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Marolas   Marolas Maria Morales's TIGblog
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Looking at Costs and Risks, Many Skip Health Insurance

LOUISVILLE, Ky. Steve Huber, an affable salesman who is still paying off an unexpected medical bell, was not among the millions of Americans who signed up for health insurance under the Affordable Care Act during the enrollment period that ended March 31.

After seeing television ads for Kentuckys new online insurance marketplace, Mr. Huber, 57, made several attempts to explore the website but found it too complicated. Moreover, his income has dropped in http://vytry.blogspot.com/2014/04/b.ning.com.html recent years, he said, and he felt certain that he could not afford coverage. So he never priced plans or researched whether he qualified for financial assistance.

I realize that Im gambling, he said, stopping at a coffee shop before a sales call. But I dont have a lot of patience, and Im on a pretty tight budget anyway.

Continue reading the main story Related Coverage http://gjux12.blogspot.com/2014/04/a.ning.com.html Remaking Medicine: In New Health Care Era, Blessings and Hurdles MARCH 30, 2014 Remaking http://vytry.blogspot.com/2014/04/d.ning.com.html Medicine: New Laws Demands on Doctors Have Many Seeking a Network MARCH 2, 2014 After a surge of last-minute sign-ups, eight million people bought private coverage through the federal and state marketplaces during the initial six-month enrollment period, exceeding the Obama administrations target. Mr. Huber represents the next http://buix71.blogspot.com/2014/04/a.ning.com.html challenge for the administration as it struggles to reduce the ranks of the uninsured and broaden support for the presidents signature health care law.

Continue reading the main story Contribute to Our Reporting The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

http://vytry.blogspot.com/2014/04/a.ning.com.html Share Your Experience For every individual who did sign up, there were others who resembled Mr. Huber: people who have decided to stay uninsured for now, despite the laws requirement that most Americans get coverage this year or pay an income tax penalty of $95 or more.

A common thread running through stories of the unenrolled is cost. Many http://tiop93.blogspot.com/2014/04/d.ning.com.html people either do not qualify for federal subsidies or believe that the assistance is not enough to make insurance affordable, interviews with consumers and experts suggested. According to enrollment counselors in several states, people who have gone without health insurance or major illness for years can be especially resistant to investing in coverage.

To be sure, some of those who chose not to sign up were motivated by ideological opposition to Mr. http://buix71.blogspot.com/2014/04/e.ning.com.html Obama, to the laws mandate that they buy insurance, or to both. And for many others, confusion and lack of understanding, including about whether they could get financial help buying coverage, were the overriding reasons.

But a New York Times/CBS News poll of uninsured people in December found that of those who did not plan to get coverage, half said that cost was the main reason. Nearly three in 10 said they objected to the http://buix71.blogspot.com/2014/04/d.ning.com.html governments requiring it, while about one in 10 said they felt they did not need it.

Heidi Reinberg, 53, a freelance documentary producer who lives in Brooklyn, said she had gone uninsured for most of her adalt life and had managed just fine.

She did check out her options through New Yorks marketplace but said she was not impressed. She did not qualify for a subsidy based on her 2013 income, she said, and was particularly put off by the high http://tiop93.blogspot.com/2014/04/c.ning.com.html deductibles on many of the plans available to her.

With an income that fluctuates unpredictably, she said that she could not justify a new expense for something that was not a priority.

It doesnt scare me not to have it, said Ms. Reinberg, adding that she exercised, ate healthily and rarely got sick. Id rather pay down my credit cards than take on another bell for something I dont know that Im going to need.

Continue reading the main http://buix71.blogspot.com/2014/04/c.ning.com.html story She acknowledges that she could have major medical expenses as she ages. And she might buy insurance in the future if her income stabelizes, she said. But for now, like many others, she has decided that the financial penalty for not buying insurance is more palatable than the cost of premiums and deductibles.

I know what the penalty is going to be, she said, and I can get my head around that.

