Tag: health

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9/11 health bill falls short in Senate test vote

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Supporters were three votes short of the 60 needed to proceed to debate and a final vote on the bill that would have provided as much as .4 billion in health care and compensation to 9/11 responders and survivors. The bill failed on a test vote, 57-42.

Fifty-seven Democrats voted for the bill and 41 Republicans opposed it. Sen. Harry Reid, the Democratic leader, switched his vote to ‘no’ at the last moment, a parliamentary move that allows him to bring the measure up again for a vote.

Backers of the legislation see this lame-duck session of Congress as possibly its last chance. The bill has passed the House.

Republican senators have promised not to consider any other bills until the Senate acts on funding the government and extending tax cuts.

The defeat was a huge blow to New York and New Jersey lawmakers who have long fought for the measure, arguing it’s morally wrong to not do more for the health needs of ailing 9/11 responders and survivors.

“We should not have to wait for tax deals to do what’s right,” said Sen. Kirsten Gillibrand, D-N.Y., a lead advocate of the bill.

Facing long odds, supporters will try to attach the 9/11 bill to the legislation that emerges from the tax deal. They’ll also press for another vote once the tax issue is settled.

Critics questioned whether the bill is affordable and does enough to ensure that only people with illnesses related to trade center dust get help.

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Wash Post Health

Health premiums surge 41%; Md., D.C. among costliest areas to insure

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The report, which presents a state-by-state analysis of private employer health insurance costs for those six years, found that by 2009, the 10 jurisdictions with the highest annual total premiums included the District and Maryland. The average employer-sponsored family premium for all states was ,027. In the District, it was ,222; in Maryland, ,833. Virginia ranked 32nd, below the national average, at ,622.

Premiums for employer-sponsored coverage include the amounts paid by employers and employees combined.

The other states with high total premiums were Alaska, Connecticut, Massachusetts, Vermont, Wisconsin and Wyoming.

The Commonwealth report did not break down how the costs were split between employer and employee over the years.

The Commonwealth Fund supports the health-care overhaul legislation. Its report Thursday said the new health-care law provisions have the potential to slow the rate of cost growth by giving states the ability to challenge excessive premium increases and by providing assistance for low- and middle-income families to pay for health insurance.

Industry analysts say, however, that figuring out how the new law will affect health-care costs, and therefore premiums, is among the trickiest issues surrounding the statute.

One of the lead authors of the report, Cathy Schoen, said health insurance costs will tend to vary by costs of care and prices charged by doctors, hospitals and diagnostic laboratories. Health-care costs tend to be somewhat higher in higher-income areas than lower-income states, she said.

In the District, Insurance Commissioner Gennet Purcell said the higher health insurance costs reflected the higher costs of doing business in the city. “The salaries here are higher, the cost of doing business is higher, and you can’t pay [in premiums] what you pay in Iowa,” she said. In addition, the District is an urban area and hard to compare to a state where the costs of living might be lower in some rural areas.

Beth Sammis, acting commissioner for the Maryland Insurance Administration, said she did not know what was behind the increase in private-sector health insurance costs. Her office reviews requests for rate increases from insurance companies. But many of the state’s large employers, such as Lockheed Martin, Northrop Grumman and Marriott, are self-insured and therefore not regulated by the state.

The report also found that deductibles rose sharply in almost all states, increasing an average of 77 percent from 2003 to 2009 in large as well as small firms. In addition, more workers are paying deductibles; 74 percent faced a deductible in 2009 compared with 52 percent in 2003.

Schoen said the rapid increase in health insurance premiums means that many working families have been forced to trade off pay raises just to hold onto their health benefits. The expanding share of premiums paid by workers themselves has also taken a greater cut out of paychecks, she said.

Other recent studies have shown that employers are shifting health-care costs to workers to help ride out the economic downturn.

