U.S. lags behind in healthcare innovation, Sebelius says

By Jessica Zigmond 

Posted: February 27, 2014 – 3:45 pm ET

Tags: Advisory Board Co.American Recovery and Reinvestment ActCommunityHospitalsKathleen SebeliusMedicarePublic Health

http://www.modernhealthcare.com/article/20140227/NEWS/301019759/u-s-lags-behind-in-healthcare-innovation-sebelius-says?AllowView=VXQ0UnpwZTVDUGFaL1IzSkUvSHRlRU9vajAwZERlTlU=&utm_campaign=am

The federal government’s top health official Thursday gave U.S. healthcare innovation a grade of Incomplete.

“That’s really the great dichotomy of the time we’re living in,” HHS Secretary Kathleen Sebelius said. “We live in a 21st century world with a 20th century delivery system. We live in a world in which the National Cancer Institute is texting teens to convince them to quit smoking, but ask any parent how easy it is to get their kid’s immunization report from the doctor’s office.”

Although new health innovations, discoveries and technologies are allowing Americans to live longer, healthier lives, the processes of patient experience—such as how patients manage their health, how they choose a physician and how doctors work together to create a treatment plan—have not always kept pace with new medicines, vaccines and procedures, Sebelius said in addressing attendees at the Care Innovation Summit put on by the Aspen Institute and Advisory Board Co.

The answer, Sebelius suggested, is twofold: Unlock and release the information that drives innovation; and align payment for care in a way that pays for better outcomes and innovations, rather than for more operations and hospital readmissions.

And the federal government can help by unlocking some of this information. HHS has been doing that in part through the Hospital Compare website, which allows patients to compare categories such as patient experience, average wait times and whether a hospital has medical imaging capabilities, Sebelius said.

HHS for years has collected data in a wide variety of areas, such as public healthMedicare, clinical trials and spending. But often that information was either difficult or even impossible to access, either because it was hidden behind walls that would require huge sums of money to access, or because the data were published in formats that were indecipherable, she acknowledged. In other words, Sebelius said, it was “lazy” data that had potentially valuable information.

Now, HHS is working to make that “active” data. Just recently, the department had its 1,000th data set released on HealthData.gov. In the past, Sebelius said, that information would have been available only to scientists and researchers who were willing to pay for it.

“What we’re finding is if we make data open and accessible, the private and nonprofit sectors use it to start innovating,” she said.

Sebelius shared a few success stories of healthcare providers who have seen significant changes through the use of electronic health records, including one physician in the small town of Plainville, Kan., who transferred her patient records to EHRs. After she did, she was surprised to learn that only 43% of patients in her practice over the age of 50 for whom colon cancer screenings were recommended were actually getting tested. The physician created a system in which she was notified if a patient didn’t follow through. In a year and a half, that number rose to 89%, and she is working toward 100%.

“Nationally there has been tremendous progress in the last five years from quills and clipboards to computers and keyboards,” Sebelius said. “When President Obama took office in 2009, 1 in 8 hospitals were using any kind of basic electronic record. By 2012, that number had tripled,” she said, adding that the number of doctors using EHRs is now more than 50% and on the rise.

These changes are due in large part to incentives included in the American Recovery and Reinvestment Act, she said, and emphasized that with those incentives also came the national protocols to become a meaningful user.

Looking ahead, Sebelius challenged members of the health reform community to agree that from now on, “We’ll look at innovation that is something that is happening for us and with us and by us,” she said, “rather than something happening to us.”

Follow Jessica Zigmond on Twitter: @MHjzigmond

Advertisements

UPDATE 1-Two U.S. hospital chains dismiss Obamacare technical woes

Source Link:  http://www.reuters.com/article/2013/11/05/hospitals-reform-idUSL2N0IQ1JN20131105

Tue Nov 5, 2013 2:49pm EST

By Susan Kelly

Nov 5 (Reuters) – Two U.S. hospital operators said on Tuesday technology problems bedeviling the federal government’s online health insurance marketplace were gradually diminishing and will not stop them from pushing ahead with plans to provide care to those who sign up.

“If any company had three years’ notice about having a website functioning for a major product launch on October 1, it would have worked. It’s frustrating that it did not work,” hospital operator Tenet Healthcare Corp’s Chief Executive Trevor Fetter said in an interview with Reuters following the company’s third-quarter earnings conference call.

