Expanding coverage while containing costs is a concern for many
in the health care industry. Read about the challenging path to
health care reform in these blog entries from Jim Lott.
Jim Lott is the executive vice president of the Hospital
Association of Southern California where he is responsible for
health care policy development, advocacy, and association
communications for hospitals serving Los Angeles, Orange, San
Bernardino, Riverside, Santa Barbara and Ventura Counties.
This will be my last post, as I am leaving HASC at the end of
next month. Health is fine, work is great, just moving on
to the next chapter of my life, which will be in health care…what
else would I do?
I have enjoyed writing this blog, and I thank all of you who have
told me that you like reading what I write. I will truly
miss doing this.
Again, I’m still at HASC until May 31, so drop me a line or
call. After I leave, you may reach me on my cell at
213-324-3262 or by email at JLottSr@me.com.
The Society of Actuaries
(SOA) recently predicted health insurance costs in the individual
market would increase 32% by 2017. Not good news,
especially considering that the blame for this increase was
placed at the doorstep of the Accountable Care Act (ACA).
Contrary to the expectations of those who developed the new
reform laws, the SOA asserts that this increase is in part due to
the poor health status of the new enrollees now eligible under
the ACA.
Most would agree that cutting health care costs requires more
active participation of the consumer in medical decision making.
It’s a cost driver the Affordable Care Act (ACA) fails to
address.
Six years ago, I wrote about the emergence of retail clinics as
“…The Next New Thing” in the delivery of
health care. Even then, for almost 10 years these
enterprises had been offering basic medical care in drug stores
in nearly half the states in the country at about 12 percent of
the cost of an emergency room visit and a third of the cost of a
visit to an urgent care center.At the time, the California Health
Care Foundation opined that, “If successful, this could change
the way many people receive routine, non-urgent medical care,
with significant implication
In my last blog, I summarized
the plan to move Medicare/Medi-Cal-covered patients residing
in eight California counties into a system of coordinated
care. The move would make California the fifth
dual-eligibles coordinated care project in the nation. In no
particular order, the following demographics about plan enrollees
worry me:
Last week, federal and state officials released their
long-anticipated Memorandum of Understanding (MOU) implementing a
three-year effort to lower costs and improve the coordination of
medical care provided to nearly half a million California seniors
who are enrolled in both Medicare and Medi-Cal. If approved
by the feds, passive enrollment of program beneficiaries over a
12-to-18-month period will start in seven counties (Orange,
Riverside, San Bernardino, San Diego, San Mateo, Alameda and
Santa Clara) in October. What this means is that the
dual-eligible program beneficiaries
Starting in January, the federal Affordable Care Act (ACA) will
require all residents to secure health insurance or pay a $95 tax
penalty, assessed only if the filer qualifies for a federal tax
return.
A physician specialist that I see regularly ordered a diagnostic
test to check on my medical condition. He explained to me
that two tests were available and he disclosed which of the two
he preferred. Of course, I did what most patients do—I
chose his preference. Later I would learn that his
preference cost almost twice as much as the other test and that I
would have to pay more than $500 for the part of the bill not
paid by my health plan. I hasten to add that I am not upset
with my doctor. Rather, I am ticked off at myself and my
health plan for how this play
A belief I regard highly is, “That government is best which
governs least,” a quote historians have attributed equally to
Henry David Thoreau and Thomas Jefferson. Mind you, the
operative meaning or the verb infinitive in the quote is “to
govern.” Few who have been paying attention to the gridlock in
our nation’s capital give high marks to our elected
representatives for meeting this core job requirement. In
fact, one credible poll gives Congress an approval rating of only
14 percent, with the Obama Administration receiving only slightly
higher marks.
We’ve all heard this one. When asked about Congress or our
state legislature, voters give low performance ratings to both
followed by, “but my representative is a good guy.” It
would seem that the same holds true about constraining the growth
of health care costs.
I learned what that meant when as a third grader my mother moved
me to a private Catholic school from an economically depressed
inner-city public school where 70 percent of the students never
made it to high school graduation and where the majority of those
who did were sub-literate.
Demand for emergency room care in California has increased by 26
percent over the last decade while capacity has remained flat or
declined in most service areas. Accordingly, some health care
analysts recommend that hospitals be allowed to operate
freestanding emergency departments (FEDs) to help meet a growing
need in the state. FED supporters also believe that the enactment
of health care reform will put greater stress on existing
hospital emergency departments because as many as 40 hospitals in
California, most with emergency rooms, will close in the coming
years.
Almost one person in five in the U.S. speaks a language other
than English at home, and half of them have limited English
proficiency (LEP). Federal laws and standards require
language assistance, including bilingual staff and interpreter
services, be provided by health care organizations receiving
federal funds.
