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Health care reform legislation passed the House this week on a party-line vote. Late Sunday night, House Democrats approved the Senate health care reform package, sending the legislation to President Obama for his signature. On Tuesday, President Obama signed the underlying bill into law, yet the House has yet to finalize the package of “fixes” that will alter the final implications of the legislation. Health Care Reform Negotiations House Democrats Pass Health Care Reform Package: The House of Representatives approved the Senate health care reform bill Sunday night by a vote of 219 to 212. The vote marks the climactic finale to a year-long debate over health care reform. In the final vote, 34 Democrats joined all House Republicans in voting against the measure. Shortly thereafter, the House also passed a package of “fixes,” by a vote of 220-211, that was sent directly to the Senate for its approval through reconciliation. On Tuesday, President Obama signed into law the Senate health care reform bill, called the “Patient Protection and Affordable Care Act.” Republicans Force Senate to Send the Reconciliation Bill Back to the House: Shortly after the President signed the Senate bill into law, Senators began deliberations on the reconciliation bill. Reconciliation protocol restricts Senators to 20 hours of debate on the measure, but it does not limit the number of amendments that can be filed. In an expression of opposition to the bill, Republicans filed 29 amendments to the reconciliation package.
After 10 hours of continuous debate, Republicans were successful in eliminating two provisions related to college financial aid in the non-health care portion of the bill. The Senate parliamentarian ruled early Thursday morning that those two provisions violated the chamber’s rules, sending the legislation back to the House for a new vote. As a result, on Thursday afternoon, the Senate voted on the reconciliation bill without those two provisions and sent the bill back to the House for a vote on final passage.Compare Uk Breast Augmentation Prices Compare breast augmentation prices from leading UK cosmetic surgeries. Read reviews on cosmetic surgery clinics. Useful guides tips and impartial information on breast augmentation. Cosmetic surgery forums. The House vote will likely come Thursday evening. What Does This Health Care Reform Legislation Mean: While the health care reform bill extends insurance coverage to 32 million more Americans by 2019, the legislation has other far-reaching implications that will be phased in sooner, during a multi-year implementation period.
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After months of public debate and private negotiations, health care reform discussions stalled following Tuesday’s Senate vote in Massachusetts. The Democratic Senate lost its 60th vote supermajority when Republican Scott Brown was elected to the United States Senate in the Massachusetts special election.
Health Care Reform Negotiations Post-Massachusetts Special Election
Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat’s 60th vote in the Senate opens up the legislation to a Republican filibuster – something the Democrats have managed to avoid thus far in the debate.
House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.
On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama’s desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called “reconciliation,” which only requires 51 votes in the Senate.
Health Care Reform Negotiations Prior to Massachusetts Special Election
Senators Urge Guarantee of Government Savings: In a letter sent last Thursday to Sen. Reid, five Democratic Senators asked for the inclusion of a “fail-safe mechanism” in the final bill. This mechanism would give Congress “the tools to keep costs under control should the current savings estimates fail to materialize.”
Both the Senate and House versions of the bill rely heavily on reductions in government spending, particularly around Medicare, to help pay for reform. Republicans and some nonpartisan analysts believe the government will not follow through on these spending reductions, which will lead to soaring costs.
President Obama Pushes for Less Protection for Biologic Drugs: Last Thursday President Obama pushed for a change in the health care reform legislation that would reduce the number of years that biologic drugs were patent protected from generic competition, previously set at 12 years. White House officials and Rep. Henry Waxman (D-CA) were negotiating for 10 years protection or less.
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Members of the news media speculated that the move to reduce biologic drug protections could be a leverage point for President Obama to pressure the drug industry to increase contributions to pay for health care reform. In fact, the Wall Street Journal reported that Congressional Democrats had already asked drug companies to contribute an additional billion or more, over and above the billion which the industry agreed to early on in the reform negotiations.
President Obama Strikes Deal with Unions: Last week Democratic negotiators struck a deal with union officials and conceded to union demands to scale back a tax on high-end insurance plans. The deal would exempt union workers from having to pay the tax until 2018, five years after the tax would apply to other workers. While the deal would help gain union support for the bill, it would also reduce the amount of tax revenue generated by about 40 percent, to billion. As such, Democratic leaders would need to find other sources of revenue to make up the difference.
