Showing posts with label Affordable Care Act. Show all posts
Showing posts with label Affordable Care Act. Show all posts
Friday, October 7, 2016
US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System
Monday, January 18, 2016
Sanders Proposes Universal Health Care: The Path to Federalization
Thursday, November 12, 2015
Emerging Concepts for Future Workers' Compensation Benefits: Portability Now
Workers' Compensation as a benefit program is beginning to evolve under the concept of "The Shared Economy." Attacked from within and without, challenged by abuse and fraud, drained by the cottage industries and vendors, national lawmakers, labor leaders, insurance companies, governmental agencies, and the media, are speaking out to change the century old system that fails to integrate with current social, political, economic and medical programs.
"We need a portable vehicle for worker protections and benefits.Traditionally, benefits and protections such as workers compensation, unemployment insurance, paid time off, retirement savings, and training/development have been, largely or partly, components of a worker’s employment relationship with an employer. The Affordable Care Act has disrupted that model, providing more independent workers a different avenue of access to health insurance. Another new model is needed to support new ways of work. We believe this model should be:
● Independent: Any worker should be able to access a certain basic set of protections as an individual regardless of where they source income opportunities.
● Flexible and pro-rated: People are pulling together income from a variety of sources, so any vehicle should support contributions that can be pro-rated by units of money earned, jobs done, or time worked, covering new ways of micro-working across different employers or platforms.
● Portable: A person should be able to take benefits and protections with them in and out of various work scenarios.
● Universal: All workers should have access to a basic set of benefits regardless of employment status.
● Supportive of innovation: Businesses should be empowered to explore and pilot safety net options regardless of the worker classification they utilize.
A recent letter from national labor leaders has called for a "portable" system of benefits that will replace the current patch-work of systems called "workers' compensation programs.":
"We need a portable vehicle for worker protections and benefits.Traditionally, benefits and protections such as workers compensation, unemployment insurance, paid time off, retirement savings, and training/development have been, largely or partly, components of a worker’s employment relationship with an employer. The Affordable Care Act has disrupted that model, providing more independent workers a different avenue of access to health insurance. Another new model is needed to support new ways of work. We believe this model should be:
● Independent: Any worker should be able to access a certain basic set of protections as an individual regardless of where they source income opportunities.
● Flexible and pro-rated: People are pulling together income from a variety of sources, so any vehicle should support contributions that can be pro-rated by units of money earned, jobs done, or time worked, covering new ways of micro-working across different employers or platforms.
● Portable: A person should be able to take benefits and protections with them in and out of various work scenarios.
● Universal: All workers should have access to a basic set of benefits regardless of employment status.
● Supportive of innovation: Businesses should be empowered to explore and pilot safety net options regardless of the worker classification they utilize.
Thursday, June 25, 2015
The Path to Federalization: US Supreme Court Again Validates the Affordable Care Act
The US Supreme Court again affirmed the validity of The Affordable Care Act. The Obamacare program, as it has been nicknamed, will continue to lead to a medical delivery program than eventually will have major repercussions on the antiquated and ineffective medical care system of the existing patch work of state workers' compensation insurance acts.
Wednesday, April 22, 2015
Single Payer: State v Federal
Does the demise of the Vermont Single Payer system signal that change is on the horizon on a national level for a more sweeping program? The medical costs of state workers' compensation programs have become so profitable for cottage industries that are directly and ancillary connected to the delivery of work related medical care that the system is our of balance. One has to look seriously at the comments by John E. McDonough in the NEJM.
"At some point, perhaps 5 to 15 years from now, as the size and scope of Medicare, Medicaid, and the ACA subsidy structure balloon far beyond today's larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans. If advanced by the right leaders at the right time, the logic of consolidation may become glaringly evident and launch us on a new path. If such consolidation is to occur, like it or not, I believe it will happen federally and not in the states — and no time soon."
The Demise of Vermont's Single-Payer Plan
John E. McDonough, Dr.P.H., M.P.A.
N Engl J Med 2015; 372:1584-1585 April 23, 2015 DOI: 10.1056/NEJMp1501050
"At some point, perhaps 5 to 15 years from now, as the size and scope of Medicare, Medicaid, and the ACA subsidy structure balloon far beyond today's larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans. If advanced by the right leaders at the right time, the logic of consolidation may become glaringly evident and launch us on a new path. If such consolidation is to occur, like it or not, I believe it will happen federally and not in the states — and no time soon."
