Do people remember how important it was to have the Federal government in charge of public programs like Medicare and Medicaid.....education and housing. The Federal government made sure that these programs worked for the benefit of the people and the national scope made all states comply with these programs. THAT IS WHY WE HAVE THESE NATIONAL PROGRAMS......What Obama and Third Way corporate neo-liberals are doing with health care besides making global markets is moving health care decisions down to the states where each state is doing something different in meeting a broad and vague national criteria. THEY ARE TAKING THE STEP OF BREAKING UP THESE NATIONAL PROGRAMS AND WE ARE WATCHING AS HEALTH CARE IS COMMERCIALIZED SEEING IT TURNED INTO THE SAME KIND OF BUSINESS AS A BANK.
If you are a person who lives from week to week the banks prey on you stealing much of the little wealth you can accumulate. If you have a predatory health system.....which this will be.....the same thing will happen. These low-cost plans will be drained of money through fraud and access will be so low-quality as to be useless. There will be no legal cover as malpractice disappears and with public justice suspended people will be in big trouble with their health. THIS TIERED HEALTH SYSTEM WILL BE A NIGHTMARE!
When a health system becomes the hospital, the clinic, the insurance agent, the medical school, and the medical device supplier.......and profit is the motive at every turn, just as with the SEC and FINRA overseeing the financial industry by working for them.....we will have a nightmare on Elm Street as these exchanges are left to determine what gets paid and who has what access to care.
MOVING THESE HEALTH SYSTEMS TO STATE LEVEL IS JUST ONE STEP TO HANDING MEDICARE AND MEDICAID TO THESE SYSTEMS AND ELIMINATE THESE FEDERAL PROGRAMS ALTOGETHER!
VOTE YOUR INCUMBENT OUT OF OFFICE
RUN AND VOTE FOR LABOR AND JUSTICE NEXT ELECTIONS!!
Some of these are long so please at least peruse the articles. It shows this issue from labor's viewpoint and from a Wall Street financial viewpoint.
'Unions oppose simply shifting retirees into exchanges because insurance will cost more and provide worse coverage, said Steven Kreisberg, director of collective bargaining and health-care policy for the 1.6 million-member American Federation of State, County and Municipal Employees in Washington. Besides, he said, health care was part of the government commitment to employees'.
Troubled Cities See Exchanges as Way to Unload Retirees
By Mark Niquette & Alex Wayne - Jul 1, 2013 8:00 PM ET
- Bloomberg Financial
A physician's assistant conducts an exam on March 1, 2013 at International Community Health Services in Seattle. The clinic, which serves patients who speak more than 50 different languages, illustrates a challenge Washington state will face as it launches its new health insurance exchange as part of the federal Affordable Care Act. Detroit (9845MF) is facing bankruptcy, and Chicago wants to cut retiree benefit costs. Both are turning to President Barack Obama’s health-care overhaul in what could become a road map for cash-strapped cities.
The municipalities plan to end or limit health coverage for retirees under 65 who don’t yet qualify for Medicare, with the expectation they can get insurance in the exchanges opening Jan. 1 under President Barack Obama’s health-care law.
With U.S. cities facing rising benefit costs and billions of dollars in unfunded liabilities, more municipalities will consider moving retirees off city rolls and into the exchanges, even if they continue to subsidize the coverage, said Neil Bomberg, a program director at the National League of Cities in Washington.
“Cities and towns will be looking at ways to reduce those costs, and the exchanges may provide a very viable mechanism,” Bomberg said in an interview.
Coverage for about 7 million people expected to enroll in health exchanges next year will cost U.S. taxpayers about $26 billion, the Congressional Budget Office says. That figure nearly doubles a year later, and exchange coverage is expected to total $1.1 trillion through 2023. A spokeswoman for the agency, Deborah Kilroe, said in an e-mail that it has no estimate of how many people in exchanges will be retirees.
