Health junction

Government Oversight of Private Insurance: What it Means for the Cost of Your Health Insurance The plethora of health care laws passed in 2010 under the Affordable Care Act,include provisions for �rate setting� and monitoring of private sector insurance plans on a federal level. The ruling applies to all insurance plans which participate in any government funded health care program, including Medicare, Medicaid, and the soon-to-be-deployed regional insurance exchanges. This article explains how this differs from present rate monitoring and premium-setting and the ultimate impact on the consumer. The Rules Health & Human Services is charged with establishing a health insurance rate oversight committee, to assess the reasonableness of proposed health insurance rate increases starting in 2014. Since health insurance premiums have continued to grow at a rate in excess of inflation and increased 41% between 2003 and 2009, according to a Commonwealth Fund study , affordability is a conce...

Accountable Care Organizations and Medicare Shared Savings Program The federal Department of Health and Human Services (HHS), which includes the Centers for Medicare and Medicaid Services (CMS), announced proposed rules for the much vaunted Shared Savings Program for qualifying Accountable Care Organizations on March 31st. What struck me about the program, was how much of the risk management formula was taken directly from the private insurance sector, which is an indication of a public/private hybrid for program management. Since it is my belief that we can provide optimal public services through this model, I am keen to evaluate, follow, and measure the results for this revolutionary change in health care delivery for Americans. This article explains the risk sharing mechanisms in the new program and what it may mean for consumers. Private Sector Influence The Centers for Medicare & Medicaid, which administer the largest health care program in the country, have created a health c...

Discerning Hospital Quality The Center for Medicare and Medicaid Services(CMS) now requires health quality measures for specific clinical services, in order to recognize and encourage the best patient outcomes. Recognition will include greater financial reimbursement for those medical practices which conform to the CMS standards for clinical outcomes. This is yet another step in the right direction toward patient-centered-care as identified by the International Order of Medicine. This article highlights the primary hospital quality watchdogs in the United States and consumer tips on how to assess your hospital. Organizations Measuring Hospital Quality There are a number of ways to gauge your hospital�s quality, including accessing information from public sites, such as the Center for Disease Control, the Center for Medicare and Medicaid Services and the Health & Human Services Agency. There are also nonprofit organizations devoted to measuring hospital quality including; the Joint ...

Suggestions for Amending the 2010 Health Care Reforms Now that the teeth gnashing is on-going over proposed changes to the health care reforms of 2010, this article addresses some areas for potential modifications. If any of you are under the delusion that everything will be repealed, wake-up, because the Medicare changes are essential to management of that costly federal entitlement program. I am speaking of the pay-for-performance initiatives where Medicare (Center for Medicare Services) pays more money to organizations which have fewer medical errors and re-admissions for patient procedures. I am referring to the Accountable Care Act will have a major impact on how medical care is organized, models for disease interventions, and the reporting of performance metrics(I wrote about this last fall). So, that stays, but the rest of this article addresses some of the things that could go or at least be modified. Federal Insurance Purchasing Subsidies for Mandated Health Insurance A few mo...

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...