The last, great hope of Republicans to see Obamacare killed outright is officially dead

. They haven't been able to repeal it. They ran a presidential campaign on ending it, and were overwhelmingly rejected. The Supreme Court decided not to overturn the entire law once already, and has now dismissed the last big case challenging the underpinnings of the law.

The court rejected a petition filed by Liberty University, a Christian college in Virginia, which had raised various objections to the law, including to the key provision that requires individuals to obtain health insurance. [...]By rejecting the Liberty University case, the justices left intact a 4th U.S. Circuit Court of Appeals of a May 2013 decision that dismissed the claims made by the college and two individuals, Michele Waddell and Joanne Merrill.

They're not going to kill it outright. They're officially out of opportunities. They're out of time legislatively, since they're going on the long recess on December 13. They'll have to change strategies now, because after January 1 repeal means taking people's insurance away, something even most Republicans will recognize isn't politically smart. So now it's going to be more efforts to chip away, to refuse to allow any fixes, to create as many obstacles as possible at the state level for implementation. All of which they will do, because it's now their entire reason for being.

Originally posted to Joan McCarter on Mon Dec 02, 2013 at 10:28 AM PST.

Also republished by Daily Kos.

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New Health Incsurance

Understanding New Health Insurance

Week of August 26, 2013

Visit USA.gov's Health Insurance webpage to learn about the new Health Insurance Marketplace and other types of health coverage. Starting October 1, 2013, you can fill out an application for health insurance through the Health Insurance Marketplace. You will be able to compare your options side-by-side and enroll in a plan that fits your budget and meets your needs. Coverage takes effect as early as January 1, 2014.

BAsic Health Insurance terms

Half of Americans can't define basic health insurance terms

By Kathryn Mayer

August 29, 2013 • Reprints

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What’s a premium again?
Forgot about the PPACA. Americans have a lot of questions about the basics of health insurance.
A new survey of 1,008 U.S. adults conducted for the American Institute of CPAs by Harris Interactive found that more than half (51 percent) could not accurately identify at least one of three common health insurance terms: premium, deductible and copay.
A third (34 percent) thought a premium was an expense at the time of receiving medical service or a prescription; more than a quarter (27 percent) thought a copay was the cost of obtaining insurance; and 12 percent did not know a deductible is the money one pays before an insurance company makes payments.
“Half of Americans would fail health insurance 101,” said Ernie Almonte, chair of the AICPA’s National CPA Financial Literacy Commission. “That’s critical insight as consumers prepare to make important decisions with implications for both their physical and fiscal well-being. Americans need to take time in the coming weeks to familiarize themselves with key terms and assess their needs so they make the best decisions for their health and financial situations.”
Not surprisingly, just as consumers struggled with basic health insurance information, the majority of Americans were unaware of the Patient Protection and Affordable Care Act and its implications.

Forty-one percent said they are not at all knowledgeable about the law and another 48 percent said they were only somewhat knowledgeable. Young people were the least knowledgeable, with nearly half, 48 percent, of adults aged 18 to 34 saying they had no knowledge.
For 11 percent of U.S. adults, the upcoming requirement to buy health insurance is their biggest financial concern. For half of the small minority who don’t have health insurance —14 percent, according to the survey — figuring out how to pay for it is their biggest concern about the mandate.

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Health Care understanding

Health Care: A Brief Glossary

Benefit package – The list of services and products that a health plan covers. Typically, the more expansive the benefit package is, the more expensive the health insurance coverage is.

Capitation – A system of paying doctors and health providers a set amount per patient per year regardless of how much health care that person uses. In theory, this creates incentives to keep people healthy and avoid using expensive services.

Cherry-picking – A process where an insurer tries to cover only the healthiest people with the lowest risk of using health services.

Community rating – This rule would require insurance companies to set premium rates based only on geography and not health status. Sometimes gender and age also are considered in rate setting.

Guaranteed issue – This rule would require insurance companies to offer health coverage to any one willing and able to pay regardless of health status or pre-existing conditions.

