SCHIPing away at the need for health insurance

When Bill Clinton’s health care proposal was foundering in the summer of 1994, a group of senators suggested that the administration put off trying to get universal coverage and insist instead on insuring all children. The idea was to make, at least, a down payment on reform.

The White House said no and pressed on with its doomed effort to get a bigger bill. The Republicans won control of Congress in the fall. It wasn’t until 1997, thanks to the unlikely duo of Sens. Ted Kennedy and Orrin Hatch, that a children’s health care program was finally passed.

One of the clearest signals President-elect Barack Obama has sent is his determination to learn from the Clinton years, and particularly from the former president’s failures on health care.

When Tom Daschle, Obama’s pick to be secretary of health and human services, returned to the Senate last week for his first round of confirmation hearings, he offered a long list of criticisms that others had directed at the original health care reform effort. This time, he said, would be different.

And this week, the House of Representatives is determined to prove Daschle right. It is scheduled to take up an extension of the State Children’s Health Insurance Program (SCHIP), as the Kennedy-Hatch initiative is called, so that 10 million kids can get health insurance. Getting more children covered before Congress starts wrangling over the larger health care bill is good politics, and the right thing to do. Congress needs to act anyway, because the program expires March 31. It might as well act fast, and act generously.

The SCHIP bill is unfinished business from the Bush years, and Democrats have no better way to show, and quickly, how different their approach to government will be from the style and priorities that prevailed during the outgoing president’s term.

President Bush twice vetoed an extension of SCHIP. He opposed the additional $35 billion the Democrats wanted to spend to cover more children and also disliked the tobacco tax they proposed using to pay for it. There are many big things people hold against Bush, but this one has always stuck in my craw. If “compassionate conservatism” – remember that phrase? – means anything, surely it should mean helping more kids go to the doctor when they need to.

Some advocates of universal coverage have argued that an expansion of SCHIP should be delayed so that the issue of covering kids can be taken up as part of a larger health proposal. The worry is that passing the most popular part of reform now (is there a more sympathetic group to cover than children?) would make it easier to delay the broader effort.

These are good faith concerns, but Congress would be right to ignore them. The economic downturn has made the expansion of SCHIP all the more urgent.

It’s not just that sharp increases in unemployment add to the ranks of the uninsured. State governments are hurting, too, and they are responding to revenue shortfalls by shrinking health care programs.

According to Families USA, a group that pushes for fundamental health care reform, states have enacted budget cuts that will leave some 275,000 people without health coverage, including 260,000 children in California. By the end of this year, if further proposed cuts go through, the number losing health coverage nationwide could rise to more than 1 million, almost half of them children. Other states have reduced benefits to those they still insure.

All this makes the case for fiscal relief to the states in a stimulus bill more compelling. It also makes clear that universal health insurance coverage should be an urgent priority. But getting the children’s program done in the meantime could create momentum for the larger program and reduce the size of the problem that needs to be solved in a comprehensive bill – 10 million kids now, the rest later.

Senate Majority Leader Harry Reid has not made any commitments as to when he would take up children’s health care, though he has listed it as a priority. It would do the new president and members of the Democrats’ expanded congressional majority no harm to move expeditiously on a proposal that is simultaneously bipartisan – SCHIP has always enjoyed significant Republican support – and embodies Obama’s oft-stated commitment to “programs that work.” This one surely does.

How often did Obama promise to “turn the page,” implying that his presidency would be very different from President Bush’s while also taking lessons from President Bill Clinton’s shortcomings? Winning a quick health care victory for children would prove he’s determined to do both.

‘No Insurance’ Towing Filling Dallas Impound Lots

DALLAS: Drivers be warned!  Dallas police are on the lookout for a different kind of offender – those driving without insurance.

A new city ordinance mandates that cars be towed as a consequence for no coverage.  The ordinance has been in effect for nine days and police are already calling it successful.

Among the cars in the City of Dallas impound lots are those that were brought in because the driver didn’t have insurance.  In fact, in just the first nine days of the New Year, Dallas police said they towed 256 cars and that another 56 we’re towed from accident sites.

Saturday was another busy day at the impound lots, where there was no shortage of people coming to claim their cars.

The new uninsured motorist ordinance makes it mandatory to at least have liability auto coverage. If uninsured drivers in Dallas are pulled over, or get into an accident, their cars can be impounded with no questions asked.

Most drivers who spoke to CBS 11 News said it’s an expensive lesson learned and one they wish they could have avoided.  ”I didn’t know it [the ordinance] was going to be enforced like that,” said driver Demond Graves.  ”I heard it a couple times on the news but I didn’t know it’s was gonna be all like that.”

