Older middle-class Americans locked out of reform

The most damaging concession in the Senate legislation has received relatively little discussion in the last few days: as the bill now stands, many Americans in their late 50s and early 60s who don't have employer-based coverage will find comprehensive insurance unaffordable.

Under the Senate bill, insurers cannot discriminate against customers who suffer from pre-existing conditions. They cannot charge women more than they charge men.
But they can demand that older Americans who are shopping in the Insurance Exchanges pay premiums that are triple what a younger customer would be expected to shell out. (The House bill only let insurers double premiums.)

Commentators such as Ruth Marcus have suggested that this makes sense: "Older people cost more money to insure than younger Americans--and more than three times as much. Is it fair to require younger people to shoulder all the extra cost?"

In theory, this might sound reasonable. But, in practice, red-lining older citizens so that younger Americans don't share in their risk just won't work. Marcus and others who support "age rating" should take a hard look at the numbers. The fact is that if this provision stands, a large share of people in this older cohort won't be able to afford good coverage.

Households in the 55-64 age group report median joint income of just $55,400. Half earn less. Only 25 percent enjoy joint income over $100,000. In other words, fully one-quarter earn somewhere between $55,400 and $100,000 --too much for a couple to qualify for more than a tiny subsidy, too little to able to afford pricey insurance. (When it comes to subsidies, the cut-off point for a family of two is $58,280.)

Middle-aged Americans need full, comprehensive coverage. Yet under the Senate plan, which offers four levels of insurance, many older middle-class households will be forced to pick the short blanket. The legislation offers four tiers, ranging from platinum plans that cover 90 percent of the cost of "essential care" to bronze plans that pick up 60 percent of medical bills, leaving 40 percent for the patient to pay out of pocket. Premiums for bronze plans will be significantly lower.

A 30-year old might feel comfortable with a bronze plan. After all, he doesn't plan to use the insurance very often. But most 60-somethings need to go to doctors regularly to control chronic diseases and address the many problems that come with age. And if they are middle-class, they probably cannot afford to shell out 40 percent of the charge every time they visit a specialist.

Granted, their out-of-pocket payments would be capped at $11,900, but for a household earning just $59,000 before taxes, $11,900 represents more than 20 percent of their after-tax income. Even for a couple earning $75,000, $11,900 is a hefty sum. No doubt, many would simply put off going to the doctor.

Just how much would a couple have to scrape together to buy a platinum plan? The Office of Personnel Management, which now oversees the Federal Employees Plan, will be contracting with private insurers. They have not done a good job of holding down premiums for government employees-- from 2001 to 2008, average premiums climb by 62.3 percent.

Judging by what federal employees pay now, it appears that under the Senate bill a top-of-the line platinum policy would cost a younger couple at least $10,000--probably closer to $12,000 in today's group market. (I'm taking these numbers from states where insurance is more expensive because insurers are required to cover people suffering from pre-existing conditions, just as they will be under reform.)

That means that even if an insurer charged the older couple only twice as much, the premiums could run as high as $20,000-$24,000 annually.

If it seems impossible that a 60-year-old couple earning $59,000 a year would be expected to pay that much,consider this: In Massachusetts, where insurers are only allowed to double (not triple) premiums based on age, an older couple in Boston faces premiums that run as high as $24,000 a year.

The Senate bill does offer some hope. If a state's insurance regulations do not let insurers gouge older customers, insurers must "comply with the State's more protective age rating requirements." And in fact, some states do shield older citizens. As Howard Dean pointed out over the weekend on Meet the Press, in Vermont, insurers can charge 60-somethings only 20 percent more--not 300 percent more.

But where you happen to live should not determine whether or not you have access to good care. That is not what I thought we meant by "universal coverage."

BY MAGGIE MAHAR, The Healthbeat  

What Healthcare Reform Means To You and to Us

President Obama will sign into law a healthcare reform bill that will provide  insurance to the 32 million Americans who are currently without it and the more than 2,000-page health insurance bill has left more than a few people wondering what the healthcare reform bill will mean to them.
      

Before we answer some of the most frequently asked questions about healthcare reform and this bill will affect you  I have a comment and a concern.

My comment; I think everyone should have access to healthcare and that having access is a matter of national security. Any nation can only be as healthy as it's people, if the people are sick they cannot work or contribute to the growth of the society.  And I think it is humane to give our citizens healthcare. 

Just today I met a 38 year old woman with breast cancer who was told if she could not explain how she was going to pay for her care that she should find a way to deal with the pain and plan to die within the year. She told me this as her daughter stood beside her holding her hand. In my mind there is something wrong with a doctor having to tell a patient to go home and die when there is treatment available because her employer does not have a benefit plan.  

However I am concerned that adding another 32 million people into our current healthcare system without adding additional nurses, doctors or hospitals will create more medical errors. The equation is this; 32 million more patients + nursing shortage + 30 percent doctor shortage + hospital closures = less time and space to see and treat each patient = more mistakes.  

If my equation is right and my 25 years in the system tells me I am, this new bill, while well intentioned will make protecting your health and safety when seeing a doctor or visiting a hospital an issue of personal security and could help to save your life.  