Comparative effectiveness research – Research that compares two or more drugs, treatments or medical interventions to see which is most effective for which type of patient. In theory, insurance providers, whether it is the government or a private company, would use this research to guide decisions on which medical treatments to cover.

Employer mandate – A requirement that businesses offer their employees health insurance. It may only pertain to businesses of a certain size. Massachusetts, for example, requires businesses with 10 or more employees to provide coverage or to pay a set amount on their behalf to purchase coverage.

Fee-for-service – The traditional and most widespread method of paying doctors and health care providers for each service provided.

Health insurance cooperative – A nonprofit health plan owned and operated by a collection of small businesses or individuals that group together to purchase health insurance so they have greater negotiating power.

Health insurance exchange – A marketplace where people can buy insurance. An exchange could be set up in many ways at the state, regional or national level. The government could regulate what plans are offered, how much insurers charge and set other rules insurers must follow. Sometimes called a “connector,” it often is compared to a menu of insurance options people can choose among similar to what is available to federal government employees. Its primary users likely would be small businesses and people buying individual insurance.

High-risk pool – Some states have insurance pools for people who insurance companies will not cover due to pre-existing conditions or poor health status.

Individual mandate – A requirement that all individuals purchase health insurance coverage. Proponents say an individual mandate is necessary to achieve universal coverage and to avoid a system where only the elderly and unhealthy purchase insurance. Opponents say it infringes on personal freedoms and is unenforceable.

Medicaid – The government health insurance program for the poor. The $333-billion program is paid for through a combination of federal and state funding, but administered by states. In 2007, about one in five people in the U.S. were enrolled in Medicaid.

Medicare – The government health insurance program for people who are 65 and older, blind or permanently disabled. In 2008, the $460-billion program provided health coverage to about 45 million people.

Medicare Advantage – This program allows Medicare beneficiaries to enroll in a private HMO or other health plan to receive their benefits.

Medical underwriting – An insurance process of evaluating an individual’s health status to decide if they should be offered insurance and how much they should pay in premiums. Underwriting is not used in the employer-sponsored insurance market only the individual market.

Pay for performance – A system that would pay doctors, hospitals and health care providers based on how well they take care of patients and not just on how much care they provide to patients.

Pre-existing condition – A prior health condition that may make people ineligible for health insurance coverage in the individual market.

Premium – The amount an insurance company charges to provide coverage. In 2008, the average annual premium for a family was $12,680 – more than twice the cost in 1999.

Public plan – The government could offer a public plan similar to Medicare as one of choice in the health insurance exchange to compete with private insurers. Republicans strongly oppose creating a public plan.

Purchasing pool – Health insurers lump the premiums people pay together to pay for health care services. In this pool, people who use few health services subsidize the costs of people who use many. This ability to “spread risk” gives large employers an advantage over small employers when buying health insurance.

SCHIP – The State Children’s Health Insurance Program was created in 1997 to provide health coverage to children not poor enough to qualify for Medicaid. The program is funded by the federal and state governments, but each state operates its program differently. In 2008, the $10-billion program provided health coverage to about 4.5 million children.

Single-payer system – A health care system in which all the funding comes from one source, usually the government. Private insurance, however, can and does exist in countries with a single-payer system, such as Canada and the United Kingdom.

Socialized medicine – A health system in which the government provides the health insurance coverage, owns the hospitals, and employs the doctors. The Veterans’ Administration health system is an example of socialized health care.

Uncompensated care – Care that doctors and hospitals provide to patients for which they never receive payment.

Underinsured – A term describing people who have insurance but are still considered financially vulnerable to high health expenses because of the limitations or cost-sharing of their plans.

Puchasing own Health Insuarance

A new report estimates that U.S. consumers who purchase their own health insurance saved $2.1 billion last year due to tougher rules in the federal healthcare law.

