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health reform Archives - ChangingMedia

Sep 16
0

A Guide to Shopping for Health Exchange Insurance Plans

By | Health | No Comments

In just two short weeks the online exchanges or health insurance marketplaces will open and millions of people will have the opportunity to begin shopping for various health insurance plans. Coverage won’t begin until January 1, 2014, but it is super important to know what you are getting into before choosing a plan.

The online exchanges are intended for small business owners and people who don’t receive health insurance through their job. If you are unsatisfied with your employer’s health insurance, you probably won’t be able to get a different plan through an exchange unless it costs you more than 9.5 percent of your income or if it doesn’t cover the required essential health benefits.

The first thing to consider when shopping for a plan is that all health insurance plans in the exchanges will be categorized into four tiers: bronze, silver, gold and platinum. Although all plans are required to cover essential health benefits, they differ in how you pay for them. The bronze plans have the lowest premiums but the highest out-of-pocket costs whereas the platinum plans are the opposite with the highest premiums and lowest out-of-pocket costs. In the bronze plans, the individual is expected to pay about 40% of health service costs with each tiered plan covering about 10% more ( so, silver: 30%; gold: 20%; platinum: 10%). The idea behind this is that if you are a generally healthy person who rarely needs more than preventative care, a bronze plan may work best for you. If you are someone who gets sick a lot and seems to need a lot of health services, a platinum plan may work best for you.

It may be easy to choose between a bronze and platinum plan, but maybe not between bronze and silver or silver and gold. One consideration is that the out-of-pocket costs for the bronze plans will be capped at $6,350. If you think the bronze plan monthly premiums are still too expensive for you, you may be able to apply for a Catastrophic Health Plan if you are under 30 or get a “hardship exemption.” In this type of plan, your monthly premium will be a lot lower but you’re only covered for 3 yearly primary care visits. If you’re have a medal plan however, you may be able to add benefits to your coverage.

Another huge consideration is the subsidies on your premiums for which you may qualify. The Advance Premium Tax Credit will be applied directly to your premiums, so you save immediately. Incomes up to 400 percent of the Federal Poverty Level will qualify for these tax credits with the lowest incomes receiving the largest credit. A general range for individual households receiving credits is an annual income between $11,490 – $45,960. If you want more specifics, you can try out the Kaiser Family Foundation’s Subsidy Calculator until October 1st.

So if you have an idea by now of what plan you’d like to go with, the last thing to do is pick an insurance company. Here is a list of estimated premiums for plans in the Baltimore area (many other states/areas can be found here). Each company will differ in the specifics on how much you pay for certain services. For example, one plan may cover completely your prescription drugs but charge you a little more for dental services. Besides price, you may want to consider how the health insurance company is run. I encourage people to check out the CO-OP insurance plans since they are non-profit and will probably put you, the patient, first.

Still confused? Don’t worry, once the exchanges open, many clinics and online/telephone support services will provide trained “Navigators” who will help you decide which plan is the best for you.

IMAGE CREDIT. [www.protocol.gov.hk].
Aug 06
0

Introducing: Evergreen Health Co-Op!

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In less than two months, health insurance exchanges around the country will be helping people to enroll in health insurance. In Maryland, you can get all your questions answered at Maryland Health Connection, our online exchange. Or you can sign up for Evergreen Health Co-Op, Maryland’s first non-profit health consumer oriented and operated plan.

One of the best things about Co-ops, besides the intent of offering affordable and comprehensive health insurance is that they will be partly managed by members. Evergreen will open positions to members on its board of directors which will make costs and operations transparent to the customers. It’s the first time that the American people will have a say in how their health insurance is run. Currently there are 24 states that have state-run co-ops, all of which have been given grants from the government.

Although Evergreen is a brand new organization, most of their insight comes from the current president and former officer of the Healthy Howard Health Plan which gives low-cost health insurance to residents of Howard County who aren’t eligible for Medicaid. The program also focuses on social determinants of health such as education, housing and employment.

