Entries in Health Care (11)


Sequester’s Medicare Cuts Mean Tough Choices for Colo. Hospitals

Hemera Technologies/Thinkstock(ALAMOSA, Colo.) -- While the immediate effects of the sequester may have been somewhat overstated, it threatens to have a very real impact on Colorado hospitals and their patients

In 2011, Medicare payments to Colorado hospitals were $253 million less than in 2009, according to the Colorado Hospital Association. Now those same institutions are facing another 2 percent decrease in reimbursement for Medicare services.

“For those folks that don’t have a balance sheet that’s healthy, and they’re already on the edge, it’s a very significant jeopardy,” Russ Johnson, CEO of San Luis Valley Regional Medical Center in Alamosa, Colorado told ABC News.  “I would expect not just with sequestration but with what’s happening in our country – maybe out of necessity to reduce costs – we’re going to see some hospitals that have been struggling finally not be able to continue.”

Steven Summer, president of the Colorado Hospital Association, said sequester cuts were about to hit especially hard in a state facing a drought and other economic challenges. For Coloradans, it will mean doctors and patients will have to make sacrifices.

“It could potentially have patient waits increase,” Summer said. “If it’s a staffing question then certainly staffing has an impact on patient care.”

Actual Medicare benefits may be protected from sequester cuts, but that does not mean patients won’t see a change in care. With a 2 percent reduction in payment for Medicare services, hospitals will have to look elsewhere to make up that lost revenue.

Beyond patient health, Medicare cuts mean Colorado hospitals have to re-evaluate how they adopt President Obama’s health care law, the Affordable Care Act.

“This postpones the kinds of decisions we need to make to transform the health care system,” Summer told ABC News. “All those decisions related to [the ACA] have to wait until we have the stability in the system, so we can implement some of those changes in the payment system.”

Copyright 2013 ABC News Radio


Seniors Have Both High Hopes and Major Concerns About the Future

Digital Vision/Thinkstock(NEW YORK) -- Despite tough economic times, at least one group of Americans is bullish about their future. They’re the baby boomers born between 1946 and 1964.

In a poll conducted of 2,250 people ages 60 and older by the National Council on Aging, UnitedHealthcare and USA Today, 75 percent of baby boomers believe life will continue to get better, due in large part to people working longer and advancements in healthcare.

However, their optimism is also tempered by some realism about the way the economy has stagnated, with a third of this group worried that they won’t be able to pay for long-term care, while 20 percent say that a major financial downturn would seriously affect their fiscal situation.

Just over seven in ten seniors earning under $30,000 annually, which is considered low income, admit to a lingering health problem and that they’re less likely to exercise than their more financially secure counterparts.

Meanwhile, about a fifth of seniors over the age of 65 are still working either full- or part-time, some because they want to, other because they have to in order to make ends meet.

“Aging in place” is another goal of most seniors -- that is, living in their own homes. Most people in their 60s say that it’s feasible to live independently, although less than half of folks in their 70s see that as a realistic possibility.

There’s another major concern brought up by the respondents in the survey -- that is, the availability of resources and services in their communities, with more than a fourth of people in their 60s worried that a lack of these services will make it more difficult to “age in place.”

Copyright 2012 ABC News Radio


Cost of Health Care Bumping Up Pizza Price

Hemant Chawla/The India Today Group/Getty Images(NEW YORK) -- The CEO and founder of Papa John's pizza wants investors to know that when the president's health care law takes effect, the price of pizza is going up with it.

According to "Papa" John Schnatter, the cost of providing health insurance for all of his pizza chain's uninsured, full-time employees comes out to about 14 cents on a large pizza.  That's less than adding an extra topping and a third the price of an extra pepperoncini.  If you want that piping hot pie delivered, the $2 delivery fee will cost you 14 times as much as that health insurance price hike.

"We're not supportive of Obamacare, like most businesses in our industry," Schnatter said on a conference call with shareholders last week, as reported by Politico.  "If Obamacare is in fact not repealed, we will find tactics to shallow out any Obamacare costs and core strategies to pass that cost onto consumers in order to protect our shareholders' best interests."

The pizza place's Facebook page was soon littered with outraged pizza lovers proclaiming they would be "happy" to pay an extra 11 to 14 cents so Papa John's employees could have health insurance.