Thursday's report by the nonpartisan Kaiser Family Foundation estimates that individual premiums would have been $1.9 billion higher in 2012 without the requirements in the federal Affordable Care Act. In addition, the nonprofit group said individual policyholders nationwide should receive $241 million in rebates this summer.
Insurers must issue rebates to individuals and small businesses if they don't spend at least 80% of their annual premiums on medical care

obamacare Mandate Insurance

When you mandate insurance, pretty much everybody gets insurance

Even before the mandate took effect in 2007, only 8% of Massachusetts residents went without insurance -- half the national figure today. The mandate, along with subsidies that make policies more affordable, has brought the Massachusetts uninsured rate down to 3%, the lowest in the country.

Now that firms with 11 or more workers are on the hook for insurance, small-business employees are less likely to go without. More low-income workers are covered. And the hard-to-persuade healthy 18-to-34 crowd has been brought into the fold: Only 6% of these "young invincibles" lack insurance today, according to the state's Center for Health Information and Analysis (CHIA), down from 18% pre-reform.

Some joined a parent's policy -- under Romneycare, as with Obamacare, you have that right until age 26. Others accepted workplace coverage they might have otherwise skipped, sometimes to everyone's benefit

CONTROLCOST OF HEALTH CARE MASSACHUSETTS

You are correct in singling out Massachusetts as a national leader in working to control the rising cost of health care (“Massachusetts Takes On Health Costs,” editorial, Aug. 5). Massachusetts was the first in the country to greatly expand access to health care to our citizens. As we always planned, we are tackling the next great challenge: rising costs. Our office has identified one of the single greatest drivers of health care costs as the prices negotiated because of the market leverage of providers rather than the quality of services offered. Our new law establishes additional tools to scrutinize market behavior without impeding it, but also allows us to monitor market activity in real time for potential negative impact and then to take necessary actions. By striking the right balance, this law will help slow the spiraling health care costs faced by businesses and consumers while also allowing the marketplace to innovate and grow. MARTHA COAKLEY Attorney General of Massachusetts Boston, Aug. 7, 2012

MEDICARE SAVINGS HEALTH CARE LAW

For Immediate Release:	Thursday, May 24, 2012
Contact:	CMS Office of Public Affairs 202-690-6145

HEALTH CARE LAW SAVED PEOPLE WITH MEDICARE OVER $3.5 BILLION ON PRESCRIPTION DRUGS
IN THE FIRST FOUR MONTHS OF 2012, MORE THAN 416,000 PEOPLE WITH MEDICARE SAVED AN AVERAGE OF $724 ON PRESCRIPTION DRUGS AND 12.1 MILLION USED A FREE PREVENTIVE SERVICE

Under the new health care law – the Affordable Care Act -- seniors and people with disabilities in Medicare have saved a total of $3.5 billion on prescription drugs in the Medicare drug benefit coverage gap or “donut hole” from the enactment of the law in March 2010 through April of 2012. The Centers for Medicare & Medicaid Services (CMS) released data today showing that, in the first four months of 2012 alone, more than 416,000 people saved an average of $724 on the prescription drugs they purchased after they hit the prescription drug coverage gap or “donut hole,” for a total of $301.5 million in savings. These savings build on the law’s success in 2010 and 2011, when more than 5.1 million people with Medicare saved over $3.2 billion on prescription drugs.

In addition, CMS announced that this year, from January through April, 12.1 million people in traditional Medicare received at least one preventive service at no cost to them – including over 856,000 who have taken advantage of the Annual Wellness Visit provided in the Affordable Care Act. In 2011, over 26 million people in traditional Medicare received one or more preventive benefits free of charge.

“Thanks to the health care law, millions of people with Medicare have paid less for health care and prescription drugs,” said CMS Acting Administrator Marilyn Tavenner. “The law is helping people with Medicare lower their medical costs, and giving them more resources to stay healthy.”

