Tuesday, July 3, 2012

Check out this great post about the Top 10 Things to Dislike About Health Care Reform...http://ping.fm/76yBp

Saturday, June 2, 2012

Saturday, April 21, 2012

Study Shows Health Care Reform Will Cost Government Over $1 Trillion

A new study, by Medicare Trustee Charles Blahous, shows that the original projections by the Congressional Budget Office (CBO) and the Medicare Trustees compared the Affordable Care Act (ACA) cost and savings projections to a baseline scenario that is different from what we actually face. This new analysis caused a great deal of criticism, but some experts argue that the report projects a distressingly accurate snapshot of the effects from the ACA.

Over the first 10 years of the ACA, government spending would be increased by over $1.15 Trillion, and this initial increase in federal deficit spending was hinted at by the CBO during the debate leading up to the passage of the ACA. According to Blahous, the savings within the health care reform bill would likely be delayed or ultimately become non-existant, while the cost increases are built into the law.

Stay tuned for more.

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Thursday, April 19, 2012

California To Push On With Health Care Reform Regardless Of Supreme Court Decision

Governor Jerry Brown’s administration is planning to implement some parts of the Affordable Care Act (Health Care Reform) even if the Federal Supreme Court overturns part or all of the reform bill. State Health and Human Services Secretary Diana Dooley said that California should implement it’s own version of Health Care Reform, and require that all California residents have health insurance, similar to the requirement that everyone have car insurance.

I applaud the intent to “do good deeds” for California, but Governor Brown is facing continuous budget deficits as things are, and needs voter approval of tax increases in order to maintain the status quo. How will he propose to add more taxes to pay for a new program with potentially escalating costs over the next decade?

Health Care Reform is not about Health Insurance Reform, it needs to first focus on health care costs and reducing the health care inflation rate by eliminating duplicated tests, increasing access to electronic medical records, prevention and maintaining the wellness of individuals, and rewarding health habits both within the health care community and in individuals. Then Health Care Reform can increase coverage to all people, and the government costs will be supported by existing tax revenues. The current system is trying accomplish this in reverse order.

Stay tuned for more.

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Wednesday, April 11, 2012

Consumer Watchdog Group Starting New Boon Doggle In California

Consumer Watchdog, a special interest group with strong ties to trial lawyers is gathering signatures to put a health insurance rate regulation measure in the November 2012 election. The measure seeks to create a new bureaucracy, funded by insurance companies, to create a new layer of regulations on top of existing state and federal regulations.

Physician groups, hospitals, doctors, and small businesses announced the launch of Californians Against Higher Health Care Costs (CAHHCC) to combat the Consumer Watchdog efforts. C. Duane Dauner, president/CEO of the California Hospital Association says that "Consumer Watchdog's ballot measure is full of false promises and devoid of real solutions. Regulating health insurance rates does not address the underlying demand and utilization forces that drive health care costs. One of the biggest drivers of increasing insurance premiums stems from the chronic underfunding of the Medicare and Medi-Cal programs. When government programs fail to pay the actual cost of caring for their beneficiaries, hospitals and other providers must shift these unreimbursed costs to private insurers, which drives up premiums. This initiative does not address governmental payment shortfalls.”

Consumer Watchdog is using the initiative precess to open up medical insurance in the same way that allowed trial lawyers to make millions of dollars off homeowners and auto insurance.

Stay tuned for more.

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Wednesday, April 4, 2012

California Families Pay For The Uninsured

California Families Pay For The Uninsured

According to the California Endowment, a private foundation concentrating on health issues, the average California family pays an additional $1400 in yearly premiums in order to cover the costs of the uninsured Californians. So even though the Federal Supreme Court may throw out the mandate provision of the Affordable Care Act, the state of California is still preparing to go it alone on some parts of health care reform.

The new child health insurance laws and the required maternity coverage mandate will stay in place, while work on the California Health Benefit Exchange -- a website to help consumers find and purchase health insurance once 2014 rolls around. Many consumer advocates are urging state lawmakers to forge ahead with a California mandate requiring everyone to have health insurance, just like the requirement to have care insurance. Further discussions are required before before any changes happen in this area.

Stay tuned for more.

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Tuesday, April 3, 2012

California Families Pay For The Uninsured

According to the California Endowment, a private foundation concentrating on health issues, the average California family pays an additional $1400 in yearly premiums in order to cover the costs of the uninsured Californians. So even though the Federal Supreme Court may throw out the mandate provision of the Affordable Care Act, the state of California is still preparing to go it alone on some parts of health care reform.

The new child health insurance laws and the required maternity coverage mandate will stay in place, while work on the California Health Benefit Exchange -- a website to help consumers find and purchase health insurance once 2014 rolls around. Many consumer advocates are urging state lawmakers to forge ahead with a California mandate requiring everyone to have health insurance, just like the requirement to have care insurance. Further discussions are required before before any changes happen in this area.

Stay tuned for more.

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Monday, April 2, 2012

Anthem Blue Cross Slipping Out of Top Spot in California Health Insurance

With the beginning of April it becomes time to start running quotes for a May 1st effective start date. The new rates and changes that Anthem Blue Cross of California announced in March now become very evident.