Public Opinion
Exit Poll Indicates Health Care Reform as Hot Button Issue: As the ballot polls closed on Tuesday night’s Massachusetts Senate election, an exit poll conducted by Frabrizio, McLaughlin & Associates indicated that 52 percent of voters said that they oppose the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing this legislation. In addition, 48 percent said that health care was the single issue driving their vote.
Polls Show Discontent: The latest Wall Street Journal/NBC News poll indicated that almost half of Americans believe the health care reform bill in Congress is a bad idea (46 percent). This figure is up dramatically from April when only 26 percent believed the plan was a bad idea. Further, just 33 percent say the plan is a good idea. Nearly half of those surveyed (48 percent) believe that passing the current legislation would be a “step backward.”
In addition, a new Quinnipiac University poll showed that public support for health care reform continues to decline. Thirty-four percent mostly approve, while 54 percent mostly disapprove. At the end of December, 53 percent of Americans mostly approved, while 36 mostly disapproved.
Looking Ahead
Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill.
Medical expenses have already touched the sky and are still rising. This has made health care insurance a necessity. Medicare supplemental insurance is designed for people on Medicare who wish to have more comprehensive coverage. These supplemental plans may include Managed Care HMO plans or Medigap PPO plans that provide you with greater access to participating physicians. Medical terms can be confusing, and before speaking with an insurance agent, you should make sure you understated his or her language.
Medical insurance premiums are a result of careful consideration by medical insurance companies and are regulated by every state. Premiums can vary depending on the type of coverage, amount of the deductible, and benefit coverage.
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Advantages of Getting Individual Health Insurance
Individual, or family, health insurance is also commonly known as personal health insurance or private health insurance . Most insurance companies offering this product will refer to it as individual health insurance. Individuals, families, self employed, student, small and large group. Traditional major medical, health savings accounts and temporary medical coverage. Individuals, families, self employed, student, small and large group. Traditional major medical, hospital, health savings accounts, temporary and short term medical coverage.
Choosing insurance in your state can be a difficult process. There are many companies to choose from and many plans within companies. Choose the right health plan based on what you want. If you have a certain doctor that you can’t bare not to see then a free-for-service plan is probably for you. Choose an individual health plan to find the cheapest health insurance coverage for the best value.
Within minutes, you can determine your eligibility, the type of plan you want and they will give you immediate quotes. Within minutes, you can receive an online health insurance quotes for life insurance and dental plans from America’s leading insurance companies. This unbiased approach to selecting a benefit package now allows you to customize your insurance quote, select the company of your choice with the benefit plan features and price that fits your situation and budget.
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The first thing for you to do is find out a niche for yourselves. Of all the niches (Mind you, you will find about 1000s of niches when you start searching for profitable niches in affiliate programs), health is often considered one that can never die down. Irrespective of how much money a man or a woman spends in luxuries and accessories, health is one aspect he would never ignore.
he confusing point is – You have over 100 and more health affiliate programs. You can very well sign up with some bottom rung health affiliate programs and start promoting the product. But remember in affiliate marketing – Your promotion technique is probably not as important as the product itself. Wow – Did you now know a trick to successful affiliate marketing or what?
Tap into a health affiliate network that promotes quality health products, and one that would probably find a good acceptance ratio from your target audience.
Any health affiliate network that provides a conversion rate of 5% on clicks or more can be considered for selection. What I mean is this – If you use PPC as a promotion technique, for every 100 clicks, you should have 5 sales or more.
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The internet offers quite a few convenient ways to buy and compare health insurance plans. They are also known as mediclaim policies which come with Texas health insurance quotes. The health insurance quotes make sure that every Texan knows about the basic features of the health insurance plans. The basic features that are mentioned in the quotes are the price of the health insurance, some basic details about the insurer age, gender, and areas that are covered under the plan. You always have the option of saving money whenever you choose to compare health insurance plans. This is because you do not end up buying an expensive health insurance policy that exceeds your budget.
Texas health insurance quotes clearly mention that a health insurance policy mainly covers the expenses caused by the major life-threatening medical ailments and procedures. An accidental death or a permanent disablement of an earning member of a family can result into a disruption in the functioning of the family. The various insurance companies
in Texas offer a huge amount of benefit once you experience a diagnosis for a particular illness that is covered under the terms of the insurance. If you compare health insurance plans offered by the various companies you should select a plan that covers unexpected calamities, emergencies, dental expenses, drug requirements, custodial needs and other forms of disabilities, temporary or permanent.
