Politico reported on a pilot program in ObamaCare. In an experiment under the Affordable Care Act, the Pioneer Accountable Care Organization program, were all able to improve patient care. Some were even able to lower Medicare costs.  The program’s results are similar to results found in the private sector, says Mark McClellan, former CMS administrator. The program is trying to reduce health care costs by increasing the health of patients through quality of care and reducing hospitalizations. In doing so, the results won’t spell immediate success for most organizations. McClellan advises that in a year, year and a half, or two years time, we will begin to see serious improvements in the health of patients, and a direct link to lowered Medicare costs. The Pioneer ACO will continue in the experiment, although some of the providers have left the program.

The L.A. Times reported that health care consumers saved nearly $1.5 billion in 2011 as a result of the Affordable Care Act (Obamacare) that limit what insurance companies can spend on expenses unrelated to medical care, including profit, a new analysis by the New York-based Commonwealth Fund shows.  Much of those savings — an estimated $1.1 billion — came in rebates to consumers required because insurers had exceeded the required limits. The study also suggests that the Affordable Care Act forced insurers to become more efficient by limiting their administrative expenses, a key goal of the 2010 law.

In some cases, insurers passed savings on to consumers in the form of lower premiums and higher spending on medical care, the researchers found.   Administrative costs in the individual market dropped in 39 states, with major improvements in South Carolina.  Insurers in 37 states spent relatively more of their customers’ premiums on medical care, with big gains in South Carolina.

Stepping up regulation of health insurance companies has been a top priority for consumer advocates, who have complained for years that insurers routinely increase premiums to pad profits and executive salaries rather than pay for medical care. The healthcare law attempts to address this by requiring insurers to spend at least 80 cents of every dollar they collect in premiums on medical care, rather than on administrative expenses.  Insurers selling to employers must meet an even tougher standard, spending at least 85 cents of every dollar on medical care.


The Washington Post published an interesting article that sheds light on Mitt Romney’s plan to help those with preexisting conditions get health insurance. Romney claimed during the past debate, “I do have a plan that deals with people with pre-existing conditions.” However, he is unable to articulate how it will help anyone other than those that have maintained continuous insurance coverage and it is still unclear how the 49 million uninsured individuals will get coverage.

As the article explains, the plan that Romney has been stressing will only help those with pre-existing conditions that have maintained continuous health insurance coverage. This means that anyone who may have had a break in coverage due to losing their job or for any other unforeseeable reason will not be helped at all by Romney’s plan.

After all of Romney’s talk about making it easier for those with pre-existing conditions to get coverage, in actuality only a small fraction of those with problem medical conditions will be helped, leaving a far greater number of people out of luck.

This plan is in stark contrast to President Obama’s health care law that allows those with preexisting conditions the same comprehensive coverage, at the same rates that every other citizen pays.  As the law says, an insurance company “may not impose any pre-existing condition exclusion.” Karen Pollitz, an insurance market expert, explains that Romney’s plan is much more unlikely to provide a solution than the president’s Affordable Care Act. Pollitz explains, “The ACA just says insurance companies can’t discriminate against you, period. If you’ve been uninsured, you can come into this market on Jan. 1, 2014, no questions asked.”


We are attaching talking points that will be useful when discussing both rehabilitation services and habilitation services as essential services under State Insurance Exchange Programs required to be created pursuant to the Affordable Care Act.  Persons suffering from a brain injury should receive adequate medical and rehabilitation services under the Affordable Care Act.  

The outcomes of rehabilitation and habilitation services and devices are consistent with core
American values because they enable people to:
• Maximize independence in the least restrictive environment;
• Live active and productive lifestyles that embrace family, work, education, and community; and
• Avert medical complications and minimize hospital readmissions.

These outcomes are important to individuals, families, and society. By promoting these outcomes, overall health care costs can be reduced, and thus provide significant value to American taxpayers.


Senior Housing News had an article about Medicare’s reimbursement being linked to quality care.  “Medicare is planning on eventually introducing a payment system for skilled nursing facilities that’s based on the quality of care being given rather than on costs and resources, but first it needs to figure out a system for doing so by analyzing results from its three-year “Nursing Home Value-Based Purchasing Demonstration” project, which ended on July 1.”

The national incentive pay program for nursing homes to provide superior quality in order to receive better payments is an initiative of the Affordable Care Act, but it will be several years in coming.  See report to Congress on the demonstration project.

Health policy experts remain optimistic that the current system can be transformed into a “higher performing, value-driven” healthcare system.  The Centers for Medicare and Medicaid Services (CMS) views the implementation of this sort of quality-based payment program as an important step in revamping how Medicare pays for healthcare services, says HHS, aiming to hold providers accountable for the quality of care they provide to Medicare beneficiaries, promote more effective, efficient and high quality care processes, and address the variation in quality across care settings.

The plan for this program will link payment to performance to “improve value for Medicare beneficiaries and other residents residing in SNFs by promoting the development and use of robust quality measures to allow patients and providers to assess the quality of skilled and non-skilled care furnished in SNFs,” says the report. “[T]he emphasis on Medicare beneficiares’ functional status can help prepare them for discharge to a less intensive non-institutional setting.”


One part of the Affordable Care Act (better known as ObamaCare) is insurance rebates–an estimated 12.8 million Americans will be getting either a check in the mail or a rebate at the office.
The Obama administration calls it the 80-20 rule.  For the first time in 2011, health insurance companies were required to spend a majority of every premium dollar, 80 or 85 cents, on actual medical care rather than administrative overhead or marketing or profit.
The insurance companies (who are setting record profits by the way) had to report back to the federal government by last June 1st and then, by August 1st, they have to return the excess in the form of rebate checks.  Now, those checks have to either go directly to consumers for people who buy their own insurance or to employers for people who get their insurance at work.
According to the Department of Health and Human Services, insurance companies are going to have to return over $1.1 billion to consumers.  The average family will get about $150 but it depends on where you live and the kind of insurance you have.