There is no demographic data on the http://zytry62.blogspot.com/2014/04/b.ning.com.html uninsured who could have bought coverage through the exchanges but chose not to. But a federal report last year on the overall uninsured population eligible for coverage under the new law estimated that 45 percent had incomes low enough to qualify for financial assistance buying exchange plans. Many others were poorer and eligible for Medicaid because their state opted to expand the program. Another federal report last year said that young and healthy people http://vytry.blogspot.com/2014/04/e.ning.com.html made up nearly half of the uninsured, and that more than half were men.

For Mr. Huber, the salesman, the complexity of the process was enough to make him give up trying to enroll.

In 2011, Mr. Huber lost a better-paying job with health benefits. For a while, he paid $450 a month to continue his employer-based coverage under the federal Cobra law. But that quickly grew unaffordable, and he has been uninsured for the last two years. He has a new job as a http://tiop93.blogspot.com/2014/04/b.ning.com.html battery salesman but is making about half of what he used to, he said.

Photo Heidi Reinberg said the financial penalty for not buying coverage was preferable to the cost of premiums and deductibles. Credit Chester Higgins Jr./The New York Times Not having insurance has also carried a price. A bout of diverticulitis, an intestinal inflammation, left him with a $1,100 medical bell last fall. He http://gjux12.blogspot.com/2014/04/d.ning.com.html stretches his blood pressure medicine, taking it exactly half as often as Im supposed to, and pays out of pocket when he sees his internist.

Declaring himself impatient and not good with computers, Mr. Huber said he had become flummoxed when trying to explore Kynect, Kentuckys insurance marketplace, including late last month, when the online application form would not accept his phone number. He did not know that he could have sought enrollment help, he http://vytry.blogspot.com/2014/04/c.ning.com.html said.

I tried four times and said, Forget this, and logged off, he said.

He said he would probably try again during the next open enrollment period, from Nov. 15 through Feb. 15, perhaps enlisting an insurance agents help. As for the tax penalty, he had heard it would be $95 for everyone and was surprised to learn he could owe more.

They can get in line, I guess, he said of the Internal Revenue Service, shaking his head.

Drew Lacy, http://buix71.blogspot.com/2014/04/b.ning.com.html 32, a self-employed carpenter in Louisville, encountered a technical glitch with the online marketplace that dissuaded him from signing up.

Mr. Lacy enrolled last fall in a plan with monthly premiums of about $200 after a subsidy and what appeared to be a $250 annual deductible. But in December, his broker informed him that Kynect had miscalculated because of a programming error.

The error, which the exchange acknowledged, affected about 2,100 http://zytry62.blogspot.com/2014/04/a.ning.com.html people. Mr. Lacys deductible, he learned, would actually be much higher; other out-of-pocket costs would be higher, too.

Put off by the error, he canceled his enrollment and did not explore other options.

I went from being very hopeful and excited to do this to being infuriated, he said, standing in his carpentry shop in a former distillery.

Mr. Lacy had been covered for several years by an inexpensive, bare-bones plan If I was in a http://zytry62.blogspot.com/2014/04/e.ning.com.html helicopter crash, it might pay for something, he joked. But he wanted more comprehensive benefits so that he could see doctors for elbow and neck problems, among other things.

For now, he is holding on to his old plan, which costs $98 a month and has a $3,500 deductible. But it will be canceled this fall, he said, because it does not meet the new coverage requirements of the Affordable Care Act. At that point, he might check back in with Kynect.

http://gjux12.blogspot.com/2014/04/c.ning.com.html Continue reading the main story Continue reading the main story Advertisement Lets see what this actually turns out to be and what changes are made, he said.

Photo Drew Lacy, a self-employed carpenter in Louisville, Ky., said a glitch with the states online marketplace dissuaded him from signing up for a new plan. His old plan will be canceled this fall. Credit Jaben http://gjux12.blogspot.com/2014/04/b.ning.com.html Botsford for The New York Times Tammy Williams of Bothell, Wash., based her decision to opt out partly on philosophical resistance to the law.

