Archive for January, 2012

Many In High Risk Pools Aren’t Protected From Lifetime Coverage Limits

Thanks to the health care overhaul, most people no longer have to worry about getting sick and running out of health insurance coverage. The law eliminated lifetime limits, which ran in many plans from $1 million to $2 million. Unfortunately, though, the change doesn’t apply to plans that enroll some of the sickest people: those who buy coverage in so-called high-risk insurance pools because they have medical problems that make them uninsurable in the private market.

People in the pools are left out because of a wrinkle in legal language. The law applies to health plans and health insurance issuers as defined by the Public Health Service Act, “but most of the risk pools aren’t licensed as an insurance issuer in their state, so from a regulatory standpoint we’re not equivalent to a commercial insurance product,” says Amie Goldman, chair of the National Association of State Comprehensive Health Insurance Plans, an educational organization for the high-risk pools.

Those affected include some of the 45,000 people who have enrolled in the new pre-existing condition insurance plans (PCIPs) established under the overhaul law and the more than 220,000 who are in the generally pricier, old high-risk pools who can’t join the new PCIPs because in order to qualify people have to be uninsured for six months.  It could be worse. Even though not required by law to eliminate such lifetime limits, some of the plans have opted against the caps anyway. That includes the PICPs run by the federal government in 23 states and the District of Columbia. (The other 27 states run their own PCIPs.)

And in some states, officials have moved to lift limits on occasion. That’s what happened in Kansas last year, where officials raised the lifetime limit in the state high-risk pool from $1 million to $3 million. Why? “We had people bumping up against the limit,” says Sandy Praeger, the state’s insurance commissioner.

Tuesday, January 31st, 2012

Nursing Homes Offer Plan To Help Cut Medicare Spending

Much attention has been focused on a House-Senate conference committee’s efforts to find ways to finance an extension of the current payroll tax break and to prevent a 27 percent cut in Medicare payments to physicians. But the nursing home industry is also facing some stiff funding reductions, and an industry trade group has come up with a proposal to help Congress cut Medicare spending while shielding nursing homes.

A proposal from the American Health Care Association, which represents skilled nursing facilities, has offered lawmakers a plan the group believes will help cut the readmission rate for nursing home patients to the hospital. That, the association says, would save Medicare money. Nursing homes would prefer their ideas over another money-saving provision in the payroll tax extension/Medicare “doc fix” legislation passed last year by the House. That bill would reduce Medicare’s reimbursement to cover “bad debt” incurred by skilled nursing facilities, hospitals and other providers from 70 percent to 55 percent by 2015.

The Senate did not adopt that House plan, but the issue is again before Congress as lawmakers seek to find a way to pay for the Medicare “doc fix” and the payroll tax holiday. A conference committee dealing with the issue has scheduled another session for Wednesday. For skilled nursing facilities in 19 states and the District of Columbia, the cut proposed by the House would be worse that the 2 percent Medicare provider cut called for in sequestration, a series of automatic cuts scheduled to begin in 2013, the association says.

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Tuesday, January 31st, 2012

Today’s Headlines – January 31, 2012

Tuesday is here. We have your headlines to get you through the morning:

Los Angeles Times: Democrats In Congress Step Up Tax-The-Rich Efforts
But after a year in which a tea-party-driven Republican Party proposed steep cuts to Medicare and other mainstays of the federal government, polls show that voters have reacted in part by taking a second look at the alternative: tapping corporations and non-earned income as a way to begin balancing the nation’s debt-ridden books (Mascaro, 1/30).

Politico: Paul Ryan Budget: Democrats Await New Proposal
Democrats are licking their chops over the idea of another Republican budget that attempts to dramatically reform the Medicare program. House Budget Committee Chairman Paul Ryan (R-Wis.) has indicated that his budget will address Medicare and could include the revised plan he crafted with Democratic Sen. Ron Wyden of Oregon. Under their plan, seniors would get “premium support” to help them buy private insurance coverage or traditional Medicare (Haberkorn, 1/30).

For more headlines … (more…)

Tuesday, January 31st, 2012

Dream Of A Medical ‘Price List’ Dies In Florida Legislature

Imagine if finding out the cost of a particular treatment or procedure at a doctors’ office was as easy as locating the prices of entrees at a restaurant. The menu might read: school physicals – $40; office visit for a cold – $80; diabetes screening – $200. But to the dismay of some consumer advocates, this push for health care pricing transparency never made it out of the kitchen.

While a Florida state House committee approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups.

Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices.

Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it.

“Next thing you know they’re going to say it has to be neon or include pictures,” he said.

(more…)

Monday, January 30th, 2012

Today’s Headlines – January 30, 2012

Good morning! Monday’s here, but don’t fret, here are your headlines:

Los Angeles Times: GOP Leaders Pledge Quick Action On Payroll Tax Break
House-Senate negotiators are expected to meet this week on extending the tax break, which amounts to about $20 a week for the average worker, as well as continuing unemployment benefits and preventing a pay cut for doctors who treat Medicare patients (Simon, 1/29).

The Washington Post’s The Fact Checker: Mitt Romney And Charges Of Medicare Fraud
Winning Our Future, a Super PAC supporting Republican presidential candidate Newt Gingrich, has released another attack on rival Mitt Romney’s business practices. A one-minute “trailer” and a 30-second TV ad that amplify the themes of corporate malfeasance accompany the nearly eight-minute video, “Blood Money.” (The title refers to the fact that a company once partly owned by Bain Capital, Romney’s firm, was found guilty of charging Medicare for unnecessary blood tests.) We were highly critical of Winning Our Future’s “King of Bain” film, awarding it Four Pinocchios, in part because it focused on business failures in which Romney was only tangentially involved (Kessler, 1/30).

