A growing number of people in Obamacare are finding out their health insurance plans will disappear from the program next year, forcing them to find new coverage even as options shrink and prices rise.At least 1.4 million people in 32 states will lose the Obamacare plan... Reported by Newsmax 5 hours ago.

1.4 Million Could Lose Coverage Under Obamacare At least 1.4 million people from 32 states could lose their health insurance under the Affordable Care Act, commonly known as Obamacare, as their plans are set to disappear from the program next year. They will have to find new coverage in a market tha... Reported by Raw Story 7 hours ago.

Keeping yourself in the pink of health is not just a matter of life and death – it’s certainly a financial matter that needs to be taken seriously. Check out these five things you need to know before you decide on getting health insurance. Reported by HNGN 6 hours ago.

Complaints about health insurance have hit a record high, driven by Medibank. Reported by Brisbane Times 19 hours ago.

Reported by SeekingAlpha 19 hours ago.

With the annual Medicare Open Enrollment Period impacting more than 24 million beneficiaries in Medicare Prescription Drug Plans, a Medicare expert identifies the Plan Finder, a web-based tool that compares the cost of Medicare Prescription Drug Plans, as the best way for struggling seniors to evaluate whether or not to switch plans this fall.

San Francisco, CA (PRWEB) October 17, 2016

Medicare Open Enrollment, October 15th to December 7th, is generally the only time each year that Medicare beneficiaries can change their Prescription Drug Plans for the following calendar year. Yet research from the Kaiser Family Foundation shows that only a small share of Medicare beneficiaries, 10% - 13% on average, voluntarily switch plans during Open Enrollment. Little is known about the reasons why people switch, but the data implies that people switch to lower their premiums.

“With drug plans the primary selection criteria should be overall total cost, not the cost of premiums,” says Esther Koch, Medicare aging network partner with the Centers for Medicare and Medicaid. “What people don’t understand is just how differently plans categorize and price drugs. Why spend more for the same set of drugs?”

Koch emphasizes that an annual drug plan review is needed. “Even if a beneficiary is satisfied with their current plan, the plan itself is likely to be changing. And for the senior, their drugs may have changed or will be changing too,” says Koch.

“Reviewing plans can be very difficult for seniors and yet their health and financial security might depend on it,” says Pat Vitucci, a San Francisco Bay Area independent financial advisor. Koch spoke about this year’s Medicare Open Enrollment Period on Pat Vitucci’s weekly radio program, "Your Financial Life," which airs on KDOW 1220AM San Francisco and KSRO 1350AM Santa Rosa.

According to Koch, the most underutilized solution for comparing drug plans is the Plan Finder at http://www.Medicare.gov/find-a-plan. It allows for an easy comparison of all drug plans available to a beneficiary. By entering zip code, drug specifics, pharmacy choices, and answering a few questions, the Plan Finder does all the work. It provides an apples-to-apples comparison of total estimated annual cost (premiums plus the cost of drugs) for each plan and lists the plans from least expensive to most expensive total cost.

“You would be amazed at the range of total cost differences between drug plans for the same set of drugs,” says Koch. Koch can speak to these variances as she assists her clients with their annual drug plan reviews and selections. For example, for 2017 she will be recommending a plan that will save one of her clients $7,000 in comparison to the least cost plan she recommended for 2016. In prior years, the cost savings ranged from $2,000 to $11,000 per year. And these numbers are for just three drugs. “As higher cost specialty drugs are being prescribed, it becomes even more important to do annual drug plan reviews and switch plans based on overall total cost,” says Koch.

Koch provides another tip: “Many seniors need help during Medicare Open Enrollment. If you are caring for an aging parent, this is an opportunity to not only help your parents but to educate yourself to their medical conditions and their health insurance coverage and costs.”

ABOUT ESTHER KOCH AND ENCORE MANAGEMENT
Esther Koch, the Founder of Encore Management, is a Gerontologist and Aging Network Partner with the Centers for Medicare and Medicaid and the Administration on Aging, and was a delegate to the White House Conference on Aging. In addition, she has a professional business background as a Stanford MBA, PricewaterhouseCoopers CPA, and CFO.

Esther is a frequent speaker on Medicare, eldercare, and other retirement and aging-related topics. Visit her Vimeo Video Channel at https://vimeo.com/estherkoch and her YouTube Video Channel at https://www.youtube.com/channel/UCYpYeO8O9iqfu-fVFaQ_ZvQ .

Encore Management assists clients with their initial Medicare elections, subsequent annual Medicare Prescription Drug Plan reviews and selections, and provides other aging advisory services. For additional information visit http://www.ENCOREmgmt.com. Reported by PRWeb 18 hours ago.

*Business Wire India*

· Sampoorna Raksha: A Term Plan
· Sampoorna Raksha Plus: A Term  Plan with Return of Premiums on Maturity
· Vital Care pro: A Critical Illnesses Plan

​​
​​As caregivers, it is only natural to want the best for our loved ones. We do everything in our capacity to safeguard their aspirations against any financial upheavals that may play spoilsport. But our lives are fraught with uncertainties, and it is difficult to predict what the future holds. What we need is a safety shield to ensure that our family’s needs are never compromised.
 
Keeping this in mind, Tata AIA Life launched three new products, *Tata AIA Life Sampoorna Raksha* - a non-linked non-participating term assurance plan,  *Tata AIA Life Sampoorna Raksha+ - *a non-linked non-participating term assurance plan with return of premium on maturity, and *Tata AIA Life Vital Care Pro*, a non-linked non-participating health insurance plan to help the customers protect their families from financial dependency in case the earning member is no more or is rendered incapable by critical illness. All the three solutions guarantee a lump sum benefit with options to choose regular monthly income, ensuring one’s loved ones would meet all their life goals without worrying on daily needs at any point.
 