Attractive Option Public and private employers began cutting coverage for former workers long before the 2010 passage of the Affordable Care Act, said Joel Ario, a former director of the federal Office of Health Insurance Exchanges. The new marketplaces, which can’t exclude people for pre-existing conditions and have tax subsidies, provide a safety net, he said.
“That will become an option that I think a lot of employers and a lot of cities would look at,” said Ario, now a managing director of Manatt Health Solutions, a Washington consulting firm that advises insurers.
The trend could reach the state level, said Scott Pattison, executive director of the National Association of State Budget Officers in Washington.
In Detroit, reducing benefits for 30,000 employees and retirees is part of Emergency Manager Kevyn Orr’s plan to avoid the largest U.S. municipal bankruptcy by erasing a $386 million deficit and attacking a long-term debt of at least $17 billion.
The city had 19,389 retirees eligible for health, life-insurance and death benefits as of June 30, 2011, according to Orr’s plan. The insurance benefits cost the city $177.4 million in fiscal 2012. Retirees contributed an additional $23.5 million.
Start Saving Orr wants to give current and former workers health-reimbursement accounts. The city would pay from $100 to $250 a month to help with medical costs or premiums under the Patient Protection and Affordable Care Act, according to a proposal to city unions.
That would cost the city as little as $27.5 million annually, according to Orr’s plan.
Chicago plans to phase out retiree health coverage by the beginning of 2017, according to a May 15 letter from Comptroller Amer Ahmad.
The city projects that health-care spending would increase to $540.7 million in 2023 from $108.8 million in 2012 without changes, according to a Retiree Healthcare Benefits Commission report in January.
Having exchanges means that “eliminating healthcare benefits for early retirees is likely significantly less onerous on those retirees,” according to the report.
Balancing Commitments “The retirement health-care system as it stands today is fiscally unsustainable, and we have a responsibility to ensure a secure financial path for Chicago taxpayers,” said Kathleen Strand, a spokeswoman for Mayor Rahm Emanuel. “The mayor also wants to ensure our retirees, who served this city honorably, have access to health care.”
Unions oppose simply shifting retirees into exchanges because insurance will cost more and provide worse coverage, said Steven Kreisberg, director of collective bargaining and health-care policy for the 1.6 million-member American Federation of State, County and Municipal Employees in Washington. Besides, he said, health care was part of the government commitment to employees.
“It’s convenient to say, ‘Well, they can go out and get coverage in the health insurance marketplace,’” Kreisberg said. “The moral obligation to the workforce remains.”
Cities may be able to supplement coverage or cost, but “if their primary interest is to simply shed those obligations completely and walk away, that’s where we’ll have conflict,” Kreisberg said.
Left Behind The exchanges won’t help all retirees, said Dwane Milnes, a former city manager of Stockton, California, which filed for bankruptcy last year.
The city ended subsidized coverage June 30, and Milnes, who is president of the Association of Retired Employees of the City of Stockton, estimated that as many as 300 won’t use exchanges because they won’t qualify for subsidies or won’t be able to afford premiums.
“They need to look at the issue of who is still going to be left uncovered, even with the exchanges, and to find some way of taking care of those folks,” Milnes said.
John Day, 52, a retired Detroit police officer, said being left to an exchange would be a slap in the face. The police and firefighters are not part of the Social Security system, and those hired before 1986 are not part of Medicare. Benefit plans were supposed to compensate.
“Imagine if they said tomorrow your Social Security, your Medicare is going away and you’re going on Obamacare,” Day said in an interview. “How would you feel?”
Model Cities Still, municipalities might not have much choice. As of fiscal 2009, the 61 most populous U.S. cities had funded only 6 percent of $126.2 billion in retiree health-care liabilities, according a report in January by the Pew Charitable Trusts.
Even though cities probably won’t be able to just offload retiree costs to the federal government, “you can be sure they will be watching Chicago and Detroit, and the implementation of the exchanges,” said Donald Boyd, senior fellow at the Nelson A. Rockefeller Institute of Government in Albany, New York.
