The Affordable Care Act was simply meant to end Federal Medicare and Medicaid and create in the US the same health delivery model using wellness and preventative care only to replace what was a first world quality health care people paid payroll taxes for decades to receive----sorry, the Medicare Trusts was looted by massive health industry fraud and this coming bond market crash FROM BOND FRAUD is designed as an excuse to say ----NO MORE SOCIAL SECURITY AND MEDICARE TRUSTS!
You know something is terribly wrong when a President running as a progressive liberal wanting to save and strengthen Medicare partners with Johns Hopkins University---the very neo-conservative health institution that pushed for Maryland's exemption from Medicare for decades creating what was an ability to deny citizens of Maryland and especially Baltimore access to the level of Medicare and Medicaid coverage ALL OTHER STATES WERE LEGALLY MEANT TO PROVIDE. So, Maryland pools all Federal health care funds for Medicare and Medicaid and then does with them what corporate pols want---much never reaching seniors and the poor. Hopkins is the face of ending Medicare and Medicaid and has communities surrounding its campus with people dying 20-30 years earlier than more affluent communities all because of this exemption from Medicare that kept people from accessing ordinary health care.
THIS EXEMPTION WAS NEVER LEGAL-----BUT WHEN CLINTON NEO-LIBERALS CONTROL THE PEOPLE'S DEMOCRATIC PARTY---NO ONE CONTESTS THIS.
The goal of Affordable Care Act was to move all US citizens over to a private Medicare called Medicare Advantage and then end Medicare Advantage. Obama and Clinton neo-liberals wrote law to end Medicare Advantage in 2020. This will keep over 80% of people from accessing the Medicare for which they paid payroll taxes for decades.
100 million is already 1/3 of Americans tied to these Federal health programs that are being privatized.
CMS covers 100 million people......through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace. But coverage isn't our only goal. To achieve a high quality health care system, we also aim for better care at lower costs and improved health.
But we can't and we don't do it alone. We need your help to find the way forward to a better health care system for all Americans.
Learn more about how we can help each other so all Americans have access to coverage, better care, and improved health.
- Medicare Advantage premiums remain stable; enrollment at all-time high
- CMS Releases First Ever Plan to Address Health Equity in Medicare
- CMS awards $67 million in Affordable Care Act funding to help consumers sign-up for affordable Health Insurance Marketplace coverage in 2016
- CMS announces Value-Based Insurance Design Model to improve care and reduce costs in Medicare Advantage Plans
- 2015 Special Enrollment Period Report – February 23 – June 30, 2015
J-CHIP by Medicare and Medicaid will create public private partnerships run by an institution controlling health care in Baltimore while it racked up life-expectancy numbers lower than anywhere in the nation----or third world. J-CHIP is the installation of micro-chips to manage all aspects of your body!
Johns Hopkins Medicine Awarded $19.9M Innovation Grant from CMS for its J-CHiP Program
Release Date: June 18, 2012
The Johns Hopkins University School of Medicine, in collaboration with the Johns Hopkins Health System (together known as Johns Hopkins Medicine, or JHM), has been awarded a $19.9 million grant by the Centers for Medicare & Medicaid Services (CMS), over a three-year period, to improve the quality and efficiency of health care delivered to JHM patients.
The grant is part of CMS’s $1 billion Healthcare Innovation Challenge, a competitive initiative that seeks to identify and support innovative opportunities to improve care delivery and achieve its three-part aim of “improving the individual experience of care, improving the health of populations, and reducing the per capita costs of care for populations.”
“This grant gives us the unique opportunity to expedite our work to reform health care delivery, provide increased value to our patients, and improve the health of our community,” says Edward D. Miller, M.D., dean/CEO of Johns Hopkins Medicine.
According to Miller, the Johns Hopkins Community Health Partnership (J-CHiP), recipient of the grant, will create a unique Baltimore-based partnership to achieve the three-part aim through the collaboration of many entities: The Johns Hopkins University, including the university’s schools of medicine, nursing and public health; Johns Hopkins Community Physicians, one of the largest primary care networks in Maryland; Johns Hopkins Home Care Group, the full-service home care provider arm of JHM; the Johns Hopkins Urban Health Institute; CMS; the state of Maryland; the city of Baltimore; Priority Partners, a Medicaid managed care organization owned jointly by Johns Hopkins and the Maryland Community Health System, a consortium of federally qualified health centers including Baltimore Medical System; five local skilled nursing facilities; and several other community organizations. J-CHiP will work closely with community representatives to ensure that its efforts are directly responsive to the unique needs of the East Baltimore community.
“This grant will permit the J-CHiP program to have a significant impact on JHM care delivery,” Miller says. “By its third year, J-CHiP will reach over 50,000 patients; create over 100 innovative health care jobs, such as care coordinators, behavioral coaches and nurse case managers; and train or retrain thousands of health care workers. By reducing unnecessary admissions and readmissions, emergency department visits and other expenditures through improved care coordination and high-quality care programs, J-CHiP will simultaneously reduce health care costs.” Through improved care measures, it is estimated that the J-CHiP program could save Medicare and Medicaid just over $50 million during the three-year window.
According to Miller, J-CHiP will accelerate ongoing efforts to promote high-quality, patient-centered care by:
- Improving community health and reducing health disparities for the underserved East Baltimore population in the seven zip codes surrounding The Johns Hopkins Hospital (JHH) and Johns Hopkins Bayview Medical Center (JHBMC) by coordinating and enhancing primary care services for Medicare and Medicaid patients with chronic disease, substance abuse, and/or mental illness. These patients account for a disproportionate share of health care services and dollars. Full integration of behavioral health care into care delivery is a key feature of J-CHiP.
- Improving acute and post-acute care delivery using transdisciplinary care coordination that will touch nearly every patient admitted to JHH and JHBMC. This program builds on the ongoing efforts of the Johns Hopkins Health System Readmissions Task Force, and it includes a bundled intervention: multidisciplinary rounds, risk screening for post-acute services, medication management, patient-family education and post-acute transition services. It will forge partnerships with five skilled nursing facilities in the neighboring seven zip codes to deploy JHBMC Care Center best practices and staff to avert unnecessary returns to acute care.
According to Brown, J-CHiP will be further strengthened by JHHC’s longstanding successful experience in managing a major Medicaid managed care program and championing innovative care delivery models in support of population health. A leader in innovative health care solutions, JHHC was created in 1995 as a partnership between the Johns Hopkins Health System and the Johns Hopkins University School of Medicine to develop and administer contractual health care relationships with managed care organizations, government programs, employers and health care providers.
