Thursday's Healthcare Quiz

Today's topic features questions about the health reform. How many will you get right this week?

Let's sum it up.

For over a month now this blog has talked about our healthcare in this country. Not everyone is going to be on our side and we get that. Our goal was to educate the people who were on the border or didn't know exactly what is really going on. Whether it was positive or negative, helpful or useless, interesting or snooze worthy, we covered it. So I want to take the time to sum a few things up if you are a new reader or if you want healthcare wrapped up in a nutshell. Allow me to start with some the basics.

The Patient Protection and Affordable Care Act, also known as Obama care, puts in place strong consumer protections, provides new coverage options and gives you the tools you need to make informed choices about your health. This act was established by president Barack Obama. His goal is to get insurance for those who are unable to get it on their own and help the people who already have it by not allowing insurance companies to charge you more if your already sick. I like many young Americans benefited from Obama care. I am 23 years old, and because of Obama care I am still able to be on my parents insurance and receive amazing coverage without having to go broke.

For the millions of Americans who benefit from Obama care we were on the edge of our seats awaiting the results of the 2012 elections to confirm that this act was going to continue helping us. Governor Mitt Romney was trying to change things for us. With the help of Paul Ryan, they developed Ryan's Plan, which would cause many seniors to have to pay more for the same insurance they are paying less for now. As we of course know Barack Obama did win the 2012 elections, so we should expect to get the help we need at least for the next 4 years.

I want to take the time to say that I support Barack Obama because I can only imagine how hard things can get being the boss of the country. He wants to help the little guys, like me. If I didn't clear up The Affordable Care Act as much as you would have liked watch this short video from President Barack Obama himself and consider all the good that will come.

Medicare from the Doctor.

In a recent article called, "Tough Hard Decision: What to do about Medicare", Dr. Ron Lambert talks about a different view concerning Medicare. By now we know what Medicare is, who uses it, and how to get it, but we never hear from the other side, the Doctors. In his article Dr. Lambert discusses the pros and cons of owing a medical practice and accepting Medicare as one of the providers. Lambert has been using the electronic medical records system in which a computerized medical record is created in an organization that delivers care, such as a hospital or physician's office. Electronic medical records tend to be a part of a local stand-alone health information system that allows storage, retrieval and modification of records. He is now considering "opting-out" from this approach and wants to start charging his patients on a month to month subscription for his services.

Why the change? Well its plain and simple, he wants more money. By having his patients pay a monthly subscription he can charge what he wants for certain procedures and not what Medicare tells him he is going to receive. Although, he does know his possible downfalls if he strays away from Medicare. One of the downfalls is that when you opt-out, Medicare doesn't let you back in for two years. So, if his plan fails he won't be able to run back to gain his patients back. He does also know his benefits of going a different route. One the benefits is direct billing. Instead of having to bill the patient, then bill the insurance and wait for their approval the send back, he is getting paid directly by the patient.

We never look at the trouble Doctor offices have to go through to make some money. Should Dr. Ron Lambert stray away from the system and do things different? Or will his venture in the the unknown world of charging patients directly prevail? He is still contemplating his decision but speaks about his life concerning Medicare is the video.

The New Health Care Rules

A recent blog written by Julie Rovner on NPR's website explains to us how with the election past us, President Obama and his administration are laying down the rules for what will be our new health care plan.  After years of disputing what will, and what will not be part of Americans health care, there are finally some ground rules that have been established.  We now know that not all, but a big chunk of President Obamas plan will be effective.  States and insurance companies have been waiting for a long time in trying to figure out what to do.  Most of the states were waiting for a final result in the presidential election to decide what to do, while others already had a plan had either Obama, or Romney won.  Now that everyone knows who will be running the country for the next four years, both states and insurance are hurrying to get the official rules that way they can move forward with their states health exchange plan.