Andrew Delara was among those busted for driving without insurance.  ”I was going to get insurance today, but they beat me to it!” he said.

Enforcement of the new ordinance has caught many off guard.  ”I’m sure some are still surprised when it happens to them, because it is something new,” explained Lt. Andy Harvey with the Dallas Police Department.

Drivers are not only responsible for the cost of the tow, but also receive a $350 fine and are charged $20 a day, for every day their car is kept at the impound lot.  The average cost of basic liability coverage is $36 a month.

The new ordinance could be making a difference.  One North Texas insurance agent said she has seen an increase in the number of drivers getting policies since the end of last year.

The largest federal health insurance program

A focused remedy is best cure for healthcare crisis

As the Senate considers the nomination of former Sen. Tom Daschle as secretary of health and human services—and as the nation looks forward to health reform—it is important that policymakers focus on what it means to “fix” health care and ask some hard questions about how we deliver medical care.

First off, everyone should agree that we must strive to get every American the health care coverage they need. 

Second, we can all agree that getting health care costs under control is both a health and economic imperative. Despite the “good news” this week that health care spending rose 6.1% to $2.2 trillion in 2007, that slowdown from previous years is still substantially higher than general inflation and health care now gobbles up 16.2 % of gross domestic product.

But high costs and the uninsured are only the visible problems with health care. The invisible problem is poor-quality care. Our third area of agreement must go beyond getting people care, to getting them the right care. 

Poor quality care and the uninsured are inextricably linked, even though few understand the link. Poor quality care robs the system of precious resources—dollars and services—that could be used to expand access and coverage.

Lawmakers need look no farther than their own back yard to ask questions about the quality and inefficiency problems. Medicare is the largest federal health insurance program, so lawmakers should ask why an elderly person spends about 11 days in the hospital in Bend, Oregon in the last two years of life, compared to 23 in Detroit or nearly 35 in Manhattan. Or why they see doctors about 15 times in Ogden, Utah in the last six months of life compared to 42 in Detroit or 60 in Los Angeles. 

They should ask why researchers found that only 57 percent of female patients aged 65–69 in Mississippi got regular mammograms, compared to 70 percent in Michigan or 74 percent in Maine, the top state. Or why in Alaska, only 71 percent of patients with diabetes got important blood tests in 2003–2005, compared to 86 percent in Michigan or 92 percent in Vermont. Or most tragically, why more than 1.6 out of every 1,000 Medicare beneficiaries in Louisiana lost a leg to amputation, compared to 0.9 in Michigan or 0.50 in Utah, a more than three-fold difference from top to bottom?

They should also ask hard questions about why people get care they may not need. Why are antibiotics prescribed inappropriately for children’s ear infections 13 million times a year, when more than 80 percent of infections get better within three days without antibiotics? 

Why in a decade did spending for back surgery called lumbar fusion rise 500 percent—from $75 million to $482 million—despite a lack of evidence supporting the effectiveness. And why do some regions of the country use vastly more resources to treat patients with similar illnesses without achieving better outcomes. 

They will find what Dartmouth researchers found, that a whopping 30 percent of health care spending—nearly $700 billion a year—pays for services that may not improve people’s health.

That’s money that could be used to cover the uninsured—if we can figure out how.

A good place to start is improving the information we have about the actual performance of doctors and hospitals with wider spread use of reports such as those Medicare has begun to make available on hospitals and a few pioneering community organizations, such as the Greater Detroit Area Health Council (GDAHC), have made available on both hospitals and doctors’ practices in their communities (www.SaveLivesSaveDollars.org). Patients need this information to make informed choices about their own care. Doctors and hospitals need this information to help them improve care. And both consumers and purchasers need information about the value they are getting for their health-care dollars. 

A second step is to put serious dollars into quality improvement efforts, building on Medicare pilot programs that spur hospitals and physician group practices to improve care and launch experiments that encourage disparate medical providers to work in teams to coordinate care and deliver it efficiently.

Finally, our payment system must reward providers for giving patients the right care at the right time, the right way. 

Now we pay providers for “doing things”: the more treatments and procedures they provide and the more they use expensive technology, the more they get paid. We need to reward, not punish, providers who deliver high-quality, cost-effective care. Moreover, providers should be fairly compensated for preventive care, for time spent coaching patients and for coordinating care for those with chronic conditions.

Many of these concepts are being tested on the ground in living laboratories such as GDAHC’s Save Dollars Save Lives campaign, one of 14 communities working with the Robert Wood Johnson Foundation’s Aligning Forces for Quality program to bring together those who get care, give care and pay for care to improve the quality of care.

As Washington turns it eye to health care reform, by all means let’s start with getting everyone access to care, but everyone should also understand that what happens to them once they get inside the hospital or doctors’ office is just as important as getting them in the door.