My quick assessment from the first half dozen quotes I've run is that Anthem has given up a huge chunk of their lead over the other individual & family health insurance companies in California. Several of their lowest cost plans no longer exist, and the remaining plans are now only slightly ahead of Aetna plans, and are a little more costly than Blue Shield of California' plans. Going into the remainder of the year, I expect to see more new clients opting for Blue Shield because they offer richer benefits at lower costs.

Stay tuned for more.

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Thursday, March 29, 2012

Health Care Reform Mandate In Jeopardy

The initial arguments in the Supreme Court hearings about the individual mandate seem to indicate that the mandate will not be accepted. The general tone of the discussions had the 4 liberal Justices supporting the mandate, and the 4 conservative Justices against the mandate. Judge Clarence Thomas sat quietly and listened to the proceedings but did not ask any questions or make any comments. It is believed that Judge Thomas will not support the mandate, thus giving a 5 to 4 advantage to overturning the mandate.

The next step is to determine if the mandate can be severed from the remainder of the Affordable Care Act, and those discussions are underway.

Stay tuned for more.

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Tuesday, March 27, 2012

Supreme Court Begins Hearing Health Care Reform Arguments

Yesterday the legal boxing began with the first round being about the Anti-Injunction Act (AIA) of 1867 and whether or not the court could actually hear arguments about health care reform mandate if no penalties had been paid yet. The AIA is the basis of all tax collections which says that you have to pay the tax before you can challenge the tax in court. From the sounds of the arguments in hearing yesterday, it appears the AIA is a none issue for the rest of the week's health care reform arguments.

Today the Supreme Court will be hearing the first arguments about the ability of the federal government to impose a mandate to buy health insurance on all citizens.

Stay tuned for more.

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Sunday, March 25, 2012

California Hospitals Taking Action Before Health Care Reform Kicks In

Hospitals all around America are struggling to find ways to reduce costs and eliminate duplication of efforts. These cost cutting measures are part of the hospitals preparation to survive once health care reform fully begins in 2014.

In California, hospitals are trying to figure out how to make due with fewer patients, because the amount hospitals will be paid for providing medical services will be based upon keeping patients from returning to the hospital. This is a whole new world for hospital administrators, and on top of that they face significant cuts to Medicare and Medicaid, which make up over 50% of California hospital revenues.

Let's hope the hospitals figure this all out, because it would be a shame to only have a couple of hospitals left a few years after health care reform kicks in.

Stay tuned for more.

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Saturday, March 24, 2012

Republicans Plan To Use IPAB Against Democrats In November Elections

The Independent Payment Advisory Board (IPAB) was created as part of the Health Care Reform bill to force cuts to drug companies, insurers, and medical service providers if Medicare spending continues to climb. Republicans believe that the IPAB would squeeze payments to service providers and eventually stifle medical innovation and cause providers to see patients with non-Medicare coverage. Effectively rationing healthcare to those who can pay more, and making it difficult for Medicare patients to get the care they need.

The House of Representatives recently passed a symbolic bill to repeal the IPAB, but that bill is expected to stall out in Congress. Many Democrats would have also voted to repeal but the Republicans added additional caps on medical malpractice awards which Democrats oppose.

The Republican strategy is to make the IPAB an issue for the elections, but to wait until after the beginning of 2013 to get the IPAB repealed. Republicans are hoping that Seniors will see them as better stewards of Medicare.

Stay tuned for more.

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Thursday, March 22, 2012

Supreme Court To Hear Mandate Arguments Next Week

The US Supreme Court will begin hearing arguments about the Health Insurance mandate in the Affordable Care Act, and ultimately decide if the mandate is constitutional or if it oversteps the federal governments powers to control commerce. Some people want the mandate to be passed (the insurance companies and democrats) and other want the mandate to be struck down (republicans).

Either way, the decision will have major impacts of the future of health care in the US, so the outcome is very important for every US citizen.

Stay tuned for more.

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Wednesday, March 21, 2012

Health Care In The US Not As Bad As Believed

In a new research report Christopher Conover from Duke University's Center for Health Policy and Inequalities Research, the facts about how America's health care system compares to those of other countries is finally laid bare. The reality is that we've got it pretty good after all. (see the article in the Los Angeles Times: http://ping.fm/LH9VW)

Some examples are: Life Expectancy in the US is greater than in all other countries, instead of 39th, if deaths related to violence and automobile accidents are removed. This adjustment seems fair since we're looking for the effects of health care on life expectancy.

Another comparison is the quality of health care outcomes. People with cancer live longer in the US than in any other country. Many of the "avoidable deaths" that could be treated are in fact caused by the lifestyle choices of Americans, and thus make the numbers look like US health care is worse than other countries.

Stay tuned for more.


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Tuesday, March 20, 2012

California Facing a Shortage of Physicians

Thirty percent of California physicians are 60 years old or more, and more retire each year than the number of new physicians that start out. This doesn't bode well for what things will look like in 2014 when there are expected to be an additional 4 million Californians that will have health insurance.

