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Health Care Reform – Panel Discussion at U of R – Part I

Posted on 08 September 2010 by admin


Sponsored by R World R Vote, Sept. 24, 2009

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Health Care Reform Brings Insurance To Early Retirees Not Eligible For Medicare

Posted on 05 September 2010 by admin

Health Care Reform Brings Insurance To Early Retirees Not Eligible For Medicare
A provision in this year’s healthcare reform legislation will provide federal subsidies to 48 employers and unions in Connecticut to help pay for medical insurance for early retirees who are not yet eligible for Medicare.

Read more on Hartford Courant

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Passing health reform could be a nightmare for Obama

Posted on 30 August 2010 by admin

Barack Obama’s quest for historic health-care legislation has turned into a parody of leadership. We usually associate presidential leadership with the pursuit of goals that, though initially unpopular, serve America’s long-term interests. Obama has reversed this. He’s championing increasingly unpopular legislation that threatens the country’s long-term interests. “This isn’t about me,” he likes to say, “I have great health insurance.” But of course, it is about him: about the legacy he covets as the president who achieved “universal” health insurance. He’ll be disappointed. Even if Congress passes legislation — a good bet — the finished product will fall far short of Obama’s extravagant promises. It will not cover everyone. It will not control costs. It will worsen the budget outlook. It will lead to higher taxes. It will disrupt how, or whether, companies provide insurance for their workers. As the real-life (as opposed to rhetorical) consequences unfold, they will rebut Obama’s claim that he has “solved” the health-care problem. His reputation will suffer.

It already has. Despite Obama’s eloquence and command of the airwaves, public suspicions are rising. In April, 57 percent of Americans approved of his “handling of health care” and 29 percent disapproved, reports the Post-ABC News poll; in the latest survey, 44 percent approved and 53 percent disapproved. About half worried that their care would deteriorate and that health costs would rise.

These fears are well-grounded. The various health-care proposals represent atrocious legislation. To be sure, they would provide insurance to 30 million or more Americans by 2019. People would enjoy more security. But even these gains must be qualified. Some of the newly insured will get healthier, but how many and by how much is unclear. The uninsured now receive 50 to 70 percent as much care as the insured. The administration argues that today’s system has massive waste. If so, greater participation in the waste by the newly insured may not make them much better off.

The remaining uninsured may also exceed estimates. Under the Senate bill, they would total 24 million in 2019, reckons Richard Foster, chief actuary of the Centers for Medicare & Medicaid Services. But a wild card is immigration. From 1999 to 2008, about 60 percent of the increase in the uninsured occurred among Hispanics. That was related to immigrants and their children (many American-born). Most illegal immigrants aren’t covered by Obama’s proposal. If we don’t curb immigration of the poor and unskilled — people who can’t afford insurance — Obama’s program will be less effective and more expensive than estimated. Hardly anyone mentions immigrants’ impact, because it seems insensitive.

Meanwhile, the health-care proposals would impose substantial costs. Remember: The country already faces huge increases in federal spending and taxes or deficits because an aging population will receive more Social Security and Medicare. Projections the Congressional Budget Office made in 2007 suggested that federal spending might rise almost 50 percent by 2030 as a share of the economy (gross domestic product). Since that estimate, the recession and massive deficits have further bloated the national debt.

Obama’s plan might add almost an additional $1 trillion in spending over a decade — and more later. Even if this is fully covered, as Obama contends, by higher taxes and cuts in Medicare reimbursements, this revenue could have been used to cut the existing deficits. But the odds are that the new spending isn’t fully covered, because Congress might reverse some Medicare reductions before they take effect. Projected savings seem “unrealistic,” says Foster. Similarly, the legislation creates a voluntary long-term care insurance program that’s supposedly paid by private premiums. Foster suspects it’s “unsustainable,” suggesting a need for big federal subsidies.

Obama’s overhaul would also change how private firms insure workers. Perhaps 18 million workers could lose coverage and 16 million gain it, as companies adapt to new regulations and subsidies, estimates the Lewin Group, a consulting firm. Private insurers argue that premiums in the individual and small-group markets, where many workers would end up, might rise an extra 25 to 50 percent over a decade. The administration and the CBO disagree. The dispute underlines the bills’ immense uncertainties. As for cost control, even generous estimates have health spending growing faster than the economy. Changing that is the first imperative of sensible policy.

So Obama’s plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation’s passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.

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Healthcare Reform With Pre-Existing Conditions: Wait 6 Months For Insurance?

Posted on 18 August 2010 by admin

The Democrats’ healthcare reform bill has been touted as the solution for Americans with pre-existing conditions that make them “uninsurable” in the eyes of private health insurance companies. Normally, underwriters for health insurance plans consider consumers with serious health problems as too high a risk to take on; they profit by collecting premiums while paying as few claims as possible. This has put much of our population in a quandary and helped fuel our current health care crisis. Indeed, it does include a ban on insurers denying coverage based on health status. In addition, it will provide subsidies for those who have been turned down when applying for insurance. Unfortunately, the proposals aren’t exactly the panacea promised by the Obama administration and Democratic congresspersons.