"I lose more than that in a week under my sofa cushion," one Facebook commenter wrote.  "I'd gladly pay 20 cents for a child to go to a doctor when they've got a cold, rather than have them show up at the ER."

Another said she's taking her money to another pizza restaurant, "one that doesn't begrudge their employees the ability to seek a doctor when they're ill."

The company sought to clarify Schattner's comments on Wednesday, telling ABC News in a statement that Schnatter's remarks were in direct response to a question about the costs of complying with President Obama's health care law.

"We certainly understand the importance of healthcare to our customers, our employees, small business owners and their employees," the company said.

But despite the pizza price increase, many of Papa John's employees may still go without employer-provided health insurance after the law takes effect in 2014.  The company would not say how many of its employees are uninsured, but in 2010, the service industry had one of the lowest rates of insured employees, with 33 percent of the workforce uninsured, according to the Kaiser Family Foundation.

Large businesses, those with more than 50 employees, are the only ones on the hook for providing health insurance under the health reform law.  While Papa John's as a whole employs 16,500 people, 80 percent of the company's restaurants are independently owned franchises.  As long as a franchise owner does not employ more than 50 people, he or she does not have to pay for employee health insurance.

The Affordable Care Act only requires employers to offer health insurance to full-time employees, almost 90 percent of whom at large businesses like Papa John's corporate offices are already covered, according to a Treasury Department official.

If the pizza company decides not to cover any full-time employees who are not currently insured, it will be hit with a $2,000 fine for each employee beyond the first 30 workers.

But part-time employees are not required to be covered under the law.  While Papa John's would not disclose how many of its employees were part-time, in the food and beverage industry as a whole, half of all workers were part time in 2010, according to the Bureau of Labor Statistics.

Where Papa John's and other restaurant chains may run into costs from the health law is under a new definition of "full-time" employees.  Anyone who works more than 35 hours, the average weekly hours of a part-time restaurant employee, is considered full-time under the law and will thus have to be provided with health insurance.

Steven Wojcik, vice president of Public Policy for the National Business Group on Health, said he expects that rather than pay for these employees to get health insurance, restaurant owners will cut back hours to keep the majority of their workforce part-time.

"What's going to happen is restaurants are going to have to make a choice," Wojcik said.  "My full-time employees, I'm going to have to move some of them to part-time.  I'm definitely not going to go out and hire more restaurant employees to stay under the 50-person cap and I may scale back some of the hours of the ones that currently work more than 30 hours per week."

Wojcik said that while some waiters, cooks and pizza makers who are already full-time may score health insurance from their employer, "we will not expect a lot more coverage of restaurant employees unless Americans are willing to pay a lot more for a meal."

Copyright 2012 ABC News Radio


Obama Admin. Partners with Health Insurers to Prevent Fraud

Tom Williams/Roll Call(WASHINGTON) -- The Obama administration is partnering with major insurers in the fight against health care fraud, announcing plans today to share billing information in an effort to identify trends and halt scams.

“Lots of the fraudsters have used our fragmented health care system to their advantage,” HHS Secretary Kathleen Sebelius told reporters today at a White House event with insurance executives. “By sharing information across payers we can bring this potentially fraudulent activity to light.”

The federal government, state investigators, and major insurers will share data and best practices to try to prevent billions of dollars in questionable payments and safeguard taxpayer resources, the administration announced.

“We will work to develop and disseminate best practices, to educate health care professionals and consumers on ways to identify and stop fraud, and to open an ongoing dialogue about the emerging trends and evolving threats throughout the healthcare marketplace,” Attorney General Eric Holder explained.

In the past, Sebelius said, the government followed the “pay-and-chase” model, paying claims first and later tracking down the ones that were fraudulent. “The money was already out the door,” she said. “Now we’re taking away the crooks’ head start.”

Copyright 2012 ABC News Radio


Health Care Ruling Will Affect Cost of Law, Number of Those Covered

iStockphoto/Thinkstock(WASHINGTON) -- Last month's Supreme Court ruling on the Affordable Care Act has both good and bad news for Americans.

According to an analysis by the nonpartisan Congressional Budget Office, about three million people on the lower rung of the income scale won't have access to free medical coverage as originally dictated by the law.

However, the ruling also means that taxpayers won't be on the hook for an additional $84 billion since the high court ruled that states have the option of not taking part in a major expansion of the government Medicaid insurance program for the poor.

