HHS to Insurers: Double-Digit Rate Hikes Will Prompt Review

The Department of Health and Human Services (HHS) has released a final rule that will allow states to scrutinize insurance companies if they propose excessive increases in insurance premiums.

The final rule, published Thursday, would give states the authority beginning in September to issue a review of any insurer that raises premiums for small or individual health insurance plans by more than 10% in a given year. The law does not, however, give states or the federal government the power to tell an insurance company that it can't enact a high rate hike.

Health Overhaul Could Double Community Health Centers' Caseload - Kaiser Health News

By Michelle Andrews

Community health centers serve 20 million people every year, and that number is expected to double by 2015, thanks to an $11 billion infusion from the health-care overhaul and $2 billion in federal stimulus funds.

If you're a middle-income worker with health insurance through your job, chances are these centers have been under your radar, since their target clients are low-income and uninsured people. But as the number of uninsured has risen to 50 million, more people than ever are struggling to get and pay for health care, and community health centers are an affordable option. As they expand, they're adding new services and new locations nationwide.

Although their mission is to provide a primary-care safety net for people in underserved areas, no one is ever turned away from a community health center. People with incomes up to 200 percent of the federal poverty level ($44,700 for a family of four in 2011) pay on a sliding scale; uninsured people with higher incomes pay the full cost of care, which is generally comparable to costs in the private sector. The centers accept Medicaid and Medicare in addition to many private insurance plans.

The new health care law is full of incentives to encourage doctors to provide "medical homes" for their patients, with coordinated care and close patient monitoring to stay on top of necessary preventive services. But community health centers have always taken this approach, say experts.

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More Small Businesses Offering Health Care To Employees Thanks To Obamacare - Rick Ungar - The Policy Page - Forbes

by Rick Ungar

The first statistics are coming in and, to the surprise of a great many, Obamacare might just be working to bring health care to working Americans precisely as promised.

The major health insurance companies around the country are reporting a significant increase in small businesses offering health care benefits to their employees.

Why?

Because the tax cut created in the new health care reform law providing small businesses with an incentive to give health benefits to employees is working.
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A Third Judge Validates Health Care Overhaul Law - NYTimes.com

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by Kevin Sack

A third federal judge upheld the constitutionality of the Obama health care law on Tuesday, reinforcing the divide in the lower courts as the case moves toward its first hearings on the appellate level.

Judge Kessler adopted the government’s position on whether Congress’s authority to regulate interstate commerce is so broad that it can require people to buy a commercial product. Past Supreme Court decisions have established the standard that Congress can control “activities that substantially affect interstate commerce.”

The judge suggested in her 64-page opinion that not buying insurance was an active choice that had clear effects on the marketplace by burdening other payers with the cost of uncompensated medical care.
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Health Care Opinion Leaders' Views on Congressional Priorities - The Commonwealth Fund

More than nine of 10 leaders in health care and health care policy believe the general direction set by the Affordable Care Act is appropriate, with nearly seven of 10 favoring implementing the law with little or no change, according to a Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. A large majority of leaders support moving forward with each of the major elements of reform, including the individual mandate, state-based health insurance exchanges, and Medicaid expansion. Survey respondents believe payment approaches that encourage care coordination for patients with chronic diseases, establish greater alignment across public and private purchasers, and incentivize the use of evidence-based medicine will be effective in achieving a high performance health system. Eighty-one percent of leaders support expanding successful cost-containment pilots contained in the Affordable Care Act as part of a federal budget deficit reduction strategy.

Citation

K. Stremikis, S. Guterman, and K. Davis, Health Care Opinion Leaders’ Views on Congressional Priorities, The Commonwealth Fund, February 2011.

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• Data Brief (540K PDF)
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Feds Approve Minnesota Medicaid Expansion | StarTribune.com

Gov. Mark Dayton's plan to expand the state's Medicaid rolls by 95,000 people has been approved by federal authorities, his office said Thursday.

The move, which begins March 1, will provide health insurance to 12,000 low-income adults who previously were uninsured, and broader coverage at lower cost to another 83,000 who received care under two state-funded programs, MinnesotaCare and General Assistance Medical Care.