It’s bad enough that the full healthcare bill, including the requirement to provide people with pre-existing conditions access to health insurance, won’t take effect until 2013. From a political standpoint, either its success can’t be used to boost President Obama’s re-election campaign, or its failure will be the responsibility of someone else if Obama is out of office. Recognizing the need for some immediate help, Congress provided for a high-risk insurance pool–similar to those proposed by Republican John McCain during the 2008 presidential campaign–in the meantime. Over half of the states in America already have high-risk health insurance pools for their residents. It costs them a total of $1 billion to insure about 200,000 patients. Expanding that system on a national level will be difficult.

However important immediate health coverage is, the Senate version has some strings attached. The Senate bill forces patients to wait six months before entering the pool. Medical advocates point out that for many conditions, such as cancer, the afflicted need medical care immediately and can’t spend several months without health insurance while hoping they survive long enough to take advantage of the government’s pool. The House of Representatives is against such a waiting period, but the Senate claims it’s necessary to stop people from dropping their more costly health insurance plans in favor of the government’s. The House understands that the healthcare reform bill, already costing over $1 trillion, needs to conserve cash wherever it can while maintaining quality. Instead of requiring a waiting period to enter the high-risk pool, their bill would penalize insurance companies that dump such patients. The health insurance plans guilty of that practice will then have to pay into the government’s pool.

In order to cover the one million uninsured Americans with pre-existing conditions, the program would need about $7 to $10 billion per year. The biggest problem with the high-risk pools is that Congress has only budgeted $5 billion for each year of the pool, which will be phased out after the rest of the healthcare reform bill (including the public option) takes effect in 2013. The government could make do with that budget if historical trends hold, with only a small percentage of people taking advantage of the government benefits they are entitled to. It appears that operating on such a belief defeats the purpose of the Democratic legislation in the first place. They want to increase access to healthcare, but are working under the assumption that a significant portion of the people who need the federal high-risk health insurance plan won’t sign up? Something doesn’t seem right about that.

(Image: Will Palmer under CC 2.0)

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they don’t have to go without a health insurance plan while waiting for a public option, if it ever gets passed. Yamileth lives in Miami, FL.

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Health Insurance Exchange Reform Weekly EasyToInsureME

Posted on 17 August 2010 by admin

DECEMBER 23, 2009

This Week in Health Reform

Senate Majority Leader Harry Reid (D-NV), may just reach his goal of getting a health care reform package approved by the Senate by Christmas. This past week, Sen. Reid clinched the 60th vote needed to pass the legislation. As of this communication, he has scheduled the final Senate vote for 7 a.m. on Christmas Eve day. In an effort to shore up votes, Sen. Reid and his colleagues struck deals to overcome hot-button issues such as abortion funding.

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Senate Negotiations

Senate Eyes Finish Line: After weeks of rancorous debate and more than 20 straight days and nights spent negotiating on Capitol Hill, Senate lawmakers cleared all three major procedural hurdles prior to a final vote on the legislation.

* The first procedural motion passed on a 60-40 vote early Monday morning , ending debate on Sen. Reid’s proposed amendments, called the “manager’s package,” and cutting off a Republican filibuster. The “manager’s package” represented a series of last-minute deals and compromises to shore up support for the legislation.
* The second procedural motion to approve the “manager’s package” passed 60-39 on Tuesday morning.
* The third motion came Wednesday and ended debate on the final legislation in a 60-39 vote, setting up the reform bill for a final vote just in time for Sen. Reid’s Christmas deadline.

Sen. Reid Carves Out State-Specific Deals to Secure the 60 Votes: On Saturday, Sen. Reid secured the 60 votes needed to pass the historic legislation, winning over Sen. Ben Nelson, (D-NE), with an amendment to prevent federal subsidies from being used for abortions. Under the new abortion provisions, states can opt out of allowing coverage for abortion. If states do offer coverage, enrollees must pay for abortion coverage separately – a compromise that has sparked criticism from both sides of the abortion divide. Sen. Nelson also secured other benefits for the state of Nebraska, including:

* Millions of dollars from the federal government to pay for the proposed cost of the Medicaid expansion in his state; and
* An exemption for Blue Cross Blue Shield of Nebraska from an annual fee on insurers.

Throughout his amendment package, Sen. Reid included several other state-specific deals to secure the 60 votes. Such last-minute deals have been criticized by Republicans, including:

* For Sen. Max Baucus, (D-MT), the package included a provision to help 2,900 residents of Libby, Mont., sign up for Medicare benefits. Many residents have asbestos-related illnesses;
* For Sen. Christopher Dodd, (D-CT), it included a measure to provide $100 million for the construction of a hospital at a public university;
* Sen. Patrick Leahy, (D-VT), negotiated for $600 million in additional Medicaid benefits for his state over 10 years;
* Sen. Bernie Sanders, (I-VT), got a $10 billion increase for community health centers over a number of years;
* Sen. Mary Landrieu, (D-LA), procured at least $100 million in 2011 from the federal government for help with Medicaid; and
* For Sen. Bill Nelson, (D-FL), the package included a measure allowing some 800,000 Florida senior citizens currently enrolled in private Medicare Advantage plans to keep their extra benefits.