So what do we know that is official from health care reform?  Julie Rovner, explains in detail some of the most important changes we can expect.  One of the biggest changes is that companies have to comply with the anti discriminatory changes that will be in effect in 2014.  Health insurance will be available to everyone regardless of their health status, or pre existing conditions.  People with pre existing conditions will not pay higher premiums, and also the most important part of this new changes is that people can not be cancelled from their health insurance due to illness.

129 million people with pre existing conditions can now feel at ease because it is officially illegal for insurance companies to discriminate.  Now of course there is still time for adjustments and change, but that time is coming to a close. People can complain or ask for adjustments, but end date for any changes will come Dec. 26th.

Another stipulation rules that both states and insurance companies will have to lay out the benefits that it will offer, Individuals, and small businesses will have to choose from packaged plans that will benefit the individual.  The rule also states that each individual will have a plan that is at minimum equal to the typical insurance plan offered by a small business.  This however, can of course vary depending on the agreement between the state and the insurance companies that have been previously agreed upon.

Another interesting fact is that each individual will have a series of plans to choose from that is broken down in the simplest of ways, it will be broken down into how much each plan will cover in medical bills.  For example, bronze will cover 60 percent, silver will cover 70 percent, gold will cover 80 precent, and platinum will pay 90 percent.

This for many Americans will be great.  Not only has the complexity of choosing a health care plan been erased, but we as Americans can feel protected now, knowing that we will no longer be taken advantage of.

For more information on the new health care plan take a look at this video

State Health Exchange Plans Extended

As we discussed in last weeks blog, all states were having to report what their plan was for the new federal healthcare plan.  According to a recent blog posted on the Beyond Health Care Reform website, it has been extended.  Not all of the states are ready to submit their decision, Some have submit their plans early, while others are still undecided.  Originally, all states were to have a plan in place by November 16th, 2012, but this has been moved up to January 1st, 2014.  Revised FAQ's on the exchange blueprint issued by the HHS pushed the federal government for an extension.

This Blog has proven to be a very helpful source because it provides a link for individuals to take a look at the current status of their states exchange process.  It allows the individual to see if their state is going to have their own plan in place, or if the state is going to have a partnership exchange, or also if the state is going to default to the federal exchange.

I recently looked up a youtube video on health care reform.  This video is awesome, it explains healthcare reform in basic terms which has helped me understand the process of our new health care plan, and also how it will work and whom it will help.  Hopefully this link to the video will help you as it has helped me.

The Health Care Quiz

It has come to my attention that many people dont know what health care is right for them. What does it cover and who does it cover? Is it free? Who can receive it? Although, all these answers are as easy as reading the the paper work that go hand in hand with them, we aren't reading them.

This is a new weekly feature that is going to give you pop quiz questions and answers on your everyday health care plans. I'll be posting questions, each with its own set of mulitple choice answers and lets see how well you know insurance.

Are We Really Ready For Change?

A great article written on the Health Care Blog by Dr.Lawrence Rosen talks about if Americans are really ready for change. He talks about how the first presidential election held so much hope for Americans, and how record voting numbers were hit in hope for change. One of the things that Americans were hopeful for was change in the health care plan that we had four years ago. Now that we have a new health care system in place in Obamacare, are we really prepared for the future that it holds? Dr. Lawrence Rosen brings up some very interesting facts about American citizens and the changes we have experienced in our health over a few decades. Obesity had increased over 130 percent in a matter of 20 years, Diabetes has more than doubled since 1996, Asthma grew from 2001 to 2009 by 4.3 million, and the prevalence of autism grew by an astonishing 289.5 percent. Why is this important? It is because of the insane amount of money that is being thrown out in health care for these health care problems and more. For example obesity medical cost amounted to more than $147 billion dollars in 2008, Diabetes estimated cost in 2007 was $174 billion, Asthma in 2007 cost Americans $56 billion dollars, and Autism and ADHD is estimated to be at $137 billion dollars per year. Most people have no idea the amount of money that is being spent in health care. If you asked someone today they would probably figure it is a lot, but seeing these numbers will certainly make your stomach turn.


