Health insurance options limited after job loss

 John Mathson had been paying about $550 a month to continue his health insurance coverage after the 63-year-old Eureka man got laid off in October after 39 years at the Evergreen Pulp mill.

For Mathson, who is undergoing chemotherapy for non-Hodgkin lymphoma and had knee surgery in September, the news got worse last week. The mill, which shut down, informed him it could no longer afford to offer health or welfare programs to any employees or retirees as of Jan. 1.

<<Related story: At more U.S. employers, the doctor is in>>Two years short of Medicare eligibility and beset by health problems, Mathson’s options for health care are limited and expensive.

“There is insurance out there, but they’re like $1,000 a month and they don’t pay anything to speak of,” said Mathson, whose wife receives coverage through Medicare due to a disability. “You still have to come up with all this money out of your pocket. You’re basically left out there, high and dry.”

With the recession and the expectation that job losses will get worse next year, a growing number of American workers will find themselves not only out of a job, but without access to affordable health coverage. Already, about 46 million Americans have no health insurance.

Last month, U.S. employers slashed 533,000 jobs – the most in 34 years – as unemployment rose to a 15-year high of 6.7 percent. In California, the jobless rate rose to 8.4 percent in November, the third-highest in the country, with cuts in nonfarm payroll positions of 41,700, according to the state Employment Development Department.

Employers’ plans

About 60 percent of American workers are covered by health plans offered by their employers, according to the Kaiser Family Foundation. It’s difficult to determine how many people who lose their jobs will lose health insurance.

Those who are lucky enough to be married to someone who has job-based insurance probably can be added to their spouse’s group policy. Some people may be able to find another job quickly enough to avoid a gap in coverage. But for many, especially older workers or those with pre-existing medical conditions, the options are few.

“Even during good times, employers trimmed and scaled back their coverage. In these tough economic times, we have to be prepared for a dramatic drop in coverage when people are losing their jobs and thus their health insurance,” said Anthony Wright, executive director of Health Access California, a coalition of grassroots health care consumer groups.

To make matters worse, traditional safety-net options – public health programs, clinics and other sources of care that receive government funding – are being cut back or threatened by state and national budget crises. Health services face major cuts under proposals made to bridge California’s estimated $41.8 billion budget deficit in the next 18 months.

LiveLong Medical Center, a group of nine Bay Area health centers that offer care to the uninsured, saw a 25 percent increase in the numbers of patients from July until the end of October compared with the same period last year.

The nonprofit group’s development director, Lillian Samuel, said she can’t determine how much of the increase is due to the jump in unemployment, but she has heard about patients who started coming to the clinics after they lost their jobs.

“The number of uninsured patients knocking on our door is growing. That’s not something we budgeted for,” she said.

People who lose their jobs and have a medical condition that makes it difficult for them to find coverage may be able to continue their insurance through the Consolidated Omnibus Budget Reconciliation Act, a 1986 federal law known as COBRA that allows workers to pay to remain on their employer’s health policy.

Workers often experience sticker-shock when they see their COBRA premiums because they’re buying their employer’s benefits (up to 102 percent of the premium). Employers pay on average $4,704 a year for individual coverage and $12,680 for families, according to the latest survey by the Kaiser Family Foundation and Health Research & Educational Trust.

“The reason COBRA is so expensive is because group insurance is a completely different market than individual insurance,” said Phil Lebherz, founder and executive director of the nonprofit Foundation for Health Coverage Education in San Jose. “Group insurance really is something where they want to keep you as an employee. … They (employers) want to compete for employees and buy the best benefits they can afford.”

People often can buy cheaper health insurance as an individual. But unlike group policies, individuals are medically underwritten, so they can be denied coverage or charged more if they have pre-existing health conditions.

At 31, Jessica Palmer is young enough that she would seem to be a prime candidate for an individual health policy that’s cheaper than her former employer’s $400 monthly COBRA payment.

But the Emeryville resident, who was laid off Oct. 30 from her position as marketing coordinator for online art retailer Art.com Inc., has allergies. Her allergies, which are not life threatening but are controlled by injections and medications, mean Palmer will pay more or be rejected entirely.

