Ctamlouis Health

February 17, 2010

The Week in Health Reform–Federal Legislative Overview

House and Senate
Things were quiet last week in Washington due to the 30 plus inches of snow the area received.   On Feb. 9 House leaders announced that due to the heavy snow in the area they would suspend votes in the House for the remainder of the week. Congress will not be in session this week due to the President’s Day recess and will reconvene the week of Feb. 22.

As a result of the congressional schedule, the timeframe for a floor vote on the McCarran-Ferguson antitrust legislation will be pushed back until the week of Feb. 22 at the earliest.   Reports have stated that the antitrust bill is part of House Speaker Nancy Pelosi’s (D-CA) strategy of moving smaller pieces of health care legislation quickly to help build momentum for a comprehensive health care reform bill. The Speaker also continues to urge House Democrats to pass the Senate bill as long as it is accompanied by a separate “reconciliation” bill that would “fix” key provisions in the Senate bill (e. g. , raising the threshold for the Cadillac tax and dropping the Nebraska Medicaid provisions) to satisfy some members of her caucus.

The Senate remained in session last week, despite the weather, although Majority Leader Harry Reid (D-NV) stated that the Senate would not conduct any votes.   On Feb. 11, Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released the highly anticipated “jobs bill” – The Hiring Incentives to Restore Employment (HIRE) Act.

Senators Baucus and Grassley issued a joint statement, emphasizing that this bill was drafted with bipartisan input.   They further stated:  “We also agree that, once properly reviewed, the package should be considered in a deliberate, but expeditious manner.   Any efforts to needlessly delay Senate completion of consideration of this package through partisan means will undermine our goal of timely action in the current economic climate.   Action on the expired provisions is long overdue.   Timely action on incentives for economic activity and job creation also is needed. ”
Hours after details of the “HIRE” legislation were released, Majority Leader Reid publicly stated that he was scrapping the bill.   Reid told reporters that when the Senate returns from its recess on Feb. 22, “we will move to a smaller package than has been talked about in the press. ”  Reid went on to state that some of the tax provisions included in the legislation – key to garnering Republican support for the deal – “confuse” the bill.   Reid went on to say that, “we don’t have a jobs bill. We have a jobs agenda. ”

The draft “HIRE” legislation addresses a number of key health care issues:

* The bill extends, by three months, the eligibility period for premium subsidies for state continuation coverage and COBRA continuation coverage to include persons who are unemployed on or before May 31, 2010.   The bill also clarifies that these subsidies are available to persons who are involuntarily terminated from their jobs after previously losing their employer-sponsored coverage due to a reduction in hours.   The premium subsidies originally were enacted as part of the American Recovery and Reinvestment Act of 2009, also known as the “stimulus bill. ”

* The bill provides for a seven-month Medicare physician payment fix (sometimes known as the “doc-fix”), maintaining physician payment rates at their current levels through Sept. 30, 2010.   Under current law, in the absence of congressional action, physicians are scheduled to face a steep rate reduction on March 1.

* The bill provides for a one-year extension of both Medicare Advantage Special Needs Plans (section 626) and Medicare Cost Plans (section 627).

* The bill includes numerous provisions addressing Medicare fee-for-service reimbursement issues.
White House Health Care Reform Summit
In a pre-Super Bowl interview on CBS, President Obama said that he would like to host a televised health care summit with Republican and Democratic congressional leaders on Feb. 25.   While specific details are not yet available, the summit represents the Obama Administration’s latest strategy to jumpstart the health care reform debate and seeks bipartisan cooperation following the loss of the Democrats’ supermajority in the Senate.   Republican leaders expressed interest in the summit, and House Republican Leader John Boehner (OH) issued a statement saying that, “The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access. “  In response, White House officials insisted that the President is not interested in starting from scratch on health reform.

This week Democratic and Republican congressional leaders also met with President Obama at the White House to discuss the jobs bill, health reform, energy, trade and other legislative priorities.

Following the meeting, the President spoke with reporters and he made the following comments about health reform:  “I’m going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals.   What I will not do, what I don’t think makes sense and I don’t think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there’s a lot of posturing.   Let’s get the relevant parties together; let’s put the best ideas on the table.   My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don’t get every single thing that I want.

New York Health Insurance

Health insurance is insurance that pays for all or part of a person’s health care bills. A health insurance policy is an annually renewable contract between an insurance company and an individual. With health insurance claims, the individual policy-holder pays a deductible plus co-payment (for instance, a hospital stay might require the first 1000 dollar of fees to be paid by the policy-holder plus 100 dollar per night stayed in hospital). Usually there is a maximum out-of-pocket payment for any single year, and there can be a lifetime maximum.

