BY RICARDO ALONSO-ZALDIVAR, ASSOCIATED PRESS
Washington — Your medical plan is facing an unexpected expense, so you probably are, too. It's a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama's health care overhaul.
The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers.
Employee benefits lawyer Chantel Sheaks calls it a "sleeper issue" with significant financial consequences, particularly for large employers.
"Especially at a time when we are facing economic uncertainty, (companies will) be hit with a multi-million dollar assessment without getting anything back for it," said Sheaks, a principal at Buck Consultants, a Xerox subsidiary.
Based on figures provided in the regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee.
The Obama administration says it is a temporary assessment levied for three years starting in 2014, designed to raise $25 billion. It starts at $63 and then declines.
Most of the money will go into a fund administered by the Health and Human Services Department. It will be used to cushion health insurance companies from the initial hard-to-predict costs of covering uninsured people with medical problems. Under the law, insurers will be forbidden from turning away the sick as of Jan. 1, 2014.
The program "is intended to help millions of Americans purchase affordable health insurance, reduce unreimbursed usage of hospital and other medical facilities by the uninsured and thereby lower medical expenses and premiums for all," the Obama administration says in the regulation. An accompanying media fact sheet issued Nov. 30 referred to "contributions" without detailing the total cost and scope of the program.
Of the total pot, $5 billion will go directly to the U.S. Treasury, apparently to offset the cost of shoring up employer-sponsored coverage for early retirees.
The $25 billion fee is part of a bigger package of taxes and fees to finance Obama's expansion of coverage to the uninsured. It all comes to about $700 billion over 10 years, and includes higher Medicare taxes effective this Jan. 1 on individuals making more than $200,000 per year or couples making more than $250,000. People above those threshold amounts also face an additional 3.8 percent tax on their investment income.
But the insurance fee had been overlooked as employers focused on other costs in the law, including fines for medium and large firms that don't provide coverage.
"This kind of came out of the blue and was a surprisingly large amount," said Gretchen Young, senior vice president for health policy at the ERISA Industry Committee, a group that represents large employers on benefits issues. Word started getting out in the spring, said Young, but hard cost estimates surfaced only recently with the new regulation. It set the per capita rate at $5.25 per month, which works out to $63 a year.
America's Health Insurance Plans, the major industry trade group for health insurers, says the fund is an important program that will help stabilize the market and mitigate cost increases for consumers as the changes in Obama's law take effect.
But employers already offering coverage to their workers don't see why they have to pony up for the stabilization fund, which mainly helps the individual insurance market. The redistribution puts the biggest companies on the hook for tens of millions of dollars.
"It just adds on to everything else that is expected to increase health care costs," said economist Paul Fronstin of the nonprofit Employee Benefit Research Institute.
The fee will be assessed on all "major medical" insurance plans, including those provided by employers and those purchased individually by consumers. Large employers will owe the fee directly. That's because major companies usually pay upfront for most of the health care costs of their employees. It may not be apparent to workers, but the insurance company they deal with is basically an agent administering the plan for their employer.
The fee will total $12 billion in 2014, $8 billion in 2015 and $5 billion in 2016. That means the per-head assessment would be smaller each year, around $40 in 2015 instead of $63.
It will phase out completely in 2017 — unless Congress, with lawmakers searching everywhere for revenue to reduce federal deficits — decides to extend it.
Kansas families buying health insurance would pay nearly twice as much under proposals offered by presidential candidate Mitt Romney than under President Barack Obama’s Affordable Care Act, according to a report released today.
Under Obama’s plan, it’s also estimated that 220,000 Kansans would gain insurance coverage by 2016, while under Romney’s plan 90,000 residents would lose coverage.
Families USA, a national nonprofit health consumer organization that claims to be nonpartisan, released a 48-page report that compared three health care plans:
• ObamaCare — The Affordable Care Act that passed in 2010.
• RomneyCare — The Massachusetts health care insurance reform law signed by then-Governor Mitt Romney in 2006.
• RomneyCandidateCare — Health care proposals of presidential candidate Romney, which include repealing the Affordable Care Act and converting the Medicaid program to a block grant while reducing federal funding provided to states.
The report was produced with the help of three health analysts who participated in the development of both RomneyCare and ObamaCare. It uses 2016 for the comparison because it’s the last year of the next president’ term of office and it is a year where there is full implementation of the Affordable Care Act.
Ron Pollack, Families USA executive director, said during a teleconference call that the Affordable Care Act and the Massachusetts health plan are similar, but there are stark differences between those and Romney’s health care proposals.
“They are as different as day and night,” Pollack said.
Among the key differences:
• 170,000 — middle-class Kansans would receive tax credit subsidies to help pay for insurance premiums under ObamaCare in 2016, while 90,000 would receive tax deduction subsidies to help pay for insurance premiums under Romney’s plans.
• $4,590 — the average size of those tax credit subsidies under ObamaCare in 2016, while the average size of the RomneyCandidateCare tax deductions subsidies would be $2,621.
• 281,600 — Kansas Medicare beneficiaries received free preventive services such as colonoscopies and mammograms in 2011 under ObamaCare. These would no longer be free under Romney’s plan.