According the Asia Pacific Mortality Protection Gap* Report published by Swiss Re, there exists a big gap in insurance coverage in Indian households. The report estimated that the gap was $8,555 billion in 2014. This means for every $100 needed for protection, only $7.8 of saving and insurance is in place for a typical Indian household, leaving a massive mortality protection gap of $92.2. It is evident from this startling gap that there is a pressing need for long-term savings and protection solutions in the country.
 
Focusing on the need of adequate life insurance, which ensures a stable financial future for one’s family, *Rishi Srivastava*, *Chief of Proprietary Channels*, *Tata AIA Life* said, “People are usually underprepared to deal with adversities because they are generally caught up in planning for their future. Our newly-launched products will not only help customers lay the foundation of well-planned financial future, but also secure sustenance in case of unforeseen circumstances. Our well-trained sales force helps customer calculate actual coverage needed to live a financially secured future without compromising on their aspirations.”

With a wide range of policy terms starting from 10 years and going to as high as 40 years, coupled with the maximum maturity age of 80 years, Sampoorna Raksha maximises the life insurance coverage period of an individual’s lifetime. The consumers have the flexibility to choose a lump sum benefit on death along with a regular monthly income. They can also opt for increasing life cover. It offers preferential premium rates for women and people with leading a healthy lifestyle.

Sampoorna Raksha+ is a term assurance plan with return of premiums on maturity. Like Sampoorna Raksha, this plan enables flexibility to the customers to opt for lump sum benefit on death along with monthly income for next ten years. One can choose to pay the premium for a limited period of five to ten years.

Changing life styles and an exponential increase in medical expenses may put people in a vulnerable state of financial planning. Vital Care Pro is aimed at protecting the customers and their loved ones from such harsh uncertainties. The product offers protection against 15 critical illnesses. Furthermore, the product offers premium rate guarantee for the entire policy term, which can be as long as 30 years. With a hassle-free purchase experience and affordable premiums, the plan also empowers its customers to protect their spouses.
 
* Swiss Re’s 2015 Mortality Protection Gap Report
 
*About Tata AIA Life*
 
Tata AIA Life Insurance Company Limited (Tata AIA Life) is a joint venture company, formed by Tata Sons Ltd. and AIA Group Ltd. (AIA). Tata AIA Life combines Tata’s pre-eminent leadership position in India and AIA’s presence as the largest, independent listed pan-Asian life insurance group in the world spanning 18 markets in Asia Pacific. Tata AIA Life has written retail new business weighted premium of Rs. 344 crore in the first half of FY 17, which represents a growth rate of 102% over previous year. As of Sep 30, 2016, the 13th month persistency of the company stands at 80.5%. At the end of FY 16, the retail claims settlement ratio of the company was 96.8%.
 
*About Tata  *
 
Founded by Jamsetji Tata in 1868, the Tata group is a global enterprise, headquartered in India, comprising over 100 independent operating companies. The group operates in more than 100 countries across six continents, with a mission 'To improve the quality of life of the communities we serve globally, through long-term stakeholder value creation based on Leadership with Trust'. Tata Sons is the principal investment holding company and promoter of Tata companies. Sixty-six percent of the equity share capital of Tata Sons is held by philanthropic trusts, which support education, health, livelihood generation and art and culture. In 2014-15, the revenue of Tata companies, taken together, was $108.78 billion. These companies collectively employ over 600,000 people. Each Tata company or enterprise operates independently under the guidance and supervision of its own board of directors and shareholders. There are 29 publicly-listed Tata enterprises with a combined market capitalisation of about $116.41 billion (as on March 31, 2016). Tata companies with significant scale include Tata Steel, Tata Motors, Tata Consultancy Services, Tata Power, Tata Chemicals, Tata Global Beverages, Tata Teleservices, Titan, Tata Communications and Indian Hotels.
 
*About AIA *
 
AIA Group Limited and its subsidiaries (collectively “AIA” or the “Group”) comprise the largest independent publicly listed pan-Asian life insurance group. It has a presence in 18 markets in Asia-Pacific – wholly-owned branches and subsidiaries in Hong Kong, Thailand, Singapore, Malaysia, China, Korea, the Philippines, Australia, Indonesia, Taiwan, Vietnam, New Zealand, Macau, Brunei, a 97 per cent subsidiary in Sri Lanka, a 49 per cent joint venture in India and a representative office in Myanmar and Cambodia.
 
The business that is now AIA was first established in Shanghai almost a century ago. It is a market leader in the Asia-Pacific region (ex-Japan) based on life insurance premiums and holds leading positions across the majority of its markets. It had total assets of US$168 billion as of 30 November 2015.
 
AIA meets the long-term savings and protection needs of individuals by offering a range of products and services including life insurance, accident and health insurance and savings plans. The Group also provides employee benefits, credit life and pension services to corporate clients. Through an extensive network of agents, partners and employees across Asia-Pacific, AIA serves the holders of more than 29 million individual policies and over 16 million participating members of group insurance schemes.
 
AIA Group Limited is listed on the Main Board of The Stock Exchange of Hong Kong Limited under the stock code “1299” with American Depositary Receipts (Level 1) traded on the over-the-counter market (ticker symbol: “AAGIY”).