People who are eligible for COBRA have 60 days from the time they are informed to make up their minds whether to take it, and Palmer is still trying to make up her mind. Until then, she is forgoing her shots and hoarding her drugs.

“I’m holding on to my last little inhaler, making sure I get every last puff,” Palmer said.

High deductibles

Individual policies often come with high deductibles, which can make the plan all but unusable for someone who can’t afford to pay $1,000 to $5,000 before coverage kicks in. Under those circumstances, such coverage acts to protect the policyholder from bankruptcy in the event of a catastrophic medical event.

That’s the problem for Karen Nichols, a user-interface designer who was also laid off from Art.com.

Nichols, 51, would like to be able to use her coverage if she needs to. She does not have access to insurance through her husband, who is self-employed and struggling in the mortgage business and has pre-existing medical conditions.

She’s not sure if she can afford the $860 COBRA payments on $1,800 in unemployment that is consumed mostly by rent. But she’s not sure she can afford to go without.

“It’s absolutely a crapshoot,” said Nichols, who lives in an unincorporated area near Hayward. “You’re betting whether you’ll stay healthy. But accidents come up that can throw you in the hospital and there you go. It can be a completely bankrupting event.”

People who have exhausted COBRA can buy insurance through another federal law called the Health Insurance Portability and Accountability Act. The law requires insurers to cover people who have used up their COBRA benefits, regardless of their health condition. Such policies are expensive and any lapse in coverage must be less than 62 days.

Also pricey is another last resort, the state high-risk pool known in California as the Major Risk Medical Insurance Program. Policies are generally 125 percent of average individual rates, and there is often a waiting list that can cause delays.

For Mathson and his wife, Joy, it’s a blow to their pride to realize they’re actually hoping they qualify for Medi-Cal, the state-federal program for the poor.

With the loss of John Mathson’s annual salary of nearly $70,000, the couple’s income has plummeted. The Mathsons, who have lived in their home since 1975, said they can no longer count on much from their 401(k) plan due to investment losses.

“With the market, we can’t even sell our house and start over,” said Joy Mathson, 61. “It doesn’t seem fair, but I guess Americans are having to get used to things not being fair.”

 

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What to do if you lose your insurance

– Consider all your options. Group coverage might be relatively easy to get if you’re married and your spouse has coverage. An individual policy might be an option, especially if you’re young and healthy.

– If you have pre-existing conditions, your options become fewer and more expensive. You could get coverage under COBRA, the federal law that requires employers with a minimum of 20 workers to extend coverage for at least 18 months, or as long as 36 months for dependents under special circumstances. While you can’t be turned down, it tends to be very expensive. And COBRA is not an option if your company went bust.

– Be creative. If you decide to work for yourself, consider joining forces with a partner or hiring an employee. It takes just two people to be eligible for group coverage.

– Don’t overlook public programs. Going from a double-income to single-income family may qualify you – or at least your kids – for certain programs. Look into such options as Healthy Families and California Healthy Kids. If you’re a veteran, you may be covered through the Veterans Administration. Workers who can prove their jobs went overseas also might qualify for a federal program.

– As a last resort, consider government-sponsored high-risk pools such as California’s Major Risk Medical Insurance Program. This is expensive and can involve a waiting period. For more information, go to www.mrmib.ca.gov.

– Other resources: coverageforall.org for general information; ehealthinsurance.com for insurance policies and prices; the U.S. Department of Labor at dol.gov and the Employee Benefit Research Institute ( www.erbri.org) for information on COBRA.

Source: Foundation for Health Coverage Education; Chronicle research.

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Doctor shortage imperils Obama’s health care reform

Spyros Andreopoulos

Sunday, December 21, 2008

There are plenty of surgeons and other medical specialists in America – more than enough, perhaps. And specialized institutionalized care of high quality is available for people who are seriously ill. But primary care – the continuing personal supervision of a family’s overall health, with emphasis on prevention and early treatment of illness – is sadly lacking for the urban poor, for most rural residents and for millions of middle-class people, too.