While the glitches that have prevented many potential health plan enrollees from signing up are disappointing, “we’re not terribly concerned about it,” Fetter said.

That is because those uninsured patients will not be able to access the new plans until January anyway, so there is still plenty of time to sign up, he said.

Fetter said problems with online access to the federal insurance exchange have been lessening, and patients can also enroll through call centers, where waiting times have been coming down. State exchanges such as the one set up in California are working much better and are offering a selection of affordable plans, he added.

“This is a really important innovation,” Fetter said. “I wouldn’t judge it by the initial performance of the federal website.”

HCA Holdings Inc Chief Executive Richard Bracken said issues with the federal website have not deterred the company from its own plans to contract with insurers to provide care to new patients.

Ninety-seven percent of HCA’s U.S. hospitals have an exchange contract with access to a bronze level insurance plan, he said. Such plans have the lowest premiums.

“We are well-positioned to participate and provide healthcare services,” Bracken said on the company’s earnings conference call.

Tenet said it has contracts with about three-quarters of all the exchange plans that are offered in its markets.

EAGER FOR PATIENTS

Hospital companies have a lot riding on the success of the insurance exchanges. Hospitals are struggling with declining admissions as many Americans have stayed away from the doctor due to lack of insurance or high deductible on their plans.

The companies expect patient admissions to grow and bad debts to decline as more patients gain insurance to pay for their care.

Tenet shares fell about 9 percent on Tuesday, to $43.96, after it provided a disappointing outlook for the fourth quarter when it released its third-quarter results on Monday.

HCA, the largest publicly owned U.S. hospital operator, was one of the only hospital chains to report a modest increase of less than 1 percent in admissions to its facilities in the third quarter. Its shares fell 2.5 percent Tuesday to $46.53.

Jefferies & Co analyst Brian Tanquilut said he believes hospitals in 2014 will benefit primarily from more people being eligible for the Medicaid health insurance program that serves the poor.

“The health reform story is intact, but near term, the volume headwinds, which have been hampering hospitals for five years, continue to persist,” he said.

 

Five Things You Don’t Know About Health-Care Reform

By 

Insurance sign-ups are just around the corner for millions of Americans under health-care reform, yet there’s still much people don’t know about this landmark legislation, particularly those changes occurring over the next decade inside hospitals, clinics, and doctors’ offices.

It’s a workforce thing. All the attention is on politics, or who will receive what benefits and where the money will come from. But the most important question is who will deliver the care and how it will be done. Most of the change will be accomplished by the health-care workforce. Transforming health care is a huge management challenge. Many clinicians and staff will have to fundamentally change their professional objectives and standards, daily routines, compensation, patient relationships, and employer relationships. The scope of health-care reform and current market pressures are unparalleled in any other industry; the re-engineering of health-care workforce roles now underway may completely change relationships between patients and clinicians in the next decade.

Biggest long-term problem: clinician shortages.An additional 30 million Americans will receive health-care coverage by the end of the decade, during a time when a further 15 million patients will become eligible for Medicare. Who will take care of all those people? By 2020, a shortage of 91,500 primary care and specialist physicians is predicted. Shortages of nurse practitioners and physician assistants, who could help fill in the gaps in primary care, also are predicted. Without enough clinicians, effective health-care reform could be stifled.

Getting paid to keep you well, rather than cure your illness. Changes in compensation for doctors and nurses will dramatically transform from quantity of work to quality of work. Until very recently, compensation and reimbursement were entirely based on the volume of patients and treatments. Now they’re beginning to reflect value-based benchmarks that will increase every year. Some of these include patient satisfaction, readmission rates, health risk assessments, and patient wellness, among other benchmarks. For hospitals, making sure patients are satisfied will become a pocketbook issue. For clinicians, careful disease management and preventive care to keep patients out of the hospital could directly affect how much they are paid.

Independent doctors’ practices are quickly fading. Physicians who hang a shingle outside a private office are becoming rarer. A recent survey showed that 55 percent of practicing physicians work for someone else, usually a hospital or a practice owned by a hospital or health system. That figure grew 8 percent in one year. Meanwhile, nearly 40 percent of physicians younger than 45 have never worked in private practice. Doctors are moving to employed positions in hospitals and health systems in search of greater stability in the rapidly changing health-care environment.

