U.S. health plans to keep some reforms, however court rules

(Reuters) - Three major U.S. health insurers that provide coverage to millions of Americans said they would keep some protections included in President Barack Obama's healthcare overhaul regardless of how the Supreme Court rules on the law.

The Supreme Court is expected to decide later this month whether to strike down all or portions of the law, Obama's signature domestic policy achievement that was passed in 2010.

UnitedHealth Group Inc, the largest health insurer by market value, announced its intention early on Monday to preserve some of the provisions that have already taken effect. Rivals Aetna Inc and Humana Inc made similar pledges later in the day.

All three said they would still offer coverage for dependents up to age 26 under their parents' plans. The companies will also continue to offer certain preventive healthcare services without out-of-pocket cost-sharing.

"The protections we are voluntarily extending are good for people's health, promote broader access to quality care and contribute to helping control rising health care costs," UnitedHealth Chief Executive Officer Stephen Hemsley said in a statement. "These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue."

The law, known as the Affordable Care Act, represented the biggest overhaul to the $2.6 trillion U.S. healthcare system in nearly 50 years. The three health insurers committed to maintaining some of the provisions that are already in place, although many of the more sweeping changes are due to take effect in 2014.

The law is designed to expand coverage to more than 30 million uninsured Americans, by establishing insurance exchanges and broadening the Medicaid program for low-income people.

Shares of UnitedHealth, Aetna and Humana fell about 1 percent, in line with a decline for the broader Standard & Poor's 500 Index

KEEPING POPULAR POLICY IN PLACE

The provision allowing children to stay on their parents' plans up to age 26 is perhaps the law's single most popular component. It has already helped about 6.6 million young adults to join their parents' health insurance plans last year, according to The Commonwealth Fund, a non-profit organization that analyzes healthcare issues.

Should the law be struck down, Republican lawmakers who opposed Obama's health reform efforts may seek to reinstate the extension of young adults dependent coverage.

The three insurers also said they will maintain a provision that provides clear ways for members to appeal coverage claim decisions.

UnitedHealth and Humana said they will keep two other provisions: forgoing lifetime dollar coverage limits on policies and eliminating rescissions, which are generally considered to be retroactive policy cancellations, except in the case of fraud.

It was not immediately clear where Aetna, the No. 3 health insurer, stood on those provisions.

Cigna Corp, another large national insurer, said it was "prepared to proceed as appropriate on behalf of our customers when the court deliberations reach their conclusion."

UnitedHealth, which serves more than 38 million members, said the protections are effective immediately and will be available to current and future plan members.

At the heart of the Supreme Court case is a requirement in the law that individuals buy health insurance coverage or face a penalty, known as the individual mandate. In return, health plans will have to provide coverage to patients with pre-existing medical conditions that would have disqualified them in the past.

Should the mandate alone be struck down, and the companies are still required to cover people regardless of health status, the insurers have said people will buy insurance only when they become ill, causing premiums to rise.

The law already bars insurers from denying coverage to children up to age 19 with pre-existing medical conditions.

UnitedHealth said it recognized the value of this provision, but said "one company acting alone cannot take that step, so UnitedHealthcare is committed to working with all other participants in the health care system to sustain that coverage."

The ban on denying coverage to those with pre-existing conditions will apply to adults starting in 2014, under the law.

DeAnn Friedholm, director for health reform at Consumers Union, said if a single company "declared they would take any comers, and their competitors do not, then they will immediately attract the sickest population, which would disadvantage them in trying to compete on prices."

"It requires a level playing field so that all the companies have to play by the same rule," Friedholm said.

(Reporting by Lewis Krauskopf in New York; Editing by Michele Gershberg and Tim Dobbyn)

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Health Reform's Fate: How the Supreme Court Will Decide

After three days of hearings on health care reform, Supreme Court justices held a secret preliminary vote Friday to deliberate the Affordable Care Act's future. Their decision is expected in late June. Jeffrey Brown and The National Law Journal's Marcia Coyle discuss the steps ahead as the justices begin their deliberations.

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Health reform's cost under scrutiny

President Obama signed the Affordable Care Act into law in 2010, but its biggest coverage provisions won't go into effect until 2014.