A major focus will be the health of the surrounding East Baltimore community. J-CHiP will work to reduce glaring health disparities in East Baltimore and translate its experience to inform other urban medical centers around the country. “J-CHiP will create new jobs, strengthen community and public-private partnerships, improve the quality of care for our patients and better enable JHM to serve as a ‘public trust,’” Brown says. “By developing and testing health care innovations, as a ‘learning laboratory,’ JHM seeks to demonstrate how academic medical centers can add significant value to care delivery in the health care reform era.”
John M. Colmers, JHM vice president of transformation and strategic planning adds, “JHM aims to become a leader in providing integrated, patient-centered care across the care continuum. The J-CHiP program, and federal grant funding in support of it, takes us one giant step closer to that goal.”
The entire world has all of last century been amazed at the performance of America's Medicare System. It is the largest public health system ever and it worked like a charm. People received accurate easy to understand statements------the data was kept private as HIPPA requires------and analysis of all this massive database was always ongoing to provide stats that allowed medical researchers and government to know health outcomes were good and people were receiving quality and safe health care. AS WITH THE FEDERAL HOUSING AGENCY----AS WITH THE FEDERAL STUDENT LOAN AGENCY----AS WITH THE SMALL BUSINESS AGENCY----AS WITH THE FEDERAL AGRICULTURAL AGENCY-----all these Federal agencies worked effectively and efficiently until they were outsourced to corporations that simply wanted to use them for fraud and implode these Federal programs to end them. Well, that is what Obama and Clinton neo-liberals in Congress are trying to do with Federal public health Medicare and Medicaid.
The effective use of Medicare ended when Reagan/Clinton started the privatization and downsizing of these agencies allowing massive and open fraud of our Medicare Trust----just as Bush did. Medicare data was then not used to assure quality and safety----it was used for private medical research sold to produce products that were then largely found to harm people.
Below you see where Baltimore has become the home base for Medicare and Medicaid technology privatization and the super-computers at Hopkins will receive all Medicare and Medicaid data where absolutely no public interest analysis will occur.
April 30, 2013
Contact Mark Meudt
Tel: 703 995 4994
General Dynamics Awarded $20 Million for Centers for Medicare & Medicaid Services
IT SupportFAIRFAX, Va. – General Dynamics (NYSE: GD) has been awarded a contract by the U.S. Department of Health & Human Services’ Centers for Medicare & Medicaid Services (CMS) to support the Beneficiary Eligibility Suite of Systems Transactions (BESST) program. The BESST systems maintain Medicare beneficiary eligibility information and support critical components of CMS’s core healthcare mission. This contract has a potential value of $19.9 million over five years.
Under this contract, General Dynamics will help maintain and enhance BESST systems. The company will create and maintain critical links between new and existing CMS systems as well as implement software enhancements. Additionally, General Dynamics’ experts will provide program management, documentation and training services and support special projects for the HIPAA Eligibility Transaction System. Work will be performed in the Baltimore, Md., area.
“The systems maintained by the Centers for Medicare & Medicaid Services are critical to ensuring beneficiaries receive accurate and efficient services,” said Marcus Collier, senior vice president of General Dynamics Information Technology’s Health and Civilian Solutions division. “General Dynamics supports CMS on many of its core programs and we will leverage this experience to bring additional value to the BESST program.”
General Dynamics delivers operations and maintenance support for several Centers for Medicare & Medicaid Services programs including the Early Retiree Reinsurance Program (ERRP), Retiree Drug Subsidy (RDS) program and the ViPS Medicare System (VMS).
For more information about General Dynamics Information Technology, please visit www.gdit.com.
Below you see where the world understands that Baltimore citizens have living conditions no better than third world nations and it centers on Johns Hopkins and Wall Street Baltimore Development's control of government and all revenue in the city. The conditions for huge health problems coming from poverty happens because Hopkins wants a stagnant economy with high unemployment and public policy is written and passed by Baltimore pols to do just that.
Failure to allow Federal funds meant to be directed to public housing, public health, public education, etc and moving those funds to grow Hopkins' corporate control in the city and overseas gives Baltimore its third world status. Now, as someone who spent much of a career in medical research and academics -----KNOWING WHAT HIPPOCRATIC OATH AND THE ETHOS OF DOCTORS TO HEALING WHAT AILS PEOPLE-----we understand that Hopkins has served as a very negative force in the health of the citizens of Baltimore.
People say ALL THEY DO IS HAVE US ANSWERING QUESTIONS----PARTICIPATING IN HEALTH STUDIES----and indeed---that is the extent of real health care in Baltimore. Trauma victims coming into emergency rooms because Federal law prohibits people being refused care in these emergency cases is a social good that is lost in the complete lack of trust citizens have in intent of Hopkins as an institution.
WHY WOULD OBAMA AS A DEMOCRAT PLACE A LARGE AMOUNT OF CONTROL OF A PRIVATIZED MEDICARE AND MEDICAID TO AN INSTITUTION THAT HAS PROVEN DISREGARD TO WHAT THEY SEE AS HUMAN CAPITAL?
The goal of Affordable Care Act was simply to make global health systems for profiteering and to meet Trans Pacific Trade Pact requirements that public health in nations be minimal.
One American City Rivals the Poor Youth of New Delhi, India for Some of the Worst-Off Teens in World
By Kara Pendleton (10 months ago) | Culture, Economy, Nation, World
A recent “WAVE” study highlights the problem of child poverty in the United States and around the globe, with findings that are shocking.
The researchers found many similarities—in all five cities, adolescents were exposed to unsanitary conditions, substance abuse and violence—but the differences between each area were especially compelling. Overall, teenagers in Baltimore and Johannesburg, despite being located in comparably wealthy countries, had far worse health outcomes and tended to perceive their communities more negatively.
The main categories studied were social cohesion, physical environment and witnessing violence in the community.
Baltimore, the only U.S. city in the study, ranked among the highest of the five study cities in witnessing community violence (only Johannesburg was higher). It ranked lowest in social cohesion, which is the level of emotional support teens get from family and neighbors. And Baltimore was in the middle of the pack in the physical environment measurements.
Voactiv notes about the disparities:
In Baltimore, which is located in the world’s richest nation per capita and just 40 miles from the White House, adolescents exhibited considerably high rates of mental health issues, substance abuse, sexual risk-taking, sexual violence and teen pregnancy.
