Big Insurance Moves in on Medicaid

• An excerpt, DECEMBER 29, 2010

Insurers Bid for State Medicaid Plans

BY AVERY JOHNSON

Health insurers are preparing to capitalize on $40 billion of new opportunities to run privately managed Medicaid plans for the states, which would position insurers to benefit from the health overhaul's expansion of Medicaid in 2014.

Medicaid, the state and federal program for the poor, has become a growth area for big insurers such as UnitedHealth Group Inc. and more specialized plans such as Molina Healthcare Inc. Texas and Georgia will solicit new contracts for their private Medicaid plans early next year, while California, Florida and others are likely to meaningfully expand their programs, companies and states have said.

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Posted in: Big Insurance,health insurance reform,Medicaid

NO to Forced Purchase of Health Insurance

While I am strongly committed to health care access for all as is available in most countries outside the US, I think this ruling is one to be strongly evaluated.

First of all why must insurance, especially in a plan largely written by the insurance and pharmaceutical industry be rammed down the throats of selected groups of people?

Secondly, most media outlets are not giving much coverage to the groups that are exempted from this proposal.  Members of Congress are excluded and to me this is the most flagrant abuse in the legislation.

There are other concerns too but I want to stick with an example of employment based insurance.

In an NPR report related to the court ruling there was a discussion of the "boomers" in age 50-64.  Right now many are unemployed, lacking coverage, and lacking employment opportunities because so many of the Republicans in Congress sent jobs from their political crony corporations out of the country, and for the most part are responsible for NAFTA and GATT.

A health policy instructor at a California university mentioned in the report that it is just the 50-64 age group that is at highest risk of developing chronic health conditions like the heart attack that left a 59 year old man with $94 thousand in debt.  He'd also been unemployed for 5 years.

This college instructor also mentioned that most chronic health conditions start appearing around age 64.

Certainly a better way to see this is to see that there is no inclusion of natural health options in the health insurance reform bill.

There is talk about "integrative" care but this model  has quickly become a copy cat of the AMA model, only the "prescriptions" are a bit different, but it is still a tightly controlled arena.  They want this limited to the few who have 'licensening'.

What you hear so little about is prevention and true natural therapies.

The traditional natural health care approach has been keeping people well for h undreds of years.  You can find out more here. We have been helping people be well and stay well in a toxic world for decades naturally and during the decades as a nurse practitioner.

Key healthcare provision voided by federal judge

A requirement that Americans buy insurance — the central provision of Obama's signature domestic achievement — is unconstitutional, the ruling says.


December 13, 2010
By Noam N. Levey and David G. Savage, Tribune Washington Bureau Reporting from Washington — Declaring a core part of the new healthcare law unconstitutional, a federal judge in Virginia has launched President Obama's signature domestic achievement into a gantlet of conservative-leaning courts that will almost certainly conclude at the Supreme Court just as the 2012 election is cresting.

In the first such decision since Obama signed the law in March, U.S. District Judge Henry Hudson ruled Monday that Congress had overstepped its power in requiring Americans to get health insurance by 2014.

Continue reading

More here

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Posted in: health insurance reform,learn natural health care,natural health care

Health Insurance Reform Bill Struck Down

By LARRY O'DELL, Associated Press Larry O'dell, Associated Press – 

RICHMOND, Va. – A federal judge declared the foundation of President Barack Obama's health care law unconstitutional Monday, ruling that the government cannot require Americans to purchase insurance. The case is expected to end up at the Supreme Court.

In his order, U.S. District Judge Henry E. Hudson said he will allow the law to remain in effect while appeals are heard, meaning there is unlikely to be any immediate impact on other provisions that have already taken effect. The insurance coverage mandate is not scheduled to begin until 2014.

Related article: Terrain Shifts in Challenges to the Health Care Law

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Posted in: health insurance reform

Saving Lives and Saving Money

The following is a quote excerpted from a Public Citizen report that looked at the US health crisis.  As we move to the unfolding of health insurance reform in 2011 it is well worth everyone's attention to the issues addressed in this post.

"...the country is in a patient safety crisis, and that medical professionals, lawmakers and regulators must do significantly more to avert it.
The 1999 landmark report, “To Err is Human,” dropped the first bombshell, reporting that between 44,000 and 98,000 Americans die in hospitals each year from medical mistakes, costing an estimated $17 billion to $29 billion annually. HHS’ new finding that medical mistakes kill 15,000 Medicare patients a month equates to 180,000 Medicare deaths per year - more than the IOM’s estimate, which attempted to cover all patients in the United States. That means that the annual death toll in this country caused by mistakes in hospitals is well over 250,000 deaths a year! But perhaps the most startling finding by HHS is that a significant number of patients suffered injuries or died needlessly, as 44 percent of the medical errors were preventable."

One of my clients recently saw the writing on the wall when he went for his regular lab work, as he is an organ transplant recipient. transplant.  The lab removed many of the tests on his doctor's order, and he will not be able to get them routinely because of program changes.

As this moves further along we see that the "advance care planning" portion is in a rule from US Department of
Health & Human Services, Centers for Medicare & Medicaid (CMS) here:
http://www.ofr.gov/OFRUpload/OFRData/2010-27969_PI.pdf
[NOTE: link went inactive following 11/29. As of 12/1 the document is available at http://tinyurl.com/3akk88e

SOURCE: Just when you thought the American people had dodged the death panel bullet (Section 1233 of the House bill), think again. Last Monday, November 29, 2010, /The Federal Register/ (page 73406) published a new funding rule for "voluntary" advance care planning consultations that changes US Department of Health and Human Services regulation pertaining to Medicare and Medicaid patients.

The new regulation states that advanced care planning consultations will now be offered (and funded) as part of the initial wellness visit for medicare patients and during all subsequent annual visits.

The Federal Register provides a uniform system for making available to the public regulations and legal notices issued by Federal agencies. Agency proclamations having general and legal effect are required to be published by act of Congress.

Has there been any media attention to this important change in health care coverage for all those receiving medicare and medicaid services" You will recall the uproar about death panels, but this week funding for these consultation sessions became part of general government regulations without fanfare.

