Mississippi leads nation in childhood immunizations

We’re No. 1 in childhood immunizations

GULFPORT -- The state Health Department announced today that Mississippi is the national leader -- ranked No. 1 -- in immunizing 2- and 3-year-olds, according to data released by the National Immunization Survey.

The NIS also designated Mississippi “most improved,” because in the 2008-2009 fiscal year, Mississippi ranked 18th.

Mississippi has an average immunization rate of 81.1 percent for the major childhood vaccinations for children 19 to 35 months of age (including DTaP, Polio, MMR, and other recommended vaccinations).

That exceeds the national average rate of 71.5 percent.

It is the Mississippi Department of Health that gives about 40 percent of all childhood vaccinations. Private providers give about 60 percent.

“Our immunization nurses in health department clinics and health care providers -- especially pediatricians and family practitioners -- across the state have been essential in achieving this goal,” said Dr. Mary Currier, state health officer. “We focus on making sure each child has the best possible protection against vaccine-preventable diseases.”

Federal Health and Human Services emails response to Utah instructing them not to use email.

Over Email, Federal Government Tells Utah It Can’t Use Email to Communicate With Medicaid Recipients

Utah officials waited for eight months to find out if the state would be allowed to use e-mail rather than paper to communicate with Medicaid recipients and save $6 million a year, he said.


"They sent us a denial by e-mail," [Utah’s Republican Governor Gary] Herbert said. "The irony is rich." The state is continuing to pursue that Medicaid waiver and several others.

I’m not sure which is more absurd: That HHS said no, or that Utah had to ask in the first place. It’s not particularly surprising, though, given the administration’s overall track record on the issue. Health and Human Services Secretary Kathleen Sebelius sent states a letter earlier this month suggesting ways they could make Medicaid more efficient and less costly. But the administration’s position on the matter essentially comes down to “don’t make cuts; instead, do more with less.” That’s just not a workable solution.

How the GOP Can Stop the Spread of Obamacare

Progressive pundits and policy wonks boast that, despite Tuesday's Republican victory in the House, ObamaCare will be very difficult to eradicate. They correctly point out that, to get rid of the Patient Protection and Affordable Care Act (PPACA), both houses of Congress must pass repeal legislation and that a Democrat filibuster would more than likely forestall any such effort in the Senate. They further point out that President Obama would certainly veto any repeal bill that somehow found its way to his desk, and that there is virtually no chance that his veto would be overridden. All of this is absolutely true. Moreover, the PPACA infection has already been introduced into the health care system and has begun to spread. Nonetheless, when the Republicans officially take control of the House in January, they will still have the ability inoculate us against future outbreaks of this contagion.

The three-stage vaccine with which the GOP can stop the spread of PPACA has already been proven effective -- in Massachusetts of all places. It will come as a surprise to many that Romneycare was not the first "universal coverage" law to be inflicted on the long-suffering citizens of the Bay State. In 1988 that state's legislature passed a health care bill containing many of the provisions that later reappeared in the 2006 boondoggle signed by Romney. That "reform" program was signed into law by then-governor Michael Dukakis, who gave it a prominent place in his résumé during his unsuccessful bid for the presidency. Like polio, however, "DukakisCare" is all but forgotten. Why? Because a group of newly elected state legislators defunded the program, delayed its implementation and, for all intents and purposes, killed it after Republican William Weld was elected governor in 1990.

The many similarities between the DukakisCare and ObamaCare situations have not received any attention in the media, of course, but they have not been lost on everyone. Mike Stopa, who unsuccessfully sought the 2010 Republican congressional nomination for the MA-3 district, offered a PPACA repeal plan whose introduction declared, "[T]he experience of Massachusetts in the late 1980's… serves as a model in our current situation." Indeed it does. Not long after the Dukakis legislation passed, the GOP made significant gains in the state legislature and immediately set about dismantling the bill. There are also parallels in the executive branch. As Stopa put it, "Michael Dukakis passed universal healthcare in 1988 and his term as governor ended in 1990. Barack Obama passed PPACA in 2010 and his term ends in 2012." All of which suggests that the "MA vaccine" could work on ObamaCare.

