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Posts Tagged ‘Care’

The following is an example of a Health Care Directive (many people still refer to this as a Living Will).   It is broken down into 3 basic parts.   1) Appointment of the Health Care Agent.   2) Health Care Instructions.   3) Making the Document Legal.    Like most legal documents, it can be a bit confusing and overwhelming.   The purpose for making this easily available to the public is simple.   To help people know what to expect before contacting a lawyer and having him or her draft a directive for them.    Nobody likes thinking about their demise or incapacity.   However, dealing with such issues is a necessary part of life.  

 

This example should not be used as a substitute for getting solid legal advice from a licensed attorney.   Every individual is different.   Please consult a lawyer in your area to discuss your specific estate planning needs.

 

 

HEALTH CARE DIRECTIVE

 

I, ___________________________________, understand this document allows me to do One or both of the following:

 

PART I: Name another person (called the health care agent) to make health care decisions for me if I am unable to decide or speak for myself. My health care agent must make health care decisions for me based on the instructions I provide in this document (Part II), if any, the wishes I have made known to him or her, or must act in my best interest if I have not made my health care wishes known.

 

And/or

 

PART II: Give health care instructions to guide others making health care decisions for me. If I have named a health care agent, these instructions are to be used by the agent. These instructions may also be used by my health care providers, others assisting with my health care and my family, in the event I cannot make decisions for myself.

 

 

PART I: APPOINTMENT OF HEALTH CARE AGENT

 

This is who I want to make health care decisions for me if I am unable to decide or speak for myself  (I know I can change my agent or alternate agent at any time and I know I do not have to appoint an agent or an alternate agent)

 

NOTE: If you appoint an agent, you should discuss this health care directive with your agent and give your agent a copy. If you do not wish to appoint an agent, you may leave Part I blank and go to Part II.

 

 

When I am unable to decide or speak for myself, I trust and appoint ___________________ to make health care decisions for me. This person is called my health care agent.   Relationship of my health care agent to me: ___________________

Telephone number of my health care agent: _________________________

Address of my health care agent: _________________________

 

(OPTIONAL) APPOINTMENT OF ALTERNATE HEALTH CARE AGENT: If my health care agent is not reasonably available, I trust and appoint _________________ to be my health care agent instead.   Relationship of my alternate health care agent to me: ___________________________Telephone number of my alternate health care agent: ___________________________ Address of my alternate health care agent: ___________________________

 

THIS IS WHAT I WANT MY HEALTH CARE AGENT TO BE ABLE TO

DO IF I AM UNABLE TO DECIDE OR SPEAK FOR MYSELF (I know I can change these choices)

 

My health care agent is automatically given the powers listed below in (A) through (D).

My health care agent must follow my health care instructions in this document or any other instructions I have given to my agent. If I have not given health care instructions, then my agent must act in my best interest. Whenever I am unable to decide or speak for myself, my health care agent has the power to:

 

(A) Make any health care decision for me. This includes the power to give, refuse, or

withdraw consent to any care, treatment, service, or procedures. This includes deciding whether to stop or not start health care that is keeping me or might keep me alive, and deciding about intrusive mental health treatment.

 

(B) Choose my health care providers.

 

(C) Choose where I live and receive care and support when those choices relate to my

health care needs.

 

(D) Review my medical records and have the same rights that I would have to give my

medical records to other people.

 

If I DO NOT want my health care agent to have a power listed above in (A) through (D) OR if I want to LIMIT any power in (A) through (D), I MUST say that here:

 

______________________________________________________________________

 

My health care agent is NOT automatically given the powers listed below in (1) and (2). If I WANT my agent to have any of the powers in (1) and (2), I must INITIAL the line in front of the power; then my agent WILL HAVE that power.

 

______   (1)  To decide whether to donate any parts of my body, including organs, tissues, and eyes, when I die.

 

______ (2)  To decide what will happen with my body when I die (burial, cremation).

 

If I want to say anything more about my health care agent’s powers or limits on the powers, I can say it here:  ________________________________________________________________________

 

 

 

 

PART II: HEALTH CARE INSTRUCTIONS

 

NOTE: Complete this Part II if you wish to give health care instructions. If you appointed an agent in Part I, completing this Part II is optional but would be very helpful to your agent. However, if you chose not to appoint an agent in Part I, you MUST complete some or all of this Part II if you wish to make a valid health care directive.

 

These are instructions for my health care when I am unable to decide or speak for myself.

These instructions must be followed (so long as they address my needs).

