Posts Tagged ‘healthcare’

By: Taylor Davidson

As many know, effective October 1st AHCCCS (Arizona’s Medicaid program) made dramatic changes to benefits eligibility (we can argue the necessity of these measures but that’s not my purpose with this column).  As a result of these changes a friend and client of mine recently received a notification that her two minor children would be losing their coverage and came to me several weeks ago as her agent to discuss options for replacing this insurance.

As recently as a few months ago I would have been able to help her with a policy for her kids that would have cost no more than tens of dollars every month ($40-$50); very reasonable and within reach of a working student and mother as she is.

But no longer.

As a result of provisions in the recent federal healthcare reform none of the insurance companies will offer those Child-Only policies anymore, you now must pay for family coverage including at least one adult. This dramatically changes the pricing, taking it out of reach of exactly those individuals who would benefit most from these coverage options.

I was discouraged when the healthcare act was passed because I knew it was putting politician’s choices between patients and their doctors as well as the companies that work to finance our healthcare needs.  But that discouragement has now come home for me at my agency.  By the stroke of a pen in Washington DC a client of mine, a hardworking, intelligent, young woman has been denied coverage for her children that she previously could have EASILY obtained and thus has been left on less secure financial footing.

As opposed to what Washington would have you believe, insurance companies are not evil, carriers do not seek out ways to deny claims, agents are not out to steal money from clients.  Mistakes are made and health claims are mishandled.  Yes.  The system is imperfect and needs improvement  Yes.  But fundamentally people making their own choices about the care they need and companies working to meet those needs is the best system ever devised in history for properly providing medical care.

We must begin to recognize the unintended consequences of our politicians’ mandates and we must see them now while they are clear and not hidden by the fog of time that makes us forget how things worked before they were run by government dictate, arbitrary rules and labyrinthine bureaucracies.  If government at all levels had just stayed out of her decisions, not tried to “help”, my friend would have coverage for her two children today.

Federal and state politicians were false with my friend when they imposed AHCCS, a program that they knew was financial unsustainable, and then promised it would be there to care for her kids.  At least though, there could have been something for her to fall back on from any one of Arizona’s private health insurers and their policies for children… except that the Rulemakers in Washington said they knew better and killed that option too.

When will our citizenry finally realize that we must keep the things that are most important to us OUT of the hands of politicians instead of willingly laying at their feet our most vital and fundamental needs?  Laying them down to the whims, fancies and false promises of those who have no further outlook than, “When’s the next election?”

In taking a closer look at the new ObamaCare healthcare initiative (which kicks in completely by 2014) you’ll find a number of new agencies, new acronyms and new bureaucracies that have been created to manage and implement the act.  It looks to me like the Federal Government is moving quickly to manage, administer and control most of the healthcare dollars. With 20% of our GDP  made up by healthcare and another 24% going towards the Federal bureaucracy it looks like the government is taking a much more active role in your life.

American business is cautious as to what the full impact of Obamacare will mean to their bottom lines. When business is uncertain, they wait.  This lingering recession has a lot to do with uncertainty coming out of Washington. With trillions on the side lines the business sector hasn’t jumped in to restart the hiring process.

Let’s hope the performance of the US Postal Service isn’t an precursory of what we are in for.

Here’s some acronyms you should get familiar with. These can all be found in the new healthcare bill;

Patient Protection and Affordable Care Act

Health Care and Education Reconciliation Act

American Recovery and Reinvestment Act

Medicaid and CHIP health program – childrens based program and Federal matching program for the lower income

(IPAB) Independent Payment Advisory Board

US Preventive Services Task Force – (rating agency for prenentive care)

Indian Health Care Improvement Act

CLASS Program – created to living assistace in communities

Patient Centered Outcomes Research Institute – non profit created to analyze results of care

Workforce Advisory Committee – agency created to provide healthcare workers

National Prevention, Health Promotion and Public Heath Council – strategy think tank

Innovation Center – within Medicare dept designed to find savings within Medicare –

State Balancing Incentive Program – within medicare – ‘enhance federal matching funds to states’

Community First Choice Option – within Medicaide – ‘enhance state support for people with disabilities’

National Health Service Corp – 5 year $1.5 billion funding school based care and nurse based clinics

Teaching Health Centers – provide payment to community ambulatory services.

Graduate Medical Education (GME) – establish training for healthcare workers

Accountable Care Organizations – hospital based program where patient savings are shared with provider

Medicare Independence At Home

Hospital Value Based Purchasing – puts the Fed gov in the medical device and supply business as a low price negotiator.

Consumer Operated and Oriented Plan (CO-OP) – helps create member run, non profit healthcare programs

Federal Medical Assistance Percentage (FMAP) – used to bench mark costs and fees for medical care.

American Health Benefit Exchanges – State based  to provide affordable coverage for biz with less than 100 employees

Small Business Health Options Program (SHOP) – Same as above

Office of Personnel Management – department responsible to ensure each state has two multi state plans in each exchange.

Basic Health Plan – a mechanism that allows each state to get into the healthcare business

Independent Payment Advisory Board – 15 member panel that will recommend cost containment ideas to Congress.

Medicare Disproportionate Share Hospital (DSH) – a mechanism to balance out payments to hospitals that help them cover uncompensated care. Eventually that states commitment to uncompensated will be covered by the state.