Your doctor may not be a doctor. One of the most striking changes for consumers may be team-based care, with physicians, nurse practitioners, physician assistants, psychologists, pharmacists, and others working together to improve quality of care and lower costs. If your health-care provider employs a team approach, when you make an appointment with your doctor you may instead see a nurse practitioner or physician assistant, depending on a quick assessment of your health status. In more than a dozen states, nurse practitioners can diagnose, treat, or prescribe with no physician involvement. Laws and regulations on the scope of practice for these clinicians are changing rapidly.

Health-care reform isn’t just about getting coverage for millions of people who don’t have it. It’s also about changing the way health care is delivered to reduce costs and improve patient care. Unless we can accomplish those two goals, increasing coverage will become prohibitively expensive. Transforming health-care delivery requires the active participation of America’s 16-million member health-care workforce.

Salka is President and CEO of AMN Healthcare, one of the nation’s largest health care staffing companies.

Language barriers could deter minorities from benefiting from healthcare reform

  • JESSICA KWONG/THE S.F. EXAMINER
  • At a panel discussion, state Assemblyman Phil Ting, D-San Francisco, promoted Assembly Bill 1263.

With California at the forefront of the most comprehensive nationwide health care reform effort in half a century, it isn’t affordability but language barriers that providers and legislators fear will prevent minorities from taking advantage of greater access to coverage.

The Affordable Care Act, which begins open enrollment in October and becomes effective Jan. 1, will make health insurance more accessible and affordable to millions of Americans who now lack insurance. But in California, where nearly 16 million people, or 43 percent, speak a language other than English — it’s 45 percent in San Francisco — implementing the act presents a challenge.

At a panel discussion about this topic Wednesday, state Assemblyman Phil Ting, D-San Francisco, promoted Assembly Bill 1263, under which California would invest $200,000 to gain $270 million in federal funds authorized by the act to fund interpreter services for state Medicaid enrollees.

Interpreters are very often “our lifeline,” Ting said, noting that many immigrant families are accustomed to having their children translate when they receive medical treatment.

The U.S. Department of Health and Human Services does not recommend using children as interpreters, especially because they often lack medical vocabulary, said panelist Annis Arthur, deputy regional manager for the department’s Office for Civil Rights.

Legislation like AB 1263 would help break down language as the barrier to health care access, Ting said.

“We can’t expect our children to be there,” Ting said. “What kind of system will they be able to access? I don’t want to hyperbolize, but in these situations it’s a case of life or death.”

Members of the Asian and Latino community helped put a human face on this issue at Wednesday’s panel.

San Francisco resident Juan Situ shared how she waited hours for an interpreter to help her fill out forms for her sister’s hospitalization, only for the situation to get no better after her procedure.

“After the surgery, the interpreter was gone and we wanted to ask the doctor why my sister was in so much pain,” Situ said in Cantonese. “Finally, the doctor came to us but there was no interpreter, so we could not communicate.”

Although California and the U.S. have great language access laws, lapses exist, said forum panelist Cary Sanders, director of policy analysis at the California Pan-Ethnic Health Network.

“Part of it is they are not aware they have the right to request language access,” she said. “That is a huge issue. We heard a couple stories today but think of all the stories we are not hearing. The system fails and we don’t know about it.”

Obamacare Presents Complex Choices For People With Disabilities

Source Link:  http://www.webmd.com/health-insurance/20130809/obamacare-presents-complex-choices-for-people-with-disabilities?src=RSS_PUBLIC

WebMD News from Kaiser Health News

By Eric Whitney, CPR
The Affordable Care Act has set new standards — called essential health benefits — outlining what health insurance companies must now cover. But there’s a catch: Insurance firms can still pick and choose to some degree which specific therapies they’ll cover within some categories of benefit. And the way insurers interpret the rules could turn out to be a big deal for people with disabilities who need ongoing therapy to improve their day-to-day lives.

Bryce Vernon is a 20-year-old film student who lives in Los Angeles and has cerebral palsy. He speaks only with the aid of a special computer mounted to his wheelchair that tracks his eye movements. Using his eyes, Vernon can indicate on a screen what letters and words he wants the computer’s voice to say.

It’s amazing technology, and Vernon gets a lot more out of it with help from speech-language pathologist Jill Tullman.

“Now Bryce, I’m want to show you this super cool random button I think you’re going to love,” Tullman tells him during a therapy session at a special camp for young people who use the technology. Vernon’s parents paid out-of-pocket for him to attend the camp.