The savings from reducing caseloads in the two state programs will offset the additional state cost in Medicaid, state budget officials have said. Medicaid, known in Minnesota as Medical Assistance, is funded jointly by the state and federal governments.
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Fewer Workers Age 60 and Up Postponing Retirement

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As the economy gradually recovers, some mature workers are feeling more comfortable about retiring now compared to last year at this time. According to a new survey from CareerBuilder, 65 percent of workers age 60 plus said they are putting off retirement because they can't afford to retire financially; down from 72 percent who said the same last year. The nationwide survey was conducted among more than 500 U.S. workers age 60 and up between November 15 and December 2, 2010.

More than one-in-four (28 percent) mature workers age 60 plus plan to retire within the next two years, while 27 percent are planning to retire in three to four years, and 18 percent in the next five to six years. Sixteen percent estimate it will be seven years or more before they can stop working, while one-in-ten workers (10 percent) don't think they'll ever be able to retire.

The primary drivers for postponing retirement are financial restraints, as indicated by 65 percent of respondents, and the need for health insurance and other benefits, as indicated by 58 percent of respondents. However, mature workers are staying on board at their companies for a variety of other reasons, including:

* Enjoy their job (39 percent)
* Enjoy where they work (36 percent)
* Fear retirement may just be boring (26 percent)
* Enjoy feeling needed (14 percent)

"It's encouraging to see that more workers have the option to retire if they want to, but there are still some who want to keep working at their companies for a variety of reasons," said Rosemary Haefner, vice president of human resources at CareerBuilder. "Twenty-two percent of workers age 60 and up that we surveyed said they have asked their employer to stay longer with the company, while 29 percent of companies said they are open to keeping workers on board a little longer.

Health Care Debate Must Not Forget the Vulnerable - The Hill's Congress Blog

By Joel C. Hunter - 02/02/11 04:00 PM ET

As some in the Senate are determined to move forward a vote to repeal health care reform, the disconnect between the rushed and charged nature of the debate on Capitol Hill and the care and caution such a momentous decision requires is striking.

As a pastor who strives to follow the scripture-recorded call of Jesus to “heal the sick,” I consider access to health care to be a faith-based goal. God desires healing and abundant life for the poor as well as the rich, and denial of health care coverage falls far short of God’s standards of justice and compassion for people.

Discerning the best path for our nation to solve such problems isn’t nearly as easy as recognizing the moral imperative. But given the scale of our health care system’s shortcomings, we need our individual acts of compassion but also systemic policy solutions.

I supported the Affordable Care Act, which President Obama signed into law last March, because I believe that government help can be one of the ways God provides for the needs of people. As in the Genesis story when God placed Joseph into government to provide for those without resources, God’s means are not limited to individual or religious institutions’ efforts today.

Dr. Joel C. Hunter is senior pastor of Northland – A Church Distributed, a nationally-recognized evangelical megachurch in Longwood, Florida. He served on the President’s Advisory Council on Faith-Based and Neighborhood Partnerships and is a member of the National Association of Evangelicals’ board of directors.

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Daily Number: Most Want to Keep or Fix Health Care Reform - Pew Research Center

Overall opinions about health care legislation passed in 2010 are not overwhelmingly favorable: 41% say they approve of the legislation while 48% disapprove. But while the public remains divided over what it wants to see done with the health care law, far more (55%) want the legislation either expanded (35%) or left as is (20%) than favor its repeal (37%). While there is very little partisan difference in opinions about the importance of revising the health care legislation passed last year, Republicans and Democrats have very different ideas about how to revise it. More than six-in-ten (64%) Republicans support repealing health care legislation while roughly half (51%) of Democrats support expanding it. Independents are divided -- 38% would repeal the legislation and 37% would expand it. Notably, the option of leaving the legislation as it is wins only modest support across the board. Read more

Designing an Exchange: A Toolkit for State Policymakers

This project builds on the NAIC model act with the purpose of providing technical assistance to state policymakers interested in a broader range of policy options for designing an insurance Exchange. Sponsored by the National Academy of Social Insurance (NASI) and funded by the Robert Wood Johnson Foundation, this project offers policymakers a toolkit that includes legislative language with alternatives and additions to the NAIC model act, as well as a narrative explaining key issues and concerns that motivated the NASI model act. The narrative also addresses longer-term policy issues that state lawmakers may reasonably defer to a later time or delegate to the Exchange. In addition, the project will include a series of issue briefs that explore critical policy issues in state implementation of the ACA; the first of these focuses on the issue of Exchange governance.

