Insuring Resources Commentary:
So what has happened in the three months since health care reform passed Congress and Pres. Obama signed it March 23rd?
Premiums have continued to rise and health care reform rules are slowly taking shape. In the end will the new rules help?
I believe in some ways they will, more people will become insured, young adults will have greater access through their parent's plans, pre-x will be eliminted for children this October and in 2014 for adults.
BUT, will premiums go down? Probably not because the bill does virtually nothing to stem the tide of rising health CARE costs, that's where the price drivers are.
We need incentives for quality and efficiency.
---------------
See this article concerning new premium increases PRIOR to health care reforms implementation.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/06/26/ED011D46ND.DTL&type=health
--------------------------
Showing posts with label cost. Show all posts
Showing posts with label cost. Show all posts
Tuesday, June 29, 2010
Wednesday, June 2, 2010
In Business Madison Magazine Details Small Business Decisions Under the PPACA
Insuring Resources Commentary:
The article below provides a great analysis on small business decision-making as health care is implemented. Dr. Samitt does a great job of laying out the small business issues and also suggests that more could have been done on the quality and cost containment side but he notes that better coordination among providers is essential. He notes that Wisconsin is well-positioned in that regard.
I've highlighted a couple of noteworthy items within the article below. These pertain to small business decision-making on whether to offer coverage or pay the penalty and on quality and cost issues and Wisconsin's current insurance marketplace.
A couple of items the article does not touch on:
1. State creation of Health Insurance Exchanges (statewide or regional) and other important decisions
***(stay tuned for a post from me on implementing HIE's in a few days)***
2. Enhancement of Wisconsin's High risk pool- Expansion of HIRSP pre -2014 to provide coverage for those with pre-existing conditions
------------ -------------- -------------
Health Care Calculation for Businesses: Coverage Versus Paying the Penalty
June 1, 2010
In Business Madison Magazine- http://www.ibmadison.com/healthcare?id=514
Large and mid-sized businesses have some calculating to do regarding the recently enacted Patient Protection and Affordable Care Act, the federal health care law, but that calculation will not be entirely monetary, according to Dr. Craig Samitt.
Samitt, president and CEO of Dean Health System in Madison, said the comparison small and mid-sized businesses must begin to make is the respective cost of providing insurance versus the cost in penalties for not providing it. That final decision does not have to be made until January of 2014, but provisions clearly prescribe that employers will have this choice themselves. (Qualified small businesses would be able to purchase insurance for their employees through state-based Small Business Health Options Programs or SHOPs.)
Since the law goes into effect in stages, Samitt believes affected businesses should map out a strategy to take advantage of the various changes that occur each year leading up to full implementation. There is the immediate benefit of small business tax credits that are retroactive to Jan. 1, 2010, and then there is the aforementioned coverage question.
Large and mid-sized employers that fail to offer what the law calls "minimum essential coverage" would be liable for an additional tax. That penalty would equal the product of the applicable payment amount (with respect to any month, 1/12 of $2,000) and the number of full-time employees employed by the employer during such month.
The penalty would apply to employers with 50 or more workers, but would subtract the first 30 workers from the payment calculation. In a hypothetical example, a company with 51 full-time employees that does not offer the still-to-be-determined "minimum essential coverage" would pay an amount equal to 51 minus 30 (or 21) times the applicable per employee payment amount up to $2,000 per full-time employee. (Businesses with fewer than 50 employees would be exempt from any employer responsibility.)
If employer-provided insurance exceeds 9.5 percent of the employee's household income, or the employer plan has an actuarial value of less than 60 percent, the coverage will not qualify as minimum essential coverage.
So the question becomes, "Do you provide coverage to employees, or do you pay penalties and have [individual] employees enter into an exchange," Samitt noted. "Obviously, this will be a challenging call for employers because it's not just about cost."
More immediately, the Act provides a temporary, sliding-scale tax credit to help small employers offset the cost of employer-provided coverage. For the purpose of the credit, a small employer generally is defined as one with fewer than 25 employees and average annual wages of less than $50,000. From 2011 through 2013, eligible employers may qualify for a tax credit for up to 35 percent of their contribution toward the employee's health insurance premium.
In 2014 and beyond, eligible employers who purchase coverage through a state exchange may qualify for a credit for two years of up to 50 percent of their contribution. (Employers with 10 or fewer employees and average annual wages of less than $20,000 would be eligible for the full credit.)
If a business belongs to an industry where the provision of health benefits is a competitive advantage, enabling them to attract and retain quality employees, Samitt believes it may be in the businesses' best interest to provide health insurance even if it costs more than paying the penalty. "Those are the things that small employers are going to have to start thinking about in terms of options regarding reform," he stated.
In general, Samitt regards the Act as good law for small businesses and for people who want to start a business but can't due to their concerns about health insurance affordability. "Businesses have had this challenge of affordability as it pertains to health care," he noted. "With these tax credits in short term, and with exchanges in longer term, smaller businesses have an opportunity to insure their employees like large businesses do."
Reform Measures
The Act tried to accomplish three things which are important to reform: broadening access to coverage, where it scores more highly in Samitt's view; and improving quality and affordability, where the jury is still out. According to Samitt, the bill's strengths are really more on the coverage side, but there is much less detail and only references pertaining to quality and cost. "At this point, it's hard to predict the impact on insurance premiums in the short- or long-term," he opined. "It's in an area where there is a lot more detail that needs to be worked out in terms of what will actually be covered, and in terms of changes in the payment system."
There is a ripe area for cost control, however. Historically, Samitt said the health care reimbursement model has been more based upon the quantity of care rather than the quality of care; because quantity of care has been rewarded, costs have continued to rise. "There are references in this bill to rewarding the quality of care, not just the quantity of care," he noted, "and if reimbursement changes to reward value, this should bend the cost curve and the premium curve."
Citing information from the Organization for Economic Cooperation and Development (OECD) Samitt said the cost curve must inevitably be bent downward. The OECD notes that U.S. health care expenditures as a percentage of gross domestic product rose from about 5% in 1960 to a projected 18% in 2010. By 2018, health care expenditures are projected to grow to 20% of GDP.
"The cost of health care is rising at an exponential rate, and rising faster than inflation, so when we look at how much we, as a society, are spending for health care, that trend is unsustainable," Samitt opined. "We will have no choice but to find a way to bend the cost curve while improving quality at the same time."
Health Care a la Carte
Ideally, Samitt said health insurance should be structured with preventive care, regular check ups, pharmacy, and catastrophic coverage. Asked if individual consumers, in order to hold down costs, should be able to pick and choose the rest, paying a la carte for things like mental health coverage, Samitt said that would be problematic and weaken universal coverage principles.
"The cost of broader insurance coverage can only be managed if the risk is adequately spread among the population," he explained. "Allowing people to shop a la carte can work for items that are truly non-necessities, like cosmetic surgery and items like that. But mental health care is not a luxury. It's a real health care concern that must be part of the 'must-haves' like preventive care, regular check ups, and catastrophic care."
"You can't have people just pay a la carte when they get sick because it's not how current coverage works," he continued. "That would be equivalent of deciding to buy auto insurance only after accidents happen."
Dr. Samitt commented on a number of topics, including the following:
On whether the bill is structured, as critics contend, to drive private insurers out of business and health care consumers into the government's arms? "The bill is not intended to drive private insurers out of business. I don't think it's designed to nationalize health care. There is no public plan in the bill. What the bill does do, though, is bring more accountability to the insurance world. The ultimate goal of the bill is to provide more citizens with better care at a lower cost.
"On the health care delivery and insurance side, this will mean the need for more integration and coordination where physicians, hospitals, and insurance plans are all working together with patients at the center, and with a focus on managing quality and cost. So that accountability is critical and the pressure to integrate is essential. What's great about Wisconsin is there are so many integrated systems like Dean-St. Mary's that are already practicing these integrated models. But that level of integration is absent in many of the greatest population areas of the nation. In most other markets, what you see more often are independent, non-aligned entities, which may drive up health care costs while not necessarily delivering higher quality care."
On whether he has any issues with the Act's requirement for insurers to use at least 80% of premiums for care services rather than administrative costs or profit taking? "In my view, the more dollars that can be directed to heath services, the better off we'll be. What we see in many integrated systems like those in Wisconsin, is those administrative costs are already on the lower side. So if there are health plans that can deliver a high quality product and spend less on administrative services and reduce waste, then why can't all health plans achieve that same level of reduction in administrative costs? So yes, that is a good provision. We should be spending more on clinical services than less."
On whether the federal government will be back to address health care reform: "Whenever you can provide more coverage, that's good. The insurance provisions in the bill are the right things to do. They make sense. However, the concern everyone has is how are we going to pay for this? That's why a big part of reforming health care will require us to think more about prevention, wellness, the appropriateness of hospitalization, and the appropriateness of getting care in the doctors' office rather than the emergency room. Those are the parts of reform that actually have to happen that are not well-specified in the bill."
Sign up for the free IB Update — your weekly resource for local business news, analysis, voices and the names you need to know. Click here.
COMMENTS
The article below provides a great analysis on small business decision-making as health care is implemented. Dr. Samitt does a great job of laying out the small business issues and also suggests that more could have been done on the quality and cost containment side but he notes that better coordination among providers is essential. He notes that Wisconsin is well-positioned in that regard.
I've highlighted a couple of noteworthy items within the article below. These pertain to small business decision-making on whether to offer coverage or pay the penalty and on quality and cost issues and Wisconsin's current insurance marketplace.
A couple of items the article does not touch on:
1. State creation of Health Insurance Exchanges (statewide or regional) and other important decisions
***(stay tuned for a post from me on implementing HIE's in a few days)***
2. Enhancement of Wisconsin's High risk pool- Expansion of HIRSP pre -2014 to provide coverage for those with pre-existing conditions
------------ -------------- -------------
Health Care Calculation for Businesses: Coverage Versus Paying the Penalty
June 1, 2010
In Business Madison Magazine- http://www.ibmadison.com/healthcare?id=514
Large and mid-sized businesses have some calculating to do regarding the recently enacted Patient Protection and Affordable Care Act, the federal health care law, but that calculation will not be entirely monetary, according to Dr. Craig Samitt.
Samitt, president and CEO of Dean Health System in Madison, said the comparison small and mid-sized businesses must begin to make is the respective cost of providing insurance versus the cost in penalties for not providing it. That final decision does not have to be made until January of 2014, but provisions clearly prescribe that employers will have this choice themselves. (Qualified small businesses would be able to purchase insurance for their employees through state-based Small Business Health Options Programs or SHOPs.)
Since the law goes into effect in stages, Samitt believes affected businesses should map out a strategy to take advantage of the various changes that occur each year leading up to full implementation. There is the immediate benefit of small business tax credits that are retroactive to Jan. 1, 2010, and then there is the aforementioned coverage question.
Large and mid-sized employers that fail to offer what the law calls "minimum essential coverage" would be liable for an additional tax. That penalty would equal the product of the applicable payment amount (with respect to any month, 1/12 of $2,000) and the number of full-time employees employed by the employer during such month.
The penalty would apply to employers with 50 or more workers, but would subtract the first 30 workers from the payment calculation. In a hypothetical example, a company with 51 full-time employees that does not offer the still-to-be-determined "minimum essential coverage" would pay an amount equal to 51 minus 30 (or 21) times the applicable per employee payment amount up to $2,000 per full-time employee. (Businesses with fewer than 50 employees would be exempt from any employer responsibility.)
If employer-provided insurance exceeds 9.5 percent of the employee's household income, or the employer plan has an actuarial value of less than 60 percent, the coverage will not qualify as minimum essential coverage.
So the question becomes, "Do you provide coverage to employees, or do you pay penalties and have [individual] employees enter into an exchange," Samitt noted. "Obviously, this will be a challenging call for employers because it's not just about cost."
More immediately, the Act provides a temporary, sliding-scale tax credit to help small employers offset the cost of employer-provided coverage. For the purpose of the credit, a small employer generally is defined as one with fewer than 25 employees and average annual wages of less than $50,000. From 2011 through 2013, eligible employers may qualify for a tax credit for up to 35 percent of their contribution toward the employee's health insurance premium.
In 2014 and beyond, eligible employers who purchase coverage through a state exchange may qualify for a credit for two years of up to 50 percent of their contribution. (Employers with 10 or fewer employees and average annual wages of less than $20,000 would be eligible for the full credit.)
If a business belongs to an industry where the provision of health benefits is a competitive advantage, enabling them to attract and retain quality employees, Samitt believes it may be in the businesses' best interest to provide health insurance even if it costs more than paying the penalty. "Those are the things that small employers are going to have to start thinking about in terms of options regarding reform," he stated.
In general, Samitt regards the Act as good law for small businesses and for people who want to start a business but can't due to their concerns about health insurance affordability. "Businesses have had this challenge of affordability as it pertains to health care," he noted. "With these tax credits in short term, and with exchanges in longer term, smaller businesses have an opportunity to insure their employees like large businesses do."
Reform Measures
The Act tried to accomplish three things which are important to reform: broadening access to coverage, where it scores more highly in Samitt's view; and improving quality and affordability, where the jury is still out. According to Samitt, the bill's strengths are really more on the coverage side, but there is much less detail and only references pertaining to quality and cost. "At this point, it's hard to predict the impact on insurance premiums in the short- or long-term," he opined. "It's in an area where there is a lot more detail that needs to be worked out in terms of what will actually be covered, and in terms of changes in the payment system."
There is a ripe area for cost control, however. Historically, Samitt said the health care reimbursement model has been more based upon the quantity of care rather than the quality of care; because quantity of care has been rewarded, costs have continued to rise. "There are references in this bill to rewarding the quality of care, not just the quantity of care," he noted, "and if reimbursement changes to reward value, this should bend the cost curve and the premium curve."
