Another sign that the economy is mired in muck, with prospects for improvement any time soon being very dim:

A new survey shows a family health plan in 2010 averages $4,000 a year, up 14% from 2009. Meanwhile, the average employer contribution to a family plan hasn’t increased at all. [...] Overall, premium growth slowed slightly this year to 3%, with the average annual cost of a family health plan reaching $13,370. Workers picked up 30% of that bill. The average plan for a single individual cost $5,049.

Slow job growth. Incremental premium increases. Higher out-of-pocket expenses for care. Forget about cost-sharing. This is massive cost shifting, and healthcare consumers are being forced to take the brunt of the cost of that coverage. | LINK

In the nascent days of Pres. Obama’s reform legislation, much in the way of healthcare policy at the start of this crucial decade proceeds incrementally. With respect to the role of small businesses, expect the use of targeted tax credits for employees as another incentive for the smallest of those private proprietorships to remain viable in both the healthcare economy and the economy in general. It’s all about baby steps and getting skin the health reform game at the outset. The Congressional Budget Office estimates the credits could give up to $40B in savings to small businesses over the next 10 years and lower annual premiums by approx. 10 percent by 2016. | PDF LINK to Commonwealth Fund white paper

Illinois will offer this week the first-in-the-nation coverage plan for its uninsured since health reform was enacted. Currently, the state has almost 2 million uninsured by estimates. The plan to place them on coverage rolls will not reach them all — only a fraction, actually. Illinois’ Pre-existing Condition Insurance Plan can only enroll enough in its high risk pool because of federal funding limitations.^[1]

The creation of high-risk insurance pools under reform is one way over the next 4 years President Obama has said he will rein in coverage costs by mimicking enrollment/disenrollment policies of states; creating service areas of operation with HHS guidance; issuing creditable appeals processes for enrollees; preventing employers from creating disincentives for employee enrollment in those pools; and utilizing accountability rules to prevent fraud.

Illinois is the first state to test the waters in this transition to healthcare exchanges set to begin in 2014. | LINK

1. Funding comes from premiums and from the federal government, which is giving the state $196 million to run the plan until 2014 when healthcare exchanges will be required under the 2010 Affordable Care Act. [↩]

It has already happened in the Minneapolis/St. Paul metro. Now Duluth is in the midst of a nurses strike.

Nurses in Duluth voted overwhelmingly to reject a new labor contract, setting the stage for a 24-hour strike.

More than 90 percent of nurses who voted from St. Mary’s Medical Center and SMDC Medical Center, and more than 86 percent of those from St. Luke’s Hospital voted to reject the contract offer primarily because it did not include language that would allow them to close a unit to new admissions if they felt overwhelmed.

Again, the issue appears to be faulty staffing (nurse:patient) ratios. | LINK

The state of Massachusetts has reached a deal with the fifth of six insurers initially denied rate hikes for coverage in that state. While nowhere near the massive increases sought in other high-profile states, Massachusetts’ most recent settlement involved a company’s requests for hikes in the 10% to 25% range for policyholders. Over 90% of coverage in Mass. has been positively affected by settlement negotiations with those five insurers which includes the individual market and small-business purchasers. The process of rate hike negotiations is just another factor in the long history of closely observed operations in a state which guarantees coverage to all of its citizens. | LINK

3/23/2010: That was the date that was supposed to change everything — the date the reform bill was signed into law by President Obama. Although the WH focus tonight was squarely on the tragedy that continues to unfold in the Gulf, the potential for healthcare and its role as a policy game-changer in the November midterms continues to loom as an unexpected burden for Obama.

Gone is the self-serving satisfaction he and the WH can revel in until beneficial changes for healthcare consumers begin to trickle in over the next year or so. The trepidation Americans feel over the true impact of the new reform legislation is just another concern amidst a strong recession and weak job recovery. Not only are consumers (employees) feeling the pressure to understand reform and its meaning for them, employers — particularly small employers — are wondering if their responsibilities in financing coverage will become more ponderous than Obama has promised.

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Former HHS Secretary from the Clinton Administration, Donna Shalala told a standing room only crowd at the AHIP convention in Las Vegas over the weekend that the recently passed healthcare reform bill’s ultimate utility will depend more on the influence of insurers and not of the government.

“The American people voted not for a government takeover of healthcare, but they committed themselves to the employer-based system and private delivery,” she told the insurance industry crowd during a session titled, “A Way Forward: Next Steps for America’s Health Care System.”

While “a great deal of money” will be spent on public insurance programs, including Medicaid and Medicare, the “basic core” of reform will involve private insurers, she said.

Kudos to Shalala for being honest in this assessment. Although many insurers have begun taking steps to work within the framework of changes that will begin within the next two to four years, the reality is that private insurers will always have a stake in healthcare delivery. The development of exchanges, private-public contracts, and other mechanisms will be the result of the necessity to create innovation to maintain a robust healthcare marketplace. | LINK

The 12000-member nursing mega-union is playing PR hardball, going after the emotional jugular in advance of a walkout over staffing demands that seems all but certain.