In spite of these changes, the CBO says the Affordable Care Act, which presumptive GOP nominee Mitt Romney says he will repeal if he wins the presidency, will remain mostly intact.

Should Obama be reelected, it would likely mean that 30 million people currently without health insurance will get covered by 2022.

Furthermore, the costs of additional coverage will be offset by new taxes and federal spending cuts that would help to lower the federal deficit, the CBO said.

Copyright 2012 ABC News Radio


Health Care Law Mandate ‘Tax’: How Much Is It?

Creatas/Thinkstock(WASHINGTON) -- Beginning in 2014, if you are uninsured, not exempt from the new mandate, and refuse to sign up for health care coverage, how much will you owe Uncle Sam?

The health care law sets out a formula to determine your penalty, which will be assessed and collected by the IRS as part of your federal income taxes.

The penalty will be the greater of a flat dollar amount per person or a percentage of your taxable income.  For dependents under 18, the penalty is half the individual amount.

The annual penalty is capped at an amount roughly equal to the cost of the national average premium for a qualified health plan — in other words you cannot be forced to pay more than it would have cost to buy a plan in the first place.

Flat dollar amount for individuals:  $95 in 2014; $325 in 2015; and $695 in 2016; increases indexed to inflation after that, subject to a cap.

For example, courtesy Blue Cross Blue Shield:  An uninsured family of three (two parents and one child under 18), not exempt from the mandate, would have a flat dollar penalty of $1,737 in 2016.

Percentage of individual taxable income:  fixed percentage of household income in excess of tax filing threshold – 1% in 2014; 2% in 2015; 2.5% in 2016.

For example (again courtesy Blue Cross Blue Shield):  An uninsured, non-exempt individual with household income of $50,000 would be forced to pay 1 percent of the difference between $50,000 and the tax threshold (let’s say $10,00 for an individual in 2014), or roughly $400. Since $400 is greater than $95, this individual would have to pay $400.

There are plenty of exemptions from the penalty. You do not face it if your insurance premiums would be more than 8 percent of your gross income, if you’re a member of an American Indian tribe, or if you lacked insurance for less than three months during a year.

The non-partisan Congressional Budget Office projects that 4 million uninsured, non-exempt Americans will refuse to get medical coverage and face the penalty in 2016.

Copyright 2012 ABC News Radio


Health Care Ruling: Business Winners, Losers

Creatas Images/Thinkstock(NEW YORK) -- For American businesses in general, and the health care industry in particular, the Supreme Court decision to uphold President Obama's overhaul law removes a great deal of uncertainty.

After months of legal challenges, the ruling gives hospitals, insurance companies, biotech firms and drug makers a clearer picture of what will happen when the major provisions of the law are expected to go into effect in 2014.

The legislation is a boon for much of the health care industry by making coverage affordable for tens of millions of uninsured Americans. But not every company will benefit. Medical equipment makers, for example, will be hit with a new tax on their sales.

There will be new fees as well as cuts in some forms of government reimbursement to health providers.

Beyond the health care industry, how will the Supreme Court ruling affect small- and medium-sized businesses?

"I would say there is actually a positive impact in that people know what to expect," said Brian Hamilton, CEO of the financial information firm Sageworks. "It's very important to remember the psychology of people who run privately held companies. If they have time to plan, the legislation is less important than the time horizon."

Hamilton said if the Supreme Court decision had led to confusion over the future of health care reform that would have been much more damaging to many firms than the cost of paying for a change that's been in the works for years.

"For the companies that have more than 50 employees who do not currently have coverage there will be an additional charge. It will be expensive, but they've been anticipating it."

On the markets today, stocks of major insurance companies dropped as analysts sorted through the ruling. UnitedHealth Group declined 3 percent, while WellPoint lost almost 6 percent. Overall, stocks were down today with the Dow Jones industrial average falling 127 points.

As far as hospital chains go, Hospital Corp. of America was up 7 percent. Quest Diagnostics, which runs laboratories, was up 2.5 percent.

The health care law will bring an influx of new patients, which will mitigate other negative trends for the hospital industry, such as a shift to quality of care measures, regulatory scrutiny over premium increases and government incentives to curb overall health care spending growth.

From a consumer standpoint, Thursday's decision is the biggest change in healthcare coverage of our lifetime, said Michael Thompson, principal in PwC's Human Resource Services Group.