President-elect Barack Obama has promised to expand health insurance coverage for everybody. But fulfilling this promise will require enough doctors on the firing line – internists, family doctors, pediatricians, gerontologists and others – to treat the additional people covered. Primary care is a part of the total healthcare system, and the Obama administration must craft a national health manpower policy to provide resources and reverse primary care’s decline.

Studies show that the number of medical students choosing training in internal medicine, family medicine and geriatrics is down, and many physicians now in practice are leaving the field. Reasons cited include long working hours, the complexity of dealing with chronically ill patients, paperwork, insurance issues and reduced reimbursement by insurers and Medicare.

A total of 56 million Americans – roughly 1 in 5 – lack adequate primary care coverage because of a shortage of physicians in their communities, according to the National Association of Community Health Centers. When large numbers of people cannot get basic preventive care or early treatment for conditions before they become serious, costs go up, and everybody ends up paying higher insurance premiums and suffering reduced access to care.

Conservative estimates by the University of Missouri and the federal Health Resources and Services Administration suggest that Obama’s health plan will increase the workload of existing primary care physicians by 29 percent between now and the next 15 years. By the same period, the supply of primary care physicians will rise by only 7 percent, leading to a shortfall of 35,000 to 44,000 primary care physicians who treat adults. Overall population growth and a growing elderly population are driving the projected shortfall.

Increasing the number of medical school graduates is one obvious solution. Expanding existing residency training programs in internal medicine and other primary care specialties is another, but any change would be painful and require major shifts in training priorities of medical schools, curricular reform, legislative relief from early student loan payment, and fixing the way doctors are paid across specialties.

Primary care doctors spend more time talking to patients to help them cope with ailments that are chronic and incurable than they spend performing tests and procedures. But talking to patients is not compensated under our perverse reimbursement arrangements that reward specialists who perform procedures.

The Medical Group Management Association, which conducts surveys of physician compensation, found that for primary care, the median pretax income increased by 21.4 percent from 1995 to 2004 compared with a 37.5 percent increase for other specialties. Fifty percent of family doctors made below $156,000 in 2004, while half of all radiologists earned above $407,000 that year.

The complexity of making the needs of patients compatible with the needs of health care institutions, and producing primary care services is almost overwhelming, but an essential part of healthcare reform. To use an architectural analogy, primary care is considered the keystone of the arch of personal health care. Without it, the system has no stability. The other components of the arch cannot serve their functions effectively, and the personal health care system will remain distorted, costing too much, delivering too little, satisfying too few.

Correcting the imbalance between the primary care practitioner and the specialist should be a top priority.

Spyros Andreopoulos is director emeritus in the Office of Communication, and Public Affairs at Stanford Medical Center. He is the editor and contributor to the 1975 book “Primary Care: Where Medicine Fails.” The article represents his opinion

Source: sfgate.com

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Medicaid applicants grow as recession widens

By KEVIN FREKING – 2 days ago

WASHINGTON (AP) — That day in July was one that Tammy Morse won’t soon forget. Five months earlier, her husband lost his job as a recruiter for the financial services industry. Once the family savings were gone, the mother of two from Stratford, Conn., saw no way to get health insurance coverage for her family other than to apply for Medicaid.

“It was humbling,” she said of her visit to the state’s Department of Social Services office. “For lack of a better way to put it, that was for other people. It wasn’t for me.”

Around the country, similar stories are playing out for thousands of families.

Since the recession began a year ago, many states have seen increases in the Medicaid rolls just as tax revenues are falling below projections. Governors have lobbied President-elect Barack Obama and Congress to help them weather the downturn by increasing the federal government’s share of Medicaid spending for at least two years.

The governors said the extra $40 billion would ease the service cuts or tax increases that legislatures need to balance state budgets.

The unemployment rate has jumped from about 4.7 percent last December, when the recession began, to 6.7 percent today. Economists estimated in a Kaiser Family Foundation report that each 1 percent gain in the unemployment rate adds 1 million people to the Medicaid and State Children’s Health Insurance Program.