 

THESE ARE MY BELIEFS AND VALUES ABOUT MY HEALTH CARE

(I know I can change these choices or leave any of them blank)

 

I want you to know these things about me to help you make decisions about my health care:

 

My goals for my health care: ________________________________________________________________________________________________________________________________________________

 

 

 

My fears about my health care: ________________________________________________________________________________________________________________________________________________

 

 

My spiritual or religious beliefs and traditions: ________________________________________________________________________________________________________________________________________________

 

 

 

My beliefs about when life would be no longer worth living:

 

________________________________________________________________________________________________________________________________________________

 

My thoughts about how my medical condition might affect my family:

 

________________________________________________________________________________________________________________________________________________

 

THIS IS WHAT I WANT AND DO NOT WANT FOR MY HEALTH CARE

 

(I know I can change these choices or leave any of them blank)  Many medical treatments may be used to try to improve my medical condition or to prolong my life. Examples include artificial breathing by a machine connected to a tube in the lungs, artificial feeding or fluids through tubes, attempts to start a stopped heart, surgeries, dialysis, antibiotics, and blood transfusions. Most medical treatments can be tried for a while and then stopped if they do not help.   I have these views about my health care in these situations:  (Note: You can discuss general feelings, specific treatments, or leave any of them blank)

 

If I had a reasonable chance of recovery, and were temporarily unable to decide or speak

for myself, I would want:

 

________________________________________________________________________________________________________________________________________________

 

 

If I were dying and unable to decide or speak for myself, I would want:

 

________________________________________________________________________________________________________________________________________________

 

 

If I were permanently unconscious and unable to decide or speak for myself, I would want:

 

________________________________________________________________________________________________________________________________________________

 

 

 

 

If I were completely dependent on others for my care and unable to decide or speak for

myself, I would want: . . . . .

 

________________________________________________________________________________________________________________________________________________

 

 

In all circumstances, my doctors will try to keep me comfortable and reduce my pain. This is how I feel about pain relief if it would affect my alertness or if it could shorten my life:

 

________________________________________________________________________________________________________________________________________________

 

 

There are other things that I want or do not want for my health care, if possible:

 

Who I would like to be my doctor:

 

________________________________________________________________________________________________________________________________________________

 

 

 

 

Where I would like to live to receive health care:

 

________________________________________________________________________________________________________________________________________________

 

 

 

Where I would like to die and other wishes I have about dying:

 

________________________________________________________________________________________________________________________________________________

 

My wishes about donating parts of my body when I die:

 

________________________________________________________________________________________________________________________________________________

My wishes about what happens to my body when I die (cremation, burial):

 

________________________________________________________________________________________________________________________________________________

 

 

Any other things:

 

________________________________________________________________________________________________________________________________________________

 

 

PART III: MAKING THE DOCUMENT LEGAL

 

This document must be signed by me. It also must either be verified by a notary public

(Option 1) OR witnessed by two witnesses (Option 2). It must be dated when it is verified or witnessed. I am thinking clearly, I agree with everything that is written in this document, and I have made this document willingly.

 

 

___________________________________

My Signature

  

___________________________________

Date signed:

 

___________________________________ 

Date of birth:

 

___________________________________ 

Address:

 

 

If I cannot sign my name, I can ask someone to sign this document for me.

 

 

_____________________________________________________

Signature of the person who I asked to sign this document for me.

 

________________________________________________________

Printed name of the person who I asked to sign this document for me.

 

 

Option 1: Notary Public

 

In my presence on___________________________________ (date), __________________________________________ (name) acknowledged his/her

signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf. I am not named as a health care agent or alternate health care agent in this document.

 

___________________________________________ 

(Signature of Notary)

 (Notary Stamp)

 

 

Option 2: Two Witnesses

 

Two witnesses must sign. Only one of the two witnesses can be a health care provider or an employee of a health care provider giving direct care to me on the day I sign this document.

 

Witness One:

(i) In my presence on _______________________ (date), ________________ (name) acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf.

(ii) I am at least 18 years of age.

(iii) I am not named as a health care agent or an alternate health care agent in this document.

(iv) If I am a health care provider or an employee of a health care provider giving direct

care to the person listed above in (A), I must initial this box: [   ]

I certify that the information in (i) through (iv) is true and correct.

 

______________________________________ 

(Signature of Witness One)

 

Address:  ________________________________________________________________________________________________________________________________________________

 

 

Witness Two:

(i) In my presence on ________________________ (date), _________________ (name) acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf.

(ii) I am at least 18 years of age.

(iii) I am not named as a health care agent or an alternate health care agent in this document.

(iv) If I am a health care provider or an employee of a health care provider giving direct

care to the person listed above in (A), I must initial this box: [   ]

I certify that the information in (i) through (iv) is true and correct.

