Health insurance

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Health insurance like other forms of insurance is a form of collectivism by means of

which people collectively pool their risk, in this case the risk of incurring medical
expenses. The collective is usually publicly owned or else is organized on a non-profit
basis for the members of the pool, though in some countries health insurance pools may
also be managed by for-profit companies. It is sometimes used more broadly to include
insurance covering disability or long-term nursing or custodial care needs. It may be
provided through a government-sponsored social insurance program, or from private
insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its
employees) or purchased by an individual. In each case, the covered groups or
individuals pay premiums or taxes to help protect themselves from unexpected healthcare
expenses. Similar benefits paying for medical expenses may also be provided through
social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as
a monthly premium or annual tax) can be developed, ensuring that money is available to
pay for the healthcare benefits specified in the insurance agreement. The benefit is
administered by a central organization such as a government agency, private business, or
not-for-profit entity.[1]

Contents
[hide]
 1 History and evolution
 2 How it works
o 2.1 Health plan vs. health insurance (United States)
o 2.2 Comprehensive vs. scheduled
o 2.3 Other factors affecting insurance prices
 3 Comparison
o 3.1 Australia
o 3.2 Canada
o 3.3 France
o 3.4 Netherlands
o 3.5 United Kingdom
o 3.6 United States
 3.6.1 California
o 3.7 Germany
 3.7.1 Insurance systems
  4 See also

 5 Notes and references

[edit] History and evolution

Main article: History of insurance

The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen
from the Peter Chamberlen family. In the late 19th century, "accident insurance" began to
be available, which operated much like modern disability insurance.[2][3] This payment
model continued until the start of the 20th century in some jurisdictions (like California),
where all laws regulating health insurance actually referred to disability insurance. [4]

Accident insurance was first offered in the United States by the Franklin Health
Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance
against injuries arising from railroad and steamboat accidents. Sixty organizations were
offering accident insurance in the U.S. by 1866, but the industry consolidated rapidly
soon thereafter. While there were earlier experiments, the origins of sickness coverage in
the U.S. effectively date from 1890. The first employer-sponsored group disability policy
was issued in 1911.[5]

Before the development of medical expense insurance, patients were expected to pay all
other health care costs out of their own pockets, under what is known as the fee-for-
service business model. During the middle to late 20th century, traditional disability
insurance evolved into modern health insurance programs. Today, most comprehensive
private health insurance programs cover the cost of routine, preventive, and emergency
health care procedures, and most prescription drugs, but this is not always the case.

Hospital and medical expense policies were introduced during the first half of the 20th
century. During the 1920s, individual hospitals began offering services to individuals on
a pre-paid basis, eventually leading to the development of Blue Cross organizations.[5]
The predecessors of today's Health Maintenance Organizations (HMOs) originated
beginning in 1929, through the 1930s and on during World War II.[6][7]

[edit] How it works

A health insurance policy is a contract between an insurance company and an individual
or his sponsor (e.g. an employer). The contract can be renewable annually or monthly.
The type and amount of health care costs that will be covered by the health insurance
company are specified in advance, in the member contract or "Evidence of Coverage"
booklet. The individual insured person's obligations may take several forms:[8]

 Premium: The amount the policy-holder or his sponsor (e.g. an employer) pays
to the health plan each month to purchase health coverage.
 Deductible: The amount that the insured must pay out-of-pocket before the health
insurer pays its share. For example, a policy-holder might have to pay a $500
deductible per year, before any of their health care is covered by the health
insurer. It may take several doctor's visits or prescription refills before the insured
person reaches the deductible and the insurance company starts to pay for care.
 Co-payment: The amount that the insured person must pay out of pocket before
the health insurer pays for a particular visit or service. For example, an insured
person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription.
A co-payment must be paid each time a particular service is obtained.
 Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-
payment), the co-insurance is a percentage of the total cost that insured person
may also pay. For example, the member might have to pay 20% of the cost of a
surgery over and above a co-payment, while the insurance company pays the
other 80%. If there is an upper limit on coinsurance, the policy-holder could end
up owing very little, or a great deal, depending on the actual costs of the services
they obtain.
 Exclusions: Not all services are covered. The insured person is generally
expected to pay the full cost of non-covered services out of their own pocket.
 Coverage limits: Some health insurance policies only pay for health care up to a
certain dollar amount. The insured person may be expected to pay any charges in
excess of the health plan's maximum payment for a specific service. In addition,
some insurance company schemes have annual or lifetime coverage maximums.
In these cases, the health plan will stop payment when they reach the benefit
maximum, and the policy-holder must pay all remaining costs.
 Out-of-pocket maximums: Similar to coverage limits, except that in this case,
the insured person's payment obligation ends when they reach the out-of-pocket
maximum, and the health company pays all further covered costs. Out-of-pocket
maximums can be limited to a specific benefit category (such as prescription
drugs) or can apply to all coverage provided during a specific benefit year.
 Capitation: An amount paid by an insurer to a health care provider, for which the
provider agrees to treat all members of the insurer.
 In-Network Provider: (U.S. term) A health care provider on a list of providers
preselected by the insurer. The insurer will offer discounted coinsurance or co-
payments, or additional benefits, to a plan member to see an in-network provider.
Generally, providers in network are providers who have a contract with the
insurer to accept rates further discounted from the "usual and customary" charges
the insurer pays to out-of-network providers.
 Prior Authorization: A certification or authorization that an insurer provides
prior to medical service occurring. Obtaining an authorization means that the
insurer is obligated to pay for the service, assuming it matches what was
authorized. Many smaller, routine services do not require authorization.[9]
 Explanation of Benefits: A document sent by an insurer to a patient explaining
what was covered for a medical service, and how they arrived at the payment
amount and patient responsibility amount.[10]
Prescription drug plans are a form of insurance offered through some employer benefit
plans in the U.S., where the patient pays a copayment and the prescription drug insurance
part or all of the balance for drugs covered in the formulary of the plan.

Some, if not most, health care providers in the United States will agree to bill the
insurance company if patients are willing to sign an agreement that they will be
responsible for the amount that the insurance company doesn't pay. The insurance
company pays out of network providers according to "reasonable and customary"
charges, which may be less than the provider's usual fee. The provider may also have a
separate contract with the insurer to accept what amounts to a discounted rate or
capitation to the provider's standard charges. It generally costs the patient less to use an
in-network provider.