Ione Whitlock is Chief of Research at LifeTree. On our current homepage she discusses these new Federal Regulations. Also posted there is her new essay titled "Heads up: Section 1233 again."

Ione discusses Congressman Earl Blumenauer's bill -- HR 5795 -- which was introduced this summer after passage of the health care bill, and two matching bills which were introduced in 2009 by Senator Rockefeller and Congressman Blumenauer. All these bills seek grants for programs to expand or enhance existing state programs for orders regarding life sustaining treatment (POLST).

One of the main goals of this legislation is to fully implement the POLST form into our health care system. POLST stands for Physician's Orders for Life Sustaining Treatement. It comes in many flavors including MOST, MOLST, POST and TPOPP, depending on the location.

Government funds will be used to educate "providers" who will work with the patients, their families and surrogates in filling out the POLST forms. They will learn the so-called "best practices" for discussing end-of-life care with dying patients and their loved ones. These funds will ensure that the POLST forms are recorded electronically.

Note: For more information on the history and implications of POLST, see "POLST: 'Self-Determination' or Imposed Death" http://www.lifetree.org/resources/polstInfo.html in LifeTree's Resources section.

New CMS Rule Establishes "Voluntary" End-of-Life Consultations

Americans weary of "voluntary" TSA pat-downs and full-body scans will be delighted to learn that "voluntary" end-of-life consultations are in their future as well.

The US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) has made it official: The "advance care planning" funding that would incentivize "voluntary" end-of-life counseling will be included in Obamacare. This funding was part of what was in the controversial "Section 1233" earlier this year. See more
extensive discussion in our alert below, posted last week.

The new CMS rule as printed in the Federal Register (Vol. 75, No. 228, Book 1) online at http://tinyurl.com/2wn5vz4
Discussion on "voluntary advance care planning" begins on page 73406.

posted 12/1/10 by IW
------------------------------------------------------------------------
Heads up: Section 1233 again.

Last March Nancy Pelosi told the American people that she and her colleagues "have to pass the bill so you can find out what's in it." Americans had already seen one part of the proposed healthcare legislation, and didn't like what they saw: The infamous Section 1233 of HR 3200 would have federalized "voluntary" end-of-life "consultations."
The section was eventually dropped.

It appears that Section 1233 is still alive and kicking.

The "advance care planning" portion is in a rule from US Department of Health & Human Services, Centers for Medicare & Medicaid (CMS) here: http://www.ofr.gov/OFRUpload/OFRData/2010-27969_PI.pdf
[NOTE: link went inactive following 11/29. As of 12/1 the document is available at http://tinyurl.com/3akk88e

The POLST part is included in pending legislation, HR 5795 "Personalize Your Care Act of 2010." See
http://tinyurl.com/24u5q37
which is a link to all the information about this bill and the actual text as a pdf at http://tinyurl.com/2a9rudq.

CMS posted the preliminary rules on Election Day; formal rules are to be published in the Federal Register on November 29. The rules include a discussion of the definition of "voluntary," although some of the more nuanced meanings of "voluntary" may have been missed (just ask any recipient of a "voluntary" TSA pat-down). The rule also includes a discussion of signature requirements for "orders" versus "requisitions" in context of diagnostic tests. The American Bar Association's Charles Sabatino, who supported Section 1233, calls the new rules "a big step forward."

Congressman Earl Blumenauer (D-OR) introduced HR 5795 this past July. It is a revised version of the legislation that he and Senator Rockefeller (D-WV) introduced last year. Blumenauer introduced HR 2911, and Rockefeller introduced S. 1150 in 2009, both titled "Advance Planning and Compassionate Care Act of 2009". Both bills included:
    * Section 211 (Advance Care Planning) was almost identical to Section 1233 of HR. 3200 " the section that was dropped from the  final bill signed in March.
    * Section 112, which would have provided funding to expand POLST.

It is Section 112 of the Rockefeller and Blumenauer bills (S 1150 and HR 2911) that is now Section 3 of HR 5795. Portability of advance directives and standards for electronic health records are also addressed in HR 5795.

Blumenauer is the congressman most often associated with POLST He is, incidentally, an advocate of legalized assisted suicide, and Rockefeller has spent decades trying to push through legislation on behalf of the organizations that evolved from the Euthanasia Society of America.

Shortly before the election, Blumenauer told a radical pro-assisted suicide group that he had reintroduced what had been known as the "death panel" legislation. He complained that Section 1233 had been dropped due to "organized opposition" from "all of the Sarah-Palin-Fox-News-tin-foil-hat" people, but "it's not stopping us from moving forward." Over the summer he had reintroduced the bill with a new name: the "Personalize Your Care Act of 2010" (HR 5795).

"Personalize" leaves the impression that this bill might put medical treatment decisions back in the hands of the individual, keeping the discussion between patient and physician. It implies that the patient might as easily "choose life" as to forgo treatment. This is pretty slick marketing, considering it is coming from the same Oregon liberals
who pushed not only assisted suicide, but rationing for "equitable distribution of resources" for "the common good." The bioethicists at Oregon Health & Science University (OHSU) who devised the "citizen parliaments" that gave Oregon its rationing scheme are some of the same bioethicists who put the fine tuning on POLST.

Blumenauer, in his remarks to the Oregon activists, went on to say that Oregon leads the way in health reform. Well, yes. Oregon health care is infamous for two things: assisted suicide, and rationing. Blumenauer's bill would impose both on the whole country.

Note: For more information on the history and implications of POLST, see "POLST: 'Self-Determination' or Imposed Death"  www.lifetree.org/resources/polstInfo.html in LifeTree's Resources section.
posted 11/24/10 by IW, revised 12/2/10 by IW

The Six Parts of the Deficit Commission's Plan for Medicare Reform Through 2020
Part #1— Reform the Medicare Sustainable Growth Rate ($26 Billion Savings)
Freezing physician pay reductions through 2013 and a one percent cut in 2014. Additionally it recommends developing a new pay formula based on care coordination and quality instead of quantity of services.
Part #2— Reform or Repeal the CLASS Act ($76 Billion Cost)
The attempt as part of the health care overhaul to address the need for residential long-term care through a voluntary insurance program is criticized as financially unsustainable under its current format.
The recommendation is for complete overhaul or repeal (the preferred option) even with a price to be paid. This is because the collection of premiums over the first five years would have provided positive cash flow.
Part #3— Medicare and Other Health Care Revisions for 2012-2020 ($316 Billion Savings)
The commission proposes the following:

• $9 billion in waste, fraud and abuse will be saved by increasing the authority and resources of the Centers for Medicare & Medicaid Services (CMS).
  