In Connecticut, a state faring better than many, enrollment in the Medicaid program has climbed from about 312,000 last December to about 329,500 in November — a 6 percent increase. Many who lost their jobs were eligible to continue group health insurance. But that is not an option in most cases because they no longer have an employer picking up a large share of their premiums.

Medicaid insures nearly one in six low-income people in the U.S. The program typically covers the very poor and about half of enrollees are children. Spending came to $333 billion in the budget year ending Sept. 30, 2007. Washington picks up about 57 percent of that; the states cover the remainder

Source: associtaedpress.com

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Insurance Pact rules tightened

Cost-cutting, patient protections added

By Kay Lazar, Globe Staff  |  December 20, 2008

New contracts for health insurance companies that provide state-subsidized coverage to thousands of Massachusetts’ working poor will include aggressive incentives for cost-cutting, but will also contain new provisions to protect patients, under an agreement reached yesterday by state regulators.

The Connector Authority Board approved the guidelines for contracts with the managed care companies that will insure the 162,000 residents covered by Commonwealth Care.

The insurance is for people who don’t qualify for health coverage at work and earn too much to qualify for Medicaid.

The new contracts will be sent out for bid in January and go into effect July 1.

Under the new rules, companies will be limited to a 2 percent increase over what was paid to carriers this fiscal year. That is substantially less than the 8 or 9 percent increases in the private sector.

But companies that bid lower than the going rate will be rewarded by receiving more customers. Under the new state rules, the lowest bidders will automatically get to pick up people who drop coverage, wait more than three months to reenroll, and do not then select a plan when they reenter.

The automatic assignment will apply only to the lowest-income patients of Commonwealth Care, the roughly 84,600 people who receive totally subsidized care.

Previously, some board members said they worried that the new process would mean many Commonwealth Care patients would end up in health plans that didn’t include their regular doctors, creating upheaval for consumers who already are struggling with financial and other issues. But the new guidelines include protections that prohibit bouncing a patient to a cheaper plan if that plan does not include the patient’s regular doctors. Patients with serious, chronic illnesses would also be protected from this auto-enrollment provision.

“This is an aggressive plan, but we think it’s reasonable,” said Jon Kingsdale, executive director of the Health Connector.

Companies would also receive incentive payments of $2 a month for each patient who receives a comprehensive annual physical, if the company improves the rate of those physicals by at least 5 percentage points. A similar $1 monthly incentive is added for the companies to report on a quarterly basis how their patients are using emergency rooms.

Some recent surveys have indicated that patients, including those covered by Commonwealth Care, continue to use emergency rooms for routine care, which is expensive and drives up overall health costs.

 

Source bostonglobe.com

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New Report Highlights the Need for Public Health Insurance Plan Option

December 19, 2008

by Astrid Fiano, Writer

House Ways and Means Health Subcommittee Chairman Rep. Peter Stark (D-CA), health care expert and U.C. Berkeley professor Jacob Hacker and Institute for America’s Future co-director Roger Hickey held a press teleconference, which DOTmed attended, in order to announce the release of a policy brief on public insurance options as a critical element of President-elect Obama’s health care reforms. The new brief is entitled “The Case for Public Plan Choice in National Health Reform,” and is authored by Hacker. The Report was published jointly by the Institute (a non-partisan research and education organization) and the Center on Health, Economic and Family Security from the U.C. Berkeley Law School.

According to the Institute, the insurance industry is opposing key elements of reform embraced by President-elect Obama, Obama’s health care point person Tom Daschle and Senate Finance Committee chairman Sen. Max Baucus (D-MT). However, the Institute says, the new brief shows that “a public insurance option is crucial to controlling health care costs and achieving quality coverage.”

