Archive for 2009
Does This Make Sense to Anyone?
Author : Toni Bigby
Dec 23rd, 2009 | by
We know. We don’t want to “make the perfect enemy of the bad” and all.
But really, this new thing about the insurance company tax exemption? We need to take another look. As of now, non-profit insurance companies that operate in the private marketplace (primarily the Blue Cross/Blue Shield companies) and spend at least 92% of premiums directly on medical costs would be exempted from the new tax on insurers in the Senate bill. (Wall Street Journal’s explanation of this “bright spot” ).
This needs to be extended to companies serving the public through Medicaid, Medicare and CHIP. Otherwise, millions of state tax dollars currently being used to provide health care to children, seniors and others will instead be sent straight back to Washington, leaving the states to find some way to make up the difference.
We don’t think anyone meant the new tax on insurers to actually be a tax on states, but that’s how it works out in the current iteration of the bill. It doesn’t make sense to us.
By the way, Associated Press offers a pretty comprehensive list of all the compromises in the Senate bill as it stands, here.
Article Tags
Blue Cross/Blue Shield • Children’s Health Insurance Plans • CHIP • health care reform • health insurance • health insurance plan • Medicaid • Medicare • SCHIP • taxes • Wall Street Journal • WSJ
One Playground Accident Away from Bankruptcy
Author : Toni Bigby
Dec 14th, 2009 | by
It’s true…the cost of health care for most families in our country has put them in a seriously helpless situation. It’s sad to think that one playground accident could bankrupt a family of four. A fall from the monkey bars, a broken leg from a football game, an ill-timed sprint in front of the swings. It’s enough to keep many parents up at night.
However, Senator Robert Casey’s (D-PA) recent amendment to the Patient Protection and Affordable Care Act (H.R. 3590) should be applauded because of its focus on protecting and improving the successful Children’s Health Insurance Program (CHIP). Our country’s children have a lot at stake in health reform. More than eight million children remain uninsured, and more are losing employer-sponsored coverage daily. Each day a child is uninsured is a lost opportunity to strengthen America’s future. Casey’s amendment goes a long way toward protecting and improving coverage for millions of children in low-income working families across the nation by:
- Providing full funding for CHIP through 2019;
- Maintaining current CHIP eligibility through 2013, and setting a floor for income eligibility for children in all states at 250 percent of poverty ($55,125 for a family of four) beginning in 2014;
- Streamlining enrollment procedures making it easier for children to get coverage and keep it;
- Ensuring that coverage for children remains affordable;
- Guaranteeing all children in CHIP the comprehensive care they need from head to toe; and
- Requiring an HHS report in 2016 that will compare coverage for children in CHIP with coverage for children in the new Health Insurance Exchange and if coverage (including benefits, cost-sharing, premiums, and other features) is comparable or better, children can be transitioned from CHIP into the Exchange in 2019.
Our nation has made great strides over the last decade in securing health coverage for low-income children of working families. We must now seize this historic opportunity to build on the success of prior efforts and the bipartisan CHIP program, and ensure that children will be better off, not worse off, as a result of health reform. This amendment will do just that.
Along with 610 organizations/individuals across the nation, we offer our strong support for the CHIP Amendment (#2790). We stand ready to work with the Senate to achieve our common goal of reforming our nation’s health care system and ensuring that all children, indeed everyone in America, have access to the health coverage they need and deserve.
Insurer Fee – Reasonable Idea… Unintended Consequences
Author : Chris Whistler
Dec 10th, 2009 | by
Whenever a new concept is proposed, those at the deliberation table automatically ask “what would happen if?” before they decide to act. With health care reform for example, the driving questions are more like: “Are the changes going to result in more Americans getting coverage? Are the proposed changes budget neutral?” Given the broad scope of the proposed health care legislation, it’s easy to see how details can get overlooked. And when time is ticking, unintended consequences have a higher chance at prevailing.
One concern that should be brought to light is the $6.7B annual fee proposed on insurers. While conceptually this might make sense given the number of Americans who will be required to obtain coverage and the new revenue that insurers stand to gain, a portion of this fee would not be limited exclusively to commercial health insurance companies. Health plans that contract with federal and state governments to serve Medicaid, Medicare, and beneficiaries of the Children’s Health Insurance Plan (also known as CHIP) would also get taxed too.
