The Future of Health Care and Health Insurance in 2009: Revisited

The Future of Health Care and Health Insurance in 2009: Revisited in Politics and Legislation

The day after Barack Obama became the 44th President of the United States, we weighed in on the chances of big change in the health insurance and health care delivery system.

Since then, times have changed. The political atmosphere has shifted. Reform proposals are out on the table.

Based on what’s happening now, let’s take a look at the top issues along with their chances of passage into law:

Single-payer health care. There are still a handful of members of U.S. Congress that want to push a single-payer health care system. Politically speaking, it’s just about impossible.

Public health insurance cooperative. Cooperatives are being tossed around as an alternative to the often contentious public health plan option. But because cooperatives historically don’t have a great track record, we’d be surprised if it was in the final bill.

Losing your current health plan. More than 60 percent of Americans are afraid that health reform will hurt their current coverage — a huge political time bomb. The fear has merit, too. One has to think that if new competition is injected into the market, it could affect health insurance rates and benefits in some way. But because this is one of the biggest factors that killed then-President Clinton’s reform efforts, we have to give lawmakers these days some credit and say your current plan is likely safe.

Public health insurance plan. Because the public health insurance option is such a polarizing provision of health reform, it’s not clear what’s going to happen. Democrats have reconciliation up their sleeves, so there is the chance it could be forced through Congress.

Employer health benefits mandate. Here’s another provision that’s politically tricky. The Blue Dog Democrats have already voiced their concerns for small businesses that might face higher health care costs — and won. Business and doctors groups are, however, divided on the issue. But because so many want an employer mandate, it just might happen.

Provider reimbursements. We haven’t heard much about changing the reimbursement system for health care providers in a while. But we think there will be some sort of provision that addresses how doctors are reimbursed for their services.

Individual mandate for insurance. During the 2008 campaign, President Obama was opposed to an individual mandate. Today, the president is open to the idea. That coupled with an endorsement from AHIP, an individual mandate seems likely.

No pre-existing condition exclusions. AHIP agreed to get rid of pre-existing condition exclusions as long as there was an individual mandate — a political win-win for lawmakers.

Electronic medical records. We still think electronic medical records are inevitable. How can our society, who so heavily relies on computers and the Internet, not apply that to the health care industry?

Reform in general. If health reform is killed at this point, it’s dire straits for future efforts. Because of the party in power in both Congress and the White House, it’s almost certain we’ll get some kind of reform. We just don’t know what the final reform will be.

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Report: Health Insurance Fraud Increasing

Report: Health Insurance Fraud Increasing in Individual Health Insurance

Health insurance fraud is on the rise. Lt. Robert Sebby, who investigates medical identity theft cases, blames unemployment and the failing economy, reports the Las Vegas Sun.

Our migration to electronic medical records probably isn’t helping much either.

Pam Dixon, executive director of the nonprofit World Privacy Forum and author of a report on medical identity theft, warns that without extensive safeguards, we are going to see this type of crime skyrocket.

Remember the medical clerk in Florida a few years ago who downloaded the records of more than 1,000 Medicare patients and gave them to a relative, who made $2.8 million in fraudulent claims with them?

While we agree with the president’s call for electronic medical records (EMR), we hope that it is done with strategy and foresight. A lot of strategy and foresight. Who wants to get a surprise bill for a diabetic’s dialysis in Maryland or an addict’s prescription swindle in Oregon?

Straightening out stolen health care is a special kind of red tape nightmare. Strict patient privacy laws and the decentralized bureaucracy of insurance providers complicates things to Kafka-esque levels.

So, let’s indeed proceed into the brave new world of computerized medical records, but let’s make sure that part of the $19 billion earmarked for the job is used to adequately protect patients’ information.

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Hospitals Slow To Adopt Electronic Medical Records

Hospitals Slow To Adopt Electronic Medical Records in General Healthcare

As we’ve blogged about before, doctors have been mighty slow in making the switch to electronic medical records even though health care experts and lawmakers have been near unanimous on its potential for improving health care quality and reducing costs.