“We can expect other cities to pick up on this,” said Richard Nathan, the institute’s former director who is studying the implementation of the health-care law. “I expect it to mushroom.”
As you see below these health insurance systems are simply moving people out of full coverage plans paid for by businesses and into high-deductible plans that cut access to care as the employee picks up more of the cost of coverage. It will be like a cable TV package where the cheaper rate will give you access to 100 channels almost none of which you watch and the ones you really want to watch are charging a much higher premium. These cable plans are worthless and we will see so too will be these state/private health insurance plans. People are finding they can only afford the preventative checkups with what is catastrophic health insurance that has a balloon of a deductible.
Enrollment by Plan Type
According to Aon Hewitt’s post-enrollment analysis for plan year 2013:
- 39 percent of employees with access to policies through the exchange enrolled in a consumer-driven health plan (CDHP)—a high-deductible plan with an HSA or HRA. In 2012, before their employers shifted to the newly launched exchange, only 12 percent of these employees were enrolled in a CDHP option.
- Conversely, the number of exchange-eligible employees who enrolled in a traditional preferred provider organization (PPO) plan decreased from 70 percent in 2012 to 47 percent in 2013.
This is a good synopsis of the private health insurance exchanges by none other than the NSA BOOZ spy machine! They are the consultant of global markets so you can tell the interest here will expand globally. What they point out that should make everyone cringe and run......these exchanges will likely become like the stock exchange where intermediaries charge all kinds of fees for service and like the stock market, we will see these health accounts soaked of value and victims of fraud. Remember, when the corporation pays these costs they have the motive to keep an eye on the insurer. When it is the consumer, the corporation buys stock in the insurer and profits off your losses. We all know how 401Ks are used as Wall Street fodder....
PerspectiveThe Emergence of Private Health Insurance ExchangesFueling the “Consumerization” of Employer-Sponsored Health Insurance
Health insurance in the U.S. is at the cusp of a major transition from an employer-driven payor model to a model directly involving many more employees and consumers. Private health insurance exchanges with a defined contribution approach represent a significant step toward catalyzing this change. In this paper—part of an ongoing series of Booz & Company Perspectives on the shift to consumerism in health insurance1—we consider the impact of this change on the payor industry and the strategic approach that leading companies need to take.
For decades, U.S. companies that offer healthcare benefits to employees have stuck to a defined benefits model, in which the company offers a standard set of health benefits and shoulders most of the financial burden and risk of healthcare cost. Over the past decade, this model has come under increasing strain as healthcare costs have more than doubled, creating an affordability crisis for employers. Now the problem has reached a tipping point. Some employers are considering a paradigm shift to their health benefits strategy that’s akin to the transition from pension plans to 401(k) accounts: switching from defined benefits toward a defined contribution model. Instead of designing and offering defined health benefits, companies make cash contributions to savings accounts that employees use to purchase insurance products of their choice. This model allows the company to cap its healthcare cost at a desired threshold, improving control of current expenses and future liabilities. In addition to the affordability problem, the employer-sponsored insurance landscape is also being altered by healthcare reform, particularly the establishment of the individual mandate and public health insurance exchanges. Healthcare reform specifically aims to make health insurance more affordable for individuals and small businesses; however, midsized and large employers might decide to use these public exchanges to control their own costs, terminating their insurance and routing employees to the public exchanges. This would compress payor margins and force payors to respond defensively with alternative solutions such as defined contribution plans and private exchanges. Meanwhile, intermediaries, such as benefits consultants, see an opportunity to strengthen their role in the value chain by offering solutions that help employers of all sizes control costs.