With the current volume of patients 40 percent of medical diagnosis are wrong and 1 in 3 prescriptions has some type of error contained in it's writing.  Can you imagine what the statistics will be with an additional 32 million people. 

In order to protect you and your loved ones from the horrors of a medical error I think every patient entering the healthcare system should have a copy of What Did the Doctor Just Say? so that they can learn how to protect themselves and their loved ones from the horrors of a medical error and I truly believe this is a matter of the utmost importance. Having made my comment and voiced my concern, let's move onto the questions everyone else is asking about the healthcare reform bill and that is how will it affect me?   

I don't have health insurance, what does this mean for me?

By 2014, every American will be required to have some form of health insurance or will be forced to pay a fine. The first year's fine would be $95 or 1 percent of their income, whichever is higher. By the second year, however, fines could rise to as much as $695 a year. Families and people meeting certain income requirements ($14,404 for individuals and $29,326 for a family of four) would be exempt from paying the fine. These people may also be eligible for the federally and state-funded Medicaid insurance program that covers poor and disabled Americans under the age of 65. 

One of the immediate changes that will take place is that young adults up to the age of 26 will be eligible to remain on their families' health insurance plans. Currently, the cut-off is 22 years old. 

Can I buy insurance through the government?
The bill does not include a public option, meaning the government will not offer health care beyond Medicare and Medicaid. People under the age of 65 who make too much to qualify for Medicaid may be eligible to receive government subsidies to help them buy private health care from new state-based insurance "exchanges," which are scheduled to begin in 2014.

My employer does not currently offer insurance, will that change?
All employers will be required to offer their employees insurance by 2014. Companies with 25 or fewer employees would receive tax credits to help them pay for the insurance. The tax credits would cover about 35 percent of the insurance cost this year and would gradually increase to about 50 percent by 2014. Employers with 50 or more workers will be required to offer employees insurance or pay a fine of up to $2,000 a piece for full-time employees that are receiving government subsidies to buy insurance through state-based exchanges. The first 30 employees would be exempt from this fine. 

How will this legislation affect senior citizens receiving Medicare?
Starting this year, all Medicare preventative services, such as cancer screenings, will be offered free of charge to senior citizens currently receiving Medicare. Also, people receiving Medicare Part D would receive an additional $250 this year to help them pay for medications that are not currently covered under the plan. 


I have insurance, how will this affect me?
Under the plan, people who are currently ill may begin seeing their premiums shrink, as the bill does not allow insurers to charge higher premiums to people who are sick. Also, people with pre-existing conditions who change insurance companies, due to a change in job status or in employer coverage, cannot be denied coverage under the bill, nor can they be charged higher premiums.

How much will this cost and how is it being paid for?
The plan will cost an estimated $940 million. Congress and the president have said that most of it will be paid for through various tax increases on individuals that earn more than $250,000 a year, as well through decreases in Medicare reimbursements to doctors and hospitals. Critics, however, say tax increases to the wealthy and Medicare cuts will not be enough to fund health reform and that the middle class will eventually be forced to help pay for it through tax and fee increases.


Questions Written By Marrecca Fiore Mar 22nd 2010 9:57AM
Comments and Concerns by Lynn R. Parker

We The People Must Create HealthCare Safety Reform, Reform That Matters to Us!!

Why isn't there a conversation from amongst our political leaders about patient safety and or Safety Reform in the healthcare debates? I can't understand their omission of this topic because safety reform could save our entire healthcare system and our lives? Let me explain.

If the Centers for Disease Control counted medical errors as a cause of death, they would be the fifth leading cause of death in America, taking more lives than motor vehicle accidents, breast cancer, and AIDS combined.

HealthGrades, our nation’s leading reviewer of healthcare quality, found that for the years 2002-04, 1.24 million errors were made while caring for hospitalized Medicare patients in the sixteen categories of error they investigated. Those errors resulted in deaths of 304,702 senior citizens. Of those deaths, 250,246 (82 percent) were potentially preventable. All totaled, those errors cost patients and taxpayers $9.3 billion dollars.

When you read the number “304,702” keep in mind it represents only in-hospital Medicare patients. The numbers do not include medical errors involving anyone under age 65, nor do they include medical errors that occur in doctors’ offices, pharmacies, rehabilitation, or long-term care facilities. No one knows how many medical errors or deaths from errors there really are. The authors of the HealthGrades study tell us that the numbers in their report “represent only the tip of the medical-errors iceberg.”

No matter what the actual numbers are, they do not begin to convey the real meaning embedded within them. Numbers cannot convey the depth of a patients’ distress when he realizes he has lost the ability to work and will soon be bankrupt due to medical costs. How can numbers convey the sadness one feels when a marriage ends under the strain of a prolonged illness? And numbers cannot begin to express the anger, depression, and resentment felt when a person’s life is ruined by a healthcare system they once trusted. The numbers are big and they are bad and yet they do not begin to tell the whole story of medical error.