The biggest benefits of the health care reform will go to lower-income families who do not have employer-sponsored health plans.

"People generally not covered by employers will be in a position of better access to coverage going forward," Thompson said.

Thompson said there will be a "tremendous" increase in the number of people covered and subsidized by the federal government.

The law establishes health insurances exchanges at the state level, but one of their roles is to administer subsidies offered by the federal government to households whose income is up to 400 percent of the poverty level, essentially the middle class.

Thompson said health care costs in many states will increase with the new rule requiring managed care providers to insure people with pre-existing conditions. But people eligible for subsidies will see costs decrease as premiums will be based on a percentage of their income, Thompson said.

Alex Morozov, Morningstar's director of health care research, said it will be "tough to speculate" how health care costs will change for consumers.

"States are going to exercise significant pressure on managed care companies regarding premium increases," he said.

Copyright 2012 ABC News Radio


Patient Whistleblower Exposes $150 Million Medicaid Fraud

Ingram Publishing/Thinkstock(WASHINGTON) -- In a real-life David versus Goliath story, a 63-year-old wheelchair-bound Medicaid patient took on the multi-billion-dollar healthcare giant Maxim Healthcare. And he won.

On Wednesday the House Oversight Committee heard the saga of how Richard West exposed Maxim’s widespread Medicaid fraud and helped government officials reclaim millions for the cash-strapped program.

“This [fraud] is wholly unacceptable,” said Rep. Trey Gowdy, R-S.C., “This is why people have lost trust in the institutions of government and why our fellow citizens have so little trust that we are spending their money as carefully as we would spend our own.”

Richard West is in a wheelchair, uses a ventilator and needs oxygen.  He also needs Medicaid so he can stay at home while getting care.

In March of 2003, West started receiving that in-home care but in September of 2004 New Jersey state officials suspended his Medicaid benefits, claiming he had exceeded his monthly cap.

West determined that his healthcare provider, Maxim, had billed Medicaid for 735 hours of nursing care he never received -- fraudulent charges that amounted to more than $20,000.

Armed with the evidence, West complained to New Jersey officials.  They ignored him. Next he went to Medicaid, then to a social worker, but the social worker did nothing. West then found an attorney who filed a whistleblower lawsuit under the False Claims Act and that triggered an investigation of Maxim.

“Somebody decided to make a profit on my disability and rip off the government,” West, also a Vietnam War veteran, told the committee. “That was wrong and the right thing for me to do was expose it.”

Today, seven years later, Gary Cantrell, a top government investigator in the Health and Human Service’s Inspector General’s office, told Congress that West is the reason Maxim Healthcare got caught and recently agreed to pay more than $150 million to, “resolve civil and criminal charges,” the “largest ever involving home healthcare services.”

Nine people -- eight former Maxim employees, including three senior managers and the parent of a former Maxim patient -- have pleaded guilty to felony charges for committing fraud, Cantrell testified.

Under the Whistleblower Protection Act, West will receive $14.8 million from the fine Maxim will pay.

In fiscal year 2010, whistleblowers like West helped recover $2.39 billion lost to fraud, according to a Taxpayers Against Fraud report cited in West’s attorney’s testimony. Gowdy said as much as one-fifth of the money Medicaid spends is wasted on fraud.

A provision of the Affordable Care Act provides an additional $350 million over the next decade to help fight fraud, resources Rep. Elijah Cummings, D-Md., said were necessary to prevent cases like West’s.

“When we invest in fraud prevention government spending more than pays for itself,” Cummings said. “That is one reason why repealing the Affordable Care Act and cutting Medicaid’s enforcement budget would be very short sighted and indeed counter-productive.”

Copyright 2011 ABC News Radio


5 Tips for Health Care Plan, Medicare Enrollment

PhotoAlto/Frederic Cirou(NEW YORK) -- With the arrival of fall, those Americans fortunate to have health insurance through their employer -- 55.3 percent in 2010 according to Census data -- often re-enroll in their health plans without much thought.

Most of the provisions of President Obama's Patient Protection and Affordable Care Act will not be implemented until 2014, but consumers should be mindful of the re-enrollment period, which occurs in October for many plans.  Nancy Metcalf, senior program editor with Consumer Reports, has these tips for the insured:

1. Watch those deadlines.

"First, don't blow it off," Metcalf said.  The insured are often busy and take for granted their health options.  Around fall, most employers also send out at least an email or two that can disappear in your inbox.