People with Medicare who hit the coverage gap “donut hole” in 2010 received a one-time $250 rebate. In 2011, people with Medicare began receiving a 50 percent discount on covered brand name drugs and 7 percent coverage of generic drugs in the “donut hole.” This year, Medicare coverage for generic drugs in the coverage gap has risen to 14 percent. Coverage for both brand name and generic drugs in the gap will continue to increase over time until 2020, when the coverage gap will no longer exist.

For more information on how the Affordable Care Act closes the Medicare drug benefit coverage gap “donut hole,” please visit: http://www.healthcare.gov/law/features/65-older/drug-discounts/index.html.

Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits like cancer screenings and smoking cessation counseling. Now, many of these benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to find and treat problems early.

For more information on Medicare-covered preventive services, many of which are now provided without charge to beneficiaries thanks to the Affordable Care Act, please visit: http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html.

To learn what screenings, vaccinations and other preventive services doctors recommend for you and those you care about, please visit the myhealthfinder tool at www.healthfinder.gov.

Thanks to the Affordable Care Act:

• Millions of uninsured Americans will gain access to quality,
•  affordable health coverage;
• No American will be denied health coverage simply
•  because they have a "pre-existing" condition;
• Insurers will no longer be able to drop an American
• from health coverage, simply because he or she got sick;
• Insurers will no longer have free rein to raise premiums without limits and accountability;
• Every insurance plan must be described in clear, factual, and transparent terms so consumers can understand
•  what they are getting for their premium dollars;
• Families can rest easy knowing young adults can stay on their family plan until age 26;
• All Americans will have no-cost access to vital preventive
• check-ups and care;
• Seniors stuck in the "doughnut hole" will get much-needed help affording their prescription drugs;
• Small businesses will get tax credits to help extend coverage to their employees; and
• Community health centers will be able to expand the number of patients they serve in states across the country.

These vital protections will make a difference for millions of American families. Don't take away our health care!

