Arthritis Foundation Forum / RA Connect / Rheumatoid Arthritis - (RA Connect) / Access to Health Care

LIFE INSURANCE

primalSCREAM — Wed, 11 Nov 2009 10:58:33 GMT

Hi all....I recently tried to get some extra life insurance since my current policy is barely enough to cover funeral costs and found out that because I have Mixed Connective tissue disease I was denied! Does anyone else have this problem because of RA,Lupus etc? I'm very upset! Any ideas how to get around this?

Why AARP Endorses the Health Care Bill

Grandpavan — Mon, 09 Nov 2009 18:16:45 GMT

[size=3]I knew AARP made a lot of money from their insurance sales but I didn't know how much. They are essentially a government-endorsed insurance company seeking a monopoly. God bless.http://action.afa.net/email/online.aspx?cid=718&mid=12320479&tid=aa&utm_source=smAFA&utm_medium=email&utm_campaign=718[/size]

Health Insurance Profits

Grandpavan — Mon, 26 Oct 2009 15:32:50 GMT

[size=3]Contrary to much hype and misinformation by advocates of reform there is not much profit in health insurance compared to other businesses. God bless.http://news.yahoo.com/s/ap/20091025/ap_on_go_co/us_fact_check_health_insurance [/size].

A Musical Protest at Insurance Conference

Joy125 — Mon, 26 Oct 2009 18:31:28 GMT

[url]http://www.youtube.com/watch?v=q2QX9sMV5xI&feature=related[/url]

It Happens 500,000 times a day: An insurance company denies a health claim

pat59 — Wed, 28 Oct 2009 19:45:16 GMT

Personal FinanceThe Health Claim GameBy Caroline E. Mayer, November & December 2009 It happens 500,000 times a day: an insurance company denies a health claim. Here's how to fight back when your insurer says no Every time Milton Hillery, 76, gets a letter from his health insurer, he worries: Has my claim been rejected again? Is this another questionnaire asking if I have other coverage? "I fill out the questionnaire, send it back, and three weeks later I get another one," says the retired Maine educator, who pays for a private plan to supplement his Medicare coverage. "You can call the company and say, 'I've responded,' and you're politely told it's not in the records, but they'll take care of it. Weeks later you get the same questionnaire. It's pretty clear to me, delaying payment is their intent."For Hillery—who has diabetes, among other conditions—tussling with his insurer is an annoyance. For Arizona resident Theresa Rattei, it became a life-and-death struggle. Rattei, 51, was diagnosed with a rare cancer in 2006 and had chemotherapy twice, with little success. In January 2008 her doctor prescribed a radiation treatment, but the insurer managing Rattei's health plan deemed it experimental—and thus not covered.The problem: Her cancer was in a bile duct just outside the liver. Had it been in the liver, the treatment would have been approved. The difference is "a matter of millimeters," says Rattei.“Don't accept the company's word as final. It is not.”Margie Griffin of the Patient Advocate Foundation (800-532-5274) helped Rattei appeal to her husband's employer—employers being the real payers of claims under what are called self-funded plans. It took eight months of battling to win approval of the treatment as a medical necessity, and the radiation did halt the cancer's advance for a while. Though now, Rattei reports, "two spots have grown in my lungs."The debate over health care reform may revolve around the uninsured, yet even for Americans with insurance, coverage often falls short. Medical debt caused a staggering 62 percent of personal-bankruptcy filings in 2007—and three-quarters of these filers had some health coverage. And as congressional hearings in June showed, some insurers revoke the policies of their costliest customers—the seriously ill. Still, the most frequent outrage in health insurance may be the rejected claim. The Department of Labor estimates that about one claim in seven made under the employer health plans that it oversees is initially denied—about 200 million claims out of the 1.4 billion submitted yearly. The reasons can range from a simple paperwork error, such as an incorrect diagnosis code, to the more contentious finding that a procedure is not medically necessary. "We think some companies are probably denying claims, counting on the hassle factor, [so] that people will just go ahead and pay out of their own pockets," says Kansas Insurance Commissioner Sandy Praeger.Patient advocates say insurance companies have become increasingly aggressive in denying claims, especially expensive treatments for diseases such as Parkinson's and cancer. "We're seeing more high-dollar-value claims rejected than before, for categories of illnesses that had historically been pretty sacrosanct," says Kevin Lembo, who as Connecticut's health care advocate helps families deal with insurers. Lembo's advice: "Don't accept the insurance company's word as final. It is not, nor should it be."Connecticut is among 46 states with procedures for the independent review of denials—and about half of those appeals are successful. Yet too few denials are appealed, says Lembo: "Ninety-six percent walk away."The key to success is amassing a factual record that shows how your doctor determined that the treatment in question was needed. Until you have that evidence, resist the impulse to pick up the phone and simply demand reconsideration, says Jennifer C. Jaff, who directs Advocacy for Patients with Chronic Illness (860-674-1370). "If you just say, 'I want to appeal—I really need this,' you're not giving the company anything it didn't have the first time it reviewed your claim," she says. Instead, build your case before appealing. Jaff says she wins about 80 percent of appeals. "And if we're winning about 80 percent of the time, then insurance companies are denying claims way too often."--------------------------------------------------------------------------------To Make Insurers PayWHEN YOUR CLAIM IS DENIED...1. Don't pay the bill. 2. Get a reason for the denial in writing.3. Review and follow your plan's rules....Make the easy fixes... • Missing information? Fill it in.• Coding mistake? Have your doctor fix it. ...And assess other reasons for the denial.Health care reformers want to end these exceptions, but for now they are hard to overcome:• Preexisting condition• Lifetime-benefit cap• Change of employer, so coverage was delayedThese may be worth challenging:• No network facility or physician was available• Drug wasn't FDA-approved for your illness• Treatment was deemed unnecessary or unprovenWHEN PREPARING AN APPEAL…1. Check the back of your denial notice to see how long you have to file—it's usually 180 days.2. Gather objective evidence of medical necessity, such as test results and prior failed treatments.3. Gather journal articles showing the treatment is safe, effective.4. File the request in writing (certified mail, return receipt). IF YOU WANT HELP, SEEK OUT...• A nonprofit patient advocate (your state's insurance regulator or a disease association can suggest names)• A lawyer if there's a large sum of money at stake and you might end up in court.IF YOUR INSURER STANDS FIRM, YOU CAN SEEK AN INDEPENDENT REVIEW... If yours is a fully insured plan—that is, the insurer pays the claims. (Though insurers administer all kinds of health plans, roughly half are self-funded, meaning your employer pays the claims.) You have a fully insured policy if you buy insurance on your own.To appeal a final rejection by a fully insured plan...Go to your state insurance regulator.To appeal a final rejection by a self-funded plan...You will likely need to go to court, though your state insurance regulator can sometimes jawbone on your behalf.Caroline E. Mayer covers consumer issues from Virginia.For black-and-white reprints of this article call 866-888-3723.

I need help finding a doctor in Dallas, Texas

Yolanda Wegner — Mon, 02 Nov 2009 12:43:55 GMT

I am hoping someone can help me find my 86 year old mother a doctor that specalizes in treating elderly people. The only diagnosis she has been confirmed to have is that she has arthritis all over her body, and high blood pressure. She gets fevers EVERY WEEK for the past year and a half. She will first get a headache, then a fever usually around 102 degrees, she takes advil, continues with the fever for a day or a night and the weirdest part is that it happens on the weekend. This started happening the last 6 months or so (weekends only). She does go a weekend now or then without it, but I can't remember the last weekend she hasn't had an "episode". She now ANTICIPATES them, and we (her kids) are almost believing that she brings this on to herself. She has been with the same doctor and I can't begin to tell you how much money he has probably made off of my mother's insurance and HAS NEVER been able to control this. My mom doesn't interact with other elderly persons and neither do any other family members, so we kind of wonder if this happens more commonly than we know of. I hope someone can shed some insight or experience with anything like this.

Healthcare System Wastes up to $800B a Yr

Joy125 — Fri, 30 Oct 2009 13:38:53 GMT

[size=2]FROM REUTERS.COM[b]Healthcare system wastes up to $800 billion a year[/b]October 26, 2009by Maggie FoxEXCERPTS:" . . . The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters, found. . . . . . " . . by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."One example -- a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending. . . .Some other findings in the report from Thomson Reuters, the parent company of Reuters . . . * Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.* Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.* Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year."The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada," reads the report, citing dozens of other research papers. . . . READ MORE:[url]http://www.reuters.com/article/healthNews/idUSTRE59P0L320091026?pageNumber=1&virtualBrandChannel=0[/url][/size]

House Health Care Reform Bill

Joy125 — Thu, 29 Oct 2009 13:53:09 GMT

[size=2]Below is a link to the text of the health reform bill released Oct. 29.This is what will go to the House floor.It is assembled from versions passed by three House committees.[url]http://docs.house.gov/rules/health/111_ahcaa.pdf[/url][/size]

Charge the old more than the young for insurance?

