On Stanly Regional Medical Center & Scotland Memorial Hospital

From The State of NC Healthcare….
“ Healthcare reform is an undeniable paradigm shift occurring at all levels of American society, from grassroots to corporate giants. It is a phenomenon that will ultimately redesign systems of healthcare delivery, finance, and management. It is a phenomenon in which organizations like Stanly Regional Medical Center and Scotland Memorial Hospital along with hundreds of other independent non-profit hospitals in the US will lead and represent the healthcare culture of small communities. On the other hand, Carolinas HealthCare System and other corporate giants will aggressively protect their own interests and profitability; small community-led healthcare will not be a top priority in reformation from their perspective.”
Read the full article here.

 

A post from The State of NC Healthcare

From Can Obama Truly Deliver?   “On October 31, Obama told CNN that he would set five immediate priorities: “stabilize” the financial system, move toward energy independence, enact some form of healthcare reform, grant middle-class tax cuts, and strengthen the education system. But he made clear that the nation has entered an era of limits because the economy is in such bad shape.”

But will Election Day exit polls further influence President-elect Obama’s “todo” list? 

According to Kenneth T. Walsh of US News and World Report(USN&WR), “about 62 percent of voters said the economy was their biggest concern–far and away the most important issue. About 19 percent listed Iraq or terrorism, and 9 percent said healthcare.”  USN&WR did not report the numbers for voters mostly concerned with energy independence, education, and other issues. If exit polls determine Obama’s response to American voters and the order in which he addresses the country’s most significant concerns, then healthcare reform is not so high on the list. With the overwhelming majority of voters depending on deliverance from the current global financial crisis, Obama’s promise of healthcare reform is likely to fade in the background.

USN&WR says that Obama’s aides “expect him to compromise in his own particular way.” They say that the President-elect will likely “scale back each of his priorities.” An unidentified, but “prominent Democrat who knows him well” says Obama will do “bits and pieces” rather than abandoning or down-sizing the issues he promised to work on. 

As far as Obama’s healthcare reform plan, it is probably safe to assume that it won’t be as aggressive as promised throughout his campaign and could settle on “insuring everyone under 18 years old so no child would be without health insurance”–not exactly the universal care that appealed to voters most concerned about healthcare. While insuring those 18 and under is, indeed, a worthy accomplishment, whether it can boost the movement toward overall reform is questionable. 

One wonders if some or a little change is better than no change at all, particularly when the larger issues continue to burden the whole system of healthcare providers and institutions as well as the entire profile of the population they must serve. Can a government-initiated healthcare reform project set out on the path of least resistance and get anywhere, especially when politically motivated? Is it likely to make a lasting impact?

It will be necessary for President-elect Obama to continuously re-evaluate his priorities; still, the American people depend on progress or at least the hope of it. In regards to healthcare reform, it is critical that leadership fuel the momentum with the knowledge that lasting and positive change is a long-term goal, that results are often slow to come into focus, and that the final page will most likely be written by future leaders and subsequent administrations. With that said, perhaps President-elect Obama will be the one who truly initiates change–not necessarily the one who signs final legislation.

President-elect Obama has a difficult task ahead because not all voters are going to be satisfied with just ”bits and pieces” of the expectations they cast along in the ballot box. As one of those voters, I am more hopeful that our President will initiate and engage in an effective healthcare reform process in which there is no turning back–one that, perhaps, may not come to an end under his tenure, but surely would not have started without vision and leadership.

 

Enrollment opens for NC high-risk health coverage

The News & Observer reports that open enrollment for NC’s high-risk health insurance pool begins Monday, October 20. [See New state health plan opens Monday] Additionally, folks who are interested about the guaranteed coverage program can find detailed information at the INCLUSIVE HEALTH website.

Inclusive Health, also known as the North Carolina Health Insurance Risk Pool (NCHIRP), provides affordable, individual health insurance coverage for North Carolinians who do not have access to an employer health plan and face higher premiums due to a pre-existing medical condition.

Inclusive Health is scheduled to begin offering coverage on January 1, 2009. Established by the State Legislature, Inclusive Health is a non-profit entity. It is not part of the state government but operates under the supervision and control of its Board.  Its Executive Director is Michael Keough.  

Inclusive Health plans are available in three options with varying deductibles and benefits that include prescription drug coverage. These plans are outlined in a downloadable PDF at the Inclusive Health website along with enrollment applications and other information. There is also a rate calculator that determines the cost of premiums according to age and whether the applicant is a smoker or non-smoker.