• $110 billion by introducing a simple annual deductible of $550 for Part A and Part B and 20 percent Medicare co-pays, with a cap of $7,500.
  
• $38 billion through Medigap supplemental insurance reform. Eliminating coverage for the first $500 and restricting coverage to 50 percent of the next $5,000 in cost sharing. As a stretch into dangerous political territory the commission recommends the same treatment for Tricare (military version of Medicare) and federal retirees.
  
• $49 billion from treating Medicaid drug rebates in the same way as Medicare for those eligible for both programs.
  
• $60 billion by reducing excess payments to teaching hospitals to 120 percent of the national average salary for residents.
  
• $23 billion from ceasing payment for unpaid Medicare deductibles and co-pays.
  
• $9 billion by bringing forward, by two years, plans to change reimbursements for home health providers.
  
• $18 billion by introducing a change in the Federal Employee Health Benefit program and providing a fixed subsidy. The commission also recommends evaluation of the program to determine, based on the experience with FEHB reform, whether a voucher system could work for Medicare.

Part #4— Aggressive Implementation and Expansion of Payment Reform Pilots
The commission sees opportunities to expand programs aggressively where there is evidence of cost control, without need for additional Congressional approval. Note that this expansion will not be at the cost of providing quality care.
Part #5— Eliminate Provider Carve-Outs from IPAB
This recommendation allows the Independent Payment Advisory Board (IPAB) to include provider groups, such as hospitals, within its authority to recommend changes in revised payment policies.
Part #6— Establish a Long-Term Global Budget for Total Health Care Spending
This requires establishing a total federal health care budget and limiting growth to GDP plus 1 percent with a process to review spending. It additionally requires structural reforms if the spending exceeds the targets. The commission also said that if spending continues to grow, tax benefits for employer provided health insurance should be eliminated.

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Posted in: death rate,end of life planning,health insurance reform,Medicaid,medical errors,Medicare

US 49th in Life Expectancy but don't tell John Boehner

Coming soon to your health insurance plan, especially as the deficit commission plans to shift more costs from employers to workers.

Please Mr Obama, stop caving in on the needs of the people who are your true "boss".  Listen up and stay away from those back room deals with politcos...

Inefficiency Hurts U.S. in Longevity Rankings By NICHOLAS BAKALAR
November 29, 2010


By any measure, the United States spends more on health care than any other nation. Yet according to the World Fact Book (published by the Central Intelligence Agency), it ranks 49th in life expectancy.
Why?
Researchers writing in the November issue of the journal Health Affairs say they know the answer. After citing statistical evidence showing that American patterns of obesity, smoking, traffic accidents and homicide are not the cause of lower life expectancy, they conclude that the problem is the health care system.
Peter A. Muennig and Sherry A. Glied, researchers at the Mailman School of Public Health at Columbia University, compared the performance of the United States and 12 other industrialized nations: Australia, Austria, Belgium, Britain, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden and Switzerland. In addition to health care expenditures in each country, they focused on two other important statistics: 15-year survival for people at 45 years and for those at 65 years.
The researchers say those numbers present an accurate picture of public health because they measure a country’s success in preventing and treating the most common causes of death — cardiovascular disease, stroke and diabetes — which are more likely to occur at these ages. Their data come from the World Health Organization and cover 1975 to 2005.
Life expectancy increased over those years in all 13 countries, and so did health care costs. But the United States had the lowest increase in life expectancy and the highest increase in costs.
In 1975 the United States was close to the average in health care costs, and last in 15-year survival for 45-year-old men. By 2005 its costs had more than tripled, far surpassing increases elsewhere, but the survival number was still last — a little over 90 percent, compared with more than 94 percent for Swedes, Swiss and Australians. For women, it was 94 percent in the United States, versus 97 percent in Switzerland, Australia and Japan.
The numbers for 65-year-olds in 2005 were similar: about 58 percent of American men could be expected to survive 15 years, compared with more than 65 percent of Australians, Japanese and Swiss. While more than 80 percent of 65-year-old women in France, Switzerland, and Japan would survive 15 years, only about 70 percent of American women could be expected to live that long.
In narrowing the blame to the American health care system, the researchers first eliminated several other factors. Obesity and smoking are the most important behavior-related causes of death, but obesity increased more slowly in the United States than in the other countries and smoking declined more rapidly, so neither can explain the differences in survival rates. Homicide and traffic fatality rates have remained steady over time, and social, economic and educational factors do not vary greatly among these countries.
But not all experts agree with this analysis. Samuel Preston, a demographer and a professor of sociology at the University of Pennsylvania, says the analysis is faulty.
“The basic message is correct — that measures of U.S. health, including mortality and morbidity, are very poor in comparison with other countries,” he said. But the Columbia researchers “have no direct evidence about the health care system in this article,” he continued. “Their conclusion is extremely speculative.”
That they did not find smoking at fault, Dr. Preston said, “is mysterious to me, particularly since they show high lung cancer mortality for the U.S.” Dr. Preston has published widely on mortality trends and the effects of smoking.
Dr. Muennig conceded that the study examined only life expectancy and health care spending in the 13 countries, and not the structure or economics of health care. “We did a pretty good job of showing that smoking isn’t the culprit,” he said.
“Smoking and obesity are still major risk factors for an individual’s health,” he said. “But they are sapping life expectancy in all countries. Whereas in the U.S. we have a highly inefficient health system that’s taking away financial resources from other lifesaving programs.” SOURCE

and from UPI, trends in waiting, as the health insurance reform bill waits to go full throttle -