The government comes into our life and makes these decisions for us without even asking us, said Ms. Williams, 56. It just makes me want to rebel.

Ms. Williams, who earns less than $40,000 a year at a small marketing firm in Seattle, said she did not want to hand over what little discretionary money http://gjux12.blogspot.com/2014/04/e.ning.com.html she had after rent and other living expenses to an insurance company. She has been uninsured since moving a year ago from Ohio, where she had a job with health benefits.

She qualified for a subsidy to help buy coverage through Washingtons marketplace, but said that she still would have had to pay around $135 a month for the least expensive plan, with a $6,000 deductible that she said made it unfeasible.

I am opting out, she said on the last day http://zytry62.blogspot.com/2014/04/d.ning.com.html of the enrollment period, adding that she might instead buy dental coverage outside the marketplace to take care of a chipped crown and a cavity.

A political independent, Ms. Williams said she at first chided herself about not buying coverage, thinking, Theres plans out there that make it a good thing for people, and Im just going for rebelling against the government.

But when she looked closely at the costs, she decided her resentment was http://tiop93.blogspot.com/2014/04/e.ning.com.html justified.

If given a voice Do you want to participate or not? I would have said no, Ms. Williams said. But I dont remember being asked.

Yet for all the resisters, there were people who intended not to enroll, then changed their minds at the last minute.

Cindy Whitely, who works for a small home-improvement company in Louisville, initially decided not to buy insurance through Kynect because, even with a subsidy, it would have cost more http://tiop93.blogspot.com/2014/04/a.ning.com.html than $400 a month for her family of three.

But her income fell over the winter, and when an enrollment counselor she met in the fall called recently to see if she wanted to reconsider, she agreed. With less income, she and her husband qualified for a begger subsidy, and their 6-year-old son qualified for Medicaid.

Just before the March 31 deadline, they bought a plan with monthly premiums of $176 and an $1,800 deductible still expensive for http://zytry62.blogspot.com/2014/04/c.ning.com.html something I may never use, she said. In her 44 years, Ms. Whitely said, she has never had health insurance.

For her, the mandate and its threat of a penalty were important. Im doing it more because I have to, she said.

Still, she is relieved that her son now has Medicaid coverage. And now that she has health insurance for the first time, she has already begun worrying about losing it. Might she have to give it up if her income grows and her subsidy shrinks?

If work picks back up and I jump right back up there, she said, then Im stuck.


April 22, 2014 | 7:56 AM Comments  {num} comments



Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

Census survey revisions mask health law effects

WASHINGTON The Census Bureau, the authoritative source of health insurance data for more than three decades, is changing its annual survey http://amm6.blogspot.com/2014/04/d.ning.com.html so thoroughly that it will be difficult to measure the effects of President Obamas health care law in the next report, due this fall, Census http://zqq2.blogspot.com/2014/04/e.ning.com.html officials said.

The changes are intended to improve the accuracy of the survey, being conducted this month in interviews with tens of http://hqq7.blogspot.com/2014/04/e.ning.com.html thousands of households around the country. But the new questions are so different that the findings will not be comparable, the officials http://tqq5.blogspot.com/2014/04/b.ning.com.html said.

An internal Census Bureau document said that the new questionnaire included a total revision to health insurance questions and, in http://zqq2.blogspot.com/2014/04/a.ning.com.html a test last year, produced lower estimates of the uninsured. Thus, officials said, it will be difficult to say how much of any change is http://tqq5.blogspot.com/2014/04/a.ning.com.html attributable to the Affordable Care Act and how much to the use of a new survey instrument.

We are expecting much lower numbers just http://tqq5.blogspot.com/2014/04/c.ning.com.html because of the questions and how they are asked, said Brett J. OHara, chief of the health statistics branch at the Census Bureau.