PAYOR CONCERNS ABOUT PRIVATE EXCHANGES
Booz & Company
Payors, too, have concerns about private exchanges. Private exchanges require a radical change to the payor’s business model—going from a purely business-to-business company to a business-to-consumer company—and there is understandable trepidation. Three concerns are most prevalent: • Margin compression: Greater choice of health plans on a private exchange may reduce cross-segment subsidization by healthier members and reduce overall payor margins. Multi-carrier exchanges could commoditize products and potentially lead to higher transaction fees—payors may have to pay an individual brokerage commission on what was formerly a group sale through a B2B channel. Finally, some payors worry that introducing some employers to a private exchange could encourage a broader transition to a lower-margin exchange market.• Administrative burden: Employees will need more decision support to select their plans. This burden may fall on the payor, which could, for example, require it to provide increased customer support to help employees select among product options,. Also, payors and exchanges will need to integrate their product, member, and billing data, which could increase administrative costs and complexity.• Disintermediation: Today, payors largely own the employer relationship and can strongly influence retention, up-sell, and cross-sell. In the future, the exchange administrator may control the sales and marketing process, diluting a payor’s contact with the customer and thus its ability to manage the relationship. _________________________________________________
If you think the Federal government is going to oversee this process to protect your interests you must have your head in the sand! These exchanges will be used for data-mining and selling data for profit. You information will be hacked and stolen just a bank accounts are now and there will be no controlling this just as we cannot get Facebook or Google to stop surveillance and selling personal data. These medical records will become just more of that data!
Do you really think health care is that negatively affected without these online databanks? Somehow we managed for decades to have good health care and good results for the most part without this.
THEY ARE SIMPLY CREATING YET ANOTHER MARKET WITH YOUR DATA!!!
Health Exchanges' Sharing of Patient Data Heightens Privacy Concerns
By Jordan Robertson - May 15, 2012 2:20 PM ET Bloomberg Financial
Victor Hand, a semi-retired railway manager in Maine, grew so alarmed when he learned that his state was building a database to store all residents' medical files that he rushed to the hospital to try to opt out.
"I sure don't want my information in that thing," Hand said. "I just don't think they can keep it private. If I knew for sure that nobody could get it but my doctors, then maybe I'd participate, but there's no way to guarantee that.''
Maine was one of the first states to set up a health information exchange -- a computer network connecting disparate medical practices, from rural, one-physician outposts to urban mega-hospitals -- to help doctors share patient files with the click of a mouse. Fueled by $548 million in federal grants as part of the Obama administration's health-care overhaul, the exchanges represent a radical change in how patient records are handled and used in treatment, Bloomberg.com reports.
The networks have also stirred controversy. In some cases, they include data without patients' consent, and privacy advocates fret that some exchanges may lose or even sell personal information.
A gap in federal law lets states set their own rules about whether to tell patients their medical data are being shared with an exchange and whether to let people opt out. The result: Many exchanges in the U.S. give patients no choice about such matters, according to the EHealth Initiative, a nonprofit organization that researches health-care technology. Many people don't know their medical files have been shared with an exchange, and they may not have a choice about having them removed.
"The whole system could get torn apart by the privacy issues," said Mark Rothstein, director of the Institute for Bioethics, Health Policy and Law at the University of Louisville's medical school. He said that if people were properly notified, most would approve of the exchanges.
There are now at least 255 exchanges throughout the country at various stages of development. New York and Texas each have 17, Florida has 12, and California and Michigan have 10 apiece, according to Washington-based EHealth Initiative. The databases have won support from care providers such as the Cleveland Clinic, Johns Hopkins Hospital and Mayo Clinic.
The exchanges may also be a boon for big insurance companies that provide the underlying technology, a market expected to grow to almost $800 million this year, according to Chilmark Research, which covers health-care technology. Suppliers include UnitedHealth Group's OptumInsight and Aetna Inc.'s Medicity.
Rushed to Hospital While concerns over privacy have scuttled formal plans for a national exchange, the federal government is pushing for standards that will let exchanges in different states communicate with each other.
The idea is to mimic cell phone networks, letting patients roam between providers and have electronic medical records follow, according to the Office of the National Coordinator for Health Information Technology, which oversees the efforts.
The exchanges have clear benefits, such as letting emergency room doctors look up an unconscious patient's medication history, lab results or record of previous problems. That can help physicians make quicker and more accurate diagnoses.
