would in Sacramento, Calif. That's according to a report issued Wednesday by the Health Care Cost Institute. The report, called the National Chartbook on Health Care Prices, uses claims and payment data from three of the largest insurance companies in the U.S. to analyze how prices for procedures vary from state to state, and city to city. The takeaway? Health care prices are crazy. "There doesn't seem to be a systematic pattern with respect to what's high and what's low," says David Newman, HCCI's executive director. Newman is lead author of an article published Wednesday online in the journal Health Affairs that accompanied the release of the Chartbook. The reports compare average state prices for 242 medical services — from primary doctor visits to coronary angioplasty to a foot x-ray — to the national average price for those services. It shows that states such as Minnesota and Wisconsin have higher than average prices while others, such as Florida and Maryland, were cheaper overall. Arizona's health care prices were generally cheaper, about 82 percent of the national average, while next door in New Mexico, care was more expensive, about 25 percent above average. And prices vary within states, too. If a Sacramento knee replacement patient doesn't want to drive the 871 miles to Tucson, he or she could drive south to Riverside, Calif., and pay $27,000 less. In Florida, the surgery costs $17,000 less in Miami than it does 180 miles north in Palm Bay. "For every mile that a consumer drives south on I-95, they will save $100," Newman says. The HCCI data is some of the most detailed and complete information available on health care prices paid by private insurance companies. It includes payment data from Aetna, Humana, UnitedHealthCare. It doesn't include claims information from The Blue Cross and Blue Shield Association, which is the largest health insurer in the country. The price variations revealed by HCCI show that the health care market is not following traditional economic and market rules. "The market just isn't working," says Zack Cooper, a professor of health policy and economics at Yale University. Cooper says in the past, analysts believed that health care costs were rising because people were using too much health care. That analysis was based on Medicare data. However, Medicare pays the same across the country. The data show that private-insurance payments vary widely and states that have low Medicare spending, like Minnesota, often have higher prices in the private insurance market. He says one major factor is the consolidation of hospitals, leading to a lack of competition. "Where one large hospital dominates the markets, that hospital is able to get higher prices," he says. "Hospitals have gotten increasingly powerful over time." The new data may give insurers and consumers better ammunition to shop around for lower prices or to negotiate better deals. But that will require people taking a different approach to choosing health care. People should be willing to travel farther for services, Cooper says. That would put powerful hospital systems in different cities in competition with one another, perhaps putting pressure on prices. And there are limits on where competition can bloom in health care, says Sarah Dash, president and co-CEO of the Alliance for Health Reform. "A woman is going to go to the one OB-GYN that she goes to. She's not going to run all over town trying to find the cheapest one necessarily," Dash says. "Where it's shoppable, where it's elective, where it's not an emergency and where the price is knowable, then there are things that can be done," she says.
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Stories of the difficult and sometimes shocking things people do to workaround the American healthcare system.
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Weekly Standard: Affordable Care Act Plan B
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Noemie Emery is a contributing editor to The Weekly Standard and a columnist for the Washington Examiner. In the event the Supreme Court does not put Obamacare out of our misery next week, Mitt Romney ought be ready to roll with the punches and come out at once with Plan B. Plan A was to have the Court sever it neatly with one swing of the axe, but there was always the possibility the Court would not follow the returns of the recent elections. Plan B should be the political process, which involves not the minds of nine, but the intent of millions, expressed in the usual ways. Thus, Plan B should be to elect politicians who will undo Obamacare with the tools given their branches of government. And so, Romney ought to say this: MY FELLOW AMERICANS: It is now up to us. The Supreme Court has ruled that the Patient Protection and Affordable Care Act — which protects no one, and which will bankrupt the country — is not unconstitutional, but that does not mean it is good. A number of things that are legal are in many ways bad: It is legal to lie (except under oath), or to stay home all day watching TV in your skivvies; but it's best not to do so, and we'd rather you'd not. And legal or not, this health care act is a disaster — born in deceit, passed in arrogance in the face of the will and the rage of the people, it has caused dissent and contention since its inception, and this has hardly worn off over time. People have not learned to love it: Their anger has deepened. Resistance hasn't diminished: It has grown. The problem is not that it expands coverage; that intention is laudable. The problem is that it is a 2,700 page blunderbuss that tries to assert central control over 16 percent of a $14 trillion economy, over the choices and actions of nearly six million health care professionals, and over the health care decisions and choices of the more than 300 million American citizens with whom they all interact. This country is drowning in debt, (along with everyone else in the first-world community), and this bill will cost much, much more than was claimed when they passed it, and that, let us remember, was quite bad enough. When it was passed in March, 2010, the Congressional Budget Office (CBO) projected its cost at $940 billion for the ten years to follow (2010-2019). That was the estimate that members of Congress heard when they voted for the bill. But the legislation was always designed to put the highest costs in more distant years: Its coverage provisions are estimated to cost $66 billion in 2014 but will rise to $265 billion by 2022. And so CBO's latest ten-year projection has grown to $1.76 trillion (for 2012-2022), which is simply debilitating for the federal budget. Large parts of this law have been proven unworkable, waivers have been showered on hundreds of cronies; businessmen, doctors, patients, and governors have all pleaded for relief from its mercies. It is already inflicting dire harm. It is having a catastrophic effect on the practice of medicine, with hospitals closing, health care more expensive, fewer companies selling insurance, fewer choices among the options remaining, and those more expensive, and more and more doctors and health care professionals either quitting the business, or planning to. In just a few instances since the bill passed, a firm based in Iowa stopped selling health care insurance, stranding about 840,000 former consumers; construction was stopped on 45 new physician-owned hospitals; and the research group the Galen Institute cited more than a dozen instances in which companies either stopped selling health care insurance or went out of business in no less than in 20 states. As options are narrowing, prices have soared, owing to (a) the bill's insistence that all people be covered, regardless of pre-existing conditions; and (b) its simultaneous insistence that all policies be comprehensive (i.e., expensive), covering contingencies that most people don't want and don't need. As a result, as Karl Rove tells us, "MIT professor Jonathan Gruber... hired to consult on the creation of the state insurance exchanges... has advised at least three states that health coverage premiums in the individual market would increase 19% to 30%" and the CBO has reported that by 2014, the millions who purchase their own insurance will pay at least $2,100 a year more than they do at present, and "If you own or work for a small business... you can expect the coverage to cost $19,200 a year for a family by 2016... and you must buy a policy or face federal fines." Among those hardest hit are young people and families, who may not earn much and need no more than bare-bones and high-deductible policies, and people on Medicare, whose payments will be cut so dramatically that many hospitals will be unable to take them, and some doctors will refuse to see them at all. Along with Medicare patients, and the budgets of millions of middle-class families, this act also lays waste to research and development,
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Rachel Martin talks with David Barbe, a family doctor in rural Missouri and president of the American Medical Association, about the Senate health care proposal.
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| 34,866 |
Millions Sign Up For Obamacare, But Worry About Possible Changes
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Open enrollment continues for the Affordable Care Act even as Republicans look at dismantling President Barack Obama’s signature legislation. Millions of Americans are signing up for coverage, even while they — and the health care industry — wonder about the future of the controversial law. Michael Caputo (@publiccaputo) of Here & Now contributor Georgia Public Broadcasting reports from Macon about how insurance plan choices have already been greatly reduced.
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Republicans' tax overhaul gets rid of the tax penalty for people who fail to maintain insurance coverage. If it becomes law, what happens to the deficit and the number of uninsured?
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| 34,867 |
Listener: What If We Outlawed Health Insurance?
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Nate Stell writes: After a quick look in the mirror at a funny-looking mole, I decided I should make a call. The difference is that I've been living in Bangalore, India, for a little more than a year now, so my experience with the doctors and insurance companies was pretty different. First, there was no insurance involved. I have a catastrophic insurance plan basically just to keep me covered so I don't get denied for pre-existing conditions once I finally come home. At any rate, the health care costs in India relative to my income are so much less than in the States that I don't need insurance here. The total cost for the original consultation with the dermatologist, the session where she removed three moles, and the pathology lab tests cost $61. This is about 19 percent of one month's salary of $325, which I would guess is roughly equivalent to that of an entry level position for a 4-year college grad in India or a diploma graduate (2 years college) with about 3-4 years experience. Read More >> The other difference is that there was no referral, I would assume because there's no insurance company worrying that I'm going to get too much care, since I'm paying for it out of pocket anyway. I called this morning at 10AM, thinking I'd have to meet a PCP and then schedule a dermatologist appt for a week or so later, but found myself in the dermatologist's office an hour later. I went back a few hours later to have the moles removed, and I'll get the results back from the lab within a week. Of course, this is just one isolated instance, but for all the flak that India gets about its inefficient bureaucracy, I couldn't help but notice that this was the simplest health care experience I've ever had. I filled out zero forms, I paid the full amount in cash, and all the work was done in a day. Crazy. This all made me wonder, and this is probably a ridiculously stupid question, but what about the flipside of the idea that everyone gets health insurance? What if the US banned health insurance? What would happen?
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Paul Ryan has said that many of his economic ideas were inspired by the work of Friedrich von Hayek, an Austrian economist who rose to prominence in the middle of the 20th century. But some of Hayek's ideas are contrary to what Ryan and other Republicans are pushing for. Read More: Hayek said there should be universal health care Adam Davidson wrote about this recently. And we'll discuss the subject on today's podcast with Nicholas Wapshott, author of Keynes Hayek: The Clash That Defined Modern Economics. In our conversation, Wapshott cited to two places where Hayek and Republicans disagree: 1. Taxes Cutting taxes before you have money to do is very Keynesian ... not Hayekian. Hayek specifically said unless the government is in surplus, you shouldn't cut taxes, because that would only increase the debt. 2. Universal Health Care Hayek also said a country should have: A generous welfare system, a safety net for people who fall through the cracks, everyone should be provided with home, universal healthcare. This seems to be skipped over by all the people who call themselves Hayekians.