It’s a common misconception that Medicaid serves all low-income individuals. But it doesn’t. It serves people with children, with disabilities or the elderly. If you’re a low-income childless adult, where do you turn? For the residents of Howard County they have their awesome comprehensive plan. For other Maryland residents they can turn to the Primary Adult Care (PAC) program which basically will hook you up with a primary care doctor but nothing else, and only if you make less than $2,000 a month. Otherwise you could turn to The Access Partnership (for people living near Johns Hopkins Hospital), the Maryland General Financial Assistance or a free health clinic such as Shepard’s Clinic. Starting January 2014, PAC will be no more, but what will happen to free health clinics?

Some clinics such as the Esperanza Center, which primarily serves the immigrant population, will continue as normal. Others may have to reconsider their purpose completely. Maybe we will see more health resource centers that focus on improving the social determinants of health. And others still might begin charging insurance companies for their services. It’s almost scary to think that free health care may become extinct but we shouldn’t have to have these non-profits filling in the gaps in the first place… right?

IMAGE CREDIT. [www.bernardhealth.com].
Jun 11
0

Domo Arigato Mr. Abe

By | Health | 2 Comments

If France can brag that they have the healthiest health care system, Japan can brag that they have the healthiest people. At a life expectancy of 82 years, the Japanese live the longest and have four full years of life on us Americans. Some people may think it’s because of their diet full of fish and low on fried foods but it could be that the Japanese have their hands-on government to thank.

First of all, even if the traditional Japanese diet is lower in fat and sugar than a lot of countries around the world, the Japanese government doesn’t care. They will still make you take nutrition classes if your waistline is over a certain amount of inches because of the Waistline Law. To Americans this may seem strange because the United States has more than three times the amount of obese people. Bloomberg and public health officers are green with envy — they can’t even ban large sodas.

In addition to the government’s heavy hand in public health, they also control most of private health matters. Every two years the Ministry of Health sets the prices for all health care services. Hospital stays cost roughly $10 a night whereas it runs in the thousands for a U.S. patient.  Doctors may get paid way less, but they also don’t have to pay for medical school and their malpractice insurance for the whole year is less than what doctors here pay in a month.

Although the Japanese government severely controls prices, the patients have all the freedom of choice. They don’t need a referral to see a specialist and they can see any doctor they please — there’s no in or out of network for insurance. And the Japanese are taking advantage of this freedom too. They see a doctor about three times more than Americans do.

Good for them, as the Japanese will always have health insurance and it doesn’t cost that much either. That’s because all health insurance companies in Japan are not-for-profit and if the company comes in the black one year, they subtract it from your premiums the next. Most Japanese people get health insurance through their employer, which helps pays for the already low-cost premium, or through the government.

So how does our reformed health system compare? Well, soon all Americans will have the opportunity to have health insurance. Though people are grumbling about a rumored increase in insurance premiums, all insurance companies must run them by the government first. And a lot of the speculations of high cost premiums don’t take into account the subsidies for people up to 400% of the Federal Poverty Level (roughly $45,000/yr). For a more realistic estimate of what insurance will cost in the exchanges, Washington D.C. recently released proposed rates. But as far as the other highlights of Japan’s health care system, particularly public health measures and cost control, it’s not looking too good. It would help if states would consider expanding Medicaid to include people making up to 133% the poverty level but so far only 23 states have taken that step.

Perhaps we don’t want our government policing our waistlines, but when it comes to providing a low-cost, equitable healthcare system for all, Japan is, quite literally, years ahead of us.

 

IMAGE CREDIT. [Ko Sasaki for The New York Times].
Apr 15
0

The Perils of Step-by-Step Healthcare

By | Health | One Comment

Medicare represents some of the greatest and worst qualities of our health care system. The positive is that it provides coverage for people over the age of 65 no matter what. After your 65th birthday you receive a little red, white and blue card in the mail that guarantees you can go see a doctor for little cost. The program serves many of our most vulnerable populations and has helped to bring many elderly people out of poverty.

On the other hand, Medicare is the foremost example of our fractured, piecemeal health care system that attempts to fix problems after they’ve occurred instead of trying to prevent them. Instead of having a simple, unified health care system, we rely on Medicare, Medicaid, non-profits and other charity groups to fill in the pieces when people don’t have employer health insurance. Medicare was built one part at a time, just as our health care system and just as Obamacare are being phased in year by year.