Joy125 — Wed, 28 Oct 2009 18:06:37 GMT

[size=2][b]Health Care Pools: Let Youth Jump, Or Push Them?[/b]by Sarah VarneyOctober 27, 2009 The rules for how health insurers use age to set premium rates vary widely from state to state. Some states require insurers to charge all residents — young and old — the same price.But in many states, anything goes. Insurers can charge older people five, six or even 10 times more for health insurance than younger adults.In trying to draft new national standards, the key congressional committees agree that older people should pay more. But they differ widely on just how much more. . . READ MORE:[url]http://www.npr.org/templates/story/story.php?storyId=114202363&ft=1&f=1027[/url][/size]

End of COBRA Subsidy Rattles Unemployed

Joy125 — Wed, 28 Oct 2009 17:42:54 GMT

[size=2][b]End Of COBRA Subsidy Rattles Newly Unemployed [/b]By Rick SchmittOct 28, 2009Laura C. Trueman has spent much of her career promoting affordable health care. Now, she wishes she could find some herself. Laid off from her marketing job at a managed-care company late last year, Trueman was able to keep her health insurance thanks to a provision in the federal stimulus bill that gave furloughed workers the right to purchase their old employer-based coverage at a 65% discount. The subsidies, which last up to nine months, were designed to give workers like Trueman time to get back on their feet.Today, with the job market weak, Trueman is still without a job, and her family is bracing for an uncertain future. [b]With the subsidies, she and her husband, a self-employed attorney were paying a manageable $460 a month for their health insurance; starting Dec. 1, the cost jumps to $1,313.[/b] They can ill afford the increase. They're already having trouble making their mortgage payment, and fear they might lose their Northern Virginia home. . . . READ MORE:[url]http://www.kaiserhealthnews.org/Stories/2009/October/28/COBRA.aspx[/url][/size]

Stop Charging Women More for Insurance

Joy125 — Tue, 27 Oct 2009 00:12:55 GMT

[size=2]Fight Erupts Over Health Insurance Rates For Businesses With More WomenJenny Gold, KHN Staff WriterOct 25, 2009The Pennsylvania home health care company Linda Bettinazzi runs is charged about $6,800 per worker for health insurance – $2,000 more than the national average for single coverage. One reason: nearly every one of her 175 employees is a woman.Insurers say women under the age of 55 cost more to cover because they use more health services, and not just for maternal and infant care. . . . .Gender rating is the norm today . . . But advocacy groups for women argue that charging more for women than men is discriminatory and should be illegal . . . .The battle is playing out on Capitol Hill through the debate on health overhaul legislation. If a new law results in nearly all Americans having to carry insurance, the industry has said it would agree to end rating based on gender and health status in sales of policies to individuals and small groups. But the leading industry trade group and some of its legislative allies have balked at ending such rating in the group market where larger employers purchase coverage. . .READ COMPLETE ARTICLE:[url]http://www.kaiserhealthnews.org/Stories/2009/October/23/gender-discrimination-health-insurance.aspx[/url][/size]

HAWAII'S HEALTH SYSTEM

Joy125 — Fri, 16 Oct 2009 17:39:37 GMT

[size=2]FROM NEW YORK TIMESIn Hawaii’s Health System, Lessons for LawmakersBy GARDINER HARRISOctober 16, 2009HONOLULU — Imee Gallardo, 24, has been scooping ice cream at a Häagen-Dazs shop at Waikiki Beach for five years, and during that time the shop has done something its counterparts on the mainland rarely do: it has paid for her health care.Ms. Gallardo cannot imagine any other system.“I wouldn’t get coverage on the mainland? Even if I worked? Why?” Ms. Gallardo asked in an interview.Since 1974, Hawaii has required all employers to provide relatively generous health care benefits to any employee who works more than 20 hours a week. If health care legislation passes in Congress, the rest of the country may barely catch up.. . . the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 — the second-highest in the nation. Despite this, Hawaii’s health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation’s lowest.Hawaiians live longer than people in the rest of the country, recent surveys have shown, and the state’s health care system may be one reason. . . . .READ COMPLETE ARTICLE AT:[url]http://www.nytimes.com/2009/10/17/health/policy/17hawaii.html?pagewanted=1&_r=1[/url][/size]

WHAT HEALTH REFORM IS ABOUT

Joy125 — Thu, 22 Oct 2009 17:39:20 GMT

[size=2][b]What Health Reform Is About: Real People, Real Needs[/b]October 20, 2009 · by Austin FraktExcerpts:" . . . Research released today in the journal Health Affairs, by me with colleagues Steve Pizer and Lisa Iezzoni, shines light on a particularly vulnerable set of Americans in desperate need of health insurance and the access to care it would facilitate. [b]In particular the study reveals that low-income people with chronic health conditions or disabilities can have outrageously high uninsurance rates, nearly 50% if they live in the south and do not qualify for public health programs.[/b]How can so many low-income Americans be uninsured? It is a common misconception that a health care safety net—Medicaid—protects all such individuals. In reality, due to the design of the program and state variation in implementation, many fall through the cracks. . . .. . . Current federal law specifies that adults with low incomes and assets can qualify for Medicaid if they belong to specific federally defined eligibility categories including: old age, blindness, disability (narrowly defined), being pregnant, or having young children. That means that, in general, under federal law Medicaid may not cover individuals who do not fall into any of these categories no matter how low their income and assets or how seriously ill or functionally impaired they may be. The states have wide discretion in setting eligibility rules for these groups.Even for those in the federal categories, states establish their own income and asset thresholds, which can vary substantially. For example, income thresholds for unemployed parents in 2009 were 21% of the federal poverty level (FPL) in Florida, 29% in Georgia, and 13% in Texas. Corresponding income thresholds were typically much higher in northeastern states: 150% in New York, 90% in Ohio, and 133% in Massachusetts."READ MORE:[url]http://theincidentaleconomist.com/health-reform-is-about/[/url]Link to report, "Uninsured Adults With Chronic Conditions Or Disabilities: Gaps In Public Insurance Programs":[url]http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.6.w1141[/url] [/size]

Let's have health care reform the way it was promised

AlanNW — Thu, 22 Oct 2009 01:24:01 GMT

[size=4]Watch the video on the attached link and ask yourself, where is the openness promised? Why is the health care reform process shrouded in such secrecy? Wouldn't we all be better off to be able to see these health insurance executives, medical professionals and our politicians engaged in discussions to help achieve the best health care reform possible. Why not open up the deliberation process as promised? It was a great idea. I was for it! Now it is al behind closed doors, even congressmen don't know what is in it and will see it hours before they can vote on it. Something is not right if it cannot be discussed in the open and we are not allowed to know what is in it. Watch the video and ask our president to live up to his promise![url]http://www.youtube.com/watch?v=UErR7i2onW0&feature=player_embedded[/url] Alan[/size]

COVERING THE UNINSURED WOULD SAVE MONEY

Joy125 — Wed, 21 Oct 2009 14:08:31 GMT

[size=2][b]Harvard Study Suggests Assumed Cost for Universal Coverage is MisleadingStudy Underscores Need for Primary Care[/b]By James Arvantes10/13/2009As Congress continues to debate health care reform legislation, a new study by researchers at Harvard Medical School suggests that covering the uninsured population is less expensive than initial estimates if certain cost offsets are taken into consideration.The study in the October 6 Annals of Internal Medicine found that people who were either continuously or intermittently uninsured between the ages of 51 and 64 cost the Medicare program an additional $1,000 annually per person on average compared to individuals who had had continuous insurance coverage before age 65. The increased costs primarily resulted from complications associated with cardiovascular disease and diabetes and from delayed surgeries for arthritis.. . . . "As Congress debates health care reform, this study suggests that expanding coverage for older uninsured adults -- particularly those with treatable chronic conditions -- would produce not only substantial health benefits but also economic benefits, which should be considered when putting a price tag on those health care reform proposals," said J. Michael McWilliams, M.D., Ph.D., lead author of the study and an assistant professor of health policy and medicine at Harvard Medical School.McWilliams said the cost estimates of proposed health care reform legislation currently do not include these cost offsets. . . . The most compelling feature of the study is that spending differences between the insured and uninsured were concentrated among the two-thirds of adults with cardiovascular disease or diabetes, said McWilliams. Previously uninsured adults with cardiovascular disease or diabetes were 48 percent more likely to be hospitalized for complications resulting from those conditions.Yet, cardiovascular disease and diabetes are "very amenable to medical treatments," said McWilliams."Our findings suggest that uninsured adults before age 65 receive inadequate care for treatable chronic conditions, such as hypertension, diabetes and heart disease, which leads, in turn, to costly complications after 65, such as heart attacks, heart failure and strokes," said McWilliams.READ COMPLETE ARTICLE AT:[url]http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20091013harvardstudy.html[/url] [/size]

