A little-noticed part of President Obama’s Affordable Care Act channels some $12.5 billion into a vaguely defined “Prevention and Public Health Fund” over the next decade–and some of that money is going for everything from massage therapists who offer “calming techniques,” to groups advocating higher state and local taxes on tobacco and soda, and stricter zoning restrictions on fast-food restaurants.
If we want to control Medicare spending, this analysis suggests we need to focus our efforts on post-acute care. Our obsession with hospital costs and physician bills may be misplaced. It could be time to look much more closely at things like the nursing home industry, the home healthcare industry, and places that specialize in long-term care.
The central provisions of the Affordable Care Act require younger and healthier Americans to buy insurance policies that will, in essence, subsidize the healthcare of older and sicker Americans. But one of Obamacares hidden taxes — a new limit on contributions to health flexible spending accounts, or FSAs — will hit older and chronically ill individuals hardest.Starting this year, the healthcare law imposes a $2,500 annual cap on an individuals contribution to an FSA that is part of an employers “cafeteria” benefits plan. Such contributions, diverted directly from ones paycheck, are not subject to federal income and payroll taxes. The money in an FSA can then be used to pay for qualified medical expenses such as deductibles, co-insurance and co-payments, as well as services not covered by insurance.
Most cancer patients would like to talk about the cost of their care with their doctors, but often don’t because they fear the discussion could compromise the quality of their treatment, researchers at Duke Cancer Institute report.
Yet many patients who do broach the subject of finances believe it helps decrease costs.
Those findings, from a survey of 300 insured patients treated at Duke and affiliated clinics in rural North Carolina, suggest that doctors can play a role in easing financial worries just by taking the problem into account.
Aging Americans worried about their droopy upper eyelids often rely on the plastic surgeon’s scalpel to turn back the hands of time. Increasingly, Medicare is footing the bill.
Yes, Medicare. The public health insurance program for people over 65 typically does not cover cosmetic surgery, but for cases in which a patient’s sagging eyelids significantly hinder their vision, it does pay to have them lifted. In recent years, though, a rapid rise in the number of so-called functional eyelid lifts, or blepharoplasty, has led some to question whether Medicare is letting procedures that are really cosmetic slip through the cracks — at a cost of millions of dollars.
The idea that uneven Medicare health care spending around the country is due to wasteful practices and overtreatment—a concept that influenced the federal health law — takes another hit in a study published Tuesday. The paper concludes that health differences around the country explain between 75 percent and 85 percent of the cost variations.
One problem is that too little money was budgeted for creating the exchanges, which are the online markets where people can choose among competing health plans and prices. It is also where those with income below a set ceiling—for example, up to $94,200 for a family of four—will be entitled to buy insurance at subsidized prices.
The Congressional Budget Office originally estimated that setting up the exchanges would cost between $5 billion and $10 billion. California alone is spending more than $900 million, yet the health-reform law allocated only $1 billion for the country as a whole. The Obama administration has been cannibalizing other federal health budgets in a mad rush to find more for the exchanges.
A second problem is complexity. The Obama administration wants something the federal government has never done: a computer system that connects HHS, the Internal Revenue Service, the Social Security Administration, Homeland Security and perhaps other departments. This is a herculean task with unclear benefits.
Ron Suskind’s book on the first two years of the Obama presidency details the transformation. In early 2009, the White House staff prepared a memo for the president that suggested that a reform plan without the mandate would reduce the ranks of the uninsured only to 28 million people (from a projected 50 million). A plan with the mandate would reduce the number of uninsured residents in the United States far more, to under 10 million.
So a health plan with the individual mandate could more plausibly be described as “universal coverage” than could a health plan without it.
It’s clear now that, notwithstanding the position he took during the campaign, Obama was always aiming for the history books. If nothing else, he has always been a man of great ambition. And once elected, he felt free to abandon his previous position on the mandate to pursue his goal of becoming the liberal leader who delivered the next great entitlement benefit. Of course, that Democrats held once-in-a-generation supermajorities in the House and Senate only further encouraged him to “go big” in early 2009.
In a world of constantly rising health-care costs, Maryland has long stood alone. Through a novel system that gave regulators unusual leverage to set prices, the state delivered care at a price that grew more slowly than elsewhere in the country — even at some of the nation’s most renowned hospitals.But after saving an estimated $45 billion for consumers over four decades, the system is in danger of running aground. Hospital expenses have risen so relentlessly in recent years that the original price controls now appear unsustainable.
Nationwide, income fluctuations are estimated to interrupt coverage for as many as 28 million people expected to bounce between Medicaid and the federally subsidized health insurance exchanges that states are working to create, according to an article in the journal Health Affairs. Among those most at risk are seasonal and hourly workers and young adults who lack coverage through their parents or jobs, experts said.
Patients who can’t see their doctors or get their medication will either avoid care or end up in publicly subsidized emergency rooms, pushing healthcare costs even higher, experts said. And insurance premiums will rise if young, healthy people get fed up with the transitions and opt out of health coverage altogether.