Crazyjames-Health

Posts Tagged ‘Reform’

Demographics In the United States, the face of internal medicine is changing rapidly, as quoted from a recent report by the U. S. Census Bureau, and the average age of Americans is also increasing dramatically. The age group of 65+ is going to double in the next quarter-century, peaking at almost one fifth of United States citizens. The 85+ group is also now becoming the fastest growing age group currently. Older citizens are healthier than ever, however the numbers of disabled and chronic condition sufferers are on the rise. This will result in a relatively concurrent rise in the demand for healthcare. Of the fourteen million people in the 65+ range who reported a disability or partial disability of some kind, the conditions being suffered from were prevalently chronic arthritis or heart disease. These factors are the driving force behind the continual growth for demand of physicians, which may result in shortages of available medical services. Other affecting issues include the rising demand for health care in general, the weakening economy, and the impending healthcare reform. Primary Care Shortage Up to 1/3rd of the current 650,000 practicing physicians will be considering retiring by the year 2020. A shortage of primary care physicians is a particular concern due to this, and also the choice of younger physicians to choose to further specialize. The reason behind this is that further specialization beyond, or a specialization instead of, primary usually results in higher salaries and more desirable employment locations. A population center, such as New York, Miami, Los Angeles, or Chicago is going to have need of highly specialized physicians, with much less competition for the available job opportunities. The shortage is expected to hit rural and underserved areas the hardest. By the year 2020, the ACFM (American Academy of Family Physicians) have suggested that there will be a deficit of over forty thousand primary care physicians (Family Practice, Internal Medicine, Pediatrics, OBGYN, to name a few). Since med school students choosing primary care as a career / profession has dropped already by almost 52% since ’97, the decline is expected to increase if nothing is done to remedy this predicament. This could turn the tables, leaving primary care physicians with the higher salaries. Weak Economy and Aging Population With the current economic hardship and enormous job losses across the country, these have unswervingly affected the cash flow to doctors and physicians. When jobs are lost, the loss of healthcare benefits is inevitable, and so access to health care is also. However, many doctors are postponing retirement since watching the stock market annihilate their retirement reserves. This delay will result in a much smaller number of employment opportunities being offered and graduating residents not finding as many available jobs as before. Residents today seem to prefer not to commit to less desirable jobs, and are choosing locum tenens opportunities. They are also putting off committing to full-time employment because of the scarcity and lower salaries. So in the near future, it appears there will be fewer and fewer good jobs available.

This week on Healthcare Reform After weeks of stalemate on Capitol Hill, lawmakers in both chambers of Congress have reported progress in their talks this week, paving the way for a possible vote on comprehensive reform legislation in health care after August recess. To help make sense of the numerous reform plans and details of the plan, review the table below. Public Plan Rooms Democrats reached a compromise: After weeks of internal strife, House Democrats on Energy and Commerce Committee reached an agreement Wednesday that will shave U.S. $ 100 billion cost of the original initiative Chamber of over 1 billion. Energy and Commerce Committee resumed markup a bill Thursday, but the full House will not vote until after the August recess. Congressional Budget Office (CBO) plan in the House: CBO helped when House Democrats’ choice for public service, when it was reported that under the proposed legislation, most people will still opt coverage by an employer for more than one option run by the government. CBO noted that, given the individual mandate, more employees enrolling for coverage with their employer. However, recent analysis has also stated that the proposal to increase budget deficits again. Senate may choose the Co-Op now Option Public: Senate Finance Committee negotiators to show that they were about to reach a bipartisan agreement that will include a plan for the cooperative model. The proposal under discussion would involve a tax on insurers and use non-profit cooperatives to compete with private insurers. The proposal does not include an employer mandate. Alternative plans of the House Republican plan for $ 700B: Wednesday, House Republicans unveiled a 700 billion U.S. plan to provide health care tax cuts and loans to assist people in purchasing insurance and receives medical malpractice. According to Republicans in the House, the proposed plan paid in full, but not yet officially CBO has estimated that the cost of the legislation. New Plan Financing Bill Senatorial CBO Score: Finance Senatorial Committee received a boost when the CBO estimates that the latest draft of the Health Committee would cost less than $ 900,000,000,000. The bill covers 95 percent of Americans in 2015 and paid in full for 10 years before, according to President of Finance Max Baucus (D-MT). Tax on “Cadillac plans Earnings Moment ‘: option on the Senate Finance Committee in the insurance tax on the value of” Cadillac plans of assistance “has attracted the Senate, and this seems to top House Democrats s’ are warming to the proposed financing. A spokesman for America’s Health Insurance Plans expressed their opposition to the plan, and many claim that a tax on insurers ultimately will be passed on to consumers. Independent Group Rates CBO: CBO report this week that the group of independent experts nominated to oversee Medicare payments would result in only $ 2 billion in savings over 10 years. AARP expressed additional concern: Obama held a small meeting room at the style of the American Association of Retired Persons (AARP) in Washington last week to address the growing concern of adults over health reform and benefit cuts later. “Surveys show that older people are more skeptical about health care reform than any other age group. Therefore, AARP wanted to walk a careful line project approved in the House. Earlier this week, AARP expressed disappointment at the lack of progress in the Senate, saying that senators had “acted.” In the future, legislators from the House plan to finish the job this week and the rest for a break of one month to return to their districts to keep discussing health care reform efforts. Recession Senate on August 7.