The lack of medical coverage in America is a serious problem as approximately 50 million people were uninsured all through 2010. The Patient Protection and Affordable Care Act, once implemented in its entirety, is expected to cover 30 million Americans currently lacking coverage.  The lack of medical insurance has had fatal consequences for individuals and the nation. In 2010 alone, 26,100 people died because they had no health insurance — that amounts to 502 preventable deaths a week.  Based on the latest report by Families USA, a health care consumer advocacy group, 24/7 Wall St. identified the 10 states with the highest number of deaths per 100,000 people due to a lack of insurance.  Of course, South Carolina ranked fourth.


4. South Carolina
• Excess deaths from a lack of insurance (per 100,000): 13.48
• Percent of population uninsured: 17.5 percent (tied for 12th highest)
• Percent living below the poverty line: 18.2 percent (seventh highest)
• Life expectancy at birth: 76.57 years (ninth lowest)

South Carolina is not a particularly healthy state: 67.4 percent of the state’s residents are either overweight or obese, just 23.3 percent eat proper amounts of fruit, only 22.9 percent eat proper amounts of vegetables and 10.7 percent are diabetic. All of these are among the highest rates in the country.

Meanwhile, much of the cost of health care falls to private individuals. The state spent about $6,300 per person on health care in 2009, among the lowest levels, and just 51.9 percent of residents have employer-based health coverage. Unfortunately, South Carolinians have trouble affording insurance on their own: Median income was just $42,000 in 2010, significantly lower than the $50,000 national average, 18.2 percent of residents live below the poverty line and the cost of health care is higher than is the case in many states.


There have been lots of polls taken about how Americans feel about the Affordable Care Act.  The amazing thing is that a majority of Americans do not approve of the law despite a majority liking most of the provisions of the law.  The easy explanation is that many Americans are misinformed about the law and/or wanted the law to go further (i.e. Medicare for all or public option or universal health care coverage).  A good portion of the opposition to the healthcare law is because Americans want more reform, not less of it.  Polls found that a large number of Americans – including about one-third of Republicans and independents who disagree with the law – oppose it because it does not go far enough to fix healthcare.

Recently Reuters/Ipsos reported on a recent poll that they took on this issue and the results are fascinating.  Strong majorities favor most of what is in the law but 56 percent of people are against the healthcare overhaul in general and 44 percent favor it.

Support for the provisions of the healthcare law was strong:

82 percent favor banning insurance companies from denying coverage to people with pre-existing conditions;

61 percent are in favor of allowing children to stay on their parents’ insurance until age 26;

72 percent back requiring companies with more than 50 employees to provide insurance for their employees.

The Guardian also had an article on the polls and Americans lack of understanding of the health care reform bill.  “Most Americans may not like Obamacare as a whole, but they seem to like it as long as it doesn’t include the mandate. Only 34% of respondents in the CBS poll approved of Obamacare as a whole, but 51% either wanted the bill kept intact or only wanted the mandate eliminated. A Fox News poll similarly discovered that only 40% of Americans favored the healthcare bill as a whole, but 51%, again, wanted to keep either the whole law or most of the law minus the mandate.”

“Yet, only 34% of the general population opposes Obamacare because it goes too far; 13% of Americans asked actually oppose it because it is too timid. When you combine those who oppose it for not going far enough with those who favor it, a majority, 56%, actually wants Obama’s healthcare bill or something more far-reaching.”

“Only 51% of adults in an April 2012 Kaiser poll responded that they had enough information to understand how the law would impact them personally. A March CBS poll gave pretty much the same result. How can Americans judge a healthcare law that will make a difference in lives, if they don’t comprehend how it will?”



The Washington Post reported the White House were tough negotiators with drug industry executives to get a 2009 deal that helped keep health care overhaul legislation from bogging down in Congress.  Internal emails obtained from the industry by the House Energy and Commerce Committee shed light on the negotiations.  The drug industry’s $80 billion commitment gave Obama some momentum at a time when health care overhaul appeared to be bogging down on Capitol Hill. Drug makers agreed to help close Medicare’s prescription coverage gap, known as the “doughnut hole,” and to make other financial contributions.

The emails reveal the distrust among participants, bitter rivalries among insurers, drug makers and hospital groups, and high anxiety on all sides about the progress of the legislation.


USA Today reported that "almost 4 million seniors saved about $2.16 billion through discounts for their prescription medications in 2011", according to the Department of Health and Human Services.  "The 2010 health care law required a 50% discount on prescription drugs in the so-called doughnut hole, or the gap between traditional and catastrophic coverage in the Medicare drug benefit, also known as Part D. In 2012, the coverage gap is $2,930. The Affordable Care Act eliminates the doughnut hole by 2020." 

In 2010, Medicare sent $250 rebate checks — totaling $846 million — to nearly 3.8 million seniors to try to counterbalance the gap. In the first two months of 2012, about 100,000 people have received $92.7 million in discounts — about $904 per person

Government costs for prescription medications through Medicare should decrease after seniors saved more than $2 billion in 2011 through discounts offered by the program. When Medicare recipients are able to take their medications, they are hospitalized less often for heart attacks, low blood sugar and asthma attacks thus reducing long term health care costs.