In comparison, adolescents in New Delhi exhibited far fewer of those behaviors and outcomes, despite residing in a much less prosperous nation.
Forbes has also reported on child poverty and how the global financial crisis has impacted it. This chart, courtesy of Statistica, is particularly revealing:
In Greece, for example, the financial crisis hit so hard that charities and churches saw a massive spike in children being given up for adoption.
Families were too poor to provide for them, and likely felt that by ceding their offspring to churches and other charities they would at least have shelter and food. The BBC reports:
Cases like this are shocking a country where family ties are strong, and failure to look after children is socially unacceptable – and it’s not happening in a country ravaged by war or famine, but in their own capital city.
The startling fact the chart reveals is that as bad as childhood poverty has gotten worldwide, our own childhood poverty level in 2008 was among the worst and was higher than some nations that saw massive spikes in 2012.
BALTIMORE UNDERSERVED COMMUNITIES NEVER RECEIVED ALL OF THE FEDERAL SAFETY NET FUNDING---THESE WERE DIVERTED SO DON'T SAY SAFETY NETS FAILED IN BALTIMORE.
While some may conclude that the need for a stronger social safety net is needed for these communities, after more than fifty years of that approach, it may be time for fresh ideas.
What is glaring in these poor communities is not how much damage and injustice has been done to people by free market capitalism, but how much it is sorely lacking. Worldwide, the marketization of economies has led to a drastic reduction in poverty. Why not try introducing it in impoverished communities in America? It’s worth a shot.
When all your health stats are captured by a private health corporation like Johns Hopkins the health data that comes out is not accurate---it is juked. Maryland data states that all the funding sent to address health issues around lead paint are working and stats look good when as we see below----the problems are worse as people are being allowed more and more to live in unsafe housing. I attended a social health justice meeting in which doctors stated openly health policies are not pursued that may curtail the business of specific health specialties and this happens when health care in a state like Maryland has been made all about profits with no oversight and accountability of patient care.
If you think having a health institution that does not care about people simply because they cannot PAY WHAT THE MARKET BEARS-----you are getting ready to join Baltimore citizens in the worst of health care ----third world clinic care gets you a checkup and a shot/meds for communicative diseases.
THIS IS WHERE THE AFFORDABLE CARE ACT EXPECTS TO HAVE OVER 80% OF AMERICANS -----WITH ALL OF HEALTH PROFITS CENTERED ON HEALTH TOURISM.
Creating a system that denies health access to US citizens while expanding to look for consumers elsewhere-----THAT IS WHAT SOCIOPATHS LOOK LIKE.
The US Constitution has laws that require this health access be available to all citizens-----it requires that payroll taxes paid for Medicare and Federal funding for Medicaid be used to provide access of all citizens to the health procedures developed USING FEDERAL, STATE, AND LOCAL TAX REVENUE. Federal funding paid for the medical research for ordinary procedures now being denied many citizens.
I HAD A YOUNG STUDENT VISTA FROM OUT OF TOWN SAY TO ME-----IT LOOKS LIKE THEY ARE JUST THROWING MONEY IN THESE COMMUNITIES WITH NO GOALS OR OVERSIGHT----I SAID---THAT IS WHAT US NGOs DO TO FUNNEL MONEY TO THEMSELVES!
'restoring it to $15 million in 2014. Just cleaning up Baltimore’s problem could easily cost that much.'
$15 million falls out of the pockets of the mayor coming from a Board of Estimates meeting in one day!
Public Health 8:51 AM May 7, 2015
Baltimore’s Toxic Legacy Of Lead Paint
By Anna Maria Barry-Jester
The red brick rowhouses on Inez Robb’s block in West Baltimore feature ornate cornices and detailed carvings above the doors and windows. Leaves are beginning to fill the trees along the median that divides the pristine block, though slender trunks betray their young age. Robb moved into her home in 1987 with a first-time home buyer’s grant from the city, just a few years before Freddie Gray and his family would move to a building that looks remarkably similar from the outside, just over a dozen blocks away.
Both blocks are located in Sandtown-Winchester, a neighborhood less than a square mile in size that came to national attention last month when Gray, 25, died after sustaining injuries while being transported in a Baltimore police van. As the media reported details of Gray’s past, it emerged that in his early years, he’d been poisoned by lead, one of the most devastating neurotoxins on the planet and one that’s especially common in Baltimore because of its poverty and the age of its housing stock.
State tests found more than 65,000 children in the city with dangerously high blood-lead levels from 1993 to 2013. Across the United States, more than half a million kids are poisoned by lead each year, and the majority come from cities like Baltimore: rust belt towns built up during the first half of the 20th century when leaded paint was dominant. As populations and employment opportunities shrank in recent decades, poverty and neglect combined with older housing allowed lead paint poisoning to plague the city.
Despite sharp declines, the city of Baltimore still has nearly three times the national rate of lead poisoning among children, and a look at the data reveals that, like other health disparities, just a handful of neighborhoods are responsible for almost all of the city’s cases over the last five years. Sandtown is one of them.
But even these relatively stark statistics hide much of the problem. The data here represents children with blood-lead levels of 10 micrograms per deciliter (ug/dL), while the acceptable limit was halved to 5ug/dL by the Centers for Disease Control and Prevention in 2012 after decades of research showed there is no safe threshold for lead exposure. More than a thousand children tested for blood-lead levels between 5 and 9 ug/dL in 2013 in Baltimore, according to the Maryland Department of the Environment.
Lead paint can be absorbed through the skin, and even a small amount of dust from frequently used doors and windows is a risk without professional abatement. Exposure to larger, lethal doses of lead is mostly non-existent in the U.S. today, but ingesting even tiny amounts can have lifelong effects, and is particularly dangerous for children under age six. Speech delays, lack of impulse control, aggressive tendencies, ADHD and other learning disabilities have been associated with exposure to lead. While it’s impossible to draw relationships between lead paint and an individual’s behavior, what happens when a population is exposed to lead is pretty clear, and it’s not pretty.
Though Baltimore has had a long and toxic relationship with lead paint, the city was originally at the forefront of enacting legislation to limit exposure for children. In 1949, the Maryland legislature was the first to ban the use of lead paint in children’s toys, but the law was overturned after pressure from the lead industry. Baltimore was the first city to offer free blood-lead level testing under the watch of an enterprising health commissioner who also spent decades showing the damage it did to the city’s children. Johns Hopkins University, located in Baltimore, was the epicenter of knowledge on the effects of lead poisoning in the 1950s, years before it approved a notorious study that knowingly exposed children to paint and dust in an effort to find cheap abatement techniques, and ended in a class-action lawsuit.
