Learning About Health-Care Reform

With new health-care reform legislation being hotly debated nationwide, it’s not surprising that a meeting on the subject Friday at the Surry County Senior Center in Mount Airy drew a crowd.

“The new health-care reform is confusing to a lot of people, so if you feel confused, you’re not alone,” Annalisa Davis, the center coordinator, said at the start of a meeting attended by about 50 people, mostly retirees.

They came to hear Bill Wilson of the AARP in Raleigh discuss the various provisions of the bill and what it means not only for senior citizens, but younger families and individuals as well as employers.

“I have yet to see the perfect piece of legislation,” said Wilson, who has many years of experience in public-policy work in the N.C. General Assembly, and gave a similar presentation Friday afternoon in Pilot Mountain.

“And this does not break that mold,” he added of health-care reform. “This is a 2,000-plus-page bill.”

While its passage was controversial and continues to be resisted by many although it has become law, Wilson told the local gathering that some of the bill’s provisions represent an improvement over the present situation.

“But what people really want to know is ’how does this affect me?’”

Medicare Changes

Given the makeup of the audience, a major focus of Friday’s program was Medicare, the federal government program that provides health-care coverage to persons 65 and older and the disabled.

Wilson assured those gathered that guaranteed benefits offered under this program will be continued under the new health-reform legislation. It also is expected to add 10 years to Medicare’s financial solvency, ensuring its continued availability.

One positive way in which Medicare will be affected, Wilson said, is by expanding wellness and preventive care coverage, which will allow annual checkups — and tests and screenings, such as bone-density screenings — at no out-of-pocket costs.

“There are huge improvements in preventive care,” Wilson continued, which are aimed at reducing costs of medical treatment by catching major problems earlier. “That’s an important part of the new bill.”

Wilson also addressed another well-documented concern related to Medicare — the so-called “donut hole” seniors have fallen into which is associated with the Medicare Part D program that subsidizes the cost of prescription drugs.

The donut hole occurs when seniors exceed $2,700 in total drug expenses in a plan year, which then requires them to pay 100 percent of their prescription costs until $4,300 is spent out of pocket. The “hole,” which 3.4 million Americans fall into annually, can appear in a hurry when extremely expensive medications are involved.

Wilson said certain provisions in the new health-care legislation are aimed at lowering out-of-pocket costs for prescription medications, gradually leading to the planned closure of the donut hole by 2020. This will include rebates being offered to Medicare beneficiaries to help offset the drug costs.

“It is still complicated, but hopefully by 2020, we’re going to simplify this a little bit,” Wilson told the audience Friday.

The health-care-reform legislation also seeks to reduce Medicare costs through such measures as identifying fraudulent providers, eliminating overpayments and implementing a vendor-certification program.

Those who attended Friday’s program had plenty of follow-up questions for Wilson regarding Medicare.

Arvid Simmons of Mount Airy wondered what will happen with reimbursement rates for medical providers under the program; specifically if people enrolled in Medicare will have to make up the difference between what a doctor or hospital charges and what’s allocated.

According to Wilson, efforts to reduce the reimbursement rate by 22 percent — as a means of keeping costs of care down — have fallen by the wayside. “I don’t know of any provider who could take a 22-percent hit,” the speaker added.

A related question concerned the problems seniors are experiencing in some locations in finding doctors who no longer will accept Medicare patients because of the paperwork and financial issues involved.

“It’s a real problem for people moving into the state, especially urban areas,” Wilson said. While a physician in Raleigh or Winston-Salem might continue to see a longtime patient, new retirees to North Carolina are having trouble finding doctors willing to treat them through the Medicare program.

Effects On Individuals

Wilson also addressed the matter of how the recent legislation will impact the uninsured or those who buy their own coverage.

Beginning in 2014, the new health-care program will provide a one-stop shopping opportunity for them to obtain coverage through “state exchanges.”

These plans will offer a standard plan of comprehensive benefits, with four levels of coverage in all. There will be no discrimination based on pre-existing conditions, according to the AARP official.

Until 2014, temporary coverage can be obtained through “high-risk pools,” but these will still be expensive compared to most plans.

“This is a temporary program to help people who have trouble buying insurance, until we get to the state exchanges in 2014,” Wilson explained.

He also pointed out that the health-reform legislation will equalize the costs of coverage, which now can be higher based on someone’s gender, health status or the fact they are older adults. “Now if you’re a female, you’ll pay exactly the same premium as a male does,” Wilson told audience members.

The measure further eliminates coverage limits for medical care, which can soon be met if a catastrophic illness strikes someone. The main reason people lose their homes is because of high health-care expenses, Wilson said. “This will go a long way toward eliminating those bankruptcies and foreclosures,” he said of the new legislation.

Tax credits are in place to assist consumers in paying their premiums, to couples earning less than $58,280 and individuals with incomes lower than $43,320.

Also, the new plan expands eligibility for Medicaid coverage, which is available to low-income persons.