[edit] Health plan vs. health insurance (United States)

In the United States, historically, HMOs tended to use the term "health plan", while
commercial insurance companies used the term "health insurance". A health plan can also
refer to a subscription-based medical care arrangement offered through HMOs, preferred
provider organizations, or point of service plans. These plans are similar to pre-paid
dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a
fixed number of services (for instance, $300 in preventive care, a certain number of days
of hospice care or care in a skilled nursing facility, a fixed number of home health visits,
a fixed number of spinal manipulation charges, etc.). The services offered are usually at
the discretion of a utilization review nurse who is often contracted through the managed
care entity providing the subscription health plan. This determination may be made either
prior to or after hospital admission (concurrent utilization review).

[edit] Comprehensive vs. scheduled

Comprehensive health insurance pays a percentage of the cost of hospital and physician
charges after a deductible (usually applies to hospital charges) or a co-pay (usually
applies to physician charges, but may apply to some hospital services) is met by the
insured. These plans are generally expensive because of the high potential benefit payout
— $1,000,000 to 5,000,000 is common — and because of the vast array of covered
benefits.[11]

Scheduled health insurance plans are not meant to replace a traditional comprehensive
health insurance plans and are more of a basic policy providing access to day-to-day
health care such as going to the doctor or getting a prescription drug. In recent years,
these plans have taken the name mini-med plans or association plans. The term
"association" is often used to describe them because they require membership in an
association that must exist for some other purpose than to sell insurance. Examples
include the National Association for the Self Employed and the Health Care Credit Union
Association. These plans may provide benefits for hospitalization and surgical, but these
benefits will be limited. Scheduled plans are not meant to be effective for catastrophic
events. These plans cost much less than comprehensive health insurance. They generally
pay limited benefits amounts directly to the service provider, and payments are based
upon the plan's "schedule of benefits". Annual benefits maximums for a typical scheduled
health insurance plan may range from $1,000 to $25,000.[12]

[edit] Other factors affecting insurance prices

A recent study by PriceWaterhouseCoopers examining the drivers of rising health care

costs in the U.S. pointed to increased utilization created by increased consumer demand,
new treatments, and more intensive diagnostic testing, as the most significant driver.[13]
People in developed countries are living longer. The population of those countries is
aging, and a larger group of senior citizens requires more intensive medical care than a
young healthier population. Advances in medicine and medical technology can also
increase the cost of medical treatment. Lifestyle-related factors can increase utilization
and therefore insurance prices, such as: increases in obesity caused by insufficient
exercise and unhealthy food choices; excessive alcohol use, smoking, and use of street
drugs. Other factors noted by the PWC study included the movement to broader-access
plans, higher-priced technologies, and cost-shifting from Medicaid and the uninsured to
private payers.[13]

[edit] Comparison
See also: Health care systems

The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares
the performance of the health care systems in Australia, New Zealand, the United
Kingdom, Germany, Canada and the U.S. Its 2007 study found that, although the U.S.
system is the most expensive, it consistently under-performs compared to the other
countries.[14] One difference between the U.S. and the other countries in the study is that
the U.S. is the only country without universal health insurance coverage.

[edit] Australia

Main article: Health care in Australia

The public health system is called Medicare. It ensures free universal access to hospital
treatment and subsidised out-of-hospital medical treatment. It is funded by a 1.5% tax
levy on all taxpayers, an extra 1% levy on high income earners, as well as general
revenue.

The private health system is funded by a number of private health insurance

organisations. The largest of these is Medibank Private, which is government-owned, but
operates as a government business enterprise under the same regulatory regime as all
other registered private health funds. The Coalition Howard government had announced
that Medibank would be privatised if it won the 2007 election, however they were
defeated by the Australian Labor Party under Kevin Rudd which had already pledged that
it would remain in government ownership.
Some private health insurers are 'for profit' enterprises such as Australian Unity , and
some are non-profit organizations such as HCF Health Insurance and GMHBA Health
Insurance. Some have membership restricted to particular groups, but the majority have
open membership. Membership to most health funds is now also available through
comparison websites like moneytime, iSelect or the decision assistance sites
HelpMeChoose and the latest entry YouCompare. These comparison sites operate on a
commission-basis by agreement with their participating health funds.

Most aspects of private health insurance in Australia are regulated by the Private Health
Insurance Act 2007.

The private health system in Australia operates on a "community rating" basis, whereby
premiums do not vary solely because of a person's previous medical history, current state
of health, or (generally speaking) their age (but see Lifetime Health Cover below).
Balancing this are waiting periods, in particular for pre-existing conditions (usually
referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds
are entitled to impose a waiting period of up to 12 months on benefits for any medical
condition the signs and symptoms of which existed during the six months ending on the
day the person first took out insurance. They are also entitled to impose a 12-month
waiting period for benefits for treatment relating to an obstetric condition, and a 2-month
waiting period for all other benefits when a person first takes out private insurance. Funds
have the discretion to reduce or remove such waiting periods in individual cases. They
are also free not to impose them to begin with, but this would place such a fund at risk of
"adverse selection", attracting a disproportionate number of members from other funds,
or from the pool of intending members who might otherwise have joined other funds. It
would also attract people with existing medical conditions, who might not otherwise have
taken out insurance at all because of the denial of benefits for 12 months due to the PEA
Rule. The benefits paid out for these conditions would create pressure on premiums for
all the fund's members, causing some to drop their membership, which would lead to
further rises in premiums, and a vicious cycle of higher premiums-leaving members
would ensue.

There are a number of other matters about which funds are not permitted to discriminate
between members in terms of premiums, benefits or membership - these include racial
origin, religion, sex, sexual orientation, nature of employment, and leisure activities.
Premiums for a fund's product that is sold in more than one state can vary from state to
state, but not within the same state.

The Australian government has introduced a number of incentives to encourage adults to

take out private hospital insurance. These include:

 Lifetime Health Cover: If a person has not taken out private hospital cover by
the 1st July after their 31st birthday, then when (and if) they do so after this time,
their premiums must include a loading of 2% per annum for each year they were
without hospital cover. Thus, a person taking out private cover for the first time at
age 40 will pay a 20 per cent loading. The loading is removed after 10 years of
 continuous hospital cover. The loading applies only to premiums for hospital
cover, not to ancillary (extras) cover.

