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This Week in Health Care Reform EasyToInsureME health insurance

JANUARY 22, 2010

This Week in Health Care Reform

After months of public debate and private negotiations, health care reform discussions stalled following Tuesday’s Senate vote in Massachusetts. The Democratic Senate lost its 60th vote supermajority when Republican Scott Brown was elected to the United States Senate in the Massachusetts special election.

Health Care Reform Negotiations Post-Massachusetts Special Election

Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat’s 60th vote in the Senate opens up the legislation to a Republican filibuster – something the Democrats have managed to avoid thus far in the debate.

House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.

On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama’s desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called “reconciliation,” which only requires 51 votes in the Senate.

Other remaining options:

1.
House and Senate Democrats could also quickly complete the merging of the two bills and vote on the combined package before Mr. Brown is sworn in.
2.
Democratic leaders could attempt to re-engage Sen. Olympia Snowe (R-ME), the only Republican who voted for the Senate Finance Committee’s bill passed in October. Democrats would need to allow her to amend the bill so that she could support its passage and give Democrats the needed 60th vote; or,
3. House and Senate Democrats could essentially start over in their respective chambers and propose scaled-back versions of the bill under “reconciliation” procedures or regular order. Reconciliation procedures would greatly limit the scope of the legislation to issues only related to raising or spending federal funds; therefore, many provisions, such as creating new insurance exchanges and an individual mandate, might be excluded.

President Obama seemed to indicate that he favors having House and Senate lawmakers start over again and produce a scaled-back bill. In addition, more moderate Senate Democrats – hesitant to push through such a huge partisan bill in light of the Massachusetts election – urged leaders to slow down.
Sen. Jim Webb (D-VA) has called on Senate leaders to suspend voting on health care reform until Mr. Brown is sworn into office. President Obama and Senate Majority Leader Harry Reid (D-NV) have iterated this same message. Further, Sen. Joe Lieberman (D-CT) called for a bipartisan effort as the best way to achieve health care reform legislation.

Health Care Reform Negotiations Prior to Massachusetts Special Election

Senators Urge Guarantee of Government Savings: In a letter sent last Thursday to Sen. Reid, five Democratic Senators asked for the inclusion of a “fail-safe mechanism” in the final bill. This mechanism would give Congress “the tools to keep costs under control should the current savings estimates fail to materialize.”

Both the Senate and House versions of the bill rely heavily on reductions in government spending, particularly around Medicare, to help pay for reform. Republicans and some nonpartisan analysts believe the government will not follow through on these spending reductions, which will lead to soaring costs.

President Obama Pushes for Less Protection for Biologic Drugs: Last Thursday President Obama pushed for a change in the health care reform legislation that would reduce the number of years that biologic drugs were patent protected from generic competition, previously set at 12 years. White House officials and Rep. Henry Waxman (D-CA) were negotiating for 10 years protection or less.

Members of the news media speculated that the move to reduce biologic drug protections could be a leverage point for President Obama to pressure the drug industry to increase contributions to pay for health care reform. In fact, the Wall Street Journal reported that Congressional Democrats had already asked drug companies to contribute an additional billion or more, over and above the billion which the industry agreed to early on in the reform negotiations.

President Obama Strikes Deal with Unions: Last week Democratic negotiators struck a deal with union officials and conceded to union demands to scale back a tax on high-end insurance plans. The deal would exempt union workers from having to pay the tax until 2018, five years after the tax would apply to other workers. While the deal would help gain union support for the bill, it would also reduce the amount of tax revenue generated by about 40 percent, to billion. As such, Democratic leaders would need to find other sources of revenue to make up the difference.

Public Opinion

Exit Poll Indicates Health Care Reform as Hot Button Issue: As the ballot polls closed on Tuesday night’s Massachusetts Senate election, an exit poll conducted by Frabrizio, McLaughlin & Associates indicated that 52 percent of voters said that they oppose the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing this legislation. In addition, 48 percent said that health care was the single issue driving their vote.

