|
|
An amazing American legislative victory over this March 2010 weekend has earned a circle on every person’s calendar. Although it’s not officially law yet, an enormous step towards universal health care has been achieved. The House has officially passed the Health Care Reform. This piece of social legislation has been a newsworthy debate by every individual who has held title of American President since 1960 when the Great Society saw the passing of Medicare and Medicaid. Universal health care coverage is the goal. The house voted 219 – 212 in favour of an overhaul of the health care system being signed into law. The Democrats passed this bill without one single Republican vote.
The second bill that passed by the House on March 21 will be the bill to make adjustments to the current legislation such as lowering the taxes on high-value insurance plans and removing kickbacks like budget reconciliations. However, President Obama made a promise to continue with the consistency of some existing Federal laws of the Hyde Agreement that has been in place since 1976.
The goal of this new bill is to make the practice of medicine and health care providers more efficient. They would be rewarded on how well they treat patients instead of the current method of how much care they provide to individual patients. The bill would also make available health coverage to approximately 32 million legal Americans, increasing the number to 95% coverage from the current 83%.
Even in Canada where Medicare has existed in one form or another since 1968, you can fall victim to debt resulting in bad credit due to medical bills from a rejected insurance claim, for items not covered by Medicare. If you are in such a predicament, a private loan could assist with the consolidation of debt as well as to help rebuild bad credit as these financial institutions understand such situations and specialize in bad credit loans.
Albeit in the United States or in Canada, like any newly implemented law, it will take time to see positive results. During the first few years, most people will notice only minor changes. If you fall into the category of denied insurance or denied insurance claims due to pre-existing conditions, the good news is that the immediate changes are severe and are directed at those insurance company’s policies. The practice of denying coverage to children with pre-existing conditions and dependent children under the age of 26 who cannot otherwise get healthcare, will allow them to remain covered under their parent’s policies. As well, adults with pre-existing conditions will be allowed to buy coverage with high-risk companies, an option that is not available now.
BHM Financial is one of the most trusted names in the Canadian car title loan industry and may be able to help build your credit in 2010. Visit our Bad Credit Loans website today, and breathe easier tomorrow!. Visit our blog for more articles about Bad Credit and Debt.
Last week, Democratic leaders in the Senate caved to Sen. Joseph Lieberman’s demands and stripped away some major provisions from their health reform legislation, including the public option and a plan that would have allowed middle-age Americans to “buy in” to Medicare. With Connecticut independent Lieberman’s support seemingly secured — for the time being — the president announced that Congress was “on the precipice” of passing comprehensive reform.
But even without these controversial components, the Democrats’ bill would still put government in charge of nearly all Americans’ health care. Patients would have fewer choices in the insurance marketplace, and taxpayers would be on the hook for a multibillion-dollar expansion of the public health care system.
Ultimately, these moves will dramatically drive up the cost and worsen the quality of health care in America.
A key element of the Democrats’ reform bill is an individual mandate, which would legally require people to purchase insurance. Starting in 2013, everyone would have to own a plan that met government specifications or pay a fine.
Proponents of such a mandate claim that it will broaden the insurance risk pool to include those who may not currently have insurance, which would eventually lead to lower premiums for everyone. Previously uninsured younger, healthy Americans would effectively subsidize older and less healthy patients.
Mandating everyone to dive into the insurance pool may seem like a good idea, but it represents a profound assault on individual freedom.
The federal government will decide what constitutes an acceptable benefit plan and what people pay for it. Government will also control how doctors are paid by insurance companies and, ultimately, how they practice medicine.
Congress does not legally force Americans to spend their own money on any other particular good or service — why should health insurance be any different?
In fact, for some Americans, health insurance isn’t a wise use of funds. Young people and health fanatics, for instance, might well shell out premiums for medical services they likely won’t use.
And those premiums can be hugely expensive. The average premium for family coverage is a whopping $12,300 a year. That rate is only going to go up if the Democrats’ plan passes.
The nonpartisan Congressional Budget Office recently estimated that individual insurance premiums under reform would be 10 percent to 13 percent higher by 2016 than they would in the absence of reform. In certain states, the increase in premiums would be even higher.
In California, for instance, the average healthy 25-year-old man would see his premiums rise 106 percent thanks to the Democrats’ reform plan. Premiums for a typical Virginia family with two children would increase 82 percent.
Some folks might be best served by paying for routine health expenses out of their own pockets rather than relying on expensive and inconsistent insurance policies.
These increases in the cost of insurance are largely the result of the reform plan’s array of new controls on insurers. Paramount among these controls is a requirement that insurers issue a policy to any customer who requests one, regardless of one’s medical history or health status.
