Posted by admin on July 4th, 2011 and filed under Health|Comments Off
At some point after Jan. 3, when Scott Walker becomes governor, Wisconsin will challenge the constitutionality of the federal law to overhaul the health care system.
Wisconsin Attorney General J.B. Van Hollen has not decided whether the state will join the lawsuit filed in Florida by 20 other states, the National Federation of Independent Business and two uninsured individuals, or file its own lawsuit.
“That work is under way,” Van Hollen said. “I have been in discussions not only with my staff but also with staff of both the Florida AG’s office and the Virginia AG’s office.”
Joining a lawsuit filed by the Virginia attorney general would be more difficult because that case includes legal issues surrounding a state law.
Van Hollen expects to make a decision in the next month or so.
The key issue in the legal challenges is whether the federal government can require people to buy health insurance or fine them for failing to do so. That requirement is considered essential if health insurers must cover people with pre-existing health problems.
Wisconsin joining the legal challenges to the law would fulfill a campaign promise by Walker while making the state a participant in a historic case almost certain to be settled by the Supreme Court.
“It is the biggest ongoing constitutional law dispute in the country, certainly the one with the most far-reaching effect,” said Andrew Coan, a professor at the University of Wisconsin Law School.
More than 20 separate challenges to the law, including lawsuits by conservative groups and individuals, have been filed in federal courts throughout the country. And most legal experts agree that both sides raise valid questions.
“This case could be decided either way without overturning any existing Supreme Court precedents,” Coan said.
So far, federal judges have dismissed two of the lawsuits – one filed in Virginia by Liberty University, founded by Jerry Farwell, and the other filed in Michigan by the Thomas More Law Center, a public interest law firm that focuses on defending the religious freedom of Christians, family values and other issues.
But federal judges in Florida and Virginia have denied the federal government’s motions to dismiss the lawsuits by the states.
Van Hollen, a Republican, wanted to challenge the health care law immediately after it was passed but needed Democrat Gov. Jim Doyle’s approval – and the governor in a strongly worded letter made clear that wasn’t going to happen.
“The State of Wisconsin will not enter into litigation intended to deny health care for tens of thousands of residents,” Doyle wrote in March.
The state also has estimated that the law would save Wisconsin 5 million to 0 million from January 2014 through June 2019 as the federal government picks up a larger share of the cost of insuring residents with limited incomes.
But Van Hollen said Wisconsin should bring a lawsuit to protect the balance of powers between the federal government and states.
“This is an issue that needs to be clarified one way or another,” he said.
If people are not required to buy health insurance, they could wait until they are sick to buy it. Health insurers regularly liken it to being able to buy homeowner’s insurance while your house is on fire.
Subsidies
The health care law provides subsidies for people and families with low to moderate incomes to buy insurance, if they don’t get affordable health benefits from an employer. The legislation specifically notes that people who don’t buy insurance – out of choice or necessity – saddle hospitals and doctors with large unpaid bills that raise costs for people with insurance.
That’s one reason for the so-called individual responsibility requirement.
But the uninsured population disproportionately includes people in their 20s and 30s. Many of them could afford to buy insurance. Economists call them “free riders.” They also tend to be healthy – and their premiums are needed to offset the cost of providing health insurance to people who are sick.
People with health problems who don’t get health benefits from an employer now are effectively locked out of the insurance market in many states because health insurers will not cover them. Changing that is one of the key provisions in the new law.
States can require people to have health insurance; Massachusetts does so now. And the federal government’s right to regulate the insurance industry is clear. The issue is whether that right also gives it the authority to require people to buy health insurance.
Opponents note that the federal government has never passed a law requiring citizens to buy a private product or service or pay a penalty.
Congress passing a health care law requiring people to buy health insurance, opponents contend, is no different from requiring people to buy vitamins or join a gym.
Ilya Shapiro, a senior fellow in constitutional studies at the Cato Institute, a libertarian think tank in Washington, D.C., said no principled limits on federal power will exist if the health care law is allowed to stand.
Economic activity
The legal arguments hinge at least to some extent on whether deciding not to buy health insurance is an economic activity.
Here’s why:
Since the 1940s, the Supreme Court has given broad authority to regulate interstate commerce under the Commerce Clause of the Constitution.
Those powers, though, are limited to economic activities.
The Constitution, under the Necessary and Proper Clause, also gives Congress the authority to enact regulations needed to regulate interstate commerce.
The Department of Justice contends that the decision not to buy health insurance is an economic decision that affects the entire health care system. It also contends that everyone, even people who are healthy, is part of the health care market.
But Shapiro and other opponents contend this reasoning would lead to a federal government of unlimited powers.
“Everything is an economic decision in some way,” he said.
Opponents contend that requiring people to buy health insurance regulates an economic inactivity.
To Coan, the UW law professor, this isn’t the key issue in the case.
“If Congress needs to regulate inactivity to make its regulation of commerce effective, the Necessary and Proper Clause gives it that power,” Coan said. “That’s how I would analyze the case.”
The federal judges in the lawsuits brought by the Thomas More Law Center and Liberty University agreed.
But Shapiro has noted that there are “many, many rulings yet.”
The lawsuits raise other issues – including complex tax issues – but more legal experts have said the most important issues involve the mandate to buy health insurance.
