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Health Insurance for Individuals

Sanctions Blocking Medicare Sales Lifted

July 21st, 2011

Sanctions blocking health insurance providers from marketing Medicare plans and taking steps to enroll new beneficiaries has been lifted by federal regulators, this according to Aetna Inc.

Removal of these restrictions are crucial because Aetna, as well as a number of other health insurance carriers, are looking to build up presence in the field of Medicare. Sanctions were imposed by the Centers for Medicare and Medicaid Services last April.

Currently, Aetna Inc. has about 1 million Medicare Advantage as well as drug-plan beneficiaries. Now, the company will be able to compete for new beneficiaries throughout the open enrollment period for Medicare in the fall.

Atena Inc Is Purchasing Genworth Financial Inc

Aetna Inc. has admitted interest in acquisitions that would increase the presence of Medicare. Recently, the company announced the purchase of Genworth Financial Inc., which is a Medicare supplement company, for just under $300 million. Unaffected by the restrictive sanctions, Medicare supplement plans were bought by individuals that held coverage under traditional Medicare. Medicare supplement plans offer beneficiaries with protection against paying any out-of-pocket expenses that may not be covered by Medicare. According to Aetna Inc., the Genworth unit featured almost 150,000 members.

Atena Inc Is Purchasing Genworth Financial Inc

The penalty was imposed by the regulator in April 2010, claiming that the company had not complied with regulations related to changes in drug-plan designs. According to CMS then, Aetna Inc. did not meet the necessary requirements, ensuring senior citizens would be able to continue receiving their medications throughout changes to the company’s plans–last years as well as the year before in 2009.

The issue grew as Aetna Inc. progressed from an open formulary for prescription medications in 2009 to a closed formulary in 2010, according to the company. With an open formulary, patients are able to receive prescriptions for just about any drug; in a closed formulary, the choices of medications available are somewhat restricted.

Creative Commons License photo credit: TR Photographics

Opt-Out Proposition Has Voter Approval

July 8th, 2011

CactusVoters at recent elections approved of a ballot measure that would make it possible for Arizona residents to opt out form any state or federally mandated health care. Informal returns indicate that Proposition 106 is leading by quite the sizable margin.

The proposition was offered by supporters in order to amend the state constitution awaiting the federal health care reform law that was recently enacted. These supporters argued that the people of Arizona should be able to keep control of their own decisions regarding health care.

According to the chairman of Arizonians Health Care Freedom, Dr. Eric Novack, “The majority of Arizona voters, I believe, have said very clearly that the decision belongs in the hands of families and not in the hands of politicians.”

As of October 13, 2010, Arizonians Health Care Freedom have raised close to two million dollars so far supporting the proposition based on a filing with the Secretary of State. In addition, Dr. Novack is also the chairman for the United States Health Freedom Coalition, which is a national advocacy group that donated a $1.5 million to the efforts in Arizona.

Groups that are in opposition of the proposition have managed to raise less than five thousand dollars as of October 13th, according to the offices of the Secretary of State in Arizona.

Those who oppose Proposition 106 believe that it may derail the many benefits of health care reform in the state or, most likely, set up a high-priced and ineffective legal challenge over clashes with the federal measure. After all, federal law almost always surpasses the state laws in such court rulings.

According to Shirley Sandelands, who is the second vice president of the Arizona League of Women voters had this to say, “We have a very strong position that we would like to have affordable health care.” In regards to the passage of Proposition 106, she said, “I have a feeling it will end up being adjudicated.”

The Buzz about Rhode Island’s Medicaid Experiment

June 29th, 2011

Republicans are pushing to restrict Medicaid costs, prompting Rhode Island to conduct an experiment. The experiment is attracting attention from a number of Conservatives, saying that it has caused considerable savings without a reduction in care for low-income patients throughout the state.

The Medicaid experiment in Rhode Island is the clearest example of the types of alterations that Republicans claim to want to make. Limitations on federal spending for the Medicaid program exist, yet states are given more freedom to make decisions on the benefits that are offered as well as cost control.

Has This Experiment Lowered Spending?

However, a closer look at the experiment in Rhode Island shows it has not yet yielded the type of savings that the supporters are claiming. In Rhode Island, federal spending for Medicaid continues to increase, including payments that the federal government would not otherwise make. In addition, unlike the Republican plan that was recently passed in the House, under which states may lose a considerable amount of government funding for their Medicaid program, Rhode Island is practically guaranteed to have more money than is estimated necessary.

Filthy Lucre (8)

What Happens if Rhode Island Goes Above Budget?

Under Rhode Island’s experiment, which was created in an agreement in 2009 between the Centers for Medicare and Medicaid Services, Medicaid spending was limited to $12 million through 2013. Rhode Island would be responsible for costs above that initial $12 million, as opposed to sharing the expense with the government. In exchange, the state was granted a greater amount of flexibility on its Medicaid operations.

$20 down the drain

Representative Cathy McMorris Rodgers, a Republican from Washington State and co-sponsor of a plan recently introduced into Congress lifting rules forbidding states from altering the eligibility requirements for Medicaid, considers the agreement with Rhode Island to be a model that other states should follow.

