Congress Extends COBRA Subsidy Program

Cobra subsidy program has been extended forinvoluntarily terminated workers. Please see article for details.

http://www.lifeandhealthinsurancenews.com/News/2009/12/Pages/Congress-Extends-COBRA-Subsidy-Program.aspx

Why do we vote for our representatives?

The link below for a youtube video makes me scratch my head. Our Congressmen and Congresswomen are suppose to have the responsibility to make wise decision for the voter of their districts but when it on Congressmen asked For a procedural effort that requires Senators to state that they have read and understand a bill that they will vote on, he is shot down.

Hummmm, I guess it is too much to ask for our Senators to read and try to understand 2000 plus page bill that will effect every America's health. I would like to ask a simply question, WHY?

The House did the same thing, they put together a 2000 + page bill and amendments and passed it less than a week. Again WHY?

Remember they are rushing to pass these bill that will not go into effect until 2014, WHY?

http://www.youtube.com/watch?v=Mz4sWdFxlmg&feature=player_embedded

Health 'Reform' Gets a Failing Grade

I found this article by Jeffrey S. Flier the dean of Harvard Medical School. What I find interesting, is he compares the current healthcare bill to the Massachusetts' plan that "suffers from problems of cost, access and quality, and needs major reform", after just a couple of years of being in effect. And he also states "Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests", is that what they say it will fix?

I just do not get why this congress is such a rush. Less than a week after they release the new and improved 1,990 page bill, they call for a vote and pass it. did the member really read and understand what they are voting for? Is it because the want to enact the quickly to Americans? No, because it will not go into effect untill 2014. So why the rush?

Please read:
Health 'Reform' Gets a Failing Grade
The changes proposed by Congress will require more draconian measures down the road. Just look at Massachusetts.
http://online.wsj.com/article/SB10001424052748704431804574539581994054014.html

Should the Healthcare Debate be One Sided?

I am confused, the President goes around saying how he wants the eliminate Medicare Advantage programs, which I have been told by some seniors that they love (I do not sell these products or supps), but when the insurance companies try to inform thei...r clients, they are required stop, what is going on? Can we not have open debate? Are we looking for solutions or elimination of private insurance companies?

Please read the below article.

GOP raps Dems for hushing insurers on Medicare
CHARLES BABINGTON - 9/22/2009 8:54:48 PM

Republican lawmakers rebuked the Obama administration Tuesday for telling health insurance companies to stop warning elderly customers about proposed health care legislation, which some equated to a gag order.

At least one prominent insurer has misrepresented the pending bills to frighten older Americans, the administration says. But GOP leaders said the companies, whose income could be reduced by the legislation, are entitled to free speech and political debate.

Tuesday's exchanges came as a Senate committee began debating a health care bill most Republicans oppose. President Barack Obama supports the bill's main provisions, and the flap over insurance companies' mailers is the latest front in a long-running dispute.
"It is outrageous that the Obama administration is trying to keep seniors in the dark about the consequences of congressional Democrats' costly government-run health care bills," House Republican leader John Boehner of Ohio said.

The Senate's GOP leader, Mitch McConnell of Kentucky, said citizens and companies "have a fundamental right to talk about legislation they favor or oppose."

The Centers for Medicare and Medicaid on Monday sent a notice to all companies that sell private Medicare coverage and stand-alone drug plans to seniors. Saying at least one insurer was misleading those customers about the proposed legislation, it told the companies "to immediately discontinue all such mailings to beneficiaries and to remove any related materials directed to Medicare enrollees from your Web sites."

The warning came after Senate Finance Committee Chairman Max Baucus, D-Mont., launched an investigation of Humana Inc. Humana is one of the largest private insurers participating in a program called Medicare Advantage.

Federal subsidies to private Medicare plans average about 14 percent higher than those involved in traditional fee-for-service Medicare coverage. The health care bills pending in Congress would reduce or eliminate the difference.

A Humana mailer, now discontinued, told customers, "if the proposed funding cut levels become law, millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable." It encouraged customers to contact their members of Congress.

McConnell criticized Baucus, without saying his name, for targeting Humana, which is headquartered in Louisville, Ky. Humana executives have contributed heavily to McConnell's Senate campaigns and a university center named for him.

Baucus said Monday, "it is wholly unacceptable for insurance companies to mislead seniors regarding any subject _ particularly on a subject as important to them, and to the nation, as health care reform."

His office said Tuesday he stands by those remarks.

Workers Keeping Voluntary Benefits: Study

If you are not offering voluntary benefits to your employees, you should reconsider. First this article prove that the employee places value in these benefits. Second, theses benefits are employee paid, therefore not cost to the employer. And third, there could benefit a tax benefit for the company if the employee elects the benefit (s). Contract Ray Ward at 916-677-2130 x101 to see if these benefits would make sense for your company.

By STAFF WRITER National Underwriter Published 9/3/2009

Despite a drop in discretionary income, only 11% of workers plan to decrease their 2010 voluntary benefits coverage, a new MetLife Inc. poll finds.

And nearly one-quarter of those planning to decrease coverage this year expect to increase their benefits during next year’s open enrollment period if the economy improves, reports MetLife, New York.

According to MetLife’s new 2009 Open Enrollment Poll, 89% of employees are planning to maintain or increase the number of benefits they select or their coverage for next year, despite the fact that 37% report that their household’s discretionary income decreased this year.

Despite the depressed economy, 89% of employees are confident in their ability to evaluate their options and pick the right employee benefits for themselves and their families. As a result, 76% plan to spend about the same amount of time this year as last when it comes to choosing their benefits.

MetLife found 13% plan to spend more time on benefit selection during this year’s open-enrollment period. Of those, 57% will spend an extra 60 minutes or more. As for their reasons for spending more time, 64% cite current economic events or financial security, and 31% say a major life event was the impetus. Additionally, 15% felt they made some wrong decisions on the employee benefits they selected during last year’s open enrollment period. Yes just 3% of all workers surveyed say that they are not confident in their ability to weigh their options and choose the right benefits.

MetLife found that employer communications make an important difference in employee involvement in their benefits decisions. Of employees who said they’ll spend more time making benefits decisions this year, 29% say their employers were communicating more about the importance of employee benefits.

“Employer communications regarding benefits need to be targeted in a way that encourages dialogue and address all family members, since half of employees share the benefits decision-making with their spouse or domestic partner,” said Dr. Ronald Leopold, vice president for MetLife’s U.S. Business.

Noting the rapid approach of the open enrollment season, MetLife recommends several steps for employers to take to ensure that employees get the information they need to make informed decisions:

--Distribute personalized, clear total compensation statements, which explain to employees the value of their complete compensation and benefits. Only 43% of employers provide a total compensation statement, another MetLife study found.

--Provide decision-support tools to employees, such as Web-based calculators, which can advise employees on which benefits to select and proper coverage levels.

--Personalize materials—for instance, by providing access to information based on employee life-stage and life events (e.g., getting married, having a child or buying a home).