Citing information from the Organization for Economic Cooperation and Development (OECD) Samitt said the cost curve must inevitably be bent downward. The OECD notes that U.S. health care expenditures as a percentage of gross domestic product rose from about 5% in 1960 to a projected 18% in 2010. By 2018, health care expenditures are projected to grow to 20% of GDP.
"The cost of health care is rising at an exponential rate, and rising faster than inflation, so when we look at how much we, as a society, are spending for health care, that trend is unsustainable," Samitt opined. "We will have no choice but to find a way to bend the cost curve while improving quality at the same time."
Health Care a la Carte
Ideally, Samitt said health insurance should be structured with preventive care, regular check ups, pharmacy, and catastrophic coverage. Asked if individual consumers, in order to hold down costs, should be able to pick and choose the rest, paying a la carte for things like mental health coverage, Samitt said that would be problematic and weaken universal coverage principles.
"The cost of broader insurance coverage can only be managed if the risk is adequately spread among the population," he explained. "Allowing people to shop a la carte can work for items that are truly non-necessities, like cosmetic surgery and items like that. But mental health care is not a luxury. It's a real health care concern that must be part of the 'must-haves' like preventive care, regular check ups, and catastrophic care."
"You can't have people just pay a la carte when they get sick because it's not how current coverage works," he continued. "That would be equivalent of deciding to buy auto insurance only after accidents happen."
Dr. Samitt commented on a number of topics, including the following:
On whether the bill is structured, as critics contend, to drive private insurers out of business and health care consumers into the government's arms? "The bill is not intended to drive private insurers out of business. I don't think it's designed to nationalize health care. There is no public plan in the bill. What the bill does do, though, is bring more accountability to the insurance world. The ultimate goal of the bill is to provide more citizens with better care at a lower cost.
"On the health care delivery and insurance side, this will mean the need for more integration and coordination where physicians, hospitals, and insurance plans are all working together with patients at the center, and with a focus on managing quality and cost. So that accountability is critical and the pressure to integrate is essential. What's great about Wisconsin is there are so many integrated systems like Dean-St. Mary's that are already practicing these integrated models. But that level of integration is absent in many of the greatest population areas of the nation. In most other markets, what you see more often are independent, non-aligned entities, which may drive up health care costs while not necessarily delivering higher quality care."
On whether he has any issues with the Act's requirement for insurers to use at least 80% of premiums for care services rather than administrative costs or profit taking? "In my view, the more dollars that can be directed to heath services, the better off we'll be. What we see in many integrated systems like those in Wisconsin, is those administrative costs are already on the lower side. So if there are health plans that can deliver a high quality product and spend less on administrative services and reduce waste, then why can't all health plans achieve that same level of reduction in administrative costs? So yes, that is a good provision. We should be spending more on clinical services than less."
On whether the federal government will be back to address health care reform: "Whenever you can provide more coverage, that's good. The insurance provisions in the bill are the right things to do. They make sense. However, the concern everyone has is how are we going to pay for this? That's why a big part of reforming health care will require us to think more about prevention, wellness, the appropriateness of hospitalization, and the appropriateness of getting care in the doctors' office rather than the emergency room. Those are the parts of reform that actually have to happen that are not well-specified in the bill."
Sign up for the free IB Update — your weekly resource for local business news, analysis, voices and the names you need to know. Click here.
COMMENTS
Tuesday, May 18, 2010
Fascinating Proposal: Creation of a new field- Health Care Delivery Science
Insuring Resources Commentary:
For long-term readers of this blog you'll recognize this article as hitting on my number one issue, health care quality and cost incentives to reduce waste in our fractured health care delivery system.
It is my firm belief that insurance reform cannot succeed without quality and cost reduction health care provider incentives to eliminate waste and focus on improved, quality health outcomes for all Americans.
This proposal, I believe, holds tremendous promise in reshaping the delivery and financing of American health care to finally focus on quality, rather than quantity.
I'll keep you updated as the Center for Health Care Delivery Science is launched.
- -- --- ---- ----- ------
By Jim Yong Kim and James N. Weinstein
Guest Editorial in the Washington Post
Monday, May 17, 2010
Health insurance reform is now law, giving millions of Americans access to the full resources of our health-care system for the first time. The question becomes: How can we ensure that they -- and all of us -- receive value-based and high-quality care?
It is well known that U.S. health-care costs, as a share of our economy, are the highest in the world but that compared to other industrialized countries, our results are the worst. The Dartmouth Atlas has documented the enormous waste in our system and shown that spending more money and performing more medical procedures do not equal better outcomes for patients.
Americans deserve health care that is coordinated across physicians and health systems, and that is effective, appropriate and safe. As a nation, we have a moral and a fiscal responsibility to ensure that all patients receive value for health services. While the achievement of health insurance reform was historic, it is time to focus on the next step: improving quality while bending the unsustainable cost curve significantly.
We are physicians and researchers; one of us is now a college president, and the other head of a leading academic medical center. We share a history of work in medicine, science, policy reform and education. We also share the view that throughout history, our most difficult problems have found scientific solutions.
We propose the rapid expansion of a new field to tackle the twin problems of how to provide high-quality health care while lowering costs: health-care delivery science.
This new field will work with the recognition that truly reforming health care requires more than the efforts of one entity. We cannot blame government or insurers or physicians for the complex and multilayered problem. No single group or entity created the puzzle that is our health-care system; it is not reasonable to expect one group to solve it.
What will lead to improvements is a multidisciplinary approach that brings the best minds to focus on the problem. Experts in management, systems thinking and engineering, sociology, anthropology, environmental science, economics, medicine, health policy and other fields must join together to apply a laser focus to fixing the delivery system.
Why? Consider the moving pieces of a patient-health system encounter. A patient comes into the emergency room. Immediately, judgments are made about how sick she is and what treatments she needs. There is no universal medical record for that patient, so the provider has no idea about her medical history, medication use or preexisting conditions. Incomplete information is relayed through layers of nurses, physicians, specialists and the shifts of personnel who replace them. In the absence of real-time information, tests are ordered and treatment decisions made. Perhaps after an overnight stay, barring complications from drug interactions or perhaps an unrecognized underlying condition, she is discharged, with no further transfer of information to a provider and, more important, no follow-up to see whether the treatment was effective. The symptoms were treated; the patient was not.
The best insurance in the world will not fix this problem. We need a whole new cadre of people committed to applying their expertise to the challenge of health-care delivery.
We have begun building that cadre at Dartmouth with the establishment of a Center for Health Care Delivery Science. But it is our hope that many more institutions will work together to generate the needed evidence on health-care delivery solutions, to disseminate that knowledge and to train the current and future professionals who will put solutions into practice. We envision a network of centers across the country that will marry research and implementation from the start -- finding and testing delivery solutions with practitioners and patients on the front lines.
The recent health legislation establishes an implicit covenant with the American people. The spirit of this covenant goes far beyond insurance. In exchange for new public and private investment in the health system, Americans expect access to effective, high-quality care within a financially sustainable system. With a robust science of health-care delivery, this goal can be achieved.
Jim Yong Kim is president of Dartmouth College. James N. Weinstein is president of the Dartmouth-Hitchcock Clinic.
For long-term readers of this blog you'll recognize this article as hitting on my number one issue, health care quality and cost incentives to reduce waste in our fractured health care delivery system.
It is my firm belief that insurance reform cannot succeed without quality and cost reduction health care provider incentives to eliminate waste and focus on improved, quality health outcomes for all Americans.
This proposal, I believe, holds tremendous promise in reshaping the delivery and financing of American health care to finally focus on quality, rather than quantity.
I'll keep you updated as the Center for Health Care Delivery Science is launched.
- -- --- ---- ----- ------
By Jim Yong Kim and James N. Weinstein
Guest Editorial in the Washington Post
Monday, May 17, 2010
Health insurance reform is now law, giving millions of Americans access to the full resources of our health-care system for the first time. The question becomes: How can we ensure that they -- and all of us -- receive value-based and high-quality care?
It is well known that U.S. health-care costs, as a share of our economy, are the highest in the world but that compared to other industrialized countries, our results are the worst. The Dartmouth Atlas has documented the enormous waste in our system and shown that spending more money and performing more medical procedures do not equal better outcomes for patients.
Americans deserve health care that is coordinated across physicians and health systems, and that is effective, appropriate and safe. As a nation, we have a moral and a fiscal responsibility to ensure that all patients receive value for health services. While the achievement of health insurance reform was historic, it is time to focus on the next step: improving quality while bending the unsustainable cost curve significantly.
We are physicians and researchers; one of us is now a college president, and the other head of a leading academic medical center. We share a history of work in medicine, science, policy reform and education. We also share the view that throughout history, our most difficult problems have found scientific solutions.
We propose the rapid expansion of a new field to tackle the twin problems of how to provide high-quality health care while lowering costs: health-care delivery science.
This new field will work with the recognition that truly reforming health care requires more than the efforts of one entity. We cannot blame government or insurers or physicians for the complex and multilayered problem. No single group or entity created the puzzle that is our health-care system; it is not reasonable to expect one group to solve it.
What will lead to improvements is a multidisciplinary approach that brings the best minds to focus on the problem. Experts in management, systems thinking and engineering, sociology, anthropology, environmental science, economics, medicine, health policy and other fields must join together to apply a laser focus to fixing the delivery system.
Why? Consider the moving pieces of a patient-health system encounter. A patient comes into the emergency room. Immediately, judgments are made about how sick she is and what treatments she needs. There is no universal medical record for that patient, so the provider has no idea about her medical history, medication use or preexisting conditions. Incomplete information is relayed through layers of nurses, physicians, specialists and the shifts of personnel who replace them. In the absence of real-time information, tests are ordered and treatment decisions made. Perhaps after an overnight stay, barring complications from drug interactions or perhaps an unrecognized underlying condition, she is discharged, with no further transfer of information to a provider and, more important, no follow-up to see whether the treatment was effective. The symptoms were treated; the patient was not.
The best insurance in the world will not fix this problem. We need a whole new cadre of people committed to applying their expertise to the challenge of health-care delivery.
We have begun building that cadre at Dartmouth with the establishment of a Center for Health Care Delivery Science. But it is our hope that many more institutions will work together to generate the needed evidence on health-care delivery solutions, to disseminate that knowledge and to train the current and future professionals who will put solutions into practice. We envision a network of centers across the country that will marry research and implementation from the start -- finding and testing delivery solutions with practitioners and patients on the front lines.
The recent health legislation establishes an implicit covenant with the American people. The spirit of this covenant goes far beyond insurance. In exchange for new public and private investment in the health system, Americans expect access to effective, high-quality care within a financially sustainable system. With a robust science of health-care delivery, this goal can be achieved.
Jim Yong Kim is president of Dartmouth College. James N. Weinstein is president of the Dartmouth-Hitchcock Clinic.
Friday, April 16, 2010
Gallup Poll results concerning cost issues and health care reform
Here are some interesting poll results since the passage of health care reform. These questions were focused on cost.
Gallup released its latest poll on health care reform and the findings continue to echo the concern about health care costs that independent experts and economists have been raising (and that the Campaign has highlighted.) Here are some key findings from the poll:
"Proponents, as well as opponents, of the new healthcare reform law think the legislation is less than perfect. Both groups agree that the bill didn't do enough to deal with rising healthcare costs."
56% of independents do not think the bill does enough to address costs.
Even among those who think the bill was a good thing, 62% think the bill does not do enough to address costs.
Gallup released its latest poll on health care reform and the findings continue to echo the concern about health care costs that independent experts and economists have been raising (and that the Campaign has highlighted.) Here are some key findings from the poll:
"Proponents, as well as opponents, of the new healthcare reform law think the legislation is less than perfect. Both groups agree that the bill didn't do enough to deal with rising healthcare costs."
56% of independents do not think the bill does enough to address costs.
Even among those who think the bill was a good thing, 62% think the bill does not do enough to address costs.
Thursday, March 25, 2010
Health care costs out of control - a cartoon
Insuring Resources Commentary:
I like to post viepoints from others, particularly when they agree with mine.
* * * * * * * * * * * * *
Health care ambulance is out of (cost) control
From The Capital Times, Madison WI
Cartoon and opnion by Phil Hands
Wednesday, March 24, 2010 10:33 pm |
I don’t usually draw cartoons on national issues, but I thought this cartoon did a pretty good job of summing up my feelings on our new health care bill.
Don't get me wrong, I'm glad the Democrats passed a health care reform bill.
It's good that insurance company's can no longer cry "pre-existing condition” and drop paying customers as soon as they get sick. I'm glad kids won't be denied insurance on the basis of pre-existing conditions anymore, and it's good that millions more Americans will have access to health insurance.
But for as massive as this bill is, there is very little in it that will actually make health care cost less and that is the crisis we are facing. Health care is too darn expensive, whether or not you have insurance to pay for it.
This bill needed to include serious tort reform and incentives to end the obscene practice of paying doctors by the amount of tests they order and not by the health of their patients. If you could somehow add provisions like these the bill, it would have been a lot better.
Tuesday, March 9, 2010
White House Holds Meeting with Top Insurers
Insuring Resources Commentary:
President Obama has said that he is incorporating GOP ideas into the final last ditch effort to enact health care reform. From the GOP he has heard repeatedly that his plan does not control rising health care costs.
Then on March 5th, as detailed in the article below, he met with Insurers that told him, and his Secretary of Health Kathleen Sebelius, that health care costs are the real problem. His chief budgetary advisor Peter Orszag has also been talking about this for a year. Let's hope its beginning to sink in.