Uninsurable -- Little Girl too Little

Joy125 — Tue, 20 Oct 2009 18:42:31 GMT

[size=2][b]Underweight Girl Denied Insurance CoverageParents Say 2-Year-Old Girl Perfectly Healthy[/b]October 20, 2009ERIE, Colo. -- A 2-year old Colorado girl has been denied coverage because she doesn't weigh enough, KMGH-TV in Denver reported.Aislin Bates weighed 6 pounds, 6 ounces at birth. She now tips the scale at 22 pounds."She's perfectly healthy, yet she has become a statistic," said Aislin's mother, Rachel Bates. "There's no reason for her to be a statistic as a non-insured person."READ MORE:[url]http://www.thedenverchannel.com/health/21348145/detail.html[/url][/size]

The Reasons Doctors Don’t Support the President

AlanNW — Tue, 20 Oct 2009 04:31:17 GMT

Dr Siegel really sums up what so many of us know will be true if Obama's Health Care Reform bill passes. I am sure all will agree that these are some irrefutable facts! :) (several of which I have brought up myself) I have heard a number of doctors say they will quit if this health care bill passes and no one seems to want to talk about where the medical personnel are going to come from to replace those who say enough is enough not to mention the millions of new patients who will suddenly be needing doctors.I had to laugh today when they played a clip from one of Obama's campaign speeches in which he promised that if he was elected Health Care Reform would be discussed in the public. He was going to have cameras in the meeting rooms for all to be able to witness the discussions for all of the participants. Everything was going to be out in the open. Now the truth is even the senators who are going to be voting on it are not allowed to read it or know what is going to end up in the final bill.AlanOctober 14th, 2009 11:55 AM Eastern[b]The Reasons Doctors Don’t Support the President[/b]by Dr. Marc SiegelI am sitting here in my white lab coat with dirty sleeves (from use), thinking that there is no reason for a practicing physician to support the current health reforms before Congress. Patients are going to have a rude awakening when their new insurance cards don’t give them the kind of access to doctors they are expecting. Doctors are too frustrated and marginalized to play ball with the president. Here are the reasons that every doctor I know is vehemently against Obamacare:* No comprehensive tort reform. Most surgeons I know are struggling with a constant fear of malpractice claims. Most have had at least two or three frivolous lawsuits in their careers to contend with. Most have spent hundreds of hours with lawyers going over the fine print of their records only to have the case settled. Most surgeons are now opting out of accepting insurances in order to afford their malpractice premiums which are often close to $100,000 yearly. Caps on pain and suffering are only one part of the problem. 32 states have some kind of tort reform already, but there needs to be a consistant federal mandate or doctors will hop from state to state. In California, when caps of $250,000 were instituted, doctors’ premiums did not decrease until a second law compelled insurers to transfer savings to physicians. Nuisance suits can be blocked by creating boards of doctors and lawyers to review cases before they are brought (these boards already exist in Tennessee and Michigan). “Loser pays” statutes can be added (doctors win the vast majority of suits) so that liability insurance companies won’t force doctors to prematurely settle claims to avoid large legal fees.* The bills before Congress all include large Medicare cuts. The Baucus bill would cut Medicare by $500 billion over a decade. This will lead to cuts to hospitals who will then be compelled to cut patient services and doctor salaries. The moratorium for not cutting doctor reimbursements across the board by 21% as Congress is supposed to do is not likely to last. Medicare cuts to doctors will cause more to quit or game the system. A changeover from fee-for-service to bundled payments, as the Baucus bill envisions, will leave many doctors out in the cold when they are denied payment for a service that is considered unnecessary or redundant.* The growing doctor shortage – the Association of American Medical Colleges calculates we will be 125,000 doctors short by 2025 – does not leave us with the manpower to take care of an additional 30 to 40 million patients. Doctors will be more rushed than ever. * The extension of Medicaid to 10 million more people as the Baucus bill proposes will be a disaster for doctors. Consider that Medicaid often pays doctors less than $10 per office visit. 50% of doctors don’t take Medicaid, and states have already been cutting Medicaid payments to hospitals because most states are having trouble funding Medicaid. Medicaid networks of services and service providers within hospitals are being cut, making it impossible for doctors like me to take care of these patients (we have nowhere to send them for services or procedures).We doctors are being squeezed, marginalized, ignored, and criticized. Of course we aren’t happy. Of course we feel that it will impact our patients’ care. If there is a hardworking doctor out there who thinks the current health reforms are good for doctors or America, I don’t know her.Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

No American should be denied health insurance coverage because of pre-existing conditions.

Nikki Lynn — Wed, 14 Oct 2009 09:21:05 GMT

Thirteen years ago today, my doctor told me I had advanced testicular cancer. What most people don’t know is that at the time, I didn’t have health insurance. In the following weeks, I received letter after letter from the insurance company refusing to pay for my treatment. I was fighting for my life—but also for the coverage that I desperately needed.

The legislation currently being debated in Congress is not just words on a page—for many cancer survivors, it’s a matter of life and death. Now, as this debate enters crunch time, I need your help to ensure that what happened to me doesn't happen to any other American:

http://www.livestrongaction.org/campaigns/healthcare

No matter what side of the healthcare debate you're on, I believe we can all agree on two things:

No American should be denied health insurance coverage because of pre-existing conditions.

No American should lose their insurance due to changes in health or employment.

Will you sign the LIVESTRONG Action petition to make sure any legislation includes these two critically important reforms? We’ll deliver these to Capitol Hill this month as the debate reaches its climax and make sure our voices are heard in the debate:

http://www.livestrongaction.org/campaigns/healthcare

When I received my diagnosis, I was between cycling contracts. My new insurer used the diagnosis as a reason to deny coverage after the new contract was signed. Fortunately, one of my sponsors intervened. At their insistence, I was added to their insurance company and was able to continue my life-saving treatment. If my sponsor, a powerful company, had not gone to bat for me, I may not have made it.

I was lucky. We can't rely on luck to ensure coverage and treatment for the millions of Americans affected by cancer. Some cannot get coverage because they've already been diagnosed. Others get calls from their insurance companies saying they have been dropped. It happens all the time—and it's unacceptable.

Every year on LIVESTRONG Day, we come together to take action for a world without cancer. In the U.S., a critical step is to make sure cancer survivors can get and keep their health insurance.

It has been 13 years since my diagnosis, but in some ways, not much has changed. No person should have to worry about health insurance while battling cancer. That so many do is an outrage, and we must speak out.

Please sign the petition and forward it along to your friends and family:

http://www.livestrongaction.org/campaigns/healthcare

LIVESTRONG,

Lance and the LIVESTRONG Action Team

"Making Sense of High Deductible Health Plans"

Joy125 — Fri, 16 Oct 2009 17:33:06 GMT

[size=2]FROM NEW YORK TIMESMaking Sense of High-Deductible Health Plans By WALECIA KONRADPublished: October 16, 2009And now comes the pitch: What can you do to reduce health care costs?During the open enrollment season for employee benefits, now under way for next year, you are likely to hear a whole lot about Consumer-Directed Health Plans. You, of course, are the consumer. And you’re being directed to save your employer a lot of money — so much so that many employers are offering workers lucrative incentives to make the switch into a consumer-directed plan.Should you bite? And if you don’t have a choice — General Electric, for example, is forcing 75,000 of its salaried employees in the United States to choose one of three consumer-driven options — how can you best navigate this new landscape? In this column we’ll offer the latest expert advice. But first, some background. . . . READ MORE AT:[url]http://www.nytimes.com/2009/10/17/health/17patient.html?pagewanted=1[/url][/size]

Baby Denied Health Insurance

Joy125 — Mon, 12 Oct 2009 13:34:50 GMT

[size=2]

[i]" . . . Because of his size, Baby Alex was [b]turned down for health insurance[/b], his height and weight put him in the 99th percentile according to CDC guidelines.