 

________________________________________ 

(Signature of Witness Two)

 

Address:

________________________________________________________________________________________________________________________________________________

 

REMINDER: Keep this document with your personal papers in a safe place (not in a safe deposit box). Give signed copies to your doctors, family, close friends, health care agent, and alternate health care agent. Make sure your doctor is willing to follow your wishes. This document should be part of your medical record at your physician’s office and at the hospital, home care agency, hospice, or nursing facility where you receive your care.

 

Some of this information was taken from Minnesota statute section 145C. 16.   This should not be considered legal advice, it is provided as a public service.

I hope you all had a wonderful Thanksgiving. Now that that’s over, Congress is back in session, and the Senate is tackling the health care reform issue.

One of the things that is being discussed in reforming our health insurance system is allowing people to buy insurance plans from other states where they might be able to find less expensive plans. I’m not sure how this is supposed to work, and here’s why.

One reason the cost of plans is lower in some states than is others is the number of mandated services a health plan is required to cover. The more a plan is required to cover, the higher the cost of coverage. For example, California has 56 required services that each plan must cover.   By contrast, Idaho has 13 state mandates. We aren’t at the top of the list by any means; Virginia has 60 mandates and Maryland has 66. Want to check out what kinds of things are mandated, click here.

Another area that needs to be addressed is how physicians and others are paid. HMO plans in California tend to be more expensive than PPO plans in the individual market, but you have lower out of pocket costs when obtaining care on an HMO plan. (The opposite is usually true in group health insurance. ) The reason this can be is through very specific networks of contracted doctors. Most people know that you don’t have coverage if you go outside the HMO network unless it’s an emergency. So maybe you just don’t offer HMOs between states.   But PPOs have networks too. If you see a contracted doctor you are covered at a higher level than non-contracted doctors. So if you are in California and buy a plan from Kansas, would you always be covered at the lower reimbursement rates?  Larger carriers like United Healthcare and Aetna have networks in most states, but what about the smaller, regional carriers without networks in other states? How would that work?

Another aspect of provider payment that affects premiums is how much providers are paid. Care in some states is less expensive than others, so how do you pay providers in the ‘expensive’ states versus the less expensive, and what will that do to the cost of insurance in those states where lower costs of care are factored into the cost of insurance? You could still end up with the problem of some people being ‘under insured’ depending on how reimbursement is worked out.

So be careful what you ask for, you may gt it. The more you want covered in a plan, the more it’s going to cost. Just remember the old marketing adage, if it sounds too good to be true, it usually is.

A proposal by Arizona Gov. Jan Brewer to cut 300,000 people from the health care plan for the poor will likely “increase the misery index,” a Prescott doctor said.

Dr. Joseph Goldberger, chief medical officer for the Yavapai Regional Medical Center and a rheumatologist with a private practice, said about 15 to 20 percent of the patients he sees at his rheumatology consulting practice are insured by the Arizona Health Care Cost Containment System, the Arizona equivalent of Medicaid. Already, AHCCCS fees to doctors have been frozen, he said.

“The untold story is patients with or without insurance continue to get the care,” Goldberger said. “They get the most expensive care of all: ER care. Everybody else ends up paying for that through higher premiums. It has a significant impact. “Many of his arthritis patients need “very expensive” medications and “without insurance, they can’t afford them at all. The bigger problem is the access to medications. “

While that may not be life threatening in all situations, it certainly increases pain levels for arthritis patients.

In some situations, such as with a lupus patient who has kidney disease and can’t get access to chemotherapy, it could be life threatening, he said.

While Goldberger understands that the state is having budget problems and that education and health care are candidates for cost cuts, there are consequences, such as the loss of federal matching funds.

Health providers face a total cut of $67. 7 million in state and federal money, according to the Arizona Hospital and Healthcare Association. The association protested the plan to transfer AHCCCS’s remaining graduate medical education money and nearly all private disproportionate hospital dollars to other uses. Arizona’s hospitals have seen $278 million in state funding cuts since 2008, trade group officials said.

Reduction in payments for training doctors – the graduate medical education money – is particularly egregious, said John Rivers, the hospital association president and CEO.

The state and federal government traditionally reimburse hospitals that train doctors who typically go through a residency in a specific area of medicine after they complete their medical training and internships, Rivers said. However, if the state doesn’t put up the money for that training, then the federal government won’t contribute its share, Rivers said.

“If we’re not training doctors, I don’t see how that is good for the people of Arizona,” Rivers said. “One of the important by-products of training doctors here is this is where they end up practicing. If they get training somewhere else, they stay there. It’s a horrible outcome for the people of Arizona. “

Already the state has only 219 doctors for every 100,000 people, while the national average is 293 physicians for every 100,000.

It’s also shortsighted economically to cut into hospital budgets as hospitals create jobs, he said. And the cuts will shrink the state’s economy by $48. 8 million in federal Medicaid matching dollars that will now go to other states.