When Medicare was introduced into the Social Security Act by President Johnson in July 1965, the program consisted of two parts – A and B. Part A covers 80 percent of hospital costs. Part B covers 80 percent of inpatient and primary care. This type of payment is referred to as cost-sharing. President Reagan tried to implement catastrophic coverage (Medicare paid for services up to a certain amount, depending on your income). So many protests resulted that he switched back to cost-sharing.

But, as you can imagine, paying for that extra 20 percent can get pretty costly. So Part C was introduced in 1997 to help both the elderly and private insurance. If you decided to enroll in part C, or Medicare Advantage, you would choose to pay a higher monthly premium instead of that 20 percent. During this same time, the Sustainable Growth Rate was implemented, which was intended to limit the increase in cost of doctor’s services, but has been suspended every year since 2002.

This lack of control added to Medicare spending, and so did the last part of the program, Part D, which covers drugs. But even this provision left coverage incomplete, with many people trapped in a “doughnut hole” with high out-of-pocket costs. So even with these four parts in Medicare coverage, you’re still paying quite a bit for your comprehensive coverage. Fortunately, if you’re low-income you can apply for more assistance or even qualify for Medicaid which will pay that 20 percent.

If you’re living with a disability, you also qualify for Medicare, but if you have a work history you may have to wait for up to two years. If you don’t, you will also qualify for Medicaid. Either way, you’ll need to lawyer up.

Yet, one of the greatest parts about Obamacare, is minimizing the out-of-pocket costs for Medicare beneficiaries. The law phases in rebates for drug costs, free primary care services and ways to improve quality of care. The biggest benefit is drug coverage as eventually, it will be 75 percent covered and will save people a lot of money since those pills can add up.

Nonetheless, since the law was enacted, Medicare has still been subject to changes because of sequestration by capping reductions to payments and limiting out-of-pocket expenses.  Fortunately in Obama’s plan, the “doughnut hole” will be closed by 2015 instead of 2020 and (unfortunately for hospitals) teaching hospitals and hospital debts will be paid less. Another controversial new provision is having wealthier Medicare beneficiaries pay more. Others have proposed Medicare changes but none offer Obamacare’s biggest addition to the program – the elimination of the “doughnut hole.”

All these changes and back-and-forth make it even harder for Medicare beneficiaries to understand. Drug coverage for this vulnerable population could mean saving an extra few hundred dollars a month, or more importantly an ER scare. I doubt most Medicare beneficiaries follow health reform closely and if they do, I bet they’re still confused about what pieces are going to be implemented that will affect them. Like our health care system, we need a concrete plan that will curb costs and improve quality of care in place of making changes step-by-step as things go wrong. Step-by-step, day-by-day doesn’t work. What we need is a fresh start!

IMAGE CREDIT. seniorjournal.com.
Apr 02
0

Happy Birthday, Obamacare!

By | Health | No Comments

Happy Belated Birthday Obamacare! In just three little years the Affordable Care Act has made some big changes but has a whole lot more to do. All of the law’s provisions won’t be in full effect until around 2020 but that doesn’t mean the law hasn’t made a big impact already.

Most of us have heard that the law has put a tax on using tanning beds, provides free preventative services, lets young adults stay on their parent’s insurance until the age of 26, will require everyone to buy health insurance, and will create health insurance marketplaces called “exchanges.” Most people don’t know the bulk of what the law has done, so in celebration of the birth of Obamacare, here’s just some of what this ambitious law has accomplished. A full list of the ACA timeline can be found here.

Prevention is worth a pound of cure…

A lot of what Obamacare has focused on in the past three years is preventative services. In its first year the law created the National Prevention, Health Promotion and Public Health Council which passed the National Prevention Strategy and the law required any new health insurance plans to include minimum prevention services. It’s been a good few years for primary care doctors too, as their programs have received billions of dollars in funding and new residencies were added for primary care in an attempt to draw more pre-meds to a sorely under-staffed field. In the past few years the ACA has also focused on workplace wellness as it provided grants to small employers with a wellness program, and tax credits to large employers who invested in certain treatment projects.