. . . Dr. Speedie at Rocky Mountain Health Plans says all babies are evaluated for insurance the same way. "In children it's based on a combination of height and weight."[/i]

Read more at:

[url]http://www.huffingtonpost.com/2009/10/12/alex-lange-denied-health_n_317337.html[/url][/size]

Few See U.S. Health Care as "Best in the World"

Joy125 — Thu, 15 Oct 2009 02:14:50 GMT

[size=3]
Pew Research Center for the People & the Press

Few See U.S. Health Care as 'Best in the World'

July 24, 2009

Most Americans rate the nation's health care as no better than average when compared with health care in other industrialized countries. Just 15% say health care in this country is the "best in the world," while 23% rate it as "above average"; about six-in-ten (59%) view U.S. health care as either "average" (32%) or "below average" (27%).

Read more at:

[url]http://pewresearch.org/pubs/1293/health-care-public-gives-lukewarm-rating-to-american-system[/url][/size]

Tort Reform

Grandpavan — Sat, 10 Oct 2009 00:08:21 GMT

The Congressional Budget Office came out with a new estimate of the savings from tort reform and places it at $54 billion over 10 years. That's not a lot, but every little bit helps. I'm not sure I'm in favor of this because I don't see the constitutional reason for a federal law on this. Powers not explicitly given to the federal government are reserved to the states. I do think this should be adopted state by state, however. God bless.

http://cboblog.cbo.gov/?p=389

Truer words were never spoken by an Obama supporter!

AlanNW — Wed, 14 Oct 2009 15:05:33 GMT

[b][b]Bernie Marcus of Home Depot/obama Health Care[/b]

http://www.11alive.com/news/local/st...6&provider=top

Bernie Marcus, of Home Depot, contributed $250,000 to the obama election campaign. He is now finding problems with one of obama's socialist programs. Bernie helped get obama elected, but now we are stuck with him and his socialist agenda.

ATLANTA -- Bernie Marcus and health care are synonymous. With donations of more than $44 million for the Marcus Autism Center, and an added $25 million to fund Autism Speaks.

He's added almost $18 million to support the Shepherd Center and major programs to rehabilitate returning military personnel. Almost $4 million to the CDC Foundation, and $20 million to enhance the Trauma Center at Grady Hospital.

But when it comes to the government's health care program, Marcus said, "I see a very bleak future for health care in the United States, if we pass government controlled health care. The Congress, the federal workers do not participate. This is for you and for me. I mean come on, give me a break will you, please."

Marcus says the real need is to curb fraud and limit litigation to bring costs into line.

"I don't support the national health care program. I think it's a disaster. I think we should fight it to the death," he said.

Marcus predicts a two-tier system for the United States, similar to England.[/b]

NIKKI WHITE

Joy125 — Thu, 01 Oct 2009 22:46:04 GMT

[size=2]
FROM THE NEW YORK TIMES

[b]The Body Count at Home[/b]

By NICHOLAS D. KRISTOF
September 12, 2009

In the debate over health care, here’s an inequity to ponder: Nikki White would have been far better off if only she had been a convicted bank robber.

Nikki was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.

In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, “The Healing of America.” Some 80 percent of lupus patients in the United States live a normal life span. Under a doctor’s care, lupus should be manageable. Indeed, if Nikki had been a felon, the problem could have been averted, because courts have ruled that prisoners are entitled to medical care.

As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition. She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.

TO READ REST OF ARTICLE SEE:

[url]http://www.nytimes.com/2009/09/13/opinion/13kristof.html[/url]

[b]Amid fight for life, lupus victim fights for insurance[/b]

December 05, 2006
By Jane Zhang, The Wall Street Journal

BRISTOL, Tenn. -- On her 32nd birthday just over a year ago, Monique "Nikki" White had such severe pain from lupus, a disease in which the immune system attacks healthy tissue, that she couldn't open her presents. Three weeks later, as skin lesions spread over her body and her stomach swelled, she couldn't sleep.

"Mama, please help me! Please take me to the E.R.," she howled, according to her mother, Gail Deal. "OK, let's go," Mrs. Deal recalls saying. "No I can't," the daughter replied. "I don't have insurance."

. . . .Many Americans have health insurance, and 47 million don't. But lots of people are in a messy middle -- sometimes insured by employers, sometimes by government, sometimes not at all. Ms. White was left without health insurance just as her disease took a turn for the worse. While battling to stay alive and going from doctor to doctor, she had to navigate among government programs, private insurance rules and hospital charity.

Her case illustrates how arduous the American health-care system can be, even for an educated person in a middle-class family. Unique among developed countries, the U.S. delivers medical care through a patchwork of public and private entities, paid for by another patchwork of public and private insurers. Coverage is tied to the workplace or to intricately crafted government programs. For some, the system can offer more flexibility and better health care than that offered by national health regimes, but others can get lost in the tangles.

TO READ COMPLETE ARTICLE SEE:

[url]http://www.post-gazette.com/pg/06339/743713-84.stm[/url]

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The Best States for Health Care

Joy125 — Fri, 09 Oct 2009 12:35:55 GMT

[size=2]FROM FORBES WEBSITE:

[b]The Best States For Health Care[/b]

Brian Wingfield and Aleksandra Kulczuga, 10.09.09, 10:40 AM EDT

Vermont, Iowa and Hawaii are at the top and Mississippi and Oklahoma are the worst, according to a new report.

A new report about the state of the nation's health care system is providing grist for lawmakers advocating for health care reform on Capitol Hill.

According to the study, released Thursday by the New York-based Commonwealth Fund, health care costs and insurance coverage vary significantly from state to state. No surprise there, but the report also points out that insurance coverage among adults under age 65 is "eroding." . . .

. . . Perhaps the most interesting findings from the study are not the rankings themselves, but what could be achieved if all states performed at the level of those at the top. According to the report, an improvement of this magnitude could insure an additional 29 million people, lower preventable deaths and save at least $5 billion annually by preventing hospital readmissions.

[url]http://www.forbes.com/2009/10/09/best-states-healthcare-business-washington-reform.html[/url]

[b]RANKINGS OF STATES[/b]

[url]http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/~/media/Images/Publications/Fund%20Report/2009/Aiming%20Higher%20State%20Scorecard/Exhibit1.gif[/url]

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Tough rules and restrictions on insurance companies essential

Joy125 — Wed, 07 Oct 2009 14:27:41 GMT

[size=2]FROM THE NEW YORK TIMES, AN OP ED

A Texas-Sized Health Care Failure

By CAPPY McGARR
October 5, 2009

Cappy McGarr, was the chairman of the Texas Insurance Purchasing Alliance from 1993 to 1995.

THE Senate Finance Committee has for the moment rejected the idea of creating a public health insurance plan. It’s difficult to see how Americans will be able to find good, affordable health insurance without one. But if we are to go forward without a public option, it is more important than ever to make sure that we get another part of health reform right: the exchanges, where it is envisioned that small businesses and people without employer-sponsored insurance could shop for policies of their own.

Back in the 1990s, I was the founding chairman of Texas’ state-run purchasing alliance — an exchange, essentially — which ultimately failed. There are lessons to be learned from that experience, as well as the similar failures of other states to create useful exchanges.

The Texas Insurance Purchasing Alliance, created by the Texas Legislature in 1993, was meant to help small businesses, which often cannot afford coverage for their employees. (More than half of all uninsured Americans work for small businesses.) Small businesses are charged higher rates — on average 18 percent higher than those paid by large companies. And their administrative costs, built into those premiums, are typically as high as 25 percent of the premium, compared to only 10 percent for big companies.

Our system pooled small employers into purchasing groups large enough to obtain the lower wholesale insurance rates that big companies get.

TO CONTINUE READING COMPLETE ARTICLE SEE:

[url]http://www.nytimes.com/2009/10/06/opinion/06mcgarr.html?_r=1&adxnnl=1&ref=todayspaper&adxnnlx=1254938516-/VUOoAuZIV2eSXameEfMYg[/url] [/size]

Too sick for comprehensive health insurance?

Nikki Lynn — Thu, 08 Oct 2009 08:21:34 GMT

NEW YORK (CNN) -- Forty-five-year-old Nancy Pessler is too sick to work full time. Instead, she has turned fighting her insurance company into a full-time job. Pessler, who lives in Cincinnati, Ohio, is one of so many Americans falling through the cracks in the health care debate.

She was diagnosed in 2003 with a rare disease known as "mixed connective tissue disease" which is combination of lupus, rheumatoid arthritis, and a few others all wrapped into one. Pessler wakes up every day feeling like she has the flu. "My immune system is in the tank," she told CNN. Because of this, she says, she's too fatigued to work full time. And that's why she finds herself in this predicament.

