AGING ICON

LIVE HOW YOU WANT TO LIVE

Confusing Debate on Health Reform

The New York Times
December 3, 2009
Editorial
Good News on Premiums
The health insurance industry frightened Americans — and gave Republicans a shrill talking point — when it declared in October that proposed reform legislation would drive up insurance costs for virtually everyone by as much as thousands of dollars a year. The nonpartisan Congressional Budget Office persuasively contradicted that claim this week.
Undaunted, the industry issued a rebuttal report, claiming again that premiums would soar. We find this second industry report no more persuasive than the first.
The insurance industry is not giving up. On Thursday, the Blue Cross and Blue Shield Association issued a report contending that the C.B.O. underestimated the expected medical costs of people who will be buying policies on the individual (nongroup) market.
(CBO notes that) the legal mandate to obtain coverage, the penalties for noncompliance, and the generous subsidies for low- and middle-income people would encourage most people to enroll without waiting to become sick.

And…
The White House
The White House Blog
December 3, 2009
Coming Attractions: Insurance Industry Funded Study is Wrong on the Facts… Again…
Posted by Dan Pfeiffer, White House Communications Director
Later today, the insurance industry releases their latest in a string of flawed analyses designed to confuse the debate around health reform.
In addition to ignoring Congress’s independent budget experts, the new report reaches its conclusions by cherry-picking which policies to analyze – a tactic we’ve seen the industry use repeatedly. Most egregiously, its alarmist headline conclusions leave out the impact that new tax credits will have on the cost of health insurance for families. That makes no sense.  In reality, the report itself acknowledges that: “[s]ubsidies will entirely or partially offset these premium increases for some individuals.”

And…
BlueCross BlueShield Association
Oliver Wyman
December 3, 2009
Impact of the Patient Protection and Affordable Care Act on Costs in the Individual and Small-Employer Health Insurance Markets
By Jason Grau and Kurt Giesa
Impact of Subsidies
Subsidies would play an important role in reducing out-of-pocket costs for certain individuals, especially those below 200% of FPL, who are likely to purchase insurance under the proposed reforms. Subsidies will cover more than 90% of premium costs for individuals in this income range, significantly reducing financial barriers to purchasing coverage.
By contrast, our analysis of the Senate bill projects that 8.7 million will not be eligible for the subsidies. Another 3.3 million people who purchase coverage will have incomes of 300-400% FPL and will be eligible for average subsidies of 45% of their premiums (which would not fully offset the cost increases we predict). Finally, 13.3 million lower-income individuals who purchase coverage will have incomes of 100-300% FPL. They will have access to subsidies of 70-90% of their premiums, which will offset much if not all of the increased premiums they will face.
Our modeling predicts that those who are eligible for subsidies will be more likely to purchase insurance than those who are not. However, subsidies will not ensure that young and healthy people participate. Short of achieving 100% coverage, adverse selection will always exist, and the young and healthy will be the most difficult to bring into the market.
Impact of Weak Individual Mandates
The Senate bill requires individuals to purchase insurance coverage or face financial penalties. An amendment accepted during mark-up of the Chairman’s Mark in the Finance Committee, and largely retained in the Senate leadership bill, substantially weakened the bill’s individual mandate. The individual mandate penalty in PPACA is set at just $95 in the first year insurance reforms become effective (2014). This penalty rises gradually, reaching a maximum of $750 per adult in 2016. This maximum penalty is likely to be only about 16 percent of an average premium in 2016, assuming current rates of medical cost inflation.
The amendment also exempts individuals whose premiums exceed 8% of their adjusted gross income (AGI). In 33 states, the average cost of health insurance exceeds eight percent of median state income. In fact, in the first year of reform 25% of the exchange-eligible population will face insurance costs in excess of the 8% AGI threshold and qualify for mandate exemption. Premium increases over a ten-year period will result in nearly half of the population qualifying for mandate exemption status.
Conclusion (excerpt)
The provision of subsidies alone will not offset the impact of insurance reforms on average premiums in the market. A balanced, sustainable insurance pool, that ensures everyone is covered, is critical to making healthcare affordable for all.

