Insuring Resources Commentary:
This should go a long way toward improving health outcomes for many, many Americans, particularly for the chronically uninsured and underinsured who will now have first dollar coverage of preventive services-- no copays, deductibles, etc.
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From the NY Times
By LESLEY ALDERMAN
Published: April 9, 2010
A PRIMARY goal of the health care overhaul was to provide insurance for more people, namely those who could not afford coverage and those with pre-existing conditions for whom insurance was too costly.
But the new law also aims eventually to improve health insurance for everyone. By now you have probably read or heard about big changes like the rules that will require insurers to cover everyone who applies, regardless of health status, and forbid them from dropping people when they get sick.
You may not yet be aware, though, of another notable improvement to insurance, a change that could save a consumer or family hundreds of dollars a year. Under the new law, insurers must offer preventive services — like immunizations, cancer screenings and checkups — to consumers as part of the insurance policy, at no additional out-of-pocket charge.
The idea is that healthy Americans will be less costly Americans.
“This is transformative,” says Helen Darling, president of the National Business Group on Health, a nonprofit organization for large employers. “We’re moving from an insurance model that was based on treating illness and injury, to a model that’s focused on improving an individual’s health and identifying risk factors.”
The trend toward offering free preventive care has been gaining steam for a decade among large companies that provide employee health benefits. “Employers recognize that if they want to control costs, they have to persuade their workers to be healthier, including their children,” Ms. Darling said.
Three out of four large companies now offer free preventive health services to their workers, according to a 2009 survey by Mercer, a benefits consulting firm. Smaller employers, though, and individual health plans have been less likely to offer free care of any type.
But under the new law, more generous “wellness” benefits should eventually be available to almost all Americans with insurance.
“Eventually” is the operable word, though. Although this feature of the law goes into effect at the end of September, it will apply to new insurance policies only. That means if you switch to a different policy, or buy a new one, the preventive services will be offered.
But if you are already in a plan, your benefits probably will not be upgraded until the plan makes a significant change, like modifying its cost structure. Simply signing up again during next fall’s annual enrollment for the same coverage you now have may not necessarily cause the new preventive-care requirement to begin. Until the Department of Health and Human Services actually writes the new regulations for this and many other parts of the law, though, no one can say for certain what will count as a event that sets the preventive care requirement in motion.
A clear exception is Medicare. Starting next year, all enrollees — even if they do not change insurance plans — will be entitled to a free annual checkup and free screenings, like colonoscopies and mammograms.
For people of all ages, many details of the new prevention benefits will remain sketchy until Health and Human Services writes the rules.
“Here, as with many other places in the legislation, much will depend on how H.H.S. writes the implementation regulations,” says Timothy S. Jost, a professor of law at Washington and Lee University School of Law and an expert on health reform.
Generally, though, here is how preventive services will be integrated into health insurance plans, beginning this fall.
NO OUT-OF-POCKET FEES New group and individual health plans must provide preventive health services at no additional charge to consumers — the services will not be subject to a co-payment or to a deductible.
BASED ON FEDERAL GUIDELINES The preventive services will include those that the United States Preventive Services Task Force, a panel of outside experts under the Health and Human Services Department, has given their top A or B rating, like screenings for H.I.V., depression, osteoporosis in postmenopausal women, as well as breast, colorectal and cervical cancer. Children will receive free screenings for conditions including iron deficiency, sickle cell diseases and hypothyroidism. A government Web site has a handy calculator that lets you enter a person’s age and gender to see what those screening recommendations would be. (We have also posted the task force’s entire list of recommendations with the online version of this column.)
In addition, immunizations recommended by the Centers for Disease Control and Prevention will be covered, including vaccines for Hepatitis A & B, tetanus-diphtheria, seasonal flu vaccines and human papilloma virus for girls 9 to 26 years old.
WHEN IT TAKES EFFECT The parts of the law governing preventive care go into effect on Sept. 23 (six months after it was signed by the president). At that point, new plans, and plans that make changes, must start to offer free preventive care. If you are covered by Medicare, the upgrades will go into effect on Jan. 1.
If these changes sound too far off, or you have resigned yourself to not seeing any benefit because you will not be changing insurance plans any time soon, take note: if you have group coverage, you may already be entitled to some free preventive benefits. Check what your plan offers, either by calling the toll-free customer service number on your membership card, looking at your insurer’s Web site, or reading the plan’s summary plan description booklet (free services are usually listed up front).
“Employees tend not to read their benefits information,” Ms. Darling said.
One of your best health habits should be to make good use of the services that will not cost you a cent.
