Congress is poised for a battle over whether a healthcare overhaul should include a new government-run health plan to compete with private companies in the effort to cover the uninsured. Democrats typically see more government involvement as a good way to check the private sector and help control costs, while Republicans fear the government will have unfair power over the market. The matter is likely to come to a head first in the Senate Finance Committee, where Chairman Max Baucus has pledged to write a bipartisan bill.
Doctors working at Texas-based JPS Health Network clinics are often forced to send patients to the emergency room to get them admitted. Necessary equipment and medical supplies are also missing, and JPS doctors still would not recommend family or friends to seek treatment at JPS facilities, according to a recently released survey of the physicians working for the taxpayer-supported public hospital system. But the physicians gave JPS' new administration high marks as doctors and hospital executives have formed teams in recent months to address the widespread deficiencies identified in the survey.
Proposed Medicare Advantage cuts and subsequent premium increases could force millions of seniors into traditional Medicare plans without care coordination and would shift more costs onto beneficiaries, according to a Blue Cross Blue Shield Association official.
Alissa Fox, senior vice president in the office of policy and representation at BCBSA, which covers 1.6 million Medicare Advantage enrollees in 42 states, the District of Columbia, and Puerto Rico, said the Obama administration's proposed 5% Medicare Advantage payment cuts to private insurers could increase beneficiary premiums by $50-$80 per month, which will force many, particularly low-income seniors, into traditional Medicare without supplemental coverage. That $50-$80 premium increase would happen if insurers passed the full payment cuts onto members, although they could also combine a smaller premium increase with service reductions, said Fox during a Monday press conference.
The Obama administration and Democrats have criticized the Republican-backed Medicare Advantage programs because they cost 14% more on average to care for than Medicare fee-for-service beneficiaries.
However, Medicare Advantage supporters, including Fox, said a benefit to Medicare Advantage is that it coordinates care for 10 million beneficiaries, which is especially important for seniors with multiple chronic illnesses, who take multiple medications and visit various doctors. That coordination of care is not present in traditional Medicare because it doesn't pay doctors for care coordination, Fox said.
Rather than across-the-board Medicare Advantage cuts, Fox said CMS should review how it pays for services, improve quality through pay-for-performance programs, and target insurers that are upcoding as a way to make more money.
"We think that there are ways to reform the program. We think it should be made more efficient. We think it should be rewarded for demonstration quality," said Fox. CMS must finalize rates by April 6, and BCBSA has already sent its comments regarding Medicare Advantage payments cuts to the federal government, said Fox.
However, beyond the 2010 payment cuts, Fox said she is also concerned about future hits to Medicare Advantage. For instance, as part of his proposed 2010 $3.1 trillion budget, President Barack Obama proposed that one-third of a $634 billion healthcare reform fund come via Medicare Advantage cuts.
"When you look at this, you need to really look at what it does to Medicare beneficiaries, and you need to make sure that the premiums are stable and predictable," said Fox.
Los Algodones, Mexico, population 4,000, is home to about 350 dentists geared to foreign patients. Their treatment comes at a huge discount—70% or more—from what Americans pay at home, a reality that many patients call an indictment of U.S. healthcare. But U.S. medical authorities warn that Los Algodones is a medical Wild West, an unregulated environment where substandard providers can do not have the same oversight that exists in the United States.
The six medical schools in Sweden have had several problems in admitting and dismissing students with serious criminal offenses in just the past two years. The cases resonate far beyond Sweden, raising fundamental questions about who is fit to become a doctor. In contrast with the United States, Swedish laws and customs are sympathetic to released offenders, saying that once they have served their time they should be treated like ordinary citizens. But the cases raise questions about protecting the rights of patients and fellow medical students and healthcare workers.
American workers are getting squeezed like no other group by private health insurance premiums that are rising much faster than their wages, according to a study. While just about all retirees are covered, and nearly 90% of children have health insurance, workers now are at significantly higher risk of being uninsured than in the 1990s, the last time lawmakers attempted a healthcare overhaul, according to the study for the Robert Wood Johnson Foundation. The study also found that nearly 1 in 5 workers is uninsured, a significant increase from fewer than 1 in 7 during the mid-1990s.
The nation's economic crisis merely adds to the urgency of reforming the healthcare system, a key White House official said while arguing that the administration has learned from past mistakes and will succeed in this effort. Nancy-Ann DeParle, director of the White House Office on Health Reform, told hundreds of people at a forum in Des Moines, IA, that the nation is ready for changes.
The effort by a new labor union to represent 14,000 Catholic Healthcare West workers in California has been dismissed by a National Labor Relations Board regional director who ruled that the contract between the employees' longtime union, Service Employees International Union, and the hospital chain bars such overtures. The ruling would seem to be a setback for the National Union of Healthcare Workers, launched this year by officials who were dismissed by the Service Employees International Union. Sal Rosselli, president of the new union, rejected that idea, saying many thousands of workers are saying they want to be rid of SEIU.
The number of individual health insurance policies that do not include maternity coverage has risen dramatically in recent years, prompting concern among consumers and a legislative effort to require California insurers to include the benefit. About 805,000 Californians have insurance policies that specifically exclude maternity coverage—a number that has more than quadrupled from 192,000 in 2004, according to the California Health Benefits Review Program.
Doctors Across New York, a program to get more doctors into the secluded corners of Upstate New York and poor neighborhoods around New York City, is announcing its first round of grants. The program is designed to help the more than 25% of New York's population living in areas designated as underserved. The state is awarding $11 million over five years to help doctors repay medical school loans in exchange for a five-year commitment to working in an underserved community in New York. Another $11 million is being awarded over the next two years to help physicians expand or establish medical practices.