Some insurers switch to cheaper drugs

UPPER NYACK, N.Y., Nov. 30 (UPI) -- Health insurers change as much as 70 percent of medication prescriptions, resulting in adverse reactions among some patients, a U.S. survey indicates.
A survey by the Global Healthy Living Foundation, a non-profit patient advocacy group, found some patients with chronic conditions who responded well to a particular drug relapsed after being switched to a cheaper drug.
"This disturbing finding is not a simple case of switching a brand-name drug for a generic one, a common and generally accepted practice used for many illnesses, and one GHLF supports," Louis Tharp, executive director of the GHLP, says in a statement. "We found that health insurance companies throughout the U.S. switch one brand-name drug for another simply because the switched drug is cheaper -- if the drugs are identical, physicians generally have no objection, the survey found, but national medical groups have said most drugs are not identical and switching can cause adverse reactions and poor recovery rates."
Tharp says his group is working with other advocacy groups, state insurance commissioners, the U.S. Food and Drug Administration and state attorneys general to see what action can be taken to stop the practice.
"Switching is a practice that is starting to get a lot of attention," Tharp says.
"Legislation pending in New York, California and Missouri would outlaw this practice," and, he added, "Louisiana passed a law last year prohibiting it."
No survey details were provided.

Perhaps this abstract from AHRP.org says more, just like the Harvard study that found only 80% or modern medicine actually works...

Medical Errors Contribute to Hospital Deaths -

In 1999, the Institute of Medicine issued a landmark report, To Err is Human, documenting the extraordinary high rate of fatal medical errors at U.S. hospitals: medical errors caused 98,000 deaths and more than a million injuries a year, most being preventable.  

Two major recent analyses of U.S. hospital safety found NO IMPROVEMENT in patient safety.

One study, by a Harvard Medical School team analyzed medical errors at 10 North Carolina hospitals found: "harm to patients was common and the number of incidents did not decrease over time."  For every 100 patients admitted to a hospital, 25 suffered harm requiring medical intervention.

The other study, by the U.S. Inspector General of the DHHS, analyzed 1,000,000 Medicare patients' hospital records documenting that 1 in 7 suffered adverse events during hospitalization in the month of October, 2010.  The IG report calculates the cost of such errors to taxpayers to be several billion dollars a year.

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Posted in: health insurance reform,US life expectancy

The Issue of Insurers: Consider the Conundrum

I was reading an LA Times article earlier this morning about insurers that failed to pay death benefits on accepted policies.
None of this surprises me because longtime a insider in insurance law tells us that these companies love collecting their premiums from you yet don't like paying out claim.
These tricks are certainly an issue of concern in the health insurance debacle.
Just wait until 2011.

Insurers Test Data Profiles to Identify Risky Clients

Life insurers are testing an intensely personal new use for the vast dossiers of data being amassed about Americans: predicting people's longevity.

Read more: http://online.wsj.com/article/SB10001424052748704648604575620750998072986.html#ixzz15vnmlh6p

Insurers have long used blood and urine tests to assess people's health-a
costly process. Today, however, data-gathering companies have such extensive
files on most U.S. consumers-online shopping details, catalog purchases,
magazine subscriptions, leisure activities and information from
social-networking sites-that some insurers are exploring whether data can
reveal nearly as much about a person as a lab analysis of their bodily
fluids.

Related

*    Inside Deloitte's Life-Insurance Assessment Technology
<http://online.wsj.com/article/SB10001424052748704104104575622531084755588.h
tml> 
*
<http://online.wsj.com/public/page/what-they-know-digital-privacy.html>
Complete Coverage: What They Know

In one of the biggest tests, the U.S. arm of British insurer Aviva
<http://online.wsj.com/public/quotes/main.html?type=djn&symbol=AV>  PLC
looked at 60,000 recent insurance applicants. It found that a new,
"predictive modeling" system, based partly on consumer-marketing data, was
"persuasive" in its ability to mimic traditional techniques.

The research heralds a remarkable expansion of the use of consumer-marketing
data, which is traditionally used for advertising purposes.

This data increasingly is gathered online, often with consumers only vaguely
aware that separate bits of information about them are being collected and
collated in ways that can be surprisingly revealing. The growing trade in
personal information is the subject of a Wall Street Journal investigation
into online privacy.

A key part of the Aviva test, run by Deloitte Consulting LLP, was estimating
a person's risk for illnesses such as high blood pressure and depression.
Deloitte's models assume that many diseases relate to lifestyle factors such
as exercise habits and fast-food diets.

This kind of analysis, proponents argue, could lower insurance costs and
eliminate an off-putting aspect of the insurance sale for some people.

"Requiring every customer to provide additional, and often unnecessary,
information" such as blood or urine samples, "simply makes the process less
efficient and less customer-friendly," says John Currier, chief actuary for
Aviva USA.

Other insurers exploring similar technology include American International
Group <http://online.wsj.com/public/quotes/main.html?type=djn&symbol=AIG>
Inc. and Prudential Financial
<http://online.wsj.com/public/quotes/main.html?type=djn&symbol=PRU>  Inc.,
executives for those firms confirm. Deloitte, a big backer of the concept,
has pitched it in recent months to numerous insurers.

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Posted in: Big Insurance,denying health insurance claims,denying insurance benefits,health insurance reform,life insurance

Safety Concerns and Health Insurance Reform

10 Riskiest Places to Give Your Social Security Number
As 2011 looms with changes for your health insurance plan this article from Kiplinger's offers some very sound advice to protect your identity and your very important data.

This goes with out many years of addressing privacy and personal data safety issues(too easy access to your data, even without you permission under HIPPA), data hacking along with data mining and collection, and sale of your data (like what was done w/o your knowledge at RealAge).

Here's how to lower the chances of your number falling into the wrong hands -- and what to do if it does.