The Demise of Vermont's Single-Payer Plan
John E. McDonough, Dr.P.H., M.P.A.
N Engl J Med 2015; 372:1584-1585 April 23, 2015 DOI: 10.1056/NEJMp1501050
Friday, August 22, 2014
Why More, Not Fewer, People Might Start Getting Health Insurance Through Work
| In an earnings call last week, Walmart announced that its workers were signing up for health insurance en masse. The news was bad for the company’s shareholders, since the added $500 million it will cost to cover them will eat into expected profits. But it also means that many more low-income families have health insurance now than did last year. The change didn’t come because of a more generous company policy. Walmart has long offered health insurance to its full-time workers for relatively low premiums — about $18 every two weeks for its lowest-paid workers. It came because many more workers decided to take advantage of the offer. It’s early yet to be sure of a strong trend, but the Walmart experience mirrors evidence from early polls and the historical experience of Massachusetts, which enacted a law similar to the Affordable Care Act in 2006. More people may be signing up for employer-based coverage than did before. When we talk about the effect of the Affordable Care Act on health insurance, we often focus on people who were shut out of the market before, either because a prior illness made insurance inaccessible to them or because a high premium put coverage out of their financial reach. What Walmart’s experience reminds us is that there were also uninsured people who simply chose not to buy coverage before there was a law requiring them to do so. Now they may be changing their minds.This increase, if it is permanent, is going to cost... |
Monday, August 4, 2014
CMS: "The Smarter Act" Introduced in the US Senate
From the folks that brought you The Smart Act comes the sequel, "The Smarter Act." Senator Bill Nelson (D-FL) on July 31, 2014 introduced, S.2731 - "A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions."
As you recall, since the Medicare Secondary Payer (MSP) was enacted in November 1980 to stop workers' compensation insurance carriers from shifting costs onto US taxpayers, there has been a constant volley of activity between the Federal government, and those who want to maintain a status quo, ie. employers, insurance carriers and "other" financially interested participants.
Congress and Medicare (Centers for Medicare and Medicaid Services [CMS]), in an effort to shore up the financially ailing Medicare program has been dueling with an employer/insurance company led coalition. The coalition successfully lobbied for The Smart Act in May 2003. Mandated regulations were published and the stakeholders, including the coalition partners filed multiple comments objecting to the process.
Purportedly S.2731 requires CMS to establish criteria: for review, calculations, time periods, appeals process, delivery of reimbursement, and immunity form retroactive laws/regulations.
The latest round of coalition supported legislation is yet another attempt to curb the tidal wave that continues to erode the workers' compensation program as it historically existed since 1911 in the US.
The real challenge to workers' compensation and its potential extinction, is whether the visionaries can look forward instead of backward. The future will be solutions to Medicare's fiscal integrity, the integration of the Affordable Care Act, preventive health care, safer workplaces and globalization of the Social Security Disability Insurance (SSDI) system.
Thursday, July 24, 2014
Appeals Court Deals Major Blow to Implementation of Affordable Care Act
Today's post is shared by WSJ Law Blog and comes from blogs.wsj.com
A federal appeals court on Tuesday dealt a serious blow to the Obama administration’s implementation of its signature health-care law, striking down subsidies available to some consumers who purchase health coverage on insurance exchanges set up by the federal government.
WSJ’s Brent Kendall has more on the breaking legal development out of Washington:
The U.S. Court of Appeals for the District of Columbia Circuit, on a 2-1 vote, invalidated an Internal Revenue Service regulation that implemented a key piece of the 2010 Affordable Care Act. The regulation said subsidies for health insurance were available to qualifying middle- and low-income consumers whether they bought coverage on a state exchange or one run by the federal government.
The ruling potentially could cripple the Affordable Care Act by making subsidies unavailable in as many as 36 states where the federal government has run some or all of the insurance exchanges.
The court sided with challengers, four individuals and three employers, who argued the health law allowed subsidies only for insurance purchases made through state exchanges. The issue became an important one after the law was enacted because more than two-thirds of the states chose not to set up their own exchanges, relying on federally run exchanges instead.