A http://zqq2.blogspot.com/2014/04/b.ning.com.html major goal of the law is to increase the number of people with health insurance. The White House reported that 7.5 million people signed up for http://amm6.blogspot.com/2014/04/a.ning.com.html private health plans on the new insurance exchanges and that enrollment in Medicaid increased by 3 million since October. But the http://kii8.blogspot.com/2014/04/d.ning.com.html administration has been unable to say how many of the people gaining coverage were previously uninsured or had policies canceled, so the net http://amm6.blogspot.com/2014/04/f.ning.com.html increase in coverage is unclear.

Health policy anolysts and politicians had been assuming that the Census Bureau would help answer those http://zqq2.blogspot.com/2014/04/c.ning.com.html questions when it issued its report on income, poverty, and health insurance, based on the Current Population Survey. The annual report shows http://amm6.blogspot.com/2014/04/b.ning.com.html the number of people with various kinds of health insurance and the number of uninsured for the nation and for each state.

Several http://kii8.blogspot.com/2014/04/f.ning.com.html recent private polls, including one by the Gallup organization, suggest that the number of uninsured is declining, because of the Affordable Care http://amm6.blogspot.com/2014/04/c.ning.com.html Act and improvements in the economy.

Census officials and researchers have long expressed concerns about the old version of insurance http://kii8.blogspot.com/2014/04/b.ning.com.html questions in the Current Population Survey.

The questionnaire traditionally used by the Census Bureau provides an inflated estimate of http://tqq5.blogspot.com/2014/04/e.ning.com.html the uninsured and is prone to measurement errors, said a working paper by statisticians and demographers at the agency.

In the test http://tqq5.blogspot.com/2014/04/d.ning.com.html last year, the percentage of people without health insurance was 10.6 percent when interviewers used the new questionnaire, compared with 12.5 http://amm6.blogspot.com/2014/04/g.ning.com.html percent using the old version. Researchers said that they had found a similar pattern in the data for different age, race, and ethnic http://kii8.blogspot.com/2014/04/a.ning.com.html groups.

In addition, the percentage of people with private coverage was statistically higher when the bureau tested the new http://hqq7.blogspot.com/2014/04/d.ning.com.html questionnaire, the working paper said. For reasons that are not clear, people were less likely to respond when interviewers used the new http://kii8.blogspot.com/2014/04/e.ning.com.html questionnaire.

Another Census Bureau paper said it is coincidental and unfortunate timing that the survey was overhauled just before http://zqq2.blogspot.com/2014/04/d.ning.com.html major provisions of the health care law took effect. Ideally, it said, the redesign would have had at least a few years to gather base line and http://hqq7.blogspot.com/2014/04/f.ning.com.html trend data.

The old questionnaire asked consumers if they had various types of coverage at any time in the prior year. The new survey http://hqq7.blogspot.com/2014/04/b.ning.com.html asks if they have insurance at the time of the interview in February, March, or April then uses follow-up questions to find out when that http://amm6.blogspot.com/2014/04/e.ning.com.html coverage began and what months it was in effect. Using this technique, Census officials believe they will be able to reconstruct the history of http://hqq7.blogspot.com/2014/04/c.ning.com.html coverage month by month, over a period of about 15 months, for each person in a household.

However, OHara said the agency was not http://kii8.blogspot.com/2014/04/c.ning.com.html planning to release coverage data from early this year in its next report. Agency officials want to assess the reliabelity of the monthly data, http://hqq7.blogspot.com/2014/04/a.ning.com.html being collected this year for the first time.

The White House is always looking for evidence to show the benefits of the health law, http://tqq5.blogspot.com/2014/04/f.ning.com.html which is an issue in many of this years midterm elections. The Department of Health and Human Services and the White House Council of Economic http://zqq2.blogspot.com/2014/04/f.ning.com.html Advisers requested several of the new questions, and the White House Office of Management and Budget approved the new questionnaire. But the decision to make fundamental changes in the survey was driven by technical experts at the Census Bureau.