By Cameron Huddleston, Contributing Editor, Kiplinger.com

McAfee, the antivirus software company, recently released a list of the most dangerous places to give your Social Security number. Many of the places on the list might surprise you:

1. Universities and colleges
2. Banking and financial institutions
3. Hospitals
4. State governments
5. Local government
6. Federal government
7. Medical businesses (These are businesses that concentrate on services and products for the medical field, such as distributors of diabetes or dialysis supplies, medical billing services, pharmaceutical companies, etc.)
8. Non-profit organizations
9. Technology companies
10.Health insurers and medical offices 

The places are ranked based on the number of data breaches involving Social Security numbers from January 2009 to October 2010. What’s most disturbing is that you must disclose your Social Security number if you want to receive services from most of those places (either as required by law or the groups' own policies).
So I asked Adam Levin, chairman and co-founder of Identity Theft 911, what people could do to prevent their Social Security numbers from falling into the wrong hands and keep their identities safe. "It’s obvious there is no slam-dunk 100% way to protect yourself," he says. "Everywhere you turn, you’re going to run into an organization looking for information from you."
However, you can take steps to lower your risk, he says. And there are things you can do to detect identity theft and limit the damage.
Don’t be so quick to give out your number. As Levin said, a lot of organizations and companies will ask for your Social Security number. But that doesn’t mean they all have to have it. You will be required to provide your Social Security number in any situation that requires your identity to be verified (such as an application for credit or a license) or about which the IRS must be notified. Otherwise, be sure to ask whether the agency, business or organization has to have it. Unfortunately, even though many groups -- such as private insurers -- can’t require your Social Security number, they might refuse to do business with you if you don’t provide it. In those cases, ask if you can give just the last four numbers rather than your full Social Security number.
Don’t ever give out your Social Security number or any other personal information to someone you don’t know who initiates contact with you by phone, e-mail or in person. For example, if you receive an e-mail that claims that you must provide personal information to claim a refund from the IRS, it’s a scam. The IRS doesn’t request information from taxpayers by e-mail.
Lock away your Social Security card. Your Social Security card belongs in a fireproof safe in your home, not in your wallet. Why? Because if someone stole your wallet, he’d be able to steal your identity, too. And don’t leave your card or any other personal information sitting out where others can see it. Levin says this is a big problem at universities, where students leave wallets, credit-card statements and other items with personal information that can easily be stolen. See 5 Steps to Protect Your College Student’s ID. Be sure to cross-cut shred any documents with your personal information once you no longer need those documents.
Protect your number from cyber thieves. Even though there’s not much you can do to protect your personal information once you hand it over to another business or organization, you can take steps to protect the data on your computer. Make sure you install antivirus and Internet security software on your computer -- and update it frequently. "If you buy the software and don’t update it, it’s like becoming a member of a gym and not going," Levin says. The McAfee Total Protection software is $59.99 (after a $20 rebate) and the Norton 360 software is $79.99. Levin also says you should frequently change passwords for your online accounts and not use the same passwords for financial accounts and social networks.
Control the damage. Even if you take all these steps, there still is a chance that you will become a victim of identity theft. That’s why it’s imperative to check your accounts daily to catch any transactions you didn’t make. “If you have time to check e-mail and a social networking site, you can find time to check your bank and credit-card accounts,” Levin says. And take advantage of the free credit report you’re entitled to once a year from each of the three credit bureaus -- Experian, Equifax and TransUnion. Go to www.annualcreditreport.com to get your reports. Rather than checking them all at once, though, order each one separately to spread out your credit checks throughout the year.
If you notice any problems, act quickly to repair the damage. You can contact the credit bureaus and ask them to put a fraud alert or credit freeze on your accounts. A fraud alert, which is free, requires lenders to make some effort to verify your identity before issuing new credit in your name. A credit (or security) freeze prevents the credit reporting companies from releasing your report without your consent. The credit bureaus charge a fee to initiate a freeze, but you might not have to pay if you're a resident of a state that waives the fee for identity theft victims. See Fraud Alert vs. Credit Freeze.
If your wallet (with your Social Security card or any credit cards inside it) is stolen, report it to the police. With a police report, you can place an extended fraud alert, which lasts seven years, on your credit report, and you'll have documentation that will help you bolster your case if you become a victim of identity theft.
See the Federal Trade Commission’s identity theft page for information about what you can do if your identity has been stolen.

Read more: http://www.kiplinger.com/columns/kiptips/archives/10-riskiest-places-to-give-your-social-security.html#ixzz14Vr3plTX

Read more »

Posted in: data mining,data theft,health insurance reform,identity theft,RealAge sells your data to Big Pharma,Social Security number

Electronic Medical Records: MORE FRAUD RISK

12/31/10

Electronic medical records not always linked to better care in hospitals, study finds

ScienceDaily (2010-12-27) -- Use of electronic health records by hospitals across the United States has had only a limited effect on improving the quality of medical care, according to a new study. ... > read full article



from October 2010
As the day looms to implement the health insurance reform bill, including the myth that electronic health records will save costs and improve care, this is a well considered warning to evaluate.

And as you can see Natural Health News has been covering this topic for quite some time.

Seventy-three people charged in healthcare fraud crimes in five states, including part of Armenian-American organized crime organization

Oct 14, 2010

By Kelly Jackson Higgins
DarkReading The threat of medical identity theft came to light yesterday with the FBI's announcement it had busted an organized crime gang that stole the identities of doctors and thousands of Medicare patients in order to operate phony clinics that bilked Medicare and insurance companies of more than $165 million in fraudulent billing.
Authorities have charged 73 people, including members of an alleged Armenian-American organized crime organization, with multiple healthcare fraud crimes. The FBI has arrested 52 of these suspects for executing what it says is the largest Medicare fraud case the DOJ has prosecuted to date. The defendants operated close to 120 fake clinics in 25 states and were indicted by authorities in California, Georgia, New Mexico, New York, and Ohio. "The emergence of international organized crime in domestic health care fraud schemes signals a dangerous expansion that poses a serious threat to consumers as these syndicates are willing to exploit almost any program, business or individual to earn an illegal profit," said Acting Deputy Attorney General Gary G. Grinder, in a statement. "The Department of Justice is confronting this evolving threat here and abroad through a number of initiatives including a strengthened Attorney General's Organized Crime Council and the creation of the International Organized Crime Intelligence and Operations Center (IOC-2) to ensure that we are focused and coordinated in our efforts to combat international organized crime."