Hospitals are also slow to adopt an electronic records system, found a report in the New England Journal of Medicine, reported the Associated Press and the Austin American-Statesman.

The survey conducted by the NEJM found fewer than 2 percent of U.S. hospitals has fully implemented electronic records, and only 8 to 11 percent have basic electronic systems.

Most point to cost as the biggest deterrent for making the switch — it costs thousands of dollars to move to electronic medical records.

But this AP/Statesman article also brought up a good point: What should be the standard software for electronic records?

For electronic records to actually be effective in improving communication, the systems of health care providers and health insurance companies need to be able to talk with one another and send data in compatible formats.

The Obama Administration, like the previous Bush Administration, made a goal to get all health care providers to switch — they’ve even allocated $19 billion to help in the American Recovery and Investment Act of 2009.

But we’re not sure whether or not they’ve come up with a standard procedure for all of this.

Maybe it’s a good thing health care providers are slow to move.

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Pay-Per-Performance Health Care Not Yet Proven To Improve Quality

Pay-Per-Performance Health Care Not Yet Proven To Improve Quality in General Healthcare

In theory, moving to a health care and health insurance system of pay-per-performance is a grand idea.

Doctors improve health care quality by adopting new technologies such as electronic medical records to help reduce errors and strengthen communication, and shy away from expensive tests that might not be necessary.

Doing these things to improve care would increase their payments for their services just as billing as many tests as possible did, if not more.

Some providers around country have indeed implemented such a system, in efforts to improve the quality of care and reduce health care costs at the same time.

But researchers at the RAND Corporation, a non-profit research organization, found that after a few years, such systems haven’t yet borne the results everyone was hoping for.

RAND researchers looked at seven different California health insurance plans and over 200 physicians groups over the course of 6 years, reported Reuters.

RAND’s assessment? So far, no “substantial” gains.

“The true benefits of these programs may take more time to be realized and it is likely that investments in other quality efforts will be needed in addition to performance-based pay,” said RAND senior policy researcher, Cheryl Damberg.

Separate studies from RAND even found pay-per-performance systems interfered with doctor-patient relationships, wrote the article.

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Will Money Spent For Electronic Medical Records Go To Waste?

Will Money Spent For Electronic Medical Records Go To Waste? in General Healthcare

When it comes to electronic medical records, there’s a near consensus that it’s a good idea. We say “near” consensus because it now seems that some are wary of investing in the technology.

Why?

For starters, it’s the way the funding for electronic records is defined in the new economic stimulus as written by Democrats in the U.S. House of Representatives.

In the bill, doctors are eligible to receive bonus Medicare payments if they use electronic records in a “meaningful way,” wrote the Wall Street Journal.

It’s understandable Republican concerns with the wording on this one. What defines “meaningful?” Does that open the door for Medicare abuse and fraud?

House Minority Republicans voiced their concerns in a letter to House Speaker Nancy Pelosi.

“Unfortunately, the $87 billion allocated for more Medicaid money for states doesn’t appear to hold them accountable for ensuring that the tax dollars are spent wisely,” wrote the letter.

Some in the health care industry agree.

“[Y]ou can bring in too much money too fast and not only waste it, but set us back,“ said John Glaser, a chief information officer for a Boston non-profit hospital.

The pessimism of Republicans and some health care professionals really isn’t surprising. The health system has proven that it’s wasteful, inefficient, and costly.

Why throw more money at a fire pit?

There’s certainly a trade-off either way you choose. If you don’t invest in medical information technology today, then we’ll be far behind our capabilities. But if we don’t go about implementing electronic records correctly, we could stand to lose millions, if not billions in the mess of the broken health system.

