Health care: After ruling, what's next?

Jul. 4, 2012 07:43 PM
The Republic | azcentral.com

Marjorie Baldwin, an economist and a health-care expert at Arizona State University, answered questions from readers last week about the Supreme Court's ruling on the Affordable Care Act.

Following is a transcript of that online session, edited for space and clarity.

Question: Now that the Supreme Court has ruled in favor, is it possible to get it overturned or changed? Is it a done deal forever?

Answer: Now the debate moves to the political arena. Gov. Romney has pledged to overturn the law if he is elected; obviously President Obama would keep it.

The people have a clear choice. Chief Justice Roberts said as much in his ruling: " ... we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation's elected leaders, who can be thrown out of office if the people disagree with them."

Q: Is there any danger of our health-care plans no longer letting us insure our young adult children not in college full time?

A: The Affordable Care Act mandates that insurers allow parents to cover young adults on their parents' health-insurance plans up to age 26. That was effective in 2010 and remains intact.

Q: So as someone who has health care through their employer, does this decision affect me, assuming I continue to get insurance through my employer?

A: Make no mistake, the Affordable Care Act, and the fact the Supreme Court has upheld it, will affect us all. The act greatly expands access to health insurance, which is clearly a good thing. But when people have health-insurance coverage, they consume more health-care services, which will drive up the costs of health care, and health insurance, for everyone. You can expect the costs of health care to increase even more rapidly than without the law.

Q: Can the state of Arizona opt out of the plan?

A: The Supreme Court ruling made it possible for Arizona to opt out of the expansion of its Medicaid program without losing all its Medicaid funding. But the state cannot opt out of other provisions of the law. For example, states must form an insurance exchange where small employers and individuals not covered by employer plans can purchase health insurance.

Q: What is going to keep the health-insurance companies from raising their premiums so high that the lower- and average-income individual will not be able to comply with the mandate?

A: The health-insurance market is competitive. If an insurer raises its premiums so that it is making exorbitant profits, other companies can undercut its premiums and take its business away. But in addition to market forces, the Affordable Care Act requires that 80 to 85 percent of an insurers' revenues go to providing quality health services to the people it insures. Administrative costs and profits are limited to 15 to 20 percent.

Q: How will services for those on Medicare be affected?

A: The act has several provisions that will effectively reduce the payments health providers receive for providing care to Medicare patients. This may cause some providers to stop seeing Medicare patients (because the payments do not cover their costs), so some Medicare patients may have a more difficult time finding a doctor. On the other hand, the act has provisions that will encourage hospitals to reduce re-admissions and reduce the number of infections acquired in the hospital. These provisions are designed to improve the quality of care for all patients.

Q: So, does this mean I can get cheap insurance for my minor child?

A: If you are having difficulty finding affordable insurance for your child now, it may become easier and more affordable through the State Health Insurance Exchange. Federal funding to help states establish the exchange is available now through 2015.

Q: Exactly how are they going to ensure that everybody abides by the law? How will they regulate this?

A: The Department of Health and Human Services has responsibility for writing the regulations that determine precisely how the law will be implemented. Enforcement is divided among a number of agencies; for example, the Internal Revenue Service will enforce the individual mandate.

Q: What is the likelihood that many states like Arizona will opt out of expanding Medicaid and thereby increase costs at the federal level? Is there a good enough incentive for states like Arizona to expand?

A: The federal government will finance 100 percent of the costs of expanding a state's Medicaid coverage from 2014 to 2016, gradually reducing to 90 percent in 2020 and subsequent years. This sounds like a strong incentive, but a state may incur administrative costs in expanding coverage that are not reimbursed, and the federal government could reduce the rate of cost sharing at any time, leaving the states to cover a greater share of the expanded coverage. Some states may be reluctant to assume that risk.

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What's Next in Health Care?

The waiting game is over for consumers, employers, health care providers and insurers. Thursday's Supreme Court ruling that upheld the 2010 health care law means ongoing trends will continue, and those who waited on the sidelines for the court will now have to implement their parts of the law.