Showing posts with label health outcomes. Show all posts
Showing posts with label health outcomes. Show all posts
Monday, April 12, 2010
Wednesday, February 17, 2010
White House Summit may Include Unveiling of New Plan
Insuring Resources Commentary:
Stay tuned for my analysis as soon as the bill is released, but in the meantime I'll offer my wish list:
1) eliminate pre-x conditions,
2) mandate individual coverage by offering a catastrophic, inexpensive health plan,
3) expand Medicaid to 150% FPL but eliminate the special deals like the Cornhusker Kickback and provide Medical Home operation incentives for states,
4) create incentives for provider transition to episode of care based reimbursement to be fully operational by 2015,
5) create efficiency and lean operation incentives and NOT just for Medicare,
6) Create 10 regional Health Insurance Exchanges to cover small businesses with less than 25 employees and individuals without employer access-- include multiple plan options
----------------
Details from multiple news sources----------
Kaiser News: White House officials "hinted on Tuesday that President Obama might post his own [health care] bill on the Internet before the bipartisan health care summit he is planning" next week, The New York Times reports. "In the nearly a year since Congress began debating a health care overhaul, Mr. Obama has yet to make his own priorities explicit. He said at the outset that he would set broad parameters for the measure and leave the details to lawmakers." Obama said last week that hoped to post to the Internet a merged bill that would address costs and expand coverage. "But Mr. Obama may be running out of time. His press secretary, Robert Gibbs, was asked Monday if the president would simply post his own bill if the House and the Senate cannot come to terms. 'Stay tuned,' Mr. Gibbs said" (Stolberg, 2/16).
Politico: "White House officials have said the president expects a unified House and Senate bill by the Feb. 25 summit. But given the lack of tangible progress on Capitol Hill during the past two weeks, it is hard to see how the president will walk into the summit with a bill that's been agreed to by both chambers" (Budoff Brown, 2/16).
Reuters: According to Gibbs, "'The president will lay out his ideas, and I would expect that Republicans will, and others will, lay out their solutions,' he said." Although Gibbs did not offer a specific timeline for its release, he did make assurances that the measure would be made public "far enough before the meeting to allow it to be reviewed. 'I don't have the exact day yet. But it will be in — in time for — for you and for others around the country to evaluate a plan,' he said" (Zengerle, 2/16).
CNN: Health and Human Services Secretary Kathleen Sebelius said Tuesday that Obama plans to use the already-passed bills as a starting point for the summit next week. "But Sebelius, in an interview with CNN Chief Medical Correspondent Dr. Sanjay Gupta, said the House and Senate bills already incorporate many GOP ideas." Among the specific examples she cited were "provisions to create special pools to make it easier for people with pre-existing illness to purchase insurance, the offering of low-cost insurance plans for young and healthy people, and regulations letting people purchase insurance across state lines —a version of which is included in the Senate bill." The president's plan will not likely include a public option, she said (2/16).
The Associated Press: After some early questions about the health summit, the GOP is now seeing its possible political upside. Although Democrats are likely to focus on expanding affordable health insurance to more people — they offer to cover 30 more million people instead of Republicans who are offering 3 million more covered — Republicans hope that "during a time of ballooning deficits … reining in rising medical costs — not coverage — could resonate with voters in an election year. ... With the summit more than a week away and lawmakers out of town for the Presidents Day recess, Republicans are in the early stages of planning their strategy for the event. … One potential hitch for Republicans is that there is not a single GOP plan" (Werner, 2/17).
Stay tuned for my analysis as soon as the bill is released, but in the meantime I'll offer my wish list:
1) eliminate pre-x conditions,
2) mandate individual coverage by offering a catastrophic, inexpensive health plan,
3) expand Medicaid to 150% FPL but eliminate the special deals like the Cornhusker Kickback and provide Medical Home operation incentives for states,
4) create incentives for provider transition to episode of care based reimbursement to be fully operational by 2015,
5) create efficiency and lean operation incentives and NOT just for Medicare,
6) Create 10 regional Health Insurance Exchanges to cover small businesses with less than 25 employees and individuals without employer access-- include multiple plan options
----------------
Details from multiple news sources----------
Kaiser News: White House officials "hinted on Tuesday that President Obama might post his own [health care] bill on the Internet before the bipartisan health care summit he is planning" next week, The New York Times reports. "In the nearly a year since Congress began debating a health care overhaul, Mr. Obama has yet to make his own priorities explicit. He said at the outset that he would set broad parameters for the measure and leave the details to lawmakers." Obama said last week that hoped to post to the Internet a merged bill that would address costs and expand coverage. "But Mr. Obama may be running out of time. His press secretary, Robert Gibbs, was asked Monday if the president would simply post his own bill if the House and the Senate cannot come to terms. 'Stay tuned,' Mr. Gibbs said" (Stolberg, 2/16).