So are we really ready for the new health plan President Obama has in place for us?  Dr. Lawrence points out that the big players in the health industry would rather have Americans sick. Why? Dr. Lawrence says that it’s the money. Of course big hospital chains, insurance and pharmaceutical companies, and medical associations want this, because that is the source of where there money comes from. They thrive off of the sick, and instead of offering a solution for prevention, they offer a pill.

 Change is happening, and that’s great. However what America needs now is not just the medical attention we deserve, but the preventative care. President Obama and his office have worked extremely hard at providing Americans with a change in the health care system that will benefit us for years to come, but what we need to ask for is not just the health care when we are sick, but the methods that prevent us from ever having to worry about getting sick. We need a change in our personal health, that way not only we can prevent obesity, and diabetes, but our children too. We can’t always rely on the government for everything we do, but educating the population instead of just offering us pills until the next refill will make us the healthy nation we need to be.

Nevada Starts Obamacare Process

A blog from NPR writer PaulineBartolone had some interesting news for her readers.  The blog takes a close look at how a Republican governor from Nevada is implementing the new Federal Health Care law.  A helpful audio news link about Nevada and its health care push was also available in the blog.  The interesting thing about this is that Nevada was one of the first states to actually join a law suit against the Affordable Care Act.  So how is it that a Republican state like Nevada is offering no resistance?  A little strange, but apparently Nevada has become one of the first states to actually start the process of a health care exchange.  Nevada does have one of the highest rates of unemployed, and uninsured in the country, so this might have been a reason for the early jump, however according to the news link, the state government wanted to avoid federal intervention.  This probably was a good idea on Nevada’s behalf because other Republican states such as Alabama who resisted the new law are now scrambling to put together a plan of their own.

Although the state government of Nevada opposed the new health care plan, a good majority of people wanted it.  As noted in HealthCare.gov many of its citizens say that they feel that they deserve this and that even though the new plan isn’t in full effect yet, differences can be seen already.  The blog provides very interesting facts and points that can be very helpful for citizens who might not know the exact details yet.  This site is a must see for the citizens of Nevada since we now know that Obamacare will be a part of its future.

What is Reasonable and Necessary care?

In an article written by Peter J. Neumann, Sc.D., and James D. Chambers, Ph.D. titled Medicare's Enduring Struggle to Define "Reasonble and Necessary" Care both Drs. Neumann and Chambers say that, Medicare has always covered medical services that are “reasonable and necessary.” As new approaches, drugs and medical technologies have been released, you would think coverage would be based on an objective analysis of outcomes and cost effectiveness. Thats not exactly the case.

Not that Centers for Medicare and Medicaid Services or CMS haven’t tried to be reasonable about “reasonable and necessary.” According to the article, in 1989 CMS specifically proposed that the words “cost effective” could be used to assess new technology. That proved to be too controversial. It later tried “least costly alternative language” for coverage of durable medical equipment and Part B medications.  This too was dismantled by the courts when plaintiffs argued that the term “reasonable and necessary” could only be applied to medical services, not to the costs of those services.

So what does fall under "reasonable and necessary health care? Reasonable and necessary health care costs of each supported child not covered by insurance, including medical, pharmaceutical, vision, dental, orthodontic and mental health costs, shall be shared equally by the parents (unless a different allocation is set forth below), and each parent shall reimburse the other for his or her share of such expenses paid by the other.

Why Medicaid is important to you.

In my recents blogs I have talked about all the benefits of Medicare and Medicaid and why we need insurances like these, but few time has been spent on where all the money is coming from and how it is going to affect us in the future. Of course we know our tax dollars contributes to these insurance programs but what is going to happen when we start needing more and more money.