-----------------
White House Holds Meeting with Top Insurers
Increasingly cast as the villain in the nation’s rising cost for health care, five of the nation’s largest health care insurers met with the Obama Administration to argue that they are bit players in a much larger production.
The meeting, called by U.S. Department of Health and Human Services Secretary Kathleen Sebelius, focused on premium increases by large insurance companies, the growing focus of health care reform efforts in Washington, D.C., amid a shaky economy.
The White House meeting included Sebelius and chief executives from UnitedHealth Group, WellPoint, Aetna, Health Care Service Corp. and CIGNA, along with a brief appearance by President Barack Obama.
White House spokesman Robert Gibbs said the president “stopped by” the March 4 meeting, armed with a letter from a 50-year-old woman from Ohio, diagnosed with carcinoma and struggling to find affordable health insurance, pleading with the president for help. Gibbs said the letter was “to remind everyone what’s at stake with the final push for health care reform and …what happens if we walk away.” He added that the president talked about the need for comprehensive reform with the health insurance executives, the need to stop blocking such reform on their part and echoed Sebelius’ call for actuarial data justifying large increases in premiums “at a time in which health care inflation is not nearly on the order of magnitude of what we’ve seen here.”
Following the meeting, Sebelius said the nation needs “some transparency” for “people to understand what’s going on.” She said the meeting “focused on what is happening with the kind of jaw-dropping rate increases that people are seeing,” according to media reports.
A Matter of Rising Costs
Ronald Williams, chairman and CEO of Aetna, was one of the attendees of the meeting and told PBS’ Nightly Business Report the session “was a strong focus on understanding the impact that these rate increases are having on working families and individuals who may be reaching the limits of affordability for individual health insurance.”
He added that all parties had a “constructive dialogue” on what is driving rate increases and steps needed to make individual insurance more affordable and sustainable for the future.
“But I think we have to start with the increase in the premium is based on the increase in the health care cost,” Williams said. “And so the premium is a cumulative result of how much more hospitals need and get in their renewals. Some hospitals are asking [for] 40% increases.”
Williams cited increases in pharmaceuticals, in physicians’ cost device and younger, healthier people dropping insurance, making the larger pool “progressively composed of those individuals who tend to be older and sicker and use more services.”
In a statement, UnitedHealth Group President and CEO Stephen J. Hemsley said, “To achieve true and sustainable reform, it is essential to first bring costs under control.
“Trying to focus the debate on insurance premiums masks the complexity of the challenge our country faces to effectively reform our health care system.,” he said. “The cost of insurance is driven by the underlying cost pressures we see throughout the health care system. The majority of our medical cost increases will be from hospitals and doctors charging higher prices and, to a lesser extent, from increased treatment volumes.”
Hemsley added that UnitedHealth Group knows “from first-hand experience” the financial challenges facing nearly 70 million Americans and wants to help find the solution.
“Unfortunately, up to this point the health reform debate has yet to truly confront the cost issue,” he said. “Our participation in today’s meeting affirms our commitment to constructive engagement and a desire to identify a fiscally responsible, sustainable path forward that truly bends the cost curve. If we can slow the soaring cost of care, our shared goal of expanding access and improving quality will be achievable.”
Regulators’ role
Also attending the session were four of the nation’s insurance regulators, representing the National Association of Insurance Commissioners (NAIC).
In a statement, the NAIC said its representatives stressed the importance of thorough and objective rate review, echoing the call for actuarially justified work without discriminating unfairly against any policyholders.
“It is absolutely critical that the state role in assuring the solvency of health plans and promoting competitive markets be preserved,” said Sandy Praeger, chair of the NAIC Health Insurance and Managed Care Committee and Kansas insurance commissioner. “Protecting consumers from high premiums remains a priority, but it is even more important to protect them from insolvency.”
President Obama has said that he is incorporating GOP ideas into the final last ditch effort to enact health care reform. From the GOP he has heard repeatedly that his plan does not control rising health care costs.
Then on March 5th, as detailed in the article below, he met with Insurers that told him, and his Secretary of Health Kathleen Sebelius, that health care costs are the real problem. His chief budgetary advisor Peter Orszag has also been talking about this for a year. Let's hope its beginning to sink in.
-----------------
White House Holds Meeting with Top Insurers
Increasingly cast as the villain in the nation’s rising cost for health care, five of the nation’s largest health care insurers met with the Obama Administration to argue that they are bit players in a much larger production.
The meeting, called by U.S. Department of Health and Human Services Secretary Kathleen Sebelius, focused on premium increases by large insurance companies, the growing focus of health care reform efforts in Washington, D.C., amid a shaky economy.
The White House meeting included Sebelius and chief executives from UnitedHealth Group, WellPoint, Aetna, Health Care Service Corp. and CIGNA, along with a brief appearance by President Barack Obama.
White House spokesman Robert Gibbs said the president “stopped by” the March 4 meeting, armed with a letter from a 50-year-old woman from Ohio, diagnosed with carcinoma and struggling to find affordable health insurance, pleading with the president for help. Gibbs said the letter was “to remind everyone what’s at stake with the final push for health care reform and …what happens if we walk away.” He added that the president talked about the need for comprehensive reform with the health insurance executives, the need to stop blocking such reform on their part and echoed Sebelius’ call for actuarial data justifying large increases in premiums “at a time in which health care inflation is not nearly on the order of magnitude of what we’ve seen here.”
Following the meeting, Sebelius said the nation needs “some transparency” for “people to understand what’s going on.” She said the meeting “focused on what is happening with the kind of jaw-dropping rate increases that people are seeing,” according to media reports.
A Matter of Rising Costs
Ronald Williams, chairman and CEO of Aetna, was one of the attendees of the meeting and told PBS’ Nightly Business Report the session “was a strong focus on understanding the impact that these rate increases are having on working families and individuals who may be reaching the limits of affordability for individual health insurance.”
He added that all parties had a “constructive dialogue” on what is driving rate increases and steps needed to make individual insurance more affordable and sustainable for the future.
“But I think we have to start with the increase in the premium is based on the increase in the health care cost,” Williams said. “And so the premium is a cumulative result of how much more hospitals need and get in their renewals. Some hospitals are asking [for] 40% increases.”
Williams cited increases in pharmaceuticals, in physicians’ cost device and younger, healthier people dropping insurance, making the larger pool “progressively composed of those individuals who tend to be older and sicker and use more services.”
In a statement, UnitedHealth Group President and CEO Stephen J. Hemsley said, “To achieve true and sustainable reform, it is essential to first bring costs under control.
“Trying to focus the debate on insurance premiums masks the complexity of the challenge our country faces to effectively reform our health care system.,” he said. “The cost of insurance is driven by the underlying cost pressures we see throughout the health care system. The majority of our medical cost increases will be from hospitals and doctors charging higher prices and, to a lesser extent, from increased treatment volumes.”
Hemsley added that UnitedHealth Group knows “from first-hand experience” the financial challenges facing nearly 70 million Americans and wants to help find the solution.
“Unfortunately, up to this point the health reform debate has yet to truly confront the cost issue,” he said. “Our participation in today’s meeting affirms our commitment to constructive engagement and a desire to identify a fiscally responsible, sustainable path forward that truly bends the cost curve. If we can slow the soaring cost of care, our shared goal of expanding access and improving quality will be achievable.”
Regulators’ role
Also attending the session were four of the nation’s insurance regulators, representing the National Association of Insurance Commissioners (NAIC).
In a statement, the NAIC said its representatives stressed the importance of thorough and objective rate review, echoing the call for actuarially justified work without discriminating unfairly against any policyholders.
“It is absolutely critical that the state role in assuring the solvency of health plans and promoting competitive markets be preserved,” said Sandy Praeger, chair of the NAIC Health Insurance and Managed Care Committee and Kansas insurance commissioner. “Protecting consumers from high premiums remains a priority, but it is even more important to protect them from insolvency.”
Friday, February 26, 2010
How to Fix the Cost Issue.... while increasing quality
Insuring Resources Commentary--
Yesterday at the Wisconsin State Capitol a leading expert on cost and quality issues in ehalth care gave a presentation to state lawmakers and others.
Here are some of the details:
Dartmouth Atlas Author Sees ACOs as Solution to Cost, Quality Concerns
Elliott Fisher, MD, Professor of Medicine at Dartmouth Medical School, presented his ideas on how Accountable Care Organizations (ACOs) could be promoted and implemented as a way to improve population health and lower costs. Fisher presented to a group of health care professionals and policymakers on February 25 in the State Capitol at a forum sponsored by the Evidence Based Health Policy Project. Fisher was a principal author of the Dartmouth Atlas that highlighted wide variations in national Medicare spending and utilization. The Atlas showed Wisconsin as having among the nation’s lowest Medicare costs, mainly due to more efficient provision of care.
The ACO model envisions provider organizations that can effectively manage the full continuum of care as real or virtually-integrated local delivery systems. This structure would be joined with targeted spending levels and health care performance measures to help achieve lower costs and better outcomes, with the providers sharing in any savings.
Fisher said while the ACO model is relatively new, it has shown promise in a number of settings. "Aligning financial and professional incentives, together with having better information that engages physicians and consumers, will enhance their ability to improve health and lower costs." He added that those areas of the country that have ACOs in place tend to have shared aims, physician engagement, use of data to drive change, and communities that are energized to make it happen.
Fisher recommends that policymakers promote the proliferation of the ACO model by legislation (as in enacting Medicare ACOs) or by easing regulatory barriers that complicate the formation of ACOs.
Yesterday at the Wisconsin State Capitol a leading expert on cost and quality issues in ehalth care gave a presentation to state lawmakers and others.
Here are some of the details:
Dartmouth Atlas Author Sees ACOs as Solution to Cost, Quality Concerns
Elliott Fisher, MD, Professor of Medicine at Dartmouth Medical School, presented his ideas on how Accountable Care Organizations (ACOs) could be promoted and implemented as a way to improve population health and lower costs. Fisher presented to a group of health care professionals and policymakers on February 25 in the State Capitol at a forum sponsored by the Evidence Based Health Policy Project. Fisher was a principal author of the Dartmouth Atlas that highlighted wide variations in national Medicare spending and utilization. The Atlas showed Wisconsin as having among the nation’s lowest Medicare costs, mainly due to more efficient provision of care.
The ACO model envisions provider organizations that can effectively manage the full continuum of care as real or virtually-integrated local delivery systems. This structure would be joined with targeted spending levels and health care performance measures to help achieve lower costs and better outcomes, with the providers sharing in any savings.
Fisher said while the ACO model is relatively new, it has shown promise in a number of settings. "Aligning financial and professional incentives, together with having better information that engages physicians and consumers, will enhance their ability to improve health and lower costs." He added that those areas of the country that have ACOs in place tend to have shared aims, physician engagement, use of data to drive change, and communities that are energized to make it happen.
Fisher recommends that policymakers promote the proliferation of the ACO model by legislation (as in enacting Medicare ACOs) or by easing regulatory barriers that complicate the formation of ACOs.
The Health Care Summit Condensed in 4 minutes
Insuring Resources Commentary:
See this for a quick summary: http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/
Philosophical differences between the Democrats and Republicans ruled the day.
Mitch McConnell (Rep- KY) argued for starting over one step at a time starting with a blank page. Sen. LaMar Thompson (R-Tenn) argued, "We don't do comprehensive well."
Sen. Tom Harkin (Dem- Iowa) argued that a comprehensive bill is necessary because its all intertwined. He's right and here's why.
1. Everyone agrees we need to eliminate pre-existing conditions. Slam dunk.
2. The first item however requires the implementation of an individual mandate or else people will wait to purchase health insurance until they get sick. If we allow that prices will be much higher because of the risk associated with insuring those individuals.
3. #2 requires the implementation of health insurance exchanges to cover individuals and small businesses to pool the risk and put millions of people in to groups to spread the risk. If we require individuals to purchase their own insurance premiums will be astronomical.... but that is what Cong. Paul Ryan (Rep- Wisconsin) wants to do by providing individuals a $2500 tax credit. That would buy about two- three months of health insurance if we have people do it on their own.
The Republicans oppose both # 2 and # 3.
Here's more from Paul Ryan- fact checking provided by Politico.com
Ryan overhypes Medicare Advantage hit
Rep. Paul Ryan (R-Wis.) claimed that under the Democrats’ plan, millions of seniors will lose their Medicare Advantage plans.
Not quite.
According to health policy experts, it’s fair to say that if the Democrats have their way, the benefits provided by Medicare Advantage will be reduced — which means that a number of seniors might choose not to enroll in the program in the future. That doesn’t mean people are going to “lose” their plans, exactly — just that fewer are likely to enroll. Seniors would still be guaranteed their traditional Medicare benefits.
Then I saw former Senator Bill Frist on MSNBC this morning and he talked about cost and changing how health care is performed and financed. He talked aboput more efficient and quality care through provider incentives. He gets it and a lot of Republicans do as well. I don't get why the Democrats still don't get this point because it could be the bridge to a major compromise..... as I've said here since August. Senator Kohl (D- Wisconsin) offered an amendment to the Senate Bill on Dec. 14th to take a huge step toward this but the amendment FAILED. At the time the Democrats had a 60-40 advantage in the Senate, and yes the amendment offered by a Democratic Senator from a blue state, FAILED.
--------------------
Link to a 4 minute video summary
http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/
See this for a quick summary: http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/
Philosophical differences between the Democrats and Republicans ruled the day.
Mitch McConnell (Rep- KY) argued for starting over one step at a time starting with a blank page. Sen. LaMar Thompson (R-Tenn) argued, "We don't do comprehensive well."