In those states that mandate “guaranteed issue,” the regulation has induced patients to wait until they actually need medical care before purchasing coverage. In order to cover the cost of an insurance pool filled exclusively with sick people, premiums must be sky-high. Indeed, guaranteed issue has driven health premiums up by as much as 200 percent in some states.
In those states that mandate “guaranteed issue,” the regulation has induced patients to wait until they actually need medical care before purchasing coverage. In order to cover the cost of an insurance pool filled exclusively with sick people, premiums must be sky-high. Indeed, guaranteed issue has driven health premiums up by as much as 200 percent in some states.
The Democrats’ reform package would also install a national “community rating” ordinance, which would restrict insurers’ ability to charge different prices to different enrollees according to their health status. It would also impose new limits on out-of-pocket spending and require all insurance plans to include certain benefits, like maternity leave and newborn care, even if a patient didn’t want them.
These rules are meant to make health coverage more affordable and robust for more Americans. But they’ll do just the opposite.
Mandated benefits can increase the cost of a basic insurance policy by up to 50 percent. And by forcing insurers to charge both the sick and the healthy similar rates, community-rating regulations virtually guarantee that everyone pays more.
Instead, we need low-cost, pragmatic policies that drive down health prices without impinging on individual freedoms.
A great first step in that direction would be for Congress to allow people to buy insurance policies across state lines.
States regulate insurance differently. Some require policies to cover a long list of procedures. Others effectively prevent competition among carriers. As a result, the price of a basic insurance plan varies dramatically from state to state.
For instance, a 25-year-old male in New Jersey has to shell out about $5,600 for a basic insurance policy. His counterpart in Kentucky can get a similar policy for just $1,000.
Currently, Americans can only purchase policies approved for sale in the state where they live. Allowing them to shop around for the best deal would instill competition and drive down prices.
Lawmakers could take a second step in the right direction by enacting major medical malpractice reform. One in eight doctors gets sued for malpractice every year.
These suits cost about $100,000 on average to defend, even though doctors are found innocent 90 percent of the time.
To avoid getting dragged into expensive legal proceedings, many doctors engage in “defensive medicine,” ordering more tests and procedures than necessary. This practice added $124 billion to national health costs in 2006 and drove more than 3 million Americans into the ranks of the uninsured.
Implementing some commonsense tort reforms — like a $250,000 cap on noneconomic damages — could reduce these costs without compromising patient care.
Congressional Democrats have been forced to trim some of their more grandiose ambitions for health reform. But the bill remains a bloated, big-government monstrosity. American taxpayers and patients alike simply can’t afford the Democrats’ vision for health reform.
Week of March 15, 2010
The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America’s Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.
Federal
With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.
The Senate has passed Jobs Bill II and shipped it off to the House, where passage is not certain. Within the bill are two health-related items of note. First, the COBRA eligibility and subsidy program will be extended to the end of 2010. (These provisions are set to expire at the end of March.) Second, the bill contains a suspension until September 30, 2010 of the cut to physician Medicare reimbursements for the current calendar year. (This provision is also set to expire at the end of March.) Aetna urged Congress to apply the “doc fix” to next year’s reimbursement as well, since insurers’ Medicare rates are based on what doctors are paid, but in the end Congress failed to make this change. Aetna and the industry will continue to find ways both to establish a more lasting, if not permanent, doc fix and to devise a legislative solution to the disconnect between doctor reimbursement and Medicare Advantage rates for 2011 and beyond.
States
ARIZONA: Budget issues remain front and center as the governor and Republican leadership proposed a plan they hope will close the $700 million deficit this year and reduce the anticipated $2.6 billion deficit in 2011. Righting the state’s fiscal ship has become a very partisan exercise, with the Republicans supporting reductions in Medicaid and KidsCare, and the elimination of full-day kindergarten. As the special session on the budget is running concurrently with the regular session, no other bill hearings were held. The oral chemotherapy parity bill may be dead for this year as proponents did not meet the deadline for submitting amendatory language.
CALIFORNIA: The Assembly Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre held a hearing last week to examine how the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) has handled issues surrounding the rescission of policies in the individual market. According to a report prepared for the committee by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, fewer than 300 of 6,000 former policyholders are participating in health insurers’ agreements to settle such cases. Republican committee members were highly critical of this witness, while De La Torre was critical of the Departments. The DMHC reported that since their settlements were completed there have only been nine rescissions over the past two years, proof that the DMHC and the health plans have revamped their processes for rescission and have worked to address the problem.
COLORADO: A bill mandating maternity and contraceptive coverage in individual policies continues to receive significant attention in the Senate. The most recent amendment proposes requiring maternity coverage in at least three of the plans marketed by an insurer. It would also allow a current member of a plan without maternity coverage to switch to a plan with maternity coverage from the same carrier during the first trimester. The other major bill would require that second level appeals be performed by physicians who are actively involved in clinical practice. This measure is counterintuitive in the current economy, since it would result in outsourcing appeals and drive up costs for plan sponsors and their employees.
