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Health Care Reform: Time to curb 'waistful' spending
January 28, 2011 - Mary Ann Heath
If we’ve learned anything over the past five to ten years, it’s that Americans, statistically and in comparison to the rest of the world, are too fat and lazy.
This is a drain not only on our lifestyles, but our pocketbooks and the economy as well. So, with that in mind, lawmakers added a provision to the health care bill that seems pretty brilliant if you ask me. In 2014, the Secretary of Health, together with the Secretary of Treasury and Secretary of Labor will start a 10-state demonstration project where insurance companies can offer enrollees incentives to participate in wellness programs. The rules seem very specific, probably for good reason, but I understand it like this: they are providing incentives for Americans to get off their lazy, oversized butts (and no it’s not a donut dangling from the end of a stick). This is an incentive, a reward for good behavior and not the government trying to force anyone to be healthy (though it appears we need some help).
Employers, or insurance plans, can offer enrollees discounts, rewards, gym memberships, etc. to participate in a wellness program. These programs may include:
• Partial or total reimbursement to a gym
• Diagnostic testing
• Waivers for copayments or deductibles for preventive care related to a health condition
• Reimbursement for smoking cessation programs
• Rewarding individuals for attending periodic health education seminars
If the secretaries feel the project is successful, starting in 2017, they can spread it to other states. Whether or not the program is deemed successful will depend how many enrollees participate and whether it saves, or costs money in the long run. It’s logical: Unhealthy people cost the system more money. Skyrocketing health care costs add to economic instability. Health care reform is really about controlling the costs, and protecting the consumer. According to Kaiser Health News (a non-profit news organization), the U.S. spent $2.3 trillion on health care expenditures in 2008 — among the highest of all industrialized countries. Government statistics from 2002 indicated about 61 percent of the American population — more than 120 million residents — are overweight or obese. This increases risk of heart disease, diabetes, high blood pressure, stroke, cancer and arthritis, according to health experts.
The U.S. is one of the most unhealthy nation’s in the world. We also spend a rediculous amount of money on health care. Do the math. Maybe its time we get moving.
Other things you may find interesting:
• Right to maintain existing coverage: So, why is everyone whining? This not only allows enrollees to keep the same coverage they have but to renew it, to add family members to it and companies may add employees to the coverage they already offer. This is what everyone is referring to when they say “grandfathered health plan.”
• Pre-existing conditions: Starting in 2014, insurance issuers will be barred from denying Americans with a pre-existing condition coverage (I touched on this in last week’s blog). They also won’t be allowed to charge them higher premiums, make them endure long waiting periods or limit their benefits. The Department of Health and Human Services estimates that between 19 and 50 percent of “non-elderly Americans” have some sort of pre-existing condition. It gets scarier. About 48 to 86 percent of Americans between 55 and 64 have a pre-existing condition and 15 to 30 percent of Americans currently in good health will develop a pre-existing condition over the next eight years. That’s a lot of people. Should health insurance cost you more, or be less available if you need it more? I don’t think so.
• No discriminatory premiums: Insurance issuers can’t charge you more based on your gender or health status.
• “Qualified Health Plans”: The bill establishes requirements for all “qualified health plans.” Plans must provide “essential coverage” (ambulatory, emergency, maternity/newborn, mental health, etc.) and meet limits established for cost-sharing (deductibles, copayments, etc.).
• Special Rules (i.e. abortion services): Yes, I’ve saved the most controversial for last. In general, no federal funds may be used for abortion services. The bill even mandates that private insurance premium funds be separated from taxpayer funds. Health care plans are not required to offer abortion coverage. States are also allowed to pass legislation choosing not to offer abortion coverage through the exchange.
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