For consumers, that means that those intimidated by what opponents called the overly complex part of the law will have to learn what will affect them, particularly if they have to buy their own insurance or pay a penalty for skipping it.

Employers who fought the law as a job killer will now have to come to grips with it and minimize the parts they don't like.

Hospitals have moved forward with electronic records, but not necessarily with the health care teams needed to prevent mistakes that can lead to penalties for care that falls below quality standards.

Insurers need to dig deep to pay rebates to consumers for premium money not spent on health care.

The states that balked at creating health care exchanges from which their residents can compare and buy health insurance must create them — or wait for the federal government to do it for them.

Because many of the law's provision kick in during 2013 and 2014, that leaves precious few months for the various groups to get to work.

"It's full speed ahead on implementing the law," says Alissa Fox, senior vice president for the Blue Cross and Blue Shield Association. She says insurers worry that a health insurance tax will increase premiums for families or cause rates to go up for young people, but concerns about the law will no longer hold back implementation. "We've had two-plus years of implementing legislation, and we'll continue."

Consumers

Although "nothing will change tomorrow," some consumers will see big changes by Jan. 1, 2014, when more aspects of the law take effect, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. Those changes include:

•Insurers will no longer be allowed to turn anyone down because of a pre-existing medical condition, such as cancer, Pollitz says.

•More patients will be eligible for Medicaid, a federal insurance program administered by the states that serves the poor and disabled. Today, people can qualify for Medicaid only if they are poor, pregnant , disabled or a child. Each state sets different financial standards to qualify for Medicaid, and some states have required that people be not just poor but "subpoor," with incomes substantially below the federal poverty level.

By 2014, however, people will become eligible for Medicaid based only on their incomes, Pollitz says, meaning single adult men with incomes up to 130% of the federal poverty level will also qualify.

•Also by 2014, the "working poor" — many of whom are eligible for employer-sponsored health care but can't afford the monthly premiums — will be eligible for subsidies to help them pay for their health insurance, said Mary Grealy, president of the Healthcare Leadership Council.

•Federal standards for health insurance plans will eliminate "junk" plans with huge deductibles that provide little to no real benefits for consumers, Pollitz says. That means consumers will have more confidence that any plan they buy on the private market will provide at least a minimum standard of quality that includes drug coverage, hospital care, maternity care and other essentials.

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What's Obamacare's prognosis? Health care professionals take the Supreme Court's temperature

Dr. Mary O'Brien, a board member of Physicians for a National Health Program, and former hospital CEO Stan Hupfeld break down what the different possible Supreme Court rulings on Obama's Affordable Care Act tomorrow would mean for health care reform.
Tune in Weeknights at 8:00/7:00c on Current TV
http://current.com/shows/viewpoint/

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Health reform law: What's at stake for small business

The health reform law is chock full of new rules and benefits for small businesses -- and all are now on the line at the Supreme Court.

The 2010 Affordable Care Act includes everything from a different way to shop for insurance to a tax credit that rewards employers for insuring workers.

The Supreme Court's decision on the law's constitutionality is due out later this month, even as soon as Monday. Generally speaking, there are three main possible outcomes: Health care reform could be upheld entirely or struck down entirely, or the court could do away with only some provisions.

There are so many facets to the law that even partial survival could yield some benefits to entrepreneurs, such as the tax credit. That's why John Arensmeyer, who leads the pro-reform group Small Business Majority, said striking down the whole law would be a nightmare.

"All the benefits will go away," Arensmeyer said. "We'll be thrown right back into the unsustainable system we've had to date."

If the justices elect to keep some parts, while knocking down others, the 906-page law could become even more confusing than it is now. Here's a list of key provisions -- and what could happen to small businesses if they're maintained or discarded.

Health care reform isn't a job killer - yet

Fines: Starting in 2014, the law requires any company with at least 50 full-time employees to provide insurance or pay fines. The size of the penalty depends on a formula in the law.

