One thing that Massachusetts has learned from its experience as a guarantor of healthcare coverage for all of its citizens is that the noblest of intentions does not come cheaply. Recently, it was announced that the state’s premiums for private insurance not only increased but also at the highest rates in the nation for family coverage. State budgets are straining, as a result. On the heels of such findings as this, Mass. Gov. Patrick (a Democrat) today announces the utilization of state government regulators to oversee rates imposed on another coverage sector — the small business.

Good news for small businesses which have sought some sort of leverage in negotiating rates for coverage for employees. The increased power the governor will impose for the state’s Division of Insurance in this role will no doubt be opposed by Insurance, but it offers another reason for Obama to monitor closely the guaranteed access healthcare microcosm that is Massachusetts. | LINK

Are pretax healthcare benefits for employees a thing of the past? Could Obama have a union fight on his hands? According to various news sources today, the president is considering taxing some employee healthcare benefits to help pay for his healthcare delivery overhaul. Just last year on the campaign trail, then-presidential candidate Obama criticized his opponent Sen. John McCain for doing the exact same thing (albeit, McCain was essentially campaigning on taxing all employee health benefits). 

Favoring this change in Obama’s tone, those who want to tax benefits in whole or in part make two main arguments. They say the tax exclusion is a generous subsidy that insulates employees from the true costs of health care, leading them to demand more of it and driving up overall costs. Critics also say the policy is unfair because it favors higher-income people. | LINK

She’s a divorced 57 year-old female who was forced to step down from her job because of the debilitating side effects from the chemotherapy used to treat her breast cancer. Initially, from the time she was diagnosed, she was able to continue to work as a high powered executive. All of that came to a halt when she stopped working and subsequently had to sell her house in order to meet her co-pay and former employer health insurance costs. Now cancer free — but still needing expensive chemo — she survives on disability income and somehow manages to meet the constant out-of-pocket expenses she now has for medical services outside of her current physician network. Comparing herself to the Bionic Woman, the woman muses, “Sometimes you sit there and think: Am I really worth this?” | LINK | PDF of study here

Until as recently as last month, the prevailing wisdom — at least among leading healthcare policy watchers — was that the healthcare industry, as an economic sector, was immune from the short term effects of a recession. As long as there are people getting sick, they’ll always come to the doctor, right? With all of the recent reports detailing  job losses week after week, it was only a matter of time before the ripple effect would be felt by healthcare organizations and their providers. Job lay-offs and losses mean lost benefits, which means a loss of margin for healthcare orgs. Consider the financial squeeze felt by the insurance companies (the providers of reimbursements to healthcare) and cuts to government payers (Medicare and Medicaid) as states get the pinch; one doesn’t have to think that lay-offs occuring among healthcare line and support personnel will not occur in short order. In fact, they already have — starting with the least senior staff in many healthcare organizations. Hit especially hard are markets in which managed care is king — like the Twin Cities region in Minnesota. | LINK

It’s tough in these economic times for everyone in every sector of the economy — including healthcare. With some patients having trouble accessing medical services for a whole host of reasons, medical debt is a sad and frustrating by-product made worse by economic uncertainty. For Minneapolis-based healthacare organization Allina, the state of Minnesota is making sure that the patient-as-consumer is not getting financially squeezed more than is legally possible. The healthcare provider is being sued by the state’s attorney general for allegedly charging higher interest rates to consumers on their unpaid medical debt; rates approximate 18 per cent. The patient essentially is being charged credit card rates on his or her medical bills. Coming soon — hospitalizations on the Visa card? | LINK

The really cool thing about the not-so-common inaugurations of newly-elected US presidents is how quickly they pursue (most of) the agendas upon which they were elected. The media frenzy surrounding such an event is the perfect forum for equally capturing the attention of both the political junkie and neophyte at probably the only time in a president’s term. With all of the actions of his seemingly ad hoc formation of the Office of the President-Elect, it comes as no surprise that Barack Obama will hit the ground running with new initiatives. Other than quickly pouncing on the 2-ton pachyderm in the room that is the recession, it appears as though the new administration will focus on reforming the delivery of healthcare. The uninsured are in Obama’s crosshairs.