Sen. Reid’s negotiations also included:

* The removal of a 5 percent tax on elective cosmetic surgeries, and the inclusion of a 10 percent tax on indoor tanning services;
* 12 years of patent protection for the makers of brand-name biotech drugs;
* An increase in the Medicare payroll tax percent of an additional 0.9 percent of income for those making $200,000 as an individual and $250,000 for couples;
* An exemption from taxes on high-value insurance plans for those with certain professions, such as firefighters, policemen, construction workers, emergency first responders and longshoremen;
* A provision allowing for doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming to get paid more than providers elsewhere; and
* About $1 billion extra in Medicaid payments for visiting nurses and other in-home or community services.

CBO Updates Estimates on Health Care Bill’s Impact: In a letter sent to Sen. Reid, the Congressional Budget Office (CBO) said that it had over-estimated the latest Senate health care bill’s impact on deficit reduction during the second decade of enactment. The original estimate indicated the overhaul would yield deficit reductions by one-half percent of GDP; the revised estimates indicate a reduction of between one-quarter and one-half percent of GDP. The CBO confirmed that its estimate over the first 10 years remains accurate, reducing the deficit by up to $132 billion by 2019.

However, in a Wednesday letter to Sen. Jeffery Sessions, (R-AL), the CBO indicated that the current Senate bill may potentially double count the savings from Medicare as a means to pay for the Senate health care bill. In the letter, CBO Director Doug Elmendorf writes: “The key point is that the savings to the (Hospital Insurance) trust fund under the (Patient Protection and Affordable Care Act) would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs.” Republicans quickly jumped on the letter as proof that the Senate’s bill will not decrease the federal deficit over time, but rather add to it.

Late last week, the CBO estimated that the revised Senate bill will cost $871 billion over the next decade to extend coverage to the uninsured. It would dramatically expand Medicaid and offer federal subsidies to those who lack affordable coverage through employers. The nation will pay for the overhaul with about $400 billion in new taxes and about $500 billion in cuts to programs such as Medicare.

Sen. Snowe Indicates “No” Vote: Despite many weeks of negotiations with Republican Sen. Olympia Snowe of Maine and several one-on-one meetings with President Barack Obama, Sen. Snowe indicated that she will vote against the Senate’s legislation without significant changes. Sen. Snowe has been a pivotal figure in the health care reform debate as the only Republican to have voted for the Senate Finance Committee’s bill, which passed in October. The loss of Sen. Snowe’s support comes as a blow to Democratic leaders who were hoping to achieve some level of bipartisan support.

Other Activities

AMA, AHA, AARP and FAH Show Support; AHIP Opposes: On Monday, both the American Medical Association (AMA) and the American Hospital Association ( AHA) sent letters to Sen. Reid indicating support for the latest version of the Senate health care bill, while highlighting requests for changes. The AMA, for example, hopes to see changes to the independent board that would be created to slow the growth of Medicare costs. Among other adjustments, the AHA requested a change that would lower Medicare payments to hospitals with high readmission rates. Endorsements also came from AARP and from the Federation of American Hospitals (FAH). In contrast, a statement Friday from America’s Health Insurance Plans (AHIP) voiced opposition to the bill, citing cuts to Medicare Advantage programs and caps on insurers’ administrative costs as problematic.

Public Opinion

December Polls Show Americans Disapprove: As a final vote on the Senate’s health care reform package nears, Americans are increasingly wary of its impact. The December Kaiser Health Tracking Poll found that:

* Only 35 percent of Americans said they would personally be better off if health care reform passes – down from 42 percent last month;
* Only forty-five percent of voters said the country would be better off with health reform – down from 54 percent last month.

The latest poll results released Tuesday from Quinnipiac University show that:

* Americans “mostly disapprove” (53 percent to 36 percent) of the Senate’s plan;
* A majority (56 percent to 38 percent) disapprove of President Obama’s handling of health care reform;
* Voters oppose (72 percent to 23 percent) using any public money in the health care overhaul to pay for abortions;
* Americans support (56 percent to 38 percent) giving people the option of coverage by a government health insurance plan; and
* A majority (64 percent to 30 percent) support allowing younger people to buy into Medicare.

As a volatile year in health care reform comes to a close, an average of monthly polls since April shows that 82 percent of Americans say an overhaul of the nation’s health care system is important for recharging the economy. However, in the most recent Robert Wood Johnson Foundation poll taken in November, 60 percent said an overhaul will not affect their personal access to health care or their family finances, and only about 40 percent said a revamping will improve access to care in the nation overall. Further, only about 30 percent believe health care reform will help the county’s financial status.

Looking Ahead

Senate lawmakers are expected to vote on their final health care reform legislation early Thursday morning, setting the stage for reconciliation with the House bill passed in November. When lawmakers return from holiday break in January, the conference committee between the two chambers is expected to begin discussions about merging the two bills. Leaders of the House and Senate had hoped to have a final bill approved by Congress and sent to President Obama before the State of the Union address, scheduled for late January or early February. However, White House officials now indicate that given January’s tight legislative calendar, this timeframe is unlikely.

