UnitedHealthcare Introduces Pharmacy Saver For Medicare Plan Members

Main Category: Medicare / Medicaid / SCHIP
Article Date: 26 Nov 2010 – 1:00 PST

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UnitedHealthcare, a UnitedHealth Group (NYSE: UNH) company, announced a new program that will enable enrollees in the company’s market-leading Medicare plans to save money on hundreds of prescription medications in 2011. This new program applies to the company’s Medicare Part D members in 2011, including most of those who receive their prescription drug benefits in conjunction with a Medicare Advantage plan from UnitedHealthcare, such as AARP® MedicareComplete.

Through collaboration with The Kroger Co., Safeway Inc. and Prescription Solutions, UnitedHealthcare has created Pharmacy Saver, a unique program that reduces members’ out-of-pocket costs on prescriptions purchased at pharmacies participating in the program to prices even lower than their co-payments, sometimes as low as $2 for a 30- or even 90-day supply. Pharmacy Saver applies to hundreds of prescription drugs, including eight of the top 10 generic drugs most commonly used by UnitedHealthcare’s Medicare plan members.

“Economic pressures are putting a strain on many people’s budgets, including many seniors and other Medicare beneficiaries living on fixed incomes,” said Tom Paul, CEO, UnitedHealthcare Medicare Retirement. “Pharmacy Saver is another example of our promise to provide our members with affordable prescription drugs. The new program combined with the other consumer-friendly features of our Part D and Medicare Advantage plans will help our members get the most value for their money in 2011.”

How Pharmacy Saver Works

Since launching its Medicare Part D prescription drug plans in 2006, UnitedHealthcare has delivered on its Savings Promise to members – a commitment that they will get the lowest available price on their medications. That lowest price could be their co-pay, or the pharmacy’s retail price, or a specially negotiated rate – whichever is the best deal for the member. Pharmacy Saver is the latest evolution of the Savings Promise.

Members enrolled in UnitedHealthcare’s Medicare plans, including its AARP® MedicareRx prescription drug plans and its AARP® MedicareComplete Medicare Advantage-Prescription Drug plans, will see their typical out-of-pocket cost for a 30-day supply of select medications decrease to as low as $2 when they purchase their prescriptions from pharmacies participating in the program.

Pharmacy Saver will provide UnitedHealthcare’s Medicare plan members valuable cost savings plus the flexibility and convenience of accessing their prescriptions at many of America’s most popular pharmacies. Beginning Jan. 1, 2011, members can take advantage of Pharmacy Saver at more than 3,000 pharmacy locations nationwide.

Pharmacies currently participating in the program include:

– The Kroger Co. and its wholly owned affiliates that have in-store pharmacies: Kroger; Ralphs; King Soopers; City Market; Dillons; Smith’s; Fry’s; QFC; Baker’s; Owen’s; JayC; Hilander; Gerbes; Pay Less; Scott’s; Fred Meyer


– Safeway Inc. and its wholly owned affiliates: Safeway; Vons; Randalls; Genuardi’s; Carrs; Dominick’s; Pavilions; Tom Thumb

– Prescription Solutions mail order pharmacy, a UnitedHealth Group company

“We believe it’s important that our members have the flexibility to access their drugs in the way that’s most comfortable and convenient for them,” said Paul. “In developing Pharmacy Saver, we worked to ensure that our members could take advantage of the cost savings regardless of whether they prefer to purchase their drugs in a retail pharmacy or through the mail.”

UnitedHealthcare will continue to enhance its Savings Promise by working with more pharmacies to bring additional savings to members in 2011.

Pharmacy Saver Strengthens UnitedHealthcare’s AARP MedicareRx Preferred Plan

A reduction in premium combined with no plan deductible and additional savings through the Pharmacy Saver program make UnitedHealthcare’s AARP® MedicareRx Preferred plan a strong option for Medicare beneficiaries in 2011.

On average, members currently enrolled in the Preferred plan will see a $5 decrease in their monthly plan premium next year. In addition, it will be the only basic Part D plan available nationwide in 2011 without a deductible.