Hospitals in Arizona employ 73,300 people and contribute $11. 5 billion to its gross economic product, according to an Arizona State University study.

While the Yavapai Regional Medical Center is not a teaching hospital and is not affected by the graduate medical aspect of the budget cuts, said Brian Hoefle, the chief financial officer, the lack of disproportionate care money from the state would result in a loss of several hundred thousand dollars.

“Gov. Jan Brewer is talking about eliminating some of those programs,” said Hoefle. “It would be up to the Legislature to decide on cuts to AHCCCS. Just because the state isn’t covering certain populations anymore doesn’t mean they won’t get sick and end up in our ER. If there’s no payment for them, it shifts the costs to the paying customers. “

The state will lose $2 from the federal government for every dollar it cuts from AHCCCS, according to Hoefle.

“That’s very frustrating,” he said.

About 15 percent of patients who use YRMC are AHCCCS clients.

Meanwhile, the hospital has already seen large increases in bad debts and charity care over the past two years, Hoefle said. Charity care – wherein patients provide their financial information and are deemed unable to pay – has doubled from 2008 through 2009. While bad debtors – those who are unable or unwilling to pay but are not working with the hospital – have increased by 18 percent over the last two years.

“If the AHCCCS program is not going to pay hospitals, it’s going to fall back on hospitals to pay,” Hoefle said. People are “going to come to the hospital and we’re going to eat it. It ultimately affects commercial insurance. We raise our rates to insurance companies and those people who can pay will ultimately pay for the state’s lack of coverage. They’re talking about the hidden tax. Whoever is paying their hospital bills is paying for those who are not paying their hospital bills. Otherwise the hospital goes out of business. “

In January of 1838, a young man in Illinois speaking to a community organization (known as the Young Men’s Lyceum) in Springfield made the argument that an ambitious leader sometime in the future of the United States would leave the “beaten path” trod by previous leaders in order to gain distinction for himself. That “towering genius,” he said, would seek distinction and if possible, have it “at the expense of emancipating slaves or enslaving freemen. “

That speaker was none other than Abraham Lincoln, our 16th president, who would gain great distinction by keeping this country on a path to live up to its founding principles that “all men are created equal. ” We continue to have much for which to thank him.

Today in the state of New York, a pack-a-day smoker spends $250 of his disposable income each month and destroys his health in the process. He then seeks medical insurance and finds it “too expensive” — after all, insurance is a form of sharing risk and his is a risky and expensive future — and then he cries out to the political leaders of his country for medical coverage regardless of “pre-existing conditions. ” Other examples of self-destructive behavior can easily be substituted.

Those leaders then turn to those of us who act wisely to protect our health. They reach into our pockets under the guise of compassion to buy votes to stay elected and in this way they subsidize unhealthy behavior. By mandating that health insurance companies ignore risk and pay the cost of self-destructive behavior, they force-feed the poison pill that will bankrupt the health insurance industry and eventually speed the bankruptcy of our nation.

How ironic. One president sets free slaves of African descent. Now a president of African descent seeks distinction and tries to enslave free men by forcing them to pay for the destructive lifestyles of their fellow citizens. And our senators and representatives are only too happy to go along. Shame on them.

Young Lincoln went on to say that, “It will require the people to be united with each other, attached to the government and laws, and generally intelligent, to successfully frustrate his designs. ” Any politician at any level of government who would vote in favor of such a plan understands neither the blessings nor the responsibilities of American liberty, and they have no place in public office.

Democrats’ strategy for merging health care reform bills began to unravel under growing attacks Wednesday, including unexpected criticism from Colorado’s two Democratic senators.

Final negotiations on merging the bills began in earnest Wednesday as congressional leaders spent more than eight hours behind closed doors at the White House using a process that bypasses a formal conference committee and cuts out Republican participation.

They dug into a series of sticky issues that separate the two versions of the bill passed by the House and the Senate — including abortion, access to health insurance by illegal immigrants, and how to pay for the sweeping legislation, which will insure an estimated 37 million Americans over the next decade.

A White House statement said they had made “significant progress in bridging the remaining gaps” between the bills.

Republicans have been howling about the process for nearly two weeks — House Minority Leader John Boehner, R-Ohio, called it “a breeding ground for more of the kickbacks” — but now congressional leaders are facing a growing mutiny within their own ranks.

Wednesday, Sen. Mark Udall, D-Colo. , suggested the talks lacked transparency and called for televising final negotiations. Sen. Michael Bennet, D-Colo. , also said final talks should be open to live cameras.

“I haven’t been in Washington long, but one thing I can tell you is this is one town that can use some fresh air, and some real transparency,” Bennet said. “The outcomes from the negotiations on the health care reform bill are far too important to be done behind closed doors. “

Those criticisms could create significant difficulties for efforts to finish the health care bill and move on to other legislation before the press of this year’s election cycle swamps Congress.

