Obama Administration Considers Requiring Veterans To Use Private Health Insurance for Coverage of Service-Related Injuries

This article discusses how the Federal government is trying to transfer their responsibility for taking care of our verterns to private insurance companies. Are these the same people that say that private insurance can not manage costs correctly and they can?

March 17, 2009 - Representatives of several veterans groups on Monday criticized a proposal that would bill private insurance companies for combat- and service-related medical care, McClatchy/Arizona Daily Star reports (McClatchy/Arizona Daily Star, 3/17). The proposal is included in President Obama's fiscal year 2010 budget proposal. Currently, the Department of Veterans Affairs covers those costs and bills health insurers only for treatment for conditions unrelated to veterans' military service.

Last month, 11 veterans groups wrote a letter to Obama, saying, "There is simply no logical explanation for billing a veteran's personal insurance for care that the VA has a responsibility to provide." The groups added that the policy would discourage employers from hiring veterans with disabilities, increase insurance premiums for disabled veterans and renege on the U.S. government's "sacred obligation" to care for the injuries veterans sustained during service (Kaiser Daily Health Policy Report, 3/10). Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, said, "Veterans of all generations agree that this proposal is bad for the country and bad for veterans," adding, "If the president and the [White House Office of Management and Budget] want to cut costs, they can start at AIG, not the VA." In a speech at VA on Monday, Obama said he hopes to increase VA funding by $25 billion over five years, but he did not address the policy proposal.

According to McClatchy/Daily Star, reaction from congressional lawmakers to the proposal has been "swift and harsh." Sen. Patty Murray (D-Wash.), a member of the Senate Committee on Veterans' Affairs, at a hearing last week described the policy proposal as "[d]ead on arrival," adding, "When our troops are injured while serving our country, we should take care of those injuries completely." Murray also said, "I don't think we should nickel-and-dime them for their care." VA Secretary Eric Shinseki at the hearing said that the plan was "a consideration," and noted that it was included as a revenue-generating provision in the department's proposed budget for 2010. Shinseki also said that "a final decision hasn't been made yet" (McClatchy/Arizona Daily Star, 3/17).

MSNBC's "The Rachel Maddow Show" on Monday included a segment on the policy proposal. The segment included an interview with Rieckhoff (Maddow, "The Rachel Maddow Show," MSNBC, 3/16).

Update on CalCOBRA

This article was published by Anthem (Blue Cross) discussing CA Assembly Bill 23 and it's effect on CalCOBRA. Also here is a link to a press release from Karen Bass (Speaker of the Assembly) about the bill: http://democrats.assembly.ca.gov/speaker/News_Room/Press/press_releases/20090402D47PR01.aspx

The new CalCOBRA legislation, California Assembly Bill 23, is expected to be signed by the Governor by the end of this week. This bill will align the current CalCOBRA legislation with the Federal Subsidy as defined by ARRA (American Recovery and Reinvestment Act). The following are high-level details you should be aware of:

• This bill states that health plans and health insurers have 14 days from the date of enactment to provide proper notification to those individuals who may qualify for the Cal-COBRA subsidy. The Department of Labor ("DOL") has agreed that the timeliness within which the state mini-COBRA programs must comply is to be determined by the states themselves. The DOL held a call with the California Department of Insurance ("CDI") and the Department of Managed Health Care ("DMHC") to assure this is understood by all three regulators.
  
  
• The mailing will go out to all individuals who had a qualifying event between Sept. 1, 2008, to the present, regardless of whether or not they had already elected CalCOBRA.
  
• The bill (AB23) currently states that California residents who were involuntarily terminated from their jobs between Sept. 1, 2008, and the present will qualify for the Cal-COBRA special election period.
  
  
• There is a notice letter being developed by Anthem in conjunction with the California Association of Health Plans ("CAHP") and other health plans in this state. Once finalized, this notice will be deemed approved by both the CDI and DMHC. We will send the notice as soon as possible following the enactment of AB 23.
  
  
• Once the bill is finalized and signed into law, we'll share a more detailed summary of the specific provisions of this law.

In the interim

• We aren't waiting on direction from the state. The Federal Subsidy is defined already and the materials and/or links to that information are at your disposal at www.dol.gov/cobra.
  
  
• We're educating people, much like what you have already been doing.
  
  
• We should not be forcing members to pay 100 percent premiums from March 1 to the present. We should be helping to educate people as to the qualifications to actually take part of the premium relief. If they don't qualify, they should be held accountable for the full premium. This is for CalCOBRA only. For Federal COBRA, the groups are required to manage this, bill their members directly and pay the carrier directly in full.
  
• Premium refunds are not an option. Keep in mind that the premium relief/subsidy is effective March 1 and doesn't qualify for premiums paid on behalf of COBRA or CalCOBRA prior to that. And this is only available for up to nine months.
  
• Participation in the subsidy is optional. The consumer must actively agree to take part in this. For Federal COBRA, the employer is held accountable for properly notifying their AEIs (Assistance Eligible Individuals) and collecting the attestation form. We don't need this form on file -- the employer does. The employer is to notify us only for reasons to re-enroll or enroll their previous employees into the COBRA program.
  
  
• There may be a gap in coverage for these members. However, only for those who had qualifying events stemming back from Sept. 1 through Feb. 17, their coverage, if now elected, must start on March 1 and the entire COBRA allowable timeframe must be deducted regardless of the effective date.

We thank you for your patience in this matter as we are all anxiously awaiting approval of this bill.

Report questions stimulus bill health IT money

Our President has been saying that electronic medical records will be one of the major ways to reduce healthcare costs, unfortunately this article points out why many medical offices will not upgrade to the electronic records.