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Sunday, July 20, 2014
Biggest Insurer Drops Caution, Embraces Obamacare
UnitedHealthcare, the insurance giant that largely sat out the health law’s online marketplaces’ first year, said Thursday it may sell policies through the exchanges in nearly half the states next year. “We plan to grow next year as we expand our offering to as many as two dozen state exchanges,” Stephen Hemsley, CEO of UnitedHealth Group, the insurance company’s parent, told investment analysts on a conference call. He was referring to coverage sold to individuals. The move represents a major acceleration for the company and a bet that government-subsidized insurance, sold online without regard for pre-existing illness, is here to stay. UnitedHealthcare sells individual policies through government exchanges in only four states now. Even analysts who follow the company closely seemed surprised. “You’re making a really big move,” Kevin Fischbeck, an analyst for Bank of America, told the company’s executives. “You’re going to do a couple dozen states. You’ve really moved in. What’s giving you the confidence … that it’s going to be stable next year?” The answer, the bosses said, is that the marketplaces look sustainable, even without some of the reinsurance and risk-spreading backstops put in place for carriers in the first few years. They know the prices now, they said. They know the regulations. They know how consumers are... |
Friday, July 18, 2014
Obamacare Fails to Fail
How many Americans know how health reform is going? For that matter, how many people in the news media are following the positive developments?
I suspect that the answer to the first question is “Not many,” while the answer to the second is “Possibly even fewer,” for reasons I’ll get to later. And if I’m right, it’s a remarkable thing — an immense policy success is improving the lives of millions of Americans, but it’s largely slipping under the radar.
How is that possible? Think relentless negativity without accountability. The Affordable Care Act has faced nonstop attacks from partisans and right-wing media, with mainstream news also tending to harp on the act’s troubles. Many of the attacks have involved predictions of disaster, none of which have come true. But absence of disaster doesn’t make a compelling headline, and the people who falsely predicted doom just keep coming back with dire new warnings.
Consider, in particular, the impact of Obamacare on the number of Americans without health insurance. The initial debacle of the federal website produced much glee on the right and many negative reports from the mainstream press as well; at the beginning of 2014, many reports confidently asserted that first-year enrollments would fall far short of White House projections.
Then came the remarkable late surge in enrollment. Did the pessimists face tough questions about why they got it so wrong? Of...
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Tuesday, July 15, 2014
Why Improving Access to Health Care Does Not Save Money
| One of the oft-repeated arguments in favor of the Affordable Care Act is that it will reduce people’s need for more intensive care by increasing their access to preventive care. For example, people will use the emergency room less often because they will be able to see primary care physicians. Or, they will not develop as many chronic illnesses because they will be properly screened and treated early on. And they will not require significant and invasive care down the line because they will be better managed ahead of time. Moreover, it is often asserted that these developments will lead to reductions in health care spending. Unfortunately, a growing body of evidence makes the case that this may not be true. One of the most important facts about health care overhaul, and one that is often overlooked, is that all changes to the health care system involve trade-offs among access, quality and cost. You can improve one of these – maybe two – but it will almost always result in some other aspect getting worse.  You can make the health care system achieve better outcomes. But that will usually cost more or require some change in access. You can make it cheaper, but access or quality may take a hit. And you can expand access, but that will increase cost or result in some change in quality. The A.C.A. was primarily about access: making it easier for people to get insurance and the care it allows. The law also tries to make changes that may bend the curve of spending... |
Monday, June 23, 2014
On-Demand Labor - Is Workers' Compensation Ready for Flex-Time Employment?
Today President Obama announced the expansion of flexible hours for governmental employees. This major trend, already exists in private industry as companies seek to expand on-demand employment.
This appears to be an expansion of the President's remarks made Saturday in his weekly address: "Then there’s the issue of flexibility – the ability to take a few hours off for a parent-teacher conference or to work from home when your kid is sick. Most workers want it, but not enough of them have it. What’s more, it not only makes workers happier – studies show that flexibility can make workers more productive and reduce worker turnover and absenteeism. That’s good for business."
A serious issue will be whether the century old workers' compensation system be able to adapt to the irregular work hours. Workers' compensation is a patchwork of systems that evolved 100 years ago in a tradeoff of benefits and legal duties. It's fiscal structure is based on premiums paid for hours worked, ie. audited payrolls.