• 40,900 — Medicare beneficiaries received help with prescription drug costs under ObamaCare, and the average amount was $610. Such help would be eliminated under RomneyCandidateCare.
Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology, helped compile the report. He said he helped with the Massachusetts health care plan and he described it as “an enormous success.” He said it provided a model for the Affordable Care Act and it works because it contains three key elements:
• It made reforms in the insurance markets so people could no longer be discriminated against because they had pre-existing conditions or became sick. According to the report, about 26 percent of nonelderly Kansans, or 627,000, have a pre-existing condition that frequently results in denial of insurance.
• It mandated that everyone buy insurance so health costs were spread among the healthy and sick.
• It included subsidies to help low-income people afford insurance.
“It has been a success by any objective measure,” he said, adding the cost of premiums have decreased. He said the uninsured rate in Massachusetts is 3 percent while the national rate is 18 percent.
For the full report, visit familiesusa.org.
Starting Aug. 1, health insurance plans must cover a new set of preventive services for women with no additional co-payments or deductibles.
These benefits include an annual wellness examination, screenings and counseling for domestic violence, contraception, and gestational diabetes screenings, and they fall under the Affordable Care Act.
Representatives from a coalition of more than 50 women’s organizations called HERvotes lauded the legislation today during a conference call. The coalition is dedicated to mobilizing women voters around health and economic issues.
“It’s the first time in our history that insurers will have to cover our preventive services at no additional costs,” said Cindy Pearson, executive director of the National Women’s Health Network. She said the network has been advocating for such health care benefits since it was founded in 1975. “Finally, our laws and health policy recognize that these preventive services are essential to women’s health.”
Previously, some plans did not cover these preventive services, or if they did, women often had to pay out-of-pocket costs. Now, plans are required to cover the services at no charge.
The new services are:
• annual wellness examination.
• gestational diabetes screening for women 24 to 28 weeks pregnant and at the first prenatal visit for women who are at a higher risk for diabetes.
• high-risk human papillomavirus, or HPV, testing every three years regardless of Pap smear results for women who are 30 or older.
• annual counseling on sexually transmitted infections.
• screening and counseling on HIV/AIDS.
• access to contraceptive methods approved by the Food and Drug Administration, sterilization procedures and education.
• breast-feeding support, supplies and counseling for pregnant and postpartum women.
• screening and counseling for domestic and interpersonal violence.
According to a U.S. Health and Human Services report, about 47 million women are in health plans that must cover these new preventive services. These are in addition to other benefits that already have kicked in, such as screenings for high blood pressure, cervical cancer and breast cancer.
Eleanor Smeal, president of the Feminist Majority Foundation, described the new benefits as a huge step forward in women's rights.
“What we have here is the single biggest legislative event for women since Title 9 in that it opens the door to health care, so women are not the other any longer. That standard care is not measured for a man and then everything for a woman is considered extra,” she said.
According to a report released this year by the National Women’s Law Center, 92 percent of health plans charge women more than men. Even with maternity coverage excluded, it found nearly a third of plans charged 25- and 40-year-old women at least 30 percent more than men for the same coverage and in some cases, the difference was far greater.
Smeal said there is a movement to repeal the Affordable Care Act, but she said her group and many others will continue to fight for women’s health care rights.
“We are determined that this stays on the books and that women have the benefits of the 21st century,” she said.
For more details on the new preventive measures and the Affordable Care Act, visit healthcare.gov.
One in four Kansans under age 65 will receive new protections under the Affordable Care Act because insurance companies will no longer be able to deny them coverage based on their pre-existing conditions.
Insurance companies also won’t be able charge a higher premium or sell a policy that excludes coverage of needed services.
These protections begin in January 2014, but children with pre-existing conditions already are protected through the federal law, also referred to as Obamacare.
“For people who need health care the most, the Affordable Care Act provides extraordinarily important protections that by and large have not existed before,” said Ron Pollack, executive director of Families USA, a national consumer health group that says it is nonpartisan.
Families USA released a handful of reports Wednesday that looked at how many people have been diagnosed with a pre-existing condition, like cancer, Alzheimer’s disease, diabetes and heart disease, and could potentially be denied health insurance or forced to pay higher costs.
It estimated that 64.8 million Americans had such a condition. That includes:
• 1.4 million Missouri residents.
• 627,000 Kansas residents.
• 33,200 Douglas and Miami county residents. The report provided data for 15 areas in Kansas.
According to Families USA, these are conservative estimates because it only looked at 69 conditions and there are more that could result in denial of coverage. Additionally, there could be people who have a condition, but it hasn’t been diagnosed yet.
During a teleconference call, Bunnie Gronborg, of Festus, Mo., talked about her struggles in getting health insurance coverage after leaving a library job because she had been diagnosed with high blood pressure, a condition that wasn’t included in the report.
She said she had no idea that she would be repeatedly denied coverage because of a condition that she hardly thought twice about because she took a pill and it was under control.
Gronborg said she hasn’t been to her primary care doctor in years for a wellness exam, mammogram or pap smear because she can’t afford it. She also has been closely monitoring a lesion on her face.
“I have spent the last several years worrying every single day, worrying that something could happen to me,” she said.
