In case you didn’t know, “Medicare does not actually pay the amount a hospital charges but instead uses a system of standardized payments to reimburse hospitals for treating specific conditions. Private insurers do not pay the full charge either, but negotiate payments with hospitals for specific treatments. Since many patients are covered by Medicare or have private insurance, they are not directly affected by what hospitals charge.”

However, “Experts say it is likely that the people who can afford it least — those with little or no insurance — are getting hit with extremely high hospitals bills that may bear little connection to the cost of treatment.”  In other words, they are picking up “the slack” of what Medicare and insurers have negotiated due to their buying power, without resemblance to what the treatment actually costs.

“An official at the American Hospital Association, a trade group, said there was a cat-and-mouse game between hospitals and insurers that affects what hospitals charge.  As insurers demand bigger discounts from a hospital, a facility may raise its charges to protect its bottom line, that official, Caroline Steinberg, said. ‘The hospital raises its rate to cover the discount,’ said Ms. Steinberg, who is the group’s vice president for trends analysis.”

“Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the nation’s largest association of health insurers, said some member companies were reporting sharp price increases of 20 to 30 percent for some services. Some insurers are seeking similar price increases from policy holders.  ’There’s very little transparency out there about what doctors and hospitals are charging for services,’ Mr. Zirkelbach said. ‘Much of the public policy focus has been on health insurance premiums and has largely ignored what hospitals and doctors are charging.’”

“Ms. Steinberg said that the Affordable Care Act required that hospital charges be limited for patients who qualify.  ’That’s driving all of the rates for uninsured patients towards the same amount that Medicare pays,’ she said.”

“In addition, bills submitted by profit-making hospitals to Medicare are typically higher than those submitted by nonprofit centers, the analysis found.  Government hospitals typically billed Medicare less than either nonprofit or profit-making hospitals, the data shows.”

“‘Medicare payments represent about 91 cents of every dollar that a hospital spends on treatment,’ Ms. Steinberg said.”

“Mr. Anderson, the hospital finance expert, said that private insurers negotiated rates with hospitals that were typically about 30 percent above what Medicare pays. He understands that hospitals will often charge above the Medicare rate, but he said the huge premiums at some hospitals make no sense.  ’If you’re charging 10 percent more or 20 percent more than what it costs to deliver the service, that’s an acceptable profit margin,’ Mr. Anderson said. ‘Charging 400 percent more than what it costs has no rational basis in it at all.’”

“The wide variation in spending to hire and train people to provide consumer assistance in the first year of the new marketplaces could have a major impact on how many people actually get coverage…states with some of the nation’s highest uninsured rates…are getting far less federal money per uninsured resident than states with low rates…according to a Kaiser Health News analysis.”  This might seem counterintuitive, but check this out:

“The biggest reason for the uneven spending on consumer assistance is that when Congress passed the health law in 2010, it assumed most states would run the online marketplaces, and it authorized broad funding for that. As it turned out, only 16 states and the District of Columbia agreed to do so.”  Whew, lucky for those of us in California, we’re one of the 16 states!

So, what are these “marketplaces”?  Perhaps you’ve heard them called “exchanges” (as they are here in California):

“The marketplaces, also known as exchanges, are the key way the law expands health coverage to about 27 million people by 2016. That’s where people will shop for and enroll in private coverage and determine if they are eligible for premium discounts, or for Medicaid, the state-federal health insurance program for the poor. While many customers will be uninsured, others with coverage will use them to take advantage of government subsidies.”

“The online marketplaces, which open for enrollment Oct. 1, were envisioned to be as easy to use as travel websites like Expedia, but experts say that many people will need help figuring out which plan is best for them and what information they might need to sign up for coverage.  ’Some have never applied for health insurance coverage before and may need assistance even to navigate the website,’ said Sonya Schwartz, program director of the National Academy for State Health Policy, and project director of State Refor(u)m, a discussion forum about implementation.”

As written in RegWatch, The Hill’s Regulatory blog, under the proposed regulations, “individuals could receive tax credits if they are not eligible for ‘affordable coverage’ via an employer-sponsored plan that covers for at least 60 percent of costs… The IRS and Department of Health and Human Services have developed a ‘minimum value calculator’ that employers could use to determine whether their plans meet previously proposed essential health benefits. Individuals could also use the calculator to determine if they are eligible for the tax credit.  As currently drafted, the credits would apply to taxpayers whose household income is between 100 percent and 400 percent of the federal poverty line, calibrated to the size of the individual’s family.  Interested parties and the public will have 60 days to comment on the proposed rules. The IRS will weigh all comments before finalizing the rules, which are set to take effect for the 2014 tax year.”