During the teleconference, Prof. Hacker explained that a core and controversial part of President-Elect Obama’s proposed health care reform is to offer a public insurance option to Americans who lack employment-based coverage. The option would be similar to conventional Medicare, managed by the Government, and paying private providers for the care. The proposed public plan would be offered through a national insurance exchange, competing with private plans “on a level playing field.” Prof. Hacker said the new policy brief being released sets out an argument for a public plan choice–that public and private insurance have distinct strengths and should be able to compete with each other so that public insurance can serve as a benchmark for private insurance, and private insurance can remedy some of the weaknesses of public insurance. According to Prof. Hacker, the plan is a hybrid approach, building upon the best elements of the present systems, while putting in place new means by which those without access to secure workplace insurance can choose among plans for affordable coverage. For those without workplace coverage, Hacker emphasized, any menu of options must include a public plan to achieve the broad goals of health care reform, namely universal insurance and improved quality.

Three-Point Plan

Prof. Hacker then briefly explained the three points of the plan discussed in the brief: cost containment, quality improvement and value. Rep. Stark then commented that the primary reason for a safety net program was to ensure care for the approximately 47 million persons who can’t afford insurance and medical care, and don’t qualify for Medicare.

In response to reporters’ questions, Rep. Stark said that any plan without a public plan option would not be supported by him, as he did not see any viable alternative. Rep. Stark also refuted the idea that Medicare was currently underpaying health care providers. Rep. Stark said that the timetable for voting on a plan would take at least a year, likely to be early 2010.

To an inquiry on how, if the government was creating the rules of the public plan, it would ensure fairness in the playing field, Prof. Hacker responded that an important element in the public plan would be that the Medicare would not be in charge of managing the plans, but run a higher-level administrative body, which would administer enrollment and competition between the public and private plans.

Parity Issues a Continuing Concern

Following the teleconference, Prof. Hacker further commented to DOTmed News on two inquires. Asked if a public plan option would address issues that might otherwise escape oversight in regulation, such as gender and racial/ethnic inequities in accessing care, treatment and prevention, and also lack of coverage for mental health treatment, Prof. Hacker responded: “I believe so. First, I would argue for true parity in mental health treatment in the public plan (a feature of my 2007 proposal: http://www.sharedprosperity.org/topics-health-care.html). Second, the evidence is clear that public insurance provides broader access, especially to more vulnerable patients. Elderly Americans with Medicare report, for example, that they have greater access to physicians for routine care and in cases of injury or illness than do the privately insured. They are also half as likely as non-elderly Americans with employment-based insurance to report common access problems, such as skipping a medical test, treatment, or follow up, and failing to see a doctor when sick. Third, the public plan, working with Medicare and private plans, could spearhead the testing and evaluation of potential delivery-system and payment reform; the collection, reporting, and use of ongoing performance data; and the streamlining of paperwork and administration in ways that would not be possible without a core role for public insurance for non-elderly Americans. I see addressing the broader disparities in care as central to this mission.”

Long-Term Care: The Next Great Challenge

Prof. Hacker was also asked if in the future, the proposed plan could be built upon to extend to disability or long-term care insurance, a major concern for those of low-income. Prof. Hacker responded, “This, to me, is the next great challenge we face in health care. Medicaid simply cannot be the way in which we handle long-term care, and private insurance is ill suited to deal with protection for long-term health costs. Commercial insurance works well to protect people against risks, such as car accidents, that vary among individuals but average out across a large population. As Harvard economist David Cutler has explained, long-term healthcare is different: It is almost impossible to predict how costly the care will be in 2040. Insurers face equally serious uncertainties about how much they must put aside to pay future bills. Because the private [long-term care] market doesn’t work well, efforts to reduce Medicaid spending by shifting the burden onto private markets won’t work well either. Tightening Medicaid rules might reduce public spending slightly. It won’t eliminate underlying costs. It certainly won’t distribute the burdens with greater dignity or fairness. The alternative is as obvious as it is difficult: The federal government should pay for long-term care through Medicare and the new public plan I propose, openly, for every American. That would staunch the fiscal bleeding that forces states to cut important services. It would also protect everyone from one of life’s most frightening risks. But this is an agenda for the future.”

Regarding healthcare legislation, Stark said that it may have to wait till 2010, due to other pressing priorities for the incoming administration and legislators.