While all this has been going on, the only thing that the average person might have noticed is new nutritional info on vending machines and at chain restaurants. But even more monumental changes have been made to the two heavyweights of America’s healthcare system – Medicare and Medicaid. A massive assessment of services is underway with the creation of the Medicaid and CHIP Payment Advisory Board. More immediately, the federal government has allowed states to begin to offer home and community-based services through Medicaid, which means more senior centers, transportation, home health aides, meal delivery or anything else that can help someone remain independent living at home.

Closing the doughnut hole…

As for Medicare, one of the biggest changes was tackling the prescription “doughnut hole.” In 2003, when the Bush administration added Medicare Part D to provide for certain types of drug coverage, the provision did not help pay for annual drug expenses between $2,250 and $5,100. Starting in 2010, Medicare patients started receiving $250 in rebates for brand name drugs, and then the following year they could get a 50 percent discount plus federal subsidies for generics. This year they can receive federal subsidies for brand-name drugs. Doughnut hole closed!

Figuring out how we pay for it all…

A lot of the ways in which the ACA is being funded (about 50 percent of it) is through Medicare and many of these funding changes occurred within the past three years. Some of this is funding received through trying out other models of payment instead of fee-for-service such as bundled payment programs and Accountable Care Organizations, which have recently been piloted. Other funding comes from an increase in Medicare Advantage premiums and a decrease in federal subsidies for this program, as well as a reduction in payment for Medicare patients who have been recently re-admitted to the hospital. This year too, wealthy elderly had a Medicare tax increase of 0.9 percent to help pay for the law.

And what it means for you…

For the future, a big obstacle will be getting the word out! The changes that affect everyone (the individual and employer mandate, exchanges, tax credits, Medicaid expansion) begin next year. Don’t delay! Now’s the time to educate yourself about how you’ll be affected and what your options will be. For all of Obamacare’s limitations, you’re sure to find it’s more than a party favor.

IMAGE CREDIT. Foxnews.com.
Mar 05
0

Bills, Bills, Bills

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If you have yet to read Steven Brill’s TIME cover story, “Bitter Pill: Why Medical Bills are Killing Us,” you should. It’s long, but it’s worth it. Though the public has been worrying about medical costs since the Great Depression, Brill does a great job illustrating just how expensive medical care is and how Obamacare doesn’t really do much to offset costs. After reading this article I asked myself a few questions. The first was, why are medical bills really so high?

The simple answer is because of the fee-for-service payment system that doctors in the U.S. have fought so long to keep. It’s a method of payment older than our country itself. When doctors would do home visits in colonial times they would charge patients per mile traveled on the horse and buggy. And although doctors don’t directly charge us for the gas to get to work in the morning, we are charged for medical education, administrative costs and other costs that aren’t directly related to one service. Even when you go to a hospital you are charged twice – once from the doctor and once from the hospital. The professional authority of doctors has allowed them to control their own fees for services as separate from the total cost.

This causes the second issue of doctors and hospital administrators dictating prices. Doctors have always charged patients on their ability to pay and not on the quality of service or on effort. For example, surgery costs have steadily increased but the actual effort of a doctor to perform a surgery has decreased. At one time only the doctor would be charged for a surgery because he did most of the work including pre-op care and rehab, now he is still charged at the same rate, but you are now paying technicians, assistants and others who are billed as well. Procedures have been simplified but medical costs remain high and continue to rise.

One of Brill’s main opinions was that an expansion of Medicare could help control costs, yet medical historian Paul Starr argues that it was the third party government programs and private insurers that led to medical inflation in the first place. Because most of the time patients don’t see their bills, the general public is unaware of the true cost. Another reason is that because third-party payers reimburse, hospitals and doctors were encouraged to raise the rates of reimbursement to offset expenses instead of figuring out how to lower costs in the first place.

All of which begs another question: how can non-profit hospitals make so much profit? Hospitals originally started to provide free care for individuals whose families couldn’t take care of them and for a while they served only charitable care. But with the increase of the middle class, patients wanted better rooms and better services so doctors and hospitals began to charge more. Because of surgery and technology, hospitals became institutions with a lot of jobs, people and money floating around. Hospitals are usually governed by an elected board of trustees but when they aren’t affiliated with a university or religious institution, can easily be bought out by a big corporation.