No one expects that issue to be resolved until 2012 at the earliest.
Deciding what to do
Van Hollen now must decide how to proceed.
Joining other states in the Florida lawsuit would give Wisconsin less control over the direction of the case.
The Florida case also may be too far along for Wisconsin to intervene.
The state also could file a friend-of-the-court brief. That would give it more flexibility in its arguments. It also could file its own lawsuit.
“We, in further analysis, may decide we want to take a little different legal or augmentative tack than them,” Van Hollen said. “There are a number of different considerations and, once again, we’ve got a little bit of time to figure out which ones prevail.”
The cost of challenging the law will depend on whether the lawsuit is handled by his staff and how the state proceeds.
Van Hollen acknowledged people have asked what difference Wisconsin could make in the outcome given the number of lawsuits already filed. But he said a multitude of parties can give a position more legal authority.
“I really do believe it makes a difference,” he said.
Posted by admin on July 3rd, 2011 and filed under Health|Comments Off
Week of June 6, 2011
While the Affordable Care Act’s (ACA) medical loss ratio (MLR) and rate review provisions have been getting most of the media attention, a new coalition of business organizations has come together to draw attention to another important requirement of the ACA. Calling themselves Stop the HIT on Small Business, more than 25 national business organizations have joined forces to work toward repeal of new taxes the ACA would impose on private health insurance starting in 2014. Business leaders behind the effort say that small business owners, their employees and the self-employed will ultimately bear the brunt of billion in additional health care costs in the first 10 years as a result of the new taxes. The group is planning Capitol Hill outreaches and grassroots efforts.
Federal
Support is growing in Congress (over 80 co-sponsors) for Mike Rogers’ (R-MI) and John Barrows’ (D-GA) legislation that would exclude agent commissions from the MLR calculation. Currently, commissions count as administrative expenses in calculating insurers’ MLRs. This support was highlighted in a House hearing last week before the Health Subcommittee of the Energy & Commerce Committee, where the larger issue of the MLR burden was front and center. Witnesses representing agents and brokers, insurers and academia all testified against the unintended, negative consequences of the MLR requirement, with agents and brokers in particular noting the direct financial impact to small business and individual agents and their families. The Rogers/Barrows bill would simply not factor commissions into the MLR calculation. The day before the hearing, Congressman Tom Price ((R-GA) introduced an even more aggressive bill, as his proposal would repeal outright the MLR provision of ACA. While it is unlikely that either bill will get traction in the Senate on its own, bipartisan support for the agents and genuine concern about unintended consequences puts this issue in play as part of any potential mega-deal on the budget/deficit/debt ceiling issue over the next few months. The Senate was not in Session last week; and the House is out this week.
States
COLORADO: Governor John Hickenlooper last week signed into law a bill establishing the Colorado Health Benefit Exchange. The legislation created a fair amount of controversy during the session, particularly among “Tea Party” Republicans. However, the final product represents the culmination of a bipartisan effort that remained inclusive of the business, advocacy and insurance industry constituencies.
CONNECTICUT: Although adjournment is set for June 8, a number of significant bills are still in process. The legislature passed a bill over the weekend that would create a health insurance exchange. The bill is expected to be signed by Governor Dannel Malloy, as the legislation, as passed, is an amended version of a bill proposed by the Malloy administration. It would create an 11-member exchange board and set rules and responsibilities for the exchange, but many policy decisions would be left for resolution at a later time. The exchange must be financially self-supporting by 2015, and the bill would allow the exchange to charge assessments or user fees to health insurance carriers to fund operations. Some lawmakers questioned the cost of the exchange. However, the nonpartisan Office of Fiscal Analysis says the planning process is not expected to require additional state money. The bill calls for exchange board members to have expertise in specific subjects, including small employer health insurance coverage, health care delivery systems, access issues that self-employed people face, barriers to individual health care coverage, health care finance and benefits plan administration.
Additional bills yet to be passed by both Houses include the SustiNet bill, now amended to create a health care reform advisory board and allow municipalities and not-for-profits to join the state employees plan. Also, a prohibition on “most favored nation” clauses in provider contracts and a broad rate review bill that would require public hearings for all rate increases over 10 percent have yet to be acted on.
ILLINOIS: A spring session of the General Assembly dominated by redistricting, workers’ compensation, budget, pensions and gambling adjourned on May 31, 2011. Minimal health care legislation passed by both chambers is awaiting signature by the governor. One important legislative development is that Aetna helped turn back attempts to amend the “non-participating” physician law that was passed last year and went into effect on June 1, 2011. The law protects consumers from being overbilled by certain out-of-network, hospital-based physicians (i.e., anesthesiologists, radiologists) who provide direct services in hospitals and ambulatory surgery treatment centers. Under the law, the patient is taken out of the middle as it ensures patients will pay no more than they would have paid to one of their carrier’s participating providers. In addition, the law allows either the physician or the insurer to use binding arbitration to resolve disputes over the reasonableness of charges or reimbursements.