Well, the challenge is that a significant portion of this fee will fall on state budgets because of the way states are required to reimburse health plans that serve its most vulnerable residents. The new fee will unintentionally require states and the federal government to ultimately come up with additional public dollars to pay for this added fee.
Also, this fee would unfortunately raise the overall costs of these government programs and place additional strains on programs that are already in extreme financial distress. For example, Ohio’s Medicaid program would have to potentially come up with an estimated $65 million annually. Subsequently, the burden of this fee will be paid for by taxpayer-funded government programs and beneficiaries that use these health plans.
Easy solution to the problem? Just exempt health plans administering government entitlement programs from the application of this fee. Problem solved; Unintentional consequence diverted.
Article Tags
Children's Health Care • Children’s Health Insurance Plans • CHIP • health care plan • health care reform • health insurance • health insurance plan • insurer fee • Medicaid • medicaid program • Ohio medicaid program • SCHIP • taxes
The Holidays are a Time for Reflection
Author : Toni Bigby
Nov 24th, 2009 | by
The holiday season is now upon us. And while this time of year is supposed to be a joyous time spent with family and friends, I find myself reflecting on the lives of people that find the holiday season to be just another reminder of their economic circumstance. The underserved – particularly those at or below the poverty level – will experience the holidays in a much different way. With more and more families facing job loss as a result of the recession, many will not have Thanksgiving feasts…many will be struggling to find ways to “make the season bright” for their children. Many are turning to the social services available within their community just to make it through another month.
Throughout my time at CareSource and with Ohio’s Medicaid program, I’ve learned to have a deep appreciation for the challenges faced by the underserved. Sure, we can try to conceptualize what a day in the life of someone living in poverty is like, but CareSource has exposed me to a much more profound way to think about the priorities of the underserved…and they did this by proactively organizing an interactive event for CareSource employees called the “Poverty Simulator.”
Because our company prides itself on helping the underserved better their lives by improving their health care, our organization does some pretty unique things to help us appreciate the challenges our members face each day – and how they prioritize getting their most basic needs met. This Poverty Simulator – organized by Think Tank, a non-profit organization that strives to build communities where all people can thrive – does just that…it allowed us to put ourselves in the shoes of our members through role-play, to gain a fuller appreciation of barriers that often preclude them from accessing health care services responsibly. It’s all done in an effort to teach us why our members make the decisions they make; ask the question they ask; need the support services they need; and where their health care fits in to the grand scheme of things they consider vital… Why? All so we can better serve them.
We’ve held this event four times this year for our employees who have described the event as “heart-wrenching,” “mind-blowing” and “eye-opening.” The simulator has been so enlightening that we included it as part of an event we hosted on Capitol Hill that allowed health care experts and interested parties to experience it firsthand. The purpose was for those following and influencing the health care debate to gain a better understanding of how poverty impacts the way people prioritize and access health care – even if it is made available to them at no cost.
It’s so easy to make general assumptions about why people make the decisions they make. But quite frankly, until you actually walk in the shoes of the underserved, it is very difficult to appreciate the complexities of living in poverty. Please take a few minutes to see what the Poverty Simulator is all about. I think you’ll find it offers a unique and profound approach for helping organizations understand the needs of its customers, and how CareSource excels at building a culture of compassion, dignity and excellence.
Article Tags
benefit bank • CareSource • giving back • Governor Strickland • health care • health care reform • medicaid program • Ohio • Ohio medicaid • poverty • role-play • social services • Thanksgiving • Think Tank • underserved • underserved Americans
The Government Says Questions are the Answer. Our Question is: Have You Tried It?
Author : Toni Bigby
Nov 13th, 2009 | by
The “Questions” Campaign
Our Federal Government is investing in a consumer education campaign called “Questions are the Answer.” The idea is to encourage people to watch out for themselves a little better - be their own advocate by asking their doctors questions like “why do I need this surgery?” and “are there any side effects from this drug?”