Tullman helps him pre-load several different ways of saying goodbye.

“Bye, later dude, later, bye, I’m out of here, see ya later,” Vernon says, testing it out.

In the parlance of health policy, the work Tullman is doing with Vernon is called “habilitative services.” It’s different from the more familiar sort of rehab people often get after an injury or surgery. Habilitative services are for people who can benefit from one-on-one time with a therapist to improve daily living skills. But such services can be expensive, and not all insurance plans have covered them.

The Affordable Care Act is changing that, says health economist Lisa Clemans-Cope with the Urban Institute.

“You’re much more likely to find these benefits in a plan in the individual market [starting in 2014] than you would be today. Far more likely,” says Clemans-Cope.

This is because “habilitative services” are included within the 10 categories of essential health benefits the ACA will require in those new plans. Still, while some categories are straightforward — such as maternity care and preventive care — the category including habilitative services leaves more room for interpretation.

For instance, insurers could choose to cover physical therapy for someone with a broken bone, but not cover long-term support services for chronic conditions, such as speech therapy for kids with developmental delays.

Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want to have specific therapies covered are going have to slog through some fine print to figure out if they’ll actually benefit from a particular policy. (The new policies will start to go on sale this fall and go into effect beginning Jan. 1, 2014.)

“This is a big improvement, but we should emphasize that it’s not totally fixed,” Clemans-Cope says. “And people are really going to have to get help to decide which plans cover the benefits they need. ”

Whether a person will be able to get the new therapy benefits also depends on where they live. The level of benefits insurers have to provide in each category is based on a model policy in each state, and some of those model policies are a lot more generous than others.

Jill Tappert, an activist in Colorado for people with disabilities, says a lot of details still need to be sorted out before she’ll be able to say whether the health care law has improved things much.

“I certainly hope the way the Affordable Care Act is implemented is a game changer for people in the disabilities community. It can be,” says Tappert, who spent years fighting for habilitative service coverage for her daughter who has autism. “The opportunity is there for policy makers to vastly improve lives.”

Barbara Vernon, Bryce’s mother, says Bryce is now covered by Medi-Cal, California’s Medicaid program. His primary insurance had been her employer-sponsored plan until she was laid off in 2009. She searched for private coverage for Bryce, but says, “Private was so unbelievably expensive, it was unaffordable.”

Barbara says her family’s insurance is “a patchwork,” with Bryce likely to stay on Medi-Cal even after his 21st birthday. She and her other son have an individual plan they have purchased, and her husband has an employer-sponsored plan — but it covers only the employee, not the family.

For his part, Bryce Vernon says his life is a lot better since getting the kind of help that many others may be able to get from the health law, starting in 2014. He works hard to get the most out of the technology and the therapy that lets him speak. His advice to others: “Never, ever give up.”

The new rules for what health insurance companies have to cover may still change. Federal regulators plan to review them as the health law rolls out and could make changes in 2016.

This piece is part of a reporting partnership among NPR, Colorado Public Radio and Kaiser Health News.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Long Term Care Insurance Not Covered by Obamacare Reports Association Director

August 14th, 2013 – 0 comments – Filed Under – by 

Los Angeles, CA, August 14, 2013 –(PR.com)– Long term care insurance is not included under provisions passed by Congress as part of the Affordable Care Act also known as Obamacare according to the director of the American Association for Long Term Care Insurance.

“We are getting an increasing number of calls from consumers wanting to know how to apply for long term care insurance once insurers must accept pre-existing health conditions,” explains Jesse Slome, executive director of the long term care insurance industry trade group. “Unfortunately I have to tell them long term care insurance is not included under Obamacare and is only available to those who can meet health requirements.”

Consumers are expected to start investigating insurance plans available under Obamacare next month and open enrollment starts October 1st.

“The Department of Health and Human Services abandoned any plans to implement the provision calling for a voluntary long term care insurance program which would have allowed those with existing health insurance to apply,” Slome notes. “They found the monthly premiums they’d have to charge would have been far too expensive for people to afford so they walked away and allowed Congress to repeal the CLASS Act.”

“There are about a dozen insurance companies currently offering private long term care insurance,” says Slome. About eight million Americans have some form of protection against the significant risk of needing long term care. “If you have some existing health conditions, we can advise whether pursuing a long term care insurance policy will even be possible.”