For the newly empowered GOP, however, the most difficult stage of the vaccination process may be the first -- getting solidly behind the defunding project. Their vociferous denunciations of PPACA notwithstanding, many House Republicans have expressed reservations similar to those of Rep. Paul Ryan: "Well, yeah, technically speaking, we can put riders in appropriations bills that say, 'No such funds can go to HHS to do x, y, or z in implementing ObamaCare.' He's gotta sign those things. And he doesn't strike me as the kind of person who would sign those things." Similar noises have been heard in the upper chamber. Retiring Senator Judd Gregg recently said, "I don't think starving or repealing is probably the best approach here …"

These and other Republicans are understandably chary of fighting a PR war with the White House. Their shellacking by Bill Clinton in 1995 is still green in their memories. But much has changed since then. Fifteen years ago, the Democrat-friendly "news" media could exert considerable control over the public perception of a battle between Congress and the President. Now, the blogosphere and conservative talk radio can -- and will -- provide an alternate narrative. And the voters who came out in such impressive numbers to repudiate the Democrats are not likely to be patient with a pusillanimous approach on this issue. Most would likely agree with the chairman of DeFundIt.org, who responded thus to Ryan's squeamishness: "[I]t is a policy battle we must fight…. Make no mistake, the conservative base will revolt against a Republican Party that backs down in a funding fight over ObamaCare."

Assuming the Republicans can absorb this reality and summon the courage to face down the President on funding, they can move to the second stage of the vaccination process. In addition to the power of the purse, the new House majority will also have subpoena power that can be used to delay implementation. They can hold numerous and protracted public hearings, while demanding all manner of documentation from the Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS). They can summon HHS Secretary Kathleen Sebelius to answer questions about her 2009 gag order to insurance companies and her growing reputation as an enemy of the First Amendment. It would also be instructive to hear CMS administrator Donald Berwick to elaborate on statements like, "Any healthcare funding plan that is just ... must redistribute wealth."

The third and final stage of the vaccine must, of course, be administered in 2012. The event that enabled Massachusetts legislators to finish off the 1988 universal coverage bill was the replacement of Michael Dukakis with Republican William Weld. The decision, by the former, not to seek reelection in 1990 made that process easier than might otherwise have been the case. Needless to say, Barack Obama is very unlikely to follow the Duke's example. However, if the President stays true to form and refuses to face the reality that the American people do want to "re-litigate" the reform issue, it is at least possible that a good Republican opponent can beat him in the 2012 presidential contest. And Tuesday's big GOP gains in key state houses and legislatures, particularly in crucial battlegrounds like Pennsylvania and Ohio, render an Obama defeat even more plausible.

Cynics will argue that, even if Obama can be given the bum's rush in 2012, that doesn't guarantee the success of this three-stage vaccine. And it is certainly true that it didn't permanently inoculate the Bay State from new and more virulent strains of health "reform." But that's hardly an argument for supinely allowing the PPACA to spread or waiting for the Supreme Court to provide a miracle cure. This contagion must be eradicated now. John Boehner was right when he said, "[W]e have to do everything we can to try to repeal this bill…" And, if outright repeal isn't possible, then the MA vaccine is the next best alternative.

AS

Obamacare already coming unraveled: McDonald’s exempted from health care reform mandate

Bloomberg Business News reports that almost one million workers won’t get a consumer protection in U.S. health law meant to cap insurance costs because the government exempted their employers.

Thirty companies and organizations, including McDonald’s (MCD) and Jack in the Box (JACK), won’t be required to raise the minimum annual benefit included in low-cost health plans, which are often used to cover part-time or low-wage employees, Bloomberg said.

The Department of Health and Human Services, which provided a list of exemptions, said it granted waivers in late September so workers with such plans wouldn’t lose coverage from employers who might choose instead to drop their health insurance altogether. Without the waivers, companies would have had to provide a minimum of $750,000 in coverage next year, increasing to $1.25 million in 2012, $2 million in 2013, and unlimited coverage in 2014, according to Bloomberg.

The Associated Press reported Sept. 30 that the new health care law could make it difficult for companies like McDonald’s to continue offering limited insurance coverage to their low-wage workers.

MBJ

Another Obamacare Casualty: McDonald's May Drop Health Plan

McDonald's Corp. has warned federal regulators that it could drop its health insurance plan for nearly 30,000 hourly restaurant workers unless regulators waive a new requirement of the U.S. health overhaul.

McDonald's warned federal regulators that it could drop its health insurance plan for nearly 30,000 workers unless regulators waive a new requirement of the U.S. health overhaul. Janet Adamy discusses. Also, Neal Lipschutz discusses the exit plan that the U.S. has agreed on to exit the governments interest in AIG.

McDonald's May Drop Health Plan: The chain has told regulators it may ditch its plan unless a new health-care requirement is waived, Janet Adamy reports.