There are many Texans who do not consider health insurance to be at all important. In that case they are strictly advised to at least go through the rules and regulations, with regard to the health insurance policies. In that process they must also compare health insurance plans to select the appropriate health insurance policy covering pre- and post-hospitalization charges, day care procedures, cashless claims and tax benefits. Texas health insurance quotes provide several options for students, small families and for employees of an organization. One should carefully go through the terms and conditions mentioned in the policy and consult an expert before signing the papers.
An Australian man has just won a settlement in a landmark age discrimination case against an Irish car rental company after being charged an extra fee for being over the age of 70. Anthony White tried to hire a car in Ireland 2 years ago when he was in his early seventies and was charged a EUR25 fee. He was also told he would not be able to car rental USA a car on his next visit as he would be over 75. White took his case to Ireland’s Equality Tribunal who ruled in his favour that the policy amounted to age discrimination. Irish Car Rentals Ltd has since changed the rule and says the decision will now be made on a case-by-case basis involving assessments of age, health, driving record and insurance coverage. A senior driver surcharge is pretty common with car rental companies – you may have read a previous blog here about it (Too Old to Drive A Rental Car?) Some suppliers charge extra if drivers are over a certain age, others have a maximum age limit for renters and some require additional documentation (like Irish Car Rentals are now doing). The surcharge is applied to cover higher insurance premiums as older drivers as seen as higher risk.
Does this case mean we may see an end to senior driver surcharges? Is it age discrimination to charge older drivers more as they are seen to be a higher risk? In that case, surely it is also age discrimination to charge car rentals someone under 25 a young driver’s fee since they too are seen as a higher insurance risk and more likely to have an accident? In the case of Mr. White, he has been driving for 50 years and felt it was unfair to blanket all older drivers. I do agree with this and think the company’s new policy is fair – it depends on each individual’s circumstances and not their age.
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How Can A Group Health Insurance Broker Assist Me?
For many companies the ability to provide group health insurance to their employees is a huge benefit that hard workers will truly value especially if they have a family to take care of at home. However sometimes the task of setting up a group health insurance program can be difficult for many new and smaller companies. Fortunately a group health insurance broker can be readily and easily used to setup and administer such a program for any company desiring to provide health insurance to their valuable employees.
A reputable group health insurance broker will normally answer any questions a company may have about providing health insurance to the members of their company. For instance did you know that a group health insurance plan will only cover full time employees? Your group health insurance broker is responsible for providing answers to questions similar in nature. In fact many health insurance companies define a full time worker or employee as someone that works a minimum of 30 hours a week at their place of employment.
In order to qualify for group health insurance a company must have at least 2 full time employees on the payroll. Naturally more is better and a group health insurance broker will advise a prospective company of facts just like this. Additionally at a minimum 50% or more of a company’s full time staff must enroll in the offered group health insurance and coverage provided by the company. There are additional rules and regulations to follow when it comes to adding dependants and newborn children to an existing health insurance plan that covers an individual as part of a group.
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When it comes to the cost of a group health insurance plan a broker will inform you that the company is required to provide or pay at least half of the health insurance premium for their full time employees. In most cases they are not required to cover any of the expenses associated with providing health insurance for an employees dependants of the best benefits a group health insurance broker can provide assistance to a company with is the proper administration of their health insurance policy. Generally speaking it normally takes about a week for a health insurance provider to review any group health care plans submitted by a company hoping to obtain health insurance for it’s workers. Sometimes this waiting period can drag on especially if there is a multitude of paperwork that needs to be completed in order to obtain the health coverage.
Clearly in the case such as the one mentioned above a knowledgeable group health insurance broker is worth their weight in gold as they can be tasked to properly prepare all of the administrative paperwork needed to complete the group health care coverage application. Their knowledge and expertise can also be used to handle or field any questions during the
insurance underwriting process which can sometimes be a very complex procedure.Health insurance covers all the medical expenses generated by illness or diseases. All the conditions covered by the health insurance are stated in the health insurance policy. Health policy is a legal contract. The price of the legal contract is called the premium. Health insurance is a contract that provides money to cover for the policyholder’s medical expenses. Because medical treatment nowadays is increasing each year, it is important that we are equipped with individual health insurance pl
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The Patient Protection and Affordable Care Act became the law of the land in 2010, but debate over its existence and implementation will rage on in the New Year. The law’s serious policy flaws are already impacting health insurance and costs, but these are part of a deeper and broader issue: the proper role for the federal government in Americans’ health care. The public’s stance on this issue has been anything but settled in the wake of the new law’s passage.
Electronic Health Records – Don’t Get Sick Without One
Electronic health records (EHRs) started as way for doctors to organize their records, make ordering more convenient, reduce repetitive tasks, reduce errors caused by bad writing and so on. However, the physician side of EHRs has been somewhat slow to catch on because of the huge barriers to entry, such as converting existing records, changing the way documentation gets done and the cost of implementing a comprehensive system. Recent government financial incentives are boosting acceptance of the MD office-based EMR.
On the consumer side, some of the same issues have hindered large scale adoption of EHRs. First of all, it takes a long time to input the information and secondly, the record is only useful if it is kept up to date, placing a lot of pressure on people to manage the information correctly. However, as technology has improved, especially with mobile applications that make it easy for the user to retreive and enter data, the use and value of EHRs for consumers has grown.
Most families keep some kind of health records, even if it’s just copies of medical reports. Unfortunately, that kind of recordkeeping isn’t all that helpful when you’re in a doctor’s office and you can’t remember when you got your last tetanus shot. Storing information electronically can improve accuracy, provide information where you need it, when you need it and allow you to analyze yours or your family’s health. But how do you choose a record keeping system to use?
Frankly, we think that there’s still quite a long way to go in this area and none of the record keeping systems do everything that we’d like. But, there are some excellent programs out there. We have selected twelve recordkeeping systems that we liked the most and explained why we think so.
(1) HealthVault
Microsoft has made a huge investment in their personal health record program and it shows. Their system offers an extensive recordkeeping system, the opportunity to create family records and links to many other applications that enhance the value of your information. Through HealthVault’s “ecosystem” of connected, patient-friendly applications, you can store copies of your health records; upload information from health and fitness devices; provide information to your doctor, coach or therapist; and access products and services. We think that Microsoft is leading the pack in this area.
We love the device integration, the tab that gives you a history of the changes that have been made and the tab that allows you to select who you will share information with. However, Microsoft is so busy promoting its affiliates that it’s hard to figure out how you as an individual user can enter data. They also use some overly technical language such as “continuity of care” documents that are quite confusing. Interestingly, there’s no real emphasis on prevention tools and that’s a big gap, in our opinion. They also need a crumb trail; we thought we saw some prevention management tools at one point, but could never find our way back to the same page!
(2) Google Health
Google is another major player that has invested a lot of time and money into their EHR. Their record is quite comprehensive with lots of dropdown menus. We found, however, that the menus weren’t always complete enough so they can create confusion. This program can link to small group of other databases. If yours is listed, it’s great. For example, if you belong to Blue Cross Blue Shield of Massachusetts, you can directly import the last two years of your medical information, saving time and improving accuracy.
There are many applications you can link to that help manage medications, find clinical trials, convert paper records, get coordination assistance, link your record to doctor’s office and more. This EHR is easy to use and contains lots of management tools but it still feels quite “young “in its evolution. Once again, not much emphasis on prevention or, if there is, it’s not obvious.
(3) Health Minder
This is a great EHR system! It’s very comprehensive, covering not just the basics but includes medical expense and claims tracking, pet medical history, family history, smoking, exercise, lifestyle issues, observations (so you can make a note when you experience something different and track what you are worried about), reminders, job related risks, environmental issues and more. The system is very easy to use. It does not have the linking and expanded apps opportunities available through the biggies such as Google and Microsoft but it’s more comprehensive and easier to use. Apparently other organizations agree because it’s won quite a few awards. It costs annually.
(4) My Healthe Vet
The VA really got it right with this online personal health record. This well designed system not only includes all of the usual health tracking options, vets can also refill prescriptions electronically, access benefit information and do research on their conditions.
(5) Health Manager
This offering from the Mayo Clinic works with Microsoft HealthVault and gives you advice from Mayo Clinic experts when you need it. Recommendations are created just for you and updated in response to your health information. The more complete your profile, the more tailored your recommendations become, making it easier for you to proactively maintain your health. This is a great marriage of Microsoft’s database function and Mayo Clinic’s diagnostic expertise.
(6) Cloud PHR Pro
Cloud PHR Pro is the paid version of Cloud PHR. You may or may not need the paid version; we just like what this mobile application does for you. There are a lot of mobile PHR apps being promoted; we like this one best. The Pro version gives you the option of caching your data, allowing you browse your health record in a doctor’s office without Wi-Fi or cellular service. The user interface is also improved, with faster load times and a more readable display of health information. Profiles can be assigned pictures, allowing you to manage your family’s health information in a more natural way. Whether you use the free or paid version, this mobile app brings information where you need it.
(7) AccessMyRecords.com
This EHR takes a somewhat different approach. Their system is designed to collect information that can be used in an emergency or in a doctor’s office. The scope of information is much greater. You are able to upload documents such as your will or trust, passport, driver’s license, birth certificate, transcripts, homeowners, automobile and life insurance policies, real estate closing documents, and more. You are issued a card that gives EMS or other helpers the ability to access your data.
There are a number of these kinds of offerings including those that put info on a microchip in a bracelet or on a memory stick that you wear around your neck. We thought this group was unusual and interesting in that it added proxies and other information that can be very relevant in an emergency situation. The service costs per individual; per couple; add children at each.
(8) GlobalPatientRecord
In addition to the usual health information, this EHR also provides a central location for all legal information, such as living will, power of attorney and Do Not Resuscitate information, emergency contacts information, reminders of future check-ups, medical history and is also available as a mobile application. Unfortunately, we couldn’t get the demo to work and the site makes it a bit difficult to know how to sign up.
(9) myMediConnect
This is one of several EHRs that eliminates the problem of getting all that information loaded. You can add your own info or pay to have the service add the information for you. This record keeping system is very comprehensive and interactive, including prescription reminders, health savings calculator, health education, and links with Microsoft HealthVault. Sign up is free but retrieval services can be expensive.
(10) CheckUp
This EHR is fairly comprehensive, as well, with the addition of automatic risk assessments. We liked the way this system handled information but found that it is very standalone with no integration with any other applications.
(11) MedsFile.com
This free system looked good but we couldn’t access the demo so we couldn’t test it very well. The EHR stores lists of medications, supplements, allergies, emergency contacts, immunizations, personal and family history, procedures and surgeries and emergency contacts. You receive a card that allows MDs or EMTs to access files from your cell phone.
(12) My Health Diary
This EHR is actually dedicated to issues related to blood such as donations and AIDS. And it has a very nice personal health record system. You can create charts of your clinical investigations including blood pressure and blood sugar readings, all types of clinical tests, treatments, diagnosis and medical images with the ability to access reports & data online. There are some excellent health calculators available here as well. It’s an interesting product with a lot of information but doesn’t seem well integrated.
Acquiring Health Insurance Quotes
Calling an insurance company for health insurance quotes may sometimes be full of hassle. First, it will really take time especially if you want to understand more about the details and you want to ask a number of questions. Secondly, when you call these insurance companies, it is a trend that your call will be put on hold. It would really be frustrating especially if you need the health insurance quotes already and you are made to deal with all these hassles when you make that phone call. But, there are positive points when you inquire for health insurance quotes over the phone.
The first good thing about getting health insurance quotes over the phone is that you get to talk to a human being who is well knowledgeable about the health insurance quotes. While the person is explaining to you the different details of the health insurance quotes, you have the choice of asking follow up questions.
When you talk to an insurance consultant through the phone, you can also inquire on other offers on that same policy you are interested on. Usually, insurance companies do adjustments on health insurance quotes to suit your needs better.
If you already like the health insurance quote presented to you by the insurance consultant, you can directly buy the policy. These transactions are usually made through credit cards.
Another option: Online Health Insurance Quotes
Given this modern day, there is another option you can explore if you want to get health insurance quotes –online. This is another simple and fast way of getting your health insurance quotes and purchasing your insurance policy.
Insurance companies now have their websites where you can check the policies they offer and ask for free online health insurance quotes. It is also an easy way for you to check on different insurance companies and to choose among the companies and the policies would suit your needs.
When you get the quotes online, it will save you more time because you receive the health insurance quotes faster and from multiple insurance companies as well. So this means you will be saving more time than you calling different insurance companies one after the other. This is also an easier way of comparing the health insurance quotes that you receive from the numerous insurance companies.
Purchasing policies online is also easy. After choosing which health insurance quote you want best, you can then acquire that health insurance policy fast and simple. You just need your credit card for this transaction –don’t worry, transactions are secured for this.
You can also choose to hire an independent agent to find you the best health insurance quotes. Some independent agents get discounts from some companies so you will get better health insurance quotes from them. Just make sure that even though you are presented with health insurance quotes that are light on your budget, they must cover your needs well too. Independent agents can be really big help especially of you do not have time for the phone calls or you do not really know how to compare and contrast health insurance quotes.
A person looking for affordable health insurance quotes can also simply apply for various health insurance quotes. Getting your hand on such diverse quotes as well as comparing all of their estimates will definitely provide you with a very sensible idea about which plans in reality can provide you with affordable health insurance.
Online health insurance quotes are available on various web sites for all if you require a health insurance quote at the lowest possible price level . Online shopping has significant advantages when it gets to surfing for health care plans . Learn about the possibilities for your gain when it gets to arriving at health insurance quotes online
The use of visiting the insurance office can be the most traditional method of getting information about your quote. If you are looking to discuss and learn more about insurance, this would be useful. For people that are concerned about different insurance issues or would like questions answered, this can be a prime choice.
If you are looking into payment protection insurance (PPI) on a mortgage, whether it is regarding a claim or if you are applying for cover, then you probably have a lot of questions. With the recent uproar regarding mis-sold PPI, it is a good idea for you to do some research before taking cover as there have been thousands of cases in the past where expensive cover was sold to clients who believed that they had to have the policy.
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Wisconsin Attorney General J.B. Van Hollen has not decided whether the state will join the lawsuit filed in Florida by 20 other states, the National Federation of Independent Business and two uninsured individuals, or file its own lawsuit.
“That work is under way,” Van Hollen said. “I have been in discussions not only with my staff but also with staff of both the Florida AG’s office and the Virginia AG’s office.”
Joining a lawsuit filed by the Virginia attorney general would be more difficult because that case includes legal issues surrounding a state law.
Van Hollen expects to make a decision in the next month or so.
The key issue in the legal challenges is whether the federal government can require people to buy health insurance or fine them for failing to do so. That requirement is considered essential if health insurers must cover people with pre-existing health problems.
Wisconsin joining the legal challenges to the law would fulfill a campaign promise by Walker while making the state a participant in a historic case almost certain to be settled by the Supreme Court.
“It is the biggest ongoing constitutional law dispute in the country, certainly the one with the most far-reaching effect,” said Andrew Coan, a professor at the University of Wisconsin Law School.
More than 20 separate challenges to the law, including lawsuits by conservative groups and individuals, have been filed in federal courts throughout the country. And most legal experts agree that both sides raise valid questions.
“This case could be decided either way without overturning any existing Supreme Court precedents,” Coan said.
So far, federal judges have dismissed two of the lawsuits – one filed in Virginia by Liberty University, founded by Jerry Farwell, and the other filed in Michigan by the Thomas More Law Center, a public interest law firm that focuses on defending the religious freedom of Christians, family values and other issues.
But federal judges in Florida and Virginia have denied the federal government’s motions to dismiss the lawsuits by the states.
Van Hollen, a Republican, wanted to challenge the health care law immediately after it was passed but needed Democrat Gov. Jim Doyle’s approval – and the governor in a strongly worded letter made clear that wasn’t going to happen.
“The State of Wisconsin will not enter into litigation intended to deny health care for tens of thousands of residents,” Doyle wrote in March.
The state also has estimated that the law would save Wisconsin 5 million to 0 million from January 2014 through June 2019 as the federal government picks up a larger share of the cost of insuring residents with limited incomes.
But Van Hollen said Wisconsin should bring a lawsuit to protect the balance of powers between the federal government and states.
“This is an issue that needs to be clarified one way or another,” he said.
If people are not required to buy health insurance, they could wait until they are sick to buy it. Health insurers regularly liken it to being able to buy homeowner’s insurance while your house is on fire.
Subsidies
The health care law provides subsidies for people and families with low to moderate incomes to buy insurance, if they don’t get affordable health benefits from an employer. The legislation specifically notes that people who don’t buy insurance – out of choice or necessity – saddle hospitals and doctors with large unpaid bills that raise costs for people with insurance.
That’s one reason for the so-called individual responsibility requirement.
But the uninsured population disproportionately includes people in their 20s and 30s. Many of them could afford to buy insurance. Economists call them “free riders.” They also tend to be healthy – and their premiums are needed to offset the cost of providing health insurance to people who are sick.
People with health problems who don’t get health benefits from an employer now are effectively locked out of the insurance market in many states because health insurers will not cover them. Changing that is one of the key provisions in the new law.
States can require people to have health insurance; Massachusetts does so now. And the federal government’s right to regulate the insurance industry is clear. The issue is whether that right also gives it the authority to require people to buy health insurance.Opponents note that the federal government has never passed a law requiring citizens to buy a private product or service or pay a penalty.
Congress passing a health care law requiring people to buy health insurance, opponents contend, is no different from requiring people to buy vitamins or join a gym.Ilya Shapiro, a senior fellow in constitutional studies at the Cato Institute, a libertarian think tank in Washington, D.C., said no principled limits on federal power will exist if the health care law is allowed to stand.The legal arguments hinge at least to some extent on whether deciding not to buy health insurance is an economic activity.
The Constitution, under the Necessary and Proper Clause, also gives Congress the authority to enact regulations needed to regulate interstate commerce.
The Department of Justice contends that the decision not to buy health insurance is an economic decision that affects the entire health care system. It also contends that everyone, even people who are healthy, is part of the health care market.
But Shapiro and other opponents contend this reasoning would lead to a federal government of unlimited powers.
“Everything is an economic decision in some way,” he said.
Opponents contend that requiring people to buy health insurance regulates an economic inactivity.
To Coan, the UW law professor, this isn’t the key issue in the case.
“If Congress needs to regulate inactivity to make its regulation of commerce effective, the Necessary and Proper Clause gives it that power,” Coan said. “That’s how I would analyze the case.”
The federal judges in the lawsuits brought by the Thomas More Law Center and Liberty University agreed.
But Shapiro has noted that there are “many, many rulings yet.”
The lawsuits raise other issues – including complex tax issues – but more legal experts have said the most important issues involve the mandate to buy health insurance.
No one expects that issue to be resolved until 2012 at the earliest.
Deciding what to do
Van Hollen now must decide how to proceed.
Joining other states in the Florida lawsuit would give Wisconsin less control over the direction of the case.
The Florida case also may be too far along for Wisconsin to intervene.
The state also could file a friend-of-the-court brief. That would give it more flexibility in its arguments. It also could file its own lawsuit.
“We, in further analysis, may decide we want to take a little different legal or augmentative tack than them,” Van Hollen said. “There are a number of different considerations and, once again, we’ve got a little bit of time to figure out which ones prevail.”
The cost of challenging the law will depend on whether the lawsuit is handled by his staff and how the state proceeds.
Van Hollen acknowledged people have asked what difference Wisconsin could make in the outcome given the number of lawsuits already filed. But he said a multitude of parties can give a position more legal authority.Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat’s 60th vote in the Senate opens up the legislation to a Republican filibusterThe Patient Protection and Affordable Care Act became the law of the land in 2010, but debate over its existence and implementation will rage on in the New Year. The law’s serious policy flaws are already impacting health insurance and costs, but these are part of a deeper and broader issue: the proper role for the federal government in Americans’ health care. The public’s stance on this issue has been anything but settled in the wake of the new law’s passage.
Fact Sheets Home Health Care
Home health care helps seniors live independently for as long as possible, given the limits of their medical condition. It covers a wide range of services and can often delay the need for long-term nursing home care.
More specifically, home health care may include occupational and physical therapy, speech therapy, and even skilled nursing. It may involve helping the elderly with activities of daily living such as bathing, dressing, and eating. Or it may include assistance with cooking, cleaning, other housekeeping jobs, and monitoring one’s daily regimen of prescription and over-the-counter medications.
At this point, it is important to understand the difference between home health care and home care services. Although they sound the same (and home health care may include some home care services), home health care is more medically oriented. While home care typically includes chore and housecleaning services, home health care usually involves helping seniors recover from an illness or injury. That is why the people who provide home health care are often licensed practical nurses, therapists, or home health aides. Most work for home health agencies, hospitals, or public health departments that are licensed by the state.
How Do I Make Sure That Home Health Care Is Quality Care?
As with any important purchase, it is always a good idea to talk with friends, neighbors, and your local area agency on aging to learn more about the home health care agencies in your community.
In looking for a home health care agency, the following 20 questions can be used to help guide your search:
How long has the agency been serving this community? Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one. Is the agency an approved Medicare provider? Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations? Does the agency have a current license to practice (if required in the state where you live)? Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for? Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family), and update the plan as necessary? Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver? How closely do supervisors oversee care to ensure quality? Will agency caregivers keep family members informed about the kind of care their loved one is getting? Are agency staff members available around the clock, seven days a week, if necessary? Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day? How does the agency ensure patient confidentiality? How are agency caregivers hired and trained? What is the procedure for resolving problems when they occur, and who can I call with questions or complaints? How does the agency handle billing? Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services? Will the agency provide a list of references for its caregivers? Who does the agency call if the home health care worker cannot come when scheduled? What type of employee screening is done?
When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have. For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first.
Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem (see the Respite Care fact sheet for more information about these services.
In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:
Illnesses/injuries, and signs of an emergency medical situation Likes and dislikes Medications, and how and when they should be taken Need for dentures, eyeglasses, canes, walkers, etc. Possible behavior problems and how best to deal with them Problems getting around (in or out of a wheelchair, for example, or trouble walking) Special diets or nutritional needs Therapeutic exercises.
In addition, you should give the home health care provider more information about:
Clothing the senior may need (if/when it gets too hot or too cold) How you can be contacted (and who else should be contacted in an emergency) How to find and use medical supplies and medications When to lock up the apartment/house and where to find the keys Where to find food, cooking utensils, and serving items Where to find cleaning supplies Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure) Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them).
A WORD OF CAUTION . . .
Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.
HOW CAN I PAY FOR HOME HEALTH CARE?
The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance.
The patient must be homebound and under a doctor’s care; The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously) The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary” The home health care agency providing the services must be certified by the Medicare program.
WHERE CAN I LEARN MORE ABOUT HOME HEALTH CARE?
There are several national organizations that can provide additional consumer information about home health care services. These include the following:
The National Association for Home Care, which can be reached at 202-547-7424 or by visiting its website at www.nahc.org. The postal address is: 228 7th St., SE; Washington, DC 20003. The Visiting Nurse Associations of America, which can be reached at 617-737-3200 or by visiting its website at http://www.vnaa.org. The postal addresses are: 99 Summer St., Suite 1700; Boston, MA 02110.
To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging (at 1-800-677-1116 or http://www.eldercare.gov can help connect you to these agencies.
Case Study
WHEN IS HOME HEALTH CARE APPROPRIATE?
Because it is not always clear to the average person when an ailing senior needs home health care and when he or she needs nursing home care, it is usually best to consult a medical professional for advice. The following case study describes one situation in which home health care proved to be the right choice.
Francis is 84 years old and recently had a stroke. She was hospitalized briefly and then discharged to continue recovering at home. To enable her to return home, her doctor called a home health care agency, and the agency gave Francis a complete home health care plan for six weeks. Since the doctor ordered the home care for Francis, Medicare paid for it.
For the first week after Francis went home, a nurse visited her every day. The nurse met with Francis’s family to discuss her special dietary needs and to arrange for exercise therapy to help Francis regain her strength. Once that was done, the nurse visited Francis twice a week to check on how well she was recovering. The home health care agency also sent a homemaker, a personal care attendant, and a physical therapist to visit Francis several times during the week. The homemaker would do the shopping and cook light meals. The personal care attendant would help Francis bathe, get dressed, and walk. The physical therapist would keep Francis moving and see to it that she got some exercise to aid in her recovery.
Home health care is a great choice for anyone who needs extra help but does not want to lose their independence or the comfort their own home can provide. With so many Americans turning 65 over the next few years, more choices are needed to help those who want to maintain their health and freedom. Home services can give you a healthy routine, safety and emotional well-being that can’t be achieved on your own, and with less expense than a hospital or institution.
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