*DISCLAIMER:*

· Tata AIA Life Insurance Company Limited (IRDA of India Regn. No. 110) CIN U66010MH2000PLC128403; registered and corporate address: 14^th Floor, Tower A, Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai – 400 013
· Tata AIA Life Insurance Sampoorna Raksha: UIN - 110N129V01
· Tata AIA Life Insurance Sampoorna Raksha+: UIN - 110N130V01
·  Tata AIA Life Insurance Vital Care Pro: UIN - 110N128V01
· For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale
· Insurance cover is available under these products.
· These products are underwritten by Tata AIA Life Insurance Company Limited. These plans are not a guaranteed issuance plans and it will be subject to Company's underwriting and acceptance.
· For complete details please contact our insurance advisor or visit the nearest branch office of Tata AIA Life or call 1-860-266-9966 (local charges would apply) or write to us at customercare@tataaia.com.
· Visit us at: www.tataaia.com or SMS 'LIFE’ to 58888

 
 

*BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/FRAUDULENT OFFERS* –

· IRDA or its officials do not involve in activities like sale of any kind of insurance or financial products nor invest premiums
· IRDA does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along with details of phone call and number​​ Reported by Business Wire India 14 hours ago.

This article appears under the title "Stronger Policy, Stronger Politics" in the Fall 2016 issue of The American Prospect magazine. Subscribe here. 

You’ve heard of a beautiful failure. What about an ugly success? That may be the best way to describe the Affordable Care Act. It has covered millions of Americans—just this year, 250,000 Louisianans signed up for Medicaid in the six weeks after the state expanded the program under the law. And the ACA has widened health coverage without spiking costs; indeed, expenditures are way below initial expectations.

But even if we could forget its shambolic launch, the ACA has hit some increasingly serious obstacles. Enrollment in the new marketplaces created by the law (aka “exchanges”) is below expectations, and the number of plans competing in them is falling, particularly outside dense urban areas. Premiums are set to rise sharply, and these increases could further destabilize the most troubled exchanges by driving away current or potential enrollees, especially the young and healthy.

Federal subsidies for most enrollees in the exchanges will protect them from premium increases, but that still won’t give them the kind of coverage that middle-class Americans with good jobs generally have. In many exchanges, the only available plans put tight restrictions on their enrollees’ choice of doctors and hospitals. Indeed, with their predominantly lower-income enrollees, limited offerings, and narrow-network plans, many of the exchanges look more and more like Medicaid, the health program for poorer Americans, and less and less like Medicare, the health program for older and disabled Americans that enjoys broad middle-class support.

Medicaid is an immensely valuable program. But the continuing problems in American health care—prices that remain out of control, costs that look set to start rising more quickly, uneven access to care of uneven quality, and the insecurity created by our patchwork system with its big remaining gaps in coverage—are too large for a small set of scattered players in the market to address effectively. Nor will such arrangements create the broad political constituency necessary not just to defend current reforms but to improve them.

In short, health-care reform is at a crossroads. Every major social policy in the past—even Social Security—has required modifications to adapt to changing conditions and respond to unexpected outcomes. To state the obvious, the ACA hasn’t entered this phase of constructive adaptation. On the one side, Republicans have demonized the law and aggressively undermined it. In the states they control, they have refused to expand Medicaid and hindered enrollment in the exchanges, and in Congress they have blocked efforts to fix problems in the law.

On the other side, the law’s supporters have emerged from their foxholes; yet many still shy away from acknowledging the need for further reform. Some defenders are reluctant to highlight problems lest they undermine the law’s still-shaky public standing or open the door to destructive changes. Others on the left aren’t loudly calling for an upgrade of the ACA because they believe it was far too timid—a “good Republican program” was Bernie Sanders’s faint praise in 2013. As a result, there remains an enormous gap between those who say, “This is actually pretty good” (realistic but not inspiring), and those who say, “Let’s replace it with Medicare for All” (inspiring but not realistic, for reasons I’ll discuss).

Right Art/AP Images Credit

Health Care on the Menu: As part of the 2016 effort to boost health insurance coverage, Barack Obama has lunch wtih Milwaukee residents who wrote to him about the Affordable Care Act. In July, the president called for a public option in areas of the country with little or no private competition in the ACA's health insurance exchanges. 

What reformers need, in other words, is a positive agenda that’s both inspiring and realistic—an agenda that won’t just address some of the real shortcomings of the 2010 law, but also create political pressure for ongoing improvements. The top imperative is clear: The exchanges must become an attractive source of affordable, quality coverage for a broad range of Americans, including the middle class.

The key to a persuasive vision that attracts broad popular support is bringing back the public option—a public plan modeled after Medicare that can serve as a backup and benchmark for private plans. Too often the public option is seen as distinct from the exchanges. Yet it’s critical to creating regulated marketplaces that work. The public option can make the exchanges more attractive to consumers, especially where private plans with broader networks are scarce. By doing so—and by working alongside Medicare to restrain prices while improving quality—it can help keep premiums in check, bring healthier people into the pool, and thereby stabilize the foundation for a functioning marketplace that includes private plans.

No less important, the public option can serve as a focal point for efforts to improve the ACA, uniting reformers behind an ambitious but achievable vision. It’s more than a policy mechanism. It’s the message of a movement for the ACA’s continuing expansion.

 

*Making It Stick*

Let’s be clear: Continuing improvement of the ACA was always going to be needed. While some of the law’s tribulations have come as a surprise, the basic challenge was apparent even before Barack Obama’s signature on the legislation was dry. The ACA wasn’t designed to be ideal. It was designed to be passable—acceptable to enough stakeholders to be enactable in a polarized Washington. Its central liability today was its central advantage back in 2010. By minimally disrupting existing coverage, it minimally threatened most of the currently insured. That was the way to get more people covered and to create a secure source of fallback coverage for everyone. Unfortunately, it wasn’t the way to build a program that would create a strong base of support among the overwhelming majority of Americans with employment-based coverage.