Stability, value and consumer-friendly benefits such as robust drug formularies and access to a network of more than 60,000 pharmacies have made the Preferred plan the nation’s largest Part D plan since the Part D program launched in 2006.

New Website Provides Resources and Information

More information about Pharmacy Saver is available here, including lists of prescription drugs that are available at a reduced cost at each of the pharmacies participating in the program.

Source:

UnitedHealth Group

The Kroger Co.

Safeway



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Today’s OpEds: Medical Students Say Don’t Repeal; ‘ObamaCare’ Waivers; The Medical Loss Ratio; Medicare ‘Doc Fix’

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Medical Students / Training;  Primary Care / General Practice;  Health Insurance / Medical Insurance
Article Date: 26 Nov 2010 – 2:00 PST

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Health Care’s Dilemma: Competition Or Collaboration? The Washington Post
Here’s the dilemma: The only way for the health-care industry to move toward accountable care is to further accelerate a process of consolidation that has already reduced competition and increased market power. … In such a market, government may be required to step in with more direct regulation and competition management than traditional antitrust rules now provide (Steven Pearlstein, 11/23).

Editorial: Reform Obamacare, Don’t Repeal It The Dallas Morning News
This bill is headed toward exploding the deficit because there’s no way Congress will suddenly start cutting Medicare. Instead, legislators should limit the tax subsidy that employers receive for offering coverage, especially for gold-plated plans. That move would raise enough to pay for the legislation, whose costs are largely tied up in subsidies to help working families buy insurance (11/24).

If Employers Walked Away From Health Coverage Kaiser Health News
An inability to continue funding the industry’s excesses would surely burst the health care cost bubble, unleashing a cascade of harshly chaotic consequences. Only then might we see a reform process that more rank and file Americans might appreciate and embrace (Brian Klepper and David Kibbe, 11/24).

Government By Waiver: The Breakdown Of Public Administration Forbes
The process vividly shows how unrealistic expectations can undermine the rule of law. Waivers are by definition an exercise of administrative discretion that benefits the party who receives its special dispensation. Yet nothing in ObamaCare explains who should receive these waivers or why (Richard Epstein, 11/23).

Why The ‘Doc Fix’ Problem In Medicare Isn’t Going Away Any Time Soon Bnet
The inconvenient truth is that most doctors and hospitals simply aren’t ready to take bundled payments or form accountable care organizations. It will take most providers years to acquire the necessary health IT and infrastructure to do this – not to mention the changes in business relationships and culture that will be required. So in the meantime, the government will have to devise a bridge strategy (Ken Terry, 11/23).


‘Opting Out’ Of Medicaid No Real Option In Mississippi The Clarion Ledger
Almost 40 percent of Mississippi’s Medicaid recipients are children, 25 percent are elderly and about 22 percent are disabled. The idea that Mississippi would somehow be better off either from a fiscal standpoint or from a public health standpoint to “opt out” of the Medicaid program is one that would be a hard sell both in the Legislature and among the state health care providers (Sid Salter, 11/24).

Sorting Out Trauma Care In NE Ohio The Cleveland Plain Dealer
It’s important that trauma care be regionalized so as to make the most of expensive resources. This discussion could have started better; it’s imperative that it end well (11/23).

Medical Students To Senate Republicans: Repeal Is Not The Solution To Our Health Care Crisis The Huffington Post
An overreliance on free market ideologies through the choice and competition you champion have already driven the Norman Rockwell physician out of business. The new reforms are not changing a perfect system, they are rescuing a system on the brink of collapse (Iyah Romm, Elizabeth Wiley, Sylvia Thompson, M.D. and John Brockman, 11/23).

Medical Losers The American Spectator
The goal of imposing a fixed medical loss ratio is to force health plans to lower prices, cut costs and provide more care. Like other aspects of Obamacare, the mandatory MLR will have the opposite effect: mandating that at least 80-85 percent of premiums be spent on medical care will lead to a rapid consolidation of health plans, reductions in physicians pay, cuts in services, and hospital closures (Robert M. Goldberg, 11/24).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.