Other health care bills defeated including taxes/insurance assessments; reporting of extensive premium loss data; and health insurance rate review. Bills currently awaiting the governor’s signature include changes to the mental-health parity and clinical trials mandates, as well as insurer recoupment requirements that the industry ultimately agreed to. Also, a health insurance exchange bill passed both chambers that would establish an exchange and appoint a study commission of legislators to report back to the Assembly by Sept. 30, 2011 regarding parameters for an exchange. Follow-up legislation could potentially be considered in the fall veto session, beginning at the end of October 2011.
MAINE: Gov. Paul LePage and the legislature’s Republican leaders found a way to avoid an override of the Governor’s recent veto of the most-favored nation prohibition bill. The bill would bar insurers from requiring a health care provider to charge an insurance company the lowest rate the provider negotiates with any other insurance carrier. In his veto message on the bill, LePage said he strongly believes that businesses have a right to contract with each other as they deem appropriate. After some Republicans complained, LePage met last week with GOP leaders and co-chairs of the legislature’s Insurance and Financial Services Committee, which unanimously endorsed the bill last month. Republican lawmakers agreed to vote to sustain the governor’s veto when the House acts on it, and the Governor agreed to submit compromise legislation. The new bill would ban most-favored nation clauses but also allow Maine’s superintendent of insurance to issue a waiver. It is unclear what conditions an insurer would have to meet to earn a waiver. The bill’s language is not yet available to the public. With session scheduled to adjourn June 15, the legislature is likely to wait until next year to take up the bill.
Governor LePage announced that Eric Cioppa, Deputy Superintendent of the Bureau of Insurance, Department of Professional and Financial will serve as Acting Superintendent effective immediately. Cioppa replaces former Superintendent Mila Kofman who resigned recently. In his former role as deputy superintendent, Cioppa was responsible for the Examination, Market Conduct, Financial Analysis, Alternative Risk Markets, Producer Licensing, Administrative Support Unit, and Research and Statistics Units of the Bureau.
MICHIGAN: In the next couple of weeks, the state Senate is expected to vote on a 0 million paid-claims tax that would be levied on insurers and third-party administrators as proposed by Governor Snyder. Specifically, the bill would establish an entirely new tax on health insurance claims as a way to match federal Medicaid funding. The 1 percent on tax on all medical claims paid under health, dental, automobile and workers’ compensation coverage would impact fully and self-insured business. Ultimately, the cost of the tax will be borne by the sponsor of that coverage – the employer or the individual who already pays for the coverage. As introduced, the tax would begin on October 1, 2011. While working with lawmakers to help them understand the impact the tax would have on constituents, Aetna has mobilized its grassroots employee network to contact their state legislators regarding the issue. The bill has a strong chance of passing, and Aetna is urging all its constituents in the state to contact the Governor’s office and legislators to express any concerns they may have about the tax.
NEW YORK: Session is scheduled to adjourn June 20, and no official exchange legislation has been advanced. The Senate Republican majority is said to have a bill draft ready that supports a market-based exchange, but it has not been introduced yet. The Administration plans to introduce a more expansive model that reportedly will include giving the governor the majority of the board appointments, the exchange de facto rate-setting authority, and the exchange authority to selectively contract and require plans to participate. The bills are expected by the second week in June. However, with many other significant issues still on the table, compromise on an exchange bill may be swept up into a larger negotiation.
A very broad autism mandate is still in play. A set of amendments was introduced to ensure that an autism coverage mandate not be broader than for any other disease coverage mandate, For example, a pharmacy rider would be required to get pharmacy coverage, and there would be a limitation on visits but no dollar or age limits. The bill is still more expansive than last year’s version, which was vetoed by then-Governor Paterson due to its million fiscal note. Governor Cuomo has not announced his position on the proposal.
NEVADA: The 2011 legislative session is winding down toward adjournment on June 6. Governor Brian Sandoval has on his desk a rate review bill that would implement a prior approval scheme, require greater transparency and public access to rate filings, and allow a Consumer Advocate to request a public hearing. The measure is sponsored by the Democratic Speaker and has the support of the commissioner who says that some aspects of the bill are needed for the state to comply with HHS rate review requirements. The Senate-sponsored bill creating the Silver State Health Exchange continues to move toward passage in the Assembly.
PENNSYLVANIA: State government had another better-than-expected revenue collection month in May and headed into the final month of the fiscal year with a nearly 0 million surplus. The news came last week as the debate in the Capitol intensified over the depth of spending cuts sought by Governor Tom Corbett. Legislative budget analysts said the state’s updated revenue collection figure through the end of May was 2 percent, or about million, over the official estimate. That means the state has collected almost .3 billion through 11 months, or 2.3 percent above the official estimate. However, the state continues to face a projected multi-billion-dollar budget deficit in the fiscal year beginning July 1. The disappearing federal stimulus money that temporarily helped buttress the state’s recession-wracked tax collections is one of the largest contributing factors.
TEXAS: A special session of the legislature, called by Gov. Rick Perry to address education and health care issues left pending when the 140-day regular session ended May 30, got off to a slow start last week. But by the end of the week, the Senate Appropriations Committee unanimously voted in support of a massive health care measure that combines three weighty regular-session bills. Now headed for a full Senate vote, the package seeks .5 billion in Medicaid savings by expanding managed care to South Texas and restructuring insurance payment systems. It also would charge Medicaid patients for unnecessary emergency room visits and penalize doctors and hospitals for preventable complications.