In the book “Lead Wars,” David Rosner, a professor at Columbia University, and Gerard Markowitz, a professor at the City University of New York, cite internal documents from the lead industry and other sources to write a compelling history of industry manipulation of data to both lay the blame on parents and families for the crisis of lead poisoning, and to keep it in products through the 1970s. In reality, the authors argue, the federal government was aware of the many dangers posed by lead, and in bowing to pressure from industry, allowed millions of children to be poisoned.
Federal legislation finally banned the use of lead paint in 1978, but by then it was in homes all over the city, and Baltimore had begun what would be a steep economic decline, leaving an increasing number of children at risk for lead poisoning as the old housing stock deteriorated.
Though dramatic reductions in lead poisoning have been made over the last two decades, inner-city kids from low-income black families still bear the burden of this legacy.
A national survey conducted in 1998-1999 found that an equal percentage of black and white families lived in homes with federally recognized risk for lead exposure. A follow-up study in 2006, the most recent national survey on housing hazards, found that, while there had been a significant drop in the percentage of white families who lived in homes with a serious lead-based paint hazard, the percentage of black families had actually increased from the previous survey [page 36].
Ruth Ann Norton, the president and CEO of Green & Healthy Homes Initiative, a national organization based in Baltimore that works to eradicate childhood lead poisoning, said the city’s historic blind eye to enforcement of laws regulating dangerous homes, and lack of will for serious investment, has left people languishing in toxic housing. In some ways, she said, the recent successes in reduction are hurting the people still at risk.
“When we tell people we’ve had a 98 percent reduction, I sometimes get applause,” Norton said in phone interview. “But the rest of that sentence is that we still have 535,000 children a year being poisoned in the United States.”
Funding for lead abatement has been subject to the same political and economic push-and-pull as many social programs. Back in 1990, the Department of Health and Human Services planned to spend $33 billion to clean up homes around the country, but only a fraction of that has been spent. In 2013, amid cutbacks, Congress slashed funding for lead abatement from $23 million to $2 million before restoring it to $15 million in 2014. Just cleaning up Baltimore’s problem could easily cost that much.
Inez Robb bought her home in 1987, at a time when the city was planning to fix up Sandtown-Winchester. Her entire block was remodeled as part of a revitalization project, and the homes are safe from lead. Today, most of the units on the block are occupied, even as the number of vacancies in the neighborhood grows. She and her neighbors don’t like the way the community has been portrayed over the last couple of weeks (“If you didn’t know, you would think that everyone was impoverished and uneducated, and it was a neighborhood full of rentals,” she said), but she acknowledged that vacant lots, empty buildings and decaying structures are holding the neighborhood back. While some people question what good came of the revitalization money, Robb sees her block as proof that housing problems can be fixed. But there is much more to be done.
CLARIFICATION (May 7, 9:52 a.m.): This article has been updated to clarify remarks made by Ruth Ann Norton reflecting the fact that while enforcement of lead laws has historically been a problem in Baltimore, it has improved over the last 15 years.
Obama and Clinton neo-liberals are doing to health care and public education what Republicans have tried for decades to do-----privatize and deregulate these industries so they can do what they want to earn profit. Predatory health care will become VERY SCARY STUFF and no regulatory oversight will create the conditions for death and harm to soar all while no public interest data surfaces to let us know.
Handing the Federal Medicare and Medicaid along with all health delivery to ACO----health organizations that are simply global health corporations made rich robbing our Medicare Trust and Medicaid funding dry with fraud-----is not how to create an efficient and effective system.
IT WAS NEVER MEANT TO----IT IS GEARED TO THE CHEAPEST OUTLET AND SENDING THE HUNDREDS OF BILLIONS OF DOLLARS FROM OUR FEDERAL PROGRAMS TO GLOBAL CORPORATIONS IN SUBSIDY AND THEFT.
Each state can install the platform for an Expanded and Improved Medicare for All which would bring back all those funds stolen by fraud and profiteering and build the oversight and accountability to STOP ALL THESE LOSES. At a time when Wall Street and global pols are using the bond market to implode the economy again all to say----
SORRY, THERE ARE NO FEDERAL TRUST FUNDS---NO CORPORATE HEALTH PLANS------ONLY PREVENTATIVE CARE FOR ALL!
A Healthy Bottom Line:
Profits or People?
By Claire Andre and Manuel Velasquez
In Alameda County, a private hospital turned away a woman in labor because the hospital's computer showed that she didn't have insurance. Hours later, her baby was born dead in a county hospital.
In San Bernardino, a hospital surgeon sent a patient who had been stabbed in the heart to a county medical center after examining him and declaring his condition stable. The patient arrived at the county medical center moribund, suffered a cardiac arrest, and died.
These two hospitals shifted these patients to county facilities not for medical reasons, but for economic ones -- the receiving hospitals feared they wouldn't be paid for treating the patient. These patients simply weren't "good business."
With little public warning, a concern for "good business" has moved to the heart of health care, a sector once relatively insulated from the pursuit of profit that drives the rest of the U.S. economy. Throughout our history, medical institutions have largely been "charitable," nonprofit establishments existing primarily to serve the community. But during the past 20 years, the number of for-profit health care facilities, ranging from national hospital chains affiliated with major academic institutions to local dialysis centers, has grown at a rate exceeding even that of the computer industry.
The ethical implications of the growing commercialization of health care have become a matter of heated controversy. Those favoring the trend toward health care for profit claim that an increased role for entrepreneurs and competition in the delivery of health care will result in a more efficient and effective health care system. For others, the pursuit of profit is antithetical to the values central to medicine.
Opposing the commercialization of health care are those who base their arguments on considerations of justice. They argue that a society as wealthy as ours has a moral obligation to meet the basic needs of all of its members. Every American, rich or poor, should have access to the health care he or she needs. The escalating costs of care and a growing unwillingness of insurance companies to cover these costs, along with government budget cutbacks, have severely restricted access to health care for the poor, the aged, and those with catastrophic health problems. The rise of for-profit health care only exacerbates the growing problem of access to care.