Sadly, for many of you reading this, medical error is not just something you’ve heard about. In fact, statistically, each of us has a two in five-or a 40 percent-chance of being harmed by a medical error each time we enter the healthcare system, so there is a very high likelihood that you or someone you know has been harmed by a medical error. If you developed an infection while in the hospital, were misdiagnosed and mistreated or you experienced a medication or medical record and billing error. At any point in the healthcare delivery system anyone of us could fall victim to a medical error and these errors are destroying lives and further draining our nations economy, thus effecting each and everyone of us.

Yet we hear nothing in the healthcare reform bill about reducing medical errors and the harm done to patients. We hear nothing about the medical disability, social security and other social service costs associated with these errors that even further drain on our economy and our entire society, families, caregivers and business owners. Sadly we do hear that bankruptcies brought about by healthcare cost are the number one cause of bankruptcy in the United States.

So again I ask why is there no conversation about safety reform in the current debates. I don't know the answer to that question (although I have my ideas). What I do know is that in order to improve the care you receive and decrease your chances of being hurt or harmed by a medical error and to help our healthcare system survive it is imperative that each of learns how to partner with our healthcare providers and learn how to make well informed healthcare decisions that are right for us and our loved ones and that we partner with our providers to decrease their chances of giving us a misdiagnosis, the wrong medication, wrong treatments and even wrong surgeries.

Your Insurance Carrier May Not Cover the Damages

Not only could you or your loved ones fall victim to a medical error, your insurance company may not pay for the care you need because of your injuries. As of October 2008, in an attempt to force hospitals to improve care and to save money, the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for a group of errors called “never events.”
They are called "never events" because it is believed these events should not and would not happen if doctors and hospitals followed established protocols designed to prevent them. Because of these beliefs the CMS no longer pays for care required after a patient is injured by a eight types of “never events.”

Eight of the 28 types of errors classified as never events are responsible for the spending of approximately $22 billion Medicare dollars each year, and those eight types of errors are the first to be excluded from payment. This group of errors includes: infections from catheters (IV and Foley catheters); pressure ulcers (bedsores); air embolisms; being given the wrong type of blood; repeat surgeries needed to remove objects left inside the patient following surgery; falls; injury or death from medications, and the post operative deaths of low risk surgical patients.
Non-payment for the care required after a never event could have devastating effects on both patients and hospitals. If, for example, you develop a pressure ulcer (a bedsore), the treatment of that ulcer may require bandages, packing, antibiotics, creams, and surgery, easily costing hundreds of dollars per day. While you are in the hospital, the hospital is required to absorb the cost of caring for your injury. Once you are discharged from the hospital you may be responsible for the costs. This will depend upon the arrangement your hospital has with Medicare or your private insurance carrier ~ recently Blue Cross/Blue Shield, Aetna, and Cigna have announced plans to restructure their policies to deny payment of never events as well.
When you consider that Medicare alone spends up to $22 billion dollars annually to treat these eight never events, you can well imagine that thousands of patients will not be able to afford the care they need after being injured by a never event without help from their insurance carriers.

We May All Have Less Access to Healthcare Even With Insurance

Before the instatement of the never rules, most patients had no idea that the development of a bedsore while in the hospital could be considered negligence or that they may be entitled to compensation for their pain and suffering. As a part of the never event regulations, doctors are required to inform patients they have fallen victim to a never event.
With more patients being made aware they have been injured by the medical system, the number of lawsuits could skyrocket, leading to increasing malpractice rates, which some doctors and hospitals will not be able to pay. The consequences of this could be that that we’ll have less access to care as doctors leave their practices and hospitals close under the financial burden of decreased reimbursements and ever increasing malpractice premiums. In fact this is already happening in some states and may become worse as more people enter the system.

With more hospitals closing, remaining emergency rooms will be overcrowded. There are already long waits to get into surviving hospitals, where workers are exhausted from dealing with high volumes of patients.

While the CMS may be well intentioned, the consequences of refusing to pay for never events could be tough on all of us. Fewer doctors and massive hospital closures present a very serious problem and that problem is ~ we don’t have anywhere else to go.

Now that we are aware of some of the problems surrounding medical errors and we know that we are all at risk of falling victim to such an error, each of us who cares about our healthcare and our safety must ask ourselves a question, and that question is: “What can I do to protect myself and my loved ones from a medical error and help to protect the only medical system we have from collapsing.

It is up to each of us who enters the healthcare system to Take Charge of our Health and Safety and to help create a movement of healthcare safety reform that is patient driven and patient centered. If enough patients and caregivers use the the patient empowerment techniques I teach in What Did the Doctor Just Say? we the people could create a Patient Safety Reform Movement and together we could help save over 100,000 people from the horrors of a medical error.
In my next post I will share the essential strategies that have been proven to prevent medical errors with you. However if you are concerned right now about your safety or the safety of someone you have to make healthcare decisions for right now you can get your copy of What Did the Doctor Just Say: How to Understand What Your Doctor Is Saying and Prevent a Medical Error From Happening to You and Your Loved Ones Right Now and learn what you can do to protect your and loved ones health and safety
As always, I hope I helped someone.