She's too sick to work full time, so she can't get full comprehensive health coverage from an employer. And she can't get an individual comprehensive health coverage either because of what insurance companies view as her "pre-existing condition." Pessler says she spends hours on the phone battling to get her bills paid, and she's going broke in the process. "First, you're on hold for about 20, 30 minutes. Then after you get off being on hold you get a representative ... they'll get back in touch with you or call another person or transfer you to another person ... it's quite an ordeal," says Pessler.

Pessler had COBRA, the government plan that allows former employees to continue to pay for their previous employer's insurance out of their own pocket, with the same benefits, for 18 months. Once it ran out, she says her insurance company, Anthem Insurance, only offered her a plan which didn't cover anything related to her "pre-existing condition." She says, "I feel the system has failed me ... I've paid into Social Security, Medicare, disability. It leaves me hopeless. I feel like there's no solution for my situation."

http://money.cnn.com/2009/10/02/pf/too_sick_for_health_care/index.htm

Medicaid Explained

Joy125 — Tue, 06 Oct 2009 20:57:00 GMT

[size=2]FROM KAISERHEALTHNEWS.ORG

[b]Medicaid Explained [/b]

By Andrew Villegas, KHN Staff Writer
Oct 05, 2009

[b]What is it and who does it cover?[/b]

Medicaid is a joint federal-state program that provides health care coverage for low-income people - primarily children, pregnant women, parents, the disabled and elderly. About 60 million people receive Medicaid benefits at some point during the year. Children account for about half of those enrolled. About one-quarter are elderly or disabled.

In addition, another national health insurance program, the Children’s Health Insurance Program (CHIP), covers more than 7 million low-income, uninsured children who are not eligible for Medicaid. That program is expected to grow to 11 million children by 2013.

Medicaid is administered by the states, although the federal government sets minimum eligibility standards and provides at least half of the funding.

[b]What is the current state of Medicaid?[/b]

The recession has undermined the budgets of many states at the same time that millions more people, hard hit by job cuts, are enrolling in Medicaid and CHIP. Even though Congress included $87 billion in the stimulus funding legislation to help states pay for Medicaid through 2010, the aid is temporary and further cuts are expected in programs.

[b]How much does Medicaid spend?[/b]

In fiscal year 2006, Medicaid spent an average of $4,575 per person: $1,708 for children, $10,691 for elderly enrollees and $12,874 for disabled persons. Total spending in fiscal year 2007 was $330 billion.

While most people enrolled in Medicaid are children and parents, most of the money spent – 68 percent in 2006 - is spent on the elderly and disabled.

[b]How will the reform proposals affect Medicaid?[/b]

Democrats see the Medicaid program as an important means of covering the uninsured. The bills differ on details but all of the pending Democratic measures would increase the maximum amount a person could earn as income and still be eligible for the program. In addition, all of these bills would extend Medicaid coverage to a new category of individuals - childless adults who fall below the income thresholds. Twenty-four states have some childless adult coverage now. And, although details again vary, all of the proposals would provide more federal funds to states to help pay for this new coverage category.

Depending on the proposal, children who currently are enrolled in the CHIP program could remain in it, enroll in a new regulated marketplace called an "exchange" or "gateway," or be enrolled in Medicaid.

Additionally, the House legislation would boost payment rates for doctors and other practitioners to the same level as Medicare payment. Right now, Medicaid physician fees are 72 percent of the fees Medicare pays to doctors. If rates aren't raised, analysts say, there won't be enough doctors to take care of the increased number of people entering the Medicaid program.

[url]http://www.kaiserhealthnews.org/Stories/2009/October/05/NPR-Medicaid-explainer.aspx[/url][/size]

"In Debate on Health, It's Coverage vs. Cost"

Joy125 — Tue, 06 Oct 2009 03:21:55 GMT

[size=2]
FROM NEW YORK TIMES

[b]In Debate on Health, It’s Coverage vs. Cost[/b]

By ROBERT PEAR
Published: October 5, 2009

TO READ COMPLETE ARTICLE SEE:

[url]http://www.nytimes.com/2009/10/06/health/policy/06health.html[/url]

EXCERPTS:

" . . . The Senate Finance Committee had been scheduled to meet Tuesday to finish work on a sweeping health care bill that it put together over the last two weeks. But it postponed the session while it waits for a cost estimate from the Congressional Budget Office.

Under the committee’s bill, there would be four levels of benefits — bronze, silver, gold and platinum — and all insurers would be required to offer, at a minimum, coverage in the silver and gold categories.

Most employer-sponsored health plans already meet the proposed federal standards. But insurers and actuaries say that one-third to one-half of policies bought by individuals and families fall short. About 17 million people buy insurance on their own, in this individual market. . .

. . . In comparing the overall benefit levels of different health plans, federal officials often use a yardstick known as actuarial value. This statistic measures the share of health care spending for a given population that is covered by a plan. Consumers pay the remainder, in deductibles, co-payments and other charges.

The four levels of coverage allowed by the Finance Committee have actuarial values ranging from 65 percent for the bronze plan to 90 percent for the platinum plan.

The Senate health committee prescribes three levels of coverage, with actuarial values from 76 percent to 93 percent.

The House bill also calls for three levels of coverage — basic, enhanced and premium — with values from 70 percent to 95 percent.

By contrast, the Congressional Budget Office says, the actuarial value of policies bought in the individual insurance market now averages 55 percent to 60 percent.

For insurance plans provided by employers, it said, the average value is 80 percent to 85 percent. And according to the Congressional Research Service, the value is slightly higher, 87 percent, for the standard Blue Cross and Blue Shield plan available to federal employees, including members of Congress. . .

. . .While higher-value plans may provide greater protection for many people, they may also cost more.

But Senator Debbie Stabenow, Democrat of Michigan, said the whole point was to improve the protection of consumers.

“The more we lower the actuarial value, the more the individual or the family will have to shoulder the costs of their plan,” Ms. Stabenow said. . . . Senator Olympia J. Snowe, Republican of Maine, said she shared that concern.

. . . The chairman of the Finance Committee, Senator Max Baucus, Democrat of Montana, said he was trying to “strike a balance between affordability and proper coverage.”

If the government does not set minimum coverage levels, he said, insurers will continue to offer low-value policies that leave consumers exposed to exorbitant costs and the risk of bankruptcy.

[/size]

EXCHANGES NEED BARGAINING POWER

Joy125 — Mon, 05 Oct 2009 16:25:38 GMT

[size=2]To Be Effective, Exchanges Need Bargaining Power

Jonathon Cohn
October 5, 2009

EXCERPTS:

" . . . The idea of an insurance exchange is relatively straightforward. If you work for a big company or, say, the federal government, every year you choose from among a set of insurance plans--all of them conforming to some minimal standard, all of them available to you regardless of pre-existing medical condition. They've been chosen by your human resources or benefit department, who--ideally--have some clue about what they're doing, more at least than you do.

If, by contrast, you work on your own or in a small company, then you may have just one choice--or no choice at all. Affordable coverage probably won't be available to you if you have existing medical problems; even if you're healthy, the coverage you get could have major gaps or be otherwise unreliable. It'd be good to know which policies work and which ones don't. But unless you happen to be an actuary or insurance broker yourself, chances are you're clueless when it comes to navigating this complex world.

It's you, the individual or small businessperson trying to buy insurance, for whom the exchanges are being created. They're basically regulated marketplaces, where you get to choose from among insurance plans more or less the same way folks in large companies do. Your premiums should be more affordable, since now you're part of a large bargaining group. You should be able to get coverage regardless of preexisting conditions, since insurers can't pick and choose which exchange customers to cover. And you should have the peace of mind that the coverage is good, since you know it's been screened by the exchange. . . .

. . . In the bills that passed three House committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee, the exchange would be a "prudent purchaser." In other words, it would have a staff that bargained with insurers to bring down premiums--and that made sure all plans lived up to strict guidelines for coverage and customer service. In effect, any insurer that wants to offer coverage through the exchanges has to get the equivalent of a "Good Housekeeping Seal of Approval" from the administrators. . . .

By contrast, the Senate Finance bill envisions much weaker exchanges. Instead of choosing which plans to make available, the exchange administrators would, by law, have to accept any plan that meets a relatively minimal set of standards.

Jon Kingsdale, who runs the Massachusetts exchange, calls that a recipe for "policy disaster," as consumers faced a dizzying array of more expensive, less regulated choices. "It would be like telling your grocery store they have to offer every single kind of bread baked by every single bakery. ... The exchanges would be nothing more than an automated Yellow Pages." . . .