ACO program Health Care Reform

The effects of healthcare reform will become increasingly apparent in 2012, and senior care providers may find themselves—and their marketing strategies—particularly impacted by Accountable Care Organizations (ACOs) as they line up to partner with hospitals and other healthcare providers.
ACOs are groups of doctors, hospitals, and other healthcare providers that work together to give coordinated care to their Medicare patients to improve care quality, ensure best outcomes, and thereby reduce Medicare costs.
Although some aspects of healthcare reform, such as expanded Medicaid eligibility, won’t kick in until 2014, providers are gearing up for a playing field that’s going to get larger, and looking for ways to reduce costs.
“Providers of all types are being more strategic of who they choose to serve under what type of model,” said Dr. Russ Richmond, the CEO of Objective Health, a McKinsey Solution for Healthcare Providers. “They’ll be focusing on how they can have sustainable enterprises on what’s probably likely to be, on average, a lower reimbursement level.”
What’s happening is that providers along the continuum of care—and that includes senior care—will seek to coordinate and integrate for best outcomes, and senior living providers may find hospitals to be a valuable referral base.
“With a lot of that care, the focus is shifted from procedure based fee-for-service care to outcome measurements,” Richmond says. “There’s a shifting in mindsets around how the formula is going to be measured, how you want to integrate or pair up.”
This is significant, as currently, healthcare providers generally make money based off of volume of care, not care quality. Conversely, ACOs offer incentives to avoid hospital readmissions by penalizing high rehospitalization rates through reduced reimbursements. Research from 2009 shows that 20% of Medicare patients end up being readmitted to hospitals within 30 days of being discharged, at a cost of billions of dollars to the benefits program ($17.4 billion in 2009, to be exact).
Richmond says he’s seeing some interesting technology and focus coming up around the transition between the hospital setting and getting into the right post-acute setting, such as skilled nursing, longer-term acute care, or assisted living environments.
“If you accept that one of the goals is cost-management, and that hospitals are one of the most expensive [environments], I think we’re gonna see in the next few years a tremendous focus on improving that focus from discharge into the right level of care,” he told SHN. “Once these organizations are partnered in terms of their care, you’re going to see real focus on getting folks to the right level of care.”
Basically, partnerships between hospitals and post-acute care providers are going to spring up, and it’s likely that large, multi-organization partnerships will dominate the scene. Richmond says he wouldn’t be surprised to see more M&A activity in that space, as there will be “more risk and more reward.”
For senior living facilities, outcomes will be crucial.
“From a hospital’s point of view, the most important criteria are outcomes measured from that organization and their record in terms of those organizations helping minimize bouncebacks into the hospital,” Richmond says. “One thing acute care providers are looking at is more evidence around who in the community is able to take patients when they’re ready to discharge, and partner with the hospital to make sure that the discharge instructions and the right transitions are made so that the patients aren’t readmitted within 30 days or more.”
Where they end up sending their patients is going to be “quite strategic,” he continues.
Despite the business opportunity for healthcare providers, not everyone is keen on the idea of participating in the Medicare Shared Savings Program, according to a poll conducted by an audit, tax and advisory firm along with a healthcare legal firm, Epstein Becker Green, and consulting firm JHD Group.
“Our survey findings indicate that healthcare leaders are still trying to get their hands around the opportunity and the risks associated with these programs,” Ed Giniat, partner and sector leader for KPMG Healthcare and Pharmaceuticals, said in a statement. “Clearly, the priority for executives is to rapidly increase their knowledge about payment model reform and to accelerate their organizations movement toward new business models.”
Many survey respondents indicated that they didn’t fully understand the ACO program and their financial implications, even after the Centers for Medicaid and Medicare posted final rules. Following the publication of the final rules, 57% of hospital and health system respondents still didn’t know how the rules would affect them, and half said they don’t know if their organization will participate in the program.
Ultimately, says Richmond, hospitals are going to look to partner with the facilities that are optimal for them, and their set of criteria for which facility to choose may differ from those that consumers may use.
“It’s undoubtedly true that a more integrated environment where there’s more risk sharing across the continuum, that there’s much more skin in the game for the hospital about where these patients go,” he says. “That harsh lens of performance in those markets shows a high degree of variability on some of those metrics, in every market, and I wouldn’t be surprised if everyone’s rushing to the same dance partner in these markets.”
Written by Alyssa Gerace

Health Reform Provision Cuts Red Tape—and Costs—for Senior Care Providers

some standards that have recently been introduced for electronic funds transfers in healthcare through the Obama Administration’s Affordable Care Act will reduce up to $4.5 billion off administrative costs for healthcare providers, including doctors and hospitals and private and government health plans, says the U.S. Department of Health and Human Services.

This cost reduction is according to estimates included in new rules that the HHS published on Jan. 5, 2011, and the two regulations that implement the Administrative Simplification provisions of the ACA and the Health Insurance Portability and Accountability Act are projected to save the healthcare industry more than $16 billion in the next decade.
“Thanks to the Affordable Care Act, health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients,” said HHS Secretary Kathleen Sebelius in a statement.
Last year, a study published in the Health Affairs journal found that for every dollar a physician receives from patients, 12% goes to cover the costs of filling out forms and performing other “excessively complex administrative tasks,” reports the HHS. However, simplifying these systems could save four hours per week of professional time for each physician, along with five hours of support staff time, the study found.
The rule, “Adoption of Standards for Health Care Electronic Funds Transfers and Remittance Advice,” adopts “streamlined standards for the format and data content of the transmission a health plan sends to its bank when it wants to pay a claim to a provider electronically and to issue a Remittance Advice notice,” says HHS.
Sometimes, the Remittance Advice (a notice of payment sent to providers) doesn’t accompany the payment the provider receives, and in instances where it’s separate from the Electronic Funds Transfers payment, the disconnect makes it difficult for the provider to match up the bill and the corresponding payment.
“Today’s rule addresses this by requiring the use of a trace number that automatically matches the two,” says HHS. “The new tracking system will allow healthcare providers to eliminate costly manual reconciliation that must currently be done.”
Interim Final Regulations can be viewed here.
Written by Alyssa Gerace

Health Care Law ruling

 U.S. Supreme Court rules on the health care law sometime between the end of March, when arguments are scheduled over three days, and June, when the court typically issues its final opinions for each term.   w

MASS HEATH CARE INSURANCE

The poll results show that residents with incomes below $30,000 — the bracket that would probably make them eligible for state-subsidized care — were the most likely to say the law is helping to control the cost of their care.