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Limits In GOP Plan Could Shrink Seniors' Long-Term Health Benefits
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Before Carmencita Misa became bedridden, she was a veritable "dancing queen," says her daughter, Charlotte Altieri. "Even though she would work about 60 hours a week, she would make sure to go out dancing once a week — no matter what," Altieri, says. "She was the life-of-the-party kind of person, the central nervous system for all her friends." A massive stroke in March 2014 changed all that. It robbed Misa, 71, of her short-term memory, her eyesight and her mobility — and it left her dependent on a feeding tube for nourishment. Now, she lives in a nursing home. Altieri is 39 and lives in Long Beach, Calif., with her husband and two small children. She can't provide the 24-hour care her mother now gets at the nursing home three miles away — all of it paid by Medi-Cal. That's California's version of Medicaid, which is government insurance for low-income people. Advocates for the elderly now worry that Misa and other low-income seniors all across the U.S. who receive long-term care in facilities or at home could see their benefits shrink or disappear under Republican-proposed legislation to limit federal Medicaid contributions to states. The proposal is part of a broader GOP plan to repeal and replace former President Barack Obama's Affordable Care Act. "My mom is getting the basic of basic care," Altieri says. "If they cut it, I don't know what to do." Nationwide, Medicaid provides long-term care and support to more than 2 million low-income Americans who are 65 and over. Medicaid is funded jointly by the federal government and the states and pays more than half of all long-term care in the country — "more than Medicare, private long-term care insurance and out-of-pocket spending combined," says Matt Salo, executive director of the National Association of Medicaid Directors. And, Salo says, it's the only public insurance that offers such care on an ongoing basis. Medicare, government insurance for people 65 and older, provides only limited long-term care to those who need it after being hospitalized. The GOP bill, scheduled for a vote on the floor of the House Thursday, would transform Medicaid from an open-ended system, in which the federal government matches state spending, to one that limits its contribution — either giving a fixed amount per enrollee, or a lump sum to the states. Critics say such caps on funding would not accommodate the inevitable hikes in cost that will come from the introduction of expensive new treatments or other cost variables. Congress has already amended the bill to allocate additional money for elderly and disabled people on Medicaid. But Eric Carlson, a directing attorney in the Los Angeles office of the nonprofit group Justice in Aging, says such an allocation would not offset the wide funding gap created by caps on federal spending. "It doesn't matter whether it's a block grant or per-capita cap," Carlson says. "Either way the federal government is setting a hard limit on federal funding available, and states are going to be forced to make due with whatever is sent to them. And it's not going to be enough." Carlson is co-author of an analysis released by Justice in Aging that says capping federal Medicaid spending, with either per-capita funding or lump-sum payments would harm older Americans, in part by forcing states to cut services for them "to the bone." "It's really a form of rationing, where you have the care based on the money that's been budgeted rather than on the needs of the people," Carlson says. "And that's entirely backwards." In 2015, Medicaid spending topped $552 billion nationwide. People who receive both Medicaid and Medicare, and people with disabilities account for more than half of overall Medicaid spending. In addition to helping low-income seniors with long-term care, Medicaid also helps pay for some of their Medicare premiums and copays. Under the GOP proposal, nursing care in a facility would remain a guaranteed Medicaid benefit, though states could reduce how much they spend on it if they were forced to cut their budgets. And Republicans might well attempt to loosen or undo federal requirements on the program, with subsequent legislation that would give states more control. Such a shift would "decimate Medicaid's current guarantee of adequate and affordable care," according to the Justice in Aging analysis. In the meantime, states could do away with benefits not guaranteed under federal law, which include at-home nursing care, personal care — which Medi-Cal covers for qualified beneficiaries — and even inpatient and nursing care in mental health facilities for the elderly. A report released last week by the nonpartisan Congressional Budget Office suggests states might cut provider payments or eliminate some of their optional services to fill the funding gap left by the restricted flow of federal money. But Oren Cass, a senior fellow with the conservative Manhattan Institute who specializes in anti-poverty law, says the current system leads to state o
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Senator-Doctor Tom Coburn picked a novel way to try to get an answer out of SCOTUS nominee Elena Kagan yesterday on the new health law -- he used veggies. An ardent opponent of the health care law, Coburn asked Kagan whether it would be constitutional if Congress required Americans to eat three vegetables and fruits a day to save on health costs. "Sounds like a dumb law," Kagan said. "But I think that the question of whether it’s a dumb law is different from ... the question of whether it’s constitutional and I think that courts would be wrong to strike down laws that they think are senseless just because they’re senseless." Read More Coburn replied: “Yeah, but I got one that's real similar to it that I think is equally dumb. I'm not going to mention which it is.” As health policy watchers know, Coburn was clearly getting at whether the new requirement to buy health insurance is constitutional -- an issue expected to be challenged in courts across the country, starting in Virginia tomorrow. One of those challenges may even make it to the Supreme Court. While Politico's Josh Gerstein suggests Kagan gave a half-answer, she sounded perfectly in tune with what the Obama administration has been saying on the issue all along: The government has broad powers to regulate interstate commerce, and buying health insurance has a big impact on interstate commerce. Lots of Republicans just flat out disagree. Senate Judiciary Republicans posted a video of part of the exchange yesterday under this headline: "Kagan declines to say gov't has no power to tell Americans what to eat." Meanwhile, the public remains divided. The latest Kaiser poll shows Americans are slightly more supportive of the overhaul bill than last month and fewer dislike it. However, only one-third of Americans like the mandate requiring them to buy insurance, and 65 percent say the disagreements between candidates of both political parties on the merits of the law stem are more about gaining political advantage than actual policy differences.
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| 34,869 |
A Rarity: Earn More, Pay More For Health Coverage
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One-size-fits-all health insurance premiums that don't take into account how much an employee earns strike many people as unfair. Why should someone who makes $30,000 a year pay the same premium for health care coverage as his boss, who pulls down three times that amount? Yet most companies continue to keep employee contribution rates the same for all employees, regardless of how much they're paid. Why don't they switch? Continue Reading One of the obvious reasons to steer clear of a salary-based premium model is that plans with more variables are harder to administer. Companies already charge different rates for single, couple and family coverage and for different types of plans. Working salary into the mix adds a layer of complexity. Some raise questions about whether an employee's wages are actually a good measure of how much he can afford to pay in premiums, particularly if there's a working spouse in the picture who earns a good salary. "Maybe it's not adopted more because it looks fairer than it is," says Helen Darling, president of the National Business Group on Health. Then there's the from-here-to-eternity argument. Once you start charging lower wage workers less, you can never go back, say experts, even if, for example, the composition of your workforce changes and you have many more workers that qualify for lower premiums. "You have to be able to live with it forever," says Raetzman. Even so, some companies have added pay differences to the premium equation. Ten percent of employers currently vary worker contributions based on salary, according to benefits consultant Mercer. And more are considering moving in that direction in coming years as a way to avoid health law penalities that could be assessed if their workers' premium contributions exceed 9.5 percent of their household income, says Steve Raetzman, a partner in Mercer's health and benefits consulting practice.
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NPR's Madeleine Brand talks to Tess Vigeland of <EM>Marketplace</EM> about two new surveys on worker compensation that finds a jump in the number of American millionaires. The surveys also suggest merit-based pay isn't working for a lot of employers.
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| 34,870 |
Get Out The Vote Efforts
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Get Out The Vote Efforts Of Candidates & Political Parties In Midterm Election Discussed.
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In a call center in Rancho Cordova, Calif., on Tuesday, all the workers wore the same T-shirt: "Keep Calm And Go Live." They were ready and waiting to take calls from consumers who could buy health insurance on California's new insurance marketplace for the first time. So the T-shirts urged calm, but the mood was ecstatic and emotional among the architects and key backers who gathered to flip the switch on the Golden State's exchange. Peter Lee, executive director of Covered California, the state's exchange, addressed a cheering crowd in this Sacramento suburb and drew a stark contrast to the grinding politics of Washington, D.C., that shuttered much of the federal government. "While Washington is talking about shutdown, we're talking about startup," said Lee, as he declared an end to the era of a punishing individual insurance market. "Gone are the days of invasive questions when you apply for insurance about your allergies, your asthma, your diabetes, your cancer. Gone," said Lee. "You're never going to be asked that again. Gone are rates based on your answers to those questions." On The East Coast While the mood was equally buoyant at a Hampton, Va., rally, the circumstances for people wanting insurance in the state couldn't have been more different. At Enrollfest, one of the few Affordable Care Act events in Virginia, organizer Gaylene Kanoyton was quick to point out that "the state is not providing any resources. So, we just have to go ahead and move on. It is a grass-roots effort. It is up to all of us as citizens to come together." Kanoyton managed to get a dozen local agencies, health centers and advocacy groups to set up tables at the Boo Williams Sportsplex in the southeastern Virginia city. She advertised the event in churches, community centers and on the radio, and says that some 400 people showed up. Among them was Brenda Harrell, 57, a former hairstylist who's lived in Hampton all her life. "I'm here to get some insurance, some coverage," Harrell said. "I've been out of work over a year, I have heart and respiratory failure, denied for Medicaid, and still don't have any coverage. I haven't seen a doctor for my breathing for over a year." She brought along her portable oxygen tank. She has $19,000 in medical debt already and can't afford new tubes for the tank. She's just been using the same ones over and over, she says. Now she has a glimmer of hope as she sits down with a certified application counselor from a local health center to help her sign up on the federal government's enrollment site, www.healthcare.gov. But the site is overloaded. They try four times, but can't do much more than enter Harrell's name and set up a password. And even if they could, Harrell would still probably be out of luck. Her income is less than $10,000 a year — too much to qualify for Medicaid in a state that's not expanding the program, and too little for a subsidy to help her buy a plan on the exchange. It will be a different story for people in similar situations in California. The state was an eager, early and bipartisan adopter of the Affordable Care Act, said Anthony Wright, executive director of Health Access, a consumer advocacy group. "We were the first state in the nation to set up an exchange, and that was under a Republican governor," Wright said. "Our bill to set up the pre-existing insurance program was co-sponsored by a Republican in our Legislature." While 2.6 million uninsured Californians are expected to qualify for a subsidy to buy private insurance, another 1.4 million will be newly eligible for Medicaid. All told, there are 5 million uninsured Californians who will have to decide what kind of coverage they want to buy to comply with the law's mandate that they have health insurance.
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| 34,871 |
To Critics, Cadillac Tax Looks Like A Yugo
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What's so wrong with the tax on high-end health plans that President Obama supports so strongly? Well, Allan Sloan writes in the Washington Post, the dirty little secret of the Cadillac tax is that more than 80 percent of the money it would supposedly raise to fund health overhaul would actually come from an increase in taxes on individuals. And those people wouldn't be just the ones making big bucks. Most of the tax burden would fall on people making $100,000 to $200,000 a year. How's that, you ask? Sloan cites an analysis from Congress' Joint Commission on Taxation that shows only $26 billion of the $149 billion a Cadillac tax would raise would come directly from a excise tax levied on the expensive plans. The rest would come from a presumed increase in taxable wages made possible by a shift of money that was spent on health plans into employees' paychecks. Read More >> As Obama told NPR last month, the tax (a 40% levy on family plans costing $23,000 or more) would protect "ordinary workers" by making sure they don't pay too much for insurance. It would also redirect money that now goes to insurers into workers' "pockets in the form of higher salaries." Sloan isn't buying that logic. "Call me skeptical -- or cynical -- but I find it hard to believe that any employer would pay more to employees if it paid less for health care," he writes. NPR's Mara Liasson reports that unions are steamed and unlikely to forgive and forget the tax hit, even if negotiations blunt the blow by raising the threshold and expanding exemptions. Union members are disillusioned with the Democrats and may not rally behind them in the midterm elections. Back at the Post, the editorial page comes out swinging in favor of the Cadillac tax as laid out in the Senate health bill, notwithstanding Sloan's column only four pages away. Besides raising money the tax would help contain health spending, the Post writes, and the administration should use negotiations on final health bill to "strengthen, not weaken, the cost-control mechanisms that have survived the legislative process."
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NPR''s John Ydstie reports on tax relief proposed by the Clinton Adminstration to help U.S. steel makers suffering from an increasing amount of foreign steel dumped on U.S. markets.
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kor_Hang
| 34,872 |
FAA Bill May Provide Relief To Air Travelers In Cramped Seats
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Air travelers frustrated by having very little legroom and narrow seats might finally see some relief under legislation passed Wednesday by the U.S. Senate. A bill reauthorizing the Federal Aviation Administration, which passed on a vote of 93-6, includes a provision requiring the FAA to set a minimum size for commercial airplane seats, including a minimum pitch, or distance between seats. Airlines have been shrinking that distance in recent years in order to cram more seats and passengers onto planes and squeeze more revenue out of each flight. The bill also provides nearly $1.7 billion in disaster aid to help residents in the Carolinas and other states recover from Hurricane Florence and other recent disasters. Lawmakers say that the funding for those affected by Hurricane Florence is just a down payment and that billions of dollars of additional funding will probably be needed in the future. The House passed the FAA bill last week, and the White House has indicated that President Trump intends to sign the bill into law. Relief for cramped air travelers The bill tackles a wide range of problems that have raised the ire of air travelers. In addition to mandating a minimum size for airplane seats to stop the shrinking of legroom, the legislation also prohibits airlines from removing passengers from overbooked planes after they've boarded. In April 2017, a United Airlines passenger who refused to give up his seat was violently dragged off a plane by security officers at Chicago's O'Hare airport. Video of the incident, showing the dragging of the passenger with a bloodied face, went viral, sparking worldwide outrage and prompting Congress to hold hearings on the practice of overbooking and bumping passengers from flights. But the bill does not address another major irritant to air travelers: the nickel-and-dime fees the airlines charge to check luggage or change reservations. A provision approved by a Senate committee would have limited fees for checked baggage and fees to change or cancel a flight, making them "reasonable" — that is, closer to the actual cost of providing the service. Airlines raked in nearly $7.5 billion from those fees last year, helping boost their bottom lines to near-record profits. But heavy lobbying from the airlines got the language stripped from the final version of the bill. "Congress has missed a historic, once-in-a-generation opportunity to stop gargantuan airlines from gouging Americans with exorbitant fees every time they fly," said Sen. Edward Markey, a Democrat from Massachusetts, in voting against the FAA bill. Other provisions in the FAA bill that would impact consumers include: Funding an increase in the number of bomb-sniffing dogs, new passenger screening technology and easing the sign-up process for expedited screenings, all aimed at shortening Transportation Security Administration lines. Expanding the onboard smoking ban to include e-cigarettes. Prohibiting passengers from talking on cellphones during flights; most airlines already ban them. Setting new rules for transporting pets and service or "emotional support" animals, including a provision making it unlawful to place a live animal in the overhead bin. This provision comes after a small dog in a carrier died after being placed in the overhead compartment on a United flight back in March. Increase the minimum rest time between shifts for flight attendants from eight hours to 10, the same as pilots. Requiring airports to provide lactation rooms for nursing mothers. Creating a "bill of rights" for passengers with disabilities. Addressing in-flight sexual assault, harassment and other sexual misconduct by establishing a task force on the issue and directing the Justice Department to develop sexual assault reporting standards. The FAA reauthorization bill allocates about $90 billion to federal aviation programs over the next five years, but it does not include a proposed increase in the $4.50-per-ticket passenger facility charge. Airport officials across the country pushed for an increase, saying the extra funding is needed to improve airport facilities and renovate outdated terminals. Republican leaders also dropped an effort to privatize the FAA's air traffic control operations, which had been backed by President Trump.