The areas that will be hardest hit are the rural areas and the inland valleys. Primarily because doctors tend to gravitate towards the coast and the metropolitan areas. Many people in the central valley will find it harder to schedule an office visit after 2014 because of this shortage of doctors.

Stay tuned for more.

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Monday, March 19, 2012

Anthem Blue Cross of California Adjusting May 1st Pricing

Anthem Blue Cross members that have already received their letters describing a May 1st rate increase will get a little relief. Updated pricing shows a slightly lower rate change than what was originally put into the letters. The amount of change in the rates depends upon the family specific, and the plan the member is enrolled in.

This is welcome news to many Blue Cross members who were affected by the rate increase. Some members will wait to see the net result of the increase before deciding if they plan to change to a lower cost option.

Stay tuned for more.

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Saturday, March 17, 2012

What If the Mandate Is Struck Down? Will Health Care Reform Survive?

The US Supreme Court will hear arguments both for and against the individual mandate, which is the central figure in the health care reform bill. Insurance companies will argue that without the mandate, the ability to provide insurance for everyone goes away. The Obama administration says that without the mandate the reset of the health care reform rules should remain in place, except for 2 rules.

The two rules that would be removed from health care reform are the requirements that insurers cover everyone that applies, and that the insurance companies use a "community rate" instead of rates based upon the applicants health characteristics. Without these two provisions, the health care reform regulations just become "business as usual" but with more required benefits, and therefore, higher costs. The exact opposite of what health care reform was supposed to do.

If the mandate is struck down, then health care reform needs to be scuttled and a new plan created.

Stay tuned for more.

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Friday, March 16, 2012

Pre-Existing Condition Insurance Plan Enrollment Is Lower Than Expected

The PCIP was expected to have 375,000 new members, but so far only 50,000 have signed up for the insurance plan. Plus the costs for the people that did sign up are much higher than was expected when the PCIP was initially created.

The PCIP California program was meant to provide affordable health insurance to people with exiting health conditions that prevented them from being able to get regular underwritten health insurance. The premiums for the PCIP plan are less than what the expected costs are supposed to be, so the Federal government is subsidizing the program. In fact, the costs of the program are more than twice as much as was originally anticipated.

Stay tuned for more.

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Thursday, March 15, 2012

California Health Mandates Could Increase State Costs


California has 53 health insurance mandates that require specific benefits to be covered in health insurance plans that are offered in California. There are more mandate bills coming in 2012 as well.

The Affordable Care Act states that each State must offer a "minimum" set of health benefits in the plans that are offered in the Exchanges. However, the ACA says that if the state mandates additional benefit levels, then the state is responsible to pay for those additional benefits. The net result of this is that Californian's will either face higher insurance costs when 2014 rolls around because the only plans offered will have rich benefit levels, or the State will have to figure out how to generate more revenue to be able to pay for the extra benefits for every citizen in the health insurance plans.

Stay tuned for more.

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Wednesday, March 14, 2012

Health Insurance Exchange Conflict

CMS has stated that insurance brokers will be allowed to "interact with consumers on the exchanges in an automated way", but left the determination as to how for each State to decide. This will enable brokers to direct consumers to the exchanges to determine if they qualify for tax credits, but many health reform groups are concerned.

Health reform groups, such as Consumers' Union and the Multiple Sclerosis Society believe that allowing brokers to access the exchanges, the brokers will obscure the information and direct consumers to specific health insurance companies, while not letting consumers know about other options.

This is ridiculous. Independent brokers have long known that their best strategy is to not favor any insurance company, but present what is in the consumer's best interest. Having an exchange won't change that perspective. Cutting brokers out of the new exchanges will result in consumers not effectively using the new health reform features, and will probably slow down the sign up of the uninsured.

Stay tuned for more.

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Sunday, March 11, 2012

Finding Health Insurance in San Diego Can Be Challenging

When searching for good health insurance plans, San Diego residents need to find a good broker website that provide information and quotes from all the major insurance companies. That way you get plenty of choices, and also the necessary information to be able to compare plans and pick the plan that best fits your needs from over 150 different options. The second part of this is to make sure the website gives you a phone number so you can speak to a knowledgeable expert to get answers to any questions you have. Using these two tips will enable you to quickly find a great health insurance plan in San Diego, with the least amount of effort.

Stay tuned for more.

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Saturday, March 10, 2012

Americans Pay More for Health Care

A new report by the International Federation of Health Plans (IFHP) shows that Americans pay more for most medical service than people in other countries. The IFHP is composed of CEOs from various Health Insurance companies worldwide.

As an example, the average price for an MRI in the US is $1080. In France the same MRI costs $281 and in Germany the cost would be $599. The average US cost for a hospital baby delivery is $9280 and the cost would be $2536 in France and $2157 in Germany.

Even worse are the price differences for drugs. In the US, the average cost for Nexium is $193, and in France the cost is $23, while Canadians pay $36.

Stay tuned for more.