Political scientists have intensively studied when and how policies develop strong support coalitions over time. The formula for success turns out to have three main ingredients: visibility (you know it’s there), traceability (you know who’s responsible for it), and collectivity (you see yourself as part of a group benefiting from it). Basically, voters should be able to see a benefit; reward politicians for delivering it or punish them for threatening it; and act collectively—ideally in an organized group—in doing so. Without these ingredients, voters tend to see policies less as solutions to immediate problems than as symbols of ideological priors. Instead of moving toward greater investment and enthusiasm, they dig in to their respective partisan camps.

Judged on that basis, the ACA is missing some ingredients. The Medicaid expansion has been high-profile and the exchanges have reached around 12 million Americans (about half the initial projections made by the Congressional Budget Office). Yet the middle-class “deliverables,” as advocates called them back in 2010, have proved mostly invisible or opaque. There’s little evidence, for example, that the millions of young Americans helped by the requirement that insurance companies cover dependents up to age 26 have changed their views of the law or their political activities in response.

To be sure, all Americans are much more secure because of new rules and marketplaces that will let them buy coverage if they get ill or lose their job. But this is a “what if?” scenario and thus cannot be counted on as a basis of active support. The same is true of slower medical inflation. To recognize it, voters have to think about counterfactuals, which is inherently difficult. Moreover, even when voters do recognize these broad benefits, it’s simply not that easy to trace them back to the law.

The upshot is that many Americans don’t feel they have a lot at stake in the ACA’s success. They may have strong partisan commitments; they may even acknowledge the law has done good things. What they don’t generally feel, however, is that the law is substantially benefiting them. And that’s a big problem: If the ACA is going to foster the self-reinforcing political pressures that helped other successful social policies become entrenched, a broad cross-section of Americans must come to see the law as critical to their own well-being and be willing to act collectively to back up that view.

To those who know my prior work, it will come as no surprise that I see the public option as the way to achieve these goals. The idea is simple. It is popular. And it actually saves serious money, freeing up the resources needed to deliver on the promise of reform. With committed backing from progressives, the public option could be the centerpiece of a broad campaign to respond to public concerns, put critics on the defensive, and expand the boundaries of the possible. Rallying behind the promise of a Medicare-like plan, this movement would demand the public option not as a stand-alone policy but as an essential component of a larger upgrade of the ACA.

Fibonacci Blue/Flickr/Creative Commons

Tea Party protesters rally against the Affordable Care Act in St. Paul, Minnesota, on April 15, 2010.

That upgrade should start with the law’s most troubled component, which is also the most crucial component for building middle-class support: the exchanges.

 

*A Better Exchange*

The exchanges were supposed to be the centerpiece of the ACA: the primary source of subsidized coverage for uninsured people not poor enough to receive Medicaid. Their enrollment, however, is well below expectations—lower than needed not just to ensure the stability of the exchanges but also to create a strong constituency in support of the law.

We’ve seen this movie before. Medicare has long allowed beneficiaries to choose to receive their benefits through regulated private plans—the system is now called “Medicare Advantage.” Two decades ago, however, private plans were pulling out of Medicare in droves, almost a third of beneficiaries didn’t have access to even one, and many predicted a “death spiral” for the remaining plans.

That didn’t happen, and a big part of the reason, as Sabrina Corlette and Jack Hoadley of Georgetown University’s Health Policy Institute show in a timely new study, is that Congress amended the program to stabilize the plans. The results were swift: Within a few years, enrollment shot up, and nearly every Medicare beneficiary had access to at least one private plan.

Now, part of the reason that private plans regained ground was that Congress gave them a hefty subsidy above the cost of treating comparable patients within traditional Medicare. But another reason was a major improvement in Medicare’s program for adjusting what plans were paid to reflect the true risk of enrollees. Indeed, despite a ratcheting down of the subsidies since 2010 (savings that offset part of the cost of the ACA), private plan participation in Medicare has grown. Moreover, there’s good evidence that the best Medicare Advantage plans deliver core benefits at least as efficiently as Medicare does, suggesting the subsidies are not necessary to maintain their participation.

The key lesson from the Medicare experience is that policy-makers need effective tools to make sure that health plans are not devastated when they end up with disproportionate numbers of high-cost patients. The tools in the ACA have proved inadequate, and some of the provisions authorizing their use are expiring since they were envisioned only as transitional. Congressional Republicans have also succeeded in curbing one such support for the market. An essential next step, then, is to strengthen and extend the “risk-adjustment” and reinsurance provisions of the law, which will require new legislation, and to put new federal dollars on the table to stabilize the most troubled markets.

Another crucial (and far more obvious) response is to increase the subsidies for enrollees in the exchanges, especially for middle-income people. These premium subsidies were always too low, and given the below-projected costs of the program—and the savings that could come from adding a public option—the case for increasing them now is overwhelming. Indeed, it’s imperative if the ACA is going to have a strong middle-class constituency. Increased subsidies should be coupled with a massive increase in outreach efforts, particularly to younger Americans, to bring in more affluent and healthy stakeholders. This, again, will require investments now that pay off later.

Reformers should also seek to make it less attractive for people who buy coverage individually to buy it outside the exchanges. As Henry Aaron of the Brookings Institution has pointed out, one way to improve the exchanges is to do what Washington, D.C., and Vermont have done: require that individual insurance plans sold outside the exchanges also be offered on the exchanges, making it impossible for insurers to stay out of the subsidized market (with its relatively poorer and less-healthy population) while still serving the rest of the individual market. This single-market requirement would have two big benefits: Insurers would be more reluctant to quit the exchanges if that also meant not offering any individual policies, and a wider selection of offerings in the exchanges would then bring in more people, especially if those offerings include the public option.

 

*The Best Option*

Nearly every argument for the public option looks stronger today than it did in 2010. Insurance markets have grown more consolidated. Provider groups have become more concentrated and more resistant to private insurers’ efforts to hold down prices. The co-ops added to the law as a sop to public-option advocates have abjectly failed, as those advocates predicted they would. And now there’s a growing chunk of the nation without any insurance competition in the exchanges. As a result of the withdrawal of major national commercial insurers, exchanges serving roughly one in five people will offer only one insurer—call it a private single payer. If that doesn’t make the case for the public option, I don’t know what does.