The law expanded eligibility for subsidized coverage to thousands more residents, and state figures a year after the law went into effect showed that more than 200,000 residents were added to state-run coverage.


The poll results also showed that the highest income group, those whose income exceeds $75,000, were more likely than the lowest income group to say the law is hurting their health costs.


Kay Lazar can be reached at klazar@globe.com.

uninsured coverage Mass Free Medical Care

Gov. Deval Patrick yesterday shrugged off a scathing inspector general’s report that found costly loopholes in the state’s $414 million free health-care pool — as Republicans pushed to put the brakes on the program.

“The depth of the issues is not as great as first read,” Patrick said of the report during the “Ask the Governor” segment on “Jim and Margery” on WTKK-FM (96.9).

The Herald this week reported that according to the IG probe, the state’s free medical care program — designed to help low-income uninsured Massachusetts residents — spent $7 million on hospital and doctors’ bills for out-of-staters and foreigners, and $6 million on duplicate claims.



“I venture to say that some of these issues might be a little exaggerated. That doesn’t mean to say an isolated incident isn’t significant,” Patrick said.

The IG’s office responded in a statement saying that because the administration had “failed to implement a claims adjudication system for outpatient claims . . . the Office commissioned its own claims editing adjudication.”

The office hired “an experienced health-care provider claims adjudication company,” Senior Assistant Inspector General Jack McCarthy said. “This vendor followed all Massachusetts laws and regulations.”

The report was hand-delivered to Health and Human Services Secretary JudyAnn Bigby on March 3, McCarthy said.

Meanwhile, Senate Minority Leader Bruce Tarr (R-Gloucester) and state Sens. Robert Hedlund (R-Weymouth), Michael Knapik (R-Westfield) and Richard Ross (R-Wrentham) called for better verification of applicants’ Medicaid eligibility, improved safeguards to prevent duplicate payments or payments for medically unnecessary procedures, and an audit of the state’s Medicaid program by the inspector general.

“We find it extremely troubling to learn there are such lax procedures in place that have allowed so many people to take advantage of the system,” Tarr said. “When health-care costs continue to grow at an unsustainable rate, we simply cannot allow such waste and abuse to continue.”

Tarr yesterday filed three amendments to the state’s 2011 supplemental budget to crack down on flaws in the system. The amendments failed last night.

“It’s deeply troubling that, in face of overwhelming evidence that health-care dollars are being spent appropriately, we failed to take action,” said Tarr, who scoffed at the majority party’s suggestion that safeguards are already in place. “If that’s the case, why was this report released?”

Hillary Chabot and Laura Crimaldi contributed to this report.

free care under healh care reform

We share the inspector general’s commitment to finding ways to enhance and improve the integrity of the claims adjudication systems at the Health Safety Net,” said Paulette Song, a spokeswoman for JudyAnn Bigby, secretary of the state’s Executive Office and Health and Human Services, “and are reviewing the 2011 report thoroughly to find opportunities to help increase efficiencies.”

Perhaps the report’s most troubling finding is that the state relies on the honor system when determining who is eligible for free care — and does not review an applicant’s assets, or even require a Social Security number to verify income, citizenship or address, Sullivan said.

This week marks the one-year anniversary of the Affordable Care Act.

Millions of Americans are already benefitting from our new health reform law. In the months ahead, even more of us will benefit if it improves care coordination, provides more preventive services, and makes coverage more affordable and secure. It only gets better from here.

That is, if we give reform time to work — and work together to make sure it gets implemented effectively.