CONNECTICUT: A proposal that would require health insurance plans to cover oral chemotherapy in the same way that intravenous chemotherapy is covered made it through the legislature’s Insurance and Real Estate Committee last week. Currently, many health plans treat the two kinds of cancer treatments differently. Chemotherapy treatments that come in pill form are often categorized as prescription drug benefits that can require patients to pay a larger share of the cost. Cancer patients, doctors and patient advocates spoke in favor of the bill, while insurers and the Connecticut Business and Industry Association opposed it, arguing that it would put a mandate on health plans that could raise costs and make it more difficult for employers to afford insurance.
GEORGIA: A bill restricting the use of rescissions in individual health insurance policies passed a Senate committee last week. Aetna continues to work with its trade organizations to educate legislators about the adverse effect of this type of legislation. Discussions also continue regarding legislation affecting the use of rental networks.
KANSAS: Roughly half way through the legislative session, several health care bills are still moving through the process. On the regulatory front, the Insurance Department has proposed a regulation that would mandate coverage of routine patient care costs while the insured is enrolled in a cancer clinical trial – a mandate that was rejected by the legislature in 2008. A hearing will be held on April 20, and Aetna will have an opportunity to present testimony on this issue. Bills still alive include mandates for autism and orally administered chemotherapy, legislation prohibiting dental contracts that require the dentist to follow a fee schedule for non-covered services, and a ban on “most favored nation” clauses by some insurers. Another bill would allow small employers to create individual HRAs to fund premium payments on individual policies, require administering insurers to offer employees the option of receiving health insurance coverage through a high-deductible health plan with an HSA, and requiring insurers who offer small group health plans to offer high-deductible health plans with HSAs, while authorizing tax deductions for health insurance premiums for individual insurance policies. Separate legislation would amend the definition of “eligible employee” to include part-time workers (currently less than 30 hours per week). Pending legislation concerning hospital charges would prohibit charging private-pay patients more than 25 percent of what the hospital’s highest volume private payer would pay for the same goods or services. Legislation that died includes a telemedicine mandate and creation of a health care insurance database for employers.
KENTUCKY: Health issues that are being hotly debated by the legislature right now include an autism mandate, a dental bill that would not allow insurers to hold dentists, optometrists or ophthalmologists to a fee schedule for non-covered services, and a bill setting a reimbursement floor for chiropractic services. The chiropractic services proposal would allow chiropractors to bill, and would require insurers to reimburse, an evaluation and management (E&M) CPT code on each and every visit. In addition to billing for follow-up services for manipulations and other therapies, the chiropractor would be allowed to submit, and the insurer required to pay, for another E&M code on each and every visit. The legislation would also add a new mandated benefit to the Kentucky statutes. Currently, reimbursement for chiropractor visits is required only if the chiropractor performs a service already covered by the health benefit plan. Under the proposal, any service within the scope of practice of a chiropractor that is billed would become a mandated benefit. Finally, the bill would require health benefit plans to provide reimbursement without the chiropractor having to provide any documentation that the services were medically necessary. Each of these bills has, or is expected to, pass at least one chamber.
SOUTH DAKOTA: Several important legislative deadlines are approaching, resulting in a flurry of activity. Bills or resolutions not passed by the second chamber by March 9 died. But the Governor has already signed a bill that amends the premium rate-setting procedure for the high-risk pool so that rates for a given classification are 150 percent of the average actively marketed premium. The pool will have to offer three or more plan designs, remove coverage requirements for the plans (such as disease management) and remove set cost-sharing values. The bill was signed by the Governor on March 1 and will become effective on July 1, 2010. The Governor has also signed a bill prohibiting rating based on injuries caused by domestic violence and legislation requiring refunds of premiums for partial months, in the case of mid-month cancellations. Both chambers have passed legislation prohibiting contract language requiring dentists to accept a fee schedule for non-covered services, and the bill awaits the Governor’s signature. Finally, the legislature passed a resolution opposing the federal health care reform proposals passed in the U.S. Senate and House.
The Week in Health Reform—Federal Legislative Overview
The White House
On March 3, President Obama continued his push for Members of Congress to complete health insurance reform legislation within the upcoming weeks. He delivered a statement to a group of medical professionals in the East Room of the White House, in which he said that he has asked Senate and House leaders to finish work on health reform and schedule final votes in the next few weeks. The President went on to say that the issues have been debated thoroughly and that now is the time to make a decision. Although he did not specifically mention the budget reconciliation process, the President said that the American people deserve an “up or down” vote on health reform in the same way that welfare reform and tax cuts were approved by Congress in the past under reconciliation rules.