That’s about to change in seven days because she will be eligible to receive Medicare, a government health insurance program for those 65 and older and for younger people with disabilities.
“I just received my Medicare card last week in the mail and, believe me, I am doing the hallelujah dance because I only have seven more days to worry and wait,” she said.
She has already made an appointment for next month with her primary care doctor.
But for her four sons, who range from 32 to 39, the worry will continue until Jan. 1, 2014. All of them have congenitally high blood pressure. Two of them are carpenters and have lost their jobs and do not have health insurance. One of them has a herniated disk and hasn’t sought treatment. The other one had digestive issues that caused him to seek treatment in a hospital emergency room and that ultimately caused him to go into bankruptcy.
“When you are uninsured, you literally make the decision to not go to the doctor,” Gronborg said. “These types of decisions are being made all over the United States every single day.”
She’s heard them over and over as vice president of Missouri Health Care For All, a nonpartisan, grassroots organization that advocates for access to affordable, high-quality care for all Missourians.
She said a working couple who lived across the street from her also filed bankruptcy because they had a child with cystic fibrosis and the insurance company capped the amount of money that it would provide for the child’s condition.
“That can happen no more because of the Affordable Care Act, and it won’t happen to adults after 2014,” she said. “The Affordable Care Act was given the title the Patient Protection Affordable Care Act, and often patient protection is overlooked and that is what we are talking about today.”
Pollack said he thought the federal legislation cleared its biggest hurdle when the Supreme Court upheld the law.
“It is possible that the November elections might change the political status of all this, but, barring that, I think the Affordable Care Act is in a stable position,” he said. “I think the biggest threat has now been passed, but we will see if the elections have any effect on changing any of this.”
While Gov. Sam Brownback is opposed to federal health care reform and is taking a wait-and-see approach in hopes it will be overturned by newly elected leaders this fall, Kansas hospitals, insurance companies and the Insurance Department are complying with regulations that are in effect and planning for future ones.
“The clock is ticking, and we don’t have a lot of time,” said Kansas Insurance Commissioner Sandy Praeger during a panel discussion Thursday at Maceli’s in downtown Lawrence.
She said the state has until Nov. 16 to decide whether it wants to enter into a partnership with the federal government on developing an insurance exchange, which is a Web-based system where consumers can shop for insurance and where eligibility for subsidies would be determined.
By being a partner, Praeger said, Kansas would be able to determine what plans are sold on the exchange and what those plans would entail, and her department would continue to provide consumer assistance.
“Right now, we hope in our department that we can — at the very least — be a partnership exchange with the federal government,” Praeger said. If not, the state’s exchange will be run by the U.S. Department of Health and Human Services.
About 60 people attended the panel discussion, which was sponsored by the Lawrence Chamber of Commerce. The other panelists were Lawrence Memorial Hospital President and CEO Gene Meyer and Michael Williams, small business vice president for UnitedHealthcare of Kansas City.
Each talked for about five minutes about federal health reform, or the Affordable Care Act, and then answered questions. The discussion touched on a number of issues, including rebates.
Williams said insurance companies have to provide rebates by Aug. 1 if they spent too much on administrative costs and profits and not enough on medical care and quality initiatives. He said UnitedHealthcare didn’t need to send any rebates out in Kansas because it met the requirements.
Beginning Oct. 1, he said, consumers will start receiving an eight-page summary of benefits and coverages if they have insurance coverage —another requirement under federal health reform, also known as the Affordable Care Act. “It’s designed to provide more consistency and clarification,” he said.
In 2014, Williams said there may be some businesses that opt to stop offering insurance to their employees because the new exchanges will be in place.
“If an employer is fed up with every year having to deal with a 10 and 15 percent increase, he or she may just say, ‘I am pushing the eject button on this and I’m walking away from it, so I am going to pay you $250 now in your salary a month extra and you go buy it through the exchange.’ That is a real probability that’s going to exist out there,” he said.
Also, businesses that have 50 or fewer workers are not required to provide insurance for their employees under health reform. Only those with 51 or more workers are required to provide coverage or pay a penalty.
Praeger said about 95 percent of the larger businesses already provide coverage as a way to attract and retain employees. She said she would not be surprised if some of these companies decide to give a direct wage contribution that would be used to buy health insurance through an exchange instead of providing insurance. Praeger said there will have to be changes in the tax codes as well.
“There’s so much to this law,” she said. “It’s very complex.”
Meyer described our health system as broken and the Affordable Care Act as a step in the right direction. He said 52 million people are uninsured and often end up using the emergency room for care. Under health reform, an estimated 32 million Americans are expected to gain coverage.
However, he said, the law does not address how care will be provided for the newly insured. He said there already is a shortage of primary care doctors nationwide and in Lawrence, especially ones who accept Medicaid.
QUESTION ABOUT HEALTH REFORM?
Kansas Insurance Commissioner Sandy Praeger will be available Aug. 1 to answer questions about federal health reform and insurance.
She will participate in an online chat at 10 a.m. on WellCommons.com. Submit your questions at any time at WellCommons.com/chats.
Praeger, a Lawrence resident and Kansas University graduate, is responsible for regulating all insurance sold in Kansas and overseeing the nearly 1,700 insurance companies and more than 94,000 agents licensed to do business in the state. She has been insurance commissioner since 2003.