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Unhappy that you can't use your flexible spending account to buy over-the-counter medications any more? You've got some friends in high places. The federal health care law's restrictions on FSAs are under assault on a variety of fronts, even as the first of these changes kicked in last month. As of January, FSA account holders can no longer use their pre-tax earnings to buy over-the-counter medicine like aspirin or antacids unless they have a doctor's prescription. Next week, Sen. Kay Bailey Hutchison (R-TX) and Rep. Erik Paulsen (R-MN) are planning to file bills undoing that limitation. Their legislation also would eliminate the law's $2,500 annual cap on contributions to FSAs, scheduled to take effect in 2013. Continue Reading As Kaiser Health News reports, companies that administer these accounts are bolstering these efforts. For weeks they've been lobbying lawmakers and staff and helping put together economic arguments against the changes. They've also been collecting stories of unhappy FSA customers like this one from John of Alabama, posted on savemyflexplan.org: I just tried to use a prescription to obtain an over the counter med for my son - a simple bottle of childrens Motrin that his doctor recommended for him while he had a fever. I had the Dr provide an Rx for the Motrin, but when I tried to use the Rx at the pharmacy, they were confused about how to charge it to the FSA card. But repealing the OTC rule isn't painless: it would deprive the government of $600 million a year in revenues that are intended to help pay for health coverage for those who can't afford it. Undoing all the FSA restrictions would lower revenues by more than $2 billion a year.
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| 34,873 |
Tens of Thousands in State Medicaid Suit
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A lawsuit against the state of Mississippi seeks to undo the largest Medicaid cutback in the nation. Some 48,000 elderly and disabled people have been dropped from eligibility in order to conserve funds. NPR's Debbie Elliott reports.
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A federally funded clinic in rural Mississippi embodies the history of community health centers in the U.S., and shows how these safety-net clinics can help minority patients during the pandemic.
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| 34,874 |
If the ACA is repealed, will claims be denied for those with pre-existing conditions?
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If the ACA is repealed, what options would I have if my insurance carrier denies coverage based on my pre-existing condition?
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Can the electoral college in December choose or decide that they don't want Trump as President anymore?
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| 34,875 |
What exactly when wrong with Obamacare?
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What is wrong with Obamacare?
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How much bugs and glitches are there in windows 10? Are they bad?
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| 34,876 |
If the ACA is repealed, what options would I have if my insurance carrier denies coverage based on my pre-existing condition?
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Once the ACA is repealed, how soon thereafter will insurers start denying coverage based on pre-existing conditions?
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If Trump dropped out of the race for POTUS, who would the republican party rush in for the nominee?
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| 34,877 |
In Maryland, A Change In How Hospitals Are Paid Boosts Public Health
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Think for a moment about what would happen if you upended the whole system of financial incentives for hospitals. What if you said goodbye to what's known as fee-for-service, where hospitals are paid for each procedure, each visit to the emergency room, each overnight stay? What if, instead, hospitals got a fixed pot of money for the whole year, no matter how many people came through the door? Would a change like that make hospitals rethink the way they care for patients? Would they think more creatively about how to keep people healthier so they wouldn't come to the hospital at all? Those very questions are being asked in Maryland, where an experiment in how hospitals are paid has been underway since early last year. The experiment came about under an agreement between the state of Maryland and the Centers for Medicare and Medicaid Services. It was championed by Dr. Joshua Sharfstein, who was then Maryland's Secretary of Health and Mental Hygiene. Sharfstein came into office in 2011, around the time the Affordable Care Act was being rolled out. Along with the expansion of health coverage for the uninsured, there was a lot of talk about improving health outcomes while cutting costs. The ACA created opportunities to test new ways of paying for and delivering care. Maryland was poised to act. That's because for nearly 40 years, Maryland had a unique system that set the rates, or the prices, that hospitals charged. Those rates were essentially the same for Medicare as they were for private insurers. In other states, Medicare pays less than private insurers, Sharfstein says. Medicare's participation in this system was contingent upon Maryland keeping price growth down. But in recent years, the system was starting to crumble. Prices were rising, and overall expenditures were also up, as hospitals tried to make up in volume what they were losing on price. Maryland had some of the highest hospital readmission rates in the country. "There were incentives built into the old system for volume," Sharfstein says. "If you can only make $2 on a pair of pants, you have to sell a lot of pants." With prices on the rise, Medicare's continued participation was in question. Rather than scrap the whole system, Sharfstein and his colleagues promised Medicare that Maryland would find a way to keep overall expenditures down while improving the quality of care and outcomes for patients. The plan hinged on ending fee-for-service payments to hospitals and moving to something called global budgeting. Instead of being paid per admission, hospitals would get a set amount of money for the entire year for patient care, regardless of how many MRI tests, ER visits or hip replacements there were. At the end of the year, if there was money left over, the hospitals could keep it. "Whereas before, hospitals could really only make money by keeping their beds filled, now they can actually do better if their community is healthier and they're preventing admissions," Sharfstein says. The state tested the approach in 10 rural hospitals. Those hospitals had to think in a new way about how to serve people outside their wards and ERs. The hospitals hired care coordinators to check with patients after they were discharged to make sure they were taking their medications and eating right, for example. Some hospitals created primary care centers in their communities, so patients had an easier way to see a doctor instead of making repeated trips to the emergency room. The hospitals also looked to partner with community groups working on issues as basic as housing. The pilot worked, and in January 2014, after 18 months of negotiations between Maryland and the federal authorities, global budgeting went statewide. It was voluntary for hospitals, but within six months every hospital in the state had signed up. Now, nearly two years into the five-year agreement, the Centers for Medicare and Medicaid Services says that hospitals are well on track to hit targets. Under the deal, Maryland has to save $330 million for Medicare over five years and reduce hospital readmission rates all while improving the overall health of residents. The Maryland Hospital Association says in the first year alone, cost savings topped more than $100 million, and hospital readmissions were down at a rate faster than the national average. "To a certain extent in the United States of America, a healthier community may mean a financial problem for the hospital, but no longer is that the case in Maryland," says Sharfstein. "And that creates a great opportunity for public health." That's because a hospital's bottom line now is directly connected to its ability to reduce preventable illnesses, a core mission of public health. "Is it a game changer? Probably," says Dr. Leana Wen, health commissioner in Baltimore. "It definitely is a game changer in concept. Because before, we were reimbursing for everything that we did to patients, not actually the care that we were providing to help patients n
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Remember that panoramic shot of all those health care lobbyists in the Senate hearing room? Well NPR's Dollar Politics team is now digging around in the latest lobbying disclosure reports. They've tallied up how much money the brand-name pharmaceutical industry spent in three critical months of the health care debate -- April, May, and June. The total? A whopping $40 million. And that's just one side of one part of the debate. Here's a cool graphic breaking down the money among the 45 different DC lobbying shops PhRMA hired in those months. And here's the main story, on tonight's All Things Considered
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Even Talking About Weakening Obamacare Provisions Weakens The Exchanges
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The Affordable Care Act is not "exploding" or "imploding," as President Trump likes to claim. But Trump does hold several keys to sabotaging the insurance marketplaces, should he so choose — one of which his administration is reportedly weighing using. Every month, the Trump administration faces a deadline to pay what are called "cost-sharing reduction" (or CSR) subsidies to insurers. Those are subsidies that reimburse insurers to help low-income marketplace customers afford health care, on top of the tax credits that help those people pay their premiums. A lawsuit filed by House Republicans during the Obama era has left the fate of those payments uncertain. Trump reportedly wants to end the payments, as Politico reported, but the White House chose this week to continue the payments once again. Still, the ongoing ambiguity about the future of the payments is apparently causing premiums to rise and insurers to pull out of markets. Obamacare isn't "imploding," but insurers are shaken Recent analyses from multiple organizations (including the Department of Health and Human Services itself) show that the exchanges aren't imploding; in fact, they're relatively stable. But the Affordable Care Act, also known as Obamacare, does have its problems: Premiums continue to increase, as they did throughout Obama's presidency (though subsidies have shielded a majority of people on the exchanges from those increases), and insurers have backed out of exchanges. Ending the CSR payments could be catastrophic for the exchanges. It could cause premiums to rise by 19 percent or even more, as the Kaiser Family Foundation found in a recent analysis — and that assumes that insurers even stay in the exchanges, Kaiser added. Likewise, weakening the individual mandate would drive up premiums, which could drive more people out of the marketplace, and on and on — a phenomenon known as a death spiral. The Trump administration has continued enforcing the mandate, but it has also indicated it may not be committed to continuing to do so. All of that could be bad for Obamacare. But even without those actions, simply talking about weakening the provisions is having a detrimental effect on markets, experts say. The Kaiser Family Foundation has written that "mixed signals" about cost sharing subsidy payments and enforcement of the individual mandate "have led to some insurers to leave the market or request larger premium increases than they would otherwise." The Congressional Budget Office has concurred. Analyzing the Senate's first attempt at a health care overhaul, the nonpartisan agency predicted that "uncertainty" could create problems in the exchanges: "Several factors may lead insurers to withdraw from the market—including lack of profitability and substantial uncertainty about enforcement of the individual mandate and about future payments of the cost-sharing subsidies to reduce out-of-pocket payments for people who enroll in nongroup coverage through the marketplaces established by the [Affordable Care Act]." The CBO's analysis of the House's bill, the American Health Care Act, contained a virtually identical passage. How the uncertainty affects insurers' decision-making From an insurer's standpoint, all of this makes it easy to raise prices or want to pull out of the markets altogether, explained J. Mario Molina, former CEO of Molina Healthcare, who has previously criticized Republican overhaul plans on NPR. He said that some insurance companies consider all of the policy uncertainty, consider the relatively small share of their business in the marketplaces, and then throw up their hands. "You're entering into a market and you don't really know what to expect, so that increases your risk," he said. "If you offer an insurance product, are the only people who are going to buy it sick people?" That makes some companies quit the marketplaces altogether. "Why should they take on this risk for what is probably for many of them a relatively small piece of their business if they don't think they're going to make any money doing it?" he said. Uncertainty surrounding the cost-sharing subsidies gives insurers a tough choice, he added: Insurers can continue business as usual, hoping they will continue receiving the reimbursements from cost-sharing. Or they can change course. "The other thing you can do, and this is what many health plans are going to do right now, is you assume the CSR is not going to be funded, and you raise your premium rates," Molina predicted. How the uncertainty could end This all gives the Trump administration its own tough choice. On the one hand, by continuing to pay the subsidies, they are keeping the exchanges going, meaning millions can continue to get that access to insurance. But on the other hand, it means opting to continue a system that the president has railed against for years. There is yet another option, says the Kaiser Family Foundation's Cynthia Cox, who specializes in private insurance: The administration
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What does it mean that in 2012 Mitt Romney has, during the Republican presidential primaries, done well in some of the same Ohio and Michigan urban-suburban counties that President Obama won in 2008 — a pattern likely to be repeated in some upcoming primaries? Some observers think it could be significant, that it might mean Romney would contest Obama more competitively in such places should the former Massachusetts governor become the GOP nominee. But it's risky to read too much into the fact that the 2012 map of Romney's areas of strength in some states resembles Obama's 2008 map. Paul Beck, a professor of political science at Ohio State University, said in an interview: "These are counties that have Democratic majorities but they're also large counties with a lot of Republicans who tend to be upscale and better educated. That's the natural Romney constituency all over the country. Read More "I wouldn't make too much of it. These are different voters. It's not like Romney is going to be able to pull away from Obama all these voters in these counties in the fall." Beck said political scientists would explain what's happening as a "compositional effect," that is, all those upscale Republicans and GOP-leaning independents in the metro areas of Cleveland, Columbus and Cincinnati are giving Romney electoral lift in roughly the same areas where Obama derived his 2008 support. Misreading the compositional effects of political contests can lead to embarrassing conclusions, Beck says. Like the classic case from decades ago in which a scholar concluded that Southern blacks were voting for segregationist candidates because such candidates kept being elected from districts with large black populations, Beck says: The problem with the conclusion was that blacks in those Southern counties at the time were denied the vote. So it was the whites in those districts who were doing the electing. What to watch for with these urban-suburban counties come Election Day, Beck says, is turnout of Republican voters in these areas. If they turn out in large numbers, then they can offset Obama's vote in these areas that should be his stronghold and make the race more interesting, Beck says.