“… and pretty soon you’re talking real money.” The late Senator
Everett Dirksen (R-IL), a politician who often spoke passionately
about the debt ceiling, federal spending and the growth of
government, is rumored to have made this statement to reporters
about the way Congress thinks about the federal budget.
Well, the Rand Corporation may have found a billion dollars that
can be taken off our nation’s yearly health care tab.
Substitute “physician assistant” or “pharmacist” in this phrase,
and this may become a commonplace introduction patients seeking
medical care will hear in the future. Why?
Legislatures throughout our nation are looking for ways to bridge
a looming shortage of doctors caused by the approaching exodus of
aging physicians and the increased demand for access to
physician-led care by millions of newly-insured Americans,
courtesy of the federal Patient Protection and Affordable Care
Act (PPACA) enacted in 2010.
The federal health care reform law enacted in 2010 – the Patient
Protection and Affordable Care Act (PPACA) – excluded illegal
immigrants from eligibility for inclusion under its expanded
health insurance coverage provisions. Now it would appear that
health coverage for these immigrants will not be in the
immigration reform plan the White House and Congress will likely
hammer out later this year.
In California, 54 percent of health care coverage provided to
residents under 65 is sponsored by our state’s employers, down
from 61 percent prior to enactment of the federal law in 2010.
Last week, the nonpartisan Congressional Budget Office (CBO)
advised Congress that seven million fewer Americans were forecast
to have employer-sponsored health insurance in 2022 due to the
federal Patient Protection and Affordable Care Act (PPACA). The
estimate is up from August, when the CBO predicted a drop of four
million people with employer-sponsored plans.
Last week, the Internal
Revenue Service (IRS) and the Health and
Human Services Agency (HHS) published rules governing the
individual mandate that, according to
HealthLeaders Media, “include such extensive exemptions that
only 2% of the population would owe a penalty, or ‘shared
responsibility payment’ for not having coverage under a health
plan.”
There is no employer mandate to provide health insurance coverage
under the Patient Protection and Affordable Care Act (PPACA)
passed in 2010, but there is a stick in the form of a
$2,000-per-year/per-worker penalty hovering over the heads of a
minority of California businesses with more than 50 company
employees. The penalty will be assessed starting with the
31st worker and beyond.What this means is that the requirement to
either provide health insurance or pay a penalty does not apply
to 5.7 million out of 6 million (96 percent) of the registered
businesses in California.
The December 31st
Ventura County Star news report that Community Memorial
Health System (CMHS) will no longer hire people who use
tobacco gets my vote for the best New Year’s resolution made by a
health care organization.
A prominent retirement investment planning firm cites two
lifespan statistics in its advertising campaign that, if true,
will stun to death any efforts to rein in the aggregate growth of
what we spend as a nation on health care. “One in three
people born today will live to be 100 years old,” says one
billboard. “The first person who will live to be 150 years
old is alive today,” says another. Thought-provoking ads,
both, and the health care cost implications of such a trend are
breathtaking.
Medicare cost the federal government $528 billion in 2010.
Current projections place that funding level above $1 trillion in
2020, and that’s after deducting $45 billion in payment cuts per
year to providers and Medicare Advantage plans during that
period, as ordered by the federal Patient Protection and
Affordable Care Act (PPACA).
With some exceptions, the federal Patient Protection and Affordable Care Act (PPACA) enacted in 2010 requires everyone to get health insurance or pay a fine. The individual mandate contained in the act takes effect in 2014 and levies fines for failure to document coverage at the greater of $95 or 1 percent of annual income capped at $285 (triple the flat rate) for that year. After that, the penalty will grow until it reaches a ceiling in 2016 of the greater of $695 or 2.5 percent of annual income capped at $2,085.The IRS will be the compliance authority, and the agency is empowe
Once a year for the past seven years, our community of hospitals
in Southern California comes together to honor the most giving of
themselves, the laborers of the planet. Okay, so we are a
little biased about the people working in our hospitals. Here are
but five of the extraordinary people we honored last week along
with their stories.
Our first award went to a nurse and social worker on the front
lines of a busy hospital who teamed up to fix a problem that
plagues emergency rooms everywhere … frequent flyers.
One of my most vivid childhood memories was when, as a teenager,
I broke my arm playing softball at school. The pain was
excruciating, but it was the quest to get medical treatment for
my fractured appendage that is most memorable. The private
hospital closest to my school in South Central Los Angeles turned
my mother and me away because I had no medical insurance.
As a consequence, with my arm resting on a clipboard, we had to
take a very long bus ride to the county hospital in East Los
Angeles where I finally received treatment after enduring many
hours of extreme pain.
Search the blog archive
Subscribe to Lott on Health Care