HHS Releases 2014 Federal Poverty Level Guidelines

January 23rd, 2014 § 0 comments § permalink

HHS has released 2014 federal poverty guidelines. Updated annually for inflation, the 2014 guidelines will set the income thresholds for subsidy eligibility on exchanges for 2015. The threshold (in the 48 contiguous states and DC) for one person will be $11,670, an $180 increase over the 2013 level. An employee’s receipt of exchange subsidies could trigger an employer shared responsibility penalty starting in 2015. IRS proposed rules include an employer affordability safe harbor based on the federal poverty level.

2014 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA

Persons in family/household   Poverty guideline

1 ………………………………………………… $11,670

2 ………………………………………………….. 15,730

3 ………………………………………………….. 19,790

4 ………………………………………………….. 23,850

5 ………………………………………………….. 27,910

6 ………………………………………………….. 31,970

7 ………………………………………………….. 36,030

8 ………………………………………………….. 40,090

For families/households with more than 8 persons, add $4,060 for each additional person.

2014 POVERTY GUIDELINES FOR ALASKA

Persons in family/household           Poverty guideline

1 …………………………………………………. $14,580

2 …………………………………………………… 19,660

3 …………………………………………………… 24,740

4 …………………………………………………… 29,820

5 …………………………………………………… 34,900

6 …………………………………………………… 39,980

7 …………………………………………………… 45,060

8 …………………………………………………… 50,140

For families/households with more than 8 persons, add $5,080 for each additional person.

2014 POVERTY GUIDELINES FOR HAWAII

Persons in family/household     Poverty guideline

1 …………………………………………………. $13,420

2 …………………………………………………… 18,090

3 …………………………………………………… 22,760

4 …………………………………………………… 27,430

5 …………………………………………………… 32,100

6 …………………………………………………… 36,770

7 …………………………………………………… 41,440

8 …………………………………………………… 46,110

For families/households with more than 8 persons, add $4,670 for each additional person

Clink on the link to the federal register:

http://www.gpo.gov/fdsys/pkg/FR-2014-01-22/pdf/2014-01303.pdf

Important near term fiscal considerations for Medicare Advantage plans

March 4th, 2013 § 0 comments § permalink

It seems that essential health programs, such as Medicaid and Medicare, are always the first on the chopping block when it comes to budget cuts. This is largely due to the fact that these programs consume an enormous percentage of federal and state budgets. While there are components of each program that are in serious need of a fix, the cuts always seem to come from the wrong place. The Medicare Advantage plan is the most recent plan being threatened.

Embedded in PPACA are $716 billion in Medicare cuts, many of which come from Medicare Advantage. Right now, the insurance industry is fighting with Centers for Medicare and Medicaid services (CMS) regarding a proposal to cut 2.2% of Medicare Advantage payments beginning in April. This payment cut would likely result in higher out-of-pocket costs for seniors and reduce their benefits and healthcare choices. CMS on the other hand, argues that this payment cut would give interested parties more of an incentive to fight harder to repeal the Sustainable Growth Rate (SGR) formula; a fatally flawed formula that has unsuccessfully been used for years to predict Medicare payments. Despite the fact that the SGR formula has virtually been flawed since its inception, it has yet to undergo a long-term fix. While developing a long-term SGR formula fix would save money and potentially boost Medicare Advantage payments in the future, cutting payment and subjecting seniors to higher out-of-pocket costs and different benefits and health services in the meantime to us seems just a little too risky.

The America Health Insurance Provider (AHIP) Center for Policy and Research recently published a report that shows when coupled with other health reform related changes, CMS’ most recent proposal for the program will reduce Medicare Advantage payments next year by more than eight percent, or approximately $11 billion. Obviously, cuts of this magnitude will have a destabilizing effect on the program and be putting at risk the healthcare coverage upon which millions of beneficiaries rely.

Institute of Medicine report on waste, fraud, and abuse in the American healthcare financing system

September 11th, 2012 § 0 comments § permalink

Everyone involved in the healthcare delivery system knows that there is waste involved and that the waste is driving health care costs. But just exactly how much waste there is in our system may surprise you. Last week, the federal Institute of Medicine issued a report that shows about 30 percent of all American health spending in 2009 — roughly $750 billion — was wasted on unnecessary services, excessive administrative costs, fraud, and other problems.