Sen. Tom Harkin (Dem- Iowa) argued that a comprehensive bill is necessary because its all intertwined. He's right and here's why.
1. Everyone agrees we need to eliminate pre-existing conditions. Slam dunk.
2. The first item however requires the implementation of an individual mandate or else people will wait to purchase health insurance until they get sick. If we allow that prices will be much higher because of the risk associated with insuring those individuals.
3. #2 requires the implementation of health insurance exchanges to cover individuals and small businesses to pool the risk and put millions of people in to groups to spread the risk. If we require individuals to purchase their own insurance premiums will be astronomical.... but that is what Cong. Paul Ryan (Rep- Wisconsin) wants to do by providing individuals a $2500 tax credit. That would buy about two- three months of health insurance if we have people do it on their own.
The Republicans oppose both # 2 and # 3.
Here's more from Paul Ryan- fact checking provided by Politico.com
Ryan overhypes Medicare Advantage hit
Rep. Paul Ryan (R-Wis.) claimed that under the Democrats’ plan, millions of seniors will lose their Medicare Advantage plans.
Not quite.
According to health policy experts, it’s fair to say that if the Democrats have their way, the benefits provided by Medicare Advantage will be reduced — which means that a number of seniors might choose not to enroll in the program in the future. That doesn’t mean people are going to “lose” their plans, exactly — just that fewer are likely to enroll. Seniors would still be guaranteed their traditional Medicare benefits.
Then I saw former Senator Bill Frist on MSNBC this morning and he talked about cost and changing how health care is performed and financed. He talked aboput more efficient and quality care through provider incentives. He gets it and a lot of Republicans do as well. I don't get why the Democrats still don't get this point because it could be the bridge to a major compromise..... as I've said here since August. Senator Kohl (D- Wisconsin) offered an amendment to the Senate Bill on Dec. 14th to take a huge step toward this but the amendment FAILED. At the time the Democrats had a 60-40 advantage in the Senate, and yes the amendment offered by a Democratic Senator from a blue state, FAILED.
--------------------
Link to a 4 minute video summary
http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/
Wednesday, February 24, 2010
Something has been missing from the debate...
Insuring Resources Commentary:
Please view this very informative podcast on the American obesity epidemic.
https://www.brainshark.com/brainshark/vu/view.asp?pi=801897475
So far on this blog I've barely touched on a key factor within the issue of improving health outcomes facing America's health care system. The epidemic of obesity. Better late than never I guess because this is a costly problem that we need to address and fix very soon. Here's some startling statistics:
Currently 64% of U.S. adults are either overweight or obese. What's an easy test? 80% of U.S. men with a waist size of 40 or above are obese.
Obesity is defined as: A person has traditionally been considered to be obese if they are more than 20 percent over their ideal weight. That ideal weight must take into account the person's height, age, sex, and build.
My ideal weight is between 160- 196lbs, that;s a huge range. So let's take the midpoint of 178 lbs. 20% more than that would be about 36 lbs or 214 lbs. At my heaviest when I was 34 I briefly weighed 217. I was most likely obese. Now I'm about 190-192.
34% of US adults are obese.
In the podcast Dr. Handel says that if we returned to 1987 obesity levels we could cover all our uninsured Americans in full right NOW.
What about children? 40% are either overweight or obese today. That means our future workforce is ENTERING employment with a chronic health condition that decreases their productivity and increases their health care costs.
What's the projection for 2030 if we don't get a handle on this?
In 2030 90% of Americans will be overweight or obese.
What's the Solution? Employer incentives within health care reform to introduce and or expand worksite wellness programs focusing on better nutrition, exercise and employee incentives. as Dr. Handel says in the podcast we also need to look at disincentives for not taking action meaning increased health insurance premiums for those who remain obese or for employers without wellness programs.
Please view this very informative podcast on the American obesity epidemic.
https://www.brainshark.com/brainshark/vu/view.asp?pi=801897475
So far on this blog I've barely touched on a key factor within the issue of improving health outcomes facing America's health care system. The epidemic of obesity. Better late than never I guess because this is a costly problem that we need to address and fix very soon. Here's some startling statistics:
Currently 64% of U.S. adults are either overweight or obese. What's an easy test? 80% of U.S. men with a waist size of 40 or above are obese.
Obesity is defined as: A person has traditionally been considered to be obese if they are more than 20 percent over their ideal weight. That ideal weight must take into account the person's height, age, sex, and build.
My ideal weight is between 160- 196lbs, that;s a huge range. So let's take the midpoint of 178 lbs. 20% more than that would be about 36 lbs or 214 lbs. At my heaviest when I was 34 I briefly weighed 217. I was most likely obese. Now I'm about 190-192.
34% of US adults are obese.
In the podcast Dr. Handel says that if we returned to 1987 obesity levels we could cover all our uninsured Americans in full right NOW.
What about children? 40% are either overweight or obese today. That means our future workforce is ENTERING employment with a chronic health condition that decreases their productivity and increases their health care costs.
What's the projection for 2030 if we don't get a handle on this?
In 2030 90% of Americans will be overweight or obese.
What's the Solution? Employer incentives within health care reform to introduce and or expand worksite wellness programs focusing on better nutrition, exercise and employee incentives. as Dr. Handel says in the podcast we also need to look at disincentives for not taking action meaning increased health insurance premiums for those who remain obese or for employers without wellness programs.
Monday, February 8, 2010
Health Care Reform Summit Feb 25th
Insuring Resurces Commentary:
This summit creates a next step for health-care reform. The House and the Senate have not been able to agree on a path forward. The president is bringing the two houses together, but not starting over. The basis for the discussion will be the two bills that have already passed, but the discussion is aimed at leading a way forward which means there may be some alterations in hopes of getting a few Republican votes.
The President, I presume will also use the occasion to change the perception on the back room Senate deals for multiple conservative Democratic Senators. But by setting this summit, he's bought them a few weeks to figure out how to hold a vote themselves. That won't be easy, but it'll be easier with the White House summit giving some structure and narrative to an effort that had collapsed into murky chaos.
Hopefully a way forward will highlight cost efficiency and quality which the GOP has been touting. Now's the time to play that card in front of a television audience.
-------------------- ------------------------------
From the Wall Street Journal- 2/8/10
President Barack Obama, seeking to give new momentum to his languishing health-care legislation, said he would sit down with Republican and Democratic lawmakers to exchange ideas on an issue that has deeply divided the parties.
With the GOP united against the Democratic bill, Mr. Obama said Sunday he would ask Republicans "to put their ideas on the table." The half-day meeting will be Feb. 25 and broadcast live, the White House said.
"I want to come back and have a large meeting, Republicans and Democrats, to go through systematically all the best ideas that are out there and move it forward," the president told CBS in an interview broadcast Sunday.
This summit creates a next step for health-care reform. The House and the Senate have not been able to agree on a path forward. The president is bringing the two houses together, but not starting over. The basis for the discussion will be the two bills that have already passed, but the discussion is aimed at leading a way forward which means there may be some alterations in hopes of getting a few Republican votes.
The President, I presume will also use the occasion to change the perception on the back room Senate deals for multiple conservative Democratic Senators. But by setting this summit, he's bought them a few weeks to figure out how to hold a vote themselves. That won't be easy, but it'll be easier with the White House summit giving some structure and narrative to an effort that had collapsed into murky chaos.
Hopefully a way forward will highlight cost efficiency and quality which the GOP has been touting. Now's the time to play that card in front of a television audience.
-------------------- ------------------------------
From the Wall Street Journal- 2/8/10
President Barack Obama, seeking to give new momentum to his languishing health-care legislation, said he would sit down with Republican and Democratic lawmakers to exchange ideas on an issue that has deeply divided the parties.
With the GOP united against the Democratic bill, Mr. Obama said Sunday he would ask Republicans "to put their ideas on the table." The half-day meeting will be Feb. 25 and broadcast live, the White House said.
"I want to come back and have a large meeting, Republicans and Democrats, to go through systematically all the best ideas that are out there and move it forward," the president told CBS in an interview broadcast Sunday.
Friday, February 5, 2010
More Evidence for Health CARE Reform
This is Data from the federal Centers for Medicare and Medicaid Services:
------------------------
Source: Health Affairs
February 05, 2010
Health care's share of the economy grew 1.1 percentage points in 2009 - the largest one-year increase in GDP share since the federal government began keeping track in 1960:
Rising health care costs are crushing our economy and adding a burden on working families and employers across the country. The new CMS data confirm that rising health care costs are driven by increases in underlying medical costs, not health plan administrative costs. In fact, the proportion of health insurance premiums that go towards administrative costs is declining as overall health care costs continue to soar. Without a national, long-term strategy to address the rapid growth in underlying medical costs, health care spending will continue to grow far faster than the economy as a whole, crowding out other important domestic priorities, such as education, energy, and deficit reduction.
The report, published today in Health Affairs, notes that the "two primary drivers of growth…are medical prices and utilization", which saw a projected increase in spending by 3.2 percent and 1.5 percent in 2009, respectively. Other key findings include:
"Hospital spending growth is projected to have accelerated from 4.5 percent in 2008 to 5.9 percent in 2009, as spending reached $760.6 billion."
"Spending growth for physician and clinical services is expected to have accelerated to 6.3 percent in 2009, up from 5.0 percent in 2008, with expenditures having reached $527.6 billion."
"Prescription drug spending is expected to have grown 5.2 percent in 2009, an acceleration of 2.0 percentage points from 2008, and to have reached $246.3 billion."
This is consistent with national data and information received from health plans (PDF) showing that health care costs are expected to increase even further due to the underlying growth in the cost of health care services.
------------------------
Source: Health Affairs
February 05, 2010
Health care's share of the economy grew 1.1 percentage points in 2009 - the largest one-year increase in GDP share since the federal government began keeping track in 1960:
Rising health care costs are crushing our economy and adding a burden on working families and employers across the country. The new CMS data confirm that rising health care costs are driven by increases in underlying medical costs, not health plan administrative costs. In fact, the proportion of health insurance premiums that go towards administrative costs is declining as overall health care costs continue to soar. Without a national, long-term strategy to address the rapid growth in underlying medical costs, health care spending will continue to grow far faster than the economy as a whole, crowding out other important domestic priorities, such as education, energy, and deficit reduction.
The report, published today in Health Affairs, notes that the "two primary drivers of growth…are medical prices and utilization", which saw a projected increase in spending by 3.2 percent and 1.5 percent in 2009, respectively. Other key findings include:
"Hospital spending growth is projected to have accelerated from 4.5 percent in 2008 to 5.9 percent in 2009, as spending reached $760.6 billion."
"Spending growth for physician and clinical services is expected to have accelerated to 6.3 percent in 2009, up from 5.0 percent in 2008, with expenditures having reached $527.6 billion."
"Prescription drug spending is expected to have grown 5.2 percent in 2009, an acceleration of 2.0 percentage points from 2008, and to have reached $246.3 billion."
This is consistent with national data and information received from health plans (PDF) showing that health care costs are expected to increase even further due to the underlying growth in the cost of health care services.
Saturday, January 23, 2010
What a Bipartisan Bill May Look Like.... if we get one at all
Insuring Resources Commentary:
Below is a link to a New York Times article depicting possible items included in a health care reform package. In this NY Times reporter's analysis of conversations with lawmakers, aides and health care policy experts he compiled these items as still doable in the post Super-majority Democratic Senate health care reform era. His list is similar to the blog post I provided a few days ago so you get the benefit of my analysis of what's possible again.
Here's my further analysis of these items:
-No pre-x for children makes sense, this probably has 85-90% support in both houses and would be agreed to easily in any health care bill.
-Dependent coverage up to age 25 is also a given. Wisconsin just approved this in 2009, effective 1/1/2010 for ages up to 27. This too would have substantial bi-partisan support.
-Grants to establish state-based health insurance exchanges for individuals and small businesses. This probably would pass both houses as it would most likely not be mandated for businesses or individuals. This could help alleviate some cost pressures for these groups. If a wide range of coverage options were offered through the Exchanges and states were encouraged to be innovative this could be very positive.
-The fed. gov't offer financial incentives for state Medicaid expansion to cover childless adults and parents. Wisconsin, with its BadgerCare program and other states who have already done this, would not be happy about this measure. In those cases perhaps there can be adjustments or bonuses to state's who go above and beyond the minimum or who have already accomplished it. This too has broad bipartisan support as long as Nebraska doesn't get its Cornhusker Kickback. Special deals cannot be a part of a compromise bill at this point. The public backlash would be too enormous.
-Tax credits for small business purchase of health insurance-- This is very bi-partisan friendly as most GOP health care proposals, including those offered by Rep. Paul Ryan (R-Janesville) and Sen. John McCain (R-Arizona), were centered on tax credit use to purchase health insurance.
This would perhaps get more GOP than Dems supporting it and would pass both houses.
For a lengthy analysis I authored of the Paul Ryan proposal for WPRI
2 years ago go to the web link at the upper left hand sidebar.
-The package could also include changes in Medicare, to reduce the growth in payments to doctors and hospitals while rewarding providers of high-quality, lower-cost care. To help older Americans, it could narrow a gap in Medicare coverage of prescription drugs, sometimes known as a doughnut hole. I don't understand why again the incentives only apply to Medicare for high quality, more efficient care. I just don't get why Congress is so reluctant to address the whole system rather than just Medicare. If they're going to make regulatory changes why sell it short and stop only at Medicare rather than addressing the whole system and the whole cost problem.