Polls Show Discontent: The latest Wall Street Journal/NBC News poll indicated that almost half of Americans believe the health care reform bill in Congress is a bad idea (46 percent). This figure is up dramatically from April when only 26 percent believed the plan was a bad idea. Further, just 33 percent say the plan is a good idea. Nearly half of those surveyed (48 percent) believe that passing the current legislation would be a “step backward.”

In addition, a new Quinnipiac University poll showed that public support for health care reform continues to decline. Thirty-four percent mostly approve, while 54 percent mostly disapprove. At the end of December, 53 percent of Americans mostly approved, while 36 mostly disapproved.

Looking Ahead

Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill. President Obama had hoped to see a final bill prior to his State of the Union address, which has been scheduled for January 27; however, it appears this goal is likely out of reach.

5 Reasons to Get Insurance Coverage for Home Health Care

Insurance protection is essential now a days because in America hospitalization is much more costlier due to increasing new facilities the health care costs gets higher and higher.

Here are five reasons to get the insurance for home health care:

1. Suppose some one gets major accident or suffering from the major illness than it is difficult to manage hospital expenses and after care. In such situation it is better to get the health care insurance that will protect hospitalization as well home health care services.

2. It is better you can buy the health insurance so that you can rest assure that the your bill will be paid by the health insurance company. Suppose some insurance like long-term insurance is very much useful for the old age and people who live alone and suffering from chronic illness, permanent disability or Alzheimer’s disease.

3. Health insurance protects yourself and your family in case you need medical care that could be very expensive. The illness and the accident are unpredictable in such a case you can’t predict your medical bills. Incase you become ill; your bills could be very high.

4. If you have sever accident and need long term care at home or critical illness. Your income get disturb because you are not performing the work and on the other hand your daily medical expenses are increases in such a situation it is essential to get insurance that provides home health care benefits. Medicare, Mediaid and long-term insurance for senior citizens, short-term insurance as other private insurance policy.

5. Medicare, Medicaid and other private insurance plans gives protection for home health care services. It is essential to get the insurance coverage of home health care services.

How to Become a Home Health Care Nurse

Home Health Care Basics

Home health care nursing is a growing industry, with a large number of patients and their families opting for home-based health care. Today there are specific academic programs to train nurses in home care. There are also a number of agencies that place home health care nurses in the appropriate environment with ailing individuals and their families. These agencies match criteria such as the nurse’s experience and qualifications, the patient’s care requirements, budget and the location of the patient and the nurse.

There is a growing need for Home Care Nurses because:

*Medicare, Medicaid and Long Term Care insurance reimbursement and documentation have changed treatment methods

*Aging baby-boomers are now in large numbers

*Changes in technology and medical care in hospitals have brought about a significant change, with shorter inpatient stay and more cases of at-home rehabilitation.

*Increasing medical outpatient procedures, with follow-up home care

*Advances in technology and medical care that have decreased mortality rates but increased morbidity and chronic illness.

The job of a Home Health Care Nurse calls for an array of skills and experience. Specializations include a wide range of treatments including emotional support, educating patients on the road to recovery from illness or injury to women who have experienced childbirth. Special care is also needed for ailing children and the elderly who need palliative care for chronic illnesses.

A practicing nurse must be able to adjust to the unique home setting of each patient. They must have good interpersonal skills to deal with the patient on the one hand and the patient’s family or support structure on the other. The nurse should be experienced and confident enough to make quick autonomous decisions, without the support structure that is available at a hospital or nursing home.

Children with disabilities, be they genetic, congenital or caused by an injury, present a separate set of challenges to a nurse. They require additional skills such as patience and understanding of the needs of the family. Progress in the medical field is not only increasing the lifespan of these children, but is also allowing them to live comparatively independent lives away from the hospital. In this area, a positive attitude and positive reinforcement is of prime importance for the development of the child.

Experienced nurses are familiar with medication procedures and have completed graduate level programs. Most agencies require that these nurses have at least one year of clinical experience prior to working in home health care. Advanced practicing nurses can expedite that training by helping new nurses understand the home health care market and teaching.