Late Tuesday, Perry added another issue to the 30-day session: redrawing boundaries for Texas’ 36 congressional districts. School finance remains the main event of the overtime session. Another bill would resurrect the interstate health care compact, favored by Republicans because it would allow member states to opt out of the federal health care reform law. Democrats oppose the effort, saying Texas would save money by cutting more low-income people from Medicaid coverage. A bigger hurdle would be Congress, which must approve the compact. The special session will last a maximum of 30 days but could conclude earlier if the legislature finishes business and adjourns.
Posted by admin on July 3rd, 2011 and filed under Health|Comments Off
Home health care helps seniors live independently for as long as possible, given the limits of their medical condition. It covers a wide range of services and can often delay the need for long-term nursing home care.
More specifically, home health care may include occupational and physical therapy, speech therapy, and even skilled nursing. It may involve helping the elderly with activities of daily living such as bathing, dressing, and eating. Or it may include assistance with cooking, cleaning, other housekeeping jobs, and monitoring one’s daily regimen of prescription and over-the-counter medications.
At this point, it is important to understand the difference between home health care and home care services. Although they sound the same (and home health care may include some home care services), home health care is more medically oriented. While home care typically includes chore and housecleaning services, home health care usually involves helping seniors recover from an illness or injury. That is why the people who provide home health care are often licensed practical nurses, therapists, or home health aides. Most work for home health agencies, hospitals, or public health departments that are licensed by the state.
How Do I Make Sure That Home Health Care Is Quality Care? As with any important purchase, it is always a good idea to talk with friends, neighbors, and your local area agency on aging to learn more about the home health care agencies in your community. In looking for a home health care agency, the following 20 questions can be used to help guide your search:
How long has the agency been serving this community? Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one. Is the agency an approved Medicare provider? Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations? Does the agency have a current license to practice (if required in the state where you live)? Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for? Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family), and update the plan as necessary? Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver? How closely do supervisors oversee care to ensure quality? Will agency caregivers keep family members informed about the kind of care their loved one is getting? Are agency staff members available around the clock, seven days a week, if necessary? Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day? How does the agency ensure patient confidentiality? How are agency caregivers hired and trained? What is the procedure for resolving problems when they occur, and who can I call with questions or complaints? How does the agency handle billing? Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services? Will the agency provide a list of references for its caregivers? Who does the agency call if the home health care worker cannot come when scheduled? What type of employee screening is done?
When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have. For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first.
Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem (see the Respite Care fact sheet for more information about these services).
In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:
Illnesses/injuries, and signs of an emergency medical situation Likes and dislikes Medications, and how and when they should be taken Need for dentures, eyeglasses, canes, walkers, etc. Possible behavior problems and how best to deal with them Problems getting around (in or out of a wheelchair, for example, or trouble walking) Special diets or nutritional needs Therapeutic exercises.
In addition, you should give the home health care provider more information about:
Clothing the senior may need (if/when it gets too hot or too cold) How you can be contacted (and who else should be contacted in an emergency) How to find and use medical supplies and medications When to lock up the apartment/house and where to find the keys Where to find food, cooking utensils, and serving items Where to find cleaning supplies Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure) Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them).
Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.
The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance.
Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met:
The patient must be homebound and under a doctor’s care; The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously) The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary” The home health care agency providing the services must be certified by the Medicare program.
To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look on the Internet at http://www.medicare.gov.
There are several national organizations that can provide additional consumer information about home health care services. These include the following:
The National Association for Home Care, which can be reached at 202-547-7424 or by visiting its website at www.nahc.org. The postal address is: 228 7th St., SE; Washington, DC 20003. The Visiting Nurse Associations of America, which can be reached at 617-737-3200 or by visiting its website at http://www.vnaa.org. The postal addresses are: 99 Summer St., Suite 1700; Boston, MA 02110.
To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging (at 1-800-677-1116 or http://www.eldercare.gov can help connect you to these agencies.
Because it is not always clear to the average person when an ailing senior needs home health care and when he or she needs nursing home care, it is usually best to consult a medical professional for advice. The following case study describes one situation in which home health care proved to be the right choice. Francis is 84 years old and recently had a stroke. She was hospitalized briefly and then discharged to continue recovering at home. To enable her to return home, her doctor called a home health care agency, and the agency gave Francis a complete home health care plan for six weeks. Since the doctor ordered the home care for Francis, Medicare paid for it.
For the first week after Francis went home, a nurse visited her every day. The nurse met with Francis’s family to discuss her special dietary needs and to arrange for exercise therapy to help Francis regain her strength. Once that was done, the nurse visited Francis twice a week to check on how well she was recovering. The home health care agency also sent a homemaker, a personal care attendant, and a physical therapist to visit Francis several times during the week. The homemaker would do the shopping and cook light meals. The personal care attendant would help Francis bathe, get dressed, and walk. The physical therapist would keep Francis moving and see to it that she got some exercise to aid in her recovery.