She was elected previously to the Kansas Senate in 1992, 1996 and 2000, and before that served one term in the Kansas House of Representatives. While in the legislature, she worked to gain passage of patient protection laws, external review of health plans and insurance, and the Kansas expansion of children's health insurance. In 2001 she led the successful campaign for mental health parity in Kansas.
Praeger was president of the National Association of Insurance Commissioners in 2008. She serves as chair of the NAIC Health Insurance and Managed Care Committee and a member of other NAIC committees and task forces.
By The Associated Press
WICHITA — Federal health care regulators have rejected a request from Kansas for a waiver of regulations on the amount of money insurance companies must earmark for health care.
The Wichita Eagle reports that the Department of Health and Human Services on Wednesday denied Kansas' request regarding the amount of premiums that individual and small-group insurance companies must spend on health care and improving health care.
A provision of the 2010 federal health care act requires companies to spend 80 cents of every dollar on health care activities. The law requires companies that fail to meet that mark to make rebates to policyholders. Companies that provide coverage to groups of 50 or more must spend 85 percent of premiums on health care.
Kansas Insurance Commissioner Sandy Praeger said the state sought the adjustment to prevent damage to the insurance market.
Four companies, Coventry, Humana, Time and Golden Rule, may have to provide rebates this year.
"Whenever you're implementing new policies that can potentially have a negative impact, you don't want to leave any stone unturned," Praeger said.
Praeger said she agreed with HHS that the insurance companies didn't prove that the rule would be harmful and that Kansas wasn't likely to appeal the decision announced Wednesday. HHS also denied a request from Oklahoma.
Steven Larsen, director of the Center for Consumer Information and Insurance Oversight in HHS, said that any company doing business in Kansas that didn't meet the 80-20 rule in 2011 would have to give rebates to its customers this August. Using numbers from 2010, Larsen said about 35,000 people would be owed $6 million.
The rule took effect in 2011 and Larsen said the amount of rebates may not be that high because companies have been working to comply with the rule.
Larsen said the government has already seen benefits of the requirement in states where companies have changed their business models.
"Insurance consumers will get lower premiums" because of it, he said.
According to HHS, Coventry spent 72.6 percent on health care, Humana 70.8 percent, Time 68 percent and Golden Rule 62 percent. He said those companies are profitable and could afford to pay the rebates.
Four other companies, Blue Cross Blue Shield of Kansas, Blue Cross Blue Shield of Kansas City, Aetna and Reserve all were at or above the 80 percent level. The provision allows 20 percent of premium dollars to be spent on administrative costs, including marketing, advertising and agents' commissions.
Praeger said some the companies will be able to prove that some of the administrative costs do improve health care and will be able to receive credit for the expense.
Larsen said one way companies could meet the mandate would be to cut agent commissions, but he said the federal agency didn't have any evidence that would hurt access to insurance.
"We value the role agents play," he said.
By Scott Rothschild email@example.com
Topeka — Abortion rights supporters Wednesday criticized Kansas legislators for approving controversial abortion restrictions and making controversial comments along the way.
“Far too many Kansas legislators feel women’s health doesn’t matter,” said Sarah Gillooly, a lobbyist for Planned Parenthood of Kansas and Mid-Missouri. She said the 2011 legislative session, which concluded Wednesday, was a “war on women.”
The Kansas chapter of the National Organization for Women demanded that Rep. Pete DeGraaf, R-Mulvane, apologize for a comment he made during debate May 13 on a bill requiring women to buy additional insurance to cover abortion; coverage that could only be used to save the life of the mother.
During that debate, Rep. Barbara Bollier, R-Mission Hills, noted that abortions would not be covered for cases of rape and incest.
DeGraaf responded, “We do need to plan ahead, don’t we, in life?”
Bollier then asked, “And so, women need to plan ahead for issues that they have no control over with pregnancy?”
DeGraaf responded, “I have a spare tire in my car. I also have life insurance. I have a lot of things that I plan ahead for.”
NOW State Coordinator Kari Ann Rinker said the remarks trivialized rape and were demeaning to women.
Asked by the Lawrence Journal-World if he wanted to explain further what he meant, DeGraaf said his comments were taken out of context and “grossly misrepresented.” When asked how, he declined to say. He said it was time to “move on.”
Rinker had brought three spare tires with her to the Capitol and wanted to give them to DeGraaf, but she was prevented by police from bringing them into the building.
Several legislators who support abortion rights were at the Kansas NOW news conference including Sen. Marci Francisco and Rep. Barbara Ballard, both Democrats from Lawrence.
Abortion opponents hailed the 2011 session as a success.
“We have established a beachhead of protection for the developing unborn child based on accurate medical knowledge about the human capacity to feel pain and responded to the public's ever-growing revulsion to direct and indirect funding of abortion businesses,” said Kathy Ostrowski, legislative director for Kansans for Life.
In addition to the abortion insurance law, the Legislature passed and Gov. Sam Brownback signed into law bills that will:
• Require annual, unannounced inspections of abortion clinics, impose new rules for them and prevent the clinics from prescribing over the phone the use of pregnancy terminating drugs.