Media organizations and others have said televising final negotiations between the House and the Senate would be natural given the enormous potential impact of the legislation.

Instead, Democrats have created a process under which House and Senate leaders will hammer out key compromises, then send the retooled bill to both chambers.

Those negotiations are expected to go for days, if not weeks, and Democratic leaders have said a conference would only provide Republicans — only one of whom voted for the bills in either chamber — a new chance at obstruction.

“This non-conference conference was a bid to speed this up and bring it to an end. A conference committee seemed one more area where Republicans would attack the Democrats and liberals would get upset with leadership,” said Julian Zelizer, an expert on Congress at Princeton University.

“The problem is it looked bad. Republicans can use that to say health care is being rushed through and done behind closed door because Democrats want to hide something,” he said. “That’s why you’re seeing Democrats now getting nervous about the process as well. “

The health bill passed by the House of Representatives Sunday would cost Nevada taxpayers an extra $613 million from 2014-2019, to provide health care to the needy.

According to early state estimates, the bill would make an additional 70,000 residents eligible for Medicaid. The state would be mandated to cover another 8,000 individuals who are now eligible but have not applied to be covered by the state health insurance program for the poor.

About 209,000 Nevadans are currently covered by Medicaid.

Including state and federal money, “the total cost of reform is $2. 3 billion,” said Mike Willden, director of the state Department of Health and Human Resources.

Willden went through the numbers for the Nevada Vision Stakeholder Group, formed to develop a plan for the future, looking ahead as much as 20 years.

Meanwhile, Gov. Jim Gibbons railed against the costs of the bill in a written statement Monday: “The bill disguises its true cost by shoving Medicaid expansions down to the state level and shuffling Congressional Budget Office estimates into later years so it appears to save federal tax dollars. It is an insult to those who truly care about meaningful health care reform. “

But Jon Sasser of Washoe Legal Services said during the Vision Stakeholder meeting the bill will expand the number of people eligible for Medicaid and that should put less stress on counties, which handle medically needy cases. “It means extra millions of federal dollars coming into our state,” Sasser said.

Most of the health care bill doesn’t kick in until 2014, Willden said. Some states are starting early, but Willden said he doesn’t see Nevada doing that because of its budget shortfall.

The federal-state dollar match for Medicaid is 50-50. Federal stimulus funds pushed that to a 64 percent federal match, saving the state $40 million to $45 million a quarter. But after the stimulus money expires Nevada will be back to picking up the 50 percent share, Willden said.

Willden said only 8 percent of the population is covered compared to 14 percent in other states. The state spends $435 per capita compared to the national average of $1,021.

OneWorld Community Health Center is looking for 6,000 kids.

The agency that generally provides health care to the underserved has received $706,264 from the federal government to create a program to enroll thousands of children in either of two government insurance programs for low-income children.

Many metro-area children are eligible but aren’t enrolled because their families don’t know the programs exist or don’t know their kids could qualify, said Andrea Skolkin, chief executive officer of OneWorld. That means some of those children are going without health care or are getting far less than they could.

OneWorld’s goal is to enroll at least 6,000 children. The agency’s outreach effort has just begun. OneWorld will place staff members in day care centers, schools, after-school programs, churches, food pantries, organizations and other places.

“We want to be where people are versus making people come to us,” Skolkin said.

They will contact families at those sites and determine whether they have children who qualify but aren’t enrolled in Medicaid or the state’s Children’s Health Insurance Program.

The staff members will have laptops to take down information and scanners to scan in citizenship documents and proof of Nebraska residency. Children must be citizens to receive the health care benefits.

The agency also will take referrals. For information, call 502-8888.

OneWorld, based in the Livestock Exchange Building, 4920 S. 30th St. , has hired a director and will employ five full-time staffers for the program. OneWorld also has a clinic in Plattsmouth.

President Barack Obama this year allocated $40 million to agencies in 42 states and Washington, D. C. , for programs to conduct enrollment efforts over the next two years.

Through a competitive process, OneWorld was one of 69 entities to receive money. Iowa doesn’t have a program among the 69. An additional $40 million will be distributed in 2012.

Enrollment among children in Medicaid and the Children’s Health Insurance Program has gradually risen in Iowa and Nebraska. The economy has worsened and awareness of the programs has broadened, spokesmen in Iowa and Nebraska say.

A child qualifies for Medicaid if his family’s annual income is at or somewhat above the federal poverty level, which is $18,310 for a family of three.

Qualifying for CHIP isn’t as stringent. In Iowa, the state raised the CHIP ceiling this year to 300 percent of the federal poverty level, or $54,930 for a family of three. Nebraska raised its income ceiling for CHIP from 185 percent this year to 200 percent, or $36,620 for a family of three.

