Archive for August 2011

Health Insurance Reform Issues Student Health Insurance

With a law as complex as the Patient Protection and Affordable Care Act (PPACA), unintended consequences are always a concern. Last week The Wall Street Journal reported that the physician community is witnessing the emergence of a significant unintended consequence — since tax-advantaged flexible spending accounts can no longer be used to pay for over-the-counter medications without a prescription, under the law, many patients are now visiting their doctors expressly for the purpose of getting new prescriptions for the OTC medications. The change in the law was meant to discourage wasteful spending on some health products and raise revenue. Instead, critics say the provision is driving up health care costs. Unintended consequences of the health care reform law is an area of focus for Aetna insurance, and will continue to urge flexibility in the implementation process to help address potential unintended consequences.

Federal
In response to various requests for clarification (including from Aetna insurance), federal regulators last week issued a Question & Answer document that further refines the previous proposed rule on student health. In short, this clarification makes it clear that nothing from PPACA applies to student health plans until policy years beginning in 2012 or until academic year 2012-2013. The Q & A also clarified that the proposed regulation must be finalized to show what parts of the PPACA would apply to student health plans. This is welcome news in the college and university community. Aetna is communicating with its clients in a manner that is consistent with last week’s clarification, though many schools were hearing conflicting advice from state regulators.

The House-passed continuing resolution includes language that would “prohibit the use of funds to pay any employee, officer, contractor, or grantee of any department or agency to implement the provisions” of the PPACA. In a letter to Finance Committee Chairman Max Baucus, HHS Secretary Kathleen Sebelius made several claims that, should the de-funding provisions in the resolution be enacted into law, seniors will lose access to Medicare Advantage plans and other services. Senate Republicans were quick to dispute these allegations stating, the scenarios the Secretary envisions are not allowed under Congressional rules, are not assumed by the Congressional Budget Office (CBO), and can be prevented by HHS.  Senator Orrin Hatch and Ways and Means Committee Chairman Dave Camp also sent Secretary Sebelius a letter expressing their disappointment in what they called the letter’s “baseless allegations,” and expressing hope that “the urgency with which this letter was sent to Chairman Baucus is also being applied in answering a growing backlog of serious questions.”  The CBO also released a letter regarding the impact of the resolution, including the impact of the de-funding provisions on Medicare Advantage. The letter shows the de-funding provisions would have a minimal MA budgetary impact of .7 billion over 10 years.

]]>

States
Governor Jan Brewer’s Special Advisor on Arizona health insurance Health Care Innovations held a meeting last week with the state’s major health insurers, including Aetna insurance, to discuss identifying IT gaps the state must address to develop the online product selection and enrollment mechanism for an insurance exchange. Social Interest Solutions, the organization that developed the enrollment form currently used by Medicaid applicants, provided a demonstration of that application process. Individual interviews will be conducted with the IT staff of each company to obtain recommendations for the new system.

The Real Estate Committee last week voted out a substitute prior-approval rate bill that retains all the problematic sections of the original bill. The sections of concern cover public hearings, new subpoena powers for the Attorney General and Connecticut health insurance Healthcare Advocate, multiple notice requirements, and new definitions of inadequate, excessive, and unfairly discriminatory. The only change is that the Commissioner would have to promulgate regulations to carry out the proposed public hearing process. The full contingent of Republicans and Rep. Linda Schofield (Dem.) voted against the bill, with Schofield stating that she was concerned the bill gets rid of any timeline under which the Department must act and would require public hearings, nonsensically, for group rates. She also said the bill would provide the Attorney General and Advocate with extraordinary subpoena powers. The Chairs indicated that the bill is a work in progress.

Florida health insurance Insurance Commissioner Kevin McCarty has disclosed that he will be submitting a medical loss ration (MLR) waiver request to HHS this week.

Georgia health insurance Insurance Commissioner Ralph Hudgens has indicated he will be submitting an MLR waiver request to HHS within a week.  Aetna insurance continues to work with the Chamber of Commerce and plan sponsors to help defeat legislation that would apply prompt-pay requirements to self funded plans, in violation of ERISA.

Oklahoma health insurance Last week State Rep. Mike Ritze, one of two doctors serving in the Oklahoma legislature, called on state officials to turn down million that would be used to implement the new federal health care law. Shortly thereafter, Governor Mary Fallin joined other state leaders in announcing that Oklahoma will accept the grant to help design and implement the information technology infrastructure to operate an Oklahoma health insurance exchange. Fallin listed the creation of such an exchange as one of her top priorities in her State of the State address earlier this month. She and others announced their support for the grant after working with state agencies to ensure that no unworkable federal mandates were included.