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Public Health: Frequency Of Dialysis Treatment Questioned, Chemotherapy Drug Shortages

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Urology / Nephrology;  Diabetes;  Public Health
Article Date: 26 Nov 2010 – 2:00 PST

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News outlets report on a variety of public health issues.

CQ Health Beat: A new study funded by the National Institutes of Health suggests that receiving dialysis six days a week results in better self-reported patient health than the conventional treatment of three times per week. “Since the brunt of dialysis costs is borne by Medicare, a boost in frequency could mean increased spending by the program, however. … Might the study eventually lead to increased Medicare outlays for dialysis? Washington, D.C. health policy consultant Alec Vachon says the question isn’t easy to answer. ‘Our kidneys work 24/7, so it should not be a surprise that more frequent dialysis – beyond standard thrice weekly – is better,’ he said. ‘But the wild cards are what CMS, patients, or dialysis providers think. Dialysis is already the single largest Medicare line item, and many patients are not keen on even three sessions per week. And would dialysis providers – most of which are for profit – find it attractive to sharply expand capacity even if Medicare would pay for added sessions?'” (Reichard, 11/23).

National Journal: Following a new report Tuesday predicting that nearly half the U.S. population could have diabetes by 2020, researchers estimate “that the diabetes problem will continue to grow without aggressive intervention that primarily focuses on weight management and combating obesity. ‘Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early on and prevent this devastating disease before it’s too late,’ said Deneen Vojta, senior vice president of the UnitedHealth Center for Health Reform Modernization (Fung, 11/23).

St. Louis Beacon: The St. Louis Diabetes Coalition is “taking its message out of doctors’ offices and to the public” through education seminars in collaboration with Saint Louis University’s Center for Outcome Research. “The coalition’s programs are free and open to everyone, but the group is especially interested in reaching people who are clueless about how best to handle a disease that’s claiming more victims as Americans get less or no exercise and eat more unhealthy foods. … The coalition’s work with SLU’s Center for Outcome Research is financed by a $99,000 grant from the St. Louis Community/University Health Research Partnership. Set up in 2009, the partnership focuses on research into diabetes and other health problems” (Joiner, 11/23).

The Associated Press/Boston Globe: “[A]lcohol-related problems are sending nearly 1,000 college-age residents to hospital emergency rooms each year,” according to an analysis by the Boston Public Health Commission. “[S]ince 2008, 18- to 22-year-olds have made 40,000 visits to city emergency rooms, and of that number, more than 2 percent were alcohol-related. Commission Executive Director Dr. Barbara Ferrer calls the numbers ‘a serious problem and a burden on the health care system'” (11/24).

The Wall Street Journal Health Blog: Amid an “ongoing problem of drug shortages,” chemotherapy drugs “are among those most in demand. … Drug shortages occur for a range of reasons that vary by medication: the unavailability of raw ingredients, FDA enforcement actions that halt production, voluntary recalls, poor inventory ordering, a change in product formulation and even rumors of an impending shortage, which can cause hoarding, according to the Institute for Safe Medication Practices” (Hobson, 11/23).

Charleston, S.C. WCBD: “People eat what is convenient and affordable — and if it’s sodium laden fast food, that’s what they’ll chow down on. A team of Medical University of South Carolina researchers studied the Chicora Cherokee neighborhood for 6 months. They looked at the impact of the environment on the people who live in the community and on the students attending Burns and Chicora elementary schools in North Charleston. They discovered the lack of affordable, healthy food options in urban communities ironic in a country with an abundance of food. ‘We determined that there were only 13 stores within a mile of Chicora Cherokee and of those 13 stores there were “zero” grocery stores’, says Amy Painter of MUSCs Center for Communities in Health Partnerships” (Murray, 11/24).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.



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RACGP: More Consultation Needed On Medicare Locals, Australia

Main Category: Medicare / Medicaid / SCHIP
Article Date: 26 Nov 2010 – 3:00 PST

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The Royal Australian College of General Practitioners (RACGP) has provided a submission to Department of Health and Ageing about the proposed Medicare Locals health reforms.

