House passes new SCHIP Bill

With 9 million uninsured children currently in the US the House voted to provide health insurance for children.

On October 25 the House of Representatives for the third time this year passed a new bill to reauthorize and expand the State Children’s Health Insurance Program (SCHIP), One day after it was introduced. However it again failed to attain a majority that would prevent a veto by the president.

The House approved the new legislation by a 265-142 vote. That vote also fell short of the two-thirds that would be needed to override a presidential veto.

The new bill mirrors the earlier version which was vetoed by Bush, but contains a number of changes made in an effort by Democratic leaders to attract greater support for the program.

The new bill clarifies that states would receive federal funding for children enrolled in the program only if their families have incomes of 300 percent of the poverty level or less, up to $51,510, for a family of three.

The bill would phase out coverage of childless adults after one year, rather than two.

The bill clarifies that states would not receive federal funding for payments made to non-citizens. The Social Security Administration would be required to verify name, Social Security number, and place of birth of enrollees and applicants.

Like the vetoed bill, the new bill would add $35 billion to the program over five years to insure more children whose parents do not qualify for Medicaid but cannot afford private insurance.

Total funding for SCHIP would be $60 billion. Supporters of the legislation estimate it would allow 10 million children to participate in the program, up from the 6.6 million currently covered.

The extra $35 billion proposed by the bill would be funded by a federal tax increase on tobacco products. Most significantly, the bill would increase the tax on cigarettes by 61 cents, to $1 per pack. It would impose additional tax increases on other tobacco products, including cigars and pipe tobacco.

This cigarette tax increase to support funding for the new program is strongly opposed by the Bush administration as per Michael Leavitt secretary of Health and Human Services.

Opponents of the earlier bill expressed concerns that the bill to add $35 billion to the State Children's Health Insurance Program would cover adults and families who earn up to $83,000 annually, as well as illegal immigrants.

The new version would strengthen the original bill's eligibility cap at 300 percent of poverty but phase childless adults off the program within one year instead of two, and clarify language stating that illegal immigrants will not be eligible.

As per the White House news release the president’s concerns with the new bill are
· The new legislation continues to allow States to avoid covering poor children first.
· The new legislation continues to cover children in families earning more than $62,000 per year (300 percent of the Federal poverty level).
· The new legislation continues to raise taxes to move 2 million children covered by private health insurance onto government-run programs.
· The new legislation continues to allow SCHIP to cover ineligible individuals.
· The new legislation shifts more responsibility to the Federal government.
http://www.whitehouse.gov/news/releases/2007/10/20071025-6.html

With Election Day looming in days and the support of 75-80% of Americans SCHIP is a priority and may be up for another vote as early as Thursday.

Remember make your voice heard VOTE Election Day November 6th

Want to make a difference?

In a survey by the Commonwealth Fund America consistently ranks behind Europe and Australia in major aspects of health care. http://www.aflcio.org/issues/healthcare/facts.cfm

Everyday in the news there are concerns over health care. America has the ability to provide the best health care in the world, yet everyday there are Americans that can not receive health care because of lack of insurance or coverage

We sit frustrated and feeling helpless wondering what one person can do to change things. It is easy to sit and complain that the government is mishandling health care and your health care concerns are not being addressed.

Kaiser Family Foundations has set up a site to compare side by side the opinions and positions of all the major candidates on health care issues.
http://www.health08.org/sidebyside.cfm

The most effective way to have our elected representatives address our concerns and set up laws to provide safe affordable quality health care is to understand the positions and proposals of the candidates. Then make a well informed decision on whose ideology best represents yours and

Vote

If your ideas are still not addressed then let your elected representatives know your concerns in writing or on-line.

Children Health Insurance
http://www.thepetitionsite.com/takeaction/469109231

Single-Payer National Health Insurance
http://www.protesthealthcare.org/

Medicare cost increases
http://www.capitolconnect.com/takeaction_aarp/

http://www.ama-assn.org/ama/pub/category/13097.html

Cancer Treatment cutbacks
http://www.protectcancerpatients.org/home/?CFID=453399&CFTOKEN=49429041


As a nurse I’ve joined professional organizations that have the financial and political clout to lobby in congress to express their opinions. Professional organizations, unions or national organizations for diseases are great places to meet and discuss your ideas with other like minded people and have the back up millions of voices instead of one.