So these hospitals with a non-profit, tax-exempt label get to keep their status even if they are now owned by a corporation and then governed by corporate management. Even many state hospitals have been sold to corporate entities. The other scenario is when a non-profit hospital then buys for-profit entities such as restaurants, rehabs, clinics, nursing homes etc. It seems that the status quo for hospitals is to increase available services and fees, expand buildings and usurp other medical entities, which all drastically raise costs for the patient. At the same time, the hospitals argue this is what patients want — top of the line technology, more services and bigger and nicer buildings. So I guess (certain) patients are getting what they want, and they’re paying for it too.

My last question was, why hasn’t anything been done to stop the medical monstrosity of health care costs? The quick answer is there have been efforts but most have been focused on Medicare and Medicaid, not on the entire system, and none have had an impact. The full explanation is for another time. As Brill notes in his article, Obamacare makes some minor, meager efforts at controlling costs but nothing impressive, mostly because of such strong hospital lobbying.

However much controlling costs is essential to having a more efficient health care system, expanding coverage was always the main priority of Obamacare. But Obamacare is adapting to peoples’ worries, as the administration recently announced they will require insurance companies to report any price increases. With Obamacare we’ve jumped over one hurdle on expanding access to care. Now we can hopefully pave a path to reducing costs.

Image courtesy of: www.helpingyoucare.com
Feb 19
0

Obamacare Keeps Calm and Carries On

By | Health | No Comments

The final count is in! The federal government will be providing health insurance exchanges for 26 states. On February 15th, states had their last chance to opt for a federal partnership to run an exchange – essentially an online marketplace for health insurance. States will always have the option to take control of the exchanges themselves (which the feds would prefer), but for now only the other 24 states have chosen to set up their own and have them running by October 1st of this year.

Some states were skeptical that they would have the funds and manpower ready to meet that deadline. But many Republican-led states simply refused to run their own exchanges because they didn’t want to be a part of Obamacare, despite the fact that most Americans agree that exchanges will work best under state control. The department of Health and Human Services ideally wanted all of the states to take control of the exchanges and will have to work hard to adjust its original plans, as has so often been the case for Obamacare. The story of the president’s signature reform has been one of change.

Indeed, that we have exchanges at all is the result of a shift in position. The basis for the exchanges is the individual mandate, which requires all U.S. citizens (with certain exceptions) to have health insurance by January 1, 2014. Originally, President Obama was against the individual mandate – a topic hotly debated in his primary battle with Hilary Clinton. Once president, he saw that there was no other choice. Without the mandate, the government couldn’t require insurers to turn away sick people as some people might wait until they were sick to buy insurance.

As of now, uninsured people with pre-existing medical conditions have been able to enroll in the government’s Pre-Existing Condition Insurance Plan, but the Obama administration announced Friday that they had to cap the plan due to financial restrictions. Other changes have been made since Obama originally proposed his vision for health reform. Obama had wanted to include a public option or a publicly-run insurance plan (similar to Medicare, which is government-run) to compete with the private insurers in the exchanges. This would potentially drive down insurance premiums and lower administrative and medical service costs.

But a public option would be tricky to get right since it wouldn’t work if too many people were enrolled, or too few. If enrollments in a public option were too numerous, providers wouldn’t be able to “cost shift” – currently, by charging higher premiums to private, fee-paying patients, doctors and hospitals gain back losses from providing services to Medicare patients, Medicaid patients and the uninsured. Conversely, if there were severe enrollment restrictions and too few people were enrolled in a public option, it would most likely be those with a high risk. This would leave the public option bankrupt and private insurers rolling in the dough from having so many healthy people enrolled.

And of course a public option is considered by conservatives to be a first-step toward a single-payer health system (a health system in which one entity pays for all health services), which liberals would cheer, but which they believe to be dangerous government intrusion on the workings of the market.

As a compromise on the public option, the Senate offered a Medicare expansion to enroll people at the lower age of 55. Neither this nor the public option could get passed so the Consumer Operated and Oriented Plan (CO-OP) was born. A CO-OP is a non-profit insurance plan controlled by the patients it insures and must be included in all state exchanges. The government is offering low-cost loans to both new groups and existing ones. Twenty-four states have received loans and their CO-OPs will be highly monitored to make sure they will repay loans and are meeting goals.