The President said that health insurance reform would change three things:
* End the “worst practices” of health insurance companies
* Give individuals and small businesses the same kind of choices members of Congress have
* Bring down health care costs for families, businesses and the government
The President made numerous references to the health insurance industry and stated that there is a fundamental disagreement between Republicans and Democrats about whether there should be more or less regulation of health insurance companies. The President concluded by emphasizing that he will do everything in his power to make the case for health reform in the coming weeks, and he also urged the American people to make their voices heard.
In addition, the President said he is open to exploring policy priorities identified by Republicans at the bipartisan summit such as:
* Conducting undercover investigations of health care providers that receive reimbursement from federal programs.
* Appropriating funds for state-based demonstration programs to test alternative approaches, including health courts, to resolving medical malpractice suits.
* Linking Medicaid eligibility expansions to higher Medicaid reimbursement for physicians.
* Clarifying that Health Savings Accounts (HSAs) may be offered through the proposed health insurance exchanges.
On March 4, Health Care Service Corporation President and CEO Pat Hemingway Hall attended a meeting at the White House, along with CEOs from other leading health insurance companies and officials from the National Association of Insurance Commissioners. The group met with Health and Human Services Secretary Kathleen Sebelius and President Obama to discuss premium issues in the individual market.
House and Senate
Congressional leaders are now focused intensely on developing legislative language that could be supported by a majority of members in both chambers. The President’s comments last week send a strong signal that such legislation, once finalized, would move through Congress under budget reconciliation procedures.
Under reconciliation rules, the House first would have to pass the Senate version of the health care reform bill, H.R. 3590, which passed on Christmas Eve last year. After that, the House would then be required to pass a separate “corrections” bill incorporating specific changes to that bill that will likely be negotiated among White House officials and House and Senate leaders. After the House passes the “corrections” bill, under budget reconciliation procedures, the Senate would need at least 50 senators to vote for the “corrections” bill. Under reconciliation rules, only a simple-majority vote of 51 votes are needed for passage (Vice President Joe Biden would be the 51st vote if only 50 senators vote for the bill) and filibusters are banned.
In order to meet the goal of sending a final health reform bill to the President’s desk before the Easter recess (which is scheduled to begin on March 29), congressional leaders would need to send legislative language to the Congressional Budget Office (CBO) for cost analysis in the very near future. On March 4, White House Press Secretary Robert Gibbs said that President Obama hopes the House of Representatives will pass the health reform bill by March 18, so the rest of the process can move swiftly.
Speaker Nancy Pelosi (D-CA) is now tasked with trying to corral votes in the House, while trying to assure those who are wary that the Senate will be willing to support the same measures. Some House members are worried about being left “holding the bag,” if the Senate decides it will not support some of the same legislative language.
In order to ensure the Democrats have enough votes, President Obama invited two groups of the Democratic Caucus to the White House on March 4 to continue to push for health reform passage. Members from the Congressional Progressive Caucus were:
Caucus Chairs Raúl Grijalva (AZ) and Lynn Woolsey (CA), Congressional Asian Pacific American Caucus Chairman Mike Honda (CA), Congressional Black Caucus Chairwoman Barbara Lee (CA), Congressional Hispanic Caucus Chairwoman Nydia Velázquez (NY), Reps. Dennis Kucinich (OH), Lucille Roybal-Allard (CA) and Jan Schakowsky (IL), as well as delegates Madeleine Bordallo (Guam) and Donna Christensen (Virgin Islands).
Afterward, Obama met with key members of the New Democrat Coalition. The New Democrats, like the Blue Dogs, are a group of fiscally conservative Democrats. Attendees of this meeting included: Reps. Jason Altmire (PA), Melissa Bean (IL), Lois Capps (CA), Joe Crowley (NY), Ron Kind (WI), Allyson Schwartz (PA) and Adam Smith (WA).
Overview: Extension of Physician Payment “Fix” and COBRA Provisions
On March 2, the Senate passed H.R. 4691, the “Temporary Extensions Act of 2010″ and President Obama signed it into law. This legislation includes a one-month extension of the Medicare physician payment “fix,” premium assistance for unemployed workers with COBRA and state continuation coverage, unemployment insurance and several other legislative provisions that expired on February 28. Before voting on passage of the bill, the Senate first voted on an amendment by Senator Jim Bunning (R-KY) that would have offset the $10 billion cost of the “extenders” package. This amendment was defeated and therefore no further legislative action was needed. The bill was later signed by the President.