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from more than 30 related articles on Natural Health News

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Natural Health News: Saving Billions without Electronic Health Records

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Saving Billions without Electronic Health Records. The issue of one single set of rules for insurance billing was promulgated in the 1970s. It is now almost 40 years since this was proposed and someone is actually showing what many, ...

1 in 10 Electronic Health Records in Error

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Mail 25.6.10 Over 800 patient records are lost by the NHS every day. The missing info includes personal health records, diagnoses & details of treatments. Often electronic data is carelessly left unencryted & without proper password . ...

Electronic Health Records, Your Data At Risk

Nov 17, 2009

I started posting articles about electronic health and medical records in 2006 on Natural Health News. I am not in favour of this push in the arena of cost savings in the US health system. To date little has been shown to indicate any ...

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Posted in: electronic health records,health,health insurance reform

Another Glitch May Impair Access Under New Health Insurance Law

Your benefits under health insurance reform can vary depending on where you live.

This clearly is representative of the failure to connect the dots before penning the law, and establishes the failure of the policy writers and planners engaged in this process.

Perhaps the taxpayers should be repaid for the extensive waste of money and resources in the fiasco that does little but line the pockets of Big Insurance.

Clearly this will raise costs and limit benefits.  It also suggests a bigger push toward privatization.

Some States Are Lacking in Health Law Authority

By ROBERT PEAR and KEVIN SACK, New York Times

WASHINGTON — Faced with the need to review insurance rates and enforce a panoply of new rights granted to consumers, states are scrambling to make sure they have the necessary legal authority to carry out the responsibilities being placed on them by President Obama’s health care law.
Insurance commissioners in about half the states say they do not have clear authority to enforce consumer protection standards that take effect next month.
Federal and state officials are searching for ways to plug the gap. Otherwise, they say, the ability of consumers to secure the benefits of the new law could vary widely, depending on where they live.
Meanwhile, state governments that have for years allowed insurers to set premiums virtually at will are gearing up to establish procedures to review rate increases.
Under the new federal standards, insurers generally must offer coverage to children under 19 and must allow adult children up to age 26 to stay on their parents’ policies. Insurers cannot charge co-payments for preventive services or impose a lifetime limit on benefits; must allow consumers to appeal a denial of benefits; and cannot rescind coverage, except in cases of fraud or intentional misrepresentation.
States have the primary role in enforcing many of the new standards. If a state fails to enforce a standard, the federal government will step in to do so — as it did in several states after passage of a health insurance law in 1996.
The federal government recently surveyed states to assess their enforcement capabilities, and the results suggest a patchwork of protections.
California, Florida, Hawaii, Michigan, Nebraska, Oklahoma, Virginia and Wyoming, among other states, said they did not have authority to enforce federal law.
Some state regulators said they would ask state legislators to expand their authority by putting the federal standards into state law next year. Others said they would rely on their powers of persuasion, the good will of insurers or general state laws that ban unfair or deceptive trade practices.
By contrast, Maryland passed a bill in April that explicitly authorizes its insurance commissioner to enforce consumer protections in the new federal law. Similar bills were signed in June by Gov. Bev Perdue of North Carolina and in July by Gov. John Lynch of New Hampshire.
Kathleen Sebelius, the secretary of health and human services, said she realized that “some states may lack the full authority they might need or desire to fully enforce” the new market rules.
The administration said its general approach was to have “states take a lead role in providing consumer protections, with federal enforcement only as a fallback measure.”
Sara Rosenbaum, a professor of health law and policy at George Washington University, said this was an awkward arrangement. “The new law creates detailed federal standards for insurance, but does not give consumers a right to sue if insurers don’t live up to their obligations,” Ms. Rosenbaum said.
Kim Holland, the Oklahoma insurance commissioner, said, “We will have to seek explicit authority from our State Legislature to make sure we can adequately enforce all the new provisions of federal law.”
Ken Ross, the Michigan insurance commissioner, said, “I fully expect insurers to comply,” even though his office “does not currently have clear authority to enforce the consumer protections enacted in federal law.”
Arizona said it was unlikely to pass legislation authorizing any state agency to enforce federal insurance standards, in view of its participation in a lawsuit challenging the federal law. Moreover, it said, Gov. Jan Brewer has “instituted an indefinite rule-making moratorium, so we have no plans to adopt rules related to enforcement” of the law.
Some states hope to secure compliance by using their power to review insurance policy forms and contracts.
In a recent bulletin, the Texas Insurance Department encouraged insurers to file amendments to standard policy forms that would bring them into compliance with federal law. John Greeley, a spokesman for the department, emphasized the word “encouraged.”
“We don’t have authority right now to require it,” Mr. Greeley said.
Florida said that if insurers did not voluntarily revise their contracts, the state “has no legal authority to force them to do so.”
The Nebraska Insurance Department said it did not have “specific authority to order compliance with federal law in the face of a refusal to comply.”
Wyoming said it did not have the authority, under its insurance code or its Unfair Trade Practices Act, to enforce federal law even if it received consumer complaints.
New Jersey, New York and Ohio said they believed they had the power to enforce federal standards.
Gov. David A. Paterson of New York said his state would require insurers to rewrite their contracts to include the new consumer protections. State officials have developed model language. In addition, Mr. Paterson said, the Legislature will consider amending state insurance laws so they “meet or exceed” federal requirements.
Within days, the Obama administration is expected to announce up to $51 million in grants to states to help them perform one of their new duties: reviewing “unreasonable increases in premiums.”
Thirteen states currently have no authority to review proposed health premium increases for most forms of coverage, according to the National Association of Insurance Commissioners. About a dozen have limited power to review increases after they take effect, while half the states require some form of state approval.
With insurers proposing heavy rate increases this year, possibly in anticipation of tougher regulation, several states have exerted their rate review authority with new vigor.
Sandy Praeger, the Kansas insurance commissioner and chairwoman of the health committee for the National Association of Insurance Commissioners, said states were eager to toughen their procedures to ward off federal interest in obtaining that authority. “The pressure is on us to prove that what we do is effective, and for states that don’t have the authority to get it done,” Ms. Praeger said. Many states will require legislation to change their rate review systems, she said.
States are also waiting for the federal Department of Health and Human Services to define unreasonable rate increases.
“That’s the big question,” Ms. Praeger said. “Unreasonable is a rather nebulous term.”