• Direct $334,000 in federal family planning funds to local health clinics instead of Planned Parenthood clinics.
• In the case of a minor, require a doctor to obtain consent from at least one parent or guardian, and both parents if they are still married.
• Prohibit abortions after the 21st week of pregnancy unless the woman or girl’s life is in danger or unless she faces substantial and permanent harm to her physical health.
— Statehouse reporter Scott Rothschild can be reached at 785-423-0668.
Gov. Sam Brownback on Tuesday defended his approval of a bill that prohibits insurance companies from offering abortion coverage unless the procedure is necessary to save the woman’s life.
“The abortion debate is a difficult one,” said Brownback, an anti-abortion Republican who has signed several anti-abortion measures this year.
“There are a number of people that do not believe it is appropriate to use taxpayer dollars for abortion. There are a number of people, they don’t want it in their insurance policy that they are paying for and that is the issue that came up in the Legislature, and the Legislature passed it and I signed it,” Brownback said.
The Kansas chapter of the National Organization for Women will conduct a news conference on the south steps of the Capitol at 11 a.m. Wednesday — the official end of the 2011 legislative session — to denounce recently approved abortion bills and the comments made by a legislator during debate of the abortion-insurance measure.
“Kansas NOW is tired of legislators, who in efforts to pass their moral agenda, ignore the horrfiying reality of crimes such as rape,” the group said in a statement.
The Kansas NOW has criticized state Rep. Pete DeGraaf, R-Mulvane, for comments he made during debate in the House on May 13.
During debate, Rep. Barbara Bollier, R-Mission Hills, noted that abortions would not be covered for cases of rape and incest.
According to a report by The Associated Press, DeGraaf responded, “We do need to plan ahead, don’t we, in life?”
Bollier then asked, “And so, women need to plan ahead for issues that they have no control over with pregnancy?”
DeGraaf then said, “I have a spare tire in my car. I also have life insurance. I have a lot of things that I plan ahead for.”
Kansas NOW has asked for $5 donations to deliver model tires to DeGraaf. The group said it has received $3,000 in donations from across the country.
Starting in July, individuals and employers who want abortion coverage would have to buy additional policies that cover only abortion.
In addition, the law also states that no state or federally administered health-insurance exchange in Kansas established under the federal health care overhaul law can offer coverage for abortions, other than to save a woman’s life.
Kansas Insurance Commissioner Sandy Praeger spent an hour Saturday morning explaining how the federal health care reforms will affect Kansans.
Individual mandates, lifetime limits, Medicaid and online “exchanges” highlighted Praeger’s discussion of the Patient Protection and Affordable Care Act at Lawrence Public Library, 707 Vt. About 70 people attended the event, sponsored by the Douglas County Democratic Party.
Praeger answered questions about specific provisions and explained how Kansas has been working with the insurance industry to satisfy the law’s requirements.
Praeger acknowledged efforts in the state and on the federal level to repeal the reforms, but said “it’s important to keep moving forward on this. … If it changes, we’ll adjust.”
Following the talk, Praeger, a former Lawrence mayor, discussed some of the issues involved in implementing the new law.
Challenge of educating Kansans
“This is a very complicated law. It has a lot of pieces.”
Praeger’s suggestion to Kansans trying to dissect all the information: visit the Insurance Commission’s website at ksinsurance.org, which provides a breakdown of the law’s provisions. Also, attend events such as Saturday’s talk, where people have the opportunity to ask questions of public officials.
Who will be most affected by the law?
The 19-34 age group.
“I think there’s some real opportunities for affordable coverage that aren’t available right now.”
The individual mandate that would require the uninsured to buy health coverage.
“How do we encourage incentives for people to buy coverage? Because the whole goal here is to get as many people covered as possible.”
“It creates a lot more competition, a more competitive market because it standardizes the policies. … People can compare apples to apples when they’re looking at policies.”
Is the new law good for Kansans?
“I think in the long run, it’s a plus.”
Sebelius, former Kansas governor, said Tuesday during a conference call that the federal law is finally freeing Americans from the power of insurance companies.
“It is giving families and small businesses relief from skyrocketing costs and establishing a new level of accountability for insurance companies. Those are goals that we’ve been talking about for years and we’re finally making some progress," she said.
That’s why it is surprising, she said, that members of Congress say they want to go back to the status quo.
Sebelius provided examples of how a repeal would affect Kansans. Among them:
• 16,800 young adults would lose their insurance coverage through their parents’ health plans.
• 1.7 million residents with private insurance coverage would find themselves vulnerable again to having lifetime limits placed on how much insurance companies will spend on their health care.
• 183,000 people would be at risk of losing their insurance at the moment they need it most — after an accident or when sick — because of a simple mistake on an application.
• 416,000 seniors who have Medicare coverage would be forced to pay a co-pay to receive preventive services, like mammograms and colonoscopies.
• 30,186 Medicare beneficiaries would see higher prescription drug costs. The new law provided a one-time, tax-free $250 rebate to help pay for drugs in the “donut hole” coverage gap in 2010. Those who fall into the “donut hole” in 2011 will be eligible for 50 percent discounts on brand name drugs. Eventually, the donut hole will be eliminated.