Medicare's open enrollment also ends earlier this year -- Oct. 15 to Dec. 7 -- as opposed to through the end of the year.  Those 65 and older who are eligible should take note in case they want to change their drug plans, for example.

2. Analyze changes in options or personal situation.

Metcalf said provisions of a plan can change, such as a different deductible, or your family situation might have changed, such as a marriage, divorce or a new baby, which can alter the optimal options for you.

3. Consider trade-offs of an HMO, PPO, or POS.

A health maintenance organization (HMO) requires the insured to have care from provider in the plan's network, often restricted to a certain geographical area, and is coordinated by your primary care physician, according to the November issue of Consumer Reports, which ranks health insurance plans.

A preferred provider organization also has provider networks but you can see an in-network specialist without a referral.  The insured can also see a doctor out-of-network but for a higher cost.

Point-of-service, or POS, plans are a hybrid of an HMO and PPO: the insured choose a primary care physician and you need a referral to see a specialist.  As with PPO plans, the insured can see a doctor out of the network.

4. When to choose a high-deductible plan.

Insured usually choose a plan with a high-deductible payment to lower monthly premium costs.  Metcalf said these are usually paired with a health savings account (HSA) with money taken from your paycheck tax-free to pay for certain medical expenses.

Those with lower health care costs may find lower premiums off-set those high-deductible costs. Or those who have a good idea of their costs -- such as planned vision or dental work -- can usually calculate how much their costs will be within their health insurance plan.  But that takes requires detailed planning, so start talking to your doctor, dentist and optometrist now.

5. Learn about the healthcare act's provisions that have taken effect.

As of now, only a few healthcare provisions have taken effect.  First, dependents up to age 26 can remain on their parents' plans regardless of whether they live in the same household, or even if those young adult children are married.  About 1.2 million people have taken advantage of that benefit this year, according to Consumer Reports.

Other provisions that are already in effect are cheaper drugs through Medicare and free preventative care through insurance plans.

Metcalf said many people have misconceptions about the embattled healthcare act, such as what it provides and when provisions will be implemented.  She suggests visiting for more details.

Copyright 2011 ABC News Radio


White House Pushes Back Against McKinsey Healthcare Report

Comstock/Thinkstock(WASHINGTON) -- The White House is pushing back against a report by consulting firm McKinsey & Company that states 30 percent of employers will “definitely or probably” stop offering health insurance coverage to employees after 2014.

The Obama administration argues that the report is an outlier, and cites studies by the Rand Corporation, The Urban Institute and Mercer that found that businesses would not change their insurance programs substantially as a result of the Affordable Care Act.

“Economists agree that employers offer health insurance to help attract and retain the most talented employees,” White House Deputy Chief of Staff Nancy-Ann DeParle wrote in a blog. “Employers will continue to seek out top talent: and the new law makes it easier for them to do so by tackling health costs and supporting small businesses. Additionally, dropping coverage is unlikely to save money for employers.”

McKinsey surveyed 1,300 employees. The report also found that 50 percent of companies that were highly aware of the provisions in the new law were likely to drop coverage.

Starting in 2014, businesses with more than 50 workers have to pay a $2,000 penalty per employee if they do not provide health coverage to their employees, but the report found that many firms would actually benefit by dropping coverage despite those fees.

The non-partisan Congressional Budget Office estimates that about three million fewer people would get coverage through their employer by 2019 as a result of the new law.

Between six and seven million people would be covered by an employment-based plan who would not be covered by one under current law. But one to two million people who would be covered by their employers currently would instead go to the exchanges for coverage.

CBO also estimated that the new healthcare law would reduce the number of uninsured to 23 million by 2019, and the share of non-elderly Americans who are insured would rise to about 94 percent from 83 percent currently. About 24 million people would purchase their own insurance, according to the CBO.

The McKinsey report comes the day that a legal battle is brewing in Atlanta over the constitutionality of the Affordable Care Act. In January, a Florida judge ruled on the side of 26 states who charge that the individual mandate -- which requires that all Americans have health insurance by 2014 -- is unconstitutional. On Wednesday, a federal judge in Georgia heard arguments from both sides, and the case is likely to end up in the Supreme Court within the year, experts say.

Copyright 2011 ABC News Radio

ABC News Radio