--Use several communication channels, such as on-site educational programs, telephone consultation services and on-line tools.

--Provide off-cycle enrollment: MetLife found 38% of employees would be interested in learning about and modifying their benefits choices more frequently than once a year, in particular those that are planning on spending more time on their benefits decisions.

The telephone poll was conducted in late July among 1,000 full-time employees, 18 years or older, at companies with 10-plus employees.

Despite a drop in discretionary income, only 11% of workers plan to decrease their 2010 voluntary benefits coverage, a new MetLife Inc. poll finds.

And nearly one-quarter of those planning to decrease coverage this year expect to increase their benefits during next year’s open enrollment period if the economy improves, reports MetLife, New York.

According to MetLife’s new 2009 Open Enrollment Poll, 89% of employees are planning to maintain or increase the number of benefits they select or their coverage for next year, despite the fact that 37% report that their household’s discretionary income decreased this year.

Despite the depressed economy, 89% of employees are confident in their ability to evaluate their options and pick the right employee benefits for themselves and their families. As a result, 76% plan to spend about the same amount of time this year as last when it comes to choosing their benefits.

MetLife found 13% plan to spend more time on benefit selection during this year’s open-enrollment period. Of those, 57% will spend an extra 60 minutes or more. As for their reasons for spending more time, 64% cite current economic events or financial security, and 31% say a major life event was the impetus. Additionally, 15% felt they made some wrong decisions on the employee benefits they selected during last year’s open enrollment period. Yes just 3% of all workers surveyed say that they are not confident in their ability to weigh their options and choose the right benefits.

MetLife found that employer communications make an important difference in employee involvement in their benefits decisions. Of employees who said they’ll spend more time making benefits decisions this year, 29% say their employers were communicating more about the importance of employee benefits.

“Employer communications regarding benefits need to be targeted in a way that encourages dialogue and address all family members, since half of employees share the benefits decision-making with their spouse or domestic partner,” said Dr. Ronald Leopold, vice president for MetLife’s U.S. Business.

Noting the rapid approach of the open enrollment season, MetLife recommends several steps for employers to take to ensure that employees get the information they need to make informed decisions:

--Distribute personalized, clear total compensation statements, which explain to employees the value of their complete compensation and benefits. Only 43% of employers provide a total compensation statement, another MetLife study found.

--Provide decision-support tools to employees, such as Web-based calculators, which can advise employees on which benefits to select and proper coverage levels.

--Personalize materials—for instance, by providing access to information based on employee life-stage and life events (e.g., getting married, having a child or buying a home).

--Use several communication channels, such as on-site educational programs, telephone consultation services and on-line tools.

--Provide off-cycle enrollment: MetLife found 38% of employees would be interested in learning about and modifying their benefits choices more frequently than once a year, in particular those that are planning on spending more time on their benefits decisions.

The telephone poll was conducted in late July among 1,000 full-time employees, 18 years or older, at companies with 10-plus employees.

http://www.lifeandhealthinsurancenews.com/News/2009/9/Pages/Workers-Keeping-Voluntary-Benefits-Study.aspx#

Canadians visit U.S. to get health care

What happens to the poor Canadians if we go to socailized medicine? Actually, the scary part of this article is that we consider angioplasty a common procedure in our system.

Deal lets many go to Michigan hospitals

BY PATRICIA ANSTETTFREE PRESS MEDICAL WRITER

Hospitals in border cities, including Detroit, are forging lucrative arrangements with Canadian health agencies to provide care not widely available across the border.

Agreements between Detroit hospitals and the Ontario Ministry of Health and Long-Term Care for heart, imaging tests, bariatric and other services provide access to some services not immediately available in the province, said ministry spokesman David Jensen.
The agreements show how a country with a national care system -- a proposal not part of the health care changes under discussion in Congress -- copes with demand for care with U.S. partnerships, rather than building new facilities.

Michael Vujovich, 61, of Windsor was taken to Detroit's Henry Ford Hospital for an angioplasty procedure after he went to a Windsor hospital in April. Vujovich said the U.S. backup doesn't show a gap in Canada's system, but shows how it works.

"I go to the hospital in Windsor and two hours later, I'm done having angioplasty in Detroit," he said. His $38,000 bill was covered by the Ontario health ministry.

Canada eyed in the health care debate

Dany Mercado, a leukemia patient from Kitchener, Ontario, is cancer-free after getting a bone marrow transplant at the Barbara Ann Karmanos Cancer Institute in Detroit.
Told by Canadian doctors in 2007 he couldn't have the procedure there, Mercado's family and doctor appealed to Ontario health officials, who agreed to let him have the transplant in Detroit in January 2008.

The Karmanos Institute is one of several Detroit health facilities that care for Canadians needing services not widely available in Canada.

Canada, for example, has waiting times for bariatric procedures to combat obesity that can stretch to more than five years, according to a June report in the Canadian Journal of Surgery.
As a result, the Ontario Ministry of Health and Long-Term Care in April designated 13 U.S. hospitals, including five in Michigan and one more with a tentative designation, to perform bariatric surgery for Canadians.

The agreements provide "more immediate services for patients whose health is at risk," Jensen said.

Three Windsor-area hospitals have arrangements with Henry Ford Hospital, Detroit, to provide backup, after-hours angioplasty. Authorities will clear Detroit-Windsor Tunnel traffic for ambulances, if necessary. The Detroit Medical Center also provides Canadians complex trauma, cancer, neonatal and other care.

"In the last few years, we've seen more and more Canadian patients," said Dr. J. Edson Pontes, senior vice president of international medicine at the DMC. They include Canadians such as Mercado, whose care is reimbursed by Canada's health system, as well as people who pay out of pocket to avoid waiting in Canada.

Pontes declined to give revenue figures for the DMC's international business, but said the program "always has been a profitable entity." About 300 of the DMC's 400 international patients last year came from Canada, he said.

Tony Armada, chief executive officer of Henry Ford Hospital, said the hospital received $1 million for cardiac care alone.

Critics of a health care system like Canada's -- a publicly funded system that pays for medically necessary care determined by provinces -- often cite gaps in Canada's care to argue that the United States should not allow its current debate over health care to move it to a socialized system.

No plan currently under discussion in Congress calls for a universal plan like Canada's, but opponents fear socialized medicine, anyway.

Canada's U.S. backup care "speaks volumes to why we don't need government to take over health care," Scott Hagerstrom, the state director in Michigan for Americans for Prosperity, said of the Canadian arrangements with Michigan hospitals. "Their system doesn't work if they have to send us their patients."

But Dr. Uwe Reinhardt, a Princeton University health economist who has studied the U.S. and Canadian health systems, said arrangements with cities like Detroit "are a terrific way to manage capacity" given Canada's smaller health care budget.

"This is efficient," he said. "At least in Canada, you don't worry about going broke to pay for health care. You do here."

Pat Somers, vice president of operations at Windsor's Hotel-Dieu Grace Hospital, one of the hospitals that sends patients to Henry Ford, said the issue of finding ways to pay for and prioritize care requests is not in only Windsor.