President Obama’s administration continues to promote health care reform. Many people are concerned with how that would affect health insurance products in Georgia. Some people wonder whether the government should provide health care will have a negative impact on medical care. Other people worry that if the government provides health insurance products that Georgia health insurance products offered by private insurance providers will be more expensive. Although people have the concern that the quality of care people will be harmed if the government gets involved. All these are serious problems that the government is trying to ease people’s minds about how their reform efforts will affect, in particular health insurance plans in Georgia. Competition among seven insurance companies in Georgia so far has helped Georgia health insurance policies in the state more affordable. Georgia residents appreciate this fact. There are a lot of government regulation and oversight of health insurance. Therefore, in Georgia, you can be sure that the policies of Georgia health insurance are fair and inclusive, and meet all the requests made by both state and federal. Georgia health insurance companies also work to reform, although the emphasis on health reform at the White House said that the major insurance companies should be reformed, is not necessarily accurate. Many major insurance companies have been pushing reforms in the industry for a long time. There are new ideas and suggestions that was made all the time. Georgia health insurance companies want more and more people have access to quality medical care, which is the same order in government. So, really, who are both working towards the same goal, and are not necessarily conflicting. The government offers several tax incentives for business owners to offer health insurance benefits for employees Georgia. It really helps business owners, and in fact the reward for being good employers. This is useful because business owners consider that a good compensation package, including vacation time, sick days and health insurance policies, Georgia, helps attract and keep good, loyal, reliable employees. This is the kind that anyone would want employees. Good employees expect to receive better health insurance benefits Georgia, when working for a company as well. So make this happen is very important that all parties involved. There can be no tax cuts for people who are buying additional health insurance Georgia Medigap products. You need to check with your accountant or tax expert to know exactly what the tax consequences of buying Georgia health insurance are medical. However, be sure that both the government and the IRS are trying to help care for their medical needs. Georgia Government also provides additional help when it comes to health insurance products in Georgia. There are programs available for children under 18 have access to health insurance benefits Georgia. Three companies to help provide these plans. Consult with a government agency under the Georgian

Most know that Senate democrats have issued a statement claiming that the August deadline on Health Care reform imposed by Barack Obama will not be met, but not many know that White House Chief of Staff Rahm Emanuel says that they will vote on the legislation, possibly as early as next week. Emanuel isn’t alone, all across the country political pressure is being utilized to gain public support, support of key democrats, and business leaders, and our region hasn’t been left out. In a discussion this past Friday, Senator Bob Casey Jr. , told a health care roundtable at the Children’s Home of Pittsburgh & Lemieux Family Center that to slow-down and not vote on a health care reform plan would be a mistake. To “stop is a very bad choice for our country, especially for our economy,” the Senator said during health care roundtable. Senator Casey hosted the roundtable via teleconference. He told the group; “I don’t have a lot of patience for those who say we need another six months. ” More than a dozen high-level health care representatives and advocates attended the small symposium some of which expressed support for an complete overhaul of our country’s health care system.