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Friday, March 9, 2012

All the Health Insurance Carriers Scramble To Keep Up

The changes due to health care reform and starting to come fast and furious, and this is making it hard for the insurance companies to keep up. In California, the state has added to the list of action items for insurance companies by requiring all health insurance plans to include maternity coverage starting July 1st.

Right now the big issue for insurance companies is the Medical Loss Ration (MLR) regulations, that require insurers to cut their administrative overhead and payout more in benefit claims.

Stay tuned for more.

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Thursday, March 8, 2012

Health Care Reform Subsidy Costs Explode

New data contained in the latest presidential budget proposal show the costs of providing subsidies to middle class citizens to help them buy health insurance in the new state insurance exchanges, have climbed by over 30% since last year. The new budget show expected costs of $478 billion over the period from 2014 - 2021.

This projected cost increase raises two concerns. First that the estimated cost of the insurance has gone up, and second, that the administration fears more employees will lose group coverage when the Affordable Care Act takes effect in 2014.

Stay tuned for more.

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Tuesday, March 6, 2012

Hospitals Will Have to Change Their Methods to Survive Health Care Reform

The new rules in the Affordable Care Act (ACA) are making hospitals look for ways to reduce costs and prevent duplicate efforts. The ACA moves the payments hospitals receive away from a fee for each service to a reward for keeping patients from returning to the hospital. This change is causing hospital administrators to begin looking for ways to streamline their actions.

This new payment methodology promotes higher-quality hospital treatment and prevents inadvertently subsidizing bad care to increase the hospital's revenue growth. These shifts will transform the hospital landscape by reducing the number of independent small hospitals, and the creation of larger hospital groups that will have more negotiating power with the insurance companies.

Stay tuned for more.

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Sunday, March 4, 2012

What Are The Top 3 Features Of A Great Small Business Wellness Program?

According to a Principal Financial Well-Beng Index, 41% of employees at small business say they would be more productive at work if their company offered a well-being program with the following 3 features:

1. Fitness Club discounts
2. On Site Preventive Screenings
3. Access to wellness experts such as nutritionists

45% of small business employees say they would participate in these well-being programs to improve their own physical health.

Stay tuned for more.

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Saturday, March 3, 2012

If you're pregnant without insurance check the information at SPF Insurance to find great solutions to get insurance coverage for your pregnancy. Pre existing condition insurance plan is a potential option.

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Anthem Blue Cross May Rate Increase Letters

The first clients with Anthem Blue Cross plans are beginning to call about alternatives to their Blue Cross plans. The rate increase will take effect on May 1st, so these subscribers are just now receiving the rate increase letters. For help finding good alternatives, contact:
SPF Insurance Services
17927 Sencillo Ct
San Diego, CA 92128
(858) 613-3628
http://spfinsurance.com

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Wednesday, February 29, 2012

Amendment to Release Religious Organizations From Contraceptive Mandate

The Senate is expected to vote on an amendment tomorrow that will keep religious employers from having to follow government mandates regarding contraception. This move was expected for a couple of weeks, and appears to finally be at hand.

Stay tuned for more.

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Monday, February 27, 2012

Health insurance California
There are a lot of health insurance options in California, so take the time to investigate your options. Visit a website to get quotes from all the major carriers, compare them, and then apply.

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Sunday, February 26, 2012

Dental Insurance Versus Dental Discount Plans

Which is the better option if you need dental services because of tooth pain? Neither option will probably allow you to see your regular dentist, because dentist's primarily take PPO plans, and PPO plans have waiting periods. So you'll have to choose an HMO dental insurance plan or a discount plan. Both HMO and discount will seem to be identical to most people because they ultimately offer you a savings off the regular prices a dentist charges.

http://ping.fm/2KWjS

Saturday, February 25, 2012

Improving Cardiovascular Health

Palomar Pomerado Health will be holding a free education program to help people improve their cardiovascular health. The program will teach attendees about risk factors and making lifestyle changes. The program is presented by Dr. Charles Hardison and will be held at the Pomerado Outpatient Pavilion Education Classroom
15611 Pomerado Road, Poway, CA 92064

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Friday, February 24, 2012

Anthem Blue Cross Announces Rate Adjustments May 1st, 2012

Blue Cross of California today announced that rates on individual and family health insurance plans will be adjusted starting on May 1st, 2012. Notices to plan members should go out during March. How much the increases are we don't know yet.

Stay tuned for more.

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Thursday, February 23, 2012

Health Insurance Companies Moving To New Payment Scheme

Several major health insurance companies, Aetna, United HealthGroup, and WellPoint, will begin paying selected primary care physicians higher fees for improved patient care in an effort to reduce long-term health care costs. Consumers will be the winner of this new payment scheme by fewer hospital visits and improved health.

Stay tuned for more.

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Wednesday, February 22, 2012

Although "Doc Fix" Bandaid In Place, No Long-Term Solution In Sight

Legislators went home for the President's Day weekend with a patch in place to prevent Medicare doctors from getting hit with a 27.4% pay cut. However, that bandaid will only last until December 31, 2012. What will they do then?