This post first appeared on The State of NC Healthcare. Tagged with: Inclusive Health, NC health insurance risk pool, NCHIRP

 

Getting there via grassroots: One woman and the healthcare reform bandwagon

I learned about Kathie McClure and VoteHealthCare.org on Adam Searing’s blog, The Progressive Pulse. (Please visit Mr. Searing’s site and watch his interview with Kathie). She’s not a politician, but she’s taking an active role in making sure those in elected leadership positions get the real picture of American healthcare.  

From VoteHealthCare.org–
Quote of the Week:  Speaking of her patients at the Lincoln Community Health Center in Durham, NC, Dr. Evelyn Schmidt says “Most of our patients have been pretty much left out in the cold by the healthcare system. The only way we’re going to succeed as a nation is if we’re healthier and better educated – and I mean everybody has to be provided for.”

VoteHealthcare.org promotes guaranteed affordable healthcare for all U.S. residents through citizen education and voter registration.  We educate citizens so they can be informed participants in the debate about our nation’s healthcare crisis.

(This post originally appeared on The State of NC Healthcare)

 

CoreSource named NCHIRP Benefits Administrator

CoreSource has been selected to administer benefits for the North Carolina Health Insurance Risk Pool (NCHIRP). The NCHIRP program is to begin offering more affordable (less expensive) health insurance to qualifying high-risk individuals in January 2009.

See NCHIRP’s official announcement here.

Trustmark Insurance has been the parent company of CoreSource since 1997. According to Google Finance, “CoreSource provides third-party administration (TPA) services of health care benefits for self-insured employers throughout the US. Through some 15 offices nationwide, the company provides its services to mid-sized and larger businesses. Services include claims administration, case and client management, COBRA/HIPAA administration, and flexible spending accounts. The company introduced a health savings account (HSA) high deductible plan in late 2005. CoreSource was spun off by Lincoln National in 1991 and acquired by Trustmark Insurance in 1997.”

 

one step closer to nc’s high-risk health insurance pool

What’s the recent buzz on NC’s new high-risk health insurance pool that’s scheduled to start up in 2009?

The Triangle Business Journal reports that North Carolina Health Insurance Risk Pool (NCHIRP) has selected CoreSource, a third-party health benefits administrator, to run its program offering health insurance to high-risk patients. CoreSource to administer North Carolina Health Insurance Risk Pool(Chris Coletta) reports that the announcement came on Thursday, June 12. A similar article (CoreSource lands insurance risk-pool contract) came out today (June 13) in the Charlotte Business Journal along with CoreSource’s company profile.

A few other recent articles in the Triangle and Charlotte Business Journals have provided brief updates on NCHIRP’s progress:

High-risk health insurance soon will be reality in North Carolina

Keough to lead North Carolina Health Insurance Risk Pool 

Enrollment in the NCHIRP program begins January 1, 2009, but there will be a waiting period for pre-existing conditions. Logan Stewart of the Mid-Atlantic Chapter of the National Multiple Sclerosis Society warns consumers:“NCHIRP allows for a reduction in the pre-existing condition waiting period if you have been insured in the months preceding enrollment in the pool. If you currently have health insurance coverage and think you might enroll in the health insurance risk pool, do not terminate your coverage until you verify the impact of termination on future benefits.”

Today, NCHIRP’s website is down (under construction); however, when available again, more information can be viewed at Points of Interest .

 

got reform?

Thanks to Jim Buie and Ron M. for getting me in gear here: 

Having so much faith in personal health care insurance is false security, especially when the insurance industry continues to narrow their gate of accessibility and drive up the cost of health care in general. Health insurance companies don’t absorb any losses they incur when payouts exceed premiums, deductibles, etc. They pass the cost of [your] care on to doctors, clinics, hospitals, etc. and to the whole body of subscribers and members. They increase premiums making it less and less accessible to others, they dictate how much they’ll pay for services (which is usually a fraction of the actual cost), and they burden Medicare along with the ones who most need the benefits it provides. 

Having insurance or Medicare doesn’t absolve one from caring about the American health care system. I know my care cost more than I pay in for premiums, co-pays, etc. And I know that the cost of my care doesn’t just evaporate into thin air. It’s passed on and on through economic levels. Someone (you) is picking up the tab. While I feel neither “good” or “bad” about the economic consequences of the care administered to me personally, it is the bigger picture that challenges my perspective of the American health care system and its components.

Over the decades, the science of health care has advanced a lot faster than the economic forces that support it. There’s no way that the 60’s model of health insurance and medicare can support contemporary medical science. For example, if you’d had a heart attack in 1965, there would have been no heart bypass, stints, angioplasty, etc and your health insurance would not have had to payout like it would have if your heart attack had happened in 2000.