SO HEALTH CARE REFORM HAS FINALLY PASSED! Yet, missed amongst the clamor surrounding, “political partisanship”, “the funding of abortion” or “the Cadillac tax” there is a significant subsidy that may provide relief to plan sponsors struggling to reign in retiree healthcare costs. This provision, referenced as the “Reinsurance Program”, creates a “reinsurance” subsidy for plan sponsors of retiree health plans providing coverage for pre- Medicare retirees over the age of 55. The Medicare Modernization Act of 2003 created an employer subsidy program (“Retiree Drug Subsidy” or “RDS”) for plan sponsors as an incentive to maintain their retiree drug plans in lieu of dropping the coverage and forcing retirees to a Medicare Part D plan. The Reinsurance Program appears to provide employers a similar incentive. The incentive under this program would be for employer groups to maintain the medical plans for their pre- Medicare eligible retirees in return for a significant subsidy. The Reinsurance Program clearly benefits employers and industries that are union-dominated and saddled with rich and expensive retiree medical plans. Ironically, as the health care reform bills have been touched by so many special interests and tainted by the political reality of compromise, one of the remaining provisions, the “Cadillac tax”, may be neutralized by the subsidy (although at print, labor presumably has worked out a deal with the White House to exempt groups with collective bargaining agreements until 2018). The “Cadillac tax”, which imposes a 40% excise tax on plans with premium costs exceeding pre-established “threshold amounts”, would increase plan costs for many of the same plans eligible for the reinsurance subsidy. For plan sponsors with a considerable retiree population the effect is that every dollar of the retiree plan premium subject to the excise tax could be significantly offset by a corresponding subsidy. What are the Potential Savings? The proposed program would establish a “temporary” Reinsurance Program for employers who provide health insurance coverage to retirees over the age of 55 and who are NOT yet eligible for Medicare. The program would reimburse employers or insurers for 80% of retiree claims between $15,000 and $90,000. For an employer group with 700 employees and 500 retirees that spends $10,000,000 a year on health insurance plans, the subsidy could be as much as $720,000, effectively reducing its retiree plan costs by 14. 4%. How Will This Reinsurance Program Work? If we can learn any lessons from the Retiree Drug Subsidy (“RDS”) program, where initially the drug subsidy was to be calculated as a percentage on ALL prescription drug claims incurred by plan sponsors, there will likely be a segment within the government that will push to dilute and reduce the category of “eligible” claims in the final calculation. The RDS formula was initially relatively simple until there was a bureaucratic decision to create “excluded” drug classes from subsidy eligibility. CMS’ rationale behind this change was to NOT pay subsidy on drugs that were excluded under the government sponsored Part D drug plan formulary. There could be a similar rationale used to create “excluded” medical expenses to align subsidy eligibility with only medical procedures approved and part of the government’s baseline plans as defined within the final bill. Moreover, the language within the two bills is unclear as to “who” gets the subsidy. The Senate bill states “. . . . the program will reimburse employers or insurers” whereas the House bill only references “employers. ” Moreover, the language in both bills state explicitly that “payments from the Reinsurance Program will be used to lower the costs for enrollees in the employer plan”. What can we interpret from this language? Will the employer not be eligible for subsidy? Will insurance carriers be able to create insurance plans for employer groups and keep the subsidy and then lower premium costs just as they do now under Medicare Advantage? How Long Will This Program Last? The subsidy is “temporary”, as the Bill appropriates only $5 billion to fund this program through January 1, 2014. Quick math shows that the monies earmarked for this program could run out quickly. The 2006 PEW Center1 Study reported significant un-funded retiree healthcare liabilities for state and local governments alone. State systems are projected to payout $9. 7 billion for “other post employment benefits”. The 30 year retiree healthcare liability was projected to be $381 billion; a conservative estimate since these figures do not include obligations for teachers or local government workers. The State of California, combined with all local governments within California, was projected to have a $6 billion retiree healthcare bill in 2009. Add to this all the large Taft Hartley plans, independent VEBA plans (i. e. the UAW VEBA) and the remaining large private sector retiree plans, one can see this earmark evaporating in a short period of time. This begs the question. How will priority be established if the government agency in charge of managing this program is inundated with applications? Will it be first come, first serve? Will there be some level of “need” established to assign priority or create qualification? Or will this program, once Health Care Reform passes, become another entitlement program that is legislated into permanency? To learn more about the potential impact of Health Care Reform on Municipal Government Medical Insurance Plans, tune in to our free webinar Wednesday, April 28th. at 9AM. For more than two decades Mark Manquen, CPA, MST has serviced clients on healthcare cost containment, innovative plan design solutions and retiree plan transition strategies within a union setting. As founder of RDS Services, LLC he has incorporated services specific to the Municipal market in areas such as GASB consulting, full service Retiree Drug Subsidy administration, and Medicare Act services. In 2008, Mark was named as one of Corp! Magazine’s Honorees for Entrepreneurs of Distinction. 1 The Pew Research Center is a non-profit, tax-exempt corporation which operates under Section 501(c) (3) of the Internal Revenue Service code. It was established in 2004 as a subsidiary of The Pew Charitable Trusts, a Philadelphia-based public charity. The Pew Research Center is a nonpartisan “fact tank” that provides information on the issues, attitudes and trends shaping America and the world. It does so by conducting public opinion polling and social science research; by reporting news and analyzing news coverage; and by holding forums and briefings. It does not take positions on policy.