If one or more workers turns to the government for help buying insurance, the company will be assessed a penalty of at least $40,000, depending on the size of its workforce. If this provision vanishes, there's one less rule for small businesses to worry about.

But the rule affects 200,000 small businesses, a tiny fraction of the nation's approximately six million employers. More than 96% of small businesses fall below the 50-employee threshold.

Individual mandate: This is perhaps the most controversial part of the law before the court. It forces every person to purchase some sort of health insurance by 2014 or pay a penalty.

The mandate counter balances another provision, one that forces insurers to take on people with pre-existing conditions. The idea of the mandate is to force healthy people who otherwise might not get insurance to join the pool of the insured, thus diluting the cost of health care.

If the mandate disappears but the 50-plus employee rule stays, insurance costs could skyrocket for small businesses who will be forced to provide workers with insurance.

Exchanges: Starting in 2014, companies with up to 100 workers will have the option to buy lower cost health insurance through employer-only exchanges set up by the states.

They're called Small Business Health Options Programs, and these exchanges are intended to bring down the cost of health care for small firms. They will make it possible for business owners to compare similar insurance plans -- just as consumers shop for other services. They also could help small firms by allowing them to effectively add their employees to a much larger pool of insurance customers.

The federal law ordered states to create them, and a dozen have already started.

Striking down this provision wouldn't necessarily stop states from creating exchanges. But it would do away with federal grants helping them do so, making the process more difficult for some, impossible for others.

Tax credits: Since 2010, some small businesses have received tax credits rewarding them for providing workers with health insurance. Eligible companies must have no more than 25 workers and pay average salaries of $50,000 or less.

Not everybody hates health reform

Losing the tax credits would mean no more help from the federal government, which averaged $2,700 last year.

But it has turned out to be an underwhelming tax credit. Employers say applying for the credit involves a lengthy, complicated formula that sometimes yields very little financial help. Only 170,300 companies received it last year for tax year 2010, even though the government estimates between 1.4 million and 4 million are eligible.

The 80% rule for insurers: Since 2011, insurance companies have been required to spend at least 80% of every dollar on medical care and not administrative costs -- or refund the difference.

This rule, known as the medical loss ratio, is especially important for small businesses. Administrative costs typically have taken up a much larger chunk of small companies' insurance costs when compared to large companies.

The rule has already been shown to work, at least in California, where 4,400 companies received $3.5 million in refunds from insurance company UnitedHealth this month. UnitedHealth was forced to return the money to comply with the 80% rule.

Eliminating the ratio would drive up insurance costs for many small companies.

Have fears of losing health insurance held you back from quitting your job to launch a business? Email Jose Pagliery and share your story. Click here for the CNNMoney.com comment policy.

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Health reform: What's at stake for small business

There's a lot in store for small business owners in President Obama's health reform law. They should keep a close eye on the upcoming Supreme Court decision.

NEW YORK (CNNMoney) -- The health reform law is chock full of new rules and benefits for small businesses -- and all are now on the line at the Supreme Court.

The 2010 Affordable Care Act includes everything from a different way to shop for insurance to a tax credit that rewards employers for insuring workers.

The Supreme Court's decision on the law's constitutionality is due out later this month, even as soon as Monday. Generally speaking, there are three main possible outcomes: Health care reform could be upheld entirely or struck down entirely, or the court could do away with only some provisions.

There are so many facets to the law that even partial survival could yield some benefits to entrepreneurs, such as the tax credit. That's why John Arensmeyer, who leads the pro-reform group Small Business Majority, said striking down the whole law would be a nightmare.

"All the benefits will go away," Arensmeyer said. "We'll be thrown right back into the unsustainable system we've had to date."

If the justices elect to keep some parts, while knocking down others, the 906-page law could become even more confusing than it is now. Here's a list of key provisions -- and what could happen to small businesses if they're maintained or discarded.

Fines: Starting in 2014, the law requires any company with at least 50 full-time employees to provide insurance or pay fines. The size of the penalty depends on a formula in the law.

If one or more workers turns to the government for help buying insurance, the company will be assessed a penalty of at least $40,000, depending on the size of its workforce. If this provision vanishes, there's one less rule for small businesses to worry about.