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Off the Charts Blog | Center on Budget and Policy Priorities | Blog Archive | Moving Forward on Health Reform’s Insurance Exchanges

by Paul N. Van de Water

Even as a number of states challenge the health reform law (the Affordable Care Act, or ACA) in court, virtually every state has begun deciding how to implement a key part of it: creating state-based exchanges that will give individuals and small businesses a choice of coverage options and promote competition among insurance companies. A study panel of the National Academy of Social Insurance released a toolkit last week to help states design these exchanges to offer affordable and accessible coverage.

As members of the panel, Center board member Dick Nathan and I have written a brief paper outlining the issues involved in designing a governance structure for an exchange.
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HR 397 Reform Americans Can Afford Act of 2011

 To repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 and to take meaningful steps to lower health care costs and increase access to health insurance coverage without raising taxes, cutting Medicare benefits for seniors, adding to the national deficit, intervening in the doctor-patient relationship, or instituting a government takeover of health care.

Sponsor: Rep. Walter Herger [R-CA2] 13 Cosponsors

Full Text

Status:

Occurred: Introduced Jan 24, 2011
Occurred: Referred to Committee View Committee Assignments
Not Yet Occurred: Reported by Committee ...
Not Yet Occurred: House Vote ...
Not Yet Occurred: Senate Vote ...
Not Yet Occurred: Signed by President ...

This bill is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee. [Last Updated: Jan 27, 2011 6:21AM]

Healthcare Economist · Health Reform’s Consumer Protections?

by Jason Shafrin

The provision of the ACA (a.k.a. Health Reform) have a number of provisions to mandate more generous health insurance benefits. Some of these provisions include the following:

• Health plans generally must allow adult children up to age 26 to stay on their parents’ policies
• Health Plans cannot charge co-payments for preventive services
• Health plans cannot impose a lifetime limit on benefits.
• Health plans must limit the percentage of revenues they can spend on administrative expenses
• Health plans are prohibited from turning away individuals with pre-existing conditions.

Some sources such as The New York Times claims that these provisions are consumer protections. Michael Cannon of the Cato Institute, however, disagrees. He writes:

“These supposed consumer protections are hurting millions of Americans by increasing the cost of insurance, increasing the cost of hiring and driving insurers out of business… [HHS] estimated that one of the law’s regulations – the requirement to purchase unlimited annual coverage – will increase some people’s premiums by 7 percent or more when fully implemented. A Connecticut insurer estimated that just the provisions taking effect last year would increase some premiums by 20-30 percent… The ban on discriminating against children with pre-existing conditions has caused insurers to stop selling child-only policies in dozens of states.”

Like all things, however, there are tradeoffs to these provisions.
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A New 'Definition' For Health Care Reform - Kaiser Health News

by James C. Capretta and Tom Miller

The principal divide in American health care policy is over what to do about rapidly rising costs. On one side are those who believe the solution is to enhance the government's power to direct the system's resources and enforce budgetary controls. This point of view animated the drafting of the recently passed health care law.

On the other side are those who believe the answer is a functioning marketplace for insurance and care, not coercion and heavy-handed regulation. The key to such a competitive market is cost-conscious consumers, something sorely lacking today.

In Congress, the new House majority plans to pass a bill to "repeal" last year's health law. That's a start (even if the odds of enactment are long for now), but House leaders know that repeal of ill-advised legislation on its own will not fix health care's complex challenges.

Pro-competition, pro-consumer-choice advocates should press for reforms that would begin to convert existing, federally subsidized arrangements from open-ended benefit guarantees into "defined contribution" programs. The comprehensive and strategic approach we propose would apply defined contribution financing by taxpayers to all three major insurance coverage platforms -- Medicare, Medicaid and private health insurance.

The defined contribution revolution is already well underway in private pensions. In 1985, some 80 percent of all full-time U.S. workers were enrolled in defined benefit pension plans sponsored by their employers. By 2006, the number had dropped to just 20 percent.

However, this wholesale shift has not yet occurred in the health care context, largely because the vast majority of Americans are in comprehensive insurance arrangements that are heavily subsidized by the federal government. Further, these subsidies are generally without limit. Incentives for employers as well as workers and consumers to economize and seek better value are thus substantially muted by existing government policy.

Full Article

H. J. Res. 19: Disapproving a rule submitted by the Department of Health and Human Services relating to "Health... (GovTrack.us)

Disapproving a rule submitted by the Department of Health and Human Services relating to "Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient Protection and Affordable Care Act".