The American Association for Long-Term Care Insurance advocates for the importance of long term care planning and supports insurance professionals who market the complete range of planning products.

Consumers interested in learning more about long term care insurance protection can read four consumer guides providing helpful information on planning and reducing long term care insurance costs. They can be accessed on the Association’s website at http://www.aaltci.org/guides and no information is required to access these guides. To connect with a designated long term care insurance professional, a member of the Association, for information and no-obligation cost comparisons call the

Contact Information:
American Association for Long-Term Care Insurance
Jesse Slome
818-597-3205
Contact via Email
http://www.aaltci.org

Read the full story here: http://www.pr.com/press-release/509590

Press Release Distributed by PR.com

Sebelius: Medicaid expansion no ‘bait and switch’

Aug 12, 2013, 2:13pm EDT Updated: Aug 12, 2013, 3:27pm EDT

Bloomberg

Source Link: http://www.bizjournals.com/atlanta/news/2013/08/12/sibelius-medicaid-expansion-no-bait.html?s=print

Dave Williams

Staff Writer- Atlanta Business Chronicle

States shouldn’t let politics get in the way of a Medicaid expansion that’s a “pretty good” economic deal, U.S. Health and Human Services Secretary Kathleen Sebelius said in Atlanta Monday.

Georgia and 20 other mostly Republican states are taking advantage of a portion of last year’s U.S. Supreme Court decision on the federal health-care law that allows states to opt out of expanding Medicaid eligibility.

Under “Obamacare,” the federal government ­­­– which currently covers about two-thirds of the state-federal health insurance program for the poor and disabled ­– would pick up 100 percent of the costs of the additional Medicaid enrollees for three years.

After that, the feds’ share would decline but still would be at 90 percent after 10 years.

“No one’s health care should be determined by their zip code,” Sebelius told an audience of state lawmakers from around the country gathered in downtown Atlanta for the National Conference of State Legislatures’ annual convention.

“There is an offer on the table.”

Sebelius said the Patient Protection and Affordable Care Act, which President Barack Obama pushed through a then-Democratic Congress in 2010, has yielded many positive results, including covering 3 million young Americans under age 26, providing free preventive care to nearly 71 million adults and saving about 3.5 million seniors an average of $700 last year on prescription drugs.

Sebelius said the last piece of the law, due to take effect Jan. 1, will help provide health insurance to the 15 percent of Americans who don’t have coverage now or buy it on the individual market.

She predicted most individuals and small business owners will save money on insurance because of the subsidies the new law provides.

She said health-care providers in states that do decide to expand Medicaid will see lower costs for uncompensated care, while governors and lawmakers in those states will be able to free tax dollars they now spend on caring for the uninsured for other priorities.

Following last year’s Supreme Court ruling, Gov. Nathan Deal cited cost considerations in deciding not to expand Medicaid eligibility in Georgia. He said enrolling individuals with incomes up to 138 percent of the federal poverty level in Medicaid would cost the state an estimated $4.5 billion during the next decade.

Deal and others also expressed concern over whether the federal government would live up to its pledge to cover all of the costs of the expansion.

But on Monday, Sebelius said some states taking part in the expansion have addressed the “bait-and-switch” issue by reserving the right to drop out of the program if the feds renege.

“There is no timeline for accepting this … or for leaving,” she told the legislators. “If you want a healthier population, looking at Medicaid expansion has got to be a piece of the puzzle.”

TN, KY are miles apart on Medicaid

By: Tom Wilemon, The Tennessean

Source Link:  http://www.wbir.com/news/article/281301/2/TN-KY-are-miles-apart-on-Medicaid

Deanna Piotrowski wound up on the wrong side of the Kentucky-Tennessee border.

She suffers from chronic conditions, cannot afford her medicine and is without health insurance. If she had settled 10 miles up the road, she would be getting Medicaid coverage.

“That’s ridiculous,” Piotrowski said. “That’s really a shame.”

Portland, Tenn., where Piotrowski lives, is not that different from Franklin, Ky., the next town up along a two-lane highway that runs past cornfields and modest homes.

Kassandra Clark says she’s lucky to live in the Kentucky town. Uncertain of prospects for health coverage at her new job, she’s grateful politicians in her state have given her a backup option.

“It shows that they care about their people, that they are there for them,” Clark said.