The Nebraska Department of Health and Human Services has estimated there may be close to 15,000 eligible children who aren’t enrolled. The Iowa Department of Public Health estimated there could be as many as 38,000 children who aren’t covered.

Two moderate Democratic Senators facing re-election battles this year said Tuesday they would oppose using a legislative tool that requires only 51 Senate votes to get health care legislation to President Barack Obama’s desk.

Sen. Evan Bayh, D-Indiana, called the move, known as reconciliation, “ill-advised,” while Sen. Blanche Lincoln, D-Arkansas, issued a news release rejecting the procedure.

“I will not accept any last-minute efforts to force changes to health insurance reform issues through budget reconciliation, and neither will Arkansans,” Lincoln said in the statement.

Both the House and Senate have passed separate health care bills, entirely on support from Democrats.

Democratic leaders were working on merging the two bills, but the nation’s political landscape changed last week when Massachusetts elected Republican Scott Brown to fill the Senate seat held by liberal Democrat Ted Kennedy for almost 47 years until he died in August.

Brown’s victory cost Democrats their 60-seat super-majority in the 100-member Senate necessary to overcome a Republican filibuster. The shift means Republicans can block Democratic initiatives such as health care reform.

Now Democratic leaders are working on a plan for the House to pass the Senate bill, along with a separate package of changes in the Senate plan that reflect compromise between the two chambers.

The package of changes would have to pass both the House and the Senate.

Without the 60-seat super-majority, Senate Democrats now are considering using the reconciliation tool that would require only 51 votes to pass the measure.

However, some Democrats in tough re-election fights worry voters will see that as legislative gimmickry, reinforcing complaints that Democratic control of Washington has been business as usual.

Bayh told CNN that using reconciliation “would destroy the opportunity, if there is one, for any bipartisan cooperation on anything else for the rest of the year. “

Senate Majority Whip Dick Durbin, D-Illinois, dismissed opposition to using reconciliation as a way to get health care legislation to the president.

“I think reconciliation has been used effectively by both parties,” Durbin said. “I wouldn’t walk away from it. It’s an option we should keep on the table. “

Senate Democrats still have 59 votes in their caucus, meaning they could lose eight Democratic votes and still have the 51 needed to pass a health care package through reconciliation.

Still, Democratic sources warn that using reconciliation is complicated and fraught with legislative hurdles, raising questions about whether it could happen even if enough congressional Democrats supported the move.

House Speaker Nancy Pelosi, D-California, emerged from a meeting with Senate Majority Leader Harry Reid, D-Nevada, late Tuesday and said they are making progress on “some kind of package,” but reiterated that at this time “there are not the votes in the House, not anywhere near, to pass the Senate bill. “

Earlier, Reid told reporters there is now “no rush” on health care.

Obama, who made health care his top domestic priority last year, will address the issue in his State of the Union Address on Wednesday, said White House Press Secretary Robert Gibbs.

Republican Scott Brown, fresh off his victory in the Massachusetts race for U. S. Senate, called on the secretary of state to send him to Washington immediately, saying Wednesday that he wants to send health insurance reform “back to the drawing board. ”

Though the state typically waits at least 10 days to collect absentee ballots before certifying, the senator-elect said he’s “confident” his margin of victory — 5 points and nearly 110,000 votes — was greater than the number of outstanding ballots.

Brown is champing at the bit to be sworn in since he would become the 41st Republican in the Senate, breaking the Democrats’ 60-vote supermajority and potentially scuttling health care reform if it returns to the chamber for a final vote.

“Since the election is not in doubt, I’m hopeful that the Senate will seat me on the basis of those unofficial returns,” Brown said, adding that he’s already spoken to members of the state’s congressional delegation, including Sen. John Kerry, and will travel to Washington Thursday. “I think it’s important that we hit the ground running because there’s some very important issues facing our country. ”

On health care reform, he said he wants “everyone” to have some form of health care coverage, but questioned plans to slash Medicare and raise taxes to do it.
video
Brown Ready to Hit Ground Running

Brown ready to hit ground running

“I think we can do it better,” he said.

The Republican senator-elect said he was focused on moving to Washington as soon as possible to try to free up some of the political gridlock there.

“I have always just wanted to go down and solve the problem regardless of party,” Brown told NBC’s “Today” Show.

“While they’re in Washington talking about what someone said in a book and what this happened, we have some very serious problems when it comes to over-taxation, overspending and Al Qaeda who are trying to kill us. So we need to get back to the basics and start solving problems that affect every person in this country,” he said.

Brown’s insurgent candidacy has forced Democrats to rethink the basics on several matters, including the massive health insurance reform bill that is tagged to cost nearly $1 trillion over 10 years. They are also reconsidering agenda items they plan to use in November’s midterm election campaigns.