The Supreme Court affirmed the Afordable Care Act and Medicaid that followed with it. The ACA's intent is to give health care coverage to lower income American's.The problem that I feel the supreme court did was give states the option to opt out of the Medicaid expansion. With all that going on we will most likely see the republican states not continue with Medicaid. Their argument is that they wouldn't be able to afford it without having to raise taxes or make some cuts to higher education. Of course Liberal states will expand.

Regardless of what happens, here are a few reasons why Medicaid matters to every American. Always remember if you are a working American that funding for these programs comes from your paycheck. Medicaid is a growing entitlement program and is very expensive.  Like Medicare it contributes a large segment our a growing debt here in the United States.  We are facing a Fiscal Cliff because of runaway entitlement spending and leaders in Washington must act before the economy tanks.

Medicaid provides a critical safety net program to many older Americans and a significant amount of its spending goes to long term care.  Actually the bulk of the program goes to paying for long term care.  If you ever have had an older relative in a nursing home you will understand. Medicaid expansion being over-turned will have an impact on employers with low-income workers.  If these workers are not insured and now cannot receive coverage in Medicaid, this means they will qualify for a subsidy in a health insurance exchange. So, what these states need to remember is that without programs like Medicaid the businesses in their states might winde up paying more in the long run anyway.

Obamacare meant for white people?

I find it interesting that many people have comments and rude remarks to say about President Obama and his health care interests. I have a friend on Facebook who, like many people, wrote constant comments on Facebook about why Obama should not be re elected and how all he is doing is bad and how all the black and Mexican people only want to vote for him so they can continue getting their free handouts. I am particularly close with this girl and found it odd that she would be saying things like that because her sister is using the free insurance that Romney is trying to get rid of.

My friend who we will call Rose, is a white women in her early 20's who just goes with the flow of what is being said and not with the facts. The comments she brings up are not only racist but incorrect. In a survey by The US Census Bureau 46 percent of white people are uninsured. That is a pretty big chunk of white people. Why is it that when we think of Medicare and health insurance peoples first thought is to blame the blacks and the minorities?

In a recent article by The Associated Press there has been an increase in racial attitudes. The jump has since increased since 2008, which is also the year Obama was elected president. Maybe people just don't like the fact that we have a black president even if his ideas are their ideas and all he wants to do is help. When the Affordable Care Act is fully implemented, 12.3 million more white people will have health insurance than have it today. I think he is helping everyone no matter their color. If Romney would have been elected 24 million white people would have been without health insurance.

These are the issues that people like my friend aren't looking close enough at. The rash idea that our tax money is going to waste on blacks and minorities needs to change. If you mad about where our money is going to look at your families and close friends and ask yourself how are they getting their health insurance? How would they survive if they weren't getting some help? How can you support someone who is trying to take something away from you rather than supporting someone who is only trying to help? Of course now white people don't have to worry about losing their insurance, at least for another four years.

Is That Kid Healthy?

I couldn't help but read this blog today about kids and there health problems in todays world.  I was just expecting another boring blog on how kids are becoming obese and we need to stop feeding them fast food, but I was wrong. A Doctor who writes occasionally for the Health Care Blog, had some very intriguing things to say.  Im sure almost everyone had heard a parent complain about childhood obesity, and to be quite honest it can get a little boring after a while.  However Dr. Lawrence Rosen changes that by taking us through a little day in the life of her pediatric practice.  He gives us some interesting insight on how the health of children has dramatically changed over the past few years.  To the surprise of Dr. Rosen, he helped a child who come to his annual check up, and found that he was actually a perfectly healthy little boy.  Dr. Rosen was a little surprised by this because it had been the only child he had seen all week that was actually healthy.  Dr. Rosen is so used to helping children who are sick that this threw him off guard.  There are a few things that I found alarming in this blog that Dr. Rosen wrote. First that of all the kids he saw during the week only one was healthy, so what does that say about the current health situation with them.  Second, was that Dr. Rosen actually gets paid more by coding in to the insurance companies that the child was sick, and providing them certain care for what ever they were sick for.  Why are these insurance companies paying more to doctors for sick kids than healthy kids?