Families who are part of an employer-provided health plan can have their unmarried children covered under the same policy until they reach age 26. “That starts this year,” Wilson said.

“This will cover a lot of young people who think they are invincible,” he added, but don’t realize that they might be hurt in a car accident and need coverage.

Penalties Possible

Individuals are required to have basic medical coverage under the reform package, and will face penalties otherwise, according to Wilson.

Beginning in 2014, those who are eligible to buy insurance through a state exchange and don’t will be assessed a penalty of $695 per year or 2.5 percent of their taxable income, whichever is greater.

The penalties are designed to generate funds to offset some of the costs of those who remain uninsured and then require care.

Employer Impact

The guest speaker also discussed the new legislation’s effects on employers Friday. “This is a big sticking part in the bill,” he said.

Under its provisions, small businesses are exempt. “For any company with less than 50 employees, there’s no requirement that you provide health insurance coverage at all,” Wilson added.

However, tax credits are available to assist those businesses in paying for coverage for eligible employees.

Around 80 percent of American businesses employ fewer than 10 people.

About 2 percent of businesses across the country will be subject to some increase in costs under the recently passed bill.

Wilson responded Friday to rumors that employees will have to pay taxes on insurance provided through company plans. “Not true,” he said.

No Dental

In response to another question from an audience member, Wilson said dental coverage remains a “big gap” in terms of the overall health-care picture. “You’re out of luck,” he told the woman who inquired about that aspect.

While there is some coverage for dental services under Medicaid, that is not the case for Medicare, Wilson said.

“It’s one of the biggest problems we have right now in this state,” the speaker said of lack of dental-care coverage. “It just impacts your entire health,” Wilson added, explaining that tooth problems can affect a person’s nutrition, for example, and lead to other medical difficulties.

Those attending Friday’s presentation seemed to come away with a better understanding of the new legislation.

“I thought it was very good,” said Nancy Walker, who believes the program was interesting as well as informative.

“We are a small business owner,” explained Walker, a Mount Airy native who know lives in Rural Hall and co-owns an electrical firm. She said she came to Friday’s meeting concerned about how health-care reform will affect her personally and her business.

“What’s in this program that we don’t know about yet, us as a little guy?” she asked.

Affordable health insurance – What you should know

There has been quite a few changes to the health-insurance industry in 2010, and there will be many more to come throughout the rest of the year. Many of the rules that currently control health insurance industries could well be changed.

It may be difficult to start looking for health insurance. Now the term “Affordable health insurance” may seem a contradiction in terms.as due to high premiums it’s not easy to believe that the coverage is actually worth the money.

The cost of health insurance coverage is small when you look at the cost of health care without the insurance.

The best way to find cheap health insurance is by checking the prices of a whole host of health insurance providers. Health insurance companies will charge you depending on many aspects such as if you are a smoker, your current weight and any existing health problems.

What you really need to know is how you can save money on health insurance. Taking the first offer that comes along will, most of the time, leave you paying more then you have to. You should also remember, just because one company has the lowest premium, this does not mean they are offering the best value for money.

Find out which physicians and hospitals are covered in your health insurance. Make sure your health care plan includes hospitals that are located nearby. Try not to be enticed by higher deductibles. Remember that a higher deductible could lower your possible monthly premium but it can also make you pay more for standard care.

Now the best tool you have available when you want to buy health insurance is to use the Internet. If you are ready to start looking for cheap health insurance, you can go online and get an online quote. Its important that you do proper research as many people are paying too much for their medical plan as some providers may charge for coverage which is unnecessary.

It's war on the wards of China's hospitals

FORGET the calls by many Chinese patients for more honest, better-qualified doctors. What Shenyang's 27 public hospitals really need, officials have decided, is police officers.

And not just at the entrance, but as deputy administrators. The goal: to keep disgruntled patients and their relatives from attacking the doctors.

Officials in this north-eastern industrial city of nearly eight million people have a point. Chinese hospitals are dangerous places to work. In 2006, the last year the Health Ministry published statistics on hospital violence, attacks by patients or their relatives injured more than 5,500 medical workers.

"The police should have a permanent base here," said a neurosurgeon at Shengjing Hospital. "I always feel this element of danger."

In June alone, a doctor was stabbed to death in Shandong Province by the son of a patient who had died of liver cancer.

Three doctors were severely burned in Shanxi Province when a patient set fire to a hospital office. A paediatrician in Fujian Province was also injured after leaping out a fifth-floor window to escape angry relatives of a newborn who had died under his care.

Over the past year, families of deceased patients have forced doctors to don mourning clothes as a sign of atonement for poor care, and organised protests to bar hospital entrances. Four years ago, 2,000 people rioted at a hospital after reports that a three-year-old boy was refused treatment because his grandfather could not pay £50 in upfront fees. The child died.

Doctors and nurses say the strains in the relations between them and patients' relatives are often the result of unrealistic expectations by poor families who, having travelled far and exhausted their savings on care, expect medical miracles.