Monday, April 1, 2013
Excerpts taken from CNN article written by Jen Christensen
The Medicare Advantage coverage plan could soon cost more, according to an announcement expected Monday. The Centers for Medicare and Medicaid Services (CMS) will announce on Monday the final Medicare Advantage rates for 2014, which are expected to be cut, saving the government money -- but potentially costing the public more.
CMS had first proposed a 2.3% reduction in what the government pays the insurance companies that provide Medicare Advantage plans. Upset, the insurance companies have spent the public comment period time lobbying legislators and running ads against the cut.
Ads from the America's Health Insurance Plans' Coalition for Medicare Choices called the proposal "drastic" and "too much" and featured seniors saying they can't afford to pay more for health care.
x About 25% of the 47 million Americans on Medicare pay more to have Medicare Advantage. The plans are run by private insurance companies that are reimbursed by the government for doing so. The plans vary, but they offer the elderly more than they would get with regular Medicare. Most plans offer prescription drug coverage; some also offer dental and vision. All the plans cap a person's out-of-pocket expenses, while regular Medicare does not.
The rate reduction, which is a part of the Obama administration's ongoing effort to save money on the program, comes on top of other reductions that all go into effect at about the same time. The result is an unusually large reduction ... about 8% less.
x Seniors won't know what the out-of-pocket costs these cuts will bring until the fall. That's when the insurance companies put in their bids for the government work. By law, those out-of-pocket expenses can't go up by more than $30 more per month. That doesn't sound like a lot, but it can add up for seniors on a fixed income.
Source CNN. Jen Christensen
Monday, March 11, 2013
Rep. Ryan's FY 2014 Budget Proposal Aims To Repeal, Replace ACA
During an interview on "Fox News Sunday," House Budget Committee Chair Paul Ryan (R-Wis.) said his fiscal year 2014 budget proposal -- which he is expected to unveil this week -- would renew the GOP's efforts to repeal and replace the Affordable Care Act, the Washington Post's "The Fix" reports (Sullivan, "The Fix," Washington Post, 3/10).
Although many GOP lawmakers -- including House Speaker John Boehner (R-Ohio) -- have said that the ACA is here to stay, Ryan said Republicans remain opposed to the law and would continue to push for its repeal because they believe the law "will not work" (Bolton, "Blog Briefing Room," The Hill, 3/10).
Ryan dismissed criticism that House Republicans have little hope of dismantling the law, saying Republicans "believe it should" be repealed (Nelson, "Washington Wire," Wall Street Journal, 3/10). He noted, "This is what budgeting is all about. It’s about making tough choices to fix our country's problems," adding, "We believe Obamacare will actually lead to hospitals and doctors and health care providers turning people away" ("Blog Briefing Room," The Hill, 3/10).
However, Ryan's call to repeal the ACA could put him at odds with GOP lawmakers who want to find common ground with President Obama to reduce the federal deficit, particularly after the Supreme Court upheld the law, according to the Los Angeles Times.
Ryan's FY 2014 budget proposal also includes a provision from his FY 2013 budget proposal to turn Medicare into a premium-support system, the Times reports. Under Ryan's plan, beneficiaries would receive a federal subsidy to purchase either private coverage or a traditional Medicare plan. Just like the 2013 plan, the 2014 blueprint also would rely on more than $700 billion in Medicare savings from the ACA to "make Medicare more solvent" (Mascaro, Los Angeles Times, 3/10).
Ryan said changing Medicare to a premium-support model "is the best way to save Medicare for future generations." He added, "This guarantees that Medicare does not change for people in or near retirement, and it also guarantees for those of us who are under the age of 55, that we actually have a Medicare program when we retire" (Zigmond, Modern Healthcare, 3/10).
In addition, Ryan said his budget blueprint would undo the ACA's Medicaid expansion and give states more control over their programs by turning Medicaid into a block-grant system, the Times reports (Los Angeles Times, 3/10). According to Ryan's budget, this would generate $770 billion in Medicaid savings over the next decade.
When asked if Obama would accept his proposed changes to Medicare and Medicaid, Ryan said, "My guess is he won't." However, he added, "I think there are things that we can do that don't offend either party's philosophy, that doesn't require someone to surrender their principles" (Brown/Sullivan, Washington Post, 3/10).