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How To Reform Health Care Reform
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Writing in the New York Review of Books, former editor-in-chief of the New England Journal of Medicine and retired M.D. Arnold Relman says President Obama's health care plan won't work. Relman outlines the changes he thinks are necessary for success but missing in the plan. IRA FLATOW, host: You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow. Up next, two stories about attempts to reform health care, first the present. My next guest has been watching our health care system evolve over many years, and he's had a great seat to watch the playing field. He began practicing in the 1940s and was, for many years, the editor of one of the most respected medical journals, the New England Journal of Medicine, and now writing in the New York Review of Books, he outlines the reasons he thinks that President Obama's plan to revamp health care won't work. Many people on both the right and the left have criticized the president's plan, and we'll be talking with more of them in the next few weeks, as we watch this move through Congress, but few have the credentials that my next guest has. Dr. Arnold Relman is professor emeritus of medicine and school medicine at Harvard Medical School. He's a retired physician, also, as I say, the former editor-in-chief of the New England Journal of Medicine. Thank you for talking with us today, Dr. Relman. Dr. Arnold Relman (Professor Emeritus of Medicine, Harvard Medical School; Former Editor-in-chief, New England Journal of Medicine): It's a pleasure to be with you, Ira. FLATOW: Welcome to SCIENCE FRIDAY. You don't think that the president's plan is going to work. Dr. RELMAN: No, I don't. FLATOW: Can you tell us why. Dr. RELMAN: Well, it's going to work, if the bill gets passed that he wants, it's going to work in the sense that a lot more people are going to have health insurance, but the basic problem with the health care system is not going to be resolved. In fact, it will probably get even worse. The basic problem is that we can't afford the rising costs of health care. It's breaking the bank. It's breaking in the private economy and in the public sector, and there's nothing in the bills that are winding their way through Congress that effectively controls health cost inflation. FLATOW: But you said if the president gets what he wants, it will work. What is not in those bills that he wants? Dr. RELMAN: Well no, I meant - no, I didn't mean that it would work. I think that what the president is asking for isn't enough. FLATOW: I see. Dr. RELMAN: What we have to have is a reform not only of health insurance, but of the health care delivery system, because that's where the basic problem lies. The delivery system is inefficient, expensive, wasteful, and it has the wrong incentives. It's become a business, and as a business, it wants to constantly increase its sales, and until we change that, we're not going to have real health care reform. FLATOW: Will a federal, as the president talks about, a competitive option, would that work in bringing down the costs? Dr. RELMAN: No, I don't think it will. We have a federal health care plan now, a huge health care plan. It's called Medicare, and it takes care of everybody over the age of 65, and it does not control costs. In fact, it's going broke. The health care costs in the Medicare plan are rising almost as rapidly as health care costs elsewhere in the system. So a federal plan is not going to help unless and until we change the way we provide health care. FLATOW: What would you like to see? Dr. RELMAN: I would like to see a system that is based entirely on a not-for-profit organization. All-for-profit health care organizations should be replaced by not-for-profit organizations. Doctors should be working for a salary in private groups, multi-specialty groups, and they should be paid on a per capita basis from a central authority, a single-payer authority, which provides coverage for comprehensive care. The doctors are paid a salary for their time. They don't get paid on a piece-work, fee-for-service basis as they are now, and so they won't have incentives to over-provide care, and because it'll be not for profit and will be regulated, they won't have any incentives or opportunity or reason to under-provide care. They'll do what doctors should do, namely, take good care of patients. FLATOW: And that will bring - keep health care costs down? Dr. RELMAN: No question about it. There is a vast amount of evidence that has been accumulated over the years which shows that at least a third of what we now provide in health care doesn't do any good. It is not worth the money. It's unnecessary. It duplicates and spends money unnecessarily, and that would - and the reason there is that excess of expenditure is that there are incentives. The providers, the hospitals and the clinics and the diagnostic services and the doctors, are paid on a piece-work basis. The more they do, the more they get paid. If we eliminate
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After months of negotiation and recent prodding from President Bush, House Republicans are optimistic that a compromise has been reached on intelligence reform. NPR's Andrea Seabrook reports.
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Small Health Insurance Co-Ops Seeing Early Success
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Many of us know the names of some of the big U.S. health insurance companies — like Blue Cross, Aetna and Wellpoint. But what about CoOportunity Health, or Health Republic Insurance of New York? These are among 23 new companies started under the Affordable Care Act. They're all nonprofit, member-owned insurance cooperatives that were begun, in part, to create more competition and drive prices down. The co-ops' rollout was funded almost entirely by federal government loans. Initial enrollment numbers for many look pretty good — but that may not be enough to make co-ops successful. Karl Sutton, for one, says he's stoked about being able to buy health insurance through a co-op. Sutton lives in a scenic region of Montana just south of Glacier National Park, where tall, dark forests and taller mountains are blanketed white in early March. During my visit, there's about 2 feet of snow on the ground, and it's zero degrees Fahrenheit outside. But it's warm inside Sutton's mobile greenhouse, and green plants are emerging from the dark earth. He grows vegetables to sell at nearby markets in Missoula and Kalispell. "This is just spinach we overwintered," he says, pointing to a row of small, leafy plants. "We're just eating it ourselves." Sutton understands co-ops because he works in one: a 10-year-old growers co-op, with revenue of more than a million dollars a year. It's run by and for its members. Sutton says he wants that model for his health insurance company, too. "When you buy into a co-op, that entitles you to one vote in the decision-making, and I think it's the one business model that actually aligns with our democracy," he says. Sutton was eager to join the new Montana Health CO-OP. He thinks if members own the company, they're less likely to overuse health care — and that saves everyone money. He knows the insurance startup is new, and still unproven. "There's a degree of concern," he says, "but ... we might as well try, because if we don't have the membership, then the health care co-op isn't going to succeed. So we have to start somewhere, and I'm willing to take that risk." A couple hundred miles and several mountain ranges away, John Morrison has a comfortable law office in Last Chance Gulch, the downtown historic district of Montana's capital, Helena. Morrison was the first president of the National Alliance of State Health CO-OPs. "In some states, co-ops are dominating the marketplace," Morrison says, "with 80 percent of the enrollees going to the co-op." That's in Maine. Morrison says most co-ops are very happy with their enrollment numbers. Their rates are often the lowest that are available through an exchange. "The co-op states have 8.4 percent lower premiums, on average, than [other states] across the marketplace," says Morrison. "So co-ops are creating that competition. They're keeping rates down in the states they're operating in." But not everybody thinks those lower premiums in some states are directly tied to whether the states have a co-op option. Bob Laszewski, an insurance industry consultant, says low prices in a company's first year don't mean much. "We haven't seen any claims yet," Laszewski says. "Getting the premium in the health insurance business is the first part of the business; having [a big] enough premium to pay the claims over time is the real test." The co-ops do have a financial cushion: federal startup loans of about $100 million each. That gives them several years to readjust prices to cover all the health care their members will need. It's likely that many of their customers are people insurance companies avoided in the past — patients who either couldn't afford insurance before the new health law's subsidies, or who were previously turned down because they were sick, says Laszewski. "These co-ops have to make it in this most problematic niche of all," says Laszewski. "In particular they're not in the large-employer market, which is the bread and butter for these guys. They're not in the Medicare Advantage business; they're not in the Medigap business; they're not in the Medicare Part D business. Those are the profitable businesses in the industry." Jerry Dworak, head of Montana's co-op, says there is enough of a margin in the new exchange market for his company to survive. He says he's especially happy with the number of customers he's been able to get in spite of HealthCare.gov simply not working for the first two months it was open. "Never in my wildest imagination, with the political capital that was involved in this thing, did I think you'd hit HealthCare.gov and it [would be] blank!" Dworak laments. "I never thought that was going to happen!" But Montana's co-op still has managed to win about 40 percent of the new exchange market. Co-ops now have 50 percent of the new market in Nebraska and Iowa, and 60 percent in Kentucky. Dworak attributes Montana's early success, in part, to tirelessly beating the bushes for customers. "It's grass-roots," he says. "One thing abo
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NPR's Robert Siegel talks to Michael Abrams, president and CEO of the Ohio Hospital Association, about his reaction to the GOP's plan to repeal and replace the Affordable Care Act.
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UnitedHealthcare Pledges To Keep Popular Coverage, Regardless Of Supreme Court
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One of the nation's largest insurers said early Monday it would continue to follow some of the rules in the federal health law that are already in effect, including keeping young adults up to age 26 on their parents' plans and ending lifetime dollar limits, no matter what the Supreme Court decides. UnitedHealthcare, which covers about 26 million people in plans that could be affected by such regulations, is the first insurer to make public such a promise. The Supreme Court justices are expected to rule sometime this month and could uphold the law, remove parts of it or reject the entire legislation. Continue Reading The insurer said no matter what, it would continue to offer policyholders no-copayment preventive services, such as cancer screenings, and third-party appeals for cases where treatments are denied. United also said it would not cancel policies retroactively, except in cases of fraud. Those rules score high on public opinion polls, even among people who say they don't like the overall law. United stopped short of saying it would continue to accept all children, no matter if they had a pre-existing medical condition. The federal law says insurers cannot reject children up to age 19 simply because they have a medical condition. While the company "recognizes the value of coverage for children" United said "one company acting alone cannot take that step," adding that it is "committed to working with all other participants in the health care system to sustain that coverage." No mention was made of other rules in the health law that some insurers find onerous, including a requirement that they issue rebates to customers if they fail to spend at least 80 percent of premiums on medical care. What happens if all or part of the law is rejected is the subject of near-constant speculation in Washington and beyond. Many experts believe that even if the court rejects the law, some things across the industry may not change immediately. For young adults on their parents' policies, for example, insurers would likely need to continue coverage until the policy's contract term expired. United did not disclose what retaining the provisions would cost. "These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue," said Stephen J. Hemsley, president and CEO of UnitedHealth Group said in a statement. "These provisions are compatible with our mission and continue our operating practices." Tim Jost, a consumer advocate and a law professor at Washington and Lee University, said he hoped other insurers follow suit. One thing the United statement demonstrates, he said, is that "the provisions are not bankrupting the industry." But, while the rules United mentioned tend to be popular in opinion polls, Jost said, other provisions in the law will do more to cover the uninsured. Those include preventing insurers from rejecting adults with pre-existing medical conditions and the government tax credits aimed at helping low and moderate income Americans purchase coverage, both of which begin in 2014. "I'm glad to hear United is doing this and I hope other insurers follow suit," said Jost. "But that doesn't solve the problem of the uninsured, which is why we need the rest of the health bill."
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Judge Richard Shelby today denied a request by the state of Utah that sought to halt same-sex marriage until the appeals process plays out. The same judge overturned Utah’s ban on same-sex marriage Friday, ruling it is unconstitutional. Utah lawyers are expected to ask a higher court to put the process on hold. The county clerk in Salt Lake City immediately began issuing licenses Friday, and hundreds more gay couples were lined up Monday to get married. The ruling drew attention given Utah’s long-standing opposition to gay marriage and its position as headquarters for the Mormon church. Howard Berkes, an NPR investigations correspondent, joins Here & Now’s Meghna Chakrabarti to discuss what to expect as the legal battle continues. Guest
Howard Berkes, NPR investigations correspondent. He tweets @hberkes.