Even after clearing so many obstacles, many are still skeptical the plan for Obamacare can be carried out. Will a federal exchange be ready by October? For one, it’s an enormous feat of information technology and logistics that will need to connect many government departments such as Homeland Security (to verify citizenship) and the IRS (to determine subsidy eligibility). By July, insurance plans for the exchanges are expected to be chosen, but will HHS have and choose the best plans?

Could the federally-run exchange look like a public option?

Will states eventually take over their own exchanges?

Will people even know about the exchanges by next year?

Will the exchanges really provide competitions for insurers?

And will policymakers be forced to make yet more changes to address these questions?

As America’s great experiment with healthcare reform unfolds, only time will tell.

IMAGE CREDIT. endthefedusa.ning.com.

 

Jan 08
0

Obamacare – Exchanges, Optimism and Irony

By | Health | No Comments

The New Year brings us optimism, good spirits and hope that America will be one step closer to equality in health care. Over the holidays, states and the Department of Health and Human Services were hard at work developing the health insurance exchanges, or in other words, an easier way for certain individuals and small business owners to purchase health insurance.

The exchanges must be ready by October 2013 for enrollment and be fully operational by January 2014. Yes, that’s optimism at its finest. In mid-December 2012 states had to decide if they were going to run the exchanges themselves or use the government plan. Though, until February 15, 2013 states can still opt for a federal partnership. So far, 19 states decided to operate the exchange themselves, seven decided to receive some help from the government and 25 have defaulted to a federal exchange.

Basically, exchanges are going to be organizations (either a government agency or a non-profit) that will help make finding health insurance simple and straightforward and will keep prices competitive among plans. Massachusetts already has had a great functioning exchange since 2007 called Health Connector. Utah also has had a functioning exchange since 2009 for small businesses but will need to expand to individuals.

All exchanges, state-run or not, will need to meet minimum standards set by the Affordable Care Act which includes hiring ‘navigators’ for assistance, client education, basic health benefits, maintaining a website, and rating health insurance plans. All exchanges must offer two plans and one must be from a non-profit. Ideally, if you are looking for insurance you’ll be able to go onto a website, browse plans, have all your questions answered either online or by phone and be enrolled with an affordable plan that fancies you within 30 minutes. Good thing it’s January so we’re all feeling extra optimistic! By 2014 people who don’t have employer health insurance (those with lower incomes will receive subsidies) and small business with up to 100 employees will be able to find health insurance plans through an exchange.  By 2017, states can decide if they want to offer exchanges to larger employers.

Originally, the intent was for exchanges to all be state-run since state legislatures probably know what works best for them as far as setting eligibility, plans and funding. It was expected that only states with small populations would default to a federal exchange, but the two most populous states with 20 percent of the nation’s uninsured, Texas and Florida, have opted for the default.

Most states that chose to have a federal Exchange did so early in advance claiming that the exchanges would be too expensive or to try to sabotage Obamacare since they don’t agree with the law. All but four states received grants to help offset costs which mainly went to hiring IT work. The states with partnership exchanges will be able to manage plans and customer service and the hope here is that the Department of Health and Human Services will try to work with states as much as possible to individualize the exchanges so that all states will have the opportunity to move to a state-based model in the future.

The irony here is that the Republican states that chose a federal exchange are going against their fundamental Republican ideals. They complain that Obamacare is big government but they certainly don’t seem to have a problem making government’s role bigger in this case. I’m staying optimistic though, the world didn’t end, Obamacare is in full effect, Republicans can still flip-flop on exchanges and I’m hoping people will remember once again George Washington’s warning in his farewell address of damaging divides due to partisan political spirits.

Dec 11
0

Medicaid Matters

By | Health | No Comments

The fiscal cliff is looming and debates are raging about whether or not to tax the rich, but starting January 2013 individuals and couples with incomes over $200,000 and $250,000 respectively are going to have to pay more in taxes anyway. These new payroll taxes will help pay for the expansion of Medicaid starting in 2014, which is projected to newly insure about 16 million people and is one of the major foundations of the Affordable Care Act. But things aren’t that simple.

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