Tuesday, January 29, 2013
Monday, January 21, 2013
Written Friday, January 18, 2013 by David Gorn, Capital Desk, California Healthline:
Covered California Lands $674 Million Federal Grant
As written ..
Peter Lee could hardly contain himself yesterday.
"In 2010, California was the first state in the nation to say we want a state-based exchange. Then, earlier this month, the federal government approved our blueprint for the exchange," said Lee, the executive director of the state's health insurance exchange, Covered California.
"And now," Lee said, "the feds have given us the resources we need to launch Covered California. This is an historic moment."Yesterday federal officials awarded $674 million to the California exchange, a Level 2 establishment grant that funds the set-up of the exchange through the end of 2014.
It was slightly short of the $706 million originally requested for the grant, but Lee was not about to quibble.
"The feds reduced 2014 potential payment for outreach and enrollment by about $30 million," Lee said. "But we think we have enough resources on hand to do the biggest outreach that I've ever seen."
State HHS Secretary Diana Dooley pointed out that the extensive planning for the exchange was accomplished in a relatively brief time frame, as the exchange board was only formed in April 2011.
"I just have to say how proud I am of the work this group has done in such a short time," Dooley said. "The work that's been done is nothing short of extraordinary."
Yesterday's federal announcement came a few hours before the board's monthly meeting -- this time held in Los Angeles -- where the good financial news continued.Exchange board member Robert Ross, who also sits on the board of the California Endowment, had another funding announcement."We are committing a minimum of $225 million to implement health care reform in our state," Ross said of the California Endowment. "There will be four major areas of spending," Ross said. "Outreach and enrollment, health workforce, chronic disease prevention and cost control and the fourth one is thinking about the population that's left behind, the undocumented."
Lee said he hopes the work being done to make health coverage affordable for low- and middle-income Californians will have a ripple effect throughout the health care industry."Covered California is not only going to make health care coverage available for millions," Lee said, "Covered California is going to be integral to creating a health care marketplace that works for everybody."
Tuesday, January 15, 2013
The following was written by Anna Gorman, Los Angeles Times. It is more than scary to read reports like this. Our hospitals are supposed to be where we are safe. Read on ....
Last December, ten California hospitals received fines for errors that resulted in either serious injury or death to a patient.
The California Department of Public Health issued a total of $785,000 in penalties for errors that include removing the wrong kidney, leaving surgical objects behind and failing to call for assistance when a patient began bleeding excessively.
The civil fines, ranging from $10,000 to $100,000, were issued to hospitals throughout the state for errors that occurred in 2010 and 2011. Two facilities in Los Angeles County and two in Orange County were among those fined.
Hospitals are required to report certain errors to the state. The goal of issuing the penalties and making them public is to reduce surgical and medication mistakes, said Debby Rogers, deputy director of the department's Center for Healthcare Quality.
"The value of the fines is bringing awareness both to the healthcare industry and healthcare providers but also to consumers," she said in a call to reporters.
Four of the hospitals fined were Kaiser facilities. At Kaiser's South Bay Medical Center, a patient died after mistakenly being given a blood thinner instead of medication to stop bleeding in the digestive tract. The state fined the facility $50,000.
At Kaiser's Oakland Medical Center, a 29-year-old woman died during a laser surgery to remove a congenital birth defect from her upper lip. The state fined the hospital $100,000.
An official with Kaiser Foundation Hospitals and Health Plan in Northern California said in a statement that she deeply regretted what occurred at its Oakland facility. "This should never have happened and we have taken steps to prevent it from happening again," said Barbara Crawford, vice president of quality and regulatory services.
Kaiser's Southern California office also submitted a statement saying that patient safety is "paramount" and that the facility took the errors very seriously and put in additional safeguards to prevent future problems.
A few of the penalties were due to surgical items being left behind in patients during operations. At Methodist Hospital of Southern California in Arcadia, surgeons left in a sponge when doing a gallbladder surgery and had to do another operation to remove it. The fine was $50,000.
Hospital spokesman Rick Miller said it was a "one-time" incident. "Since that time, we revamped our policies and procedures," he said. "There have been no other cases like this."