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Posted in: Big Insurance,health insurance reform

More Problems with Health Insurance Reform

Experience with Publicly Funded Private Health Insurance -

If you think this will just apply to those who speak English as a second language, don't overlook the great probability that Big Insurance will pull this trick on you, even if you are outside the legal immigrant groups.

To the Editor:

On October 31, 2009, Massachusetts involuntarily transferred about 30,000 legal immigrants (mostly “green card” holders) from Commonwealth Care, the state-subsidized insurance program, to a new private insurance plan. CeltiCare, a subsidiary of the out-of-state, for-profit insurer Centene, agreed to take over their care for only $1,300 per person, one third of the state's previous cost1 and well below the average cost of adequate care nationally.23 CeltiCare excluded several hospitals (and their affiliated community health centers) that have traditionally provided safety-net care for immigrants, including Boston Medical Center and Cambridge Health Alliance (CHA), where we work.

We used internal hospital data to determine the characteristics of patients who were transferred to CeltiCare and who had formerly received their primary care at CHA. A total of 1325 patients who had visited a primary care provider at CHA during the past year were moved to CeltiCare. Of these patients, 73% speak a primary language other than English, including Portuguese (24%), Spanish (20%), and Haitian Creole (9%); 19% have hypertension, and 10% have diabetes mellitus. A psychiatric disorder has been diagnosed in at least 9%.

We then evaluated the adequacy of the provider network for these patients. During the second and third months after the switch to CeltiCare, we searched CeltiCare's Web site4 for primary care providers within 5 miles of CHA's ZIP Code. The search returned 326 providers, of whom 217 were nonduplicate adult generalists. Of these providers, 25% could not be reached at the telephone number provided. Of those available by telephone, only 37% were actually accepting new CeltiCare patients, and the average wait for an appointment was 33 days. In all, only 60 providers were accepting new CeltiCare patients, and only 38 could provide service for even one of the three major linguistic minorities.

Given these findings, we believe that patients who were switched from Commonwealth Care to CeltiCare had inadequate access to primary care 3 months into this new program. We fear that such “rationing by inconvenience”5 shuts patients out of care to the detriment of their health but to the benefit of CeltiCare's bottom line. Policymakers, in Massachusetts and nationally, should reassess the role of profit-driven insurers in the provision of safety-net care.

Ruth Hertzman-Miller M.D., M.P.H.
Malgorzata Dawiskiba M.D.
Cassie Frank M.D.
Cambridge Health Alliance, Cambridge, MA
rhertzman-miller@challiance.org

http://www.nejm.org/doi/full/10.1056/NEJMc1005451

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Posted in: Big Insurance,health insurance reform

It must be a day for graphics at Natural Health News

"Neo" Health Care
By Rocky Vega, The Daily Reckoning

08/05/10 Alexandria, Virgina — This week, over 70 percent of Missourians voted for Prop C — to exempt the state from the federal insurance mandate — and, by extension, against President Obama’s health care plan. Three more states — Arizona, Florida, and Oklahoma — also have votes on deck with the hope of a possibly-binding opt out of the mandate.

From STLtoday’s coverage, via The Daily Bail’s post on the landslide vote:

“Missouri voters on Tuesday overwhelmingly rejected a federal mandate to purchase health insurance, rebuking President Barack Obama’s administration and giving Republicans their first political victory…

“‘The citizens of the Show-Me State don’t want Washington involved in their health care decisions,’ said Sen. Jane Cunningham, R-Chesterfield, one of the sponsors of the legislation [...] With most of the vote counted, Proposition C was winning by a ratio of nearly 3 to 1.”

Health Insurance Reform and how it works (sic), a flow chart from Congress

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Posted in: health insurance reform

More on Health Insurance Reform

UPDATE: 3 August - Health Insurance Reform, how it plays out

Covering New Ground in Health System Shift

http://www.nytimes.com/2010/08/03/health/policy/03insurance.html

Medicare Reform Means Some Seniors Face Benefit Cuts

See full article from DailyFinance: http://www.dailyfinance.com/story/medicare-reform-means-some-seniors-face-benefit-cuts/19578216/?icid=main|main|dl1|link3|http%3A%2F%2Fwww.dailyfinance.com%2Fstory%2Fmedicare-reform-means-some-seniors-face-benefit-cuts%2F19578216%2F&icid=sphere_copyright

UPDATE: 2 August - Judge Gives Virginia OK to Press On With Health Care Lawsuit Against Feds

U.S. District Court Judge Henry Hudson is allowing a health care

suit filed by the state of Virginia against the U.S. government to proceed, saying no court has ever ruled on whether it's constitutional to require Americans to purchase a product.

The state of Virginia can continue its lawsuit to stop the nation's new health care law from taking effect, a federal judge ruled Monday. 

U.S. District Court Judge Henry Hudson said he is allowing the suit against the U.S. government to proceed, saying no court has ever ruled on whether it's constitutional to require Americans to purchase a product. 

"While this case raises a host of complex constitutional issues, all seem to distill to the single question of whether or not Congress has the power to regulate -- and tax -- a citizen's decision not to participate in interstate commerce," Hudson wrote in a 32-page decision. Complete article

HEALTHCARE:  Impact on Access to Care, Costs

Lobbyists gear up for November

Health-policy experts across the political spectrum are wary of Obamacare’s promises to increase access to health care and lower costs.

Use 'search' to locate more than 36 related Natural Health News posts on this topic

The libertarian Cato Institute’s Michael Tanner notes President Obama recently told MSNBC’s Chuck Todd that the law “not only makes sure everybody has access to coverage but is reducing costs.”  Tanner refutes those claims: 

• “The bill doesn’t come close to giving ‘everybody’ access to coverage. According to the Congressional Budget Office, 10 years from now there will still be at least 21 million uninsured Americans. That’s an improvement over today, but it’s a far cry from the universal coverage that Obama once promised. And nearly half of the newly covered aren’t getting access to true health insurance but are being added to the Medicaid program, with all of its attendant problems of access and quality.”
  