10 million union members are represented by:
http://www.aflcio.org/issues/healthcare/

2.9 million Registered Nurses are represented by
http://nursingworld.org/MainMenuCategories/ANAPoliticalPower/ANAPAC.aspx

50 thousand physician members are represented by
http://www.ama-assn.org/

For anyone over the age of 50 and their spouses.
http://www.aarp.org/

Don’t stand alone. There is strength in numbers. Join your local political groups, go to town meetings, write editorials, or set up fund raisers for research or services.

Medicare costs increase

Most Medicare patients will pay $2.90 more per month in Part B premiums next year -- to $96.40. A majority of patients could also face hikes of $5 to $10 in monthly premiums for Part D, the Medicare prescription drug program, unless they enroll in less expensive plans.
There will also be increases in deductibles for hospital admissions and doctors' visits.

This increase in Part B of 3.1% is the lowest since 2000, but will provide only temporary relief for seniors. The smaller-than-usual hike is artificially low next year because:

Firstly, the Centers for Medicare and Medicaid Services fixed an accounting error that otherwise would have added $2.50 to beneficiaries' monthly premiums.

Secondly the new premium is based on the assumption that physicians will take a 10% cut in their Medicare reimbursement rates next year.

Physician groups have warned that patient access to care will be jeopardized. As per a survey by the American Medical Association of 8,955 physicians unless planned fee cuts are restrained:

• 77% of the physicians surveyed say they'll limit the number of new Medicare patients
• 68% of the physicians surveyed say they will limit the number of their established Medicare patients
  
  
  Congress, as it has for the last 5 years is expected to overturn the cuts or allow a modest increase. The cost will be passed on to beneficiaries in subsequent years to reflect the additional expense.
  

Government costs for health care are expected to soar in the long term unless drastic reform is undertaken.

This is especially true as the first baby boomer applied this month for Social Security. The baby boomer generation is a generation of nearly 80 million born from 1946-1964. Major changes in the health care sytem need to occur before the oldest of the baby boom generation enters the Medicare system.

• Center for Medicare and Medicaid Services (CMS) projects that by 2016, national health care spending will be over $4.1 trillion, and Medicare's share of that will be 21%.

The enrollment of baby boomers plus the prescription drug benefit, which reduces private out-of-pocket spending and increases public spending, are the main factors.

• Medicare officials said that the annual deductible for physician services will increase by $4 to $135 next year.
• The deductible for Medicare Part A, which covers inpatient hospital and hospice care as well as short stays in nursing homes, will increase from $992 to $1,024 next year.
• Medicare beneficiaries have typically paid 25% of their Part B premium cost, while federal taxpayers have covered the rest. By 2009, when means testing is fully phased in, affluent seniors will pick up 35% to 80% of their premium costs.

Beneficiaries in every state will have access to at least one drug plan with premiums of less than $20 a month, and a choice of at least five plans with premiums of less than $25 a month. The national average monthly premium for the basic Medicare drug benefit in 2008 is projected at $25. The open enrollment period for Medicare D drug program for 2008 begins Nov. 15 and ends Dec. 31.


The majority of beneficiaries could avoid any premium increase in 2008 by enrolling in a lower-cost stand-alone plan in their region or utilizing a Medicare Advantage plan with lower prescription drug premiums.

For additional info search the Center for Medicare and Medicaid website:

http://www.cms.hhs.gov/apps/media/press/factsheet.asp

or Kaiser Family Foundation: Health Care Trends

http://www.kff.org/insurance/upload/7692.pdf

or American Medical Association

http://www.ama-assn.org/

Health Insurance for children

The State Children’s Health Insurance Program SCHIP

In an attempt to address the growing number of children in the US without health insurance the State Children’s Health Insurance Program (SCHIP) was created. This is a national program that provides health insurance for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private insurance.