Kentucky has accepted federal funding from the Affordable Care Act to expand the government insurance program for the poor. Tennessee, where political opposition to “Obamacare” runs strong, has not. Kentucky is an anomaly in the South. Most Southern states have taken actionsto either block or hinder the implementation of the federal health law. Supporters of the law say it is foolhardy of politicians to refuse generous federal funding for ideological reasons, but the law’s critics say the money comes with a hefty financial hitch.

The federal government will pick up 100 percent of the costs of insuring new people brought onto state Medicaid rolls through 2016. It then phases down to a permanent 90 percent matching rate in 2020.

Joseph Smith, executive director of the Kentucky Primary Care Association, said politicians there made a pragmatic decision.

“It’s a silly decision based on ideology to refuse health care coverage to the citizens of any state,” Smith said.

Kentucky will expand coverage to an estimated 308,000 state residents with its decision.

‘We don’t have that kind of money’

But a decision about whether to expand Medicaid in Tennessee is a bit more complicated after the numbers are crunched, the state’s TennCare experience is considered and the political reality confronted. Tennessee expanded Medicaid in the 1990s, then learned it couldn’t handle the cost and had to scale back, forcing people off the program. It is a state with a larger population, which means about 100,000 more new enrollees would be eligible for its Medicaid program. And, unlike in Kentucky, Republicans are firmly in control of state government.

Fiscal responsibility matters to Republicans, said Rep. Glen Casada, who argues that Tennessee can’t afford the 10 percent match the state would have to provide beginning in 2020.

He said estimates run between $198 million and $250 million, which he believes is the closer mark. Democrats in the legislature, however, say Medicaid expansion would ultimately save the state money by lowering its cost for uncompensated care by as much as $1.6 billion.

“We’re talking probably $250 million in year four,” Casada said. “That’s a lot of money. We don’t have that kind of money just sitting around. So the question is: Do we raise taxes or what do we cut?”

And he doubts the federal government will stand by the 90 percent commitment.

“The federal government is fast approaching insolvency,” Casada said. “They cannot continue to spend money like they are spending because either the country will collapse or they will have to start cutting. The first place they are going to start cutting is the sweet deal of a 90-10 match to the states on Medicaid.”

John Graves, a Vanderbilt University professor who formerly worked for the Obama administration on health care reform, said Tennessee could protect itself from any possible future decline in matching money.

“Some other states have considered a ‘circuit breaker’ option that limits their downside risk,” Graves said. “That is, these states say they will expand for now, but if the federal government suddenly reduces its share in the future, that would immediately discontinue the expansion.”

Haslam’s plan

Gov. Bill Haslam has been trying to find a way for Tennessee to use the federal money for a state-tailored plan that would prevent a repeat of the prior TennCare expansion, when thousands of people were added to the rolls and quickly racked up medical bills. Haslam favors a plan similar to a private insurance model, in which shared costs curb the overuse of benefits. Instead of expanding TennCare rolls, the money would be used to help poor people buy private insurance, with some co-payments on medical visits and procedures. Adults on TennCare currently have co-pays only for prescriptions.

Haslam’s path is a difficult one. He has to get his plan past the Obama administration and then before the Republican-controlled state legislature.

Arkansas Gov. Mike Beebe, a Democrat, got the Republican legislature in his state to pass an expansion plan that has some similarities to what Haslam has proposed. Federal officials are working toward approving it as a demonstration project. Under the plan, the state would use federal money as “premium assistance” to buy private coverage for people eligible for Medicaid.

Kentucky Gov. Steve Beshear, also a Democrat, envisions Medicaid expansion in his state as a job creator, not a financial drain. He projects expansion will have a $15.6 billion economic impact and create nearly 17,000 jobs between 2014 and 2021.

Hospitals will take hit

The problem with boiling down the Affordable Care Act to any kernel of fiscal certainty is that the recipes differ, according to whoever is mixing the numbers.

However, one certainty is that hospitals in Tennessee will lose money without some form of Medicaid expansion. The federal law reduces special payments to hospitals that treat a disproportionate share of the poor and uninsured. Those patients were supposed to gain coverage in every state through Medicaid expansion. The law had language that would have effectively forced states to expand coverage by cutting off Medicaid funding to those that refused. But the U.S. Supreme Court struck down that portion of the law.

Vanderbilt University Medical Center, which provides more care to the uninsured than any other hospital in the region, announced last week that it is cutting expenses and eliminating jobs. The Tennessee Hospital Association has warned that small rural hospitals might be forced to close without some type of Medicaid expansion.