Pete Souza/Wikimedia Commons

President Barack Obama, Vice President Joe Biden, and senior staff, react in the Roosevelt Room of the White House, as the House passes the Affordable Care Act.

The public option isn’t only about coverage; it’s also about costs. A growing body of evidence shows that the prices paid by Medicare are more reasonable than the higher (and wildly variable) prices paid by private insurers. Medicare’s administrative costs are much lower than those of private plans. The program has spearheaded major innovations in reimbursement policy—for example, with its recent move toward the bundling of payments for particular episodes of care. By penalizing hospitals for readmissions, Medicare is getting them to pay more attention to the quality of care they provide.

The ACA leans heavily on Medicare to provide cost savings, not only through cost reductions in the program itself but also through the diffusion of its practices into the private sector (which has been going on for decades). But there are real risks to placing all the cost-control eggs in the Medicare basket. For one, Medicare serves distinct populations: older and disabled Americans. More important, using Medicare as a means to create cost savings and sustain the ACA has already provoked considerable political resistance among Medicare’s beneficiaries, whom Republicans have targeted with frightening (and generally false) claims about the ACA’s effects. A sizable public plan for non-elderly Americans would save money directly and create greater scope for federal efforts to promote innovation in the services used mostly by younger Americans.

There’s another big advantage to the public option too often neglected. When exchanges are reliant on the good graces of insurers, those who run the exchanges are reluctant to push too hard to ensure plans perform well, lest they exit the program altogether. At the extreme, policy-makers may tolerate behavior they’d never allow otherwise. When Aetna recently pulled back, it signaled a key reason was the federal government’s move to block its proposed merger with Humana. The public option gives policy-makers the greatest possible scope to pursue tough policies that are necessary to make an increasingly consolidated industry work.

To be sure, the obstacles that derailed the public option in 2010 haven’t gone away. The biggest is how to ensure provider participation in the plan. The public option should be based on Medicare, albeit with broader benefits (comparable to the mid-range silver plans on the exchanges). It should use Medicare’s infrastructure for payment and quality assurance. And it should pay providers at Medicare’s levels, plus some bonus to encourage participation (say, 10 percent, and perhaps more in states where Medicare payments are exceptionally low relative to what private insurers pay). That’s going to make the public plan highly competitive. It’s also going to make providers more reluctant to sign up for it, as well as increase the incentive for insurers to lobby against it.

But these problems have solutions, too. For insurance companies, fixing the exchanges means many more people buying their products and better management of the market to protect them if they end up with less-healthy patients. Sure, they would prefer to have all this and no public option too, but they should be offered a package deal. Most plans should be able to thrive alongside a public option, just as they have in Medicare Advantage. Though the traditional Medicare program has been much more innovative than commonly believed, it’s never going to be an HMO. Its strength is in being a big player that can leverage its reach to make major systemic changes. That role leaves plenty of room for private plans to develop models that some people value even more. Remember: Virtually all private insurance companies are eager participants in Medicare Advantage. They’ve already accepted a public option in return for a lucrative market.

It’s tempting to argue for the public option as a fail-safe in areas where there are only a few private insurers, as President Obama advocated last July in a high-profile article in the Journal of the American Medical Association. But this approach would have numerous problems. The public option should not be commissioned and decommissioned based on the private offerings from one year to the next, and once it’s offered in an exchange, it should remain there to ensure continuity of coverage. Moreover, only providing a public option as a fallback creates the very uncertainty that insurers are citing when they pull out of the exchanges today. Better to stabilize the regulated private market and add the public option in all the exchanges.

Jane Stevens/Flickr/Creative Commons

The provider side poses steeper hurdles. The concentration of providers’ groups means many are demanding—and getting—rates far higher than what Medicare pays. Nonetheless, providers continue to accept Medicare patients at historically high levels, and most efficient providers more than break even treating them (which is why charges of “cost-shifting” are wrong-headed—the main problem is inefficient systems). Still, it would be prudent to require that providers who take Medicare patients also take those covered by the public option. Medicare-participating providers are not allowed to turn down Americans younger than 65 who are permanently disabled or have end-stage kidney disease (both non-elderly populations covered by Medicare). Why should they be allowed to turn down younger Americans who are enrolled in the public option?

As a first step, we should limit so-called out-of-network charges to a multiple of Medicare’s rates, as California is currently considering. (The California bill limits payments to 125 percent of Medicare’s rates while capping patients’ out-of-pocket obligations.) This is similar to what Medicare does to limit charges by non-participating providers, and it will ensure providers have little incentive to remain outside the public option. Applied to all insurers, it will also reduce the major problem of “surprise medical bills” (when, for example, in-network hospitals use out-of-network specialists) that threatens even well-insured patients today.

California’s example brings up a final point: States will have a fundamental role in the struggle for a broader, stronger, and better ACA. Already, they have the ability to apply for special waivers to expand Medicaid through unconventional means—for example, by allowing newly eligible populations to buy insurance through the exchanges (with ample subsidies and cost-sharing protections). Starting next year, they can also apply for state “innovation” waivers to try new approaches to universal coverage, including creating their own public plans.

These waivers have risks, of course, and states must be held to high standards. But a high-standards federalist approach—which is roughly how Canada’s system of provincial plans works—has virtues, too, allowing states to experiment in ways that can inform other states’ (and national) policies. Perhaps most important, new state approaches create the opening for strange political bedfellows—the final imperative to discuss.