NEW YORK (CNNMoney) -- Capitol Hill's official budget cruncher will offer new estimates on Tuesday of one of the most controversial parts of health care reform: the government's cost of covering tens of millions of uninsured Americans.

The Congressional Budget Office's estimates will be part of its annual March revision to its budget baseline -- the marker against which any spending and tax proposals are measured.

But they also will come just two weeks before the Supreme Court will hear arguments in a landmark case brought by 26 states and the National Federation of Independent Business, which contend certain provisions in the law are unconstitutional.

Passed in March 2010, the Affordable Care Act is intended, among other things, to guarantee coverage for everyone regardless of health status and create affordable insurance options for low- and middle-income Americans.

The law would expand eligibility rules for Medicaid and subsidize the cost of health insurance for low and middle-income families buying policies on newly created insurance exchanges.

As a result, by 2021, 95% of legal, non-elderly U.S. residents will have health insurance, up from 83% currently, according to CBO's projections.

While more than half of U.S. adults under age 65 have health insurance through their employers, and the vast majority of those over 65 are covered by Medicare, an estimated 49 million nonelderly Americans remain uninsured, according to the Kaiser Family Foundation.

Last March, CBO estimated that the coverage provisions would cost $1.445 trillion over the first decade, up from its $931 billion estimate when the law was passed. On net, after counting the new insurance-related taxes and penalties the law would raise, the agency estimated the provisions would cost $1.131 trillion, up from its original estimate of $778 billion.

The reason for the different estimates: CBO measured costs over a later period of time last year.

That's bound to be one of the reasons why the agency's estimates on Tuesday will differ from those offered in 2010 and 2011.

But another reason may be the agency's unemployment rate projections, which are more pessimistic today than have been. That can add to the cost since more people than previously thought would be eligible for government-subsidized insurance.

What the CBO is not likely to provide on Tuesday is a revised overall cost estimate for the health reform law. Last year, the agency determined that the combined effect of the law's provisions -- which include various other measures to tame health care costs -- would reduce deficits by $210 billion between 2012 and 2021.

Those estimates were based on the law being implemented exactly as written. That's one reason why the Supreme Court ruling, due in June, could change the outlook of the law's budgetary effects.

Among other things, the high court will consider whether the law's individual mandate to buy health insurance is constitutional.

That mandate would require every American to obtain insurance starting in 2014 or pay an annual penalty equal to whichever is greater: 2.5% of household income or $695 per person up to a maximum of $2,085 per family.

Even if the law is preserved in its current form, no one contends that it will be a panacea for the country's long-term health cost burdens. CBO Director Douglas Elmendorf has noted as much repeatedly.

Soon after the law's passage in 2010, he told lawmakers that even "if all the health law measures are implemented, we end up with slightly lower federal health spending by the end of the 2020s." 

First Published: March 12, 2012: 5:06 PM ET

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Health reforms in China make gains, but many out of pocket

Efforts in China to widen access to medical care and improve health insurance have made impressive headway, but 173 million Chinese still face "catastrophic" health expenses, researchers reported on Friday.

The reforms were initiated in 2003 after liberalisation led to the introduction of medical fees and opened up disparities between city and countryside, leaving many with spiralling health costs and worsening care.

Publishing in The Lancet, Chinese statisticians led by Sarah Barber in the World Health Organisation's Beijing office looked at data from government-led surveys of hundreds of thousands of people in 2003, 2008 and 2011.

Over this period, insurance coverage increased from 29.7 to 95.7 percent of respondents, which meant about 1.28 billion people were covered in 2011, they found.

Physical access to health services was achieved to 83.3 percent of the population, a trend seen across geographical zones.

The average share of in-patient medical costs reimbursed from insurance also increased rapidly, from 14.4 percent in 2003 to 46.9 percent in 2011, although this meant that last year patients still had to pick up half of the tab.

Of greater concern, said the paper, was the high number -- 173 million -- of Chinese who faced "catastrophic" health expenses in 2011.

They amount to 12.9 percent of China's population, a proportion almost unchanged since 2003.