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Health Insurance Companies To Suffer Without Healthcare Reform?

Posted on 14 August 2010 by admin

With the Republican victory in Massachusetts shifting the balance in the Senate, the possibility of comprehensive healthcare reform passing any time soon appears increasingly remote. The assumption would be that health insurance companies would rejoice at the news of Scott Brown taking Ted Kennedy’s seat, and initial reactions pointed to that being the case. The stocks of for-profit health insurance companies soared upon the news. However, the rumored death of health insurance reform may not be as positive for the industry as it seems at first glance.

Health insurance would see significant changes under healthcare reform. The federal government was planning to enact regulations that would, among other things, put a cap on the health insurance premiums they can charge to people that are older or in poorer health. Reform would also prevent health insurers from denying coverage to people with pre-existing conditions. While most of these changes have the potential to hurt health insurance companies’ profits, major insurers had already made a calculated decision to support aspects of healthcare reform.

Insurers’ willingness to submit to some reform demands was largely based on the establishment of a health insurance mandate. The mandate would require all Americans to buy individual health insurance, or pay a fine. Individuals and families under a certain income level would receive federal subsidies in order to buy a health insurance plan. Health insurance companies are in favor of that portion of the Democratic proposal, because it would bring millions of new consumers to them–many of whom would be younger, healthier individuals and more profitable for insurers. Although some analysts doubt that the subsidies or penalties will be large enough to convince enough consumers to come in and offset the influx of unprofitable patients in poorer health. However, if even a fraction of the 30 million uninsured Americans signed up, health insurance companies may benefit.

In fact, prominent executives from health insurance companies like Aetna have admitted that they must turn to new models of generating revenue, whether or not any form of national healthcare reform passes. The recession has resulted in a slump in sales of group health insurance; businesses are no longer paying for insurance for laid-off employees, and some businesses have dropped their corporate health insurance altogether, due to costs. Many laid-off employees are unable to afford COBRA health insurance, even with temporary subsidies. As a result, there is a growing market for self employed health insurance. Unfortunately, that group is largely crowded out of the individual health insurance market. They may need to work on offering more affordable health insurance options for pure business reasons. While health insurance is generally considered a need, it is less essential when compared to food, water, and shelter in the minds of consumers. If health insurance quotes are too expensive, many consumers will drop them altogether. This does not bode well for the health insurance industry.

Health insurers are also wary of healthcare reform in individual states. If the current bill dies in the Senate and House of Representatives, health insurance companies may be forced to contend with 50 different sets of regulations. Some of those laws may be stricter than others. Industry trade groups, such as America’s Health Insurance Plans, think that the cost of complying with such disparate legislation may end up being even more costly than the limitations imposed by the federal legislation. Doing so will also be more difficult without the added government leverage needed to lower doctor and hospital fees.

Finally, there is a fear that if this legislation fails, it will come back even more unfavorable towards health insurance companies. If the status quo is retained, health insurers may reap more profits in the short term. However, the government may later take even more extreme action if health insurance premiums and costs continue to rise. For example, the idea of a government-run public option could gain more traction than it did this time around.

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they can find quality individual health insurance right now. Yamileth lives in Miami, FL.

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Health Reform Sparks Debate On Future Of Children’s Health Program

Posted on 12 August 2010 by admin

One of the staunchest backers of the Children’s Health Insurance Program, Sen. Jay Rockefeller isn’t ready to see it swallowed up by a new health insurance marketplace designed by Congress.

The West Virginia Democrat is a leading voice in a quietly waged debate over how best to provide health insurance to millions of children in low-income families. Rockefeller persuaded the Senate Finance Committee to maintain the program, known as CHIP, through 2019 as part of health legislation the panel approved last month. That provision was included in the Senate Democrats’ health plan unveiled Wednesday.

Rockefeller opposed earlier language in the Finance bill that would have ended CHIP after Sept. 30, 2013, when its current authorization ends, and moved those children to health insurance “exchanges” where private insurers and possibly a government-run plan would sell policies. The House health overhaul bill raises similar concerns for Rockefeller and some children’s groups. It would phase out the program at the end of 2013, moving some kids into a national exchange and placing others into Medicaid, the state-federal program for the poor.The debate revolves in part around uncertainty over the coverage and costs of insurance that would be available through the exchanges. Some children’s advocates fear that the House health bill might result in less generous coverage than CHIP and require greater out-of-pocket spending by families. “As health reform moves forward, we need to make sure children can keep their CHIP coverage and not be forced into untested private coverage,” Rockefeller said earlier this month.

Jocelyn Guyer, co-executive director at the Center for Children and Families and a senior researcher at the Georgetown University Health Policy Institute, cites worries that the coverage sold in the exchange could be too expensive for some families. “I do think the potential fear that’s out there is that there are some kids with good coverage now who, because they are facing higher premiums and cost sharing, could actually end up uninsured,” she said.