It's true, sick kids seem like they are popping up more frequently.  Pediatricians like Dr. Rosen are seeing this pattern of sick children more and more often.  So why is this?  It could be for many reason.  Children seem to have no immune system any more.  There bodies cant fight off the simple cold or flu that it used to.  We as a society have grown to listen to the media, and are so aware of all the germs and viruses there are out in the world that we need a defense system for everything.  We have pills that fight colds, pills that prevent colds, pills that prevent for everything.  We use hand sanitizer for every little thing, and we push this onto our kids.  So naturally when they go into an environment such as a school playground, they are bound to get sick from something.  Im not saying that the generation before didnt get sick, but I believe that because society was not aware of all the germs and viruses around us our immune system was more prone to fighting them back and was not caught by surprise like the immune systems of todays children.

So how is it that Doctors like Dr. Rosen gets paid more for a patient visit regardless if the child is healthy?  A doctors visit to a pediatrician isnt like seeing a specialist.  The doctor should get paid evenly across the board, regardless if the child was in for a check up, or if the child had a cold. Dr. Rosen said he wasn't complaining that he would get paid more because more children were sick, nor would most people who were in his shoes, but he did find it strange that insurance companies paid him more by entering a certain code basically stating that the child was sick.  This certainly does not say much about our insurance companies, but it makes one wonder that if all doctors are reporting that if in fact a child was truly ill, or if he was adding the sick code for the insurance companies just to get paid more.

Obamacare After the Election

So what can we expect now that we know the results of the presidential election when it comes to Obamacare?  We now know that President Obama has won a second term,  but many of us wonder what lies ahead?  A blog named Beyond Healthcare Reform had some very interesting facts on what to expect in regards to the next four years, and also after.  We know that with Romney losing, there will be no major overhaul in health care.  The Republicans left in power of course will still try to place a barrier, but they just might be fighting a loosing battle.  According to what the Beyond HealthCare Reform blog is stating, a backlog of proposed regulations implementing health reform by the Department of Health and Human Services is expected to be released.  Also states are required if they have not already to announce if they will implement health insurance exchange.  So needles to say that with the future of the presidency locked in for another guaranteed four years, the Department of Health, and many other departments, and local state governments are now scurrying to adjust for major health care changes. 


Another interesting blog provides some great information on how the states will proceed with the new Obamacare plan.  PharmExecBlog is stating that all states must report to the federal government what there state health exchanges will be.  This is a vital to the federal government because the states they are responsible for handing over services to 30 million new medicaid individuals.  This is not going to be an easy task, as there has already been outrage from some of the states, some even have vowed to refuse Obamacare at all cost.  Needless to say these upcoming weeks will be very interesting.

Whos going to take over the Senate?

The Afordable Care Act could depend on the number of senates in each state. In the article, "The Future of Health Reform May Turn on Senate Races", written by Maggie Mahar she expresses her concern following the presidential election. Mitt Romney alone could not overturn Obamacare.It would take the republican senate to overturn it and as of right now they are still in control of the senate. 51 republicans to the 47 democrats.

Maggie states that if the republicans take the senate, " the two chambers could pass legislation that would eliminate the premium subsidies designed to make health insurance affordable for middle-income and low-income families, bring an end to Medicaid expansion, and rescind the individual mandate that everyone buy insurance or pay a tax." This is not a good thing.

Maggie goes on to say that if Obama wins this election then the democrats will only need to pick up four more seats in the senate to take over control and Obama will be able to veto most attemps from the republicans to get rid of the health care reform anyway. Of course, if Romney wins then this could mean the end of Obamacare and a whole new type of health care programs. Although, Maggie does suggest a third option that could happen and that is if Romney wins but the democrats still find a way to take over the senate. This is an unlikely to happen, but is still an option. So now its up to you to decide which healthcare you want.