Politico: "White House officials have said the president expects a unified House and Senate bill by the Feb. 25 summit. But given the lack of tangible progress on Capitol Hill during the past two weeks, it is hard to see how the president will walk into the summit with a bill that's been agreed to by both chambers" (Budoff Brown, 2/16).
Reuters: According to Gibbs, "'The president will lay out his ideas, and I would expect that Republicans will, and others will, lay out their solutions,' he said." Although Gibbs did not offer a specific timeline for its release, he did make assurances that the measure would be made public "far enough before the meeting to allow it to be reviewed. 'I don't have the exact day yet. But it will be in — in time for — for you and for others around the country to evaluate a plan,' he said" (Zengerle, 2/16).
CNN: Health and Human Services Secretary Kathleen Sebelius said Tuesday that Obama plans to use the already-passed bills as a starting point for the summit next week. "But Sebelius, in an interview with CNN Chief Medical Correspondent Dr. Sanjay Gupta, said the House and Senate bills already incorporate many GOP ideas." Among the specific examples she cited were "provisions to create special pools to make it easier for people with pre-existing illness to purchase insurance, the offering of low-cost insurance plans for young and healthy people, and regulations letting people purchase insurance across state lines —a version of which is included in the Senate bill." The president's plan will not likely include a public option, she said (2/16).
The Associated Press: After some early questions about the health summit, the GOP is now seeing its possible political upside. Although Democrats are likely to focus on expanding affordable health insurance to more people — they offer to cover 30 more million people instead of Republicans who are offering 3 million more covered — Republicans hope that "during a time of ballooning deficits … reining in rising medical costs — not coverage — could resonate with voters in an election year. ... With the summit more than a week away and lawmakers out of town for the Presidents Day recess, Republicans are in the early stages of planning their strategy for the event. … One potential hitch for Republicans is that there is not a single GOP plan" (Werner, 2/17).
Sunday, January 10, 2010
Health bill 'loophole' could allow rate hikes
Insuring Resources Commentary:
The key provision being addressed in the article below is one that allows employers to establish "workplace wellness" programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels. Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more.
The advocates do have a point but, including incentives for Wellness is an important way to achieve cost savings for employer plans while improving employee health outcomes. While it may create two-tier pricing it does provide incentives for greater health. Perhaps it can be expanded beyond body mass and blood sugar so that it doesn't just impact those with diabetes.
------------------
Progressives, health groups say health bill 'loophole' could allow rate hikes
WASHINGTON (AP) -- Advocacy groups lobbied President Barack Obama and Congress on Thursday, trying to eliminate what they called a "loophole" in Senate health care legislation they said could allow insurers to raise rates on customers based on their weight or blood sugar levels.
The groups said that would contradict one of the main goals of the congressional health care overhaul, which is to eliminate insurance company practices such as charging more, or denying coverage, based on health status.
The push came amid intense behind-the-scenes negotiations on Capitol Hill and at the White House to reconcile sweeping health care legislation passed by the House and Senate into a final bill Obama could sign before his State of the Union address in early February.
House Democrats held a conference call during which a number of lawmakers vented frustration over provisions in the Senate bill they don't want to be forced to accept, most prominently a tax on high-value insurance plans that House Democrats fear could hurt middle-class workers and union members.
Obama will meet with union leaders on the issue Monday, union officials said. Aiming to build consensus on Capitol Hill over that issue and others, Obama met Thursday with key Senate architects of the health care bill, Democrats Max Baucus of Montana and Chris Dodd of Connecticut. Also, Health and Human Services Secretary Kathleen Sebelius convened a conference call of Democratic governors, some of whom have raised concerns about issues including costs to their state of a proposed Medicaid expansion.
That's been an irritant from some state officials because Sen. Ben Nelson, D-Neb., the Democrats' crucial 60th vote for the Senate health bill, got a deal to permanently exempt Nebraska from paying any cost of a Medicaid expansion in the bill. Nelson said Thursday he was working to extend the same deal to other states.
The so-called loophole is separate issue. It's a provision that allows employers to establish "workplace wellness" programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels.
Current law allows employers to vary costs for workers based on whether they can hit those targets by as much as 20 percent. The Senate bill would raise that to 30 percent, with the possibility of a further increase to 50 percent at the discretion of government officials.
Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more, even though some of them may not be physically able, through no fault of their own, to reach the goals.
"There could be an inclination to say, 'Let's raise everyone's costs and just lower them for the 15 percent that can meet the standards,'" Sue Nelson, a vice president at the American Heart Association, said in an interview.
"There's going to be a lot of people on that more expensive tier, I'm afraid. A lot of American adults."
The Senate bill also sets up a test wellness program beginning in 2014 for individuals and small businesses who buy insurance directly from insurance companies. Most Americans under age 65 are covered through their employers.
Separate provisions in the legislation would allow insurers to charge more to people who smoke and to older people.
Insurance companies generally support wellness provisions.
"Promoting prevention and wellness is a critical component of health care reform," Robert Zirkelbach, spokesman for America's Health Insurance Plans, said in a statement. He said the programs should have clear guidelines - something advocacy groups say is lacking in current law and the Senate bill - and noted they were often negotiated between employers and unions.
The wellness provision is not part of the House health care bill. Jim Manley, a spokesman for Senate Majority Leader Harry Reid, D-Nev., declined comment except to say the issue would be discussed with the House and the Obama administration during discussions for a final bill.
The key provision being addressed in the article below is one that allows employers to establish "workplace wellness" programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels. Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more.
The advocates do have a point but, including incentives for Wellness is an important way to achieve cost savings for employer plans while improving employee health outcomes. While it may create two-tier pricing it does provide incentives for greater health. Perhaps it can be expanded beyond body mass and blood sugar so that it doesn't just impact those with diabetes.
------------------
Progressives, health groups say health bill 'loophole' could allow rate hikes
WASHINGTON (AP) -- Advocacy groups lobbied President Barack Obama and Congress on Thursday, trying to eliminate what they called a "loophole" in Senate health care legislation they said could allow insurers to raise rates on customers based on their weight or blood sugar levels.
The groups said that would contradict one of the main goals of the congressional health care overhaul, which is to eliminate insurance company practices such as charging more, or denying coverage, based on health status.
The push came amid intense behind-the-scenes negotiations on Capitol Hill and at the White House to reconcile sweeping health care legislation passed by the House and Senate into a final bill Obama could sign before his State of the Union address in early February.
House Democrats held a conference call during which a number of lawmakers vented frustration over provisions in the Senate bill they don't want to be forced to accept, most prominently a tax on high-value insurance plans that House Democrats fear could hurt middle-class workers and union members.
Obama will meet with union leaders on the issue Monday, union officials said. Aiming to build consensus on Capitol Hill over that issue and others, Obama met Thursday with key Senate architects of the health care bill, Democrats Max Baucus of Montana and Chris Dodd of Connecticut. Also, Health and Human Services Secretary Kathleen Sebelius convened a conference call of Democratic governors, some of whom have raised concerns about issues including costs to their state of a proposed Medicaid expansion.
That's been an irritant from some state officials because Sen. Ben Nelson, D-Neb., the Democrats' crucial 60th vote for the Senate health bill, got a deal to permanently exempt Nebraska from paying any cost of a Medicaid expansion in the bill. Nelson said Thursday he was working to extend the same deal to other states.
The so-called loophole is separate issue. It's a provision that allows employers to establish "workplace wellness" programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels.
Current law allows employers to vary costs for workers based on whether they can hit those targets by as much as 20 percent. The Senate bill would raise that to 30 percent, with the possibility of a further increase to 50 percent at the discretion of government officials.
Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more, even though some of them may not be physically able, through no fault of their own, to reach the goals.
"There could be an inclination to say, 'Let's raise everyone's costs and just lower them for the 15 percent that can meet the standards,'" Sue Nelson, a vice president at the American Heart Association, said in an interview.
"There's going to be a lot of people on that more expensive tier, I'm afraid. A lot of American adults."
The Senate bill also sets up a test wellness program beginning in 2014 for individuals and small businesses who buy insurance directly from insurance companies. Most Americans under age 65 are covered through their employers.
Separate provisions in the legislation would allow insurers to charge more to people who smoke and to older people.
Insurance companies generally support wellness provisions.
"Promoting prevention and wellness is a critical component of health care reform," Robert Zirkelbach, spokesman for America's Health Insurance Plans, said in a statement. He said the programs should have clear guidelines - something advocacy groups say is lacking in current law and the Senate bill - and noted they were often negotiated between employers and unions.
The wellness provision is not part of the House health care bill. Jim Manley, a spokesman for Senate Majority Leader Harry Reid, D-Nev., declined comment except to say the issue would be discussed with the House and the Obama administration during discussions for a final bill.
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