“The evidence so far suggests that the reforms are working for millions of Americans. There’s no question that repeal would be a huge step backward that we can’t afford.”
— HHS Secretary Kathleen Sebelius
There’s a new federally mandated health insurance plan for Kansans whose medical conditions have made them uninsurable.
So far, 120 people have signed up.
The state began accepting applications in July and starting offering coverage Sept. 1.
To be eligible, you must meet these criteria:
• Be a resident of Kansas and a U.S. citizen or a person lawfully in the United States.
• Have been uninsured for at least six months prior to applying.
• Have a qualifying pre-existing medical condition, a denial letter from an insurance company, or a letter of insurance acceptance with a reduction or exclusion of coverage for your pre-existing condition.
http://wellcommons.com/users/kbritt/p... There are 63 medical conditions that meet the requirement. Those conditions include everything from AIDS to leukemia to Wilson’s disease.
The most common conditions among the 120 people enrolled in Kansas are:
• heart disease.
• malignant tumor.
“For those individuals with a pre-existing condition who have wanted to buy health insurance coverage, can afford to pay premiums, and had not been able to get it in the past, this certainly fills a need."
—Linda Sheppard, director of the Accident & Health Division for the Kansas Insurance Department.
The state expected to enroll 45 people per month.
“So, we are just about on target,” she said.
How the plan works
After the federal law was passed, states had to decide whether to operate a pool locally or allow the U.S. Department of Health and Human Services to establish and operate them with local contractors.
The Kansas Health Insurance Association’s board of directors decided to enter into a contract with HHS to administer the high-risk plan on behalf of Kansas.
Kansas was allocated $36 million to use to subsidize the plan from Sept. 1 through Dec. 31, 2013. The plan will end at that point because the state’s new health exchange is expected to start Jan. 1, 2014. Insurance Commissioner Sandy Praeger, Lawrence, is working on establishing the exchange.
Kansas has to renew its contract for the PCIP-KS plan with HHS every year, and just sent its application for 2011. It is proposing a 9 percent increase in premium rates.
Sheppard said the rates vary depending on age, where you live in the state, and tobacco use.
For example, she said, a 50-year-old nonsmoker would pay between $348 and $385 per month under the plan’s 2011 rates. For a smoker, it would range from $457 to $514.
Federal law requires the premium rates to be the average price of standard plans in the state insurance market.
Different high-risk plan
The premium rates are lower than the state’s other high-risk plan that was implemented in 1992.
“Back then, the federal government required states to put something in place that ensured people had the opportunity to at least get coverage,” Sheppard said.
About 1,700 people are enrolled in the State High Risk Pool. For 2010, the premium rates are 128 percent of what’s standard in the market.
Sheppard said while the prices are higher, the eligibility requirements aren’t as strict.
For example, there’s no six-month waiting period. You can get coverage if you just lost your job.
“We definitely want people to know that these pools are an available option for individuals who could not get coverage in the regular private market,” Sheppard said.
She estimated that they’ve received more than 1,400 inquiries about the new federal high-risk pool.
“There could be a lot of reasons why they don’t ultimately enroll,” she said. “Maybe it’s a situation where people check it out and they are able to come up with another option or maybe the cost is still more than they had hoped for.”
Kansas offers two insurance plans for people whose medical conditions have made them uninsurable.
They are the Pre-existing Condition Insurance Plan — Kansas, and the State High Risk Pool. For more information on both plans, visit Kansas Health Insurance Association’s website at www.khiastatepool.com. The association administers both plans.
For PCIP-KS call 877-505-0511, and for the State High Risk Pool call 800-362-9290.
About 200 people attended a four-hour community forum about federal health reform Thursday at The Oread Hotel.
There was a panel discussion among state and national health leaders, and a presentation by John McDonough, a nationally renowned expert on health reform.
The forum was sponsored by the Sunflower Foundation, which serves as a catalyst for improving the health of Kansans.
Marcia Nielsen, vice chancellor for public affairs at Kansas University Medical Center, started the program by going over some of the reasons we need health reform.
Among the reasons: We spend more than other countries and get little value in outcomes. Our death rates are not any lower.
Forty-nine million Americans are uninsured, and we continue to pay for expensive emergency room care, instead of focusing on primary care and prevention.
“We could spend it more wisely if we focused on prevention,” Nielsen said.
The need for Americans to take charge of their own health came up time and again during the forum — that if people would eat healthier, exercise more and get preventive screenings, it would reduce costs.
Nielsen went over three key components of the federal Affordable Care Act:
- Mandates insurance. Everyone has to have health insurance beginning in 2014 or they will be penalized. Twenty-four attorneys general are suing the government over this. McDonough expects the issue will make its way to the Supreme Court in two to three years. He thinks the decision will come down to Justice Anthony Kennedy.
- More tightly regulates insurance. It puts in place a number of provisions aimed at protecting citizens and monitoring the work of insurance companies more closely. “It ensures that pre-existing condition exclusions are a thing of the past,” Nielsen said. “We’ve done that for kids this year, and adults will be included in 2014.”