Renard Murray, the regional administrator for the Centers for Medicare and Medicaid Services (CMS), said there is no deadline for Tennessee to make a decision.

“That option is always on the table for a state,” Murray said, noting that when Medicaid was first created in the 1960s, some states delayed offering the optional program.

“But after several years, several decades have passed, every state now has a Medicaid program,” Murray said. “Medicaid expansion is no different.”

Kentucky is the only one of the eight states in CMS region 4that has agreed to expand its Medicaid program. Alabama, Florida, Georgia, Mississippi, North Carolina, South Carolina and Tennessee have not.

2 women, 2 scenarios

Piotrowski, who moved to Portland, Tenn., from Michigan this summer, knows little about Tennessee politics. She does know she can’t afford her medicine. A doctor in Michigan who had treated her family for generations charged her only $30 a visit and gave her drug samples for hypertension, diabetes and depression.

She left that medical arrangement and came to Tennessee so her children would have better job opportunities and live in a place with less crime. She applied for TennCare coverage and got denied.

She is trying to connect with community health centers and faith-based clinics in the area that treat people regardless of their ability to pay.

“Everything else in Tennessee I love,” Piotrowski said. “I really was disillusioned. I know there’s a lot of people that are worse off than me, but my health issues could be serious.”

Up the road in Franklin, Ky., Ashley Austin, a part-time job juggler without health insurance, smiled as she helped children with the Boys and Girls Club sell vegetables they had raised at the farmers’ market.

“I also work at Hobby Lobby,” she said. “If we are a part-time employee, our hours got cut because they do not want to provide insurance for us.”

Austin had been on her mother’s plan until she lost her job. But come Jan. 1, she’ll have health insurance because she lives in Kentucky.

Contact Tom Wilemon at 615-726-5961 or twilemon@tennessean.com.

 

Source Link:  http://www.wbir.com/news/article/281301/2/TN-KY-are-miles-apart-on-Medicaid

Health Insurance Changes Coming Your Way Under the Affordable Care Act

The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act

2014 is coming–are you ready for Obamacare? Join the YouToons as they walk through the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, when major parts of the Affordable Care Act, also known as “Obamacare,” go into effect.

This cartoon was written and produced by the Kaiser Family Foundation. Charlie Gibson, former anchor of ABC’s World News with Charlie Gibson and a member of the Foundation’s Board of Trustees, narrated the video. Creative production and animation was provided by Free Range Studios.

http://youtu.be/JZkk6ueZt-U | #HCR #affordablecareact #uninsured #medicaid #exchange #ACA #healthcarereform

What Makes U.S. Health Insurance Exchanges So Complicated

By UWE E. REINHARDT

 

Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.

There is much coverage and commentary on news Web sites about whether the health insurance exchanges called for in the Affordable Care Act will be ready by Oct. 1 for enrollment by individuals seeking health insurance in the nongroup market. Insurance bought there takes effect on Jan. 1. I sense that many of those commenting would like the exchanges to fail.

Why is setting up these exchanges so difficult? After all, they are not a novel invention. The eHealthInsurance.com Web site, for example, has since 1997 functioned as an electronic exchange for private health insurance products sold in the nongroup United States market.

That exchange and similar existing private exchanges, however, are not suitable models for the exchanges envisaged in the Affordable Care Act. They function merely as passive brokers for whatever policies private insurers under contract with them choose to list. It is up to consumers to pore over the fine print of any particular insurance contract listed on an exchange for a detailed description of coverage benefits, limitations and exclusions.

There have been many reports on how coverage gaps in the fine print of such policies can leave people who believe they have health insurance in serious financial distress once they fall ill. See, for example, an analysis by Consumer Reports.

More relevant as a model in this context might be the health insurance exchanges in several European countries that operate social health insurance systems with multiple competing private insurers — Germany, the Netherlands and Switzerland prominent among them.

Let us therefore pretend that we are residents of Switzerland and rummage around in a Swiss health insurance exchange.

All Swiss residents are required by federal statute to purchase insurance coverage for a common, comprehensive benefit package prescribed in the statute. Individuals buy that coverage on health insurance exchanges whose architecture is broken down by canton and that facilitate easy comparisons of the community-rated premiums charged by the competing private insurance carriers active in the individual’s canton.