This problem started back in 1997 as part of a deficit reduction plan that used a formula to set Medicare physician payment rates. A few years later it became obvious that the formula was not going to work, and the yearly "Doc Fix" struggle began. A simple fix is difficult because the total cost to correct the problem is $316 billion over the next decade and nobody can agree on where that money is going to come from.

Physicians are also guilty of being part of the problem because they are paid for each test or service they provide, rather than for the health of the patient. This drives medical costs up. So a fundamental change in the overall structure of the health care system is needed.

Stay tuned for more.

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Tuesday, February 21, 2012

Maternity Health Insurance in California: At the Crossroads

Maternity health insurance will be changing in California starting on July 1st, 2012. On that date all health insurance plans in California will be required to provide maternity care. The insurance companies have yet to publicly state how they will approach this, but a few rumblings have been heard.

Blue Cross is rumored to simply add the maternity care to all existing plans, while changing the name of the new maternity plans, and grandfathering all existing plans that currently do not have maternity care. Blue Shield is rumored to be working on an entirely new portfolio of health plans.

Aetna is a company that may have the most interesting response to the maternity care mandate, because none of their plans currently offer maternity care. Will they add this to existing plans, will they create new plans, or will they exit the California individual health insurance marketplace?

Stay tuned for more.

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Monday, February 20, 2012

Medicare Payment Fix To Cost Smokers, Obese, and Poor

The new legislation to fix the yearly Medicare doctor payment hole was passed by Congress and the House, and will be signed by President Obama this week. The legislation is not without costs however. To pay for the increased payments to doctors that treat Medicare patients, the administration will take money from a fund to help prevent smoking and obesity, and reduce payments to hospitals that treat large numbers of poor people.

What was that last one? Cut money going to hospitals that treat poor people? Won't that make it worse for those hospitals and the patients they treat?

I guess it decided that poor people don't vote as much, so the government will protect Medicare for the seniors that vote, and stick it to the poor people. Wow! That's government at it's finest!

Stay tuned for more.

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Sunday, February 19, 2012

Hospital Use of Electronic Medical Records Soars

Over 35% of all hospitals now use electronic records to better manage the care of patients according the Health and Human Services department. This is up from 16% in 2009, and is driven by incentive payments from Medicare and Medicaid.

"Health IT is the foundation for a truly 21st century health system where we pay for the right care, not just more care," said Sebelius.

The emphasis on electronic medical records will help in the early detection of disease outbreaks and enable the measurement of effective treatments across all providers that use the new medical IT system.

Stay tuned for more.

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Optometrist's Rise Up Against Health Care Reform

Health Care Reform appears to have overlooked the optometrist that takes care of your eyes. The insurance exchanges, that are to be the health insurance hub of the post 2014 health care reform economy, have no provision to include information about vision insurance plans. This worries optometrists.

Vision plans are the norm in the employer benefits marketplace, and these plans enable employees to get eye care and vision correction through glasses and contacts. Optometrists worry that with no connection to the exchanges, their industry will be left on the sidelines, and their patients will suffer as a result.

I empathize with them, but I also know that standard health insurance plans allow patients to see an Ophthalmologist to have their eyes checked and get vision prescriptions. Seeing an Ophthalmologist typically costs more than seeing an Optometrist, so from a cost control standpoint it's not ideal.

Stay tuned for more.

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Saturday, February 18, 2012

The 3 Pillars Of Health Care Reform

True health care reform has to be based upon 3 core parts of the health care system. The 3 pillars are healthy lifestyle reform, health care delivery/treatment reform, and health care payment reform. Each is vital to the success of any changes.

Life style reform is something that each of us controls. Our diets, our activity levels, and willingness to use preventive screenings. Health care delivery reform involves the coordination of our medical information and treatment strategies so that we eliminate duplicate and un-needed tests, while ensuring that our full medical records are available to all medical professionals when needed. Health Care payment reform involves changing the way medical services are paid for, such that necessary "wellness" and "sickness" prevention drive the delivery of monies, instead of the amount of treatments and tests.

Stay tuned for more.

http://zs6cey.org/
http://ecobabes.info/
Blue Shield of California To Provide Credits

Blue Shield of California subscribers in Department of Managed Health Care (DMHC) plans will get a one-time credit of 62% applied to their April coverage bill. The credit is the result of an agreement Blue Shield made with the DMHC to help reduce the costs for DMHC subscribers.

Stay tuned for more.

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http://kawagebo.org/

Friday, February 17, 2012

Final Guidelines For New Health Insurance Plan Benefit Descriptions Published

The Federal Health and Human Services department issued the final guidelines that large employers and health insurance companies must use to describe the benefits provided in health plans. The deadline to have the new documents complete is Sept 2012.

Beginning in September, the new plan descriptions will provide a 6 page summary of the plan information, such as co-pays and deductibles, along with estimated out-of-pocket costs for delivering a baby, and caring for Type 2 diabetes.

This new information should make it easier for consumers to select plans that will result in lower costs for their health care, by standardizing the information that each plan provides. Thereby making apple to apple comparisons a little easier.

