The Health Shopper

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.

On the whole prescription drug prices have been steady for some time and are projected to remain so through 2012. According to HHS, approximately 900,000 beneficiaries are currently receiving discounts of up to 50 percent on brand-name drugs through Medicare and have seen greater accessibility in generics.

But a recent study from NERA Economic Consulting reveals that seniors, particularly those on specialty tiers in their health plan, are currently “largely unaware” of the often-exorbitant costs of prescription drugs. “Specialty tiers”, as defined by NERA, are separate prescription categories that include “higher-cost, brand name medications… used to treat conditions like cancer, multiple sclerosis, rheumatoid arthritis, HIV/AIDS and lupus”.

The results of the study showed that Medicare consumers were not aware of Medicare Part D plans’ differences in prices of medicines for more serious recurring issues. They also misjudged the out-of-pocket costs for specialty-tier medications and thought they would be paying a co-pay (as opposed to coinsurance) for a prescription drug on the specialty tier. Overall, Medicare beneficiaries underestimated the prices of prescription drugs but, even worse, were not certain how much they were paying for each drug.

Medicare beneficiaries should consult with doctors and speak with Medicare or the provider directly before opting to use (and pay for) any prescription drugs.

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

Resolving one minor “glitch” in the new health care law could save billions over 10 years. It would put under 1 million people out of Medicaid, which is a surprisingly small percentage of the almost 50 million on Medicaid as of 2009.

Examination of Social Security benefits has been put forth as an alternative to simply providing early middle-income retirees from 62-65 Medicaid eligibility. Less than a million people would be affected by the legislation and about $13 billion would be saved over the next decade.

Of those affected, half would still be eligible for subsidies on health care via state-run exchanges and a little under half a million people would be insured by their employers.

Economists and legislators’ long-standing question has finally been addressed: Does health insurance for the poor really make a difference? As Medicare/Medicaid debts hit all-time highs, many states are cutting back their Medicaid programs. And while affordable health insurance remains a reach for the poor and uninsured, the first large-scale controlled study tackles the question of Medicaid’s influence on the uninsured.

Professor of health economics at the Harvard School of Public Health Katherine Baicker and professor of economics at M.I.T. Amy Finkelstein conducted a groundbreaking study, thanks to a peculiar situation in Oregon. Low on money, Oregon wanted to grow its Medicaid program but could only provide for 10,000 new enrollments. When almost 90,000 uninsured applied the state had to select applicants by a lottery, setting the stage for Dr. Baicker and Dr. Finkelstein’s study on the benefits of health insurance for the poor.

Using the uninsured applicants as a control group, the researchers asked those who had gotten Medicaid what difference the insurance made. The first phase of the study found vast differences between the two groups, and found that the insured had spent 25% more on medical costs. Under Medicaid, they were 35% more likely to see a doctor and 30% more likely to gain admission to a hospital, though there was no major change in ER use. Those who had insurance were also more likely to have a particular clinic and doctor they regularly checked in with.

Outside of the numbers, insurance also reported feeling much better. They were more likely to partake in preventive care with women being 60% more likely to get mammograms. And insurance made a difference for the subjects’ financial stability as well: those with Medicaid were 40% less likely to borrow money or fail to pay non-medical bills due to insurance costs.
Currently, the study is examining the health effects of health insurance. So far, 12,000 people have been interviewed and assessed for health via blood pressure, cholesterol, etc. Half of the interviewees are covered under Medicaid and half are not.

Dr. Baicker was surprised by the difference insurance made. “Being uninsured is incredibly stressful from a financial perspective, a psychological perspective, a physical perspective,” she said. “It is a huge relief to people not to have to worry about it day in and day out.”

The Congressional Budget Office has some news on federal health care spending, and it’s not all good: one projection asserts that federal health care spending could nearly double in the next two decades, comprising around 11% of the nation’s GDP (currently 5.6%). A less optimistic projection of the health care budget presents the debt at 100% of GDP in the next decade, almost 200% by 2035.

The numbers are startling, but there’s a catch: CBO is using pre-ObamaCare growth rates. Given the effects of the Affordable Care Act, from doctors’ payment cuts to decreased insurance subsidies, CBO has stated that the level of federal health care spending would not be easy to maintain long-term.

With the constitutionality of the Affordable Care Act currently up for debate in federal courts, what are your thoughts? Do you consider Medicare and Medicaid as a priority regardless of debt?

In light of attacks on the constitutionality of health care reform Obama has softened his stance on the law. He recently acknowledged the challenges involved in meeting the 2014 deadline and offered to back a proposal allowing states some leeway in implementing the major components of the law.

The president emphasized a section of the law that would allow states to construct their own variations of the reform law in 2017, as long as they retained the vision of the Affordable Care Act. He also said he would back a measure to push that deadline a bit closer, to 2014.

Currently under the health care reform law states are entrusted the task of creating health insurance marketplaces, or exchanges, and reviewing abortion insurance. States have found that reform has qualified more people for Medicaid coverage. Furthermore they also cannot remove individuals from Medicaid, which occupies about a third of states’ budgets currently, until the exchanges are in place which some feel will take an enormous toll on some states’ budgets. In response to these concerns, Obama requested that a bipartisan commission be created in order to examine the situation and find ways to make the implementation more fiscally viable.

As of June, the 15-month, 65% COBRA health insurance premium subsidy was gone. For all those who’d recently lost jobs, there was no cushion. Congress opted not to extend the legislation as keeping it until the end of the year would cost almost $8 billion.

Unfortunately, this leaves the thousands of recently unemployed to bear the monthly premium on their own. However, hope is not lost. Here are some alternatives to COBRA for the unemployed that you might be interested in checking out:

1. An insurance broker may be able to help you find an affordable health insurance plan. Consider a high-deductible plan, which tends to be cheaper. See getinsured.com for more options.

2. You may be eligible for a government-sponsored plan. Some examples include Medicaid and CHIP. It might pay to research such programs to see if you’re eligible.

3. If you’re under 26, you can get coverage under your parents’ plan!

4. It may help to distribute one family plan into multiple individual plans. This is a better option than having a whole family with no coverage.

5. Consider a high-risk pool – these carriers typically cannot deny you due to a health problem.

Most often located in rural or low income neighborhoods, community health centers have seen an increase in demand this decade.

Now as part of healthcare reform, community health centers will double yet again. As per reform legislation, community health centers will receive another $11 billion in the next five years.

A major portion of the 16 million people that will be newly insured by 2019 will receive coverage from Medicaid, a large chunk of whom will live in areas with community health centers.

In light of this skyrocketing demand and major expansion of community health centers, the biggest challenge will be staffing the centers. Community health centers may end up in competition with systems for physicians, assistants, nurses, social workers, counselors, etc. Part of the challenge is also incentivizing the centers for practitioners (though community health centers will be able to offer doctors $50,000 a year as opposed to $25,000, due to reform).

According to CDC’s most recent data, one out of every five Americans visited the emergency room in 2007. Medicaid qualifiers and adults in “fair or poor” health, as well as people over 75, are the most frequent visitors of the E.R. In 2007, the top reasons for E.R. visits were upper respiratory infections, superficial injuries and sprains – all relatively minor problems. Patients without health insurance typically have E.R. bills that are considerably higher than those that are covered, yet nonemergency trips to the E.R. occur regardless of the type of insurance – private, Medicaid, or none – that the patient had.

The New York Times recommends calling a doctor before making the trip to the emergency room, or utilizing your provider’s nurse hotline/doctor on-call feature. To explore your options with this feature/benefit and ensure your E.R. visits don’t break the bank, visit getinsured.com and review your options.