But House Democrats – longtime supporters of CHIP themselves — say the bill includes safeguards concerning benefits and would provide more stable funding for children’s insurance. House Energy and Commerce Committee Chairman Henry Waxman, D-Calif., said while CHIP has been successful, “once health care reform is in place, however, the case for a separate program for children – one that excludes their parents – is less compelling.”

The insurance exchange will provide “solid coverage that is affordable for both low-income children and their parents,” Waxman continued. To minimize disruption, he said the House bill would allow children to remain in CHIP during the first year that the exchange is up and running and any problems are being resolved.

Much depends, analysts say, on how Congress decides to handle critical areas, such as who can qualify for Medicaid, what types of benefits must be covered for children and the level of subsidies given to help families purchase coverage in an exchange.

Lawmakers see the exchange as a specialized market where, initially, small businesses and people who don’t receive employer-provided coverage would choose among standardized benefits packages. More people and businesses could participate over time. Lower-income people would qualify for federal subsidies.

A Growing Program

CHIP covers children whose family incomes are too high to qualify for Medicaid but too low to afford private insurance. Congress extended the program this year. Enrollment is expected to increase from an estimated 7.4 million in 2008 to more than 12 million in 2013, according to the Centers for Medicare and Medicaid Services.

According to preliminary estimates from the Urban Institute, about 60 percent of children in CHIP would, along with their parents, receive coverage in the exchanges. Children in families with incomes up to 150 percent of the federal poverty line – about $33,000 a year for a family of four — would go into an expanded Medicaid program. In addition, the House bill would require states that now cover CHIP children through their state Medicaid programs to continue to do so, regardless of a family’s income.

Proponents defend the House approach on three grounds. Transitioning CHIP kids into an exchange would allow entire families, many for the first time, to receive health coverage. Research has shown, when all members of families have health insurance children are more likely to receive health care services. Moving CHIP kids to the exchanges or to Medicaid also ensures a more stable source of funding than the CHIP program, which Congress would have to continue to reauthorize and fund. Budget pressures have caused some states to cap enrollment or cut benefits in their CHIP programs.

A Nov. 6 analysis by the left-leaning Center on Budget and Policy Priorities said that, as a capped federal block grant program, “in some years it (CHIP) may not provide sufficient funding nationally or adequate funding in individual states” to cover all children. The analysis also said states can limit enrollment or impose waiting lists if funding falls short.

Would Moving Kids Out Of CHIP Cost Parents More?

Addressing concerns about benefits, proponents say the House bill lays out steps to ensure that CHIP kids moved to the exchanges do not receive a lesser package. The Department of Health and Human Services would have to study the benefits and cost-sharing of CHIP programs and compare them with the benefits and cost-sharing that would be available in the exchange. By the end of 2011, the HHS secretary would have to make recommendations to Congress on how to make exchange coverage comparable to what the children received in CHIP and how to avoid any coverage interruptions as CHIP kids are moved into the exchanges. Congress would have two years to act.

Yet some children’s advocates say that the House language is significantly different from an earlier version of the bill that would have required the HHS secretary to certify that CHIP kids would have no loss of benefits before they were placed in the exchanges. While health insurers participating in the exchange are required to cover certain services, “we have no idea what type of amount, scope and duration limitations that those plans may impose,” said Bruce Lesley, president of the children’s health advocacy group First Focus. “When it comes to covered benefits, CHIP clearly goes beyond what the vast majority of commercial plans provide or what the health insurance exchange plans can be expected to provide in addressing the unique health care needs of children.”

A study First Focus released last month found that moving CHIP kids into exchanges would cause their families to pay more out of pocket for medical care. The analysis, done by the firm Watson Wyatt Worldwide, found that moving those children into health insurance exchanges could expose them and their families to anywhere from 5 percent to 35 percent in out-of-pocket costs. Cost-sharing would be higher under the Senate Finance Committee bill than under the House-passed bill.

If CHIP enrollees moved into exchanges face higher co-payments for doctor’s visits and prescriptions, their families might not enroll in the exchanges or use the benefits, said Stan Dorn, senior research associate at the Urban Institute. “The research in pretty clear: With low-income families if you charge more per visit people go without necessary services because they just can’t afford it,” Dorn said. “The benefits would be there in theory but not in reality because it’s not affordable to them.”

The Center on Budget and Policy Priorities Nov. 6 analysis concurs that for CHIP children moved into the health insurance exchange, the benefits packages would likely be somewhat less generous than what they receive in CHIP in a number of states and premiums and cost-sharing likely would be somewhat higher. But the analysis also states that total out-of-pocket health costs spending for those children’s families would generally decrease because their parents would be covered through the exchange.

In addition, the House bill would require health plans in the exchange and eventually all employer-sponsored plans to provide an essential benefits package that would include an array of services, including vision, hearing and dental care for children. And the subsidies provided to families with incomes of up to 400 percent of the federal poverty level — or $88,000 for a family of four — would be federally funded and not dependent on state funds or Congress acting to provide additional CHIP funding, the Center on Budget and Policy Priority’s report concludes.

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Health Care Reform: an Opportunity for Insurance Industry Participation in Sierra Leone’s Medical Care System

Posted on 09 August 2010 by admin

The socialized system of healthcare delivery and financing, a relic of the British colonial era, still practiced in Sierra Leone has glaringly failed and any efforts at resuscitating it without implementation of major structural and systemic reform will only serve to prolong the inevitable.