Paloma Home Health Agency Inc. provides quality service to the elderly, sick, and disabled
Let us meet your everyday needsWe can be reached at 972-346-2013 or http://www.palomahomehealth.com
WATCH IN HD// HEALTH – DIE SLOW (2009) FROM THE ALBUM GET COLOR LOVEPUMP UNITED(US)/CITYSLANG(EU)/POP FRENZY(AUS) DIRECTED BY JOHN FAMIGLIETTI CINEMATOGRAPHY BY MATT LLOYD EDITED BY LUKE LYNCH AND JOHN FAMIGLIETTI EXECUTIVE PRODUCED BY CHRISTOF ELLINGHAUS AND JAKE FRIEDMANYOU WILL LOVE EACH OTHER YOU WILL LOVE EACH OTHER YOU WILL LOVE EACH OTHER YOU WILL LOVE EACH OTHER YOU WILL LOVE EACH OTHER YOU WILL LOVE EACH OTHER www.facebook.com www.myspace.com www.twitter.com health.bigcartel.com Video Rating: 4 / 5
Posted by admin on July 1st, 2011 and filed under Health|Comments Off
States with Republican governors kept up the pressure last week on Washington to give the states greater control over health care under the Patient Protection and Affordable Care Act (PPACA). Twenty-one Republican governors sent a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius asking for greater authority over some provisions of health reform, including the ability to define “essential” health benefits and set minimum criteria for participating in insurance exchanges. They threatened not to run their own state-based exchanges if HHS does not act on their requests. Sebelius quickly responded with her own letter in which she reviewed the various options states have to reduce costs in their Medicaid programs, and she indicated she is continuing to review what authority she may have to “waive the maintenance of effort under current law.” Senate bills have already been introduced to address the role of the states in health care reform, which is sure to keep the issue on the front burner. Visit Easy To Insure ME for more info
Federal
The House Committee on Ways & Means held a hearing last week on “The Health Care Law’s Impact on Medicare and Its Beneficiaries,” featuring testimony from CMS Administrator Donald Berwick, M.D., and CMS Chief Actuary Richard Foster. Berwick testified that the PPACA has had a positive impact on Medicare beneficiaries, noting that beneficiaries now have first-dollar coverage of key preventive benefits, additional assistance with prescription drug costs, and an annual wellness visit with the physician of their choice. In response to concerns noted by several committee members about the impact of funding cuts on Medicare Advantage, Berwick indicated that Medicare Advantage enrollment increased by 6 percent from 2010 to 2011. He suggested that the program is healthy and offers robust choices. Foster’s testimony reiterated his prior projection that the PPACA will cause Medicare Advantage enrollment to decline by about 50 percent by 2017 — from a projected 14.5 million under the pre-PPACA law to 7.3 million under the new law. His testimony further explained that Medicare Advantage enrollees will experience “a large increase in out-of-pocket costs” and “less generous benefit packages” because PPACA will reduce rebates to Medicare Advantage plans, with the reduction in rebates reaching ,500 per beneficiary by 2019.
The Administration last week issued favorable guidance with respect to student health coverage that will result in little disruption, if any, to this business until at least the 2012-2013 academic year. This guidance was announced in a Notice of Proposed Rule Making (rather than as an interim final regulation), which fortunately means that the rule is not effective immediately as has been the case with most regulations relating to PPACA reforms. The proposed student health rule would create a special class of individual coverage for student health pursuant to a set of factors, e.g., written contract between school and insurer, coverage only for students and dependents, health status may not be used as a condition of eligibility. As Aetna has advocated, the impact would be delayed, as the rule (whenever finalized) would not be effective until policy years beginning on or after January 2012. Until then, student health is not subject to PPACA reforms. And, when effective, student health would be excepted from the current guaranteed issue and renewability provisions of PPACA. While it will be unclear for a while whether and how student health will be subject to the medical loss ratio (MLR) provisions of PPACA, we are encouraged by the fact that the proposed rule invites comments on whether student health should receive some sort of special accommodation (akin to the special rule for limited benefit plans) with respect to MLR, owing to the unique characteristics of the student health market.
States
ARIZONA: The industry-supported exchange bill was introduced last week under the sponsorship of the House Health Committee Chairman and the respective chairmen of the House and Senate Banking and Insurance Committees. The bill provides for a market-based mechanism; governance by a board with insurer representation; no dual regulation; and a conditional repeal provision. The first hearing will be held this week. In other news, Governor Jan Brewer appointed Don Hughes, former AHIP retained counsel, as Special Advisor for Health Care Innovation. Hughes will help direct state efforts to improve the cost-effectiveness and accessibility of health care. He will engage in strategic planning with a focus encompassing both public health care and Arizona’s large private health insurance industry.
CONNECTICUT: A jointly held public hearing of the Public Health and Insurance and Real Estate Committees was scheduled for this week on two new health care bills. The first bill would establish the SustiNet Plan Authority, a quasi-public agency empowered to implement a public health care option. The SustiNet Plan is a health insurance program that consists of coordinated individual health insurance plans that provide health insurance products to state employees, Medicaid enrollees, HUSKY Plan, Part A and Part B enrollees, HUSKY Plus enrollees, municipalities, municipal-related employers, nonprofit employers, small employers, other employers, and individuals in Connecticut. The Authority is authorized, but not required, to begin offering SustiNet coverage to employees and retirees of non-state public employers, municipal-related employers, small employers, and nonprofit employers after January 1, 2012. Beginning on January 1, 2014, SustiNet will offer coverage to individuals and employers. Among other things, the bill directs the Authority to implement primary care case management and patient-centered medical homes for all SustiNet Plan members, establish a pay-for-performance system, and establish procedures to prevent adverse selection.
