Health junction

How the latest proposed tax cuts lead to the dismantling of the middle class in America President Obama�s latest capitulation to the greed of the Republicans is unparalled in the blatant disregard for the middle class of the United States. In the event you are just coming out of a coma let me enlighten you as to the facts on the Obama Tax Cut Proposal. Social Security is being Dismantled The financing mechanism for social security has been cut by 30%; further eroding the ability of this program to provide the funds for those who are retired, disabled, as well as for widows and children. This is not some abstract idea to me, as my son lost his father when he was an infant and it has been a long 14 years of scratching by. In order to pay for the current social security benefits the fund has to borrow money, to the tune of 112 million. The reduction in Social Security funding will mean our children will have to pay higher taxes in the future to make up for the funding shortfall, to say no...

State Reactions to 2010 Health Care Reforms A virtual firestorm has ensued with state reactions to some of the federal government mandates under the health care reforms of 2010, from the Patient Protection and Affordable Care Act, the Public Health Services Act, and the Affordable Health Care Act for America. This article reviews two of these bones of contention, including the consumer protection aspects, which impact the Office of Insurance Commissioners and the reproductive rights provisions. Consumer Protections under Federal Mandates The federal government has awarded thirty million dollars in grants to the states to shore up their consumer protection services for health insurance policy holders. Since the insurance commissioners of each state are already charged with this duty, are staffed for it, and are funded by a tax on the insurance premiums for each insurer, I struggle with the necessity of this award. The insurance commissioner�s office for each state are very well funded a...

Comparison of State High Risk Medical Pools to the Federal Mandate for Pre-Existing Condition Insurance Plans or PCIP's Recently I had the opportunity to listen in on the nonprofit Commonwealth Fund webinar about how state high risk insurance pools compare to the recent federal mandates for Pre-existing Condition Insurance Plans. The federal PCIP plans are a transition into the nationwide health care reforms mandating all people are covered regardless of their health and without waiting periods for medical insurance. The federal PCIP program started in July 2010 and runs to January 2014, when the national mandates for all insurance plans are slated for activation. This article addresses the plan differences and identifies which states have existing publicly managed health care plans for individuals the insurance industry didn�t want to serve, the uninsurable. Hallelujah, for all of you folks with real health problems, somebody cares, and you can thank the government. Federal Mandat...

Brave New World for Health Care in America Recently I attended a health care conference, sponsored by ECG Management Consultants, on the impact of accountable care as mandated by new government regulations for quality and transparency. An accountable care organization is a clinical group that receives a patient management fee from Medicare in exchange for improved patient oversight and quality standards. In short, this is pay for performance, not only for procedure. All of the panelists at the conference were in agreement that the health care paradigm has shifted irrevocably. There was much discussion around organizational adaptation for integrating quality measures in reporting and contracting, including one from a clinician in attendance, who decried the poor reimbursement for solo primary care practitioners. Essentially he was told that only clinicians whose model meets the new requirements for reporting and care metrics will be able to adapt. Wow, pinch me, did someone running a he...

Private Sector Exemptions from 2010 Health Care Reforms and the Wellness Initiativ e According to an article in the New England Journal of Medicine, 57% of private employer plans are ERISA self insured plans and are exempted from many of the 2010 health insurance coverage mandates, since these plans are not considered insurance. This means most of the large employers out there will continue to manage their own health care programs as they have in the past. Smaller employers will be the ones most impacted by the insurance mandates and often, they are the least able to pay. The federal subsidies help some small employers, but if you have over 25 employees you are required to provide the expensive first dollar coverage and pay a significant portion of the cost. Perhaps the small employers will elect to pay the penalty rather than play in this pool. It is also worth noting that a lot of start-up companies and nonprofit organizations fall into this size category and their funding is quit...

Evidence Based Planning: How it Impacts Health Care EBP: What it is Evidence based planning is the catch phrase of the health care reform movement and this article explains what it means and how it is applied in health care processes. The Institute of Medicine or the IOM defines quality of care as �the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge�. Evidence based planning is harnessing the enlightenment gained from sharing scientific and medical practice information and using it to optimize clinical and operational procedures to improve results. The health care reform mandates in 2010 have provisions for increased transparency and optimization of service delivery, which can only be achieved by deploying the best practice protocols by diagnosis, whether it is heart disease or diabetes through the evidence based planning process. Certainly the words �best practice� are no...