See link below to read the whole article
---------------------
From the New York Times article
"A New Search for Consensus on Health Care Bill"
The entire article linked: http://www.nytimes.com/2010/01/22/health/policy/22health.html?ref=todayspaper
By ROBERT PEAR and DAVID M. HERSZENHORN
Published: January 21, 2010
Below is a link to a New York Times article depicting possible items included in a health care reform package. In this NY Times reporter's analysis of conversations with lawmakers, aides and health care policy experts he compiled these items as still doable in the post Super-majority Democratic Senate health care reform era. His list is similar to the blog post I provided a few days ago so you get the benefit of my analysis of what's possible again.
Here's my further analysis of these items:
-No pre-x for children makes sense, this probably has 85-90% support in both houses and would be agreed to easily in any health care bill.
-Dependent coverage up to age 25 is also a given. Wisconsin just approved this in 2009, effective 1/1/2010 for ages up to 27. This too would have substantial bi-partisan support.
-Grants to establish state-based health insurance exchanges for individuals and small businesses. This probably would pass both houses as it would most likely not be mandated for businesses or individuals. This could help alleviate some cost pressures for these groups. If a wide range of coverage options were offered through the Exchanges and states were encouraged to be innovative this could be very positive.
-The fed. gov't offer financial incentives for state Medicaid expansion to cover childless adults and parents. Wisconsin, with its BadgerCare program and other states who have already done this, would not be happy about this measure. In those cases perhaps there can be adjustments or bonuses to state's who go above and beyond the minimum or who have already accomplished it. This too has broad bipartisan support as long as Nebraska doesn't get its Cornhusker Kickback. Special deals cannot be a part of a compromise bill at this point. The public backlash would be too enormous.
-Tax credits for small business purchase of health insurance-- This is very bi-partisan friendly as most GOP health care proposals, including those offered by Rep. Paul Ryan (R-Janesville) and Sen. John McCain (R-Arizona), were centered on tax credit use to purchase health insurance.
This would perhaps get more GOP than Dems supporting it and would pass both houses.
For a lengthy analysis I authored of the Paul Ryan proposal for WPRI
2 years ago go to the web link at the upper left hand sidebar.
-The package could also include changes in Medicare, to reduce the growth in payments to doctors and hospitals while rewarding providers of high-quality, lower-cost care. To help older Americans, it could narrow a gap in Medicare coverage of prescription drugs, sometimes known as a doughnut hole. I don't understand why again the incentives only apply to Medicare for high quality, more efficient care. I just don't get why Congress is so reluctant to address the whole system rather than just Medicare. If they're going to make regulatory changes why sell it short and stop only at Medicare rather than addressing the whole system and the whole cost problem.
See link below to read the whole article
---------------------
From the New York Times article
"A New Search for Consensus on Health Care Bill"
The entire article linked: http://www.nytimes.com/2010/01/22/health/policy/22health.html?ref=todayspaper
By ROBERT PEAR and DAVID M. HERSZENHORN
Published: January 21, 2010
Wednesday, January 20, 2010
Health care reform divide grows deeper
Insuring Resources Commentary
I attended the Wisconsin Insurance Commissioner's Health Insurance Advisory Committee yesterday where we received an update on health care reform from the Nat'l Assoc. of Insurance Commissioners. I am an appointed member of the committee.
With the Massachusetts Senate victory by the GOP last night the next two weeks will define what happens with health care reform. The legislative options depicted by NAIC were not pretty and we'll see if they can compromise to improve U.S. health care. The Democrats need a Republican to pass it and that's unlikely. Hopefully they get past the rhetoric and enact true bipartisan reform that focuses on quality and efficiency while ending pre-exisitng condition exclusions and covering the majority of the uninsured.
Its ironic, for me anyway, that at the same OCI meeting we also heard an update from WHIO--- the Wisconsin Health Information Organization http://www.wisconsinhealthinfo.org/. They have established a database of 7.3 million episodes of care for 1.5 million Wisconsinites from their insurer, provider and employer health care purchasing partners. As you've heard me say before, episodes of care reimbursement is how we should reform U.S. health care to emphasize quality and efficiency and create true cost competition on both the health care and health insurance sides of the equation. Through the WHIO database providers quality and efficiency can be compared against their peers and national standards to improve health outcomes and efficiency.
I've attached the article below as it illustrates the health care debate specifically in Wisconsin and the impact of Tea Party's and the anti-gov't backlash of doing health care reform incorrectly.
--------------- -----------------
From the Jan. 19th Milwaukee Journal Sentinel
Jeff Uhlir, an accountant from Manitowoc, opposes the health care reform legislation making its way through Congress and wants more competition among private insurers to drive down costs.
"I think Americans, given the opportunity and freedom, will get their own health insurance," said Uhlir, who recently attended a tea party rally.
Barbara Aho, a self-employed landscape designer from Milwaukee, wants health care reform and wants it now.
"I don't know any health insurance company that has gone broke," she said.
The fight over health care has divided the country for nearly a year, and rather than losing steam, it appears to be reaching a fever pitch locally and nationally.
In Wisconsin, several thousand people turned out Saturday for an anti-tax "tea party" rally in Racine County. People in the movement oppose key planks of the Obama agenda, including health care reform.
And U.S. Sen. Russ Feingold, a Democrat, has been getting blistered at recent listening sessions, which he holds regularly across the state. Last week, a standing-room-only crowd at Waukesha County Technical College in Pewaukee, a Republican stronghold, overwhelmingly opposed Obama's health care effort. They questioned in particular how Feingold could champion transparency in government while negotiations on the health care legislation continue behind closed doors. Several in the crowd told Feingold that if he voted for the health care bill, he should be voted out of office. Feingold faces re-election in the fall.
Tuesday, Feingold was on Democratic home turf, holding a listening session at Washington High School in Milwaukee. The crowd there was more supportive of health care reform. If anything, several of the speakers voiced displeasure that Democrats didn't go further in the legislation by introducing a so-called public option, allowing people to buy health insurance from the government.
"I'm not surprised by the Milwaukee meeting being more favorable toward the president's plan and the Waukesha meeting being less favorable," Feingold told reporters. "I wouldn't know much about Wisconsin if I didn't know that."
Nevertheless, Rep. Jim Sensenbrenner of Menomonee Falls put in a total of 25 town hall meetings and office hour events during the recent long holiday weekend, and said people are angrier than ever over health care legislation. Compared with the comments he heard in September and October, "these were more heated, more emphatic and more concerned" as a possible final vote looms while people become more familiar with what is in the bill, he said. Sensenbrenner said people are particularly angry about the sweet deals certain lawmakers were able to carve out for their own states, such as an exemption that would allow Florida seniors to keep their Medicare Advantage plans.
Even "the few people who spoke up in favor of the bill said it had its problems," he said.
Regarding the feedback Feingold has been getting at town hall meetings, Sensenbrenner said: "I don't think he had a good two weeks."
2010 midterm impact
Even if the Democrats do get their reform bill through Congress - and to President Barack Obama's desk for signature - the issue will likely continue to resonate with the public all the way to the 2010 midterm elections.
The bill's opponents have criticized everything from what's in the bill to how it was created to the fact it was passed in the Senate on Christmas Eve. The bill's supporters have said the reform measure will insure up to 30 million people who don't currently have insurance.
And get this: According to a Jan. 8-10 Gallup survey, Americans want their member of Congress to vote for health care legislation by a margin of 49% to 46%. Yet a recent Pew Center survey found 39% favored the health care bills before Congress while 49% opposed them.
"If you think all of those people that say they don't want the bill, are people that don't want health reform - there's a good chunk of them who want a much stronger bill," Feingold said. "I think the largest group is probably the people that are for the bill. The second largest group is the people that are against the bill because they don't think they want to do anything. And then there is a third group, which is significant because they want a stronger bill."
Feingold supported the Senate version of the bill, which he said "is a reasonable compromise. It is not a government takeover of health care."
Candice Owley, a local labor leader and former nurse from Milwaukee, said two of her sons are in the restaurant business, and only one of them has health care.
"People's lives are on the line," she said later, explaining why she supported reform legislation. "We have to get moving and get the bill passed."
But Lynne Wallis, a saleswoman from Whitefish Bay, told Feingold that she supported him in previous Senate races but won't back him this fall because of his support for the Senate health care bill.
"The government does not belong in health care," she said.
Feingold responded that Medicare and the health system for veterans are government programs.
Later, Wallis said that if a vote of the American people were taken now, the reform bill "would not pass."
The next closest thing may have happened Tuesday in Massachusetts. Republican Scott Brown defeated Democrat Martha Coakley in a special election to fill the Senate seat held by the late Ted Kennedy. Brown, who opposes the reform legislation, will become the Republicans' 41st senator, smashing the Democrats' filibuster-proof supermajority in the Senate.
That could change everything, and give added fuel to the opposition.
"I can't go grocery shopping or fill up my gas tank without my neighbors asking how we can stop this train wreck and encouraging me to keep up the fight against this," Rep. Paul Ryan of Janesville said in a statement. "These aren't just Republicans. Independents and Democrats even are fed up with Washington, sick of being shut out of the process, and genuinely worried with just how quickly the federal government is encroaching into their lives."
I attended the Wisconsin Insurance Commissioner's Health Insurance Advisory Committee yesterday where we received an update on health care reform from the Nat'l Assoc. of Insurance Commissioners. I am an appointed member of the committee.
With the Massachusetts Senate victory by the GOP last night the next two weeks will define what happens with health care reform. The legislative options depicted by NAIC were not pretty and we'll see if they can compromise to improve U.S. health care. The Democrats need a Republican to pass it and that's unlikely. Hopefully they get past the rhetoric and enact true bipartisan reform that focuses on quality and efficiency while ending pre-exisitng condition exclusions and covering the majority of the uninsured.
Its ironic, for me anyway, that at the same OCI meeting we also heard an update from WHIO--- the Wisconsin Health Information Organization http://www.wisconsinhealthinfo.org/. They have established a database of 7.3 million episodes of care for 1.5 million Wisconsinites from their insurer, provider and employer health care purchasing partners. As you've heard me say before, episodes of care reimbursement is how we should reform U.S. health care to emphasize quality and efficiency and create true cost competition on both the health care and health insurance sides of the equation. Through the WHIO database providers quality and efficiency can be compared against their peers and national standards to improve health outcomes and efficiency.
I've attached the article below as it illustrates the health care debate specifically in Wisconsin and the impact of Tea Party's and the anti-gov't backlash of doing health care reform incorrectly.
--------------- -----------------
From the Jan. 19th Milwaukee Journal Sentinel
Jeff Uhlir, an accountant from Manitowoc, opposes the health care reform legislation making its way through Congress and wants more competition among private insurers to drive down costs.
"I think Americans, given the opportunity and freedom, will get their own health insurance," said Uhlir, who recently attended a tea party rally.
Barbara Aho, a self-employed landscape designer from Milwaukee, wants health care reform and wants it now.
"I don't know any health insurance company that has gone broke," she said.
The fight over health care has divided the country for nearly a year, and rather than losing steam, it appears to be reaching a fever pitch locally and nationally.
In Wisconsin, several thousand people turned out Saturday for an anti-tax "tea party" rally in Racine County. People in the movement oppose key planks of the Obama agenda, including health care reform.
And U.S. Sen. Russ Feingold, a Democrat, has been getting blistered at recent listening sessions, which he holds regularly across the state. Last week, a standing-room-only crowd at Waukesha County Technical College in Pewaukee, a Republican stronghold, overwhelmingly opposed Obama's health care effort. They questioned in particular how Feingold could champion transparency in government while negotiations on the health care legislation continue behind closed doors. Several in the crowd told Feingold that if he voted for the health care bill, he should be voted out of office. Feingold faces re-election in the fall.
Tuesday, Feingold was on Democratic home turf, holding a listening session at Washington High School in Milwaukee. The crowd there was more supportive of health care reform. If anything, several of the speakers voiced displeasure that Democrats didn't go further in the legislation by introducing a so-called public option, allowing people to buy health insurance from the government.
"I'm not surprised by the Milwaukee meeting being more favorable toward the president's plan and the Waukesha meeting being less favorable," Feingold told reporters. "I wouldn't know much about Wisconsin if I didn't know that."
Nevertheless, Rep. Jim Sensenbrenner of Menomonee Falls put in a total of 25 town hall meetings and office hour events during the recent long holiday weekend, and said people are angrier than ever over health care legislation. Compared with the comments he heard in September and October, "these were more heated, more emphatic and more concerned" as a possible final vote looms while people become more familiar with what is in the bill, he said. Sensenbrenner said people are particularly angry about the sweet deals certain lawmakers were able to carve out for their own states, such as an exemption that would allow Florida seniors to keep their Medicare Advantage plans.
Even "the few people who spoke up in favor of the bill said it had its problems," he said.
Regarding the feedback Feingold has been getting at town hall meetings, Sensenbrenner said: "I don't think he had a good two weeks."
2010 midterm impact
Even if the Democrats do get their reform bill through Congress - and to President Barack Obama's desk for signature - the issue will likely continue to resonate with the public all the way to the 2010 midterm elections.
The bill's opponents have criticized everything from what's in the bill to how it was created to the fact it was passed in the Senate on Christmas Eve. The bill's supporters have said the reform measure will insure up to 30 million people who don't currently have insurance.
And get this: According to a Jan. 8-10 Gallup survey, Americans want their member of Congress to vote for health care legislation by a margin of 49% to 46%. Yet a recent Pew Center survey found 39% favored the health care bills before Congress while 49% opposed them.
"If you think all of those people that say they don't want the bill, are people that don't want health reform - there's a good chunk of them who want a much stronger bill," Feingold said. "I think the largest group is probably the people that are for the bill. The second largest group is the people that are against the bill because they don't think they want to do anything. And then there is a third group, which is significant because they want a stronger bill."