Decisions, decisions…

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Next Year's Economic Stimulus Will Include Billions For Health Insurance Programs

Next Year's Economic Stimulus Will Include Billions For Health Insurance Programs in Politics and Legislation

For next year, President-elect Barack Obama is already planning on a massive economic stimulus package.

According to the Washington Post, the package could top $500 billion.

Large investments in health care and health insurance reform will be a part of the stimulus package, with a few major financial-assistance health care programs getting a significant funding boost.

Here are the programs in question:

SCHIP
The successful State’s Children’s Health Insurance Program will likely play a big role in the upcoming health reform plan. SCHIP has been widely regarded as a very successful, but costly, program to get children the health insurance they need. Already Congress has supported the expansion of SCHIP to include more children, and it looks like it will happen under Obama.

COBRA
U.S. Representative Pete Stark from California is calling for an expansion of COBRA, which allows unemployed people to continue their previous employer’s group health insurance coverage. But because COBRA coverage is expensive, Congressman Stark proposes providing subsidies to help the unemployed pay for the plan.

Medicaid
The Medicaid program for low-income Americans will receive up to $40 billion in the next two years as part of the stimulus.

In addition to these programs, the stimulus package will likely include some $10 billion as a down payment to help doctors, hospitals, and other health care facilities to implement electronic medical records and streamline offices with computers, wrote the Post article.

What is actually included in the package is still plenty up for debate.

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The Future of Health Care and Health Insurance in 2009. Will Change Really Happen?

The Future of Health Care and Health Insurance in 2009. Will Change Really Happen? in Politics and Legislation

Last night, we elected Illinois Senator Barack Obama to the presidency. In addition, the Democrats now have strengthened majorities in both Chambers of U.S. Congress and the White House.

That hasn’t happened since President Bill Clinton’s first term.

Democratic lawmakers have been long proponents of universal health care and insurance ideas, and expanding the federal government’s role in health care.

Now that they have power, what will they do with it? Will they, and can they, really change the fundamentals of how our health care system works?

Pretty loaded questions, yes, but we might as well speculate if anything will actually change when it comes to health care and health insurance.

Let’s take a look at five major health care issues that may be addressed in the coming years with a new president and new Democratic majority in Congress. The following will be ranked from least to most likely to change during Obama’s first term in office.

5. Universal health care for all
A one-payer universal health care and health insurance system in the United States is a long shot, no matter who is in office. President-elect Barack Obama has said if he could do it over, he would start with a one-payer system, but also said it’s likely not realistic.

Universal coverage for everyone probably won’t happen in the next 20 years, if ever.

4. Mandates for businesses to provide health benefits or help employees buy coverage
This was a big piece of Obama’s health reform plan — require all businesses, except small businesses, to offer coverage to their employees or help them pay for their own plans. But expect this part of his plan to be heavily opposed by business groups, and a likely candidate for a U.S. Senate filibuster by the Republicans.

3. Universal access to the Federal Employees Health Benefits Program
Another piece of Obama’s plan was to allow every American to buy into the group health insurance plan that’s currently only available for federal employees. On the surface, this seems like a good idea to let happen — the more participants in the group, the better they can negotiate with health insurance companies for lower rates. On the other hand, no one knows what this might cost the government and the taxpayers to fund.

2. Expanding State Children’s Health Insurance Programs (SCHIP)
The expansion of SCHIP has been a political battle since the Democrats took a majority in Congress two years ago. Twice they passed a sweeping expansion of coverage for more children, and twice it was vetoed by Republican President George W. Bush. But with the Democrats still in control and a president who himself voted for the expansion, look for this one to get passed under an Obama administration.

1. Expanding the use of electronic medical records
Most lawmakers, health care experts, and the like agree that moving medical records from paper to the computer will not only reduce medical errors and improve the quality of care, but also reduce overall health care costs and administrative overhead.

If electronic medical records don’t come into fruition in the next couple of years, we'll be fully surprised.