Studies show that the growth of for-profits decreases the availability of health care for "unprofitable" patients. Traditionally, non-profits have financed care for the poor by overcharging paying patients to subsidize services for the poor. For-profits, by refusing to serve nonpaying patients while at the same time taking a great share of paying patients, leave non profits with more of the poor to serve but with fewer paying patients to subsidize their care. Furthermore, by serving only profitable patients and offering only profitable services, for profits are able to generate high revenues, which enables them to charge lower prices for their services and to invest in attractive facilities located in areas convenient to paying patients, both of which create substantial competition for non-profits. As a result, it has become increasingly difficult for non-profits to continue to serve those who can't pay.
Opponents of commercialized health care also argue that for-profit health care institutions do not contribute their "fair share" to society. In view of the benefits health care institutions derive from society, it is unfair for them to refuse to help society serve those who can't afford care or are too costly to treat. All hospitals benefit from government subsidized programs like Medicare and Medicaid. They also profit from medical research and medical education paid for by taxpayers' money. In fairness, hospitals have an obligation to serve society's needy. Investor-owned corporations that turn away patients who can't afford to pay fail to discharge this obligation. Moreover, by not taking their fair share of unprofitable patients, for-profits place an undue burden on nonprofit and public hospitals. It's unjust that the costs of serving these patients should fall more heavily on nonprofit institutions.
Further, critics of health care for profit maintain that all persons have a right to live their lives with dignity. Mixing business with medicine will inevitably lead to abuses that violate patient dignity. A patient is in a vulnerable position, necessarily trusting that the doctor's decisions about his or her medical care will be guided solely by the patient's best interests. But in a system of for-profit health care, doctors will become subject to the control of lay managers accountable to share-holders whose primary aim is making a profit. Such hospitals will encourage doctors to promote profit-producing drugs, surgeries, tests and treatments. And, medical treatments and counseling lacking profit potential, however effective, will be discouraged. Even more worrisome are physicians who themselves own the facilities they operate. Doctors owning dialysis centers, for example, have been accused of putting patients on dialysis sooner than necessary and putting off kidney transplants that would eliminate the need for dialysis altogether.
In a system of for-profit health care, the opportunities for patient manipulation and exploitation are endless. Society must not allow the motive of economic gain to enter so directly into the practice of medicine, placing the well-being of patients in serious jeopardy, and undermining the trust so essential to the physician-patient relationship.
It is also argued that commercialized medicine will harm society, yet produce little in the way of benefits. Nonprofit hospitals undertake costly, but needed, research and maintain services which are not economically viable but which provide doctors with the training experiences necessary to medical education. Where profits rule, however, such necessary, but unprofitable, research and services important to medical education will be neglected. Furthermore, as for-profits come to dominate the health care sector, society will suffer a severe shortage of unprofitable, but critical, services, such as emergency rooms. Meanwhile, scarce resources will be squandered to produce and aggressively market lucrative, but unnecessary, services, such as cosmetic surgery.
While for-profits promise to harm society, critics continue, they fail to deliver any of the promised benefits, such as controlling health care expenditures, reducing the costs of care, and lowering the price of care. How will for-profits help control health care expenditures and the overuse of health services when, by definition, they are in the business of increasing total sales? For-profits are also unlikely to reduce the costs of care. Studies show that the rise of investor-owned hospitals has increased rather than lowered costs. Moreover, studies show that the prices charged by for-profit hospitals to paying patients, as well as the per-day expense of providing care, are higher than those of non-profits. The economic benefits promised by for-profits have not been demonstrated.
Finally, some critics of for-profit health care claim that the commercialization of medicine will lead to the abandonment of certain virtues and ideals that are necessary to a moral community. Most non profits continue to uphold an ideal of service to humankind. The virtues of caring, compassion, and charity, and a sense of community have guided their decisions about the range of services to provide and the kinds of research or education to support. The ideal of altruism has been perpetuated by physicians whose primary concern has been the alleviation of human suffering and the restoration of health. Society must not allow such important and fragile virtues and ideals to be extinguished by the self-interest that drives for-profit enterprise.
Those favoring the growing commercialization of health care argue that society ought always to follow that course of action that will bring about the greatest benefits at the least cost. A health care system run by for profits will provide the greatest benefits at the least cost.
First, for-profit health care will lower the costs of care. The amount we spend on health care every year has grown from $75 billion in 1980 to nearly $500 billion today. If this rate continues, by the year 2020, we will be spending 40 cents of every dollar we make on health care. Commercialized health care is our only hope for controlling the soaring costs and over-utilization of health services. Only the businesslike efficiency and the discipline that accompanies the drive to maximize profits can cure the ills of a system plagued by inefficiency and waste.
Under the present system, administrators and physicians have no incentives to operate in a cost-efficient manner. More concerned with institutional prestige than with the bottom line, administrators of nonprofit organizations acquire sophisticated equipment and highly trained personnel, without regard for their need or likely use. Costly technologies are adopted and services added that are only marginally beneficial. Physician's themselves are offered little incentive to concern themselves with the cost of care, and go about ordering treatments that yield little or no benefit. Moreover, the nonprofit health care system is rife with costly, under-used facilities. Cardiac operations are performed in 100 different hospitals. Millions of dollars could be saved if these 15,000 procedures could be done in 30 centers specifically built for that purpose.
As the number of for-profit health care facilities increase, we can expect to see an end to such gross inefficiency. Aiming to maximize profits, for profits will invest only in the equipment and the personnel necessary to provide services that patients actually need. Decisions about what technologies should be adopted will be based on whether the benefits of these technologies outweigh their costs. The entrepreneurial spirit will give rise to innovation in the delivery and management of services, leading to more efficient methods of production and treatment. Doctors will be forced to come to terms with what will really benefit patients, resulting in fewer unnecessary hospitalizations, shorter hospital stays, and fewer needless tests.
Lower costs also can be expected from the economies of scale achieved by for-profit corporations. Unlike nonprofit health care institutions which often operate independently of each other, for-profits are often linked together as chains, allowing for economies in financing and management, and for centralized services and shared equipment, all resulting in lower costs.
Second, society will benefit from the enhanced access to care promised by for-profits. Currently, 37 million people are without the coverage needed to afford care. For-profits can pass on savings they achieve through more cost-efficient operations by lowering the price of care, so more people are able to afford it.
Third, for-profit health care enterprises produce benefits for society because for-profits have greater and quicker access to capital at lower costs than do non-profits. At a time when massive investments of capital are needed to keep up with the state of the art in medicine, non-profits are experiencing increasing difficulty in attracting funding. For-profits, on the other hand, can lure investors by issuing stocks, securing the money sorely needed to build and renovate facilities and to replace and modernize outdated equipment.