The Committees also will hear testimony on a bill to establish the Connecticut Health Insurance Exchange pursuant to PPACA. The exchange would be a quasi-public agency offering qualified health plans to individuals and qualified employers by January 1, 2014. The bill would establish a 13-member board of directors to manage the exchange. The exchange would have the authority to review the rate of premium growth within and outside the exchange in order to develop recommendations on whether to continue limiting qualified employer status to small employers. It also would have the authority to charge assessments or user fees to health carriers to generate funding necessary to support the operations of the exchange. The bill directs the exchange board to report to the legislature by January 1, 2012 on whether to establish two separate exchanges, one for the individual market and one for the small employer market, or to establish a single exchange; whether to merge the individual and small employer health insurance markets; whether to revise the definition of “small employer” from not more than 50 employees to not more than 100; and whether to allow large employers to participate in the exchange beginning in 2017.
Aetna will submit comments on both bills through the Connecticut Association of Health Plans.
IDAHO: Draft legislation is circulating that would prohibit insurance companies and managed care organizations from refusing to contract with qualified providers solely because the provider: is not a member of a group, network or any other organization of providers contracting with the insurance company; or does not offer all of the services obtained through the group, network or organization of providers contracting with the insurance company. However, the provider may be required to comply with the practice standards and quality requirements of the contract specific to the services contracted. The bill generally is intended to impact insurers and managed care organizations. It does not contain an exclusion or exception for HIPAA-excepted benefits. As yet, the bill has not found a sponsor and has not been “introduced.” While there remains a possibility that the bill could be introduced before the deadline for committee bill introductions, it is considered unlikely.
MINNESOTA: When the legislature convened the first half of its 2011-2012 biennium last month, Republicans controlled both legislative chambers for the first time since 1972. And, Republican lawmakers wasted little time introducing bills to repeal measures passed by the 2010 legislature to fund state medical assistance, general assistance medical care, and MinnesotaCare. In his first official act as Governor, Mark Dayton signed an executive order implementing early Medicaid expansion (to 133 percent of the federal poverty level) for Minnesota, which is expected to make 95,000 more state residents eligible. Minnesota’s 8 million investment is expected to bring about .2 billion in matching federal funds. Governor Dayton also signed an executive order removing the ban on applications for federal PPACA-related grants. Minnesota is expected to receive an exchange planning grant soon. While Governor Dayton cleared the way for the state to seek grants for implementing federal health reform, it is unlikely that state legislators will be passing bills to implement the federal health reform law unless absolutely necessary. Other pending bills of interest include anti-PPACA legislation, a bill requiring guaranteed issue in the individual market, creation of a defined contribution program for childless adults with incomes at or above 133 percent of FPL (reduction from current level of 250 percent), the prohibition of dental plan fee schedules for non-covered services, and an autism coverage mandate. In addition, Governor Dayton named a new Commissioner of the Department of Commerce, Minneapolis attorney Michael Rothman.
NEVADA: The legislature convened on February 7 with a scheduled adjournment date of June 6. Governor Brian Sandoval will sponsor an exchange bill, although he opposes federal health care reform. His reasons include not wanting the federal government to take action in the state and the fact that the legislature will not meet in 2012. The Division of Insurance (DOI) has indicated that it will pursue federal reform measures, including external review. Other legislation of interest includes the establishment of a statewide health information exchange system and amending the requirements for reimbursement of out-of network services to comply with the PPACA.
TEXAS: Governor Rick Perry delivered his State of the State speech last week, which included plans to suspend the State Historical Commission and the Commission on the Arts in addressing the state’s billion budget deficit. Speaking to a joint session of the legislature, Perry said the time has finally come to streamline state government. Perry’s speech focused heavily on how strong the state’s economy is, despite the deficit. According to Perry, Texas added more jobs in 2010 than any other state in the nation. That state-wide job growth occurred in the sectors of business, health care, manufacturing, hospitality, construction and energy. Perry’s speech was highly critical of national politics, and he threatened to push back when Washington encroaches on states’ rights. His budget proposal calls for cutting more than billion in state spending on public education and another billion in higher education, plus more than billion in health and human services programs. Those cuts would come with much larger reductions in federal dollars, because states draw federal funding for programs such as Medicaid by spending state money.
VERMONT: Newly-elected Governor Peter Shumlin’s focus has been on reducing the state’s projected 0 million budget deficit. Proposals to deal with the deficit include changes to the administration of the state’s Catamount program, changes to Catamount reimbursement, imposing an assessment on managed care organizations, increasing the provider tax on hospitals, and imposing an assessment on dentists. The legislature is also considering a number of bills that would create a single-payer, government-run health care plan and require rate reviews. The bills include:
Supported by the governor, H.B. 202 would establish Green Mountain Care and the Vermont Health Benefit Exchange, through which all state residents would be eligible for health benefits. After implementation of the Green Mountain single-payer system, private insurance companies would be prohibited from selling health insurance policies in that cover services also covered by Green Mountain Care.