Later in the week, the legislature continued taking steps forward to reduce the number of uninsured Oklahomans. House Speaker Kris Steele authored a bill that defines the membership and appointments to the Health Care for the Uninsured Board (HUB), which is designed to establish a system of counseling, including a website, to educate and assist consumers in selecting an insurance policy that meets their needs.  The seven-member HUB consists of representatives from the Insurance Commissioner’s Office, the Oklahoma Healthcare Authority, insurance companies, agents and also consumers. The purpose of HUB is to implement a market-based insurance exchange.  The bill passed the House Public Health Committee at the end of the week and will proceed to the floor of the House.

Texas health insurance Legislators are wrestling with to what extent they should intervene in what residents eat, drink and breathe. In a state with some of the nation’s highest obesity and diabetes rates, supporters of various proposals say they are trying to give Texans more ways to combat unhealthy decisions by others, as well as make good choices for themselves. The president of the Texas Medical Association testified last week in favor of a bill banning the sale of unhealthful drinks (sugary fruit juices, sodas, whole milk) to students during school hours. Other related bills would allow the state to raise taxes on sweet sodas and fine restaurants for not posting nutritional information.

About 30 percent of Texas schoolchildren are obese or overweight, according to the Texas Public School Nutrition Policy. And last month, Republican Comptroller Susan Combs released a report saying obesity cost Texas businesses .5 billion in 2009 — that could rise to billion by 2030 due to the cost of health care services, absenteeism, decreased productivity and disability. Legislators will continue debate on these bills until the session adjourns on May 31.

Are you covered? Job losses can mean loss of health coverage

Article by Craig Stiff, Marketing Director for Lifespring Health

Employer-sponsored health insurance can leave you with a false sense of security. Your out-of-pocket costs may, at first, appear more affordable and less intimidating than acquiring a policy privately. But as health care costs and insurance premiums rise for the employer, those costs get passed on to you in the form of higher deductibles, less coverage, and ultimately a risk of losing coverage altogether if you lose your job.

Maintaining COBRA premiums during the transition can be exorbitant, and if a serious illness should develop while on COBRA, it’s possible other insurance companies may not approve the new policy.

Health Savings Accounts can provide an affordable alternative that doesn’t go away when the job ends and is ideal for family coverage. Additionally, HSAs can travel with you from job to job, and are not lost should your job change. A HSA combines a qualified High Deductible Health Plan (HDHP) with a tax-favored savings account. Money in the savings account helps you pay for your health insurance deductible and routine medical expenses. HSAs are 100 percent tax-deductible, as long as your HSA funds are used for eligible medical expenses.

The benefits of Health Savings Accounts:

Choosing a more Affordable health insurance plan that incorporates a HSA has many rewarding benefits. Below is a list of benefits as published recently in the Chicago Tribune Newspaper.

* Tax-free accounts could accumulate money over several years and turn into a sizable health-care nest egg for healthy people with low medical expenses. * Consumer is more likely to question health-care expenses that currently do not get much scrutiny. * High-deductible policies that must be linked with HSAs tend to be cheaper. * May be attractive to young, healthy people who are uninsured. * With incentives, could drive down cost of insurance for small- business employees

Caring For The Health of Immigrant Children

Canada is a nation of immigrants.This is particularly evident in Canadian cities with nearly four million people born outside of Canada live in Toronto, Montreal and Vancouver alone. Toronto is one of the most culturally diverse cities in the world.  As a place to experience the diversity, Canada has generally performed well: it is a peaceful, multicultural and prosperous. Too often, however, families and immigrant children are experiencing poverty, racism and poor health.

Canada agrees selectively immigrants. Those who successfully pass the selection process tend to be healthy, competent and highly motivated. TPresumably they manage to integrate. PHowever, it is now known that their health is deteriorating after they arrived here.  The medical literature shows that minorities, including immigrants, often receive health care and social services of lower quality, and have poorer health outcomes. The medical literature shows That Minorities, Including immigrants, Often Receive Health Care and Social Services of lower quality, and outcomes Have Poor Health. They are less likely to visit a doctor or a dentist regularly, or have a regular provider. They Are Likely to visit less a doctor or a dentist Regularly, or Have a regular provider. Adult immigrants are more likely to be unemployed or to be overqualified for their jobs, even if they have a university degree, and just half of the children of families of recent imigrants living in poverty. Adult immigrants are more Likely to Be Unemployed To Be or overqualified for Their Jobs, Even If They Have a university degree, and just half of the children of families of recent imigrants living in Poverty.