Proponents of for-profit enterprise in health care also support their position by maintaining that all persons have a basic right to freedom and thus a right to use their property in ways they freely choose. They argue that owners of for-profits have no special obligation to provide free services to the poor. While public funds may indeed subsidize research and medical education, it is patients and doctors who benefit from this education and research, not the owners of hospitals. If there is any obligation to serve the community in return for such subsidies, it is with patients and doctors that it lies. Nor does the possibility that hospitals have profited from an expanded market for services generated by government-subsidized programs oblige their owners to provide free care to the poor. Defense contractors profit greatly from the business generated by public funds. Yet, they are under no obligation to provide free public services. Nor can it be said that for profits unfairly impose a burden on non-profits by not assuming a fair share of the costs of caring for the poor. For-profits, unlike non-profits, pay taxes, and in doing so, can be said to pay their share in serving the poor through tax-supported public programs. To impose on owners of for profits a social obligation over and above an obligation to pay taxes is to impose an obligation on them that is not imposed on owners of other businesses.
Finally, it is argued, health care is like food, clothing and shelter. Just as these "basic needs" are sold on the market and distributed according to ability to pay, so too should health care. If some cannot afford to pay for such basic needs, it is up to the government or voluntary agencies to see that they secure it.
What is the moral response to the increasing commercialization of health care? The arguments in favor of for-profits appeal to the values we place on the freedom of free enterprise and the economic benefits that may flow from a more efficient health care system. But are we willing to uphold these values at the cost of other important values, including a concern for justice, the dignity of persons and a community-centered ethics that places the needs of people before profits? What is a "healthy" bottom line?
"I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witness, that I will fulfill according to my ability and judgment this oath and this covenant...I will apply...(treatment) for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice." -Hippocratic oath
Drug costs are soaring because US PHARMA corporations used Affordable Care Act and Trans Pacific Trade Pact policy to end Medicare's effects on containing costs and oversight and accountability to regulations have been dismantled so no one is enforcing health laws meant to contain costs.
Bill Gates used his health foundation pretending to be a non-profit to build a global PHARMA corporation just as profit-driven as any in the world. Gates is behind privatizing Medicare and Medicaid just to maximize health corporate profit and he is behind the most repressive of health policy in Trans Pacific Trade Pact. Obama appointed a Gates executive as head of Medicare to do Gate's bidding----ending Federal Medicare.
Trans Pacific Trade Pact and Obama and Clinton neo-liberals in Congress want to dismantle laws that allow PHARMA to go to generics----to dismantle laws that require clinical trials to assure safety for PHARMA and medical devices. They want to dismantle distribution regulations in the US to allow imported PHARMA and devices flow from the developing nations where all is being manufactured. THIS IS WHAT DEREGULATION OF HEALTH CARE MEANS. It will not allow any medical research proving harmful effects of a health product result in pulling it from the market-----now, they wait until millions of people are harmed or die----then they REFORMULATE AND SEND IT OUT AGAIN. Forget America being concerned about products being sent all over the world knowing them to be harmful-----SHOW ME THE MONEY IN BILLIONS OF PROFITS AND WE WILL SETTLE LATER FOR A FEW MILLIONS TO HARMED FAMILIES. Neo-liberalism in health care will be scary stuff if allowed to continue.
Make no mistake-----Federal funding to all of these medical research facilities are soaring------while Americans are being told---sorry, no Federal health trusts or Constitutionally required funding for all.
National labor and justice organization leadership knew all this was what Affordable Care Act was about----and they also know the JOBS, JOBS, JOBS mantra is bogus as well as all this will end up in International Economic Zones and FOXCONN factories overseas-----and soon coming to the US where workers will work as they do in Asian sweat shops. So, nothing good happening in any Wall Street policy!
Drug Prices Soar, Prompting Calls for Justification
By ANDREW POLLACKJULY 23, 2015 New York Times
As complaints grow about exorbitant drug prices, pharmaceutical companies are coming under pressure to disclose the development costs and profits of those medicines and the rationale for charging what they do.
So-called pharmaceutical cost transparency bills have been introduced in at least six state legislatures in the last year, aiming to make drug companies justify their prices, which are often attributed to high research and development costs.
“If a prescription drug demands an outrageous price tag, the public, insurers and federal, state and local governments should have access to the information that supposedly justifies the cost,” says the preamble of a bill introduced in the New York State Senate in May.
In an article being published Thursday, more than 100 prominent oncologists called for support of a grass-roots movement to stem the rapid increases of prices of cancer drugs, including by letting Medicare negotiate prices with pharmaceutical companies and letting patients import less expensive medicines from Canada.
“There is no relief in sight because drug companies keep challenging the market with even higher prices,” the doctors wrote in the journal Mayo Clinic Proceedings. “This raises the question of whether current pricing of cancer drugs is based on reasonable expectation of return on investment or whether it is based on what prices the market can bear.”
Pressure is mounting from elsewhere as well. The top Republican and Democrat on the United States Senate Finance Committee last year demanded detailed cost data from Gilead Sciences, whose hepatitis C drugs, which cost $1,000 a pill or more, have strained the budgets of state and federal health programs. The U.A.W. Retiree Medical Benefits Trust tried to make Gilead, Vertex Pharmaceuticals, Celgene and other companies report to their shareholders more about how they set prices and the risks to their businesses from resistance to high drug prices.
A demonstration last year against Gilead Sciences, whose hepatitis C drugs, which cost $1,000 a pill or more. Credit AIDS Healthcare Foundation The trust cited the more than $300,000 per year price of Vertex’s cystic fibrosis drug Kalydeco and roughly $150,000 for Celgene’s cancer drug Revlimid.
Even former President Bill Clinton, in a speech to pharmaceutical executives in Philadelphia last month, said it would be in the industry’s best interest to say more about its costs and pricing.
“Explain, explain, explain and disclose, disclose, disclose,” Mr. Clinton said, according to The Philadelphia Inquirer. “Don’t expect everybody to love you, but at least they will hear your side of the story.”
The pharmaceutical industry has already had the veil lifted on various practices. Drug companies now have to report the payments, including meals and entertainment, that they make to doctors for research, consulting and giving promotional speeches. The companies have also had to disclose more results of their clinical trials and in some cases have started to provide raw data to outsiders.
It is unclear if cost and pricing will become the next such area. The state bills, which are supported by some health insurers and consumer groups, have not progressed. The two senators, Republican Charles E. Grassley of Iowa and Democrat Ron Wyden of Oregon, have not reported the results of their inquiry. And shareholders of Gilead, Vertex and Celgene voted down the resolutions proposed by the U.A.W. trust, though the trust says it reached settlements with Eli Lilly and with two other drug companies it would not identify.