The report shows that unnecessary services are the biggest problem, accounting for $210 billion in annual waste. Combining that number with $130 billion in costs due to inefficiently delivered services should give providers and patients everywhere pause. Administrative waste is another big culprit, representing $190 billion. Other problem areas include care prices that are too high, fraud, and missed prevention opportunities.

The Institute members issuing the report are very clear in their assertion that something’s got to give, and their main idea how to fix the system is a very simple one—health care should be better organized and coordinated. “Left unchanged, health care will continue to underperform, cause unnecessary harm, and strain national, state, and family budgets,” the panel wrote. “The actions required to reverse this trend will be notable, substantial, sometimes disruptive — and absolutely necessary.”

“Choosing Wisely” is Key To Health Care Cost Containment

April 10th, 2012 § 0 comments § permalink

Last week, nine major medical specialty societies representing 374,000 physicians nationally began their “choosing wisely” campaign geared at reducing healthcare costs by educating the public and fellow healthcare providers about over-utilization of healthcare services.

The group released a list of 45 questionable tests and procedures that are often offered to patients unnecessarily and should be questioned as a means of reducing overall healthcare spending. Each of the nine involved practice areas, which range from the American Academy of Family Physicians to the American College of Radiology and the American Society of Clinical Oncology, developed their own lists of “Five Things Physicians and Patients Should Question” in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

This public information effort is spearheaded by the ABIM Foundation and Consumer Reports, and is intended to reduce healthcare costs in the long run. The Congressional Budget Office estimates that up to 30 percent of care delivered in the United States goes toward unnecessary tests, procedures, doctor visits, hospital stays and other services that may not improve people’s health—and, in fact, may actually cause harm. Furthermore, the federal Institute of Medicine (IOM) has estimated that as much as 30 percent of healthcare in the United States is wasted.

If current trends remain unchanged, the Centers for Medicare & Medicaid Services project U.S. healthcare spending will reach $4.3 trillion and increase from 17.3 to 19.3 percent of the nation’s gross domestic product by 2019.

“Choosing Wisely” is Key To Health Care Cost Containment

April 10th, 2012 § 0 comments § permalink

Last week, nine major medical specialty societies representing 374,000 physicians nationally began their “choosing wisely” campaign geared at reducing healthcare costs by educating the public and fellow healthcare providers about over-utilization of healthcare services.

The group released a list of 45 questionable tests and procedures that are often offered to patients unnecessarily and should be questioned as a means of reducing overall healthcare spending. Each of the nine involved practice areas, which range from the American Academy of Family Physicians to the American College of Radiology and the American Society of Clinical Oncology, developed their own lists of “Five Things Physicians and Patients Should Question” in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

This public information effort is spearheaded by the ABIM Foundation and Consumer Reports, and is intended to reduce healthcare costs in the long run. The Congressional Budget Office estimates that up to 30 percent of care delivered in the United States goes toward unnecessary tests, procedures, doctor visits, hospital stays and other services that may not improve people’s health—and, in fact, may actually cause harm. Furthermore, the federal Institute of Medicine (IOM) has estimated that as much as 30 percent of healthcare in the United States is wasted.

If current trends remain unchanged, the Centers for Medicare & Medicaid Services project U.S. healthcare spending will reach $4.3 trillion and increase from 17.3 to 19.3 percent of the nation’s gross domestic product by 2019.

Ryan targets U.S. employee healthcare tax breaks

September 29th, 2011 § 0 comments § permalink

An interesting Reuters article at http://bit.ly/nZqHpq talks about House Budget Committee Chairman Paul Ryan’s speech at Stanford University in which he advocates for replacing the income tax exclusion for people who get employer-sponsored health insurance with a refundable tax credit that they could use to purchase coverage on their own.

The public policy concept here is to reallocate the tax subsidy through the current employment-based system, which has as its origin wage freezes during WW II, with a system of refundable tax credits that would clearly empower consumers and result in a truly portable system of coverage not tied to one’s employment.  Conceptually it makes a great deal of sense, but in the current political environment, as the article points out, this approach is a “non-starter” in the Congress.

 

What Will The Super Committee Do With Federal Financing of Health Care?