Feingold supported the Senate version of the bill, which he said "is a reasonable compromise. It is not a government takeover of health care."
Candice Owley, a local labor leader and former nurse from Milwaukee, said two of her sons are in the restaurant business, and only one of them has health care.
"People's lives are on the line," she said later, explaining why she supported reform legislation. "We have to get moving and get the bill passed."
But Lynne Wallis, a saleswoman from Whitefish Bay, told Feingold that she supported him in previous Senate races but won't back him this fall because of his support for the Senate health care bill.
"The government does not belong in health care," she said.
Feingold responded that Medicare and the health system for veterans are government programs.
Later, Wallis said that if a vote of the American people were taken now, the reform bill "would not pass."
The next closest thing may have happened Tuesday in Massachusetts. Republican Scott Brown defeated Democrat Martha Coakley in a special election to fill the Senate seat held by the late Ted Kennedy. Brown, who opposes the reform legislation, will become the Republicans' 41st senator, smashing the Democrats' filibuster-proof supermajority in the Senate.
That could change everything, and give added fuel to the opposition.
"I can't go grocery shopping or fill up my gas tank without my neighbors asking how we can stop this train wreck and encouraging me to keep up the fight against this," Rep. Paul Ryan of Janesville said in a statement. "These aren't just Republicans. Independents and Democrats even are fed up with Washington, sick of being shut out of the process, and genuinely worried with just how quickly the federal government is encroaching into their lives."
Friday, January 15, 2010
Sen. Grassley says costs will increase with health reform
Insuring Resources Commentary:
Yet another opinion, on how the health care reform bills before us do not address the cost issue. This time a Republican Congressman- Sen. Grassley- cites the Congressional Budget Office and the Chief Actuary at the Dept. of Health and Human services who have analyzed the legislation and find that costs will increase.
Grassley was a key Republican in most of the Senate bill formulation talks in the fall but voted against the bill in committee and on the Senate floor because it did not address or attempt to control spiraling health care costs.
The bills do not create incentives for sustainable efficiency in the health care system. we need fundamental health care payment reform that incents efficiency based on quality health outcomes through episode of care based reimbursement. Drs and hospitals need to be paid based on outcomes not per procedure on a fee-for-service basis.
If reform does not address the cost issue the system will deteriorate further and premiums will increase.
----------------------- -------------------------
From the New York Times blog: Jan. 14, 2010
by DAVID M. HERSZENHORN
At the crux of the debate over major health care legislation is the question of why health care in America is so expensive – or to be more precise, why the cost of medical care has been growing far faster than the cost of everything else. It is far outpacing regular inflation and threatening to bust not only the federal budget but the finances of individuals and families as well.
Earlier this week the Prescriptions blog asked two experts of differing political perspectives to address two simple questions: Why is health care in American so expensive? And will the legislation emerging in Washington take sufficient steps to control costs? The experts, Joseph R. Antos, health policy researchers at the conservative American Enterprise Institute, and Jacob S. Hacker, a liberal proponent of a government-run insurance plan at Yale University, agreed – though for very different reasons – that the legislation would not do enough to control cost. You can read their responses here.
Next, Senator Max Baucus, Democrat of Montana, chairman of the Finance Committee and a leading architect of the legislation, weighed in with his own view that the bill incorporates virtually every idea put forward in the last 50 years to improve the health care system. Read the Baucus post.
Today, we hear from Mr. Baucus’s counterpart, Senator Charles E. Grassley of Iowa, the senior Republican on the Senate Finance Committee.
For months, Mr. Grassley was part of a small group of senators working to develop the legislation, but he ended up turning against the bill and opposing it both on the finance panel and on the Senate floor.
Mr. Grassley, who enjoys using Twitter to communicate with his constituents, offered the most succinct answer to the cost question so far.
“High costs come from flawed payment systems and defensive medicine,” Mr. Grassley wrote. “The system contains incentives that many times provide too much care and the wrong care, and there’s too much waste, fraud and abuse.”
Mr. Grassley’s opposition to the Democrats’ health care legislation is well known. Asked to elaborate on the reasons that he feels the bill will increase rather than decrease health care expenses, he offered the following.
A major goal for comprehensive health care reform was to lower spiraling costs, so it’s regrettable and really pretty unbelievable how the $2.5 trillion legislation that’s been passed fails to reduce rising costs. That judgment isn’t mine. It comes from the independent experts.
The nonpartisan Congressional Budget Office said on Dec. 19, “Under the legislation, federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care. The net increase in that commitment would be about $200 billion over that 10-year period.” The Congressional Budget Office and the Joint Committee on Taxation also estimated, on Nov. 30, that “the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law.”
Separately, the chief actuary for the Department of Health and Human Services said on Jan. 8 that under the Senate bill “total national health expenditures . . . would increase by an estimated total of $222 billion during calendar years 2010-2019.” In the same report, the chief actuary anticipated “an increase in overall national health expenditures ranging from $5.8 billion in 2011 to $13.8 billion in 2019.” The actuary said the Senate bill also would bend the spending growth curve upward for federal spending on health care, increasing it by $279 billion from 2010-2019.
These facts back up the majority opinion at the grassroots that health care bills passed by the House and Senate would make things worse, not better. Instead of sending this legislation to the president’s desk, Congress should work on the fundamental problems in the health care system and pass common sense medical malpractice reform to stop wasting so much money on defensive medicine, end pre-existing condition exclusions and waiting periods, start paying for value rather than volume, and empower consumers to shop around for health care and lower costs with competition, just like with other services we buy. Congress should make market reforms that help small businesses and the self-employed access health insurance.
Yet another opinion, on how the health care reform bills before us do not address the cost issue. This time a Republican Congressman- Sen. Grassley- cites the Congressional Budget Office and the Chief Actuary at the Dept. of Health and Human services who have analyzed the legislation and find that costs will increase.
Grassley was a key Republican in most of the Senate bill formulation talks in the fall but voted against the bill in committee and on the Senate floor because it did not address or attempt to control spiraling health care costs.
The bills do not create incentives for sustainable efficiency in the health care system. we need fundamental health care payment reform that incents efficiency based on quality health outcomes through episode of care based reimbursement. Drs and hospitals need to be paid based on outcomes not per procedure on a fee-for-service basis.
If reform does not address the cost issue the system will deteriorate further and premiums will increase.
----------------------- -------------------------
From the New York Times blog: Jan. 14, 2010
by DAVID M. HERSZENHORN
At the crux of the debate over major health care legislation is the question of why health care in America is so expensive – or to be more precise, why the cost of medical care has been growing far faster than the cost of everything else. It is far outpacing regular inflation and threatening to bust not only the federal budget but the finances of individuals and families as well.
Earlier this week the Prescriptions blog asked two experts of differing political perspectives to address two simple questions: Why is health care in American so expensive? And will the legislation emerging in Washington take sufficient steps to control costs? The experts, Joseph R. Antos, health policy researchers at the conservative American Enterprise Institute, and Jacob S. Hacker, a liberal proponent of a government-run insurance plan at Yale University, agreed – though for very different reasons – that the legislation would not do enough to control cost. You can read their responses here.
Next, Senator Max Baucus, Democrat of Montana, chairman of the Finance Committee and a leading architect of the legislation, weighed in with his own view that the bill incorporates virtually every idea put forward in the last 50 years to improve the health care system. Read the Baucus post.
Today, we hear from Mr. Baucus’s counterpart, Senator Charles E. Grassley of Iowa, the senior Republican on the Senate Finance Committee.
For months, Mr. Grassley was part of a small group of senators working to develop the legislation, but he ended up turning against the bill and opposing it both on the finance panel and on the Senate floor.
Mr. Grassley, who enjoys using Twitter to communicate with his constituents, offered the most succinct answer to the cost question so far.
“High costs come from flawed payment systems and defensive medicine,” Mr. Grassley wrote. “The system contains incentives that many times provide too much care and the wrong care, and there’s too much waste, fraud and abuse.”
Mr. Grassley’s opposition to the Democrats’ health care legislation is well known. Asked to elaborate on the reasons that he feels the bill will increase rather than decrease health care expenses, he offered the following.
A major goal for comprehensive health care reform was to lower spiraling costs, so it’s regrettable and really pretty unbelievable how the $2.5 trillion legislation that’s been passed fails to reduce rising costs. That judgment isn’t mine. It comes from the independent experts.
The nonpartisan Congressional Budget Office said on Dec. 19, “Under the legislation, federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care. The net increase in that commitment would be about $200 billion over that 10-year period.” The Congressional Budget Office and the Joint Committee on Taxation also estimated, on Nov. 30, that “the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law.”
Separately, the chief actuary for the Department of Health and Human Services said on Jan. 8 that under the Senate bill “total national health expenditures . . . would increase by an estimated total of $222 billion during calendar years 2010-2019.” In the same report, the chief actuary anticipated “an increase in overall national health expenditures ranging from $5.8 billion in 2011 to $13.8 billion in 2019.” The actuary said the Senate bill also would bend the spending growth curve upward for federal spending on health care, increasing it by $279 billion from 2010-2019.
These facts back up the majority opinion at the grassroots that health care bills passed by the House and Senate would make things worse, not better. Instead of sending this legislation to the president’s desk, Congress should work on the fundamental problems in the health care system and pass common sense medical malpractice reform to stop wasting so much money on defensive medicine, end pre-existing condition exclusions and waiting periods, start paying for value rather than volume, and empower consumers to shop around for health care and lower costs with competition, just like with other services we buy. Congress should make market reforms that help small businesses and the self-employed access health insurance.
Thursday, December 3, 2009
Dear Orszag: Please come to Wisconsin
Insuring Resources Commentary:
Perhaps Peter Orszag should take a visit to Wisconsin and witness what is happening daily at ThedaCare, Gunderson Lutheran, Group Health Coop and others. If 20 some health plans are already doing it why is it sooo hard that it will take 20+ years for others to catch on.
Visit www.createhealthcarevalue.com
or
http://www.healthcarevalueleaders.org/
Orszag knows these exist so why is his head in the sand?
-------------- -----------------
Orszag: Health Care Efficiencies May Take Decades Associated Press
Charles Babington
December 03, 2009
The White House budget director said Wednesday that it may take decades for America to have an efficient health care system even if Congress passes a major overhaul this year.
"It will be years to decades" before the nation has a properly working health care system that rewards quality over quantity, Peter Orszag told reporters. He said improving the quality of health care "is more like a lifelong nutrition or diet, not studying for an exam," but he added that continuous progress is a crucial goal.
Orszag is one of President Barack Obama's top aides in urging Congress to overhaul the U.S. health care system in the coming weeks. He acknowledged that many key elements of the pending House and Senate bills would not take effect for several years, but he urged Americans to embrace a gradual process.
The House-passed bill would bar insurance companies from denying coverage to sick people starting in 2013. A bill being debated in the Senate would do so in 2014.
The bills would create new government subsidies for buying insurance starting in 2014. Fines for individuals who refuse to buy insurance would begin in 2014, and increase in later years. Other provisions, such as subsidizing long-term care, also would be years away.
Orszag noted that some improvements to the health care system are already in the works. The economic stimulus bill enacted early this year included money to modernize medical record-keeping and to identify the most effective ways to address various medical needs. Both efforts should lead to better care, he said.
Orszag said the nation must move away from its long tradition of fee-for-service health care that tends to reward the number of procedures performed rather than the quality of care. The pending legislation includes pilot projects meant to reduce the number of patients who are quickly readmitted to hospitals, and to restructure payments to hospitals to discourage unnecessary procedures.
Orszag said limits on medical malpractice awards -- which many Republicans favor, but are not in the bills -- would do little to reduce health care costs.
Perhaps Peter Orszag should take a visit to Wisconsin and witness what is happening daily at ThedaCare, Gunderson Lutheran, Group Health Coop and others. If 20 some health plans are already doing it why is it sooo hard that it will take 20+ years for others to catch on.
Visit www.createhealthcarevalue.com
or
http://www.healthcarevalueleaders.org/
Orszag knows these exist so why is his head in the sand?
-------------- -----------------
Orszag: Health Care Efficiencies May Take Decades Associated Press
Charles Babington
December 03, 2009
The White House budget director said Wednesday that it may take decades for America to have an efficient health care system even if Congress passes a major overhaul this year.
"It will be years to decades" before the nation has a properly working health care system that rewards quality over quantity, Peter Orszag told reporters. He said improving the quality of health care "is more like a lifelong nutrition or diet, not studying for an exam," but he added that continuous progress is a crucial goal.
Orszag is one of President Barack Obama's top aides in urging Congress to overhaul the U.S. health care system in the coming weeks. He acknowledged that many key elements of the pending House and Senate bills would not take effect for several years, but he urged Americans to embrace a gradual process.
The House-passed bill would bar insurance companies from denying coverage to sick people starting in 2013. A bill being debated in the Senate would do so in 2014.
The bills would create new government subsidies for buying insurance starting in 2014. Fines for individuals who refuse to buy insurance would begin in 2014, and increase in later years. Other provisions, such as subsidizing long-term care, also would be years away.
Orszag noted that some improvements to the health care system are already in the works. The economic stimulus bill enacted early this year included money to modernize medical record-keeping and to identify the most effective ways to address various medical needs. Both efforts should lead to better care, he said.
Orszag said the nation must move away from its long tradition of fee-for-service health care that tends to reward the number of procedures performed rather than the quality of care. The pending legislation includes pilot projects meant to reduce the number of patients who are quickly readmitted to hospitals, and to restructure payments to hospitals to discourage unnecessary procedures.