Stay tuned for more.

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Thursday, February 16, 2012

Medicare Needs Doctors To Serve Patients

The "Doctor Fix" that is being worked on in Congress is just the tip of the iceberg of what is starting to happen in the Medicare industry. More and more physicians are realizing that serving America's older patients is a money losing practice, and they are not taking any new Medicare patients. This will leave an increasing number of new seniors without adequate healthcare, as the physicians left in the Medicare program will have increasingly larger patient loads, and therefore less time spent with each senior.

Congress is taking a very short-sighted view of this problem, and scrambling to put a small bandaid on the issue for this year. Hoping to just pass the problem on to the future. Well the future is here now, because the number of people reaching 65 is expected to climb dramatically for the next 20 years. Welcome to hell Congressman...

Stay tuned for more.

http://cun3boi.com
Congress Still Trying To Fix Medicare Doctor Payment Hole

Congress is wrapping up new legislation that aims to extend the payroll tax cut and unemployment insurance, and they attached a provision to protect payments to Medicare physicians to the bill. The hope is that enough legislators will overlook the "Doctor Fix" and vote only on the payroll tax and unemployment insurance parts of the package. House Republicans indicated that they intend to split the "Doctor Fix" portion from the rest of the bill, but said that it was too early to know how it would play out.

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Monday, February 13, 2012

How Does Mental Health & Addiction Treatment End Up In Health Care Reform?

The federal government has empowered each state to define their own set of health care standards that all insurance plans within that state must meet by 2014. This provides flexibility to the states to define the minimum benefits of plans offered in each state, but almost guarantees that each state will be different than the others. These differences will prevent insurance plans from being able to serve multiple states and will shrink the pool of people in each plan. This also leaves mental health and addiction treatment in the hands of bureaucrats.

Making the treatment of mental health and addiction part of the minimum benefits for all plans will provide relief to millions of untreated individuals. By providing care within the health insurance policies, the needed therapies can lessen the emergency room visits and help to transition these sufferers into productive citizens again. Let's make sure they are not forgotten.

Stay tuned for more.

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Saturday, February 11, 2012

Revised Birth Control Plan Won't Affect California

The revised plan to make health insurance companies provide free birth control to employees of religious organizations won't change anything in California. California already requires all health insurance plans that provide prescription benefits to include contraceptive services for free.

Stay tuned for more.

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Obama Health Care Rules Back Down From Catholics

The Obama administration yesterday changed a new health care rule that would require all religious organizations to provide free contraceptive coverage for their employees, even if it went against the religious beliefs of the organization. The change now stipulates that the insurance companies have to provide free contraceptive care to employees of religious organizations, rather than the organization itself.

This maneuver helped to soften the fallout from the previous rule, which religious groups were vehemently against. The only push back over the new rule was from the insurance industry, which worried that they would not be allowed to factor this new benefit into their prices for plans. The price effect should be small, but the primary concern of the insurance industry was the precedent this new rule would set, and worries that this would lead to new "unfunded" benefits by regulators.

Stay tuned for more.

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Thursday, February 9, 2012

New Health Care Tax Will Raise Premiums For Everyone

A new report by the actuarial firm Millman Inc. says that the new tax on health insurers' premium revenues will be passed on the consumers, and will cause problems with state Medicaid programs. The premium tax was intended to help pay for coverage of the 32 million uninsured Americans, and will be paid by all insurance companies, but under federal law the state and federal governments have to pay the tab for their Medicaid programs.

So let's see, there's a new tax on health insurance that we will have to pay because the insurance companies will pass the tax on to us in increased premiums, AND, the tax that is paid on the Medicaid program expenses (which we already pay through our income taxes) will also have to be paid by the state and federal government revenues (aka our taxes). Hmm....Sounds like we get hit with the full cost of the "health care tax". Who's bright idea was that! Oh yeah...our government. Brilliant!

The insurance industry trade group (AHIP) said that they believe consumers should be exempt from this tax that increases health care coverage costs. I agree.

Stay tuned for more.

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Tuesday, February 7, 2012

The Feds Slap California's Hand Over Medi-Cal Copays

Governor Brown's plan to charge low-income patients for medical care they receive through the Medi-Cal program were rejected by Federal health officials. The copays were part of Governor Brown's budget balancing on it was hoped that the state would save $296 Million by having poor people make co-payments for medical services.

Legislative advocates applauded the Federal health officials, and warned that imposing copays on poor people would worsen the problem by making them avoid the health care system entirely, until an emergency occurred.

Stay tuned for more details.

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Monday, February 6, 2012

Pregnant Without Insurance : A 3 Step Plan

If you are pregnant and have no insurance, or your insurance plan does not offer maternity coverage, here is a simple 3 step plan to get the coverage you need.

1. Call your Medi-Cal office to determine if you qualify for the California Medicaid program.
2. Call the Aid for Infants and Mothers (AIM) program office to see if you qualify for this program.
3. If 1 and 2 don't work, the talk to a health insurance broker about the Pre-Existing Condition Insurance Plan (PCIP California). This plan will cover you if you are already pregnant, but you must have been uninsured for 6 months. There are a few limited benefit plans that can tide you over if you don't immediately meet the 6 month criteria. Call us for more details.

