Tag Archives: medicare

Simple summaries of the Affordable Care Act – aka Obamacare

A final summary of the major changes under the Patient Protection and Affordable Care Act (PPACA) (aka Obamacare):

- Kids can continue to be covered by their parents’ health insurance until they’re 26.

- Insurers cannot impose an unreasonable premium increase without justification (generally anything less than 10% is ok).

- Insurers have to tell customers what they’re spending money on, (instead of just “administrative fee”, they have to be more specific) and those expenditures are required to follow the 80/20 rule:

- No more than 20% can be spent on administrative costs, minimum of 80% must go directly to patient care.

- A new website is made to give people insurance and health information – healthcare.gov

- Any new health plans must provide preventive care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.

 

 

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Learn more about the Affordable Care Act – summary of Medicaid expansion and costs

Medicaid is the largest health insurance program in the United States.  Presently, Medicaid provides health and long-term care coverage to 59 million individuals.

Under the PPACA (Patient Protection and Affordable Care Act), Medicaid is set to expand its eligibility for coverage to include persons with income levels at or below 133 percent of the federal poverty level. Best estimates place the increase in additional enrollees at 16 million to 18 million.

The purpose behind the expansion of Medicaid under the PPACA is to reduce the number of uninsured in the U.S., an estimated 46 million.  Using analyses provided during the debate leading up to passage of the PPACA, 32 million of the 46 million will gain access to insurance under the new law, half of which will do so via Medicaid.

Assuming a somewhat equal replacement trend (those that fall off Medicaid due to death or change in economic status are replaced by approximately the same number of new eligible enrollees) over the phase-in period set for Medicaid expansion (by 2014), Medicaid will ultimately cover nearly 70 million people.  Per the Congressional Budget Office, the cost of expansion between 2010 and 2019 to the federal government is $434 billion with an additional $20 billion allocable as states’ costs.

 

ViaHealth Reform and Medicaid Expansion

 

 

With an additional 16-18 million people on Medicaid, cost becomes a big issue. Estimates have the total cost of the whole bill (Medicare, Medicaid, etc.) at $828 billion. Take away from that $575 billion in savings from Medicare, and a bevy of new taxes.

Including higher taxes for those making more than $200K, taxes on luxury medical plans, on drugs, on high-cost medical equipment, on indoor tanning salons, and an annual fee to all insurance providers.

Added all together and the Congressional Budget Office estimates a reduction in the Federal Budget deficit, meaning that the PPACA and its increased Medicaid coverage pays for itself and saves money.

Of course, these are all estimates and subject to endless debate.

 

Source: Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended (pdf)

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Learn more about the Affordable Care Act – summary of Medicare reforms

A summary from the White House:

 

*Note: Medicare is for the elderly and Medicaid is for the poor. Most of the controversy and supreme court discussion is around Medicaid, not the below Medicare.

 

Strengthening Medicare

Nearly 50 million older Americans and Americans with disabilities rely on Medicare each year, and the new health care law makes Medicare stronger by adding new benefits, fighting fraud, and improving care for patients. The life of the Medicare Trust Fund will be extended to at least 2024 as a result of reducing waste, fraud, and abuse, and slowing cost growth in Medicare. And, over the next ten years, the law will save the average person in Medicare $4,200. People with Medicare who have the prescription drug costs that hit the so-called donut hole will save an average of over $16,000.

Lower Cost Prescription Drugs: In the past, as many as one in four seniors went without a prescription every year because they couldn’t afford it. To help these seniors, the law provides relief for people in the donut hole – the ones with the highest prescription drug costs. As a first step, in 2010, nearly four million people in the donut hole received a $250 check to help with their costs. In 2011, 3.6 million people with Medicare received a 50 percent discount worth a total of $2.1 billion, or an average of $604 per person, on their brand name prescription drugs when they hit the donut hole. Seniors will see additional savings on covered brand-name and generic drugs while in the coverage gap until the gap is closed in 2020.

Free Preventive Services: Under the new law, seniors can receive recommended preventive services such as flu shots, diabetes screenings, as well as a new Annual Wellness Visit, free of charge. So far, more than 32.5 million seniors have already received one or more free preventive services, including the new Annual Wellness Visit.