Overview: The “Health Insurance Industry Fair Competition Act” – H.R. 4626
In a letter dated March 3, 22 Democratic Senators wrote to Majority Leader Harry Reid (D-NV) urging him to bring H.R. 4626, the “Health Insurance Industry Fair Competition Act, to the Senate floor at its earliest opportunity. In the letter they state that “[this legislation] is an important step toward bringing competition to the health insurance market, and would ensure that anticompetitive abuses such as price fixing and monopolization are policed in the health insurance industry.” America’s Health Insurance Plans (AHIP) CEO Karen Ignagni maintains the position on the legislation saying, “The rhetoric surrounding repeal [anti-trust exemptions] does not match the reality of the situation. Health insurance is one of the most regulated industries in America at both the federal and the state levels. The Act is extremely limited in scope and has nothing to do with competition within the health insurance industry. In fact, a wide range of insurer activities, including mergers and many types of business practices, are and always have been subject to federal antitrust laws and to enforcement by the Department of Justice.”
Author Reference http://www.easytoinsureme.com
If President Barack Obama gets his trillion dollar health care bill passed this week by the Democrats in Congress, parents will be required to pay for their unmarried kids’ health care coverage until the age of 26. And Generation Y and ‘millenials’ will be enticed to continue slacking, without a job, well past college graduation. While ski bums everywhere are cheering the news that the federal government will be forcing parents to pay for their health insurance through age 26, parents are questioning why the federal government is enticing a whole generation to stay unemployed.
America has always been a place where hard work is rewarded regardless of one’s age, family status or educational background. If you have an idea you are committed to and make sacrifices to further the idea, you can be wildly successful in our capitalistic system. In America, you can launch a multi-billion dollar computer company from your garage, you can grow up homeless and make it Harvard and you can create a world-wide social networking movement while still in college. But you can also be a slacker if you have the means to slack. Spending a year skiing, hanging out on the beach and surfing or traveling the world are options for the few lucky ones who have parents wealthy enough to pay for such endeavors.
But should the U.S. government encourage college kids to become slackers? Does Generation Y need any more encouragement to feel entitled? And should society guarantee a 5 year hiatus from responsibility after college graduation for millions of college kids? While it is true that many college graduates today will be self-motivated to find a career, make their own money and contribute to society, Generation Y has been the most entitled generation in history. Should the American taxpayer tempt these kids further into believing that the American dream is easy to fulfill?
Obama’s health care bill is being celebrated on the slopes of Colorado and the surf shacks of California but is a dangerous precedent for future generations. Here is the exact wording:
SEC. 2714. EXTENSION OF DEPENDENT COVERAGE.
(a) In General – A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.
One could understand extending another entitlement program through age 26 in countries where the average work week is 30 hours per week and vacation time is guaranteed at 8-10 weeks per year. But is this new proposal anti-American? We aren’t supposed to reward people who don’t work hard and make sacrifices to get ahead. And we aren’t supposed to guarantee anything in America but a fair shot. America is a place where you prove your commitment to your family and your community through hard work and sacrifice. It is this ethic that we call American values.
But the American free-market system is under intense assault from President Obama and his partners in the overwhelmingly Democratic Congress. Obama has proposed massive new programs to give money, guaranteed jobs and entitlements to millions of Americans. In 2008, 36% of Americans paid no taxes. Think about the fact that more than 1/3 of our neighbors paid zero taxes. Did you pay any taxes last year? If you were part of the working group that paid for the slackers, do you really think they need another entitlement program that you will have to pay for?
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).
A WORD OF CAUTION . . .
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.
HOW CAN I PAY FOR HOME HEALTH CARE?
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.
WHERE CAN I LEARN MORE ABOUT HOME HEALTH CARE?
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.
Case Study
WHEN IS HOME HEALTH CARE APPROPRIATE?
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.
President Obama’s Health Insurance Bill
President Obama Releases New Health Care Proposal in Time for Health Summit: On Monday February 22, 2010, White House officials unveiled a new health insurance reform overhaul that builds on the Senate version passed last Christmas Eve, with some changes aimed at pleasing House Democrats who had concerns with the Senate bill. The President’s proposal does not include the public option, despite the hopes of Senate Democrats, due to White House concerns that the provision will hinder passage in the Senate. President Obama ignored requests by Republicans to scratch the Democratic plan and start over. As such, Republican leaders questioned Democratic motives and labeled the bill as a massive government takeover of America’s health care system.
Republicans Insist House Democrats Don’t Have the Votes to Pass Legislation: Minority Whip Eric Cantor (R-VA) announced on Wednesday that Democrats don’t have the necessary votes to pass the President’s proposal in the House because of three new House vacancies and lagging support among some moderate Democrats. At issue for some Democrats are weaker abortion provisions in the President’s proposal as well as the ongoing controversy over passing a bill by a simple majority, a process known as reconciliation.