Orszag said limits on medical malpractice awards -- which many Republicans favor, but are not in the bills -- would do little to reduce health care costs.
Thursday, November 19, 2009
Senate, House Democratic Health Bills Compared
Stay tuned for Insuring Resources Commentary soon.
.... in the meantime see an analysis below courtesy of the Associated Press
--------------------- ---------------------------
Senate, House Democratic Health Bills ComparedAssociated Press
November 19, 2009
A comparison of the health care bills before Congress:
The Senate Democratic bill (Patient Protection and Affordable Care Act):
WHO'S COVERED: About 94 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Illegal immigrants would not receive assistance.
COST: Coverage provisions cost $849 billion over 10 years.
HOW IT'S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 1.95 percent on income over $200,000a year for individuals; $250,000 for couples. New 5 percent tax on elective cosmetic surgery. Cuts to Medicare and Medicaid. Excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.
REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750.
REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees' coverage.
SUBSIDIES: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.
BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage: The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.
GOVERNMENT-RUN PLAN: A new federal insurance plan would be offered to compete against private carriers. The government would negotiate -- not dictate -- payment rates for medical providers. Unlike the House bill, states could opt out of the plan. It's not clear the proposal commands enough votes to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally encouraged to keep their work-provided coverage.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.
CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty, which is $29,327 a year for a family of four, for all parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Amendment expected to be offered on the Senate floor to strip the health insurance industry of its antitrust exemption.
____
The House bill (Affordable Health Care for America Act):
WHO'S COVERED: About 96 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.
COST: The Congressional Budget Office says the bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. That's under President Barack Obama's $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.
HOW IT'S PAID FOR: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers' concerns that the taxes would hit too many people and small businesses.
There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.
REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt -- a change from the original $250,000 level to accommodate concerns of moderate Democrats -- and the penalty is phased in for companies with
payrolls between $500,000 and $750,000.
Small businesses -- those with 10 or fewer workers -- get tax credits to help them provide coverage.
SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013 through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.
BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.
GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version -- preferred by moderate lawmakers -- would let the HHS secretary negotiate rates with providers.
CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.
.... in the meantime see an analysis below courtesy of the Associated Press
--------------------- ---------------------------
Senate, House Democratic Health Bills ComparedAssociated Press
November 19, 2009
A comparison of the health care bills before Congress:
The Senate Democratic bill (Patient Protection and Affordable Care Act):
WHO'S COVERED: About 94 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Illegal immigrants would not receive assistance.
COST: Coverage provisions cost $849 billion over 10 years.
HOW IT'S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 1.95 percent on income over $200,000a year for individuals; $250,000 for couples. New 5 percent tax on elective cosmetic surgery. Cuts to Medicare and Medicaid. Excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.
REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750.
REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees' coverage.
SUBSIDIES: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.
BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage: The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.
GOVERNMENT-RUN PLAN: A new federal insurance plan would be offered to compete against private carriers. The government would negotiate -- not dictate -- payment rates for medical providers. Unlike the House bill, states could opt out of the plan. It's not clear the proposal commands enough votes to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally encouraged to keep their work-provided coverage.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.
CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty, which is $29,327 a year for a family of four, for all parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Amendment expected to be offered on the Senate floor to strip the health insurance industry of its antitrust exemption.
____
The House bill (Affordable Health Care for America Act):
WHO'S COVERED: About 96 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.
COST: The Congressional Budget Office says the bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. That's under President Barack Obama's $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.
HOW IT'S PAID FOR: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers' concerns that the taxes would hit too many people and small businesses.
There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.
REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt -- a change from the original $250,000 level to accommodate concerns of moderate Democrats -- and the penalty is phased in for companies with
payrolls between $500,000 and $750,000.
Small businesses -- those with 10 or fewer workers -- get tax credits to help them provide coverage.
SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013 through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.
BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.
GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version -- preferred by moderate lawmakers -- would let the HHS secretary negotiate rates with providers.
CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.
Saturday, November 14, 2009
Republican says House Dems Rejected Common Sense Reforms
Insuring Resources Commentary:
GOP Congressman Mark Kirk says House Democrats rejected several common sense Republican proposals in the debate on the House's Health Care reform bill.
He said some proposals sought to allow greater flexibility for state innovation. In not knowing the specifics I'd say state innovation should have been encouraged but the details are missing so on its face it seems like a missed opportunity to allow for some bi-partisanship.
On another issue Kirk says Dems rejected "allowing consumers to buy coverage from across state lines."
Let's analyze that one. Wisconsin insurance regulations are some of the strongest in the nation which also does add a bit of cost to our health insurance premiums. Health mandates requiring greater coverage do often add costs to health insurance premiums. BUT, we get better and more comprehensive coverage because of it. The old adage, "You get what you pay for" definitely applies here.
The wonderful state of Alabama however does not have a stellar reputation for its insurance regulations. Health insurance is cheaper there because insurers face less restrictions and mandates.
When faced with high health care premiums many businesses would seek cheaper coverage in Alabama wouldn't they, and they'd get what they paid for, wouldn't they?
What if your employer chose to purchase coverage from an Alabama-based insurer?
______________ ______________
Republican lawmaker says House Democrats rejected GOP proposals to improve health care bill
From JS Online 11/14/09
GOP Congressman Bashes Dems Health Care Proposals
In this week's Republican address Congressman Mark Kirk says he wants to see tort reform in health care improvements.
In this week's Republican address Congressman Mark Kirk criticizes the health care proposals pushed by Speaker of the House Nancy Pelosi.
In this week's Republican address, Congressman Mark Kirk says the Democrats' health care ideas are just too expensive.
In this week's Republican address Congressman Mark Kirk says the current health care proposals cost too much and take away too much.
WASHINGTON (AP) -- House Democrats missed opportunities to improve the House-passed health care bill when they rejected Republican ideas to limit lawsuits and give states more flexibility to enact innovative changes, a GOP lawmaker said Saturday.
Delivering the Republicans' weekly radio and Internet address, Rep. Mark Kirk of Illinois said health care costs could be lowered by "reining in lawsuits" and allowing consumers to buy coverage from across state lines. Kirk promoted several provisions in the House GOP health care bill, which was rejected a week ago when the House passed the Democratic plan.
"Unfortunately, all of these commonsense Republican reforms were rejected by Speaker (Nancy) Pelosi," Kirk said in the address. "The Pelosi health care bill has no significant lawsuit reforms and does not guarantee your medical rights from government waiting lines or restrictions."
Kirk, who is in his fifth House term representing the suburbs north of Chicago, is a candidate for the Republican nomination to run for the Senate seat that was held by President Barack Obama. He called the House Democrats' health plan "a new massive spending program, supported by heavy taxes and cuts to senior health care."
"In sum, the bill opens a new trillion-dollar entitlement just as our national debt tops $12 trillion," Kirk said.
GOP Congressman Mark Kirk says House Democrats rejected several common sense Republican proposals in the debate on the House's Health Care reform bill.
He said some proposals sought to allow greater flexibility for state innovation. In not knowing the specifics I'd say state innovation should have been encouraged but the details are missing so on its face it seems like a missed opportunity to allow for some bi-partisanship.
On another issue Kirk says Dems rejected "allowing consumers to buy coverage from across state lines."
Let's analyze that one. Wisconsin insurance regulations are some of the strongest in the nation which also does add a bit of cost to our health insurance premiums. Health mandates requiring greater coverage do often add costs to health insurance premiums. BUT, we get better and more comprehensive coverage because of it. The old adage, "You get what you pay for" definitely applies here.
The wonderful state of Alabama however does not have a stellar reputation for its insurance regulations. Health insurance is cheaper there because insurers face less restrictions and mandates.
When faced with high health care premiums many businesses would seek cheaper coverage in Alabama wouldn't they, and they'd get what they paid for, wouldn't they?
What if your employer chose to purchase coverage from an Alabama-based insurer?
______________ ______________
Republican lawmaker says House Democrats rejected GOP proposals to improve health care bill
From JS Online 11/14/09
GOP Congressman Bashes Dems Health Care Proposals
In this week's Republican address Congressman Mark Kirk says he wants to see tort reform in health care improvements.
In this week's Republican address Congressman Mark Kirk criticizes the health care proposals pushed by Speaker of the House Nancy Pelosi.
In this week's Republican address, Congressman Mark Kirk says the Democrats' health care ideas are just too expensive.
In this week's Republican address Congressman Mark Kirk says the current health care proposals cost too much and take away too much.
WASHINGTON (AP) -- House Democrats missed opportunities to improve the House-passed health care bill when they rejected Republican ideas to limit lawsuits and give states more flexibility to enact innovative changes, a GOP lawmaker said Saturday.
Delivering the Republicans' weekly radio and Internet address, Rep. Mark Kirk of Illinois said health care costs could be lowered by "reining in lawsuits" and allowing consumers to buy coverage from across state lines. Kirk promoted several provisions in the House GOP health care bill, which was rejected a week ago when the House passed the Democratic plan.
"Unfortunately, all of these commonsense Republican reforms were rejected by Speaker (Nancy) Pelosi," Kirk said in the address. "The Pelosi health care bill has no significant lawsuit reforms and does not guarantee your medical rights from government waiting lines or restrictions."
Kirk, who is in his fifth House term representing the suburbs north of Chicago, is a candidate for the Republican nomination to run for the Senate seat that was held by President Barack Obama. He called the House Democrats' health plan "a new massive spending program, supported by heavy taxes and cuts to senior health care."
"In sum, the bill opens a new trillion-dollar entitlement just as our national debt tops $12 trillion," Kirk said.
Friday, November 13, 2009
Business Roundtable Wants Increased Emphasis on Cost-Effectiveness
This is an important article from the business/ employer perspective
_________________ _____________
By Donna Smith (Reuters)
WASHINGTON (Reuters) - An influential business group said on Thursday that its continued support for President Obama's healthcare overhaul hinges on whether it slows the soaring growth rate of healthcare costs.
The Business Roundtable, which represents some of the largest employers in the United States, released a report saying that "effective" healthcare reforms could save employers as much as $3,000 per worker by 2019.
"The report also shows that reform done wrong ... could make a bad situation much worse, in which case Business Roundtable could not support the bill," Eastman Kodak (EK.N) Company Chairman and Chief Executive Antonio Perez said in a statement accompanying the release of the report.
Obama said it was further evidence that the U.S. healthcare system is broken.
"If we don't pass comprehensive reform, the report finds, health care costs that are already squeezing our businesses will continue to rise, and in 10 years, employment-based spending on health care for large employers will be fully 166 percent higher per employee than it is today," the president said in a statement.
"The yearly health insurance costs for the average employee will rise to a staggering $28,530," he added, citing a finding by the report.
Companies represented by the Business Roundtable, which includes such giants as Verizon Communications Inc. (VZ.N), The Boeing Company (BA.N) and Exxon Mobil Corp. (XOM.N), provide health insurance to more than 35 million workers and their families. The group has been a major force behind the healthcare overhaul push.
The business group opposes the bill approved last week by the U.S. House of Representatives. It says the measure fails to control costs and that some provisions, including one that would create a new government insurance plan, could undermine employer-sponsored health coverage.
The report, written by Hewitt Associates for the Business Roundtable, favors some of the cost-containment reforms included in legislation passed by the Senate Finance Committee.
These include changes in the government Medicare health insurance program for the elderly that would reward quality of care and not the quantity of services and treatments performed.
The report said a strong requirement that individuals be responsible for obtaining health insurance would help ensure that premiums do not jump with a proposal that would bar insurers from rejecting people with pre-existing conditions.
The Finance Committee weakened enforcement measures of the individual mandate provision, raising concerns that healthier people will delay seeking insurance, increasing the costs for those who buy insurance.
_________________ _____________
By Donna Smith (Reuters)
WASHINGTON (Reuters) - An influential business group said on Thursday that its continued support for President Obama's healthcare overhaul hinges on whether it slows the soaring growth rate of healthcare costs.
The Business Roundtable, which represents some of the largest employers in the United States, released a report saying that "effective" healthcare reforms could save employers as much as $3,000 per worker by 2019.
"The report also shows that reform done wrong ... could make a bad situation much worse, in which case Business Roundtable could not support the bill," Eastman Kodak (EK.N) Company Chairman and Chief Executive Antonio Perez said in a statement accompanying the release of the report.
Obama said it was further evidence that the U.S. healthcare system is broken.
"If we don't pass comprehensive reform, the report finds, health care costs that are already squeezing our businesses will continue to rise, and in 10 years, employment-based spending on health care for large employers will be fully 166 percent higher per employee than it is today," the president said in a statement.
"The yearly health insurance costs for the average employee will rise to a staggering $28,530," he added, citing a finding by the report.
Companies represented by the Business Roundtable, which includes such giants as Verizon Communications Inc. (VZ.N), The Boeing Company (BA.N) and Exxon Mobil Corp. (XOM.N), provide health insurance to more than 35 million workers and their families. The group has been a major force behind the healthcare overhaul push.
The business group opposes the bill approved last week by the U.S. House of Representatives. It says the measure fails to control costs and that some provisions, including one that would create a new government insurance plan, could undermine employer-sponsored health coverage.
The report, written by Hewitt Associates for the Business Roundtable, favors some of the cost-containment reforms included in legislation passed by the Senate Finance Committee.
These include changes in the government Medicare health insurance program for the elderly that would reward quality of care and not the quantity of services and treatments performed.
The report said a strong requirement that individuals be responsible for obtaining health insurance would help ensure that premiums do not jump with a proposal that would bar insurers from rejecting people with pre-existing conditions.