On October 1, 1997 this program went into effect and was administered by the Centers for Medicare and Medicaid Services (CMS). This program provided the State Children’s Health Insurance Program (SCHIP) with $ 24 billion in federal matching funds over 10 years to help states expand health care coverage to over 5 million of the nation's uninsured children. This was the largest expansion of health insurance coverage for children in the United States since Medicaid began in the 1960s.

SCHIP is jointly financed by the Federal and State governments and is administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. SCHIP provides a capped amount of funds to States on a matching basis for Federal fiscal years 1998 through 2007. SCHIP covered 6.9 million children at some point during Federal fiscal year 2006, and every state has an approved plan.

States are given flexibility, and an enhanced match is paid to states. Some states have received Section 1115 demonstration authority to use SCHIP funds to cover the parents of children receiving benefits from both SCHIP and Medicaid, pregnant women, and other adults.

In 2007, researchers from Brigham Young University found that children who drop out of SCHIP cost states more money because they shift away from routine care to more frequent emergency care situations. In a 2007 analysis by the Congressional Budget Office, researchers determined that "for every 100 children who gain coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children." The CBO speculates this is because the state programs offer better benefits and lower cost than the private alternatives.

The program cost $40 billion federal dollars over 10 years. Despite SCHIP, the number of uninsured children continues to rise, particularly among families that cannot qualify for SCHIP. An October 2007 study found that 68.7 percent of newly uninsured children were from families 200 percent above the federal poverty level.

A proposal was made to expand SCHIP from $5 billion yearly by $35 billion over five years and was recently passed in the Congress. However it was vetoed by President George W. Bush. An attempt to override the president’s veto was made by the House of Representatives today, October 18, 2007 failed by a vote of 273 to 156 for a 13 vote shortage of the two-thirds majority needed for override.

Additional info available http://www.cms.hhs.gov/LowCostHealthInsFamChild/

Facts on Health Insurance Coverage

Most Americans have health insurance through their employers. But, employment is no longer a guarantee of health insurance coverage. As America moves from an industrial economy to a service economy, employers are placing an increased reliance on part-time and contract workers who are not eligible for coverage; fewer workers have access to employer-sponsored health insurance.

As health insurance costs rise small employers become unable to afford health benefits and larger companies may require employees to contribute a larger share toward their coverage. As a result, an increasing number of Americans have opted not to take advantage of job-based health insurance because they cannot afford it.

Who are the uninsured?

The number of uninsured increased by almost 7 million people since 2000 in which the large majority of the uninsured (80 percent) are native or naturalized citizens.

The increase in the number of uninsured in 2005 was focused among working age adults. The percentage of working adults (18 to 64) who had no health coverage climbed from 18.5 percent in 2004 to 20.5 percent in 2005 -- an increase of over 800,000 uninsured workers. Nearly one (1) million full-time workers lost their health insurance in 2005.

Nearly 82 million people – about one-third of the population below the age of 65 spent a portion of either 2002 or 2003 without health coverage .The percentage of people (workers and dependents) with employment-based health insurance has dropped from 70 percent in 1987 to 59.5 percent in 2005.

In 2005, nearly 15 percent of employees had no employer-sponsored health coverage available to them, either through their own job or through a family member. 27.4 million workers were uninsured because not all businesses offer health benefits, not all workers qualify for coverage and many employees cannot afford their share of the health insurance premium even when coverage is available.

The number of uninsured children in 2005 was 8.3 million – or 11.2 percent of all children in the U.S.

The number of children who are uninsured increased by nearly 400,000 in 2005, breaking a trend of steady declines over the last five years.

Young adults (18-to-24 years old) remained the least likely of any age group to have health insurance in 2005 – 30.6 percent of this group did not have health insurance.

Based on a three year average (2003-2005), people of Hispanic origin were the least likely to have health insurance. An average of 32.6 percent of Hispanics were without health insurance during that period.

Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more. A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.

Why is the number of uninsured people increasing?

Millions of workers don't have the opportunity to get health coverage. A third of firms in the U.S. did not offer coverage in 2005.