Health Care Summit Preview
On Thursday, the President’s Health Care Summit began at 10:00 a.m. with opening comments from the President, followed by remarks from both Republicans and Democrats. The discussion centered on four themes: controlling health care costs, overhauling the insurance market, reducing the deficit and expanding insurance coverage. Prior to Thursday, several top Republicans and some Democrats stated that expectations were extremely low for the Summit’s success.
House Republicans arrived armed with their own version of a health care bill that encourages small businesses to join together to buy insurance, gives federal money to states to run high-risk pools for those unable to obtain private insurance and limits damages in medical malpractice lawsuits. The Republican plan would cost $61 billion and cover three million people over ten years. In contrast, President Obama contends his plan would cost $950 billion and cover 30 million people over the same time period. However, officials at the Congressional Budget Office (CBO) indicated they would not be able to officially score the President’s proposal with just a summary – that legislative language is needed.
Note: A full summary of the results from the Health Care Summit will be included in next week’s newsletter
Additional Activities
WellPoint Executives Defend Premium Increases: On Wednesday, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing to examine the proposed health insurance premium increases by Anthem Blue Cross in California. Anthem, a WellPoint subsidiary, recently informed subscribers in California that premiums for individual insurance policies would be raised an average of 25 percent, with some rates going up as much as 39 percent. Angela Braly, president of WellPoint , said the premium increases were justified by soaring medical costs, and that pending legislation could make the problem worse, driving up costs further for young, healthy people.
“Raising our premiums was not something we wanted to do,” Ms. Braly said . “But we believe this was the most prudent choice, given the rising cost of care and the problems caused by many younger and healthier policyholders dropping or reducing their coverage during tough economic times. By law, premiums must be reasonable in relationship to benefits provided, which means they need to reflect the known and anticipated costs they will cover.”
In Sacramento , Leslie Margolin, president of Anthem Blue Cross in California, also testified before lawmakers, joined by vice president and general manager James Oatman. The focus of that hearing was also the proposed premium increase for California members in the individual market, with company executives pointing to the current economic climate and rising health care costs as reasons for the rate hikes.
U.S. House of Representatives Repeals Antitrust Exemption from Health Insurance Companies: On Wednesday, the House of Representatives voted 406-19 in favor of repealing a 65-year-old antitrust exemption from health insurance companies. Democrats said the repeal would lead to increased scrutiny of the industry. Yet, the non-partisan Congressional Budget Office said last year that repealing the exemption would not significantly reduce premiums because states already investigate health insurance companies.
In addition, industry executives pointed out that legislation could further hinder competition and the ability to share information to improve health care quality. “Health insurance is one of the most regulated industries in America at both the federal and the state levels,” said Karen Ignani, president and chief executive of America’s Health Insurance Plans (AHIP). “The real focus should be on addressing the rising cost of medical care, which is putting an unsustainable burden on families, employers and the federal budget,” she said.
Public Opinion
Polling Suggest Health Care Reform is Still Key to Economic Recovery: Recent polling on health care reform shows mixed reaction among the public over the proposed legislation. According to a recent CNN poll, 48 percent of those questioned said lawmakers should work on an entirely new bill and 25 percent felt that Congress should stop work on health care reform altogether.
According to the monthly poll from the nonpartisan Robert Wood Johnson Foundation, 75 percent of Americans still think it’s important that Obama include health care reform in addressing the nation’s economic crisis, while many still harbor doubts about the legislation.
When asked how health care legislation relates to their economic situation:
* Nearly 31 percent said they thought the Democratic bills would make their personal financial situation worse, compared with 10 percent who said it would improve their family budgets.
* Forty-two percent said the nation’s fiscal condition would suffer because of the legislation, compared with 26 percent who said it would get better.
* Americans were divided on whether the Democrats’ approach would improve overall access to health care around the country, with 35 percent saying it would and nearly that many disagreeing.
Health Insurance Coverage Varies Widely Based on Age: Coming just before the President’s Summit on Health Care Reform, a newly released Gallup Poll reinforces the wide degree of variability in health insurance coverage across U.S. population segments, especially when it comes to age. Eighty-four percent of 18-year-olds have health insurance, most likely because they are still covered under their parents’ policies. By age 22, health insurance coverage reaches its lowest point, with just 66 percent maintaining coverage. From age 22 on, the percentage of Americans with health insurance begins to climb, albeit slowly, reaching the 95 percent level at age 65 when Medicare becomes an option.
Looking Ahead
Legislators need to determine next steps for health care legislation coming out of the President’s Health Care Reform Summit. On Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius invited executives from the top five insurance companies to meet at HHS to discuss their companies’ insurance premiums.