Riva Litman, Ms. McMorris’ press secretary, had this to say:

“That plan is supported by both parties in Rhode Island and has saved hundreds of millions of dollars through competition-driven efficiencies and accountability.”

Creative Commons License photo credit: Images_of_Money, L. Bernhardt, Resident Loon

Making Medicaid Cuts against the Rules

June 15th, 2011

110530-N-TT977-387 In an effort to escalate health care access for low-income families and individuals, the Obama administration proposes the implementation of a new rule, making it harder for states to cut the Medicaid payments for hospitals and doctors.

This new rule may pressure a number of states to increase payment rates for Medicaid, which is generally less than what commercial insurance and Medicare pay.

Federal officials recently said that the new rule is necessary to fulfill the promise made by federal law, which states Medicaid recipients are to be granted access to the same extent of health care as the general population.

The Obama administration issued a proposal, which was published in the Federal Register, saying, “We have a responsibility to ensure sufficient beneficiary access to covered services.”

In many different states all around the country, a large number of Medicaid recipients are having a hard time finding doctors to take them on as patients because of the low payment rates for Medicaid.

Facing colossal finance problems, a large number of states have reduced or even frozen payments from Medicaid to doctors and hospitals. In addition, governors of both parties are proposing even more cuts within the year. Health care providers as well as Medicaid recipients are taking action by suing state officials in order to block cuts. In fact, a case from California is actually pending in the United States Supreme Court.

Cindy Mann is the federal official who is in charge of the Medicaid program. She says, “Tight state budgets, coupled with increased demand for services during the recession, have led many states to propose reductions in Medicaid provider payments, without clear federal guidance on how to assure access.”

The new rule will provide such guidance, yet a number of state officials have expressed their concerns.

Creative Commons License photo credit: Chairman of the Joint Chiefs of Staff

The Rise of Mail Order Has Pharmacists Ready for Battle

May 31st, 2011


Pharmacists vs. Mail Order

A brutal war has begun between mail order companies and pharmacists over where people should be allowed to fill long-term prescriptions.

Local pharmacists in the state of New York are lobbying for a legislation that prevents health plans from demanding patients with chronic illnesses to have their prescriptions filled via mail order.

While a number of health plans changed to mail order delivery several years ago due to the fact that it was less expensive for consumers and employees alike. However, drugstores have been providing prices that are somewhat more competitive, which pushes lawmakers level the playing field, making sure people are still able to go to local pharmacies to have their prescriptions filled.

The projected legislation banning mandatory mail order programs was first introduced in late February in both state chambers. In addition, the legislation also prohibits health plans from requiring patients to pay more for their prescriptions if they decide to purchase them from a local drugstore.

The Pharmacists Society of the State of New York traveled to Albany in order to plead their case. The executive director, Craig M. Burridge said, “What we are asking is to make mail order an option, not mandatory.” He continued, “We are not opposed to mail order as a convenience to the patients. But right now, they don’t have a choice.”

The big organizations that are responsible for the management of prescription drug programs, pharmacy benefit managers, believe that mail order is so appealing because not only is it more convenient, but it is less expensive as well.

The Pharmaceutical Care Management Association represents these pharmacy benefit managers. The president Mark Merritt said, “There’s going to be use of more home delivery, not less.” He also said, “It saves money and is pretty popular with consumers.”
Creative Commons License photo credit: dno1967b

Hospital Restrictions on Free Care

May 25th, 2011

Free Health Care
The Sarah Bush Lincoln Health System could anticipate somewhere in the neighborhood of two hundred patients per month to apply for free care.

Then, in 2009, the number increased to  as many as three hundred patients per month.

The executives at Sarah Bush Lincoln decided to take a closer look and determined that there was a need to set some limits. Beginning in 2010, discounted and free care, with a few exceptions, was limited to patients within a seven-county region.

Craig Sheagren, the Vice President of Financial Services for Sarah Bush Lincoln said, “I will say this: It has not made much of a difference.”

Across the state of Illinois last year, financial aid requests at hospitals rose as jobs dwindled and insurance benefits shrank, leaving less people who are even able to pay for medical care at all.

Free Care Patients on the Rise

The Executive Vice President at the Illinois Hospital Association, Howard Peters said, “We’re hearing from hospitals that they’re having record numbers of people needing charity and record numbers of people on Medicaid.”

The organization released a report last year, revealing that more than one hundred hospitals in Illinois filing community benefit reports in 2008-09 combined dispensed more than $490 million in discounted and free healthcare, which was as much as $70 million more than a year prior.

In addition, those facilities also sustained almost $2.4 billion in uncompensated costs for patients who use health plans sponsored by the government for the elderly or disadvantaged, such as Medicare and Medicaid. This is $150 million more than the year before, with more than $1 billion in bad debt.

A major factor in the uncompensated costs is the rise in Medicaid patients, most of which are children. According to the state Department of Healthcare and Family Services in Illinois, Medicaid enrollment reached a record high of 2.6 million in 2010.

Creative Commons License photo credit: Fibonacci Blue



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