A survey released in September by the Kaiser Family Foundation and the Health Research and Educational Trust found that workers with health benefits are paying an average of 30 percent of the premium for family coverage and 19 percent of the premium for single coverage this year, the highest in 12 years of surveys by the two organizations.

Last year, workers were paying an average of 27 percent of the premium for family coverage and 17 percent for single coverage.

Staff researcher Lucy Shackelford contributed to this report.

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Wash Post Health

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Workers’ health insurance costs for 2011 include higher premiums and co-payments

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The selection is likely to be even less appealing this year than last. According to experts and industry insiders, recent trends suggest rates will continue to rise and employers will continue to shift more of the cost of health insurance onto workers – asking them to shoulder a larger share of premiums, for instance, or increasing out-of-pocket costs such as deductibles and co-pays.

This past year, overall premiums for employer-sponsored coverage – meaning the amounts paid by employer and employee combined – rose a relatively modest average of 3 percent for family coverage, according to a study by the Kaiser Family Foundation and the Health Research & Educational Trust. But the share of such premiums covered by the worker increased from 27 percent to 30 percent, with the result that the amount paid by workers rose an average of 13.7 percent.

The most comprehensive statistics on plan offerings for 2011 won’t be available for months. But a September survey of employers by Mercer, a leading benefits consulting company, suggests last year’s patterns will continue.

Overall, the employers said that they expected their health-care costs to increase between 9 and 12 percent – but that they planned to use cost-saving measures to effectively bring that increase down to 6 percent. Some 57 percent said one way they would do this would be to have their employees pay a greater share of the cost of coverage.

Many employers also said they would try to lower their costs by prompting employees to improve their health: Forty-four percent said they will add health management or wellness programs. An additional 38 percent said they will add incentives for employees to participate in existing programs.

Tracy Watts, a partner at Mercer, said this often involves lowering employee premiums or giving them gift cards for participating in health assessment surveys. These reviews alert workers to steps they could take to improve their health.

“There may even be incentives to achieve your ideal biometrics – blood pressure and body mass index, for instance,” she said. “That’s very encouraging, because it suggests that employers believe that focusing on members’ health is a good thing to do.”

Impact of the new law

Because this is the first major open-enrollment period since key provisions of the new health-care law started taking effect, many workers will wonder how much of the plan changes they see is due to the legislation. Not much, say analysts.

The law’s most market-altering changes – including provisions that may or may not control premiums – don’t kick in until 2014.

“We’re three years away from that,” said economist Paul Fronstin of the nonprofit Employee Benefits Research Institute. “For the most part, the plans don’t know what they’re going to be doing [in response]. It’s just too soon.”

There is a notable exception: On their next annual renewal date, all plans will be required to comply with certain mandates such as eliminating lifetime dollar limits on benefits and allowing parents to put adult children up to age 26 on their plan. Insurers that make certain changes to existing plans or employers that switch insurance carriers will have to offer additional benefits such as free preventive services.

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Wash Post Health

No clear path for GOP on health care repeal

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And that might not be a bad thing if you’re a GOP strategist. It keeps the issue Senate Republican leader Mitch McConnell calls the “tipping point” in the midterm elections alive for 2012, when they’ll try to unseat Obama himself.

Republicans will control the House in January, but they don’t have the votes to overcome a Senate filibuster, much less Obama’s veto on repeal. Plan B, denying funds to carry out the law, could backfire if it escalates to a government shutdown.

Other options call for legislative guerrilla tactics.

Republicans could use the oversight authority of Congress to slow down or block regulations, essentially tying up the instruction manual for the overhaul. Expect flyspeck scrutiny of agencies implementing the law.

GOP lawmakers may be able to pick off unpopular provisions. Obama has already said he’s willing to “tweak” an IRS reporting requirement that small businesses find burdensome. Another target is a yet-to-be-named board with the power to make Medicare cuts. And look for a move to tighten restrictions on abortion coverage.

“It would be foolish to expect that Republicans will be able to completely reverse the damage Democrats have done as long as a Democrat holds the veto pen,” McConnell said, outlining the GOP agenda Thursday. “There’s just no getting around it.”

The GOP’s repeal strategy is fluid. Aides say no decision has been made on the first bill that House Republicans will take up in the new Congress, and party leaders have put taxes and government spending ahead of health care repeal as priorities.

“This is not a ‘Jeopardy!’ question where there is just one right answer,” said Rep. Joe Barton, R-Texas, a leader on health care. “House Republicans are committed to repealing the existing Obamacare bill. That’s not window dressing, but we are going to do a three-pronged approach. We’ll do repeal, we’ll do a reform bill, we’ll do a defunding bill. It’s all of the above.”

The repeal slogan energized big-government foes in the midterm elections, helping turn out Republican voters. However, trying to deliver on it could stir up a backlash. Exit polls on Election Day found voters divided. Forty-eight percent said they supported repealing the overhaul, but 47 percent said it should be expanded or kept as it is.

At his postelection news conference, Obama pretty much dared Republicans to follow through on their threat. Citing popular provisions of the law, such as help for seniors with high prescription costs and guaranteed coverage for people with medical problems, the president said, “I don’t think you’d have a strong vote for people saying … ‘Those are provisions I want to eliminate.’”

Mindful that some of the new benefits are popular, House Republican leader John Boehner has stressed that a “replace” measure preserving some aspects of Obama’s overhaul would go with legislation to repeal it. But not all his followers agree. Some conservatives want a straight vote on repeal that would leave the “replace” part for later.

“There is a critical difference whether the first fight is a repeal fight or it’s repeal and replace,” said Michael Needham, CEO of Heritage Action for America. “A straight repeal vote would go through the House with every Republican on it and a number of Democrats,” increasing pressure on the Senate.

And then there’s the wild card: federal budget politics.

If Obama and the Republicans can strike a grand bargain to reduce government deficits, it could open a path for GOP ideas such as curbs on malpractice lawsuits. Subsidies for the uninsured could be slowed or pared back, since the big coverage expansion under the law doesn’t start until 2014.

“It will be far easier to scale back an entitlement nobody has received than a program that people are already on,” said economist Douglas Holtz-Eakin, who served as a top policy adviser for 2008 GOP presidential candidate John McCain.

The last Republican to run the federal Health and Human Services Department isn’t forecasting repeal.

“I think it either fails in the Senate or is vetoed by the president,” said former HHS Secretary Mike Leavitt. “Ultimately, there will be some kind of a budget summit or bipartisan attempt to break the logjam, and many of the provisions of health reform will be put on the table at that time, and there will be changes.”

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Wash Post Health

Health insurance law covers people with preexisting medical conditions

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Now the plans are up and running in every state. So far, the response has been modest and reviews are mixed. For some, the new preexisting-condition insurance plans – PCIPs, also known as high-risk pools – have offered a lifeline that has enabled them to afford crucial treatment that they otherwise would have skipped or had to pay for themselves. Others, however, have been frustrated by strict eligibility rules that have shut them out of the plans, and still others find the coverage too expensive.

The pools are intended to act as a stopgap until the state-based health insurance exchanges created under the health-care overhaul are up and running in 2014. (At that time, anyone without affordable job-based coverage will be able to buy insurance on one of the exchanges.) For the period between now and then, the new law established a billion insurance program for up to an estimated 6 million people with preexisting medical conditions.

Even before the federal overhaul was enacted, 35 states offered programs for people with preexisting conditions. But from a consumer’s point of view, those programs have several weaknesses, including premiums that can be up to twice as expensive as private coverage and waiting periods of up to a year.

The new pools are somewhat different. Premiums for the oldest participants can’t be more than four times those charged to the youngest. The plans have to cover a comprehensive range of services, and preexisting conditions must be covered immediately. An individual’s out-of-pocket costs beyond the premiums are capped at ,950 through 2011.

For Gillian Sender, the new plan has been an enormous relief. Uninsured since December when she left her job in newspaper advertising sales, Sender, 52, started feeling fatigued and bloated over the summer. She went to a community health center near her home in Milwaukee to get it checked out in July and was referred to a gynecologic surgeon, who told her she had uterine cancer.

That week, as she grappled with her diagnosis and panicked about how she would pay for her upcoming hysterectomy, chemotherapy and radiation, family members told her about the new options for people with preexisting conditions. Sender immediately signed up for a plan with a ,500 deductible, for which she pays 8 monthly.

Although the plan’s Aug. 1 start date meant she had to pay for her surgery, she’s covered for the chemotherapy and radiation. “I was more terrified of not having insurance than the diagnosis itself,” says Sender. “It’s definitely affordable, and the coverage is fabulous.”

The plans vary significantly from state to state. States were given the option of running their own program or letting the federal government do so; 27 states opted to run their own plans.

A recent report by University of Kansas researchers found that monthly premiums for a 50-year-old nonsmoker ranged from a few hundred dollars to more than ,000 across the country.

The comparable premium in the federally administered plans, which all have a deductible of ,500, averages 5. Those plans are available in Virginia, where premiums range from 9 to 6, and the District, where premiums cost 4 to 9. In Maryland, which runs its own plan, premiums run from 1 to 8, with a ,500 deductible.

Other key plan features that vary widely by state include deductible amounts, limits on out-of-pocket spending for care outside a plan’s provider network, and coverage of medications and preventive services without first requiring people to meet the deductible, says Jean Hall, an associate research professor and co-author of the report.

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Employers looking at health insurance options

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But last week a leading manufacturer told workers their costs will jump partly because of the law. Also, a Democratic governor laid out a scheme for employers to get out of health care by shifting workers into taxpayer-subsidized insurance markets that open in 2014.

While it’s too early to proclaim the demise of job-based coverage, corporate number crunchers are looking at options that could lead to major changes. Gov. Phil Bredesen, D-Tenn., said the economics of dropping coverage are “about to become very attractive to many employers, both public and private.”

That’s just not going to happen, White House officials say.

“The absolute certainty about the Affordable Care Act is that for many, many employers who cover millions of people, it increases the incentives for them to offer coverage,” said Jason Furman, an economic adviser to President Barack Obama.

Yet at least one major employer has shifted a greater share of plan costs to workers, and others are weighing the pros and cons of eventually forcing employees to strike out on their own.

“I don’t think you are going to hear anybody publicly say ‘We’ve made a decision to drop insurance,’ ” said Paul Keckley, executive director of the Deloitte Center for Health Solutions. “What we are hearing in our meetings is, ‘We don’t want to be the first one to drop benefits, but we would be the fast second.’ We are hearing that a lot.” Deloitte is a major accounting and consulting firm.

“My conclusion on all of this is that it is a huge roll of the dice,” said James Klein, president of the American Benefits Council, which represents big company benefits administrators. “It could work out well and build on the employer-based system, or it could begin to dismantle the employer-based system.”

Employer health benefits have been a middle-class mainstay since World War II, when companies were encouraged to offer health insurance instead of pay raises. About 150 million workers and family members are now covered.

When lawmakers debated the legislation, the nonpartisan Congressional Budget Office projected it would only have minimal impact on employer plans. About 3 million fewer people would be covered through the job, but they’d be able to get insurance elsewhere.

Two provisions in the new law are leading companies to look at their plans in a different light.

One is a hefty tax on high-cost health insurance aimed at the most generous coverage. Although the “Cadillac tax” doesn’t hit until 2018, companies may have to disclose their exposure to investors well before that. Karen Forte, a Boeing spokeswoman, said concerns about the tax were partly behind a 50 percent increase in insurance deductibles the company just announced.