By winning the Senate seat in Massachusetts by nearly the same margin that President Obama defeated Sen. John McCain in November 2008, Brown takes away Democrats’ filibuster-proof majority and can pull a reverse-Obama — claiming a mandate to defeat the health care legislation now stuck in Congress.

Despite the upset, Obama adviser David Axelrod said administration officials will take into account the message voters delivered Tuesday but declined to go further.

“It’s not an option simply to walk away from a problem that’s only going to get worse,” Axelrod said of the health care bill.

Sen. Susan Collins, R-Maine, said one of the many messages coming out of the Massachusetts election is that Americans are sick of partisan gridlock, but voters also had a much more expansive recommendation.

“They want better performance out of Washington, they want us focusing on the troubled economy and the need for more jobs and . . . they’re tired of sweetheart deals that were sneaked into the health care bill. They want that kind of bill to be negotiated in the open. And they’re tired of politics as usual and they also want controls. They don’t want unfettered, one-party control,” Collins told Fox News.

Collins said she cannot support a bill “that imposes billions of dollars for new taxes, slashes Medicare by $500 billion and would actually cause insurance rates to go up. ”

“We really should start from scratch and do a completely bipartisan bill,” she added

But Pennsylvania Gov. Ed Rendell said that Americans oppose the health insurance changes because “the administration and its supporters, myself included, haven’t done a good enough job explaining to people what’s in this bill. ”

Rendell said he wants to go back to the drawing board in order to better communicate the message. If that fails, and a filibuster is threatened, then Democrats shouldn’t “just cave” but should make the other side “explain why they’re trying to block the bill with this type of political chicanery. ”

“I haven’t heard one good alternative offered by any Republican except let’s start at the beginning, let’s start all over. Start all over to do what?” he asked.

Rendell added that he wants to call the GOP’s bluff.

“Let them filibuster, let them take to the floor and speak endlessly and endlessly about why this is bad for the American people and what the alternative is,” he said.

As the debate continues over whether to scrap the year-long health insurance reform effort, some are also looking at whether Republicans can repeat the feat in Massachusetts in other states.

Seven Senate seats now held by Democrats are now considered toss-ups in November — Nevada, Colorado, Arkansas, Illinois, Pennsylvania, Delaware and Connecticut. Four Republican seats are in the same situation — Missouri, Kentucky, Ohio and New Hampshire.

“I think anybody who’s up for election this November ought to take seriously what the people of Massachusetts had to say in that special Senate election,” said Sen. Joe Lieberman. D-Conn.
Sen. John Cornyn, R-Texas, head of the National Republican Senatorial Committee, said Democrats nationwide should be on notice

“Americans are ready to hold the party in power accountable for their irresponsible spending and out-of-touch agenda. ”

But Democratic Senatorial Campaign Committee Chairman Robert Menendez cautioned against “taking a single unique election and extrapolating what it means for the midterms 10 months away. ”

Still, Menendez said he doesn’t want to sugarcoat what happened and Democrats will be sorting through the lessons in the days ahead.

Week of March 15, 2010

The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America’s Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.

Federal

With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.

The Senate has passed Jobs Bill II and shipped it off to the House, where passage is not certain. Within the bill are two health-related items of note. First, the COBRA eligibility and subsidy program will be extended to the end of 2010. (These provisions are set to expire at the end of March. ) Second, the bill contains a suspension until September 30, 2010 of the cut to physician Medicare reimbursements for the current calendar year. (This provision is also set to expire at the end of March. ) Aetna urged Congress to apply the “doc fix” to next year’s reimbursement as well, since insurers’ Medicare rates are based on what doctors are paid, but in the end Congress failed to make this change. Aetna and the industry will continue to find ways both to establish a more lasting, if not permanent, doc fix and to devise a legislative solution to the disconnect between doctor reimbursement and Medicare Advantage rates for 2011 and beyond.

States

ARIZONA: Budget issues remain front and center as the governor and Republican leadership proposed a plan they hope will close the $700 million deficit this year and reduce the anticipated $2. 6 billion deficit in 2011. Righting the state’s fiscal ship has become a very partisan exercise, with the Republicans supporting reductions in Medicaid and KidsCare, and the elimination of full-day kindergarten. As the special session on the budget is running concurrently with the regular session, no other bill hearings were held. The oral chemotherapy parity bill may be dead for this year as proponents did not meet the deadline for submitting amendatory language.

CALIFORNIA: The Assembly Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre held a hearing last week to examine how the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) has handled issues surrounding the rescission of policies in the individual market. According to a report prepared for the committee by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, fewer than 300 of 6,000 former policyholders are participating in health insurers’ agreements to settle such cases. Republican committee members were highly critical of this witness, while De La Torre was critical of the Departments. The DMHC reported that since their settlements were completed there have only been nine rescissions over the past two years, proof that the DMHC and the health plans have revamped their processes for rescission and have worked to address the problem.