Employment And Salary

In the United States, according to the Department of Labor, there were 2.4 million nurses in America, and many in the medical fraternity believe there is a gross shortage in nursing staff. The shortage is expected to grow to 10% in 2010. The average salaries for nurses in the US are:

*,450 for hospital nursing

*,000 for home care

*,200 for nursing care facilities

Training And Continuing Education

Home health care nurses require:

*Associate degree in nursing (ADN), takes 2-3 years to complete

*Bachelor of Science degree in nursing (BSN), takes 4 years to complete. This course allows nurses to pursue advancement into administrative positions or research, consulting, and teaching. It is also essential to become a clinical nurse specialist, nurse anesthetist, nurse midwife, and nurse practitioner (U.S. Department of Labor, 2004).

*Master’s degree in nursing (MSN), with a minimum of two years post-clinical experience for advanced nursing

*All nurses need to have supervised clinical experience during their training

Nurses can also earn specialized professional certificates online in Geriatric Care or Life Care Planning.

All nurses, whether they are working at a hospital, nursing facility, or in home care, need to have continuing education. With constant advances in medicine and the changing face of health care staying abreast with the latest developments enhances patient care and health procedures. Continuing education is offered by universities, continuing education programs, and internet sites. The American Nurses Association (ANA) or the American Nurses Credentialing Center (ANCC) is a popular avenue for continuing education.

The career of a home health care nurse is rewarding. Advances in medicine and decreasing mortality and increasing morbidity bring new challenges and opportunities. It provides an opportunity to make a difference one life at a time. Proper education combined with clinical experience will make the home health care nurse an important cog in the wheel of medical care of tomorrow.

Health Care Reform March 15 2010

Week of March 15, 2010

The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America’s Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.

Federal

With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.

The Senate has passed Jobs Bill II and shipped it off to the House, where passage is not certain. Within the bill are two health-related items of note. First, the COBRA eligibility and subsidy program will be extended to the end of 2010. (These provisions are set to expire at the end of March.) Second, the bill contains a suspension until September 30, 2010 of the cut to physician Medicare reimbursements for the current calendar year. (This provision is also set to expire at the end of March.) Aetna urged Congress to apply the “doc fix” to next year’s reimbursement as well, since insurers’ Medicare rates are based on what doctors are paid, but in the end Congress failed to make this change. Aetna and the industry will continue to find ways both to establish a more lasting, if not permanent, doc fix and to devise a legislative solution to the disconnect between doctor reimbursement and Medicare Advantage rates for 2011 and beyond.

States

ARIZONA: Budget issues remain front and center as the governor and Republican leadership proposed a plan they hope will close the 0 million deficit this year and reduce the anticipated .6 billion deficit in 2011. Righting the state’s fiscal ship has become a very partisan exercise, with the Republicans supporting reductions in Medicaid and KidsCare, and the elimination of full-day kindergarten. As the special session on the budget is running concurrently with the regular session, no other bill hearings were held. The oral chemotherapy parity bill may be dead for this year as proponents did not meet the deadline for submitting amendatory language.

CALIFORNIA: The Assembly Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre held a hearing last week to examine how the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) has handled issues surrounding the rescission of policies in the individual market. According to a report prepared for the committee by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, fewer than 300 of 6,000 former policyholders are participating in health insurers’ agreements to settle such cases. Republican committee members were highly critical of this witness, while De La Torre was critical of the Departments. The DMHC reported that since their settlements were completed there have only been nine rescissions over the past two years, proof that the DMHC and the health plans have revamped their processes for rescission and have worked to address the problem.

COLORADO: A bill mandating maternity and contraceptive coverage in individual policies continues to receive significant attention in the Senate. The most recent amendment proposes requiring maternity coverage in at least three of the plans marketed by an insurer. It would also allow a current member of a plan without maternity coverage to switch to a plan with maternity coverage from the same carrier during the first trimester. The other major bill would require that second level appeals be performed by physicians who are actively involved in clinical practice. This measure is counterintuitive in the current economy, since it would result in outsourcing appeals and drive up costs for plan sponsors and their employees.

CONNECTICUT: A proposal that would require health insurance plans to cover oral chemotherapy in the same way that intravenous chemotherapy is covered made it through the legislature’s Insurance and Real Estate Committee last week. Currently, many health plans treat the two kinds of cancer treatments differently. Chemotherapy treatments that come in pill form are often categorized as prescription drug benefits that can require patients to pay a larger share of the cost. Cancer patients, doctors and patient advocates spoke in favor of the bill, while insurers and the Connecticut Business and Industry Association opposed it, arguing that it would put a mandate on health plans that could raise costs and make it more difficult for employers to afford insurance.

GEORGIA: A bill restricting the use of rescissions in individual health insurance policies passed a Senate committee last week. Aetna continues to work with its trade organizations to educate legislators about the adverse effect of this type of legislation. Discussions also continue regarding legislation affecting the use of rental networks.

KANSAS: Roughly half way through the legislative session, several health care bills are still moving through the process. On the regulatory front, the Insurance Department has proposed a regulation that would mandate coverage of routine patient care costs while the insured is enrolled in a cancer clinical trial – a mandate that was rejected by the legislature in 2008. A hearing will be held on April 20, and Aetna will have an opportunity to present testimony on this issue. Bills still alive include mandates for autism and orally administered chemotherapy, legislation prohibiting dental contracts that require the dentist to follow a fee schedule for non-covered services, and a ban on “most favored nation” clauses by some insurers. Another bill would allow small employers to create individual HRAs to fund premium payments on individual policies, require administering insurers to offer employees the option of receiving health insurance coverage through a high-deductible health plan with an HSA, and requiring insurers who offer small group health plans to offer high-deductible health plans with HSAs, while authorizing tax deductions for health insurance premiums for individual insurance policies. Separate legislation would amend the definition of
“eligible employee” to include part-time workers (currently less than 30 hours per week). Pending legislation concerning hospital charges would prohibit charging private-pay patients more than 25 percent of what the hospital’s highest volume private payer would pay for the same goods or services. Legislation that died includes a telemedicine mandate and creation of a health care insurance database for employers.

KENTUCKY: Health issues that are being hotly debated by the legislature right now include an autism mandate, a dental bill that would not allow insurers to hold dentists, optometrists or ophthalmologists to a fee schedule for non-covered services, and a bill setting a reimbursement floor for chiropractic services. The chiropractic services proposal would allow chiropractors to bill, and would require insurers to reimburse, an evaluation and management (E&M) CPT code on each and every visit. In addition to billing for follow-up services for manipulations and other therapies, the chiropractor would be allowed to submit, and the insurer required to pay, for another E&M code on each and every visit. The legislation would also add a new mandated benefit to the Kentucky statutes. Currently, reimbursement for chiropractor visits is required only if the chiropractor performs a service already covered by the health benefit plan. Under the proposal, any service within the scope of practice of a chiropractor that is billed would become a mandated benefit. Finally, the bill would require health benefit plans to provide reimbursement without the chiropractor having to provide any documentation that the services were medically necessary. Each of these bills has, or is expected to, pass at least one chamber.

SOUTH DAKOTA: Several important legislative deadlines are approaching, resulting in a flurry of activity. Bills or resolutions not passed by the second chamber by March 9 died. But the Governor has already signed a bill that amends the premium rate-setting procedure for the high-risk pool so that rates for a given classification are 150 percent of the average actively marketed premium. The pool will have to offer three or more plan designs, remove coverage requirements for the plans (such as disease management) and remove set cost-sharing values. The bill was signed by the Governor on March 1 and will become effective on July 1, 2010. The Governor has also signed a bill prohibiting rating based on injuries caused by domestic violence and legislation requiring refunds of premiums for partial months, in the case of mid-month cancellations. Both chambers have passed legislation prohibiting contract language requiring dentists to accept a fee schedule for non-covered services, and the bill awaits the Governor’s signature. Finally, the legislature passed a resolution opposing the federal health care reform proposals passed in the U.S. Senate and House.

Reasons Why Most Patients Choose Home Health Care Services

Home health care is the phrase used for the process of providing treatment and medical care that is usually done in the premises of the patient’s home by competent and certified health providers such as nurses, caregivers, or physical therapists. There are two kinds of home health care that may be administered; one is the informal or casual supervision where in the administration of the health care is done by the patient’s family members while the formal administration is executed by the professional health providers.

Home health care service aims to provide the patient the maximum level of comfort while they are being treated for their ailment. The services that they offer include health and psychological help that consist of wounds treatment, teaching the patients how to deal with pains, and other kinds of treatment that is related to health. Home health care services may also include performing easy everyday tasks like cooking and preparing meal for the patient, going to the toilet, helping them take the medication at the correct interval and other tasks that the patient cannot be able to do.

The people who are more likely to avail of home health care services are those who are newly discharged from the hospital but still needs extra care especially if the patient is still very weak and cannot perform the complicated processes of medical care on their own.

In the United States more patients prefer the informal method of home health care because aside from the fact that they do not have to pay more for the services of the professional caregivers, they also get the chance to have the company of their loved ones. In the event they would need the help of the nurses and doctors, their services will be taken care of and be paid for by their insurance company, if they have one.

Finding home health care services is not a big problem because there are so many health institutions that offer and provide their services for very affordable rates. Your doctor or any other medical worker can help and recommend you the institutions that are competent enough to help you with your health issues. Finding the perfect home health care provider is the key to a better and more effective treatment of the patient’s ailment.

Compared to nursing institutions, home health care is way too affordable that’s why most patients especially the elderly prefer to stay in their home while they are recuperating from their ailment. A home health care service is the best route to take especially if the condition of the patient is not that severe. When your loved one is on the good hands of good and reliable home health provider, you can be sure that the recuperation process of the patient will only take short period of time.

Home health care is advisable if you think the patient is not comfortable being left alone, there is danger of falling, the patient might forget to take the medicines at the right time, or if there is no one to take care of your loved ones because you have to work, or because the patient’s physician advised to do so.

Home Health Care ? Alternative To Do Everything By Yourself

You may be overwhelmed by the pressure of caring the older members of your family who require constant care; but you are not alone. There are millions of adults who finds a hard time taking care of older relatives or parents while working and taking care of their children. Sometimes one is pressed down under the dual pressure of taking care of older members and his own needs; but your work is also as important as taking care of the elder people. If you don’t take care of your own responsibilities, you will land nowhere. When that happens you won’t be able to take care of anyone else.

Using home health care is a good option to get the rest and get relief you need while still making sure that the elder people are getting proper care and protection. Don’t feel guilty if you take some time off to take of yourself and your own family, but home health care is a necessity if you want to continue to care for your loved ones in the future. If you are in a dilemma whether to get the services of home health care, consider the following benefits of using home health care:

Your loved ones are taken care of by trained medical staff – Hiring home health care is far safer than hiring strangers to care for your loved ones. Since home health care workers are trained medical professionals, should an emergency arise in your home, these medical professionals can respond properly.

Social interaction – Every people needs social interaction, even the elder people in your home. Hiring home health care workers even if for couple of days, gives your loved ones the chance to talk with and interact with other people, which will help them stay more connected to the world.

Prescription Support – You may be concerned about the elder people in your home, whether they eat nutritiously, when you can’t be there to give them a meal. You may be concerned whether your loved ones take their medications when they need to, in your absence. If you have a home health care staff then you can be sure that your loved ones are having nutritional diet and having their medications at the right time.

Meeting Obligations – If you hire home health care workers, then you don’t have to worry about meeting your other obligations like your professional work and appointments or taking your loved ones to doctor or parks. You can meet your other obligations knowing that your loved ones are being safely driven wherever they need to go.

These are few of the benefits you will get if you hire home health care staffs. Don’t overburden yourself with responsibilities and obligations to your elder people and work; instead consider hiring home elder care services as an alternative to do everything by yourself.