When Ann Sullivan, a 65-year-old, chronically ill retiree from Kennebunkport, Maine, was rushed to the hospital in December with sudden shortness of breath, she fretted that she was having a heart attack.
Sullivan was taken to Southern Maine Medical Center, which is a part of the state's health information exchange, so her doctor knew quickly what to look for: blood clotting in the lungs from a previous treatment. He diagnosed it as a chest cold and sent her home.
"Asking for Trouble"
"It gives me peace of mind -- tremendous peace of mind -- that something's there all in one place and that I'm being looked at holistically,'' said Sullivan, who said this was the fastest she had ever been discharged.
Yet many patients may not even know their data are being used. In the U.S., 48 exchanges give patients no choice at all about such matters, according to the EHealth Initiative.
"If you don't ask people and you just do it, you're asking for trouble," Rothstein said. "It's foolish. It's a shortcut that doesn't pay off in the long run."
Joy Pritts, chief privacy officer for the Office of the National Coordinator, said government officials are taking steps to ensure that patients have a say over inclusion and updating laws to impose privacy and security requirements on exchanges.
"We ensure that patients have some sort of meaningful choice and they're involved in the process," she said.
Patients Unaware Maine offers a case study in what can go right -- and wrong -- with exchanges. By some measures, the state's exchange is a success. It holds the medical files on more than 1 million residents, or three-quarters of the population. Still, the state's American Civil Liberties Union discovered that many patients weren't told their files were in the database, provoking a privacy outcry and prompting the passage of a new state law mandating that patients get an opt-out form at treatment.
Medical data are "at the heart of my humanness," said Kathleen McGee, a 58-year-old artist and environmental consultant from Bowdoinham, Maine, who campaigned for the law. "I don't think anyone else should have that information."
Devore Culver, chief executive of HealthInfoNet, the nonprofit that runs Maine's exchange, said many medical professionals had been ignoring a requirement the exchange imposed at its launch in 2008 that they alert patients. He said he welcomes the new law.
Identity-Theft Threat "It's a constant education challenge to keep people on the front lines informed about notification," said Culver. He said 10,000 patients have opted out, only a slight increase since the opt-out statute was enacted.
A big concern over sharing health records is that the information, which often contains a person's most private data, is a prime target of thieves. Medical providers suffer more breaches than any other type of organization, with 690 involving a total of 23 million records since 2005, according to the Privacy Rights Clearinghouse, a nonprofit consumer advocacy organization.
Medical identity theft, a form of insurance fraud in which thieves masquerade as others to receive treatments, affects 1.5 million people in the U.S. every year, according to the Ponemon Institute, an independent research organization.
Another concern is that exchanges with shaky finances could be tempted to sell data to marketers, which is permitted if the information is exchanged in an anonymous form.
Dave Miller, chief security officer of Covisint, a division of Compuware Corp. that makes technology for health information exchanges, said that while there is widespread interest in selling the data, it's not being done yet. Target customers would be pharmaceutical companies, academics and government researchers, he said.
"This is the stuff where everyone is on edge and waiting for the other guy to jump first and see if he gets his butt sued," Miller said.
Even patient-friendly policies can yield shortcomings. A recent report by the New York Civil Liberties Union found "significant flaws" in that state's exchanges, which cover nearly 3 million people. New York has an "opt-in" model, which is generally seen as the most favorable to patients. A key concern in New York is that because it's an all-or-nothing model, patients can't control which information is shared.
California Doctors Balk Some doctors have reservations, too. In California, health-care providers have refused to join exchanges because of membership and technology costs, according to Dorothy Glancy, a law professor at Santa Clara University who has studied the state's exchanges.
In Santa Barbara County, one of the nation's most ambitious exchanges collapsed in 2006 after repeated technical delays and a failure to sell health-care providers on the business case for making the investment.
Little could persuade Hand, the semi-retired railway worker, that it's wise to join a health information exchange.