"The ministries are quite aware of" waits for care in Sarnia and Hamilton, she said. "That's why we are investing in a wait list strategy" to best determine how to prioritize cases for people who need hip and knee replacements, cataract surgery and treatment for cancer, for example.
Mercado, 26, faced a longer wait because he could not find a matching blood donor, even though his family conducted a broad search.

He said doctors told him money was limited for transplants, particularly ones using unmatched donors, which are riskier.

After his family's doctor wrote the Ontario ministry, the agency agreed to pay $200,000 for the operation.

The family, their church and Mercado's school, Conestoga College in Kitchener, raised another $51,000 to cover expenses going back and forth to Detroit.

"I think of this every day as a gift from God," Mercado said.

Contact PATRICIA ANSTETT: 313-222-5021 or panstett@freepress.com
link: http://freep.com/article/20090820/BUSINESS06/908200420/1319/

Is it a Lie When You Use Numbers That Only Tell Part of the Story?

Check it out It's true that the United States spends more on health care than anyone else, and it's true that we rank below a lot of other advanced countries in life expectancy. . . . One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks. In their 2006 book, 'The Business of Health,' economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place. That discovery indicates our health-care system is doing a poor job of preventing shootouts and drunk driving but a good job of healing the sick. All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases. Chicago Tribune columnist Steve Chapman.

Link: http://www.chicagotribune.com/news/columnists/chi-oped0816chapmanaug16,0,1666314.column

Benefits Are More Than Just Medical Insurance

Many small to medium sized employers think that if they offer only medical insurance that they are keeping their costs down and that they have a benefit package to offer their employees. Yes and no!

Yes, it is better than nothing but the business is competing for employees with larger companies that offer more choices. So, with that in mind consider the cost of turnover. Department of Labor states that the cost to replace an employee is 1/3 their annual salary, that means it would cost $6,933 to replace a $10 per hour employee. If you can keep one employee from leaving because of a better benefit package, how much will you save? How much better will your customer service be? Will you increase customer loyalty?

In addition, most larger company offer addition benefits that are paid for by the employees thru payroll deduction. Guess what, as a small business owner you can do the same thing. Offer your employees plans such as disability, life and other plans that provide the employee protection for them and their family and now you have a more complete benefit package. Also did you know that if your employees choose these plan that you might be able to pre-tax the deduction, which means the company can SAVE some money on their portion of payroll taxes.

To learn more about how you can increase your benefit package, please contact me at 916-677-2130 ext. 101.

Obama Wrong on AARP Endorsement

I understand things continue to change in the healthcare debate but, when the President or any politician lies to try to influence our citizens, they are not doing their job. You need to check into almost everything they say, how sad!

August 11, 2009

At his town hall event in Portsmouth, New Hampshire, President Obama went too far in claiming the support of AARP:

Obama: We have the AARP on board because they know this is a good deal for our seniors. …

[A]nother myth that we’ve been hearing about is this notion that somehow we’re going to be cutting your Medicare benefits. We are not. AARP would not be endorsing a bill if it was undermining Medicare, okay?

But AARP, while in support of overhauling the health care system, hasn’t endorsed any bill. AARP Chief Operating Officer Tom Nelson issued a statement, saying: "While the President was correct that AARP will not endorse a health care reform bill that would reduce Medicare benefits, indications that we have endorsed any of the major health care reform bills currently under consideration in Congress are inaccurate."

Nelson said AARP had been "working with Democrats and Republicans to fix our broken health care system" and added: “We share the President’s commitment to act this year, and our members appreciate his insistence that any final reform package will not reduce Medicare benefits for the millions of people that literally depend on that program as a lifeline."

A hat tip to ABC News’ Political Punch blog for writing about this claim.

Posted by Lori Robertson on Tuesday, August 11, 2009 at 7:32 pm
Filed under The FactCheck Wire · Tagged with Barack Obama, health care

Link to this article: http://factcheck.org/2009/08/obama-wrong-on-aarp-endorsement/

Cost, Not Universal Coverage, is Top Health Care Concern for Voters

Another survey shows that many of the survey numbers uses to show support for the proposed healthcare reform are only part of the message. It seems that very few surveyed top concern is quality of care or inconvenience of the current system. Overall people are concerned with the tax hikes associated with the plans. Some people say this comes down to party lines but look at the unaffiliated voters: 50% to 30% do not want the reform with tax hikes and two-to-one want to keep current coverage verses reform. So, when you hear surveys that 61% to 70% of Americans want reform, look further into the number to see what they really want!

Rasmussen Reports Saturday, July 18, 2009

Sixty-one percent (61%) of voters nationwide say that cost is the biggest health care problem facing the nation today. The latest Rasmussen Reports national telephone survey finds that just 21% believe the lack of universal health insurance coverage is a bigger problem.

Only 10% believe the quality of care is the top concern, and two percent (2%) point to the inconvenience factor of dealing with the current medical system.

Given a choice between health care reform and a tax hike or no health care reform and no tax hike, 47% would prefer to avoid the tax hike and do without reform. Forty-one percent (41%) take the opposite view.

The opposition is stronger when asked about a choice between health care reform that would require changing existing health insurance coverage or no health care reform and no change from current coverage. In that case, voters oppose reform by a 54% to 32% margin.

Surveys released at the end of this past week show that 78% believe the passage of health care reform is likely to mean middle-class tax hikes. Also, by a 50% to 35% margin, Americans oppose the creation of a government insurance company to compete with private insurers.

Polling released earlier in the week found that 46% favored the health care plan working its way through Congress while 49% were opposed. However, there have been many developments on Capitol Hill since that survey was completed. Updated polling will be conducted next week.

On all questions in the new survey, there are huge partisan differences with Democrats holding one view while Republicans and voters not affiliated with either party hold another.

On the question of the biggest health care problem, Republicans and unaffiliated voters overwhelmingly say cost is number one. While Democrats lean in that direction, they are much more evenly divided. Fifty-two percent (52%) of those in President Obama’s party say cost is the top concern, but 35% think it’s the lack of universal coverage.

On the trade-off with taxes, 73% of Democrats would rather have reform and a tax hike while 79% of Republicans say the opposite. As for unaffiliateds, they side with the GOP by a 50% to 30% margin.

On the trade-off between reform and keeping your current insurance coverage, Democrats opt for reform by a two-to-one margin. Unaffiliated voters prefer keeping their existing insurance coverage by two-to-one. Republicans overwhelmingly prefer to maintain their current insurance.

Earlier surveys have shown that health care reform is the top priority for Democrats. But Republicans and unaffiliated voters view deficit reduction as more important.

Please sign up for the Rasmussen Reports daily e-mail update (it’s free) or follow us on Twitter. Let us keep you up to date with the latest public opinion news.

See survey questions and toplines. Crosstabs are available to Premium Members only.

