Category Archive - Individual

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Virginia Dems Turn Against Health Insurance Mandate

Tuesday, February 2nd, 2010

For the past year, the Obama administration and Democrats on Capitol Hill have been looking to pass a comprehensive healthcare reform bill. After the government-run public option favored by liberals was eliminated from contention, the prevailing options have involved increased regulation of the health insurance industry combined with a health insurance mandate. Officials in many states’ governments have promised to sue the federal government if the bill passes, claiming that the mandate provision is unconstitutional because the federal government doesn’t have the authority to force purchases from private health insurance companies. The majority of legal scholars believe that the mandate is constitutional, and the fact that most of the attorney generals threatening lawsuits are Republicans has led many to believe they were thinking more of political concerns than constitutional ones.

However, Democrats in the Virginia state legislature are now going against their own party. The state Senate passed a bill that would make such mandates illegal. The mandate, which is similar to the system active in Massachusetts and would require all people to buy individual health insurance (albeit with federal subsidies for lower- and middle-income Americans), is obviously unpopular with Republicans. Even though the Democratic party controls the state Senate, five members of its caucus broke ranks in order of voting for the measure banning mandates. For President Obama and supporters of healthcare reform, the situation is not looking good–in 2008, Virginia went for Obama. Admittedly, the Democrats who crossed over hail from conservative districts; but if members of his own party are beginning to lose their resolve in the face of mid-term elections, what’s next?

By the way, Republican Governor Bob McDonnell is likely to sign the bill, although some state senators say that the bill will be pre-empted by federal law and is legally worthless.

(Image: Mr. T in D.C. under CC 2.0)

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Mental Health Mood Boost: More Coverage From Health Plans Coming Soon

Monday, February 1st, 2010

For decades the National Mental Health Association has been fighting a perception battle amongst the general public; or at least those who are not affected by mental health disorders. So afflicted by its own persona, the association itself recently changed its own name.

Mental Health America! (as it’s now known) has amassed some 300 affiliate organizations across the country who lobby on behalf of their individual members for, among other things, mental health coverage in group health insurance plans. This week, their collective voices were heard and shared by Kathleen Sebelius, the U.S. Secretary of Health and Human Services.

Under a new law affecting all health insurance plans on July 1, 2010, employers and their group health plans cannot limit coverage for mental health treatment for less than the treatment of physical conditions like cancer and heart disease. That means insurers cannot set higher co-payments, deductibles or limits on inpatient or outpatient visits to psychiatrists or psychotherapists. It’s an insurance disparity that’s commonplace with health insurance plans, but one that doctors say have made it extremely difficult for people to obtain treatment for disorders like bipolar disease, drug and alcohol abuse and autism.

According to statistics from Mental Health America!, only about 18 percent of all adults in the United States ever seeks treatment for mental health disorders. The most likely limitation to seeking treatment, say doctors, is medical insurance restrictions on care that is not related to a physical ailment. For years, most traditional group health insurance plans have issued separate deductibles for mental health care and physical health care. The new rules will put an end to this practice, essentially combining these deductibles so those with a need for ongoing mental health conditions can afford to get treatment.

“Patients with mental illness often have general medical conditions like diabetes or high blood pressure that require treatment at the same time,” said Irvin Muszynski, an attorney with the American Psychiatric Association. “So a combined deductible makes sense.”

The change is two years in the making, as a 2008 law was adopted with bi-partisan support that significantly expanded the rights of people with mental health conditions.

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Efficient or Effective? – Hospitals Embrace Pay For Performance

Monday, February 1st, 2010

Life after Scott Brown has yet to be determined.

But one thing is for sure: no one in the Republican or Democratic parties would publicly deny after record deficits is that efficient health care comes down to a simple equation; doing more with less is a sure fire way to cut costs. Whether or not Obama gets his spending freeze next year, health insurance companies and medical practitioners will be looking for ways to infuse their efficiencies. Electronic medical records and patient management systems are quickly becoming the new-now-next frontier in the quest for industry reform. Chances are, it won’t take a federal mandate to make the flow of medical records abandon the paper highway and take an electronic route. Health care companies had been looking at the issue five years before health care reform became a top priority in Congress.