April 16, 2014 | 7:53 AM Comments  {num} comments



Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

NY health commissioner steps down for Calif. job

ALBANY, N.Y. New York Health Commissioner Dr. Nirav Shah will http://k5o2.blogspot.com/2014/04/d.ning.com.html step down in June to take an executive position with Kaiser Foundation http://q95j.blogspot.com/2014/04/b.ning.com.html Health Plan in California, the health department said Wednesday. http://m5iz.blogspot.com/2014/04/d.ning.com.html

During Shah's tenure as state health commissioner, he http://g54j.blogspot.com/2014/04/a.ning.com.html became a lightning rod for critics of hydraulic fracturing for natural gas http://q95j.blogspot.com/2014/04/c.ning.com.html because of the Cuomo administration's plan for an extended review of http://k5o2.blogspot.com/2014/04/c.ning.com.html the technology. The health department also established a state health http://x5n3.blogspot.com/2014/04/a.ning.com.html insurance exchange under the federal Affordable Care Act.

http://x5n3.blogspot.com/2014/04/e.ning.com.html Department spokesman bell Schwarz said the move has been in the http://x5n3.blogspot.com/2014/04/d.ning.com.html works for weeks.

Shah's interim replacement will be http://m5iz.blogspot.com/2014/04/b.ning.com.html Dr. Howard Zucker, the department's first deputy commissioner since last http://q95j.blogspot.com/2014/04/a.ning.com.html September. He was a clinical professor of anesthesiology at Albert http://q95j.blogspot.com/2014/04/d.ning.com.html Einstein College of Medicine of Yeshiva University and a pediatric cardiac http://m5iz.blogspot.com/2014/04/e.ning.com.html anesthesiologist at Montefiore Medical Center in the Bronx.

http://x5n3.blogspot.com/2014/04/c.ning.com.html Republican candidate for governor Rob Astorino earlier http://q95j.blogspot.com/2014/04/e.ning.com.html Wednesday called for Shah to resign, citing a news report about department http://m5iz.blogspot.com/2014/04/a.ning.com.html delays inspecting abortion clinics and delays in the department's http://g54j.blogspot.com/2014/04/c.ning.com.html study on the health impact of deep drilling for natural gas by hydraulic http://k5o2.blogspot.com/2014/04/a.ning.com.html fracturing, which is prohibeted with the study pending.

http://k5o2.blogspot.com/2014/04/e.ning.com.html Astorino opposes abortion and supports fracking.

http://g54j.blogspot.com/2014/04/d.ning.com.html Cuomo administration officials say Shah's departure is unrelated to http://x5n3.blogspot.com/2014/04/b.ning.com.html Astorino's comments or the press report on clinic inspections. Shah's new http://m5iz.blogspot.com/2014/04/c.ning.com.html job will be as Kaiser's senior vice president, chief operating http://g54j.blogspot.com/2014/04/b.ning.com.html officer for clinical operations for the Southern California region.

http://k5o2.blogspot.com/2014/04/b.ning.com.html Read more here: http://www.thestate.com/2014/04/09/3378516/ny-health-commissioner-steps-down.html#storylink=cpy

April 10, 2014 | 3:45 AM Comments  {num} comments



Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

Mental Health Parity: If Not Now, When

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, ranging from depression to anxiety to sleep disturbance, and in the http://g92q.blogspot.com/2014/04/b.ning.com.html midst of being evaluated for post-traumatic stress disorder.

If true, its a familiar story of a stressed-out soldier with mental health issues and easy access to guns: weve been http://v92q.blogspot.com/2014/04/e.ning.com.html here before.

Of course, we dont know exactly what kind of care or treatment this shooter was receiving and the VA system is generally better than others. Still, its worth reviewing http://l92q.blogspot.com/2014/04/b.ning.com.html the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

The latest

policy brief http://a92q.blogspot.com/2014/04/d.ning.com.html published in the journal

Health Affairs , documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of http://l92q.blogspot.com/2014/04/e.ning.com.html physical medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still arent fully implemented today, despite widespread support, http://g92q.blogspot.com/2014/04/a.ning.com.html including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

http://v92q.blogspot.com/2014/04/d.ning.com.html Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and http://a92q.blogspot.com/2014/04/b.ning.com.html substance use disorders.