Sponsor:	Rep. John Carter [R-TX31](no cosponsors) Cosponsors:
Text:	Full Text
Status:	Introduced Jan 12, 2011 Referred to Committee View Committee Assignments Reported by Committee ... House Vote ... Senate Vote ... This resolution is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee. If this joint resolution proposes an amendment to the Constitution, three-fourths of the states must ratify the proposal. A joint resolution, if not amending the constitution, may also be signed into law by the president. [Last Updated: Jan 13, 2011 6:12AM]
Last Action:	Jan 12, 2011: Referred to the House Committee on Energy and Commerce.

Status Updates

H.R. 103: To amend the Social Security Act to improve choices available to Medicare eligible seniors by... (GovTrack.us)

To amend the Social Security Act to improve choices available to Medicare eligible seniors by permitting them to elect (instead of regular Medicare benefits) to receive a voucher for a health savings account, for premiums for a high deductible health insurance plan, or both and by suspending Medicare late enrollment penalties between ages 65 and 70.

Sponsor:	Rep. Marsha Blackburn [R-TN7]hide cosponsors Cosponsors: Ronald Paul [R-TX14] Mike Pence [R-IN6] Phil Roe [R-TN1] Dana Rohrabacher [R-CA46] Peter Sessions [R-TX32]
Text:	The text of this legislation is not yet available on GovTrack. It may not have been made available by the Government Printing Office yet.
Status:	Introduced Jan 5, 2011 Referred to Committee View Committee Assignments Reported by Committee ... House Vote ... Senate Vote ... Signed by President ... This bill is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee. [Last Updated: Jan 8, 2011 6:16AM]
Last Action:	Jan 5, 2011: Referred to House Energy and Commerce

Current Status

CBO: GOP Repeal of Health Reform Will Add $230 Billion to Deficit, Eliminate Coverage for 32 Million, and Americans Will Pay More for Less | The Gavel

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by Karina

The nonpartisan Congressional Budget Office (CBO) just released an estimate of the Republican bill to repeal the Affordable Care Act and finds the GOP plan explodes the deficit and will have a devastating impact on the health of millions of Americans.

According to CBO, here’s what the GOP repeal bill means for Americans:

Adds $230 billion to the deficit over the first ten years and more than $1.2 trillion in the second decade (around one-half percent of GDP)

32 million Americans will lose health coverage

Americans will get fewer health benefits for their money

Americans purchasing health insurance on their own will see their costs rise

Health care premiums for Americans getting coverage through large employers will go up

CBO: GOP Repeal of Health Reform Will Add $230 Billion to Deficit, Eliminate Coverage for 32 Million, and Americans Will Pay More for Less | The Gavel

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• Repealing health-care reform would cost hundreds of billions of dollars -- and Eric Cantor knows it (voices.washingtonpost.com)
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Improving The Health Law In 2011: Realistic Ways To Reach Bipartisan Compromise - Kaiser Health News

by Robert Laszewski, President of Health Policy and Strategy Associates

The new health care law can be changed in ways that would make it acceptable to a bipartisan majority in the new Congress -- and, therefore, to the American people. But to find this elusive middle ground requires consideration of the competing philosophies at the heart of the nation's political divisions regarding this sweeping measure.

For starters, liberals want a health insurance system in which everyone is covered in a more equitable health insurance pool, but conservatives argue the individual mandate used to accomplish this goal is an unconstitutional encroachment on individual freedom.

Liberals also want a standardized competitive marketplace for health insurance ensuring consumers get comprehensive benefits, but conservatives argue that this would destroy choice and the free market, and create hundreds of pages of rules about what people can and can't buy.

And liberals want every citizen to be entitled to a comprehensive health insurance plan -- a defined benefit. But conservatives want individuals to have incentives, including tax incentives, to purchase and use coverage responsibly -- defined contribution health insurance.

However, there are ways to modify the new health law so that it includes the key elements both sides see as central to moving toward covering everyone and doing it in a way we can better afford.
The key elements of such a compromise could include:

1. Eliminating the individual mandate and replacing it with freedom of choice with responsibility

2. Eliminating the benefit mandates in the new law and creating a free market of health insurance choices, but with a standardized baseline for ease of comparison

3. Eliminating the "Cadillac" tax on high cost health insurance plans and introducing elements of a conservative defined contribution approach to the existing liberal defined benefit legislation

4. Using the budget gains from limiting the existing health insurance tax preference to pay for such things as improving the now inadequate insurance subsidies for the middle-class, permanently fixing the Medicare physician payment issue, or for reducing the deficit.

