Happy Holidays from Health Care -- From Policty to Practice

We're taking some much needed time off from our coverage of Health Care Policy to celebrate the season with our loved ones. We want to sincerely thank you for your readership, your comments and your participation.

Here are our top posts from 2009:

• Obama to Cut Medicare Advantage
• What does the public think about the proposed healthcare coverage?
• Senate produces another healthcare plan

We'll be back in January with more coverage.

We wish you Happy Holidays!

Medicare 'buy-in': A bargain or burden?

USAToday reports that buying into Medicare at 55 — an option that may be added to the Senate's plan to revamp the health care system — might not be such a bargain. Details of the plan remain secret pending analysis by the Congressional Budget Office, which will project its cost to those who might be eligible and the federal government. People ages 55 to 64 who are uninsured or paying high premiums in the individual market likely would be eligible. Most of those with employer-provided coverage would not.

Liberal Democrats backing the plan see it as a potential salvation for people approaching retirement with chronic diseases or medical risks. Sen. Sheldon Whitehouse, D-R.I., says it would be like "finally entering safe harbor after years of stormy seas."

Moderate members of the Democratic caucus have concerns, however. Sen. Ben Nelson, D-Neb., on Sunday called it a potential forerunner of a single government insurance plan for everyone. Sen. Joe Lieberman, I-Conn., appearing on CBS' Face the Nation with Nelson, said it could add to the federal deficit.

Learn more: Medicare 'buy-in': A bargain or burden?

Pressure is Coming down on Congress to Pass Healthcare Reform

This article in the Washington Post highlights how Vice President Joe Biden has warned Congress that if they do not agree on healthcare soon the opportunity for a "sweeping overhaul of the $2.5 trillion system will be lost for a generation."

Obama's team have been long pressing lawmakers to reach an agreement and to pass the bill. The bill has been passed by the House of Representatives but has struggled to reach 60 votes that the Democrats need. With each passing day that the bill is not passed the number of uninsured Americans increase.

What does the public think about the proposed healthcare coverage?

At the Health Affairs Blog, they reveal the results of a study done by Zogby International, where the online panelists were polled about they way they feel about certain coverages on the House and Senate's current bills for the healthcare reform.

They got public opinion on:
1) Financing of the healthcare reform
2) Employer Mandate
3) Illegal immigrants
4) Abortion coverage

Read the results here. Which of the four above do you believe is the biggest concern for the public option? Which one defiantly has to be focused on by the government? Which of the four above do you see as the biggest road bump into instating public insurance?

Complimentary Webinar: Assessing the Impact of Healthcare Reform on the Business of Medicare: An Interview with Gorman Health Group

December 15, 2009

2-3PM EST

Space is limited.
Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/504426600

Mention Priority Code: P1507W1BLOG

John Gorman, CEO, Gorman Health Group, along with Jean LeMasurier, Senior Vice President, Public Policy, Gorman Health Group will examine the current state of US healthcare reform, and its short and long term impact on Medicare plans including the financial, operational and strategic implications of the proposed bills.

About the Speakers:

Jean D. LeMasurier
Senior Vice President for Public Policy
Gorman Health Group

Jean LeMasurier joined Gorman Health Group after a 30 year career with the Centers for Medicare and Medicaid Services (CMS). Jean provides strategic planning and consulting services to Medicare Advantage Health Plans, Medicare Part D Prescription Drug Plans, drug companies and employers on programs under the Medicare Modernization Act.
Her areas of focus include health policy and health care reform and advising plans and employers on retiree options. Engagements include analysis of Medicare market opportunities, strategic advice on CMS legislative and regulatory requirements, audits and gap analyses to assure implementation of regulatory compliant programs.
Jean is also engaged in policy analysis, public speaking and educational and training activities.
As a senior CMS career official, Jean was responsible for the leading the $40 billion Medicare Managed care programs for many years, including serving as the Director of Policy and the Acting Director/Deputy Director of Operations and Regulatory Oversight. Jean also served as a Senior Advisor in the Employer Operations and Policy Group which implemented the employer provisions of the Medicare Modernization Act.
Jean also worked as a professional staff member on the Senate Finance Subcommittee on Health.

John K. Gorman
Chief Executive Officer

John Gorman is CEO of Gorman Health Group, a company he founded in 1996 (under its predecessor name, Managed Care Compliance Solutions) to provide Medicare regulatory compliance advisory services to healthcare payers. Under John’s leadership, Gorman Health Group has since emerged to beco

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista

Macintosh®-based attendees
Required: Mac OS® X 10.4 (Tiger®) or newer

Kansas citizens see cuts to Medicaid customer service

According to the Topeka Capitol Journal, the The Kansas Health Policy Authority has slashed $233,000. This accounts for almost 240,000 calls dealing with Medicaid for low income families and children. The Medicaid customer service call center will also be eliminated for providers as of February 1, 2010. All inquires will be fielded by email and mail

Do you find these kinds of cuts problematic to provider care? What other impacts will closing call centers for Medicare have?

‘Medicare Advantage’ at Issue in Senate

David M. Herszenhorn of The New York Times discusses the focus of today's senate debate with healthcare. He writes, the focus Friday will be on proposed reductions to Medicare Advantage, the privately administered plans that provide enhanced benefits but now typically cost the federal government more than traditional Medicare.

Further, "the Democrats, in the health care legislation, essentially seek to end subsidies for Medicare Advantage plans that cannot match or beat the cost of traditional Medicare."


Learn more: ‘Medicare Advantage’ at Issue in Senate

Aventis to pay N.C. $2.2 million as part of Medicaid settlement

Triangle Business Journal reports that Drug-maker Aventis Pharmaceuticals Inc. has agreed to pay $2.2 million to North Carolina for underpaying rebates to Medicaid for allergy medications.

The payment is part of $95.5 million settlement the company has reached with states and the federal government, according to North Carolina Attorney General Roy Cooper.

Learn more: Aventis to pay N.C. $2.2 million as part of Medicaid settlement

I Deserve Health Care Ad

After many submissions OFA and a panel of experts have finally chosen a winner for the Health Reform Video Challenge. If you haven't seen it yet make sure to check it out below. What are your thoughts on health reform?

Women's Insurance Amendment Set For Senate's First Health Bill Vote

As the Senate debates the health reform legislation, amendments are being advanced and Senators are reacting to the bill. Kaiserhealthnews.org reports that, "A bipartisan amendment to increase insurance benefits for women ... gets the first Senate vote Tuesday on health care overhaul legislation." The provision, co-sponsored by Sens. Barbara Mikulski, D-Md., and Olympia Snowe, R-Maine, "would require policies to include a variety of yearly screenings and was inspired in part by controversial recommendations last month that women undergo fewer mammograms and Pap smears to test for cancer." Mikulski said the amendment does not "mandate that you have a mammogram at age 40. What we say is discuss this with your doctor, but if your doctor says you need one, my amendment says you are going to get one." According to the AP, "The Congressional Budget office said the amendment would cost $940 million over a decade."

Learn more: Women's Insurance Amendment Set For Senate's First Health Bill Vote