Nearly two-fifths (38 percent) of all workers are employed in smaller businesses, where less than two-thirds of firms now offer health benefits to their employees.

Rapidly rising health insurance premiums are the main reason cited by all small firms for not offering coverage. Health insurance premiums are rising at extraordinary rates. Over the past five years the average annual increase in inflation has been 2.5 percent while health insurance premiums for small firms have escalated an average of 12 percent annually.

Even if employees are offered coverage on the job, they can't always afford their portion of the premium. Employee spending for health insurance coverage (employee's share of family coverage) has increased 143 percent between 2000 and 2006.

Losing a job, or quitting voluntarily, can mean losing affordable coverage – not only for the worker but also for their entire family. Only seven (7) percent of the unemployed can afford to pay for COBRA health insurance – the continuation of group coverage offered by their former employers. Premiums for this coverage average almost $700 a month for family coverage and $250 for individual coverage, a very high price given the average $1,100 monthly unemployment check.

How does being uninsured harm individuals and families?

Lack of insurance compromises the health of the uninsured because they receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates than insured individuals.

Regardless of age, race, ethnicity, income or health status, uninsured children were much less likely to have received a well-child checkup within the past year.

The uninsured are increasingly paying "up front" -- before services will be rendered. When they are unable to pay the full medical bill in cash at the time of service, they can be turned away except in life-threatening circumstances.

About 20 percent of the uninsured (vs. 3 percent of those with coverage) say their usual source of care is the emergency room. The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices.

Studies estimate that the number of excess deaths among uninsured adults age 25-64 is in the range of 18,000 a year.

What additional costs are created by the uninsured population?

The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis.

Hospitals provide about $34 billion worth of uncompensated care a year.

Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage.

The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300.

Getting Everyone Covered will Save Lives and Money

The impacts of being uninsured are clear and severe. Many uninsured individuals postpone needed medical care which results in increased mortality and billions of dollars lost in productivity and increased expenses to the health care system. There also exists a significant sense of vulnerability to the potential loss of health insurance which is shared by tens of millions of other Americans who have managed to retain coverage.

According to data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey

SOURCE: National Health Interview Survey, 2006

In 2006, 14.8 percent of Americans, or 43.6 million, were currently without health insurance.

The visit rate for patients with no insurance was about twice that of those with private insurance in emergency departments. Lack of insurance compromises the health of the uninsured because they receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates than insured individuals

Conversely, patient visits to physician offices were higher for individuals with private health insurance compared to those with no insurance.

Among working-age Adults (those ages 18-64), 19.8% did not have health insurance in 2006. An increase in the percent uninsured from 18.9% the year before. Over 8 in 10 uninsured people came from working families – almost 70 percent from families with one or more full-time workers and 11 percent from families with part-time workers

Approximately 9.3% of children under the age of 18 did not have health insurance in 2006, an increase in the uninsured from 8.9% in 2005.

Almost a third (32.1 percent) of Hispanic people were uninsured when interviewed in 2006.

While 10.4 percent of non-Hispanic white persons and 15.9 percent of non-Hispanic black persons were uninsured when interviewed.

A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service such as accidents or dental care.

To learn more about other topics, visit the Data and Statistics page for more survey data, tools, and other resources from across CDC.

This document is also available as a printable .pdf file.Health Insurance Coverage Facts on Health Insurance Coverage

Every American should have health care coverage, participation should be mandatory, and everyone should have basic benefits.

Health Care 101

What are your major problems with the health care system?
Tired of the confusion over health insurance, coverages, services covered?
There is help through the maze.

I'm a Registered Nurse in New York City with 30 years of experience in the Heath Care Industry. I have worked for years in hospitals and home care agencies. As a case manager I evaluated the needs of patients to provide necessary services.

Health Care options are numerous and diverse. Even the most educated people have difficulty understanding the health care system. In my years as a nurse I have found that many people when faced with the stress of illness are uncertain of where to turn. The prospect of dealing with a health insurance company to justify the care they feel is necessary and covered is not what most people expect as part of their treatment.

Please send me your concerns and stories.