TO READ COMPLETE ARTICLE SEE:

[url]http://www.kaiserhealthnews.org/Columns/2009/October/100509Cohn.aspx[/url]
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Discrimination by Insurers Likely Even with Reform

Joy125 — Mon, 05 Oct 2009 03:02:41 GMT

[size=2]Discrimination by Insurers Likely Even With Reform, Experts Say

Economic Pressure Could Give Rise to New Biases Against Prior Conditions

By David S. Hilzenrath
Washington Post Staff Writer
Sunday, October 4, 2009

Any health-care overhaul that Congress and President Obama enact is likely to have as its centerpiece a fundamental reform: Insurers would not be allowed to reject individuals or charge them higher premiums based on their medical history.

But simply banning medical discrimination would not necessarily remove it from the equation, economists and health-care analysts say.

If insurers are prohibited from openly rejecting people with preexisting conditions, they could try to cherry-pick through more subtle means. For example, offering free health club memberships tends to attract people who can use the equipment, says Paul Precht, director of policy at the Medicare Rights Center.

Being uncooperative on insurance claims can chase away the chronically ill. For people who have few medical bills, it is less of a factor, said Karen Pollitz, research professor at the Georgetown University Health Policy Institute.

And to avoid patients with costly, complicated medical conditions, health plans could include in their networks relatively few doctors who specialize in treating those conditions, said Mark V. Pauly, professor of health-care management at the University of Pennsylvania's Wharton School.

By itself, a ban on discrimination would not eliminate the economic pressure to discriminate. . . .

TO READ COMPLETE ARTICLE SEE:

[url]http://www.washingtonpost.com/wp-dyn/content/article/2009/10/03/AR2009100302483.html[/url][/size]

Republican Natl Cttee Tax Attack Goes Too Far

Joy125 — Wed, 30 Sep 2009 02:01:50 GMT

[size=2]FROM FACTCHECK.ORG

[b]RNC Tax Attack Goes Too Far

An RNC Web ad claims Democrats would tax ordinary wheelchairs. Not true.[/b]

September 29, 2009

Summary

The Republican National Committee claims in a new Web ad that Democratic health care plans propose taxes on "charities and small businesses. A doctor’s tax. Taxes on your health insurance. Even a tax on medical supplies."

It’s perfectly true, as the ad says, that "hundreds of billions" in taxes are being proposed – spread over 10 years. But the ad exaggerates and misleads in a number of ways:

* It makes a downright false claim that ordinary wheelchairs would be among "medical supplies" subject to a proposed tax on manufacturers and importers. That’s not true: Wheelchairs and roughly half of all other medical devices would be exempt. (When we pointed this out, an RNC official said the ad would be modified, however.)

* It features a proposed tax on medical laboratory services that has already been dropped.

* The alleged tax on "charities" is actually a proposed limit on federal income tax deductions for charitable gifts by individual taxpayers in the highest brackets, not a tax levied directly on the charities themselves.

* Similarly, the "small business" tax also refers to a proposed tax increase on individuals making more than $280,000 a year ($350,000 for families), only some of whom own small businesses. The vast majority of small-business owners don’t bring in enough to be affected.

The ad claims "your health insurance costs will skyrocket," but independent experts disagree. The head of the Congressional Budget Office says the biggest tax proposed in the Senate Finance Committee plan, for example, would reduce health care spending, because it cuts a tax incentive that encourages spending.

#######################

An excerpt from the ANALYSIS:

. . . . The Web ad claims that because of these taxes, "your health insurance costs will skyrocket." But the RNC’s list of taxes doesn’t back that up. The Joint Committee on Taxation estimated that several of the taxes mentioned in the ad – on tests, scans, X-rays and medical devices – would be passed along to consumers but would only add "about 1 percent" to the cost of premiums.

Other taxes mentioned in the ad – [b]the misleading references to taxes on “charities” and “small businesses” – are actually changes in income tax rates for those in the top tax brackets. That won’t cause anyone’s “health insurance costs” to “skyrocket.”[/b] The excise tax on high-cost health plans might raise premium costs (or reduce benefits) for the relative few who are covered by them, but the CBO didn’t estimate how much. Both the CBO and JCT directors told the Senate Finance Committee on Sept. 22 that the tax on so-called “Cadillac” plans would cause some employees to choose less-expensive plans, which, in turn, would cause their compensation to increase. The JCT estimates on revenue the government would receive from the tax include “additional income tax and payroll tax receipts” that would be received under such a scenario, said JCT Chief of Staff Thomas Barthold. And overall, the agencies see the tax as decreasing health spending. [b]CBO Director Douglas Elmendorf said in his testimony: “[I]mposing this tax would, in our judgment together with the Joint Tax Committee staff, reduce health spending over time by make – by removing what is essentially a subsidy in the current tax code to buy more health insurance relative to buying things that you have to purchase with after-tax income.”[/b]

[b]The RNC also fails to note that all of the bills being debated in Congress propose subsidies for low- and moderate-income individuals to help them buy insurance. Whether “your” premium goes up or down, depends on your income, as well as health status and current health care costs – and on the legislation, as we’ve noted before. [/b]For instance, according to an analysis by the Lewin Group, a subsidiary of UnitedHealth Group that operates independently of the company, the House bill as introduced would decrease families’ health care spending on average.

TO READ COMPLETE ARTICLE:

[url]http://www.factcheck.org/2009/09/rnc-tax-attack-goes-too-far/[/url][/size]

The Underinsurance Problem Explained

Joy125 — Wed, 30 Sep 2009 21:07:46 GMT

[size=2]FROM KAISERHEALTHNEWS.ORG

[b]The 'Underinsurance' Problem Explained[/b]

By Jenny Gold, KHN Staff Writer
Sep 28, 2009

[b] Who are the underinsured?[/b]

People who are described as underinsured have health benefits that don’t adequately cover their medical expenses. Often, consumers discover they’re underinsured the hard way – when they break a leg or have a serious illness, such as cancer, and their medical bills exceed their benefits enough that it is difficult for them to pay.

In some cases, people who are underinsured have coverage through employer-sponsored plans; they have high out-of-pocket expenses or skimpy benefits. In other cases, consumers have bought coverage on the individual market that covers only catastrophic costs. Some polices might feature high deductibles and co-payments, as well as exemptions for specific conditions or expensive treatments, or limit annual and lifetime benefits.

[b]How many people are underinsured?[/b]

Health experts say that the number of people who are underinsured is rising rapidly, and that the problem is increasingly affecting the middle class, as well as people with lower incomes. An estimated 25 million Americans between the ages of 19 and 64 were underinsured in 2007 — a 60 percent increase since 2003, according to a study in the journal Health Affairs.

Individuals were considered underinsured if they spent more than 10 percent of their incomes on out-of-pocket medical expenses (5 percent if they were low-income) or more than 5 percent on deductibles. Low-income adults were at the highest risk of being underinsured.

The increase in the underinsured is partly due to the fact that as health care and insurance costs have gone up, employers have bought policies with higher deductibles and co-payments and asking their workers to pay a greater share of the premiums.

[b]What kinds of problems do the underinsured face?[/b]

Some of the underinsured avoid going to the doctor or getting prescriptions filled because they can't afford it. Others end up with medical debt and other severe financial problems.

Often, sicker or older (those just short of qualifying for Medicare) people are underinsured because they can't afford comprehensive coverage. One reason? Only 18 states limit how much insurers can base premiums on factors such as age, health status and gender.

[b]How will the health overhaul proposals affect the underinsured?[/b]

The major proposals being debated in Congress would require insurers to provide a minimum set of benefits that are designed to take care of most patients' needs. In addition, the proposals would limit consumers’ out-of-pocket costs – as long as they stay within network - and would prohibit insurers from imposing annual or lifetime limits on coverage.

In addition, the legislation would bar insurers from basing enrollees' premiums on health status and gender. Backers say that these regulations would make it easier for people to afford coverage that would reduce the number of underinsured. Moreover, pending proposals would provide subsidies for people who have low or modest incomes, in an effort to make comprehensive coverage more affordable. And Medicaid, the state-federal program for the poor and disabled, would be expanded to include more lower-income people.

[url]http://www.kaiserhealthnews.org/Stories/2009/September/28/underinsured-explainer.aspx[/url][/size]

Medicare Coverage Explained

Joy125 — Wed, 30 Sep 2009 21:04:12 GMT

[size=2]FROM KAISERHEALTHNEWS.ORG

Medicare Coverage Explained

By Jessica Marcy, KHN Staff Writer
Sep 22, 2009

What is Medicare and who is covered?

Medicare is the federal program that covers many of the health costs for people age 65 and older as well as people younger than 65 who are permanently disabled. No one is excluded because of income or pre-existing conditions.

Medicare covers 45 million Americans. Of those, seven million are disabled.