I have a question. Well, actually two. Why are we as health care consumers who collectively spend trillions of dollars each year on health care likely to ask more questions about a $15 dinner than a doctor’s diagnosis? Why isn’t there a menu listing the costs associated with the services/procedures/drugs that a doctor says we need before we decide whether or not we can actually afford the service? The way we pay for health care is like we have a high interest credit card with no limit. We buy now and pay later – so much later that our future generations will still be paying because many of us are hesitant to ask: “Do I really need this? Is this my only option? Should I get a second opinion?”
Who is Responsible?
Yes, doctors should elicit patient questions and answer them fully. And many doctors – but not all – even take the opportunity to answer the questions their patients don’t think to ask like – “What are your health care goals? Do you want to live pain free? Be able to play competitive sports? What are the side-effects you have experienced from this particular drug or procedure?”
But docs cannot bear the weight of this burden alone, nor should they. Patients have a responsibility to become informed and to take necessary actions to improve their health. Families ought to help in the decision-making process and be supportive. Health plans should be well equipped with clinicians and medical professionals that proactively help their members understand what options they have (and quite frankly, they probably have a little more time than a doctor can spare during a typical office visit).
Yes, patients should ask at least the obvious questions outlined at the link referenced above. But the historical reluctance to question the health care provider continues to linger on…Don’t get me wrong – I appreciate the wealth of knowledge that doctors amass. Often times, they know too much which makes it that much harder to communicate to those of us who can’t even remember our own blood type. And besides, it’s hard to ask a question of someone who’s halfway out the door, instructing you to come back for another billable visit and who’s just probably told you something you didn’t necessarily want to hear.
So What’s the Point?
My point is, even if you engage your doctor in meaningful conversation about his/her diagnosis, the doctor should not be the only one responsible for deciding what is best for you. Each one of us should have an entire team established– us, as the health care consumer, our family, our doctor, and our health plan – all working together in unison. Why? Because too many of us pay for decisions made simply because the doctor “says so.” WE as a country need to decide collectively that WE will begin to make informed decisions in the future – not just the billable ones charged to an unrestricted credit card.
Article Tags
AHRQ • clinic • consumer education • credit card • doctor • government • health care reform • health plans • high interest credit card • patient • patient empowerment • provider • surgery • “Questions are the Answer”
The “Public Option” is NOT Revolutionary… Actually, It’s Been Working Great For Years
Author : Bobby Jones
Nov 6th, 2009 | by
You’ve probably noticed that the health care reform debate has shifted from health care reform to health “insurance” reform. Despite its efforts to work collaboratively, the insurance industry is the simple target to blame for the health care mess we so urgently need to fix. (There is no single villain, of course. It’s the entire system that’s broken.)
However, that may explain the “co-op” approach passed as part of the Senate Finance Committee bill. But, as 30 Senators pointed out in a letter to Senate President Harry Reid, co-ops (as currently written in America’s Healthy Future Act) are pretty much a non-solution:
The Senate Finance Committee included a cooperative approach to insurance market competition. While promoting more co-ops may be a worthy goal, it is not realistic to expect local co-ops to spring up in every corner of this country. There are many areas of the country where the population is simply too small to sustain a local co-op plan. We are also concerned that the administrative costs associated with financing the start-up of multiple co-op plans would far outstrip the seed money required to establish a public health insurance program.
There’s another point made further down in that letter that really is something to think about:
The major differences between the public option and for-profit plans are that the public plan would report to taxpayers, not to shareholders, and the public plan would be available continuously in all parts of the country.
Guess what? We’re already here. Established and ready to serve. A health plan that is accountable to taxpayers. CareSource, the nation’s second largest, not-for-profit Medicaid health plan and a number of other organizations like us around the country have been helping Americans get the care they need at the right place, at the right time and at a lower cost.
My point here is that even though the health care system is broken, there are still a lot of working parts, including a number of proven, experienced and effective non-profit insurance companies in place that can help get a “public option” off the ground. The best part – we can do it fast and transparently.
And while 47 million Americans now have no health care at all, speed and honesty is a big part of what we all need.
More Is Not Better – The Story of Fragmentation of Care
Author : Craig Thiele, M.D.