A new dynamic now exists in both the delivery of both wage loss benefits and medical benefits. This new frontier will have a profound effect upon the national workers' compensation program.
Wages historically form the basis of establishing rates for both temporary and permanent disability benefits. Some of those benefits are subject to reconstruction based on limited/reduced wages, ie. temporary disability benefits. Some wages not reconstructed, ie. permanent disability benefits.
The cost of medical benefits is an escalating challenge to the entire system. Medical benefits are paid entirely by the employer. As medical/pharmaceutical benefits continued to soar in cost, and the Federal medical care program continues to expand, the Affordable Care Act, workers compensation program will become less stable.
Over the decades the concept and ethic of work, as we have know it to exist, has changed. Adding the processes of, the expansion of flexible work hours and on-demand employment on a global basis, will require readjustment of the workers' compensation delivery system.
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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
Monday, June 16, 2014
Undocumented Aliens Ensnared By Workers' Compensation
Peter Rousmaniere comments today about the problems, threats and fears that undocumented aliens confront with the nation's patchwork of compensation programs. Injured undocumented aliens in states than mandate the submission of a social security number to file an initial application for workers' compensation benefits are particular targets for criminal fraud enforcement.
"The eight million undocumented workers comprise about 6% of the total civilian workforce. By studying estimates of undocumented worker penetration by occupations ranked by injury risk, one can reasonably project that undocumented workers sustain one out of every ten work injuries. This high volume is invisible to almost everyone except for adjusters, case managers, lawyers and others who work directly with injured workers and have learned their work and life patterns. The rate varies greatly, from maybe 2% in West Virginia, a low foreign-born population state, to over half within the fruit and vegetable producing counties of southern California."
Reconciliation of this issue remains uncertain for a multitude of reasons. The future of immediate national reform of immigration laws this election cycle now looks bleak with Eric Cantor's recent primary defeat. States will continue to use Social Security information for tax collection and enforcement, in addition to the reconciliation of other programs such as Medicare and unemployment benefits.
Ironically as Rousmaniere points out in his commentary, the power of the employer over the employee, is a huge challenge to the improvement of safety and health in the workplace. Shifting the burden from employers to US taxpayers is problematic. As the Affordable Care Act is fined tuned in the years ahead, the issue of undocumented aliens will become both a more dominate moral and legal issue in need of reform.
Tuesday, March 4, 2014
New Law’s Demands on Doctors Have Many Seeking a Network
Dr. Sven Jonsson, a primary care physician in this rural community, is seeing a steady tide of new patients under President Obama’s health care law, the Affordable Care Act. And so far, it is working out for him. His employer, a big hospital system, provides expensive equipment, takes care of bureaucratic chores and has buffered him from the turmoil of his rapidly changing business.
“This is just a much saner place for me right now,” said Dr. Jonsson, 52, who left private practice to work for the system, Baptist Health, in 2012. “I’m probably going to live another five years.”
“This is just a much saner place for me right now,” said Dr. Jonsson, 52, who left private practice to work for the system, Baptist Health, in 2012. “I’m probably going to live another five years.”
About 25 miles away in the more affluent suburb of Crestwood, Dr. Tracy Ragland, 46, an independent primary care physician, is more anxious about the future of her small practice. The law is bringing new regulations and payment rates that she says squeeze self-employed doctors. She cherishes the autonomy of private practice and speaks darkly of the rush of independent physicians into hospital networks, which she sees as growing monopolies.
The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act....
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The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act....
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Thursday, December 5, 2013
President Obama Statement on the Benefits of the Affordable Care Act
Thanks to Monica, thanks to everybody standing behind me, and thanks for everybody out there who cares deeply about this issue. Monica’s story is important because for all the day-to-day fights here in Washington around the Affordable Care Act, it’s stories like hers that should remind us why we took on this reform in the first place.
And for too long, few things left working families more vulnerable to the anxieties and insecurities of today’s economy than a broken health care system. So we took up the fight because we believe that, in America, nobody should have to worry about going broke just because somebody in their family or they get sick. We believe that nobody should have to choose between putting food on their kids’ table or taking them to see a doctor. We believe we’re a better country than a country where we allow, every day, 14,000 Americans to lose their health coverage; or where every year, tens of thousands of Americans died because they didn’t have health care; or where out-of-pocket costs drove millions of citizens into poverty in the wealthiest nation on Earth. We thought we were better than that, and that’s why we took this on. (Applause.)