NAIC Blasts Health Czar

The Association of State Insurance Commissioners are coming out against the centralization of healthcare the House is proposing. They argue that the proposed Health Choices Adminstration "would merely add more regulation and cost without enhancing consumer protection.” Are they listening?

Posted on lifeandhealthinsurancenes.com

By ARTHUR D. POSTAL Published 7/16/2009

WASHINGTON BUREAU -- The National Association of Insurance Commissioners is asking the leaders of 3 House committees to give up the idea of creating a separate federal agency with strong powers to oversee health delivery.

The proposal is in Section 141 of the “committee print” of H.R. 3200, “America’s Affordable Health Choices Act,” the health system bill now being marked up in the House.

The provision would create the Health Choices Administration, an independent federal agency headed by a commissioner appointed by the president.

The HCA would have market conduct oversight authority as well as authority to establish standards for operation of the public health coverage plan that is part of the House bill.

The HCA also would have authority to establish standards for qualified private plans and oversee the health insurance exchange that would serve as an Internet-based clearinghouse for health insurance information and choices.

The House Ways and Means Committee is meeting today to mark up the finance-related sections of H.R. 3200.

The House Energy and Commerce and Education and Labor Committees will mark up their portions of the bill next week.

The plan is to have the bill ready for floor action by next Thursday.
In a letter sent to the chairmen and highest-ranking members of each of the House committees drafting the final bill, Sandy Praeger, the Kansas insurance commissioner and chairman of the Health Insurance and Managed Care Committee at the NAIC, Kansas City, Mo., argues that the HCA would merely add more regulation and cost “without enhancing consumer protection.”

Praeger cites what she says are the “egregious failures” created by the inability of the federal Centers for Medicare and Medicaid Services to properly oversee marketing of Medicare Advantage plans.

Reliance on federal Medicare Advantage oversight left “millions of seniors exposed to deceptive, fraudulent and abusive sales tactics that would have been prevented had the states been allowed to act,” Praeger writes.
The NAIC believes that a single federal blueprint is unlikely to be effective in every state because “health care delivery systems, demographics, rural and urban mix, economies and labor markets are distinctive and regulations that fail to take those distinctions into account will damage markets and consumers,” Praeger writes.

The House bill would give the proposed HCA director no guidance about the content of health coverage standards, “making it probable that these standards would change dramatically with each new administration,” Praeger writes.

Praeger also warns that healthy consumers may opt to pay the modest annual penalty the bill would impose on individuals without acceptable health coverage rather than pay much more to buy health insurance.
That would cause “adverse selection that increases the cost of coverage for all and defeating the purpose of the requirement that all Americans obtain coverage,’ Praeger writes.

Lawmakers reject tax to pay for health reform

It seems interesting that Washington changes their story on healthcare almost daily, here is the latest. I find interesting is that they keep pointing to the problem of the "Cadillac Plans". In most cases, where do you find these "Cadillac Plan", they are the ones offered to government employees and to union members. These group are often discussed as posssibly exempted from the new proposals. Interesting!

Sun Jul 12, 2009 3:55pm EDT By David Alexander
WASHINGTON (Reuters) - U.S. lawmakers on Sunday criticized a plan to raise taxes on the wealthy to pay for a $1 trillion healthcare overhaul and warned Congress was unlikely to meet President Barack Obama's goal of passing the measure by August.

Republican Senator Judd Gregg said finishing a healthcare bill by Congress' August recess was "highly unlikely" because the Senate Finance Committee had not yet completed a draft. Senator John Kyl, the Republican whip, said there was "no chance" it would be done before the break.
"President Obama was right about one thing. He said if it's not done quickly, it won't be done at all. Why did he say that? Because the longer it hangs out there, the more the American people are skeptical, anxious and even in opposition to it," Kyl told ABC's "This Week" program.
Obama has made healthcare reform his top legislative priority and hopes to sign the bill in October. The United States spends more than $2 trillion annually on healthcare, twice any other nation, but it ranks worse than most developed countries on measures of health like life expectancy.

Some 46 million are uninsured and have little access to routine healthcare, relying instead on costly emergency room visits.

Committee leaders in the House of Representatives plan to introduce a healthcare overhaul measure on Monday and consider amendments later in the week, even as they search for ways to fund the 10-year program.

Representative Charlie Rangel, head of the House Ways and Means Committee, said the bill would include a tax on Americans earning more than $350,000 per year that would raise $540 billion over 10 years. The tax would begin in 2011 and have higher rates at the $500,000 and $1 million income levels.

'CADILLAC' PLANS
Asked if Obama would support Rangel's tax proposal, Health Secretary Kathleen Sebelius said the U.S. leader wanted to pay for the healthcare overhaul by finding savings in the system and cutting tax deductions claimed by rich Americans, but he was open to other options.

"President Obama has outlined his preferred payment plans," Sebelius told CNN's "State of the Union" program, adding that Obama had found $660 billion in savings within the existing system and proposed to raise another $330 billion by capping the itemized tax deductions of wealthier Americans.

"I think the bottom line is, it's got to be paid for," Sebelius added. "We all need to play a role."
Pressed on whether the president could support Rangel's approach, Sebelius said, "I think everything is on the table and discussions are under way."

Representative Eric Cantor, the second-ranking Republican in the House, told the "Fox News Sunday" program Rangel's bill included an "incredible half a trillion dollar tax on folks making over $200,000 a year."

"Half of those people are the ones making the decision as to whether to hire Americans or not," he said, asking why the government would make it more difficult for them to hire people now out of work due to the recession.

Senator John Kyl, the Republican Whip, also flatly rejected any such tax increase.
"We're in a recession," he told CNN. "It would be a job killer. It would be exactly the wrong thing to do any time, but especially when we're in the middle of a recession.

Senator Richard Durban agreed, telling ABC's "This Week" show, "I think we're going to have a different approach." He did not spell how he would raise new revenue for the program.
Senator Lamar Alexander said he would favor limiting tax deductions on high-priced employer-sponsored health insurance plans -- so-called "Cadillac" plans. Healthcare benefits for employees are currently tax deductible, and some argue the costliest plans encourage wasteful healthcare spending.

Alexander said he would use the revenue gained from the plan to give money to all Americans to be used toward the purchase of purchase private insurance.

"I'm willing to stop giving tax deductions to people for Cadillac health insurance plans in order to give everybody a chance to buy their own health care insurance and not add a penny to the debt. I think that would be a good way," Alexander said.

Democratic Senator Debbie Stabenow rejected that approach, telling CNN, "The one thing that is off the table is taxing employee benefits."

This Week in Health Reform

In this article, provided by Anthem Blue Cross, gives an overview of healthcare debate in Washington. It seems that the President is still trying to jam socialized medicine down our throats. Another interesting fact, is that the huge profits that the carriers are suppose be getting is only 3 cents on the dollar.

As Congress returned to Washington after the Fourth of July Recess, the aggressive timetable set to pass bipartisan legislation by the end of the summer suffered a setback on Wednesday as key senators expressed doubt as to whether they could hammer out legislation in this short amount of time. The White House continues to push Congress to stick to its timetable.