The purpose of health insurance is to help people cover their health care costs which usually include doctor visits, hospital stays, surgery, procedures, tests, home care, and other treatments and services.

According to the latest United States Census Bureau figures, around 85% of citizens have health insurance. 59. 5% of these people receive their health insurance coverage through an employer, and about 9% purchase it directly from the market. Government sources cover 27. 3% of the population. Those without health insurance coverage are expected to pay privately for medical services.

Types of New York Health Insurance (http://new-york. ixs. net/General/New-York-Health-Insurance/index. aspx ) The types of health insurance in New York are group health plans, individual plans, and government health plans such as Medicare and Medicaid. In the United States, government-funded Medicare programs help to insure the elderly and end stage renal disease patients.

Group Health Plans

A group health plan offers health care coverage for employers, student organizations, professional associations, religious organizations, and other groups. The employer may pay for part or all of the insurance cost (premium).

Individual and Family Health Insurance

Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. These types of health care plans are sold directly to individuals. For those of you who are unemployed or self-employed, an individual health insurance policy is always an option. Unfortunately rates for these policies are high and the coverage is usually less comprehensive than a managed care plan. The good news is that, in many cases, your insurance premium will be tax deductible. Of course, if you’re married, you can always try to catch a ride on your spouse’s group health insurance benefits plan.

Health insurance can be further classified into fee-for-service or indemnity (traditional insurance) and managed care. Both group and individual insurance plans can be either fee-for-service or managed care plans.

Managed Care Health Insurance

These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan.

There are three main types of managed care plans:

• Health Maintenance Organizations (HMO)

• Point-of-Service (POS)

• Preferred Provider Organizations (PPO)

All of these plans offer substantial health insurance benefits to members and their families. If you’re fortunate enough to have a choice of plan, consider the advantages, and disadvantages, of each. Compare the cost of care, the difference in premiums, deductible amounts and your freedom to choose a doctor outside the plan. There are numerous other coverages to compare as well — from prescription drugs to dental to alternative therapies. Be sure you understand the fine points of each.

Indemnity or Fee-For-Service Plan

Normally it covers the same expenses as managed care. The difference is your doctor is paid for each visit with the claim filed by either the patient or the medical provider. A big advantage– unlike some managed care plans, Fee-for-Service allows the patient a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork.

However, you’ll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.

Short-Term Health Insurance

Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care. It covers for a limited period of time, and may be an ideal solution for those between jobs or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA (Health Insurance Portability and Accountability Act) Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise.

Medical Savings Account (MSA)

Medical savings account (MSA) is the most recent development in the area of health insurance. The principle behind the MSA is to take the bulk of the financial risk, and premium payments, away from the managed care and indemnity insurers, and allow individuals to save money, tax free, in a savings account for use for medical expenses. Individuals or their employers purchase major-medical policies, medical insurance policies with no coverage for medical expenses until the amount paid by the patient exceeds a predetermined maximum amount, such as 2500 dollar per year. These policies have extremely high deductibles and correspondingly low monthly premiums and the participants take the money that they would have spent on higher premiums and deposit it in an MSA. This money accrues through monthly deposits and also earns interest, and can be spent only to pay for medical care

What’s The Best Health Insurance Plan?

There is no one “best” plan for everyone. The best match for you and your family may be different than the best match for someone else. In order to help you answer this question, here are a few things to consider:

1. Are you going to need long-term coverage or just something for the short-term?

If you’re between jobs for 1-6 months, you may want to go for short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.

2. Are you looking for basic coverage or more comprehensive coverage?

Some insurance plans offer basic coverage (i. e. , primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness. Other insurance plans that offer more comprehensive coverage may include benefits such as preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.

3. Would you pay for your services before you use them or when you use them?

If you choose a health insurance plan with a low monthly premium, you’re likely to have a higher co-payment or deductible. If you don’t anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.

4. How important to you is easy access to specialists?

Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. So, if you prefer easier access to specialists, you may wish to consider a different type of plan.

5. Do you have a specific doctor or hospital that you would like to visit for healthcare?

Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.

6. What is the most you could pay out in case of a serious illness or injury?

Health insurance plans typically place limits on how much a member is required to pay out per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you’ve contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. If you’re concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you’re considering.

No matter what insurance plan you may choose, educate yourself and understand all the basics of the health insurance before finalizing anything.

For more information about New York Health Insurance visit: http://new-york. ixs. net