What is the current state of Medicare?

Medicare is a huge program; it makes up 13 percent of the federal budget.

The program faces a number of critical challenges including the financing of care for an aging population, improving the management of care for chronically ill, high-cost beneficiaries and setting fair payments to providers and plans.

Medicare is spending more than it is taking in from taxes and is projected to nearly double from $477 billion in 2009 to $871 billion in 2018, according to the Congressional Budget Office. In May, the Obama administration announced that Medicare's Hospital Insurance Trust Fund is projected to run out of money in 2017. To keep it solvent, Congress would have to increase taxes, reduce benefits and/or reduce payments to hospitals or other providers.

Currently, disabled people wait to qualify for Medicare for two years. If that wait were to be eliminated, it would cost the program an additional $113 billion over 10 years.

What are the benefits and what do they cost?

Medicare is divided into four parts – A, B, C and D.

Medicare Part A pays for inpatient hospital, skilled nursing facility, home health and hospice care. Most people do not pay a premium for Part A and have a $1,068 deductible for inpatient hospital stays.

Part B pays for physician, outpatient and preventive services, as well as some home health visits. Most pay a $96.40 monthly premium, with a $135 deductible. In addition, people are responsible for 20 percent of the bill.

Part A and Part B operate on a fee-for-service arrangement: patients choose their own doctors and hospitals and those providers generally bill Medicare directly.

Part C, also known the Medicare Advantage program, allows beneficiaries to enroll in a private health plans – such as HMOs - and receive all Medicare-covered benefits. The initial idea was to improve coordination of care at a lower cost than fee-for-service. However, the federal government spends more on average per beneficiary inthe Medicare Advantage program than traditional Medicare.

Part D is the voluntary, subsidized prescription drug benefit administered by private plans. The premiums and deductibles for Part D vary, depending on the plan. The drug plan covers 75 percent of allowable drug expenses up to $2,700 and then does not kick back in until the patient has reached a catastrophic limit of $4,350 on out-of-pocket spending. This creates a “doughnut hole” in which patients have to pay 100 percent of prescription costs.

About 90 percent of beneficiaries have some form of supplemental insurance to fill in the benefit gaps.

Medicare does not pay for some important services for the elderly and disabled, such as long-term care in nursing homes or routine dental and vision care.

How could reform proposals affect Medicare?

Congressional proposals have provisions to make Medicare more efficient and slow the growth in Medicare spending.

To curtail Medicare spending some suggested provisions would reduce federal payments to Medicare Advantage plans and require improvements in hospital practices to cut down the number of patients who need to be readmitted. Another provision would trim the yearly increase in payments to hospitals and other providers. Depending on the final bill, the government may get some savings on prescription drug prices.

Under a deal with the pharmaceutical industry, if a bill passes, Medicare beneficiaries would see a 50 percent price reduction of brand-name prescription drugs that currently cost full price when the patient hits the "doughnut hole." And in the House bill, the gap in prescription coverage would be phased out completely over 14 years.

Some proposed bills would cost the government money. For example, the House bill would increase costs by $230 billion over 10 years by eliminating planned cuts in Medicare payments to doctors. In addition, the bills call for paying primary care doctors and other providers more money for coordinating patient care and making more low-income Medicare patients eligible for subsidies.

[url]http://www.kaiserhealthnews.org/Stories/2009/September/22/medicare-explainer-npr.aspx[/url][/size]

Employer Based Insurance Explained

Joy125 — Wed, 30 Sep 2009 20:59:43 GMT

[size=2]FROM KAISERHEALTHNEWS.ORG

Employer-Based Insurance Explained

By Andrew Villegas, KHN Staff Writer
Sep 28, 2009

What is it and who does it include?

Most Americans -- 162 million -- get health insurance through their employers. Sixty percent of employers offer health benefits, according to a new survey by the Kaiser Family Foundation and the Health Research and Educational Trust. Generally, employers subsidize the cost of the insurance, but workers share the expense through a variety of payments, including premiums, co-payments and deductibles.

Bigger companies are more likely to offer health insurance. Ninety-five percent of employers with more than 50 workers and almost three-quarters of companies with 10 to 24 workers provide insurance. But fewer than half of employers with three to nine workers give their employees health benefits.

Workers often don't have much choice of insurance plans, especially at smaller firms, according to the survey. About 86 percent of companies that provide benefits offer only one insurance plan. Larger employers tend to give more choices. Overall, about 53 percent of covered workers have a choice of plans. Most employers offer prescription-drug coverage as part of their insurance plan, although often workers are required to pick up some of the costs.

About 60 percent of people who get their insurance through work are enrolled in preferred provider organizations (PPOs), which generally use a network of doctors and providers who work on a fee-for-service basis but offer a discount to plan members. Enrollees in these plans are permitted to go to providers outside the network but generally must pay a higher share of the cost. Another 20 percent of covered workers are in health maintenance organizations (HMOs). The rest are in a variety of other plans.

What's the cost of employer-based health insurance?

In 2009, the average cost of employer-based health insurance is $13,375 for a family, which is a 5 percent increase over 2008, the Kaiser survey found. The cost of an individual plan remained steady at $4,824. On average, workers' contributions were $3,515 for family coverage and $779 for an individual policy.

But the workers' share of premiums varies considerably, with few people paying nothing and many contributing more than 25 percent of the cost.

Deductibles have also been rising sharply. Among smaller firms, where the rate of increase has been greatest, 40 percent require deductibles of at least $1,000. That's twice as many as only two years ago.

How will the overhaul proposals affect work-based insurance?

All of the Democratic proposals would require individuals to have insurance. Those without health insurance would be required to pay a fine, unless it would be an economic hardship. The House bill and the Senate Health, Education, Labor and Pensions Committee require employers above a certain size to offer coverage to workers. If they do not provide that coverage, the employers must pay a penalty. The Senate Finance Committee bill would not require employers to offer coverage, but would require employers with 50 or more workers to reimburse the government if their employees used government help to buy coverage.

Lawmakers are considering ways to help small businesses pay for coverage. For example, the Senate Finance bill would offer tax credits to firms with 25 or fewer workers that help pay for health insurance coverage. In addition, legislation being debated would create insurance "exchanges" that would offer competing plans, an effort to keep the price of policies down.

To pay for the cost of extending coverage to more Americans through expanding Medicaid, the state-federal program for the poor, and giving subsidies to people whose employer doesn't have a plan, many in Congress would like to tax the most expensive insurance policies -- often described as "Cadillac" coverage. Right now, policies are exempt from income taxes. Government studies have suggested that taxing employer-provided health benefits could raise an estimated $246 billion.

[url]http://www.kaiserhealthnews.org/Stories/2009/September/28/NPR-employer-explainer.aspx[/url][/size]

Federal Employees' Health Benefits Explained

Joy125 — Wed, 30 Sep 2009 20:55:51 GMT

[size=2]

[b]FROM KAISHERHEALTHNEWS.ORG

Federal Employees' Health Benefits Explained[/b]

By Jessica Marcy, KHN Staff Writer
Sep 21, 2009

[b]What is the Federal Employees Health Benefits Program and who is eligible?[/b]

The Federal Employees Health Benefits Program (FEHBP) is the "marketplace" for full-time government employees and qualified retirees to select health and dental insurance offered by insurance companies and employee associations. The federal government is the largest employer in the country and more than 8 million people — including current employees, retirees, their spouses, dependents and survivors — are enrolled in FEHBP.

[b]What kind of plans are offered?[/b]

Customers enjoy a wide range of insurance options, from catastrophic coverage plans with high deductibles to health maintenance organizations to high-end plans with many choices of doctors. Last year, the combined total of plans offered around the country totalled 269. While the number of choices for individual workers varies, based on their geographic location, everybody has a choice of at least 10 fee-for-service plans.

FEHBP provides coverage without regard to pre-existing conditions or age. There are no waiting periods for coverage.

[b]How much do plans cost?[/b]

The most common plan, the Blue Cross Blue Shield Standard option for federal workers, set deductibles this year at $300 for individuals and $600 for families. It limits out-of-pocket expenses to $5,000 per family for services from preferred health care providers and $7,000 overall.

[b]On average, the government pays 72 percent of premiums.
[/b]
[b]The monthly cost to the worker for the Blue Cross Blue Shield Standard plan is $152.06 for an individual and $356.59 for a family.[/b]

[b]How will the overhaul proposals affect people in FEHBP?[/b]

There is little that would change for FEHBP participants if a Democratic reform proposal were to pass. Most FEHBP recipients would not be affected by the minimum benefit standards expected in the bills because their benefits already meet those standards.