And that’s what’s gotten lost a little bit over the last couple of months. And our focus, rightly, had to shift towards working 24/7 to fix the website, healthcare.gov, for the new marketplaces where people can buy affordable insurance plans. And today, the website is working well for the vast majority of users. More problems may pop up, as they always do when you’re launching something new. And when they do, we’ll fix those, too. But what we also know is that after just the first month, despite all the problems in the rollout, about half a million people across the country are poised to gain health care coverage through marketplaces and Medicaid beginning on January 1st -- some for the very first time. We know that -- half a million people. (Applause.) And that number is increasing every day and it is going to keep growing and growing and growing, because we know that there are 41 million people out there without health insurance. And we know there are a whole bunch of folks out there who are underinsured or don’t have a good deal. And we know the demand is there and we know that the product on these marketplaces is good and it provides choice and competition for people that allow them, in some cases for the very first time, to have the security that health insurance can provide.
The bottom line is this law is working and will work into the future. People want the financial stability of health insurance. And we’re going to keep on working to fix whatever problems come up in any startup, any launch of a project this big that has an impact on one-sixth of our economy, whatever comes up we’re going to just fix it because we know that the ultimate goal, the ultimate aim, is to make sure that people have basic security and the foundation for the good health that they need.
Now, we may never satisfy the law’s opponents. I think that’s fair to say. Some of them are rooting for this law to fail -- that’s not my opinion, by the way, they say it pretty explicitly. (Laughter.) Some have already convinced themselves that the law has failed, regardless of the evidence. But I would advise them to check with the people who are here today and the people that they represent all across the country whose lives have been changed for the better by the Affordable Care Act.
The other day I got a letter from Julia Walsh in California. Earlier this year, Julia was diagnosed with leukemia and lymphoma. “I have a lot of things to worry about,” she wrote. “But thanks to the [Affordable Care Act], there are lots of things I do not have to worry about, like…whether there will be a lifetime cap on benefits, [or] whether my treatment will bankrupt my family…I can’t begin to tell you how much that peace of mind means...” That’s what the Affordable Care Act means to Julia. She already had insurance, by the way, but because this law banned lifetime limits on the care you or your family can receive, she’s never going to have to choose between providing for her kids or getting herself well -- she can do both.
Sam Weir, a doctor in North Carolina, emailed me the other day. “The coming years will be challenging for all of us in family medicine,” he wrote. “But my colleagues and I draw strength from knowing that beginning with the new year the preventive care many of our current patients have been putting off will be covered and the patients we have not yet seen will finally be able to get the care that they have long needed.” That’s the difference that the Affordable Care Act will make for many of Dr. Weir’s patients. Because more than 100 million Americans with insurance have gained access to recommended preventive care like mammograms, or colonoscopies, or flu shots, or contraception to help them stay healthy -- at no out-of-pocket cost. (Applause.)
At the young age of 23, Justine Ula is battling cancer for the second time. And the other day, her mom, Joann, emailed me from Cleveland University Hospital where Justine is undergoing treatment. She told me she stopped by the pharmacy to pick up Justine’s medicine. If Justine were uninsured, it would have cost her $4,500. But she is insured -- because the Affordable Care Act has let her and three million other young people like Monica gain coverage by staying on their parents’ plan until they’re 26. (Applause.) And that means Justine’s mom, all she had to cover was the $25 co-pay.
Because of the Affordable Care Act, more than 7 million seniors and Americans with disabilities have saved an average of $1,200 on their prescription medicine. (Applause.) This year alone, 8.5 million families have actually gotten an average of $100 back from their insurance company -- you don’t hear that very often -- (laughter) -- because it spent too much on things like overhead, and not enough on their care. And, by the way, health care costs are rising at the slowest rate in 50 years. So we’re actually bending the cost of health care overall, which benefits everybody. (Applause.)