The move is one of the clearest indications that new rules may disrupt workers' health plans as the law ripples through the real world.

Trade groups representing restaurants and retailers say low-wage employers might halt their coverage if the government doesn't loosen a requirement for "mini-med" plans, which offer limited benefits to some 1.4 million Americans.

The requirement concerns the percentage of premiums that must be spent on benefits.

While many restaurants don't offer health coverage, McDonald's provides mini-med plans for workers at 10,500 U.S. locations, most of them franchised. A single worker can pay $14 a week for a plan that caps annual benefits at $2,000, or about $32 a week to get coverage up to $10,000 a year.

Last week, a senior McDonald's official informed the Department of Health and Human Services that the restaurant chain's insurer won't meet a 2011 requirement to spend at least 80% to 85% of its premium revenue on medical care.

McDonald's and trade groups say the percentage, called a medical loss ratio, is unrealistic for mini-med plans because of high administrative costs owing to frequent worker turnover, combined with relatively low spending on claims.

Read entire article: WSJ

Even the President is having a hard time dealing with the Health Care Law's red tape.

White House misses early deadlines in ObamaCare implementation

Critics say missed deadlines and other signs show the Obama administration is stumbling out of the gate on its early steps to implement the president’s health-care law.

The Department of Health and Human Services (HHS) has already missed as many as four deadlines under the law – not on any major regulations — but still a worrying trend, critics say.

Congressional staff and industry representatives have also been asking HHS for a timeline specifying when it will issue the numerous regulations required by the law. They were shocked to find the agency has not produced such a document, one aide said.

The issue is important because vast industry sectors are trying to plan their own implementations of the health-care law and most of the details remain in bureaucrats’ hands, leaving a vacuum of uncertainty about the final burdens the law will impose.

The missed deadlines include creating task forces on breast cancer and Alaskan health care, publishing a list of new authorities granted under the law, and setting a schedule for a Government Accountability Office study and financial audit.

HHS spokeswoman Jessica Santillo noted the administration had already implemented numerous parts of the health care law in advance of deadlines.

“HHS has been working to get the benefits of the new law to the American people as quickly as possible which is why several important benefits are taking effect well in advance of their deadlines, such as ending the practice of rescinding coverage of Americans who get sick, and allowing young adults under 26 to stay on their parents coverage,” Santillo said.

She defended the administration’s approach on one of the missed deadlines – a requirement under the health-care law that HHS publish “a list of all of the authorities provided to the secretary under this act” on its website.

Santillo pointed The Daily Caller to a page listing the names of sections in the law, such as “Sec. 1562. Conforming amendments.”

Republican critics say the list, which links to parts of the actual bill text, doesn’t meet the letter or spirit of the law’s requirement, which is included in a section of the law titled, “Transparency in government.”

“Now it looks like the simplest job assigned to the Obama administration – outlining its own new authorities and responsibilities — was so daunting that HHS decided just to reprint the table of contents from the new law until they can sort things out,” said Lisa Miller, a spokeswoman for Rep. Joe Barton of Texas, a key Republican on health-care issues. “It’s troubling because, if they can’t even explain what they are supposed to do, how do we expect them to actually manage a sixth of the economy?”

While missing the deadlines, the administration has found time to send promotional material touting the law’s benefit, including a brochure for senior citizens and post cards from the IRS advertising tax breaks under the law.

The brochure for seniors may improve the law’s perception among lawmakers – the 111th Congress is the oldest in history by average age – but it is not assuaging some Republicans who call it propaganda.

Read more at The Daily Caller


Health Care Reform

Obamacare’s Cooked Books and the “Doc Fix”

The Obama administration continues to insist (see this post from White House budget director Peter Orszag) that the recently enacted health-care law will reduce the federal budget deficit by $100 billion over ten years and by ten times that amount in the second decade of implementation. They cite the Congressional Budget Office’s cost estimate for the final legislation to back their claims.

And it is undeniably true that CBO says the legislation, as written, would reduce the federal budget deficit by $124 billion over ten years from the health-related provisions of the new law.

But that’s not whole story about Obamacare’s budgetary implications — not by a long shot.

For starters, CBO is not the only game in town. In the executive branch, the chief actuary of the Medicare program is supposed to provide the official health-care cost projections for the administration — at least he always has in the past. His cost estimate for the new health law differs in important ways from the one provided by CBO and calls into question every major contention the administration has advanced about the bill. The president says the legislation will slow the pace of rising costs; the actuary says it won’t. The president says people will get to keep their job-based plans if they want to; the actuary says 14 million people will lose their employer coverage, many of whom would certainly rather keep it than switch into an untested program. The president says the new law will improve the budget outlook; in so many words, the chief actuary says, don’t bet on it.