Such expense shocks are a major concern, because they "are very likely to contribute to poverty" by draining savings, said the study.

"As yet, the large public investments do not seem to have offered strong financial protection for households against catastrophic health events," it said.

The survey covered 193,000 people in 2003, 177,000 in 2008 and 59,000 in 2011.

The study's authors said the questionnaires have been used every five years since 1993 and described them as consistent and reliable barometers of health care.

But this was questioned by specialists with a US foundation, the China Medical Board (CMB), based in Cambridge, Massachusetts.

In a commentary also published by The Lancet, the CMB's Lincoln Chen and Dong Xu said "all sorts of biases" could arise in a survey whose questions were selected and then conducted by a government ministry.

"Given the growing maturation of health reform, China should consider establishing an independent commission consisting of stakeholders and academics," they said.

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British minister heckled over health reforms

LONDON (AP) — Britain's health minister was angrily heckled Monday over health care reforms that the government says will improve efficiency but opponents claim threaten the foundation of the country's state-funded health care service.

Protesters jostled Health Secretary Andrew Lansley as he arrived for the 10 Downing Street meeting on the reforms. Demonstrator June Hautot, 75, accused Lansley of trying to privatize the National Health Service.

"The NHS is not for sale. There is no privatization," Lansley told her — but the government is still struggling to convince skeptics of that.

Britain's Conservative-led government is planning a major overhaul of the NHS, which provides free treatment to all Britons. The government says the reforms will cut bureaucracy, improve treatment and give doctors more control over health care management.

Opponents say the changes will give private companies a bigger share of heath care and undermine the system's universality.

The overstretched health service is Britain's biggest employer, costing more than 100 billion pounds ($158 billion) a year, and is a source of both constant complaints and national pride.

Making the system more efficient has proved an elusive goal since the NHS was established in 1948. The latest reforms come as Britain seeks to trim spending by 80 billion pounds ($127 billion) by 2015 in a bid to cut the country's deficit.

The proposed law is meeting stiff resistance in Parliament, and more than 150,000 people have signed an online petition calling for it to be scrapped.

The sweeping reforms are opposed by several large medical organizations, including the British Medical Association, the Royal College of Nursing and health care unions.

They said they were not invited to Monday's meeting, which was attended by government officials and the new consortia of doctors that will take over health management from local health care trusts.

"There are quite a few myths that we need to bust about this reform," Prime Minister David Cameron said Monday, insisting he would push the changes through. "We need to do everything we can to explain to people that this is about improving and enhancing our NHS, not in any way endangering it."

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Health insurance reforms key focus

The federal government hopes its latest attempt to impose a means test on the private health insurance rebate will pass federal parliament's lower house this week.

The government believes it has secured the three crossbench votes necessary to get its Fairer Private Health Insurance Incentives bills through the House of Representatives.

If Greens MP Adam Bandt and independents Rob Oakeshott and Andrew Wilkie support the legislation as expected, it could pass the house as early as Tuesday.

But Opposition Leader Tony Abbott has appealed to the crossbenchers to side with the coalition against the reforms, saying they represent another broken Labor promise.

'I think it's the job of the independents to keep the government honest, not to allow the government to be dishonest,' Mr Abbott told Network Ten on Sunday.

Mr Abbott even went so far as to call on former Liberal turned independent speaker Peter Slipper to 'keep faith' with his electorate and vote with the coalition.

'Will he take the chair or will he support his electorate?'

Under the reforms, the government will means test the rebate for individuals earning more than $80,000 a year and families earning more than $160,000.

Labor has been battling to get the changes - which also increase the Medicare levy surcharge for those without cover - through parliament since it won office four years ago.

The Senate has twice rejected the proposals, which the government says will save the commonwealth coffers $2.4 billion in the first three years and $100 billion by 2050.

Another issue back in the parliamentary spotlight this week will be same-sex marriage.

Two private member's bills aiming to legalise same-sex marriage will be introduced into the lower house on Monday morning - one from Labor backbencher Stephen Jones and another co-sponsored by Mr Bandt and Mr Wilkie.