 Medicare Levy Surcharge: People whose taxable income is greater than a

specified amount (currently $70,000 for singles and $140,000 for couples) and
who do not have an adequate level of private hospital cover must pay a 1%
surcharge on top of the standard 1.5% Medicare Levy. The rationale is that if the
people in this income group are forced to pay more money one way or another,
most would choose to purchase hospital insurance with it, with the possibility of a
benefit in the event that they need private hospital treatment - rather than pay it in
the form of extra tax as well as having to meet their own private hospital costs.
o The Australian government announced in May 2008 that it proposes to
increase the thresholds, to $100,000 for singles and $150,000 for families.
These changes require legislative approval. A bill to change the law has
been introduced but was not passed by the Senate.[15][16] An amended
version was passed on 16 October 2008. There have been criticisms that
the changes will cause many people to drop their private health insurance,
causing a further burden on the public hospital system, and a rise in
premiums for those who stay with the private system. Other commentators
believe the effect will be minimal.[17]

 Private Health Insurance Rebate: The government subsidises the premiums for
all private health insurance cover, including hospital and ancillary (extras), by
30%, 35% or 40%, depending on age. The Rudd Government announced in May
2009 that as of July 2010, the Rebate would become means-tested, and offered on
a sliding scale.

[edit] Canada

Main article: Health care in Canada

Health care is constitutionally mainly a provincial government responsibility in Canada

(the main exceptions being federal government responsibility for services provided to
aboriginal peoples covered by treaties, the Royal Canadian Mounted Police, the armed
forces, and members of parliament). Consequently each province administers its own
health insurance program. The federal government influences health insurance by virtue
of its fiscal powers - it transfers cash and tax points to the provinces to help cover the
costs of the universal health insurance programs. Under the Canada Health Act, the
federal government mandates and enforces the requirement that all people have free
access to what are termed "medically necessary services," defined primarily as care
delivered by physicians or in hospitals, and the nursing component of long term
residential care. If provinces allow doctors or institutions to charge patients for medically
necessary services, the federal government reduces its payments to the provinces by the
amount of the prohibited charges. Collectively, the public provincial health insurance
systems in Canada are frequently referred to as Medicare. This public insurance is tax-
funded out of general government revenues, although British Columbia and Ontario levy
a mandatory premium with flat rates for individuals and families to generate additional
revenues - in essence a surtax. Private health insurance is allowed, but in six provincial
governments only for services that the public health plans do not cover, for example,
semi-private or private rooms in hospitals and prescription drug plans. Four provinces
allow insurance for services also mandated by the Canada Health Act, but in practice
there is no market for it. All Canadians are free to use private insurance for elective
medical services such as laser vision correction surgery, cosmetic surgery, and other non-
basic medical procedures. Some 65% of Canadians have some form of supplementary
private health insurance; many of them receive it through their employers.[18] Private-
sector services not paid for by the government account for nearly 30 percent of total
health care spending.[19]

In 2005, the Supreme Court of Canada ruled, in Chaoulli v. Quebec, that the province's
prohibition on private insurance for health care already insured by the provincial plan
violated the Quebec Charter of Rights and Freedoms, and in particular the sections
dealing with the right to life and security, if there were unacceptably long wait times for
treatment, as was alleged in this case. The ruling has not changed the overall pattern of
health insurance across Canada but has spurred on attempts to tackle the core issues of
supply and demand and the impact of wait times.[20]

[edit] France

Main article: Health care in France

The national system of health insurance was instituted in 1945, just after the end of the
Second World War. It was a compromise between Gaullist and Communist
representatives in the French parliament. The Conservative Gaullists were opposed to a
state-run healthcare system, while the Communists were supportive of a complete
nationalisation of health care along a British Beveridge model.

The resulting programme is profession-based: all people working are required to pay a
portion of their income to a not-for-profit health insurance fund, which mutualises the
risk of illness, and which reimburses medical expenses at varying rates. Children and
spouses of insured people are eligible for benefits, as well. Each fund is free to manage
its own budget, and used to reimburse medical expenses at the rate it saw fit, however
following a number of reforms in recent years, the majority of funds provide the same
level of reimbursment and benefits.

The government has two responsibilities in this system.

 The first government responsibility is the fixing of the rate at which medical
expenses should be negotiated, and it does this in two ways: The Ministry of
Health directly negotiates prices of medicine with the manufacturers, based on the
average price of sale observed in neighboring countries. A board of doctors and
experts decides if the medicine provides a valuable enough medical benefit to be
reimbursed (note that most medicine is reimbursed, including homeopathy). In
 parallel, the government fixes the reimbursment rate for medical services: this
means that a doctor is free to charge the fee that he wishes for a consultation or an
examination, but the social security system will only reimburse it at a pre-set rate.
These tariffs are set annually through negotiation with doctors' representative
organisations.
 The second government responsibility is oversight of the health-insurance funds,
to ensure that they are correctly managing the sums they receive, and to ensure
oversight of the public hospital network.

Today, this system is more-or-less intact. All citizens and legal foreign residents of
France are covered by one of these mandatory programs, which continue to be funded by
worker participation. However, since 1945, a number of major changes have been
introduced. Firstly, the different health-care funds (there are five: General, Independent,
Agricultural, Student, Public Servants) now all reimburse at the same rate. Secondly,
since 2000, the government now provides health care to those who are not covered by a
mandatory regime (those who have never worked and who are not students, meaning the
very rich or the very poor). This regime, unlike the worker-financed ones, is financed via
general taxation and reimburses at a higher rate than the profession-based system for
those who cannot afford to make up the difference. Finally, to counter the rise in health-
care costs, the government has installed two plans, (in 2004 and 2006), which require
insured people to declare a referring doctor in order to be fully reimbursed for specalist
visits, and which installed a mandatory co-pay of 1 € (about $1.45) for a doctor visit, 0,50
€ (about 80 ¢) for each box of medicine prescribed, and a fee of 16-18 € (20-25 $) per
day for hospital stays and for expensive procedures.

An important element of the French insurance system is solidarity: the more ill a person
becomes, the less the person pays. This means that for people with serious or chronic
illnesses, the insurance system reimburses them 100 % of expenses, and waives their co-
pay charges.

Finally, for fees that the mandatory system does not cover, there is a large range of
private complementary insurance plans available. The market for these programs is very
competitive, and often subsidised by the employer, which means that premiums are
usually modest. 85% of French people benefit from complementary private health
insurance.[21][22]

[edit] Netherlands

Main article: Health care in the Netherlands

In 2006, a new system of health insurance came into force in the Netherlands. This new
system avoids the two pitfalls of adverse selection and moral hazard associated with
traditional forms of health insurance by using a combination of regulation and an
insurance equalization pool. Moral hazard is avoided by mandating that insurance
companies provide at least one policy which meets a government set minimum standard
level of coverage, and all adult residents are obliged by law to purchase this coverage
from an insurance company of their choice. All insurance companies receive funds from
the equalization pool to help cover the cost of this government-mandated coverage. This
pool is run by a regulator which collects salary-based contributions from employers,
which make up about 50% of all health care funding, and funding from the government to
cover people who cannot afford health care, which makes up an additional 5%.