"Insurance companies will get it -- that one really scares me -- marketers will get it, drug companies will get it, crooks will get it," said Hand, who plans to opt out of the exchange. He acknowledged that privacy poses risks, too: "If I have a stroke and the delay takes 10 minutes, then I lose the gamble.'"
Keep in mind as they move to change the way we receive health care so that most will not be able to afford much health care options....they are also watching as pension quaranty implodes from more and more corporate bankruptcy to shed these costs.
THE PROBLEM WITH HEALTH CARE IS MASSIVE CORPORATE FRAUD OF OUR ENTITLEMENTS AND HEALTH CARE WASTE. CORPORATIONS ARE ROLLING IN PROFITS.....THEY CAN MEET THESE OBLIGATIONS!
DO YOU HEAR YOUR THIRD WAY CORPORATE NEO-LIBERAL FIGHTING FOR YOUR HEALTH AND PENSION?
Pension Benefit Guaranty Corp. running $34 billion deficit
By Michael A. Fletcher,November 16, 2012
The federal agency that insures pensions for 43 million Americans saw its deficit swell to $34 billion in the past year, the largest in its 38-year history.
In its annual report released Friday, the Pension Benefit Guaranty Corp. blamed the growing shortfall on its inability to charge private employers adequate premiums for insuring pensions.
Citing the increasing deficit, PBGC Director Joshua Gotbaum called on Congress to give the agency power to set its own premiums. “We continue to hope that PBGC can have the tools to set its own financial house in order, the way other government and private insurers do,” he said in a statement.
The Obama administration has called on Congress to give PBGC’s board the power to set premiums. But those efforts have been unsuccessful, in large part because some members of Congress say that a new premium structure could significantly raise costs for companies whose retirement funds already are at risk of running out of money. Although Congress has raised PBGC premiums repeatedly in the past, they have not gone up in recent years.
PBGC is funded by a combination of insurance premiums from private pension plans, investment returns on its $85 billion in assets and recoveries from bankrupt companies. It receives no taxpayer money, and its leaders say it has has sufficient reserves to cover its obligations.
Overall, the agency saw its long-term liabilities increase $12 billion to $119 billion, while its assets grew by $4 billion over the past year.
If the shortfalls continue, Gotbaum warned, “PBGC may face for the first time the need for taxpayer funds. That is a situation no one wants.”
The agency has proposed setting premiums that reflect the perceived riskiness of the pension plans it insures, with financially shaky firms paying more to have their pension promises guaranteed by the agency.
But business lobbyists have branded the proposal a non-starter. They say any increases would work against the agency’s larger goal of enhancing the troubling retirement security landscape confronting many Americans by making it more expensive for the dwindling number of firms that have pension plans to insure them.
Currently, fewer than one in six private-sector workers are covered by defined-benefit pensions, a percentage that has been shrinking for three decades. More than half of private-sector workers have no retirement coverage through their employers.
Meanwhile, 53 percent of Americans are in danger of being unable to maintain their standard of living in retirement, according to the Center for Retirement Research at Boston College.
The agency’s deficit also has been fanned by low interest rates, which under accounting rules makes many troubled pension funds look even weaker.
In addition to its growing deficit, the PBGC said that at the end of 2010 it faced $332 billion in potential liabilities from fiscally unsound plans that could end up in its hands in the future.
In the fiscal year ended in September, the agency paid nearly $5.5 billion in benefits to 887,000 retirees whose plans have failed, and 614,0000 people are expected to collect benefits from the agency once they retire. In that year, the agency also assumed responsibility for the pensions of 47,000 people in newly failed plans.
The agency also is charged with discouraging financially trouble firms from jettisoning their pension obligations. Last year, the agency helped protect the pensions of 130,000 employees of American Airlines, which is in bankruptcy, according to the report.
It also helped preserve the pensions of 37,000 people whose companies have emerged from bankruptcy, including Houghton Mifflin Harcourt Publishing, the food retailer A&P, and the publishing company Lee Enterprises.