While Congress considers health care reform options and how to pay for them, it's important to keep in mind that insurer profits - typically blamed for rising health care costs - in fact have little impact on health care premiums. According to PricewaterhouseCoopers research from 2008, only three cents of every health care premium dollar is spent on health insurer profit.

Public Plan

Obama Reaffirms Support for Public Option: Backing away from earlier comments made by White House Chief of Staff Rahm Emanuel indicating the government would be open to a health reform plan that did not include a public option, President Barack Obama reaffirmed his support for a government-run plan in a statement released this week while traveling in Russia.

HELP Price Tag Drops: Sens. Ted Kennedy (D-MA) and Christopher Dodd (D-CT), who are leading the Senate Health, Education, Labor and Pensions Committee (HELP), said Thursday that they had whittled down the cost of their health reform plan to $611 billion over 10 years. Debate during Wednesday's mark-up session raised questions about the overall cost, however, and suggested that when Medicaid expansions are factored in, the cost could exceed the $1 trillion mark.

The HELP committee is relying on the Finance Committee's plan to account for the additional 34 million Americans that would not be covered under the HELP proposal, including plans to expand Medicare.

Financing the Plan

Taxing Health Benefits Loses Steam: In a move indicating a rejection of bipartisan compromise Tuesday, Sen. Harry Reid (D-NV) sent word to Sen. Max Baucus (D-MT) that he should drop the concept of taxing employer-provided health care benefits, a move that would require the Senate Finance Committee to consider additional payment cuts or tax increases to offset more than $300 billion as a result.

Hospital Industry Agreement: Vice President Joe Biden formally announced Wednesday that the hospital industry agreed to contribute $155 billion over 10 years toward the cost of insuring uninsured Americans.

House Side Activity: House Democrats continue to develop their health reform proposal and are expected to release their plan to pay for health care reform by the end of this week. Democrats are focused on an income tax increase for the highest earners and are close to ruling out a proposed "sin tax" tax on sodas and other sugary drinks.

Looking Ahead

The Senate HELP committee hopes to complete its markup by late this week or early next. The Senate Finance Committee is still negotiating its bill and continues to mull options on how to pay for the overhaul. The House may begin marking up legislation in Committee next week.

For up to the moment information on Health Care Reform, please visit the Health Action Network.

Washington Healthcare Update

It is a recent Washington Update on proposed healthcare changes from National Association of Health Underwriters:

NAHU Washington Update - 07/02/2009

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Details Still to Come on Health Overhaul Plans

Senators negotiating a bipartisan health care reform plan in the Finance Committee left for the July Fourth recess without any consensus, but Finance Chairman Max Baucus said he has developed ways to pay for legislation that would cost less than $1 trillion over 10 years.

Limiting the bill’s spending to $1 trillion is a significant step for the committee, which has been seen as the main arena for those in the Senate hoping to get a bipartisan health care bill. However, Baucus, who is not in election cycle and opted to stay in Washington during recess to work on health reform, did not provide details and gave no indication of when he will be ready to mark up a bill.

While Baucus continues to work behind the scenes on the yet-to-be-introduced bipartisan bill, last week the Senate Health, Education, Labor and Pensions (HELP) Committee continued toiling through titles of a draft bill that is still missing many sections. Senator Chris Dodd adjourned the mark-up on June 25, saying the panel will reconvene July 6 with the goal of finishing by July 10.

The Finance and HELP Committees share jurisdiction over broad portions of the proposed health care overhaul, and it is not clear yet how their separate efforts will be integrated into a single legislative package. Work in the House is also in the initial stages, with three committees that have jurisdiction over parts of the legislation holding hearings last week.

HELP Committee Marks up Kennedy/Dodd Bill

Over the past two weeks, the Senate HELP Committee has worked on marking up sections of the Kennedy/Dodd bill dealing with preventive care, care quality, workforce issues, accessibility and cost control. Today, the committee issued the missing language on the core issues of creating a public plan to provide an alternative to private insurance and requiring employers to offer coverage or pay a penalty.

The new draft creates a government-run public program option to be offered through state gateways called the Community Health Insurance Option. The plan specifies that physicians will be paid based on negotiated fees rather than Medicare rates and are not compelled to participate. These entities would be non-profit and subject to state solvency rules as well as newly created federal solvency rules. These new plans would initially begin with federal money. Although they would be subject to state consumer protections and in some limited cases state benefit mandates, there is no mention of whether they would have to comply with other state rules, such as paying state premium taxes.

The employer mandate provisions specify that employers with more than 25 employees must offer coverage to both full- and part-time employees and must pay 60% of the cost (pro-rata share for part-time employees) or $750 annually for each employee ($375 for part-time employees).

The new draft also contains some positive changes to the previous minimum loss ratio provision, changing it to a reporting requirement as well as some enhancements to the grandfathering provisions that would allow changes to cost sharing and benefits as long as they were not significant. Additional positive changes were made to the risk adjustment provisions, which now appear to adjust risk over entire markets rather than just inside the gateway and specifies that risks for the individual and group markets will be pooled separately while including participants both inside and outside the gateway.

A small change was also made to the navigator provisions to specify that, for enrollment purposes, the job of the navigator is to facilitate enrollment but not assist with the enrollment process, which is a big improvement over the original draft. What this means is that the navigator would help people understand where to enroll but would not actually enroll individuals in coverage.

The change we have been seeking to allow groups over 50 to use claims experience in the rating process was not included, and the modified community rating provisions remain at two to one. We will seek additional amendments as the mark-up continues.

Dodd said his committee considered close to 216 amendments during the mark-up. Of those, the committee has accepted 87 and rejected 22 amendments presented by Republicans.

Like the Finance Committee proposal, the HELP draft has been hampered by extremely high cost estimates. Today they received a cost estimate on the provisions in the parts of the bill subject to their jurisdiction of $611 billion over 10 years, a reduction from the previous estimate due to program cuts made to the previous draft.

Meanwhile, initial cost estimates have emerged on a new voluntary long-term care insurance program included in the Senate HELP Committee draft.

The Community Living Assistance Services and Supports (CLASS) Program―a long-time priority of Senator Edward Kennedy―would save nearly $58 billion over 10 years, including a $2.5 billion reduction in Medicaid spending, according to a cost analysis released June 26 by the Congressional Budget Office and Joint Committee on Taxation.

Under CLASS, participants would have to contribute monthly premiums for five years before qualifying for benefits that are triggered by evidence of functional limitation, including cognitive impairment.

Premiums would average $65 per month, adjusted for age, although students and those with incomes less than 100% of the federal poverty level would pay $5 per month.

While the long-term care program would be a government-run insurance plan, it is intended to complement private long-term care insurance, not compete with the products, Democratic aides claim. Benefits under the program are intended to only cover about half the average cost of long-term care, according to a summary distributed by HELP staff.