The report may be accessed at: institute.ourfuture.org/hacker

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CBO Reports Analyze Major Health Insurance Proposals’ Potential Effects on Federal Budget, the Uninsured, Costs

CBO Reports Analyze Major Health Insurance Proposals’ Potential Effects on Federal Budget, the Uninsured, Costs

      Two new reports from the Congressional Budget Office outline “more than a few fiscal challenges for lawmakers hoping to write legislation” to overhaul the U.S. health care system, CQ Today reports. According to CBO, “serious concerns exist about the efficiency of the health care system, but no simple solutions are available to reduce the level or control the growth of health care costs” (Armstrong, CQ Today, 12/18). The report indicates that the number of uninsured will rise to about 54 million in 2019 if no changes are made to the current system (Marcus, Bloomberg/Philadelphia Inquirer, 12/19).

For the reports, CBO analyzed 115 health care proposals and provided cost and savings estimates for each (Edney, CongressDaily, 12/18). CBO did not “endorse any options, but it fleshed out many ideas circulating on Capitol Hill,” the New York Times reports (Pear, New York Times, 12/19). One report examined the most important issues in the analysis of major health care proposals, and the other examined the budget implications of various proposals (Armstrong, CQ Today, 12/18). Many health care proposals that President-elect Barack Obama and congressional Democrats have proposed, CBO found, “would carry a high price tag and would generate only modest savings,” the Times reports (New York Times, 12/19).

Medicare, Medicaid Proposals
According to CBO, a proposal that would allow U.S. residents ages 62 to 64 to pay to participate in Medicare could reduce the number of uninsured residents by 80,000 and decrease costs by $1.2 billion over 10 years. A proposal that would increase the eligibility age for Medicare to 67 could reduce costs by $85.6 billion over 10 years, CBO found (CQ Today, 12/18).

In addition, according to CBO, a proposal that would require physicians and hospitals to adopt electronic health records and other health care information technology to participate in Medicare could reduce costs by $7 billion in the first five years and by a total of $34 billion over 10 years. The proposal “would also lower health insurance premiums in the private sector,” CBO found.

A proposal that would provide physicians who meet certain performance measures with bonuses though Medicare could reduce the “volume and intensity of services provided to their patients” and decrease costs by $5 billion over 10 years, according to CBO. CBO also found that reversing scheduled reductions in Medicare reimbursements to physicians and freezing payments at 2009 levels would cost the federal government $318 billion over 10 years.

A proposal that would allow the federal government to negotiate directly with pharmaceutical companies on prices for medications under the Medicare prescription drug benefit “would produce small if any savings,” CBO found. According to CBO, a proposal that would require pharmaceutical companies to provide the federal government with a 15% rebate or discount on brand-name medication covered under the Medicare prescription drug benefit could reduce costs by $110 billion over 10 years. A proposal that would close the “doughnut hole” coverage gap in the Medicare prescription drug benefit would cost more than $130 billion over 10 years, according to CBO (New York Times, 12/19).

In addition, according to CBO, a proposal that would allow residents in families with annual incomes of as much as 300% of the federal poverty level to pay to participate in Medicaid would reduce the number of uninsured residents by 1.1 million and decrease costs by $7.8 billion over 10 years (CQ Today, 12/18).

The cost of Medicare and Medicaid will double from 2009 to 2019 and reach $1.4 trillion without changes to the program, according to the report (Appleby, USA Today, 12/19).

Other Proposals
A proposal that would require employers to offer health insurance to employees or pay a fee to the federal government would raise $47 billion in additional revenue over 10 years, CBO found. The federal government could use the additional revenue to offset the cost of a national high-risk health insurance pool, which would cost $16 billion over 10 years, according to CBO (New York Times, 12/19).

A proposal that would reduce the income and payroll tax exemptions for health benefits would raise $452 billion in additional revenue over 10 years, according to CBO. According to CBO, in the event that the federal government replaced the tax exemptions with tax deductions or subsidies to purchase health insurance, the proposal would raise $552 billion and $606 billion in additional revenue, respectively, over 10 years (CongressDaily, 12/18).