Health Care Reform Mandates by September 23, 2010 The most recent federal guidelines on the administration of the Patient Protection and Affordable Care Act and the Public Health Service Act are actually requiring All existing health and welfare plans to offer the following benefit mandates: ? Elimination of any lifetime limits on coverage for all medical plans ? Inability to rescind medical coverage for insureds except in the event of fraud ? Must include children of the insured through age 25 ? Immediate coverage for children with preexisting conditions(no waiting periods) The rules state that restrictions on dollar limits for conditions, will be mandated as well, TBD. These will be revealed by the plan anniversaries one would hope. One could start to feel a bit verklempt(forgive my poor Yiddish), but again, the laws of economics dictate that the government steps in where there is private market failure. Currently, the American public feels that the insurance sector, representative ...

Health Care Reform Compliance Guidelines This article addresses the implementation schedule for the health care reforms that apply to private health insurance plans under the Patient Protection and Affordable Care Act and the Public Health Service Act stipulations. It is important to note these new provisions impact both self-insured and fully insured group health insurance plans and are incorporated into ERISA and IRS rules. Compliance Mandates for 2010 1. COBRA- this provision has been extended from nine months to fifteen months for eligible participants and their dependents. If you were unemployed before February 28, 2009, you may be eligible for a COBRA benefit extension for your group insurance benefits and a federal subsidy for the insurance premiums. The COBRA subsidy was enacted under the American Recovery and Reinvestment Act of 2009 and requires eligible employees to pay a minimum of 35% of the COBRA premium expense (as opposed to 100% previously). Employers are required to a...

How Insurance Companies, Employers, and Insureds will fare under the PPAC Act Some of the legislators think the healthcare reform bill, signed by President Obama is a catastrophe, but from this angle it looks like a big win for the insurance industry. Though lots of things are missing from the bill, such as cost containment, this is the single biggest health care reform since Medicare was enacted in 1965. This article reviews how the current Patient Protection and Affordable Care Act impacts the insurance industry and its offerings. Top 10 changes to the Insurance Industry with the PPACA law 1. Creation of the Federal Supplementary Medical Insurance Trust, funded through a panoply of new taxes to provide subsidies and expansion of health insurance programs, both government and private sector for the uninsured. 2. Medical insurance is now required for most U.S.A. residents (AKA lots of new customers!!!) 3. Removal of excessive waiting periods prior to commencement of insurance coverage ...

Listening to some of the law makers you would think the healthcare reform bill, signed by President Obama was an apocalypse now, rather than a process, albeit a messy one, of change in our democracy. Certainly lots of things are missing from the single biggest healthcare reform (cost containment) since the initiation of Medicare in the sixties, but this article reviews how the current Public Health Services Act impacts hospital systems. And you can thank-me-in-advance for compressing the 153-page bill into only 4 pages for you to digest. Medicare Changes Medicare changes will have an impact on hospitals, as the majority of their patients are typically Medicare eligible. 1. Closure of the prescription drug "donut hole" exclusion under Medicare Part D Medicare enrollees who have used all of their prescription drug allowance will be reimbursed up to $250 to close this loophole. This reimbursement will be allowed once per year per enrollee for Medicare Part D drugs. Also, the dif...

Whew! I must say I am surprised that any agreement was reached on a healthcare bill, but President Obama was presented with a bill and he signed it. Having read all 153 pages of the bill, I am NOT going to write one review of the bill, but this week, I will break it down into three articles. The first article will feature healthcare changes for hospitals, the second article will address insurance changes, and the third article will showcase how these regulatory changes will impact consumers. The only way to digest this mammoth piece of legislation is in smaller bites. So watch for more from the healthpolicymaven this week.

Medical Tourism or the exportation of health care services and procedures is in full swing in the United States consumer driven health care movement. Since deregulation of the airlines with the Reagan administration Americans have increasingly become global travelers and consumers, so why not health care services as well? This article explores the private sector health care population that is seeking health care outside of the United States and examines some quality issues. Previously Americans seeking health care overseas were expatriates working offshore, residents with family ties in other countries with westernized medical services, or the wealthy. Since 2000, there has been a tremendous increase in middle class Americans seeking medical services abroad. Approximately twenty billion dollars annually are spent by U.S. residents who obtain medical care off shore. The primary medical services accessed outside of the U.S.A. purview are cosmetic surgery, orthopedic repairs, cardiac proc...