The planned introduction of the national network of primary healthcare organisations, known as Medicare Locals, is supported in principle by the College, and the College believes primary healthcare organisations are an important component of national health reform. Nevertheless, the College has concerns about some aspects of Medicare Locals and would like to see further detail from the government regarding their implementation.

RACGP President Professor Claire Jackson said that the College has voiced concern regarding the government’s immediate plan as part of this initiative to remove the responsibility for the provision of access to after-hours medical care from general practice, and replace it with a telephone medical advice service run by Medicare Locals.

“We have urged the government to review the after-hours care arrangements, noting the decimation of after-hours care which occurred under similar circumstances in the UK. Unless these issues are addressed, patient access to after-hours care may be very much curtailed.

Professor Jackson said that the College welcomes the government’s commitment to work with the profession and key stakeholders regarding the establishment of the primary healthcare organisations, as well as its commitment to the integration of quality primary healthcare, facilitated by general practitioners with strong clinical leadership.

“However, if poorly designed, the introduction of a regional system will generate additional layers of bureaucracy, expense, and red tape. Therefore, when exploring options for regional structures, it is vital that there is ongoing and meaningful consultation with the profession at both a national and local level.

“If high quality healthcare is to be achieved at a local level between the primary healthcare and hospital sectors, a formal, structured and meaningful relationship between the primary healthcare organisations and local hospital networks needs to be established and maintained, and GPs should be at the forefront of these reforms. Progression towards a more collaborative approach by primary healthcare organisations and local hospital networks will cultivate and foster an integrated culture of mutual understanding, cooperation, and respect between both sectors,” she said.

The College is committed to work with all levels of government to improve access to high quality care to better meet the needs of local communities.

To read the RACGP’s submission to the Department of Health and Ageing about the proposed Medicare Locals health reforms, visit here.

Source:

Royal Australian College of General Practitioners



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UCare Uses Cloud Computing Solutions From IkaSystems To Simplify Medicare Enrollment And Reconciliation, Reign In Administrative Costs

Main Category: Medicare / Medicaid / SCHIP
Also Included In: IT / Internet / E-mail
Article Date: 26 Nov 2010 – 4:00 PST

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UCare, the fourth largest health plan in Minnesota, has gone live with solutions from ikaSystems designed to improve interactions with Medicare Advantage enrollees while supporting the plan’s administrative cost reduction and compliance goals. ikaSystems, a premier provider of enterprise-level cloud computing solutions for health insurance plans, is helping UCare both ease the complexity of Medicare Advantage enrollment and reconciliation processes and supply prospective members with a robust enrollment experience via the Internet.

“At the same time, we wanted to improve our interactions with prospective members by supplying a highly functional Web portal for enrollment. We felt that ikaSystems delivered a solution that helped prospective members enroll and connect with us easily, efficiently and cost-effectively.”

“After evaluating several vendors, it became clear that ikaSystems had the ideal solution for supporting our membership growth without increasing administrative costs,” said Beth Monsrud, senior vice president and chief financial officer at UCare. “At the same time, we wanted to improve our interactions with prospective members by supplying a highly functional Web portal for enrollment. We felt that ikaSystems delivered a solution that helped prospective members enroll and connect with us easily, efficiently and cost-effectively.”

UCare, which serves more than 200,000 members across Minnesota and western Wisconsin, was searching for a way to help the organization manage its Medicare enrollment growth through streamlined enrollment processes, stay compliant with Medicare regulations and control the administrative costs associated with member and payment reconciliation. After an extensive search, UCare selected ikaMedicareGateway based on its ability to meet all three criteria, plus the Member Portal for its ability to automate the enrollment process for prospective members.

According to Monsrud, “In previous open enrollment sessions, UCare would bring in temporary employees to handle manual enrollment processes, which became more cumbersome year after year as our membership expanded. This year, just two months after deploying ikaSystems’ solutions, we have already eliminated the need to bring on extra help, enabling us to significantly reduce administrative costs.”

