Search is not available for this dataset
query
stringlengths 1
13.4k
| pos
stringlengths 1
61k
| neg
stringlengths 1
63.9k
| query_lang
stringclasses 147
values | __index_level_0__
int64 0
3.11M
|
|---|---|---|---|---|
What's a Spinalectomy?
|
Spinalectomy. That's the new word for the day. That's what I'm going to have on Monday. It will be an eight-hour surgery, and the doctors will remove the vertebra and the tumor. They will replace the vertebra with an artificial one. When it's done, and after a long recovery, I should have less pain, maybe even no pain. And that tumor will be gone for good. There were other options. They could remove just part of the vertebra and follow up the surgery with very precise radiation. But the tumor is so close to my spinal column now that they probably wouldn't be able get it all. Which would mean that after the operation -- and all the pain that comes with it -- the problem wouldn't be solved. The tumor could grow again. And if that happened, there'd be no other options except maybe chemo. It was pretty easy to reject this option. The procedure I'm going to have is usually done when someone has primary spinal cancer, and there aren't any tumors in other parts of the body. When someone like me comes in, with mets all over, doctors will normally say it's not worth it to do something like the spinalectomy. I think it is. And luckily I have doctors who agree. Still, when you listen to the list of things that could possibly go wrong, of the risks involved, it's pretty sobering. Out of all the procedures I've had, including brain surgery, I think this one will be the most complicated, and the most dangerous. I'll be in the hospital most of next week, so the blog entries won't show up regularly. We'll try to put up updates as we can, and I should be back online the following week.
|
Before Anthem Blue Cross of California got dinged for looking to raise rates by as much 40 percent, the company was put in a harsh political spotlight over cancellation of policies for people in the midst of expensive medical procedures. Last year, Anthem Blue Cross, a unit of WellPoint and the biggest for-profit insurer in the state, agreed to pay a big fine and issue new coverage to the affected people who wanted it. Other insurers also agreed to settle with the state over retroactively canceling policies on technicalities, a practice known as "rescission." All told California collected almost $14 million from insurers. Around 6,000 people affected by rescissions were eligible to get new policies under the settlements. But did they? Read More >> Not very many actually. A report for a California Assembly committee checking up on things found less than 300 people have gotten coverage from their former insurers under the deals. The independently prepared report called the results "highly disappointing." What went wrong? The settlements were too complicated and the state agencies involved in carrying them out didn't do a good enough job reaching out to eligible people. The report's author is Dr. Bryan Liang, a doctor and lawyer who runs the Institute of Health Law Studies at California Western law school in San Diego. The bottom line, he wrote: Unfortunately, bluntly put, the settlement agreements have done little to bring justice to those who have had their health insurance policies illegally rescinded and represent limited deterrence against insurer abuses. The numbers speak for themselves: almost no victim took advantage of the settlement agreements to hold insurers accountable. You can see Liang's recent testimonyhere.
|
eng_Latn
| 34,900 |
Health Cost Increases
|
-- NPR's Patricia Neighmond reports economists are predicting that after several years of almost static insurance costs, large increases in premiums are only around the corner.
|
health care provider, now wants to change its status and move into for-profit care -- a move that has alarmed many.
|
eng_Latn
| 34,901 |
The Unintended Consequences Of A Program Designed To Help Homeowners
|
A Maryland program designed to help struggling homeowners ended up contributing to foreclosures in some cases. Researchers say it's an example of unintended consequences of some government policies.
|
The new Medicare prescription drug plan is complex, confusing, and irrational, according to health policy expert Jonathan Oberlander. A month after the rollout of the new Medicare Prescription drug plan, many seniors are finding it difficult to get the drugs they need. Oberlander teaches about the politics of medicine at the University of North Carolina at Chapel Hill. A co-editor of The Social Medicine Reader, Volume III: Health Policy, Markets and Medicine (2005), he also wrote The Political Life of Medicare (2003).
|
eng_Latn
| 34,902 |
Ohio Family-Planning Services At Mercy Of Budget Bill
|
Working its way through the Ohio Legislature is a state budget bill that has major implications for the way family-planning services are provided. The Ohio budget contains language that puts family-planning clinics at the bottom of the list to receive funding. Family Planning Association of Northeast Ohio operates several independent family-planning clinics. They do not provide abortions and have no affiliation with Planned Parenthood, but the clinics are still at the end of the line under a new tiered system because they give referrals. Ahead of the facilities are local health departments, places like emergency rooms and free clinics. Family Planning's executive director, Mary Wynne-Peaspanen, says if there's any money left over — which she says is not likely — "then they could consider applications from independent, specialty clinics like my organization and like Planned Parenthood." The budget bill from the Republican-controlled Legislature could well put the nonprofit out of business. Since 1970, it has served primarily low-income women, but it's facing an anticipated 40 percent hit to its funding. "They've been very clear about the fact — at the General Assembly — that their target is Planned Parenthood. But that doesn't change the fact that there are other organizations that will be impacted by this funding," Wynne-Peaspanen tells Jacki Lyden, host of weekends on All Things Considered. National Trend In Ohio and elsewhere, family-planning clinics typically provide a range of women's health services, like cancer screenings, blood pressure tests and contraceptive services. Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center, says the vast majority of women who are sexually active have used contraception at some point in their lives. "So on one level, we as a nation have recognized that contraceptives are not only what everybody uses, but they also are very important for women's health," she says. "There is, however, a minority of politicians who try to use any issue related to 'sex' to make some kind of political hay out of it." Waxman says a handful of states are looking at centers that receive Medicaid or state funding for family-planning services — and some are cutting the budgets. Those states include Indiana, Arizona, Wisconsin and now Ohio. The Anti-Abortion Lobby Michael Gonidakis is the president of Ohio Right to Life, one of the groups that lobbied hard for the current legislative approach. He admits the ultimate objective is a straightforward one. "Our goal is to find a way to end abortion. Not make it illegal, but to end it," he says. "We're big proponents of adoption reform, foster care reform, and we want to find ways to continue to help women who find themselves in unintended pregnancy, to realize that they can have their baby, that there's support services there for them to keep their child." He doesn't expect that women will have less access to family planning, not even those who are low-income. "There's nowhere — and I repeat, nowhere — in the state of Ohio where there won't be other options in a very close walking proximity to ... a clinic that may go out of business," he says. "We're doing some good things here in Ohio, and there's access to these types of services and care for low-income women across the state." But it still worries Jess Locher, a 28-year-old uninsured cosmetologist in Chardon. She went to the local branch of the Family Planning Association as a teenager. Ten years later, the mother of two still goes to the same clinic because she can't afford anything else. "If they took family planning away, I wouldn't be getting the female care that I need because my job doesn't offer me insurance, so I couldn't afford to go to a gynecologist," Locher says. Take Texas, For Example Ohio is on the verge of making decisions that would alter the way family planning is funded. Texas started down this road two years ago. "When the Tea Party wave came through Texas in 2010, there was a big movement to oust Planned Parenthood from all of the state health programs," says journalist Becca Aaronson. Aaronson, who covers health care for the Texas Tribune, says state lawmakers took a three-pronged approach to cutting family-planning funds. They cut family-planning funding, then set up a tiered financing system prioritizing comprehensive health clinics. Third, they prohibited any group affiliated with a provider that performed abortions from participating in the Medicaid women's health program. More than 50 clinics throughout Texas closed their doors. As the dust settled, the consequences of this policy started to become apparent, Aaronson says. "The state estimates that roughly 24,000 babies are going to be born as a result of these changes, and that's because women don't have as much access to birth control," she says. The spike caused enough of a stir in Texas for state legislators to restore some of the funding to family planning. "They decided
|
The California Supreme Court rules that the Catholic Charities group must provide employees with health plans that include birth control coverage. The court rules the group is not covered by exemptions for religious organizations, because it provides secular services. NPR's Richard Gonzales reports.
|
eng_Latn
| 34,903 |
Medicare Key To Conquering Deficit Dilemma
|
What provides health care coverage to 47 million Americans, consumes 12 percent of the federal budget, and accounts for $1 of every $5 spent on health care in the U.S. each year? If you answered Medicare, you win a piece of the nation's deficit problem -- a big piece. "If you look past the next eight to 10 years, Medicare is the deficit problem," says Douglas Holtz-Eakin, former head of the Congressional Budget Office. "And there's simply no way we can address our fiscal problems without coming to terms with Medicare's future." It's a future that includes 78 million baby boomers, the first of whom are just now getting their Medicare cards. Health policy analyst Jeff Goldsmith, who has studied the boomer generation, says that has been largely overlooked in the debate over the new health law. "In the first 10 years of health reform being implemented, you'll see 30-some-odd million baby boomers become eligible for and enroll in Medicare," he says. That's an increase in Medicare's population of about 30 percent. Unless you change who is eligible for the program -- something no one seems to be suggesting -- there are really only two ways to make Medicare cost less: Pay health care providers like doctors and hospitals less, or make Medicare patients pay more. Until now, neither has been very popular politically. "Conventional politics are providers say, 'No, no, no, I can't live with less.' Citizens say, 'No, no, no, I can't pay more.' But the ultimate irony here is conventional politics have to change," says Holtz-Eakin, now president of the American Action Forum, a Republican think tank. "Because the numbers don't add up. "Either we proactively take this on as a nation, or international lenders are going to say, 'Forget it, drop dead,' and we'll have an enormous economic crisis." Goldsmith says one small ray of hope is that the generation coming onto Medicare isn't quite as attached to it as the current one. "I don't think the typical baby boomer has thought for more than five minutes about the effect of Medicare on their lives, because they're not old," Goldsmith says. "And Medicare is perceived as something for old people." Still, it may be hard to load much more cost onto patients. Over the past decade, Medicare recipients have already been asked to spend more of their own money out of pocket on health care. According to the nonpartisan Kaiser Family Foundation, median out-of-pocket spending on health care rose from 11.9 percent in 1997 to 16.2 percent in 2006. Or, as President Clinton's Medicare chief Bruce Vladeck puts it more succinctly, "What people don't understand about Medicare is how crappy the benefit package is." Asking Medicare beneficiaries with higher incomes to pay more -- another popular idea among would-be deficit reducers -- probably won't fill the gap, either. Vladeck says that's because there probably won't be that many high-income boomer beneficiaries. "They've lost their retiree health benefits," he says. "They've lost their pensions. They had most of their wealth in their houses," which aren't worth nearly as much as they used to be. Then there's what Vladeck calls the regional politics of Medicare. Because the program is so large, and health care is so expensive, Medicare winds up being a major source of federal funding in virtually every congressional district. That leads to politicians often wanting to boost funding rather than cut it. Vladeck says that scene played out repeatedly during this year's health care overhaul debate, with members from "these allegedly conservative parts of the country saying, 'This bill is too expensive and we can't afford it,' but holding out for special treatment in Medicare payments to providers in their districts." There's one other big problem stemming from the new health care law, Goldsmith says. It made a lot of funding reductions to Medicare providers -- about a half-trillion dollars over the next 10 years -- but uses that money to help pay for expanded coverage for the rest of the population. "That's a significant amount of money. And if that money is to be spent on extending the benefits, it certainly isn't going to be available for deficit reduction," Goldsmith says. "So if you wanted to reduce the deficit, you'd have to go back and challenge the physicians, the hospital community, the health plans to accept additional reductions -- very difficult to do." Most analysts say getting a handle on health care costs in general would go a long way toward solving the Medicare problem. But no one is sure how to do that, either. RENEE MONTAGNE, host: In the coming months, you can expect politicians to highlight many government programs they consider wasteful or just plain wrong. Many of those programs will have one thing in common: They're actually a tiny part of the federal budget. A few things do cost a lot, and their cost is growing over time. One of the biggest is Medicare, which takes up 12 percent of the federal budget all by itself. NPR's Julie
|
It's open enrollment time and seniors will find changes this year when they sign up for Medicare prescription drug benefits, called Part D plans. About two million new baby boomers are expected to enroll this year.
|
kor_Hang
| 34,904 |
Musicians Struggle To Buy Insurance In A City That Thrives On Music
|
It looks like Kalu James is living the life as a musician. He's standing under a neon sign, ready to play guitar at Austin's famous Continental Club. And when he's not here, he's hustling to pay his bills. "Being a full-time musician means you have three other side jobs, you know?" he says. James moved to Austin about eight years ago and got health insurance for the first time this year. He pays $22 a month, after the $200 subsidy he gets through the Affordable Care Act. Even that is a lot, because he earns only $15,000 a year. He gets help paying his monthly premium through a local nonprofit. "We still have to worry about counting the quarters and the pennies when we leave these venues," he says. Health insurance doesn't come easily. Austin thrives on its reputation as the live music capital of the world and is making far more than quarters and pennies from music. The city estimates the commercial music industry pumps $1.6 billion into the local economy every year. But Austin has a lot of people like James struggling to afford life here. "A lot of people didn't understand just how dire that situation is," says Nikki Rowling, the founder and CEO of the Titan Music Group. "We have hard data that shows it." The Titan Music Group recently conducted a large survey and several focus groups of musicians in Austin; it produced the Austin Music Census for the city. The census found that 20 percent of Austin musicians live below the federal poverty level. More than 50 percent qualify for federal housing subsidies, and nearly 19 percent lack health insurance. A lot of Austin musicians rely on the Health Alliance for Austin Musicians for help. "Close to 60 percent of our membership doesn't even qualify for the subsidies that are given through the Affordable Care Act," says Reenie Collins, the alliance's executive director. And Texas didn't expand Medicaid, which would have helped those musicians below the poverty line. Her organization helps in two ways. This year, HAAM gave Kalu James and about 300 others money to afford their premiums for plans bought on the exchange. It also coordinates low-cost health care for about 2,000 members every year. It partners with doctors and hospitals to give these musicians medical, dental, vision, hearing and mental health care. Backstage at the Moody Theater, dobro player Tom Caven is getting ready to go onstage. "Travel anywhere in the United States," Caven says, "you tell them you're from Austin, [and] they almost always say, 'Austin City Limits,' you know? This is very much the identity. And if we lost that, we'd just be another up-and-coming city with no personality." Caven is an executive at the Seton hospital network, an organization that partners with HAAM. He is also a physician and treated musicians in Austin for almost 20 years. Caven's band, The Stray Bullets, is performing at a local "battle of the bands" to raise money for HAAM. "Some people feel like you just ought to work hard enough to have health insurance," he says. "But working in a safety-net hospital, like I do, you see people that come in. They're working really hard — working sometimes two and three jobs to support their family." Thanks to fundraisers and other private donations, HAAM's Collins plans to triple the number of musicians who will get help with their premiums next year. She's also a passionate advocate of Medicaid expansion, which would help many musicians in Austin. "Many, many people think, 'Oh, HAAM's not needed anymore.' Well, that's not really true," she says, "because Texas did not expand Medicaid." While more people have become insured since the rollout of the exchanges, Texas still has the highest uninsured rate in the country — about 17 percent. This story is part of NPR's reporting partnership with local member stations and Kaiser Health News.
|
You may be on summer vacation, but the interest groups looking to make their mark on legislation to overhaul health care are working harder than ever. The Wall Street Journal reports that delays on Capitol Hill make this month the key time to "snare one-on-one meetings with lawmakers back in their home districts." Take Tim Trysla, a lobbyist at Alston + Bird. Makers of diagnostic imaging equipment are among his clients. "If you're looking for savings, don't come at us," says Trysla, who has called on 120 legislators, sometimes taking General Electric execs along to make the case for protecting payment for medical scans. (Check out a nifty WSJ interactive graphic on lobbying spending here.) Read More >> Trying to figure out what works and what doesn't in improving the health-care system? It never hurts to follow the money. NPR's Richard Knox digs into the money pit in Massachusetts, where a 3-year-old law expanding coverage has pushed the proportion of uninsured down to 2.6 percent--lowest in the nation.. The remarkable achievement has come at a high cost. Now, the state is looking to save money by paying doctors and hospitals a fixed annual amount for each patient rather than shelling out for services whenever they're rendered. "In the world of health care, this is big news," Knox says. The Food and Drug Administration has concluded that some drugs used to treat rheumatoid arthritis in children and teenagers need a tough warning about an increasing the risk of lymphoma and other cancers. The affected drugs include Johnson & Johnson's Remicade, Amgen's Enbrel and Abbott Lab's Humira.
|
eng_Latn
| 34,905 |
Special Interests Pony Up For Health Changes Their Way
|
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.
|
Health care spending continued to rise in 2012, but it did so at a relatively low rate for the 4th year in a row. The report from the Centers for Medicare and Medicaid Spending said overall spending on health care increased 3.7 percent over the previous year.
|
eng_Latn
| 34,906 |
FRONTLINE & NPR Investigate "The Healthcare Divide" in America
|
The Healthcare Divide Tues., May 18, 2021 at 10/9c on PBS and on YouTube Streaming at 7/6c at pbs.org/frontline & in the PBS Video Appwww.facebook.com/frontlineTwitter: @frontlinepbs Instagram: @frontlinepbsYouTube: youtube.com/frontline COVID has put a spotlight on disparities in American healthcare and the large urban hospitals hit hard by the pandemic. But many of these "safety net" hospitals, whose primary mission is to serve low-income, working-class communities, have been in crisis for years. This month, The Healthcare Divide, an investigation from FRONTLINE, NPR and American University's Investigative Reporting Workshop, examines the market forces and uneven government support that are deepening the healthcare divide, with profits at some hospitals booming, while many safety nets struggle to stay afloat. "I think we're on the brink of a precipice," Dr. Bruce Siegel, president of America's Essential Hospitals, says in the film. "Even before the pandemic, many of these [safety-net] hospitals were losing money and the pandemic is only going to make that worse." "Unless there's a substantive change in the way safety nets are funded, things are simply going to keep going in the direction they are, which is a great disparity in how patients are taken care of," says Dr. Chris Young, chief of the medical staff at Erlanger, the safety-net hospital in Chattanooga, Tennessee. "That divide is only going to grow." The Healthcare Divide, a documentary from FRONTLINE producers Rick Young, Emma Schwartz & Fritz Kramer and NPR correspondent Laura Sullivan, premieres Tues., May 18, on PBS (check local listings) and online. NPR will air a story as a part of this joint investigation that same day on All Things Considered (see stations and local broadcast times and NPR.org/stations). FRONTLINE, NPR and the Investigative Reporting Workshop have previously collaborated on numerous projects — most recently in Plastic Wars, an investigation of how the plastics industry publicly promoted recycling as the solution to the waste crisis despite internal industry doubts, from almost the beginning, that widespread plastic recycling could ever be economically viable. Other collaborative projects have included an in-depth look at Trump's Trade War with China and investigations of Hurricane Maria and Hurricane Sandy relief efforts (Blackout in Puerto Rico and Business of Disaster), and America's affordable housing crisis (Poverty, Politics and Profit). Now, in The Healthcare Divide, this award-winning team probes why some hospitals are thriving and others are in dire shape. "It's a little unfathomable to me how a hospital system could be making a huge profit in the middle of a COVID pandemic," says Dr. Brad Spellberg, chief medical officer at the safety-net hospital, LAC-USC Medical Center, where the documentary shows the heavy burden COVID took during the winter surge earlier this year. "This system itself makes no sense and when you have a system that makes no sense, there are going to be some winners and there are going to be some losers. Is that how you want your health care to be delivered?" The documentary traces the story of the safety-net hospital Erlanger, whose struggle to stay afloat led it to focus on more profitable aspects of healthcare, raising concerns among the staff about the hospital's dedication to its core mission. "We were seeing patients in hallways and in the waiting room," says Dr. Sudave Mendiratta, chief of emergency medicine at Erlanger. "It became very clear that spending money as an organization to gain market share and to increase volume was not effective to deliver quality care." The film also takes viewers to the hub of the healthcare industry: Nashville, where more than 50 years ago for-profit hospitals chains took root, most prominently Hospital Corporation of America, HCA. As the investigation shows, the growth of these hospital chains and the subsequent consolidation of the industry, both for-profits and nonprofits, has created a progressively competitive environment that has made it harder for safety-net hospitals to live up to their mission and stay afloat. "So that dynamic you have today in American healthcare is that wealthy hospital systems are able to invest in [profitable business lines]," says Siegel. "They're able to attract more commercial, privately insured patients. It makes it even more profitable and then they can invest even more. So you have the situation where, really you have two tiers in a way rich hospitals are getting richer and the poor hospitals are getting poorer." Says Jeff Goldsmith, a long-time healthcare consultant,"The real problem is the inequities in the society as a whole have reached the point where we really need to address them. The disparities in the circumstances of the hospitals are an outgrowth of a failure of social policy and politics. That's what I believe. I'm not going to blame the hospitals." The documentary also explores how Medicai
|
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.
|
yue_Hant
| 34,907 |
Morning Rounds: How The House Would Pay For Health Overhaul
|
Let the darts game officially begin. House Democrats yesterday formally released their proposal for health overhaul -- complete with details on how they'd pay for it -- and tacked it to the wall. But, as NPR's Julie Rovner points out in this morning's Morning Edition, this draft of the bill is just a starting point. In headlines this morning, critics are already taking aim at familiar targets in the House bill: New taxes. On the rich. As the New York Times points out: Starting in 2011, a family making $500,000 would have to pay $1,500 in additional income tax to help subsidize coverage for the uninsured. A family making $1million would have to pay $9,000. Families making less than $350,000 would not be taxed. The Times has a handy chart to help you see how you and your family would fare, and the AP has a quick breakdown on who and what would be covered. (More on how small businesses would be affected after the jump) Read More >> The proposal would require most employers with a payroll over $250,000 a year to offer health insurance to their workers, or pay into a government fund that would help insure those employees. For companies with payrolls of $400,000 or more, that fee would be eight percent of their payroll How many small businesses would be affected? According to the Wall Street Journal, ...businesses with between five and nine workers, representing about one million employers, had an average payroll of around $375,000 a year. A report from the Kaiser Family Foundation found that only about half of firms with three to nine workers offered health benefits in 2008. House leaders may be jubilant to get even a draft of a bill on the table but as Politico reports, even in the House, the draft bill is far from final. For example, provisions to reinstate price controls on prescription drugs used by seniors is sure to draw the ire -- and lobbying firepower -- of drug companies. Stay tuned. It should be a rollicking three weeks in Congress as all this gets hammered out. What do you think of the House plan so far?
|
NPR's David Welna talks with Lisa about the campaign reform bill, already passed by the Senate, which the House will consider when they return from their holiday recess this week.
|
eng_Latn
| 34,908 |
Most Uninsured Don't Know Health Coverage Deadline Looms
|
Next week is the last chance for most people without insurance to sign up for individual health coverage for the remainder of 2014. Yet according to the latest monthly tracking poll from the Kaiser Family Foundation, more than 60 percent of those without coverage still don't know that. The survey, conducted March 11-17, found that 39 percent of the uninsured between ages 18 and 64 did know that March 31 is the deadline to sign up for individual health insurance this year. Forty-three percent didn't know that date, and 18 percent thought the deadline was later or had already passed. Possibly even more ominous for those supporting the law: Half of the uninsured people surveyed said they are likely to remain uninsured this year, even though that could leave them subject to a fine. Forty percent said they planned to get coverage. Adding to the confusion, on Tuesday night the Obama administration announced that people will be able to sign up for insurance after March 31 if they say they had problems enrolling by the deadline. That could lead the administration to a serious political problem next year, when taxes come due, should very large numbers of people end up owing fines. That's especially true if many claim they weren't properly made aware of them. Health industry consultant Robert Laszewski is one of many commentators who think the administration will find a way to avoid making people pay, at least next year. At the heart of this speculation is an exemption from the penalty for those who can claim "another hardship in obtaining health insurance." That's the last of 14 hardship categories, which include being evicted, filing for bankruptcy, or being unable to pay existing medical bills. There is at least some good news for backers of the law in this latest monthly tracking poll, which has a margin of error of plus or minus 3 percentage points. For the first time since last fall, overall support for the Affordable Care Act is ticking up slightly, to 38 percent (from a low of 33 percent in November), and opposition is down to 46 percent (from 50 percent in January). And by a margin of 2 to 1, those polled still prefer to keep and/or fix the law rather than repeal and/or replace it with a GOP alternative. Just under 60 percent want the law left alone and/or fixed, while 29 percent said it should be repealed or repealed and replaced with a Republican alternative.
|
The House blew up the end-of-year deal to extend the payroll tax holiday, but it insists it's the Senate's fault. If both chambers fail to forge a compromise, taxes go up, unemployment benefits expire and payments to Medicare doctors get cut by 27 percent — all starting Jan. 1.
|
eng_Latn
| 34,909 |
As Its Drug Pricing Plans Fall Through, Trump Administration Turns To Congress To Act
|
The Trump administration has dropped one of the meatiest portions of its plan to reduce drug prices. The Department of Health and Human Services said it will no longer pursue a rule that would have prohibited the payment of certain rebates on drugs in Medicare Part D and Medicaid plans. The idea was to target the middlemen, pharmacy benefit managers, whose negotiations with drugmakers and insurers influence the costs consumers pay for drugs. The hope was the rule would have effectively pressured drugmakers to give discounts to consumers instead of middlemen, HHS secretary Alex Azar said in remarks to the media in February. "Passing discounts directly on to the patient will move us toward a real market for drugs," said Azar. "We're going to fundamentally rewire how we pay for drugs in this system." Right now, if you're a Medicare Part D beneficiary, and you need to pick up a drug that has a $120 list price, you might have to pay that full price, even if the middleman that negotiates on behalf of your insurer only pays a net price of $100 for it, after rebates. The idea of this proposal was that the consumer would only have to pay the discounted price. When the rule was first announced, drugmakers supported the idea, and some drug pricing experts said it could be an effective move. "This is a huge potential change, transformative," Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh told NPR. But some critics were concerned that the move wouldn't address drugs' list prices that are the starting point for negotiations. Also, there was a worry that the elimination of rebates could ultimately cost seniors more, in higher premiums on their Medicare plans. The nonpartisan Congressional Budget Office in May determined the plan would cost the federal government $177 billion over nine years, largely from increases in the government's share in the cost of premiums. In a briefing with reporters Thursday, Azar said the administration scrapped the plan after getting feedback from the public and stakeholders. "At the end of the day, while we support the concept of getting rid of rebates, while we appreciate and are passionate about the problems and the distortions in the system caused by this opaque rebate system, we're not going to put seniors at risk of their premiums going up." "Congress perhaps might even take this up — they have more tools than we do," Azar said. "They can actually look more holistically at changes to the system that could also mitigate or protect seniors from bearing any impact of change. I don't have those tools; they might have those tools." A senior Trump administration official, who spoke on background during a separate briefing Thursday, echoed those sentiments, saying their primary focus is to support a legislative deal to lower drug prices and that there was concern this change would disrupt those efforts. Drugmakers were in favor of trying to bring consumer prices down by targeting middlemen. The drug industry trade group PhRMA called the rollback of the plan "a blow to seniors who could have paid less for their medicines at the pharmacy counter." "Of all the policies proposed in Washington right now, this was the only proposal that would provide immediate savings at the pharmacy counter, instead of only saving the government or insurance companies money," said Holly Campbell, PhRMA's deputy vice president of public affairs in a statement. Other stakeholders cheered the administration's reversal of the proposed rule, including groups representing private insurers, public sector health plans and pharmacy benefit managers. They pointed to the prices set by drugmakers as a better focus for efforts to reduce drug costs. "Any solution should start with addressing drug prices," T.J. Crawford, a spokesman for CVS Health, which operates a large pharmacy benefit manager, wrote to NPR. Matt Eyles, president and CEO of America's Health Insurance Plans, said in a statement: "As we all know, drug prices and price increases are set and controlled solely by drugmakers. They alone could decide to reduce prices – and can do so today." The rebate reversal is the second defeat for the administration on drug pricing in a week, coming just days after a court struck down another pillar of its drug pricing plans, a proposed regulation to require that drug companies disclose prices in ads. Azar says the administration hasn't given up on lowering drug prices. But Congress will have to play a bigger role. "We have many other things that we're doing in drug pricing," he says. "We are working on a bipartisan basis with Congress on drug pricing legislation." The White House official who briefed reporters Thursday said people in the administration don't plan to "twiddle our thumbs" while the legislative process plays out, and are working on a number of plans. President Trump hinted at one idea last week — a "most favored nation" clause that would
|
NPR's Larry Abramson reports that Congress is taking the cable industry to task for rising rates. At a hearing yesterday, cable executives claimed that increased program costs force rates upwards. Senators agreed that competition, not regulation, will bring them under control.
|
eng_Latn
| 34,910 |
To Changing Landscape, Add Private Health Care Exchanges
|
We've been reporting a lot lately on the troubled rollout of President Obama's signature health care law. But at the same time, there are rumblings of a major shift in the way companies offer private health insurance to workers. It involves what are called "private health care exchanges." These are similar to — but completely separate from — the public exchanges you've heard so much about. Some experts say this new approach soon could change how millions of Americans receive their health care. Dean Carter is the chief human resources officer for Sears Holdings, which means he has shifted more than 50,000 employees onto this new kind of health care system. And he thinks this is the future. "In my 20 years of HR and working with benefits," Dean says, "this fundamentally changes the game." The change Dean is talking about is kind of like what happened when most companies stopped offering pensions. Instead, many just contribute money to their workers' retirement accounts. With health care now, some companies are saying: "Here's $300 to $400 a paycheck. Go use that toward buying insurance on a 'private exchange.' " For years, at big conferences attended by benefits managers, there has been talk about private health care exchanges, with four, five or six different carriers competing on price to offer people insurance. But it seemed to be something maybe 10 years in the future. Then the Affordable Care Act passed. And that made exchanges seem more doable right away for the private sector, too. "When we began to look at it, and it looked like it was a good idea for our associates and Sears Holdings, we leaned in fast," says Carter. In the past, the whole company was essentially trapped in a health plan for several years with one insurance company, says Carter: "For two to three years, the entire employee population would be locked in to using that carrier alone. ... If that carrier decided there would be cost increases year on year, you were basically loaded into those cost increases." But in private health care exchanges, every year multiple insurance companies have to compete on the exchange. And individual employees shop for the various plans, and select an insurance company based on the price they offer for benefits. "We believe the competitive nature enables us to save on costs and our employees to save on costs," says Carter. Akshay Kapur, a principal with the consulting firm Booz & Co., studies health care and private exchanges. And he says these exchanges reduce costs, both through competition and by changing employee behavior. "Once you give a fixed amount of money to employees, they will make health care choices that are appropriate or optimal for themselves and their family," says Kapur. Kapur says that will mean fewer healthy people going to the doctor too frequently. For example, some plans have premiums as low as $5 a paycheck but with a $6,000 deductible. That might be a good option for someone who is healthy and doesn't expect to go to the doctor. Most plans, though, also offer some free checkups, to make sure people are going to the doctor enough to catch any health problems early on. In theory, these new private exchanges might sound good. But, there are problems. Christine Trapp, 42, has been battling advanced-stage breast cancer. She also works for a major retailer that's switching to a private exchange, which she says has been having the same kind of problems as the public exchanges. The website wouldn't work, and she couldn't get help on the phone, Trapp says, calling it "very overwhelming and confusing." And, she says, "contacting the company to get answers was very difficult — 20-, 30-, 40-minute wait times." As it turned out, her employer is chipping in $417 per paycheck. And with that, she could have gotten a similar plan to the one she had before for a few dollars less per paycheck. But she couldn't figure that out. So she signed up for the most expensive platinum plan because she was scared about losing her doctors and fouling up her cancer treatment. That's going to mean a 25 percent cut in her take-home pay. She makes $37,000 a year and has two kids in college. So for now, Trapp says, she's going to try to save money however she can. Going forward, as more companies make this shift, will competition rein in rising health care costs for workers? Or will workers end up paying more anyway, because employers keep making them shoulder more of the health care burden? DAVID GREENE, HOST: This is MORNING EDITION, from NPR News. Good morning. I'm David Greene. LINDA WERTHEIMER, HOST: And I'm Linda Wertheimer. We've been reporting on the troubled rollout of Obamacare's insurance exchanges. Now, let's hear how it's going for the completely separate, private industry health care exchanges. For the millions of people who have insurance through their jobs, this could represent a huge shift in how they get their health care. NPR's Chris Arnold reports. CHRIS ARNOLD, BYLINE: Dean Carter is the ch
|
A new survey from NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health details people's attitudes towards relationships, finances, families, health and discrimination. Host Michel Martin is joined by Matt Thompson of NPR's Code Switch team to discuss the poll's results.