Dr. Risa Lavizzo-Mourey is president and CEO of the Robert Wood Johnson Foundation, and Vernice Davis Anthony is president and CEO of the Greater Detroit Area Health Council

How to get flood insurance

What you should know about flood insurance

Here’s some basic information about flood insurance provided by Mike Howard, a spokesman for the Bothell office of the Federal Emergency Management Agency.

Q: How do I get flood insurance?

A: It’s available only from the Federal Emergency Management Agency. But numerous insurance agencies can help owners of homes and businesses obtain it.

Q: How much does flood insurance typically cost?

A: The average annual cost for a residential policy in Washington state is $580. In King County, the average annual cost is $590.

Q: Is everyone eligible to buy flood insurance?

A: Anyone is eligible who lives in a community participating in the national flood insurance program. That program ensures communities are passing ordinances that protect their citizens against flooding. Virtually every community in Washington state participates in the program.

Q: If I sustained flood damage once and made a claim, can I still get insurance now?

A: Yes. That is the virtue of the national flood insurance program. But your degree of flood risk may affect your policy’s cost.

Q: If my property floods repeatedly, can I still be insured?

A: Again, yes, if you’ve paid the premiums. No matter how often an area floods, properties there can be protected by insurance, so long as the properties comply with flood plain ordinances.

But FEMA may work with your community to reduce the incidence of flooding by encouraging a buyout or facilitating the elevation of your property.

Q: How can I learn more?

A: Visit www.fema.gov/hazard/flood/index.shtm or call 1-800- 621-3362.

Insurance scams charged in New Jersey

New Jersey authorities have charged seven people in an alleged workers’ compensation scam that they say left many people without insurance.

Those charged are accused of operating companies that linked workers’ compensation insurance carriers and clients.

The companies are charged with submitting false information and claims to the insurers and pocketing the benefit payments. The owners of the companies also kept money submitted by clients to pay insurance premiums, the state alleges.

The scam netted about $1.5 million for those who owned the companies or operated as insurance brokers.

Indicted on charges of conspiracy, racketeering and related charges were: Justin Sciarra, 59, of Medford; Paul Brown, 43, of Bellmawr; Michael Magee, 34, of Berlin; James Maconaghy, 41, of Mount Laurel; William Griffith, 53, of Reading, Pa.; Paul Hopkins, 58, and his wife Adrienne, 48, both of Marlton.

10.9 million Americans Have Individual Health Insurance Policies

About 10.9 million Americans under age 65 purchased individual health insurance policies at some point in 2006, but only 7 million were covered by these policies for the full year, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. The 3.9 million individuals who had individual health insurance policies for part of the year were covered for about six months on average. 

AHRQ’s analysis also shows that of Americans who bought individual policies for part of the year, nearly 44 percent were able to obtain coverage for the full year because they or their spouse got a job that offered health insurance or they had incomes low enough to quality for Medicaid or other public insurance. Most of this coverage came from employers.

Forty percent obtained employer-sponsored health insurance. 

Three percent enrolled in Medicaid or other public insurance. 

Less than 1 percent obtained both employment-based insurance and public insurance. 

People buy individual health insurance generally because they can’t get insurance from their employers, have lost a job that offers insurance, or do not qualify for Medicaid or other public programs.

AHRQ, which is part of the U.S. Department of Health and Human Services, works to enhance the quality, safety, efficiency, and effectiveness of health care in the United States. The data in this AHRQ News and Numbers summary are taken from the Medical Expenditure Panel Survey, a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid. For more information, go to Length of Coverage in the Individual Health Insurance Market for the Non-Elderly U.S. Population, 2006, MEPS Statistical Brief 227.

Blue Shield of California Reinstates Insurance for Patients it Dropped

Karen Vincis insurer – Blue Shield

In a bid to put to rest legal troubles over a practice of canceling patients’ health insurance policies after they got sick, Blue Shield of California has agreed to grant coverage again to nearly 700 such patients.

The company will also reimburse them for medical bills they’d paid when they didn’t have coverage. The state of California, in return, dropped its case against the company and stopped its pursuit of $12.6 million in proposed fines, the Los Angeles Times reported this morning.

A number of big California health insurers got into public relations and legal messes over the cancellation of plans after patients get sick, a practice that goes by the medical sounding term “recission.” The insurers claimed the patients weren’t upfront about their medical histories and preexisting conditions when they applied for coverage.

Other companies that have agreed to reinstate patients’ policies include Health Net, WellPoint’s Anthem Blue Cross and Kaiser Permanente.