• “Even further from reality is the president’s continued insistence that the new law is ‘reducing costs.’ In fact, the administration’s own chief health-care actuary reports that the law will actually raise US health-care spending by $311 billion over 10 years. This failure to control costs means that the law will add significantly to the already crushing burden of government spending, taxes and debt.”
  
• “Anyone who thinks that their insurance premiums will be going down in the foreseeable future is going to be disappointed. The law does nothing to restrain the growth in insurance costs. In fact, the Congressional Budget Office says that premiums will double over the next six years, roughly the same rate of increase as would have occurred without health-care reform.”

Meanwhile, Dr. Steffie Woolhandler, a professor of medicine at Harvard Medical School and cofounder of Physicians for a National Health Program (PNHP), told the SocialistWorker.org that the health-reform bill was actually written by the insurance industry and doesn’t address underlying problems:

• “The big problem with the bill is that so much money and power is being handed to the private health insurance industry, which is the cause of the problem in the first place.… If you look at the [political] donations, plenty of insurance industry money did go to the Democrats. An insurance industry vice president, Elizabeth Fowler, actually came to work for Sen. Max Baucus, the head of the Senate Finance Committee, and was the author of the Baucus Framework for the legislation.”
  
• “Under the new ‘exchanges’ set up under the law for the uninsured to go to buy insurance, people will have to spend up to 9.5 percent of their income for policies that cover only 70 percent of health care costs. So you would still be in a situation of having insurance that was so skimpy that you would have difficulty getting care when you needed it. As you know, Massachusetts has the prototype of this reform. If you go on the Internet to look at our insurance exchange, it’s called the Massachusetts Connector. For someone in their mid-50s, the cheapest policy available that would meet the mandate for someone who is paying the full rate—which is anyone who makes more than $33,000 in income a year—costs more than $5,000 per year in premiums. Then, if you get sick, there’s a $2,000 deductible—so you have to take another $2,000 out of your pocket before the insurance kicks in. And then, for the next $15,000 in health spending, you’re responsible for 20 percent of everything—$3,000. So it’s extremely expensive if you get sick and have to use it once you buy it.”
  
• “That means that many people will still lack access to care—because they won’t be able to afford to use their insurance policy, even if they own it.”

 Sources:

• “Obamacare’s Broken Promises,” by Michael D. Tanner, Cato Institute, July 20, 2010:http://www.cato.org/pub_display.php?pub_id=11993
• “This Cure Leaves the Disease Untreated,” Interview with Dr. Steffie Woolhandler, SocialistWorker.org, March 29, 2010: http://socialistworker.org/2010/03/29/cure-doesnt-treat-the-disease

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Posted in: health insurance reform,healthcare access,healthcare costs,Obamacare

Federal Panel Limits Preventive Care

How an Obscure Federal Panel Limits Preventive Care

This time is isn't Big Insurance limiting your access to health care, its Big GOV!

By requiring that insurers cover certain screening tests and other kinds of preventive services, the Affordable Care Act has thrust an obscure federal advisory panel into the spotlight. The U.S. Preventive Services Task Force(USPSTF), which has been around for a quarter of a century, grades preventive services by their clinical value, and the reform law requires that all services with a grade of “A” or “B” be covered. But what Congress didn’t reckon with in adopting this mandate is the conservatism of the USPSTF, which includes primary care doctors but not specialists.

Read Complete Story: 
http://industry.bnet.com/healthcare/10003056/healthcare-reform-how-an-obscure-federal-panel-limits-preventive-care/

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Posted in: Big Government. limits to health care,Big Insurance,health insurance reform,natural health news,preventive care

Greed, Health Costs win over Better Care

Amidst the concern for profit ant about any cost, this fellow shows a degree of integrity missing from the daily scene for decades

A mathematical David stuns a healthcare Goliath

July 15, 2010| By Duke Helfand, Los Angeles Times

A respected actuary working from his rural Riverside County home — and for a time from a hospital bed — uncovers the errors that led Anthem Blue Cross to cancel rate increases of up to 39%.

Finally someone else has some good comments regarding the REAL issues in insurance reform - price-fixing for profit is a long standing tradition

Buried deep in the 2,000 pages of health reform legislation is yet another attempt to slam a cap on health insurance rates: States may, if they wish, bar insurance companies that raise premiums by an “unreasonable” amount from participating in the state insurance exchanges that will begin operating in 2014. Federal regulations have yet to be written, but I suspect that the end result will be a state-by-state rerun of the current drama that’s playing out in Massachusetts. And in the end, the effort to impose price controls by government fiat will fail miserably.

Read complete article - Greed from Insurers Won't Control Costs

Medicare Rationing begins in 2011

Several examples from NHN posts re: insurance "reform"

Natural Health News: Health Insurance Update on Current Issues

Jul 08, 2010

If you believe this is just a fluke with or without health insurance reform, be prepared for more. Blue Shield of California is accused of overcharging for safety-net insurance. A Los Angeles woman says in a lawsuit that the health plan ...

Update: Facts on the Health Insurance Reform Bill

Mar 26, 2010

About the health reform bill http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill/ http://static1.firedoglake.com/1/files/2010/03/mythfactshcr-2.pdf. This information is provided by Creating Health ...

Why Insurance Reform Doesn't Get You Better Health

Jan 04, 2010

Senator Lieberman who is holding positive movement on insurance reform in limbo may have reason to be concerned, especially where women's health is concerned. It seems as if the controversy over Hadassah Lieberman, the Senator's wife, ...

Married? Pay More Under Health Insurance Reform

Jan 11, 2010

The disparity comes about in part because subsidies for purchasing health insurance under the plan from congressional Democrats are pegged to federal poverty guidelines. That has the effect of limiting subsidies for married couples with ...

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Posted in: health insurance reform