All of this helps explain why the president of the United States would be so sensitive about the release of the actuary’s official report that he would dispatch political subordinates to undermine it with the media.

It’s not the chief actuary’s assignment to provide estimates of non-Medicare-related tax provisions, so his cost projections for Obamacare do not capture all of the needed budget data to estimate the full impact on the budget deficit. But it’s possible to back into such a figure by using the Joint Tax Committee’s estimates for the tax provisions missing from the chief actuary’s report. When that is done, $50 billion of deficit reduction found in the CBO report is wiped out.

And that’s before the other gimmicks, double counting, and hidden costs are exposed and removed from the accounting, too.

For instance, this week House and Senate Democratic leaders are rushing to approve a massive, budget-busting, tax-and-spending bill. Among its many provisions is a three-year Medicare “doc fix,” which will effectively undo the scheduled 21 percent cut in Medicare physician fees set to go into effect in June. CBO says this version of the “doc fix” would add $65 billion to the budget deficit over 10 years. The entire bill would pile another $134 billion onto the national debt over the next decade.

If the Obama administration gets its way, this three-year physician-fee fix will eventually get extended again, and also without offsets. Over a full 10-year period, an unfinanced “doc fix” would add $250 to $400 billion to the budget deficit, depending on design and who is doing the cost projection (CBO or the actuary).

Administration officials and their outside enthusiasts (see here) say the Democratic Congress shouldn’t have to find offsets for the “doc fix” because everybody knows a fix needs to be enacted and therefore should go into the baseline. (By the way, the history of the sustainable growth rate [SGR] that Ezra Klein provides at the link above is a misleading one. The SGR was a replacement for a predecessor program that too had run off the rails — the so-called “Volume Performance Standard” enacted by a Democratic Congress in 1989.)

But supporting a “doc fix” is not the same as supporting an unfinanced one on a long-term or permanent basis. Not everybody in Congress is for running up more debt to pay for a permanent repeal of the scheduled fee cuts, which is why such a repeal has never been passed before. In the main, the previous administration and Congresses worked to find ways to prevent Medicare fee cuts while finding offsets to pay for it.

But that’s not the policy of the Obama administration. The truth is the president and his allies in Congress worked overtime to pull together every Medicare cut they could find — nearly $500 billion in all over ten years — and put them into the health law to pay for the massive entitlement expansion they so coveted. They could have used those cuts to pay for the “doc fix” if they had wanted to, as well as for a slightly less expansive health program. But that’s not what they did. That wasn’t their priority. They chose instead to break their agenda into multiple bills, and “pay for” the massive health entitlement (on paper) while claiming they shouldn’t have to find offsets for the “doc fix.” But it doesn’t matter to taxpayers if they enact their agenda in one, two, or ten pieces of legislation. The total cost is still the same. All of the supposed deficit reduction now claimed from the health-care law is more than wiped out by the Democrats’ insistent march to borrow and spend for Medicare physician fees.

And the games don’t end there. CBO’s cost estimate assumes $70 billion in deficit reduction from the so-called “CLASS Act.” This is the new voluntary long-term-care insurance program that hitched a ride on Obamacare because it too created the illusion of deficit reduction. People who sign up for the insurance must pay premiums for at least five years before they are eligible to draw benefits. By definition, then, at start-up and for several years thereafter, there will be a surplus in the program as new entrants pay premiums and very few people draw benefits. That’s the source of the $70 billion “savings.” But the premiums collected in the program’s early years will be needed very soon to pay actual claims. Not only that, but the new insurance program is so poorly designed it too will need a federal bailout. So this is far worse than a benign sleight of hand. The Democrats have created a budgetary monster even as they used misleading estimates to tout their budgetary virtue.

There is much more, of course. CBO’s cost projections don’t reflect the administrative costs required to micromanage the health system from the Department of Health and Human Services. The number of employers looking to dump their workers into subsidized insurance is almost certainly going to be much higher than either CBO or the chief actuary now projects. And the price inflation from the added demand of the newly entitled isn’t factored into any of the official cost projections.

We’ve seen this movie before. When the government creates a new entitlement, politicians lowball the costs to get the law passed, and then blame someone else when program costs soar. Witness Massachusetts. Most Americans are sensible enough to know already that’s what can be expected next with Obamacare.