In addition to deploying the Enrollment Pathways module of ikaMedicareGateway, UCare has also gone live with the Reconciliation Module, which helps health plans minimize discrepancies, perform more efficient discrepancy resolution, and minimize resources and rework during member and payment reconciliation processes.

“Health plans today are being forced to navigate an increasingly complex landscape. The regulatory impact of upcoming health care reform will require significant resources and flexibility to meet evolving business needs,” said Ravi Ika, chief executive officer of ikaSystems. “UCare has identified an opportunity to automate and streamline previously manual, cumbersome processes with ikaSystems, which will free up valuable resources to focus on the bigger challenges on the horizon.”

ikaMedicareGateway and ikaPortals are a part of ikaEnterprise, an end-to-end cloud computing-based solution for health plan business process optimization and intelligence management. It includes full sales cycle automation, core claims adjudication, care management and proactive quality measurement and reporting with self-service portals for sales, administrative, employer, member and provider use. ikaEnterprise has been successfully deployed, typically in a software-as-a-service (SaaS) model, in some of the nation’s finest health plans to reduce administrative costs in their commercial, Medicare and Medicaid business lines.

Source:

UCare

ikaSystems Corp.



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Medicaid: Texas GOP Activists Push To Drop The Program; Fla. Nurse Practitioners Vy For Larger Role

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Nursing / Midwifery;  Primary Care / General Practice
Article Date: 25 Nov 2010 – 3:00 PST

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Dallas Morning News: “Tea party members and other conservative activists pushed state lawmakers Tuesday to vote to nullify the federal health care law and get out of Medicaid, though one GOP senator said the largely federally funded program pays for nursing home care for the elderly and disabled and is ‘not all bad.’ … Former Republican gubernatorial candidate Debra Medina and dozens of others said the Legislature should declare the federal law void and also refuse to set up a state health insurance exchange. … Leading Republican senators … found themselves arguing against suggestions that the state forgo billions in federal Medicaid funds and cut off current recipients (Garrett, 11/23).

Dallas Morning News, in a separate story: A study required by a state bill last session, “of what Texas would do if the national Medicaid health program for the poor were abolished — or federal matching money to states were slashed — will examine how the state might improve its existing Medicaid or scrap it, Health and Human Services Commission chief Tom Suehs said today.” The study will be ready “early next month” and Suehs “said a major theme will be that states such as Texas with a high proportion of poor, uninsured residents are mistreated by the current Medicaid formula for determining how much federal match money a state gets” (Garrett, 11/23).

The (New London, Conn.) Day: “A coalition of health care provider groups, social workers and advocates for the poor asked the federal government on Monday to reverse the state’s decision to let insurers negotiate lower reimbursement for doctors and hospitals in the HUSKY health insurance program [the state’s Medicaid managed care program]. … The department changed the portion of the 2009 waiver agreement that said that the insurers that offer HUSKY coverage – Aetna, AmeriChoice and the nonprofit Connecticut Health Network – must pay participating doctors and other providers of care at rates at least equal to those paid under traditional fee-for-service Medicaid” (Mann, 11/23).

Sunshine State News: Nursing advocates in Florida argue that they could save the state at least $1 billion if nurse practitioners could be used by the Medicaid program. “Though Florida’s nurse practitioners must meet the national standards, the state is one of just two that severely restricts their scope of practice, says Susan Lynch, a nurse practitioner in Orlando.” Stan Whittaker, chairman of the Florida Council of Advanced Practice Nurses PAC, “said, ‘Utilizing (nurse practitioners) has significantly reduced costs to Medicaid programs in other states. We are ready and able to do the same for Florida. It is in the public interest for this to happen, and really the better question is why it hasn’t happened already. … Citing the Tennessee model, Lynch believes that a $1 billion Medicaid cost reduction is conservative for Florida. If Tennessee’s experience were matched, Florida’s savings would top $3 billion annually” (Ward, 11/24).

