This has potentially huge ramifications on the insurance industry. Time will tell if it does any good . . . or anything at all.

By Patrick Yoest
Of DOW JONES NEWSWIRES

WASHINGTON (Dow Jones)–The White House on Tuesday publicly backed legislation to repeal the health insurance industry’s antitrust exemption, a small part of the Obama administration’s still-uncertain strategy to pass broader health overhaul legislation.

The bill, which the U.S. House of Representatives will vote on Wednesday, would remove insurers’ long-time exemption to competition laws, which Democrats hope will lower premiums in insurance markets by giving consumers more choices. The exemption for insurance companies was enacted in the McCarran-Ferguson Act of 1945.

Specifically, the bill would strip the exemption for egregious violations such as price fixing, bid rigging and market allocation. The White House Office of Management and Budget in a statement announced its support for the legislation, saying that “this bill will benefit the American health-care consumer by ensuring that competition has a prominent role in reforming health insurance markets throughout the nation.”

House Rules Committee Chairwoman Louise Slaughter, (D., N.Y.), a leading proponent of the bill, suggested that it is a matter of fairness that the industry is subject to the same rules as other companies.

“This industry has enjoyed a big giveaway for far too long, and it’s about time that it plays by the same rules as everyone else,” Slaughter said.

America’s Health Insurance Plans, an industry trade group, said in a statement Tuesday that the health insurance industry is already highly regulated and that mergers and other business practices are already subject to federal antitrust laws. Further, it cited “legal uncertainty” that would be created by the new law, which it said would chill developments in the industry.

Leading insurers in AHIP include Aetna Inc. (AET), Humana Inc. (HUM), Cigna Corp. (CI) and UnitedHealth Group Inc. (UNH).

It’s uncertain how Republicans will come down on the bill. A spokesman for House Minority Leader John Boehner (R., Ohio) said Boehner had not announced how he would vote.

Congressional Democrats are still trying to find their footing on health care, even though the White House introduced an 11-page document intended to act as a road map for blending House and Senate-passed versions of the legislation.

House Speaker Nancy Pelosi (D., Calif.) said she is “very pleased” with the White House proposal and that it is “getting a good reception” with House Democrats. But Rep. Peter DeFazio (D., Ore.), who appeared with Pelosi as part of a push for the anti-trust legislation, cited his own concerns about the omission from the plan of a government-run health insurance plan and a nationwide exchange for buying insurance.

DeFazio suggested the White House plan has not been presented as a take-it-or-leave-it proposition.

“We’re really beginning the process in the caucus over again,” DeFazio said. “There’s no fait accompli. There’s been no whipping, there’s been no pushing.”

-By Patrick Yoest, Dow Jones Newswires; 202-862-3554; patrick.yoest@dowjones.com

for full article go HERE

BusinessWeek had an awesome Cover Story on 10 Ways to Cut Health Care Costs. Please read.

10 Ways to Cut Health-Care Costs Right Now
Employers and hospitals don’t have to wait for Congress to address inefficiencies and waste

By Catherine Arnst

Seven hundred billion dollars. That’s a ballpark estimate of how much money is wasted in the U.S. medical system every single year, according to a new Thomson Reuters (TRI) report. A sum equal to roughly one-third of the nation’s total health-care spending is flushed away on unnecessary treatments, redundant tests, fraud, errors, and myriad other monetary sinkholes that do nothing to improve the nation’s health. Cut that figure by half, and there would be more than enough money to offer top-notch care to every one of America’s 46 million uninsured.

None of the health-care reform bills on the table in Washington do anything meaningful to address that wasted $700 billion. Nor do they call for changes in the underlying flaw that drives much of the waste—the fee-for-service system that pays doctors and hospitals for the amount of medical care delivered rather than for its quality. Under fee-for-service there is no financial incentive for doctors to eliminate waste, since they wouldn’t pocket any of the resulting savings. They would just earn less.

A BIG STEP FORWARD

BusinessWeek has looked at 10 such attempts to lower health-care costs and improve patient care. These innovations cannot have the same impact as a comprehensive federal bill. Nor are the gains from private efforts assured.

1. CRACK DOWN ON FRAUD AND ABUSE

Crime pays big when it comes to health care. This huge industry is run pretty much on the honor system. As law enforcement agencies have cracked down harder on illegal drugs, organized crime has diverted resources into multimillion-dollar medical scams, where there is less chance for detection. The FBI figures that fraudulent billings to Medicare, Medicaid, and private insurers account for 3% to 10% of total health spending, and the bureau concedes its estimates may be low. “Everywhere we look, we see evidence of fraud,” says Lewis Morris, chief counsel for the Office of the Inspector General at the U.S. Health & Human Services Dept.