Would you like to comment on these proposed regulations?

One of our colleague’s grandmothers passed away from colon cancer, so this disease hits close to home for us here at Geldin Insurance.  Interestingly, she did not smoke.  But her husband did. Perhaps there will be a follow up study demonstrating the correlation with second-hand smoke.

Does someone you know have colon cancer?
Do you smoke?

According to an article published on Nurse.com:  ”Gram and colleagues found that female smokers had a 19% increased risk compared with women who never had smoked, while male smokers had an 8% increased risk compared with never-smokers.

In addition, women who started smoking when they were 16 or younger and women who had smoked for 40 years or more had a substantially increased risk of about 50%. The dose-response association between the number of cigarettes smoked per day, number of years smoked and number of pack-years smoked and colon cancer risk was stronger for women than it was for men.”

If you want more details, you can read the abstract.

Although our society is already very anti-smoking, other parts of the country, and the world, do not discourage smoking nearly enough.  Maybe this study will encourage more parents, teachers, and other responsible adults to squelch any urge young girls in their network may have.

Is there a young girl that you know that needs to learn of this study before she starts to smoke?
Could we present this in a better format for you to share it with her?
Please share your stories in the comments section below or on our Facebook page.
Thank you! We look forward to reading your stories and learning from your experiences.

“The latest drafts of health insurance applications related to the Affordable Care Act are shorter and easier to complete than previous editions that drew wide criticism for their complexity. Applicants must still provide financial information, but questions about health history that insurers now ask will be eliminated.”

“…applicants will have to provide detailed snapshots of their incomes to see whether they qualify for government assistance. Individuals will have to gather tax returns, pay stubs and other financial records before filling out the application…Low-income uninsured people will be steered to government programs like Medicaid.”

“Administration officials expect most consumers to apply online through new health insurance marketplaces that will be operating in each state. A single application form will serve to route consumers to either private plans or the Medicaid program. Identification, citizenship and immigration status, as well as income details, are supposed to be verified in close to real time through a federal “data hub” that will involve pinging Social Security, Homeland Security and the Internal Revenue Service. Currently, applying for health insurance individually entails filling out a lengthy questionnaire about your health. Under Obama’s overhaul, insurers will no longer be able to turn away the sick, or charge them more. The health care questions will disappear, but they’ll be replaced by questions about your income. Consumers who underestimate their incomes could be in for an unwelcome surprise later on in the form of smaller tax refunds.”

Is this good news?  Would you rather be submitting health information or financial information?  Does three pages seem more appropriate, or is it still too long?  Please do share your thoughts and comments in the comments section below or on our Facebook page.

According to an article in Amarillo Globe News, “In the first quarter this year, Amarillo National Bank paid almost $51,600 in incentives and awarded 216 paid half-days off to 280 workers who used the bank’s health clubs, participated in fitness assessments or did both, according to an ANB report…While ANB had a 5 percent annual increase in its total 2012 health plan cost, it is seeing a 6 percent annual decrease in its average claims per employee, according to a first-quarter update Ware provided.  Average claims per ANB health-club participant stand 30 percent lower than those of a nonparticipant, the report said.”

ANB found that “Simply providing fitness centers at the main branch location wasn’t enough, Ware said.  The question became, ‘How do you encourage people to use them?’ he said.  So the bank added incentives, but tied those perks to results, ANB Wellness Director Joseph Callahan said.”

“Everybody has an equal opportunity (to earn incentives),” Callahan said. “We just want to get everybody involved and buying into what we’re doing.”

The same article states that “Almost 230 employees received fitness assessments in the first quarter, collectively reaching a 2.5 percent decrease in body-fat percentage, when compared with the same quarter last year.  The group also made gains in aerobic fitness, muscular strength and endurance, and overall fitness scores, ANB information said.  More bank employees also underwent cholesterol and other screenings to “buy down” their health insurance deductibles, Callahan said.  ’A lot of times, people just don’t go to the doctor for those regular health screenings,’ Callahan said. ‘They don’t know they have high cholesterol.  We want a healthy culture. We want to create a place where people see this as a benefit to work in a company that cares about your health.”

And congratulations are in order: “This year, ANB’s program gained Fit-Friendly Workplace Platinum Award recognition from the American Heart Association and it took Well Workplace Gold honors from the Wellness Council of America in 2012, according to those entities’ websites.  Amarillo National Bank is the only recognized Fit-Friendly company in Amarillo, American Heart Association spokeswoman Rosalyn Mandola said.”