Consider the findings of The Commonwealth Foundation, an independent research think tank in New York who conducted a thorough survey of attitudes amongst medical care providers about how to make health care “click” in an era of reform. The survey of 1,256 “opinion leaders” in health policy and “innovators in the health care industry,” developed by Harris Interactive revealed that a majority of respondents (57 percent) believe that pay-for-performance is the only business model out there that makes sense. They also indicate that patients with chronic illnesses who require ongoing disease management (those with heart disease, diabetes, etc.) require the most intensive overhaul for health care delivery. Evidence based medicine (EBM), another buzz phrase in medical care today, is the second-most accepted approach for reigning in costs.

With doctors now forced to manage their time against an insurance company clock — where patient counts are the benchmark for payments by health insurance plans — EBM should emerge as a less attractive option since the practice involves much more one-on-one time with individual patients to determine the most appropriate course of treatment. Moving toward an EBM-based practice would likely slow down movement in the waiting room and thus, less billable visits. But more and more of our most respected health care institutions are proving that doctors and hospitals can have their EBM cake and eat it too. Insurance companies, who have been notoriously gun shy about the proof that EBM leads to better care, are starting to come around now that some of the nation’s most respected pioneers in the EBM movement have proven that using it more in everyday practice will save insurance plans in the long-run.

“The irony is that while it comes up all the time among providers, no one talks specifically about what evidence-based medicine is,” says Paul Keckley, executive director of the Vanderbilt Center for Evidence-Based Medicine, Nashville, Tenn. “Many people believe that somehow it is a new idea or that it’s a tradition-based practice. There’s a direct correlation between evidence-based medicine and the need to take out unnecessary costs and there’s now considerable avoidable cost in the health care system, such as the inappropriate use or overuse of antibiotics, lab tests and imaging, which are done more often out of [physician] preference than based on the evidence.”

Sound familiar? If not, it will very soon as the battle over affordable health insurance and health care reform transforms into health insurance reform on Capitol Hill.

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Health Insurance in Obama’s Own Words

Thursday, January 28th, 2010

It took nearly 30 minutes into an hour-plus long speech for President Obama to mention healthcare reform. Some would accuse him of burying the issue to avoid further criticism, while others were heartened by his renewed focus on other issues. Here are Obama’s own words from last night’s state of the union address:

  • Why he decided to tackle healthcare reform: “By now it should be fairly obvious that I didn’t take on health care because it was good politics. I took on health care because of the stories I’ve heard from Americans with pre-existing conditions whose lives depend on getting coverage, patients who’ve been denied coverage, families — even those with insurance — who are just one illness away from financial ruin.

  • Why he thinks the public is skeptical about his proposals: “This is a complex issue, and the longer it was debated, the more skeptical people became. I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, the process left most Americans wondering, “What’s in it for me?”"
  • What’s in it for the average American (most of whom already have health insurance)? “The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. It would require every insurance plan to cover preventive care….Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses.”
  • How will it affect the national deficit? “Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office — the independent organization that both parties have cited as the official scorekeeper for Congress — our approach would bring down the deficit by as much as $1 trillion over the next two decades.”
  • Why he thinks health insurance plan reform can’t wait: “After nearly a century of trying — Democratic administrations, Republican administrations — we are closer than ever to bringing more security to the lives of so many Americans. [...] I also know this problem is not going away. By the time I’m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans and neither should the people in this chamber.”
  • His challenge to Republicans: “if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors and stop insurance company abuses, let me know. Let me know. Let me know. I’m eager to see it.”
  • Next steps: “As temperatures cool, I want everyone to take another look at the plan we’ve proposed. There’s a reason why many doctors, nurses and health care experts who know our system best consider this approach a vast improvement over the status quo. Here’s what I ask Congress, though: Don’t walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. Let’s get it done. Let’s get it done”

(Image: transplanted mountaineer under CC 2.0)

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State of the Healthcare Reform Union

Wednesday, January 27th, 2010

President Barack Obama is giving his first State of the Union address tonight, airing on all major networks. Will he talk about healthcare reform?