A slight frowning haunted the Democrats in the House of Representatives when just a month ago a Republican has been sent to Washington by his people to gain the seat Sen. Ted Kennedy vacated upon the latter’s demise. Senator Scott Brown won the election and upheld against the late senator’s advocacy of bringing reform on health care after decades of championing the bill in the senate. It took several administrations before finally the country had an optimistic president who goes beyond political boundaries and test the delicate waters of partisanship in the person President Obama. Filibuster that is Brown as expected by many, there are still maneuvers in the house that shone hope on the Democrats and several Republicans who pushes health care reform. The health care sector represented by doctors and nurses whether in their medical scrubs in practice or those in corporate uniforms that works for managerial positions is also divided in opinion. Whereas the first reason of the anxiety of these people is the entry in the law that would somehow actually limits the patients’ right to choose a practitioner. Though this idea has been shun off by the authors, there is still doubt that is never removed from the healthcare providers. Thus for the part of the people in nursing uniforms, this issue is an important milestone that when passed with great legislative errors or beyond the process would eventually lead to chaos. While every sector that will be affected by the reform has been consulted and is still being constantly consulted, the conservatives would actually maneuver the moves into technicalities and procedural issues rather than that of the essence and merits of the bill itself. “We’ve got to put all the pressure we can on these Democrats to make sure this bill never, ever happens,” House minority leader John Boehner said on Time. The issue being implied by Rep. Boehner is no longer on the aspect of having a reform but rather eradicating reform at all by killing the bill with the Republican votes. This statement of the House minority leader seems to be so dubious albeit dangerous as the image of the House as a whole is being disparaged. People badly need reform on health care and so are those professionals in medical scrubs. The President now is in a make or break situation. He wishes that by the end of March, that bill he longed be passed will be on his desk. But he also expressed and expected the worst that might happen that will be caused by partisan ideologies and business as usual practices. But the President’s side is seeing a great hope again as they believe that the health care reform does not benefit the few but instead every American. Because of its expanded capability like pre-existing condition is no longer a hindrance in securing insurance, people of any class with or without pre-existing conditions can still save money. Well, the President’s camp talks about betterment of the bill and not basically trampling reform aside. The health care reform brawl is somehow expected to end by the end of this month when the President either have bill on his desk or simply a message of failure. But no matter the outcome would be, the challenge remains in the heart of every legislator – they needed to act not because their party wanted it to be but rather because majority of Americans will benefit from it.

(Plano, TX) – The perennial advice to take charge of your health has a timely new twist. Simply going for a second doctor’s opinion isn’t enough today when there are hundreds of complementary and alternative therapies available. President Obama has even expressed his openness to including complementary and alternative medicine (CAM) into our health care system at a town hall meeting in Arnold, Missouri. “My attitude is that we should do what works,” President Obama said. “So I think it is pretty well documented through scientific studies that acupuncture, for example, can be very helpful in relieving certain things like migraines and other ailments — or at least as effective as more intrusive interventions. ” The President added that “Unfortunately, the hardest thing to do in politics — and certainly in health care reform — has been to get policymakers to make investments early that will have long-term payoffs. ” He elaborated that elected officials and those in the private insurance system make the same, short-term calculations on health care and that the current thinking in our health care system is going to have to change to a priority on prevention. Congressional health care reform efforts have already started looking at expanding accepted options beginning with Senate hearings last February chaired by Sen. Tom Harkin (D-IA). The field of complementary and alternative medicine (CAM), more recently called Integrative Medicine, ranges from ancient healing techniques to the latest technologies and innovations. Doctors have become even more aggressive in urging patients to assume responsibility for their own health because lifestyle is a critical factor in good health. According to researchers at the Harvard School of Public Health in Boston, a 2005 study shows that tobacco smoking and high blood pressure are responsible for up to 20% of the deaths in America each year. Being overweight or having limited physical activity may account for an additional 10% of deaths. Dallas author Alan Smith notes, “To obtain a medical license in America it is not necessary to have even a single hour of study in CAM. Just because a doctor says there isn’t anything else they can do for you does not mean that nothing more can be done!” In the new, expanded hardcover edition of his book, UnBreak Your Health (June 2009) Mr. Smith suggests that relying only on your doctors is like trying to play without a full deck of cards because there are too many options missing. “Each one of us must take responsibility for our own health and look at every opportunity available today for better health including complementary and alternative therapies that have been shown to be safe and effective for decades, hundreds, even thousands of years” he added. UnBreak Your Health was published in 2007, quickly becoming an award-winning book featuring in local, regional and national publications. Mr. Smith has been a guest on more than 45 radio shows in major markets across the country such as Dallas, Denver, Seattle and San Francisco and he currently hosts an Internet program on complementary and alternative therapies located at http://www. unbreakyourhealth. com/podcasts. htm