Southern Political Report / The (SC) State House Report: “Next year looks to be interesting for the state’s Department of Health and Human Services. … Not only is DHHS, which administers Medicaid, facing a projected $228 million shortfall this fiscal year, which ends June 1 but the agency announced this week the likelihood it will run out of reimbursement money for Medicaid providers – doctors, hospitals, etc. – as soon as March 4, unless it gets additional mid-year solutions” (Davis, 11/23).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.



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N.J. Assembly Passes Bills To Fund Family Planning Clinics, Expand Medicaid Eligibility

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Sexual Health / STDs;  Women’s Health / Gynecology
Article Date: 24 Nov 2010 – 1:00 PST

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The New Jersey Assembly on Monday passed two bills that would restore funding to family planning clinics and expand eligibility for Medicaid coverage of family planning services, the Asbury Park Press reports. The bills now go to the Senate for consideration in early December.

The bills passed along party lines, but neither received the 54 votes needed to override a possible veto by Gov. Chris Christie (R). In June, Christie vetoed similar legislation that would have reversed state budget cuts to family planning clinics, and the Senate failed to override the measure on a party-line vote.

One of the bills (A 3274) would transfer $5 million in reserve funding to state family planning clinics. The measure passed 45-25 with nine abstentions. The bill would prohibit the money from being used to pay for abortion services. Republican critics of the measure argue that the funds would allow family planning clinics that provide abortions to use other sources of revenue for the procedure.

The other bill (A 3273), which passed 44-25 with 10 abstentions, would require New Jersey to apply to the federal government to expand Medicaid coverage for family planning services to people with incomes between 133% and 200% of the federal poverty level, as allowed under the federal health reform law (PL 111-148). Twenty-seven states already have secured federal permission for such expansions. If approved, New Jersey would receive more than $15 million in federal funds over two years by spending $1.1 million in state funds (Symons, Asbury Park Press, 11/22).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women Families.

© 2010 National Partnership for Women Families. All rights reserved.



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Tax dollors to fund Abortions

posted by Marge Skalecki on 24 Nov 2010 at 6:54 am

Please stop using my hard earned money to fund a procedure that I find so offensive and horrendous, to end the lives of the unborn children who will never see the light of day. The Good Lord will not allow his innocents to be murdered all in the name of a womens rights. It is a terrible sin against humankind, and all that is good.

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Health Spending Proposals, Health Law Repeal Divide Lawmakers

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance
Article Date: 24 Nov 2010 – 3:00 PST

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The Wall Street Journal reports that proposals for cuts in health spending by President Barack Obama’s deficit-reduction commission are drawing opposition from health companies, doctors and some consumer groups. “How to tackle health costs has become a sticking point for the 18-member committee, which last week concluded three days of meetings without a firm agreement among members. Under proposals from the bipartisan commission’s two co-chairmen – Alan Simpson, a retired Wyoming Republican senator, and Erskine Bowles, a White House chief of staff to former President Bill Clinton – seniors in Medicare and military retirees would pay a greater portion of their health costs, doctors would get lower reimbursements and employers would face a cap on their tax exemption for providing workers with health insurance.” It also opens the door for resurrecting the “public option.”

“Responding to the draft proposals, advocates for seniors and other consumer groups said cutting Medicare and Medicaid would hurt the most vulnerable Americans. … [S]ome corners of the health industry, not wanting to take any chances, say they are preparing to fend off the draft report’s recommendations” (Adamy, 11/22).

USA Today: As the health spending proposals are splitting lawmakers and health groups, the nation as a whole remains divided as support for the tea parties grows. “Just about as many Americans want Tea Party-backed members of Congress to take the lead in setting policy during the next year as choose President Obama, a USA TODAY/Gallup Poll finds. In a survey taken Friday through Sunday, 28% say Obama should have the most influence on government policy next year while 27% say the Tea Party standard-bearers should. GOP congressional leaders are chosen by 23%, Democratic congressional leaders by 16%.” Tea Party members were swept into office in part around the furor over the health law (Page, 11/22).