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Health insurance premiums and other costs will rise for many workers in 2011

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Higher premiums

The employee’s share of the average ,770 total premium for family coverage went up 14 percent this year, to ,997, according to the annual employer health benefits survey conducted by the Kaiser Family Foundation and the Health Research & Educational Trust and released last month. (Kaiser Health News is a program of the foundation.)

In the past five years, employees’ premium contributions have grown 47 percent, while overall premiums increased 27 percent. Workers’ relative share of the premium this year grew to 30 percent of the total for family coverage, up from 27 percent last year.

Higher deductibles

More than a quarter of employees now face annual deductibles of at least ,000, according to the Kaiser/HRET study. Some plans offer a health savings account, or HSA, an option that lets you sock away money tax-free to cover health-care expenses.

Katie and Ricky Harbaugh have a high-deductible plan. When their daughter Kylie was born last year, they got hit with roughly ,000 in out-of-pocket costs, including a ,000 deductible and 20 percent coinsurance for hospitalization.

In previous years, Katie Harbaugh’s company made a ,500 contribution to her HSA to help cover the deductible. But last year, her employer eliminated the HSA along with its contribution. The Hagerstown, Md., couple is still paying off the medical bill. “For a person like me who has a family, a high-deductible plan just doesn’t work,” says Katie Harbaugh. “I have two kids. Last year alone I was in the emergency room three times.”

More coinsurance

When you visit the doctor or a specialist, it’s likely you’ll still pay a flat co-payment of or some other amount. But increasingly, health plans are adding coinsurance, meaning you will also pay a percentage of the charges. For example, 53 percent of plans now require coinsurance charges for hospital admissions, up from 42 percent two years ago, according to the PricewaterhouseCoopers Health and Well-Being Touchstone survey of 700 companies. Coinsurance is also on the rise for prescription drugs and emergency room visits, according to the survey.

Typically, coinsurance isn’t charged after you’ve reached your plan’s out-of-pocket maximum, says Mike Thompson, a principal in Pricewaterhouse-Coopers’s human resources practice. But that out-of-pocket limit may still be more than you can afford, he adds. “As employees make their choices, it’s important to say, ‘If the worst happens, how much would I have to pay out-of-pocket?’ ”

Extra for dependents

The health-care overhaul gave parents the option of keeping their adult children under the age of 26 on their policies, but there’s likely to be a price associated with that, say benefits consultants. Increasingly, plans are charging for every dependent on a plan rather than including an unlimited number in a single family premium.

Workers may also increasingly see another strategy to limit costs: surcharges, typically ranging from 0 to 0, for spouses who could get insurance through their own jobs. “If you have coverage available somewhere else, they want you off their books,” says Sara Taylor, health and welfare solutions leader at Aon Hewitt.

Emphasis on wellness

But the changes aren’t all bleak. To help sidestep the rising costs, you may be able to make some plan changes work to your financial advantage next year and get better care at the same time.

Most employers already have wellness programs of some sort. They may offer smoking cessation or weight management classes, for example, or discounts on gym memberships. Next year, employers expect to beef up wellness programs, hoping to save money by keeping employees healthier, according to a survey released in September by human resources consultants Mercer.

Increasingly, employers are linking participation in wellness programs with employee health insurance costs. Employers may give workers a break on premiums or deductibles, for example, if they meet certain biometric targets for healthy blood sugar, blood pressure and cholesterol levels, says Tracy Watts, a partner at Mercer.

As companies try to get a handle on chronic disease costs, they’re also dangling the possibility of access to better, cheaper insurance for employees who take certain steps.

For example, workers who fill out a health-risk assessment might get slightly lower premiums in the company’s core plan. If the questionnaire identifies them as having a chronic condition that needs treatment, and if they participate in a disease management program and work with a health coach to keep their diabetes in check, for example, they might “graduate” into a plan with better benefits and lower cost-sharing.

Some may dislike the Big Brother approach, but companies aren’t apologizing.”The problem [with voluntary programs] is that people don’t participate,” says Watts. “So they’re trying different strategies.”

This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. /

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