The pharmaceutical and biotechnology industry trade groups say the transparency bills would be costly to comply with and would provide misleading information.
Even some people concerned about drug prices say that the cost to develop a particular drug has little to do with that drug’s price and that knowing such information will not keep prices down.
“The past R&D cost is really kind of a red herring,” said Len Nichols, a health care economist at George Mason University, referring to research and development. “The current revenue doesn’t pay for past R&D; it pays for current R&D.”
Prices for cancer drugs, some of which extend lives by only a couple of months, routinely exceed $100,000 a year, and some new ones exceed $150,000. And it is not unusual for the list prices of existing drugs to rise 10 percent or more year after year, far beyond the rate of inflation. The prices of older drugs for multiple sclerosis have risen from about $10,000 per year in the late 1990s to more than $60,000 now, according to a study, even as competition in the market has intensified with the introduction of new products.
Cost transparency bills have also been introduced in California, Massachusetts, North Carolina, Oregon and Pennsylvania.
Three of the bills require disclosures for drugs costing $10,000 or more per year. The others have different criteria. Besides development costs, some of the bills would require disclosure of the costs of manufacturing, marketing and advertising. At least some of the bills also ask for a history of price increases, the profit attributable to the drug and how much a company spends in providing financial assistance to patients using the drug.
Two of the bills would allow the states to act on the information, not just require disclosure. Pennsylvania’s would allow insurers to refuse to pay for a drug if the manufacturer did not file the required report. In Massachusetts, a state commission would be able to set a maximum price for a drug if it determined that the price set by the manufacturer was significantly high compared with the benefits, costs or prices in other countries.
Most of the bills have not been acted upon, though hearings were held in California and Oregon.
The sponsor of the California bill, Assemblyman David Chiu, pulled it back shortly before a committee was to vote on it, apparently because it did not have sufficient support. The bill could be picked up again next year.
“This is a new topic for many of my colleagues to grapple with,” said Mr. Chiu, a Democrat from San Francisco. He said the bill was necessary because “greater transparency leads to better policy results.”
Mitch Greenlick, a Democrat from Portland who is chairman of the Health Care Committee in Oregon’s House of Representatives, said the bill was prepared with input from the health insurance industry, but was “not ready for prime time.” He added that the issue would be further studied.
“What are we going to do with that information?” he said. “It’s interesting to have, I suppose, but the drug companies are shameless, and they charge what they can get away with.”
Insurers and consumer groups told the Oregon Legislature that more disclosure was needed because the state had to decide whether to pay for certain drugs. Representatives of the pharmaceutical industry said the bill was unfair and would discourage industry investment in Oregon.
She also said that focusing on costs ignored the value of the drugs. Some drugs, for instance, can save money for the health system over all by keeping people out of the hospital, she said.
Pharmaceutical executives do not typically tie the price of any particular drug to its development cost. But they do say that their sales have to recoup their investment in research and development if the companies are to stay in business.
They often cite the Tufts Center for the Study of Drug Development at Tufts University, which last year said companies spent an average of $2.6 billion to bring a drug to market, up from an estimate of $800 million in 2003. That includes the cost of failures. And almost half the figure is opportunity cost, the amount a company might have earned if it had invested money elsewhere rather than spending it on drug development.
Critics are skeptical of that figure, saying that the Tufts center gets funding from the pharmaceutical industry and uses data supplied by the drug companies, but does not disclose which drugs are used as the basis of the estimates.
Pharmaceutical executives often say they price the drugs based on the value they provide, though often a detailed explanation of that is not provided. In many cases, it appears, the price of new drugs is set in comparison to rival drugs already on the market, and usually a bit higher. Companies then can raise their prices for the older drugs.
“We all look at each other and keep pace with each other,” said a director of one multiple sclerosis drug developer, who spoke on the condition of anonymity. “Honestly, there is no science to it.”
Write A Comment John Rother, chief executive of the National Coalition on Health Care, a group of insurers, consumer organizations, labor unions and employers concerned about drug prices, said his group hoped to introduce transparency legislation in Congress, but aimed at determining how drug companies estimate the value of their drugs, not the research and development costs.
“The industry has used R&D costs for the justification, but anyone who is reasonably sophisticated understands those are sunk costs and have little to do with pricing,” Mr. Rother said. “The more important information is any calculation of value. If the drug actually cures people, then what costs in health care are you saving?”
Dr. Jerry Avorn, a professor at Harvard Medical School and critic of some drug company practices, said the industry “has brought this on itself by charging prices that are so astonishing, it makes citizens wonder, ‘Where did this figure come from?’ ”
Obama and Clinton neo-liberals are again posing progressive by using terms like---bringing health care to the poor----saving Medicare-----all while the goal is the opposite. Defunding the Federal program required by the US Constitution having this program supplement payment for health care that American citizens cannot afford was the cornerstone to opening Federal funding to medical research projects and meeting New Deal and War on Poverty health laws. The poor in America have had access to all the care they needed without Affordable Care Act unless they live in Republican areas like Baltimore that deliberately designed health policy that kept citizens from this access. What the Affordable Care Act does is keep people from going to any hospital for life-saving medical procedures so as to make hospitals more profitable with this exclusion.
Since these policies will send tens of millions of Americans to an early death-----and that number growing far higher as more Americans fall into poverty-----they needed to make it sound progressive by saying NOW PEOPLE HAVE HEALTH INSURANCE. Of course having health insurance and accessing health care are VERY DIFFERENT THINGS. The Affordable Care Act also sends Medicaid to a gutted-of-funding third world clinic care-----preventative only -----when it used to provide access to low-income people to most of ordinary hospital care.
WHO KNEW REPUBLICAN STATES WOULD REFUSE TO EXPAND MEDICAID WHEN THEY ARE SET ON ENDING THE PROGRAM? OBAMA AND CLINTON NEO-LIBERALS IN CONGRESS THAT PASSED THE LAWS MAKING SURE PEOPLE WILL NOT BE ABLE TO ACCESS HEALTH CARE.
All Maryland pols supported Affordable Care Act as did national labor and justice organizations all knowing it would end access to ordinary health care guaranteed to Americans through Federal programs Constitutionally protected.
Having insurance does not mean you get health care
Joseph Paduda | Policy | January 30, 2011
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There’s no question the Accountable Care Act needs work – everyone agrees on that.