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Adm: Price Fixers To The World
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Robert talks with John MacMillan, an analyst who's been following the Archer Daniels Midland Corporation for Prudential-Bache Securities, about the suit that was brought against the food conglomerate. ADM pled guilty to price fixing in the market for lysine and citric acid, two corn-based products. MacMillan says that the fallout from the case may continue, especially since a parallel case involving the price of corn-based sweeteners was dropped.
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Texas turns to the private sector to try to cut Medicaid costs. Under a program called Disease Management, a company gets in touch with the 55,000 Medicaid patients who incur the highest expenses and tries to get them to better manage their diseases such as diabetes or high blood pressure. Bill Zeeble of member station KERA in Dallas reports.
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For Many, Affordable Care Act Won't Cover Bariatric Surgery
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Uninsured Americans who are hoping the new health insurance law will give them access to weight loss treatments are likely to be disappointed. That's especially the case in the Deep South, where obesity rates are among the highest in the nation, and states will not require health plans sold on the new online insurance marketplaces to cover medical weight loss treatments like prescription drugs and bariatric surgery. Dr. Erin Cummins directs the bariatric surgery department at Central Mississippi Medical Center in the state capital of Jackson. She grew up in the Delta, her husband is a cotton farmer, and although she's petite and fit, she understands well enough how Mississippians end up on her operating table. "You have to realize in the South, everything revolves around food. Reunions, funerals, parties — everything revolves around food," Cummins says. That long-standing food culture, as well as other factors like inactivity and poverty, have saddled Mississippi with the highest obesity rate in the nation. Doctors here are no longer surprised to see 20-somethings with diabetes, hypertension, sleep apnea, heart disease and severe joint pain. And the prevalence of severe and super-obesity is growing rapidly. For those patients, bariatric surgery is considered the most effective treatment to induce significant weight loss. Cummins describes the procedure: "We're restricting the stomach size to where a patient isn't going to eat as much. Then we reroute the intestines a little bit and realign it to delay digestion, so to speak, to bypass it. So everything a patient eats in a gastric bypass is not going to be absorbed." After surgery, many of the complications of obesity, like sleep apnea and high blood pressure, are reversed. Multiple studies have found that about 80 percent of diabetics can stop medication in the first year. Medicare and about two-thirds of large employers cover bariatric surgery in the U.S. But the procedure is pricey — an average of $42,000 — and many small employers, including those in Mississippi, don't cover it. When the Affordable Care Act became law in 2010, one goal was to erase those sorts of regional variations in access. "Our hope was that there would be a single benefit for the entire country, and as part of that benefit there would be coverage for obesity treatment," says Dr. John Morton. He is director of bariatric surgery at Stanford University Morton, and has led national and state lobbying efforts to get insurance coverage for the surgery. But amid worries that a uniform set of benefits would be too expensive in some states, and sensitive to the optics of the federal government laying down one rule for all states, the U.S. Department of Health and Human Services changed course. It decided instead to match benefits to the most popular small group plan sold in each state, in essence reflecting local competitive forces. That's led to an odd twist: In more than two dozen states, obesity treatments – including intensive weight loss counseling, drugs and surgery – won't be covered in plans sold on the exchanges. Bariatric surgery won't be covered on the exchanges in Alabama, Louisiana, Arkansas, Texas and Mississippi. That's where, according to the Centers for Disease Control, obesity rates are among the highest. Morton applauds the growing awareness around obesity prevention in the U.S., but, he says, some 15 million Americans who are already severely obese still need medical treatment. "If they don't have insurance, they're not going to get the therapy," Morton says. "We see cancer therapy covered routinely. We see heart disease covered routinely. Why is it that we don't see obesity coverage routinely?" Therese Hanna, Executive Director of the Center for Mississippi Health Policy, isn't surprised that obesity treatments are excluded on the insurance exchange in her state. She says it all has to do with keeping cost down for many people who will be buying insurance for the first time. "With the discussions around what should be covered under the exchange within the state, a lot of it had to do with balancing cost versus the coverage," says Hanna. Mississippians who buy insurance on the exchange, Hanna says, will likely be the cashiers, cooks, cleaners and construction workers that make up much of the state's uninsured. And even though many of them will qualify for federal subsidies, the price of monthly premiums must be kept low. "If you try to include everything, the cost would be so high that people wouldn't be able to afford the coverage, so you defeat the purpose," Hanna says. The discussion in Mississippi, she says, has focused on providing care for things like high blood pressure, diabetes and heart disease. "So we have a lot of needs to be covered other than obesity itself." Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kais
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What do Americans want from Washington on health overhaul? Opinion is evenly split on overhaul legislation, with 43 percent of Americans in favor of passage and 43 percent opposed, according to the latest Kaiser Health Tracking Poll. But ask people about specifics, and the picture changes quite a bit. More than two-thirds of people favor important planks in the administration's overhaul plan. Read More >> Oh, really? What do they like? Ask people how important reforming the way health insurance works is, and 76 percent say it's "extremely" or "very important." Even a majority of Republicans--64 percent--see things that way. Other planks that do well: providing insurance tax credits for small businesses, closing the Medicare "doughnut hole" for prescription drugs and creating insurance marketplaces for the purchase of individual plans. A majority of Americans blame the politicians for the lack of action. Some 59 percent say the delays are a result of both parties "playing politics," Kaiser says. And in an ominous sign ahead of mid-term elections, almost three in five of the people polled said they would be either disappointed or angry if nothing gets done. Who knows if those findings will have any effect on the legislators convening Thursday for President Obama's health summit. Results of other polls rounded up by the Washington Post have been showing for a while that Americans like some of the particulars of contained in the administration's proposal, even if by some measures the nation remains split on the passage of legislation that would make them a reality.
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Uninsured Coloradans: Study Shows Impact on Children
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A new study confirms that children in Colorado without health insurance are more likely to become seriously ill, and even die, than children who are insured. Dr. Jim Todd, one of two Children???s Hospital physicians who conducted the research, discusses the findings with Ryan Warner.
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NPR'S Ina Jaffe reports from Maryland on efforts to meet the demand for childcare which arises when women leave welfare to join the workforce.
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From Risking His Life To Saving Lives, Ex-Coal Miner Is Happy To Take The Paycut
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Growing up the son of a coal miner in southern West Virginia, David Wiley saw the downside of the profession up close. His father had been injured in the mines, lost several fingers and damaged his knees and back. "He was just really beat up," Wiley says. So when it came to find his own line of work, Wiley says he had no desire to work in the coal mines. For a couple of years after high school, Wiley tried his hand at manufacturing and welding jobs in the neighboring state of North Carolina. But when Wiley decided to return to West Virginia in his early 20s, the job opportunities were few and far between, and when he received a job offer to work in the mines for a starting wage of $22 an hour, the pay was too good to pass up. "I was excited," says Wiley, "that's really good money for anybody. A young kid like me, I'd never made that kind of money." Wiley worked the overnight shift, beginning at 11 p.m. and clocking out at 7 a.m. and spent his nights scooping up spilled coal, helping to install structural supports in the tunnel ceilings, and cleaning and maintaining the mine for the next shift. Much of the work was in the dark and it usually involved heavy manual labor. "Everything in the mines is heavy," Wiley says. "The lightest thing is a 50-pound bag of rock dust." Wiley says that for a while, the high pay made up for difficulty of the work, but he says that he soon began to develop pain in his knees and back, and a falling rock injured his foot. Wiley also notes that the grueling hours meant he had little time to spend with his wife and children. "You'd come home and sleep all day. You really didn't have no life," says Wiley. "You're just a walking zombie." The final straw, Wiley says, was the instability of working in the mines. "You can tell when the coal market is up, then you can tell when the bottom drops," he says, "because they start laying people off." For more than five years, Wiley says he shuffled between different mining operations in southern West Virginia, as they opened and closed, riding out the off-periods with savings and by signing up for unemployment. "One mine might work good for a year, then it might shut down," he says. "Then you go somewhere else and it could work for two years, then it might shut down. I worked at one mine, we had over 500 men there at one time and they shut the doors. Five-hundred people lost their jobs ... The last time that I got laid off, the coal market was so down that you couldn't buy a job." Wiley says that the last time he was laid off, he began applying to every minimum wage he could find in the area. "I was willing to take anything and everything," Wiley says. One day, he came across an online job posting for an ambulance driver with STAT Emergency Medical Services in Pineville, W.V. Though he'd never worked in the medical field, Wiley says he was desperate, and decided to apply. He remembers speaking with the company's hiring manager on the telephone, "basically crying because my unemployment was getting ready to run out. I had two babies at the time. I couldn't figure out how I was going to feed them, and he gave me a shot." I was a shock at first, he says, going from having made around $30 an hour to minimum wage work at $8.75. But he needed a way to help support his family, and the constant demand for healthcare in the area meant plenty of opportunities to work overtime. "I've come in at 3:00 in the morning and not gotten off until 3:00 in the morning," Wiley says. He says he knew within his first month that he'd made the right decision in picking his new line of work. "I fell in love," Wiley says. "It's a steady job. You don't have to worry about losing your job, because it's always here." In the two years since he was hired on at STAT EMS, Wiley has graduated from ambulance driver to become an Emergency Medical Technician, and he's currently enrolled in a paramedic science course at a local community college. Wiley plans to continue in the medical field as far as he can. And, despite lower pay, the meaning he derives from his interactions with his patients has made a huge difference in his life. "You pick up somebody, and they're on the verge of death. And you drop them off and they're shaking your hand, saying, 'You meant a lot to me.' " Wiley says, "It makes you feel you're somebody — that's enough payment."
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Today's the day we'll finally get to see the recipe for health overhaul cooked up by Sen. Max Baucus, Democratic chairman of the Senate Finance Committee. He's been the focus of plenty of attention from the administration, the media and, of course, interest groups that have a lot at stake in how a health overhaul shakes out. So would you be surprised to learn that Baucus has received $3.9 million in contributions from the health industry over the last two decades? The Associated Press reports that figure and says Baucus has gotten more money from health interests than any other elected federal official except President Obama and three other senators. Read More >> Take a look at Baucus data compiled by OpenSecrets.org, and you'll see three of the five top contributors to his political action committees in recent years have strong health-care agendas: health insurance powerhouse Blue Cross/Blue Shield and drugmakers Schering-Plough and Amgen. Separately, some Tribune newspaper reporters looked at the turnabout at the American Medical Association, long an opponent of health overhaul and now a supporter of Obama's plans. Critics say doctors will have a lot to gain from changes in the works and they won't be making many sacrifices to get them, the article says. Sweet deal just for docs? Probably not. Robert Laszewski, a close watcher of the Washington health scene, told the Trib reporters all the big interests that had opposed reform, including insuraners and drugmakers, were essentially bought off. Last month Laszewski wrote on his blog that contemplated cuts in federal health payments to providers of care would more than be made up for by the expansion of Medicaid and subsidized insurance for those without coverage today.
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Sick in America: Hispanics Grapple With Cost And Quality Of Care
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In our recent poll on what it means to be sick in America, one ethnic group stands out as having special problems – Hispanic Americans. The national survey, conducted by NPR with the Robert Wood Johnson Foundation and the Harvard School of Public Health, sheds new light on Hispanics' health issues. It runs counter to the widespread impression that African-Americans are worst-off when it comes to the cost and quality of health care. Take the pocketbook issue. When we asked about the burden of out-of-pocket costs – the medical bills not covered by insurance or any government program — 42 percent of Hispanics say this is a "very serious" problem for them. That's more than twice the proportion of non-Hispanic whites with recent illness who say so, and 8 percentage points higher than African-Americans. Continue Reading Robert Blendon of Harvard, who helped design the poll, says Hispanics "are more likely to be uninsured or have insurance with big holes in it than African-Americans." That may be, he says, because Hispanics are more likely to live in rural areas or in cities where fewer supports are available for uninsured or poorly insured people. "A lot of Hispanics work for small businesses with terrible insurance or none at all," Blendon notes. The National Alliance for Hispanic Health says that Hispanics are more likely to lack health insurance than any other group – 31 percent are uninsured, compared to 21 percent of non-Hispanic blacks and 12 percent of non-Hispanic whites. Other recent data show that nearly half of all Hispanics are on Medicaid or income-eligible for the program, a safety net for the poor and near-poor. That's higher than any other U.S. racial or ethnic group. (Hispanics are also highest in being eligible for Medicaid but not enrolled.) Elderly Hispanics are also less likely than other groups to be on Medicare. That all fits with another finding from the Sick in America poll. Among Hispanics who've been seriously ill within the past year, one in four say they weren't treated as well because of their health insurance situation. That's almost twice as many as recently sick whites. Hispanics report more problems with the quality of their care too. An unusual feature of the Sick in America poll is that it compared the experience and opinions of Americans who have been hospitalized within the past year or had serious illness requiring "a lot of medical care" with those without major illness. Most polls don't separate out the sick and the well, so the problems of those with recent experience of the U.S. health care system can be masked. It turns out thatnearlytwice as many Hispanics with recent illness (42 percent) say their care was poorly managed than sick whites (23 percent). Hispanics are far more likely to say they had to wait for test results (32 percent) compared to whites (19 percent) or blacks (15 percent). And Hispanics are much more likely to say they didn't get access to the latest technology (29 percent) than whites (12 percent) or blacks (13 percent). Blendon says there's no evidence that Hispanics have higher expectations of health care than other groups, which could explain these perceptions. "My gut feeling is that they would have lower expectations," he says. The Harvard researcher, an expert on public opinion and health care, predicts that these previously uncovered perceptions about health care among Hispanics are likely to become more visible. "Hispanics are becoming a greater proportion of the US population and are having more influence in politics and policy," Blendon says. "So their concerns about health care are likely to be heard more widely in the future." MICHEL MARTIN, HOST: Now, we'd like to switch gears and talk a little bit about staying healthy and what that means in this country. You might have had an opportunity to catch some of the stories from NPR's Sick in America series. NPR partnered with the Robert Wood Johnson Foundation and Harvard School of Public Health to interview more than 1,500 adults to find out what it's like to be sick in America and to find out whether attitudes about health care differ between people who have been sick recently and those who have not. Now, last week, we talked about some of the challenges faced by minorities, in particular. This week, we wanted to dig further into one of those groups, Hispanic people, because the answers of Hispanic respondents really stood out on a number of questions about the cost of care and the quality of care compared to both whites and blacks. NPR's science correspondent, Richard Knox, is back with us to tell us more about this. Welcome back. Thanks for joining us again. RICHARD KNOX, BYLINE: Thanks, Michel. MARTIN: Now, first, let me say, in our conversation last week, you talked about the fact that the survey found that, overall, people of whatever background - if they'd been sick - had a different response to the health care system than people who had not. But, even saying that, there are areas in
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President Trump blamed Democrats Monday morning for a “caravan” of thousands of mainly Honduran migrants attempting to reach the U.S. USA Today immigration reporter Alan Gomez (@alangomez) joins Here & Now‘s Peter O’Dowd to discuss why migrants are on the move now and who benefits politically from their actions.
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A Young Man With Parkinson's Worries About The Costs Of A GOP Health Plan
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Many millennials have their hands full now, as they launch into adulthood — jobs, homes and partners. But 33-yr-old Ford Inbody is already thinking about a time when he won't be able to work. He has Parkinson's disease. Every night after work, he and his wife Cortney walk their two dogs through their neighborhood in Overland Park, Kan. For now, going out for an evening's stroll is easy. But many of their evening conversations revolve around a time they know is coming — when these walks will be more difficult. Inbody was diagnosed with young-onset Parkinson's disease three years ago. When he was 25, he started noticing confusing health symptoms like joint stiffness, tremors and loss of smell. He says initially he was relieved to get a definitive diagnosis. But, he says, "I then started doing more research about it, that's when it became a little bit scary. There is no cure. There is no way to slow the progression of the disease. There's nothing really except just symptom management." Since the diagnosis, the couple has had to dramatically rethink their future. "We had to very much start considering life planning," he says. "We had to make sure, you know, are we going to have enough income." They're not planning to have kids and are bracing for a much more modest lifestyle than they once imagined. They live now with Ford's grandmother, to save money for the day when the degenerative disease will eventually force him to stop working. For now he gets health insurance through his job at a law firm, training attorneys on corporate policies. But Ford and Cortney worry about how his condition will progress and how they'll pay for health care when he can no longer work. Cortney works in the human resources department for a chocolatier. It is possible Ford could go on her insurance, but when they first ran the numbers, that was prohibitively expensive. So they thought Ford would get private insurance at a reasonable price despite his condition on the Affordable Care Act exchange; then he'd probably transition to Medicaid when his condition gets bad enough. That's been his plan. But ever since the election, he's been preoccupied with the developments of repeal and replace. It's a constant concern, he says — "reading the news every day, checking out all the different stories that are going on." Inbody read every word of the original GOP replacement plan, released on March 6. He was somewhat relieved to see that, at least so far, it includes the requirement that insurance companies cover preexisting conditions in every plan on the exchange. "It's not like a complete 'all is lost' situation," he says. "And I certainly am not jumping from the roof and concerned that Republicans are trying to doom me to a life of no care." But he does have questions about how this will all play out, in terms of his own situation. Chris Sloan, a senior manager with the research and consulting firm Avalere Health, says it's true Inbody will be able to get some sort of insurance policy, regardless. But there's a big difference between how the new tax credits he'd get under the GOP plan would compare with the subsidies he'd get under the ACA to help him pay for insurance costs. "The changes to the tax credits and to the subsidies available could mean that he's going to have to pay more," Sloan says. "Depending on his finances, some of those changes could mean that he has to pay a lot more to get coverage on the individual market." Today the annual ACA subsidies are based on income and the cost of coverage in each region. Under the GOP proposal, Inbody and his wife would, instead, get a flat $5,000 per year to help pay for health insurance coverage for them both. So when Inbody stops working and the couple's income is much lower, they won't get extra help in the GOP plan to pay for monthly health insurance premiums. That's not all. Sloan also explains that, under the GOP plan, some extra help for out-of-pocket costs will disappear. "With this new proposal, that just doesn't exist anymore," he says. Sloan says there's also nothing in the new plan to stop another problem — many exchange policies cover fewer medications than employer-based plans, and the networks of doctors and hospitals are getting narrower. The bill also proposes drastic changes to Medicaid. Inbody could very well end up on Medicaid — it's the insurance many people with disabilities rely on. The Republican plan would limit how much money states get for each Medicaid recipient. And though that amount would go up each year, the increase would be based on overall inflation, not the increase in medical costs. So eventually, Sloan says, the federal government would be giving states a lot less money, relative to the cost of health care. "Then the state has to make a decision. In Kansas's case, they'll have to say, 'How do we make up that difference?' " Sloan says. "They can say, 'You know what, we're just going to reduce eligibility. Previously, we gave Medicaid to people up to this i
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This story is part of an NPR nationwide analysis of states' revenue and budgets during the pandemic. New Jersey extended its fiscal year by three months in the face of massive revenue shortfalls caused by the COVID-19 pandemic. Instead of developing a full fiscal year budget amid the outbreak, lawmakers passed, and Democratic Gov. Phil Murphy signed, a temporary spending plan to keep the state operating from July through September. "In the most essential terms, this three-month plan can be described in two words: cuts and uncertainty," Murphy said in June. "And it contains plenty of each." The $7.6 billion budget includes $1.2 billion in spending cuts and delays a $951 million payment toward the public worker pension system until October. Murphy also signed legislation passed by the Democratic-controlled legislature allowing the state to borrow $9.9 billion to make up for sinking revenues. Republicans have sued to block the plan. Officials said the state could be short by as much as $20 billion by the end of 2021, and Murphy has continued to emphasize the need for major federal cash assistance from the Trump administration. Joe Hernandez covers New Jersey state government for WHYY and WBGO
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EpiPen-Maker Mylan Settles For $465 Million In Medicaid Dispute
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Drugmaker Mylan N.V. announced Friday that it had reached a $465 million settlement with the U.S. Justice Department and other government agencies to resolve questions over rebates required by the Medicaid program. The deal settles allegations by the Centers for Medicare and Medicaid Services that Mylan had misclassified the EpiPen as a generic drug and had not paid the appropriate rebates that are required by law. Andrew Slavitt, the acting head of CMS, detailed the allegations in a letter to Sen. Ron Wyden, D-Ore., this week. Slavitt told Wyden that Mylan had misclassified EpiPen as a "non-innovator" or generic drug, when it should have been classified as a brand-name product. Slavitt said the agency had informed Mylan multiple times of the misclassification. Drugs companies pay rebates to the Medicaid program of 23.1 percent for brand-name drugs and 13 percent for generics. Mylan paid only the 13 percent for $1 billion worth of EpiPens that Medicaid bought between 2011 and 2015. That cost state and federal taxpayers $163 million, he said. Mylan was facing potentially large penalties. Companies are required to report a drug or device's correct classification and can be fined up to $100,000 per violation under the terms of the Medicaid Drug Rebate Program. Mylan has come under increasing scrutiny by lawmakers on Capitol Hill, federal agencies and state attorneys general after the company raised the price for the EpiPen more than 500 percent since 2008. The device is an auto-injector used to reverse serious allergic reactions. Mylan said the settlement "did not provide for any finding of wrongdoing."
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Well, well, WellPoint. Now some folks in the Indiana-based insurer's backyard say whopping rate increases on the company's individual health coverage aren't limited to California. The Indianapolis Star reports on hikes of 31 percent and more that are set to kick in March 1. It's all perfectly legal. In Indiana, insurers that want to raise premiums more than 30 percent in a year have to get the approval of state regulators. WellPoint said it did. Read More >> Even so, customers are outraged, the Star says. "It doesn't make sense to me," a 52-year-old early retiree facing a 38 percent increase in monthly premiums, tells the Star. For its part , WellPoint told the paper rising health care costs were to blame and that the company supports health care overhaul to fix the underlying problems. The insurer said in January that its medical costs 8.9 percent in 2009. President Obama and Health and Human Services Secretary Kathleen Sebelius lambasted the insurer's Anthem Blue Cross of California unit for hiking rates as much as 39 percent. Health overhaul, Obama said over the weekend, is still needed to take a bite out of problems like this one. Now Congress wants an explanation for the Anthem premium increase in California. But, as the San Francisco Chronicle reports, Anthem isn't alone in raising rates in the Golden State. Health Net and Aetna are also charging a lot more for health coverage, making it tough for people who buy their insurance to shop around.
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GOP Health Bill Penalizes Patients Who Let Insurance Lapse
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Before he was diagnosed with head and neck cancer in 2015, Anthony Kinsey often went without health insurance. He is a contract lawyer working for staffing agencies on short-term projects in the Washington, D.C., area and sometimes the 90-day waiting period for coverage through a staffing agency proved longer than the duration of his project — if health coverage was offered at all. When Kinsey, now 57, learned he had cancer, he was able to sign up for a plan with a $629 monthly premium because the agency he was working for offered group coverage that became effective almost immediately. The plan covered the $62,000 surgery to cut out the diseased bone and tissue on the left side of his face, as well as chemotherapy and radiation. His share of the treatment cost was $1,800. If the GOP health plan recently approved by the House becomes law, people like Kinsey who have health problems might not fare so well trying to buy insurance after a lapse. The Republican bill would still require insurers to offer coverage to everyone, including people who have pre-existing medical conditions, such as diabetes, asthma or even cancer. But it would allow states to opt out of the federal health law's prohibition against charging sick people more than healthy ones. In those states, if people have a break in coverage of more than 63 days, insurers could charge them any price for approximately a year when the consumers next apply for coverage — effectively putting health insurance out of reach for many sick people, analysts say. After a year, they would be charged a regular rate again. Coming up with a figure for how many people have pre-existing conditions that could put them at risk for facing unaffordable health insurance premiums has been the subject of debate, with estimates ranging from 133 million on the high end to 2 million on the low end. What we know is that before the Affordable Care Act, also known as Obamacare, insurers in the individual market frequently charged people more if they were sick. According to a 2009 survey of individual market insurers by America's Health Insurance Plans, a trade group, 34 percent of coverage was offered at higher-than-standard rates, and 6 percent of those offers included waivers that excluded coverage for specific conditions. It's not only people who have a gap in coverage who could be affected if a state seeks the health law waiver, some health policy analysts suggest. Anyone with a pre-existing condition — even those who have maintained continuous insurance coverage — could pay higher rates. That's because the bill opens the door for insurers to set rates for people based on their health. "If you have a pre-existing condition, you're going to be put into the block of business with the sicker risk pool," said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. Requiring people to maintain continuous coverage is the Republicans' preferred alternative to Obamacare's individual mandate that requires people to have insurance or pay a fine. But there are many reasons people may have a gap in coverage, especially if they're sick, say consumer advocates. "If they're diagnosed with cancer and going through a grueling treatment, they might move closer to their caregiver or the cancer center," said Kirsten Sloan, vice president for policy at the American Cancer Society Cancer Action Network. "They may quit their job for that reason, or they may lose their job." Once people have a gap in coverage they may really be in a bind if the available coverage is unaffordable. To address this, the Republican bill requires states to set up a high-risk pool or reinsurance program or participate in a federal risk-sharing program. State high-risk pools, which were available in 35 states before the ACA passed, have been widely criticized, however, as inadequate for people with expensive health care needs. Premiums were often extremely high, and there were frequently lifetime or annual limits on coverage. Some plans excluded coverage for as long as a year for the very conditions people needed insurance. Still, Thomas Miller, a health economist and resident fellow at the American Enterprise Institute, says high-risk pools offer a reasonable solution for the 2 million to 4 million people in the individual market he estimates have pre-existing conditions but would otherwise be medically uninsurable or offered such high-cost coverage that they couldn't afford it. The $130 billion over nine years that the bill sets aside to use for high-risk pools or other individual market activities, along with an additional $8 billion over five years for states that get waivers from ACA community-rating requirements, "could be adequate" to meet the need, he said. Besides, he argued, the higher rates would last only for a year. "Once you've paid up, you graduate back to the regular market," Miller said. "It's not like being sentenced to the gulag." Kinsey said he plans to keep
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House Democrats want the country's top insurance companies to reveal some intimate financial details including how much their top executives make and what their profits are. Information requests from the House Energy and Commerce Committee went out to the companies on Monday, with a deadline of September 14. It's still unclear which companies will cooperate but already the industry has showed some apprehension about handing over the information. Robert Zirkelbach is a spokesman for the group, America's Health Insurance Plans: "This is a fishing expedition that is designed to silence the health-insurance industry," said Zirkelbach. "It's an effort to change the debate to focus on health insurers rather than focus on the solutions to the health care concerns that the American people have raised." The letter sent to the companies asks them to name all employees who were paid more than $500,000 in a single year between 2003 and 2008. It also asks for details about corporate events held off site since Jan. 1, 2007.
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Shorter Enrollment Period For Obamacare Proposed By Administration
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President Trump has promised to repeal and replace the Affordable Care Act without taking insurance away from the millions of people who gained coverage under the law. On Wednesday his Department of Health and Human Services made its first substantive proposals to change the marketplaces for individual coverage, commonly known as Obamacare. The proposed rules aim to keep insurers in the market during a transition to a new system. One way is to tighten up when people can sign up for coverage. Insurers like Aetna. The company's CEO, Mark Bertolini, said Wednesday that Obamacare is failing. "It's in a death spiral," he said at a conference sponsored by The Wall Street Journal. "And in the first look at this quarter it's not going to get any better. It's getting worse." Bertolini hinted that Aetna may follow insurance giant Humana, which said Tuesday it was dropping out of the ACA exchanges altogether because not enough healthy people are buying insurance. HHS's proposed changes are designed to make the individual health care market less vulnerable to gaming by consumers. Insurance companies have complained that many people delay signing up until they're sick and then drop coverage after getting care. The administration's proposals include cutting the annual open enrollment period to about six weeks instead of three months — to reduce the number of people who buy a policy because they find out about a health issue during that time. HHS will also require people who want to sign up for coverage during so-called special enrollment periods to first prove they qualify because of a life change like losing a job or getting divorced. "The overall effect of many of the policies here would actually, over time, I think, actually shrink enrollment, not grow enrollment," says Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. The rules would make it harder to enroll, and adding more paperwork will just turn off more people, she says, citing research into Medicaid and other public benefit programs. And the people who leave are likely to be the healthier ones, making the situation even worse for insurance companies. "Your healthy people are the ones who are going to be more likely to say, 'Oh, this is too much of a pain in the neck. I'm not going to go through with this,' " Corlette says Still, Caroline Pearson, senior vice president at consulting firm Avalere, says some change is needed. "The special enrollment periods are a real problem in the market," she says. Her research shows that people who buy insurance during special enrollment periods incur a disproportionate share of money spent on health care. The HHS proposal also allows insurers to increase deductibles and copayments, by loosening the standards of coverage. Right now plans are rated in terms of what proportion of the costs a customer pays. The new rules would widen the band by 2 percentage points, so that a plan that's marketed as covering 60 percent of health costs could actually pay for as little as 56 percent of those. The proposal also says insurance companies can demand consumers pay off any missed premiums before they get a new policy. Today, a consumer can enroll in a plan, pay for just one month and then continue coverage for 90 days before getting cut off. The following year, the insurance company has to write a new policy even if the person hasn't paid for those three months. "In total, I think that the rule is helpful for insurers but probably not enough to change plans' minds in how to approach the exchange markets," Pearson says. "Plans that were going to leave the market will probably still leave the market and plans that were inclined to stay in will probably stay in, albeit a little happier." Humana is, therefore, unlikely to rethink its decision because of these changes. As HHS tried to stabilize Obamacare while Congress debates its ultimate fate, the IRS is relaxing its plans to enforce the ACA's tax penalty. The agency had planned to reject tax returns of people who didn't say whether they had health insurance during the tax year. But the IRS changed that policy in response to Trump's executive order directing all federal agencies to ease the burden of the health care law. Taxpayers may still owe the penalty if they don't have coverage, however. "Legislative provisions of the ACA law are still in force until changed by Congress, and taxpayers remain required to follow the law and pay what they may owe," the IRS said in an emailed statement. Pearson at Avalere says the combined actions by HHS and the IRS could lead healthy people to drop their insurance coverage. "In total, I actually think the exchange market is going to shrink in size, dramatically, as a result of both the rule and the IRS move." KELLY MCEVERS, HOST: After weeks of talking about repealing and replacing the Affordable Care Act or Obamacare, the Trump administration made a move today. The Department of Health and Human Serv
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Aiming for women voters, Democratic presidential nominee Barack Obama has made equal pay for equal work a growing issue in his campaign. He's pushing for a Senate bill that would nullify a Supreme Court ruling that gives women a 180-day limit to file complaints about unequal pay. This year, the issue of equal pay for equal work has come up primarily because of Lilly Ledbetter, who shared her story at the Democratic National Convention last month. "Late in my career, someone left a note in my box at work showing my pay versus three males," she says. "We four were doing the exact same job, and their pay was drastically higher than mine." In fact, it was nearly double. That happened in 1998, the same year Ledbetter retired after two decades at the Goodyear tire plant in Gadsden, Ala. Her complaint eventually made its way to the Supreme Court. Last year, the court ruled that she needed to have filed her complaint within 180 days of when the discrimination occurred — and she had missed that deadline. The court's decision transformed Ledbetter from plaintiff to political cause. Now the Obama campaign is rallying around her case. But critics, including John McCain, say if the legislation passes, businesses will face frivolous lawsuits.
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Letting States Decide Health Coverage Could Make It Harder To Buy
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A last-minute attempt by conservative Republicans to dump standards for health benefits in plans sold to individuals would probably lower the average person's upfront insurance costs, such as premiums and deductibles, say analysts on both sides of the debate to repeal and replace the Affordable Care Act. But it will very likely also induce insurers to offer much skimpier plans, potentially excluding the gravely ill and putting consumers at greater financial risk if they need care. As part of the push by House GOP leaders to gain more support for their plan, they amended the bill Thursday to allow states to decide, starting next year, which, if any, benefits insurers must provide on the individual market, rather than requiring health plans to include the Affordable Care Act's 10 "essential health benefits, according to House Ways and Means Chairman Kevin Brady, R-Texas. For example, a woman who had elected not to have maternity coverage could face financial ruin from an unintended pregnancy. A healthy young man who didn't buy drug coverage could be bankrupted if diagnosed with cancer requiring expensive prescription medicine. Someone needing emergency treatment at a nonnetwork hospital might not be covered. What might be desirable for insurers would leave patients vulnerable. "What you don't want if you're an insurer is only sick people buying whatever product you have," says Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island insurance commissioner. "So the way to get healthy people is to offer cheaper products designed for the healthy people." Such a change could give carriers wide room to do that by shrinking or eliminating from plan requirements the 10 essential health benefits required by the ACA, including hospitalization, prescription drugs, mental health treatment and lab services — especially if state regulators don't step in to fill the void, analysts said. Conservative House Republicans want to exclude the rule from any replacement, arguing it drives up cost and stifles consumer choice. On Thursday, President Trump agreed after meeting with members of the conservative Freedom Caucus to leave required essential benefits out of the measure under consideration, according to White House press secretary Sean Spicer. "Part of the reason that premiums have spiked out of control is because under Obamacare, there were these mandated services that had to be included," Spicer told reporters. Pushed by Trump, House Republican leaders agreed late Thursday to a Friday vote on the bill, but they were still trying to line up support. "Tomorrow we will show the American people that we will repeal and replace this broken law because it's collapsing and it's failing families," said House Speaker Paul Ryan, R-Wis. "And tomorrow we're proceeding." When asked if he had the votes, Ryan didn't answer and walked briskly away from the press corps. But axing essential benefits could bring back the pre-ACA days when insurers avoided expensive patients by excluding services they needed, says Gary Claxton, a vice president at the Kaiser Family Foundation who analyzes health care markets. (Kaiser Health News is an editorially independent program of the foundation.) "They're not going to offer benefits that attract people with chronic illness if they can help it," said Claxton, whose collection of old insurance policies shows what the market looked like before. One Aetna plan didn't cover most mental health or addiction services — important to moderate Republicans as well as Democrats concerned about fighting the opioid crisis. Another Aetna plan didn't cover any mental health treatment. A HealthNet plan didn't cover outpatient rehabilitative services. Before the ACA, most individual plans didn't include maternity coverage either. The House replacement bill could make individual coverage for the chronically ill even more scarce than a few years ago because it retains an ACA rule that forces plans to accept members with pre-existing illnesses, analysts say. Before President Barack Obama's health care overhaul, insurers could reject sick applicants or charge them higher premiums. Lacking that ability under the proposed Republican law but newly able to shrink benefits, insurers might be more tempted than ever to avoid covering expensive conditions. That way the sickest consumers wouldn't even bother to apply. "You could see even worse holes in the insurance package" than before the ACA, says Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University. "If we're going into a world where a carrier is going to have to accept all comers and they can't charge them based on their health status, the benefit design becomes a much bigger deal" in how insurers keep the sick out of their plans, she says. Michael Cannon, an analyst at the libertarian Cato Institute and longtime Obamacare opponent, also believes that dumping essential benefits while forcing insurers
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Republican Rep. Tom Cole of Oklahoma tells Steve Inskeep the House should pass the Republican health care plan. But he says to not sweat the details, because the Senate will change the bill anyway.
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She Lost Her Job And Health Insurance And Had To Fight To Get A New Plan
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Liz McLemore was laid off from her digital marketing job in early March, and her health insurance coverage disappeared along with it. "I've always been a saver, so I wasn't as concerned about the monthly money coming in," says McLemore, who's 42 and lives in Inglewood, Calif. "But I really was concerned about the [health] insurance." Like millions of others, she has always had health insurance coverage through her job, so she never had to think about it. Now, she suddenly had to figure out how to find coverage in the middle of a pandemic. Like most people who lost jobs, she had a few options: Medicaid, COBRA and the insurance exchanges set up by the Affordable Care Act. There was also a deadline — most have 60 days from when they lose coverage to enroll in a new plan. McLemore opted to enroll in a plan from Covered California, her state's ACA insurance exchange. It wasn't easy — she had to call the county at one point, talk to the insurance company and navigate a difficult application. The toughest part was computing an annual income for her ACA insurance application. That calculation would have to incorporate earnings from the job she had lost, along with the unemployment that she was collecting from the state, and also $600 a week from the federal government's enhanced relief for jobs lost during the pandemic. McLemore says it took weeks to enroll. But she was determined to get health coverage — not just "because we're in the middle of a pandemic" but also because she wanted to be able to afford hospital care in case she got into an accident or got injured, like falling down the stairs, while doing daily activities. "You just got to fight through," she says. In the end, she got a bronze plan on the exchange. It cost her $340 a month — a lot higher than the $60 she paid for her job-based plan. "My prescription cost is a little bit higher, my copay [for a doctor's] visit is actually like three times as high, the deductible is different," she says. "So it's not quite the same thing, for more money — but it's better than nothing." She says the extra $600 a week helps with that additional expense for now, but that federal payment will stop at the end of July when the provision ends. Read more stories in Faces Of The Coronavirus Recession.