The Finance Committee weakened enforcement measures of the individual mandate provision, raising concerns that healthier people will delay seeking insurance, increasing the costs for those who buy insurance.
Friday, October 30, 2009
The House Health Care Reform Bill
We now have health care reform bill sfrom both the House and the Senate. They will be debated over the next few weeks and then come to a final vote in each House. Then a conference committee will negotiate a final bill to be voted on by each House of congress. Its projected that the final bill could be signed by President Obama in time for Christmas.
Coverage Highlights-**Provides coverage for 96% of legally residing Americans.
** Subidizes coverage for the poorest Americans
** Caps annual out-of-pocket costs
** Eliminates Pre-x condition exclusions
Fiscal and Cost Issues
** Cuts federal deficit by $30 mill over ten years according to the CBO
** Individuals with annual incomes over $500,000, as well as families earning more than $1 million, would face a 5.4 percent income tax surcharge.
** Cuts Medicare expenditures by 1.3% annually
** The House bill imposes a fine of up to 2.5 percent of an individual's income. Both versions include a hardship exemption for poorer Americans.
** Requires larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.
CNN, conforming with the rest of our wonderful media, ignores the question of whether true cost controls and waste reduction strategies exist within this bill.
I'll get a copy of the bill and research those questions.
--------------------------------- ----------------------------
From CNN, October 31, 2009
The battle over health care reform reached another milestone Thursday as top House Democrats unveiled sweeping legislation that includes a highly controversial public health insurance option.
The nearly 2,000-page bill -- a combination of three versions passed by House committees -- would cost $894 billion over 10 years to extend insurance coverage to 36 million uncovered Americans, according to House Speaker Nancy Pelosi.
However, the bill's total cost, including Medicare changes, is expected to be higher and could push the price tag over $1 trillion, according to an initial CNN analysis.
The bill guarantees that 96 percent of Americans have coverage, Pelosi stated. The claim is based on an analysis by the non-partisan Congressional Budget Office.
Among other things, the bill would subsidize insurance for poorer Americans and create health insurance exchanges to make it easier for small groups and individuals to purchase coverage. It would also cap annual out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.
Pelosi's office said the bill would cut the federal deficit by roughly $30 billion over the next decade. The measure is financed through a combination of a tax surcharge on wealthy Americans and spending constraints in Medicare and Medicaid.
Specifically, individuals with annual incomes over $500,000, as well as families earning more than $1 million, would face a 5.4 percent income tax surcharge. Medicare expenditures would be cut by 1.3 percent annually.
"Today, we are ... laying the foundation for a brighter future for generations to come," Pelosi said on Capitol Hill.
"For Americans struggling with the cost of health care, this is an urgently needed bill," said House Majority Leader Steny Hoyer, D-Maryland. "This is an idea whose time has come."
President Obama praised House Democrats for forging "a strong consensus that represents a historic step forward."
Republicans tore into the bill, characterizing it as a series of tax increases and new regulations that would destroy jobs while doing little to stop spiraling health care costs.
"This really is a government takeover of health care in America," said Rep. Mike Pence, R-Indiana. "It appears for all of the world like a massive government-run insurance plan paid for with a freight train of mandates and taxes and bureaucracy."
Critics argue that the Democrats' $894 billion price tag excludes the cost associated with closing the Medicare "donut hole" prescription drug coverage gap.
The donut hole refers to some drug costs left uncovered by Medicare before catastrophic coverage kicks in. Pelosi highlighted plans to close the gap while discussing the bill Thursday.
Under the public option in the House plan, health care providers would be allowed to negotiate reimbursement rates with the federal government, according to Democratic leadership aides.
Pelosi and other liberal Democrats had argued for a more "robust" public option that ties reimbursement rates for providers and hospitals to Medicare rates plus a 5 percent increase. Several Democrats representing rural areas, however, complained that doctors and hospitals in their districts would be shortchanged under such a formula.
The Democratic leadership "pushed as hard as they could" for the robust option but couldn't win majority support for it, said liberal New York Rep. Jerrold Nadler. "There is no point crying over spilt milk."
The House bill differs from legislation now being considered by the Senate in a number of critical ways. Senate Majority Leader Harry Reid, D-Nevada, also favors a public option but would allow individual states to opt out of the plan. Reid would allow for the creation of nonprofit health care cooperatives; the House bill does not include such a measure.
A bill recently passed by the Senate Finance Committee does not include a tax surcharge on the wealthy but would instead impose a new tax on high-end health care policies, dubbed "Cadillac plans" by critics. A large number of House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.
Individuals under the $829 billion Senate Finance Committee plan would be required to purchase health insurance coverage or face a fine of up to $750. The House bill imposes a more stringent fine of up to 2.5 percent of an individual's income. Both versions include a hardship exemption for poorer Americans.
The Senate Finance Committee bill would require large companies to contribute to the health care costs of lower income workers if those workers receive a government subsidy for insurance. The House legislation would require larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.
Democratic leaders in both chambers agree on establishing nonprofit health care cooperatives and stripping insurance companies of an antitrust exemption that has been in place since the end of World War II.
Moderate House Democrats, whose votes are needed to pass the bill, appeared to be cautiously optimistic. They didn't, however, offer any definitive judgments.
"I'm not leaning one way or the other right now, but I just have to get into the bill and read it for myself," said Rep. Baron Hill, D-Indiana. "I'm hoping to be able to vote for it."
The House Democratic leadership posted the bill online Thursday and agreed to give members at least 72 hours to read it before a vote. Under that timetable, the full House could begin debating the bill next week.
Any bill passed by the House of Representatives will eventually have to be merged with legislation passed by the Senate. Both chambers would then have to pass a revised measure before sending it to Obama to be signed into law.
One thorny issue remaining to be resolved among House Democrats is the final abortion language in the bill. Rep. Bart Stupak, D-Michigan, has been pushing leaders to add stronger language prohibiting the use of federal money to pay for abortions under new health care reforms.
Stupak has vowed that if he isn't allowed a vote on the issue, a group of 40 anti-abortion Democrats will work to block the bill from getting to the House floor.
Leadership aides admit that they need to find compromise wording on abortion but say they are confident the issue will be resolved by the time the bill gets to the floor.
Coverage Highlights-**Provides coverage for 96% of legally residing Americans.
** Subidizes coverage for the poorest Americans
** Caps annual out-of-pocket costs
** Eliminates Pre-x condition exclusions
Fiscal and Cost Issues
** Cuts federal deficit by $30 mill over ten years according to the CBO
** Individuals with annual incomes over $500,000, as well as families earning more than $1 million, would face a 5.4 percent income tax surcharge.
** Cuts Medicare expenditures by 1.3% annually
** The House bill imposes a fine of up to 2.5 percent of an individual's income. Both versions include a hardship exemption for poorer Americans.
** Requires larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.
CNN, conforming with the rest of our wonderful media, ignores the question of whether true cost controls and waste reduction strategies exist within this bill.
I'll get a copy of the bill and research those questions.
--------------------------------- ----------------------------
From CNN, October 31, 2009
The battle over health care reform reached another milestone Thursday as top House Democrats unveiled sweeping legislation that includes a highly controversial public health insurance option.
The nearly 2,000-page bill -- a combination of three versions passed by House committees -- would cost $894 billion over 10 years to extend insurance coverage to 36 million uncovered Americans, according to House Speaker Nancy Pelosi.
However, the bill's total cost, including Medicare changes, is expected to be higher and could push the price tag over $1 trillion, according to an initial CNN analysis.
The bill guarantees that 96 percent of Americans have coverage, Pelosi stated. The claim is based on an analysis by the non-partisan Congressional Budget Office.
Among other things, the bill would subsidize insurance for poorer Americans and create health insurance exchanges to make it easier for small groups and individuals to purchase coverage. It would also cap annual out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.
Pelosi's office said the bill would cut the federal deficit by roughly $30 billion over the next decade. The measure is financed through a combination of a tax surcharge on wealthy Americans and spending constraints in Medicare and Medicaid.
Specifically, individuals with annual incomes over $500,000, as well as families earning more than $1 million, would face a 5.4 percent income tax surcharge. Medicare expenditures would be cut by 1.3 percent annually.
"Today, we are ... laying the foundation for a brighter future for generations to come," Pelosi said on Capitol Hill.
"For Americans struggling with the cost of health care, this is an urgently needed bill," said House Majority Leader Steny Hoyer, D-Maryland. "This is an idea whose time has come."
President Obama praised House Democrats for forging "a strong consensus that represents a historic step forward."
Republicans tore into the bill, characterizing it as a series of tax increases and new regulations that would destroy jobs while doing little to stop spiraling health care costs.
"This really is a government takeover of health care in America," said Rep. Mike Pence, R-Indiana. "It appears for all of the world like a massive government-run insurance plan paid for with a freight train of mandates and taxes and bureaucracy."
Critics argue that the Democrats' $894 billion price tag excludes the cost associated with closing the Medicare "donut hole" prescription drug coverage gap.
The donut hole refers to some drug costs left uncovered by Medicare before catastrophic coverage kicks in. Pelosi highlighted plans to close the gap while discussing the bill Thursday.
Under the public option in the House plan, health care providers would be allowed to negotiate reimbursement rates with the federal government, according to Democratic leadership aides.
Pelosi and other liberal Democrats had argued for a more "robust" public option that ties reimbursement rates for providers and hospitals to Medicare rates plus a 5 percent increase. Several Democrats representing rural areas, however, complained that doctors and hospitals in their districts would be shortchanged under such a formula.
The Democratic leadership "pushed as hard as they could" for the robust option but couldn't win majority support for it, said liberal New York Rep. Jerrold Nadler. "There is no point crying over spilt milk."
The House bill differs from legislation now being considered by the Senate in a number of critical ways. Senate Majority Leader Harry Reid, D-Nevada, also favors a public option but would allow individual states to opt out of the plan. Reid would allow for the creation of nonprofit health care cooperatives; the House bill does not include such a measure.
A bill recently passed by the Senate Finance Committee does not include a tax surcharge on the wealthy but would instead impose a new tax on high-end health care policies, dubbed "Cadillac plans" by critics. A large number of House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.
Individuals under the $829 billion Senate Finance Committee plan would be required to purchase health insurance coverage or face a fine of up to $750. The House bill imposes a more stringent fine of up to 2.5 percent of an individual's income. Both versions include a hardship exemption for poorer Americans.
The Senate Finance Committee bill would require large companies to contribute to the health care costs of lower income workers if those workers receive a government subsidy for insurance. The House legislation would require larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.
Democratic leaders in both chambers agree on establishing nonprofit health care cooperatives and stripping insurance companies of an antitrust exemption that has been in place since the end of World War II.
Moderate House Democrats, whose votes are needed to pass the bill, appeared to be cautiously optimistic. They didn't, however, offer any definitive judgments.
"I'm not leaning one way or the other right now, but I just have to get into the bill and read it for myself," said Rep. Baron Hill, D-Indiana. "I'm hoping to be able to vote for it."
The House Democratic leadership posted the bill online Thursday and agreed to give members at least 72 hours to read it before a vote. Under that timetable, the full House could begin debating the bill next week.
Any bill passed by the House of Representatives will eventually have to be merged with legislation passed by the Senate. Both chambers would then have to pass a revised measure before sending it to Obama to be signed into law.
One thorny issue remaining to be resolved among House Democrats is the final abortion language in the bill. Rep. Bart Stupak, D-Michigan, has been pushing leaders to add stronger language prohibiting the use of federal money to pay for abortions under new health care reforms.
Stupak has vowed that if he isn't allowed a vote on the issue, a group of 40 anti-abortion Democrats will work to block the bill from getting to the House floor.
Leadership aides admit that they need to find compromise wording on abortion but say they are confident the issue will be resolved by the time the bill gets to the floor.
Tuesday, October 20, 2009
More Small Business Stats- The Case for Reform
This is from a report from the U.S. Dept. of Human Services-
A new report, "Insurance at Risk: Small Business Employees Risk Losing Coverage" details how small businesses are increasingly dropping health insurance and why.
The report notes:
Employees of small businesses are 50 percent more likely to lose coverage as workers at large businesses. Half of workers in small firms that do not offer health benefits remain uninsured.
Premiums for employer-based health insurance have more than doubled since 2000, rising three times faster than wages. As a result, fewer small businesses provide coverage for their employees. In 2000, 57 percent of firms employing less than 10 workers provided coverage. In 2009, only 46 percent of similar-sized firms provided coverage.
In one national survey, nearly three-quarters of small businesses that did not offer benefits cited high premiums as the reason, and on average small businesses pay up to 18 percent more than large firms for the same health insurance policy. This is due in part to high broker fees (which can be up to 10 percent of premiums)and health plan administrative costs that are three to four times those in the large group market.
A new report, "Insurance at Risk: Small Business Employees Risk Losing Coverage" details how small businesses are increasingly dropping health insurance and why.
The report notes:
Employees of small businesses are 50 percent more likely to lose coverage as workers at large businesses. Half of workers in small firms that do not offer health benefits remain uninsured.
Premiums for employer-based health insurance have more than doubled since 2000, rising three times faster than wages. As a result, fewer small businesses provide coverage for their employees. In 2000, 57 percent of firms employing less than 10 workers provided coverage. In 2009, only 46 percent of similar-sized firms provided coverage.
In one national survey, nearly three-quarters of small businesses that did not offer benefits cited high premiums as the reason, and on average small businesses pay up to 18 percent more than large firms for the same health insurance policy. This is due in part to high broker fees (which can be up to 10 percent of premiums)and health plan administrative costs that are three to four times those in the large group market.
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