|
eng_Latn
| 34,911 |
Health Care Hurting Because Of The Recession
|
In the U.S., millions of people have lost their jobs and their health insurance. Even those who still have insurance may find themselves cutting back on medical treatments and care. In this recession, are you making difficult decisions about your health care? Guests: Julie Rovner, NPR's health policy correspondent Francesca Lunzer Kritz, writes a weekly column on health care costs for the Los Angeles Times; author of "Cut health costs, not your care" published Dec. 29 in the Los Angeles Times. LYNN NEARY, host: This is Talk of the Nation. I'm Lynn Neary in Washington. Neal Conan's away. Many of the just over three and a half million people who lost their jobs since the beginning of the recession have lost their health insurance as well. Even people who had health insurance face tough financial questions. A recent report by the Kaiser Family Foundation says nearly half of all Americans report someone in their family cutback or put off medical care or skimped on prescription medicine to cut costs. And some hospitals and doctors report seeing patients whose health is suffering because of the recession. Stressed out about their financial situation, they may be drinking or smoking too much and canceling gym memberships, when they need them most. Is it possible to stay healthy and save money on medical costs? We'll find out. It's part of our occasional series, Your Life in a Recession. Today, your health care in a recession. Later on, on the Opinion Page, Clarence Page takes issue with Larry King's assertion that there's a lot of advantages to being black these days. But first, your health care in a recession. Are you cutting back on your health care? What are you doing to reduce your health cost? Tell us your story. Our phone number, 800-989-8255 and the email address is [email protected]. And you can join the conversation at our Web site, go to npr.org and click on Talk of the Nation. NPR health policy correspondent Julie Rovner is here with us in Studio 3A to help through the maze of health care once again. Good to be with you, Julie. JULIE ROVNER: Nice to be here. NEARY: So listen, is there really hard evidence that people are cutting back on medical care because of the recession or is this all anecdotal? ROVNER: Well, there are some hard evidence. We certainly see the poll that you cited from the Kaiser Family Foundation, I should point out that was done in October, which was really just at the start of what we think of as, you know, the big financial meltdown. And I should point out that these were not necessarily people without insurance. We're seeing a lot of people with insurance. One of the things we've been seeing certainly accelerate over this last year is people with insurance being asked to pay more by their employers. Particularly this year, I think a lot of people have their open seasons and their new insurance starts at the beginning of the year. And they're being asked to pay more in premiums, in co-payments, in deductibles, so suddenly, their health costs are going up. One of the things we're seeing is that people may be asked to take these wage freezes or you know, even pay cuts. NEARY: Right. ROVNER: And yet, their health-insurance costs are going up at the same time. Health insurance or health care - health spending is going up still much faster than inflation and much, much faster than wages. So we're all feeling this pinch of health-care costs going up much more rapidly. And it obviously hurts much more at a time when we do and feel like we do have less money to spend on it. NEARY: Yeah, so what are the health implications if people are beginning to skimp on health care as a way to save money? ROVNER: Well, certainly this is where it becomes much more anecdotal, but you know, talking to doctors, talking to hospitals, you know, you're seeing people, obviously if you go off your blood pressure medication or your cholesterol medication that can have health care, you know, consequences large and small. You can obviously have a heart attack or a stroke or, you know, something catastrophic. People who are, you know, taking antidepressants can have, you know, problems with depression coming back, you know, more chronic conditions that can recur. Certainly there are issues of people simply having, you know, a lot more stress. People who had been going to the gym and losing weight are now, you know, reported to be gaining weight again, you know, eating perhaps cheaper but more, you know, more caloric food and therefore gaining weight or perhaps even just more comfort food... NEARY: Right. ROVNER: (Laughing) And gaining weight because we are stressed. NEARY: Of course, because this whole, you know, stress is going to make people sicker. ROVNER: That's right. And you know, stress is not helpful for people who have certain chronic conditions, things like, you know, high blood pressure which stress can actually have an impact on. NEARY: Yeah. Let's take a call now. We've got Lynn calling
|
Reports of poor conditions at Walter Reed Army Hospital have highlighted failures to adequately care for service members returning from Iraq and Afghanistan. Concerns about military hospitals, as well as the VA system, have lead to hearings, investigations and resignations.
|
eng_Latn
| 34,912 |
More Preventive Health Services Approved For No-Cost Coverage
|
The Affordable Care Act says that preventive health tests or services recommended by the U.S. Preventive Services Task Force have to be available to most insured consumers without any out-of-pocket cost. Since the law was enacted, the list of services that people are entitled to has grown. In 2014, the task force recommended two new services and tweaked a handful of others that had previously been recommended. Under the health law, preventive care that receives a grade of A or B on the recommended list by the nonpartisan group of medical experts must be covered by health plans without charging consumers. Only grandfathered plans are exempt from the requirement. The newest recommended services are hepatitis B screening for adolescents and adults at high risk for infection and low-dose aspirin for pregnant women who are at high risk for preeclampsia, a condition characterized by an abrupt increase in blood pressure that can lead to serious complications for the woman and baby. In its hepatitis B screening recommendation, the task force said there was new evidence that antiviral treatments improved outcomes in people at high risk for the liver infection, including those from countries where the infection is common, people who are HIV-positive and injection drug users. Although it's not a big cost from an insurance perspective, the March of Dimes welcomes the task force recommendation regarding use of low-dose aspirin to prevent preeclampsia in high-risk women, says Dr. Siobhan Dolan, an OB-GYN at Montefiore Medical Center in the Bronx, who's a medical adviser to the March of Dimes. "What's exciting about this is that now we have something to offer women that's a low-risk strategy," says Dolan. Preeclampsia accounts for 15 percent of all preterm births. The task force also issued a recommendation for gestational diabetes screening after 24 weeks in asymptomatic pregnant women. That service, however, is already being offered at no cost by health plans following an Institute Of Medicine study commissioned by the Department of Health and Human Services that identified gaps in existing coverage guidelines. In its review of screening for gestational diabetes, the task force found sufficient evidence that it reduces the risk for complications such as preeclampsia, large birth-weight babies, and shoulder dystocia, when the baby's shoulders become stuck inside the mother's body during delivery. The task force recommendations take effect for the plan year that begins one year after they're issued so for many consumers, these provisions won't take effect until 2016.
|
This week on Latino USA: Young Men, Sex and Health. While they need it just as often, young men access reproductive health care far less frequently than females. This not only puts them at greater risk for undetected illnesses, but it also means they have a lot of unanswered questions about their health. But the Young Men’s Clinic (YMC) in New York’s Washington Heights is working to change that. And soda sales across the country are fizzling so they’ve found a new target hoping to get sales bubbling again. Finally, what major hurdles do Latino men face? We find out.
|
eng_Latn
| 34,913 |
Cost Estimates Climb For Nebraska Medicaid
|
In the latest round of the health overhaul's "Showcase Showdown," the actuaries of Milliman, Inc., are projecting the federal law will cost the state of Nebraska between $526 and $766 million in unfunded Medicaid costs over the next 10 years, depending on how many folks actually sign up. The report, commissioned by Republican Gov. Dave Heineman's administration, says the biggest expense would be the cost of paying medical claims for around 30,000 more Nebraskans. Washington will pick up most of that cost, but the 10 percent that eventually falls to the state still measures in the hundreds of millions, according to Milliman's report. Other costs include new administrative expenses and changes to a drug rebate program. Read More As you may have guessed, the report's ultimate meaning is being refracted through red and blue lenses. In dueling statements, Nebraska's Republican senator, Mike Johanns said it details "the type of no-win decisions that the new health care law forces on our state," while Democratic Senator Ben Nelson argued "it actually illustrates how much of a burden health care costs are to Nebraska families." Nelson, you may recall, won a deal for the state in the Senate version of the overhaul that would have diverted the full bill for expanding Medicaid to the federal government. But, that unpopular provision - derided as "the Cornhusker Kickback" - was stripped before the final bill cleared the House. The same actuary, Milliman's Rob Damler, put together projections for Indiana, too. A May 6 letter says the state would likely spend an extra $3.6 billion over 10 years because of the overhaul. An earlier memo between Indiana's health secretary and the staff of Gov. Mitch Daniels, a prominent critic of the health law and rising Republican star, suggested one overlooked provision affecting drug rebates could cost the state $400 million over that time. Cindy Mann, the top federal official for the Medicaid program, told us in April that such estimates were overblown and assumed a worst-case scenario that forthcoming regulations would soften. But, when rules for the drug program became available, Milliman revised its estimate down to still-massive $298 million for the same provision. Reached by phone, Damler said his firm was working on projections for other states, too. He cautioned that these estimates wouldn't translate readily to other places, though. Each state government has different rules for Medicaid. Nebraska, for instance, currently covers more parents in its Medicaid program than Indiana, so the impact of the overhaul will appear smaller.
|
You may be on summer vacation, but the interest groups looking to make their mark on legislation to overhaul health care are working harder than ever. The Wall Street Journal reports that delays on Capitol Hill make this month the key time to "snare one-on-one meetings with lawmakers back in their home districts." Take Tim Trysla, a lobbyist at Alston + Bird. Makers of diagnostic imaging equipment are among his clients. "If you're looking for savings, don't come at us," says Trysla, who has called on 120 legislators, sometimes taking General Electric execs along to make the case for protecting payment for medical scans. (Check out a nifty WSJ interactive graphic on lobbying spending here.) Read More >> Trying to figure out what works and what doesn't in improving the health-care system? It never hurts to follow the money. NPR's Richard Knox digs into the money pit in Massachusetts, where a 3-year-old law expanding coverage has pushed the proportion of uninsured down to 2.6 percent--lowest in the nation.. The remarkable achievement has come at a high cost. Now, the state is looking to save money by paying doctors and hospitals a fixed annual amount for each patient rather than shelling out for services whenever they're rendered. "In the world of health care, this is big news," Knox says. The Food and Drug Administration has concluded that some drugs used to treat rheumatoid arthritis in children and teenagers need a tough warning about an increasing the risk of lymphoma and other cancers. The affected drugs include Johnson & Johnson's Remicade, Amgen's Enbrel and Abbott Lab's Humira.
|
eng_Latn
| 34,914 |
Pirates, Or No Pirates?
|
Our dilemma today: pirates, or no pirates? Do we follow the story (just because it is instrinsically iteresting)? Or, do we wait to see if there's a unique angle we can add. I confess I am torn because, on the one hand, I find every aspect of this story compelling -- it reminds us that, although we live in a modern age, many of our ancient inflictions remain. Plus the story has it all: the lawlessless, the human story, the military strategy, the fact that the pirates are now vowing to retaliate (which I find hilarious! Wait a second here, you hold people hostage, but nobody's supposed to fight back? are you kidding me?) On the other hand, if you have alrady heard it on the morning shows and on cable. What more do you need to hear from us? Other issues in the works: there are some truly compelling education stories out there. Do we tackle them singly or try to group them together? More on cities in crisisWe expect to have an interview with the Mayor of Las Vegas Oscar Goodman. What's it like to run a city that's kind of become a symbol for wretched excess. And later in the week, we're thinking about that story about the Turkish television news anchor who did his commentary in blackface. If you hadn't heard about it, Here it is: It's actually a fairly complicated issue of symbolism, and it's strange. Speaking of commentary, I did not deliver one today. I am sure some of you are grateful, but to those who are not. It was Easter and, because I try to be topical, I almost always prepare it on Sunday. And in order to have uninterrupted time with the family and to focus on the day; I did not.
|
A solid majority of Americans believe with President Barack Obama that any remaking of the present health-insurance system should include a public option, according to a new Quinnipiac University poll. But here's the rub. Only a small minority of them would want to be insured by such a plan. That's a fairly intriguing paradox. An excerpt from the press release announcing the poll results: Although 69 percent of voters nationwide say Americans should have the option of government- run health insurance, only 28 percent would choose to be covered by it, according to a Quinnipiac University national poll released today. Voters say 49 - 45 percent they would pay more to reform health care, but a total of 72 percent don't want to pay more than $500 a year. Read More >> A Quinnipiac researcher had this analysis of the poll's results: "American voters want their fellow countrymen to have the option of a public plan, but don't want a public plan for themselves because they are satisfied personally with their health care," said Peter Brown, assistant director of the Quinnipiac University Polling Institute. "That presents a challenge to those who want Americans to pay more to reform the system." "In addition, seven out of ten voters aren't willing to chip in what amounts to the price of a cheese pizza per week - without extra toppings - in order to finance an overhaul," Brown added. "Opposition to paying any additional taxes ranges from 40 percent among lower paid voters to 52 percent among those making more than $100,000 per year." It's not often that cheese pizza gets mentioned in the health-care debate. Maybe fewer cheese pizzas would mean healthier Americans who would need to use health care less often which would reduce the cost of health care. But that's a discussion for another time.
|
ltz_Latn
| 34,915 |
Q&A: Recession Hits Social Security, Medicare Funds
|
The condition of the government's biggest benefit programs worsened in the last year because of the recession and because people are living longer, an annual report card says. Social Security's trust fund will be essentially used up by 2037 — four years sooner than last year's estimate, its trustees reported. Medicare won't be able to meet its obligations beginning in 2017 — two years sooner than previously projected, the trustees said. The annual report released Tuesday by the programs' trustees shows that if the federal government did nothing before 2037, Social Security could pay only 78 percent of promised benefits after that date. Here are some questions about what these estimates mean and how the programs work — as well as some possible solutions and their political implications. How has the recession worsened the finances of both programs? Both Social Security and Medicare are funded by the payroll taxes paid by virtually all workers. Because so many people have lost their jobs during this recession — 5.7 million so far — the revenue from payroll taxes has declined. That means the balance in the trust funds is less than was anticipated. Remind me how Social Security's finances work. Current workers pay the benefits for current retirees. In fact, current workers pay more in payroll taxes than is required to pay all Social Security benefits being paid right now. The surplus is used to buy special U.S. treasury bonds that go into the Social Security trust fund. As more people in the baby boom generation retire, the number of workers for each retiree will fall. Eventually, the payroll taxes paid by workers won't cover all the promised retiree benefits. That's now expected to happen in 2016. At that time, the Social Security trust fund will begin to redeem its U.S. treasury bonds to fill the gap. The 2009 trustees report estimates the trust fund will have used all its bonds by 2037, at which time Social Security will be able to pay only 78 percent of currently promised benefits. What are the prospects that I'll get my promised benefits if I retire after 2037? You're almost certain to receive a large portion of the promised benefits, though possibly not all of them. But the prospect that Congress would allow Social Security payments to drop 22 percent in one year in 2037 is politically unthinkable. So what can the government do to avoid this? Solving Social Security's financial problems is a big political challenge, but not a huge financial challenge. Some combination of a small payroll tax increase and modest reductions in benefits could close Social Security's financial gap. There is no shortage of proposals to do this. It's also possible lawmakers could look for other sources of revenue to close the gap. What happened to the idea of allowing individuals to privatize a part of their Social Security contributions? One of the reasons it's been difficult to make changes in Social Security financing in recent years is because the debate got bogged down in arguments over whether a portion of the payroll tax should be diverted into private investment accounts. That idea is less in vogue now after the huge fall in the stock market. With that option off the table, it may be easier politically to get a financial fix. Now remind me how Medicare is financed. It's rather complex, so let's take a step back. Health care coverage is available under Medicare to anyone who is eligible for Social Security benefits, including the elderly but also the disabled. It's financed by a combination of taxes, subsidies and out-of-pocket payments by those who use the system. Medicare Part A covers hospital stays. It is paid for by direct taxes on workers and employers, plus set fees in the form of deductibles and coinsurance, which are paid by those using the services. The fees vary every year, but are generally more than what it would cost under a private insurance plan. The report out Tuesday concerns only the trust fund for Part A. The other sections of Medicare are funded through premiums or revenues from income tax. In 2008, Part A was financed by a 1.45 percent add-on to the Social Security tax. What about Medicare Parts B, C and D? Part B is a little trickier. Medicare Part B, or supplemental insurance, is intended to cover what Part A doesn't — things like doctor visits and, more recently, preventive care, like mammograms and prostate cancer screening. It's technically voluntary, but most people buy into the system. It costs an individual $96.40 per month, plus deductibles and co-pays. Part C is known as Medicare Advantage. It's essentially a program run by private-sector health insurers — HMOs — that compete with each other to offer seniors additional health services for additional fees. The government pays the plans to provide this service, the amount of which is controversial. In 2003, Congress passed a bill that added a Part D to Medicare, making prescription drug coverage available for purchase through the progr
|
The latest employment numbers showed far fewer jobs were created in March than in February, disappointing those who had hoped robust growth from the winter months would hold into spring. The news overshadowed an effort from the White House to reach out to Republicans on the tax-and-spend front. The president said he would trim the growth in retirement programs if the GOP would accept some higher taxes. NPR's Scott Horsley talks to Robert Siegel about how the two issues are related.
|
eng_Latn
| 34,916 |
Florida Leads Insurance Sign-Ups, Despite Political Opposition To Overhaul
|
When Florida workers promoting President Obama's health law marketplace want instant feedback on how they're doing, they go to an online "heat map." The map turns darker green where they've seen the most people and shows bright red dots for areas where enrollment is high. "The map shows us where the holes are" and which communities need to be targeted next, said Lynn Thorp, regional director of the Health Planning Council of Southwest Florida. She hands out information about the health law's marketplace at rodeos, farmers markets, hockey games and almost any place where people gather. The mapping strategy is one reason why a Republican-controlled state like Florida, whose leaders have criticized the health law at practically every turn, is leading the nation in signing people up for private Obamacare health plans. With two weeks to go until the deadline for 2015 enrollment, Florida's tally exceeds that of even Democrat-led California, which has twice the population, uses three times as much federal funding for outreach and has built its own online marketplace. "It's surprising Florida has done as well compared to other states, and they will be looked at by folks who want to learn lessons to promote enrollment," said Joel Ario, managing director for Manatt Health Solutions, a consulting firm, who worked for the administration setting up the exchanges soon after the law was passed. As of mid-January, 1.27 million Floridians had enrolled in exchange plans, according to federal data, compared with 1.2 million Californians. Texas, which has 6 million more people than Florida, enrolled about 919,000 people in private plans. Both Florida and have a 22 percent uninsured rate. California's rate is 17 percent, according to the latest census data. "It is truly ironic that Florida leads the nation in enrollment ... with leadership that has actively opposed the law," said Leah Barber-Heinz, executive director of Florida CHAIN, an advocacy group involved in outreach efforts. "It shows true commitment on the part of many and it portrays an extremely high need for affordable coverage. There are other reasons cited for Florida's robust enrollment —including intense competition among insurers in several big counties and the high degree of coordination among the nonprofits and community groups which received federal grants to sign people up. Another key factor is the state's decision not to expand Medicaid under the law. That's left consumers with incomes above the federal poverty level of $11,600 per year with no coverage option other than to buy a private plan — with help from sliding-scale government subsidies. About 800,000 Floridians who make less than the federal poverty level are shut out altogether because they make too little to qualify for subsidies for private plans, but too much to qualify for Medicaid. In Florida, adults with children qualify for Medicaid only if their income is below 34 percent of the poverty level. Childless adults are ineligible. Florida is one of 22 states that chose not to expand Medicaid after the U.S. Supreme Court made that provision optional for states. In contrast, California expanded Medicaid to those making up to 138 percent of the poverty level, or $16,100 for an individual. The program has grown by 2.3 million people since fall of 2013, boosted partly by publicity for the online marketplace. Covered California spokesman James Scullary said the exchange isn't allowed to enroll people in private plans if their incomes fall between 100 and 138 percent of the federal poverty line, because they qualify for Medicaid. Jon Urbanek, senior vice president of Florida Blue, the state's dominant insurer, credits Florida's strong enrollment in private plans, in part, to the state's decision not to expand Medicaid. He also points to the intense outreach by thousands of the carrier's insurance agents. Florida Blue has conducted about 3,000 "town-hall" style meetings at its 18 retail centers. "We knew going in that this was going to be a face-to-face, get in the community type of action to build trust with people," he said. Florida has also gained from having an older population which is more likely to buy coverage than younger people, Ario said. That population is centered in a handful of urban areas such as Miami, Orlando and Tampa, making them easier to target, he said. Then there's the unusual effort to coordinate outreach. John Gilbert, national field director for Enroll America, a nonprofit doing outreach in 10 states, said Florida has benefitted from having several large nonprofits with experience signing up children for Medicaid. They have worked together closely – helped in part by the heat map. Thorp of the Southwest Florida Health Planning Council describes how every time she hands out Obamacare flyers at a fair, or counsels at a local library, the action get entered into a computer log, which immediately changes the heat map. That way, other outreach workers see where contacts have been
|
In Illinois, Republicans object to a map that endangers their delegation in a state with a Democratic-controlled legislature and governor. The opposite is underway in Texas, where the Republican legislature and governor approved a map that Democrats say doesn't accurately reflect population growth.
|
eng_Latn
| 34,917 |
Beehives Stolen from California Nut Grower
|
Beekeepers have been struggling with a mysterious disease that's destroying their colonies. Now they have to fend off thieves. One California nut grower, who needs bees to pollinate his trees, says robbers stole 180 of his hives, costing him about $70,000.
|
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.
|
eng_Latn
| 34,918 |
To Lower Costs, Mass. May Restructure Doctor Pay
|
Massachusetts is proud of its landmark 3-year-old health insurance law. It has brought the state's proportion of uninsured down from around 10 percent in 2005 to only 2.6 percent — the lowest in the nation. But the achievement is in jeopardy. Massachusetts has the highest health costs in the country. "The critical point is whether or not we can begin to do something about cost control," says Dolores Mitchell, who heads a state commission that buys coverage for 310,000 government workers and their families. "We've just got to do it." Mitchell and nine other experts have a plan to bring Massachusetts health costs under control. They worked for nine months, under a legislative mandate, to come up with the official blueprint. Eliminating The "Fee-For-Service" Model The first thing they decided — unanimously and right off the bat — was that the current way of paying doctors, hospitals and other medical providers has got to go. "It was absolutely clear," Mitchell says. "There was no argument about that." In other words, Massachusetts is going to try to kill off fee-for-service. That's the time-honored system that pays health care providers a separate fee for every service they provide. In the world of health care, this is big news. For years, experts have lamented that fee-for-service payment drives costs up because it gives health providers a strong incentive to do more doctor visits, more tests, more procedures, more hospitalizations. Also, fee-for-service doesn't pay for many things that might reduce health costs and keep people healthy. But no state has ever tried to eliminate this payment method across the board. Massachusetts policymakers want to replace fee-for-service with "global payment" — paying groups of health providers a flat yearly fee for each patient they cover. "Global means it's for all services," says Dr. Rick Lopez, chief physician executive of Atrius Health, one of Massachusetts' biggest doctor groups. "It includes when the patient comes in to see the physician, hospitalization, pharmacy, skilled nursing facilities, home care services — the whole spectrum." About half of Atrius Health's 900 doctors are already on global payments. "Global payment actually allows us the freedom to look at the best way to provide patients' care at the right time, the right place," Lopez says. For instance, it allows nurse Chris Roddy to pay close attention to patients who could cost Atrius Health a lot of money in hospital bills. In a fee-for-service system, nobody would pay her to do that. On one recent morning, she was checking in on Connie Johnson, an 81-year-old patient with severe heart failure, diabetes and a history of strokes. Roddy calls her three times a week. "What was your weight this morning?" Roddy asks. In heart failure, even a pound or two of weight gain can signal an ominous change. Johnson says the scale read 229. "Excellent! Excellent!" Roddy says. Johnson says her blood sugar reading was 110. "Sweet!" says Roddy. "All right, my dear, so you know when to give me a jingle. Take care!" The phone care works both ways, Roddy says. "Some people call every day, some we beg to call and they don't. What a lot of people have said to us is when they call — and they call for everything — they like to get a human," she says. "They don't have to go into voice mail and press 6. They get to actually talk to a human being." The idea is to keep Connie Johnson and others like her out of the hospital. It works, Lopez says. Johnson is healthier, happier — and Atrius Health saves money. Ensuring Patients Get Care But some worry "global payment" sounds suspiciously like the managed care "capitated" HMO plans of the 1990s. Those plans were also based on paying health care providers a fixed amount per patient. That experiment failed, because it gave doctors and hospitals an incentive to hold back on care. To avoid a repeat of that experience, advocates of global payment say health providers will have to be watched closely. "You need someone monitoring this," says Nancy Kane of the Harvard School of Public Health. "You can't just walk away because you've set the limit." Kane is a health care finance expert who also served on the recent Massachusetts Payment Reform Commission. She says there are ways these days to prevent stinting on care. "There's a lot of quality measuring that can go on now that didn't used to be available," she says. "We now have electronic medical records. It's easier to monitor what's going on. So I think the whole reporting system and the intention to maintain a monitoring infrastructure is all critical to avoiding the bad days of managed care." Kane says there are also reliable ways now to protect health plans, so they don't lose their shirts by signing up older or sicker patients. A National Model? The stakes in this new experiment are high — and not just for Massachusetts. "The nation's looking at us because we've done the universal coverage," Kane says. "And now everybody's saying 'Ha
|
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.
|
eng_Latn
| 34,919 |
Surprised By A Medical Bill? Join The Club. Most Americans Say They Have Been
|
A Texas man has a heart attack – and good medical insurance – and still finds himself on the hook for $109,000 in medical bills. Another man in Florida owed $3,400 for a CT scan, after his insurance company pays its part. And woman who had surgery for back pain was billed more than $17,000 for a urine test that her insurance company refused to pay. These stories – all featured in the Bill-of-the-Month series from NPR and Kaiser Health News — seem like anomalies. But a recent survey of American adults shows they are actually the norm. Most survey respondents — 57 percent — have been surprised by a medical bill they thought would be paid for by their insurance companies, the survey from the research group NORC at the University of Chicago finds. "People get surprised by all kinds of bills, for all kinds of reasons," says Caroline Pearson, a senior fellow at NORC. Pearson herself says she was not expecting the problem to be so widespread. The survey shows that 53 percent of those surveyed were surprised by a bill for a physician's service, and 51 percent got an unexpected bill for a laboratory test – like the urine test featured in our earlier story. Hospital and health care facility charges surprised 43 percent of respondents, and 35 percent reported getting unexpected bills for imaging services, like the CT scan featured by NPR. The survey shows that while some of the unexpected bills come because doctors or hospitals where patients are treated don't participate in the patients' insurance networks, the majority come because patients expect their insurance to cover more than it actually does. Most people blame their insurance companies for the bills that aren't covered, rather than blaming doctors or hospitals who may not have joined the insurance companies' networks. "There's really deep confusion about people's insurance, and they actually don't have a good idea of what's going to be covered when," Pearson says. She suggests people should study their policies very carefully to understand what's covered. An earlier survey conducted in 2015 by Consumers Union found about a third of people got an unexpected medical bill after their insurers paid less than expected.
|
in which pharmaceutical maker, Smith Kline Beecham, has agreed to pay the federal government $325 million for allegedly over-billing Medicare and Medicaid for laboratory tests. The out of court settlement results from a government investigation into the health care industry, known as `Operation Labscam.'
|
eng_Latn
| 34,920 |
In Zimbabwe, Doctors Are Taking To The Streets To Strike Over Diminishing Pay
|
When Robert Mugabe was ousted in 2017, Zimbabweans thought the new administration would right the economic ruin. But instead, life has gotten worse. Doctors are striking over diminishing pay.
|
Do physicians in the main support the Obama-congressional health-care overhaul or not? A straight-forward question without an equally straight-forward answer apparently. For example, a market research company, HCD Research Inc., just this week asked a panel of 900 doctors their opinion. The question: "Which of the following best describes your overall opinion regarding the Obama Administration's current plan for health-care reform?" HCD Research reports that 71 percent of the doctors had an unfavorable opinion while 29 percent reported they felt favorably. Meanwhile here was another question: "If you had the opportunity to choose your career today, how would your knowledge of health care reform affect your choice to go into the medical field?" Similar to the first response, 63 percent said they'd do something else while 32 percent said they'd be as likely to become docs. Read More >> An Investors Business Daily/TIPP poll from last September also found 65 percent of doctors opposing the overhaul. And 45 percent in the IBD/TIPP poll said they "would consider leaving their practice or taking an early retirement" if the overhaul became law. All right, try squaring all that negativity with a survey done last year of 2,130 docs. Asked in a survey by two doctors at Mt. Sinai School of Medicine whether or not they supported the now-defunct public option, 63 percent of those docs said they did. Given how much many docs complain about Medicare and Medicaid reimbursements, that's a fairly stunning result and doesn't seem to jibe at all; with the ant-overhaul sentiment of the other survey. Unless the doctors in the HCD and IBD polls opposed the overhaul because it didn't have a public option, which seems unlikely. Based on all this, who really know what doctors think?
|
eng_Latn
| 34,921 |
Georgia's 'Coverage Gap' Leaves Many Uninsured
|
The state did not expand Medicaid so many of their target audience — African-Americans and Latinos — may make too much to qualify for Medicaid but too little to get subsidies.
|
The Obama administration announced Tuesday that it's delaying a key part of the Affordable Care Act. Businesses will now have another year to prove that they are providing health insurance — or that their employees otherwise have health insurance from some other source. Companies had complained that the reporting requirements to prove this were too complicated and burdensome.