 

*Looking for Love in All the Wrong Places*

Successful policies have strong backers—the kinds of backers who will campaign for a public option. Successful policies also build unlikely alliances, swinging opponents into the pro column over time. It’s not just that policies need support from the other side when political winds change. It’s also that unlikely allies—even reluctant allies making the best of a bad situation—have the greatest impact on the potentially convincible. When a GOP governor or prominent corporate leader backs the ACA, it signals that a good Republican or genuine business representative can support a reform identified with the other side.

In the near term, the biggest opportunities for such alliances involve Medicaid. Nineteen states continue to refuse to expand their programs, leaving an estimated three million to four million Americans caught in the gap between qualifying for Medicaid and qualifying for subsidies in the new exchanges. They do so despite full federal funding for the initial expansion (and 90 percent in perpetuity), despite tens of billions in potential reimbursement for doctors and hospitals in their state, despite the resulting slower growth in their economies, and, above all, despite the enormous hardship they are creating for low-income people. While Republican governors have proved more willing to buck the GOP line than Republican legislatures have, there’s little sign that most of the holdout states will relent absent serious new pressure.

Fortunately, it’s not hard to see where that pressure could come from. The Supreme Court said that all Medicaid funds could not be conditioned on states expanding their programs. But new federal legislation that put in place significant but not draconian penalties for states that failed to increase Medicaid eligibility would likely pass constitutional muster—especially if a Democrat-appointed justice were to assume the seat left open by the death of Antonin Scalia. The pot could be sweetened by extending full federal financing of the expansion for additional years. If holdout states not only had to forgo big benefits but also had to pay higher costs, the incentives to comply would become overwhelming.

A second potential source of unexpected support is the business community. Most employers have been only tangentially affected by the ACA—they were either already offering insurance that more or less met the law’s standards, or they weren’t providing it at all and still don’t have to. As a result, they have largely accepted the 2010 law but without any great enthusiasm.

Where could business support come from? One possibility is smaller employers. The ACA created new options and subsidies for firms below the 50-worker threshold (the point at which firms face penalties if they don’t insure their workers). But these provisions have largely failed to encourage small employers to use the ACA’s infrastructure to provide coverage. A major problem is that small-business owners are unaware not just of the option of enrolling their workers through the marketplaces but also of the availability of tax credits they would receive to lower the cost.

Better advertising the benefits of the ACA to small businesses would certainly help. But we should go further. Under the current law, if an employer doesn’t provide coverage, workers have to seek out plans on their own. A far better system would ask all employers whether they cover their workers, and automatically enroll those workers when they don’t. Workers could still opt out if, for example, they had insurance through a spouse or acknowledged they would have to pay a tax penalty for going without coverage. But this relatively simple step of automatic coverage could radically change the system: The default for workers without employment-based coverage would change from no insurance to insurance through the exchanges. Employers of these newly covered workers would then be required to make a modest contribution to the cost based on employees’ wages (higher when they’re higher) and firms’ size (lower when it’s smaller, with no charge for employers with 50 or fewer workers—just as in the ACA today).

Pete Souza/Wikimedia Commons

President Obama signs the Affordable Care Act into law on March 23, 2010. 

Of course, this will be a heavy lift. But it’s the best way to ensure workers get coverage as well as foster a deeper business stake. And it’s the right policy. Liberals and conservatives agree that employment-based coverage has real downsides. It makes workers excessively worried about leaving or losing a job, places a burden on smaller businesses that provide coverage, and probably deters entrepreneurship as a result. The ACA has proved that big employers still have plenty of incentives to offer coverage. Yet the share of small employers providing it continues to decline, and large employers may move away from guaranteed coverage in the future even if there’s a penalty. If they do, automatic enrollment in the exchanges ensures their workers don’t fall through the cracks—while, again, bringing more big, diverse groups into the exchanges.

Figuring out how to better integrate employers into the ACA wouldn’t just be good for the law’s political entrenchment. It would ensure that the system could evolve and adapt as the economy changed. Creating that potential is precisely why reformers need to fix not only the policy features of the ACA but also its politics.

 

*The Fierce Urgency of Now*

Fixing the ACA’s politics won’t be easy. A president can strengthen the law without new legislation. States can improve what they’re doing without national policy changes. But the big steps I have called for—expanding the exchanges, adding a public option, rewriting the Medicaid rules, bringing in employers—will require new federal legislation. That means their prospects will depend critically on what happens in this year’s elections.

Thankfully, it won’t depend as critically on whether reformers can get 60 votes in the Senate. Now that the ACA is law, a good deal of what needs to be done can be accomplished through the budget process, which isn’t subject to a filibuster. Budget legislation must meet other rules, most notably that it doesn’t raise the deficit. This means increased premium subsidies or changes in Medicaid rules will require offsetting revenues or spending reductions, or both. As I’ve argued, at least some of this fiscal space could come from the public option.

Yet even without the 60-vote hurdle, Democrats are going to have to create serious cross-pressures on Republicans, especially if the GOP continues to hold the House. They need to portray the ACA’s limitations as a preventable illness rather than a chronic condition—the outcome of Republicans’ attacks on the law and unwillingness to support attractive remedies. They need to own the ACA’s formidable successes and make Republicans own its fixable shortcomings, especially Republicans in more moderate districts and states.

Which is why all advocates of universal insurance—even those who believe that Medicare for All is the goal—need to embrace and build on, not scorn, the ACA. It’s attractive to think the only way to get to “real” reform is to bury the law and create something else. But the history of health reform in rich democracies suggests otherwise. The British National Health Service was built on a far more modest national insurance program. Most European systems moved from programs focused on wage earners to universal or near-universal programs that turned once-private sickness funds into quasi-public institutions. In Canada, provincial programs (initially just for hospital care) were stepping stones to today’s comprehensive (though still provincially based) system.