COLORADO: A bill mandating maternity and contraceptive coverage in individual policies continues to receive significant attention in the Senate. The most recent amendment proposes requiring maternity coverage in at least three of the plans marketed by an insurer. It would also allow a current member of a plan without maternity coverage to switch to a plan with maternity coverage from the same carrier during the first trimester. The other major bill would require that second level appeals be performed by physicians who are actively involved in clinical practice. This measure is counterintuitive in the current economy, since it would result in outsourcing appeals and drive up costs for plan sponsors and their employees.

CONNECTICUT: A proposal that would require health insurance plans to cover oral chemotherapy in the same way that intravenous chemotherapy is covered made it through the legislature’s Insurance and Real Estate Committee last week. Currently, many health plans treat the two kinds of cancer treatments differently. Chemotherapy treatments that come in pill form are often categorized as prescription drug benefits that can require patients to pay a larger share of the cost. Cancer patients, doctors and patient advocates spoke in favor of the bill, while insurers and the Connecticut Business and Industry Association opposed it, arguing that it would put a mandate on health plans that could raise costs and make it more difficult for employers to afford insurance.

GEORGIA: A bill restricting the use of rescissions in individual health insurance policies passed a Senate committee last week. Aetna continues to work with its trade organizations to educate legislators about the adverse effect of this type of legislation. Discussions also continue regarding legislation affecting the use of rental networks.

KANSAS: Roughly half way through the legislative session, several health care bills are still moving through the process. On the regulatory front, the Insurance Department has proposed a regulation that would mandate coverage of routine patient care costs while the insured is enrolled in a cancer clinical trial – a mandate that was rejected by the legislature in 2008. A hearing will be held on April 20, and Aetna will have an opportunity to present testimony on this issue. Bills still alive include mandates for autism and orally administered chemotherapy, legislation prohibiting dental contracts that require the dentist to follow a fee schedule for non-covered services, and a ban on “most favored nation” clauses by some insurers. Another bill would allow small employers to create individual HRAs to fund premium payments on individual policies, require administering insurers to offer employees the option of receiving health insurance coverage through a high-deductible health plan with an HSA, and requiring insurers who offer small group health plans to offer high-deductible health plans with HSAs, while authorizing tax deductions for health insurance premiums for individual insurance policies. Separate legislation would amend the definition of “eligible employee” to include part-time workers (currently less than 30 hours per week). Pending legislation concerning hospital charges would prohibit charging private-pay patients more than 25 percent of what the hospital’s highest volume private payer would pay for the same goods or services. Legislation that died includes a telemedicine mandate and creation of a health care insurance database for employers.

KENTUCKY: Health issues that are being hotly debated by the legislature right now include an autism mandate, a dental bill that would not allow insurers to hold dentists, optometrists or ophthalmologists to a fee schedule for non-covered services, and a bill setting a reimbursement floor for chiropractic services. The chiropractic services proposal would allow chiropractors to bill, and would require insurers to reimburse, an evaluation and management (E&M) CPT code on each and every visit. In addition to billing for follow-up services for manipulations and other therapies, the chiropractor would be allowed to submit, and the insurer required to pay, for another E&M code on each and every visit. The legislation would also add a new mandated benefit to the Kentucky statutes. Currently, reimbursement for chiropractor visits is required only if the chiropractor performs a service already covered by the health benefit plan. Under the proposal, any service within the scope of practice of a chiropractor that is billed would become a mandated benefit. Finally, the bill would require health benefit plans to provide reimbursement without the chiropractor having to provide any documentation that the services were medically necessary. Each of these bills has, or is expected to, pass at least one chamber.

SOUTH DAKOTA: Several important legislative deadlines are approaching, resulting in a flurry of activity. Bills or resolutions not passed by the second chamber by March 9 died. But the Governor has already signed a bill that amends the premium rate-setting procedure for the high-risk pool so that rates for a given classification are 150 percent of the average actively marketed premium. The pool will have to offer three or more plan designs, remove coverage requirements for the plans (such as disease management) and remove set cost-sharing values. The bill was signed by the Governor on March 1 and will become effective on July 1, 2010. The Governor has also signed a bill prohibiting rating based on injuries caused by domestic violence and legislation requiring refunds of premiums for partial months, in the case of mid-month cancellations. Both chambers have passed legislation prohibiting contract language requiring dentists to accept a fee schedule for non-covered services, and the bill awaits the Governor’s signature. Finally, the legislature passed a resolution opposing the federal health care reform proposals passed in the U. S. Senate and House.

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