So that’s what this law means to millions of Americans. And my main message today is: We’re not going back. We’re not going to betray Monica, or Julia, or Sam, or Justine, or Joann. (Applause.) I mean, that seems to be the only alternative that Obamacare’s critics have is, well, let’s just go back to the status quo -- because they sure haven’t presented an alternative. If you ask many of the opponents of this law what exactly they’d do differently, their answer seems to be, well, let’s go back to the way things used to be.
Just the other day, the Republican Leader in the Senate was asked what benefits people without health care might see from this law. And he refused to answer, even though there are dozens in this room and tens of thousands in his own state who are already on track to benefit from it. He just repeated “repeal” over and over and over again. And obviously we’ve heard that from a lot of folks on that side of the aisle.
Look, I’ve always said I will work with anybody to implement and improve this law effectively. If you’ve got good ideas, bring them to me. Let’s go. But we’re not repealing it as long as I’m President and I want everybody to be clear about that. (Applause.)
We will make it work for all Americans. If you don’t like this law -- (applause) -- so, if despite all the millions of people who are benefitting from it, you still think this law is a bad idea then you’ve got to tell us specifically what you’d do differently to cut costs, cover more people, make insurance more secure. You can’t just say that the system was working with 41 million people without health insurance. You can’t just say that the system is working when you’ve got a whole bunch of folks who thought they had decent insurance and then when they got sick, it turned out it wasn’t there for them or they were left with tens of thousands of dollars in out-of-pocket costs that were impossible for them to pay.
Right now, what that law is doing -- (baby talks.) Yes, you agree with me. (Laughter.) Right now, what this law is doing is helping folks and we’re just getting started with the exchanges, just getting started with the marketplaces. So we’re not going to walk away from it. If I’ve got to fight another three years to make sure this law works, then that’s what I’ll do. That’s what we’ll do. (Applause.)
But what’s important for everybody to remember is not only that the law has already helped millions of people but that there are millions more who stand to be helped. And we’ve got to make sure they know that. And I’ve said very clearly that our poor execution in the first couple months on the website clouded the fact that there are a whole bunch of people who stand to benefit. Now that the website is working for the vast majority of people, we need to make sure that folks refocus on what’s at stake here, which is the capacity for you or your families to be able to have the security of decent health insurance at a reasonable cost through choice and competition on this marketplace and tax credits that you may be eligible for that can save you hundreds of dollars in premium costs every month, potentially.
So we just need people to -- now that we are getting the technology fixed -- we need you to go back, take a look at what’s actually going on, because it can make a difference in your lives and the lives of your families. And maybe it won’t make a difference right now if you’re feeling healthy, but I promise you, if somebody in your family -- heaven forbid -- gets sick, you’ll see the difference. And it will make all the difference for you and your families.
So I’m going to need some help in spreading the word -- I’m going to need some help in spreading the word. I need you to spread the word about the law, about its benefits, about its protections, about how folks can sign up. Tell your friends. Tell your family. Do not let the initial problems with the website discourage you because it’s working better now and it’s just going to keep on working better over time. Every day I check to make sure that it’s working better. (Laughter.) And we’ve learned not to make wild promises about how perfectly smooth it’s going to be at all time, but if you really want health insurance through the marketplaces, you’re going to be able to get on and find the information that you need for your families at healthcare.gov.
So if you’ve already got health insurance or you’ve already taken advantage of the Affordable Care Act, you’ve got to tell your friends, you’ve got to tell your family. Tell your coworkers. Tell your neighbors. Let’s help our fellow Americans get covered. Let’s give every American a fighting chance in today’s economy.
Thank you so much, everybody. God bless you. God bless America. (Applause.)