It seems unlikely. His administration has been dropping hints that the speech will focus more directly on the economy, specifically job creation. Expanding individual health insurance coverage has been a slog, as well as a drain on his popularity ratings. While Obama recently said that he would rather be a great one-term President as opposed to a mediocre two-term one, he is nevertheless refocusing on issues that the middle-class believes is more important.

Most Americans receive affordable health insurance through their employers. 10% of Americans are unemployed. What happens to this slice of the population? COBRA health insurance is helpful, but most people without jobs don’t have the money to pay for the entire health insurance premium without an employer covering some of the cost. Obama has not managed to collect the dots in the minds of the public.

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Fewer Americans Receiving Needed Care

Wednesday, January 27th, 2010

With all the talk about healthcare reform, many people on all sides of the issue can forget about who it is intended to help. There is healthy disagreement on the best method of solving the predicament of the uninsured. Some people want a public option, while others desire more regulation of health insurance companies. Still others believe that chucking existing regulations and letting the market do its work unfettered is ideal.

The recession has resulted in many people losing their jobs, along with their health insurance. The National Center for Health Statistics has found that about 15% of the United States population lacks medical insurance. Even after excluding undocumented immigrants (who wouldn’t be covered by healthcare reform anyway), there are still millions of Americans left uninsured.

In 2009, a rapidly increasing number of respondents claimed that cost prevented them from seeking needed health care. Those without health insurance are often also without a regular health care provider. Access to a primary care physician is a key indicator of good health.

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If Democrats Dump Reform, Will GOP Back Off?

Tuesday, January 26th, 2010

Democratic political adviser David Plouffe is encouraging his party to move ahead on healthcare reform. Right now, doing so seems like the last thing any political strategist would recommend. Why would a man largely responsible for getting President Barack Obama elected suggest doing so, especially after the bruising loss in staunchly blue Massachusetts?

According to Plouffe, recent polls show that the majority of Americans still agree with the overall objective of the Obama administration: to expand medical insurance coverage while simultaneously lowering costs. While the public is very skeptical of the Democrats’ specific proposals, scaling back or abandoning the legislation may not help that. After all, the party and its members are already associated with the issue. Even Congressional Democrats turn against it, Plouffe believes that Republicans will continue to attack them for having the audacity to put forth such comprehensive reforms in the first place. If the legislation is actually passed, he thinks that the public will have the opportunity to eventually measure its positive aspects; whereas failure would not stop the attacks.

Do you believe that the heat would come off of Democrats if they let their comprehensive health insurance bill die, or would it just humiliate them further?

(Image: David Ortez under CC 2.0)

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Obama Compares Healthcare Reform to Buzz Saw, Races Into Blade

Monday, January 25th, 2010

When a tree trunk faces a buzz saw, the result is usually negative for the tree. The only way for the tree to avoid being cut in half is to stop the conveyor belt drawing it closer. Right now, Democrats are like that tree. President Obama recently admitted as much during a recent town hall meeting.

Obama said that healthcare reform had reached “a bit of a buzz saw” with the Democratic loss of a filibuster-proof majority in the Senate. He is encouraging Democrats to press on with regulating the health insurance industry regardless. This is in contrast to senators such as Chris Dodd, who suggest that they press the pause button on the issue before their heads are cut off. Unlike the President, most members of Congress are up for re-election this year.

Contrary to his previous statements about scaling back, Obama is now calling for the revival of attempts to pass comprehensive healthcare reform. Many are advising him to turn his focus towards the economy, but Obama attempted to connect the dots: his belief is that the soaring cost of individual health insurance has the potential to bankrupt many Americans.