H.B. 80 would create a single-payer health care system called Ethan Allen Health. If the secretary of Human Services obtains a waiver from the exchange requirement, private insurance companies will be prohibited from selling insurance policies in the state for coverage of services covered by Ethan Allen Health. But it would not prohibit individuals from purchasing supplemental health insurance covering services not already covered by Ethan Allen Health.
S.B. 57 would establish Green Mountain Care as a single-payer health care system, which will include coverage provided under a health benefit exchange, Medicaid, and Medicare.
H.B. 146 would establish a public health care coverage option called Green Mountain Care that would require Vermont residents to have health care coverage at least equivalent to the actuarial value of Green Mountain Care and would assess a financial penalty against those who fail to maintain such coverage. The bill would institute a candy and soft drink tax as well as a 10 percent payroll tax on all employers with more than four employees to fund Green Mountain Care.
S.B. 56 and H.B. 165 would amend current rate review procedures to require written approval from the commissioner before a health insurance policy can be issued and to require that all rate and form filings be filed electronically. Rate changes would require approval by the commissioner prior to implementation and notice to plan members of rate changes and a 30-day comment period.
H.B. 82 would require health insurers to disclose to the Department of Banking, Insurance, Securities, and Health Care Administration the fee schedules they negotiate with providers, and directs the department to post the information on its website.
Posted by Astoreid Reffitt on February 14th, 2011 and filed under diet|Comments Off
It is important to ensure that your Health Insurance cover is sufficient to meet the needs of you and your family both now and in the future. There are many factors which will have a bearing on your final decision. In order that you do not miss anything out it is best to look at the advantages and disadvantages of each option together.
Which type of plan? There are five kinds of plans to think about when choosing Health insurance: Preferred Provider Organization,Point of Service Plan,Traditional Indemnity,Health Maintenance Organization and Health Savings Account. Read up about each and see which is best for you before making your final choice.
Coverage and Benefits : Each type of Health Insurance will have different benefits and level of coverage within them. Make sure that you consider each of the areas of coverage you may require: maternity, prescription, childcare, annual health check-ups, immunization and emergencies. Aim for maximum unlimited lifetime benefit.
Costs: Costs will vary depending on the type of plan you chose and the coverage within the plan. Different payment and cost plans include deductible, co-insurance and co-payments with various lifetime maximums and limitations of cover built in. The lowest premium may not be the most advantageous to take as it could entail unreasonably high deductibles. If you have a pre-existing condition that requires routine medical treatments or visits to the doctor, then you may be better off paying a higher premium with lower deductibles. Sit down and work it out before signing up.
As mentioned before there are pros and cons to each of the different types of plan and payment types. Some plans offer fewer restrictions but it is likely that these may cost more. The opposite may be true of course, lots of restrictions and a low premium. Work out what’s best for you based on the amount you can afford to pay and the level of cover you think you need.
Choosing your Health Insurance is important and getting it right first time can save a whole lot of money and stress. Do not feel pressurised to sign up to the first policy you see, look at a selection to make sure you are getting the best value for money and the correct level of cover. Look at cost, cover, benefits and the pros and cons of each policy and then make your decision. Bear in mind your circumstances may change and so do not take too light a coverage.
Posted by Astoreid Reffitt on February 14th, 2011 and filed under diet|Comments Off
Some people really want to maintain there good health as it is very important to them. Healthy people are more energized, they get deeper sleep, and they are in shape. To keep up good health and to stay fit it is extremely important to practice good lifestyle choices, and balance a good diet as well as a good exercise program. Your habits are surely the hardest thing to change.
If you are always tired and lethargic, you can’t be hale and hearty. You have a lot of effort physically and even mentally to get fit in the first place. Other than exercising, you must adapt to different dietary habits in which junk food is not included. Overweight people who refuse to change will always suffer from a lot of health problems.
The first thing you need to do is form good habits. This will make you or break you depending on what you decide. The most important thing is positive thinking. Your mind needs to be clean and clear of negativities. Thoughts that are depressing will hinder you in the big scheme of things. By doing yoga you can both meditate to relax and exercise. This is a great option to get those joints going that haven’t done much in a while.
Eating healthy is a must. A good idea is to eat simple things like veggies, fruits, nuts, and lean meat. If you don’t eat refined foods, then you can and will stay stronger and also in good health. Diabetes, cancer, and obesity are just a few of the diseases that people suffer from due to many bad dietary habits. Making small changes day by day can change things in the future.
It is best to avoid drinking and smoking all together. You need to exercise at least three times a week, and it is best to do so in the morning as you feel good and energized all throughout the day. Exercising will put you in a good mood, and it will be a lot easier to maintain your positive attitude.
Getting involved in sports that you like to remain active including running, walking, swimming, or biking is very important. Whatever you like to do, if it’s possible to do it in open air, then it will be even better. It makes you feel more renewed. No matter what you choose, don’t make any radical changes. Instead, start simple and build up to ensure longevity and help form very positive health habits that you won’t want to live without.
Posted by Astoreid Reffitt on February 8th, 2011 and filed under diet|Comments Off
Not everyone knows how to pay attention to their health appropriately and need a little encouragement to do so. To educate community members about necessary medical care and ways in which to get it, it is advocated to hold a health fair in the community. If the need is there, it is possible create one.