For more headlines … (more…)

Monday, January 30th, 2012

‘Oy Vey’: Jewish Republicans In South Florida See Little To Like In Health Care Law

DELRAY BEACH, Fla. —  Waiting for Newt Gingrich to arrive at a Republican Jewish Coalition rally here late afternoon Friday, Connie Cestari, 80, said health care will be a top issue for her in November.

She said she’s voting Republican in part to make sure the 2010 health overhaul gets overturned, because it gives the government too big a role in health. “They are taking another freedom from you,” she said.

Cestari, of Boynton Beach, Fla., said she was not aware of benefits the law has already given her or other seniors — such as free preventive tests or the gradual closing of the doughnut hole gap for those with Medicare drug coverage.

Asked what she thought of the Republican plan to turn Medicare into a voucher program that would limit federal funding for the program, she said she wasn’t aware of it.

Cestari’s attitude toward the health overhaul reflects the findings of numerous polls about the law: Most people don’t know the law’s details, and many seniors think it will  hurt them.

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Sunday, January 29th, 2012

Bipartisan Report Highlights Gaps, Recommendations For Health IT

It’s been three years since Congress approved a nearly $30 billion plan to digitize health care records, yet much of the health care industry is still drowning in paper, a coalition of policymakers from the left and right said Friday.

The Bipartisan Policy Center released a 43-page report detailing the gaps in health IT implementation–the biggest concern being a delay in getting the various systems to be able to talk to one another.

Bill Frist (File photo by Bipartisan Policy Center)

“Health information is fundamental to all the new models of care,” said former Sen. Bill Frist (R-Tenn.), a heart surgeon and co-chair of the Bipartisan Policy Center, a nonprofit research organization in Washington. “Data has got to flow seamlessly throughout this system.” (Frist is a member of the Kaiser Family Foundation’s Board of Trustees. Kaiser Health News is an editorially independent program of the Foundation.)

The government initiative, passed as part of the 2009 financial stimulus package, gives doctors, hospitals and other providers funding incentives to switch to digital record systems.  That effort is also considered one of the key elements to overhauling the country’s health care system. Proponents say that electronic records will reduce medical errors and help cut costs by reducing duplicative tests and care. It can also provide enhanced population data to find out the most effective procedures.

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Friday, January 27th, 2012

Heavy Doctors Avoid Heavy Discussions

Research already demonstrates that physicians are sometimes uncomfortable talking about weight with their obese  patients.  Now, a new study shows that the doctors’ weight makes a difference too.

Physicians who pack on the pounds discuss weight loss less frequently with obese patients than doctors who have normal body-mass indexes (18 percent versus 30 percent), according to the report published this week in the medical journal Obesity.  And they’re significantly less confident of their ability to provide effective counseling about diet (37 percent vs. 53 percent) or exercise (38 percent vs. 56 percent).

The findings come from an Internet survey of 498 family doctors, internists and general practitioners conducted early last year by researchers at Johns Hopkins Bloomberg School of Public Health.  Two-thirds of the physicians were male, almost three-quarters were at least 40 years old and 53 percent were overweight or obese.

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Friday, January 27th, 2012

Today’s Headlines – January 27, 2012

Happy Friday! Here are your morning headlines:

Politico: Health Care Reform: House GOP Waits For Supreme Court
House Republicans have tried to repeal various pieces of President Barack Obama’s health reform law, but they haven’t touched the least popular piece: the individual mandate. One reason for that: They don’t want to give the Supreme Court a reason not to strike it down (Haberkorn, 1/26).

Los Angeles Times: Senate Blocks GOP Attempt To Deny Debt-Ceiling Increase
The nation’s debt limit held steady at about $5.9 trillion during 1990s, when the Clinton administration was balancing the budget. But it virtually doubled under President George W. Bush to $11.3 trillion after the federal government put the Iraq and Afghanistan wars as well as an expanded Medicare prescription drug benefit on the national credit card. Debt continued to rise after Obama took office, with increased government spending on the federal stimulus and a decline in tax revenues as the economy struggled to recoup from the recession (Mascaro, 1/26).

For more headlines … (more…)

Friday, January 27th, 2012

Health Law Is A Family Affair For CMS’ Tavenner

Marilyn Tavenner, the president’s nominee to head the Centers for Medicare and Medicaid Services, was already hoarse when she began her speech at the Care Innovation Summit in Washington D.C. today. However, that did not stop Tavenner, the agency’s acting administrator, from delivering a laundry list of the 2010 health law’s benefits and achievements, including a particularly personal one.

Tavenner, acting administrator of CMS, speaks at a Care Innovation Summit event Thursday. (Photo by Jessica Marcy/KHN)

An estimated 2.5 million young adults have gained coverage through the law’s under-26 provision, and “one of those happens to be my daughter,” a type-1 diabetic, Tavenner said. “I have personally benefited from this provision.”

Tavenner will likely make some of the same arguments for the law and CMS initiatives when – or if – she encounters a grilling at her yet-to-be scheduled Senate confirmation hearing. She took over the agency’s top job after previous chief Donald Berwick, a recess appointee whose nomination never went through the confirmation process, stepped down in December. Tavenner made a point to pause and give Berwick credit for his work at CMS. (more…)

Thursday, January 26th, 2012

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