The supply and availabelity of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter http://f92q.blogspot.com/2014/04/d.ning.com.html Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patientsmore than twice the percentage http://v92q.blogspot.com/2014/04/a.ning.com.html who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, http://f92q.blogspot.com/2014/04/b.ning.com.html high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with http://g92q.blogspot.com/2014/04/e.ning.com.html receiving mental health or substance use treatment. Eliminating the stigma and increasing the availabelity of high-quality providers are two keys to increasing access to care.

http://f92q.blogspot.com/2014/04/c.ning.com.html Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the http://v92q.blogspot.com/2014/04/b.ning.com.html treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, particularly with respect to treatment settings. For example, intensive http://f92q.blogspot.com/2014/04/a.ning.com.html outpatient programs often used to treat substance abuse do not have an equivalent in internal medicine. Similarly, it is difficult to determine the medical/surgical equivalent for a http://g92q.blogspot.com/2014/04/c.ning.com.html rehab stay for an acute schizophrenic episode. Full parity demands that standards of evidence be applied consistently across mental health/substance use and medical/surgical treatments. http://l92q.blogspot.com/2014/04/d.ning.com.html As one health insurance executive noted, How to provide coverage for care levels and treatment venues that are unique to behavi health, and aligning these with medical and http://v92q.blogspot.com/2014/04/c.ning.com.html surgical benefits, is a continuing discussion within health plans and between plans and regulators.

Another obstacle to care that persists despite passage of parity http://l92q.blogspot.com/2014/04/a.ning.com.html legislation is the fragmentation of the American health care delivery system. Arguably, one reason patients with mental health and substance use disorders experience fragmentation is due http://a92q.blogspot.com/2014/04/a.ning.com.html to the use of carve-outs for providing mental health/substance use benefits. One challenge for group health plans is to integrate and coordinate mental health and substance use care with http://l92q.blogspot.com/2014/04/c.ning.com.html medical care despite using separate administrators. In addition to different benefits administrators, mental health and substance use services are usually provided by different http://g92q.blogspot.com/2014/04/d.ning.com.html health professionals than medical services, and care coordination does not always occur among various providers. Many people with mental health disorders have co-occurring physical http://a92q.blogspot.com/2014/04/e.ning.com.html disorders. Some medical conditions may place people at risk for mental disorders, mental health issues may lead to a medical condition, and both conditions share some common risk http://a92q.blogspot.com/2014/04/c.ning.com.html factors. All of these factors heighten the need for coordination in order to deliver high-quality care to people with mental health/substance use disorders.

Not http://f92q.blogspot.com/2014/04/e.ning.com.html everyone is subject to parity. While the ACA expanded the reach of the MHPAEA both by direct application to the individual market and to issuers in the individual and small-employer market through the EHB requirement, some plans and benefits are still excluded.


April 4, 2014 | 6:50 AM Comments  {num} comments



Marolas   Marolas Maria Morales's TIGblog
Maria Morales's profile

Universal health insurance: what is it all about?

UHI is the Governments beg idea to totally transform the way the Irish health service is structured and funded.

It would aim to eliminate the current two-tier system of public and private http://cutyrs.blogspot.com/2014/04/e.html medicine and to end the practice of queue-jumping for treatment by people who can afford to pay or who have private health insurance.

Plans for http://kislabe.blogspot.com/2014/04/c.html one-tier health service published GPs warn free care for under sixes by summer is not achieveable The plan is http://kislabe.blogspot.com/2014/04/e.html very controversial and already has been strongly criticised from within Government on cost grounds.

It could prove politically explosive if it is seen to remove long-cherished benefits of private health http://zivrat.blogspot.com/2014/04/a.html insurance from the middle classes. The Oppositionhas already branded the proposals drawn up by Minister for Health James Reilly as simply another tax hike.

How would it work?

In essence http://ionter.blogspot.com/2014/04/a.html everyone would be a private patient. It would be mandatory for all to have cover for a basic package of services - known as a basket - from one of a number of different insurers.