Fix Health Care Policy



Health Care Reform

More Proof: They Knew, But Hid It From the Public

From the American Spectator

What Lies Beneath


OFFICE POLITICS

The economic report released last week by Health and Human Services, which indicated that President Barack Obama's health care "reform" law would actually increase the cost of health care and impose higher costs on consumers, had been submitted to the office of HHS Secretary Kathleen Sebelius more than a week before the Congressional votes on the bill, according to career HHS sources, who added that Sebelius's staff refused to review the document before the vote was taken.

"The reason we were given was that they did not want to influence the vote," says an HHS source. "Which is actually the point of having a review like this, you would think."

The analysis, performed by Medicare's Office of the Actuary, which in the past has been identified as a "nonpolitical" office, set off alarm bells when submitted. "We know a copy was sent to the White House via their legislative affairs staff," says the HHS staffer, "and there were a number of meetings here almost right after the analysis was submitted to the secretary's office. Everyone went into lockdown, and people here were too scared to go public with the report."

In the end, the report was released several weeks after the vote -- the review by the secretary's office reportedly took less than three days -- and bore a note that the analysis was not the official position of the Obama administration.

Rationing of Care by the Government happens every day

Part of the argument against the government takeover of health care for Americans has been that it would result in rationing of care. Proponents dismissed these claims as scare tactics. But, the simple truth is the Federal Government already runs a portion of health care through Medicare and Medicaid. Those programs provide an example of what we can expect from the system.
Health Care supporters are quick to use the same argument when they are demonizing the "evil" insurance companies that "profit from the misery of the American people." But, the AMA, that group of doctors who supported the President's efforts and showed up with their white coats to the White House, has a report that shows the demonization is a smoke screen.

Will the new Health Care Entitlement result in more denied care? The record indicates that the answer to that question is a resounding yes.

In 2008, Medicare led the pack of AMA's own National Health Insurer Report Card as the most frequent denier of coverage. Of the eight insurers listed on that report, Medicare was the most likely to reject a claim, sending away 6.85% of requests. This was more than any private insurer and double that of the private insurers’ average.

The results for 2009 were only slightly better for Medicare beneficiaries. Last year Medicare was no longer the most frequent denier. However the agency was still double the denials of the head of the pack, Aetna. Aetna decreased the number of denials by 5 percent in a year, a full percentage point more than Medicare's current rate of 4 percent.

Could it be that commercial health insurers have more efficient claims processing centers? Could it be that the private sector is just more all around efficient?

In the case of health insurance claims, firms make more money when they deny more claims, right? Those evil money hungry creeps! So how is the profit motive leading to more private-sector claims approvals?

The truth is competition between insurers INCREASE claims approvals. Most physicians and hospitals must take Medicare because it represents so large a share of the healthcare spending. On the other hand, physicians may decide to only accept patients whose insurance companies have prompt payment with fewer denials. This leads to some incentive for insurance companies to DECREASE claims denials. The way to INCREASE access and DECREASE health care problems is to INCREASE competition.

Get it? Yeah? Well, your leaders in Washington, don't.

It is important to point out that the differential claims denial rates also has a lot to do with the demographics of Medicare and commercial insurance enrollees. Almost all Medicare enrollees are over 65, while commercial insurers have enrollees who are of varying ages. Since older individuals are more likely to demand high cost medical procedures, if high cost medical procedures are the ones that are more likely to be denied then Medicare’s higher denial rate may simply be due, in part, to the composition of its enrollees.

Whatever the reason, the fact that Medicare denies more claims than commercial insurers should dispel the myth that the government is simply a benevolent entity, while commercial insurers are ruthless, profit-hungry wolves.

And then there's the absolute ineptitude that comes from federal rules and government agencies as witnessed just recently by a California Medicaid benificiary; a woman with cancer.

Mom With Cancer Gets Insurance Help For Transplant


A Hollywood woman who was dropped from Medicaid coverage while needing a bone marrow transplant is finally getting the coverage and treatment she needs to stay alive.

Diana Smith is battling a rare form of Leukemia and needs the transplant to survive. She managed to raise money to pay for it thanks to her friends and the community, but then last week she found out her Medicaid coverage was dropped – putting her operation on hold.

Smith had gone through six months of radiation and chemotherapy -- one week out of every month. She is in remission and had a donor for a transplant; being in remission is a prerequisite for the transplant.

But her hopes of receiving the transplant were dashed in March, when she says, the Social Security Administration contacted her –without her soliciting it -- and told her that her three year-old son was entitled to receive Social Security disability payments. Even though she didn't ask for it, she signed the form and received her son's first check.