If there are taxes on health plans, as some lawmakers have proposed, people with FEHBP would face the same taxes as those in other plans.

While health reform bills would set up a Health Insurance Exchange or Gateway to provide a marketplace for individuals and businesses to buy coverage, the current proposals would generally restrict FEHBP consumers — or other people with employer-sponsored insurance — from using such an exchange.

[url]http://www.kaiserhealthnews.org/Stories/2009/September/21/federal-workers-explainer-FEHBP-npr.aspx[/url] [/size]

Answers to Your Health Care Questions

Joy125 — Tue, 29 Sep 2009 18:53:52 GMT

[size=2]Sept. 28, 2009

[b]Answers to your health care questions[/b]

By TODD SPANGLER and PATRICIA ANSTETT
FREE PRESS STAFF WRITERS

Federal health reforms under discussion in Congress have spurred hundreds of questions. Starting today, a team of Free Press reporters will answer your questions.

See link:

[url]http://www.freep.com/article/20090928/FEATURES08/90927017/1033/FEATURES08/Answers-to-your-health-care-questions[/url]
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Opposing Views and Gag Orders

AlanNW — Thu, 24 Sep 2009 15:24:06 GMT

[b]House Republicans Call for Hearing on Health Insurance Company 'Gag Order'[/b]

Republicans on the House Ways and Means Committee wrote a letter Thursday to Chairman Charles Rangel, D-N.Y., urging a hearing on the decision to launch a probe into Humana over a mailer Sen. Max Baucus claimed misled seniors about proposed changes to Medicare.

House Republicans on Thursday called for a hearing to examine the Obama administration's decision to probe a major insurance company, at the behest of Sen. Max Baucus, over a mailer to customers about health care legislation -- a move they call a politically motivated "gag order" on critics of the Democratic plan.

Republican criticism has swelled since the Centers for Medicare and Medicaid Services launched a probe into Humana, at the request of Baucus, D-Mont., over a mailer Baucus claimed misled seniors about proposed changes to Medicare.

Humana, one of the largest private carriers serving seniors under the Medicare Advantage program, focused its mailer on the potential for cuts to the service, which were being debated in the Finance Committee on Thursday.

Republicans say the administration was essentially punishing Humana for questioning the plan and firing a warning shot at any other companies that might be thinking of doing the same. The Department of Health and Human Services on Monday not only targeted Humana, but sent out a broad directive to all Medicare Advantage participants, telling them to "immediately discontinue all such mailings" and remove any such material from their Web sites.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, said the order went out to about 200 companies Monday night, just as the Senate Finance Committee was about to start debate on its version of health care reform.

"This is an effort to stifle any dissent," he said.

"They are silencing opposition to the president's Medicare cuts," said Sage Eastman, spokesman for Rep. Dave Camp, ranking Republican on the House Ways and Means Committee.

Camp and the other minority members of the House Ways and Means Committee wrote a letter Thursday to Chairman Charles Rangel, D-N.Y., urging a hearing in order to "investigate the unusual and potentially politically motivated decision by CMS to eliminate the flow of factual information from private health plans to their enrollees."

"While these programs need to be made more efficient, if the proposed funding cut levels become law, millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable," it said.

It urged seniors to sign up with Humana for regular updates on the legislation and encouraged them to contact their lawmakers in Washington.

Humana was expressing concern about proposals to cut Medicare and Medicaid spending by about $500 billion over 10 years -- including payments to Medicare Advantage plans by about $125 billion.

Congressional Budget Office Director Douglas Elmendorf on Thursday agreed that seniors in the Medicare Advantage plans could see reduced benefits under Baucus' legislation.

But Baucus said the proposed bill would not cut benefits.

"I'm not going to let insurance company profits stand in the way of improving Medicare for seniors," he said in a statement, calling efforts to mislead seniors "wholly unacceptable."

Democrats continued to assert that the company had made a false claim and that Republicans were again demonstrating their affinity for the insurance industry.

Baucus said the mailer could be a violation of federal regulations. However, Republicans responded with Clinton administration guidance that prohibiting such information would violate basic freedom of speech and other constitutional rights of the Medicare beneficiary as a citizen.

AARP, which also helps administer Medicare plans in conjunction with United Healthcare, has weighed in on that part of the health care debate as well -- only on the other side.

The AARP continues to feature ads on an affiliated Web site defending the Medicare changes. One ad blasts critics for spreading "myths and scare tactics," and claims the reforms will not "hurt" Medicare but "actually strengthen it by eliminating billions of dollars in waste and lowering drug prices." Another AARP article declares, "Controlling the rising costs of Medicare doesn't mean cutting benefits."

Eastman said AARP is not being held to the same standard.

"If you're going to silence the critics you need to silence the proponents too," he said. "This clearly smacks of politics."

A representative with the AARP could not be reached for comment.

FOXNews.com's Judson Berger and The Associated Press contributed to this report.

http://www.foxnews.com/politics/2009/09/24/house-republicans-hearing-health-insurance-company-gag-order/

ON MEDICARE SPENDING

Joy125 — Mon, 28 Sep 2009 20:46:07 GMT

[size=2]FROM THE WASHINGTON POST:

By Lori Montgomery
Washington Post Staff Writer
Monday, September 28, 2009

After years of trying to cut Medicare spending, Republican lawmakers have emerged as champions of the program, accusing Democrats of trying to steal from the elderly to cover the cost of health reform.

It's a lonely battle. The hospital associations, AARP and other powerful interest groups that usually howl over Medicare cuts have also switched sides. Last week, they stood silent as the Senate Finance Committee debated a plan to slice more than $400 billion over the next decade from Medicare, the revered federal insurance program for people over 65, and Medicaid, which also serves many seniors.

With the Finance Committee set to resume deliberations Tuesday, cuts to government health programs are expected to account for at least half the funding for its health-care reform package. A competing bill drafted by House leaders would cut spending even more sharply.

AARP and other groups say the cuts are small enough to be absorbed without affecting services, and many health policy analysts tend to agree. But the size of the cuts is less relevant than the widespread calculation that health-care providers and their most frequent patients have much to gain from President Obama's overhaul of the nation's health system.

[b]Cutting Medicare does not necessarily mean reducing spending but rather slowing its rate of growth. Such efforts are usually aimed at reducing the federal budget deficit. Spending is cut, and, from the perspective of doctors, hospitals and other providers, the cash disappears. This time the cuts would finance a vast expansion of coverage for the uninsured, creating a new pool of nearly 30 million customers. Earlier this year, industry groups agreed in talks with the White House to forgo billions in Medicare and Medicaid payments to help cover the cost of reform. [/b]

. . . . With seniors likely to make up nearly 20 percent of the electorate in 2010, Republicans see Medicare as a potent campaign issue. In the Finance Committee, GOP senators moved repeatedly to strip the spending cuts from the bill.

. . . Clinton and a Republican Congress approved a package of cuts remarkably similar to the one now on the table. The Balanced Budget Act of 1997 was expected to save $112 billion over five years -- a 9 percent reduction in projected spending on par with the 10 percent in the Baucus bill. The cuts wound up saving so much more than expected that Congress reversed some of them in 1999 and 2000, said Jon Gabel, a senior fellow at the National Opinion Research Center.

Service to seniors was largely unaffected . . .

TO READ REST OF ARTICLE SEE:

[url]http://www.washingtonpost.com/wp-dyn/content/article/2009/09/27/AR2009092703277.html[/url]

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2010 Insurance changes

SassySyl — Sat, 26 Sep 2009 01:38:31 GMT

[font=Comic Sans MS][size=3]I just received in the mail today enrollment package for my 2010 insurance renewal through my husbands employer. Its scary! Everything has went up except for the premium :blink: The deductible doubled for each of us, and there are 4 of us. The co-pay went sky-high and prescription co-pay doubled for mail order and stayed the same for 30 day supply through retail drug store. And how do they think we are suppose to afford the premium plus deductibles and co-pays plus 20 to 50% of what they don't pay? This is just crazy!
Why are we paying for insurance and not be able to afford to use it? Its high way robbery, and they are getting by with it.
Instead of health reform it, it should be insurance reform. That's the problem more so than the other. If the insurance companies were forced to make insurance affordable for everyone--sliding scale for lower-income and free to ones that can prove they can't afford the cost with a government grant program in place to help with the insurance cost, everyone would be able to afford health care without this argument over health care reform. It would be a win situation for the doctors as well as the insurance companies--more business for all, and the ones without ins. now would have coverage to see the doctors which would give them money as well as the ins. company would be receiving more clients paying for insurance.

Has anyone else received any information about their insurance plans for 2010?

Warm Thoughts,
Sylv [/size][/font]