Posts Tagged ‘Medicare’
Oct 6th, 2010 | by
This year has marked a series of milestone anniversaries for many of our nation’s most well known public programs. Programs that have become synonymous with stability, security and health care. They are: Social Security, Medicare and Medicaid. And, let’s not forget one of the most significant pieces of legislation our nation has seen in the last 20 years – the Americans with Disabilities Act (ADA).
You may be wondering why a large health plan like CareSource would care about the ADA or public programs in general. It’s actually pretty simple. It’s because each of our members is touched by at least one of these programs every day. Moreover, our members have tenaciously navigated the pitfalls of bureaucracy to secure and retain a benefit that is fundamental to their sheer existence. And, a good portion of them are just beginning to realize the opportunities that now lay before them as a result of the ADA (which, by the way, strives to remove significant barriers for individuals with disabilities. More on this later.)
Social Security – Celebrating 75 Years of Security
Despite being well past the age where most Americans can begin to receive benefits, the Social Security program is still viewed as one of the most important programs in our country. In fact, according to the AARP, nine out of ten adults held this view consistently in 1995, 2005 and 2010. Social Security underscores the importance of many of the values we advocate for today – independence, safety and financial peace of mind. As technology and innovation allow us to live longer, these values will remain essential to a more secure and productive tomorrow.
Medicare and Medicaid Turn 45
When Lyndon B. Johnson signed Medicare and Medicaid into law in 1965, do you think he ever dreamed it would result in health coverage for more than 100 million Americans just 45 short years later?
It’s a dream that many of us are proud to fathom. It’s a fiscal challenge we’d like to forget. But without these two programs, America would be a very different place. While not necessarily perfect, these programs have driven us as a society to build a health care system that allows us to live longer, employ millions of Americans and provide the strength a nation needs to forge ahead. Yes, some might agree that we have lost our footing along the way, but the passage of the Patient Protection and Affordable Care Act will be a milestone that will be celebrated just four short years from now.
ADA Celebrates 20 Years
July 26, 2010 marked the 20th anniversary of this historic legislation enacted to break down barriers in housing, the workplace, schools, malls, telecommunications and public transportation for people with disabilities. Despite its worthwhile advancements, leading advocates realize there is still much more work to be done. Our nation has focused heavily on supporting disabilities financially and medically, but not really as much on merging these ideals in a way that fosters inclusion and independence.
As we reflect on the needs of the more than 65,000 members with disabilities we serve in Ohio and Michigan, it is with great humility that we continue our advocacy to extend our reach to cover more individuals with disabilities. Doing so will ensure that they receive health care in a way that is person-centered, comprehensive, coordinated and in a setting where they can thrive and succeed.
Charting New Milestones
As a non-profit health plan, we recognize the foundation these programs have established for the current generation and for generations to come. The programs mentioned above as well as countless others have truly inspired the advent of companies like ours that are adamantly focused on supporting the underserved. In this commemorative year, we want to take this opportunity to honor each person who works tirelessly every day to help our nation’s most vulnerable reach their next important milestone. Happy Anniversary!
Article TagsAARP • ADA • Americans with Disabilities Act • Anniversary • Care Coordination • Disability • health care reform • Medicaid • Medicaid Eligibility • Medicare • michigan medicaid • Ohio medicaid • Patient Protection and Affordable Care Act • President Johnson • public programs • Rehabilitation Services Commission • Social Security
Mar 23rd, 2010 | by
On behalf of the 15 million Americans who will be eligible for Medicaid as a result of health care reform…we thank you.
On behalf of the children that need health care to support every possible opportunity for a successful and productive life…we thank you.
On behalf of Americans who must choose between buying food and getting health care…we thank you.
On behalf of the senior citizens who are wondering how to maintain their health on a modest budget…we thank you.
Despite the contentious year-long debate, Congress has done what’s right for the American people. Making health care a right – not a privilege – is a fundamental element that has been sorely missing from the ideals of our nation…until now!
Was this the best possible outcome? Probably not.
Does the new legislation fix every problem that ails the current health care system? No, not really.