- Creates state insurance exchanges. These will be for people who work in a place that doesn’t offer coverage or the coverage is not affordable. It is meant to be one-stop shopping, she said. It’s a place where Kansans can enter their information, and the exchange will determine if they qualify for Medicaid or if they qualify for a subsidy. Then, it will enroll you in a health insurance plan. McDonough added that if people are offered coverage by their employer, then they can’t participate in the exchange.
They served on the panel discussion along with Sharon Homan, vice president for public health at the Kansas Health Institute; Dr. Jennifer Brull, president of the Kansas Academy of Family Physicians; and Susan Sherry, deputy director of Community Catalyst.
Nielsen served as the facilitator. She asked them questions about reform, and then they took questions from the audience, which was mostly people who worked in the health care field. When polled by McDonough, a majority of the audience thought health reform was “a good thing.”
From the frontline
Brull’s comments seemed to strike a chord with the audience. Brull is a family doctor in Plainville, a town of about 2,000 people in northwest Kansas.
She is happy that she will be reimbursed for the uninsured whom she is caring for now. But, she’s concerned that there will not be enough primary doctors to care for the newly insured.
“My plate is already full,” she said.
She addressed the huge difference in salaries for specialists versus primary doctors.
“If you don’t make it more attractive, you aren’t going to attract students. They aren’t dumb,” she said.
Brull also talked about the tough choices and costs of end-of-life care. Does a dying cancer patient spend $100,000 on chemotherapy that likely will make them feel horrible and give them another month to live, or does one spend $100,000 on a trip or hospice care?
She wished tort reform had been addressed in health reform. She said the costs to be ready for a possible lawsuit are too high. The panel agreed with her.
Nielsen said, “We don’t have a system that allows doctors to be sorry.”
Praeger added, “Bad things happen in hospitals. It’s not a perfect system.”
When it comes to electronic medical records, Brull is a proponent. She said it helps her keep better track of her patients and the quality of care she is providing. The system pointed out that only 43 percent of her patients, who should have received a colorectal screening, had received one.
“I was shocked,” she said.
After spending more time with patients on the issue, the percentage is now 87.
Brull warned the panel and audience that she sees a lot of scared patients, especially the older generation. She said they are worried about what they perceive as government-controlled care, although they are enrolled in Medicare.
“I can’t even imagine the work that lies ahead,” she said.
There will be a public forum on health reform Oct. 28 in Lawrence.
The forum, “On the Front Line: Local Response to Health Reform,” will be from 8:15 a.m. to noon at the Oread Hotel on Kansas University’s campus.
A panel of state experts will open the forum with a discussion of the roles that federal government, state agencies, providers and consumers must play in health reform.
The panelists include Sandy Praeger, Kansas Insurance Commissioner; Andy Allison, executive director of Kansas Health Policy Authority; Dr. Jen Brull, president of Kansas Academy of Family Physicians; Sharon Homan, vice president for public health at the Kansas Health Institute; and Susan Sherry, of Community Catalyst in Boston.
The keynote speaker will be John McDonough, who has been on the forefront of health reform.
He was the senior health advisor to Sen. Edward Kennedy and played an influential role in conceptualizing health reform, served as an elected representative from 1985-1997 in the state of Massachusetts, and led “Healthcare For All,” an advocacy organization designed to support consumers as Massachusetts adopted comprehensive state health care reform in 2006.
The forum, sponsored by the Sunflower Foundation, is free and open to the public. However, because space is limited, advance registration is required.
To learn more and register, visit the foundation’s Web site at www.sunflowerfoundation.org or call Alisa Browning at (785) 232-3000.
In Kansas, 260,400 people will be eligible for $1 billion in new tax credits beginning in 2014 that will reduce the cost of private health insurance.
The majority — 96 percent — of these Kansans will be in working families.
Families USA, a health care consumer group, released these findings in a report “Lower Taxes, Lower Premiums: The New Health Insurance Tax Credit in Kansas” today.
“This is the largest middle-income tax cut in history, and it will enable many hard-working Kansans to afford health insurance premiums that have stretched family budgets."
— Ron Pollack, executive director
The Patient Protection and Affordable Care Act, which was enacted in March, will extend health coverage to millions of Americans by expanding Medicaid to those with the lowest incomes and by creating tax cuts to help low- and middle-income individuals and families afford private coverage.
These tax cuts will be provided in the form of new, refundable tax credits that will offset a portion of the cost of health insurance premiums.
The credits will help Kansans with incomes up to four times the federal poverty level. That’s $88,200 for a family of four.
Generally, the tax credits will be available to:
• The uninsured who have incomes between 133 and 400 percent of poverty level. That’s between $29,325 and $88,200 for a family of four.
• Some people who earn below 133 percent of poverty level who do not qualify for Medicaid. These would be immigrants who are legal residents but have been in the United States for fewer than five years.
• People whose contribution to job-based coverage is greater than 8 percent of their household income, and their income is at or below 400 percent of poverty.
Other Kansas findings:
• 65 percent of those eligible for the tax credits will be in working families with an annual income at or above 200 percent of poverty level. That’s $44,100 for a family of four.
• But, 57 percent of the dollars will be targeted for families with incomes below 200 percent of poverty. That’s because the size of the tax credit is based on a sliding scale based on income.