If we talk about the health of Canadian children, it is important to keep in mind that one child in five is an immigrant or child of immigrant parents. If we talk about the Health of Canadian children, it IS important to keep in mind That One child in five gold Is An immigrant child of immigrant parents. The health of immigrant children is clearly a priority if we want all Canadian children reach their full potential. The Health of immigrant children a priority IS Clearly if we want all Canadian children Their reach full potential.

For now, we are not doing enough. For now, we are not doing enough.
Different experiences, but similar needs different experiences similar goal Needs

Every child needs generally similar for healthy development: a loving family, a safe and healthy, nutritious food, education and access to health care. Every Child Needs Generally similar for healthy development: a loving family, a safe and healthy, nutritious food, education and access to Health Care. For immigrant children, those needs may be more difficult to fill. For immigrant children, Those Needs May Be more difficulty to fill.

Immigrant children may come home with health problems not covered in their home countries, not to speak English or French, have different beliefs about health and illness and different expectations of the health system. Immigrant Children May Come home with Health Problems not Covered in Their Home Countries, not to speak French or Français, Have different Beliefs about Health and Illness and different expectations of the Health System. Even the climate may be completely foreign to them. Even the climate May Be Completely foreign to ‘em. For refugees, often fleeing hunger, violence and chaos in their country of origin, the difficulties are even greater. For Refugees, Often Fleeing hunger, violence and chaos in Their Country of Origin, The Difficult Even are greater.

After arriving in Canada, immigrant children may be in a place where the crime rate is high, the transport is poor, and where stores that sell affordable and familiar foods are scarce. After Arriving in Canada, immigrant children in a place May Be Where the crime rate is High, the transport is poor, and blind Where That sell affordable and familiar foods are scarce. Their parents may have to work long hours for low wages, sometimes occupying more than one job at a time, reducing the time spent with family. Their Parents May Have To work long hours for low Wages, occupying Sometimes More than one job at a time, Reducing the Time Spent with family. The family must adjust to a new school system and find caregivers they trust. The family must adjust to a new school system and find caregivers THEY trust. In all cases, there is an intense period of adjustment to the new country in which attention could be paid less than optimal health issues common. In all boxes, There Is a year intense period of Adjustment to the new country in Which Could Be careful Paid Less Than Optimal Health from common.

Despite these challenges, many immigrant children adapt and do well. Despite challenges thesis, Many immigrant children do well and adapted. But too often, the needs of immigrant children are not well met. But too Often, the immigrant children of Needs are not well met.

As a society, how can we develop systems of support for immigrant families that meet our quality health care? As a society, How Can We develop systems of support for immigrant families That Meet Our Quality Health Care?

The label “immigrant” encompasses a variety of backgrounds, ethnicities, cultures and countries. The label “immigrant” encompasses a Variety of backgrounds, ethnicities, cultures and Countries. Some immigrants are rich, some not, some have had to face long periods of deprivation, while others are well fed and received care and quality education. Some immigrants are rich, not Some, Some Have Had to face long period of deprivation, while Others are well fed and Received care and quality education. Most are here by choice, but some others, for example, refugees are here because they can not stay in their home country. Most are here by choice, Some Other purpose, for example, Refugees are here Because THEY Can not stay in Their home country. To improve care, we must consider these factors. To Improve Care, We Must Consider thesis factors. There is no universal solution. There Is No universal solution.
Beyond language: appropriate care to the culture Beyond language: Culturally Appropriate Care

Patients who do not speak English should have access to competent interpreters to enable them to understand their carer and vice versa. Patients Who Do not speak Français Should Have Access to competent interpreters to enable Them to Understand Their carer and vice versa. However, language is only the starting point. However, Language is only the starting point. People of different cultures may also have belief systems on health very different; beliefs and expectations about health, illness and treatment. People of different cultures aussi May Have Health Belief systems on very different; Beliefs and expectations about Health, Illness and Treatment. A mismatch between the models of health beliefs can lead to misunderstandings or disagreements, resulting in poor treatment compliance and monitoring ineffective. A mismatch models of Between the Health Belief Can lead to misunderstanding or disagreement, Treatment Resulting in poor compliance and ineffective monitoring.

This is especially true for chronic diseases like diabetes, which must be managed over time with both medications and lifestyle changes. This is Especially true for chronic diseases like diabetes, Which Must Be Both managed over time with medications and lifestyle exchange. To effectively manage diabetes, patients and families need to understand and use a large amount of information: the effect of high sugar levels and low on the body, the effect of food, exercise and the insulin on blood sugar, how to give insulin injections, how to measure sugar levels, the meaning of the ups and downs of blood sugar, and what constitutes an emergency. To Effectively manage diabetes, patients and families Need to Understand and use a large Amount of information: the effect of high and low Sugar Levels on the body, the effect of food, exercise and insulin on the blood sugar, how to Give insulin injections, how to measure sugar Levels, The Meaning of the ups and downs of blood sugar, and What Constitut year emergency.