But it is definitely a start. We elected our leadership to do what is best for the American people given the challenges our country is currently facing. Right now, what is best has arrived in the form of a new and improved health care system that will turn away no one; that will take care of our children; and most importantly, that is in reach to all Americans.
- Expansion of Medicaid to everyone (under age 65) below 133% of the Federal Poverty Level by 2014– removing categorical eligibility which currently forces many individuals in poverty to go uninsured.
- Creation of state-based health exchanges through which individuals can purchase coverage, with premium and cost-sharing credits available to individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,404 to $43,320 for individuals and $29,326 to $88,200 for a family of four.
- An individual mandate for all to ensure all Americans participate in the insurance risk pool resulting in lower cost coverage options for all. Requires insurers to cover those with pre-existing conditions, removes lifetime limits, prohibits rescission of coverage and mandates prevention services be covered at 100 percent.
- Equalization of treatment of managed care and fee-for-service under the Medicaid drug rebate program.
- Closure of the Medicare prescription drug “doughnut hole” by 2020.
- Reauthorization of the Medicare Advantage Special Needs Plan program.
- Improved coordination for Medicare and Medicaid dual-eligibles.
Each of these provisions propels our country into a new era in health care for which we should embrace and build upon. There are many that vow to fight the passing of this bill, and that’s to be expected. But we should applaud all of our policymakers for remembering why and how this nation was created…to be a land of opportunity, of freedom, and of equality. Thank you, Congress, for doing what’s right for all people.
Article Tagscongress • cost of health care • drug rebate program • Federal Poverty Leve • fee-for-service • health care costs • health care exchange • health care reform • health insurance • individual mandate • managed care • Medicaid • Medicare • Medicare Advantage • michigan medicaid eligibility • ohio medicaid eligibility • poverty level • state based health exchanges
Feb 11th, 2010 | by
We all hear “Presidents Day” and think “Washington and Lincoln.” Banks and post offices are closed and for some, another well deserved federal holiday. But that’s just habit.
This year, we might do well to remember another group of presidents–those who have done their best to establish a better health care system for the nation. Every president for the past 75 years has been part of the struggle, yet we still have a system that not only bankrupts individual citizens without regard, it decimates state budgets and paralyzes the federal government from making substantive improvements to the nation’s economy.
While Lyndon Johnson gets much of the credit for getting Medicare and Medicaid passed into law, the true hero of Medicare was John F. Kennedy, who worked, negotiated, and hammered out a solution that would help Americans – and actually found a way to get it approved by Congress.
Medicare has worked fairly well for fifty years—but at the time, the same doubts were voiced that we are hearing today—the bill’s imperfections were too great. At a rally in New York to support health care for the elderly, Kennedy confronted the question: “We’ve got great unfinished business in this country,” he said, “and while this bill does not solve our problems in this area, I do not believe it is a valid argument to say ‘This bill isn’t going to do the job.’ It will not, but it will do part of it.”
The comprehensive health care reform we need today is even more critical than when Kennedy spoke those words in 1962. No, it may not be entirely accomplished by the plans now being discussed in Congress. Yes, it’s imperfect, but the cost of doing nothing is unacceptable. Turning our backs now, when we have a solid plan that insures over 90 percent of Americans; that bends the health care cost curve; that brings down premiums and that strengthens Medicare for seniors, is simply irresponsible. This plan is the closest we’ve ever come to true reform.
There’s no need to give up. Let’s call upon Congress to deliver a bill to the President in recognition of President’s Day. Moreover, for all the presidents before him who have fought tirelessly to get Americans a health care system that will move us one step closer to handling this country’s “unfinished business.”
What do you thing has been the most significant achievement in reforming health care up until now, and which President do you think gets the most credit?”
Article TagsAbraham Lincoln • congress • George Washington • health care • Health Care Presidents • health care reform • JFK • John F. Kennedy • Lyndon Johnson • Medicaid • Medicare • Medicare costs • michigan medicaid • Ohio medicaid • Ohio medicaid program • Presidents' Day • reforming health care • support health care
Jan 26th, 2010 | by
There’s really only one thing that worries me about the Massachusetts election. I’m not troubled by the fact that the Democrats lost filibuster-proof control of the Senate. Control shifts back and forth as often as who is going to host the Tonight Show on NBC.