But the rule affects 200,000 small businesses, a tiny fraction of the nation's approximately six million employers. More than 96% of small businesses fall below the 50-employee threshold.

Individual mandate: This is perhaps the most controversial part of the law before the court. It forces every person to purchase some sort of health insurance by 2014 or pay a penalty.

The mandate counter balances another provision, one that forces insurers to take on people with pre-existing conditions. The idea of the mandate is to force healthy people who otherwise might not get insurance to join the pool of the insured, thus diluting the cost of health care.

If the mandate disappears but the 50-plus employee rule stays, insurance costs could skyrocket for small businesses who will be forced to provide workers with insurance.

Exchanges: Starting in 2014, companies with up to 100 workers will have the option to buy lower cost health insurance through employer-only exchanges set up by the states.

They're called Small Business Health Options Programs, and these exchanges are intended to bring down the cost of health care for small firms. They will make it possible for business owners to compare similar insurance plans -- just as consumers shop for other services. They also could help small firms by allowing them to effectively add their employees to a much larger pool of insurance customers.

The federal law ordered states to create them, and a dozen have already started.

Striking down this provision wouldn't necessarily stop states from creating exchanges. But it would do away with federal grants helping them do so, making the process more difficult for some, impossible for others.

Tax credits: Since 2010, some small businesses have received tax credits rewarding them for providing workers with health insurance. Eligible companies must have no more than 25 workers and pay average salaries of $50,000 or less.

Losing the tax credits would mean no more help from the federal government, which averaged $2,700 last year.

But it has turned out to be an underwhelming tax credit. Employers say applying for the credit involves a lengthy, complicated formula that sometimes yields very little financial help. Only 170,300 companies received it last year for tax year 2010, even though the government estimates between 1.4 million and 4 million are eligible.

The 80% rule for insurers: Since 2011, insurance companies have been required to spend at least 80% of every dollar on medical care and not administrative costs -- or refund the difference.

This rule, known as the medical loss ratio, is especially important for small businesses. Administrative costs typically have taken up a much larger chunk of small companies' insurance costs when compared to large companies.

The rule has already been shown to work, at least in California, where 4,400 companies received $3.5 million in refunds from insurance company UnitedHealth this month. UnitedHealth was forced to return the money to comply with the 80% rule.

Eliminating the ratio would drive up insurance costs for many small companies.

Have fears of losing health insurance held you back from quitting your job to launch a business? Email Jose Pagliery and share your story. Click here for the CNNMoney.com comment policy.  

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Frost & Sullivan: What's Next for Mobile Health?

MOUNTAIN VIEW, Calif., June 5, 2012 /PRNewswire/ -- The mobile health (mHealth) market is playing an ever larger role in healthcare delivery and management.  With the saturation of mobile applications (apps) that support varied healthcare purposes, from smoking cessation tools and regional allergy alerts to instant heart rate readings, connected health is at the fingertips of end-users. 

Frost & Sullivan Senior Industry Analyst Zachary Bujnoch's moderation of the panel, "What's Next for mHealth?" at the 9th Annual Healthcare Unbound Conference & Exhibition on July 19 to 20, 2012 at the Hotel Kabuki in San Francisco, California promises to place a spotlight on the prospects and adversities mHealth industry players face in this up-and-coming market.  His moderation will draw from insight gained from Frost & Sullivan's research, Analysis of the U.S. Broadband mHealth Applications Market.   

If you are interested in more information, please send an email to Britni Myers, Corporate Communications, at britni.myers@frost.com, with your full name, company name, job title, telephone number, company email address, company website, city, state and country.

Wireless technology has a number of distinctive characteristics that make it an attractive platform for delivering healthcare anytime and anyplace. Wireless networks, ranging from body area to wide area networks, are increasingly ubiquitous. Devices with embedded wireless connectivity are used more often to manage personal health and wellbeing, giving rise to apps like chronic care management, fitness tracking, medication compliance, and diagnostic monitoring.  Already, the number of mHealth app purchases is in the tens of thousands each year.