Throughout the world, total state control and management of industries, services, markets and the means of production are gradually becoming a relic of the past. This model as practiced in the Sierra Leone healthcare system has empirically been proven to have served only to stifle innovation, growth, productivity and quality output with a resultant decline in overall living and healthcare standards of the citizenry. The current state of the hospitals and health centers glaringly highlights the systemic problems endemic in the entire government owned, managed, financed and operated health care system.

The continued operation of such a decadent and dilapidated delivery and financing system, lacking in even the basics of a modern healthcare infrastructure continues relegating Sierra Leone to the very bottom of the human development index.

The transformation thus of the medical healthcare delivery and financing system into a private insurance or a national insurance based system offers opportunities not only for insurers to develop market-based medical insurance plans and policies but also serves to effectuate the Ministry of Health & Sanitation’s desired policy goals, as espoused in the 2002 National Health Policy Paper.

Both policy and regulatory officials, healthcare providers, the insurance industry and other stakeholders must be engaged to effectuate implementation of fundamental systemic reforms if the country is to avert an even greater catastrophe.

Privatization:

 

Under the proposed privatization plan, the Ministry of Health & Sanitation will be transformed from ownership and management of hospitals, clinics, and employer of last resort for all physicians, nurses and ancillary healthcare providers into a health agency with only policy and regulatory functions.

The goal will be for the health agency to serve as a policy and regulatory watch dog mandated with ensuring that adequate and quality medical care is provided at the various private hospitals, clinics and pharmacies that will inevitably be established with the break-up of the current government owned facilities.

With the break-up and subsequent purchase or leases of these hospitals, clinics, health centers and other facilities, investors and entrepreneurs in an effort to realize maximum returns on investments, will economically be compelled to upgrade quality and standard of care, introduce state of the art equipment and technologies and engender a type of market forces competition which will inure only to the betterment of health consumers in the country.

A much needed infusion of capital into the health care industry by such a privatization plan will clearly spur additional economic activities in ancillary industries, as the dynamic forces of privatization and market mechanism forces of demand and supply will ensure competition for the healthcare pie.


Divestiture of Government Ownership:


The dismantling of the current mammoth and highly inefficient government owned healthcare delivery and financing entity must from a public policy perspective be designed and restructured to ensure governmental ownership and management divestiture from hospitals and other health care facilities.

Under such a scenario the government’s current enormous but woefully mismanaged capital outlay for health services will be substantially decreased as inefficiencies of corruption, salaries of providers, infrastructure maintenance, costs of medications and diagnostic equipments and other overhead operating costs will no longer be recurrent expenditures from the nation’s depleting coffers.

A system based entirely on a private market-based national health insurance plan with private enterprise and market competition at its core appears the most logical reform policy route to ensure a future sound, efficient and profitable health care infrastructure.

 Health Insurance Plans:

The cog which the proposed new system must revolve around is a nationwide network of affordable health insurance plans creatively designed to ensure a greater pool participation of a majority of the population. In such a system health insurance companies and provider organizations will be established to market various health plans, with minimum services and premiums based on market conditions. The responsibility for monitoring compliance by the various plans would fall under the ambit of both the Ministry of Health and Sanitation and the Sierra Leone Insurance Commission.


Multi-Payer System:


A major plank in this proposed health care delivery and financing privatization hinges on the enactment of health insurance legislation providing for employers to provide health care for their employees and dependants as part of a standard benefits package with concomitant tax incentives and governmental subsidies to ensure compliance. With such legislation the virtual free socialized medical care system, the costs of which have been borne exclusively by the government will now be based on a multi-payer system in which government, employees and employers will all participate.

With the system as currently structured however, only the government has a financial interest and stake and when other programs conflict with the financing of health care, politicians have only been too willing to sacrifice the health of their citizens on he alter of their greed and personal aggrandizement.

It is envisaged that health insurance providers will introduce concepts and plans, such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), through alliances of health providers and insurance companies and marketed to employers, labor unions, governmental ministries and corporations on an annual premium basis.

The competition engendered by such health organizations for the medical insurance pie will subsequently result in competitive rates, coverage, deductibles, co-payments and premiums to make health care costs affordable for all.


The Unemployed:


As unemployment and underemployment are perennial problems in the Sierra Leonean economy, the provision of health care benefits to this category of the population must remain the responsibility of government. Medical services provided to this category of citizens in a private enterprise environment must be reimbursed by the government on a negotiated and pre-determined fee schedule or an insurance mechanism established in which government negotiates with providers and carriers for the provision of services.

As an example a fund established by levying taxes on the private health care providers, envisaged to emerge with such privatization, could be instituted and utilized to pay for these indigent services.

Further, since the hospitals, medical clinics and other medical facilities will be operated as businesses, either for profit or as non-profit organizations, the market forces of demand and supply will certainly ensure that patient quality care, improvements in diagnostic technologies, competent personnel and a general responsiveness to the demands of the clients will drive the new marketplace. The lethargic and inefficient atmosphere witnessed at most government hospitals today with customer service virtually non existent would be a philosophy of the past.