Health Care System Needs Reform, Not a Government Takeover
Believe it or not, America boasts some of the world’s best doctors, the most advanced health care system, and the most technically superior resources in the world, bar none. Those who travel globally and have gotten sick know that their first choice for treatment would be in the U.S. Though heatlh care in America is, more expensive thanany other country, many of the worlds wealthiest come to the U.S for surgical procedures and complex care, because it holds a worldwide reputation for the gold standard in health care.
To examine the complex health care issue, a small research study was conducted from randomly selected doctors in mdnationwide.org’s best doctors database. We ask 50 top doctors, located in different states and who practice different specialty fields, ” Is a universal health care plan good for America?” Forty-eight of these doctors essentially responded that it was a “bad idea” that would have negative mpacts on the quality of our nation’s health care.
Social Engineering Your Health Care
One of the greatest mis-conceptions some people have relied on with regard to the health care debate is that, given a universal health care system, every person in the U.S. would receive the highest quality health care – the kind our nation is renowned for and that we currently receive. However, unlike some public amenities, health care is not a collective public service like police and fire protection services, therefore the Government cannot provide the same quality of health care to everyone, because not all physicians are equally good orthopaedic surgeons, internists, neurosurgeons, etc, in the same way that not all individuals in need of health care are equally good patients.
As an analogy – stay with me – when you design a software program, there are many elements that are coded on the back-end, and used to manipulate certain aspects of the software program, that your average “John Doe” who uses the software(the end user) does not understand or utilize, nor do they care about these elements. Certain aspects of the program are coded, so that when one uses that portion of the program, other elements of the program are manipulated and automatically follow the present or next command.
Likewise, once a universal health care plan is implemented in America and its massive infrastructure is shaped, private insurance companies will slowly disappear, and as a result, eventually patients will automatically be forced to utilize the government’s universal health care plan. As part of such a system, patients will be known as numbers rather than patients, because such a massive government program would provide compensation incentive based on care provided, patients would become “numbers,” rather than “patients.”
In addition, for cost savings reasons, every bit of health information, including your own, will be analyzed, and stored by the Government. What are the consequences? If you’re a senior citizen and need a kneereplacement at the age of 70, the government may determine that you’re to old and it’s not worth the investment cost, therefore instead of surgery, you may be given medication for the rest of your life at a substantial cost savings to the government, and at a high quality of life price to you.
Solutions:
Fixing the current U.S. health care system might require that we;
1. Encourage prevention and early diagnosis of chronic conditions and management.
2. Completely reform existing government health care programs, including Medicare and Medicaid.
3. Forgive medical school debt for those willing to practice primary care in under-served areas.
4. Improve access to care, provide small businesses and the self-employed with tax credits, not penalties for providing health care.
5. Encourage innovation in medical records management to reduce costs.
6. Require tort reform in medical malpractice judgments to lower the cost of providing care.
7. Keep what isn’t broken-research shows 80% of Americans are happy with their current insurance, therefore, why completely dismantle it?
8. Reimburse physicians for their services.
9. Innovate a system in which Medicare fraud is dramatically decreased.
Devil In the Details
Socialized medicine means:
1. Loss of private practice options, reduced pay for physicians, overwhelming numbers of patients, and increasing burn-out may reduce the number of doctors pursuing the profession.
2. Patient confidentiality will need to be compromised, since centralized health care information will be maintained by the government and it’s databases.
3. Healthy people who take care of themselves will pay for the burden of those with unhealthy lifestyles, such as those who smoke, are obese, etc.
4. Patients lose the incentive to stay healthy or aren’t likely to take efforts to curb their prescription drug costs because health care is free and the system can easily be abused.
5. The U.S. Government will need to call the shots about important health decisions dictating what procedures are best for you, rather than those decisions being made by your doctor(s), which will result in poor individualized patient care.
6. Tax rates will rise substantially-universal health care is not free since citizens are required to pay for it in the form of taxes.
7. Your freedom of choice will be restricted as to which doctor is best for you and your family.
8. Like all public programs, government bureaucracy, even in the form of health care, does not promote healthy competition that reduces costs based on demand. What’s more, accountability is limited to the budgetary resources available to police such a system.
9. Medicare is subsidized by private insurers to the tune of billions of dollars, therefore if you take them out of the equation, add a trillion dollars or more to the current trillion dollar- plus cost estimates.
10. Currently, the government loses an estimated $ 30 billion a year due to Medicare fraud. Therefore, what makes anyone think that this same government will be able to run & operate a universal health care system that is resistant to fraud and save money while doing so?.