The remaining 45% of health care funding comes from insurance premiums paid by the
public, for which companies compete on price, though the variation between the various
competing insurers is only about 5%. However, insurance companies are free to sell
additional policies to provide coverage beyond the national minimum. These policies do
not receive funding from the equalization pool, but cover additional treatments, such as
dental procedures and physiotherapy, which are not paid for by the mandatory policy.

Funding from the equalization pool is distributed to insurance companies for each person
they insure under the required policy. However, high-risk individuals get more from the
pool, and low-income persons and children under 18 have their insurance paid for
entirely. Because of this, insurance companies no longer find insuring high risk
individuals an unappealing proposition, avoiding the potential problem of adverse
selection.

Insurance companies are not allowed to have co-payments, caps, or deductibles, or to

deny coverage to any person applying for a policy, or to charge anything other than their
nationally set and published standard premiums. Therefore, every person buying
insurance will pay the same price as everyone else buying the same policy, and every
person will get at least the minimum level of coverage.

[edit] United Kingdom

Main article: National Health Service

The UK's National Health Service (NHS) is a publicly funded healthcare system that
provides coverage to everyone normally resident in the UK. It is not strictly an insurance
system because (a) there are no premiums collected, (b) costs are not charged at the
patient level and (c) costs are not pre-paid from a pool. However, it does achieve the
main aim of insurance which is to spread financial risk arising from ill-health. The costs
of running the NHS (est. £104 billion in 2007-8)[23] are met directly from general
taxation. The NHS provides the majority of health care in the UK, including primary
care, in-patient care, long-term health care, ophthalmology and dentistry.

Private health care has continued parallel to the NHS, paid for largely by private
insurance, but it is used by less than 8% of the population, and generally as a top-up to
NHS services. There are many treatments that the private sector does not provide. For
example, health insurance on pregnancy is generally not covered or covered with
restricting clauses.[24] Typical exclusions for Bupa schemes (and many other insurers)
include:
ageing, menopause and puberty; AIDS/HIV; allergies or allergic disorders; birth control,
conception, sexual problems and sex changes; chronic conditions; complications from
excluded or restricted conditions/ treatment; convalescence, rehabilitation and general
nursing care ; cosmetic, reconstructive or weight loss treatment; deafness; dental/oral
treatment (such as fillings, gum disease, jaw shrinkage, etc); dialysis; drugs and dressings
for out-patient or take-home use† ; experimental drugs and treatment; eyesight; HRT and
bone densitometry; learning difficulties, behavioural and developmental problems;
overseas treatment and repatriation; physical aids and devices; pre-existing or special
conditions; pregnancy and childbirth; screening and preventive treatment; sleep problems
and disorders; speech disorders; temporary relief of symptoms.[25] († = except in
exceptional circumstances)

There are a number of other companies in the United Kingdom which include, among
others, AXA[26], Aviva, Groupama Healthcare and Pru Health. Similar exclusions apply,
depending on the policy which is purchased.

Recently (2009) the main representative body of British Medical physicians, the British
Medical Association, adopted a policy statement expressing concerns about
developments in the health insurance market in the UK. In its Annual Representative
Meeting which had been agreed earlier by the Consultants Policy Group (i.e. Senior
physicians) stating that the BMA was "extremely concerned that the policies of some
private healthcare insurance companies are preventing or restricting patients exercising
choice about (i) the consultants who treat them; (ii) the hospital at which they are treated;
(iii) making top up payments to cover any gap between the funding provided by their
insurance company and the cost of their chosen private treatment." It went in to "call on
the BMA to publicise these concerns so that patients are fully informed when making
choices about private healthcare insurance."[27] The NHS offers patients a choice of
hospitals and consultants and does not charge for its services.

The private sector has been used to increase NHS capacity despite a large proportion of
the British public opposing such involvement.[28] According to the World Health
Organization, government funding covered 86% of overall health care expenditures in the
UK as of 2004, with private expenditures covering the remaining 14%.[29]

[edit] United States

Main articles: Health insurance in the United States, Health insurance reform, and Health
care in the United States

The United States health care system relies heavily on private health insurance, which is
the primary source of coverage for most Americans. According to the CDC,
approximately 58% of Americans have private health insurance.{[30]} Public programs
provide the primary source of coverage for most senior citizens and for low-income
children and families who meet certain eligibility requirements. The primary public
programs are Medicare, a federal social insurance program for seniors and certain
disabled individuals, Medicaid, funded jointly by the federal government and states but
administered at the state level, which covers certain very low income children and their
families, and SCHIP, also a federal-state partnership that serves certain children and
families who do not qualify for Medicaid but who cannot afford private coverage. Other
public programs include military health benefits provided through TRICARE and the
Veterans Health Administration and benefits provided through the Indian Health Service.
Some states have additional programs for low-income individuals.[31]

A recent study found that 62 percent of all bankruptcies filed in 2007 were linked to
medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health
insurance.[32] In just three years, the Medicare and Medicaid programs will account for 50
percent of all national health spending.[33] This has fueled an outcry for an overhaul of the
health care system in the United States. The House of Representatives passed a health
care reform bill by a vote of 220-215 on November 7, 2009. [34] Currently the fate of the
bill rests on the Senate. The legislation once included changes that would give the
government the power to negotiate policy premiums and to provide a public option, but
in an effort to acquire the necessary votes to prevent a Republican filibuster the public
option was eliminated from the bill. This would have given citizens the option to buy into
public programs like Medicare for which current members pay only $96.40 monthly.[35]
Instead the bill now requires that all Americans purchase private health insurance or be
subject to fines.[35][36][not in citation given] The insurance industry represents a significant lobbying
group in the United States. The major health interests have spent an average of $1.4
million per day to lobby Congress so far this year and are on track to spend more than
half a billion dollars by the end 2009. On March 21, 2010, the House of Representatives
passed a bill proposed by President Obama, which will supposedly offer a wide range of
coverage and extend it to roughly 32 million more Americans without coverage.

[edit] California

In 2007, 87% of Californians had some form of health insurance.[37] Services in California
range from private offerings: HMOs, PPOs to public programs: Medi-Cal, Medicare, and
Healthy Families (SCHIP).

California developed a solution to assist people across the State and is one of the only
States to have an Office devoted to giving people tips and resources to get the best care
possible. California's Office of the Patient Advocate was established July 2000 to publish
a yearly Health Care Quality Report Card on the Top HMOs, PPOs, and Medical Groups
and to create and distribute helpful tips and resources to give Californians the tools
needed to get the best care.[38]

Additionally, California has a Help Center that assists Californians when they have
problems with their health insurance. The Help Center is run by the Department of
Managed Health Care, the government department that oversees and regulates HMOs and
some PPOs.