Blue Shield didn’t admit wrongdoing and, in a prepared statement, said, “With this settlement, we can put these matters to rest and enter 2009 with new procedures in place to clarify the responsibilities of insurers and our customers in the future,” according to LAT.

Some consumer advocates weren’t satisfied. Jerry Flanagan of the advocacy group Consumer Watchdog, told the Times, that the settlement “does not adequately protect against future rescissions — no admission of wrongdoing, no mandatory fines, no clarification of the legal standard” for rescissions

Florida Task Force Set to Vote on Citizens Insurance Reforms Today

1.4 million? An 11-member task force charged with making recommendations on how to depopulate Florida’s high risk property insurer and return it to its original purpose as a market of last resort is voting today in Tampa today.

The Citizens Property Insurance Corporation Mission Review Task Force has been asked to develop a report on changes — statutory and operational– needed to return Citizens “to its former role as a state-created, noncompetitive residual market mechanism that provides property insurance coverage to risks that are otherwise entitled but unable to obtain such coverage in the private insurance market.”

Citizens has become the largest home insurer in the state. It now has about 1.1 million policies, which is down from a high of 1.4 million due to depopulation efforts undertaken in 2008.

But critics, including private market competitors, want to see Citizens shrink even more. The recommendations before the task force would block more homeowners from accepting policies from Citizens if they have reasonably priced options in the private marketplace.

The task force is being asked whether the so-called “15 percent” rule should be retained. This rule provides that a homeowner with a private market offer can still get Citizens coverage if the premium quote from the private carrier is more than 15 percent higher than the Citizens premium. The adoption of this rule several years ago has meant some homeowners are now in Citizens because it is cheaper, not because there is a lack of private insurance available.

The task force is also being asked to vote whether to eliminate the current freeze on Citizens’ rates that has been in place since 2007.

Today’s meeting is the last for the task force, which must submit its recommendations to the Florida Legislature by Jan. 31.

Members of the task force include representatives of the Legislature, Gov. Charlie Crist, Chief Financial Officer Alex Sink, the Office of Insurance Regulation and Citizens.

AIG’s Boren, O’Brien to Head New Ironshore Environmental Insurance Unit

AIG President, Joe Boren, confers with AIG Environmental President (and President of the National Brownfield Association), Ken Cornell

Bermuda-based Ironshore Inc. announced that Joe Boren and John O’Brien have joined as CEO and president, respectively, of its newly established Environmental Insurance facility.

The company said the new unit will write environmental and casualty products with focus on middle market commercial risks. The products will serve wholesale and retail markets and will include products for contractors, fixed facilities including real estate, professional service companies and manufacturing operations.

Both men are joining Ironshore from AIG Environmental, one of the largest writers of environmental insurance.

Boren will report to Shaun Kelly, CEO of Ironshore’s U.S. operations, who also came to Ironshore from AIG along with his boss, Kevin Kelley, formerly head of AIG’s Lexington Insurance and now CEO of all Ironshore operations.

The Ironshore Environmental Insurance unit will be located at Ironshore’s New York office.

Boren was formerly chairman and CEO of AIG Environmental, where he has worked for the last 13 years. Prior to AIG, he worked for 25 years in the environmental industry, starting as a regulator and ending as chief operating officer of an environmental firm.

O’Brien was president and chief operating officer of AIG Environmental and had been with AIG for the last 17 years. He joined the AIG companies in 1992 as an underwriter and most recently served as executive vice preident of AIG Environmental’s commercial and middle market divisions.

FACTBOX-US healthcare spending hit $2.2 trillion in 2007

Jan 6 (Reuters) – U.S. healthcare spending rose to $2.2 trillion in 2007, or $7,421 per person, an increase of more than 6 percent from the previous year, the U.S. Centers for Medicare and Medicaid Services reported on Tuesday.

Here are some facts about healthcare spending in 2007:

• Healthcare made up 16.2 percent of U.S. Gross Domestic Product in 2007.
•  In 2007, 31 percent of healthcare dollars went to hospitals, 21 percent to physicians and clinics, 7 percent on administrative costs, 10 percent to drugs, 25 percent to “other” and 6 percent to nursing homes.
•  Private insurance paid 35 percent of this; Medicare 19 percent; Medicaid and the State Children’s Health Insurance Program 15 percent; 12 percent from other public funds; 7 percent from other private sources; and 12 percent was paid for out of pocket by patients.
•  Hospital spending was $696.5 billion while doctor and clinical services spending was $478.8 billion.
•  Medicare, the federal health insurance program for the elderly, spent $431.2 billion overall in 2007 while Medicaid, the state-federal health insurance plan for the poor and disabled, spent $329.4 billion.
•  Private health insurance premiums were $775 billion while patients spent $268.6 billion out of their own pockets.