In April, Medicaid canceled her universal health care policy because her income level had risen with her son's payments – making her ineligible for the insurance program.

The problem is Jackson Memorial Hospital could not provide the procedure because the risk is too high. The universal policy from Medicaid helps shield the hospital from liability in this kind of case. Without it, they are subject to liability issues.

Even though Smith offered to cancel her son's disability benefits, she was told it's too late.

CBS 4

Of course, following the report local state officials, and the hospital jumped in to help see that the woman received the surgery. But, should you have to call the television reporter, or a Congressman everytime one of the newly hired Health Care bureacrats decides you and your doctor have it all wrong?

How Much More Of This Silliness Will Come Out Before November?

The Democrats ability to spin the Health Insurance Reform into a positive by November was already seriously in doubt. Now comes this

CRS: Health Law May Allow Viagra Coverage for Sex Offenders

The Congressional Research Service confirmed in a memo Wednesday that rapists and sex offenders may get federally subsidized Viagra and other sexual performance enhancing drugs under the recently passed health care reform law — information that Republicans charge will haunt Democrats in upcoming elections.

“Providing child molesters with taxpayer-funded Viagra shows the folly of government-run health care. Senators who allowed this to happen will be haunted by this vote for years to come,” said John Hart, a spokesman for Sen. Tom Coburn (R-Okla.).

Coburn, who requested the CRS review of the health care reforms, sought to add last-minute changes to the health care reconciliation bill that would prohibit sex offenders from receiving drugs such as Viagra under the health care law. However, that amendment was defeated during the Senate’s vote-a-rama.

According to the CRS, under existing rules there are no prohibitions against providing erectile dysfunction drugs to rapists, pedophiles or other types of sex offenders. The new law does “not appear to prohibit a qualified health plan in a health insurance exchange from providing coverage for drugs prescribed to treat ED for a non-incarcerated beneficiary who was previously convicted of rape, child molestation, or another sex offense” the CRS said in its memo, dated April 2 but released Wednesday. The report also said that “a convicted rapist, child molester, or other sex offender who is not incarcerated would not appear to be excluded from enrolling in a qualified health plan offered through an American Health Benefit Exchange in their state solely because of that conviction.”

Jim Manley, a spokesman for Majority Leader Harry Reid (D-Nev.), accused Coburn, who made the memo public, of a disingenuous political ploy. “This is just another attempt at hype by Sen. Coburn as he goes about trying to make a mockery of the legislative process. If he has a problem, offer legislation and deal with the issue in a constructive fashion instead of issuing a press release. To be clear, his goal is to repeal a law that will provide tax credits to small businesses, protect families from insurance companies that deny coverage based on pre-existing conditions, close the doughnut hole, allow parents to keep their young adult children on their policies,” Manley said.

Changes coming to health insurance plans

Consumers and employers who provide health insurance are scrambling to understand what will change in their premiums and benefits once the recently passed law goes into effect.

The new legislation applies broadly to nearly all private plans. That includes policies offered by large self-insured employers, through whom about half of the nation's covered workers get their insurance.

Some new rules — such as barring insurers from rejecting children with medical conditions or from canceling policies retroactively — are aimed at problems that mainly affect the 17 million people who buy their own insurance in the so-called non-group market.

But even the approximately 175 million Americans who get group coverage through their jobs will see changes.

Employers are flooding benefit firms with questions.

"We're getting a lot of calls (asking) ... to translate what this law means," says Kelly Traw, a principal with benefits consultancy Mercer. "That's a daunting task right now."

Some specific changes to policies and benefits aren't spelled out in the law. While some changes mandated by the new law appear fairly straightforward — no lifetime caps on coverage, for example — other provisions are missing crucial details, which must be clarified by the Department of Health and Human Services in regulations.

It will be up to the HHS secretary, for example:

• To define the breadth of coverage in an "essential benefits package."

• To determine how insurers will calculate how much they spend on direct medical care, a key point because insurers who don't meet specific spending benchmarks must issue rebates to consumers.

An HHS spokesman wouldn't provide details on when regulations will be issued. But, with some provisions set to go into effect by the end of September, pressure is on to move quickly.

 

Among the unknowns is the effect on premiums in the next couple of years. New taxes on drug companies, device makers and insurers don't begin until at least 2012. But when they do, economists expect that the increases will be passed along to employers and consumers. Barring insurers from setting lifetime coverage limits may also put upward pressure on premiums.

 

Read more at Kaiser Health News