The Dawn of a New Day - 5 BIG wins in the Health Care reform Act

1. Health insurance companies will not be able to discriminate against you because you have a pre-existing condition.

The problem has been that millions of adults and children have been denied insurance specifically because they have a medical condition. The Kaiser Family Foundation says that 21 percent of people who apply for health insurance on their own get turned down, or charged a higher price or offered a plan that does not cover their pre-existing condition. This will stop!

2. Young adults will be able to keep their parents' insurance until age 26.

The health care reform legislation requires insurance companies to allow dependent children to stay on their parents' insurance policies until age 26. The children can't have jobs that offer insurance, and they must be claimed as dependents on their parents' taxes.

Currently dependents get booted off Mom and Dad's health insurance much earlier than this, depending on the state they live in, sometimes as early as age 19. This will stop!

3. You will be eligible for a subsidy to buy insurance if you make less than $88,000 per year for a family of four.

Starting in 2014, the health care reform bill provides subsidies for people who don't get insurance from their employers and therefore have to buy it on their own. The amount of the subsidy will computed based on your income, whether you're single or have a family, your age, and where you live. For example:

• A 40-year old making $30,000 a year in a medium-cost area of the country will get an $850 subsidy toward buying a policy, which should cost about $3,500, according to a Kaiser Family Foundation subsidy calculator.

• A 40-year-old in the same city who has a family of four and is making $60,000 will get a $4,220 subsidy toward a policy that costs $9,435.

You can estimate your own subsidy by using this Kaiser subsidy calculator.

4. If your employer does not offer insurance, that might change!

Starting in 2014, if your company employs more than 50 people, it will be required to offer you a health plan that covers at least 60 percent of your overall health costs, or the company will be fined $750 per year per full-time worker. That fine could increase to $2,000 if the reconciliation act passes.

5. Health care reform has major benefits for senior citizens!

The AARP reports that health care legislation does important things for seniors:

• It gives people on Medicare new access to free preventive services such as screenings for cancer and diabetes.
  
• It will decrease and then, by 2020 it will close the "doughnut hole," Part-D drug payment gap where Medicare stops paying once a senior has spent more than $2,830 on prescription drugs and resumes when the individual's out-of-pocket spending has reached about $4,550.
• Spending for Medicare beneficiaries is budgeted to increase 2 percent each year.

Surprise! People favor passage of health reform

A telephone survey of 1,005 adults was conducted by the Gallup organization on March 22, the day after Congress enacted health reform legislation. The margin error is 4 percentage points. The results show that "More Americans call Congress' passage of a healthcare reform bill "a good thing" (49%) than call it "a bad thing" (40%). Reaction is predictably partisan, with independents evenly divided.

In my opinion, when folks really get to understand how this bill will interrupt our endless cycle of cost increase and non coverage, that support will continue to increase!

Gallup concludes, "Passage of healthcare reform was a clear political victory for President Obama and his allies in Congress. While it also pleases most of his Democratic base nationwide, it is met with greater ambivalence among independents and with considerable antipathy among Republicans. Whether these groups' views on the issue harden or soften in the coming months could be crucial to how healthcare reform factors into this year's midterm elections. Given that initial public reaction to Sunday's vote is more positive than recent public opinion about passing a healthcare reform bill, it appears some softening has already occurred."

On the first day that health reform becomes law

The United States House of Representatives is poised to take an historic vote today on whether or not to implement health care reform. You will often hear opponents say that the bill does "not take effect" until 2014, but actually, there are many improvements that will occur right away. This is a good time to reflect on what this vote could mean for all of us.

On the first day that health reform becomes law:

· Annual caps on coverage will be eliminated
· Rescisions - the practice of dumping people even if they have paid their premiums – will be eliminated
· Pre-existing conditions for children will be eliminated, followed later by the elimination of all pre-existing conditions
· Parents will be allowed to have their children on their health insurance policy until age 26
· The "Donut Hole" Medicare Part D drug coverage gap will be decreased with a $250 rebate

In short, in addition to expanding coverage, reducing the deficit and helping to decrease costs, there is a lot other immediate benefits to like in this new bill. We need to encourage our representatives not to blink, and to take this momentous step for all of our citizens.

Guess which country in the graph below has the worst health care statistics

You will often here the opponents of health care reform say that costs are increasing all over the world, and not just here at home. As the graph above makes clear, the costs of US health care are rising much faster than anywhere on the planet. In 2009, health insurance companies made their largest profits in history, and still dealt out staggering premium increases. And after all of this. some people are still scared of some government regulation? We are a nation of suckers!