Mr Bandt wants both bills referred to a parliamentary inquiry which is considering another piece of Greens legislation on the same issue.

While senators are tied up with budget estimates hearings, the lower house will also hear more debate this week on Labor's plan to abolish the controversial construction industry watchdog.

Its Building and Construction Industry Improvement amendments aim to replace the Howard government's Australian Building and Construction Commission (ABCC) with a Fair Work Building Industry Inspectorate.

These changes were first introduced in 2009 but lapsed when parliament was prorogued for the 2010 election.

The opposition has vowed to fight the legislation.

In question time, the government will be trying to keep the focus on its economic credentials.

But the coalition will do all it can to keep the pressure on the government over the Craig Thomson affair and the Australia Day protest stuff-up involving Mr Abbott and his comments about the Aboriginal tent embassy.

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Health bodies reject NHS reforms

3 February 2012 Last updated at 10:23 ET The reforms apply only to the NHS in England Physiotherapist leaders have joined the Royal College of GPs in calling for the health bill in England to be scrapped, increasing pressure on the government.

The Chartered Society of Physiotherapy, which has over 50,000 members, said the views of patients and professionals had been ignored.

The college, which represents 34,000 GPs in England, said the overhaul threatened to damage NHS care.

A health minister said he was "baffled" by the RCGP's criticisms.

The interventions come despite further amendments being made to the bill on Wednesday.

The changes include making it clear the health secretary would retain ultimate control over the NHS, and strengthening the requirement of the regulator to ensure the different providers competing for patients also work together to provide seamless services for patients.

They were put forward in response to concerns raised by the House of Lords and will be debated next week.

'No alternative'

But the RCGP said they did not go far enough and it was now time for the whole bill to be withdrawn.

It follows a similar call by the British Medical Association, Royal College of Nursing and Royal College of Midwives.

Health Minister Simon Burns said he found the criticism from GPs ''baffling''

But all three of these are unions, which prompted the government to suggest they were motivated by the dispute over pay and pensions - whereas the RCGP is part of the professional arm of the health service which sets standards.

It is also significant because GPs are widely thought of as one of the main beneficiaries of the reforms, as they are supposed to get more control over how NHS funds are spent.

But the college said they could no longer work with government on the bill because its concerns over competition and bureaucracy had not been addressed.

It also said the overhaul would hamper the ability of the health service to make the savings it has been asked to in the coming years to cope with factors such as the ageing population and rising cost of new drugs.

RCGP chairman Dr Clare Gerada said: "The decision was not taken lightly, but it is clear that the college has been left with no alternative.

Chair of the Royal College of GPs, Dr Clare Gerada: ''The bill is a mess''

"We cannot sit back. Instead, we must once again raise our concerns in the hope that the prime minister will halt this damaging, unnecessary and expensive reorganisation which, in our view, risks leaving the poorest and most vulnerable in society to bear the brunt."

She told the BBC Radio 4 Today programme that the bill would "turn the National Health Service into thousands of different health services, all competing for the same patients, the same knee, the same brain, the same heart.

"Patients will find their care will be fragmented, it will be on different sites, it won't join up, it will be difficult to hand over care and it will be phenomenally expensive to keep track of all these competing parts of the NHS."

Continue reading the main story July 2010 - White Paper published, setting out plans which involve giving GPs control of the budget while encouraging greater competitionJanuary 2011 - Bill underpinning the changes gets its first readings in the House of CommonsMarch 2011 - Lib Dem spring conference votes for radical change to "damaging" plans amid mounting concerns among health groupsApril 2011 - Bill paused so that government can carry out a two-month "listening exercise" to address criticismsJune/July 2011 - Listening exercise leads to a series of changes to the bill, limiting competition and improving accountabilitySeptember 2011 - Bill makes it to the Lords, leading to more amendments being tabled; expected to return to the Commons in spring 2012October 2011 - National board established in shadow form to oversee new system as groups of GPs start piloting new arrangementsApril 2013 - Board and GP groups to formally take control of the systemLike many of the medical royal colleges, the RCGP has to date been critical of the plans.

But it had until now been saying it was willing to work with ministers to improve them.