August 9th, 2011 § 0 comments § permalink

Last week’s enactment of the Budget Control Act didn’t just raise the debt ceiling and reduce federal spending. It also mandated the creation of a bipartisan 12-member joint congressional committee (known as the “super committee”) that will be tasked with coming up with over $1 trillion dollars in proposed cuts to federal spending by November 23. Washington is currently buzzing with speculation as to who will serve on the committee, if the committee will be able to come to an agreement and what their recommendations will be, and how their work will impact the movement of federal legislation this fall. No matter how you slice it, though, it looks like public health care financing changes are on the horizon.

Many potential health-related spending cuts have already been identified and included in the recommendations of the bipartisan independent deficit reduction committee that completed its work last year. The deficit reduction group negotiations led this spring and summer by Vice President Biden, and the bipartisan Senate “Gang of Six” have also already revealed many options. Some of the most commonly discussed potential health-related changes address Medicare, including raising the Medicare eligibility age, imposing stricter Medicare fraud and abuse standards, restructuring Medicare benefits, raising the Medicare Part B premiums, changing the payment formulas for Medicare providers including doctors and hospital systems, developing a Medicare premium support or voucher program, and creating restrictions for subsidized Medigap plans. Other options include eliminating the CLASS Act program, restructuring state Medicaid payments to a block-grant format, imposing Medicaid drug rebate requirements on Medicaid/Medicare dually eligible individuals and making changes to the federal tax treatment of health insurance, among others.

But what if the super committee can’t meet its deadline and agree on the proposed cuts? Or what happens if one or both chambers of Congress fail to pass legislation to enact their proposed changes or President Obama declines to sign such legislation? According to the terms of the Budget Control Act, if legislation is not enacted by the end of the year, automatic across-the-board cuts come into play. Medicaid is exempt from mandatory cuts, so some advocates working with Medicaid clients may actually prefer that option. But on the other hand, Medicare provider reimbursement would not be exempt, and neither would many of the discretionary programs within HHS and other departments. That means that PPACA grants to states and other health reform programs and offices would see automatic and immediate budgetary reductions that could have a substantial impact on implementation.

CMS Study: Reform Will Raise Healthcare Spending By 0.1%

August 1st, 2011 § 0 comments § permalink

Politico (7/29, Norman) reports, “The Affordable Care Act will drive health care spending up slightly, to nearly a fifth of the country’s gross domestic product by 2020, while extending insurance coverage to 30 million more Americans, a new report from” the Centers for Medicare and Medicaid Services (CMS). Yet, “health care’s hefty share of the country’s economic output is reached through an average annual growth in medical spending of 5.8 percent over the next decade — just 0.1 percent more than would have been spent without the health reform law, the report claims.” The findings were published Thursday in the journal Health Affairs.

The Wall Street Journal (7/29, Adamy) says that according to the data, the ACA will change who pays for healthcare in the US. By 2020, government will be responsible for nearly 50% of healthcare costs, mainly because of the expanded Medicaid provision in the law. Meanwhile, employers will pay for a somewhat smaller portion of healthcare costs because it is expected that some companies will cease to provide coverage. Nevertheless, the actuaries who compiled the data warned that their projections could be altered if parts of the healthcare law are revamped.

Bloomberg News (7/29, Young) reports the data suggest that the ACA “‘just rearranges health-care spending so different people get to take advantage of it,’ said Joseph Antos, an economist at the American Enterprise Institute, a Washington policy organization, in a telephone interview yesterday. ‘It really doesn’t reduce health-care spending.’”

The Hill (7/29, Pecquet) reports in its “Healthwatch” blog, “Spending on prescription drugs and physicians and clinical services will grow much faster than without the law (10.7 percent in 2014 for drugs and 8.9 percent for clinical services), while the law will have relatively little effect on hospital spending despite the millions of newly insured people.” This is because “‘many of the newly insured will be younger and healthier,’ the actuaries wrote, ‘[and] are expected to use physician services and prescription drugs to a greater extent than hospital or other more intensive services.’”

The Washington Times (7/29, Cunningham) reports that these data “gave Republicans — who uniformly opposed the legislation — an opportunity to remind Mr. Obama of the emphasis he put on cutting back health care costs. While trying to sell his health care plan in 2009, Mr. Obama frequently stressed ‘bending the cost curve.’” Commenting on the study, Sen. Orrin G. Hatch (R-UT) said, “Simply put, this report states the obvious, that Americans have known for more than a year — the $2.6 trillion law only makes the fundamental problem of skyrocketing health care costs worse.”