The Washington Post: “Liberal groups in Wisconsin are bracing for a fight over contraception coverage under Medicaid. Battle lines are being drawn over sex education in North Carolina. And conservatives in several states intend to try to limit the ability of private insurers to cover abortions.” The renewed challenges are part of a new GOP effort to bring social issues to the fore with their new power in Congress. The move is shocking some who saw the election as more a referendum on the economy, not on social issues like abortion (Somashekhar, 11/21).

CQ HealthBeat: Democrats are using the release of rules dictating how much insurers must spend on medical care to tout the law as a repeal try by Republicans looms. “Democrats in Congress included language in the law on a national medical loss ratio (MLR) as a way to curb health insurance premium prices without directly capping them, which politically would have been more difficult. Under the MLR standard, beginning in 2011 insurers will face new mandates on how they spend premium money and must issue rebates if they do not comply. The MLR standard is complex to explain and not easily captured in a sound bite. And it’s part of a law not universally popular. Yet the announcement of the regulation offered battered Democrats a chance to highlight health care, hold out the possibility of rebate money going directly to consumers and again criticize GOP plans for the law’s repeal. Beginning in 2012, $1.4 billion worth of rebates may go to policyholders, HHS said” (Norman, 11/22).


Roll Call: Republicans aren’t silencing their dissent of the law, however. “The Senate is scheduled to vote after Thanksgiving on legislation to repeal a small but increasingly maligned provision of President Barack Obama’s health care overhaul, and the Republican author of the repeal is optimistic that it will pass this time. … Sen. Mike Johanns said the changes that he made to the legislation since its defeat in a floor vote earlier this year should address opponents’ concerns, including their suspicion that the measure’s true purpose was to undermine the health care law. Johanns’ revised proposal, to be voted on Nov. 29 as an amendment to a food safety bill, would repeal a change in tax reporting requirements ushered in by the health care law. Even Obama has conceded that the provision is onerous on small businesses and warrants adjustment” (Drucker, 11/22).

It’s not the only showdown among Republicans and Democrats. The parties’ leaders – Speaker Nancy Pelosi and Minority Leader John Boehner – themselves also appear headed for a showdown as they swap jobs, the Tribune Washington Bureau/Los Angeles Times reports. “They are a political and personal odd couple, a pair of wary prizefighters who nonetheless have maintained a cordial relationship and respect for each other’s political skills. But when Republicans take control of the House in January, Boehner and Pelosi will swap jobs as minority leader and House speaker, and their interpersonal dynamics will be tested anew. … Boehner’s priorities include trying to repeal the healthcare overhaul that Pelosi considers among her greatest accomplishments” (Mascaro and Simon, 11/23).

Other Republicans, including moderate Maine Sens. Olympia Snowe and Susan Collins, are signing onto a letter that supports the lawsuit challenging the health law’s constitutionality, The Washington Post’s 44 blog reports based on news accounts from Maine. “As the lone Republican on the Senate Finance Committee who voted to move the bill – which at the time included an individual mandate (though Snowe made clear then that she didn’t support that provision) – to the full Senate last year, Snowe was the only Republican senator who supported the bill at any stage. She did not vote for final passage of the bill in March” (DeLong, 11/22).

One Republican congressman-elect who came under fire for asking why he had to wait a month after he takes office for federal health coverage is the target of a new campaign from liberal groups, CBS News reports. “Rep.-elect Andy Harris is the target of a new radio and Facebook campaign aimed at portraying the incoming Republican and his colleagues as hypocrites on the subject of health care. … The conservative Maryland doctor was one of many Republicans this year who campaigned against President Obama’s health care reforms, so Democrats seized on his complaint and sought to portray Harris and others as hypocrites. Now the liberal advocacy group Americans United for Change is pressing that message with a new campaign directed at Harris’ constituents. The group today launched a radio ad that will air this week in Maryland markets” (Condon, 11/22).