By ERICA WERNER, Associated Press Writer

Tuesday, March 10, 2009(03-10) 06:19 PDT WASHINGTON, (AP) --

Billions of stimulus dollars meant to spur doctors to switch to electronic record-keeping may not be enough to do the job, a private consulting firm said Monday.

The stimulus bill that President Barack Obama signed last month contained $19 billion for health information technology, including $17 billion for incentives and penalties to encourage doctors and hospitals to abandon paper record-keeping and go high-tech beginning in 2011.

But particularly for doctors in small practices, the high cost of installing electronic records systems could outweigh the incentives and penalties for failing to comply, the new analysis said.

The study by Avalere Health, an information company serving government and the health care industry, said as many as half these doctors might decide they are better off financially with the status quo.

"How rapidly will physician offices make these investments, particularly those smaller offices with less capital?" said Jon Glaudemans, a senior vice president at Avalere.

"Frankly if the choice is between continuing health insurance for your staff and buying a new IT system that gets paid back over five years, that's going to challenge an office manager or administrator anywhere in the country."

A Health and Human Services Department spokeswoman cited a Congressional Budget Office estimate that 90 percent of doctors would be using health IT by 2019 thanks to the stimulus bill.

"The investments are designed to help make new systems more affordable for doctors and were never intended to wholly subsidize the adoption of this technology," Jenny Backus said. "As the market for health IT expands, the costs for these systems will come down."

Using government cost estimates, Avalere researchers found that it would cost about $124,000 for a single doctor or small practice to upgrade to electronic health records over the five year period from 2011-2015 when the stimulus bill offers incentives to do so.

But the total incentive payments a doctor could get over that time period only add up to $44,000.

In 2015, penalties start to kick in for doctors who haven't switched to electronic record-keeping. But in one scenario mapped by Avalere, the starting penalty would be $5,100 a year — far less than how much it would cost to install and maintain an electronic health system.

Add in the shaky economy, the uncertain outlook for a health care overhaul, and the government's failure to define, so far, what kind of electronic health systems will be deemed acceptable. Together they make switching to electronic record-keeping a leap of faith for some doctors, the analysis said.

The expense of making the switch is compounded by the fact that many systems now available can't communicate with each other so that if a small doctors' office upgrades to electronic records, the benefits are limited.

The ultimate goal is for systems to be "interoperable" so that a patient's records can be shared among doctors' offices, but the rules to make that happen remain largely unwritten.

It's unclear how quickly the Obama administration will begin putting forward rules outlining how doctors and hospitals can qualify for the money. The director of the Office of National Coordinator for Health IT will be responsible for much of the rule-making but that person has not been appointed.

Baucus promises health-care action

Again, I find it interesting that the leaders in the Federal Government say they do not want government run healthcare by saying they want employers to continue to provide healthcare to their employees but at the same time they want to reduce the employer's deductions on healthcare premiums. I also like how they say that they do not want a socialized medicine (single-payer) but they will not rule it out.

By Michael Vitez The Philadelphia Inquirer Staff Writer

Sen. Max Baucus, chairman of the Senate Finance Committee and one of the most influential voices in Washington on health care, promised yesterday to introduce comprehensive health-care legislation in June, certainly before the chamber's August recess.

He said that he planned to introduce a bipartisan bill with Sen. Charles E. Grassley (R., Iowa) that would adopt a mix of public and private solutions and that he hoped 70 senators would approve it.

"Enacting comprehensive health-care reform . . . is my top priority," said Baucus, a Montana Democrat. "So much that my office wonders whether I spend enough time on other matters. I want to make sure it passes this year" and is phased in over two or three years.

Baucus said passage last month of CHIP legislation insuring 11 million more children, followed by health provisions in the recent stimulus bill, was the beginning.

"Now it's time to move from first steps to giant steps," he said. "There's never been a better moment. The stars are all aligning. . . . I don't know if any president has been as committed as President Obama."

Baucus said it was too early to be specific about exactly how things would work under the legislation. He spent last year holding hearings and writing a white paper, "A Call to Action," which he said was similar to Obama's and close to the new Massachusetts plan now providing near-universal coverage to residents there.

"We got a huge mess on our hands," he said. "Everything's got to be on the table - everything."

Baucus spoke to reporters - live and via the Internet - at the Kaiser Family Foundation in Washington. He said he supported employer-based health insurance, which is how 170 million Americans get coverage, but favored trimming the deductions that employers received for their health-care contributions.

"I do not want to eliminate that deductibility to companies," he said. "But I do think it should be trimmed or limited. It's regressive. It skews the system."

The biggest opportunity, he said, would lie in reforming payments so they rewarded quality care. "How we pay for what we get - that's where the reform has to be," he said.

Mark Pauly, a professor at the University of Pennsylvania's Wharton School, said yesterday in an e-mail that "based on the state of the science, I do not think that America is yet ready to base payment on quality in many areas. This is an aspiration, not a policy."

Baucus said he wanted universal coverage, but not a single-payer system.

"We need to come up with a uniquely American solution, which is a combination of public and private," he said. "I think we'd be spending capital inefficiently to pursue single-payer. I think there should be choice, flexibility, in our reform package. This is not a single-pay country."

Health-policy analysts said yesterday they were not surprised by Baucus' remarks.

"All along Obama has been saying he's not going to go with a single-payer," said Robert I. Field, a health-policy professor at the University of the Sciences in Philadelphia. "It's consistent with . . . the political realities."

Not everyone has accepted this. Rep. John Conyers Jr. (D., Mich.) will visit Philadelphia on Saturday in support of H.R. 676, the National Health Care Act, which would create a single-payer, universal health-care system. Conyers will speak at 10:30 a.m. at Thomas Jefferson University's Connelly Auditorium, 11th and Locust Streets, and at 1 p.m. at the Penn Newman Center, 3720 Chestnut St.