(Image: Let Ideas Compete under CC 2.0)

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How Pharmacists Can Lead To Affordable Health Insurance

Monday, January 25th, 2010

One of the best ways to remain in good health is to have a closer relationship with your health care provider. He or she can help you get past medical misunderstandings, which could have a negative impact on your health if not corrected. Obviously, health insurance is less expensive when you are healthy.

Unfortunately, that kind of personalized attention has become less common. Co-payments and co-insurance percentages may mean that you don’t see your primary care physician as often as you should. Your local pharmacist can help fill in the gap. For the price of your prescription, you can speak with him or her about it. Ask any questions you have about your medication! Although pharmacists aren’t medical doctors, they nevertheless have education and a body of knowledge about the topic.

Studies have shown that one of the causes of wasted healthcare expenses is the accidental misuse of medication. If you have a chronic condition that must be managed with prescriptions, a lack of clarity regarding the instructions could land you in the hospital. Patients with athsma, high blood pressure, and Type-2 diabetes are among those who could benefit. Walgreens is launching a program of “medication coaches” with the latter. The program could make a dent in the $290 billion medical insurance companies and patients spend each year on illnesses that are preventable with proper medication management.

(Image: quinn.anya under CC 2.0)

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Virtual Fitness: Employers Creating Online Workout ‘Buddy’ Networks

Sunday, January 24th, 2010

Health insurance providers are offering their own versions of a virtual fitness system for the Web junkie set. Following a successful internal beta test with its own employees, “Aetna Health Connections Get Active!” is a group / team oriented fitness and nutrition program tailored to Aetna’s commercial employer health plan customers.

The company reports that more than 57 percent of its 35,000 employees in the United States participated in the “Get Active Aetna” program. One Aetna official from Arlington, TX reports the program helped him to lose 120 pounds. Other employees say the social networking component of the program has helped them connect with others who they otherwise wouldn’t have considered shaping up with. The program is a private-label product of Providence, RI-based Shape Up The Nation.

Even before the current Twitter and Facebook fanatics flocked to the Internet, Med School buddies Brad Weinberg and Rajiv Kumar learned from their early clinical days that patients who were the most successful at losing weight, increasing their exercise, quitting smoking and sticking to their goals all had one thing in common: they had social networking profiles and used their online friends to push them forward.

Aetna isn’t the only group health plan provider to put exercise in the cloud. Cigna, UnitedHealth and other major insurance companies offering their own brands of virtual fitness tracking and exercise regimes, to their own employees and to their plan subscribers. These companies and other FORTUNE 500s regularly report substantial cuts in healthcare costs, employee morale and retention by offering wellness programs that are fully integrated into social networking sites.

Some online fitness program providers work with companies to generate customized reports that tell CEOs which employees are using the program and how often. Other companies fully-integrate the data into Human Resources systems to cross-reference it with group health insurance claim information. While privacy advocates have concerns about the usage of such data to discriminate against employees in some way, national statistics tend to favor the employer:

  • The Kaiser Family Foundation reports: Nationwide, employer-sponsored health coverage premiums for family coverage have increased by 97% since 2000, from $6,438 to $12,680 in 2008.
  • Many have experienced 16% increases during the last 3 years much due to the rising epidemic of obesity and overweight adults.
  • A study in the Journal of Health Affairs noted that per person health care spending for obese adults is 56 percent higher than for normal-weight adults. Over 15 years, the additional costs incurred by obese adults with private health insurance versus normal-weight adults increased from $272 to $1,244 per person per year. The International Journal of Obesity reports, weight gains of 20 pounds are associated with medical care cost increases of >$500 over the last three years.
  • Obese workers lose about 13 times more days per year of work from injury or illness. (In an organization of 10,000 employees, with 32% obesity, that equates to 334,880 hours or an estimated 161 full time employees. With an average national salary of $38,500, the total cost of lost days can be as much as: $6,198,500 per year.)

Online nutritionists, exercise coaches and member message boards are also growing in popularity outside the workplace since real-live trainers are finding work in other industries and more exercise enthusiasts are cutting their gym memberships to save money.

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