Health All Day

Archive for November, 2009

Health Care Cuts Draw Criticism

A proposal by Arizona Gov. Jan Brewer to cut 300,000 people from the health care plan for the poor will likely “increase the misery index,” a Prescott doctor said.

Dr. Joseph Goldberger, chief medical officer for the Yavapai Regional Medical Center and a rheumatologist with a private practice, said about 15 to 20 percent of the patients he sees at his rheumatology consulting practice are insured by the Arizona Health Care Cost Containment System, the Arizona equivalent of Medicaid. Already, AHCCCS fees to doctors have been frozen, he said.

“The untold story is patients with or without insurance continue to get the care,” Goldberger said. “They get the most expensive care of all: ER care. Everybody else ends up paying for that through higher premiums. It has a significant impact.”Many of his arthritis patients need “very expensive” medications and “without insurance, they can’t afford them at all. The bigger problem is the access to medications.”

While that may not be life threatening in all situations, it certainly increases pain levels for arthritis patients.

In some situations, such as with a lupus patient who has kidney disease and can’t get access to chemotherapy, it could be life threatening, he said.

While Goldberger understands that the state is having budget problems and that education and health care are candidates for cost cuts, there are consequences, such as the loss of federal matching funds.

Health providers face a total cut of .7 million in state and federal money, according to the Arizona Hospital and Healthcare Association. The association protested the plan to transfer AHCCCS’s remaining graduate medical education money and nearly all private disproportionate hospital dollars to other uses. Arizona’s hospitals have seen 8 million in state funding cuts since 2008, trade group officials said.

Reduction in payments for training doctors – the graduate medical education money – is particularly egregious, said John Rivers, the hospital association president and CEO.

The state and federal government traditionally reimburse hospitals that train doctors who typically go through a residency in a specific area of medicine after they complete their medical training and internships, Rivers said. However, if the state doesn’t put up the money for that training, then the federal government won’t contribute its share, Rivers said.

“If we’re not training doctors, I don’t see how that is good for the people of Arizona,” Rivers said. “One of the important by-products of training doctors here is this is where they end up practicing. If they get training somewhere else, they stay there. It’s a horrible outcome for the people of Arizona.”

Already the state has only 219 doctors for every 100,000 people, while the national average is 293 physicians for every 100,000.

It’s also shortsighted economically to cut into hospital budgets as hospitals create jobs, he said. And the cuts will shrink the state’s economy by .8 million in federal Medicaid matching dollars that will now go to other states.

Hospitals in Arizona employ 73,300 people and contribute .5 billion to its gross economic product, according to an Arizona State University study.

While the Yavapai Regional Medical Center is not a teaching hospital and is not affected by the graduate medical aspect of the budget cuts, said Brian Hoefle, the chief financial officer, the lack of disproportionate care money from the state would result in a loss of several hundred thousand dollars.

“Gov. Jan Brewer is talking about eliminating some of those programs,” said Hoefle. “It would be up to the Legislature to decide on cuts to AHCCCS. Just because the state isn’t covering certain populations anymore doesn’t mean they won’t get sick and end up in our ER. If there’s no payment for them, it shifts the costs to the paying customers.”

The state will lose from the federal government for every dollar it cuts from AHCCCS, according to Hoefle.

“That’s very frustrating,” he said.

About 15 percent of patients who use YRMC are AHCCCS clients.

Meanwhile, the hospital has already seen large increases in bad debts and charity care over the past two years, Hoefle said. Charity care – wherein patients provide their financial information and are deemed unable to pay – has doubled from 2008 through 2009. While bad debtors – those who are unable or unwilling to pay but are not working with the hospital – have increased by 18 percent over the last two years.

“If the AHCCCS program is not going to pay hospitals, it’s going to fall back on hospitals to pay,” Hoefle said. People are “going to come to the hospital and we’re going to eat it. It ultimately affects commercial insurance. We raise our rates to insurance companies and those people who can pay will ultimately pay for the state’s lack of coverage. They’re talking about the hidden tax. Whoever is paying their hospital bills is paying for those who are not paying their hospital bills. Otherwise the hospital goes out of business.”

10 Tips on Being Independent With Home Health Care

Health care is increasingly expensive and rising costs are a concern for most people.

Funding long-term care needs planning the US Health Department Statistics indicates that almost 10 million people in the US will require Home Health Care. And costs of care are rising each year. To cover health related contingencies people need to protect themselves with insurance that pays for home health care.

1. Well before retirement plan for any contingencies that may arise in old age. Plan on being independent in every way and put in place a rock solid financial plan.

2. Consult a retirement planning expert or insurance expert and find out the advantages and disadvantages of insurance that pays for long-term home care.

3. Surf the internet and read articles and tips on home health care and how to protect yourself financially.

4. Study your existing health policy and try and get a insurance policy that covers all aspects not covered by health care. Long term or home care becomes essential with injuries, serious illnesses, and old age.

5. Before investing in an insurance policy that covers home health care find out what in actuality the policy will cover and be sure to read the fine print. Any clauses you don’t understand ask the insurance agent or company for clarifications.

6. Buy a comprehensive policy that will meet your needs. Choose a policy that covers nursing home care, home care, and has a rider that covers expenses incurred by family during the illness like costs of food or transport to and from hospitals. Choose the coverage intelligently.

7. Find out whether the policy you are purchasing is tax qualified or non-tax qualified. When an insurance policy is tax qualified you can deduct premiums as medical expense up to the set limit.

8. When purchasing a policy think about aspects like inflation find out all about inflation protection and higher daily benefit rate. Choose wisely depending on your age, gender, family health tendencies and so on.

9. Buy home health care insurance from financially sound companies. Check aspects like independent financial ratings from sources like A M Best Company or Fitch Investors Services.

10. Practice preventive health care and take good care of your health by eating balanced meals, exercising daily and getting regular health checks.

Home health care covers a whole gamut of services: nursing care, doctors visits, companionship, light housekeeping, as well as meal preparation. While government services too provide for home care the regulations are extensive and the system cannot cover many cases. Home health care can also cover occupational therapy, physical therapy, speech therapy, and skilled nursing. Home health care is concerned with the medical needs of patients. Home health care funding is covered by leading insurance companies as well as Medicare, Medicaid, the Older Americans Act, the Veteran’s Administration, and more.

Gop Claims Health Care Plan Is Merely Camouflage

The White House issued proposals Monday for health care reform that have won kudos from several Democratic lawmakers, a sure sign, say Republicans, of how little GOP input is in the plan.

Republicans have agreed to show up at the White House Thursday for a summit on health care, but are heading there with a dim view of the outcome.

“It’s disappointing that Democrats in Washington either aren’t listening, or are completely ignoring what Americans across the country have been saying,” U.S. Senate Minority Leader Mitch McConnell, R-Ky., said in a written statement.

“House Republicans welcome any good faith effort to start over on health care reform but the bill President Obama unveiled today is just more of the same government-run insurance, mandates and taxes the American people have overwhelmingly rejected,” added Rep. Mike Pence, R-Ind.

The White House, however, insists that the bill is more than just camouflage, but rather represents compromise.

“Senator McCain in the campaign had a proposal to add — to add those dependents on to your parents’ health care up to a certain age to allow for what is a gap in the uninsured based on when someone leaves the dependency of their parents and gets a job that provides health care,” said White House Press Secretary Robert Gibbs, noting that provision has been included in the president’s proposals.

Gibbs argued that 160 Republican amendments were included in varying pieces of legislation that made its way through the House and Senate.

“Inexplicably, all those ideas weren’t good enough,” he said.

Indeed in its effort to appear bipartisan, the White House included in its health care proposals listed on its Web site a section on Republican initiatives that were included in the legislation passed by Congress and included in the president’s latest plan.

Among them were provisions to allow health insurance premiums to vary based on participation in employer wellness programs, grants to states to evaluate medical liability reform ideas, automatic enrollment by employers in health insurance and ability for employees to opt-out.

Az Reps Remain On Health-Care Fence

When it comes to the president’s health-care reform, both of Southern Arizona’s congressional representatives are seen as “in play,” uncommitted votes that could go either way.

Which is putting both under intense pressure to get off the pointy end of the fencepost they’re perched on, one way or the other.

Congressman Raúl Grijalva, who doesn’t like the fact the Senate bill doesn’t have a public option, was summoned to the White House Thursday afternoon with seven other progressives for a sit-down with the president, who has said he wants the effort sewn up by the time Congress leaves for Easter break on March 26.

Grijalva left the Roosevelt Room roundup sounding like he’s close to voting for with the president, despite the lack of a public option he considers critical. After the meeting, he said a partial victory on health care would be better than losing everything, at this point.

Congresswoman Gabrielle Giffords, meanwhile, is the target of tea party rallies and a week long “Code Red” robocall campaign by the National Republican Congressional Caucus, which is targeting voters in swing districts. The script warns listeners to call Giffords “before it is too late and tell her to vote ‘no’ on Nancy Pelosi’s dangerous health-care scheme.”

On the other side, Organizing for America took out an ad in USA Today that says, “You Fight, We’ll Fight.” It pledged 8 million volunteer hours to assist congressional representatives who hold steady on supporting the plan, which Giffords has already said she doesn’t like. Arizona Director Jessica Jones said that so far, 700 volunteers are committed to help the state’s Democrats.

“We will be making sure that we are backing up their legislators and letting them know their constituents are behind them,” Jones said, because too many Americans have gone without insurance for too long. “We’ve been debating this for a year now and it’s really crunch time. We need to get this bill passed.”

Although majorities of the Senate and House approved separate health-care versions, they must settle on identical versions before it can become law. And with the loss of the 60th vote in the Senate with Scott Brown’s election, the plan that seems to have the most traction so far hinges on the House signing off on the bill that passed the Senate on Christmas Eve. But House Democrats have found a lot not to like in that package.

In January, Giffords sent a letter to House Speaker Pelosi saying the Senate reform version would be too costly when the state’s fiscal position is already dire.

That package could cost the Arizona billion over the next decade, she wrote, because of its requirements to put more people on the rolls for the the state’s version of Medicaid, which provides health care to low-income residents.

Her spokesman, C.J. Karamargin, said that if the bill comes to the floor of the House with the same language she objected to in January, she will not be able to support it. Asked if she can offer her support if the concerns are worked out on reconciliation, Karamargin said, “We’d have to weigh that promise if it’s made.”

Although the House leadership has already included Giffords, as well as Rep. Harry Mitchell, as one of several possible “vote switchers,” Giffords was not part of the group invited to sit down with the president Thursday.

Grijalva said the group vented complaints about the bill, primarily the lack of a public option. While President Obama reportedly said he pledged to continue working on those areas, he focused attention on the benefits of the package, from more money to community health centers to more regulation on insurance companies. And he drew a parallel with Social Security, that started small but grew over time to become the sweeping entitlement program it is now.

“The president made a compelling case,” Grijalva said. “He presented an argument that if we don’t get this first block done, we’ll never get the rest.”

He didn’t take a head count, Grijalva said. “That’s going to be the most agonizing week for me. I hate to vote for a bill that doesn’t have the public option, but I don’t want to hand the opponents of health-care reform a victory, either.”

Brown Vows To Send Health Care Reform ‘back To The Drawing Board’

Republican Scott Brown, fresh off his victory in the Massachusetts race for U.S. Senate, called on the secretary of state to send him to Washington immediately, saying Wednesday that he wants to send health insurance reform “back to the drawing board.”

Though the state typically waits at least 10 days to collect absentee ballots before certifying, the senator-elect said he’s “confident” his margin of victory — 5 points and nearly 110,000 votes — was greater than the number of outstanding ballots.

Brown is champing at the bit to be sworn in since he would become the 41st Republican in the Senate, breaking the Democrats’ 60-vote supermajority and potentially scuttling health care reform if it returns to the chamber for a final vote.

“Since the election is not in doubt, I’m hopeful that the Senate will seat me on the basis of those unofficial returns,” Brown said, adding that he’s already spoken to members of the state’s congressional delegation, including Sen. John Kerry, and will travel to Washington Thursday. “I think it’s important that we hit the ground running because there’s some very important issues facing our country.”

On health care reform, he said he wants “everyone” to have some form of health care coverage, but questioned plans to slash Medicare and raise taxes to do it.
video
Brown Ready to Hit Ground Running

Brown ready to hit ground running

“I think we can do it better,” he said.

The Republican senator-elect said he was focused on moving to Washington as soon as possible to try to free up some of the political gridlock there.

“I have always just wanted to go down and solve the problem regardless of party,” Brown told NBC’s “Today” Show.

“While they’re in Washington talking about what someone said in a book and what this happened, we have some very serious problems when it comes to over-taxation, overspending and Al Qaeda who are trying to kill us. So we need to get back to the basics and start solving problems that affect every person in this country,” he said.

Brown’s insurgent candidacy has forced Democrats to rethink the basics on several matters, including the massive health insurance reform bill that is tagged to cost nearly trillion over 10 years. They are also reconsidering agenda items they plan to use in November’s midterm election campaigns.

By winning the Senate seat in Massachusetts by nearly the same margin that President Obama defeated Sen. John McCain in November 2008, Brown takes away Democrats’ filibuster-proof majority and can pull a reverse-Obama — claiming a mandate to defeat the health care legislation now stuck in Congress.

Despite the upset, Obama adviser David Axelrod said administration officials will take into account the message voters delivered Tuesday but declined to go further.

“It’s not an option simply to walk away from a problem that’s only going to get worse,” Axelrod said of the health care bill.

Sen. Susan Collins, R-Maine, said one of the many messages coming out of the Massachusetts election is that Americans are sick of partisan gridlock, but voters also had a much more expansive recommendation.

“They want better performance out of Washington, they want us focusing on the troubled economy and the need for more jobs and … they’re tired of sweetheart deals that were sneaked into the health care bill. They want that kind of bill to be negotiated in the open. And they’re tired of politics as usual and they also want controls. They don’t want unfettered, one-party control,” Collins told Fox News.

Collins said she cannot support a bill “that imposes billions of dollars for new taxes, slashes Medicare by 0 billion and would actually cause insurance rates to go up.”

“We really should start from scratch and do a completely bipartisan bill,” she added

But Pennsylvania Gov. Ed Rendell said that Americans oppose the health insurance changes because “the administration and its supporters, myself included, haven’t done a good enough job explaining to people what’s in this bill.”

Rendell said he wants to go back to the drawing board in order to better communicate the message. If that fails, and a filibuster is threatened, then Democrats shouldn’t “just cave” but should make the other side “explain why they’re trying to block the bill with this type of political chicanery.”

“I haven’t heard one good alternative offered by any Republican except let’s start at the beginning, let’s start all over. Start all over to do what?” he asked.

Rendell added that he wants to call the GOP’s bluff.

“Let them filibuster, let them take to the floor and speak endlessly and endlessly about why this is bad for the American people and what the alternative is,” he said.

As the debate continues over whether to scrap the year-long health insurance reform effort, some are also looking at whether Republicans can repeat the feat in Massachusetts in other states.

Seven Senate seats now held by Democrats are now considered toss-ups in November — Nevada, Colorado, Arkansas, Illinois, Pennsylvania, Delaware and Connecticut. Four Republican seats are in the same situation — Missouri, Kentucky, Ohio and New Hampshire.

“I think anybody who’s up for election this November ought to take seriously what the people of Massachusetts had to say in that special Senate election,” said Sen. Joe Lieberman. D-Conn.
Sen. John Cornyn, R-Texas, head of the National Republican Senatorial Committee, said Democrats nationwide should be on notice

“Americans are ready to hold the party in power accountable for their irresponsible spending and out-of-touch agenda.”

But Democratic Senatorial Campaign Committee Chairman Robert Menendez cautioned against “taking a single unique election and extrapolating what it means for the midterms 10 months away.”

Still, Menendez said he doesn’t want to sugarcoat what happened and Democrats will be sorting through the lessons in the days ahead.

Moderate Dems Reject Reconciliation To Pass Health Care

Two moderate Democratic Senators facing re-election battles this year said Tuesday they would oppose using a legislative tool that requires only 51 Senate votes to get health care legislation to President Barack Obama’s desk.

Sen. Evan Bayh, D-Indiana, called the move, known as reconciliation, “ill-advised,” while Sen. Blanche Lincoln, D-Arkansas, issued a news release rejecting the procedure.

“I will not accept any last-minute efforts to force changes to health insurance reform issues through budget reconciliation, and neither will Arkansans,” Lincoln said in the statement.

Both the House and Senate have passed separate health care bills, entirely on support from Democrats.

Democratic leaders were working on merging the two bills, but the nation’s political landscape changed last week when Massachusetts elected Republican Scott Brown to fill the Senate seat held by liberal Democrat Ted Kennedy for almost 47 years until he died in August.

Brown’s victory cost Democrats their 60-seat super-majority in the 100-member Senate necessary to overcome a Republican filibuster. The shift means Republicans can block Democratic initiatives such as health care reform.

Now Democratic leaders are working on a plan for the House to pass the Senate bill, along with a separate package of changes in the Senate plan that reflect compromise between the two chambers.

The package of changes would have to pass both the House and the Senate.

Without the 60-seat super-majority, Senate Democrats now are considering using the reconciliation tool that would require only 51 votes to pass the measure.

However, some Democrats in tough re-election fights worry voters will see that as legislative gimmickry, reinforcing complaints that Democratic control of Washington has been business as usual.

Bayh told CNN that using reconciliation “would destroy the opportunity, if there is one, for any bipartisan cooperation on anything else for the rest of the year.”

Senate Majority Whip Dick Durbin, D-Illinois, dismissed opposition to using reconciliation as a way to get health care legislation to the president.

“I think reconciliation has been used effectively by both parties,” Durbin said. “I wouldn’t walk away from it. It’s an option we should keep on the table.”

Senate Democrats still have 59 votes in their caucus, meaning they could lose eight Democratic votes and still have the 51 needed to pass a health care package through reconciliation.

Still, Democratic sources warn that using reconciliation is complicated and fraught with legislative hurdles, raising questions about whether it could happen even if enough congressional Democrats supported the move.

House Speaker Nancy Pelosi, D-California, emerged from a meeting with Senate Majority Leader Harry Reid, D-Nevada, late Tuesday and said they are making progress on “some kind of package,” but reiterated that at this time “there are not the votes in the House, not anywhere near, to pass the Senate bill.”

Earlier, Reid told reporters there is now “no rush” on health care.

Obama, who made health care his top domestic priority last year, will address the issue in his State of the Union Address on Wednesday, said White House Press Secretary Robert Gibbs.