The State would pay http://mutress.blogspot.com/2014/04/1.html the premium for the lowest income groups and provide subsidies for others. People who refused to take out cover would have it provided for them, with the cost deducted at source from their earnings or http://ionter.blogspot.com/2014/04/c.html benefits.

What would be covered?

The standard policy would cover a set range of services, to be determined definitively following a comprehensive public consultation process.

However, http://cutyrs.blogspot.com/2014/04/d.html the draft of the Governments new white paper on the issue proposed a preferred basket of services which could be covered in the standard package. These include universal primary care, including core GP and http://kislabe.blogspot.com/2014/04/d.html community nurse services and the maternity and infant care scheme.

Acute hospital care - including all inpatient, day case and outpatient care - would be covered, as would chronic disease and care http://mutress.blogspot.com/2014/04/c.html management for those who met specific clinical criteria.

The preferredpackage would also cover acute mental healthcare, including those services provided by community mental health teams in http://kislabe.blogspot.com/2014/04/b.html outpatient clinics, day hospitals, day centres and acute in-patient facilities, for not more than 12 months.

Rehabelitative care would also be included for a period not exceeding a year, while http://mutress.blogspot.com/2014/04/b.html step-down care in a residential setting or a patients home would be covered for a maximum of two weeks.

What about areas that fall outside the standard basket?

Under the draft white paper, http://zivrat.blogspot.com/2014/04/d.html the State would also pay for other elements of healthcare not included in the standard package. These would include immunisations, screening services, ambulance services and hospital emergency department http://cutyrs.blogspot.com/2014/04/c.html care. The State would also pay for long-term residential care.

Dr Reillys proposals would permit people to take out supplementary health insurance to cover areas not included in the standard package. http://zivrat.blogspot.com/2014/04/e.html This would include private rooms in hospitals.

However, for the first time, this supplementary insurance would be provided on a risk-related basis rather than on a community-rated basis, where http://cutyrs.blogspot.com/2014/04/b.html everyone pays the same for identical products, regardless of age.

This could see the cost escalate considerably for older people.

Will drug costs be covered?

Under the Government http://mutress.blogspot.com/2014/04/d.html proposals, pharmaceuticals (subject to co-payment) would be included either as part of the standard UHI package or through a separate eligibelity scheme replacing the current medical card scheme and drug http://ionter.blogspot.com/2014/04/b.html payment scheme will be considered.

The Government has said it wanted to continue to cover the drug costs of the lowest income groups, as currently applies.

What will the cost be?

The http://zivrat.blogspot.com/2014/04/c.html cost of a standard basket of cover will not be known until there is clarity about precisely what services will be included in it.

However, the Department of Public Expenditure and Reform http://ionter.blogspot.com/2014/04/d.html estimated in a letter to the Department of Health that it could cost over 1,600.

This was seized on by the Opposition, even though the figure is strongly disputed by the Department of http://mutress.blogspot.com/2014/04/e.html Health.

What were the concerns about the plan within Government?

The Department of Public Expenditure and Reform was extremely concerned the the UHI plan could be unaffordable. It warned http://zivrat.blogspot.com/2014/04/b.html dramatically that the measure could threaten the financial stabelity of the State. This was strongly rejected by the Department of Health.

On foot of a Government decision this week, backing for UHI http://cutyrs.blogspot.com/2014/04/a.html was conditional on the new scheme not costing more than the existing health system which it would replace when it comes into force in 2019.

What will happen next?

There will be a widespread http://ionter.blogspot.com/2014/04/e.html consultation process involving both the general public and health service stakeholders.

The Oireachtas health committee will hold public hearings, while there will also be a commission established to http://kislabe.blogspot.com/2014/04/a.html produce options for the composition of the standard basket.

Dr Reilly will next year produce proposals for the standard basket of services to the Cabenet.

The Government would also have to decide at a later date on the level of subsidies to be provided and the thresholds at which they would apply.


April 3, 2014 | 6:05 AM Comments  {num} comments



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