A low cholesterol diet can prevent illness and allow you to live a healthy life. Building this type of diet into your lifestyle can be the foundation for an excellent preventive program that is dedicated to giving you and your family many more healthy years.
Prevention is key. We need to institute programs that detect health risks early and prevent them from becoming life threatening diseases. Low cholesterol diet programs can go hand in hand with preventive diagnostics, health risk assessments, counseling and intervention.
It is critical that consumers, healthcare providers, employers and policymakers embrace a culture of prevention in approaching healthcare challenges. Roughly four percent of Americas $2.2 trillion dollars in annual healthcare spending is devoted to prevention.
As long as prevention techniques are not practiced daily, Americans will continue to experience alarming levels of obesity and serious illnesses like heart disease, stroke, diabetes and cancer.
A low cholesterol diet will go a long way in arresting Americas health care challenges. A new and different healthcare culture must be adopted. We are making great gains in treating diseases but not in preventing them. Preventive healthcare has been successfully tested at St. Luke’s Regional Medical Center.
“The prevention model developed by U.S. Preventive Medicine represents an innovative, tangible way to engage hospitals, physicians, employers and consumers in the shared mission of improving America’s health.”
David B. Nash, M.D., M.B.A, Chairman, Department of Health Policy at Jefferson Medical College of Thomas Jefferson University and Chairman, U.S. Preventive Medicine’s National Advisory Board.
The American Heart Association reports that the lifetime risk of developing hypertension is approximately 90 percent for adults between the ages 55 and 65. One third of those affected are not aware they have this condition. So much of this has to do with diet.
The World Health Organization reports that 50 percent of the deaths and disability from heart disease and strokes worldwide can easily be cut. It will take a combination of cost effective national efforts and individual actions. A low cholesterol diet can reduce major risk factors such as high blood pressure, high cholesterol and obesity.
The Centers for Disease Control and Prevention reports that preventive efforts in the area of diet can benefit the 17 million Americans with type 1 or type 2 diabetes.
According to the Organization for Economic Cooperation and Development, the U.S. spends more than twice per capita on healthcare than any other country in the world. However, our health outcomes rank below many other developed nations.
America has approximately 80 million baby boomers who are marching gracefully toward seniority. The duel approach of a low cholesterol diet and healthcare prevention programs must be incorporated into lifestyles now before its too late.
If the elections approaching, politicians talk about “health crisis that threatens the United States,” as if he wanted to do something, until they were elected. The experts say the costs of the study of health care is one of the biggest problems facing the country in terms of cost and quality of care.
Providing the insurance?
Government
Federal, state and local authorities on, 39 millionemployees (including military), 39 million Medicare beneficiaries (a number that occasion, the first baby boomers will receive up to 65) and 41 million Medicaid will. Of course, governments do not have to generate their own income. Everything that comes from one place: taxpayers. With an average of 7 health insurance and pharmaceutical lobbyists for every member of Congress, it is easy to understand, taking into account as the feet of the legislature, when it comes to improving health care for its members. (However,Receive free health insurance for life. You probably say, “What’s wrong?”)
Employers
Employers offer health insurance to 120 million Americans. Those who decide to accept the insurance have hundreds of dollars a month deducted from their wages than their share of the premium their employers pay for health insurance. In 2005, the average worker paid over $ 2700 for the group insurance by an employer.This does not include annual deductible and co-payments for doctor visits, prescriptions, hospitalization, surgery, etc.. The National Coalition for the medical reports, insurance premiums for employees increased by 73% over the period 2000-2005. Compare that with a cumulative rate of inflation over the same period by 14% and a cumulative wage increase of 15%. Obviously, the difference of 1% does not come anywhere close to a 73% increase in premiums.-health care
Of course, the employerTo increase the premiums. In fact, the NCHC web site relates this troubling information: “The costs of health insurance are the most rapidly increasing costs for employers. Unless something changes dramatically, health insurance, the cost exceeds the benefits in 2008. ” Since the point that in business to make a profit is to have the employer at least two ways: (1) spend a portion of the additional premium for employees, (2), new employees less and give smaller pay poses to others;Danger (3) pay more for their products and services and / or (4), that workers who have health insurance all together.health care
Even if your insurance through your employer, you must be careful to read and understand the fine print. Do not see a doctor without permission. Not able to find in “Network Neighborhood”, without expecting to pay most of your doctor. You must go to a hospital? I hope you know and think clearly, becauseYou may need to call your auto insurance company or hospital to get the OK button. We’ve all heard the horror stories of people who rushed someone to the hospital “false” in an emergency situation and have been denied insurance coverage because they lacked “a deal” with the hospital in question.
http://www.healthcare.pannipa.com/2009/11/americas-health-care-crisis-and-what-you-can-do-about-it-who-can-help-me/
|
|