In turn, an understanding of this information means to integrate them into a belief system that lasted a lifetime. In turn, an understanding of this information means clustering to integrate Them Into a Belief Systems That Lasted a Lifetime. In some cases, this information interfere with the set of beliefs. In Some Cases, this information interferes with the set of Belief. As a simple example, the belief that “sugary foods are bad for health” is potentially dangerous for a child with hypoglycemia, but it is still common in our culture. As a simple example, the Belief That “sugary foods are bad for health” is Potentially dangerous for a child with hypoglycemia, But It Is Still common in our culture. Families from different cultures may have other beliefs that impact also marked on the treatment, and these beliefs must be recognized and addressed. Families from different cultures Other Beliefs That May Have Impact on the marked-aussi Treatment, and thesis and Beliefs Must Be Addressed reconnu.

In extreme cases, patients and carers may decide that all the other “wrong” or is “stubborn” about the disease, leading to frustration on both sides, and most importantly , poor disease control. In extreme boxes, patients and carers decide That May all the other “wrong” or is “stubborn” about the disease, Leading to frustration on Both Sides, and MOST importantly, poor disease control. Caregivers should take the time to examine the beliefs of their patients about the disease, to discover how they compare to their own beliefs, and addressing any incompatibility. Caregivers Should Take the time to examine the Beliefs of Their patients about the disease, to discover how to compare THEY Their Own Beliefs, and Addressing Any Incompatibility. At the same time, society in general and health facilities in particular must recognize the need for culturally appropriate care and advocate. At the Same time, society in general and in Particular Health Facilities Must Recognize the Need for Culturally Appropriate Care and advocate.
Beyond the walls of the hospital support networks and formal Beyond the walls of the hospital and formal support networks

Social support networks, both formal and informal, are essential to the health of children and family. Social support networks, formal and informal Both, are essential to the Health of Children and Family. Indeed, a strong network of social ties does not mean only to have someone in a crisis, it is a resource for child care, employment, or places to buy food and get to known knowledge systems mixtures as the school system. Indeed, a strong network of social ties Does not mean only to Have Someone In a crisis, it IS a resource for child care, employment, or places to buy food and get to knowledge systems mixtures Known as the school system. Many new immigrants need resources like this to adjust to a new country, but left most of their support network or friends, colleagues and extended family behind. Many new immigrants Need resources like this to adjust to a new country, aim left MOST of Their support network or friends, colleagues and extended family behind.

In Toronto and other cities, social service agencies are part of the formal network of support. In Toronto and Other cities, Social Service Agencies are Part of the formal network of support. Many of them offer their services to immigrant communities in particular, although this is not all communities that have a corresponding body. Many of Them Their offer services to immigrant Communities in Particular, although This Is Not all Communities That Have A Corresponding body. By helping communities with employment, language training and housing, social services agencies play an important role in helping new immigrants during their transition to life in a new country. By Helping Communities with Employment, housing and language training, social services Agencies play important role in year Helping new immigrants transition to life DURING Their in a new country. By immigrant families in contact with others, they can help the development of informal support networks. By immigrant families in contact with Others, They Can Help the development of informal support networks.

The social support networks may also have more direct effects on health. The social support networks aussi May Have More direct effects on health. A social service agency or another immigrant family can be the first point of contact for a parent whose child is sick. A social service agency or Another immigrant family Can Be the first point of contact for a parent Whose child is sick. If the family of a child with a chronic health condition does not trust the health care team, a religious leader or community can play the important role of advocate and mediator. If the family of a child with a chronic health condition Does not trust the Health Care Team, a Religious leader or the community Can Play important role of advocate and mediator.
Employment for new immigrants Employment for new immigrants

Immigrants are more conducive to having a university degree than Canadians born in Canada, many immigrants also have graduate degrees or professional. Immigrants are more Conducive to Than Having a university degree Canadians born in Canada, immigrants Also Have Many graduate degrees or professional. Unfortunately, immigrants often fail to find a job that matches their skills and their motivation when they arrive in Canada, which in turn means they are less likely to get a job with health benefits and sick leave, and more likely to lose a day’s wages if they take leave to care for a sick child. Unfortunately, immigrants Often fail to find a job That matches Their skills and Their motivation When They arrive in Canada, Which in turn means clustering They Are less Likely to get a job with Health Benefits and sick leave, and more Likely to lose a day’s Wages if THEY take leave to care for a sick child. They also have fewer opportunities for job training and career advancement. Theys aussi Have Fewer Opportunities for job training and career advancement. In 2007, the unemployment rate among immigrants aged 25 to 49 years was 6.6% compared to 4.6% for those born in Canada. In 2007, the Unemployment Rate Among immigrants aged 25 to 49 years Compared to WAS 6.6% 4.6% For Those born in Canada.