"Today, we are seeing the tip of the iceberg in the U.S. mHealth market's potential," said Bujnoch.  "mHealth will continue on a steep growth curve as increasingly sophisticated mobile technologies and relationship-management tools disrupt the market."

Though a number of real barriers remain to be overcome, mHealth technology has great potential for encouraging healthy living. The "What's Next for mHealth?" panel will explore how people are benefiting from the new care practices and solutions enabled by wireless technology and device platforms. The panel will also discuss innovations in wireless health, emerging business models and trends, as well as key considerations in implementing these technologies to improve health outcomes.

"mHealth is an important theme at our Healthcare Unbound Conference, which also covers innovative applications of remote monitoring, home telehealth, eHealth, social media and gaming," said The Center for Business Innovation Managing Director Satish Kavirajan.  "These approaches help to manage diseases, promote wellness and facilitate accountable care."

In addition to Frost & Sullivan's participation in the "What's Next for mHealth?" panel, other panelists include Vice President of Product Strategy and Innovation of Macadamian Technologies Matt Hately; Assistant Medical Director and Chief Medical Information Officer of Kaiser Permanente, SCAL Region, John Mattison, MD; Co-Chairman of Health 2.0 and The Health Care Blog Founder Matthew Holt; Chief Strategy and Commercial Officer of WellDoc Chris Bergstrom; CEO of Rock Health Halle Tecco; and Managing Principal of Verizon Connected Healthcare Solutions Nancy M. Green.

The partnership with the 9th Annual Healthcare Unbound Conference & Exhibition is within Frost & Sullivan's Connected Health program. 

About The Center for Business Innovation
The Center for Business Innovation (TCBI) organizes conferences and exhibitions for the U.S. and international markets. For additional information, please visit www.tcbi.org.  

About Frost & Sullivan   
Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today's market participants. 

Our "Growth Partnership" supports clients by addressing these opportunities and incorporating two key elements driving visionary innovation: The Integrated Value Proposition and The Partnership Infrastructure.

The Integrated Value Proposition provides support to our clients throughout all phases of their journey to visionary innovation including: research, analysis, strategy, vision, innovation and implementation.  The Partnership Infrastructure is entirely unique as it constructs the foundation upon which visionary innovation becomes possible.  This includes our 360 degree research, comprehensive industry coverage, career best practices as well as our global footprint of more than 40 offices.   

For more than 50 years, we have been developing growth strategies for the global 1000, emerging businesses, the public sector and the investment community. Is your organization prepared for the next profound wave of industry convergence, disruptive technologies, increasing competitive intensity, Mega Trends, breakthrough best practices, changing customer dynamics and emerging economies?  

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Court: What's left of health law without mandate?

WASHINGTON (AP) — The heart of the Obama administration's health care overhaul hanging in the balance, the Supreme Court is turning to whether the rest of the law can survive if the crucial individual insurance requirement is struck down.

The justices also will spend part of Wednesday, the last of three days of arguments over the health law, considering a challenge by 26 states to the expansion of the Medicaid program for low-income Americans, an important feature toward the overall goal of extending health insurance to an additional 30 million people.

As the arguments resumed Wednesday morning, a small group of demonstrators gathered outside. Supporters of the law held a morning news conference where speakers talked about the importance of Medicaid. And, marching on the sidewalk outside the court, supporters repeated chants they've used the past two days including "Ho, ho, hey, hey, Obamacare is here to stay." ''Protect our care. Protect the law," supporters chanted as several played instruments including a trumpet and drum.

Opponents of the law, including Susan Clark of Santa Monica, Calif., also stood outside the court. Clark, who was wearing a three-cornered colonial-style hat, carried a sign that read "Obamacare a disaster in every way!"

"Freedom, yes. Obamacare, no," other opponents chanted.

The first two days of fast-paced and extended arguments have shown that the conservative justices have serious questions about Congress' authority to require virtually every American to carry insurance or pay a penalty.