There have been plenty of adjustments in the insurance industry over the years; however, those collective adjustments in cost and policy are inadequate in contemporary health care. They cannot support the advances in medical technology, pharmaceuticals, advanced [life-saving] treatments and other procedures that maintain quality of life, etc.

What if continued stem cell R&D proves a cure for cancer resulting in a treatment that is obviously very costly? Could the insurance industry alone meet that challenge without an absolute crash? Progressive thinking would have to let go of that antiquated design of health insurance because the real value of scientific and medical advances in society is its social impact–not its economic consequences.

The question becomes one of delivery: Is it possible for one to get progressive care under a “system” designed to pay for leeches, roots, and blood-letting? While that question might sound absurd, the point is that medical science and health insurance are not in the same century. Medical science could freeze right where it is and, still, it would take decades for the insurance industry to catch up.

Political forces are another factor in the delivery of an American health care system, especially this election year. I don’t expect a drastic stopping/starting point in health care reform; however, I’m voting for the candidate who is firm on health care reform and who has the ability to to spark the difficult and lengthy reform process. I’m looking for a candidate who realizes the potential of what medical science can provide and the economy can support. I’ll support the candidate who has the vision that all the possibilities serve every American citizen–not just the ones who can pay for it.

Although I’m perfectly safe and sound in my own little health care world, I’m still for reform, and sooner better than later.

The following comes entirely from NYU’s Clincial Correlations Blog at http://www.clinicalcorrelations.org/  -and -  http://www.clinicalcorrelations.org/?cat=19 : 

John McCain (R)
This plan is similar to other Republicans’ in proposing a system of health care tax credits. In particular, a tax credit of up to $5,000 would allow families to buy health insurance, including plans from across state lines. McCain also proposes the same changes that other candidates have: insurance portability, tort reform, IT investment, and reform of Medicare reimbursement to focus on “diagnosis, prevention, and care coordination.” One point has particular relevance for our VA hospital: veterans should have “freedom to choose to carry their VA dollars to a provider that gives them the timely care at high quality and in the best location.”

The financing of his tax credits is not discussed on his web site, though the NY Times reports that “employers would no longer be allowed to deduct health care costs from their taxes under his plan.”

Hillary Clinton (D)
Clinton would require every individual to choose an insurance plan. Anyone could keep their current insurance if they were satisfied with it. Two other choices would be available: a menu of private options offering the same benefits that members of Congress receive, the other a Medicare-style public plan. Tax credits would be offered to working families to make it easier for them to afford insurance.

How would this be paid for? The details aren’t spelled out, and this is where the complications come in. (See the detailed analysis of Clinton’s plan at the blog Health Care Policy and Marketplace Review.) In particular, the Clinton plan predicts that “most savings [will] come through lowering spending due to quality and modernization.” As Robert Laszewski of the Health Care Policy blog says, this could be Clinton’s most dangerous assumption. If quality and modernization cannot ensure savings by themselves, if providers and payers cannot agree on cost-limiting measures, if more taxes on the higher brackets (i.e. the rich) will not be enough to balance the books (as Clinton assumes), what will happen to the Clinton plan?

Alongside Clinton’s individual mandate for health insurance, there are requirements for other participants in the system. Insurance companies “will end discrimination” and “ensure high value,” while “drug companies will offer fair prices”; providers will work collaboratively to deliver high-quality, affordable care; “large employers” will be expected to provide health insurance or contribute to the cost of coverage (small employers will receive a tax credit to offer coverage, or start doing so).

What “fair prices,” “high quality,” and “large employers” are supposed to mean has been a source of debate even before the first Clinton health plan. How will affordable coverage be mandated when some estimates place the cost of family health coverage at $12,000 per year? If twenty-five employees is the cutoff definition for “large business” (as the Clinton campaign has indicated), what would smaller businesses be required to provide?

Barack Obama (D)
Like Hillary Clinton’s plan, as well as those of many other Democratic candidates, Obama’s “Plan for a Healthy America” proposes universal coverage, made possible through a number of proposals. Individuals and small businesses would be able to “buy affordable health care similar to that available to federal employees” or choose from a newly created federal insurance program. A proposed National Health Insurance Exchange would allow anyone to enroll in participating private plans. Medicaid and CHIP would be expanded and employers would be obligated to finance at least part of their employees’ health coverage. The plan would make illegal discrimination by insurance companies on the basis of pre-existing conditions.