A smile and a pat on the back does not clear enough to welcome immigrants. A smile and a pat on the back Does not Clear Enough to welcome immigrants. Canada must continue to strive to identify and break down the barriers that immigrants face when they try to find a job, including the recognition of foreign credentials, support professionals trained to upgrade their skills and use their training in Canada, and lobbying employers to hire skilled immigrants. Canada must continue to Strive to Identify and break down the Barriers That immigrants face When They try to find a job, Including the recognition of foreign credentials, media professionals trained training to upgrade skills and Their use Their training in Canada, and lobbying to hire skilled Employers immigrants. Immigrants are not the only people who will benefit, employers will also benefit from diversity, as well as their customers and their patients. Immigrants are not the only people Who Will Benefit, Employers Will Also Benefit from diversity, as well as Their Customers and Their Patients.
The challenges are not limited to immigrant children are not limited The challenges to immigrant children

Immigrant children face health problems, but they are not alone. Immigrant children face Health Problems, They Are Not Alone goal. We can not forget other disadvantaged groups such as Aboriginal children, children living in poverty, children with chronic illnesses or disabilities and children whose parents have drug addictions or serious mental health problems. We Can not Forget Other Disadvantaged Such groups as Aboriginal children, children living in Poverty, Children with Chronic Illness or Disabilities and Children Whose Parents Have Serious drug addiction or Mental Health problems.

Without support, these children can not reach their full potential. Without support, thesis Can not Reach Their children full potential. They are less likely to succeed in school and more likely to live in poverty. They Are Likely to Succeed in less school and more Likely to Live in Poverty. Instead of trying to solve these problems in 20 years, we have to prevent now. Instead of Trying to solve Problems in thesis 20 years, We Have to Prevent now. Canada needs a national strategy for poverty reduction, better support systems and funding sources for education and early childhood care and more opportunities in disadvantaged neighborhoods. Canada needs a national strategy for poverty reduction, better support systems and Funding sources for education and early childhood care and more opportunities in Disadvantaged Neighborhoods. If children can not develop optimally, we all lose. If Children Can not Develop optimally, we all lose.

As a society, institutions and individuals, we must continue to be sensitive to the needs of disadvantaged children. As a society, institutions and Individuals, we must continue to Be Sensitive to the Needs of Disadvantaged Children. We must also continue to work with underrepresented communities to address their needs. We must continue to work with aussi underrepresented Communities to Address Their Needs. Any solution that we could get under the partnership. Any solution That We Could Get Under the partnership.

Denis Daneman, MB, BCh, FRCP (C) is a pediatrician in chief at The Hospital for Sick Children (SickKids), chairman of the department of pediatrics at the University of Toronto and chair of pediatrics at the RS McLaughlin Foundation. Denis Daneman, MB, BCh, FRCP (C) Is A pediatrician in chief at The Hospital for Sick Children (SickKids), chairman of the department of pediatrics at the University of Toronto and chair of pediatrics at the RS McLaughlin Foundation. He is a specialist in pediatric endocrinology, and his research interests include diabetes, insulin resistance, eating disorders and the provision of health care. He Is a specialist in pediatric endocrinology, and His Research Interests include diabetes, insulin resistance, Eating Disorders and the provision of Health Care.

Archive Archive of pediatricians in the area of ??the corner of Pediatricians

Elizabeth Lee Ford-Jones, MD, FRCP (C) is a specialist in infectious diseases and clinical researcher at The Hospital for Sick Children and professor of pediatrics at the University of Toronto. Elizabeth Lee Ford-Jones, MD, FRCP (C) Is A specialist in infectious diseases and clinical researcher at The Hospital for Sick Children and professor of pediatrics at the University of Toronto. She is co-editor of Paediatrics and Child Health, the official journal of the Canadian Paediatric Society. She is co-editor of Paediatrics and Child Health, the official journal of the Canadian Paediatric Society. She also participated in the design of the book of the Canadian Paediatric Society, care guide for children and young new Canadians. She participated in the design aussi of the book of the Canadian Paediatric Society, care guide for children and young new Canadians.

Incoming search terms: