Four years ago, the hot new idea for reining in health costs was the health savings account, a savings vehicle tied to a high-deductible insurance policy and designed to make patients more responsible for – and more aware of – the expenses involved. The thinking was that such accounts would slow spiraling medical costs for both employers and consumers.
Today, with only 5 percent of the 114 million Americans covered at work opting for such health plans, their future is in question. In Texas, regarded as the birthplace of the HSA, only 387,000 people have signed up out of the 12 million with employer-provided insurance. Proponents point to small companies – including some in Texas – that have used the lower-cost plans to offer coverage for the first time.
Meanwhile, critics argue that the plans benefit only the healthy and wealthy, with sick patients who can’t afford deductibles of more than $2,000 doing without care. Under the 2003 federal law that established them, HSAs must be coupled with high-deductible health plans carrying at least a $1,050 deductible for an individual or $2,100 for a family.
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The union that represents home health aides—one of the fastest growing occupations in the city—is intensifying its drive to secure higher wages and benefits for 30,000 workers.
Members of 1199 SEIU will hold a rally inside the WaMu Theater at Madison Square Garden on Aug. 7 and have threatened to strike if contracts are not agreed upon with 25 New York City-area home care agencies by the middle of September.
Some 8,000 aides never had contracts and the rest are working under expired deals. Negotiations have begun with a few employers, but the union says the majority have not come to the table.
“When you look at the work they do, even the standards we’re fighting for aren’t enough,” said 1199 SEIU president George Gresham, whose mother worked as a home health aide. “But you have to start somewhere.” The union is looking to raise the minimum pay for a unionized home health aid above $8 and to maintain health benefits that have already been cut over the last few years.
The rate of HIV infections among African Americans in New York City is higher than that of several third-world countries, including Nigeria, according to a report issued this week by the nonprofit Black AIDS Institute.
About 3.3% of the city’s black population is infected with the virus, compared with 3.1% of blacks living in Nigeria. In Manhattan alone, one in six African American men between the ages of 40 and 54 are infected.
“People think the AIDS epidemic is over, but it’s not,” said Phill Wilson, chief executive of the nonprofit institute. “We’ve known that African Americans have been disproportionately impacted by AIDS for a while, but what’s distressing is that this trend is continuing.”
The report comes at a time when the state Department of Health is preparing to make the controversial move of shifting HIV/AIDS patients who receive Medicaid into managed care plans. Some nonprofit officials have decried the move because many of the best doctors specializing in AIDS care do not participate in managed care plans.
PREGNANCY & CHILDBIRTH | Detroit News Examines Debate Over Certified Professional Midwives’ Qualifications
The Detroit News on Tuesday examined the debate between the medical community and home birth advocates over where women should give birth and who is best qualified to perform deliveries. According to CDC’s National Center for Health Statistics, about 1% of births annually are performed outside of hospitals.The American Medical Association last month issued a statement that said the “safest setting for labor, delivery and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex.” AMA and the American College of Obstetricians and Gynecologists also have said a hospital is the safest place to give birth because medical staff are readily available if complications arise. The groups also have said that physicians and certified nurse midwives, who have formal nursing certification, are the most appropriate professionals to oversee deliveries. Certified nurse-midwives are licensed in all states and most often practice in hospitals or medical centers.However, many home birth advocates have said that formal nursing certification is not necessary for a midwife to oversee home births and that certified professional midwives, who do not have nursing certification, are able to oversee births successfully. About one-half of states license CPMs, although many midwife advocates are calling for universal licensure of CPMs to expand birthing options for women. Many medical groups have said CPMs, who must deliver 40 infants to be certified, do not have enough training to handle complications. Steffany Hedenkamp, communications coordinator for The Big Push for Midwives Campaign, said medical groups’ efforts to limit CPMs are “anti-competitive,” adding, “With this integration of [CPMs] we see increased access to care.” Erin Tracy, an ob-gyn at Massachusetts General Hospital, said the 40 deliveries CPMs are required to oversee is “less than … interns do in one month,” adding, “You need more of a medical background to understand medical complications” (Detroit News, 7/29).
Public spending—including safety net insurance, tax exemptions and deductions, and subsidies for medical research and education—made up roughly 56% of U.S. health expenditures, according to an analysis published online in the journal Health Affairs. The estimate, by the Agency for Healthcare Research and Quality economists Thomas Selden and Merrile Sing, shows public spending for those not in long-term care or other institutions was $752.9 billion in 2002, or $2,612 per person, on average.
Of that, the economists said that tax subsidies, which aid middle- and upper-income families to a greater degree than the poor, accounted for $214.8 billion, or nearly 30% of public spending. For those earning at least 400% of the federal poverty threshold, or $21,200 for a family of four, public spending covered 46% of expenditures. That’s compared with 80% for those with incomes that fall below the poverty level. The poor were more likely to receive means-tested public benefits, the authors said. “Clearly, the distribution of overall public spending across income groups depends upon more than just the incidence of means-tested public insurance programs,” the authors wrote.
Public spending for seniors easily outpaced aid for children. On average, seniors received $6,921 in 2002 compared with $1,225 for children. — by Melanie Evans
Article from Modern Healthcare
All 16 Senate sponsors of the Healthy Americans Act—a broad bill that would effectively end employer-sponsored healthcare in favor of insurance from a pool of providers—have called on the two major-party presidential candidates to work with them on health reform legislation.
“We believe it is vital that we start working now to ensure that all of our people have high-quality care early in the next administration without breaking the bank,” the senators wrote in a letter sent to Sens. Barack Obama (D-Ill.) and John McCain (R-Ariz.). The senators go on to say that a strong, bipartisan coalition “will allow a reform initiative to survive the assaults of politics and interests that afflict any serious reform proposal.”
In May, congressional budget auditors said that the bill, primarily sponsored by Sen. Ron Wyden (D-Ore.), a member of the Senate Finance Committee, and Sen. Robert Bennett (R-Utah), would be “self-financing” or budget-neutral in its first year, eventually yielding a surplus.
As written, the legislation would provide incentives to buy basic private health plans and make health insurance more portable. People with incomes below the federal poverty level could receive subsidies to buy insurance, and states would be given more flexibility to give consumers more choices in insurance available on the private market. — by Matthew DoBias.
Article from Modern Healthcare
Critical telecommunication and work force challenges contribute to greater disparities in access to health care in rural areas, according to panelists at a House Agriculture Subcommittee on Specialty Crops, Rural Development and Foreign Agriculture hearing last week, CQ HealthBeat reports.
Wayne Myers of the Maine Health Access Foundation, representing the National Rural Health Association, said it is “extremely difficult and expensive” to recruit and retain physicians and health care providers in rural areas. Tom Morris, acting associate administrator for HHS‘ Health Resources and Services Administration’s Office of Rural Health Policy, discussed current programs meant to retain doctors in rural communities including the National Health Service Corps — where more than half of the participants go to practice in rural areas — and the National Rural Recruitment and Retention Network, which over the past four years has placed about 2,900 clinicians in rural areas.
Subcommittee Chair Mike McIntyre (D-N.C.) said that federal grant and loan programs are essential to improving rural health care. McIntyre said, “With limited dollars available for rural health care programs, we must ensure they are used in ways that address the challenges and with sufficient federal coordination.”
Gov. Arnold Schwarzenegger’s (R) signature this week on a bill banning health insurers from rewarding their employees for rescinding or limiting coverage comes on the heels of state regulators reaching deals with the state’s five major insurers over rescissions.
The governor signed AB 1150 by Assembly member Ted Lieu (D-Torrance) on Tuesday. It is one of several bills aimed at the individual insurance market that lawmakers introduced following state investigations into rescissions, a practice in which insurers revoke policies after people get sick and file claims.
Only people who buy coverage in the individual health insurance market are subject to rescissions; members of group plans cannot have their coverage rescinded. An estimated 14 million Americans, including three million in California, have individual policies.
A bill recently signed by Pennsylvania Gov. Ed Rendell (D) will require private health insurance companies in the state to provide diagnosis and treatment coverage of up to $36,000 per year for residents under age 21 with autism spectrum disorder, the Philadelphia Inquirer reports. The law, which is scheduled to take effect in July 2009, also requires insurers to provide coverage for applied behavioral analysis therapy that experts say is a key element in treatment of the disorder.Patients needing treatments that exceed the $36,000 limit will be eligible for state Medicaid reimbursements to cover the extra expense. Health plans that provide coverage to businesses with fewer than 50 employees will be exempt from the new law.
Currently, children with autism can enroll in the state’s Medicaid program, which is managed by the Department of Public Welfare and spends about $185 million annually on medical-assistance programs for residents under age 21 with autism, the Inquirer reports. Under the new law, those children would be transferred from the Medicaid program into private health plans that could reduce state spending by about $13 million in the first year after it is implemented, according to the Inquirer.
Presumptive Republican presidential nominee Sen. John McCain (Ariz.) on Thursday discussed issues related to cancer at a town hall meeting in Columbus, Ohio, hosted by cyclist and testicular cancer survivor Lance Armstrong, the Los Angeles Times reports.
During the event, McCain, a melanoma survivor, said, “I was in a battle with melanoma. And I know … somewhat, at least to a small degree, how tough that battle can be. And yes, I’ve become a fanatic. Yes, I admit it. When I see a woman with a child in the sun, I go over and say, ‘Get sunscreen on that child, please.'” McCain, a former smoker, also criticized tobacco industry lobbyists.
According to the Times, “McCain’s appearance at the summit was widely panned by liberal groups that have criticized his health insurance plan, which some independent analysts say could make it more difficult for people with health problems to find coverage.” McCain has proposed to replace a tax break for employees who receive health insurance from employers with a refundable tax credit of as much as $2,500 for individuals and $5,000 for families to purchase private coverage, and critics maintain that the plan “might impose hardships on cancer survivors, for example, because insurance companies might balk at covering people with pre-existing conditions,” the Times reports.