The Health Shopper

As of today almost all employer-sponsored health plans will be required to cover contraceptives without deductibles, co-pays, etc. 28 states currently require health plans to cover contraceptives to some extent; the new ruling has made them completely cost-free.
The only exception is religious organizations, nonprofits, and places of worship that employ individuals of the same faith.

Today, the provision known as the Medical Loss Ration will drop. This provision requires health insurance companies to spend 80% of their consumers’ premiums on medical care, as opposed to marketing or overhead costs. If they do not do this, the companies will be required to send back a rebate check detailing the amount they did not spend on medical care.

The Department of Health and Human Services has detailed the parameters for qualification as a medical expenditure, though these rules are still being “fine-tuned”.

Yesterday the Supreme Court confirmed that, as expected for this year’s term term, it will rule on the constitutionality of the Patient Protection and Affordable Care Act. The Court plans to hear 5.5 hours of arguments on the case by March of next year; a ruling is expected in June.

The ruling aims to answer two essential questions: is the individual mandate, which requires individuals to purchase health insurance, is constitutional? And if not, should the entire piece of legislation be nullified?

The federal government has pushed through various consumer protection and premium regulation pieces in the act; the law also provides a number of options for individuals to get insured, such as the new federal and state-run health exchanges. Florida, leading a coalition of 26 states, is spearheading the case against the law on the grounds that the government cannot mandate the purchase of health insurance.

Update: Shortly after the confirmation of the hearing White House Communications Director Dan Pfeiffer released a statement saying, “We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree.”

Califonia gov. Jerry Brown made his way through approximately 140 proposed laws in time for a midnight deadline. Among the new CA laws passed are the following:

• Insurers are required to provide autism coverage.
• Children aged 12 and above are given access to STD-preventive care sans parental consent.
• Cancer-causing tanning beds are now illegal for use by teenagers under the age of 18, in an effort to curb early-onset skin cancer and exposure to known carcinogens.

It’s that time of the year again, folks! The Surpreme Court’s 2011-2012 term began yesterday on Oct. 1, and a number of cases have reached the Court’s desk, two of the which have important implications for health care.
According to Andrew Cohen at The Atlantic, “in Caraco Pharmaceutical v. Novo Nordisk, the justices will broker a dispute between generic drug manufacturers and their brand-name counterparts. And in Mayo Collaborative Services v. Prometheus Laboratories, the justices will return again to the issue of whether a doctor’s diagnostic methods may be patented”.
The former, Caraco Pharmaceutical v. Novo Nordisk could massively impact prices of pharmaceuticals and the consumer’s access to generic drugs. The Mayo Collaborative Services v. Prometheus Laboratories case examines whether labs can patent certain diagnostic tests.
The star of the health care cases, however, is the Affordable Care Act. The constitutionality of reform has long been a subject of debate, and CNN predicts that we may have a verdict on the case by next June.
So keep your eyes peeled: there are big cases coming up in the high courts!

What’s next in health care reform? Women.

As of next summer, when new reform provisions kick in, regular checkups and tests along with some forms of birth control will be more widely accessible to women. Annual well-woman visits, diabetes screenings, all contraception, and support for breast-feeding mothers will be covered under most health insurance plans, with no co-insurance, deductibles or co-pays for those services. This change is intended to increase overall wellness among women and decrease the numbers of abortions and unwanted pregnancies by improving the quality of women’s health care.

The new reform provisions also place emphasis on preventive care services, including HPV and HIV screenings, contraceptive patient counseling, gestational diabetes screenings, and domestic violence counseling.

More and more, families are looking to public health insurance options for their children’s coverage thanks to greater access to public plans and job losses, according to a recent study by the University of New Hampshire. This seems to be particularly true for more rural as well as inner-city areas where overall coverage rates have generally been lower than suburban areas.

According to the researchers, unemployment is the key factor in the trend. With unemployment, employer-provided coverage is usually terminated and due to the drop in income families and individuals often become newly qualified for public plans. Eligibility for health insurance plans has also been expanded, which helps push families and individuals in making the choice to go to public insurance. The research also uncovered an unfortunate situation: nationwide, about 9 percent of children do not have any type of coverage; over half of them are eligible for coverage through Medicaid and/or SCHIP.

“Research demonstrates that most of these eligible children come from states with low participation rates and are disproportionately Hispanic. Because those who have health insurance are healthier overall and, more importantly, because healthy children are more likely to become healthy adults, focusing on covering eligible children should remain at the forefront of the nation’s agenda,” the researchers said.

As of Jan. 1, a variety of preventive screenings and services have been fully covered under Medicare. However, beneficiaries may not be fully aware of the new preventive services offered. The Centers for Medicare and Medicaid Services (CMS) has acknowledged that public awareness of the benefits needs to be increased, and that more needs to be done despite continuing efforts.
According to CMS, over 50 percent of Medicare beneficiaries utilized the new preventive screenings, but very few of the Medicare recipients have taken advantage of the Annual Wellness Visit, which includes consultations with health care providers to go over medical history, genetic inclinations, prescriptions, risk factors, choices for treatment, and to create screening schedules and take basic measurements.
Some of the free screenings include:

• Annual mammogram
• Annual prostate cancer screening
• Annual diabetes screening, twice a year for prediabetic patients
• Colonoscopy every 10 years, every 2 years for high risk patients
• Bone mass measurement every 2 years

After a year in action, there are mixed feelings on health care reform today.