2. DEVELOP A HEALTHY WORKFORCE

When Johnson & Johnson (JNJ) CEO William C. Weldon met with President Obama over the summer, he communicated a key message: Prevention pays. Weldon knows, because J&J has been offering comprehensive wellness programs to its 100,000 employees since 1995. Internal studies found that in the four years ended in 2002, those efforts saved $225 per employee per year.

3. COORDINATE CARE THROUGH FAMILY DOCTORS

A patient suffering from one or more chronic diseases may depend on several doctors, and rarely do they communicate with one another. This lack of care coordination means it’s nearly impossible to arrange complementary treatments, cross-check prescriptions, and avoid ordering the same diagnostic tests over and over. The resulting duplications and follow-up care cost the nation $25 billion to $50 billion a year.

4. MAKE HEALTH A COMMUNITY EFFORT

We are not a fit nation. One-third of U.S. adults are obese, and health spending on this group grew 80% from 2001 to 2006, to $166.7 billion.

5. STOP INFECTIONS IN HOSPITALS

Far too often, the biggest danger to patients is not their disease but the hospitals that treat them. Every year 1.7 million patients develop infections while in hospital, and 99,000 die as a result. These hospital-acquired infections add $30 billion to the nation’s annual health-care bill—and almost all are preventable. “For a long time there was a sense that a lot of these infections were inevitable,” says Dr. Donald Goldmann, senior vice-president of the nonprofit Institute for Healthcare Improvement. “But in the last five or six years medical professionals have come to realize we can do a lot better if we follow a zero-tolerance policy.”

6. GET PATIENTS TO TAKE THEIR MEDICINE

Three out of four Americans do not take their medicine as directed. This noncompliance leads to additional doctor visits, hospitalizations, and treatments that together add some $177 billion a year to the nation’s health-care bill, according to the National Council on Patient Information & Education.

7. DISCUSS OPTIONS NEAR THE END OF LIFE

One-quarter of Medicare dollars are spent in the last year of patients’ lives. The costs of end-of-life care vary wildly, however. The Dartmouth Institute for Health Policy has found that spending is nearly three times higher in Manhattan than in areas of Colorado, mainly because patients in Manhattan average 21.9 days in the hospital during their last six months, compared with only 6.3 days in Grand Junction, Colo. Yet higher costs don’t translate to longer or better lives.

8. USE INSURANCE TO MANAGE CHRONIC DISEASE

In 2009, UnitedHealthcare (UNH) introduced the Diabetes Health Plan, a new type of benefit that offers financial rewards to patients who manage their disease properly. Three companies, including General Electric (GE), are testing the plan, and 15 more workplaces signed on to roll it out in 2010. Employees who participate in the UnitedHealthcare plan must adhere to specific treatment guidelines and agree to be tracked by the insurer to make certain they are sticking with the program. In return, co-pays on their diabetes drugs are waived, along with other fees related to managing their disease.

9. LET WELL-INFORMED PATIENTS DECIDE

When Floyd “Jack” Fowler Jr. holds focus groups of heart patients, he’s amazed at their misplaced faith in the benefits of medical procedures. “They all think they’ll die if they don’t have bypass surgery or angioplasty,” says Fowler—even though studies show that both procedures extend lives or prevent heart attacks in only a tiny minority of especially sick patients. But hardly anyone knows this, he says.

10. APOLOGIZE TO THE PATIENT

Doctors regularly complain that fear of malpractice suits forces them to order far more tests and procedures than necessary. Although President Obama has said he is open to legislation that would limit malpractice awards, there may be a simpler solution. Sometimes all it takes is an apology.

The University of Michigan Health System adopted the policy in 2001 and reports that malpractice claims fell from 121 a year to 61 in 2006. The honesty “takes away some of the anger of patients and the ‘gotcha’ of plaintiff lawyers,” says Douglas B. Wojcieszak, who founded Sorry Works! after losing his brother to a medical error. “You don’t need any legislation, judge, or politician to do this—it’s simply customer service.” The University of Illinois Medical Center in Chicago started a formal apology program in 2006 and says the number of claims has since declined 40%, despite a 20% increase in clinical activity

Adult obesity rates increased in 23 states and did not decrease in a single state in the past year, according to F as in Fat: How Obesity Policies Are Failing in America 2009, a report released today by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

How Obesity Policies are Failing in America

July 2009

The percentage of obese or overweight children is at or above 30 percent in 30 states. Mississippi had the highest rate of adult obesity at 32.5 percent, making it the fifth year in a row that the state topped the list. Four states now have rates above 30 percent, including Mississippi, Alabama (31.2 percent), West Virginia (31.1 percent), and Tennessee (30.2 percent). Eight of the 10 states with the highest percentage of obese adults are in the South. Colorado continued to have the lowest percentage of obese adults at 18.9 percent.