It doesn’t worry me that Senator Elect Scott Brown will try to block any potential of health care reform. We’ve come too far over the past year…really over the past half century…to turn back now.
I’m also not concerned that the Democrats will try to force through a health care reform policy -just to get it done. Forcing through policy doesn’t always go over well to voters in an election year – especially those with long-term memories. However, a recent poll by the Kaiser Foundation indicates the American public, including skeptics, become more supportive of health care reform after being told about many of the major provisions in the bills.
But what is worrisome…troubling…concerning to me is that momentum will waver, and the true ideals of health care reform will be lost. We must be sure the following elements of health care reform stay in place:
- Increase Medicaid eligibility – whether its 133% or 150% (which I would prefer), we need to make sure reform protects our most vulnerable citizens
- Protect our children – CHIP programs work…that’s why so many of our policy-makers rose to the occasion to protect in the current bills – Sen. Casey, Sen. Rockefeller, Sen. Reid, etc.
- Affordable Coverage for All – Don’t let purchasing health insurance be burdensome to the majority – continue with plans to provide government assistance through subsidies to those under 400% of the national poverty level
- Use of a state based health care exchange to act as a transparent clearinghouse for consumers to purchase coverage
- Cost containment to bend the unsustainable curve of health care costs
- Medicare & Medicaid benefit integration and financing for dual eligibles within a managed care model to rebalance the long-term care system to increase use of home and community based support services. Shifting more of this high-need population into coordinated managed care arrangements could produce significant savings while ensuring options for consumers where they desire to reside.
Sure, CareSource is a non-profit health plan that believes there is always room for improvement, but we support health care reform. Give non-profits wider opportunities to control costs, enable insurance companies to accept anyone with pre-existing conditions, include an individual mandate so that we all pay our fair share and, reimburse for positive outcomes, etc.
So to do my part in making sure Congress knows that I don’t want the momentum to subside in Washington, I used this source to send Congress – and my local newspapers – a letter:
This one is for Ohio citizens…but if you live outside of Ohio, you can go to FamiliesUSA to send your own letter to Congress.
Please let Congress know that we cannot afford to take our eye off the goal just because of one election. We must move forward with health care reform. Our country deserves it.
Article TagsAffordable Health Coverage • Children’s Health Insurance Program (CHIP) • congress • exchange • health care reform • Health Coverage • Kaiser Foundation • Massachusetts Miracle • Medicaid • Medicare • michigan medicaid • Ohio medicaid • Ohio medicaid program • poverty • Scott Brown • Senator Scott Brown • Senator-elect Scott Brown • support health care reform
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.
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.
Article TagsCo-op • Dr. Elliott Fisher • exchange • fragmentation • fragmentation of care • health care • health care reform • Kaiser Family Foundation • Medicaid • Medicare • michigan medicaid • michigan medicaid program • NPR • Ohio medicaid • Ohio medicaid program • Public Option • public plan • Public Radio • WOSU-AM
Oct 9th, 2009 | by
Senate Finance Committee Completes Mark-up; Expected to Vote Out of Committee on Oct. 13
The Senate Finance Committee completed debate on proposed health care legislation at 2:18 am last Friday. The Finance Committee was the last congressional panel to consider a health care reform bill and plans to vote this week after the bill’s final language has been made public and the Congressional Budget Office has provided final cost figures. Democrats hold a 13-10 committee majority which clears the way for the full Senate to begin debating the measure on October 13, 2009.
The panel considered many amendments over a two-week period and voted to reduce or waive fines for people who fail to buy coverage and give states money to help insure low-income Americans.
The legislation, estimated to cost $900 billion over 10 years, mandates that Americans get insurance and provides subsidies to those who need them, creates nonprofit cooperatives to offer an alternative to private insurance companies, and prohibits insurers from denying coverage to people with pre-existing medical conditions.
Instead of approving a public option amendment, the finance panel voted 12-11 for a compromise plan offered by Sen. Maria Cantwell, D-Wash., that would give federal funds to states to negotiate with private managed care plans to buy coverage for people who would not qualify for the Medicaid program. This compromise option would be eligible to people with income between 133-200% FPL. For individuals, that means income between $14,403 annually and $21,660. For families of four, the eligibility would be $29,326 to $44,100.
Individual mandate – Lowering the Penalty & Allowing Exemptions Dismays Insurers
An amendment proposed by Senators Charles Schumer (D-NY) and Olympia Snowe (R-ME) was also approved that reduce the penalty for those who fail to comply with an individual insurance mandate to $750 per adult, from $1,900 per family as originally proposed. It also waives the penalties in 2013 and phases them in through 2017. In addition, people who would have to pay more than eight percent of their income to buy insurance would be exempt from the penalties, down from 10 percent.
This amendment is of significant concern to commercial insurers as it could allow 2 million Americans to remain uninsured without contributing to the insurance pool.
Insurers are outraged by the risk involved as they would be required to guarantee coverage for all Americans should the health reform measure pass. A strong individual mandate made this option feasible.
Other notable items:
- By a vote of 13 to 9, the committee approved an amendment by Senator Jay Rockefeller (D-WV) that would keep low-income children in the Children’s Health Insurance Program (CHIP), instead of covering them through the Exchanges. This was a key interest for CareSource as we hope to continue to provide coverage to children who qualify through CHIP in Ohio and Michigan.
- Physician groups were upset to find out that the hospital industry is exempt from a crucial cost-cutting measure related to Medicare payments included in Senate Finance Chairman’s mark. Hospitals were held exempt because they were able to negotiate a $155 billion cost-cutting agreement with Baucus and the White House.
The bill that emerges from Baucus’s panel must be merged with one that passed the Senate Health, Education, Labor and Pensions (HELP) Committee for debate and vote by the full Senate and eventually reconciled with a House measure.
Across the Capitol, Democratic leaders in the House met privately with moderate members, with liberals, and then with first-termers as they struggled to achieve a consensus on legislation to bring to the floor. Majority Leader Steny Hoyer announced it would probably be at least two more weeks before House legislation was ready.
Article TagsCharles Schumer • CHIP • co-op plan • exchange • health care reform • health insurance • Jay Rockefeller • managed care • Maria Cantwell • Max Baucus • Medicaid • Medicare • michigan medicaid • michigan medicaid eligibility • michigan medicaid program • non-profit • Ohio medicaid • ohio medicaid eligibility • Ohio medicaid program • Olympia Snowe • public plan • senator • Steny Hoyer
Oct 2nd, 2009 | by
“Funny or Die”, the comedic website developed by Will Ferrell, Adam McKay and Chris Hench posted a hilarious video about the health insurance industry called “Protect Insurance Companies PSA”. Obviously satiric, the clip showcases many Hollywood personalities supporting the need for health care reform to protect Americans from the interests of greedy health insurance executives. The clip ends with a call to action to support the public option, and email your Congressman.
The only unfortunate thing about this video is that it lumps all insurance companies together. But there are some insurance companies – ours for instance – that actually support reform efforts that offer the uninsured an array of affordable health care options from which to choose. Look, the truth is we are embarking on a new era in health care. The entire health care industry – providers, hospitals and insurance companies alike – will be completely revolutionized once reform is introduced. And the legacy insurance companies who have profited unscrupulously will find it hard to adjust because they’ve operated the same way for years.
The insurance companies of the future – those that are non-profit, customer-focused first, and genuinely engaged in finding ways to decrease spending while increasing quality – are the companies ready to thrive in this new era. Do we stand to benefit? Of-course we certainly hope so. But I’d rather have a system that rewards transparency, honesty, inclusion, wellness and empathy than one that rewards profitability and size.
Public option, co-op, exchange, expanded Medicaid and/or individual mandates …whatever shape reform ends up taking, there are a handful of progressive companies ready to embrace this new world. Will Ferrell and team are funny indeed! I just hope they know there are some insurance companies out there that support his team’s ideals and don’t make us all pay for the sins of others!