One facility, UC San Francisco Medical Center, received its sixth fine since 2007. In 2010, a nurse practitioner prescribed a cancer patient a medication that she was allergic to, resulting in her spending time in the intensive care unit and a skilled nursing facility.
The fact that the hospital has had so many fines is "obviously concerning to us," Rogers said.
After the error, the medical center re-trained staff on procedures regarding allergies and evaluated the nurse practitioner workload. The hospital also now has a comprehensive electronic health records system that makes it easier to access patient information, said Josh Adler, chief medical officer of UCSF Medical Center.
Rogers said the state recently proposed regulations that would raise the amount of penalties, making the initial fine $75,000, the second $100,000 and the third $125,000. The regulations also would allow the state to issue fines for errors that do not rise to the level of "immediate jeopardy" to patient health and safety.
The two Orange County hospitals that were fined were Mission Hospital Regional Medical Center in Mission Viejo and Orange Coast Memorial Medical Center in Fountain Valley.
Since 2007, the state has fined 141 hospitals a total of $9.6 million in penalties. The state has collected $7.5 million of that amount.
Friday, January 11, 2013
Sunday, January 6, 2013
Here is a great article written by Michael J. Mishak, of the Los Angeles TImes last December:
Facing a federal deadline, the CA Legislature must move quickly to pass measures to implement President Obama's healthcare law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law.
Legislative leaders have said they also want to overhaul environmental regulations, curb soaring tuition at public colleges, and tweak the state's tax structure and ballot-initiative system.
But healthcare remains one of the largest and most immediate challenges.
The federal Affordable Care Act takes effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty. State lawmakers must pass a series of rules to clear the way for enrollment in a new state-run insurance market next fall, including a requirement for insurers to cover consumers who have preexisting medical conditions and limits on how much they can charge based on age.
Gov. Jerry Brown is expected to call a special session of the Legislature next month — concurrent with the regular session — so healthcare bills that he signs can take effect within 90 days rather than the next year.
"It's a very, very big undertaking to make the promise of the Affordable Care Act a reality," said state Health and Human Services Secretary Diana Dooley. "We are working as hard and as fast as we can in a very complex area with a lot of conflicting information."
As an early adopter of the Affordable Care Act, California has already laid much of the groundwork.
It was the first state to establish an insurance exchange after Congress passed the legislation in 2010. More than 30 other states have since sought federal help in enacting their own. Millions of Californians will be able to purchase coverage, with federal subsidies earmarked for families earning about $92,000 or less annually.
One of the most significant proposals will be an expansion of Medi-Cal, the state's health insurance program for the poor. About 2 million low-income Californians would be newly eligible under the expansion, with the federal government subsidizing costs for the first three years. The state would then shoulder a portion of the bill.
According to a Kaiser Family Foundation study, the expansion could cost the state $6.3 billion over a decade, meaning a 1.7% increase in the amount California spends on Medi-Cal.
California got a head start on the effort by signing up more than 550,000 low-income people in a temporary program. They are expected to automatically move into Medi-Cal in 2014.
Lawmakers will also consider legislation that would create a health plan for people who cannot afford insurance on the open market but make too much money to qualify for Medi-Cal. The option, known as the Basic Health Plan, would provide coverage for individuals with incomes between 133% and 200% of the federal poverty level, or between $15,000 and $21,800 a year.
State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and author of the proposal, said the plan was needed to help California's working poor. "I don't think they should be choosing between putting food on the table and buying health insurance," he said.
Insurers urged lawmakers to resist requirements that could make policies offered through the exchange unaffordable.
"We think the Affordable Care Act does much to get millions of people coverage, but new insurance taxes, costly benefit requirements and age pricing restrictions all have the potential of driving up costs," said Nicole Evans, a spokeswoman for the California Assn. of Health Plans.
Healthcare advocates said it was critical for the Legislature to promote policies that would ensure a mix of healthy and sick policyholders to keep premiums affordable.
"It should be a goal of the state to have millions of people enrolled on Day 1," said Anthony Wright, executive director of the consumer group Health Access California, "to bring in those federal dollars and make healthcare cheaper for everybody."