The economic viability of healthcare businesses will depend largely on the clientele they can attract and maintain utilizing the above yardstick. Providers of lousy health care plans and services will inevitably loose business to competitors as every year participants will have an opportunity to change health insurance plans.

Since a large population of Sierra Leone resides in rural areas, the proposed privatization plan will ensure the expansion of health care facilities into areas currently inadequately serviced. This plan will ensure that clinics and doctors put up shop in every part of the country in order to tap into the healthcare services available in these rural areas.


Challenges to Insurance Companies:


Designing an insurance system and plan to cater to the needs of the rural population who often are self employed in farming and mining activities posses a challenge to insurers in Sierra Leone, who in the past have been largely passive and unimaginative in policy design to meet the challenges and risks confronting the nation’s socio-economic landscape.

Proactive and creative underwriting of risks must be undertaking by underwriters, actuaries and marketing specialists to design, tailor and price health insurance coverage to meet the diverse needs of the insuring public. For example, the creation of pools by occupational categories could be one method by which insured’s, engaged in similar trades could be encouraged to form co-operatives for purposes of obtaining health insurance coverage at affordable rates for themselves and dependants. Premium payments through the pooling together of the co-operatives commodities can be an alternative payment method for the medical services. Health insurance companies could possibly establish subsidiary or ancillary companies solely for the handling of payments made by cash crops.

The current system under which nearly all doctors and related health care providers are employed by the government while at the same time owning private practices would be changed with a concomitant government savings on salaries, productivity and other fringe benefits. As privatization takes over in the hospitals, physicians, nurses and other providers will no longer be on the government’s payroll but will rather be independent contractors with their own practices.

Conclusion:

Whilst a micro version of the proposed reform has mushroomed in an ad hoc manner over the years with some large companies and corporations contracting with individual physicians and clinics for the provision of health care to their employees and dependants, the kind of systemic and structural overhaul needed to forestall a total collapse of the system and extend similar services to all could only be realized by a comprehensive approach along lines of reforms proposed in this policy paper.

 




The author, Mr. Kortor Kamara has over 25 years experience in the insurance industry both in Sierra Leone and the United States. He is a Chartered Property & Casualty Insurer and holds the Workers Compensation Claims Professional (WCCP) designation. He is a Member of the Chartered Insurance Institute (London); Certified Self-Insurance Claims Administrator-State of California; Registered World Bank Consultant and has served as a Consultant on various Insurance initiatives in Sierra Leone, including design of the country’s first Title Insurance Policy.


In addition, Mr. Kamara is a graduate of Fourah Bay College, University of Sierra Leone, 1978-1981; studied Law at both the Univerisity of West Los Angeles School of Law and the California Southern School of Law in Riverside. He is currently a Doctoral Candidate in Insurance and Risk Management.


Through association with Saddleback Re, were he serves as the Regional Manager, Africa Division, Mr. Kamara is intimately involved in the provision of reinsurance coverage, policy design, loss control, training and risk management services to the African Insurance marketplace.

www.saddlebackre.com.

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Differences Between The Republican and Democratic Healthcare Reform Bills

Posted on 28 July 2010 by admin

The Republican Party has spent the past several months serving as vocal opposition to the healthcare reform bills supported by the Barack Obama administration and Democratic members of Congress. During that time, they have seen success in influencing public opinion. However, many were frustrated that Republicans hadn’t offered their own plan. Surely they didn’t believe that the health insurance system in the U.S. is perfect the way it is? Well, the wait is over. Senate Minority Leader John Boehner has acknowledged the public’s demand for an alternative with the debut of the GOP’s healthcare reform bill. Obviously, a party that has disagreements with most parts of the Democrats’ bills in the House of Representatives and Senate has written a significantly different bill. How exactly are the proposals different?

Length: The Democrats’ bill is a whopping 1,990 pages long. Meanwhile, the Republican version clocks in at a more reasonable 230 pages. Most politicians should find the latter’s length (akin to the average novel) more manageable than the entire encyclopedia that is the former. Mandate: Republicans have eliminated the mandate that would require virtually all individuals to buy health insurance plans, as well as one that would force employers to provide insurance. Those mandates are central to the Democratic bill; their intent is to make sure that the cost of health insurance is spread among a large pool, as opposed to only the sickest of our population. Pre-existing Conditions: Unlike the bills proposed by the Democrats, the Republican bill would not ban health insurance companies from denying coverage to those with pre-existing conditions. This falls in line with the party’s more anti-regulatory stance on business. Interstate Insurance Sales: People will be allowed to buy a health insurance plan across state lines under the Republican bill. Insurance is cheaper in some states, since there are fewer requirements or restrictions on what insurers do or do not cover. Abortion Coverage: The Republican bill includes stricter prohibitions on funding of abortions. Democrats have already included a provision that would prevent federal subsidies (given to low income individuals to buy insurance) from being used directly on abortion services. However, the Republicans go further by preventing people who receive the subsidies from buying any health insurance plan that covers abortion entirely–even if they never end up using that particular option. The Republican party has a stronger pro-life base, so this provision could help draw them in. On the other hand, this could also backfire against the Republicans, who have capitalized off the grassroots anger over the possibility of a government bureaucracy making your health care decisions for you. Medical Malpractice: Trial lawyers have been loyal contributors to Democratic politicians. That may be why there isn’t significant legislation involving medical tort reform in their bill. Republicans would like to limit jury awards for things like pain and suffering. The most plaintiffs could be awarded would be $250,000 in medical malpractice cases (excluding actual, proven economic harm) Cost: The most recent estimates show the Democrats’ plan as costing over $1 trillion over the next decade, while Republicans haven’t yet revealed how much their plan will cost. Given how much they complain about the Democratic proposals super-sizing the national debt, it can reasonably be expected that their bill will have a lower price tag.

