Scott Kirksey's blog

Re-Assessing the Value of Wellness and Prevention

Two of the hotter topics in today’s health landscape are wellness care and prevention care.  Both are highly controversial for all stakeholders in the health care industry as insurance providers and employers decide what benefits to offer employees.  Is there truly a financial incentive for these groups to provide wellness and prevention care?  It’s certainly a topic worth exploring.

Health Reform and Preventative Care Programs

Health reform is helping to spur a new renaissance in America’s preventative care model.  This February, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the organization would be investing, as mandated by PPACA, $750 million in programs designed to fight preventable conditions through the Prevention and Public Health Fund.  “This investment is going to build on the prevention work already under way to help make sure that we are working effectively across the federal government as well as with private groups and state and local governments to help Americans live longer, healthier lives,” Sebelius said in a press statement.[1]

Author: Scott Kirksey

HHS Program Expands to Tackle Health Promotion and Disease Prevention

Last week, the U.S. Department of Health and Human Services (HHS) unveiled Healthy People 2020, which identifies the nation’s 10-year goals for promoting health and preventing disease.

This program, and its associated educational materials, can serve as a helpful resource to brokers and agents as they provide support to their clients.  While most insurance coverage is still geared to treating individuals when they get sick, identifying resources to promote a healthier lifestyle is an important goal for everyone, no matter what age or type of insurance coverage they have.     

Author: Scott Kirksey

Health Care Reform Update: Fighting Health Care Fraud

No matter who is in control of the White House or Congress, one bipartisan activity that will continue in the coming years is the fight against health care fraud.  Both Democratic and Republican Administrations have supported a number of anti-fraud programs to identify criminal activities that hurt consumers and cost U.S. taxpayers dearly.   

Recently, the U.S. Department of Health and Human Services (HHS) and Department of Justice (DOJ) announced the launch of another round of initiatives to fight health care fraud, including hosting fraud summits in several cities.  A HHS press release published on November 5th explains “(t)he summits are part of a larger effort on behalf of the Obama Administration to root-out waste, fraud, and abuse within the U.S. health care system.”  In 2009, HHS reports that “anti-fraud efforts put $2.51 billion back in the Medicare Trust Fund resulting from civil recoveries, fines in criminal matters, and administrative recoveries.”

Author: Scott Kirksey

Low Enrollment for Pre-Existing Condition Insurance Plan

One of the biggest obstacles with obtaining health care was the limited access that people with pre-existing conditions had to health care coverage.  A new plan – the Pre-Existing Condition Insurance Plan – was launched this summer as part of the Affordable Care Act. It’s meant to provide access to health care for those denied coverage due to pre-existing conditions.

To meet the criteria, a person must have problems getting health insurance because of a medical condition and have been uninsured for at least six months.

When putting together this plan, government economists predicted 375,000 people would enroll and gain coverage this year alone. They questioned if the $5 billion allotted for this program would be sufficient.

It turns out it’s more than sufficient.

Author: Scott Kirksey

First Round of Health Care Changes Go Into Effect

More than six months after the bill was signed, some aspects of the new health care law go into effect. As of yesterday, September 23, any insurance plan that is new or renewed will have to follow the new guidelines as outlined by the Affordable Care Act.

Curious what the provisions entail? Any new or renewed plan must incorporate the following into their plans:

  • Elimination of lifetime maximums for services.
  • Offer coverage to children with pre-existing conditions.
  • Broaden preventive care to provide certain preventive services without co-pays or
        cost-sharing.
  • Allow adults up to age 26 to remain on their parents’ health plans.
  • Prohibited from canceling or rescinding coverage.
Author: Scott Kirksey

Missouri Votes Against New Health Care Law

In a surprise vote last Tuesday, Missouri voters came out to vote for Proposition C, a ballot referendum that aims at nullifying a key component of the new federal healthcare law that individuals be required to purchase health insurance.  An overwhelming majority – 71 percent – of voters approved this referendum.

The referendum was intended to nullify the section of the law requiring individuals to obtain health insurance or face a tax penalty. Supporters hope it will send a strong signal to Washington that the federal government shouldn’t dictate people’s health care choices.

There was virtually no mention of Proposition C before Tuesday’s election. Even though a majority of voters approved the referendum, just a small fraction of Missouri residents were out voting that day.

Author: Scott Kirksey

Re-Assessing the Value of Wellness and Prevention

Two of the hotter topics in today’s health landscape are wellness care and prevention care.  Both are highly controversial for all stakeholders in the health care industry as insurance providers and employers decide what benefits to offer employees.  Is there truly a financial incentive for these groups to provide wellness and prevention care?  It’s certainly a topic worth exploring.

Health Reform and Preventative Care Programs

Author: Scott Kirksey

Federal Government Plan Based on Massachusetts Plan Proves Worrisome

There are many that don’t know what to expect when the new health law is fully enacted. To see the results, take a look at the current universal health care plan in Massachusetts, a plan that is “essentially identical” to the national plan, according to President Obama.

The Massachusetts program was intended to insure all state residents, while decreasing costs. It has not fulfilled the second objective.

The plan, passed in 2006, is struggling along. In order to contain costs, Governor Duval Patrick imposed artificial price caps on premium rates earlier this year. In April, his insurance commissioner rejected 235 of 274 requests for increases by insurers, despite insurers finding them necessary to cover claims expenses.

Author: Scott Kirksey

Rate Increases Typical

Late last year, there was a big outcry when Wellpoint raised their premium rates in California by as much as 39 percent. A new survey finds that this double-digit increase is not unusual at all.  It found the average increase averaged around 20 percent.

According to the survey released by Kaiser Family Foundation, which polled just over 1,000 people who receive individual coverage rather than employer-group coverage, around 77 percent reported an increase. Most paid the increase but 16 percent switched to another insurer or a lower cost plan. As a result, the average increase actually realized for all respondents was only 13 percent.

Author: Scott Kirksey

Employer Coverage Could Be in Jeopardy

A recent article in Fortune Magazine backs what we’ve been saying all along. The new health care reform law is just not sustainable.

The new law is dependent upon expanding and sustaining the current employer-based system that insures many Americans through their jobs. According to documents released, companies such as AT&T, Verizon, Deere and Caterpillar are exploring their options when it comes to health insurance coverage, including dumping health care coverage and instead, paying the penalty fee to the government.

Author: Scott Kirksey
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