In a news release Monday, the union cited several examples of what it calls dangerous staffing. Among them: a nurse at Methodist Hospital in St. Louis Park who said a dying patient “had to sit in his own feces” because no one was available to clean him up, and a nurse at Mercy Hospital in Coon Rapids who called for help when a patient’s surgical incision ripped open, “but nobody came.”

An expected and noble strategy, but one that could backfire. Although tableaus of patient horror stories like these evoke a visceral response, assigning these incidents to something as isolated, discrete, and simple as staffing inequities irresponsibly assumes public ignorance of the end product of something more insidious and global — a broken healthcare delivery system that yearns to be fixed via negotiation and cooperation, not bullying and scare tactics. Twin Citians as citizens and patients can easily understand that. | LINK

It continues to be a rather interesting and fun exercise watching how Massachusetts handles being the example of state-sanctioned guaranteed healthcare coverage. Over the past couple of months the escalating heat brought on by some of the state’s major insurers to test the state government’s reach on the regulation of premiums crescendoed recently, with a judicial ruling that expressed that the state was able to cap premium rate increases coverage for small businesses. Although the insurer in this case (Neighborhood Health Plan) agreed to only a 7.7 percent increase (down from an original 11 percent increase), other insurers are still pursuing the courts via the appeal process.

In a statement, Governor Deval Patrick applauded the settlement. “I appreciate the willingness of Neighborhood Health Plan to work with us to provide immediate relief from skyrocketing premiums,’’ he said, “and hope they will be an example to other health plans as well.’’

Time will tell; but for now, the first test over challenges to the state government’s insurance commission to regulate rates by its insurers guaranteeing small group and individual coverage seems to be in favor of the state. For Neighborhood Health, I wonder if they consider this episode one of “leading by example”. | LINK

Until today the major significance of June 1 was important for two healthcare policy-related developments: the initiation of the restructured GAMC safety net here in Minnesota, and the one-day nursing walkout. Since the latter is rescheduled for the 10th, the former kicks off today with as much uncertainty for its future stability as those ongoing nursing-hospital talks are currently demonstrating.

With the new focus of GAMC as one of operating within a strict healthcare (capitated) budget of sorts, many beneficiaries of the program in its former incarnation are not only finding it as challenging to negotiate it in order to retain the level of care they have gotten used to; they are also realizing that its current policy is somewhat finite and inflexible.

That is, until they are able to take advantage of a state-run program using matched federal funds later this year, they are realizing that access to that care has just become as complicated — almost intentionally so. Such is the case of a Duluth man with schizophrenia who now has to travel to the Twin Cities in order to receive the care he has become accustomed to, by necessity.

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The purported one-day walkout is still on schedule to happen a week from yesterday, and the CEO of one of the health systems in the Twin Cities is exercising his philanthropic tendencies.

The chief executive of Allina Hospitals and Clinics is voluntarily working without pay until the Twin Cities’ biggest hospital chain reaches an agreement with its nurses.

Allina is the only group so far to make public any action which acknowledges the concern of the 12,000-strong nurses’ union — additionally, addressing the possibility that upper management would take pay furloughs if need be. At best, the move looks like a gesture of goodwill. At worst, a game of PR one-upsmanship against the other hospital and healthcare systems who have yet to appear to address the nursing collective in any public way. | LINK

It’s being billed as the biggest nursing strike in this country’s history, and, based upon the overwhelming rejection of Twin Cities nurses of their current pay and benefit structure, it may occur.

“The nurses have stood up like never before and cast a historic vote for patient safety,” said John Nemo, spokesman for the Minnesota Nurses Association.

…which has been the general message of nursing, who say that most Twin Cities hospitals that employ them are not guaranteeing ideal staffing situations which ensure patient safety. They accuse the hospitals of using recession-speak to maintain minimum staffing arrangements across most acute hospital care units. Hospitals say nursing demands are “unreasonable” and that they are “well compensated” and have current contractual stipulations in place that allow for incremental payraises and benefit promotion. June 1 is the scheduled 1-day walkout date. Next move is the hospitals’. | LINK

Preauthorization as a requirement by insurance companies to continue providing coverage for treatments that end up outside of a policyholder’s terms is nothing new; it is a necessary evil providers must deal with on a daily basis to make sure their patients get the care they need if current covered treatments are no longer adequate. Pharmacologic therapies make up the bulk of treatment reviews Insurance requires as part of preauthorization. But adult mental health services (particularly within the discipline of psychology) in the state of Massachusetts are playing an increasingly controversial role in these administrative matters that place employers, providers, and patients in a protracted battle against insurance companies to continue these types of treatments.

“We are seeing what seem to be excessive preauthorization and other reviews that we don’t typically see for other medical services,’’ said Matt Selig, executive director of Health Law Advocates, a public interest law firm based in Boston.

The advocacy legal firm will probably join other groups in filing legal challenges on behalf of therapists and patients. The largest insurer of workers’ mental health services in Massachusetts says it tries to contain costs by making sure patients continue to receive the covered care they need. It seems as though patients in dire need of those services requiring preauthorization feel otherwise. | LINK