As you can see, there are significant differences in the bills. Above all, Republicans acknowledge that their bill would insure less people than the Democratic bill. Although both parties care about lowering the percentage of uninsured individuals and families in addition to the budget deficit, there is a trade-off. The latter appears to be a higher priority for the GOP. It appears inevitable that healthcare reform will pass at some point, possibly before the end of this year. The details of the Democratic proposals have been discussed for weeks, while the solutions presented by the Republicans have just made their formal debut. Boehner plans to finalize his party’s bill soon, in order for it to be presented when debate on the finalized Democratic bill begins on the House floor. So far, neither strategy for reforming our healthcare system seems ideal. Despite that, it is positive that more options are being presented to the American people. The greater number of minds put together, the faster we can fix the unavailability of affordable health insurance plans in this country.

(Image: makelessnoise under CC 2.0)

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they don’t have to go without a health insurance plan while waiting for a public option, if it ever gets passed. Yamileth lives in Miami, FL.

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Healthcare Reform – Rep. Anh “Joseph” Cao, Republican Vote for Bill

Posted on 25 July 2010 by admin

Healthcare reform just passed in the House of Representatives over the weekend. It was expected that most Democrats would vote for it, and that virtually all Republicans would oppose it. That prediction turned out to be mostly accurate, but the biggest surprise of the night was the one Republican who crossed party lines to vote in favor of the healthcare reform bill. Louisiana Representative Anh “Joseph” Cao’s vote was largely up for grabs. While the first-term legislator has been relatively nondescript and has voted with the rest of his party on most other issues, his district is heavily Democratic. Cynics would paint his support for health insurance plan reform as an attempt to increase his chances of re-election; however, Cao claims that it was the best choice for his poor constituents, a large population of which are uninsured. He has also pushed for greater funding of hospitals, as well as the ongoing Hurricane Katrina recovery efforts.

The bill probably wouldn’t have passed without Cao’s vote, since the Democrats barely reached the needed 218 votes to pass the historic reform. It didn’t help that 39 Democrats defied Speaker Nancy Pelosi to oppose healthcare reform. He also gives the proposals a veneer of bipartisanship. Although Cao waited until the bill had already passed to cast his votes, Minority Whip Eric Cantor’s efforts to steer Cao back into line failed.

So how did this key vote come to be? Cao jumped on board at the last minute, after the House agreed to add an amendment that strengthened the healthcare reform proposal’s ban on funding abortion. The original language prevented health insurance subsidies (used by lower-income individuals and families to buy plans on the exchange market that will be established) from being specifically used to pay for abortion services. That provision wasn’t strong enough for some pro-life Democrats like Bart Stupak, who wanted to amend the bill. House leaders did not want their amendment to reach the floor, but anti-abortion Cao helped spark the compromise yesterday by calling the White House himself and pledging his support for reform if it was included. After some wrangling, their amendment passed by 240 to 194. The version of the bill that was passed forbids people from using government subsidies to buy any health insurance plan that includes abortion coverage, except for when there is rape, incest, or danger to the mother’s life. The addition of the amendment allowed the devout Jesuit to vote “yes”.

Cao’s vote in favor of healthcare reform may have torpedoed his political aspirations. He has alienated Republicans nationwide by bucking the trend of rejecting the bill. On the other hand, his views in general are unlikely to appeal to voters in a district where Obama received three-quarters of the vote in last year’s presidential election–a larger percentage of Democratic party is pro-choice, and many are unhappy with the bill despite being in favor of universal health care. He is unlikely to receive much financial banking from either national party or their bases, although Republicans are chalking his shocking vote up to his being from a “tough district” with a larger than normal percentage of people without a health insurance plan. Cao’s victory was largely a fluke; he won a hurricane-delayed election in December against an opponent infamously charged with hiding cash in his freezer (Democrat William Jefferson). Still, it’s nice to see a politician following his conscience.

Now, the healthcare reform bill will move on to the Senate. The future of the ban on abortion coverage in the public option (as well as subsidized private health insurance plans) that swayed Cao is unclear. Both sides are gearing up for a heavy debate over the issue. Will Cao regret his vote if the Senate ends up weakening the restrictions?

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they can get a health insurance plan right now while waiting for a public option, if it ever gets passed. Yamileth lives in Miami, FL.

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