[edit] Germany
Main article: Health care in Germany

Germany has Europe's oldest universal health care system, with origins dating back to
Otto von Bismarck's Social legislation, which included the Health Insurance Bill of
1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of
1889. As mandatory health insurance, these bills originally applied only to low-income
workers and certain government employees; their coverage, and that of subsequent
legislation gradually expanded to cover virtually the entire population.[39]

Currently 85% of the population is covered by a basic health insurance plan provided by
statute, which provides a standard level of coverage. The remainder opt for private health
insurance[citation needed], which frequently offers additional benefits. According to the World
Health Organization, Germany's health care system was 77% government-funded and
23% privately funded as of 2004.[29]

The government partially reimburses the costs for low-wage workers, whose premiums
are capped at a predetermined value. Higher wage workers pay a premium based on their
salary. They may also opt for private insurance, which is generally more expensive, but
whose price may vary based on the individual's health status.[40]

Reimbursement is on a fee-for-service basis, but the number of physicians allowed to

accept Statutory Health Insurance in a given locale is regulated by the government and
professional societies.

Co payments were introduced in the 1980s in an attempt to prevent over utilization. The
average length of hospital stay in Germany has decreased in recent years from 14 days to
9 days, still considerably longer than average stays in the United States (5 to 6 days).[41][42]
Part of the difference is that the chief consideration for hospital reimbursement is the
number of hospital days as opposed to procedures or diagnosis. Drug costs have
increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to
contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable
to other western European nations, but substantially less than that spent in the U.S.
(nearly 16% of GDP).[43]

[edit] Insurance systems

Germany has a universal multi-payer system with two main types of health insurance.
Germans are offered three mandatory health benefits, which are co-financed by employer
and employee: health insurance, accident insurance, and long-term care insurance.

Accident insurance (Unfallversicherung) is covered by the employer and basically

covers all risks for commuting to work and at the workplace.

Long term care (Pflegeversicherung) is covered half and half by employer and employee
and covers cases in which a person is not able to manage his or her daily routine
(provision of food, cleaning of apartment, personal hygiene, etc.). It is about 2% of a
yearly salaried income or pension, with employers matching the contribution of the
employee.

There are two separate systems of health insurance: public health insurance (Gesetzliche
Krankenversicherung) and private insurance (Private Krankenversicherung). Both
systems struggle with the increasing cost of medical treatment and the changing
demography. About 87.5% of the persons with health insurance are members of the
public system, while 12.5% are covered by private insurance (as of 2006).[44]

[edit] See also

 Economic capital
 Health care compared - tabular comparisons of the US, Canada, and other
countries not shown above.
 Healthcare reform
 Health care
 Health care politics
 Health economics
 Health insurance exchange
 Health insurance mandate
 Health insurance in the United States
 Health maintenance organization
 Injury cover
 List of insurance topics
 Philosophy of Healthcare
 Public health
 Self-funded health care
 Single-payer health care
 Social health insurance
 Social security
 Social welfare

[edit] Notes and references

1. ^ How Private Insurance Works: A Primer by Gary Claxton, Institution for Health
Care Research and Policy, Georgetown University, on behalf of the Henry J.
Kaiser Family Foundation.
2. ^ Howstuffworks: How Health Insurance Works.
3. ^ "Encarta: Health Insurance". Archived from the original on 2009-10-31.
http://www.webcitation.org/5kwqZV6V7.
4. ^ See California Insurance Code Section 106 (defining disability insurance).
http://caselaw.lp.findlaw.com/cacodes/ins/100-124.5.html In 2001, the California
Legislature added subdivision (b), which defines "health insurance" as "an
individual or group disability insurance policy that provides coverage for hospital,
medical, or surgical benefits."
5. ^ a b Fundamentals of Health Insurance: Part A, Health Insurance Association of
America, 1997, ISBN 1-879143-36-4.
6. ^ Thomas P. O'Hare, "Individual Medical Expense Insurance," The American
College, 2000, p. 7, ISBN 1-57996-025-1.
7. ^ Managed Care: Integrating the Delivery and Financing of Health Care - Part A,
Health Insurance Association of America, 1995, p. 9 ISBN 1-879143-26-1.
8. ^ Agency for Health care Research and Quality (AHRQ). "Questions and
Answers About Health Insurance: A Consumer Guide." August 2007.
9. ^ http://www.healthharbor.com/HealthInsPriorAuth.html
10. ^ http://www.healthharbor.com/HealthInsReadingEOB.html
11. ^ "Comprehensive Health Insurance vs. Scheduled Health Insurance".
12. ^ "Mini Medical Plans On The Move".
13. ^ a b The Factors Fueling Rising Healthcare Costs 2006, PriceWaterhouseCoopers
for America's Health Insurance Plans, 2006, accessed 2007-10-08.
14. ^ "Mirror, Mirror on the Wall: An International Update on the Comparative
Performance of American Health Care". The Commonwealth Fund. May 15,
2007. http://www.commonwealthfund.org/Content/Publications/Fund-Reports/
2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-
Comparative-Performance-of-American-Healt.aspx. Retrieved March 7, 2009.
15. ^ http://www.australianunity.com.au/au/hins/Misc/MedicareSurcharge.asp#
16. ^ http://parlinfoweb.aph.gov.au/piweb/Repository/Legis/Bills/Linked/
27050802.pdf
17. ^ http://www.abc.net.au/news/stories/2008/08/12/2332647.htm
18. ^ Private Health Insurance in OECD Countries. OECD Health Project. 2004.
http://books.google.com/books?
id=oUM39nDp2s4C&dq=employer+provided+private+health+insurance+in+cana
da. Retrieved 2007-11-19.
19. ^ National Health Expenditure Trends, 1975-2007. Canadian Institute for Health
Information. 2007-11-13. ISBN 9781554651672.
http://secure.cihi.ca/cihiweb/dispPage.jsp?
cw_page=PG_876_E&cw_topic=876&cw_rel=AR_31_E. Retrieved 2007-11-19.
20. ^ Hadorn, D. (2005-08-02). "The Chaoulli challenge: getting a grip on waiting
lists". Canadian Medical Association Journal 173: 271.
doi:10.1503/cmaj.050812. PMID 16076823.
http://www.cmaj.ca/cgi/content/full/173/3/271?etoc.
21. ^ "L'assurance maladie".
22. ^ John S. Ambler, "The French Welfare State: surving social and ideological
change," New York University Press, 30 September 1993, ISBN 978-
0814706268.
23. ^ HM Treasury (2007-03-21). "Budget 2007" (PDF). p. 21. http://www.hm-
treasury.gov.uk/media/3/4/bud07_completereport_1757.pdf. Retrieved 2007-05-
11.
24. ^ http://www.carehealth.co.uk/pmiexpln.htm
25. ^ BUPA exclusions.
26. ^ AXA PPP healthcare.
 27. ^ http://web2.bma.org.uk/bmapolicies.nsf/searchresults?
OpenForm&Q=FIELD+Subject+contains+Private+Healthcare+AND+FIELD+Da
tePolicy+contains+2009~8~50~Y
28. ^ "Survey of the general public's views on NHS system reform in England"
(PDF). BMA. 2007-06-01.
http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFnhssystreform2007/$FIL
E/48751Surveynhsreform.pdf.
29. ^ a b World Health Organization Statistical Information System: Core Health
Indicators.
30. ^ http://www.cdc.gov/nchs/fastats/hinsure.htm
31. ^ U.S. Census Bureau, "CPS Health Insurance Definitions".
32. ^ Himmelstein, D, E., et al, “Medical Bankruptcy in the United States, 2007:
Results of a National Study, American Journal of Medicine, May 2009.
33. ^ Siska, A, et al, Health Spending Projections Through 2018: Recession Effects
Add Uncertainty to The Outlook Health Affairs, March/April 2009; 28(2): w346-
w357.
34. ^ www.cnn.com/2009/POLITICS/11/07/health.care/index.html
35. ^ a b http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?
p_faqid=2100
36. ^ http://news.yahoo.com/s/ap/us_health_care_overhaul
37. ^ CHIS 2007 Survey
38. ^ OPA, About California's Patient Advocate
39. ^ History of German Health Care System
40. ^ Gesetzliche Krankenversicherungen im Vergleich(English Translation)
41. ^ Length of hospital stay, Germany
42. ^ Length of hospital stay, U.S.
43. ^ Borger C, Smith S, Truffer C, et al. (2006). "Health spending projections
through 2015: changes on the horizon". Health Aff (Millwood) 25 (2): w61–73.
doi:10.1377/hlthaff.25.w61. PMID 16495287.
44. ^ SOEP - Sozio-oekonomische Panel 2006: Art der Krankenversicherung