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Saturday, February 4, 2012

ObamaCare Stubs Toe On Catholics

The new change in the Health Care Reform package, that removes the exemption religious organizations had with respect to providing birth control as part of their employee health insurance plans, has angered many in the small Democratic block that helped pass the health care reform bill. Previously church organizations were allowed to exclude any benefits that were against the religious beliefs of the organization, but the new rules do away with that exemption.

Many religious schools, non-profits, and hospitals will now have to provide health services that go against their beliefs. This has caused many to indicate they may decide to drop health care plans for their employees instead of following the new rules.

Oh what a fickle web we weave when first we practice to deceive. Oh well, stay tuned to see what happens next.

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Friday, February 3, 2012

Congressional Republicans Working New Health Care Reform Package

Congressional republicans have not given up on getting Obama's Affordable Care Act repealed or at least rendered in operative. Republicans have started working on a new version of health care reform to replace the ACA, which they feel is very flawed. The details of the new Republican plan are not worked out yet, but word has it that medical liability reform and allowing health insurance companies to sell policies across state borders are part of outline the Republicans are working on.

Stay tuned for more details.

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Thursday, February 2, 2012

New Single Payer Health Plan For California?

The California Senate is working on a revamped version of a single payer health plan for all Californians. The estimated cost of the plan is $210 billion, more than 2 times the size of the entire state budget for 2011. This sounds like a program that is busted before it even starts because there is NO WAY to pay for the cost of the plan.

However, cost and not having the money has never slowed down the California government in the past, so why should now be any different. Even though the state is struggling with ongoing budget deficits, state Senators think they can find twice as much as they currently have for just a single program. Good Luck with that!

Stay tuned for more.

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Health Insurance And "The Law Of Large Numbers"

Insurance companies know that a small percentage of people will get cancer each year. What they don't know is who will get it. The law of large numbers says that an insurance company can accurately control their risk by insuring as large a pool of people as possible. The larger the pool is, the better their prediction will be regarding how many people in the pool will have any specific health issue, so the better they can predict their expenses and keep costs lower.

This is the reason why the health insurance mandate is needed. By spreading the risk of expensive health problems across a larger number of people, the cost for each person is kept lower.

Stay tuned for more.

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Majority of Americans Don't Like Health Care Mandate

In a new Kaiser Health Tracking Poll, a majority of the participants did not like the mandate which would require everyone to have health insurance.  The poll showed that 67% did not want the mandate, and 54% want the Supreme Court to strike down that provision of the Affordable Care Act.

What this tells me is that the industry needs to better explain the reason why the mandate is the only way to prevent health care costs from spiraling out of control when health care reform kicks takes effect in 2014.  Americans don't seem to understand the "law of numbers" concept that rules all insurance products like home insurance, liability insurance, and of course, health insurance.

Stay tuned for more details.

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Wednesday, February 1, 2012

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Anthem Blue Cross of California Announces HIPPA Rate Adjustment

Anthem Blue Cross of California announced that effect April 1st, 2012 they would adjust the pricing for their Individual HIPAA and Conversion plans.  These rate adjustments are done once each year.  Members affected by the adjustments will be notified by mail.

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Tuesday, January 31, 2012

Federal Judge Blocks California Mediaid Payment Cuts

A federal judge blocked the Medi-Cal payment reductions that were to help California reduce it's budget deficit by $623 million.  U.S. District Court Judge Christina A. Snyder ruled that the state can not reduce payments to doctors, dentists, and other providers by 10%.  This ruling will help to lessen the burden being placed on the lowest income members of California.  The proposed 10% cuts would have caused an even greater loss of medical professionals that would agree to treat Medi-Cal patients.  Most Medi-Cal providers state that providing benefits to these people is a "contribution" physicians make to society, because doing so costs them money.

California officials state that the proposed cuts would still allow the state to meet the standards of care set forth by the federal government.  They anticipate the ruling will be overturned.

Stay tuned for more...

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Do We Want A Single Payer Health Care System In California?

The California state Senate came up 1 vote short of passing another version of a single payer health care system.  The proposed "single-payer" would be the California state government.  Where the money to pay for the new program would come from, nobody knows.  It's not like California has a budget surplus and can create expensive programs out of thin air.

Democratic state Senators argue that the large European countries all have single payer systems so California should as well.  The Republicans counter with the idea that following the economically struggling European countries "down the rabbits hold" doesn't look like a sound and well thought out solution.

Stay tuned for more on this topic.