The article closes with this: “Program overhead, salaries and incentives are covered by the bank’s health-care claims savings, Ware said.   ‘To our family, wellness is important,’ he said. ‘I think the biggest difference is that healthy employees are happy employees. Since we’re so customer-service oriented, we want all the employees to feel good because they offer better customer service.  We’ve also seen a boost in morale. People are happier. They’re taking better care of themselves.”

So, what are your takeaways from this article?  Please share them in the comments section below, or on our Facebook page.

A KaiserHealthNews article primarily focused on the battle in Florida and states that “Fourteen states, many in the Republican-controlled South, have already rejected the Medicaid expansion, while 20 have agreed to comply with the law, according to consulting firm Avalere Health” which provided an enlightening map.

“The industry notes it gave up billions in future Medicare reimbursements during negotiations over the health law three years ago with the expectation it would recoup those dollars in part through Medicaid’s expansion…Also backing the expansion are insurers and consumer advocates, as well as several leading business groups, including the Florida Chamber of Commerce and Associated Industries of Florida…But the National Federation of Independent Business, a small business group which filed one of the lawsuits seeking to overturn the law, opposes expansion. And the Florida Medical Association has remained neutral because it says its members are split. The American Medical Association was a key supporter of the health law.”

What would you like to see happen?  Should Medicaid be expanded?  Why or why not?  Perhaps you need more information.  What questions do you still have that we can work at answering for you?  Please share your thoughts below, or on our Facebook page.  We look forward to continuing the conversation with you!

1. “Preparing for the 2014 employer mandate:  The employer mandate applies only to large employers. Whether an employer is defined as large under PPACA (generally companies with 50 or more employees) depends on the number of its full-time equivalent employees. Companies with 50 or more full-time workers (averaging at least 30 hours per week) must offer minimum health care coverage that is affordable.” So, this year is the time to determine if you, or your employer, is ”subject to the mandate.”  If an employer “offer(s) coverage in 2014, the coverage must meet the minimum value standards and the contributions the employer requires of employees cannot be so high the coverage is unaffordable relative to the employee’s household income,” says Jean C. Hemphill, practice leader of Ballard Spahr‘s health care group.  Please reach out to us if you need help determining the affordability of your (or your employer’s) plan.
2. Public exchanges: EBN writes that “Employers are required to provide employees with notice alerting them of the existence of public insurance exchanges. It is thought that the government will issue a model notice for this purpose.”  Please let us know if you need a sample of this notice.  The exchange for California is Covered Califonia.
3. Waiting periods: Per EBN ”Another design-related issue employers must factor into their plans is that under PPACA, waiting periods for health care coverage cannot exceed 90 days. The 90-day period begins when the employee is otherwise eligible for coverage. Employers with a high-turnover workforce that currently have long waiting periods will have to shorten them.  If an employer requires employees to work a minimum number of hours to qualify for coverage, it may need to monitor workers’ timesheets in 2013 to determine if and when coverage needs to be offered in 2014; this may be complicated for seasonal employees and other employees with variable hours.”  Please contact us for help in determining if your policy meets the qualifications for providing coverage.
4. Pre-existing and non-discrimination prohibitions: There are new rules in 2014, but “employers can expect notice and guidance well before implementation.”  We’ll share those rules in a blog post as soon as we receive them.
5. Wellness programs: The Act “includes rules that prohibit plans from discriminating against individuals based on a range of health-related factors.”  Check with your insurer, or us, for help in determining if your 2013 plan will be in compliance in 2014.
6. Upcoming fees and taxes: “Patient-Centered Outcomes Research Institute, established by PPACA, will collect and publish information about clinical effectiveness of treatments for patients. It will be paid for through fees assessed against insurers and self-funded plans equal to $2 ($1 in the first year) per covered life. The assessment will last seven years and eventually be adjusted for inflation. Employers with self-funded plans will need to report and pay these fees starting in July 2013.”  Wow, that’s coming up really fast!

Well, that’s a lot to take in…good thing we all have a few months to get ready!  And we’re happy to help you in any way we can…we look forward to speaking with you soon!

In rebuttal, “Sebelius informed the committee that, come summer, there will be many people on the ground in every state educating the American people on the law and what to expect in the months to come. Additionally, she promised that HHS will be holding webinars to educate people on the role of navigators and how they may be of help during this process. However, when Senator Baucus asked for concrete data on the people in each state who will be going around educating people, the secretary had no answer.”