Las Vegas Sun: Confusion also remains among health care providers. “Doctors, hospitals, insurers and other medical professionals know they have to adhere to provisions outlined in the health care reform bill Congress passed in March. But with newly elected representatives and senators heading to Washington, many who have vowed to do away with health care mandates, the medical industry is hesitant to spend millions of dollars to redefine the way it does business for a law that could look very different very soon. … Because the changes are expensive, providers are loath to make them while Republicans, who will control the House in January, continue to promise widespread overhaul of the bill. Worse, health care practitioners say they don’t know what changes to make because the government hasn’t written specific regulations yet” (Goldberg, 11/22).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.



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Encouraged Under Health Law, Plans Drawn For Accountable Care Organizations

Main Category: Medicare / Medicaid / SCHIP
Article Date: 24 Nov 2010 – 3:00 PST

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CQ HealthBeat: Accountable Care Organizations were “given a boost” under the health care law “but they must be carefully structured to get the job done, the Medicare Payment Advisory Commission said Monday. … The commission said in a letter to the Centers for Medicare and Medicaid Services (CMS) that in order to work, ACOs can’t simply be given bonus payments if they meet goals for controlling costs and improving quality. They must also pay for some of the overruns if they exceed the spending target they are given. The letter adds that ACOs could also help Medicare patients ‘receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs'” (Reichard, 11/22).

Knoxville News Sentinel: “The health reform law encourages accountable care organizations, or ACOs, as a way to improve the quality of care for Medicare beneficiaries and reduce unnecessary costs. … ACOs expand the concept of a patient-centered medical home to include not only a primary care practice but hospitals, specialists and other health care professionals who are ultimately held accountable for the cost and quality of care delivered. … Summit Medical Group, East Tennessee’s largest primary care physician group, intends to pursue the establishment of an ACO. … Summit is investing millions of dollars in systems, resources and infrastructure that its physicians believe will improve care coordination and result in an improved clinical outcome, improved patient experience and an improved financial outcome” (Harrington, 11/23).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.



Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
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NCPA Statement On Avalere Health Study Details Need For More Careful Selection Of Medicare Part D Plans By Enrollees

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Article Date: 24 Nov 2010 – 3:00 PST

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National Community Pharmacists Association (NCPA) Executive Vice President and CEO Kathleen Jaeger issued the following statemen in response to the Avalere Health study analyzing how the formulary and cost-sharing benefits changes made by various Medicare Part D prescription drug plans affect seniors:

“The study released today by Avalere Health underscores the importance for seniors and caregivers of reading the fine print when determining what plan is best for the particular Medicare beneficiary, because some of the headline-grabbing offers might not best meet their medication needs.

“Community pharmacists are a valuable resource for patients and caregivers navigating the Medicare Part D prescription drug program maze. Given that much has changed from its launch four years ago to today, community pharmacists stand ready to help enrollees determine what plan works best during the annual open enrollment season.

“More than ever before, a consumer needs to be fully informed about the total prescription drug plan being offered including deductibles, co-pays and the actual cost of the drug. Sometimes, when something sounds too good to be true, it is. In some cases, consumers are having their choice of community pharmacies taken away, some plans are pushing mail order pharmacies with 1-800 lines all of which take the personal interaction out of providing quality care in dispensing medication and corresponding counseling. And, in most cases, the long-established relationships between patients and their community pharmacists are being broken in the quest for a Part D plan to simply increase its market share. We can’t let patient care take a back seat to market share.

“Our goal is to offer our expertise in helping seniors navigate the complex enrollment process. Community pharmacists can either explain or show seniors and their caregivers how to use the Medicare.gov website to find the plan that is best for them. On this site, you can click on the Part D Plan Finder and ‘plug in your drugs’ and your local pharmacy to understand what is truly the best option to ensure that seniors receive quality care. Not only do community pharmacists understand the Medicare system, but the personal relationships they have developed with their patients are invaluable in providing the patient education necessary for making these determinations.”

The National Community Pharmacists Association (NCPA®) represents the interests of America’s community pharmacists, including the owners of more than 23,000 independent community pharmacies, pharmacy franchises, and chains. Together they represent a $93 billion health-care marketplace, have more than 315,000 employees including 62,400 pharmacists, and dispense over 41% of all retail prescriptions.

Source: National Community Pharmacists Association



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