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Saturday, January 28, 2012

Here's A Case Study In Affordable Health Insurance

A recent client called me to ask about getting health insurance for her family and wanted to ask some questions to make sure she was on the right track.  After a few minutes I found out that she and her husband wanted to have children, so maternity insurance was important.  Her plan was to get the cheapest pregnancy insurance plan she could find, and put the whole family on it (herself, her husband, and their 4 year old daughter).
I quickly pointed out that her husband and daughter did not need the extra benefits of maternity care, and that having a family deductible would double her out of pocket costs for the prenatal and delivery costs.  My recommendation was to put her husband and daughter on a separate non-maternity health insurance plan, and put her on a maternity plan that would minimize her out of pocket costs.
Her initial plan would have put everyone in the family into the Anthem Blue Cross Lumenous HSA 5000 plan, at a cost of  $612/month.  My strategy put her into the Blue Shield PPO 5000 plan and her husband and daughter into the Anthem Blue Cross ClearProtection 5000 plan for a combined cost of $320/month.
She was so happy to realize that they would easily be able to afford the monthly premium costs, and by looking at the California Maternity Health Insurance page on the SPF Insurance website, she knew what her expected costs for the pregnancy would be.  To get affordable health insurance San Diego couples need to work with an expert health broker to find the best solution.
Stop back for more case studies in the future.

Friday, January 27, 2012

New Report Shows Number Of Uninsured Still Rising

A new Gallup survey shows that in 2011, 17.1 percent of all Americans did not have  health insurance.  This is up  from 16.4 percent uninsured in 2010.  The trend is still climbing even with the start of health care reform.  The economy is one of the main contributors to the increase, but uncertainty around the health care reform package is making many people wait to see what happens in 2014.

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An analysis by the Associated Press shows that most of the uninsured live in states where the health care exchange efforts have not yet started.

Let's hope thing begin to change for the better, or the beginning of 2014 is going to be very interesting.

Wednesday, January 25, 2012

Anthem Blue Cross of California Introduces ACO Plans

Anthem Blue Cross announced new plans that will utilizing the Accountable Care Organizations that they have introduced in Los Angeles, Santa Clara, and San Diego California.  Accountable Care Organizations (ACO) were created by health care reform as a method of controlling health care costs better.  
These new plans are available for small  businesses in the 3 areas listed above.  The plans provide the flexibility of a PPO with the  cost and care advantages of an HMO.
The plans utilize a three tier network of providers.  The highest benefit tier uses the new ACO providers to manage the cost of patient care, and provides the lowest costs for the patient.  The next lower tier uses the normal Blue Cross PPO network of providers and will maintain the standard costs to the patient.  The last tier is the "out of network" providers that will cost patients more to use, but provides access to any doctor at any time.
These plans will become available starting April 1st, 2012.

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Monday, January 23, 2012

Sunday, January 22, 2012

The Passing of Joe Paterno is Heart Felt

The news this morning of Joe Paterno death is a heavy blow to all college football fans.  His name will always be looked upon as a champion of winning, and doing the basic dirty work to succeed.  The recent events about one of his assistant coaches can not dim the flame he started burning.  His torch will be carried in the hearts of all football players for the next generation.

My thoughts go out to the Paterno family, and I hope they know how we fans feel about the man.  He was a great man.

Rest in peace Joe....

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Friday, January 20, 2012

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IRS Provides New Guidance On W2's For Small Businesses

The IRS has issued new guidance regarding companies having to add health benefits to employee W2 forms by the end of 2012.  The new guidance says that businesses with less than 250 W2 employees will not have to add the health benefit information this year, but companies with greater than 250 employees will have to meet this deadline.

This is great news for businesses with fewer employees.  The IRS said that the guidance with stay in force until in the IRS issues new changes.

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Thursday, January 19, 2012

Health Care Reform Changes for 2012

The changes coming in 2012 will be mostly cosmetic and in preparation for 2014.  Small Businesses will bear the brunt of most changes, but there will be some modifications for the individual marketplace as well.

The big changes for small business are the preparation for W2 changes that the IRS has mandated for 2013, in which businesses will have to report the value of each employee's health insurance benefits on the employee's W2.  Other changes are due to the minimum benefit health plan definitions that the federal Health and Human Services department decided to pass on to the states to decide.  In California, the insurance companies have been asked to provide the state with their most popular individual and small group health insurance plans.  The state intends to use this information to help guide the definition of the minimum benefit standards.

For individuals in California, the state decided to require that all individual health plans provide maternity care starting on July 1st 2012.  This will result in a costly new benefit being added to all plans that don't currently offer maternity care, and therefore will likely increase premiums for everyone.

Stay tuned for further updates....

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Wednesday, January 18, 2012

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Tuesday, January 17, 2012

Update on Health Care Reform in 2012

The Affordable Care Act continues to roll out, and there are new changes that will take place in 2012.  These changes will require businesses, insurance companies, state regulatory agencies and everyday people to do things a little differently.

Big change for businesses is the requirement to report the cost of health insurance benefits, provided by the company, on each employee's W2's next year.  The change for State Insurance Departments is for them to define what the required minimum benefit levels will be for health insurance plans that will be in force on Jan 1st 2014, and to continue building health insurance exchanges that consumers can use to shop for post-2014 insurance plans.

None of these changes will be easy, and the tweaks and modifications to health care reform happen on a regular basis.  So it's important to keep on top of these changes so you can prepare for what's to come.

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