Meanwhile Health and Human Services (HHS) “is requesting from Congress an additional $554 million to be used for outreach and education related to implementation of PPACA. While HHS may have a concrete use in mind for the money, it is highly unlikely that a Republican-controlled House will approve the additional funding. Recent surveys have indicated that the majority of the American public do not have enough information and do not have a true understanding of how the health reform law will impact them. There is a clear need for more education and outreach of PPACA.”

In a separate article, NAHU reported that during the same week, “The House Small Business Committee held a hearing to discuss PPACA implementation. During opening remarks, Chairman Sam Graves (R-MO) expressed serious concern over the impact of employer rules, high costs and inevitable staff cuts that will occur as a result of the health reform law. Ranking Member Nydia Velazquez (D-NY) acknowledged the fact that insurance premiums under the health reform law are likely to increase but wanted to discuss ways to improve the take-up of small business tax credits…Specifically, Doug Holtz-Eakin, former director of the Congressional Budget Office, noted that we are still unaware of the true economic impacts of the law. He stated that the law will cost “$24 billion and 80 million hours of paperwork… time spent complying with those regulations, to give you some perspective, that’s 40,000 full-time employees filling out paperwork for a year nonstop….

“A small-business owner who, on behalf of NFIB, testified at the hearing said that the 30-hour requirement is the most detrimental employer requirement because many employers will cut hours to employees so they don’t have to pay the benefits. It is not that the employers do not necessarily want to offer their employees coverage; it is that they cannot afford to. The CFO of another very small business also testified during the hearing. In this case, however, the small business applied and received tax credits made available under PPACA. As a result, for the first time ever, this company’s costs went down 12%.

“The law’s unpredictability was discussed, specifically in terms of the challenges it poses to consumers and small businesses…A whopping 97% of the nation’s small businesses have fewer than 50 employees. Representative Kurt Schrader (D-OR) highlighted that something had to be done within the law to make compliance with PPACA more feasible for businesses with less than 100 employees…Insurance premium cost differences between the young and the old and what that means for small businesses was a hot topic during the hearing too.”

What questions do you have about PPACA? Please share your comments below or on our Facebook page. We look forward to answering as many of your questions and concerns as we can!

“A study in Diabetes Care revealed women with diabetes had higher risk of mortality compared with men. “Cardiovascular disease in particular has a greater impact on females with diabetes than males, especially when the disease is diagnosed late, as is often the case,” said co-author Madonna Roche. “Clinicians could consider glucose control in addition to CVD risk factors when designing treatment strategies for patients, recognizing that female patients may be at higher risk than males for adverse outcomes.”  The entire article can be found on Medscape.

Not only do “Women with diabetes have a greater risk for death than men with diabetes,” the study shows that “Cardiovascular disease [CVD] in particular has a greater impact on females with diabetes than males, especially when the disease is diagnosed late, as is often the case,” coauthor Madonna M. Roche, MSC, from the research and evaluation department, Newfoundland and Labrador Centre for Health Information, St. John’s, told Medscape Medical News.”

“Clinicians could consider glucose control in addition to CVD risk factors when designing treatment strategies for patients, recognizing that female patients may be at higher risk than males for adverse outcomes,” Ms. Roche suggested.”

Generally speaking, world wide, “the incidence and prevalence of diabetes have been increasing in recent years. All too often, type 2 diabetes is diagnosed late, sometimes as long as 9 to 12 years after the disease develops, and as a result, complications are often present at the time of diagnosis.”

This study “aimed to compare the risk for all-cause, CVD, AMI, and stroke mortality and hospitalizations for men and women with and without diabetes, as well those with early and late diagnoses of diabetes.”

“Both men and women with diabetes were more likely to die, to be younger at death, to have a shorter survival time, and to be admitted to hospitals than men and women without diabetes (P < .01). However, these risks were stronger in women than in men.”

“Ms. Roche suggests that treatment strategies for men and women should be individualized based on patient age, duration of diabetes, hypoglycemia risk, and presence or absence of CVD.  Perhaps the focus should be on not only glucose control but rather all CVD risk factors, recognizing that female patients may be at a higher risk than males for adverse outcomes. Cardiovascular risk factors may have a stronger effect on women than on men. Also, CVD risk factors tend to be less aggressively treated in women. In addition, data from the Newfoundland and Labrador Component of the Canadian Community Health Survey show that women with diabetes are less likely to use insulin, to have their hemoglobin A_1c levels tested, or to be prescribed aspirin and cholesterol-lowering medications than are men with diabetes.  We hope that this study will raise awareness of the increased risk of mortality and hospitalization outcomes that females have when diabetes is present,” she said.”

If you have some experience with the topics raised by this study, please do share them with us, either in the comments section below or on our Facebook page.  We look forward to learning from your experiences!