According to CBO, research to determine the cost-effectiveness of medications could reduce costs by $1.3 billion over the next 10 years and decrease total spending on health care by less than one-tenth of 1%. The establishment of a process for FDA approval of generic versions of biotechnology medications could reduce costs by $12 billion over 10 years, CBO found (New York Times, 12/19). A proposal that would increase the federal cigarette tax by $1 per pack could raise $95 billion in additional revenue over 10 years, and a plan that would impose a tax of three cents on each 12-ounce can of nondiet beverages could raise $50 billion in additional revenue, according to CBO (USA Today, 12/19

Source: kasier.org

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Health insurance group spent $1.6M lobbying in 3Q

WASHINGTON – America’s Health Insurance Plans spent more than $1.6 million lobbying on a host of pharmaceutical, insurance and tax-related issues during the third quarter, according to a recent disclosure form.

The health insurers’ trade group lobbied on the Medicare Advantage program, Medicare prescription drug price negotiations, health insurance reforms in the individual market and tax issues related to health savings accounts.

The group also lobbied on eligibility and outreach issues tied to the State Children’s Health Insurance Program, which provides coverage to poor children. It supports standard eligibility for both that program and Medicaid in all states, and it also supports expanded eligibility for children under the SCHIP program.

Besides Congress, the trade group lobbied the White House, Centers for Medicaid and Medicare Services, Department of Health and Human Services, the Drug Enforcement Administration and others, according to the form filed Oct. 20 with the House clerk’s office.

The association has more than 1,300 members, including large managed care companies like WellPoint Inc., UnitedHealth Group Inc., Humana Inc. and Aetna Inc.

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Source: http://www.msnbc.msn.com/id/28279328/

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Families May Get Insurance for Kids

Families may get insurance for kids

By SUNITA VIJAYAN
The Salinas Californian

First 5 Monterey County is considering a pledge of nearly $430,000 to help the state extend healthcare coverage to local children.

The local news comes on the heels of a decision announced Wednesday by First 5 California to provide $16.7 million to the Managed Risk Medical Insurance Board, which administers the state’s Healthy Families program. That funding would provide continued health care coverage for more than 65,000 children up to age 5 while the state works through its fiscal predicament.

Locally, Francine Rodd, executive director of First 5 Monterey County, said they have not yet pledged any funds because they are awaiting their commissioners’ direction, who are expected to vote on the pledge at a Jan. 26 meeting in Salinas.

First 5 California came from the voter-passed Proposition 10 in November 1998, which added a 50-cent per pack tax on cigarette sales to fund community health programs intended to better the lives of children from birth to age 5, and their families.

Should the local commission approve the pledge, Rodd said, about 1,700 children would receive health care coverage during a six-month period ending June 30. About 275 children a month would be enrolled in the plan.

Rodd said the local First 5’s participation in the program is purely monetary; the state will run the operation, processing and selecting eligible applicants. She said children whose parents have lost

health coverage due to job loss or reduced income would be the target group.

“Because of the economic situation, there is an increased need for health insurance,” Rodd said. “We’re anticipating that if they have to start waiting lists, it would mean people would not receive insurance coverage. It’s one less thing to have to worry about as we recover from the financial crisis.”

Rodd said local contributions, if any, to the state’s children’s health program is dependent on the commissioners’ vote.

Statewide, First 5 California said 46 local commissions have agreed to take up the request.

“Providing funding is consistent with our vision that families are healthy and stable, and live in communities that respect children,” Rodd said.

Source: thecalifornian.com

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Health insurance group spent $1.6M lobbying in 3Q

Health insurance group spent $1.6M lobbying in 3Q
Wednesday December 17, 11:43 am ET

Health insurance group spent over $1.6 million lobbying federal government in third quarter

 

WASHINGTON (AP) — America’s Health Insurance Plans spent more than $1.6 million lobbying on a host of pharmaceutical, insurance and tax-related issues during the third quarter, according to a recent disclosure form.The health insurers’ trade group lobbied on the Medicare Advantage program, Medicare prescription drug price negotiations, health insurance reforms in the individual market and tax issues related to health savings accounts.