Our own history tells the same story: LBJ had two-thirds Democratic majorities in 1965, and he could only create universal federal insurance for the aged (Medicare) and targeted coverage for the poor (Medicaid)—the two groups conspicuously left out of the employment-based system. Even Social Security started small and grew big. For its first 15 years, the federal old-age insurance program was caught in limbo, with its opponents successful blocking the increases in coverage and funding necessary for it to successfully compete with state assistance programs for the indigent aged (set up alongside the federal program in 1935). As late as the early 1950s, these state relief initiatives were reaching three times as many people, and Social Security faced a serious conservative push for “repeal and replace.” It expanded only when Republican Dwight Eisenhower, under pressure from Democrats and labor unions, decided that it was a better way to deal with retirement insecurity.

The reasons for Eisenhower’s decision are instructive. Conservatives were divided, because they worried that the assistance programs were a fiscal burden on the states and an invitation to dependency (because those programs didn’t require contributions). Meanwhile, corporations had built their private pensions on top of Social Security and wanted the public program to pay out more so they could pay out less. Of course, Eisenhower also knew Social Security was popular. But the massive popular support and “elderly lobby” we now associate with the program was mostly an effect, rather than a cause, of the big expansion that he supported. In a very real sense, Social Security built its own support.

If the ACA is to take its place alongside Social Security, it will need to start building its own support, too—and everyone who believes in reform must pitch in to make that happen. If the law is increasingly sidelined, we won’t go back to the status quo ante; the right will be emboldened and the most promising stepping stone for broadened coverage and effective cost control will be lost. Forget Medicare for All. Reformers will be lucky to hold on to what has already been achieved.

Much will hinge on what happens this fall. With a GOP president and Congress, the problems facing the ACA could open the door to destructive changes. If Democrats instead have the White House and a stronger position in Congress—a Senate majority, perhaps, and maybe a House one, too—destructive changes are still a big risk. But there’s far greater scope for moving the debate in the positive direction it needs to go if the virtuous cycle of self-reinforcing improvements is to begin—to launch a concerted campaign for fixing the exchanges, adding a public option, creating effective pressures on GOP governors to expand Medicaid, and making the exchanges the default source of coverage for those without workplace insurance.

If that potential is realized, we may look back at 2017 as a turning point much like the GOP capitulation on Social Security in the early 1950s: not the end of the debate but the beginning of the right debate about how to ensure affordable, quality health care for all Americans. The ugly success could turn out to be a beautiful success, after all.  Reported by The American Prospect 16 hours ago.

In this publication, we address how Dubai is leading the way in the application of technology to its healthcare insurance system and how the health insurance law is developing around these initiatives. Reported by Mondaq 15 hours ago.

Reported by 9News 12 hours ago.

Clinics, health plans, hospitals and health care organizations to benefit from enhanced searching capabilities

La Grange, Ill. (PRWEB) October 17, 2016

Health Navigator announced today that it has partnered with Find-A-Code, the most complete medical coding and billing resource library available, to improve productivity and efficiency for professionals who process billing and payment of medical services. As part of the collaboration, Find-A-Code users will have access to an additional 14,000 medical search terms and codes.

“Find-A-Code makes medical coding easier by providing extensive search terms that are linked to medical codes, which makes them a natural partner for Health Navigator,” said Patty Maynard, senior vice president of business development, Health Navigator. “In the same spirit as Find-A-Code, our system of coded chief complaints is always being updated to keep up with changes in medical coding and trends in patient calls and inquiries. And our Natural Language Processing technology connects the plain language of patient symptoms to these industry codes.”

Users and subscribers of Find-A-Code’s online resources use search terms to help identify appropriate codes more efficiently. Customers range from small clinics to large medical practices, hospitals, teaching colleges, health insurance companies and the federal government. Find-A-Code data aligns with codes from major health organizations, such as Medicare, Medicaid, Centers for Disease Control and Prevention, health plans, the American Medical Association, American Hospital Association, and the American Dental Association.

“Find-A-Code customers need to quickly identify relevant codes, which is why we are laser-focused on gathering the most appropriate search terms for each code,” said David Berky, chief information officer, Find-A-Code. “Our partnership with Health Navigator significantly expands our library of search terms, so users can find what they’re looking for faster.”

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About Health Navigator
Based in La Grange, Ill., Health Navigator is a privately owned health information company that provides a sophisticated, comprehensive telehealth experience, from the chief complaint to the final diagnosis. The Health Navigator platform uses complex databases and a diagnostic engine to capture, organize and present a more efficient virtual encounter for health care providers, e-Health companies and patients. To learn more, visit http://www.healthnavigator.com. Follow on LinkedIn.

About Find-A-Code
Find-A-Code provides the most complete coding and billing resource library available anywhere. Find-A-Code’s libraries include extensive information for all major sets (ICD-10-CM/PCS, CPT®, HCPCS, DRG, APC, NDC, ICD-9 and more), along with a wealth of supplemental information, including newsletters and manuals (AHA Coding Clinics, CPT Assistant, DH Newsletters, Medicare Manuals). All information is indexed, searchable and organized for quick access and cross-referencing. Find-A-Code is designed to help coders avoid denials, save time and get fast answers to medical coding and billing questions. For more information, visit http://www.findacode.com.

Media Contact: Barbara Tabor / (651) 450-1342 / Barbara(at)taborpr(dot)com Reported by PRWeb 11 hours ago.

Patch Bed-Stuy, NY -- The mammograms are also available to women with health insurance, who will be billed normally. Reported by Patch 7 hours ago.