Nov 4th, 2009 | by
It’s the Fragmentation, People
I heard a story that didn’t surprise me, but may surprise you, especially if you haven’t heard much about fragmentation of care. It was called “The Telltale Wombs of Lewiston, Maine,” on National Public Radio. At the start, the story seemed to be pointing a finger at doctors for providing services (especially surgeries) that their patients don’t really need, sometimes with negative results. This point of view has been around awhile, and frankly, does not do justice to a complex situation.
In the end, here’s what I heard that concerned me:
“(Dr.) Elliott Fisher…compared Medicare recipients with similar levels of sickness in areas throughout the whole United States. Fisher looked at places where elderly people used relatively few health care services and compared them with places where elderly people used a lot of health care services.
‘The patients in the high-spending regions were getting about 60 percent more care; 60 percent more days in the hospital; twice as many specialist visits,’ Fisher says. ‘And yet when we followed patients for up to five years, if you lived in one of these higher-intensity communities, your survival [rate] was certainly no better, and in many cases a little bit worse.
This is probably because of something called fragmentation of care. In high-use areas, it’s often the case that many different doctors play a role in the care of a patient; many specialists are responsible for overseeing only a small part of the person. This increases the amount of treatments, tests and hospitalizations that people get, and exposes people to more risk of harm from medical error and side effects.”
For most Americans, fragmentation of care is a difficult idea to accept: It’s hard to understand that more care isn’t necessarily better for you.
But study after study has borne out the truth of this completely anti-intuitive conclusion. In fact, Fisher and other researchers estimate that almost one-third of the care given in our country today is that kind of care — care that may not help.
In some studies, it is estimated that the United States spends more than $2 trillion on health care every year. If 10 percent of this care provided is unnecessary, this would cost $200 billion. Some estimate it may be as high as 30 percent, or roughly $600 billion.
What lesson should we take from this about health care reform overall? It seems to me that whatever the final form it takes, reform must confront and solve these issues, including fragmentation of care. Whether we go with “exchanges,” “co-ops,” a “public option,” Medicaid expansion, or a combination of all of them, attention must be paid to avoid fragmentation by coordinating care.
It seems too obvious to point out that non-profit insurers like CareSource have been improving outcomes and controlling costs through care coordination for years now. We certainly hope that Congress, in its wisdom, will put that experience to work.
Ask your health care reform questions here
Article Tags
Co-op • Dr. Elliott Fisher • exchange • fragmentation • fragmentation of care • health care • health care reform • Kaiser Family Foundation • Medicaid • Medicare • NPR • Public Option • public plan • Public Radio • WOSU-AM
Can We Wait Until 2014?
Author : Chris Whistler
Oct 14th, 2009 | by
The US Senate Finance Committee just approved a health care plan that includes a provision that would significantly expand Medicaid. This is great on so many levels. However, it has one flaw. That being, the full expansion wouldn’t actually start until 2014. Is it just me, or does that seem to contradict the whole idea of protecting the most vulnerable first?
Yes, it’s true that we’ve been trying to fix the health care system since at least 1948. So from one point of view, spending another few years trying to get it right doesn’t seem out of line. But imagine if all you hear around you is that health care reform is going to make a difference in the lives of the 47 million uninsured Americans right now, but then you find out that you have to wait longer than everybody else. Then, to make matters worse, your income is among the lowest in America and is the primary reason you are uninsured in the first place.
The unfortunate truth about this health care plan is that once again, those who are most in need are expected to wait longer than the rest of us. This includes hard working people with low incomes who just don’t happen to have dependent children – the current ticket for most people to qualify for Medicaid. And parents who are doing all they can to make ends meet for their children who are blocked from Medicaid coverage because their very limited income is deemed too high for them to qualify. The list goes on.
Where’s the justice in waiting to expand Medicaid until 2014? Or, maybe more pragmatically, where is the preventive care and coordination that is going to enable the right care at the right time in the right setting – you know, rather than causing the first stop to be in an emergency room after waiting until the cancer spreads, the diabetes worsens, or the heart attack occurs.
Doesn’t it make sense to have health care coverage for those that need it most first?
Ask your health care reform questions here