Full report:


Comment From Don McCanne:  Recent reports from the insurance industry, including this report from the BlueCross BlueShield Association, have been targeted by proponents of the current leading reform model as biased reports without credibility – witness the comments by The White House and The New York Times (both also biased). But the fundamental message from the insurance industry is very valid: the reform proposal before Congress does not do nearly enough to control health care costs, and the mandates, subsidies and penalties are inadequate to ensure that all risks are adequately pooled.
This report confirms once again that the subsidies are inadequate, particularly for middle-income families, and likely will result in adverse selection as the healthier take their chances on remaining uninsured. It confirms that the penalty for being uninsured is too small to ensure compliance with the insurance requirement. It also confirms that a very large and rapidly growing number of individuals will be exempt from the mandate to purchase insurance simply because their incomes are inadequate to be able to afford the plans.
There is one statement in this report that the proponents of the proposal before Congress should take careful note of, and it is remarkable that it is coming from the insurance industry: "A balanced, sustainable insurance pool, that ensures everyone is covered, is critical to making health care affordable for all."
The dysfunctional, fragmented model of health care financing that Congress is moving forward with can never create a balanced, sustainable risk pool, nor can it ensure that everyone is covered, nor can it make health care affordable for all.
We really do need a balanced, sustainable pool that includes everyone and is equitably financed: an improved Medicare for all.

December 8, 2009 Posted by | Uncategorized | Leave a comment

PsychoAnalyst/Coach and Dietitian Available

Emotion now has the services available of a psychoanalyst/coach and a dietitian on Monday and Wednesday. Call 718-332-5678 for appointments.

November 25, 2009 Posted by | Uncategorized | Leave a comment

E-Motion Wellness Spa opens in November

E-Motion Wellness Spa, located at 1711 Sheepshead Bay Road offers Patient Advocates, Personal Motivational Coaching, Nutrition by a Licensed Dietician all coordinated by physicians.  The office is now making appointments for November. Call 347-965-9222. Evening and weekends are available.

October 27, 2009 Posted by | Uncategorized | 1 Comment

Verizon 2010 Open Enrollment

We have been informed that a letter went out to employees letting them know that the open enrollment packages will be mailed shortly. Many people have told us that they don’t bother to open the envelopes because they don’t want to change their plans. We have also been getting calles from members who were shocked that their were changes to their plan last year. They only realized that as they went to the doctors or hospitals in 2009. This year it is very important to look at your plan choices carefully. You may be entitled to a lot more benefits than you are taking advantage of. The following HMO\’s wil be offered in 2010:

808 – Capital District Physicians Health
825 – Blue Alliance NY
843 – Univera Healthcare NY
822 – HIP Health Plan of NY
814 – Empire BCBS HMO of NY (now called Anthem EPO NY/NE)
847 – Aetna INC HMO
838 – HealthNet of Connecticut
827 – Independent Health of Buffalo
817 – United Health Care Passport/Harvard Pilgrim

October 11, 2009 Posted by | Uncategorized | 1 Comment

Patients being forced into HMO’s!

Doctors are reporting that insurers are requiring PCP referrals for services such as x-rays, MRI’s and lab tests, forcing patients to use HMO rules even for out of network services.  We are receiving reports of doctors trying to get out of lease arrangements because they cannot make the rent, even on Madison Ave. Patients are telling us that co-pays and deductibles are higher and more services are not covered by employer sponsored plans. Doctors are still looking for new patients to make up the loss on per patient income.

September 22, 2009 Posted by | Uncategorized | Leave a comment

LinkedIn and Facebook gets notice

SUN-B is now a 501(c)3 not for profit corporation. We have started to gain notice on LinkedIn and Facebook by posting members news. We get on the front page of other groups who work with seniors and we get on the email list for those groups as well. I’m getting direct emails from some very prestigeous people in the field who read these posts as well. Look up SeniorUmbrellaNetworkofBrooklyn in groups.
 