Apparently, expansion of the federal government’s role in financing Medicaid is a priority. According to the WaPo, Obama plans on allowing states temporarily to sign up jobless residents for Medicaid, with the federal government for the first time paying the entire cost of doing so. Even more boldly, the new president will also provide “unprecedented” federal subsidies to increase the affordability of COBRA, a temporary coverage mechanism for laid-off workers that, for many, remains unaffordable. 

Call it Obama’s initial stimulus package for the ailing healthcare economy — a lame beast whose failing function needs life support on an extraordinary scale not seen in almost fifty years since the formation of Medicaid. Perhaps even more extraordinary is the expectation, even among liberals, that this increase in healthcare financing by the federal government is still not enough — as unemployment numbers continue to skyrocket into 2009. | LINK

Unemployment carries with it all of the mystery of Pandora’s box. Many unemployed beneficiaries are just now finding out that healthcare is not a given as the first checks roll out. Much of a laid-off worker’s healthcare coverage has to do with the spectrum of coverage from the his/her previous employer. For the vast majority of people out of work, the ability to maintain the same level of healthcare coverage has simply become too burdensome. At the tip of the post-unemployment iceberg is an entity whose rules characterize the inability for so many to receive coverage after a job loss — COBRA.

COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) is a law passed by the U.S. Congress during the Reagan administration that, among other things, mandates an insurance program giving some employees the ability to continue health insurance coverage after leaving employment. It allows for coverage for up to 18 months in most cases. If the individual is deemed disabled, coverage may continue for up to 29 months. In the case of divorce, coverage may continue for up to 36 months. COBRA does not apply, on the other hand, if employees lose their benefits coverage because the employer has terminated the plan altogether or if the employer has gone out of business.

It also does not require the employer to pay for the cost of providing continuation coverage. Instead, it allows employees and their dependents to maintain coverage at their own expense by paying the full cost of the premium the employer previously paid, plus up to a 2% administrative charge (50% for the latter 11 months under the disability extension).

Ouch! | LINK | LINK 2

Happy New Year! from Doctor Pundit. Posting to resume on 1/2/09.

• Minnesota’s most populous county will end fee-for-service Medicare. Sign of the troubled economy? Docs gotta put food on the table, too.
• Medicare Part D open enrollment to end on 12/31.
• Healthcare plan beneficiaries scramble to take advantage of last minute procedures before benefit resets on 1/1. Looks like some docs will put food on the table.

At a time when the weak economy is hurting the industry, medical groups say they are grateful for the bump in business, however temporary. To cope with demand, doctors are adding hours and delaying vacations. High-deductible plans with health savings accounts were introduced in 2004 and now cover about 10 percent of insured Minnesotans. At the same time, deductibles for traditional plans — known as preferred provider organizations — also have jumped, with a $1,000 deductible now the national norm, according to benefits consultant firm Mercer.

Hiring freezes. Acute care and same-day procedure clinic closures. Shrinking inpatient censuses. These are the problems healthcare organizations’ hospitals and clinics are having in these troubled economic times. Brought on by beneficiaries’ lack of coverage via job losses and lingering Medicaid and Medicare cuts in reimbursements, the financial crises shared by these institutions have led to rather disastrous results, bankruptcies chief among them. | LINK | RELATED LINK

Happy Holidays from Doctor Pundit!  Posting to resume 12/26/08.

• Plavix is the agent of choice for a multitude of preventive therapies and treatments for stroke and cardiac disease; but , its method of action may be affected by those with a certain genetic variant.
• All I want for Christmas is universal healthcare delivery?
• The American Red Cross is seriously revving up operations for Obama’s inauguration.
• What’s to blame for the sharp increase in drug-drug interactions in elderly patients?

In addition, almost 30 percent of seniors are taking at least five prescription medications and many combine prescription and nonprescription drugs. Among commonly used medications, drug-to-drug interactions extend beyond prescription drugs, with nearly half involving the use of over-the-counter medications or dietary supplements.

• The good news: healthcare is second only to the economy as the most significant concern among consumers. The bad news? The margin of difference is 75 percent to 7 percent.

While jobs in the healthcare sector are still very strong and relatively stable in the midst of this faltering economy, the forecast for expansion of many non-profits does not look too rosy.  In the face of declining patient rolls in many acute care facilities, healthcare organizations’ (including many here in the Twin Cities) working capital are shrinking entities in previously robust financial portfolios.  At the core of future restraints are employee job losses, and by extension, their individual healthcare coverage and benefits. | LINK