CNNMoney (7/29, Kavilanz) notes that experts expressed markedly different reactions to the report. For instance, Leslie Norwalk, “former acting administrator for CMS, said the report paints a ‘very difficult’ situation for the country.” Norwalk added that it “shows health care spending is growing faster than the economy and faster than inflation. … Health care spending will double by 2020, and the government will pay 50% of that — this is troubling.” In contrast, Deborah Chollet, “senior fellow and health economist at Mathematica Policy Research,” argued, “The good news is that many more people will get health care coverage, for very little change in the rate of increase in overall health care spending.”

Federal Health Care Spending Remains a Top Priority

May 11th, 2011 § 0 comments § permalink

The future of Medicare and Medicaid and other public health spending programs will remain a top focus in Washington, DC, this week as Democrats and Republicans pursue negotiations on both the budget and raising the debt ceiling.

Vice President Joe Biden is leading bipartisan secret talks and significant cuts to Medicaid ($750 billion is the number being whispered around town) may be on the table in order to get the GOP votes needed to raise the debt ceiling. In addition, GOP leaders remain wishy-washy on their commitment to Representative Paul Ryan’s budget proposal, which would bring significant private-market changes and funding reductions to Medicare. Adding to the drama are two expected Senate budget plans that may be released this week. Senate Budget Committee Chairman Kent Conrad (D-ND) is expected to unveil his budget plan this week, which will contain Medicare cuts, and freshman GOP Senator Pat Toomey (R-PA) is expected to release another plan that will balance the budget in nine years but not touch Medicare spending.

Deficit Talks Could Impact Health Care Spending

May 2nd, 2011 § 0 comments § permalink

The federal debt and deficit also are top of mind for members of Congress as the nation nears its statutory debt limit. Treasury Secretary Timothy Geithner has said that the nation will hit the debt limit by May 16 but that Treasury can take steps to avoid a default until July 8. These talks could have health care implications, as many of the deficit-limiting proposals and spending cuts being discussed involve government-related and PPACA health care spending programs. Republicans are pressing for limits on federal spending in exchange for raising the debt ceiling, and House Majority Leader Eric Cantor (R-VA) has suggested that Republicans might extend debate on the measure well beyond May 16.

The so-called “Gang of Six,” a bipartisan group of senators working on deficit reduction plans, is widely expected to release its proposal in the near future. The proposal will be based on recommendations from the National Commission on Fiscal Responsibility and Reform, which were released in December 2010 and included significant health care changes, including the possibility of eliminating the federal income tax exclusion for employer-based health coverage, as well as eliminating the PPACA CLASS Act provisions that would create a new federal long-term care program. Members of the so-called Gang of Six are Sens. Mark Warner (D-VA), Saxby Chambliss (R-GA), Kent Conrad (D-ND), Dick Durbin (D-IL), Tom Coburn (R-OK) and Mike Crapo (R-ID).

In addition to the Gang of Six talk, on May 5 Vice President Biden will convene a bipartisan group of members of Congress for the first in a series of negotiations on deficit reduction. President Obama called for the group in an April 13 speech on deficit reduction. Members of the group are:

  • Senate Finance Committee Chairman Max Baucus (D-MT)
  • Senate Appropriations Committee Chairman Daniel Inouye (D-HI)
  • Senate Minority Whip Jon Kyl (R-AZ)
  • House Majority Leader Eric Cantor  (R-VA)
  • Assistant Democratic Leader Rep. James Clyburn (D-SC)
  • House Budget Committee Ranking Member Chris Van Hollen (D-MD)

We do NOT have a market economy in health care – the facts speak otherwise

March 2nd, 2011 § 0 comments § permalink

Kudos to my brother Jim for sharing the following with me which I find worthy, from a content perspective, to post:

Fun Facts to Continue Knowing and Telling

I’ve mentioned it several times before, but it bears repeating. In no country in the developed world do “consumers” of health care pay a smaller share of medical expenditures out of pocket than the United States. Or, let me repeat this one more time:

For every $1 spent on health care in the United States, 12 cents comes out of the pocket of consumers.

In other words, 88% of medical spending comes from third parties (and yes, I know that I pay insurance premiums, but that does not mean that the insurance company is not making the payments … think about my incentives to play an extra round of golf when I pay a one-time membership fee at the beginning of the year versus when I pay each time I play).

For those wondering, about half of these third party expenditures are from private insurers and the other half from government payments.

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