Proposed financing of his plan includes increased efficiency from investment in information technology, better management of chronic diseases, and promotion of preventive medicine. Obama is also in favor of repealing the ban on direct negotiation by the Medicare drug plan (Part D) and proposes decreased payments to private Medicare plans (which on average charge 12% more than government-run Medicare). In addition, a proposed national reinsurance plan for catastrophic coverage would decrease premiums by having government shoulder the cost of the longest and most expensive hospital stays, for example in the ICU. No dollar figures are given in his proposal.

 

North Carolina Health Insurance Risk Pool, 339 days and counting

North Carolina’s new high-risk health insurance pool is scheduled to begin guaranteeing access to health insurance for high-risk individuals with pre-existing conditions on January 1, 2009 after the state legislature passed Session Law 2007-532 (House Bill 265), AN ACT TO ESTABLISH THE NORTH CAROLINA HEALTH INSURANCE RISK POOL (NCHIRP).

Contrary to what some NC tax payers think and believe, NC High-Risk Health Insurance is not free. It is not a welfare program or public assistance. It is not an entitlement program that gives out something for nothing.

 

The North Carolina Health Insurance Risk Pool, or NCHIRP, will make sure that folks who are looking to purchase health insurance but who have a chronic disease or condition or a disability can get coverage for a reasonable premium.

NCHIRP is significant in reducing the number of adult NC citizens who are presently uninsured. The high-risk pool means the provider of last resort (BCBSNC) cannot charge high-risk individuals more than 200% above the normal rate.  200% is a lot; but the changes still result in about a 50% reduction of high-risk coverage premiums that were previously allowed by the state.  Someone currently paying $1600/month for high-risk coverage will get a break of about $800./month.  So, the new rates will make it at least a little easier to get and keep coverage.

A significant aspect of the NCHIRP that has been mostly neglected in the media coverage is the opportunity and assistance it offers those who are currently receiving  Social Security Disability and Medicare benefits but would like to re-enter the work force. For many of these folks, the cost of high-risk health insurance has far exceeded their potential work income. The departure from monthly SSDI benefits isn’t necessarily the issue; it’s the loss of Medicare.

The reduction in high-risk health insurance costs supports the goals of independence and self-sustainability for disabled adults. The NCHIRP is quite significant in this aspect. NCHIRP inconjunction with the Social Security Administration’s Ticket to Work program and North Carolina Vocational Rehab has the capability to serve disabled adults who want a shot at self-sufficiency and independence. It might take several years to see the positive results of their efforts, yet one cannot discount its potential. Now, it’s up to individuals who qualify for the programs to courageously engage their own efforts.

For more information, visit these sites:

The North Carolina Health Insurance Risk Pool Website

The North Carolina Institute of Medicine

The North Carolina Hospital Association

NC Health Access Coalition

NC Justice Center

Duke University Center for Health Policy

UNC School of Public Health, Health Policy and Administration 

 

waiting (and waiting, and waiting, and waiting, and…)

Sunday’s Charlotte Observer has a good article about the difficulties of the disabled and their right to social security insurance disability (SSDI) benefits. The article specifically targets the lengthy application and approval process as well as what can happen in the interim for a lot of folks.

The benefit of SSDI isn’t just about the money. It includes Medicare, which for some people is the only means of getting the health care they need. Getting approved is not easy. In fact, it is a very long process that can take years. And sometimes, as the article points out, the process takes longer than some folks can survive. About two-thrids of SSDI applicants are initially denied benefits and must file an appeal that goes before a federal court judge. According to the Observer, the wait for a hearing increased to 658 days in July 2007. If a person has no other source of income, that wait can translate into a litany of misfortunes including losing a home, not being able to pay utility bills, and going without medicines or treatments.

So why are so many claims denied right away? Maybe a history of abuse by individuals who, perhaps, really don’t qualify for benefits have pushed the system to the level of automatic skepticism. That really hurts those who need a fast approval–especially the ones who need that Medicare card. Hiring an attorney can help, but the best lawyers can’t rush a federal court hearing because the system is set up on a first come, first served basis. An attorney is allowed an automatic 25% of the first payout of a claim paid retroactively. A person waiting for two years might get a lum sum of $20,000 initially, but for some the payout comes too late.

The system needs a good audit of management and resources. SSDI isn’t a free ride. It’s an insurance policy paid by social security taxes for those under the age of 65. If you haven’t worked or paid social security, you don’t qualify. SSDI is not welfare nor is it a public assistance program. It’s meant for workers who can’t work anymore because of permanent disability. SSDI workers are overwhelmed and overworked because the number of claims continue to increase with the baby boomer generation. 

The waiting and waiting and waiting can be fatal.           

http://www.charlotte.com/local/story/251546.html