NAHU shares the HELP Committee Republicans’ concerns about the long-term costs of the Democrats’ proposal and the wide and unspecified latitude it would give to the Health and Human Services secretary to manage the program. Republicans generally would rather provide people tax deductions for private long-term care insurance premiums or tax credits to purchase services directly, an approach NAHU supports.

The program’s benefits would be at least $50 per day, according to the committee summary. Many of the program’s details would be left to the secretary, who could, for example, raise and lower premiums, set benefit levels and determine eligibility for benefits. She could also close enrollment to the program or even ask Congress to repeal it if she determines that it is on track to become insolvent. [return to top]

House Expected to Take Action on Tri-Committee Proposal

On the other side of the Capitol, after narrowly passing a controversial “cap and trade” energy bill and a week of hearings on the House Democratic leadership’s tri-committee draft proposal, Democrats came no closer to winning GOP support for their health bill, although that does not seem to be a priority.

The House Ways and Means Committee plans to mark up its portion of health care overhaul legislation starting the week of July 13, and the Energy and Commerce and Education and Labor Committees are likely to follow similar schedules. This is perfect timing to coincide with our popular Washington fly-in with other agent and broker groups.

Democrats are narrowing their options and are beginning to confront the difficult issues of how to raise hundreds of billions of dollars to fund the overhaul.

Ways and Means Committee Chairman Charlie Rangel said he is aiming for an approximately $1 trillion package, paid for about equally by cost savings and revenue increases. He said he still does not have estimates from the Congressional Budget Office on the cost of the bill, which would impose mandates on individuals to purchase coverage and require employers to provide it. The bill would give subsidies to low-income individuals and small businesses and make a variety of changes to the Medicare payment system.

Representatives are considering a variety of revenue-raising options, including a surtax on the adjusted gross income of top earners as well as taxes on sugary sodas and alcohol. [return to top]

Wal-Mart Comes Out in Favor of Employer Mandate

Wal-Mart Stores Inc., the nation’s largest private employer, announced Tuesday that it would support a mandate on businesses to help expand health care coverage, an about-face from other employer groups that have strongly opposed any such requirement.

Wal-Mart’s support adds backing to the idea of a mandate, which Democrats want to add to health care overhaul legislation. The company issued a statement in support of the mandate along with the Service Employees International Union and the Center for American Progress, two liberal-leaning groups that have been pushing for a health care overhaul.

“We are for shared responsibility. Not every business can make the same contribution, but everyone must make some contribution. We are for an employer mandate which is fair and broad in its coverage, but any alternative to an employer mandate should not create barriers to hiring entry level employees,” the groups said in a statement.

Other employer groups led by the U.S. Chamber of Commerce have been firmly opposed to any form of employer mandate or requirement that employers pay substantially to help expand health care coverage. NAHU has long aired similar concerns.

But Wal-Mart’s backing comes with some conditions, spokesman Greg Rossiter said. According to Rossiter, Wal-Mart wanted an employer mandate that would have companies pay in based not on how many employees they have but on “profit per employee.” That would favor companies such as Wal-Mart with high numbers of low-wage employees by lowering the per-employee cost of any mandate.

If an employer mandate is constructed otherwise, “it certainly could become a disincentive” to support it, Rossiter said. He added that a mandate should also come along with “affordable options” for people to buy health care coverage as well as tax credits for small businesses to help them provide coverage for their employees.

Leslie Dach, Wal-Mart’s head of government relations, stated that a mandate should not be written in a way that makes it harder to hire low-wage workers. “We believe the mandate should cover as many businesses as possible and cover part-time as well as full-time employees,” Dach said. “Any alternative to an employer mandate should not create barriers or disincentives to hiring workers with disabilities, entry level employees or people from low-income families.”

Currently, Democrats are drafting legislation that seems certain to include some sort of employer mandate. A draft of health care overhaul legislation in the House has a “pay or play” requirement that would require employers to offer coverage or pay into a fund to help people buy insurance. The Senate HELP Committee draft contains a similar proposal, and the Senate Finance Committee is also examining some version of the policy. [return to top]

CMS Suspends Agent/Broker Compensation Policies for Further Review

On June 26, the Centers for Medicare and Medicaid Services announced that it is suspending implementation of the agent and broker compensation requirements set forth in a June 5 memorandum titled “2009 Medicare Advantage and Prescription Drug Program Agent and Broker Compensation Refinements and Compensation Rate Adjustment for 2010.”

CMS’s actions are in response to issues and concerns raised by NAHU and other stakeholders regarding the requirements, and confusion over whether an initial compensation fee should be paid for 2009 enrollments from a PDP to an MA plan.

NAHU will be weighing in with the agency in the next week before it issues a memo clarifying which enrollments in 2009 are eligible for the higher compensated initial broker commissions.

A key point of confusion has been whether or not agents will qualify for an initial commission when they enroll into Medicare Advantage plans beneficiaries who have previously had traditional Medicare or a stand-alone prescription drug plan. Otherwise, such a beneficiary would be considered a renewal and the agent would receive the lower renewal compensation level.

CMS is weighing guidance surrounding the definition of a “like plan type” in that an agent moving a beneficiary into a “like” plan receives the lower renewal compensation.

For 2010, however, CMS said agents and brokers should be paid an initial fee for enrollments from a PDP to an MA plan. [return to top]

HHS Rescinds Bush Medicaid Rules

The Health and Human Services Department rescinded three controversial Bush administration regulations governing Medicaid on Monday and said it would postpone and possibly change or rescind a fourth.

The regulations were among seven that the Bush administration tried to implement in 2007 and 2008 that sent health care providers, state governments and advocates for the poor into a lobbying frenzy. Critics charged that the administration was trying to shift the burden for about $19.6 billion in Medicaid spending over five years from the federal government to the states.

The department’s action was not unexpected. Democrats have been particularly critical of the regulations and introduced several bills in the 110th Congress to stop them. A series of congressional moratoria delayed implementation of most of the regulations until June 30.

One of the regulations the department rescinded narrowed Medicaid payments for what are called “case management services” that some states offer to Medicaid clients. Another prohibited Medicaid reimbursement for administrative costs incurred by schools and for transporting Medicaid-eligible children to school. A third narrowed the definition of “outpatient services” under Medicaid to medical treatment performed outside a hospital or clinic. The regulation that was postponed limited taxes that some states assess on health providers to help pay the state portion of Medicaid expenses.

That regulation cannot take effect before June 30, 2010, and HHS Secretary Kathleen Sebelius said that the Centers for Medicare and Medicaid Services may “give additional consideration to alternative approaches.” Sebelius also said she ordered the three regulations rescinded because they might have harmed Medicaid beneficiaries. [return to top]

Results of New CNN Poll Suggest Lack of Support for Health Reform

According to a new national poll released this week, “most people worry that their health care costs would go up if the Obama Administration’s proposals were enacted into law and only one in five thinks that his or her families would be better off under the Obama plan.”