|
eng_Latn
| 34,922 |
Same Surgery, Different Cost: Insurance Explained
|
Princeton economist Uwe Reinhardt argues that health care should be looked at from an unemotional, economic perspective. Reinhardt explains the practice of price discrimination, the process by which the cost of care is negotiated between hospitals and insurance companies.
|
NPR's Julie Rovner reports that horseback riders, roller-bladers, and other sports enthusiasts are perplexed about a new health care law. It's intended to prevent health insurance discrimination, but could also keep some sports injuries from being covered.
|
eng_Latn
| 34,923 |
Can You Keep Your Old Health Plan? It May Depend On Where You Live
|
President Obama's proposal to try to let more people keep their canceled health insurance policies sounded so simple when he announced it Thursday. "Insurers can extend current plans that would otherwise be canceled into 2014. And Americans whose plans have been canceled can choose to re-enroll in the same kind of plan," he said in unveiling the proposal at the White House. In other words, if your insurance company says so, you can keep your existing health policy for another year. But you might have missed what the president said right before that: "State insurance commissioners still have the power to decide what plans can and can't be sold in their states." Indeed. But there's a problem with that. "In some of these states it may actually be against state law to implement the president's proposal," says Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. Corlette says several states — some put the number at around a dozen — have basically written the Affordable Care Act's requirements into their own state laws. But it also means that starting Jan. 1, 2014, even if the federal government says canceled plans can continue for another year, state regulators might find their hands tied by their own state laws. Indeed, Corlette says eight states have already moved to prevent or restrict insurers from renewing plans now that extend into 2014. That's something the federal law does not prevent. But in most of the states, whether or not to allow insurers to reverse the cancellations will, indeed, be up to state regulators. And they seem to be divided on the issue, along lines that are not necessarily partisan. California's insurance commissioner, for example — a Democrat — has announced that he will support allowing insurers to go forward if they want to. But Mike Kreidler, the state of Washington's commissioner — also a Democrat, and a former member of Congress — has said an emphatic no. He says his state's health exchange is working smoothly and he sees no reason to make changes now. "It would have been very disruptive to try to figure out a way to implement the president's suggestion," Kreidler says. "And, quite frankly, I'm not even sure it would have been feasible under the best of circumstances." Kreidler says allowing canceled plans to continue would also be unfair to the state's insurance companies. The firms have already set their rates based on the assumption that most people will be buying plans that do meet the new requirements. "When you change the rules halfway through the game, all of a sudden everything they'd been operating under with certain assumptions goes away," Kreidler says. "And that would have been very difficult for the market." That may be true, says Kansas Insurance Commissioner Sandy Praeger, but she's worried about people in her state being unable to get onto the balky federal website and get any insurance at all. That's why she's planning to take up the president's offer, even if the older plans don't cover a full array of benefits or pre-existing conditions, as the new rules require. "Our first responsibility is to protect the consumers," Praeger says, "and at least in my mind that means finding a way to let them stay on those policies if they want." About the only thing that's clear right now: More than ever, if you're shopping for an individual or small-business plan, the kind of health insurance you can get depends in large part on where in the country you live. AUDIE CORNISH, HOST: From NPR News, this is ALL THINGS CONSIDERED. I'm Audie Cornish. ROBERT SIEGEL, HOST: And I'm Robert Siegel. The House of Representatives today passed the Keep Your Health Plan Act. It's aimed at people whose insurance policies have been cancelled because of the Affordable Care Act. Though it's not expected to have any future in the Senate, it does send a message. Meanwhile, President Obama's new proposal to fix the law is turning out to have some limitations of its own. NPR's Julie Rovner reports. JULIE ROVNER, BYLINE: It all sounded so simple when the president announced it yesterday. PRESIDENT BARACK OBAMA: Insurers can extend current plans that would otherwise be cancelled into 2014 and Americans whose plans have been cancelled can choose to reenroll in the same kind of plan. ROVNER: In other words, if your insurance company says so, you can keep your existing health plan for another year, but you might have missed what the president said right before that. OBAMA: State insurance commissioners still have the power to decide what plans can and can't be sold in their states. ROVNER: Indeed, but there's a problem with that says Sabrina Corlette. She's a research professor at Georgetown University. SABRINA CORLETTE: In some of these states, it may actually be against state law to implement the president's proposal yesterday. ROVNER: Corlette says a healthy minority of states, some put the number around a dozen, have basically written the Affordable Ca
|
Update 8:20 p.m: Late Thursday, Health and Human Services Secretary Kathleen Sebelius extended the deadline until Dec. 14 for states to decide whether to run an exchange on their own. Come Friday, states will have to decide whether they will run their own insurance exchanges under President Obama's sweeping health law. These exchanges will be where people and small businesses go to shop for insurance. The policies offered will have to meet minimum standards. And there will be subsidies on a sliding scale for people who need them. Those will be available for people earning up to four times the federal poverty level, or about is about $40,000 to $45,000 for a single person. At noon Thursday, we'll convene a Twitter chat about the exchanges: why they matter and how they could transform the health insurance marketplace. Look for the hashtag #healthexchange Our lineup includes: NPR's Julie Rovner, who put together this explainer on the exchanges. Colorado Public Radio's Eric Whitney, who recently reported on the state's early decision to build an exchange. Health economist Austin Frakt, part of the brain trust at the Incidental Economist blog, will chime in. Avalere Health's Caroline Pearson's will bring her insights to the party. And NPR's Richard Knox will help fill us on what's happened with the pioneering exchange in Massachusetts. Update 3:45 p.m.: David Schultz pulled together highlights from the chat. . .
|
eng_Latn
| 34,924 |
Laid Off, But College Costs Keep Adding Up
|
Dean and Terry Stanton have two sons in college, and their daughter is planning to start in the fall. They had the financing all figured out until a couple of months ago. The Stantons talk with Renee Montagne about how they are juggling college costs now that Dean has been laid off from his job in Silicon Valley.
|
As Democrats debate whether to support a “Medicare for All” program, proponents say such a system would save billions in administrative costs. Here & Now’s Peter O’Dowd speaks with Sabrina Corlette (@SabrinaCorlette), research professor at the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute, about the dollar value of those costs. This article was originally published on WBUR.org.
|
eng_Latn
| 34,925 |
Making The Rich Pay More For Medicare
|
When it comes to reducing Medicare spending, asking wealthier seniors to pay more is one of the few areas where Democrats have shown a willingness to even consider the subject. "I do believe there should be means testing. And those of us with higher income in retirement should pay more," said Sen. Dick Durbin, D-Ill., on last Sunday's Meet the Press. "That could be part of the solution." Robert Moffit of the conservative Heritage Foundation says it will have to be part of the solution if Medicare is to withstand the onslaught of 78 million baby boomers. "If we [boomers] insist on what we are entitled to under the current law, we are going to guarantee the shrinkage of economic opportunities for our kids and our grandchildren," he said. "I think it's a very, very bad future for this country if we do not get federal entitlements under control." Besides, making the rich pay more would hardly be breaking new ground. Medicare already charges wealthy people more and poor people less. "We already don't have a common standard social insurance system where everybody gets the same benefits," Moffit says. "We already have means testing." Indeed, as part of a 2003 Medicare law, Congress imposed higher outpatient premiums for the program's optional Part B on wealthier beneficiaries. And then in 2010, as part of the Affordable Care Act, Congress asked wealthier beneficiaries to pay more for their prescription drug coverage, too. Meanwhile, at the other end of the income scale, says Moffit, low-income Medicare beneficiaries get special breaks. The very poorest get coverage through Medicaid. And even those with moderate incomes are spared having to pay increases in their outpatient premiums in years when there's no or only a small increase in Social Security. "When premiums go up, if premium increases exceed their cost-of-living adjustment for Social Security they're held harmless," he said. "They don't pay the higher premiums." So Moffit thinks there's plenty of precedent, and plenty of room, to increase the amount, or lower the income threshold for better-off beneficiaries. "Given the size of the debt, it's probably a good idea for Congress to simply say to the rest of taxpayers, 'Look, we're not going to require you to continue to subsidize the wealthiest retirees. That's probably not the best policy,' " he said. "Those people who can afford to pay more for their health care should do it." But that sentiment is far from universal. For one thing, wealthy means something far different when it comes to Medicare than it does when it comes to income taxes. "Higher income is defined as people with incomes of $85,000 or more, and obviously in the tax world we're talking about people with $250,000 in income or higher," said Patricia Neuman of the nonpartisan Kaiser Family Foundation. Then there's the idea that Medicare premiums are the only thing most seniors pay when it comes to health care. Rep. Allyson Schwartz, D-Pa., who has worked on Medicare issues, says that's hardly the case. "They get Medigap; they get supplemental insurance. There are copays," she said, referring to the idea that seniors tend to have both lower incomes, and higher health care costs, than most other Americans. She added: "We want to make sure that we don't do anything that reverses that universality or the benefits and hurt beneficiaries." There's still one more complication: The Affordable Care Act imposed one other new Medicare tax on the wealthy that's just about to take effect. Starting in January, people with incomes over $200,000 will have to pay the Medicare payroll tax on income from interest, dividends and other nonwage activities. That's one more place budget negotiators won't be able to go to mine more money from Medicare.
|
"I'm in the 1 Percent. Please, Raise My Taxes" — that was the headline of a recent New York Times op-ed written by billionaire Eli Broad.
|
eng_Latn
| 34,926 |
A Fainting Spell After A Flu Shot Leads To $4,692 ER Visit
|
Matt Gleason had skipped getting a flu shot for more than a decade. But after suffering a nasty bout of the virus last winter, he decided to get vaccinated at his Charlotte, N.C., workplace in October. "It was super easy and free," said Gleason, 39, a sales operations analyst. That is, until Gleason fainted five minutes after getting the shot. Though he came to quickly and had a history of fainting, his colleagues called 911. And when the paramedics sat him up, he began vomiting. That symptom worried him enough to agree to go to the hospital in an ambulance. He spent the next eight hours at a nearby hospital — mostly in the emergency room waiting area. He had one consult with a doctor via teleconference as he was getting an electrocardiogram. He was feeling much better by the time he saw an in-person doctor, who ordered blood and urine tests and a chest X-ray. All the tests to rule out a heart attack or other serious condition were negative, and Gleason was sent home at 10:30 p.m. And then the bill came. The patient: Matt Gleason, who works for Flexential, an information technology firm in Charlotte. He is married with two children. Total bill: $4,692 for all the hospital care, including $2,961 for the ER admission fee, $400 for an EKG, $348 for a chest X-ray, $83 for a urinalysis and nearly $1,000 for various blood tests. Gleason's insurer, Blue Cross and Blue Shield of North Carolina, negotiated discounts for the in-network hospital and reduced those costs to $3,711. Gleason is responsible for that entire amount because he had a $4,000 annual deductible. (The ambulance company and the ER doctor billed Gleason separately for their services, each about $1,300, but his out-of-pocket charge for each was $250 under his insurance.) Service provider: Atrium Health Pineville (formerly called Carolinas HealthCare System-Pineville), a 235-bed nonprofit hospital in Charlotte and one of more than 40 hospitals owned by Atrium. Medical service: On Oct. 4, Gleason was taken by ambulance to Atrium Health Pineville's emergency room to be evaluated after briefly passing out and vomiting following a flu shot. He was given several tests, mostly to check for a heart attack. What gives: Fainting after getting the flu vaccine or other shots is a well-described phenomenon in the medical literature. But once 911 is summoned, you could be facing an ER work-up. And in the U.S., that usually means big money. The biggest part of Gleason's bill — $2,961 — was the general ER fee. Atrium coded Gleason's ER visit as a Level 5 — the second-highest and second-most expensive — on a 6-point scale. It is one step below the code for someone who has a gunshot wound or major injuries from a car accident. Gleason was told by the hospital that his admission was a Level 5 because he received at least three medical tests. Gleason argued he should have paid a lower-level ER fee, considering his relatively mild symptoms and how he spent most of the eight hours in the ER waiting area. The American Hospital Association, the American College of Emergency Physicians and other health groups devised criteria in 2000 to bring some uniformity to emergency room billing. The different levels reflect the varying amount of resources (equipment and supplies) the hospital uses for the particular ER level. Level 1 represents the lowest level of ER facility fees, while ER Level 6, or critical care, is the highest. Many hospitals have adopted the voluntary guidelines. David McKenzie, reimbursement director at the American College of Emergency Physicians, said the guidelines were set up to help hospitals charge appropriately. Asked if hospitals have an incentive to perform extra tests to get patients to a higher-cost billing code, McKenzie said: "It's not a perfect system. Hospitals have an incentive to do a CT exam, and taxi drivers have an incentive to take the long way home." The guidelines don't determine the prices hospitals set for each ER level. Hospitals are free to set whatever prices they want as long as their system is consistent among patients, he said. He said the multiple tests on Gleason suggest the hospital was worried he could be seriously ill. But he questioned why Gleason was told to stay in the ER waiting area for several hours if that was the case. It's also not clear if Gleason's history of fainting and overall good health was considered. Blue Cross and Blue Shield of North Carolina said in a statement that the hospital "appears to have billed Gleason appropriately." It noted the hospital reduced its costs by about $980 because of the insurer's negotiated rates. But the insurer said it has no way to reduce the general ER admission fee. "We work hard to negotiate discounts that reduce costs for our members, but costs are still far too high," the insurer said. "This forces consumers to pay more out of pocket and drives up premiums." Gleason in fighting his bill actually got the hospital to send him its entire "chargemaster" price list for ev
|
You may be on summer vacation, but the interest groups looking to make their mark on legislation to overhaul health care are working harder than ever. The Wall Street Journal reports that delays on Capitol Hill make this month the key time to "snare one-on-one meetings with lawmakers back in their home districts." Take Tim Trysla, a lobbyist at Alston + Bird. Makers of diagnostic imaging equipment are among his clients. "If you're looking for savings, don't come at us," says Trysla, who has called on 120 legislators, sometimes taking General Electric execs along to make the case for protecting payment for medical scans. (Check out a nifty WSJ interactive graphic on lobbying spending here.) Read More >> Trying to figure out what works and what doesn't in improving the health-care system? It never hurts to follow the money. NPR's Richard Knox digs into the money pit in Massachusetts, where a 3-year-old law expanding coverage has pushed the proportion of uninsured down to 2.6 percent--lowest in the nation.. The remarkable achievement has come at a high cost. Now, the state is looking to save money by paying doctors and hospitals a fixed annual amount for each patient rather than shelling out for services whenever they're rendered. "In the world of health care, this is big news," Knox says. The Food and Drug Administration has concluded that some drugs used to treat rheumatoid arthritis in children and teenagers need a tough warning about an increasing the risk of lymphoma and other cancers. The affected drugs include Johnson & Johnson's Remicade, Amgen's Enbrel and Abbott Lab's Humira.
|
eng_Latn
| 34,927 |
Some Seniors Would Be Shielded From Medicare Cuts
|
Nearly three million of the 10.5 million seniors in private Medicare health plans would be at least partly shielded from the planned cuts to the program under the Senate Finance Committee health overhaul bill, according to a Kaiser Health News analysis. Over a decade, the committee would cut $117 billion from the Medicare Advantage plans, shifting $10 billion of that amount to temporarily protect beneficiaries in parts of 13 states and reward high-quality plans. Medicare Advantage plans, created in the late 1980s, became increasingly popular as private insurers in some areas offered seniors more benefits than the traditional Medicare program run by the government. But the plans on average cost more than traditional Medicare, and the Obama administration and congressional Democrats want to curtail spending and use the savings to help cover the uninsured. Some senators on the committee, worried about the effect on seniors enrolled in the plans — and the possible political consequences — acted to cushion the impact on constituents. In the House, lawmakers also slashed Medicare Advantage, but didn't make any exceptions. Geography is Destiny Under the Finance Committee bill, plans serving seniors in South Florida, New York City and parts of Louisiana would continue to get funding for services outside traditional Medicare over 10 years. This provision would cost $5 billion, and it includes an unspecified amount for bonuses for high-quality plans operating anywhere in the United States. That extra money would help the plans continue to offer some of the benefits their members enjoy now, such as zero co-pays for doctor visits and coverage for hearing aids and eyeglasses not offered in traditional Medicare. This provision affects members who are in these plans as of 2012. But the advantages of the enhanced plans would diminish over time, as the bill would cut funding by five percent each year. Another $5 billion would be allocated to help prop up falling benefits, but the money would be spread to health plans in parts of a dozen states from 2012 to 2019. Among the metropolitan areas that would benefit are Los Angeles; San Francisco; Minneapolis; Nashville, Tenn.; Birmingham, Ala.; Denver; Long Island, N.Y.; Tampa, Fla.; Tulsa, Okla.; Pittsburgh; Salt Lake City and Phoenix, Ariz. Insurers, which are fighting the overall cuts to the program, said temporary protections for selected areas will lessen the impact on seniors. "This will slow the bleeding, but it won't stop it," said Douglas Armstrong, director of policy analysis at the Blue Cross and Blue Shield Association. Lawmakers benefit, too. "It makes the cuts politically more palatable," said Leslie Norwalk, who was acting director of Centers for Medicare and Medicaid Services in the administration of President George W. Bush. The major seniors' lobbying group, AARP, favors cutting funding to Medicare Advantage to bring its spending into line with the rest of Medicare, and it is still weighing the need for the exceptions in the bill. "While we support reducing the excess subsidies for Medicare Advantage, we also want to ensure that plans have time to adjust to any changes that may be made to Medicare Advantage in order to minimize any impact on our members," said Nora Super, a lobbyist for AARP. Questions of Fairness The government has been paying private insurers running Medicare Advantage plans 14 percent more on a per capita basis than traditional Medicare pays. About 23 percent of seniors are covered by Medicare Advantage plans, though the figure is closer to 45 percent in some parts of the country where plans offer richer benefits, including Miami and New York. Questions of fairness have plagued the Medicare Advantage program for years because seniors in some areas, such as South Florida and New York, are offered much richer benefits than people living elsewhere. Funding to Medicare Advantage plans varies nationwide because it is based on average Medicare spending by county. The higher the spending level, the more money Medicare Advantage plans receive. The disparities would continue under the legislation. But making cuts is tricky, says Gail Wilensky, who ran the Medicare program in the early 1990s and is now a senior fellow at Project HOPE, an international health education foundation. "How you try to get to a more level playing field needs to be done carefully because of the vulnerability of the population and the politics involved," she said. Sen. Bill Nelson, D-Fla., a Finance panel member, had been one of the most outspoken critics of proposals to cut funding to Medicare Advantage plans. But in the end, he struck a deal on an amendment providing the extra funding, which according to his office would help 800,000 of the one million Florida seniors enrolled in the plans. Among others who signed on were Democrats Max Baucus of Montana, the chairman; Ron Wyden of Oregon and Charles E. Schumer of New York. Nelson spokesman Dan McLaughlin said the senator sti
|
If Texas Gov. Rick Perry is going to have problems with Republican voters over an issue, it apparently isn't going to be his controversial use of the phrase "Ponzi scheme" to describe Social Security. A new USA Today/Gallup poll found that 43 percent of Republicans were either inclined to increase their support or unswayed by his negative characterization of the entitlement program. Curiously, 36 percent said they didn't know enough to venture an opinion. Read More Only 19 percent of GOP voters said they were less likely to support Perry because of his Ponzi comment though it had a more negative impact on independents, with 32 percent saying they were turned off. The poll isn't necessarily bad news for Mitt Romney. If he keeps hammering Perry for threatening Social Security, for instance, the former Massachusetts governor could conceivably convert some of those voters in the 32 percent that didn't know enough to have a strong opinion. Also, it seems to confirm Romney's "electability" argument that Perry's views would be "toxic" in a general election against Obama. The independent voters needed for a candidate to win the White House are clearly more critical of Perry's Social Security stance than Republicans.
|
eng_Latn
| 34,928 |
In Howard Co., Md., Public Option Finds Support
|
The Senate version of the health care bill includes a public option, which would let individuals who don't get insurance on the job and small businesses choose a government-sponsored plan. During this year's health care debate, NPR has used Howard County, Md., as its sounding board. Vic Broccolino, president and CEO of Howard County General Hospital, and Mark Applestein, a urologist and president of the hospital's professional staff, offer their take on the public option. Neither sees the public option as a problem.The health care overhaul debate in Congress now centers on two bills: the House measure and the Senate Democrats' version unveiled Wednesday. They differ in important ways. Here are answers to questions you may have about the bills: Would the health care bills before Congress require that I obtain health insurance and punish me if I don't? Starting in 2013 or 2014, most Americans would be required to have health insurance coverage or face a financial penalty. Individuals would have to show proof of coverage on their federal income tax returns. Exempt from this requirement would be those with low incomes – many of whom would be covered under an expanded Medicaid program – as well as Native Americans and individuals claiming a religious exemption. The House would require most individuals to have coverage by 2013 or pay a penalty of up to 2.5 percent of their incomes. The penalty wouldn't exceed the cost of the average plan sold in new insurance exchanges. People who don't make enough money to file income taxes would be exempt. The Senate requirement would take effect in July 2014. The penalty for not having coverage would be $95 in 2014, $350 in 2016 and $750 in 2017 and thereafter. You would be exempt if the cost of insurance exceeded 8 percent of your income. I own a business. Would I have to provide health insurance to my workers? House and Senate bills handle the issue differently, but both impose some obligation on all but the smallest employers. Under the House bill, companies with annual payrolls above $750,000 would be required to provide insurance or pay a fee equal to 8 percent of payroll. The fees would be lower for firms with payrolls between $500,000 and $750,000; companies with payrolls smaller than $500,000 would be exempt. Under the Senate bill, employers wouldn't be required to provide coverage. But if any of their workers got government assistance in getting insurance, the employers would have to pay an annual fee of $750 for each of their employees. Companies with fewer than 50 workers would be exempt. Both the House and Senate bills set requirements for what constitutes minimally adequate coverage. They are designed to prevent employers from pushing most of their premium costs on to their workers, while claiming to be providing insurance. I like my health insurance. Can I keep it? Both proposals would allow individuals and businesses to keep policies they already have. But if you want to switch insurers or change coverage, the new policies would have to meet certain minimum benefit standards, which may differ from what you have now. I buy my own insurance. How would the legislation affect how much I pay? Individuals would be able to purchase coverage through new state or national "exchanges" — regulated marketplaces that would offer several standardized types of plans from a variety of insurers and possibly a government-run option. New rules would bar insurers from varying premiums based on health status or gender, but would allow differences for age, geographic location and family size. Premiums could go down for some people – those with health problems, for example — and rise for others, such as younger people. Both bills would also require annual review of insurers' rate increases and allow government regulators to bar from the exchange any insurer with "excessive" premium hikes. Federal subsidies could lower premiums if you qualify. Would I be able to buy health insurance from the "public option" that I've heard so much about? What is it, anyway? Maybe. Both bills make a public option — a government-run insurance plan — one of the choices offered to people eligible to buy coverage through either state or national exchanges. The Senate allows states to opt out of offering a public option. Uninsured people, and those who purchase their own coverage or work for eligible small businesses, would be able to buy through the exchange. If you have job-based insurance, you probably would not be able to buy through the exchange, unless your portion of the premium exceeds 9.8 percent of your income in the Senate bill and 12 percent in the House bill. Over time, larger businesses may also be able to purchase through the exchange. I can't afford health care coverage. What happens to me? Under the Senate bill, if you make up to 133 percent of the poverty level, or $29,327 for a family of four, you would be eligible for Medicaid, the state-federal program for the poor and disabled. Those ma
|
How will the overturning of Proposition 8 in California play out in the upcoming elections? Also: the health-care opt-out in Missouri, Tuesday's primary results in Kansas/Michigan/Missouri, a look at the racial campaign in Tennessee's 9th congressional district and a sneak preview of next week's primaries.
|
eng_Latn
| 34,929 |
New Republic: Birth Control Different Than Starbucks
|
Jonathan Cohn is the senior editor of The New Republic. The controversy over contraception has faded a bit. Congressional Republicans are rethinking efforts to overturn a requirement that would make birth control coverage a mandatory part of health insurance. Rush Limbaugh has stopped talking about the issue, at least for the moment. But the issue hasn't gone away entirely. The administration is still working on ways to accommodate the wishes of some large religious institutions opposed, for reasons of faith, to sponsoring employee benefits that cover contraception. (On Friday, it unveiled a few options and announced it was seeking public comment on them.) Conservatives, meanwhile, continue to press their case. With that in mind, let's talk about a conservative argument that isn't simply about religion or the morality of birth control. It's the suggestion that birth control coverage simply doesn't belong in health insurance, because it's not an expense that all of us should be subsidizing. Among those making that argument recently was syndicated columnist Mona Charen. After arguing that contraception costs "less than the cost of a weekly trip to Starbucks" and that a variety of programs, public and private, make free contraception available to the poor, Charen draws a distinction between birth control and other types of drugs: Contraceptives are not a matter of life and death. But even if they were, such as cancer drugs are, is that an argument for forcing insurance companies to provide them free? Why not force free distribution of all medicines? The mandate makes no economic, social or moral sense. Actually, it makes economic, social and moral sense. Let's put aside the question of whether contraception coverage should be "free," because that's not really the issue anymore. Republican Senators Roy Blunt and Marco Rubio, along with the Conference of Catholic Bishops, have said they oppose any requirement that forces employers to cover contraception, regardless of whether such coverage requires out-of-pocket expenses. And, one more time, let's dispense with this notion that every woman can get birth control for less than the weekly cost of Starbucks. As noted here previously, the cheap drugs at Target, Walmart, and the other big chains are great if you take the standard combination hormonal pills, which combine estrogen and progestin. But some people cannot or should not take those pills. They're not good for postpartum women who are breast-feeding, for example, and they cause side effects for many others. They may not be as effective, for some women, as methods like intrauterine devices, depo-provera, or surgical sterilization. How many women fall into those categories? It's a minority of the population, to be sure. But that's always the story with health care and health insurance. At any one time, most people don't require expensive medical care. Only a small number of people do. It's precisely for the sake of that group — the ones who face high expenses, and could face financial or medical turmoil without assistance — that insurance exists. Keep in mind that, at some point or another, pretty much everybody falls into that category. Maybe you're not a woman who needs expensive birth control. You might still be a woman, or a man, who ends up with heart disease. Or allergies. Or a chronic gastro-intestinal problem. Or cancer. Insurance is there to take care of you, so why shouldn't insurance be there to take care of a woman who needs more expensive forms of contraception? No, birth control isn't treatment for an acute condition. It's routine, preventative care. But that hardly undermines the case for coverage. Think about eye exams for a moment. Or blood pressure checks. Both of these are widely available, for very low cost. In fact, if you do the math, over the course of a year either one would cost less than a year's supply of even generic hormonal contraception. But insurance typically covers those costs and, under the Affordable Care Act, insurance must cover those costs — because this sort of care keeps people from getting serious medical conditions and, quite possibly, saves money in the long run. The very same things are true of birth control. Pregnancy is a wonderful thing, but it's also a serious medical condition that requires serious medical attention. (Those of you unfamiliar with what pregnancy entails might want to consult this page from the American Academy of Family Physicians — or ask a woman who has been pregnant.) Don't forget, too, that some women take contraception to control their menstrual cycles or for reasons that aren't really related to avoiding pregnancy. Some critics insist there's a difference between screening for hypertension or vision problems, on the one hand, and controlling the timing of pregnancy, on the other. Non-procreative sex, they say, is a purely voluntary act, for which others should not have to pay. "No one is touching your birth control, ladies," conservative w
|
Reaction to the Hobby Lobby case was as divided as the decision itself. The justices ruled that businesses can cite religion to opt out of covering contraceptives under the new health care act.
|
eng_Latn
| 34,930 |
Health Think Tank Crunches Health Prices For The Masses
|
It turns out we may not know nearly as much about all the money spent on health care in the U.S. as we thought we did. But there's a new group that wants to, well, remedy that. The problem, Martin Gaynor, chairman of the Health Care Cost Institute, told Shots, is that "two-thirds of the population has private [health] insurance, but most of the information comes from Medicare." That's because Medicare, being government run, is the only large insurer whose claims information has been available for academics to crunch. In fact, it's been the detailed analysis of Medicare data that's has allowed the Dartmouth Atlas to show the wide variations in health care across the U.S. Still, many have worried that what happens to people age 65 and over may not necessarily reflect what's happening to everyone else. Continue Reading So Gaynor, who's also a professor of economics and health policy at Carnegie Mellon University in Pittsburgh, along with a small group of academics, persuaded four of the nation's largest private health insurers — Aetna, Humana, UnitedHealthcare and Kaiser-Permanente — to give them access to information about what the insurers paid for care given to some 40 million people. (Personal information has been removed from the database.) "That's 40 percent of the privately insured population in the U.S.," Gaynor said. The group's first study, which examines spending and use trends in 2010 in the under-65 population, is already finding trends that would be hard to discern from Medicare data. The first big take-home message, said Gaynor, is that while spending went up relatively slowly — about 3.3 percent — the biggest factor was an increase in "prices to providers." In other words, people didn't get more care, but they and their insurers paid more for the care they got. That also showed up in the fact that individuals' out-of-pocket spending grew slightly. Prices rose for both inpatient and outpatient surgical procedures; for emergency room visits, and for brand-name prescription drugs from 2009 to 2010. Generic drugs were about the only category for which prices fell, 6.3 percent. Some analysts, like Aaron Carroll, are already using the new numbers to worry about potentially ominous trends in the health care system. Another of the more provocative findings in the study is that spending rose fastest — 4.5 percent — for the 18 and under age group, something you'd never find in Medicare data. That rise compares to 3.1 percent for those aged 55-64 and 2.3 percent for those aged 19-44. Why? Gaynor says an answer will take more research. And HCCI says it will be happy to share what it expects to be a twice-a-year data dump with other academics and nonprofit research outfits. "Our goal is to create a data resource," he says.
|
Costco, the members-only discount retailer, is testing sales of individual health insurance policies. The pilot program launched last month in California. It targets mom-and-pop business owners, and those without a job or without job-provided health insurance.
|
eng_Latn
| 34,931 |
Fixing Medicaid's Myriad Problems
|
An increasing number of officials and analysts are saying that Medicaid cannot be fixed. Medicaid is the nation's largest health insurance provider for the poor and its budget is straining local and federal governments.
|
With a little more than one week before the legislature adjourns for the year, there's little hope for plans to provide health insurance for more low-income children. Earlier this summer, the issue got bogged down in debates over illegal immigration.