So let’s talk about the specifics – what needs fixing, why, and how can we get those fixes passed.
First, let’s understand how bad our current system is. Some who want to repeal and/or replace the ACA continue to publicly state we have “the best health care in the world.”
While that may – or may not – have been true at some point, it is increasingly clear that the US health care system is not anywhere close to best in class. A study done by the Commonwealth Fund compares our system to those in ten other industrialized countries, with sobering results.
Here are key findings:
◾Adults in the United States are far more likely than those in 10 other industrialized nations to go without health care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with their insurers or discover insurance wouldn’t pay as they expected.
◾One third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared to as few as 5 percent to 6 percent in the Netherlands and the U.K.
◾One-fifth of U.S. adults had major problems paying medical bills, compared to 9 percent in France, the next highest country, 2 percent in the U.K., 3 percent in Germany, and 4 percent in the Netherlands.
One finding is particularly scary: “Although the uninsured were at highest risk for skipping needed care, working-age U.S. adults with below-average incomes who were insured all year were significantly more likely than those with above-average incomes to go without needed care because of costs and have serious problems paying medical bills -- nearly half (46%) went without needed care and one third had one bill problem, double the rates reported by above-average income insured adults.”
You read that right – having insurance does not mean you get health care, and if you do, you still have to pay a substantial portion of the bill out of your own pocket.
The study examined health care and health insurance in eleven countries, all with much lower costs than the US — a differential that undoubtedly helps them compete in international markets. As globalization continues, American companies will find the disparity in health care costs will be a growing problem, diminishing their ability to compete with companies from Germany, Japan, Korea, and Switzerland.That said, ACA is anything but perfect. Let’s start our discussion with something that isn’t in the bill: Medicare physician payment reform.
Fixing Medicare’s horrendously broken physician reimbursement scheme known as RBRVS is critical. Congress has to come up with a long term solution that:
a) better recognizes the primary importance of primary care
b) incentivizes outcomes rather than pays for piece work
c) is less likely to be abused by Congressional cowardice and ineptitude
A big part of the solution is already in place – the Independent Payment Advisory Board (IPAB). This from California Healthline:
Beginning in 2014, IPAB must recommend Medicare spending cuts if the program’s growth rate exceeds the average of the consumer price index and the Medical Care CPI. Barring congressional action to make equivalent cuts, IPAB’s recommendations would become law. The board would exempt decisions affecting hospitals and other provider groups until 2020, but the Congressional Budget Office estimates that IPAB still could hold down Medicare spending by $15.5 billion between 2015 and 2019, according to a new report from Stephen Zuckerman of the Urban Institute.
A good start to be sure, but just a start. And note that we’ve still got to wait ten years before IPAB can address hospital costs, ten years that will likely produce significant inflation driven by technology, utilization, and price increases. We’re already seeing hospitals successfully thwart the new severity-adusted DRGs through more sophisticated coding…
Instead, we should move up IPAB’s effective date by at least a year, and ideally two for physicians and perhaps seven years for facilities.
If we are serious about deficits, then let’s get serious. What the new Congress does about IPAB will tell us a lot about whether it will live up to the oft-voiced commitment to reduce government spending.
What does this mean for you?
Watch what Congress does about physician payment reform. If this isn’t addressed in a meaningful, comprehensive, and sustainable way than there’s little chance Medicare costs will be controlled until IPAB goes into effect.
Below you see what will become the only access to health care in the US for over 80% of Americans----and it is tied to corporations receiving money to dole out a wellness program that will evolve into REQUIRED/MANDATORY PARTICIPATION to these programs. Now, Americans can do with encouragement to get active -----the US has the best results in the world in Federal health activism and fitness programs. We are getting people engaged with no mandatory participation.
What will evolve from these Affordable Care Act laws is complete control of a person's health through monitoring from birth to death with the patient having no control over what is prescribed and what products are required. All health institutions have to say is that what is being demanded will improve health.
Think what this will look like in a deregulated health system where medical and PHARMA patents are soaring from research having no checks and balances---and a doctor invested or working for an institution involved in the money-making patent will force a patient to use a product that they know may harm the patient down the road. I say doctor----but health insurance corporations/hospitals/doctors/medical device corporations are now one great big global health system all tied to you using their products.
Failing to participate in wellness will result in ever-higher insurance rates and ultimately lost employment. Forget wanting to create your own way to approach wellness---or better yet--- forget not being concerned about those pounds on your hips----
THIS WILL BE MILITARY BOOT CAMP ----GET DOWN AND GIVE ME FIFTY SOLDIER!
All of this wellness is tied to lab testing to monitor blood levels of all kinds of now medically important biotechnological measurements. Whereas grandmom and pop sat down every day to eggs, bacon, fat-back gravy, and a large serving of meat and potatoes and lived to be 90------that is freedom of choice that does not exist in data-driven health care.
It's the same as having to create all kinds of education measurements and data to justify creating new global education corporations. IT IS NOT NEEDED----IT CREATES PROFITS.
Wellness Program Incentives and the Affordable Care Act
July 1, 2013
Wellness Corporate Solutions, LLC | Wellness Program Incentives and the Affordable Care Act
Federal law generally prohibits group health insurance plans from discriminating based on health factors.
However, special rules exist to allow employers to make financial incentives a part of their wellness
programs — provided they follow certain guidelines.
On June 3, 2013, the federal government issued new rules governing wellness program incentives. The
purpose the rules is threefold:
1. To define the responsibilities of wellness program providers and plan administrators
2. To prevent discrimination in group health coverage
3. To increase the maximum rewards allowable under the law
This following is a brief outline of the law and should not be construed as legal advice. Click here to
download a complete copy of the regulations.
II. Types of Wellness Programs
The rules define two categories of wellness programs: Participatory and Health-Contingent.
a. Participatory Wellness Programs
Participatory wellness programs either do not provide rewards of any kind, or do not require participants to
satisfy any standard relating to a health factor. Examples include:
Subsidized gym membership
Reward for participating in a biometric screening (regardless of the results)
Reward for attending an optional health education seminar
Reward for completing a smoking cessation program (regardless of whether the individual stops
Participatory wellness programs must be made available to all similarly-situated individuals regardless of
health status. These programs are not required to adhere to the five requirements described in Section III
b. Health-Contingent Wellness Programs
The rules divide health-contingent wellness programs into two categories:
Activity-only: Reward is based on completing an activity related to a health factor
Outcomes-based: Reward is based on attaining or maintaining a specific health outcome