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Minnesota Governor Lays Out Health Care Goals

Minnesota Governor Lays Out Health Care Goals in General Healthcare

Now that Minnesota has been crowned this year’s top health care system in the nation, they’re trying to keep up their reputation.

Minnesota Governor Tim Pawlenty recently announced a health care plan that will implement electronic medical records statewide by 2011, reported the Minneapolis Star-Tribune.

Governor Pawlenty’s plan to move to electronic records starts with 50,000 state employees, who could have access to the system as soon as next year.

“We need to give them the tools so they can make good decisions. This would be a significant breakthrough in the way we maintain information in this state,” said Governor Pawlenty.

State employees will also get health reimbursement accounts to help pay for out-of-pocket medical expenses with tax-free savings.

Governor Pawlenty has already created a number of health care initiatives including prescription drug price shopping, ordering medicine from Canadian pharmacies, and nursing home report cards.

These efforts could be key reasons Minnesota ranks so high on their delivery of health care to residents.

Sounds like Minnesota and Governor Pawlenty want to keep that number one rank.

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Electronic Health Records Improve Care Quality, But With an Expensive Price Tag

Electronic Health Records Improve Care Quality, But With an Expensive Price Tag in General Healthcare

This week, the New England Journal of Medicine published a national survey of 2,758 physicians asking them about electronic medical records.

The survey, partly funded by the U.S. Department of Health and Human Services, found that very few doctors were using a complete electronic system, reported USA Today.

Only 4 percent of doctors used a system that not only helped store a patient’s medical records electronically, but also had safety features to reduce medical errors such as alerting doctors of possible negative drug interactions.

Thirteen percent had a basic electronic system with no safety measures, and 42 percent are planning on making the move eventually, wrote the article.

So what’s the hold up? Cost.

According the USA Today article, making the move to an electronic system can cost a doctor upwards of $40,000 per year — and sometimes more once the cost of tech support is included.

With those high costs, it’s no wonder doctors are slow to make the switch to an electronic medical records system.

But it’s not like doctors don’t think electronic records are good idea.

And now doctors can see very strong evidence that an electronic system has a huge positive impact on health care quality, thanks to the government-sponsored study.

“Certainly, the idea of electronic records is terrific. But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting,” said a New Jersey doctor in an interview with The New York Times.

Unfortunately, the high price tag means slow movement.

“We are [still] a long way from universal adoption,” said Karen Bell, from the Office of Health IT Adoption.

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Another Pennsylvania Health Care Reform Proposal

Another Pennsylvania Health Care Reform Proposal in Politics and Legislation

The health care reform plan from Pennsylvania Governor Ed Rendell isn’t the only proposal on the table in the state Legislature.

State Senate Republicans recently laid out a different approach to reforming the insurance system and providing more affordable coverage.

The plan, named HealthNet PA, includes a collection of different bills that aim at expanding coverage, offering tax credits to businesses and those who open Health Savings Accounts, and helping health care providers start using electronic medical records.

HealthNet PA will also offer better access to free health clinics for low-income residents, along with a new volunteer network of doctors and facilities who will offer free specialty care, reported the Philadelphia Inquirer and the Associated Press.

Residents who cannot find Pennsylvania health insurance because of a pre-existing health condition would be able to get coverage through a new state-subsidized high risk pool — the state would pay one-third of the premium.

The plan will cost an estimated $100 million a year, according to state Senator Edwin B. Erickson.

Financing will come from a few different sources, wrote the AP article — the 25 cent cigarette tax, money from traffic tickets for moving violations, and from extra money from a fund that helps doctors buy medical malpractice insurance.

“This plan is realistic, affordable, and sustainable,” said Senator Erickson.

The main criticism from Governor Rendell’s administration was that the Senate Republicans’ plan doesn’t guarantee enough care for uninsured residents.

But the governor’s alternative plan remains stalled in the state Senate, so it looks as if both sides will have to come to a compromise.

On a final note for the weekend: For all the dads out there, we hope you have a wonderful Father’s Day this Sunday!

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