Fighting Fraud: The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Thanks in part to these efforts, we recovered $4.1 billion in taxpayer dollars in 2011, the second year recoveries hit this record-breaking level. Total recoveries over the last three years were $10.7 billion. Prosecutions are way up, too: the number of individuals charged with fraud increased from 821 in fiscal year 2008 to 1,430 in fiscal year 2011 – nearly a 75 percent increase.

Improving Care Coordination and Quality: Through the newly established Center for Medicare and Medicaid Innovation, this Administration is testing and supporting innovative new health care models that can reduce costs and strengthen the quality of health care. So far, it has introduced 16 initiatives involving over 50,000 health care providers that will touch the lives of Medicare and Medicaid beneficiaries in all 50 states.

Providing Choices while Lowering Costs: The number of seniors who joined Medicare Advantage plans increased by 17 percent between 2010 and 2012 while the premiums for such plans dropped by 16 percent – and seniors across the nation have a choice of health plans.

 

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Timeline of government healthcare in the United States

The Supreme Court’s ruling on President Barack Obama’s healthcare overhaul comes after a century of debate over what role the government should play in helping people in the United States afford medical care. A look at the issue through the years:

1912: Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House.

1929: Baylor Hospital in Texas originates group health insurance. Dallas teachers pay 50 cents a month to cover up to 21 days of hospital care per year.

1935: President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first.

1942: Roosevelt establishes wage and price controls during World War II. Businesses can’t attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk.

Keep readingHealthcare reform’s long history in the U.S.

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U.S. Population Growth at 9% – Economists Need An Ego Check

Despite the slowest decade of population growth since the Great Depression, the USA remains the world’s fastest-growing industrialized nation and the globe’s third-most populous country at a time when some are actually shrinking.

The United States reached 308.7 million in 2010, up 9.7% since 2000 — a slight slowdown that many experts say was caused by the recession and less immigration.

Even so, U.S. growth is the envy of most developed nations.

USA Today are you kidding me? Sometimes being the odd duck out is great but in this case I’m calling B.S.

Before I get to that it’s interesting to note that we are now up 309 million people, that’s a lot. It represents a burgeoning population way beyond what Yvon Chouinard calls ideal cities. These are places where the population is 250,000 to 350,000, “large enough to have all the culture and amenities of a city and still be governable – like Santa Barbara, Auckland, and Florence”.

I’m tempted to agree with him since I grew up in a place of that size. Sometimes the discussion needs to go beyond monetary policy and focus on quality of life. Taking into account food supply, health factors, and environmental concerns.

It’s an interesting line of thinking but let’s get back to the so-called ‘envy’.

It stands to point out that economic theory on GDP growth is grossly over represented in our cultural consciousness. Just look at our latest recession and tell me where all our economists were on that one. They are notorious for promoting ideologies in the face of massive bubbles and even letting themselves become the politicians, city planners, and business people who know everything. It used to be that economists would caveat and asterisk everything they say, now they will read your palm and tell you how to run your household.

I see the same happening in this article from the USA Today. The topic is population growth and how that affects social services. Somehow they are arguing that our growth is the key to fixing our insolvent social services programs like social security and medicare. Like piling on taxpayers will magically cure decades old problems. Even more vexing they claim other countries are envious of us.

Tell that to my grandpa who lives on social services. There is no envy lost on him. The truth is that our society is maturing (albeit very slowly) into the right mixture of government vs personal. All the Tea Party and Libertarians exist for a reason and I think it is because our government programs are off balance. We don’t need the government telling us how to get married or who to love, but we do need the government keeping prisoners and the insane of the street.

When it comes to the elderly I think we have it all wrong. Pushing them out of our society and into ‘homes’ does a double damage to our society. It costs us money and it hurts our communities. If there is one thing our ailing communities need it is more elderly roaming the blocks, raising children, and talking to neighbors. There is so much that they bring to families and neighborhoods it is hard to undervalue, but with our current social services we lock them away like prisoners.

The goods news is that all those ‘envious’ countries in the article will soon be dealing with this “problem of the elderly”. I bet many will miss the boat and make poor choices (like California letting out prisoners) rather than the right ones (like developing cultural programs to promote elderly care).

In the end, we may find that population growth isn’t at all related to social services. That it is a community topic and should be discussed by family leaders, church leaders, and other local members. At the very least I would hope we can keep the economists performing economic judgments and not letting them determine society’s ills through GDP forecasts.