 Navigating your health benefits for dummies. Charles M Cutler MD Tracey A

Baker CFP (c)2006 ISBN 978-0-470-08354-3

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 True Crime
SPONSORED BY:

Open Enrollment
How do you get 30 million Americans to sign up for
health insurance? With great difficulty.

PHOTOS

How Will Health Care Reform Affect You?

A look at how different groups will fare under the new law.

By Sarah Kliff | Newsweek Web Exclusive

Mar 29, 2010
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With health-care reform now the law of the land, the Obama administration faces a
logistical challenge no simpler than wrangling votes in Congress: enrolling more than 30
million Americans in health insurance. If the Congressional Budget Office prediction
holds true, 19 million additional Americans will carry health insurance when the
individual mandate becomes law on Jan. 1, 2014. By 2019, another 13 million will be on
the rolls. The federal government will provide matching funds for the Medicaid
expansion—in 2014, the program will open to all Americans living below 133 percent of
the Federal poverty level—as well as grants to help states build their insurance
exchanges. Washington will also handle enforcement via the Internal Revenue Service,
requiring Americans to file proof of insurance with their tax return.

SUBSCRIBE Click Here to subscribe to NEWSWEEK and save up to 77% >>

But many of the administrative tasks fall to individual states: creating exchanges; raising
awareness; deciding on enrollment processes; building an enrollment infrastructure, both
physical and technological; and making all of it easy for consumers to use. "It's an
aggressive timeline," says Genevieve Kenney, a health-policy analyst at the Urban
Institute, of the 2014 deadline. "But we're not going into it blind."

From the passage of Medicare in 1965 up through Massachusetts's universal coverage

program in 2007, health-care administrators have conducted an ongoing trial in wide-
scale enrollment. The results? Successful transitions are indeed possible but incredibly
complicated. They have historically required a sweeping outreach effort alongside
meticulous attention to details, and they stumble without both key elements in place. "Its
nonsexy stuff," Kenney says of the enrollment processes. "But if coverage is your goal,
and this legislation does reflect that belief, [then] all the evidence we have shows the
importance of creating good systems to support enrollment."

Medicare, the first large-scale, no-military government health-insurance program,

demonstrated the brute force of bureaucracy. President Lyndon B. Johnson signed
Medicare into law on July 30, 1965 with a daunting directive: have the program up and
running by July 1, 1966. In "Reflections on Implementing Medicare," Robert Ball, the
commissioner of Social Security during the implementation, remembers enlisting the help
of the United States Post Office, the Internal Revenue Service, and the Forest Service,
who had "rangers out in the woods looking for hermits to sign up on the voluntary plan."
The Social Security Administration itself hired 8,000 additional employees, opened 100
offices in that first year and printed up 100 million leaflets on the program. The intensive
approach worked: 93 percent of seniors signed up for the voluntary, $3-per-month
Medicare Part B program within just 11 months of Johnson's signature.
Medicare was bolstered by a pro-government zeitgeist at the time, managed by Great
Society Democrats who, on the heels of their 1964 landslide victory, were accustomed to
creating government agencies with the stroke of a pen. Theodore Marmor, author ofThe
Politics of Medicare, says, "There was the sense that government agencies could move
quickly and competently without the huffing and puffing."

Thirty years later, faith in government had significantly eroded when Congress created a
more piecemeal program: the State Children's Health Insurance Program, or SCHIP
(pronounced ess-chip). Its $4 billion in yearly matching grants went to states that insured
low-income children. While the law took effect even faster than Medicare—it was signed
in August 1997, enrolling children in October of the same year—participation numbers
were much lower. While Medicare reached nearly all of its target enrollees in less than a
year, 21 percent of SCHIP-eligible children remained unenrolled a decade after the
program became law, according to a report from the Urban Institute. Moreover, from
state to state, enrollment numbers varied widely, from a high of 93 percent in
Massachusetts to a low of 59 percent in Texas in 1999.
If Medicare underscored the importance of widespread outreach, SCHIP was a crash
course in behavioral economics: small nudges throughout the enrollment process had
huge effects on consumer decisions. SCHIP was not a sweeping, federal program in the
vein of Medicare; no federal agency mandated how to track down potential beneficiaries.
So each state developed its own program that, depending on usability, could encourage or
discourage potential beneficiaries from signing up. When Texas, for example, required
SCHIP participants to renew benefits every six months instead of every 12, SCHIP
enrollment dropped by 29 percent. Changes can also push enrollees in the right direction.
After Georgia revamped its SCHIP program by launching an online application and
loosening renewal requirements, participation numbers shot up from 48,000 in 1999 to
300,000 in 2005. The most recent reauthorization of SCHIP, signed by President Obama
in February 2009, included a list of eight best practices in enrollment, rewarding states
that use at least five of them. "States are innovating," says the Urban Institute's Kenney,
"and they're coming to a growing consensus about how to do this best."