The entire medical royal college community has discussed coming out en masse to oppose the plans, but a draft statement that was drawn up last week was never signed off.

The BBC understands a number of other colleges are currently discussing whether to toughen their opposition.

Dr Helena Johnson, chair of the Chartered Society of Physiotherapy, said: "Together with many other health professionals, we have tried to engage constructively and make sensible suggestions throughout the bill's passage through Parliament.

"But time and time again, the views of patients and health professionals have been ignored. The government seems determined to press ahead with these reforms."

Health Minister Simon Burns told the BBC that the RCGP had previously supported at least some elements of the bill.

But he added: "Now we have this constant criticism and I find it in one way baffling, because it's not representative of what I hear GPs up and down the country saying, now that they're beginning to engage in having the powers to determine the care that needs to be commissioned for their patients."

He added: "We have been carefully listening to the ideas raised as the bill has progressed through Parliament and, as a result, we tabled a series of amendments to safeguard the future of the NHS."

The Health Secretary Andrew Lansley is also facing a hearing in March where the Information Commissioner will seek to force Mr Lansley to release a secret government report on the risks of the NHS reforms.

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U.K. Health Service Faces Damage From Reforms, Editors Say

January 31, 2012, 6:22 AM EST By Kristen Hallam

(Updates with Department of Health comment in seventh paragraph.)

Jan. 31 (Bloomberg) -- Britain’s National Health Service will need another overhaul in five years if “damaging” changes being implemented by the government are allowed to continue, the editors of three U.K. health-care publications said.

The Health and Social Care Bill, proposed by the Conservative-led coalition government, calls for “reforms designed and implemented so badly that another major NHS reform program is guaranteed within five years,” the leaders of the British Medical Journal, the Health Service Journal and Nursing Times wrote in an editorial simultaneously published in all three publications.

The bill, which applies only to England, would be the biggest shakeup in the history of the 64-year-old National Health Service. The legislation includes proposals aimed at expanding the number of private companies that offer health-care services to NHS patients. It would also create an unspecified number of groups to commission services and create a national agency to take on duties now performed by regional trusts.

“Let us try to salvage some good from this damaging upheaval and resolve never to repeat it,” the editors wrote.

‘Drop the Bill’

Stopping the bill would save about 360 million pounds ($567 million) by eliminating the need to set up new groups to manage the NHS and a regulator to oversee the changes, according to a second editorial in the BMJ. It would also save about 650 million pounds a year needed to run the organizations, Kieran Walshe, a professor of health policy and management at the Manchester Business School, wrote in the editorial.

“The government could argue that, in the special economic circumstances of the day, it makes sense to drop the bill,” Walshe wrote. “They would also neutralize an issue which has become increasingly politically toxic.”

The legislation would save 4.5 billion pounds through the next national election and 1.5 billion pounds each year after that, the Department of Health said today in an e-mail.

“It’s completely untrue to suggest that dropping the bill would save the NHS money,” the department said. “Our reforms are based on what NHS staff themselves have consistently said: They want more freedom from day-to-day bureaucracy and political interference so they can get on with the job of caring for patients. This is exactly what this bill achieves.”

House of Lords

The legislation is going through the House of Lords, and any amendments made there would have to be approved by the House of Commons before the bill is submitted for royal assent.

“We repeat our offer today to work with the government on introducing general practitioner-led commissioning on condition that it drops this unnecessary bill,” Andy Burnham, the Labour Party lawmaker who acts as spokesman on health policy, said in a statement. “We can support giving clinicians a bigger role in shaping NHS services, but it could be delivered more quickly, with less disruption and at much lower cost without this bill.”

Parts of the government’s plan, including increased competition, greater choice for patients and more involvement by general practitioners in commissioning treatment, could be accomplished under existing rules, Walshe wrote.

The BMJ is run by the British Medical Association. The Nursing Times and Health Service Journal are published by Emap Inform, which is owned by private-equity firm Apax Partners and Guardian Media Group Plc, according to the company’s website.