Adult obesity rates now exceed 25 percent in 31 states and exceed 20 percent in 49 states and Washington, D.C. Two-thirds of American adults are either obese or overweight. In 1991, no state had an obesity rate above 20 percent. In 1980, the national average for adult obesity was 15 percent. Sixteen states experienced an increase for the second year in a row, and 11 states experienced an increase for the third straight year.

Mississippi also had the highest rate of obese and overweight children (ages 10 to 17) at 44.4 percent. Minnesota and Utah had the lowest rate at 23.1 percent. Eight of the 10 states with the highest rates of obese and overweight children are in the South. Childhood obesity rates have more than tripled since 1980.

The F as in Fat report contains rankings of state obesity rates and a review of federal and state government policies aimed at reducing or preventing obesity. Some additional key findings from F as in Fat 2009 include:

* The current economic crisis could exacerbate the obesity epidemic. Food prices, particularly for more nutritious foods, are expected to rise, making it more difficult for families to eat healthy foods. At the same time, safety-net programs and services are becoming increasingly overextended as the numbers of unemployed, uninsured and underinsured continue to grow. In addition, due to the strain of the recession, rates of depression, anxiety and stress, which are linked to obesity for many individuals, also are increasing.
* Nineteen states now have nutritional standards for school lunches, breakfasts and snacks that are stricter than current USDA requirements. Five years ago, only four states had legislation requiring stricter standards.
* Twenty-seven states have nutritional standards for competitive foods sold a la carte, in vending machines, in school stores or in school bake sales. Five years ago, only six states had nutritional standards for competitive foods.
* Twenty states have passed requirements for body mass index (BMI) screenings of children and adolescents or have passed legislation requiring other forms of weight-related assessments in schools. Five years ago, only four states had passed screening requirements.
* A recent analysis commissioned by TFAH found that the Baby Boomer generation has a higher rate of obesity compared with previous generations. As the Baby Boomer generation ages, obesity-related costs to Medicare and Medicaid are likely to grow significantly because of the large number of people in this population and its high rate of obesity. And, as Baby Boomers become Medicare-eligible, the percentage of obese adults age 65 and older could increase significantly. Estimates of the increase in percentage of obese adults range from 5.2 percent in New York to 16.3 percent in Alabama.

Key report recommendations for addressing obesity within health reform include:

* Ensuring every adult and child has access to coverage for preventive medical services, including nutrition and obesity counseling and screening for obesity-related diseases, such as type 2 diabetes;
* Increasing the number of programs available in communities, schools, and childcare settings that help make nutritious foods more affordable and accessible and provide safe and healthy places for people to engage in physical activity; and
* Reducing Medicare expenditures by promoting proven programs that improve nutrition and increase physical activity among adults ages 55 to 64.

The report also calls for a National Strategy to Combat Obesity that would define roles and responsibilities for federal, state and local governments and promote collaboration among businesses, communities, schools and families. It would seek to advance policies that

* Provide healthy foods and beverages to students at schools;
* Increase the availability of affordable healthy foods in all communities;
* Increase the frequency, intensity, and duration of physical activity at school;
* Improve access to safe and healthy places to live, work, learn, and play;
* Limit screen time; and
* Encourage employers to provide workplace wellness programs.

The Wall Street Journal had an interesting piece on deciphering your Health Insurance Plan. Read it for some interesting horror stories about people not understanding the terms of their plans.

The top 5 tips offered to help understand health insurance plans are as follows:

1) Start by making sure you have the full plan explanation, sometimes called the certificate of coverage, certificate of insurance or evidence of coverage. Though the document may be tough reading, the briefer summaries in marketing brochures can be “misleading,” says Mila Kofman, superintendent of the Maine bureau of insurance.

2) Closely check your out-of-pocket maximum, which represents the most you should have to pay for care in a given year. This important protection often comes with subtle qualifications.

3) Pay attention to the terms of your deductible.

4) Check how your plan handles doctors who don’t participate in your insurer’s network. Typically, plans that do provide out-of-network benefits pay only a percentage of so-called usual-and-customary fees. That can leave you with a significant charge.

5) Watch out for excluded benefits and coverage caps, including lifetime and annual limits on payouts. Some plans pay only a set fee per day of a hospital stay, for instance, which could leave you on the hook for thousands of dollars. Drug benefits don’t always include every medication. Some plans exclude maternity coverage, and some individual-market plans may not include care for pre-existing conditions. Insurers typically refuse to cover treatments they don’t consider “medically necessary.”

Understand Your Plan

Here are some helpful links for answers to frequently asked questions about health insurance:

• How much protection does health insurance offer and how can consumers know?
• Plan for Your Health
• Managing Medical Bills: Strategies for Navigating the Health Care System
• HealthCareCoach.com
• Questions and Answers About Health Insurance
• Health Insurance Glossary