|
eng_Latn
| 34,932 |
The Challenge Of Taking Health Apps Beyond The Well-Heeled
|
When you hear the phrase "digital health," you might think about a Fitbit, the healthy eating app on your smartphone, or maybe a new way to email the doctor. But Fitbits aren't particularly useful if you're homeless, and the nutrition app won't mean much to someone who struggles to pay for groceries. Same for emailing your doctor if you don't have a doctor or reliable Internet access. "There is a disconnect between the problems of those who need the most help and the tech solutions they are being offered," said Veenu Aulakh, executive director of the Center for Care Innovations, an Oakland, Calif.-based nonprofit that works to improve health care for underserved patients. At most digital health "pitchfests," it's pretty much white millennials hawking their technology to potential investors. "It's about the shiny new object that really is targeted at solving problems for wealthy individuals, the 'quantified-self' people who already track their health," Aulakh said. "Yet ....What if we could harness the energy of the larger innovation sector for some of these really critical issues facing vulnerable populations in this country?" A small but growing effort is underway to do just that. It's aimed at using digital technologies – particularly cellphones – to improve the health of Americans who live on the margins. They may be poor, homeless or have trouble getting or paying for medical care even when they have insurance. The initiatives are gaining traction partly because of the growing use of mobile phones, particularly by lower-income people who may have little other access to the Internet. The Affordable Care Act and the expansion of Medicaid have added millions of previously uninsured people to the nation's health care system, including community health clinics that serve poor and largely minority populations, according to a California Health Care Foundation report. (California Healthline is an editorially independent publication of the California Health Care Foundation.) In California alone, the number of people on Medi-Cal, the state's version of the Medicaid program for the poor, rose from 7.5 million in 2010 to 12.4 million by early 2015. Many Americans remain uninsured, however, because they live in states that have declined to expand Medicaid eligibility. Health advocates say it's important to tailor digital health technologies to lower-income people not only to be fair, but because they're more likely to have chronic illnesses, like diabetes, that are expensive to treat. Health-care providers have incentives as well. They are being rewarded financially under the Affordable Care Act, Medicare and Medicaid for keeping patients healthy, and this goes beyond simply performing medical procedures and prescribing drugs. For now, experiments targeting low-income people are a tiny part of the digital health industry, which racked up an estimated $4.5 billion in venture funding in 2015 alone. Entrepreneurs are still trying to figure out how they're going to get paid by serving this population, and government health programs like Medicaid and Medicare are taking a while to figure out how they're going to pay providers for approaches that don't involve a doctors' visit. But Jane Sarasohn-Kahn, author of the California Health Care Foundation report, says investors are getting more interested in digital health initiatives for low-income patients simply because there are so many of them. Investors are eyeing the "fortune at the bottom of the pyramid," she said, much as Walmart profits from selling low-priced items to millions. "It's now sexy to scale," she says. "If you can have impact [on many people], inexpensively, you can make a lot of money. If we get it right, we can do well and do good." Some initiatives are simple and cheap, like Text4Baby. The free text-messaging service for pregnant women and new moms offers information in English and Spanish about prenatal care, labor and delivery, breastfeeding, developmental milestones, and immunizations. The specific texts are timed to the baby's due date. Operated by the nonprofit ZERO TO THREE and the mobile health company Voxiva, Inc., Text4Baby has reached nearly 1 million women since starting in 2010. In one survey, more than half of them reported yearly incomes of less than $16,000. Other experiments are far more elaborate. In California and Washington state, San Francisco-based Omada Health is testing a version of Prevent, a diabetes and heart disease prevention program that's been modified for "underserved" populations – basically people on Medicaid or who are uninsured. The free program offers patients a digital scale as well as behavior counseling and education, access to a personal health coach and an online peer network. To adapt the program, the company made it available in Spanish and English and lowered its reading level from ninth grade to fifth grade. Bilingual health coaches were hired, and the educational materials now acknowledge potential food acces
|
As more Americans become obese, the number of views on being overweight multiply: Fat is beautiful. Fat costs us money. You can be fit and fat. Being fat is worse than smoking. We'll look at American attitudes about obesity. <br /><br />Guests: <br /><br /> <STRONG>Peter Stearns</STRONG><br /> *Provost and professor of history at George Mason University<br /> * Author of <EM>Fat History: Bodies and Beauty in the Modern West</EM> (New York University Press, revised 2001) <br /><br /> <STRONG>Jonathan Rouch</STRONG><br /> *Senior writer for the <EM>National Journal</EM><br /> *Correspondent for <EM>The Atlantic Monthly</EM> <br /> *Writer in Residence at the Brookings Institution <br /><br /> <STRONG>Donna Jarrell</STRONG><br /> *Co-editor, <EM>What Are You Looking At?: The First Fat Fiction Anthology</EM> (Harvest Books, 2003)
|
eng_Latn
| 34,933 |
Up For Discussion: Cost Of Cancer Care Avoided Too Often
|
When the diagnosis is cancer, the expenses can pile up in a hurry. Even people with insurance can face steep copayments for drugs, a sizable share of hospital bills and significant incidentals. These side effects of cancer care are sometimes even called "financial toxicity." So wouldn't it make sense for doctors and patients to talk over the financial strain that cancer treatment might bring and what might be done to manage it? Well, it's not always easy for patients to bring it up, says S. Yousuf Zafar, a gastrointestinal cancer specialist at Duke Cancer Institute. He and his colleagues recently asked hundreds of insured cancer patients at Duke and three affiliated rural cancer clinics about their financial concerns. Median household income for the people in study was about $60,000 a year, and the median out-of-pocket costs for their care were nearly $600 a month . "The bottom line was that patients want to talk about the cost but only a minority actually do," Zafar tells Shots. The people who did talk about financial issues told the researchers it was helpful to do so. "They said it helped decrease their expenses," Zafar says. Unfortunately, in this study the researchers didn't get into the details of how that happened. But he drew one possible way from his own practice. "I treat colon cancer, and I have the option of giving a drug as an IV or an oral pill," he says. "If I give the pill form, the patient faces a copay even if they have insurance, and that copay goes away if I give the intravenous version." The two forms of the drug are pretty much the same when it comes to effectiveness, though the side effects differ a little. "For the most part, it doesn't matter to me," he says. "It comes down to patient preference and cost." Why don't most patients ask about costs? "Many said they didn't think their financial problems were bad enough to bring it up," he says. "Many said they wanted the best care regardless of costs." And they may have been worried that doctors might cut corners on care after a cost discussion. Some patients said it's not their doctor's job to think about the costs, Zafar says, and others figured the doctor wouldn't know what to do about them anyway. Patients might have a point there. "I don't think the majority of oncologists are prepared to have a discussion about cost," he says. "Quite honestly, we haven't received the training to do so." In the meantime, doctors can direct patients to social workers and financial counselors to lend a hand. "Any help is likely better than none," Zafar says. Doctor need to get with it, though. "We can't necessarily give the best care to patients unless we address cost," Zafar says. The research hasn't been published yet. Zafar will present the findings to cancer specialists at the American Society of Clinical Oncology annual meeting in Chicago in a few weeks.
|
Stories of the difficult and sometimes shocking things people do to workaround the American healthcare system.
|
kor_Hang
| 34,934 |
Economics For 12th Century French Peasants
|
On today's Planet Money: Is hope unfulfilled worse than no hope at all? Medieval historian Philip Daileader says it might be. People in places like 12th and 13th century France lived far more constrained economic lives than we do, but they had no expectations that their situations would ever improve. Link from the podcast: 123 recommendations for the Australian health care system. Bonus: After the jump, a guy in Israel wonders how Americans put up with their health care system. Download the podcast; or subscribe. Intro music: Tracey Thorn's "Raise the Roof." Find us: Twitter/ Facebook/ Flickr. Read More >> Reuven M. Lerner, who lives in Israel, caught Friday's podcast on health care. He writes: For years, I have wondered how it could be that Americans aren't rioting in the streets over the abysmal state of health care in the country. We lived in Chicago from 2003-2007 while I was in graduate school; during that period, we had a baby and my wife was diagnosed with a serious condition requiring expensive treatment. Thank goodness we had good health insurance, allowing us to pay "only" about $1500/month in premiums, copayments, and fees. I'll admit that the care we received was excellent, but if I hadn't been consulting on the side, and if we hadn't been fortunate enough to buy into a group plan, we would have been totally sunk. Let me contrast that with the Israeli health system: You pay 5% of your income as an insurance premium, or a much smaller amount if you're unemployed. (There's basically no such thing as someone lacking health insurance in Israel.) You can choose from four providers ("sick funds"), each of which is a non-profit entity that must accept you no matter what, and which must offer the same baseline set of services and medicines that the government mandates. Each sick fund can offer additional services above and beyond this, including everything from dental care, to personal nurses in case of hospitalization, to alternative care. You can choose your doctor from among those registered with your particular fund (and many doctors work with several funds). Overall, the system seems to work remarkably well: I can choose my doctor, and see him whenever I want, paying a co-payment of $1 (yes, onedollar) for the first visit I make each quarter. When we need to see a specialist, we go to see the doctor of our choice from within the fund.If we want to see someone from outside of our sick fund, we must ask for permission in writing, but to date we have been approved for just about everything. Hospital visits, MRIs, and CTs are completely covered — no co-pays, and no intolerable waits. (Yes, you will wait several weeks to get an MRI if it isn't urgent. But so what?) Medicines can be expensive, but the government uses its bargaining power to negotiate prices far lower than what you pay in the United States. Private care is also available, if you prefer; many doctors work off-hours in private clinics, and many hospitals allow doctors to perform everything, including surgery, on a private basis. There seems to be a reasonable balance between public and private needs — so you'll generally get fine treatment as a regular patient, but you can always opt to use private treatment, if you need. There also seem to be perennial funding problems at government-owned hospitals, which the government then funds out of tax money. And of course, if the medicine that you need is outside of the government-mandated (and negotiated, and subsidized) "basket," you're forced to pay market prices. Every year, additional treatments are added to the medical service basket, but I don't envy those who have to decide what goes in and what stays out. I'm not saying that everything is perfect with the Israeli health system; there are funding problems, and doctors sometimes strike (yes,strike!) to protest the decent, but far from exceptional, salaries that they receive. (No private helicopters here!) But by having a number of competing non-profits whose rates are capped by law, and whose services must adhere to a government-set minimum, you end up with a high-quality, low-cost health system that removes many of the worst profit incentives from the insurance industry, replacing them with incentives to keep people healthy. My impression is that Germany has a similar system, but I don't know enough about it to compare. A quick closing anecdote: Several months ago, when Bibi Netanyahu was elected prime minister, he floated a bunch of trial balloons while putting together his initial budget. One of the items that caused the greatest amount of protest was his plan to charge about $2.50 (yes, two and a half dollars) per *night* that someone would stay in the hospital — up from the current amount, which is zero. There was a firestorm of protest, with people saying that Netanyahu was so heartless that he wanted to charge people to be sick! The proposal was immediately taken off of the table. The bottom line, then, is that the s
|
Economist Julianne Malveaux and Farai Chideya discuss the latest in economic and employment news. Topics include a report that consumers spent slightly less this past April than they did in March, and comments by Barack Obama on affirmative action.
|
eng_Latn
| 34,935 |
Texas Politicians And Businesses Feud Over Medicaid Expansion
|
Dallas's Parkland Hospital treats a lot of people without health insurance. On a November day in 1963, emergency room doctors at this county hospital frantically tried to save an American president who could not be saved. These days, emergency room doctors frantically try to treat 240,000 patients every year. "So you can see we have every treatment area filled up. Beds are in the hallways and the rooms are all full," says Dr. John Pease, chief of emergency services. In Texas, about 1 in 4 people is uninsured. By federal law, the county hospital's emergency room cannot turn sick patients away, no matter their ability to pay, so Parkland opens its arms. Last year it cost Parkland Hospital three quarters of a billion dollars to provide what is called "uncompensated care" — mostly treating patients without health insurance. Parkland is hardly some 90-pound weakling, but $765 million of red ink will strain any hospital. Dallas County Judge Clay Jenkins, who oversees the county hospital, says it doesn't have to be this way. "A huge chunk of that could be paid for," Jenkins says. "It's about $580 million a year that would be brought in by the Medicaid expansion monies." Expanding Medicaid was intended to be a key element of the Affordable Care Act. Medicaid expansion covers uninsured adults, mostly working poor, who don't make enough to buy health insurance on the exchanges. Twenty-nine states and the District of Columbia have taken up the charge of Medicaid expansion. But when the U.S. Supreme Court gave the individual states the option to opt of Medicaid expansion, then-Texas-Gov. Rick Perry could not opt out fast enough. Texas hospitals had to eat $5.5 billion in uncompensated care last year. The reason is this: After the Affordable Care Act passed, the amount of money the federal government provides to hospitals for uncompensated care was significantly reduced. In 2013, while contemplating a second run at the presidency, Perry had a message for Tea Party conservatives across the nation. "Thank you all for being here," he started. "The first day of April. Seems to me an appropriate April Fool's Day — makes it perfect to discuss something as foolish as Medicaid expansion and to remind everyone that Texas will not be held hostage by the Obama administration's attempt to force us into this fool's errand of adding more than a million Texans to a broken system." Perry's speech was a clear message to the Republican-dominated state Legislature: Medicaid expansion is part of Obamacare, and Texas hates Obamacare. The problem is that in hating the Affordable Care Act, the state is leaving on the table as much as $100 billion of federal money over 10 years — money that could pay for health insurance for more than 1 million of its working poor. This is driving many in the state's business community bonkers. "It's our money that we are sending to Washington, D.C.," says Bill Hammond, CEO of the Texas Association of Business, which includes many of the state's richest and most powerful business owners. "We are not getting it back," he says. "We pay for it with corporate income tax, we pay for it with our personal income tax and we pay it in the fact that our premiums are higher than they would be if everyone was insured." Texas has the second-highest health insurance premiums in the country, right behind Florida. And Texas has the third-highest property taxes in the country. In Dallas, for example, more than half of property owners' county property tax bill goes to reimburse Parkland Hospital for the uncompensated care it has to provide. "Texas businesses pay almost 63 percent of all state and local taxes," Hammond says. He says if the state expanded Medicaid it would save Texas business billions of dollars a year that could be invested in upgrading equipment, hiring new employees, providing raises and rewarding shareholders. For every dollar the state would pay into Medicaid expansion, it would earn back $1.30 from the economic activity created, according to an analysis by Ray Perryman. He's an economist who has consulted for the Texas Legislature and six governors. That economic activity would top out at $3 billion in 10 years, creating 300,000 new jobs each year, he says. "It's infused in some areas that have direct impact on the economy in a lot of fundamental ways that extends beyond the year in which it occurs," Perryman explains. "You may be prolonging someone's work life 10 or 15 years, or maybe solving a chronic illness problem that's going to drain hundreds of thousands of dollars from the system over time that's avoidable if people get health care earlier." Totally aside from the health benefits, Perryman says, when you look at the numbers, "You look at them and you say, 'This is a no-brainer. We need to be doing this.' It's really an apolitical situation. It's just math." But it's much more than just the math. As the 84th session of the Texas Legislature comes to a close, there's been no debate at all about Medic
|
The final five Republican candidates met for a debate Thursday night in Houston — Texas is one of a dozen states voting next Tuesday in the presidential primaries.
|
eng_Latn
| 34,936 |
'Biotech Rider' In Budget Angers Opponents Of Genetically-Modified Crops
|
Hidden inside the massive federal budget that President Obama signed on Thursday is a small paragraph that has infuriated opponents of genetically-engineered crops. The provision is designed to protect those crops from court challenges. Audie Cornish talks to Dan Charles for more.
|
You may be on summer vacation, but the interest groups looking to make their mark on legislation to overhaul health care are working harder than ever. The Wall Street Journal reports that delays on Capitol Hill make this month the key time to "snare one-on-one meetings with lawmakers back in their home districts." Take Tim Trysla, a lobbyist at Alston + Bird. Makers of diagnostic imaging equipment are among his clients. "If you're looking for savings, don't come at us," says Trysla, who has called on 120 legislators, sometimes taking General Electric execs along to make the case for protecting payment for medical scans. (Check out a nifty WSJ interactive graphic on lobbying spending here.) Read More >> Trying to figure out what works and what doesn't in improving the health-care system? It never hurts to follow the money. NPR's Richard Knox digs into the money pit in Massachusetts, where a 3-year-old law expanding coverage has pushed the proportion of uninsured down to 2.6 percent--lowest in the nation.. The remarkable achievement has come at a high cost. Now, the state is looking to save money by paying doctors and hospitals a fixed annual amount for each patient rather than shelling out for services whenever they're rendered. "In the world of health care, this is big news," Knox says. The Food and Drug Administration has concluded that some drugs used to treat rheumatoid arthritis in children and teenagers need a tough warning about an increasing the risk of lymphoma and other cancers. The affected drugs include Johnson & Johnson's Remicade, Amgen's Enbrel and Abbott Lab's Humira.
|
eng_Latn
| 34,937 |
Obamacare Won't Affect Most 2012 Taxes, Despite Firm's Claim
|
If you haven't done your taxes yet, this ad from H&R Block might make you feel even more anxious. "The Affordable Care Act means big changes this year when you file your taxes," says the young woman in the ad, with a smug smile. She then claims to have read "all 900 pages" of the law so she can offer you a "solution." We wanted more details about whether the federal law was really making this year's taxes more difficult, so we asked Meg Sutton, the tax firm's senior adviser for tax and health care services. "The big changes are, really, just filing that return," she said. "And so, getting into the office, recording your income and your household size, that's the biggest change you'll see." Except people have to do that every year. So we asked if there are new forms people have to file this year because of the health care law. "No," said Sutton. When we pressed her, she said the big change is in preparing for the new federal subsidies that millions of Americans will be able to apply for to help them buy individual health insurance policies next year. Because people can start signing up for plans from the new health insurance marketplaces as early as October of this year, a 2012 return could come in handy. "The 2012 tax return will be used to establish a baseline to determine your eligibility for a tax credit to pay for health care benefits," Sutton said. Eligibility for the new health insurance subsidies will be based on income and family size. Information from 2012 tax returns — the returns people are filing this year — should be automatically pulled up on a computer screen when people apply for the subsidies this fall. "But it's just a baseline," says Tara Straw, of the advocacy group Health Care for America Now, which supports the Affordable Care Act. "Nothing in that return locks people into a certain income or a certain family composition that is unchangeable if it's not representative of their actual situation in 2014," Straw says. What will actually determine whether people get a subsidy, and how big it will be, isn't what they report on their tax forms this year at all, but how much they estimate they'll make in 2014. That could be the same as what's on their tax form this year, or it could be very different. So when Straw sees the H&R Block ad saying the Affordable Care Act means big changes this year when you file your taxes, she says it's "fairly misleading." "Unfortunately right now, with this ad, it sounds like they're just trying to drum up business by emphasizing complications," she says. A recent poll shows two-thirds of Americans don't really understand the health care law. Straw acknowledges that's a problem. "That's actually where companies like H&R Block could be doing a real service if they're actually using their outreach to the community to help educate people on the benefits," says Straw. H&R Block says it's doing that by offering all its customers a free health care and tax review this year that they say takes about five minutes. They also have a guide to how the law might affect different tax profiles. But as far as filing any new tax forms related to the health care law, those will come in April of 2015. This story is part of a partnership with NPR, Colorado Public Radio and Kaiser Health News.
|
Hurricane Sandy presented pitfalls for Mitt Romney and President Obama. Malcom Mayes sees a president a little too eager about the storm, while Signe Wilkinson thinks Romney is eager to have the federal government do too little.
|
eng_Latn
| 34,938 |
Crisis In Russia's Health Care
|
NPR's Michele Kelemen reports from Moscow on how Russia's economic crisis is affecting the country's health care system. Dentists, including some Americans who have set up shop in Russia with new technology and products, are now having trouble restocking.
|
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.
|
eng_Latn
| 34,939 |
Gaps In Health Coverage Can Disrupt Preventive Care
|
People without health insurance don't get enough preventive care — simple but important things like vaccinations and blood tests. But surely having insurance every now and then is better than none at all, because people can get caught up on their tests when they are covered, right? That's a widely held view, and one that would be good news to the millions of people who go on and off health insurance each year. Some of them are losing or changing jobs. Others slide on and off Medicaid as they take on temporary work, marry or divorce. But it's not reality, according to a new study of people with diabetes. For them, regular preventive care can mean the difference between a normal life and serious health problems like stroke, heart attack and amputation. But it's not happening. Continue Reading "We found there was no threshold," says Rachel Gold, an assistant investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon. "You really have to have continuous coverage to have good preventive care." The people in the study were going to the doctor; they had gone to federally funded "safety net" clinics in Oregon at least three times from 2005 through 2007. About half of the 3,384 people with diabetes in the study were uninsured, and about half had public insurance like Medicaid. The people who had breaks in their insurance coverage were much less likely to get tests that diabetics are supposed to have at least once a year, including cholesterol screening, kidney function and HbA1c screening. In fact, they did no better than the people who never had any insurance coverage when it came to getting those tests done. That might be because the uninsured people have to pay small copays, around $5. That may not seem like much, Gold says, but add up four tests, and "for someone who's low income, they might wait." She doesn't have the data to prove that, but says the doctors in the 50 clinics who participated in the study say they think that's the case. Her results were published the January Journal of the American Board of Family Medicine. Unfortunately for the people with diabetes, putting off tests like the A1c mean they'll have a lot harder time keeping their diabetes in control now, and they're more likely to have more serious complications later on. Gold told Shots: "You're being cheap in the present for something that's much more expensive in the future." Missing out on regular preventive care also means a much bigger bill for taxpayers, who ultimately pay the cost for the uninsured when people are hospitalized. That's why the Affordable Care Act mandates coverage without copays or deductibles for diabetes tests and other preventive care. (Though as NPR's Julie Rovner recently reported, most people don't know that.)
|
The California Supreme Court rules that the Catholic Charities group must provide employees with health plans that include birth control coverage. The court rules the group is not covered by exemptions for religious organizations, because it provides secular services. NPR's Richard Gonzales reports.
|
eng_Latn
| 34,940 |
Democrats Stress Immediate Effects Of Health Bill
|
Republicans have threatened to make the controversial health care overhaul a central issue in every congressional race next fall. So Democrats want to have something to show for their efforts — before the November elections. And President Obama has begun telling voters not just what the overhaul will do for them, but what it will do for them right away. In Ohio this week, Obama offered a laundry list of benefits that would take effect in six months to a year, including a guarantee that children can get health insurance — even if they have a pre-existing illness — and a measure that would let young adults stay on their parents' policies until they turn 26. Democrats in Congress are being encouraged to use these talking points with their constituents. The White House is trying to shift the conversation away from the messy legislative process — which Republicans are keying on — and instead focus on what the health care overhaul would do for families and businesses. Focus On What's Coming Soon Many of the plan's most important benefits wouldn't kick in till 2014. Those include the guarantee that anyone can buy insurance; the exchanges where individuals and small businesses can shop for policies; and the government subsidies to help pay for them. Because it's hard to campaign on changes that are more than three years away, Democrats are also stressing the overhaul's smaller, but more immediate impacts. In the short run, the plan would provide tax credits to small businesses that offer health insurance to their workers. It would give $250 to seniors to help pay for prescription drugs, if they fall into the coverage gap known as the "doughnut hole." And it would impose a variety of popular, fast-acting restrictions on the insurance industry: No more lifetime limits on coverage. And no more canceling a policy just because someone gets sick. Then There Are The Downsides ... But the overhaul wouldn't directly limit the cost of insurance policies. In fact, in the short run, costs could go up. Insurance companies would have to cover more right away, but the requirement that people buy insurance wouldn't take effect until 2014. Between now and then, more people may drop their insurance, leaving a smaller pool of policyholders to pay for expanded coverage. "The policy goal is correct, and that is to give people more health security," said Karen Ignagni, president of America's Health Insurance Plans, an industry trade group. "It's very difficult to accomplish without having everyone participate — if you don't expect that the costs are going to go up." Anti-tax activists warn there are other immediate effects that the president didn't talk about in his Ohio speech. The overhaul would quickly impose multibillion-dollar levies on drugmakers, medical device makers and the insurance industry itself. "There's taxes that kick in right away. There's even more taxes that kick in after a very few years," said Ryan Ellis, policy director for the group Americans for Tax Reform. "Look, there's short-term benefits the president is talking about that he has every right to talk about from this bill. But if he's going to be honest, he needs to also talk about the short-term costs." The health care overhaul would raise taxes on individuals making more than $200,000 in 2013, and on so-called Cadillac health insurance plans in 2018. Democrats say they're confident they can win the political argument, if voters consider both the costs and the benefits of the health care bill. They'll have an easier time, though, if some of the benefits are in effect when voters go to the polls. MELISSA BLOCK, host: One of the arguments that President Obama is making to undecided House Democrats, as well as to voters, is this: The health-care overhaul isnt just a big fix for down-the-road problems. Some benefits of the bill would kick in right away, as NPR's Scott Horsley reports. SCOTT HORSLEY: If the health-care bill passes, many of the most important consumer benefits won't kick in 'til 2014, including the guarantee that anyone can buy insurance, the exchanges where individuals and small businesses can shop for policies, and the government subsidies to help pay for them. It's hard to campaign on changes that voters won't see for more than three years, though. So in Ohio this week, President Obama repeatedly stressed the overhaul's smaller, but more immediate, impacts. SOUNDBITE OF SPEECHES President BARACK OBAMA: This year ... within the first year ... starting this year HORSLEY: The president offered a laundry list of benefits that would take effect in six months to a year, including a guarantee that children can get health insurance even if they have a pre-existing illness, and a measure aimed at one the president's core constituencies: young adults. President OBAMA: I see some young people in the audience. (Soundbite of cheering) President OBAMA: If you're an uninsured young adult, you will be able to stay on your parents'
|
On Monday we read from your emails. On Inauguration Day, we asked listeners to tell us what domestic issue the president should focus on in the next four years. Based on your emails, health care was among the top contenders. From Debbie in San Antonio, Texas: "As a physician, my life would be better if we had universal health coverage. I want to take care of patients regardless of their ability to pay, and I want patients to be able to get necessary tests and medications."
|
eng_Latn
| 34,941 |
Your Photo Of The Day
|
"Black cloth is the mark of a widow. She will wear something black every day she remains on earth until God decides she should join her husband. ... Transylvania, Romania ... is unique among the former Soviet Bloc for the way it has preserved its way of life. After World War II, for 40 years of communist rule, a few valleys in Maramures escaped collectivized farming because of poor soil and hilly landscape. In the post Cold-War period, preservation continued because of pervasive impoverishment which slows the advancement of modernity into the reaches of northern Transylvania." From The Color of Hay: The Peasants of Maramures, a monograph of photographs by Kathleen Laraia McLaughlin. "Your Photo Of The Day" is curated from our Flickr group. Sometimes it makes sense, sometimes it doesn't. Submit your photos here.
|
Here's a look at what you're reading today: Twitter pal @reneerico shares an article about the employment picture in California. The SF Chronicle reports that the state's underemployment rate hit 21.9 percent in September. That's a whole lot of people who can't find as much work as they need. Meantime, @kkemple is looking at the country's perception of stimulus spending. The Christian Science Monitor has a great graphic that shows how different community types (tractor country, emptying nests, boom towns, etc) feel about the government spending millions of dollars to get the economy moving again. @philipkeeton is deep in tax land with an article from Tax Vox about whether fining people for not getting health insurance could be considered a tax on the middle class. As for me, I'm digging into the archives over at the New York Times for articles about high Medicare costs in the 1970's. We'll have more on that on tomorrow's podcast. Share your own recommended reading in the comments below.
|
kor_Hang
| 34,942 |
Your Health Bill Questions Answered
|
Now that the big health bill is law, people have more questions than ever. How will it affect their families and their health care? NPR's health policy correspondent, Julie Rovner, explains some of the key provisions in the new law. My son is going to turn 23 in June. Under the new health bill, he can stay on our plan until he's 26, but I've heard this doesn't go into effect for six months. Do we have to enroll him in alternative insurance in those intervening months, or will he be allowed to stay on that plan continuously? — Patricia Fontana of Berkley, Calif. This is a provision that doesn't take effect for six months, and actually, most people won't have a chance to enroll their children in their plans until their next open season. For some people, it won't be until next January. So, yes, you're going to have to find other insurance. For those with employer-provided insurance, under COBRA they can pay to add their young adult children to their plan, but this can be very expensive. For healthy young people, you can probably find some cheaper insurance for them in the intervening months, and that's what most people are going to have to do. This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance though a temporary subsidized high-risk pool. Can you explain the high-risk pool? If I am eligible, will my husband and daughter be covered, too? — Sarah Tamor of Santa Monica, Calif. A national high-risk pool is supposed to start in 90 days to cover those who have been uninsured for six months and have pre-existing conditions. There's $5 billion to help subsidize it, but the premiums could still be pretty high, as they are in most of the state high-risk pools that exist. And the premiums can vary by age — older people can be charged four times as much as younger people. You have to have been uninsured for six months in order to be eligible. I don't think your husband and daughter will be allowed to join unless they are also high-risk, and they probably wouldn't want to because premiums will be high. Insurance companies won't have to insure those with pre-existing conditions until 2014, so a national high-risk pool will be there in the interim. It looks like with the new law, we could find a policy in the risk pool right away if we were uninsured for six months, but if we have insurance — even if it is inadequate — we can't change until 2014, when the [restrictions on] adult pre-existing conditions go away. Are these really our only options? — Audrey Hagan of Jackson, Wyo. I'm afraid so. In this new interim risk pool that we were just talking about, you need to be uninsured for six months, and premiums are likely to be high. These are for people who have no other options. The idea is to give people something in the interim. But this couple has insurance, even though they write that it's inadequate. This high-risk pool is really for those who have nothing and want something to tide them over until 2014, when insurers can't turn them away for pre-existing conditions. I am a small-business owner, and every year my premium has gone up by at least 20 percent. Will the new health care law help keep the cost of health insurance down? — Katherine MacColl, Conway, Mass. That is certainly the hope. It's doubtful anyone really thinks this new law will bring premiums down. The idea is that it will stop premiums from going up as fast. There is a large effort in this bill to protect small businesses. There is a tax break that goes into effect right away that will be from 35 percent of the premium up to 50 percent of the premium. There will be these new exchanges that will begin in 2014 that will hopefully help create competition that will help keep premiums lower, if not low. That will help small businesses, again. There are a lot of things in this law that hopefully will create changes in the way health care is delivered and paid for that will help stem the growth of health care costs. But no one is suggesting this is the magic bullet. How does the new law affect people who have insurance through the TriCare program? That's the private insurance plan for Defense Department workers and military families. It turns out that people with TriCare won't be affected by the new law, and that's both good and bad. It's good in that if you have TriCare, it means that you won't have to go out and buy any other insurance. TriCare is sufficient to cover the individual mandate that you have insurance. It's bad if you have an adult child who's 24 or 25 — you won't be able to keep them on your TriCare, because TriCare only covers dependents up to age 23. A lot of people are upset by that, and there's already been a bill introduced in the House that would allow people on TriCare to keep their dependents on TriCare until age 26. I'm a medical student. I've heard from some doctors that reimbursements will decline. For those of us who have the choice of going into primary care or sp
|
Mary Horomanski of Erie, Pa., received a bill of more than $284 billion. The<em> Erie Times News</em> reports that's more than the combined national debts of Hungary and South Africa.
|
eng_Latn
| 34,943 |
High Court Considers States' Authority over HMOs
|
The U.S. Supreme Court hears arguments on the powers states have to regulate the managed health-care industry. A Kentucky law, seeking to give consumers wider choices in selecting doctors, is being challenged by the health-care industry. Hear NPR's Julie Rovner.
|
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.
|
eng_Latn
| 34,944 |
There's No Such Thing As A Free (Steak) Dinner, Financial Analysts Say
|
If you are even close to retirement you have probably received one of those postcards inviting you to a free steak dinner at a local restaurant or hotel to learn about investment opportunities. But New York Times “Your Money” columnist Ron Lieber warns consumers should talk with trusted financial planners before agreeing to buy the financial products offered at these events. As with many pitches that seem too good to be true, Lieber (@RonLieber) says these are not always what they purport to be. He joins Here & Now‘s Robin Young to discuss the potential pitfalls.
|
On Wednesday, the Centers for Medicare and Medicaid Services released a massive spreadsheet containing a comparison of what hospitals across the country bill for the 100 most popular medical procedures. The document revealed wild disparities in pricing from hospital to hospital. Robert Siegel speaks with Princeton professor Uwe Reinhardt, who studies health care economics, about how the American hospital system evolved this way.
|
eng_Latn
| 34,945 |
Obama's HHS Hits Health Insurers' Steep Premium Hikes
|
Another skirmish in the war between the Obama Administration and the health-insurance companies occurred Thursday. The Health and Human Services Department issued a document today meant to focus attention on big premium increases the insurers are imposing in 2010 and the big paychecks the top companies' CEOs have received in recent years. A report snippet: Recent economic data show that profits for the ten largest insurance companies increased 250 percent between 2000 and 2009, ten times faster than inflation.12,13 Last year, as working families struggled with rising health care costs and a recession, the five largest health insurance companies -- WellPoint, UnitedHealth Group, Cigna, Aetna, and Humana -- took in combined profits of $12.2 billion, up 56 percent over 2008.14 These health insurance companies' profits grew even as nominal GDP decreased by 1 percent over this same time period.15 WellPoint accumulated more than $2.7 billion in profits in the most recent quarter alone.16 The health-insurance industry fired back. An excerpt from a statement by Karen Ignani, the head of America's Health Insurance Plans which represents health insurers: "It's time to stop the politics of vilification and focus on what Americans need most: real health care reform that addresses the serious and urgent problems facing our nation. "Increases in the cost of coverage in the individual market shine a spotlight on the urgent need to reduce the growth of underlying medical costs and to bring everyone into the system. If reform doesn't address these pieces, it will not solve the serious problems that individuals, families, and employers face. That is why health plans have proposed fundamental reform of health insurance markets and a long-term strategy to reduce rising health care costs. Read More >> "Health insurance premiums are increasing in the individual market because of soaring medical costs and because younger and healthier people are dropping their coverage due to the economy. In 2009, according to a report from the Department of Health and Human Services' Centers for Medicare and Medicaid Services released on January 5th, rising costs for hospitals, physicians, and prescription drugs led to the largest growth in health care spending as a share of GDP since the government started keeping track 50 years ago. At the same time, the portion of premiums that went towards health plans' administrative costs and profits declined for the second year in a row."
|
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.
|
eng_Latn
| 34,946 |
What To Expect From Health Care Open Enrollment
|
Health care open enrollment under the Affordable Care Act starts Nov. 1. This year, there will be price hikes for many plans, and in a number of places, there will be just one insurer offering coverage. Here & Now‘s Jeremy Hobson hears more from Bertha Coombs of CNBC. Guest Bertha Coombs, correspondent for CNBC. She tweets @berthacoombs.
|
The board of General Motors, under intense pressure to cut costs, has reportedly told the United Auto Workers Union to accept lower healthcare benefits for employees and retirees by the end of June or risk forced reductions. UAW officials say they are willing to accept changes in GM's healthcare plan, but not all of the changes. Jerome Vaughn of Detroit Public Radio reports.
|
eng_Latn
| 34,947 |
WellPoint Hikes Insurance Rates Closer To Home
|
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.
|
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.
|
eng_Latn
| 34,948 |
Risk-Taking Required
|
NPR Senior News Analyst Daniel Schorr says the attempt to broker the "road map" for peace will require risk-taking by Israel, the Palestinians and the United States.
|
Daniel talks with Mark Kincaid who until recently worked for the Texas Office of Public Insurance Counsel (OPIC) - an independant state agency that monitors how insurance companies operate. OPIC recently conducted a survey of insurers doing business in Texas on those companies confidential underwriting guidelines. In many cases, Kincaid says, insurance companies will disqualify applicants for seemingly groundless reasons, such as working in casinos or beauty parlors.
|
eng_Latn
| 34,949 |
Orbitz, Home Depot, CheapTickets and Expedia are just some of the websites that use price-steering or price discrimination techniques .
Some sites show pricier results depending on what device you are using, while others alter the prices at random .
|
It's no secret that advertising is often targeted to online users, but it may surprise you to learn the extent to which pricing is also personalized. According to a study by computer scientists at Northeastern University, many major e-commerce sites personalize prices per customer, depending on what software they use or their browser history. The difference in costs can be as large as ten per cent, and most sites don't even warn you when they are using price steering techniques. Scroll down for video . Different person, different price: According to a new study, major e-commerce sites like Travelocity and Home Depot personalize prices per customer, depending on what software they use and their browser history . One of the culprits guilty of 'price discrimination' - customizing the prices of products - is travel-booking website Orbitz. Researchers found that users who are logged onto the Orbitz website are charged an average of $12 less than those who are not logged on. The same goes for online travel services company CheapTickets. Neither CheapTickets nor Orbitz tells customers that prices alter depending on the user. Websites also discriminate based on what devices customers are logged onto. For example, Travelocity offers an unspoken $15 discount for people using Apple's iOS operating system. Home Depot, on the other hand, suggests products that are about $100 more expensive to customers using a mobile device, as opposed to those on a desktop computer. Expedia and Hotels.com, both under Expedia Inc, steer people to more expensive products at random with a method called A/B testing. For example, one group of users in the study was shown an average hotel listing price of $187. Another group using the same search terms was shown prices that were $17 cheaper. And travel discount site Priceline personalizes search results based on a user's history of clicks and purchases. The researchers monitored the results of 300 real online users as well as creating hundreds fake profiles to reach their results. As they explain in the paper, user personalization can be beneficial in many ways. 'For example, when a user searches on Google with an ambiguous query such as "apple," there are multiple potential interpretations,' reads the paper. 'By personalizing the search results (e.g., by taking the user's history of prior searches into account), Google is able to return results that are potentially more relevant (e.g., computer products, rather than orchards).' But when these personalized results are such that they manipulate the user into spending more money, it falls in something of an ethical grey area. Expedia spokesman Dave McNamee explained to the Wall Street Journal: 'Presenting different booking paths and options to different customers allows us to determine which features customers appreciate most. Pricing is not manipulated by Expedia.com.' And Stephen Holmes, a spokesperson for Home Depot, said the findings are accurate but that the company is not 'intentionally steering search results'. Lead researcher Christo Wilson admits that when it comes to online shopping, things do get complicated. 'In the real world, there are coupons and loyalty cards, and people are fine with that,' he said. 'Here, there's a transparency problem. The algorithms change regularly, so you don't know if other people are getting the same results.'
|
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.
|
eng_Latn
| 34,950 |
Economics Of Latest Pandemic Relief Bill
|
President Trump's call to boost pandemic relief payments to $2,000 remains stuck in the Senate. Economists say there are more targeted ways to provide help to the people who need it most.
|
Hurricane Katrina left many survivors in urgent need of medical care and without money to pay for it. Many of the hundreds of thousands of evacuees in other states will likely qualify for Medicaid, but unless Congress acts, those host states will be expected to pick up part of the bill.
|
yue_Hant
| 34,951 |
Long-Term-Care Insurance: Who Needs It?
|
Americans routinely buy all sorts of insurance — for cars, homes, health and even pets and boats. But when it comes to long-term-care insurance, relatively few sign up. Out of more than 313 million Americans, only about 8 million have any such protection, according to the American Association for Long-Term Care Insurance. The low participation rate largely reflects the high cost of long-term-care insurance. Geneva Hunter, 66, is among those without protection. She is well aware of how helpful it would be to have such insurance. She gets schooled on that point each day: Her 89-year-old mother, Ida Christian, who has Alzheimer's disease, lives with her. "I do not have [the insurance] because at the time it was offered [through my company], I could not afford it and take care of my mother at the same time," said Hunter, a member of one of three families being profiled by NPR in a series called Family Matters: The Money Squeeze. "I think it was close to $400 a month," Hunter said. "That's a lot of money when you are caring for somebody else." But with each passing birthday, Hunter feels more pressure to buy insurance. "I know it's expensive, but I have to do it," she says, because she fears becoming a financial burden to her daughter. Many Americans share that financial goal: to not burden others. But the reality is that each year, an estimated 11 million U.S. adults need some type of long-term care. Such care can be crushingly expensive: Just one hour of home-health-aide care costs roughly $20, while the average private nursing home room costs $87,000 a year. Neither routine employer-based medical insurance nor Medicare will pay for extended periods of custodial care. Scott Hawkins, 46, and a member of another family in the NPR series, says he hasn't yet explored getting long-term-care insurance. In fact, future elder-care costs are so daunting that only humor can help defuse the ticking financial bomb. "Our youngest daughter [Carley] is a little bit of a comedian and she made the comment one time to us, 'Hey, when you guys get old, don't worry about it' — and we were thinking she is going to say something nice," he said. Instead, she suggested her parents plan on living with their older daughter, Chelsea, who is studying to be a pharmacist. Scott recalls Carley joking that he would "eat better if you live at Chelsea's house because she'll be making twice as much money as I make being a schoolteacher!" For the nation's roughly 78 million baby boomers, the time for humor about who will prepare their meals is quickly running out. Many boomers, people born between 1946 and 1964, are expected to fall so far into poverty trying to provide themselves with paid care that they will qualify for Medicaid — the medical care program for the deeply impoverished. A fortunate few will have long-term-care insurance, but even that option is looking sketchy as more companies exit the business. Insurance giants such as Prudential and MetLife have recently pulled back from offering long-term-care policies. Others, such as John Hancock and Genworth Financial, have turned to state regulators, seeking permission to dramatically hike premiums. Depending upon the location, the insurers' requests for higher rates have been for amounts such as 18 percent or 40 percent or, in a few cases, 90 percent. Here are answers to some common questions about long-term-care insurance. What is long-term-care insurance? This type of policy covers basic daily needs over an extended time. While health care insurance or Medicare helps pay for immediate medical expenses, say, a surgeon's bill, long-term-care insurance helps people cope with the cost of chronic illnesses, such as Alzheimer's disease, or various disabilities. The policies pay for assistance with everything from the basics — bathing and dressing — to skilled care from therapists and nurses for months or even years. Do you have to be in an institution to collect your benefits? Long-term-care insurance typically covers out-of-pocket expenses that come with home care, assisted living and nursing homes. Most policies have a waiting period that works like a deductible. So if you need the help of a home-nursing aide, you may have to wait 90 or 120 days before your benefits start to cover those costs. How much does insurance cost? The American Association for Long-Term Care Insurance says people should expect to pay an average of $3,335 per year to cover a couple of healthy 60-year-olds on a plan that pays out a $150 daily benefit for up to three years. But prices can vary dramatically, depending upon factors such as the purchasers' age, the level of inflation-adjustment protection and whether the daily benefit will be $100, or some larger amount, say, $150 or $200. Why is the coverage so expensive? The premiums are high and rising because providing long-term care can be so risky for the insurer. In contrast, the potential claim on an insured home can be reasonably estimated. If a $100,000 home is
|
As a part of the 2021 How I Built This Summit (At Home) we have selected 10 Fellows, and we'd like to introduce you to each of them. In this episode: Mark Atlan co-founded ZappCare to help make sure that people living on tribal lands have access to health and medical services close to their homes. Also, Zach Correa hopes to connect users of lemonGRAFT to the people in their own neighborhood that grow fresh produce.
|
eng_Latn
| 34,952 |
When Sleeping In The Car Is The Price Of A Doctor Visit
|
Broken teeth are all too often a punchline in conversations about poor people in rural places. But for Heather Wallace, dental problems are anything but funny. "Basically it's just like a nerve pain. Your whole body locks up; you have to stop for a second to try to breathe," she said. "And sometimes if it hurts bad enough, you might cry." Wallace and her husband, James, are both in their 20s. In early June, they traveled a couple of hours from Knoxville, Tenn., to a free medical clinic in Chattanooga hosted by the nonprofit group Remote Area Medical. The Wallaces joined about 100 people camped out in their cars — and a few in tents — overnight to get a morning medical or dental visit. James Wallace earns about $9 an hour working in hotels, and he said Heather earns a little less. The job barely pays enough to cover groceries, he said, and doesn't come with health insurance or other benefits like dental care. "We don't have it; we can't afford it, and we don't make enough to be penalized at the end of the year so either which way it goes we don't have the money to pay for it," he said. Under the Affordable Care Act, millions more Americans now have insurance through online exchanges and Medicaid. But like the Wallaces, many still lack coverage, especially in states like Tennessee, where elected leaders declined to expand Medicaid. The Wallaces were camped out on a blanket outside Red Bank High School in Chattanooga on a Friday afternoon, the day before the clinic was set to open Saturday morning. They said they make too much money for Medicaid, and they looked into an ACA exchange plan but couldn't afford the premiums. President Trump has promised to replace the ACA, also known as Obamacare, with something better. But the Congressional Budget Office estimates a plan passed by the House of Representatives would leave 23 million more Americans uninsured, and Senate Republicans have yet to reveal the details of their plan. Amid debates about health policy, RAM has for decades put on these clinics serving low-income people around the country. It now holds dozens each year. Founder and President Stan Brock said most patients lack dental or vision coverage, and those who have some kind of health insurance often can't afford their copays and deductibles. "That is something that we hear all the time — it's costing me so much money before my insurance kicks in," Brock said. Heather Wallace said Obamacare "was not what they said it was gonna be," and suggests that maybe the United States should move to a system like Canada's, where everyone is covered by single-payer government program. James Wallace agreed. "Make it to where everybody can have health insurance, and they'd have more productive members of society and maybe drop the percentage of Americans on food stamps," he said. But both say they have low expectations for any major changes from Washington. Neither voted in the 2016 election, though James Wallace said he likes the way Trump speaks his mind. Sabra Howard, 55, voted for Trump because she wanted change, and she hopes he can follow through on his campaign promises. "I just want him to sit down and talk with, you know, the people smarter than me and come up with a good plan that will help everybody," she said. Howard was among scores of people who slept in their cars overnight in the high school parking lots waiting to receive medical care. She lives just outside Chattanooga and has a few chronic health issues, but her most pressing concern is her teeth. Over the years, she said she prioritized her children's dental care over her own. She has gradually lost all of her upper teeth and has learned not to smile so that people don't notice. At the clinic, she received a teeth cleaning and met with a physician assistant to talk over her health issues and update her medication. "I think I probably still [smile] every once in awhile, I'm sure, but intentionally? No. You take a picture, you don't open your mouth all the way," she said. Howard has also trained herself not to lisp when she talks on the phone for her work-from-home customer service job. She said she loves the work, but she doesn't receive benefits because she is a temporary employee. Her dental problems have compounded her financial struggles; she said she turned down an opportunity to sell insurance because of them. "I felt like, you know, I'd be sitting there talking to a client, and next thing I know, they realize I don't have teeth," she said. "And who wants to buy insurance from somebody that, you know, don't have any teeth?" Howard has mixed feelings about government involvement in health care, and she worries about people taking advantage of benefits. But she said too many people are struggling to afford care. "I don't really think government should be all in it, but I think that a lot of people need someone to speak for them," she said. Howard says she just wants to be able to take care of herself; she's trying get a position with benefits. U
|
It's one of the most popular items, but often it seems to be as far as humanly possible from the entrance. The Planet Money team looks at two very different theories about why that is.
|
eng_Latn
| 34,953 |
We Asked People What They Know About Obamacare. See If You Know The Answers
|
The Affordable Care Act brought the rate of uninsured Americans to a record low 9 percent in 2015. It's the major achievement of the controversial health care law and one the Obama administration likes to tout whenever it can. Health and Human Services Secretary Sylvia Burwell did just that in an interview with NPR on Tuesday. "We have the lowest uninsured rate in the nation's history," Burwell said. "Twenty million Americans have insurance that didn't have insurance before the Affordable Care Act. For many people, they consider it just a basic part of their health care." But many of those surveyed in a new NPR/Ipsos poll got it wrong. About half believed that the number of people without insurance had increased or stayed the same, or said they didn't know what the law's effect has been on insurance coverage. That was a failure of communication on the part of the Obama administration, says Bill Pierce, a senior director at APCO Worldwide, who advises health care companies on strategic communications. "They needed to use the president more," said Pierce. "If this was his No. 1 achievement, and something he was proud of doing, it was the kind of thing that he needed to be out there and talking about all the time." Democrats were better informed than Republicans, with 54 percent of Democrats saying the law had reduced the number of people without insurance, compared to 41 percent of Republicans. One problem, Pierce said, is that the law was passed in 2010 but didn't go fully into effect for years. In that time, the website that housed the insurance exchange, the most public part of the program, failed. "By the time the insurance rate started to fall, a lot of minds were already set," he said. NPR's poll was designed to gauge the public's knowledge of some basic aspects of the U.S. health care system. The results come as Republicans on Capitol Hill are working to repeal the law. The Senate early Thursday morning passed a measure taking the first step toward dismantling the law. While many people in the poll were misinformed about the big picture when it comes to Obamacare, they had stronger knowledge about the details of the law. The majority of those surveyed know that the ACA protects people with pre-existing conditions from being refused coverage and that it requires insurance companies to pay for preventive care. However, the heated debate during the 2008 presidential race over so-called "death panels" left a mark. About a third of those surveyed believed Obamacare places limits on end-of-life medical care and another half were not sure. Only 18 percent correctly said that no such limits exist under the law. Beyond Obamacare, many people had a good grasp of the overall quality of the U.S. health care system. The majority was aware that Americans generally pay more for health care than people in other countries and that even so, health care outcomes in the U.S. do not have "the best results in the world." The poll also reiterated findings from a separate survey from the Kaiser Family Foundation last week that showed that people are about evenly split on their view of the Affordable Care Act. Still, most people don't want lawmakers to repeal the law until they have a replacement plan in place. Only 14 percent favor repeal without a replacement plan. That message seems to have gotten through to lawmakers. Earlier this month, Republican leaders in the House and Senate were advocating an immediate Obamacare repeal, with a slow phaseout while they consider ways to replace the law so people who have insurance can still get it. But many lawmakers walked those plans back this week in statements and via Twitter. Some, including President-elect Donald Trump, said they did not want to see a repeal until a replacement is ready. "We're going to be submitting, as soon as our secretary is approved, almost simultaneously — shortly thereafter — a plan. It will be repeal and replace. It will be, essentially simultaneously," Trump said in a news conference Wednesday. The poll surveyed 1,011 adults on Jan. 4 and 5, 2017.
|
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?
|
eng_Latn
| 34,954 |
When Your Family Doctor Is Also Your Shrink
|
Insurance coverage for mental health and treatment of substance abuse is getting big boost this year. Implementation of a law that mandates equal coverage of physical and mental health treatment is picking up steam. Come 2014, the health overhaul law will require that insurance exchanges also guarantee coverage. Still, the laws don't address one important fact: Many people get their mental health treatment from their primary care doctor, bypassing the traditional mental health system altogether. Read More And that may mean they don't always get the best treatment, advocates say. Take depression, for example: 60 percent of prescriptions for antidepressants are written by primary care doctors, says Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness. Yet, cognitive behavioral therapy -- working with a counselor to recognize and replace distorted patterns of thought -- is known to be an effective treatment for depression without the side effects of antidepressants. But an “ob/gyn who’s writing the prescription for an SSRI has no training in CBT,” says Sperling. SSRIs, or selective serotonin reuptake inhibitors, are a class of antidepressants that work by increasing the level of the neurotransmitter serotonin in the brain. "So the question is, is that patient getting the full range of treatment options?" he asks. A recent report from the Center for American Progress, a Washington think tank that supported the Democratic health overhaul, notes that the new law seeks to bolster primary care and those policies will likely continue the trend toward primary care treatment for mental health issues. But the report, by Leslie Russell, suggests that's not a bad thing. Better integrating mental health coverage into primary care "would make a substantial contribution toward expanding access" for patients, the report says, "improving the physical health of people with mental illness and the mental health of people with chronic physical illnesses, and addressing current health care inequalities for people with mental health problems, especially for those who are from racial and ethnic minorities." And the Obama administration is looking at it from the reverse angle as well. Last month, the Department of Health and Human Services announced a $26.2 million grant to help 43 community behavioral health centers put primary care into their services. "The long-established split between 'mental' and 'physical' health is not justified in research and should not be perpetuated in health care," HHS Secretary Kathleen Sebelius said at the time.
|
NPR's Tavis Smiley talks with health commentator Dr. Vanessa Northington Gamble about the possibility that in the future, doctors may prescribe medication based on ethnicity.
|
eng_Latn
| 34,955 |
Health Law Provides No Guarantees Of Access To Birthing Centers
|
Insurance coverage for maternity care is required in most individual and small group plans under the federal health law, extending such coverage to plans where it used to be rare. But for women who prefer services provided by midwives and birthing centers, there are no coverage guarantees, despite the law's provisions that prohibit insurers from discriminating against licensed medical providers. Most women give birth in hospitals and are attended by obstetricians, but a growing number choose to deliver their babies at birthing centers. The centers, typically staffed by midwives, offer women who are at low risk for complications an alternative to traditional hospital labor and delivery, eschewing common medical interventions such as drugs to induce labor and electronic fetal monitors, among other things. In 2012, 53,635 births in the United States took place outside the hospital, or 1.36 percent of all births, according to a study released Tuesday by the Centers for Disease Control and Prevention. Twenty-nine percent — 15,577 births — occurred at freestanding birthing centers. (The rest were primarily home births.) Although still a tiny percentage of the nation's total, the proportion of births at these centers increased 70 percent between 2004 and 2012, the CDC report found. Under the health law, Medicaid is required to cover the services of licensed freestanding birth centers. Coverage of midwifery services had earlier been mandated by federal law. "Birth centers and certified nurse-midwives have a good record of safety and patient satisfaction and birth outcomes," says Cynthia Pellegrini, senior vice president for public policy and government affairs at the March of Dimes. Birth centers are also significantly less expensive than hospitals. The average hospital charge for a vaginal birth without complications was $10,166 in 2010, compared to $2,277 for a birth center, according to data from the Agency for Healthcare Research and Quality and the American Association of Birth Centers. Some advocates predict that coverage of birth centers in private insurance plans will become routine now that Medicaid, which pays for roughly 50 percent of all births in the United States, has embraced their use. But at this time, coverage for birth centers and for midwives, who work in a variety of settings, including hospitals, is less predictable in private insurance plans. When Sean and Stephanie Taylor learned she was pregnant last July, Stephanie, 30, initially planned to use an OB-GYN and deliver in a hospital near the couple's home in Rancho Santa Margarita, Calif. But after visiting her doctor a few times she began to have misgivings about the practice's routine use of ultrasounds, among other things, during her visits. "I wondered, is this really necessary?" says Stephanie. "I'm a really healthy person, and I'm not high risk. I started to question all of this." The couple's Blue Shield of California HMO plan, which they have through her job as an executive assistant at a credit union, doesn't have midwives or birth centers available in the couple's network. When Stephanie asked her OB-GYN to approve a request for her to use a nurse midwife out of the insurer's network, he declined, as did Blue Shield. In its denial letter, Blue Shield said her plan allows for the coverage of midwife services. But it noted that since there are none available in her medical group, she was limited to using any participating obstetrician. "If someone can get better, less expensive care, why are their hands tied?" says Stephanie. "People should have the right to choose what's best for them." She and her husband decided to pay the $5,500 charge for the midwife and birth center on their own. Their baby is due in April. Blue Shield of California declined to discuss the details of Stephanie Taylor's case. In an email response, the company said that generally people insured through an employer-provided HMO "must access medical services from providers within the plan network in order to be covered. While some exceptions exist, going outside the plan network is rarely authorized when providers within the network are able to offer maternity care." Under the health law, maternity and newborn care is one of the 10 essential health benefits that must be covered in individual and small group plans unless they have grandfathered status. But the law doesn't require that specific types of providers be covered, says Dania Palanker, senior counsel at the National Women's Law Center. Starting this year health plans are prohibited from discriminating against licensed or certified health care providers who want to participate in their networks. However, the law says, insurers aren't required to contract with any particular provider. Midwifery and birth center advocates say they're uncertain how the nondiscrimination provisions will be applied or enforced, and the Department of Labor says it's not issuing any further guidance. "It leaves us in the dark," says
|
Even though the Supreme Court declared the Affordable Care Act constitutional, voters in battleground states remain polarized about the law. But a new NPR survey finds there are signs that the gap between opponents and supporters has become a little smaller.
|
eng_Latn
| 34,956 |
California Woman Considers Insurance Options After ACA Rates Rise
|
The average price for health insurance policies under the Affordable Care Act will rise by 22 percent next year, though the costs to individual consumers will still vary. A California woman reacts to the new prices and considers her options.
|
The Senate's healthcare bill would make big changes to the government's Medicaid program. Lulu Garcia-Navarro talks with John Baackes, CEO of L.A. Care Health Plan.
|
eng_Latn
| 34,957 |
The United States and Cuba exchanged prisoners two weeks ago .
The move was part of a change in U.S. policy toward the island nation .
Dissidents reported several arrests ahead of a planned rally Tuesday .
|
Havana, Cuba (CNN)Two weeks after the United States and Cuba agreed to thaw decades of icy relations, the U.S. State Department blasted the Cuban government for reportedly arresting at least six dissidents. There was no comment from Cuban authorities on the arrests that were reported by other dissidents and the U.S. State Department. "We are deeply concerned about the latest reports of detentions and arrests by Cuban authorities of peaceful civil society members and activists," State Department spokesman Jeff Rathke said in a statement. Roberta Jacobson, the assistant secretary of state for Western Hemisphere Affairs, wrote Tuesday on Twitter that "Freedom of expression remains core of U.S. policy on Cuba, we support activists exercising those rights and condemn today's detentions." Jacobson is expected to travel to Havana in January to lead U.S. efforts to normalize relations with Cuba, U.S. government officials had previously said. The reported detentions came after a Cuban performance artist called for an open forum to demand changes from the country's single-party communist government. The event was due to take place in Havana's revolution square, the central plaza usually reserved for speeches from Fidel and Raul Castro and visiting dignitaries like Pope John Paul II. Cuban dissidents said the artist, Tania Bruguera, well-known for pushing the limits of freedom of expression in Cuba, was also arrested before the protest could begin. Bruguera had tried to convince Cuban officials to allow the event to go forward but on Tuesday the government-run union for artists and writers released a statement calling her proposal a "political provocation" meant to derail improving U.S.-Cuban relations. Government critic and blogger Yoani Sanchez wrote that she supported the event but on Tuesday tweeted that she was under house arrest and her husband had been taken away by police. CNN saw a police car and two uniformed police officers, as well as at least two men in civilian clothes who appeared to be security agents, outside the building where Sanchez lives on Tuesday. No one answered her door when the CNN crew tried to reach her for comment. Cubans have limited access to the Internet and despite a social media campaign to raise awareness about the event, the protest never materialized Tuesday. On December 17, Cuba released U.S. contractor Alan Gross, who'd been held since 2009 for smuggling satellite equipment onto the island. His freedom was part of a landmark deal paving the way for a major overhaul in U.S. policy toward Cuba. Cuba also freed a Cuban double agent who had worked as a U.S. intelligence source and who'd been held for more than 20 years, although authorities did not identify that person for security reasons. For its part, the United States released three of five Cuban intelligence agents convicted of espionage in 2001.
|
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.
|
eng_Latn
| 34,958 |
Contraception Is Free To Women, Except When It's Not
|
For Stephanie Force, finding a birth control method that she likes and can get without paying out of pocket has been a struggle, despite the Affordable Care Act's promise of free contraceptives for women and adolescent girls in most health plans. The 27-year-old physician recruiter in Roanoke, Va., was perfectly happy with the NuvaRing, a flexible vaginal ring that women insert monthly to release hormones to prevent pregnancy. But her insurer, Anthem, stopped covering the branded product and switched her to a generic version in early 2020. Force says the new product left her with headaches and feeling irritable and short-tempered. After talking to her OB-GYN, Force tried an IUD. But that made her feel worse: She had bad cramps, gained 10 pounds and developed severe hormonal acne. Plus, she was charged $248 for an ultrasound her provider used to guide the insertion of the device, a charge she successfully fought. Force also considered a couple of birth control products approved in recent years: a non-hormonal vaginal gel called Phexxi and a vaginal ring called Annovera that can be used for a year. But Phexxi isn't covered by her employer health plan, and she would owe a $45 copayment for Annovera. Despite the Affordable Care Act's guarantees for free contraception coverage, Force's experience illustrates that even for women whose health plans are subject to the law's requirements, obtaining the right product at no cost can be onerous. New types of contraceptives aren't automatically incorporated into the federal list of required methods that insurers use to guide coverage decisions. In addition, some health plans continue to discourage use of even long-established methods, like IUDs, by requiring providers to get approval from the plan before prescribing them. Consumer advocates who have studied the issue say a process is spelled out in federal rules for women to get the contraceptives they need, but far too few people know that's an option. (For more on how to do this, see the final section below.) Ultimately, Force went back to the generic version of the NuvaRing, despite the side effects she continues to experience. She'd prefer to be on the branded NuvaRing, which didn't give her problems, and the ping-ponging from method to method has left her exhausted and furious. "I cannot believe what hoops I have had to jump through between September 2020 and June 2021," Force says, "between switching from the generic NuvaRing to the IUD and then back, fighting my insurance and OB-GYN's office on the ultrasound charge." In a statement, Anthem says, "Anthem health plans cover 222 contraceptive products at $0 cost share on our ACA Preventive List." The company went on to say that it covers "at least one product" in each of 18 categories of contraception methods approved by the FDA. A policy meant to cut contraceptives' costs Contraception is a very personal choice, and what meets one woman's needs may not meet another's. If avoiding pregnancy is a woman's top priority, a virtually fail-safe method like an IUD may be the right solution. But for someone who's considering getting pregnant soon, a readily reversible method like a birth control pill might be the best option. Side effects are important to consider as well, since women respond differently to the hormones in various birth control products. Before the Affordable Care Act (ACA) required no-cost birth control coverage, researchers estimate that up to 44% of women's out-of-pocket health care spending went toward contraceptives. The ACA requires most commercial health plans to cover a comprehensive list of Food and Drug Administration-approved methods without charging women anything. Church plans and religious nonprofits, as well as employers and schools that object to contraception, are exempt from the coverage requirements. Plans that were grandfathered under the law are also exempt. Uninsured women don't benefit from the mandate either. But the federal rules do not require health plans to cover every single contraceptive. After the ACA passed in 2010, the federal Health Resources & Services Administration (HRSA) developed guidelines for women's preventive services. Those guidelines say women should have access without cost sharing to a list that covers the 18 FDA-approved methods, including oral contraceptives, vaginal rings, cervical caps, IUDs, implantable rods and sterilization. Under federal rules, health plans must cover at least one product in each category. New products are left out Neither the HRSA guidelines nor a birth control chart published by the FDA addresses newer methods, including Phexxi, a gel that regulates vaginal acidity to reduce the odds a sperm reaches an egg. It was approved by the FDA last year. Nor do they incorporate fertility-awareness mobile phone apps the FDA approved in recent years such as Natural Cycles, which tracks a woman's temperature and menstrual cycle to avoid pregnancy. "There's a real need for new guidance that kee
|
Democrats and Republicans still can’t agree on the terms of a COVID-19 economic relief package and on spending bills to keep the government running. Here & Now’s Robin Young gets the latest from NPR’s Claudia Grisales. This article was originally published on WBUR.org.
|
eng_Latn
| 34,959 |
Utah Philanthropists Restore Medicaid Dental Benefit
|
When the Utah legislature cut dental care from its Medicaid plan earlier this year, Gov. Jon Huntsman asked the public to make donations. They delivered, raising the $2 million needed to restore the benefit. But critics say it's the role of government, not philanthropists, to pay for essential services. Jenny Brundin reports.
|
With a little more than one week before the legislature adjourns for the year, there's little hope for plans to provide health insurance for more low-income children. Earlier this summer, the issue got bogged down in debates over illegal immigration.
|
eng_Latn
| 34,960 |
How Health Care Became So Expensive
|
Health care spending in the United States more than tripled between 1990 and 2007. This 3-part series explores the rising costs, and why our care hasn't necessarily gotten better.
|
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.
|
eng_Latn
| 34,961 |
Maryland's Next Health Care Experiment
|
Maryland is embarking on a new health care experiment. Governor Martin O’Malley has announced that his state will cap how much its hospitals are allowed to spend. If the plan works, hospitals will be rewarded for keeping people out their beds, not in them. Maryland’s plan essentially caps all hospital spending at the state’s growth rate, which is about half the rate of the revenue growth hospitals have seen in the last 10 years. Jay Hancock of Kaiser Health News tells Here & Now’s Sacha Pfeiffer that the plan is an ambitious one. “One economist told me that this is the most ambitious thing that has been tried to control health care costs in the last 50 years.” For decades, Maryland has been unique in the U.S. for requiring hospitals to charge the same amount for the procedures they perform. Guest
Jay Hancock, senior correspondent at Kaiser Health News. He tweets @jayhancock1.
|
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.
|
eng_Latn
| 34,962 |
One Man's Decision To Go Without Health Insurance
|
How much is health insurance worth? Not enough for one 53-year-old freelance writer to pay for it out of his own pocket. Duncan Moore, a reporter who has covered the ups and downs of health care for years, explains his surprising decision in the Los Angeles Times. "I'm the last person I would have imagined living without a safety net between me and the medical risks of early middle age," he writes. But after Moore left his last full-time job and no longer qualified to continue his coverage by paying $447.12 a month, he figured he was better off taking his chances. Read More >> Moore is healthy and has a good family history, so he thought he wasn't taking a huge gamble. But just as important, he didn't see real advantages to insurance anyway. He has negotiated discounts directly with doctors for his regular care and has enough salted away to cover bigger expenses, up to about $50,000. For the really catastrophic stuff, he's not confident insurers would pay. Ever hear of rescission? That's the euphemism for insurers canceling coverage after the fact to avoid paying big claims. "To a person like me, who is on the margin," Moore writes, "rescissions are the deciding factor between purchasing and not purchasing insurance." He'd like to be insured again some day, but expects to go without coverage until it's more affordable and regulated to protect him better from companies' arbitrary decisions. Until then, he says, he'll pocket the money that otherwise would have padded the profits of some insurer.
|
Right after college, Adam Shepard boarded a train with only $25. In his book <em>Scratch Beginnings: Me, $25, and the Search for the American Dream</em>, he writes about spending a year as a day laborer and living in a homeless shelter before finding a steady job and an apartment.
|
eng_Latn
| 34,963 |
How The Boss Deals With Health Law Could Affect Your Paycheck
|
With health insurance costs climbing and open enrollment season almost upon us, you might expect that the boss will do everything to wriggle out of new requirements coming down with the federal health overhaul. But that may not be the case. And in a way you might not expect, those decisions could put you on the hook for higher deductibles, copayments and out-of-pocket costs. The issue? Some of plans are changing because employers have decided that they don't need to hold onto the special “grandfather” provision that the new health care law offered them. Read More Many employers are deciding to add benefits required by the health reform law, according to a new survey, instead of taking the option of sticking closely to the plans they already have. Under the law, employers are allowed to be exempted from a number of the rules because their plans would be “grandfathered,” which could exempt you from some of the additional costs. To retain grandfathered status, plans can't increase employee coinsurance rates at all or raise deductible and copayment levels significantly higher than the rate of medical inflation. They also can't lower their own premium contribution more than 5 percentage points. A survey of nearly 1,100 employers by benefits consultant Mercer found that just 53 percent believe they’re likely to hang onto grandfathered status for all their plans in 2011. That's quite a bit lower than the 67 percent to 85 percent the federal government estimated in June when it released interim regulations on grandfathered plans. On the other hand, employers have calculated that many of the new required benefits for plans that don’t have grandfathered status are not very pricey or are benefits they already provide, such as free preventive care and access to ob/gyns without a referral. "Companies decided to just go ahead and make changes because the things that would be required of them if not weren’t big enough,” says Tracy Watts, a partner at Mercer. So what changes are employers considering to manage costs — and increase what employees pay -- that would cause them to lose their grandfathered status? 35 percent would increase deductibles or out-of-pockets payments above the limits. 23 percent would raise copays above permitted levels. 31 percent would increase co-insurance levels beyond grandfathered limits.
|
Robert Siegel speaks with our regular political commentators, E.J. Dionne, of the <em>Washington Post</em> and Brookings Institution, and David Brooks, of the <em>New York Times</em>. They discuss the two-month extension for a tax break and unemployment benefits signed into law.
|
eng_Latn
| 34,964 |
California Settlements Haven't Helped Many Dropped By Insurers
|
Before Anthem Blue Cross of California got dinged for looking to raise rates by as much 40 percent, the company was put in a harsh political spotlight over cancellation of policies for people in the midst of expensive medical procedures. Last year, Anthem Blue Cross, a unit of WellPoint and the biggest for-profit insurer in the state, agreed to pay a big fine and issue new coverage to the affected people who wanted it. Other insurers also agreed to settle with the state over retroactively canceling policies on technicalities, a practice known as "rescission." All told California collected almost $14 million from insurers. Around 6,000 people affected by rescissions were eligible to get new policies under the settlements. But did they? Read More >> Not very many actually. A report for a California Assembly committee checking up on things found less than 300 people have gotten coverage from their former insurers under the deals. The independently prepared report called the results "highly disappointing." What went wrong? The settlements were too complicated and the state agencies involved in carrying them out didn't do a good enough job reaching out to eligible people. The report's author is Dr. Bryan Liang, a doctor and lawyer who runs the Institute of Health Law Studies at California Western law school in San Diego. The bottom line, he wrote: Unfortunately, bluntly put, the settlement agreements have done little to bring justice to those who have had their health insurance policies illegally rescinded and represent limited deterrence against insurer abuses. The numbers speak for themselves: almost no victim took advantage of the settlement agreements to hold insurers accountable. You can see Liang's recent testimonyhere.
|
It rained again on Wednesday in California — welcome news to just about everyone. The state is in the midst of a record-setting drought. But the state will need a lot more rain to change the long term outlook. And some residents in areas affected by wildfires are guarding against mud and debris flows.
|
eng_Latn
| 34,965 |
What To Do If You Just Lost Health Insurance With Your Job
|
The coronavirus pandemic poses both a public health and an economic crisis. Squarely in the middle of those concerns are fears about medical bills and loss of employer-provided health insurance.
|
Former presidential speech writer David Frum says the GOP made a mistake by not working on the health care bill. The position cost him his job last week at a conservative think tank, but he says the think tank was well within its rights.
|
eng_Latn
| 34,966 |
7 Ways Federal Law Changes Health Care
|
If you've tuned out the federal health care law, you might want to tune back in today. A set of new consumer protections kicks in, six months after the bill was signed into law. Here's a handy guide to some of the changes -- and some of the caveats in the fine print. Keep in mind how they affect you will depend on what kind of insurance you have. Read More First of all, insurers must allow parents to keep an adult child up to age 26 on their health plan. And those young adults can't be charged more than any other dependent. Some insurers began this policy early -- during the summer. BUT: This doesn't technically begin until your new plan year begins – for many, that will be Jan. 1, 2011. And, if your child has an offer of coverage from their own employer, they might not be able to be on your plan. Also, insurers can't charge copays or deductibles for preventive services like breast cancer screening and cholesterol tests. BUT: Grandfathered plans -- those that don’t change at all from the previous plan year -- don’t have to follow this new requirement. Now, insurers must cover children up to age 19 with a pre-existing medical condition: New individual plans and all group plans – like those you get at work - can’t refuse to cover a child. BUT: Grandfathered individual health plans can refuse to cover a child. Insurers can no longer cancel your coverage once you get sick, a practice known as rescission. BUT: If you committed outright fraud and intentionally hid something, your insurer can refuse to pay. Also under the new law, you – not your insurance company – get to decide which primary physician, gynecologist, obstetrician and pediatrician you see among your plan’s list of approved providers. BUT: The usual obstacles remain, like whether they're taking new patients or have an appointment available tomorrow. Starting today, your insurance company cannot require you to make additional payments if you visit an emergency room that's out-of-network for a medical emergency. BUT: Once again, grandfathered plans are exempted. Also, there's no more limits on the amount your insurance company will pay out in a given year, or over a lifetime. BUT: Annual limits will be phased out. First, they’ll be set to $750,000 for all employer plans and new individual plans, rising to $1.25 million after Sept. 23 of 2011 and then to $2 million the following September. And remember, several provisions of the new health law have already kicked in. They are the high risk pool for people who have been uninsured for six months, help for employers to keep early retirees covered, and tax credits for small business.
|
The big finance bill Congress passed earlier this year left lots of key details unresolved. So, not surprisingly, lobbyists have been swarming the government agencies charged with hammering out all the new rules. The latest: In an effort to influence the new rules, somebody sent several forged letters to the Commodities Futures Trading Commission, a key government agency. The letters were sent as part of the public comment process for an arcane rule that could have big financial implications. In a statement yesterday, the head of the CFTC said: Read More: 'fraudulently submitted' ... the Commission recently became aware of some comment letters that were fraudulently submitted in response to a proposed rulemaking. We ... have referred the matter to the Justice Department. The letters were purportedly from an exec at Heinz (the food company), a Burger King franchise owner, a local judge, and a county sheriff, among others, according to Bloomberg News, which broke the story earlier this week. They were apparently sent by a PR firm, which in turn blamed the forgeries on an Arkansas subcontractor, Bloomberg said. The Arkansas subcontractor blamed it on another subcontractor. Rabbit holes within rabbit holes. The PR firm wouldn't name its client. The finance bill will require many derivatives to be traded through clearinghouses. That's supposed to increase both the transparency and stability of the derivatives market, which played a key role in the financial crisis. The letters were arguing over details in the proposed rules that would limit ownership of the clearinghouses by banks and other financial firms. Several of the letters contained identical passages criticizing banks for their "cartel-like" control of the derivatives market, Bloomberg says. Given the central role the clearinghouses will play, ownership rules could have big financial implications for the banks, exchanges, and other players who participate in the derivatives market. Countless details like this are being worked out in offices all over Washington right now. And, inevitably, the people most involved in trying to exert influence are inside players who stand to profit (or lose) the most from the new rules.
|
eng_Latn
| 34,967 |
Health Law Makes Prevention Easier To Come By
|
What does prevention actually thwart? Health spending, President Obama's top health officials hope. Announcing new requirements for insurers to pay for preventive care Wednesday as a result of health overhaul, Health and Human Services Secretary Kathleen Sebelius said, "Too many Americans don't get the preventive care they need to stay healthy and keep health care costs down for all of us." Insurers will have to cover preventive services - with no co-pays or deductibles - that are recommended by the U.S. Preventive Services Task Force, whose job is to weigh the scientific evidence. Those preventive services range from colonoscopies to blood-pressure screening; some recommendations vary by gender and age. Read More Most experts think that's good news for patients. But, will does it actually save money? Officials predict premiums for private insurance plans will jump 1.5 percent because of the provision, but that it may eventually decrease total health spending. Last year, the Congressional Budget Office questioned the assumption that prevention saves money, saying only 20 percent of such services lower spending. That's because it takes many colonoscopies -- at a couple thousand dollars a pop -- to catch one case of colorectal cancer. "Screenings really aren't designed to save money," said economist Ken Thorpe, an advocate for prevention. The government could have saved $850 million by not covering things the task force doesn't recommend, the CBO said in an earlier report. In 2008, Medicare covered 18 preventive services. Only seven were backed by the task force, and 3 were explicitly advised against. However, limiting coverage is less popular than expanding it. In November, the task force said women should wait until age 50, rather than 40, to get mammograms. A political maelstrom ensued. In the end Senate Democrats included a health law provision telling insurers to basically ignore the task force's guidance. As reported by Kaiser Health News, a bunch of advocates for other diseases want to see preventive coverage reach beyond the task force's current suggestions, too. Diabetes and HIV advocates, for instance, think the group sets the bar too high for evidence, and that insurers should be required to cover screening for those diseases more broadly. Among the hazards of performing services the evidence doesn't support, said Dr. Ned Calonge, the task force's chairman is that "all it does is spend money without benefit." The bar should be high for providing preventive care - which by definition means doing tests and procedures to healthy folks.
|
As Michigan lifts its indoor mask mandate for those fully vaccinated against COVID-19, business owners and customers feel both confusion and political tensions over whether to mask in public.
|
eng_Latn
| 34,968 |
In 'Medicare For All,' Health Care Is Seen As A 'Critical Service'
|
<em>New York Times </em>investigative reporter Sarah Kliff talks about the costs and challenges of switching to a universal healthcare system — and what it might mean to eliminate private insurance entirely.
|
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.
|
eng_Latn
| 34,969 |
'Life, Death And Politics' Treating Chicago's Uninsured
|
The first time Dr. David Ansell went into the men's room at Cook County Hospital in Chicago, he immediately ran out. "It was so bad, I couldn't use it," he says. "I ran across the street and had to use the bathroom there. It was quite an introduction to my first day at County." Ansell is now the vice president for clinical affairs and chief medical officer at Rush University Medical Center. But he began his medical career in 1978 at County, Chicago's public hospital, where he worked as an attending physician for almost two decades. His social history of the hospital, County: Life, Death and Politics at Chicago's Public Hospital, details his own time on the wards — and examines health care in America from the perspective of the uninsured. Working at County, Ansell says, made him realize just how much the current payment system drives health care inequalities. "There's a misunderstanding that if you just go to the [emergency room], that's health care," he says. "It's not. ... And I don't think the public or politicians really understand that. I think the last health reform attempt which is being bandied about — we don't know what's going to happen — is likely to fall short with regards to equity." Doctors Within Borders Cook County Hospital, where Ansell worked, was a public hospital, a place that treated people with nowhere else to go. Physicians and residents who worked at County, meanwhile, were entering an environment with underfunding, mismanagement, high patient demand, safety concerns and antiquated equipment. "I went into medicine because I wanted to help people, and when I went to medical school, I found it very disillusioning," Ansell says. "County was a place that many of us went because we believed that disease had social etiologies — the idea that disease just emanated from the individual and wasn't somehow constrained or influenced by societal factors. Going to a place like Cook County Hospital was a place where we could live those beliefs out." Health care at County was very different from care at private or university hospitals. When Ansell first started treating patients, County had no air conditioning, poor sanitation and limited patient privacy. "The beds were lined up one after another, separated by curtains, but there was really no privacy," he says. "Patients would roll in and they'd be lined up around the walls of this one room, and the middle was lined with stretchers and wheelchairs. You were forced to take histories and examine patients under these conditions." In 2002, a new hospital called the John H. Stroger Jr. Hospital opened in Chicago, replacing Cook County. The facility provides more dignified conditions for patients. But the new facility, Ansell says, cannot compensate for social inequalities and limited access to preventive health care. "Just yesterday I had a conversation with a physician [who] says there's a many-months wait to see the eye doctor," he says. "There are 4,000 patients waiting to get a colonoscopy. This is not a screening colonoscopy — they've got blood in their stool. ... The new hospital and the doctors and the nurses and the clinics are spectacular, [but] if you look at the whole system and you look at the outcomes we're getting ... people are going blind waiting to see the eye doctor, in a country where it doesn't have to be." Health Inequalities On the South Side of Chicago, the life expectancy of an African-American male is eight years lower than that of a Caucasian man, Ansell explains. "When you look at the reasons for it, at least half of this is [because of] heart disease and cancer and things that could be treated," he says. "One of the problems with our current system is segregating people by insurance status, which ends up limiting the options of care — especially when you get down to the specialty care that people need." During his 17 years at Cook County, few if any of Ansell's patients could get their hips replaced — or other medically necessary but not trauma-related treatments. "The only fair way to do this is where people have a card that gets them in, where that card is accepted widely and broadly by everyone, and [giving people] choice," he says. "So you could go anywhere you want, you get the care you want, and choose your own doctors — and that would be some sort of universal plan — Medicare for all, single-payer. We need a system that really gives patients — poor or rich — adequate care." August, 1978. Dog days in Chicago. The windows overlooking Ogden Avenue were open in a futile attempt to induce a breeze. A kamikaze fly buzzed my head. The air was thick as syrup. My shirt was Saran Wrap plastered to my body. A distant rumble from trucks and cars that barreled past the clinic on Ogden waltzed its way up the four floors to the cubicle where I sat. The room was no larger than a closet. A chair and an examination table wedged in. No sink. A partition, about seven feet high, separated my stall from the next one. A polyester curtain p
|
Roughly 27 million low-income Americans rely on Community Health Centers. The deal that ended the government shutdown did not include more funding for these centers — and many are already running out of money. Where else can people go for care? | Want to support 1A? Subscribe to our podcast and give to your local public radio station at donate.npr.org/1A. Email the show at [email protected].
|
eng_Latn
| 34,970 |
Report: State Deficits Hurt AIDS Programs
|
A new study by the Kaiser Family Foundation says the current fiscal crises in many states is jeopardizing programs that help the poor pay for AIDS medication. Over the past year, 16 states have had to restrict access to their AIDS Drug Assistance Program, leaving thousands wondering how they will pay for treatment. Hear NPR's Brenda Wilson.
|
Democrats and Republicans still can’t agree on the terms of a COVID-19 economic relief package and on spending bills to keep the government running. Here & Now’s Robin Young gets the latest from NPR’s Claudia Grisales. This article was originally published on WBUR.org.
|
kor_Hang
| 34,971 |
Health Care: Were The Risks Of Repeal Without Replace Too High?
|
Updated at 2:54 p.m. ET After the Senate's attempt to replace the Affordable Care Act collapsed Monday, Republican leaders immediately began talking about repealing the health care law in hopes of coming up with a replacement later. But by midafternoon Tuesday, Senate Majority Leader Mitch McConnell's plan to hold a vote on a repeal-only bill had faltered, too. Sen. Shelley Moore Capito, R-W.Va., was the first to say that she wouldn't support the repeal effort because of the threats it poses to people's coverage. She was followed by fellow Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska. "I did not come to Washington to hurt people," Capito said in a statement. "I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia's decision to expand Medicaid." The replacement bill's language is based on the repeal bill that that passed by the House and Senate in 2015 but was vetoed by President Barack Obama. Here's how the repeal would have changed the Affordable Care Act, compared with the House and Senate bills. After Trump was elected in November, Republicans in Congress considered reviving the so-called "repeal and delay" strategy and rejected it. The risks that made it so unpalatable then may have doomed it now. Here are some of the biggest impacts with straight-up repeal: 1. The Cost Of Insurance Premiums Would Skyrocket While McConnell and Trump called this plan a straight repeal of the Affordable Care Act, it would in fact have left many parts of the law in place. That is because under Senate rules, legislators can only repeal the parts of the law that have a budget or tax impact. The individual mandate that everyone, healthy or sick, must buy insurance would disappear. But the rule that insurers must write policies for anyone, no matter their health status, would stay. "Insurers would have to take people with pre-existing conditions, but the sense is that healthy people without that mandate wouldn't sign up," says Larry Levitt, vice president of the Kaiser Family Foundation, a health care research organization. "So insurers, with that kind of uncertainty, would immediately raise rates." The Congressional Budget Office analyzed the 2015 legislation in January and said that if it was to pass, insurance premiums would rise 20 percent to 25 percent in the first year. Under McConnell's plan, that would have been 2018. 2. Millions Would Lose Their Insurance Those high prices would have driven millions of people out of the insurance market. The same CBO report estimated that the number of people without insurance would increase by 18 million in the first year if legislation similar to the 2015 bill became law. That is almost the same number of people who gained insurance in the seven years since the Affordable Care Act passed. About 10 million people would have lost coverage because they would drop their individual plans, 5 million would be dropped from the Medicaid rolls and 3 million would lose their employer-provided coverage, the CBO said. It also said that within 10 years, 32 million more people would be without insurance than if the ACA stayed in place. 3. Insurance Markets Would Unravel Rising rates and fewer people in the market are the two ingredients for the much-invoked "death spiral." That would occur if rates rise so much that nobody can afford insurance and the entire market collapses. And that is what the Republican's proposed repeal of the Affordable Care Act, or Obamacare, would have done, according to multiple health care analysts. Robert Laszewski, president of Health Policy and Strategy Associates, a consulting firm, says a repeal and delay "would just cause more market calamity without a known replacement."
|
Update 8:20 p.m: Late Thursday, Health and Human Services Secretary Kathleen Sebelius extended the deadline until Dec. 14 for states to decide whether to run an exchange on their own. Come Friday, states will have to decide whether they will run their own insurance exchanges under President Obama's sweeping health law. These exchanges will be where people and small businesses go to shop for insurance. The policies offered will have to meet minimum standards. And there will be subsidies on a sliding scale for people who need them. Those will be available for people earning up to four times the federal poverty level, or about is about $40,000 to $45,000 for a single person. At noon Thursday, we'll convene a Twitter chat about the exchanges: why they matter and how they could transform the health insurance marketplace. Look for the hashtag #healthexchange Our lineup includes: NPR's Julie Rovner, who put together this explainer on the exchanges. Colorado Public Radio's Eric Whitney, who recently reported on the state's early decision to build an exchange. Health economist Austin Frakt, part of the brain trust at the Incidental Economist blog, will chime in. Avalere Health's Caroline Pearson's will bring her insights to the party. And NPR's Richard Knox will help fill us on what's happened with the pioneering exchange in Massachusetts. Update 3:45 p.m.: David Schultz pulled together highlights from the chat. . .
|
eng_Latn
| 34,972 |
Obamacare Enrollment Period Extended 6 Weeks
|
Following a problem-plagued launch of the HealthCare.gov website, the White House on Monday officially announced a six-week extension to sign up for coverage under the law's individual mandate. The move has been expected since White House Press Secretary Jay Carney acknowledged last week that there was a "disconnect" in the enrollment timeline given the technical issues that have dogged the website. The Department of Health and Human Services on Monday said that consumers have until March 31, 2014 to sign up for coverage. As NPR's Julie Rovner reported last week: "Technically, people are supposed to have coverage starting Jan. 1, 2014. But ... you actually have until the end of March, which is also when the current open enrollment period ends. Still, the way the sign-up works, you have to enroll by the middle of the month before you want coverage for the insurance to take effect in time. So right now, to be covered by the end of March and avoid being penalized, you have to enroll by Feb. 15." Republican lawmakers have called for a one-year delay in the start of the so-called "individual mandate," which requires individuals to purchase health care or pay a penalty. Monday's announcement comes a day after HealthCare.gov experienced yet another embarrassing failure – with the website going down completely for several hours. "The failure took place at a vendor called Verizon Terremark, and ... presumably took down other clients as well as HealthCare.gov," Rovner says. "By 7 a.m., federal officials say, the data hub at HealthCare.gov that certifies things like citizenship and eligibility for tax credits was back up and running. And by mid-afternoon [Monday], the rest of the website was back up and running as well, they said. It's not known how many people tried and failed to get on Sunday," she says.
|
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.
|
eng_Latn
| 34,973 |
Humana Inc. Overcharged Medicare Nearly $200 Million, Federal Audit Finds
|
A Humana Inc. health plan for seniors in Florida improperly collected nearly $200 million in 2015 by overstating how sick some patients were, according to a new federal audit, which seeks to claw back the money. The Health and Human Services Office of Inspector General's recommendation to repay, if finalized, would be "by far the largest" audit penalty ever imposed on a Medicare Advantage company, said Christopher Bresette, an HHS assistant regional inspector general. "This [money] needs to come back to the federal government," he said in an interview. Humana sharply disputed the findings of the audit, which was set for public release Tuesday. A spokesman for the company said Humana will work with Medicare officials "to resolve this review" and noted that the recommendations "do not represent final determinations, and Humana will have the right to appeal." Medicare Advantage, a fast-growing private alternative to original Medicare, has enrolled more than 26 million people, according to America's Health Insurance Plans, an industry trade group. Humana, based in Louisville, Ky., has about 4 million members and is one of the largest of these insurers. While popular with seniors, Medicare Advantage has been the target of multiple government investigations, Department of Justice and whistleblower lawsuits and Medicare audits that concluded that some plans boosted their government payments by exaggerating the severity of illnesses they treated. One 2020 report estimated that improper payments to the plans topped $16 billion the previous year. But efforts to recover even a tiny fraction of the overpayments in past years have stalled amid intense industry opposition to the government's audit methods. Now the OIG is rolling out a series of audits that could for the first time put health plans on the hook for refunding tens of millions of dollars or more to Medicare. The OIG is planning to release five to seven similar audits within the next year or two, officials said. The Humana audit, conducted from February 2017 to August 2020, tied overpayments to medical conditions that pay health plans extra because they are costly to treat, such as some cases of cancer or diabetes that have serious medical complications. Auditors examined a random sample of 200 patients' medical charts to make sure the patients had the diseases the health plans were paid to treat, or that the conditions were as severe as the health plan claimed. For instance, Medicare paid $244 a month — or $2,928 for the year — for one patient said to be suffering from serious complications of diabetes. But medical records Humana supplied failed to confirm that diagnosis, meaning the health plan should have received $163 less per month for the patient's care, or $1,956 for the year, according to the audit. Similarly, Medicare paid $4,380 too much in 2015 for treatment of a patient whose throat cancer had been resolved, according to the audit. In other cases, however, auditors said Medicare underpaid Humana by thousands of dollars because the plan submitted incorrect billing codes. In the end, auditors said Medicare overpaid Humana by $249,279 for the 200 patients whose medical charts were closely examined in the sample. Based on those 200 cases, auditors used a technique called extrapolation to estimate the prevalence of such billing errors across the health plan. "As a result, we estimated that Humana received at least $197.7 million in net overpayments for 2015," the audit states, adding that Humana's policies to prevent these errors "were not always effective" and need improvement. The OIG notified Humana of its findings in September 2020, according to the audit. A final decision on collecting the money rests with the Centers for Medicare & Medicaid Services, or CMS, which runs Medicare Advantage. Under federal law, the OIG is responsible for identifying waste and mismanagement in federal health care programs but can only recommend repayment. CMS had no comment. Though controversial, extrapolation is commonly used in medical fraud investigations — except for investigations into Medicare Advantage. Since 2007, the industry has criticized the extrapolation method and, as a result, largely avoided accountability for pervasive billing errors. Industry protests aside, OIG officials say they are confident their enhanced audit tools will withstand scrutiny. "I believe what we have here is solid," OIG official Bresette said. Michael Geruso, an associate professor of economics at the University of Texas-Austin who has researched Medicare Advantage, said extrapolation "makes perfect sense," so long as it is based on a random sample. "It seems like this is a healthy step forward by the OIG to protect the U.S. taxpayer," he said. The OIG used the extrapolation technique for the first time in a February audit of Blue Cross and Blue Shield of Michigan that uncovered $14.5 million in overpayments for 2015 and 2016. In response, Blue Cross said it would take steps to fer
|
You may be on summer vacation, but the interest groups looking to make their mark on legislation to overhaul health care are working harder than ever. The Wall Street Journal reports that delays on Capitol Hill make this month the key time to "snare one-on-one meetings with lawmakers back in their home districts." Take Tim Trysla, a lobbyist at Alston + Bird. Makers of diagnostic imaging equipment are among his clients. "If you're looking for savings, don't come at us," says Trysla, who has called on 120 legislators, sometimes taking General Electric execs along to make the case for protecting payment for medical scans. (Check out a nifty WSJ interactive graphic on lobbying spending here.) Read More >> Trying to figure out what works and what doesn't in improving the health-care system? It never hurts to follow the money. NPR's Richard Knox digs into the money pit in Massachusetts, where a 3-year-old law expanding coverage has pushed the proportion of uninsured down to 2.6 percent--lowest in the nation.. The remarkable achievement has come at a high cost. Now, the state is looking to save money by paying doctors and hospitals a fixed annual amount for each patient rather than shelling out for services whenever they're rendered. "In the world of health care, this is big news," Knox says. The Food and Drug Administration has concluded that some drugs used to treat rheumatoid arthritis in children and teenagers need a tough warning about an increasing the risk of lymphoma and other cancers. The affected drugs include Johnson & Johnson's Remicade, Amgen's Enbrel and Abbott Lab's Humira.
|
eng_Latn
| 34,974 |
Health Care Law's Birth Control Mandate Ruled Unconstitutional
|
HealthCare.gov may not be the only challenge facing the Affordable Care Act. The ACA has now lost a key battle in court. The federal appeals court in Washington has ruled that a Catholic-owned company has the right to pursue a lawsuit against the health care law. Frank and Phil Gilardi, two brothers who own produce distribution companies in Ohio, filed a legal challenge against the birth control mandate within the law. The company has long excluded birth control coverage for its employees based on religious grounds. The new health care law requires business with more than 50 employees to offer health coverage, including FDA-approved birth control, at no extra cost. Guest
Jennifer Haberkorn, health care reporter for Politico. She tweets @jenhab.
ROBIN YOUNG, HOST: Lawsuits challenging the birth control requirement of the affordable health care act are getting closer to the Supreme Court. Some entities, such as churches, are exempt from the mandate that businesses with more than 50 employers - or employees, rather - offer health insurance that provides FDA-approved birth control at no extra cost. Last week an appeals court ruling cleared the way for Frank and Phil Gilardi, two Catholic brothers from Ohio who own a produce company. They want to move forward with their lawsuit. They claim the mandate violates their religious beliefs. Jennifer Haberkorn is health care reporter at Politico. Jennifer, so this appeals court overturned a lower court ruling. So what does the new appeals court ruling mean going forward? JENNIFER HABERKORN: This means this lawsuit can proceed. The owners were granted an injunction, which would block the law from going into effect for them, and it allows the case to move forward. YOUNG: So they have long excluded birth control in the plan that they offer. They're adamantly against both birth control and abortion. The trucks in the produce company have signs on the trucks saying that, they're very open about that, and so this decision says that they can continue that denial of coverage while they continue with their lawsuit. HABERKORN: That's right. Under the Affordable Care Act, if you don't provide birth control and other forms of preventive care in your employer health insurance plan, you would face fines. YOUNG: And there are other lawsuits that also challenge the contraception coverage requirement and also made the challenge based on religious grounds. One was in July from Conestoga Wood Specialties, this is a cabinetmaker owned by Mennonite Christians. And there was another in June, and this was a suit brought by Hobby Lobby stores. How did the courts decide in those two suits? HABERKORN: The courts decided in different directions. These were federal appeals courts. In the Hobby Lobby case, the store owners were granted an injunction, meaning the policy is blocked for them. They don't have to abide by it, and their case can move forward. In the Conestoga Wood case, their injunction was denied, and because those suits were decided in different directions, the losing party in both cases appealed to the Supreme Court, and the Supreme Court now has those cases. They're working through the paperwork, and they will decide within the next couple weeks whether to take up one of those lawsuits. YOUNG: So the Supreme Court is going to decide whether to take up either of those two cases, and again very different rulings. So courts ruled that the Mennonite Christians could not deny coverage based on religious grounds but that Hobby Lobby stores could? HABERKORN: That's right. This is essentially the same legal question, but the courts decided in different direction, which suggests that it's an issue ripe for the Supreme Court, the highest court in the land, to decide the case. YOUNG: Well, that also underscores how courts rule differently because here you have a group of - it's a religious organization, Mennonite Christians, although it's their for-profit arm, the wood specialties company, and the other is not a religious organization, it's a story, Hobby Lobby stores. HABERKORN: Exactly, which kind of makes it interesting. You would think on the surface that the Mennonites might have a stronger case, but obviously the courts did not think that was the correct analysis. In the Hobby Lobby case, they argue that even if they themselves, as the store owners, are not using it, they don't want to be party to making contraception and birth control available to anyone who works for them. YOUNG: Well, it becomes very interesting because a Justice Department arguing in a case said that the Religion Freedom Restoration Act did not alter a basic legal principle that corporations are distinct from owners. In other words, they're not people and so that this religious protection doesn't apply to people like the owners of the Hobby Lobby stores or the Gilardi brothers. But this Supreme Court has ruled that corporations are people in the Citizens United case. HABERKORN: That's right, and I think that is go
|
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.
|
eng_Latn
| 34,975 |
Thousands Could Lose Affordable Care Act Coverage
|
Today is the last day for about 400,000 people to retain health insurance through federal healthcare insurance subsidies under the Affordable Care Act. Individuals who are currently receiving coverage but have failed to present the necessary documents verifying income and citizenship will be cut off. While some are rushing to validate their subsidies, others are gearing up for the new open enrollment starting November 15. Julie Rovner, senior correspondent for Kaiser Health News speaks with Here & Now’s Jeremy Hobson about the latest news on the ACA.
Wall Street Journal: Hundreds of Thousands Face Health Law Subsidy Deadline
Guest
Julie Rovner, senior correspondent for Kaiser Health News. She tweets @jrovner.
|
Among the Americans whose health insurance arrangements will definitely be changed by the new health care law are members of Congress themselves. The law stipulates that lawmakers and some members of their staffs enroll in new health insurance exchanges. But an apparent drafting error in the law makes it unclear when that transition is supposed to occur.
|
eng_Latn
| 34,976 |
Consumers Hunting For Health Insurance Find High Prices — And Some Great Deals
|
This post was updated Dec. 14 at 9:30 a.m. to note that Maryland extended enrollment until Dec. 22. Gene Kern, 63, retired early from Fujifilm, where he sold professional videotape. "When the product became obsolete, so did I," he says, "and that's why I retired." Kern lives in Frederick, Md., and has been an enthusiastic enrollee in Maryland's health exchange since it began in 2014. But this fall he received a letter from his insurer explaining that the cost of his policy's premium would jump from $800 a month to $1,300 in 2018. Premiums have risen for many 2018 policies, though most people won't actually have to swallow those higher costs, because subsidies have gone up, too. Gene Kern is one of the exceptions. "Because of my income, I am slightly above the 400 percent poverty level," he says, "and as a result I get no subsidy from the government." So Kern has switched to an HMO plan on the insurance exchange for around $900 a month. That's more than 20 percent of his income, which comes partly from Social Security and partly from his retirement account. But, he says, "It's the best I can get," and he wants very much to stay insured for the next two years, at which point he will qualify for Medicare. Louise Norris is a health insurance broker and analyst in Colorado. She says there are a number of people like Kern who earn too much for a subsidy and will pay more for health insurance next year than they did in 2017. "Rates are high," she says. "There's no way to sugarcoat that." But she warns her clients against the temptation to get a less expensive plan that doesn't comply with the minimum standards set out by the ACA. "It seems like a good deal because it's cheap," Norris says. "But then you find yourself being that person who has a heart attack and needs triple bypass. And hundreds of thousands of dollars later you wish you had that ACA-compliant plan." Prices for ACA-compliant health policies went up in Tennessee, too, where state regulators approved average rate increases ranging from 20 to 40 percent. Brenda Linn has already been paying $750 a month just to cover her own medical needs; so the retired kindergarten teacher and her husband logged on to HealthCare.gov to check the price of 2018 plans. To her surprise, the website brought up a great deal. "And I'm like, 'Dave, this has to be a mistake,' " she says. The price Linn was quoted was less than $5 a month. Why? A slight loss of income had made her eligible for a subsidy for 2018. "Because we didn't qualify last year, I wasn't really that hopeful," Linn says. But a large majority of marketplace shoppers do get subsidies. And for 2018, on aggregate, these subsidies are larger. Tony Garr, a volunteer application assistant with the Tennessee Health Care Campaign, says more than ever this year, people should shop around on the exchange to see what kind of subsidies they may be eligible for. "Generally speaking, they will find out that help is there," he says. Any many people who got a price break in the way of a subsidy in the past can get even more for their money this year. For example, Daniel Prestwood, who is self-employed and cleans fish tanks around Nashville, says he found a better plan for 2018, with monthly premiums that dropped from $300 to $200. He says he tries not to get too frustrated by the political wrangling over health care. "All I know is that for 2018 I'll have a good health care plan in place," he says, "and that's the best I can hope for at this point." And even with the Trump administration's efforts to hobble the ACA, in Tennessee, the number of applications processed by federally funded insurance guides — known as navigators and certified application counselors — has already surpassed last year's. As of early last week, with 10 days left in open enrollment, more than 1,200 individuals had applied with official help, eclipsing the total from all of 2016, when the enrollment period was several weeks longer. While application assistants only work with a tiny fraction of the 235,000 Tennesseans who have marketplace plans, Sandy Dimick of Family and Children's Services Nashville, says she expects total enrollment will exceed last year's total, as well. Navigators around the U.S. have worried that cuts to the federal advertising budget in 2017, and a lack of cheerleading from the White House, could drive down enrollment. Take note: Though enrollment for most states ends Friday night, residents of nine states (California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, New York, Rhode Island and Washington) and the District of Columbia have slightly more time to sign up. This story is part of NPR's reporting partnership with local member stations and Kaiser Health News. Selena Simmons-Duffin, a producer at NPR's All Things Considered, is working temporarily with NPR member station WAMU, as part of an exchange program at the network. Blake Farmer can be found on Twitter @FlakeBarmer.
|
Carl reads three quotes from the week's news ... this week, the Health Care saga continues, two pilots err in the air, and a very special twosome takes the tee.
|
eng_Latn
| 34,977 |
Insurance Brokers' Fees Won't Count As A Health Care Expense
|
The Obama administration ruled today that fees paid to health insurance brokers and agents won't count as medical care expenses, under limits imposed on insurers in the 2010 federal health law. That decision, in one of the regulations for implementing the health overhaul, is sure to disappoint insurance agents, as you might have guessed. But it's more important than you might have imagined. Here's why. Under the federal health law, insurers must spend at least 80 percent of the money they get through premiums on medical care and quality improvement. Of looked at another way, administrative costs can't exceed 20 percent. If they do, the insurers have to give rebates to consumers. For insurers of large groups, the target is 85 percent, or no more than 15 percent on administrative costs. Continue Reading Brokers had lobbied hard to have their fees included on the medical care side and not counted as administrative costs, which also includes such expenses as marketing and executive salaries. Brokers argued commissions would be cut and agents could lose their jobs, if the fees were counted as expenses. That would leave consumers without as much access to brokers, who help them choose health insurance. But consumer advocates fought the move, saying commissions are clearly administrative costs and removing them would make it easier for insurers to avoid paying the required rebates to consumers. Those rebates will go out next year to individuals and small-business policyholders whose insurers fail to hit spending targets this year. The rebates could come in the form of reduced premiums. The brokers lost. "If your insurance company doesn't spend enough of your premium dollars on medical care or quality improvement this year, they'll have to give you rebates next year," said Marilyn Tavenner, who is on her first day as chief of the Centers for Medicare and Medicaid Services. "This will bring costs down and give insurance companies the incentive to focus on what matters for patients — high quality health care." Late last month, the National Association of Insurance Commissioners adopted a resolution urging Congress to amend the federal health law to exempt broker commissions from the tally, known as the "medical loss ratio." This followed an earlier effort, in July. But the NAIC vote was closely divided, and it had raised no objection to inclusion of broker commissions a year ago when the draft rule was first issued. Tim Jost, a law professor and a NAIC consumer advocate, says he is pleased that broker commissions remain in the administrative cost calculation. The overall requirement that insurers spend at least 80 percent of revenue on medical care "is a major benefit to consumers" and will help slow premium growth because "it will result in rebates from insurers who don't bring down premiums." The Department of Health and Human Services did agree to phase out rather than abruptly halt special allowances for the administrative expenses of so-called mini-med plans that offer limited benefits to individuals or small groups. Under an earlier rule, rebates to employers would have been taxable, so the final rule says any rebates given for group policies should be in the form of lower premiums or "in other ways that are not taxable." It will then be up to the employer or group policyholder to "ensure that the rebate is used for the benefit of subscribers." In addition, the rule requires insurers to provide notices of rebates not only to the employer, but also to the enrollees.
|
NPR's Melissa Block talks to Medicare and Medicaid Services administrator Thomas A. Scully about the Bush administration's decision to ease rules that mandate hospitals must examine and treat people who require emergency care, even those who are unable to pay. The new rule goes into effect on Nov. 10, 2003 along with another provision: hospitals will no longer need to have specialists "on call" around the clock.
|
eng_Latn
| 34,978 |
Mass. Law Uncovers More Uninsured Than Expected
|
How to achieve universal health coverage is a major issue in this year's presidential campaign. Massachusetts has implemented a 2006 law requiring nearly every citizen to sign up for health insurance or pay a tax penalty.
|
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.
|
eng_Latn
| 34,979 |
AARP Endorses House Democrats' Health Bill
|
Here comes the AARP to endorse Democrats' health legislation, just in time for big votes on the House floor that could come as soon as Saturday. The Associated Press reports the influential group representing retirees and older people will publicly back the unified health legislation in the House. The AARP Web site promises "a major health reform announcement" at 11:30 EST today. AARP's support would give House Democrats a big boost. Half of Americans over 50 belong to the organization, AARP's lobbying director David Certner told NPR's Peter Overby. Read More >> Critics say AARP is conflicted on overhaul because the group make lots of money on health insurance sold under the AARP brand. Last year AARP pocketed $222 million in royalties from UnitedHealthcare, which issues most of the policies marketed with the AARP name. That's nearly as much as dues paid by AARP's members, Overby notes. AARP defends its dual roles, advocate for health overhaul and seller of insurance products. "We are driven by our policy," Cerner said. "Our policy drives our advocacy. Our policy drives what we do in terms of our product. And that's been the way it has been from the beginning." Update: As expected, AARP today threw its weight behind House Democrats on health overhaul, saying, the proposal "delivers on key priorities we've been fighting for." Some of the things AARP likes are closing the out-of-pocket "doughnut hole" in the Medicare drug benefit and measures to prevent insurance denials on the basis of age and health status. Watch video of the endorsement below:
|
Medicare could be around much longer than previously feared, thanks to savings expected under the new federal health law. And the law could help keep some Medicare recipients, including a wave of baby boomers who'll soon be eligible for coverage, stick around longer, too. Starting in January of next year, Medicare beneficiaries will begin to receive many preventive screenings and services free -- no copayment or coinsurance required. Read More They’ll also get a free annual wellness visit with their doctors to develop a personalize prevention plan. But the health law doesn’t explicitly encourage the preventive activity that might help seniors most: working out. "The single most effective thing you can do to maintain your health, especially in your 70s, is exercise," says Dr. Peter Hollmann, who is chairman of the public policy committee for the American Geriatrics Society. The health overhaul requires that preventive services recommended by the U.S. Preventive Services Task Force be covered for seniors at no charge. But on the subject of exercise, the task force doesn't say much. It doesn't evaluate the preventive value of exercise at all -- not surprising since its focus is on services and screenings. The only statement the task force makes is that there's not enough evidence about the effectiveness of doctors promoting physical activity to recommend for or against it. Even so, advocates for seniors hope the annual wellness visit will provide a chance to encourage Medicare beneficiaries to get out and about. "If you want to be healthy in your 80s, keep moving in your 70s," says Hollmann. "Even if you've already lost some ground, you can keep from losing more by ramping your program to your capacity."
|
kor_Hang
| 34,980 |
Detroit Automakers Fight Hospital Expansions
|
Detroit's Big Three automakers are fighting plans to build new suburban hospitals. Hospital officials say they need customers from affluent suburbs to offset the cost of caring for the city's poorest patients. Auto executives fear new hospitals will increase insurance premiums for companies -- and eventually raise car prices. Quinn Klinefelter of Detroit Public Radio reports.
|
Ed Whitacre, GM's chairman and interim CEO, says he thinks the struggling company will turn a profit in 2010. That would be the first time that's happened since 2004. It's a bold forecast and it depends on a number of factors outside the company's control.
|
eng_Latn
| 34,981 |
Is National Health Overhaul Just California Redux?
|
As the debate over health overhaul plods along in the Senate, what are the odds something will actually get done? Some point to Massachusetts, a trailblazer that legislated universal coverage three years ago, as an example of what can be done. But Kaiser Health News' Jordan Rau reminds us not to forget California, where Republican Gov. Arnold Schwarzenegger tried mightily and futilely to cover the uninsured. What went wrong? Proponents of change failed to do enough soon enough to win support from Republicans. The left wasn't on board either, arguing Schwarzenegger's proposals weren't adequate. Then there were the budget problems--California's budget woes led to tension over how much to subsidize coverage for less-well-off folks. Read More >> In the end, Schwarzegger's plan foundered on a 7-1 bipartisan vote against it by the California Senate Health Committee in January 2008. Will Obama's plans die, too? Maybe not. After a recent lobbying trip to DC, Donald Crane, president of the California Association of Physician Groups, told Rau, "Where we saw a train wreck in California, we see movement here in Washington." Back in Massachusetts, researchers are combing the data to figure out how the state's universal coverage plan is working out. A paper just out in the journal Health Affairs takes a look at what has happened with employers and the plans they offer employees. The bottom line: worries that employers would drop coverage or drastically scale back the benefits didn't come to pass. Indeed, insurance options on the job have "remained strong," the researchers from the Urban Institute say, and workers rate the options more highly after the change than before the law. There have been some problems, however, with higher premiums and out-of-pocket costs for workers at smaller companies.
|
NPR's Alex Chadwick speaks with Cal Tech seismologist Kate Hutton about the aftershocks from yesterday's 6.5 magnitude earthquake along California's Central Coast.
|
eng_Latn
| 34,982 |
Shopping For Health Insurance? Try The Mall
|
As the number of Americans without health insurance grows, the nation's largest health insurance company is having success in Florida with a new idea: retail stores that sell insurance directly to consumers. From the outside, you might mistake it for a cell phone store. It's a friendly looking storefront in a new shopping plaza, deep in the South Florida suburbs. Inside, there aren't cell phones for sale, but health coverage. Doug Bartel, with Blue Cross and Blue Shield of Florida, says the marketing plan for retail health coverage is not that different from cell phones. The first key: Put the stores in locations with good foot traffic. In Pembroke Pines, not far from Fort Lauderdale, a slow but steady stream of customers comes through the door at the Florida Blue store: retirees, the self-employed, small business owners, young people just starting their careers. Most have one thing in common: They currently have no health coverage. "Basically, I'm just a young guy looking for some type of coverage. Eventually, you're going to need coverage. And, you can't be young forever," William Boateng says. The 28-year-old student and part-time pharmacy worker is studying to become a physician's assistant. He came in to buy health coverage. The plan he chose costs about $150 a month and includes full coverage of visits to the emergency room. That became important to him because of what happened to a friend. Boateng says his friend got into a fight, hit his head and had to be taken to the emergency room. The friend found himself with a bill for $10,000. "All of a sudden, a 20-something-year-old individual (who) had very minimal debt now has accrued a lot of debt that he's still liable and responsible for. And I just didn't want to have that uncertainty under my belt," Boateng says. Marketing To The Uninsured This is Blue Cross and Blue Shield of Florida's second retail store. They target a huge market: the estimated 4 million Floridians who currently have no health insurance. Bartel says that number includes workers who increasingly are being forced to make their own decisions on health coverage. "The reality is with health care costs being what they are, fewer and fewer employers are offering coverage," he says. "So, you might not be offered health insurance from your work, or you might be given an allowance, so to speak, where you're given a couple hundred dollars a month, but it's your choice to go do with that money what you want." And once you're in the door, the customer representatives have an array of coverage plans to choose from: blue chip plans with full hospitalization, doctors' visits and catastrophic health coverage, down to medical discount cards at $20 per month. Limits To Low-Cost Plans? Rick Curtis, president of the Institute for Health Policy Solutions, a research group that studies the health care industry, notes that retail stores duplicate services already available by phone or on the Web. And he's leery of low-cost plans that offer limited coverage. "I'm concerned that some people who get that kind of coverage — or very limited, just preventive and primary care and no catastrophic coverage — don't really understand the limits of what they're getting," Curtis says. A 'Retail Transformation' Bartel says there's something larger going on here: a retail transformation of the health care industry. Consumers now choose their own storefront MRI centers and are comfortable going to health clinics in Wal-Marts. "These stores are part of that overall retail transformation," Bartel says. "So, you're seeing increased transparency. You're seeing more interactive stuff on the Web. People want to purchase health insurance in a variety of different ways. Maybe you're comfortable online, maybe you want to talk to someone in person, or maybe you want to come into a store." Blue Cross and Blue Shield says its retail stores have been successful, and the company is making plans to open several more. Other Blue Cross and Blue Shield affiliates have been studying the concept and have already opened health insurance stores in South Carolina, Alabama and Pennsylvania MELISSA BLOCK, host: The number of Americans without health insurance is going up, and fast. By one estimate, it increases at the rate of 14,000 people a day. The growing number of uninsured is a problem, but also a marketing opportunity. In Florida, the nation's largest health-insurance company is having success with a new idea: retail stores that sell health insurance directly to consumers. From Miami, NPR's Greg Allen reports. GREG ALLEN: From the outside, you might mistake it for a cell phone store. It's a friendly looking storefront in a new shopping plaza, deep in the South Florida suburbs. Inside, there aren't cell phones for sale, but health coverage. Doug Bartel, with Blue Cross/Blue Shield of Florida, says the marketing plan for retail health coverage is not that different from cell phones. The first key: put the stores in locations w
|
On Wednesday, the Centers for Medicare and Medicaid Services released a massive spreadsheet containing a comparison of what hospitals across the country bill for the 100 most popular medical procedures. The document revealed wild disparities in pricing from hospital to hospital. Robert Siegel speaks with Princeton professor Uwe Reinhardt, who studies health care economics, about how the American hospital system evolved this way.
|
eng_Latn
| 34,983 |
Blue Shield Of California Loses Its Tax-Exempt Status
|
One of California's largest health insurers, Blue Shield of California, could be on the hook for a massive tax bill after the state revoked its tax-exempt status. The company is appealing the decision which could cost the health insurer tens of millions of dollars a year. The dispute comes as the nonprofit is facing mounting criticism for operating like a for-profit company.
|
in which pharmaceutical maker, Smith Kline Beecham, has agreed to pay the federal government $325 million for allegedly over-billing Medicare and Medicaid for laboratory tests. The out of court settlement results from a government investigation into the health care industry, known as `Operation Labscam.'
|
eng_Latn
| 34,984 |
Steep Hikes In Insurance Rates Force Alaskans To Make Tough Choices
|
Gunnar Ebbesson is used to paying a lot for health insurance, but the small business owner from Fairbanks got a shock recently when his quote came in for next year's coverage. "I don't understand who can afford this," he says. "I mean, who really can afford this? I can pay it, but I can't afford it." The premium for his family of five came to more than $40,000 a year. That's for a bare-bones plan with a $10,000 deductible — the plan that's through the marketplace set up by the Affordable Care Act. Customers can begin buying plans on HealthCare.gov starting on Nov. 1, and do so through Jan. 31, 2016. Rates for individual health plans went up an average of 7.5 percent nationally, but Alaska is a special case. It has the highest premiums in the country and it has seen some of the highest percentage increases over the past two years. Why that's true is still murky. There are a tangle of suggested reasons that likely play a role — among them that the state has relatively few doctors in certain specialties, only two insurers offering plans on the individual market, and relatively few people seeking insurance that way. What's clear is that a lot of people who have to buy that insurance are feeling the pinch. Ebbesson makes a good living and he doesn't qualify for a subsidy to help pay for insurance because his family income is more than $142,000 a year. But, he says, his insurance costs more than his mortgage. "I'm not able to put money in retirement, savings for my kid for college — my 10-year-old. Believe me," he says, "I could find lots of stuff to do for my future with $40,000." Ebbesson supports the Affordable Care Act. He calls the Alaska rates a wrinkle in the law that needs to be fixed. The average 2016 premium for a 40-year-old in Anchorage is $719 a month — more than double the national average. Most Alaskans, and most Americans, qualify for a subsidy that rises with premium increases — insulating consumers from the big jump. But about 5,000 Alaskans pay the full sticker price. "We want people to have access to affordable coverage and that's not happening right now in the marketplace in Alaska," says Eric Earling, spokesman for the insurance company Premera Alaska, one of only two companies selling on Alaska's exchange. Earling says even with the high prices, the company is losing millions of dollars on Alaska's tiny individual market. He says in the first six months of this year, 37 Premera customers filed over $11 million in claims. "The important thing is they deserve access to coverage, and we're glad they have it," he says. "The trick is creating a sustainable environment where those costs can be absorbed in a way that doesn't adversely impact all consumers." Premera is proposing legislation that would use Alaska's high risk pool to allow the biggest claims to be paid from a special fund. The state's Division of Insurance hasn't taken a position on the idea. Victoria Cronquist is a dental hygienist in Anchorage. She doesn't care what the solution is, as long as it helps her find more affordable insurance. "It's just getting too expensive," she says. "I'm up against the wall. I can't do it all." This year, she pays $1,600 a month for herself, her husband and two kids, ages 16 and 20. She gets a stipend from her work to help pay that premium, but her rate is going up to $2,600 a month next year. And her stipend isn't going up. Cronquist says she may cancel her insurance. "To be quite frank, to have a $2,600 monthly premium payment and all this is stressful to me," she says. "Extremely. And that increases my odds of getting ill! That's the other way I look at it." Cronquist doesn't take the decision lightly. Her family has dropped health coverage in the past. They had to pay a steep price when her daughter ended up in the ICU a few months later. Gunnar Ebbesson, from Fairbanks, also has a difficult decision ahead. He's thinking about dropping his policy and putting money toward savings instead. Ebbesson says his family could fly to Thailand for any big, necessary medical procedures. If something catastrophic happened, though, it would put his family in a tough position. "It's a scary proposition," he says. "There's always bankruptcy but, my goodness, why should I be having to even think about things like that related to my health insurance?" The high rates will push more Alaskans into a category that allows them to avoid paying the penalty for going uninsured. The law includes an "unaffordability" exemption if the lowest cost insurance amounts to more than 8 percent of your income. This story is part of NPR's reporting partnership with Alaska Public Media and Kaiser Health News.
|
<em>New York Times </em>investigative reporter Sarah Kliff talks about the costs and challenges of switching to a universal healthcare system — and what it might mean to eliminate private insurance entirely.
|
eng_Latn
| 34,985 |
Does The United States Need The AstraZeneca Vaccine?
|
A new study shows the AstraZeneca COVID-19 vaccine is 79 percent effective against symptomatic disease, according to a statement by the company. The same trial also showed a 100 percent efficacy in preventing hospitalization. The new study was based in the United States and it could provide the framework for emergency authorization by the Food and Drug Administration. Some European countries paused their use of that vaccine due to fears of potential rare blood clotting, though subsequent studies have shown the shot does not increase the risk for blood clots. Find all our coverage of the COVID-19 crisis here. Does the United States actually need the AstraZeneca vaccine? How quickly could it get emergency authorization?
|
You may be on summer vacation, but the interest groups looking to make their mark on legislation to overhaul health care are working harder than ever. The Wall Street Journal reports that delays on Capitol Hill make this month the key time to "snare one-on-one meetings with lawmakers back in their home districts." Take Tim Trysla, a lobbyist at Alston + Bird. Makers of diagnostic imaging equipment are among his clients. "If you're looking for savings, don't come at us," says Trysla, who has called on 120 legislators, sometimes taking General Electric execs along to make the case for protecting payment for medical scans. (Check out a nifty WSJ interactive graphic on lobbying spending here.) Read More >> Trying to figure out what works and what doesn't in improving the health-care system? It never hurts to follow the money. NPR's Richard Knox digs into the money pit in Massachusetts, where a 3-year-old law expanding coverage has pushed the proportion of uninsured down to 2.6 percent--lowest in the nation.. The remarkable achievement has come at a high cost. Now, the state is looking to save money by paying doctors and hospitals a fixed annual amount for each patient rather than shelling out for services whenever they're rendered. "In the world of health care, this is big news," Knox says. The Food and Drug Administration has concluded that some drugs used to treat rheumatoid arthritis in children and teenagers need a tough warning about an increasing the risk of lymphoma and other cancers. The affected drugs include Johnson & Johnson's Remicade, Amgen's Enbrel and Abbott Lab's Humira.
|
eng_Latn
| 34,986 |
Americans Want Public Health Insurance Option But Won't Use It
|
A solid majority of Americans believe with President Barack Obama that any remaking of the present health-insurance system should include a public option, according to a new Quinnipiac University poll. But here's the rub. Only a small minority of them would want to be insured by such a plan. That's a fairly intriguing paradox. An excerpt from the press release announcing the poll results: Although 69 percent of voters nationwide say Americans should have the option of government- run health insurance, only 28 percent would choose to be covered by it, according to a Quinnipiac University national poll released today. Voters say 49 - 45 percent they would pay more to reform health care, but a total of 72 percent don't want to pay more than $500 a year. Read More >> A Quinnipiac researcher had this analysis of the poll's results: "American voters want their fellow countrymen to have the option of a public plan, but don't want a public plan for themselves because they are satisfied personally with their health care," said Peter Brown, assistant director of the Quinnipiac University Polling Institute. "That presents a challenge to those who want Americans to pay more to reform the system." "In addition, seven out of ten voters aren't willing to chip in what amounts to the price of a cheese pizza per week - without extra toppings - in order to finance an overhaul," Brown added. "Opposition to paying any additional taxes ranges from 40 percent among lower paid voters to 52 percent among those making more than $100,000 per year." It's not often that cheese pizza gets mentioned in the health-care debate. Maybe fewer cheese pizzas would mean healthier Americans who would need to use health care less often which would reduce the cost of health care. But that's a discussion for another time.
|
One reason Medicare patients join HMOs is to get prescription drug coverage. But many HMOs have eliminated drug coverage. They say it's too expensive. NPR's Patricia Neighmond reports on one HMO that is trying another approach to cutting drug costs.
|
eng_Latn
| 34,987 |
House Asks: How Much Do Insurance Company Executives Make?
|
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.
|
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.