The poll suggests that 55% of Americans think the U.S. health care system is in need of a great deal of reform, with four in 10 saying only some reform is needed. [return to top]

What Does the Public Want?

I find it interesting how the media says there is a large percentage of Americas that want public healthcare. When I talked to people, most of them seem confused. They like the idea a better system but, are surprised to learn that the systems that are used as models for reform, the Canadian or Massachusetts system, provide low levels of service and that is not what they want either.

So before you believe that Americas understand and really know what they are want when they answer these media surveys, please look at the results of a Kaiser Family Foundation (April 2009) survey, where they asked the basic question then provide the responders with some additional information and see how the results changed.

• 67% favor creating a public option “similar to Medicare”

• When told that public plans would be the first step toward single-payer, government-run health care, overall support drops to 41%
• When told that the government could have an unfair advantage over private plans, overall support drops to 32%

• 71% support “requiring employers to offer health insurance to their workers or pay money into a government fund”

• When told that mandates are “more fair because today some employers pay for health insurance and some do not,” overall support rises to 78 percent
• When told that the approach may mean some job loss, overall support drops to 27%

I believe, like most people, that the healthcare can be improved and be more cost effective. My concern is when Washington promote systems that provide low quality of service as a standard (see my blog http://yourlegacybenefits.blogspot.com/ for articles about the level of service provided in Canada and Massachusetts) instead real solutions like the Safeway system and a real medical records system. I just have to ask is it about finding a solution or wanting more governmental control?

By Ray Ward of Legacy Benefits & Insurance Services

RayWard@YourLegacyBenefits.com

www.YourLegacyBenefits.com

Senate's Health-Care Draft Calls for Most to Buy Insurance, Nixes Obama's 'Public Option'

The Senate has come out with their healthcare proposal; on the positive side they are not proposing a public plan. But there are questions:

1) The proposal requires a State-based Exchange for enrollments of individual and small groups, and this Exchange must be self sustaining. In the past, some in Washington blamed health brokers as an unneeded administrative cost. Is the Exchange a way to eliminate brokers? Wouldn’t the Exchange be an administrative cost? Good brokers provide not only comparative pricing service but communication and administrative services to their clients, will the Exchange provide quality services to the purchaser of these plans or can we expect DMV or Post Office quality service?

2) Why are undocumented workers granted an exemption form having coverage? Would this be a reason not to become documented? Will they still have access to services? I do not understand why we would have a law that forces our citizens and legal immigrates must pay for services that is given to people who haven’t become legal residents.

3) Missing in this proposal is mention of Section 125 pre-taxing of premiums, daycare expenses and unreimbursed medical expenses. While HSA’s out-of-pocket limits are mentioned the pre-taxing of these accounts is also not mentioned. I have a lot of clients that have these accounts it helps them manage their expenses and help keep money in their pocket. Since there are members of Congress that want to eliminate these accounts, I believe that they should clear in their proposal what their intent is.

Next question, what will the House proposes?

By Lori Montgomery and Shailagh Murray - Washington Post Staff Writers - Friday, June 19, 2009

A draft proposal in the Senate to overhaul the nation's health-care system would require most people to buy health insurance, authorize an expansion of Medicaid coverage and create consumer-owned cooperative plans instead of the government coverage that President Obama is seeking.

The document, distributed among members of the Senate Finance Committee yesterday afternoon, addressed none of the funding questions that have consumed House and Senate negotiators in recent days. But it included an array of coverage provisions that were drastically scaled back from earlier versions, as lawmakers seek to shrink the bill's overall cost. The proposal, for instance, would reduce the pool of middle-class beneficiaries eligible for a new tax credit meant to make insurance more affordable.

The absence of a "public option" marks perhaps the most significant omission. Obama and many Democrats had sought a public option to ensure affordable, universal coverage, but as many as 10 Senate Democrats have protested the idea as unfair to private insurers. In its place, the draft circulated yesterday outlines a co-op approach modeled after rural electricity and telecom providers, subject to government oversight and funded with federal seed money.

Yesterday, Senate Finance Committee Chairman Max Baucus (D-Mont.) met with four Republicans, including Sen. Charles Grassley (Iowa), the ranking GOP member on the panel, along with two Democratic colleagues in an attempt to find bipartisan consensus. Baucus dubbed the group "the coalition of the willing."

Meanwhile, in the House, Democrats are exploring a range of funding options, including a surtax on the rich and an increase in the payroll tax imposed on all U.S. workers. The list also includes new taxes on sugary drinks and alcohol, along with broader levies, such as a national value-added tax of up to 3 percent.

The Senate's preferred option -- taxing the health benefits that millions of Americans receive through their employers -- is also on the House list. So is Obama's favorite idea: limiting the value of itemized deductions for the nation's wealthiest 3 million taxpayers.

Rep. Richard Neal (D-Mass.), chairman of the Ways and Means subcommittee charged with developing a financing plan, said lawmakers have not "embraced any particular source of revenue." But he confirmed that big, broad-based taxes like the payroll tax and a value-added tax are under discussion, mainly because they have the potential to raise "a lot of money" for an expansion of health coverage expected to cost more than $1 trillion over the next decade.

The House will not unveil a financing plan until after the July 4 recess, Neal said, though House leaders were expected to release an outline of the rest of their plan today, with a goal of putting a bill to vote later this summer. The Senate is aiming to debate its legislation in July as well, and is seeking a bill that would cost less than $1 trillion.

Maintaining that tight schedule could prove difficult, though, because daunting issues remain in both chambers. One area of contention is the extent to which private employers must subsidize public coverage for their workers if the companies don't offer their own plan or if the premiums are unaffordable. The Congressional Budget Office has warned that if lawmakers don't find the right formula, employees may flee their company plans for federal coverage, sending government costs soaring.

The draft in the Senate committee spells out one possible solution: It would require employers to pay 50 percent of Medicaid costs for workers enrolled in the low-income program and 100 percent of the cost of health-insurance tax credits for eligible employees. Workers could forfeit employer coverage only if the cost exceeds 12.5 percent of their income.

The draft, earlier reported on by washingtonpost.com blogger Ezra Klein, spells out four options for requiring employers to provide coverage, with exemptions for firms with up to 200 employees. It would fine individuals who do not purchase coverage, though certain groups, including Native Americans and undocumented workers, would be exempted.

It also would loosen eligibility requirements for Medicaid, a proposal certain to alarm many governors who are grappling with budget crises.

How Safeway Is Cutting Health-Care Costs

Wow, this is a great example of private industry finding a solution to control costs verses the Federal government wanting to copy a program (MA system) that has produced increasing costs and reducing access to service.

Market-based solutions can reduce the national health-care bill by 40%.

JUNE 12, 2009 By STEVEN A. BURD

Effective health-care reform must meet two objectives: 1) It must secure coverage for all Americans, and 2) it must dramatically lower the cost of health care. Health-care spending has outpaced the rise in all other consumer spending by nearly a factor of three since 1980, increasing to 18% of GDP in 2009 from 9% of GDP. This disturbing trend will not change regardless of who pays these costs -- government or the private sector -- unless we can find a way to improve the health of our citizens. Failure to do so will make American companies less competitive in the global marketplace, increase taxes, and undermine our economy.