We can do this

The US Center for Medicare and Medicaid Services has just reported that U.S. health spending reached $2.5 trillion in 2009, and that health care's share of the economy grew 1.1 percentage points to 17.3 percent. This is the largest one-year increase in health care spending since the federal government began keeping track in 1960. Where I work, our insurance asked for a 35% rate increase to maintain our employee coverage for one more year. The same thing happened to my wife's family business this year. This experience has been repeated all over the country.

These findings underscore the fact that we are all experiencing an unprecedented "Tax" on the cost of our health care, except instead of coming from the government, it is being imposed by the insurance industry, who simply pass along their cost of paying for our dysfunctional system, while they also charge us for lobbying our Congressional representatives to stop needed reform. This is sick.

It is time to become outraged! The need for comprehensive health care reform to rein in unsustainable spending growth has never been more clear. The increasing burden on American families, businesses, and our state and local governments cannot be sustained.

What can we do now? Is there anything that might attract bipartisan support? Assuming that the minority party is willing to also work on this, I think that implementing a few modest steps now would help tremendously:

• Require that all be covered, with subsidy for the poor, and real penalties for those who opt out.
• Eliminate pre-existing conditions and have true community rating.
• Establish an online health plan marketplace in each state where plans can compete on benefits, service and price. Allow national plans to compete, but do not eliminate local plans.
• Monitor quality results by plan, and publish the results for all to consider when purchasing.
• Allow everyone to have an income tax deduction for their plan costs (not just employer plans) up to a certain annual cost.
• Enact reasonable tort reform legislation that actually directs most of the money to those who are injured.
• Require payment reform for care delivery, that incentivises provision of primary care, and encourages doctors and hospitals to provide the best care (not the most expensive), and are aware of and held accountable for their quality of care results.

We can do this, but only if our law makers work together and stop playing gotcha like middle school students. Actually, I apologize to the middle school students. They would do a better job.

"We have met the enemy, and he is us!", Pogo

The US House and the Senate have both passed health care reform bills, and it is now up to the Conference Committee to craft a compromise bill that must then be passed by each legislative body. If a bill is ultimately signed into law by President Obama, we are likely to hear years of arguments as to whether or not this bill is a good or bad thing for our nation.

What likely will not be debated, however, is our corrupt and sclerotic political system that has produced these bills. Instead of honest debate, and collaboration about how to solve a problem, we have been treated to our representatives cynically selling their votes for this bill in order to to "buy votes back home" from local voters who continue to fall for this kind of nonsense. Want examples? Here are just a few:

Senator Ben Nelson, D-Neb., has insisted that the federal government promise to pick up the full cost of Medicaid expansion in his state, costing about $100 million over 10 years, paid for by the residents of other states. In addition, he insisted that a private, physician-owned hospital being built in Bellevue, Neb., be able to get referrals from doctors who own it, which according to new regulations will be illegal throughout the rest of the country.

Senator Christoper Dodd, D-Conn., procured $100 million dollars for construction of a hospital at a public university in his state.

Senator Patrick Leahy, D-Vt., negotiated $600 million in additional Medicaid benefits for his state over 10 years. Massachusetts is getting $500 million in Medicaid help for similar reasons, all paid for by those of us in other states.

Senator Mary Landrieu, D-La., extracted an extra $300 million in special funds for a new "Louisiana Purchase."

Senator Joe Lieberman, I-Conn.,along with most Republicans, has just taken the insurance money and tried to stop everything those lobbyists do not want.

Longshoremen union supporters of Democrats were exempted from most of a new tax on high-value health insurance plans, as were electrical linemen, police officers, firefighters, emergency first responders and workers in construction, mining, forestry, fishing and certain agriculture jobs.

As citizens can vote these people out of office any time we want, and yet we do not. We can insist on ethical behavior, but we do not. Yes, these bills are a complicated mess in many ways, although probably the best that we can do for now.

The problem is us. When we continue to re-elect corrupt, cynical politicians, who buy our votes with our own money, we get exactly what we deserve. So far, they have not been able to underestimate us.

All I want for Christmas!

The Cost of Dying, 60 Minutes, November 22, 2009

60 Minutes presented an outstanding program that tells the story in human terms about how our country manages to waste so much money while not properly caring for those we love at the end of life. If you missed the program, take 14 minutes of your time to watch this outstanding piece of excellent TV journalism.