The group also lobbied on eligibility and outreach issues tied to the State Children’s Health Insurance Program, which provides coverage to poor children. It supports standard eligibility for both that program and Medicaid in all states, and it also supports expanded eligibility for children under the SCHIP program.

Besides Congress, the trade group lobbied the White House, Centers for Medicaid and Medicare Services, Department of Health and Human Services, the Drug Enforcement Administration and others, according to the form filed Oct. 20 with the House clerk’s office.

The association has more than 1,300 members, including large managed care companies like WellPoint Inc., UnitedHealth Group Inc., Humana Inc. and Aetna Inc.

Source: http://biz.yahoo.com/ap/081217/health_insurers_lobbying.html?.v=1&printer=1

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Recession hitting local hospitals

Jacksonville Business Journal

A growing population of uninsured and underinsured heading to the emergency room with little or no ability to pay for their care is one of several alarming trends that health care officials say will make 2009 a challenging year.

It was top-of-mind among six executives from Jacksonville’s health care facilities, who discussed on Tuesday some of the headwinds they face as part of a Cornerstone luncheon at the Hyatt Regency. More than 600 area business leaders attended the Jacksonville Regional Chamber of Commerce industry-focused CEO summit.

The health care industry has a direct economic impact of $7 billion in Jacksonville, and a $21.7 billion direct impact in Northeast Florida including its related industries, according to the Center for Global Health and Medical Diplomacy at the University of North Florida. It also employs one in six Jacksonville residents, and is the fastest-growing segment of employment in the region.

But it is not insulated from the woes affecting the broader economy, as Hugh Greene, chief executive of Baptist Health, pointed out.

Throughout 2008, businesses with health coverage for their employees began chipping away at coverage and increasing deductibles to offset rising operating costs and a lagging economy. More employers dropped health insurance plans as the year progressed before eliminating jobs, too.

Douglas Baer, chief executive of Brooks Health System, said the deterioration of employer-based health insurance coverage is widening the gap between patients who can afford to pay for their care and those who can’t.

It has created a two-tier health care system — one level for those who have income and insurance to pay for health care services, another for those who don’t and access the emergency room as their primary care, said James Burkhart, president and administrator of Shands Jacksonville.

Burkhart said Shands has already seen a double-digit increase in self-pay and charity cases this year.

Shands in October announced plans to close its Gainesville hospital, Shands AGH, next fall in an effort to cut $65 million from the system’s budget. The family of eight hospitals anticipated budgetary shortfalls in the coming years, which is a likely scenario at hospitals across the country.

James Wood, chief executive of Memorial Health, said there were 200 more people accessing care at the emergency room in November than last year. Wood said he anticipates the trend will accelerate.

Memorial already sees a majority of patients — 63 percent — whose care is paid through Medicare or Medicaid, and another 5 percent completely unable to afford care. That leaves just under a third of patients who are covered by private insurance.

People who can afford health care are in some cases choosing to wait. Nationwide, 30 percent of hospitals are reporting a moderate to significant decline in patients seeking elective procedures, and nearly 40 percent say admissions overall have dropped, according to a November report from the American Hospital Association.

Meanwhile, nearly 100,000 more people enrolled in Medicaid this year than health officials expected, adding pressure to hospitals already shortchanged by low reimbursements through the government aid programs.

“We’re finding ourselves in a position of having to add beds when the number of people able to pay for those beds is declining,” Wood said.

And funding those projects may become more troublesome, as access to credit remains tight. Hospitals saw interest payments on borrowed funds increase by an average of 15 percent from July to September compared to the same year-ago period, according to the American Hospital Association.

The pressures have already had a significant impact on the bottom line. The American Hospital Association reported that hospitals have seen a margin decline to negative 1.6 percent in the third quarter compared to a positive 6.1 percent during the same prior-year period.

As a result, many hospitals are reconsidering or postponing investments in facilities or equipment, cutting administrative costs, and reducing staff.

“We need to be fiscally prudent to get through this time,” said Greene.

Source: www.bizjournals.com

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