Massachusetts, the most recent experiment in health-care reform, drew on lessons of the
importance of both wide-scale outreach and low-level details. The state legislature
approved a universal insurance mandate in April 2006, and the Connector, a newly
created organization to regulate the insurance exchange, was charged with the task of
putting the policy into action. The group spent $4 million on outreach alone, hosting 150
events across the state in the course of 21 months. The Connector partnered with the
Boston Red Sox, local grocery stores, pharmacies, and local faith groups. "The biggest
challenge was volume of requests coming in," says Joan Fallon, the Connector's
communications director, who ran the outreach campaign. "We were a small staff and the
people that reached us needed to hear back. I remember feeling a little overwhelmed."
They developed an online portal that has won awards for its usability. The site handled 80
percent of the state's new enrollments. As of 2008, lack of insurance in the general
population had dropped to 2.6 percent, the lowest rate in the nation.

For today's health-care reformers, Massachusetts has become the latest chapter to study:
42 states sent representatives to the state's January conference on how to implement
universal coverage. Anxious administrators barraged Fallon with questions about how to
execute the impending law. Massachusetts officials presented panels on their public
awareness campaign, the structure of their enrollment campaign, and state-administered
benefits. "You can leave no stone unturned," Fallon instructed them. "If a state has a fine
for not having health insurance, it also has a responsibility to let people know the law is
there and help them come into compliance." A wise lesson, but one that, if the history of
health-care reform is any indicator, administrators will find to be much easier said than
done.

© 2010

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 o Reply
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Posted By: SJJJ @ 04/15/2010 6:16:23 PM

The 30 million new enrollments are going to want their monies worth!! I'm
guessing they will spike the system like never seen before and gov estimates will
be a mile off like they have been with social security and every other unfunded
entitlement!! The path to financial crisis is paved with good intentions we can't
afford!!

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o Report Abuse

Posted By: McKatam @ 04/11/2010 5:00:09 PM

Those who claim to oppose socialized medicine should have, as their first priority,
abolition of the Veterans Administration health care system. This is true
socialized medicine, with facilities owned by the government, and all personnel
government employees. Would you advocate the military personnel should have
to seek medical care with their own money in whatever country they happen to be
in? Actually, women in the military already have that problem, with some
necessary procedures not covered by the VA. Happily, if they can get to Europe,
they will find universal health care, where they will get good care at low cost. So,
really, those of you angry about "Obamacare," how do you feel about this huge
bureaucracy called the VA, and do you think it should be abolished? Should
soldiers wounded in Afghanistan have to get medical care from local practitioners
and pay for it with their own money? And even if you think battlefield injuries
should be treated, why should that be expanded to cover their wives and children?
Why don't they just buy their own health insurance in the open market? Or is
being a soldier a pre-existing condition for which treatment for injuries by bullets
and IEDs won't be covered?


o Reply
o Report Abuse

Posted By: Askme @ 04/08/2010 12:12:58 PM

I've been reading the Health Care Bill at http://thomas.loc.gov/ H.R.3590 Patient
Protection and Affordable Care Act Subtitle F-Shared Responsibility for Health
Care Sec. 1501. Sec. 1502 deals with penalty and IRS requirement to send out
notices to those without health insurance coverage to inform of the Exchange
pools and Title IX: Revenue Provisions - Subtitle A Sec.9002 Requires employers
to disclose on employees' W-2 Form to the IRS the cost of health insurance policy
 from employer to employee. H.R.3200 America???s Affordable Health Choices
Act of 2009 informs of imposing a Tax on individuals without an insurance policy
and to employers not offering an insurance policy.

Also go to http://dpc.senate.gov/healthreformbill/healthbill05.pdf Subtitle F-

Shared Responsibility for Health Care Sec. 1501. Sec. 5000A. discusses the
penalty to those without an insurance policy and Sec. 1502. and Sec. 6055. deals
with reporting health insurance coverage to the IRS. Subtitle A-Revenue Offset
Provisions Sec. 9002. Employer to report insurance coverage on employee???s
W-2 Form to IRS.
Title IX-Revenue Provisions - Subtitle A-Revenue Offset Provisions Sec. 9002
deals with reporting cost of employer health coverage on employee's W-2 Form.

Reply

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Enter comments if any for reporting abuse

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Newsweek on Digg

What is Digg?

Managed Care

Managed care plans are health insurance plans that contract with health care providers
and medical facilities to provide care for members at reduced costs. These providers
make up the plan's network. How much of your care the plan will pay for depends on the
network's rules.

Restrictive plans generally cost you less. More flexible plans cost more. There are three
types of managed care plans:

 Health Maintenance Organizations (HMO) usually only pay for care within the
network. You choose a primary care doctor who coordinates most of your care.
 Preferred Provider Organizations (PPO) usually pay more if you get care within
the network, but they still pay a portion if you go outside
 Point of Service (POS) plans let you choose between an HMO or a PPO each time
you need care

Medicare

Medicare is the U.S. government's health insurance program for people age 65 or older.
Certain people under age 65 can qualify for Medicare, too, including those with
disabilities, permanent kidney failure or amyotrophic lateral sclerosis.

Medicare helps with the cost of health care, but it does not cover all medical expenses or
the cost of most long-term care. The program has four parts:

 Part A is hospital insurance.

 Part B helps pay for medical services that Part A doesn't cover.
 Part C is called Medicare Advantage. If you have Parts A and B, you can choose
this option to receive all of your health care through a provider organization, like
an HMO.
 Part D is prescription drug coverage. It helps pay for some medicines

Medicaid
Medicaid is government health insurance that helps many low-income people in the
United States to pay their medical bills. Although the Federal government establishes
general guidelines for the program, each state has its own rules. Your state might require
you to pay a small part of the cost for some medical services.

You have to meet certain requirements to be eligible for Medicaid. These might involve

 Your age
 Whether you are pregnant, disabled or blind
 Your income and resources
 Whether or not you are a U.S. citizen or a lawfully admitted immigrant

Centers for Medicare and Medicaid Services

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Save Money on Your Medications

Do You Know How to Spend Less on Your Drugs?
Drugs can be very expensive and may strain your budget, especially if you have a chronic
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Stay In the Home You Love – Learn About PACE!