The Cost of Dying, CBS TV 60 Minutes, November 22, 2009

Two News Stories that Help to Make It Clear Why We Need Comprehensive Health Care Reform

Big insurers spend much less on medical care than previously reported

Dow Jones Newswire reports that a US Senate Commerce Committee investigation found that the six largest US health insurers spent less on medical care than what industry officials estimated. Of the total amount received in premiums by the companies in the individual insurance market, 74 cents of every dollar were spent on medical care, according to a review of publicly available of data on industry earnings. Meanwhile, America's Health Insurance Plans estimated that the industry spent an average of 87 cents of every premium dollar on medical care. Click Here for Complete Story

HMOs planning large 2010 premium increases despite strong 3Q earnings.

Forbes Magazine notes that although "most of the major managed-care companies" have announced strong 3Q results, the message "during this earnings season is that HMOs are focused on rebuilding margins, even if it makes insurance even less affordable." Goldman Sachs analyst Matthew Borsch "calls it 'the highest pricing trend in years.' The premium increases he's seeing are in the neighborhood of 13 to 15 percent for next year." Analysts say HMOs are concentrating on making up for operating profit margins, which "reached zero last year for the industry as whole." Moreover, the companies not only want recompense for the "higher costs" they incurred this year from COBRA, they must "cover rising ordinary medical costs that show no signs of slowing down." Barclays analyst Joshua Raskin predicts overall health spending in 2010 will "climb 9 percent."

Click here for the complete story

The bill is HR 3962, the Affordable Health Care for America Act

The Whatcom Alliance for Health Care Access is a long time community health care study group that I participate in, which is dedicated to improving access and quality of care in Whatcom County, Washington. It is composed of citizens from all walks of life and segments of society. On November 2, 2009, they reviewed HR 3962 and released their findings. What follows is my edited version of their conclusions.

General Comments on the Bill

• This is a very comprehensive reform package that lays the ground work for providing changes and incentives to the delivery system that will reduce waste and improve outcomes overtime.
• Strong, thoughtful approach to Medicare payment reform that will result in implementation of recommendations over time
• Recognition and inclusion of reform initiatives. Specifics include a focus on wellness and prevention, expanding support for primary care training, creating opportunities for state and community level pilot projects and innovations and recognition of the importance of consumer engagement in reducing costs and improving outcomes.

Specific Comments Relative to Principles of Reform

1. Need to provide coverage and care for all people at all times regardless of age, employment status, economic circumstances and preexisting conditions
• Bill effectively addresses underwriting issues relative to age, health status and pre-existing conditions and creates level playing field for public and private market
• Bill provides options for all individuals (including low income) and most businesses to access affordable and in some cases subsidized health coverage through the exchange or through Medicare or Medicaid

2. Need to improve patient outcomes and reduce waste through improved care coordination, and a focus on primary care and preventive care.
• Emphasis on reduction of waste and fraud throughout bill including provisions in Medicare and Medicaid changes are seen as addressing this issue
• Reform elements throughout bill to increase primary care training including expanding residency options seen as positive
• Medical home recognition and including support of medical home pilot programs and shared decision making seen as effective
• Elimination of co-payments and deductibles for preventive services in Medicare and Medicare supports access to preventive care
• Grant program to help small employers to strengthen workplace wellness programs and support of community preventive services grants seen as important steps.

3. Need to assure consumer choice of providers and public and private plans
• Addressed through establishment of exchange and creation of a self sustaining public option.

4. Need to simplify the system (insurance administration, etc.) so that it is user friendly (understandable and transparent to consumers.)
• Creating level playing field in terms of underwriting and enactment of administrative simplification to reduce paperwork, standardize transactions and improve transparency seen as important step forward

5. Need to control costs and improve quality of care by reforming the payment system so that it rewards results and not activity and holds providers accountable for outcomes not procedures.
• Increased payments for primary care under Medicaid important step
• Addressing of Medicare payment rates based on geography and geographic variations in health spending through IOM studies with provisions for adopting recommendations is needed for cost control and quality improvement in Medicare
• Provisions for Center for Medicare and Medicaid Innovation creation and empowerment, creation of Accountable Care Organization program and Comparative Effectiveness Research Agency all needed to identify quality measures, provide the science to implement evidence based care and provide the incentives for the delivery system to implement those changes
• Changes to Medicare Advantage plans seen as supporting this principle

Some Persisting Questions and Issues

1. Affordability will be an ongoing challenge that needs to be monitored and addressed. How will that be handled?
2. What role will the public options play in health reform proposals to drive innovation?
3. Is financing adequate and sustainable?