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Family Reach CEO Carla Tardif To Speak Monday, October 17 at The White House As Vice President Biden Releases Final Cancer Moonshot Task Force Report

WASHINGTON, DC - (PRWEB) October 17, 2016

Family Reach Foundation, a national non-profit dedicated to eliminating the financial burden of cancer for patients and their families, today announced that it has joined the Cancer Moonshot initiative led by Vice President Joe Biden. Cancer Moonshot was launched in June 2016, following a commitment from President Obama at the 2016 State of the Union Address to accelerate progress towards prevention, treatment, and a cure for cancer.

Family Reach offers a financial lifeline to families fighting cancer, helping them pay the everyday bills - rent, groceries, gas, and more - that quickly become overwhelming in the face of treatment. Cancer patients are 2.65 times more likely to go bankrupt than people without cancer, and 46 percent of cancer patients cut back on basic necessities like food and clothing to pay for cancer care, with some skipping medication to save money. In response to the Vice President’s call for collaboration, Family Reach will launch the Family Reach Financial Treatment Project - providing families fighting cancer with the resources and support they need to address their whole financial health. This includes:· Financial planning - counseling patients and their families on their current financial situation to better plan for existing and upcoming expenses
· Financial navigation - helping patients and their families navigate the complexities of health insurance and identify the best options available for their specific medical needs
· Education - ensuring patients and their families are aware of opportunities for financial assistance that are available to them
· Direct monetary assistance - covering the everyday costs that families face when caring for a child with cancer, from living expenses to hospital parking costs and more

The project will kick off in January 2017 as a pilot at Seattle Cancer Care Alliance and Tufts Medical Center. By intervening at the clinical level, the Family Reach Financial Treatment Project aims to remove financial barriers - ensuring access to care and adherence to life-saving treatment, ultimately increasing a patient’s chance of survival. The impact on each patient’s financial health and medical outcomes will be measured and reported on by clinical research experts from the Hutchinson Institute for Cancer Outcomes Research and Tufts Medical Center. Evidence generated through this program will support policy transformation designed to reduce cancer treatment-related financial burden and improve cancer patients’ outcomes.

“We see families lose everything because they miss work or lose their jobs all together; they incur travel costs to and from the hospital and have countless medical expenses added to their daily budget. Families report having to choose putting gas in the car to access treatment over buying groceries or paying the utility bill,” said Carla Tardif, CEO of Family Reach. “We are beyond honored to partner with the Vice President and his Cancer Moonshot Task Force, to bring attention and support to the millions of families who are struggling financially simply because they are trying to care for themselves or a sick child.”

Since its launch in 2003, Family Reach has raised more than $16M in support of more than 10,000 families across the US. Under Tardif’s leadership, Family Reach has gained increased recognition on the national stage, adding celebrity chef Ming Tsai to its National Advisory Board, and earning support from celebrities such as Matt Damon, Emily Blunt, John Krasinski, and David Ortiz.

On October 17, Tardif will join Vice President Biden at the White House complex to share Family Reach’s mission and stories of families they have helped. Vice President Biden will present the final report of the Cancer Moonshot Task Force, along with his own Executive Findings after traveling to many of the major nerve centers in the cancer community. He will also unveil a new set of Federal actions, private sector actions, and collaborative partnerships to further advance the goals of the Cancer Moonshot Task Force. More information on the Cancer Moonshot can be found here https://www.whitehouse.gov/CancerMoonshot.

To interview Carla Tardif, a family who has received support from Family Reach, or a representative from the pilot hospitals for the Family Reach Financial Treatment Project, contact Ashley Willis at 609-279-0050 x105 or ashley(at)resoundmarketing(dot)com.

About Family Reach
Family Reach Foundation is a national non-profit dedicated to eliminating the financial burden of cancer for patients and their families. Family Reach offers families a financial lifeline, helping them manage the overwhelming financial and emotional barriers of the disease. Family Reach believes no family should be forced to choose between buying groceries or paying for their cancer treatment. Working in close collaboration with more than 145 hospitals and cancer centers nationwide, Family Reach provides immediate financial assistance, education and outreach to qualified families in need. For more information, visit http://www.familyreach.org. Reported by PRWeb 8 hours ago.

The Pennsylvania Insurance Department announced insurance rate increases of more than 30 percent for Affordable Care Act individual health insurance plans in the state Monday, as well as its intention to support Highmark Inc. in its suit against the federal government over millions of dollars in missing risk corridor payments. Insurers in Pennsylvania requested an average rate increase of 32.5 percent for individual marketplace plans in 2017, as well as an average 7.1 percent increase for small… Reported by bizjournals 7 hours ago.

Reported by DallasNews 6 hours ago.

PHILADELPHIA--(BUSINESS WIRE)--On Friday, October 21, Health Partners Plans (HPP) President and CEO William S. George will speak at Harvard University about the groundbreaking food access partnership he founded. As one of the 15 highest-rated Medicaid plans in the country according to the National Committee for Quality Assurance’s (NCQA) Medicaid Health Insurance Plan Ratings 2016–2017, the Pennsylvania-based managed care organization has seen significant success through a first-of-its-kind col Reported by Business Wire 5 hours ago.

It's nearly open enrollment season. Starting Nov. 1, individuals can go on the health exchange and pick a new health insurance plan, or stick to their old one. According to John Franchini, the New Mexico Superintendent of Insurance, this enrollment season brings a 24 percent increase in prices for individuals shopping for insurance. That's actually a fairly low number, Franchini says, compared to national trends. For small businesses, the story is a little different. There's an individual health… Reported by bizjournals 4 hours ago.

A leading conservative group is asking the GOP-led Congress to resist lobbying efforts for a “taxpayer bailout” of the struggling ObamaCare health-insurance law. Reported by FOXNews.com 3 hours ago.

Patch Windsor Terrace-Kensington, NY -- The mammograms are also available to women with health insurance, who will be billed normally. Reported by Patch 23 hours ago.