Sunday, November 24, 2013
Obamacare Has a Friend in the Health Care Industry
In the LA Times today, Noam Levey writes that Obamacare has an ace in the hole: the insurance industry. Sure, they have their gripes:
But since 2010, they have invested billions of dollars to overhaul their businesses, design new insurance plans and physician practices and develop better ways to monitor quality and control costs.This is really a crucial point. Like it or not, the entire health care industry has spent the past three years gearing up for the rollout of Obamacare. At this point, they're committed—and doubly so since the Republican Party very clearly has no real alternative for them. This means that all the doom-mongering on Fox... |
Friday, October 18, 2013
The Many Ways the Government Shutdown Hurt Public Health and the Environment
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Political extremists pushed our nation to the brink out of sheer obstinance. Speaker Boehner could have ended this days ago by simply letting the full House vote on reopening the government. Instead, he declared himself a willing hostage to the radical wing of his party. The reopening of the government and avoiding default are obviously good news. But the deal that allowed it to happen should be a signal to the environmental community to gird for the battles ahead. The deal puts off the big fights for just a couple of months. House Republicans had a long list of anti-environmental provisions they threatened to add to the debt limit before the Affordable Care Act became their single-minded focus, and they could be part of the brinksmanship next time around.... |
Thursday, September 26, 2013
Work Comp Steps Up to ACA
The Affordable Care Act's impact on workers' compensation is going to take many forms. David DePaolo points out in his shared blog today some of the aspects as the ACA is close to launch. Whether the ACA is going to emasculates the workers' compensation system is yet unknown It is sure heading that way in the new less litigious and aging society.
One of the big questions I have had since the Affordable Care Act became law was how the workers' compensation underwriting market would react since it seemed that there would be a broadening in the class of health care workers coming into the scene. That question was given some evidence yesterday when ProAssurance, a writer of medical professional liability insurance based in Birmingham, Ala., announced a proposed acquisition of Pennsylvania-based workers' compensation writer Eastern Insurance Group for $205 million. Eastern offers workers’ compensation to employers with generally 1,000 employees or less that traditionally pay an average premium per policy of $21,956, according to filings with Securities & Exchange Commission. Also, Eastern concentrates on low- to middle-hazard classes of businesses, primarily in the Mid-Atlantic, Southeast, and Midwest regions. In 2012, it reported workers comp premiums written of $182.9 million. Among those employers Eastern counts as policy holders are small hospital systems, long-term care facilities, physician and dental practices and home health care providers.... |
Monday, September 23, 2013
State Politics and the Fate of the Safety Net
Only 2% of acute care hospitals nationwide are safety-net facilities, but they provide 20% of uncompensated care to the uninsured. Because most are in low-income communities, they typically generate scant revenue from privately insured patients. The Medicaid Disproportionate Share Hospital (DSH) program was established to help defray their costs for uncompensated care. Currently, Medicaid DSH disburses $11.5 billion annually to the states, which have considerable latitude in allocating these funds. Some states carefully target their DSH payments to hospitals providing large volumes of uncompensated care, but others, such as Ohio and Georgia, spread their payments broadly, transforming the program into a de facto subsidy of their hospital industry. Because the Affordable Care Act (ACA) was expected to dramatically expand insurance coverage, safety-net hospitals were expected to need less DSH money. Therefore, to reduce the cost of expanding Medicaid, the ACA reduced Medicaid DSH funding by $18.1 billion between fiscal years 2014 and 2020. To allow time for coverage expansion to take effect, the cuts are back-loaded — starting at $500 million (4% of current national DSH spending) in 2014 but reaching $5.6 billion (49% of current spending) in 2019. The DSH cuts are so deep in part because Congress assumed that all... |
Related articles
- It's Complicated: Obamacare's Choices for People with Disabilities (workers-compensation.blogspot.com)
- Law Will Shift Demographics For Medicaid Toward Healthier Group, Study Finds (workers-compensation.blogspot.com)
- Hacking the Affordable Care Act (workers-compensation.blogspot.com)
- Walmart CEO Mike Duke Pushes Back Against Company's Minimum Wage Reputation (workers-compensation.blogspot.com)
- The Trend to Supersize Hospitals (workers-compensation.blogspot.com)
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Wednesday, September 18, 2013
For Workers Leaving Their Jobs, Health Exchanges Offer Insurance Choices Beyond COBRA
Workers who lose their jobs and their employer-based health insurance will have new coverage options when the Affordable Care Act's state marketplaces open in October. But consumer advocates are concerned many may not realize this and lock themselves into pricier coverage than they need.
 Many of these people will likely be better off buying a plan on the state health insurance marketplaces, also called exchanges. Plans sold there must cover a comprehensive set of 10 "essential health benefits," and consumers can choose among four plan types with different levels of cost-sharing. Premium tax credits will be available to people with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for an individual in 2013), often making exchange coverage significantly more affordable than COBRA. "COBRA was a transitional type of coverage while you're between jobs, but now we have a subsidized form of coverage available, exchange plans with subsidies," says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities. It's... |
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