At Safeway we believe that well-designed health-care reform, utilizing market-based solutions, can ultimately reduce our nation's health-care bill by 40%. The key to achieving these savings is health-care plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies' costs have increased 38% over the same four years.

Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity). Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.

As much as we would like to take credit for being a health-care innovator, Safeway has done nothing more than borrow from the well-tested automobile insurance model. For decades, driving behavior has been correlated with accident risk and has therefore translated into premium differences among drivers. Stated somewhat differently, the auto-insurance industry has long recognized the role of personal responsibility. As a result, bad behaviors (like speeding, tickets for failure to follow the rules of the road, and frequency of accidents) are considered when establishing insurance premiums. Bad driver premiums are not subsidized by the good driver premiums.

As with most employers, Safeway's employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member's behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.

At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.

Today, we are constrained by current laws from increasing these incentives. We reward plan members $312 per year for not using tobacco, yet the annual cost of insuring a tobacco user is $1,400. Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors. If these limits are appropriately increased, I am confident Safeway's per capita health-care costs will decline for at least another five years as our work force becomes healthier.

The Healthy Measures program currently applies only to our nonunion work force. While we have numerous health and wellness provisions in our union contracts, we are working with union leaders like Joe Hansen of the United Food and Commercial Workers to incorporate healthy measures provisions in our union work force as well.

While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation's direct health-care bill would be $550 billion less than it is today. This is almost four times the $150 billion that most experts estimate to be the cost of covering today's 47 million uninsured. The implication is that we can achieve health-care reform with universal coverage and declining per capita health-care costs.

There is a very real possibility that we will see positive transformational health-care reform in the near future. I am encouraged by the effort I see on Capitol Hill, particularly the bipartisan effort in the Senate. While some tough issues remain, if we continue to work in a bipartisan manner I believe we will resolve these issues successfully and find agreement on meaningful reform.

Mr. Burd is CEO of Safeway Inc., and the founder of the Coalition to Advance Healthcare Reform.

Doctor Wait Times, Costs, ER Visits in Massachusetts Climb

There are many articles about the short falls in the Massachusetts new Universal Health Plan which many people say the federal government should use as the structure for socialized healthcare in the US, the main problems are long waits times to see a doctor, inability to find a primary care doctor, and higher costs. I found that this blog puts the information together in one spot. If you are not comfortable with the author, google the Boston Globe articles on this subject and you can confirm the information over many articles that have written.

The best laid schemes o’ mice and men
Gang alt a-gley (go off the planned line)

Robert Burns, 1759-1796

More people are seeking care in Massachusetts hospital emergency rooms, and the cost of caring for ER patients has soared 17% over two years. This is despite efforts to direct patients with nonurgent problems to primary care doctors instead, according to new state data. Visits to Massachusetts emergency rooms grew 7% between 2005 and 2007, to 2,469,295 visits. The estimated cost of treating those patients jumped from $826 million to $973 million.

“ER Visits, Costs in Massachusetts Climb,” Boston Globe, April 24, 2009

Long wait times in Boston may be driven in part by the healthcare reform initiative that was put in place in Massachusetts in 2006. The initiative succeeded in covering many of the state’s uninsured patients. However, it has been reported that many patients in Massachusetts are encountering difficulty in accessing physicians. Long appointmend times in Boston may signal what could happen nationally in the event that access to health care is expanded through healthcare reform. Increased demand resulting from improved access to care for 47 million uninsured people can be expexted to extend doctor appointment wait timen in many markets.

Merritt Hawkins & Associates, “2009 Survey of Physician Appointment Wait Times,” www.merritthawkins.com

Among the political cognoscenti, Massachusetts is considered the Bluest of the Blue States, the Elite of the Elite, the Leaders of the Liberal Health Reform Band. It is the state where President Obama received his law school education, where Senator Edward Kennedy has fought for a single payer system for 40 years, where Obama’s closest health care advisors, Dean David Cutler, PhD, of Harvard and Robert Blumenthal, M.D., of Massachusetts General and National Coordinator for Health Information Technology,reside, and where the nation’s first “universal health plan” was spawned and has been in operation for three years.

Yet, despite this political firepower, something seems to have gone askew. Massachusetts health costs are the highest in the land. Despite the highest concentration of physicians per capita and lowest rate of uninsured among the states (2.6%), people are having a hard time finding doctors, especially primary care practitioners but other specialists as well. Bay State residents are flocking to high-cost emergency rooms for care in unprecedented numbers. And all of this in an affluent states which is supposed to set an example for other states to follow.

The average wait times for appointments in Boston for cardiology are 21 days, dermatology 54 days, obstetrics-gynecology 70 days, orthopedic surgery 40 days, and family practice 63 days.

The average cumulative wait times for the 5 specialties just mentioned are,

Boston, 50 days

Philadelphia, 27 days

Los Angeles, 24 days

Houston, 23 days

Washington, D.C., 23 days

San Diego, 20 days

Minneapolis, 20 days

Dallas, 19 days

New York, 19 days

Denver, 15 days

Miami, 15 days

Portland, 14 days

Seattle, 14 days

Detroit, 12 days

Atlanta, 11 days

Conclusion

In Massachusetts and Boston, expanded access through a near-universal coverage plan has consequences - higher costs, increased ER use, harder times finding doctors, longer waiting times for doctor appointments.

Most people who say they understand HSAs really don't

This article points out a problem we have Health Saving Accounts, most people do not understand them well enough to make an informed decision. The triple tax savings and the flexibility of the account are key components and need to be communicated. Unfortunately it seems that most employers and brokers only discuss the reduced premiums. If you would like more information on HSA's, please contact me at RayWard@YourLegacyBenefits.com or visit the US Treasury site for details.

Wednesday, June 3, 2009 - post on blog: http://www.blogbythenumbers.com/2009/06/most-people-who-say-they-understand.html

That’s the word from Guardian Life Insurance. New research from the company shows that while 59% of consumers know of HSAs, most of those folks don’t understand that contributions and qualified withdrawals are tax free, 52% and 55% admitted as much respectively. Sixty percent said they didn’t know they can take their HSA with them if they switch jobs.

Guardian used Opinion Research Crop to survey 1,000 adults last December. Overall, just one in seven said they owned an HSA.

The knowledge gap is important, according to Guardian’s Tim Bireley, because HSAs coupled with HDHPs are a good fit for both employers and workers looking for ways to cope with expensive medical costs and health insurance bills.

His company thinks they’ve found a way to move the ball forward by pairing a critical illness program with an HSA/HDHP. That deals with a primary consumer concern about the products. The logic is that since workers are scared they won’t be able to find the money if illness strikes before they’ve booked a decent balance in the account, give them a CI policy to bridge that gap in the event they do get sick.