Thursday April 29, 2010

PACE - the Program of All-inclusive Care for the Elderly - is a special Medicare program
for adults over age 55 living with disabilities. PACE was created as a way to provide you,
your family, caregivers, and health care professional health care a way to meet your
health care needs in the community where you live instead of a nursing home.

Who Is Eligible for PACE?

According to Medicare, you can join PACE if you:

 are 55 years old or older

 live in the service area of a PACE organization
 are certified by the state in which you live as meeting the need for the nursing
home level of care
 are able to live safely in the community when you join

If you are enrolled in PACE and need nursing home care, the PACE program pays for it
and will continue to coordinate your care. Interestingly, although you must be certified to
need nursing home care to be in PACE, only about seven percent of people in the
program actually reside in a nursing home.

PACE Services
The PACE program provides the following care and services:

 Adult day care including nursing, physical, occupational and recreational

therapies, nutritional counseling, and social work services
 Medical care provided by a PACE physician familiar with your history, health
needs and preferences
  Home health care and personal care including meals and other activities of daily
living
 All necessary prescription drugs
 Medical specialists such as audiology, dentistry, optometry, podiatry, and speech
therapy
 Respite care
 Hospital and nursing home care when necessary

Resources:

 Quick Facts about PACE

 List of PACE Programs By State
 PACE4You Website

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

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Obama Nominates Donald Berwick to Lead Medicare

and Medicaid
Monday April 26, 2010

Last week, President Obama nominated Donald Berwick, MD to be

the first permanent administrator of the Centers for Medicare and
Medicaid Services (CMS) in almost four years.

Dr. Berwick - a professor of pediatrics and healthcare policy at

Harvard medical School -- is an authority on quality improvement in
the U.S. healthcare system. Dr. Berwick is currently the president and
CEO of the Institute for Healthcare Improvement, a not-for-profit
organization in Cambridge, Mass., committed to improving
healthcare.

Berwick Will Oversee Major Changes at CMS

If confirmed by the Senate, Dr. Berwick will manage significant changes in the Medicare
and Medicaid programs that will result from passage of the health reform bill. The
legislation, signed into law by President Obama last month, expands Medicaid to an
additional 16 million people and calls for billions of dollars in cuts from the Medicare
budget.
Berwick will also be responsible for creating and implementing pilot programs to find
ways of delivering health care services that are cost effective and more focused on
quality.

Senate Debate Likely

In a prepared statement, Senator Max Baucus (D-Mont.), chairman of the Senate Finance
Committee, praised Dr. Berwick as "an experienced health policy expert and researcher
whose career has focused on innovative and effective ways to improve healthcare
quality."

Although several physician groups - such as the American Medical Association and the
American College of Cardiology - have praised the nomination, a few Republican
Senators have been critical, alleging that Berwick may support linking quality outcomes
to physician and hospital payments, which they equate to "rationing" of health care.

I completely agree with the Dr. Berwick's nomination. I think it will lead to an
improvement in our health care delivery system, especially the quality of care provided to
a large segment of the U.S. population. Senator Baucus sums it best, "Implementing
innovative ideas that work and boosting healthcare quality will be critical goals for the
next administrator of CMS, particularly in our fight to deliver better healthcare outcomes
and lower costs for patients across the country . . . I look forward to an expeditious
review of Dr. Berwick's nomination in the Finance Committee."

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

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Got a Question About Your Health Insurance or Health

Reform? Ask Dr. Mike!
Friday April 23, 2010
One of my greatest joys is to share my health-related knowledge and experience in a way
that engages people and helps simplify their journey through the healthcare system. As a
physician and health educator, I'm committed to helping you receive the information that
you need to make informed decisions about your health.

I will be happy to answer questions about your health insurance and about the health
reform legislation signed into law in March. If I don't have the answer, I will research it
for you or provide you with resources that are credible and up to date.

If the answer to your question is of interest to other readers, I may post it as a FAQ or in
my Blog or newsletter.

Please understand that I cannot make any decisions for you regarding your health
insurance requirements. Hopefully, I can point you in the right direction so you can make
an informed decision that best meets your healthcare coverage and financial needs.

If you cannot afford health insurance, I may be able to help you find resources in your
state and give you some tips on how to save on your healthcare.

To ask me a question about health insurance or health reform, email me at

[email protected].

What do you think? Leave a comment below or in the Health Insurance Forum.

Please be aware that I cannot provide any medical advice, recommend any treatment
for you, or diagnose a health problem. Please consult your healthcare provider if you
have specific concerns about your health.

..................................................

Photo © Stockphoto

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COBRA Subsidy Extended Until End of May

Wednesday April 21, 2010

In February 2009, Congress passed the American Recovery and Reinvestment Act
(ARRA) to help deal with the nation's economic crisis. An important part of ARRA was
health insurance funding for workers who lost their jobs.

Under ARRA, laid-off employees who were eligible for COBRA received help paying
for health insurance coverage. The federal subsidy paid 65% of the cost of a worker's
monthly COBRA premium for up to nine months for people laid off between September
2008 and December 2009.

Congress has extended the COBRA subsidy several times since the initial passage of
ARRA.

Duration of Subsidy Extended Again

On 04/15/2010, President Obama signed into law an extension of unemployment benefits

and the COBRA premium assistance. This extension provides a COBRA premium
subsidy for eligible individuals who are involuntarily terminated from employment
through May 31, 2010.

Because of continued prolonged unemployment in the country, Congress may consider

extending the CPBRA subsidy until the end of the year.

Remember that your COBRA benefit only lasts for a total of 18 months. It's important
for you to plan for health insurance after you are no longer covered by COBRA.

What Is COBRA?
If your former employer has more than 20 employees, the company is required by a 1986
federal law to offer you the option to pay for an extension of your health insurance
coverage for at least 18 months. COBRA can be very expensive. If you are getting
coverage for yourself, you may have to pay up to $400 per month; family coverage may
be more than $1000 per month.

In the U.S. in 2009 the average monthly COBRA premium for a family is $1,111. With
the federal subsidy, that premium is $389 each month. For the typical American worker,
the average monthly unemployment benefit is $1,333. Unfortunately, families who have
lost their COBRA subsidy will have to pay more than 80% of their monthly
unemployment check for health insurance!

You can find more information about COBRA on the website of the U.S. Department of
Labor.
Information from Dr. Mike:

 How to Keep or Find Affordable Health Coverage When Laid Off

 COBRA Continuation Coverage

What do you think? Please leave a comment below or in the Health Insurance Forum.

To stay up to date on health insurance issues get Dr. Mike's Health Insurance Newsletter.

..............................................
Photo © iStockphoto.com

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