Individuals can purchase supplemental benefits — e.g., coverage for private rooms in hospitals or alternative medicine — from the same companies on the same exchanges. The premiums for these benefits, however, are medically underwritten, which means that they depend in part on the applicant’s health status.

Private insurers in Switzerland are not allowed to earn profits on the common, comprehensive, social-insurance benefit package they cover, but they can earn profits on the supplemental benefits.

The Swiss company Comparis, a general insurance broker, among other exchanges operates one for health insurance, and it is available in English.

To receive premium quotes from competing insurers, one enters the postal code of one’s residence (e.g., 3010 for a part of the city of Bern). One is also asked to identify one’s current insurance carrier in a pop-up list of carriers serving the canton. As if I were a Swiss resident, I randomly clicked on “Publisana” from that list. (A new resident would click on “Relocating to Switzerland.”)

Because basic benefits are standard across Switzerland, the only consumer choice with regard to the benefit package is the deductible, which can range from 300 to 2,500 Swiss francs. (At current exchange rates, a Swiss franc is about $1.06.)

At the bottom, one can choose comparisons among standard coverage, a gatekeeper model (with a general practitioner), health maintenance organizations and telemedicine (shown as Telmed). I recommend “standard,” offering free choice of provider.

Click on “Continue,” and up comes the comparison of premiums for one’s chosen deductible for policies sold in one’s canton. Monthly and annual premiums of the various insurers are shown, along with the savings one could achieve by switching insurers.

A click on “request quote” leads to a page offering supplementary insurance for various items. A click on the “i” in green provides information on each supplementary benefit. Note that generous maternity benefits are included in the basic coverage and one can opt for additional services. (European men do not seem to view being forced to pay for maternity care an affront. At least one critic of the Affordable Care Act in the United States, on the other hand, has denounced inclusion of maternity benefits among the basic benefits as “Obamacare’s War on Men.”)

Swiss insurance exchanges seem quite simple and user friendly. Presumably, no one needs the assist of an insurance navigator to work through this Web site.

So why can’t the insurance exchanges under the Affordable Care Act be as simple as those in Switzerland? Why would it take almost three years to set up the American exchanges? And why will American buyers of health insurance need specially trained navigators to help them navigate these exchanges?

There are several reasons.

For one, the exchanges are but one small component of America’s highly complex health insurance system and must be stitched smoothly onto its many facets — a challenge that would be just as demanding for anyone proposing to move toward universal health insurance coverage through private insurers, even in the absence of deliberate attempts to sabotage the effort.

Swiss exchanges do not determine the public subsidies to which lower-income Swiss residents are entitled. These subsidies are handled by a different, cantonal authority. Therefore the Swiss exchanges do not have to determine eligibility for insurance. By contrast, in the United States, state-based exchanges must coordinate with the Internal Revenue Service to determine eligibility for subsidies and their magnitude.

The American exchanges must also work with the state-administered Medicaid programs, to determine whether an applicant on the exchanges should be referred to Medicaid, and with small employers.

Furthermore, some American exchanges will be “active” — they will actually negotiate premiums with insurers.

Finally, the Swiss exchanges need to feature premiums only for exactly the same health benefits. Individuals have a choice only over the deductible in the policy. The Affordable Care Act does specify the basic benefits that must be covered, which each state can translate into its own basic benchmark package. There will be four levels of covered benefits (bronze, silver, gold and platinum) that are likely to differ mainly by the degree of cost-sharing (deductibles, co-payments and co-insurance). But some variation of covered services around the state benchmark package nevertheless will be possible within the same actuarial value of a policy, adding some complexity.

Benefit packages on the American exchanges will also vary by the degree of choice among providers that different policies permit. Presumably, the exchanges will have to ascertain the adequacy of the networks of providers attached to particular policies.

In short, comparing the various offerings on the American exchanges will not be nearly as simple as it is on the Swiss exchanges; hence the need for the specially trained navigators.

Americans insist on choice and pluralism among insurance products, enabling them to find coverage they believe will fit their personal needs. That choice, desirable though it may be, comes at a stiff price, with two dimensions.

First, it adds considerably to monetary outlays on administrative functions, which in the United States run about twice per capita what they are in other countries. And to make careful and responsible choices takes a great deal of a person’s time.

Article Link: http://economix.blogs.nytimes.com/2013/07/19/what-makes-u-s-health-insurance-exchanges-so-complicated/