• 112,200 uninsured residents will be eligible for tax credits.
• 148,300 insured residents will be eligible for tax credits.
How will tax credits work?
• The dollars from the credit will flow directly to the health plan in which the individual or family enrolls.
• The credits will be advanceable, meaning money will be available to pay the premium at the time of enrollment.
• The credits will be refundable. Families with very low incomes who do not owe taxes will be eligible for these credits to assist with the cost of premiums.
The entire report can be found online at Families USA's website.
Bob Hanson, public information officer for the Kansas Insurance Department, said the department is working on health reform implementation, and would keep consumers updated on developments as they progress.
He had no comments about the report.
A reader submitted the following question through the Lawrence Journal-World's soundoff line. I thought it was important to share:
Q: Since Congress has passed and the president has signed the health bill reform, how can we sign up for affordable insurance? Where do we start? Who do we contact?
A: The health insurance reforms adopted as part of the Patient Protection and Affordable Care Act (PPACA) are phased in over the next five years, according to Bob Hanson, public information officer for the Kansas Insurance Department. Many provisions will not take effect until Jan. 1, 2014. However, some new protections must be included in health plans issued or renewed on or after Sept. 23, 2010.
“PPACA is primarily focused on improving access to coverage and has not yet addressed cost in a meaningful way,” he said.
For Kansans who have pre-existing conditions and do not currently have insurance, the law helped establish the Kansas Pre-Existing Insurance Plan to make coverage available to eligible Kansans through the end of 2013. After that, according to the legislation, everyone will be mandated to have coverage or face a penalty. The opportunities for coverage will be expanded (with possible premium subsidies) through a state-based exchange that will compare similar plans from companies offering health insurance coverage throughout the state.
For information on PPACA and coverage opportunities, go to www.ksinsurance.org and click on the health reform information links at the top of the home page, or go to www.healthcare.gov, the new federal website.
You also can call the Consumer Assistance Hotline in Kansas 800-432-2484.
: http:// www.ksinsurance.org
Hey business owners! Are you ready for the changes coming this year due to health reform?
If not, you might want to attend this event:
The Lawrence Chamber of Commerce will present a seminar and panel discussion Tuesday, July 27, on the federal health care reform’s impact on small employers.
The event will be from 8:30 a.m. to 10:30 a.m. Tuesday, July 27, at Maceli’s, 1031 N.H.
Panelists will include Kansas Insurance Commissioner Sandy Praeger, Lawrence Memorial Hospital CEO Gene Meyer, and Gerry Hollis, a senior associate at Willis HRH, among others.
The seminar will address how the Patient Protection and Affordable Care Act might affect businesses. Specifically, it will look at what impact the legislation will have on health care benefits offered, health care costs, and possible availability of other benefits for employees.
The discussion will focus on immediate health reform changes that are scheduled to occur Sept. 23.
The event costs $10 for Chamber members and $15 for nonmembers. The deadline to register is Friday, July 23. To register, call 865-4411, e-mail firstname.lastname@example.org, or click on the Lawrence Chamber of Commerce website.
They clean our dishes, cook our meals and grow our food.
But lower-wage — and particularly immigrant — workers don’t always get paid for all the work they do in our community.
It’s called “wage theft,” and several area workers who have experienced it shared their stories Saturday at the first Lawrence Worker Justice Coalition meeting at Plymouth Congregational Church, 925 Vt.
Juan Miguel Turcios, an undocumented immigrant from Honduras, gave one example of how businesses in Lawrence treat such workers unfairly. Turcios, who has been in the United States four years, said he was recently hurt on the job. That injury led to an infection and a $4,000 hospital visit — an expense his employer won’t pay, and one he can’t. http://www2.ljworld.com/photos/2010/jul/10/194889/
It’s a story that’s becoming more and more common and was the catalyst for Saturday’s meeting and future worker justice clinics, said Shannon Gorres, director of Hispanic ministries at Plymouth.
“We continue to hear stories of workers not being paid,” she said.
Gorres said those stories of wage theft include employers simply not paying employees for weeks and months at a time, using wages as rent in homes the employers own, and denying overtime and minimum wage. “They think they have no leverage,” Gorres said.
But Saturday’s meeting was a first step to empower area workers to fight for better treatment. Monthly worker justice clinics, featuring lawyers, volunteers and advocates, will help low-wage workers understand their rights. The clinics will also serve as an entry point for worker rights complaints.
Adam Huggins, a representative for the U.S. Department of Labor, spoke at the meeting and said his agency wants to help workers obtain fair wages and treatment, whether they’re U.S. citizens or undocumented workers. The department has started a new campaign called “We can help” that encourages workers to make complaints when labor laws are violated.
Getting education and awareness out to the community is also vital, Gorres said, as the community may not realize such unfair treatment of workers happens here in Lawrence.
And she thinks the Lawrence community would be outraged if they knew some of the area businesses they frequent don’t treat workers fairly.
“I don’t want to eat food made with slave labor,” she said. “Support businesses that support ethical employment practices.”
For details of the new health care reform plan here's an AP article about "the health overhaul law" and the enforcement of the 'patients bill of rights.' Hopefully this sheds a bit of light on the confusion about health care reform.