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Stories: 1) Journalist Reports On 'Life, Death And The Taliban' 2) Of 'Public' Options And 'Government' Plans
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Listener: Hospital Offers 30 Percent Off
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Erik Filkorn, a town selectman in Vermont who appeared on a Planet Money podcast in February, writes: I had an interesting experience with a hospital recently. I got a bill for $8,000 for some surgeries for my son. I waited a month to see if Blue Cross would take a bite out of it. They didn't. Then my wife lost her job and waiting another month seemed prudent or necessary anyway. Finally, I called them and asked if I could divide the payments over two months and they said, "Yes, but if you can pay today, I can take 30% off." Needless to say, I went for it. Next day, I decided to see if the anesthesiologists would be similarly sympathetic. No such luck.
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NPR Kathy Lohr reports that doctors at the Louisiana State Medical Center are being sued because they refused to give a patient an abortion. Abortion rights advocates say the patient should have qualified for a life-saving Medicaid abortion and that the hospital violated federal law by not performing the procedure.
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System Sees Rise in Medicare Drug Prices, Profits
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As debate continues over whether the U.S. government should negotiate directly with drug makers over Medicare drug prices, we measure how well Americans have been served by the market so far. Medicare drug prices and premiums have gone up during the first year of the benefit, as have profits for drug companies and insurers. The new Democratic majority in Congress has promised to enable the government to negotiate Medicare drug prices with manufacturers. Currently, the law expressly forbids the government to do that. President Bush says he would veto the change, because, he says, competition among private insurers lowers drug prices more effectively than government negotiation could. MELISSA BLOCK, host: The incoming Democratic majority in Congress has promised to authorize the government to negotiate Medicare drug prices with manufacturers. Currently, the law expressly forbids the government to do that. The White House opposes the change, arguing that competition among private insurers lowers drug prices far more effectively than government negotiation could. NPR's Snigdha Prakash reports on what effect competition has had so far. SNIGDHA PRAKASH: One way of judging whether seniors have been getting a good deal on their Medicare drugs is to look at how much money drug-makers are making on those drugs. Richard Evans, pharmaceutical analyst at Sanford Bernstein and Company says the new drug benefit has added between 1 and 1.5 percent to the industry's profits, or about $2 billion. That's mostly because companies can now charge the government higher prices for drugs used by the millions of people who get both Medicare and Medicaid, the government's medical program for the poor. Until this year, Medicaid paid for their drugs. Now, Evans says, Medicare's Part D Program does. Mr. RICHARD EVANS (Sanford Bernstein and Company): In Medicaid, discounts that the industry provided were about 30 percent, maybe a little bit higher. The Part D, the discounts are in the neighborhood of 10 percent. PRAKASH: So, as those patients went from Medicaid to Medicare, the drug industry got a hefty price increase. The group Families USA measures the performance of private insurers another way. It compared how prices on the 20 drugs most frequently prescribed to seniors changed over six months, from November 2005, when seniors were choosing their Medicare plans to April of this year. The group's executive director, Ron Pollock, says virtually all the Medicare Part D insurers raised prices during that time. Mr. RON POLLOCK (Executive Director, Families USA): For Fosamax, used for osteoporosis, 99 percent of the plans increased their prices. For Lipitor, more than 97 percent of the plans increased their prices. PRAKASH: The median price increase, Pollock says, was about 4 percent, far outpacing the increase in the Consumer Price Index during the same time. Mr. POLLOCK: And what that means is that seniors who live on a fixed budget and their Social Security checks only go up with inflation, these prices of drugs are rising quite a bit fast and so, over time, it means that these drug prices will be increasingly unaffordable. PRAKASH: The insurers raised prices for seniors because the drug companies were charging more. Historically, price increases have accounted for almost half of the drug industry's profit growth. David Sho(ph), head of health-care research at the Prudential Equity Group, says the government is to blame for the fact that private insurers didn't get a better deal on Medicare drugs. Mr. DAVID SHO (Head of Health-care Research, Prudential Equity Group): The government isn't really, really, really trying to save money, and it hasn't given the tools to the insurance industry to really, really save money. The way you save money in health care is by limiting choice. PRAKASH: That is by telling seniors the program will cover a very short list of drugs so that no matter who's negotiating, private insurers or the government, drug-makers are motivated to cut their prices to get on that list. Regardless, drug-industry analysts like Richard Evans are betting that the escalating cost of the Medicare drug program will force the next administration, Republican or Democrat, to negotiate lower drug prices. Snigdha Prakash, NPR News, Washington.
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NPR's Julie Rovner reports on some of the problems that have plague managed care and led to its demise. According to most experts in the health field, the booming economy led to the downfall of managed care.
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States Sue Drug Industry for Alleged Medicaid Fraud
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Attorneys general in at least 16 states are suing drug makers, accusing them of overcharging Medicaid programs for prescription drugs in a scheme to increase profits.
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Affordable housing across the country is facing an onslaught few saw coming — investors looking to cash in on real estate that was dedicated to people with low incomes. An investigation by WBUR finds financial firms seek outsized profits for themselves in a federal housing program paid for by taxpayers. Lawmakers say these investors are subverting Congress’s intent for the law and are looking for ways to stop them. WBUR’s Beth Healy reports. This article was originally published on WBUR.org.
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Alabama Inmates Sue for Better Health Care
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Sick inmates are suing the state of Alabama over the quality of health care in state prisons. Diabetics, cancer patients and other prisoners with chronic diseases say they are routinely denied treatment, putting their lives in danger. NPR's Debbie Elliott reports.
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In a warm-up for a confab with insurers at the White House Thursday, Health and Human Services Secretary Kathleen Sebelius put them on notice this morning that they had a lot of explaining to do about what they charge for policies. "Something is not working well here," Sebelius said in 15-minute talk to the National Association of Black Journalists at the Kaiser Family Foundation. Members of the association are in town for a conference on health disparities. She said she was looking forward to her "chat" with executives of five companies that she said last year recorded a collective $12 billion in profits then tried to pass on "jaw-dropping," double-digit rate increases to policyholders. Read More >> Sebelius was preparing to meet at 11 a.m. with executives from UnitedHealth Group, WellPoint, Aetna, Health Care Service Corporation and CIGNA HealthCare, along with leaders from the National Association of Insurance Commissioners. Sebelius and the White House have tried to vilify the insurance industry in recent weeks to revive their health overhaul efforts. They were given ammunition when Anthem Blue Cross, a subsidiary of WellPoint and California's largest for-profit health insurer, moved to raise rates by as much as 39 percent. The insurer has since delayed the rate increase until May. Update: After the meeting, the insurance execs talked with the press. Bloomberg covers it here. Galewitz is a reporter with Kaiser Health News, a nonprofit news service.
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Health Overhaul Could Threaten Student Health Plans
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Colleges and universities say some rules in the new health law could keep them from offering low-cost, limited benefit student insurance policies -- and they're seeking federal authority to continue offering them. But their request drew immediate fire from critics who say student health plans should be held to the same standards as other insurance. Among other things, the colleges want clarification that they won’t have to offer the policies to non-students. The American Council on Education and 12 other trade groups representing colleges say the Administration needs to make changes. It may be impossible “to continue to offer student health plans” otherwise, they say in an Aug. 12 letter to Health and Human Services Secretary Kathleen Sebelius. Also, the colleges say that some provisions of the law should not apply to them, including those that require insurers to spend at least 80 percent of their revenue on medical care and bar them from setting annual coverage caps. Many of the provisions at issue don’t go into effect until 2014, but the colleges say they need clarity soon because they are negotiating long-term contracts with insurers now. HHS spokeswoman Jessica Santillo said the secretary has received the letter and "looks forward to sending a response." The request comes amid continued scrutiny of student health plans -- including an ongoing investigation by New York Attorney General Andrew Cuomo, who said in April that some of the plans leave students "at risk while providing massive profits for insurance companies." His investigation found that policies offered to New York students were inexpensive, ranging from as little as $100 a school year to more than $2,500. But the benefits also vary widely, with some capping annual coverage at $25,000 a year or setting per-illness caps as low as $700. "Buying these kinds of low-quality products with low premiums enables colleges" to keep down students' costs. "But the problem is the protection provided students under the plans isn't sufficient," says Mark Rukavina of the Access Project, an advocacy group in Boston that has studied student health plans. "If you are a student who needs care, given the caps on benefits, you are in trouble." More than half of colleges nationwide offer student insurance plans, according to a March 2008 study by the Government Accountability Office. While 80 percent of college students were insured, often through their parents' coverage, only 7 percent bought their own policies or purchased one of the school-based plans, according to the GAO. Annual caps like those in student health plans are barred by the new health law, starting in 2014. Starting this year, insurers must offer at least $750,000 in coverage per year, although insurers or employers can apply for a waiver from that restriction. Colleges say their plans don't fall under the annual cap requirement, because they are considered "limited duration" policies, meaning they expire after a certain number of months, generally the school year. They also say such limited duration policies do not have to meet rules requiring insurers to spend an average of at least 80 percent of revenue on direct medical care, rather than administrative costs or profits, or issue rebates to policyholders. Law professor Bryan Liang disagrees. "That sounds like wishful thinking on their part," says Liang, a critic of student health plans who is executive director of the Institute of Health Law Studies at California Western School of Law in San Diego. Even if the plans are considered limited duration policies, he says, such policies are regulated by states, which can set similar spending rules. Many student plans would flunk the spending test. A recent report by Massachusetts state officials, for example, found that spending on medical care among the 13 insurers offering student plans in the state ranged from 46 percent to 89 percent, with the average at 69 percent. Requiring them to meet even some of the new rules could drive up premiums, colleges say. Premiums could increase, for example, if regulators determine that student health plans are considered "individual" policies, rather than group plans that often get a better rate, says Steven Bloom, assistant director of federal relations at the American Council on Education. Additionally, the colleges fear they would be required to offer the plans to anyone who applies for one, even if they are not a student, Bloom says. Liang, the law professor, doubts that colleges would be forced to offer insurance to anyone who walks into a campus health center. "That's like saying I, as a non-IBM employee, could go to IBM and say you need to give me insurance," says Liang, who sent a letter Aug. 17 to Sebelius in response to the education council’s request. He does not think school plans should be offered any special protection in the regulations now being developed to implement the health reform law. The school based policies "financially benefit the school
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"Welcome to Iowa State University. May I take your paper, please?" A bill circulating in the Iowa state Senate would rate professors' performance based on student evaluations. Just student evaluations. Low-rated professors would be automatically fired — no tenure, no appeals. The bill's author, state Sen. Mark Chelgren, a Republican, argues that too many students are taking on student loan debt but not getting their money's worth in the classroom. "Professors need to understand that their customers are those students," Chelgren told the Chronicle of Higher Education. Though the bill appears unlikely to pass, it has made national news because of the broader debate around student debt, the cost of college and what, exactly, students are getting for their money. And therein lies the paradox. Yes, students are paying, often handsomely, for their degree. But they're not exactly customers, either. They're participants in an experience — one that is meant to be challenging, even grueling. And that's why simple satisfaction surveys may not be the best measure of professors' performance, as our previous reporting explains.
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Insurance Companies To Remove Benefit Caps
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On Sept. 23, insurance companies will no longer be allowed to place a lifetime limit on the benefits they pay out. For the vast majority of people with health insurance, the caps have been nothing to worry about. But lifting the limits is one of several changes taking place next week as a result of the new health care overhaul law.
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The nation's largest private employer will no longer provide a healthcare plan for new part-time employees, according to <em>The New York Times</em>. Walmart is also raising premiums for many full-time staff. The reason is rising costs, according to a company spokesman quoted in the story.
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