Together, we’re working to build better care — care that is better coordinated, more centered on meeting the needs of patients, and more affordable. That's why I'm asking you to encourage the Senate to stand strong against efforts to repeal or defund health reform.

It’s time to move forward and fix our health care system.

We simply can’t afford to let anyone undermine our efforts to make America’s health care system work better for all of us — and especially for older adults, patients with multiple chronic conditions and their family caregivers.

Just ask Leslie Schlienger, a nurse from south Florida, who is working on the front lines.


Since graduating from nursing school in 1980, Leslie has been a head nurse in Veterans Administration and community hospitals, earned her certification in rehabilitation nursing and her master’s degree in nursing administration. For the last dozen years she’s been a home health nurse, and a critical part of her work is coordinating clients’ care with family, friends and medical professionals.

"The fragmentation of how care is delivered is a big issue," Leslie says. "Because of all the specialties, a single patient often has two or three physicians, and I’ve seen some with as many as seven or eight. Patients are overwhelmed by that. They’re lost in that system." (Read the rest of Leslie's story here.)


Now more than ever, we need better care coordination, improved communication among providers, medical records at our fingertips, and a system that doesn’t leave vulnerable patients and their family caregivers to fend for themselves.

To mark the one-year anniversary of the Affordable Care Act and honor the millions of Americans working every day for better care, urge your Senators to focus on fixing our health care system and reject any attempts to repeal or defund health reform.

I’ve already sent my message to Congress. Please send yours now!

Sincerely,

Medicare Advantage

Improvements to Medicare Advantage • Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare. These additional payments are paid for in part by increased premiums by all Medicare beneficiaries—including the 77% of seniors not enrolled in a Medicare Advantage plan. • The new law levels the playing field by gradually eliminating Medicare Advantage overpayments to insurance companies. • If you are in a Medicare Advantage plan, you will still receive guaranteed Medicare benefits. • Beginning in 2014, the new law protects Medicare Advantage members by taking strong steps to ensure that at least 85% of every dollar these plans receive is spent on health care, rather than administrative costs and insurance company profits.

Ventas buying Nationwide Health for $5.8 billion

2 hours, 27 minutes ago

(AP:NEW YORK) Ventas Inc. said Monday that it will buy Nationwide Health Properties Inc. in a $5.8 billion stock deal, creating the nation's largest health care real-estate investment trust.

The Nationwide purchase solidifies Ventas' position as a leading owner of senior housing communities, along with real estate properties including skilled nursing facilities, hospitals, and office buildings. The move also will make the company more diverse, combining Ventas' health care facilities with Nationwide's focus on senior housing and long-term care facilities.

The company will have more than 1,300 assets in 47 states, the District of Columbia, and two Canadian provinces. That includes operating 643 senior housing facilities and 379 skilled nursing facilities.

Ventas said private pay sources will account for 70 percent of the company's net operating income. Meanwhile, senior housing will account for about 55 percent of the combined company's net operating income, with skilled nursing facilities and medical office buildings accounting for about 22 percent and 11 percent, respectively.

Health care is one of the fastest growing segments of the economy, and both companies foresee growth as the population ages with the first wave of 79 million baby boomers turning 65 in 2011. Health care spending is projected to grow to 20 percent U.S. gross domestic product by 2019, from about 18 percent today.

Health Costs Municipal Employees

jayboat How about having Municipal employees pay more than five dollars as their co-pay? Who else get health insurance with no deductibles? Make municipal employees join the GIC and pay the same co-pays and deductible as state employees. That will save the taxpayer millions of dollars.

MUNICIPAL HEALTH COSTS

A group of Massachusetts mayors, fed up with what they say is legislative inaction on skyrocketing municipal health care costs, has launched a ballot initiative for 2012 aimed at giving cities and towns more flexibility in reducing expensive benefits for employees, retirees and elected officials. Health costs in Massachusetts have added more than $1 billion to municipal budgets from 2001 to 2008, and some cities now devote close to 20 percent of their budgets to health care.