Most individuals do not like making appointments with their doctors if it can be avoided. However, individuals need to be aware that there are medical complications that may occur if they do not have regular checkups at their local doctor’s office. For instance, one of the biggest ?silent killers? is hypertension, or high blood pressure. The symptoms of hypertension are not realized until it is too late and the body is already harmed. A regular appointment with the doctor for a blood pressure check, especially for those over 50 years of age and those who have a family history of hypertension, is essential.
Obviously, the first thing that needs to be done is find a location for the health fair. Select a location where there is a lot of foot traffic. It can be indoors or outdoors, depending on the requirements. Often community centers, veteran association halls, school gyms, and fire stations are beneficial places to hold health fairs.
Once the organizer has secured a location, the next task is to find health professionals from all walks of life willing to set up a stand. Educations vendors should be one of the top priorities. These vendors would include cholesterol and blood pressure screenings, nutrition guides, body fat evaluations, smoking cessation assistance, alternative health information, information and guidance for low income medical assistance, and family planning information. As well, research the vendors to make sure there will be no legal complications. Locate if any of the tests require signed disclaimers.
Aside from making the health fair education, it should be fun as well. Have a special area set up for kids to learn about important health topics. Create a massage section in the health fair. Have it catered, but of course, with healthy snacks, and hold a raffle for prizes from the vendors.
In order to get people to show up to the health fair, there needs to be a strategic plan for promotion. Best sources of promotion include newspaper and radio advertisements, posted signs, and fliers in local shops. If allowed, post a memo about the fair in the school bulletin.
Hold a yearly health fair. If not too many people show up for the first one, do not become discouraged. The more years it exists, the more likely more will come. Health is an important topic for individuals to know and a health fair is a great way to present it.
If you are considering buying a new health product then you can get hold of good info on my online resources hcg blend premium and hcg blend premium.
Posted by Natasha Tishee on October 8th, 2010 and filed under diet|Comments Off
For any readers that have already hit that magical age you will already have had to face the fact that losing weight is harder. There are a number of reasons for this, a key one being that every decade after 40 you loose 6% to 8% of your muscle, and that muscle helps to burn body fat. So without it it becomes harder and harder as you get older to shake of those extra pounds.
You have two choices ahead of you, to maintain the muscles you have to get more in order to better achieve your weight goals. This doesn’t mean you need to become a huge muscle body builder or bulk up! But it does mean you need to stop avoiding the weights part of a workout. You need to consider creating a workout that mixes in cardio for weight loss as well as some resistance training for those muscles.
Weekly exercise routine involves 30 minute sessions three times a week. Ideally you want to mix it up so you reach all the areas, free weights, kettle bells and body weight will do the job. Just three 30 minute sessions a week where you push yourself hard.
You will find your weight loss actually improves as that lean muscle helps burn the fat. Exercise you should have in the workout include jumps, presses, swings, pull ups, pull downs, squats, lunges and push ups. Just this alone will get you a trim waistline once the weight has gone, without the need for any extra specific ab moves.
In the days that you are not weight training you can add in some interval high intensity training if you want to loose the weight quicker. Make sure you are eating a healthy and balanced diet, keep meals small and eat more frequently. There should be the right balance of good carbohydrates, the right fats, lean protein and of course lots of fruit and vegetables. Portion control is one of the key things that people trying to loose weight slip up on, usually overweight people eat portions far too large. Find some healthy snacks for when you get peckish and drink lots of water.
Posted by admin on July 13th, 2010 and filed under 6 pack abs diet|Comments Off
If there is any set of people that need female six pack abs workout, they are women. Because of the nature of women and the type of food they eat, they have interest on six pack abs diet than men. If you are a lady and desire to have sleek and sexy abs, then this is an opportunity for you to read this article to the end.
As a female, if you want to get a flat stomach fast, you need to change some things you doing in order to get perfect abs workouts. You also need to work hard, just like men usually do in respect of abdominal exercises flat stomach. The truth about six pack abs package is that you don’t need to do hard work before getting lose weight flat stomach. Just follow the simple instruction and you are done.
Many ladies don’t know the important of getting workout for a flat stomach or the need to get the perfect abs. You require female six pack abs workout to burn your belly fat fast while making sure to be eating sugar-free and low carb food to help build your flat tummy.
You need to do more exercises that can help on full body metabolic-surge workouts. The exercises like crunches, ab twists and sit-ups may not be enough to get rid of your fat belly. You may also need to design an effective diet that can help lose fats around your waist. Note that female physiology is different from men, make sure you calculate your daily calorie needs and adjust the amount of foods you eat.
In conclusion, the secret to female six pack abs workout is to find the right exercise routine and make sure you eat diet foods. I have seen many ladies attending continuous training for their abs at the gym with the wrong exercises, only to quit in the end and point their failure to genetic reasons.
Are you looking for female six pack abs workout? then, click <a rel=”nofollow” onclick=”javascript:pageTracker._trackPageview(‘/outgoing/article_exit_link’);” href=”http://weightlossfreefacts.blogspot.com/”>Six Pack Abs</a> for more inormation.