--With assistance from Gonzalo Vina in London and Chris Kay in Abuja. Editors: David Risser, Robert Valpuesta

To contact the reporter on this story: Kristen Hallam in London at khallam@bloomberg.net

To contact the editor responsible for this story: Phil Serafino at pserafino@bloomberg.net

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England’s Health Service Faces Damage From Reforms, Editors Say

January 31, 2012, 6:22 AM EST By Kristen Hallam

(Updates with Department of Health comment in seventh paragraph.)

Jan. 31 (Bloomberg) -- Britain’s National Health Service will need another overhaul in five years if “damaging” changes being implemented by the government are allowed to continue, the editors of three U.K. health-care publications said.

The Health and Social Care Bill, proposed by the Conservative-led coalition government, calls for “reforms designed and implemented so badly that another major NHS reform program is guaranteed within five years,” the leaders of the British Medical Journal, the Health Service Journal and Nursing Times wrote in an editorial simultaneously published in all three publications.

The bill, which applies only to England, would be the biggest shakeup in the history of the 64-year-old National Health Service. The legislation includes proposals aimed at expanding the number of private companies that offer health-care services to NHS patients. It would also create an unspecified number of groups to commission services and create a national agency to take on duties now performed by regional trusts.

“Let us try to salvage some good from this damaging upheaval and resolve never to repeat it,” the editors wrote.

‘Drop the Bill’

Stopping the bill would save about 360 million pounds ($567 million) by eliminating the need to set up new groups to manage the NHS and a regulator to oversee the changes, according to a second editorial in the BMJ. It would also save about 650 million pounds a year needed to run the organizations, Kieran Walshe, a professor of health policy and management at the Manchester Business School, wrote in the editorial.

“The government could argue that, in the special economic circumstances of the day, it makes sense to drop the bill,” Walshe wrote. “They would also neutralize an issue which has become increasingly politically toxic.”

The legislation would save 4.5 billion pounds through the next national election and 1.5 billion pounds each year after that, the Department of Health said today in an e-mail.

“It’s completely untrue to suggest that dropping the bill would save the NHS money,” the department said. “Our reforms are based on what NHS staff themselves have consistently said: They want more freedom from day-to-day bureaucracy and political interference so they can get on with the job of caring for patients. This is exactly what this bill achieves.”

House of Lords

The legislation is going through the House of Lords, and any amendments made there would have to be approved by the House of Commons before the bill is submitted for royal assent.

“We repeat our offer today to work with the government on introducing general practitioner-led commissioning on condition that it drops this unnecessary bill,” Andy Burnham, the Labour Party lawmaker who acts as spokesman on health policy, said in a statement. “We can support giving clinicians a bigger role in shaping NHS services, but it could be delivered more quickly, with less disruption and at much lower cost without this bill.”

Parts of the government’s plan, including increased competition, greater choice for patients and more involvement by general practitioners in commissioning treatment, could be accomplished under existing rules, Walshe wrote.

The BMJ is run by the British Medical Association. The Nursing Times and Health Service Journal are published by Emap Inform, which is owned by private-equity firm Apax Partners and Guardian Media Group Plc, according to the company’s website.

--With assistance from Gonzalo Vina in London and Chris Kay in Abuja. Editors: David Risser, Robert Valpuesta

To contact the reporter on this story: Kristen Hallam in London at khallam@bloomberg.net

To contact the editor responsible for this story: Phil Serafino at pserafino@bloomberg.net

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Health Minister Simon Burns defends NHS reforms

Health Minister Simon Burns defends the Government's NHS reforms, insisting they are on track to make £70bn worth of savings over four years. Report by Sophie Foster. Like us on Facebook at http://www.facebook.com/itn and follow us on Twitter at http://twitter.com/itn

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Health reforms will push NHS 'over a cliff edge'

Shadow Secretary of State for Health Andy Burnham says that the Government's controversial health reforms threaten to push the NHS "over a cliff edge". . Report by Sophie Foster. Like us on Facebook at http://www.facebook.com/itn and follow us on Twitter at http://twitter.com/itn

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Shadow health secretary Andy Burnham: Too dangerous to go ahead with NHS reforms

Andy Burnham urges health secretary Andrew Lansley to drop his NHS reforms,
saying they have little support from medical professionals.

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