Caryn’s profile is getting a lot of activity also, as an expert in health policy and private medical practice management.  

September 12, 2009 Posted by | Uncategorized | Leave a comment

NYS Governor signs health insurance laws

On July 29, 2009, Governor David A. Paterson signed into law three bills in order to make health insurance more affordable and increase people’s access to health care:

  • Unmarried Dependents:  can be covered under a parent’s group health insurance policy until they are 29.  The families, not employers, would pay the premiums for their children. Under this bill, the children can be covered regardless of financial independence;
  • COBRA and State Continuation:  will be extended from 18 to 36 months; and
  • Managed Care Reform: will install several protections for the insured with regards to benefits and claim payment.  These protections include:
    • Prohibiting insurers from treating an in-network provider as out-of-network because the referring provider was out-of-network;
    • Reducing the time insurers have to review requests for post-hospital health care at one’s home; and
    • Limiting heath insurers’ and HMOs’ ability to delay payment or deny claims by sending a coordination of benefits questionnaire.

 Below is the link for the full press release from Governor Patterson:

http://www.ny.gov/governor/press/press_0729095.html

 

Please call me if you have any questions or concerns regarding the new legislation or any of your insurance needs.  If you know of anyone who would be interested in these updates, please let me know and I will add him/her to the distribution list.

 

Sincerely,

Robert S. Israel, CLU 
Long Island Planning Group, Ltd.
6800 Jericho Tpke.
Suite 203W
Syosset, NY 11791
516-682-8400 phone
516-682-8590 fax
http://www.liplanning.com

 

 

 

 

 

August 18, 2009 Posted by | Uncategorized | Leave a comment

Health Reform goes on vacation

The Affordable Health Care Choices Act will not come to a vote unitl September as Washington goes home for vacation. They return in September, when it will be seen whether they have gotten enough support at home to proceed with a vote. It will be the jobs of our representatives job to make people understand what is really in the bill, instead of the rhetoric and mis-dis information we are getting from the media.
 
Some things you should know about the bill:
1. It does not effect any collective bargaining agreement.
2. It does not dictate plan design, so whether you have to change your doctor will be up to the insurance plan, not the government.
3. It improves access to coverage for preventive services by mandating services for immunizations and well child care be covered in all plans.
4. It provides grants for improvements to health delivery systems and patient information systems.
5. It is not one big health system. It gives everyone a Cafeteria (the same choices that Congress has) menu of plans to choose from. Each plan will have their own premium cost, deductibles and co-pays. They will all be required to cover anone who can pay the premium.
 
 

August 5, 2009 Posted by | Uncategorized | Leave a comment

Paid Family Leave

Wednesday, July 29th

@12:00 p.m.

on the Steps of City Hall

 

 

A bill to insure that workers in the city of New York can earn paid sick time will be introduced by Council Member Gale Brewer in August.   At noon on July 29th, she will be joined on the steps of City Hall by other elected officials, low-wage workers, business owners, labor leaders, public health experts, advocates for children, women and the aging, The New York State Paid Family Leave Coalition and A Better Balance to urge the City Council to support this important legislation. Please join us!  

With warnings from federal officials that we could face a worse outbreak of H1N1 flu this fall, the urgency is even greater to act now so that workers can follow the Center for Disease Control’s advice to stay home or keep children home from school if they have flu symptoms.

Momentum is building in support of paid sick time — and with your continued help we can make it happen.

http://cityroom.blogs.nytimes.com/2009/07/16/momentum-seen-for-requiring-paid-sick-leave/

Please let us know you will join us on

Wednesday, July 29th at 12:00PM

RSVP via phone @ 212-558-2276 or via e-mail @ NYSPaidFamilyLeave@gmail.com

 

July 24, 2009 Posted by | Uncategorized | Leave a comment

Linked In, Facebook and Twitter

Do you think of Facebook, Linked In or Twitter when you want health information? They are all planning to be your gateway to storing your health data. Do you trust them or would you prefer a government or corporate agency to secure your privacy?

July 17, 2009 Posted by | Uncategorized | Leave a comment