|
eng_Latn
| 34,988 |
Prevention Efforts May Not Reduce Health Care Costs
|
If you can prevent people from getting sick or detect disease early, you can save money for the health care system, right? Maybe not, says the Congressional Budget Office. So far, in looking at health overhaul bills now moving through Congress, the CBO has failed to attribute any savings to increased efforts to provide preventive efforts like stop-smoking programs. "It's very Kafka-esque, isn't it?" says Rob Gould, president and CEO of the Partnership for Prevention, an umbrella organization of public health and health industry groups. "We know from our research that some prevention does save money." Former CBO health analyst Joe Antos, now at the American Enterprise Institute, says preventive services often cost more than they save. In screening people for cancer, for example, he says, "you screen literally millions of people, sometimes at fairly high cost per screen. You'll pick up some true positives, people who really have the disease. You'll pick up some false positives." Then all those people have to be followed up by the medical system, which costs even more money. "By the time you're all through — studies have demonstrated this time and time again — screening as a preventive health measure, by and large, doesn't work unless you can narrow it down to roughly the right patient population," he says. That, however, doesn't make all preventive services cost adders rather than cost cutters. Gould says his group looked at 25 clinical preventive services that were recommended by the U.S. Preventive Services Task Force. "We found that indeed six of the services did save money and 12 were highly cost-effective," he says. By cost-effective, he means the intervention cost less than $50,000 per added year of life. By contrast, Gould says, a mechanical device to keep alive a patient with congestive heart failure "is $900,000 for an additional year of life." While Gould takes issue with the CBO's scoring of the existing House and Senate bills, Ken Thorpe of Emory University takes issue with the bills themselves. "On the prevention side, at least in the congressional proposals, there is not a coherent, effective prevention strategy really designed to prevent disease in the first place," says Thorpe, who is also executive director of the Partnership to Fight Chronic Disease, another public health umbrella organization. Thorpe says there are proven ways to use prevention strategies to reduce the incidence of very expensive ailments like obesity, diabetes and high blood pressure. But they need to be more broadly deployed. Gould, meanwhile, says he worries that even if the bills contained more comprehensive preventive programs, the CBO would still not give them credit for saving money. Even when the scorekeepers do concede that some prevention and wellness programs do work as intended, he says, "they warn us that living longer would cost the government more money because people would be using additional Social Security and Medicare payments. "So if the answer to the question is that people would be living longer and healthier lives, then you're asking the wrong question." The CBO, however, is not charged with deciding whether a bill is good or bad — only how much it costs the federal government. Value judgments are left to members of Congress to make and to the people who vote for them. ROBERT SIEGEL, host: One of the ways lawmakers had hoped to save money as part of the overhaul was by emphasizing prevention and wellness. Getting people to lose weight, stop smoking or detect disease earlier seemed like a sure bet to bring down health care spending. But as NPR's Julie Rovner reports, budget scorekeepers don't see it that way. JULIE ROVNER: Almost every time President Obama talks about the health care overhaul, he talks about prevention. Here's how he put it at a forum this afternoon before the AARP. President BARACK OBAMA: So that instead of just spending billions of dollars on costly treatments when people get sick, we're spending some of those dollars on the care they need to stay well, things like mammograms and cancer screenings and immunizations - common sense measures that will save us billions of dollars in future medical costs. ROVNER: Common sense maybe, savings of billions of dollars, not so fast. According to the Congressional Budget Office, the prevention programs included in the House and Senate bills it's reviewed so far won't save any money for the federal government. In fact, CBO says that'll actually cost money. Joe Antos of the American Enterprise Institute is a former CBO health analyst. He says it's unfortunately true that many preventive health services simply cost more than they save. Widespread disease screening for things like cancer is a good example. Mr. JOE ANTOS (American Enterprise Institute): Because you screen literally millions of people, sometimes at fairly high costs per screen. You'll pick up some true positives, people who really have the disease, you'll pick up some false
|
Despite recent attention to the issue of obesity and its relation to health problems such as diabetes and hypertension, not one state showed a decline in the rate of obesity, according to the Trust for America's Health on Obesity, a nonprofit organization.
|
eng_Latn
| 34,989 |
The Economics Of Health Care (Australian Style)
|
Peter writes: Watching the US health care debate from a distance, with the context of the Australian system on my mind, one question keeps coming up: why does it cost so much more in the USA? The pharmaceutical benefit scheme (PBS) ensures that no matter how much a particular medication costs, the most I will pay is $33-$35/month. The PBS is set up around the very idea that the patient shouldn't have an interest in the cost of a medication. If the most appropriate medication costs twice as much as something that will kind of do the job, the government will cover the difference. Medicare, which covers all Australians, will pay doctors for each consultation. This is a little misleading as the scheduled fees set by the government are generally low, so usually an out of pocket expense is incurred. There are doctors who charge only the scheduled amount (bulk bill) but these generally feel like a McDonald's drive through, with each appointment lasting 5-7 minutes. I prefer to have 15 -20 minutes set aside for the appointment, so I pay an extra $22. Read More >> I've seen footage of people complaining (often quite loudly) that the USA is about to become some kind of socialist, commy, pinko nightmare. My only experience is socialized medicine and it works very well in Australia. If it weren't for the medication I could keep my out of pocket expenses at nil, but I've chosen to pay more for some services and make use of the private system if I ever need to go to hospital. These are my costs: Consultations:GP (5-6 visits yr): $22 (govt pays additional $33)Specialist (1 visit/yr): $0 (govt pays additional $60ish) -- bulk billed(GP costs can change in my case. Frequently, if I only need a new script the GP will bulk bill because it only takes three minutes.My specialist now charges an out of pocket expense for new patients, as a long term patient I've been grandfathered.) Private Health Insurance (hospital cover): $65/month (govt pays additional $27) Average cost: $1061/year
|
As Democrats debate whether to support a “Medicare for All” program, proponents say such a system would save billions in administrative costs. Here & Now’s Peter O’Dowd speaks with Sabrina Corlette (@SabrinaCorlette), research professor at the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute, about the dollar value of those costs. This article was originally published on WBUR.org.
|
eng_Latn
| 34,990 |
Britain's Health System Defended
|
The National Health Service in the U.K. has become a punching bag for some critics of proposals to remake the U.S. health-care system. Among the inflammatory charges, Sen. Edward Kennedy wouldn't have received state-of-the-art care for his brain tumor in a place like Great Britain because health overseers would have found extending the life of the 77-year-old unworthy of the expense. "Well, I'm sorry to say that's the most ludicrous thing that I've heard," Ara Darzi, a surgeon and former minister of health, tells Steve Inskeep on Tuesday's Morning Edition. It's an example, Darzi says, of the "lies that have been used to set fear against reform." Read More >> Darzi also co-wrote a Washington Post op-ed to set matters straight. Here are a few things he thinks Americans should know: All Britons are registered with primary care doctors who see them without charging patients a fee. The docs are independent contractors compensated in part for the quality of care they provide, so "they can focus on what works not what pays." Patients can choose their providers of health care and, starting next spring, the NHS will be the first health system in the world to publish quality measures for every department in every hospital. To critics of change, the U.K. embodies concerns that a faceless bureaucrat will make life and death decisions restricting care. Darzi turns that right around. "Americans fear that countries such as Britain and Canada ration care -- and that such rationing could and should never be tolerated in the United States," the Post editorial says. "Yet 47 million uninsured is quite an extreme form of rationing. So at this moment, the burden of proof falls upon those who oppose change -- for they stand in defense of fear. Bonus track: Darzi, a proficient practitioner of minimally invasive surgery, likes to listen to Pink Floyd while operating.
|
On Wednesday, the Centers for Medicare and Medicaid Services released a massive spreadsheet containing a comparison of what hospitals across the country bill for the 100 most popular medical procedures. The document revealed wild disparities in pricing from hospital to hospital. Robert Siegel speaks with Princeton professor Uwe Reinhardt, who studies health care economics, about how the American hospital system evolved this way.
|
eng_Latn
| 34,991 |
Senior Advocates Oppose Meals on Wheels Changes
|
Faced with a growing population of seniors who depend on Meals on Wheels service, New York City proposes using frozen meals delivered weekly, instead of the near-daily deliveries now typical. Senior advocates say the change may be devastating for participants, many of whom rely on the program for contact with the outside world. Cindy Rodriguez of member station WNYC reports.
|
As Democrats debate whether to support a “Medicare for All” program, proponents say such a system would save billions in administrative costs. Here & Now’s Peter O’Dowd speaks with Sabrina Corlette (@SabrinaCorlette), research professor at the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute, about the dollar value of those costs. This article was originally published on WBUR.org.
|
eng_Latn
| 34,992 |
$11 Prescriptions: What U.S. Health Care Can Learn From Germany
|
With Meghna Chakrabarti Germany has a private health care system like the U.S., but even the sickest patients rarely pay more than $11 for a prescription. Journalist Noam Levey, who writes about national health care policy for the Los Angeles Times, spoke with On Point’s Meghna Chakrabarti to discuss the differences –– and similarities –– between the U.S. and Germany’s health care systems. “Nobody’s health care system is an exact replica of anybody else’s, and of course nobody does it like we do. But most other countries have a bit more rational systems for the way they do things,” Levey says. “I think a lot of people think, ‘Oh, if it’s Europe, it must be a single payer system. It must be like Medicare-for-all, the government just has a health insurance plan, and everybody gets their coverage that way.’ That is true in some places, like the United Kingdom. But, it’s not true in Germany or Holland or Switzerland or a number of other wealthy countries.” Guests Noam Levey, writes about national health care policy out of Washington, D.C., for the Los Angeles Times. (@NoamLevey) Leigh Purvis, director of health services research at the AARP Public Policy Institute. (@leighdrugwonk) Interview Highlights On Germany’s health care system Noam Levey: “American patients know all too well that when you go to the drug store you often times don’t know how much your co-pay is going to be [or] how much your deductible is going to be. You could be paying a few bucks for that drug that your doctor prescribed to you [or] you could be paying a thousand dollars. Germany has a much more tightly regulated limit on how much patients can be required to pay for a whole range of medical services. … The maximum per prescription cost for German patients is basically 10 euros or about 11 dollars. In many cases it’s lower than that, and there are, for lower income patients, exemptions. Remember, I said that if drugs are really expensive, that puts pressure on insurers to raise premiums. Well, insurers can’t charge patients more, because it’s a 10-euro maximum, so they instead were under pressure to raise the premiums.” On Germany’s “sickness funds” NL: “Just as in this country, where when the price of drugs goes up, that puts pressure on the insurance premiums that all of us have to pay. German “sickness funds,” as they’re called, these are health insurers, but they’re a little bit different than ours because they’re not-for-profit and they’re much more highly regulated than ours are. But, when those sickness funds had to cover very expensive drugs starting in the early 2000s, they were under a lot of pressure to raise premiums, and that of course was not going to be popular with German patients. So there was a growing consensus about a decade ago that something had to be done.” On differences between the FDA and sickness funds NL: “The FDA is a safety regulatory agency. It’s trying to figure out whether the drug is safe and, broadly speaking, effective. There is a European process for the European equivalent of the FDA that does the same thing. But the FDA is not charged with comparing these new drugs to existing therapies and trying to make a judgment about whether new drugs are better or worse … [Sickness funds are] not a government agency. It is an independent non-governmental agency. It’s actually not even located in Berlin, where the government is. It’s in Cologne, on the other side of Germany. One important part of what this agency is charged with doing is looking at what the drug companies are submitting.” On Germany’s differing model for drug price negotiation NL: “The insurers are private, so they’re independent from one another. But, very importantly, they negotiate collectively. So all the insurers get together and they sit across the table from the negotiators — from Eli Lilly or Pfizer or Sanofi — and they use this independent report as a point to inform their negotiations. … This collective negotiation means that there’s one price that is agreed to in the system and then really, really importantly [and] really, really different from the way we do it here: It’s public. It’s transparent. We know — and Germans know — what the price that is negotiated between the drug companies and the sickness funds is. And of course that’s completely different than here, where everything is a black box.” From The Reading List Johnson & Johnson’s Xarelto Advertisement: The First U.S. Direct-To-Consumer TV Drug Ad To Disclose Price Los Angeles Times: “German patients get the latest drugs for just $11. Can such a model work in the U.S.?” — “Patients who come to the Havelhöhe cancer clinic in the leafy outskirts of Germany’s capital are often very sick. “Struggling with advanced-stage cancers, many need strong doses of expensive, cu
|
Matthew Yglesias made the chart above for a post about the notion of a carbon tariff. Yglesias notes that as part of any climate change bill, the Senate may want to slap a tariff on trading partners that don't try to curb greenhouse gases. The idea is to prevent a cap-and-trade program from putting American manufacturers at a disadvantage -- with the primary bogeyman being China. Which is compelling enough on its own. But I like Yglesias' chart for the urgency it gives to the latest pricing news from European Union countries. America's largest trading partner is reporting little or negative inflation. As a whole the European Union is experiencing average inflation of a mere 0.6 percent. For the 16 countries that use the euro, it's -0.3 percent. Those are scary numbers. Economists like to see a certain amount of gentle inflation -- something about 3 percent -- and they're not seeing it. "We are seeing another round of substantial contraction of the already depressed economy," writes Carl Weinberg of High Frequency Economics. Weinberg says the situation amounts to falling output -- in the Eurozone, it's barely ticking upward and still down by double digits from last year -- followed by falling prices, failing businesses and the laying off of workers. If you like the positive-ish view, try this from Bloomberg: "Manufacturing surveys continue to paint a rosy picture of the near-term outlook," said Carsten Brzeski, an economist at ING Groep NV in Brussels. "The industrial recovery will continue but, of course, no recovery follows a straight upward line. New setbacks are likely." Read More >> The Bureau of Labor Statistics reports that its price index for imports in September 2009 was down 12 percent from the same month last year. From August 2009 to last month, the index eked out a climb of 0.1 percent. Marc Chandler, of the Brown Brothers Harriman currency desk, says the relatively weak U.S. dollar should lead to more expensive imports. Chandler notes that in the latest report, imports from Canada and the Pacific Rim -- including China and Japan -- were up 0.1%. Goods from the European Union went up by 0.5 percent from August to September but are down 4.6% from 2008. He argues that if imports cost more, then domestic manufacturers can keep their prices higher, too -- and perhaps help avoid a cycle of deflation. "That means that a greater rise in import prices would, in the current environment, be more desirable," he writes.
|
eng_Latn
| 34,993 |
The 'Ghosts' And 'Orphans' Of HealthCare.gov
|
2.1 million Americans have insurance today after signing up for through the health-care exchanges. More than 1.6 million signed up in December alone. Then there are those who signed up for a plan, but whose information never was transmitted to insurance companies — the “orphans.” Another group of people — dubbed the “ghosts” — are not on the government’s list of people who’ve chosen a plan, but are nevertheless considered enrolled by the insurers providing the plans. This means that people who think they have insurance may actually not. Jay Hancock, senior correspondent for Kaiser Health News, joins Here & Now’s Robin Young to explain the details. Guest
Jay Hancock, senior correspondent at Kaiser Health News. He tweets @jayhancock1.
MEGHNA CHAKRABARTI, HOST: Well, let's move on to other major news regarding the Affordable Care Act on this New Year's Day: the 2.1 million Americans who will start getting health insurance coverage beginning today. According to the Department of Health and Human Services, more than 1.6 million of them signed up through federal and state exchanges in December alone. And then there are the orphans and ghosts, those people who think they signed up. Jay Hancock is a reporter at Kaiser Health News. And Jay, the people who signed up through the state and federal websites, but their info never got fully transmitted, they're being referred to as orphans or the orphans of heathcare.gov. What's happened to them? What's their story? JAY HANCOCK: Well, we don't fully know yet because today is D-Day, and we're still - we're going to see exactly how all this is playing out in the next couple of weeks. But the orphans are part of I guess what we can call the continuing, ongoing imperfect rollout of the health law. As we all know, the computers didn't run very well. They have improved over the last few weeks. The administration kept moving back deadlines for signup to get coverage today, which is, you know, day one when you can be covered under this four-year roll-up, almost, of the ACA. Pre-existing conditions, people who had their plans canceled, this is the day. There was this huge rush by the insurance companies to get everybody signed up. And while the front end of the computers seemed to be improving and working pretty well, you know, heathcare.gov, where you go on, you register, you put in your name, you make your payment. People are worried about the back end of the computer system, the part that talks to the insurance companies and gets your information to the health plan. And what people fear may be orphans are folks who signed up on the front end, and all the information didn't quite make it to the insurance company, and so people are expecting situations, the insurance companies expect this, HHS, the Department of Health and Human Services, expect this, that some people will seek coverage, they may go to a pharmacy today, they may need to go to the ER, they may need to go to a doctor this week, who will not have their insurance cards yet, and the insurance company may not even have a record that they are insured. CHAKRABARTI: Well, let me ask you, so those are the orphans. Briefly, who, then, are the ghosts? HANCOCK: The ghost is something else that the industry is talking about, which is sort of the opposite problem, which is insurance companies are getting all these records, electronic files from heathcare.gov and the state-based marketplaces of people who are enrolled, and it is expected that some of these folks might not actually be enrolled at the insurance company. The insurance company may think it has customers that it doesn't really have, again the fault being not totally precise computer software. CHAKRABARTI: Right, so are the - is the administration or the insurance companies, have they given you any sort of estimate on when the gap is going to be closed, and all these issues with orphans and ghosts will be fully sorted out, so everyone knows who is insured properly? HANCOCK: Yeah, I mean, that is the big question, and that's been the question of the ACA rollout all fall long is how will it work, when will these issues get put to rest and how many people will be enrolled. As you noted, about two million people have signed up in the private exchanges, which is different from the Medicaid expansion, which is another big part of Obamacare, and the administration has been expecting about seven million people to be signed up. You have until March 31 to sign up if you're uninsured to get insurance and not be penalized on your tax form, but it's a - it's never been done before. It's hugely complex computer systems, legislation. We have this litigation going on that we just talked about. And it's unclear when it'll all get sorted out. What everybody is saying, insurance companies, pharmacies, HHS is that we will work with you. We want to make this work. Insurers are giving people up until January 10 to pay. Pharmacies are
|
As the U.S. Census Bureau resumes some 2020 census field operations put on hold by the pandemic, House Democrats are moving forward with proposals for major changes to the national head count as requested by the bureau. The coronavirus relief bill released Tuesday includes provisions that would push back by four months the legal deadlines for the bureau to deliver 2020 census results — including the latest state population counts used to redistribute congressional seats and Electoral College votes among the states, and the data used to redraw voting districts. If passed, the legislation would also boost the emergency budget for the census by $400 million. But the bill, known as the Heroes Act, is not expected to gain traction in the Republican-led Senate. It does offer some insight into the House Democrats' wish list for the constitutionally mandated count of every person living in the country. The bill includes a provision that would block the Trump administration's ongoing efforts to use government records to produce data about the U.S. citizenship status of every person living in the country, as well as requiring Census Bureau Director Steven Dillingham to provide a monthly report about the count's progress to lawmakers.
|
kor_Hang
| 34,994 |
Numbers Of Americans With Health Plans Way Up, But States Vary
|
A Gallup poll released Tuesday suggests the Affordable Care Act is significantly increasing the number of Americans with health insurance, especially in states that are embracing it. It echoes previous Gallup surveys, and similar findings by the Urban Institute and Rand Corp. In the latest survey, the percentage of uninsured Americans dropped from 18 in September 2013 to 13.4 in June 2014. States that chose to follow the health law's provisions most closely, by both expanding Medicaid and establishing their own health insurance marketplaces, saw their uninsured rate drop nearly twice as much (as a group) as states that declined those opportunities. "So there's a clear difference in the states that have implemented those mechanisms versus those that haven't," says Gallup's Dan Witters. Arkansas saw the biggest decline in its uninsured rate, from 22 percent to 12 percent. Kentucky, Delaware and Colorado also saw significant declines. "To drop 10 percent in the uninsured rate within really just six months is really an incredible achievement," says Dr. Joe Thompson, Arkansas' surgeon general. Thompson lobbied for his state's unique, bipartisan Medicaid expansion, which uses federal funding to buy private insurance for people with low incomes. He says about 80 percent of those with new, private insurance in Arkansas purchased it with Medicaid subsidies. "Those other states that have chosen not to make something good happen out of the Affordable Care Act," Thompson says, "are missing that opportunity on behalf of their citizens." Those states include Georgia, Indiana and Mississippi, all of which saw their own rates of uninsured residents drop less than 2 percentage points. Sam Mims, a Republican state legislator from southwest Mississippi, says the Affordable Care Act is still not the right way to go for his state. "Access to health care is not expanding Medicaid," he says. "Mainly from a financial standpoint we simply cannot afford to expand Medicaid and we will not expand Medicaid." Mims says the Legislature is taking steps to expand access to health care, such as allocating more money to federal clinics, opening access to mental health clinics, and working on programs to get more doctors and dentists to the state. Not all states that expanded Medicaid saw big drops in the percentage of uninsured. Massachusetts and Hawaii, for example, saw declines of less than 1 point. Witters says that's because those states already had very low rates of uninsured residents prior to the passage of the Affordable Care Act. California, which fully embraced the law but has a higher number of uninsured than any other state, saw a decrease of 5.3 points in its uninsured rate, according to the survey. The telephone poll was part of the Gallup-Healthways Well-Being Index; it included more than 178,000 people interviewed in 2013 and more than 88,000 people surveyed in the first half of 2014. This story is part of a reporting partnership between NPR and Kaiser Health News. Additional reporting by Jeffrey Hess, of Mississippi Public Broadcasting.
|
On Monday we read from your emails. On Inauguration Day, we asked listeners to tell us what domestic issue the president should focus on in the next four years. Based on your emails, health care was among the top contenders. From Debbie in San Antonio, Texas: "As a physician, my life would be better if we had universal health coverage. I want to take care of patients regardless of their ability to pay, and I want patients to be able to get necessary tests and medications."
|
eng_Latn
| 34,995 |
Wellness At Work Often Comes With Strings Attached
|
If you get health insurance at work, chances are you have some sort of wellness plan, too. But so far there's no real evidence as to whether these plans actually improve the health of employees. One thing we do know is that wellness is particularly popular with employers right now, as they seek ways to slow the rise of health spending. These initiatives can range from urging workers to use the stairs to requiring comprehensive health screenings. The 2014 survey of employers by the Kaiser Family Foundation found that 98 percent of large employers and 73 percent of smaller employers offer at least one wellness program. (Kaiser Health News is an editorially independent program of the foundation.) What makes wellness so popular with companies? "It really is part of their strategy to help employees be healthy, productive, and engaged," says Maria Ghazal, vice president and counsel at the Business Roundtable, whose members are CEOs of large firms. "And it's really part of their strategy to be successful companies." And there's another reason wellness has gotten so pervasive, said health consultant Al Lewis. Workplace wellness is a big industry unto itself. "It's somewhere between $6 [billion] and $10 billion, which creates an awful lot of people saying, 'Do more of this stuff,' " he says. Lewis has become something of a crusader against the spread of wellness around the nation. (He's co-author of an e-book detailing its failings.) Among the many problems with wellness plans, he says, is that a lot of them aren't so innocent. "We call them pry, poke, prod and punish programs," he says. That refers to programs that ask intrusive questions like how much alcohol a person consumes and whether a woman is planning to become pregnant. They might also require significant medical interventions or tests, such as comprehensive blood assays. The plans urge employees to participate and punish them if they don't. Under federal rules, wellness programs must be voluntary. But more than a third of large companies now use financial incentives, which include both rewards and penalties for those who don't participate, according to the Kaiser Family Foundation survey. For example, at Penn State University last year, officials were forced to backtrack on a plan that would have required professors and other nonunion workers — and their spouses — to undergo comprehensive health screenings every year, including measurements of cholesterol, blood sugar and body mass. Those who declined would be charged an extra $100 a month for insurance. Employees rebelled, and the university didn't implement the fines. Ironically, says Lewis, for all the money some wellness plans spend to screen thousands of people, most companies don't actually have that much health spending that could be saved by wellness. "In a company with 10,000 workers," he says, "they might have had 10 heart attacks, of which one may have been theoretically preventable with a wellness program." That's a big reason why most independent studies have found little or no cost savings. When there have been savings, health economists Aaron Carroll and Austin Frakt wrote for The Upshot, part of The New York Times, they tend not to have come from improving workers' health. "Wellness programs can achieve cost-savings — for employers — by shifting higher costs of care to workers," they wrote. In other words, if people don't participate or don't meet the wellness goals, they pay more for health coverage. Some programs can even do harm, says Lewis. For example, false positive results from screening low-risk people end up causing workers anxiety and their health plans still more money. Lewis is quick to add that screening tests recommended by the U.S. Preventive Services Task Force are appropriate, but their guidelines "are routinely ignored by corporate wellness programs." But not everyone outside the wellness industry is quite so pessimistic. Harvard health economist Kate Baicker is the lead author of a 2010 study that found some potential savings. "It could be that when all the full set of evidence comes in it will have huge returns on investment, and the billions we're spending on it are completely warranted," Baicker says. But for now, "there are very few studies that have reliable data on both the costs and the benefits." Meanwhile, the federal government is divided on how to regulate this area. The Affordable Care Act embraces the wellness concept. It lets employers link up to 30 percent of premiums to participation in wellness activities — and up to 50 percent if those activities involve quitting tobacco. But the independent Equal Employment Opportunity Commission is suing several companies, including Honeywell, with its more than 130,000 workers. It says their programs discriminate against those with disabilities. The idea of having to follow more than one set of rules is frustrating employers. "We want to be certain that following the Affordable Care Act is what we're supposed to be d
|
The school Nutrition Association says an unintended consequence of the law is that fewer kids are buying lunches. The group is lobbying for a host of changes that would give them more flexibility.
|
eng_Latn
| 34,996 |
One Nation, Two Health Care Extremes
|
The U.S. spent $2.6 trillion on health care in 2010 — more than the entire economy of France or Britain. But the amount spent and how it's used varies from state to state. And no two states are more different than Texas and Massachusetts. At 25 percent, Texas has the highest rate of uninsured people in the nation. Massachusetts, where a 2006 law made coverage mandatory, has the lowest rate — fewer than 2 percent of people are uninsured. Monday's All Things Considered takes a look at two Americans who are living the reality of that difference. In Texas, Melinda Maarouf, 55, is one of 6 million Texans without health coverage. In Massachusetts, Peter Brook, 51, is one of the 439,000 residents who now have coverage as a result of the state law. In Texas, Walking A Health Care 'Tightrope' For Texans, having health problems without health insurance often means an anxious scramble for care at overcrowded charity clinics or the local emergency room. Melinda Maarouf knows that experience all too well. She's a teacher's aide at the Faith Christian Academy, a private school just outside Houston. "Unfortunately, we're a small school and the budget doesn't allow for insurance for the employees," she says. Maarouf is divorced and has a daughter in college. The school where Maarouf works can't afford to bring her on full time right now, so she makes just over $11,000 a year. That income puts her right around the federal poverty line, and it makes for some hard health choices. Continue Reading She has high blood pressure and has skipped pills to make her prescriptions last longer. "I can always tell when the blood pressure's elevated," she says. "I feel uncomfortable. I feel edgy and kind of shaky, and my ears ring." Maarouf knows that if she doesn't keep her blood pressure under control, she could have a stroke, heart attack or kidney damage. She recently found help at a charity clinic where she pays only $25 per visit. Even so, Maarouf says the blood pressure is all she can afford to treat right now. "I haven't had a Pap smear — goodness, I couldn't even tell you — probably since my daughter was born, and she's 26," she says. "I haven't had a well-woman exam. And I'm sure it's time for some routine blood work." Maarouf has never had a mammogram and she's continued to push off some needed dental work — but medical bills scare her. In 2010, she went to the emergency room with chest pain. Doctors didn't find anything wrong, but she ended up with $3,000 in bills. Maarouf couldn't keep up with the payment plan, so she simply shoved the bills into the bottom of a drawer and swallowed her anxiety. "Oh, my credit's pretty much shot, as far as that goes. But there's not much I can do about it," she says. "You just have to move on, do what you have to do to survive." Like millions of other working Texans without minor children, Maarouf can't get Medicaid. And she's years away from Medicare. Hospitals in Texas spend over $4 billion a year treating uninsured patients like Maarouf. Some of the cost gets absorbed by county taxpayers and some gets shifted onto insured Texans, who pay higher premiums for their own coverage. Maarouf says she feels stuck and exposed. "It's like you're sort of walking a tightrope. I sometimes feel like I'm on the edge of a cliff. As long as everything is status quo and there's no glitches or bumps in the road, I feel OK," she says. "But I sometimes feel like I'm one emergency room visit away from a catastrophe." In Massachusetts, Uninsured Get Relief Five years before Massachusetts started offering free and subsidized coverage, Peter Brook couldn't afford health insurance or the daily insulin and needles he needs to treat his diabetes. Things have changed for Brook since the Massachusetts health care law, the same one that helped shape the federal Affordable Care Act. "When I didn't have health insurance, I'd use a needle for 30 days, like 150 shots or something, so it gets a little bit dull," says Brook, who does odd jobs like landscaping to cover his basic needs. When he had health complications related to his diabetes, he didn't have money for care. The worst was a digestion problem that would bring on crippling stomach pain. "I would tend to hole up in a fetal position at home, and then over the course of week or two, my skinny body would lose 25 to 30 pounds and then I'd end up looking like a death camp survivor," he says. And then there was the time Brook fractured a pinkie and set it by taping the broken section to his ring finger. The pinkie is still crooked, but today Brook has free health insurance and a regular doctor at the South Boston Community Health Center. His only expense is a $3.65 copay for prescriptions, which adds up to about $14 a month. "I now have good health care, so that is a weight off of my mind," he says. "It's been a year and half since I've been in a hospital, and for the first 50 years of my life I never went six months without an inpatient hospital stay for one thing or a
|
The new Medicare prescription drug plan is complex, confusing, and irrational, according to health policy expert Jonathan Oberlander. A month after the rollout of the new Medicare Prescription drug plan, many seniors are finding it difficult to get the drugs they need. Oberlander teaches about the politics of medicine at the University of North Carolina at Chapel Hill. A co-editor of The Social Medicine Reader, Volume III: Health Policy, Markets and Medicine (2005), he also wrote The Political Life of Medicare (2003).
|
eng_Latn
| 34,997 |
Health Care Co-Ops Explained
|
In the debate over possible changes to the nation's health care system, health co-ops — basically, nonprofit insurers run by people who have that insurance — have been on the back burner. But the concept is gaining some traction.
|
Randall Enos and Nate Beeler have differing diagnoses of health reform.
|
eng_Latn
| 34,998 |
Weekly Roundup: Thursday, June 21
|
Congress struggles to commit to immigration legislation, while the First Lady heads to the U.S.-Mexico border to visit children who have been separated from their parents. The Supreme Court reshapes how Americans shop online, and the United States withdraws from the United Nations Human Rights Council. This episode: political reporter Asma Khalid, Congressional correspondent Scott Detrow, White House reporter Ayesha Rascoe, political editor Domenico Montanaro, and State Department correspondent Michele Kelemen. Email the show at [email protected]. Find and support your local public radio station at npr.org/stations.
|
Here's a look at what you're reading today: Twitter pal @reneerico shares an article about the employment picture in California. The SF Chronicle reports that the state's underemployment rate hit 21.9 percent in September. That's a whole lot of people who can't find as much work as they need. Meantime, @kkemple is looking at the country's perception of stimulus spending. The Christian Science Monitor has a great graphic that shows how different community types (tractor country, emptying nests, boom towns, etc) feel about the government spending millions of dollars to get the economy moving again. @philipkeeton is deep in tax land with an article from Tax Vox about whether fining people for not getting health insurance could be considered a tax on the middle class. As for me, I'm digging into the archives over at the New York Times for articles about high Medicare costs in the 1970's. We'll have more on that on tomorrow's podcast. Share your own recommended reading in the comments below.
|
eng_Latn
| 34,999 |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.