5. Letting states have the flexibility to experiment with alternatives

New Disenrollment Period Offers Some Medicare Consumers One More Chance To Change Their Health Coverage

-- Consumers Should Carefully Review Their Options Before Making a Change --

New York, NY—Medicare consumers who are enrolled in Medicare private health plans, commonly known as Medicare Advantage plans, and who become dissatisfied with their choice, can disenroll during the Medicare Advantage Disenrollment Period (MADP), which runs from January 1 to February 14. Consumers who disenroll from their private plan can switch only to Original Medicare—the traditional Medicare program administered by the federal government. Most people who switch to Original Medicare can also change their Medicare prescription drug coverage. The MADP replaces the Open Enrollment Period, which ran from January 1 to March 31 in past years.

“People with Medicare who become unhappy with their Medicare Advantage plan have one more opportunity to change their coverage before being locked in until next fall,” said Joe Baker, president of the Medicare Rights Center. “Because the window is shorter than in past years, consumers should review their coverage options carefully and consider all of the implications of making a change before doing so.”

What are my options during the Medicare Advantage Disenrollment Period? If you have: A Medicare Advantage private health plan with prescription drug coverage, you can switch to Original Medicare plus a prescription drug plan OR Original Medicare without a prescription drug plan A Medicare Advantage Private Fee-For-Service (PFFS) plan that does not include prescription drug coverage and a stand-alone prescription drug plan, you can switch to Original Medicare, but you must keep your current prescription drug plan Original Medicare or Original Medicare and a prescription drug plan, you cannot make any changes during this time

Although Original Medicare covers most necessary services and is accepted by most doctors and facilities across the country, it does not cover the full cost of care. Many consumers who enroll in Original Medicare choose to purchase supplemental coverage to help pay for out-of-pocket costs such as deductibles and coinsurance.

However, people who disenroll from their Medicare private health plan may have limited ability to buy supplemental coverage. State laws vary on when consumers can purchase Medicare supplemental policies, also known as Medigaps. Call your State Health Insurance Assistance Program (SHIP) to find out if and when you can enroll in a Medigap plan in your state. You can find the number for your local SHIP by visiting www.shiptalk.org or calling 800-MEDICARE.

Consumers who disenroll from their private plan should be aware that they may need to join a stand-alone Medicare prescription drug plan in order to maintain drug coverage. Medicare Rights advises consumers who are choosing a plan to consider not only premium and copayment costs, but also whether the drugs they take are on the plan’s formulary (list of covered drugs). Consumers should also check to see whether the plan places any restrictions on the drugs they take. Restrictions can take the form of quantity limits, prior authorization, and step therapy. To learn more about choosing a Medicare prescription drug plan that best meets your needs, visit Medicare Interactive.

Medicare Rights advises consumers who wish to change their health coverage to do so by calling 800-MEDICARE rather than their plan. If you need to keep or add Medicare prescription drug coverage, it is best to make your coverage change by enrolling in a stand-alone drug plan. When you enroll in a drug plan, you will automatically be enrolled in Original Medicare. Changes made during the MADP are effective the first of the following month.

Learn more about changing your Medicare private health plan on Medicare Interactive.

Resources

• Find the number for your local State Health Insurance Assistance Program (SHIP) at www.shiptalk.org.
• 800-MEDICARE
• Medicare Interactive (www.medicareinteractive.org), the Medicare Rights Center’s free web-based counseling tool, can help you evaluate your coverage options.

AP-GfK Poll: Baby boomers fear outliving Medicare - Yahoo! News

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By RICARDO ALONSO-ZALDIVAR and JENNIFER AGIESTA

The first baby boomers will be old enough to qualify for Medicare Jan. 1, and many fear the program's obituary will be written before their own. A new Associated Press-GfK poll finds that baby boomers believe by a ratio of 2-to-1 they won't be able to rely on the giant health insurance plan throughout their retirement.

The boomers took a running dive into adolescence and went on to redefine work and family, but getting old is making them nervous.

Now, forty-three percent say they don't expect to be able to depend on Medicare forever, while only 20 percent think their Medicare is secure. The rest have mixed feelings.

Yet the survey also shows a surprising willingness among adults of all ages to sacrifice to preserve Medicare benefits that most Americans say they deserve after years of paying taxes into the system at work.


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