The outcome of the case will affect nearly all Americans and the ruling, expected in June, also could play a role in the presidential election campaign. Obama and congressional Democrats pushed for the law's passage two years ago, while Republicans, including all the GOP presidential candidates, are strongly opposed.

But the topic the justices take up Wednesday only comes into play if they first find that the insurance mandate violates the Constitution. If they do, then they will have to decide if the rest of the law stands or falls.

The states and the small business group opposing the law say the insurance requirement is central to the whole undertaking and should take the rest of the law down with it.

The administration argues that the only other provisions the court should kill in the event the mandate is stricken are insurance revisions that require insurers to cover people regardless of existing medical problems and limit how much they can charge in premiums based on a person's age or health.

The federal appeals court in Atlanta that struck down the insurance requirement said the rest of the law can remain in place, a position that will be argued by a private lawyer appointed by the justices, H. Bartow Farr III.

On Tuesday, the conservative justices sharply and repeatedly questioned the validity of the insurance mandate.

If the government can force people to buy health insurance, justices wanted to know, can it require people to buy burial insurance? Cellphones? Broccoli?

Audio for Tuesday's court argument can be found at: http://apne.ws/Hft6z3.

The court focused on whether the mandate for Americans to have insurance "is a step beyond what our cases allow," in the words of Justice Anthony Kennedy.

"Purchase insurance in this case, something else in the next case," Chief Justice John Roberts said.

But Kennedy, who is often the swing vote on cases that divide the justices along ideological lines, also said he recognized the magnitude of the nation's health care problems and seemed to suggest they would require a comprehensive solution.

And Roberts also spoke about the uniqueness of health care, which almost everyone uses at some point.

"Everybody is in this market, so that makes it very different than the market for cars or the other hypotheticals that you came up with, and all they're regulating is how you pay for it," Roberts said, paraphrasing the government's argument.

Kennedy and Roberts emerged as the apparent pivotal votes in the court's decision.

The law envisions that insurers will be able to accommodate older and sicker people without facing financial ruin because the insurance requirement will provide insurance companies with more premiums from healthy people to cover the increased costs of care.

"If the government can do this, what else can it not do?" Justice Antonin Scalia asked. He and Justice Samuel Alito appeared likely to join with Justice Clarence Thomas, the only justice to ask no questions, to vote to strike down the key provision of the overhaul. The four Democratic appointees seemed ready to vote to uphold it.

Kennedy at one point said that allowing the government mandate would "change the relationship" between the government and U.S. citizens.

"Do you not have a heavy burden of justification to show authorization under the Constitution" for the individual mandate? asked Kennedy.

At another point, however, he also acknowledged the complexity of resolving the issue of paying for America's health care needs.

"I think it is true that if most questions in life are matters of degree ... the young person who is uninsured is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries. That's my concern in the case," Kennedy said.

Justice Ruth Bader Ginsburg said she found the debate over health care similar to an earlier era's argument about the Social Security retirement system. How could Congress be able to compel younger workers to contribute to Social Security but be limited in its ability to address health care? she wondered.

"There's something very odd about that, that the government can take over the whole thing and we all say, Oh, yes, that's fine, but if the government wants to preserve private insurers, it can't do that," she said.

___

Associated Press writers Jesse J. Holland and Jessica Gresko contributed to this report.

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What's Slowing Down Americans' Health Care Spending?

A new government report shows that the rise in health care spending slowed for the second consecutive year. Meanwhile, health insurance premiums continue to climb as workers pay an ever-growing share of the cost. Ray Suarez discusses what's behind these changes with Susan Dentzer of Health Affairs.

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What's The Apps: Lost Weight, Feel Great!

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What's The Apps: Lost Weight, Feel Great!

It's the new year! And for most people, with every new year comes new years resolutions, the most common of which involves weight loss. In this episode of WTA, Jon Q highlights a fitness and nutritional app and service that can help you accomplish your goals! JQ also provides some quick tips on how you can shed those unwanted pounds and keep em off. http://tchno.be/w9oWbV

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